Cut Neck, Department of E.N.T in a Tertiary Centre: How We Approach.

Cut neck injury needs prolonged hospitalization, high cost care, reduced quality of life and above all death. Proper exploration is a must in preventing co-morbidities like shock, sepsis, laryngotracheal stenosis or fistula formation. Neck trauma can involve muscles, vessels, nerves, bone and hollow viscera. Though the repair of neck means planning and skill for repair of the structure, the tracheal repair needs special attention to avoid tracheal stenosis. 12 patients were included in the prospective study of 8 months. Management plan was undertaken which were thoroughly studied and discussed with respect to two tracheoplasty cases done in ENT OT, AMCH. Apart from haemodynamic stability all patients were assessed for injury to hollow viscera and planned accordingly as this centre is an important centre for airway reconstruction. Male female ratio was 11:1. Suicidal cut neck injury was the most common cause. Two cases were of tracheal stenosis post tracheostomy. One of the case had associated neurovascular injury but with patent airway. Rest of the cases were repaired under general and/or local anaesthesia. Primary aim should be to maintain airway and to look for the extent of injury to reduce morbidity. Expertise of surgeons' skill is developing every day hence the successfulness of repair will be tested by least of morbidity. From this institute which is skilled in airway reconstruction we could comment that airway reconstruction team should be an integral part of surgeons' team.

Proposal of New Key Step in Lateral Approach Thyroidectomy in Light of Comparison of Surgical Outcomes of Medial versus Lateral Approach Thyroidectomy: A Randomised Controlled Study.

OBJECTIVE: Thyroid surgery has travelled a long path, from a surgery which once was considered deemed to fail and even led to death, to the current time when newer techniques are being tested to make the incision smaller and smaller. The aim of our study is to give a precise detailed stepwise description of medial and lateral surgical approach with the anatomical basis and to compare their feasibility and safety. METHODS: 104 cases presenting with thyroid swelling in the Department of Otorhinolaryngology, Assam Medical College Dibrugarh from January 1, 2019, to December 31, 2019, were selected and randomisation was done based on day of admission from OPD. Basic demographic data, preoperative diagnosis, operative time, blood loss, need for transection of strap muscles, and complications were recorded. RESULT: The distribution of thyroid cases according to age ranged from 17 to 81 years. The prevalence of thyroid disorders was the highest (37.5%) in the age group of 31-40 yrs. Of a total of 104 thyroid cases, 49 were colloid goitre, 24 were multinodular goitre, 9 were follicular neoplasm category 4, 4 were papillary thyroid carcinoma, 2 were follicular neoplasm category 3, and 3 were follicular neoplasm category 5. CONCLUSION: Out of the two approaches, lateral approach thyroidectomy showed better results with fewer complications. A single structure (superior belly of omohyoid) can be used as a guide to preserving all vital structures related to the thyroid gland.

Juvenile Nasopharyngeal Angiofibroma: A Rise in Incidence.

Juvenile nasopharyngeal angiofibroma is a very rare, highly vascular, uncapsulated and locally invasive tumor. Recently a changing trend has been seen in its epidemiology, pathogenesis, diagnosis, medical management, pre-operative care, surgical management and post-operative care including radiotherapy. Study the changing trend basically in the north-eastern region of south-east Asia and its prospects. Retrospective study of patients presenting with JNA between the study period of 6 months (October 2014-March 2015) in the, Department of Otolaryngology and Head and Neck Surgery, Assam Medical College, Dibrugarh, Assam, India. Incidence in comparison to previous studies has increased. Eight patients were treated in the study period. Different approaches were used. Mean age of presentation was 18 years and more than 75 % of them were either Stage III or Stage IV. Different approaches like transpalatine, transpalatine along with transnasal, lateral rhinotomy and endoscopic surgery were used. The recurrence rate was 12.5 %. Surgery by transpalatine approach should be the choice of treatment. Endoscopic resection should be only used for Stage I or Stage II disease.

Head and Neck Tuberculosis: Scenario in a Tertiary Care Hospital of North Eastern India.

INTRODUCTION: Tuberculosis has affected mankind since time immemorial and with emergence of AIDS both extrapulmonary and pulmonary tuberculosis presents increased morbidity and mortality along with an increased financial burden upon the developing nations. MATERIALS AND METHODS: The study is a hospital based observational study of one year duration carried out in the Department of ENT in a tertiary care hospital of North Eastern India. RESULTS: Total of 63 cases were detected. Females comprised 60.3% of the study population as against 39.7% males. Most commonly affected age group were of 15 to 24 years age (57.1%). Cervical tubercular lymphadenitis was the most common lesion 90.5% (57 cases) followed by laryngeal tuberculosis 7.9% (5 cases) and tubercular otitis media with mastoiditis 1.6% (1 case). Level II lymph node was mostly affected either single or in groups (75.4%) followed by level III node (57.9%). Successful outcome of the treatment with Category I regimen was achieved in 96.8% of the cases. CONCLUSION: Head and neck tuberculosis is not an uncommon disease and though cervical lymphadenitis is the most common presentation, isolated involvement of the larynx, ear and other subsites are not an entirely unknown entity. The clinical presentation of tuberculosis of the head and neck region can be varied and often misleading. It is therefore important for the clinician to be aware of the condition and consider it in their differential diagnosis.

Negative regulation of natural killer cell in tumor tissue and peripheral blood of oral squamous cell carcinoma.

Natural killer (NK) cells are the key lymphocytes in solid tumors. Its activity is regulated by both germline encoded receptors and cytokine microenvironment. We conducted a case-control study to investigate the activation status of NK cell in oral squamous cell carcinoma (OSCC). NK cell activation was assessed in context of NK cell cytotoxicity and transcript expression of NK cell receptors (NKp46 and KIRs) and NK cell associated cytokines (IL-1ß, IL-2, IL-10, IL-12ß, IL-15, IL-18, IL-21, IFN-γ, TNF-α and TGF-ß). The results revealed possible mechanisms involved in reduced NK cell activation in peripheral circulation: quantitative deficiency of NK cell number and lowered cytotoxicity together with qualitative NK impairments caused by--(1) decreased expression of NK activating receptor NKp46, (2) increased expression of NK suppressive cytokines--IL-10 and TGF-ß and (3) induction of FOXP3(+)CTLA4(+) suppressor cells. On the other hand, in the tumor tissue, escape of NK immune surveillance appeared to be modulated by upregulation of TGF-ß and IL-10 together with downregulation of NK cell activating cytokines (IL-2, IL-12ß, IL-15, IL-18, IL-21 and IFN-γ) and NK receptors (NKp46 and KIRs). In addition, our study supported the earlier contention that TNF-α and IL-1ß expression levels may be used as markers of malignant transformation in oral leukoplakia. In conclusion, the study provided an insight into the negative regulation of NK cell in tumor tissue and peripheral blood of OSCC patients, which can be exploited to boost the current NK cell and cytokine based immunotherapy for the treatment of oral cancer.

Association of killer cell immunoglobulin-like receptor gene 2DL1 and its HLA-C2 ligand with family history of cancer in oral squamous cell carcinoma.

Killer cell immunoglobulin-like receptors (KIR) are involved in regulating natural killer cell activation through recognition of their human leukocyte antigen (HLA) class I ligands. We conducted a case-control study with 169 oral squamous cell carcinoma (OSCC) patients and 177 healthy participants to study the genomic diversity of KIR and HLA loci and KIR gene expression in context of family history of cancer (FHC) in OSCC. Polymerase chain reaction (PCR) sequence-specific priming approach was used to type 16 KIR genes in individuals. SSP-real-time PCR was used for HLA class I ligand genotyping and real-time quantitative reverse transcriptase PCR was used to determine the expression of KIR gene. KIR2DL1(+)-HLA-C2(+) genotype was higher and positively associated with OSCC. Notably, all KIR2DL1(+)-HLA-C2(+) genotypes occurred exclusively in patients with FHC, showing a strong positive association of KIR2DL1(+)-HLA-C2(+) genotype with FHC. In addition, all younger age group patients (<55 years) with FHC were positive for KIR2DL1(+)-HLA-C2(+) genotype suggesting association of the genotype with early onset of disease. RNA transcript abundance of inhibitory KIR2DL1 in FHC patients, particularly of lower age groups (<45 and 45-54 years), supports the contention. Further, KIR2DL3(+)-HLA-C(+) genotype was negatively associated with OSCC. Our findings suggest KIR2DL1(+)-HLA-C2(+) genotype as heritable risk factor in OSCC predisposing to OSCC at younger age. Interestingly, KIR2DL3(+)-HLA-C(+) genotype was seen to be protective in OSCC. This study may be useful towards cancer surveillance and early detection of oral cancer in patients with FHC.

Assessment of Pb-slag, MSWI bottom ash and boiler and fly ash for using as a fine aggregate in cement mortar.

Three types of wastes, metallurgical slag from Pb production (SLG), the sand-sized (0.1-2 mm) fraction of MSWI bottom ash from a grate furnace (SF), and boiler and fly ash from a fluidised bed incinerator (BFA), were characterized and used to replace the fine aggregate during preparation of cement mortar. The chemical and mineralogical behaviour of these wastes along with the reactivities of the wastes with lime and the hydration behaviour of ordinary Portland cement paste with and without these wastes added were evaluated by various chemical and instrumental techniques. The compressive strengths of the cement mortars containing waste as a partial substitution of fine aggregates were also assessed. Finally, leaching studies of the wastes and waste containing cement mortars were conducted. SLG addition does not show any adverse affect during the hydration of cement, or on the compressive strengths behaviours of mortars. Formation of expansive products like ettringite, aluminium hydroxide and H2 gas due to the reaction of some constituents of BFA and SF with alkali creates some cracks in the paste as well as in the cement mortars, which lower the compressive strength of the cement mortars. However, utilization of all materials in cement-based application significantly improves the leaching behaviour of the majority of the toxic elements compared to the waste as such.

Production of cement clinkers from municipal solid waste incineration (MSWI) fly ash.

This communication reports the laboratory scale study on the production of cement clinkers from two types of municipal solid waste incineration fly ash (MSW ash) samples. XRD technique was used to monitor the phase formation during the burning of the raw mixes. The amount of trace elements volatilized during clinkerization and hydration, as well as leaching behaviours of the clinkers obtained from optimum compositions, were also evaluated. From the results it is observed that all of the major components of ordinary Portland cement (OPC) clinkers are present in the produced clinkers. Results also show the volatilization of considerable amounts of Na, K, Pb, Zn and Cd during the production of clinkers. However, major parts of the toxic elements remaining in the clinkers appear to be immobilized in the clinkers phases. Hydration studies of the clinkers obtained from optimum compositions show that the clinkers prepared from raw MSW ash are more reactive than the washed MSW ash based clinkers. TG/DTA analyses of the hydrated pastes show the formation of hydration products, which are generally found in OPC and OPC derived cements. The initial study, therefore, shows that more than 44% of MSW ash with the addition of very small amounts of silica and iron oxide can be used to produce cement clinkers. The amount of CaCO3 necessary to produce clinkers (approximately 50%) is also smaller than the same required for the conventional process (more than 70%).

Behavior of B, Cr, Se, As, Pb, Cd, and Mo present in waste leachates generated from combustion residues during the formation of ettringite.

The behavior of B, Cr, Se, As, Pb, Cd, and Mo in the leachates generated from two combustion residues, coal-fired power plant fly ash and municipal solid waste incineration ash, during precipitation of ettringite is presented. Experiments also were performed using modeled waste leachates as well as controlled solutions containing all the investigated elements. Moreover, to determine the possible effect of pH, lime treatment was conducted using the waste and modeled leachates. Results indicated the removal of B, Se, and Cr from the leachates because of incorporation of their oxyanions in the ettringite structure. The removal of B could further be explained by considering the structure of ettringite and monosulfoaluminate. The removal of Pb also occurred, probably because of lime-induced precipitation of Pb(OH)2. Similarly, the removal of As was observed as a result of lime-induced precipitation of Ca3(AsO4)2 and incorporation into the ettringite structure. On the other hand, the precipitation of ettringite did not reduce the concentrations of Mo and Cd because of the complex nature of these elements in the leachates. The results also suggest that the presence of high amounts of constituents such as Cl-, an alkali metal in the solution, also affected ettringite precipitation behavior. Moreover, elemental speciations as well as the presence of other constituents in the solution affected the incorporation by ettringite.