Public opinion on renal transplantation in Brunei Darussalam

Brunei Darussalam is a small Muslim country with a high prevalence and incidence of kidney disease. At present, there is no local transplant program for patients on the renal replacement therapy program. In order to assess feasibility of a local transplant program, we decided to conduct a survey to assess public opinion on renal transplantation. The majority of the 300 respondents (78.7%) were willing to donate their kidneys if needed. Even after learning of the small theoretical risks of kidney failure, 72.33% of all respondents were still willing to proceed with transplantation. Respondents who had relatives on dialysis and who had a higher education level were more willing to donate their kidneys. There was no significant difference between Muslims and non-Muslims. Most respondents (59.7%) preferred to have transplantation done locally. This study shows that most Bruneians are receptive of the idea of living related kidney donations, which augurs well for the sustainability of a new program. More work is needed to overcome other barriers like the availability of surgical expertise and facilities and cost-benefit considerations.     

Role of oral clonidine on intraopereative haemodynamic stability for craniotomies of intracranial space occupying lesion

This was an analytical comparative study. Aim of this study was to observe the effect of oral clonidine on intra operative haemodynamic stability in intracranial space occupying lesion (ICSOL) patients who underwent craniotomy. Total 60 patients were distributed into case and control group. Number of cases was 30 in each study group of this study. Mean age of experimental and control were significantly close to each other. Baseline weight, pulse, systolic blood pressure, diastolic blood pressure and mean pressure also showed a significant similarity between each group. Variable of each group was collected during different events of craniotomy. All variable of pulse, systolic blood pressure, diastolic blood pressure and mean pressure were tabulated by line chart and fluctuation of variable was measured by significance test. The fluctuation of mean pressure was respectively 11.6%, 11.2%, 12.4%, 11.4%, 14.2%, 15.6%, 10% and 9.4% in different events of craniotomy in hemodynamically unstable group and it was respectively 11.1%, 10.9%, 10.4%, 9.9%, 9.2%, 9.4%, 8.6% and 8.7% in hemodynamically stable group. 'P' value was less than 0.05. It was observed that fluctuation of haemodynamic parameters were significantly less in experimental group where oral clonidine was used as premedication.     

Colles' fracture - is it a signal of osteoporosis?

Asymptomatic post-menopausal osteoporosis is common but some-times associated with pain and deformity. Symptomatic osteoporosis is usually associated with fracture. A 59 years old post-menopausal woman presented with a history of acute low-back-pain. She had menopause for 12 years. She gave history of colles' fracture at about two years back. Her mother died as consequences of femoral neck fracture. MRI of vertebral spine showed demineralization with partial collapse of D6,7,12 and L1 vertebra. Dual energy X-ray absorptiometry of vertebra showed BMD T-score of -4.5. Patient was managed with IV infusion of zoledronic acid, oral intake of vitamin D and calcium supplements and with regular non-weight-bearing exercises. Her condition improved gradually. During post-menopausal period, every women must be aware of osteoporosis and any fracture in that time must be evaluated to rule out osteoporosis.     

Testicular tumour - a diagnostic dilemma

A 45 year-old man presented to us with upper abdominal lumps of different sizes with heaviness and mild pain. He underwent two surgeries previously one was right sided orchidectomy through scrolal incision and another one laparatomy which was done four months later of 1st one. But in both situations - no biopsy were taken & failed to establish a diagnosis. On the basis of clinical, bio-chemical and radiological examinations - it was a diagnostic dilemma. Then we performed laparotomy followed by debulking and biopsy was taken for histopathological examination. It revealed metastatic teratoma of testis.     

The sentinel vein: an anatomical guide to localisation of the dorsomedial cutaneous nerve in hallux surgery

Damage to the dorsomedial branch of the medial dorsal cutaneous nerve is not uncommon in surgery of the hallux. The resultant morbidity can be disabling. In the light of the senior author's operative observation of a sentinel vein, we undertook a cadaver study to investigate the anatomical relationships of the dorsomedial branch of the medial dorsal cutaneous nerve. This established that in 14 of 16 cadaver great toes exposed via a modified medial incision, there is an easily identified vein which runs transversely superficial and proximal to the nerve. In a prospective clinical study of 171 operations on the great toe using this approach, we confirmed this anatomical relationship in 142 procedures (83%), with no complaint of numbness or pain in the scar at follow-up. We attribute this to careful identification of the 'sentinel' vein and the subjacent sensory nerve, which had been successfully protected from damage. We recommend this technique when operating on the great toe.     

Interleukin 3 and schizophrenia: the impact of sex and family history

Chromosome 5q21-33 has been implicated in harboring risk genes for schizophrenia. In this paper, we report evidence that multiple single nucleotide polymorphisms in and around interleukin 3 (IL3) are associated with the disease in the Irish Study of High-Density Schizophrenia Families (ISHDSF), the Irish Case-Control Study of Schizophrenia (ICCSS) and the Irish Trio Study of Schizophrenia (ITRIO). The associations are sex-specific and depend on the family history (FH) of schizophrenia. In all three samples, rs31400 shows female-specific and FH-dependent associations (P=0.0062, 0.0647 and 0.0284 for the ISHDSF, ICCSS and ITRIO, respectively). Several markers have similar associations in one or two of the three samples. In haplotype analyses, identical risk and protective haplotypes are identified in the ISHDSF and ITRIO samples in several multimarker combinations. For ICCSS, the same haplotypes are implicated; however, the risk haplotypes observed in the family samples become protective. Several significant markers, rs440970, rs31400 and rs2069803, are located in and around known estrogen response elements, promoter and enhancer of the IL3 gene. They may explain the sex-specific associations and be functional for the expression of IL3 gene.     

Interface software for DOSXYZnrc Monte Carlo dose evaluation on a commercial radiation treatment planning system

Purpose As the conventional graphical user interface (GUI) associated with DOSXYZnrc or BEAMnrc is unable to define specific structures such as gross tumor volume (GTV) on computed tomography (CT) data, the quantitative analysis of doses in the form of dose-volume histograms (DVHs) is difficult. The purpose of this study was to develop an interface that enables us to analyze the results of DOSXYZnrc output with a commercial radiation treatment planning (RTP) system and to investigate the validity of the system. Materials and methods Interface software to visualize three-dimensional radiotherapy Monte Carlo (MC) dose data from DOSXYZnrc on the XiO RTP system was developed. To evaluate the interface, MC doses for a variety of photon energies were calculated using the CT data of a thorax phantom and a uniform phantom as well as data from patients with lung tumors. Results The dose files were analyzed on the XiO RTP system in the form of isodose distributions and DVHs. In all cases, the XiO RTP system perfectly displayed the MC doses for quantitative evaluation in the form of differential and integral DVHs. Conclusion Three-dimensional display of DOSXYZnrc doses on a dedicated RTP system could provide all the existing facilities of the system for quantitative dose analysis.