Pedicled omental transfer for limb salvage in Buerger's disease

We performed pedicled omental transfer in 62 patients with Buerger's disease at the Department of Surgery, J.L.N. Hospital, Ajmer between January 1990 and December 1996. All were male and had evidence of limb ischaemia. Post-operative results in these patients consisted of relief of intermittent claudication in 92%, disappearance of rest pain in 94%, disappearance of limb coldness in 83%, disappearance of discolouration in 82%, and healing of ischaemic ulcers in 83%. Tissue oxygen saturation in the affected limb improved from a mean of 84.8+/-3.6% in the preoperative period, to 89+/-1.5% at 12 h, 93.1+/-1.8% at 72 h and 96+/-1.2% at the end of 2 months of follow-up. Claudication distance improved from a mean of 75+/-20 m in the pre-operative period to 1000+/-110 m at 2 months of follow-up in 57 of 62 patients. Major amputations were not required in any patient, thus conserving the limb. We conclude that pedicled omental transfer offers promising results in patients with limb ischaemia due to Buerger's disease.     

FREE VERSUS PEDICLED OMENTAL GRAFTS FOR LIMB SALVAGE IN BUERGER'S DISEASE

Background : Buerger's disease is a disabling and progressive disease that affects young smokers with a variable and unpredictable course. Free or pedicled omental transfer are the possible modes of management for these patients, and these modes are compared in the present study. Methods : Of the 43 patients who had Buerger's disease who were treated at the Department of Surgery, Jawahar Lai Nehru (JLN) Hospital, Ajmer, between January 1990 and December 1995, 15 patients underwent application of free omental grafts (group A); 28 patients underwent pedicled omental transplantation (group B). The clinical results obtained with the use of either technique were compared. Results : There were no statistically significant differences in the relief of intermittent claudication (80% v.v 82%), rest pain (82%vs 91%), coldness (83%vs 87%), discolouration (80%vs 82%), ulceration (75%vs 78%) and post-amputation ulcer healing (75%vs 86%) in the two groups (P > 0.05); but the time taken for the relief of intermittent claudication, rest pain and coldness was significantly less in group B. Major amputations were not required in both the groups. Conclusions : These findings suggest that the ultimate clinical benefits obtained with the use of either free or pedicled omental grafts in patients with Buerger's disease are similar, supporting a possible local action of the omentum.     

Preoperative Thoracic Spine Magnetic Resonance Imaging for Spinal Cord Stimulation: Should Such a Recommendation Be an Absolute Requirement?

ObjectiveCurrent published guidelines recommend advanced imaging, specifically, thoracic magnetic resonance imaging (MRI), prior to implantation of epidural paddle spinal cord stimulator (SCS) leads. Preoperative imaging may affect surgical approach to minimize risk of complications. We aimed to assess the impact of preoperative thoracic MRI on surgical planning in a large series of surgical paddle SCS lead placements in a real-world setting.Materials and MethodsThis is a retrospective study of a prospectively maintained data base of 160 patients treated by SCS with awake thoracic surgical paddle lead placement in a single academic functional neurosurgery center from 2013 to 2021. All patients had a thoracic MRI prior to implantation. Abnormal MRI findings were reviewed to determine their potential impact on the safety of surgical paddle lead placement. A minor impact was defined as anatomical areas to avoid with paddle lead placement. Major impacts included significant deviations from standard approach to electrode placement.ResultsNone of the 160 patients had signs or symptoms referable to thoracic spine pathology prior to lead implant. Sixty-seven had abnormal thoracic MRI findings, and 36 had abnormal MRI findings that impacted surgical planning. Thirty-one patients had MRI findings with minor impact. Five patients (more than 3%) had findings with major impact.ConclusionsThis is the largest case series assessing the impact of preoperative thoracic MRI on surgical planning for patients undergoing paddle SCS placement. Twenty-two percent of patients had MRI findings that impacted surgical planning with 3% requiring additional surgical decompression for safe paddle lead placement. Without advanced imaging to inform surgical planning, unnecessary risk may have been placed on these patients. Although such imaging has been recommended by consensus committees in published guidelines, our study is the first to present a large institutional experience of real-world data that demonstrates its importance.     

Axial aponeurofasciocutaneous groin flap: an extended concept

The concept of including external oblique aponeurosis along with the time-tested groin flap as a single vascularized unit heralds a versatile and unique application in the armamentarium presently available. This concept, though simple, has not been previously reported in the world literature. In view of its potential benefits and simplicity, we felt the need to bring this concept to the attention of our colleagues.     

Comparative Natural History of Visual Function From Patients With Biallelic Variants in BBS1 and BBS10

PurposeThe purpose of this study was to compare the natural history of visual function change in cohorts of patients affected with retinal degeneration due to biallelic variants in Bardet-Biedl syndrome genes: BBS1 and BBS10.MethodsPatients were recruited from nine academic centers from six countries (Belgium, Canada, France, New Zealand, Switzerland, and the United States). Inclusion criteria were: (1) female or male patients with a clinical diagnosis of retinal dystrophy, (2) biallelic disease-causing variants in BBS1 or BBS10, and (3) measures of visual function for at least one visit. Retrospective data collected included genotypes, age, onset of symptoms, and best corrected visual acuity (VA). When possible, data on refractive error, fundus images and autofluorescence (FAF), optical coherence tomography (OCT), Goldmann kinetic perimetry (VF), electroretinography (ERG), and the systemic phenotype were collected.ResultsSixty-seven individuals had variants in BBS1 (n = 38; 20 female patients and 18 male patients); or BBS10 (n = 29; 14 female patients and 15 male patients). Missense variants were the most common type of variants for patients with BBS1, whereas frameshift variants were most common for BBS10. When ERGs were recordable, rod-cone dystrophy (RCD) was observed in 82% (23/28) of patients with BBS1 and 73% (8/11) of patients with BBS10; cone-rod dystrophy (CORD) was seen in 18% of patients with BBS1 only, and cone dystrophy (COD) was only seen in 3 patients with BBS10 (27%). ERGs were nondetectable earlier in patients with BBS10 than in patients with BBS1. Similarly, VA and VF declined more rapidly in patients with BBS10 compared to patients with BBS1.ConclusionsRetinal degeneration appears earlier and is more severe in BBS10 cases as compared to those with BBS1 variants. The course of change of visual function appears to relate to genetic subtypes of BBS.     

Sulfonated biochar catalyst derived from eucalyptus tree shed bark: synthesis,characterization and its evaluation in oleic acid esterification

Herein, fatty acid (oleic acid, OA) was upgraded to fatty acid methyl ester (FAME) via esterification reaction using sulfonated biochar obtained from eucalyptus tree shed bark as solid acid catalyst. Under the optimal esterification conditions (i.e., at 65 °C for 2 h using a methanol/OA molar ratio of 10 : 1 with a catalyst dosage of 4 wt%), the FAME yield was 97.05 ± 0.28% when a solid acid catalyst prepared by loading 6 g of p-Toluenesulfonic acid (p-TSA) on 2 g of activated biochar (p-TSA₃/ABC) was used. The remarkable performance of the p-TSA₃/ABC could be attributed to its high acidity (468.8 μmol g⁻¹) and dominance of the SO₃H acid site on the catalyst surface. Experimental findings showed that the p-TSA₃/ABC was relatively stable due to its highly functionalized structure. The catalyst was recycled for five successive cycles and exhibited no dramatic decrease in catalytic activity.

Herein, fatty acid (oleic acid, OA) was upgraded to fatty acid methyl ester (FAME) via esterification reaction using sulfonated biochar obtained from eucalyptus tree shed bark as solid acid catalyst.     

Characterization of predominant Mycobacterium tuberculosis strains from different subpopulations of India

The predominant strains from India belong to Central-Asian (CAS) and the East-African-Indian (EAI) clade of Mycobacterium tuberculosis. The two clades have also been shown to be geographically partitioned. The study of such strains may help to understand the characteristics that make M. tuberculosis an effective pathogen and its overrepresentation in certain populations. M. tuberculosis isolates characterized by spoligotyping under a population based tuberculosis study covering different regions from the North and South India were further analyzed by restriction fragment length polymorphism (RFLP) and by deletion analysis of M. tuberculosis specific deletion region 1 (TbD1). The genetic relationship of the two clades inferred using different genetic markers showed good correlation. In the North where the CAS clade predominates the isolates are characterized by presence of high IS6110 copy number and absence of TbD1 region whereas in the South where the EAI clade predominates the isolates are characterized by low copy number of IS6110 and presence of TbD1 region. The ancestral EAI strains were found to be less often associated with drug resistance or young age as compared to the CAS clade. The study highlights that the EAI lineage is well established in India and that CAS may be emerging or more recently introduced to India. The results depict a distinction in the lineage of strains from the North versus South India indicating a need to study if the pathogen has adapted to specific human populations.     

Tongue abscess: a rare clinical entity

Swelling of the tongue is a rare clinical entity. It is a potentially life-threatening condition, as it could result in airway compromise. The differential diagnosis of acute tongue swelling includes hemorrhage, infarction, abscess, tumor, and edema. A tongue abscess should be considered in all cases of acute tongue swelling, especially when host defenses are severely impaired. Although the diagnosis of lingual abscess can be reached clinically because of the rarity of the condition, in neglected cases, the diagnosis can be difficult. Despite of the rarity and complexity of this condition, its management strategy is relatively simple. In the present study, we describe a case of a tongue abscess on the anterior two-thirds of the tongue in a 60-year-old woman, and discuss the pathophysiology, diagnosis, and treatment of this complex entity.