Normative values for maximal respiratory pressures in an Indian Mangalore population: A cross-sectional pilot study.

OBJECTIVE: The objective of the pilot study is to obtain normal maximal inspiratory and expiratory pressures for individuals in the age group 20-70 years in the Mangalore population and to predict normal values according to age, sex, height, and weight using the regression equation. MATERIALS AND METHODS: Two hundred and fifty subjects were selected through a convenient method of sampling. Fifty subjects each were enrolled in the following age groups: 20 to 29, 30 to 39, 40 to 49, 50 to 59, and 60 to 70. Each group had 50 subjects (males-25 and females-25). Baseline data such as height, weight, body mass index were recorded. Maximal inspiratory pressure (PI) and expiratory pressure (PE) were determined following standardized protocol. RESULT: With regard to PI max and PE max, the measured values were significantly lower than those recorded in previous studies for both males (30%) and females (20%). We found that age served as the best factor for the prediction of PI max and PE max in both genders. CONCLUSION: The results of this study can be used to predict respiratory muscle strength in healthy adult subjects, and the strategy employed in this study will serve as a useful, simple, reproducible, rapid assessment of respiratory muscle function and also aid the planning of treatment.

A status report on management of cleft lip and palate in India.

INTRODUCTION: This national survey on the management of cleft lip and palate (CLP) in India is the first of its kind. OBJECTIVE: To collect basic data on the management of patients with CLP in India for further evaluation. MATERIALS AND METHODS: A proforma was designed and sent to all the surgeons treating CLP in India. It was publicized through internet, emails, post and through personal communication. SUBJECTS: 293 cleft surgeons representing 112 centers responded to the questionnaire. Most of the forms were filled up by personal interview. RESULTS: The cleft workload of the participating centers is between 10 and 2000 surgeries annually. These centers collectively perform 32,500-34,700 primary and secondary cleft surgeries every year. The responses were analyzed using Microsoft excel and 112 as the sample size. Most surgeons are repairing cleft lip between 3-6 months and cleft palate between 6 months to 1 year. Millard and Tennison repairs form the mainstay of lip repair. Multiple techniques are used for palate repair. Presurgical orthopedics, lip adhesion, nasendoscopy, speech therapy, video-fluoroscopy and orthognathic surgery were not always available and in some cases not availed of even when available. CONCLUSION: Management of CLP differs in India. Primary surgical practices are almost similar to other studies. There is a lack of interdisciplinary approach in majority of the centers, and hence, there is a need for better interaction amongst the specialists. A more comprehensive study with an improved questionnaire would be desirable.

Twenty years' follow-up of a de-epithelialised turnover flap.

The authors have used the de-epithelialised turnover flap (Thatte's Flap) for covering compound defects over the tendo-achilles in 31 patients in the period covering 1980-2000. Two of these patients have come up for follow-up after 20 years. In this late follow-up, the results are good and the tendon which was bridged by the dermis of the flap is functioning to allow the patients to stand on their toes. The de-epithelialised turnover flap is a simple and easy technique giving good long-term results. In spite of all the new advances in flap coverage, the de-epithelialised turnover flap is a good alternative for the tendo-achilles area in the armamentarium of a plastic surgeon.

Intravenous injection of elemental mercury: A report of two cases.

Two cases of intravenous injection of elemental mercury are described in this report. One patient succumbed and the other remains asymptomatic two years after the surgical removal of all the injected mercury. Management of intravenous injection of elemental mercury (intended to be an aphrodisiac in these two cases) is discussed here and the need for surgical removal of all accessible mercury has been emphasized.

Studies on the interaction of the dye, stains-all, with individual calcium-binding domains of calmodulin.

We show that the calcium-mimic dye, Stains-all, is a convenient probe to study the structural features of the individual calcium-binding sites of calmodulin (CaM) and related calcium-binding proteins (CaBP). These peptides bind the dye in their calcium-binding sites, and induce a circular dichroism (CD) band in the bound dye in the 620 nm (J band) region, which is abolished upon the addition of calcium. Replacement of Asp by Asn in the + x position of the weaker calcium-binding site (site I of CaM) abolishes the dye binding, while the same change in the higher affinity site IV attenuates the binding of the dye and does not abolish it. Replacement of Tyr in site IV with Trp does not distort the geometry, although it increases the dye binding affinity.

Calcium ion binding to delta- and to beta-crystallins. The presence of the "EF-hand" motif in delta-crystallin that aids in calcium ion binding.

Abnormal levels of endogenous calcium ions are known to induce eye lens opacity, and a variety of causative factors has been proposed, including calcium-mediated aggregation and precipitation of the lens proteins crystallins. We have specifically looked in some detail at the interaction of Ca2+ with various crystallins and its consequences. Lenses incubated in solutions containing 10 mM Ca2+ or 5 mM Tb3+ opacified. Fluorescence titration of crystallins with TbCl3 revealed that this ion binds to delta- and beta-crystallins in solution. Equilibrium dialysis showed that four Ca2+ ions bind to one delta-crystallin tetramer with an affinity of 4.3 x 10(3) M-1. Analysis of the amino acid sequence of delta-crystallin reveals the presence of a calmodulin-type "helix-loop-helix" or "EF-hand" calcium ion binding conformational motif in the region comprising residues 300-350. This is a novel feature of the molecule not reported so far. No other crystallins appear to have this motif. beta-Crystallin also binds four Ca2+ ions/aggregate unit of mass 160 kDa, with an affinity of 2.6 x 10(3) M-1, presumably in the midregion of the molecule that is rich in anionic and polar residues. Circular dichroism spectroscopy shows that the binding of calcium ion leads to subtle conformational changes in the molecules, notably in the tertiary structure.

An objective study of the dimensions of the ischial pressure point and its correlation to the occurrence of a pressure sore.

A simple non-invasive technique has been used to study the dimensions of the ischial pressure point in normal and paraplegic individuals. The same technique charts the surface area of the gluteal impression. The data obtained in these two groups of patients (normal and paraplegic) have been analysed to see if it is possible to predict the greater susceptibility of certain individuals to suffer from pressure sores over the ischial tuberosity.

Middle ear function in cleft palate.

This study is based on an impedence audiometric evaluation of three groups of patients-20 with un-operated cleft palate, 28 normal subjects as controls and 20 operated cleft palate patients. Four major parameters have been analysed: middle ear pressure, static compliance, acoustic reflex and tympanometry. It was confirmed that in the normal child Eustachian tube function improves with growth and the critical age when the middle ear pressure becomes normal in almost all the normal children is 5 to 6 years. This process of improvement is disturbed in the presence of a cleft palate. Poor Eustachian tube function, evidenced by persistent negative middle ear pressure, continues to be commonly seen in the older subjects with un-operated cleft palates. The static compliance that reflects the elasticity of the conducting mechanism of the middle ear is poorer in cleft palate patients. It was also observed that when the cleft palate had been repaired before the age of 6 years, Eustachian tube function improved significantly in the older age group as shown by the lower incidence of negative middle ear pressure and Eustachian tube block. The high incidence of serous otitis media is apparently unaffected by surgery on the cleft palate and is responsible for some degree of hearing loss encountered in the older patients with operated cleft palates. Thus the incidence of hearing loss as studied by acoustic reflex is higher in all age groups in the presence of a cleft palate.

The use of de-epithelialised "turn over" flaps in the hand.

Two examples are presented of the application of the principles of de-epithelialised "turn over" flaps in the hand. These flaps were used to resurface a post-infective volar skin defect on a finger and to correct an adduction contracture in the first web space of the hand. The reasons for their use and their advantages are briefly discussed.

Median cleft lip associated with bimanual hexadactyly and bilateral accessory toes: another case.

Another case of median cleft lip associated with bimanual hexadactyly and bilateral accessory toes is presented. This is the third instance of the anomaly in a patient of Indian descent out of four cases reported in the literature.