Objectives: History of ascariasis is very old. One quarter of the world's population is known to be infected by ascariasis. It is endemic in various parts of Bangladesh. We aimed to study the various types of clinical presentations, complications and different diagnostic tools and to assess various options for the management of biliary ascariasis. Materials and Methods: Ninty eight cases of hepatobiliary ascariasis were studied over a period of 2 years (April 03 - April 05). All the patients were aged between 12 and 73 years and all were admitted with acute right upper abdominal pain. Ultrasound was the diagnostic tool of choice with 100% results. Results: In this study, biliary ascariasis was found to be more common in females 64.29% (64 patients). The most common presentation was upper abdominal pain in 100% of the patients (98 patients). Complications observed were obstructive jaundice in 08.16% (8 patients), cholangitis in 74.49% (73 patients). History of worm emesis was present in 21.42% (21 patients). Conservative management was successful in 96.94% (95 patients). During follow-up, worm reinvasion of the biliary system occurred in 7.1% (three patients). Conclusion: In endemic countries, biliary ascariasis should be suspected in patients with biliary disease. Most of the patients respond to conservative management. Keywords: Acute upper abdominal pain; biliary ascariasis; Ultrasonography DOI: 10.3329/jdmc.v19i1.6247 J Dhaka Med Coll. 2010; 19(1) : 25-28.

Background: Mirizzi syndrome is a condition, difficult to diagnose pre-operatively and treat, represent a particular challenge for hepatobiliary surgeons. Furthermore, it increases the risk of intra-operative biliary injury, particularly during laparoscopic cholecystectomy. The aims of this study were to point out some particular aspect of diagnosis and treatment of this condition that will be helpful for the surgeons. Methods:We retrospectively reviewed all records of the patients, surgically treated for Mirizzi syndrome from Patients' presentation, diagnostic methods, treatment and complications were recorded.Results: During the study period, a total of 1320 cholecystectomy were performed, out of which 50 patients were diagnosed with Mirizzi syndrome, representing an incidence rate of 3.78%. Male to female ratio was 0.72:1 and mean age was 54.14 years. When we analyzed the main symptoms in the clinical debut, we found that common features were jaundice (31, 62%), cholangitis (20, 40%) and abdominal pain (22, 44%). Roux en Y hepaticojejunostomy was the treatment of choice and subtotal cholecystectomy were done for 7 cases and laparoscopic cholecystectomy for 2 cases. Mean hospital stay was 4.8±2.9 days. There was no post-operative mortality. Two cases of biliary fistula resolved with conservative management and another case required percutaneous treatment for resolution of an intraperitoneal postoperative collection. Conclusion:Mirizzi syndrome continues to be a disease of difficult diagnosis and treatment. General surgeons without long experience in hepatobiliary surgery should refer the patient to a specialized hepatobiliary surgical center. In most of the cases biliary reconstruction is inevitable. It is important for the surgeons to know the disease and possible intra-operative challenging situations.

DOI: http://dx.doi.org/10.3329/jdmc.v21i1.13251 J. Dhaka Med. Coll. 2012; 21(1): 120-123

DOI: http://dx.doi.org/10.3329/jdmc.v20i2.10532 J. Dhaka Med. Coll. 2011; 20(2): 116-118

Fifty four cases of histopathologically or cytopathologically confirmed tuberculosis of the breast were found during a period of 3 years in surgery outpatient department of Dhaka Medical College Hospital, Dhaka, which was accountable for 2.42% of all breast diseases. All the patients were female. Most of the cases were in third and fourth decades. Among them, 3 patients were lactating and 1was pregnant. Diagnosis was suspected clinically on the basis of lump or lumpiness and/or solitary or multiple chronic discharging sinuses in the breast or axilla. Breast lumps in 33 cases simulated carcinoma. Histopathological examination was done to establish the nature of the pathology. All patients were treated with four drug combination (4FDC) anti tubercular therapy for 12 months. However, forty patients required some forms of surgery DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21539 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 185-187