Outcomes of Varus Derotation Femoral Osteotomy By Angle Blade Plate in Legg-Calve-Perthes Disease for Patient Above Eight Years of Age in The Lateral Pillar B or B/C Group

Legg-Calve-Perthes disease (LCPD) that starts after 8 years (late onset) usually follow more aggressive course and the long-term outcome is also poor. Treatment method of LCPD that will produce best results is controversial particularly if the patients are with late-onset presentation. This prospective study was conducted from January 2015 to January 2019 at Dhaka Medical College Hospital and Health N Hope Hospital, Dhaka, Bangladesh. We evaluated the radiographic outcomes for patients who had varus derotation femoral osteotomy (VDRO). We followed up 16 patients who had femoral varus osteotomy. All patients were above 8 years of age at clinical onset. The involvement of femoral epiphysis was in either in B or B/C in lateral pillar classification. All patients had MRI done to confirm radiological diagnosis and classification. The mean age was 9.5 years (range, 8 to 12 years). Final outcome was evaluated by using the Stulberg classification which was radiological. Important exclusion criteria were patient with bilateral involvement and requirement of femoral varus >30 degree. We had 81.25% of our patient with satisfactory outcomes. Among them there were Stulberg grade I, 0 cases; Stulberg grade II, 13 cases (81.25%); Stulberg III, 3 cases (18.75%), Stulberg IV and V both 0 case each. The surgical outcomes for varus derotation femoral osteotomy in late onset LCPD patients over 8 years old were showing the good results than other modalities of non surgical and surgical methods.

A Modified Approach for Harvesting Non Vascularized Fibular Graft for Pediatric Age Group

The conventional technique of harvesting free non-vascularized fibular grafting is associated with different scale of morbidity and usually a long scar. We follow a technique that causes minimum interference to the surrounding soft tissues to harvest the desired length of fibula. This prospective study was performed at Department of Orthopaedics, Dhaka Medical College Hospital from January 2018 to December 2018. Thirty patients of average age 10.5 years (range 8 to 14 years) were taken up for the study. The fibula was harvested by two separate incisions, 1 cm each at proximal and distal extent of proposed length of graft after elevating the periosteum circumferentially using a periosteum elevator. Compression bandage and above knee plaster immobilization was applied that help to reduce hematoma formation. The mean follow up is 12 months. The patients were evaluated clinically and by radiology. Twenty nine patients showed good results. One patient had delayed wound healing resulting in fair result. This modified approach of harvesting fibula reduces donor site morbidity and is safer and easier than conventional approach.

Management of Neglected Rupture of Tendoachilles with Long Gap by Flexor Hallucis Longus Tendon Transfer

The tendo achilles is one of most important tendon in human body which often injured through direct trauma or indirect stress on a weakened tendon. Longer the duration after injury the injured parts likely to move apart, fibrosis and degeneration leading to difficulty in repair or reconstruction. Usually a phase of 4 weeks or more without specific treatment is regarded as chronic or neglected rupture. Different authors described many management protocols about the tendo achilles rupture but there is no procedure of choice for neglected rupture with long gap. Prospective case series of 21 patients of neglected tendo achilles rupture with long gap treated with flexor hallucis longus tendon (FHLT) transfer was taken for study from January 2019 to December 2020 in Mymensingh Medical College Hospital, Bangladesh. Average age of patients was 39.47 years with range 22-65 years. Fifteen (15) cases of traumatic rupture in this study with average age 32.66 years and pathologic 6 cases with average age 56.5 years were recorded. We grafted FHLT from channel by incising Henry's knot. Krackow et al.'s technique was followed for tendon mobilization and bone fixation. We made procedure simpler and cheaper; instead of using interference screw the sutured tendon pulled through the heel and anchored over rubber tube or button by Cole method. Post-operative complications were less with one patient with superficial infection which eventually recovered 3 cases of mild pain and 2 cases of numbness. Questionnaire for surgical outcome measure are satisfactory in 19 patients (90.47%). Final follow up AOFAS score at 6 month (91.61±5.41) was highly significant (p<0.001) in comparison to preoperative score (38.71±9.78). These are comparable to other study. Above mentioned scores indicate the reliability of the surgical system. But our study is a prospective case series with minimum cases. To establish the best procedure for neglected tendo achilles rupture with long gap we recommend further study with larger group and Randomized Controlled Trial (RCT) study among different procedure.

Prospective Study of Deterioration of Quality-of-Life among Elderly Women with Untreated Fracture of Neck of Femur in Rural Areas of Mymensingh, Bangladesh

Elderly women are very much prone to develop fracture at neck of femur sustained by even minute trauma. Most of the cases are due to fall. Osteoporosis gives rise to this vulnerable condition. In developing countries like Bangladesh the women of rural areas are the prime victims mostly due to illiteracy. To assess the quality-of-life (QOL) of elderly women (>60 years) with untreated hip fractures in a rural areas in Mymensingh, Bangladesh is the objective of this study. This prospective study was done from January 2019 to December 2019 in Orthopaedics and Traumatology Department of Mymensingh Medical Hospital, Mymensingh, Bangladesh. Twenty-five elderly women with untreated fracture neck of femur were enlisted in this study. EuroQol (EQ-5D) was applied to assess the Quality of life of subjects before and after the situation. Twenty-five elderly women of healed operated neck of femur were included as comparison group, matched for age, economic condition and educational status among neighborhood people. So, sample size was fifty. Wilcoxon signed rank test and Mann-Whitney U test were applied to compare EQ-5D mean scores. Participants with hip fracture, 60% (15/25), 68% (17/25), 68% (17/25), 60% (15/25) and 92% (23/25) reported severe problems with mobility, pain, usual activity, self-care and anxiety respectively. The EQ-5D mean score among the elderly with fracture neck of femur was 0.198 (SD 0.14). It was low when compared with the same subjects before the occurrence of the event (Z-6.522, p<0.001) and as compared with the comparison group (Z-7.92 p<0.001). QOL scores assessed using EQ-5D index scores was poor among elderly women with untreated fracture neck of femur as compared with the healed operated comparison group. Vast majority of study participants in this study were reported severe problems like mobility, pain, usual activity and self-care and anxiety.

Outcome of Danis-Weber Type-B ankle fracture treated by Pre-contoured Distal Fibular Locking Plate

Danis-Weber type-B ankle fracture is one of the most common injuries in young and active individual. This fracture offers a considerable challenge to orthopedic surgeon. Though there are several options for treating such type of fracture, ORIF by Pre-contoured Distal Fibular Locking Plate is the preferred option in the recent years. This descriptive type of observational study was performed from July 2017 to June 2019 in NITOR. Thirty (30) patients, 22 male and 8 female with an average age of 39 years with Danis-Weber type-B ankle fracture underwent ORIF by Pre-contoured Distal Fibular Locking Plate for fractured fibula and ORIF by 4.0mm cannulated cancellous screw for fractured medial malleolus. All the patients were initially managed by analgesic and short leg posterior slab. Average follow up was 24 weeks. Final outcome was assessed by AOFAS score. The main cause of injury was RTA (56.67%). Mean operation time was 1.2 hours. Mean duration of Hospital stay was 16.43±1.73 days. Superficial infection was in 3.33% and skin necrosis in 3.33% patient. Mean duration of radiological healing was 12.73±0.39 weeks. At final follow up, mean dorsi flexion was 10.93°±0.357° and plantar flexion was 50.93°±0.357°. Ninety percent (90%) patient had no difficulties in walking on any surface; 96.67% patient had stable ankle hind foot; 86.67% patient had good. Ten percent (10%) had fair and 3.33% patient had poor alignment of foot. The mean score in this study was 88.67±2.31. Satisfactory outcome was observed in 86.67% patients and 13.33% had unsatisfactory results. On the basis of results in the present study, it can be concluded that treatment of Danis-Weber type-B ankle fracture by Pre-contoured Distal Fibular Locking Plate is an effective and reliable method.

Clinical Outcome on Comminuted Femoral Shaft Fractures in Adults Treated by Minimally Invasive Plate Osteosynthesis (MIPO) with Locking Plate

Intramedullary nailing is a pillar in the treatment of femoral shaft fractures. But it is not possible in all cases especially in comminuted fractures. This study has been designed to explain the importance of Minimally Invasive Plate Osteosynthesis (MIPO) with the locking plate in the treatment of comminuted Femoral Shaft Fracture. Twenty (20) such patients were treated by MIPO and analysis has been done in this study to get fruitful result and to find out the effectiveness of this procedure who were admitted at Mymensingh Medical College Hospital, Mymensingh, a tertiary level hospital of Bangladesh from February 2018 to January 2019. Mean age of the patients were 49.20±14.41 years. Based on AO classification, there were 4, 8 and 8 patients belong to type A, B and C respectively. The union period for all the patients was in between 12 to 14 weeks. The mean union period was 12.90±1.997 weeks. Mean follow up period was 19.70±2.77 weeks. Mean full weight bearing period was 16.50±1.10 weeks. In Thoresen scoring system excellent result was 9(45%), good result was 10(20%) and fair result was 01(5%). Mal-alignment happened in two cases. However, delayed union and broken screws were found in two cases each of which was treated accordingly. Comminuted Femoral shaft fracture with MIPO procedure is more effective treatment than intramedullary nailing. Furthermore, mal-alignment is the basic complexity that must be taken away intraoperatively.

Core Decompression with Non Vascularized Fibular Graft as Modern Surgical Treatment of Early Hip Avascular Necrosis

Cellular death of bone due to impairment of the blood supply leading to collapse resulting in pain, and loss of joint function is known as avascular necrosis (AVN). The head of femur is the most common bone affected by avascular necrosis followed by talus and scaphoid. We evaluate the results of core decompression with non-vascularized fibular graft in avascular necrosis of femoral head. This quasi experimental study was done at Mymensingh Medical College Hospital, Dhaka Medical College Hospital and some other private hospitals of Bangladesh. The study includes patients who underwent core decompression and non-vascularized fibular grafting in avascular necrosis of femoral head from January 2017 to December 2018. In this study we evaluated total 20 patients and majority of the patients belongs to the group of 20-30 years. Out of 20 patients, 8 of them were unilaterally involved rest 12 had bilateral involvement. Out of 24 hips of bilateral involvement 4 were grade III and IV (Ficat and Arlet classification) therefore not included in the study. So, we study 28 hips only. The average success rate was 90% after core decompression and non-vascularized fibular bone grafting. Harris hip score of 60 on presentation had poorer outcome. Patients with less than 80 degrees of flexion had poorer outcome.

Management of Fractures of the Distal Third of Tibia by Distal Tibial Locking Plate by MIPO Technique

Distal tibial fractures are difficult to manage as the bone is subcutaneous with depleted muscular cover; the consequent decreased vascularity leads to complications. Minimal invasive plate osteosynthesis (MIPO) is a very good option for managing this type of fractures. This study was carried out to evaluate the outcome of patients treated with distal tibial locking plate by MIPO technique. Twenty patients with distal tibia fractures treated with distal tibial anatomical locking plate were prospectively studied from July 2013 to December 2016. The result was excellent in 18(90%) of patients i.e. 18 patients had an AOFAS score of 90 or greater out of a possible 100 points. The mean score was 94.28; the mean time for radiological union was 20.1 weeks with a range of 16 to 30 weeks. We encountered superficial infection in 02 (10%) of our patients which were managed with dressings and appropriate antibiotics. Two patients had union with valgus angulation of less than 5°. No malunion was detected. One patient had ankle stiffness requiring extensive physiotherapy to regain range of movement. Plate removal was done in 4 cases. MIPO technique is a good fixation method for fractures distal third of tibia, preserving blood supply & fracture hematoma.

Clinical Outcome in Intra Articular Distal Humerus Fractures in Adults Treated with Different Hardware in a Tertiary Level Hospital of Bangladesh

In adults, distal humerus fractures are infrequent and frequently intra-articular. Customarily encompass both medial and lateral columns. Operative management gives constructive outcomes. The aim of this study was to evaluate clinical outcome in intra articular distal humerus fractures in adults treated by different hardware. This prospective study consists of 20 purposively selected patients with intra articular distal humerus fractures treated by surgical intervention with different hardware who were admitted to Mymensingh Medical College and Hospital, Bangladesh in between November 2016 to October 2018. Surgical approaches were standard dorsal with or without olecranon osteotomy. The mean age of the patients was 32.3 years, range between 18-55 years. The maximum patients i.e. 85% were between 18-45 years. Seventy percent (70%) of the cases admitted were due to Road traffic accident (RTA). Most of the patients were males 14(70%) with right upper limb was involved in 13(65%) cases. Mean Mayo Elbow Performance Score was 81.5 post-operatively. According to Mayo Elbow Performance (MEP) score clinical outcome was excellent in 20%, good in 50%, fair in 25% and poor in 10% of patients. Distal humerus fractures are censorious in nature. Proper anatomical articular reconstruction and stable fixation by surgical intervention helps in fruitful results.

Outcome of Operative Management of Lumbar Spinal Canal Stenosis at Mymensingh Medical College & Hospital

Variety of conditions may be responsible for low back pain but lumber spinal canal stenosis is an important cause of low back pain. Lumber spinal canal stenosis usually presents with low backache with neurogenic claudication and shortness of walking distance in adult patient. Surgical management of lumbar spinal canal stenosis by decompression surgery is effective method. This prospective interventional study was performed in patient with clinical features like low back pain with radicular pain, neurogenic claudication, signs of root compression, positive MRI findings attending in department of Orthopaedic Surgery Mymensingh Medical College Hospital and Private Hospital from July 2016 to June 2019. Thirty patients were evaluated among those 20(66.6%) were 50 years and above. The mean age was 47.5±1.6 years. Male to female ratio was roughly 8:1. Almost all of the patients had low backache with radiation to the back of the thigh and leg with motor weakness (60%). About 66.6% of the patients had sensory deficit and 83.3% had neurogenic claudication. Majority (80.0%) of the patients at presentation had a suffering of 12 or >12 months. The mean duration of suffering was 14.7±5.1 months. About 55% of the patients were able to perform heel-walking and 36.0% tip-toe walking. Nearly 57% of the patients had sensory deficit along the distribution of 1st sacral nerve and 53.3% along the distribution of lumber 5 nerves. Diagnosis shows that 16.6% of patients had L4 lesion, 50% L5, 10.0% patients had L4 & L5 and 46.6% S1. Laminectomy was done in 26.6% of patients, laminectomy and disectomy in 33.3% and laminectomy, discectomy & foraminal decompression in 40.0% of patients. Twenty five (83.5%) of patients was free from symptoms. Eighty percent (80.0%) of patients shows minimal disability and 20.0% moderate disability on the basis of Oswestry Disability Index, while by MacNab criteria, most (80%) of patients was excellent, 10% good and another 10% fair. Repeated measure ANOVA statistics showed that mean Oswestry score decreased significantly from 54.5% at baseline to 22% at the end of 1 year (p<0.001).

Giant Cell Tumour of the Talus: A Rare Case Report

Giant-cell tumor constitutes 4-20% of all primary bone tumors in south East Asian population. They are benign locally aggressive bone tumour first described by cooper in 1818. These tumors occur predominantly in meta-epiphyseal region. Most often they are located around the knee joint. Although most of the tumors are diagnosed on plain radiograph alone, varying CT and MRI presentations of these tumors are essential to narrow down the differentials has an extended pre operative assessment.

Incidence of Negative Appendicectomy in Clinically Diagnosed Patients of Acute Appendicitis

This study was conducted in the department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2016 to December 2017 and performed to assess the negative appendicectomy on histopathology followed by clinically and laboratory investigations based diagnosed acute appendicitis. To perform this prospective study 200 patients with pain in right iliac fossa of both sexes randomly selected and were evaluated by history, clinical examination, laboratory investigations (USG, CBC) and scoring system. Among 200 patients male 124 and female 76 under went appendicectomy 36 were histopathologically normal appendix. Over all negative appendicectomy (NAR) 18%, among them 14.5% (18/124) were male & 23.67% (18/76) were female.

Evaluation of Outcome of Exchange Nailing with Autogenous Bone Graft for Treating Aseptic Nonunion of Femoral Shaft Fracture

Femoral shaft fractures are severe injuries and challenging for both, the patient and the surgeon. This study has been designed to assess the success rate of exchange nailing with autogenous cancellous bone graft for the treatment of non united femoral shaft fractures previously treated by ORIF with intramedullary nail. This quasi experimental study was carried out in the Department of Orthopaedics & Traumatology of Dhaka Medical College Hospital and NITOR from July 2007 to December 2008. Thirteen patients were followed up regularly for at least 1 (one) year after each operation to assess the functional outcome as well as union time according to the prescribed scoring system. Final outcome was analyzed by SPSS-18 version. Level of significance was set at 0.05 (p<0.05). In this study exchange nailing with autogenous cancellous bone graft were done for femoral shaft fracture with nonunion in 13 patients. Mean±SD age was 39.08±5.780 years; Male: Female = 9:4. Among 13 nonunion fractures, all (100%) were united after exchange nailing with autogenous cancellous bone graft in aseptic condition. Mean union time was 26.97±2.976 weeks in static mode of fixation. Union time was highest in atrophic type of fracture and lowest in hypertrophic type of fracture. Final outcome according to modified Thoresen's score was satisfactory 92.29%; according to modified Silvia's score was 10.77±0.832. Exchange nailing with autogenous cancellous bone graft is an effective method of treatment in femoral shaft fracture with nonunion after intramedullary nailing. It provides a good scope to reinforce the optimum mechanical stability by a larger diameter nail and locked if necessary; as well as biological stimulation by reaming and bone grafting.

Comparative Study of Stabilization of Humerus Supracondylar Fracture in Children by Percutaneous Pinning From Lateral Side and Both Sides

The aim of this prospective experimental study was to analyze the radiological and clinical results of the supra condylar fracture of Humerus in children and conducted the functional outcome of closed reduction and internal fixation by percutaneous Kirschner-wire from lateral side and crossed technique in the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Sher-E-Bangla Nagor, Dhaka, Bangladesh from July 2011 to June 2013. Patients diagnosed as closed Supracondylar fracture of Humerus in children due to trauma were the study population. Total 30 patients aged 2 to 12 years irrespective of sex were included in the study and were divided in 2 groups. Information obtained included age, sex, type of fracture, management, outcomes and complications. The mean age was 7.80±2.08 and 5.93±2.31 years for Group I and Group II patients. Age range was 2-12 years. Males were predominant 11(73.3%) Group I and Group II. Fractures were primarily caused by fall from tree and left side predominant. In Group I the time elapsed between injury and surgery was minimum 2 hours and maximum 24 hours with mean±SD was 9.20±7.20, while in Group II minimum and maximum of 3 and 48 hours respectively with mean±SD was 9.60±11.01. Minimum and maximum post operative hospital stays were 1 and 2 days in Group I and Group II. Follow-up were carried out after 1, 3, 6 and 12 weeks of operation. Loss of post operative range of motion of elbow and loss of carrying angle was not significant (p>0.05). Functional outcome was analyzed by Flynn's grading. In this study there were 3(20%) cases with excellent, 10(66.67%) were good and 2(13.33%) were fair functional outcomes in Group I. In Group II excellent, good and fair functional outcome were 3(20%), 9(60%) and 3(20%) respectively. After chi-square test there was no significant difference between two groups.

Lupus cystitis: An unusual presentation of systemic lupus erythematosus

Lupus cystitis is a rare complication of systemic lupus erythematosus (SLE) and occurs in association with gastrointestinal symptoms. This rare disorder has been reported mainly from Japan. We report a 20 year old female who diagnosed as having SLE associated with paralytic ileus and chronic interstitial cystitis. Treatment with intravenous methylprednisolone, cyclophosphamide pulse therapy followed by oral prednisolone and azathioprine led to amelioration of manifestations. Later she developed lupus nephritis which was treated with mycophenolate mofetil.

Opportunistic infections of central nervous system in AIDS

HIV/AIDS is a new epidemic in current century. Predominant route of transmission is sexual. Virtually all systems are affected either directly by virus or by oppurtunistic infections or by malignancy. Neurological complications may occur at any stage of disease. Clinical manifestations may be acute, subacute or chronic. Presentation and diagnosis are often confusing. Central nervous system toxoplasmosis and tuberculous meningitis are commonest opportunistic infections in advanced HIV patients. Patients frequently present with focal neurodeficit. Mortality is high i.e., 13 (54%) out of 24 cases of opportunistic infectious in the study carried out at the SSKM Hospital during the period January 2005 to December 2006.

Chloroform- and water-soluble sol-gel derived Eu+++/Y2O3 (red) and Tb+++/Y2O3 (green) nanophosphors: synthesis, characterization, and surface modification

Eu+++ and Tb+++ ions have been incorporated into nanodimensional yttrium oxide host matrices via a sol-gel process using Y5O(OPr(i))13 as precursor (OPr(i) = isopropoxy). The as-synthesized white powders have been annealed at different temperatures. Photoluminescence (PL) spectroscopy and X-ray diffraction (XRD) have been used as tools for documenting the characteristics of these powders. For Eu+++-doped powders, a comparison of the Eu+++, 5D0-->7F1, and 5D0-->7F2 peak intensities in the emission spectra reveals that the dopant ions are occupying unsymmetrical sites in the host yttrium oxide in all the samples. For Tb+++-doped powders, the characteristic terbium 5D3-->7Fn and 5D-->7Fn (n = 2-6) transitions were visible only in the samples that had been annealed above 500 degrees C. Samples of the doped particle powders were suspended in chloroform by fragmenting the powder with and without sonification under the presence of trioctylphosphine oxide, or a mixture of oleic acid and dioctyl ether. The resulting clear colorless (for Eu+++) and light green translucent (for Tb+++) solutions of the suspended particles showed red and green luminescence upon UV excitation, respectively. In addition, suspension in water has been achieved by fragmenting the powder in the presence of dichloroacetic acid. Transmission electron micrograph investigation of the soluble particles shows single dispersed particles along with agglomerates. The changes in the luminescence due to fragmentation of the particle powder and due the influence of the surfactant of the suspended colloidal particles are discussed.

Laparoscopic common bile duct exploration using a rigid nephroscope

Background

Patients with cholelithiasis and choledocholithiasis are increasingly managed with laparoscopic bile duct exploration and cholecystectomy. Large impacted bile duct stones continue to defy laparoscopic extraction. This study explored the feasibility of laparoscopic bile duct clearance using a rigid nephroscope, which is suited to extracting large stones.

Method

This prospective study recruited patients with large bile duct stones and a bile duct wider than 8 mm on ultrasonography. In addition to standard ports for laparoscopic cholecystectomy, a custom-made 9-mm port was introduced in the epigastrium for the rigid nephroscope, which was negotiated into the bile duct through a choledochotomy. Rigid graspers and lithotripters were introduced through the nephroscope to fragment and remove the calculi.

Results

Between December 2005 and September 2008, 18 patients had nephroscope-guided bile duct exploration (mean(s.d.) age 49(13·9) years, bile duct diameter 11·3(2·3) mm). Three patients had solitary stones and 15 had multiple calculi. Most of the stones were removed with graspers, but the lithotripter was required in five patients. The mean(s.d.) hospital stay was 6(2·3) days. Two patients required postoperative endoscopic retrograde cholangiopancreaticography for residual stones.

Conclusion

The rigid nephroscope was useful for laparoscopic bile duct exploration, particularly for large impacted stones.

True knot in Ryles tube: a case report

Insertion of Ryles tube is a simple routine procedure. During its insertion, minor complications like trauma to nose, nasopharynx and oral cavity do happen from time to time. But as the Ryles tube is usually inserted blindly, potentially life threatening complications like inadvertent entry into trachea, cranial cavity and intravascular penetration have been reported. Folds and kinks may occur, but true knot of the Ryles tube, which we now report, is very rare.

Male urethral cancer

A 55 years old man presented with long standing voiding obstructive symptoms like poor stream, frequency of micturition, straining at micturition and a sense of incomplete evaluation since 2002. He was clinically diagnosed a case of stricture urethra. Later he developed a swelling in the penoscrotal region with retention of urine in March 2005 and was treated by dilatation. But on removal of the catheter he developed retention again for several times and ultimately for gross periurethral sepsis, urinary diversion was required in May 2005. In October 2005, biopsy from the scrotal abscess wall established the diagnosis of urethral carcinoma. In November 2005 extensive penoscrotectomy was done followed by chemo-radiotherapy. But the prognosis was so bad that the patient died in November 2006. Urethral carcinoma is a rare disease diagnosed in the department of urology, Mymensingh Medical College Hospital, the prognosis of which is also poor even after extensive operations.

Pyomyositis: a diagnostic problem

A case of a 45-year-old lady presenting with symptoms suggestive of pancreatitis is described. Initially the findings on Imaging were ambiguous while the enzyme studies were against the diagnosis of pancreatitis. Recurrence of symptoms and with Increased intensity prompted repeated imaging and further investigations. Finally, by a combination of CT scan, MR imaging and muscle biopsy the rare diagnosis of pyomyositis was established. The fact that this case was difficult to diagnose because of its rarity and its mimicking pencreatitis is discussed.

Leiomyoma of the urinary bladder

Benign mesenchymal tumors of the bladder are rare and comprise less than 1% of the all bladder neoplasms. Leiomyoma is the most common type and comprises 35% of these tumors. These tumors may develop in submucosal (63%), intramural (7%) or subserosal (30%) layer, at any region of the bladder. The clinical presentation is varied and may include obstructive symptoms(50%), irritative symptoms (38%) and hematuria (11%). There are asymptomatic cases (19%), which make the diagnosis more difficult. Occurs more frequently in women than in men (3:1). The most common diagnostic investigations are ultrasonography, intravenous urography, computerized tomography scan and the magnetic resonance imaging. A 66 year old man presented with long standing voiding obstructive symptoms. Various examinations were performed in the last 2 years and was diagnosed either prostatic enlargement or bladder tumor. Cystoscopy was not available for confirming the diagnosis. The surgical exploration revealed a well-circumscribed mass at the bladder neck with moderate enlargement of the prostate. The pathological examination revealed a leiomyoma of the bladder. The post operative period was uneventful and the patient is doing well, without recurrence of the symptoms.

Effect of body temperature on mortality of acute stroke

OBJECTIVES

The exact relation between body temperature and mortality of acute stroke victims is poorly understood. However, body temperature can affect the outcome of stroke cases in relation to mortality. In the initial (4-12 hrs) hours of stroke, the temperature rise is often neurogenic in origin and mortality is also higher with raised body temperature. Though the anatomical lesion or nature of lesion along with other established risk factors influence the mortality of stroke cases, change in temperature does affect the outcome of stroke cases. We sought to find out the significance of stroke victim's body temperature (within 4-12 hrs) with respect to short-term mortality rate in our study.

METHODS

We selected 100 ischemic and 100 hemorrhagic stroke patients proved by CT scan of brain and 2-hrly oral temperature was strictly recorded for the initial 4-12 hrs of admission.

RESULTS

It was evident from the study that hyperthermia (>37.5 degrees C) was associated with highest mortality rate in both hemorrhagic (51.78%) and ischemic (56.66%) cases. In normothermic group, mortality was 13.5% and 8.8% in hemorrhagic and ischemic group respectively, whereas hypothermia (<36.5 degrees C) was associated with 0 % mortality.

CONCLUSION

Hyperthermia in acute stroke victim carries a bad prognostic parameter in short term basis.

Effect of outer-membrane permeabilizers on the activity of antibiotics and plant extracts against Pseudomonas aeruginosa

Several known outer membrane permeabilizers increased susceptibility of a highly resistant pathogenic strain Pseudomonas aeruginosa to different antibiotics and plant extracts. Of all the chemicals tested, EDTA, sodium citrate and sodium hexametaphosphate (HMP) were found to be potent permeabilizers as shown by enhanced lysis of the bacteria in the presence of lysozyme. In the presence of EDTA and sodium citrate susceptibility of the strain to gentamicin and rifampicin increased markedly. The strain was resistant to vancomycin but became susceptible when grown in the presence of increasing amounts of EDTA and sodium citrate. Similar results were obtained for erythromycin when treated with sodium citrate. EDTA was found to be most potent permeabilizer in enhancing the activity of the plant extracts. Though HMP was an effective permeabilizer it had a weak or no effect on the activity of the antibiotics and plant extracts.

Peptides from the N-terminal end of bovine lactoferrin induce apoptosis in human leukemic (HL-60) cells

To determine the effects of the multifunctional iron-binding glycoprotein, lactoferrin (LF) and related compounds on the growth of leukemic cells, human myeloid leukemic cells (HL-60) were exposed to bovine lactoferrin (bLF) and proteolytic hydrolysates of bLF. Pepsin hydrolysates of bLF showed a greater growth suppressive effect than tryptic hydrolysates or mature bLF. Four peptides with proliferation inhibition activity were purified from pepsin hydrolysates by ion-exchange chromatography, reverse-phase HPLC, and gel-filtration. All peptides were from the N-terminal end, in a region where lactoferricin B (Lfcin B), an antibacterial peptide, is located. Among the four peptides, peptide 1 (pep1) was found to exhibit highest activity and corresponded to residues 17 to 38 of bLF, with a molecular weight of 2753.88. The IC50 value of this peptide was 6.3 micrograms/ml. Three other peptides were less active and corresponded to sequences 1 to 16 and 45 to 48, linked by disulfide-bridge (pep2, molecular mass of 2430.13), 1 to 15 and 45 to 46 linked by disulfide bridge (pep3, molecular mass of 2017,92) and from residues 1 to 13 (pep4, molecular mass of 1558.73). Cell proliferation inhibition activity of the peptides was thought to be due to induction of apoptosis, which was evaluated by DNA ladder formation, DNA fragmentation, enhanced expression of phosphatidyl serine, and morphological changes. The IC50 values of the three peptides were confirmed using synthetic peptides and were consistent with those of purified peptides.

Isolation and structure elucidation of a new antifungal and antibacterial antibiotic produced by Streptomyces sp. 201

An antibacterial and antifungal antibiotic was isolated from the culture filtrate of Streptomyces sp. 201, and its structure was determined as 2-methyl-heptyl isonicotinate by extensive use of NMR spectroscopy. The compound exhibited marked antimicrobial activity against Bacillus subtilis, Shigella sp., Klebsiella sp., E. coli, Proteus mirabilis, and the pathogenic fungi, Fusarium moniliforme, F. semitectum, F. oxysporum, F. solani and Rhizoctonia solani.

Role of ultrasonography and urinary cytology in diagnosing recurrence of superficial urinary bladder cancer compared to cystoscopy

Urinary cytology, ultrasonogram of the urinary bladder and cystoscopy were done in 99 cases of urinary bladder cancer patients in the department of urology of Dhaka Medical College Hospital (DMCH), Dhaka, during the period from January 1997 to December 1998. Pre transurethral resection of bladder tumour (TURBT), urinary cytology was positive in 20.20% cases and ultrasound scan was positive in 96.9% cases. Histopathological examination revealed 95.96% as transitional cell carcinoma:- Grade I (3.0%), Grade II (62.6%) and Grade III (34.4%). During follow-up urinary cytology was positive in only one case whereas ultrasound scan was positive in 53.5% cases of whom only 21.6% patients had actual recurrent bladder tumours proved by cystoscopy. Statistical analysis of the three tests and histopathology showed significant variation though by Chi-square test the ultrasound scan is found superior to urinary cytology. We conclude when ultrasonography of the urinary bladder shows any suspected lesion it should be examined by cystoscope and biopsy should be taken from the suspected area for confirmation. Neither urinary cytology nor ultrasound scan can replace cystoscopic examination.

Yeast protease B-digested skimmed milk inhibits angiotensin-I-converting-enzyme activity

Angiotensin-1-converting-enzyme (ACE) inhibitory activity was identified in skimmed milk digested with cell-free extract of yeast Saccharomyces cerevisiae. Simultaneously, a protease enzyme involved in the production of ACE-inhibition materials in digested skimmed milk was purified to homogeneity from the cell-free extracts of S. cerevisiae by ammonium sulphate fractionation and chromatography in DEAE-Sephacel, D-tryptophan methyl ester-Sepharose 4B, Hiload Superdex G-200 and HPLC Mono-Q chromatography. The purified enzyme was identified as protease B, based on the molecular mass on SDS/PAGE and the N-terminal amino acid sequence of the enzyme. The optimum pH for digestion of skimmed milk and production of ACE-inhibition materials was pH 4.8. The IC(50) of the hydrolysate was 0.42 mg of protein/ml when skimmed milk was digested with yeast protease B.

Coordinate production of cephamycin c and clavulanic acid by Streptomyces clavuligerus

Production of cephamycin c and clavulanic acid by Streptomyces clavuligerus was investigated using different media in shake flask condition. Highest cell growth (3.8 g/L) was observed in glycerol, sucrose, proline and glutamic acid (GSPG) medium. Although, GSPG medium supported maximum growth, it was least effective for the synthesis of both cephamycin and clavulanic acid. Yield of cephamycin and clavulanic acid was maximum in dextrin and K medium, respectively. High and low level of constituents of dextrin medium, affected production of both cephamycin and clavulanic acid. Biosynthesis of clavulanic acid was associated with production of cephamycin c.

Distribution of phage type of Vibrio cholerae O1 biotype ElTor in Indian scenario (1991-98)

During the period 1991-98, distribution of biotype, serotype and phage type of V. cholerae O1 strains isolated from different parts of the country and referred to the National Institute of Cholera and Enteric Diseases, Calcutta were studied. Of the 8101 strains received, 5613 (69.2%) were subjected to phage typing. All these strains belonged to the biotype ElTor and Ogawa was the predominant serotype (96.08%). The strains were clustered into only two types--types 2 and 4 and around 10 per cent strains remained untypable. However, using the new scheme, all these strains were found to be typable and 8 major types were recognized of which type number 27 was the predominant type (66.12%). The distribution of a common type throughout the country suggests that a particular clone of V. cholerae O1 is probably circulating all over India. A constant monitoring through phage typing is necessary to observe the emergence of any new clone of V. cholerae O1 in India.

Induction of apoptosis in HL-60 cells by skimmed milk digested with a proteolytic enzyme from the yeast Saccharomyces cerevisiae

Bovine skimmed milk digested with cell-free extract of the yeast Saccharomyces cerevisiae was found to exhibit proliferation inhibition activity towards human leukemia (HL-60) cells. The optimum pH for digestion of skimmed milk and production of the proliferation inhibition factor was pH 4.8. Nondigested skimmed milk exhibited little suppressive effect on the proliferation of HL-60 cells. An active enzyme involved in the production of cell proliferation inhibitory materials from skimmed milk was purified from the cell-free extract of S. cerevisiae by a series of column chromatographies: DEAE-Sephacel, D-tryptophan methyl ester-Sepharose 4B, Hiload Superdex G-200 and HPLC Mono Q. The homogeneous purified enzyme and exhibited a molecular mass of 33 kDa in sodium dodeceyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and was identified as protease B by N-terminal amino acid sequence analysis. Bovine skimmed milk digested with purified protease B was found to inhibit proliferation activity of HL-60 cells most strongly when digestion was conducted at pH 4.8. The cell proliferation inhibition activity induced by digested skimmed milk was shown to be due to the induction of apoptosis, demonstrated by the formation of apoptotic bodies and fragmentation of DNA in treated cells. The proliferation inhibition factors produced were recovered in the soluble fraction of 92% ethanol, suggesting that the factors were hydrophilic low molecular mass substances derived from skimmed milk.

In vitro transformation of ampicillin to cephalexin by free and immobilized cells of Streptomyces sp

In vitro transformation of ampicillin to cephalexin was studied using calcium alginate-immobilized and free Streptomyces sp. strain DRS-1 packed in glass columns. Tris-HCl buffer containing ampicillin was continuously circulated through the columns for four cycles, each cycle (with fresh ampicillin) being continued for 5 h. The pattern of product formation was identical in both cases, i.e. in each cycle, after reaching a certain concentration, its formation did not increase. Product formation was always higher with immobilized cells. Conversion of ampicillin to cephalexin by the strain was affected by cell and substrate concentration.

Laparoscopic cholecystectomy in multiple laparotomy Crohn's disease

Patients with complicated Crohn's disease often require several surgical procedures resulting in multiple adhesions. They also have an increased incidence of gallstones. Laparoscopic cholecystectomy is associated with several advantages but is problematic for the inexperienced surgeon in the presence of multiple adhesions. Laparoscopic cholecystectomy was performed successfully in three patients with Crohn's disease who had previous extensive abdominal surgery. The average operative time was 75 min, with an average hospital stay of 2 days and minimal blood loss. There were no postoperative complications. Provided specific precautions are taken during establishment of the pneumoperitoneum, an adequate adhesiolysis can be performed, rendering laparoscopic cholecystectomy feasible and safe in such patients.

Experimental biofilm and its application in malathion degradation

Mixed bacterial culture consisting of three different strains of Micrococcus sp. (AG 36, AG 94 and AG 98) and two strains of Pseudomonas sp. (AG 7 and AG 52) and its individual components was passed through a sand column and 25.5-92% of cell dry mass was found to be retained (adsorbed) on it. Incubation of sand soaked in mineral medium containing glucose as a sole carbon source resulted in formation of a biofilm with 1.2-2.5-fold increase in biomass. A 61% degradation of malathion by the mixed culture biofilm could be achieved in 4 d.

Complications of latissimus dorsi myocutaneous flap breast reconstruction

AIMS

To review the experience of a single unit in post-mastectomy reconstruction using the latissimus dorsi flap.

METHODS

A retrospective review of 111 cases treated between 1984 and 1993. The notes were evaluated for type of procedure, associated treatment and complications.

RESULTS

A significant morbidity of this procedure was demonstrated with 41 (37%) patients requiring a second operation during the period of the study. The majority of these second operations were related to the prosthesis used to achieve symmetry. Second operations were more common in those who had saline-filled prostheses. Other complications seen included wound infection, small areas of flap necrosis, hypertrophic scars and problems with the donor scar. No differences in complication rates were demonstrated for delayed vs immediate procedures or for patients receiving or not receiving radiotherapy. No life-threatening complication were seen during the study.

CONCLUSIONS

The latissimus dorsi reconstruction is reliable but the overall programme is beset with considerable morbidity. This factor needs to be taken into consideration when discussing reconstructive options with the post-mastectomy patient.

Degradation of fenitrothion by Bacillus stearothermophilus adhering to silica

B. stearothermophilus strain AG-49, when cultivated in mineral medium in the presence of silica (SA), adhered to SA. Adhesion depended on age of culture, contact time and glucose concentration of the culture medium. Mid-exponential phase culture (5 h) required minimum contact time (30 min) for maximum adhesion. 0.6% glucose concentration was optimum. Quantitative variation in protein and saccharide extractable in sodium chloride and sodium dodecyl sulfate (SDS) was observed. Five % degradation of fenitrothion by adherent B. stearothermophilus could be achieved in 4 d.

Crohn's disease presenting with acute colonic perforation

Crohn's disease is well known for its multiple intestinal complications. The chronic nature and fibrous inflammation which invariably accompanies this disease explains the relative rarity of free intestinal perforation. The true incidence of free bowel perforation is difficult to assess but 1-2% is the anticipated occurrence during the course of illness. We present a case of Crohn's disease which presented for the first time with acute colonic perforation, an extremely rare entity, and review the current world literature.