Hole-retaining Lobeplasty for Type I Ear Lobe Deformities.

Background: The aesthetic aspect of Type I incomplete split ear lobe is underestimated. Most of the hole-retaining techniques described for large and split ear lobes are difficult to perform in Type I deformity. Aim: (1) To conduct a pilot study based on the postoperative review of the cases of Type I ear lobe deformities surgically managed with hole-retaining lobeplasty in a tertiary care centre in South India.(2) To assess the postoperative outcome of the hole retaining lobeplasty based on the Global aesthetic improvement scale and Patient satisfaction in Likert scale. Materials and Methods: A pilot study of hole-retaining lobeplasty technique was done based on the postoperative review of 6 patients with bilateral type1 incomplete split ear lobes who were operated in our institution with the same. The results were validated based on descriptive statistics and postoperative outcomes using GAIS score and Patient Satisfaction Score measured in a Likert scale. Results: None of the patients had any postoperative complications. At six months follow up, all patients had centrally placed, circular ear holes, well settled support flap and rounded lobe contour with an average GAIS score of 4.83 ± 0.38. All the patients were satisfied with their newly created ear hole and lobe contour, with an average Patient Satisfaction Score of 4.8 ± 0.4. Conclusion: Hole- retaining lobeplasty is a simple, cost effective, single staged, day-case procedure for repair of Type I large ear holes, that can be easily duplicated by young plastic surgeons with is aesthetically better, circular and centrally placed ear hole with a more rounded ear lobe with support to prevent recurrence.

Curcumin encapsulated dual cross linked sodium alginate/montmorillonite polymeric composite beads for controlled drug delivery.

The aim of the present work is fabrication of dual cross linked sodium alginate (SA)/montmorillonite (MMT) microbeads as a potential drug vehicle for extended release of curcumin (CUR). The microbeads were prepared using in situ ion-exchange followed by simple ionotropic gelation technique. The developed beads were characterized by Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), X-ray diffraction (X-RD) and scanning electron microscopy (SEM). The effect of MMT on encapsulation efficiency of CUR and intercalation kinetics was investigated. Dynamic swelling study and in vitro release study were investigated in simulated intestinal fluid (pH 7.4) and simulated gastric fluid (pH 1.2) at 37 °C. Results suggested that both the swelling and in vitro release studies were influenced by the pH of test media, which might be suitable for intestinal drug delivery. The release mechanism was analyzed by fitting the release data into Korsmeyer-Peppas equation.

South Indian calcaneal talar facet configurations and osteoarthritic changes.

The purpose of this study was to determine the talar facet configuration of South Indian calcanei, measure the angle between the anterior and middle facet planes of these calcanei, and assess the relation between the above parameters and the degenerative changes in the subtalar joints. The angle between the anterior and middle talar facets was measured in 222 South Indian adult calcanei. The degree of sclerosis was measured on radiographs of the calcanei. Lipping and osteophytes around the joints were recorded by visual inspection. The facet patterns observed were fused anterior and middle facets (Type I), three separate facets (Type II), absence of the anterior facet (Type III), three merged facets (Type IV), and a new pattern of absent anterior and fused middle and posterior facets (Type V). An anterolateral impression was present in nine calcanei. Type I was the predominant pattern (72%). Type II configuration had the least mean angle (125 degrees) and had less number of calcanei with significant osteoarthritic changes. A wider angle was observed in Type I and Type III calcanei. Type IV and Type V were observed in only three and one calcanei, respectively. Lipping and osteophytes were observed in Type I to IV configurations. There was no correlation between the facet configuration and the radiological subchondral sclerosis in the posterior talar facet of the calcanei. This study reveals that the talar facet configuration of calcanei and the angle between the anterior and middle facets influence the stability of the subtalar joints and development of osteoarthritis.

Anatomical variations of the cutaneous innervation patterns of the sural nerve on the dorsum of the foot.

The present study attempts to determine the cutaneous pattern of distribution of the sural nerve on the dorsum of the foot to note the predominant pattern present and whether there was any association between the innervation pattern and sex or side. A total of 260 Indian feet (78 adult feet: 60 male, 18 female; 52 fetal feet: 20 male, 32 female) were dissected. The results showed six patterns of innervation of the toes by the sural nerve. In Type I, the lateral side of the little toe was supplied by the sural nerve alone and the adjacent sides of the 2nd, 3rd, 4th, and 5th toes by the superficial peroneal nerve alone (35.38%). In Type II the lateral side of the little toe was supplied by the sural nerve alone and the adjacent sides of the 4th and 5th toes by the sural nerve along with the superficial peroneal nerve (10%). In Type III the lateral side of the little toe was supplied by the sural nerve alone and the adjacent sides of the 3rd, 4th, and 5th toes by the sural nerve along with the superficial peroneal nerve (21.15%). In Type IV the lateral 1(1/2) toes were supplied by the sural nerve alone and the adjacent sides of the 3rd and 4th toes by the superficial peroneal nerve alone (3.85%). In Type V the lateral 1(1/2) toes were supplied by the sural nerve alone and the adjacent sides of the 3rd and 4th toes were supplied by the sural nerve along with the superficial peroneal nerve (5%). In Type VI the lateral 2(1/2) toes were supplied by the sural nerve alone (24.61%). The predominant patterns were Type I (35.38%), Type VI (24.61%), and Type III (21.15%). There was no association between the innervation pattern of the sural nerve and sex or side. The pattern, which is usually described, was found in only 35.38% of feet. Considering the variation in the pattern of cutaneous distribution of the sural nerve in Indian feet, the function of the sural nerve may be to supply a wider area of skin than is usually described.

Triplication of the lesser occipital nerve.

Triplication of the lesser occipital nerve (LON) was observed bilaterally in an adult male cadaver during routine prosection of the posterior triangle. The three LONs were studied to determine the clinical importance of this variation. The origin of one LON was from a nerve to the trapezius that had a common origin with the trunk of the supraclavicular nerve (C3,4) from the cervical plexus. Such a common origin of a LON may explain the pain referred to the shoulder and arm that is experienced by some patients with cervicogenic headache. Another LON ran across the roof of the posterior triangle, passed through the trapezius and was closely related to the point of exit of the greater occipital nerve (GON) from the trapezius. This LON supplied the nape of the neck, back of the scalp and the auricle. The anomalous course taken by this LON through the trapezius may be an explanation for cervicogenic headache precipitated by neck movement. The close relationship of this variant LON to the exit of the GON from the trapezius seems to be relevant to the management of cervicogenic headache. The authors suggest that the reason for the complete pain relief experienced by some patients with cervicogenic headache by anesthetic blockade of the GON may be because both the GON and LON are blocked simultaneously due to their proximity in these patients.

Gender- and age-related differences in the morphology of the corpus callosum.

The size and shape of the adult corpus callosum may vary with gender and age. There is, however, little data on the morphology of the corpus callosum in the Indian population. The purpose of this study was to measure the size of the corpus callosum in normal adult Indian males and females, and to identify gender- and age-related differences. The size of the corpus callosum on midsagittal section was measured in 100 (50 males, 50 females) normal adult Indians using magnetic resonance imaging. The length of the corpus callosum, the width of the genu, trunk, and splenium, the area of the splenium, and the total area of the corpus callosum were measured. The length of the brain also was measured. Means were compared for significant difference by gender using the Student's unpaired t-test and by age using ANOVA followed by Duncan's multiple range test. Gender was estimated by discriminant function analysis and age was estimated by regression analysis from significant parameters. The corpus callosum was longer in males and the discriminant score to differentiate gender was determined with an accuracy of 66%. The length of the corpus callosum increased with age and regression equations for predicting age was derived from the length of the corpus callosum. The width of the trunk and genu decreased with age in males but not in females.

Anomalous flexor digiti minimi brevis in Guyon's canal.

In an adult male cadaver, the flexor digiti minimi brevis, a muscle of the hypothenar eminence, was found to arise from the superficial transverse septum (between the superficially placed flexor carpi ulnaris, palmaris longus, and flexor carpi radialis muscles, and the deeply placed flexor digitorum superficialis muscle) in the distal fourth of the flexor aspect of the left forearm. The muscle exhibited two strata of muscle fibers at its origin. The superficial stratum was a thin layer of transversely running fibers confined to the forearm, which has not been previously reported. The deep stratum, a thick layer of longitudinally running fibers, formed the bulk of the muscle. It traversed Guyon's canal superficial to the ulnar nerve and vessels to reach the hypothenar eminence. Its course through Guyon's canal could be a cause for ulnar tunnel syndrome. The ulnar nerve trunk innervated not only the anomalous flexor digiti minimi brevis muscle, but also abductor digiti minimi and palmaris brevis. This may be due to the common phylogeny of these three muscles from the same muscle mass.

Dual sensory innervation of the dorsum of the thumb.

The value of the thumb has been described as being almost equal to the rest of the fingers combined (Decker and du Plessis, eds. 1986, Lee McGregor's synopsis of surgical anatomy. 12th ed. p 496). Normal hand function is dependent upon the integrity of both the sensory and motor innervation of the thumb. A thorough knowledge of normal and anomalous sensory innervation of the digits has clinical application because of the increased use of local anesthesia and developments in plastic surgery involving the skin of the digits. Herein is reported an unusual variation in the sensory innervation of the thumb in an adult cadaver. The normal innervation of the dorsum of the thumb is reviewed, and the clinical importance of this variation is discussed.

Hematological profile of HIV positive patients.

A series of 500 HIV positive patients referred to our centre for CD4 and CD8 cell enumeration are included in this study. The following parameters were studied in each of these patients: Hb, RBC indicates, WBC count, platelet count, three part differential count, absolute CD4 and CD8 counts. Male:Female ratio of 4.9:1 was noted 30.8% patients has anemia (Hb<10 gm%), with an average Hb value of 8.1 gm%. The anemia was normochromic, normocytic in 61% of patients, microcytic in 33% and macrocytic in 6% patients. The absolute CD4 count was less than 200 ul in 50.2% patients with an average value of 92/ul. Thrombocytopenia was seen in 13% patients with average platelet count 0.92x10(3)/ul.