Browsing by Author "Karki, B"
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Publication Bilobar agenesis of thyroid gland with hypertrophied isthmus(Institute of Medicine, 2010) Sharma, P; Karki, B; Gautam Ghimire, P; Shrestha, M; Ghimire, A; PathaK, AAbstract Bilobar agenesis of thyroid gland is a rare presentation of thyroid gland. Here we report an 18 years male presenting with history of midline swelling in the neck. Ultrasonography and CT neck revealed bilateral agenesis of thyroid gland with hypertrophied isthmus.Publication Evolving Experience in The Management of Empyema Thoracis(Kathmandu University, 2011) Shrestha, K; Shah, S; Shrestha, S; Thulung, S; Karki, B; Pokhrel, DPABSTRACT Background Empyema thoracis a disease of significant morbidity and mortality, especially in the developing world. However, the optimal management of empyema thoracis remains controversial. Objective To analyse evolving experience in clinical presentation, management, outcome and factors contributing to adverse morbidity in empyema thoracis. Methods This is hospital based retrospective study of patients who were diagnosed with empyema thoracis in cardiothoracic and vascular surgery (CTVS) unit, Bir Hospital, Kathmandu, Nepal over a period of one year (July 2009 to June 2010). A total of forty-six adult cases were categorized into two treatment groups: (i) thoracotomy for decortication (ii) segmentectomy, lobectomy and redo-thoracotomy for pneumonectomy. The median duration of illness prior to hospital admission was compared. The presence of loculated pleural fluid determined the need for thoracotomy. Results Out of forty-six cases, twenty- nine (63.04%) who had early thoracotomy (<22 days) had prompt symptomatic recovery. Forteen out of seventeen (82.35%) of the patients who were initially treated with thoracocentesis or tube thoracostomy eventually needed thoracotomy. There was a positive shift in management towards early thoracotomy resulting in prompt symptomatic recovery. Significant complications were noted in eight patients who had delayed thoracotomy. Complications included recurrent empyema with lung abscess (n = 3), restrictive lung disease (n = 3), bronchopleural fistula (n = 1) and scoliosis (n=1). Conclusion Early thoracotomy and decortication was found to be an excellent surgical procedure with good functional results and high patient satisfaction rate. KEY WORDS empyema, thoracotomy, complicationsPublication Laparoscopic Cholecystectomy: Conversion Rate and Associated Factors for Conversion(Kathmandu University, 2019) Malla, BR; Shakya, YR; Rajbhandari, N; Karki, BABSTRACT Background Laparoscopic cholecystectomy is the standard surgical treatment of gall bladder disease. However, conversion to open cholecystectomy is inevitable in certain cases. Different centers has reported different conversion rate and factors associated with conversion. Objective To identify the conversion rate, postoperative complication and factors associated with conversion. Method This retrospective study included all laparoscopic cholecystectomy cases attempted in Dhulikhel hospital during the year 2015 and 2016. Records of all patients were reviewed to find out demography of the patients, indications of laparoscopic cholecystectomy, rate of conversion to open, underlying reasons for conversion and postoperative complications. Result Out of 644 cases of laparoscopic cholecystectomy, 452 (70.18%) were female and 192 (29.81%) were male with the mean age of 39 years. Over all conversion rate to open cholecystectomy was 1.86% with the frozen calot’s triangle as the most common reason for conversion. The overall postoperative complication was found to be 1.24% with no major bile duct injury. Acute cholecystitis is a significant preoperative predictor for the conversion into open cholecystectomy. Conclusion Laparoscopic cholecystectomy can safely be done with low conversion rate and complication. Appreciation of the predictor factors help the patient and surgeon for appropriate treatment plan. KEY WORDS Laparoscopic cholecystectomy, Conversion, Open cholecystectomyPublication Sepsis: a private hospital experience in Nepal(Institute of Medicine, 2006) Lakhey, S; Karki, B; Sakya, S; Pandey, SBAbstract Introduction: Sepsis, severe sepsis and septic shock are associated with high mortality. Data about patient profile and outcome of sepsis in ICU of Nepal is lacking. This study was conducted to investigate the source of infection leading to sepsis, its complications and eventual outcome. Material and Methods: It is a prospective study carried out from August 2004 to July 2005 in the ICU of B & B Hospital. The patients admitted in the ICU with the diagnosis of sepsis in accordance to the criteria laid down by American College of chest physician and Society of Critical Care Medicine were analysed and followed up. Age, sex, source of infection, duration of stay in the ICU, Co-morbidities (Mc Cabe’s score), associated severe sepsis, septic shock, acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS), disseminated intravascular coagulation (DIC) and the eventual outcome of sepsis were taken into account. The cause of death was also studied. Infection was diagnosed on the basis of clinical, radiological and microbiological parameters. Results: Of the 28 patients included in the study, 53.6% were male and 46.4% were female, the youngest was 15 years old and the oldest was 93 years old. More than half of the patients were more than 60 years old (53.6%)the average stay in the ICU was 6 days and the main source of infection was lung/respiratory tract (57.14%). 10.7% had sepsis, 89.3% had severe sepsis, 82% had septic shock, 42.9% had MODS, 32.1% hadARDS and 7.1% had DIC. The overall mortality was 39.3%. In elderly the mortality rate was higher (46.7%). The mortality rate was highest in patients with MODS. The mortality rate of sepsis, severe sepsis and septic shock increased progressively from 0%, 39.3% and 47.8% respectively. The mortality rate in patients with ARDS was 55.6%. The most commonly failing organ was circulatory system (82.1%). The mortality was 100% in patients with 3 or more organ failure. Conclusion: Sepsis with its complications has high mortality in our hospital that is similar to the recent findings in Brazil, Norway and USA. Awareness of sepsis and its appropriate treatment as per Surviving Sepsis Campaign Guidelines has become mandatory to reduce its mortality.Publication Submandibular thyroid(Institute of Medicine, 2010) Karki, B; Sharma, P; Ghimire, P GAbstract Submandibular thyroid is one of the rare locations of ectopic thyroid tissue. Only few cases have been reported in the literature. We report a case of 16 year old female patient presenting with ectopic submandibular thyroid tissue. Diagnosis was based on ultrasound and cytology. Keywords: Nepal, submandibular ectopic thyroidPublication Surgical Outcome of Limberg’s Flap Reconstruction in the Treatment of Pilonidal Sinus Disease in a Community Hospital(Kathmandu University, 2022) Karki, B; Rajbhandari, NABSTRACT Background Pilonidal sinus disease is an acquired condition that commonly arises in the hair follicles of the gluteal cleft with male predominance. Different treatment modalities have been described in the literature ranging from simple incision and drainage, wide local excision to complex plastic flaps. Objective To evaluate the efficacy and outcome of Limberg’s flap reconstruction in a community hospital. Method This is a prospective study conducted over two-year duration in forty-two patients in the department of Surgery at Dhulikhel Hospital Kathmandu University Hospital from January 2017 till December 2018. Result Total of 42 patients were operated ranging from 16-31 years with mean of 22.86 years, male to female ratio was 7.5:1, 52% were students and 19% were drivers. Mean operative duration was 61.86±25.3 minutes, length of hospital stay was 2.83±1.68 days, mean duration of drain in situ was 4±1.34 days, mean days for return to work was 14.5±5.7. We had a complication rate of 9.52% out of which 4.76% had seroma, 2.38% hematoma, 2.38% wound infection, and there was no flap necrosis or recurrence. Conclusion It is a simple, easy to learn and safe procedure with good cosmetic results and low recurrence rate. It can be considered as an alternative to other flap and plasty procedures KEY WORDS Limberg’s flap, Flap surgery, Pilonidal, Sinus