Immunohistochemical Expression of Synaptophysin in the Adult and Developing Cervical and Lumbar Enlargements of the Spinal Cord of Rabbit

Background: The principle findings of synaptophysin immunoreactivity (SynpIR) during the ontogeny of rabbit spinal cord are: At E14, SynpIR precedes in the entire marginal layer especially at the entrance zone of dorsal root and motor neurite outgrowth emerged from the basal plate. At E21, SynpIR is expressed in the motoneurons of ventral and lateral horns of mantle layer growing into the ventrolateral columns of marginal layer. Methods: We found intensely stained thick tracts and diffuse axons among proliferating neuroblasts of mantle layer. The peripheral parts of ventral horns were occupied with closely packed multipolar neurons from which long dendrites departed toward the surface of marginal layer. Results: At E28, pronounced SynpIR presented in the ventral grey horn while the white matter was faintly stained., meanwhile the dorsal horn was more cellular than ventral and lateral horns. Few intensively SynpIR fibers cross the dorsal and ventral commissures. In adult, profuse SynpIR appeared in the entire grey matter, and stained dendrites departed from neurons in the lateral laminae into the adjacent funiculi as finger-like projections. These projections did not reach the surface, so that the outer one-third to onefourth of the funiculi contained little or no SynpIR. In the periphery of ventral horns, we found large multipolar neurons with faintly stained cytoplasm. The white matter and the neuroepithelial cells surrounding the central canal were almost unstained. Conclusion: Synaptophysinis a reliable marker for fiber outgrowth and synapse formation in therabbit spinal cord, and its differential expression levels is specific and almost completed before birth.

Sphincter saving surgeries for locally advanced low rectal cancer after neoadjuvant chemoradiation

Rectal cancer accounts for the largest distribution within one anatomical region of the large bowel, with approximately one third of all CRC located within the rectum. The Golden standard treatment of primary rectal cancer is curative surgical resection; however, affine balance remains between disease cure and restoration of gastrointestinal continuity. Combined modality has proven efficacy in many malignant tumors with advantage of organ preservation. Forty nine [49] patients with low rectal carcinoma were included in a prospective study, between Jan 2007 and Jan 2012. Preoperative chemoradiation was administrated to all patients and subjected to different techniques of sphincter saving surgery. Stage I and Stage IV disease at diagnosis were excluded from the study. Forty nine patients were included in the study. 27 [55%] patients were male and 22 [45%] were female the age range from 23 years to 70 years with the median age 46 years. The main presenting symptoms were bleeding per rectum and tenesmus. Stage II 18 patients [36.7%,], stage III 31 patients [63.3%. Complete clinical and pathological response in 3 patients [6%], and complete clinical response with only microscopically residual carcinoma in 20 patients [41%], partial response in 18 patients [36.7%], and no significant response in 8 patients [16%] 7 from 8 were mucoid carcinoma. Low anterior resection [LAR] in 22 patients [44.9%], Hartman 's procedure in 4 patients [8.1%], Coloanal pull-through [COP] was done in 19 patients [38.9%] and perineal colostomy in 4 patients [8.1%]. For patients with cola-anal pull-through technique complete dehiscent and retraction observed in 2 cases, Major leakage in one case, stenosis in 4 cases. There is tendency of colorectal cancers to affect younger groups. Most patients presented in advanced stage. Neadjuvant chemo radiation is an excellent tool in sphincter saving surgery. Coloanal pull- through technique is not wide spread technique for low rectal cancer with good oncological safety and acceptable functional outcome

Cutaneous Manifestations of Chronic Kidney Disease-An Observational Study in 100 Cases.

Chronic Kidney Disease (CKD) presents with an array of cutaneous manifestations. Newer changes are being described since the advent of haemodialysis, which prolongs the life expectancy, giving time for these changes to manifest. This cross sectional study was performed in 100 cases of CKD admitted in nephrology department of Dhaka Medical College Hospital (DMCH) and Bangabandhu Sheikh Mujib Medical University (BSMMU) from April 2008 to August 2008 to evaluate the prevalence of dermatologic problems. Among them most belong to 2nd to 5th decade, 68 are male and rests are female. Glomerulonephritis (44%), Diabetes mellitus (22%), Obstructive uropathy (13%) and Hypertensive nephropathy (12%) are found common causes of CKD. Among these patients 38% patients were treated with conservative treatment, 31% with intermittent peritoneal dialysis (IPD), 19% with haemodialysis and 12% with some form of immunosuppressive therapy. Total 88% of study population had some form of skin disorder; pallor was the most common (82%), while xerosis (61%), pruritus (53%), pigmentation (37%) and bacterial infection (37%) were other common problems. Purpura and fungal infection was 29% and 27% respectively. Viral infection (9%), dermatitis (4%), gynaecomastia (1%), kyrle's disease (3%) are relatively less common findings. Lindsay's nail was seen in 23% of patients and was more prevalent in glomerulonephritis and diabetic patients with prevalence of 13% and 9% respectively. Other nail changes included koilonychia (4%), subungual hyperkeratosis (1%), splinter hemorrhages (3%) onychomycosis (8%) and Beau's lines (1%). So, CKD is associated with a complex array of cutaneous manifestations caused either by the disease or by treatment.

Comparison of pancreatic remnant reconstruction methods after pancreatoduodenectomy

Surgery remains the main-stay therapy for periampullary carcinoma [PC] and provides the only chance of cure. Improvements of surgical technique, increased surgical experience and advances in anesthesia, intensive care and parenteral nutrition have substantially decreased surgical complications and increased the survival. We evaluate the safety and feasibility of 3 reconstruction methods of pancreatic remnant after Pancreatoduodenectomy [PD] such as Telescoping, Duct-to-mucosa pancreaticojejunostomy or pancreaticogastrortomy. This is Comparative prospective study of reconstruction methods of pancreatic remnant after PD was conducted on periampullary carcinoma patients admitted to South Egypt Cancer Institute from Nov.2008 to July 2012. Forty -one patients with periampullary carcinoma consisted of 23 men and 18 women with age ranged between 17-70 years, with a median age of 56 years. Characteristics of patients in the three groups were compared with Chi-square test. A variable was analysed with the Logistic Regression test. Survival rate was analyzed by use Kaplan-Meier test. P-value < 0.05 was considered statistically significant. 9 patients underwent duct-to-mucosa PJ, 17 patients Telescoping of pancreas into the jejunum and 15 patients PG, 30 stenting of pancreatic duct. There was a significant difference between 3 variable methods of reconstruction in leakage rate, operative time, technical difficulty and between stenting and non stenting pancreatic duct. Duct-to-mucosa PJ was least leakage rate, least post operative complication but associated with the longer reconstructive time and same resection time and it was the somewhat difficult. Duct-t-mucosa-PJ safe, least leakage, least blood loss; however PG is associated with more functional deterioration

Role of multislice computed tomography in evaluation of colo-rectal neoplasm

Computed tomographic [CT] colonography is a noninvasive, rapidly evolving technique that has been shown in some studies to be comparable with conventional colonoscopy for the screening of colorectal cancer. The addition of intravenous contrast material to CT colonography can aid differentiation of true colonic masses from pseudolesions such as residual stool and improves the depiction of enhancing masses that might otherwise be obscured by residual colonic fluid. The aim of this study is to assess the role of multi detector computed tomographic colonography in staging of colo-rectal neoplasm and detection of synchronous lesons such as adenomatous polyp. The study included fifty-five patients with suspected colo-rectal neoplasm and underwent MDCT colonography and fibro-optic colonoscopy on the same day. The MDCT colonography with IV contrast media has 94% accuracy for identifying tumor wall invasion by colorectal carcinoma and 71% accuracy for identifying regional lymph nodes involvement and the sensitivity of both MDCT colonography and fibro-optic colonoscopy equal in detection of polyps more than 5 mms. The contrast enhanced MDCT colonography is an excellent investigating tool in staging of colo-rectal neoplasm in detection of synchronous adenomatous polyps more than 5 mms

Determining Gestational Age in a Low-resource Setting: Validity of Last Menstrual Period.

The validity of three methods (last menstrual period [LPM], Ballard and Dubowitz scores) for assessment of gestational age for premature infants in a low-resource setting was assessed, using antenatal ultrasound as the gold standard. It was hypothesized that LMP and other methods would perform similarly in determining postnatal gestational age. Concordance analysis was applied to data on 355 neonates of <33 weeks gestational age enrolled in a topical skin-therapy trial in a tertiary-care children’s hospital in Bangladesh. The concordance coefficient for LMP, Ballard, and Dubowitz was 0.878, 0.914, and 0.886 respectively. LMP and Ballard underestimated gestational age by one day (±11) and 2.9 days (±7.8) respectively while Dubowitz overestimated gestational age by 3.9 days (±7.1) compared to ultrasound finding. LMP in a low-resource setting was a more reliable measure of gestational age than previously thought for estimation of postnatal gestational age of preterm infants. Ballard and Dubowitz scores are slightly more reliable but require more technical skills to perform. Additional prospective trials are warranted to examine LMP against antenatal ultrasound for primary assessment of neonatal gestational age in other low-resource settings.

Acceptability of massage with skin barrier-enhancing emollients in young neonates in Bangladesh.

Oil massage of newborns has been practised for generations in the Indian sub-continent; however, oils may vary from potentially beneficial, e.g. sunflower seed oil, to potentially toxic, e.g. mustard oil. The study was carried out to gain insights into oil-massage practices and acceptability of skin barrier-enhancing emollients in young, preterm Bangladeshi neonates. Preterm infants of <33 weeks gestational age were randomized to high-linoleate sunflower seed oil, Aquaphor Original Emollient Ointment, or the comparison group (usual care). A survey was administered at admission to assess routine skin-care practices prior to admission and at discharge to assess acceptability of emollient therapy during hospitalization. Oil massage was given to 83 (21%) of 405 babies before hospital admission, 86% (71/83) of whom were delivered at home. Application of oil, most commonly mustard oil (88%, 73/83), was started within one hour of birth in 51 cases (61%) and was applied all over the body (89%, 74/83) one to six (mean 2.2) times before admission. Of infants who received emollient therapy in the hospital, 42% (n=32) of mothers reported that the emollient applied in the hospital was better than that available at home, and only 29% would use the same oil (i.e. mustard oil) in the future as used previously at home. No problems resulted from use of emollient in the hospital. Topical therapy with sunflower seed oil or Aquaphor was perceived by many families to be superior to mustard oil. If caregivers and health professionals can be motivated to use inexpensive, available emollients, such as sunflower seed oil that are beneficial, emollient therapy could have substantial public-health benefit.

Trends in use of referral hospital services for care of sick newborns in a community-based intervention in Tangail District, Bangladesh.

The Projahnmo-II Project in Mirzapur upazila (sub-district), Tangail district, Bangladesh, is promoting care-seeking for sick newborns through health education of families, identification and referral of sick newborns in the community by community health workers (CHWs), and strengthening of neonatal care in Kumudini Hospital, Mirzapur. Data were drawn from records maintained by the CHWs, referral hospital registers, a baseline household survey of recently-delivered women conducted from March to June 2003, and two interim household surveys in January and September 2005. Increases were observed in self-referral of sick newborns for care, compliance after referral by the CHWs, and care-seeking from qualified providers and from the Kumudini Hospital, and decreases were observed in care-seeking from unqualified providers in the intervention arm. An active surveillance for illness by the CHWs in the home, education of families by them on recognition of danger signs and counselling to seek immediate care for serious illness, and improved linkages between the community and the hospital can produce substantial increases in care-seeking for sick newborns.

Clinical and bacteriological profile of neonatal septicemia in a tertiary level pediatric hospital in Bangladesh.

The present article is a descriptive analysis of clinical and bacteriological profile of neonatal septicemia in a tertiary care hospital in Bangladesh. Eighty six neonates with suspected sepsis were enrolled, out of which 30 were culture positive. Clinical presentation was non-specific. Majority (70%) of the cultures isolated gram negative bacilli, most commonly E.coli and Klebsiella. These isolates were most often sensitive to gentamicin, ciprofloxacin, and third generation cephalosporins. Twelve out of 30 culture positive cases died.

Important aspects in the management of hand injuries

This paper reviews important considerations in the functional use of the hand when faced with the repair of injuries of the finger tips, digital and palmar tendons, and' injuries of the metacarpophalangeal bones and joints. The surgical principles involved in the repair of such injuries are discussed and illustrated

Finger tip injuries

Eighty-eight patients with ninety finger tip injuries were treated: free grafts 48 and pedicle flaps 19. The simplest and fastest methods of repair were full thickness and split thickness grafts. The most satisfactory donor area for full thickness grafts was the inner aspect of the arm. In children and women the inguinal region was a more appropriate donor area. The hypothenar area was a very good donor site for split thickness and full thickness grafts. Skin flaps gave the best sensory and cosmetic results. The disadvantages of free grafts were the delay and the deficiency of the sensory return, and those of cross finger flaps were the disfigurement and liability of injury to the extensor tendon of the donor finger. The awkward position of the finger in thenar flaps was a source of discomfort. lnframammary flaps were bulky and disfiguring. Proximal amputation was reserved for manual labourers, especially in the little and ring fingers