The morphological features of encapsulated follicular variant of papillary thyroid carcinoma (FVPC) are reviewed and the controversies and diagnostic difficulties in the diagnosis of FVPC are discussed.

Regenerating lost pulp tissue as a result of trauma or disease is very interesting and an exciting concept and revascularization via blood clotting is considered to be a feasible and practical approach in this direction. This method has been practiced since long with promising results reported by studies but so far consensus on treatment protocols as well as the nature of tissues formed inside the root canal space is lacking. The objective of this review is to appraise root canal revascularization via blood clotting procedures strived in endodontic practice and the contemporary recommendations for their successful outcome.

Background: Iodine is an essential micronutrient. Its daily requirement for adults is placed at 150 μg/day. This amount is normally supplied by well-balanced diets and drinking water, except in areas where food and water are deficient in iodine. Iodine is essential for production of thyroid hormones, which are essential for normal growth and development and for regulation of a number of homeostatic functions. Inadvertent use of iodized salt can lead to hypothyroidism. Aim: To study the association of hypothyroidism a) with excess iodized salt usage; and b) with hypertension and diabetes. Settings and Design: Multispecialty hospital located in municipal corporation of Vijayawada, Andhra Pradesh. The subjects included in this study were selected from outpatient section, using random sampling technique. Materials and Methods: This cross-sectional study was conducted from November 2011 to August 2012, for a period of 10 months and included 120 subjects with hypothyroidism and 339 non-hypothyroid subjects. Statistical Analysis: All statistical analyses were performed using MS Excel 2007 software and appropriate tests of statistical significance including chi-square test, P-values, odds ratios (ORs), and confidence intervals (CIs) were applied. Results: There was statistically significant association of hypothyroidism with excess usage of iodized salt, with hypertension and diabetes. Conclusion: Excess iodine, through global iodization of table salt can lead to hypothyroidism, which is more associated with hypertension and diabetes, the two most important diseases commonly encountered in the community. So, iodine supplementation should be restricted to pockets of iodine deficiency only.

Introduction: Myasthenia gravis (MG) is a neuromuscular disorder characterized by weakness and fatigability of skeletal muscles. There is a paucity of data regarding the disease in the state of Andhra Pradesh. Objective: Our aim was to study the clinical profile of patients with myasthenia gravis admitted to government general hospital, Guntur, Andhra Pradesh. Materials and Methods: We studied the cases of 36 myasthenia gravis patients admitted to the government general hospital, Guntur from September 2003 to April 2011. Results: The median age of presentation was 40 years. Male to female ratio was 3:1. The presenting complaint was ptosis in 44.44% of the cases. The other major complaint was lower limb weakness (38.89%). Serum levels of acetylcholine receptor (AChRs) antibodies were more in males (18) than in females (9.22). Conclusion: The median age of presentation and sex ratio matched that with the pattern in India. Ptosis may suggest a possibility of myasthenia gravis to the clinician more easily than any other complaint.

Aims: To identify the indications for flexible fiber optic bronchoscopy (FOB) and to compare the pre- and post-bronchoscopy diagnoses. Settings and Design: A retrospective case record based study of 322 subjects who had been admitted in the different wards of a tertiary care teaching hospital in south India and had undergone flexible fiber bronchoscopy for various indications was conducted. Materials and Methods: The demographic data, chest radiographic findings, pre-bronchoscopy suspected clinical diagnosis, bronchoscopy findings, microbiological results, pathological data, and post-bronchoscopy confirmed clinical diagnosis were recorded as per a pre-designed pro forma and analyzed. Results: The mean age of the patients was 52.99 years (SD ± 15.1, range: 17-82). The top three pre-bronchoscopy suspected clinical diagnoses were pulmonary tuberculosis (n = 129, 40%), lung malignancy (n = 99, 30.7%), and bacterial pneumonia (n = 57, 17.7%). The distribution of the clinical diagnoses post-bronchoscopy was as follows: Bacterial pneumonia (n = 58, 18%), lung malignancy (n = 56, 17.4%), and pulmonary tuberculosis (n = 28, 8.7%). FOB confirmed the diagnoses of lung malignancy, bacterial pneumonia, and pulmonary tuberculosis in 45.5%, 31.6%, and 18.6% of the respective suspected diagnostic categories. Twenty-four (85.7%) cases of confirmed pulmonary tuberculosis and 45 (80.4%) cases of confirmed lung malignancy were rightly suspected by the clinician prior to bronchoscopy. Overall, the diagnosis could be established in 142 (44.1%) cases with the help of FOB. Conclusion: Bronchoscopy could establish a diagnosis in less than half of the cases. The commonest suspected pre-bronchoscopy clinical diagnosis was pulmonary tuberculosis, but the commonest confirmed post-bronchoscopy diagnosis was bacterial pneumonia. Lung malignancy category had the best correlation between pre-bronchoscopy and post-bronchoscopy diagnosis.

Introduction: Anemia in pregnancy is a ubiquitous problem, more so in the developing countries. Many of the changes that accompany blood loss appear later, rather than sooner, because obstetric patients are usually young fit adults with an expanded blood volume. In such cases, the needs for blood transfusions mainly depend on the clinical condition rather than the preoperative value of the hemoglobin (Hb) and blood loss. This is usually due to the tolerance of these chronic anemia patients to the accompanying blood loss. Aim: This study was aimed to see how frequently the patients actually received blood perioperatively. Material and Methods: This was a retrospective analysis of patients who underwent emergency cesarean sections. A total of 303 patients underwent emergency cesareans with Hb <8.5 g% over a period of 18 months in our hospital. These patients divided into three groups based on Hb status, Group I <7 g%, Group II 7-8 g%, and Group III >8 g%. Patients in each group were studied regarding the perioperative blood transfusion, any multiple units received, and complications encountered Results: In Group I, blood transfusion done in 88% cases fell drastically to 30% in Group II and 20% in Group III. No significant complications were noted and all patients were discharged without any morbidity. Conclusions: The lower cutoff value of Hb level for an emergency surgery remains a big enigma, which needs further evaluation. Clinical judgment in conjunction with the monitoring of tissue oxygen delivery determines the individual patient's transfusion trigger, and not the use of categorical magic number. Parturient women tend to have lower hematocrit values due to physiological changes and dilutional effect, but they still can tolerate this chronic anemia without any ill effects. This may be one of the reasons for the reduced need for blood transfusion in our study and also for the successful outcome in spite of severe anemia.

Background: The cephalograms are invaluable in diagnosis, treatment planning, and evaluation of treatment results. Digital cephalograms have several advantages. Conventional cephalograms can be converted to digital format by scanning on a flatbed scanner. More recently it was reported that conventional cephalograms photographed with a digital camera can be used for doing cephalometric analysis. However, the accuracy of the measurements is not very clear. Aim: To compare the accuracy of angular and linear measurements obtained from scanned and photographed images of conventional cephalograms with that of manually traced original cephalograms. Materials and Methods: Twenty cephalograms of patients taken in natural head position (NHP) were converted to digital format by scanning on a flatbed scanner and also were photographed with a high resolution digital camera. Both images were digitized with Vista Dent OC Imaging ^TM cephalometric software. Customized cephalometric analysis was performed on both images, and the measurements were recorded. Results: Statistical analysis was done using paired Student's t-test and intraclass correlation coefficient tests. The results showed that; 1. There was significant distortion when analog cephalograms were converted to digital format by photographing. 2. Scanned images were more comparable to the original cephalograms than photographed images. 3. Among the linear and angular measurements, linear measurements showed significant variation than angular measurements. Conclusion: It is acceptable to use digital photographs of cephalograms if angular measurements are primarily required. However, these images might not be acceptable if linear measurements are needed.

Aim: The aim of this study was to evaluate the applicability of the Tanaka-Johnston and Moyer's methods for predicting the size of permanent canines and premolars in Nalgonda population. Materials and Methods: 200 sets of dental casts (13-16 years) of the permanent dentition with no detected abnormalities were obtained from children attending in and around the schools of Nalgonda. The actual mesiodistal crown diameters were measured with digital vernier calipers (Zoom, Japan) to accuracy of 0.01 mm. The actual values were then compared with the predicted values derived from the Tanaka and Johnston equations and Moyer's probability tables. Correlation and linear regression analyses were performed between the predicted and the actual tooth size and standard regression equations were developed. Results: In the present study, Tanaka and Johnston regression equation overestimated the mesiodistal widths of permanent canine and premolars (P < 0.001). At all probability levels in Moyers prediction table, there was no statistical difference between the actual and predicted mesiodistal widths of maxillary and mandibular canines and premolars. Conclusion: Tanaka and Johnston analysis overestimated the actual widths of the unerupted canines and premolars in the maxillary and mandibular arches of male and female subjects of Nalgonda population. New standardized regression equations were formulated for the prediction of the mesiodistal widths of unerupted canines and premolars. Moyer's prediction tables can be used at all probability levels for male and female subjects of Nalgonda.

Skeletal dysplasias constitute a heterogeneous group of bone growth disorders resulting in abnormal shape and size of the skeleton. Thanatophoric dysplasia (TD) is one of the rare, lethal osteochondrodysplasia. A 28-year-old, healthy, non-consanguineously married woman with history of one previous abortion was brought to the hospital at 26 weeks of gestation for antenatal evaluation. Ultrasound examination showed a single live fetus with biparietal diameter corresponding to 26 weeks of gestation. Femur, humerus, and other long bones were very short with femoral length corresponding to 16-18 weeks. The thoracic cavity was small and irregular. Based on these findings, a diagnosis of lethal bony dysplasia was offered. Medical termination of pregnancy was performed at 28 weeks of gestation. Post mortem autopsy and radiological examination confirmed the diagnosis. This case report emphasizes the need into the insight regarding the problem of congenital malformations and their early prenatal diagnosis, which will aid in an alternative option of termination of pregnancy when an affected fetus is detected. Genetic counseling and evaluation of the prognosis on the basis of molecular results should be considered an important issue.

Patient with Down's syndrome (DS) are found to have an increased risk of developing various hematological disorders. There is 46- to 83-fold increased risk of acute myeloid leukemia (AML) and 10- to 27-fold increased risk of acute lymphoid leukemia (ALL). One of the most characteristics feature of Down syndrome associated AML (DS-AML) is that vast majority of case (c.70%) of AML in DS are megakaryoblastic i.e. M7 as per FAB classification (DS- AMKL). Virtually, all cases of DS-AMKL occur within the first 5 years of life. The median age of presentation of AMKL is 1.8 years. We report a case of AMKL in a newborn with Down's syndrome.

Hepatic encephalopathy is a serious life-threatening complication of liver disease. It is often associated with hypoglycemia in majority of cases. However, we report the case of a 3-year-old boy with hepatitis-B-virus-related chronic liver disease who presented with hepatic encephalopathy stage-three precipitated by malaria, who developed hyperglycemia while on admission. He was hepatitis B surface antigen positive and had two pluses (++) of Plasmodium falciparum malaria parasitaemia on peripheral film with deranged liver function tests and elevated serum lipase. He was managed conservatively; later, after recovering completely he was discharged home.

Meckel's diverticulum occurs in about 1-3% of the general population. The majority of them are asymptomatic and incidentally identified at laparotomy. The most common complication due to Meckel's diverticulum in adults is intestinal obstruction. Phytobezoar is a concretion of poorly digested fruit and vegetable fibres that is found in the stomach commonly causing symptoms varying from dyspepsia to epigastric mass. Phytobezoars can rarely cause small intestinal obstruction. Herein, we have reported a case of phytobezoar in Meckel's diverticulum presenting as small bowel obstruction in a 38-year-old female.

Spontaneous rupture of an abdominal hernia is rare and usually occurs in incisional or recurrent groin hernia. The hernial contents can be covered primarily by mesh repair if the general condition of the patient and local condition of the operative site allows it or it can be covered by skin followed by delayed mesh repair. We report a case of spontaneous rupture of incisional hernia with transection of small bowel and perforation in a 60-year-old woman who had developed hernia following a cesarean operation and was managed by resection and end-to-end anastomosis and herniorrhaphy.

Teeth are important structures in the oral cavity with many associated functions. Loss of teeth may be inevitable due to several reasons. Replacement of teeth should be done to restore the functions like mastication, phonetics, and esthetics. In present day, many treatment options are available, among them treatment with implants had evolved as a major choice. Among all types of implants, endosseous implants had gained more importance than any other type of implants. In present case report, patient wearing conventional denture was successfully treated with implant-supported prosthesis.

Periodontitis is a disease characterized by varying the amount of bone loss and the regeneration of the bone structure, which is lost, is an uphill task. Grafts have been used extensively for regeneration, but each of these materials has its own limitations. No single alternative graft material except autograft provides all three components (osteoconduction, osteoinduction and osteogenic cells) for bone regeneration. The clinical applications for each type of material are dictated by its particular biochemical and structural properties. In situations where the grafting site is compromised, composite grafts consisting of several materials have been used, with a successful outcome. A non-contained defect was treated with de-mineralized bone matrix (Xenograft with Type I collagen granules), hydroxyapatite mixed with peripheral blood (PB) and Type I collagen guided tissue regeneration membrane was used to cover and stabilize the graft. Treatment was done using resorbable membrane and composite graft mixed with PB. Dramatic reduction in pocket depth, with radio opacity and outstanding bone fill was seen at the end of the treatment.

Successful treatment of cleft lip and palate requires a multidisciplinary approach from birth to adulthood. This article discusses the problem based diagnosis and treatment approach in an adolescent with a repaired cleft lip and untreated cleft palate. A treatment plan was developed to address the chief complaint of the patient. Maxillary expansion was done with a bonded hyrax screw rather than a quad helix, so as to shorten the pre-surgical treatment time followed by surgical closure of the oronasal fissure.