Browsing by Author "Pokharel, R"
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Publication Correlation of Pelvic Parameters with Isthmic Spondylolisthesis(Kathmandu University, 2021) Shrestha, S; Lakhey, RB; Paudel, S; Kafle, D; Pokharel, RABSTRACT Background Spondylolisthesis is one of the major causes of low back pain. The anterior shift of the vertebra is mostly at L4 and L5 levels. Several types have been described, most common being the isthmic type. Pelvic parameters are said to be associated with development and progression of listhesis, and should be evaluated while treating it. Objective To study the correlation of Pelvic parameters with isthmic spondylolisthesis. Method It was a cross sectional case control study. In 68 cases with Isthmic Spondylolisthesis and of 34 cases with low back pain without listhesis (control), the spinopelvic parameters like lumbar lordosis, pelvic incidence, pelvic tilt and sacral slopes were measured together with degree of slip with lateral radiographs. Findings were analyzed and compared with control group. Result In control group, the pelvic incidence was 50.44±4.78o, the sacral slope was 34.38±6.79o, the pelvic tilt was 15.97±5.31o, and the lumbar lordosis was 46.76±6.78o. In Isthmic Spondylolisthesis group, the pelvic incidence was 60.85±6.79o, the sacral slope was 40.40±6.91o, the pelvic tilt was 20.63±7.51o, and the lumbar lordosis was 57.31±7.11o. The difference in spinopelvic parameters amongst control and Isthmic Spondylolisthesis group was statistically significant (p < 0.001). The degree of slip was directly proportional to the pelvic incidence angle (grade I=52o, II =62o and III 72.5o). Conclusion Spino-pelvic parameters are higher in isthmic spondylolisthesis group and is significantly associated with severity of the slip. KEY WORDS Isthmic spondylolisthesis, Lumbar lordosis, Pelvic incidence, Pelvic tilt, Sacral slopePublication How Effective is Non-surgical Management in Pediatric Intussusception?(Institute of Medicine, 2014) Pokharel, RAbstract Introduction: Intussusception is common in infants and young children. Healthy babies are prone to this problem. Severe intermittent pain, vomiting, pallor, and sweating are suspicious to this problem. Early diagnosis helps to prevent surgical intervention. Late presentation may lead to intestinal perforation and serious complications. Methods: Diagnosed cases of intussusception within a year at TUTH were studied prospectively. Patients initially evaluated with ultra sonogram. Patients without complications and contra indications were taken to the radiology department for reduction by non-surgical method (Barium enema). Complicated and contraindicated cases managed surgically. Results: Total 21 cases admitted within a year. Male: Female ratio was 2:1. Mean age at presentation was 20.05 months (5 - 48 months). The average symptoms duration was 36.11 (6-72) hours. Abdominal pain & cry, vomiting, and blood in stool were common presenting symptoms. Among 21 cases, 18 underwent non-surgical procedure: two were contra indicated for it and one self reduced. In non-surgically managed group 13 had successful reduction and five failed. Failed cases were managed surgically. In our series, two recurrences noticed. One in surgically managed group, presented after five months of surgery and managed successfully with non-surgical method. Second case was in non-surgical group, presented after three months of first reduction. This was also managed successfully by non-surgical technique. Conclusion: Early detection and complete diagnosis of pediatric intussusception is desirable for non-surgical management. Surgical intervention is considered only in contra indications, unsuccessful, and perforation during non-surgical procedures. Ultrasonography is the diagnostic choice but operator’s variation should consider. Keywords: Pediatric intussusception, non-surgical management.Publication Multifocal Tubercular Osteomyelitis Involving Bilateral Symmetrical Second Metacarpals(Institute of Medicine, 2012) Pokharel, RAbstract Abstract: Skeletal tuberculosis involving small bones of the hand is less common. We report a case, 6 year old boy, of bilateral symmetrical tubercular osteomyelitis of second metacarpals. He presented with gradually increasing swellings over bilateral hands over duration of one month. There was no other significant history relating to tuberculosis. Hand X-rays showed expansive lesions of bilateral second metacarpals. Thick pus and necrotic tissue was removed from both the swelling and from the bone. Presence of typical tubercular granuloma in the histopathological examination confirmed the diagnosis. The boy was treated with antitubercular drugs and improved after completion of anti-tubercular treatment. Tuberculosis can present in different ways, and should be kept as one of the possible diagnosis of several bony pathologies including metacarpals and phalanges, especially in this part of the world where tuberculosis endemic. Keywords: tubercular dactylitis, metacarpals, symmetrical