Applicability of new proposed novel tooth numbering system for primary teeth An observational study

Objective: The aim of the present study was to check the reliability and applicability of new proposed tooth numbering system (TNS) for primary teeth that will aid the dentist to overcome the disadvantages of existing TNS and enable to note the primary teeth in an easier and more precise way. Study Design: This observational questionnaire survey was conducted in an institution consisting 11 questions in English format. Four hundred samples were randomly selected which included under graduates, postgraduates, and faculty. Self-structured questionnaires were given in order to assess the reliability and applicability of the new proposed TNS. Data obtained were subjected to statistical analysis. Chi-square test was used to compare the responses between different study groups, and P value was set at P < 0.05. Results: According to the participants, the new TNS maintains the anatomical midline, easily readable, written and typed though required extra concentration. It is easy to converse and can be followed by beginners. It does not require extra timing and can be used routinely. With mixed dentition, it does not take more time, but there are chances of confusion or overlap while recording. Conclusion: The new Havale's Alphaneumarical Dental Notation system can be used routinely by undergraduates and postgraduates as well as clinicians and can apply or follow the system in regular dental practice.

Use of Palmer’s Point in Creation of Pneumoperitoneum in Patients of Previous Abdominal Surgeries and To Check Efficacy of the Visceral Slide Technique for Detection of Abdominal Wall Adhesions

In patients with history of previous abdominal surgery, creation of pneumoperitoneum during laparoscopicprocedure involves risk of complications as there is association of underlying adhesions at the umbilicus site.Palmer’s point is alternative site of primary port insertion. For creating pneumoperitoneum, visceral slidetechnique is used to detect the movement of viscera immediately deep to the abdominal wall. This techniqueis reliable in identifying adhesion-free areas of the abdominal wall. This study was undertaken to evaluate useof Palmer’s point in creation of pneumoperitoneum in patients of previous abdominal surgeries and to checkthe efficacy of the visceral slide technique for detection of umbilical adhesions in these patients. This one-yearstudy was conducted on 30 patients with previous history of abdominal surgery in the Government MedicalCollege, Jammu. Visceral slide test was conducted using a real time ultrasonography machine with a 7.5 MHzabdominal transducer placed in a sagittal plane at the umbilicus and the ultrasound scan focused on theinfraumbilical region between the anterior abdominal wall and the aortocaval complex. A normal visceral slide(positive test) is movement of the viscera more than 1 cm. An abnormal visceral slide (negative test) is definedas movement of the viscera less than 1 cm. At the end of the surgery, intra-operative, early and late complicationswere evaluated. Adhesions under the umbilicus were present and absent in 15 (50%) patients each. Thevisceral slide technique was negative in 9 (30%) and positive in 21 (70%) patients. Sensitivity, specificity,positive predictive value, negative predictive value and accuracy of visceral slide technique was 60%, 100%,100%, 72% and 70% respectively. Definitive evidence of the efficacy of Palmer’s point in creation ofpneumoperitoneum could not be established due to the small sample size and patients with limited spectrum ofabdominal surgeries. Further studies in the form of multicenter randomized control trials are needed to verifythe utility of Palmer’s point for creation of pneumoperitoneum and to evaluate the role of visceral slidetechnique in diagnosing intra-abdominal adhesions preoperatively.

Fingertip reconstruction: study of functional and cosmetic results of various local flaps and grafting techniques in patients attending a tertiary care center in North India

Background: Finger injuries are becoming more common with the increasing use of mechanical, industrial, and household appliances. There are six main types of repair for this injury. The replacement of skin loss in digital injuries, particularly on the volar aspects, is an important part of hand-injury management. It would be of value to know the best type of cover, especially for sensory reinnervation as well as for subjective evaluation, cosmetic appearance and freedom from complications. The objective of this study was to measure incidence of age, sex, site, pattern of injury as well as to evaluate and compare the functional and cosmetic results of the various local flap and grafting techniques in finger reconstruction distal to metacarpophalangeal joint.Methods: In a prospective study between May 2014 to October 2018 consisting of 50 patients (43 males, 7 females), aged between 2 years and 54 years, with soft tissue loss distal to metacarpophalangeal joint were treated with either free split-thickness skin grafts, palmar flaps, cross-finger flap or pedicle flaps from the abdomen. The follow-up period ranged from 10 days to 15 months from the date of surgery. Subjective and objective evaluation was done and graded as excellent, good, fair and poor.Results: In this series there were 2 good and 6 fair results for split skin grafting; 9 good and 6 fair results for v-y plasty; 5 excellent, 12 good and 4 fair results for cross finger flap; 1 good and 1 fair result for radial artery based flap; 1 excellent and 1 good for first metacarpal artery based flap and 2 good results for abdominal flap. Overall 6(12%) had excellent, 27(54%) had good and 17(34%) had fair results. None of them had poor results.Conclusions: The group of patients with cross-finger flaps had less subjective complaints and more normal objective testing results than the other groups. When an extensive tactile pad avulsion exists, the cross-finger pedicle flap offers the best long-term result with fewer secondary problems. The exclusive use of any one method cannot be advocated since each serves an useful purpose under proper conditions.

Insuflación con aguja de Veress en punto de Palmer, hasta presión intraabdominal de 25 mmHg. Técnica para mejorar la seguridad del acceso laparoscópico ginecológico / Veress needle inflation at Palmer's point, up to intra-abdominal pressure of 25 mmHg. Technique to improve the safety of gynecological laparoscopic access

RESUMEN Objetivos: El objetivo del estudio es observar los beneficios de la entrada laparoscópica con trocar para la óptica, tras la insuflación previa con aguja de Veress en punto de Palmer, hasta conseguir una presión intraabdominal de 25 mmHg. Material y método: Estudio prospectivo de 115 cirugías laparoscópicas realizadas con la técnica anteriormente descrita, por el mismo equipo quirúrgico; de julio de 2014 a marzo de 2018, en el Departamento de Ginecología del Hospital General Santa María del Puerto. Resultados: El tiempo medio de las maniobras de acceso fue de 175 segundos. En el 84.3 % de las ocasiones, el acceso a la cavidad abdominal se consiguió en el primer intento. Sólo en dos ocasiones (1.7%), fue necesario cambiar la técnica de acceso. No se objetivó ninguna complicación o efecto adverso en el 96.5% de las cirugías. En dos pacientes (1.7%) se produjo un enfisema subcutáneo, en una ocasión un enfisema epiploico (0.9%) y en una paciente (0.9%), se objetivó una ligera intolerancia anestésica durante la realización del neumoperitoneo. No se registró durante el estudio ninguna complicación mayor asociada a las maniobras de acceso. Conclusiones: La entrada con presiones altas intraabdominales tras insuflación con aguja de Veress en punto de Palmer, es una técnica segura y reproducible para evitar complicaciones mayores, durante las maniobras de acceso a cavidad abdominal. Además, esta técnica no produce efectos adversos anestésicos relevantes secundarios a las altas presiones en pacientes sanas, debido al escaso tiempo durante el que se mantienen las mismas.

ABSTRACT Objectives: The aim of the study is to observe the benefits of laparoscopic trocar entry for optics, after previous insufflation with Veress needle at Palmer's point, until an intra-abdominal pressure of 25 mmHg is achieved. Material and method: Prospective study of 115 laparoscopic surgeries performed with the previously described technique, by the same surgical team; from July 2014 to March 2018, in the Department of Gynecology of the Hospital General Santa María del Puerto. Results: The average time of access maneuvers was 175 seconds. In 84.3% of the cases, access to the abdominal cavity was achieved on the first attempt. Only on two occasions (1.7%), it was necessary to change the access technique. No complication or adverse effect was found in 96.5% of the surgeries. Subcutaneous emphysema (1.7%) occurred in two patients, epiploic emphysema (0.9%) and in one patient (0.9%), a slight anesthetic intolerance was observed during the pneumoperitoneum. No major complications associated with the access maneuvers were recorded during the study. Conclusions: The entry with high intra-abdominal pressures after insufflation with Veress needle at Palmer's point, is a safe and reproducible technique to avoid major complications, during maneuvers of access to the abdominal cavity. In addition, this technique does not produce relevant adverse anesthetic effects secondary to high pressures in healthy patients, due to the short time during which they remain.

Resultados de la reparación con sutura artroscópica de las lesiones periféricas cubitales del complejo fibrocartílago triangular (CFCT) (Palmer 1B/Atzei 1) / Arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears

INTRODUCCIÓN: Las Lesiones del Complejo Fibrocartílago Triangular (CFCT) son causa común de dolor Ulnar en la muñeca, la artroscopia es el estándar de oro para el diagnóstico y tratamiento de las mismas. Realizamos un trabajo retrospectivo evaluando la función y resultados de los pacientes operados con técnica artroscópica con la lesión CFCT Palmer 1B/Atzei 1. MATERIAL Y MÉTODO: Evaluamos 24 pacientes con 25 lesiones de CFCT palmer 1B/Atzei 1. El 88% en edad laboral entre 19 a 57 años (34 años promedio) con un seguimiento promedio de 9 meses. Todas las lesiones fueron reparadas con técnicas artroscópicas y puntos de sutura adentro afuera y afuera adentro. Se evaluó el Rango de Movilidad (ROM), fuerza de agarre, escala de Mayo de Muñeca y escala de DASH. RESULTADOS: Hemos tenido mejoras en test del dolor y la fuerza, el ROM promedio fue 70° para la extensión, 85° de flexión, 20° para la desviación radial y 30° de desviación cubital. El Score de muñeca de mayo fue excelente en el 64%, Bueno en el 16%, Satisfactorio en el 20% y no hemos tenido malos resultados. Nuestro Dash Score pre operatorio fue de 86 puntos y en el Post operatorio de 13 puntos. El promedio de la fuerza comparativa contralateral fue del 70%. CONCLUSIÓN: La reparación artroscópica de las lesiones Palmer 1B/ Atzei 1 dan resultados satisfactorios mejorando los ROM, recuperando la fuerza de forma total o parcial y disminuyendo el dolor. Encontramos que el tiempo entre la cirugía y los resultados obtenidos influye en los resultados y cuanto mayor es el seguimiento mejor los resultados. Tipo de estudio: Serie de casos. Nivel de evidencia: IV.

OBJECTIVE: Lesions of the Triangular Fibrocartilage Complex (CFCT) are a common cause of ulnar pain in the wrist; arthroscopy is the gold standard for the diagnosis and treatment of them. We performed a retrospective study evaluating the function and results of patients operated with an arthroscopic technique with Palmer 1B / Atzei 1 lesion. MATERIAL AND METHODS: We evaluated 24 patients with 25 CFCT lesions palmer 1B / Atzei 1. 88% of working age between 19 to 57 years old (average 34 years) with a follow-up of 9 months. All injuries were repaired with arthroscopic techniques and stitches inside and outside inside. The Mobility Range (ROM), grip strength, May Wrist score and the DASH Score were evaluated. RESULTS: We have had improvements in pain and strength tests, the average ROM was 70 ° for extension, 85 ° for flexion, 20° for radial deviation and 30 ° for ulnar deviation. The Wrist Score of May was excellent at 64%, Good at 16%, Satisfactory at 20% and we have not had bad results. Our preoperative Dash Score was 86 points and in the Post-operative of 13 points. The average of the contralateral comparative force was 70%. CONCLUSION: The arthroscopic repair of the Palmer 1B / Atzei 1 lesions gives satisfactory results improving the ROM, recovering the strength totally or partially and decreasing the pain. We found that the time between surgery and the results obtained influences the results and the greater the follow-up the better the results. Type study: Number of cases. Level of evidence: IV.

Treatment for Palmar-Foot Hyperhidrosis Based on Spleen and Stomach / 中国中医药信息杂志

Palmer-foot hyperhidrosis is one kind of focal hyperhidrosis, with symptoms of sweating hands or feet. Some people even have sweat dripping off their hands or feet. This article studied the views of TCM on palmer-foot hyperhidrosis, expounded the pathological and physiological relationship between palmer-foot hyperhidrosis and spleen and stomach, and proposed that clinical treatment should be based on the syndrome differentiation and treatment of spleen and stomach, which can achieve certain efficacy.

Peeling Palmar Skin.

A 20-year-old male presented with asymptomatic peeling of palmar skin of 1 month duration ( Fig. 1). He gave history of similar episodes since 3 years, all of which occurred during the winter season and subsided without treatment in a period of 2 to 3 months. He also complained of excessive sweating over palms. There was no personal or family history of atopy. Cutaneous examination revealed exfoliation of skin over the volar aspect of the palms and fingers. Soles were spared. Palmar hyperhidrosis was also noted. Onset in adulthood, absence of itching and/ or fluid-filled blisters, and negative KOH mount excluded dyshidrotic eczema, acral peeling skin syndrome, epidermolysis bullosa simplex, and dermatophytid and convened the diagnosis of keratolysis exfoliativa. Keratolysis exfoliativa is characterized by annular erythema with an air-filled blister arising in the center, followed by superficial collarette and lamellar peeling of glabrous palmoplantar skin. Synonyms include dyshidrosis lamellosa sicca and lamellar dyshidrosis. Emollients, urea, and lactic acid may be used; however, treatment is not necessary as the condition is asymptomatic.

Sarjeev's supernumerary tooth notation system: A universally compatible add-on to the Two-Digit system.

Aim: To give notation for quadrants, tooth position, and the type of supernumerary teeth for both permanent and deciduous dentition. Tooth numbering provides dentists with an essential shortcut in clinical record keeping. Materials and Methods: Three systems are favored worldwide: the Zsigmondy/Palmer system, the Universal system, and the Federation Dentaire Internationale (FDI) Two-Digit system. Histories of all tooth-numbering methods were traced and the strengths and deficiencies of each system were reviewed. The FDI Two-Digit system is widely used throughout the world, except USA, and is the only method that makes the visual sense, cognitive sense, and computer sense. Conclusion: On review it was noticed that all tooth notation systems in vogue have a drawback as they do not provide any information or notations for supernumerary teeth such as paramolar, distomolar, mesiodens, and fused teeth.

Treatment of Palmer Class 1A Triangular Fibrocartilage Complex Injuries with Arthroscopic Partial Resection

PURPOSE: We reported the clinical results of Palmer class 1A triangular fibrocartilage complex (TFCC) injuries treated with arthroscopic partial resection. METHODS: This study included eighteen patients with Palmer class 1A TFCC injury. The results of arthroscopic partial resection were analyzed based on the preoperative and postoperative evaluation of visual analogue scale pain scale, range of motion, grip strength, Mayo wrist score, ulna grind test, ulna stress test and ulnocarpal tenderness. RESULTS: According to the Mayo wrist score, the results were excellent in 10 patients, good in 4, fair in 2, and poor in 2. There was no correlation among the worker's compensation, interval from injury to surgery, age and the treatment results. Patients with complication and scapholunate interosseous ligament tears had a poor clinical outcome. CONCLUSION: The arthroscopic TFCC partial resection is considered as an useful and effective treatment in Palmer class 1A TFCC injuries.

The Effect of Acupuncture Stimulation on Sympathetic Skin Response, Sympathetic Flow Response, and Palmer Emotional Sweating Evoked by Electric Stimulation to the Forehead / 全日本鍼灸学会雑誌

The effect of acupuncture on the autonomic nervous system was analyzed by simultaneous measurement of sympathetic skin response (SSR), sympathetic flow response (SFR) and Palmer emotional sweating evoked with electric stimuli to the forehead at random interval and intensity. The mutual relation of measurements by those parameters was examined electrophysiologically.<BR>The subjects were ten healthy male volunteers. SSR at the left palm and SFR at the fingertip of the left forefinger were measured using laser doppler flowmetry, and emotional sweating at teh right palm was measured with the ventilated capsule method (hydrography). The measurements were performed in two sessions, with and without acupuncture stimulation that was given at L14 with the technique of sparrow picking (1Hz) for 1 minute and retaining the needle for 10 minutes. The amplitude of SSR, the reduction rate of SFR, and the sweat rate were measured before and after acupuncture stimulation, while those were measured before and after resting in the other session as a control study. As a result, habituation in each response was not seen and the correlation coefficient in each index was low, while SSR and Palmar sweating were inhibited significantly in the stimulation group only, and SFR was inhibited in both groups.<BR>These results suggested that acupuncture stimulation might inhibit the activity of the skin sympathetic nerve system.