The effectiveness of long-acting penicillin (penidur) in preventing recurrences of dermatolymphangioadenitis(DLA) and controlling skin, deep tissues, and lymph bacterial flora in patients with "filarial" lymphedema.

Dermatolymphangioadenitis (DLA) is a common and serious complication of so-called "filarial" and bacterial non-filarial lymphedema of the limb, affecting skin, lymphatics and lymph nodes. In our previous studies, we demonstrated that more than 60% of patients revealed presence of bacterial isolates in deep tissues, tissue fluid and lymph from the lymphedematous limbs. The question remained open whether elimination or suppression of bacteria dwelling in lymphedematous tissues by administration of low doses of penicillin for long time periods would prevent recurrence of DLA attacks. In this study, we retrospectively evaluated a self/community-selected group of patients with lymphedema of the lower limbs with respect to the efficacy of long-acting penicillin in preventing episodes of DLA. There were no microfilariae or anti-filarial antibodies detected in the investigated group. The questions we asked were: (a) how effective is the benzathine penicillin in preventing recurrences of DLA attacks and (b) how does its long-term administration influence the bacterial spectrum of leg skin, deep tissues, lymph and lymph nodes and sensitivity to antibiotics. Two randomly selected groups of patients, receiving and not receiving penicillin during the same period of time, were compared. Evidently lower recurrence rate of DLA was observed in the treated group (p < 0.002). There was increased prevalence of cocci and gram-positive bacilli with a concomitant decrease of gram-negative bacilli on the foot and calf skin surface. Simultaneously, decreased prevalence of gram-positive cocci and gram-negative bacilli isolates in limb deep tissues and lymph was seen. No resistance to penicillin and other tested antibiotics developed in isolates from the skin surface, deep tissues and lymph. We conclude that long-lasting penicillin is effective in preventing recurrent DLA attacks.

[Contribution of fungi to chronic dermatitis and lymphangitis in patients with filariasis]. / Udzial grzybów w przewleklym zapaleniu skóry i naczyn limfatycznych u pacjentów z filarioza.

Adenolymphangitis is a common occurrence in filarial lymphedema. Damage to the lymphatics by F. bancrofti is followed by obliteration of lymph vessel and lymph stasis. Obstruction of lymphatics prevents the microbs skin penetration. Presented studies were performed to evaluate the role of fungi colonization of the skin among patients with filarial lymphedema. The fungal colonization of skin in patients with filarial lymphedema may be an important reason for chronic inflammatory disorders.

Bacteriological studies of blood, tissue fluid, lymph and lymph nodes in patients with acute dermatolymphangioadenitis (DLA) in course of 'filarial' lymphedema.

Filarial lymphedema is complicated by frequent episodes of dermatolymphangioadenitis (DLA). Severe systemic symptoms during attacks of DLA resemble those of septicemia. The question we asked was whether bacterial isolates can be found in the peripheral blood of patients during the episodes of DLA. Out of 100 patients referred to us with 'filarial' lymphedema 14 displayed acute and five subacute symptoms of DLA. All were on admission blood microfilariae negative but had a positive test in the past. Blood bacterial isolates were found in nine cases, four acute (21%) and five subacute (26%). In 10 acute cases blood cultures were found negative. Six blood isolates belonged to Bacilli, four to Cocci and one was Sarcina. To identify the sites of origin of bacterial dissemination, swabs taken from the calf skin biopsy wounds and tissue fluid, lymph and lymph node specimens were cultured. Swabs from the calf skin biopsy wound contained isolates in nine (47%) cases. They were Bacilli in nine, Cocci in three, Acinetobacter and Erwinia in two cases. Tissue fluid was collected from 10 patients and contained Bacilli in four (40%) and Staphylococci in three (30%). Lymph was drained in four patients and contained isolates in all samples (100%). They were Staphylococcus epidermis, xylosus and aureus, Acinetobacter, Bacillus subtilis and Sarcina. Three lymph nodes were biopsied and contained Staphylococcus chromogenes, xylosus, Enterococcus and Bacillus cereus. In six cases the same phenotypically defined species of bacteria were found in blood and limb tissues or fluids. In the 'control' group of patients with lymphedema without acute or subacute changes all blood cultures were negative. Interestingly, swabs from biopsy wound of these patients contained isolates in 80%, tissue fluid in 68%, lymph in 70% and lymph nodes in 58% of cases. In healthy controls, tissue fluid did not contain bacteria, and lymph isolates were found only in 12% of cases. This study demonstrates that patients with acute episodes of DLA reveal bacteremia in a high percentage of cases. Diversity of blood and tissue bacterial isolates in these patients points to a breakdown of the skin immune barrier in lymphedema and subsequently indiscriminate bacterial colonization of deep tissues and spread to an blood circulation.

Role of rapid imprint cytology in the diagnosis of skin cancer and assessment of adequacy of excision.

Imprint cytotechnique was employed in 20 cases of maligant skin tumours (11 squamous cell carcinoma, 4 basal cell carcinoma and 5 malignant melanoma) to evaluate the reliability of the technique by comparing the results with histologic diagnosis. In ten cases margins of the excised tumours were also subjected to imprint and histopathologic studies to assess the clearance of malignancy. All the tumours were correctly diagnosed in imprint smears. Similarly 100% cytohistopathologic correlation was also obtained in the assessment of excisional margins of the tumours. The technique of imprint cytology may be employed for quick diagnosis of skin cancers and in assessment of clearance of surgical field during surgery.

Anatomical basis for the clinical application of the arterial supply of musculus pectoralis major.

The pattern of arterial supply to the various parts (clavicular, sternocostal and aponeurotic) of the pectoralis major muscle was studied in 7 cadaver dissections and 10 angiograms by injecting a radio-opaque substance. Three main arteries supplied the muscle, i.e. the pectoral branch of the thoracoacromial trunk (TAT-PB), the lateral thoracic artery and the perorating branch of the internal thoracic artery, supported by other branches of the TAT and the superior thoracic artery. It is observed that the TAT-PB, a chief vascular pedicle, anastomoses freely with other arteries and supplies most parts of the muscle. The present study is mainly focussed on the exclusion of the chief vascular pedicle of muscle to eliminate the confusion of previous studies and prevent the unnecessary hindrance and complications of the muscle flap.

Repair of burns of the scrotum using a gracilis myocutaneous flap.

An unusual case of isolated burns of the scrotum reconstructed by a unilateral gracilis myocutaneous flap is reported because of its clinical rarity.

Macroradiographic study of post-burn contracture of limbs.

Fifty patients with post-burn contracture involving various joints of the limbs were analysed. To study the minor skeletal changes the patients were subjected to macroradiography. In half of the patients various types of pathology were observed and their therapeutic and prognostic significance have been discussed.

Blood gas studies in thermal burns.

In the present study we have included 25 cases with a relatively small extent of burns as compared to those described in many of the other published work. We have chosen the 3rd post-burn day as the day of reference (because most of the patients did not turn up before that day) from which day onwards adequate number of observations were available. Arterial blood gas studies revealed significant decrease in arterial partial pressure oxygen on 5th and 8th post-burn days with lowest mean value on 8th post burn day and then a gradual rise towards the normal value. Arterial partial pressure of carbon dioxide fell after the burn to reach the lowest value on the 5th post burn day and then returned towards the normal value. Arterial hydrogen ion concentration also fell (i.e. arterial blood pH rise) in the post-burn course. This was significant on the 11th post burn day.

Respiratory functions in thermal burns.

In our present series, respiratory functions were observed in patients with a relatively small extent of burn compared to that commonly represented by the published works, and for a considerable duration of time (three weeks), commencing soon after the burn trauma. Respiratory rate increased in the post burn trauma and the peak expiratory rate was observed on the 8th post burn days and then it gradually fell but still remaining much higher than the control normal value. The minute volume and tidal volume also showed similar rise on the 8th post burn day and then gradually fell to below the mean level of 3rd post burn day before the 3rd post burn week. Forced vital capacity, forced expiratory volume in one second, forced expiratory volume in three seconds, forced expiratory volume in one second as a percentage of forced vital capacity, forced expiratory volume in three seconds, as a percentage of forced vital capacity and peak expiratory flow rates, did not vary much and indicated no significant respiratory abnormality.

Management of scalp injuries.

Scalp avulsions of various origin are frequently seen, owing to rapid industrialization and the increased incidence of road-traffic accidents. This article deals with 20 such cases seen and treated by the authors in the last 5 years. The victims were predominantly young females. The anatomic and pathophysiologic aspects of avulsion injury are considered in detail, and various modalities of treatment are discussed. With intact pericranium, split-skin grafting remains the treatment of choice. In the presence of bare bone, local flap is preferred, if feasible. If not, then the outer table of the skull is chiseled out or multiple drilling is done through it to accelerate the formation of granulation tissue. Subsequently, this is covered by split-skin grafting. Of course, the grafts do not grow hair and the patients need to wear a wig for total psychological and functional rehabilitation. Prevention remains still the best remedy.

Traumatic avulsion of penile and scrotal skin.

Due to the use of high speed machinery in industry and the rapid mechanisation of agriculture an increasing number of avulsion injuries are being referred for treatment. This paper describes our experience in the management of ten patients with extensive traumatic avulsion of the penile and scrotal skin, treated by primary split-thickness skin grafting.

Temporomandibular ankylosis.

Temporomandibular ankylosis is commonly seen in children and young adults. Trauma in childhood is the commonest cause. Treatment of choice is by surgical intervention. Depending upon the local findings a gap arthroplasty or interposition arthroplasty is the procedure carried out. Early mobilisation is recommended.

Primary tumours and tumour-like conditions of the mandible.

Reports on comprehensive mandibular tumours are very rare. The present article describes a total of 81 primary tumour and tumour-like lesions of the mandible seen at the University Hospital, Banaras Hindu University, during last 16 years. In the mandible the ratio of odontogenic to nonodontogenic tumors is 1.6:1. Ameloblastomas constitute 56% of the odontogenic tumors. Among the benign mesenchymal tumours of the jaw 58% are neoplastic and 42% are nonneoplastic in which cementoostoid tissue is laid down secondary to inflammatory process. Over all 40 cases are benign 28 potentially malignant (ameloblastoma) and 13 are malignant lesions. Among the malignant mandibular tumours, bone tumours are more common than the soft tissue sarcomas. Microscopically mandibular osteosarcomas are better differentiated than similar tumours in the long bones. Local, segmental, or radical surgery seems to be the treatment of choice in the mandibular tumours.