Genetic polymorphisms in NAT1, NAT2, GSTM1, GSTP1 and GSTT1 and susceptibility to colorectal cancer among Filipinos

@#Objectives. Polymorphisms in metabolic genes which alter rates of bioactivation and detoxification have been shown to modulate susceptibility to colorectal cancer. This study sought to evaluate the colorectal cancer risk from environmental factors and to do polymorphism studies on genes that code for Phase I and II xenobiotic metabolic enzymes among Filipino colorectal cancer patients and matched controls. Methods. A total of 224 colorectal cancer cases and 276 controls from the Filipino population were genotyped for selected polymorphisms in GSTM1, GSTP1, GSTT1, NAT1 and NAT2. Medical and diet histories, occupational exposure and demographic data were also collected for all subject participants.Results. Univariate logistic regression of non-genetic factors identified exposure to UV (sunlight) (OR 1.99, 95% CI: 1.16-3.39) and wood dust (OR 2.66, 95% CI: 1.21-5.83) and moldy food exposure (OR 1.61, 95% CI:1.11-2.35) as risk factors; while the NAT2*6B allele (recessive model OR 1.51, 95% CI :1.06-2.16; dominant model OR 1.87, 95% CI: 1.05-3.33) and homozygous genotype (OR 2.19, 95% CI: 1.19-4.03) were found to be significant among the genetic factors. After multivariate logistic regression of both environmental and genetic factors, only UV radiation exposure (OR 2.08, 95% CI: 1.21-3.58) and wood dust exposure (OR 2.08, 95% CI: 0.95-5.30) remained to be significantly associated with increasing colorectal cancer risk in the study population.Conclusion. This study demonstrated that UV sunlight and wood dust exposure play a greater role in influencing colorectal cancer susceptibility than genotype status from genetic polymorphisms of the GST and the NAT` genes.

Proboscis lateralis with rhinosinusitis

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This report aims to describe unique manifestations of proboscis lateralis and highlight the importance of a multidisciplinary approach to address the problems that arise from this rare congenital anomaly.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 13-year-old girl diagnosed with proboscis lateralis presented with a trunk-like appendage projecting from the surface of the right supramedial canthal area. She also had clear nasal discharge, nasal congestion, mouth-breathing and snoring since birth. Paranasal Sinus (PNS) CT scan with 3D reconstruction showed agenesis of the right paranasal sinuses and expansile aeration of the left paranasal sinuses. Due to her condition, the drainage system of the paranasal sinuses was obstructed causing chronic rhinosinusitis (CRS). This hindered plans for reconstructive surgery despite medical management, hence, the patient underwent Endoscopic Sinus Surgery (ESS).<br /><strong>CONCLUSIONS:</strong> Proboscis lateralis is a rare congenital anomaly that results in aesthetic problems as well as airway concerns such as rhinosinusitis and obstructive sleep apnea syndrome (OSAS). Management entails a multidisciplinary approach to address functional and aesthetic problems of the patient.</p>

True congenital macroglossia surgically managed using a modified Kole technique

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe a 2-year-old boy with true congenital macroglossia surgically managed using a modified Kole technique.<br /><strong>METHODS:</strong> <br /><strong>Design:</strong> Surgical Innovation<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 2-year-old boy presented with congenital macroglossia, associated with difficulty feeding and phonating. On physical examination, the massive tongue had both increased length and width. At rest, it protruded between the upper and lower teeth with drying and fissuring of the tip. Dribbling of saliva and mandible prognathism were also noted. The child was surgically treated with a modified Kole technique, wherein the apex of the anterior wedge resection was extended to the posterior third midline. Final histopathology was consistent with cavernous hemangioma.<br /><strong>CONCLUSION:</strong> The modified Kole technique proved viable as the preoperative results were considered satisfactory. Tongue volume was uniformly reduced in length and width enabling mouth and jaw closure while tongue sensation and mobility were preserved. Feeding, speech intelligibility and cosmesis were markedly improved. Future application of this modification may prove its usefulness.</p>

Pediatric endoscopic sinus surgery in a tertiary government hospital: Patient profile and surgical indications

Objective: To describe the clinical and demographic profile of patients who underwent pediatric Endoscopic Sinus Surgery (ESS) and the indications for which the procedure was performed. Methods: Design: Cross-sectional Study Setting: Tertiary Government Hospital Subjects: Using the medical record registry, all patients below 18 years of age who underwent ESS under the Department of Otorhinolaryngology – Head and Neck Surgery of a tertiary government hospital in Metro Manila between December 31, 1999 and January 1, 2008 were reviewed. The age, sex, clinical presentation indications for doing ESS and extent of surgery done were described. The Lund MacKay Grading for nasal polyposis and Scoring for sinusitis were also applied and cross-referenced. Results: Twenty-seven children aged 7 to 17 years underwent ESS. The mean age was 12.9 years with most (15 patients) belonging to the adolescent age group (13-17 years). Male to female ratio was 1.45:1. The mean interval from onset of symptoms to the first outpatient consultation was 1.5 years; the most common presenting symptoms were nasal obstruction (85.2%) and discharge (59.3%). All of the patients who underwent pediatric ESS had chronic rhinosinusitis: either with nasal polyposis (85.2%), an antrochoanal polyp (11.1%) or both (3.7%). The Lund Mackay Grading for nasal polyps and sinusitis scores were cross-referenced: patients with larger, grade III nasal polyps tended to have more extensive sinus disease than those with grade II polyps. On their first consultation, the patients tended to present with extensive nasal polyp and sinus disease indicating the need for surgery. All patients with CRS and nasal polyposis underwent polypectomy with ethmoidectomy, uncinectomy and maxillary antrostomy, with additional frontal sinusotomy for a 17-year-old male and a 17-year-old female, both with grade 3 polyposis. The three patients who had antrochoanal polyps underwent polypectomy with uncinectomy and maxillary antrostomy. There were no operative complications such as cerebrospinal fluid leak and orbital injury reported.

Laryngeal Tiririt (Bridge): For microlaryngeal surgery shake

Objective: To design an instrument for steadying instrument handling during microlaryngeal surgery using an operating laryngoscope. Method: Our device design takes its cue (pun intended) from professional billiards players like our very own Efren "Bata" Reyes. The laryngeal tiririt (bridge or rake) draws inspiration from the billiards bridge (locally known as tiririt) used to extend the player's reach when the cue ball is too far to make an accurate shot. Setting: The laryngeal tiririt was used and tested by senior residents in microlaryngeal surgeries done in our institution. Result: The laryngeal tiririt greatly improved the accuracy required in laryngeal surgeries without adding up huge set up or expensive equipment. (Author)