Pectoralis Major Myocutaneous Flap Reconstruction in Head-and-Neck Malignancy – Experience from a Tertiary Care Center

Background: The pectoralis major myocutaneous (PMMC) flap as a pedicle flap is still a reliable option to reconstruct thedefects following major oncological resections of head-and-neck cancer. It is the workhorse in centers where the facilities forfree tissue transfer are not available. Our aim is to assess the complications of PMMC flap reconstruction.Materials and Methods: A retrospective analysis of records of 17 patients who underwent reconstruction with PMMC flapas a pedicle flap for head-and-neck malignancies from 2013 to 2019 in the Department of Surgical Oncology, GovernmentThoothukudi Medical College Hospital, Thoothukudi, was performed.Results: Records of 17 patients who received PMMC flap were taken for analysis. Of those 17 patients, three were female. Ofthose 17 patients, 15 had oral cavity malignancy and 2 had malignant parotid tumors. PMMC was used to cover the mucosaldefect in eight patients, skin defect in two patients, and both in seven patients as bipaddle flap. None of the patients had a totalloss of flap, but one case of marginal necrosis and three cases of partial intraoral flap dehiscence were noted. Oral cavity defectaccounts for 15 flaps and the remaining 2 were done to reconstruct the defect following resection of the malignant parotid tumor.Conclusion: In centers without free tissue transfer facility, PMMC is still the gold standard flap in head-and-neck reconstruction.The morbidity is very minimal in experienced hands.

Methacholine Challenge Test as an Adjunctive Investigative Tool in Patients with Asthma-Like Symptoms: The Sabah Experience

Introduction: Patients with asthma-like symptoms pose a diagnostic dilemma when physical examination is normal. The usual practice in Malaysia would be to give empirical asthma treatment. Bronchial challenge test (BCT) is widely used in many countries to diagnose asthma objectively but it is not widely available in Malaysia. Objective: To describe our experience with BCT using methacholine at Queen Elizabeth Hospital as a supporting tool in the investigation of patients with asthma-like symptoms. Methodology: Review of case notes of patients who underwent BCT from July 2008 till April 2009. BCT was performed via dosimeter technique. Results were classified as high hyper responsiveness if the provocative dose of methacholine required to achieve 20% fall in FEV1 (PD20) was less than or equal to 0.125 μmol, moderate hyper responsiveness if PD20 was between 0.125 to 1.99 μmol or mild hyper responsiveness if PD20 was between 2.00 to 6.6 μmol. PD20 of more than 6.6 μmol constitutes a negative MCT. Results: 29 patients had BCT during the study period. 19 cases were included in this review. The age ranged from 13 to 70 years old. There were 12 males and 7 females. Duration of symptoms ranged from 2 weeks to 23 years. BCT was positive (mild or moderate hyper responsiveness) in 10 out of 19 patients. No patient had high bronchial hyper responsiveness. Conclusions: BCT is a useful adjunctive tool in the investigation of patients presenting with asthma-like symptoms. This test obviates empirical asthma treatment. BCT should be made available in all major hospitals in Malaysia.

Anti-inflammatory activity of commiphora caudata [Wight and Arn]

Ethyl acetate and methanolic extracts of Commiphora caudata syn: Protium caudatum were tested for anti-inflammatory activity in rats by carrageenan-induced hind paw oedema method. Both ethyl acetate extract and methanolic extract of Commiphora caudata [200 mg/kg of body weight] exhibited significant anti-inflammatory activity when compared with control. Indomethacin was used as a reference anti-inflammatory drug

Liquid chromatographic determination of bicalutamide in formulation and biological fluids based on cyclodextrin enhanced fluorescence

A liquid chromatographic procedure was developed for the determination of a new anticancer agent Bicalutamide in plasma using fluorescence detection by using beta-Cyclodextrin as an enhancer. Chromatography was performed using a reversed phase trimethylsilyl bonded silica column with a mobile phase of water: acetonitrile [30:70] at a flow rate of 1 ml/min. Detection of the eluted peaks was observed using excitation and emission wavelengths of 272 and 328 nm, respectively. Chromatographic run lime did not exceed 10 minutes with no interference of endogenous material. The calibration curve was linear over the concentration range of 0.1 to 0.35 ug/ml and inter- and intra-assay imprecision was less than 10%. The lower limit of quantitation was assessed at 3.96X10 [-5] microg/ml, 1.01X10 [-4] microg/ml and lower limit of detection was 1.3X10[-5] microg/ml, 3.34X10 [-5] microg/ml in formulation and biological fluids respectively