Neck involvement in early carcinoma of tongue. Is elective neck dissection warranted?

Objective: To evaluate need of elective neck dissection in patients with early oral tongue cancer, and to see the pattern of involvement of different lymph node levels. Methods: Ninety four patients with T1-T2, N0 squamous cell carcinoma of the oral tongue were treated with a partial glossectomy and an elective modified radical neck dissection. Results: Thirty two patients had T1 and 62 patients had T2 lesion. In patients with T1 carcinoma, 9 out of 32 had metastases (28%), whereas in patients with T2 carcinoma, 21 out of 62 showed metastases(34%).Thus, the overall rate of occult lymph node metastases was high(32%).In our study skip metastases to level III was seen in only in 2 patients (6%) but there was no skip metastases seen involving level IV or V. Conclusion: The overall micrometastases rate in our patients (32%) warrants elective neck dissection in early cases also. The incidence of metastases to level IV and V from T1-T2 oral tongue cancer is low so these lymph nodes should be removed only when there is intraoperative suspicion of extensive metastases in levels I,II or III.,otherwise supraomohyoid neck dissection is sufficien

Laryngotracheal trauma: its management and sequelae

OBJECTIVE: Laryngotracheal trauma is a rare but clinically important injury. Complications are frequent. Early recognition, accurate evaluation and proper treatment is vital. In order to learn from our past experience and refine our management, we reviewed our cases. METHODS: Fifteen patients with external laryngotracheal injuries were analyzed retrospectively. The outcome was assessed both in terms of voice and airway, on short term and long term basis. RESULTS: Commonest cause of injury was cut throat injuries followed by road traffic accidents. The main presenting symptoms and signs were hoarseness, haemoptysis, odynophagia and stridor. Major laryngeal injuries (10 cases) outnumbered minor injuries (5 cases). A good association exists between the symptoms of haemoptysis and stridor at presentation and severity of the injury. Sites of laryngeal injury included; thyroid cartilage, mixed soft tissue and cartilaginous injuries, thyrohyoid membrane, aryepiglottic fold and cricothyroid membrane. Ten patients presented within 24 hours of the injury. Out come (airway and voice) was good in 12 patients whereas it was poor in 3 patients. Poor results were seen in patients who had delayed surgical intervention. CONCLUSION: The presence of stridor and haemoptysis are suggestive of major injury. Early surgical intervention is recommended for all major injuries to ensure a good outcome

An unusual case of cauda equina secondary to spinal metastasis of thyroid cancer

Abstract INTRODUCTION: Cauda equina secondary to metastatic follicular thyroid cancer of the lumbosacral area is a rare entity. CASE REPORT: We report an unusual case of a 52-year-old male who presented with backache, lower limb weakness, and perianal numbness. A CT-scan of the lumbosacral area showed an enhancing mass at the L4, L5 and S1 vertebrae. Histopathology after excision revealed a metastatic thyroid cancer. Hence, a CT scan of the neck and chest was performed which showed a nodule in the left lobe of the thyroid and a mass in the left chest wall. A total thyroidectomy and excision of the chest wall lesion was undergone, which was diagnosed as a follicular carcinoma of the thyroid. CONCLUSION: Metastatic workup of spinal metastasis should include evaluation of the thyroid gland

Ectopic cervical thymic cyst in a seven year old: A diagnostic challenge.

Cervical thymus cyst is a rare entity and resembles lymphangioma or branchial cleft cyst therefore, presents as a diagnostic challenge. It has a slight male predominance and presents on the left side of the neck in up to 70% of cases. It is a painless mass that progressively increases. We present a case of a seven year old child with a right sided neck swelling that would increase on phonation therefore, adding to the complexity of the case. Surgical excision was performed and final histopathology revealed an ectopic thymic cyst

Affective Organizational Commitment in Global Strategic Partnerships: The Role of Individual-Level Microfoundations and Social Change

The roles and commitment of employees within global strategic partnerships are imperative to their success. Whilst previous studies have addressed certain individual-level microfoundations and social change in an interpretivist manner, this study first proposes a theoretical framework consists of individual-level microfoundations, social change and affective organizational commitment—interlinked with social identity theory. We then validate the 16-item scale for individual-level microfoundations and the 24-item scale for social change based on data collected from global strategic partnerships. For testing of our conceptualization, path modeling finally confirms significant relationships between the constructs. Our findings further present the partial mediating role of social change between individual-level microfoundations and affective organizational commitment. Therefore, the study provides a new pathway in advancing our understanding of global strategic partnerships. It also validates two new constructs directly relevant to managing global strategic partnerships. We discuss theoretical and practical implications of these linkages and contributions, and conclude by providing suggestions for future research

Concurrent papillary thyroid carcinoma and synovial cfarcinoma of the neck in an adult male

INTRODUCTION: Synovial sarcoma makes up 8-10% of all soft tissue sarcomas, and constitutes 3-10% of all sarcomas occurring in the head and neck region. It shows male predominance (3:2), and the mean age of presentation is 30 years. CASE REPORT: A 51-year-old gentleman presented with right-sided neck swelling which had been progressively increasing in size for the past 2 years. A computed tomography (CT) scan revealed a large heterogeneously enhancing mass on the right side of the neck measuring 7.5 × 6.2 cm. Biopsy of an enlarged node revealed papillary thyroid carcinoma. The patient subsequently underwent total thyroidectomy with right neck dissection. Final histopathology revealed a papillary carcinoma of the thyroid, and the right-sided mass was shown to be monophasic synovial sarcoma. CONCLUSION: We present a case of a concurrent pathology of neck papillary thyroid carcinoma with monophasic synovial sarcoma. We experienced difficulty in diagnosis and misdirection due to raised C-reactive protein (CRP) levels, until final histopathology of the neck mas

Gradenigo\u27s syndrome: Surgical management in a child

Otits media is a common problem. Some of its complications that were seen frequently in the preantibiotic era are rare today. We report a case of an 8 year boy who presented with earache, retro-orbital pain and diplopia secondary to a sixth nerve palsy--Gradenigo\u27s syndrome. In this syndrome infection from the middle ear spreads medially to the petrous apex of the temporal bone. Work-up includes CT scan of the temporal bones. Timely management with intravenous antibiotics (+ surgery) is needed to prevent intra-cranial complications

Calcifying fibrous pseudotumour of maxilla: A rare entity mimicking malignancy: A case report

Occurrence of inflammatory pseudotumour in head and neck region or nose and paranasal sinuses is rare. However, when they do occur, they could be quite aggressive. Etiologically, they are believed to be reactive than neoplastic, and calcification may suggest end-stage. Their clinical presentation and radiologic features may resemble a malignancy. Grossly, they are not encapsulated, but multilobulated and can be circumscribed or infiltrative. Histologically, they constitute of bland spindle cells with scant cytoplasm and occasional mitotic figures. Scattered lymphocytic and plasma cell infiltrates with abundant dense hyalinized collagenous stroma and focal small calcifications are seen. Presence of atypia, DNA aneuploidy, and abnormal p53 expression may suggest malignant potential. Though not known to metastasize, they can lead to local complications, causing destruction of bone and surrounding tissues. Management is mainly by surgical excision though adjunct corticosteroids have been advocated. We report such a rare case of calcifying fibrous pseudotumour of maxilla

Factors associated with recurrent nasal polyps: a tertiary care experience

OBJECTIVE: To assess the factors associated with recurrence of nasal polyps in operated patients by endoscopic surgery. METHODS: A retrospective study was conducted on 192 patients operated for nasal polyps in a hospital set-up between 2001 and 2007. The median follow-up period was 24 months (range 12 months to 60 months). Ten variables were analyzed to study their association with polyp recurrence namely; age, gender, history of purulent nasal discharge, facial pain, anosmia, post nasal dripping (PND), headache, nasal allergy, asthma and computed tomography (C.T) staging. Analysis of recurrences was accomplished using independent sample t-test, chi-square and Fishers exact test. A probability value of p \u3c 0.05 was selected as the level of significance. RESULTS: During the study period, recurrences developed in 36 patients, with a rate of 19%. No association of recurrence with age, gender, purulent nasal discharge, facial pain, anosmia, post nasal dripping, headache, nasal allergy, and asthma were observed. The C.T staging was significantly higher among the group with recurrence as compared to the group without recurrence (p \u3c 0.001). CONCLUSION: Patients presenting with extensive disease suggested by C.T scan staging are at higher risk for the development of recurrences after endonasal surgery for nasal polyps

Frequency, Indications And Complications Of Pulmonary Artery Catheter Insertion In Adult Open-Heart Surgery Patients Of A Tertiary Care Hospital

Background: Patients presenting for cardiac surgery have unstable cardiovascular disease and haemodynamics with multiple coexisting diseases. Optimal monitoring in the perioperative period is very important for best perioperative outcome. The introduction of the flow-directed pulmonary artery catheter (PAC) into clinical practice is one of the most important and popular advances in the field of cardiac anaesthesia. The objective of the study was to determine the frequency, indications and complications of pulmonary artery catheter insertion in adult open-heart surgery patients.Methods: A Prospective observational study was conducted at cardiac operating rooms and Cardiac Intensive care unit (CICU) of Aga Khan University Hospital for a period of six months from Nov 2015 to April 2016.Two hundred and seven patients were included in this study. PAC was inserted through right/left internal jugular vein or subclavian vein. Complications noted were arrhythmias (atrial and ventricular), right bundle branch block, coiling and knotting, pulmonary artery rupture, and infection up to 72 hours of PAC insertion. Frequency and percentage were computed for gender, comorbids (Hypertension, Diabetes, Chronic kidney disease, Chronic Obstructive Pulmonary Disease) and PAC frequency of insertion, indications and complications were noted.Results: The frequency of PAC insertion was 47.83%. Major indications for PAC insertion were poor left ventricular function, acute coronary syndrome, cardiogenic shock, significant left main disease and valvular heart disease patients. Minor complications were found in 23.22% cases, which included arrhythmia in 19.2% cases and coiling in 4.02%.CONCLUSIONS: TPulmonary artery catheter insertion is a safe technique with useful clinical application in the management of high-risk cardiac surgical patients. The PAC insertion rationale must be standardized to confirm the judicious use