Management of Traumatic Dacryocystitis and Failed Dacryocystorhinostomy Using Silicone Lacrimal Intubation Set

The aim of this work is to study the management and success rate of traumatic dacryocystitis and failed dacryocystorhinostomy (DCR) using Silicone lacrimal intubation set. A prospective study was conducted at a tertiary eye care hospital, India from February 2006 to January 2008. This study material comprised 50 patients of traumatic dacryocystitis and failed dacryocystorhinostomy. Anterior single flap external dacryocystorhinostomy with Silicon intubation was performed in all the patients. The patients were followed up at weekly intervals for 1 month and thereafter every 2 months for 1 year post operatively. Criteria determining success were based on resolution of epiphora and patency on syringing. In traumatic dacryocystitis, 21(91.3%) cases fulfilled these criteria while 23(85.2%) cases of failed DCR were successful. The overall success rate (88%) was determined with an average follow-up of 1 year. Globally, the technique was effective in 85% of cases. The results were comparable with other similar studies. This study concludes that performing a DCR in traumatic dacryocystitis and failed DCR taking into consideration the complications and chances of failure is a challenge for the surgeon. We opine that External dacryocystorhinostomy with Silicon Intubation is one of the most effective modality in dealing with such cases.     

Toxic effects of cypermethrin and methamidophos on bovine corpus luteal cells and progesterone production

This study was planned and executed with the aims to explore corpus luteal primary cell culture as an “animal alternate testing system” in toxicity studies and in vitro toxic effects of cypermethrin (CY) 90% (pyrethroid) and methamidophos (MTP) 73% (organophosphate) on morphology and progesterone secretory activity of bovine corpus luteal cells and tissue. For this purpose, primary cell cultures of bovine corpus luteum (CL) cells were maintained in Dulbecco's Modified Eagle Medium (DMEM) supplemented with 5% fetal calf serum (FCS). Toxicity evaluation were based on viable CL cell counts, morphological changes in CL cells, ability of CL cells to produce progesterone and histological changes in CL tissue at different hours post exposure to CY and MTP. The changes induced by both the insecticides were time and dose dependant. Viable cell counts and progesterone concentration decreased significantly (P<0.05) with the treatment of CY and MTP when compared to control. Corpus luteal cells exposed to CY showed more severe toxic effects as compared to MTP, though the difference was non-significant. Cellular or tissue alterations included degenerative changes in luteal cells, pleomorphic changes, nuclear degeneration and vacuolation, cell shrinkage and rupture, cloudy swelling and hydropic degeneration, less cytoplasmic granulation, cell elongation, hyalinization and cytoplasmic haziness and stripling and necrosis. It was concluded that both the insecticides induce toxic effects in terms of viable counts, morphological and histological changes and progesterone production of bovine CL cells. Cypermethrin exhibited more adverse toxic changes in viable cell counts, progesterone production and histological findings as compared to methamidophos.     

Randomized Clinical Trials of Constitutional Acupuncture： A Systematic Review

The aim of this systematic review is to compile and critically evaluate the evidence from randomized clinical trials （RCTs） for the effectiveness of acupuncture using constitutional medicine compared to standard acupuncture. Ten databases were searched through to December 2008 without language restrictions. We also hand-searched nine Korean journals of oriental medicine. We included prospective RCTs of any form of acupuncture with or without electrical stimulation. The included trials had to investigate constitutional medicine. There were no restrictions on population characteristics. Forty-one relevant studies were identified, and three RCTs were included. The methodological quality of the trials was variable.     

Limb salvage in malignant tumours of the upper limb using vascularised fibula.

INTRODUCTION: Modern reconstructive techniques can prevent amputation in most cases of malignant musculoskeletal tumours. The free fibula has emerged as the primary method of bridging long bone gaps during limb salvage. METHODS: Limb salvage was attempted in 23 patients (15 males and eight females) aged 17-57 years. The tumour was located in the humerus in 18 patients, radius in four patients and the metacarpals in one patient. Osteogenic sarcoma was the most common tumour (11 cases) followed by Ewing's sarcoma in six patients. After neoadjuvant chemotherapy, MRI was repeated and resectability assessed. Wide local excision was performed and the bony defect bridged by free fibulae. RESULTS: All the flaps survived. The average length of defect reconstructed was 18 cm and the average time for bone union was 7 months. At a minimum follow up of 12 months, 21 patients were alive and disease free. One patient required amputation due to recurrence and one died of metastatic disease. Secondary surgery was needed in eight patients (five tendon transfers, two latissimus dorsi flap readjustments and one bone graft). Overall patient satisfaction was high with 21/23 patients having a useful limb. CONCLUSION: Limb salvage in the upper limb using vascularised fibula in patients with malignant musculoskeletal tumours can result in good tumour control along with reasonable limb function.