This article discusses the role of imaging and clinical endoscopic assessment in staging and managing laryngeal cancers. Laryngeal cancer accounts for about 30% of head and neck cancers and is more common in men. Imaging such as CT and MRI help identify the extent of tumor invasion and lymph node involvement, allowing for more accurate staging of cancers. This supports determining the appropriate treatment approach whether it be surgery, radiation therapy or chemotherapy. Accurate staging is important for prognosis and management of laryngeal cancers.

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9. 1. Role of Imaging and Clinico-Endoscopic Assessment in the Upstaging and Management of
Laryngeal Malignancies
Rashad Rafiq Mattoo, Sajad Majid Qazi, Basharat Rashid, Zubair Lone 1
2. A Precious Stone to Surgery: Al Zahrawi—A Literary Review
M.U.Z.N. Farzana, I. Al Tharique 17
3. Giant Primary Hydatid Cyst of Spleen—A Rare Clinical Entity
Dharmendra Kumar Pipal, Harmendra Kumar Pipal, Saurabh Kothari, Poojan Purohit,
Anupam Bhargava, Vibha Pipal 21
4. Comparison between Intravenous Injection of Iron Sucrose and Oral Administration of Iron for the
Treatment of Iron Deficiency Anemia in Pregnancy
Vineeta Yadav, R Nagarathanama, Nagendra Prasad 25
5. Sociodemographic Determinants of Tobacco Use among Patients Admitted in a Tertiary Care Hospital
Balamurugan G., Vijayarani M. 29
ContentsResearch & Reviews : Journal of Surgery

10. RRJoS (2016) 1-16 © STM Journals 2016. All Rights Reserved Page 1
Research & Reviews: Journal of Surgery
ISSN: 2319-3425(online), ISSN: 2349-3712(print)
Volume 5, Issue 3
www.stmjournals.com
Role of Imaging and Clinico-Endoscopic Assessment in the
Upstaging and Management of Laryngeal Malignancies
Rashad Rafiq Mattoo1,
*, Sajad Majid Qazi1
, Basharat Rashid2
, Zubair Lone1
1
Department of Otorhinolaryngology Head and Neck Surgery, Government Medical College,
Srinagar, Jammu and Kashmir, India
2
Department of Preventive and Social Medicine, National Institute of Unani Medicine, Kottigepalya,
Bengaluru, Karnataka, India
Abstract
Carcinomas of larynx are the very common primary head and neck malignancies. Cancer of
larynx accounts for 30 percent of all head and neck cancers. The American Cancer Society’s
most recent estimates for laryngeal cancer in the United States for 2013 are, about 12,260
new cases are laryngeal cancer, being 9680 in men and 2580 in women. Laryngeal cancer has
also a strong socioeconomic association, being twice as common in more deprived groups
compared to the more affluent groups. Anatomically larynx is divided three sub divisions and
certain potential spaces through which cancer tends to spread outside the site of its origin.
The causal relationship between alcohol and tobacco intake, genetic predisposition, diet, and
socioeconomic conditions in the development of squamous cell cancers of the head and neck
applies as well to laryngeal cancer. Site predilection for the origin of cancers of laryngeal
cancers being, glottic carcinoma 60 to 65%, supraglottic carcinoma 30 to 35% and subglottic
carcinoma less than 5%. Clinico-endoscopic evaluation can be undertaken with indirect
laryngoscopy, fibre optic laryngoscopy/telescopic laryngoscopy (700
hopkins) and direct
laryngoscopy. Imaging (USG, CECT±CEMRI) plays a significant complementary role to
clinical endoscopy in pretherapeutic staging of laryngeal malignancies. In present study,
patients of laryngeal malignancy were treated by radiotherapy or concurrent chemoradiation,
some by total laryngectomy with neck dissection and few by total laryngectomy with partial
pharyngectomy along with neck dissection and further some patients were treated by total
laryngectomy alone depending upon the best treatment options.
Keywords: Laryngeal carcinoma, clinico-endoscopic assessment, radiological imaging,
pretherapeutic staging
INTRODUCTION
Carcinomas of larynx are the very common
primary head and neck malignancies. Cancer
of larynx accounts for 30 percent of all head
and neck cancers [1]. The American Cancer
Society’s most recent estimates for laryngeal
cancer in the United States for 2013 are, about
12,260 new cases are laryngeal cancers being
9680 in men and 2580 in women. Squamous
cell carcinoma (SCC) is the most common
malignant neoplasm of the larynx. Regarding
site predilection for the origin of cancers of
laryngeal cancers being; glottic carcinoma
being 60 to 65%, supraglottic carcinoma 30 to
35% and subglottic carcinoma less than 5%
[2]. One of the most important influences on
prognosis is the presence of metastases to the
cervical lymph nodes. The causal relationship
between alcohol and tobacco intake, genetic
predisposition, diet, and socioeconomic
conditions in the development of squamous
cell cancers of the head and neck applies as
well to laryngeal cancer. Chemical
carcinogens in the workplace that relate to
laryngeal cancer include asbestos, nickel
compounds, and certain mineral oils. Glass-
wool has been associated with an increased
mortality for laryngeal cancer in an Italian
study [3].
Clinico-Endoscopic Evaluation
This can be undertaken with indirect
laryngoscopy (I/L), fibreoptic laryngoscopy
(FOL)/telescopic laryngoscopy (700
Hopkins)
and direct laryngoscopy. Office endoscopic
assessment of the larynx is more useful than

11. RRJoS (2016) 17-20 © STM Journals 2016. All Rights Reserved Page 17
Research & Reviews: Journal of Surgery
ISSN: 2319-3425(online), ISSN: 2349-3712(print)
Volume 5, Issue 3
www.stmjournals.com
A Precious Stone to Surgery: Al Zahrawi—A Literary
Review
M.U.Z.N. Farzana1,
*, I. Al Tharique2
1
Department of Amraz-e-Niswan wa Qabalat (Gynaecology and Obstetrics), Institute of Indigenous
Medicine, University of Colombo, Rajagiriya
2
Pharmacy Department (Unani), National Ayurvedic Teaching Hospital, Colombo, Sri Lanka
Abstract
Islamic medicine, also known as Arabic Medicine and Greeco-Arab medicine, refers to
medicine developed during the Golden Age of the Arab practiced within the Mediterranean as
well as most Islamic countries greatly. Then it is broadened from Spain to central Asia, India
and Sri Lanka. There was massive enlightenment in the Arab-Islamic world, during that time
Europe was very much embrace of the Dark Ages. The Renaissance of European science was
very much thankful to the affluent of the sciences by Islamic Golden Age. But, in the East, the
development of Muslim scholars developed botany, pharmacy, chemistry and science that the
Muslim world is given credit for science and medicine.
There are many scholars of Baghdad who translated and assimilated the Greek effort, while
incorporating their own experiences. The most eminent scholars such as Muhammad Ibn
Zakariya Al Razi, Ali Ibn Al Abbas Al Majoosi, Al Zahrawi, Al Tabbari, Abu Ali Ibn Sina, Ibn
Al Haitham, and Ibn Zuhar Ibn Rushdetc mostly contributed to the medicine in that era.
Various medical scientists were materialized in medieval period, but Al Zahrawi (934–
1013AD) was one of the greatest physicians at that time; especially he was the pioneers in the
surgery and his contribution in surgery not to concurrent with now.
Keywords: Al Zahrawi, surgery, Islamic medicine
INTRODUCTION
The dark period (8th
–15th
century) of European
scholars who were interested in science and
philosophy came to realize how much they
needed to learn from the Arab, because the
knowledge of science was nothing during that
era in Europe (dark period). Then they set
about studying Arab manuscripts in these
disciplines and translating the most importance
ones into Latin. There were a lot of
outstanding physicians such as Muhammed
Ibn Zakariya Al Razi or Razes (865–994), Abu
Ali Al Hussain Ibn Sina or Avicenna (981–
1037) who remarkably contributed to the
scientific treasure of this era, in the Arab
world [1]. Meanwhile, in the Western world,
the Muslim physicians and philosophers
strongly promoted the scientific movement
[2]. Abdul Qasim Al Zahrawi or Abucasis
(936–1013), Ibn Zuhr or Avenazoaz (1092–
1162) and Ibn Rushd or Averroes (1126–1198)
were the most eminent physicians in the
Western region [3].
Cordoba was the capital of Spain in the 9th
century which has several teaching institutions
and had the largest collection of books. When
someone complimented Sir Isaac Newton on
his outstanding scientific achievements, he is
reported to have said that he could see the
father, it was became he stood on the
shoulders of giants. Every field of human
endeavor, including science and medicine has
produced such giant figures. One such giant, in
the field of surgery in particular and in
medicine in general was Abul Qasim Khalaf
Ibn Al Abbas Al Zahrawi known as Albucasis,
whose monumental work played a vital role in
preserving and transmitting the scientific
legacy of the Greeks to Europe and in
enriching it by his own seminal
contributions [4].
BIOGRAPHY
Abul Qasim Khalaf Ibn Al Abbas Al Zahrawi
(936–1013AD) also known in the west as
Albucasis was born in the town of Al Zahra

12. RRJoS (2016) 21-24 © STM Journals 2016. All Rights Reserved Page 21
Research & Reviews: Journal of Surgery
ISSN: 2319-3425(online), ISSN: 2349-3712(print)
Volume 5, Issue 3
www.stmjournals.com
Giant Primary Hydatid Cyst of Spleen—A Rare Clinical
Entity
Dharmendra Kumar Pipal1,
*, Saurabh Kothari1
, Poojan Purohit1
, Anupam Bhargava1
,
Vibha Pipal2
1
Department of General Surgery, Dr. Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
2
Department of Gynaecology, Jodhpur, Rajasthan, India
Abstract
Hydatid cyst (echinococcosis) is a zoonotic disease, caused by infestation of larval form of
parasite of tapeworm, Echinococcus granulosus (eg). Humans are infected through faeco-oral
route by the ingestion of food and milk, contaminated by dog faeces containing the ova of
parasite or by direct contact with dog. Liver is the commonly involved organ (57.8%)
followed by the lungs (26.4%). The kidneys, spleen, brain, soft tissues of neck, appendix and
mesentery are less frequent sites. This case report describes the management of a huge
primary hydatid cyst of spleen in a 58-year-old female by en bloc splenectomy. A 58-year-old
female patient presented with complaining of pain abdomen and lump in left hypochondrium
FPR 6–7 months of duration. Per abdominal examination was in favour of splenomegaly.
Patient was further investigated by ultrasound (USG) abdomen and computed tomography
(CECT) abdomen and finally diagnosed as a case of large primary hydatid cyst. She was
treated surgically by en bloc splenectomy with preoperative and postoperative antihelminthic
drugs. Complete en bloc resection of spleen is reserved for gold standard treatment for
primary hydatid cyst of spleen as it results in complete removal of all parasite and parasitic
tissue from the body. Hydatid cyst of spleen is a rare disease but it should be considered as a
differential diagnosis in each case of splenic cyst especially in those geographical regions
where the disease is endemic. Once diagnosed a splenic hydatid, surgical management by
splenectomy is a gold standard treatment.
Keywords: Hydatid cyst, splenectomy, Echinococcus granulosus
INTRODUCTION
Hydatid disease is a major worldwide health
problem which is mainly encountered in sheep
and cattle raising area of the world and is
endemic in South America, Africa, Middle
East, Turkey, Southern Europe, India, New
Zealand and Australia. It is a zoonosis caused
by ingesting eggs of the parasite Echinoccocus
granulosus. Hydatid cyst is most frequently
found in the liver (60–70%), which act as a
first filter followed by lungs (30%) which acts
as a second filter. However it can, though rare,
occur in any organ primarily or in association
with hepatic or pulmonary or as multiorgan
hydatidosis such as muscles, bones, kidneys,
spleen, thyroid, pancreas, breasts etc. Dog is
the definitive host of example while sheep,
cattle and human beings are the intermediate
host. Splenic hydatid cyst is a rare entity, it
can occur primarily or in association with
hepatic, pulmonary or multiorgan hydatidosis.
Most of the cases of hydatid cysts are acquired
in childhood. It has a long latent period
ranging from 5–20 years. Splenic hydatid cyst
is a very uncommon event as the ova of
parasite get trapped in filters such as liver and
lungs before reaching to the systemic
circulation. The eggs of parasite escaped from
liver–lung barrier can result in splenic hydatid
cyst formation. Secondary hydatid cyst usually
follows systemic dissemination or by
intraperitoneal spread of ruptured liver hydatid
cyst or after surgery.
Hydatid cyst has three layers:
1. Adventitia (pseudocyst): It is an
inseparable fibrous tissue due to reaction
of liver/spleen to the parasite.
2. Laminated membrane (ectocyst): It is
formed by the parasite itself; is white,

13. RRJoS (2016) 25-28 © STM Journals 2016.All Rights Reserved Page 25
Research & Reviews: Journal of Surgery
ISSN: 2319-3425(online), ISSN: 2349-3712(print)
Volume 5, Issue 3
www.stmjournals.com
Comparison between Intravenous Injection of Iron
Sucrose and Oral Administration of Iron for the
Treatment of Iron Deficiency Anemia in Pregnancy
Vineeta Yadav*, R Nagarathanama, Nagendra Prasad
Department of Obstetrics and Gynecology, Rajarajeshwari Medical College, Bengaluru,
Karnataka, India
Abstract
The aim of this study was to compare the therapeutic benefits of intravenous iron and oral
iron administration for the treatment of iron deficiency anemia (IDA) in pregnancy. A total of
50 patients with gestational age between 25 and 35 weeks with established IDA with
Hemoglobin (Hb) 7–9 g/dl were randomized to receive either oral ferrous sulphate 200 mg
twice daily or required dose of intravenous iron sucrose 200 mg in 100 ml NS on alternate
days. The Hb level, hematocrit, mean corpuscular volume and packed cell volume were
measured at recruitment and on 1st
week, 3rd
week and at 37 weeks. Adverse drug reactions
were also noted in both the groups. Hb values varied drastically with time between the two
groups at 1st
week, 3rd
week and at term. Intravenous iron sucrose helped in treating IDA in
pregnancy more effectively than oral iron therapy, without any side effects or reactions.
Keyword: Iron deficiency anemia (IDA), iron sucrose, oral iron therapy
INTRODUCTION
Iron deficiency anemia (IDA) is the most
common nutritional deficiency in pregnant
women. As per the World Health Organization
(WHO), IDA is about 18% in developed
countries and 35–75% (average 56%) in
developing countries. Anemia is estimated to
affect 20–50% of the world’s population and
pregnancy is one of the most important risk
factors. The Centre for Disease Control and
Prevention defines anemia when hemoglobin
(Hb) and hematocrit values are less than 11
g/dl and 33% in the first and third trimester
and 10.5 g/dl and 32% in the second trimester
[1]. Globally, the prevalence of anemia is
55.9% with variations between developed and
developing countries. In India, prevalence
ranges between 33% and 89%. Estimates of
the worldwide prevalence of iron deficiency
anemia in pregnancy are much higher than
estimates in the developed world, due to
malnutrition and lack of prenatal iron
supplement programmes in underdeveloped
countries [2]. IDA has varied consequences on
both maternal and fetal wellbeing. Maternal
consequences include cardiovascular
symptoms, reduced physical and mental
performance, increased risk of infection, pre-
eclampsia, postpartum hemorrhage, blood
transfusions etc. Anemia is responsible for 40–
60% of maternal deaths in non-industrialized
countries. Fetal consequences are increased
risk of growth retardation, prematurity,
intrauterine death, pre-labour rupture of
membranes and infection [3]. The common
treatments of IDA include oral/parenteral iron
and blood transfusion. Oral iron administration
is associated with side effects and takes long
period of time for treatment. Parenteral
administration of iron dextran, iron sorbitol is
associated with anaphylactic reactions and
blood transfusions are associated with cross
reactions and viral infections [4]. Iron sucrose
has been shown to have several advantages
such as low incidence of side effects, high
availability for erythropoiesis, little renal
excretion and low tissue accumulation and
toxicity [5–7].
AIMS AND OBJECTIVES
To compare the efficacy and safety of
intravenous iron sucrose and oral iron
administration for the treatment of iron
deficiency anemia in pregnancy.

14. RRJoS (2016) 29-34 © STM Journals 2016.All Rights Reserved Page 29
Research & Reviews: Journal of Surgery
ISSN: 2319-3425(online), ISSN: 2349-3712(print)
Volume 5, Issue 3
www.stmjournals.com
Sociodemographic Determinants of Tobacco Use among
Patients Admitted in a Tertiary Care Hospital
Balamurugan G.1,
*, Vijayarani M.2
1
Department of Mental Health Nursing, M.S. Ramaiah Institute of Nursing Education and Research,
MSRIT Post, Bangalore, Karnataka, India
2
College of Nursing, Indiranagar, Bangalore, Karnataka, India
Abstract
Tobacco use is the most important contributor to morbidity and premature death among
modifiable lifestyle factors. More than five million of those deaths are the result of direct
tobacco use while more than 600 000 are the result of nonsmokers being exposed to second-
hand smoke and the annual death toll could rise to more than eight million by 2030. A cross-
sectional survey was conducted where males and females of 18–65 years of age who were
admitted and gave informed consent, were included in the study. Sample size (398) was based
on an estimated prevalence of tobacco use of 23–47%, confidence interval 95%, and precision
15% in Master sample size estimation software 2.0. Males and females between 18–65 years
of age, who were admitted as inpatient atleast for 24 h, able to speak and willing to
participate in the study, were included. Self-reported daily tobacco use questionnaire was
administered through face to face interview. Bivariate analysis was done for each variable
under study in relation to daily tobacco use. Unadjusted Odds ratios and 95% confidence
intervals were obtained. Variables of interest such as age, gender, religion, and
socioeconomic status were put in the regression model. Overall 28.6% of the study population
(20.8% men and 7.7% women) was using tobacco on a daily basis. Among the tobacco users,
the various modes by which tobacco was consumed included cigarette smoking (45.6%),
beedies (22.8%), Kutka (18.4%) and tobacco leaves (26.3%). The present study suggests that
preventive message needs to be modified to make the tobacco control more effective.
Keywords: Tobacco, prevention, smokeless, abuse, lifestyle
BACKGROUND
One of the major problems the society is
facing is the increasing substance use and
abuse [1]. Despite many studies of this
problem, there is still little understanding of
the causes, appropriate treatment and, most
importantly, successful approaches to
prevention [2]. Tobacco serves as the gateway
to drug addiction—addicts progress from one
drug to the next, which is usually more potent
and hazardous than the previous one [3]. In
India, tobacco chewing is also prevalent,
whereas in other parts of the world, smoking is
more common [1].
Tobacco use is the most important contributor
to morbidity and premature death among
modifiable lifestyle factors [4]. Tobacco use
and exposure comes in both smokeless and
smoking forms. Smokeless tobacco is
consumed in unburnt forms through chewing
or sniffing and contains several carcinogenic,
or cancer-causing, compounds. Smoking
tobacco, by far the most commonly used form
globally, contains over 4000 chemicals, of
which 50 are known to be carcinogenic [5].
Tobacco kills up to half of its users, i.e., nearly
6 million people each year. More than five
million of those deaths are the result of direct
tobacco use while more than 600 000 are the
result of nonsmokers being exposed to second-
hand smoke and the annual death toll could
rise to more than eight million by 2030 [6].
India, with a population of 1.2 billion,
currently has around 275 million tobacco
users, and it may increase up to 1.5 billion by
2020 [7].
Factors which push the population to the risk
of tobacco use need to be found out and
preventive strategies devised accordingly [8].

15. (RRJoS) ISSN 2319-3425 ( Online)
ISSN 2349-3712 (Print)
Surgery
Research & Reviews
Journal of
conducted
Ch Instrumentation/ /
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Energy Science/ /
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