Although generally regarded as a benign and chronic condition, neurofibromatosis can be associated with acute vascular and neurological complications. We report the case of a patient with neurofibromatosis who developed massive haemothorax as a result of spontaneous rupture of the left vertebral artery and left subclavian artery. The case was a diagnostic and management challenge.

ED staff should routinely be offered booster immunization for pertussis.

Abstract:Tympanoplasty without mastoidectomy is performed to prevent recurrent infection and reconstruct the sound conducting mechanism. In our study 60 patients were selected for tympanoplasty operation. All operations were done in Dhaka National Medical college hospital and private hospital in Dhaka city. Choice of incision was post auricular approach. 20% of patients were operated under general anesthesia and 80% of patients were operated under local anesthesia. Age range of patient was between15 to 40 yrs. Female patients were predominant. Follow up of patients were up to 2yrs. Overall success rate was 93.3%. Keyword-TympanoplastyIntroduction:

Abstract:Objective: To evaluate the effect of preoperative short course of oral steroids followed by postoperative topical nasal steroids sprays on nasal polyp recurrence after endoscopic nasal polypectomy. Methods: Forty eight patients of both genders with symptoms and signs of nasal polyps were included in this prospective study between January 2006 and December 2009. Their ages ranged between 18 and 60 years. The sample was divided into two groups. Group I constituted 24 patients treated by endoscopic nasal polypectomy without oral and local steroid therapy. Group II consisted of 24 patients also treated by endoscopic nasal polypectomy but received preoperatively 60mg prednisolone tablets daily for one week and postoperatively topical nasal steroid spray (Mometasone furoate suspension) for three months. All patients were followed up for at least one year. Recurrence of nasal polyps was assessed endoscopically at three, six and 12 months after surgery. Any evidence of nasal polyps-formation of whatever size was considered as recurrence. Results: Forty eight patients (32 males and 16 females) with sinonasal polyposis were included in this study. Male to female ratio was 2:1. Patients' age ranged from 18 to 60 years; median age was 42 years. Recurrence rates at three, six and 12 months after surgery for the first group of patients were 8.33% (2 patients), 25% (6 patients) and 41.6% (10 patients) accordingly, while the recurrence rates for the second group were 4.1% (1 patient), 8.3% (2 patients) and 12.5% (3 patients) accordingly. Conclusions: Preoperative short course of oral steroid followed by postoperative nasal steroid spray show significant reduction in the recurrence rate of nasal polyps after endoscopic nasal polypectomy.

Following surgical procedures, the duration of hospital stay has undergone a significant reduction in recent years. However, there are some risks associated with short-stay thyroid surgery. An analysis has been made of data from patients who underwent shortstay thyroid surgery, analyzing the complications associated with this procedure. Overall 70 consecutive patients undergoing thyroidectomy in 2009 and 2010 were prospectively analyzed. Post-operative care included routine ward overnight observation. The discharge criteria were: stable vital signs; apyretic; no wound or airway problems; tolerating diet; and established autonomy at discharge. Data were collected regarding patients’ discharge criteria status, length of hospital stay and readmission, as well as morbidity (post-operative haemorrhage, recurrent laryngeal nerve injury and hypocalcaemia) and mortality. This series comprised 30 total thyroidectomies, 38 hemi-thyroidectomies and 2 isthmusectomies. No cases of death or post-operative haemorrhage occurred in any of these patients. Permanent unilateral recurrent laryngeal nerve injury was observed in 1 patient (1.42%). Transient postoperative hypocalcaemia occurred in 6 patients, whereas permanent post-operative hypocalcaemia was observed in 2 patients (2.85%); 2 patients were re-admitted and required early calcium supplementation. Five patients failed to tolerate the diet during the immediate post-operative period. The average duration of hospital stay was 1.02 days. Considering the 2 patients who required re-admission due to hypocalcaemia, the total length of hospital stay was 1.05 days. In conclusion, the one-day surgery model is safe and effective in patients undergoing surgery for thyroid disorders. DOI: http://dx.doi.org/10.3329/jdnmch.v17i2.12201 J. Dhaka National Med. Coll. Hos. 2011; 17 (02): 13-17