Benign tumors of the larynx: a clinical study of 50 cases

Objective

The study was undertaken to identify the common type of lesions, and the age, sex distribution, symptomatology, sites of involvement and prognosis of the same.

Study design

A two-year prospective study was conducted from January 2005 to December 2006.

Setting

The study was conducted at SMS Medical College, Jaipur, Rajasthan, India—a tertiary referral hospital.

Patients

A total of 50 patients with benign laryngeal lesions were included in the study based on symptoms such as hoarseness of voice, foreign body sensation, throat pain, neck mass and cough and with positive clinical findings on indirect laryngoscopy and neck examination. The patients were in the age group of 14–63 years. All nonoperative cases and malignant cases were excluded. Diagnostic hematological and radiological investigations and therapeutic microlarygoscopic procedures were employed.

Results

A male preponderance with a male:female ratio of 2.5:1 was observed. Majority of the patients were in the age group of 21–30 years. Vocal cord polyps were observed to be the commonest type of lesions. In our study, hoarseness of voice, cough, foreign body sensation and throat pain were found to be the commonest symptoms. Out of the 50 patients in the study group, only 6% patients got complete relief with voice rest and vocal rehabilitation; 94% patients required surgery, which included microlarygoscopy and endolaryngeal surgery. There was no recurrence in cases of vocal polyps and nodules during the period of observation.

Conclusion

Microlaryngeal surgery and voice rest offer a cost-effective, useful and safe method for the management of benign laryngeal lesions. With the inclusion of lasers, they can be more precisely operated. As such, the standard treatment of choice in all types of benign tumors of the larynx should consist of a triad of approach by microlaryngeal surgery (either microscopic or endoscopic, with or without use of lasers), voice rest and vocal rehabilitation.

     

Study of dynamic magnetic resonance imaging in diagnosis of pelvic organ prolapse

Background

Pelvic floor dysfunction and prolapse affect 50?% of women past middle age. Failure to recognize the complex set of pelvic floor defects in individuals leads to most post-surgical failures. Imaging has so far not had an established role in the investigation of prolapse. The present study is an attempt to define the role of magnetic resonance imaging in POP.

Materials and methods

Thirty patients with clinically graded stage III/IV prolapse underwent routine physical examination and grading of POP in the Department of Obstetrics and Gynaecology, AIIMS. Dynamic MR evaluation with TRUFISP configuration was done and organ prolapse was measured through the hiatal line (HMO classification). The agreement of MRI, physical examination and intra-operative examination was analyzed using kappa as the test of agreement.

Observations and results

Twenty-eight subjects with grade III and 2 subjects with grade IV prolapse were enrolled. The mean age was 52.8 and the mean parity was 3.63. On MRI, 19 patients were found to have grade III prolapse, 4 had grade IV prolapse and the rest had grade I and II prolapse. There was poor agreement of MRI with clinical examination in anterior and middle compartments (k 0.161, k 0.144). The agreement between MRI and Intra-operative findings was 0.369, 0.422 for anterior and posterior compartments. Kappa was 0.085 for rectocele and 0.710 for enteroceles. The agreement was better for posterior compartment and enterocele. MRI detected 5 out of 8 enteroceles intra-operatively.

Conclusion

The study demonstrates that while dynamic MRI does not confer any additional advantage in the diagnosis of anterior and middle compartment defects, the diagnosis of enteroceles, which may be missed clinically, is efficiently made on dynamic MRI imaging. Additionally, MRI can differentiate enterocele from a high rectocele which can further classify the surgery needed. There is also a need to standardize the protocol and the role of MR imaging in POP.     

Lipo-γ-AApeptides as a new class of potent and broad-spectrum antimicrobial agents

There is increasing demand to develop antimicrobial peptides (AMPs) as next generation antibiotic agents, as they have the potential to circumvent emerging drug resistance against conventional antibiotic treatments. Non-natural antimicrobial peptidomimetics are an ideal example of this, as they have significant potency and in vivo stability. Here we report for the first time the design of lipidated γ-AApeptides as antimicrobial agents. These lipo-γ-AApeptides show potent broad-spectrum activities against fungi and a series of Gram-positive and Gram-negative bacteria, including clinically relevant pathogens that are resistant to most antibiotics. We have analyzed their structure-function relationship and antimicrobial mechanisms using membrane depolarization and fluorescent microscopy assays. Introduction of unsaturated lipid chain significantly decreases hemolytic activity and thereby increases the selectivity. Furthermore, a representative lipo-γ-AApeptide did not induce drug resistance in S. aureus, even after 17 rounds of passaging. These results suggest that the lipo-γ-AApeptides have bactericidal mechanisms analogous to those of AMPs and have strong potential as a new class of novel antibiotic therapeutics.     

Genetic variants and evolutionary analyses of heparin cofactor II

Heparin cofactor II (HCII) belongs to serpin superfamily and it acts as a thrombin inhibitor in the coagulation cascade, in a glycosaminoglycan-dependent pathway using the release of a sequestered hirudin-like N-terminal tail for interaction with thrombin. This serpin belongs to multiple member group V2 of vertebrate serpin classification. However, there is no comprehensive study illustrating the exact phylogenetic history of HCII, to date. Herein, we explored phylogenetic traits of HCII genes. Structures of HCII gene from selected ray-finned fishes and lamprey varied in exon I and II with insertions of novel introns of which one in core domain for ray-finned fishes in exon II at the position 241c. We found HCII remain nested in the largest intron of phosphatidylinositol (PI) 4-kinase (PIK4CA) gene (genetic variants of this gene cause schizophrenia) at the origin of vertebrates, dated about 500 MY old. We found that sequence features such as two acidic repeats (AR1-II), GAG-binding helix-D, three serpin motifs and inhibitory reactive center loop (RCL) of HCII protein are highly conserved in 55 vertebrates analyzed. We identified 985 HCII variants by analysis of 1092 human genomes with top three variation classes belongs to SNPs (84.3%), insertion (7.1%) and deletion (5.0%). We identified 37 deleterious mutations in the human HCII protein and we have described these mutations in relation to HCII sequence–structure–function relationships. These understandings may have clinical and medical importance as well.     

Apnea testing with continuous positive airway pressure for the diagnosis of brain death in a patient with poor baseline oxygenation status

Apnea testing is a key component in the clinical diagnosis of brain death. Patients with poor baseline oxygenation may not tolerate the standard 8-10 min apnea testing with oxygen insufflation through tracheal tube. No studies have assessed the safety and feasibility of other methods of oxygenation during apnea testing in these types of patients. Here, we safely performed apnea testing in a patient with baseline PaO₂ of 99.1 mm Hg at 100% oxygen. We used continuous positive airway pressure (CPAP) of 10 cm of H₂O and 100% oxygen at the flow rate of 12 L/min using the circle system of anesthesia machine. After 10 min of apnea testing, PaO₂ decreased to 75.7 mm Hg. There was a significant rise in PaCO₂ and fall in pH, but without hemodynamic instability, arrhythmias, or desaturation. Thus, the apnea test was declared positive. CPAP can be a valuable, feasible and safe means of oxygenation during apnea testing in patients with poor baseline oxygenation, thus avoiding the need for ancillary tests.     

Genetic predisposition to oxcarbazepine induced Stevens�CJohnson syndrome

Stevens–Johnson syndrome (SJS) is a rare immunologic reaction that may involve skin or various mucosal surfaces. The etiology may range from multiple pharmacologic agents to viral infections. Associated findings can range from minimal skin and mucosal involvement to extensive dermal exfoliation, nephritis, lymphadenopathy, hepatitis, and multiple serologic abnormalities. We report a female patient of 38 years with a history of drug allergy who was administered oxcarbazepine for the management of right partial bronchial seizure due to left parasagittal mass lesion following which she developed papular rashes all over the body and diagnosed as SJS. Although carbamazepine (CBZ) is the most common cause of SJS, a new anticonvulsant, oxcarbazepine, which is structurally related to CBZ, has been shown to induce SJS.     

A rare case of survival from primary amebic meningoencephalitis

Primary amebic meningoencephalitis (PAM) is a rare and fatal disease of central nervous system (CNS) caused by Naegleria fowleri, an ameba found in soils and warm waters. It enters the CNS after insufflation of infected water by attaching itself to the olfactory nerves. The infection is usually difficult to diagnose and has a poor prognosis. The present case is one such case in which CSF examination led us to the diagnosis of PAM and finally to a favorable outcome when treated with Amphoterracin B and antibiotics.