Schwannomas of Ear, Nose, Throat and Neck

Schwannoma is a benign tumour of nerve sheath origin with latent malignant potential. All cranial nerves can give rise to schwannoma except for olfactory and optic nerves, which are devoid of Schwann cell. Schwanommas are usually asymptomatic and present late owing to compression of nerve of origin. We present our study of 19 cases of schwannoma arising from unusual sites in head and neck, having varied presentation and the challenges faced in management of these cases. These cases presented in detail to the department of Ear, Nose and Throat, KEM Hospital, and were thoroughly evaluated clinically and radiologically to formulate a management strategy. Schwannoma of the head and neck is a rare entity but should be considered as differential diagnosis in unilateral nasal mass cases, palatal masses, anterior and lateral neck masses. Nerve of origin may not always be clear preoperatively but the possibility of postoperative loss of nerve function should be kept in mind. Radiological investigations like computed tomography scan and magnetic resonance imaging play a pivotal role in management. In case of nonvascular neck tumours, fine needle aspiration cytology is crucial but has low accuracy in the diagnosis of neural tumors. Histopathology of excised tumour remains the gold standard in diagnosis

Sewing Needle Migrating from Esophagus into Prevertebral Space: A Challenging Case

Oesophageal foreign body presents as a medical emergency and requires immediate evaluation and treatment. We are reporting a rare case of sewing needle in esophagus migrating into the prevertebral space at thoracic inlet level. A 13-year-old mentally retarded female child was brought in emergency at midnight with complaint of accidental ingestion of sewing needle with the thread. Patient was posted for rigid esophagoscopy under general anaesthesia, no needle could be visualised and only thread of the sewing needle was removed. So patient was taken up for neck exploration along with gastroenterologists. Further careful dissection confirmed the needle in the pre vertebral space, which was removed successfully with artery forceps. Patient was given IV antibiotics for 10 days. Patient had an uneventful recovery and was discharged after 10 days. Pointed metallic slender foreign bodies can perforate and migrate very fast in the neck or chest and can lead to morbidity and mortality. Multidisciplinary approach offers a great advantage in surgical planning and proper patient management

Effects of Altered Maternal Folic Acid, Vitamin B 12 and Docosahexaenoic Acid on Placental Global DNA Methylation Patterns in Wistar Rats

Potential adverse effects of excess maternal folic acid supplementation on a vegetarian population deficient in vitamin B 12 are poorly understood. We have previously shown in a rat model that maternal folic acid supplementation at marginal protein levels reduces brain omega-3 fatty acid levels in the adult offspring. We have also reported that reduced docosahexaenoic acid (DHA) levels may result in diversion of methyl groups towards DNA in the one carbon metabolic pathway ultimately resulting in DNA methylation. This study was designed to examine the effect of normal and excess folic acid in the absence and presence of vitamin B12 deficiency on global methylation patterns in the placenta. Further, the effect of maternal omega 3 fatty acid supplementation on the above vitamin B12 deficient diets was also examined. Our results suggest maternal folic acid supplementation in the absence of vitamin B 12 lowers plasma and placental DHA levels (p,0.05) and reduces global DNA methylation levels (p,0.05). When this group was supplemented with omega 3 fatty acids there was an increase in placental DHA levels and subsequently DNA methylation levels revert back to the levels of the control group. Our results suggest for the first time that DHA plays an important role in one carbon metabolism thereb

Percent global DNA methylation in Wistar rat placenta.

<p>*p<0.05 when compared to control (Normal folate, normal B₁₂); ^† p<0.05 when compared to NFBD (Normal folate, B₁₂ deficient); ^‡p<0.05 when compared to EFBD (Excess folate, B₁₂ deficient), NFBDO: normal folate, B₁₂ deficient, omega 3 supplemented, EFB: Excess folate, normal B₁₂ ; EFBDO: Excess folate, B₁₂ deficient, omega 3 supplemented.</p

Dam plasma folate, vitamin B₁₂ and homocysteine levels.

<p>**<i>P</i><0.01 when compared to control;</p>†<p><i>P</i><0.05, </p>††<p><i>P</i><0.01 when compared to NFBD;</p>‡<p><i>P</i><0.05, </p>‡‡<p><i>P</i><0.01 when compared to EFB;</p>§§<p><i>P</i><0.01 when compared to EFBD.</p><p>AA: Arachidonic acid; Control: Normal folate, normal B₁₂, NFBD: normal folate, B₁₂ deficient, NFBDO: normal folate, B₁₂ deficient, omega 3 supplemented, EFB: Excess folate, normal B₁₂, EFBD: Excess folate, B₁₂ deficient, EFBDO: Excess folate, B₁₂ deficient, omega 3 supplemented.</p

One-Carbon Cycle: Interactions of folic acid, vitamin B₁₂ and DHA.

<p>THF- tetrahydrofolate; 5, 10-MTHF- 5, 10-methylenetetrahydrofolate; 5-MTHF- 5-methyltetrahydrofolate; MTHFR- methylenetetrahydrofolate reductase; MS- methionone synthase; SAH- S-adenosylhomocysteine; SAM- S-adenosylmethionine; DHA-docosahexanoic acid; PE-DHA- phosphatidylethanolamine-DHA; PC-DHA-phosphatidylcholine-DHA; PEMT- phosphatidylethanolamine-N-methyltransferase; DNMT- DNA methyltransferase; HMT- Histone methyltransferase; ↓- reduced; ↑↑-increased.</p

Composition of the diets.

<p>*<b>Mineral mixture (g/kg mixture):</b>Calcium carbonate, 357; Potassium Phosphate, 196; Potassium Citrate, 70.78; Sodium Chloride, 78; Potassium Sulphate, 46.6; Magnesium Oxide, 24; Ferric Citrate, 6.06; Zinc Carbonate, 1.65; Manganous Carbonate, 0.63; Cupric Carbonate, 0.3; Potassium Iodate, 0.01; Sodium Selenate, 0.01; Ammonium Paramolybdate, 0.007; Sodium Metasilicate, 1.45; Chromium Potassium Sulphate, 0.275; Lithium Chloride, 0.01; Boric Acid, 0.08; Sodium Fluoride, 0.06; Nickel Carbonate, 0.03; Ammonium Vanadate, 0.006; Sucrose, 221.02.</p>†<p><b>Vitamin mixture (g/kg mixture):</b>Nicotinic Acid, 3; Calcium Pantothenate, 1.6; Pyridoxine-HCl, 0.7; Thiamin –HCl, 0.6; Riboflavin, 0.6; D-Biotin, 0.02; Vitamin B₁₂ (in 0.1% Mannitol), 2.5;Vitamin E, 15;Vitamin A, 0.8; Vitamin D-3, 0.25;Vitamin K, 0.075;Folic acid, 0.2 (control) and Sucrose 974.655, was used to make total weight of the vitamin mixture to 1 kg.</p><p>Control: Normal folate, normal B12, NFBD: normal folate, B12 deficient, NFBDO: normal folate, B12 deficient, omega 3 supplemented, EFB: Excess folate, normal B12, EFBD: Excess folate, B12 deficient, EFBDO: Excess folate, B12 deficient, omega 3 supplemented.</p