Role of lateral neck dissection in cancers of the larynx and hypopharynx with No neck

Radical neck dissection is a standard procedure carried out for the teatment of palpable nodes in the neck but if carried out electively in cases where there are no palpable nodes in the neck it is considered to be an overtreatment with its associated morbity. Lateral neck dissection was carried out on twenty patients who had T31 T4 lesion of the larynx and hypophar-vnx with NO neck. The dissection entails removal of Level II. III and IV nodes. Occult metastasis 80% and 85% respectively. The mean follow up was 13 monts. It appears from our study that elective lateral neck dissection is a promising and safe procedure and may be useful as an important prognostic tool in sampling the lymph nodes and predicting recurrences in the neck.     

Unilateral recurrent pleural effusion in a renal transplant patient

Pleural effusion is a frequent complication in patients undergoing hemodialysis (HD). We report a patient on HD with a novel cause of recurrent unilateral pleural effusion. A 45-year-old female patient on long-term maintenance HD presented to us with recurrent unilateral pleural effusion. She had a history of poor quality dialysis, severe anemia and severe hypertension. Despite correcting these factors and even after undergoing successful renal transplantation, she continued to have recurrent effusion. Left upper extremity venography demonstrated severe stenosis of the subclavian vein and an increased venous flow in the ipsilateral arteriovenous (AV) fistula. Ligation of the AV fistula led to dramatic resolution of the pleural effusion. Hemodialysis patients who develop unexplained pleural effusions ipsilateral to a functioning AV fistula should be investigated for stenosis in the brachiocephalic vein, particularly those patients who have had previous catheterizations of the jugular or subclavian veins on the same side as the effusion. Correcting the stenosis by venous angioplasty and/or ligation of the ipsilateral fistula can dramatically resolve the pleural effusion. A high index of suspicion is required to diagnose this complication for meaningful intervention.     

Serum uric acid level in newly diagnosed essential hypertension in a Nepalese population: A hospital based cross sectional study

Objective

To develop the missing link between hyperuricemia and hypertension.

Methods

The study was conducted in Department of Biochemistry in collaboration with Nephrology Unit of Internal Medicine Department. Hypertension was defined according to blood pressure readings by definitions of the Seventh Report of the Joint National Committee. Totally 205 newly diagnosed and untreated essential hypertensive cases and age-sex matched normotensive controls were enrolled in the study. The potential confounding factors of hyperuricemia and hypertension in both cases and controls were controlled. Uric acid levels in all participants were analyzed.

Results

Renal function between newly diagnosed hypertensive cases and normotensive healthy controls were adjusted. The mean serum uric acid observed in newly diagnosed hypertensive cases and in normotensive healthy controls were (290.05±87.05) µmol/L and (245.24±99.38) µmol/L respectively. A total of 59 (28.8%) participants of cases and 28 (13.7%) participants of controls had hyperuricemia (odds ratio 2.555 (95% CI: 1.549-4.213), P<0.001).

Conclusions

The mean serum uric acid levels and number of hyperuricemic subjects were found to be significantly higher in cases when compared to controls.     

O2-Dependent Efficacy of Novel Piperidine- and Piperazine-Based Chalcones against the Human Parasite Giardia intestinalis

Giardia intestinalis is the most frequent protozoan agent of intestinal diseases worldwide. Though commonly regarded as an anaerobic pathogen, it preferentially colonizes the fairly oxygen-rich mucosa of the proximal small intestine. Therefore, when testing new potential antigiardial drugs, O₂ should be taken into account, since it also reduces the efficacy of metronidazole, the gold standard drug against giardiasis. In this study, 46 novel chalcones were synthesized by microwave-assisted Claisen-Schmidt condensation, purified, characterized by high-resolution mass spectrometry, ¹H and ¹³C nuclear magnetic resonance, and infrared spectroscopy, and tested for their toxicity against G. intestinalis under standard anaerobic conditions. As a novel approach, compounds showing antigiardial activity under anaerobiosis were also assayed under microaerobic conditions, and their selectivity against parasitic cells was assessed in a counterscreen on human epithelial colorectal adenocarcinoma cells. Among the tested compounds, three [30(a), 31(e), and 33] were more effective in the presence of O₂ than under anaerobic conditions and killed the parasite 2 to 4 times more efficiently than metronidazole under anaerobiosis. Two of them [30(a) and 31(e)] proved to be selective against parasitic cells, thus representing potential candidates for the design of novel antigiardial drugs. This study highlights the importance of testing new potential antigiardial agents not only under anaerobic conditions but also at low, more physiological O₂ concentrations.     

Repair of the pharyngeal defect following pharyngo-laryngectomy (with special reference to gastric transposition)

It is well known that reconstructing the alimantary canal following total laryngo-pharyngectomy is not an easy task. Present paper deals with problems encountered in the management of 28 circumferential lesions of the hypopharynx, with emphasis on the reconstruction following surgery. C. T. Scan has been found to be useful in pre-operative assessment of resectability of such a case. The transposed stomach was found to be more versatile and reliable in the reconstruction following laryngopharyngectomy than the use of pectoralis major myocutaneous flap. The gastric pull up surgery provided excellent palliation in terms of early commencement of oral feeding and short hospital stay with minimum of post-operative complications (the mortality rate was 7 percent).     

Solubilization of homopolymers and copolymers by block copolymer micelles in dilute solutions

Solubilization by micelles of a three-block copolymer poly(styrene-butadiene-styrene) with a polybutadiene core was studied by the light scattering method on three types of solubilizate: polybutadiene with (a) low and (b) high molar mass (with respect to the polybutadiene block of the copolymer), and (c) a block copolymer poly(styrene-butadiene-styrene) with a high content of butadiene. True solubilization of polybutadiene into the cores of spherical micelles occurs in case (a); in case (b) polybutadiene forms partially stabilized, emulsion-like large droplets. In case (c) stable mixed micelles are formed having either lower or higher molar mass with respect to that of the original micelles, depending on the ratio of molar masses and on the composition of both copolymers. A similarity between solubilization of hydrocarbons by micelles of soaps or surfactants in aqueous solutions and solubilization of polymers by copolymer micelles in selective solvents is pointed out.     

The etiology and management of pharyngo-cutaneous fistulae following laryngectomy

One hundred and ten cases of carcinoma of the larynx and laryngopharynx have been retrospectively analysed for the incidence and etiological factors for the fistula formation following radical surgery. The fistulae occurred significantly more often in radiation failed salvage surgery group than in cases undergoing primary surgery. Of 54 cases in the former group, 40 (74.5 percent) developed pharyngeal fistulae, 24 of these healed spontaneously within two months, whereas, 14 cases required subsequent surgical repair. However, of 54 cases undergoing primary surgery, only 9 (16 percent) developed pharyngeal fistulae, all of which healed spontaneously.