THE OUTCOME OF PULSELESS PINK HAND FOLLOWING CLOSED SUPRACONDYLAR FRACTURE HUMERUS IN PEDIATRICS.

Management of children with supracondylar humeral fractures with pulseless pink hands is still controversial, whether to choose operative or conservative treatment. Proponents of conventional treatment mentioned that most patients can restore the motor and sensory function of the hand shortly after the injury without the need to restore distal pulse by surgery. Opponents of this treatment strategy claim that many patients will develop limb shortening a few years after the injury leading to functional and psychological problems. In this study, we made a comparison of the outcomes of each treatment to help in making policy for the treatment of such types of injuries in our center. This study answers the question "Which method is preferred for treating supracondylar humeral fracture with suspected vascular injury represented by pulseless pink hand, and what are the short and long-term outcomes of each treatment method. The main objective of the study is to settle a policy for the treatment of such types of injuries in our center. This study is a retrospective for the 10-year period from 2010 to 2020, it included 74 patients with blunt trauma to one upper extremity. All patients were children aged one year to fourteen years. Patients with penetrating trauma, combined penetrating and blunt trauma, victims of burns and explosions, and patients with other co-morbidities were excluded. We have two treatment strategies: Conservative (watchful waiting) and Operative exploration. We compared the outcomes of these two strategies regarding the short-term outcome (6 months follow-up) and the long-term outcome (5 years follow-up). We looked for acute and chronic limb ischemia and chronic pain syndrome as the short-term follow-up, while we took limb shortening and chronic limb ischemia and limb function as variables of the long-term follow-up. We don't have the ability to control patients for the psychological examination by a psychiatrist, therefore; we excluded this variable from our study.

Methylenetetrahydrofolate reductase genetic polymorphisms and toxicity to 5-FU-based chemoradiation in rectal cancer.

BACKGROUND: There is a large degree of variation in tumour response and host toxicities associated with neoadjuvant chemoradiation for rectal cancer patients. We performed a complimentary pharmacogenetic study to investigate germline polymorphisms of genes involved in 5-fluorouracil (5-FU) and irinotecan pathways and their potential association with clinical outcomes and toxicities from neoadjuvant chemoradiation in patients with rectal cancer treated in a prospective genotype-directed study. METHODS: The germline DNA of 131 patients was genotyped for 10 variants in TYMS, MTHFR, DPYD, UGT1A1, ABCC1 and SLCO1B1 genes. Ninety-six patients were treated with 5-FU/radiotherapy (RT) and 35 received 5-FU/RT/irinotecan. Relationships between genetic variants and adverse events, tumour response, overall and disease-free survivals were assessed. RESULTS: MTHFR 1298A>C and MTHFR diplotypes (for 677C>T and 1298A>C) were associated with chemoradiation-related toxicity when 5-FU was used alone. MTHFR haplotypes (677C-1298C) and diplotypes (CA-TA and TA-TA) showed, respectively, a protective and a negative effect on the incidence of severe diarrhoea or mucositis. No association was observed between genetic markers and drug response. CONCLUSION: MTHFR polymorphisms can potentially predict toxicity in patients treated with 5-FU as a single chemotherapeutic drug.