Role of intralesional bleomycin in recurrent or residual keloids and hypertrophic scars

Background: Keloids and hypertrophic scars are difficult to treat. There are many modalities available with variable success rate. Triamcinolone is still the most commonly used drug but recurrence and partial response to this conventional treatment is still a major concern. Many studies have proved the role and efficacy of intralesional bleomycin and this study was done to assess the role of intralesional bleomycin in recurrent and residual lesions.Methods: The patients with recurrent lesion or residual lesions after the injection of triamcinolone were enrolled in the study. Patients received local infiltration of bleomycin. The injections were scheduled at monthly intervals for three consecutive months. They were followed at 1st, 2nd, 3rd, and 12th months. Scar assessment was done by calculating its volume, Vancouver scar scale (VSS) and visual analogue score (pain and pruritis). Side effects were also recorded. Final assessment was done at 1year for any recurrence.Results: Twenty-five patients completed the study. The most common location of scars was presternal (52%) and trauma was the most common cause in scars (20%). We observed the decrease of volume of 75.85% which was highly significant on statistical analysis (p=0.001). Similarly, statistically significant difference was noticed in VSS, VAS for pain and pruritis. No systemic side effects were noticed. No recurrence was noted at the end of 12 months.Conclusion: Intralesional bleomycin is found to be useful in management of recurrent or residual lesions. It can be a potential option in the management of recurrent and residual hypertrophic scars and keloids.

Endometritis in Bovine: A Review

Endometritis is an inflammation of the endometrial lining of uterus without systemic signs, which is associated with chronic postpartum infection of the uterus with pathogenic bacteria. Prevalence rate of endometritis in India ranges from 3 to 25% in cows. The rate of endometritis in buffaloes which were covered under Amul and Dudhsagar dairy ranged from 10 to 48 per cent in Gujarat. The classification of endometritis is based on vaginal mucus viz., mild, mucopurulent, purulent and endometritis with mucopurulant or purulent fluid in uterus and severity of infection viz., acute, sub clinical and chronic endometritis. Clinical endometritis is manifested by presence of a purulent uterine discharge detectable in the vagina after 21 days or more post partum, or mucopurulent discharge detectable in the vagina after 26 days post partum. The metabolic disorders like milk fever and ketosis are related to an increase risk of developing endometritis. The endometritis is the complex of diseases that includes retained placenta, puerperal metritis, endometritis, pyometra and other non-specific infections of the uterus. The FSH concentrations from the pituitary are unaffected by uterine disease and so waves of ovarian follicles emerge in the first weeks after parturition. Classical diagnosis of endometritis on the basis of clinical manifestation and rectal examination is common. New diagnostic device Metricheck, Cytobrush and ultrasonography is adequate to diagnose endometritis. Endometritis is often self-limiting with recovery occurring after subsequent estrous cycles. The effective treatment is one which increases the uterine defense and excludes bacterial infections, but should not inhibit the normal uterine defense mechanism. PGF2α in combination with intrauterine antibacterial drugs, immunomudulators and herbals agents like Garlic extract, Neem oil are the treatment of choice for Endometritis in bovine with variable success rate.

Directional sensory thalamus deep brain stimulation in poststroke refractory pain

Thalamic deep brain stimulation (DBS) for chronic pain is performed in selected patients with a variable success rate. We report the use of recently developed directional DBS in a patient with hemibody central poststroke pain (CPSP) and its added value in the induction of pleasant, pain-distracting paresthesia’s throughout the contralateral body side. A 68-year-old man suffered from multiple strokes in the left hemisphere 11 years before presentation, resulting in medically refractory right-sided hemibody CPSP. He was implanted with a directional DBS electrode in the left ventrocaudal nucleus of the thalamus. A directional single-segment contact configuration produced a better improvement throughout the contralateral body side than ring-mode and other directional configurations. Treatment led to a reduction of almost 50% in pain. This case demonstrates the value of directional DBS in the treatment of chronic pain, as steering increases selectivity and reduces side effects in a small target area surrounded by structures with high functional diversity.

Primary and Secondary Consequences of Rotator Cuff Injury on Joint Stabilizing Tissues in the Shoulder

Rotator cuff tears (RCTs) are one of the primary causes of shoulder pain and dysfunction in the upper extremity accounting over 4.5 million physician visits per year with 250,000 rotator cuff repairs being performed annually in the U.S. While the tear is often considered an injury to a specific tendon/tendons and consequently treated as such, there are secondary effects of RCTs that may have significant consequences for shoulder function. Specifically, RCTs have been shown to affect the joint cartilage, bone, the ligaments, as well as the remaining intact tendons of the shoulder joint. Injuries associated with the upper extremities account for the largest percent of workplace injuries. Unfortunately, the variable success rate related to RCTs motivates the need for a better understanding of the biomechanical consequences associated with the shoulder injuries. Understanding the timing of the injury and the secondary anatomic consequences that are likely to have occurred are also of great importance in treatment planning because the approach to the treatment algorithm is influenced by the functional and anatomic state of the rotator cuff and the shoulder complex in general. In this review, we summarized the contribution of RCTs to joint stability in terms of both primary (injured tendon) and secondary (remaining tissues) consequences including anatomic changes in the tissues surrounding the affected tendon/tendons. The mechanical basis of normal shoulder joint function depends on the balance between active muscle forces and passive stabilization from the joint surfaces, capsular ligaments, and labrum. Evaluating the role of all tissues working together as a system for maintaining joint stability during function is important to understand the effects of RCT, specifically in the working population, and may provide insight into root causes of shoulder injury.

Comparative study between ondansetron vs Palonosetron for controlling postoperative nausea and vomiting

Postoperative nausea and vomiting (PONV) is a major complication in patients who undergo surgery under general anaesthesia. Various drug regimens and antiemetic interventions have been tried from time to time for prevention of PONV but with a variable success rate. The aim of the study is to compare between ondansetron vs Palonocstron for controlling postoperative nausea and vomiting. In this prospective study, 100 patients aged 18-60 years of ASA GRADE-I and II scheduled for undergoing surgery under general anaesthesia after taking informed written consent at a tertiary care hospital, were randomly divided into two groups of 50 each. Group-A was given palonosetron 75 μg and Group-B was given ondansetron 4 mg. At 72 hours, nausea and vomiting were statistically significant between ondansetron and palonosetron groups. Postoperative side-effects such as headache, dizziness and drowsiness were not statistically significant between ondansetron and palonosetron groups. In conclusion, the antiemetic efficacy of palonosetron is similar to that of Ondansetron for preventing PONV during the first 24 hours after patients who undergo surgery under general anaesthesia. But after 72 hours, nausea and vomiting were statistically higher in ondansetron group than palonosetron group. CBMJ 2017 July: Vol. 06 No. 02 P: 15-20

Theoretical Basis for Prediction of Drilling Fluid Removal in Annuli

Displacement processes are part of several drilling fluid operations. These operations include non-trivial items like changing from water based drilling fluid to oil based or opposite, casing cleaning operations, change to completion fluids or displacement operations during cementing. Among these operations, cementing is the most important and difficult because the scope is to create a permanent barrier and permanent zonal isolation in operations involving only limited volumes of fluids and slurries. Empirical guidelines have been implemented to improve displacement processes in wells. Analytical and numerical models are frequently used. The models seem to be efficient in predicting pressure losses. However, they seem to be incapable of accurately predict the displacement efficiency. Laboratory experimental results have been evaluated and have been scaled up to for field application with variable success rate. These difficulties are caused by the presence of too many length scales or other dimensional scales.

DIAGNOSIS AND TREATMENT OF POSTERIOR INTEROSSEOUS NERVE ENTRAPMENT: SYSTEMATIC REVIEW

ABSTRACT Compressive syndromes of the radial nerve have different presentations. There is no consensus on diagnostic and therapeutic methods. The aim of this review is to summarize such methods. Eletronic searches related terms, held in databases (1980-2016): Pubmed (via Medline), Lilacs (via Scielo) and Google Scholar. Through pre-defined protocol, we identified relevant studies. We excluded case reports. Aspects of diagnosis and treatment were synthesized for analysis and tables. Quantitative analyzes were followed by their dispersion variables. Fourteen studies were included. All studies were considered as level IV evidence. Most studies consider aspects of clinical history and provocative maneuvers. There is no consensus on the use of electromyography, and methods are heterogeneous. Studies have shown that surgical treatment (muscle release and neurolysis) has variable success rate, ranging from 20 to 96.5%. Some studies applied self reported scores, though the heterogeneity of the population does not allow inferential analyzes on the subject. few complications reported. Most studies consider the diagnosis of compressive radial nerve syndromes essentially clinical. The most common treatment was combined muscle release and neurolysis, with heterogeneous results. There is a need for comparative studies . Level of Evidence III, Systematic Review.

Exclusions for resolving urban badger damage problems: outcomes and consequences

Increasing urbanisation and growth of many wild animal populations can result in a greater frequency of human-wildlife conflicts. However, traditional lethal methods of wildlife control are becoming less favoured than non-lethal approaches, particularly when problems involve charismatic species in urban areas. Eurasian badgers (Meles meles) excavate subterranean burrow systems (setts), which can become large and complex. Larger setts within which breeding takes place and that are in constant use are known as main setts. Smaller, less frequently occupied setts may also exist within the social group’s range. When setts are excavated in urban environments they can undermine built structures and can limit or prevent safe use of the area by people. The most common approach to resolving these problems in the UK is to exclude badgers from the problem sett, but exclusions suffer a variable success rate. We studied 32 lawful cases of badger exclusions using one-way gates throughout England to evaluate conditions under which attempts to exclude badgers from their setts in urban environments were successful. We aimed to identify ways of modifying practices to improve the chances of success. Twenty of the 32 exclusion attempts were successful, but success was significantly less likely if a main sett was to be excluded in comparison with another type of sett and if vegetation was not completely removed from the sett surface prior to exclusion attempts. We recommend that during exclusions all vegetation is removed from the site, regardless of what type of sett is involved, and that successful exclusion of badgers from a main sett might require substantially more effort than other types of sett.

Endoscopic balloon dilatation of subglottic stenosis

Children with subglottic stenosis present a challenging problem to otolaryngologists. In many cases, a tracheostomy is necessary to safeguard the airway, but morbidity and mortality in the tracheostomized child may be significant. Therefore attempts to improve the airway by endoscopic means are often made; unfortunately, these have a variable success rate. Recent encouraging results in the use of balloon dilatation for subglottic stenosis led us to the successful use of this technique in a child whose stenosis had not responded to conventional endoscopic techniques. The reasons for the success are discussed.

Tarsal Tunnel Syndrome and Additional Nerve Lesions in the Same Limb

Compression neuropathy in the lower extremity is common. The occurrence of more than one lesion of the nerve in the same limb is less frequent. Thirteen patients with 15 cases of tarsal tunnel syndrome associated with one or more additional lesions of the sciatic nerve or its branches of the same lower extremity are presented. Electrodiagnostic studies confirmed tarsal tunnel syndrome with conduction abnormalities at a number of lo cations along the sciatic, common peroneal, posterior tibial, or plantar nerves by mechanical impingement, met abolic axonal abnormality, or both. Seven of the 13 patients were treated with tarsal tunnel release. Six cases treated operatively improved significantly. Surgery on a previously operated foot or the existence of diabetes mellitus carried a fair prognosis. The association of back pain with or without previous surgery did not appear to affect the outcome of the tarsal tunnel release. No improvement in symptoms was apparent in the six unoperated patients during the period of the study. Multiple lesions of the nerves of a single extremity may account for the variable success rate of tarsal tunnel release.