Serum immunoglobulin E levels in patients with head and neck cancer

Serum immunoglobulin E levels were estimated in 50 patients with head and neck cancer and in 25 controls. Mean serum IgE value was significantly higher in patients with various sites of cancer in the head and neck region other than carcinoma of the tonsil. The levels increased with advancement in the stage of cancer. There was, however, no difference in mean serum IgE value with respect to the character of the lesion, to the histopathological type of growth or to radiotherapy. In patients with carcinoma of the tonsil, the mean serum IgE concentration was significantly lowered.     

Skeletal changes in Indian childhood cirrhosis

Thirty children with histopathological diagnosis of Indian childhood cirrhosis were studied for bone changes. Clinical diagnosis of ricket, based on skeletal deformities were made in seven cases. Radiological changes included osteoporosis in nine (30%) cases; osteoposis with healing or healed ricket in five (16·7%); and lines of arrested bone growth in ten (33·3%) cases. Mean serum calcium and phosphorus was low with increase in serum alkaline phosphate in cases of ricket complicating Indian childhood cirrhosis as compared to cases without ricket as well as normal controls. Biopsy from iliac creast inwelve cases, showed histopathological evidence of healing ricket in three cases.     

Anesthetic considerations in steroid-induced mediastinal lipomatosis

Mediastinal lipomatosis (ML) is a benign condition characterized by circumscribed overgrowth of adipose tissue producing mediastinal widening that can cause errors in diagnosis on chest roentgenogram. We describe a case of steroid-induced ML leading to difficulty in central venous catheterization during surgery and its other implications for anesthesiologists. Because many patients receive long-term steroid administration and present for surgical intervention, it is essential that they undergo detailed preoperative evaluation to exclude Cushing's syndrome and various pressure effects. IMPLICATIONS: This case report highlights problems during right internal jugular vein cannulation resulting from high back pressure and flow from superior vena cava obstruction in steroid-induced mediastinal lipomatosis. Other anesthetic considerations in mediastinal lipomatosis are also discussed.     

Cryptosporidiosis associated with animal contacts

Transmission of Cryptosporidium sp. within the general public was studied. We were looking for a possible risk of infection associated with animal contacts. Investigation of the animal contacts of affected individuals led to the formulation of the hypothesis that animals are a source of cryptosporidiosis. The research was done in the Region of Ljubljana, an area with 587,000 inhabitants during a period of three years. Stool specimens of 338 persons with acute enteric diseases were positive for Cryptosporidium sp. Diagnosis was done with an immunofluorescence test and modified Ziel-Neelsen staining. Processing of statistical data was done with the medical software application EPI INFO 6. According to our questionnaire, direct contact with animals occurred in 49 of the 338 cases of cryptosporidiosis, and was more frequently registered in males (Odds ratio = 1.96). Subgenotyping analysis revealed the presence of two subgenotypes of Cryptosporidium parvum bovine (GPB and GPC) in humans. These data indicate that genetic heterogeneity in C. parvum bovine genotype exists in a localized area and that farm animals can be a source of infection.     

Congenital fibrolipoma of anal canal

Although rare, congenital lipomatosis presents during first few months of life as large sub-cutaneous fatty masses on chest with extension into skeletal muscle bundles. Only a few such cases have been reported in the literature. A rare case of congenital fibrolipoma of anal canal in a 3-day-old male child is being documented in the present report.     

Prevention of urinary and anal incontinence: role of elective cesarean delivery

PURPOSE OF REVIEW: Currently, prophylactic elective cesarean to prevent incontinence is being promoted without robust evidence supporting it, this has created confusion among health personnel [corrected]. Past research centered on defining the damaging effect of vaginal birth on continence whilst the limited research on elective cesarean considered it protective. Cesarean delivery has economic, obstetric, gynecological and psychosocial consequences, but incontinence is not uncommon with a persistent morbidity. There is confusion among health personnel about advocating elective cesarean delivery to prevent incontinence. Reviewing current research would facilitate obstetric thinking. RECENT FINDINGS: Multiplanar endosonography and three-dimensional magnetic resonance imaging scanning are reportedly better in delineating structural alterations in the continence mechanism following vaginal birth and could be applied to postcesarean incontinence. Incontinence can follow vaginal or elective cesarean delivery and the severity following either mode is comparable. Urinary incontinence can resolve, persist or start de novo and the primiparous prevalence is similar following cesarean or vaginal birth. Transient anal incontinence can manifest during pregnancy. Paradoxically, pelvic floor strengthening exercises are beneficial for pregnancy-related incontinence, yet urinary incontinence occurs in nulliparas notwithstanding a strong pelvic floor. SUMMARY: Improved imaging techniques should promote a better understanding of postcesarean incontinence. Since severe incontinence can occur after elective cesarean, its reportedly preventative role deserves more scrutiny. When incontinence occurs without labor, it is transient or shows exercise-related improvement; the role of elective cesarean delivery seems tenuous and needs careful evaluation. Current evidence does not support the routine use of elective cesarean to prevent incontinence so the delivery mode should continue to be dictated by obstetric considerations.     

Results of radiotherapy with, or without, salvage surgery versus combined surgery and radiotherapy in advanced carcinoma of the hypopharynx

There is considerable controversy surrounding the optimum treatment of advanced hypopharyngeal cancers. Curative radiotherapy with surgical salvage in reserve is an accepted protocol as is also a combined treatment of surgery and radiotherapy. The present study is a retrospective analysis of the survival results of 195 cases treated in a single centre. The combined surgery and radiotherapy group comprised a greater number of pyriform fossa and post-cricoid tumours whereas, the curative radiotherapy group had a higher proportion of posterior pharyngeal wall tumours. Actuarial two-year disease-free survival rates were significantly better with combined treatment when results of stage III and IV lesions (164 patients) of all sites are taken together, as compared to those obtained with curative radiotherapy without salvage (p = 0.000) or radiotherapy with surgical salvage for residual/recurrent tumours (p = 0.0021).