A Comparative Study Between Mastectomy Flap Quilting Sutures with Axillary Drain Versus Conventional Sutures with Axillary and Pectoral Drain in Reducing Post-Modified Radical Mastectomy Seroma Formation.

The aim of this study was to compare quilting suture with axillary drain versus conventional sutures with axillary and pectoral drain on the formation of seroma after modified radical mastectomy with axillary lymph node dissection. The study was undertaken among 90 female patients with breast cancer who were candidates for modified radical mastectomy with axillary clearance. The intervention group (N = 43) with quilting and axillary drain placement and the control group (N = 33) without quilting with axillary and pectoral drain placement. All the patients were followed up for complications pertaining to this procedure. There were no significant differences between the two groups with regard to demographic characteristics, comorbidities, pre-operative chemotherapy, post-operative pathological findings, lymph node involvement or clinical staging. The incidence of seroma formation on follow-up was significantly lower in the intervention group than that in the control group (23% versus 58%; p < 0.05) whereas there was no significant difference with respect to flap necrosis, superficial skin necrosis and wound gaping between the two groups. Furthermore, it took a shorter duration for seroma to resolve in the intervention group (4 days versus 9 days; p < 0.001) with a smaller duration of hospital stay (4 days versus 9 days; p < 0.001). The use of quilting sutures for flap fixation in order to obliterate dead space post-modified radical mastectomy with placement of axillary drain significantly reduced seroma formation along with shorter duration of wound drainage and a smaller hospital stay with only slightly increased operative time. Therefore, we recommend quilting of flap as a routine step after mastectomy.

Interplay of lattice distortion and electronic structure in BaBiO3.

We investigate room temperature core level and valence band spectra of BaBiO3 using x-ray photoemission spectroscopy and band structure calculations. The features in the valence band spectrum were studied using density functional theory (DFT) under local density approximation (LDA) and Tran Blaha modified Becke Johnson (TB mBJ) exchange potential. The calculations were performed for three different structural parameters; monoclinic, cubic and monoclinic (M[Formula: see text]). Our results of the core level spectrum and DFT calculations rule out charge disproportionation of the Bi ions. The valence band spectrum displays gap at the Fermi edge and fine structures in the region close to the Fermi edge. The DFT calculation under TB mBJ for the monoclinic structure is able to generate gap and match the energy positions of the fine structure in a better way. Our calculation results show that there are holes in the O 2[Formula: see text] states and unequal transfer of electrons to the states of the Bi ions. Such mechanism could lead to bond disproportionation and its association with the fine structures in the valence band. The current results reveal the significance of strong link between the lattice distortion and electronic structure and hence to its physical properties.

Subjective and objective evaluation of frontal smile esthetics in patients with facial asymmetry-a comparative cross-sectional study.

AIM AND OBJECTIVES: To analyze the relationship between subjective and objective evaluations of pre-treatment posed smiles in patients with facial asymmetry and to assess the influence of dentofacial structures involved in asymmetry on the perception of smile attractiveness. SAMPLE: Thirty-five patients (25 males and 10 females) between 18 and 25 years of age with facial asymmetry were selected. MATERIALS AND METHODS: Pre-treatment clinical photographs of posed smiles were subjectively evaluated by a panel of 20 orthodontists, 20 oral surgeons, and 20 laypersons. A customized Smile Mesh program was used for objective evaluation of the same smiles. Direct comparison among three smile groups (unattractive, slightly attractive, and attractive) for different Smile Mesh measurements was carried out using two-way anova test. Additionally, linear regression was performed to evaluate whether these measurements could predict the attractiveness of captured smiles. RESULTS: Patients with 'slightly attractive' smiles had a significantly greater distance between the incisal margin of the maxillary central incisor and the lower lip during smiling. The Smile Index was significantly greater in attractive smiles. However, based on the coefficients of linear regression, no objectively gathered measurement could predict smile attractiveness. CONCLUSIONS: Attractiveness or unattractiveness of smiles in patients with facial asymmetry could not be predicted by any measurement of Smile Mesh. The presence of facial asymmetry did not significantly influence the perception of smile esthetics.

Visual evoked potential & brainstem auditory evoked potentials in acute attack & after the attack of migraine.

PURPOSE: To study the effect on visual evoked potential (VEP) and brainstem auditory evoked potential (BAEP) at time of acute attack and after 7 days of the attack of migraine. MATERIAL AND METHODS: We studied BAEP and pattern reversal VEP in 25 patients during acute attack and after 7 days of the attack. The diagnosis of migraine was established according to criteria given by international headache society (IHS). Peak and interpeak latencies (IPL's) of BAEP and P100 latency of VEP were the main criteria to judge abnormalities. RESULTS: There were prolonged peak and interpeak latencies in BAEP and prolonged peak latency (P100) in VEP at the time of acute attack of migraine. The data of these abnormal recording were highly significant. After 7 days when the attack was over, we recorded the BAEP and VEP again. The observation obtained at this time was comparable to normal values. CONCLUSIONS: From the observation of this study we can safely conclude that in acute attacks of migraine there may be some pathological changes in different areas of brain and brainstem, producing changes in evoked potential which are statistically highly significant. However, these changes are reversible, as the values of BAEP & VEP on 7th day after the attack were comparable to those observed in normal healthy control.

Delayed cerebellar ataxia--a complication of Plasmodium falciparum malaria.

Cerebellar ataxia is an unusual post malarial complication. We encountered 10 patients of this disease (3 in 1992 and 7 in 1994) during the malaria epidemic period in Bikaner, Rajasthan. All patients were permanent residents to malaria endemic areas. The ataxic symptoms appeared after an afebrile period of 2-7 days. The neurological examination revealed no other abnormality except a cerebellar syndrome interfering with normal gait and speech. Lower limbs were affected more than the upper limbs and the mean delay between onset of fever and onset of cerebellar ataxia was 13 days. Peripheral blood film of all cases showed gametocytes of Plasmodium falciparum and in two cases schizonts of the same. All the patients improved within one month without any residual deficit. Further follow up for next 4 weeks revealed no abnormality.