Evolving a System of Classification for Scalp Defects and Methods of Reconstruction

Background: Scalp wound closure requires good understanding of scalp anatomy, knowledge of a algorithm for reconstruction ofscalp defects, good planning, adequate debridement, proper execution and proper post-operative care. Aim and objective: Theaim of the study was to use a simple algorithm to reconstruct scalp defects of various sizes and to study the efficacy of thealgorithm in reconstruction of scalp defects. Materials and Methods: All patients with scalp defect who presented to theDepartment of Burns Plastic and Reconstructive surgery at Kilpauk government medical college were studied. Reconstructionof scalp defect was planned based on the algorithm. All patients were followed up for a period of 1 year post operatively.Results: The scalp defects were reconstructed based on the algorithm. Smaller defects were managed with primary closureand SSG. Larger size defects and defects without periosteum were given local or distant flap. All patients recovered well withlesser rate of complications. Conclusion: Reconstruction of scalp defect is made easy with the use of the algorithm for choiceof treatment based on the defect size.

Microalbuminuria among obese and non-obese individuals: a case control study

Background: Microalbuminuria among obesity cases reflects specific glomerular damage or is the marker of generalized endothelial cell dysfunction is still debatable. Thus, this study aimed to assess the presence of microalbuminuria among obese persons and non-obese individuals, who were euglycemic and normotensive.Methods: A case control study was conducted among patients attending outpatient department of general medicine in Govt Thiruvarur Medical College, Thiruvarur, for their illnesses from June 2017 to December 2017. A total of hundred participants with fifty obese cases and fifty non obese controls were included in this study. Detailed history and examination were done by the principal investigator and the same was documented in a proforma. Data entry was done using Microsoft excel and the statistical analysis includes odds ratio were calculated using Statistical Package for Social Sciences (SPSS) software version 17.Results: Among the study participants, 32% and 4% had microalbuminuria in obese and non-obese group, respectively. Also, obese participants were 11.29 times at higher chances of having microalbuminuria when compared to the non-obese patients with significant p value (p=0.002).Conclusions: Microalbuminuria can be used to predict the risk of complications in obese subjects in order to bring down the overall morbidity and mortality related to renal function.

​Study of Paraumbilical Perforators in a Normal Population Group and its Clinical Correlation with Paraumbilical Perforator Based Abdominal Flaps in South Indian Population

Aim: To analyse the perforators around umbilicus in a normal population group. To assess the clinical versatility of paraumbilicalperforator based abdominal flaps.Materials and Methods: Doppler analysis of site of paraumbilical perforators was done in 50 individuals of varying age groups,with normal abdominal wall. 32 patients having upper limb defects were reconstructed with paraumbilical perforator basedabdominal flaps, in the Department of Burns, Plastic and Reconstructive Surgery, Kilpauk Medical College, Chennai, duringthe period of two years 2016 and 2017, and analysed.Discussion: The perforators in paraumbilical region, were Dopplered in normal individuals. The paraumbilical region was dividedinto 4 zones and the perforator pattern was studied. The clinical study was done in the case series of the paraumbilical perforatorbased abdominal flaps, done in the department. The flaps were based on the perforators in all the zones of paraumbilical regionstudied.Results and Conclusion: The commonest position of the paraumbilical perforator was analysed. It was found that theparaumbilical perforator based abdominal flaps can be harvested in any zone, in any direction. The versatility of flap design,with comfortable and amiable positioning of the upper limb with abdomen, makes these flaps reliable and a “user-friendly”option in the reconstruction repertoire of the upper limb defects.

Safety Profile and Therapeutic Efficacy of One Cycle of Lu177-PSMA in End-Stage Metastatic Castration-Resistant Prostate Cancer Patients with Low Performance Status / 대한핵의학회잡지

PURPOSE: The aim of this study was to evaluate safety and therapeutic efficacy of lutetium 177 prostate-specific membrane antigen (Lu-177-PSMA) in metastatic castration-resistant prostate cancer (mCRPC) patients with low performance status.METHODS: Twenty-two patients already treated with anti-androgens and docetaxel were enrolled for one cycle of Lu-177-PSMA therapy. Haemoglobin, total leukocyte counts, platelets and serum creatinine for toxicity profile while prostate specific antigen (PSA), Eastern Cooperative Oncology Group (ECOG) performance status, visual analogue scale (VAS) and analgesic quantification scale (AQS) for therapeutic efficacy were recorded pre and 8 weeks post therapy. Wilcoxon signed-rank and ANOVA tests were used for statistical analysis.RESULTS: Partial response (PR), stable disease (SD) and progressive disease (PD) for PSAwere seen in 5 (22.7%), 13 (59.1%) and 4 (18.2%) patients respectively treated with mean 6.88 GBq dose of Lu-177-PSMA. 8/22 (36.4%) patients showed ≥ 30% drop in PSA. Grade 3 haemoglobin toxicity was seen in 5/22 (22.7%) patients. No patient developed grade 4 haemoglobin toxicity. No patients had grade 3 or 4 leukocytopenia or thrombocytopenia. Wilcoxon signed-rank test showed statistical significant (P < 0.05) difference in pre and post treatment ECOG, VAS, and AQS scores. The ANOVA test showed statistically significant difference in mean doses of Lu-177-PSMA used in three PSA response groups while difference was non-significant for other variables.CONCLUSION: We concluded that Lu-177-PSMA therapy has adequate pain palliation in end-stage mCRPC patients with low performance status and it has a potential to become effective therapeutic option in properly selected patients.

Safety Profile and Therapeutic Efficacy of One Cycle of Lu177-PSMA in End-Stage Metastatic Castration-Resistant Prostate Cancer Patients with Low Performance Status / 대한핵의학회잡지

PURPOSE@#The aim of this study was to evaluate safety and therapeutic efficacy of lutetium 177 prostate-specific membrane antigen (Lu-177-PSMA) in metastatic castration-resistant prostate cancer (mCRPC) patients with low performance status.@*METHODS@#Twenty-two patients already treated with anti-androgens and docetaxel were enrolled for one cycle of Lu-177-PSMA therapy. Haemoglobin, total leukocyte counts, platelets and serum creatinine for toxicity profile while prostate specific antigen (PSA), Eastern Cooperative Oncology Group (ECOG) performance status, visual analogue scale (VAS) and analgesic quantification scale (AQS) for therapeutic efficacy were recorded pre and 8 weeks post therapy. Wilcoxon signed-rank and ANOVA tests were used for statistical analysis.@*RESULTS@#Partial response (PR), stable disease (SD) and progressive disease (PD) for PSAwere seen in 5 (22.7%), 13 (59.1%) and 4 (18.2%) patients respectively treated with mean 6.88 GBq dose of Lu-177-PSMA. 8/22 (36.4%) patients showed ≥ 30% drop in PSA. Grade 3 haemoglobin toxicity was seen in 5/22 (22.7%) patients. No patient developed grade 4 haemoglobin toxicity. No patients had grade 3 or 4 leukocytopenia or thrombocytopenia. Wilcoxon signed-rank test showed statistical significant (P < 0.05) difference in pre and post treatment ECOG, VAS, and AQS scores. The ANOVA test showed statistically significant difference in mean doses of Lu-177-PSMA used in three PSA response groups while difference was non-significant for other variables.@*CONCLUSION@#We concluded that Lu-177-PSMA therapy has adequate pain palliation in end-stage mCRPC patients with low performance status and it has a potential to become effective therapeutic option in properly selected patients.

A Randomized Controlled Study to Compare the Total and Hidden Blood Loss in Computer-Assisted Surgery and Conventional Surgical Technique of Total Knee Replacement

BACKGROUND: Total knee arthroplasty (TKA) is associated with considerable blood loss. Computer-assisted surgery (CAS) is different from conventional TKA as it avoids opening the intramedullary canal. Hence, CAS should be associated with less blood loss. METHODS: Fifty-seven patients were randomized into two groups of CAS and conventional TKA. In conventional group intramedullary femoral and extramedullary tibial jigs were used whereas in CAS group imageless navigation system was used. All surgeries were done under tourniquet. Total and hidden blood loss was calculated in both groups and compared. RESULTS: The mean total blood loss was 980 mL in conventional group and 970 mL in CAS group with median of 1,067 mL (range, 59 to 1,791 mL) in conventional group and 863 mL (range, 111 to 2,032 mL) in CAS group. There was no significant difference in total blood loss between the two groups (p = 0.811). We have found significant hidden blood loss in both techniques, which is 54.8% of the total loss in the conventional technique and 59.5% in the computer-assisted navigation technique. CONCLUSIONS: There is no significant difference in total and hidden blood loss in the TKA in CAS and conventional TKA. However, there is significant hidden blood loss in both techniques. There was no relation of tourniquet time with blood loss.

Fluoride sorption using Morringa Indica-based activated carbon

Batch adsorption experiments using activated carbon prepared from Morringa Indica bark were conducted to remove fluoride from aqueous solution. A minimum contact time of 25 min was required for optimum fluoride removal. The influence of adsorbent, dose, pH, co-ions [cations and anions] on fluoride removal by the activated carbon has been experimentally verified. The adsorption of fluoride was studied at 30°C, 40°C and 50 °C. The kinetics of adsorption and adsorption isotherms at different temperatures were studied. The fluoride adsorption obeyed both Langmuir and Freundlich isotherms and followed a pseudo first order kinetic model. The thermodynamic studies revealed that the fluoride adsorption by Morringa Indica is an endothermic process indicating an increase in sorption rate at higher temperatures. The negative values of delta G° indicate the spontaneity of adsorption. SEM and XRD studies confirmed the surface morphological characteristics of the adsorbent and the deposition of fluoride on the surface of the material