Distal Common Bile Duct Tuberculosis with Obstructive Jaundice: A Case Report.

Tuberculosis (TB) isolated in Common Bile Duct (CBD) is very rare and its treatment is somewhat controversial. We report a case of distal CBD tuberculosis diagnosed as cholangiocarcinoma. A 40 year old man presented with obstructive jaundice without abdominal pain, fever or weight loss. Ultrasonography and Magnetic Resonance Cholangio-Pancreatography (MRCP) indicated a mass lesion in the Distal CBD, which caused structure of the distal common bile duct. As Cholangiocarcinoma was suspected, he underwent Whipple procedure (pancreaticoduodenectomy). Histological examination of resected specimen revealed typical features of tuberculosis in the distal CBD, pancreatic head and lymph nodes. The rest of the abdominal cavity was unremarkable. Anti-microbial therapy for tuberculosis is started for 12 month course and he is well.

Interlocking intramedullary nailing in fracture shaft of the femur.

This prospective study was done to evaluate the result of interlocking intramedullary nailing in fracture shaft of the femur under the Department of Orthopaedic Surgery in Mymensingh Medical College Hospital during the period of January 2007 to December 2008. In this study total 66 patients were purposively selected for interlocking nailing initially but 6 patients did not report in subsequent follow up. So, the result of the study was based on 60 patients. There were 38 males and 22 females with the age range of 18 to 70 years, with an average age of 34 years. Motor vehicle accident was the most common cause of the fracture shaft of the femur (60%) and the second most common cause was fall from height (20%). Right sided involvement was more (66.67%). Majority of the patients had fracture lower third of the femur (70%). Among the patients farmer was the most common (33.33%) group and the next was housewife. The mean union time was 17 weeks with the range of 14 to 30 weeks. Postoperative complications were found, such as infection (3.33%) and nonunion (1.66%). The functional outcome of this study was evaluated by Klemm & Borner criteria. Excellent functional outcome was found in 80%, good in 15% and fair in 5%.

Human errors in medical practice: systematic classification and reduction with automated information systems.

We review the general nature of human error(s) in complex systems and then focus on issues raised by Institute of Medicine report in 1999. From this background we classify and categorize error(s) in medical practice, including medication, procedures, diagnosis, and clerical error(s). We also review the potential role of software and technology applications in reducing the rate and nature of error(s).