Does the use of a flap during abdominoperineal resection decrease pelvic wound morbidity?

We hypothesized that the use of muscle flaps, known as tissue transfer (TT), at the time of abdominoperineal resection (APR) reduces perineal wound complications. A restrospective review of patients undergoing an APR at the University of Washington (1984-2003) was conducted. Perineal wound complications and eventual wound healing were compared in patients with and without TT. Ninety-two patients (mean age, 56.6 years) underwent APR; 23.9 per cent (n = 22) had concurrent TT. Patients undergoing TT were more likely to have cancer (91% vs. 77%, P = 0.05) and radiation therapy (86% vs. 52%, P < 0.01). Operative times were nearly 2 hours longer in patients having TT (7.4 hours +/- 2.5 hours vs. 5.6 hours +/- 1.8 hours, P = 0.03), but lengths of stay were similar (13 +/- 5.9 days vs. 12 +/- 7.6 days, P = 0.5). Patients undergoing TT had a higher rate of all wound-healing complications (59% vs. 40%, P = 0.1) and major wound-healing complications (32% vs. 26%, P = 0.6). However, these differences were not statistically significant. No differences in major complications were identified in patients with and without preoperative radiation therapy (26% vs. 28%, P = 0.8). Fifteen per cent (n = 14) of all patients failed to heal wounds at 6 months, but only 9 per cent (n = 2) of patients undergoing TT failed to heal their wounds at 6 months compared with 17 per cent (n = 12) in the non-TT group (P = 0.3). After controlling for important covariates, patients undergoing TT during an APR did not have a significantly lower rate of wound complications. The impact of TT on wound healing in patients with recurrent cancer and preoperative radiation therapy is suggestive of a benefit but requires prospective investigation.     

Evaluation of near infrared spectroscopy as screening tool for detecting intracranial hematomas in patients with traumatic brain injury

Background

Traumatic Brain Injury (TBI) is one of the most common surgical emergencies in service hospitals of India. Computed tomography (CT) has been a consistent and reliable technique for detecting intracranial hemorrhages but is limited by its non-availability in most service hospitals. Therefore the need for a cheaper, portable and easily available option required to be explored. The aim of this study was to determine the sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of Near Infra Red Spectroscopy (NIRS) against the gold standard of NCCT head.

Serum cations (calcium and magnesium) in leprosy

Serum cations (calcium and magnesium) were studied in 80 leprosy patients and 40 normal healthy individuals to find out the correlation between the clinical status of leprosy with these cations levels in the serum. There was significant decrease of serum calcium in lepromatous leprosy (7.42 +/- 0.7 mg%, t = 14.12, P less than 0.001), which seems to be related with the extent of leprosy lesions and duration of illness as few patients (22.2%) with minimal lesions and shorter duration of illness had serum calcium within normal range. Serum magnesium was significantly decreased in all types of leprosy cases and lepromatous leprosy patients showed highly significant decrease in serum magnesium level (1.02 +/- 0.2 mEq/L, t = 14.54, P less than 0.001).     

Eplerenone in the Treatment of Polypoidal Choroidal Vasculopathy

Overactivation of mineralocorticoid receptor pathways has been implicated in the pathophysiology of central serous chorioretinopathy (CSCR). Recently, mineralocorticoid receptor antagonists such as eplerenone have demonstrated success in treating subretinal fluid in CSCR. This case demonstrates a patient who was initially presumed to have subretinal fluid secondary to CSCR and was started on a trial of oral eplerenone. It quickly became evident that her subretinal fluid was secondary to a peripapillary polypoidal choroidal vasculopathy network, but she demonstrated a significant improvement with oral eplerenone. To the authors'' knowledge, this is the first case of eplerenone use to treat polypoidal choroidal vasculopathy.Key Words: Eplerenone, Mineralocorticoid antagonist, Polypoidal choroidal vasculopathy