Bangladesh Medical Journal The official organ of the <a title="BMA" href="" target="_blank">Bangladesh Medical Association</a>. Full text available. Bangladesh Medical Association en-US Bangladesh Medical Journal 0301-035X Factors Affecting the Success Rate of Renal Stone Treatment by Extracorporeal Shock Wave Lithotripsy <p>ESWL is one of the treatment modalities for kidney stones smaller than 2 cm. However, not all ESWL treatments are successful. The success rate has been reported to be between 50% to 87%, depending on various factors. This study was conducted to evaluate factors affecting the success rate of renal stone treatment by extracorporeal shock wave lithotripsy (ESWL). The study was carried out for a period of one year where total 96 patients with single or multiple radio-opaque renal stones treated with ESWL monotherapy using Stortz Modulith SLX-F2 lithotriptor were included. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments (&lt;4mm). The results of treatment were correlated with the patient characteristics (age, sex, body mass index) and stone features (size, site, number and radio density). At 3-months follow-up, the overall success rate was 76%. Among them, repeated ESWL sessions were required in 19 patients (53.9%). Post-ESWL complications were recorded in 8 patients (12.5%). Four factors had statistically significant impact on the success rate, namely stone site, size (the largest diameter of the stone), stone number, BMI (body mass index) of the patient. The success rate is highest for stones located in the upper calyx (26/26; 100%) and lowest for those located in lower calyx (15/20; 75%) (p=0.019). Stone with a largest diameter of &lt;15mm are associated with a success rate of 93.6% (59/63), compared to 75.82% (25/33) for those with a diameter of &gt;15mm (p=0.01). The success rate is also higher for single stone (76/84; 90.5%) than multiple stones (8/12; 66.7%) (p=0.02). Patients with lower BMI (&lt;24) have a better success than higher BMI (&gt;25) (p=0.001).Other factor including age, sex and stone radio density compared to ipsilateral 12th rib have no significant impact on the success rate. The success rate for ESWL for the treatment of renal stones can be predicted by stone size, location, number, and patient BMI.</p> <p>Bangladesh Med J. 2017 May; 46 (2): 1-6</p> Abul Hasanat Muhammad Afzalul Haque Md Waliul Islam Humayun Kabir Kallol Md Shaful Alam Babul Muhammad Habibur Rahman ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 1 6 10.3329/bmj.v46i2.40214 Microbiological Study of Chronic Suppurative Otitis Media <p>Chronic suppurative otitis media (CSOM) is a prevailing and notorious infection in developing countries causing serious local damage and threatening complications. The purpose of the present study was determine the microbiological profile of isolates from discharge in CSOM. This study was conducted at out-patient department of ENT at Rajshahi Medical College Hospital, Rajshahi from January 2014 to December 2014. Samples were taken from 185 patients (both male and female) in all age groups suffering from chronic suppurative otitis media. Their Gram staining, culture, and biochemical tests were carried out to identify the organisms. It showed the predominance by staphylococcus aereus (29.13%), followed by Pseudomonas Aeruginosa (22.83%), Streptococcus Pyogen (14.96%), E.Coli (9.44%), Proteus Mirabilis (6.29%), Klebsiella Pneumonia ( 4.72%).</p> <p>Bangladesh Med J. 2017 May; 46 (2): 7-9</p> Rifat Nousin Shumi Abdullah Siddiqe Arefa Akter ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 7 9 10.3329/bmj.v46i2.40210 Incidence of Central Diabetes Insipidus among the Patients Undergoing Pituitary Tumor Surgery through Trans-sphenoidal Approach <p>This study was carried out to find out the incidence of central diabetes insipidus (DI) among the patients undergoing pituitary tumor surgery through trans-sphenoidal approach either endoscopic or microsurgical for the first time. Patients with central (Neurogenic) diabetes insipidus prior to surgery, comorbidities like diabetes mellitus, kidney diseases, electrolyte imbalance, recurrent cases were excluded from this study. Patients were followed up to 7th postoperative day by recording and analyzing findings of postoperative serum electrolytes, urinary specific gravity, hourly urinary volume for establishing diabetes insipidus. 76.9% and 23.1% of patients developed diabetes insipidus those who underwent pituitary tumor surgery by trans-sphenoidal endoscopic approach and microsurgical approach respectively. 70% and 30% of patients did not develop diabetes insipidus those who underwent pituitary tumor surgery by trans-sphenoidal endoscopic and microsurgical approach respectively. There was no significant deference between the approaches were found. Fisher exact test was done and p-value was 0.712. Prediction of DI help us in pre-operative counseling and post-operative management of the patients as well as to reduce complications related morbidity after pituitary tumor surgery.</p> <p>Bangladesh Med J. 2017 May; 46 (2): 10-15</p> KM Tarikul Islam Shamsul Alam Rezaul Amin Haradhon Deb-nath Mohammad Hossain Akhlaque Hossain Khan ATM Mosharef Hossain Kanak Kanti Barua ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 10 15 10.3329/bmj.v46i2.40211 Sero-prevalence of Transfusion Transmissible Infections among Voluntary Blood Donors of Khulna Medical College Hospital <p>Transfusion transmitted infections (TTI) are a great concern of safety for patients. Blood transfusion is a lifesaving procedure but always caries a potential risk of infections.The present study was designed to evaluate the prevalence of infectious disease markers and frequency in males and females of various age groups among healthy blood donors. A retrospective review of donor record over a period of 2 years between 2015 to2016 was done at the department of transfusion medicine Khulna medical college Hospital, Khulna, Bangladesh.Among the total 37,266 donors,358(0.96%) donors were infected and therefore not suitable for blood donations.HBV was found to be the most frequent infection with a total frequency of 0.72% followed by TP (0.20%), HCV (0.03%) and HIV (0.01%). None of the blood samples showed positivity for malarial parasite.Majority of the seropositive donors, (47.96%) were in the age group of 26 to 35 years followed by 29.47% in 18 to 25 years’ age group.</p> <p>Bangladesh Med J. 2017 May; 46 (2): 16-21</p> SM Tushar Alom Kanak Jyoti Mondal Shirin Tarafder Farah Anjum Sonia Poritosh Kumar Chowdhury Md Shoriful Islam ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 16 21 10.3329/bmj.v46i2.40212 Predisposing Factors and Surgical Management of Obstructive Sleep Apnoea in Children <p>Obstructive sleep apnoea (OSA) is a condition characterized by episodic partial or complete obstruction of the upper airway during sleep. This cause apnoea or cessation of breathing. During sleep, muscles around the airway relax causing the throat and upper airway to narrow. This leads to snoring, but it can also lead to the airway being blocked. Trying to breathe against a blocked airway causes oxygen levels to fall and carbon dioxide to rise. This cross-sectional study was conducted in Department of ENT, Dhaka Shishu (Children) Hospital and Dhaka Medical College Hospital from April to September’2015. The purpose of the study was to prevent significant morbidity and enhancement of child growth. One hundred children of OSA were studied by detail history and clinical examination. All children whose parents consulted their ENT surgeon in Dhaka Shishu(Children) Hospital and DMCH for snoring or laboured breathing during sleep (nocturnal sweating particularly in the nuchal area, unusual sleeping positions, restless sleep, awakening and excessive movements, intercostals recession and dry mouth) were included in the study. More common predisposing conditions for OSA were obesity and Craniofacial anomalies which were 34% and 27% respectively. In present study most of the children (73%) were managed by Adenotonsillectomy and 27% children were manage by Adenoidectomy. Outcome data have demonstrated that surgical therapy can be successful in the treatment of OSA.</p> <p>Bangladesh Med J. 2017 May; 46 (2): 22-25</p> Syed Hasan Imam Al-Masum Syed AM Asfarul Abedin Anup Kumar Chowdhury Bishwojit Kumar Saha Md Nazmul Islam Md Mahbub Alam ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 22 25 10.3329/bmj.v46i2.40213 Aetiological Evaluation of Patients with Meningitis in a Tertiary Care Hospital of Bangladesh <p>Meningitis is a global health problem as mortality is high and a large proportion of survivors suffered from significant morbidity. The physicians are facing this challenge of emergency identification of this clinical syndrome, establishing its etiology and its prompt treatment not only to ensure survival but also to prevent long term sequelae in these patients. Poor outcomes caused by bacterial meningitis due to delays in diagnosis and treatment. In Bangladesh, the epidemiological study regarding meningitis in adults is rare. Rapid &amp; easily available as well as specific test or means are also not in our hand. The aim of this study was to evaluate the aetiology of patient with meningitis in tertiary care hospital of Bangladesh.The main objective was to evaluate the aetiology of meningitis of patients admitted in medical wards of a tertiary care hospital. The study was a descriptive type of observational study. The study was carried out in the Department of Medicine, Dhaka Medical College Hospital, a tertiary level hospital of Bangladesh from first July 2013 to thirty first December 2013. A total 50 patients were enrolled with Meningitis, diagnosed on clinical, biochemical, other investigational background , fulfilling the inclusion and exclusion criteria. Patients having feature of meningitis was enrolled in the study after getting informed written consent from patient or attendant. Detail demographic data were collected from the informant was recorded in structured case report form. Clinical examination and relevant investigation with CSF study were done. Routine follow up of the patient was done. Data analysis was conducted with SPSS software. Among the 50 patient the mostly affected groups were below 40 years of age comprising 66%. The mean(±SD) age was 33.04 ±18 years. There was an overall male preponderance with a male to female ratio 1.63:1 (N=31 vs N=19). The highest number of patients were presented with fever (100%), headache (98%) and altered mental status (88%). Among all 50 cases of meningitis 27(54%) were diagnosed as pyogenic, 9 (18%) were tuberculous meningitis and 14(28%) were viral . Out of 27 pyogenic meningitis cases 19 (70.37%) developed convulsion, out of 9 tuberculous meningitis 3 (33.33%) developed convulsion and 11 (78.57%) out of 14 viral cases had convulsion, that is convulsion was more common in viral cases. Sixteen male patients (51.61%) and 11 female patients (57.89%) had pyogenic meningitis, 5 male patients (16.12%) and 4 female patients (21.05%) had tuberculous meningitis. On the other hand, 10 (32.25%) male and 4 (21.05%) female had viral meningitis. P value was 0.369, So the male and female difference was not statistically significant. Diagnosis was made on the basis of clinical findings and CSF study. Pyogenic were more common than viral cases and tubercular meningitis. Meningitis is foremost causes of morbidity and mortality. It is recommended that provision of proper health care support, Proper and rapid detection and others investigation facilities reduce the disability. In the interim, this study provides data that can inform public health strategies directed at assessing and reducing meningitis severity and meningitis events.</p> <p>Bangladesh Med J. 2017 May; 46 (2): 26-31</p> Sadia Islam Md Nazmul Hasan Md Azharul Hoque Mohammad Selim Shahi Md Atikur Rahman Mehedi Hasan ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 26 31 10.3329/bmj.v46i2.40215 Elevated Level of Plasma B-Type Natriuretic Peptide (BNP) as a Prognostic Marker in Patients with Acute Coronary Syndrome <p>Acute coronary syndrome (ACS), a life-threatening manifestation of coronary artery disease, ranges from unstable angina (UA) to acute myocardial infarction (AMI). To reduce the morbidity and mortality resulting from acute coronary syndrome, we should have to find out some predictor or prognostic indicator. A prognostic indicator should be available at the time of initial patient’s evaluation, in order to maximize the potential benefits of early risk assessment. This study designed to evaluate plasma BNP as a prognostic tool in patients with acute coronary syndrome. A prognostic cohort study was carried out with 90 (ninety) acute coronary syndrome patients on the basis of their clinical and laboratory criteria with age range of 30 to 90 years in the department of biochemistry, BSMMU, in collaboration with department of cardiology, NICVD, BSMMU and BIRDEM. Plasma BNP concentrations were measured on enrollment and then grouping of the study subjects were done on the basis of their empirical cut off value of plasma BNP concentration. All the patients were free from heart failure, renal disease, thyroid disease and hepatic disorder. Main outcomes were mortality, morbidity and survival after hospital discharge with or without any disability. All the subjects were categorized into two and to see the significance between two groups in relation to age and sex Unpaired –t test and Chi square test were done. Finally, Binary logistic regression was done. Among 90 acute coronary syndromes patients, there were 74(82.2%) male and 16(17.8%) female with mean age of the study population 51.8 years and the age range of 30 t0 90 years. Among enrolled patients, 24 (26.7%) were NSTEMI and 66 (73.3%) were STEMI that includes 29 (32.2%) anterior MI, 21 (23.3%) inferior MI, 16 (17.8%) other varieties of MI. All the study subjects were grouped into two on the basis of empirical cut off value of plasma BNP 640pg/ml on enrollment. Group I with plasma BNP level less than 640pg/ml includes 57 (63.3%) subjects and group II with plasma BNP more than 640pg/ml includes 33 (36.7%) subjects. Among group I (n=57) good recovery, morbidity and mortality found to be in 41(71.9%), 15(26.3%) and 1(1.8%) patients and those in group II (n=33) found in 6(18.2%), 19(57.6%) and 8(24.2%) patients respectively. Keeping the group I in reference category binary logistic regression analysis done, showing odds ratio 11.5 with p- value 0.000. The odds ratio 11.5 indicates that there is 11.5 times higher chance of getting bad outcome in ACS patients having higher plasma BNP concentrations.</p> <p>Bangladesh Med J. 2017 May; 46 (2): 32-37</p> Dilshad Parvin Md Nasir Uddin Md Shahjahn Kabir Afsana Ahmed SM Rahat Hossain Md Mahbubur Rahman Md Mozammel Hoque ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 32 37 10.3329/bmj.v46i2.40216 Risk Factors of Burst Abdomen in Emergency Laparotomy <p>Burst Abdomen is a preventable condition in which many risk factors play their role and lead to life threatening complications. This study was carried out to find out various risk factors of burst abdomen following emergency laparotomy, to find out the high risk group of patients for burst abdomen, to determine the predictors of burst abdomen, to prevent the rate of burst abdomen &amp; find out morbidity and mortality of burst abdomen. This cross sectional study was done among 100 cases of burst abdomen occurring in Sir Salimullah Medical College &amp; Mitford Hospital, Dhaka and Dhaka Medical college,Dhaka during the period of July,2011 to December,2011. The patients were admitted for various surgical problems and underwent emergency laparotomy. Burst abdomen was taken into account. Another group of 100 patients who undergone emergency laparotomy but did not develop burst abdomen were also taken into account to make a comparison with the burst group. Patients who undergone elective laparotomy,paediatric age group,patients undergone exploration through mini laparotomy or transverse incision,patients with pregnancy were excluded from the study populations.Patients were assessed by history taking, examination and appropriate investigation before surgery and observed post operatively for any complication. The results were prepared on 100 patients underwent emergency laparotomy in SSMCMH &amp; DMCH. Burst abdomen following emergency laparotomy results from multifactorial causes. The main outcome measure found significant as the risk factors of burst abdomen in this study were peritonitis (95%),anaemia (26%),malnutrition (18%), in the preoperative period; inadequate peritoneal toileting and faulty surgical techniques in the per operative period; and wound infection (62%), postoperative cough (28%), abdominal distension (22%). The result also shows that the rate of burst abdomen is still very high in SSMCMH &amp; DMCH and most of them occur in operations done by trainee surgeons (86%) and in those patients who has 3 or more of the risk factors (44%). We hope this study will arouse awareness and concern about this problem, so that more active steps will be taken for its prevention by identifying the high risk groups. This will certainly reduce the incidence of burst abdomen.</p> <p>Bangladesh Med J. 2017 May; 46 (2): 38-42</p> Muhammad Harun Ar Rashid Liton Kumer Shaha Sanjana Sharmin Shashi Imtiaz Faruk ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 38 42 10.3329/bmj.v46i2.40217 Effect of Verapamil Adjuvant with Local Anaesthetic Mixtures in Supraclavicular Brachial Plexus Block <p>Among the various approaches to block brachial plexus , supraclavicular approach offers a high success rate for elbow, forearm and hand surgery . Various adjuvant drugs have been used with local anesthetics in order to decrease the time of onset and prolong the duration and quality of regional blocks. So efforts were made to combine the adjuvant with local anesthetics to improve patient and surgeon satisfaction. In this randomized study we tried to see the effect of verapamil in brachial plexus block as an adjuvant with local anaesthetic .This randomized study wasconducted in Anaesthesiology department of ShaheedZiaurRahman Medical College Hospital after approved by the ethical review board of this hospital.The study subject were divided into two groups (Group A=only local anaesthetics&amp;Group B=local anaesthetics with Verapamil) , 30 IN numbers in each group. Group-A patients was administered 15ml of 1% lignocaine with 15 ml of bupivacaine 0.25% while in Group-B patients was administered injection verapamil 3.5 ml (3.5 mg) in addition to the above mixture. In this study mean onset time of sensory block was 11.53 ± 1.4 minutes in group - A and 7.12 ± 1.68 minutes in group – B which is not statistically significant (p value = 0.057). The mean onset time of motor block in group A was 15.26 ± 1.96 min, and in group B was 11.58 ± 2.68 min and this difierence isstatistically significant (p value=0.000152). Duration of motor block was 96.30 min and 115.08 min in group A and Group B respectively. Sensory block was 157.26 min and 188.0 min in group A and Group B respectively. Regarding the heart rate, no significant difference was detected between the groups at the time of preanesthesia and at the 5 min after anaesthesia. Compared with group B patients, group A patients shows slight but statistically significant increased heart rate at the 10 min (80, 92 beat/min respectively) after brachial plexus block. At 30 minute after, mean systolic BP was 97.9±4.7 mmHg in group A and 84.3±5.0 mmHg in group B. At 45 minute after, mean systolic blood pressure was 94.6±15.6 mmHg and 84.3±5.0 mmHg in group A and group B respectively. At 60 minutes after, mean systolic blood pressure was 59.6±6.0 mmHg in group A and 61.2±9.4 mmHg in group B. At 15, 30 and 45 minute difference was statistically significant (p&lt;0.05) between two groups. In conclusion, the study revealed that verapamil can be used as an adjuvant to decrease the onset time of sensory and motor blocks of bupivacaine in supraclavicular block. Moreover, verapamil doses in regional blocks did not show any hemodynamic side effects.</p> <p>Bangladesh Med J. 2017 May; 46 (2): 43-47</p> Md Arman Ali Md Latifur Rahman Mehdi Hassan Rezwanur Rahman Kai Nur Asfia Mohammad Anisur Rahman SK Murad Ahmed ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 43 47 10.3329/bmj.v46i2.40218 Comparison of Test Validity of Magnetic Resonance Imaging in the Diagnosis of Diffierent Grades of Astrocytoma <p>Accurate detection of astrocytomas is very difficult. The purpose of the present study was to evaluate the usefulness of MRI in detection of intracranial astrocytoma. This cross-sectional study was conducted at the Department of Radiology and Imaging with the collaboration of Department of Neurosurgery and Department of Pathology at Sir Salimullah Medical College (SSMC &amp; MH), Dhaka from January 2013 to December 2013 for a period of one year. All the clinically suspected and CT scan diagnosed cases of intracranial astrocytoma patients of any age of both sexes were included as study population. All cases having no contraindication for MRI underwent MR examination. MR imaging was obtained with 0.5 Tesla machine (SIEMENS). The postoperative resected tissues were examined histopathological in the respective department. Then the collected reports were compared with findings of MRI. The sample size of the present study was 48 astrocytoma patients. The highest sensitivity was found in grade III astrocytoma (90.5%) followed by grade II (85.7%) grade IV (75.0%) and grade I (60.0%). The highest specificity was found in grade I astrocytoma (97.7%) followed by Grade III (96.3%), grade IV (92.5%) and grade II (91.5%). The highest accuracy was found in both grade I astrocytoma (93.7%) and grade III (93.7%) followed by grade II (92.5%) and grade IV (89.6%). In the conclusion, MRI is an effective tool for the diagnosis of astrocytoma. MRI has a high diagnostic validity for the detection of different grades of astrocytoma.</p> <p>Bangladesh Med J. 2017 May; 46 (2): 48-52</p> Swati Munshi Farid Ahmed Bibekananda Halder Abdullah Yousuf Md Mahbubur Rahman Snigdha Sarker ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 48 52 10.3329/bmj.v46i2.40219 Pigmented Villonodular Synovitis Treated as Spondyloarthritis for Four Years- A Case Report <p>Pigmented villonodular synovitis (PVNS) is a rare disorder where abnormal synovial proliferation and insidious swelling are the characteristic features. As insidious joint swelling has many common causes and PVNS is rare entity, so that it may be missed or under evaluated. Here inconclusive biopsy findings at an early stage and features resembling spondyloarthritis (SpA) delayed the diagnosis. A 28-year-old young man presented with insidious swelling of knee. Here repeated aspiration and synovial fluid analysis with routine serological and radiological examination were inconclusive. Then he was labeled and treated as spondyloarthritis (SpA) for four years without improvement. After four years of sufferings he admitted here and reached the diagnosis of PVNS with the help of MRI and synovial biopsy. Sometimes rare disease diagnosis is complicated by the absence of typical features and inconclusive reports. Common differentials may mimic the diagnosis and rare disease may loss the attention. Here PVNS was treated as SpA for four years before being diagnosed.</p> <p>Bangladesh Med J. 2017 May; 46 (2): 53-55</p> Md Masudul Hassan Md Ekramul Islam Md Nazrul Islam Abul Khair Ahmedullah Md Nazmul Hasan ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 53 55 10.3329/bmj.v46i2.40220 Thrombocyteapheresis for the Treatment of Essential Thrombocythemia Presented as a Digital Ischaemia- A Case Report <p>Thrombotic manifestations of essential thrombocytosis (ET) may be a life threatening condition. The conventional cytoreductive therapy or radioisotopes may take long time to reduce the platelet counts whereas thrombocyteapheresis can reduce the count more rapidly. Here the reported case is an essential thrombocytosis presented with digital ischaemia and was managed with intermittent flow centrifugal thrombocyteapheresis combined with hydroxyurea to reduce the platelet count.Thrombocytopharesis is an effective method and safe to reduce platelet count acutely. Thrombocyteapheresis has been done for the first time for the treatment of essential thrombocythemia (ET) in BSMMU probably also in Bangladesh.</p> <p>Bangladesh Med J. 2017 May; 46 (2): 56-58</p> Md Nazmul Hasan Sheikh Anisul Haque ABM Al Mamun Ashraful Hoque Md Ashadul Islam ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 56 58 10.3329/bmj.v46i2.40221 Haemolytic Diseases of Newborn (HDN)- A Case report <p>Allo-antibody mediated Haemolytic diseases of newborn in the common term of blood group fetomaternal incompability. Most of the HDN are due to Anti-D allo antibody of a D-Negative mother where the child is D positive1. In this case study we describe an unusual HDN in a D+ve mother where the child is also D positive. Fetomaternal incompability is a clinical syndromes in the fetus Caused by the placental transfer of a maternal allo-antibody. Blood group incompability is the major cause of incompability. Among blood groups ABO, Rhesus, Kell, Kidd, Duffy are mostly involve in HDN. About 2/3rd of all pregnancy are ABO incompatible, but it is of very mild type and usually not identified. But rhesus &amp; others blood groups involve rest 1/3rd incompatibility, which are severe form of HDN.</p> <p>Bangladesh Med J. 2017 May; 46 (2): 59-60</p> Ayesha Khatun Jolly Biswas MM Habibullah Atiar Rahman Zillur Rahman Bhuiyan Danis Arefin Biswas ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 59 60 10.3329/bmj.v46i2.40223 Choroid Plexus Papilloma with Dandy Walker Variant: Co-existence or Association- A Case Report <p>Choroid plexus tumors are rare intracranial tumors which account for 0.4-0.6% of all brain tumors. Choroid plexus tumors represent a spectrum of neoplasms derived from papillary epithelium of normal choroid plexus, including well-differentiated papilloma (WHO grade I), intermediate form as atypical Choroid Plexus Papilloma (WHO grade II) and highly aggressive choroid plexus carcinomas (WHO grade III). Though rare, it is responsible for the communicating hydrocephalus in children due to overproduction of cerebrospinal fluid. Due to advances in molecular biology and better understanding of the tumorigenesis of choroid plexus papilloma, now it is established that several genetic syndromes and central nervous sytem abnormalities are associated with this tumor. Here, we reported a case of a 10 months old child who presented with sudden deterioration of consciousness level and after thorough evaluation, diagnosed as a case of Choroid Plexus Papilloma with Dandy Walker Variant. Till date, this is the first reported case of the association/ co-existence of such two conditions which needs further evaluation.</p> <p>Bangladesh Med J. 2017 May; 46 (2): 61-65</p> Mohammad Hossain Nazmin Ahmed Narendra Shalike Md Rokibul Islam Soumen Samadder Mohammad Shahnawaz Bari Satish Kumar Shah ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 61 65 10.3329/bmj.v46i2.40222 Managing Progressive Subcutaneous Emphysema in Patient on Invasive Positive Pressure Ventilation <p>Subcutaneous emphysema (SE) results from air leak from lung parenchyma into the least resistance subcutaneous tissues. Mostly a self limiting condition but extensive subcutaneous emphysema (ESE) may lead to anxiety, disfigurement, discomfort, respiratory embarrassment, upper airway obstruction and systemic air embolism and requires active management. We report successful management of progressive SE in a patient on invasive positive pressure mechanical ventilation using a newer approach and also discuss the role of surgical tracheostomy as a rescue measure.</p> <p>Bangladesh Med J. 2017 May; 46 (2): 66-67</p> Anudeep Jafra Dheeraj Kapoor ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 66 67 10.3329/bmj.v46i2.40224 Obituary news May-17 <p>Abstract not available</p> <p>Bangladesh Med J. 2017 May; 46 (2): 68</p> Kazi Shafiqul Halim ##submission.copyrightStatement## 2019-02-14 2019-02-14 46 2 68 68 10.3329/bmj.v46i2.40225