Evaluation of Necessity of Appendectomy After Conservative Treatment of Uncomplicated Acute Appendicitis in Children

Background: Acute appendicitis is one of the most common emergency clinical conditions among children. It has two-way treatment options, one is surgical procedures, and another is a conservative approach. In the modern arena conservative treatment approach for acute appendicitis is one of the most preferred options. The aim of the study was to find out the solution to clinical conditions and reduce the procedure of injudicious appendectomy.Material & Methods:This prospective observational study was carried out at the Department of Paediatric Surgery, Dhaka Medical College Hospital, Dhaka to assess the necessity of appendectomy following conservatively managed uncomplicated acute appendicitis. A total of 62 children with uncomplicated acute appendicitis were included in the study. Then a conservative treatment started with the combination of inj. Ceftriaxone (100 mg/kgper day), inj. Metronidazole (1.5 mg/kg/ tds) and inj. Amikacin (7.5 mg/kg/ bd) therapy for five days with associated supportive management. The patients were assessed after 24 hours of treatment, who responded to the above management were the continued for same treatment at least five days then discharged and were followed up for 6 months.Results:Mean age was 8.95 ± 2.10 years within range from 4 years12 years. The male-female ratio was 1.58:1. The mean duration of hospital stay was 5.26 ± 0.63 days. On day 5, 59 (95.1%) were discharged and 3 (4.9%) underwent surgery during the conservative treatment period. A total of 8(13of .0%) cases have recurred during the first 6 months after treatment. Conclusions:Antibiotic treatment in patients with acute appendicitis is quite effective, the success rate is 95.1% during the period of treatment, and the recurrence rate is 13.0%.

Factors influencing the outcome of patients with acute extradural haematomas undergonig surgery.

Background: Acute extradural haematoma (EDH) remains most common cause of mortality and disability resulting from traumatic brain injury. In the last three decades, improvements in rescue, neuromonitoring, diagnostic procedure and intensive care have led to better outcomes. The purpose of this study was to evaluate the factors influencing the outcome in patients with EDH undergoing surgery treated in a tertiary hospital in Bangladesh. Methods: In this retrospective study, 102 consecutive patients with acute EDH who underwent craniotomy were included. The study was carried out from July 2003 to December 2005. The diagnosis was made clinically and radiologically by CT scan. Patients were grouped on the basis of Glasgow Coma Scale (GCS) and operative outcomes were evaluated by Glasgow Outcome Scale (GOS) Results: More than half sampled respondents’ (57%) age were more than 20 years while rests of the patients below 20 years with male predominance (Male: Female -12:1). About 7 in 10 respondents (70.6%) were working. Similarly, majority of the respondents (79.4%) had lost more than 30 ml blood. A notable proportion of the respondents (73.5%) had good GCS score (9-15 score) during admission. Similarly majority of the respondents (70.6%) had GCS score 9-15 and 29.4% had GCS score 3-8 before surgery. Road Traffic Accident (RTA) (65%) is the most common cause of EDH followed by assault (20%) and fall from height (12%). Temporal and temporo-parietal locations were the most common site of EDH (56%). Patients with good GCS before surgery had significantly better outcome (89%) compare to those who had bad GCS (10%). Conclusion: Level of consciousness before surgery is the most important factor affecting the outcome. Hence, early diagnosis and surgical intervention is very essential.

Immunofluorescent microscopic findings in glomerulonephritis.

Histopathology and direct immunofluorescence (DIF) microscopy were performed on renal biopsy specimens of 60 clinically suspected cases of glomerulonephritis (GN). Histopathological diagnosis was obtained in 44 (73.3%) cases and immune complex deposition were detected by DIF in 28 (46.7%) cases. Immune complex deposition were observed in all cases of membranous GN, systemic lupus erythematosus (SLE), and rapidly progressive GN (RPGN), most of the cases of diffuse proliferative GN (2 out of 3) mesangioproliferative GN (12 out of 15) and focal glomeruloscleros is (3 out of 5 cases). No immune deposits were observed in minimal change GN, chronic GN, and diabetic nephropathy. Histopathological diagnosis was not obtained in 16 (26.7%) cases, 3 (5%) of which showed immune complex deposition by DIF. Anti-GBM nephritis was demonstrated in one (3.6%) case, the rest were immune complex nephritis.

Study on Mycobacterium tuberculosis: the primary drug resistance pattern.

The study was carried out to investigate the primary drug resistance pattern of tubercle bacilli isolated from the pulmonary tuberculosis patient attended in Shyamoli TB clinic, Dhaka. Sputum from 961 suspected tuberculous patients were randomly collected and stained by Ziehl-Neelsen (Z.N) stain. 135 were microscopically positive for Acid Fast Bacilli (AFB). Among them 30 patients were excluded from the study as they received antitubercular treatment before. So only 105 microscopically positive cases were cultured on Lowenstein-Jensen (L-J) media and 100 showed pure growth and rest 5 were contaminated with fungus. These 100 cases were studied on 4 antitubercular drugs. Out of these 100 isolates, 91 were M. tuberculosis and rest 9 in the nonchromogen group of mycobacteria other than tuberculosis (MOTT) species. Among 91 M. tuberculosis species, 89 (97.80%) to Isoniazid (INH), 73 (80.21%) to Rifampicin (RMP) and 91 (100%) to Streptomycin (SM) and Ethambutol (ETHM) were sensitive. Of the 9 MOTT species, 4 (44.44%) to SM, 7 (77.78%) to ETHM were sensitive and all (100%) were resistant to INH and RMP. Among the 100 isolates, 27 (18 M. tuberculosis and 9 MOTT) were resistant to 4 drugs either single or in combination. Of the 18 (66.67%) M. tuberculosis species, 16 (59.26%) to RMP, and 2 (7.41%) to RMP and INH were resistant. Of the 9 (33.33%) MOTT species, 4 (14.81%) to RMP and INH, 3 (11.11%) to RMP, INH and SM and 2 (7.41%) to RMP, INH, SM and ETHM were resistant.

Effect of PEMF on fresh fracture-healing in rat tibia.

The present experiment was designed to find out whether PEMF can act as a healing agent on induced fracture of rat tibia. Eighty rats were taken for this experiment. Under general anaesthesia mid-shaft of tibia and fibula of all rats were osteotomied, Intramedullary nailing was done for proper alignment of the fractured fragments. The animals were then divided into two groups: group-1 and Group-II. Each group contained forty animals. Out of these forty animals twenty were treated as experimental and twenty as control. From the third day of osteotomy, PEMF was applied to experimental rats around the osteotomy sites for a period of nine hours a day. PEMF was not applied to the control rats. The animals of group-1 and group-II were sacrificed after applied one week and three weeks of PEMF, respectively. Radiological and microscopical examination of the callus were performed. Gross and microscopic measurements of the callus were statistically analysed. The growth of callus was taken as a criterion of fracture healing. The results of the present experiment revealed significant enhancement of fracture healing in group-I. The results of the radiological evaluation of group-II experimental animals were also consistent with the morphological analysis. It was concluded that healing of fractured rat tibia was enhanced by the application of PEMF and this effect of PEMF was more pronounced at the end of third week.

Effect of high protein carbohydrate free diet on the evolution of diabetes mellitus in rats.

Diabetes was induced in seventy seven Long Evans rats of both sexes by injecting streptozotocin (STZ). Some of these diabetic rats were provided with a high protein-carbohydrate (HP-CHO) free diet. The diabetic state of the rats on HP-CHO free diet was compared with that of the diabetic rats on normal diet and the control rats on normal diet. Diabetic state was assessed through the diet consumption, body weight changes, urinary glucose loss and blood glucose estimation. From the fifth day the rats on HP-CHO free diet showed significant reduction of blood glucose level and urinary glucose loss.

Dissecting microscopic (DM) and light microscopic (LM) study of the intestinal mucosa of Bangladeshi population.

A total of 67 specimens of proximal intestinal mucosa, one from each subject, were examined under dissecting microscopy (DM) and light microscopy (LM). Majority of the subjects were adults and males. The overall per-oral biopsy failure was 13. DM was found to be useful to demonstrate gross villous atrophy. It also helped to orientate the specimens properly before fixation for embedding and sectioning. DM and LM findings did not concord in 17% of the specimens. In all of these specimens the mucosal surface which appeared normal under DM revealed grade-2 change under LM. The present study showed that dissecting microscopy (DM) of the intestinal mucosa is not an alternative for histologic examination under LM. However, scanner of light microscope (SLM) can be used as an alternative for DM.

Effect of pulsed electromagnetic field on healing of experimental nonunion in rat tibiae.

To see the effect of Pulsed Electromagnetic Field (PEMF) on nonunited fracture healing, nonunion was induced in rat tibiae and PEMF was applied on it. Out of five different techniques utilised for inducing nonunion soft tissue interposition was found to be the most suitable and effective method of experimental induction of nonunion. Twenty eight experimental and 15 control rats were finally evaluated for the effect of PEMF applied for up to 8 weeks. After sacrifice of 8 experimental and 4 controls, 6 experimental and 3 controls, again 6 experimental and 3 controls and finally 8 experimental and 5 controls at 2, 4, 6 and 8 weeks respectively of PEMF application no significant difference as to the quality of healing was observed between the experimental and control animals. It was thus concluded that PEMF appeared to have no beneficial effect on the healing of nonunited fractures in experimental set-up.

Site predilection of oral cancer and its correlation with chewing and smoking habit--a study of 103 cases.

Like many other countries in South East Asia, oral cancer is one of the common cancers in Bangladesh. This report is based on one hundred and three cases of biopsy proven squamous Cell Carcinoma of the oral cavity collected from different Medical Institutions in Dhaka. The aim was to find out relationship between chewing and smoking habit and anatomic site of the cancer in oral cavity. It has been observed that oral cancers are common in older age groups and the proportion is higher in males as compared to females. Buccal mucosa has been the commonest site, the next being the anterior two-thirds of tongue. A high percentage of patients revealed tobacco habits in the form of chewing with betel quid and or smoking. Both smoking and chewing were found to be important in males in all the anatomical sites and chewing of tobacco with betel quid appeared to play a dominant role in the females. Duration of betelquid chewing and smoking seem important. Site of origin of the majority of the lesions corresponded with site maximally exposed to betelquid with or without incorporation of tobacco. In majority of the cases the cancer was well differentiated.

Ewing's sarcoma of maxilla--a case report.

This paper reports the case of an adolescent girl who was admitted in the ENT ward, IPGMR in February '88 with the complaints of nasal obstruction, nasal discharge associated with progressive swelling of the right side of her face for 1 year. She had an operation at Chittagong Medical College Hospital 1 year back for some problem in the right side of the nose. No history of pain, nasal bleeding or visual disturbance were present. The nasal mass was mobile, insensitive and did not bleed on touch, but the facial swelling was red, soft and cystic. Clinically diagnosed as an Antral growth with Ethmoidal involvement. Radiologically revealed soft tissue swelling, obliteration of nasal fossa and opacification of sinuses. After surgical resection the facial mass was diagnosed as Ewing's sarcoma histopathologically. The patient needed radiotherapy but did not follow it.

Hepatitis-B virus infection in Dhaka, Bangladesh.

Three thousand six hundred and ten patients with acute hepatitis in two large hospitals in Dhaka city were tested for HBsAg. Besides, 780 commercial blood donors, 126 doctors and 576 apparently healthy persons were also tested. Passive haemagglutination technique was applied for this test. Patients with post-transfusion hepatitis and doctors with acute hepatitis showed the highest incidence, being 60% and 65.5% respectively. HBsAg was detected only in 15.4% of children and 27.2% of adult patients with acute hepatitis.

Frequency of orcein positive HBsAg in liver specimens obtained from medical college museums, medicolegal autopsies and wedge biopsies.

85 liver samples were stained with H & E and orcein. Of these 40 were from medicolegal autopsies, 30 from preserved specimens of medical college museums and 15 wedge biopsies. Three of the five cirrhotic museum specimens showed HBsAg by orcein. The remaining cases including three cirrhosis and two HCC were negative for HBsAg. HBsAg was found to be more frequently associated with cirrhosis. The autopsy samples were histologically normal and HBsAg was not seen. Old museum specimens did not loose their orcein positivity despite preservation in formalin for a long time.

Evaluation of buccal smear as an indicator of nutritional status.

One hundred and forty eight healthy and 152 undernourished children with varying degrees of severity were studied to see if their buccal smear correlated with undernourishment. The frankly undernourished children had retrograde changes more often than the other children. But the proportion of children showing no retrograde changes was similar in the different groups. It was concluded that buccal smear is not a dependable indicator of under nutrition.

Abnormalities of early conceptus: a morphological study of 500 cases.

Although MR and PT are post-conception family planning measures, a large number of women were found to be non-pregnant. In the absence of direct evidence, presence of necrosis in the placental tissue in 20.8% cases is regarded as suggestive of abnormal ova which might have ended in abortion.

A clinicopathologic study on patients suffering from "chronic dysentery".

Fifty adult patients with the self diagnosis of "chronic dysentery" were studied. Their faeces were examined microscopically; they were sigmoidoscoped and their rectal mucosa were examined histologically. Most of them had irritable bowel syndrome. Their sigmoidoscopic appearances were normal and the histology showed only mild increase in the numbers of round cells in the lamina propria. This was regarded as normal for the local population. Ten patients showed cysts of Entamoeba histolytica in the faeces. This was thought to be unrelated to the symptoms. Only four patients had sigmoidoscopic as well as histologic evidence of moderate to severe proctocolitis. One of them was proven to be a case of amoebic colitis. These findings have been discussed.