Pectoralis major myocutaneous flap in head and neck reconstruction: an interesting experience from central India regional cancer center

Background: Head and neck cancer are sixth most common cancers worldwide with cancer of oral cavity most common. The primary treatment modality for oral cavity cancer has been surgery and defects resulting from the ablation of the tumors require reconstruction. the PMMC flap offer an easy, less time consuming with minimal postoperative complication as a reconstructive option in the hands of reconstructive surgeon. The objective of our study was to give a precise description of our experience with the PMMC flap as a reconstructive option in post-ablative head and cancer surgery.Methods: The current prospective study was conducted in the Department of Surgical Oncology, Regional cancer center, Pt. JNMC, Raipur (C.G.), India from the January 2014 to June 2015. Detailed clinical history and examination of the patients were recorded. All Investigations relevant to the study were done before the surgical procedure. Procedure was performed as per standard protocol and reconstruction was made with PMMC flap. Data was compiled in MS Excel and checked for its completeness and correctness. Then it was analyzed.Results: In the present study male to female ratio was 2:1. Most of the patients belongs to the age group of 41-60 (55.55%) followed by 21-40 (30.15%). In the present study majority of patient of oral malignancy presented with lower alveolus malignancy (36.5%) followed by buccal mucosa malignancy (19.06%).Conclusions: Pectoralis major myocutaneous flap was found to be a versatile flap for reconstruction of large defects in Head and Neck region with minimal complication rate.

Clinical and ultrasonological features of adenomyosis and its histopathological correlation

Background: Adenomyosis is a common gynaecological condition that affects the menstruating women. Uterine enlargement, dysmenorrhoea and HMB are regarded as the cardinal clinical symptoms of adenomyosis. Classically it was thought, compared with ultrasonography, when adenomyosis is suspected, MRI enables more accurate diagnosis of the disease.Methods: 78 subjects were enrolled after an informed consent that had complaints of HMB, Dysparenuia, dysmenorrhea, and chronic pelvic pain. Detailed history of the enrolled subjects was taken, followed by a clinical examination. These patients were then subjected to TVS where myometrial echo texture, presence of myometrial cysts, blurring of endomyometrial junction was noted. After hysterectomy, histopathological diagnosis was obtained.Results: 78 subjects enrolled in the study. The mean age was 44.2 years. 43.5% had parity of 4 or more. HMB was present in 97.8% and dysmenorrhea in 93.48 % of HPE positive patient. Transvaginal sonography had a sensitivity of 89.13%, specificity of 90.62%, positive likelihood ratio of 9.51, negative likelihood ratio of 0.12, positive predictive value of 93.18%, negative predictive value of 85.29% and a diagnostic accuracy of 89.74%.Conclusions: Thus adenomyosis has a prevalence of 30.23%. HMB with dysmenorrhoea and chronic pelvic pain helps in diagnosis. TVS is both sensitive and specific in diagnosing adenomyosis without need for additional diagnostic tool. Endomyometrial junction blurring is the sensitive and specific criteria on TVS

A comparative study of ropivacaine 0.5% versus ropivacaine 0.75% for spinal anesthesia in lower limb orthopedic surgery in ASA Grade – I/II adult patients: A prospective study

Aims and Objectives: The aim of the study was to compare the clinical efficacy and safety of isobaric ropivacaine 0.5% and 0.75% in spinal anesthesia under: (a) Onset and duration of sensory and motor block, (b) duration of analgesia, and (c) adverse effects. Methods: A total of 60 patients undergoing elective lower limb orthopedic surgery under spinal anesthesia were divided into two groups (I and II) of 30 each. Group I received 3ml of isobaric ropivacaine 0.5% Group II received 3 ml of isobaric ropivacaine 0.75%. The study parameters were recorded at baseline and then at specified intervals. Statistics: By professional statisticians using SPSS 18 version. Student t-test was used for continuous variables, and Chi-square test was used for discrete variables. Results: The onset of sensory blockage in Group I was 3.17 ± 1.29 min and 2.60 ± 1.19 min in Group II which was statistically not significant (P > 0.05). The onset of motor blockade in Group I was 3.90 ± 1.54 min and 3.10 ± 0.96 min in Group II which was statistically significant (P < 0.05). Median time to reach the highest level of analgesia was 12.4 ± 2.81 min in Group I, and 10.7 ± 2.56 min in Group II. The difference was statistically significant. Regression of sensory level to T10 dermatome in Group I was 99.64 ± 21.30 min and 139.66 ± 25.70 min in Group II which was statistically significant (P < 0.05). Duration of the motor blockade in Group I was 126 ± 14.53 min and 175 ± 30.60 min in Group II which was statistically significant (P < 0.05). The time of the first request of analgesics in Group I was 130 ± 16.24 min and 171.1 ± 32.77 min in Group II which was statistically significant (P < 0.05). There were no significant differences in the adverse effects of both drugs. Conclusions: Intrathecal isobaric ropivacaine 0.75% in comparison to isobaric ropivacaine 0.5%: (1) Produces quicker onset of motor block and prolonged duration of sensory and motor block. (2) Does not alter hemodynamic stability. (3) Has no difference in the onset of sensory block.&nbsp

Elsevier FREQUENCY ESTIMATION OF UNDAMPED EXPONENTIAL SIGNALS USING GENETIC ALGORITHMS

Abstract: In this paper, we consider the problem of frequency estimation of undamped superimposed exponential signals model. We propose two iterative techniques of frequency estimation using genetic algorithms. The proposed methods use an elitism based generational genetic algorithm for obtaining the least squares and the approximate least squares estimates. In the simulation studies, it is observed that the proposed methods give nearly efficient estimates, having mean square error almost attaining the corresponding Cramér-Rao lower bound. The proposed methods significantly do not depend on the initial guess values otherwise required for other iterative methods of frequency estimation. It is also observed that the proposed methods have fairly high breakdown point with respect to different types of outliers present in the data. Outlier robustness and accuracy of the proposed methods are compared with the classical approaches for this problem. Keywords: Approximate least squares estimator, Cramér-Rao bound, frequency estimation, genetic algorithm, least squares estimator, undamped exponential signals model

Combined spinal epidural for labor analgesia comparison of two different doses of intrathecal bupivacaine 1.25 mg and fentanyl 25 µg with bupivacaine 2.5 mg and fentanyl 25 µg

Background and Objective: The responsibility of the anesthetist in obstetrics is very high. This study compares two different low doses of intrathecal bupivacaine 1.25 mg and 2.5 mg along with 25 µg fentanyl as the spinal component of combined spinal epidural (CSE) analgesia in the early part of labor, followed by epidural top-up. Methodology: Approval was obtained from the institutional review board and written informed consent was obtained from 60 healthy term primigravida or the second gravid parturients, with cephalic singleton pregnancy between 36 and 42 weeks, ASA Grade I/II patients. The study was conducted using low-dose intrathecal bupivacaine 1.25 mg and fentanyl 25 µg (GroupI) with bupivacaine 2.5 mg and fentanyl 25 µg (Group II) as the spinal component of CSE analgesia in the early part of labor. We compared the two with respect to their onset, duration of sensory and motor block, quality of analgesia during early part of labor and the side effects of the drugs. Results: The onset of analgesia was equally rapid with both groups within 5 min, lower incidence of motor block with Group I compared to Group II. Duration of analgesia was longer in Group II, associated with higher dermatome levels of sensory block with longer time for regression of the block. Coclusion: We found that bupivacaine 1.25 mg was as effective as bupivacaine 2.5 mg when added to fentanyl 25 µg for CSE.&nbsp

Neonatal Volkmann Ischemic Contracture: Case Report and Review of Literature

Abstract Background Neonatal Volkmann ischemic contracture in newborns is a devastating condition with lifelong consequences. Case Report We report a neonate born with necrotic skin lesions and bullae on right dorsal thenar aspect of hand, who subsequently developed compartment syndrome requiring fasciotomy. Review and Conclusion Necrotic skin lesions with/without swelling, bullae are invariably present at birth in these patients and should be recognized as a sentinel finding of underlying tissue ischemia/compartment syndrome. Early recognition and prompt surgical intervention can be limb saving. A range of radiologic abnormalities and contractures were noted in upto 84% of such patients followed long term. Hence, we recommend close follow-up until occurrence of epiphyseal fusion in these patients

Metastatic malignant melanoma of parotid gland: A case report and review of literature

Melanoma of the head and neck region metastasizes to cervical lymph nodes but parotid gland is a rare location for metastasis. We report a case of a cutaneous malignant melanoma of the face which metastasized to parotid gland. Metastatic infiltrations were also observed in intraparotid lymph nodes. The pattern of spread of melanoma in the head and neck region and its significance to treatment of salivary gland is reviewed in our report

Clinicopathological study of cerebellar astrocytoma in children

Introduction: The first successful treatment of a pediatric brain tumor was in 1879 when Sir William Macewen successfully removed a meningioma from a 14-year-old girl. Brain tumors are the most common form of solid tumors and the leading cause of death from solid tumors in children (SEER program 1975–1999). Materials and Methods: Study area: This study was conducted at Bangur Institute of Neuroscience (BIN) and S.S.K.M Hospital. Study Population: Patients attending BIN OPD and admitting in BIN and S.S.K.M Hospital wards were selected. Inclusion Criteria: The following criteria were included in the study: (a) Patients with the diagnosis of cerebellar astrocytomas after magnetic resonance imaging investigation, (b) patients giving consent to be included in the study, and (c) patient willing to come for follow up. Study Period: The study period was 2 years (from September 1, 2010, to December 31, 2012). Sample Size: All diagnosed cases of cerebellar astrocytoma during the stated period. Exclusion Criteria: Patients not willing for the study were excluded from the study. Study Design: This was a non-randomized prospective clinical study. Pilocytic astrocytomas are the most common pediatric brain tumors in our population and are most commonly located in the cerebellum. Results: Most of the patients, 20 (90.9%), had neurological improvement on discharge. 1 patient (4.5%) died during the hospital course. The follow-up time period ranged from 3 months to 2 years, with a mean follow-up period of 1.5 years. Recurrence was observed in 5 patients (22.72%), but reoperation was done in 3 patients (13.63%). Of them, 1 patient (4.5%) received radiotherapy in spite of that recurrence was developed in 1.5 years. 2 patients (9.09%) have been kept under observation because these are asymptomatic. The solid consistency of tumors led to a poor prognosis, as it was associated with a greater number of ICU admissions, recurrence of tumors, and repeat surgeries (13.63%). The follow-up time period ranged from 3 months to 2 years, with a mean follow-up period of 1.5 years. Conclusion: A “wait and see” strategy is justified in patients with non-progressive recurrent or residual cerebellar LGG after primary tumor resection (23.30) radiotherapy can be considered