NepMed Repository :: Browsing by Author "Joshi, MR"

Browsing by Author "Joshi, MR"

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Ancient cystic pelvic schwannoma presenting as a right iliac fossa mass
(Kathmandu University, 2005) Rai, BR; Chaudhary, D; Thapa, P; Joshi, MR; Dongol, UMS; Singh, DR; Sharma, SK
Schwannoma 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 Schwannoma
Empyema thoracis
(Kathmandu University, 2007) Singh, DR; Joshi, MR; Thapa, P; Nath, S
Abstract Objective: To review the management of Empyema Thoracis in the surgical department of Kathmandu Medical College Teaching Hospital. Methods: Thirteen cases with Empyema thoraces treated in the surgical department of the hospital with different modalities of treatment was taken for study and analyzed for morbidity, mortality, and hospital stay. Results: there was a single mortality in the thoracotomy group. Video assisted thoracic surgery or VATS debridement or deloculation was successful in the eight of the patients with shorter stay in the hospital. One patient who refused surgery was treated with streptokinase with good result. Conclusion: Streptokinase may be effective in the treatment of empyemas. Video assisted thoracic surgery or VATS has definite advantage over traditional surgery in terms decreased morbidity, mortality, earlier hospital discharge and cosmesis in the treatment of empyema. Keywords: Empyema thoracis, VATS, Decortications, Streptokinase
Omental torsion: a case report
(Kathmandu University, 2005) Chaudhary, D; Rajkarnikar, R; Joshi, MR; Thapa, P; Singh, DR; Sharma, SK
Omental 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, appendicitis
Prevalence of different types of gallstone in the patients with cholelithiasis at Kathmandu Medical College, Nepal
(Kathmandu University, 2009) Pradhan, SB; Joshi, MR; Vaidya, A
Abstract Background: Gallstone disease known as cholelithiasis is the most common digestive surgical disorder and account for an important part of health care expenditure. Attempt was made to analyse the gallstone for typing depending upon the composition. Aims & objectives: The main objective of this study was to see the prevalence of different types of gallstone in Nepal and to correlate them with the clinical findings. Materials & methods: Gallstones of 80 different patients who underwent cholecystectomy for cholelithiasis were collected from 20th January 2005 to 16th May 2006 in Department of Pathology, Kathmandu Medical College Teaching Hospital. Detailed history was taken. Stones were analyzed with chemical and enzymatic methods using clinical spectrophotometer. Results & conclusion: The most commonly involved age group for cholelithiasis (32.5%) is found to be 30-39 years with a female predominance (M: F=1:3.2). Cholelithiasis was found more commonly among non-vegetarian with the vegetarian: non-vegetarian ratio 1:9. Mixed type stone was found to be the most common type of stone comprising 78.75%, followed by cholesterol stone 12.5%, Brown pigment stone 7.5% and Black pigment stone 1.25%. Key words: Gallbladder, cholelithiasis, Gallstone
Total thyroidectomy: the treatment of choice in differentiated thyroid carcinoma
(Kathmandu University, 2005) Shrestha, SK; Joshi, MR; Sharma, SK
Introduction: Clinically detectable thyroid carcinoma constitutes less than 1% of human cancers. Ninety percent of all thyroid malignancies are differentiated papillary and follicular carcinoma. Surgery plays a key role in differentiated thyroid carcinoma as it carries excellent prognosis, lower recurrence rate and low mortality rate but controversy persists for extent of surgery and optimal surgical management of lymph node metastasis. Patient and Method: A retrospective analysis was done for the cases that underwent total thyroidectomy with lymph node dissection for differentiated carcinoma of thyroid in Kathmandu Medical College during two year periods (Oct 2001 to Oct 2003). Result: In our experience with 18 cases of Differentiated Thyroid Carcinoma (DTC) treated with total thyroidectomies and lymph node dissection, papillary carcinoma was predominant with 83% incidence. Disease was prevalent in 50 to 60year age group. Except two cases of transient hypocalcaemia and few wound related complications, there have been no other complications. Conclusion: Total thyroidectomy with lymph node dissection is safe and effective, so, the treatment of choice in cases of differentiated thyroid carcinoma.
Ultrasound: An extension of clinical examination
(Kathmandu University, 2007) Singh, DR; Joshi, MR; Dangol, UMS; Koirala, U; Pradhan, RL; Shrestha, BR; Mishra, CD
Aims and objectives: To study the impact the use of portable ultrasound can have for the benefit of the patients when used by doctors other than radiologist, in this case surgeons. Methods: Ultrasound performed by surgeons in the pre-operative, operative and post-operative period was studied. Patients presenting to the Hospital with acute abdomen was subjected to ultrasound. They were either pre-operative or post-operative patients. Five patients were scanned intraoperatively. The impact of these scans to the patients as well as the clinicians was studied. Results: This is an ongoing study and preliminary results of the scans show two pre-operative diagnosis of acute appendicular collection and one acute hydronephrosis. In the operation room, ultrasound was done on 5 cases. On three occasions, it was to locate renal stones so that it could be extracted with ease. On two of the case, it was t to confirm the adequacy of common bile duct exploration thereby allowing primary closure of the common bile duct. Post-operatively, it was used in four cases of which in two cases post-operative hemorrhage were detected timely within hours. In the other two cases, the surgical team was assured that the patient’s complaint was not surgically related. Conclusion: Ultrasound should be an extension of the clinical examination when indicated and all clinicians should be proficient in its use in their respective fields Keywords: ultrasound, non-radiologist, surgeons, per-operative ultrasound
Upper GI Endoscopy in Children- in an adult suite
(Kathmandu University, 2005) Joshi, MR; Sharma, S K; Baral, MR
Although Upper GI endoscopy is commonly performed in adults, paediatric endoscopy is not available in many of our referral centres. The efficacy and safety of upper GI endoscopy in paediatric age group performed in adult suite of Kathmandu Medical College is reviewed. Patients and Method: A retrospective study of endoscopies performed on children aged up to 15 years in an adult endoscopy suite of Kathmandu medical college over last one year is presented. All cases were the referred cases from paediatric unit for various problems. Results: Endoscopy in paediatric group comprises only 6% of total upper GI endoscopies performed during the same year. Sex ratio was almost equal. Most cases (87%) were performed under local anaesthetic and well tolerated by the patients. Recurrent abdominal pain (RAP) was the commonest indication and among them one third of cases had significant positive finding. Conclusion: Upper GI endoscopy is a useful diagnostic tool in children. Where specialized paediatric endoscopy units are not feasible i.e. developing countries, endoscopic services to children can be safely provided in adult endoscopy suite with or without sedation. Upper GI endoscopy is well tolerated by children even without sedation. Key words: Endoscopy, Recurrent abdominal pain.
Use of percutaneous thread loop to hold the vermiform appendix during laparoscopic appendectomy
(Kathmandu University, 2007) Joshi, MR; Shrestha, SK; Thapa, PB; Koirala, U; Bhattarai, P; Dongol, UMS; Singh, DR; Sharma, SK
Introduction: 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

Browsing by Author "Joshi, MR"

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