Roux-en-Y longitudinal Pancreatico Jejunostomy for Pancreatic Calculi in Children

Background: Pancreatic calculi is distinctly uncommon in children and usually present wit recurrent abdominal pain. Objective: To assess the effectiveness of longitudinal pancreatico-jejunostomy in relieving intractable abdominal pain in children with pancreatic calculi. Methods: this prospective study was conducted from 2003-2009 at Paediatric Surgery Department of BSMMU. Ductal decompression by longitudinal pancreatic jejunostomy (LPJ) was done in 14 children (10 male, 4 female) suffering from intractable abdominal pain due to pancreatic calculi. The operative outcomes were divided in to satisfactory and unsatisfactory according to whether the patients were completely or almost completely relieved of pain or continued to be troubled by pain. The main outcome measures were pain relief, postoperative morbidity and mortality. Results: There was no mortality and no significant postoperative morbidity. 14 patients were followed up till 2009. The mean follow-up period were 22 (range 8-72) months. Operative results was satisfactory (no pain) in 12 patients and unsatisfactory (moderate pain) in 2 patients. Complete pain relief was seen 12 patients. Conclusion: Longitudianal pancreatico-jejunostomy is a good operative procedure to relieve intractable abdominal pain in patients with pancreatic calculi. Key words: Pancreatic calculi; Pancreatico-jejunostomy; abdominal pain  DOI: 10.3329/bsmmuj.v3i2.7055BSMMU J 2010; 3(2): 72-7

Roux-en-Y longitudinal Pancreatico Jejunostomy for Pancreatic Calculi in Children

Background: Pancreatic calculi is distinctly uncommon in children and usually present wit recurrent abdominal pain. Objective: To assess the effectiveness of longitudinal pancreatico-jejunostomy in relieving intractable abdominal pain in children with pancreatic calculi. Methods: this prospective study was conducted from 2003-2009 at Paediatric Surgery Department of BSMMU. Ductal decompression by longitudinal pancreatic jejunostomy (LPJ) was done in 14 children (10 male, 4 female) suffering from intractable abdominal pain due to pancreatic calculi. The operative outcomes were divided in to satisfactory and unsatisfactory according to whether the patients were completely or almost completely relieved of pain or continued to be troubled by pain. The main outcome measures were pain relief, postoperative morbidity and mortality. Results: There was no mortality and no significant postoperative morbidity. 14 patients were followed up till 2009. The mean follow-up period were 22 (range 8-72) months. Operative results was satisfactory (no pain) in 12 patients and unsatisfactory (moderate pain) in 2 patients. Complete pain relief was seen 12 patients. Conclusion: Longitudianal pancreatico-jejunostomy is a good operative procedure to relieve intractable abdominal pain in patients with pancreatic calculi. Key words: Pancreatic calculi; Pancreatico-jejunostomy; abdominal pain  DOI: 10.3329/bsmmuj.v3i2.7055BSMMU J 2010; 3(2): 72-7

Pattern of Childhood Malignant Tumour in the Paediatric Surgery Department of Bangabandhu Sheikh Mujib Medical University

Background: Childhood malignancy is fast becoming an important paediatric problem in Bangladesh. They differ markedly from adult malignancy in their nature and distribution. This is a 5 years retrospective study of childhood malignant tumour as seen at the paediatric surgery department of Bangabandhu Sheikh Mujib Medical University (BSMMU). Objectives: The objective of this study is to determine the types of malignant patients admitted in the paediatric surgery department of BSMMU and also to know their age and sex distribution. Methods: This is a 5 years retrospective study from January 2005 to December 2009 in the paediatric surgery department of BSMMU, Dhaka, Bangladesh. All admitted malignant patients, aged up to 15 years diagnosed by means of histological or cytological examination included in this study. Results: Seventy (70) malignant patients were admitted during the study period, 65.7% patients were male and 34.3% patients were female with a male female ratio of 1.9:1. Fifty two (74.3%) patients were below 5 years and eighteen (25.7%) patients were between 5 to 15 years. The Wilms’ tumour was the most common malignant tumour which accounted for 42.8%. Hepatoblastoma was the second most common (24.2%). The other malignant tumours were neuroblastoma (15.7%), Non-Hodgkins lymphoma (5.7%), Rhabdomyosarcoma (4.2%), malignant fibrous histocytoma (1.4%), Fibroscarcoma (1.4%), Osteosarcoma (1.4%), malignant sacrococcygeal teratoma (1.4%), carcinoma of the rectum (1.4%0. Conclusion: Based on the result of this study, Wilms’ tumour is the commonest paediatric solid malignancy in our country. Carcinoma of the rectum may rarely occur in paediatric age group. Key words: Frequency; malignant solid tumor; children. DOI: http://dx.doi.org/10.3329/bsmmuj.v4i2.8638 BSMMU J 2011; 4(2):99-10

One stage transanal full thickness pull-through operation for rectosigmoid Hirschsprung's disease

The surgical management of Hirschsprung's disease (HD) has changed from the original staged operations to the latest introduced minimally invasive one stage techniques. One stage transanal full thickness Swenson-like procedure is a new concept of single stage procedure for HD. We reviewed the early outcome of one stage transanal Swenson-like pull-through operation for rectosigmoid HD. By using the transanal concept we choose to apply Swenson's principle in transanal dissection for the primary treatment of HD and describe technical aspects and impact on fecal and urinary function. We reviewed our series of HD patient who underwent one-stage transanal full thickness, Swenson-like rectosigmoid dissection, assessing for postoperative stricture or stenosis, anastomotic leak, enterocolitis, obstruction and long-term results for bowel and urinary function. Of 15 patients all had the transanal resection, the age of the patients ranged from 6 months to 5 years. The average length of resection was 20 ± 5 cm. Mean follow-up was 24 months. 10 patients were at least three years old at follow-up and were assessed for urinary and fecal continence. All had the voluntary bowel movement and urinary continence. Three patients had episodes of postoperative enterocolitis and two patients developed stenosis at the anastomotic site. Postoperative frequent bowel movement was present in all patients and continued for 2-8 weeks. In conclusion, our data support the fact that a modification of Swenson's original transabdominal dissection concept using the recently describe transanal approach is an excellent technique for HD and produces excellent long-term outcome for fecal and urinary function.

Vascularized dorsal dartos flap to prevent fistula in tubularized incised plate urethroplasty for primary distal and mid shaft hypospadias

The aim of the present study was to evaluate the importance of neourethral covering using vascularized dorsal flap for preventing fistula in Tabularized incised plate (TIP) urethroplasty. The study included 52 children (aged 2-10 years) who had hypospadias repaired including 44  with distal and 8  with mid shaft hypospadias. In all children, a standard tabularized incised plate urethroplasty was followed by reconstruction of new surrounding urethral tissue. A longitudinal dartos flap was harvested from excessive dorsal preputial and penile hypospadiac skin and transposed to ventral side by a buttonhole maneuver. It was sutured to the glans wings and the neomeatus and to the corpora covernosa over the neo-urethra. Thus the new urethra was completely covered with well-vascularzed subcutaneous tissue. At a mean follow-up of 18 months, the result was successful with no fistula or urethral stenosis, except 2 of the mid penile hypospadias. All patients had good functional and cosmetic results with straight penis and vertical slit shaped meatus at the tip of the penis. The 2 patients developed tiny fistula, which were closed spontaneously after meatal dilatation. In conclusion, urethral covering should be part of TIP urethroplasty. A dorsal well-vascularized dartos flap, button holed ventrally is a good choice for preventing fistula for distal and mid shaft hypospadias.

Excision of choledochal cyst in children by Roux-en-Y hepaticojejunostomy

The aim of this study was to review our experience of total excision with Roux-en-Y hepatico-jejunostomy for the surgical management of type I and type IVa choledochal cysts in 30 children. Among them, 22 were in type I and 8 in type IVa choledochal cysts. All had complete excision and Roux-en-Y hepaticojejunostomy with no morality. Morbidity consisted of prolong drainage (n=2) and late onset cholangitis/pancreatitis (n=4). Choledochal cyst generally has an excellent prognosis with early complete excision and Roux-en-Y hepaticojejunostomy

IoT-Based Intelligent Gas Leakage Detection and Fire Protection System

Gas Leakage and its fatal effects are a great concern throughout the world, especially in developing countries like Bangladesh. Every year lots of people died and countless damages to assets occur due to the fire caused by the gas leakage. Not only that but gas leakage and explosion are also very harmful to the climate. Thus, a system to detect gas leakage and preventive measures is of utmost importance. In this project, we design and implement an intelligent IoT prototype to detect gas leakage, and the fire caught by gas leakage. Our goal is to minimize the effect of gas leakage by taking some protective measures. When the gas sensor, detects the gas leakage, the solenoid valve shuts off the gas line, and the exhaust fan starts to run. Again, when the flame sensor detects a fire, the sucker throws the fire extinguisher balls to the fire. The GSM SIM module notifies the user by sending a message to his smartphone. The buzzer sounds when a mishap occurs and the LCD monitor always shows the status of the system. In this way, we have efficiently designed and implemented a low-cost and intelligent gas leak detection and fire suppression system

Community People Preparedness and Response on Prevention and Control of COVID-19 Best Practice in Bangladesh

Purpose: The major objectives of the study were to assess the knowledge, attitude & practice (KAP) towards community preparedness and response on prevention of COVID-19 among the community people. Method: A sample survey was conducted to collect data from people admitted to a district-level tertiary hospital for the treatment of various health complications during the COVID-19 pandemic. A total of 300 randomly selected patients and their attendants were interviewed in the hospital setting. Results: The mean knowledge score was 18.73 out of 24 and the main sources of information were TV (86.5%), radio (13%), newspaper (13%), social media (13.5%), friends/relatives (14%), formal healthcare providers (6%) and religious leaders (3%). Knowledge was significantly poor among aged people, women, less educated, and less earning. The majority of the participants (79%) suggested wearing facemasks as effective tools to prevent COVID-19 from spreading, whereas 56% mentioned maintaining physical or social distance as crucial to prevent the infection. We found strong relationship between monthly total family expenses and wearing of facemasks by gender to prevent the COVID-19 (x2= 18.405; Cramer’s V= .17, df = 8; sig; P= < .018). Similarly maintaining physical/social distance to prevent COVID-19 is also related to respondents’ economic strata (x2= 43.741; Cramer’s V= .14, df = 20; Sig; P= < .002). Conclusions: Awareness program on COVID-19 is very important to prevent the spread of the deadly virus.  Effective communication intervention with increasing treatment facilities is essential for the prevention and control of COVID-19. Government and development agencies should prioritize the COVID-19 response program with regular health care services.