Abdul Yazid Mohd Kassim

Can Granisetron Injection Used as Primary Prophylaxis Improve the Control of Nausea and Vomiting with Low- Emetogenic Chemotherapy?

BACKGROUND The purpose of this study is to examine the risk of uncontrolled chemotherapy-induced nausea and vomiting (CINV) among patients receiving low emetogenic chemotherapy (LEC) with and without granisetron injection as the primary prophylaxis in addition to dexamethasone and metochlopramide. MATERIALS AND METHODS This was a single-centre, prospective cohort study. A total of 96 patients receiving LEC (52 with and 42 without granisetron) were randomly selected from the full patient list generated using the e-Hospital Information System (e-His). The rates of complete control (no CINV from days 1 to 5) and complete response (no nausea or vomiting in both acute and delayed phases) were identified through patient diaries which were adapted from the MASCC Antiemesis Tool (MAT). Selected covariates including gender, age, active alcohol consumption, morning sickness and previous chemotherapy history were controlled using the multiple logistic regression analyses. RESULTS Both groups showed significant difference with LEC regimens (p<0.001). No differences were found in age, gender, ethnic group and other baseline characteristics. The granisetron group indicated a higher complete response rate in acute emesis (adjusted OR: 0.1; 95%CI 0.02-0.85; p=0.034) than did the non-granisetron group. Both groups showed similar complete control and complete response rates for acute nausea, delayed nausea and delayed emesis. CONCLUSIONS Granisetron injection used as the primary prophylaxis in LEC demonstrated limited roles in CINV control. Optimization of the guideline-recommended antiemetic regimens may serve as a less costly alternative to protect patients from uncontrolled acute emesis.

Development of Total Knee Replacement Digital Templating Software

In this study, by taking full advantage of digital X-ray and computer technology, we have developed a semi-automated procedure to template knee implants, by making use of digital templating method. Using this approach, a software system called OrthoKneeTMhas been designed and developed. The system is to be utilities as a study in the Department of Orthopaedic and Traumatology in medical faculty, UKM (FPUKM). OrthoKneeTMtemplating process employs uses a technique similar to those used by many surgeons, using acetate templates over X-ray films. Using template technique makes it easy to template various implant from every Implant manufacturers who have with a comprehensive database of templates. The templating functionality includes, template (knee) and manufactures templates (Smith & Nephew; and Zimmer). From an image of patient x-ray OrthoKneeTMtemplates help in quickly and easily reads to the approximate template size needed. The visual templating features then allow us quickly review multiple template sizes against the X-ray and thus obtain the nearly precise view of the implant size required. The system can assist by templating on one patient image and will generate reports that can accompany patient notes. The software system was implemented in Visual basic 6.0 Pro using the object-oriented techniques to manage the graphics and objects. The approaches for image scaling will be discussed. Several of measurement in orthopedic diagnosis process have been studied and added in this software as measurement tools features using mathematic theorem and equations. The study compared the results of the semi-automated (using digital templating) method to the conventional method to demonstrate the accuracy of the system.

AN AUTOMATED SIZE RECOGNITION TECHNIQUE FOR ACETABULAR IMPLANT IN TOTAL HIP REPLACEMENT

Preoperative templating in Total Hip Replacement (THR) is a method to estimate the optimal size and position of the implant. Today, observational (manual) size recognition techniques are still used to find a suitable implant for the patient. Therefore, a digital and automated technique should be developed so that the implant size recognition process can be effectively implemented. For this purpose, we have introduced the new technique for acetabular implant size recognition in THR preoperative planning based on the diameter of acetabulum size. This technique enables the surgeon to recognise a digital acetabular implant size automatically. Ten randomly selected X-rays of unidentified patients were used to test the accuracy and utility of an automated implant size recognition technique. Based on the testing result, the new technique yielded very close results to those obtained by the observational method in nine studies (90%).

A 45-degree radiographic method for measuring the neck shaft angle and anteversion of the femur: a pilot study

Purpose. To propose a novel method to measure the neck shaft angle and anteversion of the femur using anteroposterior and 45° oblique radiographs. Methods. Three human subjects were used to verify the 45° oblique method. The true neck shaft angle and anteversion of the femur were determined using computed tomography. The true values were compared with the values derived by the 45° oblique method after correcting the distortion using a formula. Results. With the true values based on computed tomography as references, the neck shaft angle and anteversion of the 3 subjects deviated +0.82° to +4.66° and −2.14° to +2.55° in lateral 45° oblique radiographs, respectively, whereas the corresponding values in medial 45° oblique radiographs were +0.98° to +5.93° and −10.09° to +1.58°. The lateral 45° oblique method resulted in smaller range of deviation and were more accurate. Conclusion. This 45° oblique method is useful in surgical planning, especially for femoral derotational osteotomy in children. This new method enables easy calculation of the true neck shaft angle and anteversion, with low radiation exposure.

Simple multifunctional angle measurement method in orthopaedic

Few types of angle measurementin orthopedic diagnosis process have been studied (Cobb’s Angle, Q-Angle, Bohler’s Angle and Intermetatarsal Angle). A standard and simple multifunctional angle measurement method was identified to help diagnosis and analysis work in orthopedic radiology. Some basic mathematic theorems and equations have been applied to make sure the reliability of the method. The angle measurement method was then tested in an application named OrthokneeTMwith successful results.

Use of Computed Tomography in Determining the Occurrence of Dorsal and Intra-articular Screw Penetration in Volar Locking Plate Osteosynthesis of Distal Radius Fracture

BACKGROUND The use of volar locking plate in distal radius fracture can lead to extensor tendon rupture due to dorsal screw penetration. The aim of our study was to investigate the occurrence of dorsal and intra-articular screw penetration using CT scan after volar distal radius osteosynthesis for distal radius fractures. METHODS Thirty patients who underwent distal volar locking plate for distal radius fracture were included in a retrospective study. In all 30 patients no dorsal and intra-articular screw penetration were detected on standard AP and lateral views of a plain radiograph. CT scan of the operated wrist was performed to determine the number of intra-articular and dorsal screw penetrations. Clinical examination was performed to determine the wrist functions in comparison to the normal wrist. RESULTS Nineteen wrists were noted to have screw penetration either dorsally or intraarticularly. The highest incidence is in the 2nd extensor compartment where 13 screws had penetrated with a mean of 2.46 mm. Six screws penetrated into the distal radial ulnar joint and five screws into the wrist joint with a mean of 2.83 mm and 2.6 mm, respectively. However, there was no incidence of tendon irritation or rupture. CONCLUSIONS This study demonstrated a high incidence of dorsal and intra-articular screw penetration detected by CT scan which was not apparent in plain radiograph. We recommend that surgeons adhere to the principle of only near cortex fixation and downsizing the locking screw length by 2 mm.

Metaplastic breast carcinoma with upper limb gangrene

Metaplastic breast carcinomas (MBCs) are rapidly growing tumors with histological heterogeneity, and triple negative receptor status. The aim of this case report is to highlight a case of advanced MBC with axillary artery infiltration leading to gangrene of the ipsilateral upper limb, in a young woman.

Skeletal-Related Events among Breast and Prostate Cancer Patients: Towards New Treatment Initiation in Malaysia's Hospital Setting

The human skeleton is the most common organ to be affected by metastatic cancer and bone metastases are a major cause of cancer morbidity. The five most frequent cancers in Malaysia among males includes prostate whereas breast cancer is among those in females, both being associated with skeletal lesions. Bone metastases weaken bone structure, causing a range of symptoms and complications thus developing skeletal-related events (SRE). Patients with SRE may require palliative radiotherapy or surgery to bone for pain, having hypercalcaemia, pathologic fractures, and spinal cord compression. These complications contribute to a decline in patient health- related quality of life. The multidimensional assessment of health-related quality of life for those patients is important other than considering a beneficial treatment impact on patient survival, since the side effects of treatment and disease symptoms can significantly impact health-related quality of life. Cancer treatment could contribute to significant financial implications for the healthcare system. Therefore, it is essential to assess the health-related quality of life and treatment cost, among prostate and breast cancer patients in countries like Malaysia to rationalized cost-effective way for budget allocation or utilization of health care resources, hence helping in providing more personalized treatment for cancer patients.

A new and improved size detection algorithm for acetabular implant in total hip replacement preoperative planning

Preoperative templating in Total Hip Replacement (THR) is a method to estimate the optimal size and the best position of the implant. Today, observational (manual) size recognition techniques are still used to find a suitable implant for the patient. Therefore, a digital and automated technique should be developed so that the implant size recognition process can be effectively implemented. For this purpose, we have introduced the new technique for acetabular implant size recognition in THR preoperative planning based on the diameter of acetabulum size. This technique enables the surgeon to recognise a digital acetabular implant size automatically based on the two points selected on the patients acetabulum. Based on the testing result, the average time taken for the acetabular implant templating process in preoperative planning using a new automated technique was much less than using the digital line distance method.

Design of Total Hip Replacement digital templating software

In this study, by taking full advantage of digital X-ray and information technology, we have developed a semi-automated procedure to template hip implants, by making use of digital templating techniques. Using this approach, a software system called OrthoHip™ has been developed. The OrthoHip™ templating process uses a similar technique to that used by an orthopaedic surgeon, using manual templates over general X-ray films. From an image of patients X-ray, the OrthoHip™ template helps in quickly and easily selecting to the approximate template size needed. The visual templating features then allow the user to quickly review multiple template sizes against the X-ray and to thus obtain a nearly precise image of the implant size required. The system can assist by templating the patients image and generating database reports that can accompany the patients notes. The software system was implemented in Java programming, using object-oriented techniques to manage the graphics and objects. The approaches for image scaling used in this research also will be discussed. The study compared the results of the semi-automated (using digital templating) method to the conventional or observational method to demonstrate the accuracy and the utility of the system.