Browsing by Author "DR, Singh"
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Publication Ancient cystic pelvic schwannoma presenting as a right iliac fossa mass(Kathmandu University, 2005) BR, Rai; D, Chaudhary; P, Thapa; MR, Joshi; UMS, Dongol; DR, Singh; SK, SharmaSchwannoma is rare in pelvis. Ancient schwannoma is rarer histological subtype of schwannoma. We report a very rare case of pelvic schwannoma presenting with right sciatica and right iliac fossa pain. Clinical and imaging findings were suggestive of Peritoneal Hydatid cyst. The tumour was resected completely with marked clinical improvement. Histopathological examination showed Ancient cystic schwannoma. Key words: Benign pelvic Schwannoma, Benign retroperitoneal tumour, Giant ancient Schwannoma, Presacral Cystic SchwannomaPublication Controversies in the management of acute pancreatitis(Kathmandu University, 2004) DR, Singh; A, Mehta; UMS, DangolIntroduction: Acute pancreatitis accounts for three to five percent of admission to hospital for abdomen pain. Though most are of mild form, the severer form takes a toll of some ten percent. Aims and objectives: This study aims to make a retrospective analysis of some fifty four admissions for acute pancreatitis admitted to Kathmandu Medical College Teaching Hospital in the past twenty four months. It also aims to highlight some of the controversies that have come up as to its management. Results: Among the 54 admissions for acute pancreatitis, there were thirty nine patients. Sixteen (41%) of them were female and twenty three (51%) male. Their ages ranged from twenty one to ninety years, with an average of forty one years. Surprisingly no patients were between sixty to eighty years bracket. Thirteen (33%) of the patients had gall stones in ultrasound. Two (5%) of the patients were suffering from mumps and Eleven (28%) no causal factors were found. While thirteen (33%) patients suffered from alcoholic pancreatitis. All of them were male. Of the alcoholic group, five (38%) had recurrent attacks. Five (38%) from the biliary and two (18%) from the idiopathic group had recurrent attacks. Four patients were operated on emergency basis. Three with the diagnosis of peritonitis and another eighty four year old lady with features of associated cholangitis were found to have acute pancreatitis at operation. One of them underwent peritoneal toileting; two had cholecystectomy and peritoneal toileting while the eighty four year old lady underwent cholecystectomy, common bile duct exploration and peritoneal toileting. All fared well post-operatively. Keywords: acute pancreatitis, microliths, buscopan, idiopathic pancreatitisPublication Intra-abdominal abscess presenting as a thigh abscess(Kathmandu University, 2004) D, Chaudhary; A, Magar; P, Thapa; DR, Singh; SK, SharmaSecondary thigh abscesses are rare, and their cause is often obscure. We report a case of an elderly diabetic who presented with thigh abscess secondary to tuberculous sacroilitis. Key words: Secondary thigh abscess, retroperitoneal abscess, tuberculous sacroilitisPublication Omental torsion: a case report(Kathmandu University, 2005) D, Chaudhary; R, Rajkarnikar; MR, Joshi; P, Thapa; DR, Singh; SK, SharmaOmental torsion is a rare cause of acute abdomen. Most often it presents with sign and symptoms of acute appendicitis. It is seldom considered in the differential diagnosis preoperatively based on clinical findings and the diagnosis is only established during surgery. We present a case of omental torsion in a middle aged male patient who presented with findings suggestive of appendicular perforation and underwent emergency laparotomy. Key words: acute abdomen, omentum, torsion, appendicitisPublication Removal of central venous catheter fragment embolus in a young male(Kathmandu University, 2006) PB, Thapa; R, Shrestha; DR, Singh; SK, SharmaA 22 years male admitted with severe pancreatitis with central venous catheter implanted for central venous pressure monitoring and for providing total parental nutrition developed catheter fragment embolus due to accidental fracture of the same while manipulating it. Non surgical retrieval of the same was done by radiological intervention without any complication. Key words: intravascular catheter fragments, transfemoral venous approach, interventional proceduresPublication Stripping without a Stripper(Kathmandu University, 2004) DR, Singh; SK, ShrethaVaricose veins afflict some 10 to 20%of the population in the west. It is believed to be less prevalent in the developing nations1, 2 . Though there are absolute indications of surgery for varicose veins, people in Nepal come for treatment of the varicose veins either to join the army or to work abroad. Not all hospitals in Nepal are equipped with a vein stripper. In KMCTH, we studied 29 patients who had their long Saphenous veins stripped either with a stripper or by tunnelling around the Saphenous vein. We found that the long Saphenous vein could be stripped via the tunnelling method with an additional incision above the knee joint which is cosmetically accepted by our patients. Moreover the patients were much satisfied because of minimal or no bruises in the post-operative period as compared to those who had the long Saphenous vein stripped with a stripper. Keywords: varicose veins, stripping, stripperPublication Use of percutaneous thread loop to hold the vermiform appendix during laparoscopic appendectomy(Kathmandu University, 2007) MR, Joshi; SK, Shrestha; PB, Thapa; U, Koirala; P, Bhattarai; UMS, Dongol; DR, Singh; SK, SharmaIntroduction: Laparoscopic appendectomy, although not as widely performed as laparoscopic cholecystectomy, it has got definite advantage over the conventional open procedure. Controversy exists regarding the closure of stump. Our institute practices intracorporeal knot tying using 3 ports. Difficulties are observed in three port technique to hold the appendix during knot tying. We use a percutaneous thread loop. Advantage of the use of loop was evaluated. Patients and method: Prospective study was carried out during 18 months. Total cases were randomly divided in non-loop and with loop group. Operative procedure was same. Cases were compared in terms of operating time, post-operative hospital stay and complications. Results: Total patients were 66. Thirty two in non-loop group and 34 in with loop group. Mean age was 27.89 yrs. Most of the cases were females (62%). Mean operating time was less in loop group although statistically not significant. There was no difference in post operative hospital stay. Use of loop was not associated with added complications. Conclusion: Use of percutaneous loop to hold the appendix reduces the operating time and replaces the need of fourth port. It is safe and effective without any increased morbidity. Key words: Laparoscopic appendectomy, Intracorporeal knot, Percutaneous loop