Rehabilitation of a mandibular segmental defect with magnet retained maxillofacial prosthesis.

Resection or loss of a portion of the mandible can result in a variety of functional, cosmetic and psychological deficits that are dependent on the extent of the defect, the concomitant therapy and the timing of rehabilitative efforts. These impairments greatly affect the patient's Quality of life (QOL). The thrust in cancer care is not simply on survival but on rehabilitation, which aims to improve multiple impairments and QOL. This article describes a case of a 58-year-old female with segmental resection of the anterior mandible, extending to lower lip, resulting in a large intraoral as well extra oral defect. Prosthodontics rehabilitation was done using a two-piece intra oral and extra oral prosthesis oriented to each other using magnets. Use of magnets for retaining the extra oral prosthesis simplifies the clinical and laboratory phase enhancing patient's comfort and psychological morale.

Scope of prosthodontic services for patients with head and neck cancer.

Patients with head and neck cancer face high morbidity due to the disease and its treatment and are affected on a variety of personal and physical levels. Maxillofacial prosthetics offer support for other disciplines in a multidisciplinary setting; can help to prevent / minimize the sequelae from disease and treatment, and offers the patient help in the rehabilitation process. Maxillofacial prosthodontics focuses on optimizing the disrupted rudimentary function of individuals whose rehabilitation will be a lifelong proposition. Normal function may not be achieved but optimal function should always be achieved and the patients can lead a near to normal life.

Acute respiratory distress syndrome due to Strongyloides stercoralis in non-Hodgkin's lymphoma.

Strongyloides stercoralis is a nematode endemic in tropical and subtropical regions. In immunocompetent subjects, pulmonary disease caused by the parasite is unremarkable but the same can be life threatening in immunocompromised subjects. Though described in literature it is rarely seen in Indian subjects. We report a patient with ARDS due to Strongyloides stercoralis complicating non-Hodgkin's lymphoma with neutropenia.

Atypical carcinoid tumour.

Carcinoid tumour is a rare entity accounting for less than two percent of bronchial neoplasms. The clinical presentation is highly variable and rarely, it may present as a solitary pulmonary nodule. More offten, it presents as a central endobronchial tumour. The peripheral type of carcinoid tumour is relatively rare.

Pattern of lung cancer in elderly.

OBJECTIVES: The aim of the study was to evaluate the clinical spectrum of the lung cancer in the Indian patients. METHODS: All the patients above the age 60 years referred to the chest clinic of Apollo Hospitals, during the period 1989-2000 were evaluated for lung cancer with fibreoptic bronchoscopy, fluoroscopic guided transbronchial lung biopsy, transbronchial, needle aspiration and/or CT guided percutaneous fine needle aspiration biopsy. Retrospective data of 1400 patients was analyzed statistically. RESULTS: There were 512 patients (439 males, 73 females) with confirmed primary lung cancer. There were 62% ex-smokers, 10% current smokers and 28% non-smokers amongst males, whereas amongst females there were 10% ex-smokers and 90% non-smokers. Cough of more than 3 weeks duration was the commonest symptom seen in 85% (n = 435) followed by fever and weight loss. Radiologically the commonest feature was collapse-consolidation in 77% (n = 397). Central endobronchial tumours were seen in 204 patients (39.8%), whereas peripheral tumours were seen in 308 (60.2%). The diagnostic yield of transbronchial lung biopsy alone was as high as 48%, whereas the yield on CT guided percutaneous fine needle aspiration biopsy alone ranged from 32%-40%. There was no statistical difference in histological subtypes (non-small cell or small cell lung cancer) in the various groups studied. However, in those patients above the age of 80 years (group C) small cell lung cancer was more frequently seen. CONCLUSION: Primary lung cancer should always be suspected in elderly Indian subjects with unexplained cough and other constitutional symptoms of weight loss and fever.

Clinical profile of ARDS.

OBJECTIVES: Several studies have been published in western literature on incidence, prevalence, clinical course, outcome and mortality in patients with acute respiratory distress syndrome (ARDS). There are very few studies on the pattern of ARDS seen in Indian population. There are anecdotal reports of ARDS associated with different tropical diseases and the exact association of these life-threatening disorders with ARDS is not clearly described in the Indian literature. The study was carried out to identify the clinical pattern of Indian patients who died of ARDS. METHODS: This was a three and a half year retrospective study comprising of 98 patients who died of ARDS in the intensive care unit of Apollo Hospital, a tertiary care referral centre between January 1999 to June 2002. The present study looked at only those patients who died from ARDS and did not evaluate the clinical outcome or survival pattern of ARDS patients. The criteria used for diagnosis of ARDS was based upon American/European consensus statement for definition of acute lung injury (ALI) and ARDS. The patient demographic data consisted of age, sex, associated major illness in the part, clinical disorders associated with ARDS, length of hospital stay, use and duration of mechanical ventilation and the presence of sepsis and organ failure defined by ACCP/SCCM consensus conference definition. Seventy patients were ventilated with volume control mode and 28 patients with pressure control ventilation. Lung protective strategy was used in all the cases comprising of low tidal volumes at the rate of 5-ml/kg-body weight. Statistical analysis of the data was done by SPSS 10 for windows (SPSS, Inc., Chicago, Illinois). RESULTS: There were 98 patients during the study period who died of ARDS. Fifty one males and 47 female patients. Thirty patients had primary pulmonary infection, 18 had severe sepsis with multiorgan failure, 12 patients had polytrauma and 10 each had recent abdominal surgery and pancreatitis. Length of ICU stay was less than 10 days in 58 patients whereas in 40 patients it was more than 10 days. Duration of mechanical ventilation was less than seven days in 80 patients and more than seven days in 18 patients. Positive body fluid cultures were obtained in 42 out of 98 patients and of these, 14 patients had microbiological diagnosis established by blood culture, another 14 by endotracheal secretion culture, eight by urine culture and in the remaining six patients based upon wound cultures. The commonest organisms isolated from the body fluids were Pseudomonas and Klebsiella. CONCLUSION: Primary pulmonary infection was associated with ARDS is one-third of patients. Multiorgan failure was seen in 18% of patients who died from ARDS. Severe sepsis was identified as a significant risk factor for ARDS.

A comparison of sputum examination for acid fast bacilli by modified Schaeffer & Fulton stain, Ziehl-Neelsen stain & cold stain.

A comparative study of Ziehl-Neelsen stain, cold stain and modified Schaeffer and Fulton stain was carried out to evaluate the efficiency of modified Schaeffer and Fulton method in sputum examination for acid fast bacilli (AFB). Of 187 sputum samples studied, 67 (35.82%) were reported positive by Ziehl-Neelsen stain and cold stain method while 66 (35.29%) were reported positive by modified Schaeffer and Fulton method. In comparison with Ziehl-Neelsen staining, 98.58 per cent positivity was reported by modified Schaeffer and Fulton method. Modified Schaeffer and Fulton method is found to be simple, reliable, less expensive and as efficient as Ziehl-Neelsen stain and cold stain for demonstration of acid fast bacilli in sputum.