Evaluation of outcome of surgical excision of the nidus of osteoid osteoma of long bone.

Osteoid osteoma is a benign bone tumour usually found in the lower extremities of children and young adults. This tiny bone tumour causes pain out of all proportion to its size and hinders the daily activities. This Quasi-experimental study conducted in the department of Orthopaedic surgery of BSMMU from January 2008 to December 2009. Twenty one patients were included in the study where purposive sampling technique was used on the basis of inclusion and exclusion criteria and all the ethical conditions were fulfilled. Diagnosis was almost obtained by taking history, clinical examination, and relevant investigations. Clinical variables were age, sex, site, pain, swelling, deformity and outcome variables were painless active life, removal of swelling, prevention of deformity, rate of recurrence. After localization of the tumour with the help of C arm, the nidus was excised in a small block of bone. The outcome is categorized by consensus, as clinically successful, only if the patient was free of pain and was taking no medication. The treatment was considered to have failed if a subsequent procedure had been performed to remove tumour. Among 21 cases, 14(66.7%) were male and 7(33.7%) were female. Maximum number of patients 15(71.4%) was between 10 years to 20 years. Most of the patients (76.2%) affected by osteoid osteoma were young students and most of the patients (95.2%) experienced moderate aching pain, usually aggravating at night which was typically relieved by aspirin or other NSAIDs (71.4%). Lower limbs (76.2%) particularly femur and tibia were commonly affected. Out of 21 patients, 19(90.5%) patients have got immediate pain relief or required no medication. In only 2 patients (9.5%), subsequent procedure has been performed to relief pain. So, successful outcome (in 19 out of 21) was significantly (p<0.001) higher in comparison to failed. Surgical excision of the nidus is a simple and easy procedure and does not require extensive resection of bone. If localization is done properly success rate is high and patients can return to normal daily activities.

Management of unicameral bone cyst by using freeze dried radiation sterilized bone allograft impregnate with autogenous bone marrow.

Unicameral bone cyst is a common benign bone tumor and most frequent cause of the pathological fracture in children. We have started a prospective study for that treatment of unicameral bone cyst by using freeze dried radiation sterilized bone allograft impregnated with autogenous bone marrow in the department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University (BSMMU) during May 1999 to April 2012. Aim of this study was to see Freeze dried radiation sterilized bone allograft impregnate with autogenous bone marrow a satisfactory graft material in the treatment of unicameral bone cyst as well as factors such as patients age, sex, cyst size and site of lesion influence on cyst healing. A total 35 patients of unicameral bone cyst were operated. In this study out of 35 patients, male were 22(62.86%) and female were 13(37.14). Male Female ratio 22:13(1.70:1) Age of the patients ranging from 2 years 6 month to 20 years, mean age 12.18 years more common 11 years to 20 years 29(82.86%) patients. Common bones sites involvements are proximal end of Humerus 20(57.14%), proximal end of Femur 7(20 %), proximal end of Tibia 3(8.57%), Calcanium 2(5.71%), proximal end of Ulna 1(2.86%), shaft of Radius 1(2.86%) and Phalanx 1(2.86%). Final clinical outcome of unicameral bone cyst treated by thorough curettage of cavity and tightly filled with freeze dried radiation sterilized bone allograft impregnate with autogenous bone marrow in which healed (success rate) 88.57% (31) and recurrence rate is 11.43% (4). P value is <0.001. Follow up period was 6 month to 11 years. From our study it was realized that freeze dried radiation sterilized bone allograft impregnated with autogenous bone marrow is useful graft material for healing of the lesional area as well as restoring structural integrity for the treatment of unicameral bone cyst.

Outcome of early active mobilization in flexor tendon repair in zone II in hand.

Early controlled motion programs after flexor tendon repair in zone II of hand are designed to minimize adhesion formation by promoting the excursion of repaired tendons. The flexor tendon surgery especially in zone II is complicated. It is simplest in the newly injured and unscarred digit and the results of correctly rehabilitated primary repair are likely to be the best attainable. We conducted a study including 18 patients with 52 digits involving 80 flexor tendons in zone II to observe and record the result of the primary or delayed primary repair with early active mobilization protocol. Thirteen (72.22%) patients were below 30 years of age. Sixteen cases (88.89%) were sustained injury by sharp instrument either accidentally or by assault. Ring and little finger were involved in 50% instances. The repair was done with the modified Kessler core suture technique with locking epitendinous sutures with a knot inside the repair site, using polypropylene 4-0 and 6-0 sutures. The final assessment was done at 6 months post repair using the Louisville system of Lister et al. 61.54% (n=32) digits were shown excellent result whereas good results were seen in 23% (n=12) digits. Fair was shown 7.69% (n=4) digits and 7.69% (n=4) digits were shown poor results. P value was <0.001 by Z test which is significant. Complications included tendon rupture in 3(5.77%) cases (one thumb, one ring and one little finger) and contracture in 4(7.69%) cases whereas superficial infection and flap necrosis was seen in one (1.92%) case each. The primary or delayed primary repair of cut flexor tendons in zone II using the modified Kessler core suture and epitendinous suture with early active mobilization protocol has been given good result, with minimal complications.

Melphalan plus prednisolone in the treatment of multiple myeloma.

Various chemotherapies are used for better remission of symptoms of multiple myeloma as it is not a curable disease. This study was carried out to evaluate the response of melphalan plus prednisolone therapy for the treatment of Multiple myeloma. The study was conducted in the outpatient department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January to December 2009. A total of 21 patients were included in this study. Combinations of melphalan plus prednisolone were given. Data were analyzed by paired 't' test to evaluate the response after treatment. Most of the patients were within 40-60 years with a male predominance. Haemoglobin level significantly raised after therapy (p<0.001) and ESR was found significantly reduced of these patients after treatment (p<0.001). On the other hand no significant change seen in calcium level before & after therapy (p=0.713). Significantly raised albumin and B2 microglubulin level were also found after treatment (p<0.001). After therapy with malphalan plus prednisolone, 11(52.38%) patient's M Protein reduction was >75%, 7(33.33%) patients M Protein reduction was 50-75%, 1(9.5%) patient's M Protein reduction was >25-50% and 1(12.50%) patient's M Protein reduction was <25%. Mean±SD M protein values before & after therapy were 50.23±19.49 gm/l and 21.01±16.11 gm/1 respectively. M protein level significantly reduced after treatment (p<0.001).

Baker's method in the management of equinus deformity in cerebral palsy.

This prospective study was conducted in the department of orthopedic surgery in Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh, from January 2005 to December 2007. Total number of 20 patients with 37 feet of equinus deformity due to cerebral palsy was managed by Baker's method. Equinus deformity in cerebral palsy is not uncommon in our outpatient department. Before operation patient walks on tip toes and after operation by Baker's method by apponeurotic lengthening of gastrocnemius muscle, with extensive physiotherapy, patients can able to walk normally in plantigrade feet. Among 20 patients only the spastic diplegic or hemiplegic equinus deformity in cerebral palsy was between 3 years to 12 years with a mean age of 5 years 9.6 months (SD+/-2 years 4.97 months). There were 3(15%) unilateral and 17(85%) bilateral cases. Among 20 cases, 13(65%) were male and 7(35%) were female. All cases were followed up for period ranging from 4 month to 28 months. Final clinical outcome was satisfactory (excellent and good) in 34(92%) feet and unsatisfactory (fair plus poor) in 3(8%) feet (p<0.001).

Evaluation of surgical management of primary spinal tumours.

Spinal tumours, which are 5-10% of skeletal tumours, cause considerable morbidity and present challenging situations in their management. Surgery is often used in the treatment of spinal tumours. Now a day only few specialized spinal care centers have developed in Bangladesh. The prospective study regarding surgical management of primary spinal tumour might be beneficial for proper planning and patient management. All patients who underwent surgical resection of a primary tumor of the spine between July 2006 and May 2008, at the Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Patients were uniformly staged before surgery and baseline demographic and surgical variables were recorded, as well as an evaluation of general health related quality of life were done. Thirty-two patients (16 males and 16 females) were eligible for the study. Average age was 43.25 (range 15 to 85). There were 8(25%) vertebral body and pedicle tumors and 3(9.37%) extradural, 16(50%) intradural-extramedullary and 05(15.67%) intradural intramedullary. Only 5(15.63%) developed complication. In this series out of 32 patients, 15(46.88%) achieved excellent result and 10(31.25%) got good result and 5(15.5%) achieved fair and remaining 2(6.25%) patients achieved poor results after the management. Complete neurological involvement of patient did not show complete recovery. In addition to surgery, radiotherapy and chemotherapy are needed to sterilize the tumour bed. Early detection and surgery of primary spinal tumour give satisfactory results and patient can return to their normal life.

Osteopoikilosis.

Osteopoikilosis is very rare autosomal dominant disorder of unknown etiology which is found incidentally on radiological examination. It is also known as Albers-Schonberg disease or osteopathia condensans disseminata, characterized by the presence of multiple and often symmetrical radio-dense lesion in osseous tissue. Here we report a case of osteopoikilosis in a 30 years old man presented with left hip joint pain and restricted movements. Radiological study showed typical features of osteopoikilosis. Necessary investigations were done to exclude osteoblastic metastasis, tuberous sclerosis and synovial chondromatosis. The patient was treated with pharmacological and non-pharmacological approach with significant improvement of joint pain and movements.

Is affluent society aware of their health status?

Our study was done on 111 participants of different government institutions who were involved in the highest most responsibilities in their respective jobs. Their higher educational level, job stress, type1 personality affect a lot on their health status. Therefore, it was our concern to investigate the various health risk factors and their impacts on the health status of this study group. The aim of the study was to determine the prevalence and distribution of hypertension, diabetes mellitus, obesity, physical activity level and smoking status among the subjects. This cross-sectional study was done from July 2006 to June 2007. 2.7% of the subjects were newly diagnosed as hypertensive as well as urinary sugar was present in 3.6% of the subjects. The overall prevalence of hypertension was 24.32% and diabetes was 11.71%. Subjects who adopted regular physical exercise were less likely to develop hypertension. No significant association was found between BMI and hypertension as well as diabetes mellitus. In spite of their higher educational level, 30% of the subjects were smokers. So, regular check up of health status even in a year is necessary.

Varied presentation of biliary ascariasis and its consequences.

It is a prospective study was done in the department of surgery of Sher-E-Bangla Medical College hospital from September 2004 to June 2005. Twenty cases selected for the study. Among 20 cases 16 is female & 4 is male. The age range of the patient was between 20 years to 65 years. Ultrasonography is the main tool of diagnosis. ERCP is not available in this regional hospital. CT scan not done because it is expensive for the poor patient who are the mainly the subject in this study. Eighty percent (16) of the cases present with recurrent upper abdominal pain. Thirty percent (6) with acute Cholecystitis, 25% (5) with obstructive jaundice, 25% (5) with Cholangitis 5% (1) with mild pancreatitis, 5% (1) with perforation of hollow viscus and 5% (1) with hepatolithiasis. Seventy percent (14) of the cases treated conservatively 25% (5) cases have under gone routine elective operation and 5% (1) cases have under gone emergency operation. Females are the common victims (M:F-1:4). Provision of safe drinking water, regular deworming and improvement of personal hygiene can largely reduces the dreadful consequences due to infestation by worm.

Morphometric evaluation of immunoglobulin A-containing and immunoglobulin G-containing cells and T cells in duodenal mucosa from healthy dogs and from dogs with inflammatory bowel disease or nonspecific gastroenteritis.

OBJECTIVE: To investigate the distribution of IgA- and IgG-containing cells and T cells in the villi of duodenal mucosa from healthy dogs and from dogs with inflammatory bowel disease (IBD) of gastroenteritis. DESIGN: Case-control study. ANIMALS: 28 dogs, grouped according to clinical and histologic criteria: 11 dogs with IBD, 8 dogs with non-specific gastroenteritis, and 9 healthy dogs. PROCEDURE: Endoscopic biopsy specimens of duodenal mucosa from each dog were stained specifically for IgA and IgG heavy chains and pan T-cell (CD3) antigen, using immunoperoxidase techniques. Morphometric analysis, performed via an image-analysis system, was used to count IgA- and IgG-containing cells and T cells within paired contiguous villi from each dog. RESULTS: cells were the predominant immune cell type in all groups of dogs. Significant differences in the villus distribution of IgA- and IgG-containing cells and T cells were not observed. Healthy dogs had significantly higher T-cell counts than had dogs with IBD or gastroenteritis. Dogs with nonspecific gastroenteritis had a significantly higher concentration of IgA-containing cells than the other groups of dogs had. Significant group differences for IgG-containing cells also were evident, with dogs with IBD having the lowest cell counts. CONCLUSIONS AND CLINICAL RELEVANCE: High concentrations of IgA- and IgG-containing cells and T cells in the villus lamina propria cannot be reliably used to distinguish IBD from other intestinal disorders in dogs. Evaluation of T cells may be the most discriminatory method for differentiating dogs with IBD from clinically normal dogs via examination of intestinal biopsy specimens.