Surgical Treatment of Sublingual Gland Ranulas

Abstract Introduction Ranulas are divided into oral (OR) and plunging (PR) and comprise the most common pathology of the sublingual gland. This study presents a case series of patients operated due to OR and PR within different type of modalities in a 1-year period. Objective The aim of this study is to determine the optimal surgical treatment of ranulas based on our results as well as in the literature review. Methods The medical charts of 7 patients with sublingual gland ranulas treated in 2020 were reviewed. Results The median age of the patients was 19. Three patients with OR were treated by marsupialization, micromarsupialization, and sublingual gland excision. Four patients with PR were operated via cervical approach in three cases and intraoral approach in one case. No recurrence was observed in 14 months of follow-up, on average. Conclusion Micromarsupialization should be consider as the primary treatment for OR. In case of recurrent OR and primary or recurrent PR, the best results might be obtained by radical excision of the sublingual gland, which can be performed without resection of the ranula sac with the intraoral approach.

Extraparotid Warthin Tumors Imitating Metastasis of Oral Cancers

Abstract Introduction Extraparotid Warthin tumor (WT) is a very rare entity, especially when synchronous with oral cancer (OC). Objective The present study presents a case series of extraparotid WTs detected in the surgical specimen of patients treated for OC. Methods From 2007 to 2016, 336 patients were operated for OC in our institution. Neck dissection was performed in 306 patients. Results In the 306 patients operated for OC whose necks were dissected, unexpected WTs were observed in 4 surgical neck specimens. In 3 cases, extraparotid WTs were responsible for tumor, node, metastasis (TNM) overstaging before surgery. Conclusion Extraparotid WTs may be discovered during neck dissection in ∼ 1% of OC patients, and they may mimic neck metastasis, especially in positron-emission tomography/computed tomography (PET/CT) imaging.

Comparison and agreement between venous and arterial gas analysis in cardiopulmonary patients in Kashmir valley of the Indian subcontinent

Arterial blood gas [ABG] analysis is routinely performed for sick patients but is fraught with complications, is painful, and is technically demanding. To ascertain agreement between the arterial and peripheral venous measurement of pH, pCO[2], pO[2], and bicarbonate levels in sick patients with cardiopulmonary disorders in the valley of Kashmir in the Indian subcontinent, so as to use venous gas analysis instead of arterial for assessment of patients. Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, a 650-bedded tertiary care hospital in North India located at an altitude of 1584 m. One hundred patients who required ABG analysis were admitted. Peripheral venous blood was drawn within 5 min of an ABG measurement, and the samples analyzed immediately on a point of care automated ABG analyzer. Finger pulse oximetry was used to obtain oxygen [SpO[2]] saturation. Data were analyzed using Pearson correlation and bias [Bland Altman] methods. The venous measurements of pH, pCO[2], pO[2] and bicarbonate, and the digital oxygen saturation were highly correlated with their corresponding arterial measurements. Bland Altman plots demonstrated a high degree of agreement between the two corresponding sets of measurements with clinically acceptable differences. The difference in pO[2] measurements was, however, higher [-22.34 +/- 15.23] although the arterial saturation and finger oximetry revealed a good degree of agreement with clinically acceptable bias. Peripheral venous blood gas assessment in conjunction with finger pulse oximetry can obviate the routine use of arterial puncture in patients requiring ABG analysis

Vitamin D toxicity in adults: a case series from an area with endemic hypovitaminosis D

Vitamin D deficiency state is endemic to the Kashmir valley of the Indian subcontinent. Physicians often treat patients with high doses of vitamin D for various ailments and on occasion the prescribed doses far exceed the requirements of the patients. Ten cases of hypercalcemia due to vitamin D intoxication are presented with features of vomiting, polyuria, polydipsia, encephalopathy and renal dysfunction. All the patients had demonstrable hypercalcemia and vitamin D levels were high in nine of the 10 cases. The patients had received high doses of vitamin D and no other cause of hypercalcemia was identified. Treatment of hypercalcemia resulted in clinical recovery in nine cases. We conclude that hypervitaminosis D must be considered in the differential diagnosis of patients with hypercalcemia in endemically vitamin D deficient areas. A careful history and appropriate biochemical investigation will unravel the diagnosis in most of the cases

Factors affecting survival in patients with oesophageal atresia and tracheo-oesophageal fistula

To evaluate the various factors affecting survival in babies with oesophageal atresia and tracheo-oesophageal fistula. Descriptive study. The study was carried out at the Department of Paediatric Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences [PIMS], Islamabad from March 2004 to March 2005. All neonates with oesophageal atresia [EA] and tracheo-oesophageal fistula [TEF] during the study period were included in the study. Patients having isolated EA were excluded. A total of 80 patients were included in the study. Patients were received from the emergency department, OPD and Neonatal ICU. Diagnosis was confirmed by passing a radio opaque orogastric tube. Investigations were done to look for other associations. After stabilisation, right thoracotomy was performed, fistula was ligated and divided. An attempt was made to do a primary oesophago-oesopahgostomy. Nasogastric feeding was started on 2nd post-operative day. A contrast oesophagogram was performed on the 7th postoperative day and having ruled out leak, oral feeding was started. Out of the total, 33 [41%] survived and 47 [58%] patients died. Out of 47 deaths 20 [25%] died before surgery and 27 [34%] died after surgery. Mean follow up period was 6 months. Sixteen [20%] patients had anastomotic leak, 24 [30%] had anastomotic stricture, and 64 [80%] patients had postoperative pneumonia. We conclude that proper antenatal check ups will detect the problem early, avoid home deliveries and hence improve survival. Pneumonitis and septicaemia significantly affect survival. Availability of ICU is one of the main determinants of survival. The likely cause of high mortality rate in pre-operative patients in our series is non-availability of NICU due to limited space in our setup

Safety in laboratories: Indian scenario

Health and safety in clinical laboratories is becoming an increasingly important subject as a result of emergency of highly infectious diseases such as Hepatitis and HIV. A cross sectional study was carried out to study the safety measures being adopted in clinical laboratories of India. Heads of laboratories of teaching hospitals of India were subjected to a standardized, pretested questionnaire. Response rate was 44.8%. Only 60% of laboratories had person in-charge of safety in laboratory. Seventy three percent of laboratories had safety education program regarding hazards. In 91% of laboratories staff is using protective clothing while working in laboratories. Hazardous material regulations are followed in 78% of laboratories. Regular health check ups are carried among laboratory staff in 43.4% of laboratories. Safety manual is available in 56.5% of laboratories. 73.9% of laboratories are equipped with fire extinguishers. Fume cupboards are provided in 34.7% off laboratories and they are regularly checked in 87.5% of these laboratories. In 78.26% of laboratories suitable measures are taken to minimize formation of aerosols. In 95.6% of laboratories waste is disposed off as per bio-medical waste management handling rules. Laboratory of one private medical college was accredited with NABL and safety parameters were better in that laboratory. Installing safety engineered devices apparently contributes to significant decrease in injuries in laboratories; laboratory safety has to be a part of overall quality assurance programme in hospitals. Accreditation has to be made necessary for all laboratories

Kaposi sarcoma in a non HIV patient

We report a case of a 45 year old non HIV infected female, who presented with multiple painful, livid reddish brown plaques, papules and nodules on both lower limbs and left index finger. The cutaneous nodular lesions on biopsy showed characteristic features of Kaposi's sarcoma. This case is reported due to paucity of Kapsi's sarcoma in non HIV persons. It is typically a disease of older men from European and Mediterranean region. Here we present a case report of classic Kaposi's Sarcoma in a young Indian female

Circumcision in babies and children with plastibell technique: an easy procedure with minimal complications - experience of 316 cases

Circumcision is the commonest surgery performed in the Muslims. In our country circumcision is performed by barbers, medical technicians, quacks and doctors including paediatric surgeon. As yet there is no consensus for the best age and method for circumcision. To evaluate the safety of various methods of circumcision at different age groups and to suggest the best age Et method of circumcision. A retrospective study was conducted to review the 316 consecutive circumcision performed by the author at Shifa International Hospital Islamabad from June 1998 to September 2001. All babies poundt children who underwent circumcision by the author were included in the study. Babies having circumcision as a part of hypospadias repair were excluded. Circumcision below two year was done by plastibell under local anaesthesia and circumcision above two years was performed by open technique under general anaesthesia. Of the 316 circumcisions 227 [72%] were performed in the first week of life by the plastibell. 17 [5%] children had circumcision from 2-12 years of age mostly by open method. Overall incidence of complications was 2% [7 patients]. Two had bleeding from the circumcision site which was controlled by local measures. Bell impaction was seen in two patients at 1.6 years Et 3 years age and parents of two babies were concerned about inadequate circumcision. Circumcisions performed in the neonatal period had minimal number of complications. Circumcision can be safely performed in a hospital set-up within first month of life preferably in the first week if the baby is otherwise well. Plastibell is a safe method for babies under one year. Older children should have circumcision by open method. Plastibell can be a safe technique if performed by trained GPs under aseptic conditions

Bronchiectasis SICCA: a case report

Bronchiectasis is a permanent abnormal dilatation of bronchi and bronchioles. The disease is characterized by copious amount of productive cough with chronic ill health. This is due to continues infection by the opportunistic organisms in the abnormally dilated bronchial tree. Bronchiectasis sicca or dry bronchiectasis is a very rare condition in which there are all the features of bronchiectasis except for the absence of copious amount of sputum which is usually a hall mark of bronchiectasis. We are presenting a case report of an 8 years old girl who presented with history of cough since two years of age and failure to thrive. She was diagnosed as a case of pulmonary tuberculosis and treated adequately. Later she developed cough which was initially productive but for the last two years it had become mostly non productive with occasional episodes of productive cough. CT scan and bronchography confirmed extensive bronchiectasis involving the whole left lung. Child had two episodes of haempotysis. Bronchoscopic evaluation showed classical features of bronchiectasis except for minimal amount of clear secretions and no pus in the tracheobronchial tree

Induction of labor as a planned program

Induction of labor near term in selected cases to procure a vaginal delivery of a selected time. The Aga Khan University Hospital, Karachi 1995 - 1996. Labor induced after ripening of the cervix with Folly's catheter, Prostine vaginal Pessary. Labor pains initiated with Prostaglandins, ARM syntocinon infusion or both. Vaginal/abdominal delivery with due safety to mother and child. Vaginal deliveries obtained in 89.2% cases, 10.8% cesarean section rate, no maternal or fetal mortality

Successful revascularization of severely damaged lower limb in a three years old child

Reimplantation and revascularization surgery is essential component of all trauma centres in the developed countries. In children revascularization can only be performed using special microsurgical techniques. We are presenting a case of a three years old female child who was referred to us from another hospital with history of trauma to the right leg by falling of a steel object. It resulted in fracture of tibia and fibula near the knee joint with division of major vessels and loss of circulation to the limb. Successful revascularization using an autologous long saphenous vein graft resulted in full recovery and function of the limb

Splenic cyst - a rare entity

Splenic cyst is a rare condition and is usually asymptomatic unless very large in size. We are reporting a case of large splenic cyst in an 11 year old girl who presented with a 3-month history of left upper quadrant pain and abdominal distension. Total splencctomy was performed due to the involvement of the splenic blood vessels and minimal residual splenic pulp

Clinical presentation and diagnosis of colorectal cancer

Fifty-six patients with colorectal carcinoma were managed during the period January 1995 to July 1996 at Hayat Shaheed Teaching Hospital, Peshawar. The male to female ratio was 1.24:1 with a mean age of 45.64 years. A Large number of patients [28.57%] were in the younger age group i.e.

Evaluation of dowdo [wheat-milk gruel] in children with acute diarrhea

Appropriate feeding practices have an important impact on diarrhoeal disease management in developing countries. We evaluated the efficacy of feeding dowdo, a wheat-milk gruel, traditionally used as a weaning food in the Northern Areas of Pakistan. Dowdo was compared with khitchri, a rice-lentil mixture, in acute diarrhoea through a randomized trial. Seventy- six children between 6 and 36 months of age, with acute watery diarrhoea of less than seven days were recruited. After rehydration with standard World Health Organization [WHO] glucose-based oral rehydration solution or intravenous Ringers lactate, patients were randomly assigned to either diet group. Dowdo and Khitchri were found to be equally effective in terms of stool frequency and output, duration of diarrhoea, weight gain and duration of hospitalization. The results indicate that feeding dowdo was as effective as khitchri in children with acute diarrhoea. Additionally, acceptability of dowdo was better than Khitchri. It is recommended that dowdo be used for nutritional management of diarrhoeal disease in children in the Northern Areas of Pakistan

Management of an ancurysmal bone cyst

Aneurysmal bone cyst is a rare, non-neoplastic, expansile bony lesion that mainly affects children and young adults. It may cause diagnostic confusion with a bone tumor. These cysts are frequently treated surgically, but recurrence is very common and surgery is hazardous, especially when the lesion is adjacent to the growth plate. A case report of an aneurysmal bone cyst in an 11 year old child is presented with serial radiographic changes and discussion on its management