Fracture zygoma and its management our experience

Zygoma is a very crucial component which maintains facial contour. Fractures involving zygoma isvery common, in fact it is the second most common facial bone to the fractured following facialtrauma (next only to nasal bones). Fractures involving maxilla not only creates cosmeticdeformities, it also causes disruption of ocular and mandibular functions too. This article attemptsto discuss in detail the etiopathogenesis and the various management options available. It alsoincludes our 3 years experience in treating these patients at Stanley Medical College Chennai.During the period of 3 years between 2010 - 2012 about 82 patients got treated in our institution forfaciomaxillary trauma.

‘old foley’s in a new bottle’- USE OF FOLEY’S CATHETER IN ANTERIOR MAXILLARY WALL FRACTURES

ABSTRACT Management of comminuted zygomaticomaxillary fractures are is an entity that has always tested the skill of surgeons. A variety of methods have been coined over the years for management of these fractures. Packing the antrum with a gauze or  balloon can be used in much comminuted fractures especially with anterior antral wall communication. Internal immobilization with a Foley’s balloon catheter is being used widely in Blow out fractures of orbit and rarely in tripod fractures. Despite a thorough search, not much literature could be found of its use in anterior maxillary wall fractures. The purpose of this article is to appraise this technique in anterior maxillary wall fractures.

Randomised controlled clinical trial comparing the clinical outcome of autologus fascia lata to synthetic mesh for abdominal sacrocolpopexy among successfully repaired vault prolapse patients

INTRODUCTION: Vaginal vault prolapse has been defined by the International Continence Society as descent of the vaginal cuff below a point that is 2 cm less than the total vaginal length above the plane of the hymen. Coexisting pelvic floor defects like cystocoele, rectocele or enterocele may be present in 72% of patients with vault prolapse. Pelvic organ prolapse has negative impact on quality of life of these women due to associated urinary, faecal and coital dysfunction. It is important to assess the defects of the different vaginal compartment and counsel these women before planning surgical management. A clear understanding of the supporting mechanisms of the uterus and the vagina are important in order to make the right choice of the corrective procedure and also to minimise the risk of occurrence of vault prolapse. SCOPE OF THE STUDY: Management of vaginal vault prolapse may be complex and surgical reconstruction can be challenging. The most appropriate operative procedure and approach should be selected to achieve an optimal result for the patient with vaginal vault prolapse. In the literature, several vaginal and abdominal procedures have been described to treat vault prolapsed and there is no consensus on the most effective approach or technique. Evidence shows that abdominal repair yields better long terms results with reduced incidence of recurrence. Sacrocolpopexy is a valid technique to treat apical and anterior vaginal wall prolapse. Abdominal sacrocolpopexy using synthetic mesh has proven its worth overtime. METHODOLOGY: Study Design: It is a prospective, single blinded, randomised controlled clinical trial. Sample Setting: It is a single blinded randomised controlled clinical trial (RCT) performed to compare the clinical outcome of autologous fascia lata over synthetic mesh in successfully repaired cases of vault prolapse by abdominal sacrocolpopexy. The study was conducted in the department of Urogynaecology, Institute of Social Obstetrics and Government Kasturba Gandhi Hospital for Women and Children, Madras Medical College, a tertiary care Hospital in Chennai, India. The study group comprised predominantly patients belonging to the low socio-economic status. The study population was mostly the referral patients with clinical evidence of vaginal vault prolapse. Duration of the Study: The study was conducted from April 2009 to March 2012. Sample: 58 Vaginal vault prolapse patients (N=58) were included in this study. Out of this 28underwent abdominal sacrocolpopexy with autologous Fascia Lata and 30 with Synthetic Mesh. Inclusion Criteria: Women with stage 3 to stage 4 vaginal vault prolapse (primary) or recurrent vaginal vault prolapse scheduled for abdominal sacrocolpopexy were included. Exclusion criteria: 1. Stage 1 to 2 vault prolapse. 2. Vaginal vault prolapse with abnormal pap smear. 3. Comorbid medical diseases like valvular heart disease, ischaemic heart disease, chronic obstructive pulmonary disease, renal / liver disease and central nervous system disorders. 4. BMI more than 30. SUMMARY AND CONCLUSIONS: Blood loss, duration of surgery & hospital stay did not differ significantly in the two groups. ANATOMICAL SUCCESS: Amongst the successfully repaired patients using autologus fascia lata, objective anatomical success rates were superior with reference to POP Q points Aa, Ba, Ap, Bp compared to synthetic mesh. However the anatomical outcome of C point in fascia lata group was comparable to that of mesh group. FUNCTIONAL SUCCESS: In the current study post operative resolution of lower urinary tract symptoms was equal in both fascia lata and synthetic mesh group. URINARY SYMPTOMS: None in the fascialata group developed UTI however3.6% in synthetic mesh group developed urinary tract infection in the postoperative follow up. Combining Burch colposuspension along with ASCP for patients who had coexisting SUI (overt and occult) and vault prolapse has relieved SUI in both groups. The number of participants who developed denovo SUI was 10.7% in fascia lata group and 3.3% in mesh group. None developed denovo urgency and urge urinary incontinence were same in both groups. BOWEL SYMPTOMS: Complete resolution of all pre operative bowel symptoms occurred in the autologous fascia lata group incontrast to the mesh group where 3% reported faecal urgency in the postoperative follow up. SEXUAL SYMPTOM: With fascia lata suspension, none developed de novo dyspareunia unlike mesh suspension. Nevertheless in the synthetic mesh group none developed mesh exposure / extrusion or infection post operatively. In the fasci lata group, there was no significant postoperative morbidity like haematoma infection and muscle herniation from the harvested site. The current study has revealed that vault prolapse repair by abdominal sacrocolpopexy using autologous fascia lata has comparable anatomical success to synthetic mesh. The functional outcome (clinical success) was better with autologous fascia lata suspension compared to mesh suspension. • This study highlights that autologous fascia lata is a versatile graft with comparable efficacy to mesh. Offers good and durable mechanical support of the vaginal vault. In future, larger and prospective, randomized clinical trials and a long-term follow-up are needed to further evaluate durability, anatomical outcomes and patient satisfaction after ASC with autologous fascia lata. RECOMMENDATIONS: Autologous Fascia lata is strong, pliable and homologous tissue does not involve foreign body reaction or infection. After repetitive notifications of FDA about nonuse of mesh in pelvic floor surgeries, there is increasing scope of biological grafts in reconstructive surgeries. According to this study, autologous fascia lata compares favorably in efficacy to monofilament, polyprophylene mesh and it is not associated with any significant morbidity. Follow up in our series of patients is adequate to assess accurately treatment efficacy, harvest site morbidity and patient satisfaction. There had been good medium term followup results in our study and patient satisfaction with the procedure is high. The successfully operated patients who were completely asymptomatic (in both groups) reported high patient satisfaction rate. The following advantages of autologus fascia lata has been proved in this study: • It is a scientific proven operation which is independent of synthetic graft and is devoid of mesh related problems and other surgery related complications like infection, extrusion, chronic vaginal pain, constipation and dyspareunea. • Because of minimal complications , abdominal sacro colpopexy using fascia lata can be offered to patients who hail from remote villages with no access for followup. • Autologous graft is readily available with the patient and the patient is not dependant on any commercial material for suspension. The anatomical and functional outcomes of autologus fascia lata are equivalent to that of synthetic mesh in abdominal sacrocolpopexy for management of vault prolapse, Hence abdominal sacral colpopexy using autologous fascia lata may be considered primarily for women with vaginal vault prolapsed

Hypoplasia of all paranasal sinuses A case series and Literature review

Hypoplasia of maxillary sinus is a rather rare condition. Review of literature reveal that so far only 6 cases have been reported. Hypoplasia of frontal and sphenoid sinuses has beendocumented rather frequently. In this article the authors report two rare cases of hypoplasia involving all paranasal sinuses which has not been reported so far in literature. This is actuallyan incidental finding when routine CT scan of sinuses was performed. This patient was clinically asymptomatic. Awareness of this condition is important because of implications involved in performing FESS surgery in these patients. Routine x-rays will lead to erroneousdiagnosis of sinus infection because of the opacity seen in the poorly developed sinus area.

Residual negative symptoms differentiate cognitive performance in clinically stable patients with schizophrenia and bipolar disorder

Cognitive deficits in various domains have been shown in patients with bipolar disorder and schizophrenia. The purpose of the present study was to examine if residual psychopathology explained the difference in cognitive function between clinically stable patients with schizophrenia and bipolar disorder. We compared the performance on tests of attention, visual and verbal memory and executive function of 25 patients with schizophrenia in remission and 25 euthymic bipolar disorder patients with that of 25 healthy controls. Mediation analysis was used to see if residual psychopathology could explain the difference in cognitive function between the patient groups. Both patient groups performed significantly worse than healthy controls on most cognitive tests. Patients with bipolar disorder displayed cognitive deficits that were milder but qualitatively similar to those of patients with schizophrenia. Residual negative symptoms mediated the difference in performance on cognitive tests between the two groups. Neither residual general psychotic symptoms nor greater antipsychotic doses explained this relationship. The shared variance explained by the residual negative and cognitive deficits that the difference between patient groups may be explained by greater frontal cortical neurophysiological deficits in patients with schizophrenia, compared to bipolar disorder. Further longitudinal work may provide insight into pathophysiological mechanisms that underlie these deficits

Inter arm blood pressure difference: an indicator of cardiovascular risk

Background: Overall prevalence of hypertension in India is 33% in urban and 25% in rural areas. For optimal health blood pressure of less than 120 mm of Hg systolic and 80mm of Hg diastolic is to be maintained. According to American heart association, inter arm BP difference of more than 20 mm of Hg systolic and 10 mmm of Hg diastolic are associated with peripheral vascular disease, vasculitis, connective tissue disorders and congenital anomalies. Though the guidelines quote that it is mandatory to examine pressure in both arms before diagnosing hypertension this system is not followed, which has led to increase in misdiagnosis of HT. The present study aims to determine the magnitude of interarm difference in young healthy individuals and to assess whether family history of HT and BMI is related to higher interarm difference.Methods: 110 normal healthy medical students both males & females are recruited for the study .after obtaining institutional ethical clearance the participants in the study are informed about the study process and detailed history obtained .after 5 min of rest BP is assessed by sphygmomanometer first in right arm & then left. Statistical analysis done using paired t test, correlation between variables done with chi square test. Results: statistically significant difference p10mm of Hg and diastolic interarm >5mm of Hg ,though this value is not statistically significant ,it shows that people with family history of hypertension is more prone to interarm BP difference.Conclusions: Interarm difference exists in norma lhealthy volunteers and interarm difference  of >10 mm of Hg systolic & >5 mm of Hg diastolic should be investigated further as these subjects are more prone to develop cardiovascular morbidities .hence we conclude that interarm difference is a sensitive noninvasive and simple method of detecting individuals prone for cardiovascular morbidities.

A two-year study of patterns and prevalence of congenital malformations

Background: India is undergoing an epidemiological transition; communicable diseases are on the decline due to better living conditions and healthcare delivery. On the other hand, the relative increase in the prevalence of non-communicable, chronic and genetic diseases threatens to be a public health problem in India like congenital malformations. Congenital malformations remain one of the least focused areas of disease surveillance in India compared with communicable and some chronic diseases. Thus, data on the magnitude of birth defects are essential to plan preventive strategies and organize methods of supportive care for affected individuals and families. The aim of this study is to study the incidence and prevalence of the birth defects and the patterns of congenital malformations in our institute and the various risk factors influencing the occurrence.Methods: A cross sectional study was conducted on all Ant natal patients and deliveries conducted in the institution for a period of two years from June 2015 to May 2017. Mediscan Systems extended a big hand in further confirmation of diagnosis. A detailed history was taken regarding the patients and husband’s age, parity, occupation, previous obstetric outcome, family history of birth defects and exposure to teratogens and environmental factors and intake of periconceptional folate. Data analysis was done with respect to age, parity, consanguinity, sex, previous defects.Results: CNS defects were the most recognisable malformations at birth. Pick up rate for CVS anomalies were low requiring expertise. As against the wide prevalence of cardiac defects across total population the reported prevalence is less as similar to rest of the studies done in many centres across the country. Target scan has halved the burden of birth defects.Conclusions: Congenital malformations though cannot be prevented totally but can be minimised and if detected early will reduce the mental agony in the mother and family. Prenatal counselling, periconceptional folate, anomaly scan, Prenatal diagnosis reduce the incidence of birth defects