Idiopathic Normal Pressure Hydrocephalus: Surgical Outcome of Endoscopic Third Ventriculostomy Comparing VP Shunt

Background:Normal-pressure hydrocephalus (NPH) affects the older people and the presentations aregait disturbance, incontinenceand dementia. The reason is still unknown and there is increased CSF volume causing pressure to the periventricular brain causing the symptoms where there is no evidence of absorption failure or obstruction of the CSF pathway. Aims: The main objective of this study is to compare the surgical outcome of endoscopic third ventriculostomy (ETV) and VP shunt (VPS) in NPH.Methodology: Atotal of 24 patients were included in the study where 12 patients underwent ETV and 12 patients VPS. Patients having a definite cause of hydrocephalus and multipleco-morbid diseases were excluded from the study. Various Scoring systems were studied to see the efficiency of ETV. Results:About 60% of patients were successfully recovered. 40% needed to revision surgery either VP shunt or LP shunt. Some scales showed higher effieciency of ETV.Conclusion: ETV in NPH is a safe and effective procedure. Whether the CSF absorption is hampered at arachnoid granulation is doubtful for failure cases. ETV is a short procedure with a good success rate in selected patients

Medicinal Properties Of Different Parts Of Acacia Nilotica Linn (BABUL), Its Phytoconstituents And Diverse Pharmacological Activities

Acacia nilotica Linn commonly known as Babul is a multipurpose tree. As the world is turning back towards the herbal drug, it is the need of the hour to re-evaluate the knowledge of traditional medicine through vast review. In the Unani traditional system of medicine, all parts of the plant have been used as a remedy for various diseases and are imputed for their medicinal properties. Hence, this review presents an overview of the medicinal properties of different parts of A. nilotica L. used in Unani medicine, its phytochemical constituents, and diverse pharmacological activities. The information related to this drug was retrieved using the classical Unani sources viz., Al-Qanun fi’l Tibb (Canon of Medicine), Iksir-i-A‘zam, Al Hawi fi’l Tibb (Continens Liber), Tarjuma Kamil al-Sana‘a al-Tibbiyya, Dhakhira Khawarizm Shahi, Biyaz-i-Kabir and Tibb-i-Akbar for medicinal properties used in Unani Medicine. Further for other traditional uses, phytoconstituents and pharmacological activities, different search engines like PubMed, Medline, Google Scholar, Ovid, Science Direct and Scopus were also browsed. A. nilotica possesses various medicinal properties as per classical Unani texts such as astringent, tonic, wound healing, aphrodisiac, expectorant, resolvent, and antispasmodic. In vivo, in vitro, and clinical studies from the published articles validate the fact that A. nilotica is a potential source of various bioactive compounds having various pharmacological properties and therapeutic uses. The various pharmacological activities are anti-inflammatory, analgesic, antibacterial, anticancerous, antidiabetic and antihypertensive properties. This review concludes that the Unani medicinal effects of A. nilotica are proven by scientific studies.

IL-17 assay in adult T-cell leukemia/lymphoma patients with dermatophytosis

Assess IL-17 level as proinflamtory cytokine and predictor for the outcome of inflammatory process in ATLL patients with dermatophytosis. Isolation and identification of different types of dermatophytes infecting patients with ATLL. 58 subjects were included in this study [16 adult patients with adult T-cell leukemia / lymphomaclinically diagnosed to have dermatophytosis, 14 adult patients with adult T-cell leukemia / lymphoma clinically diagnosed to have no dermatophytosis, 12 age and sex matched patients clinically diagnosed to have dermatophytosis and 16 Age and sex matched apparently healthy Controls]. Sampleswere examined microscopically using 20% KOH and cultured on into SDA containing chloramphenicol [0.5%] with/without cycloheximide [0.5%] and Dermatophyte test medium [DTM]. in the non-ATLL patients with dermatophytosis, the serum IL-17 level was significantly increased compared with the healthy controls. In ATLL patients either with or without dermatophytosis, the IL-17 levels were significantly lower than those in the healthy controls. There was no significant difference in the IL-17 level between ATLL patients with dermatophytosis and those without dermatophytosis. Again, it is suggested that ATLL patients have low levels of IL-17, which cannot be enhanced by the presence of dermatophytosis. Among patients with ATLL with dermatophytosis [Group I] T. rubrum was the commonest dermatophyte causing infection; 64% of samples [tineacorporis 46%, tineaunguium 18%], whereas T. mentagrophytes was the 2[nd] commonest dermatophyte; 27% [tineaunguium 27%], lastly T. tonsurans; 9% [tineacorporis 9%]. In patients with Non-ATLL with dermatophytosis [Group III] T. rubrum was also the commonest dermatophyte causing infection; 64% of samples [tineacorporis 7%, tineaunguium 14%, tineapedis 43%], whereas T. mentagrophytes was the 2nd commonest dermatophyte; 29% [tineaunguium 7%, tineapedis 22%], lastly T. tonsurans; 7% [tineacorporis 7%]. Our data provides clinical evidence linking Th17 cells to immune deficiency in ATLL and opens a new avenue in the study of tumor immunotherapy based on promoting Th17 cell population

Off Pump CABG along with Resection of Giant Thymoma : A Case Report.

Coronary artery disease is the most common form of heart disease and the single most important cause of premature death world-wide. Thymomas are anterior mediastinal neoplasms, characterized by epithelial cells and lymphocytes. Although they are often encapsulated and well differentiated tumors, they can show local invasion, pleural invasion or extrathoracic metastasis. In this article, we report the case of a rare patient who underwent thymectomy along with off-pump coronary artery bypass graft surgery.

Abundance of Road Traffic Accidents among Medicolegal Postmortem Cases..

This retrospective study was conducted at the Dhaka Medical College (DMC) morgue during the period of Jan 2008 to Dec 2008. The objective of this study was to find out the abundance of Road Traffic Accidents (RTA) cases among medicolegal post mortem examinations performed at DMC morgue and in this relation to evaluate the present situation of RTA in our country. It has been observed that RTA cases are the most common cases among various types of medicolegal post mortems. A total of 2714 postmortems were conducted during the study period and out of which 813 (29.95%) cases were of RTA, among the victims 545 (67.03%) were male and 268 (32.96%) were female. Highest incidence (30.38 %) of RTA was observed among the age group 21 to 30 yrs. Most accidents occurred at daytime 282 (34.68%), followed by night 233 (28.66%). Greater number of accidents occurred during September 90 (11.07%), followed by January 85 (10.45%) and December 83 (10.20%). Commonest victims were pedestrians 564 (69.37%). Most accidents took place on highways 650 (79.95%) and buses were the most dangerous vehicle causing highest number of accidents 307 (37.76%), followed by truck 141 (17.34%). Among the cases 100% victims had multiple abrasion and bruise, laceration were present in 654 (80.44%), and intra cranial injury 527 (64.82 %).

Malignant hemangiopericytoma in the gluteal region: a rare entity.

We present here a case of malignant hemangiopericytoma in a 40-year-old female who presented with a history of slowly growing mass in left gluteal region for about 1.5 years. She was evaluated and a mass of 10 x 7.5 x 5.5 cm 3 was found on computed tomography. The tumor was resected and was sent for histopathological evaluation. Grossly the tumor was encapsulated and on cut section it was nodular. Microscopy showed spindle cells forming cords and sheets separated by thin delicate stroma consisting largely of thin-walled vessels revealed by reticulin stain. Pleomorphism and mitotic figures were seen. It was diagnosed as a case of malignant hemangiopericytoma of gluteal region. The patient underwent radiotherapy and did apparently well. She is on regular follow-up because long-term follow-up is essential in all cases as recurrence can occur several years after treatment.

Leiomyoma of scrotum.

Leiomyoma is a benign tumor of smooth muscles. Leiomyoma originating from the scrotum is a rare entity. We report here a case of 50-year-old male who presented with a 4-cm lump in the left side of scrotum. Clinically, it was provisionally diagnosed as sebaceous cyst and was excised. The histopathology showed findings consistent with leiomyoma. There was no cytological atypia or mitosis. The final diagnosis of solitary leiomyoma of scrotum was given. The patient was followed up regularly and is doing fine for last 4 months.

Clinico-pathological study in large posterior fossa midline tumors.

This cross sectional analytic study was carried out among the admitted patients of the department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka during the period of 1st July 2002 to 31st December 2004. The age ranged from 2.5 years to 70 years. The size of all posterior fossa tumors at presentation were more than 3 cm and the mean size of posterior fossa tumor was 4.38 cm. 62% of posterior fossa mid-line tumors were mixed density in NECT (non-contrast CT).Regarding enhancement characteristics, mild-moderate enhancement and marked heterogeneous enhancement was equally distributed 46% followed by marked homogeneous enhancement only 08%.. The calcification was present only in 07 (14%) patients and most of them were ependymoma. Histopathologically, medulloblastoma was the common variety (32%). The CT scan diagnostic modality sensitivity, accuracy and positive predictive value were 100%, 84.78% and 84.78% respectively but in MRI diagnostic modality 100%, 91.30% and 91.30% respectively.

Neurovascular injury after anterior cruciate ligament reconstruction: a case report and review of the literature

Injury to the popliteal artery and tibial nerve following harvesting of the medial hamstring tendons is a complication that has not been described. We report a unique case of popliteal artery and tibial nerve injury following hamstring graft harvest for the use in ACL reconstruction. The popliteal artery and tibial nerve anatomy and technique of graft harvest are briefly described

Mitral stenosis in a girl of five years.

Mitral stenosis(MS) detected below the age of 20 years is called juvenile mitral stenosis (JMS). JMS constitute 25-40 % of all cases of isolated mitral stenosis, though overall incidence of rheumatic fever and rheumatic heart disease (RHD) within mixed population is 7.5- 7.8 per thousand. The patient was 5 years old girl hailing from Modhupur, Tangail got herself admitted into CCU Mymensingh Medical College Hospital with the complaints of low grade fever, shortness of breath and also associated with failure to thrive. She was ill looking, mildly anaemic. Precordial examination revealed apex beat was in the left 5th intercostals space, tapping in nature, palpable P(2). There was left parasternal heave. 1st heart sound loud, pulmonary component of the 2nd heart sound was accentuated, opening snap with mid diastolic murmur with pre systolic accentuation. Routine blood examination reveals leucocytosis with raised ESR. C-reactive protein (CRP) and ASO titre were significantly raised. X-ray chest P/A view showing the features of mitral stenosis. Echocardiography showing MS (moderate) with pulmonary hypertension. She was treated with antibiotics and other relevant drugs and discharge with an advice for follow up and take preparation for cardiac intervention.

Neurophysiology in clinical practice.

Clinical neurophysiology is concerned with the recording of generation and propagation of electrical potentials of nerve and muscle cells. It can provide important information about brain and neuromuscular disorders. Electro encephalogram (EEG), Evoked potentials (EP), Nerve conduction study (NCS) and electromyogram (EMG) are the four main techniques used in clinical neurophysiology. EEG reflects the electrical activity arising from the cerebral cortex. Evoked Potentials are measurements of classic stimulus response. VEP, SSEP and BSAEP are most useful in diagnosing Multiple Sclerosis, Plexus lesions and 8(th) cranial nerve tumor, CP angle tumor respectively. Nerve conduction studies are the measurement of velocity of nerve impulse. It gives information about the lesion of a myelinated nerve. Electromyogram gives information about the integrity of innervations, condition of neuromuscular junctions and also condition of the muscle fiber itself.

Studies on clinical pattern of glomerulonephritis.

A prospective study of primary glomerulonephritis covering two and half years period was done at Dhaka Medical College Hospital & IPGMR, Dhaka from June 90 to July 92. A total of 100 cases were included in this study. All of the patients were of 13 years and above, clinically diagnosed, and by laboratory investigations, the diagnoses were established. In this study, we have tried to find out age incidence, sex ratio, possible aetiological factors, common clinical presentation, biochemical parameters and histological typing of primary glomerulonephritis.

Scorpion sting syndrome in a general hospital in Saudi Arabia.

To evaluate the incidence of scorpion stings and to draw the attention of clinicians, concerning the dilemma of scorpion sting syndrome and its management in the Kingdom of Saudi Arabia [KSA]. In a retrospective survey, 251 cases were presenteds with scorpion stings to the Emergency Department of the Armed Forces Hospital, Riyadh, KSA during a period of 15 years [April 1986 to April 2000]. Their ages ranged from 2 months to 101 years [male to female ratio was 2.6:1] and 70.6% of the cases were under 20 years of age. The mean annual incidence of the scorpion sting in the month of May was 16.7%, with the highest mean percentage of approximately 36% each year. The seasonal sting cycle showed the highest record was in the summer period [51%] as compared to the lowest winter period [10%]. Local pain was the primary presenting complaint [95%], with a total systemic toxicity of 78.3% and 35.2% of these were children. Hypertension, sweating, salivation and tachycardia were the most common signs of systemic symptoms. The majority of patients received analgesia, local anesthetics, and application of ice and a period of observation dictated by clinical findings. Eighty-two patients [32.6%] had signs of serious envenoming, requiring admission. There were no deaths. All of these cases were mainly treated symptomatically. The beneficial effect of antivenom in protecting victims against scorpion stings is still questionable. The higher risk groups of systemic toxicity were either those with ages less than 10 years or greater than 50 years, being more susceptible due to their decreased physiologic reserves and increased debilitation

Hairy cell leukaemia with advanced treatment - a case report.

A case of hairy cell leukaemia (HCL), a rare leukaemia, is reported here. The patient was presented with high grade continuous fever with left upper abdominal discomfort for 6 days. He was moderately anaemic, had no peripheral lymphadenopathy with mild hepatosplenomegaly. He was anaemic (Hb-7.8 gm/dl), total leukocyte count was 20 x 109/L. Peripheral blood film showed lymphocytosis (92%) with neutropenia (8%) and absolute neutophil count (ANC) was 1 x 109/L. On review, 88% of the peripheral cells had peripheral hairy projections resembling hairy cell (HC). Bone marrow examination was consistent with HCL (morrow hairy cell = 52%) including marker studies. Tartrate resistant acid phosphatase test (TRAP) was also positive. He had opportunistic mycobecterial infection giving a positive bronchial lavage for acid fast bacilli. After controlling the infection he was advised a single dose chemotherapy of 2-chlorodeoxyadenosine (2-CDA). After that he was in partial remission and after 25 months clinical and pathological relapses occurred and a second dose of 2-CDA was given and the patient went into complete remission.

A case report on Wilson's disease.

A case of Wilson's disease, a rare autosomal recessive disorder of copper metabolism is reported here. The patient was presented with the difficulty in speech and writing for 4 years and also on walking for 1 year. He also noticed difficulty to perform any work by hands for 6 months. He had splenomegaly and bilateral gynaecomastia. His speech was low volume slurred and monotonous, muscle tone was mildly increased, and gait was limping. Slit lamp examination of eye revealed bilateral Kayser-Fleischer ring with normal visual acuity. Investigations revealed low serum albumin(26 gram/L), increased alanine trans-aminase ( A.L.T=57 U/L). Ultrasonogram of hepatobiliary system revealed coarse hepatic tissue echotexture with splenomegaly. Liver scan showed slightly nonuniform radiotracer distribution in the liver, there was slight increased bony uptake. Serum caeruloplasmin level was 11.51 mg/dl. 24 hours urinary copper excretion was 150 microgram per day. Liver biopsy revealed cirrhotic change. Now he was advised for taking copper chelating agent (penicillamine) in a dose of 1 gram/day.

A case of acromegaly.

A fifty years old woman hailing from Purbadhala of Netrokona district complaining of gradual enlargement of hands, feet, nose and other acral parts of the body for about last eight years. She noticed coarsening of the skin and gradual protrusion of her lower jaw. She complained of headache, vertigo, frequent passage of urine, increased thirst, weight loss and fatiguability. She was found hypertensive having blood pressure 200/110 mm of Hg. Her appearance was coarse with rough skin. There were enlargement of hands, feet, nose, lower jaw with prognathism and enlargement of other acral parts. Investigations revealed high plasma glucose level, both fasting and 2 hrs. after glucose, high level of growth hormone, failure of suppression of growth hormone during OGTT. Thyroid function tests of the patient were found normal with increased heel pad size and enlarged sella turcica in all diameters. She was diagnosed as a case of acromegaly due to growth hormone hypersecretion.

Risk factors & clinical presentations--a study of eighty-five hospital admitted stroke cases.

Stroke is the commonest neurological cause of morbidity and mortality. Changes in risk factors may influence stroke incidence. Definitive diagnosis of the type of stroke is necessary for management and it has a strong impact on stroke outcome. A total of eighty-five consecutive stroke patients irrespective of age and sex admitted during the period of August 2000 to June 2001 were studied. They were asked about occupation, area of habitat, smoking habit, family history of ischaemic heart disease and/or stroke, any febrile illness, recent history of productive cough, dysuria and diarrhoea. They were searched for hypertension, diabetes mellitus, ischaemic heart disease, valvular heart disease and dislipidaemia. In every patient complete blood count, urine examination, fasting blood glucose and serum lipids, ECG, x-ray chest were performed. CT scan of brain was performed in 68 cases. Male was found 81.18% of cases with age 62.54 +/- 13.08 (m +/- SD) years. Female were 18.82% of cases with age 58.81 +/- 12.77 (m +/- SD). 75.29% of patients were belongs to middle class family. 51.76% of patients came from rural area and 48.24% of patients came from urban area. 78.82% of patients were hypertensive. Infection was associated with 37.65% of cases. Hemiplegia was commonest presentation (88.24%). Though altered consciousness was found more in haemorrhagic stroke (54.84%) but it was not significantly. High from ischaemic cases (p > 0.10) Male suffer more from stroke. Hypertension is the commonest risk factor. Infection is a common association of stroke. Altered consciousness is not a reliable guide to differentiate between ischaemic and haemorrhagic stroke is hospitalized cases.

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.

Comparative studies on IFAT, ELISA & DAT for serodiagnosis of visceral leishmaniasis in Bangladesh.

The purpose of the study was to estimate the specificity and sensitivity of different serological methods for the diagnosis of visceral leishmaniasis in Bangladesh. Blood samples from 155 suspected kala-azar patients together with 80 sick subjects and 50 healthy subjects from the endemic areas were collected. Out of the 155 suspected kala-azar patients, bone marrow were collected from 126 patients. All bone marrow samples were examined by direct microscopy. 92 bone marrow samples were also examined by culture method. Blood samples were examined by various serological tests. Out of 126 marrow samples, LD bodies were present by microscopy in 77 (61.1%) cases and out of 92 marrow samples, cultures for LD bodies were positive in 33 (35.9%) cases. All the three serological tests (IFAT, ELISA & DAT) were positive in all parasitologically positive kala-azar patients. They were also positive in seven (15.5%) out of 45 parasitologically negative cases and 10 (34.4%) out of remaining 29 cases in whom bone marrow samples were not available. Thus the serological tests proved to be simple, non-invasive, highly sensitive and specific methods for the diagnosis of visceral leishmaniasis. DAT is the simplest of these serological tests, although these tests did not differ in sensitivity and specificity.

Isolation and characterization of Helicobacter pylori strains from peptic ulcer patients in Dhaka, Bangladesh.

To study the association of Helicobacter pylori with peptic ulcer and the associated histopathological changes, to characterize the isolated strains in terms of their protein profile, 83 peptic ulcer cases were studied. A high association of H pylori with peptic ulcer (duodenal ulcer 77%, gastric ulcer 75%) and gastritis (74%) was observed. Age and smoking did not have any relationship with H pylori infection. The infection was predominantly associated with the 'quiescent' form of chronic gastritis. Comparative sodium dodecyl sulfate polyacrylamide gel electrophoresis of whole cell extracts of the local isolates and a reference strain from Australia showed a general homogeneity between the strains with obvious interstrain differences. However, the difference between the local isolates and the reference strain was more marked. Significant association of H. pylori with peptic ulcer along with strain variations were observed.