NepMed Repository :: Browsing by Author "Shrestha, UK"

Browsing by Author "Shrestha, UK"

Now showing 1 - 9 of 9

Benign broncho-esophageal fistula in an adult
(Institute of Medicine, 2009) Singh, KN; Pradhan, S; Thapa, B; Shrestha, UK; Sayami, P
Abstract Tracheoesophageal and bronchoesophageal fistulas are usually diagnosed early in life after an infant presents with difficulty in feeding or recurrent pneumonia. These conditions rarely present in adulthood. We report the case of a 65-year-old man who presented with chest discomfort and cough particularly after meals for three months. Workup including a barium esophagogram revealed bronchoesophegeal fistula. Dissection of the fistula and pedicled intercostal muscle flap repair was done.
Endovascular Treatment for Traumatic Thoracic Aortic Injury: A Case Report
(Institute of Medicine, 2018) Shrestha, UK; Shrestha, KR; Gurung, D; Upreti, MR; Adhikari, A; Gurung, A
Abstract As majority of blunt traumatic injury with aortic tear die, we see limited numbers of survival in the hospital. Thoracic endovascular treatment for traumatic aortic injury is rare. Endovascular treatment, where available, is the trend for traumatic aortic injury for all age group. Both morbidity and mortality are significantly decreased with endovascular intervention. Twenty nine years old male patient driving a car collided with truck and had thoracic aortic pseudoaneurysm with multiple skeletal fractures that underwent successful endovascular stent graft along with fixation of all fractured bones. Key words: Endovascular stent graft, Thoracic aortic injury, Thoracic aortic pseudoaneurysm, Thoracic endovascular aortic repair
Management of Pseudoaneurysms in IV Drug Users
(Institute of Medicine, 2011) Sapkota, R; Sapkota, S; Thapa, B; Shrestha, KR; Rajbhandari, N; Shrestha, UK
Abstract Introduction: Pseudoaneurysms are major vascular complications in intravenous drug abusers. They are potentially fatal, often infected and require urgent management. Method: This is a retrospective study of the prevalent practice of their management in our center. The inpatient medical charts of the patients spanning 5 years (Sep 2006 to Aug 2011) were reviewed. Data were obtained on their demographic, clinical, management and outcome parameters. Result: Among the thirty intravenous drug users presenting with pseudoaneurysms (excluding one who bled to death before surgery), 28 had their femoral artery involved. Most of them (90%) were infected. Nearly half of the patients (45%) were seropositive for HIV and/or HCV. All were operated, with no mortality. Ligation and debridement was the technique used almost exclusively (83%). One brachial artery wasrepaired primarily, whereas 3 femoral and 1 brachial pseudoaneurysms were managed with autologous saphenous vein bypass. Five patients had neurological complications, and 5 others had non-limb threatening claudication which got better with medical management. Mean follow up period was 11 months. Conclusion: Ligation and debridement appears to be a simple, safe and effective procedure in infected pseudoaneurysms in IV drug users. Keywords: Claudication, IV Drug Users, Infected Pseudoaneurysms, Ligation
Neurological Complications in Surgical Management of Carotid Body Paragangliomas
(Institute of Medicine, 2013) Shrestha, UK
Abstract Introduction: Carotid body tumors are rare neoplasm and must be considered in the evaluation of all lateral neck masses. Though surgical excision of carotid body tumor is a challenge to the surgeon, early surgical excision is considered. Cranial nerve injuries are common because of its proximity to the carotid body tumor. Methods: Fifteen carotid body tumors operated on 14 patients over ten year period from July 2003 to June 2013 were retrospectively reviewed. Six (42.9%) of the patients were male and eight (57.1%) were female. The average age was 41.9 years (23 to 70 years). Physical examination, radiological evaluation, method of treatment and postoperative complications were studied. Four cases belonged to Shamblin class II and 11 to Shamblin class III. Six (40%) cases were operated with carotid shunt and four (26.7%) with clamping of carotid artery. Division of external carotid artery was required in five (33.3%) cases. Polytetrafluoroethylene graft was used to maintain continuity of internal carotid artery in three (20%) cases and external carotid artery was transposed to internal carotid artery in one (6.7%) case. Results: Complete resection was possible in all cases. Cranial nerve palsies were noted in five (33.3%) cases. Two of them had complete recovery whereas three (20%) had permanent palsy. No stroke and mortality occurred. Conclusion: Carotid body tumor has higher risk of cranial nerve paresis which requires good surgical skills to ensure complete removal. Vascular excision with continuity to internal carotid artery may be required while undertaking complete carotid body tumor excision. Keywords: carotid body tumor, carotid paraganglioma, cranial nerves, Shamblin classification
Popliteal artery injury in and about knee injury: An experience in Manmohan Cardiothoracic vascular and transplant center
(Institute of Medicine, 2015) Baral, RK; Shrestha, K R; Sapkota, R; Shrestha, UK
Abstract Introduction: Knee dislocation is a common knee injury leading to neurovascular insufficiency. Penetrating injury to the popliteal fossa is also associated with neurovascularv injuries. Amputation rate is high amongst popliteal artery injury associated with bone injury. Delayed detection and late interventions are the factors contributing for limb loss in these cases. We present our experience of the popliteal artery injury from a tertiary care center over the period of 3 years. Method: It is a retrospective analysis of prospectively collected data of cases of popliteal arterial injury over the period of three years (July 2011 till June 2014). Data were analyzed on their demographic, clinical, management and outcome parameters with SPSS 17. Result: There were total 35 popliteal artery injuries in 34 patients associated with injuries of knee. Twenty two (65%) patients were male and rests were female. Mean age of these patients was 23±12 years, with age ranging from 15 to 76 years. Twelve patients had amputation and were identified and treated late. Most of the patients reach our center late mean time 9±5 hours and as late as 7 days. Conclusion: High index of suspicion is required to identify the popliteal artery injury in patients with injuries in and about the knee. Early vascular surgical consultation and intervention is required to alleviate its poor outcome. Keywords: knee injury, popliteal artery injury
Problems faced in the surgical management of rheumatic heart disease in Nepal
(Institute of Medicine, 2000) Shrestha, BM Singh; Joshi, PR; Dali, B; Timila, R; Shrestha, UK; Marahatta, MN; Koirala, B; Sharma, GP; Bhatta, M
Abstract Rheumatic heart disease (RHD) is a very common cardiac disease in Nepal. The public awareness among Nepalese population is negligible, therefore it is seen in very early age and in severe form. The majority of the patients are of low socio-economical condition, who cannot afford expensive valve replacement surgery. All these facts create a daunting problem in the surgical management of the disease for the newly established open heart surgery unit. The first regular open heart surgery in Nepal was started on 20 February 1997 in Tribhuvan University teaching Hospital (TUTH), Kathmandu. Closed heart surgery was the only procedure available for isolated mitral stenosis in the past. Since 1997 in three years, a total of 285 cases of RHD were referred for surgery. Male to female ratio was 1.1:1.0. The youngest patient was 3 years and oldest 58 years with a mean age of 30 years. There were 32 patients (11%) under the age of 16 years. The isolated mitral valve disease was found in 195 cases (68%), aortic valve disease in 28 cases (10%) and double valve disease in 62 cases (22%). In the mitral valve disease, severe subvalvular fusion and calcification were found in 101 (52%) and 76 patients (39%) respectively, whereas closed mitral commissurotomy (CMC) was possible in only 69 patients (35%). In 3 years, 104 cases of valve surgeries were performed at TUTH. CMC was perfomed in 55 cases whereas open heart surgery in 49 cases of RHD patients. Here we present our difficulties in beginning regular open heart surgery in Nepal and the problems faced by our patients. Keywords: Rheumatic heart disease, open heart surgery, Nepal
Retrospective study on extracranial neck schwannomas in tertiary care hospital in Nepal
(Institute of Medicine, 2014) Shrestha, UK; Shrestha, KR
Abstract Introduction: Schwannomas are relatively rare tumors arising from Schwann cells that ensheath the peripheral nerves. The study aim was to identify extracranial neck schwannomas treated in a tertiary care hospital in Nepal. Methods: We reviewed medical records of all patients with extracranial head and neck schwannomas treated at our department from July 2004 to June 2014. Results: Ten such patients consisted of 7 males and 3 females were identified, with a mean age of 37.8 +/- 10.7 years (range: 20 to 54 years) with solitary schwannomas. Mean size of tumor was 5 cm (range: 2-10 cm). Most of the patients (60%) presented with asymptomatic palpable mass. Of these ten, 50% had a left sided neck mass. Seven originated from vagus nerve while three from sympathetic chain. The average duration of symptoms ranged from one month to two and half years. In all cases, tumor was completely resected through cervical approach. All tumors were enucleated keeping nerve of origin intact. In all cases, the tumor was completely resected surgically. The average follow up period ranged from one month to 108 months (median: 24 months). No major postoperative complications were noted. Two patients (20%) developed Homer's syndrome and one (10%) had temporary hypoglossal nerve palsy which recovered within three months. Conclusion: Non-vestibular extracranial head and neck schwannomas most frequently present as an innocuous longstanding unilateral neck mass. The mainstay of treatment is complete excision preserving the nerve of origin. Early recognition of Schwannomas is key to optimal treatment. Keywords: cranial nerves, Horner's syndrome, Schwannoma
Upper gastrointestinal bleeding in chronic pancreatitis
(Institute of Medicine, 2010) Kandel, BP; Ghimire, B; Lakhey,PJ; Shrestha, UK; Khakurel, M
Abstract Pseudoaneurysm of peripancreatic vessels is a rare complication of chronic pancreatitis. Being close to the pancreas, splenic artery is the most frequently affected vessel whereas right gastroepiploic artery pseudoaneurysm is very rare. Rupture of such pseudoaneurysm is a rare cause of upper gastrointestinal (GI) bleeding. We report a patient of chronic pancreatitis with past history of pancreatic duct stenting who presented with massive upper GI bleeding and stent migration. Bleeding from pseudoaneurysm of right gastroepiploic artery was detected in angiography. Coil embolization was done but later rebleeding occurred and was managed with laparotomy and ligation of the pseudoaneurysm. Patient improved during postoperative period. Keywords: chronic pancreatitis, embolization, pseudoaneurysm
Video-Thoracoscopic Management of Empyema Thoracis in tertiary level thoracic unit
(Institute of Medicine, 2013) Shrestha, UK; Thapa, B; Baral, R; Sapkota, R; Sayami, P
Abstract Introduction: Thoracic empyema is a common problem. Use of minimal access surgery for the treatment is comparatively new. We audited our results with VATS in thoracic empyema. Methods: We analyzed the retrospective data from the patients who received Video-Assisted Thoracoscopic Surgery (VATS) for empyema thoracis from April 2011 to April 2013 at Manmohan Cardio-thoracic Vascular and Transplant Center (MCVTC). Results: Of the 44 patients who underwent surgery for empyema of various stages, 37 patients underwent the procedure via VATS. The average age was 26.4 ±17.19 yrs (1-64). The male to female ratio was 2:1. The duration of symptoms before VATS intervention varied very widely (7-712 days avg: 92.7±28.8 days). The duration was 32 days on an average among patients in whom deloculation sufficed but was 111 days among those in whom decortication was required. A complete VATS procedure with satisfactory lung expansion at the end of the procedure was possible in 34 patients (100% patients who underwent deloculation and 88% of those who underwent decortications). Inadequate lung expansion forced conversion in three and subsequent collapse necessitated re-operation in one. The operative times were: VATS converted to open decortication (150 mins), completed VATS decortication (60-180 mins, avg: 125.7 mins) and VATS deloculation (45-120 mins, avg: 69 mins). Post-operative chest tube drainage was shorter in patients in whom a successful VATS procedure was completed 4.0 Vs 40 days). Conclusion: Videothoracoscopic approach is feasible in surgical management of empyema thoracis. The results seem to be better in earlier stages. Keywords: Deloculation, decortication, empyema, Video-assisted thoracoscopic Surgery (VATS)

Browsing by Author "Shrestha, UK"

Results Per Page

Sort Options