Mammary tuberculosis is a rare entity in western countries but a continuing problem in endemic areas like Bangladesh. Its clinical patterns and treatment strategies are changing day by day. In this study we showed our clinical experience on 50 cases of mammary tuberculosis. This is a prospective nonrandomized observational descriptive study. A total of 50 consecutive adult female patients with no other co morbid diseases and who were diagnosed cytologically or histologically as case of mammary tuberculosis were enrolled in the study over a period of 04 years since 2006 to 2010 in general surgical unit of Chittagong Medical College Hospital and Chittagong general hospital. The average ages of presentation were 38 years. Ten(20%) patients were lactating at the time of presentation and six(12%) patients were nulliparious. 40(80%) patients had breast lump at presentation. Among them 20(40%) presented with multiple sinuses with lump,10(20%) had abscess with lump,05(10%) had abscess drainage scar with underlying lump and 05(10%) presented with isolated breast lump.06(12%) presented with multiple sinuses with abscess formation. Another 04(8%) patients had multiple sinuses only at presentation. Ten (20%) had constitutional symptoms in the form of fever, weight loss and night sweat. Twenty (40%) had axillary lymphaedenopathy in association with breast lesion. Diagnosis were confirmed by cytological and or histological findings of epitheloid granulomas.All patients were given antitubercular chemotherapy ( 9 months regimen) in combination with surgical intervention (45 out of 50 cases) as necessary in the form of excision of masses, incision and drainage of abscess and sinectomy. Mammary tuberculosis is a continuing problem in developing countries. Presentation may mimic benign lesion or carcinoma of the breast. Diagnosis can be made on high index of suspicion in endemic areas. Cytological or histological findings of granulomatous inflammation consisting of caseation necrosis, epitheloid cell and Langhans giant cell can give definitive diagnosis. Treatment is by anti tubercular chemotherapy with or without surgical intervention where necessary.

Summary Multiple myeloma, generally a disease of the elderly, is a complex disorder that causes a multitude of clinical symptoms and signs and therefore presents significant diagnostic challenge to the clinician specially if the age of onset is unusually early. Here we present one young patient suffering from multiple myeloma. JCMCTA 2013; 24 (1):67-69

Thrombolysis is the commonest modality of revascularization and Streptokinase is the most widely used thrombolytic agent in Bangladesh. The thrombolytic efficacy of streptokinase has been found to be low ( 50-60%) in various international studies and its efficacy in our population requires to be investigated. ST-segment resolution 90 minutes after thrombolysis is an excellent marker of successful myocardial reperfusion having good sensitivity and specificity and thus can be used as an effective tool to determine reperfusion success. This study aimed to determine the thrombolytic failure with streptokinase in acute ST elevation myocardial infarction using 90 minute ST resolution on electrocardiogram and to compare the failure rate in this study with that found in other studies. This cross sectional observational study was conducted amongst the patients admitted in the coronary care unit (CCU) at Chittagong Medical College Hospital (CMCH) during September 2011 to February 2012. An ECG was performed at admission and 90 minutes after starting streptokinase infusion. Thrombolytic failure with streptokinase was defined using electrocardiogram criteria of less than 50 percent reduction in ST elevation in the worst infarct lead after 90 minutes of streptokinase infusion. Univariate analysis was used to test association of clinical variables with study outcome. A total of 82 patients (82 percent) failed thrombolysis using streptokinase. The failures were associated with four variables in univariate analysis model including anterior location of myocardial infarct (p-value < 0.001), longer symptom onset-to-needle time (p-value is 0.02), hypertension (p-value is 0.03) and diabetes (p-value is 0.03). Failure rates were higher compared to four international trials (GUSTO-1- 46%, Chen et al76%, Lee et al-56.8%, Riffat Sultana et al-38.5%). The failure rate was higher compared to that found in some of the international studies done both in Asian and western population which could be due to higher prevalence of streptococcal infection and hence anti-streptococcal antibody in our population. This group of patients may benefit from other early reperfusion strategy like recombinant tissue plasminogen activator (tPA) or primary PCI within 1 to 2 hours. JCMCTA 2013 ; 24 (2): 30-35