Browsing by Author "Singh, Y P"
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Publication Solitary skull metastasis as initial presentation of hepatocellular carcinoma(Institute of Medicine, 2017) Pradhan, S; Phuyal, S; Kumar, A; Ghimire, B; Singh, Y PAbstract Hepatocellular carcinoma (HCC) is the most common primary tumor of liver. HCC usually metastasizes to regional lymph nodes and lungs, less commonly to bone and rarely to the skull. Herein we present a case of 73 year old gentleman who presented with an occipital swelling. CT head detected mass suggestive of hemangiopericytoma with a differential of metastasis and MRI showed heterogenous signal intensity mass probably metastasis. Cytological diagnosis revealed cranial metastasis. Subsequent CECT abdomen reported a 12x11x11cm heteregenous enhancing mass suggestive of hepatocellular carcinoma. Patient was planned for craniectomy and transarterial chemoembolization to treat primary cancer but he refused further treatment inspite of extensive counseling. Primary presentation with skeletal metastases is rare in HCC and only few cases have been reported so far but it should be considered in the differential diagnosis in patients with subcutaneous scalp mass. Keywords: Hepatocellular carcinoma, Skull metastasisPublication Surgical management of extrahepatic portal vein obstruction at University Hospital(Institute of Medicine, 2017) Shah, S; Ghimire, B; Kansakar, P B S; Bhandari, R S; Lakhey, P J; Vaidya, P; Singh, Y PAbstract Introduction: Extrahepatic portal vein obstruction (EHPVO) is a second most common cause of portal hypertension which causes upper gastrointestinal (GI) bleeding. Primary management of upper GI bleeding is endoscopic therapy. However, surgery is performed as a secondary management of upper GI bleeding and if patients fail to respond endoscopic management or complications of EHPVO develops. The aim of the study was to determine the perioperative outcome of surgery done for EHPVO. Methods: This is retrospective observational study of all the patients of EHPVO, who were undergone surgical management at Tribhuvan University Teaching Hospital in between April 2015 to March 2017. Data were collected from case sheets of the patients. The demographic and clinical characteristics of the patients, and perioperative and short term outcome of the surgical management of EHPVO patients were analysed. Results: Total 34 patients were included in the study including 20 males (58.8%) and 14 (41.2%) females with median age of 17 years (4 to 45 years). Most common presentation of EHPVO were fullness in upper abdomen (34/34) upper GI bleeding (29/34). Most of the patients had anemia (33/34), splenomegaly (34/34) and hypersplenism (28/34).Shunt surgery was performed in 20 patients and modified Hassab’s procedure in 14 patients. There was no post-operative severe complication except one mortality in Hassab’s procedure. The median duration of surgery was higher in shunt surgery group compared to devascularisation group (240 minutes versus 180 minutes). There were no significant differences in intraoperative blood loss, total hospital stays and recurrent upper GI bleeding in both surgery groups. Conclusions: Surgical management for EHPVO have good perioperative and short term outcome. Keywords:Esophageal varices, Hypersplenism, Portal biliopathy,Portal vein obstruction