Prostate cancer metastasis to cervical node chain-an unusual clinic-pathological finding

Prostate carcinoma is one of the most common cancers in males all around the world. Head and neck squamous cell carcinoma is amongst the leading carcinoma (HNSCC) in men especially in the sub-continent. There are around 150 lymph nodes on either side in the neck and cervical lymph nodes are a common site for head and neck malignancies to metastasize however carcinoma of prostate may in rare cases metastasize to cervical chain, therefore warranting a neck dissection. In case of unknown primary of head and neck extensive work up is required to find the primary site. Our case provided a similar picture with a single enlarged node which on biopsy to our surprise revealed adenocarcinoma of prostate

Ewing sarcoma of larynx: A rare case in a 5-year-old boy

Ewing Sarcoma of the head and neck region is an extremely rare entity. Treatment usually involves surgery, chemotherapy and radiotherapy in varying sequences. We present the third case to date of Ewing sarcoma of the larynx in a paediatric population. A 5-year-old boy presented to emergency room with acute respiratory distress. Computerized tomography scan showed a mass in the supraglottis; he was intubated using videolaryngoscope and tracheostomy was avoided, mass was removed by cold dissection. Final histopathologic examination revealed Ewing sarcoma. Further workup showed no systemic metastasis. Patient was advised adjuvant therapy which the family refused. Currently he is doing fine on 2 years of follow-up

Recurrent Dermatofibrosarcoma Protuberans of the Parotid: A case report and review of literature

In 1924, Darier and Ferrand described Dermatofibrosarcoma Protuberans as a progressive and recurring dermatofibroma. It is a locally aggressive sarcoma originating from dermal and subdermal tissue of the skin. It usually begins as a small plaque that grows over a period and later manifests as multiple small subcutaneous nodules. It is more commonly found in females as compared to males and typically occurs in between 2nd and 5th decades of life. Most frequently involved regions of the body are torso and proximal ends of extremities and very rarely head and neck region is the site of involvement. The mainstay of treatment of this entity is surgery. The rate of recurrence of this disease is very high in about 50% of the cases and it may also express rare distant metastasis. It is a radiosensitive tumour and radiation may play a role in reducing risk of recurrence. We present a case of a 35 years old male with recurrent Dermatofibrosarcoma Protuberans of right parotid gland

Level I nodal positivity as a factor for involvement of the submandibular gland in oral cavity carcinoma: A case series report

Introduction: The routine practice of neck dissection in the surgical management of oral carcinoma has evolved into a more functionally conservative approach. Over time, the rationale for removal of the submandibular gland has been questioned. Routine extirpation of the submandibular gland can aggravate the xerostomia experienced by many patients, significantly affecting their quality of life. Objective: The objective of the present study was to determine the incidence of submandibular gland metastases in oral cavity carcinoma and to identify possible factors that may affect their involvement. Methods: A total of 149 cases of oral carcinoma presenting at a private tertiary care hospital in Karachi, Pakistan, over the course of 1 year were reviewed retrospectively. Results: Histopathological data showed that the submandibular gland was involved in 7 (4.7%) cases. Involvement of level I lymph nodes was found in all of the cases. Direct extension of primary tumor was noted in two cases when the primary tumor was in the floor of the mouth. Conclusion: The results suggest that preservation of the submandibular gland during neck dissection for oral carcinoma can be practiced safely when there is no evidence of direct extension of the primary tumor toward the submandibular gland or when there is no clinical or radiological evidence of neck disease in level I. Presence of pathological lymph nodes in level I requires caution when contemplating preservation of the submandibular gland

Use of endoscope in teaching of otolaryngology residents about site and size of tympanic membrane perforation and its impact on degree of hearing loss in adult patients: A cross sectional study

Objective: To determine the association between site and size of perforation of the tympanic membrane and the level of conductive hearing.Methods: The cross-sectional study was conducted from November 2015 to October 2016 at Aga Khan University Hospital Karachi and comprised patients with tympanic membrane perforation without any other middle-ear disease. Karl-Storz Rigid Endoscope attached to a camera was used to take pictures of the tympanic membrane. Site of the perforation was determined using a vertical line to divide the membrane into two anterior and posterior halves. Size of the perforation was calculated as a percentage of the total membrane using Image J software. Data analysis was done using Stata 12.Results: Of the 55 patients, 29(53%) were males and 26(47%) were females. The overall mean age was 33+/-15 years. With every 5% increase in the size of perforation, the hearing loss increased by 1 decibel. A difference of 5.5 decibels was noted between anterior and posterior perforations of similar size.Conclusion: Hearing loss increased with increase in the size of perforation

Prevalence of allergic fungal sinusitis among patients with nasal polyposis

Objective: To determine the frequency of allergic fungal sinusitis among patients with nasal polyps, and to compare Lund-Mackay scores of patients with and without allergic fungal sinusitis.Methods: The cross-sectional longitudinal study was conducted at a tertiary healthcare centre in Karachi, Pakistan, from December 2016 to November 2018, and comprised patients with sinonasal polyposis undergoing surgery. The patients were categorised as having allergic fungal sinusitis when histopathology showed allergic mucin with fungal hyphae and culture was positive for fungal growth. Lund-Mackay scoring of each patient was noted and mean scores of allergic fungal sinusitis and non-allergic fungal sinusitis patients were compared. Data was analysed using SPSS 25.Results: Of the 114 patients, 61(53.5%) were males. The overall mean age was 37.3±15.3 years. Of the total, 27(23.7%) patients had allergic fungal sinusitis. There was a significant relationship between asthma and allergic fungal sinusitis (p=0.03). The mean Lund-Mackay score was significantly higher for allergic fungal sinusitis patients (p\u3c0.01). Recurrence was seen in 11(9.6%) cases.Conclusions: About one-fourth of patients with nasal polyps had allergic fungal sinusitis, and such patients showed significantly high mean Lund-Mackay score

Training in temporal bone surgery: A review of current practices

The temporal bone consists of complex anatomy, and the presence of various vital structures in close proximity makes the surgery of temporal bone highly challenging. Such a surgery requires years of training under the direct observation of trainers. Over the course of history, different training models have been adopted by experts to help train the young surgeons in this complex procedure. Cadaveric dissections of the temporal bone remains the gold standard in training of residents as the cadavers present the actual anatomical details which the surgeons encounter while operating on patients. However, due to scarcity of available cadavers, their one-time-only usage and high cost of involved in such trainings, experts have developed newer techniques of training, including three-dimensional reconstruction models and virtual reality simulators. Most of the literature on simulation in training of residents focuses on anatomical understanding and development of the surgical technique. There has been significant improvement in these techniques over time. With the addition of haptic feedback in the newer virtual simulation models, simulation has edged closer to basic modules of temporal bone dissection. the current review article was planned to have an overview of the different techniques in detail that are currently being in used

Management of laryngotracheal trauma: A review of current trends and future directions

Laryngotracheal trauma is rare but can pose serious threats to one\u27s life. Presenting symptoms vary according to the severity of injury. Immediate Airway control is first step in the management, intubation should be considered by a senior member of the trauma team if the injury is minor while tracheostomy should be reserved for more severe injuries. Evaluation by a fibre-optic laryngoscopy and CT scan should be done whenever possible. Reconstruction is done according to the site involved using suture, titanium miniplates and stents. Tissue engineering has added a new horizon in this management but up till now complete laryngotracheal regeneration is very far-fetched, but tissue regeneration at individual sites have shown some positive results. More work needs to be done in this less explored field including laryngeal transplantation

How Functional and Emotional Ads Drive Smartphone Adoption: A Study of University Students of Pakistan

The purpose of this study is to examine the advertising strategies and know that how the functional and emotional ads drive smartphone adoption how they capture the attention of audience and fulfill their demands by ads. Advertising play important role in decision making. Firms use emotional ads to hit positive emotions about products it help us to know that how functional and emotional ads help in awaking the person's adoption feeling. The study investigates the influence of emotional and functional ads on indiviuals purchasing behavior that how many people change their purchasing towards smartphones. We use quantitative approach in this study. This research is survey based and we done collection of data through questionnaire. All the data accumulated through questionnaires are transferred into numerical form through SPSS (statistical package for the social science) and PLS (partial least square) it accepts the numerical variable. we collected the data of 509 respondents. The purpose of this study is to identify that what are the variables which effects so they have to be a simple and make a good and functional ad which attract the audience. Another one is also showing significant relationship between emotional advertising and expected enjoyment they have to make a benefits and facilities which their product give they have to see their competitors that what they are doing and comeup with something new to encourage the customers they have to connect people by showing emotional images. Moreover, another significant relationship is There is significant relationship between attitude towards using and adoption intention now my suggestion that to increase adoption intention they have to fulfill all the needs of their customers It is also recommended that research should also be done by using different variables It is also recommended that research should also be done in offices and take the employees perception

How Functional and Emotional Ads Drive Smartphone Adoption: A Study of University Students of Pakistan

The purpose of this study is to examine the advertising strategies and know that how the functional and emotional ads drive smartphone adoption how they capture the attention of audience and fulfill their demands by ads. Advertising play important role in decision making. Firms use emotional ads to hit positive emotions about products it help us to know that how functional and emotional ads help in awaking the person's adoption feeling. The study investigates the influence of emotional and functional ads on indiviuals purchasing behavior that how many people change their purchasing towards smartphones. We use quantitative approach in this study. This research is survey based and we done collection of data through questionnaire. All the data accumulated through questionnaires are transferred into numerical form through SPSS (statistical package for the social science) and PLS (partial least square) it accepts the numerical variable. we collected the data of 509 respondents. The purpose of this study is to identify that what are the variables which effects so they have to be a simple and make a good and functional ad which attract the audience. Another one is also showing significant relationship between emotional advertising and expected enjoyment they have to make a benefits and facilities which their product give they have to see their competitors that what they are doing and comeup with something new to encourage the customers they have to connect people by showing emotional images. Moreover, another significant relationship is There is significant relationship between attitude towards using and adoption intention now my suggestion that to increase adoption intention they have to fulfill all the needs of their customers It is also recommended that research should also be done by using different variables It is also recommended that research should also be done in offices and take the employees perception