Open port placement of the first laparoscopic port: a safe technique.

BACKGROUND: Blind insertion of the Veress needle and of the first trocar is a significant cause of complications in laparoscopic surgery. Despite this risk, the closed technique is still more popular than the open one. Our aim is to report the results of our experience with the routine use of the modified open technique in laparoscopic surgery and to describe the technical details of the creation of pnuemoperitoneum by the open technique that we used. METHODS: A prospective study was conducted in the department of surgery at Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi. A modified method of open laparoscopy was performed on 755 consecutive patients requiring laparoscopy or laparoscopic surgery over a 5-year period from August 1998 to February 2003 in 1 surgical unit. RESULTS: The mean time taken was 4 minutes (range, 2 to 10). No intraoperative complications occurred during trocar insertion. Forty-nine (6.49%) patients had minor umbilical sepsis, 22 (2.91%) had periumbilical hematoma, but none had umbilical hernia during 3 months of follow-up after surgery. CONCLUSION: Based on our own experience, we recommend open laparoscopy as a safe and easy approach for routine laparoscopic interventions.     

Factors Influencing Hearing Preservation in Acoustic Tumor Surgery

In patients who underwent neurosurgery for excision of acoustic tumors, we used correlation and multivariate logistic regression analysis to study relationships among nine variables thought to have value in predicting hearing preservation. These variables included auditory perceptual, auditory neurophysiologic, and imaging-related characteristics of acoustic tumor dimensions. The univariate correlations showed two general trends. The first trend demonstrated relationships among imaging-related acoustic tumor dimensions (size or porus acousticus widening) with either postoperative hearing or brainstem auditory evoked potential (BAEP) abnormalities (tumor size and postoperative hearing; porus acousticus widening and postoperative hearing; tumor size and preoperative BAEP abnormalities). The second trend reflected interrelationships among preoperative audiometric variables that were not related to postoperative hearing outcome. Logistic regression analysis of eight independent variables on the presence or absence of postoperative hearing found that porus acousticus widening was the best prognostic indicator for hearing outcome. When the porus acousticus was widened, the odds ratio was 11:1 that hearing would be lost postoperatively. Viewed as a whole, the literature on prognostic variables related to hearing preservation has been limited, almost entirely, to univariate relationships. To determine more accurately which preoperative variables have unique prognostic value, more complex multivariate, analysis procedures will be required. Additionally, standardized criteria for assessment and reporting of auditory test results are also needed.     

Evaluation of high sensitivity C-reactive protein and glycated hemoglobin levels in diabetic nephropathy

Diabetic nephropathy (DN) is one of the major long-term complications of diabetes mellitus (DM). Type 2 DM is frequently associated with an inflammatory status, but limited information is available on the relationship between low-grade inflammation and DN. The aim of the study is to determine the serum level of high sensitivity C-reactive protein (hsCRP) in DN patients and to compare with that of normal subjects and to study the association between serum hsCRP levels and glycated hemoglobin (HbA1c) levels. Fifty DN patients in the age group of 50- 60 years with more than ten years of duration of diabetes were recruited for this study and 25 age-and sex-matched healthy subjects were included in this study as controls. Serum hsCRP levels were measured by turbidometry method. There was a statistically significant increase in serum hsCRP levels in DN cases as compared to normal controls. The hsCRP levels showed a positive correlation with HbA1c in DN. These results suggest that estimation of serum hsCRP levels and aiming at good glycemic control help in early intervention and prevention of further com-plications in diabetic patients.     

Efficacy of nasolabial flap in reconstruction of fibrotomy defect in surgical management of oral submucous fibrosis: a prospective study

Purpose

Various surgical modalities have been used in the surgical management of oral submucous fibrosis with variable results. This prospective study evaluates the efficacy of nasolabial flap in the reconstruction of fibrotomy defect in surgical treatment of oral submucous fibrosis in terms of functional and esthetic outcomes.

Material and method

In this prospective study, we treated 20 patients of oral submucous fibrosis surgically. The surgical protocol was consisting of bilateral fibrotomy, temporal myotomy, and coronoidotomy or coronoidectomy followed by reconstruction of fibrotomy defect with bilateral extended nasolabial flaps. All patients were prescribed with nutritional supplements and antioxidants. Vigorous mouth opening exercise was made compulsory for every patient. Preoperative and postoperative evaluation was done for interincisal mouth opening, function of mastication, and cosmetic results. Patient’s regular follow-up was done for 2 years.

Results

Postoperatively, we noted excellent increase in the interincisal mouth opening relieving trismus. Patient’s ability to chew solid food was increased significantly. Extraoral scar was minimal and well accepted by all the patients. There was no morbidity of the donor site. There was no injury to the facial nerve in all cases. The only drawback was intraoral hair growth which went on reducing with mucosalization of the graft tissue.

Conclusion

Random pattern nasolabial flap is a very good option for intraoral reconstruction of fibrotomy defect in surgical treatment of oral submucous fibrosis with excellent functional and cosmetic results with minimal complications.