Quality of life in patients with vitiligo using the short form 36

Vitiligo is an acquired pigmentary disorder affecting 0.5-1% of the world's population. Affected individuals often have low self-esteem, and poor quality of life (QOL) due to the disfigurement caused by the disease [1]. Vitiligo's impact on QOL compared to other diseases using general health questionnaires like the Short Form 36 (SF-36) is not well understood. We performed a cross-sectional study of patients with vitiligo and controls using the SF-36 and compared our scores to studies of patients with depression, chronic lung disease, psoriasis, atopic dermatitis, arthritis, cancer, congestive heart failure, myocardial infarction, type 2 diabetes, hypertension, and healthy adults.

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Relook on Mastoid Cavity Obliteration: A Prospective Study

Abstract

Canal wall down (CWD) mastoidectomy is the operation of choice for unsafe variety of chronic otitis media. But open mastoid cavity poses many problems. The solution of these problems is obliteration of mastoid cavity that is self-cleaning and easily maintained. In our study we aim to establish the effective technique for mastoid cavity obliteration in CWD mastoidectomy and review its efficacy in producing a dry, low maintenance cavity. This was a non-randomized longitudinal prospective study, performed over 2½ years in the department of ENT in a tertiary care hospital of Kolkata. Patients of chronic otitis media unsafe variety within the age group of 16–60 years were included in our study. Chronic otitis media unsafe variety with intratemporal or intracranial complications, and extensive cholesteatoma or granulation tissue that can't be cleared completely during operation were excluded. There was no statistical significance for hearing improvement between CWD mastoidectomy without obliteration and CWD mastoidectomy with obliteration. There was significant statistical significance for obliteration of cavity, epithelized cavity and dry cavity between CWD mastoidectomy without obliteration and CWD mastoidectomy with obliteration. Persistent discharge and granulation were significantly more in non-obliterated group. The time taken by the ear to become dry is much shorter after mastoid cavity obliteration. Moreover, lifelong aural toilet and dependence on an ENT surgeon is avoided. Inspite of all these, a few pre-conditions must be fulfilled before embarking on this type of surgery.

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Deep Neck Space Infections-A Study in Diabetic Population in a Tertiary Care Centre

Abstract

This study is intended to analyze the clinical profile and outcomes of deep neck space infection in diabetic patients in our tertiary care centre. A prospective study of 1 year duration from 30th September 2015 to 30th September 2016 at department of Otorhinolaryngology, Gauhati Medical College and Hospital, Guwahati. A total of 45 diabetic patients who presented with DNSI are included in this study. Their demographic profile, etiology, bacteriology, treatment, duration of hospital stay, complications and outcomes have been analyzed. 45 patients were recorded; 32 (71.11%) were men, and 13 (45%) were women, with a mean age of 63.27 ± 7.55 years. There were 30 patients (66.67%) who had associated systemic diseases apart from diabetes mellitus. The parapharyngeal space in 13 patients (28.89%) was the most commonly involved space. Odontogenic infections in 18 patients (40%) and upper airway infections 9 patients (20%) were the two most common causes. Klebsiella pneumonia in 29 patients (64.44%), was the commonest organism isolated through pus cultures. All the patients except one (97.78%) came with abscess and underwent surgical drainage. One patient (2.22%) with carbuncle underwent regular dressing. Six patients (13.33%) had major complications. Those patients with other underlying systemic diseases or complications tended to have a longer hospital stay and were older. No cases of death has been reported. (mortality rate, 0%). DNSI patients with diabetes have a more severe clinical course. They are likely to have complications more frequently and a longer duration of hospital stay. In clinical practices while dealing with these patients more vigilance is required. On admission empirical antibiotics should cover K. pneumonia. Early surgical drainage remains the main method of treatment. Primary prevention can be achieved by orodental hygiene, regular dental check ups and in this part of the country by avoidance of substance abuse like tobacco chewing.

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Metastases to the Parathyroid Glands: A Comprehensive Literature Review of 127 Reported Cases

Abstract

Metastases to the head and neck organs are uncommon, potentially representing the initial presentation of an occult malignancy. Single case reports and small series report metastases to the parathyroid gland, but there is no large review of the literature on secondary tumors involving the parathyroid glands. A review of the English literature between 1950 and 2017 was performed of all metastases or secondary involvement of the parathyroid glands. One hundred and twenty-seven cases of metastatic tumors were reported, although potentially significantly unrepresented in autopsy series (parathyroid glands are not routinely examined) and due to reporting bias. Women were affected more commonly than men (5.8:1; 99 vs. 17, respectively), with a mean age at presentation of 58.5 years, when reported. The most common primary sites of malignancies that metastasized to the parathyroid glands were breast carcinomas (66.9%, n = 85), melanoma (11.8%, n = 15), and lung carcinoma (5.5%, n = 7), with carcinomas representing 86.6% of metastases. Metastases were nearly always identified as part of widely metastatic disease, with only five (3.2%) cases reported as isolated metastases. Tumor-to-tumor metastases comprised 5.5% of all metastases to the parathyroid glands (metastases to parathyroid adenoma). A significant clinical finding of metastases to the parathyroid glands was the development of deranged calcium homeostasis, well beyond the 9 (7.2%) cases with primary parathyroid gland disease present. Although concurrent conditions (renal disease; bone metastases) may partially affect calcium metabolism, the onset of calcium derangement seemed to coincide with parathyroid gland metastases and not systemic disease. In summary, metastases to the parathyroid glands are uncommon, potentially under-recognized in patients who have otherwise widely metastatic tumors. Women are affected more often than men, with breast carcinomas (66.9%) and melanoma (11.8%) the most common primary tumors. Calcium homeostasis is affected, probably as a result of parathyroid gland parenchymal destruction.

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Sinonasal Tract Alveolar Rhabdomyosarcoma in Adults: A Clinicopathologic and Immunophenotypic Study of Fifty-Two Cases with Emphasis on Epithelial Immunoreactivity

Abstract

Sinonasal tract (SNT) alveolar rhabdomyosarcoma (ARMS) are frequently misdiagnosed, especially in adults. Fifty-two adult (≥18 years) patients with SNT ARMS were reviewed and characterized by immunohistochemistry and molecular studies. Twenty-six females and 26 males (18–72 years; mean 43.2 years), presented after a short duration (mean 2.6 months) with a large (mean 5.5 cm) destructive nasal cavity mass, involving multiple contiguous paranasal sites (n = 46) and with cervical adenopathy (n = 41). The tumors showed an alveolar, nested to solid growth pattern below an intact, but often involved (n = 9) epithelium with frequent necrosis (n = 37), destructive bone invasion (n = 30), and lymphovascular invasion (n = 25). The neoplastic cells were dyshesive and dilapidated, with crush artifacts. Rhabdoid features (n = 36) and tumor cell multinucleation (n = 28) were common. Mitotic counts were high (mean 17/10 HPFs). The neoplastic cells showed the following immunohistochemical positive findings: desmin (100%), myogenin (100%), MYOD1 (100%), MSA (96%), SMA (52%), CAM5.2 (50%), AE1/AE3 (36%); other positive markers included S100 protein (27%), CD56 (100%), synaptophysin (35%), and chromogranin (13%). Overall, 54% show epithelial marker reactivity. Molecular studies showed FOXO1 translocations (81%) with PCR demonstrating PAX3 in 72.7% tested. Patients presented with high stage (IV 24; III 26) and metastatic disease (lymph nodes n = 41; distant metastases n = 25) (IRSG grouping). Surgery (n = 16), radiation (n = 41) and chemotherapy (n = 45) yielded an overall survival of 36.1 months (mean; range 2.4–286); 18 alive without disease (mean 69.6 months); 7 alive with disease (mean 11.0 months); 1 dead without disease (63.7 months); and 26 dead with disease (mean 18.5 months). SNT ARMS frequently present in adults as a large, destructive midline mass of short symptom duration, with high stage disease. The alveolar to solid pattern of growth of cells with rhabdoid-plasmacytoid features suggests the diagnosis, but epithelial immunohistochemistry markers are present in 54% of cases, leading to misdiagnosis as carcinomas if muscle markers are not also performed. Overall survival of 36.1 months is achieved with multimodality therapy, but 64% have incurable disease (16.9 months). Mixed anatomic site (p = 0.02) was a significant adverse prognostic indicator, while stage (0.06) and tumor size >5 cm (0.06) approached marginal significance.

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Relook on Mastoid Cavity Obliteration: A Prospective Study

Abstract

Canal wall down (CWD) mastoidectomy is the operation of choice for unsafe variety of chronic otitis media. But open mastoid cavity poses many problems. The solution of these problems is obliteration of mastoid cavity that is self-cleaning and easily maintained. In our study we aim to establish the effective technique for mastoid cavity obliteration in CWD mastoidectomy and review its efficacy in producing a dry, low maintenance cavity. This was a non-randomized longitudinal prospective study, performed over 2½ years in the department of ENT in a tertiary care hospital of Kolkata. Patients of chronic otitis media unsafe variety within the age group of 16–60 years were included in our study. Chronic otitis media unsafe variety with intratemporal or intracranial complications, and extensive cholesteatoma or granulation tissue that can't be cleared completely during operation were excluded. There was no statistical significance for hearing improvement between CWD mastoidectomy without obliteration and CWD mastoidectomy with obliteration. There was significant statistical significance for obliteration of cavity, epithelized cavity and dry cavity between CWD mastoidectomy without obliteration and CWD mastoidectomy with obliteration. Persistent discharge and granulation were significantly more in non-obliterated group. The time taken by the ear to become dry is much shorter after mastoid cavity obliteration. Moreover, lifelong aural toilet and dependence on an ENT surgeon is avoided. Inspite of all these, a few pre-conditions must be fulfilled before embarking on this type of surgery.

http://ift.tt/2eYoyrE

Quality of life after thyroidectomy in patients with nontoxic nodular goiter: A prospective cohort study

Abstract

Background

Using the thoroughly validated Thyroid-Related Quality-of-Life Patient-Reported Outcome (ThyPRO) questionnaire, the purpose of this study was to investigate changes in disease-specific quality of life (QOL) after surgical treatment in patients with benign nontoxic multinodular goiters.

Method

Patients with goiters scheduled for thyroid surgery (n = 106) and individuals from the general population (n = 739) were studied. The ThyPRO data before, 3 months, and 6 months after surgery were compared with normative scores from the general population using a linear mixed model and t tests.

Results

Before surgery, patients with goiters experienced poorer scores on all scales compared to the general population. After surgery, moderate to large improvements were seen in goiter symptoms, tiredness, anxiety, and overall QOL. After surgery, all scales returned to values equal to the general population. The degree of anxiety was, in fact, lower than in the general population.

Conclusion

Thyroid surgery leads to significant benefit among patients with benign nontoxic goiters by restoring QOL equal to that in the general population.

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