Free Flap Reconstruction in Head and Neck Surgery: Experience in Bangabandhu Sheikh Mujib Medical University.

Free flap reconstruction after surgical ablation of head & neck cancer greatly improve the surgical outcome. Microvascular anastomosis is an important part of Microsurgery and it is not widely practiced in every center. A retrospective review was conducted in the Head & Neck Division of Otolaryngology-Head & Neck Surgery Department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from May 2016 to June 2017. Total 20 patients with head & neck cancer had been treated surgically between this period and 14 patients were reconstructed with free flap. The focus of this study is to establish the surgical outcome, which is more with free flap reconstruction in the patients previously diagnosed as head & neck cancer. We reconstructed 14 cases of oral cavity carcinoma (Stage IV) with the free flap. Majority cases were carcinoma involving the buccal mucosa with retromolar trigone (36%) followed by buccal mucosa (22%), buccal mucosa with lower alveolus (21%), carcinoma tongue with floor of the mouth (14%) and floor of the mouth (7%). Radial forearm freflap (RFFF) were commonly used in 10 cases (71.4%) and Anterolateral thigh flap (ALT) used in four cases (21.5%). Partial flap loss was seen in one case and wound infection occurred in another case but both were managed successfully with postoperative dressing and debridement. Microvascular free flap reconstruction can be a good choice after surgical removal of the head & neck cancer diseases and it should be practiced in every well-equipped tertiary medical center with the help of properly trained surgeon.

Perceptions and preparedness of veterinarians to combat brucellosis through Brucellosis Control Programme in India.

BACKGROUND AND AIM: Brucellosis caused by bacteria belongs to the genus Brucella is an important zoonosis and constitutes a serious public health hazard worldwide including India. The present study aimed to estimate the knowledge of veterinarians on brucellosis, its public health threat, diagnosis, and vaccination. MATERIALS AND METHODS: This cross-sectional study was conducted during 2013-2015 and 453 veterinarians representing 11 states/Union Territories (UT) of India (Assam, Tripura, Meghalaya, Goa, Karnataka, Madhya Pradesh, Uttar Pradesh, Delhi, Jammu and Kashmir, Tamil Nadu, and Punjab) were interviewed using self-administered questionnaire. RESULTS: Out of 453 veterinarians, 71.74% stated handling of the animals on day-to-day basis and 28.25% were engaged in administration activities. The veterinarians ranked foot-and-mouth disease and brucellosis at the first and fourth ranks among the list of ten economic impacted diseases in the country. A significant association was observed between laboratory confirmation with those who handled brucellosis-suspected cases (p=0.000). Similarly, significant association was noted for the availability of vials/slides (p=0.114), vacutainers (p=0.008), icebox (p=0.103), and refrigerator (p=0.106) for those who preferred laboratory diagnosis. Only 20% of the veterinarians recommended vaccination against bovine brucellosis, and 17% obtained laboratory confirmation for the brucellosis-suspected cases. CONCLUSION: The study highlighted the need for awareness programs, laboratory facilities, veterinary doctors, and protective measures for the veterinarians for combating brucellosis through the control program in the country.

Total Lip Reconstruction after Excision of Cancer with Composite Radial Forearm Palmaris Longus Tendon Free Flap.

Reconstruction of total lip is a challenging task for a plastic surgeon. It becomes more complicated when there is loss of additional tissues like angle of mouth, buccal mucosa or floor of the mouth. Radial forearm flap with palmaris longus tendon provides an easier but reliable technique for three dimensional lip reconstructions with good functional and aesthetic outcome. In this short observational series we included 5 patients of total lip reconstruction and conducted at Sylhet MAG Osmani Medical College Hospital and Private Clinic of Sylhet, Bangladesh from January 2014 to December 2017. Among these one was a case of basal cell carcinoma of upper lip and rest was squamous cell carcinoma of lower lip. The mean age was 71 years. All the flaps survived and patients had normal speech and oral continence. Composite radial forearm flap with palmaris longus tendon is a good, reliable option for total lip reconstruction.

Farm Community Impacts of Foot-and-Mouth Disease Outbreaks in Cattle and Buffaloes in Karnataka State, India.

This study was conducted to assess the impact of Foot-and-mouth Disease (FMD) outbreak in cattle and buffaloes on farming community in Kolar district, Karnataka state, India. Primary data were collected using pre-tested schedule from 178 sample farms using multistage random cluster sample technique. The results revealed that 78% of surveyed villages were affected with FMD. The FMD incidence risk was high across the herd sizes, whereas the mortality risk was high in small herds. In indigenous cattle, the highest loss due to FMD was distress sale (208 USD) followed by other losses, whereas, in Crossbred cattle, the highest loss was mortality loss (515 USD) followed by distress sale (490 USD), milk yield loss (327 USD), treatment cost (38 USD) and extra labour engagement expenses for nursing of FMD-affected bovines (30 USD). In local and upgraded buffaloes, the mean total loss per affected animal was 440 USD and 513 USD, respectively. A very high variability in the loss per animal was observed across the type of losses in the Crossbred cattle, and it may be due to differences in age of the FMD-infected animal, value of the animal, milking stage, lactation levels, herd sizes and labour engagement levels, etc. In local and upgraded buffaloes, the mean total loss per animal was 639 USD and 1008 USD, respectively. The sensitivity analysis for 5% change in price revealed that the mean total loss per animal was positively correlated with price. Further, the social impact elicitation revealed that majority of the livestock owners perceived FMD had caused permanent asset loss, which in turn increased psychological stress of the family. The estimated losses and social impact due to FMD signify the importance of the intervention to control the disease and thus socio-economic gain to the farmer and society at large.

Silicone granulomatous reactions after first metatarsophalangeal hemiarthroplasty.

We reviewed 55 patients (78 feet) who had undergone silicone hemiarthroplasty of the first metatarsophalangeal joint for hallux valgus (40) or hallux rigidus (38). At a mean period of 4.5 years (1 to 11), 56 feet had radiological evidence suggestive of silicone granulomatous disease. The frequency and severity of the changes increased with time from the operation. Histological material from three revisions confirmed the presence of silicone granulomata. We recommend that the operation of silicone hemiarthroplasty for hallux valgus and hallux rigidus be abandoned.

Fatal suffocation by rubber balloons in children: mechanism and prevention.

This paper presents five autopsy cases of children who died as a result of an accidental choking on latex (rubber) balloons. All of the investigated cases suffocated by an intact (non-broken), pear-shaped and medium-sized balloon of less than 9 cm in length and 4 cm in width. The mouthpieces of all the involved balloons were upward and above the vocal cords, while the nosepieces were downward in the larynx and the trachea. The application of continuous suction forces to uninflated or partially air-filled balloon is considered the most crucial factor in causing asphyxiation by rubber balloon. An uninflated balloon is usually placed outside the mouth cavity where the child sucks the balloon into the mouth, either during a repeated trial of inverting the balloon inside-out or during the application of a direct suction to their bulb. A partially air-filled balloon is usually placed inside the mouth cavity then it is pushed further inside by movements like sucking or chewing. Other important factors are a sudden slippage of the mouthpiece from the fingers or teeth of the child, as well as the panic of the suffocation. The process of suffocation is also facilitated by the counterforce, which results from a sudden pressure of the mouth cavity over the bulb of the balloon, and the consistency of the balloons as pliable objects. Once the balloon enters the airway, it is less likely to be expelled. Supervision of children by adults and proper education programs are needed to decrease this problem.

Evaluation of the paraskeletal clamp system (Mennen plate) in treatment of mandibular fractures.

In this study, we used the relatively recent Paraskeletal clamp system (Mennen plate) to evaluate its effectiveness in the treatment of mandibular fractures. This study was conducted on eight patients with mandibular fractures selected from the out patient clinic, Oral Surgery Department, Faculty of Oral and Dental Medicine, Cairo University. Patient sample consisted of six males and two females, four patients were children below the age of 11 years, while the other four were edentulous above the age of 58. Each patient was thoroughly examined both clinically and radiographically. Data collected from each patient were recorded in a special examination chart. Under general anesthesia, the fracture was exposed using a submandibular approach. The fractured segments were reduced and fixed using micro-5 Mennen plates. All patients were followed up both clinically and radiographically for six months postoperatively. Results obtained from this study showed uneventful healing of all patients with no cases of non-union, bony infection or osteomyelitis as proven both clinically and radiographically. All the patients presented normal functioning occlusion and facial symmetry. No bony step deformities were detected.

The oral and intratracheal toxicities of ROUNDUP and its components to rats.

The toxicities of ROUNDUP and its component chemicals, glyphosate (N-phosphonomethylglycine) and polyoxyethyleneamine (POEA), were determined at 0, 1, 3, 6 and 24 h following administration to rats. The intratracheal administration of glyphosate (0.2 g/kg), POEA (0.1 g/kg), a mixture of glyphosate (0.2 g/kg) + POEA (0.1 g/kg), or ROUNDUP (containing 0.2 g/kg glyphosate and 0.1 g/kg POEA) elicited immediate respiratory effects which were more severe and which lasted longer in the groups receiving the POEA-containing preparations than in the glyphosate alone group. By 1 h, all test preparations had caused deaths, but more occurred from the POEA-containing preparations than from glyphosate. The po administration of POEA (1 g/kg), the mixture of glyphosate (2 g/kg) +POEA (1 g/kg), or ROUNDUP (containing 2 g/kg glyphosate and 1 g/kg POEA) produced diarrhea and blood-stained weeping from noses. Death was only seen from POEA at 24 h. Glyphosate (2 g/kg po) produced transient diarrhea without nose bleeds; POEA caused diarrhea at 1 h; and the mixture of POEA + glyphosate produced diarrhea later that increased in severity with time. Bloody nose secretions were seen only with the preparations that contained POEA. No deaths, respiratory effects or bloody nose secretions occurred in controls given saline. Both POEA and glyphosate caused lung hemorrhages and lung epithelial cell damage with po or intratracheal exposures. These results indicate POEA and preparations that contained POEA were more toxic than glyphosate.

Role of fluoride on corrodability of dental amalgams.

The role of fluoride ions on the corrosion behavior of some commercial dental amalgam in artificial saliva solution at pH level 7.1 was studied by using impedance and potentiodynamic polarization techniques. It was found that, the presence of F- ions in an artificial saliva solution at pH 7.1 increases the corrodability of different types of dental amalgam. Sever pitting corrosion occurred at level of 100 mM F- ions. The formulation of amalgam alloys greatly affect the resistance to pitting corrosion; the resistance of the amalgam to pitting follows the order: Dispersalloy >> Phasealloy > Oralloy > Tytin > Valiant-pH.D. It is recommended to avoid oral treatment involving high F- ions concentration in the presence of amalgam restorations.