Selective Neck Dissection for Node-Positive Oral Cavity Squamous Cell Carcinoma: A Retrospective Cohort Study

Abstract Introduction Selective neck dissection inclinically node-negative neckisconsidered the standard of care for oral squamous cell carcinomas (SCCs). Controversy still prevailsinnode-positive disease regarding the extent of neck dissection. In our part of the world, comprehensive neck dissection is mostly considered to be the minimal optimal treatment for palpable neck disease. Objective To compare regional control and disease-specific survival between clinically node-positive and node-negative patients undergoing selective neck dissection for oral SCC. Methods This was a retrospective cohort study conducted in the department of ENT, Head and Neck surgery at a tertiary care hospital. All patients with biopsy-proven oral and lip SCC, with or without nodal disease, who underwent selective neck dissection between April 2006 and July 2015 were included in the study. Results During the study period, 111 patients with oral SCC underwent selective neck dissection, of whom 71 (62%) were clinically node-negative and 40 (38%) patients had clinically positive nodes in the neck. The mean follow-up was 16.62 months (standard deviation [SD]: 17.03). The overall regional control rates were 95 versus 96% for clinical negative versus positive nodes, respectively (p = 0.589). The disease-specific survival was 84.5% in the node negative group versus 82.5% in the node-positive group (p = 0.703). Conclusion Selective neck dissection in node-positive neck oral SCC has similar regional control rates when compared with node-negative neck SCC. The difference in disease-specific survival between the two groups is also not significant.

Synthesis of silver and gold nanoparticles from leaf of Litchi chinensis and its biological activities

Objective: To synthesize and isolate silver and gold nanoparticles from Litchi chinensis leaf methanolic extract, and to evaluate its comparative biological activities including muscles relaxant, analgesic, anti-inflammatory and antidiarrheal. Methods: The gold and silver nanoparticles were synthesized by dissolving methanolic extract in gold chloride and silver nitrate solution separately which were confirmed by colour change and UV-Vis spectroscopy, and pellets were collected through centrifugation. Biological activities of the extract were conducted on BALB/c mice through various standard methods and the data were subjected to One-way ANOVA. Results: The colorless gold chloride solution changed to purple soon after the addition of plant extract, demonstrating that the reaction took place and gold ions were reduced to gold nanoparticles, while colorless silver nitrate solution changed to light and dark brown that was indicative of silver nanoparticles. The muscles relaxant activity showed that silver nanoparticles were more effective than gold nanoparticles and methanolic extract in traction test. The analgesic activity showed that silver and gold nanoparticles showed highest percentage decrease in acetic acid induced writhing at the doses of 50, 100 and 150 mg/kg b.w. The highest anti-inflammatory activity was produced by gold nanoparticles followed by silver nanoparticles, while low activity was observed in methanolic leaf extract. Only the crude methanolic extract showed significant antidiarrheal activity as compared to the standard drug atropine sulphate, while antidiarrheal activities of gold and silver nanoparticles were non-significant. Conclusions: The present work concludes that isolated silver and gold nanoparticles from leaf methanolic extract shows strong muscles relaxant, analgesic and anti-inflammatory activities while crude methanolic extract possesses good antidiarrheal activity.

Experience of peritoneal dialysis in renal failure in children

Objective: To determine the course and efficacy of peritoneal dialysis in children presenting with renal failure

Study Design: Quasi experimental study

Place and Duration of Study: The study was conducted at the Nephrology department of Children's Hospital and Institute of Child Health Lahore from Feb 2007 to Feb 2008

Material and Methods: Forty children diagnosed with renal failure at the Nephrology department of Children's Hospital and Institute of Child Health, Lahore were evaluated for the efficacy of PD, duration of PD and the associated complications

Results: There were 55% cases of acute renal failure and 45% cases of chronic renal failure. The mean duration of PD was 3.8 days. About 75% of all the patients improved with PD. The mortality rate was 22.5%. Leading complications were Catheter-related [leakage/blockade] and peritonitis

Conclusion: We concluded that peritoneal dialysis is lifesaving procedure which improves the acute metabolic derangements of renal failure in children. It is associated with certain complications but the benefits outweigh the complications

Comparison of anaesthetic efficacy of 4% articaine primary buccal infiltration versus 2% lidocaine inferior alveolar nerve block in symptomatic mandibular first molar teeth

Objective: To evaluate success of pulpal anaesthesia of mandibular 1st molar by using 4% articaine in buccal infiltration versus 2% lidocaine in inferior alveolar nerve block

Study Design: Randomized control trial

Place and Duration of Study: Department of Operative Dentistry, Sardar Begum Dental College, Gandhara University, Peshawar, from March to August 2014

Methodology: One hundred and fifty-six emergency patients, who had 1st molar diagnosed with irreversible pulpitis, participated in the study. Subjects were divided into two groups by random allocation. One group received 4% articaine buccal infiltration and the other group received inferior alveolar nerve block of 2% lidocaine. Subjects' self-reported pain response was recorded on Heft Parker Visual Analogue Scale after local anaesthetic administration during access cavity preparation and pulp extirpation

Results: Mean age of subjects was 31.46 +/- 10.994 years. The success rate of 4% buccal infiltration was 76.9%; whereas the success rate of 2% lidocaine inferior alveolar nerve block was 62.8%. There was no statistically significant difference between the two groups

Conclusion: 4% articaine buccal infiltration can be considered a viable alternative to 2% lidocaine inferior alveolar nerve block in securing successful pulpal anaesthesia for endodontic therapy

Comparison of effectiveness of 4% articaine buccal infiltration versus inferior alveolar nerve block in symptomatic mandibular 1[st] molar tooth

Objective: to evaluate the pulpal anaesthesia of mandibular 1st molar by using 4% articaine in two different techniques i-e buccal infiltration and inferior alveolar nerve block

Methodology: ninty emergency patients who had 1st molar diagnosed with irreversible pulpitis participated in the study. Subjects were randomly allo-cated into two groups One group received 4% articaine buccal infiltration and the other group received inferior alveolar nerve block of 4% articaine. Subjects' self reported pain response was recorded on Heft Parker Visual Analogue Scale after local anesthetic administration during access cavity preparation and pulp extirpation

Results: mean age of subjects was 32.96 years +/- 10.105 years. The success rate of 4% articaine buccal infiltration was 71.11% whereas the success rate of 4% articaine inferior alveolar nerve block was 64.4%. There was no statistically significant difference between two groups

Conclusion: since there was no difference between the two procedures 4% articaine buccal infiltration can be considered a viable alternative to inferior alveolar nerve block in securing successful pulpal anesthesia for endodontic therapy

Prostatic carcinoma; association between serum prostatic specific antigen [PSA] and gleason grade

During the past many years the availability of serum PSA as a screening marker, has encouraged its use to diagnose both prostatic cancer and its recurrence. Patients with high S/PSA are at increased risk of advanced carcinoma prostate and screening at an earlier stage would help to manage it accordingly. The aim of this study was to determine association between serum prostatic specific antigen [PSA] levels and Gleason grade in prostatic carcinoma patients. Descriptive, case series study. Department of Urology and Renal Transplantation in collaboration with Institutional laboratory of Bahawal Victoria Hospital, Bahawalpur. June 2012 to June 2014. Total 160 patients of age 50-80 years with biopsy proven prostatic carcinoma were included. Patients with h/o radiotherapy for prostatic carcinoma and anti-androgen therapy were excluded. Histological slides of each patient were reviewed by using the Gleason grading system. Gleason grade of each patient was correlated with his serum prostatic specific antigen [PSA] report which was done before surgery or biopsy. In our study, mean age was 66.89 +/- 9.28 years. Mean serum PSA was 21.41 +/- 13.67 ng/ml. Intermediate grade cancer was found in 38.75% patients followed by moderate to poorly differentiated cancer in 31.86% patients. Gleason score >/= 7 was significantly higher in patients with serum PSA >20 ng/mL than those with serum PSA

Comparison of inter appointment pain between calcium hydroxide mixed with 2% chlorhexidine and calcium hydroxide mixed with normal saline; a randomized controlled trail

The objective of this study were to determine which medium [normal saline or 2% chlorhexidine] is more efficient when mixed with calcium hydroxide in reduction of interappointment pain. Eighty subjects from Department of Operative and Endodontics, Sardar Begum Dental College were randomly divided into two groups; Group 1 had 40 subjects who received calcium hydroxide mixed with 2% Chlorhexidine while in group 2, the subjects received calcium hydroxide mixed with 0.9% normal saline after chemomechanical preparation. The mean pain experienced by the subjects was less in group 1 after 6, 12, 24 and 48 hours of the preparation. As intra canal dressing, combination of calcium hydroxide and chlorhexidine was more effective than that of calcium hydroxide and saline, in reducing interappointment pain

Severe hypocalcaemia following coronary artery bypass grafting due to hypoparathyroidism

A 55 years old man was extubated on first postoperative day following coronary artery bypass grafting at 7:30 am. The same day at 5 pm, he became drowsy but arousable only on painful stimuli with severe generalized hypertonia and bilateral upgoing plantars. He was reventilated and a provisional diagnosis of cerebrovascular accident was made. CT scan of brain was normal except for bilateral basal ganglia calcification. On further investigations, he was found to be severely hypocalcaemic due to hypoparathyroidism. All symptoms resolved on the treatment of his hypocalcaemia. There was no history of neck surgery in this patient and the case additionally highlights important interaction between parathyroid hormone [PTH] in calcium metabolism

Frequency of metabolic abnormalities in urinary stones patients

To determine the'frequency of metabolic abnormalities in the serum and urine of patients with urinary stones disease. Two hundred patients with either multiple or recurrent urolithiasis diagnosed on ultrasonography and intravenous urography were included in this study. 24 hour urine sample were collected from each patient and sent for PH, specific gravity, Creatinine, uric acid, calcium, phosphate, oxalate, citrate and magnesium. In addition, blood sample of each patient was also sent for serum levels of urea, creatinine, uric acid, phosphate and calcium. Mean age of patients was 38 +/- 7.75 years with male to female ratio of 2:1. The main presenting complaint was lumber pain and 82.5% patients were found to have calcium oxalate stones on chemical analysis. Metabolic abnormalities were found in 90.5% patients, whereas there were no metabolic abnormalities in 19 [9.5%] patients. Forty patients [21.5%] only had one metabolic abnormality and 157 [78.5%] patients had multiple metabolic abnormalities. Hyperoxaluria was the most commonly observed metabolic abnormality and was found in 64.5% patients. Other significant metabolic abnormalities were hypercalciuria, Hypercalcemia, hypocitraturia and hyperuricemia. This study concludes that frequency of metabolic abnormalities is very high in patients with urolithiasis and hyperoxaluria, hypercalciuria and hypocitraturia are the most important metabolic abnormalities observed in these patients

Teaching anatomy at undergraduate level -- a survey amongst students comparing use of powerpoint and blackboard

To find out a more effective method for teaching anatomy at undergraduate level by comparing PowerPoint and Blackboard-Chalk modes. Comparative study. This study was conducted at the departments of anatomy at Army Medical College, Islamic International Dental College, Islamabad Medical and Dental College in Rawalpindi/Islamabad from March to May 2010. 130 students who were exposed to both the PowerPoint and Blackboard-Chalk based lectures in three medical and dental colleges, were selected at random from class nominal roll. A specially designed questionnaire was sent to them. 82% [106] of the students returned the survey form with the response. Various advantages and disadvantages of both the PowerPoint and Blackboard-Chalk method were highlighted in the students' response. 65%, 62% and 60% of the students recommended that a combination based upon Blackboard as main format, and supplemented by PowerPoint should be used in lectures [embryology, histology and gross anatomy], gross anatomy demonstrations and histology practical respectively. The PowerPoint was recommended to be used in the beginning to outline the lecture and summarize the things at the end with picture showing wherever needed. A strategy based upon mixing PowerPoint with Blackboard as main format is preferred by undergraduate students in anatomy

Comparison between double J [DJ] ureteral stenting and percutaneous nephrostomy [PCN] in obstructive uropathy

To compare the complications rate of percutaneous nephrostomy and double J ureteral stenting in the management of obstructive uropathy. Total number of 300 patients of age 20-80 years who underwent JJ stenting or percutaneous nephrostomy for obstructive uropathy were included in this study. Patients were divided in two groups i.e. A and B. In group A, 100 patients who underwent double J ureteral stenting while in group B, 200 patients who underwent percutaneous nephrostomy tube insertion were included. The stent was inserted retrograde by using cystoscope, under mild sedation or local anesthesia. While the percutaneous nephrostomy was done under ultrasound guidance by using local anesthetic agent. Complications were noted in immediate post-operative period and on follow up. Majority of the patients were between 36 to 50 years of age with male to female ratio was 2.6:1. The most common cause of obstructive uropathy was stone disease i.e. renal, ureteric or both. Post DJ stent, complications like painful trigon irritation, septicemia, haematuria and stent encrustation were seen in 12.0%, 7.0%, 10.0% and 5.0% patients respectively. On the other hand, post-PCN septicemia, bleeding and tube dislodgment or blockage was seen in 3.5%, 4.5% and 4.5% respectively. In this study, overall success rate for double J stenting was up to 83.0% and for percutaneous nephrostomy [PCN] was 92.0% [p < 0.0001]. Percutaneous nephrostomy is a safe and better method of temporary urinary diversion than double J stenting for management of obstructive uropathy with lower incidence of complications

Frequency of carcinoma of prostate in clinically benign prostatic hyperplasia and role of different screening tests

To assess the frequency of carcinoma in clinically benign prostatic hyperplasia and role of digital rectal examination [DRE] and prostatic specific antigen [PSA] in assessment of these patients. Patients admitted to the Department of Urology and Renal Transplantation with lower urinary tract symptoms [LUTS] due to enlarged prostate. Descriptive Study. Department of Urology and Renal Transplantation, Quaid-I-Azam Medical College /Bahawal Victoria Hospital, Bahawalpur, from January 2007 to December 2010. Patients presenting with lower urinary tract symptoms over the age of 50 years were evaluated on International Prostate Symptoms Score [IPSS], clinically examined and post-voiding residual urine determined on abdominal ultrasonography. The selection criteria were; Refractory retention of urine, Severe IPSS, absence of signs of malignancy on Digital Rectal Examination [DRE] and post-voiding residual urine more than 100 ml. Thus a total 300 patients were selected. Patient's blood sample was sent to laboratory to assess Prostate Specific Antigen [PSA] level pre-operatively. All these patients underwent either transurethral resection of prostate [TURP] or transvesical prostatectomy [TVP] and prostatic tissue was sent for histopathology. In this study, 13.33% patients were found to have carcinoma of prostate inspite of being clinically benign prostates in all patients, irrespective of PSA range. The PSA value was found < 4ng/ml in 211 [20.33%] patients and remaining 89 [29.67%] patients had PSA value > 4ng/ml. In this study, 9.95% patients had carcinoma prostate inspite having normal PSA and benign prostate on DRE while with rising PSA levels and normal DRE, chances of malignancy detection increases [66.67%]. We conclude that although frequency is low the possibility of malignancy in clinically benign enlarged prostate should be borne in mind whenever subjecting the patient for screening, assessment and treatment. DRE alone is insufficient to detect malignancy. PSA in combination with DRE is beneficial in predicting prevalence of carcinoma prostate.

Need for chest tube after video assisted thoracoscopic [VATS] lung biopsy

To observe the effects of early removal of chest tube drain after video assisted thoracoscopic [VATS] lung biopsy. We prospectively evaluated the removal of chest tube drain at six hours or 24 hours after the VATS-lung biopsy in fifty consecutive patients with no evidence of air leak after the lung biopsy. Our results show that removal of chest tube drain at 6 hours was not associated with complications such pneumothorax, atelectasis or pleural effusion as compared to the 24 hours removal of the drain[p>0.05]. Early removal of chest tube drain is safe in patients where air leak has been documented to be absent. Since it was a non-randomized evaluation, further randomized study in our population is needed to confirm these findings

Ultrasonography, X-ray and intravenous urography [IVU]

To know the sensitivity and specificity of ultrasound with plan abdominal film [X-ray KUB] compared to IVU in evaluation of renal colic. To develop a protocol for investigations of renal colic. Experimental. Department of Urology and Renal Transplantation, Quaid-I-Azam Medical College/ Bahawal Victoria Hospital, Bahawalpur. From July 2010 to December 2011. The number of cases for the study were one hundred and fifty. Patients of either sex of age range from 10 to 50 years with suspected urinary tract stone disease, PUJ obstruction and structure ureterovesical junction were included in this study. While patients of age <10 years, renal failure and with history of hypersensitivity to contrast media were excluded from the study. After routine investigations, ultrasonography, plain X-ray KUB and IVU were performed in every patient at radiology department, Bahawal Victoria hospital, Bahawalpur. The mean age of patients was 41.14 +/- 1.30 years. The ratio of male to female was 2.8:1. Presenting complaints of patients were flank pain. Maximum duration of complaint was 5-6 years. USG + X-ray KUB findings were obstructing renal stone, ureteric stone and PUJO in 97[64.67%], 25[16.67%] and 28 [18.67%] patients respectively. While on IVU, obstructing renal stone, PUJO and ureteric stone was found in 87[58%], 31[20.67%] and 32[21.33%] patients respectively. this study shows that ultrasonography and plain X-ray abdomen [KUB] in sufficient for the diagnosis of renal disease presenting with renal colic

Prophylactic use of antibiotics to prevent flare-up in endodontic treatment

The aim of this study was to assess the effectiveness of giving antibiotics during root canal treatment to reduce pain. Sixty patients with asymptomatic necrotic teeth were included in the study, which was carried out at the Department of Operative Dentistry, Altamash Institute of Dental Medicine, Karachi and was spread over one year. Two groups, A and B, were formed. Thirty patients in group A were given prophylactic antibiotics. Patients in group B formed the study group. Postoperative flare-up pain recorded at 4, 12, 24 and 48 hours was not statistically significant between the two groups. It was concluded that there was no statistical significance of giving prophylactic antibiotics to prevent inter-appointment flare-up. The risk of inappropriate use of antibiotics and widespread antibiotic resistance appear to be far more important than any possible perceived benefits

Incidence of endodontic flare-ups using either calcium hydroxide or creosote as intracanal medicament in symptomatic teeth

To enhance our knowledge about the superior intracanal medicament available for reducing the interappointmentpain in endodontic treatment. Hundred symptomatic teeth presenting to the Department of Operative Dentistry, Khyber College of Dentistry were included in this study. All teeth underwent conventional root canal treatment. The canals were dried and one of the following two medicaments was inserted into the canal in random sequence: Group 1: Calcium Hydroxide paste; Group 2: Creosote. Before dismissal, the preoperative pain experienced on the previous night was recorded using a visual analogue pain scale. Patients were instructed to record the degree of pain experienced 4 hours, 12 hours, 24 hours and 48 hours after the treatment. Patients who received Calcium hydroxide have a lower incidence of flare-up when compared to Creosote. Based on this study, Calcium Hydroxide is the superior intracanal medicament in terms of postoperative pain

role of factors contributing to oral and dental health status

The objective of the present study was to find various reasons or factors which contribute to poor oral and dental health. This study was carried out in three months from Sept to Nov 2009. One hundred and thirty five subjects were included in this study by convenience sampling method. A proforma was made to record the information. One hundred and five subjects [77.8%] were educated while 22.2% were uneducated. The participants belonged to good, satisfactory and poor socioeconomic classes [12.6%, 51.9% and 35.6% respectively. Negligence was the main reason for poor oral and dental health [44.4%] followed by unawareness [26%]. Education and socioeconomic condition had no significant effect on the oral and dental health [P-value 0.713 and 0.061 respectively]

Replacements of amalgam restorations - a study

The aim of this study was to register various reasons for replacement or repair of amalgam restorations of patients visiting a dental institution hospital in Peshawar, Pakistan, and to compare the results of the present study with the international studies carried out on this subject. A cross sectional study on 123 patients, aged 10-60 years, visiting for the replacement or repair of their 210 amalgam restorations was carried out over a period of 10 months. These patients were examined clinically and radiographically to find out the reasons of the failed amalgam restorations which needed replacement or repair while the teeth were still vital and restorable. In 123 patients, 210 amalgam restorations were examined. Seven reasons were found responsible for replacement or repair of restorations; Secondary caries [37.61%], marginal degradation [22.38%], dislodgment of fillings [20.47%], poor anatomy restored [14.76%], fracture of filling's material [11.42%], macroleakage gap [5.71%] and fracture of teeth [3.80%] were found in 210 restorations. The failed restorations with single reason [85.72%] and combined reasons [14.28%] were also assessed in this study. Secondary caries was the most prevalent reason for replacement or repair, followed by marginal degradation. The results also showed that the failed restorations with one reason were dominant over the restorations with multiple reasons in this study

Histological comparison of human thymus glands between groups of different ages

To compare the thickness of the capsule and interlobular connective tissue, and number and diameter of Hassal's corpuscles in human thymus between two groups of young and old patients. Comparative study. The study was carried out in the Anatomy Department at Army Medical College Rawalpindi from Sep 2007 to Oct 2007. Forty specimens of human thymus were separated into two groups. Group A included 20 specimens from patients between 1-25 years while Group B had same number of specimens of more than 40 years of age. These specimens were fixed in 10% formalin solution and then processed for paraffin embedding. Five micron thick sections were made. Haematoxylin and eosin stain, and PAS stain were used. The thickness of thymic capsule and interlobular connective tissue, number and diameter of Hassal's corpuscles in both groups were noted. Statistically significant differences were found in the thickness of capsule and interlobular connective tissue, number and size of Hassal's corpuscles in specimens of different age groups. In old age, there is definite increase in the thicknesses of capsule and interlobular connective tissue with Hassal's corpuscles decreasing in number but increasing in diameter

Hypospadias repair

The Departments of Urology, Pediatric Surgery and Plastic Surgery, Quaid-e-Azam Medical College, Bahawal Victoria Hospital, Bahawalpur. Jan 1999 to Dec 2004. Prospective. Patients admitted with hypospadias in these departments were included in this study except patients with multiple failed repairs previously. Standard procedures were practiced for every type of defect i.e. MAGPI and Mathieu's repair for coronal hypospadias, Snodgrass urethroplasty for proximal and distal penile hypospadias. The age range observed during this study was 1.5 to 25 years while 64% of patients were less than 10 years of age. The type of defect was coronal in 25%, penile in 60%, penoscrotal and perineal in 15% of the patients. Initial success rate was 78% and overall success rate was 92%. Complications observed were fistula formation 7%, stenosis of anastomotic site 7% and dehiscence of repair 3%. Thorough evaluation of urethral and penile malformation brings best outcome of surgery for hypospadias. Hypospadias repair should be offered to the child before school going age so as to prevent psychological impacts of genital malformations