Mastoid obliteration using temporo-parietal fascia flap—our experience

The management of cholesteatomatous ear disease by open cavity mastoidectomy is plagued by a number of cavity problems. A chronically discharging cavity besides being a frustrating dilemma to the surgeon is also a social handicap to the patient. Obliteration of such discharging cavities seems to be an effective therapeutic modality. This paper deals with mastoid obliteration using a vascularized axial pattern temporoparietal fascia flap. Twenty post-mastoidectomy cases were retrospectively studied for cavity problems and prospectively for efficacy of the technique in terms of achieving a dry ear and hearing improvement. Also included is an extensive review of literature regarding the various causes of cavity problems and techniques of obliteration.     

Adult paratesticular sarcomas: A report of eight cases

Eight adult paratesticular sarcomas seen at a Regional Cancer Centre over a 7-year period are described. There were three cases of rhabdomyosarcoma (RMS), three cases of leiomyosarcoma (LMS), and two cases of liposarcoma (LS). The RMS occurred in a younger age group (3rd decade) than the LMS and LS (6th and 7th decades). Most of our patients presented with advanced disease after orchiectomy at other hospitals, three with recurrent or residual disease and four with metastasis. The single patient with RMS who received intensive adjuvant therapy is free of disease at 84 months in spite of the advanced stage at presentation. All three patients with LMS had an unfavourable clinical course. Both the patients with LS had well differentiated (WD) tumours and presented with recurrences, one over several years, following initial local excisions. The necessity for early adequate surgical and adjuvant therapy and the need for a uniform treatment policy are discussed. © 1994 Wiley-Liss, Inc.     

Field trial of Abate and Teknar for Simulium (Diptera: Simuliidae) control in India.

Simulium breeding was eliminated in a river up to 30 km with 0.1 ppm Abate (temephos) for 30 min exposure. Teknar (Bacillus thuringiensis var. israelensis) at 10 ppm for 10 min exposure resulted in 98.4% and 87.9% reduction up to 20 m in 2 sections of a small stream.     

Primary adenoid cystic carcinoma of larynx

A rare case of Adenoid cystic carcinoma of larynx is presented and discussed in brief.     

Surgical voice restoration in alaryngeal patients

Blom Singer’s technique of surgical voice restoration in laryngectomized patient is a highly successful method of speech rehabilitation. This technique has been further simplified and adopted in 20 of our cases with 90% success in acquiring speech. Though primary tracheo-oesophageal puncture (TEP) is a good attempt of rehabilitation, we feel that post-operative healing and fibrosis will displace the puncture site causing difficulty to insert the prosthesis by the patient. The high success rate with secondary TEP makes us believe that it is a better technique to be adopted. Further, plan for secondary TEP will give enough time to the patients to develop oesophageal speech, if they are capable of.     

Correlates of alcohol consumption and tobacco use among tea industry workers of Assam

An epidemiological study on alcohol and tobacco (smoking and nonsmoked tobacco) use was carried out in tea garden population of Assam, one of the largest agroindustries of India. A total sample of 2,264 individuals (male, 1,033; female, 1,231) aged 15 years and older was interviewed in 2002-2003 to collect information about alcohol and tobacco use using a predesigned and pretested questionnaire. Age-adjusted prevalence of alcohol consumption was 59.2% (male, 69.3%; female, 54%). Smoking was more common among males (13.2%) than females (2%). However, use of nonsmoked tobacco was almost as popular among female (71.9%) as among males (75.3%). More than half of the respondents (54.7%) were multiple users of alcohol and tobacco. Prevalence of alcohol consumption, nonsmoked tobacco use, and smoking among the young age group (15-24 years) was 32.2%, 52.5%, and 2.2%, respectively. Prevalence of smoking increased with age, and more than a quarter of males above 54 years were smokers. Similar age trends in the prevalence of alcohol and nonsmoked tobacco was not observed. Sociodemographic correlates, like education, occupation, and marital status, emerged as important predictors of substance uses irrespective of sex. Association of income with substance use was weak in this study, perhaps due to homogeneity of income level. Users of alcohol and tobacco were mostly illiterate, manual workers, and widows/widowers. However, smokers were more common among sedentary worker. Not withstanding the limitations of the study, the findings of the study are useful for planning interventional strategy to control alcohol and tobacco use for better health outcome.     

Minimally invasive locking plate osteosynthesis for fractures of the distal tibia--results in 20 patients

AIMS: We report our experiences with minimally invasive locking plate osteosynthesis (MILPO), for distal tibia fractures, with specific reference to fracture union and complications encountered. PATIENTS AND METHODS: Twenty patients underwent MILPO for open and closed distal tibia fractures between March 2003 and December 2004. Fractures were classified according to the AO system. Open fractures were graded using the Gustilo and Anderson classification and closed fractures via the Tscherne classification system. RESULTS: There were 16 males and 4 females of mean age 44.7 years (range 19-69 years). Thirteen patients had temporary external fixation, prior to definitive fracture fixation. Minimum follow-up was 12 months and average time to full weight bearing in the closed fracture group (12 patients) was 18.1 weeks (range 8-32 weeks) and 19.3 weeks in the open fracture group (8 patients, range 8-44 weeks). Fracture healing was defined as radiological evidence of bridging mature callus combined with pain-free full weight bearing. In the open fracture group, four fractures united within 6 months, one within 6-12 months and one united 12 months after surgery; there were two cases of non-union. In the closed fracture group, seven fractures united within 6 months, three fractures between 6 and 12 months and two after 12 months from surgery. Two of the 20 patients required additional procedures to aid bone healing in the post-operative period. Three of the 20 patients required metalwork removal, for delayed wound breakdown in two cases and wound infection in one case. An uneventful recovery was made following this, in all three cases. There was one case of implant failure due to plate breakage at 32 weeks post-op. The fracture site was opened and re-plated at 32 weeks with a DCP. There were no complications following this. CONCLUSION: MILPO was used for definitive fixation of high energy, open and closed, peri-articular distal tibia fractures. This approach aims to preserve bone biology and minimise surgical soft tissue trauma. This surgical approach may provide an answer to treating a challenging group of fractures and further research is warranted.     

Endoscopic dacryocystorhinostomy vs KTP 532 laser-assisted endoscopic dacryocystorhinostomy

Objectives

Advances in endoscopy and lasers have improved surgical management of chronic nasolacrimal duct obstruction. This is a preliminary comparison between standard and laser assisted endoscopic dacryocystorhinostomy (DCR).

Study Design

Combined retrospective and prospective study.

Setting

Tertiary referral hospital.

Patients and Methods

Thirty-eight cases of chronic nasolacrimal duct obstruction underwent endoscopic DCR (26 standard and 12, laser-assisted) and were assessed at 3 and at 6 months postoperatively by nasal endoscopy.

Results

Three months postoperatively (n=38), total relief of epiphora among the nonlaser group was 80.76 vs 75% in the laser group (P=0.982). At 6 months (n=19), the laser group had recorded 100% symptomatic relief compared to 85.71% in the nonlaser group (P=0.964). The laser group suffered fewer complications (33.33 vs 46.15% for nonlaser group).

Conclusion

Lasers show promise in long-term management of duct obstruction and are associated with fewer complications. A larger study is required before and generalization is made.