Case: Solid mass in the left Iliac fossa with acute abdomen

The patient was seen at my chamber in practice. The girl of 11 years presented with severe abdominal pain and intermittent fever of two days duration.
Menustartion yet not started.

On examination, moderate tenderness was present in the left iliac fossa but no mass could be palpated. The patient was admitted on emergency and given conservative treatment for Acute Abdomen. Later, on evaluation a solid mass of 5cmX 4 cm was found in the left Iliac fossa on ultrasonography.
The patient was improved on conservative treatment of antibiotic, fluid, antipyretic and analgesic.
The follow up X-ray also showed a solid mass pushed the uterus to upward and to the right.
Laparotomy was done. The mass was found to be of ovarian origin and brown in color.
The change of color and solidity of the mass is likely due to haemorrhage into the overy due to torsion of the ligament of the overy.

News: we organised workshops on management of severe malaria

We have organised training programs for the physicians of the malaria prone areas in our hospital from 1st June 2008 in three batches, each bach having 5 day course. About 60 doctors from mainly from government health centres and some of our hospital attended the program.

The program was sponsored by GFATM and cordinated by the Malaria Control Program of Bangladesh Health Directorate and supported by WHO.

In the program, case defination of malaria, clinical presentation, diagnosis and assessment, management, recovery and follow up of severe malaria were elaborately discussed.

In addition, picture quiz were interesting and also there was multiple case studies. In the hospital real cases were seen,examined and recoded and then presented by the participants.

There was special session for microbiology- microscopic identification of malarial parasite, Rapid diagnostic test and preparation of thickand thin film.

The whole program was in micro-teaching format and participatory in nature.

Professor Emran bin Yunus, who is working as monitor in different countries of Africa and Asia on Malaria Research Program was focal person of the programs in our hospital, a private one and Chittagong Medical College Hospital, the public hospital.

I worked as the resouce person and the co-ordinatorof the program that is organised in our hospital.

We are happy that the program ended successfully on 18th June, 2008.

Case: Near Drowning

A boy of 13 months admitted in our hospital after 4 days of drowning with unconsciousness and repeated convulsion.

He was drowned in salt water pond four days back and stayed drowned for half an hour. After recovery from the pond, he was admitted in the local health centre but with no improvement.

On admission in our hospital he was unconscious and hypotonic. his GCS score was 4/15,
Hr-136/m, BP-120/70 mmHg, He was dysnoec but there was no other chest finding.
Opthalmoscope finding was normal.

His CBC, electrolytes was found normal.X-ray chest -normal.

He was labeled as a case of Near Drowning.

His convulsion was difficult to control. After repeated trial with Inj Phenobarbitone, Phenytoin and mannitol , it was controlled after after 2 days. By the next, few days though he regained his consciousness, but he developed spasticity of the limbs, visual impairment and hearing defect.


Dr. Badrud Doza
Dr. Fahim

Link: Drowning

Case: Ectodermal dysplasia-anhydrotic type

The mother with worry in her face told me in the outdoor setting that the boy, 10 months old, has no sweating and shoots to high rise of temperature especially in hot environment.

He was normally delivered, breast fed, immunized with normal milestone development, first child of a non-consanguineous parents of a upper middle class family, had no other major illness in the past.
On examination, the child is otherwise healthy, alert, well nourished. But his hair is sparse, scant eyebrow, no eruption of tooth, dry skin, little deformed nail. IQ normal.
His systemic examination reveals normal.
Provisionally we diagnosed the patient as Ectodermal Dysplasia-anhydrotic type

His skin biopsy was done which indicates the absence of epidermis and absence of sweat glands that conforms to the diagnosis.


Badrud Doza

Selected links for ED : 1) National Foundation for Ectodermal Dysplasia

Case: Spleenectomy with postoperative convulsion and impaired consciousness in a case of Thalassemia

A boy of 11 years was suffering from Thalassemia major. He was advised for spleenectomy as the huge spleen was causing respiratory embarrassment.

He was operated without any trouble. But he developed convulsion in the mid night which was focal in the right hand. He was given anticonvulsants and Inj Calcium. His electrolytes and the calcium show normal level. His convulsion was continuing intermittently. His convulsion become generalized and he GCS falls to 8. He was given Inj phenobarbitone and Sodium Valproate orally.

Convulsions were controlled and his consciousness was gradually improving. His speech was initially slurred which was also later improved.

We had a plan for CT scan but as the patient improved completely patient took the discharge.

We level the case as Thalassemia major with post operative convulsion due to emboli.

Dr. Badrud Doza
Dr. Shoma Chowdhury
Related link:
1) Thalassemia Foundation
2)International Thalasemia Foundation

Case: Pulmonary atresia with VSD and PDA

A girl of 8 years admitted in our hospital with hyperpyrexia of 3 days duration.

She is well built, of good nutrition, no pallor, but had cyanosis and clubbing
Precordial examination reveals cardiomegaly and a murmur in the pulmonary area with both systolic and diastolic in component with radiation to the clavicle. Other systems found normal

Her X-ray shows cardiomegaly with right vetricular enlargement. ECG shows right ventricular hypertropy and Echo shows Pulmonary Atresia, VSD and PDA.

The patient traveled to India earlier and was seen by great cardiac surgeon Dr. Devi Sethi.
The fever was of viral origin. After it subsided, patient was discharged and the parents were taking preparation to have the operation done at Bangalore shortly.


Dr. Badrud Doza
Dr. Fahim

Link : Pulmonary Atresia

Case: Hematoma of the liver

Sumon, 10 yrs of age from chittagong, was admitted with the complaints of fever for 7 days and passage of blood in the vomiting and stool for 3 days. He had a h/o trauma 15 days back.

Patient was alert but irritable, no jaundice, had rapid pulse and low pressure, was moderately pale. Patient had hematomegaly(4 cm) with severe tenderness.

Initially doctors was under the impresion of hepatitis. But his clinical condition was not fully correlating with hepatic failure to explain the hematomesis and melena.

His Hb was 3.4 gm/dl, ESR 82 mm/1st hour, TC of WBC-16000/cmm, Neutrophil-76%, Lympho -10%, Platelet 400,000/cmm, pheripheral blood film shows polymorphonuclear leaucocytosis.

His serum bilirubin was 1%, SGPT-157.5 unit/L, HbsAg negative, PT -normal.

USG reveals that hematoma/Abcess in the Rt love with approx. 5 cm X 6 cm in size.

We managed the patient with 2 units of blood and antibiotics.

Dr. Badrud Doza
Dr. Saiful Islam

Link: Hematoma of the Liver