Effect of Moringa oleifera seed flour on the rheological, physico-sensory, protein digestibility and fatty acid profile of cookies.

In the present study, debittered Moringa Oleifera seed flour (DDMF) rich in protein, vitamins, minerals and balanced amino acid and fatty acid profile was used to develop functional cookies. DDMF was incorporated at 25, 50, 75 and 100% levels and studied their effect on flour rheological, physicochemical, micro-structural, sensory and nutritional properties of cookies. The results revealed that the addition of an increasing amount of DDMF from 0 to 100% increased water absorption (59.5-77%) by farinograph study; cookie dough hardness (89.2-284.7 N); decreased pasting temperature (60.2-30.1 °C) and peak viscosity (696-9 BU) by amylograph study. SEM studies of cookies indicated that, in control cookies, starch granules are completely gelatinized and enmeshed in the gluten protein matrix, whereas, in 50% DDMF incorporated cookies, partially gelatinized starch granules are seen embedded in a weak protein matrix. Sensory evaluation showed that incorporating DDMF, up to 50% of cookies had clean mouthfeel without any residue formation and were highly acceptable; however, beyond that limit, they became brittle. The addition of 50% DDMF increased cookies' in-vitro protein digestibility, mineral contents, and fatty acids content. Thus, the nutritional quality of cookies concerning quantity and quality of protein and fat could be enhanced by incorporating DDMF.

Reconstruction in Breast Conservation Therapy-Single Tertiary Care Institution Experience with 472 Patients.

Breast conservation therapy (BCT) is now internationally accepted treatment for early breast cancer. Despite of high incidence of carcinoma breast in India, BCT rates are very low as compared to the west. In this article, we wish to share our experience of breast conservation with oncoplasty in Indian women. A retrospective analysis of case records of patients treated with oncoplastic breast conservation from January 2009 to June 2014 in a single surgical oncology unit in a tertiary cancer institute. Demographic patient data, stage of disease, location of primary tumour, use of neo-adjuvant chemotherapy if received, tumour size and breast size ratio, reconstruction method used, post-operative complications and aesthetic score of patients were analysed. Various methods of oncoplasty and partial breast reconstruction used are discussed. Four hundred and seventy-two patient records were found suitable for analysis. Most common stage of presentation was T2N0 in 189 patients (40%). Forty-one patients received neo-adjuvant chemotherapy (NACT). Tumour arising in upper outer quadrant was most common site, seen in 268 (56.7%). The most common method of reconstruction was volume displacement, done in 57.6% patients. Overall surgical complications included wound infection with or without dehiscence, seroma formation, partial flap necrosis and fat necrosis. Cosmesis was found to be excellent in 23.09% and good in 58.47% at 6-month follow-up. Breast conservation with oncoplasty is oncologically safe for early breast cancer treatment and has good cosmetic outcome with high patient satisfaction rates. Its practice should be encouraged in Indian set-up also.

Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) for Prevention of Breast Cancer-Related Lymphedema-a Preliminary Report.

Lymphatic microsurgical preventing healing approach (LYMPHA) for prevention of breast cancer-related lymphedema (BCRL)-a preliminary report BCRL-is a chronic debilitating condition which impairs quality of life of breast cancer survivors. The aim is to study the feasibility of preventing lymphedema by performing "Lymphatic Microsurgical Preventive Healing Approach (LYMPHA)." Patients undergoing breast cancer surgery with complete nodal dissection were taken up for the study. After the standard axillary nodal dissection, lymphatics were identified by the help of blue dye and were anastomosed with a tributary to the axillary vein. Post-operatively, patients were followed up clinically for development of lymphedema and lymphoscintigraphy was performed after treatment completion. A total of 35 patients were enrolled for the study. The average BMI was 29.5. LYMPHA was feasible in all cases. The number of lymphatics identified was 1 to 5 per axilla. Two patients developed transient lymphedema which resolved with conservative therapy and patients were able to discontinue the compression garment. Follow-up lymphoscintigraphy is performed in two patients, which showed normal lymphatic flow. LYMPHA is a feasible technique, not difficult to perform, takes a short time, is accomplished in same general anesthesia as for axillary dissection, and gives no extra scar. The early results are promising and long-term follow-up may make the procedure as a routine.

Preservation of Aesthetics of Breast in Pectoralis Major Myocutaneous Flap Donor Site in Females.

BACKGROUND AND OBJECTIVES: In females, raising a pectoralis major myocutaneous flap is challenging and primary closure of flap donor site causes breast deformity with medial displacement of nipple areola complex. To avoid this distortion, a new method of donor site closure is devised. METHODS: A parasternal skin paddle which has better vascularity is planned while doing a pectoralis major myocutaneous flap in females and a lateral flap planned along the lateral breast curve is used to cover the donor site. The lateral flap donor site is primarily closed. This prevents medial displacement of nipple areola complex. RESULTS: A total of 47 patients underwent donor site flap closure technique. Minor complications in form of marginal necrosis near the tip of the flap were observed in 10.6 % patients. The donor breast of all these PMMC flaps had good contour and aesthetic positioning of nipple areola complex. CONCLUSION: Donor site morbidity with respect to breast distortion has not been studied so far in case of females so our study stands unique in this aspect. Using this technique of planning PMMC in females ensures a skin paddle of better vascularity and restores the breast aesthetics.

Sternal Resection and Reconstruction for Malignant Phylloides Tumor.

Malignant phylloides tumor is a locally aggressive breast neoplasm constituting less than 1 % of all breast cancers. It has a tendency for local recurrence and management is multidisciplinary. We hereby report a case of total sternal resection and reconstruction using Biopore HDPE prosthesis for Malignant Phylloides tumor.

Parotid duct relocation in buccal mucosa cancer resection.

Buccal mucosal cancer is commonly seen in India with patients presenting in advanced stages of the disease. Its excision commonly mandates division of parotid duct as a part of disease or its margin. We have adopted a simple method to salvage the parotid gland by cannulating the duct and rerouting the saliva into the oral cavity at a different site. This has now become a protocol at our center. A total of 562 patients from 2002 to 2012 have undergone this procedure. This has markedly reduced the incidence of sialocele and parotitis in early postoperative period, which may delay wound healing and subsequent radiotherapy.

Subacute intestinal obstruction: an enigma revisited.

Sixty-three patients presenting with subacute intestinal obstruction (SAIO) were studied. Thirty (47.6%) reported recurrent symptoms. Exaggerated bowel sound, visible/palpable bowel loops, distention of abdomen and abdominal lumps were observed in 60.3%, 28.5%, 25.3% and 19.0% patients, respectively. Thirty (47.6%) required emergency laparotomy. Investigations revealed lesions requiring surgery in 14 of 33 patients which were relieved with conservative treatment. The accuracy of ultrasonography, contrast enhanced computed tomography (CECT) scan and diagnostic laparoscopy was 57.1%, 100% and 100%, respectively. Ileum was the most common site of obstruction (79.5%). Adhesions and small intestinal strictures were the two most frequent cause of obstruction seen in 31.8% and 27.2%, respectively. Tuberculous pathology was demonstrated in 23 (52.2%). Previous abdominal surgery was found to be the only predictor of the success of conservative treatment (13/19 versus 7/44). All patients of SAIO, whose symptoms were relieved with conservative treatment, and who do not have history of abdominal surgery, should be subjected to CECT and/or diagnostic laparoscopy in order to discover the underlying cause of the obstruction. When these diagnostic modalities are not available, laparotomy is an effective alternative for this group of patients.

Abdominal cocoon: clinical presentation, diagnosis, and management.

A 15-year-old girl presented with features suggestive of sub-acute intestinal obstruction (SAIO) with a palpable abdominal lump. Contrast-enhanced computed tomogram (CECT) abdomen revealed congregated small gut loops confined to a single area and encased in a thick membrane suggestive of abdominal cocoon. On laparotomy, a thick white membrane was found encasing most of the small gut. The cocoon was excised releasing the encased small bowel. The patient was relieved of her symptoms following surgery. Histopathology of excised cocoon membrane revealed granulomatous inflammation consistent with tuberculosis. The patient was discharged on ninth postoperative day with advice to take anti-tuberculosis drugs for 6 months. The possibility of abdominal cocoon should be considered in patients with SAIO and abdominal lump. Abdominal cocoon being a rare condition, CECT is useful in clinching the diagnosis and planning elective surgery in experienced hands.