Browsing by Author "Joshi, R"
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Publication A study on fine needle aspiration cytology of epididymal nodules(Institute of Medicine, 2018) Thapa, R; Gurung, P; Kafle, N; Pradhanang, S; Hirchand, S; Lakhey, M; Joshi, RAbstract Introduction: Fine needle aspiration cytology (FNAC) is a rapid and relatively inexpensive technique used extensively in the diagnosis of a large variety of neoplastic and nonneoplastic lesions in many organs.There are very few literature reports documenting the role of fine needle aspiration cytology (FNAC) in the evaluation of epididymal nodules. The aim of this study was to highlight the cytomorphologic features of FNAC in epididymal nodules. Methods: A descriptive study was carried out in all the patients presented with palpable epididymal nodules for FNAC over a period of two and half years in department of pathology, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu. FNAC was performed using 23 gauge needle with 10ml syringe. Smears were routinely stained with PAP, Giemsa stain and Special stains whenever needed. Results: A total of 31 cases of non – neoplastic lesions were identified. Age ranged from 15 to 52 years. Majority of cases were of tuberculous epididymitis accounting for 38.70%. Conclusions: FNAC serves as an important tool to screen and diagnose all palpable epididymal nodules and provides information for further management. Keywords: Fine needle aspiration cytology, epididymal nodules, neoplastic, non-neoplastic lesionsPublication Management of Liver Abscess at Teaching Hospital(Nepal Health Research Council, 2011) Shrestha, S K; Joshi, R; Dongol, U MS; Singh, D R; Sharma, S KBackground: A current assessment of liver abscesses should allow for better understanding of the pathogenesis of the disease and improve the effectiveness of diagnosis and treatment. Amoebic liver abscess occurs more commonly than the pyogenic liver abscess on a worldwide basis. The purpose of the study is to investigate the clinical presentation and management option for liver abscess. Methods: A prospective observational study was conducted from January 2007 to December 2010, in Kathmandu Medical College Teaching Hospital. We recorded and analyzed the clinical presentations, diagnostic modalities, treatment programmes of all liver abscesses. Results: Liver abscess was more common in males, 24(85.7%) males and 4(14.3%) females, occurring more frequently in right lobe of liver. Most patients presented with nonspecific clinical and biochemical features. Twenty (71.4%) patients presented with chills & rigors. Five patients (17.8%) presented jaundice and none had transaminases raised but 15(56.3%) had raised alkaline phospahatases. Eight (28.5%) patients were treated with antibiotics alone. USG guided drainage was done in 12(42.8%) patients and 6(21.4%) required surgical exploration with laparoscopic deroofing in 2(7.1%) patients. The largest size was 1100cc.with right lobe predominance in 20(76.9%) patients and single lobe involvement in 22(78.4%) patients. Six (21.4%) patients had multiple liver lobes involved. Three (7.1%) patients had ruptured liver abscess and 3(7.1%) had right sided pleural effusion. Seventeen (60.7%) patients were diagnosed have amoebic liver abscess. Ten (35.7%) patients were found to have pyogenic liver abscess. One (3.5%) had tuberculosis. Conclusions: Liver abscess requires a high degree of suspicion for early diagnosis. When appropriate therapy in the form of antibiotics in combination with percutaneous drainage or surgery is administered the mortality is very low. However, significant morbidity is still a problem in old debilitated persons with other core morbidities. Keywords: liver abscess, clinical features, percutaneous drainage and management.Publication Semirigid Ureteroscopy with Pneumatic Lithotripsy for Ureteral Stone(Nepal Health Research Council, 2011) Dongol, UMS; Acharya, L; Subba, K; Khambu, B; Joshi, R; Shrestha, S K; Singh, D RBackground: Ureteral stones present with acute loin to groin pain. The objective of this study is to find out the outcome and safety of semi-rigid ureterscopy with pneumatic lithotripsy for treatment of ureteral stones of >30 mm2 and to assess the impact of size and location on stone free (SF) rate. Methods: Total 110 patients with isolated ureteral stone size>30 mm2 were included in this study and treated with pneumatic lithotripsy using 8/9.8 Fr. Semi-rigid ureteroscope (Stiema Germany). Stones were fragmented into 2-3mm particles and removed. Outcome parameters assessed at 3 months follow up were stone free rate(SF), Efficiency Quotient (EQ), and impact of stone size and site on SF/EQ was also analyzed. Similarly, patient demographics, procedures, patient related parameters and complications were also noted. Results: The overall SF rate at 3 months follow up was 69.33% and efficient Quotient (EQ) 52.52%. The SF/EQ for upper, middle and lower third of ureteral stone was 55/37.67,6/43.57, 92/84.40 respectively (P-value< 0.001). The SF for stone size 30-110 mm2 and >110mm2was 78% and 67% respectively. There were no major complications seen. Overall minor complication rate was 5.45 % (minor ureteral perforations-5, urinoma formation 1). Conclusions: Semi-rigid ureteroscopy with pneumatic lithotripsy is a safe, simple and effective procedure for ureteral stones with excellent success rate for distal ureteral stones. The stone free rate and EQ are statistically significant (P value<0.001) between upper, middle and lower ureteral stones. Stone size has a direct impact on the SF rate and EQ. Keywords: semirigid uerteroscopy, pneumatic lithotripsy.Publication Ureter Quadruplication with Huge Ureteral Cyst(Nepal Paediatric Society (JNPS), 2015) Joshi, R; Singh, DRAbstract: Ureteral quadruplication is an extremely rare congenital anomaly. It was first reported in 1975. The patients may present with different features and complications in respect to this congenital anomaly. They may also present with other congenital anomalies. Diagnosis sometimes is difficult and may need to be investigated with Magnetic Resonance Urogram, CT scan apart from routine investigations like ultrasonography and intravenous urogram. Surgical treatment should be based on the operative and investigational finding. We present the twelfth reported case but the first from Nepal. It was associated with a large ureteral cyst with diagnostic dilemma. Surgical exploration was done with a provisional diagnosis of large retroperitoneal cyst.