Browsing by Author "Sapkota, R"
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Publication A comparison of Success of autologous Blood Patching in Sealing of Bronchopleural Fistula of Primary and Secondary Spontaneous Onset(Institute of Medicine, 2014) Thapa, B; Sapkota, R; Sayami, PAbstract Introduction: Autologous Blood patching (ABP) has been used to treat Broncho pleural fistula in spontaneous pneumothorax with varying success. We evaluated the safety and efficacy of ABP when used in patients with primary (PSP) versus secondary (SSP) spontaneous pneumothorax. Methods: All patients with spontaneous pneumothorax with no evidence of pleural infection and in whom the air leak did not subside despite 48 hours of conservative management were included. A CT scan was done to categorize if there was underlying lung disease and classify patients into primary and secondary spontaneous categories. These patients underwent blood patching in one to three episodes in 50ml aliquots. Comparisons of the demographic profile, smoking status, success rate and complications in these two groups were done. Results: Between July 2012 and January 2014, 76 patients underwent ABP. The overall success rate of ABP was 58%. There were 29 patients who were classified as PSP and 47 with SSP. There was no difference in the sex distribution but patients with PSP were younger (P= 0.00), were more likely to present earlier (P=0.04) and had higher rates of residual pneumothorax (P= 0.05) after chest tube insertion. The success rates in the two groups were similar (P=0.76).The rate of complications was low and not different in the two types (P=0.58). Conclusion: ABP has modest success in sealing air leak of spontaneous onset. We found the success and complication rates in the two types of spontaneous pneumothoracesto be equivalent. Keywords: air leak, autologus blood patching, pneumothoraxPublication Impalement Injury to The Heart(Kathmandu University, 2011) Pradhan, S; Sapkota, R; Shrestha, U K; Amatya, R; Koirala, BABSTRACT Cardiac impalement injury is rare and one of the most severe penetrating chest injuries, often fatal. The management of penetrating cardiac injuries is a challenging one. The success in management of impaling cardiac trauma requires stabilization of the impaling object, expeditious transfer to a facility for open heart surgery, rapid imaging, access to blood and blood products and a ready surgical team. We report a case of impalement injury to the heart by a stick, transfixing the right ventricle and its successful treatment. KEY WORDS Impalement injury, Penetrating cardiac injury, Cardiac injury, Cardiac impalementPublication Management of Pseudoaneurysms in IV Drug Users(Institute of Medicine, 2011) Sapkota, R; Sapkota, S; Thapa, B; Shrestha, KR; Rajbhandari, N; Shrestha, UKAbstract Introduction: Pseudoaneurysms are major vascular complications in intravenous drug abusers. They are potentially fatal, often infected and require urgent management. Method: This is a retrospective study of the prevalent practice of their management in our center. The inpatient medical charts of the patients spanning 5 years (Sep 2006 to Aug 2011) were reviewed. Data were obtained on their demographic, clinical, management and outcome parameters. Result: Among the thirty intravenous drug users presenting with pseudoaneurysms (excluding one who bled to death before surgery), 28 had their femoral artery involved. Most of them (90%) were infected. Nearly half of the patients (45%) were seropositive for HIV and/or HCV. All were operated, with no mortality. Ligation and debridement was the technique used almost exclusively (83%). One brachial artery wasrepaired primarily, whereas 3 femoral and 1 brachial pseudoaneurysms were managed with autologous saphenous vein bypass. Five patients had neurological complications, and 5 others had non-limb threatening claudication which got better with medical management. Mean follow up period was 11 months. Conclusion: Ligation and debridement appears to be a simple, safe and effective procedure in infected pseudoaneurysms in IV drug users. Keywords: Claudication, IV Drug Users, Infected Pseudoaneurysms, LigationPublication Neurovascular injury in supracondylar fracture of Humerus(Institute of Medicine, 2012) Shrestha, K R; Sapkota, R; Rajbhandari, N; Thapa, B; Shrestha, U KAbstract Introduction: Supracondylar fractures of the humerus are the commonest upper limb fractures in children, accounting for up to 70% of all pediatric elbow fractures. Supracondylar fractures of the humerus can be managed in outpatient setting but are often complicated by neurovascular injury. Methods: Retrospective study including 187 patients who had presented with supracondylar fracture of humerus with 47 neurovascular injuries during the period of July 2007 to June 2011. Out of 142 patients with Gartland type III fracture 107 underwent immediate open reduction, exploration and internal fixation. Results: Vascular injury is commonly associated with type II supracondylar fracture with posterior displacement. Twenty-two patients had vascular injury and all of them had satisfactory outcome after surgery. Conclusion: A careful clinical evaluation, urgent surgical treatment and adequate fracture reduction can prevent lifelong handicap. Keywords: P ulseless hand, Supracondy lar fracture, Vascular injuriesPublication Popliteal artery injury in and about knee injury: An experience in Manmohan Cardiothoracic vascular and transplant center(Institute of Medicine, 2015) Baral, RK; Shrestha, K R; Sapkota, R; Shrestha, UKAbstract Introduction: Knee dislocation is a common knee injury leading to neurovascular insufficiency. Penetrating injury to the popliteal fossa is also associated with neurovascularv injuries. Amputation rate is high amongst popliteal artery injury associated with bone injury. Delayed detection and late interventions are the factors contributing for limb loss in these cases. We present our experience of the popliteal artery injury from a tertiary care center over the period of 3 years. Method: It is a retrospective analysis of prospectively collected data of cases of popliteal arterial injury over the period of three years (July 2011 till June 2014). Data were analyzed on their demographic, clinical, management and outcome parameters with SPSS 17. Result: There were total 35 popliteal artery injuries in 34 patients associated with injuries of knee. Twenty two (65%) patients were male and rests were female. Mean age of these patients was 23±12 years, with age ranging from 15 to 76 years. Twelve patients had amputation and were identified and treated late. Most of the patients reach our center late mean time 9±5 hours and as late as 7 days. Conclusion: High index of suspicion is required to identify the popliteal artery injury in patients with injuries in and about the knee. Early vascular surgical consultation and intervention is required to alleviate its poor outcome. Keywords: knee injury, popliteal artery injuryPublication Prediction of surgical site infection and other adverse postoperative outcomes(Institute of Medicine, 2009) Luitel, BR; Kandel, SP; Shrestha, B; Sapkota, R; Bhandari, RSAbstract Background: To predict surgical site infection, hospital acquired pneumonia, wound dehiscence, and mortality based on SENIC index in Nepalese perspective in surgical patients. Methods: A Retrospective study was conducted at Department of Surgery, Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from October 2007 to September 2008. Surgicalinfection risk factors assessed by the traditional wound-classification system (clean, cleancontaminated, contaminated, and dirty-infected wound) and by the SENIC risk index (length of intervention more than 2 hours, more than three discharge diagnoses, abdominal surgery, and contaminated or dirty infected wound) were compared by Receiver Operating Characteristic (ROC) curve. Results: The SENIC index showed a good ability to predict SSI, Hospital Acquired pneumonia, wound dehiscence and in hospital mortality. If the index score is higher, the outcome is poorer. By using SENIC index score the area under ROC curve for SSI, pneumonia, wound dehiscence and in hospital mortality was 82.2±4.8, 90.5±2.4, 85.1 ±4.7 and 96.9±1.2 % respectively with sensitivity above 95% for all the parameters. Conclusion: This study shows that the SENIC risk index results are reproducible, and the index can be used to predict rates of SSI and other adverse postoperative complications in developing countries as well. Keywords: Prediction, SENIC Index, surgical site infectionPublication Spontaneous omental hematoma(Institute of Medicine, 2009) Bhandari, RS; Sapkota, R; Mishra, P; Singh, KPAbstract Spontaneous omental bleeding is a rare entity, and usually presents with various combination of sudden abdominal pain, shock, peritonitis and hemoperitoneum. A 68 year female presenting with acute abdomen and without antecedent trauma had obscure hemoperitoneum. Exploration revealed hemoperitoneum and hemorrhagic omentum with a huge clot. Keywords: Spontaneous omental hematoma, acute abdomen, hemoperitoneum, surgeryPublication Video-Thoracoscopic Management of Empyema Thoracis in tertiary level thoracic unit(Institute of Medicine, 2013) Shrestha, UK; Thapa, B; Baral, R; Sapkota, R; Sayami, PAbstract Introduction: Thoracic empyema is a common problem. Use of minimal access surgery for the treatment is comparatively new. We audited our results with VATS in thoracic empyema. Methods: We analyzed the retrospective data from the patients who received Video-Assisted Thoracoscopic Surgery (VATS) for empyema thoracis from April 2011 to April 2013 at Manmohan Cardio-thoracic Vascular and Transplant Center (MCVTC). Results: Of the 44 patients who underwent surgery for empyema of various stages, 37 patients underwent the procedure via VATS. The average age was 26.4 ±17.19 yrs (1-64). The male to female ratio was 2:1. The duration of symptoms before VATS intervention varied very widely (7-712 days avg: 92.7±28.8 days). The duration was 32 days on an average among patients in whom deloculation sufficed but was 111 days among those in whom decortication was required. A complete VATS procedure with satisfactory lung expansion at the end of the procedure was possible in 34 patients (100% patients who underwent deloculation and 88% of those who underwent decortications). Inadequate lung expansion forced conversion in three and subsequent collapse necessitated re-operation in one. The operative times were: VATS converted to open decortication (150 mins), completed VATS decortication (60-180 mins, avg: 125.7 mins) and VATS deloculation (45-120 mins, avg: 69 mins). Post-operative chest tube drainage was shorter in patients in whom a successful VATS procedure was completed 4.0 Vs 40 days). Conclusion: Videothoracoscopic approach is feasible in surgical management of empyema thoracis. The results seem to be better in earlier stages. Keywords: Deloculation, decortication, empyema, Video-assisted thoracoscopic Surgery (VATS)