Browsing by Author "Acharya, L"
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Publication Allergic Fungal Rhinosinusitis in Chronic Rhinosinusitis(Nepal Health Research Council, 2011) Shrestha, S; Kafle, P; Akhter, J; Acharya, L; Khatri, R; KC, TBackground: Rhinosinusitis is the inflammation of nasal and paranasal sinus mucosa and is associated with mucosal alteration ranging from inflammatory thickening or gross nasal polyp formation.The main objective of this study is to etermine the prevalence of allergic fungal rhino sinusitis among the patients having chronic rhino sinusitis with or without polyps who under goes functional endoscopic sinus surgery. Methods: The patient with chronic rhinosinusitis with or without polyp who FESS were studied. Surgical specimens were sent for mycology and histopathological analysis for identification of fungus. Results: Headache 41(82%) and nasal block 45(90%) were the commonest clinical presentation. Out of 50 patients,fungal elements were detected by KOH in 8(16%) of cases and histopathological examination in 11(22%) of cases. Conclusions: Allergic Fungal Rhinosinusitisis a common disorder in patients with chronic rhinosinusitis, it needdifferent specific tests for the diagnosis, a more specific diagnostic tests are fungus culture, and IgE to fungal antigen and skin test are needed for definite diagnosis. Keywords: allergy, fungus, rhinosinusitis, sinusitisPublication Histomorphological Spetrum of Breast Lesions(Nepal Health Research Council, 2011) Parajuli, S; Koirala, U; Khatri, R; Acharya, L; Suwal, ABackground: Cancer of the breast is the second most common cause of cancer in women. Mass in the breast, whether benign or malignant is a cause of anxiety to the patients and the family members. All breast lumps are considered to be carcinomas until proved otherwise and are the causes of concern both for the patient and surgeon. Methods: This is a retrospective study conducted in Kathmandu Model Hospital for a total duration of three years from August 2007 to August 2010. Results: 114 sample of breast tissue sent for histopathology were studied. Peak incidence of benign lesion was in between 21-30 years and malignant lesions in between 31-50 years. No breast lesions were seen in the first decade of life. Cancer of the breast was seen in 12.28% of cases. Fibroadenoma and fibrocystic disease were the commonest benign lesion and infiltrating ductal carcinoma was the commonest malignant lesion. Specimens from 10 male breasts were received. Gynaecomastia was the most common lesion encountered in males. Infiltrating ductal carcinoma was seen in a 70 year old male. Conclusions: Breast cancer is one of the commonest causes of breast lump particularly in women and is growing public health problem in Nepal. Keywords: breast cancer, breast lumps, excisional biopsy.Publication Role of CaCO3 alone and CaCO3 plus Vitamin D3 in terms of Calcium Phosphorus Product in Chronic Kidney Diseases(Nepal Health Research Council, 2011) Adhikary, L; Acharya, S; Acharya, LBackground: CaCO3 alone and CaCO3 plus vitamin D3 metabolites are commonly prescribed in CKD patients. The objective of this study is to analyze the changes in Ca x P product, calcium level and phosphorus level in CKD patients receiving calcium carbonate alone and calcium carbonate with vitamin D3 in combination. Methods: A prospective, cross sectionalstudy among CKD patients under maintenance hemodialysis two times a week were studied over a period of one year. The patients were divided into two groups receiving oral CaCO3 alone and CaCO3 plus vitamin D3 once a day. The patients were followed for 1 month and result of Ca x P product was analyzed accordingly. Results: Mean decrease of Ca x P product in CaCO3 group is (50.42+/-8.85 to 47 +/-6.63) in one month, p value =0.001(0.6-5) and CI- 95%. There is also significant reduction of phosphorus level in CaCO3 group than CaCO3 plus vitamin D3 group. Mean decrease in phosphorus in CaCO3 group is (5.51+/-0.76 to 5.17+/- 0.05) in one month. P value =0.01(0.14-0.53) and CI 95%. Conclusions: There is a significant decrease in Ca x P product and phosphorus level was observed in CKD patients taking CaCO3 alone. Keywords: calcium carbonate, calcium phosphorus product, chronic kidney disease, vitamin.Publication Semirigid Ureteroscopy with Pneumatic Lithotripsy for Ureteral Stone(Nepal Health Research Council, 2011) Dongol, UMS; Acharya, L; Subba, K; Khambu, B; Joshi, R; Shrestha, S K; Singh, D RBackground: Ureteral stones present with acute loin to groin pain. The objective of this study is to find out the outcome and safety of semi-rigid ureterscopy with pneumatic lithotripsy for treatment of ureteral stones of >30 mm2 and to assess the impact of size and location on stone free (SF) rate. Methods: Total 110 patients with isolated ureteral stone size>30 mm2 were included in this study and treated with pneumatic lithotripsy using 8/9.8 Fr. Semi-rigid ureteroscope (Stiema Germany). Stones were fragmented into 2-3mm particles and removed. Outcome parameters assessed at 3 months follow up were stone free rate(SF), Efficiency Quotient (EQ), and impact of stone size and site on SF/EQ was also analyzed. Similarly, patient demographics, procedures, patient related parameters and complications were also noted. Results: The overall SF rate at 3 months follow up was 69.33% and efficient Quotient (EQ) 52.52%. The SF/EQ for upper, middle and lower third of ureteral stone was 55/37.67,6/43.57, 92/84.40 respectively (P-value< 0.001). The SF for stone size 30-110 mm2 and >110mm2was 78% and 67% respectively. There were no major complications seen. Overall minor complication rate was 5.45 % (minor ureteral perforations-5, urinoma formation 1). Conclusions: Semi-rigid ureteroscopy with pneumatic lithotripsy is a safe, simple and effective procedure for ureteral stones with excellent success rate for distal ureteral stones. The stone free rate and EQ are statistically significant (P value<0.001) between upper, middle and lower ureteral stones. Stone size has a direct impact on the SF rate and EQ. Keywords: semirigid uerteroscopy, pneumatic lithotripsy.