Browsing by Author "Ghimire, RK"
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Publication A rare presentation of post hysterectomy retroperitoneal haematoma(Institute of Medicine, 2005) Rana, A; Gurung, G; Singh, KP; Ghimire, RKAbstract Post-hysterectomy adynamic ileus, which improved after spontaneous resolution of perirenal retroperitoneal haematoma, is reported.Publication A Retrospective Study of Magnetic Resonance Imaging Findings in Acute Encephalitis Syndrome(Institute of Medicine, 2015) Songmen, S; Panta, OB; Maharjan, S; Paudel, S; Ansari, MA; Ghimire, RKAbstract Introduction: MRI is the imaging modality of choice to investigate acute encephalitis and is recommended in all patients as soon as possible in whom diagnosis is uncertain. This study aimed to study the pattern of brain involvement in MRI in patients with acute encephalitis syndrome and to correlate the findings with clinical and laboratory data. Methods: The study was a retrospective hospital record based review conducted at Tribhuvan University Teaching Hospital. MRI and records of patients undergoing MRI for acute encephalitis syndrome during two years duration was studied. Data analysis was done using IBM SPSS 20.0. Results: A total of 47 MRI were studied among which 11(23.40%) were pediatric and 36(76.59%) were adult population. Edema was the commonest manifestation. Cerebral hemisphere (temporal lobe) was the commonest location involved 34(72.3%). Basal ganglia and thalamus involvement was also fairly common. Five (26.31%) out of 19 patients had positive Japanese encephalitis, 5(26.31%) had HSV antigen positive serology and in 8(42.10%) no etiology could be found. Posterior fossa and basal ganglia involvement was the most predominant findings in Japanese encephalitis and involvement of medial temporal lobe was seen in all cases of Herpes encephalitis. Fifteen patients had good prognosis: complete recovery or minimal residual deficit, while four patients were either dead or left against medical advice. Conclusion: Medial temporal lobe involvement was seen in all cases of Herpes encephalitis; and thalamus and basal ganglia involvement was predominant pattern in Japanese encephalitis. Posterior fossa involvement was common probably due to a non-conventional etiological agent. Keywords: Acute Encephalitis Syndrome, MRI, Herpes encephalitisPublication Determination of complications in computed tomography guided fine needle aspiration cytology of lung mass(Institute of Medicine, 2016) Joshi, BR; Khadgi, K; Ghimire, RKAbstract Introduction: The purpose of this study was to determine the complications of computed tomography (CT) guided fine needle aspiration cytology (FNAC) of lung mass. Methods: This prospective study was done in 56 patients in Department of Radiology and Imaging, Tribhuvan University Teaching Hospital (TUTH). The CT guided FNAC was performed in patients having lung mass. The complications during CT guided FNAC were recorded and statistical analysis was done. Results: Among 56 individuals 29 were males and 27 were females, age ranging from 42 to 80 years. Most of the lesions were located in upper lobe of lungs. There were no complications in 34 cases whereas 16 cases had local hemorrhage, 5 cases had pneumothorax of less than 30% and 1 case had pneumothorax of more than 30%. Conclusion: CT guided FNAC is a safe procedure for diagnostic accuracy without significant complications. Keywords: Complication, CT guided FNAC, Fine Needle Aspiration Cytology, Lung massPublication Evaluation of Hounsfield Unit in adult brain structures by CT(Institute of Medicine, 2016) Mishra, D; Ghimire, RK; Chand, RB; Thapa, N; Panta, OBAbstract Introduction: The purpose of study was to evaluate the Hounsfield unit (HU) values in adult brain structures by computed tomography (CT). Hounsfield units (HU) describe relative densities of structures by CT. Different pathological process causes the change in attenuation by different tissues resulting in change of HU of the tissues so we should know the normal HU values to track the changes. These HU values are correlated with different clinical condition and different slice thickness. Methods: A prospective study was done in 72 patients of age above 18 years. All CT scans were performed using 16 row multi-detector CT (Neusoft New Viz16). Two sets of images were reconstructed first one with 5 X 5 mm and second one with 3 X 3 mm slice thickness. For quantitative analysis, HU measurements were obtained by drawing elliptical/ circular region-of-interests (ROI) on various anatomical structures on both 5mm and 3mm slice images. Statistical analysis was done with t test,one way ANOVA and descriptive analysis. Results: HU values for different anatomical area were: thalamus 34.50±1.92, caudate nucleus 36.64±2.01, internal capsule 31.40±2.16, pons 32.70± 2.39, dentate nucleus 30.70±2.22, cerebellar peduncle 30.90±2.37, hemisphere 39.62±2.38, vermis36.77±2.39, lateral ventricle 9.86±2.60, putamen 36.66±1.65, globus pallidus, 36.68±1.87, juxta 28.28±2.42, periventricular 29.18±2.78, deep 27.13±2.06, cortex 34.26±2.25, subcortical 27.36±2.49, corpus callosum 28.71±1.98. There was significant difference in HU values of genu of internal capsule, caudate nucleus, periventricular white matter, dentate nucleus, cerebellar peduncle & hemisphere for the 5mm and 3mm slice thickness. Conclusion: HU of gray and white matter of brain were 34.54 ± 2.54 and 28.25 ±2.00 respectively Keywords: Attenuation, Brain, Computed Tomography, Hounsfield Unit, Slice thicknessPublication Giant cell tumor of patella(Institute of Medicine, 2012) Paudel, S; Kayastha, P; Pokharel, P; Shah, A; Ghimire, RK; Ansari, MAAbstract Giant cell tumor of bone also known as osteoclastoma is a distinct clinical, roentgenographic and pathologic entity with specific characteristics. It is a benign but locally aggressive neoplasm of the epiphyseal or metaphyseal-epiphyseal region of long tubular bones extending to the articular surface. It usually occurs after skeletal maturation and is one of the rare bone tumors that more frequently affects women. We report here a case of giant cell tumor originating from the right patella diagnosed on fine needle aspiration cytology.Publication Measurement of Portal Vein Diameter, Peak Systolic Velocity and Pulsatility Index by Ultrasound Doppler Evaluation in Asymptomatic Nepalese Population(Institute of Medicine, 2017) Songmen, S; Panta, Om B; Neupane, NP; Ghimire, RKAbstract Introduction: Portal vein diameter and Doppler studies give hemodynamic information that can correlate with disease status. Their normal values are not established in Nepalese population. This study aims to establish the normal values of portal vein diameter, PSV and PI in Nepalese population and study their variability with age, gender and ethnicity. Methods: Cross-sectional hospital based study. All adults more than 20 years of age attending ultrasound OPD of Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu for general health checkup were included. Patients with liver disease, cardiac disease and ascites were excluded. A single observer took all measurements. Data were entered in a predesigned proforma and analysis was performed with SPSS 21.0. Results: Two hundred patients were included in the study. The mean age was 44.34+12.9 years. The mean portal vein diameter was 10.41+1.18mm. The mean portal vein PSV was 33.35+9.3cm/s and PI was 0.76+0.07. There was a positive correlation of portal vein diameter with age (r=0.345; p<0.001). Also, mean portal vein diameter was significantly higher in males (10.9+0.99mm) than in females (9.9+1.1mm). PSV and PI did not differ with age, gender or ethnicity. Conclusions: Mean portal vein diameter in this study is comparable with previous standards. Keywords: Peak systolic velocity, portal vein diameter, pulsatility indexPublication Pulmonary Arteriovenous Malformation: A Rare Cause of Right to Left Shunt(Institute of Medicine, 2015) Panta, OB; Songmen, S; Ansari, MA; Ghimire, RKAbstract Pulmonary arteriovenous malformations are rare anomalies where pulmonary arteries and veins communicate by passing the pulmonary capillary bed. They are mostly congenital in origin, however sometimes may be acquired. They may present as a diagnostic dilemma in plain radiography. Computed tomography angiogram has emerged as the diagnostic modality of choice not only for diagnosing the case but also for delineating the angioarchitecture that is useful in treatment planning by surgery or transcatheter embolisation. Here we present a case of a child with large pulmonary arteriovenous malformation being treated as pneumonia and finally diagnosed on computed tomography angiogram. Keywords: Computed tomography, Pulmonary arteriovenous malformation, Right to left shuntPublication Sonographic measurement of the atrium of fetal lateral ventricle in low risk population of pregnant women at 16-38 weeks of gestation(Institute of Medicine, 2016) Yadav, B; Thapa, BR; Ghimire, RK; Joshi, BRAbstract The purpose of this study was to establish the size of atrium of fetal lateral ventricle and to evaluate its changes in normal fetuses in low risk population of pregnant women in the second and third trimesters of pregnancy. Methods: This was a prospective cross-sectional study involving 290 women with uncomplicated singleton gestation between 16-38 weeks. Atrium was visualized in 264 cases. The fetal biparietal diameter (BPD) was measured first. Atrium was measured at the level of the glomus of the choroid plexus, perpendicular to the ventricular cavity, positioning the calipers inside the echoes generated by the lateral walls. Nomogram of the sizes of atrium was prepared. Results: Atrium was visualized in 91% of the fetuses. The ages of the patients ranged from 17-30 years (mean 24.29, SD 2.78). The maximum numbers of case were at 23 and 27 weeks of gestation and the minimum number of cases were at 37 weeks of gestation. The mean size of the atrium of lateral ventricle was 6.28mm, (SD1.2; range 3.5-8.9 mm). The size of atrium showed significant positive correlation with gestational age (r2 value of 0.78; p<0.001 for atrium) Conclusion: Atrium of lateral ventricle showed continuous increment and showed significant correlation with the gestational age. The findings were consistent with the previous studies done by various authors. The percentile fitted values and nomograms will be valuable for the serial measurement of the atrium of lateral ventricle for complicated pregnancies. Keywords: ventricle, atriumPublication Sonographic measurement of the size of fetal cisterna magna in low risk population of pregnant women at 16-38 weeks of gestation(Institute of Medicine, 2018) Yadav, B; Ghimire, RK; Joshi, BRAbstract Introduction: The purpose of this study was to determine the normal size values of fetal cistern magna(CM) and to evaluate its changes in normal fetuses in low risk population of pregnant women in the second and third trimesters of pregnancy using transabdominal ultrasonography. Methods: This was a prospective cross-sectional study involving 290 women with uncomplicated singleton gestation between 16-38 weeks. CM was visualized in 264 cases. Gestational age was calculated by measuring fetal biparietal diameter (BPD). CM was measured from the posterior aspect of the cerebellar vermis to the inner edge of occipital bone. Nomogram of the sizes of CM was prepared. Results: CM was visualized in 91% of the fetuses. The ages of the patients ranged from 17-30 years (mean 24.29, SD 2.78). The maximum numbers of case were at 23 and 27 weeks of gestation and the minimum number of cases were at 37 weeks of gestation. The mean size of the CM was 6.32mm, (SD1.09; range 3- 9 mm). Conclusion: The size of fetal CM showed continuous increment and showed significant positive correlation with the gestational age( r2 value of 0.48; p<0.001). The findings were consistent with the previous studies done by various authors. The percentile fitted values and nomograms will be valuable for the serial measurement of the CM for complicated pregnancies. Keywords: cisterma magna, ultrasonography, vermisPublication Urological complications after Kidney transplantation(Kathmandu University, 2010) Chalise, PR; Sharma, UT; Gyawali, PR; Shrestha, GN; Joshi, BR; Gurung, GS; Ghimire, RK; Kafle, MP; Sigdel, MR; Shah, DS; Raut, KB; SidharthABSTRACT Background Renal transplantation is a regular service at Tribhuvan University Teaching Hospital and complications have been known to occur after it. This study was conducted to assess complications after transplantation. Objectives To determine the incidence of urological complications after living related renal transplantation at Tribhuvan University Teaching Hospital. Methods A clinical study was performed (from August 2008 to July 2010) which included 50 living-related renal transplantations at Tribhuvan University Teaching Hospital. All the donors and recipients were evaluated preoperatively with necessary investigations and followed up postoperatively with standard hospital transplant protocol. The incidence of urological complications were documented and analyzed. Results Fifty living-related, renal transplantations were carried out during the study period. Seven doors had minor post operative complications; three had post operative fever, two had chest infections and each one had superficial surgical site infections and severe pain at incision site. Ureteroneocystostomy was performed with double J stent in all recipients. Urological complications were noted in 12 (24%) recipients. Clinical significant hematuria occurred in four cases. One patient had ureteric necrosis and urinary leak which required re-exploration post operatively. Two patients developed delayed ureteric stricture which were managed by antegrade Double J stenting and ureteric reimplantation. Peri-graft abscess occurred in two cases, which were drained percutaneously. surgical site infections was seen in one case. Conclusions Urological complications are inevitable in renal transplantation and our complications rate appears similar to that reported in literature. Key words double J stent, renal transplantation, urological complications