Chemical Cauterization Research Articles

TREATMENT OF RADIATION-INDUCED PELVIC DAMAGE AFTER RADIATION THERAPY FOR PROSTATE CANCER

Background. Radiation-induced damage to the pelvic organs (post-radiation proctitis, cystitis, urethritis) is a frequent complication after radiotherapy for prostate cancer. The reported frequency of late radiation damage to the pelvic organs is up to 30 %.Material and methods. The paper presents treatment outcomes of 149 with radiation-induced pelvic injuries caused by brachitherapy (15 patients) and combination treatment including brachitherapy and external beam radiation therapy (28 patients) for stage T1–3N0M0 prostate cancer. Radiationinduced rectitis (proctitis) was revealed in 149 patients and complications of the urinary tract after radiation treatment were noted in 107 (72 %) patients. Potency failure was observed in 98 % of cases. All patients received conservative treatment and 8 (5 %) of these patients underwent surgery after inefficient conservative treatment. Results. Favorable effect of conservative therapy of radiation-induced rectitis was obtained in 141 (95 %) patients. Eight (5 %) patients underwent colostomy due to the formation of vesicle-rectal fistula. Chemical cauterization of the mucosa of the bladder and rectum in patients with erosive hemorrhagic and hemorrhagic rectitis and cystitis was effective and safe. The frequency of post-radiation complications was found to be less after brachitherapy than after combination treatment using brachitherapy and external beam radiation.

Outpatient Curettage and Electrocautery as an Alternative to Primary Surgical Closure for Pediatric Gastrocutaneous Fistulae

BACKGROUND The development of a gastrocutaneous fistula (GCF) after gastrostomy tube removal is a frequent complication that occurs 5%-45% of the time. Conservative therapy with chemical cauterization is frequently unsuccessful, and surgical GCF repair with open primary layered closure of the gastrotomy is often required. We describe an alternative approach of GCF closure that is an outpatient, less invasive procedure that allows patients to avoid the comorbidities of general endotracheal anesthesia and intraabdominal surgery. METHODS This is an Institutional Review Board approved retrospective review of all patients who underwent GCF closure from January 2010 to July 2016 at a tertiary care children's hospital. Demographics including age, weight, body mass index, comorbidities, and initial indication for gastrostomy tube were recorded. Operative details such as ASA score, operative duration, type of anesthesia, and airway were noted. Based on surgeon preference, two types of operative closure were used during that time frame: primary layered closure or curettage and cautery (C&C). The latter is a procedure in which the fistula tract is first scraped with a fine curette, and then the fistula opening and tract are cauterized circumferentially. Finally, the presence of a persistent fistula and the need for formal reoperation were determined. RESULTS Sixty-five unique patients requiring GCF closure were identified. Of those, 44 patients (67.6%) underwent primary closure and 21 patients (32.3%) underwent C&C. The success rate of primary closure was 97% with one patient experiencing wound breakdown with persistent fistula. The overall success rate of C&C was 66.7% (14/21). Among those 14 patients, 11 (52.4%) GCF patients were closed by 1 mo. An additional two patients' gastrocutaneous fistulae were closed by 4 mo (61.9%). One GCF was successfully closed with a second C&C procedure. Seven of the 21 patients (33.3%) required subsequent formal layered surgical closure. C&C had significantly shorter operative times (13.5 ± 14.7 min versus 93.4 ± 61.8, P <0.0001) and significantly shorter times in the postanesthesia care unit (101.8 ± 42.4 min versus 147 ± 86, P <0.0001). Patients were intubated with an endotracheal tube 88.6% of the time for primary closure and 23.8% of the time for C&C.Among patients admitted for an elective procedure, the average length of stay for primary closure was 1.9 d as compared to 0 d for the C&C group. Among patients who underwent C&C with a persistent fistula, there were no significant differences in time since initial creation of gastrostomy, age, body mass index, or ASA score. CONCLUSIONS Our study verifies that primary closure remains the gold standard for persistent GCF. However, C&C is a safe, outpatient procedure that effectively treats a GCF the majority of the time in children. We suggest that in select patients, it may be an appropriate initial and definitive procedure for GCF closure.

A Comparative Study of Various Office Procedures for the Management of Small to Medium Size Tympanic Membrane Perforations

A hospital based prospective study to compare and evaluate the efficacy and convenience of various office procedures like chemical cauterization, fat plug myringoplasty and butterfly cartilage tympanoplasty. This interventional, prospective, longitudinal study carried out on 300 patients in the ENT department of a tertiary care medical college hospital in central India between January 2009 and January 2015. The success rate was found to be 94.54, 91.12 and 97% in chemical cauterization, fat plug and butterfly cartilage tympanoplasty respectively (p value 0.246). In all the groups there were significant improvement in terms of hearing in decibels and AB gap postoperatively. No statistically significant association was found in between the failure rates in all the groups. From this study we conclude that all the procedures were simple, rapid, reliable, cost effective, takes less time and minimum hospital stay (day care) than conventional tympanoplasty. We strongly recommend these procedures in place of tympanoplasty in small to medium size central tympanic membrane perforations according to condition and convenience of the patients.

Outpatient curettage and electrocautery as an alternative to primary surgical closure for pediatric gastrocutaneous fistulae

BackgroundThe development of a gastrocutaneous fistula (GCF) after gastrostomy tube removal is a frequent complication that occurs 5%-45% of the time. Conservative therapy with chemical cauterization is frequently unsuccessful, and surgical GCF repair with open primary layered closure of the gastrotomy is often required. We describe an alternative approach of GCF closure that is an outpatient, less invasive procedure that allows patients to avoid the comorbidities of general endotracheal anesthesia and intraabdominal surgery. MethodsThis is an Institutional Review Board approved retrospective review of all patients who underwent GCF closure from January 2010 to July 2016 at a tertiary care children's hospital. Demographics including age, weight, body mass index, comorbidities, and initial indication for gastrostomy tube were recorded. Operative details such as ASA score, operative duration, type of anesthesia, and airway were noted. Based on surgeon preference, two types of operative closure were used during that time frame: primary layered closure or curettage and cautery (C&C). The latter is a procedure in which the fistula tract is first scraped with a fine curette, and then the fistula opening and tract are cauterized circumferentially. Finally, the presence of a persistent fistula and the need for formal reoperation were determined. ResultsSixty-five unique patients requiring GCF closure were identified. Of those, 44 patients (67.6%) underwent primary closure and 21 patients (32.3%) underwent C&C. The success rate of primary closure was 97% with one patient experiencing wound breakdown with persistent fistula. The overall success rate of C&C was 66.7% (14/21). Among those 14 patients, 11 (52.4%) GCF patients were closed by 1 mo. An additional two patients’ gastrocutaneous fistulae were closed by 4 mo (61.9%). One GCF was successfully closed with a second C&C procedure. Seven of the 21 patients (33.3%) required subsequent formal layered surgical closure. C&C had significantly shorter operative times (13.5 ± 14.7 min versus 93.4 ± 61.8, P <0.0001) and significantly shorter times in the postanesthesia care unit (101.8 ± 42.4 min versus 147 ± 86, P <0.0001). Patients were intubated with an endotracheal tube 88.6% of the time for primary closure and 23.8% of the time for C&C.Among patients admitted for an elective procedure, the average length of stay for primary closure was 1.9 d as compared to 0 d for the C&C group. Among patients who underwent C&C with a persistent fistula, there were no significant differences in time since initial creation of gastrostomy, age, body mass index, or ASA score. ConclusionsOur study verifies that primary closure remains the gold standard for persistent GCF. However, C&C is a safe, outpatient procedure that effectively treats a GCF the majority of the time in children. We suggest that in select patients, it may be an appropriate initial and definitive procedure for GCF closure.

Rebooting the Zahnreihen: Analysis of the Jaw‐wide Patterning cues in the Adult Gecko Dentition

Unlike mammals, it is common for reptiles to replace their teeth throughout life. Through exploring the mechanisms of tooth replacement, particularly in adult reptiles we will learn about the cells and molecules that are required for the regeneration of the dentition. Wholemount preparations, x-rays and μCT scans of most lizards show that each functional tooth appears to line up with a series of unerupted teeth that are in progressively less mature stages of development going posteriorly (Zahnreihen). The position of the Zahnreihen is at approximately 147° to the jaw margin. The next teeth that are fated to replace a functional tooth do not appear in the mouth until they have reached a threshold size and have moved into position. It has been hypothesized that the unerupted teeth secrete factors that regulate the pace of tooth formation and spacing. All unerupted teeth are connected to each other via a dental lamina that extends around the jaw, extending deep into the soft tissue lingual to the functional teeth. Using an unbiased, surgical approach we asked whether there were signals emanating from the unerupted teeth and dental lamina. We carried out 4 types of surgeries in defined regions: enucleation of unerupted teeth with minimal disruption of the dental lamina, enucleation plus scrambling of the dental lamina, enucleation plus chemical cauterization of remaining epithelium or a sham control. Animals were analyzed at 7d, 14d, or 1–8 months. The macroscopic and microscopic phenotypes confirmed that teeth were removed successfully and that recovery was taking place except when cauterization was carried out. There was an initial wave of apoptosis that tapered off by 5 days. Next a spike in proliferation occurred in both torn epithelium and surrounding mesenchyme that lasted for at least 1 week. In long term followup we found that simple tooth removal delays but does not impact overall patterning. In contrast, cauterization of the dental lamina causes a block in tooth formation that does not recover from the cut edges (up to 8 months follow-up). The mesenchyme on its own is completely unable to induce new teeth from other types of epithelia such as oral mucosa or glandular epithelium. The dental epithelium is therefore instructive and is the key tissue that must be present for new teeth to form. Molecular readouts that will be presented include the location of putative stem cells (BrdU label retention, SOX2 antibody staining), changes in gene expression (in situs and RNAseq) and evidence of polarity of the epithelium being re-established (in situs). This data will be used to map out the sequence of recovery in dental epithelium leading to reestablishment of the Zahnreihen. Support or Funding Information Studies were supported by an NSERC Discovery Grant (RGPIN-2016-05477) to JMR. TMG was supported by an NIH F32 Postdoctoral Fellowship (F32DE024948). KB is supported by Killam and Michael Smith Foundation for Health Research postdoctoral fellowships. Palatal view of an adult gecko with approximately 40 functional teeth in each quadrant. Each marginal tooth defines the start of a Zahnreihen (diagonal row of unerupted teeth). Not shown is the continuous dental lamina to which all teeth are attached. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The effects of sclerotherapy with 5% trichloroacetic acid on the cyst diameter and ovarian tissue in the rat ovarian cyst model

The aim of this study was to compare the effects of only aspiration with aspiration and 5% trichloroacetic acid (TCA) application on ovarian cyst size and ovarian reserve. The ovarian cysts of 14 rats that were divided into two groups randomly were investigated after total salpingectomy procedure. G1 was the group of saline application after cyst aspiration, while in G2, after aspiration 5% TCA at half amount of aspiration volume was injected into the cyst and re-aspirated after five minutes. The abdomens of the rats were closed and re-explored after 1 month. The cyst diameters of the rats in each group were measured. Ovaries were removed for histopathological examination. There was no significant difference in cyst diameter in G1 before and after aspiration. In G2, there was a significant decrease in cyst size after TCA application. Ovarian follicle counts were not significantly different between the two groups. In conclusion, application of 5% TCA to the ovarian cysts for five minutes significantly reduces the cyst size.Impact StatementWhat is already known on this subject: Minimally invasive therapies come into prominence to avoid surgical complications and diminished fertility in the treatment of ovarian cysts. USG-guided aspiration and sclerosis has been reported as cost-efficient and effective treatment methods for localised benign cysts in other organs such as the thyroid, parathyroid, liver, kidney and spleen. It has been shown that sclerotherapy applied to infertile women with ovarian cysts reduces pelvic pain without affecting the number of follicles, term pregnancy and abortion rates, extracted oocytes, embryo quality or hormonal levels when compared to non-ovarian cystic infertile women. TCA is a chemical agent that is topically applied, not systemically absorptive, which causes denaturation of proteins and structural cell death, resulting in coagulation necrosis after chemical cauterisation. For this reason, we used 5% TCA to treat simple ovarian cysts on a rat model.What the results of this study add: In this experimental study, we showed that the application of 5% TCA into the cyst for five minutes – then aspirated – significantly reduced the size of the ovarian cysts. Five percent TCA application did not affect the ovarian reserve.What the implications are of these findings for clinical practice and/or further research: Our study is original because of the fact that to the best of our knowledge, this is the first study about the use of 5% TCA in treatment of ovarian cysts in the literature.

The Cannabinoids Δ8THC, CBD, and HU-308 Act via Distinct Receptors to Reduce Corneal Pain and Inflammation.

Background and Purpose: Corneal injury can result in dysfunction of corneal nociceptive signaling and corneal sensitization. Activation of the endocannabinoid system has been reported to be analgesic and anti-inflammatory. The purpose of this research was to investigate the antinociceptive and anti-inflammatory effects of cannabinoids with reported actions at cannabinoid 1 (CB1R) and cannabinoid 2 (CB2R) receptors and/or noncannabinoid receptors in an experimental model of corneal hyperalgesia.Methods: Corneal hyperalgesia (increased pain response) was generated using chemical cauterization of the corneal epithelium in wild-type (WT) and CB2R knockout (CB2R−/−) mice. Cauterized eyes were treated topically with the phytocannabinoids Δ8-tetrahydrocannabinol (Δ8THC) or cannabidiol (CBD), or the CBD derivative HU-308, in the presence or absence of the CB1R antagonist AM251 (2.0 mg/kg i.p.), or the 5-HT1A receptor antagonist WAY100635 (1 mg/kg i.p.). Behavioral pain responses to a topical capsaicin challenge at 6 h postinjury were quantified from video recordings. Mice were euthanized at 6 and 12 h postcorneal injury for immunohistochemical analysis to quantify corneal neutrophil infiltration.Results: Corneal cauterization resulted in hyperalgesia to capsaicin at 6 h postinjury compared to sham control eyes. Neutrophil infiltration, indicative of inflammation, was apparent at 6 and 12 h postinjury in WT mice. Application of Δ8THC, CBD, and HU-308 reduced the pain score and neutrophil infiltration in WT mice. The antinociceptive and anti-inflammatory actions of Δ8THC, but not CBD, were blocked by the CB1R antagonist AM251, but were still apparent, for both cannabinoids, in CB2R−/− mice. However, the antinociceptive and anti-inflammatory actions of HU-308 were absent in the CB2R−/− mice. The antinociceptive and anti-inflammatory effects of CBD were blocked by the 5-HT1A antagonist WAY100635.Conclusion: Topical cannabinoids reduce corneal hyperalgesia and inflammation. The antinociceptive and anti-inflammatory effects of Δ8THC are mediated primarily via CB1R, whereas that of the cannabinoids CBD and HU-308, involve activation of 5-HT1A receptors and CB2Rs, respectively. Cannabinoids could be a novel clinical therapy for corneal pain and inflammation resulting from ocular surface injury.

Current Approaches to Epistaxis Treatment in Primary and Secondary Care.

The lifetime prevalence of epistaxis is approximately 60%, and 6-10% of the affected persons need medical care. In rare cases, severe bleeding calls for the rapid initiation of effective treatment. This review is based on pertinent articles that were retrieved by a selective search PubMed, and on the authors' clinical experience. There are no German guidelines for the management of epistaxis. The available evidence consists mainly of retro spective analyses and expert opinions. 65-75% of the patients who require treatment can be adequately cared for by their primary care physician or by an emergency physician with baseline measures. If there is persistent anterior epistaxis, an otorhinolaryngologist can control the bleeding sastisfactorily in 78-88% of cases with chemical or electrical cauterization. Nasal packing is used if this treatment fails, or for posterior epistaxis. In a retrospective study, surgical treatment was found to be more effective than nasal packing in the treatment of posterior epistaxis (97% versus 62% treatment success). Percutaneous embolization is an alternative treatment for patients whom general anesthesia would put at high risk. The treatment of severe or recurrent epistaxis requires the interdisciplinary collaboration of the primary care physician, the emergency physician, the practice-based otolaryngologist, and the hospital otolaryngology service. Uniform guidelines and epidemiological studies on this topic would be desirable.

Otoendoscopic management of small to medium sized tympanic membrane perforation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Chronic suppurative otitis media (CSOM) is a wide spread disease of developing countries like India especially in rural areas. A perforated tympanic membrane results in loss of hearing due to decreased drum area and liability to recurrent infection of the middle ear mucosa. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;A prospective study was conducted over a period of 18 months in the Department of ENT, HNS, Government Medical College, Srinagar with total of 36 patients were enrolled. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This study consists of male 12 and 24 females mean age 32 yrs hearing loss average 26 db. Management methods were grouped in group A, B, C and D fat myringoplasty, chemical cauterization (trichloroacetic acid), fat myringoplasty + chemical cauterization: and transcanal transtympanic myringoplasty using tragal perichondrium respectively with least success seen in group B 55% and 100% seen in group D. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Otoendoscopic management of small to medium sized TM perforations with different methods is a cost effective, less traumatic procedure, cosmetically better and functionally effective in terms of hearing improvement.&lt;/span&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Application of Platelet Rich Fibrin Matrix to Repair Traumatic Tympanic Membrane Perforations: A Pilot Study.

Trauma in the form of instrumentation, slap, blast, accident, and sporting injury can result in tympanic membrane (TM) perforations which spontaneously recover in 53-94%. The closure rates of TM perforation due to above causes do not vary greatly; however, some otolaryngologists prefer to perform immediate microsurgical procedures to accelerate the recovery process. Our aim is to study the efficacy of Trichloroacetic acid (TCA) Chemical Cauterization (50%) and Platelet rich fibrin (PRF) Plug Myringoplasty technique in healing traumatic tympanic membrane perforations. To evaluate the preoperative and postoperative hearing outcome from the procedure and compare them. Study design is prospective study. A pilot study was carried out amongst selected 25 patients with central perforations in the Department of ENT, for duration of 2years from July 13 to July 15. All 25 patients underwent PTA assessment & TCA (50%) and Autologous PRF Plug Myringoplasty technique done and follow up to 6months postoperatively. The success rate traumatic tympanic membrane closure was found to be 92%. Pre- and post-operative hearing assessments of each patient were done & showed statistically significant air-bone gap closure with success rate of 88% (p<0.05). From this study, the closure rate in traumatic tympanic membrane perforation by TCA (50%) and PRF Plug Myringoplasty technique was 92% with statistically significant hearing improvement (88%). This technique can be recommended as a time and cost effective office based procedure for treatment of traumatic tympanic membrane perforations.

Epistaxis management - our point of view and literature review

Abstract Nasal haemorrhage or epistaxis is the most common otolaryngologic emergency. It affects about 60% of the population and a percentage of 6% do not cease spontaneously, medical approach being needed. The management of epistaxis varies depending on its severity and etiology. The therapeutic conduct of this ENT emergency is based on three main principles: 1. local haemostasis; 2. detection and ceasing of the cause; 3. evaluation and correction of hypovolemia if necessary. Haemostasis can be done by chemical or electric cauterisation after identifying the bleeding source, by nasal packing, by endoscopic or external surgery or, in special cases, when none of the above methods returns any results, embolization. The current paper emphasizes our experience and a brief literature concerning epistaxis management in patients presented in the Emergency Room, in chronic cases of vascular intranasal tumors with recurrent bleeding, in iatrogenic haemorrhages, and none of the least we will bring into discussion the treatment applied for patients diagnosed with hereditary hemorrhagic telangiectasia.

Endoscopic management of anterior and posterior epistaxis

The current management for epistaxis encompasses a wide variety of options that include pressure and intranasal decongestants, nasal packing, chemical and electrical cauterization, endovascular embolization, and surgical ligation of offending vessels. For episodes of epistaxis refractory to the more conservative measures, the use of the rigid endoscope has significantly increased the efficacy of therapeutic techniques by improving visualization of and access to intranasal bleeding sites. This review highlights the endoscopic approach to manage cases of severe epistaxis through direct cauterization, ligation of the sphenopalatine artery, and ligation of the anterior ethmoid artery.

Surgical treatment for symptomatic non-ossifying fibromas of the lower extremity with calcium sulfate grafts in skeletally immature patients.

Non-ossifying fibromas (NOFs) are common benign bone lesions found in children and adolescents. They usually involve metaphysis of long bones, tend to gradually disappear with age and usually do not require surgery, while they are not associated with pathological fractures. The aim of this study was to evaluate the outcome and efficacy of a single-stage procedure, comprising curettage of the lesion and calcium sulfate pellet (CaSP) grafting, in skeletally immature patients with large, symptomatic NOF of the lower extremity, and the possible limitations of the procedure. Nine skeletally immature patients with symptomatic NOF of the lower extremity were treated between 2013 and 2016. Details of age, history of presentation, location and size (in mm) of the lesion, histology and follow-up details were recorded. Lesions were classified in Ritschl radio-morphological stages. CaSP integration was assessed by Irwing's classification. The average size of lesions was 54.6mm in length (range 31-95). All lesions were symptomatic. The average bone expansion in relation to the bone diameter was 67.4% in the transversal plane (range 31-100) and 77.8% in the sagittal plane (range 55-100). Mean patient age at time of treatment was 9.8years (range 7-14); mean follow-up was 2years (range 2-4). All the patients were symptomatic, and 8 out of 9 (89%) NOFs were Ritschl type B. All the patients were treated surgically with a single-step approach, as described. On average, 86mL of CaSPs was used per case (range 10-250). None of the patients required internal fixation. At last follow-up visit, CaSPs were fully incorporated in all the patients according to Irwing's classification (Stage 3). No serous drainage from wounds was recorded in any of the patients. No cases of pathological fracture, bone deformity, growth arrest or growth disturbance or infection were observed. At last follow-up visit, all the patients had resumed full sport and daily life activities. CaSPs offer a safe, cheap, convenient alternative to the autograft as an implant substitute that helps regeneration of bone in the defects produced by curettage of large, symptomatic NOFs. Chemical cauterization of bone walls does not interfere with CaSP integration into bone tissue.

Gingival Depigmentation Using Scalpel Technique: A Case Report

Excessive gingival pigmentation is a major esthetic concern for many people. Though, it is not a medical problem, many people complain of dark gums as unaesthetic. Gingival hyperpigmentation is believed to be a genetic trait in populations and is more appropriately termed physiologic or racial gingival pigmentation; a condition, which affects all races differently. Gingival pigmentation can be removed for esthetic reasons using methods like chemical cauterization, bur abrasion, scalpel surgery, cryosurgery, electrosurgery, gingival grafts and laser techniques. A case is reported here where surgical depigmentation was performed.

Large Keratocystic Odontogenic Tumor involving entire maxillary sinus: A common pathology in uncommon location

Keratocystic odontogenic tumor (KOT) is an odontogenic neoplasm of jaw which occurs more frequently in mandible. Its occurrence in maxilla is relatively infrequent. This article reports a case of large KOT of left maxilla involving the entire maxillary sinus extending up to the infra-orbital rim, in a middle aged person. The pathology was treated with surgical enucleation and chemical cauterization. Taking into the consideration the high recurrence rate of KOT, regular and periodic follow up is necessary in such cases. At 2 years follow up the present case showed normal healing with no recurrence. Keywords: Odontogenic keratocyst, Jaw, Tumor, Maxillary Sinus

The Effectiveness of Matrix Cauterization With Bichloracetic Acid in the Treatment of Ingrown Toenails.

Chemical matricectomy is performed mainly by 2 agents, phenol and sodium hydroxide. Chemical matricectomy with phenol has a low recurrence rate and good cosmetic results, but it produces extensive tissue destruction and can result in drainage and a delayed healing time. These adverse effects have brought forward the use of chemical agents such as sodium hydroxide and trichloroacetic acid for matricectomy. This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 90% bichloracetic acid (BCA) in the treatment of the ingrown nails. A total of 30 patients with 58 ingrown toenail edges were included in this study. All of the patients underwent chemical matricectomy with 90% BCA after partial nail avulsion. Adverse effects such as postoperative pain and drainage were minimal in most of the patients. One patient who underwent matricectomy had recurrence in a single nail edge (1.8%) at the 12th month of the follow-up. No recurrence was observed in 29 patients during mean follow-up period. This was considered to be statistically significant (p < .001). This is the first study to use BCA for the treatment of ingrown toenail. Partial nail avulsion followed by BCA matricectomy is a safe, simple, and effective method with low rates of postoperative morbidity and high rates of success. Therefore, partial nail avulsion and BCA matricectomy can be used as an alternative treatment method for the treatment of ingrown toenails.

Epistaxis in Children: Aetiology, Management and Outcome

Background: Although epistaxis is a common problem in preschool and school children, it is often considered as trivial and overlooked. As a result recurrent epistaxis sometimes may occur which, in some cases, may even be fatal.Objective: The present study was, undertaken to determine the etiological profile and outcome of treatment of epistaxis in children.Methods: This cross sectional study was conducted in Dhaka Shishu Hospital, Dhaka from January 2012 to December 2013. In cases of mild bleeding and stable patient, detailed history was noted along with management of the bleeding. In case of severe bleeding, history was taken after the bleeding was controlled. The diagnosis of epistaxis was based on clinical history, physical findings, laboratory investigations with examination of the nose and nasopharynx. All patients were treated conservatively initially and chemical cauterization of the specific area was considered only when conservative means failed to control the epistaxis.Results: Total 50 cases of epistoxis were enrolled. Nearly half (46%) of the patients were 3-4 years old and the rest 54% 5-6 years old with mean age being 4.6±0.9 years. Majority (68%) of the patients was male with male to female ratio being 2:1. Over twothirds (68%) of the patients were from lower middle class. All patients’ had anterior nasal bleeding. Seventy percent had acute epistaxis and the rest (30%) had recurrent epistaxis. Nearly half (46%) of the patients had inflammatory diseases, 28% had upper respiratory tract infections (URI), 16% had history of nasal trauma, 12% allergic rhinitis and very few patients (2%) had idiopathic causes. Eight percent patients developed shock and were resuscitated along with management of bleeding. Over one-quarter (28%) of the patients developed recurrent epistaxis and only 6% had facial oedema. All patients recovered uneventfully.Conclusion: The study concluded that the common causes of epistaxis in children in our country is inflammatory and infectious diseases of nose and upper respiratory tract and most of the epistaxis could be managed with conservative treatment alone.Bangladesh J Child Health 2015; VOL 39 (2) :73-76

Resolving Epibole With Polymeric Membrane Dressings in Home Care.

The management of chronic (nonhealing) wounds with epibole is challenging and costly, especially when the problem is not promptly identified or the patient is intolerant to conventional treatments. We describe the use of a polymeric membrane dressing (PMD) in 3 patients with chronic (nonhealing) wounds and epibole who were unable to be treated with traditional interventions such as silver nitrate or sharp debridement. Patient 1 was a 51 year-old male with a right foot stasis ulcer with 60% fibrin/slough to the wound bed, patient 2 was a 58-year-old female with a stage 4 pressure injury of the left hip with undermining, and patient 3 was a 62-year-old female with a dehisced abdominal surgical wound. The use of PMD, when applied using a specific technique, proved to be effective for resolving epibole in 3 patients with nonhealing wounds of differing etiologies. Based on these experiences, we postulate that topical therapy using a PMD may provide an effective alternative means for resolving epibole and promoting wound healing in patients unable to undergo surgical excision or chemical cauterization.

Enucleation with Peripheral Ostectomy and Chemical Cauterization for Unicystic Ameloblastoma and Odontogenic Keratocyst: Primary Modality of Choice or still a Secondary Alternative? A Report of 18 Cases

Enucleation with Peripheral Ostectomy and Chemical Cauterization for Unicystic Ameloblastoma and Odontogenic Keratocyst: Primary Modality of Choice or still a Secondary Alternative? A Report of 18 Cases

Evaluation of therapeutic efficacy of Surana Modaka in Arshas

Arshas (haemorrhoids) is the commonest condition among the anorectal diseases in our day-to-day practice in terms of incidence. It is a very disagreeable condition for the patient and often creates restlessness. This disease has no particular sectorial affinity and is equally distributed throughout the world. Modern Science has very little to offer in terms of medicinal treatments of haemorrhoids. Prevalent modern para-surgical measures have been enumerated. Surgical techniques of performing haemorrhoidectomy are many and their complications such as pain, anal incontinence, stricture etc. are well known. Management of Arshas only on Ayurvedic lines seems to be more appropriate. Sushruta, basically a surgeon described four principal therapeutic measures in the management of Arshas, viz. medicinal, chemical cauterization, thermal cauterization and surgical excision. It may be pointed out here that enumeration of these measures in a definite order is suggestive of similar methods to be preferred first. By keeping all these principles in mind, a herbal formulation by name Surana Modaka is prepared to see its efficacy in Arshas.