Occupational Nerve Injuries due to Metallic Foreign Bodies: A Case Series of Eighteen Patients.

Introduction: Peripheral nerve injuries (PNIs) remain an important health problem. PNIs mostly affect young men as this age group is mostly involved in road traffic accidents and other injuries at workplace. PNI can occur from foreign bodies like metal chips while working in industries using lathe machines. Among PNI's, injuries to the ulnar nerve, the brachial plexus and the median nerve are the most frequent lesions encountered. Materials and methods: This presentation is on a series of 18 cases of nerve injuries among industrial workers located from finger level up to the arm excluding the brachial plexus due to metallic foreign bodies entering while operating lathe machines over a period of two years with patients being followed-up over a one year period. Results: Mean age in this series was 31.3 years with age range 16-40 years and all were males. Two patients had more than one nerve involvement and one patient had associated vascular injury. All the patients showed functional improvement. Most common nerve injured was median nerve. Most common site for nerve injury was forearm. Combined lesions most commonly involved the ulnar and median nerves. Conclusion: Social cost of traumatic peripheral nerve injuries is significant since it has a higher incidence in young, previously healthy, and economically active people.

Differential absorption lidar data acquisition and control system for remote detection of trace chemicals including methane and thiodiglycol.

We report the design and development of a data acquisition and control system for high-speed acquisition of weak, backscattered differential signals and synchronized sequential operation of all subsystems of a tunable, mid-infrared Differential Absorption Lidar (DIAL) system. The presence of a low-level concentration of chemical species results in weak differential return signals. The differential signal also varies dynamically with respect to background atmospheric conditions. The challenge is to measure this low level of differential signal with high resolution and also control the sequence of operation of subsystems such as lasers and scanners for real time testing and evaluation in open field conditions. The concentration spread of the chemical species varies rapidly with distance. In order to capture this spatial variation, the lidar signal should be sampled and digitized at a high sampling rate. A customized Peripheral Component Interconnect based data acquisition of a 12-bit resolution, 30 Mega samples per second sampling rate, and an industrial personal computer-based control system has been realized. Detection algorithms and the firing sequence of the laser have been developed indigenously and implemented in the LabVIEW platform. The developed graphical user interface has various modes of operation as per user requirement and is capable of executing automatic operations for the developed DIAL system in order to detect and identify the chemicals. The performance has been evaluated by detecting the chemical species thiodiglycol at 800 m using 3190 and 3300 nm (online and offline wavelengths) with a differential cross-section of 2.5 × 10-23 m2. Similarly, methane has been detected and quantified with concentration of 2.2 ppm up to 300 m using 3316 and 3326 nm (online and offline wavelengths, respectively).

Effect of bone bank processing on bone mineral density, histomorphometry & biomechanical strength of retrieved femoral head.

BACKGROUND & OBJECTIVES: Standard processing of the bone grafts involves deep-freezing and sterilization with gamma irradiation which may alter mechanical properties of the bone graft. This study was aimed at measuring the effect of bone bank processing on the mechanical properties of bone allograft and its correlation with bone mineral density [BMD, dual-energy X-ray absorptiometry (DEXA Scan)] and histomorphometric indices. METHODS: Femoral heads retrieved from patients undergoing hip replacement surgeries were used as the material. Twenty femoral heads were under taken in the study. Each femoral head was cut into two equal cubes. One cube was subjected to BMD measurement using DEXA Scan followed by unilateral compression test. Histomorphometric indices such as trabecular number (Tb. N.), trabecular separation (Tb. S.), trabecular thickness (Tb. T.) and bone volume (B.V.) were calculated on the same specimen by a computer software. The other cube was kept in deep freezer (-76°C) for a minimum of three weeks, followed by gamma irradiation and subjected to similar tests. RESULTS: Results were compared in pre- and post-processed bone specimens. A significant loss of biomechanical strength (P<0.001) with mean a loss of 18.90 per cent was found in post-processed samples in uniaxial compression tests. Similarly, BMD (mean decrease by 13.8%, P<0.01) and histomorphometric indices such as Tb. T. (mean decrease by 12.37%, P<0.01), Tb. S. (mean increase by 12.60%, P<0.001) and B.V. (mean decrease by 20.84%, P<0.01) were found. However, Tb. N. was not significantly affected. INTERPRETATION & CONCLUSIONS: The current method of processing of bone allografts i.e. deep-freezing and gamma irradiation appeared to cause a significant reduction in the biomechanical strength of allogenic bone which was more suitable to be use in the morselized form. Appropriate consideration for decreased strength needs to be given when using allogenic bone graft as a structural graft.

Lasers in stapes surgery: a review.

BACKGROUND: Lasers in stapes surgery are used to divide the anterior and posterior crus of the stapes, divide the stapedius tendon and perforate the footplate. The ideal laser should not penetrate deeply into the perilymph (thereby increasing its temperature). It should be conducted through optical fibres, allowing easy manipulation, and should have good water absorption, equating to high bone ablation efficiency. OBJECTIVES: This review discusses the various different lasers used in stapes surgery with regard to their properties and suitability for this type of surgery. In particular, the laser parameters used are discussed to facilitate their clinical use.

The management of otitis externa in UK general practice.

Acute otitis externa is common and provides a heavy workload for general practitioners. We aim to determine the first-line treatment used by general practitioners in the management of otitis externa and subsequent second-line treatment in a hospital ENT clinic. In addition, this study aims to ascertain whether local and national guidelines are being followed appropriately. A prospective observational study on the management of otitis externa in consecutive patients referred to an ENT emergency clinic was undertaken. Data were collected and analysed on symptoms, initial management by general practitioners, findings and treatment in the ENT clinic. A total of 106 patients were studied. The mean duration of symptoms before presentation to clinic was 13 days; 42% of patients received no treatment by their GP prior to referral to the ENT emergency clinic. Only 14% of patients received topical antibiotics alone, whilst 44% received oral antibiotics, either alone or in conjunction with topical antibiotics by their GP. Of the 106 patients, 86% received topical antibiotics in the ENT emergency clinic and oral antibiotics were reserved for those presenting with complicated acute otitis externa. Topical antibiotics are associated with a decrease in disease persistence, whilst oral antibiotics are associated with an increase. However, general practitioners are prescribing oral antibiotics more often than required. There are few regional guidelines and no explicit national guidelines on the management of acute otitis externa for GPs to refer to. We suggest the implementation of national guidelines to aid clinical practice.

Mie lidar observations of lower tropospheric aerosols and clouds.

Mie lidar system is developed at Laser Science and Technology Centre, Delhi (28.38°N, 77.12°E) by using minimal number of commercially available off-the-shelf components. Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser operating at 1064nm with variable pulse energies between 25 and 400 mJ with 10 Hz repetition rate and 7ns pulse duration is used as a transmitter and off-axis CASSEGRAIN telescope with 100mm diameter as a receiver. Silicon avalanche photodiode (Si-APD) module with built-in preamplifier and front-end optics is used as detector. This system has been developed for the studies of lower tropospheric aerosols and clouds. Some experiments have been conducted using this set up and preliminary results are discussed. The characteristics of backscattered signals for various transmitter pulse energies are also studied. Atmospheric aerosol extinction coefficient values are calculated using Klett lidar inversion algorithm. The extinction coefficient, in general, falls with range in the lower troposphere and the values lie typically in the range 7.5×10(-5) m(-1) to 1.12×10(-4) m(-1) in the absence of any cloud whereas this value shoots maximum up to 1.267×10(-3) m(-1) (peak extinction) in the presence of clouds.

Single Step Endodontic Management of Immature Apices using MTA.

AIM: To examine the clinical and radiographic appearance of teeth with immature apices that were treated by single step procedure using mineral trioxide aggregate (MTA). SUMMARY: Creation of a physiological hard tissue barrier with calcium hydroxide in a nonvital tooth although quite predictable has certain limitations, such as the very long duration of the treatment spread over multiple visits and increased risk of root fracture. Plugging the root canal end with MTA has been advocated as an alternative treatment modality for open apices. The technique has been proven to be successful in many recently reported cases. The cases reported here present the successful treatment of two traumatized maxillary central incisors with open apices and periapical lesions using MTA. In this case report, MTA has been used to create a hard tissue barrier after disinfection of the root canal.

A case report of cemento-ossifying fibroma.

The concept of 'fibro-osseous lesions' of bone evolved over the last several decades to include two major entities: fibrous dysplasia and ossifying fibroma as well as the other less common lesions such as florid osseous dysplasia, periapical dysplasia, focal sclerosing osteomyelitis, proliferative periostitis of garrie and ostitis deformans. The cemento-ossifying fibroma is a central neoplasm of bone as well as periodontium which has caused considerable controversy because of confusion of terminology and criteria of diagnosis. The cemento-ossifying fibroma is odontogenic in origin where as ossifying fibroma of bony origin. This article reports a case of an 11-year-old male who came to us with the history of swelling at the maxillary anterior region causing difficulty in closing of mouth as well as mastication.

Radix Entomolaris: A Clinical Challenge.

A major anatomical variant of the two-rooted mandibular first molar is a tooth with an additional distolingual third root: The radix entomolaris (RE). It is essential to anticipate and find all roots and canals during root canal treatment. Proper angulations and interpretation of radiographs help to identify pulp chamber and root anatomy. If present, an awareness and understanding of this unusual root and its root canal morphology can contribute to the successful outcome of root canal treatment.

Submerged and Impacted Primary Molars.

Submerged tooth is the one that is depressed below the occlusal plane. Dental ankylosis is thought to be a major cause of submergence. Submerged deciduous teeth have the potential to cause malocclusion not only by prevention of their exfoliation and subsequent replacement by permanent teeth but also by causing tilting of proximal teeth and extrusion of opposing tooth. The purpose of this report is to present three different cases of submerged deciduous teeth and their clinical effects.

Familial Cleidocranial Dysplasia.

Cleidocranial dysplasia or mutational dysostosis or cleidocranial dysostosis is a generalized skeletodental dysplastic disorder, inherited in an autosomal dominant pattern. The expression of this disorder can vary widely in severity, even within the same family. This is a relatively rare disease and has no standard effective treatment option as of yet. Here we present a case report of affected mother and son with classical manifestations of the disease.

Diffusion-weighted magnetic resonance imaging: its uses in otolaryngology.

Over recent years, there has been an increase in otolaryngology publications concerning diffusion-weighted magnetic resonance imaging. The aims of this review paper are to summarise the basic principles of diffusion-weighted magnetic resonance imaging, and to provide an overview of current otolaryngological applications and areas of research. Diffusion-weighted magnetic resonance imaging is a radiological technique which has shown promising results in various areas of otolaryngology. However, studies of diffusion-weighted magnetic resonance imaging are difficult to compare, as different imaging parameters and techniques have been used. The role of this imaging modality within otolaryngology is yet to be fully elucidated. Diffusion-weighted magnetic resonance imaging may prove to be a useful adjunct in both the pre- and post-operative care of otolaryngology patients.

Cemento-ossifying fibroma--a rare case.

The concept of 'fibro-osseous lesions' of bone has evolved over the last several decades and now includes two major entities: fibrous dysplasia and ossifying fibroma, as well as the other less common lesions such as florid osseous dysplasia, periapical dysplasia, focal sclerosing osteomyelitis, proliferative periostitis of garrie, and ostitis deformans. The cemento-ossifying fibroma is a central neoplasm of bone as well as periodontium which has caused considerable controversy because of confusion regarding terminology and the criteria for its diagnosis. The cemento-ossifying fibroma is odontogenic in origin, whereas ossifying fibroma is of bony origin. This article reports a rare case of an 11-year-old male who came to us with the history of swelling in the maxillary anterior region causing difficulty in closing of mouth as well as in mastication.

Delayed replantation of avulsed teeth.

Dental injuries are very common and their extent has been classified by Ellis. Avulsion of tooth is a grievous injury and ranges from 1-16% among the traumatic injuries, of which maxillary anterior are commonest. Reimplantation of avulsed teeth is a standard procedure. However, it has certain limitations. Most often their management is very challenging. In this case report we are presenting the management of maxillary incisors by replantation after 36 hrs in a 12 year old girl.

Laparoscopic lateral pancreaticojejunostomy: our experience of 17 cases.

BACKGROUND: Although lateral pancreaticojejunostomy (LPJ) is one of the most commonly performed procedures for the management of chronic obstructive pancreatitis, it is seldom performed laparoscopically. We report our experience of 17 consecutive laparoscopic LPJ (lap LPJ) and their outcome. METHODS: Seventeen patients (nine male and eight female) with ages ranging between 16 and 48 years underwent lap LPJ by a single surgical team. The most common presenting symptoms were abdominal pain and weight loss. RESULTS: The mean operating times for lap LPJ and lap LPJ with one or more additional procedures were 277 min and 377 min, respectively. The mean hospital stay was 5.2 days. Conversion to laparotomy was required in four patients. There were no deaths and the overall complication rate was 11.8%. On follow-up, ranging from 3 months to 1 year, 82.3% of the patients were pain-free. CONCLUSIONS: Lateral pancreaticojejunostomy is the surgical procedure of choice for the management of chronic obstructive pancreatitis. The same procedure can be performed laparoscopically; although it is technically demanding, the results are excellent. However, the procedure is still in the early phase of feasibility owing to the limited number of cases reported in the world literature.

Serological study of hepatitis A virus infection amongst the students of a medical college in Delhi & evaluation of the need of vaccination.

BACKGROUND & OBJECTIVES: Recent seroepidemiological studies have demonstrated a decrease in the seroprevalence of hepatitis A virus (HAV) infection, thereby increasing the pool of susceptible adult population. Health care workers, especially those working in paediatric wards and nurseries, are at an increased risk of developing HAV infection. The present study was undertaken to determine the prevalence of antibody against HAV (IgG anti-HAV) among a batch of medical students of the Maulana Azad Medical College, New Delhi, so as to identify the proportion of students who would be susceptible to HAV infection and hence would benefit from a vaccination programme against HAV. METHODS: A total of 91 medical students were enrolled and divided into groups on the basis of sex. The serum samples were evaluated for the presence of immunoglobulin (IgG) against HAV (IgG anti-HAV) using a commercially available enzyme linked immunosorbent assay (ELISA) kit. RESULTS: The mean age of all the subjects was 19.9 +/- 1.5 yr and the male: female ratio was 1.2: 1. Fifty seven (62.6 +/- 5.1%) students were positive for IgG anti-HAV while 34 (37.4%) were seronegative and hence susceptible to HAV infection. No statistically significant difference was observed in the seroprevalence of HAV between males and females [64 +/- 6.7% (32/50) versus 60.9 +/- 7.6% (25/41)]. INTERPRETATION & CONCLUSION: our results indicate that more than one-third of the medical students were seronegative for IgG anti-HAV and hence at an increased risk of developing HAV infection as a result of occupational exposure. Therefore, we suggest that students in a health care set up should undergo vaccination against HAV after pre-vaccination immunity screening.

Family history of hypertension and left ventricular mass in youth: possible mediating parameters.

Whether positive family history (FH) of essential hypertension (EH) in normotensive youth is associated with increased left ventricular mass (LVM) and hemodynamic, anthropometric, and demographic parameters previously associated with increased LVM in adults is unknown. To examine these issues, 323 healthy youth (mean age, 13.6 +/- 1.3 years), 194 with positive FH of EH (61% African Americans, 39% whites) and 129 with negative FH of EH (33% African Americans, 67% whites) were evaluated. Hemodynamics were measured at rest and during four stressors (ie, postural change, car driving simulation, video game, forehead cold). Echocardiographic-derived measures of LVM were indexed separately to body surface area and height(2.7). Controlling for age and race differences (ie, 74% of African Americans v 47% of whites had positive FH), the positive FH group exhibited greater LVM/height(2.7), LVM/body surface area, higher systolic (SBP) and diastolic blood pressures (DBP), and total peripheral resistance index (TPRI) and lower cardiac index at rest (P < .05 for all). The positive FH group also displayed higher peak SBP or DBP and higher TPRI increases to each stressor and came from lower socioeconomic status backgrounds (P < .05 for all). Regression analyses indicated that FH of EH was not a significant determinant of LVM/height(2.7) after accounting for contributions of gender (greater in men), general adiposity, resting cardiac index and blood pressure (BP), and TPRI responsivity to video game and cold stimulation (P < .05 for all). Thus, greater LVM index in positive FH of EH youth appears in part related to their greater BP and TPRI at rest and during stress.