Real-World Outcomes of Patients Starting Intravenous and Transitioning to Subcutaneous Vedolizumab in Inflammatory Bowel Disease.

BACKGROUND: Real-world data on starting intravenous (IV) vedolizumab (VDZ) and transitioning to subcutaneous (SC) treatment in inflammatory bowel disease (IBD) are scarce. AIMS: To assess treatment outcomes of patients with IBD starting IV VDZ and switching to SC VDZ in routine clinical care. METHODS: Adult patients with IBD switching from IV to SC VDZ treatment between 1 March 2020 and 31 December 2021 were identified from the Swedish IBD quality register. The primary outcome was SC VDZ persistence. Secondary outcomes included clinical remission, changes in quality of life (QoL) according to EuroQual 5-Dimensions 5-Levels (EQ-5D-5L) and the Short-Health Scale (SHS) and inflammatory markers, including faecal Calprotectin (FCP). RESULTS: Altogether, 406 patients with IBD (Crohn's disease, n = 181; ulcerative colitis, n = 225) were identified. After a median follow-up of 30 months from starting IV VDZ treatment, the persistence rates were 98%(178/181) in Crohn's disease and 94% (211/225) in ulcerative colitis. Most patients (84%) transitioned during maintenance therapy, and the median follow-up from switch to SC VDZ was 10 months. Compared to baseline, statistically significant improvements were observed in all domains of the SHS, EQ-5D index value and visual analogue scale. Median (interquartile range) FCP concentrations (µg/g) decreased from 459 (185-1001) to 65 (26-227) in Crohn's disease (n = 45; p < 0.001) and from 646 (152-1450) to 49 (20-275) in ulcerative colitis (n = 58; p < 0.001). CONCLUSION: Initiating IV VDZ and switching to SC treatment was associated with high persistence rates and improvements in measures of QoL and FCP. These findings are reassuring for patients who start IV VDZ and switch to SC VDZ.

Intramedullary Nailing System in Unstable Both Bone Diaphyseal Fractures in Children.

Background Forearm fractures in pediatric population is usually managed conservatively. Unstable fractures need operative intervention like closed or open intramedullary nailing or open reduction and internal fixation with plates and screws. However, there is no consensus regarding the method of treatment according to age group. Objective To standardize the use of elastic nailing system as effective form of treatment in terms of function, cost and lower complications as compared to widely used titanium nails in developed countries.Method Sixty eight pediatric patients with both bone forearm diaphyseal fractures were managed with closed reduction and intramedullary fixation with rush nail or k-wire and followed at least for 6 months for evaluation of radiological and functional outcome. Result Patients were divided into two age groups, Group A for age of 5 to 9 years (26 patients) and Group B for age of 10-15 years (42 patients). The mean time for union for Group A patient was 7.31 weeks which was significantly lower than that of Group B patients of 9.33 weeks (p-value < 0.05). All the patients in Group A had excellent outcome and 36 (85.7%) patients had excellent outcome and 6 (14.3%) had good outcome in Group B. 5 out of 68 cases (7.35 %) had minor complications (2 in Group A and 3 in Group B). The mean time for implant removal was 17.9 weeks in Group A and 22.9 in Group B. Conclusion Intramedullary fixation for unstable diaphyseal both bone fractures of forearm is safe and cost effective method of treatment with good to excellent functional outcome with union time being significantly lower in younger age group.

Safety and Efficacy of Spinal Anaesthesia in Percutaneous Nephrolithotomy.

INTRODUCTION: Renal stone is one of the common entities occurring in our population. There are different treatment modalities of stones; out of those percutaneous nephrolithotomy is one of the most popular and effective for the renal and upper tract stones. This study is based to compare the safety and efficacy of spinal anaesthesia and general anaesthesia in PCNL. METHODS: In a randomized prospective study 60 patients were divided in two groups; group 1 (n=30) underwent PCNL in general anaesthesia and group 2 (n=30) underwent PCNL in spinal anaesthesia in prone position with the conventional technique. Demographic, operative data, post operative complications, patients' satisfaction rate and follow up complications were recorded and analyzed between two groups. RESULTS: Mean age in group 1 was 39.10±12.45years and 36.10±14.18 in group 2 (P=0.100). Mean stone size in group 1 was 3.75±1.27cm and 3.23±1.36cm in group 2 (P=0.129).Similarly the operative time was 89.10 ± 49.38 min and 62.53±35.91 min in group 1 and group 2 respectively (P=0.042). There was no significant difference between the complications regarding the anaesthesia. Post operative nausea and vomiting were significantly higher in group 1 and headache in group 2 (p=<0.001). Overall patient satisfaction rate was higher in group 2 then in group 1 (p=0.01). Hospital stay in group 1 was 5.27±1.87 days and 4.53±1.88 days in group 2 (p = 0.07). Stone success rate was similar in each group (p =0.50). CONCLUSIONS: Spinal anaesthesia is a safe and effective method in performing PCNL.

Orthotopic neobladder urinary diversion for carcinoma of urinary bladder.

BACKGROUND: Invasive cancers of urinary bladder need radical cystectomy as an optimal treatment. Urinary diversions of different types are available after the procedure. Orthotopic neo-bladder reconstruction is an emerging technique of diversion in suitable patients. The aim of this study was to see the outcome of this procedure in our set up. METHODS: The patient with carcinoma of urinary bladder who underwent radical cystectomy and orthotopic neo- bladder reconstruction during five year period were included in the study from department of surgical oncology in a hospital. Studer type ileal pouches were made in all the patients and their outcomes were studied. RESULTS: There were 30 patients among which 28 were male and 2 female. Age ranged from 38-60 years with mean age of 49.6 years. Average operative time was 330 minutes. Average hospital stay was 16 days (range 14-30 days). Majority of patients were transitional cell carcinoma 26 (86.7%) in histology. Majority of cases presented in stage II (53.3%). Post-operative complications were ileus in 30%, urinary leak in 26.6% and pneumonia in 13.3% of patients. Mortality was 1 (3.3%) on 29th postoperative day. Patients were able to micturate with satisfactory stream postoperatively. CONCLUSIONS: Orthotopic neobladder has similar complication rates compared with other forms of continent diversions. This method gives less psychological trauma to the patients with higher acceptance. So we recommend transforming the technique from ileal conduits to neobladder in well-established pelvic reconstruction set ups.

Sentinel lymph node biopsy in breast cancer patients after overnight migration of radiolabelled sulphur colloid.

OBJECTIVE: To evaluate the performance and feasibility of sentinel lymph node biopsy in breast cancer patients using technetium-99m (99mTc) sulphur colloid and gamma probe. METHODS: From May 2000 to March 2001, 70 patients with a tumour less than 5 cm with clinically negative axillary lymph nodes underwent sentinel node biopsy followed by standard axillary dissection. 99mTc sulphur colloid was injected around the primary tumour the day before surgery and a gamma probe was used to detect the sentinel lymph node during the surgical procedure. Sentinel lymph node biopsy was compared with standard axillary dissection for its ability to accurately reflect the final pathological status of the axillary nodes. RESULTS: The sentinel lymph node was successfully identified in 67 of 70 patients (95.71%). The number of sentinel lymph nodes ranged from 1-5 (mean 1.5) and non-sentinel nodes ranged from 5-22 (mean 13.3). Of the 67 patients with successfully identified sentinel lymph nodes, 43.28% (29/67) were histologically positive. Sensitivity of the sentinel lymph node to predict axilla was 82.75%; specificity was 100%. Positive and negative predictive values were 100% and 88.3% respectively. The sentinel lymph node was falsely negative in five patients, yielding an accuracy of 92.53%. Sentinel lymph node biopsy was more accurate for T1 tumours than for T2 tumours. CONCLUSIONS: The gamma probe guided method after overnight migration of 99mTc sulphur colloid is technically feasible for detecting sentinel lymph nodes in most breast cancer patients, accurately predicting the axillary lymph node status, and appears more accurate for T1 lesions than for larger lesions. This minimally invasive axillary staging procedure represents a major advance in the surgical treatment of breast cancer.

How we performed chest wall reconstruction: analysis 31 cases.

OBJECTIVE: To see the results of patients who underwent chest wall resection and reconstruction (CWRR). SETTING AND DESIGN: Retrospective descriptional study. MATERIAL AND METHODS: We retrospectively reviewed all patients who underwent CWRR at Xingtai People's Hospital in China and B.P. Koirala Memorial Cancer Hospital in Nepal. A total of 31 patients were reviewed. Among them, 20 were male and 11 female. The median age was 63 years. The indications for resection were primary chest wall tumor in 21 patients (67.7%), lung cancer with invasion of chest wall 6 (19.4%), recurrence of breast cancer 2(6.3%), radiation necrosis 1(3.2%) and skin cancer 1(3.2%). RESULTS: The mean number of rib resected was 3.6 ribs, which induced a mean defect of 97.1 cm2. Concomitant resection was done in 13 patients, including lung resection 10, partial resection of diaphragm 2, and partial sternectomy 1. Seven patients underwent soft tissue reconstruction (STR) alone and 5 patients skeletal reconstruction (SR) alone. Simultaneous SR and STR were performed in 19 patients. Three patients (9.7%) developed postoperative complications. The median survival period was 22 months. CONCLUSION: Primary chest wall tumor and lung cancer invading chest wall are the most common diseases indicating CWRR. Simultaneous bony and soft tissue reconstruction was reliable for chest wall reconstruction in most cases and prevents postoperative complications.