With improvement in economic and social conditions and the use of effective anti-tuberculous ther... more With improvement in economic and social conditions and the use of effective anti-tuberculous therapy, the developed nations and most developing nations have enjoyed a decline in tuberculosis (TB) for several decades. However, over ten million cases of TB are reported annually and TB continues to kill nearly two million people each year. Extrapulmonary TB comprises 15–30% of new TB cases, and tuberculous lymphadenitis is an important manifestation. Tuberculous cervical lymphadenitis, or scrofula, accounts for at least 70% of TB cases involving the head and neck. The majority of cases occur without systemic symptoms or concurrent pulmonary TB. In addition to cervical lymphadenitis, tuberculosis can produce isolated disease in the oral cavity, ear, salivary glands, mandible, nose, and larynx. These infections can have various manifestations and it is important for the clinician to recognize and diagnose head and neck TB promptly. This chapter reviews the epidemiology, clinical manifest...
Suppurative fungal infection of the thyroid is an extremely rare condition even more so in an imm... more Suppurative fungal infection of the thyroid is an extremely rare condition even more so in an immunocompetent patient. Fungal infections of the thyroid usually occur in immunocompromised patients with hematological malignancies, recipients of bone marrow and solid organ allografts on immunosuppression, and patients with AIDS. A 65-year-old male presented with swelling in the front of the neck for 2 years. Examination revealed a cm non-tender, firm swelling of the right lobe of the thyroid. The patient was taken up for a subtotal thyroidectomy. Intra-operatively, an abscess cavity with pus was found in the right lobe of the thyroid. Histopathology revealed features of fungal abscess and staining demonstrated fungal hyphae characteristic ofAspergillusssp.
Objective. To define otomycosis and determine the predisposing factors and microbiology in primar... more Objective. To define otomycosis and determine the predisposing factors and microbiology in primary otomycosis.Study Design. Prospective study of two years and review of the literature.Setting. Academic Department of Otolaryngology in a coastal city in India.Patients. 150 immunocompetent individuals of whom 100 consecutive patients with a clinical diagnosis of otomycosis are considered as the study group and 50 consecutive patients with no otomycosis are considered as the control group.Results and Observations. Instillation of coconut oil (42%), use of topical antibiotic eardrops (20%), and compulsive cleaning of external ear with hard objects (32%) appeared to be the main predisposing factors in otomycosis. Aspergilli were the most common isolates (80%) followed byPenicillium(8%),Candida albicans(4%),Rhizopus(1%), andChrysosporium(1%), the last being reported for the first time in otomycosis. Among aspergilli,A. nigercomplex (38%) was the most common followed byA. fumigatuscomplex (...
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2011
To determine the clinical features, investigations, intra-operative findings, surgical approaches... more To determine the clinical features, investigations, intra-operative findings, surgical approaches used and the results of the treatment for paragangliomas of the head and neck. Retrospective study of 14 cases of paragangliomas in head and neck seen over a period of 10 years including five carotid body tumors, seven glomus jugulares and two glomus tympanicums. HRCT scans and bilateral carotid angiography were done in all cases of glomus jugulare. Pre-operative embolization was done in most cases. The trans-cervical approach was used for all cases of carotid body. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare tumors. Postaural tympanotomy approach was used for both patients with glomus tympanicum. In one case of extratympanic glomus jugulare tumor with hypoglossal palsy, a neck exploration was done to isolate and excise the tumor. Five patients with carotid body tumors presented as unila...
Most thyroglossal duct cysts are located at or very close to the midline. They generally manifest... more Most thyroglossal duct cysts are located at or very close to the midline. They generally manifest as painless neck swellings, and they move on protrusion of the tongue and during deglutition. We describe a case of thyroglossal duct cyst that was unusual in that the cyst was located far from the midline, it did not move on protrusion of the tongue, and it was associated with symptoms of dysphagia and extensive neck swelling that mimicked a colloid goiter.
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2008
Laryngoceles usually present as cervical masses with or without hoarseness of voice. They are mos... more Laryngoceles usually present as cervical masses with or without hoarseness of voice. They are mostly unilateral and may be symptomatic or asymptomatic. They are classified as internal, external or combined. They have been described to be an occupational hazard among wind instrument players or glass blowers. They also occur in association with neoplasms of the larynx. Here we report five patients with laryngoceles of whom two had bilateral laryngoceles, which are very rare. One patient had associated laryngeal malignancy for which total laryngectomy was performed. Two cases underwent excision via cervical approach. The rest were managed conservatively. Symptomatic cases have to be managed surgically while asymptomatic ones may be managed conservatively.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2011
Arterio-venous (A-V) malformations of the ear are uncommon lesions. While most are secondary to t... more Arterio-venous (A-V) malformations of the ear are uncommon lesions. While most are secondary to trauma, spontaneous lesions are very rare. A-V malformations anywhere in the body can have a range of clinical effects from mild disfigurement to cardiac failure. Treatment of these lesions poses a challenge to the surgeon due to their extreme vascularity and high incidence of recurrence. Highly selective arterial embolization and surgical resection offer the best chance for cure. In this article, the authors present a case of acquired A-V malformation of the ear, which was treated successfully by surgical excision without pre-operative embolization with no recurrence on follow-up proving that in areas of easy and superficial access, a preoperative embolization need not be routinely carried out in cases of small to medium sized vascular tumors.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2009
Purpose To investigate cases of trauma in head and neck region; to elucidate the characteristic p... more Purpose To investigate cases of trauma in head and neck region; to elucidate the characteristic problems in a developing country. Design and setting Prospective study; 324 patients with trauma related to head and neck analysed in a tertiary care center from August 1999 to August 2005 Results 33.6% of patients fell in 21-30 year age group. Road traffi c accidents (41.4%) were the most common cause of trauma. Nasal bone fractures were the most common fractures. 72.84% presented with bleeding and 72.22% with pain. 92.9% had tenderness. Only 15% of the patients could afford a CT scan. Plain radiograph diagnosed fractures in 83.33% of cases. ORIF was the treatment of choice in cases of fractures of the zygoma, maxilla and mandible. Open reduction and internal fi xation (ORIF) gave good long-term results with satisfactory cosmosis. Most of our patients did not have any signifi cant sequelae. Cerebral concussion was the most common associated injury (35.48%). Conclusion In developing countries, one cannot follow the approaches used for RTAs in developed countries. Treating surgeons will have to select investigation tools and treatment options according to the socioeconomical and cultural variations, which differ from country to country, and also within different parts of the country. Keywords Trauma Road traffi c accidents (RTA) Assault Fractures Open reduction and internal fi xation (ORIF) Closed reduction Cosmesis
Bear attacks are reported from nearly every part of the world. The chance of a human encountering... more Bear attacks are reported from nearly every part of the world. The chance of a human encountering a bear increases as the remote bear territory diminishes. The sloth bear is one of the three species of bears found in India, which inhabits the forests of India and its neighboring countries. Here we describe a teenager who came to us with a critical injury involving the face, temporal and occipital bones inflicted by a sloth bear attack. He underwent a temporal exploration, facial nerve decompression, pinna reconstruction, and occipital bone repair to save him from fatality.
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2011
To estimate the average operative blood loss in tonsillectomy and adenotonsillectomy and the vari... more To estimate the average operative blood loss in tonsillectomy and adenotonsillectomy and the various factors affecting it. A prospective study of estimation of blood loss in 100 patients who underwent tonsillectomy and adenotonsillectomy. Data collected included the age, sex, operative indication, clotting time, Hb levels and usage of pre-operative antibiotics. Cold knife dissection method for tonsillectomy and curettage method for adenoidectomy were used. Measurement by calorimetric method of estimation being simple and accurate was used for estimation. Study undertaken at a tertiary referral hospital catering to an urban, semi-urban and rural populace. Blood loss was more in males and increases as age advances both in adenotonsillectomy and tonsillectomy. Blood loss was more in fibrosed tonsils, at lower hemoglobin levels and at higher clotting times. It was less in cases who received pre-operative antibiotics. The average blood losses in males and females during tonsillectomy wer...
Objective:We report an advanced presentation of osteomyelitis of the temporal bone secondary to m... more Objective:We report an advanced presentation of osteomyelitis of the temporal bone secondary to malignant otitis externa.Method:We present a case report and a review of the world literature concerning osteomyelitis of the temporal bone secondary to malignant otitis externa.Results:A 60-year-old diabetic man developed osteomyelitis of the temporal bone and a temporoparietal abscess as advanced complications of malignant otitis externa. He was successfully treated in our institution using a post aural incision after draining the abscess and excising the fistula, a modified radical mastoidectomy with canal wall down procedure with sequesterectomy and debridement of surrounding area done.Conclusion:The terms ‘osteomyelitis of the temporal bone’, ‘skull base osteomyelitis’ and ‘malignant otitis externa’ have not been clearly defined, and have in the past often been used interchangeably in the literature. Osteomyelitis of the temporal bone can occur secondary to malignant otitis externa, ...
A clinically useful test for eustachian tube function (ETF) is still lacking. Here we plan to eva... more A clinically useful test for eustachian tube function (ETF) is still lacking. Here we plan to evaluate the mucociliary function of the ET by saccharin and methylene blue test, and compare the outcome of surgery with normal and abnormal ET functions. STUDY DESIGN: Case series with planned data collection.
All bones of the facial skeleton and spine are susceptible to osteomyelitis due to various predis... more All bones of the facial skeleton and spine are susceptible to osteomyelitis due to various predisposing conditions. Current radiological tools are sufficient to provide adequate diagnosis. Treatment can be conservative resection of the diseased bone with adequate clearance in all cases except in cases of osteomyelitis due to osteoradionecrosis (ORN) where resection has to be more radical. In today's antibiotic era, osteomyelitis in the head and neck is a rare occurrence. Dealing with osteomyelitis in head and neck bones is not the same as in other bones of the body due to the nature of the bones, complex anatomy of the region, and esthetics. Our purpose was to analyze the behavior of osteomyelitis in the head and neck bones and its management. A total of 84 cases of osteomyelitis in head and neck were reviewed in a 10-year period. Pus for culture, antibiotic sensitivity, and radiology were the main investigations. A medical line of treatment was effective in acute cases. Surgery was opted for in chronic cases. Mandible, frontal bone, cervical spine, maxilla, temporal bones, and nasal bones were involved, in descending order of frequency, i.e. the mandible was the most common bone affected. Nine patients were diagnosed as having acute osteomyelitis (11%); 75 were diagnosed as having chronic osteomyelitis (89%). Radiation-induced ORN leading to osteomyelitis was the most common cause of osteomyelitis of the mandible (13 of the 32 cases; 41%). Odontogenic infections and chronic sinusitis each gave rise to osteomyelitis in 3 of 10 cases (30%) of the patients with osteomyelitis of the maxilla. Chronic sinusitis was the main cause of frontal bone osteomyelitis in all 20 cases (100%). Tuberculosis (10 of 15 cases; 67%) and malignancy (5 of 15 cases; 33%) were the main predisposing factors in cervical spine osteomyelitis. Malignant external otitis (MEO) with diabetes mellitus was an underlying factor in all four cases of osteomyelitis of the temporal bone. Of the 18 patients with a diagnosis of ORN, the mandible was found to be the most susceptible bone (13 cases; 72%), followed by the maxilla (four cases; 22%) and cervical spine (1 case). Acute osteomyelitis responded to antibiotics. Sequestrectomy was carried out in all chronic cases but in cases of ORN more radical surgery was performed.
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2005
With the global immunization programme of children there is a progressive decline in the number o... more With the global immunization programme of children there is a progressive decline in the number of diphtheria cases. It is a disease commonly affecting the children caused by Corynebacterium diphtheriae usually affecting the mucous membrane of the nose, pharynx or larynx. Cutaneous diphtheria is a rare entity. We present a rare case of cutaneous diphtheria in a 15-year-old boy with nasal pharyngeal and laryngeal involvement. The patient developed anaphylactic reaction to antidiphtheritic serum (ADS) during treatment, all of which were managed successfully.
With improvement in economic and social conditions and the use of effective anti-tuberculous ther... more With improvement in economic and social conditions and the use of effective anti-tuberculous therapy, the developed nations and most developing nations have enjoyed a decline in tuberculosis (TB) for several decades. However, over ten million cases of TB are reported annually and TB continues to kill nearly two million people each year. Extrapulmonary TB comprises 15–30% of new TB cases, and tuberculous lymphadenitis is an important manifestation. Tuberculous cervical lymphadenitis, or scrofula, accounts for at least 70% of TB cases involving the head and neck. The majority of cases occur without systemic symptoms or concurrent pulmonary TB. In addition to cervical lymphadenitis, tuberculosis can produce isolated disease in the oral cavity, ear, salivary glands, mandible, nose, and larynx. These infections can have various manifestations and it is important for the clinician to recognize and diagnose head and neck TB promptly. This chapter reviews the epidemiology, clinical manifest...
Suppurative fungal infection of the thyroid is an extremely rare condition even more so in an imm... more Suppurative fungal infection of the thyroid is an extremely rare condition even more so in an immunocompetent patient. Fungal infections of the thyroid usually occur in immunocompromised patients with hematological malignancies, recipients of bone marrow and solid organ allografts on immunosuppression, and patients with AIDS. A 65-year-old male presented with swelling in the front of the neck for 2 years. Examination revealed a cm non-tender, firm swelling of the right lobe of the thyroid. The patient was taken up for a subtotal thyroidectomy. Intra-operatively, an abscess cavity with pus was found in the right lobe of the thyroid. Histopathology revealed features of fungal abscess and staining demonstrated fungal hyphae characteristic ofAspergillusssp.
Objective. To define otomycosis and determine the predisposing factors and microbiology in primar... more Objective. To define otomycosis and determine the predisposing factors and microbiology in primary otomycosis.Study Design. Prospective study of two years and review of the literature.Setting. Academic Department of Otolaryngology in a coastal city in India.Patients. 150 immunocompetent individuals of whom 100 consecutive patients with a clinical diagnosis of otomycosis are considered as the study group and 50 consecutive patients with no otomycosis are considered as the control group.Results and Observations. Instillation of coconut oil (42%), use of topical antibiotic eardrops (20%), and compulsive cleaning of external ear with hard objects (32%) appeared to be the main predisposing factors in otomycosis. Aspergilli were the most common isolates (80%) followed byPenicillium(8%),Candida albicans(4%),Rhizopus(1%), andChrysosporium(1%), the last being reported for the first time in otomycosis. Among aspergilli,A. nigercomplex (38%) was the most common followed byA. fumigatuscomplex (...
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2011
To determine the clinical features, investigations, intra-operative findings, surgical approaches... more To determine the clinical features, investigations, intra-operative findings, surgical approaches used and the results of the treatment for paragangliomas of the head and neck. Retrospective study of 14 cases of paragangliomas in head and neck seen over a period of 10 years including five carotid body tumors, seven glomus jugulares and two glomus tympanicums. HRCT scans and bilateral carotid angiography were done in all cases of glomus jugulare. Pre-operative embolization was done in most cases. The trans-cervical approach was used for all cases of carotid body. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare tumors. Postaural tympanotomy approach was used for both patients with glomus tympanicum. In one case of extratympanic glomus jugulare tumor with hypoglossal palsy, a neck exploration was done to isolate and excise the tumor. Five patients with carotid body tumors presented as unila...
Most thyroglossal duct cysts are located at or very close to the midline. They generally manifest... more Most thyroglossal duct cysts are located at or very close to the midline. They generally manifest as painless neck swellings, and they move on protrusion of the tongue and during deglutition. We describe a case of thyroglossal duct cyst that was unusual in that the cyst was located far from the midline, it did not move on protrusion of the tongue, and it was associated with symptoms of dysphagia and extensive neck swelling that mimicked a colloid goiter.
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2008
Laryngoceles usually present as cervical masses with or without hoarseness of voice. They are mos... more Laryngoceles usually present as cervical masses with or without hoarseness of voice. They are mostly unilateral and may be symptomatic or asymptomatic. They are classified as internal, external or combined. They have been described to be an occupational hazard among wind instrument players or glass blowers. They also occur in association with neoplasms of the larynx. Here we report five patients with laryngoceles of whom two had bilateral laryngoceles, which are very rare. One patient had associated laryngeal malignancy for which total laryngectomy was performed. Two cases underwent excision via cervical approach. The rest were managed conservatively. Symptomatic cases have to be managed surgically while asymptomatic ones may be managed conservatively.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2011
Arterio-venous (A-V) malformations of the ear are uncommon lesions. While most are secondary to t... more Arterio-venous (A-V) malformations of the ear are uncommon lesions. While most are secondary to trauma, spontaneous lesions are very rare. A-V malformations anywhere in the body can have a range of clinical effects from mild disfigurement to cardiac failure. Treatment of these lesions poses a challenge to the surgeon due to their extreme vascularity and high incidence of recurrence. Highly selective arterial embolization and surgical resection offer the best chance for cure. In this article, the authors present a case of acquired A-V malformation of the ear, which was treated successfully by surgical excision without pre-operative embolization with no recurrence on follow-up proving that in areas of easy and superficial access, a preoperative embolization need not be routinely carried out in cases of small to medium sized vascular tumors.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2009
Purpose To investigate cases of trauma in head and neck region; to elucidate the characteristic p... more Purpose To investigate cases of trauma in head and neck region; to elucidate the characteristic problems in a developing country. Design and setting Prospective study; 324 patients with trauma related to head and neck analysed in a tertiary care center from August 1999 to August 2005 Results 33.6% of patients fell in 21-30 year age group. Road traffi c accidents (41.4%) were the most common cause of trauma. Nasal bone fractures were the most common fractures. 72.84% presented with bleeding and 72.22% with pain. 92.9% had tenderness. Only 15% of the patients could afford a CT scan. Plain radiograph diagnosed fractures in 83.33% of cases. ORIF was the treatment of choice in cases of fractures of the zygoma, maxilla and mandible. Open reduction and internal fi xation (ORIF) gave good long-term results with satisfactory cosmosis. Most of our patients did not have any signifi cant sequelae. Cerebral concussion was the most common associated injury (35.48%). Conclusion In developing countries, one cannot follow the approaches used for RTAs in developed countries. Treating surgeons will have to select investigation tools and treatment options according to the socioeconomical and cultural variations, which differ from country to country, and also within different parts of the country. Keywords Trauma Road traffi c accidents (RTA) Assault Fractures Open reduction and internal fi xation (ORIF) Closed reduction Cosmesis
Bear attacks are reported from nearly every part of the world. The chance of a human encountering... more Bear attacks are reported from nearly every part of the world. The chance of a human encountering a bear increases as the remote bear territory diminishes. The sloth bear is one of the three species of bears found in India, which inhabits the forests of India and its neighboring countries. Here we describe a teenager who came to us with a critical injury involving the face, temporal and occipital bones inflicted by a sloth bear attack. He underwent a temporal exploration, facial nerve decompression, pinna reconstruction, and occipital bone repair to save him from fatality.
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2011
To estimate the average operative blood loss in tonsillectomy and adenotonsillectomy and the vari... more To estimate the average operative blood loss in tonsillectomy and adenotonsillectomy and the various factors affecting it. A prospective study of estimation of blood loss in 100 patients who underwent tonsillectomy and adenotonsillectomy. Data collected included the age, sex, operative indication, clotting time, Hb levels and usage of pre-operative antibiotics. Cold knife dissection method for tonsillectomy and curettage method for adenoidectomy were used. Measurement by calorimetric method of estimation being simple and accurate was used for estimation. Study undertaken at a tertiary referral hospital catering to an urban, semi-urban and rural populace. Blood loss was more in males and increases as age advances both in adenotonsillectomy and tonsillectomy. Blood loss was more in fibrosed tonsils, at lower hemoglobin levels and at higher clotting times. It was less in cases who received pre-operative antibiotics. The average blood losses in males and females during tonsillectomy wer...
Objective:We report an advanced presentation of osteomyelitis of the temporal bone secondary to m... more Objective:We report an advanced presentation of osteomyelitis of the temporal bone secondary to malignant otitis externa.Method:We present a case report and a review of the world literature concerning osteomyelitis of the temporal bone secondary to malignant otitis externa.Results:A 60-year-old diabetic man developed osteomyelitis of the temporal bone and a temporoparietal abscess as advanced complications of malignant otitis externa. He was successfully treated in our institution using a post aural incision after draining the abscess and excising the fistula, a modified radical mastoidectomy with canal wall down procedure with sequesterectomy and debridement of surrounding area done.Conclusion:The terms ‘osteomyelitis of the temporal bone’, ‘skull base osteomyelitis’ and ‘malignant otitis externa’ have not been clearly defined, and have in the past often been used interchangeably in the literature. Osteomyelitis of the temporal bone can occur secondary to malignant otitis externa, ...
A clinically useful test for eustachian tube function (ETF) is still lacking. Here we plan to eva... more A clinically useful test for eustachian tube function (ETF) is still lacking. Here we plan to evaluate the mucociliary function of the ET by saccharin and methylene blue test, and compare the outcome of surgery with normal and abnormal ET functions. STUDY DESIGN: Case series with planned data collection.
All bones of the facial skeleton and spine are susceptible to osteomyelitis due to various predis... more All bones of the facial skeleton and spine are susceptible to osteomyelitis due to various predisposing conditions. Current radiological tools are sufficient to provide adequate diagnosis. Treatment can be conservative resection of the diseased bone with adequate clearance in all cases except in cases of osteomyelitis due to osteoradionecrosis (ORN) where resection has to be more radical. In today's antibiotic era, osteomyelitis in the head and neck is a rare occurrence. Dealing with osteomyelitis in head and neck bones is not the same as in other bones of the body due to the nature of the bones, complex anatomy of the region, and esthetics. Our purpose was to analyze the behavior of osteomyelitis in the head and neck bones and its management. A total of 84 cases of osteomyelitis in head and neck were reviewed in a 10-year period. Pus for culture, antibiotic sensitivity, and radiology were the main investigations. A medical line of treatment was effective in acute cases. Surgery was opted for in chronic cases. Mandible, frontal bone, cervical spine, maxilla, temporal bones, and nasal bones were involved, in descending order of frequency, i.e. the mandible was the most common bone affected. Nine patients were diagnosed as having acute osteomyelitis (11%); 75 were diagnosed as having chronic osteomyelitis (89%). Radiation-induced ORN leading to osteomyelitis was the most common cause of osteomyelitis of the mandible (13 of the 32 cases; 41%). Odontogenic infections and chronic sinusitis each gave rise to osteomyelitis in 3 of 10 cases (30%) of the patients with osteomyelitis of the maxilla. Chronic sinusitis was the main cause of frontal bone osteomyelitis in all 20 cases (100%). Tuberculosis (10 of 15 cases; 67%) and malignancy (5 of 15 cases; 33%) were the main predisposing factors in cervical spine osteomyelitis. Malignant external otitis (MEO) with diabetes mellitus was an underlying factor in all four cases of osteomyelitis of the temporal bone. Of the 18 patients with a diagnosis of ORN, the mandible was found to be the most susceptible bone (13 cases; 72%), followed by the maxilla (four cases; 22%) and cervical spine (1 case). Acute osteomyelitis responded to antibiotics. Sequestrectomy was carried out in all chronic cases but in cases of ORN more radical surgery was performed.
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2005
With the global immunization programme of children there is a progressive decline in the number o... more With the global immunization programme of children there is a progressive decline in the number of diphtheria cases. It is a disease commonly affecting the children caused by Corynebacterium diphtheriae usually affecting the mucous membrane of the nose, pharynx or larynx. Cutaneous diphtheria is a rare entity. We present a rare case of cutaneous diphtheria in a 15-year-old boy with nasal pharyngeal and laryngeal involvement. The patient developed anaphylactic reaction to antidiphtheritic serum (ADS) during treatment, all of which were managed successfully.
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Papers by Kishore Prasad