Karapandzic flap for reconstruction of lip defects.

PURPOSE: Systematic evaluation of the Karapandzic flap in the reconstruction of lip defects after ablative surgery. PATIENTS AND METHODS: Patients who had a Karapandzic flap to reconstruct lip defects were analyzed with reference to demographic details, histology and location of the tumor, and dimensions of resection. The functional aspects of the reconstruction were assessed in terms of the size of the oral stoma, preservation of oral competence, and facial expression, in addition to speech, diet and ease of cutlery, and denture usage. The esthetic outcome was assessed with a 4-point scale and in addition the symmetry of the commissure at rest and function, preservation of the philtrum, and lip projection also were assessed. The complications were noted. RESULTS: Seven patients underwent Karapandzic flap reconstruction (4 males, 3 females) with an age range of 43 to 98 years. Three tumors were located in the upper lip, 4 in the lower lip, and there were 5 squamous and 2 basal cell carcinomas. The lip defects ranged from 40% to 75% of the lip circumference. The oral stoma was of a reduced circumference in all cases but did not lead to any functional compromise in terms of oral competence, facial expression, speech, diet, denture and cutlery usage, and sensation. There were no wound complications in our series. The esthetic outcome was considered excellent/good in 85% of cases. The commissure was symmetrical in all except 1 patient, the philtrum was preserved in all cases of lower lip reconstruction, and the projection of the lip was reduced in edentulous patients. CONCLUSIONS: The Karapandzic flap is a reliable technique that offers consistently good functional and esthetic outcomes after reconstruction of lip defects.     

Retrohepatic cavoatrial bypass for coarctation of inferior vena cava with a polytetrafluoroethylene graft

Eight patients with chronic Budd-Chiari syndrome resulting from coarctation of the inferior vena cava underwent operation. Transatrial dilatation was of no avail in the first case. The obstructed segment was directly visualized in the subsequent seven cases by a transthoracic, transdiaphragmatic, retroperitoneal approach. In these latter seven cases, severe hourglass constriction of the inferior vena cava was observed just above the right hepatic vein. There was no evidence of inflammation, extrinsic compression, or thrombosis. Retrohepatic cavoatrial bypass with an antibiotic-sterilized aortic homograft was unsuccessful in three patients. Five patients including one with homograft failure underwent successful retrohepatic cavoatrial bypass with a polytetrafluoroethylene graft (20 mm plain in four cases and 16 mm ringed graft in one case). These patients have been followed up for 21 months to 6 years with no recurrence of symptoms. The term coarctation of the inferior vena cava appears more appropriate than membranous obstruction of the inferior vena cava because of the operative findings in the present series.     

Quality of dying in head and neck cancer patients: a retrospective analysis of potential indicators of care.

OBJECTIVE: The objective of this study was to evaluate the quality of the dying experience in a cohort of head and neck cancer patients by a retrospective analysis of potential indicators of care. STUDY DESIGN: The study design included retrospective case note analysis of previously evaluated factors considered important in the care of terminally ill patients and validated indicators of care obtainable from administrative data. The documented factors were analyzed to indicate specific elements of the quality of death and dying experience. RESULTS: Pain was a common symptom (84%) and was managed successfully in all patients, with 93% receiving opioids. Management of other symptoms, except neuropsychological problems, were satisfactory. Sixty-three percent of patients died in hospital and only 22% had a relative present at the time of death. Resuscitation status was documented in only 65% of the notes, though none were admitted to the intensive care unit or underwent resuscitation. Fifty-three percent of patients were admitted as an emergency in the last month of life and bleeding was the most common cause of admission. CONCLUSION: Valuable information can be obtained from a focused retrospective analysis. The indicators evaluated suggest that biomedical aspects of care are being recognized and addressed, although there is room for improvement. Psychosocial and spiritual aspects of care were not documented and must be taken into account to assess the "complete quality of dying" experience.     

Granulocytic sarcoma of the lips: report of an unusual case.

Granulocytic sarcoma (GS) is a rare localized, extramedullary tumor composed of immature cells of granulocyte series. It is capable of marked local tissue destruction. This condition can be a precursor of acute myeloid leukaemia by months or years making its diagnosis critical. Its occurrence has been described in multiple sites including skin, lymph nodes, bone, and visceral organs. It is extremely rare in the oral cavity and only 30 cases have been reported in the literature to date and often as a lump in the gingiva, palate, and extraction sockets. We describe the first reported case of GS presenting as a solitary lump in the lip and review the pertinent literature.     

Familial aggregation in tropical fibrocalculous pancreatic diabetes

There is very little information on the genetic factors associated with fibrocalculous pancreatic diabetes (FCPD). Ninety-eight first-degree relatives of FCPD patients were subjected to detailed studies, which included glucose tolerance tests, x-ray films of the abdomen, ultrasonography, and studies of exocrine pancreatic function. The study shows that there is a familial aggregation of FCPD with evidence of vertical transmission of the disease from parent to offspring in some families. Routine screening of families of FCPD probands helped to pick up cases in the stage of impaired glucose tolerance. There is heterogeneity in FCPD with respect to familial factors. Some families show marked familial aggregation of FCPD while in others the disease occurs either sporadically or in association with other family members who have abnormal glucose handling.     

Fibrocalculous pancreatic diabetes and obesity

Fibrocalculous pancreatic diabetes (FCPD) is a form of diabetes secondary to chronic pancreatitis that is found in tropical countries. Most patients with FCPD are lean and many are frankly undernourished. Four patients with FCPD who were obese are reported in this paper and this is the first report of obesity in FCPD patients.     

Budd chiari syndrome and coarctation of inferior vena cava

Budd Chiari Syndrome encompasses several aetiological factors. Coarctation of inferior vena cava is characterised by an hour glass constriction of the cava with or without occlusion of the terminal hepatic veins. The latter may be occluded with minimal or no changes in the interior vena cava. This entity has been reported worldwide, but commonly from Africa, China, India and Japan. Characteristic findings on ultrasonography, and functional hepatography are illustrated. Surgical procedures for caval decompression (including operative features in authors’ series of 24 patients), portal decompression, hepatic venous decompression, and relief of ascites are outlined. Arguments for or against congenital hypothesis, primary thrombotic theory, or primary inflammatory cause are listed. The possibility of filarial aetiology is discussed. Based on the Hunterian Lecture Delivered by Professor Solomon Victor at the Royal College of Surgeons of England, London, in 1991     

Venous isthmus plasty for coarctation of inferior venacava

A male aged 40, presented with hour glass type of obstruction of the supra hepatic segment of the inferior venacava (ivc). This segment was exposed by a posterolateral thoracotomy. A linear venotomy after proximal and distal clamping revealed a shelf like fibrous tissue obstructing the venacava. This shelf was excised. Venotomy was closed using a patch of Goretex graft. Immediate postoperative follow up is gratifying with patentivc. This is a new surgical approach for coarctation ofivc.