Browsing by Author "Pokhrel, Biraj"
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Publication Adenosquamous Carcinoma of Gallbladder with Unusual Prognosis: A Case Report(Nepal Medical Association, 2023) Gyawali, Siddinath; Pokhrel, Biraj; Sharma, Deepak; Bhatta, Naveen Chandra; Kandel, Bishnu Prasad; Lakhey, Paleswan JoshiAbstract The adenosquamous carcinoma of the gallbladder is a rare variant accounting for only 1-4% of all primary gallbladder carcinoma. Regardless of the histological types, all gallbladder carcinomas have silent and rapid progression resulting in delayed diagnosis and poor prognosis. Even with medical and/or surgical interventions, the median survival of patients with adenosquamous carcinoma, one of the histological variants, is less than a year. However, we present a case of adenosquamous carcinoma with an unusually better prognosis. A 70-year-old female patient, after being diagnosed with gallbladder carcinoma was suggested for surgical resection but was lost to follow-up since then. Two years later, the patient presented and was managed with extended cholecystectomy. The slow progression and non-recurrence of the tumour during follow-up for two years after the surgery indicates a better prognosis in this case.Publication Anuria, an Atypical Presentation of Leptospirosis: A Case Report(Nepal Medical Association, 2022) Khanal, Shambhu; Pokhrel, Biraj; Pokhrel, Madalasha; Thapa, Rukshar; Nepali, RabinAbstract: Leptospirosis, an underreported disease, is a highly prevalent spirochaetal zoonotic disease in both tropical and temperate climates. Symptoms can range from mild illness to potentially life-threatening infection. Laboratory tests are nonspecific. Microbiological confirmation is not widely available in endemic developing countries like Nepal. We need to rely on the serologic test, which has its own pitfalls in the initial days of illness. Here, we report a case of 56 years old female from the western region of Nepal who presented with fever, jaundice and anuria. She initially tested negative for leptospirosis but was later found to be positive in the second week of illness. Unlike the usual non-oliguric renal failure in leptospirosis, she presented with anuria requiring haemodialysis and subsequently had a good recovery with treatment. We highlight the importance of clinical suspicion and logical interpretation of serologic tests based on its timing from the onset of illness.Publication Persistent Vitello-Intestinal Duct Masquerading as Acute Appendicitis: A Case Report(Nepal Medical Association, 2023) Neupane, Subita; Kashyap, Ashutosh; Pokhrel, Biraj; Pathak, Roshan; Koirala, Dinesh PrasadAbstract The vitello-intestinal duct normally regresses with the development. But, in certain cases, it could persist and present as Meckel's diverticulum. Here we report a case of an eight-year-old boy presenting with peri-umbilical abdominal pain, vomiting and loose stool. He was initially diagnosed and managed as acute appendicitis but did not improve, rather developed features of intestinal obstruction. Exploratory laparotomy was done which revealed persistent vitello-intestinal duct and was managed surgically. This case report highlights that in any case of suspected acute appendicitis, the complications of persistent vitello-intestinal duct should be considered as one of the differentials.Publication Pituitary Apoplexy Complicated by Cerebral Infarction: A Case Report(Nepal Medical Association, 2021) Pokhrel, Biraj; Khanal, Shambhu; Chapagain, Parikshit; Sedain, GopalAbstract: Cerebral infarction is a rare complication of pituitary apoplexy, which can result in significant morbidity if not treated on time. Pituitary apoplexy mostly occurs in pre-existing adenoma, which can remain undiagnosed until symptoms arise. Here, we present a case of a 26-year-old man with undiagnosed acromegaly who presented with left retro-orbital pain, diminished vision of the left eye, and right hemiparesis. Neuroimaging revealed large hemorrhagic sellar mass and ischemic infarction in the left middle cerebral artery territory. Emergency transcranial tumor excision was done, which resulted in significant neurological recovery.