Survival and prognostic association in stage IV colorectal cancer patients treated with chemotherapy in Bangladesh.

OBJECTIVE: Prognostic factors in colorectal cancer have lesser been evaluated in developing countries. This study aims to determine overall survival and prognostic factors for metastatic colorectal cancer patients who were non-operable and received chemotherapy. METHODS: The study retrospectively investigated 67 inoperable metastatic colorectal cancer patients at Square Hospital, Bangladesh. The primary endpoint was overall survival, and the secondary endpoints were prognostic association with factors. Survival probabilities were calculated by non-parametric Kaplan-Meier method and compared by log-rank test. Univariate and multivariable Cox proportional hazard models were implemented to assess the prognostic association. RESULTS: Median survival of the entire cohort was 14 months (95% confidence interval: 11-25). In multivariable analysis, two prognostic factors were independently associated with survival: Karnofsky performance status and carcinoembryonic antigen. Patients with Karnofsky performance status <70 had significant higher risk of death than those with Karnofsky performance status ≥70 (adjusted hazard ratio 4.25, 95% confidence interval: 2.15-8.39). Higher risk of death was found to be associated with higher carcinoembryonic antigen: adjusted hazard ratio was 1.72 (95% confidence interval: 0.81-3.68) and 2.96 (95% confidence interval: 1.25-7.01) for patients with carcinoembryonic antigen 10-100 and >100 ng/ml, respectively, while comparing with carcinoembryonic antigen <10 ng/ml. The presence of peritoneal metastasis and grade-III tumour significantly worsened the survival in univariate analysis (hazard ratio 2.46, 95% confidence interval: 1.32-4.57 and hazard ratio 1.74, 95% confidence interval: 1.01-3.03, respectively) but not in multivariable analysis (adjusted hazard ratio 1.92, 95% confidence interval: 0.88-4.18 and adjusted hazard ratio 1.25, 95% confidence interval: 0.66-2.36, respectively). CONCLUSION: The study reported survival of stage IV colorectal cancer patients undergo chemotherapy and identified that Karnofsky performance status and carcinoembryonic antigen are the poor prognostic factors to this cohort adjusting for other factors.

Prolonged survival with maintenance pemetrexed for a multiple primary malignancy.

Despite the fact that multiple primary malignancies (MPMs) are not new and have been diagnosed for about a hundred-year time, literatures on lung and colon primaries are scarce. We report a case of a 62-year-old Asian Bangladeshi man with stage IV lung adenocarcinoma who developed a metachronous stage II colon adenocarcinoma approximately 3 years later. A chemotherapy protocol of six cycles of pemetrexed/cisplatin followed by maintenance pemetrexed was used, and surgery was done for the colon primary. With more than 5 years of periodic follow-up, his disease remains stable without any local or metastatic recurrence. Definitive therapeutic protocols are unavailable, but information taken with caution from case reports may be of importance for treatment decisions of MPMs. We believe that management with careful judgement by a multidisciplinary team may result in a good outcome with longer survival.

Surgical anatomical measurements of patellar ligaments for blind method of medial patellar desmotomy of cattle during upward patellar fixation in Bangladesh / Mediciones anatómicas quirúrgicas del ligamento patelar por técnica ciega en la desmotomía medial patelar de ganado durante la fijación superior de la patela en Bangladesh

The study was aimed to determine the accurate location of giving incision and the width of the incision required to correct the problem of upward patellar fixation during blind method of medial patellar desmotomy. We took measurements of patellar ligaments in stifle joint of 50 indigenous and 50 crossbred slaughtered cattle without any apparent musculo-skeletal disorders were analysed. The average length and width of lateral, middle, and medial patellar ligaments for indigenous cattle were 9.360 +/- 0.339 and 3.056 +/- 0.226; 10.230 +/- 0.382 and 2.019 +/-0.258; 10.519 +/- 0.429 and 2.430 +/-0.232; for crossbred cattle 10.636 +/- 0.601 and 3.608 +/- 0.368; 11.580 +/- 0.724 and 2.330 +/- 0.205; 12.366 +/- 0.710 and 2.890 +/- 0.234 cm respectively. The average groove width for indigenous cattle and crossbred cattle between middle and medial ligament were 1.356 +/- 0.160 and 1.828 +/-0.186 cm and the highest width of groove between middle and medial patellar ligaments from the level of most cranial bulging of the cranial tibial tuberosity in the upward direction were 4.234 +/- 0.269 and 5.645 +/-0.358 cm respectively. Parameters measured were significantly different (p0.05) between indigenous and crossbred cattle. This study was suggested that incision should be made 4.234 +/- 0.269 and 5.645+/-0.398 cm proximally from the level of the most cranial bulging of cranial tibial tuberosity at the groove between middle and medial patellar ligaments, 2.430 +/-0.232 and 2.890+/-0.186 cm the mean width of the medial ligament to be cut during blind method of medial patellar desmotomy in indigenous and crossbred cattle respectively during surgical correction of upward patellar fixation.

El estudio fue dirigido a determinar la ubicación exacta de la incisión y el ancho necesario de la incisión para corregir el problema de la fijación superior patelar durante la técnica ciega de la desmotomia medial patelar. Se tomaron y analizaron medidas del ligamento patelar en la rodilla de 50 bovinos indígenas y 50 bovinos mestizos de criadero, sacrificados sin aparentes trastornos músculo-esqueléticos. El promedio de longitud y ancho lateral, central y medial del ligamento patelar para el ganado indígena fueron 9,360 +/- 0,339 y 3,056 +/- 0,226; 10,230 +/- 0,382 y 2,019 +/- 0,258; 10,519 +/- 0,429 y 2,430 +/- 0,232, y para el ganado mestizo 10,636 +/- 0,601 y 3,608 +/- 0,368; 11,580 +/- 0,724 y 2,330 +/- 0,205; 12,366 +/- 0,710 y 2,890 +/- 0,234 cm, respectivamente. El promedio del ancho del surco para el ganado bovino indígena y el mestizo entre el ligamento medio y ligamento medial fue 1,356 +/- 0,160 y 1,828 +/- 0,186 cm, y el máximo ancho del surco entre el ligamento medio y ligamento medial patelar desde el nivel más craneal del abultamiento de la tuberosidad tibial craneal en dirección hacia superior fueron 4,234 +/- 0,269 y 5,645 +/- 0,358 cm, respectivamente. Los parámetros medidos fueron significativamente diferentes (p 0,05) entre el ganado indígena y el ganado mestizo. Este estudio puede sugerir que la incisión puede ser hecha 4,234 +/- 0,269 y 5,645 +/- 0,398 cm proximalmente desde el nivel más craneal del abultamiento de la tuberosidad tibial craneal hasta el surco entre el ligamento patelar medio y medial. 2,430 +/- 0,232 y 2,890 +/- 0,186 cm fue la media del ancho del ligamento medio a ser cortada durante la técnica ciega de la desmotomía medial patelar del ganado indígena y mestizo respectivamente, durante la corrección quirúrgica de fijación superior patelar.