Structural anatomy of deep fascia, it’s implication in the pathogenesis of compartment syndrome of upper limbs and objective assessment of the effect of fasciotomy

Background: Deep fascia is dense and well developed in limbs. In the upper limb the deep fascia is tightly adherent to the underlying muscles especially in the forearm, thereby, restricting the space available to muscular swelling causing painful compartment syndrome. Division of this inelastic fascia or fasciotomy is an emergency procedure to decrease the morbidity and mortality.Methods: 30 patients with acute compartment syndrome of the upper extremity of various aetiologies were studied. Adults with painful, swollen and tense upper extremities with progressive neurological dysfunction were studied. Compartment pressures before and after fasciotomy were measured by a standard Whiteside’s device. Various fasciotomies were carried out and associated skeletal and vascular injuries were also noted.Results: The majority of patients were males with average age being 29.33 years. 56.67% patients with upper limb compartment syndrome sustained road traffic injury, 20% were constrictive tight cast, 20% of patients sustained burn and 1 patient was shot by bullet. Of the 30 patients fractures of both ulna and radius (40%) were the most common. Fractures of the humerus, radius, ulna and small bone of metacarpals together account for 36.67% of the affected patients. 3 patients were found to have injury to major vessels. Compartment pressure was measured by Whiteside’s device and fasciotomy resulted in a drastic drop of the pressure from pre-fasciotomy pressure of 44.8±7.9 mmHg to post-fasciotomy pressure of 12.33±3.61 mmHg.Conclusions: The diagnosis of compartment syndrome should be confirmed swiftly and prompt fasciotomy is the treatment of choice. This offers the best chance at decreasing compartment pressure and preventing further damage.

Unipolar pedicled latissimus dorsi transfer for elbow reanimation in traumatic brachial plexus injuries

Background: Brachial plexus injuries are troubling for the patients socially, economically and emotionally. Elbow joint being a large and vital joint needs to be reanimated so that the patient can carry out his routine work and bring the hand to the mouth. Number of procedures have been defined but latissimus dorsi being a large muscle is the muscle of choice for transfer in cases who present late. Bipolar latissimus dorsi transfers have often been reported but unipolar latissimus dorsi transfer has also been described. Authors have studied the unipolar muscle transfer, it’s surgical technique and results.Methods: In this study 18 patients were studied for demographic data, pre- and post-operative flexion of the elbow and the MRC grade of the corresponding movements. Diagnostic work up in the form of nerve conduction velocity, electromyography and magnetic resonance imaging were carried out and evaluated for their significance in traumatic brachial plexus injuries.Results: In this study 13 patients had avulsion of the C5-6 roots on magnetic resonance imaging. The patients presented after a period of 128.83±56.76 days. Substantial time elapsed and ruled out primary brachial plexus reconstruction or nerve transfers. The average elbow flexion improved from 6.67±5.69 degrees (range: 0-20 degrees) to 86.94±12.38 degrees (range: 65-110 degrees) following unipolar latissimus dorsi transfer. 12 patients (66.67%) developed M4 or M4+ power.Conclusions: Unipolar latissimus dorsi muscle transfer is a reliable method and most of the patients develop adequate strength and satisfactory function at the elbow joint.

Tissue expansion as an aesthetic alternative for facial resurfacing: a single centre series of 92 patients

Background: The visibility, vulnerability and social stigmata of facial scars whether by burn, nevi or trauma can be compelling for the patient as well as challenging for the surgeon. Restoration to normal form and aesthetics require tissue replacement which has good colour and texture match and produce minimal visible scarring.  Although many other options are available for a given defect, tissue expansion offers the best alternative which meets almost all the criteria of an ideal procedure.Methods: Among 92 patients with deformities over various facial subunits were operated and expanders 50 ml to 300 ml inserted subcutaneously adjacent to the scar. Prior planning, accurate measurement and choice of ideal expander is extremely important. A precise and practical method of calculation for determination of amount and duration of expander was used. Any secondary deformity to adjoining vital structures was avoided.Results: Results were meticulously and critically analyzed. Different shapes, dimensions and volume of expanders were used depending on the anatomical site which was to be expanded. A total of 118 expanders were inserted in 92 patients. The average volume of tissue expanders used was 170.33 ml. Majority of the expanders used had volume of 200 ml (62.71%). Post-expansion volume was 240.67 ml and the over expansion done was 41.3% over the pre-expansion volume of 170.33 ml. Surgical outcome and cosmesis was assessed by the patient’s perspective and was considered fair by 57.61% patients.Conclusions: The study underlines the clinical application, reasons for overexpansion as well as shortcomings and complications of tissue expansion.

Anti-nociceptive effect of seed extract of Acacia tortilis in rodents

Background: Management of pain is a primary clinical concern for any pathology in medical field. Addiction liability of opioids and troublesome gastrointestinal side effects of NSAIDs leads to intensive research for compound with lesser side effects.The aim of the study to evaluate the anti-nociceptive activity of Acacia Tortilis Seed Extract (ATE) in experimental animals.Methods: First of all, animals were randomly allocated into four groups of six animals each. In acetic acid induced writhing test model, Group I (NC) served as vehicle control received saline/Tween 80 0.1%, 10ml/kg BW orally, group II (ATE-100) and III (ATE-200) received ATE in dose of 100 and 200mg/kg BW orally respectively and group IV received the standard drug diclofenac sodium in dose of 50 mg/kg BW orally. Group I to IV were same in rest of three experimental models. One additional group of standard drugs (group V) morphine sulfate in dose of 5 mg/kg BW subcutaneously (SC) was allocated for screening method hot plate and tail flick tests. In Formalin induced paw licking test, three additional groups (group V) morphine sulfate in dose of 5mg/kg BW SC, group VI- morphine+naloxone (5mg/kg SC +2mg/kg intra-peritoneally (IP) and group VII - ATE+ naloxone (200mg/kg BW orally +2mg/kg BW IP) were also made.Results: The ATE when administered orally in dose of 100 and 200mg/ kg body weight (BW), produced significant analgesic activity (P <0.01) in acetic acid induced writhing syndrome and late phase of formalin test. In the hot plate test in mice and tail flick test in rats, ATE in same doses also showed significant analgesic activity (P <0.05) which is almost equally efficacious to standard drug diclofenac sodium (50mg/kg BW orally) but far less efficacious than morphine sulfate (5mg/kg BW subcutaneous).ATE (200mg/Kg BW orally) activity did not blocked by naloxone (2mg/kg intra-peritoneal).Conclusions: ATE possesss significant anti-nociceptive activity as evidenced in all the animal models of nociception. It might exert its effect through the peripheral mechanism of analgesic action possibly by interference in biosynthesis, release and/or action of prostaglandins and leukotrienes.

Multivitamin and micronutrient treatment improves semen parameters of azoospermic patients with maturation arrest.

The study was undertaken to evaluate the efficacy of multivitamin and micronutrient supplementation in azoospermic patients with maturation arrest. A total of 35 azoospermic patients showing maturation arrest on testicular biopsy were recruited in this study. The patients were divided into two groups. Untreated group (n=11) without any treatment and treated group (n=24) who received multivitamins, micronutrients and co-enzyme Q10. The sperm concentration, motility and morphology were evaluated at monthly interval. The results showed reduction in liquefaction time and relative viscosity of the semen in the treated group. Further, in treated group there was appearance of spermatozoa (4.0 million/ml) exhibiting progressive motility (7%) and normal morphology (6%), even in the first follow up visit. The sperm count, motility and normal morphology increased significantly on subsequent visits. Within 3 months (3 visits) 2 pregnancies were reported. These observations indicate that multivitamin and micronutrient supplementation improve the qualitative and quantitative parameters of seminogram in patients with azoospermia of maturation arrest.

Atherosclerosis in diabetes mellitus: role of inflammation.

Inflammation plays a central role in the pathophysiology of atherosclerosis, starting from initiation, through progression and ultimately the thrombotic complications of atherosclerosis. Diabetes mellitus is a major risk factor for atherosclerosis. Hyperglycemia-induced endothelial dysfunctions, along with hypercoagulable potential of diabetes mellitus, accelerate the process of atherothrombotic complications. Therefore, clinically feasible markers to monitor subtle systemic inflammatory burden and specific add-on therapy for the same constitute need of the present day. The understanding of the concept of inflammation in diabetes-accelerated atherosclerosis can be used practically to predict future cardiovascular risk by evaluating inflammatory biomarkers and to design clinical trials making inflammation as a therapeutic target.