Browsing by Author "Shrestha, RKM"
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Publication Appendicular perforation(Institute of Medicine, 2011) Malla, BR; Shrestha, RKMAbstract Introduction: Appendicitis is the most common acute abdominal condition presenting in hospital. Appendicular perforation is a major complication of appendicitis. The objective of the study is review the cases of appendicular perforation in respect of its incidence, sex preference, clinical features, investigations, treatment and postoperative wound infections Methods: A retrospective study was conducted reviewing the records of the patients who were admitted in Dhulikhel hospital with the diagnosis of appendicular perforation from January 2009 to December 2010. Results: A total of 332 cases of appendicular disease were admitted during the study period. Out of them, 42 patients had appendicular perforation. It constituted 12.6% of total appendicular diseases. The male to female ratio in perforation was 6.1: 1. The common age group for the perforation was 30- 50 years with mean age of 35 years. The mean duration of pain before presentation to the hospital was 4.5 days.All the cases of appendicular perforation had spread of pain from right iliac fossa to all over the abdomen, and anorexia. Vomiting was found in 83.33% of the cases. All the cases had rebound tenderness and rigidity all over the abdomen. None had free gas under diaphragm. Retrocaecal shaft perforation was found in most of the cases. Post operative wound infection was found in 14.2% of the cases. Conclusions: Appendicular perforation is a severe complication of appendicitis. Appendicular perforation has no sex preference. It is common in elderly age group. Spread of pain from right iliacfossa to all over the abdomen, anorexia and rebound tenderness were found in all cases. Elevated total leukocytes count and shift to left were significant in case of appendicular perforation. Retrocaecal appendix is more prone to perforation. Keywords: Appendicitis, appendicular disease, appendicular perforationPublication Laparoscopic Cholecystectomy Complication and Conversion Rate(Kathmandu University, 2010) Malla, BR; Shrestha, RKMABSTRACT Background Laparoscopic cholecystectomy has become standard method for treating gallstone. However, different centres have reported different complications and conversion rate. The objective of this study was to evaluate complications and conversion of laparoscopic cholecystectomy into open cholecystectomy in Dhulikhel Hospital, Kathmandu University, Nepal. Methods Files of all patients who had laparoscopic cholecystectomy from January 2005 to December 2009 were reviewed. Out of 119 laparoscopic cholecystectomy cases, 102 were included in the study as complete information was lacking in the rest. Results Out of 102 cases, 80 were female. Symptomatic cholelithiasis were 76.47%. The mean hospital stay was 2.48 days. Postoperative complications occured in 5.88% patients. Conversion rate to open cholecystectomy was 3.92%. Conclusions Laparoscopic cholecystectomy is a reliable and safe surgery. With growing experience in laparoscopic technique, it is possible to bring complications and conversion rate to minimum. However, there will be no significant improvements once learning curve is reached. Rather, the nature of biliary injury may become more severe. Key Words cholecystectomy, conversion, gallstone, laparascopicPublication Outcomes of Extra Corporeal Shock Wave Lithotripsy in Renal and Ureteral Calculi(Kathmandu University, 2014) Joshi, HN; Karmacharya, RM; Shrestha, R; Shrestha, B; de Jong, IJ; Shrestha, RKMABSTRACT Background Since the introduction in early 1980s, Extracorporeal Shockwave Lithotripsy (ESWL) became the accepted first line treatment modality for renal and upper ureteric stones. It is simple, safe and effective noninvasive procedure which can be performed without anaesthesia in outpatient basis. The objective of this study was to determine the efficacy of ESWL to achieve complete stone clearance in the patients with different sizes of renal and upper ureteric stones. Objective The aim of this study was to assess the outcome, efficacy and complications of ESWL in the treatment for renal and ureteric stones in terms of the site and the size of the stone in the patients presented at Dhulikhel Hospital Kathmandu University Hospital. Method In this prospective study a total of 430 (214 renal and 216 ureteric) cases of urinary stone disease in 257 male and 173 female patients treated by ESWL at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of May 2010 to June 2012 were included. Data of patients with renal and ureteric stones were evaluated for stone site, size, and number of sessions. Data were analyzed using spss 13.0. Result Out of 430 cases, the overall stone free rate in after 1st session was 341 (79.3%) at one month and in three months follow up (3 sessions) it was increased up to 414 (96.3%). In 16 (3.7%) patients treatment was failed. Average size of the stone was 12.24 (SD± 3.65) mm. Stone free rate was 154 (72%) in the case of renal and 187 (86.6%) in the case of ureteric stones in first session. In three months follow up (three sessions) it was 204 (95.4%) and 210 (97.2%) respectively for renal and ureteric stones. In relation to size the stone free rate in <10mm, 10-15mm and > 15mm was 97%, 97% and 90%. Conclusion ESWL is the first line preferred choice for renal and upper ureteric stones which provides the maximum stone free rate in the case of stone size smaller than 1.5cm. KEY WORDS ESWL, outcome, renal stones, ureteric stones, urinary stone disease, urolithiasisPublication Urinary Bladder Carcinoma: Impact of Smoking, Age and its Clinico-Pathological Spectrum(Kathmandu University, 2013) Joshi, HN; Makaju, R; Karmacharya, A; Karmacharya, RM; Shrestha, B; Shrestha, R; de Jong, IJ; Shrestha, RKMABSTRACT Background Urinary bladder carcinoma is common urological malignancy. Although epidemiological evidence favors role of occupational exposure to chemical carcinogen as the aetiological factor of bladder carcinoma, many cases arise with no obvious occupational exposure to chemical carcinogen. Tobacco and cigarette smoking is common in both rural and urban areas of Nepal. Objective The objective of this study was to determine the impact of smoking and age in urinary bladder carcinoma with related clinicopathological correlations. Method A total of 56 (44 males and 12 females) cases of urinary bladder cancer treated at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of January 2004 to December 2013 were included in the study. Data of patients with Urinary bladder cancer were obtained from hospital records and evaluated for age, sex, history of smoking, clinical presentations, cystoscopic findings and histopathological characteristics. Results Out of 56 cases, 51 (91.1%) of the patients had hematuria. History of smoking was found in 44 patients. Smoking was found much higher in males (88%) than females (41.66%). Transitional cell carcinoma (TCC) was the most common histological variety, which was seen in 51 (91.07%) patients. The significant impact of smoking was found in terms of grade of TCC. Conclusion The incidence of bladder carcinoma is higher in male and TCC is the most common variety of Urinary bladder malignancy. History of smoking correlated with grade. KEY WORDS Bladder cancer, bladder carcinoma, smoking, transitional cell carcinoma