Browsing by Author "Shrestha, BM"
Now showing 1 - 7 of 7
Results Per Page
Sort Options
Publication A comparison of 25 gauge Quincke spinal needle with 26 gauge Eldor spinal needle for the elective Caesarian sections: Insertion characteristics and complications(Kathmandu University, 2003) Tabedar, S; Maharjan, SK; Shrestha, BR; Shrestha, BMObjective: The study was designed to compare the insertion characteristics and incidence of PDPH between 25 gauge Quincke needle and 26 gauge Eldor needle for spinal anaesthesia in elective c/s. Method: 60 pregnant women (aged 19-35yrs and weighing 58 –67kg) undergoing elective caesarean section were randomized into group A (Quincke spinal needle group) or group B (Eldor spinal needle group). Spinal anaesthesia was performed with 2.9 ml 0.5% heavy bupivacaine using 25 gauge Quincke spinal needle in group A and 26 Gauge Eldor spinal needle in group B. Onset, time of first identification of backflow of CSF, number of attempts, level of sensory and motor blockade, failure of anaesthesia, inadequate anaesthesia and incidence of PDPH were recorded. Result: Quincke spinal needle was found easy at insertion, first attempt was successful in 90% of cases, whereas Eldor spinal needle was successful at first attempt in only 60% of cases. Early identification of CSF was seen in Eldor spinal needle group in 3.5 seconds vs. 5.2 seconds in Quincke spinal needle group. Blood mixed CSF was seen in 8 Quincke spinal needle group vs. none in Eldor spinal needle group. Onset was similar between both groups i.e. in 6 minutes. Failure of anaesthesia was none in Eldor spinal needle group vs. 2 in quincke spinal needle group. Height of sensory block achieved was T4 level in 26 parturients,T6 in 1 ,T8 in 1 and no anaesthesia at all in another 2 parturient as compared to T4 level in 29 and T3 in 1 parturient in Eldor spinal needle group. The degree of motor block with the use of Bromage criteria showed a motor score of 1or 2 in 26 parturients in Quincke spinal needle group vs. same in all cases in Eldor spinal needle group. The total incidence of PDPH was 8.3 %( 5 out of 60 parturient) which occurred all in Quincke spinal needle group. 2 parturient who developed severe PDPH required epidural blood patch. Conclusion: 26 gauge Eldor spinal needle was found to be better than 25 gauge Quincke spinal needle for caesarian sections to decrease the incidence of PDPH, though not all insertion characteristics were in favour of the Eldor needle. Key Words: Anaesthetic technique, spinal; equipment, spinal needles; complications, headache.Publication Abdominal Wall Scar Endometrioma(Kathmandu University, 2017) Jackson, A; Smith, J; Shrestha, BMABSTRACT Abdominal wall scar endometrioma is an uncommon clinical entity, which presents with lump and cyclical abdominal pain during menstruation, which develops after caesarean section or gynaecological procedures. Differential diagnosis includes a haematoma, desmoid tumour, incisional hernia, sarcoma, metastatic malignancies and suture granuloma. Adenocarcinoma developing from abdominal wall scar endometrioma are aggressive and carry poor prognosis. An awareness of this clinical entity is important to establish its diagnosis early and ultrasound scan, magnetic resonance scan, or a computerised tomographic-guided localization followed by surgical excision provides best outcome. Here in, a case of abdominal wall scar endometrioma is reported and review of pertinent literature is presented. KEY WORDS Caesarean section, diagnosis, endometrioma, scar, treatmentPublication Blood loss during and after transurethral resection of prostate: A prospective study(Kathmandu University, 2008) Shrestha, BM; Prasopshanti, K; Matanhelia, SS; Peeling, WBAbstract Objectives: Transurethral resection of prostate (TURP) is the gold standard treatment for symptomatic prostatic bladder outlet obstruction. Haemorrhage during and after TURP can lead to signi cant morbidity and mortality. The purpose of this study was to assess the in uence of anaesthesia, operating time, weight of resected prostatic tissue and its histology on blood loss during and after TURP and to revisit the available body of evidence in the literature of urology. Materials and methods: This is a prospective study of a cohort of 100 consecutive patients who had undergone TURP over a period of one year, where the data was collected on a performa speci cally designed for the study, which included the type of anaesthesia administered, resection time, amount of blood lost during and after TURP, weight of the resected prostatic tissue and histology. Results: Sixty seven patients underwent TURP under spinal anaesthesia (SA) and 33 under general anaesthesia (GA). The median intraoperative (SA: 89.95 (5-936); GA: 105.40 (5-517) mls), postoperative (SA: 72.37 (15-387); GA: 136.43 (11-969) mls) and total (SA: 162.32 (29-1200); GA: 241.83 (21-1251) mls) blood losses were not signi cantly different between the two groups (95% C.I. -9.90 to 19.22, p= 0.46). The total operating time (SA: 29.70 (10-55); GA: 29.80 (10-65) minutes) and weight of resected prostate (SA: 21.90 (3-45); GA: 18.00 (4-60) gms) were similar between the two groups. There was a trend towards increased blood loss when BPH was associated with prostatitis (N=8). Of these, 3 patients required blood transfusion as compared to 1 patient in rest of the group, although this was not statistically signi cant (95% C.I - 67.2 to 1120.4, p = 0.87). Conclusions: The intraoperative, postoperative and total blood losses related to TURP were not in uenced by the type of anaesthesia, resection time, weight of the resected prostate and the histology. Key Words: Transurethral resection of prostate, blood loss, anaesthesia, prostatitis, carcinoma, aspirinPublication Epidural anaesthesia and analgesia(Kathmandu University, 2004) Maharjan, SK; Shrestha, BMObjective Among various methods of providing analgesia during surgery for e.g., parenteral opiates and NSAIDS, epidural anaesthesia and analgesia seem to have beneficial efficacy and less side effect profiles. Methods This study was conducted in 153 patients coming for operation at KMCTH between August 2003 to August 2004. Patients were divided in two groups, one group were operated under sole epidural anaesthesia and the other group received a combination of either general anaesthesia or spinal anaesthesia. Results 39 (25.5%) patients underwent sole lumbar epidurals, 36 (23.5%) patients received a combination with spinal (CSE) and 78 (51.0%) were under Combination with general anaesthesia. The patients were interviewed among whom it was found that satisfactory analgesia was reported by 75 cases and 73 cases reported excellent analgesia. Patchy anaesthesia observed in 5 cases who underwent sole epidural anaesthesia. Discussion & Conclusion Patients undergoing major surgery with epidural anaesthesia and analgesia had stable cardiovascular parameters, minimal neuroendocrine response, less respiratory complications including SIRS and sepsis, lower incidence of thromboembolic events, less blood loss, reduced hospital stay and better pain control.Publication Helicobacter pylori infection, glandular atrophy, intestinal metaplasia and topography of chronic active gastritis in the Nepalese and Japanese population: The age, gender and endoscopic diagnosis matched study(Kathmandu University, 2007) Matsuhisa, T; Miki, M; Yamada, N; Sharma, SK; Shrestha, BMBackground: The incidence and mortality from gastric cancer is high in Japanese but extremely low in Thailand. It is different among Asian countries. The aim of this study is to investigate the difference of peptic ulcer disease, glandular atrophy, intestinal metaplasia and topography of chronic active gastritis between the Nepalese and Japanese population. Materials and methods: Nepalese patients were paired with Japanese patients by age, gender and endoscopic diagnosis in order to compare the prevalence of H. pylori infection (N=309) and the difference of H. pylori related peptic ulcer disease (N=48). Glandular atrophy and intestinal metaplasia scores were also compared between the Nepalese and Japanese population in H. pylori positive cases (N=152) and negative cases (N=145) using paired cases by age, gender and endoscopic diagnosis. Paired H. pylori-positive Nepalese and Japanese population were also used to compare the ratio of corpus gastritis to antrum gastritis (C/A ratio) (N=152). Results: Among peptic ulcer diseases, gastric ulcer was frequent in Japanese and duodenal ulcer was frequent in Nepalese. The prevalence of H. pylori infection in the Nepalese and Japanese population were similar. Glandular atrophy and intestinal metaplasia scores in the H. pylori positive Japanese were significantly higher than those of Nepalese in all positions according to triple site biopsy. Furthermore, there were significant differences in glandular atrophy and intestinal metaplasia scores between in the H. pylori-negative Nepalese and Japanese population except intestinal metaplasia score in the greater curvature of the upper corpus. Japanese C/A ratio was significantly higher than that of Nepalese. Corpus predominant gastritis (C/A ratio>1.00) was characteristic in the elderly Japanese. Nepalese was antrum predominant (C/A ratio<1.00) in every age group. Conclusions. Gastric ulcer was a common disease in Japanese, in contrast duodenal ulcer was common in Nepalese. H. pylori infected Japanese patients showed severe atrophic and metaplastic gastritis in comparison with Nepalese. These results may be associated with the high incidence of gastric cancer in Japanese. Corpus predominant gastritis was found in the elderly Japanese and antrum predominant gastritis was found in every age Nepalese. Key words: H. pylori, atrophy, metaplasia, corpus-predominant gastritis, NepalPublication Ureteric complications following renal transplantation: An eight years experience(Kathmandu University, 2006) Shrestha, BM; Darby, CR; Moore, RHObjectives: Ureteric complications (UCs) following renal transplantation (RT) cause significant morbidity and ureteric stents are employed to bridge the vesico-ureteric anastomosis with a view to preventing these complications. The purpose of this study was to examine the incidence of UCs and outcomes following RT in both stented (STG) and non-stented groups (NSTG) of RT patients. Methods: This is a retrospective study of a cohort of 650 consecutive RTs [STG (N=267; 41%) and NSTG (N=383; 59%)] performed over a period of 8 years, where the data were retrieved from a prospectively maintained computerised database and case-notes. Results: The overall incidence of UCs was 6.5% (42/650), which consisted of ureteric obstruction (UO) in 4.3% (28) and ureteric leak (UL) in 2.2%(14) of patients. The incidence of UO was significantly high in the NSTG compared to the STG (6.3% vs.1.5%; P=0.002). However, the incidence of UL (3.4% vs.1.3%; P=0.1) and post- transplant urinary tract infection (UTI) (44% vs.41%; P=0.57) were not significantly different between the STG and NSTG groups. UO and UL were associated with significantly high incidence of UTI (P=0.001 and 0.01, respectively). All UCs were managed successfully without allograft loss. Conclusions: Routine stenting of ureteric anastomosis resulted in reduced incidence of UO without concomitant increased risk of UTI. Key words: Renal transplantation, vesico-ureteric anastomosis, stent, complicationsPublication Vacuum-assisted closure (VAC) therapy in the management of wound infection following renal transplantation(Kathmandu University, 2007) Shrestha, BM; Nathan, VC; Delbridge, MS; Parker, K; Throssell, D; McKane, WS; Karim, MS; Raftery, ATObjectives: Wound infection in the setting of immunosuppressed state such as renal transplantation (RT) causes significant morbidity from sepsis, prolongs hospital stay and is expensive. Vacuum-assisted closure (VAC) therapy is a new technique of management of wound based on the principle of application of controlled negative pressure. The aim of this study was to assess the efficacy of VAC therapy in the management of wound infection following RT. Materials and methods: This is a prospective study of a cohort of 180 consecutive RTs performed over a period of 4 years, where the data were retrieved from a prospectively maintained computerised database and case-notes. Results: 9 of 180 (5%) patients developed wound infection following RT which led to cavitations and dehiscence with copious discharge, and refused to heal with conventional treatment. All 9 cases were treated with VAC therapy. The VAC system was removed after a median of 9 (range 3-30) days when discharge from the wound ceased. Four patients were discharged home with portable VAC device and managed on an outpatient basis, where the system was removed after a median 5.5 (range 3-7) days. The median hospital stay after initiation of VAC therapy was significantly shorter (5, range 2-12 days) than on conventional treatment prior to VAC therapy (11, range, 5-20 days) (p=0.003). Complete healing was achieved in all cases. Conclusions: The use of VAC therapy is an effective and safe adjunct to conventional and established treatment modalities for the management of wound infection and dehiscence following RT. Key words: Renal transplantation, wound infection, vacuum-assisted closure therapy