Evaluation of Short Term Outcome of Stapled Transanal Rectal Resection (STARR) for ODS (Obstructed Defecation Syndrome) by Comparing Pre and Post-operative ODS Score.

Obstructed defecation syndrome (ODS) is a common anorectal problem and it can be corrected by various surgical approaches but most of these have high recurrence and complication rates. Antonio Longo introduced Stapled transanal rectal resection (STARR) in 2003 as a minimally invasive transanal operation for correction ODS associated with rectocele and or rectal intussusception. This study was designed to assess the short term outcome of Stapled Transanal Rectal Resection (STARR) as a surgical treatment of Obstructed Defecation Syndrome (ODS). This is a quasi experimental study which was carried out in the department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from May 2016 to June 2017. Seventeen (17) patients were included in the study. Patients with obstructed defecation syndrome and rectocele and or rectal intussusception admitted in the department of Colorectal Surgery were enrolled in the study as per inclusion and exclusion criteria. History, clinical examination, Proctoscopy, Colonoscopy and MR Defecography was done for evaluation of the patients. During evaluation preoperative Longo's ODS score of every patient also determined and compared with postoperative ODS score. The patient was followed up regularly at one, three and six months after each operation. The ODS score in 82.35% patients improved significantly. The postoperative score was high (13-15) only in 02(11.8%) patients probably due to presence of physiological factors. Post-operative defecatory urgency was developed in only 02(11.76%) patients. Major postoperative complication like hemorrhage or rectovaginal fistula did not develop in any patient. STARR is an effective, less invasive and simple procedure for the treatment of ODS with rectocele and/or rectal intussusception without major morbidity but other physiological causes of ODS should exclude preoperatively because its presence makes the surgical intervention fruitless.

Anorectal Malformations and Associated Anomalies in Children.

Anorectal malformations (ARM) incorporate a broad spectrum of diseases, can affect both sexes, and involve the distal anus and rectum as well as the uro-genital tracts. Defects range from the minor which can be treated easily with an excellent outcome, to those are complex and often associated with other anomalies are difficult to manage with poor functional prognosis. This study was done to observe the hospital incidence of Anorectal malformations, frequency of types, sex distribution and spectrum of associations with ARM. The effects of presence of associated anomalies on morbidity and mortality also observed. Detailed history, clinical examinations and relevant investigations were performed for the primary and as well as the associated anomalies. A total of 80 patients were admitted in the department of pediatric surgery in Mymensingh Medical College Hospital during the period of June 2016 to May 2017. Age of the patients was ranging from 1-180 days with the mean age of 0.49±1.002 months. Male: Female ratio was 1.6: 1. Among them 48(60%) were high and 32(40%) were low variety of ARM. In male 37(46.2%) had high and 13(13.7%) were low variety whereas in female 11(13.7%) were high and 19(23.7%) had low ARM. Associated anomalies were seen in 25(31.2%) patient -18 in males and 7 in females; 20 in high and 5 in low ARM. Associated anomalies were uro-genital 11(13.8%), cardiovascular 10(12.5%), vertebral 4(5%), limb defects 3(3.5%) and others 2(2.5%). Four patients have more than one anomaly. Anorectal malformations occur more in boys than girls. Males were more likely to have high lesions and without fistula was the common defect. Low variety ARM were found more in females with Anovestibular fistula is the commonest defect. The most common associated anomalies were recto urinary fistula (13.8%). Associations were more in high than low ARM but not significant (p>0.05). Post operative complications were more in high ARM in both sexes with associated anomalies. The effects of types and associations on morbidity and mortality were significantly different (p<0.05).

Evaluation of Breast Lump - Comparison between True-cut Needle Biopsy and FNAC in MMCH: A Study of 100 Cases.

One-fourth of all women suffer from breast disease in their lifetime. World Health Organization estimated that over 508,000 women died in 2011 due to breast cancer worldwide.For several years, fine needle aspiration cytology (FNAC) was the most practiced method for the pathological diagnosis of breast lump specially differentiation of benign from malignant. The advent of core needle or True-Cut biopsy (TCB) in the new millennium has resulted in many surgeons switching to TCB since it provides a sufficient amount of tissue for pathologists to make an accurate histological diagnosis.During the study period, patients present with clinically palpable breast lump admitted in different surgicalunits of MMCH, among them 100 patients selected purposively. Then a prospective comparative study was carried out in the Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2017 to February 2018. Out of a total of 100 patients, who presented with suspicious breast lump, as clinically diagnosed 68 patients had benign breast lump and 32 patients had malignant breast lump. FNAC confirmed the diagnosis of breast carcinoma in 27 patients with sensitivity 89.65% and specificity 66.66%. True-cut biopsy confirmed the diagnosis of breast carcinoma in 29 patients with sensitivity 96.66% and specificity 100%. It also gave the definitive histological type and grade which correlated with the final histopathology report in 29 out of the 30 patientsTCB also provides adequate tissue for the evaluation of molecular markers which have extreme therapeutic value.

The Role of Histological Assessment of Distal Doughnut in Low Anterior Resection for Low Rectal Cancer.

Anterior resection (AR), especially low anterior resection (LAR), for low rectal cancer and colorectal anastomosis is a technical challenge to surgeons. But by using circular stapling devices now it is possible make more LARs technically feasible. A stapled end-to-end colorectal anastomosis is increasingly adopted following a low anterior resection for low rectal cancer. This descriptive cross-sectional study was carried out in the department of Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from December 2015 to December 2016. The ensuing doughnuts created from the stapling device are routinely sent for histological analysis. However, its efficacy remains debatable. This study aims to determine the role of sending distal doughnut for histological examination following a stapled end-to-end colorectal anastomosis done in low anterior resection for low rectal cancers.

Motor Outcome of Stroke Patients with Low Dose Levodopa Therapy.

Stroke is one of the leading cause of disability worldwide. Motor function deficits due to stroke contribute to overall low quality of life. The objective was of this study is to observe functional motor outcome after stroke with low dose Levodopa therapy. This prospective follow up study was carried out in the Department of Neurology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2014 to June 2016 to see the effect of low dose of Levodopa (110mg) on motor outcome after stoke disability. Motor deficit was measured by Medical Research Council (MRC) grading and Rivermead Mobility Index (RMI) score. Two groups were selected by simple random method, consisted of both ischemic and hemorrhagic stroke. All the patients of both the groups were suffering from at least some post stroke motor disability and attended full course of physiotherapy. The group (L) received 110mg Levodopa with physiotherapy. On the other hand (NL) group received only physiotherapy. They were all followed up for four times within two months of time and were assessed for recovery of motor function. Mean age was 59.03±11.56 years in Levodopa (L) group and 57.10±12.41 years in the Non Levodopa (NL) group; Males were predominant in both groups. Ninety three (77.50%) cases had ischemic stroke and 27(22.50%) cases had hemorrhagic stroke. Most common risk factors were hypertension and smoking. No known risk factor was detected in 8 (6.67%) patients. Single or multiple risk factors were confirmed in 112 patients (93.33%). MRC score was significantly higher both in affected upper and lower limb in Levodopa group comparing non Levodopa group at 4th visit. RMI score was also significantly higher in Levodopa group comparing non Levodopa group at 4th visit. The Levodopa (L) group showed better recovery pattern than Non Levodopa (NL) group. It can be concluded that motor recovery was better with administration of a single low dose of Levodopa in combination with physiotherapy. Motor outcome was significantly higher in levodopa group than non-levodopa group.

Incidence of Negative Appendicectomy in Clinically Diagnosed Patients of Acute Appendicitis.

This study was conducted in the department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2016 to December 2017 and performed to assess the negative appendicectomy on histopathology followed by clinically and laboratory investigations based diagnosed acute appendicitis. To perform this prospective study 200 patients with pain in right iliac fossa of both sexes randomly selected and were evaluated by history, clinical examination, laboratory investigations (USG, CBC) and scoring system. Among 200 patients male 124 and female 76 under went appendicectomy 36 were histopathologically normal appendix. Over all negative appendicectomy (NAR) 18%, among them 14.5% (18/124) were male & 23.67% (18/76) were female.

Comparative Study of Stabilization of Humerus Supracondylar Fracture in Children by Percutaneous Pinning From Lateral Side and Both Sides.

The aim of this prospective experimental study was to analyze the radiological and clinical results of the supra condylar fracture of Humerus in children and conducted the functional outcome of closed reduction and internal fixation by percutaneous Kirschner-wire from lateral side and crossed technique in the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Sher-E-Bangla Nagor, Dhaka, Bangladesh from July 2011 to June 2013. Patients diagnosed as closed Supracondylar fracture of Humerus in children due to trauma were the study population. Total 30 patients aged 2 to 12 years irrespective of sex were included in the study and were divided in 2 groups. Information obtained included age, sex, type of fracture, management, outcomes and complications. The mean age was 7.80±2.08 and 5.93±2.31 years for Group I and Group II patients. Age range was 2-12 years. Males were predominant 11(73.3%) Group I and Group II. Fractures were primarily caused by fall from tree and left side predominant. In Group I the time elapsed between injury and surgery was minimum 2 hours and maximum 24 hours with mean±SD was 9.20±7.20, while in Group II minimum and maximum of 3 and 48 hours respectively with mean±SD was 9.60±11.01. Minimum and maximum post operative hospital stays were 1 and 2 days in Group I and Group II. Follow-up were carried out after 1, 3, 6 and 12 weeks of operation. Loss of post operative range of motion of elbow and loss of carrying angle was not significant (p>0.05). Functional outcome was analyzed by Flynn's grading. In this study there were 3(20%) cases with excellent, 10(66.67%) were good and 2(13.33%) were fair functional outcomes in Group I. In Group II excellent, good and fair functional outcome were 3(20%), 9(60%) and 3(20%) respectively. After chi-square test there was no significant difference between two groups.

Tuberculoid granulomatous lesion of the pharynx--review of the literature.

Pharyngeal involvement in tuberculosis is rare and is usually secondary to pulmonary tuberculosis. We report a very rare case of chronic granulomatous pharyngitis, which later turned out to be due to primary tuberculosis of the pharynx. The clinical presentation, diagnosis, treatment and complications of this rare clinical entity are presented.

Fourth branchial pouch cyst: an unusual cause of neonatal stridor.

Fourth branchial pouch anomalies are extremely rare and only a few such cases showing sinuses and cystic masses have been reported in the literature. We describe a patient who presented on the third day of life with cystic neck swelling of fourth branchial pouch origin giving rise to respiratory obstruction and stridor. Despite repeated aspiration of the cystic mass to relieve respiratory obstruction, rapid recurrence of the mass continued to cause stridor and ultimately required surgical excision. The clinical, radiological, and histopathological findings of this unusual condition are discussed with a review of the literature.

Metastatic osteosarcoma of the ethmoid: an unusual cause of recurrent epistaxis and proptosis.

Osteosarcoma is the most common primary malignant tumour of bone and it usually metastasises to the lung. In the nasal cavity metastatic disease is extremely rare. We describe a case of osteosarcoma presenting with recurrent epistaxis, and proptosis due to secondaries in the nasal cavity. To our knowledge such a case has not been reported previously in the available English literature.