Journal Issue: No 2, Issue 30, APRIL-JUNE, 2010
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Volume
Number
Issue Date
2010
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Osteosynthesis of intercondylar humerus fracture using bryan and morrey approach
(Kathmandu University, 2010) Lakhey, S; Sharma, S; Pradhan, RL; Pandey, BK; Manandhar, RR; Rijal, KP
Abstract
Background: The olecranon approach has been the gold standard for surgical approaches to fracture fixation of distal
articular surface of humerus. Although it provides a good exposure, it also has disadvantages of delayed union, non-
union and implant related complications at the osteotomy site.
Objective: The aim of this study was to determine the functional outcome of displaced intra-articular distal humerus
fracture fixation using an alternative approach: the Bryan and Morrey approach.
Materials and methods: Twenty patients with twenty AO type C1 and C2 intercondylar fractures of the distal humerus
had bicolumnar fixation of the distal humerus with two contoured reconstruction plates and screws on the dorsal surface
or various combinations of a single reconstruction plate, screws and K-wires using a Bryan and Morrey approach.
Twelve of the patients were male and eight were female. The average age of the patients was 44.8 years. Eleven patients
had sustained the injury as result of fall and nine of the patients had sustained it in road traffic accidents. Right elbow
was involved in fifteen patients and left in five. All patients were followed up for 12 months post operatively.
Results: All twenty fractures had united at 4 months follow-up. The mean fixed flexion deformity was 9.0º (range 0º-
15º) and the mean arc of motion was 115.0º (range 85º- 130º). All patients had grade 4 triceps strength and stable elbows
at the end of 12 months follow up. One patient had deep seated wound infection resulting in necrosis of the triceps
tendon requiring a second operative procedure.
Conclusions: Bryan and Morrey approach is a simpler, easier and better approach as compared to the other posterior
approaches to the elbow joint, and therefore, can be used as the approach of choice for fixation of fractures of the distal
articular surface of humerus.
Key words: Fracture, Intercondylar Humerus, Osteosynthesis
Correlation of serum free prostate-specific antigen level with histological findings in patients with prostatic disease
(Kathmandu University, 2010) Lakhey, M; Ghimire, R; Shrestha, R; Bhatta, AD
Abstract
Background: Prostate Specific Antigen (PSA) has been widely used in the diagnosis and management of patients with
prostate cancer. It may be elevated in other prostatic diseases and surgical procedures. PSA exists in two forms, a major
bound form (cPSA) and a free form (fPSA).
Objectives: The objective of the study was to determine the relationship between serum fPSA levels and histologic
findings in biopsy specimens of men with prostatic disease.
Material and methods: This study includes 91 patients planned for transurethral resection of prostate (TURP). Blood
samples were collected before TURP and tested for fPSA. Histology of the tissue samples collected after TURP were
studied and the relationship with fPSA analysed using SPSS 11.5.
Results: The median values for benign, premalignant and malignant lesions were 1.8ng/ml, 4.5ng/ml and 13.20ng/ml
respectively (p<0.001). Most cases of benign prostatic hyperplasia(BPH) without inflammation had fPSA levels <2ng/
ml, while most with active inflammation had levels >5ng/ml. Low grade prostatic intraepithelial neoplasia (LGPIN)
saw levels <5ng/ml while high grade intraepithelial neoplasia (HGPIN) and prostate cancer (PCa) had levels > 5ng/mL
(p<0.05). For detection of high grade lesions (HGPIN and PCa), the sensitivity and specificity of fPSA level > 5ng/ml
was found to be 88.8% and 90.2% respectively.
Conclusions: Serum fPSA is elevated marginally in patients with BPH without inflammation. Active inflammation and
high grade lesions are associated with fPSA level more than 5 ng/ml.
Key words: Benign prostatic hyperplasia, fPSA, prostate cancer, prostatic intraepithelial neoplasia.
Antimicrobial susceptibility pattern and serotyping of Streptococcus pneumoniae isolated from Kanti Children Hospital in Nepal
(Kathmandu University, 2010) Rijal, B; Tandukar, S; Adhikari, R; Tuladhar, NR; Sharma, PR; Pokharel, BM; Gami, FC; Shah, A; Sharma, A; Gauchan, P; Sherchand, JB; Burlakoti, T; Upreti, HC; Lalitha, MK; Thomas, K; Steinhoff, M
Abstract
Background: Invasive pneumococcal disease is a significant cause of morbidity and mortality worldwide and it is a
major cause for childhood deaths in Nepal.
Objectives: The aim of this study was to establish the antimicrobial susceptibility pattern of Streptococcus pneumoniae
and perform serotype responsible for pneumococcal disease in Nepal.
Materials and methods: All together 3774 children from 2 to 60 months who fulfilled the enrollment criteria for
suspect of bacterial pneumonia, sepsis or meningitis were enrolled for etiologic studies of severe illness. During the
study period 60 isolates of Streptococcus pneumoniae were isolated and the antimicrobial susceptibility testing and
serotyping were performed.
Results: The study showed that 24 (52.17%) isolates were resistant to Cotrimoxazole, 3 (6.5%) isolates were
intermediately resistant to Penicillin but no Penicillin resistant strains were isolated. The 1 (2.17%) isolate was recorded
as Erythromycin and Chloramphenicol resistant and only 1 (2.17%) isolate was found intermediately resistant to
Cefotaxime. Of the 60 isolates, serotyping result was available only for 46 isolates. The most common serotypes were
serotype 1 (27. 65%) followed by serotype 5 (19.14%) and serotype 4 (8. 5%) respectively followed by serotype 39, 23F,
7F, 19B, 12A, 14, 18F, 6B, 32, 16, 19F and 25F.
Conclusions: Alarming level of Cotrimoxazole resistance demands revision of pneumonia treatment policy in Nepal and
rising tendency of other drug resistance against Streptococcus pneumoniae showed use of these drugs for the treatment
of meningitis, pneumonia and other serious infections needs extended research. The common serotype 1, 5 and 4 need
to be incorporated in pneumococcal vaccine to immunise children in Nepal.
Key words: Antimicrobial susceptibility, Streptococcus pneumoniae, Serotyping, Nepal