Delayed orchidopexy: failure of screening or ascending testis.
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Adolescent↗
Biomedical subjects
K Agrawal
Publications and source records attributed to K Agrawal.
Rigid nasendoscope with video camera system for intubation in infants with Pierre-Robin sequence.
We describe an alternative intubation technique using a rigid nasendoscope and a video camera monitor system in two infants with Pierre-Robin sequence presenting for palatoplasty. After induction with an inhalational anaesthetic technique, the tracheas of the infants could not be intubated with direct laryngoscopy using a Wisconsin blade. In the absence of a flexible paediatric fibrescope, a rigid endoscope (2.7 mm, 70 degrees lateral illumination) was passed orally to provide a view of the glottis on the monitor screen. A tracheal tube, bent into a J-shape using a stylet, was inserted orally and manipulated into the trachea, under video guidance. This technique proved to be simple, permitting a favourable view of the glottis. It should be considered for passing a tracheal tube through the vocal cords in infants who present with a difficult airway.
Female↗
Moustache reconstruction using an extended midline forehead flap.
A new method for reconstruction of the upper lip and moustache is presented. An extended midline forehead flap is described, which is a modification of the classical midline forehead flap in which the flap is extended into the hair-bearing scalp. Simultaneously, a nasal alar defect was reconstructed using the non-hair-bearing forehead skin in a patient with cancrum oris. The flap is reliable, technically easy to raise, does not require any special expertise and causes minimal donor site deformity. However, it is a multistage procedure and hence causes prolonged morbidity.
Adult↗
A lung cyst following blunt chest trauma.
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Cysts↗
An inexpensive self fabricated pressure clip for the ear lobe.
Pressure therapy is an integral part of keloid treatment. There are certain areas of the body which are prone to keloid formation but are not amenable to pressure therapy. The ear lobe is one such area. A simple, self fabricated and inexpensive pressure clip has been used for applying postoperative pressure to the ear lobe. This is fabricated with cold-cure poly methyl methacrylate and orthodontic wire. This has been used in 41 ear lobe keloids in 26 patients along with postexcisional triamcinolone acetonide therapy, 5 ear lobe reconstructions and 2 cases of ear lobe clefts over a period of 8 years. Although these clips are not very aesthetic, still the acceptability is very high as the patients were well motivated. A total of 27 ear lobes in 18 patients of ear lobe keloids have undergone ear boring after 6-18 months of pressure therapy. The only complication noticed is in the form of pressure ulcer due to continuous pressure in two patients at the beginning of our experience with these clips. These healed well after temporarily stopping the use of the clip.
Ear, External↗
Wuchereria bancrofti microfilariae in the dentigerous cystic fluid: an unusual presentation.
An unexpected and unusual presence of Wuchereria bancrofti microfilariae in the cystic fluid of a maxillary dentigerous cyst in an 8-year-old boy is being reported for the first time. This was an incidental finding during routine fine-needle aspiration cytological examination.
Animals↗
Isolated Tessier no. 1 cleft of the nose.
We report 3 patients with isolated cleft or coloboma of the nose--an extremely rare occurrence. This entity belongs to no. 1 of Tessier's classification of craniofacial clefts. Excessive separation of the medial and lateral nasal processes of the frontonasal process may be the genesis of this condition. Management should address two points: the cleft and the associated malformations of the cartilaginous nasal framework.
Adult↗
Ex vivo expression of nitric oxide synthase isoforms (eNOS/iNOS) and calmodulin in human penile cavernosal cells.
PURPOSE: Nitric oxide (NO) synthesized by nitric oxide synthase (NOS) is recognized as the central mediator of penile erection. This process appears to be mediated mainly by neuronal NOS (nNOS), which is localized to the nonadrenergic, noncholinergic innervation of the penis. However, the role of non-neuronal penile constituents (specifically the cavernosal smooth muscle), as well as other NOS isoforms in NO production in the human penis is not well understood. The present study evaluates the expression of non-neuronal (inducible and endothelial) isoforms of NOS in human penile cavernosal smooth muscle cells in culture. MATERIALS AND METHODS: Primary culture was initiated with explants of human corpora cavernosa. For gene expression studies, total RNA was extracted from cavernosal cells and subjected to reverse transcriptase polymerase chain reaction (RT-PCR). For NADPH-diaphorase histochemistry, the cells were incubated with 1 mM beta-NADPH and 0.5 mM nitrobluetetrazolium at 37C for 3 hours. For indirect immunofluorescence and electron microscopy, cells were incubated overnight at 4C with specific primary (eNOS; calmodulin) and secondary antibodies. A conventional avidin biotin complex technique was used for electron microscopy. RESULTS: The mRNA expression studies revealed that these cells express both endothelial (eNOS) and inducible (iNOS) forms. Localization studies showed positive signals for NADPH-diaphorase, eNOS, and calmodulin. The electron microscopic evaluation confirmed the localization of eNOS to the cytoplasm and small vesicles in the cells. CONCLUSIONS: These findings support the hypothesis that human cavernosal smooth muscle cells express both endothelial and inducible forms of NOS, which may significantly contribute to NO production in the penile architecture during the erectile process.
Calmodulin↗
An innovative method of reconstruction of large skeletal chest wall defects.
The reconstruction of large skeletal defects of the chest wall is considered complex and difficult. A simple technique for this repair, using polymethylmethacrylate ribs that are prefabricated in a prosthodontic laboratory using heat cure polymer, is presented. These ribs are used as bone substitutes while reconstructing the chest wall defect. The prefabricated polymethylmethacrylate ribs have been used to reconstruct the large chest wall defects after resection of chest wall tumors in three patients. There was risk of severe paradoxical movement of the chest wall without the skeletal defect reconstruction. In all of the cases, there was no need for postoperative mechanical ventilation and there was no paradoxical movement. Cosmetically, it was highly satisfactory. In one patient, the stainless steel wire caused a sinus after 1 year of reconstruction, requiring removal of the wire and the rib, but it did not compromise the stability of the chest wall. We conclude that reconstruction of large chest wall defects with prefabricated polymethylmethacrylate ribs is simple, cost-effective, and easy to plan and execute.
Adult↗
The effect of insulin-like growth factor 1 on craniofacial bone healing.
Human insulin-like growth factor 1, a known regulator of bone formation, was investigated for its possible effect on membranous bone formation in a rat model. Full-thickness bone defects (10 x 10 x 1 mm) were created in the rat calvarium, and insulin-like growth factor 1 was administered by an osmotic minipump directly into the defect enclosed by the periosteum and dura mater. The dose of insulin-like growth factor 1 was 100 micrograms every 2 weeks. The defects were studied radiographically, macroscopically, and microscopically at 3, 6, 9, and 12 weeks. The group treated with insulin-like growth factor 1 showed qualitative and quantitative differences when compared with the control group. The amount of new bone formation in the group treated with insulin-like growth factor 1 was significantly larger than that of the control group. In the insulin-like growth factor 1 group, the location of new bone formation occurred in the center and at the margin of the bone defect. In the control group, bone was formed only around the margin of the bone defect. This study suggests that insulin-like growth factor 1 improved membranous bone healing in vivo and that insulin-like growth factor 1 makes mesenchymal precursor cells of bone differentiate directly into bone-forming cells.
Animals↗
Tetanus caused by human bite of the finger.
A case of generalized tetanus after human bite of the finger is reported. The patient recovered with institutional care. We propose that secondary invasion by Clostridium tetani is the cause for infection. It could be prevented by immediate tetanus prophylaxis, thorough debridement, and primary repair of the wound.
Adult↗
Self-fabricated two-point discriminator tester.
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Surgery, Plastic↗
Vitiligo: repigmentation with dermabrasion and thin split-thickness skin graft.
BACKGROUND: Vitiligo is a common benign condition of great concern. Though a large number of medical and surgical treatment methods are available, none of them is fully dependable in all the areas. OBJECTIVE: Split-thickness skin grafting (STSG) has been used for the treatment of vitiligo for over three decades, but it did not gain popularity. This presentation evaluates the degree of repigmentation achieved with this technique, its complications, and drawbacks. METHODS: A case series of 21 patients with 32 localized, stable, and refractory vitiligo patches treated institutionally by dermabrasion and thin STSG has been presented. The patients have been followed up for 1-6 years. Three patients lost to follow-up before 1 year have not been included. RESULTS: The graft take was 100% in 27 patches and 90-95% in the remaining five. One hundred percent repigmentation was achieved in 22 patches and 90-95% in 10. Time taken for satisfactory color match was 4-9 months (average, 6.3 months). The complications encountered were all minor and did not affect the results. CONCLUSION: This is a simple, outpatient procedure performed under local anesthesia resulting in an excellent color match on a long-term follow-up. This technique can be used over any part of the body, including the hair-bearing areas, without compromising the end results.
Adolescent↗
Vitiligo: surgical repigmentation of leukotrichia.
BACKGROUND: Patients with vitiligo frequently have premature gray hair. Until recently the literature was silent about its management. While surgically treating vitiligo, we incidentally observed repigmentation of gray hair. OBJECTIVE: Based on our observations we undertook this study to see the effect of surgical treatment of vitiligo on repigmentation of leukotrichia, as well as to evaluate the percentage of repigmentation, if any, in the different hair-bearing areas, and the time taken for it. METHODS: A case series of eight patients with nine patches of localized, stable, and refractory vitiligo with leukotrichia of 3-12 years duration is presented. The patients were followed up for 2-6 years. One patient was lost from follow-up after 2 months. The vitiligo was treated by dermabrasion and thin split-thickness skin grafting under local anesthesia, as outpatients. RESULTS: Repigmentation of the hair occurred in all the areas but it was seen earlier (3 months) and was more complete in the eyebrows (70-95%). In the scalp and the beard areas it started later (6-9 months) and was around 50-60% only. The degree of pigmentation increased until about 3 years after surgery. No complications in the form of graft loss or alopecia were observed. CONCLUSIONS: Partial to near-total repigmentation of leukotrichia can be achieved surgically. Contrary to the present theory, we hypothesize that melanocytes also migrate from the repigmented epidermis to the hair follicle, resulting in repigmentation of the hair.
Adolescent↗
Enhancement of erythropoietin production by selective adenosine A2 receptor agonists in response to hypoxia.
The purpose of this study was to characterize the effects of two new adenosine A2 agonists, 2-(p-(2-carboxyethyl)phenethyl amino)-5'-N-ethylcarboxamidoadenosine (CGS-21680) and N6-(2(3,5-dimethoxyphenyl)-2-(2-methylphenyl)ethyl)-adenosine (DPMA), on erythropoietin (EPO) production in vivo and in vitro. Intravenous injections of CGS-21680 (100 to 500 nmol/kg mouse/day) and DPMA (50 to 500 nmol/kg mouse/day) for 4 days produced significant increases in serum levels of EPO in exhypoxic polycythemic mice. CGS-21680 (10(-7) to 10(-6) mol/L) and DPMA (10(-8) to 10(-5) mol/L) also produced significant increases in medium levels of EPO in a cloned EPO-producing Hep3B hepatocellular carcinoma cell line after 18 hours of incubation in 1% O2. Both compounds also increased cellular cAMP levels significantly in a dose-dependent manner after 1 hour of incubation. A2 receptor binding assays with tritiated CGS-21680 revealed a single type of adenosine receptor binding site on Hep3B cell membranes with a dissociation constant of 132.9 nmol/L and a binding capacity of 270.6 fmol/mg protein. The Ki competition binding values versus tritiated CGS-21680 were 217 nmol/L for CGS-21680 and 86.8 nmol/L for DPMA. These results indicate that adenosine A2 receptor activation amplifies EPO production in response to hypoxia, both in vivo and in vitro.
Adenosine↗
Multiple trichoepitheliomas with rare features.
A case of multiple trichoepitheliomas associated with epidermal cysts is reported. The trichoepithelioma lesions were florid and extensive with large nodulo-cystic lesions on the face and a new variant simulating hidradenitis suppurativa near the gluteal cleft.
Epidermal Cyst↗
Oculocutaneous manifestations in xeroderma pigmentosa.
Xeroderma pigmentosum (XP) is a rare genetic disease characterised by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation. The oculocutaneous features of 10 patients with XP were studied retrospectively. General features included parental consanguinity (40%), familiarity (60%), onset of symptoms in first 2 years (50%), malignant skin neoplasms (60%), and carcinoma of the tongue (20%). Among the ocular features, 50% of patients presented with photophobia. Lid freckles or atrophic skin lesions were seen in all patients. Lower lid tumours were seen in 30%, chronic conjunctival congestion in 40%, corneal opacification in 40%, squamous cell carcinoma of limbus in 20%, bilateral pterygium in 40%, and visual impairment in 50%. The clinical features (ocular and cutaneous) of the cases are discussed.
Adolescent↗