Radiofrequency Catheter Ablation of WPW Syndrome in National Institute of Cardiovascular Diseases, Dhaka: Initial and Four Years Follow-up Results.

Background: Radiofrequency (RF) catheter ablation is an effective method of treatment of patients with WPW syndrome. The purpose of this study was to analyze the initial and follow -up results of RF ablation of such cases in our hospital. Methods: 255 cases with WPW syndrome that had delta wave in sinus rhythm ECG underwent electrophysiological studies in this hospital. All the cases underwent radiofrequency ablation. These cases are selected for analysis. Results: Ablations were performed in these 255 patients between December 2005 and December 2008. One accessory pathway (AP) was found in 250 patients, two accessory pathways-in 05 patients. The mean duration of the procedure was 130 ± 32 min. The initial and overall success rate was 92.15% and 95.68% respectively. Major complications encountered are none. Conclusions: RF ablation of WPW syndrome has good initial (92.15%) and overall (95.68%) success rate and low recurrence rate (5.00%) at long term follow-up.

Intralesional bleomycin in the treatment of cutaneous warts: A randomized clinical trial comparing it with cryotherapy.

Background: Though not in regular practice, intralesional (IL) bleomycin has been used for the treatment of warts since the 1970s and on the other hand, till now cryotherapy is quite regularly used to treat warts. Aim: Our aim was to assess the evidence for the efficacy of IL bleomycin, in comparison with a control group of similar sample receiving cryotherapy, in the treatment of cutaneous warts. Methods: Patients were randomized using computer-generated codes to receive either cryotherapy (double freeze-thaw cycle) or IL bleomycin (0.1% solution with concurrent anesthesia) for a maximum of four treatments 3 weeks apart and a maximum of five warts treated in each visit for both groups. Patients had their warts measured at base-line and with each return visit including a post treatment follow-up that was 8 weeks apart from last treatment taken. Results: Of the 73 patients completing the study, 39 (53%) were treated with IL bleomycin and 34 (47%) were treated with cryotherapy. Out of 155 treated warts, 87 (56%) were treated with IL beomycin and 68 (44%) were treated with cryotherapy. The clearance rates in context of number of patients and number of warts were 94.9% and 97% for bleomycin and 76.5% and 82% for cryotherapy respectively ( P < 0.05 by x 2 analysis and RR = 7.67). Conclusion: IL bleomycin injection was significantly more effective than cryotherapy for treatment of cutaneous wart.

Patient with bilateral breast enlargement and hypospadias.

A 20 year old man was admitted in the surgical unit of Dhaka Medical College Hospital on August 2007 presented with Hypospadias & underdeveloped penis from childhood, gradual enlargement of both breasts for the last 10 years, absence of axillary and pubic hair from puberty & painful swelling of both testes for the last 3 years. The patient was regarded as a female upto the age of 10 years. He has got no voice change since puberty. On examination he had average body built, there was bilateral gynaecomastia, hypospadias, rudimentary penis & absence of pubic and axillary hair. His testosterone level, serum prolactin level, serum progesterone level, serum estradiol level was done. Cytology on buccal smear done and ultrasonography revealed no ovary and uterus. Ultimately patient was diagnosed as a case of androgen insensitivity syndrome (AIS). The case is reported for clinical awareness & to share our experience.

Upper abdominal mass with diagnostic dilemma.

A 32 years old gentleman presented with a lump occupying the epigastric, left hypochondriac and umbilical region for the last 3 months which gradually increased in size & dull aching pain. He also complained of low grade fever and early satiety. On examination, he had a lump on upper abdomen which was irregular, firm, mildly tender, lobulated surface, restricted mobility, dull on percussion. USG examination of HBS revealed hepatomegaly and SOL in liver. CT abdomen revealed soft tissue mass in left upper abdomen. FNA revealed cells of mesenchymal origin. Per operatively a large lobulated, myxomatous highly vascular mass arising from the fundal part of the stomach was found and removed. Histopathology report comments about two differential diagnosis-leiomyosarcoma and gastrointestinal stromal tumour. CD117 immunostaining confirmed it was gastrointestinal stromal tumor (GIST). Post operatively patient was treated by Imatinib and is now under regular follow up.

Childhood acute poisoning in a tertiary medical college hospital of Bangladesh.

A total of 193(4.7%) cases of acute childhood poisoning admitted to paediatric Unit of Khulna Medical College Hospital, Bangladesh over a period of two years were studied to see the age and sex distribution, ingredients used, seasonal variation etc. Out of them 107(55.4%) cases were male and rest 86(44.6%) were female. 01-03 years was the most vulnerable age group to be affected. Kerosene was the commonest form of ingredient to be used. Overall mortality rate was 4.66%. Childhood poisoning was a common Medical emergency with considerable morbidity and mortality. Parents should be educated to keep the kerosene out of reach of the children. So, that mortality and morbidity can be reduced to a great extent.

External carotid ligation in extensive haemangioma of tongue & lip.

Two patients were admitted in the surgical unit of Mymensingh Medical college Hospital on September 2005 & April 2006. The first case was a lady of 18 years presented with sudden huge enlargement of tongue & lower lip for 07 days resulting difficulty in deglutition & respiration. Since childhood she noticed multiple elevated bluish spots over the tongue, cheek & lips. The second case was a young man of 20 years presented with multiple diffuse swelling of lips, left side of face, cheek, lower eyelid since birth, which was gradually increasing in size. Colour Doppler evaluation of the lesions in both the cases revealed features suggestive of haemangioma. Bilateral external carotid artery ligation by skin crease incision at the level of upper border of thyroid cartilage was done in both the cases. In first case, tongue size reduced back to oral cavity in post operative period. After 04 weeks of operation tongue size became almost normal with only multiple bluish residual swelling. In second case, the swelling size gradually reduced in post operative period. Both the patients are under regular follow up.

Histopathology based cancer pattern in Mymensingh region of Bangladesh.

To our knowledge, population-based published data regarding the cancer profile in Mymensingh region of Bangladesh is not available. This study was designed to provide information regarding the frequencies of cancers through sample data retrieved from histopathology (surgical pathology) laboratory based cancer registry from two laboratories in Mymensingh. All malignant tumours recorded in 2006 in the register of pathology laboratory of Mymensingh Medical College and one private pathology laboratory in Mymensingh town were taken as sample data for analysis in terms of age groups, gender and types of cancer with relation to site. A total of 470 cases diagnosed as cancer were found in the register, of which males were 249(53%) and females were 221(47%) with male to female ratio 1.2: 1. Highest numbers of cases were found in the age group of 51-60 years. In male group frequency of malignant tumours was found in the age group of 51-60 years and the female group it is 41-50 years. Top five sites of cancer, irrespective of sex, were of stomach, uterine cervix, colo-rectum, lymph nodes and breast. According to decreasing order of frequency, in the males, the top five cancers were of stomach, lymph node, oesophagus, urinary bladder and colo-rectum. In the female groups these were of uterine cervix, breast, ovary, colo-rectum and stomach. Cancer cases in the age group of 51-60 years were significantly higher in males than in females (p<0.001). The commonest cancers in males and females were of stomach and cervix, respectively. As the analysis was based only on surgical specimens, the exact incidence of cancer of lung and liver could not be evaluated. Because, majorities of the malignancies in these organs are diagnosed mainly on cytological examination. Population-based cancer registry should be maintained to explore the exact patterns of cancer in the study region. Cervical cancer screening program and eradication of H. pylori infection program may be helpful for the reduction of incidence of cancer in this region.

Evaluation of 35 cases of abdominal lymphoma.

Abdominal lymphoma is not a common clinical entity in Bangladesh. Still, in our Clinical practice we come across such problem occasionally. Because of their rarity and variable unusual behaviour, such case may present a major challenge even to experienced clinicians. Thirty five cases are reported in this series of which 29 were male and 6 were female (M:F = 4.8:1). Cases were collected from BSMMU, DMCH, MMCH, different clinics of Dhaka. Mean age was 36.7 years. Out of 35 cases 20(57.15%) had primary abdominal lymphoma, 08(22.85%) had secondary lymphomatous involvement, 07(20%) were cases of nodal lymphomas with or without superficial lymphnode involvement. All patients presented with gastrointestinal symptoms with or without an abdominal lump. Duration of symptoms of these patients ranged from 03 months to 02 years. In only 02 patients a clinical diagnosis of lymphoma was made pre-operatively. Various operative procedures were performed according to circumstances. Most common site of involvement was small intestine followed by large intestine, mesenteric lymphnodes, rectum and stomach. Among 35 cases, 28(80%) were Non-Hodgkin's, lymphoma 05(14.28%) were Hodgkin's and lymphoma 2(5.71%) were unclassified. All of the patients were referred to oncologist. Some of the patients received chemotherapy. The patients were followed up for a variable period. This study showed that abdominal lymphoma has a good prognosis provided diagnosed and treated early.

Patch test for the detection of contact allergens.

Patch Test was done in 340 suspected allergic contact dermatitis patients having different ages of both sexes during the period of January 2000 to December 2003 in the department of Dermatology and Venerology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Of these 340 cases 145 (42.65%) were male and 195 (57.35%) were female. Among these 340 cases, 250 (73.53%) cases were tested with international standard series allergen (ISS) and 90 (26.47%) cases with cosmetic series allergen (CSS), of which patch test was positive in 125 (50%) cases and 65 (72.22%) cases respectively. The 125 positive cases with ISS consisted of 56% male and 44% female. In 65 CSS positive cases 90.77% were female and 9.23% were male. Highest incidence of positive patch test was found in 61.54% cases in the age group of 30-39 years in ISS and 71.43% cases in the age group of 20-29 yrs in CSS. In ISS--Potassium Dichromate (19.2%), Fragrance mix (17.6%), Nickel Sulphate (15.2%) and PPD (11.2%) were found to be the common allergen and in CSS--Octyl Gallate (27.69%), Getrimide (18.92%), Balsum of Peru (15.38%), Thiomersal (12.31%) were found to be the common allergens.