Background: Speech abnormalities due to velopharyngeal insufficiency (VPI) sig-nificantly affect communication skills, self-esteem, and scholastic performance. It leads to a poor social, emotional, educational, and behavioral development and a poor quality of life overall in cleft lip palate (CLP) patients. Its early diagnosis and severity assessment using video-nasoendoscopy and speech assessment can significantly contribute to management. The present study evaluated VPI in CLP patients using both tools. Methods: A total of 48 patients with repaired cleft palate were subjected to speech and video-nasoendoscopic assessment. Speech assessment measured severity of hypernasality, speech in-telligibility, and voice quality. Video-nasoendoscopy evaluated velopharyngeal port closure to grade the severity of VPI. The speech assessment and video-nasoendoscopy findings were ana-lyzed and correlated. Results: There was a moderately strong statistically significant negative correlation between the grade of VPI and hypernasality ( r =-0.542, p = 0.000). There was a stronger statistically significant negative correlation of grade of velopharyngeal port insufficiency with speech intel-ligibility ( r =-0.634, p = 0.000). About 72% of the patients had abnormal voice quality. Conclusion: This study is the first attempt at diagnosing and grading VPI on a quantitative scoring based on a ratio scale for the motion of soft palate and pharyngeal walls. The strong correlation between endoscopic grading and speech analysis findings warrants further evalua-tion of nasoendoscopic grading of VPI in more studies.(c) 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by El-sevier Ltd. All rights reserved.

Breast reconstruction in extensive post-mastectomy defects is challenging for a reconstructive surgeon. While a plethora of options is available for breast reconstruction, pedicled latissimus dorsi (LD) flap remains the flap of choice for most surgeons. However, the size of the skin paddle of the LD flap may not suffice for extensive defects. We present a technical modification in the planning of the LD flap for its use in extensive defects.

Nerve reconstruction is a priority after soft tissue reconstruction with a free/pedicled flap in acute electrical burns of hand. Autologous cable nerve grafting is the method of choice of nerve reconstruction in such cases. Successful nerve graft revascularization is a significant determinant of the quality of nerve regeneration.[1]

Post traumatic complex defects of the forearm require multiple operations and prolonged rehabilitation. Segmental bony defects of the radius and ulna are occasionally seen as part of these complex wounds. There are a few options in bridging the skeletal defect. These include corticocancellous bone grafting, creation of a one bone forearm, and vascularised fibula. Vascularised bone grafting is superior in an ischemic and fibrosed area as it enhances local blood supply. The fibula is usually used to bridge the defect in one bone, i.e. the radius. A young male presented with an open comminuted fracture of radius and ulna following a crush injury to the left upper limb. The reconstruction was done in two stages—first a pedicled thoracoumbilical flap for soft tissue and in later stage a double-barrel free fibula flap for segmental bone loss. The above approach offered the best chance of skeletal healing in a complex defect. The patient was able to gain reasonably good upper extremity function with the described technique.

Chronic lymphocytic leukemia (CLL) is a neoplasm of mature B-cells of unknown etiology. There is a site-specific increased incidence of second malignancy in patients with CLL. Leukemia and cancer can thus occur in the same patient either simultaneously or sequentially. We present a case of gastric adenocarcinoma in a patient with chronic lymphocytic leukemia. A 47-year old female presented with a history of abdominal pain for one year, along with nausea and vomiting for two months. On examination, she was pale and had generalized lymphadenopathy. Her abdominal examination revealed vague fullness in the epigastrium, but there was no definite palpable mass. The complete hemogram showed features suggestive of CLL, which was later confirmed by a lymph node biopsy and bone marrow examination. While upper gastrointestinal endoscopy revealed an ulceroproliferative growth in the body of the stomach, its biopsy revealed a well-differentiated adenocarcinoma. Gastric cancer developing in a patient with CLL may be due to the immunological impairment associated with other etiological factors, such as Helicobacter pylori infection, smoking, etc. The treatment of gastric cancer consists of a gastrectomy with regional lymphadenectomy followed by adjuvant chemotherapy. The co-existence of CLL and carcinoma stomach can pose a challenge in the management of such patients.

Existing many systems were supporting task level parallelism usually involving the process of task creation and synchronization. The synchronization of task requires the clear definition about existing dependencies in a program or data-flow restraints among functions(tasks), or data usable information of the tasks. This thesis describes a method called Symbol-Table method which will used to exploits and detects the task level parallelism at inner level of sequential C-programs. This method is made up of two levels: a normal symbol table and an extended symbol table. A sequential program of C language is the input to the normal gcc compiler in which the procedures are defines as functions(tasks). Than we generate a normal symbol table with specific command by gcc compiler in Linux as an output. Then we use the information of that symbol table for generating the extended symbol table with additional information about variable's extended scopes and inner level function dependency. This extended symbol table is generated by the use of previously generated normal symbol table on the basis of variable's scope and L-value/R-value attributes. By that table we can identify the functions and variables those who are sharing the common variables and those who are accessing the different functions with extended scopes respectively. Then we can generate the program dependency graph by the using of that extended symbol table's information with a specific java program. A simple program for using this method has been implemented on a 64-bits linux based multiprocessor. Finally we can generate the Function graph for every variable in the program with the help of table's info and dependency graph's states. From that graph we can get the info about extended scoping of variables to identify and exploit the task level parallelism in the program. Then we can apply the parallelism with MPI or other parallel platforms to get optimized and error free parallelism.