PROSPECTIVE RANDOMIZED STUDY ON TWO DOSE FRACTIONATION REGIMENS OF HIGH DOSE RATE BRACHYTHERAPY FOR CARCINOMA CERVIX: COMPARISON OF CLINICAL RESPONSE AND COMPLICATIONS IN ORGANS AT RISK

Introduction: Cancer Cervix is treated with a combination of external beam radiotherapy and intracavitary brachytherapy. With the recent American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix, at least Equivalent Dose 2 > 80 Gy for patients with complete response or partial response with residual disease less than 4cm is recommended. For non responders or those with tumors larger than 4cm at the time of brachytherapy, tumor dose escalation to an Equivalent Dose 2 of 85-90 Gy is recommended to point A. Present study was designed to see the feasibility of these guidelines in terms of local tumor control and toxicities to rectum and bladder in our group of patients. Material and Methods: Fifty patients of biopsy proven cancer cervix were enrolled. After pre-treatment evaluation all patients were delivered external beam radiotherapy 50 Gy in 25 fractions at 200 cGy/day with concurrent cisplatin on weekly basis. Patients were then randomized into three applications (Group A), four applications (Group B) of HDR Brachytherapy of 6 Gy each so that total treatment time does not exceed 8 weeks. BED and LQED were calculated and assessment of response and complications were assessed. Statistical analysis was done using Chi square test. Results: Mean age of the patients was 50 years. No significant hematological toxicities and radiation reactions were seen during external beam radiotherapy. The mean BED of group A for tumor, rectum and bladder was 137.3 Gy, 112.53 Gy and 103.23 Gy respectively and of group B was 155.3 Gy, 120.98 Gy and 111.95 Gy respectively. The mean EQD2 in group A at tumor, rectum and bladder was 74 Gy, 54.08 Gy and 61.94 Gy respectively and in group B was 82 Gy, 59.18 Gy, and 66.60 Gy respectively. There was no statistically significant difference in local response and early and late bladder reactions in both the groups. Conclusion: In a follow up of six months we did not find any significant difference in toxicities of rectum and bladder. Long term follow up is needed to see for late rectal and bladder toxicities.

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Comparison Between With Kirschner-wires Only And Combined Screw Fixation in Proximal Reverse Chevron osteotomy(PCMO) For Hallux Valgus Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000231 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Hwa Jun Kang ◽

Hong-Geun Jung ◽

Jong-Soo Lee ◽

Sungwook Kim ◽

Mao Yuan Sun

Keyword(s):

Hallux Valgus ◽

Screw Fixation ◽

Fixation Method ◽

Kirschner Wires ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Severe Hallux Valgus

Category: Bunion Introduction/Purpose: Kirschner-wires fixation, sometimes we have encountered pin irritation or pull-out. This is the reason why we consider additional fixation. Moreover, there are few reports according to comparison of fixation method, and Most of them focused on comparison K-wires or screw fixation only. Purpose of study is to compare clinical and radiographic outcome between Kirschner-wires only and combined screw fixation. Methods: The study included two different groups according to fixation methods. One with Kirschner-wires fixation (KW group) included 117 feet(of 98 patients), the other with combined screw fixation (KWS group) 56 feet (of 40 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. Results: The mean AOFAS score improved preoperative 65.5 to 95.3 at final follow up in group A, while preoperative 56.5 to 88.6 at final follow up. Pain VAS decreased from 5.7 to 0.5 in group A, whereas from 6.2 to 1.6 in group B. The mean HVA all improved from preoperative 38.5 to 9.3 at final follow up in group A and 34.7 to 9.1 in group B. The mean IMA and MSP also improved significantly at final follow up. In comparative analysis, the IMA did not show significant difference between postoperative and final state in group A, while showed significant increase in group B. Conclusion: We achieved favorable clinical and radiographic outcomes with minimal complications in patient with moderate to severe hallux valgus in both groups. However, this study shows no statistically significant difference in IMA during follow-up period and lower recurrence rate. Therefore we need to consider combined fixation method to provide better stability and can expect lower recurrence rate.

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Clinical results of Visian implantable collamer lens implantation according to various sizes and implantation angles

European Journal of Ophthalmology ◽

10.1177/11206721211033468 ◽

2021 ◽

pp. 112067212110334

Author(s):

Bu Ki Kim ◽

Young Taek Chung

Keyword(s):

Case Series ◽

Clinical Results ◽

Implantable Collamer Lens ◽

Retrospective Case ◽

Significant Difference ◽

Lens Implantation ◽

Group A ◽

The Mean ◽

Group B

Purpose: To investigate the clinical outcomes of Visian implantable collamer lens (ICL) implantation according to lens size and implantation angle. Setting: Onnuri Smile Eye Clinic, Seoul, Republic of Korea. Design: Retrospective case series. Methods: This study included 566 eyes of 283 patients treated with ICL implantation. Patients were divided into three groups: horizontally implanted same-sized ICL (group A), horizontally implanted different sized-ICL (group B: large ICL and small ICL) and same sized-ICL implanted with a different implantation angle (group C: horizontal and vertical). Results: At 12-month follow-up, the mean vault was 0.78 ± 17, 0.48 ± 0.13, 0.71 ± 0.18 and 0.44 ± 0.16 mm when large and small sized ICL was used in group B ( p < 0.001), and when ICL was horizontally and vertically implanted in group C ( p = 0.021), respectively. And the mean SE was −0.11 ± 0.30, −0.34 ± 0.42, −0.3 ± 0.56 and −0.64 ± 0.66 dioptres (D), when the large and the small sized ICL was used group B ( p = 0.039), and when the ICL was horizontally and vertically implanted in group C ( p = 0.036), respectively. No significant difference in UDVA, IOP and ECD between both eyes in groups B and C was observed. No statistical difference was found in the vault between both eyes for groups B and C. Conclusions: The vault was significantly higher and the SE was significantly more hyperopic when a larger-sized ICL was used or the ICL was horizontally implanted compared to when the ICL was vertically implanted.

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COMPARATIVE EVALUATION OF THE EFFICACY OF 4% MANGOSTEEN GEL AND 1% CHLORHEXIDINE DIGLUCONATE GEL IN MANAGEMENT OF PATIENTS WITH CHRONIC GINGIVITIS: A RANDOMIZED CLINICAL TRIAL

International Journal of Research in Ayurveda and Pharmacy ◽

10.7897/2277-4343.1206161 ◽

2022 ◽

Vol 12 (6) ◽

pp. 6-11

Author(s):

Vinayaka A.M. ◽

Gayathri G.V. ◽

Triveni M.G.

Keyword(s):

Clinical Trial ◽

Plaque Index ◽

Age Group ◽

Chlorhexidine Digluconate ◽

Gingival Index ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B

To clinically evaluate & compare the efficacy of 4% Mangosteen Gel and 1% chlorhexidine digluconate gel in managing patients with chronic gingivitis. Materials and Methods: A total of 50 patients with an age group of 20-45 years diagnosed with generalized plaque-induced gingivitis were selected for this clinical trial once attaining their informed consent. A thorough case history was chronicled comprising plaque index (P.I.), gingival index (G.I.) and Sulcus bleeding index (SBI) at baseline; then full-mouth scaling and polishing (SAP) was performed by a solitary attuned examiner. Patients were then randomly assigned into two groups using a computer-generated random numbering sequence system. Patients in group A received 4% Mangosteen Gel, and group B received 1% chlorhexidine digluconate gel for home application. The post-treatment follow-up examination for P.I., G.I. and SBI changes were assessed after 14 days and 21 days and compared with baseline data. Results: In both the groups, the mean plaque index, gingival index and sulcus bleeding index scores were significantly decreased after the 14th and 21st day compared to baseline scores. There was no significant difference between the groups, but only in group B, there was a substantial difference in SBI scores observed on day 21. Conclusion: 4% Mangosteen Gel and 1% chlorhexidine digluconate gel were clinically effective when used as an adjunct to SAP in managing patients with gingivitis. Hence, 4% Mangosteen Gel can be considered an alternative to 1% chlorhexidine digluconate gel without any side effects in managing generalized plaque-induced gingivitis.

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Comparison of microdebrider-assisted endoscopic sinus surgery and conventional endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps

Romanian Journal of Rhinology ◽

10.2478/rjr-2019-0011 ◽

2019 ◽

Vol 9 (34) ◽

pp. 91-95

Author(s):

Ramiya Ramachandran Kaipuzha ◽

Nirmal Coumare Venkataramanujam ◽

Padmanabhan Karthikeyan ◽

Davis Thomas Pulimoottil

Keyword(s):

Endoscopic Sinus Surgery ◽

Mucosal Injury ◽

Sinus Surgery ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Mean Time ◽

Sinonasal Polyposis

AbstractOBJECTIVE. To study and compare the benefits of microdebrider-assisted endoscopic sinus surgery and conventional endoscopic sinus surgery in terms of subjective and objective improvement in symptoms of nasal polyposis.MATERIAL AND METHODS. This study involved 60 patients with bilateral sinonasal polyposis scheduled to undergo Endoscopic Sinus Surgery. The patients were randomized into two groups: Group A -Conventional endoscopic sinus surgery and Group B -Microdebrider-assisted endoscopic sinus surgery.RESULTS. There was a significant difference in the mean VAS at 3 months postoperatively in Group B, but no significant difference at 6 months postoperatively following either of the two methods. The mean time for surgery (p<0.01) and the mean intraoperative blood loss (p<0.01) were significantly lower in Group B.CONCLUSION. A well-trained surgeon with proper anatomical knowledge, good instruments, hypotensive anaesthesia, minimal mucosal injury and regular proper follow-up will have similar postoperative results with both methods.

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Role of Zinc in Patients Presenting with Recurrent Hepatic Encephalopathy in Medical Unit of Tertiarycare Hospital Lahore

Esculapio ◽

10.51273/esc20.251631 ◽

2020 ◽

Vol 16 (03, july 2020-Septmber 2020) ◽

Author(s):

Asma Kamal ◽

Asifa Kamal ◽

Naeem Afzal ◽

Shazia Siddique ◽

Khadija Tahir

Keyword(s):

Hepatic Encephalopathy ◽

Zinc Supplementation ◽

Mean Value ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Improved Outcome

Abstract Objective: To observe the effects of zinc replacement on hepatic encephaopahty. To reducce hospital admission and heath burden by reducing episodes of recurrent hepatic encephalopathy. Methods: This study was carried out on 160 patients presenting with hepatic encephalopathy in medical ward of services hospital Lahore. The aim of the study was to assess the role of zinc in the improvement of encephalopathy. Results: The mean age of patients in group A was 55.78 and that in group B was 56.88years.There was significant difference in mean value of hepatic encephalopathy grade in both groups A and B after 3 months of follow up (p.value 0.027) indicating zinc is beneficial in treatment of hepatic encephalopathy. Conclusion: Our study showed that zinc replacement improved outcome in patients with Hepatic encephalopathy. Key words: Hepatic encephalopathy, zinc supplementation, chronic liver disease.

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Methotrexate plus narrow band ultraviolet B (NBUVB) versus methotrexate alone in the treatment of moderate to severe plaque psoriasis: A randomized clinical trial

Nepal Journal of Dermatology Venereology & Leprology ◽

10.3126/njdvl.v13i1.14298 ◽

2016 ◽

Vol 13 (1) ◽

pp. 12-23 ◽

Cited By ~ 1

Author(s):

Dhan Keshar Khadka ◽

S Agrawal ◽

T K Dhali

Keyword(s):

Plaque Psoriasis ◽

Negative Impact ◽

Ultraviolet B ◽

Plaque Type ◽

Number Of Patients ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B

Introduction: Psoriasis is a chronic, recurring inflammatory disease affecting the skin, joints and nails that has a significant negative impact on the quality of life. Efficacy of combination of methotrexate/narrowband ultraviolet B (NBUVB) phototherapy in the treatment of psoriasis has been rarely assessed. Objectives: To compare the therapeutic efficacy of methotrexate plus NBUVB phototherapy combination vs. methotrexate in the treatment of moderate to severe chronic plaque psoriasis. Material and methods: Seventy-nine patients with chronic plaque-type psoriasis (body surface area involvement >2%) were randomized to receive either methotrexate/NBUVB phototherapy (group A) or methotrexate (group B). End point of treatment was 75% reduction in Psoriasis Area and Severity Index (PASI75) Score or up to 12weeks, whichever was earlier. Patients were then followed up for a period of 12 weeks for assessment of adverse effect, DLQI and relapse.Results: Of 79 patients, 69 completed the treatment period and follow-up. PASI 75 was achieved in 35/39(89%) patients in group A and 34/40(85%) patients in group B (P=0.052). The mean number of weeks (P = 0.031), the mean cumulative dose of NBUVB (8.2±3.5J/cm2)) and the mean number of phototherapy sessions (12±3)) required to achieve PASI 75 were less in group A compared with group B. There was no significant difference in the number of patients who relapsed during the follow- up period (P = 0.68). Conclusion: Combination of methotrexate and NBUVB phototherapy provides more rapid clinical improvement compared with methotrexate monotherapy in the treatment for chronic plaque-type psoriasis.NJDVL Vol. 13, No. 1, 2015 Page: 12-23

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Feasibility of the Oberlin Procedure in Late Presentation Cases of C5-C6 and C5-C7 Brachial Plexus Injuries in Adults

Hand ◽

10.1177/1558944720918325 ◽

2020 ◽

pp. 155894472091832

Author(s):

Álvaro B. Cho ◽

Carlos H. V. Ferreira ◽

Fernando Towata ◽

Gabriel C. Almeida ◽

Luiz Sorrenti ◽

...

Keyword(s):

Brachial Plexus ◽

Nerve Transfer ◽

Elbow Flexion ◽

Late Presentation ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Flexion Strength

Background: Oberlin et al presented a new technique for nerve transfer that completely changed the prognosis of patients with brachial plexus injury. Currently, most of the literature addresses cases submitted to early surgical intervention, before 12 months from injury, showing consistent good results. The aim of this study was to evaluate the feasibility of the Oberlin procedure in late presentation cases (≥12 months), comparing the elbow flexion strength with patients operated earlier. Methods: We retrospectively reviewed 49 patients with partial brachial plexus injuries submitted to the Oberlin procedure. They were divided into 2 groups. Group A included 39 patients operated with <12 months of injury. The mean postoperative follow-up was 22.53 months. The interval from injury to surgery varied from 4 to 11 months (±8.45 months). Group B included 10 patients with surgery ≥12 months after injury. The mean postoperative follow-up was 32 months. The interval from injury to surgery ranged from 12 to 19 months (±15.4 months). Patients were evaluated monthly after surgery and the elbow flexion strength was measured using the British Medical Research Council scale. Results: In Group A, 24 patients presented with either good (M3) or excellent (M4) elbow flexion strength. In Group B, 9 patients presented with either good (M3) or excellent (M4) elbow flexion strength. A significant difference was not seen in the postoperative elbow flexion strength among the 2 groups. Conclusion: Biceps reinnervation with the Oberlin procedure is still feasible and should be attempted after more than 12 months of injury in partial brachial plexus injuries.

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Randomised prospective comparative analysis of functional outcome of osteosynthesis of intra-articular distal humerus fracture using triceps reflecting and transolecrenon approach

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20202043 ◽

2020 ◽

Vol 6 (4) ◽

pp. 722

Author(s):

Nuthan Jagadeesh ◽

Nibin Sanil ◽

Vishwanath M. S.

Keyword(s):

Functional Outcome ◽

Distal Humerus ◽

Articular Fractures ◽

Complex Anatomy ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Approach Group

Background: Intra articular fractures of distal humerus is one of the demanding injuries to manage due to its complex anatomy. Open reduction internal fixation is able to achieve painless, stable and mobile joint. This study is aimed at comparing functional outcome of patients treated with triceps reflecting and olecranon osteotomy approach.Methods: A hospital based randomized comparative study of 40 patients who diagnosed with distal humerus intraarticular fracture admitted in our hospital from April 2017 to March 2019. Triceps reflecting approach (group A) was used in 20 patients and olecranon osteotomy approach (group B) in 20 patients. Elbow range of movements and Mayo elbow performance score (MEPS) was used to compare outcome.Results: The mean elbow range of motion is 95.8±13.5 degree at 1 year follow up in group A and 94.5±9.3 degree in 1 year follow up at 1 year follow up in group B. The mean MEP score at end of 1 year in group A was 93.8±2.9 and in group B was 91.5±3.2 shows excellent results but there was no statistically significant difference between MEP scores of two groups. We observed 6 patients developed extension lag less than 10 degree in group A which was clinically insignificant to patients and 7 patients developed hardware prominence in group B.Conclusions: Triceps reflecting Bryan Morrey approach is equally effective as olecranon osteotomy approach in treatment of distal humerus intra articular fracture with less complication and operative time.

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Acrylic and Epoxy-pin External Skeletal Fixation Systems for Fracture Management in Dogs

Indian Journal of Animal Research ◽

10.18805/ijar.b-4265 ◽

2021 ◽

Author(s):

Surbhi Kuldeep Tyagi ◽

Hari Prasad Aithal ◽

Prakash Kinjavdekar ◽

Amarpal . ◽

Abhijit Motiram Pawde ◽

...

Keyword(s):

Healing Time ◽

Soft Tissue Trauma ◽

Handling Characteristics ◽

Fracture Management ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Tissue Trauma

Background: The metallic ESF systems are not easily available in the field and have fixed frames leading to less versatility in size and direction. Free forms of external skeletal fixators (acrylic and epoxy-pin) have advantages as they can be customized. Both acrylic and epoxy-pin ESF systems have been evaluated biomechanically in earlier studies; in the present study both are compared clinically.Methods: Twenty four dogs presented with 27 fractures of long bones, were randomly divided into 4 groups, according to the bones involved, group A was divided into A-I (radius-ulna) and A-II (tibia-fibula) sub-groups and group B was divided into B-I (radius-ulna) and B-II (tibia-fibula) sub-groups.Result: The mean ± SE fracture healing time in animals was 48.85 ± 2.56 days with no significant difference between two groups.The early presented cases and the ones with less soft tissue trauma showed better gait scores during the follow up period. Both acrylic and epoxy-pin fixators provided stable fixation and the technique can be practiced at field conditions with minimal facilities. Epoxy-pin ESF owing to better handling characteristics of epoxy resin is easier to construct than the acrylic ESF.

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Modified Percutaneous Achilles Tendon Lengthening by Triple Hemisection for Achilles Tendon Contracture

BioMed Research International ◽

10.1155/2019/1491796 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Yangjing Lin ◽

Jin Cao ◽

Changgui Zhang ◽

Liu Yang ◽

Xiaojun Duan

Keyword(s):

Achilles Tendon ◽

Recurrence Rate ◽

Operative Time ◽

Achilles Tendon Rupture ◽

Tendon Lengthening ◽

Group A ◽

Achilles Tendon Lengthening ◽

The Mean ◽

Group B

Background. Both percutaneous Achilles tendon lengthening by triple hemisection and the traditional open Z-lengthening are effective methods for Achilles tendon contracture. This study aims to evaluate the efficacy and safety of this new therapeutic method, which is based on the percutaneous sliding technique with three hemi-cuts in the tendon, as compared with the traditional open Z-lengthening. Methods. Retrospective analysis of the Achilles tendon contracture cases in our hospital between January 2010 and September 2016 was conducted. Twenty-five cases received percutaneous Achilles tendon lengthening (group A), and 30 patients who underwent open Z-lengthening during the same period were in the control group (group B). Operative time and hospital stay were statistically analyzed. Incision complication, equinus recurrence rate and Achilles tendon rupture morbidity were recorded. The function was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) score. All cases in group A received Magnetic Resonance Imaging (MRI) of ankle preoperatively and in the follow-ups. Results. The mean follow-up period was 42.04 months in group A and 61.7 months in group B. The entire operative time and the mean hospitalization days were lower in group A than in group B. No incision and infection complication occurred in group A. The infection rate in group B was 3.3%. Equinus recurrence rate was 4% in group A and the equinus recurrence rate in group B was 21.4%. In group A, the mean AOFAS score increased from 64 ± 10.16 points preoperatively to 96.08 ± 3.17 at final follow-up, while the score in group B increased from 63.48 ± 6.2 points to 85.4 ± 10.3. MRI showed continuity of the Achilles tendon and homogeneous signal in group A. Conclusion. Modified surgery can significantly reduce the risk of Achilles tendon rupture, provide better balance in soft tissue strength between ankle dorsiflexion and ankle plantarflexion, helping to avoid recurrence of the deformity.

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