Browsing by Author "Kayastha, P"
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Publication Adult Granulosa Cell Tumor of the Ovary Diagnosed after Laparoscopic Salpingoophorectomy(Kathmandu University, 2025) Ansari, SN; Shrestha, E; Kayastha, P; Bista, KBABSTRACT Ovarian malignancies of uncommon variety are seen in 10% of cases of all ovarian tumors. Approximately 5% of such cases are granulosa cell tumor of ovary (GCT). In adolecents, the adult type Granulosa cell tumor (AGCT) is rare and the major concern is fertility preservation. Prognosis of the adult type granulosa cell tumor is favorable after surgery, as most cases present at early stages. We report a case of an 18-year girl who presented to our center with histopathological report of the adult type granulosa cell tumor. She underwent laparoscopic left salpingoophorectomy at another center for a 28.5 X 22.5 cm right adenexal mass. The patient denied completion surgery at our center and remained on follow-up. Patient is doing fine on follow-up to date. In young girls who present with complex adenexal mass, a strong suspicion of rare ovarian malignancies like granulosa cell tumor should be considered. For cases with incomplete surgery but fertility concern granulosa cell tumor should be monitored vigilantly for recurrence. KEY WORDS Adenexal mass, Adolescence, Fertility preservation, Granulosa cell tumorPublication Comparison of the Mean Cross-sectional Area of the Median Nerve between Pregnant and Non-Pregnant Women Using Ultrasonography in a Tertiary Level Hospital, Nepal(Kathmandu University, 2023) Adhikari, G; Regmi, PR; Paudel, S; Lamichhane, B; Kayastha, P; Maharjan, S; Amatya, IABSTRACT Background The median nerve is subjected to compression in the carpal tunnel giving rise to a constellation of symptoms known as carpal tunnel syndrome. It is the most frequent form of peripheral entrapment neuropathies and is most prevalent in the middle age females. The most common cause of this syndrome is idiopathic. One of the known secondary causes is pregnancy. Objective To compare the mean cross sectional area of median nerve using ultrasound in pregnant and non-pregnant females at carpal tunnel inlet and its variations with different trimesters. Method The study was conducted during a period of one year (October 2014 to September 2015). A total of 204 participants were evaluated among which 102 were nonpregnant and 102 were pregnant. Among the 102 pregnant participants, 34 females each were in the first, second, and third trimesters. A convenience sampling technique was used for the selection of the participants. The mean cross-sectional area of the median nerve was calculated in both of these groups in both hands by using the direct method. The mean cross-sectional area of non-pregnant female was used as the reference value to which that of pregnant female were compared. Data obtained were compiled and analyzed using Statistical Package for Social Sciences Version 16. Result The overall mean cross-sectional area of the median nerve in non-pregnant females was 6.76 ± 1.05 mm2 and in pregnant females was 6.84 ± 1.09 mm. No statistically significant difference was noted in the mean cross-sectional area of the median nerve in either hand in both pregnant and non-pregnant females. No statistically significant difference was noted in the overall mean cross-sectional area between the non-pregnant and pregnant females. There was no significant difference in the mean cross-sectional area within the different trimesters in both hands on intergroup comparisons. Conclusion Ultrasound examination of the median nerve and measurement of its cross- sectional area is a useful diagnostic tool in the evaluation of carpal tunnel syndrome. Ultrasound has the advantage of easy availability, low cost, quick scan time, able to scan a long segment of nerve and examine the structures in both static and dynamic states. Besides, it also helps in the identification of various anatomic variants and pathologies within or adjacent to carpal tunnel. KEY WORDS Carpal tunnel, Mean cross sectional area, Median nerve, UltrasonographyPublication Comparison of Ultrasonography with Computed Tomography in Diagnosis and Staging of Lung Cancer(Kathmandu University, 2024) Paudel, S; Kayastha, P; Suwal, S; Nepal, B; Bhusal, KR; Bhusal, KR; Katwal, S; Regmi, PRABSTRACT Background Ultrasound (US) can aid in lung cancer diagnosis and staging in peripheral-based lesions by demonstrating chest wall invasion, aiding as a guide to biopsy, and detecting supraclavicular lymph nodes which are often missed by computed tomography (CT). Objective This study is to compare the ultrasound with computed tomography in the diagnosis and staging of lung cancer. Method This was an observational prospective study conducted from October 2020 to April 2023 in patients with or suspected lung cancer sent for imaging assessment to the Department of Radiology and Imaging. Out of 306 patients who underwent computed tomography scan, a total of 234 patients with proven lung cancer were subjected to ultrasound of the chest, liver, bilateral adrenal, and supraclavicular regions for the evaluation of lung mass, pleural effusion, and metastasis in lung, adrenal, and supraclavicular lymph nodes. Diagnostic values of ultrasound to detect peripheral lung lesions, chest wall invasion, pleural effusion, liver and adrenal metastasis, and supraclavicular lymph nodes were compared with contrast-enhanced computed tomography scans. Ultrasound’s performance was evaluated against computed tomography scans as the gold standard, using the chi-square test, z-test, and area under the curve for comparison (p < 0.05 for significance). Result The majority of patients (53.8%, n=126) were aged 61-75, with 53% being male and 89% smokers. Ultrasound was superior in detecting pleural effusion (sensitivity 80.3%, NPV 92.2%, AUC 0.860) and supraclavicular lymph nodes (sensitivity 72.2%, NPV 91.6%, AUC 0.817). Conclusion In resource-constrained settings like Nepal, where advanced imaging may be limited, integrating ultrasound with contrast-enhanced computed tomography significantly improves lung cancer diagnosis. This non-radiation approach is particularly beneficial for peripheral lesions, patients with renal function impairment and aiding effective staging of lung cancer. KEY WORDS Computed tomography, Lung cancer, Role, UltrasoundPublication Correlation between Computed Tomography and Ultrasonography Findings in Patients with Fatty Liver(Kathmandu University, 2024) Kayastha, P; Paudel, S; Chapagain, P; Shingh, SS; Adhikari, B; Joshi, S; Katwal, SABSTRACT Background Fatty liver disease, linked to obesity, alcohol consumption, and insulin resistance, is characterized by pathological fat deposition exceeding 5%. Its rising global prevalence, particularly in Southeast Asia, highlights the need for effective diagnostic modalities. Objective To find the correlation between computed tomography and ultrasonography findings in patients with fatty liver. Method A prospective cross-sectional study was conducted on 211 patients from December 2016 to October 2017. Patients referred for computed tomography chest and abdomen were included, excluding those with diffuse or focal liver disease other than fatty liver. Computed tomography attenuation values were measured using non- contrast sequences, with participants showing mean hepatic attenuation less than +48 Hounsfield units subjected to further ultrasound and shear wave elastography examinations. Data were analyzed using Microsoft Excel and SPSS, with associations examined through Pearson correlation, ANOVA and Shapiro-Wilk test. Result The study included 100 males and 111 females, aged 21 to 65 years. The mean computed tomography attenuation was +40.31 Hounsfield units. A moderately strong negative correlation was found between Computed Tomography attenuation and ultrasound grades of fatty liver (Spearman’s coefficient = -0.775, p = 0.005). No significant correlation was observed between computed tomography attenuation and shear wave elastography values, nor between patient age and hepatic attenuation. Conclusion This study demonstrates a significant correlation between computed tomography attenuation and ultrasound grades of fatty liver, highlighting their complementary roles in diagnosing fatty liver disease. However, no significant correlation was found between computed tomography attenuation and shear wave elastography values. KEY WORDS Attenuation, Computed tomography, Elastography, Fatty liver, UltrasoundPublication Correlation between Femoral Intercondylar Notch Width and Anterior Cruciate and Posterior Cruciate Ligament Widths on MRI of Knee Joint(Kathmandu University, 2023) Ghimire, P; Kayastha, P; Suwal, S; Katwal, S; Dhakal, P; Lamichhane, S; Lohani, BABSTRACT Background Anatomic variations have been implicated as one of the intrinsic causes of injuries to the cruciate ligaments which can induce a functional deficiency to the knee. Narrow cruciate ligament widths as well as narrow femoral intercondylar notch widths can increase the risk of these ligaments rupturing. Objective To correlate the width of the femoral intercondylar notch (ICN) with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) widths on MRI of the knee joint. Method A total of 46 patients who met the inclusion criteria were evaluated. Intercondylar notch was identified on coronal T1W images while anterior cruciate ligament and posterior cruciate ligament were identified on proton density coronal images. All the widths were measured in the same plane at a mid-coronal level where anterior cruciate ligament and posterior cruciate ligament cross each other. Result Our result showed a significant correlation between the widths of intercondylar notch and anterior cruciate ligament (r = 0.68, p < 0.001) and between intercondylar notch width (INW) and posterior cruciate ligament width (r = 0.65, p < 0.001). Overall, the mean intercondylar notch width measured was 17.5 ±2.5 mm (range 11.8 to 21.8 mm), the mean anterior cruciate ligament width was 5.9 ±1.3 mm (range 3.3 to 8.6 mm), and the mean posterior cruciate ligament width was 8.9 ±1.5 mm (range 5.9 to 11.8 mm). A statistically significant difference was observed between males and females for mean widths of intercondylar notch (p < 0.001) and posterior cruciate ligament (p=0.01). However, no statistically significant difference was seen for anterior cruciate ligament width (p=0.07) between the two genders. Conclusion Measurement of the femoral intercondylar notch width can be used as an indicator of anterior cruciate ligament and posterior cruciate ligament widths which can further assist to identify the individuals who are more susceptible to cruciate ligament injuries. KEY WORDS Anterior cruciate ligament, Cruciate ligament injury, Intercondylar notch width, MRI, posterior cruciate ligamentPublication Sonographic Quantification of Ovarian Volume in Adults Attending General Health Checkup and General Out Patient Department in Tribhuvan University Teaching Hospital(Kathmandu University, 2020) Upadhyaya, RP; Ansari, MA; Jha, A; Kayastha, P; Paudel, SABSTRACT Background Ultrasonography is the easily available, cheap and reliable method for evaluation of ovaries. Ovarian volume is the major factor in the diagnosis of various ovarian pathologies and confusing discrepancies are found in the literature. Objective To determine the ovarian volume among individuals attending outpatient department in tertiary level hospital. Method Descriptive cross sectional study design was used; 305 patients of 16-60 years attending general outpatient department in the Tribhuvan University Teaching Hospital, Kathmandu, Nepal were included. Ovarian volume was calculated by using transabdominal ultrasonography. Data was collected in the predesigned proforma and analyzed using statistical package for the social sciences software. Result The study showed mean total ovarian volume 5.95 ± 2.44 cc (centimeter cube) with mean right ovarian volume 5.94 ± 2.70 cc and mean left ovarian volume 6.05 ± 2.79 cc. Significant decrease in ovarian volume with age was observed. Height and weight did not show significant correlation with ovarian volumes and no significant variation seen in the volumes of right and left ovaries. Periovulatory ovaries show significantly higher volumes on right side than luteal phase. Similarly, significantly higher volume of left ovary seen in mixed ethnic group than mongoloid group. Conclusion Measurement of ovarian volume is important for evaluation and management of ovarian disorders. Ultrasonography which is readily available, simple and cost effective is better suited for our environment than other imaging modality. Values of ovarian volume from this study may provide a baseline of normal ovarian volume in our community. KEY WORDS Ovary, Ultrasonography, Volume