Role of Peptic Ulcer Perforation (PULP) score to Predict the Outcome in Patients with Perforated Peptic Ulcer

Background: Peptic ulcer disease is a global burden of disease associated with potentially life-threatening complications, including bleeding, perforation and obstruction. Perforated peptic ulcer (PPU) is a frequent emergency condition worldwide with associated morbidity and mortality. Variations in the clinical presentation, as well as delay in diagnosis and work-up at admission to the hospital, may potentially cause a worsening of symptoms and a deterioration of the clinical condition, with a detrimental outcome. Therefore, accurate and early identification of high-risk surgical patients with perforated peptic ulcers (PPUs) is important for triage and risk stratification. Currently, the ASA score and the Boey score are the most frequently used prognostic scoring systems in patients with PPU. Yet, the ASA score is a general surgical risk score not intended for PPU patients in particular. Moreover, the external validation of the Boey score is uncertain. PULP score appears to have the greatest predictability of the outcome of perforated PUD. Aim of the study: The objective of the study was to evaluate the role of the PULP score in the prediction of outcomes in patients with a perforated ulcer.Material & Methods:It is an observational cross-sectional study, carried out in the Department of Surgery, Dhaka Medical College Hospital, Dhaka. Ethical approval was obtained from the Dhaka Medical College ethical review board. Patients aged 18 to 60 years admitted to the emergency department with a clinical diagnosis of perforated peptic ulcer disease, confirmed by different investigation modalities, e.g, imaging, sonography, laboratory test, etc were enrolled in the study. The data regarding sociodemographic, clinical, biochemical, radiological and surgical profiles were recorded. The operation was done by upper midline incision under general anesthesia. A modified Graham’s patch technique was used to repair the duodenal ulcer. Postoperative follow up was conducted meticulously. Patient outcome was assessed during their hospital stay and then OPD follow-up or by telephone interviews up to 30 days after the intervention. All the information is recorded in the data collection sheet. All collected questionnaires were checked very carefully to identify the error in the data. Data processing work consisted of registration schedules, editing computerization, preparation of dummy tables, and analyzing and matching data. Data was processed and analysed with the help of the computer program SPSS and Microsoft excel. Quantitative data are expressed as mean and standard deviation and qualitative data as frequency and percentage. The comparison was done by tabulation and graphical presentation in the form of tables, pie charts, graphs, bar diagrams, histograms &charts etc.Results:Present study demonstrates that the maximum number of patients (43.0%) was between 51-60 years of age group, mean age of the patient was 49.35 ± 11.7 years. The male and female ratio was 3.54:1. Maximum (57%) patients came from urban, (36%) rural and (7%) urban non-slum areas. In this study, the most common signs were tachycardia (100%), abdominal tenderness (100%), abdominal rigidity (100%), absence of vowel sound (86.2%), and obliteration of liver dullness (78.7%), dehydration (67.5%). The time lapse between the onset of symptoms and admission to the hospital varied from 4 hours to 4 days. Most of the patients (76.0%) were admitted after 24 hours. In this study, PULP score was assessed according to the operational definition of optimal cut-off point 7, below this considered as low-risk patients. in this study 85% were 0-7 PULP scores and 15% were PULP scores 8-18. Patients’ condition after proper treatment, symptoms, degree of abnormalities or dependence on the daily physiological activity and the clinical outcome had evaluated and measured by follow up and close monitoring. The study shows that 69.0% of the patients recovered completely, but 24.0% of patients had developed complications. The mortality rate in this study was 7.0%. Finally, a correlation of the PULP score with mortality of perforated PUD was carried out. Among the 7 expired cases the, PULP score was correlated with 6 cases like high risk. In 93 cases of recovered, the PULP score was predicted in 84 cases as low risk. So the effectiveness of PULP has proven significant in the prediction of mortality in perforated PUD patients. The Sensitivity and Specificity of the Peptic Ulcer Perforation (PULP) score was 85.7% and 90.3% respectively. Similarly, the positive predictive value and accuracy rate for the same was 40.0% and 90.0% respectively.Conclusion: Patients with perforated peptic ulcer (PPU) often present with acute, severe illness that carries a high risk for morbidity and mortality. Several prognostic scoring systems have been suggested to identify high-risk surgical patients with perforated peptic ulcers accurately and early. The present study demonstrates that the PULP score can be used to predict 30-day mortality accurately in patients operated for PPU. The prognostic predictors included in the PULP score can be readily identified prior to surgery. The PULP score can assist in the accurate and early identification of high-risk patients with PPU.

Pattern of Tumor Lysis Syndrome in Patients with Acute Lymphoblastic Leukemia

Background: Prevention and treatment of tumor lysis syndrome (TLS) depends on immediate recognition of patients at risk. Therefore, we conducted this study to determine the frequency and risk factors of TLS in patients with acute lymphoblastic leukemia (ALL). Objective: The aim of the study was to observe the frequency of Tumor lysis syndrome in patients with Acute Lymphoblastic Leukemia.Material & Methods:This cross-sectional study was conducted at the department of Haematology in Bangabandhu Sheikh Mujib Medical University (BSMMU), over a period of 12 months following approval of this protocol. Total 50 patients admitted with ALL were included in this study after careful history taking, examination and appropriate investigations fulfilling inclusion and exclusion criteria, irrespective of their gender, race, ethnic group and age. Ethical issues were ensured properly. After briefing the aims and objectives and potential risk and benefits, written informed consent was taken from each subject. Interviews were done by investigator herself using separate case record form. After editing and encoding, data was analyzed by computer with the help of SPSS 24.Results:The mean age of patients was 21.24�.83 (SD) years with majority aged less than 20 years (54%) and male gender (62%). Prevalence of TLS was found to be 26% (n=13), wherein spontaneous onset (n=8, 61.54%) and lab TLS (n=9, 69.23%) was more frequent than therapy induced TLS (n=5, 38.46%) and clinical TLS (n=4, 30.77%). The most common biochemical changes occurred within 3 days before chemotherapy and 7 days after initiation of chemotherapy among TLS patients was hyperuricemia (69.23 and 76.92% respectively) and hyperkalaemia (61.54 and 69.23% respectively) with significant differences compared to non-TLS patients (p value <0.05). Initial WBC count and serum LDH of all patients was 52.51�.70 x109/L and 1591.53�95.47 U/L respectively, wherein majority patients with TLS had significantly higher WBC count ?50 x109/L (61.54%) and serum LDH ?1000 U/L (92.31%) compared to non-TLS patients (16.22 and 21.62% respectively, p value <0.05). Multivariate analysis showed that serum LDH ?1000 U/L was the significant independent predictors of developing TLS (OR=13.07, 95% CI: 1.93-101.23).Conclusions:TLS was commonly found in patients with ALL, wherein spontaneous onset and lab TLS was more common than therapy induced TLS and clinical TLS. However, a large multicenter study is needed to corroborate these findings.

Is depression a concern among medical students: a cross sectional study in different academic years of a private medical college in Bangladesh

Background: Depression is not uncommon among medical students all over the world. Few studies have been conducted so far in Bangladesh to depict its actual prevalence and severity. So, the aim of this study was to assess the severity of depression and the level of difficulty faced by medical students in different academic years.Methods: This cross-sectional study was conducted in North East medical college of Bangladesh from January 2018 to June 2018 involving 443 students from 1st year to 5th year. Students were instructed to fill up the patient health questionnaire (PHQ-9) which incorporates diagnostic and statistical manual of mental disorders (DSM-IV) depression diagnostic criteria categorized as no, mild, moderate, moderately severe, and severe depression and also evaluates their level of function.Results: The prevalence of depression was quite high (79.68%). 196 (44.24%) and 157 (35.44%) students had mild and major depression respectively, while 90 (20.32%) showed no depression. Students with major depression were scored as moderate depression 24.38%, moderately severe depression 8.35%, and severe depression 2.71%. Moderate depression was significantly higher in year 1 and year 2 students in comparison to year 3, 4 and 5. Students from year 1 to year 5 with mild, moderate, moderately severe and severe depression experienced varying degree of difficulty in their daily activities. Almost all the students in all years with severe depression found themselves very difficult or extremely difficult to cope.Conclusions: High prevalence of depression among medical students is really alarming and underlying factors need to be addressed.

Analgesic and antihyperglycemic activity evaluation of Bambusa vulgaris aerial parts.

Bambusa vulgaris, also known as ‘Ora Bansh’ in Bangladesh is grown throughout the country for housing and scaffolding purposes. As part of our analgesic and antihyperglycemic plants of Bangladesh screening program, it was of interest to evaluate the analgesic and antihyperglycemic potential of aerial parts of the plant. Methanolic extract of aerial parts (MEBV) at doses of 50, 100, 200 and 400 mg per kg significantly reduced the number of writhings in acetic acid-induced pain model Swiss albino mice by 25.9, 29.6, 37.0, and 44.4%, respectively compared to reductions of 40.7 and 51.9%, respectively, obtained with 200 and 400 mg per kg of a standard analgesic drug, aspirin. MEBV, at doses of 100, 200 and 400 mg per kg also significantly lowered blood glucose levels in mice, respectively, by 32.8, 45.8, and 55.3% compared to control mice. A standard antihyperglycemic drug, glibenclamide, when administered at a dose of 10 mg per kg lowered blood glucose level by 50.8%. Taken together, the results indicate that the aerial parts of the plant possess considerable analgesic and antihyperglycemic potential, which can possibly be attributed to the presence of alkaloids and saponins in the extract.

Association Between Vasoactive-Inotropic Score and Mortality in Pediatric Septic Shock.

Objective: To assess the association between Vasoactive Inotrope Score (VIS) and mortality in children with fluid-refractory septic shock. Methods: A retrospective chart review of 71 children (age 1 mo-16y) admitted with fluid-refractory septic shock in pediatric intensive care unit during a two year period was done. We divided our cohort into two groups viz Highvasoactive inotrope score (Group-H) and ‘Low-vasoactive inotrope score’ (Group-L) based on a cut-off value of 20. Results: 73% of the children were in Group-L. The mortality rate was 44% and 100% in Group L and Group H, respectively. Conclusion: High inotropic score in children with septic shock is associated with high mortality rate.

Clinical Profile of Hypertrophic Cardiomyopathy in a Tertiary Level Hospital.

Background- Hypertrophic cardiomyopathy (HCM) is a genetically transmitted disease with diverse natural history for which the potential to produce adverse consequences has been emphasized. However, the possibility of this disease remaining clinically dormant for many years has not been as widely appreciated. Certainly, the clinical recognition of previously undiagnosed patients with HCM may be advantageous by permitting risk stratification for sudden cardiac death or for timely pharmacologic therapy when symptoms intervene. The purpose of this study was to assess the disease pattern and the extent to which hypertrophic cardiomyopathy (HCM) exists undetected in a suspected group of population never diagnosed to have any cardiovascular disease, referred from the primary care facilities to one of the largest tertiary level hospital of Bangladesh. Methods-We prospectively conducted an echocardiographic survey in 3648 cases between 19-03-2009 to 03-08-2010 (18 months) in the cardiac centre of Combined Military Hospital, Dhaka, Bangladesh. Results- A total of 3648 cases referred by primary care physicians underwent echocardiogram either to confirm a new diagnosis or to exclude obvious cardiovascular abnormalities. Hypertrophic cardiomyopathy was identified in 148 patients (4.06%) who was not known have any cardiac disease before. At diagnosis, age ranged from 20 to 83 years (mean 52.19) with male gender preponderance (85.81%). Ninety eight patients (67%) had no functional limitation and the remaining fifty patients reported with symptoms mostly giving multiple responses like chest pain (39.2%), palpitation (18.9%), dyspnoea (22.3%), unusual fatigability (16.9%) and syncope (6.8%). Twelve patients had strong suspicion of familial predisposition depending on the symptomatology of the familial tree but were confirmed only in 03 cases by echocardiography. Basal left ventricular outflow obstruction (gradients 20 to 76 mm Hg) was evident in 14 patients (9.45%). Relatively variable phenotypic expression of the disease was substantiated by diffuse thickening of left ventricular wall occurring more commonly than localized distributed hypertrophy (56.08% vs. 43.94%, respectively). Electrocardiogram was abnormal in almost 95% of cases and typical pattern of left ventricular hypertrophy was observed in 25.68% cases. Conclusion -This prospectively assembled data show that HCM cases may remain asymptomatic, clinically dormant and undetectable for many years (often to advance ages) in our community. The actual prevalence of the disease in our community needs to be ascertained which might exceed the prevalence mentioned in the text books.

Coil Occlusion of Coronary Cameral Fistula: A Case Report.

Congenital coronary artery fistula is a rare anomaly that can cause several types of morbidity and mortality. Interventional occlusion of coronary artery fistula has become a well-accepted alternative to surgical therapy. A coronary cameral fistula originating from right coronary artery (RCA) and draining to right atrium (RA) was occluded with a detachable coil in a two years old girl in catheterization laboratory of Combined Military Hospital (CMH) Dhaka. This is the first ever case of coil occlusion of coronary cameral fistula in Bangladesh, which led to the writing of this report.

Acute Coronary Syndrome in the Young - Risk Factors and Angiographic Pattern.

Coronary artery disease (CAD) is a worldwide health epidemic. Acute coronary syndrome is a potentially life-threatening condition and patient may die or become disabled in the prime of life. There is documented evidence that South Asian people develop CAD at a higher rate and also at an early age. If the affected individual is 40 yrs old or below, the tragic consequences are catastrophic. Methods: It was a retrospective observational study to find out the pattern of acute coronary syndrome in the young (40 years old or less) in a military hospital (CMH Dhaka) from July 2007 to July 2008 and to analyze the risk factors and the angiographic characteristics of coronary vessels. Consecutive 64 young patients including both male and female admitted into this hospital were the study subjects. Out of these patients 53 were males and 11 were females. Among these patients coronary risk factors and angiographic pattern were studied. 64 older patients with Acute coronary syndrome (age more than 40 years) were also studied. Results: Out of 64 young patients 15.6% patients presented to this hospital as UA, 9.37% presented as Non-Q MI, 28.12% Acute Anterior MI, 14.06% Acute Anteroseptal MI, 26.56% Acute Inferior MI, 6.25% Acute Infero-posterior MI. Smoking was the most common risk factor among these young patients. 64.06 % patients were smoker. Dyslipidaemia was present among 50 % patients, 37.55 % were hypertensive, 15.62% were diabetic, and 15.62 % were obese. SVCAD was the most common lesion and it was 53.12 %. 26.56% patients had DVCAD and TVCAD was present among 20.31 % patients. In the older group (more than 40 years) most common risk factor was dyslipidaemia (71.88%) and smoking was present among 48.43% patients. Conclusion: Young patients have a different risk factor profile in comparison with older patients. Smoking is a strong and quite common coronary risk factor in the young ACS patients who are 40 years or less. Risk factor identification and control is very crucial in the primary and secondary prevention in young patients with CAD.

Prevalence of asymptomatic bacteriuria and its consequences in pregnancy in a rural community of Bangladesh.

This was a cross-sectional followed by cohort type of study conducted among the pregnant mothers of second trimester in the rural areas of Rajshahi district. Initially 1800 pregnant mothers ofsecond trimester were selected from 18 unions applying 2-stage random sampling. A total of 216 pregnant mothers with asymptomatic bacteriuria were paired among the rest of the healthy pregnant mothers (without bacteriuria) on the basis of age, gravida and economic status for cohort study to relate asymptomatic bacteriuria with the incidence of symptomatic bacteriuria, hypertensive disorders in pregnancy (HDP) and pre-term delivery. The matched paired pregnant mothers werefollowed monthly interval up to delivery. The prevalence of asymptomatic bacteriuria was 12% among the pregnant mothers in rural Rajshahi. E. Coli was the commonest causative agent of both asymptomatic and symptomatic bacteriuria. The results of this study suggest that asymptomatic bacteriuria were more prone to develop symptomatic bacteriuria, hypertensive disorders in pregnancy and pre-term delivery than that of the healthy mothers (without bacteriuria). Screening of bacteriuria in pregnancy and proper treatment must be considered as an essential part of antenatal care in this rural community.

Massive recurrent hemorrhage due to duodenal diverticulum--role of tattooing and suture plication.

We report a 79-year-old lady with massive recurrent GI bleeding from a duodenal diverticulum arising at the mesenteric border. We used tattooing during endoscopy as a method for identifying the bleeding source at surgery. The diverticulum was treated with suture plication.

Aetiology of diarrhoea in a birth cohort of children aged 0-2 year(s) in rural Mirzapur, Bangladesh.

The incidence of aetiology-specific diarrhoea and the pathogenicity of infectious agents in a birth cohort (n=252) in rural Bangladesh were determined. Stool specimens or rectal swabs were collected from diarrhoeal cases over two years and routinely on a monthly basis. Stool samples from children with diarrhoea were compared with stool samples from children without diarrhoea to calculate rates of isolation and pathogenicity of agents. In total, 1750 stool specimens from diarrhoea patients and 5679 stool specimens from children without diarrhoea were tested. An infectious agent was identified in 58% of the stool specimens from diarrhoea patients and 21.6% of the stool specimens from children without diarrhoea. The most commonly-isolated pathogens from all specimens were enterotoxigenic Escherichia coli (ETEC), enteroadherent E. coli, Shigella, Campylobacter jejuni, Giardia, and rotavirus. ETEC (ST and LT-ST toxin), enterotoxigenic Bacteroides fragilis, Shigella, and rotavirus were associated more with disease than with asymptomatic infections. Aetiology-specific infections were associated with acute episodes. The isolated enteropathogens were essentially the same as those found in other tropical rural settings. Enterotoxigenic B. fragilis was also identified as a pathogen. Ongoing vaccine efforts focusing on Shigella, rotavirus, and ETEC would be useful.

Diabetic neuropathy and zinc therapy.

This was a double blind study conducted on 60 subjects; 20 age and sex matched healthy controls (Group-I), 20 patients of diabetes mellitus with neuropathy who received placebo for 6 weeks (Group-IIA); and 20 patients of diabetes mellitus with neuropathy who were given oral 660 mg zinc sulphate for 6 weeks (Group-IIB). Serum zinc level, fasting blood sugar (FBS), blood sugar 2 hour after breakfast (2HABF) and motor nerve conduction velocity (MNCV) were estimated on day 0 and after 6 weeks in all subjects. Serum zinc levels were significantly low (p<0.001) in group II-A and II-B as compared to healthy controls (group-I) at base line. After 6 weeks the changes in pre and post therapy values of FBS, 2HABF and MNCV (median and common peroneal nerve) were highly significant (p<0.001) for group II-B alone with insignificant change (p>0.05) in group II-A. Therefore, zinc therapy helps in achieving better glycemic control and improvement in peripheral neuropathy as assessed by MNCV.

F wave latency--a frequent and early involved nerve conduction parameter in young diabetic subjects.

F-wave latency measurement is a sensitive parameter of diabetic neuropathy than the conduction velocities. This study was carried out to measure F-wave latency and to see which conduction parameters are affected frequently and early. A total number of 62 patients of which 32 newly diagnosed and 30 controls were included in the study. Ulnar motor nerve conduction velocity was found slowed in 6(18.75%) diabetic subjects, but F-wave latency was found prolonged in 16(50%) diabetic subjects. 28(87.5%) diabetic subjects had normal peroneal nerve conduction velocity but peroneal F wave was found prolonged in 17(53.12%) diabetic subjects. This result suggests that F-wave latency is more frequently & early involved conduction parameter in diabetic subjects.

Retrospective analysis of abdominal surgeries at Nepalgunj Medical College (NGMC), Nepalgunj, Nepal: 2 year's experience.

BACKGROUND: Abdominal surgeries are the commonest major operations that are performed in the department of surgery. AIM: To find out the different causes of emergency and elective abdominal surgeries at Nepalgunj Medical College Teaching Hospital (NGMCTH) Nepalgunj, Nepal. MATERIAL AND METHOD: This is a retrospective study conducted in the department of surgery at NGMCTH Nepalgunj, Nepal, over a period of 2 years (2001 to 2003). The patients included in this study were drawn from Banke, Bardiya, Kailali, Kanchanpur, Surkhet, Dang, Dailake, and Tikapur. They belong to both sexes and different age groups. All the records of these patients under went laparotomy for elective as well as emergency conditions were included in this study. The data were analyzed; tabulated and following results were obtained. RESULTS: The commonest cause of emergency laparotomies were peritonitis (peptic ulcer, enteric and appendicular perforations) whereas, the commonest cause of elective laparotomies were chronic cholecystitis with cholelithiasis followed by chronic appendicitis and pyloric obstruction. CONCLUSION: Over all, cholecystectomy for cholecystitis with cholelithiasis was the commonest operation, which was done in last two years. This disease may be because of excessive use of saturated animal fat and vegetable oil. Peritonitis was the 2nd commonest cause of abdominal surgery. Among the causes of peritonitis, peptic ulcer perforations were the frequent followed by enteric and appendicular perforations. Appendicitis was the 3rd commonest cause of abdominal surgery. Nepal, being a Hindu country, people consume excessive amount of meat, and possibly due to this, the disease of the appendix was very high as compared to other Asian countries where people live on bulk cellulose diet.

Management of dengue by the WHO guided national guidelines.

A total of 90 adult patients of Dengue admitted in Sir Salimullah Medical College and Mitford Hospital, Dhaka during the period from July 2002 to December 2002 were studied to see the presentation, spectrum of disease and outcome of management. Majority (52%) of cases was in the age group 21-30 years. Out of 90 patients 74 patients (82.22%) were male and 16 (17.78%) were female. Maximum number of cases (43%) was found in the month of August. Most of the cases (77%) were from Dhaka City. Classical type of Dengue fever was the commonest (80%) variety. Thrombocytopenia was found in 80% cases. Platelet count came down below 10000/cumm only in 1.1% of the patients. The patients were diagnosed mainly by clinical criteria. Serological tests were done only in selected cases. Majority (80%) of the patients was managed by sponging, paracetamol and Oral Rehydration Salt (ORS). Blood transfusion was required in 18% cases and platelet concentrate was given only in 1.1% cases. There was no mortality in this study.

Smoking enhances age related brain atrophy--a quantitative study with computed tomography.

This is a prospective study done on Bangladeshi people during the period from January 1999 to December 2002. Cases were collected from the department of Medicine in Sir Salimullah Medical College, Dhaka; Sher-e-Bangla Medical College, Barisal and Bangabandhu Sheikh Mujib Medical University, Dhaka. We examined the chronic effect of smoking on brain atrophy quantitatively with Computed Tomography (CT). Study was performed on 219 smokers and same numbers of non-smokers from 40 to 70 years old with neither neurological nor focal abnormality in brain CT. Brain atrophy index (BAI) which was a quantitative marker of brain atrophy reported previously, was calculated from each brain CT. Smokers showed a significant increase in BAI compared to non-smokers in groups 50-54 years (p<0.01), 55-59 years (p<0.01), 60-64 years (p<0.05) and 65-70 years (p<0.05). It was suggested that age-related brain atrophy was increased by chronic smoking through advanced atherosclerosis.

Frequency of abortion in different seasons and age groups.

During the routine histopathological examination of the specimens in the department of Pathology, Mymensingh Medical College, the investigators observed variation in the frequency of abortion in different months in comparison to other cases. This is a descriptive study and was designed to find out the frequency of abortion in comparison to other cases in different seasons and mothers' age groups. A total of 1382 specimens were examined histologically in one year period from July 2000 to June 2001, of which 130 (9.41%) were histologically diagnosed as abortion i.e. retained products of conception (RPOC). The frequency of abortion cases was highest in May (18.98%) followed by June (17.31%). The frequency of abortion was lowest in September (1.69%). Abortion cases were significantly associated with relatively hot season (March-August) than that of cold season (September to February; p < 0.01). The frequency of abortion was found to be highest in age group of 26 to 30 years. Management facilities of abortion should be readily available during the high frequency of abortion i.e. relatively hot season especially April, May and July, to reduce maternal mortality from complications of abortion.

Single dose intravenous regional antibiotic in clean orthopaedic procedures.

Patients undergoing clean orthopaedic operations with tourniquet in Orthopaedic Department of a tertiary level hospital in Dhaka during August 1999 to March 2002 were consecutively enrolled in a prospective clinical study to explore the efficacy and safety of regional prophylaxis with single dose antibiotic. Eighty two patients with 83 operations received 750-mg cefuroxime in 40 & 20 ml of distilled water, into a dorsal vein of the foot or hand respectively to be operated on immediately after the tourniquet was inflated. Patients with bilateral operation, regional administration of cefuroxime were also repeated for the operation on the other extremity. Follow up ranged from 3 weeks to 2 years & 7 months. None of the patients experienced local or systemic adverse effects following regional administration of cefuroxime. Also none developed early infection (superficial or deep) during the follow-up period. Infective complications at distant sites like UTI were observed in one case with bilateral corrective osteotomy for knocked knee deformity. It was probably due to catheterization in the immediate post-operative period, which was rapidly cured following antibiotic treatment and removal of catheter. Regional administration of single dose antibiotic appears to be a safe and effective prophylaxis for the control of early infection in clean orthopaedic procedures. Late infection is blood borne and that can not be controlled by prophylactic use of antibiotic.

Extrapulmonary tuberculosis in surgical specimens.

Tuberculosis is a very common lesion in surgical specimen in our country. This study was designed to explore the distribution of extrapulmonary tuberculosis (EPTB) in various organs through examination of surgical specimens. A total of 103 specimens were diagnosed as tubercular lesion by histological evaluation in the department of pathology, Mymensingh Medical College and a private laboratory during the period from January 1997 to August 1998. Out of 103 cases 36 were male and 67 were female (M: F = 1:1.8) and their age ranged from 4-75 years (median age 28 years). The lesions were distributed as follows: lymphnode 86 (84.9%), intestine 9 (8.7%), bone 2 (1.9%), epididymis 2 (1.9%), fallopian tube 1 (0.97%), pharynx 1 (0.97%) tonsil 1 (0.97%) and nasal mucosa 1 (0.97%). Out of 86 cases of tubercular lymphadenitis, 61 (89.7%) were cervical, 6 (6.8%) were mesenteric and 1 (1.5%) was inguinal. Sixty nine percent clinically diagnosed cases were consistent with histological findings (18 out of 26). This study reveals, in our locality, EPTB is very common in early adulthood with female preponderance. Cervical lymph node is very common sites for EPTB.