Introduction: Gallstone disease occurs in 3%-20% of the world population and about 15% of people with gallstone disease develop stones in the common bile duct (CBD). Smaller stones are amenable to be removed by endoscopic retrograde cholangio-pancreatography (ERCP) while larger stones require surgery-either open or by laparoscopic. Materials and Methods: This was a prospective study between January 2010 and December 2012 in two hospitals in Chittagong, Bangladesh, on ultrasonography upper abdomen. And where ultrasonography was not able to diagnose the location and cause of obstruction than magnetic resonance cholangio-pancreatography (MRCP) was done. To rule out malignancy, contrast enhanced computerized tomography was done in selected cases. The patients were divided into two groups on the basis of management-Group A: CBD exploration with insertion of T-tube and Group B: CBD exploration with primary closure. All operated patients underwent a longitudinal choledochotomy. Then the stones were removed and CBD was flushed with normal saline ensuring no distal obstruction. Initially we used T-tube cholangiogram to see distal clearance which was replaced by choledochoscope later on. Primary closure was done in 37 (53%) cases where T tube drainage was given in 34 (47%) cases and T-tubes were kept in situ for 9-10 days. Bile duct was closed with interrupted absorbable catgut 3-0 suture and a sub hepatic drain was kept for 48 hours. All patients were given pre-operative and post-operative antibiotics and follow up was taken for next 6 months. Results: Out of 71 patients, 46 (61%) were females and 29 (39%) males. In all patients cholecystectomy was done along with CBD exploration. Three patients who were planned for primary closure without T-tube, T-tubes were inserted due to CBD trauma, oozing, and gross swelling. Complication like biliary leakage was seen in only one patient with primary closure which was managed by keeping subhepatic drain for 5 days. Two patients in the T tube group developed wound infection while only one developed this complication in the primary closure group. No patient in the study developed cholangitis. No patient was expired in the study. Conclusions: Primary closure without external drainage after choledochotomy is feasible, safe, and cost-effective.
A subdural hematoma is a collection of blood below the inner layer of the dura but external to the bran and arachnoid membrane.Chronic subdural hematoma is commonly associated with cerebral atrophy, occur in the elderly after apparently insignificant head trauma. The incidence of Chronic subdural hematoma increases with age and after 70 years of age. Surgical evacuation of hematoma is indicated in patients who are clinically deteriorate or do not improve. Surgery can bring a rapid clinical improvement with a favorable outcome in over 80% of patient. Methods: This study was a prospective intervention study. Results: It was observed that 29 (96.6%) patients were alive in group A and 27 (90.0%) patients alive in group B in GOS scoring on the 7th POD. The alive patients were again divided into 4 sub groups, as shown in the table. Among total 60 patients, in Group A 1(3.4%) died and 3 (10.0%) died in Group B. After 3 months follow up, it was observed that 29 (96.6%) patients were alive in group A and 27 (90.0%) patients alive in group B. The alive patients were again divided into 4 sub groups, as shown in the table. Persistent vegetative and severe disability was not improved in Group B. Conclusion: In my study it was observed that the surgical outcome in single burr hole craniotomy is better than double burr hole craniotomy for treating of chronic subdural hematoma. Bang. J Neurosurgery 2020; 9(2): 99-104
Background: Pilonidal sinus is a common disease of young adult usually caused by insertion of fallen hair into skin (Gluteal cleft). Wide excision surgery is a common practice but due to high recurrence and long duration of healing there are more simple alternatives. Our experience with transposition of Rhomboid flap in the treatment of pilonidal sinus are described. The conventional way of treatment of pilonidal sinus is block excision and lay open of the sinus result in 5-14 days hospital stay healing time of 6-10 weeks. In our study all patients hospital stay was 2-3 days, healing time was less than two weeks with minimum complication. The aim of the study is to do rhomboid flap for the treatment of pilonidal sinus, so to avoid complications and recurrence, to shorten hospital stay and to give better outcome. Methods: Total 6 patients of 18-40 years of age after doing all investigations and clinical examinations, excision of pilonidal sinus was done and repaired by rhomboid transposition flap in the same setting. All the patients were followed up post operatively for 3 months to see any discharging sinus. Results: All 6 patients were discharged on 3 rd post operative day and stitches were removed on 8 th post operative day and approximate time to resume their work is 14 days. Conclusion: Pilonidal sinus surgery is a challenging operation for the surgeon because of recurrence and complication. Rhomboid flap technique has become familial because of its advantage of early healing, less hospital stay and very low recurrence rate.
Osteoma is a slow growing benign mesenchymalosteoblastic tumor formed by maturebone tissue. The most common site reported is the fronto-ethmoidal region andneighboring sinuses.Involvement of the temporal and occipital squama is extremelyrare. Like giant osteomas in other locations of the skull, they can reach large volumesbut are essentially benign and potentially curable by excision.The author present acase of giant osteoma in Temporo-Parieto-Occipital region in a teenage girl. Bang. J Neurosurgery 2020; 9(2): 173-177
Introduction: An acute subdural hematoma (SDH) is one of the most lethal of all head injuries. A good number of patients are encountered in Dhaka medical college and hospital with acute subdural hematoma. There are many modalities for the treatment of acute subdural hematoma, such as decompressive craniectomy with multidural stabs, craniotomy with durotomy. This comparative study was carried -out in the Department of Neurosurgery, Dhaka Medical College and Hospital, Dhaka, during Jan 2016 – Dec 2017, to compare the effect of the decompressive craniectomy with multidural stabs and craniotomy with durotomy in respect to the post operative GCS and GOS. As well as to assess and compare the post operative complications. The type of the study is prospective randomized controlled clinical trial. Materials and Methods: For this purpose, a total of 56 patients of both sex and any age with acute subdural hematoma attended in the above hospital were included in this study. Among them 28 patients underwent decompressive craniectomy with multidural stabs and rest 28 underwent craniotomy with durotomy. Data were collected and analyzed by different variables like age, sex, GCS on admission, GCS on 7th POD, GOS at one month and some complication like operative recurrence, seizure and mortality. Patients or attendants who refuse interview, who managed conservatively and patient who didn’t give consent, patients having severe respiratory distress and or shock, who came after 24 hours of trauma and who had no history of trauma were excluded from the study. Results: The following observations and results were obtained in this study. Nearly two third (63.0%) patients of DC MDS group and 18 (64.3%) in CT DT group age belonged to 21 to 40 years. Most (85.7%) of the patients of DC MDS group and 22 (78.6%) in CT DT group were male. Almost a half (46.4%) patient of DC MDS group and 12 (42.8%) patients of CT DT group GCS on admission belonged to 4 to 8 scale. The differences between two groups were not significant (p>0.05). Nearly a half (46.4%) patient of DC MDS group and 6 (21.4%) patients of CT DT group GCS on 7th POD belonged to 9 to 12 scale. Mortality observed almost one third (32.1%) and 12 (42.9%) in patients of DC MDS group and CT DT group respectively. Regarding the GOS at one month follow up, it was observed 12 (42.9%) patients of DC MDS group and 2 (7.1%) patients of CT DT group had good recovery. About the relation between GCS (on admission) with GOS at one month, we saw that 10(37.7%) patient. GCS was ≥8 where GOS was 4+5 and compare to CT with DT group 9 (32.1%) patients. The difference was statistically significant (p<0.05) and GCS (7th POD) with GOS, it was seen 15 (53.3%) patients GCS was e”8 where GOS was 4+5 and compare to CT with DT group 9 (32.1%) patients. About the complications 4 (14.3%) patients of DC MDS group had both surgical recurrence and seizures. 12 (42.9%) patients of CT DT group had seizures and 11 (39.3%) patients had surgical recurrence. Conclusion: Though mortality between these two groups was not significant, GCS on 7th POD and GOS on 30th POD were significantly better in decompressive craniectomy with multidural stabs group and operative recurrence and seizure was less in decompressive craniectomy with multidural stabs group and was statistically significant. Bang. J Neurosurgery 2021; 10(2): 192-200
Background : Infantile hemangioma is a benign vascular tumor. Considerable controversy exists as to the management of hemangiomas. The purpose of this study was to see the efficacy and safety of orally administered prednisolone and propranolol in combination for treatment of potentially disfiguring or functionally threatening hemangiomas Materials and methods: In this prospective study, thirty two patients of hemangioma with age range of 1 month to 5 years were included who were treated with oral propranolol (1 mg/kg/ day in two divided doses) and oral prednisolone (2 mg/Kg/ day in single dose) in combination. This study was conducted in outpatient Department of Pediatric Surgery of Chattogram Medical College Hospital from January 2016 to December 2017. Changes in size and color of lesions were the two evaluating factors to see the efficacy of the treatment. Therapeutic response was graded as excellent, good, poor and no response. Results: Overall therapeutic response was 92.62% (29 patients). Excellent response was noted in 21 patients (65.62%) and in 3 patients (9.38%) there was no response. Range of treatment period was 6 to 20 weeks. No side effects except excessive weight gain was noted (6.25%). Conclusion: Combined use of low dose oral prednisolone and propranolol is more effective and safe for treatment of hemangioma. Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 23-26
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