Surgical management of parapharyngeal tumors - our experience

Fifteen cases of parapharyngeal tumors treated surgically in ENT department of Calcutta National Medical College in last 2 years were included, 80% cases were of benign tumors, most common being schwannomas. Most important investigation was found to be CT scan. The study gives an overview regarding the surgical approach, based upon the extent and histology of the tumor and transcervical approach was found to be most efficient for all practical purpose.     

Paranasal sinus mucoceles: a comprehensive retroprospective study in Indian perspective

Paranasal sinus mucoceles are the most common expansile lesion of the paranasal sinuses. Hereby we present a comprehensive retroprospective study on the paranasal sinus mucoceles in our geographic area which is very significantly lacking till now which we hope would immensely help comparative analysis and management in near future.     

Primary osteogenic sarcoma of the skull

BACKGROUND: An osteogenic sarcoma of the skull is rare, particularly as a primary tumor. The incidence of primary osteogenic sarcomas of the skull is about 1 to 2% of all skull tumors. CASE DESCRIPTION: A 21-year-old male was initially evaluated because of a large mass that had been growing for 7 months. The patient had been experiencing frequent headaches and tenderness at the site of the lump for about a month before being seen by the neurosurgeon. A computed tomography scan revealed a large mass, 12 cm x 7 cm, involving the scalp extending from the right temporal region to the vertex. A magnetic resonance imaging (MRI) scan showed a large mass arising from the posterolateral aspect that was 90% extracranial and 10% intracranial on the right side of the skull. The MRI showed marked vascularity and neovascularity of the tumor. An angiogram was performed, which demonstrated that the mass was fed by the branches from the right external carotid artery. The patient subsequently underwent surgery for embolization of the right occipital and superficial temporal arteries and removal of the mass. Pathology evaluation of a specimen revealed a high-grade osteoblastic osteosarcoma. CONCLUSION: We review the literature of reported cases of primary osteogenic sarcomas of the skull to discuss the common clinical presentation, evaluation methods, and recommended treatment plans.     

Development of an ethyl laurate-based microemulsion for rapid-onset intranasal delivery of diazepam

An ethyl laurate-based microemulsion system with Tween 80 as surfactant, propylene glycol and ethanol as cosolvents was developed for intranasal delivery of diazepam. Phase behavior and solubilization capacity of the microemulsion system were characterized and in vivo nasal absorption of diazepam from microemulsion formulations was investigated in rabbits. A single isotropic region, which is considered as a bicontinuous microemulsion, was found in the pseudo-ternary phase diagrams developed at various Tween 80: propylene glycol: ethanol ratios. With the increase of Tween 80 concentration, the microemulsion region area, microemulsion viscosity, and the amount of H(2)O and ethyl laurate solubilized into the microemulsion system increased; however, the increase of ethanol percentage produced opposite effects. Diazepam, a practically water-insoluble drug, displayed a high solubility of 41 mg/ml in a microemulsion consisting of 15% ethyl laurate, 15% H(2)O, and 70% (w/w) surfactant/cosurfactant (Tween 80:propylene glycol:ethanol at 1:1:1 weight ratio). Nasal absorption of diazepam from this microemulsion was found to be fairly rapid. At 2 mg/kg dose, the maximum drug plasma concentration was arrived within 2-3 min, and the bioavailability (0-2 h) after nasal spray compared with intravenous injection was about 50%. These results suggest that this ethyl laurate-based microemulsion may be a useful approach for the rapid-onset delivery of diazepam during the emergency treatment of status epilepticus.     

Camptocormia treated with bilateral pallidal stimulation

The authors report the neurological, neurophysiological, and neuropsychological effects of using long-term bilateral pallidal high-frequency deep brain stimulation (DBS) in a case of disabling camptocormia. Deep brain stimulation electrodes were implanted stereotactically to target the globus pallidus internus (GPi) bilaterally. Local field potentials (FPs) were recorded using the DBS electrodes and concurrent abdominal flexor electromyography (EMG) potentials during camptocormic episodes. Videotaped assessments of the movement disorder and neuropsychological evaluations of the patient before implantation and 6 months after initiation of pallidal stimulation were recorded. There was significant functional improvement following long-term pallidal stimulation, and some improvement was noted in neuropsychological scores. A temporal correlation between the GPi FPs and EMG-recorded rectus abdominis potentials was evident. There were no treatment-related adverse effects. The authors have found that long-term pallidal stimulation was safe and offered functional benefit to a patient with this severely disabling condition. The physiological studies may help further the understanding of the pathophysiology of this rare entity.     

Increased occupancy of dopamine receptors in human striatum during cue-elicited cocaine craving.

In all, 19 research subjects, with current histories of frequent cocaine use, were exposed to cocaine-related cues to elicit drug craving. We measured the change of occupancy of dopamine at D2-like receptors with positron emission tomography (PET) and inferred a change of intrasynaptic dopamine (endogenous dopamine release), based on the displacement of radiotracer [(11)C]raclopride. Receptor occupancy by dopamine increased significantly in putamen of participants who reported cue-elicited craving compared to those who did not. Further, the intensity of craving was positively correlated with the increase in dopamine receptor occupancy in the putamen. These results provide direct evidence that occupancy of dopamine receptors in human dorsal striatum increased in proportion to subjective craving, presumably because of increased release of intrasynaptic dopamine.     

Fistula of submandibular gland-a rare presentation

Salivary fistulas commonly affect parotid gland. Sabmandibular fistulas are very rare. Most of them are congenital in origin and may be associated with abnormalities of the branchial apparatus. Traumatic submandibular fistulas on the other hand are very rare entities with only few cases reported till date.     

Histomorphologically intact primary human breast lesions and cancers can be propagated in nude mice

The natural history of various human breast lesions and cancer in patient is difficult to study since diagnosis is established only after surgical ablation and therefore the clinical course of the undisturbed lesion in vivo can no longer be followed. Development of an experimental system which can propagate and maintain human breast lesions and cancer, similar to those seen in surgical breast specimens, may be a first step in the analyses of these various entities. We report that histomorphologically intact human breast lesions and cancer can be recreated in an experimental system using athymic nude mice. When the dissociated cells from surgical breast cancer specimens are embedded in extracellular matrices (collagen gel, Matrigel, or a mixture of the two) and then transplanted into athymic nude mice, the transplanted cells undergo morphogenesis to reflect their original phenotype. A mixture of the two matrices most closely mirrored the breast tissue in situ when stained with Alcian blue-PAS which stains for mucins. In this mixture, not only is the histomorphology recreated, but well-established clinical molecular markers including the estrogen receptor, c-erbB-2 (HER-2/neu), and aberrant cell proliferation are maintained. With the use of an appropriate extracellular matrices, surgical specimens of human breast lesions and cancer can be analyzed in an in vivo experimental system.     

Senile chorea treated by deep brain stimulation: a clinical, neurophysiological and functional imaging study.

We report on a patient with senile chorea, treated with deep brain stimulation of the left globus pallidus internus and subsequently the left ventralis oralis posterior nucleus of the thalamus. Deep brain field potential recordings and functional imaging using single photon emission tomography enabled us to suggest pathophysiological mechanisms for the symptoms.