Objective Tandem occlusions involving both the extracranial internal carotid artery (ICA) and an intracranial artery typically respond poorly to intravenous (IV) tissue plasminogen activator (t-PA). We retrospectively review our experience with proximal ICA stenting and stent-assisted thrombectomy of the distal artery. Methods The data included patients that underwent carotid stenting and mechanical thrombectomy between 2012–2013. Radiographic, clinical, and procedural data were drawn from case notes, imaging records and discharge reports. Clinical outcomes were evaluated using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRs). Results Seven patients, with a mean age of 66.4 years and a mean admission NIHSS of 18.3, underwent this procedure and were included. Each presented with an occlusion of the proximal ICA, with additional occlusions of the ICA terminus ( n = 3), middle cerebral artery ( n = 5), or anterior cerebral artery ( n = 1). Recanalisation of all identified occlusions was achieved in all patients, with a Thrombolysis in Myocardial Infarction (TIMI) score of 3 and a Thrombolysis in Cerebral Infarction (TICI) score >2b achieved in each case. Mean time from onset of stroke symptoms to recanalisation was 287 min; mean time from first angiography to recanalisation was 52 min. Intracranial haemorrhages occurred in two patients, with no increase in NIHSS. There were no mortalities. Mean NIHSS at discharge was 4.9, and mRs at 90 days was one in all patients. Conclusions Treatment of tandem extracranial ICA and intracranial occlusions in the setting of acute ischaemic stroke with extracranial carotid artery stenting followed by adjunctive intracranial mechanical thrombectomy is both safe and effective, but further evaluation of this treatment modality is necessary.

<p class="abstract"><strong>Background:</strong> The objective of the study was <span lang="EN-IN">to evaluate the role of radiological imaging in correlation with clinical finding in assessing the severity of nasal and paranasal diseases and in differentiating benign pathologies from malignant sinonasal masses. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">In this study 50 patients with complaints of nasal obstruction , nasal discharge, epistaxis were subjected to detailed clinical examination and evaluated radio logically with X ray PNS, CT and MRI of PNS and biopsy taken from nasal and paranasal masses for histopathological confirmation. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The main presenting complaints were nasal obstruction (82%) followed by nasal discharge (66%), headache and allergic symptoms (52%). The most common type of disease involving nose and paranasal sinuses was inflammatory disease (86%), followed by benign disease (10%) and malignant disease were found in (4%) of cases. The most common benign disease involving nose and paranasal sinuses were inverted papilloma (80%), followed by hemangioma of nasal septum (20%). The most common radiological pattern of sinus involvement is osteomeatal type seen in 38% of cases, followed by unclassified pattern in 23.8%.Maxillary sinuses were most commonly involved in the study 82% cases. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">CT is the modality of choice in imaging the paranasal sinuses for evaluating the chronic diseases and associated complication and provides a reliable pre-operative road map. MR imaging plays a critical role in evaluation of sino nasal tumors.</span></p>

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Multivariate statistical techniques were employed for monitoring of ground-surface water interactions in rivers. The river Varuna is situated in the Indo-Gangetic plain and is a small tributary of river Ganga. The study area was monitored at seven sampling sites for 3 years (2010-12), and eight physio-chemical parameters were taken into account for this study. The data obtained were analysed by multivariate statistical techniques so as to reveal the underlying implicit information regarding proposed interactions for the relevant area. The principal component analysis (PCA) and cluster analysis (CA), and the results of correlations were also studied for all parameters monitored at every site. Methods used in this study are essentially multivariate statistical in nature and facilitate the interpretation of data so as to extract meaningful information from the datasets. The PCA technique was able to compress the data from eight to three parameters and captured about 78.5% of the total variance by performing varimax rotation over the principal components. The varifactors, as yielded from PCA, were treated by CA which grouped them convincingly into three groups having similar characteristics and source of contamination. Moreover, the loading of variables on significant PCs showed correlations between various ground water and surface water (GW-SW) parameters. The correlation coefficients calculated for various physiochemical parameters for ground and surface water established the correlations between them. Thus, this study presents the utility of multivariate statistical techniques for evaluation of the proposed interactions and effective future monitoring of potential sites.

This study shows that therapeutic and preventive measures correctly instituted have significantly reduce the mortality, particularly with reference to cardiac and infectious causes. The discrepancy between antemortem and post-mortem diagnosis in 2010 is still very high at 9.30 percent. The autopsy will continue to remain relevant especially in elucidating the molecular cause of disease.

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Extracorporeal septoplasty is a valuable tool in the armamentarium of the nasal surgeon for the reconstruction of the severely deviated septum. Extracorporeal septoplasty offers the surgeon the opportunity to correct the septum under direct visualization, shape the nasal vault and address the nasal dorsum with the ultimate goal of providing both form and function for the patient with a complex septal deviation. The study was conducted with the aim to measure the outcomes of extracorporeal septoplasty in severely deviated nasal septum, relief of symptoms (nasal obstruction), surgical complications, if any, revision, if any with objective to evaluate the functional outcome and aesthetic aspects of extracorporeal septoplasty. This was a prospective observational study of 35 patients with severe deviated nasal septum with or without external deformity of nose attending the ENT OPD between Jan 2015 and Jan 2016 at Sri Aurobindo Medical College and Post Graduate Institute, Indore (M.P.). In this study, 17 patients (48.57%) shows excellent improvement on VAS scale, out of which 13 patients shows excellent improvement and 4 patients shows good improvement on photographic assessment. 11 patients (31.43%) show good improvement on VAS as well as photographic assessment and 7 patients (20%) show moderate improvement on VAS scale and fair improvement on photographic assessment. Extracorporeal septal reconstruction is an important surgical option for the correction of the markedly deviated nasal septum. Fixation of the straightened and replanted septum at the nasal spine and dorsal septum border with the upper lateral cartilages is essential. Spreader grafts for stabilization of the internal nasal valve and dorsal onlay grafts to prevent dorsal irregularity are strongly encouraged.