Management of thromboangiitis obliterans using distraction osteogenesis: A retrospective study

Background:

Thromboangiitis obliterans (TAO), also known as Buerger disease, is characterized by thrombosis in medium-sized arteries and veins along with a marked inflammatory response. TAO can be managed by using the principle of distraction osteogenesis to induce neoangiogenesis. We report thirty patients of TAO in the age-group of 20–50 years were treated with the Ilizarov method.

Materials and Methods:

Patients with severe rest pain (n=30), absent distal pulsation (n=30) and ulcer (n=6) and/or gangrene of the toes (n=4), who had failed the conservative pharmacological modalities of treatment were included. A lateral tibial corticotomy was performed and distraction applied by use of olive wire. A two-ring frame was used for all cases.

Results:

Of the 30 cases, 25 patients became pain free while 1 had partial relief of pain. The four patients worsened on treatment and developed frank infection were amputed. The average distraction was 1.8±0.3 mm (range: 1.5–2.2 cm). The mean consolidation period was 98±11 days, after which the fixator was removed. The total duration of treatment was 122±23 days. There were two cases of osteomyelitis in our series; both healed after debridement and both patients had good result, with relief of pain. The ulcers started healing by 4–6 weeks.

Conclusion:

The principle of the distraction osteogenesis including neoangiogenesis can be used for treatment of TAO and has an acceptable complication rate.     

Does catheter choice during embryo transfer alter the pregnancy rate?

Background

Although every step in the in vitro fertilisation (IVF) procedure is important, the impact of embryo transfer (ET) on pregnancy rate (PR) is significant. Of all the crucial aspects of ET the type of catheter used and the technique of transfer on the PR has drawn the maximum attention and controversy. We aimed to compare the outcome of two different ET catheters on the PR.

Method

A prospective analysis comparing the classical Frydman (Laboratoire CCD, France) and the soft Cook (Cook Medical, Indiana, USA) ET catheters was performed. Primary end-point was clinical pregnancy rate (CPR); secondary end-points were rates of difficult transfer. A total of 1,446 ETs were performed in women undergoing IVF treatment, of which 723 cycles were randomised to the Cook catheter and 723 to the Frydman catheter.

Results

It was observed that, although the Cook catheter was related to a slightly higher PR, the overall comparison failed to indicate a significant difference in CPR. It was also seen that the ease of transfer did not significantly affect the PRs.

Conclusion

Individual variables during ET may not contribute significantly to the success of an IVF programme; however, a holistic approach encompassing all the factors is quintessential to improve the PR.     

Liver transplantation in Indian Armed Forces—initial experience

Background

This study retrospectively analyses the initial experience of liver transplantation (LT) in the Indian Armed Forces.

Methods

Fifty-three patients underwent LT at Army Hospital (R&R) Delhi Cantt. between March 2007 and March 2011. Of these 35 patients underwent deceased donor liver transplantation (DDLT) and living donor liver transplantation (LDLT) was carried out in 18 patients. The surgical techniques, complications and mortality were analysed.

Results

A high consent rate of 35.9% for organ donation was achieved by the Armed Forces Organ Retrieval and Transplantation Authority (AORTA). Biliary complications occurred in five patients (9.4%). However, most of them could be managed by endoscopic interventions. Hepatic artery thrombosis (HAT) occurred in five patients (9.4%). Of these, two DDLT grafts were revascularised following HAT, by creating extra-anatomic arterial conduits with excellent outcome. The overall mortality was 18.8% (n = 10). There was no significant difference in the overall complications or mortality in patients undergoing DDLT or LDLT.

Conclusion

The overall survival and morbidity in this study is comparable to those from other centres. Urgent revascularisation of grafts following HAT should be attempted as it can salvage grafts with satisfactory outcome. There is a reduction in the incidence of biliary complications with refinements in surgical techniques.     

Evaluation of smartphone‐based testing to generate exploratory outcome measures in a phase 1 Parkinson's disease clinical trial

Background : Ubiquitous digital technologies such as smartphone sensors promise to fundamentally change biomedical research and treatment monitoring in neurological diseases such as PD, creating a new domain of digital biomarkers. Objectives : The present study assessed the feasibility, reliability, and validity of smartphone‐based digital biomarkers of PD in a clinical trial setting. Methods : During a 6‐month, phase 1b clinical trial with 44 Parkinson participants, and an independent, 45‐day study in 35 age‐matched healthy controls, participants completed six daily motor active tests (sustained phonation, rest tremor, postural tremor, finger‐tapping, balance, and gait), then carried the smartphone during the day (passive monitoring), enabling assessment of, for example, time spent walking and sit‐to‐stand transitions by gyroscopic and accelerometer data. Results : Adherence was acceptable: Patients completed active testing on average 3.5 of 7 times/week. Sensor‐based features showed moderate‐to‐excellent test‐retest reliability (average intraclass correlation coefficient = 0.84). All active and passive features significantly differentiated PD from controls with P < 0.005. All active test features except sustained phonation were significantly related to corresponding International Parkinson and Movement Disorder Society–Sponsored UPRDS clinical severity ratings. On passive monitoring, time spent walking had a significant (P = 0.005) relationship with average postural instability and gait disturbance scores. Of note, for all smartphone active and passive features except postural tremor, the monitoring procedure detected abnormalities even in those Parkinson participants scored as having no signs in the corresponding International Parkinson and Movement Disorder Society–Sponsored UPRDS items at the site visit. Conclusions : These findings demonstrate the feasibility of smartphone‐based digital biomarkers and indicate that smartphone‐sensor technologies provide reliable, valid, clinically meaningful, and highly sensitive phenotypic data in Parkinson's disease. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.     

Missile Injuries of Brain – an Experience in Northern Sector

During a period of one year, from Jan 99 to Dec 99, 60 cases of missile injuries were treated at our centre. 59 were males and one was a female and their average age was 25 years. 43 patients had suffered splinter injuries, 12 had gunshot wounds and 5 had suffered injuries by improvised explosive devices. Glasgow coma scale was < 5 in 8 patients, 5–8 in 14, 8–12 in 30 and 13–15 in 8 patients. Extensive comminution of skull bones was found in 10 patients. 35 patients had more or less clear penetration of the skull and the rest had orbito-cranial or facio-cranial wounds. CT scan revealed small haemorrhagic contusion with in-driven bones without mass effect in 15, contusion with mass effect in 36 cases, cortical contusions without in driven bones (tangential injuries) in 3, distant intracranial contusions in 4, intraventricular haemorrhages in 5, multilobar injuries in 14, and unilobar injury in 40. 52 patients were operated upon at our centre of which 30 were operated within 24 hours, 10 between 24 to 48 hours, 12 between 48–72 hours. Six patients were treated conservatively and 2 required only simple closure of scalp wound. Craniectomy was done in 10 and craniotomy in 42 patients. Two patients developed wound sepsis, one each developed aspiration pneumonia, septicemia, deep vein thrombosis and post-traumatic hydrocephalus. On follow up at 6 months, outcome as per Glasgow outcome scale was as follows: good outcome – 42, moderate disability in 7, severe disability in 6 and death in 5 patients. Retained bone fragments were found in 40% on follow up CT scan but none had brain abscess.Key Words: Brain, Craniotomy, Favourable outcome, Less aggressive surgery, Missile injury