NepMed Repository :: Browsing by Author "Gyawali, PR"

Browsing by Author "Gyawali, PR"

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Correlation of Calcium, Phosphorus, Uric Acid and Magnesium Level in Serum and 24 hours Urine of Patients with Urolithiasis
(Kathmandu University, 2011) Gyawali, PR; Joshi, BR; Gurung, CK
ABSTRACT Bakcground Urinary stones disease is common pathology encountered in urological practice in Nepal. Supersaturated urine and its stagnation are well known facts for the development of urolithiasis. Metabolic disorders like hypercalciuria, hyperuricaemia, hypocitraturia are also responsible for formation of urolithiasis. Objective The aim of this study was to identify the level of calcium, phosphorus, uric acid, and magnesium in the blood and urine of Nepalese patients with urinary stones. Methods This study was conducted over a period of six months (From May to November 2010). It is a descriptive cross sectional study and quantitative method was used for analysis. Primary data were collected and utilized from 79 cases. Results: The prevalence of urolithiasis in male patients was 65.8% and 34.2% in female patients (p<0.05). Serum calcium in stone former and non-stone former was 8.3±1.2 and 7.5±1.5 (p<0.01) respectively. Serum phosphorus and uric acid in both groups were statistically not significant (p value 0.269 and 0.597 respectively) though in 24 hours urine of stone formers value of phosphorus was 447.9±182.4 but in non-stone formers it was 186.5±118.7 (p<0.001). Magnesium level in urine was 48.1±69.7 and 131.4±86.9 (p<0.001) respectively. Conclusion Higher level of calcium in serum was found in patients with urolithiasis in our population. Though phosphate level in blood serum was not different in the both groups but in urine phosphate and magnesium levels were significantly different. KEY WORDS hypercalciuria, hyperphosphaturia, hyperuricosuria, hypocitraturia, urolithiasis
Pattern of Renal Cell Carcinoma – A Single Center Experience in Nepal
(Kathmandu University, 2011) Sidharth; Luitel, BR; Gupta, DK; Maskey, P; Chalise, PR; Sharma, UK; Gyawali, PR; Shrestha, GK; Sayami, G; Joshi, BR
ABSTRACT Background Renal tumor is the 13th most common malignancy in the world and more than 90% of renal tumors are renal cell carcinomas. As there is no data available on renal cell carcinoma in Nepal, hence this study was undertaken to analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal. Objectives To analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal. Methods The case records of 50 consecutive patients with renal cell carcinoma presenting at the Tribhuvan University Teaching Hospital, Kathmandu from July 2006 to June 2011 were retrospectively evaluated for presenting symptoms, physical finding, investigation and histopathology report. Results Out of 50 patients, 64% were male and 36% were female. The age ranged between 11 to 78 years (mean ± SD: 55 ± 15 years). Fifty four percent of patients were smokers. Incidentally tumor was detected in 40% cases by ultrasonography and the typical triad was present in only 4%. The tumor was occupying upper pole in 40% of cases. The tumor size ranged from 3 to 15 cm (mean ± SD: 7.3 ± 2.9 cm). Histopathologically, 76% of the patient had organ confined renal cell carcinoma (T1- 2 N0 M0). Clear cell was the most common type seen in 86%. Fuhrman’s nuclear grade 2 was found in 50%. Conclusion Many of the renal cell carcinoma are detected incidentally, at an early stage and are of clear cell subtype. KEY WORDS Incidental renal tumor, Nepal, Renal cell carcinoma.
Phaeochromocytoma in Nepal – A Single Centre Experience
(Kathmandu University, 2012) Maskey, P; Shrestha, GK; Luitel, BR; Gupta, DK; Sidarth; Chalise, PR; Sharma, UK; Gyawali, PR; Joshi, BR
ABSTRACT Background Phaeochromocytomas are rare tumors of chromaffin cells of neural crest that classically present with symptoms of catecholamine excess such as palpitations, headache and sweating. They are diagnosed by measuring plasma or urinary levels of catecholamines or their metabolites. Anatomic localization is done by computed tomographic scan or magnetic resonance imaging, or meta-iodobenzyl guanidine scan in certain cases. Adequate preoperative catecholamine blockade prevents perioperative hemodynamic instability. Objectives To study the clinical spectrum and management of phaeochromocytomas in a tertiary care centre, Tribhuvan University Teaching Hospital, in Nepal. Methods Retrospective review of case records of histologically proven cases of phaeochromocytomas from 2008 -2011 was done, and data collected on clinical spectrum, diagnostic modalities, perioperative management and follow-up. Results Tweleve cases of phaeochromocytomas were operated. The mean age was 36.41±14.07 years. There were 2 bilateral phaeochromocytomas and 1 extra- adrenal paraganglioma. Apart from the common symptoms of catecholamine excess, patients had atypical presentations like psychiatric manifestations and blurred vision. A combination of urinary Vanillyl Mandelic Acid and computed tomographic scan was used for diagnosis, and open surgery was done in all cases. Pre-operative blood pressure control was achieved by prazocin or calcium channel blockers. Ten patients had intraoperative surge in blood pressure. There were no major morbidity or mortality. Three patients had high blood pressure post- operatively, but were effectively managed with antihypertensives. Conclusion Phaeochromocytomas can have variable presentation. Good preoperative preparation and perioperative management can result in an excellent outcome. KEY WORDS Hypertension, Paraganglioma, Phaeochromocytoma, Prazocin, Vanillyl Mandelic Acid
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

Browsing by Author "Gyawali, PR"

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