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The keystone-design perforator-based flap for leg defects: a synthesis of philosophies
No full textAim: The classical keystone-design flap, although elegantly employed for various trunk defects, has limited movement on the leg. This study aims to modify the keystone–design flaps for leg defects.Methods: A keystone-design flap, in which perforators are identified and dissected, is described specifically for elliptical defects overlying the tibia.Results: It retains the unique advantages of both the perforator island flap concept as well as the keystone-design philosophy.Conclusion: The technique as well as the possibilities of raising such flaps over various areas of the leg is outlined
Imaging and cytological analysis of 92 patients with Japanese encephalitis
No full textAim: Japanese encephalitis (JE) is caused by a mosquito-borne flavivirus and demonstrates high mortality and serious sequelae. Imaging and cytological examinations are important for the diagnosis of JE. We performed this study to analyze the imaging and cytological characteristics of JE.Methods: This study enrolled 92 JE patients with 108 cerebral spinal fluid (CSF) samples. Diagnosis was based on clinical features and positive immunoglobulin M antibodies against JE virus, which were measured using enzyme-linked immunosorbent assay. All patients received detailed neurological examinations, relevant cerebrospinal fluid tests, and brain neuroimaging (computed tomography, magnetic resonance imaging, or both).Results: Prominent involvement in the hippocampus was observed in 10 patients on neuroimaging, in addition to classic involvement in the thalamus and basal ganglia. Lumbar puncture pressure was normal in 61 CSF samples. White cell count increased in 81.19% of CSF samples, 67.65% and 83.33% of CSF samples demonstrated normal chloride and glucose concentrations, respectively, and 82.52% of CSF samples demonstrated > 0.4 g/L protein content. JE patients demonstrate mixed-cell reaction on cerebrospinal fluid cytology in the early phase, which subsequently mainly develop as mainly lymphocyte reaction or typical lymphocyte reaction.Conclusion: JE imaging is characterized by bilateral thalamic involvement, and the basal ganglia and hippocampus are also commonly affected. The mixed-cell reaction in JE lasts longer than in general viral encephalitis. This may facilitate the differential diagnosis of JE
Auricular seroma: a new concept in management
No full textAim: Auricular seroma is a cystic swelling with a collection of serous fluid between the perichondrium and cartilage. The successful treatment of auricular seromas remains a challenge because this disease has a high propensity for recurrence.Methods: A total of 20 patients with auricular seromas were treated by remodeling a corrugated rubber drain.Results: All patients tolerated the procedure well. No patient had any collection of fluid after the removal of the splint. No patient experienced pain, fever, or edema after treatment. The seroma disappeared without disfigurement. There were no recurrences on further follow-up.Conclusion: Aspiration and splint application by remodeling a corrugated rubber drain provides very simple, minimally invasive, and effective management of seromas. It is a cost-effective treatment that prevents patient distress from fluid recollection and social embarrassment
Prognostic significance of neutrophil-to-lymphocyte ratio in glioblastoma
No full textAim: The neutrophil-to-lymphocyte ratio (NLR) has prognostic value in patients with a variety of cancers. The purpose of this study was to investigate the prognostic value of NLR in patients with glioblastoma.Methods: A prospective study was conducted on patients receiving surgery for glioblastoma. Preoperative NLR was recorded and correlated with other prognostic factors and survival.Results: Fifty-one patients were included in the study. The mean NLR ratio was 6.7 ± 4.6. Using receiver operating characteristic curve analysis, an NLR cut-off value of 4.7 was determined to best predict survival. Patients with NLR ratios exceeding 4.7 differed significantly from those with NLR ratios ≤ 4.7 and were associated with reduced survival. Patients with gross total tumor excision had a median survival of 18 months, whereas the median survival time was 11 months in patients with subtotal tumor excision. No significant difference in survival was observed with respect to patient age, gender, Karnofsky performance status, or tumor location. Using multivariate analysis, NLR and extent of tumor resection were identified as factors with independent prognostic power.Conclusion: Neutrophil-to-lymphocyte ratio is an inexpensive, widely available biomarker of glioblastoma aggressiveness and should be used alongside current glioblastoma prognostic factors
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