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Background and objectives: Basic components for Intra-cardiac repair of TOF are the same in every cardiac center except the timing which varies according to the capability of the team. Free PR is inevitable in case of a trans-annular patch which ultimately leads to RV dilatation, dysfunction, arrhythmia and failure with time. There is an ongoing endeavor to reconstruct the RVOT with the aim to avoid free PR in physiological repair. If RVOT reconstruction is done, RV dysfunction is absent or delayed which can avoid further re intervention. Monocuspid reconstruction of PV is commonly practiced in many centers but its long term outcome is poor though it helps to achieve aless stormy ICU course. Modified monocusp or bicuspid PV reconstruction is adopted in many centers using 0.1mm PTFE membrane. We represented the results of Modified Monocus PV reconstruction using a 0.1mm PTFE patch in repair of TOF with a trans-annular patch. Methodology: A total, 42 patients diagnosed as TOF were treated from January 2016 to October 2020. Age ranged from 18 months to 35 years, weighing 10 kg to 70 kg. 38 patients had TOF and 4 had DORV with PS. The trans-annular patch was followed by implantation of a 0.1-mm PTFE valve using posterior fixation. Results: Among the total42 patients,28 were male and 14 were females. Mean age was10.51±7.49 yrs and BSA was 0.90±0.34 kg/m2. Mean total bypass time was 187±31 min, cross-clamp time was 123.63±25.42 min. Out of 42 patients, 9(21.43%) had a PV gradient 0-10 mm/Hg, 24(57.14%) had 10-20 mm/Hg, and 9(21.43%) had >20 mm/Hg in the post-operative echocardiogram. PR gradient was trivial in 7(16.67%), mild in 31(73.1%), moderate in 4(9.52%) patients. Follow-up echocardiogram revealed PR gradient remained trivial in 4(10%) patients, augmented from trivial to mild in 3(7.5%) and mild to moderate in 05(12.5%) patients. It remained moderate in 03(7.5%). There was no severe PR. ICU stay was 89±32.6 hours and mean hospital stay 11.48±2.1 days. Conclusions: Initial results using a transannular patch with a modified monocuspvalve to repair the RV outflow tract in cases of tetralogy of Fallot were promising. There were only a slight pressure gradient and mild regurgitation in most of the cases. A medium or long-term follow-up study is required to confirm these findings and compare them with results obtained using other techniques. AKMMC J 2021; 12(2): 82-90

Background: We aimed to report different patterns of chest computed tomographic (CT) findings in coronavirus disease-19 (COVID-19) infected patients in Bangladesh. Methods: This was a cross-sectional descriptive study of 200 consecutive reverse transcriptase polymerase chain reaction (RT-PCR) positive patients who underwent CT chest. Distribution, type of abnormal lung findings and Prevalence were recorded. Result: Among the total study cohort of 200 patients, 148(74 %) were males and 52 (26 %) were females with mean age of 53.9 ± 16.7 years (range 20–92 years). We observed lung parenchymal abnormalities in 125 (62.0 %) cases whereas 75 (37.5 %) RT-PCR positive cases had a normal chest CT. Common symptom was cough in 108 (54%), Only 18.0% of the patients were dyspneic. Among the patients with abnormal CT findings bilateral involvement was commonest 98/125 (78.4 %), multilobar (54.0 %) lung involvement with a predominant peripheral and posterior distribution was more commonly observed. With regards to the type of opacity, ground glass opacity (GGO) was the predominant abnormality found in 122/125 cases. Pure GGO was observed in 29 (23.2 %), most common pattern was GGO mixed with consolidation was noted in 52(41.6 %). GGO with crazy paving pattern was seen in 33 (26.4 %) and sub pleural linear and curvilinear lines were seen in 23(18.4%). Peri-lesional or intralesional segmental or subsegmental pulmonary vessel enlargement was observed in 36 (70.6 %) cases. Conclusion: In this study population, we found a high proportion of symptomatic laboratory-confirmed SARS-CoV-2 patients had positive chest CT findings. Patients with a positive CT showed typical findings of predominant GGOs in a bilateral and multilobar distribution with peripheral predilection. AKMMC J 2021; 12(1) : 38-44

Background: The coronavirus disease (COVID-19) is a multisystem disease that sometimes affects the cardiovascular system (CVS) during acute illness and follows a protracted course in a proportion of patients causing ‘post-COVID syndrome’. Exercise tolerance test (ETT) can assess functional capacity and imaging modalities like echocardiography and cardiac magnetic resonance (CMR) can assess structural and functional status of cardiovascular system (CVS) efficiently. However, the pattern of cardiovascular involvement and its effect on functional capacity in COVID-19 survivors long after the index illness are inadequately known. This study was carried out to detect the functional status and imaging findings in COVID-19 recovered healthcare workers. Methods: This cohort study was carried out in the Department of Cardiology of the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from July 2021 to December 2021. Thirty male healthcare workers, previously not known to have any cardiac disease, who suffered from reverse transcriptase polymerase chain reaction (RT-PCR)-confirmed COVID-19 of mild severity at least 3 months back were included. Besides clinical evaluation, ETT, echocardiography and CMR were done. Results: The mean age was 37.2±4.7 years. The mean time interval from RT-PCR positivity was 317.4±85.7 days. The functional capacity was good in the study subjects; the achieved metabolic equivalents (METs) were 13.0±1.5. The mean left ventricular ejection fraction (LVEF) was 66.9% ± 6.2%; all were within the normal range. The mean LV global longitudinal strain (LVGLS) was -19.2% ± -1.9%; 6 patients had LVGLS

Background & objective : The knowledge of normal diameter of lumbar spinal canal is very important for diagnosing lumbar spinal canal stenosis and also for performing spinal surgeries at the lumbar level by Neurosurgeons and Orthopedicians. However, it varies widely among ethnic groups and between sexes in the same ethnic group. The present study was conducted to describe the morphometry of lumbar vertebrae at the level of L3-L5. Methods: This descriptive cross-sectional study was conducted on 302 patients (aged 20-60 years) at Ibrahim Cardiac Hospital & Research Institute between July 2019 to December, 2020 who underwent diagnostic CT scans for abdominal or genitourinary complaints without any known vertebral column pathology or complaints of low back pain or other abnormalities attributable to lumbar spine. Patients having sciatic pain with or without pain in the back, having past history of back surgery and patients with osteophytes or developmental anomalies, trauma or vertebral fracture and known case of lordosis, scoliosis or kyphosis or other abnormalities in lumbar vertebrae were also excluded. A CT scan was performed using 128-slice multi-detector CT with unenhanced CT images from the level of diaphragm to pubic symphysis so that the area from D12 to S1 vertebra be covered (field of view). Sections 3-mm thick with reconstruction up to 1 mm were analyzed and different parameters of the spinal canal and vertebral body were measured in sagittal and transverse sections. The images were reconstructed in true axial, coronal, and sagittal planes. The canal-body ratio (CBR) was determined by dividing the sagittal diameter of the spinal canal by the sagittal diameter of the vertebral body. Result: The findings of the present study demonstrate that nearly two-thirds (65.5%) of the subjects were early middle-aged or middle-aged with mean age of the subjects being 43 years. A male predominance was observed in the series with male to female ratio being 4:1. The study revealed that all the dimensions of the canal and the body in transverse and sagittal sections were observed to increase from level L3 to L5, while the canal body ratio was decreased slightly from L3-L5. The males have significantly wider vertebral body at all levels (L3-L5) of lumbar vertebrae compared to their female counterparts. Vertebral body diameter in sagittal section at L3 was significantly greater in males than those in females; however, they were not different between sexes at L4 and L5 levels. Canal-body ratio (CBR) was fairly comparable between males and females at L3 and L4, but it was greater in males than that in females at L5. No significant difference was observed between L3 & L4 and L4 & L5 in the same individuals in terms of CBR. Conclusion: The study concluded that there are significant variations in some of the lumbar spinal canal dimensions and vertebral body measurements (including CBR) from L3-L5 between males and females. Although there was no significant difference between L3 and L4 in the same individuals in terms of CBR, there was reasonable difference between L4 and L5 lumbar vertebrae. The findings are of much significance in the investigation of vertebral column pathology in the context of our population. Ibrahim Card Med J 2021; 11 (1): 8-13

Background: Atrial Septal Defects (ASD) can be closed surgically using conventional midline sternotomy or minimal invasive technique. This study was done to evaluate the outcome and safety of the minimal invasive cardiac surgical (MICS) approach using right vertical infra axillary incision (RVAI) for the repair of ASD. Methods: We performed a prospective observational cross-sectional analysis on 50 patients who were diagnosed as ASD of various types and not amenable to device closure. Their surgery was done RVAI using central cardiopulmonary bypass. Outcome of the study was evaluated using the following variables: length of the incision, satisfaction of patients, mortality, infection of surgical site, blood transfusion, duration of total operation, intensive care unit (ICU) stay, mechanical ventilation, hospital stay and aortic occlusion. Operations were done between December 2013 to December 2020. All the recruited patients were treated through RVAI as per patient’s choice. Results: Mean age was 11.4± 6.4 years. 18(36%) were male and 32(64%) were female. Body weight ranged from 10 to 65 kg. Mean length of incision was 6.2±0.8 cm. Mean aortic occlusion time was 42±14 min. ASD closed directly, using autologous treated pericardial patch or dacron patch. Mean total operation time was 4.08±0.6 hours and mean mechanical ventilation time was 8.3±5 hours. Average ICU stay was 35.6±6 hours and total hospital stay was 7.2±0.9 days. There was no significant blood loss. Only 10 patients required intravenous (IV) analgesics in the post-operative period. One patient required re-exploration, one conversion to median sternotomy and one suffered from superficial skin infection. There were no operative or late mortalities. Patient satisfaction was excellent. Conclusions: MICS technique using RVAI for surgical repair of ASD revealed a safe procedure and could be performed with excellent cosmetic and clinical outcomes. It provided a good alternative to the standard median sternotomy. Cardiovasc j 2021; 14(1): 37-43

Background: Tetralogy of Fallot (TOF) is one of the most common congenital cardiac defect. In patients with small PV annulus, it has to be augmented to certain diameter by cutting annulus. In these cases, transannular patch is used free PR is inevitable. Free PR with transannular patch ultimately leads to RV dilatation, dysfunction, arrhythmia and failure with time. Monocuspid reconstruction of PV is commonly practiced in many centers but its long-term outcome is poor though it helps to achieve a less stormy ICU course. Modified monocusp or bicuspid PV reconstruction is a good choice where 0.1mm PTFE patch is used. Objectives: We are presenting the results of bicuspid PV reconstruction using a 0.1mm PTFE patch as a method of RVOT reconstruction in repair of TOF with transannular patch. Methods: A total, 42 patients diagnosed as TOF were treated from January 2016 to October 2020. Age range 18 months to 35 years, weighing 10 kg to 70 kg. 38 patients had TOF, 4 had DORV with PS. The transannular patch was followed by implantation of a 0.1-mm PTFE modified monocusp valve using posterior fixation. Results: Among total patients 28 were male and 14 were female. Mean age 9.58±5.6 yrs. Bypass time was 187±31 min, cross-clamp time 123.63±25.42 min. Out of 42 patients, PR gradient was trivial in 7(16.67%), mild in 31(73.1%), moderate in 4(9.52%) patients. First, a follow-up echocardiogram revealed no significant deterioration of PR gradient. ICU stay was 89±32.6 hours and mean hospital stay 11.48±2.1 days. Conclusion: Initial results using a transannular patch with a modified monocusp valve to repair the outflow tract in cases of Tetralogy of Fallot were excellent. There were only a slight pressure gradient and mild regurgitation in most of the cases. DS (Child) H J 2020; 36(2): 114-119

Background: Although all mitral valves are not repairable, most non rheumatic valves and a substantial proportion of rheumatic valves are amenable to repair. Repair preserves the normal valvular tissue, so the left ventricular function is well maintained post-operatively. Combined aortic and mitral valve surgery is associated with increased mortality and morbidity. Several studies have shown the superiority of DVR (Double valve replacement) in this entity to prevent reoperation. Some other data suggested superiority of aortic valve replacement combined with mitral valve repair in double valve disease. No study had been done over Bangladeshi population. Our aim was to compare the short-term outcome of mitral valve repair and aortic valve replacement with double valve replacement. Methods: It was a prospective non-randomized observational study took place in the Department of Cardiac Surgery of National Institute of Cardiovascular Disease. In this study post-operative result of double valve replacement was compared with aortic valve replacement and mitral valve repair. Total 60 patients under went aortic valve replacement with either mitral valve replacement (n=30) marked as group A or (n=30) repair marked as Group B. Results: Aortic cross clamp time and cardiopulmonary bypass time was higher in group B than group A but it was well tolerated without any short-term measurable consequences. Required inotrope support was 49.8±2.3 hours in group B and 87.2±3.5 hours in group A (p

Introduction: The frequent and widespread use of imaging in clinical practice, particularly CT, has led to a steep increase in incidental ndings of asymptomatic solitary pulmonary nodules. In this situation, histocytopathological analysis is needed to conrm the diagnosis by CTguided biopsy / FNAC. So, the researcher purposively, designed this study. The aim of this study was to assess the outcomes of CT-Guided Fine-Needle Aspiration Cytology and Core Needle Biopsies of Solitary Lung Lesions. CT-uoroscopy guidance helps in this process by accurate needle positioning thus increase the success rate. Materials and Methods: This was a retrospective study conducted at the Department of Radiology & Imaging in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, during January 2017 to January 2019.Atotal of 270 patients who were referred to the Department of Radiology& Imaging for the evaluation of suspicious solitary lung lesions after the detection of a solitary pulmonary nodule in X-ray or CT scan, were included in this study. The results of CT uoroscopy–guided biopsy and FNAC for the included patients were analyzed to determine the diagnostic accuracy, complication rates, and independent risk factors for diagnostic failure and severe pneumothorax in this study. The factors related to the patients' solitary lesions, and procedures were evaluated by univariate analyses using the twosided Student t test for numeric values and Chi-squared test for categorical values where p

Background: Infective vertebral lesions usually involve the vertebral column, including the bone, intervertebral disk and paravertebral soft tissues. Variable imaging characteristics in conjunction with clinical findings can facilitate early diagnosis and treatment. MRI is a powerful imaging tool that can be help to evaluate spinal pathology specially infection. Typical MRI findings of infective vertebral disease are vertebral endplate destruction, bone marrow and intervertebral disc signal intensity changes and para vertebral soft tissue involvement. Objective: This study was aimed to assess whether the MRI can different the in differentiate the invective vertebral lesions from benign or malignant Tumors. Methods: This cross-sectional study was conducted on a total of 52 clinically suspected patients of infective vertebral lesions to establish diagnostic accuracy of MRI. The validity of MRI diagnosis for infective vertebral lesion was compared against CT-guided fine needle aspiration cytological (FNAC) diagnosis. Results: The sensitivity, specificity, positive and negative predictive values (PPVs and NPVs) and finally diagnostic accuracy of MRI were calculated by comparing the MRI diagnoses with those of fine needle aspiration cytological diagnosis of vertebral lesions. Finally the sensitivity, specificity, PPV and NPV of MRI diagnosis for infective vertebral lesion were 95.6%, 85.7%, 97.7% and 75.0% respectively. The overall diagnostic accuracy was 94.2%. Conclusion: Finding of this study suggested that MRI should be considered as the imaging modality of choice for patients with suspected infective vertebral lesions. Bangladesh Med Res Counc Bull 2020; 46(3): 233-239

Background & objective: The aim of this study was to verify whether the ocular lens of type-2 diabetic retinopathy patients was thicker (measured by high resolution Ultrasonography) than those of non-diabetic individuals.The study also evaluated the differences in lens thickness (LT) between right and left eyes of diabetic retinopathy patients, and the differences in LT between proliferative and background retinopathy cases. Methods: This case-control study was conducted on 68 subjects (34 cases and 34 controls) aged 20-60 years in the Department of Radiology and Imaging, BIRDEM Hospital from March 2015 to February 2016. Adult patients suffering from type-2 diabetic retinopathy confirmed by slit-lamp examination were selected as cases, while apparently healthy subjects were taken as control. Patients with history of heart failure, ocular surgery, acute eye conditions, such as, conjunctivitis, scleritis, cataract or any other co-morbidities were excluded. Ocular mean lens thickness was measured by high resolution ultrasonography and was compared between case and control groups by Un-paired t-Test. Results: The study showed that type 2 diabetic patients had significantly thicker lenses than their non-diabetic counterparts (in right eye:case 4.1 ± 0.3 mm versus control 3.7±0.1 mm, p

Background & objective: The present study was intended to demonstrate the role of Multidetector Computed Tomography (MDCT) in defining the extracardiac vascular abnormalities including the pulmonary arterial tree, Major Aortopulmonary Collateral Arteries (MAPCAs), patent ductus arteriosus (PDA), and detection of the common and uncommon findings in Fallot’s Tetralogy cases for proper pre-surgical evaluation. Methods: A retrospective review of all multidetector CT images acquired to evaluate suspected cases of Tetralogy of Fallot, presented at Ibrahim Cardiac Hospital & Research Institute between July 2017 and July 2018, was done. This comprised of a total of 35 cases who were examined by 64-slice MDCT. The patients were divided into four main groups: those with classic Tetralogy of Fallot with no associations, those with common associations, those with uncommon associations and those with a combination of common and uncommon associations. Results: In the present study, majority of the patients had levocardia (93.6%), situs solitus (96.9%) with none of the patients having either atrio-ventricular or arterio-ventricular discordance. Major findings of the patients were VSD (93.8%), right ventricular outflow tract obstruction (65%) with ventricular hypertrophy (75%). All patients had overriding of aorta with over 60% of the patients having 50% and 28% > 50% overriding. Approximately 3.1% of the patients had MPA atresia. MPA stenosis was detected in 93.3% of the cases. Conclusion: A customized approach to MDCT imaging improves the diagnostic accuracy and reduces unnecessary prolongation of the study and sedation times. A careful preoperative perception of the complex cardiovascular anatomy in patients with Tetralogy of Fallot aids in exposing the patients to a directed and prepared surgical approach. Ibrahim Card Med J 2019; 9 (1&2): 16-22

Broad ligament pregnancy is a rare obstetric condition. Its diagnosis is quite difficult andmanagement is challenging. Here we report a case of a 26 years old primi gravida conceivedfollowing laparoscopy and ovulation induction. Diagnosis of the broad ligament pregnancywas done by a transvaginal ultrasound at her 9 weeks and was proceded with laparoscopyfollowed by laparotomy. A right broad ligament pregnancy was found and the sac with fetuswas removed. Laparoscopy was converted into a laparotomy as there was an uncontrollablebleeding from the broad ligament. Here we present a case of this extreme rare type of broadligament pregnancy. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 164-166

Broad ligament pregnancy is a rare obstetric condition. Its diagnosis is quite difficult and management is challenging. Here we report a case of a 26 years old primi gravida conceived following laparoscopy and ovulation induction. Diagnosis of the broad ligament pregnancy was done by a transvaginal ultrasound at her 9 weeks and was proceded with laparoscopy followed by laparotomy. A right broad ligament pregnancy was found and the sac with fetus was removed. Laparoscopy was converted into a laparotomy as there was an uncontrollable bleeding from the broad ligament. Here we present a case of this extreme rare type of broad ligament pregnancy. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 123-125

Background: COR-KNOT® (LSI Solutions, New York, NY, USA) is an automated suture securing device has not been well known. We report a case series for first automated knotting device used for minimally invasive heart valve surgery in Bangladesh. Method and Results: To overcome the challenge of knot securing via a Key-Hole surgery we have used CORKNOT ®. The newest device is capable of remotely and automatically secure sutures and simultaneously can cut and remove the excess suture tails. We covered the spectrum of heart valve surgery: There was one case of bioprosthetic aortic valve replacement, one case of mitral valve repair, one case of bioprosthetic mitral valve replacement, one case of failed mitral valve repair with COR-KNOT® explantation followed by mechanical mitral valve replacement and one case of redo-mitral valve replacement. Average length of hospital stays was 5 ± 1days. There was one reopening, one post-operative atrial fibrillation. No wound infection and no 30day mortality. Conclusion: We conclude, COR-KNOT® is a safe and effective tool to reduce the duration of operation. Clinical outcome of heart valve surgery with COR-KNOT® is comparable with other methods of suture tying methods. Bangladesh Heart Journal 2019; 34(2) : 127-131

Background & objective: Computed tomography (CT) is claimed to accurately diagnose many forms of congenital cardiovascular disease in children, particularly in the diagnosis of extracardiac vascular anomalies. The present study is intended to describe the role of CT in the evaluation of congenital cardiovascular disease in children. Methods: The study included children with congenital heart disease (CHD) who underwent CT pulmonary angiography in the Cardiac Imaging Department of Ibrahim Cardiac Hospital & Research Institute, Dhaka between 2015-2017 for investigations of various congenital heart diseases. CT scan was done on Multidetector scanner from Siemens or Philips. Routine preprocedure was done as per protocol of the CT angiography study. Breath holding technique was explained to the older patients who were able to follow breath holding instructions. Plain CT scans of thorax followed by early arterial phases were obtained after negative test dose of the non-ionic contrast by injecting 12 to 40 ml of intravenous contrast media (Iopamidol 350 mg) through antecubital vein by pressure injector at a rate of 1.5 ml/second Scan was obtained 6 seconds after starting of the intravenous contrast. Results: The mean age of the patients was 5.3 ± 0.5 years. Over 60% of the children were male giving a male to female ratio of roughly 3:2. Majority (92%) of children had levocardia with aorta being predominantly originated from the left ventricle (95%). Nearly two-thirds (65%) of the aortas had 50% overriding, 33% had > 50% overriding. Over three-quarters (76%) had left-sided arch and 21% had right-sided arch. Majority (87%) of pulmonary arteries originated from the right ventricle: 50% were of normal size and 44% were narrower than normal. In a few cases both right and left pulmonary artery were absent. In 90% cases right and left pulmonary arteries and veins were confluent. Nearly two-thirds (64%) of the pulmonary arteries were stenosed and 5% did not have any pulmonary valves. Presence of collaterals was commendably high (42%). Seventy percent of the patients had Tetralogy of Fallot (TOF) and over one-quarter (26%) had Patent Ductus Arteriosus (PDA). Interatrial septal defect was found in 21% and intervetricular septal defect in 79% cases. Increased and decreased vascularity of the lungs were found in 13 and 15% of the cases respectively. Other cardiac anomalies were negligible. Conclusion: The findings of the study suggest that the CT pulmonary angiography in the evaluation of CHD has a number of merits and could be done in the diagnosis of pulmonary vascular structures particularly the extra cardiac vascular anomalies. Ibrahim Card Med J 2017; 7 (1&2): 31-36

Total anomalous pulmonary venous connection is a rare congenital cardiac anomaly in which the pulmonary veins have no connection with the left atrium and connect directly to the right atrium or to one of the systemic veins. In the diagnosis of total anomalous pulmonary venous connection, the presence and severity of the venous obstruction is important. Computed Tomography (CT) imaging is known to be a useful method for the evaluation of total anomalous pulmonary venous connection. Here we report 3 cases of total anomalous pulmonary venous circulation (TAPVC) where 32 slice CT scan played an important role in pre-operative diagnosis and management. Age of the patients ranged from seven months to sixteen years. Symptoms of the patients’ varied from fatigue, shortness of breath, mild cyanosis and reduced growth for their age. Echocardiography done revealed dilated right cardiac chambers and atrial septal defect (ASD) with suspicion of TAPVC. CT scan was performed and it provided detailed information about intra-cardiac anatomy, pulmonary veins and their confluence, route, drainage and most importantly their distance and relation with the left atrium. It also provided information about coronary sinus and its drainage. This information is very important for surgical mapping and planning. Ibrahim Card Med J 2016; 6 (1&2): 73-77

Here we reported three cases of unilateral tubal and ovarian absence, along with laparoscopic images and images during ceasarean section in Anwer Khan Modern Medical College. Three patients with primary infertility of 6-8 years duration were reported as non-visualization of right adnexal structures on transvaginal ultrasound and hysterosalpingography. Absence of right adnexal structures of varying degree were detected during laparoscopy. Subsequent evaluation of renal system with Intravenous Pyelography were done. Ipsilateral absence of the fallopian tube and ovary without any other system anomalies were detected. Vascular accidents, Congenital defects or torsion could be the possible etiologic factors. Laparoscopy is a feasible option as a diagnostic tool for these cases.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 97-100

Background & objective: Ultrasonogram (USG) and computed tomography (CT) are often used in the evaluation of gall-bladder carcinoma. Thepresent study was conducted to determine the usefulness of USG and CT scan in diagnosing gallbladder carcinoma.Materials & Methods: This cross-sectional observational study was conducted at Department of Radiology and Imaging, BIRDEM in collaboration with the Departments of Hepato-biliary Surgery, and Histopathology of the same institute over a period of 3 years fromJuly 2004 to June 2006. A total of 42 patients (ranging from 40-80 years) were initially included on the basis of signs and symptoms of gallbladder carcinoma and underwent USG and CT scan for preoperative radiological diagnosis, its extension and operability. Following operation all the resected specimens were sent for histopathological evaluation. The diagnostic accuracies of USG and CT scan were then compared against histopathological diagnoses by using Kappa statistics.Result: In the present study, the mean age of the patients was 60 (range: 40-80) years with female preponderance. About 40% of the gall-bladder were contracted and reduced in size and 32.5% large and distended on USG examination, while 45% of the gall-bladder were contracted and reduced in size and 25% distended and large on CT examination. Approximately 40% had irregularly thickened wall and 21.2% diffusely thickened wall on USG and 30% of gallbladder wall were diffusely thickened and 45% irregularly thickened on CT scan. The present study showed hepatic parenchymal invasion to be 22.5% on USG and 42.5% on CT scan. The sensitivity and specificity of USG in diagnosing GB carcinoma were 93.9 and 71.4% respectively. Similarly, the sensitivity and specificity of CT scan in detecting GB carcinoma were 97.1 and 83.3% respectively. The test of agreement (Kappa test) revealed an almost 90% agreement between the two procedures meaning that the two diagnostic modalities are almost comparable in diagnosing gall bladder carcinoma (p

Massive Pulmonary Embolism (PE) is associated with significant mortality, especially if compounded by haemodynamic instability, right ventricular dysfunction and right atrial thrombus. Thrombolysis can be lifesaving in patients with major embolism and cardiogenic shock, and accelerates the resolution of thrombus. Only three fibrinolytic agents - namely streptokinase, urokinase, and recombinant tissue plasminogen activator (Alteplase) have been approved in the treatment of PE, with studies demonstrating similar safety profiles. We report the case of a 33 year old Bangladeshi female with a history of recent ankle fracture and immobilization, who presented with massive PE, leading to cardiac arrest. Upon rapid resuscitation, urgent echocardiogram revealed right ventricular dysfunction with floating right atrial thrombus, and she was successfully treated with 1.5 million IU of Streptokinase over 2 hours as per accelerated regimen recommended by the European Society of Cardiology (ESC) guidelines, resulting in successful resolution of the right heart thrombus, and significant clinical improvement. Subsequent CT Pulmonary Angiogram confirmed the diagnosis of PE, and she was anticoagulated to a PT/INR of 2.0 to 3.0.Anwer Khan Modern Medical College Journal Vol. 7, No. 1: Jan 2016, P 60-63

Truncus arteriosus communis (TAC) is a rare heart disorder with the prevalence of approximately 1%, mostly in male newborns with congenital heart defect (CHD). In this disease, aorta and pulmonary artery have not separated during fetal development and both originate jointly from a truncal vessel. In addition, various disorders are reported as associations of mitral and tricuspid valve defects, atrial septal defect (ASD), pulmonary hypertension, increase in heart rate and discharge syndrome. Ibrahim Cardiac Med J 2014; 4(2): 68-71

Ruptured Valsalva aneurysm is a rare cardiac anomaly that may be congenital or acquired, a coexisting cardiac lesion might be present. The presentation may range from an asymptomatic murmur to cardiogenic shock. Most of these cases were earlier diagnosed using echocardiography and conventional angiography. But with the availability of advanced imaging modalities like cardiac CT this condition can be accurately assessed noninvasively. The high spatial resolution of cardiac CT provides anatomical details of the aneurysm by depicting a jet of contrast materials extending from the aneurysm and adjacent cardiac chamber. We report a case of ruptured aneurysm arising from the non-coronary sinus with a fistulous track connecting the sinus with the right atrium. This case was evaluated by 32 slice cardiac MDCT (Multi detector computed tomography) imaging. This was later confirmed peroperatively. Ibrahim Cardiac Med J 2014; 4(2): 64-67

A 65 year lady with chest and back pain was referred to our hospital with suspected case of acute coronary syndrome. A computed tomography (CT) aortic angiogram showed dissection of abdominal and thoracic aorta. Patient was initially treated by drugs for controlling heart rate and blood pressure with analgesics but due to progression of disease and involvement of left subclavian artery ostium referred for surgical intervention. She underwent left carotid-subclavian bypass and TEVAR (Thoracic endovascular aortic repair) with good outcome. The present case is a good demonstration revealing that in absence of clinical suspicion and diagnostic imaging, acute aortic dissection represents a diagnostic dilemma which requires immediate action.Anwer Khan Modern Medical College Journal Vol. 6, No. 1: January 2015, Pages 46-49

not availableJ Bangladesh Coll Phys Surg 2015; 33(4): 232-234

DOI: http://dx.doi.org/10.3329/icmj.v2i1.17419 Ibrahim Cardiac Med J 2012; 2(1): 57-60

Mediastinal cavernous lymphangioma is a benign rare lesion originating from lymphatic system. It is usually asymptomatic. We have presented a 2 year old male child with fever for seven days. Opacity was found in chest X-ray in the upper part of right hemithorax, merged with the mediastinum.CT scan of chest was performed, which revealed a large, lobulated, smoothly marginated non-enhancing, low density, mediastinal mass, involving right half, extending from root of neck. Finally, pathological examination of the surgical sample indicated ?Cavernous lymphangioma’. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12612 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct’12

Coarctation of aorta (CoA) is a congenital vascular malformation usually diagnosed and corrected early in life but the diagnosis is missed or delayed unless there is a high index of suspicion. Long-term survival is exceptional in patients with untreated aortic coarctation. In our case report, we present a late diagnosis of aortic coarctation in a 24-year-old male who was relatively asymptomatic until he presented with progressive exertional dyspnoea, fatigue, headache and poorly controlled hypertension despite getting a combination of antihypertensive agents in his 2nd decade of life. The patient was managed by surgery of aorta. The coarcted segment was mobilized, resected totally followed by insertion of interposition tube graft of prosthetic material (PTFE) 20 mm in diameter with ligation and transfixation of patent ductus arteriosus (PDA). After 4-year follow-up visit, the patient is in good clinical condition. Ibrahim Cardiac Med J 2012; 2(2): 50-53

Many researchers have tried for aspiration of endometrioma followed by alcohol or tetracycline sclerotherapy in order to avoid delicate surgical procedure as well as to keep a functioning ovarian reserve. It has traditionally being used for recurrent cases of endometriomas. But this case report illustrates the importance of applying this procedure in unavoidable and exceptional circumstances.