Browsing by Author "Sayami, P"
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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 Predictive value of ultrasonography in the diagnosis of palpable breast lump(Kathmandu University, 2003) Pande, AR; Lohani, B; Sayami, P; Pradhan, SA lump is the first symptom in over 80 percent of all patients with cancer of the breast. Consequently, the finding of any lump in the breast is a highly significant sign and warrants a thorough investigation. The present study was undertaken to study the predictive value of ultrasonography in the diagnosis of palpable breast lumps. Fifty-two female patients with palpable breast lumps that were unilateral underwent ultrasonography of the breast. Thirty-six of these patients who had solitary, unilateral, solid lumps were followed up with FNAC/biopsy/mammography and the findings were compared. The mean age group was seen to be 41 years. The youngest patient was 17 years old and the oldest was 80 years. The validity of USG in the diagnosis of palpable breast lumps was calculated. A sensitivity value of 95%, specificity of 94.10%, positive and negative predictive values of 95.50% and 93.75% were noted and were comparable to other similar studies. The sensitivity, specificity, positive and negative predictive values were statistically significant (p=0.0000006) and were comparable to the values obtained by different studies conducted elsewhere. Among the multiple USG parameters, shape, margins, vascularity, surrounding tissue character, sound transmission through the lump were more significant in the diagnosis of benign vs. malignant lumps. Echogenicity and echotexture were of less significance. Key words: Breast lump, Ultrasound, FNACPublication 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