ABSTRACT
Abstract: Introduction: Repair of congenital heart diseases has become a routine in infancy because of the physiological benefit of promoting normal growth and development, limiting the pathophysiological consequences of cardiac defects such as volume overload, pressure overload, and chronic hypoxemia. The concept of “fast track” postoperative care postcardiac surgery, predicated on early extubation, has been present for the last two decades. Advances in surgical techniques and postoperative management have altered the expectations for mechanical ventilation following cardiac surgery. Objective: The objective of the current study was to evaluate the timing of first extubation and compare the outcome of patient extubated early with others; we also evaluated the predictors of early extubation in our cohort. Materials and Methods: Between Julys to December 2019, BSMMU, Dhaka, Bangladesh 60 consecutive patients undergoing cardiac surgery were preoperatively selected for post-operative admission in the postanaesthesia care unit (PACU) and were included in this study the PACU pathway. This study included children <1 year of age undergoing surgery for congenital heart disease. Timing of first extubation was noted, and patients were dichotomized in the group taking 6 h after completion of surgery as cutoff for early extubation. The outcome of the patient’s extubated early was compared with those who required prolonged ventilation. Variables were compared between the groups, and predictors of early extubation were evaluated using multivariate logistic regression analysis. Results: One hundred and ninety four (33.8%) patients were extubated early including 2 extubation in operating room and 406 (70.7%) were extubated within 24 h. Four (0.7%) patients died without extubation. No significant difference in mortality and reintubation was observed between groups. Patient extubated early had a significant lower incidence of sepsis (P=0.003) and duration.....................

ABSTRACT
Abstract: A fracture bone usually heals by the formation of new bone at the fracture site. Occasionally, only fibrous tissue is formed, when this happens both surgeon & patient are disappointed. The bone is a specialized form of connective tissue may account for its ability to heal by the formation of new bone. The humerus is a long bone connecting two important joints of upper limb- which has wide range of movement having very little bony stability in shoulder joint and distal elbow joint which is a uni axial hinge joint. This prospective study of "treatment of nonunion of humeral shaft fracture by locking plate and screws augmented with autogenous cancellous bone grafting" was carried out during the period of 1st December 2018 to 31th May 2019 at Rajshahi Medical College Hospital, Rajshahi, Bangladesh. Sample size will be calculated by using following statistics = 384. Purposive sampling (non-randomized) according to availability of the patients and strictly considering the inclusion and exclusion criteria. Data will be collected with a pre-tested structured questionnaire containing history, clinical examination, laboratory investigations, pre-operative, per-operative, postoperative follow up findings and complications. 16 Patients were selected by using non randomized sampling method. The age ranges from 28-60 years. The mean age of occurrence was 38.19 (+10.04) years. Motor vehicle accident was the commonest cause of fracture found in 81.25% cases. Second most common cause was fall from height (12.50%). Right side involvement was more (62.50%). Among the affected people ser\Tce holders and shopkeepers were commonest (25% each), next were businessmen and farmers (18.75% each). The mean union time was 16.38 (+2.78) weeks. Postoperative complications were noticed such as wound infection (6.25%) and shoulder pain (6.25%). There was no complication (81.25%). Functional outcome of this treatment was analyzed by Constant and Murley ...........................

ABSTRACT
Abstract: Here, we report a 18 year-old man presented with tremor. The patient had a history pancolonic ulcerative colitis and he had been on corticosteroid in degression and azathioprine (AZA). He had no history of other medications, herbal or alcohol; no other diseases were diagnosised and no family history of note. The patient presented 1 month after taking AZA 2 kg/mg/day Involuntary, rhythmic movements and twitching of hands. Physical examination was normal. Biological tests and Electromyogram (EMG) were in favor of a physiologic tremor which is probably of toxic origin, and retain the diagnosis of tremor secondary to adverse effects of AZA. The outcome was favorable the day after stopping AZA. Despite its rarity, the tremor remains a significant side effect due to the socioeconomic effect that it induces.

ABSTRACT
Abstract: Background: The main reason to use prophylactic drainage in laparoscopic cholecystectomy (LC) is to reduce complications such as intra-abdominal collections thereby decreasing the overall mortality and morbidity rate but it has been reported that placement of drain leads to shoulder pain. The pain disappeared spontaneously within 1-3 days and occurred in 23% of the group with drains and 4% in the group without drains [1]. Materials and Methods: In this prospective randomized comparative study, 60 patients of ASA physical status I and II belonging to age group of 18-70 years undergoing elective laparoscopic cholecystectomy were randomly allocated into 2 groups of 30 patients each, Group A (LC with drain) and Group B (LC without drain) patients were assessed in terms of post-operative shoulder pain from post-operative day-1 to day-4 which was measured using visual analogue scale (VAS). Results: Shoulder pain was significantly higher in Group A (LC with drain) in comparison to Group B (LC without drain) at post-operative day-1 to day-4. Conclusion: In the patients undergoing laparoscopic cholecystectomy, use of subhepatic drain is associated with increased shoulder pain.

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Abstract: Ruptures of the distal tendon of the biceps brachii are rare, explaining the late diagnosis. The origin is often traumatic in a young, hard-working man. Surgical treatment has evolved a lot and several surgical techniques are described, and they have reported good results. We report 3 cases of rupture of the distal tendon of the biceps brachii treated surgically by anchors, by anterior single approach as well as the results obtained.

ABSTRACT
Abstract: The essential bone cyst is a benign lytic lesion, which is mainly observed during growth. It is located near a growth cartilage, on the metaphyseal side. The most frequent locations are the upper extremity of the humerus and femur. Essential bone cysts are asymptomatic, apart from pathological fractures due to weakening of the bone. The spontaneous evolution of the cyst is towards diaphyseal migration, at the cost of several fractures. We report the case of a 16-year-old child who presented with an iterative fracture of the humerus on an essential bone cyst, having migrated in the diaphyseal position and treated surgically. Through our work, we want to focus on the predictive factors of recurrence and illustrate through a case study, the diagnostic and therapeutic approach of the essential bone cyst.

ABSTRACT
Abstract: Arteriovenous Malformationis a rare primary lesion of the spine. The lesion could be located extra or intra dural. The conus medullaris malformation is a special lesions which leads to progressive myelopathy or radiculopathy. The lesion is characterized by multiple feeding arteries, multiple niduses, and complex venous drainage. The neurological deficits may be improved dramatically over time when these lesions are successfully treated, however, the numerous feeding arteries and multiple niduses create a potential for recurrence.We report a case of a 36-year-old man complaining of serious lower limbs muscle weakness. The MRI scan showed multiple arteriovenous systems go around the conus medullaris. The spinal cord is enlarged with spinal cord edema. Embolization was proformed to stop the blood flow of main feeding artery. Post-operation the lower limb muscle weekness has been significantly improved. The patient can walk without additional support. Until the 3 months follow-up, the clinical result was satisfied.