Touraine Solente Gole syndrome: The elephant skin disease

Touraine Solente Gole syndrome is a rare hereditary syndrome of primary pachydermoperiostosis, with the characteristic triad of pachydermia (or elephant like skin), periostosis and acropachia. A 27-year-old patient presented with aesthetic deformity of forehead due to deep skin folds and coarsening of facial features due to progressive thickening of skin. Associated palmoplantar hyperkeratosis with broadened of finger and toe tips and digital clubbing were noticed. Dermatologic evaluation revealed cutis verticis gyrata of scalp, seborrhoeic hyperplasia of face and hyperhidrosis. Natural history of the disease and aetiopathogenesis were reviewed. Aesthetic correction of forehead through frontal rhytidectomy was attempted.KEY WORDS: Clubbing, cutis verticis gyrata, frontal rhytidectomy, hypertrophic osteoarthropathy, pachyderma, periostosis     

Limberg Flap for Sacrococcygeal Pilonidal Sinus a Safe and Sound Procedure

Sacrococcygeal pilonidal sinus (SC-PSD) is an acquired condition usually seen in young adults especially males. This prospective study has been performed to determine effects of the Limberg flap rotation surgery for sacrococcygeal pilonidal sinus, its feasibility to the patients, their compliance, and outcomes such as wound infection, postoperative pain relief, recurrence rates, and return to work. A total of 30 patients were operated by the same two surgeons from January 2009 to June 2011, including both primary and recurrent diseases, and patients with previous incision and drainage done for the pilonidal abscess. All patients successfully underwent surgery, with very minimal postoperative pain, stayed in hospital for average 5 days, returned to work after 3 weeks, with 3 patients having flap edema, 2 having flap necrosis, and no recurrences so far. Patients with flap edema and flap necrosis took 2–3 weeks to heal with regular dressing and antibiotic usage. Limberg flap for sacrococcygeal pilonidal sinus was found very useful and sound in terms of postoperative pain, infection rates, and early return to work with almost nil recurrences.     

Simple and effective approach for the treatment of traumatic wounds in non‐diabetic patients: a prospective open study

Infection is one of the most important obstacles in the wound‐healing process. Conventional methods used for the treatment of wound infections have their own limitations and hence, are difficult to control. If infection is not addressed well in time, it will further increase morbidity and cost of treatment. An attempt was made to develop a simple and effective treatment modality by using citric acid as the sole antimicrobial agent to control bacterial infections of traumatic wounds. A total of 259 cases of traumatic wounds infected with a variety of bacteria were investigated for culture and susceptibility, and susceptibility to citric acid. Citric acid ointment (3%) was applied to traumatic wounds to determine its efficacy in their treatment of traumatic wounds. In a culture and susceptibility study, a total of 369 aerobic bacteria and 7 fungi were isolated, with Staphylococcus aureus (30·31%) being the most common isolate and ciprofloxacin (61·43%) being the most effective agent. All the isolates were found to be inhibited by citric acid in in vitro studies (minimum inhibitory concentration – 500–2500 µg/ml). Citric acid ointment was found effective in controlling infections. Out of 259 cases, 244 (around 95%) were healed completely in 5–25 applications of 3% citric acid. As citric acid has antibacterial activity and wound‐healing property; hence it is the best alternative for the treatment of traumatic wounds. Besides these properties, citric acid has no adverse effects and it is a good dressing agent.     

Environmental enrichment upregulates micro‐RNA‐183 and alters acetylcholinesterase splice variants to reduce anxiety‐like behavior in the little Indian field mouse (Mus booduga)

Environmental enrichment (EE) has an influential role in reducing behavioral reactivity to stress. We previously observed that EE reduces the anxiety‐like behavior in the field mouse Mus booduga accompanied by a reduction in the expression of molecules involved in the stress pathway. In this study, we demonstrate the effect of different housing condition on regulation of micro‐RNA‐183‐SC35‐mediated splicing of acetylcholinesterase (AChE). Adult male M. booduga were captured from an agricultural field and housed under nonenriched standard conditions (SC) for 7 days and considered as directly from the wild (DW). On day 8, individuals were randomly assigned to three groups; DW, SC, and EE. The DW group's anxiety‐like behavior was assessed in the elevated plus maze (EPM) and open field test (OFT). The SC and EE groups were transferred to their respective conditions and housed for another 30 days. The mice housed in EE showed less anxiety‐like behavior on EPM and in OFT compared with DW and SC mice. Interestingly, miR‐183 expression was increased following exposure to EPM in EE mice but not in SC mice. Subsequently, the upregulated miR‐183 expression suppresses the SC35 expression and shifting of splicing from AChE‐S (synaptic) to AChE‐R (read‐through) form, whereas standard housing condition downregulate miR‐183 and induces the splicing of AChE. The upregulated AChE‐R form possibly terminates ACh transmission, which is reflected in the level of anxiety‐like behavior. Overall, the present study suggests that EE effectively regulates the miR‐183 pathway to reduce anxiety‐like behavior. © 2012 Wiley Periodicals, Inc.     

Metal-ceramic screw-retained implant fixed partial denture with intraoral luted framework to improve passive fit

Passive fit of a long-span screw-retained implant prosthesis is an important criteria for the success of the restoration. This article describes a technique for fabricating a ceramometal implant fixed dental prosthesis (FDP) for a long-span partially edentulous situation by altering the conventional screw-retained design. The possibility of a passive fit is maximized by intraoral luting of the cast frame to milled abutments, and the potential framework distortion during fabrication is compensated to a major extent. Retrievability is ensured by screw retention of the prosthesis to the implants. Compared with conventional porcelain fused to metal screw-retained FDP, this prosthesis is relatively inexpensive to fabricate.     

Altered Immunogenicity of Donor Lungs via Removal of Passenger Leukocytes Using Ex Vivo Lung Perfusion

Passenger leukocyte transfer from the donor lung to the recipient is intrinsically involved in acute rejection. Direct presentation of alloantigen expressed on donor leukocytes is recognized by recipient T cells, promoting acute cellular rejection. We utilized ex vivo lung perfusion (EVLP) to study passenger leukocyte migration from donor lungs into the recipient and to evaluate the effects of donor leukocyte depletion prior to transplantation. For this purpose, female pigs received male left lungs either following 3 h of EVLP or retrieved using standard protocols. Recipients were monitored for 24 h and sequential samples were collected. EVLP‐reduced donor leukocyte transfer into the recipient and migration to recipient lymph nodes was markedly reduced. Recipient T cell infiltration of the donor lung was significantly diminished via EVLP. Donor leukocyte removal during EVLP reduces direct allorecognition and T cell priming, diminishing recipient T cell infiltration, the hallmark of acute rejection.     

Antipsychotics,Delirium, and Acute Respiratory Distress Syndrome: What Is the Link?

Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate and ultimately leads to respiratory failure. Patients who develop ARDS often have prolonged and complicated hospital courses putting them at risk for intensive care unit (ICU) delirium. Patients with ICU delirium often need chemical sedation, mechanical ventilation, prolonged duration of ICU and hospital stays, and they experience long‐term cognitive impairment and increased mortality. In a patient with ARDS, ICU delirium further complicates the hospital course and increases the risk of morbidity and mortality. Antipsychotics are prescribed to decrease the severity and duration of ICU delirium, thus potentially decreasing their risk of morbidity and mortality. However, antipsychotics are associated with many adverse effects including respiratory failure. Given the long‐term sequelae associated with the development of ICU delirium and the risks associated with antipsychotic use, clinicians must weigh the risks and benefits of antipsychotic use. This review investigates the interrelationship between ARDS, delirium, and antipsychotic use. In addition to discussing relevant studies evaluating antipsychotics for the prevention and treatment of delirium, we investigate safety concerns with the use of antipsychotics, especially as they relate to ARDS. Using the data compiled in this review, clinicians can make an informed decision about the use of antipsychotics for the prevention or treatment of delirium, with special consideration for their patients with ARDS. Future studies are needed to critically evaluate antipsychotic timing, dose, and duration for the prevention and treatment of ICU delirium and specifically evaluate the impact in special populations, particularly patients with ARDS.     

Chondrosarcoma of the mandible: a case report

Chondrosarcomas are malignant tumours of cartilaginous origin. They range from a well-differentiated growth resembling a benign cartilage tumour to a high-grade malignancy with aggressive local behaviour and the potential to metastasize. Only 5% to 10% of chondrosarcomas are known to occur in the head and neck region. A case of chondrosarcoma of the anterior region of the mandible is presented, along with a review of the relevant literature.