Showing papers by "Khulna Medical College published in 2013"
04 Feb 2013
TL;DR: Overall mortality after initial surgical treatment was 16%.
Abstract: Neonatal intestinal obstruction is the most common surgical emergency in newborn. Ideally neonatal surgery should be done in an organized neonatal surgical unit. This study was done mostly in general surgical setup in Khulna without any facility of NICU and TPN. The aim of this study was to detect the patterns of neonatal intestinal obstruction and to find out the problems and outcome of surgical treatment. This retrospective study was done between January 2008 and December 2010, in Khulna Medical College Hospital, Khulna Shishu Hospital and a private clinic in Khulna. A total of 205 neonates with intestinal obstruction were treated surgically. Babies of both sexes up to 28 days of age were included in this study. Common causes of neonatal intestinal obstruction were anorectal malformation (ARM), intestinal atresia, Hirschsprung's disease (HD), meconium ileus and malrotation of midgut. Male-female ratio was 1.6:1 and about 13% was premature. Out of 205 neonates, there were ARM-73, HD-47, meconium ileus-38, intestinal atresia-29, malrotation-13 and others-5. Total 172 (84%) survived. Those were ARM (94%), Hirschsprung's disease (91%), meconium ileus (79%), intestinal atresia (55%), malrotation of gut (85%) and others (40%). Overall mortality after initial surgical treatment was 16%. Prognosis of surgical treatment depends on early intervention, expert anaesthesia, associated anomaly and complication, gentle handling of delicate tissue and intensive postoperative management. Medical practitioners were the first attending physician in most instances. So both physicians and surgeons have a contributing role in reducing mortality. DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13638 Bang Med J (Khulna) 2012; 45 : 6-10
23 citations
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TL;DR: CT scan of brain reveals multiple bilateral symmetrical calcification seen in the brain parenchyma involving basal ganglia, thalamus, para ventricular region, and cerebellar nucleus suggestive of Fahr's syndrome with meningoencephalitis.
Abstract: Miss Merry, 17 years old girl hailing from Barobila., Patkelghata, Satkhira was admitted in Khulna Medical College Hospital on 27-06-2010 with the complaints of fever, convulsion and unconsciousness for 7 days. She has also some hearing impairment, behavioral abnormalities and stunted growth since her childhood. On examination she was deeply unconscious, anaemic and febrile. CT scan of brain reveals multiple bilateral symmetrical calcification seen in the brain parenchyma involving basal ganglia, thalamus, para ventricular region, and cerebellar nucleus. Multiple ill defined hypodense areas are seen in the both parieto-occipital region, suggestive of Fahr's syndrome with meningoencephalitis. DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13628 Bang Med J (Khulna) 2012; 45 : 33-35
14 citations
04 Feb 2013
TL;DR: Varied presentation of abdominal tuberculosis included pain in abdomen (95%), fever (84.6%), weight loss (88%) and mass in abdomen and predetermined clinical assessment can be readily applied for earlier diagnosis.
Abstract: This study included 32 female and 20 male patients. Varied presentation of abdominal tuberculosis included pain in abdomen (95%), fever (84.6%), weight loss (88%) and mass in abdomen. Laparoscopic and open adhesiolysis (18.75%) resection and anastomosis (12.5%), stricturoplasty (12.5%), loop ileostomy (25%), closure of perforation (18.75%) and limited right hemicolectomy (12.5%) were the procedures carried out. Two patients expired with a mortality rate of 4%. The diagnosis of abdominal tuberculosis is difficult due to lack of specific signs and symptoms. However predetermined clinical assessment can be readily applied for earlier diagnosis. Surgical exploration is reserved for equivocal cases and for those who present as emergencies. DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13637 Bang Med J (Khulna) 2012; 45 : 3-5
6 citations
03 Feb 2013
TL;DR: The Incidence of invasive cervical carcinoma can be reduced by development of health education and promotion of national screening programme such as Visual Inspection of cervix (VIA), Colposcopy and vaccination against Human Pappiloma Virus (HPV).
Abstract: Cervical cancer is the most common prevalent cancer that continues to be a major health care problem world wide. It is still an important cause of mortality and morbidity in the developing countries. An estimated 500,000 new cases of cancer cervix and 233.000 deaths occurred in the year 2000 and almost 80% of these cases happen in the developing countries. Hospital based statistics indicated cervical cancer constitutes 22-35% of the female cancer in different areas of Bangladesh and India. A retrospective study was done in Gynaecology and Obstetric department in KMCH between January 2004 to January 2009 to see the incidence, correlation of age, parity, socioeconomic condition and clinical staging, treatment and other risks factors of carcinoma cervix. Out of total 120 diagnosed cases of cervical cancer were evaluated regarding their clinio-demographic profile, appearance of growth, clinical staging and types of treatment done . The results showed 49% of patient were in the age group of 31-40 years, 26% were in the 41-50 years group, early age at first coitus (70%), most of the patients (82%) presented with advanced stage and referred for radiotherapy or chemo radiation. One in ten female cancers diagnosed world wide are cancers of the cervix and there is seven fold variation in the incidence of cervical cancer between the different regions of the world. The Incidence of invasive cervical carcinoma can be reduced by development of health education and promotion of national screening programme such as Visual Inspection of cervix (VIA), Colposcopy and vaccination against Human Pappiloma Virus (HPV). DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13623 Bang Med J (Khulna) 2012; 45 : 11-14
5 citations
04 Feb 2013
TL;DR: This data indicates that conventional excisional excision is a viable treatment for central giant cell granuloma, and the use of a second type of excision, called a “cell reprograming”, is recommended.
Abstract: Not available DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13636 Bang Med J (Khulna) 2012; 45 : 1-2
5 citations
TL;DR: Mortality from AME was 15% and low GCS score was associated with higher fatality, which is 4 times higher than the overall mortality in paediatric ward.
Abstract: Objective: To estimate the outcome of acute meningoencephalitis (AME) in children and evaluate the impact of prognostic factors. Design and setting: A prospective cross sectional study was conducted in the paediatric ward of Khulna Medical College Hospital from 2007- 2009. Method: All admitted children, aged 1 month to 12 years, satisfying the case definition were enrolled into the study. Cerebrospinal fluid (CSF) was collected for cytology and biochemistry to categorize AME into pyogenic, viral or normal varieties. CSF was tested for common bacterial antigen and, along with serum was also tested for Japanese encephalitis virus antibodies. Patients were monitored twice daily until the final outcome. Results: One hundred and forty children were inducted constituting 2.5% of admissions. Infants (30%) were the worst sufferers. Twenty one (15%) children with AME died which is 4 times higher than the overall mortality (3.8%) in paediatric ward (p S Pneumoniae . Low GCS score was associated with higher mortality (p Conclusions: Mortality from AME was 15%. Low GCS score was associated with higher fatality. (Key Words: Outcome; prognostic factors; meningoencephalitis; Bangladesh) DOI: http://dx.doi.org/10.4038/sljch.v42i1.5291
2 citations
03 Feb 2013
TL;DR: Relaparotomy should be considered as a procedure after a near miss fatality of mother after caesarean section, according to a retrospective descriptive study done in a tertiary level referral and teaching hospital, Khulna, Bangladesh.
Abstract: The objective was to determine the indicatons, management and the outcome among the patient who underwent relaparotomy after caesarean section and to suggest the way to improve the quality of care. This was a retrospective descriptive study done in a tertiary level referral and teaching hospital, Khulna, Bangladesh, out of 55 cases requiring relaparotomy after caesarean section. Over a period of 15 months from 1st January 2011 to 31st march 2012, 1180 caesarean deliveries were done, out of total 3270 deliveries. During this period, relaparotomy was done in 55 cases. Among these, 10 cases followed caesarean delivery at this institute itself, while 45 cases have had caesarean delivery at peripheral hospitals. Postpartum haemorrhage in 31 cases (56.36%) and rectus sheath haematoma in 8 cases (14.55%) were the leading cause of relaparotomy. Among the 55 cases, 39 had emergency caesarean delivery while 16 had elective operation. Procedures undertaken at laparotomy were hysterectomy in 21 cases (38.18%), resuturing of uterine wound with uterine brace suture in 13 cases(23.63%), bilateral uterine arteries and ovarian vessels ligation in 7 cases (12.73%), drainage of haematoma in 8 cases (14.55%), and repair of anterior abdominal wall & peritoneal toileting in 5 cases (9.09%). A third laparotomy was done in 3 cases of which 2 cases were due to secondary PPH, a negative relaparotomy was done in one case. There were 7 maternal deaths following relaparotomy caused by hemorrhagic shock, septicaemia & renal failure and was 12.73%. Caesarean section is a life saving operation. However maternal mortality and near miss fatality after relaparotomy following caesarean section are common. So, relaparotomy should be considered as a procedure after a near miss fatality of mother. DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13625 Bang Med J (Khulna) 2012; 45 : 19-23
2 citations
03 Feb 2013
TL;DR: Block height with low dose of Hyperbaric Bupivacaine for caesarean section is more predictable and haemodynamically stable in lateral position, according to a study exploring the efficacy of spinal anaesthesia.
Abstract: Spinal Anaesthesia (SAB) is a popular anaesthetic technique in LUCS. SAB is performed in sitting and lateral position. The aim of this study is to explore the efficacy of spinal anaesthesia ie, height of block and haemodynamic changes with low dose hyperbaric bupivacaine in different position in LUCS. Total 80 of ASA grade I & II elective LUCS patient preloaded with 800-1000 ml of isotonic fluid were allocated randomly to receive different doses (10 mg, 12 mg,) of 5% Hyperbaric bupivacaine at L4-L5 interspaces in sitting (S group) and in lateral (L group) position to compare the height of block and haemodynamic changes. In sitting position in 10 mg dose group (S 10) adequate block developed in 7 patients out of 20 (35%) with no fall of systolic BP, in 12 mg dose group (S12) adequate block developed in 14 patients out of 20 (70%) with fall of systolic BP>1/3rd in 2 patients (10%). In lateral position groups (L group) with 10 mg dose ((L 10 group), 17 patients out of 20 got adequate block (85%) with fall of systolic BP>1/3rd in 2 patients out of 20 (10%) and in 12 mg dose group (L 12) adequate block in 20 patients out of 20 (100%) with fall of systolic BP>1/3rd in 5 patients out of 20 (25%). So block height with low dose of Hyperbaric Bupivacaine for caesarean section is more predictable and haemodynamically stable in lateral position DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13624 Bang Med J (Khulna) 2012; 45 : 15-18
2 citations
TL;DR: Pseudomyxoma peritonei is a rare clinical entity characterized by abundant extracellular mucinous material in the peritoneal cavity and tumoural implants on thePeritoneal surfaces and Debulking surgery with intraperitoneal hyperthermic chemotherapy is the treatment.
Abstract: Pseudomyxoma peritonei (PMP) is rare clinical entity characterized by abundant extracellular mucinous material in the peritoneal cavity and tumoural implants on the peritoneal surfaces. The origin of PMP is controversial. It often arises from the goblet cells of large bowel or appendix. There is increase in MUC-2 secreting cells and accumulation of excessive mucin secreted by these cells in the peritoneal cavity. A ruptured appendiceal mucinous adenoma is the most common origin. Low grade ovarian malignancy is often associated. Patient may present with growing abdominal masses associated with abdominal pain, nausea, vomiting, fatigue and weight loss. Ultrasonogram and CT scan of the abdomen have role in diagnosis but diagnosis is often difficult before laparotomy or laparoscopy. Debulking surgery with intraperitoneal hyperthermic chemotherapy is the treatment. DOI: http://dx.doi.org/10.3329/fmcj.v7i2.13523 Faridpur Med. Coll. J. 2012;7(2):88-92
2 citations
03 Feb 2013
TL;DR: This review is an attempt to discuss the subtypes, associated anomalies, diagnostic consideration and treatment recommendations of patients with MRKH syndrome and aimed to make the specialists of other discipline, general physicians and the gynaecologists well aware of the entity.
Abstract: The Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, the second most common cause of primary amenorrhoea usually remains undetected until puberty and is characterized by congenital aplasia or hypoplasia of the uterus and most of the vagina in women showing normal secondary sexual characteristics. MRKH syndrome may be isolated (type I) but is more frequently associated with renal, vertebral, and, to a lesser extent, auditory and cardiac defects (MRKH type II or MURCS association). Complete evaluation of MRKH patient includes genital, urinary tract, cardiac, spinal and auditory assessment which need multidisciplinary approach. This review is an attempt to discuss the subtypes, associated anomalies, diagnostic consideration and treatment recommendations of patients with MRKH syndrome and aimed to make the specialists of other discipline, general physicians and the gynaecologists well aware about the entity. DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13626 Bang Med J (Khulna) 2012; 45 : 24-29
1 citations
04 Feb 2013
TL;DR: The ROS was associated with cystic changes in size with extensive adhesion with peitoneuum, omentum and right ureter drawn and impacted within the cyst wall, and opinion of ovarian preservation during hysterectomy for benign indications and the sequelae should be discussed with patient.
Abstract: The most common symptom of residual ovarian syndrome (ROS) is chronic pelvic pain. Extensive pelvic adhesions are the typical operative findings, while follicular cysts and corpus luteum hematoma were the common pathological findings of the residual ovaries. However, malignant changes are also recorded. In this case report the ROS was associated with cystic changes in size with extensive adhesion with peitoneuum, omentum and right ureter drawn and impacted within the cyst wall. Opinion of ovarian preservation during hysterectomy for benign indications and the sequelae should be discussed with patient. Our case was carefully managed with adhesiolysis and cystectomy. DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13629 Bang Med J (Khulna) 2012; 45 : 36-37
04 Feb 2013
TL;DR: A 14 years unmarried girl came with lower abdominal pain and mass with severe dysmenorrhoea with a history of lower abdominal surgery 5 months back but after laparotomy it was detected didelphys uterus and left uterus was non-communicated with vagina forming haematometra.
Abstract: Mullerian duct anomalies are not uncommon. Anomalies may be diagnosed in infancy, adolescene or young adulthood. Female patient may present with a mass resulting from mucocolpos, haematocolpos, haematometra or primary amenorrhoea, delayed menarche, infertility and repeated pregnancy loses. A 14 years unmarried girl came with lower abdominal pain and mass with severe dysmenorrhoea with a history of lower abdominal surgery 5 months back. Clinically it was diagnosed as ovarian cyst but after laparotomy it was detected didelphys uterus. Left uterus was non-communicated with vagina forming haematometra. Right uterus well developed with one tube and healthy ovary. DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13627 Bang Med J (Khulna) 2012; 45 : 30-32
TL;DR: Perinatal factors particularly problem during pregnancy, and socioeconomic factors particularly familial disharmony have significant influences on this condition, finding one-quarter of school children experience parasomnia.
Abstract: Background Parasomnias are undesirable events occurring in the sleep-wake transition period. Several predisposing factors are reported to induce parasomnia in preschool children. Objective To es timate the magnitude of parasomnia in school children and to evaluate its relationship with possible predisposing factors . Methods Five hundred children aged 5- 16 years from a boys' school and a girls' school in Khulna City, Ban gladesh, were randomly selected for the study conducted fromJuly to December 2011. The survey was don e in two steps: self-administered questionnaire and clinical interviews of affected students and their parents. Apart from demographic features, questionnaires included details of perinatal and personal fac tors as well as familial and socioeconomic factors . The diagnoses of variants of parasomnias was based on the criteria for category-based classification by the American Academy of Sleep Medicine. Results Seven hundred thir teen filled questionnaires revealed parasomnia in 187 (26.2%) children. Most parasomnias were accompanied by other sleep disorders, in which 23 (12.3%) having primary dyssomnias including 18 (9.3%) obstructive sleep apnea, and 10 (5.3%) parasomnias with hypersomnias . Nightmares (7. 4%) were highest among the parasomnias fo llowed by nocturnal enuresis (4.1 %) and sleep terrors (3 .4%). More girls experienced parasomnias than boys (107 /360 vs . 80/353, respectively; P= 0.039) . Perinatal factors such as problems during pregnancy (17 .1 %) or eventful delivery (25. 7%), and socioeconomic factors such as familial disharmony (11.8%) and low socioeconomiclevel (3 1.6%) had positive associations with parasomnia. Conclusion One-quarter of school children experience parasomnia. We found perinatal factors particularly problem during pregnancy, and socioeconomic factors particularly familial disharmony have significant influences on this condition.
TL;DR: A rare case of primary non-Hodgkin’s Lymphoma in a 52-year-old female presented with a large mass in the right lobe of thyroid, established by fine needle aspiration cytology followed by surgery and finally confirmed by histopathology.
Abstract: A rare case of primary non-Hodgkin’s Lymphoma in a 52-year-old female presented with a large mass in the right lobe of thyroid. The diagnosis was established by fine needle aspiration cytology (FNAC) followed by surgery and finally confirmed by histopathology. DOI: http://dx.doi.org/10.3329/jom.v14i1.14584 J MEDICINE 2013; 14 : 83-84
TL;DR: Lichtenstein tension free repair of inguinal hernia is safe and effective method where recurrence rate is reasonably low and during follow up period no mesh rejection and discharging wound sinus related to presence of foreign body is observed in the study.
Abstract: Inguinal hernias are common and the results of surgical repair are often satisfactory but recurrence rate are variable. To prevent recurrences prosthetic materials have been increasingly used in hernia repair. In this study Lichtenstein technique of tension free mesh repair for inguinal hernia done in 140 cases in the period from July 2010 to June 2012 and outcome measured in terms of early and late morbidity especially recurrences. Seroma developed in 08 patients (5.6%) and haematoma and transient testicular swelling developed in 06 patients (4.2%) and 15 patients (10.6%) respectively. Only 2 patients (1.4%) developed wound infection and 01 patients (.71%) developed recurrences of hernia. Post operative neuralgia developed in 05 cases (3.5%). During follow up period no mesh rejection and discharging wound sinus related to presence of foreign body is observed in the study. So Lichtenstein tension free repair of inguinal hernia is safe and effective method where recurrence rate is reasonably low. DOI: http://dx.doi.org/10.3329/medtoday.v25i1.15900 Medicine Today 2013 Vol.25(1): 6-8
TL;DR: A 65 years old farmer with the complaints of progressive exertional breathlessness, non-productive cough and recurrent episodes of fever is diagnosed as idiopathic pulmonary fibrosis variety of ILD, a rare case for developing awareness among the clinicians.
Abstract: A 65 years old farmer was admitted in Medicine ward with the complaints of progressive exertional breathlessness, non-productive cough and recurrent episodes of fever. The patient had clubbing and chest examination revealed end inspiratory crackles. Chest x-ray, CT scan of chest and spirometry revealed the features of interstitial lung disease (ILD). So we diagnosed the case as idiopathic pulmonary fibrosis variety of ILD. We reported this rare case for developing awareness among the clinicians. DOI: http://dx.doi.org/10.3329/medtoday.v24i1.14118 Medicine TODAY Vol.24(1) 2012 pp.52-54