A Young Female With Takayasu Arteritis Involving the Coronary Arteries.

A rare form of large vessel vasculitis, Takayasu arteritis (TA) typically affects the aorta and its primary branches and rarely involves the coronary arteries. We present a case study of a female patient who had refractory hypertension and coronary artery disease for which she underwent percutaneous transluminal angioplasty. Subsequently, she was diagnosed with Takayasu arteritis. We wish to underscore the significance of timely identification and intervention as pivotal factors in improving patient outcomes and optimizing the effectiveness of therapeutic strategies in managing TA.

To Assess Symptomatic Profile in Patients with Chronic Rhinosinusitis Before and After Functional Endoscopic Sinus Surgery by Sinonasal Outcome Test-22.

Purpose: This study designed to compare the symptomatic profile of diagnosed patients of chronic rhinosinusitis (CRS) before and after functional endoscopic sinus surgery (FESS) by a 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire. Study design: Observational mixed-design study. Materials and Methods: It is an observational mixed-design study conducted in the department of ENT, Dr. S.N. Medical College, jodhpur from February 2021 to September 2022. A total of 50 patients were included in our study who underwent functional endoscopic sinus surgery. Their symptomatic improvement based on the SNOT-22 score, was compared before and after surgery. Follow-up of patients was done at 1 month and 3 months by SNOT-22 score. Results: A total of 50 patients were included in our study, 42 patients were telephonically communicated and followed up, and 8 patients were lost to follow-up, so 42 patients' data were analyzed. The mean age was 35.42 years. The mean total SNOT-22 score preoperatively was 45.64, postoperatively at 1 month was 6.57, and postoperatively at 3 months was 2.52. The mean difference between preoperative and postoperative scores was 43.11. This shows a significant reduction in postoperative scores as well as improvement in symptoms at the end of 3 months. Conclusion: Preoperatively 64.24% of the patients had a grand total score of 20-50 (showing a moderate impact on quality of life) and 35.71% of patients having a score > 50 (showing a severe impact on quality of life). Observations in our study suggest that Functional endoscopic sinus surgery provides a significant symptom-specific improvement as well as a significant quality of life improvement in patients with chronic rhinosinusitis with or without polyposis. SNOT-22 questionnaire provides an ideal way to understand and grade the disease severity preoperatively and compare the symptomatic improvement after functional endoscopic sinus surgery in patients with chronic rhinosinusitis.

Eccrine Porocarcinoma of Dorsum of Nose: A Rare Case Report.

Eccrine porocarcinoma (EPC) is an uncommon malignant tumor derived from the eccrine sweat glands. Because of its various pathological features, it is often confused with other malignant cutaneous tumors. We present a case of 78-year- old female having ulcerative lesion over external nasal pyramid. Biopsy suggested of squamous cell carcinoma. Tumor was excised and reconstruction was done using paramedian forehead flap. Post operative Histopathological Examination (HPE) suggested of eccrine porocarcinoma.

Anomalous Subarcuate Canal and Artery: A Rare Anatomical Variation.

Introduction: An aberrant or anomalous subarcuate artery and its canal is an extremely rare and clinically significant finding. If accidentally nicked or injured, it can cause inadvertent hemorrhage and obscure the surgical field. Case Report: We present a case of 21 year old made with Chronic Otitis Media of the right ear who was incidentally diagnosed with a dilated subarcuate canal and an aberrant subarcuate artery atypically associated with lateral semicircular canal and facial nerve. Conclusions: Prior knowledge of this symptomatically dormant variation is important, particularly in retrofacial tympanomastoidectomy and cerebello-pontine angle tumor surgeries. Pre-operative temporal bone scans are advisable in such cases.

Decipher the inhibitory potential of phytocompounds from Leptadenia reticulata on dopamine D2 receptor to enhance prolactin secretion.

Dopamine is secreted by the hypothalamus, which inhibits the proliferation and effectiveness of lactotroph cells that release prolactin via dopamine D2 receptor (D2R). D2R activation inhibits lactotroph cell prolactin synthesis and regulates prolactin gene expression. Although, commercial medications are available for hypogalactia and agalactia, various plant sources significantly alleviate these problems. Leptadenia reticulata (Jivanti) is one of the important medicinal plants often consumed by nursing mothers to improve breast milk production. However, mechanism and chemical constituents involved in the inhibition of D2R by Jivanti is unclear. Therefore, in this study the phytocompounds reported from Jivanti were used for in-silico analysis to predict D2R inhibitory potential. The binding affinity value of campesterol and ß-sitosterol (- 10.1 and -10.0 kcal/mol) with D2R has high revealed by molecular docking and stable interaction reveled by molecular dynamics simulation. Thus, these lead compounds could exert more D2R inhibitory activity resulting into prolactin release, which may lead to an increase in breast milk production. Although all selected compounds had fine permeation, non-toxic, and non-carcinogenic characteristics predicted by ADMET, campesterol had good solubility, absorption characteristics compared to other. Therefore, Jivanti, which is traditionally known medicinal plant, could be explored as a medication candidate to boost breast milk production.

A Clinico-Pathological Study of Allergic Fungal Rhinosinusitis at a Tertiary Care Center of Western Rajasthan.

Allergic fungal rhinosinusitis (AFRS) is a non-invasive fungal sinusitis resulting from an immunologic response to the presence of extra mucosal fungal hyphae in the sinuses. Here we studied clinicopathological characteristics of AFRS among patients of chronic rhinosinusitis with nasal polyposis who underwent Functional Endoscopic Sinus Surgery (FESS) at a tertiary care in western Rajasthan. Standard ethical protocol was followed for the present study. We did a prospective study on admitted patients of chronic rhinosinusitis with nasal polyposis in the department of Otorhinolaryngology and Head & neck surgery, Dr. S. N. Medical College, Jodhpur from January 2018 to August 2019, who underwent FESS. The patient's history, clinical and endoscopic findings with radiological features were recorded. Biopsy specimens were sent for fungal staining, culture, and histopathology. As per Bent and Kuhn criteria, 25 cases out of 100 were diagnosed as AFRS, mean age was 27.46 ± 13.36. Nasal obstruction and nasal discharge were the most common symptoms. On histopathological examination fungal hyphae found in 18 cases (72%), allergic mucin in 25 cases (100%) and eosinophilic infiltrate in 20 cases (80%). Fungal culture positive in 15 cases (60%) of AFRS. In which aspergillus flavus present in 12 (80%). Allergic fungal rhinosinusitis should be considered as an important differential diagnosis in patients with chronic rhinosinusitis with nasal polyposis and for this surgery should be the treatment of choice.

Tracheobronchial Foreign Bodies: The Importance of Timely Intervention and Appropriate Collaboration.

The aim of study is to determine epidemiological profile of the cases suspected to have laryngotracheobronchial foreign body, average interval between onsets of symptoms and presentation to our tertiary centre, average interval between admission and active surgical intervention, incidence of various clinical, radiological and intraoperative findings. All patients presenting to our institution with suspicion of foreign body inhalation who underwent rigid bronchoscopy from October 2012 to April 2018 were considered for this study. Data compilation of these patients was done which included age, sex, chief complain, time of onset, time of presentation to hospital, time till intervention was undertaken, clinical and radiological findings, nature of foreign body, history of ingestion, intraoperative findings and post-operative recovery. All these aspects were then evaluated. Our study included 89 cases who underwent rigid bronchoscopy under General Anaesthesia. 67.4% were male and 71% were children less than 2 years of age. 36% presented within the first 48 h and 64% of these were managed within 24 h of presentation. Of these 50.6% gave history of foreign body inhalation and cough was the most common presentation in 92.1%. Collapse was the most common radiological finding in 42.7% cases. Lodgement of foreign body was slightly more on right side (45.5%). Most of the foreign bodies were of vegetative nature-84.7%. There was no mortality out of all 89 cases. Although the mortality and complication rate has decreased significantly after the advent of endoscopically assisted bronchoscopy, still attention needs to be given to earlier diagnosis of foreign body aspiration and earlier referral to an ENT surgeon for bronchoscopy if required. Also the time duration between intervention to be undertaken from the time of symptom onset can be decreased with a better collaboration between the Radiologist, the Paediatrician and the Otorhinolaryngologist.

Endoscope-assisted (with robotic guidance and using a hybrid technique) interhemispheric transcallosal hemispherotomy: a comparative study with open hemispherotomy to evaluate efficacy, complications, and outcome.

OBJECTIVEEndoscope-assisted hemispherotomy (EH) has emerged as a good alternative option for hemispheric pathologies with drug-resistant epilepsy.METHODSThis was a prospective observational study. Parameters measured included primary outcome measures (frequency, severity of seizures) and secondary outcomes (cognition, behavior, and quality of life). Blood loss, operating time, complications, and hospital stay were also taken into account. A comparison was made between the open hemispherotomy (OH) and endoscopic techniques performed by the senior author.RESULTSOf 59 cases (42 males), 27 underwent OH (8 periinsular, the rest vertical) and 32 received EH. The mean age was 8.65 ± 5.41 years (EH: 8.6 ± 5.3 years; OH: 8.6 ± 5.7 years). Seizure frequency per day was 7 ± 5.9 (EH: 7.3 ± 4.6; OH: 15.0 ± 6.2). Duration of disease (years since first episode) was 3.92 ± 1.24 years (EH: 5.2 ± 4.3; OH: 5.8 ± 4.5 years). Number of antiepileptic drugs per patient was 3.9 ± 1.2 (EH: 4.2 ± 1.2; OH: 3.8 ± 0.98). Values for the foregoing variables are expressed as the mean ± SD. Pathologies included the following: postinfarct encephalomalacia in 19 (EH: 11); Rasmussen's syndrome in 14 (EH: 7); hemimegalencephaly in 12 (EH: 7); hemispheric cortical dysplasia in 7 (EH: 4); postencephalitis sequelae in 6 (EH: 2); and Sturge-Weber syndrome in 1 (EH: 1). The mean follow-up was 40.16 ± 17.3 months. Thirty-nine of 49 (79.6%) had favorable outcomes (International League Against Epilepsy class I and II): in EH the total was 19/23 (82.6%) and in OH it was 20/26 (76.9%). There was no difference in the primary outcome between EH and OH (p = 0.15). Significant improvement was seen in the behavioral/quality of life performance, but not in IQ scores in both EH and OH (p < 0.01, no intergroup difference). Blood loss (p = 0.02) and hospital stay (p = 0.049) were less in EH.CONCLUSIONSEH was as effective as the open procedure in terms of primary and secondary outcomes. It also resulted in less blood loss and a shorter postoperative hospital stay.

Head and neck leiomyosarcoma.

Soft tissue sarcomas of head and neck region, account for 4-15% of all soft tissue sarcomas and less than 1% of all neoplasms in this region. Leiomyosarcoma is malignant tumor of smooth muscle which accounts for only 4% of head and neck sarcomas. The tumor is commonly encountered as a slow growing, discrete firm, and non-ulcerated painless mass. The physical appearance of these tumors can be deceptively benign and can be mistaken for non-malignant conditions. An early diagnosis and aggressive initial treatment remains the mainstay of therapy for a good prognosis. We are presenting eight cases of primary leiomyosarcoma of head and neck region with review of literature and highlight the need for early prudent diagnosis and treatment.

Benign tumors of the larynx: a clinical study of 50 cases.

OBJECTIVE: The study was undertaken to identify the common type of lesions, and the age, sex distribution, symptomatology, sites of involvement and prognosis of the same. STUDY DESIGN: A two-year prospective study was conducted from January 2005 to December 2006. SETTING: The study was conducted at SMS Medical College, Jaipur, Rajasthan, India-a tertiary referral hospital. PATIENTS: A total of 50 patients with benign laryngeal lesions were included in the study based on symptoms such as hoarseness of voice, foreign body sensation, throat pain, neck mass and cough and with positive clinical findings on indirect laryngoscopy and neck examination. The patients were in the age group of 14-63 years. All nonoperative cases and malignant cases were excluded. Diagnostic hematological and radiological investigations and therapeutic microlarygoscopic procedures were employed. RESULTS: A male preponderance with a male:female ratio of 2.5:1 was observed. Majority of the patients were in the age group of 21-30 years. Vocal cord polyps were observed to be the commonest type of lesions. In our study, hoarseness of voice, cough, foreign body sensation and throat pain were found to be the commonest symptoms. Out of the 50 patients in the study group, only 6% patients got complete relief with voice rest and vocal rehabilitation; 94% patients required surgery, which included microlarygoscopy and endolaryngeal surgery. There was no recurrence in cases of vocal polyps and nodules during the period of observation. CONCLUSION: Microlaryngeal surgery and voice rest offer a cost-effective, useful and safe method for the management of benign laryngeal lesions. With the inclusion of lasers, they can be more precisely operated. As such, the standard treatment of choice in all types of benign tumors of the larynx should consist of a triad of approach by microlaryngeal surgery (either microscopic or endoscopic, with or without use of lasers), voice rest and vocal rehabilitation.