Aim:The aim is to study the assessment of feasibility of medial sural artery perforator (MSAP) free flap for head and neck reconstruction at our center.Materials and Methods:Oral cancer patients with squamous cell carcinoma of the tongue, buccal mucosa, and floor of mouth cancer attending our center were reconstructed using MSAP flap after oncologic resection. Handheld 8 MHz Doppler was used to identify the perforator preoperatively.Results:We reconstructed 10 patients using MSAP flap. The flap was designed according to defect and donor site was primarily closed in all cases. Excellent results were seen in nine patients reconstructed with MSAP flap without any postoperative complication. Flap failure occurred in one patient due to venous thrombosis. The thickness of flap ranged from 4 to 8 mm. The vascular pedicle length ranged from 9 to 13 cm.Conclusion:The MSAP flap is appropriate for medium-sized oral defect reconstruction, with a long pedicle of matching caliber, adequate tissue volume, and minimal donor-site morbidity which makes it comparable to other microvascular free flaps such as radial artery free flap (RAFF) and anterolateral thigh flap.
Objective:The objective of this study was to retrospectively study Chiari I malformation patients (<18 years) treated surgically.Materials and Methods:Chiari I malformation patients (<18 years) treated surgically at our institute were retrospectively studied.Results:During the study period between January 1999 and June 2011, fifty patients, aged ≤18 years with Chiari malformation, were treated surgically and formed the basis for this series. There were 21 female children (42%) and 29 male children (58%), with a female-to-male ratio of 1:1. At the last follow-up, oropharyngeal symptoms were improved in 33% (n = 3/9). Headache/neck/back pain improved in 69.56% of children (n = 16/23). Upper-extremity pain/weakness/numbness improved in 73.91% of children (n = 17/23). Ataxia improved in 66.66% of children (n = 4/6). Lower-limb weakness/hyperreflexia improved in 83.33% of children (n = 5/6). At follow-up, magnetic resonance imaging for patients with syrinx was available for 75% of patients (n = 30/50) and not available for 25% of patients (n = 10/40). Syrinx was diminished in size or resolved in 66.33% of patients (n = 19/30) and the remaining was same for 36.66% of patients (n = 11/30).Conclusions:The main goal of surgery is to arrest the progression of neurological deficits. Foramen magnum decompression with a lax duroplasty is the surgical procedure of choice.
Introduction: Women diagnosed with HIV/AIDS may transmit the infection to their child during pregnancy, childbirth, or breastfeeding. However, the risk of mother-to-child transmission of HIV may be reduced by the use of antiretroviral therapy (ART). Objective: The main aim of the study is to appreciate the declining trend of HIV in babies with HIV positive mother by implementation of PPTCT services. Methodology: A retrospective study of detection of HIV positive mothers among all the antenatal patients attending OPD and including the patients coming in Emergency services and delivered at Mahila chikitsalaya, SMS Medical College, Jaipur from July 2008 to Dec 2017 was included in the study. They were screened for HIV status and further management of all HIV positive patients. Results: Total 220445 patients have attended OPD over 10 years from 2008 to 2017 among which total 150077 patients have tested for HIV (68.07%). Among these 240(0.15%) patients were found HIV reactive. From history, we could elicit sexual contact as a prime mode of infection in these women 198(82.50%), followed by blood transfusion in 31 (12.91%), and through needle injury/sharing in 11(4.58%). The CD4 count was more than 200 in 86% women. In total 240 patients 3 patients were aborted that were excluded. Out of 237 HIV-infected women, 35.02% (83) had a cesarean delivery and vaginal delivery was primary mode of delivery in 154(67.94%). HIV-infected women were more likely to have preterm, IUGR and anemia (16.45, 8.86%, 6.4%). There were no maternal mortality. Mean age of HIV positive women was 24.62±3.6 years. Mean parity was 1.72±0.48. In total 237 deliveries, 60(25.31%) babies were low birth weight. Mean birth weight was 2354.60±499g. Among total 154 vaginal deliveries, only 2 (1.29%) babies were found HIV ELISA positive at 18 months and in 83 LSCS, only 2 babies (2.40%) were found HIV positive. Among 237 deliveries, 229 babies (96.62%) were alive and rest 8 babies (3.37%) were still birth. In total 229 alive babies, 25 babies were admitted in NICU and early neonatal mortality occurs in 8 babies, and late neonatal mortality occurs in 6 babies. Among total alive 229 babies, 160(69.86%) babies were on breastfeed and 69(30.13%) babies were on top feed. Conclusion: Good antenatal care and multidisciplinary team approach can optimize pregnancy outcomes in HIV-infected women.
Masseter hypertrophy is a rare condition. It is mostly idiopathic with no known cause. It is recognized as an enlargement of one or both masseter muscles. Most patients complain of facial asymmetry; however, symptoms such as trismus, protrusion, and bruxism may also occur. This article reports a case of bilateral masseter hypertrophy with retrognathic mandible in which comprehensive treatment was rendered to the patient by using a combination approach.
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