SPINDLE CELL CARCINOMA OF LARYNX- A DISTINCT CLINICOPATHOLOGICAL AND HISTOLOGICAL ENTITY

Spindle cell carcinoma (SpCC) is a variant of squamous cell carcinoma with biphasic components and more aggressive behaviour. Its rarity and histopathological pattern pose a diagnostic challenge. Early diagnosis and treatment result in a decrease in local and distant metastasis. Case 1 is a 71-year-old female presented with hoarseness of voice and dyspnoea for 2 years without any risk factors. Fibre-optic laryngoscopy (FOL) revealed smooth polyp hanging from anterior two-third of the left vocal cord. Microlaryngoscopic excision revealed SpCC followed by post-operative radiotherapy and is currentlyalive. Case 2 is a 72-year-old male presented with worsening stridor for 2 years post-excision of laryngeal nodule and history of smoking and hookah use for >20 years. He developed dysphonia after a few months with fixed hard level 3 nodes at the right side. FOL showed a polypoid mass extending from the left vocal cord into the supraglottis. Fine-needle aspiration cytology of the neck swelling confirmed the diagnosis of SpCC. Computerised tomography (CT) chest/abdomen showed distant metastasis. Palliative radiotherapy was given, but the patient died after 3 months due to locoregional failure. Case 3 is a 35-year-old male presented with a history of hoarseness for 3 years with no risk factors. FOL showed a 1.2-cm polypoid growth on the right vocal cord. Total laryngectomy was performed and histopathology showed SpCC. Radiotherapy was given and the patient is alive without disease with regular follow-ups. Smoking and alcohol are thought to be the contributing factors causing this disease. Biphasic nature of the tumour requires pathological sampling for diagnostic confirmation. Surgery combined with radiotherapy has a better survival outcome. SpCC is a rare tumour with a tendency for locoregionalrecurrence. Surgery should remain the mainstay of treatment followed by post-operative radiotherapy for a better control.Key words: Larynx, radiotherapy, spindle cell carcinom

Laser treatment of laryngeal papillomatosis in a young child: anaesthetic and surgical management

Abstract The authors report the case of a 4-year boy who required anaesthetic and surgical care during LASER excision of laryngeal papillomatosis. He presented with hoarseness and stridor and underwent emergency tracheostomy after confirmation of laryngeal papillomas on CT scan. He required LASER treatment under general anaesthesia with a requirement of paediatric LASER-safe endotracheal tube but unfortunately, this was not available in the country. Balanced anaesthesia technique using inhalational anaesthetic, muscle relaxant and narcotic is used with modifications. After three successful surgical sessions, the airway became patent and tracheostomy was de-cannulated. The perioperative issues surrounding this process are discussed including anaesthetic induction in the patient with a compromised airway, maintenance anaesthetic techniques, methods used for ventilation during LASER surgery of the upper airway, surgical implications and hazards of LASER to the operating room personnel

Choices to Decrease Cooling Tower Water Wastage in Fertilizer Plants (Lagging KPIs)

Water recognizes our planet gap with all the others we think about. There are numerous districts where our freshwater assets are lacking to meet natural needs and thus we all associated with inquire about discover approaches to evacuate these imperatives. We face various difficulties in doing that, particularly since 1965, the paper Water reserve Exploration has assumed a significant profession in revealing and scattering existing study. This paper recognizes the issues confronting water today and future research expected to more readily advise the individuals who endeavor to make a progressively manageable and attractive future. In fertilizer lagging key performance indicators at cooling tower water wastages addressed by experimentally to overcome the evaporation, blow-down and make-up water losses from maximum (576 ) to minimum 288 level to promote environment sustainability

Some Remarks on Results Related to ∇-Convex Function

In the present article, we give new techniques for proving general identities of the Popoviciu type for discrete cases of sums for two dimensions using higher-order ∇-divided difference. Also, integral cases are deduced by different methods for differentiable functions of higher-order for two variables. These identities are a generalization of various previously established results. An application for the mean value theorem is also presented

Grading complication following radical cystectomy and ileal conduit for bladder cancer using clavien grading system

Objective: To determine the 30-day complication rate of radical cystectomy and urinary diversion using a validated system.Study Design: An analytical descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 1990 to 2010.Methodology: Patients who had undergone ileal conduit (IC) formation, following radical cystectomy (RC) for muscle invasive transitional cell carcinoma, were studied, using a prospectively maintained data base. Basic details were determined, complications were noted and graded according to the modified Clavien grading system (CG). Results were presented using descriptive statistics. Results: Of all the RC performed at this hospital 89 patients received IC. Of them 75 were male and 14 female. Mean age was 60 years. Mean duration of hospital stay was 14 days. Ten patients each received pre-operative chemotherapy and radiotherapy, respectively. Mean duration of surgery was 8.2 hours, with mean estimated blood loss of 1334 ml. Preoperative radiotherapy was associated with more complications. No other factor like ASA, co-morbidities, blood loss or duration of stay influenced the complications. Fifty patients (56.2%) did not have any complications. Most common complication of wound infection was seen in 7 patients (CG-2), followed by uretero-ileal leakage in 5, requiring percutaneous intervention under local anaesthesia (GC-3a). Mortality rate was 4.5%, classified as CG-V. Conclusion: Radical cystectomy with Ileal conduit is a major procedure with a good safety profile at this institute. Longterm follow up is still needed to evaluate delayed complications and quality of life

A comprehensive review on role of phytochemicals in human health

Phytochemicals are plant extracts that are widely used due to their ability to provide health benefits and their therapeutic activity against several disorders. They are also called phytonutrients as they are not really the part of our diet but have several positive effects on ourhealth. They are found to decrease the risk factor of cardiovascular disorders and coronary heart disorders. It has also been found that phytochemicals diminish the risk ratio of several types of cancers including breast, colon and skin cancers. This article revolves around taking carotenoids, chlorophyll and fibers as examples of phytonutrients to evaluate their beneficial role in several diseases. These phytochemicals have been found to be associated with antioxidant activity, retinol activity, cell signaling, improvement of glycemic control, protection against high blood pressure, facilitation in defecation and anti-cancerous activity

Topical nanoemulsion of turmeric oil for psoriasis: characterization, ex vivo and in vivo assessment

Psoriasis is a chronic; T lymphocyte mediated autoimmune inflammatory disorder characterized by well-defined erythematous (reddish) plaques with large adherent silvery scales that affects the skin and other parts of the body. The essential oil in turmeric is anti-inflammatory and effective in treating chronic disorders like psoriasis that have inflammation as a root symptom. Nanoemulsions are isotropic, thermodynamically stable transparent (or translucent) systems of oil, water, surfactant and co-surfactant with a droplet size usually in the range of 20–200 nm. Their long-term stability and ease of preparation (spontaneous emulsification) make it promising tool for drug delivery. The aim of this study was to obtain nanoemulsions of turmeric oil for psoriasis and to evaluate their physical stability, irritation potential and in vivo inflammatory activity. For the preparation of nanoemulsion titration method was used which was composed of 15% turmeric oil, 42 % Smix (1:1) and 43 % distilled water. The nanoemulsion was stable during the period of study and was found to be practically non-irritating in the organotypic HET-CAM model. The anti inflammatory activity of optimized nonoemulsion was carried out by carragennen induced paw edema and found to be 70.35 % inhibition

Vivax malaria and chloroquine resistance: a neglected disease as an emerging threat

In Pakistan, Plasmodium vivax contributes to major malaria burden. In this case, a pregnant woman presented with P. vivax infection and which was not cleared by chloroquine, despite adequate treatment. This is probably the first confirmed case of chloroquine-resistant vivax from Pakistan, where severe malaria due to P. vivax is already an emerging problem

Spontaneous Coronary Artery Dissection: A Case Series of 9 Patients With Literature Review.

Spontaneous coronary artery dissection is an increasingly recognized nonatherosclerotic cause of acute coronary syndrome. Reports regarding the prognosis and natural history of this disease are limited. In addition to the diagnostic difficulty, this condition poses a significant therapeutic challenge due to the lack of specific management guidelines. We present here a case series of 9 patients with spontaneous coronary artery dissection. Additionally, this article reviews the incidence, clinical characteristics, risk factors, diagnostic modalities, therapeutic approaches, and patterns of recurrence in patients with spontaneous coronary artery dissection