Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of gallbladder disease, but conversions to open cholecystectomy are still inevitable in certain cases. Knowledge about the rate and underlying reasons for conversion could help surgeons during preoperative assessment and improve the informed consent of patients. We decide to review the rate and causes of conversion of our LC series. This study included 320 consecutive laparoscopic cholecystectomies from January 2017 to December 2019 at Community Based Medical College Hospital Bangladesh, Mymensingh. All patients had surgery performed by same surgeon. Conversion to open cholecystectomy required in 15 (4.6%) patients. Out of 15 cases, the highest number of patients 10(66.6%) were in age group 50 to 59 years with a mean age of 60.1 years and standard deviation (SD) of 9.8 years. Of them 9 (60%) were male. The most common reasons for conversion of them were severe adhesions at calot's triangle 6 (40%) and acutely inflamed gallbladder 5 (33.3%), bleeding 2 (13%). No surgical procedures are complication free. The most common complication was superficial wound infection 8(2.5%). Delayed complications seen in our series is port site incisional hernia 2 (0.62%). Male gender, age older than 60 years, previous upper abdominal surgery, diabetes, and severity of inflammation were all significantly correlated with an increased conversion rate to laparotomy. LC is the preferred method even in difficult cases. This study emphasizes that although the rate of conversion to open surgery and complication rate are low in experienced hands, the surgeons should keep a low threshold for conversion to open surgery. CBMJ 2020 July: Vol. 09 No. 02 P: 14-18
The diabetic foot, the foot of diabetic patients with ulceration, infection and/ or destruction of the deep tissues associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb is quite common. A descriptive, cross-sectional study was carried out with an objective of assessing the common presentations and management outcome of diabetic foot. The study was carried out in the Surgery Department of Mymensingh Medical College Hospital, Mymensingh with a conveniently selected 130 patients of diabetic foot according to inclusion and exclusion criteria. The study period was one year. Out of 130 cases, the highest number of patients 55(42.4%) were in age group 50 to 59 years with a mean age of 60.1 years and standard deviation (SD) of 9.8 years. Majority of the patients 91(70.0%) were male. Of them, 83(91.2%) were smokers. Of 130, 51(39.2%) patients were illiterate and 41(31.5%) were farmer. Majority 67(51.53%) patients had history of uncontrolled diabetes for 10-15 years. Most of the patients, 97(74.6%) were presented with neuropathic ulcer, whereas 24(18.4%) ischemic ulcers and 9(7.0%) were infective ulcers, and majority of the lesions 49(37.7%) were located on toes. Highest number of patients, 44(33.8%) were treated conservatively, while 37(28.4%) were treated by debridement, dressing and resurfacing, 17(13.1%) were treated by incision and drainage, and 32(24.6%) patients were treated by amputation. Most of the patients, 108(83.1%) were cured, of them, 36(33.3%) were treated conservatively, while 31(28.7%) by debridement and dressing, 17(15.7%) were treated by toe disarticulation, 13(12.0%) by incision and drainage, 4(3.7%) by above knee amputation, 4(3.7%) by ray amputation and 3(2.8%) by below knee amputation. Illiterate male smokers in their 6th and 7th decades of life with uncontrolled diabetes are the victim of diabetic foot. Neuropathy, vasculopathy, infections and trauma are identified risk factors. Conservative treatment, debridement and dressing, off-loading, culture-guided antibiotics therapy and amputations are the most successful modalities. CBMJ 2017 July: Vol. 06 No. 02 P: 25-31
Protein-energy malnutrition (PEM) also referred to as protein-calorie malnutrition, is a potentially fatal body-depletion disorder. PEM develops in children and adults whose consumption of protein and energy is insufficient to satisfy the body's nutritional needs. The modified ‘Wellcome classification' was used to classify the PEM in children into marasmus, kwashiorkor, marasmic-kwashiorkor and underweight. However, in most cases the deficiency is combined. It was found that among the South Asian countries (Surveyed from 1990-2000) prevalence of wasting was 11.6% in Bangladesh, 18% in India, 11% in Pakistan, 11% in Nepal, 14% in Srilanka, 4% in Bhutan and 17% in Maldives. Malnutrition increases one's susceptibility to and severity of infections, and is thus a major component of illness and death from the diseases. This, a cross sectional study for a period from July 2008 to June 2009 to explore the changes of serum electrolytes in PEM so that effective measures making availability of adequate proteins and calories to all age groups especially to under five children through the ongoing nutrition programs to save these group of children. A total of 100 subjects aged 18 months to 5 years were enrolled for this study. Out of them 50 were the severely malnourished children regarded as Group I and 50 apparently healthy children considered as Group II. Z score of weight-for-age of Group I and Group II children were calculated by using CDC growth chart: USA, 2000. Data were collected through clinical evaluation from pre selected questionnaires and blood samples were taken for laboratory investigations. Serum potassium was measured by Ion selective electrode (ISE) method & serum calcium was determined by Colorimetric method using the test kit. Statistical significance of difference between two groups were evaluated by using unpaired 't’ test with the help of SPSS software package. For each analytical test, the level of significance was set at 0.05 and p-value < 0.05 was considered significant. Analyzing the findings of the present study, it can be concluded that significant decrease of serum potassium and calcium occur in malnourished children. CBMJ 2017 January: Vol. 06 No. 01 P: 12-16
There are many causes of fecal halitosis like poor oral hygene, bowel obstruction, GERD, oral malignancy, liver failure etc. Gastrocolic fistula is a rare cause of fecal halitosis. Gastrocolic fistula is a rare complication of adenocarcinoma of the colon. Despite radical resections, these patients usually have a poor prognosis with a mean survival of 23 months and long-term survival is rarely reported. A 40-year-old man of Netrokona district presented with diffuse abdominal pain, vomiting, fecal smell from mouth and weight loss for 3 months. A Barium enema revealed fistulous communication in between left colic flexure upto body of the stomach. Upper gastrointestinal tract endoscopy done repeatedly but report was normal. Colonoscopic report was a growth seen at 60 cm from anal verge and the scope couldn't be passed up. Histopathological report of colonoscopic biopsy was non specific chronic colitis. His part of colon, sleeve resection of stomach were resected en bloc. As per histopathological report, sections from the transvers colon tumor revealed an adenocarcinoma composed of malignant glands with an infiltrative pattern. Adjuvant chemotherapy with capecitabine and oxaliplatin was administered after surgery. Our patient is alive. En bloc resection with adjuvant chemotherapy offers the best treatment option for gastrocolic fistulas. This is one of the patients with greater survival reported in the medical literature. CBMJ 2017 January: Vol. 06 No. 01 P: 34-38
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