BackgroundFree‐flap reconstructions (FFRs) are the standard‐of‐care following resections for oral cancer. This study assessed an alternative, the pedicled submental flap (SF) for its versatility, oncological outcomes, and comparative operative time and cost.MethodsThis was a longitudinal prospective study of 1169 patients of oral cancer reconstructed with the SF. Oncological outcomes in terms of recurrence rate and disease‐free survival (DFS), were analyzed in 730 cases with a minimum of 18 months follow‐up. Surgical time and cost were compared between 20 SFs and 14 FFRs performed consecutively.ResultsSF was used to reconstruct defects in the cheek (29.2%), mandible (41.6%), tongue (26.3%) and palate (2.7%) with a 94% flap survival. N+ at level 1 did not adversely affect the recurrence rate as compared with N+ at levels other than level 1 (27.52% vs 29.81%). SFs took a shorter time (186 minutes vs 474 minutes) and cost significantly less than FFRs (P < .0001).ConclusionsSF can reconstruct various oral defects, is sturdy, and esthetically and functionally satisfactory. The procedure time is much shorter than for FFR and costs considerably less. With careful case selection and meticulous clearance, SF reconstruction is oncologically safe even in N+ neck.

Background: Malaria has a wide clinical spectrum ranging from uncomplicated disease to a fatal one. The objectives were to study clinical profile of Malaria with special reference to its complications and outcome.Methods: A prospective observational study was done in a tertiary care hospital including total of 300 patients diagnosed with Vivax or Falciparum Malaria. Data on patients’ clinical details with investigations, complications, and outcome was recorded and analysed using SPSS version 17.Results: Out of 300 patients, 179 had Vivax and 121 had Falciparum Malaria. Oliguria, high coloured urine, altered sensorium, convulsion, breathlessness, bleeding was more common in Falciparum malaria. Hypoglycaemia, thrombocytopenia, renal and hepatic involvement and ALI/ARDS were also more common in falciparum group. However, ALI/ARDS was more fatal in vivax group. Complications, outcome and biochemical parameters were correlated with parasite index and the correlations were statistically significant. Out of 22 deaths, 12 patients were from falciparum and 10 were from vivax group. Most common complication leading to death was ARDS/ALI, followed by AKI, convulsion, hepatic involvement and bleeding in decreasing order in both types of Malaria. Three patients with parasitic index <5% and 19 patients with parasitic index >5% died.Conclusions: Clinical profile of Falciparum Malaria was more complicated. Metabolic complications with multi organ involvement, ALI/ARDS and mortality were more in Falciparum Malaria. Correlation of parasitic index with complications, biochemical parameters and outcome in both the groups was statistically significant.

QUESTIONS TO BE ANSWEREDIn this retrospective study we have correlated the clinical, ultrasonological and pathological findings of breast masses to answer whether we could rely on ultrasound and Fine Needle Aspiration (FNAC) findings for the further management of patients. MATERIAL AND METHODSThis is a retrospective study done at Vidya Cancer Hospital, Gwalior, Madhya Pradesh, India. This study has included patients from Jan. 2014 to Jan. 2016. The total number of patients is 50. The clinical examination is done by an oncology team which includes a surgical oncologist, medical oncologist, radiation oncologist and gynaecologist. The ultrasound is done by an oncoradiologist. The pathological examination is done by an oncopathologist. The ultrasonology findings assessment is done according to the American College of Radiology, Breast Imaging Reporting and Data System (BI-RADS). The statistical analysis is done by using standard formulas. DISCUSSIONIn our day-to-day practice, we often see so many breast lumps. All the patients and their family members are in great agony. We as clinicians have to give quick results by non-invasive methodology. In today's era nothing could be advocated merely on clinical experience, it has to be evidence based. To create evidence, we have done this study. We found even a good clinical examination and ultrasound by a good team could solve most of the diagnostic dilemmas of breast masses. In our study, the sensitivity and specificity of clinical examination were 100% and 88% respectively. We tried to compare it with other studies, but we were unable to compare it with because of wide variations in those studies for they were either not focusing on clinical examination or it was not a team effort. Yes, we have been able to compare the sensitivity and specificity of ultrasound and FNAC findings. In our study, the sensitivity and specificity of ultrasound was 100% and 88% respectively which was comparable to 95.7% and 89.2% respectively in Lehman et al Study. In our study the sensitivity and specificity of FNAC was 93.3% and 88% respectively, which was 66.6% and 81.8% in Homesh NA et al study. The difference in sensitivity and specificity may be because our pathologist was always in coordination with the clinicians and ultrasonologist. Apart from this, we came across very interesting finding that our pathologist was not able to give any conclusive findings in clinically suspicious an d BIRADS 4 findings. CONCLUSIONThis study has shown that a good team work could do wonders and a good clinical and ultrasonological examination could sort out most of the diagnostic dilemmas of breast masses. FNAC does well in frankly benign and malignant lesions. Any lesion which is suspicious and BIRADS 4 should undergo an upfront biopsy rather than FNAC. Fallacy was the number of patients included in this study was too small to make a final remark and secondly it is not a blinded study.

A young man with bronchial asthma and an abnormal chest X-ray A S Kashyap, S Kashyap A 29-year-old man with bronchial asthma of 5 years duration was using inhaled salbutamol. In view of recurrent exacerbations, he had been put on oral prednisolone 20 mg/day for the last year. He did not smoke tobacco or drink alcohol. He had no other complaints. Clinically he had moon facies, buValo hump, centripetal obesity, purple striae on flanks and proximal myopathy. His blood pressure was 140/100 mmHg. Chest examination revealed polyphonic rhonchi in all areas. The rest of the general and physical examination was normal. Investigations revealed a normal haemogram, urinalysis, fasting and post-prandial plasma glucose, serum sodium, potassium, calcium and phosphate levels. Pulmonary function test showed an obstructive pattern. His chest X-ray (postero-anterior) is shown in figure 1. Chest X-ray a year earlier had been normal. Serum cortisol levels were 130 nmol/l at 08.00 h (normal 140-690 nmol/l) and 76 nmol/l at 16.00 h (80-330 nmol/l). Urine 24-hour calcium was 3.2 mmol (< 3.8 mmol). Questions1 What are the abnormalities seen on the chest X-ray? 2 What is the pathophysiology of these abnormalities ?Figure Chest X-ray (postero-anterior)Postgrad Med J 2000;76:41-60

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