Browsing by Author "Pradeep Jain"

Now showing 1 - 18 of 18

A review of rare palatal fractures and their management
(Regional Institute of Medical Sciences, 2021) Umesh Kumar; Pradeep Jain
Objective: The objective of this study was to diagnose rare palatal fractures and to subcategories them to formulate a definitive treatment plan depending upon the fracture lines. Materials and Methods: All patients presenting in triage with palatal fractures were classified after computed tomography scan. Thirteen patients diagnosed with complex and transverse palatal fractures were included in the study. Complex fracture was further subdivided into five groups: (a) comminuted, (b) oblique, (c) S shaped, (d) C shaped, and (e) T shaped. The patients were divided into two groups. In Group A, six patients were managed without palatal vault plating, and in Group B, seven patients were managed with palatal vault plating along with anterior alveolar and anterior maxillary buttress plating. Results: Twelve patients presented with complex fracture and one patient presented with transverse fracture. The male-to-female ratio and age range of the study were 5.5:1 and 15–55 years, respectively.Le Fort I and II fracture was present in five patients, isolated Le Fort II fracture in four patients, Le Fort I was present in two, and Le Fort I, II and III fractures was present in two patients. Conclusion: Complex palatal fractures can be subcategorized which simplifies the management and documentation of the fracture. Palatal vault plating should be attempted in cases where there are two large fracture segments to achieve the better stability of fracture and reduce the duration of maxillomandibular fixation in postoperative period. © 2021 Journal of Medical Society | Published by Wolters Kluwer-Medknow.
Alteration in transforming growth factor-β1 gene expression in hypertrophic scar
(National Institute of Science Communication and Information Resources (NISCAIR), 2014) Jyoti Gupta; Amol Patel; Pradeep Jain
In human, development of hypertrophic scar is a complex interaction of growth factors, cytokines and abnormal processes of wound healing. The exact role of transforming growth factor beta (TGF-β) in pathogenesis of scar has not been well looked into Indian setup. Hence, the present study becomes imperative to understand its pathogenesis with the aim to evaluate the role of cytokine, such as, TGF-β1, before and after 6 months of application of a herbal cream. This study is intended to find out the differential expression of TGF-β1 gene after the herbal cream treatment and improvement in the hypertrophic scar. The total RNA was isolated from the samples using Trizol and cDNA was prepared for RT-PCR analysis. The expression of TGF-β1 was high in 72.5% cases of hypertrophic scar, while 27.5% cases showed lower expression before treatment. After 6 months of application of the herbal cream, the expression of TGF-β1 gene was significantly down regulated (77.5%), while no changes were observed in 22.5% of hypertrophic scar cases. The variation in the gene expression of TGF-β1 could be due to several factors, such as, different age group, depth of injury and delay in healing of wounds. However, the efforts have been made to cure such patients as they suffer from psychological problems, especially with the scars on exposed parts of the body including face.
Columellar-frenulum angle - A significant clinical parameter in assessing the degree of severity in unilateral cleft lip
(American Cleft Palate Craniofacial Association, 2016) Madhubari Vathulya; Pradeep Jain
Objectives: The study was carried out to learn if the columellar-frenulum angle could be used as one of the most important anthropometric measurements to predict the clinical severity in unilateral cleft lip patients. Settings and Design: This is a prospective case series conducted at Banaras Hindu University, Varanasi, India. Methods and Material: The study was based on the Thomson and Reinders criteria (1995), and various anthropometric measurements, including the columellar-frenulum angle, were measured. A total of 30 patients (21 boys and 9 girls) were included in the study. The ages of the children varied from 4 months to 15 years. The left side was affected in 18 patients, and 2 gave a significant positive family history. All the patients were subjected uniformly to Tennison's cleft lip repair. Patients with strictly unilateral complete cleft lip and palate were included in the study. Microform clefts, incomplete cleft lips, and bilateral clefts were excluded from the study. Statistical Analysis: The data was analyzed using Pearson's correlation coefficient. Results: The CF angle correlated negatively with the soft tissue defect of the cleft, cutaneous lip length, and vermilion lip length discrepancies from normal and soft tissue width just behind the alveolus. Conclusions: CF angle promises to offer a method by which prognosis of clefts can be predicted in terms of its severity in patients with unilateral cleft lip. © Copyright 2016 American Cleft Palate-Craniofacial Association.
Cryptic bacteria of lower limb deep tissues as a possible cause of inflammatory and necrotic changes in ischemia, venous stasis and varices, and lymphedema
(Mary Ann Liebert Inc., 2015) Waldemar L. Olszewski; Marzanna Zaleska; Ewa Stelmach; Ewa Swoboda-Kopec; Pradeep Jain; Karoon Agrawal; Sashi Gogia; Arun Gogia; Piotr Andziak; Marek Durlik
Infections and inflammation of the lower limb skin, soft tissues, and vessels are more common than in other body regions. The aim was to determine whether cryptic bacteria dwelling in deep tissues are the cause. Methods: We performed bacteriologic studies of specimens harvested from arteries of amputated ischemic legs, leg varices, and tissue fluid/lymph and lymphatics in lymphedema. Results: Calf arteries contained isolates in 61% and femoral arteries in 36%, whereas normal cadaveric organ donors' arteries in 11%. Bacterial deoxyribonucleic acid (DNA) was detected in 70%. The majority of isolates belonged to the coagulase-negative staphylococci and Staphylococcus aureus; however, highly pathogenic bacteria were also detected. All were sensitive to all antibiotics except penicillin. Saphenous vein varices contained bacterial cells in 40% and controls 4%; bacterial DNA was found in 69%. The majority of bacteria were S. epidermidis and S. aureus susceptible to all antibiotics except penicillin, Lymph and epifascial lymphatics limb contained bacteria in 60% and 33% samples, respectively and controls in 7%. Most were S. epidermidis susceptible to all antibiotics except penicillin. Conclusion: Cryptic bacteria are present in lower limb tissues and may play a pathologic role in surgical site infections. Proper antibacterial prophylaxis should be considered when planning surgical interventions. © 2015 Mary Ann Liebert, Inc.
Hydraulics of tissue fluid during pneumatic compression in lymphedema of lower limbs
(2011) Waldemar L. Olszewski; Pradeep Jain; Marzanna Zaleska; Marta Cakala; Tomasz Gradalski; Sylwia Szopinska
Background: Physiotherapy of edema in cases with obstructed main lymphatics of lower limbs requires knowledge of how high external pressures should be applied manually or set in compression devices in order to generate tissue pressures high enough to move tissue fluid to the non-swollen regions and how to measure its flow rate. Methods: We measured tissue fluid pressure and flow in subcutaneous tissue of lymphedematous limbs stage II to IV at rest and during pneumatic compression under various pressures and inflation timing. An 8-chamber sequential compression device inflated to pressures 50 to 120 mmHg, for 50 sec each chamber, with no distal deflation was used. Pressures were measured using wick-in-needle and electronic manometer. Fluid flow was calculated from continuously recorded changes in limb circumference using strain gauge plethysmography. Results: Before massage, in all stages of lymphedema, stagnant tissue fluid pressures in subcutaneous tissue ranged between -1 to +10 mmHg and did not differ from those measured in normal subjects. Pressures generated in tissue fluid by pneumatic compression reached 40 to 100 mmHg and were lower than those in inflated chambers. High pressure gradient through the skin was caused by its rigidity (fibrosis) and dissipation of applied compression force to proximal non-compressed limb regions. The calculated volumes of displaced tissue fluid ranged from 10 to 30 ml per compression cycle to reach in some cases 100 ml in the groin region. Conclusions: tissue fluid pressures generated by a pneumatic device were found lower than in the compression chambers. The obtained results point to the necessity of applying high pressures and longer compression times to generate effective tissue fluid pressures and provide enough time for moving the stagnant fluid.
Infragluteal fasciocutaneous flap for management of recurrent ischial pressure sore
(Medknow Publications, 2018) Umesh Kumar; Pradeep Jain
Objective: The objective of the study was to determine the feasibility of infragluteal fasciocutaneous flap in recurrent ischial pressure sore. Materials and Methods: In our study, from 2015 to 2017, nine patients suffering from recurrent ischial sore with scars of previous surgery were managed with infragluteal fasciocutaneous flap. Wound bed was prepared by surgical debridement and negative pressure wound therapy in each case. In two cases, gracilis muscle flap was used as adjuvant to fill up the residual cavity. Donor area of flap was primarily closed. Results: Infragluteal fasciocutaneous flap was used in all nine cases. Superficial distal congestion was present in two cases. Haematoma (1) and infection (1) at flap donor site occurred. Recurrence of ulcer was observed in two cases which were managed by bursectomy and advancement of the bridge segment of the original infragluteal fasciocutaneous flap. All flaps survived without any major complication. Discussion: Ischial pressure sores have a tendency of recurrence after conservative or flap surgery. Scars due to previous surgeries adjacent to the pressure sore preclude the use of local skin or muscle flap. Infragluteal fasciocutaneous flap is a thick reliable fasciocutaneous flap that can be used for resurfacing recurrent ischial pressure sore. This flap has an axial pattern blood supply along with rich subfascial and fascial plexus supplied by various perforators. Conclusion: Infragluteal fasciocutaneous flap is reliable option for managing recurrent ischial sore as it transposes well-vascularised thick fasciocutaneous flap from adjacent posterior thigh and its bridge segment can be further used in case of recurrence. © 2018 Indian Journal of Plastic Surgery | Published by Wolters Kluwer-Medknow.
Isolated microglossia: A case report
(Regional Institute of Medical Sciences, 2015) Sanjib Singh Nepram; Pradeep Jain; Rajshree Devi Huidrom
A case of microglossia is reported herewith. 7 month old child had a small tongue but there were no breathing, feeding difculties. He had a small mandible ith no arch collapse. He had no dentition on the mandible but had 4 teeth on the upper jaw. © 2015 Journal of Medical Society.
Lateral cephalometric evaluation in cleft palate patients
(Infor-Press, 2009) Pradeep Jain; Anand Agarwal; Arvind Srivastava
The aim of the study. The lateral cephalometric study in children with cleft palate was carried out to find out the cause of maxillary retrusion and to see if there were other changes induced by this entity in the maxillofacial morphology Material and methods. Lateral cephalometric evaluation of 28 patients with un-operated cleft palate (group A), 12 patients with operated cleft palate (group B) and 10 controls (group C) was done by tracing the lateral cephalographs, marking the various landmarks and taking the mean of each measurements made thrice Results. It showed significant decrease in maxillary length and S-N-ANS angle indicating maxillary hypoplasia in all group A patients, significantly so in 16-20 years age group. Group B patients having undergone palatal repair in their childhood revealed significant increase in lower anterior facial height, the other parameters being insignificantly altered when compared with control Conclusions. The findings suggest an intrinsic deficiency not only in maxilla but contrary to the past belief also in mandible. There was no significant difference in the cephalometric measurements between un-operated and operated cleft palate patients.
National Consensus Statement on Role of Bisoprolol across Cardiovascular Continuum: Special Focus on Women
(Journal of Association of Physicians of India, 2025) Hriday Kumar Chopra; Kamal Kumar Sethi; Tiny Nair; Chandrashekhar Kashinath Ponde; Saumitra Ray; Sarita Rao; Shanmunga Sundaram; Dinesh K. Khullar; Navin C. Nanda; Jatinder Pal Singh Sawhney; Sarita M. Bajaj; Yatin Mehta; Arvind Kumar Pancholia; Pradeep Jain; Ashok Kumar Omar; Aditya K. Kapoor; Rishi Rishi Sethi; Atul Damodar Abhyankar; Vinod Kumar Sharma; Anil Dhall; Ajay Kumar Sinha; Shishu Shankar Mishra; Satya Narayan Rautray; Gyarsi Lal Sharma; Ashwani Mehta; Rajeev Agarwala; Rajeev Kumar Rajput; Ajay Umakant Mahajan; Sanjay C. Porwal; Ramesh K. Hotchandani; Vishal Rastogi; Rajeev Passey; Mohan Bhargava; Justin Paul Gnanaraj; Dorairaj Prabhakaran; Vivudh Pratap Singh; Vinod Mittal; Vitull Kumar Gupta; Anil Kumar Bhalla; Virender Kumar Katyal; Ishwarappa Balekundri Vijaylakshami; Asha Moorthy; Poonam Malhotra; Vanita Arora; Mona Bhatia; Prabhavathy Bhat; Shibba Takkar Chhabra; Sugandhi Gopal; Tripti Deb; Preeti Gupta; Hemlata Tewari; Anupam Goel; Rekha Mishra; Lovelina Singh; Zakia Khan; Geeta S. Sheth; Chandra Mukhi; Inder Pal Singh Kalra; Yogender Kumar Arora; Uttara Das; Kavita Tyagi; Satya Nand Pathak; Samir Kubba; Saurabh Bagga; Asha Mahilmaran; Ameet Sattur; Rohit Tandon; Dharmender Jain; Hetan C. Shah; Cecily Mary Majella; Ravi Prakash; Manish Aggarwal; Ruchi Verma; Sumit Sethi; Alka Gujral; Kanika Sood; Sonia Rawat; Varsha Kaul; Surinder S. Arora; Manjiti Arora; Veena Bhat; Anil Kumar Bali; Sanjay Sood; Shakuntala Dawesar; Bhushan K. Dawesar; Nilakshi Deka; Makarand Paithankar; Rajiv Handa; Nitish Parmar; Sheikh U. Nabi; Naveen K. Garg; Sandeep Sharma; Vivek Tandon; Manoj Pabrai; Samshad Alam; Manju Tyagi; Manisha Sahay; Manju Hotchandani; Anupama Kathpalia; Ish Kathpalia
Cardiovascular diseases (CVDs) represent a significant health concern worldwide, with women facing distinct challenges in the prevention, diagnosis, and management of these conditions. In India, hypertension is a prevalent cardiovascular (CV) risk factor, affecting nearly one-third of adults, and women experience a disproportionately high burden across all age-groups. The CV continuum, which spans from risk factors to CV events and ultimately to heart failure (HF), demonstrates how the progression of CVD impacts women at each stage differently due to gender-specific mechanisms like hormonal influences, pregnancy complications and the effects of menopause. This manuscript aims to present a set of consensus statements developed by an expert panel in India, focusing on the role of bisoprolol across the CV continuum with special attention to women. The consensus was formed based on a thorough review of clinical experiences, existing clinical data and alignment with both global and regional clinical guidelines. The manuscript highlights the gender-specific CV risks faced by women, their higher mortality rates following acute cardiac events, delayed diagnoses and less aggressive treatments. It also discusses bisoprolol as an effective therapy for managing hypertension, HF and other CV conditions in women. Bisoprolol's benefits include consistent blood pressure (BP) control, improved outcomes in HF and reduced CV risks, particularly in postmenopausal women and those with comorbidities. The manuscript underscores the need for gender-tailored approaches to the CV continuum, from prevention through to management, to address these challenges and improve outcomes for women. © The Author(s).
Preparation of two component Fibrin Glue and its clinical evaluation in skin grafts and flaps
(Georg Thieme Verlag, 2024) Samir Saxena; Pradeep Jain; Jyoti Shukla
Tissue adhesive is one of the alternative to conventional suturing and has some added advantages. Fibrin glue has been used in obtaining haemostasis foUovving trauma to spleen and liver. It has also been used in repair of dural tear and bronchial fistula. Fibrin glue is a biological tissue adhesive based on the final stage of coagulation wherein. Thrombin acting on fibrinogen converts it into fibrin. Thus, it has components, one is fibrinogen and another is thrombin. VVe have prepared both components of fibrin glue. Fibrinogen was obtained from patient's own blood and thrombin from fresh frozen plasma of screened healthy donor. The glue was used in 20 cases requiring skin graft or flap. The results "vera compared vvith conventional suturing method. Use of the fibrin glue is simple, safe, cost effective, and rapid technique to fix the skin grafts and flaps with avoidance of peroperative bleeding and postoperative collection. It also has better overall results. © 2024 Georg Thieme Verlag. All rights reserved.
Pressures and timing of intermittent pneumatic compression devices for efficient tissue fluid and lymph flow in limbs with Lymphedema
(2013) Marzanna Zaleska; Waldemar L. Olszewski; Pradeep Jain; Sashi Gogia; Arun Rekha; Samsita Mishra; Marek Durlik
Pneumatic compression of tissues with lymph stasis is, aside from the manual massage, a commonly used therapeutic modality in limb lymphedema. A number of pneumatic devices have been constructed. There is lack of reports of comparative studies determining inflation pressure levels, inflation/deflation cycle times, and total pumping times. Aim: We tried to answer the question how high compression pressure and how long compression timing should be applied to the limb soft tissues to reach tissue fluid (TF) head pressure above 30 mmHg, necessary to initiate proximal flow. Methods: TF pressures were measured subcutaneously during intermittent pneumatic compression in the lymphedematous limbs stage II to IV. Pressures of 50, 80, and 120 mmHg and timing 5, 20, and 50 sec were applied. Results: a) the TF head pressures were lower than those in inflated chambers, b) inflation time of 5 and 20 sec was not long enough to generate TF head pressures above 30 mmHg, even if the compression pressures were as high as 120 mmHg, c) the 50 sec timing allowed to reach head pressures above 30 mmHg; however, they remained always lower than in the compression chamber, d) TF head pressures differed at various levels of the limb depending on the soft tissue mass, e) deflation of the inflated whole sleeve for 5 and 20 sec was followed by high end pressures, whereas that of 50 sec brought about pressure drop to 0, facilitating refilling with TF of the distal parts of the massaged limb. Conclusions: Our observations point to the necessity of applying high pressures and compression times over 50 sec, to generate effective TF pressures and provide enough time for creating TF flow. Short inflation times generate TF pressures as in one-chamber devices that preclude its effectiveness compared to the multi-chamber devices. © 2013, Mary Ann Liebert, Inc.
Sagittal Maxillary Fracture: Diagnosis and Management
(Georg Thieme Verlag, 2021) Umesh Kumar; Pradeep Jain
Background The sagittal maxillary fracture often coexists with maxillary fractures and warrants a definitive management strategy together with other maxillary fractures. Method This study was conducted on 60 patients suffering from sagittal maxillary fracture. Palatal fractures were classified into six subgroups. During management, patients were divided into three groups. In group A, patients with type I, IV, V, and VI were managed with maxillomandibular fixation and anterior maxillary buttress stabilization. Group B patients included type II, III, and IV palatal fractures. These fractures were undisplaced and were managed with maxillomandibular fixation, anterior alveolar plating, and anterior maxillary buttress stabilization. Group C included type II and III fractures with visible gap in the palate and were managed with maxillomandibular fixation, palatal vault plating, anterior alveolar plating, and anterior maxillary buttress stabilization. Result Sagittal maxillary fracture was more common in young males. Le Fort I and II fractures were more frequently associated with it in isolation or in combination. Parasagittal and sagittal fractures were the most common types. Sixteen patients of group A, twenty patients of group B, and twenty-four patients of group C were managed. Malocclusion (2), plate extrusion (2), and oroantral fistula (2) were the most common complications. Conclusion Sagittal maxillary fracture can be diagnosed with clinical and radiological examination. Palatal vault plating is required in displaced palatal fractures of type II and III. Single plate fixed in posterior half of middle one-third of palate gives sufficient stability to the palatal vault. © 2021 Georg Thieme Verlag. All rights reserved.
Simple Tips for Ear Lobule Reconstruction-“Lobuloplasty Revisited”
(Springer, 2019) Madhubari Vathulya; Vaibhav Jain; Pradeep Jain
Lobuloplasty is one of the most common procedures done in outpatient basis. It is performed by a wide spectrum of surgeons ranging from general surgeon to plastic surgeon. Inspite of the innumerous techniques used, the ultimate aim of the surgery is to obtain a soft supple lobule with a well-hidden cosmetic scar without the complication of recurrence. Single site local anaesthesia, scoring and undermining of the lobule flaps and the introduction of a small cartilage piece in recurrent cases can change the outcome of the patients result. This article explains how subtle changes are still possible in common procedures like lobuloplasty to change the outcome of the results. © 2017, Association of Otolaryngologists of India.
Soft-tissue reconstruction for exposed orthopedic implants in injured extremities
(Regional Institute of Medical Sciences, 2019) Vaibhav Jain; Pradeep Jain; Shivi Jain
Background: Exposure of orthopedic implants before fracture union is quite frequent in clinical practice. There is no definite rule as of now whether to retain or replace the exposed implant with an external fixator. Objectives: The aim of the study was to find the ultimate outcome after retaining the exposed implant and providing a skin and soft-tissue cover. Materials and Methods: Thirty-two patients with exposed orthopedic implants reported to us with an average of 6 weeks after the original orthopedic procedure. The local soft-tissue infection was treated with a targeted antibiotic therapy. There was delay in the soft-tissue reconstruction for an average of 24 days. Six patients also received “negative pressure wound therapy.” The soft-tissue defects (ranging from 4 cm × 3 cm to 25 cm × 10 cm) were compounded with exposure of olecranon plate in four and intramedullary tibia nails in five, and 23 exposed plates and screws. The various muscle and fasciocutaneous flaps were used according to the region of the defect. Results and Conclusions: All the flaps behaved well except one. One of the patients suffered from wound discharge and chronic sinus, but none suffered from pain or fracture nonunion up to 9 months follow-up. Removal of the implant was required in only one patient because of sharp edge. Thus, coverage of exposed implants should always be considered as the first option before replacing it with external fixator. © 2019 Journal of Medical Society | Published by Wolters Kluwer-Medknow.
Submental intubation: A solution for anesthetic dilemma in mid- and panfacial fractures
(Regional Institute of Medical Sciences, 2015) Dhrubajyoti Deka; Vaibhav Jain; Parthapratim Dutta; Prabal Goswami; Pradeep Jain
Introduction: Faciomaxillary injuries are very common following trauma, specifically following road traffic accidents. Many a time, those injured present with panfacial fractures. Such patients need urgent surgical attention for stabilization and fixation of the fractures. Materials and Method: The patient is intubated by oral route in the conventional manner with an armored tracheal tube as the first step. This tube is taken out externally via a mucosal incision in the floor of mouth and submental incision and connected with the ventilator. The cuff is inflated and the tube is secured with the suture with the skin. The skin and the mucosal incisions are closed. Discussion: Securing the endotracheal tube during the operation for patients with panfacial fracture without coming in the way of oral procedure always poses a problem for the anesthetist. Fracture of the base of the skull or the naso-orbital ethmoid complex excludes the option of nasal intubation, while oral intubation would prevent the surgeon from obtaining a proper occlusion. In these circumstances, submental intubation is a simple and safe procedure that can be carried out. However, if a patient needs prolonged intubation even after surgery due to upper respiratory obstruction, tracheostomy remains the procedure of choice. Conclusion: Submental intubation is helpful in allowing the surgeon to operate intraorally and ensure proper dental occlusion in patients with panfacial fractures. © 2015, Regional Institute of Medical Sciences. All rights reserved.
The Use Of Marlex Mesh For Incisional Hernia Repair
(Georg Thieme Verlag, 2024) N.N. Khanna; Pradeep Jain
Forty cases of incisional hernia underwent operation on which Marlex mesh was used routinely to strengthen the repaired defect. No patient had any major complication in the post-operative period. No patient has so far shown recurrence. Thus Marlex mesh appears to be a satisfactory synthetic prothesis in the repair of incisional hernias. © 2024 Georg Thieme Verlag. All rights reserved.
Therapeutic potential of silicone gel sheet treatment and alteration in transforming growth factor beta gene expression in hypertrophic scars
(Regional Institute of Medical Sciences, 2018) Jyoti Gupta; Vaibhav Jain; Pradeep Jain
Background: The management and prevention of hypertrophic scars is a challenging problem. Various efforts are made by the researchers to understand the mechanism of the abnormal healing and also to offer better therapy to control these unusual scars. Silicone gel sheet is widely used as the first-line therapy for hypertrophic scars. Objective: The present study has been designed to find out the efficacy of silicone gel sheet treatment on transforming growth factor beta gene(s) expression. Subjects and Methods: The total RNA was isolated from forty hypertrophic scar cases with median age of 42 years before starting the treatment and at 6 months after the silicone gel sheet therapy using Trizol. The cDNA was synthesized for the quantitative gene expression analysis of transforming growth factor beta gene (1, 2, and 3) by real-time polymerase chain reaction. Results: The observations showed that the mRNA expression of transforming growth factor beta (TGF β)-1 and -2 gene in hypertrophic scars was much higher, i.e., 2.6- and 3.8-fold, respectively, when evaluated and compared with controls. The present study also evaluated the efficiency of silicone gel sheet treatment therapy in hypertrophic scars in relation to altered expression of TGF-beta genes. After 6 months of therapy, the mRNA expression of TGF β-2 gene was significantly downregulated (P = 0.01) and β-3 insignificantly upregulated. Patients’ assessment scale showed complete cure in 12.5% of cases, and major improvement was observed in 45% of cases. Conclusion: The silicone gel sheet therapy is useful for treating the hypertrophic scars by downregulating expression of profibrotic TGF β-1 and -2 genes. © 2018, Regional Institute of Medical Sciences. All rights reserved.
Tissue fluid pressure and flow during pneumatic compression in lymphedema of lower limbs
(2011) Waldemar L. Olszewski; Pradeep Jain; Govinda Ambujam; Marzanna Zaleska; Marta Cakala; Tomasz Gradalski
Background: Physiotherapy of edema in cases with obstructed main lymphatics of lower limbs requires knowledge of how high external pressures should be applied manually or set in compression devices in order to generate tissue pressures high enough to move tissue fluid to nonswollen regions and to measure its flow rate. Methods: We measured tissue fluid pressure and flow in subcutaneous tissue of lymphedematous limbs stages II to IV at rest and during pneumatic compression under various pressures and inflation timing. An 8-chamber sequential compression device inflated to pressures 50-120? mmHg, for 50? sec each chamber, with no distal deflation, was used. Pressures were measured using a wick-in-needle and electronic manometer. Fluid flow was calculated from continuously recorded changes in limb circumference using strain gauge plethysmography. Results: Before massage, in all stages of lymphedema, stagnant tissue fluid pressures in subcutaneous tissue ranged between -1 and +10? mmHg and did not differ from those measured in normal subjects. Pressures generated in tissue fluid by pneumatic compression reached 40-100? mmHg and were lower than those in inflated chambers. High pressure gradient through the skin was caused by its rigidity (fibrosis) and dissipation of applied compression force to proximal noncompressed limb regions. The calculated volumes of displaced tissue fluid ranged from 10 to 30? ml per compression cycle, to reach in some cases 100? ml in the groin region. Conclusions: Tissue fluid pressures generated by a pneumatic device were found lower than in the compression chambers. The obtained results point to the necessity of applying high pressures and longer compression times to generate effective tissue fluid pressures and to provide enough time for moving the stagnant fluid. © 2011, Mary Ann Liebert, Inc.