Retrospective study on the effectiveness and indications of different types of flaps used for reconstruction of head and neck

Defects following head and neck surgery can be closed by direct closure when the defect is small, and where local conditions dictate that there is enough lax tissue. Flowever, for larger defects or in situations when direct suture is not applicable, surgical defects may be filled by free grafts, local flaps, pedicled flaps which may be either axial or musculocutaneous, or by using free tissue transfer. This study was conducted in attempt to clarify the success rate of different types of flaps in common use for head and neck reconstruction, the effectiveness of different flaps in terms of functional and esthetic results and which flap is the best for certain defects in head and neck region. In this retrospective study, among the patients with head and neck cancer treated in The Department of Otorhinolaryngology, Head and Neck Surgery, Hiroshima University, in the period from Jan.2004 to Dec.2009, patients whom post ablative defects needed to be reconstructed by flaps were only included. Patients whom defects were repaired either without flaps or by other means of reconstruction [e.g. gastric pull up] were excluded. The flaps among this study were compaired in terms of flap survival and functional outcomes [speech intelligibility, early starting of oral intake and cosmetic appearance]. This study was conducted upon 38 patients, they were 9 [23.68%] females and 29 [76.31%] males with a mean of age of 61 years [range 36- 84 years]. According to the site of the defect needed to be reconstructed after ablation of the primary lesion, patients were divided into three groups: 1-Patients with defects in the oral cavity and oropharynx which resulted from resection of malignant tumors involving or extending into oral cavity and oropharynx [26 patients] [Gl]. 2-Patients with defects in the hypopharynx which resulted from resection of cancer involving the hypopharynx [8 patients] [G2]. 3- Patients with post maxillectomy defects following resection of sinonasal cancer [4 patients] [G3]. In this study all defects resulted from resection of primary lesions were reconstructed immediately after ablation. As regarding patients with oral and oropharyngeal defects [n-26], the most common flap that was used in reconstruction was the pectoralis major myocutaneous flap [PMMF], that was used in ten patients followed by the radial forearm fasciocutaneous free flap that was used in seven patients, transverse rectus abdominas myocuianeous [TRAM] flap that was used in four patients, the fibula osseocutaneous free flap that was used in three patients and lastly the scapula free flap which was used in two patients. For hypopharyngeal defects [n=8], reconstruction was done in all patients with the free jejunal flap except in a single patient that was performed with the pectoralis major myocutaneous flap. In patients with craniosinonasal defects [n4], the TRAM flap was used in four patients to seal the oro-riasal communication and-the fascia lata for reconstruction of the anterior skull base defects. Overall evaluation of different types of flaps for reconstruction of head and neck defects revealed that radial forearm free flap and PMMF is the best two choices in terms of flap survival and functional outcome for reconstruction of oral cavity defects, free jejunal flap gave fair results for reconstruction of the hypopharynx and finally the TRAM flap isn't the best choice for reconstruction of the maxillary defects. Radial forearm free flap and pectoralis major myocutaneous flap [PMMF] are the best choice for reconstruction of oral cavity defects

effect of the trematode Echinostoma liei and certain non-vector snails as biocontrol agents against infectivity of Schistosoma mansoni larval stages to their hosts under laboratory conditions

The present investigation was carried out to study the effect of the non-medically important parasite Echinostoma liei in the presence of three non-vector snails [Planorbis planorbis, Melanoides tuberculata and Helisoma duryi] on the infectivity of the larval stages of Schistosoma mansoni to Biomphalaria alexandrina and to albino mice [Mus Musculus].The infection rates of Biomphalaria alexandrina exposed to Schistosoma mansoni miracidia in the presence of Planorbis, Melanoides and Helisoma snails at ratios of 1B: 5 non-vector snails were significantly lower being 62.9%, 46.9% and 44.4% versus to 83.7% in control group. Also, there are reduction in mean total numbers of cercariae/snail and duration of shedding specially in the presence of Planorbis and Helisoma snails, while the prepatent periods were elongated by the presence of Planorbis and Melanoides snails. Snails exposed to Echinostoma liei miracidia showed reduction in infection rates in the presence of the three studied non-vector snails and in duration of shedding by the presence of Melanoides and Helisomd snails. Snails exposed to both parasites showed reduction in the infection rate especially in the presence of Melanoides and Helisoma snails. No Biomphalaria snails were infected with both parasites in the groups maintained with H. duryi at ratios of 1B: 3H and 1B: 5H. The lowest total number of schistosome and echinostome cercariae was in the group of 1B: 3M. The presence of non-vector snails with infected Biomphalaria suppressed the infectivity of schistosome cercariae to the experimental mice

Epinephrine ameliorating response of serum proteins and protein fractions to whole body gamma irradiation in albino rats

The present study was carried out to investigate the role of epinephrine in modifying the radiation induced effects on serum protein as presented by total protein, protein fractions and albumin/globulin [A/G] ratio in adult albino rats. Epinephrine was intraperitoneally injected at a concentration of 200 microg/kg body weight, 15 min, pre-[or just after] whole body gamma-irradiation of rats at a dose of 6 Gy [single dose]. Studies have been undertaken at periods of 1 hr, 4 hrs, 1, 3 and 7 days after irradiation. Data of the present study revealed that whole body gamma-irradiation induced significant decreased in the total content of serum protein and albumin at 1, 3 and 7 days post radiation exposure alpha[1] -globulin significantly increased only on the 1[st] hr post-irradiation, however alpha[2]-globulin significantly increased along all the experimental periods. Beta-globulin insignificantly changed after irradiation but gamma-globulin significantly decreased during the experimental periods. These changes were associated with significant decreases in A/G ratio at 3 and 7 days post-irradiation. Administration of epinephrine pre-or after radiation exposure produced some amelioration in the radiation induced changes in the studied parameters. So, it could be concluded that epinephrine plays a beneficial radioprotective role through its pharmacologic properties

Epinephrine as a metabolic regulatory hormone in irradiated rats

The role of epinephrine as a regulatory hormone was examined in normal and irradiated rats. Epinephrine was intraperitoneally injected into rats at a concentration of 200 microg/kg body weight. Epinephrine was injected either 15 minutes before or just after whole body gamma irradiation 6 Gy [single dose]. The variations in serum epinephrine, norepinephrine, triglycerides, lipase activity, glucose and lactic acid were selected as biochemical markers in this study. Biochemical estimations were undertaken at 1 hr, 4 hrs, 1, 3 and 7 days after treatment [after irradiation]. The data obtained revealed that the treatment of normal rats with epinephrine induced a significant increase in serum epinephrine level 1 hr after injection, while the level of norepinephrine significantly increased at 4 hrs. Lipase activity significantly increased on the 1[st] hr post treatment. A significant decrease in the level of triglycerides was recorded 1 and 4 hrs post treatment. Serum glucose significantly increased at 1 and 4 hrs post treatment, while no significant changes were recorded for lactic acid. In gamma irradiated rats, the level of serum epinephrine significantly decreased at 1 hr followed by significant increases recorded at 1, 3, and 7 days after irradiation. Norepinephrine levels significantly decreased after irradiation during all the experimental time periods. The levels of triglycerides show significant increases accompanied by a decrease in lipase activity. A temporary decrease of glucose level was recorded at 1 hr followed by significant increase recorded at 1, 3, and 7 days post irradiation. Lactic acid levels show significant increase during all the experimental time periods. The data revealed that treatment of rats, with epinephrine, either pre or post irradiation, has diminished the radiation induced changes in most of the studied parameters. Accordingly, it could be concluded that epinephrine could exert a beneficial protective role against certain radiation induced disorders through acting as a regulatory hormone of the metabolic pathways

Production of acidophilus and bifidus butter milks from buffaloes' milk

Acidophilus and bifidus buttermilks were prepared by mixing acidophilus and bifidus milks with cultured buttermilk at different ratios. Titratable acidity, acetaldehyde, diacetyl, lactic acid bacterial count and sensory evaluation were determined when fresh and 3, 7, and 14 days of storage at 6. Acidity and acetaldehyde were higher in acidophilus and bifidus milks than cultured buttermilk and acidophilus or bifidus buttermilks all through storage period. Diacetyl content was higher in cultured buttermilk than that in the other products. Lactobacillus acidophilus, Bifid bacterium bifidum and mesophilic lactic culture counts increased during the first three days of storage, then decreased up to 14 days of storage. Sensory evaluation showed that scores of fresh and stored acidophilus and bifidus buttermilks increased as the proportion of acidophilus and bifidus increased to 30%. Acceptable and palatable fermented dairy products as a dietary adjuncts with effective therapeutic action, can be made by mixing acidophilus or bifidus milk with cultured butter milk by 2:8 or 3:7, respectively

Guidelines for management of pregnancy on top of IUD with the help of ultrasound

The possibility of pregnancy with IUD in situ is small but the event is clinically significant ranging between 1-4/100 women/year. From this work I can recommend removal of the IUD whenever the gestational age is less than 8 weeks. Between 8-12 weeks removal is recommended if the IUD is situated below the gestational sac. No attempt for removal is to be done if the pregnancy is more than 12 weeks or the IUD is found lateral or above the sac and pregnancy is more than 8 weeks

Imidazole protects the cardiovascular and respiratory systems against whole body gamma-irradiation "an experimental study"

The radioprotective effect of imidazole on the blood pressure, heart and respiratory rates was investigated in adult male rats. Whole body gamma-irradiation at a dose level of 6 Gy. exerted a significant hypotension and tachycardia after one and seven days post gamma-irradiation. There was a significant decrease in respiratory rate after one day of irradiation, but, a significant increase after 7 days, post-irradiation. Administration of imidazole [350 mg/kg] did not significantly affect the blood pressure, but significantly increased heart and respiratory rates after one and seven days of imidazole administration. Imidazole [350 mg/kg] 5-15 minutes before whole body, gamma-irradiation at a dose level of 6 Gy. significantly antagonised the effect of gamma-irradiation on blood pressure, heart and respiratory rates. Meanwhile imidazole completely abolished the effect of gamma-irradiation on the respiratory rate, but it did not completely abolish the effect on the blood pressure and heart rate. The results of the present investigation indicate that imidazole [350 mg/kg] is a good protector against gamma-irradiation induced changes on blood pressure, heart and respiratory rates

Radioiron tracer technique for study of shortened red cell life span in bilharzial heptosplenomegaly and its restoration through splenectomy

In this work, the red cell life span is measured using radioiron Fe[59] in bilharzial hepatosplenomegalic cases before and 45 days after splenectomy as well as in normal controls. Red cell count and bone marrow examinations are also carried out in the bilharzial cases. The results reveal that bilharzial hepatosplenomegaly is associated with anaemia, shortened red cell life span and normal normoblastic series. 45 days after splenectomy, anaemia becomes corrected, and the red cell life span is lengthened and the normoblastic series of the bone marrow becomes more active. It has been thus concluded that splenectomy is of definite value in improving anaemia which accompanies bilharzial hepatosplenomegaly as it eliminates red cell overdestruction and releases the bone marrow from the humoral suppression of the enlarged spleen