Evaluation the Anesthesia Techniques for Reduction of Intraoperative and Postoperative Complications and Post-Operative Morbidity and Mortality Of Stroke Patients in ICU

Objective: In this study our main objective is to evaluateanesthesia techniques for reductions in intraoperative andpostoperative complications and post-operative morbidity andmortality of stroke patients in ICU.Method: This Retrospective study was carried out at theDepartment of Surgery, tertiary care hospital, Dhaka from June2017 to June 2018 where 120 patients who underwent differenttypes of surgery were randomized to receive thoracic epiduralanalgesia along with general anaesthesia in Group-A (60patients) and only GA in Group-B (60 patients) were includedthe study.Results: During the study, most of the patients belong to 41-50years age group for both Group A (47.78%) and group B(43.34%). Most of the patients in group A faced cardiac surgeryand in group most of the patients faced neurologic surgerybefore stroke. Also, 89% of Group-A patients stay in ICU for39-4 hours whereas Group B it was 11%.Conclusion: From our results; we can say that, TEA incombination with general anesthesia for surgery iscomparatively safe rather than general anesthesia whichreduces stroke development in patients. Further study isneeded for better outcome.

Management of Inferior Vena Cava Injury in a Non Specialized Tertiary Hospital-a Case Report.

Abdominal vascular injury are among the most challenging and lethal injuries in the traumatized patients. Inferior vena cava (IVC) is the most frequently injured vein during the blunt or penetrating trauma. Ligation of IVC, venorrhaphy, venoplasty, end to end anastomosis, endovascular stenting or graft interposition should be considered in selected cases. However most of the procedures require special setting and surgical team. Relatively simple procedure e.g. venorrhaphy produces narrowing of lumen in many cases. Ligation of IVC may result in thrombosis and embolism thus increases morbidity of patients. Here, in the present case the authors report a patient with IVC injury repaired by venoplasty (cavaplasty) with great saphenous vein patch in a non specialized tertiary hospital and it can be performed by a team led by general surgeon.

Comparative Study between Slow Shock Wave Lithotripsy and Fast Shock Wave Lithotripsy in the Management of Renal Stone.

Background: Renal calculi are frequent causes of ureteric colic. Extracorporeal shock wave lithotripsy is the most common treatment of these stones. It uses focused sound waves to break up stones externally. Objective: To compare the efficiency of slow and fast delivery rate of shock waves on stone fragmentation and treatment outcome in patients with renal calculi. Materials and Methods: This prospective study was done in the department of Urology, National Institute of Kidney diseases and Urology, Sher-e-Bangla Nagar, Dhaka from July 2006 to June 2007. Total 90 patients were treated using the Storz Medical Modulith ® SLX lithotripter. Patients were divided into Group A, Group B and Group C – each group having 30 subjects. Group A was selected for extracorporeal shockwave lithotripsy (ESWL) by 60 shock waves per minute, Group B by 90 shock waves per minute and Group C by 120 shock waves per minute. Results: Complete clearance of stone was observed in 24 patients in Group A and 13 patients in both Group B and Group C in first session. In Group A only 3 patients needed second session but in Group B and Group C, 12 and 8 patients needed second session. In Group A only one patient needed third session but third session was required for 3 patients in Group B and 5 patients in Group C for complete clearance of stone. In Group A, subsequent sessions were performed under spinal anesthesia and in Group B under sedation and analgesia (p>0.001). Mean number of sessions for full clearance of stones in group A was 1.37 ± 0.85, in Group B was 1.8 ± 0.887 and in Group C was 2.0 ± 1.083. Significant difference was observed in term of sessions among groups (p>0.05). In first follow-up, complete clearance of stones was seen in 24 patients in Group A and 13 in both Group B and Group C. In second follow-up, 3 patients in Group A, 12 in Group B and 8 in Group C showed complete clearance of stones. It was observed that rate of stone clearance was higher in Group A than in Group B and Group C. Multiple logistic regression analyses revealed that slow delivery rate (60 SW/min) as well as age (younger), symptom (painful) at onset, stone location (upper and middle calyx) and size (small) were independent prognostic factors determining stone clearance after ESWL of renal stone. Conclusion: Slow rate shock wave delivery improves efficacy of ESWL treatments of renal stone and decreased number of sessions, shock waves and treatment time.

Negative PressureWound Therapy (NPWT) in open wound management: A study of 16 Cases in Orthopaedic Department of Faridpur Medical College Hospital.

Wound management is a major concern in open fracture cases. Negative Pressure Wound Therapy (NPWT) is an advanced method for managing open wounds. It is a topical treatment using sub-atmospheric pressure to increase blood flow, remove bacteria and increase growth of granulation tissue in the wound. The study was performed to evaluate the results of NPWT in patients with open fracture in lower extremity. Using Aquarium pump as an NPWT device, 16 patients were prospectly treated for open fractures in their inferior extremity. Mean patients' age range was 21 to 60 yrs. The patients under study either had suffered from trauma, fall or had post operative wound infection. Many of them had wounds with underlying tendon or bone exposure. Necrotic tissues were debrided before applying NPWT. Dressings were changed every 3rd or 4th day and treatments were continued for 07 to 28 days. Exposed tendons and bones were successfully covered with healthy granulation tissue in all cases, depth of the wounds reduced as well as surface areas. In 12 cases coverage of granulation tissue were achieved and further managed by skin grafting, 4 cases with wound infections were closed with secondary suture. No significant complications were noted regarding the treatment. NPWT was found to facilitate the rapid formation of healthy granulation tissue on open wounds in lower extremity and thus to shorten healing time and minimize secondary soft tissue defect coverage procedures.

Giant Juvenile Fibroadenoma of the Breast: Report of 2 Cases.

Giant fibroadenomas are benign tumors, but their rapid growth and large size together with their rarity may determine difficulties in the clinical approach. The authors present 2 cases of giant juvenile fibroadenoma of the breast in girls aged 14 and 16 years, and the respective diagnostic workup and conservative surgical treatment. The diagnosis was made on fine needle aspiration cytology which was confirmed on histopathology. These tumours are almost always benign and should be treated with breast conserving surgery.

Stapled Haemorrhoidopexy Compared with Conventional Haemorrhoidectomy--A Systematic Review.

Haemorrhoids are one of the most common anorectal disorders. Conventional haemorrhoidectomy (CH) is the most commonly practiced surgical technique. Stapled haemorrhoidopexy (SH) [procedure for prolapsed haemorrhoids (PPH)] is newly developed method for the surgical management of Haemorrhoids. This review looks at the surgical management of prolapsed haemorrhoids in light of this recent development and suggests a treatment approach based on this current evidence. A Medline, Pubmed and Cochrane data base search was performed using key words "haemorrhoid" or 'hemorrhoid' and staple. Relevant papers e.g. randomized controlled trials, review and metaanalyses from different parts of the world were collected. Data were analyzed and compiled. Though early small RCTs (stapled haemorrhoidopexy comparing with traditional excisional surgery) have shown stapled haemorrhoidopexy is less painful and it is associated with quicker recovery but recent large meta-analyses and long term follow up have shown SH is associated with a higher long term risk of haemorrhoid recurrence and symptoms of prolapse.

Rate of Conversion and Postoperative Complications of Laparoscopic Cholecystectomy in District Level Hospital of Bangladesh..

Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of gallbladder disease, but conversion to open cholecystectomy and postoperative complications are still inevitable in certain cases. Knowledge of the rate and underlying reasons for conversion and postoperative complications could help surgeons during preoperative assessment and improve the informed consent of patients. We decide to review the rate and causes of conversion and postoperative complications of our LC series. This study included 760 consecutive laparoscopic cholecystectomies from July 2006 to June 2011 at Faridpur Central Hospital and Faridpur Medical College Hospital. All patients had surgery performed by same surgeon. Conversion to open cholecystectomy required in 19 (2.5%) patients. The most common reasons for conversion were severe adhesions at calot's triangle (6, 0.83%) and acutely inflamed gallbladder (5, 0.66%). The incidence of postoperative complications was 1.58%. The most common complication was wound infection, which was seen in 5 (0.66%) patients followed by biliary leakage in 3 (0.40%) patients. Delayed complications seen in our series is port site incisional hernia (2, 0.26%). LC is the preferred method even in difficult cases. Our study emphasizes that although the rate of conversion to open surgery and complication rate are low in experienced hands, the surgeons should keep a low threshold for conversion to open surgery and it should not be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon.

Low-dose β-carotene Supplementation and Deworming Improve Serum Vitamin A and β-carotene Concentrations in Preschool Children of Bangladesh.

Despite the national vitamin A and antihelminthic prophylaxis programmes, both intestinal geohelminths and subclinical vitamin A deficiency continue to be prevalent among children in developing countries. Studies on potential synergistic effects of vitamin A supplementation and deworming on retinol status have inconsistent results. The purpose of the present study was to investigate the impacts of low-dose β-carotene supplementation and antihelminthic therapy on serum retinol and β-carotene concentrations in preschool children of Bangladesh. Two hundred and forty-four children, known to be infected with Ascaris lumbricoides, were randomized into four treatment groups: I-IV. Group I and II received two oral doses of 400 mg of albendazole each, the first dose at baseline and the second dose after four months; Group III and IV received placebo in place of albendazole. In addition, Group I and III received 1.2 mg of β-carotene powder in capsule daily for six months, and Group II and IV received placebo in place of β-carotene. Serum retinol and β-carotene levels were measured before and after six months of the interventions. Serum retinol and β-carotene increased significantly in Group I where both antihelminthic therapy and daily β-carotene supplementation were given (p<0.05 and p<0.001 respectively). Antihelminthic therapy alone only improved serum β-carotene concentration (p<0.0001). Low-dose β-carotene supplementation, along with an antihelminthic therapy, synergistically improved vitamin A status. This finding has public-health implications for improving vitamin A status of children in developing countries.

Intestinal transport of water, sodium & glucose from an electrolyte solution with & without bicarbonate.

In this study we have evaluated the role of bicarbonate on water and sodium transport in normal and secreting ilea of rabbits as controversy exists regarding the inclusion of bicarbonate in oral rehydration solution (ORS). In anaesthetized rabbits 10 cm closed ileal loops were constructed and filled with 5 ml of an electrolyte solution with and without bicarbonate, which contained polyethylene glycol (PEG; mol wt 4,000) as a non-absorbable marker. The fluid was withdrawn after an hour and analyzed for PEG, sodium and glucose. Similar studies were carried out in loops one hour after exposure to 1 microgram/ml of purified cholera toxin. Body temperature was maintained at 37 degrees C during the experiment by using a lamp. The mean +/- SE of water and sodium absorption, with bicarbonate versus without bicarbonate, was -1.4 +/- 0.1 vs -1.1 +/- 0.3 ml/h/10 cm, and -340.8 +/- 23.0 vs -308.4 +/- 35.6 mM/h/10 cm, respectively from secreting rabbit ilea. A similar effect was observed in normal ilea. It is concluded that bicarbonate containing electrolyte solution has no additional promoting effect on water and sodium absorption in normal or secreting ilea of rabbits.

Octreotide (SMS 201-995) as an antisecretory agent in cholera toxin & bile acid induced intestinal secretion in an in vivo animal study.

The effect of Octreotide (SMS 201-995), synthetic somatostatin analogue on small intestinal and colonic fluid secretion induced respectively by cholera toxin (CT) and deoxycholic acid (DCA) was investigated in rabbits using in vivo isolated loops. After exposure to CT and DCA, marked fluid accumulation was observed in the small intestinal and colonic loops, along with elevation of jejunal and colonic mucosal cyclic AMP concentrations. Octreotide inhibited CT and DCA induced small intestinal and colonic secretion, dose-dependently. This anti-secretory effect was observed after both intramuscular and oral administration of octreotide. In contrast, octreotide did not affect the elevated mucosal cyclic AMP concentrations. These results suggest that octreotide inhibits CT and DCA induced intestinal secretion, and this anti-secretory effect is produced by affecting processes beyond cyclic AMP formation.

Study of makeshift hospital during cholera outbreak.

This is a report on the study of utilization pattern of a makeshift hospital during a major cholera outbreak, by analyzing data on dehydration status, distance covered, number of deaths averted, and operation-wise comparison with other permanent facilities. To avoid unnecessary deaths due to dehydration and to ensure prompt and adequate care to suddenly accumulated debilitated patients, the makeshift hospital intervened. Subsequent to the intervention, a gradual reduction in patient admissions and cholera case accumulations was noted. Nearly half the cholera cases attending the makeshift hospital came from relatively far (13 + miles). The reporting of the majority (72%) of cholera patients with none-to-mild dehydration indicates an increased awareness of the need for early treatment during a cholera outbreak. Early attendance of diarrhoeal patients probably saved more patients by preventing shock and complications. Para-professionals given a short training accomplished similar efficacy as in a permanent facility. Nearer the affected areas, a simple but effective temporary facility is more effective than a sophisticated facility which is further away and takes several hours to reach, with risk to patients.