NepMed Repository :: Browsing by Author "Gurung, GS"

Browsing by Author "Gurung, GS"

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Comparative Study of CT and Direct Cholangiogram for Evaluation of Obstructive Jaundice
(Institute of Medicine, 2016) Gurung, GS
Abstract Introduction: The main aim of the study was to compare the findings of CT (computed tomography) and direct cholangiogram for the evaluation of obstructive jaundice. Methods: A retrospective hospital based study was done among 62 patients with suspected biliary obstruction at Annapurna Neuro Hospital and TUTH from 2013 to 2015. CT scan of the abdomen and DC (PTC) were done in each patient. The level and cause of obstruction were evaluated by these modalitics. Results:In this study, male to female ratio was 1:1.5 showing female predominance. The mean (+SD) age of the patients was 65.5 +15.6 years and range of from 28-94 years. CT and DC (PTC) identified hilum as the most common level of obstruction in71% and 69.4% of the patients. The most common malignancies were cholangiocarcinoma and gall bladder carcinoma, identified by CT and DC (PTC) respectively, which were present in over one third (35.5%) of the patients. Further, CT and DC (PTC) identify edpostoperative stricture as the most common benign aetiology in 6.4% and 4.8% of the patients respectively. Moreover, sensitivity of CT and DC (PTC) for malignant lesion 75% and 98% while specificity was 96.2% and 54.5% respectively (P value 0.000). Conclusion: CT and DC (PTC) showed the almost similar accuracy in evaluating the level of obstruction at hilar region. Carcinoma of gall bladder and cholangiocarcinoma are the commonest malignancies whereas postoperative stricture was the commonest benign actiology. Early diagnosis and proper treatment will significantly reduce complication, morbidity and mortality rates. Keywords: Computed Tomography, Direct cholangiogram, Obstructive jaundice
Failed Back Syndrome: Evaluation with MRI
(Institute of Medicine, 2016) Gurung, GS
Abstract Introduction: One of a major late post operative complication of discectomy is persistent pain and radiculopathy also termed as failed back syndrome. The study aims to evaluate the MRI findings of failed back syndrome. Methods: A retrospective hospital record based study among 53 patients was carried out at multimodality- imaging center associated with a tertiary care neurological center in Kathmandu, Nepal. MRI of patients performed for persistent pain after discectomy were selected for duration of 3 years and reviewed. All MRIs were performed with and without contrast enhancement. Three radiologists reported the MRIs with mutual consensus in disputed issues. All data were entered in SPSS spreadsheet and analysis was done using SPSS version 19. Results: The mean age of the patients was 45.9± 16.1 years. Out of the total 53 cases, the operative site was at cervical spine in 35.8% cases, in lumbar spine in 64.2% cases and none in dorsal spine. Predominant epidural fibrosis without any other cause attributed to radiculopathy in 93.5% patients. Recurrent Disc herniation was noted in 6.5% patients whereas spondylodiscitis was seem in only one (1.9%) patient at C6-C7 level. The most common level operated in lumbar spine was L5-S1 (28.3%) followed by L4-L5 (24.5%) and in cervical spine was C4-C5 and C5-C6 contributing 17% each. Conclusion: The study concluded that the common causes of failed back syndrome were epidural fibrosis, recurrent disc herniation and rarely spondylodiscitis. Keywords: Syndrome, MRI, Failed Back
Spectrum of MRCP findings: An Initial Experience with 3.0 Tesla Magnetic Resonance Imaging System in Nepal
(Institute of Medicine, 2015) Gurung, GS; Subedi, K; Karki, DB
Abstract Introduction: Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive magnetic resonance imaging (MRI) examination used in the evaluation of hepatobiliary and pancreatic tree. It is a non-invasive alternative to endoscopic retrograde cholangiopancreatography (ERCP). Here we attempted to summarize the spectrum of MRCP findings in a cohort of patients undergoing MRCP examination in a 3.0 Tesla MRI system, the first of its kind in Nepal. Methods: The study was carried among patients undergoing MRCP in a 3.0 Tesla MRI system from November 24, 2014 to June 29, 2015. 167 patients (73 male and 94 female, age range, 1-87 years, mean age, 49.8years) were identified who underwent MRCP. MRCP was performed on a 3.0 Tesla MR scanner (Ingenia, Philips Medical System) using a sixteen-element quadrature phased array body coil over the liver. The MRCP findings were reviewed and various imaging findings were recorded. The findings were analyzed using SPSS. Results: MRCP was normal in 44(26.2%) patients. Various findings were found in the biliary ducts, liver, gall bladder, pancreas and outside the pancreas and liver. Commonest biliary duct pathology was choledocholithiasis (25.7%). Commonest liver pathology was chronic liver disease (3%). Commonest pancreatic parenchymal pathology was acute pancreatitis (4.2%). Commonest pancreatic duct pathology was dilated pancreatic duct (5.4%). Gall bladder was seen in 37 (22%) patients, and 30 patients were status post cholecystectomy (17.9%). Extra pancreaticobiliary findings included pleural effusion, ascites, splenomegaly, juxtapapillary duodenal diverticulum etc. Conclusion: MRCP is the choice of investigation for the non-invasive diagnosis of pancreaticobiliary disorders. In the current review, we have summarized the spectrum of MRCP findings and shared an early experience with 3.0 Tesla MRCP system in Nepal. The findings are comparable to the existing literature in the subject. Keywords: Bile ducts, Gall bladder, Magnetic resonance cholangiopancreatography (MRCP)
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; Sidharth
ABSTRACT 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
Venous Diseases of Lower Limbs: Retrospective Analysis of Duplex Ultrasound Findings
(Institute of Medicine, 2015) Gurung, GS
Abstract Introduction: Venous pathologies of the lower limb include acute deep venous thrombosis and chronic venous insufficiency. Deep vein thrombosis can cause pulmonary embolism, which is a serious medical emergency. Deep venous thrombosis usually manifests with limb pain and swelling in high risk group whereas chronic venous insufficiencies manifests with limb swelling, telengiectasia, varicosities and skin changes including ulceration which also cause serious morbidity. The aim of this study was to ret-rospectively analyze the findings of duplex ultrasound in patients with venous disease of lower limbs. Methods: A retrospective hospital-based study in 386 patients was carried out analyzing the records of duplex ultrasound findings at Kathmandu Imaging Center, Maitighar, Kathmandu, Nepal. Clinical information and Duplex ultrasound findings including status of deep veins, superficial veins, sapheno- femoral junction, sapheno-popliteal junctions and perforators were reviewed. Associated findings of deep vein thrombosis and venous incompetence were also noted. Results: The patient population composed of almost equal numbers of males 200(52%) and females 186(48%). Majority 197(51%) of venous Duplex examination was normal. 129(33%) of patient had chronic venous insufficiency. Similarly, 60(15.5%) of patients had deep vein thrombosis and among these deep vein thrombosis patients, 3(5%) had chronic venous insufficiency. Mean age of patients with deep vein thrombosis was 52.4±17.5 years. Males predominantly suffered from deep vein thrombosis with male to female ratio of 1.9:1. However, chronic venous insufficiency was seen in slightly younger patients with mean age of 40.8±14.7 years and males were more frequently affected by chronic venous insufficiency with male to female ratio of 1.3:1. Conclusion: Venous duplex study is an essential tool for evaluation of lower limb venous pathology. From the study, it can be concluded that, the commonest abnormality found in the patient were varicosity, deep vein thrombosis and chronic venous insufficiency. Keywords: CVI, Duplex ultrasound, DVT, Varicose vein, venous disease

Browsing by Author "Gurung, GS"

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