Background: Tracheostomy is a surgical procedure, often a life saving measure in a variety of clinical conditions. It is one of the commonest procedures carried out on the critically ill patient. The most common causes of non-malignant airway obstruction are head and severe facial trauma, cerebrovascular accident, coma, respiratory burn and presence of foreign bodies in airway etc. Tracheostomy is an increasingly utilised adjunct in the ICU management of patients. Effective tracheostomy management involved the multi-professional team in a coordinated approach. Objectives: To study the indications of tracheostomy in non-malignant disorders. Study design: Cross-sectional study. Study setting and period: Department of Otolaryngorhinology and Head- Neck surgery (Unit- 1,2,3), General Surgery, ICU, Casualty, Neurosurgery, Thoracic surgery, Burn & Plastic Surgery and relevant OPD in Dhaka Medical College Hospitalfrom6th September 2015 to 5th March 2016. Methods: A hospital based cross-sectional study. Fifty patients admitted to hospital, underwent tracheostomy for non-malignant factors. Purposive samplings technique was used. Detail demographic data were collected from the informant and recorded in structured case record form. Clinical examination and relevant investigation were done meticulously. All collected questionnaire checked very carefully to identify the error in the data. Data processing work consist of registration schedules, editing computerization, preparation of dummy table, analyzing and matching of data. Result: A total of 50 patients of non-malignant pathology causing airway patency loss in different ward unit of DMCH were selected. In this study, maximum numbers of patients (36%) were between 51-70 years age groups with mean age was 47.23±11.57 years. It was observed that, frequency of non-malignant aetiology for tracheostomy gradually increases with age. Study show that, 51-70 years was most frequent age group (36%). Out of 50 cases 82% were male. Present study show that socioeconomically majority patients were poor class (52%), highest percentage of patient comprised of day labourer (30%). Head trauma (12%) and cerebrovascular accidents (9%) were the most common etiological factor trauma was the major aetilogical group (50%),followed by, central drive problems or neurological disease (38%) and elective tracheostomy was done. Conclusion: Head and facial trauma, cerebrovascular accident, coma, respiratory burn and presence of foreign bodies etc. are common aetilogical factors. It was found that tracheostomy is safer alternative to intubation when a prolonged artificial airway is required. Bangladesh J Otorhinolaryngol 2022; 28(2): 157-164
Background: Deep neck abscess is a common clinical entity in developing countries like ours. Despite the widespread use of antibiotics, deep neck infections do not disappear and remain one of the most difficult emergencies encountered in daily clinical practice. The extent and severity of the illness could become life-threatening. Therefore, coping with deep neck abscess remain a challenge to otolaryngologists. This study aimed to analyze the bacteriological pattern and antimicrobial susceptibility in deep neck space abscesses. Material Methods: It was a cross-sectional observational study. 50 patients with deep neck space abscesses fulfilling the inclusion and exclusion criteria admitted to the department of ENT Head Neck Surgery, Rangpur Medical College Hospital, Rangpur, from 1st July 2017 to 30th December 2017 were enrolled in this study. Pus from deep neck space abscess was collected by either aspiration or incision and drainage with proper aseptic measure and sent by sterile test tube to microbiology department immediately. Data were collected by detailed history taking and clinical examination investigations with informed written consent and analyzed by SPSS (version 20). Results: In this study most commonly involved deep neck spaces were Submandibular (38%), Peritonsillar (32%), Retropharyngeal (14%), and parapharyngeal (8%) spaces. Streptococcus viridans was the most prominent organism 14 (28%) followed by Klebsiella pneumonia 9(18%) and Staph. aureus 4 (8%). The most effective antibiotic was Ceftriaxone 34(79%) followed by Cefuroxime 30 (70%) and Erythromycin 23(54%). Aerobic organisms were highly sensitive to Cefuroxime (83%) and Ceftriaxone (83%) followed by Erythromycin (48%). Anaerobic organisms were sensitive to Clindamycin (100%), Metronidazole (100%), and Erythromycin (100%) followed by Ceftriaxone (75%). Conclusion: The most frequently isolated organism in deep neck space abscesses were Streptococcus viridans and Staphylococcus aureus and sensitivity results showed the majority of isolates are susceptible to Ceftriaxone and Cefuroxime.
Background: Oral cancer is a common neoplasm worldwide which has a increased incidence and mortality rate over the past decades. In spite of skilled surgical and radio therapeutic modalities it is characterized by poor prognosis and a low survival rate. Lymph node metastasis is an important negative prognostic factor in oral cancer. In this study, pattern of cervical lymph node metastasis in oral carcinoma has been described. Such information may contribute to the understanding of oral cancer management plan. Methods: This cross-sectional observational study was conducted in the Otolaryngology and Head-Neck surgery department of Dhaka Medical College Hospital. The study period was from January 2018 to June 2018. A total of 50 patients were selected by purposive sampling technique. Data were collected by study physician himself. Then these collected data were recorded in structured case report forms. Clinical examination and relevant investigations were done. After planned surgical procedure post operative histopathological reports were collected. All collected questionnaire were checked very carefully. Data were processed and analyzed with the help of computer program SPSS and Microsoft excel. Quantitative data were expressed as mean and standard deviation and qualitative data as frequency and percentage. Comparison were done by tabulation and graphical presentation in the form of tables, pie chart, graphs, bar diagrams, histogram & charts etc. Result: Overall demographic features of 50 patients revealed that, the maximum incidence was seen in the age group 31-50 years (54.0%), mean age of the patient was 49.6 ±9.2 year. Male and female ratio was 4.5:1. In this study most of the tumors were well and moderately differentiated, 34.0% and 62.0% respectively. Aetiology and predisposing factors revealed that the most common were cigarette smoking, betal quid and alcohol consumption, present in 52.0%, 28.0% and 22.0% of patients respectively. Post operative histopathology reports showed that 24 patients (48.0%) had neck node metastasis among which 59.4% were with tumor size >1 cm. Tumors with the depth of invasion >3 mm had a very high risk of metastasis (P<0.0001), as compared to tumor less than 3 mm in thickness. Out of the 24 patients with nodal metastasis 17(34.0%) patients had a single node metastasis (N1). Level I and Level II were the commonest site to be involved (14 patients). Nodal metastasis predominantly occurred from primary tumour site of tongue (22.0%) and floor of the mouth (14.0%). It was seen that patients with higher grade had a higher risk of metastasis (grade 1:–29.4%, grade 2:- 54.8%, grade 3:– 100.0%). Conclusion: Oral carcinoma may appear at any sub site, although there are certain areas in which it is found more frequently, such as the oral tongue, cheek and floor of the mouth. Lymph node metastasis is more common in oral carcinoma mostly level I & II, which is one of the most relevant prognostic factors. Elective neck dissection can be considered in all patients with tumors more than 3 mm in thickness. J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 41-46
Introduction: Follicular neoplasms represent a wide clinical spectrum of diseases, with tremendous overlap in clinicopathologic diagnosis, management, and prognosis. Suspicious sonographic features in conjunction with FNAC of thyroid nodules provide the most accurate preoperative diagnosis to guide therapy. Keeping the perception in mind, we summarize our experience with thyroid nodules that were defined as cellular follicular lesions by comparing the clinical, sonographic, and cytological features that were examined histologically to define the most reliable criteria of malignancy. Aim of the Study: The aim of the study was to find out the cytological diagnosis of thyroid follicular lesions and their correlation with histological findings. Methods: This cross-sectional observational study was conducted at the department of Otolaryngology, National institute of ENT, Tejgaon, Dhaka following approval of the protocol for the duration of 6 months. A total of 30 patients were included and they were subjected to details history taking, physical examination, and necessary investigations. We analyzed the data using SPSS version 23, and Chi-square test was used to analyze the significance level of P (<0.05). Results: A total of 30 consecutive patients with a follicular lesion on FNAC (5 men and 25 women) were included in this study. Their mean (SD) age was 46.7 (±13.0) years. Thyroid cancer was diagnosed on histopathology in 8 patients (27%). Papillary cancer was the most common cytologic finding in 6 patients [75%]) and 2 patients (25%) had a diagnosis of follicular cancer. Of the 6 patients with papillary cancer, 2 (33%) had a follicular variant of papillary cancer. The benign histologic diagnoses were follicular adenoma in 6 cases (27%), thyroiditis in 3 cases (13%), and nodular goiter in 13 (60%). The presence of a solitary nodule was not predictive of malignancy (p=0.57). Solid echo structure (p<0.02), presence of microcalcification (p<0.01), and hypoechoic nodules ...
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