Immunogenetic analysis of Buerger's disease in India.

In order to understand the role of HLA linked factors in determining susceptibility to Buerger's disease, we have studied 21 unrelated Asian Indian patients belonging to the North Indian states of Punjab, Haryana, Uttar Pradesh and Delhi, representing mainly a lower socioeconomic background. The data was compared with healthy controls belonging to the same ethnic group. The study revealed an over representation of HLA-B40 (60+61) (chi2=6.12; P<0.02) and DR2 (chi2=10.2; P<0.002). Amongst the patients no particular association or linkage disequilibrium with any of the five alleles of the MIC-A gene could be derived in the small sample size studied.

Long-term results after microlymphaticovenous anastomoses for the treatment of obstructive lymphedema.

Over the last 14 years, 134 patients with obstructive lymphedema have been treated with microlymphaticovenous anastomoses. Ninety patients were available for long-term follow-up study. Of these, 52 patients were treated by microlymphatic surgery only and 38 of them also had segmental or radical reduction surgery, either at the same time or secondarily. Objective assessment was undertaken by volume and circumferential measurements. Initially, lymphangiography was used, but a study demonstrated increased edema immediately following the investigation in one-third of the patients and it was abandoned, both preoperatively and postoperatively. In the microlymphaticovenous anastomoses only group (N = 52), subjective improvement occurred in 38 patients (73 percent). Objectively, volume changes showed a significant improvement in 22 patients (42 percent), with an average reduction of 44 percent of the excess volume. In the microlymphaticovenous anastomoses and reduction surgery, usually segmental, group (N = 38), subjective improvement occurred in 30 patients (78 percent) and objective improvement occurred in 23 patients (60 percent), with an average reduction of 44 percent of the excess volume. Of those followed up, 67 patients (74 percent) have been able to discontinue the use of conservative measures, with an average follow-up of 4.0 years and average reduction in excess volume of 26 percent. There was a 58 percent reduction in the incidence of cellulitis following surgery. In those patients who were improved, drainage resulted in increased softness of the limbs. Edema of the hand diminished considerably in most patients, although this was difficult to measure. These long-term results indicate that microlymphaticovenous anastomoses have a valuable place in the treatment of obstructive lymphedema and should be the treatment of choice in these patients. Reduction surgery can be used as an adjunct in some of these patients, especially in the posteromedial aspect of the upper arm. Liposuction has been used in failed cases or in patients in whom no lymphatics could be found. Improved results can be expected with earlier operations because patients referred earlier usually have less lymphatic disruption.

Results of management of facial palsy with microvascular free-muscle transfer.

This paper reports our experience in facial reanimation using free innervated muscle transfer in 69 patients with long-term facial palsy. The majority of patients were treated in two stages with cross-facial nerve graft as the first stage and microvascular muscle transfer at the second stage. The gracilis muscle was used in 62 patients. A system of grading results has been utilized in the long-term evaluation. The overall final result was excellent or good in 51 percent of 47 patients who were available for follow-up. Although the results are not completely satisfactory, they justify the use of this approach to a difficult clinical problem. The results are improving as technical modifications to the procedure have evolved. The gracilis muscle is a reliable free transfer with internal anatomy conductive to use for reanimation of the paralyzed face. This type of transfer, in our experience, has proved superior to nonmicrosurgical methods for treatment of complete and severe incomplete facial palsy. The seventh cranial nerve is used in the innervation of the transferred muscle, the ipsilateral being preferable if available. The authors believe that use of the same cranial nerve is superior to methods that involve other cranial nerves, where spontaneity is often not achieved.

The quality of life in successful live-related renal allograft recipients in India.

BACKGROUND: The high cost of maintenance of haemodialysis makes most patients in India and elsewhere opt for a renal transplant. The degree of rehabilitation can best be assessed by evaluating the quality of life in successful recipients. METHODS: We studied vocational rehabilitation, social relations, sexual and married life, psychological status and life satisfaction in 51 successful live-related renal allograft recipients using Schwab's depressive scale, Bigot's life satisfaction index and the Kamofsky physical scale. RESULTS: Eight-four per cent of our patients had returned to their original jobs. Ninety-eight per cent of patients had a Kamofsky scale of 90-100 and 81% were leading a normal married life. Ninety-four per cent of them led an active social life. CONCLUSION: Successful live-related renal transplantation is associated with a good quality of life and should be the treatment of choice for patients with end-stage renal disease.

Spontaneous rupture of spleen in viral hepatitis A.

A twenty-five year old man presented with history of fever, malaise and jaundice and developed a spontaneous rupture of the spleen during hospital admission. Investigations revealed deranged liver function tests and positive serology for hepatitis A.

Carcinoma of buccal mucosa: incidence of regional lymph node involvement.

Histopathological findings in 57 surgical specimens of T3 and T4 buccal mucosa cancers are reviewed. The incidence of the well-differentiated tumours (including verrucous carcinoma) was 61%. A moderate degree of lymphocytic infiltration of the tumour was present in 37% of patients. Histologically proven cervical lymph node deposits were present in only 16% of the patients. Amongst the group of patients with clinically enlarged lymph nodes, metastatic disease was histologically demonstrated in 17.5% at level I and 14% at level II of neck nodes. Amongst group of patients with no palpable nodes in the neck, metastatic disease was histologically demonstrated in 11.7% at level I and 9% at level II of neck nodes. These findings contra-indicate an elective neck dissection and indicate the need to confirm histologically the presence of lymph node deposits doing a radical neck dissection in patients with buccal mucosa cancer. This well-differentiated tumour has a much lower tendency to metastasize than cancers in other sites of the oral cavity.

Primary cutaneous mucormycosis in a premature neonate and its management by tumescent skin grafting.

Primary cutaneous mucormycosis is a rare and often fatal disease of infants and neonates. This is a case report of successful management of potentially fatal cutaneous fungal sepsis and use of tumescent technique to harvest a large skin graft with minimal blood loss in a premature neonate.

Detection and separation of fenpropathrin, flucythrinate, fluvalinate, and PP 321 by thin-layer chromatography.

Four synthetic pyrethroids having alpha-cyano ester groups, i.e., fenpropathrin, flucythrinate, fluvalinate, and PP 321, are separated by thin-layer chromatography and detected by a new set of chromogenic reagents. Synthetic pyrethroids containing the alpha-cyano group react with sodium hydroxide to liberate cyanide which forms pink spots with o-dinitrobenzene and p-nitrobenzaldehyde. The detection limit is 0.1 microgram and the method can be applied for identification and confirmation of these synthetic pyrethroids in vegetables.

A simple technique for the excision of vascular malformations of the scalp.

A simple technique for the excision of vascular malformations of the scalp is described herein. Surgical excision is easily accomplished by placing hemostatic sutures all around the lesion outside the line of excision, whereby minimal blood loss is achieved. The resulting defect can be covered by a split skin graft or flap.

An experimental study on the effect of nifedipine on ischaemic skin flap survival in rats.

Vasodilators have been employed previously in an attempt to improve survival of ischaemic rat skin flaps. The effect of nifedipine, a calcium channel blocker, on skin flap survival was studied using a standard experimental rat model. The control group had a mean flap necrosis of 37.009%. Rats treated by nifedipine starting 1 day preoperatively and continued for 1 week postoperatively had a mean necrosis of 10.0953%. Rats treated by nifedipine started postoperatively and continued for 1 week had a mean flap necrosis of 12.289%. Treated groups had significantly lower flap necrosis in comparison to untreated controls. There was no significant difference in flap necrosis between the two treated groups. This study shows that nifedipine improves survival in standard ischaemic rat skin flaps.

Evaluation of lymphatic drainage in free flaps by lymphoscintigraphy: a preliminary study.

Lymphatic drainage from free flaps was studied by lymphoscintigraphy in 14 patients in whom free vascularised flaps were used to cover defects caused by trauma or tumour ablation. Lymphoscintigrams were done after intradermal injection of Technetium-99m-Dextran in the flap and in the corresponding contralateral normal area. The retention of radioactivity at the injection sites after 1 h was computed and expressed as percentages of baseline activity at the time of injection. 25 studies were done in 14 patients at intervals varying from 9 days to 6 years postoperatively. In all cases, radioactivity was detected beyond the flaps in the lymphatic channels and draining lymph nodes. There was no significant difference (P = 0.27) between the retention of activity in the flaps (mean 88.68%; s.e.m. 1.25) and that in the corresponding contralateral control area (mean 86.88%; s.e.m. 1.35). This study shows that lymphatic drainage in a free flap is established early after surgery.

Free-flap urethroplasty for a complex, long-segment stricture of the bulbomembranous urethra.

Long strictures of the bulbomembranous urethra are a challenge of modern urology, with no absolutely reliable technique for a favorable outcome. The authors describe a technique of urethroplasty using the radial forearm free flap, in a patient suffering from posttraumatic stricture, with excellent results.