Sonographic Evaluation of Colonic Carcinoma in Comparison to Colonoscopy.

Colon cancer is one of the main causes of cancer death. Diagnosis requires the examination of the entire large bowel by means of radiological or endoscopic techniques. Though there is not a remarkable advancement in gastrointestinal (GI) tract evaluations, the modern radiological imaging methods emphasize the importance of ultrasonography (US) evaluations and stand US out as the scanning method in malignancies of the GI tract. The objective of this study is to investigate the role of ultrasonography in the diagnosis of cancers of the colon & it's accuracy in comparison to colonoscopy. This cross sectional analytical study included a total of 62 patients, including 38(61.29%) male and 24(38.71%) female patients who came at Mymensingh Medical College Hospital & Popular Diagnostic Center, Mymensingh from January 2013 to November 2015 & whose ultrasonography and endoscopic examinations were planned with suspicion of colon cancer. Considering the colonoscopic biopsy as a gold standard, the sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the ultrasonography were evaluated manually. All patients underwent ultrasonography and colonoscopy and results were compared with histopathologic diagnosis. Malignancy was histopathologically identified in 37(59.68%) patients. The sensitivity of ultrasound to identify colon cancer was 86.48%, its specificity was 84%, positive predictive value and negative predictive value was 88.89% & 80.77% respectively. The sensitivity of endoscopic intervention was 100%, its specificity was 96% and positive predictive value was 93.7%. Likewise, a series of analytical and clinical parameters were evaluated, in an attempt to establish associated factors of a colon cancer by means of the statistical package SPSS 13.0 for Windows. Therefore, we believe that abdominal ultrasonography which is non-invasive, easily accessible, cost-efficient method may detect a colonic mass or wall thickening consistent with a colonic carcinoma with a high degree of accuracy.

Exceptional Multiple Foreign-Body Ingestion by a Patient with Schizophrenia.

Swallowing foreign body in adult is uncommon. This mostly occurs accidentally or in psychologically unsound patient. A 32-years-old male patient with abdominal pain admitted in surgery department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh with a history of swallowing various objects. After endoscopic confirmation and psychological evaluation he underwent laparotomy and 29 different objects were removed from his stomach by Gastrotomy. He was psychiatrically evaluated after recovery from operation and was found to be suffering from Schizophrenia with cannabis use. The aim of reporting this case can raise awareness at the patients complains should be taken seriously to prevent morbidity and even mortality.

Non-alcoholic Fatty Liver Disease (NAFLD)--A Review.

Non-alcoholic fatty liver disease (NAFLD) is an emerging problem in Hepatology clinics. It is closely related to the increased frequency of overweight or obesity. It has recognised association with metabolic syndrome. Central obesity, diabetes mellitus, dyslipidemia are commonest risk factors. Association with hepatitis C genotype 3 is also recognised. NAFLD is an important cause of cyptogenic cirrhosis of liver. It affects all populations and all age groups. Most patients with NAFLD are asymptomatic or vague upper abdominal pain. Liver function tests are mostly normal or mild elevation of aminotranferases. Histological features almost identical to those of alcohol-induced liver damage and can range from mild steatosis to cirrhosis. Two hit hypothesis is prevailing theory for the development of NAFLD. Diagnosis is usually made by imaging tools like ultrasonogram which reveal a bright liver while liver biopsy is gold standard for diagnosis as well as differentiating simple fatty liver and non-alcoholic steatohepatitis (NASH). Prognosis is variable. Simple hepatic steatosis generally has a benign long-term prognosis. However, one to two third of NASH progress to fibrosis or cirrhosis and may have a similar prognosis as cirrhosis from other liver diseases. Treatment is mostly control of underlying disorders and dietary advice, exercise, insulin sensitizers, antioxidants, or cytoprotective agents. The prevalence of NAFLD is increasing. So it needs more research to address this problem.

Primary extramedullary esophageal plasmacytoma - a case report.

Extramedullary plasmacytomas are very uncommon tumors, may occur commonly in the upper respiratory passages. These are rarely seen in the middle and lower gastrointestinal system and exceptional to originate in the esophagus. We present a novel case of a 65-year old man who presented with dysphagia and weight loss. After taking detailed clinical history and physical examination endoscopy was performed that showed an ulcero-proliferative lesion involving the lower third of esophagus. Histopathological examination revealed sheets of malignant plasma cells, some with prominent nucleoli. Immuno-histochemistry could not be done due to unavailability. A bone marrow biopsy was performed which was negative for involvement. This is a rare case of esophageal plasmacytoma diagnosed on endoscopy in a patient presenting with dysphagia.

Parotid gland metastasis - an unusual presentation of adenocarcinoma of lung.

Lung cancer is the most frequent malignant disease and the most common cause of cancer death in the world. Primary carcinoma of the lung was an uncommon cancer until the 1930s. Common cell types in bronchial carcinoma are squamous 35%, Adenocarcinoma 30%, Small-cell 20%, Large-cell 15%. We present a case of a bronchial neoplasm metastasis to the parotid gland. A 50 years old male patient presented with a 7×5cm painless parotid mass that was metastatic adenocarcinoma on histopathology. Then we thoroughly examined the patient and he was investigated accordingly. There was an abnormal shadow in the lung on chest x-ray, CT revealed a lung tumour on left side. Metastasis to the parotid gland from any distant primary site is quite unusual. We are going to present this case in the journal because of its rarity. Parotid gland metastasis from the lung is rare & if a careful examination is not performed primary focus may be overlooked, negatively affecting the lifetime survival rate & the prognosis of the patient.

A case of acute insulin poisoning with attempt to suicide.

A 18 years old girl with no known comorbidities was admitted in female medicine ward through the emergency department with rapid onset of semi consciousness due to hypoglycaemia (plasma glucose in admission was 2.0mmol/L). She had history of self-injection of insulin (regular insulin 300 units) subcutaneously in abdominal wall. However she didn't developed serious complications of hypoglycaemia and was subsequently discharged after conservative treatment.

Case report on carotid body tumor.

A 40 years old lady presented to us with the complaints of repeated attack of syncope with left sided neck swelling. Ultrasonography, Color Doppler study and arteriography were done which revealed a solid vascular mass in the carotid bifurcation. Mass was resected and histopathology was done. Histopathologic findings were typical of a carotid body tumour. As carotid body tumour is a rare disease. So, we are going to present this in this article.

Duodenal carcinoid tumor - a case report.

Carcinoid tumors are well differentiated neuroendochrine tumors which most frequently involve the gastrointestinal tract; however duodenal carcinoid tumors are rare. They can present with various clinical symptoms and are difficult to diagnose. A 52 years old lady presented with the symptoms of recurrent upper abdominal pain, burning sensation of whole body and passage of loose stool. On endoscopy of upper GIT, there was a duodenal polyp. Polyp was removed by endoscopic resection and tissue was taken for biopsy. Histological findings of biopsy specimen shows carcinoid tumor. As duodenal carcinoid tumor is a rare presentation so we are going to present this case in this article.

Cirrhosis of liver and portal vein thrombosis - a review article.

Cirrhosis is characterized by diffuse hepatic fibrosis and nodule formation which can occur at any age with significant morbidity and is an important cause of premature death. Occlusive portal vein thrombosis (PVT) is common complication of chronic liver disease with prevalence ranging from 1% to 16% of population. The occurrence of portal vein thrombosis is influenced by local factors (cirrhosis with associated liver architectural changes and increased resistance effects), systemic factors (inherited and acquired abnormalities leading to hyper coagulability) and development of hepatocellular carcinoma. The majority of patients with cirrhosis PVT are diagnosed on radiographic studies although in some patients PVT may present with decompensated chronic liver disease but the natural history of PVT in patients with cirrhosis is largely unknown. However patients with cirrhosis and PVT have been shown to have inferior survival in comparison with patients without PVT.

Comparative Study of Treatment Outcome with Tenofovir Alafenamide and Entecavir in Patients with HBV Related Acute on Chronic Liver Failure.

Major causes of acute insult in Hepatitis B virus related acute on chronic liver failure in the Asian region are reactivation of Hepatitis B virus and super infection with hepatitis A and E virus (ACLF). Anti viral therapy should be started as soon as possible in the ACLF patients at presentation while waiting for confirmation by HBV DNA level. This randomized controlled trial was carried out at the Department of Hepatology, BSMMU, Bangladesh from September 2019 to august 2020 with Hepatitis B virus related ACLF patient. This trial was conducted among twenty seven HBV acute on chronic liver failure patient to compare Child Turcotte pugh (CTP) score, Model for end stage liver disease (MELD) score, Asia Pacific Association for study of Liver (APASL) ACLF Research consortium (AARC) score, survival of the patients and HBV DNA level at 3 months with antiviral therapy between tenofovir alafenamide (25mg) and entecavir (0.5mg) group. CTP score, MELD score and AARC score were significantly (p<0.05) decline from baseline to all subsequent follow-up at 1st (at 7 days), 2nd (at 14 days), 3rd (at 30 days) and 4th (at 90 days) in each group but non significant (p>0.05) difference occurred between two group. All twenty seven patients had detectable HBV DNA level at pre-treatment and all survived patients became undectable at 4th, 90 days follow-up. Total 10 patients (37.07%) were survived at 90 days follow-up, out of them seven patients (70.0%) were in tenofovir alafenamide group and three patients (30.0%) were in entecavir group which was statistically significant (p<0.05) in between two group. Hepatic encephalopathy and hepatorenal syndrome were most common causes of death in both groups. Both drugs tenofovir alafenamide and entecavir significantly improves liver functions but the former one is superior regarding survival.

Hepatocellular carcinoma metastasis to the tip of the coracoid process.

Hepatocellular carcinoma (HCC) is the commonest and the most frequent primary malignant tumour of the liver. Chronic hepatitis B is the most common cause of HCC. Metastatic HCC has an aggressive course and a poor outcome. Common sites of hematogenous metastasis are lungs, bones & adrenal glands. Involvement of vertebra, pelvis, rib & skull is reported but coracoid process of scapula is an extremely rare site of metastasis. Thus we are going to present an unusual site of metastasis of HCC to the tip of the coracoid process of left scapula which was presented as a nodular swelling over the lateral aspect of left shoulder. On examination viral marker revealed HBsAg positive & negative negative hepatitis C virus (HCV). Ultrasonography of abdomen revealed large, well defined, heterogenous mass measuring 12×7.5 cm in the left lobe of liver. Chest radiograph showed a small radio opaque shadow on the tip of the coracoid process of left scapula. Fine needle aspiration cytology (FNAC) was done from the nodule & cytological examination showed malignant hepatocytes & traversing endothelial cells resembling hepatocellular carcinoma.

Clinical profile of 250 cases of amoebic liver abscess.

Liver abscess is an emergent public health burden with considerable morbidity. Its prevalence varies from country to country. This prospective study was carried out in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh and Sher-E-Bangla Medical College Hospital, Barishal, Bangladesh from January 2004 to December 2009 to asses clinical pictures of 250 cases of amoebic liver abscess. Majority of patients were male (84%) presenting with upper abdominal pain (96.8%). High grade fever was present in 74% cases. Vomiting & nausea in 29.2% while loss of appetite in 42% patients. Only 4% patients showed diarrhea. On examination, tenderness in right hypochondriac was the predominant signs (95%) associated with hepatomegaly in 80% cases. Seventy eight percent cases showed leucocytosis. Serum alkaline phosphatase was raised in 66% patients. Colour of the aspirate was chocolate/brown in 80% cases. It is our experience that although complications are found hardly, they may take a menacing course if diagnosed, managed or both at the eleventh hour.

A case of Gaucher's disease progressing to liver cirrhosis.

We are going to present a 17 year old female with Gaucher's disease. The patient presented with fever, cough, respiratory distress & abdominal heaviness. There was mild pallor, redness of palm of hands & raised temperature. Liver was hugely enlarged along with splenomegaly. X-ray chest showed non specific bronchiectatic change in both lungs. Ultrasonography of abdomen revealed marked hepatosplenomegaly with no ascites. Bone marrow examination showed cellular marrow with plenty of megakaryocytes. Most of the cells were smear cells & there was histiocytes proliferation & infiltration of bone marrow by small atypical cells. Histologically, lipid was found in hepatocytes in moderate amount. The portal areas showed high lipid contents in macrophages. Different clinical findings & incidental diagnosis of lipid storage disease submerged us in diagnostic dilemma. We give conservative treatment with antibiotic cefuroxime, syrup lactulose & vitamins and this patient was improved.

Demographics and cell types of bronchial carcinoma of a tertiary care hospital in Bangladesh.

Geographical and socio-economic factors such as climate, culture, ethnic origin, diet and life style such as smoking have been noted to influence the occurrence of bronchial carcinoma. We conducted this study to document the frequency of various histological types of bronchial carcinoma and correlated it with their demographic characteristics. This descriptive study was carried out among admitted patient with the suspicion of Bronchial carcinoma from January 2010 to January 2011 in medicine units of Mymensingh Medical College Hospital, Mymensingh. Among those only 30 consecutive histopathologically &/or cytological confirmed cases of Bronchial carcinoma were included in the study. No age, gender, environmental or occupational limits were applied for the selection of patients. Patients already diagnosed by some other hospital presenting to our unit with complications were not included in the study. Age rang were 26-70 years. Majority of patients i.e. 63.33% (n=19) were found to be in their fourth and sixth decade of life. Males were 86.66% (n=26) as compared to females 13.44% (n=4) and male to female ratio were 6.5:1. The majority of the patients were belonged to urban areas 63.34% (n=19), while 36.66% (n=11) came from the Rural population. In this study smokers were 86.66% (n=26) and nonsmokers were 13.33% (n=4). In Occupational distribution farmers were 33.33% (n=10), service holders were 20% (n=6), businessman were 16.66% (n=5), all the female were house wife 13.33% (n=4). Specimens for histopathological study were collected by trans-thoracic needle aspiration under CT or ultrasono-guided. The results of cell types in histopathologically proven 30 Bronchial carcinoma patients were; 10(33.36%) adenocarcinoma, 7(23.33%) squamous cell carcinoma, 6(20%) small cell carcinoma, 4(13.33%) large cell carcinoma and 3(10%) non-small cell carcinoma.

A 10 year old boy with rectal carcinoma.

A 10 year old boy with mucinous carcinoma of rectum is a rare case at this age. Here the patient presented with constipation, mucus in stool & abdominal pain since one month. He got consultation from several physicians & went through sonology of whole abdomen several times. There he was missed diagnosed as a case of pyloric stenosis. We came to a probable diagnosis by doing simple digital rectal examination which seemed to be a hard rectal swelling. The diagnosis was established by colonoscopy followed by biopsy. Carcinoma rectum must be considered as a differential diagnosis if patient presents with altered bowel habit, per rectal bleeding, abdominal pain in conjunction with weight loss.

Pattern of poisoning in a tertiary level hospital.

This cross sectional observational study was carried out in the Department of Medicine, Mymensingh Medical College Hospital over a period of 4 months from January 2012 to April 2012 to assess the clinico-epidemiological condition of different types of poisoning and to evaluate immediate hospital outcome. Suspected case of poisoning aged 12 years or above of either sex was included. Patients of paediatric age group, having other co-morbid condition and died before clinical evaluation were excluded. This study revealed that rural people (76.9%), aging 20-30 years (46.3%) were mostly affected in poisoning. Patients belong to low socioeconomic group (65.3%), illiterate (26.5%) and educated up to primary level (29.9%) were mostly identified. Regarding the occupation this study showed student (30.6%) and farmer (25.2%) were predominantly involved. In this series organophosphorus compound (63.9%) poisoning was in the top of the list followed by benzodiazepine (6.8%). Suicidal attempt (81.6%) was found as a motive of poisoning in maximum cases. Among the precipitating factors quarrel with spouse, girl or boy friend (46.9%) were significant in number. In this study outcome was measured as complete recovery (92.5%) and death (3.4%).

Assessment of the Relationship between Non-motor features and Severity of Parkinson's Disease Patients in Bangladesh.

Parkinson's disease (PD) is second most common neurodegenerative disorder after Alzheimer's disease that may present with both motor and non-motor symptoms (NMSs). Many of the ignored NMSs may potentiate further deterioration of the patient's quality of life (QoL). But there is scarcity of data regarding NMSs of PD patients and their relationship with the disease severity in Bangladesh. This study was aimed to investigate the frequency of NMSs and assess their debatable impact on the severity of PD patients in Bangladesh. This cross-sectional type of observational study was conducted in neurology department of Dhaka Medical College Hospital, Bangladesh from January 2012 to June 2013 which recruited 60 eligible PD patients. The PD patients and disease severity was demonstrated by UK Parkinson's Disease Society Brain Bank criteria for idiopathic PD and the Hoehn and Yahr scale respectively. Whereas, NMSs were demonstrated by the self-structured questionnaire which had encountered 30 common symptoms of PD. The mean age of our study cohort was found 57.88±10.56 years with male female ration 2:1. According to the Hoehn and Yahr (H & Y) severity scale 38.3%, 38.3%, 20.1% and 3.3% patients had been suffering from stage ?, stage II, stage III and stage ?V Parkinson's disease respectively. Irrespective of the severity of the PD the frequency of NMSs was nocturia (66.7%), sadness or blues (65.0%), memory disturbance (61.7%), anxiety (58.3%), insomnia (56.7%), orthostatic hypotension (55.0%), erectile dysfunction (50.0%), urinary urgency (46.7%), anhedonia (45.0%), olfactory disturbance (38.3%), constipation (38.3%), hyper or hypo sexuality (31.7%) and restless leg syndrome (31.7%). However, after head-to-head NMSs analysis, daytime dribbling of saliva (p=0.024), urinary urgency (p=0.036), nocturia (p=0.001), weight loss (p=0.001), anhedonia (p=0.027), excessive daytime sleepiness (p=0.024), insomnia (p=0.007), vivid dream (p=0.024), REM behavior disorder (p=0.010), restless leg syndrome/ periodic leg movements (p=0.043) had significantly been reported higher among the stage II PD patients than that of stage I patients. Whereas fall (p=0.001), dysphagia or choking (p=0.002), constipation (p=0.003), fecal incontinence (p=0.033), excessive daytime sleepiness (p=0.033), anxiety (p=0.036) and anhedonia (p=0.044) were significantly more prevalent among the advanced stage (III) than stage (II) PD patients. Mean total NMS increased significantly with PD severity based on H and Y staging with a mean NMSQ-T (Non-Motor Symptoms Questionnaire Test) of 5.43 in stage 1, 9.22 in stage 2, 13.75 in stage 3 and 17.0 in stage 4 (p=0.0001). This study revealed that there was high frequency of NMSs among the PD patients and most common symptoms were nocturia, sadness, memory impairment, anxiety, insomnia, orthostatic hypotension, erectile dysfunction, anhedonia, urinary urgency and constipation. Finally, the more advanced disease as indicated by a higher H&Y stage was associated with significantly higher number of reported NMSs.

Ultrasonographic evaluation of morphologic pattern of amoebic liver abscess.

We evaluated sonographically 250 cases of amoebic liver abscess (ALA). Seventy eight percent (78%) of the ALA was located in the right lobe of the liver and 15% in the left lobe and rest of the abscesses occupied both lobes. ALA was round in 50% and oval in 40% of the cases without significant wall echoes. Eighty eight percent (88%) of these were inhomogeneous. Twenty one percent (21%) of these lesions was contiguous with the liver capsule. Post therapy sonographic evaluation showed that there was complete resolution of the abscesses within one year in 90% cases, other showed residual abnormalities in the form of hypoechoic in 7% and hyperechoic in 3% cases. We concluded that serological and clinical data in combinations with these non specific sonographic features are sufficient for the management and follow up of ALA obviating the need for expensive and invasive techniques in most of the cases.

Cardiovascular complications of chronic renal failure - an updated review.

Chronic kidney disease (CKD) is a worldwide public health problem. Cardiovascular disease (CVD) is frequently associated with CKD, which is important because individuals with CKD are more likely to die from CVD than to develop kidney failure. CVD in CKD is treatable and potentially preventable and CKD appears to be a risk factor for CVD. In order of incidence and frequency systemic hypertension, left ventricular failure, congestive cardiac failure, ischemic heart disease, anaemic heart failure, rhythm disturbances, pericarditis with or without effusion, cardiac tamponade, uraemic cardiomyopathy are various cardiovascular complications encountered in patients with chronic renal failure. A patient may present with one or more complications of cardiovascular system. The survival rate and prognosis to a great extent depends on proper management of these complications. Use of regular dialysis and renal transplant has changed the death pattern in developed countries but it is still a major problem in developing country. The aim of this article is early detection of CKD and proper management of it thereby preventing the major cardiovascular complications.

POEMS Syndrome.

A 49 years old male patient admitted with 2 years history of lower extremity symmetrical sensorimotor polyneuropathy, sclerodermic skin change, erectile dysfunction, hepatosplenomegaly and monoclonal gammopathy. The clinical evaluation met the criteria for the diagnosis of (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes) POEMS syndrome. The patient was treated with corticosteroid and melphelan and responded well. We present a case different from the other cases with severe unusual burning sensation all over the body, which was his sole complaint and with this complaint he visited lot of doctors including psychiatrist.