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.

Outcome of Percutaneous Tenotomy in the Management of Congenital Talipes Equino Varus by Ponseti Method

Congenital talipes equino varus (CTEV) is a common complex congenital anomaly affecting approximately 1 per 900 live births in Bangladesh. Current trends in the treatment of idiopathic clubfoot have shifted from extensive surgical release to more conservative techniques. The Ponseti method that includes manipulation, serial casting, percutaneous tenotomy and bracing has recently become very popular for the management of CTEV with reported excellent outcomes. The purpose of this study was to evaluate the outcomes of Percutaneous Tenotomy in the treatment of equinus deformity of idiopathic clubfoot. Between June 2012 and November 2013 we treated 47 feet in 34 children by the Ponseti method. The standard protocol described by Ponseti was used. Percutaneous tenotomy of the Achilles tendon was performed under local anaesthesia in the outpatient department of Dhaka Medical College Hospital. The Pirani score was used for assessment and mean follow up time was 12 months. The compliance of percutaneous tenotomy among the 47 feet was recorded and 40(85.1%) were good, 4(8.5%) were fair and 3(6.4%) were poor. The rating of final outcome of percutaneous tenotomy after one year follow-up periods among 47 feet, 36(76.6%) were good, 11(23.4%) were fair and zero (0%) were poor. This study permits to conclude the percutaneous tenotomy in Ponseti method as a safe, effective outdoor procedure to correct the residual equinus deformity of club foot after serial casting.

Urinary tract anomalies in patients with anorectal malformation

Urinary tract anomalies are common associated anomalies in anorectal malformation (ARM) and major contributory factor for high morbidity and mortality in ARM. In this study, urinary tract anomalies were evaluated in 72 patients of ARM (43 high varieties & 29 low varieties) that were admitted in Dhaka Medical College & Hospital (DMCH) during the period of January 2007 to April 2008. In all cases, evaluation was done by ultrasonogram (USG) and voiding cysto-urethrography (VCUG). Intravenous urography (IVU) was done in selected cases. Urinary tract anomalies were found in 20(27.85%) cases of ARM patients. These anomalies were significantly higher 16(37.2%) in high variety of ARM than 4(13.8%) those with low variety of ARM. The pattern of urological anomalies were vesicoureteral reflux (VUR - 35%), hydronephrosis due to PUJ obstruction (25%), posterior urethral valve (PUV - 15%), renal agenesis (10%), duplex ureter (10%) and bladder diverticulum (5%). Before definite management of ARM urological evaluation is essential to prevent renal damage and to reduce the morbidity and mortality.

Bis[benzylN′-(3-phenylprop-2-enylidene)dithiocarbazato-κ2N′,S]mercury(II)

In the title compound, [Hg(C₁₇H₁₅N₂S₂)₂], the Hg^II ion lies on a crystallographic twofold rotation axis giving a very distorted tetra­hedral coordination geometry best described as bis­phenoidal, being chelated by two deprotonated N,S Schiff base ligands through the azomethine nitro­gen and the thiol­ate sulfur donors. The dihedral angle between the two chelating ligand moieties is 79.75 (10)°. In the crystal, weak C—H⋯S inter­actions give rise to chains extending along the c axis.

Bis[benzyl 3-(3-phenyl-prop-2-enyl-idene)dithio-carbazato-κ(2)N(3),S]cadmium

In the title complex, [Cd(C₁₇H₁₅N₂S₂)₂], the Cd^II ion is located on a twofold rotation axis and exhibits a coordination number of four within a very distorted coordination environment that is best described as bis­phenoidal. The two deprotonated Schiff base ligands chelate the Cd^II ion through the azomethine N and the thiol­ate S atom. The dihedral angle between the two chelating ligands is 84.01 (9)°. Weak inter­molecular C—H⋯S inter­actions lead to the formation of chains along the c axis.

A phase II study of capecitabine-gemcitabine(CapGem) as a first line therapy in Bangladeshi patients with locally advanced or metastatic pancreatic adenocarcinoma

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Background: Pancreatic cancer is one of the cancers with very poor prognosis because of its diagnosis at an advanced or metastatic stages. There is no consensus on the optimal management of locally advanced or metastatic pancreatic cancer. This phase II study was designed to evaluate the efficacy and safety of CapGem in patients (Pts.) with pancreatic adenocarcinoma. Methods: From January 2001 to December 2004, 30 pts with; histologically / cytologically proven, bidimensionally measurable locally advanced or metastatic pancreatic adenocarcinoma, age 18∼75 years with ECOG performance status 0∼3, no prior chemotherapy, life expectancy >3 months, adequate bone marrow, renal, hepatic and haematological values were enrolled. It was an open - labeled, non-randomized, single - centered and prospective study. The pts received Capecitabine 750mg/m2 twice dailly,days 1–14,orally and Gemcitabine 1000mg/m2 days 1 & 8, intravenous infusion at an interval of 21 days.The efficacy was measured by response rates, CA-19.9 & pain status and safety was measured by adverse events and laboratory blood values. Results: This study consisted of 16 (53.33%) male and 14 (46.67%) female pts. Median age was 52 years. 18 (60%) pts were inoperable locally advanced and the remaining 12 (40%) were metastatic diseases where 8 hepatic and 4 pulmonary. In total, 152 cycles chemotherapy were administered with a median of 5.06 cycles per pt and 28/30 pts were evaluated for responses. The overall response was 9 ( 32.14%) with 2 complete and 7 partial responses. 14 pts (50%) had stable diseases and 5 (17.86%) had progressive diseases. There was 55% decrease in CA-19.9 and pain reduction was 60%. Overall survival was10 months. Grade 3 haematological toxicities were observed as follows: neutropenia 30% and anaemia 18%. Some non- haematological toxicities including nausea & vomiting 30%, diarrhoea 20% and hand foot syndrome 10% were observed. Conclusions: This phase II study supports the use of CapGem combination in chemo naive locally advanced or metastatic pancreatic adenocarcinoma due to its promising anti-tumor activity with well-tolerated toxicities in Bangladeshi pts.

No significant financial relationships to disclose.

A phase II study of docetaxel-carboplatin as first line therapy in the patients with visceral metastatic breast cancer: A Bangladesh experience

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Background: Metastatic breast cancer is heterogeneous and treatment decisions are influenced by multiple factors. Docetaxel remains as the standard chemotherapy agent in the management of metastatic breast cancer. We conducted a phase II study to examine the efficacy and tolerability of docetaxel with carboplatin in the treatment of visceral metastatic breast cancer patients. Methods: From July 2000 to December 2004, 32 patients with; histologically/cytologically proven, bidimensionally measurable visceral (pulmonary & hepatic) metastatic breast cancer, age 18–75 years with ECOG performance status 0–3, no prior chemotherapy, life expectancy > 3 months, adequate bone marrow, renal, hepatic and hematological values were enrolled. It was an open-labeled, non-randomized, single-centered and prospective study. The patients received docetaxel (75 mg/m2) and carboplatin AUC 5 on day 1 at an interval of 3 weeks. Outcome measures were response rates and tolerability was measured by adverse events and laboratory blood values. Results: This study consisted of 30 female and only 2 male patients. Median age was 55 years. 18 patients (56.25%) were presented with pulmonary metastases, where as there were 12 patients (66.67%) with single lung and the remaining 6 patients (33.34%) with bilateral lung metastases.14 patients (43.75%) had hepatic metastases. In total, 168 cycles chemotherapy were administered with a median of 5.25 cycles per patient, and 29/32 patients were evaluable for responses. The overall response was 62.07% with 8 complete responses and 10 partial responses. 6 patients (20.69%) had stable disease and only 5 patients (17.24%) had progressive disease. Grade 3 hematological toxicities were observed as follows: neutropenia (24%) and anemia (15.6%). Some non-hematological toxicities (including nausea, vomiting, fluid retention and peripheral neuropathy) in 15 patients (51.72%) were observed. No severe febrile neutropenia and no fatal events were observed. Conclusions: This phase II study supports the use of docetaxel-carboplatin combination in chemo naïve visceral metastatic breast cancer patients due to its very promising effects with well tolerated toxicities in Bangladeshi population.

No significant financial relationships to disclose.

Comparison of different methods of intracerebral administration of radioiododeoxyuridine for glioma therapy using a rat model

The Auger electron emitting agent 5-[125I]iodo-2'-deoxyuridine (i.e. [125I]IUdR) holds promise for the treatment of residual glioma after surgery because this thymidine analogue kills only proliferating cells. However, malignant cells which are not synthesizing DNA during exposure to the radiopharmaceutical will be spared. To determine whether tumour incorporation of [125I]IUdR could be enhanced by protracted administration, we used a C6 cell line, growing in the brains of Wistar rats, as a glioma model and compared three methods of intracerebral delivery of [125I]IUdR. Twenty-four hours after administration of drug, autoradiography of brain sections demonstrated nuclear uptake of the radiopharmaceutical in cells throughout tumour while normal brain cells remained free of radioactivity. The [125I]IUdR labelling indices (% +/- s.e.m.) achieved were 6.2 (0.4) by single injection, 22.5 (4.1) using a sustained release polymer implant (poly(lactide-co-glycolide)) and 34.3 (2.0) by mini-osmotic pump. These results emphasize the need for a sustained delivery system as a prerequisite for effective treatment. These findings are also encouraging for the development of a sustained release system for radiolabelled IUdR for use in the treatment of intracranial tumours, particularly in the immediate postoperative setting.

Iodo-2'-deoxyuridine (IUdR) and 125IUdR loaded biodegradable microspheres for controlled delivery to the brain

The aim of this work was to develop sustained local release systems for radioiodinated iodo-2'-deoxyuridine (125IUdR) from biodegradable polymeric microspheres to facilitate the controlled delivery of 125IUdR to brain tumours. The selective uptake of IUdR into the cell nucleus results in cell disruption over the short range of the low energy Auger electrons. The biodegradable microspheres can be precisely implanted in the brain by stereotactic techniques and the IUdR within the microspheres is protected from degradation and thus a sustained source of radiolabelled IUdR is available in the vicinity of the residual tumour cells. Poly(lactic-co-glycolic acid), PLGA (85:15), microspheres containing cold IUdR and the Auger-electron emitter 125I, as 125IUdR were prepared using the O/W, O/O and W/O/W emulsion-solvent evaporation methods. The W/O/W emulsion method was most effective in achieving good drug loading with the use of bovine plasma in the internal water phase. Also effective in improving the drug loading was the use of 20% acetone in the dichloromethane and the presence of Span 40 in the organic phase. Electrolytes (NaCl and IUdR) in the external aqueous phase also improved drug loading. After an initial rapid release from the microspheres, a sustained release was observed over 15 days for the 'cold' IUdR. The sustained release portions of the release curves showed Higuchi (t1/2), diffusion controlled release kinetics. The radiolabelled IUdR microspheres showed a burst release effect of 30-40% followed by a sustained release over 35 days.