Study design: Open label study to determine drug dose for a randomized double-blind placebocontrolled parallel study. Objectives: To assess the efficacy and side effects of oral D 9 -tetrahydrocannabinol (THC) and rectal THC-hemisuccinate (THC-HS) in SCI patients. Setting: REHAB Basel, Switzerland. Method: Twenty-five patients with SCI were included in this three-phase study with individual dose adjustment, each consisting of 6 weeks. Twenty-two participants received oral THC open label starting with a single dose of 10 mg (Phase 1, completed by 15 patients). Eight subjects received rectal THC-HS (Phase 2, completed by seven patients). In Phase 3, six patients were treated with oral THC and seven with placebo. Major outcome parameters were the spasticity sum score (SSS) using the Modified Ashworth Scale (MAS) and self-ratings of spasticity. Results: Mean daily doses were 31 mg with THC and 43 mg with THC-HS. Mean SSS for THC decreased significantly from 16.72 (77.60) at baseline to 8.92 (77.14) on day 43. Similar improvement was seen with THC-HS. We observed a significant improvement of SSS with active drug (P ¼ 0.001) in the seven subjects who received oral THC in Phase 1 and placebo in Phase 3. Major reasons for drop out were increase of pain and psychological side effects. Conclusion: THC is an effective and safe drug in the treatment of spasticity. At least 15-20 mg per day were needed to achieve a therapeutic effect.
Broad ligament pregnancy is a rare obstetric condition. Its diagnosis is quite difficult andmanagement is challenging. Here we report a case of a 26 years old primi gravida conceivedfollowing laparoscopy and ovulation induction. Diagnosis of the broad ligament pregnancywas done by a transvaginal ultrasound at her 9 weeks and was proceded with laparoscopyfollowed by laparotomy. A right broad ligament pregnancy was found and the sac with fetuswas removed. Laparoscopy was converted into a laparotomy as there was an uncontrollablebleeding from the broad ligament. Here we present a case of this extreme rare type of broadligament pregnancy. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 164-166
Background: Atrial Septal Defects (ASD) can be closed surgically using conventional midline sternotomy or minimal invasive technique. This study was done to evaluate the outcome and safety of the minimal invasive cardiac surgical (MICS) approach using right vertical infra axillary incision (RVAI) for the repair of ASD. Methods: We performed a prospective observational cross-sectional analysis on 50 patients who were diagnosed as ASD of various types and not amenable to device closure. Their surgery was done RVAI using central cardiopulmonary bypass. Outcome of the study was evaluated using the following variables: length of the incision, satisfaction of patients, mortality, infection of surgical site, blood transfusion, duration of total operation, intensive care unit (ICU) stay, mechanical ventilation, hospital stay and aortic occlusion. Operations were done between December 2013 to December 2020. All the recruited patients were treated through RVAI as per patient’s choice. Results: Mean age was 11.4± 6.4 years. 18(36%) were male and 32(64%) were female. Body weight ranged from 10 to 65 kg. Mean length of incision was 6.2±0.8 cm. Mean aortic occlusion time was 42±14 min. ASD closed directly, using autologous treated pericardial patch or dacron patch. Mean total operation time was 4.08±0.6 hours and mean mechanical ventilation time was 8.3±5 hours. Average ICU stay was 35.6±6 hours and total hospital stay was 7.2±0.9 days. There was no significant blood loss. Only 10 patients required intravenous (IV) analgesics in the post-operative period. One patient required re-exploration, one conversion to median sternotomy and one suffered from superficial skin infection. There were no operative or late mortalities. Patient satisfaction was excellent. Conclusions: MICS technique using RVAI for surgical repair of ASD revealed a safe procedure and could be performed with excellent cosmetic and clinical outcomes. It provided a good alternative to the standard median sternotomy. Cardiovasc j 2021; 14(1): 37-43
Background & objective: Ultrasonogram (USG) and computed tomography (CT) are often used in the evaluation of gall-bladder carcinoma. Thepresent study was conducted to determine the usefulness of USG and CT scan in diagnosing gallbladder carcinoma. Materials & Methods:This cross-sectional observational study was conducted at Department of Radiology and Imaging, BIRDEM in collaboration with the Departments of Hepato-biliary Surgery, and Histopathology of the same institute over a period of 3 years fromJuly 2004 to June 2006. A total of 42 patients (ranging from 40-80 years) were initially included on the basis of signs and symptoms of gallbladder carcinoma and underwent USG and CT scan for preoperative radiological diagnosis, its extension and operability. Following operation all the resected specimens were sent for histopathological evaluation. The diagnostic accuracies of USG and CT scan were then compared against histopathological diagnoses by using Kappa statistics. Result:In the present study, the mean age of the patients was 60 (range: 40-80) years with female preponderance. About 40% of the gall-bladder were contracted and reduced in size and 32.5% large and distended on USG examination, while 45% of the gall-bladder were contracted and reduced in size and 25% distended and large on CT examination. Approximately 40% had irregularly thickened wall and 21.2% diffusely thickened wall on USG and 30% of gallbladder wall were diffusely thickened and 45% irregularly thickened on CT scan. The present study showed hepatic parenchymal invasion to be 22.5% on USG and 42.5% on CT scan. The sensitivity and specificity of USG in diagnosing GB carcinoma were 93.9 and 71.4% respectively. Similarly, the sensitivity and specificity of CT scan in detecting GB carcinoma were 97.1 and 83.3% respectively. The test of agreement (Kappa test) revealed an almost 90% agreement between the two procedures meaning that the two diagnostic modalities are almost comparable in diagnosing gall bladder carcinoma (p<0.001). Conclusion:The study findings indicate that both USG and CT scan are ideal,non-invasive, safe imaging modalities for diagnosis of gallbladder carcinoma. CT scan has an additional advantage in defining the extension of the disease and involvement of surrounding structures including lymph nodes and hepatoduodenal ligament. gallbladder wall thickening. The mass replacing the gallblader fossa is the most common appearance. CT scan can differentiate between complicated cholecystitis and advanced gallbladder carcinoma by few specific findings 3 .In this country, gallbladder carcinoma is not uncommon. Ultrasonography and CT scan are two important diagnostic tools available in our country to evaluate the hepatobilliary system. By utilization of these advanced imaging modalities, carcinoma gallbladder can be detected early when these tumors are still localized. Thus survival time of the patients can be increased by early removal of tumors. To the best of our knowledge, no published data are available in this country in the field of ...
Here we reported three cases of unilateral tubal and ovarian absence, along with laparoscopic images and images during ceasarean section in Anwer Khan Modern Medical College. Three patients with primary infertility of 6-8 years duration were reported as non-visualization of right adnexal structures on transvaginal ultrasound and hysterosalpingography. Absence of right adnexal structures of varying degree were detected during laparoscopy. Subsequent evaluation of renal system with Intravenous Pyelography were done. Ipsilateral absence of the fallopian tube and ovary without any other system anomalies were detected. Vascular accidents, Congenital defects or torsion could be the possible etiologic factors. Laparoscopy is a feasible option as a diagnostic tool for these cases.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 97-100
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