Unusual Bleeding Research Articles

Performance and safety evaluation of a cold ablation robot-guided laser osteotome (CARLO) in 28 midface osteotomies

The CARLO (cold ablation robot-guided laser osteotome) is a compact device with integrated multiple sensory, steering and safety checking elements. A multi-center study was performed to evaluate the CARLO device for the linear part of midface osteotomy in 28 patients. Feasibility, success rate, safety, performance and experience of the surgeons were assessed and evaluated. All 28 procedures were completed with CARLO without falling back to the conventional methods, giving a technical success rate of 100%. For 27 (96%) cases, procedural success was achieved with cutting lines deviation less than 2 mm. For 25 procedures, the CARLO-cutting was conducted smoothly. In the other 3 cases, some minor difficulties related to the reference markers were reported. For 18 procedures, no change for the cutting path was necessary. For the other 10 cases, cut path was adapted. Intraoperative re-planning was possible, easy and quick without significant delay of the procedures. No CARLO-related adverse events were recorded. Especially, there was no unexpected and unusual bleeding during the CARLO-conducted osteotomy. The time needed for the registration ranged from 1 to 12 min (median = 4). The CARLO-cutting lasted for 5 to 21 min (median = 7). The present study demonstrated feasibility, simplicity, safety, reliability and accuracy of CARLO for the linear part of midface osteotomy.

Constant Partition Dimension of Different Anticancer Drug Structures

Cancer is the rapidly expanding number of unwelcome cells in the body. Carcinogens are substances that cause symptoms. A certain type of chemical molecule in cigarette smoke is known as a carcinogen. It can spread to several bodily parts. Some of this illness's indications and symptoms include a lump, unusual bleeding, a persistent cough, weight increase or decrease, etc. One of the biggest contributors to this malignant illness is tobacco chewing. Factors include obesity, a bad diet, laziness, and increasing alcohol consumption. Anticancer medications are used to cure this disease. In this work, we studied some of the anticancer medications in terms of partition dimension, where the partition resolving set is an improper subset to settle the entire atom set of a graph into a unique way to access each atom independently.

Severe acquired hemophilia A associated with COVID-19 vaccination: A case report and literature review.

Acquired hemophilia A (AHA) is a rare autoimmune disease caused by an antibody that inhibits coagulation factor VIII activity. More than half of patients with AHA cannot identify underlying disorders. The remaining patients are associated with malignancies, autoimmune diseases, skin diseases, infections, and medications. Here, we present a case of 56-year-old Korean man with underlying hypertension, dyslipidemia, and diabetes mellitus who developed AHA following the second dose of BNT162b2 COVID-19 vaccination. He presented with a large 20 × 30 cm-sized hematoma along the psoas muscle and intracranial hemorrhage, necessitating intensive care with mechanical ventilation and continuous renal replacement therapy. Laboratory testing demonstrated that activated partial thromboplastin time and prothrombin times were 74.7 seconds (normal range 29-43 seconds) and 17.2 seconds (normal range 12.5-14.7 seconds), respectively. Laboratory tests confirmed AHA with undetectable factor VIII activity (<1.5%) and a positive factor VIII antibody with a titer of 8.49 Bethesda units/mL. Recombinant factor VIIa (NovoSeven®) was administered every 2 hours to control the bleeding, alongside immunosuppression with methylprednisolone 1 mg/kg daily and cyclophosphamide 2 mg/kg daily to eliminate the autoantibody. Despite the treatments, the patient developed sepsis and succumbed 14 weeks after admission. This rare case underscores the importance of monitoring for AHA following COVID-19 vaccination. Although the benefits outweigh the risks of vaccination, AHA should be considered in the differential diagnosis of unusual bleeding following the vaccinations. Early diagnosis and management before severe bleeding are critical for successfully controlling life-threatening bleeding.

Bleeding hands in a young girl

Hematohidrosis is a rare disorder involving the spontaneous excretion of sweat contaminated by blood cells. We reported the case of an 8-year-old girl with unusual painless bleeding from her fingertips with no underlying disease or psychotic disorder. On examination, it disappeared as soon as it was wiped without leaving any sign of trauma and reappeared within a few seconds. Her secretions were confirmed as blood with a benzidine test and blood components were observed on microscopic examination of the fluid. Thus, a diagnosis of hematohidrosis was made and her symptoms decreased after treatment with oral propranolol.

Should ultrasound assessment of the endometrium be necessary in patients treated with Tamoxifen?

Tamoxifen is a nonsteroidal selective estrogen receptor modulator that is used mainly for adjuvant treatment of estrogen receptor-positive breast cancer. However, tamoxifen, due to its estrogen-mimicking effects, has been linked to various uterine conditions including menstrual irregularities, and endometrial cancer. Considering that in women taking tamoxifen, ultrasonographical endometrial thickness can be increased without an underlying pathology and that the tamoxifen induces only an extra endometrial cancer in 1 per 1000 women per year of use, patients undergoing tamoxifen treatment don't typically undergo regular examinations of the endometrium, including ultrasonography. Routine ultrasonographic screening for endometrial lesions could result in excessive intervention for non-symptomatic endometrial conditions, undue stress, and might even negatively affect patients' adherence to tamoxifen therapy, which is crucial for reducing breast cancer recurrence and mortality. Nevertheless, if any unusual bleeding arises, an endometrial evaluation is necessary.

Vitreous haemorrhage revealing haemophilia C

Aims/Purpose: To report a rare case of vitreous haemorrhage revealing factor XI deficiency in 83‐year‐old man.Results: A 83‐year‐old man presented with 6 months history of painless visual loss in the right eye (OD). There was no prior ophthalmic history, trauma or unusual bleeding tendency. Ophthalmic examination showed a best corrected visual acuity limited to hand motion in OD and 20/40 in the left eye (OS). Slit examination revealed the presence of bilateral grade 3 nuclear cataract. Fundus examination was unremarkable in OS but could not be visualized in OD. B scan ultrasonography revealed vitreous haemorrhage without retinal detachment. Etiological assessment revealed prolonged activated partial thromboplastin time. Further investigations revealed the presence of a hereditary coagulopathy, namely, haemophilia C or factor XI deficiency (factor XI level &lt; 1%). The patient underwent successful cataract extraction and pars plana vitrectomy with silicone oil tamponade without prophylactic treatment. Peri‐operative fundus examination revealed superior branch retinal vein occlusion. Partial visual recovery was noted. No bleeding events were observed during follow‐up.Conclusions: Factor XI deficiency is a rare disorder. Haemorrhagic symptoms are variable since there is no correlation between haemorrhagic risk and factor level. In severely affected patients, cataract extraction and vitrectomy can be performed safely without prophylactic treatment.

Comparison of one-stage and chromogenic factor VIII assays to tailor the dose of recombinant factor VIII-Fc fusion protein (rFVIIIFc, efmoroctocog alfa) in adult patients with haemophilia A: Single-centre, real-world experience of surgery.

Efmoroctocog alfa (rFVIIIFc) is an extended half-life FVIII used notably in surgery for patients with haemophilia A. More information is needed of its usage in real-life. Adult patients with HA followed at the Lyon Comprehensive Hemophilia Care Center who underwent a surgery with rFVIIIFc were included in this retrospective analysis. The pharmacokinetics of rFVIIIFc was assessed by plasma factor VIII clotting activity (FVIII:C) using both one-stage (OSA) and chromogenic substrate (CSA) assays. A total of 39 major and 31 minor surgeries were performed in 49 patients treated with rFVIIIFc. The median dose of rFVIIIFc infused before major and minor surgeries respectively was 67.5 ((interquartile range [IQR] 52.6-76.9) and 48.0 (38.5-51.8) IU/kg. For major surgeries, during the first postoperative week, the median residual FVIII:C was 78 (64.5-101.5) IU/dL with OSA and 99 (71-118) IU/dL with CSA (p<.0001). After surgery, rFVIIIFc doses were adjusted according to CSA results. This led to a significant decrease of rFVIIIFc consumption compared to what would have been proposed according to the OSA assay, without unusual bleeding or appearance of inhibitor. Considering the high price of the molecule, this was also associated with a significant cost reduction. Dose adjustment of rFVIIIFc according to FVIII: C measured by CSA is effective, safe and well tolerated in patients with haemophilia A undergoing invasive surgery.

Five new F10 variants in hereditary factor x deficiency detected by high-throughput sequencing.

Factor X deficiency is a rare inherited bleeding disorder. To date, 181 variants are reported in the recently updated F10-gene variant database. This study aimed to describe new F10 variants. The F10 gene was analysed in 16 consecutive families with FX deficiency by a targeted high-throughput sequencing approach, including F10, F9, F8 genes, and 78 genes dedicated to haematological malignancies. We identified 19 variants (17 missense, one nonsense and one frameshift) and two copy number variations. Two patients presenting a combined FVII-FX deficiency showed a loss of one F10 gene copy (del13q34) associated with a missense variant on the remaining allele, leading to a FX:C significantly lower than the FVII:C level and explaining their unusual bleeding history. We reported five novel variants. Three missense variants (p.Glu22Val affecting the signal peptide cleavage site, p.Cys342Tyr removing the disulphide bond between the FX heavy and light chains, and p.Val385Met located in FX peptidase S1 domain) were detected at compound heterozygosis status in three patients with severe bleeding symptoms and FX:C level below 10 IU/dL. Two truncating variants p.Tyr279* and p.Thr434Aspfs*13 leading to an altered FX protein were found at heterozygous state in two patients with mild bleeding history. This study showed the feasibility and the interest of high-throughput sequencing approach for rare bleeding disorders, enabling the report of F10 gene screening in a 3-weeks delay, suitable for clinical use. The description of five new variants may contribute to a better understanding of the phenotype-genotype correlation in FX deficiency.

Epidemiological and clinical presentation of head and neck neoplasia: a review

Head and neck squamous cell carcinoma (HNSCC) stand at the sixth position most, amongst all the malignancies worldwide. Neoplasms arising in the oral cavity, larynx, pharynx, salivary gland and nasal cavity are all included in the head and neck malignancies. More than 90% of malignancies of the oral cavity are squamous cell carcinomas (SCC). Among the four head neck cancer sub-sites combined, the mean age at the time of diagnosis has risen, in the last four decades. Studies have documented a male predilection. A small percentage of SCC cases are inherited or are familial. Cigarette smoking, alcohol consumption, betel quid chewing, poor nutrition, poor oral hygiene, HPV, Epstein-Barr virus and Candida albicans infections are the etiological agents who have the ability to cause HNSCC. Non healing ulcer, difficulty in swallowing, change in voice, swelling, sore throat- that doesn’t get better- are the symptoms of head and neck cancers. Moreover, there may be unusual bleeding, facial swelling or difficulty in breathing.

A Preoperative Evaluation Revealing a Rare Coagulation Factor Deficiency

Constitutional factor II deficiency is a rare coagulation disorder. The autosomal recessive form has an estimated prevalence of 1-2 million. Clinical symptoms depend on the rate of factor II deficiency. We report a fortuitous discovery of an isolated factor II deficiency in a 9-year-old girl of 1st degree consanguineous parents, following a preoperative assessment of drainage of her abundant pericardial effusion, the biological assessment showed a factor II rate &lt; 1%, a prothrombin rate at 3% and a TCA &gt; 120 sec, the dosage of the other coagulation factors are without anomalies. Through this observation we recall the rarity of this deficit and thought about it in the face of unusual bleeding in newborns of consanguineous parents, as well as the necessity of collaboration with international registries to establish codified diagnostic and therapeutic guidelines. Keywords: Factor II; Congenital Hemorrhagic Diseases; Rare Coagulation Factor Deficiency Abbreviations: FFP: Fresh Frozen Plasma

Digestive hemorrhage and fever as a result of a double secondary aortoenteric fistula following the repair of a juxtarenal abdominal aortic aneurysm and an infection of the aortobifemoral bypass graft: a case report.

During aortoc reconstructive surgery, the patient may present with a variety of unusual complaints, including fever and GI bleeding. These symptoms are indicative of problems, including the development of an aortoentric fistula, particularly when there is a double secondary fistula. The patient was admitted to the hospital due to hematemesis, melena, and high-grade fever after undergoing synthetic grafting aortobifemoral bypass (anatomical reconstruction) and partial resection of the juxtarenal abdominal aortic aneurysm. Pus discharge and a double aortoenteric fistula in unusual sites such as the second-third portion of the duodenum and caecum are visible in upper GI endoscopy and computed tomography angiography. The patient underwent a two-stage open surgery, the first stage involving aortic limb graft exclusion and extra anatomical reconstruction, and the second stage involving graft removal, fistula management, and bowel repair. Then the patient spent a few days in the surgical intensive care unit before being discharged. Primary and secondary AEF are the two categories of AEF. In patients who underwent aortic reconstruction surgery, the frequency of secondary AEF ranges from 0.36 to 1.6%. Due to the 8:1 injury ratio in the secondery AEF, men suffer more injuries than women.There are two types of fistula depending on whether or not the suture line is involved. The first form is graft enteric erosion, which excludes the suture line, while the second type is entric graft fistula, where the suture line is included. Most common site fistula is third and fourth part of duodenum and least common site is fistula formation in large bowel. An uncommon complication is double secondary AEF following aortic reconstruction surgery. Since one of the most significant presentations an AEF patient can present with is major GI bleeding and sepsis, A delay in seeking immediate medical treatment could result in the patient's death. It should be emphasized that one of the mechanisms for AEF formation and a frequent cause of sepsis in patients is recurrent aortic graft infection following aortic reconstruction surgery.

Review on Car-T Cell Therapy for Cancer Treatment

A set of illnesses known as cancer involve abnormal cell proliferation and have the ability to invade or spread to different bodily regions. These stand in contrast to benign tumours, which remain stationary. A lump, unusual bleeding, a persistent cough, unexplained weight loss, and a change in bowel habits are all potential warning signs and symptoms. Chimeric antigen receptors (CARs), often referred to as chimeric immunoreceptors or artificial T cell receptors, are receptor proteins that have been modified so that T cells now have the ability to target a particular antigen. Because they integrate antigen-binding and T cell activation functions into a single receptor, the receptors are chimeric. CAR T cell treatment is a form of treatment in which the patient's immune cells, called T cells, are altered in a lab so that they will adhere to and kill cancer cells. An apheresis machine receives blood from a vein in the patient's arm through a tube, filters out all white blood cells—including T cells—and returns the remaining blood back to the patient. The T cells are then genetically modified in the lab to contain the gene for a unique receptor known as a chimeric antigen receptor (CAR). The CAR T cells are multiplied in a lab before being infused into the patient in large numbers. In order to destroy cancer cells, the CAR T cells can connect to an antigen on the cancer cells.

Libido-sexual disorders and abandonment of injectable contraceptives among users of the Ivorian Association for Family Well-Being in Korhogo, Côte d'Ivoire.

The recent introduction of modern contraceptive methods in resource-limited countries is confronted with the occurrence of undesirable effects that hinder their use in the long term. This study conducted among the users of the Ivorian Association for Family Well-Being in Korhogo describes the libido-sexual problems associated with the discontinuation of injectable contraceptives in former users. The objective of the study was to identify the factors that led to the abandonment of injectable contraceptives among female users of the Ivorian Association for Family Well-Being in Korhogo between 2018 and 2019. Qualitative data were collected from 15 former users (24-38 years old) of injectable contraceptives duration of 2-3 months. Additional data were collected from five health workers aged 35-60 years. In-depth interviews were conducted to explore the experience with injectable contraceptives and reasons for discontinuation. Following data collection, audio-recorded data were transcribed, translated, and coded using thematic analysis through an inductive approach. Side effects identified as associated with injectable contraceptives include libido-sexual disorders, unusual bleeding, and weight gain. The most common reason for discontinuation were libido-sexual disorders, which impacted the households' intimacy and provoked their abandonment or the change of contraceptive methods among injectable contraceptive users. Adverse events were dominated by libido-sexual disorders, unusual bleeding, and weight gain leading to the abandonment or change of the contraceptive. These results suggest points of intervention for increasing continuation among users. This intervention should include training of health workers to investigate and manage adverse events related to the use of injectable contraceptives and the improvement of communication between health workers and users on adverse events of injectable contraceptive use.

Bloody Wrath and Healing Touches: Joseph and His Brothers in Early Imāmī Shīʿī Tafsīr

Abstract The meetings between Joseph and his brothers in Egypt are often portrayed in Qurʾān commentaries as dramatic occurrences. A few early Imāmī-Shīʿī commentaries mention a peculiar account that describes the heated clash between the brothers and Joseph following Joseph’s accusation that one of them stole from him. A comparative examination shows that a second version of this tradition appears in contemporary Sunnī exegesis, and that earlier Jewish Midrashim influenced both Muslim versions. This paper will suggest that the Muslim versions consciously altered the Jewish exegetical narrative to agree with the qurʾānic one and that the Islamicized version of the tradition was adopted “back” into later Jewish exegesis. The differences between the Imāmī and Sunnī versions suggest that each community had independent access to rabbinic lore. The paper also studies elements in the Imāmī version that are absent from both the Sunnī and Jewish versions, including unusual bleeding from various organs and a golden pomegranate. Finally, it offers some preliminary observations concerning the considerations that might have led to the unique developments exhibited in the Imāmī version.

Stomorrhagia Revealing Hemophilia in an Infant: About a Case Treated at CHUOwendo

Introduction: Persistent oral bleeding in a child may be a sign of a bleeding disorder. The objective of this work is to describe the diagnostic and therapeutic aspects of hemophilia. Observation: We report the case of an 11-month-old male infant who had been admitted to the maxillofacial surgery department for persistent post-traumatic gingivorrhagia in a patient with no particular history. The clinical examination noted a wound with a layer of gingival bleeding, hematomas in the two upper limbs. Biological exploration revealed normochromic microcytic anemia at 6.5 g/dl; 97% prothrombin rate. The treatment consisted of gingival suture with tranexamic acid compression dressing, vitamin k injection and transfusion of 2 iso-group, iso-rhesus blood bags. The persistence of bleeding led to a search for coagulation factors, with factor VIII returning to less than 1%, concluding with the diagnosis of hemophilia A. Transfusion of an iso-group iso-rhesus blood bag to stop the bleeding. Transfer of the patient to the hematology department for specialized care. Discussion: Any unusual bleeding from the cephalic and bucco-facial sphere in an infant should raise the question of hemophilia. Conclusion: Stomatorrhagia is the evocative sign and the suture accompanied by blood transfusion a means of treatment.

A thrombophilic allele of clotting Factor VII/VIIa promoting recurrent pulmonary emboli, clinical details, and a structural model of the altered protein: a case report

BackgroundThe clotting or hemostasis system is a meticulously regulated set of enzymatic reactions that occur in the blood and culminate in formation of a fibrin clot. The precisely calibrated signaling system that prevents or initiates clotting originates with the activated Factor Seven (FVIIa) complexed with tissue factor (TF) formed in the endothelium. Here we describe a rare inherited mutation in the FVII gene which is associated with pathological clotting.Case presentationThe 52-year-old patient, with European, Cherokee and African American origins, FS was identified as having low FVII (10%) prior to elective surgery for an umbilical hernia. He was given low doses of NovoSeven (therapeutic Factor VIIa) and had no unusual bleeding or clotting during the surgery. In fact, during his entire clinical course he had no unprovoked bleeding. Bleeding instances occurred with hemostatic stresses such as gastritis, kidney calculus, orthopedic surgery, or tooth extraction, and these were handled without factor replacement. On the other hand, FS sustained two unprovoked and life-threatening instances of pulmonary emboli, although he was not treated with NovoSeven at any time close to the events. Since 2020, he has been placed on a DOAC (Direct Oral Anticoagulant, producing Factor Xa inhibition) and has sustained no further clots.Possible mechanism of (unauthorized) FVII activationFS has a congenitally mutated FVII/FVIIa gene, which carries a R315W missense mutation in one allele and a mutated start codon (ATG to ACG) in the other allele, thus rendering the patient effectively homozygous for the missense FVII. Structure based comparisons with known crystal structures of TF-VIIa indicate that the patient's missense mutation is predicted to induce a conformational shift of the C170's loop due to crowding of the bulky tryptophan to a distorted "out" position (Fig. 1). This mobile loop likely forms new interactions with activation loop 3, stabilizing a more active conformation of the FVII and FVIIa protein. The mutant form of FVIIa may be better able to interact with TF, displaying a modified serine protease active site with enhanced activity for downstream substrates such as Factor X.ConclusionsFactor VII can be considered the gatekeeper of the coagulation system. Here we describe an inherited mutation in which the gatekeeper function is altered. Instead of the expected bleeding manifestations resulting from a clotting factor deficiency, the patient FS suffered clotting episodes. The efficacy of the DOAC in treating and preventing clots in this unusual situation is due to its target site of inhibition (anti-Xa), which lies downstream of the site of action of FVIIa/TF.

Machine Learning Applied To Cervical Cancer Data

Cervical cancer is a type of cancer that occurs in the cells of the cervix. Cervix is the lower part of the uterus that connects to the vagina. It arises due to the abnormal growth of cells and spreads to other parts of the body. Smoking is also considered as one of the main causes for cervical cancer. Long term use of Oral contraceptive pills can also cause cancer. Also having multiple pregnancies can cause cervical cancer. Cervical cancer often has no symptoms in its early stages. It is fatal most of the time. The most common symptom is unusual vaginal bleeding. Here the machine learning algorithms are used to predict the occurrence of cervical cancer. Predicting the presence of cervical cancer can help the diagnosis process to start at an earlier stage.

Clues of incomplete reversal of heparin in cardiac surgery.

In our center, an unusual rate of patients had abnormalities of hemostasis in immediate postoperative period of cardiac surgery. Our objectives were to identify the cause of these sudden hemostasis abnormalities and to evaluate the performances of point of care coagulation testing. In this prospective and descriptive study, we included 33 consecutive patients undergoing elective cardiac surgery for 1month. Heparin-induced anticoagulation and calculation of the protamine dose were tested by the Hemostasis Management System Plus device (Medtronic, Minneapolis, MN, USA). Fifteen minutes after the end of the protamine infusion, activated clotting time (ACT), activated partial thromboplastin time and anti Xa activity were measured. In case of unusual clinical bleeding, a Quantra analysis (Stago, HemoSonics LLC, Charlottesville, VA) was added. Residual antiXa activity >0.2 IU/mL after neutralization was present in 44% of patients. Our investigation concluded incomplete heparin reversal. There was no association between cellular reinfusate and the presence of heparin. The unusual rate of hemostasis abnormalities was explained by a less efficient protamine reversal of heparin. ACT and Clot Time Ratio (CTR, Quantra system) correlated with AntiXa with Spearman's coefficients of 0.85 (p < .0001) and 0.95 (p = .0012), respectively. About ACT, a threshold of 150 seconds had a sensitivity of 85% [58-97] and a specificity of 85% [58-97%] for detection of AntiXa>0.2. For CTR, a threshold of 1.4 had a sensitivity of 67% [30-94] and a specificity of 100% [18-100]. The use of point of care coagulation testing is effective in detecting incomplete reversal of heparin.

Therapeutic Effects of Natural Products Isolated from Different Microorganisms in Treating Cervical Cancer: A Review

&lt;p&gt;Cervical cancer is defined as a cancer arising in the cells of cervix&amp;nbsp;that causes unusual vaginal bleeding, discharges, pain in the&amp;nbsp;pelvic region, or pain during sexual activity. Cervical cancer is currently reported to be&amp;nbsp;the fourth most prevalent malignancy among women globally. Surgery includes&amp;nbsp;pelvic lymphadenectomy as well as radical hysterectomy, radiotherapy, as well as chemotherapy are the most common therapies for treating&amp;nbsp;cervical cancer. Another approach includes targeted medication&amp;nbsp;which affects the epidermal growth factor receptor (EGFR) and cyclooxygenase-2 (COX-2) for the curing&amp;nbsp;cervical cancer. However, these therapies have the potential for risks and complications: surgery can result in bleeding and may cause organ&amp;nbsp;damage surrounding the surgery, and clots may also start to form&amp;nbsp;in the deep veins of the legs; radiotherapy can result in menopause, infertility, discomfort, or pain during intercourse; and chemotherapy can actually impact rapidly dividing cells along with cancer cells&amp;nbsp;in the human body system. In this review, we will discuss about the use of several Randomised controlled trials (RCTs) for treating malnutrition in various oncology patients. In this review, we will discuss about the various therapeutic effects of natural products isolated from different microorganisms in treating cervical cancer.&lt;/p&gt;

Predicting Difficult Laparoscopic Cholecystectomy Based on Clinicoradiological Assessment

Background: Laparoscopic Cholecystectomy (LC) has become the treatment of choice for symptomatic gallstone disease. But it becomes difficult to perform safely and some cases require conversion to Open Cholecystectomy (OC). There is no clear consensus among the laparoscopic surgeons to determine preoperative parameters that can predict difficult laparoscopic cholecystectomy. The aim of this study is to predict the difficult laparoscopic cholecystectomies by correlating with preoperative clinical and radiological findings.&#x0D; Materials and methods: This prospective observational study was performed in the Department of Surgery at Chittagong Medical College Hospital for a period of one year from April 2018 to March 2019. The sample size was 151. Pre-operative clinical and ultrasonographic criterias were correlated with intraoperative difficulties encountered. Peroperative difficulties were considered in terms of pericholecystic adhesion, difficult callots triangle dissection, difficult GB bed dissection and unusual bleeding during surgery.&#x0D; Results: Out of 151 patients underwent LC in this study; 93 (61.6%) cases the procedure was uneventful and the other 58 (38.4%) procedures were difficult. Among those difficult 58 cases, 13 (8.6%) patients required conversion to open cholecystectomy. Difficult LC were found in BMI &gt;30kg/m2, hospitalization for 3 or more times due to acute painful attack and GB wall thickness &gt;3 mm.&#x0D; Conclusion: Pre-operative prediction of difficult LC can be determined by correlating with clinical and radiological findings that help the surgeons to better prepare for intra-operative difficulties and risk of conversion to open cholecystectomy.&#x0D; IAHS Medical Journal Vol 4(2), December 2021; 70-73