Browsing by Author "Sharma, UK"
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Publication 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 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 Musculoskeletal ultrasound: Is it underutilised?(Kathmandu University, 2007) Sharma, UK; Shrestha, DNAPublication 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 abdomen