This prospective study was conducted to compare the outcome between medical and surgical treatment of primary intracerebral haemorrhage at the department of Neurosurgery, Dhaka Medical College

Background: Acute extradural haematoma (EDH) remains most common cause of mortality and disability resulting from traumatic brain injury. In the last three decades, improvements in rescue, neuromonitoring, diagnostic procedure and intensive care have led to better outcomes. The purpose of this study was to evaluate the factors influencing the outcome in patients with EDH undergoing surgery treated in a tertiary hospital in Bangladesh. Methods: In this retrospective study, 102 consecutive patients with acute EDH who underwent craniotomy were included. The study was carried out from July 2003 to December 2005. The diagnosis was made clinically and radiologically by CT scan. Patients were grouped on the basis of Glasgow Coma Scale (GCS) and operative outcomes were evaluated by Glasgow Outcome Scale (GOS) Results: More than half sampled respondents' (57%) age were more than 20 years while rests of the patients below 20 years with male predominance (Male: Female -12:1). About 7 in 10 respondents (70.6%) were working. Similarly, majority of the respondents (79.4%) had lost more than 30 ml blood. A notable proportion of the respondents (73.5%) had good GCS score (9-15 score) during admission. Similarly majority of the respondents (70.6%) had GCS score 9-15 and 29.4% had GCS score 3-8 before surgery. Road Traffic Accident (RTA) (65%) is the most common cause of EDH followed by assault (20%) and fall from height (12%). Temporal and temporo-parietal locations were the most common site of EDH (56%). Patients with good GCS before surgery had significantly better outcome (89%) compare to those who had bad GCS (10%). Conclusion: Level of consciousness before surgery is the most important factor affecting the outcome. Hence, early diagnosis and surgical intervention is very essential.

Abstract

Severe traumatic brain injury is common in all developing

Introduction:Aneurysms resemble bubbles or focal dilation of arteries that occur at weak points of the artery wall (figure-1). There are many factors for its formation. These factors include genetic predisposition, the anatomy of the artery and its branches, 'wear-andtear' on the wall of the arteries due to blood flow, artery disease and cigarette smoking 1 . Aneurysms are the most common at circle of Willis in the central skull base. Approximately 80% of aneurysms arises from anterior circulation of the brain, while 20% form posterior circulation of the brain 1.2 .It is uncommon to diagnose an aneurysm before it has ruptured and most people with aneurysms are unaware that they have an aneurysm until it bursts. Overall 3.6-6% of normal population has aneurysm, among them 1.4-1.9 % rupture in a year. Women have more tendencies to rupture. There is seasonal variation of rupture 3 .

Objective: Sitting position for operation of posterior fossa lesions, occipital and posterior parietal lesions, foramen magnum, upper cervical spinal lesions provides an excellent visualization because of slack of brain due to gravity drainage of CSF and blood. Hence gross total tumour removal relatively easy and less complicative.Methods: From January 2008 to march 2010 total 30 cases underwent neurosurgical procedure in sitting position. Physical characteristics including patients age, sex, size of the tumour and histological diagnosis were collected. The post operative image were studied to see the extent of tumour removal and early detection of complications. Almost all patients required peroperative cerebral venous line or peripheral inserted central venous line, precordial doppler sound, ETCO2, O2 saturation and close monitoring of blood pressure.Results: Venous air embolism were detected in two cases (6.6%). Total tumour removal was possible in 17 (56.6%) cases and subtotal in 11 (36.6%) cases. There were 4 (13.33%) mortality in thirty cases, two cases from CP angle tumour and another case from petroclival meningioma and another from pineal region tumour. There was pneumocephalus in almost all cases and post-operative new facial paresis in 10 (33.3%) cases. Fifth cranial nerve palsy developed in 3 (10%) cases. Temporary lower cranial nerve palsy developed in 2 cases. Post-operative tumour bed haematoma developed in 4 (13.33%) cases. Most of the patient had good outcome (GOS 5).Conclusion: Sitting position can be safely done with good preoperative physiological, peroperative close monitoring of the patient regarding blood pressure, ETCO2 and oxygen saturation. However postoperative complication like tumour bed haematoma, pneumocephalus, cranial nerve palsy have to be bring in mind.Bangladesh Journal of Neuroscience 2012; Vol. 28 (1): 45-51

Per rectal bleeding is a frequently encountered clinical complaint in routine medical/surgical practice in paediatric patients. It has different aetiology in both extremes of age. This study was carried out in an attempt to find out causes, presentation and the proper management that can be offered to the affected infants and children.This retrospective study was carried out from January 2012 to December 2014 in the department of Paediatric Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. All patients presenting with the complaint of per rectal bleeding were included. But patients who needed emergency surgical intervention were excluded from this study. The data were reviewed for gender, age, causes of rectal bleeding and type, number, site, recurrence rate and the modality of treatment employed in children having colorectal polyp. Technetium-labeled red blood cells scans was used for the diagnosis of Meckel's Diverticulum. Complete blood picture and routine stool examination were done for all cases.Most polyp cases were diagnosed with digital rectal examination (DRE). Colonoscopy was performed for some cases in the Paediatric Gastroenterology Department of BSMMU. Also all the rectal polyps and colonic mucosal biopsies taken during colonoscopy submitted to histopathological examination. Per rectal bleeding was the chief complaint in 326 (1.5%) patients Out of 21,533 patients presenting to the outpatient department of Paediatric Surgery of BSMMU, Dhaka, Bangladesh over a period of three years. In this study, it was reviewed 326 patients, among them 208 (63.89%) were boys and 118 (36.19%) were girls. The male female ratio was 1.8:1. The ages ranged from 14 months to 14 years (mean age: 5.8years) at diagnosis. The most common aetiology was juvenile polyps which were found in 209 (64.11%) of the cases. It was to be found that anal fissure in 33 (10.12%) patients, rectal prolapse in 27 (8.2%) patients, non-specific colitis in 15 (4.60%) patients, Meckel's Diverticulitis in 3 (0.9%) patients, juvenile polyposis coli in 5 (1.5%) patients and familial adenomatous polyposis coli (FAP) in 4 (1.2%) patients. However, the cause of per rectal bleeding remained unknown suspecting chronic constipation in 30 (9.20%) patients. No statistically significant differences were observed between males and females as well as different age groups regarding the means of the underlying causes of per rectal bleeding in children(p > 0.05). The prevalence of anal fissure in less than 2 years old patients and juvenile polyps in the 2-6 years old patients were significantly higher than the other causes (p < 0.001). Other causes of per rectal bleeding prevailed in children were more than 2 years old. Colorectal polyps are common causes of per rectal bleeding in children. Proper physical examination including DRE along with the colonoscopy promotes both rapid and accurate diagnosis and the opportunity for immediate therapeutic measures.

<p>There are contradictory reports on the findings of magnetic resonance image (MRI) in lumbar intervertebral disc prolapse. A study was conducted on 54 patients using 3 of 4 clinical criteria (low back pain with radiation down to the lower limbs, radicular pain along specific dermatomes, positive straight leg raising test, presence of neurological symptoms and signs e.g. motor or sensory deficit and MRI of lumbosacral spine of the respondent). Evaluation of MRI of lumbosacral spine was done based on extent of disc prolapse, disc degeneration, nerve root compression neural foramen compromise. The logistic regression analysis between the findings of MRI and the clinical features show that there was a significant association in the neural foramen or lateral recess (Odd's ratio 7.106, p&lt;0.05), the root compression (p&lt;0.01) as well as the disc extrusion (p&lt;0.05). There was no statistical association between clinical levels and other MRI findings like disc protrusion and disc bulge (p value 0.21 and 0.14, respectively). The strength of agreement between clinical and MRI diagnosis level of disc prolapse was calculated using kappa statistics (k-value). The test revealed a very good agreement for L3/4 (k-value = 0.812) and good agreement for L4/5 and L5/SI  level (k-value 0.75 and 0.75 respectively) between these two procedures, suggesting that level of disc prolapse could be correctly  diagnosed without MRI findings.  In conclusion, clinically diagnosed levels associate well with MRI levels, but all MRI abnormalities do not have any clinical significance.</p><p> </p>