Rare combination of anomalies and its management with conservative and effective approach.

Transverse vaginal septum is a rare anomaly that results from incomplete fusion of urogenital sinus, and the vaginal parts of the Mullerian duct. Cervical atresia/dysgenesis is still a rare uterovaginal anomaly that can be congenital or acquired leading to fertility problems. Transverse vaginal septum when it coexists with cervical dysgenesis, it becomes a rare combination where management becomes highly complex. This case report deals with interdisciplinary role of conservative surgical management and custom made prosthetic appliances in the management of transverse vaginal septum and cervical atresia at an early stage and perhaps this goes to be the first-line treatment option with the expertise in laparoscopic surgery along with prosthetic management.

Hair band retained prosthetic reconstruction of bilaterally missing ears: a case of congenital atresia of external auditory canals and pinna.

INTRODUCTION: Auricular defects present reconstructive challenges, especially if they are bilateral. Surgical reconstruction provides effective results for defects; however for some patients surgical intervention is contraindicated. This case report describes an easy clinical technique to rehabilitate a patient with auricular defects. The prime purpose of this treatment rendered was to restore the lost auricular structure to the patient's satisfaction in an elegant, comfortable and cost effective manner. PATIENT: A thirteen year old female patient, who had bilaterally missing ears, was referred with a chief complaint of discomfort caused due to her existing hair band prosthesis and unsatisfactory esthetics. There was constant formation of ulcers at the site where the prosthesis came in contact with the skin. Considering the patient's age, ease of use and economic status, hair band retained ear prosthesis was selected. Silicone ear prostheses were fabricated on acrylic substructure to ensure fit, esthetics. Beneath the acrylic plates, a thin layer of soft silicone material was attached. The ear prostheses of both sides were connected with a metal hair band to retain. DISCUSSION: The newly fabricated prosthesis overcame the limitations of the existing one. The patient and her parents were satisfied with the results. CONCLUSION: The hair band retained silicone ear prosthesis is esthetic, economical and easy to use as a facial prosthesis. The addition of soft liner provided a cushion-like effect, thus reducing the formation of any ulcers due to pressure.

Rehabilitation of post surgical maxillectomy defects using interim obturators-a case series.

Prosthetic rehabilitation of extensive maxillectomy defects are exigent given the difficulties faced due to loss of palatal bone,teeth and surrounding supporting tissues which help in retention, support and stability of the prosthesis. An interim maxillary obturator is a prosthesis which is made after surgical resection of a portion or all of one or both maxilla where initial healing is completed. Frequently many or all teeth in the defect area are replaced by this prosthesis. It plays a vital role in preventing the facial disfigurement and irritation to the surgical site thereby enhancing the healing and restores the functional capabilities such as speech, mastication, deglutition etc. To gain better retention and stability, preservation of the unaffected regions is needed which can be achieved by proper surgical planning and designing of the prosthesis. This case series describes rehabilitation of three extensive maxillectomy defects with hollow open and closed interim obturators.

Aesthetic finger prosthesis.

Complete or partial fingers are the most commonly encountered forms of partial hand losses. Though finger amputations are commonly due to traumatic injuries, digit loss may also be attributed to congenital malformations and disease. Irrespective of the etiology, the loss of a finger has a considerable functional and psychological impact on an individual. In order to alleviate these problems, partial or complete finger prosthesis may be fabricated. This clinical report portrays a method to fabricate silicone rubber prosthesis for a patient who has a partial finger loss caused due to trauma.

Resuscitation orders and their relevance to patients' clinical status and outcomes.

BACKGROUND: Documented resuscitation orders have relevance in the management of a pulseless, unresponsive patient. Although useful, the frequency of their documentation in the case notes of newly admitted medical patients is not well established. AIM: To investigate the frequency of early clear documentation of resuscitation orders in patients' admission notes. DESIGN: Retrospective audit. METHODS: The admission notes of 618 medical admissions to an Australian tertiary referral teaching hospital between January and December 2007 were reviewed to calculate the frequency of clear resuscitation documentation. Certain outcomes of each admission, such as in-hospital death, were obtained via hospital-based computerized records. RESULTS: Within the first 24 h of admission, discussions regarding resuscitation were not documented for 78% of patients. Of the 482 patients with no documented resuscitation orders, 5 patients died during their index admission. Of the 136 patients with documented resuscitation orders, 24 patients died during their index admission. As age or a measure of clinical debility increased, the absolute number and relative proportion of resuscitation discussions increased significantly (P<0.0001) and the number and proportion of patients deemed not for resuscitation also increased (P<0.0001). CONCLUSION: Those patients apparently targeted for discussion were older, more frail and acutely unwell. We propose widespread use of a clinical scoring system to identify those patients who need their resuscitation status clarified early in their admission prior to clinical deterioration.

Attempted suicide and the lunar cycle.

An analysis of 383 cases of attempted suicide presented to the Accident and Emergency Department during 12 complete lunar cycles (one year) gave no support for an association between attempted suicide and the lunar cycle, especially the full moon. No control for weekends or holidays was made.