Improvement of Liver Function, Quality of Life and Survival after Insertion of Endoprosthesis in Advance Malignant Biliary Obstruction.

Obstructive jaundice due to advance malignancy is a fatal problem. It most commonly occurs at the distal common bile duct or at the hilum of liver. Magnetic Resonance Cholangio Pancreatography (MRCP) and Computed Tomography (CT) are most useful in identifying the underlying cause as well as localize the position of the stricture. For those patients with unresectable disease, progressive jaundice constitutes an immediate threat to their survival, in addition to significant loss to their quality of life secondary to pruritus, malaise and cholangitis. Effective and lasting decompression of the biliary tree is a priority and consists of positioning of a biliary endoprosthesis (stent). To observe the improvement of liver function, quality of life and survival after successful insertion of endoprosthesis (stenting) in malignant biliary obstruction, a study was performed in the department of surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2013 to August 2014, in 50 patients with clinically visible jaundice and unresectable disease. There were significant (p<0.001) reductions in the levels of serum bilirubin, serum alkaline phosphatase, serum SGPT and Prothrombin time from the time of admission to 2 weeks and 3 weeks after stenting. Physical and functional quality of life was greatly improved 2-4 weeks after stenting, where emotional quality remained the same throughout the study period. Successful palliation by stenting of malignant biliary obstruction is a priority to achieve improvements in liver function, quality of life and prolong survival. Endoscopic stent placement appears to be safe, well tolerated and can be offered without delay as a primary treatment option for all patients with unresectable malignant biliary lesion.

Ethical issues in surgical intervention in medical college hospitals.

The aim of this study was to investigate the ethical issues of the patients selected for surgical interventions. A total of 105 patients were selected consecutively on the basis of defined criteria at the Department of Surgery and the Department of Gynecology & Obstetrics of Sir Salimullah Medical College Mitford Hospital, Dhaka from March 2007 to November 2007. Results showed that 76.19% of the patients were found to be literate and 23.81% were illiterate. In profession, 53.34% of the patients were found to be involved in household works, 16.19% were service holders, 12.38% were businessmen, 9.52% were cultivators, 5.71% were students and the rest were day laborers. Nearly 60.0% of the patients had no monthly income. Most of the patients were adults of age ranges from 16-70 years. Results about ethical issues showed that 52.38% of the patients had no knowledge about surgical treatment of their diseases prior to operation, 26.67% had poor knowledge and 20.95% had sufficient knowledge. Adequate counseling earlier to surgical intervention were ensured for 11.43% (n=12) patients only. Rest of the patients (88.57%) was not experienced counseling before operation. Nearly 81.0% of the patients did not understand about their treatment by surgical intervention. About 94.0% of the patients and their close relatives had no knowledge about informed consent and its importance as well as procedure of obtains but they sign it just before operation. Around 91.0% of the informed consents were not taken in presence of any witness. In postoperative counseling, 88.57% of the patients had not counseled. Nearly 66.0% of the patients did not satisfy about their treatment. In conclusion, truth-telling through counseling and informed consent were not found to be exercised properly in most of the patients undergoing surgical interventions in medical college hospitals.