Star excursion balance test for assessment of dynamic instability of the ankle in patients after harvest of a fibular free flap: a two-centre study.

We aimed to show that the star excursion balance test can identify instability in the ankle of patients who have had harvest of a fibular free flap. We compared the reach distance of the operated leg against that of the non-operated leg in 26 patients who had had harvest of the flap over a period of three years from August 2009 at two different centres. The goal of the test is to reach as far as possible with one leg in eight directions while balancing on the other. We also assessed the overall function of the operated leg using the Foot and Ankle Disability Index (FADI) and the American Orthopaedic Foot and Ankle Score (AOFAS). The star excursion balance test is simple and cheap, and is quick and easy to do in the outpatient department.

Hematological findings and severity of G6PD deficiency in Vataliya Prajapati subjects.

OBJECTIVES: The present study was undertaken to assess the clinical implication of G6PD deficiency in Vataliya Prajapati (VP) subjects in Surat. METHOD: Blood samples of 954 children and 690 adults were collected in camps. Cord blood samples of 57 neonates born to VP mother were also collected. Medical history and other relevant information of all subjects were obtained. Samples were screened for G6PD deficiency by NBT test and the enzyme activity was estimated by WHO method. Hematological parameters were measured on hematology analyzer while reticulocyte count was measured using new methylene blue dye. RESULTS: The G6PD enzyme deficiency was detected in 27.5% males and 12.8% females. The enzyme levels in deficient subjects suggested class II variant. Hematological studies indicated mild anemia in G6PD deficient persons. Reticulocyte count was slightly raised (p <0.05). Out of eight G6PD deficient neonates one developed mild jaundice. Five deficient male adults gave the history of hemolytic crisis, three of them had typhoid, one tuberculosis and remaining one had fever of unknown origin. CONCLUSION: G6PD deficiency in majority of Vataliya Prajapati subjects is of mild type. However it is essential to test every Vataliya Prajapati subject for G6PD deficiency as certain infections and drugs can cause crisis in deficient person.

Extensive vertebral haemangioma with cord compression in two patients: review of the literature.

Two cases of extensive vertebral haemangioma with progressive neurological deficits are described. Successful treatment was accomplished with palliative surgical decompression after preoperative embolization in one case and with postoperative radiotherapy in the other. Preoperative embolization, palliative surgical decompression and postoperative radiotherapy appear to provide satisfactory outcome in patients with extensive haemangiomas.

Marginal gap formation of composites in dentine: effect of water storage.

This study investigated the effects of water storage on the marginal adaptation of two composite resins (Spectrum TPH and Ariston AT), two polyacid-modified composite resins (Dyract AP and F2000) and a new PRG composite (Reactmer) to dentine over time. Two cylindrical dentine cavities (1.5 mm diameter and 1.5 mm deep) were prepared on the horizontally sectioned surfaces of freshly extracted teeth. In each tooth, one cavity was restored using composites with their respective bonding system and the other without the bonding system. The sample size for each material with/without bonding system was 6. The composites were placed in one increment, bulk-polymerized, immediately finished/polished with the Sof-lex discs system and fine polished on 30 microm silicon carbide/9 microm aluminium oxide lapping film discs in a microgrinding system. The specimens were then stored in distilled water at 37 degrees C and the maximum marginal gap width between the material and the dentine wall was determined at 24 h, 1 week, 2 weeks, 3 weeks and 4 weeks using a measurescope at x500 magnification. Results were subjected to statistical analysis using monva, anova/Scheffe's post hoc test and independent samples of t-test at significance level 0.05. At all time intervals, no significant difference in marginal gap formation was observed between materials. Where bonding systems were not used, a decrease in gap widths over time was observed with most materials but only Dyract AP exhibited a significant decrease. The latter was observed after 2 weeks storage in water. The use of bonding systems reduced dentine marginal gaps significantly and is therefore mandatory for all composites evaluated. Marginal gaps arising from polymerization contraction of conventional, polyacid-modified and PRG composites cannot be fully compensated by hydroscopic expansion. Clinical relevance Bonding systems are mandatory for all composites when bonding to dentin. In the event of a bond failure at placement, hygroscopic expansion of composites can reduce marginal gaps but not completely.

Influence of ZOE temporary restorations on microleakage in composite restorations.

This study investigated the influence of zinc-oxide eugenol (ZOE) temporary restorations on microleakage in composite restorations. Class V cavities were prepared on the buccal surfaces of 32 freshly extracted, non-carious human premolars. The teeth were randomly divided into four groups of eight teeth. Specimens in Group 1 (control) received no temporary restoration. Group 2 and 3 specimens were covered with IRM (Type III ZOE cement) mixed at powder:liquid (P:L) ratio of 10g:1g and 10g:2g, respectively. Specimens in Group 4 were covered with poly-carboxylate cement (eugenol-free) mixed at a P:L ratio of 2.85g:1g. The temporary restorations were removed mechanically with an ultrasonic scaler after one week storage in distilled water at 37 degrees C. The preparations were washed and restored with Scotchbond Multi-Purpose Plus and Z100 according to manufacturers' instructions. The restorations were finished, thermally stressed for 400 cycles and subjected to dye penetration testing. Results were analyzed using Kruskal-Wallis and Mann-Whitney tests at a significance level of 0.05. At both enamel and dentin margins, the microleakage associated with Group 3 was significantly greater than for Groups 1, 2 and 4. For Groups 1 and 4, leakage at the dentin margins was significantly greater than in enamel margins. For the groups pretreated with IRM, no significant difference in dye penetration scores was observed between enamel and dentin. Pre-treatment with IRM mixed at a P:L ratio of 10g:2g significantly increased microleakage and is not recommended clinically.

Influence of eugenol-containing temporary restorations on bond strength of composite to dentin.

This study investigated the influence of eugenol-containing temporary restorations on bond strength of composite to dentin. Thirty-two freshly extracted human molars were embedded and horizontally sectioned at a level 2 mm from the central fossa to obtain a flat dentin surface. The teeth were randomly divided into four groups of eight teeth. Specimens in Group 1 (control) received no pre-treatment with any temporary restorations. Group 2 and 3 specimens were covered with IRM (eugenol-containing) mixed at powder: liquid (P:L) ratio of 10 g: 1 g and 10 g: 2 g, respectively. Specimens in Group 4 were covered with polycarboxylate cement (eugenol-free) mixed at a P:L ratio of 2.85 g: 1 g. The temporary restorations were mechanically removed with an ultrasonic scaler after one-week storage in distilled water at 37 degrees C. The dentin surfaces were cleaned with pumice-water slurry and treated with Scotchbond Multi-Purpose Plus bonding system according to manufacturer's instructions. Composite (Z100) columns (3 mm diameter, 2 mm high) were applied and shear bond testing was carried out after 24 hours storage in distilled water at 37 degrees C using an Instron Universal testing machine with a cross-head speed of 0.5 mm/minute. The mode of failure was examined using a stereomicroscope at X40 magnification. Results were analyzed using one-way ANOVA/Scheffes's post-hoc test at significance level 0.05. Ranking of bond strengths was as follows: Group 1 (22.58 MPa) > Group 2 (21.14 MPa) > Group 4 (15.35 MPa) > Group 3 (13.02 MPa). Group 3 had significantly lower bond strength than Groups 1 and 2. No significant difference in dentin bond strength was observed between the Group 1 (control) and Groups 2 and 4. Although the predominant mode of failure for Groups 1, 2 and 4 was cohesive in dentin, all specimens in Group 3 exhibited adhesive failure. Pre-treatment with polycarboxylate cement or IRM mixed at P:L ratio of 10 g: 1 g did not affect shear bond strength of composite to dentin. IRM mixed at a lower P:L ratio of 10 g: 2 g significantly decreased bond strength.

Regularization method for scatter-glare correction in fluoroscopic images.

Fluoroscopic images are degraded by scattering of x-rays from within the patient and by veiling glare in the image intensifier. Both of these degradations are well described by a response function applied to either the scatter-free or primary intensity. The response function is variable, with dependence on such factors as patient thickness and imaging geometry. We describe an automated regularization technique for obtaining response function parameters with a minimal loss of signal. This method requires a high-transmission structured reference object to be interposed between the x-ray source and the subject. We estimate the parameters by minimizing residual correlations between the reference object and the computed subject density after a scatter-glare correction. We use simulated images to evaluate our method for both ideal and clinically realistic conditions. We find that the residual root-mean-square (rms) error ideally decreases with an increasing number of independent pixels (N) as (1/N)1/2. In simulated 256x256 angiograms mean normalized rms errors were reduced from 40% to 11% in noise-free images, and from 41% to 17% in noisy images, with a similar improvement in densitometric vessel cross-section measurements. These results demonstrate the validity of the method for simulated images and characterize its expected performance on clinical images.

Selective laser trabeculoplasty v argon laser trabeculoplasty: a prospective randomised clinical trial.

AIMS: To compare the effectiveness of selective laser trabeculoplasty (SLT, a 532 nm Nd:YAG laser) with argon laser trabeculoplasty (ALT) in lowering the intraocular pressure (IOP) in patients with medically uncontrolled open angle glaucoma. METHODS: A prospective randomised clinical trial was designed. Patients were randomised to treatment with either SLT or ALT and were evaluated at 1 hour, 1 week, 1, 3, and 6 months post-laser. RESULTS: There were 18 eyes in each group. Baseline characteristics were similar in both groups. In the SLT group the mean IOP at baseline, 1, 3, and 6 months was 22.8 (SD 3.0), 20.1 (4.6), 19.3 (6.0), and 17.8 (4.8) mm Hg, respectively. In the ALT group, the mean IOP at baseline, 1, 3, and 6 months was 22.5 (3.6), 19.5 (4.7), 19.6 (5.6), and 17.7 (3.3) mm Hg, respectively. There was a greater anterior chamber reaction, 1 hour after SLT v ALT (p< 0.01). Patients with previous failed ALT had a better reduction in IOP with SLT than with repeat ALT (6.8 (2. 4) v 3.6 (1.8) mm Hg; p = 0.01). CONCLUSION: SLT appears to be equivalent to ALT in lowering IOP during the first 6 months after treatment. There is a slightly greater anterior chamber reaction 1 hour after SLT. Patients with previous failed ALT had a significantly greater drop in IOP when treated with SLT v ALT. These results need to be confirmed with a larger sample size.

Craniofacial resection for malignant neoplasms of the skull base: an overview.

Advances in combined transcranial and transfacial (craniofacial) approaches for malignant tumors involving the anterior skull base have demonstrated improved survival. The technique allows adequate assessment of the intracranial extent of the tumor through an appropriate craniotomy. Vital structures, such as the dura, brain, and blood vessels, can be protected or resected and reconstructed safely. An en bloc excision can be accomplished. Dural defects and/or tears are satisfactorily repaired under direct vision, ensuring a watertight closure. Finally, adequate closure of the soft tissue defect is obtained, thus segregating the cranial cavity from the potentially infected nasal cavity and the nasopharynx with a resultant decrease in morbidity. Operative mortality is low, although complication rates are high. The technique is safe and continues to be improved to reduce morbidity. To evaluate the true impact of this surgical procedure on improvement in survival as well as quality of life, a multiinstitutional registry with uniform indications is indicated. With increasing experience and well-defined indications, improvement in survival (from 50% to 60%) and reduction in morbidity (from 30% to 40%) can be demonstrated through multiinstitutional, cooperative efforts.

Preliminary experience with use of a selective 5HT3 receptor antagonist (ondansetron) to prevent high dose chemotherapy induced emesis.

Ondansetron was used as an antiemetic along with dexamethasone during 16 cycles of highly or moderately ematogenic chemotherapy. There was major control in two cycles and complete control in the remaining 14. Side effects were minor and did not require discontinuation of the drug. This combination, therefore, appears to be safe and effective in preventing chemotherapy induced emesis.

Dinitrochlorobenzene treatment of verrucae plana.

In a purely clinical, unbiased study, 50 patients with verrucae plana were treated with dinitrochlorobenzene for 1-24 weeks, keeping half the lesions as controls. The results were statistically insignificant when the treated patients were compared to the control group.

Unusual cutaneous manifestations of anhidrotic ectodermal dysplasia--a case report.

Congenital ectodermal dysplasia is a group of familial disorders that affect tissues and organs of ectodermal origin to varying degrees. Our patient with classical X-linked anhidrotic ectodermal dysplasia (AED) showed unusual skin manifestations including cafe-au-lait spots on the face, neck, buttock, and lumbo-sacral region; depigmentation of mucous membrane of the lower lip, buccal cavity, and left arm; absence of tragii; plantar keratoderma; and kyphosis of lower cervical and upper thoracic spines which have not been previously reported in the world literature.

HLA antigens in three populations of India.

In blood samples from a Hindu population of Uttar Pradesh (North India) and from two Muslim groups, one from Andhra Pradesh (South India) and the other from Gujurat (West India), frequencies of 38 HLA-A, -B and -C antigens were investigated. Eight antigens - A23, A25, A29, A32, Bw45, B21, Bw22 and Bw53 - were absent in the Hindu population, four different antigens - A29, Bw52, B14 and Bw42 - were absent in Hyderabad Muslims, two antigens - A31 and Bw45 - were lacking in Surat Muslims. The three populations showed considerable genetic heterogeneity. The genetic difference between the two Muslim groups was small, but the Hindu population showed pronounced differences from each of the Muslim groups.

Evaluation of Desensol As a Standard Patch Test Kit.

In a study undertaken to find out the usefulness of 'Desensol' patch test kit to detect contact allergens, in 200 cases revealed 24 cases with negative patch test with all the antigens and 55 cases reacted to even the Vaseline control. -Excluding these 79 cases, the common contact allergens were potassium bichr6ma,te, (40.49%), TMTD(28.92%), PPD(24.79%), epoxy resin (23.14%), colophony (19.0%), nickel sulfate (19.0%), Framycetin (19.0%) and nitrofurazone (19.0%). Desensol patch test kit is lacking in certain antigens while in our country due to varied environmental factors and social customs, a person is exposed to a large number of natural and man-made contact allergens. So usefulness of such a kit like. Desensol is limited.

A genetic study of some Gujarat populations.

A study of gene frequencies at 24 loci and their phenotypes in four castes of Gujarat indicates their general alignment with other populations of western India. There is distinct genetic heterogeneity among them, which appears to be maintained by an endogamous breeding structure. The presence of some marker alleles suggests appreciable African influence in at least one of the castes, but other explanations are possible.