Comprehensive functional outcome analysis and importance of bone remodelling on personalized cranioplasty treatment using Poly(methyl methacrylate) bone flaps.

Cranioplasty involves the surgical reconstruction of cranial defects arising as a result of various factors, including decompressive craniectomy, cranial malformations, and brain injury due to road traffic accidents. Most of the modern decompressive craniectomies (DC) warrant a future cranioplasty surgery within 6-36 months. The conventional process of capturing the defect impression and polymethyl methacrylate (PMMA) flap fabrication results in a misfit or misalignment at the site of implantation. Equally, the intra-operative graft preparation is arduous and can result in a longer surgical time, which may compromise the functional and aesthetic outcomes. As part of a multicentric pilot clinical study, we recently conducted a cohort study on ten human subjects during 2019-2022, following the human ethics committee approvals from the participating institutes. In the current study, an important aspect of measuring the extent of bone remodelling during the time gap between decompressive craniectomy and cranioplasty was successfully evaluated. The sterilised PMMA bone flaps were implanted at the defect area during the cranioplasty surgery using titanium mini plates and screws. The mean surgery time was 90 ± 20 min, comparable to the other clinical studies on cranioplasty. No signs of intra-operative and post-operative complications, such as cerebrospinal fluid leakage, hematoma, or local and systemic infection, were clinically recorded. Importantly, aesthetic outcomes were excellent for all the patients, except in a few clinical cases, wherein the PMMA bone flap was to be carefully customized due to the remodelling of the native skull bone. The extent of physiological remodelling was evaluated by superimposing the pre-operative and post-operative CT scan data after converting the defect morphology into a 3D model. This study further establishes the safety and efficacy of a technologically better approach to fabricate patient-specific acrylic bone flaps with improved surgical outcomes. More importantly, the study outcome further demonstrates the strategy to address bone remodelling during the patient-specific implant design.

Adjunctive cognitive remediation for schizophrenia using yoga: an open, non-randomized trial.

BACKGROUND: Yoga therapy (YT) improves cognitive function in healthy individuals, but its impact on cognitive function among persons with schizophrenia (SZ) has not been investigated. AIMS: Evaluate adjunctive YT for cognitive domains impaired in SZ. METHODS: Patients with SZ received YT or treatment as usual (TAU; n = 65, n = 23, respectively). Accuracy and speed for seven cognitive domains were assessed using a computerized neurocognitive battery (CNB), thus minimizing observer bias. Separately, YT was evaluated among patients with Bipolar I disorder (n = 40), Major Depressive Disorder (n = 37), and cardiology outpatients (n = 68). All patients also received routine pharmacotherapy. Patients were not randomized to YT or TAU. RESULTS: Compared with the SZ/TAU group, the SZ/YT group showed significantly greater improvement with regard to measures of attention following corrections for multiple comparisons; the changes were more prominent among the men. In the other diagnostic groups, differing patterns of improvements were noted with small to medium effect sizes. CONCLUSIONS: Our initial analyses suggest nominally significant improvement in cognitive function in schizophrenia with adjunctive therapies such as YT. The magnitude of the change varies by cognitive domain and may also vary by diagnostic group.

Histopathology slide projector: a simple improvisation.

The ability to examine histopathology and other hematological slides under microscope is a necessary and important service which should be available in every health facility. The slides need to be projected on to a screen. We describe an inexpensive and easily constructed technique for projecting magnified images of slides using a simple microscope. It is effective both for making observations and for use as a teaching aid.

Gigantomastia due to retromammary lipoma: An aesthetic management.

INTRODUCTION: A "giant" lipoma is defined as a tumor having dimensions greater than 10 cm. Giant lipomas are rare and giant breast lipomas are exceptionally uncommon. Only six cases have been described in world literature till date. Herein we describe a case of giant breast lipoma and discuss its surgical management. CASE REPORT: A 43-year-old lady presented with left sided unilateral gigantomastia. Clinical examination, radiology and histopathology diagnosed lipoma. Excision of the tumor was planned, together with correction of the breast deformity by reduction mammoplasty using McKissok technique. A tumor measuring 19 cm × 16 cm × 10 cm and weighing 1647 grams was removed. The nipple areola complex was set by infolding of the vertical pedicles and the lateral and medial flaps were approximated to create the final breast contour. The patient is doing well on follow up. DISCUSSION: Giant lipomas are rare and of them, giant breast lipomas are extremely uncommon. They can grow to immense proportions and cause significant aesthetic and functional problems. The treatment is excision. But reconstruction of the breast is almost always necessary to achieve a symmetric breast in terms of volume, shape, projection and nipple areola complex symmetry compared to the normal opposite breast. Few authors have used various mammoplasty techniques for reconstruction of the breast after giant lipoma excision. Our case has the following unique features: (i) It is the third largest breast lipoma described in the literature till date, weighing 1647 grams; (ii) The Mckissock technique has been used for parenchymal reshaping which has not been previously described for giant breast lipoma. CONCLUSION: This case demonstrates that reduction mammoplasty after giant lipoma removal is highly rewarding, resulting in a smaller-sized breast that is aesthetically more pleasing, has better symmetry with the contralateral breast, and provides relief from functional mass deficit.

Paraspinal transposition flap for reconstruction of sacral soft tissue defects: a series of 53 cases from a single institute.

STUDY DESIGN: Case series. PURPOSE: To describe paraspinal transposition flap for coverage of sacral soft tissue defects. OVERVIEW OF LITERATURE: Soft tissue defects in the sacral region pose a major challenge to the reconstructive surgeon. Goals of sacral wound reconstruction are to provide a durable skin and soft tissue cover adequate for even large sacral defects; minimize recurrence; and minimize donor site morbidity. Various musculocutaneous and fasciocutanous flaps have been described in the literature. METHODS: The flap was applied in 53 patients with sacral soft tissue defects of diverse etiology. Defects ranged in size from small (6 cm×5 cm) to extensive (21 cm×10 cm). The median age of the patients was 58 years (range, 16-78 years). RESULTS: There was no flap necrosis. Primary closure of donor sites was possible in all the cases. The median follow up of the patients was 33 months (range, 4-84 months). The aesthetic outcomes were acceptable. There has been no recurrence of pressure sores. CONCLUSIONS: The authors conclude that paraspinal transposition flap is suitable for reconstruction of large sacral soft tissue defects with minimum morbidity and excellent long term results.

Posterior arm flap in management of axillary contracture.

INTRODUCTION: Management of post burn contracture can be difficult, particularly for the axilla. Any handicap related to upper limb has a detrimental physical, psycohological, and economical effect. PATIENTS AND METHODS: We have released 20 axillae in 16 patients. These patients had axillary contracture for long duration and 5 had been operated previously by release and skin graft. We used posterior arm fasciocutaneous flaps for coverage of the defect after release of contracture. RESULTS AND CONCLUSION: All the patients had a good post op release. Their range of movement is excellent. No post op splintage was utilised in any of the cases with no incidence of recontracture.

Double gall bladder-a rare entity.

Cholecystectomy is the most commonly performed operation in surgery. Variations inanatomical disposition are not infrequent. However variations in number of cystic ductand gall bladder is quiet rare. This poses a diagnostic and management problem withcomplications during surgery and missed gall bladder being reported in world literature. We here by report a case of double gall bladder with double cystic duct that was managed by laparoscopic surgery.

Sacrococcygeal masses other than meningomyelocele.

This series comprises of a variety of sacrococcygeal masses other than meningomyelocele that presented to the department of pediatric surgery of Medical College Kolkata over last 10 years. In this series, 23 cases of sacrococcygeal masses are included. Barring meningomyelocele, teratoma constitutes a major group of cases. It also includes few other interesting and atypical masses such as presacral dermoid, degenerated nerve fiber, fibrofatty tissue, rhabdomyosarcoma, etc. This is an endeavor to enlighten ourselves so that the diagnosis and management of unfamiliar sacrococcygeal masses can be done.

Doctor patient communication-a vital yet neglected entity in Indian medical education system.

Doctor patient communication is the most important and an integral part of any treatment regimen. Properly carried out it has been shown to have a therapeutic effect equivalent to drugs. Despite being so important part of treatment it is more than often taken and carried out casually. Apart from apathy towards this practice, its omission in the medical study curriculum is an important factor. This study was carried in amongst the surgical residents of surgical departments of various medical colleges to assess the attitude of surgical residents towards patient doctor communication. A questionnaire was forwarded by mail and email and the response was assessed: The responses of the surgical residents from various residents from different medical colleges were similar. Most of the residents prefer inclusion of communication skill in medical education curriculum.

Large neurofibroma of trunk.

UNLABELLED: Neurofibroma is a benign tumor of cutaneous nerves. These are benign tumors which may have a varied presentations ranging from a cosmetic problem to a spinal tumor which may lead to neural complications. We here by present a case where the patient has become an appendage of the tumor and its the mass of the tumor that has handicapped the patient. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12262-010-0129-x) contains supplementary material, which is available to authorized users.

Reinforced tension line suture closure after midline laparotomy in emergency surgery.

Midline laparotomy is an emergency surgical operation frequently performed in cases of intra-abdominal pathology. Closure of the incision is usually done by continuous suturing by mass closure. In an emergency operation the intra-abdominal milieu is usually contaminated leading to gut oedema and, hence, an increase in postoperative intra-abdominal pressure. It is complicated by wound dehiscence, burst abdomen, etc. The cause of this complication is an increase in horizontal tensile forces on the site of the insertion of sutures which cuts the sheath. In this technique of reinforced tension line suture peak tensile forces are distributed from the suture base to the surrounding tissue through a horizontal suture, thereby preventing the suture from cutting through the tissue. From July 2007 to June 2009 patients requiring laparotomy were randomly divided into test and control groups by a 'closed envelope' technique. Their postoperative intra-abdominal pressure was recorded by urinary bladder catheter manometry. The result of this technique was compared with the incidence of burst abdomen in cases where it was closed by continuous suture. A total of 190 patients underwent laparotomy. In 90 the abdomen was closed by reinforced tension line (RTL) and in 100 patients by continuous suturing. None of the RTL group had a burst abdomen. Thirteen who had closure by continuous suture had a burst abdomen. The analysis of the results was done using the chi-square test. On comparing the incidence of burst abdomen in cases operated by continuous suture technique and by RTL, the P value was found to be 0.0026 which is highly significant. On analysis of the incidence of burst abdomen in cases having a grade II intra-abdominal pressure the P value was found to be 0.0009 which is highly significant. Closure of midline incision by RTL reduces the incidence of burst abdomen. Registration No. PROVCTRI/2008/091/000269 (http://www.ctri.in).

Congenital intra-mesosigmoid hernia- a case report of a rare sigmoid mesocolon hernia.

Internal hernia is the protrusion of the viscera through normal or abnormal peritoneal or mesenteric apertures within the confines of peritoneal cavities.

Radiographic griding of subcutaneous soft tissue metallic foreign bodies in emergency department.

Radiographic grid for localization of soft tissue metallic foreign bodies is a modification of traditional radiography. Twenty localization procedures using simple radiographic grid was successfully performed. Its low cost and easy to perform makes it a useful tool in emergency setting.

Scenario of neonatal surgery in West Bengal with reference to cases of anorectal malformation.

Pediatric Surgery, though a super specialty does not enjoy the glamour and importance like other specialities, though, dealing with the most delicate of mankind, the children. The reasons for this are manifold and the results of this, brutal. This is a retrospective study carried at the major institutes of West Bengal where departments of pediatric surgery exist. We have observed a gross discrepancy between the number of patients admitted for surgically correctable congenital malformations and the standard state/national frequency of these disorders. We focus on the plight of a child not able to reach the level III health care system with a pediatric surgical back up and analyze the pros and cons with constructive criticism of the existing system.

Franz kaspar hasselbach (1759-1816).

Franz Kaspar Hasselbach (1759-1816) was an eminent anatomist and surgeon, remembered for his invaluable contributions in fields of anatomy and surgery. He gave accurate discription of triangle of Hasselbach made almost 200 years back, and it forms the basis of classification of inguinal hernia and is the cornerstone for laparoscopic repair of hernia, unheard of in his era. He has a number of eponyms named after him.

Persistently erected penis in a child for 6 months: A management dilemma.

Priapism is the presence of a persistent, usually painful, erection of the penis unrelated to sexual stimulation or desire. It is a true emergency requiring urgent intervention. Priapism is frequently idiopathic in etiology, but it is associated with a number of important medical conditions and pharmacologic agents. Cases have been reported in world literature on children having priapism, the etiology of these cases are mostly hematological. Our case is a child having persistently erected penis for more than 6 months. Despite a thorough search, no report of similar case could be found in world literature.

Improvised laparoscopic stone picker.

Laparoscopic cholecystectomy is the treatment of choice for calculus cholecystitis. It is frequently complicated by stone spillage and retrieval of these stones is a cumbersome process which is frequently complicated by injuries. Moreover left over stones frequently leads to complication. We have hereby improvised a laparoscopic hand instrument which quickly and easily recovers intraabdominal free and scattered gall stones with a loss of little bit of intra-abdominal CO(2). This stone picker was applied in over 50 cases with successful recovery of stones and a mean loss of about 0.1 Lts of carbon dioxide gas.

Pleuropulmonary blastema with cystic nephroma - A rare presentation and surgical dilemma.

Pleuropulmonary balstema with cystic nephroma is a rare dual pathology of pediatric age group. The etiopathogenesis of this entity is not known, still researches indicate towards a common genetic cause. We report a case of this dual pathology in a one and half year old male. Till now only 5 cases have been reported.