Modified Stennert's Protocol in Treating Acute Peripheral Facial Nerve Paralysis: Our Experience.

The aim of this study was to know the effect of modified Stennert's protocol on Bell's palsy and delayed onset post traumatic facial nerve paralysis. Retrospective study method which included 26 patients was done. Of this 19 patients had Bell's palsy and seven patients had delayed onset post traumatic facial nerve paralysis. All patients started on modified Stennert's protocol. Nineteen patients were observed and had idiopathic facial nerve paralysis. Fifteen patients showed clinical improvement by the 10th day and by the end of 1 month, 18 patients showed significant symptomatic improvement. One patient had residual defects at 6 months. Of the seven patients with delayed onset post traumatic facial nerve paralysis, three patients had to undergo facial nerve decompression, the remaining four receiving only modified Stennert's protocol. Improvement was seen in three patients by the 10th day. By the end of 1 month a total of five patients showed significant symptomatic improvement. Our experience suggests that regardless of the cause, sudden onset facial paralysis responds favorably to administration of modified Stennert's regimen, resulting in faster recovery and lesser sequelae.

Customised acrylic nasal stents following recanalisation of modified Young's procedure.

INTRODUCTION: Maintaining the patency of the nasal vestibule following recanalisation of a modified Young's procedure can be a difficult task, as restenosis is quite common. MATERIALS AND METHODS: Sixteen patients underwent recanalisation of a modified Young's procedure, between January 2005 and December 2007, in the ENT--head and neck surgery department of a tertiary centre. Three different stent types were used following recanalisation: silicone suction tube tips, dental wax plate stents and customised acrylic stents. RESULTS: The silicone suction tube stents prevented restenosis. They were visible in the post-operative period, and there appeared to be some blunting of the nasal valve region, with no functional impairment. Dental wax plates had a high rate of restenosis and were uncomfortable and unsightly. The customised acrylic stents were more acceptable in the post-operative period, and enabled nasal valve angulation to be maintained. CONCLUSION: The customised acrylic stent described was a superior alternative to such stenting methods as repeated packing, silicone suction tubes and dental wax plates, following recanalisation of a modified Young's procedure.

Role of KTP-532 laser in management of oral submucous fibrosis.

INTRODUCTION: Oral submucous fibrosis is a chronic disease characterised by progressive inability to open the mouth. Various treatment modalities are available for its management, but these have largely been ineffective. MATERIALS AND METHODS: Nine cases of oral submucous fibrosis underwent a release procedure using a KTP-532 laser, from March 2005 to January 2006, within the ENT-head and neck surgery department of a tertiary centre. RESULTS: Pre- and post-operative mouth-opening was compared using the Wilcoxon signed rank test, and a significant difference observed (Z = -2.690, p = 0.007). Follow up over an average period of 12 months showed encouraging results. CONCLUSION: This preliminary study indicated that adequate release of oral submucous fibrosis can be achieved by using a KTP-532 laser release procedure, with minimal morbidity and satisfactory results. These promising results should encourage more widespread use of this technique in the management of this condition.

Short-term heart variability and oxidative stress in newly diagnosed essential hypertension.

We sought to evaluate oxidative stress parameters like malondialdehyde, total antioxidant status, and time, frequency domain heart rate variability indices in newly diagnosed untreated hypertension. We also sought to study the correlation between heart rate variability and oxidative stress parameters in normotensive and newly diagnosed untreated essential hypertensives. Fourteen normotensive males and 36 newly diagnosed male hypertensives were enrolled for the study. Malondialdehyde, total antioxidant status, and heart rate variability in the frequency and time domain were studied in the hypertensive and normotensive group. Malondialdehyde was significantly higher in the hypertensive group, whereas total antioxidant status was significantly higher in the control group. SDNN, RR triangular index, RMSSD, log(10) low-frequency power, log (10) high-frequency power, log (10) total power, and heart rate variability during deep breathing test was significantly lower in hypertensive patients compared to normotensive controls. SDNN, RMSSD, high-frequency power, and high-frequency power normalized had significant negative correlation with malondialdehyde. Low-frequency power normalized positively correlated with malondialdehyde. Total antioxidant status had a significant negative correlation with blood pressure. The study gives further evidence for a decreased heart rate variability and elevated oxidative stress in hypertension.

Association between protein bound sialic acid and high sensitivity C-reactive protein in prehypertension: a possible indication of underlying cardiovascular risk.

The global burden posed by cardiovascular disease due to a rising incidence of known risk factors like essential hypertension underlines an urgent need to identify other potential risk factors like dyslipidemia, elevated levels of high-sensitivity CRP (hsCRP), Apo-B, and sialic acid in prehypertensive subjects. This study sought to examine the possible alteration in the levels of hsCRP, plasma protein bound sialic acid, and other lipid risk factors and the possible interactions among these parameters in prehypertensive subjects. Forty prehypertensive and 34 normotensive male subjects were enrolled in the study. Lipid profile, hsCRP, Apo-B, sialic acid, and lipid risk ratios were estimated in both the groups. There was no significant difference between fasting glucose and BMI in either group. The levels of total cholesterol, triglycerides, direct LDL-cholesterol, non-HDL cholesterol, and Apo-B were significantly increased in prehypertensive subjects compared with controls. The risk ratios calculated as direct LDL-cholesterol/Apo-B, total cholesterol/HDL-cholesterol, non-HDL-cholesterol/HDL-cholesterol were significantly elevated in prehypertensive subjects. There was also a significant increase in hsCRP and protein bound sialic acid in prehypertensive subjects in comparison with normotensive subjects. Correlation analysis revealed a significant association between the protein bound sialic acid with hsCRP, LDL cholesterol, and LDL-C/Apo-B. The findings of the present study suggest that in prehypertension, there is an association between protein bound sialic acid and hsCRP that reflects the clustering of cardiovascular risk factors in these subjects.

Altered oxidant-antioxidant status in non-obese men with moderate essential hypertension.

BACKGROUND: Although a wide number of experimental evidences are available regarding oxidant-antioxidant disturbance in hypertension, clinical data supporting it is lacking in men in early stages of hypertension. AIMS: The objective of the study was to evaluate oxidative status and antioxidant activities in males with stage I essential hypertension. MATERIALS AND METHODS: Thirty hypertensives and 21 normotensives were included in the study. Protein carbonyl, reduced glutathione, glutathione peroxidase, catalase and fasting glucose were assessed in both the groups. STATISTICAL ANALYSIS: Results were analyzed by student's 't' test and linear regression analysis test. RESULTS: Plasma protein carbonyl and glutathione peroxidase were significantly increased and catalase and GSH were significantly reduced in the hypertensive group compared to normotensive subjects. There was a significant negative correlation between glutathione peroxidase and catalase in the test group. CONCLUSIONS: The data from the present study indicates an alteration in oxidant-antioxidant status in non-obese men in early stages of essential hypertension.

A novel tilt table testing protocol for investigating patients suspected to have neurally mediated syncope.

We have observed that a series of 3 Valsalva maneuvers performed at 1-minute intervals between the 15th and 18th minute of a drug-free tilt table test resulted in intense presyncope and hypotension in a 32 yr old male with micturition syncope. In contrast, five apparently healthy subjects tolerated a 70 degree head-up tilt table test for 45 min with five Valsalva maneuvers incorporated into the testing protocol. Thus, we hypothesize that the use of a series of Valsalva maneuvers during a drug free head-up tilt table test might improve the diagnostic yield without compromising test specificity in patients suspected to have neurally mediated syncope.

Effect of estrogen on plasma ceruloplasmin level in rats exposed to acute stress.

BACKGROUND: Plasma ceruloplasmin, a copper containing protein, belongs to a class called acute phase proteins. Reduced level of ceruloplasmin was associated with Wilson's disease and Menke's kinky hair disease in man, primarily affecting copper metabolism. Stress was known to increase Ceruloplasmin. Several stress associated changes were commonly observed in women at menopause and also those who underwent overiectomy. Present experiment investigated the effect of estrogen on ceruloplasmin level in acute stress. AIMS: To assess the estradiol induced changes in plasma ceruloplasmin concentration on exposure of the rats to acute stress. SETTINGS AND DESIGN: Acute stress was induced by forcing the rats to swim till exhaustion. The rats were overiectomised bilaterally to remove the primary source of sex hormones. And hormone replacement was done later. MATERIAL AND METHODS: Wistar albino female rats were used. Acute stress was induced before overiectomy, following recovery from surgery, and again after Estradiol Valerate injection (for 10 days) in same group of rats. The plasma ceruloplasmin was estimated immediately after stress during each stage--that is preoperative control, stressed control, after overiectomy and then following treatment with Estradiol Valerate. STATISTICAL ANALYSIS USED: Paired sample T test was applied to analyze the findings. RESULTS: We found lowest ceruloplasmin level after stress in overiectomised animals, while on substitution of estradiol the trend appeared to be reversed. CONCLUSION: The result suggested a direct effect of estrogen on hepatic ceruloplasmin production/release and this could account for some of the beneficial effects of hormone replacement therapy.

A quantitative assay of porphyrins in leprosy patients. A spectrophotometric study.

Quantitative estimations of porphyrin in the blood, urine, and feces of 30 leprosy patients under treatment with dapsone, ten untreated cases, and 100 normal subjects were done by Rimington's method. Dapsone had no adverse effect on porphyrin metabolism because none of the cases of leprosy under study developed statistically significantly raised porphyrin levels in the blood, urine, and stools. Although erythrocyte coproporphyrin levels were significantly higher in leprosy patients than controls and urinary uroporphyrin levels significantly lower, most values fell within the normal range. These differences did not appear to have any clinical significance, and their cause remains unknown.