Pattern of malignancy in clinically solitary thyroid nodule.

Solitary thyroid nodule (STN) is a common thyroid disorder. Clinically recognized thyroid carcinoma constitutes less than 1% of human malignant tumours. The risk of malignancy in solitary thyroid nodule is greater than other thyroid swelling. The risk of malignancy in generalized thyroid swelling is about 3% and in solitary thyroid nodule it is about 15%. This study was carried out in Surgery and ENT Department, Mymensingh Medical college Hospital from November 2008 to October 2009 to see pattern of malignancy in clinically solitary thyroid nodule. Total 108 patients of STN was included in this study, majority of the patients were within 20-39 years age group with female predominance. In addition to thyroid swelling some patients presented with other symptoms like cervical lymphadenopathy in 6(5.56%), dysphagia 2(1.85%), hoarseness of voice 2(1.85%) and metastatic lesion in bone 1(0.92%) cases. Among 108 cases of solitary thyroid nodule only 19 cases were malignant. Patients with malignant lesion presented with shorter duration of symptoms. Out of 19 malignant cases 6(31.58%) cases presented with features of metastasis. Malignancy was more predominant in male (25.00%) than the female (14.47%) in STN. Out of 19 malignant cases, 12(63.16%) were papillary carcinoma, 5(26.31%) were follicular carcinoma and 2(10.53%) cases were medullary carcinoma. Study showed significant difference (p<0.01) between papillary & follicular carcinoma and significant difference (p<0.001) between papillary & medullary carcinoma. Papillary carcinoma was most common among all thyroid malignancies in patients with solitary thyroid nodule.

Clinicopathological stages of carcinoma breast patient.

Carcinoma of breast is the second most common cancer among women next to uterine cervical cancer in Bangladesh. It was well established that 5 years survival rates greatly vary among the different stages of carcinoma of breast disease. The study was carried out to see the stages of presentation of carcinoma of breast patient to a tertiary level hospital attended first time for medical help as well as to find out the factors responsible for the late (advanced) stage presentation. This descriptive type of cross sectional study was carried out in the department of surgery, Mymensingh Medical College and Hospital (MMCH) during the period of May 2010 to April 2011. A total of 110 cases admitted with carcinoma breast diagnosed by means of FNAC positive or suspicious findings were selected purposively during the study period. Patients were staged initially according to the TNM staging system by through clinical examination as well as final clinicopathological stages were done after histopathological examination of the resected specimen (breast with or without axillary lymphnode) in resectable cases. Among the advanced stage presentation, attempts were made to find out the factors responsible for advanced stage of the disease. The results showed that carcinoma of breast predominantly a disease of female and comparatively younger age group 40-49 years affected mostly in 40.9% cases with a mean age of 44.02 ± 10.32 years. Premenopausal lady mostly affected in 63.6% cases. Majority of patients presented in advanced stage of the disease in 62.8% cases. Multiple factors were observed responsible for the advanced stage of the disease - among them delay in hospital presentation, poor socioeconomic condition and illiteracy have found to be associated which were statistically significant (p<0.001). It was needed for mass awareness program against the breast cancer in our society. Necessary steps should be taken for the initiation of breast self examination (BSE) to patients and clinical breast examination (CBE) to health care providers.

Preparation of Manganese Oxide Nanoparticles with Enhanced Capacitive Properties Utilizing Gel Formation Method.

Development of efficient and environmentally benign materials is important to satisfy the increasing demand for energy storage materials. Nanostructured transition-metal oxides are attractive because of their variety in morphology, high conductivity, and high theoretical capacitance. In this work, the nanostructured MnO2 was successfully fabricated using a gel formation process followed by calcination at 400 °C (MNO4) and 700 °C (MNO7) in the presence of air. The suitability of the prepared materials for electrochemical capacitor application was investigated using graphite as an electrode substrate. The chemical, elemental, structural, morphological, and thermal characterizations of the materials were performed with relevant techniques. The structural and morphological analyses revealed to be a body-centered tetragonal crystal lattice with a nano-tablet-like porous surface. The capacitive performances of the MNO4- and MNO7-modified graphite electrodes were examined with cyclic voltammetry and chronopotentiometry in a 0.5 M Na2SO4 aqueous solution. The synthesized MNO7 demonstrated a higher specific capacitance (627.9 F g-1), energy density (31.4 Wh kg-1), and power density (803.5 W kg-1) value as compared to that of MNO4. After 400 cycles, the material MNO7 preserves 100% of capacitance as its initial capacitance. The highly conductive network of nanotablet structure and porous morphologies of MNO7 are most likely responsible for its high capacitive behavior. Such material characteristics deserve a good candidate for electrode material in energy storage applications.

Correlation between clinical presentation, peroperative finding and histopathological report in acute appendicitis.

Acute appendicitis is usually encountered clinically as acute abdomen. Typical cases are easy to diagnose, but sometimes it is very difficult to make a diagnosis in atypical cases. The objective of the study was to determine the diagnostic accuracy in patient of clinically diagnosed acute appendicitis. This prospective study conducted in Mymensingh medical college hospital on 1136 patients presented with acute abdomen and clinically diagnosed as acute appendicitis from July 2004 to June 2010. Emergency appendicectomy was done in all consecutive patients after relevant investigation. Intraoperative findings along with histopathological reports were compared with clinical diagnosis. On the basis of histopathological report, 85.65% were found to have acute appendicitis with misdiagnosis in rest of the subjects requiring unnecessary explorations. Negative exploration was more in emergency than office hour. This may be due to diagnostic inaccuracy and decision-making in the management of the acute appendicitis. Management errors can be significantly reduced by accurate preoperative diagnosis of acute appendicitis by improving clinical skill and appropriate investigations.

A 12 years old boy with carcinoma rectum.

Primary gastrointestinal malignancy constitutes approximately 2% of pediatric neoplasm and colorectal carcinoma is the second most common malignancy among them. This is one of the rarer diseases in children. Carcinoma of the rectum must be considered as a differential diagnosis in childhood if patient presents with per rectal bleeding in conjunction with abdominal pain & weight loss. In our article a 12 years old boy with Mucin secreting adenocarcinoma is being presented. The patient presented with incontinence of stool, with abdominal pain and history of swelling of left lower abdomen during defaecation. He got admitted in a district hospital for several times and USG of whole abdomen was done for several times but no abnormality was detected. Later on, by simple digital rectal examination (DRE) he was clinically diagnosed as a case of CA Rectum and eventually, the diagnosis was established by colonoscopy followed by biopsy.

A young lady with secondary tuberculosis of breast.

Tuberculosis of breast is an extremly rare form of extrapulmonary tuberculosis even in endemic area like Bangladesh and the incidence is 0.25-4.5% of all breast lesions. The diagnosis is difficult because of nonspecific clinical, radiological and histopathological findings. Very often biopsy specimens are inadequate and microscopy or culture is negative. It is usually suspected in a multiparous woman who may be immunocompromised. We report a case of breast tuberculosis in a 26 years old multiparous lady who previously present with two times attack of right sided breast lump and then diagnosed as a case of breast abscess and treated by incision and drainage with antibiotics in a nearby local hospital. During her third time attack she admitted into Mymensingh Medical College Hospital with right sided breast lump with multiple discharging sinuses for one month. Biopsy was taken from the lump and sinus tract and histopathological report confirmed the diagnosis as a case of tuberculosis of breast. Her X-ray chest showed tubercular lesion in lungs. So this is a case of secondary breast tuberculosis. This case highlights how difficult is the diagnosis of a case of breast tuberculosis for which the patient may require even mastectomy at very late case. So this case is reported.

Giant penoscrotal filariasis.

A 42 year old male individual having a hugely distended scrotum and barely perceptible penis, unable to maintain his livelihood on account of his handicap and socially withdrawn for the fear of humiliation, got admitted into the Surgery department of Mymensingh Medical College Hospital in August 5, 2007. The person had been carrying the so called curse for the last four years. On the basis of clinical, serological and haematological examinations, diagnosis was established as lymphatic filariasis causing elephantiasis of the scrotum. After assessment for operative feasibility, the patient underwent an operation in August 20, 2007 during which, ligation of both the spermatic cords, excision of the scrotum along with the testicles and reposition of the penile shaft into the anterior pelvic wall in the subcutaneous plane (Fleying procedure) was performed. The scrotum measured about 36 inches in diameter and weighed 40 kgs after excision. Histopathological examination of the scrotal skin confirmed the diagnosis. The patient was released without any complication, on the 11th post operative day after removal of stitches, with indwelling urethral catheter. He was prescribed Doxicycline for the next 8 weeks, a drug which has been found to be effective in treating filariasis in a number of studies, and acts by killing a symbiotic bacteria necessary for the survival of the worm. Follow up after 3 months was uneventful.

Clinicopathological Study of Enterocutaneous Fistula in Mymensingh Medical College Hospital.

Enterocutaneous fistulae are a major catastrophe to the patients and surgeons and it still has high incidence of morbidity and mortality and their management remains a big challenge. Enterocutaneous fistula presents the surgeon with challenges of metabolic disorders and extensive sepsis. Total management of an intestinal fistula requires skill in nutritional support, stoma therapy, elimination of sepsis, well timed and well carried out surgery. Postoperative enterocutaneous fistulae account for approximately 80% of enterocutaneous fistulae. The majority of the intestinal fistula (75-85%) is iatrogenic occurring in the postoperative period following anastomotic dehiscence. They arise following emergency abdominal surgery for intestinal obstruction, inflammatory bowel disease or cancers. Protein calorie malnutrition alters the patients immune response, inflammatory reactions and tissue regenerations, all of which are essential for wound repair. The present study is an effort to highlight the incidence of enterocutaneous fistula after emergency and elective resection and anastomosis of gut with discussion over recent trends and developments in its management and compare with other studies. Objectives of the study are to determine the various clinicopathological features and management protocol of enterocutaneous fistula. There are recent advances in nutritional support. This descriptive type of cross-sectional study was carried out in the Department of Surgery, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh from October 2010 to September 2011. Total 42 cases of enterocutaneous fistulae were selected purposively. Enterocutaneous fistulae are more common in patients of low economic condition. Enterocutaneous fistulae are more common after emergency abdominal surgery. Spontaneous closure occurred in 17(40.48%) cases and surgery needed in 25(59.52%) cases. Of them 20(80.00%) were healed and 5(20.00%) were expired. In spite of improvement in the management protocol of enterocutaneous fistula, there is still high unacceptable morbidity and mortality rate. Total parenteral nutrition (TPN) is not available and very costly, and health care facilities are also limited in our country. Patients with enterocutaneous fistula require fluid, electrolytes and nutritional support. Anaemia, dehydration, electrolytes imbalance should be corrected prior to abdominal surgery if possible. Surgical treatment for enterocutaneous fistula should be performed only after failure of conservative treatment of more than 12 weeks.

Choledochal cyst.

Choledochal cyst, a congenital anomaly, is a premalignant condition. Progressive damage to the bile ducts and to the liver parenchyma may also have association with the condition. Subsequent risk of developing cholangiocarcinoma may be lessen by early diagnosis and prompt definitive surgical treatment, that may even permanently correct the condition. A young lady was admitted into Mymensingh Medical College Hospital and was presented with pain in the upper abdomen associated with intermittent vomiting for several months. Her per abdominal examination revealed an ill defined mass in the epigastrium and right hypogastrium with diffuse tenderness. Patients may also present with attacks of jaundice of obstructive type, but this was absent in this particular case. Diagnosis of choledochal cyst was confirmed by the ultrasound. On exploration, the cyst was excised and Hepatico-jejunostomy and jejuno-jejunostomy was done by Roux-en-Y method. Her post operative period was uneventful and followed up till to date. Purpose of this presentation is to emphasize early diagnosis and definitive treatment of this developmental anomaly that may predispose to malignancy.

Urinary incontinence due to duplication of ureter--a case report.

A seventeen years old female student from Nakla, Sherpur was admitted in the surgical unit I of Mymensingh Medical College Hospital (MMCH) on 28th October 2000 with the one and only complain of continuous dribbling of urine since her birth. Besides her urinary incontinence she used to have urge for micturition and normal voiding pattern as well. She has a good physique but a very depressed mental state. IVU suggested about the duplication of the right ureter but not clearly. Voiding cystourethrogram excluded any degree of vesicoureteral reflux. During examination under anesthesia (EUA) a tiny orifice was noted in the urethro-vaginal septum just below the external urethral orifice through the orifice delineated whole of the ecotopic ureter. Right heminephrectomy was done including excision of the pelvis and proximal part of the upper ureter that was draining directly to the exterior. Postoperative recovery was uneventful and the patient got rid of the ever-disgusting problem.

Tuberculous prostatitis--a case report.

Tuberculous prostatitis is a rare condition. A 55 years-old man admitted into a surgery unit of Mymensingh Medical College Hospital with features of prostatism. After clinical examination and investigations, it was diagnosed as a case of benign enlargement of prostate (BEP) and surgery was decided to do. During exploration a large cystic cavitation found in prostate and the intact median lobe taken out for histopathological examination, which revealed tuberculous granuloma. The patient had no evidence of past or present pulmonary tuberculosis. He was treated with anti-tubercular chemotherapy and responded well. No such case is found reported in Bangladesh yet in through medline search database. So, the case is reported here.