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.

Estimation of Amylase in Serum and Pleural Fluid among HIV Known Seronegative Patients with Tuberculous Pleural Effusion.

Background: Myocardial Pleural TB is one of the most frequent extra-pulmonary manifestations of tuberculosis. Extra Pulmonary tuberculosis is the area of concern for the diagnosis of tuberculosis. Aim of this study is to estimate enzyme Amylase levels in serum and pleural fluids of HIV seronegative exudative tuberculous pleural fluids and their possible role in the diagnosis of tubercular pleural effusion. Methods: A total number of 100 patients were selected to do this study. Selected individuals were randomly included in this study as cases and controls, 50 members each. The samples of blood and pleural fluid were tested for amylase within the stipulated time, on the same day, to prevent the loss of analyte by CNPG method. Results: Among Group I or Cases, the mean value of serum amylase and pleural fluid amylase was 53.044 and 77.122 respectively. Among Group II or controls, the mean value of serum and pleural fluid amylase was 49.508 and 63.238 respectively. Conclusion: Serum and pleural fluid Amylase levels indicate a coexisting pathology of pancreas, gastrointestinal tract and malignancies. According to our study, diagnosing Tuberculous pleural effusion by assessing amylase levels has less sensitivity and specificity.

Acute nonspecific carditis in adolescents presenting with Stokes-Adams attacks.

Three patients, aged between 12 and 17 years presented with Stokes-Adams attacks as a result of atrioventricular block, atrioventricular silence and ventricular arrhythmias, complicating acute myocarditis. All the patients required temporary pacing for a few days. One patient required hemodialysis for anuria. All the patients made complete recovery.