Assessment of heart rate variability as an index of cardiac autonomic modulation in control and depressed persons

Under steady state conditions, heart rate displays spontaneous beat-to-beat fluctuation. This fluctuation results from the continuous interaction between the neural or humoral control of cardiovascular function. The fluctuation of heart rate around its mean is called heart rate variability [HRV]. The mechanisms underlying the relationship between depression and cardiac events remain unclear. A disturbance of cardiac Sympathovagal balance is one of the most plausible candidates in depressed patients. To evaluate cardiac Sympathovagal activity in depressed, non cardiac patients. A 24-hour Holter electrocardiogram [ECG] was recorded in 15 newly diagnosed depressed patients and 15 healthy age and sex matched control subjects. Sympathovagal balance was evaluated through time domain parameters of Heart rate variability [HRV]. 15[th] patients with depression disorders were found to have elevated resting heart rate [HR], low heart rate variability [HRV]; decreased Mean NNI, SDNN, rMSSD and pNN50. There is considerable evidence of cardiac autonomic dysregalation. In depressed patients, measured by HRV parameters and these abnormalities may explain the increased cardiac morbidity and mortality rates in these patients

Scalp reconstruction after extirpation of large advanced tumor [experience in 10 cases]

This study was conducted on ten patients with large scalp tumors Seven patients [70%] were advanced basal cell carcinoma eroding calvarium and reaching the dura matter in 2 patients. The other patients were sqamous cell carcinoma [30%]. Wide local excision was done with minimum safety margin [>/= 1cm] the eroded bones and dura mater was excised by neurosurgeon. Immediate reconstruction of the dura and bone was done using fascia lata and bone cement. Cutaneous coverage was achieved by free lattissimus dorsi in 3 patients. radial forearm flap in 1 patient, local bilobed and trilobed flaps in 5 patients and split-thickness skin graft in the remaining one. No flap loss occurred, infection occurred in 2 patients, gaping in one patient that required secondary procedure and donor site seroma in one patient. Mortality was 20% and recurrence in one patient. in spite of the relative risk of mortality and morbidity yet surgical excision offers the only remaining chance for those desperate patients with extensive tumors for whom no adjuvant measures are available. Those patients were always ready to get rid of offensive odor, repeated bleeding and disfigurement associated with the tumor