A Case Report of Middle Aortic Syndrome: A Rare Vascular Disorder.

The middle aortic syndrome (MAS) is rare (about 0.5-2% of all the cases of aortic coarctation) vascular disorder characterized by severe narrowing in the descending thoracic aorta, abdominal aorta, or both. It can be congenital or acquired due to several conditions.MAS may present clinically as uncontrolled hypertension, abdominal angina or lower limb claudication. Surgical treatment is effective in controlling symptom and improves life expectancy.

Aorto-bi-Femoral Bypass for Aorto-Iliac Occlusive Disease: Recent Experience at the National Institute of Cardiovascular Diseases (NICVD).

Background & Objectives: Aorto-bi-femoral bypass is one of the most important surgical strategies in vascular surgical practice. The procedure is employed in surgical revascularization for both stenotic and aneurysmal diseases involving the aorto-iliac segment. The present study was carried out to analyze our recent experiences with this procedure for aorto-iliac occlusive diseases (AIOD) at the National Institute of Cardiovascular Diseases (NICVD). Materials and Methods: Over a period of 3 years (April 2008 to March 2011), a total of 47 patients underwent aorto-bi-femoral or aorto-bisiliac bypass grafting for AIOD using a Y-graft prosthesis. The mean age of the patients was 46.4 years (range 25-75 years). Thirty eight of the patients were male and the remaining 9 were female. A retroperitoneal approach was used in 27 patients. In the remaining 20 patients, the operation was done using a transperitoneal approach. A Gelatin-coated Dacron Y-graft prosthesis was used in 43 (5 of which were silver-coated prosthesis) patients while PTFE (Polytetrafluoroethylene) prosthesis was used in the remaining 4 patients. The operation was carried out under epidural anesthesia with sedation in most cases. Results: The operation was well-tolerated in all patients. There was no intraoperative mortality in this series. Two patients died in the immediate post-operative period- one due to myocardial infarction and the other due to acute renal shut-down leading to renal failure accounting for a mortality rate of 4.3%. Wound infection and lymphorrhoea at the groin incision site were the two main immediate post-operative complications. There was no incidence of graft infection in this series. Twelve patients were available for post-operative follow-up up to 2 years. Out of them, 5 patients returned with occluded grafts 8-23 months after the operation. Three of these patients underwent graft excision with re-do Y-graft bypass. The remaining two were treated with extra-anatomic bypass (Axillobifemoral). Conclusions: Aorto-bi-femoral bypass is an effective surgical strategy for occlusive diseases involving the abdominal aorta and the iliac arteries. The procedure is well-tolerated with a low incidence of early post-procedural complications and graft failure. However, poor adherence of the patients to follow-up remains a significant obstacle for evaluating the long-term outcome of this procedure.

PCR for mecA Gene of Methicillin Resistant Staphylococcus Aureus.

The study was under taken to detect mecA gene of methicillin resistant Staphylococcus aureus (MRSA) by PCR. It was carried out in the department of Microbiology, Mymensingh Medical College in collaboration with the Department of Medicine under the Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh between the periods from July 2006 to June 2007. A total of 40 S. aureus strains were used in this study. Isolates of S. aureus were identified by standard microbiology technique and their antimicrobial susceptibility test was done by disk diffusion method according to NCCLS. Minimum inhibitory concentration (MIC) of oxacillin was determined for all isolates by standard agar plate dilution method. All strains were tested for mecA gene by PCR. Out of 40 S. aureus strains 15(37.5%) were detected as MRSA by disk diffusion and agar dilution method but 10(25%) yielded mecA gene by PCR. Detection rate of MRSA by disk diffusion and agar dilution test showed significant difference to that by PCR (p<0.001).

Thyroid disorders in Khulna district: a community based study.

This study reports the prevalence of thyroid diseases and their relationship to autoimmunity in a population of Khulna district where goitre is not endemic. A survey was performed among citizens of a union of Khulna district. The study population consisted of a random sample of the students of primary schools, secondary schools and people of nearby areas. History taking, neck examination for goitre and blood examination for thyroid hormones was done from each subject. Blood sample was measured for thyroid hormones and thyroid microsomal antibody (TMAb) using radioimmunoassay method. Of the total 925 individual studied, 527 was female and 398 was male with age ranges from 2-62 years (mean 19.86 +/- 13.62 years). The overall occurrence of thyroid disease was estimated to be 20.43%. The spectrum of thyroid disorders showed highest incidence of diffuse goitre (7.35%), followed by sub-clinical hypothyroidism (6.59%), hypothyroidism (4.97%), hyperthyroidism (0.86%) and sub-clinical hyperthyroidism (0.65%). The incidence of thyroid disorders was observed to be highest in the 11-45 years age group (79.89%). Female outnumbered male, the ratio being 2.5:1 with preponderance of female subjects in all disease groups. The prevalence of all goitre was 10.49%. TMAb estimation was performed in 318 samples, of them 48 cases (15.09%) was found to be autoimmune thyroid disease. Of the total sub-clinical and overt hypothyroidism, the incidence of autoimmune thyroid disease was 29.29% and non-goitrous thyroid dysfunction was more common than goitrous one. Three of 38 (7.89%) euthyroid goitrous subjects showed positive antibody. Interestingly, 16 of 181 (8.84%) individual had a positive antibody, which was considered normal by neck examination. Goitre prevalence of 10.49% in this study indicates the region to be a mild iodine deficient area. Chronic autoimmune disease is likely to be one of the etiological factors for thyroid disorders in this southern zone.

Direct trocar insertion: alternative abdominal entry technique for laparoscopic surgery.

The study was designed to assess the feasibility of direct trocar technique for accessing the abdominal cavity for operative laparoscopy. A retrospective review of 1500 patients who underwent Laparoscopic cholecystectomy in Mymensingh Medical College Hospital and a private hospital between January 1999 and July 2002 was done. The transumbilical direct trocar entry method was used in 1375, the veress needle insertion technique was employed in 106 patients and open laparoscopy was used in 19 patients. Six (0.4%) Major complications occurred; 4 enterotomy and 2 omental herniation. All the enterotomy was related to primary access. Three (0.22%) during direct trocar entry method and another by open laparoscopy method. The bowel was repaired. Two patients had omental herniation through the umbilical port site related to open laparoscopy method which were repaired. Based on our experience the direct trocar technique is a safe approach to abdominal entry for laparoscopic surgery without prior pneumoperitoneum.

Brief report on Ziprasidone.

Ziprasidone is a new antipsychotic with combined dopamine and serotonin receptor antagonist activity. The initial evidence suggests an effective dosage range of 80-160 mg/day. Clinical trials suggest that the drug is an effective antipsychotic in schizophrenia and schizo-affective disorder with a beneficial effect on negative symptoms and symptoms of depression. The main adverse effects appear to be somnolence (14%) and nausea (10%). Ziprasidone has relatively fewer side effects and yet has at least equivalent efficacy for florid 'positive' symptoms compared to conventional anti psychotics. The additional serotonergic actions deliver further efficacy against 'negative' and affective symptoms of schizophrenia. Reduced effects on cognitive abilities compared to conventional anti psychotics make Ziprasidone more attractive.