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

Diagnostic value of fine needle aspiration cytology in parotid tumors

Objective: To evaluate the usefulness and accuracy of fine needle aspiration cytology in the diagnosis of parotid gland tumors.Methods: We reviewed files of all patients who underwent parotidectomy for various parotid pathologies at Aga Khan University Hospital. Study design included a comparison between results of preoperative FNAC with final histopathological diagnosis. Galen & Ganbino method was used to calculate sensitivity and specificity of FNAC.Results: Among 50 patients reviewed, there was one false positive and 3 false negative results reported on FNAC. This gives a sensitivity of FNAC for reporting malignancy to be 74% and specificity to rule out malignancy 97%. No significant complications were reported while performing the procedure.CONCLUSION: FNAC is a safe and effective modality in diagnosis and treatment planning of patients with parotid tumors

Usage of Subscribed & Open Access Information Resources by LIS Research Scholars

Objectives of this study were to investigate the usage of subscribed and open access resources, preferences, level of awareness, reasons to utilize subscribed & open access information resources, and problems being faced while using the information resources by Library and Information Science (LIS) research scholars. Quantitative method followed by survey research design was used to conduct this study. Self-administered questionnaire validated by field experts was used to gather the data from the participants. The population of this study was postgraduate LIS research scholars from Punjab, who were enrolled in M. Phil. (2015-2017) and Ph. D. (2015-2018) programs. The survey was administrated personally. The data was gathered from 78 research scholars of Library and Information Science from the five LIS schools in Punjab. The data were analyzed through Statistical Package for Social Sciences (SPSS) Software. This study found that LIS participants preferred both resources like, subscribed and open access resources. The use of subscribed resources by Library and Information Science research scholars was preferred to open access resources for finding the articles and accessible anywhere of the world. There is a tendency among the researchers that due to lack of awareness, limited knowledge about existing research facilities, they do not fully utilize open access resources for their research and the database developed by the institution(s). A bunch of scholars does not aware of open access resources and due to this their utilization of this facility is quite low. Most of the libraries and the organization(s) do not have the facility and resources to have access to “subscribed electronic resources” due to heavy cost. Present study concludes that the LIS scholars prefer to use open access resources because of free availability on internet as compared to subscribed resources. Subscribed resources have a limited access only within the campus

Obesity and high risk pathological features of papillary thyroid carcinoma: A retrospective analysis of a university hospital in Pakistan

BACKGROUND: Incidence of papillary thyroid carcinoma (PTC) and the frequency of obesity is increasing globally. In literature, relationship between excessive body weight and bad prognostic features of PTC is still debatable. In this study, we aimed to explore the association of obesity with high risk pathological features of PTC in a population treated by total thyroidectomy +/- neck dissection. MATERIALS AND METHODS: Retrospective analysis of patients at Aga Khan University Hospital from January 2013 to December 2014, who underwent total thyroidectomy +/- neck dissection due to PTC. Patients were grouped according to World Health Organization (WHO) classification of BMI. They were categorized into two groups, i.e. normal (BMI= 18.5 - 24.9 kg/m2) and obese (BMI = 30 kg/m2) as none of our patients lie in underweight and overweight category. Pathological features i.e. T-stage, multifocality, bilaterality, extrathyroidal extension, vascular invasion and N-stage were assessed. All tumors were staged according to TNM staging system proposed by 2010 American Joint Committee on Cancer (AJCC). Odds ratio (OR) with 95% confidence interval was used to examine the association between BMI ∧ pathological characteristics of PTC. RESULTS: A total of 53 patients were treated for PTC in two-years period. There were 38 female and 15 male patients. Twenty-eight patients had BMI in normal while twenty-five in obese category. Patients who were in obese category had a significantly greater risk of having a multifocal tumor (OR=5.55, p-value=0.02) and bilaterality (OR=6.54, p-value=0.01) compared to normal weight patients. No positive associations were identified between BMI and extrathyroidal extension, high T-stage, vascular invasion and N-stage. CONCLUSION: Obesity is not associated with high risk pathological features such as extrathyroidal extention, high T-stage, vascular invasion and N-stage in PTC. Although it has been correlated with multifocal and bilateral tumors in this retrospective study, the presence of these factors alone is not adequate to support the association conclusively

Aggressive embryonal rhabdomyosarcoma presenting as schwanoma : a case report

Rhabdomyosarcomas (RMS) are thought to arise from pluripotent muscle cell precursors intended to form the bodyís future striated muscle. Due to the wide distribution of striated muscle across the body these tumors may appear anywhere and cause symptoms accordingly. Presenting symptoms are highly variable and based on the tumor size and location making clinical diagnosis difficult. The diagnosis of RMS is based on histological examination; however they express varying cytologic pictures representing the different stages of rhabdomyoblasts and their development into skeletal muscle presenting pictures from highly to poorly differentiated neoplasms. Therefore their histological diagnosis also requires the use of specialized stains and complex staining procedures which may not be available at peripheral centers. Here we would like to present a highly aggressive embryonal rhabdomyosarcoma of the maxilla, presenting as a schwanoma on initial histopathology

Angioembolization in itractable epistaxis—a tertiary care experience

Objective: To review the role of angioembolization in the control of intractable epistaxis at our institution. Methods: A retrospective review of the charts of the patients between Jan 2001 to June 2010 at Aga Khan University Hospital, Karachi was done. All patients who underwent angioembolization for intractable epistaxis were included in the study. Patients with nasal or nasopharyngeal mass were excluded. Data was analyzed by using SPSS version 16. Results: Total numbers of the patients were 16. Fourteen (87.5%) patients were male and 2(12.5%) were female with mean age 51.2 ± 12.922 years (range 26-71 years). In 11(68.75%) patients there were no associated risk factors for epistaxis, 3(18.75%) patients had uncontrolled hypertension, 1(6.25%) patient had road traffic accident and 1(6.25%) patient had bleeding after nasal surgery. All patients were initially treated by anterior and posterior nasal packing for 48 to 72 hours. Angioembolization successfully controlled epistaxis in all 16 (100%) patients initially. However, in 2(12.5%) cases embolization had to be repeated; in 1 patient on the same day and in another patient after one month of initial procedure. The average length of stay after angioembolization was 1.9 ± 0.854 days. No major or permanent complication was observed. Two (12.5%) patients developed minor complications (1 patient experienced facial pain for 7 days and another patient developed haematoma at the site of femoral artery). Conclusion: Angioembolization is a safe and effective treatment option for intractable epistaxi

Frequency of cervical nodal metastasis in early stage squamous cell carcinoma of the tongue

ntroduction Oral cavity carcinoma is an aggressive tumor, with the tongue being one of the most common subsites of involvement. Surgery is a gold standard method of dealing with advanced-stage tumors. However, for early-stage carcinomas of the tongue, the management remains controversial. Several studies have indicated that early-stage cancers have a high chance of occult cervical node metastasis, which, if left untreated, can greatly affect the prognosis. Certain parameters can help identify patients with occult cervical node metastases, and can avoid unnecessary neck dissection in node negative patients. Tumor thickness is one such objective parameter. Objective To estimate the frequency of cervical lymph node metastasis in patients with early-stage, node-negative (N0) squamous cell carcinoma of the tongue. Methods In-patient hospital data was reviewed from January 2013 until March 2014, and 78 patients who underwent primary resection of the tumor and neck dissection for biopsy-proven, early stage squamous cell carcinoma of the tongue were included. Data such as tumor thickness, tumor differentiation and presence of occult nodal metastasis in the surgical specimen were gathered from the histopathology reports. The frequency of subclinical cervical lymph node metastasis in patients with early-stage squamous cell carcinoma of the tongue was estimated. Results A total of 69% of the patients with tumor thicknesses \u3e 5 mm had tumor metastases in the neck nodes, while 100% of the patients with tumor thicknesses \u3c 5 mm had no neck nodal metastasis. Conclusion A tumor thickness \u3e 5 mm is significantly associated with subclinical metastasis, and prophylactic neck dissection is warranted in such cases

Emergency airway management of a patient with tracheal stenosis

We are presenting a case of a 26 year old healthy male, who came with gradual worsening of dyspnoea following prolonged intubation and ventilation, after a road traffic accident five months back. On arrival in ER, he was hypoxaemic with severe respiratory distress. He was transferred to the operation room (OR) for emergency tracheostomy. During the transfer, he was placed in an upright position with oxygen at 15 L/M. In the OR, anaesthesia was induced with sevoflurane gradually. Direct laryngoscopy was done which revealed normal vocal cords. A size 4.00 mm ID endotracheal tube was impossible to pass more than 1-2 cm distal to vocal cords. Due to a large leak, size 8 tube was passed below the cords and cuff was inflated slightly to reduce air leak. Oxygen saturation dropped to 95-96% and surgeon was asked to start tracheostomy. Findings included an almost complete subglottic stenosis, 2 cm below the vocal cords. A tracheostomy tube was inserted below the stenotic lesion which was followed by direct laryngoscopy

Two cases of primary laryngeal amyloidosis

The larynx is a rare site of involvement of amyloidosis. We report two cases of laryngeal amyloidosis. Both patients were middle aged females with history of persistent hoarseness. Fibreoptic laryngoscopy used for diagnosis in both and debulking of the tumour was performed. Histopathological examination confirmed the diagnosis of amyloidosis. Appropriate follow up is an important part of the long-term management of the disease

Health care professionals’ compliance to tracheal suctioning policy at a tertiary care hospital

Objective: To assess the compliance of tracheal suctioning practices against the standard guidelines of a tertiary care hospital, with regard to the participants’ professional characteristics.Methods: Using cross sectional study design, forty health care professionals (HCPs) were assessed twice, using a quantitative structured observational design, for tracheal suctioning practices, in one of the surgical care units of the tertiary care hospital. Tracheal suctioning policy which was used as a tool, its inter-rater reliability was tested and each step showed the Kappa value of 0.65 to 1.000. Data was analyzed using epidata info version 3.5.1 and SPSS version 19.Results: From a total of 80 observations, 30% showed compliance, 50% partial compliance whereas, 20% indicated non-compliance.Conclusion: The study results highlight the need for improving the overall compliance with the tracheal suctioning guidelines of evidence based practices to minimize the adverse effects and enhance patient safety related to tracheal suctioning practices. The current study also provides an opportunity to motivate the HCPs compliant in the practices of tracheal suctioning by appreciate their competence