A prospective, randomised study was carried out to compare the effect of pre-operative shaving with chemical depilation on wound infection in 100 patients. It was shown that depilatory creams saved time for pre-operative preparation and had an advantage in areas where shaving was difficult. The use of depilatory creams was shown to be effective, atraumatic, non-toxic and could be self-administered. Depilatory creams could be used safely on granulating wounds and did not give rise to bacterial growth. Their use was associated with a significant reduction in skin-surface bacteria and was cheaper compared with shaving. The best practice is to refrain from hair removal unless it interferes with the surgical procedure or wound closure. If hair has to be removed, it should be done using a depilatory cream. The depilatory cream has an advantage in areas which are difficult to shave or if the patient is scheduled to undergo diagnostic procedures and operations in the same area in close succession. The fight against post-operative wound infections has long been undertaken by practitioners. The authors realise that surgical-site infections are frequently caused by the bacteria commonly found on the skin; hence, reducing the number of bacteria on the skin has been a common pre-operative practice.
Preparation; Shave; Cream
We report a rare case of prune belly syndrome associated with congenital pouch colon, which was managed successfully.
Congenital pouch colon; hydronephrosis; prune belly syndrome
Background & objectives:
Estimation of parathyroid hormone (PTH) levels is important in the management of metabolic bone disorders. Here we describe a simple, sensitive and specific second generation immunoradiometric assay (IRMA) to detect intact PTH levels using different solid phase matrices. Different methods for immobilization of antibodies have also been evaluated.
Experiments were carried out with physical adsorption of antibodies, covalent coupling using 2 per cent glutaraldehyde and N,N’ carbonyldiimidazole. In all cases, antibodies raised against C-terminal were used as solid phase agent. Detector antibodies were N terminal antibodies that were radio-iodinated with 125I followed by gel purification. Several of the antibodies coupled to various solid phase matrices were incubated with PTH standards and the detector antibody as well as the commercially available tracer from DiaSorin kit to identify a suitable match pair.
The best pair was polyclonal C-terminal PTH antibody along with the kit tracer from DiaSorin with regards to antibody coated to magnetic cellulose particles. Among the various antibodies and the solid phases evaluated, the best assay was obtained with the matched pair of antibodies (70×G67 and 70×G68) from Fitzgerald immobilized on polystyrene tubes. The polyclonal antibody against C-terminal PTH was chosen as the capture antibody and 125I labelled polyclonal antibody against N-terminal PTH as the tracer. The sample values obtained in the antibody coated tubes were comparable to those obtained using a commercial kit.
Interpretation & conclusions:
The results indicated the feasibility of adopting this system for further development into a PTH IRMA for regular production as there is no indigenous kit available for intact PTH.
125I-labelled; immobilized antibodies; IRMA; magnetic cellulose; PTH
To analyse the factors affecting clinical and functional outcome of Veau-Wardill-Kilner palatoplasty in various types of cleft palate.
Materials and Methods:
Demographic data were retrieved from case records and a detailed speech, language and hearing and an orthodontic analysis were carried out prospectively.
Mean age at operation was 2.7 years; whereas mean age at the time of evaluation was 6 years. Most of the patients (43.3%, 13/30) had a bilateral cleft lip and palate. The postoperative fistula had developed in 31% (4/13) of the patients with bilateral clefts and in 17% (1/6) and 9% (1/11) of the patients with left unilateral and isolated cleft palate respectively (P<0.05). Eight per cent (2/24) of the patients operated before 2 years of age developed a fistula as compared to 66.6% (4/6) of the patients who had undergone a repair after 2 years of age (P<0.01). Severe speech abnormality was seen in 33.4% of the patients having postoperative fistula as compared to 16.6% of non-fistula patients (P<0.05). Derangement of speech was found in 66.6% of the patients who had undergone surgery after the age of 2 years as compared to the patients (13%, 3/24) undergoing correction before 2 years of age (P<0.05). Hearing loss was seen most commonly in patients with bilateral cleft palate as compared to the other varieties (P>0.05). Tympanic membrane (TM) abnormalities were also more common in bilateral cleft patients (P<0.05). Mean maxillary arch length, arch circumference and maxillary inter-canine and inter-molar width were significantly reduced as compared to the control group (P<0.001).
Socially acceptable quality of speech can be achieved in more than 85% of the patients. The postoperative fistula is associated with poor speech; bilateral cleft and older age being the risk factors for fistula formation. Many patients require audiological surveillance even when asymptomatic. Maxillary growth is impaired in all the patients despite early surgery.
Cleft palate; cleft care; facial clefts; orthodontics; Veau-Wardill-Kilner
A neonate with unilateral complete duplex system with congenital giant megaureter of the upper moiety presenting as abdominal lump is reported. A left upper moiety nephroureterectomy was performed. Such an anomaly with this presentation has not been reported in neonates.
Duplex kidney; hydronephrosis; megaureter
A 4-year-old girl presented with non-bilious vomiting and loss of appetite and weight. At laparotomy, a non-communicating pyloroduodenal duplication cyst was present. Subtotal excision of the cyst and cauterization of the mucosal lining of the common wall was performed. The post-operative recovery was uneventful.
Gastric duplication; gastric outlet obstruction; pyloroduodenal duplication
Epidermoid cysts of the floor of the mouth represent <0.01% of all oral cysts. Only few cases have been reported so far. We report a case of a 24 years man with a large sublingual swelling for 17 years, unable to take solid meals. The swelling was approximately 13 × 13 cm, non-tender, non-transilluminant, with doughy consistency and with patent visible Wharton’s duct openings on both the sides. Initial decompression of the lesion was done to facilitate nasotracheal intubation followed by partial excision of the cyst with marsupialization. Histopathological examination revealed a thick wall cyst lined with pseudostratified squamous epithelium without any evidence of dermal appendages suggestive of epidermoid cyst. Postoperative care included extraction of the loose infected dentures and physiotherapy of the ankylosed temporomandibular joints. Clinical progress was uneventful and cosmetic appearance was acceptable on 6 month and 2 years follow up with normal mastication function.
Epidermoid cyst; Floor of the mouth; Excision with marsupialization
In the title compound, C38H36F2N4O4, the pyrazole rings form dihedral angles of 50.02 (4) and 18.05 (4)° with their attached fluorobenzene rings, and make dihedral angles of 76.08 (4) and 73.54 (5)° with the aromatic ring of the attached phenoxy group. In the crystal, the molecules are connected by weak C—H⋯π interactions.
In the title compound, C17H15FN2O2, the essentially planar pyrazole ring [maximum deviation = 0.026 (1) Å] makes dihedral angles of 72.06 (7) and 33.05 (7)°, with the phenyl and fluorobenzene rings, respectively. The dihedral angle between the two six-membered rings is 87.88 (7)°. In the crystal, intermolecular N—H⋯O and C—H⋯F hydrogen bonds link the molecules into layers lying parallel to the bc plane.
The asymmetric unit of the title compound, C11H12N2O, consists of two crystallographically independent molecules (A and B) with similar geometries. Both molecules exist in a keto form, the C=O bond length being 1.286 (2) Å in A and 1.283 (2) Å in B. The dihedral angles between the pyrazole ring and the attached phenyl ring are 43.28 (12) and 46.88 (11)°, respectively, for A and B. The ethyl unit in molecule B is disordered over two positions with a site-occupancy ratio of 0.508 (5):0.492 (5). In the crystal, each of the independent molecules forms a centrosymmetric dimer with an R
2(8) ring motif through a pair of N—H⋯O hydrogen bonds. These dimers are further connected into a three-dimensional network by intermolecular N—H⋯O and C—H⋯O hydrogen bonds. Intermolecular C—H⋯π interactions are also present.
Ever since the discovery of antibiotics, the quality of human life greatly improved in the 20th century. The discovery of penicillin transformed the medicine industry and initiated a search for a better antibiotic every time resulting in several synthetic and semi-synthetic antibiotics. Beginning with the 1937 sulfa drug tragedy, the drug regulations had a parallel growth along with the antibiotics and the antibiotic-based generic Pharma industries. This review article is focused on the scenario depicting current global Pharma industries based on generic antibiotics. Several regulatory aspects involved with these industries have been discussed along with the complexity of the market, issues that could affect their growth, their struggle for quality, and their compliance with the tightened regulations. With the skyrocketing commercialization of antibiotics through generics and the leveraging technologic renaissance, generic industries are involved in providing maximum safer benefits for the welfare of the people, highlighting its need today..
Antibiotic; generic drug; Hatch-Waxman Act; US regulation
In the title compound, C21H17ClFN3O2, the 1H-pyrazole ring makes dihedral angles of 36.73 (7), 18.73 (7) and 60.88 (8)°, respectively, with the mean planes of the chlorophenyl, 4-oxopiperidine and fluorophenyl rings. The molecular structure is stabilized by an intramolecular C—H⋯N hydrogen bond, which forms an S(6) ring motif. In the crystal, intermolecular C—H⋯O hydrogen bonds link molecules into chains along . In addition, intermolecular C—H⋯F hydrogen bonds with an R
1(7) ring motif connect neighbouring chains into layers parallel to the ac plane.
The title compound, C13H16N2O3S, consists of two crystallographically independent molecules with similar geometries and exists in a keto form, the C=O bond lengths being 1.267 (2) and 1.254 (2) Å. In both molecules, the pyrazole rings are approximately planar, with maximum deviations of 0.017 (2) and 0.010 (2) Å, and the dihedral angles between the pyrazole and phenyl rings are 83.63 (11) and 70.07 (12)°. In one molecule, an intramolecular C—H⋯O hydrogen bond with an S(6) ring motif is observed. In the crystal, intermolecular N—H⋯O and C—H⋯O hydrogen bonds link the molecules into two-dimensional networks parallel to the ab plane.
The title compound, C16H13FN2OS, has undergone enol-to-keto tautomerism during the crystallization process. The 1H-pyrazole-5-one ring [maximum deviation = 0.0198 (11) Å] is inclined at angles of 33.10 (5) and 79.57 (5)° with respect to the fluorophenyl [maximum deviation = 0.0090 (12) Å] and phenylthiol [maximum deviation = 0.0229 (3) Å] rings attached to it. In the crystal, neighbouring molecules are linked into inversion dimers, generating R
2(8) ring motifs. These dimers are further linked into two-dimensional arrays parallel to the bc plane via intermolecular N—H⋯O, C—H⋯F and C—H⋯O hydrogen bonds. The crystal is further stabilized by weak π–π [centroid–centroid distance = 3.6921 (7) Å] and C—H⋯π interactions.
In the title compound, C28H22ClFN6O2, the piperazine ring adopts a chair conformation and the least-squares plane through the four coplanar atoms forms dihedral angles of 69.37 (13) and 56.56 (12)°, respectively, with the pyrazole and cyanophenyl rings. The dihedral angles formed between the pyrazole and the attached fluoro- and chlorophenyl rings are 34.16 (10) and 73.27 (12)°, respectively. In the crystal, intermolecular N—H⋯O, C—H⋯N and C—H⋯O hydrogen bonds link the molecules into sheets parallel to the ac plane.
Report of 125 pediatric patients of empyema thoracis treated by open decortication, highlighting the presentation, delay in referral, operative findings, the response to surgical intervention and follow-up.
Materials and Methods:
All the children who underwent open decortication for stage III empyema thoracis during the study period were included. Preoperative workup included hemogram, serum protein, chest radiographs and contrast-enhanced computed tomographic (CECT) scan of the chest.
One hundred and twenty-five patients (81 males, 44 females) (age 3 months–12 years, mean 4.9 years) were operated during a 4.5-year period. Among them, two children underwent bilateral thoracotomies. Also, 81.6% patients were referred 3 weeks after the onset of disease (mean duration 9 weeks). Intercostal chest drainage (ICD) had been inserted in (119) 95% cases. Thickened pleura, multiloculated pus and lung involvement were invariably seen on CECT scan. Bronchopleural fistula was present in 10 patients and empyema necessitatis in 2. Decortication, removal of necrotic tissue and closure of air leaks was performed in all the patients. Necrotizing pneumonia was seen in (35) 27.5% cases. Mean duration of postoperative ICD was 7 days. Follow-up ranged from 3 months to 4 years (mean 12 months). There was no mortality. Six patients had proven tuberculosis.
The duration of the disease had a direct relationship with the thickness of the pleura and injury to the underlying lung. Delayed referral causes irreversible changes in the lung prolonging recovery. Only 18% presented within the early period of the disease. Meticulous open surgical debridement gives gratifying results. The status of the lung at the end of surgery is a major prognostic factor.
Contrast-enhanced computed tomographic chest scan; decortication; empyema thoracis; pediatric
Surgical management of tumors of the external ear remains controversial with regard to the extent of resection and the efficacy of piecemeal resection compared to standard en bloc resection. The objective was to study the results of lateral temporal bone resection with soft tissue resection used at our centre in managing a series of such cases.
Tertiary referral centre
A retrospective study was carried out on seven cases of temporal bone malignancies treated at our center, with lateral temporal bone resection by the otologic microsurgical technique and superficial parotidectomy, with adjuvant radiotherapy where indicated. The mode of presentation, clinical and pathological staging, extent of surgical resection, reconstructive methods used and adjuvant therapy given were evaluated. The disease free survival on follow-up was noted.
Disease free survival achieved was comparable with other published series, with acceptable morbidity patterns.
Lateral temporal bone resection using otologic microsurgical technique with soft tissue resection is an effective way of achieving control of temporal bone malignancies.
Lateral temporal bone resection; External auditory meatus carcinoma
The objective was to correlate the number, size and extent of the nodules as determined during the preoperative clinical examination of the thyroid gland, USG, intra-operative examination and histopathology. Also, FNAC (with or without USG guidance) and USG findings suggestive of malignancy were correlated with the final histopathology.
Tertiary referral centre
A retrospective chart review was done for 106 patients who underwent surgery for benign or malignant nodular thyroid disease in our center, between Jan 2004–Dec 2006.
USG has 7 times higher predictive value than clinical examination in detecting number of nodules and determining size of nodules. USG guided FNAC has a sensitivity of 85.71% and specificity of 90.0% in detecting malignancy in nodular thyroid disease. However for predicting malignancy in thryoid nodules, this study shows that USG has a sensitivity of 20.0% and specificity of 97.67%.
In patients with nodular thyroid disease, USG can accurately determine the number and the size of the nodules. It is extremely useful in guiding FNAC; However its role in predicting malignancy is doubtful. We therefore recommend that USG guided FNAC be carried out as a routine in the evaluation of thyroid nodules.
Nodular thyroid disease; Ultrasonography; Guided FNAC
To determine the role of thickness of the primary lesion in early Squamous Cell Carcinoma (SCC) of the oral tongue for decision-making regarding the management of possible occult cervical node metastases.
Tertiary referral centre
Patients who were treated by the authors for early (T1, T2) primary lesions in the oral tongue in two malignancy treatment centres of the Armed Forces Medical Services were included in this prospective study. Where the primary lesion was less than 04 mm in depth, the neck was not addressed electively. Those who developed nodal disease in the neck on follow up were subjected to comprehensive neck dissection. In those patients where the tumour thickness was more than 04 mm, the neck was addressed with at least a supra-omohyoid neck dissection. Postoperative radiotherapy was given as per standard indications. The patients were followed up as per standard protocol.
Disease free survival rate achieved was 86% and this compares well with survival rates achieved by other workers.
Treatment of neck nodes in early (T1,T2) SCC of the oral tongue can be expectant in cases where tumour thickness is less than 04 mm, but where it is more than 04 mm elective treatment of the neck is recommended.
Carcinoma Tongue; Elective Neck Dissection; Thickness of lesion
Chemotherapeutic agents are known to cause multiple toxicities such as myelotoxicity, nephrotoxicity and ototoxicity. A prospective study was carried out on 60 patients receiving Cisplatin based chemotherapy in a tertiary care centre. The effects of Cisplatin on auditory function were studied using metabolic, biochemical and audiological parameters. The auditory effects were correlated with the dose and duration of chemotherapy. The study concluded that a significant percentage (15%) of patients who were subjected to chemotherapy based on Cisplatin developed high frequency sensorineural hearing loss which was permanent and irreversible in nature.
Chemotherapy; Cisplatin; Ototoxicity