Histological risk score and its role in predicting recurrence in early-stage oral squamous cell carcinomas

Context: Oral squamous cell carcinoma (OSCC) comprises more than 90% of oral cancers and is the most common carcinoma affecting the oral cavity. Early stage T1/T2 OSCC have a heterogeneous prognosis and a significant number of patients develop loco regional recurrence (LRR) and have reduced disease free survival (DFS) with increased disease related mortality. Aims and Objectives: To assess the impact of the three parameters used in Brandwein-Gensler risk model along with lympho-vascular invasion (LVI), depth of invasion (DOI) and lymph node metastases in predicting LRR in early stage OSCC. Materials and Methods: This was a retrospective study on early stage T1/2 OSCC patients over a period of 2 years who received treatment by surgical resection and had follow-up data. LRR was assessed based on recurrence of OSCC at the initial site or in regional lymph nodes. Results: Out of 1135 OSCC cases during our study period a total of 207 cases befitted our inclusion criteria. Recurrence was noted in 113 (54.6%) cases. Univariate analysis identified LVI (P < 0.00001), DOI (P < 0.00001), nodal involvement (P < 0.00001), worst pattern of invasion (WPOI) (P < 0.00001), lymphocytic host response (LHR) (P = 0.004), perineural invasion (PNI) (P = 0.012) as strong statistically significant risk factors for LRR. Conclusion: Adequate assessment of simple parameters on routine H and E by incorporating Brandwein-Gensler histological risk scoring model at the initial presentation can help prognosticate and predict LRR and select patients for post-surgical adjuvant therapy.

Takotsubo cardiomyopathy complicating a twin pregnancy at partum

Takotsubo cardiomyopathy is a rare syndrome characterized by acute left ventricular dysfunction with regional left ventricular ballooning, mimicking myocardial infarction. This condition is often described in post-menopausal women. Authors present a case in an elderly primi with twin gestation immediately after Cesarean surgery. We discussed her presentation, investigations, diagnosis, management and outcome. 35 year female, a primi with twin pregnancy developed chest pain and shortness of breath immediately after Cesarean surgery. Her Electrocardiograph was abnormal, and Echocardiogram demonstrated abnormal apical ballooning of the left ventricle and severe dysfunction. Cardiac enzymes were elevated and chest skiagram showed pulmonary edema. She was managed in the intensive care unit with oxygen supplementation, diuretics and inotropes. She made an excellent recovery with normalization of left ventricular ejection fraction within 8 days. During the six months follow up, she was asymptomatic and left ventricular function remained normal.

Segment IV liver cyst with biliary communication following laparoscopic deroofing.

Simple cysts of the liver rarely have a biliary communication. We record the development of a biliary communication following laparoscopic deroofing of a segment IV simple cyst of liver and document its successful sclerosis with tetracycline.

A new streptomycete producing diphenyl sulfone antibiotic--S. sulfonensis.

About 359 actinomycetes were isolated from 8 different natural substrates collected from different parts of Andhra Pradesh. The isolates were screened on the basis of their inhibitory effect against test organisms. Finally one potent antibiotic producer was chosen having broad-spectrum activity against Gram-positive and Gram-negative bacteria and it was found to produce a diphenyl sulfone antibiotic. On the basis of morphological, cultural, physiological and biochemical characters, the diphenyl sulfone antibiotic producer was identified as a new species and was designated as S. sulfonensis.

A new variety of Chainia olivacea from marine sediment off Gulf of Mannar.

A new variety of Chainia olivacea was isolated from marine sediment off Gulf of Mannar. The morphological, cultural, physiological and biochemical characters were studied, compared to known species and identified as a new variety of Chainia olivacea. Antibiotic activity of the strain was tested against both Gram positive and Gram negative bacteria as well as fungi and yeasts. Sodium chloride tolerance was also tested.

Isolation and characterisation of bioactive actinomycetes from marine sediments.

Actinomycetes (28) were isolated from marine sediments off Madras coast by plating on Starch-Casein Agar medium. After preliminary studies, five isolates which were found to be promising were selected for detailed morphological, cultural, Physiological and biochemical studies. The genera encountered were Streptomycetes. Out of these five isolates, three isolates exhibited very good broad spectrum antibacterial activity. The sodium chloride tolerance of these five isolates was also tested.