Detection of temporal bone cholesteatoma by multidetector computed tomography

Objective: To determine the CT patterns of temporal bone cholesteatoma in patients presenting with chronic discharge from ear

Methodology: This was a cross-sectional study conducted at Department of Radiology, Rehman Medical Institute Peshawar from January 2013 to June 2014. 78 patients with chronic discharging ear, who were referred from E.N.T outpatient department, were included in the study. All scans were performed on 128 slice Multidetector Computed tomography [MDCT] scanner.O.Smm reconstructed images in bone window and 3mm images in soft tissue window were viewed on 5.1 vitrea workstation in axial, coronal and sagittal planes. The CT studies were correlated with clinical examination findings, surgical and histopathology. Basic radiologic patterns of cholesteatoma described on CT scan were assessed. The data was processed using Microsoft excel 2007

Results: Cholesteatoma was present in 48 [61%] cases. The disease was bilateral in 7 cases [14 %], 39 [81 %] were unilateral. 25 [52%] were left sided and 14 [29%] right-sided. 24 [30 %] patients were characterized as having otomas-toiditis whereas 7[8%] patients were radiologically difficult to characterize if they were cholesteatoma or not

Conclusion: Cholesteatomas can cause bone erosions and should be detected early. The important role of MDCT lies in the early detection of cholesteatoma, and more conservative surgical procedures can be used to eradicate the disease

Management of 30 cases of malignent skin lesions at the lower eyelid and cheek with cervicofacial flaps

To assess suitability of this flap with respect to defects in this area. Observation study. Department of Plastic Surgery and Burns Bolan Medical College and Complex Hospital Quetta, from January 2003 to December 2009. 30 cases were operated with reconstruction using cervicofacial flaps. Patients were selected through Out Patient Department. Follow up 3 and 6 months. Flaps survival was 100% with partial flaps necrosis a tip of the flaps in 4 cases, with large defects recurrence was observed in five cases. Procedure was found to be suitable with regards to large defect i.e. [4 cm to 6 cm]

phase II study of gemcitabine concurrent with radiation in locally advanced squamous cell carcinoma of head and neck: a trial of the cancer research group Pakistan

To evaluate the efficacy and toxicity of weekly gemcitabine as a radiosensitizer concurrent with radical radiotherapy in locally advanced carcinoma of head and neck. From August 2001 to January 2002, thirty-nine patients with stage III or IV B inoperable carcinoma of head and neck were enrolled. Patients with histopathologically confirmed squamous cell carcinoma with at least one bidimensionally measurable lesion, no prior chemotherapy or radiotherapy, and a KPS of 60 or above were included. Patients with nasopharyngeal, glottic or sub-glottic cancer were excluded. Gemcitabine 150mg/m2 or a total dose not exceeding 200 mg was given on day 1, 8, 15, 22, 29, and 36 during radiation treatment. Radiation was delivered with conventional fractionation to a total dose of 66-70Gy. Miller's criteria was used for response evaluation. RTOG/EORTC acute radiation [and chemotherapy] morbidity scoring system and WHO grading of acute and sub acute toxicity criteria were used for documentation of toxicity. All 39 patients were evaluable for toxicity but only 35 patients were evaluable for response. An overall response rate of 94.3% [95% CI; 80.8-99.3] was seen with a partial response rate of 71.4% and complete response rate of 22.9% [95%CI; 10.4-40.1]. Grade 3 mucositis was seen in 28 patients [71.8%]. Grade 4 mucositis was seen in 2 patients [5.1%]. Pharyngeal toxicity was the second-most common toxicity. Grade 2 toxicity was seen in 12 patients [30.8%] and grade 3 in 6 patients [15.4%]. Despite vigorous symptomatic and supportive care acute toxicities led to treatment interruption in 40% of patients. A high overall response rate and a high rate of acute toxicity are seen at a weekly gemcitabine dose of 150mg/m2 concurrent with radiation. This shows that gemcitabine is a potent radiosensitizer with a marked tumor and normal tissue radio sensitization

Deformity and disability index in patients with leprosy

Leprosy continues to be a serious challenge in most of the developing countries, contributing significantly to the physical and social disability of the patients afflicted. The aim of this study was to estimate the disability rate in patients of leprosy. Patients and methods This study of deformities and disabilities in leprosy was conducted on 100 diagnosed cases of leprosy [70 males and 30 females], aged 9-70 years. Forty one% of the cases [32% males and 9% females], were found to have various deformities and disabilities. The deformity and disability rate was higher in males than in females and it was positively associated with increasing age and duration of the dis ease. The disability rate was much higher in patients with multibacillary leprosy [42.5%] than in paucibacillary leprosy [23.7%], the highest being in lepromatous leprosy patients [68.5%]. Hands were affected most frequently [32%] followed by feet [30%] and eyes [16%]. The most commonly found deformities and disabilities were anesthesia of hands and feet, claw hands, resorption of toes and plantar ulcers. According to WHO disability grading, 59% of the patients had no disability, 10% had grade 1 and 31% had grade 2 disability. Disability assessment is very important not only to evaluate the effectiveness of the leprosy control programs but also for the patients whose important worry is the stigmatizing deformities caused by the disease. The earlier detection of sensory loss might reduce these secondary deformities