Browsing by Author "Sharma, UK"
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Publication A Rare Case of Synchronous Renal Cell Carcinoma and Adrenocortical Carcinoma(Institute of Medicine, 2014) Gupta, DK; Chapagain, S; Subedi, PP; Luitel, BR; Maskey, P; Chalise, PR; Sharma, UK; Gyawali, PR; Shrestha, GK; Joshi, BRAbstract We report a rare case of synchronous adrenocortical carcinoma and renal cell carcinoma. A 60 year male, a known diabetic and hypertensive under treatment, while undergoing routine investigations and ultrasonography of abdomen, was incidentally detected to have adrenal as well as renal masses. On computed tomograghy scan right adrenal mass measured about 10 x 8 cm while the renal mass was 4.6 x 3.8 cm in size, Urinary vanillylmandelic acid and 24 hr urine metanephrine were within normal limits. Similarly, serum cortisol and dihydroepiandrosterone were in normal range. Patient underwent right adrenalectomy with right partial nephrectomy. Histopathological examination of adrenal mass revealed adrenocortical carcinoma while that of renal mass revealed clear cell renal cell carcinoma. Keywords: Adrenalectomy, adrenocortical carcinoma, renal cell carcinomaPublication Anatomical Variations of Renal Artery in Nepalese Live Kidney Donors(Institute of Medicine, 2015) Thakur, DK; Sedhain, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PRAbstract Introduction: Donor nephrectomy is unique surgery to predispose the surgeon on stress as healthy donors have major surgery purely for others’ benefit. Renal vessels are known with the wide range of variations which can lead to major complications or life threatening events if unrecognized. A thorough knowledge of anatomic variations in renal artery facilitates surgeons to anticipate and manage these potential risks and prevent the complications. Here we present anatomical variations in RA in Nepalese live kidney donors. Methods: This prospective observational study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Live kidney donors over a period of 17 months (From June 2013 to October 2014) presenting for donation were evaluated for renal vasculature with 64- slice multidetector computed tomography and the findings were correlated with intraoperative findings during donor nephrectomy. Results: Sixty three donors were enrolled in the study. Male & female ratio was 1:2.1. Age ranged from 18 years to 64 years (Mean 44.58 years).Anomalous RA was seen in 25 cases (39.7%). Fifty six percentages of anomalies were seen in female and 44% in male. Majority of anomalies were on left side (22.2%). The most common anomaly was supernumerary RA seen in 16 cases (25.5%) Accessory RA was seen in 11 cases (17.5%). Prehilar bifurcation was seen in 11 cases (17.5%). Aberrant RA was seen in 5 cases (8%). Preoperative CT angiographic findings correlated with intraoperative findings in all cases (r = 1, p = 0). Polar branch was transected accidentally in two cases which were repaired at bench surgery. Conclusion: Anatomical variations of renal artery in Nepalese donors are comparable with other populations. Thorough knowledge of the variations can minimize complications and improve outcome during nephrectomy. Keywords: CT renal angiography, Donor nephrectomy, Renal arteryPublication Cervical Capillary Haemangioma: A Case Report(Kathmandu University, 2014) Sharma, K; Sharma, UK; Sigdel, BABSTRACT Capillary haemangioma is a common benign lesion occurring at multiple areas of body. They have unique radiological appearances and are confirmed by histological examinations. However capillary haemangioma of cervical region is a very rare condition. Such a case is presented here. It presented as an extramedullary intradural mass compressing the cord and corresponding root giving rise to myeloradiculopathic symptoms. Total enblock excision of the lesion gave a total cure. KEY WORDS Capillary haemangioma, cervical, enblock excisionPublication Clinical, MRI and Arthroscopic Correlation in Internal Derangement of Knee(Kathmandu University, 2011) Sharma, UK; Shrestha, BK; Rijal, S; Bijukachhe, B; Barakoti, R; Banskota, B; Pradhan, I; Banskota, AKABSTRACT Background The traumatic or degenerative internal derangement of the knee requires certain investigations for the establishment of diagnosis, in addition to clinical history and a thorough physical examination. The use of arthrography and arthroscopy improves the accuracy of the diagnosis. MRI scanning of the knee joint has often been regarded as the noninvasive alternative to diagnostic arthroscopy. Objective The purpose of the study was to correlate clinical and low field MRI findings with arthroscopy in internal derangement of the knee. Methods Forty one patients with suspected internal derangement of the knee were subjected to MR examination followed by arthroscopy. Clinical criteria used were history, mode of injury, Mc Murray’s, Apley’s grinding, Thessaly’s test for meniscal injury. Drawer test was considered to be essential for clinical diagnosis of cruciate ligament injury. MRI of the knee was performed in low field open magnet (0.35T, Magnetom C, Seimens). Arthroscopy was done within two months of MR examination and was considered gold standard for the internal derangement of the knee. Results The sensitivity, specificity, diagnostic accuracy of clinical examination were 96.1%, 33.3% and 73.1% respectively for medial meniscal tear; 38.4%, 96.4% and 78.1% respectively for lateral meniscal tear. The sensitivity, specificity, diagnostic accuracy of MRI were 92.3%,100% and 95.1% for medial meniscal tear; 84.6%96.4% and 92.6% respectively for lateral meniscal tear. Conclusion Clinical examination showed higher sensitivity for medial meniscal tear compared to MRI, however with low specificity and diagnostic accuracy. Low field MRI showed high sensitivity, specificity, diagnostic accuracy for meniscal and cruciate ligament injury, in addition to associated derangement like articular cartilage damage, synovial thickening. KEY WORDS arthroscospy, knee, MRI.Publication Clinico-radiological profile of stroke in eastern Nepal: A computed tomographic study(Kathmandu University, 2006) Naik, M; Rauniyar, RK; Sharma, UK; Dwivedi, S; Karki, DB; Samuel, JRAim: Stroke is a frequent cause of death and disability in elderly patients. This study was carried out to establish the pattern of various types of cerebrovascular accident (CVA) in eastern Nepal and to correlate the clinical data and radiological findings in cases of stroke. Materials and methods: All the patients clinically diagnosed as stroke and referred to the radiology department for Computed tomography (CT) of the brain over a period of 1 year were included. Results: There were 150 patients with stroke (104 males and 46 females), aged 7 to 91 years in which infarction (58%) was more common than haemorrhage (42%) in both group of age (≤ 40 years and > 40 years). Smoking was the commonest risk factor noted in 40.66% cases followed by hypertension (40%). Excessive meat consumption (more than 4 times a week) was seen in 69.1% cases. In early Middle Cerebral Artery (MCA) territory infarction presenting within six hours of onset, positive CT findings were seen in 40% cases among which, obscuration of the lentiform nuclei was diagnostic. Conclusion: In this part of Nepal, infarction is more common than haemorrhage as the cause of stroke and in contrary to western population; hemorrhagic stroke constitutes a significantly higher proportion of stroke. Smoking is the commonest risk factor followed by hypertension and it is also seen in combination with alcohol in many cases. Excessive meat consumption could be an additional risk factor for stroke in this part of Nepal. In younger age group (≤ 40 years), haemorrhage is more common than infarction and alcohol consumption is the commonest risk factor. Key Words: Computed tomography, stroke, CVAPublication Comparison of Different Estimating Equations for Prediction of Glomerular Filtration Rate in Living Kidney Donors(Institute of Medicine, 2017) Poudyal, S; Pradhan, M; Chapagain, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PRAbstract Introduction: Assessment of renal function is a crucial step in evaluation of living kidney donors. The standard method for determining renal function is measurement of glomerular filtration rate (GFR) using I-123 iothalamate, Tc-99m Diethylene Triamine Pentaacetic Acid (DTPA) and 51Cr-Ethylene Diamine Tetraacetic Acid. As these methods are expensive and cannot be used in all clinical settings, it is common practice to estimate GFR by creatinine-based equations. The objective of this study is to compare commonly used estimating equations for the prediction of GFR in Living Kidney Donors. Methods: In 75 healthy kidney donors, GFR estimated by Modification of Diet in Renal Disease Study equation (MDRD), Cockcroft-Gault formula(CG), Chronic Kidney Disease Epidemiology Collaboration(CKD- EPI) equation and 24 hour urinary creatinine clearance were compared to GFR measured by Tc-99m DTPA. Statistical analysis was done using Dunnett’s test and Bland-Altman plot. Similarly, accuracy, precision and bias of each equation were assessed. Results: Mean GFR calculated by DTPA clearance, CG, MDRD, CKD-EPI equations and 24 hour urine creatinine clearance were 83.35±8.59, 78.99±17.17, 93.30±17.12, 96.34±13.36 and 137.96±43.65 ml/min/1.73m2 respectively. Applying Dunnett’s test, GFR by CG equation minimally underestimated GFR measured by DTPA (p=0.612) whereas GFR estimated by MDRD (p=0.034), CKD-EPI(p=0.03) and 24 hour urine creatinine clearance(p<0.001) were statistically significant. CG equation had the highest accuracy. Using Bland-Altman plot, the precision of CKD-EPI equation was the highest among all. Conclusion: There is no single creatinine-based estimating equation to assess GFR with utmost accuracy and precision at the same time. Keywords: creatinine clearance, Diethylene Triamine Pentaacetic Acid, living kidney donorsPublication Does Stone Culture Predict Systemic Inflammatory Response after Percutaneous Nephrolithotomy?(Institute of Medicine, 2014) Luitel, BR; Chalise, PR; Gyawali, PR; Sharma, UK; Shrestha, GK; Joshi, BRAbstract Introduction: Systemic inflammatory response syndrome (SIRS) is a common and important complication after percutaneous nephrolithotomy (PNL). This study was carried out with the objective of finding out the association between stone culture and PostPNL- SIRS. Methods: A prospective study was done in the urology unit, Tribhuvan University Teaching Hospital from July 2009 to June 2011. Preoperative midstream urine, intraoperative pelvic urine and stone fragments were sent for culture in all patients undergoing PNL. The primary outcome was SIRS on second postoperative day. Data analysis was done using Statistical Package for Social Sciences (SPSS) 17.0 version. Results: Out of 47 patients 22 (46.8%) patients developed SIRS on second postoperative day. Stone and pelvic urine culture positivity rate was 8(17%) and 6(12.8%) respectively with P. aeruginosa E. coli and Proteus spp being the common organisms isolated, most of which were sensitive to amikacin. Positive stone culture was the significant risk factor for SIRS (P=0.018). Conclusion: Positive stone culture is an important risk factor for SIRS after PNL. Routine stone culture is beneficial in patients undergoing PNL for the subsequent postoperative management. Keywords: Percutaneous nephrolithotomy, Stone culture, Systemic Inflammatory Response Syndrome (SIRS)Publication Extracorporeal Shock Wave Lithotripsy for urolithiasis; a single center study(Institute of Medicine, 2013) Sharma, UK; KC, NagendraAbstract Introduction: The introduction of extracorporeal lithotripsy (ESWL) revolutionized the treatment of urinary stones since its invention in early 1980s.At many institutions, ESWL is the procedure of choice for proximal ureteric stones and renal stones. This paper analyzes and provides a general approach to the ESWL patients, discuss the outcomes and problems area, as well as to develop awareness among the patients necessitating stone management. Methods: This was a prospective observational study. Total of 91 cases were included in this study. Patients from different clinics and OPD were selected for ESWL therapy. Study period were from Jan 2011 to June 2012. All the patients had undergone excretory urogram before selecting for the SWL in order to rule out distal obstruction and to assess the size of the stone and its location. Results: More than 90 patients with renal and upper ureteric stones were subjected for ESWL over one and half year’s period (Jan 2011- Jun 2012) in an ESWL center in Kathmandu. Conclusion: ESWL is an effective and patient friendly means to treat upper urinary and renal stones. Stone size, and location greatly affect the stone free rate, morbidity and secondary procedures following ESWL. Keywords: fragmentataion, stones clearence, steinstrassePublication Extracorporeal Shockwave Lithotripsy Versus Ureteroscopy with Pneumatic Lithotripter in Treating Proximal Ureteric Stones(Institute of Medicine, 2014) Sharma, UKAbstract Introduction: In recent years, ESWL (Extracorporeal Shockwave Lithotripsy) has proved a ate and easily reproducible method for treatment of calculi in upper urinary tract particularly above iline crest. Recently other modalities, particularly ureteroscopy with LASER lithotripsy and pneumatic lithotripsy (URS/ICPL) to treat the upper ureteric stone are very popular with less morbidities and good stones clearance. So, this study aims to compare the success rate, complications and efficiency of ESWL and URS/ICPL for the upper ureteral stones. Methods: Patients were prospectively included the radio-opaque, solitary stones of 5 to 20 mm size without evident UTI (Urinary tract infection) located between the UPJ (Uretero- pelvic junction and S1 joint (Sacroiliac Joint) were included. Post procedural X-ray KUB was taken immediately in URS group and three weeks after ESWL group. Immediate and week after patients were assessed for complication. Disintegrations and clearance of the stones were assessed. Results: Total of 78 patients were included in this study. Of which 46 were in ESWL and 32 were in URS/ICPL groups. Both groups had stones size and location of same size and site. In URS group majority had stone disintegration and clearance with proximal dislodgement of fragment or total stone of 21.9% Multiple sessions needed to clear the stones in ESWL group was 17.3%. DJ Stenting needed after the URS was in 75% of cases. In ESWL group, disintegration immediately after the procedure was noted in 82.6% of cases. Auxillary services needed after the URS were ESWL, ureterolithotomy, second session URS. Majority did not have major complication in either group. In URS group 12.5% of patients had fever and UTI, treated with conventional antimicrobials. Ecchymosis at the site in ESWL were in 28 cases (p0001) Efficiency Quotient (EQ) for ESWL and URS were 31.8% and 18.2% respectively (p-0.18). Conclusion: ESWL and URS/ICPL can be offered to patient for treatment of upper ureteric stone with minimal and acceptable complications ESWL can be done on daycare basis whereas URS/ACPL needed to be admitted in hospital. Keywords: Extracorporcal Shockwave Lithotripsy, ureteroscopy, ureterie stonePublication Factors affecting stone clearance in Percutaneous Nephrolithotomy(Institute of Medicine, 2018) Poudyal, S; Rai, BDK; Dhital, P; Pradhan, M; Chapagain, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PRAbstract Introduction: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large and complex renal stones. It is of paramount importance to deliver the maximum clearance with minimal morbidity. There are different anatomical, stone-related and patient-related factors affecting the stone-free rate. This study is conducted to delineate the factors predicting stone clearance in PCNL. Methods: A prospectively maintained database of 114 cases, who underwent PCNL between January to October 2016 in Tribhuvan University Teaching Hospital, was analysed. Age, gender, body mass index, surgical and medical history, renal anomalies, American Society of Anesthesiologists score, tract size, type of tract dilatation, fluoroscopy time, stone density, stone location and burden, skin to stone distance, presence of hydronephrosis, and duration of surgery were correlated with the stone clearance. Stone clearance was evaluated with either X-ray or ultrasound of the kidneys, ureters and bladder up to three months of PCNL. Result: Stone clearance rate was 85.96%. Stone burden(p<0.001), stone location(p=0.03), number of calyces involved by stone(p<0.001) and presence of hydronephrosis(p=0.005) were statistically different between stone-free and stone-residue group. Multifactorial analysis showed that stone burden, location and no. of calyces involved by stone were the only factors effecting stone free rate. Area under curve for the stone burden was 0.842 (p<0.001). Conclusion: Stone burden, location and number of calyces involved by the stone are the principal factors determining the stone clearance in PCNL. Keywords: Percutaneous Nephrolithotomy, Renal calculi, Stone clearancePublication Intrathyroid metastasis presenting as a solitary thyroid nodule: An unusual case of clinically silent lung cancer(Kathmandu University, 2008) Sharma, UK; Rauniyar, RK; Adhikary, S; Sinha, AAbstract Metastases in the thyroid gland are very rare. Carcinoma lung is one of the tumours, which may metastasize to the thyroid. We report a 60-year-old lady with intrathyroid metastasis presenting as a solitary thyroid nodule. Fine needle aspiration cytology from the nodule showed features of metastatic adenocarcinoma. Further detail evaluation revealed primary lung adenocarcinoma with secondaries to adrenals, retroperitoneal and bilateral axillary nodes. This report emphasizes this unusual clinical presentation of carcinoma lung with wide spread secondaries; and a solitary thyroid nodule can be a presenting complain of a metastatic disease. Key words: Intrathyroid metastasis, Ultrasound, Carcinoma lungPublication Intravesical foreign body: Case report(Kathmandu University, 2006) Sharma, UK; Rauniyar, D; Shah, WFForeign bodies of the urinary bladder may occur by self insertion or migration from the neighbouring organs. All the foreign bodies when left for long act as a nidus for calculus formation. The patient usually presents with dysuria, intermittent urinary tract infection or suprapubic pain. Here we report two cases of vesical foreign body which was removed by the cystoscopy. Key words: Urinary bladder, Foreign bodyPublication Magnetic Resonance Imaging Evaluation of Musculoskeletal Diseases of Ankle and Foot(Kathmandu University, 2018) Sharma, UK; Dhungel, K; Pokhrel, Dinesh; Tamang, S; Parajuli, NPABSTRACT Background Ankle and foot pain is a common clinical problem, that may be due to a variety of soft tissue and osseus abnormalities. Magnetic resonance imaging plays vital role for diagnosing internal derangement of the ankle joint, assessing soft tissue structures around the ankle such as tendons, ligaments, nerves and osseus structures. Method Retrospective magnetic resonance imaging evaluation of the ankle and foot was done in 100 patients using 0.3T and 1.5T magnetic resonance imaging. Clinical history included pain, swelling of the ankle and foot, trauma, twisting injury, palpable mass and difficulty in walking. Result Fifty two patients were male and 48 patients female aged 6 months to 70 years. Ligaments tear were the commonest and seen in 22% patients. Tenosynovitis found in 17%, Pigmented villonodular synovitis (PVNS) in 3%, Achilles tendon abnormality in 8%, stress fracture-9%, osteomyelitis-8%, soft tissue vascular malformation in 5%, soft tissue and bone tumor-4%, marrow edema-20%, osteoarthritis-10%, Osteochondral lesion of talus-8%, sinus tarsi syndrome-3%, posterior impingement-5%, plantar fasciitis-2%, Sever disease-2%, peroneus tendon split-2%. The commonest clinical presentation was pain and swelling of the ankle in 42 patients, twisting/inversion injury of the ankle in 23 patients followed by traumatic injury with difficulty in walking in 20 patients and palpable mass in 8 patients. Ligaments injury were mostly associated with inversion/twisting injury. Conclusion Magnetic resonance imaging is advantageous for assessing soft tissue structures around the ankle and foot, such as tendons, ligaments, nerves, masses and occult osseus lesions. It provides a quick, non-invasive tool for the diagnosis of related injuries and guide for the further treatment planning. KEY WORDS Ankle, Foot, Magnetic resonance imaging, MusculoskeletalPublication Musculoskeletal ultrasound: Is it underutilised?(Kathmandu University, 2007) Sharma, UK; Shrestha, DNAPublication Open Anderson Hynes Pyeloplasty in Ureteropelvic Junction Obstruction: An Institutional Experience(Institute of Medicine, 2015) Subedi, PP; Chapagain, S; Thakur, DK; Poudyal, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PR; Shrestha, GKAbstract Introduction: Ureteropelvic junction obstruction (UPJO) is one of the common causes of hydronephros is in children and adults. The cause may be congenital or acquired. The standard management of UPJO has classically been an open Anderson-Hynes (A-H) dismembered pyeloplasty. This study is an audit of A-H pyeloplasty done for patients with UPJO presenting to our institution. Methods: A retrospective analysis was done in the Urology unit, Tribhuvan University Teaching Hospital from July 2013 to November 2014. All patients undergoing A-H pyeloplasty were included for review. Preoperative data regarding the demographics, presentation, diagnostic tools used, details of the surgery, postoperative complications, duration of hospital stay and follow up findings were reviewed. Initial follow up was scheduled at two weeks, then at three months and at one year. At 3 months, DTPA renogram was obtained to assess the function and clearance of the treated kidney. Results: The age of the patients ranged from 5 months to 69 years. Flank pain was the most common presenting complain. Most of the patients were males and left sided obstruction was common. The most common diagnostic modality used was USG and excretory urography. CT urography was done in cases of secondary UPJO. DTPA scan was used in select cases for baseline documentation of the function of the involved kidney. The average duration of surgery was 2 hours and 30 minutes. The mean duration of hospital stay was 5 days. The most common complication was urinary tract infection. Conclusion: Open A-Hpyeloplasty is the most common surgery done for UPJO at our institution. The outcome can be improved by attention to the principles of A-H pyeloplasty. Keywords: hydronephrosis, A-H pyeloplasty, ureteropelvic junction obstructionPublication Pattern of Renal Cell Carcinoma – A Single Center Experience in Nepal(Kathmandu University, 2011) Sidharth; Luitel, BR; Gupta, DK; Maskey, P; Chalise, PR; Sharma, UK; Gyawali, PR; Shrestha, GK; Sayami, G; Joshi, BRABSTRACT Background Renal tumor is the 13th most common malignancy in the world and more than 90% of renal tumors are renal cell carcinomas. As there is no data available on renal cell carcinoma in Nepal, hence this study was undertaken to analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal. Objectives To analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal. Methods The case records of 50 consecutive patients with renal cell carcinoma presenting at the Tribhuvan University Teaching Hospital, Kathmandu from July 2006 to June 2011 were retrospectively evaluated for presenting symptoms, physical finding, investigation and histopathology report. Results Out of 50 patients, 64% were male and 36% were female. The age ranged between 11 to 78 years (mean ± SD: 55 ± 15 years). Fifty four percent of patients were smokers. Incidentally tumor was detected in 40% cases by ultrasonography and the typical triad was present in only 4%. The tumor was occupying upper pole in 40% of cases. The tumor size ranged from 3 to 15 cm (mean ± SD: 7.3 ± 2.9 cm). Histopathologically, 76% of the patient had organ confined renal cell carcinoma (T1- 2 N0 M0). Clear cell was the most common type seen in 86%. Fuhrman’s nuclear grade 2 was found in 50%. Conclusion Many of the renal cell carcinoma are detected incidentally, at an early stage and are of clear cell subtype. KEY WORDS Incidental renal tumor, Nepal, Renal cell carcinoma.Publication Phaeochromocytoma in Nepal – A Single Centre Experience(Kathmandu University, 2012) Maskey, P; Shrestha, GK; Luitel, BR; Gupta, DK; Sidarth; Chalise, PR; Sharma, UK; Gyawali, PR; Joshi, BRABSTRACT Background Phaeochromocytomas are rare tumors of chromaffin cells of neural crest that classically present with symptoms of catecholamine excess such as palpitations, headache and sweating. They are diagnosed by measuring plasma or urinary levels of catecholamines or their metabolites. Anatomic localization is done by computed tomographic scan or magnetic resonance imaging, or meta-iodobenzyl guanidine scan in certain cases. Adequate preoperative catecholamine blockade prevents perioperative hemodynamic instability. Objectives To study the clinical spectrum and management of phaeochromocytomas in a tertiary care centre, Tribhuvan University Teaching Hospital, in Nepal. Methods Retrospective review of case records of histologically proven cases of phaeochromocytomas from 2008 -2011 was done, and data collected on clinical spectrum, diagnostic modalities, perioperative management and follow-up. Results Tweleve cases of phaeochromocytomas were operated. The mean age was 36.41±14.07 years. There were 2 bilateral phaeochromocytomas and 1 extra- adrenal paraganglioma. Apart from the common symptoms of catecholamine excess, patients had atypical presentations like psychiatric manifestations and blurred vision. A combination of urinary Vanillyl Mandelic Acid and computed tomographic scan was used for diagnosis, and open surgery was done in all cases. Pre-operative blood pressure control was achieved by prazocin or calcium channel blockers. Ten patients had intraoperative surge in blood pressure. There were no major morbidity or mortality. Three patients had high blood pressure post- operatively, but were effectively managed with antihypertensives. Conclusion Phaeochromocytomas can have variable presentation. Good preoperative preparation and perioperative management can result in an excellent outcome. KEY WORDS Hypertension, Paraganglioma, Phaeochromocytoma, Prazocin, Vanillyl Mandelic AcidPublication Risk-based Management of Non-muscle Invasive Bladder Cancer: Experience from Tribhuvan University Teaching Hospital(Kathmandu University, 2016) Luitel, BR; Chalise, PR; Sidharth; Gupta, DK; Subedi, P; Chapagain, S; Sharma, UK; Gyawali, PR; Shrestha, GK; Joshi, BRABSTRACT Background Most of the recent evidences suggest for risk-based management of non muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence and progression. Objective This study was conducted to assess the recurrence and progression of non muscle invasive bladder cancer in Nepalese patients using European Organization for Research and Treatment of Cancer (EORTC) risk tables and to assess the effectiveness of intravesical therapy to reduce the risk of recurrence. Method A prospective observational single centre study was conducted at Tribhuvan University Teaching Hospital from January 2010- December 2012. Forty six patients with non muscle invasive bladder cancer who underwent transurethral resection of bladder tumor and completed two years follow up were included. According to the European Organization for Research and Treatment of Cancer (EORTC) risk table, the patients were divided into low, intermediate and high risk groups. The patients received postoperative adjuvant therapy and surveillance as per the European Association of Urology guidelines. Result Among the 46 patients, the overall two year recurrence and progression rate was 8 (17%) and 1 (2%) respectively. Out of seven patients in low risk category, none of them developed recurrence or progression of disease. Out of 15 patients in intermediate risk category the one year and two year recurrence rate was 13% and 20% respectively. Out of 24 patients in high risk category the one and two year recurrence rate was 17% and 21% respectively. The risk reduction by use of intravesical Bacillus Calmette Guerin (BCG) for recurrence in high risk category was 58% and 60% in first and second year respectively. In our study, the overall and individual risk group, the one and two year recurrence rate was lower than that predicted by European Organization for Research and Treatment of Cancer risk table. Conclusion Risk-based management of non muscle invasive bladder cancer by using the European Organization for Research and Treatment of Cancer risk table is a useful method of management, though its prediction rates are lower in Nepalese population. KEY WORDS EORTC, intravesical therapy, NMIBC, progression, recurrence, risk tablePublication Roundworm infestation presenting as acute abdomen in four cases – sonographic diagnosis(Kathmandu University, 2005) Sharma, UK; Rauniyar, RK; Bhatta, NInfestation with Ascaris lumbricoides (roundworm) is very common in the tropics and subtropics. Patients with ascariasis can be asymptomatic or may present with different clinical features in the form of simple nausea, decreased appetite, abdominal pain or more severe bowel obstruction, perforation, intussusception, biliary colic etc. Ultrasonography (USG) can be quick, safe, noninvasive and relatively inexpensive tool in diagnosing the presence of worms and also evaluating response to treatment (1, 2, and 3). Here we present four cases of roundworm infestation presenting with acute abdomen in the emergency department, which were diagnosed by USG and further imaging features of ascariasis on USG is described. Key Words: Roundworm, Ascariasis, Ultrasonography, Acute abdomenPublication Use of Magnetic Resonance Imaging in the Evaluation of Acute Cholecystitis in Emergency Setting(Kathmandu University, 2022) Sharma, UK; Thapa, DK; Thapaliya, S; Pokhrel, A; Baskota, B; Rai, UABSTRACT Background Acute cholecystitis is one of the commonest surgical disease. The rapid diagnosis at its early stage is one of the crucial factor in patient care and management. Objective To evaluate the role of magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) in the diagnosis or exclusion of acute cholecystitis, coexisting choledocholithiasis, and acute pancreatitis in emergency setting. Method This study was conducted in the department of radiodiagnosis B&C teaching hospital, Birtamod, Nepal from July 2016 to November 2019. Patients, clinically diagnosed as acute cholecystitis or biliary condition with positive Murphy’s sign with or without jaundice and deranged Liver Function Test, raised Leucocyte counts were evaluated by Magnetic Resonance imaging. The sensitivity, specificity, Positive Productive Value (PPV), Negative Productive Value (NPV) were calculated for the diagnosis of acute cholecystitis. Data was entered and analysed by using SPSS version 20. Result There were 40 patients included in our study. Among them 27 (67.5%) were females and 13 (32.5%) male. The age of the patients ranged from 16 years to 79 years, mean age 49.4 years. Majority of the patients were in the age group of 40-60 years (57.5%). The overall sensitivity, specificity, Positive Productive Value and Negative Productive Value of Magnetic Resonance imaging diagnosis of acute cholecystitis were 100%, 66.6%, 94.4% and 100% respectively. Acute cholecystitis associated with gall stone disease were common and found in 72.5% cases, with sensitivity 96.5%, specificity 27.7%, Positive Productive Value 77.7% and Negative Productive Value 75.0%. Conclusion Magnetic resonance imaging (MRI)/Magnetic resonance cholangiopancreatography (MRCP) is an excellent tool for the evaluation of biliary pathology and can be used for the preoperative evaluation of acute cholecystitis at the emergency setting. KEY WORDS Acute Cholecystitis, Cholelithiasis, Magnetic resonance cholangiopancreatography