Does augmentation of intramedullary nails by a buttress plate effectively restore lateral wall integrity in intertrochanteric fractures.

BACKGROUND: Recent studies have proved the importance of intact lateral trochanteric wall, thus buttressing/fixing the broken lateral trochanteric wall irrespective of the implant, is likely to improve the alignment and outcome. We compared the outcome of lateral wall buttressing by trochanteric buttress plate (TBP) supplemented to proximal femoral nailing versus proximal femoral nailing alone in patients of broken lateral wall intertrochanteric fractures. MATERIAL AND METHOD: Sixty patients of intertrochanteric factures (IT) of femur with broken lateral wall were randomized into group A or B and were treated with either proximal femoral nail (PFN) alone or proximal femoral nail augmented with trochanteric buttress plate (PFN + TBP), respectively. The TBP plate used was primarily fixed to proximal femur via 8 mm hip screw and 6.4 mm antirotation screw of the PFN. Operative time, blood loss, radiation exposure, quality of reduction, functional outcome, union time, and complications were compared. RESULT: The mean age was 60.03 + 7.60 (range 42 to 70 years), with male to female ratio of 4:1 and left to right ratio of approximately 1:1. The mean follow up in the series was 16.2 months (range 13 to 36 months). Mean duration of surgery, mean intra-operative blood loss, and mean number of exposures in group A (PFN alone) were 64.88 + 12.24 min (48 to 88), 93 + 1.18 ml (60 to 120), and 32.13 (24 to 46) and in group B (PFN with TBP plate) were 91.86 + 12.78 min (70 to 122 min), 144.8 + 3.6 ml (116 to 208 ml), and 56.6 (38 to 112), respectively. Twenty-five patients and 28 patients in groups A and B respectively achieved score of 4 Chang quality reduction. Mean union time was 13.4 weeks in group A whereas in group B was 11.6 weeks. Mean HHS score in group A was 87.86 with 90% patients in comparison to 94.13 and 97% cases having excellent to good results in group B. In group A, 24 patients, while 29 patients in group B, had excellent to good results. Four patients had hip pain, four had impingement of screws, two had screw migration, three had Z/reverse effect, and four patients had shortening of more than 1 cm in group A. In group B, only one patient had impingement and none of the patient had hip pain, infection, implant failure, Z effect, or shortening. CONCLUSION: The lateral trochanteric wall in IT fractures is significantly important, and when the lateral wall is broken, it can lead to poor results. TBP plate which is applied laterally on femur along with nail and fixing the plate with hip screw and antirotational screw provides faster union, early weight bearing, better reduction, and so better hip functions. TBP can be used successfully to augment, fix, or buttress the lateral trochanteric wall giving excellent to good results but at the cost of surgical time, blood loss, and radiation exposure.

Stand-off detection of solid targets with diffuse reflection spectroscopy using a high-power mid-infrared supercontinuum source.

We measure the diffuse reflection spectrum of solid samples such as explosives (TNT, RDX, PETN), fertilizers (ammonium nitrate, urea), and paints (automotive and military grade) at a stand-off distance of 5 m using a mid-infrared supercontinuum light source with 3.9 W average output power. The output spectrum extends from 750-4300 nm, and it is generated by nonlinear spectral broadening in a 9 m long fluoride fiber pumped by high peak power pulses from a dual-stage erbium-ytterbium fiber amplifier operating at 1543 nm. The samples are distinguished using unique spectral signatures that are attributed to the molecular vibrations of the constituents. Signal-to-noise ratio (SNR) calculations demonstrate the feasibility of increasing the stand-off distance from 5 to ~150 m, with a corresponding drop in SNR from 28 to 10 dB.

High resolution line scan interferometer for solder ball inspection using a visible supercontinuum source.

A line scan interferometer, which comprises a visible supercontinuum source coupled to Fourier domain Michelson interferometer, is used to obtain 3D images of ~300 µm high solder balls on a semiconductor die with 125 nm axial and 15 µm lateral resolution. The ability to measure curved surfaces enables the determination of solder ball shape defects in addition to ball height. We show that the maximum measurable angular tilt from the sample surface normal for a given source power depends on the surface roughness of the sample. As an example, we demonstrate height measurement over +/-20 degrees from the normal on the solder balls and over +/-60 degrees on a rough steel ball bearing sample.

Power adjustable visible supercontinuum generation using amplified nanosecond gain-switched laser diode.

Supercontinuum (SC) light with a continuous spectrum covering 0.45-1.2 microm is scaled from 250-740 mW by varying the repetition rate of an amplified, frequency doubled, telecom laser diode. Efficient SC generation requires minimal non-linearity in the amplifier and anomalous dispersion pumping close to the fiber zero dispersion wavelength. Based on simulations, we present a 2-stage design that separates pulse break-up from spectral broadening to enhance the SC bandwidth for quasi-CW pumping.

Expression of Ki-67 in odontogenic cysts: A comparative study between odontogenic keratocysts, radicular cysts and dentigerous cysts.

INTRODUCTION AND OBJECTIVES: Odontogenic cysts are the most common cysts of the jaws and are formed from the remnants of the odontogenic apparatus. Among these odontogenic cysts, radicular cysts (RCs) (about 60% of all diagnosed jaw cysts), dentigerous cysts (DCs) (16.6% of all jaw cysts) and odontogenic keratocysts (OKCs) (11.2% of all developmental odontogenic cysts) are the most common. The behavior of any lesion is generally reflected by its growth potential. Growth potential is determined by measuring the cell proliferative activity. The cell proliferative activity is measured by various methods among which immunohistochemistry (IHC) is the commonly used technique. Most of the IHC studies on cell proliferation have been based on antibodies such as Ki-67 and proliferating cell nuclear antigen. MATERIALS AND METHOD: In the present study, the total sample size comprised of 45 cases of odontogenic cysts, with 15 cases each of OKC, RC and DC. Here, an attempt is made to study immunohistochemical (streptavidin-biotin detection system HRP-DAB) method to assess the expression of Ki-67 in different layers of the epithelial lining of OKCs, RCs and DCs. OBSERVATIONS AND RESULTS: Ki-67 positive cells were highest in epithelium of OKC as compared to DC and RC. CONCLUSION: The increased Ki-67 labeling index and its expression in suprabasal cell layers of epithelial lining in OKC and its correlation with suprabasal cell layers of epithelial lining in DC and RC could contribute toward its clinically aggressive behavior. OKC is of more significance to the oral pathologist and oral surgeon because of its specific histopathological features, high recurrence rate and aggressive behavior.

Power scalable mid-infrared supercontinuum generation in ZBLAN fluoride fibers with up to 1.3 watts time-averaged power.

Mid-infrared supercontinuum (SC) extending to ~4.0 mum is generated with 1.3 W time-averaged power, the highest power to our knowledge, in ZBLAN (ZrF(4)-BaF(2)-LaF(3)-AlF(3)-NaF...) fluoride fiber by using cladding-pumped fiber amplifiers and modulated laser diode pulses. We demonstrate the scalability of the SC average power by varying the pump pulse repetition rate while maintaining the similar peak power. Simulation results obtained by solving the generalized nonlinear Schrödinger equation show that the long wavelength edge of the SC is primarily determined by the peak pump power in the ZBLAN fiber.

Third order cascaded Raman wavelength shifting in chalcogenide fibers and determination of Raman gain coefficient.

Cascaded Raman wavelength shifting up to three orders from 1553 nm to 1867 nm is demonstrated in As(2)S(3)-chalcogenide fibers. Due to a long zero dispersion wavelength for the sulfide fiber (>4.5 mum), pumping the fiber at 1553 nm results in generation of cascaded Stokes orders based on stimulated Raman scattering. Using the threshold power for the Raman orders, we estimate the Raman gain coefficient for the As(2)S(3) fibers to be ~5.7x10(-12) m/W at 1550 nm. Observation of higher Raman orders is limited by damage to the fiber at input intensities >1 GW/cm(2).

Oral cancer: Etiology and risk factors: A review.

Oral cancer is the sixth most common malignancy in the world. Oral cancer is of major concern in Southeast Asia primarily because of the prevalent oral habits of betel quid chewing, smoking, and alcohol consumption. Despite recent advances in cancer diagnoses and therapies, the 5.year survival rate of oral cancer patients has remained at a dismal 50% in the last few decades. This paper is an overview of the various etiological agents and risk factors implicated in the development of oral cancer.

Pigmented lesion of buccal mucosa.

Pigmented lesions are commonly found in the mouth. Such lesions represent a variety of clinical entities, ranging from physiologic changes to manifestation of systemic illness and malignant neoplasm. Diagnosis of such lesions requires a proper case history, extraoral and intraoral examination, and, in some cases, biopsy, aspiration cytology, and laboratory investigations. Here we present a case of purple lesion on the buccal mucosa of a 34-year-old male patient which was provisionally diagnosed as mucocele but on the basis of histopathological picture it was finally diagnosed as angiofibroma, and we also discuss the clinical and histopathological differential diagnosis.

Unilateral lichen planus: A rare case report.

Oral lichen planus (OLP) is a mucocutaneous disease with well-established clinical and histopathological features. It has a prevalence of approximately 1%. The etiopathogenesis is poorly understood. The annual malignant transformation is less than 0.5%. There are no effective means to either predict or to prevent such event. Clinically, OLP present as bilateral symmetrical lesion and hence lichen planus isolated to a single oral site other than the gingiva is very uncommon. On the other hand lichenoid reaction (LR) are the lesions which are similar clinically and histopathologically with OLP, but they are induced with some drug reaction and usually they do not show bilateral pattern like lichen planus. We reported a very uncommon case of unilateral lichen planus which was clinically diagnosed as LR, but in the absence of any cause-effective relationship biopsy was taken for histopathological examination Histopathologically, LR cannot be differentiated with OLP, so the final diagnosis was made on the immunohistochemical ground.

Multilocular unicystic ameloblastoma of mandible.

Introduction. We report a rare case of unicystic ameloblastoma (UA) of mandible which showed multilocular radiolucency on the left side of mandible on radiographic examination which is very unusual, and the majority of the cases of UAs till date has been reported of unilocular radiolucency. On histopathological examination, an odontogenic cystic lining that proliferates that intraluminally resembling ameloblastomatous epithelium was observed, leading to a definitive diagnosis of unicystic ameloblastoma. Case Presentation. A 42-year-old male patient presented with a swelling on the left side of the mandible extending from 33 to 36. Radiographically, it showed a multilocular radiolucent lesion resembling odontogenic cyst; however, the final diagnosis was made on histopathological ground with the inclusion of radiological and clinical features. Conclusion. It can be concluded that at present, histopathologic examination is the most sensitive tool for differentiating between odontogenic cysts and UAs. However, both clinical and radiologic findings share equal contribution to the final diagnosis.

Mid-infrared supercontinuum generation to 4.5 microm in ZBLAN fluoride fibers by nanosecond diode pumping.

A mid-infrared supercontinuum (SC) is generated in ZBLAN (ZrF4-BaF2-LaF3-AlF3-NaF...) fluoride fibers from amplified nanosecond laser diode pulses with a continuous spectrum from approximately 0.8 microm to beyond 4.5 microm. The SC has an average power of approximately 23 mW, a pump-to-SC power conversion efficiency exceeding 50%, and a spectral power density of approximately -20 dBm/nm over a large fraction of the spectrum. The SC generation is initiated by the breakup of nanosecond laser diode pulses into femtosecond pulses through modulation instability, and the spectrum is then broadened primarily through fiber nonlinearities in approximately 2-7 m lengths of ZBLAN fiber. The SC long-wavelength edge is consistent with the intrinsic ZBLAN material absorption.