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   Table of Contents - Current issue
July-December 2019
Volume 7 | Issue 2
Page Nos. 35-84

Online since Friday, February 21, 2020

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Prevention is better than cure p. 35
Arjun Gurmeet Singh, Pankaj Chaturvedi
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Basic concepts in research methodology and biostatistics for head and neck oncologists Highly accessed article p. 37
Krishnakumar Thankappan
Research is an integral part of head and oncology. Understanding the methodology of research, either clinical or basic science, is important for an oncologist involved in such projects. It is equally essential for a head and neck surgeon, radiation, or medical oncologist to have a working knowledge of the topic so that he/she could be familiar with the current research, articles and latest developments in the field. This article is a primer in Research methodology and Biostatistics, giving a summary of the basic concepts in the study design, measures of treatment effects, hypothesis testing, diagnostic tests, assessment of outcomes, and statistical tests.
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An update on medullary carcinoma thyroid p. 45
Mithun Raam, Anish Jacob Cherian, Mazhuvanchary Jacob Paul, Deepak Thomas Abraham
Medullary thyroid carcinoma is a rare neuroendocrine tumor arising from parafollicular cells of the thyroid gland. It occurs in both hereditary and sporadic forms which are associated with the gain of function mutations in rearranged during transfection proto-oncogene on chromosome 10q11.2. There are various syndromic and sporadic clinical presentations, and the understanding of the molecular pathophysiology and its genotype–phenotype correlation has led to mutation-based risk stratification and guidelines for evaluation and management. The authors present a current review of the literature with regard to pathophysiology, molecular basis, clinical presentation along with genotype–phenotype correlation and guidelines for evaluation and management.
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Induction chemotherapy in sinonasal malignancies: A review of literature p. 52
Narayana Subramanian, Filippo Marchi, Andrea Luigi Camillo Carobbio, Francesco Missale, Deepak Balasubramanian, Krishnakumar Thankappan, Subramania Iyer
Sinonasal cancers form a distinct subset of head-and-neck tumors. They exhibit varied histologies with different clinical outcomes. These tumors are rare, and there exists no randomized trial identifying the ideal treatment for these patients. Induction chemotherapy (CT) has been tried with varying success for different purposes such as bioselection, improving outcomes, orbital preservation, and reduction in the extent of surgery. The purpose of this review is to examine and present the literature regarding the use of induction CT in sinonasal cancers and their outcomes.
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Comparing the suppressing effect of dexmedetomidine versus lidocaine in cough during anesthesia emergence: A double-blinded randomized clinical trial p. 62
Sohaila Saidie, Hesameddin Modir, Bijan Yazdi, Esmail Moshiri, Abolfazl Mohammadbeigi
Background: Cough, laryngospasm, bronchospasm, and tachycardia are physiological responses during anesthesia emergence (AE) and endotracheal extubation. The study addressed the efficacy of dexmedetomidine (DEX) versus lidocaine (LID) in suppressing cough during AE. Materials and Methods: A double-blinded randomized clinical trial enrolled 120 eligible hospitalized patients undergoing general anesthesia. Patients randomly assigned into three groups who (1) infused 0.5 mcg/kg intravenous (IV) DEX, (2) 1.5 mg/kg IV LID, and (3) 10 mL of normal saline (PBO), 10 min before anesthesia. The laryngospasm, cough frequency (CF) (P < 0.05). Significant statistical difference was observed in Ramsay score (RS) except at, SaO2, heart rate (HR), mean blood pressure (BP), and RS was measured, and data were analyzed by analysis of variance (ANOVA), Chi-square, and ANOVA for repeated-measures tests in SPSS 20. Results: No significant difference was uncovered in BP, SaO2, frequency of laryngospasm, and duration of surgery among the groups (P > 0.05), but DEX having lower HR and CF (P < 0.05). A significant statistical difference was observed in RS except at 50 and 60 min (P < 0.05), with a lower RS in the LID and DEX than in the PBO, but both intervention groups were not different. Conclusion: Although RS in the DEX is not different from the LID, DEX demonstrates a reduced HR and CF and appears to be an appropriate drug without side effects on suppressing cough during AE.
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Low survival of advanced laryngeal cancers: Time to change the treatment regime? p. 67
Sandeep Vijay, Sajith Babu Thavarool, S Manu, Naveen George, Raveena R Nair
Background: This study aimed to detect the survival outcome of patients who underwent primary laryngectomy in comparison to the salvage total laryngectomy at our institution. Methodology: A retrospective analysis of patients who underwent laryngectomy in our institution from 2009 to 2016 either as primary surgery or as salvage surgery was done. Results: Fifty-four patients were assessed in the current study. Primary laryngectomy was done in 33 (60.4%) patients and savage laryngectomy in 21 (39.6%) patients. The common complication following laryngectomy was wound infection (68.5%) followed by pharyngocutaneous fistula (29.6%). The five year disease free survival in primary and salvage laryngectomy patients were 46% and 32 % respectively. DFS showed a decreasing trend with increase in T-stage and also node positivity. The overall survival (5 years) was found to be 52% for primary laryngectomy cases and 37% for salvage cases. Conclusion: Salvage laryngectomy was found to have higher incidence of postoperative complications. The overall survival and DFS was found to be lesser for salvage cases than primary laryngectomy. T- and N-stage have an important role in determining survival. The survival of advanced laryngeal cancers is dismal with surgery and radiotherapy.
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Surgical excision with the negative margins offers best cure rates for ameloblastoma: A case series and review of literature p. 72
Hitesh R Singhavi, Ameya A Pai, Manish Mair, Sudhir Nair, Deepa Nair, Pankaj Chaturvedi
Objectives: The purpose of the study was to report a case series of ameloblastoma treated by radical approach with a negative margin. Study Design: The clinical, demographic, and the histopathological data of 24 biopsy-proven ameloblastoma were obtained and analyzed retrospectively from the electronic medical records. Statistical analysis was done using the software SPSS 20.0. Disease-free survival was calculated using Kaplan–Meier analysis. Results: The mean age of the patients in the study group was 46.6 (range, 17–69) years with male to female ratio of 1.18:1. The most common site of origin was mandible (75%). There was a significant positive linear correlation between size and age of the patients with a correlation coefficient of 0.85 (P = 0.042). Patients having multicystic ameloblastoma had a significantly higher age of presentation and larger size than unicystic ameloblastoma (P < 0.05). The mean distance of the closest mucosal/bony cut margin from the lesion was 6 mm (range 1–45 mm). All patients were alive, and 95.8% of the patients were disease free at a mean follow-up of 48 months. Conclusion: We recommend appropriate radical treatment for most of the patients of ameloblastoma with a negative margin except for small unicystic ameloblastoma. Thus, it is time to revisit the concept of conservative procedures in the management of ameloblastoma.
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Ocular melanoma: A rare entity p. 79
Raj Nagarkar, Sirshendu Roy, Ashvin Wagh, Gauri Kokane, Aditya Adhav, Samadhan Pawar
Malignant melanoma of eyeball is a rare entity. The overall incidence of malignant melanoma is 3%–7% per year worldwide. Early detection and meticulous treatment planning and its execution are challenge to surgeons. A 38-year-old male presented with loss of visionin one eye, and after investigating, it turned out to be malignant melanoma of the eyeball. He was treated surgically by enucleation of the eyeball followed by prosthetic rehabilitation.
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Lemierre's syndrome: A calamitous complication of oropharyngeal infection p. 82
Roopesh Yarappa, Sakshi Gagneja, Sourya Acharya, Shreya Gattani
Lemierre's syndrome is an infectious thrombophlebitis of internal jugular vein (IJV) which occurs rarely, as a complication of oropharyngeal infection. We report an unusual case of a 36-year-old healthy female who presented with high-grade fever with chills, sore throat, and diffuse swelling of the neck on the right side. Examination revealed pharyngitis with swelling on the neck on the right side with palpable submental and submandibular lymph nodes bilaterally. Local site ultrasonography revealed thrombosed right IJV with subcentimetric regional lymph nodal enlargement. She was started on prophylactic intravenous antibiotics and anticoagulants, awaiting blood culture report. A detailed workup was done to rule out occult malignancy, and autoimmune as well as thrombotic screening was also negative. The etiological agent could not be identified as blood cultures were negative; she had already received antibiotics prior to admission. She responded to treatment, and there were no metastatic complications. Though the syndrome is rare, it has severe manifestations and mortality can be reduced, if timely diagnosed and managed.
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