Hernia through the suprapubic catheterization (SPC) site is rare. Attention is required for such ... more Hernia through the suprapubic catheterization (SPC) site is rare. Attention is required for such hernias as they get obstructed due to the narrow neck. We report this rare presentation in an elderly gentleman with obstructed incisional hernia through the SPC site, which was reduced and subsequently had a successful mesh repair.
Pilonidal Sinus affects different regions of the body, gluteal cleft being the most common. This ... more Pilonidal Sinus affects different regions of the body, gluteal cleft being the most common. This condition affecting the penis is extremely rare with only a few case reports around the world. It is prone for complications like infection, actinomycosis, abscess formation, erectile dysfunction and phimosis amongst others. We present a case of Pilonidal sinus of the penis where a pre-operative diagnosis was made and appropriate treatment in the form of circumcision prevented complications.
Background: Early identification of stroke with good accuracy is important in the delivery of eme... more Background: Early identification of stroke with good accuracy is important in the delivery of emergent stroke care. Prehospital care providers rely mainly on patient’s physical findings, which may mislead the care provider, resulting in a misdiagnosis of stroke. Blood pressure assessments are not part of the commonly used prehospital stroke scales and are often overlooked by prehospital care providers. Objectives: To determine if there is an association between patients’ blood pressure routinely measured by EMS providers in the field and hospital diagnosis of stroke. Methods: Systolic and diastolic blood pressures were extracted from the electronic prehospital care reports of all patients brought to Long Island College Hospital (LICH) by LICH Emergency Medical Services (EMS) from January 1, 2010 through December 31, 2011. Accuracy of prehospital providers’ diagnosis of stroke was calculated by retrospectively comparing prehospital providers’ impressions with the gold-standard “Get W...
Brain rhythms are more than just passive phenomena in visual cortex. For the first time, we show ... more Brain rhythms are more than just passive phenomena in visual cortex. For the first time, we show that the physiology underlying brain rhythms actively suppresses and releases cortical areas on a second-to-second basis during visual processing. Furthermore, their influence is specific at the scale of individual gyri. We quantified the interaction between broadband spectral change and brain rhythms on a second-to-second basis in electrocorticographic (ECoG) measurement of brain surface potentials in five human subjects during a visual search task. Comparison of visual search epochs with a blank screen baseline revealed changes in the raw potential, the amplitude of rhythmic activity, and in the decoupled broadband spectral amplitude. We present new methods to characterize the intensity and preferred phase of coupling between broadband power and band-limited rhythms, and to estimate the magnitude of rhythm-to-broadband modulation on a trial-by-trial basis. These tools revealed numerous...
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2009
The majority of Brain Computer Interfaces have relied on signals related to primary motor cortex ... more The majority of Brain Computer Interfaces have relied on signals related to primary motor cortex and the operation of the contralateral limb. Recently, the physiology associated with same-sided (ipsilateral) motor movements has been found to have a unique cortical physiology. This study sets out to assess whether more complex motor movements can be discerned utilizing ipsilateral cortical signals. In this study, three invasively monitored human subjects were recorded while performing a center out joystick task with the hand ipsilateral to the hemispheric subdural grid array. It was found that directional tuning was present in ipsilateral cortex. This information was encoded in both distinct anatomic populations and spectral distributions. These findings support the notion that ipsilateral signals may provide added information for BCI operation in the future.
We read with great interest the article by Fothergill et al 1 that address the concern about preh... more We read with great interest the article by Fothergill et al 1 that address the concern about prehospital identification of stroke. American Heart Association/American Stroke Association guidelines on the early management of adults with ischemic stroke highlight the role of emergency medical services (EMS) and find EMS use to be strongly associated with decreased time to initial physician examination, initial computed tomography imaging, and neurological evaluation. 2 Therefore, the stroke chain of survival relies heavily on the accuracy with which EMS providers can identify strokes. The study by Fothergill et al is the first one to validate the use of Recognition of Stroke in the Emergency Room (ROSIER) scale for EMS providers. They compared ROSIER with Face Arm Speech Test (FAST), an another widely used prehospital stroke scale. Even though ROSIER has more test items and we would expect it to perform better than FAST, much to our surprise is that ROSIER had similar operating characteristics as FAST. In addition, Fothergill et al concluded that adding seizure assessment to FAST would improve the recognition of stroke by EMS providers. Our data suggest the same, and we therefore agree with this recommendation. 3 ROSIER is a 7-item scale and includes all the elements of FAST. Taking advantage of this, Fothergill et al 1 used an interesting methodology where they performed only the ROSIER scale on suspected patients with stroke and abstracted FAST scores embedded in the ROSIER assessment. It would seem from the reported sensitivity of 97% that few cases are missed. As the authors acknowledge, perhaps this is because ROSIER was only performed in cases of suspected stroke. Our concern here is how the patients were classified as suspected strokes in the first place? Were there any prehospital patients' characteristics such as specific medical history, presenting complaint, or EMS call type that prompted the EMS providers to use ROSIER to evaluate the patient? Furthermore, did the authors retrospectively search their stroke registry to find and enumerate cases transported by the ambulance service where ROSIER was not performed but the patient actually had a stroke? The authors make mention of an additional 32 cases of suspected stroke that did not get the (Stroke. 2014;45:e25.
Objective: Electrocortical stimulation (ECS) has been well established for delineating the eloque... more Objective: Electrocortical stimulation (ECS) has been well established for delineating the eloquent cortex. However, ECS is still coarse and inefficient in delineating regions of the functional cortex and can be hampered by after-discharges. Given these constraints, an adjunct approach to defining the motor cortex is the use of electrocor-ticographic signal changes associated with active regions of the cortex. The broad range of frequency oscillations are categorized into two main groups with respect to the sensorimotor cortex: low and high frequency bands. The low frequency bands tend to show a power reduction with cortical activation, whereas the high frequency bands show power increases. These power changes associated with the activated cortex could potentially provide a powerful tool in delineating areas of the motor cortex. We explore electrocorticographic signal alterations as they occur with activated regions of the motor cortex, as well as its potential in clinical brain map...
The conventional way of reconstructing an orbital exenteration defect associated with a maxillect... more The conventional way of reconstructing an orbital exenteration defect associated with a maxillectomy is to cover it with a soft tissue free flap and camouflage it with a spectacle-mounted orbital prosthesis. Also, there are some reports on the use of bone flaps. The objective of this study was to review the reconstructive options for a defect resulting after orbital exenteration and maxillectomy. This study concerns a retrospective case series of 20 patients. Electronic medical records, including clinical details, operative notes, and follow-up data, were analyzed. Defects were analyzed for their reconstructive components. The reconstructive methods used were studied by the types of flap used, bony versus soft tissue types of reconstruction, and the prosthetic method used to rehabilitate the eye. Outcomes were analyzed for flap success rate. Descriptive methods for data analysis were used. Fourteen patients underwent a soft tissue reconstruction alone and 6 underwent bony reconstruction. The free rectus abdominis was the commonest soft tissue flap used. This article presents the outcome of reconstruction in such patients and the utility of individual flaps for their ability to replace different components of the defect. Ideal reconstruction should address all individual defect components of facial contour, orbital, palatal, skull base, and skin defects. The free rectus abdominis flap remains the common choice. When a composite socket reconstruction is to be achieved, the innovative free tensor fascia lata flap with the iliac crest bone and internal oblique muscle is an option.
Objective-Brain computer interface (BCI) systems have emerged as a method to restore function and... more Objective-Brain computer interface (BCI) systems have emerged as a method to restore function and enhance communication in motor impaired patients. To date, this has been primarily applied to patients who have a compromised motor outflow due to spinal cord dysfunction, but an intact and functioning cerebral cortex. The cortical physiology associated with movement of the contralateral limb has typically been the signal substrate that has been used as a control signal. While this is an ideal control platform in patients with an intact motor cortex, these signals are lost after a hemispheric stroke. Thus, a different control signal is needed that could provide control capability for a patient with a hemiparetic limb. Previous studies have shown that there is a distinct cortical physiology associated with ipsilateral, or same sided, limb movements. Thus far, it was unknown whether stroke survivors could intentionally and effectively modulate this ipsilateral motor activity from their unaffected hemisphere. Therefore, this study seeks to evaluate whether stroke survivors could effectively utilize ipsilateral motor activity from their unaffected hemisphere to achieve this BCI control. Approach-To investigate this possibility, electroencephalographic (EEG) signals were recorded from four chronic hemispheric stroke patients as they performed (or attempted to perform) real and imagined hand tasks using either their affected or unaffected hand. Following performance of the screening task, the ability of patients to utilize a BCI system was investigated during on-line control of a 1-dimensional control task. Main Results-Significant ipsilateral motor signals (associated with movement intentions of the affected hand) in the unaffected hemisphere, which were found to be distinct from rest and contralateral signals, were identified and subsequently used for a simple online BCI control task. We demonstrate here for the first time that EEG signals from the unaffected hemisphere, associated with overt and imagined movements of the affected hand, can enable stroke survivors
Electrocorticography (ECoG)-based brain-computer interface (BCI) systems have emerged as a new si... more Electrocorticography (ECoG)-based brain-computer interface (BCI) systems have emerged as a new signal platform for neuroprosthetic application. ECoG-based platforms have shown significant promise for clinical application due to the high level of information that can be derived from the ECoG signal, the signal's stability, and its intermediate nature of surgical invasiveness. However, before long-term BCI applications can be realized it will be important to also understand how the cortical physiology alters with age. Such understanding may provide an appreciation for how this may affect the control signals utilized by a chronic implant. In this study, we report on a large population of adult and pediatric invasively monitored subjects to determine the impact that age will have on surface cortical physiology. We evaluated six frequency bands--delta (<4 Hz), theta (4-8 Hz), alpha (8-13 Hz), beta (13-30 Hz), low gamma band (30-50 Hz), and high gamma band (76-100 Hz)--to evaluate the effect of age on the magnitude of power change, cortical area of activation, and cortical networks. When significant trends are evaluated as a whole, it appears that the aging process appears to more substantively alter thalamocortical interactions leading to an increase in cortical inefficiency. Despite this, we find that higher gamma rhythms appear to be more anatomically constrained with age, while lower frequency rhythms appear to broaden in cortical involvement as time progresses. From an independent signal standpoint, this would favor high gamma rhythms' utilization as a separable signal that could be maintained chronically.
palate was carried out. This resulted in a Class IIa defect according to classification of maxill... more palate was carried out. This resulted in a Class IIa defect according to classification of maxillectomy defects by Brown et al. [3] [Figure 1]. The defect size was 3 cm × 4 cm. The objective of reconstruction was to get an oro-antral separation and to provide a base for the dental prosthesis. The defect was reconstructed with a free radial forearm adiposo-fascial flap harvested from the left forearm. Adiposo-fascial flap harvesting involves few technical modifications from the conventional radial forearm fasciocutaneous free flap harvesting. The flap was marked on the forearm skin. The margin of the flap was marked with a hypodermic needle dipped in methylene blue, the tip of the needle needed to reach the subcutaneous layer [Figure 2]. A lazy "S" incision was placed extending from a point 2 cm proximal to the wrist crease to a point 2 cm distal to the ante-cubital fossa. The skin flap was elevated in the subcutaneous plane to leave the layer of adipose tissue on the fascia [Figure 3]. The fascia with fat, incised along the dye markings, was harvested based on
The development of oral cancer proceeds through discrete molecular changes that are acquired from... more The development of oral cancer proceeds through discrete molecular changes that are acquired from loss of genomic integrity after continued exposure to environmental risk factors. It is preceded in the majority of cases by clinically evident oral potentially malignant disorders, the most common of which is leukoplakia. Early detection of these oral lesions by screening methods using suitable markers is critical as it mirrors molecular alterations, long before cancer phenotypes are manifested. Assessment of salivary interleukin-6 (IL-6) as a marker of malignant progression was undertaken in patients with leukoplakia having coexisting periodontitis (n = 20), periodontitis patients without leukoplakia (n = 20), and healthy controls (n = 20) by competitive enzyme-linked immunosorbent assay. Results showed elevation of IL-6 levels in leukoplakia with coexisting periodontitis and in periodontitis patients when compared to healthy control (P < 0.001). Within the leukoplakia group, IL-6 level was found to be increased with increase in the severity of dysplasia. The use of tobacco was seen to play a significant role in the elevation of salivary IL-6.The importance of IL-6 as a specific marker for leukoplakia with dysplasia and the role of tobacco as an independent risk factor has been highlighted.
The free fibula is a versatile and commonly used free flap in microvascular reconstruction. It al... more The free fibula is a versatile and commonly used free flap in microvascular reconstruction. It allows for reconstruction of both bone and soft tissue defects. In head and neck reconstruction, the skin paddle harvested along with the flap allows for the reconstruction of skin or oral mucosal defects. After skin paddle harvest, the donor site can be closed primarily or with skin grafts. Grafting the donor area is the common method used. However, this could lead to delayed healing because of the poor graft over the area of peroneal tendons. Propeller flaps have been extensively reported for closure of leg skin defects. We report a series of 10 patients in whom we used a local propeller flap for the closure of the fibula flap skin donor site. The donor defects could be satisfactorily closed without the need of a skin graft in 9 patients. This method is simple, reliable, and suitable for closing small to medium defects.
Hernia through the suprapubic catheterization (SPC) site is rare. Attention is required for such ... more Hernia through the suprapubic catheterization (SPC) site is rare. Attention is required for such hernias as they get obstructed due to the narrow neck. We report this rare presentation in an elderly gentleman with obstructed incisional hernia through the SPC site, which was reduced and subsequently had a successful mesh repair.
Pilonidal Sinus affects different regions of the body, gluteal cleft being the most common. This ... more Pilonidal Sinus affects different regions of the body, gluteal cleft being the most common. This condition affecting the penis is extremely rare with only a few case reports around the world. It is prone for complications like infection, actinomycosis, abscess formation, erectile dysfunction and phimosis amongst others. We present a case of Pilonidal sinus of the penis where a pre-operative diagnosis was made and appropriate treatment in the form of circumcision prevented complications.
Background: Early identification of stroke with good accuracy is important in the delivery of eme... more Background: Early identification of stroke with good accuracy is important in the delivery of emergent stroke care. Prehospital care providers rely mainly on patient’s physical findings, which may mislead the care provider, resulting in a misdiagnosis of stroke. Blood pressure assessments are not part of the commonly used prehospital stroke scales and are often overlooked by prehospital care providers. Objectives: To determine if there is an association between patients’ blood pressure routinely measured by EMS providers in the field and hospital diagnosis of stroke. Methods: Systolic and diastolic blood pressures were extracted from the electronic prehospital care reports of all patients brought to Long Island College Hospital (LICH) by LICH Emergency Medical Services (EMS) from January 1, 2010 through December 31, 2011. Accuracy of prehospital providers’ diagnosis of stroke was calculated by retrospectively comparing prehospital providers’ impressions with the gold-standard “Get W...
Brain rhythms are more than just passive phenomena in visual cortex. For the first time, we show ... more Brain rhythms are more than just passive phenomena in visual cortex. For the first time, we show that the physiology underlying brain rhythms actively suppresses and releases cortical areas on a second-to-second basis during visual processing. Furthermore, their influence is specific at the scale of individual gyri. We quantified the interaction between broadband spectral change and brain rhythms on a second-to-second basis in electrocorticographic (ECoG) measurement of brain surface potentials in five human subjects during a visual search task. Comparison of visual search epochs with a blank screen baseline revealed changes in the raw potential, the amplitude of rhythmic activity, and in the decoupled broadband spectral amplitude. We present new methods to characterize the intensity and preferred phase of coupling between broadband power and band-limited rhythms, and to estimate the magnitude of rhythm-to-broadband modulation on a trial-by-trial basis. These tools revealed numerous...
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2009
The majority of Brain Computer Interfaces have relied on signals related to primary motor cortex ... more The majority of Brain Computer Interfaces have relied on signals related to primary motor cortex and the operation of the contralateral limb. Recently, the physiology associated with same-sided (ipsilateral) motor movements has been found to have a unique cortical physiology. This study sets out to assess whether more complex motor movements can be discerned utilizing ipsilateral cortical signals. In this study, three invasively monitored human subjects were recorded while performing a center out joystick task with the hand ipsilateral to the hemispheric subdural grid array. It was found that directional tuning was present in ipsilateral cortex. This information was encoded in both distinct anatomic populations and spectral distributions. These findings support the notion that ipsilateral signals may provide added information for BCI operation in the future.
We read with great interest the article by Fothergill et al 1 that address the concern about preh... more We read with great interest the article by Fothergill et al 1 that address the concern about prehospital identification of stroke. American Heart Association/American Stroke Association guidelines on the early management of adults with ischemic stroke highlight the role of emergency medical services (EMS) and find EMS use to be strongly associated with decreased time to initial physician examination, initial computed tomography imaging, and neurological evaluation. 2 Therefore, the stroke chain of survival relies heavily on the accuracy with which EMS providers can identify strokes. The study by Fothergill et al is the first one to validate the use of Recognition of Stroke in the Emergency Room (ROSIER) scale for EMS providers. They compared ROSIER with Face Arm Speech Test (FAST), an another widely used prehospital stroke scale. Even though ROSIER has more test items and we would expect it to perform better than FAST, much to our surprise is that ROSIER had similar operating characteristics as FAST. In addition, Fothergill et al concluded that adding seizure assessment to FAST would improve the recognition of stroke by EMS providers. Our data suggest the same, and we therefore agree with this recommendation. 3 ROSIER is a 7-item scale and includes all the elements of FAST. Taking advantage of this, Fothergill et al 1 used an interesting methodology where they performed only the ROSIER scale on suspected patients with stroke and abstracted FAST scores embedded in the ROSIER assessment. It would seem from the reported sensitivity of 97% that few cases are missed. As the authors acknowledge, perhaps this is because ROSIER was only performed in cases of suspected stroke. Our concern here is how the patients were classified as suspected strokes in the first place? Were there any prehospital patients' characteristics such as specific medical history, presenting complaint, or EMS call type that prompted the EMS providers to use ROSIER to evaluate the patient? Furthermore, did the authors retrospectively search their stroke registry to find and enumerate cases transported by the ambulance service where ROSIER was not performed but the patient actually had a stroke? The authors make mention of an additional 32 cases of suspected stroke that did not get the (Stroke. 2014;45:e25.
Objective: Electrocortical stimulation (ECS) has been well established for delineating the eloque... more Objective: Electrocortical stimulation (ECS) has been well established for delineating the eloquent cortex. However, ECS is still coarse and inefficient in delineating regions of the functional cortex and can be hampered by after-discharges. Given these constraints, an adjunct approach to defining the motor cortex is the use of electrocor-ticographic signal changes associated with active regions of the cortex. The broad range of frequency oscillations are categorized into two main groups with respect to the sensorimotor cortex: low and high frequency bands. The low frequency bands tend to show a power reduction with cortical activation, whereas the high frequency bands show power increases. These power changes associated with the activated cortex could potentially provide a powerful tool in delineating areas of the motor cortex. We explore electrocorticographic signal alterations as they occur with activated regions of the motor cortex, as well as its potential in clinical brain map...
The conventional way of reconstructing an orbital exenteration defect associated with a maxillect... more The conventional way of reconstructing an orbital exenteration defect associated with a maxillectomy is to cover it with a soft tissue free flap and camouflage it with a spectacle-mounted orbital prosthesis. Also, there are some reports on the use of bone flaps. The objective of this study was to review the reconstructive options for a defect resulting after orbital exenteration and maxillectomy. This study concerns a retrospective case series of 20 patients. Electronic medical records, including clinical details, operative notes, and follow-up data, were analyzed. Defects were analyzed for their reconstructive components. The reconstructive methods used were studied by the types of flap used, bony versus soft tissue types of reconstruction, and the prosthetic method used to rehabilitate the eye. Outcomes were analyzed for flap success rate. Descriptive methods for data analysis were used. Fourteen patients underwent a soft tissue reconstruction alone and 6 underwent bony reconstruction. The free rectus abdominis was the commonest soft tissue flap used. This article presents the outcome of reconstruction in such patients and the utility of individual flaps for their ability to replace different components of the defect. Ideal reconstruction should address all individual defect components of facial contour, orbital, palatal, skull base, and skin defects. The free rectus abdominis flap remains the common choice. When a composite socket reconstruction is to be achieved, the innovative free tensor fascia lata flap with the iliac crest bone and internal oblique muscle is an option.
Objective-Brain computer interface (BCI) systems have emerged as a method to restore function and... more Objective-Brain computer interface (BCI) systems have emerged as a method to restore function and enhance communication in motor impaired patients. To date, this has been primarily applied to patients who have a compromised motor outflow due to spinal cord dysfunction, but an intact and functioning cerebral cortex. The cortical physiology associated with movement of the contralateral limb has typically been the signal substrate that has been used as a control signal. While this is an ideal control platform in patients with an intact motor cortex, these signals are lost after a hemispheric stroke. Thus, a different control signal is needed that could provide control capability for a patient with a hemiparetic limb. Previous studies have shown that there is a distinct cortical physiology associated with ipsilateral, or same sided, limb movements. Thus far, it was unknown whether stroke survivors could intentionally and effectively modulate this ipsilateral motor activity from their unaffected hemisphere. Therefore, this study seeks to evaluate whether stroke survivors could effectively utilize ipsilateral motor activity from their unaffected hemisphere to achieve this BCI control. Approach-To investigate this possibility, electroencephalographic (EEG) signals were recorded from four chronic hemispheric stroke patients as they performed (or attempted to perform) real and imagined hand tasks using either their affected or unaffected hand. Following performance of the screening task, the ability of patients to utilize a BCI system was investigated during on-line control of a 1-dimensional control task. Main Results-Significant ipsilateral motor signals (associated with movement intentions of the affected hand) in the unaffected hemisphere, which were found to be distinct from rest and contralateral signals, were identified and subsequently used for a simple online BCI control task. We demonstrate here for the first time that EEG signals from the unaffected hemisphere, associated with overt and imagined movements of the affected hand, can enable stroke survivors
Electrocorticography (ECoG)-based brain-computer interface (BCI) systems have emerged as a new si... more Electrocorticography (ECoG)-based brain-computer interface (BCI) systems have emerged as a new signal platform for neuroprosthetic application. ECoG-based platforms have shown significant promise for clinical application due to the high level of information that can be derived from the ECoG signal, the signal's stability, and its intermediate nature of surgical invasiveness. However, before long-term BCI applications can be realized it will be important to also understand how the cortical physiology alters with age. Such understanding may provide an appreciation for how this may affect the control signals utilized by a chronic implant. In this study, we report on a large population of adult and pediatric invasively monitored subjects to determine the impact that age will have on surface cortical physiology. We evaluated six frequency bands--delta (<4 Hz), theta (4-8 Hz), alpha (8-13 Hz), beta (13-30 Hz), low gamma band (30-50 Hz), and high gamma band (76-100 Hz)--to evaluate the effect of age on the magnitude of power change, cortical area of activation, and cortical networks. When significant trends are evaluated as a whole, it appears that the aging process appears to more substantively alter thalamocortical interactions leading to an increase in cortical inefficiency. Despite this, we find that higher gamma rhythms appear to be more anatomically constrained with age, while lower frequency rhythms appear to broaden in cortical involvement as time progresses. From an independent signal standpoint, this would favor high gamma rhythms' utilization as a separable signal that could be maintained chronically.
palate was carried out. This resulted in a Class IIa defect according to classification of maxill... more palate was carried out. This resulted in a Class IIa defect according to classification of maxillectomy defects by Brown et al. [3] [Figure 1]. The defect size was 3 cm × 4 cm. The objective of reconstruction was to get an oro-antral separation and to provide a base for the dental prosthesis. The defect was reconstructed with a free radial forearm adiposo-fascial flap harvested from the left forearm. Adiposo-fascial flap harvesting involves few technical modifications from the conventional radial forearm fasciocutaneous free flap harvesting. The flap was marked on the forearm skin. The margin of the flap was marked with a hypodermic needle dipped in methylene blue, the tip of the needle needed to reach the subcutaneous layer [Figure 2]. A lazy "S" incision was placed extending from a point 2 cm proximal to the wrist crease to a point 2 cm distal to the ante-cubital fossa. The skin flap was elevated in the subcutaneous plane to leave the layer of adipose tissue on the fascia [Figure 3]. The fascia with fat, incised along the dye markings, was harvested based on
The development of oral cancer proceeds through discrete molecular changes that are acquired from... more The development of oral cancer proceeds through discrete molecular changes that are acquired from loss of genomic integrity after continued exposure to environmental risk factors. It is preceded in the majority of cases by clinically evident oral potentially malignant disorders, the most common of which is leukoplakia. Early detection of these oral lesions by screening methods using suitable markers is critical as it mirrors molecular alterations, long before cancer phenotypes are manifested. Assessment of salivary interleukin-6 (IL-6) as a marker of malignant progression was undertaken in patients with leukoplakia having coexisting periodontitis (n = 20), periodontitis patients without leukoplakia (n = 20), and healthy controls (n = 20) by competitive enzyme-linked immunosorbent assay. Results showed elevation of IL-6 levels in leukoplakia with coexisting periodontitis and in periodontitis patients when compared to healthy control (P < 0.001). Within the leukoplakia group, IL-6 level was found to be increased with increase in the severity of dysplasia. The use of tobacco was seen to play a significant role in the elevation of salivary IL-6.The importance of IL-6 as a specific marker for leukoplakia with dysplasia and the role of tobacco as an independent risk factor has been highlighted.
The free fibula is a versatile and commonly used free flap in microvascular reconstruction. It al... more The free fibula is a versatile and commonly used free flap in microvascular reconstruction. It allows for reconstruction of both bone and soft tissue defects. In head and neck reconstruction, the skin paddle harvested along with the flap allows for the reconstruction of skin or oral mucosal defects. After skin paddle harvest, the donor site can be closed primarily or with skin grafts. Grafting the donor area is the common method used. However, this could lead to delayed healing because of the poor graft over the area of peroneal tendons. Propeller flaps have been extensively reported for closure of leg skin defects. We report a series of 10 patients in whom we used a local propeller flap for the closure of the fibula flap skin donor site. The donor defects could be satisfactorily closed without the need of a skin graft in 9 patients. This method is simple, reliable, and suitable for closing small to medium defects.
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Papers by mohit Sharma