Endoscopic Orientation of Juxta-pituitary Carotid in Transsphenoidal Approaches: Critical Considerations for Clinical Applications

Abstract Introduction In sphenoid sinuses with ill-defined carotid bony landmarks, accidental injury of the internal carotid artery (ICA) remains one of the most challenging complications, which is particularly reported in the endoscopic endonasal transsphenoidal approaches (EETAs). Objectives To describe an anatomical model for the endoscopic orientation of the juxta-pituitary segment of the ICA in relation to the lateral opticocarotid recess (OCR) as a nearby bony landmark. Methods Dissection was performed progressively, simulating the EETA, in twenty fresh adult cadavers. After reducing the posterior and lateral walls of the sphenoid sinuses, various measurements were taken from both lateral OCRs to "contact points" on the juxta-pituitary segment of the ICA and lateral margins of the pituitary gland. Results The current results have enabled us to divide the region between the lateral OCRs into 3 compartments: 2 lateral parasellar compartments contain juxta-pituitary segments of the ICA with a mean width of 8 mm and a narrow range from 7 mm to 10 mm; and a central intercarotid sellar compartment represents the safe region for bone drilling, showing widely variable widths ranging from 9 mm to 20 mm. In all specimens, the variation in the width of the intercarotid compartment correlated with the distance between both lateral OCRs. Conclusion The present study improves surgeon awareness of the variations in the course of the ICA through the EETA along sphenoid sinuses with ill-defined bony landmarks. An appreciation of the measurements taken in the present study can help in operative training, and can also provide a base for future studies to confirm ICA courses associated with a higher risk of injury.

Effect of Incorporation of Corn Bran, Dried Carrot Pomace and Dried Tomato Pomace on Quality Attributes of Chicken Nuggets

A study was conducted to improve dietary fibre content of chicken nuggets by incorporating corn bran (CB), dried carrot pomace (DCP) and dried tomato pomace (DTP) as dietary fibre sources. Lean meat was replaced with each dietary fibre source at 3%, 6% and 9% level. One product from each fibre source was selected on the basis of sensory evaluation. Sensory acceptability of 3% fibre treated nuggets was comparable with control and further increase in fibre level resulted in a decline in sensory acceptability. All CB and DCP treated nuggets were harder and firmer than control while 3% DTP treated nuggets were harder than control. Fibre addition resulted in less springier and less cohesive nuggets. Yellowness increased in DCP added nuggets while both redness and yellowness increased in DTP added nuggets. Fibre treated nuggets had less moisture and cholesterol content and higher protein, ash, crude fibre, emulsion stability and cooking yield. pH of DCP and DTP treated nuggets was lower than control. Drastic increase in total dietary fibre and insoluble dietary fibre content was observed in treated nuggets. Sensory scores of nuggets declined significantly while thiobarbituric acid reacting substance value (TBARS) and microbial counts increased significantly during refrigerated storage. It is concluded that incorporation of dietary fibre at 6% level resulted in healthier and fibre enriched nuggets with higher cooking yield and acceptability upto 15th day of refrigerated storage

Bilateral simultaneous endoscopic dacryocystorhinostomy: outcome and impact on the quality of life of the patients

Introduction: Bilateral simultaneous endoscopic dacryocystorhinostomy (endo-DCR) has received little attention in the literature, thus many surgeons continue to address bilateral nasolacrimal duct obstruction at two stages, rather than in the same setting. Objective: To evaluate the feasibility and the outcome of simultaneous bilateral Endo- DCR and its impact on the quality of life of the patients. Methods: We have conducted a retrospective analysis of patients who underwent bilateral simultaneous endo-DCR between March 2013 and February 2017 at our tertiary care institution. The reviewed data included clinical presentation; operative details; success rate; pre and postoperative evaluation of the symptoms of the patients, using the Nasolacrimal Duct Obstruction Symptom Score Questionnaire; satisfaction of the patients, and improvement in the quality of life, assessed by the Glasgow Benefit Inventory (GBI) questionnaire. Results: Out of 128 cases in which endo-DCRs were performed, 13 were bilateral (26 sides). Postoperative success was documented in 24 of the 26 sides (92.3%), with a mean follow-up duration of 16.2 months. The two failed sides were reported in the same case. The preoperative symptom score ranged between 12 and 80 (mean ± standard deviation [SD]: 38.23 ± 15.7). The postoperative symptom score was significantly lower (mean ± SD: 5.4 ± 12.9). The success rates in unilateral and bilateral cases were comparable, with no statistically significant difference. A notable improvement in the quality of life of the patients was also reported, with a mean GBI score of 81.38 ± 12.37. Conclusion: Our results support that a simultaneous bilateral endo-DCR is a safe procedure that offers a high success rate, spares the patient from the stress of a second surgery, provides the patient with a bilateral resolution of the symptoms, and confers an immediate improvement in the quality of life of the patients (AU)

Precipitating factors, clinical features and outcome of diabetic ketoacidosis in children and adolescents admitted in a tertiary care hospital in Dhaka.

Background Information: Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (DM). It is an acute complication of type 1 DM. Objective: This study was designed to identify the precipitating factors, clinical features and immediate outcomes of DKA in children and adolescents. Method: This was a retrospective study which was done in the department of Pediatrics, BIRDEM, from January 2002 to April 2007. Data were collected from the hospital record for all diabetic children below 18 years admitted with DKA. Result: Fourty nine children and adolescents were admitted with DKA. Sixty one percent were known cases and the remaining (39%) were new DM. Majority were female (63%). Most (49%) of the children were between 11- 15 years. Infection was the commonest (49%) precipitating factor followed by insulin omission (24%). Major clinical features were kussmaul breathing (94%) and dehydration (94%).Eighty eight percent patients improved after treatment and mortality was 12%. Conclusion: Infection was the commonest precipitating factor of DKA. Kussmaul breathing and dehydration were the commonest clinical features. Most of the patients improved after treatment.

Nonsyndromic Aplasia Cutis Congenita: a Case Report.

Nonsyndromic aplasia cutis congenita is a condition in which babies are born with localized areas of missing skin. These areas resemble ulcers or open wounds, although they are sometimes already healed at birth. Lesions most commonly occur on the top of the head (skull vertex). In some cases, the bone and other tissues under the skin defect are also underdeveloped. If the baby is born by cesarean section, then the patient's attendants recognize the wound as an injury which might be performed by the surgeon at the time of cesarean section. We are reporting this type of a case whose father attempted to take legal procedure against the surgeon, but finally he understood that this was a congenital disease of his baby.

Methamphetamine (YABA) Abuse: A Case Study in Young Male.

Methamphetamine dependence is a serious worldwide public health problem with major medical, psychiatric, socioeconomic & legal consequences. Various neuronal mechanisms implicated in methamphetamine dependence have been suggested. Drugs of abuse are of two types: natural drugs and synthetic psychotropic substances. The former includes opium, cocaine and cannabis. The latter includes pethidine, barbiturates, tranquillizers, amphetamines. There has been increasing incidence of addiction to certain drugs amongst young people in our country. Our patient is a student of private university of 24 year old male with a history of YABA addiction for 4 years. Without having it he can't do anything. If he cannot take it, peevish temperament occurs. He collects drugs from the local spots or particular person. This condition is very much dangerous to the individual and socio-economic condition of country.

Knowledge And Awareness About The Risk Of HIV/AIDS Among Truck Drivers Of A Selected Area.

This cross- sectional study was conducted among the truck drivers at Daulatdia Ghat, Goalanda, Rajbari district. The objective of this study was to find out the knowledge and awareness about the risk of HIV/AIDS transmission among the truck drivers .Out of 226 respondents, 37.3% were within the age group 25 to 35 years. Most of the respondents (74%) were married and 44% were educated up to primary level. Half of the respondents (50%) had monthly income from taka 10,000 to taka 15,000 per month. From this study, it was found that 97% respondents had heard the name of HIV/AIDS, 61.8% had known about HIV/AIDS from media and newspaper. In respect of the route of HIV transmission, 39.8% of respondents thought that HIV is transmitted by sexual activities and 58.7% thought the disease is transmitted by syringe, transfusion. About 47.8% respondents thought that HIV can be detected from blood and 76% knew the fate of HIV/AIDS is death. Majority (82.5%) of the respondents obtained correct knowledge about HIV/AIDS transmission and 13.2% of them knew the place where test of HIV can be done.

Status And Utilization Of Maternal Health Care Services In A Selected Rural Area Of Bangladesh.

Improvement of maternal health care services is regarded as an important component for achieving targets of MDGs by the year 2015. A cross-sectional community based study was carried out to find out the status and utilization of maternal health care services in Pangsa Upazilla of Rajbari District among 517 mothers who had at least one child up to 1 year of age. The study was conducted from June to August in the year 2008. Data were collected through face-to-face interview using purposive sampling technique. Most of the respondents were in the age group of 20-29 years (69.05%) and 35.01% of them had received primary education. Sixty seven percent of them had average monthly income of Taka 3001-5000. Eighty percent of the respondents were at the age group of 15-19 years when they got married. Most of the mothers (71.57%) got antenatal care during their last pregnancy and more than 80% of them had completed their TT vaccination schedule during pregnancy period. More than 80% of the deliveries were taken place at home. Eighty five percent of the deliveries were normal delivery and most of them (77.76%) were attended by the untrained traditional birth attendants (TBA). Hemorrhage was found to be the highest reported obstetric complication (37.50%). This study offered a picture of the maternal health care services in rural Bangladesh and detected the need for future work in this area.

Holmium YAG laser treatment of superficial bladder carcinoma.

Holmium YAG laser is one of the new modalities of treatment of urinary bladder tumor. Thirty patients of superficial bladder carcinoma were selected from the Urology out patient department of Dhaka Medical College Hospital from January 2004 to July 2004. Among thirty cases, 18 were recurrent and 12 were primary superficial bladder carcinoma. Out of thirty patients, 24 were male and six were female. Patients were treated with Holmium YAG laser under spinal anesthesia. Before resection, cold cup biopsy were taken from the apex and after resection of the tumor, another cold cup biopsy were taken from the base of the tumor. Holmium YAG laser therapy was given with a 550 micron end firing quartz laser fiber through the working element of resectoscope. Small tumors (< 1 cm) were ablated and large tumors (1-4 cm) were resected. The initial laser setting was 0.5 to 0.8 J and 10 Hz. For resection of the tumor, a slightly higher energy of 1 to 1.2 J was used at 10 to 12 Hz. After resection, bleeding vessels were coagulated. The resected tumor was evacuated by Elik's evacuator. All cases were followed for 6 to 12 months by history, physical examination, urine analysis, sonogram and cystoscopy three monthly. Bleeding was minimum during the procedure and no transfusion was required. Complications like obturator jerk, clot retention or perforation were not developed. No recurrence was found during the 6 to 12 months follow up period. The procedure was found safe, effective, and acceptable. The study was conducted to evaluate the initial result of Holmium YAG laser for the treatment of superficial bladder carcinoma. We warrants further studies in this regard.

A prospective study of prenatal and postnatal development of thymus of Deshi chicken.

Thymus was one of the primary lymphoid organs along with the bursa in birds. The growth of the thymus of deshi chicken (Gallus Domesticus) from prenatal embryonic day fifteen (ED15) to postnatal day ninety (D90) were studied. In macroscopic study, it was found as a paired, lobulated gland, one half of which was located on either side of the neck. Each half consists of six to eight, flattened, ovoid to elongated, pale white to yellowish white lobes of varing size and shape of lymphoid tissue lying in the sub-dermal connective tissue of the neck. Histologically, the thymus of deshi chicken at embryonic day fifteen was covered by a very thin connective tissue capsule from which septa arises and divides the gland into lobes and lobules. The lobules were homogenous, small in size and the cortex and medulla were demarcated. Lobules have developing Hassall's corpuscles and they were of uniform shape and size. The lobules become well developed with advancing age. The cortex gradually becomes thicker and was packed with large lymphocytes. Hassall's corpuscles became larger and there number increases at postnatal period (D90) in the medulla of the thymus. The growth and development of thymus at each stage of the study period were found to be significantly high. The present finding of thymus of deshi chicken was found similar to the adult hybrid chicken. The study also indicates that the chicken thymic cell population, structure & functions was similar to the human thymus histologically. It was also found that the chicken embryo allows easy experimental access to all the stages of the thymic development so the present study will be helpful for experimentation on lymphoid organs and to understand pathophysiology of immunological diseases of human.

Effects of age in the structure of the bursa of Fabricius of deshi chicken of Bangladesh.

The bursa of Fabricius of deshi chicken from prenatal ED15 to postnatal D90 were studied. The growth and development at each stage of the study period were highly significant.

Pernicious anaemia with subacute combined degeneration of cord in a Bangladeshi male.

Pernicious anaemia (PA) has previously not been reported from Bangladesh. A case is described which had the typical clinical features of PA with subacute combined degeneration of the cord and polyneuropathy. The patient had typical macroovalocytosis, megaloblastic bone marrow and Schilling test result in the range of PA. Vitamin B12 level in the serum was markedly reduced. There was rapid clinical and haematological response to vitamin B12 therapy.