Browsing by Author "Adhikary, S"
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Publication A comparative study of early vs. delayed laparoscopic cholecystectomy in acute cholecystitis(Kathmandu University, 2009) Yadav, RP; Adhikary, S; Agrawal, CS; Bhattarai, B; Gupta, RK; Ghimire, ANAPublication Abdominal Cocoon in an Adolescent Male(Kathmandu University, 2012) Shakya, VC; Agrawal, CS; Rajbanshi, SK; Pradhan, A; Khaniya, S; Adhikary, SABSTRACT Abdominal cocoon is an uncommon peritoneal condition characterized by partial or complete encasement of small bowel by a thick rind of fibrous tissue and adhesions. Only few cases of this disease have been reported in world literature. The etiology of this condition is unknown, and most often it is found in adolescent girls from tropical or subtropical countries, and usually diagnosed incidentally on exploration. Surgery (membrane dissection and extensive adhesiolysis) is the treatment of choice. Here, we report a case of abdominal cocoon in a 20-year-old male patient, with a brief review of the literature. KEYWORDS Abdominal cocoon; adhesiolysis; intestinal obstructionPublication Endoscopic Excision of A Fibroadenoma Breast: Trans Axillary Approach(Kathmandu University, 2012) Adhikary, S; Sood, S; Dhungel, K; Rajbanshi, S; Shakya, V; Khaniya, SABSTRACT Benign breast lumps affect 10% of females in their lifetime. Surveillance, assurance, medications and surgical excision are options available to surgeons. Avoiding scars on the breast is an inherent feminine desire. Numerous minimal invasive approaches have evolved due to this concern. The time honoured circumareolar incisions camouflages the scar to a large extent, yet the incision still remains on the breast tissue and unfortunately the scar undergoes the same old sequelae as with any other scars both aesthetically or psychosocially. The close by anatomical space; axilla provides an easy access for endoscopic breast surgery. We utilized this area and applied our expertise to remove a fibroadenoma in a teenager which spared her breast from the scar. The technique was safe and effective. It conserved aesthetics and led to a better compliance. KEY WORDS breast lump, endoscopic breast surgeryPublication Evaluation of risk factors, diagnosis and treatment in carcinoma breast - A retrospective study(Kathmandu University, 2006) Bhattacharya, S; Adhikary, SBackground: Breast cancer is becoming more common in societies that hitherto enjoyed a low incidence of the disease. In countries like Nepal, it is one of the common malignancies in females, and its incidence is increasing with changing lifestyles, demographic and socioeconomic profiles. Ignorance on the part of the patient, lack of screening programmes and diagnostic facilities combine to increase the morbidity and mortality. This study was done to determine the risk factors, assess common modes of presentation in breast malignancies, and to evaluate treatment modalities commonly employed to manage them. Methods: A retrospective analysis of new cases of carcinoma breast admitted to BP Koirala Institute of Health Sciences over a period of 5 years (April 2000 - February 2005) was carried out. A total of 75 cases were studied to collect data on risk factors, clinical profile and treatment. Old cases and those with inadequate documentation were excluded. Results: There were 70 females and 5 males; the mean age was 62.6 years in males and 45.7 years in females. The age at menarche ranged from 11-16 years, the mean being 13.47 years. Among the females, 45.71% were post- menopausal. History of breast carcinoma in first-degree relatives was present in 6.67% of the patients. The mean duration of symptoms before presentation was 13.6 months, most patients presenting with a painless lump. The majority of tumours were in the upper outer quadrant (36%), with 88% of patients presenting in Stage III and IV. Surgery was performed in 46 patients, 65.22% underwent Modified radical mastectomy, and chemotherapy was provided to 33 patients. Combination therapy was given to16 patients. Conclusion: Breast cancer occurred mostly in middle-aged, married, multiparous females, most of whom presented at an advanced stage. Modified radical mastectomy was the most commonly performed operation. Key words: Breast cancer, risk factors, treatmentPublication Iliopsoas abscess: Analysis and perspectives from an endemic region of Eastern Nepal(Kathmandu University, 2007) Yadav, RP; Agrawal, CS; Adhikary, S; Kumar, M; Regmi, R; Amatya, R; Gupta, RKAbstract Objective: To evaluate the clinical profile and outcome in patients with iliopsoas abscess. Methods: A descriptive study was carried out in B.P. Koirala Institute of Health Science, Dharan, Nepal from February 2005 to March 2006. The medical records of all thirty six patients admitted in surgery ward with diagnosis of iliopsoas abscess during the study period were analyzed. Results: Thirty six patients were included the study. There were 22 (61.1%) males and 14 (38.9%) females with a mean age of 24.33 ±19.19 years. Demographic distribution of the patients revealed the highest number 13 (36.1%) from Sunsari district, eastern part of the country. Right sided unilateral involvement was the most common presentation and only 2 cases had bilateral involvement. In none of our patients the dorsolumbar spine radiograph revealed any involvement of the bone. The most common complaints were pain in lower abdomen and lump in iliac fossa with flexion deformity at hip joint. All the patients underwent open surgical drainage and their outcomes were analyzed in term of cure, morbidity and mortality. Staphylococcus aureus was the most common organism 24 (61.5%) isolated. Twenty two (91.66%) of Staphylococcus aureus samples were sensitive to ciprofloxacin. There was one mortality in the group who died of septicaemia secondary to necrotizing fascitis. Six patients had wound infection, which were cured by regular dressing. Conclusion: On the basis of our experience and review of available relevant literature, we can conclude that a high index of suspicion and awareness of the varying clinical picture are required to diagnose this condition properly. Ultrasonography should still be the preferred imaging modality as it is cheap, safe, cost effective and readily available. Ciprofloxacin should be used as a first line drug. Image guided aspiration may be practical in selected cases having little pus and traditional open drainage should be considered without hesitation. Key words: Psoas abscess, ultrasound abdomen, bacteriology, operative interventionPublication Intrathyroid metastasis presenting as a solitary thyroid nodule: An unusual case of clinically silent lung cancer(Kathmandu University, 2008) Sharma, UK; Rauniyar, RK; Adhikary, S; Sinha, AAbstract Metastases in the thyroid gland are very rare. Carcinoma lung is one of the tumours, which may metastasize to the thyroid. We report a 60-year-old lady with intrathyroid metastasis presenting as a solitary thyroid nodule. Fine needle aspiration cytology from the nodule showed features of metastatic adenocarcinoma. Further detail evaluation revealed primary lung adenocarcinoma with secondaries to adrenals, retroperitoneal and bilateral axillary nodes. This report emphasizes this unusual clinical presentation of carcinoma lung with wide spread secondaries; and a solitary thyroid nodule can be a presenting complain of a metastatic disease. Key words: Intrathyroid metastasis, Ultrasound, Carcinoma lungPublication Postoperative intussusception following transverse colostomy: A case report with its pathogenesis(Kathmandu University, 2009) Shakya, VC; Agrawal, CS; Koirala, R; Khaniya, S; Shrestha, AB; Adhikary, SAbstract Postoperative idiopathic intussusception is considered to be a distinct entity, and has been reported following different operations. We present a 45-year-old female with postoperative ileoileal intussusception following a transverse loop colostomy for sigmoid volvulus, in which there was a kinked loop of bowel forming the lead point. The pathogenesis and literature review of this disorder is discussed. Key words: postoperative intussusception, lead point, kink, motility disorderPublication Splenic Epidermoid Cyst(Kathmandu University, 2007) Maskey, P; Rupakheti, S; Regmi, R; Adhikary, S; Agrawal, CSSplenic epidermoid cyst is a rare cystic disease affecting the spleen. We report a young male who presented with a painless abdominal lump. Ultrasonography and CT scan of abdomen showed a huge cystic lesion of obscure origin. At laparotomy a huge cyst was found to be arising from the superior pole of the spleen, and its removal necessitated splenectomy. Histopathological findings were consistent with splenic epidermoid cyst. The aetiopathology and different treatment modalities of splenic cysts are discussed. Key words: splenic cyst, epidermoid cyst, pseudocyst, splenectomy