Non recurrent laryngeal nerve with right aberrant subclavian artery in recurrent case of papillary carcinoma of thyroid: an interesting clinical entity.

Background/objectives: A nonrecurrent laryngeal nerve is a rare anatomical variant and a routine preoperative imaging studies are not indicated. NRLN is related with absence of the brachiocephalic trunk and aberrant (mainly retroesophageal) course of theright subclavian artery which is evident on contrast enhanced CT scan of the chest.Case report: The patient presented with a swelling in the neck for 4 months which is slowly increasing in size. Patient gives history of a surgery done in the neck with an old midlinesuprasternal scar which was done 40 years earlier.laryngoscopic mirror examinartion was normal with moving vocal cords. Rest of the oral and oropharyngeal examination along with completeblood picture and biochemical investigations were normal. The patient was not a known diabetic or hypertensive.Conclusion: Accurate knowledge of frequent variations of the nerve along with the non recurrent variant reduces the risk of intraoperative injury. A nonrecurrent laryngealnerve(NRLN) is a rare anatomical variant and a routine preoperative imaging studies are not indicated. NRLN is related with absence of the brachiocephalic trunk and aberrant(mainly retroesophageal) course of the right subclavian artery which is evident on contrast enhanced CT scan of the chest.

Need of optical aids for schools for blind students in Pune and Nasik districts and compliance of their use

Purpose: To assess the need for spectacles and low-vision aids (LVA) in students attending schools for the blind and study their compliance with use. Methods: Comprehensive ocular evaluation was performed using a hand-held slit lamp and ophthalmoscope. Vision acuity was measured using a logarithm of the minimum angle of resolution (logMAR) chart for distance, as well as for near. Spectacles and LVAs were dispensed after refraction and LVA trial. Follow-up was performed to assess the vision using the LV Prasad Functional Vision Questionnaire (LVP-FVQ) along with compliance with use after 6 months. Results: Of the 456 students examined from six schools, 188 (41.2%) were female; 147 (32.2%) were <10 years of age. In all, 362 (79.4%) were blind since birth. The students dispensed only LVAs were 25 (5.5%), only spectacles were 55 (12.1%), and both spectacle and LVAs were 10 (2.2%). The vision improved using LVAs in 26 (5.7%) and using spectacles in 64 (9.6%). There was a significant improvement in LVP-FVQ scores (P < 0.001). Also, 68/90 students were available for follow-up, of whom 43 (63.2%) were compliant to use. Causes of not wearing spectacles or LVA in 25 were left somewhere or lost 13 (52%), broken 3 (12%), uncomfortable to use 6 (24%), not interested to use 2 (8%), and got operated 1 (4%). Conclusion: Although the dispensing of LVA and spectacles improved the visual acuity and vision function of 90/456 (19.7%) students, nearly a third were not using them after 6 months. Efforts need to be taken to improve the compliance of use