Effect of Sildenafil Citrate on Pulmonary Arterial Systolic Pressure and Sub-maximal Exercise Capacity in Chronic Obstructive Pulmonary Disease.

Background Pulmonary hypertension (PH) often complicates Chronic Obstructive Pulmonary Disease (COPD). Sildenafil reduces pulmonary arterial pressure associated with multitude of diseases. Objective To evaluate the use of Sildenafil in Pulmonary Hypertension associated with COPD. Method This randomized control study enrolled 72 patients: 61 completed the study. Thirtypatients with COPD received Sildenafil 25 mg thrice daily and 31 patients with COPD received optimal medical therapy for four weeks. Symptom assessment and dyspnoea grading was done with modified Borg scale and Modified Medical Research Council (MMRC) grade. The functional assessment was done with WHO functional classification. The estimation of pulmonary arterial systolic pressure and six minute walking distance was done before and after four weeks of the administration of therapy in both groups. Adverse reaction profiling was done for Sildenafil. The primary outcomes were the changes in pulmonary arterial systolic pressure and six minute walk test. The secondary outcomes were change in modified Borg scale for dyspnoea, MMRC grading and WHO functional class. Result The mean decrease in pulmonary arterial systolic pressure in Sildenafil group was significant as compared to controls (9.87+7.84 mmHg Vs 5.93+7.44 mmHg, P=0.048). The mean increase in six minute walk distance was significantly more in cases as compared to controls (48.13+25.79 m Vs 32.59+32.96 m,P=0.047). The changes in modified Borg scale was not significant (1.20+1.92 to 1.55+1.23; P=0.401). There was significant changes in MMRC grade (p=0.037). There was no significant change in WHO functional class after four weeks (p=0.071). Conclusion Sildenafil marginally decreased pulmonary arterial systolic pressure and increased six minute walk distance in COPD patients. It improved MMRC grading without affecting modified Borg's Scale and WHO functional class.

The results of autogenous tibial periosteal transplants for full thickness cartilage defects in the knee joints of pigs.

An experimental study was conducted to demonstrate macroscopic and microscopic healing of full thickness cartilage defects with mature stable hyaline cartilage after autogenous tibial periosteal transplants in the knee joints of pigs. Similar full thickness osteochondral defects were created in the medial femoral condyles of both knees in 10 healthy young adult pigs. Periosteal transplants were performed on the left knees and the right knees used as controls. The pigs were sacrified in two groups at 6 weeks and 3 months. The knees were inspected for healing and stability of the graft. Microscopic sections were taken and evaluated using a histological score developed by O'Driscoll. Macroscopically, almost all defects with periosteal grafts healed with a translucent bluish-white colour indicating articular cartilage formation. There was good restoration of the bony contour and filling of the defects were superior to controls. Histologically, we were able to demonstrate immature hyaline cartilage which matured at 3 months. The newly formed tissue was stable and well-incorporated. It had almost complete bonding to the adjacent articular margin, good reconstitution of the osteochondral junction and a well maintained structural integrity. We concluded that periosteal transplants in the knee of a pig model healed with mature stable hyaline cartilage.

Pattern of leukemias: a ten-year incidence study of 242 cases.

This paper presents an analysis of data collected from 242 cases of acute and chronic leukemia observed during a 10-year period. The incidence of childhood leukemia was 26.45%. In the present series, it was 35.95% for ALL, 21.9% AML, 38.4% CML and 2.89% CLL. The incidences of ALL and CML were found comparable to other series from Bombay. The geographical variations in the pattern of leukemias as observed in India are discussed.