Pediatric idiopathic macular hole � A case report and review of literature

Macular hole in the pediatric age group is usually post-traumatic unlike, the adult counterpart. Herein we describe a case of idiopathic macular hole occurring in a 9-year-old male who presented to us with complaints of diminution of vision in OD (oculus dextrus) for 2 months. The child underwent 25-gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. On follow-up his best-corrected visual acuity improved with type 1 closure of macular hole.

Primary epithelial splenic cyst: A rare encounter

Splenic cysts are rare with an overall incidence of 0.07% in a large autopsy series and 0.5% among all the splenectomies done. The parasitic splenic cysts, usually caused by Echinococcus granulosus, account for 60% of all primary splenic cysts. The primary epithelial cysts account for 10% of all splenic cysts. We report a case of 30-year-old female presenting with left upper abdominal pain and heaviness. Computed tomography revealed a multiloculated cyst in spleen. Hydatid serology was negative. Total splenectomy was done. Histopathological evaluation was done and a diagnosis of primary epithelial splenic cyst was given.

Treatment Results Of Carboplatin Based Concurrent Chemoradiation For Locally Advanced Cervical Carcinoma

Background: Carcinoma of cervix is the most common malignancy of women at our center and the majority of cases present locally advanced stages. The aim of this study was to assess the efficacy and toxicity of carboplatin based concurrent chemoradiation in patients with locally advanced cervical carcinoma. Methods: Fifty seven locally advanced cervical cancer patients were enrolled in this study and fifty eligible patients were received weekly carboplatin at dose of area under curve 2, along with radical radiotherapy. The total dose of 50 Gy in 25 fractions over a period of 5 weeks was given during external beam radiotherapy and 19.5 Gy (6.5 Gy per fraction/week) was given during high dose rate achytherapy. Results: After two months of completion of treatment the complete response rate was observed in 37(74%) patients, with 11 (22%) patients had partial response and 02 (04%) patients had stable disease or no response to treatment. The hematological toxicities with grade III were observed in 06(12%) patients and grade IV observed in 02(04%) patients. Conclusion: Despite initial promising results with acceptable toxicities, further large randomized study is needed to judge the efficacy of carboplatin along with radical radiotherapy in cervical cancer patients.

Detection of Coronary Artery Diseases: Comparative Study of Multidetector Computed Tomography Angiogram (64 slice scanner) and Conventional Angiogram.

Methods: It was cross sectional comparative study conducted in National Institute of Cardiovascular Diseases and Bangabandhu Sheikh Mujib Medical University. Total 80 patients were included in the study who underwent MDCT and coronary angiogram. Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy or efficacy for single vessel disease were 87.5%, 96.4%, 91.3%, 94.7% and 93.75% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy or efficacy for double vessel disease were 84.0%, 94.5%, 87.5%, 92.85% and 91.25% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy or efficacy for triple vessel disease were 69.5%, 91.22%, 76.19%, 88.13% and 85.0% respectively. Conclusion: Coronary angiography is a promising technology that already appears to have high performance to assess patient base, vessel base and segment base sensitivity, specificity, positive predictive value, negative predictive value and accuracy in detecting coronary artery stenosis.

Cardiac Drugs Requirement during Off-Pump Coronary Artery Bypass (OPCAB) Surgery- A Comparison between Combined High Thoracic Epidural Anaesthesia (HTEA) with GA and GA Alone.

Background : During off pump coronary artery bypass surgery (OPCAB) to provide adequate myocardial protection cardiac anaesthesiologist frequently needs to use various pharmacological intervention rather than physiological manipulation. This is challenging to overcome the adverse effects of the various drugs. During the past few years, high thoracic epidural anaesthesia (HTEA) as an adjunct to general anaesthesia has become more popular and has been shown to be potentially beneficial in patients with coronary diseases. It provides good protection from stress response, ensures hemodynamic stability, improves distribution of coronary blood flow and reduce demand for oxygen and perioperative arrhythmia. Objective : This study has been undertaken with a view to compare the requirement of intraoperative cardiac drugs between HTEA with General Anaesthesia(GA) and GA alone. Methods: Prospective, randomized case control study was undertaken in sixty patients, without having left main coronary disease, left ventreicular ejection fraction <35% or contraindication of regional anaesthesia scheduled for OPCAB. They were divided into two groups, thirty in each group. Group A patients received GA alone and group B patients received high thoracic epidural anaesthesia with GA. Requirement of drugs (antiarrhythmic, inotropes, vasoconstrictor, vasodilators,Esmolol e.g.) during operation were recorded. Results: Dopamine was needed in 27(90.0%)patients in group A and 11(36.7%) patients in group B, adrenaline was used in 15(50.0%)patients in group A and 4(13.3%) in group B; Dobutamine was used only in 5(15.0%) patients in group A and ephedrine was required only in 2(5.0%) in group B. Regarding the Antiarrhythmic drugs, Lignocanie, Amiodarone and DC Shock was required only in 17(55.0%), 12(40.0%) and 5(15.0%) patients respectively only in group A. In vasodilators group, Nitropruside was used in 5(15.0%) and 1(3.3%) patients in group A and group B respectively. Esmolol was used in 17(55.0%) patients in group A and 1(3.3%) in group B. Significant (p<0.05) difference were found in use of all drugs between two groups except Ephedrine and Nitropruside . Conclusion: The anaesthetic technique HTEA with GA required minimum intra operative cardiac drugs than GA only.