Browsing by Author "Nepal, B"
Now showing 1 - 2 of 2
Results Per Page
Sort Options
Publication 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 Surgical Management of Primary Hyperparathyroidism: An Institutional Study on Surgical Quality Control(Institute of Medicine, 2017) Nepal, B; Singh, YP; Pokhrel, A; Sayami, P; Sayami, GAbstract Introduction: Surgery is key treatment of primary hyperparathyroidism. With the inclusion of serum calcium measurement in routine biochemistry panel, majority of primary hyperparathyroidism can be detected in earlier asymptomatic phase. Preoperative localization by Ultrasonography and Sestamibi scan combined together along with CT or MRI in ectopic adenoma enables for focused minimal invasive surgery. Intraoperative intact PTH (IPTH) measurement is used as a surgical quality control in primary hyperparathyroidism surgery. This study was undertaken to look into current status of surgical management of primary hyperparathyroidism in the tertiary care center in Nepal. Methods: This was a prospective observational study conducted in Department of Surgery. Tribhuvan University Teaching Hospital Kathmandu, Nepal from November 2014 to October 2016. Demography profile, preoperative symptoms, duration of symptoms, preoperative serum calcium, phosphate, immediate preoperative iPTH level and intraoperative iPTH level, post-operative calcium level and localization techniques were recorded. Final pathology report of each of the patients were recorded. Results: Thirteen patients were operated for primary hyperthyroidism. Mean age of the patients was 36:15 years. None of the patient had multi-glandular disease on preoperative localization. Mean preoperative Calcium level was 12.8±0.9 mg/dl and mean preoperative iPTH level was 998+805 pg ml. As Intraoperative iPTH measurement was used to ascertain the successful adenoma removal, mean IPTH intraoperative iPTH after the removal of the adenoma was 175±167 pg/ml. Mean difference of iPTH was 823±725 (p 0.024). There was mean decrease of 81% of iPTH after surgery well above 50% decrease confirmatory of successful adenoma removal. None of patients had reported with recurrent symptoms till date. Conclusion: Hypercalcemia should be subjected for iPTH scanning to identify more asymptomatic patients and Surgery is key treatment and intraoperative iPTH assay is used for confirmation of adenoma removal. Keywords: Hypercalcemia, Primary Hyperprathyroidism, Focused Parathyroidectomy, iPTH monitoring