NepMed Repository :: Browsing by Author "Makaju, R"

Browsing by Author "Makaju, R"

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Acute appendicitis: Analysis of 518 histopathologically diagnosed cases at the Kathmandu University Hospital, Nepal
(Kathmandu University, 2010) Makaju, R; Mohammad, A; Shakya, A
Abstract Background: Appendicitis is important as it is a common surgical emergency. There is no medical treatment for it, timely surgery is mandatory to prevent morbidity and mortality. Objectives: The objective of this study was to analyse the pathologic findings, the demographics, and, look for the existence of the so called aetiopathogenetic factors in the context of current prevailing beliefs regarding acute appendicitis, the most common current reason for emergency abdominal surgery. Materials and methods: This was a retrospective study. It was carried out at the Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. All histopathologically diagnosed cases of acute appendicitis during the period January 1, 2004 to April 30, 2010 were included. Their macrospcopic and light microscopic examination findings were analyzed. Results: A total of 518 histopathologically diagnosed cases of acute appendicitis were found. Age distribution of these cases was between 6 to 84 years. Mean age was 30. 94+ 15.75 years. Sex distribution consisted of 313 (60.42%) cases in males and 205 (39.58%) cases in females. Fecalith in the appendiceal lumen was seen only in 8 (1.54%) of cases. Granuloma and carcinoid was seen in 3 (0.58%) and 1 (0.19%) cases respectively. Perforation was seen in 11 (2.12%) cases. Foreign bodies, gallstones, strictures, helminthic infection, carcinoma or any other obvious/apparent aetiologic/ pathogenetic lesions/findings were not seen in any of the cases. Histopathologically staged distribution revealed that 180 (34.75%) cases were of early acute appendicitis, 250 (48.26%) cases were of acute suppurative appendicitis, and 88 (16.99%) cases were of acute gangrenous appendicitis. Conclusion: This study did not confirm the existing popular notion that luminal obstruction is the pathogenetic hallmark for acute appendicitis. Therefore, further research on this common surgical emergency is surely warranted. Key words: Acute appendicitis, fecalith, gangrenous
Clinico-Pathological Correlation of Colorectal Diseases by Colonoscopy and Biopsy
(Kathmandu University, 2017) Makaju, R; Amatya, M; Sharma, S; Dhakal, R; Bhandari, S; Shrestha, S; Gurung, R; Malla, BR
ABSTRACT Background Colonoscopy is a simple, safe and well tolerated procedure, the visualization of the mucosa of the entire colon and terminal ileum to detect intestinal abnormalities and obtain biopsy leads to the early detection of the pathologic process and institution of appropriate therapy. Objective To find out the correlation between clinical and histopathological diagnosis of colorectal diseases. Method A cross-sectional study was conducted at Department of Pathology, Dhulikhel Hospital, Kathmandu University Hospital from Jan. 2015 - Jan. 2016. Altogether, 95 colonoscopic biopsies were examined and recorded clinical data using pre-designed pro forma. The specimens were grossed, processed and embedded using standard procedures, stained with Hematoxylin and Eosin stain and were analyzed using light microscope. Special stains Ziehl Neelsen, and Periodic Acid-Schiff were used whenever necessary. Result Analyses of 95 cases of colonoscopic biopsies were done. The most common clinical diagnosis was polyp in 49 cases (51.57%) and the common histopathological diagnosis was non-neoplastic polyps 31(32.63%). There was no correlation in cases for suspected infectious colitis, microscopic colitis and hemorrhoids. Conclusion Colonoscopy is incomplete without biopsy and histopathology is the gold standard for the diagnosis of colorectal lesions. The clinico-pathological correlation for neoplastic lesions was excellent. However, correlation was poor in non-neoplastic lesion. KEY WORDS Colonoscopy, colorectal lesions, histopathology
Clinicomorphological Spectrum of Ovarian Cystic Lesions
(Kathmandu University, 2016) Dhakal, R; Makaju, R; Bastakoti, R
ABSTRACT Background Ovarian cysts, which present as neoplastic and non-neoplastic lesions, are the most common gynaecological cause of hospital admissions. Early diagnosis is difficult due to asymptomatic nature. Clinical, radiological and gross examination alone cannot distinguish benign from malignant lesions, hence, histopathological examination is important for diagnostic, therapeutic and prognostic approach. Objective The objective of the study is to analyze the spectrum of ovarian cystic lesions with their clinico-morphorgical features. Method This is a prospective study done in between July 2014 and July 2015 in Dhulikhel Hospital-Kathmandu University Hospital. Clinical data of patients were obtained from hospital records and requisition submitted along with the tissue specimens received in the department. Result A total 84 cases of ovarian cystic lesions were studied. Among these, 47 (55.9%) were non-neoplastic lesions, 33 (39.3%) were benign neoplasms, two (2.4%) were borderline and two (2.4%) were malignant neoplasms. The most common non- neoplastic lesions were follicular cysts, 26 (55.3%) followed by simple cysts 14 (29.8%), hemorrhagic cysts five (10.6%) and corpus luteal cysts two (4.3%). Among all neoplasms, 19 (51.4%) were mature cystic teratoma followed by 10 (27.0%) cases of mucinous cystadenoma and four (10.8%) cases of serous cystadenoma. Between two (5.4%) malignant cases, one was immature cystic teratoma and the other was mucinous cystadenocarcinoma. Besides these, two (5.4%) cases of borderline mucinous cystadenoma were also present. Conclusion Ovarian cystic lesions are difficult to categorize on the basis of clinical and radiological findings. Histopathological examination plays a significant role to differentiate benign lesion from malignant as well as for the proper management. KEY WORDS Neoplasm, non-neplastic lesions, ovarian cyst
Correlation between Endoscopic and Histopathological Findings in Gastric Lesions
(Kathmandu University, 2015) Sharma, S; Makaju, R; Dhakal, R; Purbey, B; Gurung, RB; Shrestha, R
ABSTRACT Background Stomach is a common site for wide variety of lesions. The visualisation of the site with biopsy leads to the early detection of the pathologic process and appropriate therapy. Objectives The objective of this study is to correlate the histopathological pattern of endoscopic biopsies with distribution of gastric lesions according to age and sex. Method The retrospective study was carried out among 50 cases with endoscopic biopsies and histopathological assessment, received at Department of Pathology, Dhulikhel Hospital- Kathmandu University Hospital. Result Out of 50 cases majority of cases were of male gender with male: female ratio was 1.3:1. Our study showed a poor correlation between endoscopic and histopathological evidence of inflammation in the stomach. Two cases were diagnosed as intestinal metaplasia which were diagnosed as ulcer and erosion endoscopically. Out of 32% of cases diagnosed endoscopically as ulcer, only one case was confirmed histopathologically. Our study showed good correlation in the cases of carcinoma. Out of 17 cases diagnosed endoscopically as gastric carcinoma correlated histopathologically as gastric adenocarcinoma. Majority of carcinoma cases showed ulcerating fungating growth followed by ulcero-proliferative growth. Conclusion Endoscopy is incomplete without biopsy and histopathology is the gold standard for the diagnosis of endoscopically detected lesions. Endoscopic examination and histopathological examination of suspected gastric lesions should go parallel and neither should be a substitute of each other. KEY WORDS Carcinoma, endoscopy, helicobacterpylori, histopathology.
Correlation of Cervical Pap Smear with Biopsy in the Lesion of Cervix
(Kathmandu University, 2016) Dhakal, R; Makaju, R; Sharma, S; Bhandari, S; Shrestha, S; Bastakoti, R
ABSTRACT Background Cervical cancer can be controlled to a greater extent by screening to improve morbidity and mortality. Pap smear is important screening method, which has proven to be highly effective in reducing the number of cases and the mortality from cervical carcinoma. Any abnormality detected in pap smear has to be confirmed with cervical biopsy, which remains the reference investigation. Objective To find the changes of cervical cytology by pap smear, to classify cervical lesions into malignant and benign groups on cytological and histopathological basis and to correlate the changes observed in cervical cytology with cervical biopsy. Method This is a prospective cross sectional study done in between July 2014 and July 2015 in Dhulikhel Hospital, Kathmandu University Hospital. During the period, all the samples requested for pap smear were studied. The cases who had undergone both pap smear and cervical biopsy were compared. Clinical data were obtained from requisition submitted along with the cytology and tissue specimens received in the department. Result During the study period, total 1922 pap smears were performed and out of them 75 patients were advised to do cervical biopsy. On cytology, out of total 1922 number of cases, 67.90% were normal, 27.90% were inflammatory smears, 3.80% were unsatisfactory (inadequate) and 0.40% were high grade intraepithelial lesions. Highest numbers of patients screened for pap smear ranged from 31 to 40 years. On histopathology, 78.70% had chronic cervicitis, 8% had normal findings, 1.30% had moderate and 6.70% had severe squamous intraepithelial lesions. The frank malignancy was found in 5.30%. The mean age ± SD for carcinoma was 52.75±6.29. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value of pap smear were 77.80%, 100%, 100% and 97% respectively considering cervical biopsy as the gold standard Conclusion This study revealed a good correlation of cervical cytology with cervical biopsy. Pap is a cost effective screening method for early detection of premalignant and malignant cervical lesions. However, biopsy is considered as the gold standard for the confirmation of abnormalities detected in cervical smear. KEY WORDS Biopsy, cervix, pap smear
Darier White disease
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Amatya, A; Karn, D; Aryal, E; Makaju, R; Shakya, A; Priyadarshinee, A
Abstract Darier’s disease was described inependently by Darier and White in 1989 AD. Reported prevalence varies from 1/100,000 in Denmark to 1 in 30- 35,000 in northern England and Scotland.1 Darier’s disease has been reported from other parts of the world, however,there has been no reported cases in Nepal. It is an inherited autosomal dominat disease characterized by dark crusty lesions over the seborrheic areas of the skin. We are reporting a case of Darier’s disease in a Nepalese patient who developed skin leison’s over his face and body at the age of 12 years. We took skin punch biopsy from the leisons, which showed findings suggestive of Darier’s disease. Our case was treated with isotrerenoin and topical keratolytics. He responded with the given treatment within two weeks of therapy.
Histopathological Changes in the Chorionic Villi and Endometrial Decidual Tissues in the Product of Conception of Spontaneous Abortion Cases
(Kathmandu University, 2015) Makaju, R; Shrestha, S; Sharma, S; Dhakal, R; Bhandari, S; Shrestha, A; Tamrakar, S
ABSTRACT Background Spontaneous abortion refers to a pregnancy that ends spontaneously before the fetus has reached a viable gestational age or expulsion or extraction of an embryo or fetus weighing 500 g or less from its mother. The Maternal Mortality Morbidity Survey of Nepal 2008/09 reported that 7% of maternal deaths in Nepal were due to complications related to abortion. Objective The main objective of this study was to examine the histopathological changes in the chorionic villi and endometrial decidual tissue in products of conception obtained from women with spontaneous abortion. Method This is a retrospective study of 111 patients admitted in the Department of Obstetrics and Gynecology at Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH) with the diagnosis of spontaneous abortion during the period of January 2013 to January 2014. Result Among 111 cases of spontaneous abortions, products of conception was seen in 73 (65.77%) and with only one cases of choriocarcinoma. Majority of cases belongs to age group 21-30 years. The most common decidual changes were inflammation (41.4%) followed by fibrin deposition 29.7%. Majority of the cases shows hydropic changes as histopathological changes in chorionic villi. In the present study, minimum age of lady was 15 years and the maximum age was 45 years and the mean age was 25.09±5.58 years at the time of abortion. Among the cases, maximum 69 (62.2%) of them belonged to age group 21-30 years. Correlating the age group with number of abortions was found to be significantly different (Chi-square= 92.35, df= 3, p < 0.001) among four different age groups. Conclusion The histopathological diagnosis of spontaneous abortion will help in further management of the patient. Further study is required to know the cause of different histopathlogical changes in villi as well as in the decidua. KEY WORDS Chorionic villi, endometrial decidual tissue, maternal mortality, product of conception, spontaneous abortion
Histopathological Findings of Endometrial Samples and its Correlation Between the Premenopausal and Postmenopausal Women in Abnormal Uterine Bleeding
(Kathmandu University, 2014) Sharma, S; Makaju, R; Shrestha, S; Shrestha, A
ABSTRACT Background Abnormal uterine bleeding is considered as one of the most common problems among women. The therapy is incomplete without knowing the underlying pathology. Objectives To determine the types and frequency of endometrial pathologies in patients presenting with abnormal uterine bleeding at Dhulikhel Hospital Kathmandu university Hospital. Methods This is retrospective study total 100 cases were included over a period of one year of Abnormal Uterine bleeding. Results Out of 100 cases of Abnormal uterine bleeding, 61% were due to non-organic cause with a commonest histopathological findings proliferative endometrium. 27% cases were due to organic cause with pregnancy related condition as most common finding. 12% were reported as inadequate. The rate of postmenopausal bleeding declined with increasing age in the postmenopausal period and endometritis was the predominant finding. Conclusion There is an age specific association of Abnormal uterine bleeding with increased incidence in perimenopausal age group. Postmenopausal bleeding declined with increasing with endometritis the most common finding. Dilation and curettage is helpful to exclude other organic pathology. It is useful for diagnosis and to know pathological incidence of organic lesions in cases of Abnormal uterine bleeding prior to surgery. KEY WORDS Abnormal uterine bleeding, histopathology
Problem Based Learning in Medical Education
(Kathmandu University, 2012) Mansur, DI; Kayastha, SR; Makaju, R; Dongol, M
ABSTRACT Problem based learning, originally introduced in the Medical School at Mc- Master University in Canada in the late 1960s, and is now being used as a learning method in many medical schools in the United Kingdom and worldwide. Problem based learning have been adapted in many medical colleges of Nepal be used either as the mainstay of an entire curriculum or for the delivery of individual courses. Institution of Medicine, Tribhuvan University in 1980, BP Koirala Institute of Health Sciences at Dharan in 1999, KUSMS with the great support of faculties from Harvard University in 2001, Patan Academy of Health Sciences (PAHS), and lately all the affiliated medical colleges of Kathmandu University have adapted Problem based learning KEY WORDS Medical Education, PBL
Retrospective histopathological analysis of various neoplasms of different parts of the gastrointestinal tract seen at the Kathmandu University Teaching Hospital (KUTH), Dhulikhel, Nepal
(Kathmandu University, 2006) Mohammad, A; Makaju, R
Objective: To find out the spectrum of various histopathologic types of primary neoplasms of different parts of the gastrointestinal tract (oesophagus, stomach, small intestine, colorectum, anal canal) seen at the Kathmandu University Teaching Hospital (KUTH), Dhulikhel as there exists a worldwide wide variation in the distribution of various neoplasms of different parts of the gastrointestinal tract, which appears largely due to exogenous factors rather than due to inherent differences between populations. Materials and methods: This was a retrospective study. It was carried out at Kathmandu University Teaching Hospital (KUTH), Dhulikhel, Kavre, Nepal. All neoplasms of the gastrointestinal tract seen at the KUTH during the period 1st January 2004 to 31 st December 2004 were included in this study and examined by light microscope (LM). Results: A total number of 18 cases of neoplasms of the gastrointestinal tract were seen. Out of these, 3 (16.7%) were of the oesophagus (all squamous cell carcinoma), 10 (55.5%) were of the stomach (six intestinal type and four diffuse type), 2 (11.1%) were of the small intestine (one was lymphoma of the mucosa associated lymphoid tissue – MALTOMA and other was a malignant gastrointestinal stromal tumour - GIST), 3 (16.7%) were of the colorectum (all adenocarcinoma), and none was of the anal canal. Conclusion: Relatively large number of cases of the carcinoma of the stomach were found in our this small series of the cases of the gastrointestinal tract in comparison to the Western countries. Key words: Neoplasms, gastrointestinal tract, gastric carcinoma intestinal type, gastric carcinoma diffuse type, Kathmandu University Teaching Hospital (KUTH).
Retrospective histopathological analysis of various neoplasms of the female reproductive system (FRS) seen at the Kathmandu University Teaching Hospital, (KUTH) Dhulikhel, Nepal
(Kathmandu University, 2006) Mohammad, A; Makaju, R
Objective: To find out the spectrum of various histopathological types of primary neoplasms of different parts/organs of the female reproductive system seen at the Kathmandu University Teaching Hospital (KUTH) as there exists a worldwide wide variation in the distribution of various neoplasms, which appears largely due to exogenous factors rather than due to inherent differences between populations. Material and Method: This was a retrospective study. It was carried out at KUTH. All neoplasms of the female reproductive system seen at the KUTH during the period of 20 months from 1 st January 2004 to 31 st August 2005 were included in this study and examined by light microscope (LM). Results: A total number of 60 cases of neoplasms of the female reproductive system were seen. Out of these, 1 (1.7%) was of the vagina (squamous cell carcinoma, papillary variant); 16 (26.7%) were of the cervix of the uterus (all squamous cell carcinoma in advanced stage); none were of the endometrium; 20 (33.3%) were of the body of the uterus/uterine muscle (all liomyomas); 16 (26.7%) were of the ovary, (11 benign, consisting of nine mature cystic tertoma, also known as dermoid cyst, one serous papillary cystdenoma and one mucinous cystadenoma; and, five malignant, consisting of two serous cystadenocarcinoma, two mucinous cystadenocarcinoma and one mixed mucinous and serous cystadenocrcinoma); and, 7 (11.6%) were of the breast (two benign, consisting of fibroadenoma and five malignant, all consisting of infiltrating ductal carcinoma in advanced stage). Conclusion: There were relatively a large number of cases of advanced stage of cancer of uterine cervix. All breast cancers seen were also in advanced stage. Endometrial carcinoma was conspicuously absent in our this small series of cases. Key words: Neoplasms, female reproductive system (FRS), Kathmandu University Teaching Hospital (KUTH)
The Correlation Between Fine Needle Aspiration Cytology and Histopathology of Head and Neck Lesions in Kathmandu University Hospital
(Kathmandu University, 2013) Rajbhandari, M; Dhakal, P; Shrestha, S; Sharma, S; Shrestha, S; Pokharel, M; Shrestha, I; Shrestha, B; Makaju, R
ABSTRACT Background Fine needle aspiration cytology (FNAC) with it’s minimally invasiveness has been a well accepted procedure in the initial diagnosis of various swellings. With time and experience high sensitivity and specificity of FNAC over conventional open biopsy has lead to the wide acceptance of this procedure. Objective To evaluate the utility of aspiration cytology as a first-line diagnostic tool in palpable head and neck masses and correlate with histologic results for evaluating diagnostic accuracy. Methods A hospital based prospective, comparative study was conducted among patients with various swellings at Head and Neck regions in the Department of Pathology, Dhulikhel Hospital between July 2011 to June 2012. FNAC were done from the palpable masses of head and neck regions and were compared with biopsy findings of the same lesions. Data entry and analysis performed using SPSS version 16. The sensitivity, specificity and accuracy rates were calculated. Results A total 64 patients were subjected to both FNAC and histopathological examination (HPE). Total 39 (61 %) were females and 25 (39 %) were males with M: F ratio of 1:1.6. The age group ranged from 9 to 80 years. Twenty five percent of patients were in the age group below 20 years. The highest number of cases included lymph nodes 29 (45%) followed by thyroid 24(37.5 %), salivary glands 10(16%) and 1 case (1.6%) was a soft tissue swelling over the occipital region. Highest sensitivity, specificity and accuracy rate for diagnosis by FNAC were observed in thyroid. The overall sensitivity and specificity of FNAC were 86% and 97% respectively in determining the various pathologies. The overall accuracy of FNAC in present study was 87.4%. Conclusion FNAC is a minimally invasive first line investigation with a high sensitivity and specificity for the diagnosis of various head and neck lesions KEY WORDS FNAC, lymph nodes, salivary Glands, thyroid
Typhoid fever in Dhulikhel hospital, Nepal
(Kathmandu University, 2004) Sharma, N; Koju, R; Karmacharya, B; Tamang, MD; Makaju, R; Nepali, N; Shrestha, P; Adhikari, D
One hundred and twelve cases of typhoid fever presenting in outpatient and emergency department of Dhulikhel Hospital in Nepal were studied. In this study, it was found that 71% typhoid fever cases were less than 30 years of age group with male to female ratio of 3:1. Fever over 5 days followed by headache and chills were major presenting symptoms. Widal test and blood culture for Salmonella typhi were positive in 59% and 49% cases respectively. Two third of our study population had total leucocyte count of normal range. The fever clearance time was significantly better with ofloxacin compared to ciprofloxacin (p<0.05) and ceftriaxone compared to chloramphenicol (p<0.05). The release from treatment was significantly shorter with ceftriaxone compared to ofloxacin, ciprofloxacin and chloramphenicol (p<0.01). Ceftriaxone was found to be 100% sensitive to salmonella typhi. Amoxicillin was only 52.1% sensitive to Salmonella typhi. Early diagnosis and institution of appropriate antibiotic therapy is of paramount importance in the management of typhoid patients. Key words: Typhoid fever, salmonella typhi, fever clearance time, release from treatment
Urinary Bladder Carcinoma: Impact of Smoking, Age and its Clinico-Pathological Spectrum
(Kathmandu University, 2013) Joshi, HN; Makaju, R; Karmacharya, A; Karmacharya, RM; Shrestha, B; Shrestha, R; de Jong, IJ; Shrestha, RKM
ABSTRACT Background Urinary bladder carcinoma is common urological malignancy. Although epidemiological evidence favors role of occupational exposure to chemical carcinogen as the aetiological factor of bladder carcinoma, many cases arise with no obvious occupational exposure to chemical carcinogen. Tobacco and cigarette smoking is common in both rural and urban areas of Nepal. Objective The objective of this study was to determine the impact of smoking and age in urinary bladder carcinoma with related clinicopathological correlations. Method A total of 56 (44 males and 12 females) cases of urinary bladder cancer treated at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of January 2004 to December 2013 were included in the study. Data of patients with Urinary bladder cancer were obtained from hospital records and evaluated for age, sex, history of smoking, clinical presentations, cystoscopic findings and histopathological characteristics. Results Out of 56 cases, 51 (91.1%) of the patients had hematuria. History of smoking was found in 44 patients. Smoking was found much higher in males (88%) than females (41.66%). Transitional cell carcinoma (TCC) was the most common histological variety, which was seen in 51 (91.07%) patients. The significant impact of smoking was found in terms of grade of TCC. Conclusion The incidence of bladder carcinoma is higher in male and TCC is the most common variety of Urinary bladder malignancy. History of smoking correlated with grade. KEY WORDS Bladder cancer, bladder carcinoma, smoking, transitional cell carcinoma

Browsing by Author "Makaju, R"

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