Effect of pre-treatment with desferrioxamine and mannitol on radical production and kidney function after ischaemia-reperfusion. A study on rabbit kidneys

The effects of pre-treatment with mannitol and the iron chelator desferrioxamine on oxygen radical formation and glomerular and tubular function after ischaemia in the rabbit kidney were studied. Radicals were measured with ESR and spin trapping. At reperfusion after 60 min of renal ischaemia there was a significant increase in the production of free radicals in the venous effluent from the kidney. Administration of either mannitol or desferrioxamine given before ischaemia and before recirculation reduced the radical production significantly. The iron chelator appeared to be more effective. Glomerular function measured 48 h after reperfusion was significantly better after pretreatment with desferrioxamine and mannitol compared with mannitol alone. Tubular function did not differ between the two pre-treatment groups.

The value of fine needle aspiration biopsy in the management of breast disease

Fine needle aspiration biopsy is a technique used all over the world in the diagnosis and management of breast lumps. It is safe, quick, accurate, cost effective and acceptable to the patients. We reviewed 234 fine needle aspiration biopsies performed over a period extending from 1991-1993 for diagnosis of breast lesions. Majority of the patients presented with breast lumps (89.7%). On FNAB 144 (61.4%) cases were reported as benign and 60 (25.6%) as malignant. Histological diagnosis was available in 116 cases. On comparison with open biopsy diagnosis, FNAB was found to have a sensitivity of 96.4%, a specificity of 95.5% and efficiency rate of 96.2%. The results of the study endorse the use of FNAB as an accurate and effective technique in the management of breast ailments in our set-up.

Local control in medically inoperable lung cancer: an analysis of its importance in outcome and factors determining the probability of tumor eradication

PURPOSE

For patients who are medically unable to tolerate a surgical resection for technically resectable non-small-cell lung carcinoma, radiation therapy is an acceptable alternative. We report on the effect of achieving local control of the primary tumor on survival end-points, and analyze factors that may influence local control.

METHODS AND MATERIALS

We reviewed the records of 152 patients with medically inoperable non-small-cell lung carcinoma treated at our institutions. All patients had technically resectable lesions and no evidence of metastatic disease. Treatment was delivered using megavoltage irradiation to doses ranging from 45 to 75 Gy.

RESULTS

For patients with tumors 3 cm or less, locally controlling the tumor significantly improved survival (p = .0371). Patients with T1 tumors had a higher probability of survival and disease-free-survival than patients with larger tumors if the primary tumor was locally controlled, but this survival advantage disappeared if the tumor was not controlled. Overall, patients with smaller tumors had a lower incidence of distant spread, but this association was maintained only when the primary tumor was controlled (36 month risk of 10%, 23%, and 57% for tumors < 3 cm, 3-4.9 cm, 5 cm or greater, respectively, p = .0027). For patients whose tumors were not controlled, there was no significant difference in the risk of distant dissemination by tumor size. Higher radiation doses influenced local control and metastatic spread. We observed no influence of the initial field size in the risk of local control and in the probability of survival.

CONCLUSION

Radical radiation therapy is an effective treatment for small (T1 or < 3 cm) tumors when treated to doses of 65 Gy or more, and should be offered as an alternative to surgery in elderly or infirm patients. New therapeutic strategies to improve the local control rate should be considered for larger tumors, through the use of hyperfractionated treatment, endobronchial "boost" irradiation, and sensitizing chemotherapy agents.

Diarrhoea and feeding practices of young children attending two selected urban clinics in Dhaka

Data were collected from 150 mothers attending the outpatient departments (OPD) of one maternal-child health (MCH) clinic and one paediatric hospital in Dhaka for treatment of diarrhoea of their children during the period from March '90 to May '90. Feeding practices before and after occurrence of diarrhoea were evaluated to determine the knowledge and practice of changes in dietary patterns. The majority (58.67%) of children, who were all less than 5 years old, were in the younger age group (0-1 year) with slightly more occurrence in male children. The incidence rate was higher among children of low-income families and uneducated mothers. Among the children, 60.67% had 6-8 loose stools per day and 66% suffered from watery diarrhoea, which was mostly in the younger (0-1 year) age group (p < 0.001). The majority (60%) of mothers had incorrect knowledge about changing their children's diets; only 40% knew how to do it correctly, which was significantly (p < 0.001) related to the educational level. During diarrhoeal episodes among the 0-1 year age group, the number of mothers exclusively breastfeeding increased considerably (14.77% to 35.23%), and the number of mothers only partially breastfeeding decreased (62.5% to 43.18%), withholding (48.38%) or adding (9.68%) some items, or both (13.98%), showing significant change (p < 0.005) in diet with the education of mothers. "Some food items cause diarrhoea, others increase the frequency of loose motion, and withholding or adding some food cures it," they believed. The results of the study show that, through proper nutrition education, mothers can be helped to provide better home management of diarrhoea.

Radiation therapy in the management of medically inoperable carcinoma of the lung: results and implications for future treatment strategies

Surgery is the treatment of choice for resectable non-small cell lung carcinoma. For patients who are medically unable to tolerate a surgical resection or who refuse surgery, radiation therapy is an acceptable alternative. We reviewed the records of 152 patients with medically inoperable non-small cell lung carcinoma treated at our institution between 1982 and 1990. Patients with metastatic disease, mediastinal lymph node involvement or unresectable tumors were excluded. The actuarial overall survival at 2 and 5 years was 40% and 10%, respectively. The disease-free survival at 2 and 5 years was 31% and 15%. The disease-free survival for patients with T1 tumors was 55% at 2 years, versus 20 and 25% for T2 and T3 lesions, respectively (p = .0006). Increasing tumor dose was also associated with increasing disease-free survival (p = .0143). Overall, 66% percent of the patients were considered to have failed. Of these, 70% showed a component of local failure and 45% failed distantly. Patients with T1 tumors experienced a lower probability of failing locally or distantly than did patients with T2 or T3 tumors. A reduced risk of local and distant failure was seen for patients treated to doses of greater than 65 Gray, especially for T1 tumors. We conclude that radical radiation therapy is an effective treatment for small tumors when treated to doses of 65 Gray or more. Since local failure is the prominent pattern of relapse in patients with large tumors, new therapeutic strategies should be considered for this patient group.

The influence of age on the durability of Carpentier-Edwards biological valves. Thirteen years follow-up

Two hundred and ninety-nine patients received 325 Carpentier-Edwards biological valves from April 1976 to April 1982. Valves were placed in the following positions: 150 aortic (AVR), 120 mitral (MVR), 26 multiple (MR), 2 pulmonary (PR) and 1 tricuspid (TR). The mean age was 54.7 years. The total follow-up time was 2545 patient-years. Patients were divided into different age groups: less than 40, 40-49, 50-59, 60-69 and greater than 70 years and were followed-up for reoperations and tissue failure. Ninety-three operations were performed in 91 patients (30.5%) for valve related dysfunctions. The main cause of reoperation was primary tissue failure (85%). The respective incidence and risk of reoperation in the different age groups were 51.5% and 5%, 41.5% and 4%, 32% and 3%, 18% and 2.5%, and 0% for greater than 70 years of age. The risk of reoperation decreased significantly with increasing age (P less than 0.05). The respective incidence and risk of tissue failure in the age groups were 43.8% and 4.1%, 35% and 4%, 27.3% and 3.2%, and 17.2%, 2.4% and 0%. The freedom from reoperation and tissue failure was significantly higher in the older patient (greater than 60 years) compared to the younger patients (less than 60 years). The commonest cause of failure in young patients was calcification, while in older patients it was cusp rupture. Comparing aortic and mitral bioprostheses in the different age groups showed no difference between these valves in patients less than 50 years of age.(ABSTRACT TRUNCATED AT 250 WORDS)

CSF hydrocele--unusual complication of V-P shunt

CSF hydrocele as a complication of migration or extrusion of the peritoneal end of the V-P shunt has rarely been reported. Here the case of a 6 month old infant, born at 28 weeks gestational age, is reported. The baby was noted to have scrotal swelling, exacerbated by crying, two months after insertion of ventriculoperitoneal shunt. The hydrocele resolved following revision of the shunt. Possible pathophysiological causes are discussed.

Oral Versus Vaginal Misoprostol for Induction of Labour

It is sometimes difficult to select the most effective, easy to use, safest, widely accepted and less expensive method for induction of labour and thereby spontaneous vaginal delivery. Prostaglandin E1 analogue ie misoprostol as a successful method both in oral and vaginal form has been used for induction of labour. The present study was conducted with an aim to compare the efficacy and safety of oral and vaginal administration of misoprostol tablets for cervical ripening and induction of labour in pregnant women using similar dosing regimen in two groups of pregnant women. A prospective randomized trial was done on one hundred pregnant women for the purpose. They were between 37 and 42 weeks of gestation with singleton pregnancy, cephalic presentation and unfavourable cervix (modified Bishops score of 4 or less) in the department of Obstetrics and Gynaecology of Dhaka Medical college Hospital during the period between February 2003 and March 2004. The mode of delivery did not vary significantly between the two groups. Mean induction delivery interval, mean doses of misoprostol, number of women delivered within 24 hours, oxytocin requirement and mean time to delivery were nearly similar in the two groups. Only nulliparous women in oral group took longer time to deliver than vaginal group though it was not statistically significant. The mode of delivery also did not differ significantly. The proportion of emergency caesarean section was high in vaginal group than oral group. Neonatal outcome was satisfactory and the results were comparable. (J Bangladesh Coll Phys Surg 2006; 24: 44-49)