A Biomechanical Comparison between Taylor’s Spatial Frame and Ilizarov External Fixator

Taylor’s spatial frame (TSF) and Ilizarov external fixators (IEF) are two circular external fixator commonly used to address complex deformity and fractures. There is currently no data available comparing the biomechanical properties of these two external fixators. This study looks into the mechanical characteristics of each system. TSF rings with 6 oblique struts, 4 tube connectors, 4 threaded rods, and 6 threaded rods were compared to a standard IEF rings with 4 threaded rods. Compression and torsional loading was performed to the frame as well as construct with Polyvinylchloride tubes. TSF rings with 4 tube connectors had the highest stiffness (3288 N/mm) while TSF rings with 6 struts was the least stiff. The situation was reversed for torsion where TSF rings with 6 oblique struts had the highest torsional stiffness (82.01 Nm/Degree) and frame Ilizarov rings with 4 threaded rods the least. Standard TSF construct of two ring with 6 oblique struts have better torsional stiffness and lower axial stiffness compared to the standard IEF.

Stenting of Iliac Artery through Brachial Approach.

In some cases the iliac artery occlusive disease cannot be approached through standard access. The preferred access sites are the ipsilateral retrograde femoral and the contralateral antegrade cross-over, although occasionally these approaches do not allow an effective engagement of the lesion, especially when there is a total occlusion or complex aortoiliac lesion. We are reporting a case of iliac artery stenting through brachial approach.This technique is safe and effective. It provides enough support for stiff balloon or stent catheter to be advanced through this long sheath.

A Case Report of Middle Aortic Syndrome: A Rare Vascular Disorder.

The middle aortic syndrome (MAS) is rare (about 0.5-2% of all the cases of aortic coarctation) vascular disorder characterized by severe narrowing in the descending thoracic aorta, abdominal aorta, or both. It can be congenital or acquired due to several conditions.MAS may present clinically as uncontrolled hypertension, abdominal angina or lower limb claudication. Surgical treatment is effective in controlling symptom and improves life expectancy.

Mycotic Aneurysm of Aorta Following Mitral Valve Replacement – A Case Report.

The term mycotic aneurysm refers to aneurysm associated with infection by microorganism. Sir William Osler first coined the term mycotic aneurysm in 1885 by disclosing the relation between abnormal cardiac valves and infection with micrococci not with fungi. An 11 years old female from Feni presented with asymptomatic vascular swelling in abdomen referred by a cardiologist. CT angiogram revealed fusiform aneurysm in distal part of abdominal aorta involving ostioproximal part of both common iliac arteries and saccular aneurysm of distal part of superior mesenteric arteries suggestive of mycotic aneurysm. Patient underwent vascular operation aorto biilliac bypass by PTFE graft with excision and ligation of aneurysm of superior mesenteric arteries .Mycotic aneurysm in bacterial endocarditis is rare. It is a challenging job for the cardiologists, infectious disease specialists and vascular surgeon. Time appropriate skilled prompt surgical management can bring smile for both patients and physicians.

Aorto-bi-Femoral Bypass for Aorto-Iliac Occlusive Disease: Recent Experience at the National Institute of Cardiovascular Diseases (NICVD).

Background & Objectives: Aorto-bi-femoral bypass is one of the most important surgical strategies in vascular surgical practice. The procedure is employed in surgical revascularization for both stenotic and aneurysmal diseases involving the aorto-iliac segment. The present study was carried out to analyze our recent experiences with this procedure for aorto-iliac occlusive diseases (AIOD) at the National Institute of Cardiovascular Diseases (NICVD). Materials and Methods: Over a period of 3 years (April 2008 to March 2011), a total of 47 patients underwent aorto-bi-femoral or aorto-bisiliac bypass grafting for AIOD using a Y-graft prosthesis. The mean age of the patients was 46.4 years (range 25-75 years). Thirty eight of the patients were male and the remaining 9 were female. A retroperitoneal approach was used in 27 patients. In the remaining 20 patients, the operation was done using a transperitoneal approach. A Gelatin-coated Dacron Y-graft prosthesis was used in 43 (5 of which were silver-coated prosthesis) patients while PTFE (Polytetrafluoroethylene) prosthesis was used in the remaining 4 patients. The operation was carried out under epidural anesthesia with sedation in most cases. Results: The operation was well-tolerated in all patients. There was no intraoperative mortality in this series. Two patients died in the immediate post-operative period- one due to myocardial infarction and the other due to acute renal shut-down leading to renal failure accounting for a mortality rate of 4.3%. Wound infection and lymphorrhoea at the groin incision site were the two main immediate post-operative complications. There was no incidence of graft infection in this series. Twelve patients were available for post-operative follow-up up to 2 years. Out of them, 5 patients returned with occluded grafts 8-23 months after the operation. Three of these patients underwent graft excision with re-do Y-graft bypass. The remaining two were treated with extra-anatomic bypass (Axillobifemoral). Conclusions: Aorto-bi-femoral bypass is an effective surgical strategy for occlusive diseases involving the abdominal aorta and the iliac arteries. The procedure is well-tolerated with a low incidence of early post-procedural complications and graft failure. However, poor adherence of the patients to follow-up remains a significant obstacle for evaluating the long-term outcome of this procedure.

Thromboembolic Occlusion of Left Bracheal artery Protein-C and Protein-S Deficiency – A Case Report.

Protein-C and Protein-S deficiency states are responsible for 3-5% (Protein-C) and 2-3% (Protein-S) of patients with venous thrombosis. Some cases of arterial thrombosis have been reported. It occurs twice as often in female as in males. A 50 years old lady presented with acute severe pain in the left upper limb for 2 days. On investigation she was diagnosed as a case of bracheal artery thrombosis with Protein-C & Protein-S deficiency. Bracheal thromboembolectomy was done and discharge her with life long warfarin therapy. In one year follow up the patient had no untoward event and INR done every month and warfarin is adjusted.

Surgical Management of Vascular Complications in Intravenous Drug Abusers: Experience at the National Institute of Cardiovascular Diseases (NICVD), Bangladesh.

Background: Intravenous drug abuse (IVDA) is a global health care problem that has tremendous socio-economic implications. Vascular complications following IVDA are not uncommon and may have serious consequences. At the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, there has been a steady increase in the number of cases with vascular complications of IVDA in the recent years. Objectives: The present study was undertaken to evaluate our surgical strategy for the management of various vascular complications following IVDA. Materials and Methods: Over the last 5 years, a total of 45 patients presented at the NICVD with various complications of IVDA. Thirty seven patients presented at the emergency department with bleeding from ruptured aneurysm or with impending aneurysm rupture. The remaining 8 patients presented at the vascular outpatient with deep venous thrombosis, superficial thrombophlebitis and chronic venous insufficiency. After resuscitation when necessary, excision of aneurysm was done either with simple ligation of the artery (Group A) or with restoration of arterial continuity (Group B). Outcome in the two groups were compared against the following parameters; acute limb ischemia, chronic limb ischemia, wound infection and lymphorrhoea. Results: There was no in-hospital mortality in this series. Both ligation and restoration of arterial continuity following aneurysmectomy were effective in treating the bleeding aneurysm. However, statistically significant differences were seen between the two groups in terms of acute and chronic limb ischemia. Restoration of arterial continuity was more effective in preventing acute and chronic limb ischemia. Conclusions: In Bangladesh, the incidence of IVDA with vascular complications is increasing at an alarming rate. In patients presenting with arterial pseudoaneurysms, surgical management should be aimed at restoration of arterial continuity whenever feasible.

Cost- Effective Management of Venous Ulcer.

Background: Venous disorders are very common. About 20% of the population suffer from varicose veins, 2% have skin changes which may precede venous ulceration1. Venous ulcers represent a common and debilitating condition associated with significant financial loss for the patients as well as the society. Treatment options for these patients are costly and time consuming. In this study we tried to find out cost -effective measures for treating this group of patients. Method: To evaluate the effectiveness and safety of superficial and perforating leg venous surgery along with pharmacotherapy 66 patients with chronic venous leg ulcers are prospectively studied. After proper history taking and clinical examination all patients underwent venous duplex ultrasonography. Patients were divided into two groups. Group I (n=30) includes patients undergoing saphenofemoral ligation and stripping of the great saphenous vein (GSV). In group II (n=36) patients underwent saphenofemoral and incompetent leg perforator ligation along with stripping of the GSV. Conservative measures, local ulcer care and pharmacotherapy were common in both groups. Result: Postoperative complications, total hospital stay and ulcer healing were studied. Ulcer healing was earlier in group II. Remarkable complications were similar in both the groups. Conclusion: For effective and economic care of venous leg ulcers, combination of standard surgical procedures including incompetent perforator and saphenofemoral ligation with great saphenous vein stripping and standard physio-pharmacotherapeutic care is essential. This combined modality of treatment is highly effective in early and complete ulcer healing in patients suffering from venous ulcers.

Peripheral Vascular Stents in Clinical Practice.

The development of endovascular stents has been a major advance in the treatment of vascular diseases. Endovascular interventions are quickly replacing bypass surgery and endarterectomy as the primary treatment options for stenotic peripheral arterial lesions. Studies using stents in the carotid and iliac arteries have shown acceptable clinical outcome. In this review the basic aspects of different stents are discussed.

Changes of placental diameter thickness and cotyledon in eclampsia.

The study was done to see the changes of placental diameter, thickness and number of cotyledons in eclapmsia. A total 45 placenta, 25 from eclamptic mother and 20 from normal pregnant mother were collected from Gynaecology and Obstetric department of Mymensingh Medical College and Hospital (MMCH). Study was done in Anatomy department of Mymensingh Medical College (MMC). Macroscopic study of the formol saline fixed placentas revealed that, compared to the controls there was trend of less placental diameter in eclamptic group(p=0.0004). Cotyledon number was found to be significantly less in eclampsia (p=0.0001). However there was no significant difference in placental thickness in eclamptic placenta than that of normal group. Statistical significance of difference between two groups was calculated by using Students "t" test. A difference between the two groups was considered to be significant when p<0.005. The morphological changes in placenta are possibly due to reduced uteroplacental blood flow in eclampsia.

High resolution ultrasound of ophthalmic patients in a tertiary hospital.

The study was done to find out pathologic processes in ophthalmic patients in different age group to understand the use, role and limitations of ultrasonography in the diagnosis of ocular pathology in this locality. A prospective study was done on total 143 patients from September 2004 to January 2006 who attended Centre for Nuclear Medicine & Ultrasound, Mymensingh for ultrasound evaluation of eye. Total 100 (69.93%, n=100) cases were male and 43 (30.06%, n=43) cases were female. The age ranges were 2 months to 80 years. A variety of ocular pathology was diagnosed with the help of high resolution ultrasound (HRUS) with unique ultrasound appearance. Bulk of the referral patients had history of ocular trauma (38.46 %, n= 38) and most commonly detected pathology in these group are vitreous hemorrhage (34.44%, n=34) and cataract formation (28.28%, n=28). Almost all of the patients did not have conclusive diagnosis clinically and by conventional means available before ultrasonography were performed. High resolution sonography may be used as a valuable tool for evaluation of ophthalmic pathology as a well suited, noninvasive method, and only practical imaging modality for assessing those cases particularly when light conducting media are opaque.

Gross morphometry of human placenta in eclampsia.

The study was done to see the gross morphologic changes of placenta in human normal pregnancy and eclapmsia, with the aim that it would be able to increase the general body of knowledge regarding the gross morphology of normal placenta and the changes that occur in eclampsia in our population. Total of 45 (n=45) placenta, 25 (n=25) from eclampsia and 20 (n=20) from normal pregnant cases were collected from Gynaecology and Obstetric Department of Mymensingh Medical College & Hospital (MMCH). Study was done in Anatomy Department of Mymensingh Medical College (MMC). Macroscopic study of the formol saline fixed placentas revealed that, compared to the controls there was trends of lower weights and volumes of placentas in eclamptic group. Statistical significance of difference between two groups was calculated by using Students "t" test. A difference between the two groups was considered to be significant when p<0.005.

Tc-99m DTPA scintigraphy in soft tissue tumor.

Tc99m-DTPA scintigraphic study were done in Centre For Nuclear Medicine and Ultrasound (CNMU) Mymensingh presented with palpable soft tissue mass. All the patients referred to CNMU for ultrasonic evaluation of the mass. Taking proper consent form patient and we did the Tc-99m DTPA scanning of the masses. The study was carried out using Tc-99m DTPA in three phases dynamic, blood pool after 5 min, followed by a late scan after 2 hr. The uptake was categorized as consistently positive, initially positive but latter (progressively) negative, initially negative but latter (progressively) positive and consistently negative. Among our studied cases there were both benign and malignant lesion that were proved by histopathology after excisional biopsy. Two cases were inconclusive. Histologically proven lipoma showed no uptake of DTPA considered as consistently negative. Two cases of rhabdomyosarcoma showed consistently positive.

Prenatal diagnosis of achondroplasia.

A 25 years old lady came to Centre for Nuclear Medicine and Ultrasound, Mymensingh for ultrasonographic evaluation of gestational condition. Transabdominal ultrasonogram showed mal development of skeletal system with abnormally shortened limbs. This seems to be a case of achnodroplasia, which was proved subsequently true after termination of pregnancy.

Placenta previa and it's relation with maternal age, gravidity and cesarean section.

The placenta provides the essential connection between the mother and the developing fetus. Placental position were routinely mentioned in an ultrasound report starting from early second trimester to the end of third trimester when asked for pregnancy evaluation. The aim of this study was to see the prevalence of lower segment placenta (placenta previa) and its relations with previous cesarean section delivery, parity and maternal age. The study conducted in Centre for Nuclear Medicine and Ultrasound (CNMU) Mymensingh in a period from January 2001 to December 2002. About 2536 pregnant women (those included in this study) underwent ultrasound examination during pregnancy at third trimester. The prevalence of lower segment placenta was 1.34%. The highest prevalence of placenta previa (2.58%) was seen in 3rd and higher gravida group. Also the highest prevalence were seen 30 yr. and above age group in compare to below 30 yr. age group. No increased prevalence of placenta previa were seen in previous cesarean section (C / S) delivery group (0.65%) in compare to normal delivery group (1.97%). From our study it was seen that development of lower segment placenta has relation with increased number of gravidity and maternal age but no increased prevalence were seen in subjects with previously done cesarean section

Ultrasound guided fine needle aspiration cytology for diagnosis of mass lesions of liver.

The therapeutic and prognostic evaluation of malignant neoplasia of liver depends mostly on morphologic diagnosis. Ultrasound guided fine needle aspiration cytology (FNAC) of liver has been proved to be a rapid, reliable and cost-effective method for cytological diagnosis of hepatic mass lesions. This study was undertaken to find out the frequency of different benign and malignant space occupying lesions (SOL) of liver from patients attending for FNAC in Mymensingh. Ultrasound guided FNAC was performed on 108 patients with hepatic mass lesions from September 2, 2001 to August 19, 2003. There were 67 (62.0%) males and 41 (37.96%) females with a mean age 53 year (SD +/- 14) ranging from 2 to 83 years. Samples were adequate in 101 (93.5%) and inadequate in 7 (6.5%). Out of 101 adequate samples only one was benign (liver abscess) and 100 were malignant. Of the malignant lesions hepatoblastoma was in 1 (1%), hepatocellular carcinomas in 8 (8%), metastatic adenocarcinomas in 73 (73%) and unclassified malignancies were in 18 (18%). Most of the hepatocellular carcinomas occurred in males (7 in 8). The frequency of metastatic adenocarcinoma was more in males (39 vs. 34) but the difference is not significant (p > 0.05). Ultrasound guided FNAC of liver is a rapid, reliable and cost-effective diagnostic method. It can be practice in any centres where ultrasound facility and specialist pathologists are available.

Prevalence of antithyroid microsomal antibody in thyroid patients of endemic goitre area.

The region of greater Mymensingh known for iodine endemicity, recently came under iodine supplementation as a result of mandatory universal iodination of salt program. Autoimmune thyroid diseases (AITD) are among the most common human autoimmune disorders & presence of autoantibodies to the microsomal antigen (AntiMCAb) is a hallmark of disease activity. Both iodine deficiency & iodine supplementation precipitate increase rate of autoimmunity to the thyroid gland. Study was undertaken to determine prevalence of AntiMCAb positive cases among patients with various thyroid diseases. High resolution ultrasound (HRUS), serum thyroid hormone assays & scintiscan were used to classify the thyroid patients into 8 categories. 221 patients were studied during the stipulated period of 3 months. Male patients were 60 & female patients were 161. Age ranged from 11 to 65 years with median age 29.4 years. AntiMCAb test were done with radioimmunoassay (RIA). 126 patients had antimicrosomal antibody (57.01%). All form of hypothyroid (atrophic, goitrous, Hashimoto's) have very high rate of AntiMCAb positive cases. Highest 89.28% were seen in patients showing feature of Hashimoto's thyroiditis or generalized feature of AITD in HRUS with hypothyroidism, followed had 61.29% positive cases, However, antithyroid antibody was found in all form of thyroid disorders. Nodular goiter had 21.73% antiMCAb positive cases. AntiMCAb found positive at the rate of 33.33% in euthyroid patients with HRUS feature of AITD & diffuse euthyroid goiter, 40% in subclinical hypothyroid, 40% in subclinical hyperthyroid. Female rated higher in range of antimicrosomal antibody positivism. 59% of all thyroid patients among female subjects were AntMCAb positive, where as 51.67% male thyroid patients were positive. Highest number of positive cases found in the 30-35 age group. No definite pattern, however, was observed among age distribution. 20 age matched sample from patients unsuspected of thyroid disease shows 10% AntiMCAb positive compared to 73.33% of the same among same age group of thyroid patients. Frank Hashimoto's thyroiditis with positive antiMCAb and hypothyroidism were all detected by HRUS.

Gall stone in pregnancy.

Gallbladder disease is four times as common in women as in men, and pregnancy appears to contribute to the development of gallstones. During pregnancy, most women receive ultrasound scans, which are highly sensitive in detecting gallstones. The study was undertaken to evaluate the prevalence of gallstones among the pregnant woman. The aim was to determine any significant difference in the prevalence of gallstone among the pregnant woman compared to the generalized prevalence of gallstone in our community. METHODS: The maternal gallbladder was examined in 1336 consecutive obstetric ultrasound scans performed for medical indications at 3rd trimester of pregnancy. The study was conducted in Centre for Nuclear Medicine and Ultrasond (CNMU) Mymensingh on randomly selected subjects, among those who came here for ultrasound evaluation of pregnancy. 500 control were taken from age group between 20-30 yrs who came here for ultrasound examination of lower abdomen other than pregnancy. RESULTS: Gallstone were found in total one hundred eight cases. Prevalence of gallstone in pregnant woman was 8.08% (n=108). The age ranges were 20 to 45 yrs with mean age of 28.21 +/- 4.95 (mean +/- SD) yrs. The highest prevalence (12.71%) were seen in 3rd or higher gravida group with mean age of 30.32 +/- 4.74 yrs. Significantly higher cases of gallstone were found in multiparity compared to control population of same age group. CONCLUSIONS. Repeated pregnancy causes increased gallstone formation due to changes in gallbladder kinetics leading to stasis and stone formation.

Hydrops fetalis: report of 3 cases.

Ultrasound is a well recognized imaging modality for prenatal diagnosis of fetal congenital anomalies. Reported cases are hydrops fetalis diagnosed during ultrasonic evaluation of fetal condition in the Center for Nuclear Medicine and ultrasound (CNMU), Mymensingh. Only fetal ascites was detected in one case of 26 +/- 2 wks of gestation, fetal ascites with hydramnios and thick placenta was seen in another case of 28 +/- 2 wks of gestation. In third case, there was fetal ascites, scalp edema, hydrothorax and myelomeningocele with oligohydramnios at 20 +/- 2 wks of gestation; sonographic diagnosis was hydrops fetalis with myelomeningocele. Follow up was advised in first two cases and third case was terminated electively. To decrease the mortality rate and to improve the outcome of hydrops fetalis cases appropriate prenatal investigations and therapy is needed. Recent advances in prenatal ultrasound have made possible the early detection of hydrops fetalis which is helpful for proper management in time.