Functional outcome of patients undergoing replantation of hand at wrist level-7 year experience

Background:

Replantation is defined as reattachment of amputated limb using neurovascular and musculoskeletal structures in order to obtain recovery of limb. Re-vascularisation involves all the above steps in case of limb injuries that result in a near total amputation.

Aim and Objective:

To study the functional outcome of patients undergoing replantation of hand at wrist level.

Material and Methods:

This is a retrospective study of patients who underwent replantation of total amputation of hand at wrist level within a period of Jan 2003-June 2010. We evaluated post operative functional outcome compared to uninjured hand taking into consideration: 1. The patient''s overall satisfaction with the hand. 2. Recovery of flexor and extensor function of thumb and fingers. 3. Recovery of thumb opposition. 4. Recovery of sensations in the median and ulnar nerve distribution. 5. Ability of surviving hand to perform daily tasks.

Results:

There were total seventeen patients and age range was two years to 55 years. Out of 17 patients,16 were males. All the replantations were successful except for one.

Summary:

The results showed that, although the replanted hands were never functionally as good as the contralateral hand the patients were able to perform most of the daily activities.KEY WORDS: Replantation, wrist amputation, hand amputation     

Acute Renal Failure during Pregnancy Secondary to Spontaneous Perirenal Hematoma

A 32-year-old pregnant female presented with right flank pain, hematuria, and ARF at 25 weeks of gestation. Imaging studies demonstrated right perinephric hematoma, which compressed the inferior vena cava. ARF improved with expectant care as the hematoma gradually resolved.     

Robotic-Assisted Hysterectomy for the Management of Severe Endometriosis: A Retrospective Review of Short-Term Surgical Outcomes

Objectives:

The primary objective was to examine the safety and feasibility of robotic-assisted laparoscopy in a cohort of women treated surgically for stage III and IV endometriosis. The secondary objective was to explore whether the stage of endometriosis affected surgical outcome.

Methods:

In this cohort study, 43 women with severe endometriosis were treated with robot-assisted laparoscopic hysterectomy with unilateral or bilateral salpingo-oophorectomy for stage III (n = 19) or stage IV (n = 24) disease.

Results:

Histopathologic evaluation confirmed endometriosis in all patients, and fibroids were also shown in 12 patients. The median actual operative time was 145 min (range, 67–325 min), and the median blood loss was 100 mL (range, 20–400 mL). All but one of the procedures were completed successfully robotically. The length of hospital stay was 1 d for 95% of patients (41 of 43), and 2 patients had prolonged stays of 4 d and 5 d, respectively. One patient was readmitted for a vaginal cuff abscess; this represented the only complication identified in this series.

Conclusions:

Robot-assisted laparoscopic surgery appears to be a reasonably safe and feasible method for the definitive surgical management of women with severe endometriosis.     

Current biomedical waste management practices and cross-infection control procedures of dentists in India

Objectives: To investigate the knowledge, attitudes and behaviour of dentists working in dental clinics and dental hospitals regarding biomedical waste management and cross‐infection control. Methods: A national survey was conducted. Self‐administered questionnaires were sent to 800 dentists across India. Results: A total of 494 dentists responded, giving a response rate of 61.8%. Of these, 228 of 323 (70.6%) general dentists reported using boiling water as a sterilising medium and 339 (68.6%) dentists reported disposing of hazardous waste such as syringes, blades and ampoules in dustbins and emptying these into municipal corporation bins. Conclusions: Dentists should undergo continuing education programmes on biomedical waste management and infection control guidelines. Greater cooperation between dental clinics and hospitals and pollution control boards is needed to ensure the proper handling and disposal of biomedical waste.     

The Incentive Dilemma: Intrinsic Motivation and Workplace Performance

Incentive plans are a core component of many radiology positions and are often considered a major factor in the ability to recruit and retain high-performing radiologists. Financial incentives are widely thought to be effective at motivating individuals, but there is considerable evidence to the contrary. In this report, the authors examine basic assumptions about financial incentives and debate the potential negative impact of financial incentive systems on performance at radiology practices.     

MRI of female urethra and periurethral pathologies

Introduction and hypothesis

Accurate diagnosis of a wide spectrum of urethral/periurethral pathologies in women remains challenging due to its anatomical location and nonspecific clinical presentations. Magnetic resonance imaging (MRI) has emerged as the modality of choice for diagnosing female urethral and periurethral pathologies due to its multiplanar scanning capability, superior soft tissue differentiation, noninvasive nature, and overall excellent contrast resolution.

Methods

In this narrative review, we describe the use of MRI to visualize the female urethra and periurethral pathologies.

Results

MRI can confidently characterize lesions into cystic or solid, provide a more succinct differential diagnosis, and in some cases provide a specific and accurate diagnosis, enabling surgeons to prepare a roadmap before operative procedure. Moreover, functional MRI can be useful to assess dynamic disorders such as urethral hypermobility.

Conclusions

We provide a comprehensive review of normal MR anatomy of the female urethra, as well as the MR features of practically important urethral and periurethral lesions.