ABSTRACT
Background: Congenital pseudarthrosis of the tibia, a rare but well-known disorder, has been remarkably resistant to all types of therapy designed to promote healing. Successful treatment consists of the union of the pseudarthrosis and maintenance of that union without malunion, re-fracture, or excessive shortening (<2cm) of the leg. The principle of treatment of congenital pseudarthrosis of the tibia (CPT) with the Ilizarov method corrects all angular deformities and maximizes the cross-sectional area of the pseudarthrosis. Nineteen patients with a total of 19 CPT were treated using the Ilizarov apparatus. CPT is the most perplexing challenging pediatric orthopaedic problem especially when the patient of below years of age and has a history of the previous operations and tibia narrow and osteoporotic. Therefore, the purpose of this study was to evaluate the results of treatment of CPT by the Ilizarov method. Material & Methods:The prospective study was done from July 2008 to June 2010 at the National Institute of Traumatology and Orthopedic Rehabilitation, Dhaka. Various forces were used to treat the pseudarthrosis site including compression, distraction, open reduction, resection and shortening, resection and bone transport, and a temporary intramedullary k-wire given through calcaneum and talus into the tibial medullary cavity.Results:Lengthening was performed in all except one of the 19 patients. One patient had developed nonunion in both the pseudarthrosis site and proximal corticotomy site. The deformity was tried to correct in all cases. The union rate was 94.73% with one treatment. There were three early re-fracture. Eight patients. had a persistent residual deformity of ankle valgus from 5-9 degrees and five patients had residual angular deformity at the pseudarthrosis site from 5-10 degrees.Conclusions:One patient’s angulation degree required revision surgery, Ilizarov. All patients were given Previous sites, residual angular deformity, and natural history were considered predisposing factors for re-fracture. Two re-fractures united with months (range 10 months). This technique produced initial pseudarthrosis with the correction associated with deformity inequality. angulation and valgus.
ABSTRACT
Back ground: Obesity is a potential risk factor for cardiovascular morbidity and mortality. As certain cardiovascular disorders associated with autonomic nerve which dysfunction often coexist in obese persons, investigations of autonomic nerve function especially parasympathetic nerve function in obese, for detection of early autonomic impairment can be potentially important to prevent complications. Objective: The present study was done to observe the parasympathetic nerve function status in obese persons in order to investigate the relationship of autonomic nerve function with obesity. Study design: This study was conducted in the department of Physiology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during July 2006-June 2007. For these 40 apparently healthy obese subjects of both sexes with BMI > 25 kg/sqm. were included in study group. Age and sex matched 40 apparently healthy non obese subjects with BMI range 18.5-22.9 kg/ sqm. were taken as control for comparison. Methods: To assess parasympathetic nerve function status, heart rate response to valsalva(valsalva ratio), heart rate response to deep breathing and heart rate response to standing (30th:15th ratio) were determined by 3 noninvasive cardiovascular reflex tests . Data were collected by recording ECG of all subjects under test condition. The correlations of these parasympathetic nerve function parameters with BMI were also studied. Unpaired Student‘t’ test and Pearson correlation coefficient test were used for statistical analysis. Results: Valsalva ratio (1.47±0.24 vs 1.67±0.31), HR response to deep breathing (19.62±5.55 vs 27.59±6.51) and HR response to standing (1.07±0.07 vs 1.13±0.018) were significantly decreased in obese subjects than those of non obese control. All these parameters were negatively correlated with BMI. and these relatioship were statistically significant. Conclusion: The results of this study indicate that parasympathetic nerve function may be reduced in apparently healthy obese subjects.