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To the best of our knowledge, this is the largest case series describing the use of a melolabial flap for postlaryngectomy pharyngoplasty. It is an excellent alternative for pharyngoplasty, especially in cases post chemoradiotherapy. It accomplishes the goal while removing the restrictions of local and distant flaps. Although donor site morbidity is acceptable, specific consent is required due to the possibility of functional and cosmetic impairment. Additional cases with a larger sample size and a longer follow-up period can assist corroborate our first findings. In addition, because we tend to protect facial vessels for this flap, a follow-up about the compromise of oncological safety at level IB is required. In our case series, however, there was no recurrence until the final follow-up. As a result, it is a better option to pharyngoplasty post laryngectomy [ABSTRACT FROM AUTHOR]

Laryngeal histoplasmosis is a very rare cause of laryngitis which is encountered usually in the immunosuppressed states but can also occur in immunologically intact status. We report a rare case of laryngeal histoplasmosis in a man in his 60s, a chronic smoker who presented with a history of progressive hoarseness for 3months. The glottic growth was biopsied. The rarity of diagnosis was aided by histopathological examination of the tissue, which revealed histoplasmosis. Management was done with intravenous liposomal amphotericin B and oral itraconazole with complete resolution of symptoms. [ABSTRACT FROM AUTHOR]

A 58-day-old female infant reported with complaints of fever, difficult breathing, loose stool, vomiting and refusal to feed for 4 days. Laboratory work showed anaemia, leucocytosis with elevated neutrophils and thrombocytopenia along with high C-reactive protein and D-dimer with bilateral patchy infiltrate on Xray and positivity for COVID-19. Her blood culture was also positive for Gramnegative bacilli (acinetobacter lwoffii). Along with antibiotics, she was given 50 ml convalescent plasma. She was off oxygen within 2 days and showed improvement in lung lesions, and RT-PCR was negative by day 7 and discharged by day 10 of transfusion. [ABSTRACT FROM AUTHOR]

Objectives: Reconstruction of head and neck cancer ablative defects is challenging. A modification of the nasolabial flap (islanded pedicled nasolabial flap [ipNLF]) is an easy and reliable option for reconstruction of small- to medium-sized defects of the head and neck, especially in resource-constrained and high-volume centers.Study Design and Methods: We present the retrospective analysis of 27 consecutive patients reconstructed with ipNLF at two high-volume cancer centers, Homi Bhabha Cancer Hospital, Varanasi, India; and Army Hospital Research and Referral, New Delhi, India. The functional outcomes measured were duration of weaning of feeding and tracheotomy tubes and speech assessment (speech intelligible rating score [SIR]) postsurgery. Complications assessed were flap loss, orocutaneous fistula, donor site wound dehiscence, oral incompetence, and angle of mouth deviation.Results: The most common ablative defect was of the oral cavity (22 patients), followed by the oropharynx (4 patients) and hypopharynx (1 patient). The mean operating time for flap harvesting and insetting was 57.7 minutes. The mean durations for postoperative feeding tube and tracheotomy removal were 10 and 5 days, respectively. Twenty-four subjects had SIR scores of I or II. None of the subjects had flap loss, orocutaneous fistula, or donor site wound dehiscence. Twenty-five subjects had no oral incompetence, and 26 subjects had no or minimal angle of mouth deviation.Conclusion: This is the largest series of ipNLF to date and emphasizes the versatility, reliability, reproducibility and excellent functional and acceptable cosmetic outcomes of this flap for the reconstruction of judiciously chosen head and neck ablative defects.Level Of Evidence: 2C Laryngoscope, 130: 1967-1972, 2020. [ABSTRACT FROM AUTHOR]

A 3-month-old child was presented with haemoptysis with respiratory distress. Imaging was suggestive of a cavitary lesion in the lung with surrounding consolidation. Diagnosis of a primary lung pathology like congenital pulmonary airway malformation was considered. Based on clinical suspicion and prior experience, a Tc-99m pertechnetate radionuclide study was performed, which clinched the diagnosis of foregut duplication cyst. Intraoperative findings confirmed the presence of a neuroenteric cyst. The child remains asymptomatic on follow-up awaiting neurosurgical intervention for the intraspinal component of the cyst. [ABSTRACT FROM AUTHOR]

Background: The vitiligo of the penis and vulva is a difficult to treat region of the body where the existing surgical repigmentation methods usually do not give satisfactory results. Objective: This study was conducted to evaluate the efficacy of microskin grafting in stable genital vitiligo. Methods: Four male patients and 1 female patient were included in this study, and microskin grafting was performed in the stable vitiliginous areas of genitals under regional anaesthesia. Results: The microskin grafting technique has shown desired results at these sites with near total pigmentation and negligible donor area deformity. Conclusion: The microskin grafting for vitiligo is simple, reliable, and the most cost-effective technique of tissue grafting that has all the benefits of the latest cellular grafting techniques without its high cost and infrastructure. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the outcome of children with bilateral Wilms’ tumor (BWT) treated on All India Institute of Medical Sciences-Wilms Tumor-99 (AIIMS-WT-99) protocol. Materials and Methods : All children with BWT, registered in our solid tumor clinic from August 1999 through December 2010 were included. Results: Of the 178 fresh cases of Wilms Tumor (WT) treated during this period, 11 (6.2%) had bilateral involvement. All patients except one (12 and 3 cm), had massive bilateral tumors of more than 10 cm on each side. There were eight boys and three girls in the age range 6–30 months. One patient had Denys-Drash syndrome. Twenty renal units were operated upon (12 tumorectomy, five partial nephrectomy, and three nephrectomies), while one patient with inferior vena cava (IVC) thrombus died of renal failure. Tumor spill occurred in three units, lymphnode was positive in two patients. Local recurrence occurred in four patients (six of 18 renal units (33%)—two bilateral and two unilateral). There was one recurrence in the liver that was treated with radio-frequency ablation. The 5-year overall survival (OS) was 90% (95% confidence interval (CI) = 50.8–98.6) and the relapse free survival (RFS) was 38% (95% CI = 6.1–71.6). Conclusion: Massive BWT respond poorly to preoperative chemotherapy, are often not amenable to partial nephrectomy/ tumorectomy and have a higher local recurrence rate, giving a poor RFS. [ABSTRACT FROM AUTHOR]

The article discusses the clinical guidelines for wound management while also discussing the Society for Wound Care and Research (SWCR) which was set up in 2006 with the aim of conducting both social service and clinical research.

Bovine Endometritis accounts for about 20% of total reproductive disorders in dairy animals, affecting the general health of animals and adversely affects their productive and reproductive performance. Endometritis is defined as inflammation of the glandular layer of uterus. Peri-parturient complications viz. retained placenta, dystocia, twins, dead fetus, milk fever increase the risk of endometritis by delaying involution and reducing cow's ability to control uterine infections. The etiology of endometritis is multi-factorial, (bacteria, fungi and viruses) making the disease difficult to diagnose, treat and eradicate. Endometritis causing bacterial pathogens are mixed cultures that include Staphylococcus, Streptococcus, Escherichia, Klebsiella and anaerobic bacteria such as Fusobacterium necrophorum and Bacteroides species. Diagnosis is based on clinical manifestations, rectal examination and Ultrasonography. Ideal therapy for endometritis is to eliminate bacteria from uterus but should not inhibit normal uterine defense mechanism. [ABSTRACT FROM AUTHOR]

Background: To evaluate the role of positron emission tomography-computed tomography (PET-CT) in staging and determining early treatment response to chemotherapy in children with neuroblastoma (NB) and its correlation with the final outcome. Patients and Methods: Seventeen patients of NB with mean age of 51.5 months (age range 2-132 months; 14 males, 3 females) underwent serial 18F-flourodeoxygl ucose (FDG) PET-CT imaging. All 17 patients were for staging before any treatment. Twelve of 17 patients underwent I-131 meta-iodobezylguanidine (MIBG) scan and bone scan. MIBG uptake was seen in the primary lesion in 11/12 patients. MIBG uptake in bones was seen in 3/12 patients. All bone lesions were concordant on MIBG and bone scan. Early response to chemotherapy was evaluated after two cycles using PET-CT. A 30% reduction in longest diameter was taken as cut-off value for response on CT based on the response evaluation criteria in solid tumors criteria. Response on PET-CT was assessed using percentage improvement in lesion to background SUV ratio, taking a value of 50% as cut-off. Final outcome based on follow-up ranging from 6 to 43 months (mean 18.8 months) served as reference. Results: All 17 patients showed increased FDG uptake at the primary site. Seven of the 17 patients (41.2%) showed metastasis. Lymph nodes were the most common site of metastatic disease followed by bone, bone marrow, lung and meninges. For response evaluation, change in the size of the primary tumor was noted in 11/17 (64.7%) patients on CT. Treatment response was noted in 12/17 patients (70.6%) on PET-CT. Eleven out of 17 (65%) patients showed response in both CT and PET-CT. Five out of 17 patients showed no response in both. Discordant findings on CT and PET were noted in one (5.9%) patient where PET showed response but no response was seen on CT. Two patients with initial response but with distant metastases expired during follow-up. Conclusion: PET-CT has potential in the initial staging of NB. PET-CT also appears to be a good modality for response assessment in patients with moderate and high FDG uptake on the baseline scan. However, no significant beneficial effect was seen in patients with low baseline FDG uptake. [ABSTRACT FROM AUTHOR]

Congenital esophageal stenosis (CES) is a rare cause of dysphagia in children. Diagnosis is often apparent on esophagogram. Surgical treatment for the subtype with tracheobronchial remnants (TBR) includes resection and anastomosis of the stenosed segment, myectomy, enucleation of cartilage, etc., These procedures are not suitable if the stenosed segment is long. We present a case of a 5-year-old boy who was diagnosed as CES and was successfully managed with stricturoplasty with some innovative modifications. [ABSTRACT FROM AUTHOR]

Abstract: Background: The primary aim of this study is to detail the problems, complications, their avoidance, and management with transanal pull-through developed from experience with 65 patients. Methods: A retrospective study of 65 patients who underwent transanal pull-through between January 2002 and December 2006 was conducted. Their medical charts and operative notes were reviewed for problems encountered during surgery, postoperative period, and follow-up. Results: In 46 patients, a primary transanal pull-through was performed, whereas in 19 with a prior colostomy, followed staged pull-through was done. The minimum follow-up was 6 months, with an average of 22 months after surgery (range, 6-47 months). Sixteen patients (25%) experienced at least 1 complication. These included inadvertent full-thickness mobilization of the rectum in 3 (4.6%), retraction and bleeding of colonic mesenteric vessels in 2 (3.7%), difficulty in mobilizing intraperitoneal colon in 1 (1.5%), and a false-positive frozen section in 2 patients (3%). Early postoperative complications occurred in 7 patients (11%), which included sphincter spasm in 3 (4.6%), anastomotic leak in 1 (1.5%), cuff abscess in 2 (3%), and enterocolitis in 1 (1.5%). Late postoperative complications in 46 patients (70%), occurring from 1 week till 3 months of follow-up included perianal excoriation in 22 (34%), increased stool frequency in 20 (31%), anal stenosis in 3 (4.6%), and enterocolitis in 2 patients (3%). Methodology is detailed for avoidance and management of problems and complications. Individual patient analysis, complications timing, and strategy for management are discussed. Conclusion: Patient outcomes for transanal pull-through have improved significantly as a result of combination of experience and the ability to avoid and manage associated complications. Experience, avoidance, and interdiction are key factors in complication management. [Copyright &y& Elsevier]

Abstract: Background: Neurological involvement due to intraspinal extension in sacrococcygeal malignant germ cell tumors (SC-MGCTs) has rarely been reported. Aim: To evaluate the incidence, presentation, management and the outcome of patients of SC-MGCT with intraspinal extension. Materials and Methods: Case records of all cases of SC-MGCT from 2001 to 2008, were reviewed to identify cases with vertebral involvement and intraspinal extension. They were evaluated in terms of their presentation, response to therapy, extent of surgical resection, recovery of neurological symptoms and outcome. Results: Of the 31 cases of SC-MGCT, 5 (16%) had intraspinal extension. Age ranged from 12 to 84months (median 24months). Four patients had Altman type 4 disease (stage 4) and 1 had Altman type 3 (stage 3) disease. The intraspinal extension in all patients was detected on contrast CT scan. Patients presented with neurological symptoms in the form of lower limb paresis (80%), bowel and bladder (20%) incontinence. All the tumors responded to pre-operative chemotherapy. Gross complete local resection could be achieved in 4(80%). Neurological recovery was complete in all except for persisting neurogenic bladder in one. During follow up of 3–32months, all were alive with no recurrence. Conclusions: SC-MGCT presenting with neurological deficits due to intraspinal extension is usually advanced disease. These patients respond to chemotherapy and surgical resection and most have complete neurological improvement. [Copyright &y& Elsevier]

Purpose Based on copy number alterations and transcriptional profiles, the posterior fossa tumors (medulloblastoma (MB), ependymoma and pilocytic astrocytoma) have been classified into various subgroups. The study design was aimed to identify and catalog genome-wide copy number alterations and differential gene expression in different types of North-Indian pediatric posterior fossa tumors and matched control tissue through Molecular Inversion Probe (MIP) Based and Human Transcriptome Array. Experimental design MIP based OncoScan Array and Human Transcriptome Array 2.0 were used to molecularly-categorize histopathologically and immunohistochemically proven tumor samples on the basis of copy number variations and altered gene expression patterns and/or alternative splicing events. Results Based on molecular, histopathological/immunohistochemical and age-dependent factors MB was subgrouped into group-3 MB, Wnt and SHH; ependymoma into balanced, numerical and structural/anaplastic; and pilocytic astrocytoma was stratified age-dependently. Compared with the vermis tissue of MB, the vermis tissue of ependymoma showed higher levels of gain and losses compared with their counter tumor parts implicating metastasis within the confined region. Group-3 MB and anaplastic ependymoma represented highest differentially expressed genes both at gene and exon levels in the CN altered regions compared with other subgroups of MB and ependymoma respectively. Conclusion This multiomics approach based molecular characterization of posterior fossa tumors together with clinical and histopathological factors may help us in the area of personalized medicine. [ABSTRACT FROM AUTHOR]