Camptodactyly: An unsolved area of plastic surgery

BACKGROUND: Camptodactyly refers to permanent flexion contracture at the proximal interphalangeal joint. Most cases are limited to fifth-finger involvement. Although common, the treatment of camptodactyly is controversial. Many published studies have emphasized conservative treatment, while others have described surgical procedures. The problem with this deformity is that it presents in several forms, which means that there is no single model for effective treatment. The aim of this paper is to present the difficulties encountered with this condition and the management thereof on an individual basis. METHODS: This is a case series of 14 patients (nine males, five females) who underwent surgical treatment. The results were classified using the method from Mayo Clinic as excellent, good, fair, and poor. RESULTS: Fourteen patients with 15 fingers underwent surgery, and the results achieved were as follows: excellent, 0; good, 1; fair, 6; poor, 8. The treatment of camptodactyly still remains controversial, and hence proper planning individualized to each patient is needed to achieve the maximal improvement with realistic goals. CONCLUSIONS: Although we performed individualised surgery, our careful follow-up was not able to identify any method as superior over another with respect to gain in extension and loss of flexion. We therefore propose that the extensor mechanism should not be disturbed during surgery to treat camptodactyly cases.

Bone mineral density and urinary hydoxyproline are already abnormal in newly diagnosed patients with epilepsy in this North Indian study

Background & Objective:Epilepsy may have an impact on bone health of the patients even before drug therapy is initiated, particularly in the developing countries. This is in view of long delay in diagnosis and lifestyle changes. Therefore, in this study, bone health markers like bone mineral density (BMD) and urinary hydroxyproline were assessed in newly diagnosed epilepsy patients. Methods: The BMD was assessed by DEXA scan, and 24 hour urine hydroxyproline was estimated colorimetrically in 25 newly diagnosed epilepsy patients. Other bone markers like calcium, phosphorus, vitamin D and alkaline phosphatase were also estimated. Results were compared with 25 age and sex matched healthy controls, and were analyzed statistically. Results: The BMD and vitamin D were found to be significantly decreased (p0.05). Conclusions: Bone health is found to be already compromised in epilepsy patients in this study from North India. BMD and urinary hydroxyproline may act as simple, non-invasive, convenient and inexpensive markers to assess bone health in these patients

Performance of a low cost magnifying device, magnivisualizer, versus colposcope for detection of pre-cancer and cancerous lesions of uterine cervix / 부인종양

OBJECTIVE: To assess the performance of a low cost magnifying device (Magnivisualizer) compared to a standard optical colposcope for detection of precancerous and cancerous lesions of the uterine cervix. METHODS: A total of 659 consecutive symptomatic women attending a gynecologic outpatient clinic underwent unaided visual inspection followed by cytology, visual inspection of the cervix using 5% acetic acid (VIA), and VIA under magnification (VIAM) with the Magnivisualizer. All women, independently of test results, were referred for colposcopic examination. Colposcopic-directed biopsies were obtained from all positive lesions and compared to positive VIAM cases. RESULTS: The detection rate for VIA positive lesions was 12% (134/659), while it was 29% for VIAM positive lesions (191/659). The sensitivities of detection of cervical intraepithelial neoplasia (CIN) 2 and higher lesions were 61.7% for VIA, 88.3% for VIAM, and 86.7% for colposcopy, with a specificity of 58.5% for VIA, 55.8% for VIAM, and 90.4% for colposcopy. The performance of colposcopy and VIAM was moderate (kappa, 0.48; 95% confidence interval [CI], 0.41 to 0.54) for detection of CIN 1 and higher lesions and excellent (kappa, 0.87; 95% CI, 0.82 to 0.94) for detection of CIN 2 and higher lesions. CONCLUSION: In low resource settings, where colposcopic facilities are not available at the community level, a simple low-cost, handheld Magnivisualizer can be considered a valid option for detection of cervical precancerous and cancerous lesions. However, it cannot replace traditional colposcopy because it has a low specificity that results in many unnecessary biopsies.

Therapeutic drug monitoring for antiepileptic drugs using HPLC: An experience at a tertiary care hospital in India

This study was carried out to analyse retrospectively the data of 1,349 patients receiving antiepileptic drugs (AEDs) distributed drug wise into subtherapeutic, therapeutic, toxic and not detectable ranges. Patients were divided into three groups based on the monotherapy they received. In Phenytoin group (n=1255), 26.4% were found to be in therapeutic range, 51.6% in the subtherapeutic range and 20.6% in the toxic range. For Carbamazepine (n=63), 52.4% were in the therapeutic range, 14.3% were in subtherapeutic range, 31.7% in the toxic range and 1.6% were undetectable. Phenobarbitone levels (n=31) were found to be 64.5% in therapeutic range, 22.6% in subtherapeutic range, 9.7% in toxic range and 3.2% in the undetectable range. In 100 patients of phenytoin analyses which were under good seizure control and free of adverse effects, 46% were found to be in therapeutic range, 31% were in subtherapeutic range and 23% were found to be in toxic range. On the basis of this data, it is recommended that therapeutic drug monitoring should be carried out in all patients receiving AEDs for better overall management and long term clinical outcome.

Fortified human milk in the small for gestational age neonate.

OBJECTIVE: To assess the nutritional advantage of fortified human milk in the small for gestational age neonate. METHODS: Term asymmetric small for gestational age babies were randomly assigned to either the study group or the control group. The babies in the study group received fortified EBM, (more proteins, calories, vitamins and minerals) whereas babies in the control group received EBM only. Babies were followed up weekly for a period of 28 +/- 2 days for physical growth (weight, length and OFC). Biochemical markers of nutritional status (Blood urea, serum calcium, phosphorus, alkaline phosphatase, serum electrolytes and serum protein) were done initially and then on Day 28 +/- 2. RESULTS: The weight gain in the study group (38.77 +/- 7.43 g/day) was significantly better than in the control group (28.71 +/- 3.18 g/day). The length and OFC gain in the study group (1.14 +/- 0.33 cm/week and 0.62 +/- 0.07 cms/week, respectively) were significantly better than in the control group (0.87 +/- 0.17 cm/week and 0.49 +/- 0.07 cm/week respectively). The biochemical markers of nutrition, however, were not significantly different in the two groups. CONCLUSION: Fortified breast milk results in improved physical growth in the term asymmetric small for gestational age neonate.

Plasma tocopherol levels: a preliminary reference range.

Alpha-tocopherol level was measured spectrofluorometrically in 279 healthy volunteers to establish reliable reference values and to compare possible sex and age-related differences. In the present study, men had higher tocopherol levels than women (p<0.05) and older subjects had lower values. This study provides reference values for alpha-tocopherol that may assist it evaluating the anti-oxidant defense.

Plasma lipoperoxides: a preliminary reference range.

We measured lipoperoxides, as malonaldehyde (MDA) by thiobarbituric acid reaction in serum from 80 male and 120 female volunteers to establish reliable reference values and to compare possible sex- and age- related differences. In the present study women had higher MDA concentration in serum than do men (p<0.05) and older subjects had higher values (p<0.05). These age related results support the suggestions that lipid peroxidation increases with increasing age.