Browsing by Author "Singh, DR"
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Publication Ancient cystic pelvic schwannoma presenting as a right iliac fossa mass(Kathmandu University, 2005) Rai, BR; Chaudhary, D; Thapa, P; Joshi, MR; Dongol, UMS; Singh, DR; Sharma, SKSchwannoma is rare in pelvis. Ancient schwannoma is rarer histological subtype of schwannoma. We report a very rare case of pelvic schwannoma presenting with right sciatica and right iliac fossa pain. Clinical and imaging findings were suggestive of Peritoneal Hydatid cyst. The tumour was resected completely with marked clinical improvement. Histopathological examination showed Ancient cystic schwannoma. Key words: Benign pelvic Schwannoma, Benign retroperitoneal tumour, Giant ancient Schwannoma, Presacral Cystic SchwannomaPublication Controversies in the management of acute pancreatitis(Kathmandu University, 2004) Singh, DR; Mehta, A; Dangol, UMSIntroduction: Acute pancreatitis accounts for three to five percent of admission to hospital for abdomen pain. Though most are of mild form, the severer form takes a toll of some ten percent. Aims and objectives: This study aims to make a retrospective analysis of some fifty four admissions for acute pancreatitis admitted to Kathmandu Medical College Teaching Hospital in the past twenty four months. It also aims to highlight some of the controversies that have come up as to its management. Results: Among the 54 admissions for acute pancreatitis, there were thirty nine patients. Sixteen (41%) of them were female and twenty three (51%) male. Their ages ranged from twenty one to ninety years, with an average of forty one years. Surprisingly no patients were between sixty to eighty years bracket. Thirteen (33%) of the patients had gall stones in ultrasound. Two (5%) of the patients were suffering from mumps and Eleven (28%) no causal factors were found. While thirteen (33%) patients suffered from alcoholic pancreatitis. All of them were male. Of the alcoholic group, five (38%) had recurrent attacks. Five (38%) from the biliary and two (18%) from the idiopathic group had recurrent attacks. Four patients were operated on emergency basis. Three with the diagnosis of peritonitis and another eighty four year old lady with features of associated cholangitis were found to have acute pancreatitis at operation. One of them underwent peritoneal toileting; two had cholecystectomy and peritoneal toileting while the eighty four year old lady underwent cholecystectomy, common bile duct exploration and peritoneal toileting. All fared well post-operatively. Keywords: acute pancreatitis, microliths, buscopan, idiopathic pancreatitisPublication Empyema thoracis(Kathmandu University, 2007) Singh, DR; Joshi, MR; Thapa, P; Nath, SAbstract Objective: To review the management of Empyema Thoracis in the surgical department of Kathmandu Medical College Teaching Hospital. Methods: Thirteen cases with Empyema thoraces treated in the surgical department of the hospital with different modalities of treatment was taken for study and analyzed for morbidity, mortality, and hospital stay. Results: there was a single mortality in the thoracotomy group. Video assisted thoracic surgery or VATS debridement or deloculation was successful in the eight of the patients with shorter stay in the hospital. One patient who refused surgery was treated with streptokinase with good result. Conclusion: Streptokinase may be effective in the treatment of empyemas. Video assisted thoracic surgery or VATS has definite advantage over traditional surgery in terms decreased morbidity, mortality, earlier hospital discharge and cosmesis in the treatment of empyema. Keywords: Empyema thoracis, VATS, Decortications, StreptokinasePublication Intra-abdominal abscess presenting as a thigh abscess(Kathmandu University, 2004) Chaudhary, D; Magar, A; Thapa, P; Singh, DR; Sharma, SKSecondary thigh abscesses are rare, and their cause is often obscure. We report a case of an elderly diabetic who presented with thigh abscess secondary to tuberculous sacroilitis. Key words: Secondary thigh abscess, retroperitoneal abscess, tuberculous sacroilitisPublication Omental torsion: a case report(Kathmandu University, 2005) Chaudhary, D; Rajkarnikar, R; Joshi, MR; Thapa, P; Singh, DR; Sharma, SKOmental torsion is a rare cause of acute abdomen. Most often it presents with sign and symptoms of acute appendicitis. It is seldom considered in the differential diagnosis preoperatively based on clinical findings and the diagnosis is only established during surgery. We present a case of omental torsion in a middle aged male patient who presented with findings suggestive of appendicular perforation and underwent emergency laparotomy. Key words: acute abdomen, omentum, torsion, appendicitisPublication Removal of central venous catheter fragment embolus in a young male(Kathmandu University, 2006) Thapa, PB; Shrestha, R; Singh, DR; Sharma, SKA 22 years male admitted with severe pancreatitis with central venous catheter implanted for central venous pressure monitoring and for providing total parental nutrition developed catheter fragment embolus due to accidental fracture of the same while manipulating it. Non surgical retrieval of the same was done by radiological intervention without any complication. Key words: intravascular catheter fragments, transfemoral venous approach, interventional proceduresPublication Stripping without a Stripper(Kathmandu University, 2004) Singh, DR; Shretha, SKVaricose veins afflict some 10 to 20%of the population in the west. It is believed to be less prevalent in the developing nations1, 2 . Though there are absolute indications of surgery for varicose veins, people in Nepal come for treatment of the varicose veins either to join the army or to work abroad. Not all hospitals in Nepal are equipped with a vein stripper. In KMCTH, we studied 29 patients who had their long Saphenous veins stripped either with a stripper or by tunnelling around the Saphenous vein. We found that the long Saphenous vein could be stripped via the tunnelling method with an additional incision above the knee joint which is cosmetically accepted by our patients. Moreover the patients were much satisfied because of minimal or no bruises in the post-operative period as compared to those who had the long Saphenous vein stripped with a stripper. Keywords: varicose veins, stripping, stripperPublication Ultrasound: An extension of clinical examination(Kathmandu University, 2007) Singh, DR; Joshi, MR; Dangol, UMS; Koirala, U; Pradhan, RL; Shrestha, BR; Mishra, CDAims and objectives: To study the impact the use of portable ultrasound can have for the benefit of the patients when used by doctors other than radiologist, in this case surgeons. Methods: Ultrasound performed by surgeons in the pre-operative, operative and post-operative period was studied. Patients presenting to the Hospital with acute abdomen was subjected to ultrasound. They were either pre-operative or post-operative patients. Five patients were scanned intraoperatively. The impact of these scans to the patients as well as the clinicians was studied. Results: This is an ongoing study and preliminary results of the scans show two pre-operative diagnosis of acute appendicular collection and one acute hydronephrosis. In the operation room, ultrasound was done on 5 cases. On three occasions, it was to locate renal stones so that it could be extracted with ease. On two of the case, it was t to confirm the adequacy of common bile duct exploration thereby allowing primary closure of the common bile duct. Post-operatively, it was used in four cases of which in two cases post-operative hemorrhage were detected timely within hours. In the other two cases, the surgical team was assured that the patient’s complaint was not surgically related. Conclusion: Ultrasound should be an extension of the clinical examination when indicated and all clinicians should be proficient in its use in their respective fields Keywords: ultrasound, non-radiologist, surgeons, per-operative ultrasoundPublication Use of percutaneous thread loop to hold the vermiform appendix during laparoscopic appendectomy(Kathmandu University, 2007) Joshi, MR; Shrestha, SK; Thapa, PB; Koirala, U; Bhattarai, P; Dongol, UMS; Singh, DR; Sharma, SKIntroduction: Laparoscopic appendectomy, although not as widely performed as laparoscopic cholecystectomy, it has got definite advantage over the conventional open procedure. Controversy exists regarding the closure of stump. Our institute practices intracorporeal knot tying using 3 ports. Difficulties are observed in three port technique to hold the appendix during knot tying. We use a percutaneous thread loop. Advantage of the use of loop was evaluated. Patients and method: Prospective study was carried out during 18 months. Total cases were randomly divided in non-loop and with loop group. Operative procedure was same. Cases were compared in terms of operating time, post-operative hospital stay and complications. Results: Total patients were 66. Thirty two in non-loop group and 34 in with loop group. Mean age was 27.89 yrs. Most of the cases were females (62%). Mean operating time was less in loop group although statistically not significant. There was no difference in post operative hospital stay. Use of loop was not associated with added complications. Conclusion: Use of percutaneous loop to hold the appendix reduces the operating time and replaces the need of fourth port. It is safe and effective without any increased morbidity. Key words: Laparoscopic appendectomy, Intracorporeal knot, Percutaneous loop