7th POD Research Articles

Stroboscopy and acoustic analysis of voice following endotracheal intubation in otological surgeries

BackgroundStroboscopy is an endoscopy that is performed with intermittent light at a frequency that approximates the frequency of a moving object so that it appears in slow motion or motionless. It is used to analyze the structure and motion of the vocal fold.Aim and objectiveTo compare the stroboscopic findings of various vocal parameters such as symmetry, amplitude, periodicity, mucosal wave of vocal folds, and glottis closure before and after elective endotracheal intubation and to compare acoustic analysis of voice using fundamental frequency, intensity, maximum phonation time, and dysphonia severity index in patients before and after elective intubation, who were undergoing otological surgeries. It also assesses the correlation between changes in these vocal and acoustic parameters and the size of the endotracheal tube, duration of intubation, and number of attempts made during intubation. This study creates awareness and provides insights to avoid intubation-related vocal fold injury.MethodsThis was a prospective cohort study involving 31 patients done in a Tertiary Care Centre. All patients who underwent otological surgeries by elective endotracheal intubation were included. All of them underwent stroboscopic and acoustic evaluation preoperatively, 24 h, and 7 days postoperatively.ResultsStatistically significant changes in mucosal wave pattern score were observed in the 1st postoperative day that reverted to normal by the end of 7th postoperative day and in GRBAS which was significant at the end of both 1st and 7th POD. Other parameters like fundamental frequency, intensity, DSI, MPT, amplitude, symmetry, periodicity, and glottis closure remain unaltered. There was a moderate positive correlation between the duration of intubation (minutes) and mucosal wave 1st POD (P-value: 0.003).ConclusionThe majority of the patients (61%) had normal laryngeal structures. A total of 39% had evidence of injury, the most common being right vocal fold hemorrhage improved by the end of 7th postoperative day and became normal.

Study on Outcome of Phacoemulsification Cataract Surgery with Clear Corneal Steep Axis Incision

A prospective, observational study was conducted in the Department of Ophthalmology, Combined Military Hospital (CMH), Dhaka, Bangladesh, from April to October of 2019, to observe the outcome and determine the amount of surgically induced astigmatism in phacoemulsification cataract surgery done with clear corneal incision. A total of 60 patients were included in this study. Cataract extraction was done in all the patients by phacoemulsification through clear corneal incision with foldable intraocular lens implantation. All the surgeries were done with INTREPID Micro-Coaxial system using the INFINITI Vision system by the same surgeon under local anaesthesia. The patients were followed up on 1st, 7th, and 30th POD. The parameters recorded were uncorrected visual acuity, best-corrected visual acuity, slit lamp examination, and keratometry. Due to clear corneal incision on steep axis, the steep meridian became flat, from 44.329±1.473D (diopter) (as found in pre-operative keratometry) to 43.971±1.431D (on the 30th post-operative day). On the other hand, the flat meridian became steeper from 43.225±1.471D (pre-operative) to 43.225±1.501D (on the 30th day). At preoperative examination and 30th day follow-up visit, astigmatism was determined as 1.10±0.319 and 0.583±0.413 respectively. The change of astigmatism was statistically significant (P<0.05). CBMJ 2024 January: vol. 13 no. 01 P: 41-45

A Comparative Evaluation of Corneal Endothelium between Diabetic & Non-Diabetic Patients Undergoing Phacoemulsification in a Tertiary Hospital

Objective: To compare changes of corneal endothelium after phacoemulsification in diabetic patient comparison to non-diabetic patient. Methods: This prospective observational study was conducted over 100 patients in a tertiary hospital from 01st January to 30th July 2020. Patients were selected purposively based on specific selection criteria. Patients were allocated into two groups: Group-I: cataract patient without diabetes mellitus and Group-II: cataract patient with diabetes mellitus. Selected patients underwent detailed ophthalmic and systemic examination as well as relevant laboratory investigation. Phacoemulsification was done in every patient by a single experienced surgeon under local anesthesia. Patients were evaluated pre-operatively, 7th POD and after one month post-operatively. In each visit, visual acuity, endothelial cell count, endothelial hexagonality, cell variability and central corneal thickness were recorded. All the relevant data were recorded in a pre-designed data collection sheet. Results: The mean age of patients in group I and II were 54.40+3.22(SD) and 54.86+3.07(SD) years respectively. In group I, 29 (58%) were male and 21(42%) were female whereas in group II, 33 (66%) were male and 17(34%) were female. In Group-I, visual acuity in preoperative period, 7th POD and after one month were 0.734, 0.232 and 0.148 respectively and in Group-II, preoperatively, 7th POD and after one month were - 0.730, 0.260 and 0.148 respectively. In group I, Endothelial cell count per square millimeter in preoperative, 7th POD and after one month were- 2681.76, 2543.62 and 2518.68 respectively and in Group-II, preoperative, 7th POD and after one month were - 2596.62, 2378.84 and 2270.46 respectively. Hexagonality of endothelial cell count in group-I, pre-operative, 7th POD and after one month value were 64.34, 61.08 and 59.12; in group-II, pre-operative, 7th POD and after one month value were 63.80, 56.04 and 53.10 respectively. Cell size variability in group-I, pre-operative, 7th POD and after one month value were 30.76, 33.96 and 35.42; in group-II, pre-operative, 7th POD and after one month value were 29.58, 33.90 and 35.98 respectively. Central corneal thickness in group-I, pre-operative, 7th POD and after one month value were 534.04, 589.12 and 560.68; in group-II, pre-operative, 7th POD and after one month value were 530.12, 630.24 and 569.94 respectively. Conclusion: By analyzing the results and findings, it may be concluded that corneal endothelium was greatly changed after phacoemulsification in diabetic patient in compare to non-diabetic patient. J. Natl. Inst. Ophthalmol. 2022; 5(2):9-15

Efficacy of Autologous Blood Clot in Primary Pterygium Surgery Compared With Suture Technique in a Tertiary Hospital of Bangladesh

Purpose: The aim of this study is to assess the efficacy among patients undergoing pterygium excision and conjunctival autograft utilizing autologous blood or sutures. Methods: A randomized controlled trial of 1 year and 5 months, with 60 eyes from 60 patients having primary nasal pterygium. As indicated by inclusion criteria, they were chosen and randomized into two arms for conjunctival autograft: treated arm A (30) with autologous blood and arm B (30) with stitches (10-0 monofilament nylon). Preoperative and postoperative results were assessed and analyzed statistically. Follow-up was done at first, seventh, 1-month, 3-month, and half-year postoperative days. Resulting factors were total surgical time, postoperative comfort, graft stability, and recurrence. Results: 60 patients; mean age of 46.77 ± 7.04 (SD) in arm A (30) and 46.17±7.53 (SD) in arm B (30). In arm A, 22 males (73.3%) and 8 females (26.7%) where arm B had 20 males (66.7%) and 10 females (33.3%). Total surgical time in arm A was 24.73 ± 3.69 (SD) minutes and in arm B was 32.23 ± 4.59 (SD) minutes (p < 0.001). Follow-up at the 1st and 7th POD showed significant discomfort in arm B (mean ranks 41.82 and 40.62) compared to arm A (mean ranks 19.18 and 20.38), respectively (p < 0.001). At 1st POD, only 3 (10%) graft retractions in arm A. Within 6 months of follow-up, all grafts were stable; 1 (3.3%) recurrence and 1 (3.3%) granuloma in arm B only. Conclusion: In primary pterygium surgery, autologous blood showed excellent postoperative results with no recurrence and reduced surgical time. So, it seems to be an effective surgical means to treat primary pterygium.

Efficacy of Autologous Blood Clot in Primary Pterygium Surgery Compared With Suture Technique in a Tertiary Hospital of Bangladesh

Purpose: The aim of this study is to assess the efficacy among patients undergoing pterygium excision and conjunctival autograft utilizing autologous blood or sutures. Methods: A randomized controlled trial of 1 year and 5 months, with 60 eyes from 60 patients having primary nasal pterygium. As indicated by inclusion criteria, they were chosen and randomized into two arms for conjunctival autograft: treated arm A (30) with autologous blood and arm B (30) with stitches (10-0 monofilament nylon). Preoperative and postoperative results were assessed and analyzed statistically. Follow-up was done at first, seventh, 1-month, 3-month, and half-year postoperative days. Resulting factors were total surgical time, postoperative comfort, graft stability, and recurrence. Results: 60 patients; mean age of 46.77 ± 7.04 (SD) in arm A (30) and 46.17±7.53 (SD) in arm B (30). In arm A, 22 males (73.3%) and 8 females (26.7%) where arm B had 20 males (66.7%) and 10 females (33.3%). Total surgical time in arm A was 24.73 ± 3.69 (SD) minutes and in arm B was 32.23 ± 4.59 (SD) minutes (p < 0.001). Follow-up at the 1st and 7th POD showed significant discomfort in arm B (mean ranks 41.82 and 40.62) compared to arm A (mean ranks 19.18 and 20.38), respectively (p < 0.001). At 1st POD, only 3 (10%) graft retractions in arm A. Within 6 months of follow-up, all grafts were stable; 1 (3.3%) recurrence and 1 (3.3%) granuloma in arm B only. Conclusion: In primary pterygium surgery, autologous blood showed excellent postoperative results with no recurrence and reduced surgical time. So, it seems to be an effective surgical means to treat primary pterygium.

A Comparative study between Decompressive Craniectomy with Multidural Stabs and Craniotomy with Durotomy in Acute Subdural Hematoma

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

Limberg Flap is a Safe and Effective Procedure for the Surgical Treatment of Pilonidal Sinus in Sacrococcygeal Region

Pilonidal sinus in the sacrococcygeal region is an acquired condition and usually seen in young male adults. Diagnosis is indicated by to see the site and appearance of chronic discharging opening, and identification of midline pit in the natal cleft. The management of the sacrococcygeal pilonidal sinus varies from clipping of hairs with good hygiene of the area, wide excision of the area with primary or secondary closure and newer flap procedures, but none is widely accepted. The main concern for the treatment to the patient is the recurrence. This prospective study has been performed to determine the effectiveness and safety of the Limberg flap procedure for sacrococcygeal pilonidal sinus for new and recurrent cases. Primary end point was rate of recurrence and secondary end points were its complianceand complications such as wound infection, postoperative pain and return to work. A total of 17 patients were operated from March 2012 to June 2016.Both primary and recurrent diseases were included. All patients successfully underwent surgery. Patients complained very minimal postoperative pain. LO were average 2 days. All patients were discharged with negative suction drain in situ. Drains were removed on 7th POD and stitches were removed on 9th to 12th postoperative day. All patients returned to work after 2nd weeks. In our study no recurrence or major complications were found. Limberg flap for sacrococcygeal pilonidal sinus was found very useful and effective in terms of recurrence rate and patients morbidity.
 J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 6-8

Vesico-Vaginal Fistula Repair Through Abdominal Approach

Background: Vesico-Vaginal Fistula (VVF) is a major cause for concern in many developing countries with significant morbidity. Among the different techniques abdominal approach of VVF repair is important one.
 Objective: To find out the outcome of VVF repair by abdominal approach.
 Materials and Methods: It is a prospective study. Twenty-three patients with VVF were operated with abdominal approach from the period of January 2016 to January 2019. Age of patients, co-morbidities, cause, size and location of VVF were evaluated. Then abdominal approach of VVF repair was done. Operative time and need of blood transfusion were encountered. Post operative (POD) urine leakage, wound infection or other complications were enlisted. Patients were discharged with keeping urethral catheter for 14 days. Follow up was done after 1 and 3 month and in each follow up history and physical examination was done. All collected data were evaluated.
 Results: Mean age of the patient was 40 years. Among the 23 patients 12 (52%) patients had history of total abdominal hysterectomy, 9 had history of caesarian section and 2 cases had history of pelvic surgery. VVF repair was done at least 12 weeks after its occurrence. Operative time ranged from 90 minutes to 150 minutes. In the immediate POD no obvious complications were noted except one patient developed wound infection on 7th POD. Follow-up done as per schedule and no recurrence of VVF noted.
 Conclusion: VVF repair through abdominal approach is a feasible, safe and effective technique if performed meticulously.
 KYAMC Journal Vol. 11, No.-3, October 2020, Page 129-132

Efficacy of Local use of Metronidazole Solution among Acute Appendicitis Patients for the Prevention of Wound Infection after Appendectomy: A Randomized Control Trial

Background: Prevention of wound infection after appendectomy is very important for the post-operative management of the acute appendicitis patients.
 Objective: The purpose of the present study was to validate the efficacy of local application of metronidazole solution in the wound after closing of peritoneum in the prevention of appendectomy wound infection.
 Methodology: This randomized control trial was conducted in the Department of Surgery at Rajshahi Medical College Hospital, Rajshahi, Bangladesh from July 2009 to June 2011 for a period of two years. Patients admitted with features of uncomplicated and complicated acute appendicitis (Gangrenous or perforated) underwent emergency appendectomy by grid iron incision in all the units of surgery were selected as study population. The study population were divided into two groups into group A and group B. In group A (treatment group) after closure of peritoneum the exposed tissue was washed and was flooded with 100ml of metronidazole solution with 5 gm/ml concentration and was waited for one minute and in group B (control group) with the same amount of sterile saline solution. All patients were evaluated daily for evidence of wound infection such as fever, unusual wound pain with recording of pulse, temperature. Suspected wounds were checked on 3rd, 5th and 7th POD routinely after removal of dressing.
 Result: A total number of 200 patients were recruited for this study and was divided into two groups in equal number. Therefore, 100 cases were in group A and the rest of 100 cases were enrolled in group B. The mean age with SD of group A and B were 25.06±9.14 years and 23.82±7.51 years respectively. Uncomplicated appendicitis was found in 66 cases and 70 cases in group A and B respectively (p>0.05). In metronidazole wound wash group only 5 patients developed wound infection, however, in saline wash group 22 patients developed infection. Among the positive cultures Staphylococcus aureus was 3 cases and Escherichia coli was in 7 cases.
 Conclusion: In conclusion rate of wound infection is less in the group treated with the local application of metronidazole solution after appendectomy
 Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 54-58

Comparative study on Post Tonsillectomy use of Antibiotics and Placebo

Tonsillectomy is the most frequently performed surgical procedure in Otolaryngological practice. We included 110 patients and divided into antibiotic group and placebo group, and followed up upto 7th POD. Parameters of observation were pain, fever, nausea & vomiting, reactionary & secondary haemorrhage, duration of hospital stay and return to normal diet. The result of this study showed that post operative pain and return to normal diet improved in antibiotic treated group than those who received placebo, but there is no statistically significant difference between two groups in respect of fever, nausea & vomiting, reactionary & secondary haemorrhage and duration of hospital stay.
 Bangladesh J Otorhinolaryngol; October 2017; 23(2): 153-158

Clinical Evaluation of Corticosteroid on Post Operative Morbidity in Impacted Lower Third Molar Surgery

Introduction: Mandibular third molar is most commonly dental impacted and it’s removal is not without morbidity. Post operative pain, swelling and trismus are universal. This study was carried out to compare the effect of co-administered corticosteroid and diclofenac Na+/K+ with diclofenac Na+/K+ alone on the post operative morbidity like pain, swelling and trismus after surgical removal of impacted lower third molars.
 Materials and Methods: The study was a prospective study done over a period of 01.01.13 to 30.06.14 in Department of Oral & Maxillofacial Surgery (OMS), Military Dental Center, Combined Military Hospital, Dhaka and the department of OMS Dhaka Dental College and Hospital, Dhaka. Sixty patients were included in the study and were randomly divided into two study groups: Control group received only diclofenac Na+/K+, Experimental group received corticosteroid and diclofenac Na+/K+. Pain, swelling and trismus were evaluated before, 1st, 2nd and 7th POD after surgery.
 Results: Among the 60 cases common type of impaction was horizontal and vertical type (30%) followed by Mesioangular (23%) and Distoangular (17%). All corticosteroid groups showed statistically significant (p < 0.01) improvement in pain and trismus at 1st and 2nd pod, but statistically significant (p < 0.01) improvement of swelling occur only on 2nd pod as compared to control group.
 Conclusion: Corticosteroid and diclofenac Na+/K+ combination was found effective for early recovery and the patients who used this combination suffered less pain, swelling and trismus after impacted mandibular third molar surgery.
 Medicine Today 2020 Vol.32(1): 5-9

Comparative Study of Efficiency between Povidone Iodine and Normal Saline Lavage in the Treatment of Acute Peritonitis

Background: Control of the primary site of sepsis is the main determinant of good surgical outcome. Objective: The purpose of the present study was to compare the efficiency between povidone iodine and normal saline lavage in the treatment of acute peritonitis. Methodology: This was a randomized clinical trial conducted in the Department of Surgery at Dhaka Medical College & Hospital, Dhaka, Bangladesh. Patients with acute peritonitis due to gastrointestinal causes who were admitted in the different units of Dhaka Medical College Hospital during the study period were selected as study population. Among them patients who were treated with povidone iodine were enrolled in the present study in group A and patients who were treated with conventional normal saline were in group B. Results: A total number of 1050 patients were recruited for this study. Among them 100 patients were enrolled in the present study of which group A (50 patients) for povidone iodine and group B (50 patients) for conventional normal saline. On 7th POD wound infection was found in Group A and Group B were 11(22.4%) and 21(44.7%) respectively. Statistically significant difference in post operative complication of wound infection was observed on 7th POD between the groups (p<0.05). Post operative hospital stay in Group A and Group B were 11.50 ± 4.48 and 13.46 ± 5.13 days respectively. There is statistically significant difference in post operative hospital stay between the groups (p<0.05). Conclusion: Statistically significant difference observed in post operative complication of wound infection and burst abdomen on 7th POD between the groups. The present study there is statistically significant difference in post operative hospital stay between the groups also observed. Bangladesh Journal of Infectious Diseases 2017;4(1):15-20

Study on Efficacy of Dexamethasone and Methylprednisolone in Postoperative Swelling and Trismus Following Mandibular 3rd Molar Surgery

Introduction: Surgical removal of 3rd molars causes significant swelling and trismus which are unpleasant and uncomfortable for the patient even when teeth are removed by gentle surgical technique. Our surgical procedures can lead to serious inflammatory reactions in the facial soft tissues and should be minimized as much as possible. The aim of this study was to compare the effect of a single intramuscular (I/M) dose of two different corticosteroids on postoperative facial soft tissue swelling and trismus.Methodology: This interventional study was conducted in oral and maxillofacial surgery department of BSMMU. 60 patients (33 male and 27 female)were included in this study and were randomly divided into two groups. In Group-I, 30 patients were included and 4mg of Dexamethasone was injected into the Deltoid region 30 minutes prior to extraction of mandibular 3rd molars. In Group-II,another 30 patients were included and 40mg of Methylprednisolone was injected into theDeltoid region 30 minutes prior to extraction of mandibular 3rd molars.Facial swelling was evaluated preoperatively, on 2nd POD and 7th POD by using measuring tape. Trismus was determined by measuring the maximum inter-incisal distance pre-operatively, on 2nd POD and 7th POD by vernier caliper.Result:Result showed that swelling and trismus was significantly reduced in both groups, p>0.05(not significant).Conclusion:The result concluded that the preoperative single dose of I/M administration of Dexamethasone or Methylprednisolone significantly reduces postoperative swelling and trismus after surgical removal of mandibular 3rd molars.J Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 60-64

The Kinetics of Anti-HLA Antibodies in the First Year after Kidney Transplantation: In Whom and When Should They Be Monitored?

The impact of the kinetics of the anti-HLA antibodies after KTx on the occurrence of acute rejection as well as the better time-point to monitor anti-HLA Abs after transplantation is not completely defined. This prospective study followed 150 patients over 12 months after transplantation. Serum IgG anti-HLA Abs were detected by single antigen beads after typing donors and recipients for loci A, B, C, DR, and DQ. Before KTx, 89 patients did not present anti-HLA Abs and 2% developed “de novo” Abs during the 1st year, 39 patients were sensitized without DSAs, and 13% developed DSA after surgery; all of them presented ABMR. Sensitized patients presented higher acute rejection rates (36.4% versus 13.5%, p < 0.001), although 60% of the patients did not present ABMR. Patients, in whom DSA-MFI decreased during the first two weeks after surgery, did not develop ABMR. Those who sustained their levels presented a rate of 22% of ABMR. 85% of patients developed ABMR when MFIs increased early after transplantation (which occurred in 30% of the DSA positive patients). In the ABMR group, we observed an iDSA-MFI sharp drop on the fourth day and then an increase between the 7th and 14th POD, which suggests DSA should be monitored at this moment in sensitized patients for better ABMR prediction.

Ebstein’s anomaly with constricitve pericarditis

Ebstein’s anomaly is a rare congenital cardiac malformation that affects the tricuspid valve commonly, but its association with pericardial disease is even rarer. We report a case of 25 year old man presented with dyspnoea on exertion and fatigability. A diagnosis of Ebstein’s anomaly with atrial septal defect (ASD) with constrictive pericarditis was confirmed using transthoracic echocardiography. Peroperatively pericardiotomy was done after meticulous dissection of pericardium. Under cardiopulmonary bypass tricuspid valve was replaced with 29 mm Edward life science porcine tissue heart valve with direct closure of ASD. Patient showed excellent symptomatic improvement and was discharged on 7th POD with advice and after 3 months of follow up patient was doing well post operartive day.Bangladesh Heart Journal 2016; 31(1) : 46-49

Surgical Outcome of Chronic Subdural Haematoma: An Analysis of 300 Cases

Chronic Subdural Heamatoma (CSDH) is defined as collection of blood in the brain’s surface, subdural space between dura and arachnoid. It is one of the most common clinical entities in daily neurosurgical practice among the elders, several weeks after the head injury. CSDH doesn’t always produce symptoms but when it does, it generally requires surgical treatment. The diagnosis and treatment are well established, but the cause of recurrence, complications and related factors are not completely understood. This study evaluated the clinical features, radiological findings and surgical results in a large series of patients treated at the Neurosurgery department of Dhaka Medical College Hospital. 300 consecutive patients (250 men and 50 women) age ranging from 30-85 years, GCS 5-15, volume of blood &gt;25cc, symptomatic with CSDH were treated by one or two burr hole craniostomies. Haematoma cavity was irrigated with normal saline and closed system subdural drainage was continued for 1-2 days from January 2012 to December 2015. The clinical outcome was measure on 1st, 3rd, 5th and 7th POD using GCS scoring and GOS after 4 and 8 weeks of operations. Most patients 94%(282) had good recovery (GOS 5,4,3), 4%(12) showed no changes (GOS 2) and 2%(6) worsened (GOS 1). Recurrence of haematoma was recognized in 5%(15) patients 1-8 weeks after the first operation. 4%(12) patients suffered post operative complications of which 1.33%(4)patients were acute subdural haematoma caused by incomplete haemostasis of the scalp wound, 1.33%(4)patients were tension pneumocephalus and remaining due to hypertension, use of anticoagulants, poor general health and medical problems. Careful haemostasis and complete replacement of subdural haematoma with normal saline to prevent influx of air into the subdural space will further improve the surgical outcome for patients with CSDH.J Dhaka Medical College, Vol. 24, No.2, October, 2015, Page 126-131

Effect of age on immediate postoperative tissue reaction following surgical extraction of impacted mandibular third molar

Background: Postoperative morbidity following third molar surgery is affected by a number of factors. The aim of this study was to determine the effect of age on immediate postoperative tissue reactions following mandibular impacted third molar surgery. Objectives: To assess the discomforts after impacted mandibular third molar extraction in different aged patient. Methods: 100 patients, 54 Female and 46 male, aged 18 to 42 years comprised the study materials. Tooth extrac­tion was performed with buccal guttering technique after adequate elevation and reflection of full thickness mucoperiosteal flap. Pain, swelling and trismus were evaluated preoperatively and on 2nd POD and 7th POD. Data was processed and analyzed using SPSS and was compiled and test of significance was done using Chi square (x2) test and un-paired 't' test. Results: Statistical analysis of the data indicated that pain and swelling was significantly less and significant maximum mouth opening was achieved in early aged patient than late age when preoperative and postoperative results were compared. Conclusion: As postoperative immediate tissue reactions are more in late aged patient than younger so impacted mandibular third molar should extract in early age.

Bicuspid aortic valve with severe aortic stenosis: a case report

A bicuspid aortic valve (BAV) can be a serious disorder of heart valve in which the valve only has two leaflets or flaps that control blood flow through the heart. Between one and two percent of all people have this defect and it affects more men than women. This report presents a case of severe aortic stenosis with mild to moderate aortic regurgitation due to bicuspid aortic valve with hypertension. A 37 years old male presented with high record of blood pressure and occasional shortness of breath on exertion. Echocardiography (Color Doppler) revealed severe aortic stenosis with mild to moderate aortic regurgitation due to bicuspid aortic valve with moderately severe concentric LV wall hypertrophy. Surgical treatment (aortic valve replacement) was scheduled based on echocardiography findings. On surgical resection a well defined bicuspid aortic valve was found with calcification and friable valve leaflet. Histopathology of valve tissue shows large areas of calcification. Patient was discharged from hospital on 7th POD with an advice to attend cardiac surgery OPD after 1 month. Aortic valve replacement must be considered in this type of lesion.Bangladesh Med J. 2015 May; 44 (2): 105-108

Effects of Lornoxicam on Anastomotic Healing: A Randomized, Blinded, Placebo-Control Experimental Study

Introduction and Aim. With the implementation of multimodal analgesia regimens, Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are often administered for optimal pain control and reduction of opioid use. The aim of the study was to examine the effects of lornoxicam, a NSAID, on anastomotic healing employing an animal model. Materials and Methods. A total of 28 Wistar rats were randomly assigned in two groups. All animals underwent ascending colonic transection followed by an end-to-end hand sewn anastomosis. Group 1 received intraperitoneally lornoxicam before and daily after surgery. Group 2 received intraperitoneally an equal volume of placebo. Half of the animals in each group were euthanized on the 3rd pod and the remaining on the 7th pod. Macro- and microscopic indicators of anastomotic healing were compared using a two-tailed Fisher exact test. Results. The lornoxicam group significantly decreased fibroblast in growth and reepithelization of the mucosa at the anastomotic site on the 3rd pod and significantly increased occurrence of deep reaching defects, necrosis, and microabscess on the 7th pod. Conclusion. Lornoxicam administration during the perioperative period adversely affects histologic parameters of intestinal anastomotic healing. These effects of lornoxicam administration were not found to induce significant increase of anastomotic dehiscence in the rat model.

Pre-emptive effect of dexamethasone injection and consumption on post-operative swelling, pain, and trismus after third molar surgery. A prospective, double blind and randomized study

AimTo evaluate the preventative effect of intravenous 4 mg of dexamethasone and 8 mg oral dexamethasone on post-operative pain, swelling and trismus after the surgical extraction of mandibular third molars. Materials and methodsA randomized clinical trial comprised of 200 patients (control group I intravenous and experimental group II orally) with impacted lower third molars, average age 20.8 years with no local or systemic problems, with bilateral impacted lower third molars, were operated under local anesthesia. Group I was given 4 mg IV and group II was given 8 mg orally of dexamethasone 1 h before procedure. The choice of which side to operate first and the amount of concentration of medication to use was made randomly and double-blindly. Post-operative pain was evaluated using a visual analog scale (VAS) and the degree of swelling was evaluated through facial reference points' variation. The presence of trismus was analyzed through measurement of the interincisal distance (IID). These assessments were obtained before the operation and 24 h, 48 h and 7th POD. ResultsNo significant difference was found in facial swelling and trismus between IV 4 mg injection and oral 8 mg consumption after lower third molar surgery (student t test P > 0.05). The visual analogue scale scores for pain assessment showed no significant difference between IV injection and oral route of dexamethasone (student t test P > 0.05). ConclusionPatients can be administered 8 mg oral dexamethasone is as effective as 4 mg intra venous route without much difference in final outcome at any given point of time.