Isolation and Characterization of Anti-Inflammatory Compounds from Ficus microcarpa L.f. Stem Bark.

The anti-inflammatory effect of the ethyl acetate extract of F. microcarpa bark (EAFMB) was investigated in acute and chronic (21 days) inflammation induced in Wistar albino rats. EAFMB (200 mg/kg b.w.) exhibited comparable anti-inflammatory effects to the reference drug, with a reduction of 59.48% at 4 h in acute inflammation and 83.96% on day 21 in chronic inflammation. Bioassay-guided fractionation using DPPH radical scavenging activity led to isolating and identifying three compounds from EAFMB: oleanolic acid, catechin, and p-hydroxycinnamic acid. All these compounds demonstrated the concentration-dependent inhibition of COX enzymes and the protection of egg albumin from heat-induced denaturation. Catechin exhibited the highest COX inhibition (COX-1 and COX-2 IC50 = 9.02 and 50.38 µM, respectively) and anti-denaturation effect (IC50 = 27.13 µg/mL) compared to oleanolic acid and p-hydroxycinnamic acid. These isolated compounds are likely responsible for the anti-inflammatory activities of F. microcarpa bark.

Columellar Lengthening in Primary and Secondary Rhinoplasty for Binder's Syndrome: A Fresh Perspective.

Binder's syndrome is a developmental disorder with a short columella and nasal base flaring among the many features that have been described. Since the nose occupies the central position over the face, these features appear as a major cosmetic deformity for which patients seek correction. Traditionally various designs of V-Y advancement flap from the upper lip have been described, but they are not without problems. In this article, the authors have discussed a novel design that can mitigate those problems and also described a method of providing additional vascular safety in case of secondary rhinoplasty.

Childhood Burns Leading to Skeletal and Soft Tissue Deformities: A Case Report.

Postburn contracture is an undesirable sequel of burn injury which affects patients in many ways. A secondary deformity of the growing skeleton in case of pediatric burn patients is a challenging problem to reconstructive surgeons, and careful planning and staged correction is required for such patients. Here we discuss a case of burn injury sustained in childhood and its consequent deformities and their management.

Acetic acid dressings: Finding the Holy Grail for infected wound management.

BACKGROUND: Wounds have since long, contributed majorly to the health-care burden. Infected long-standing non-healing wounds place many demands on the treating surgeon and are devastating for the patients physically, nutritionally, vocationally, financially, psychologically and socially. Acetic acid has long been included among agents used in the treatment of infected wounds. In this study, we have evaluated the use of acetic acid for topical application in the treatment of infected wounds. MATERIALS AND METHODS: A total of 100 patients with infected wounds were treated with topical application of 1% acetic acid as dressing material after appropriate cleaning. A specimen of wound swab was collected before first application and further on days 3, 7, 10 and 14. Daily dressings of wounds were done similarly. Minimum inhibitory concentration (MIC) of acetic acid against various organisms isolated was determined. RESULTS: The patients treated ranged between 9 and 60 years, with the mean age 33 years. Nearly 70% of patients were male. Aetiologies of wounds: infective 35, diabetic 25, trauma 20, burns 10, venous ulcers 5 and infected graft donor site 5. Various microorganisms isolated include Pseudomonas aeruginosa (40%), Staphylococcus aureus (2%), Acinetobacter (12%), Escherichia Coli (5%), Proteus mirabilis (3%), Klebsiella (18%), methicillin-resistant S. aureus (10%), Streptococcus (2%) and Enterococcus (1%), Citrobacter (1%). Few wounds (6%) also isolated fungi. About 28%, 64% and 8% of patients isolated no growth on culture after 7, 14 and 21 days, respectively. MIC of all isolated organisms was ≤0.5%. CONCLUSION: pH of the wound environment plays a pivotal role in wound healing. Acetic acid with concentration of 1% has shown to be efficacious against wide range of bacteria as well as fungi, simultaneously accelerating wound healing. Acetic acid is non-toxic, inexpensive, easily available and efficient topical agent for effective elimination of wound infections caused due to multi-drug resistant, large variety of bacteria and fungus.

A Refined Technique for Management of Nasal Flaring: The Quest for the Holy Grail of Alar Base Modification.

"A smile is happiness you'll find right under your nose"- Tom Wilson. This quote holds true just for patients, not for surgeons. The correction of the nose always poses a challenge to the cosmetic surgeon. Deformities of the external and internal nose may be congenital or acquired and may be secondary to soft tissue and/or osseo-cartilaginous abnormalities, leading to aesthetic and/or functional consequences. Alar flare poses a common problem, sometimes alone and sometimes in conjunction with other external deformities. Alar base reduction is generally considered when the interalar distance exceeds the intercanthal distance. It has been well documented that this simple additional procedure brings about a substantial enhancement in the nose. Various techniques have been described and used in the past, each having their benefits and drawbacks, with the modified Weir wedge excision, Aufricht nasal sill excision, and Bernstein V-Y advancement being the common ones. We hereby describe a technique that is simple yet effective in achieving the desired results and at the same time aims at preventing relapse to obtain satisfactory long term results.

Revisiting the Pencil Wire Twister: An Instrument par excellence.

The need for twisting wires is an integral aspect of maxillofacial surgery. The act of using the commonly available wire twister exposes the operating surgeon as well as the patient to injury by the sharp edges of wire turning around. Pencil wire twister is advantageous in being safer for both the patient as well as the surgeon. In this paper, the authors discuss the feasibility of wider use of this immensely useful instrument.

An Innovative Technique for Columellar Reconstruction using 'Flip-Over' Buccal Mucosa Flap.

Loss of columella is a significant deformity and its reconstruction proves to be quite difficult. An 18-year-old lady had loss of columella due to burn while steam inhalation at a young age and required reconstruction for the same. Labial mucosa has been used as a source of tissue for columellar reconstruction since long. We describe a modification of the buccal mucosal flap to manage a difficult case of columellar deficiency. The buccal mucosa flap was used to cover the columellar defect in the usual manner in the first stage and in second stage, along with division of the base, the residual length of the mucosal flap was used to add to the thickness of columella by doubling it on itself.

Autologous Fat Transfer for Esthetic Contouring of Face in Posttraumatic Nonfunctional Maxillofacial Deformities.

The transfer of autologous fat has been performed since the 1890s; however, its popularity has increased owing to better understanding of fat harvesting and processing techniques. In this article, fat grafting procedure has been used to correct posttraumatic facial deformities in 25 cases. As healing of grafted fat is unpredictable, we have used longer follow-up of 2 years. Evaluation was performed using facial photographs and MRI scans. Scientific literature describes an absorption rate ranging from 20 to 90%. High fat graft resorption rates have been attributed to traumatic handling of the graft during harvest, processing, and injection. Various processing techniques have been suggested. The goal of these techniques is to obtain greater adipocyte cell survival and, consequently, more reliable clinical results. In our study, we have used syringe aspiration and low-speed centrifuge for processing of fat which has resulted in good clinical outcomes.

Namaste (counterbalancing) technique: Overcoming warping in costal cartilage.

BACKGROUND: Indian noses are broader and lack projection as compared to other populations, hence very often need augmentation, that too by large volume. Costal cartilage remains the material of choice in large volume augmentations and repair of complex primary and secondary nasal deformities. One major disadvantage of costal cartilage grafts (CCG) which offsets all other advantages is the tendency to warp and become distorted over a period of time. We propose a simple technique to overcome this menace of warping. MATERIALS AND METHODS: We present the data of 51 patients of rhinoplasty done using CCG with counterbalancing technique over a period of 4 years. RESULTS: No evidence of warping was found in any patient up to a maximum follow-up period of 4 years. CONCLUSION: Counterbalancing is a useful technique to overcome the problem of warping. It gives liberty to utilize even unbalanced cartilage safely to provide desired shape and use the cartilage without any wastage.

"Ride-on" technique and other simple and logical solutions to counter most common complications of silicone implants in augmentation rhinoplasty.

UNLABELLED: Augmentation rhinoplasty can be carried out using a wide range of materials including autologous bone and/or cartilage as well as alloplasts. Use of biologic bone and cartilage grafts results in lower infection rates, but they are associated with long-term resorption and donor-site morbidity. Alloplastic materials, in particular silicone, have been associated in literature with extrusion, necrosis of the tip, mobility and deviation or displacement of the implant, immobile nasal tip and infection. However, they have the advantages of being readily available and easy to reshape with no requirement for harvesting autografts. AIM: To overcome these problems associated with silicone implants for which the authors have devised a novel technique, the "rideon technique". MATERIALS AND METHODS: The present study was carried out on 11 patients over a period of 4 years. The authors have devised a simple technique to fix the silicone implant and retain it in place. Restricting the implant to only dorsum avoided common complications related to the silicone implant. RESULTS: The authors have used this technique in 11 patients with encouraging results. Follow-up ranged from 12 months to 36 months during which patients were assessed for implant mobility, implant extrusion and tip necrosis. There was no incidence of above mentioned complications in these patients. CONCLUSION: The "rideon technique" provides excellent stability to silicone implants and restricting the implant only to dorsum not only eliminates chances of tip necrosis and thus implant extrusion but also maintains natural shape, feel and mobility of the tip.

Pure red cell aplasia associated with thymoma.

A case of thymoma with mixed spindle and lymphocytic variety along with acquired, secondary, chronic pure red cell aplasia is an uncommon entity. The presented case is a case of anterior mediastinal tumour with marked anemia. On histopathologic and hematological examinations, it proved to be a case of thymoma along with pure red cell aplasia. High index of suspicion, bone marrow examination, radiological including CT scan examination, total thymectomy after preparation with repeated blood transfusion remains the mainstay of treatment. Prolonged corticosteroid therapy leads to remission for upto ten months after operative intervention.