Browsing by Author "Subba, K"
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Publication Biliary Complications after Laparoscopic Cholecystectomy(Nepal Health Research Council, 2011) Koirala, U; Subba, K; Thakur, A; Joshi, M R; Thapa, P; Singh, D R; Sharma, S KBackground: The reported prevalence of biliary tract disruption following laparoscopic cholecystectomy has ranged from 0% to 7% in early reports. Bile leaks are the most common biliary complication of laparoscopic cholecystectomy. Methods: Total 530 patients who had undergone laparoscopic cholecystectomy from January 2004 to November 2006 at Kathmandu Medical College Teaching Hospital were studied for biliary complications after laparoscopic cholecystectomy. Results: We reviewed 500 laparoscopic cholecystectomies performed at our institution and found 13 cases of bile extravasation and/or biloma formation and/or bile duct injuries (prevalence, 2.6%). One bile duct transection was acutely recognized and treated with hepaticojejunostomy. Three lateral bile duct injuries were also acutely recognized, two of them were managed with primary repair of CBD without T tube and the other was managed with repair and T-tube drainage. Two patients had postoperative generalized biliary peritonitis, one of whom was undergone exploratory laparotomy and found to have lateral injury on CBD which was managed with repair and T-tube drainage, whereas the other was undergone diagnostic laparoscopy with clipping of duct of Lushka. Two patients presented within seven days with biloma, one was treated with percutaneous drainage alone, the other treated with percutanous drainage was found to be complete transection of CBD on subsequent ERCP and managed with late hepaticojejunostomy. One patient with continued bile leak from surgical drainage tube for more than one week was managed with ERCP, diagnosed to be bile leak from duct of Lushka, managed by sphincterotomy and bile duct stenting. One patient presented with obstructive jaundice 6 months after laparoscopic cholecystectomy was found to have Bismuth type II bile duct stricture and was undergone hepaticojejunostomy. The remaining three had bile leak from surgical drainage which resolved within one week without further complication. Conclusions: Laparoscopic cholecystectomy appears to be associated with a higher incidence of bile duct injury than previous reports of open cholecystectomy. Possible explanations include variant anatomy plus failure to obtain an operative cholangiogram, inadequate dissection, injudicious use of cautery or clip placement, inherent limitations of the procedure, or the learning curve associated with a new technology. Key words: biliary tract, laproscopic cholecystectomy.Publication Semirigid Ureteroscopy with Pneumatic Lithotripsy for Ureteral Stone(Nepal Health Research Council, 2011) Dongol, UMS; Acharya, L; Subba, K; Khambu, B; Joshi, R; Shrestha, S K; Singh, D RBackground: Ureteral stones present with acute loin to groin pain. The objective of this study is to find out the outcome and safety of semi-rigid ureterscopy with pneumatic lithotripsy for treatment of ureteral stones of >30 mm2 and to assess the impact of size and location on stone free (SF) rate. Methods: Total 110 patients with isolated ureteral stone size>30 mm2 were included in this study and treated with pneumatic lithotripsy using 8/9.8 Fr. Semi-rigid ureteroscope (Stiema Germany). Stones were fragmented into 2-3mm particles and removed. Outcome parameters assessed at 3 months follow up were stone free rate(SF), Efficiency Quotient (EQ), and impact of stone size and site on SF/EQ was also analyzed. Similarly, patient demographics, procedures, patient related parameters and complications were also noted. Results: The overall SF rate at 3 months follow up was 69.33% and efficient Quotient (EQ) 52.52%. The SF/EQ for upper, middle and lower third of ureteral stone was 55/37.67,6/43.57, 92/84.40 respectively (P-value< 0.001). The SF for stone size 30-110 mm2 and >110mm2was 78% and 67% respectively. There were no major complications seen. Overall minor complication rate was 5.45 % (minor ureteral perforations-5, urinoma formation 1). Conclusions: Semi-rigid ureteroscopy with pneumatic lithotripsy is a safe, simple and effective procedure for ureteral stones with excellent success rate for distal ureteral stones. The stone free rate and EQ are statistically significant (P value<0.001) between upper, middle and lower ureteral stones. Stone size has a direct impact on the SF rate and EQ. Keywords: semirigid uerteroscopy, pneumatic lithotripsy.Publication Triiodothyronin, Thyroxine and Thyrotropin in Vitiligo(Kathmandu University, 2011) Subba, K; Karn, D; Khatri, RABSTRACT Background Vitiligo is a common pigmentary disorder of the skin, affecting individuals globally. Not only is this ailment psychologically incapacitating, it also has a high incidence of autoimmunity, signifying that its manifestations may be the portrayal of dysfunction of immune system. Objective The aim of this study is to find out the situations of abnormal thyroid function test (TFT) in vitiligo patients. Methods A prospective cross sectional study was conducted at the Dhulikhel Hospital, KUTH, Dhulikhel during November 2008 to January 2011 with the objective to assess the thyroid function tests in vitiligo patients. Results Total 66 vitiligo patients with male 30 (45%) and female 36 (55%). Total 26 (39.39%) vitiligo patients have been found to have abnormal thyroid function test. Among them 10 had abnormal T3, seven had abnormal T4 and 12 had abnormal TSH level. Thyroid function test were normal in other vitiligo patients. Total seven vitiligo had high level of T3 than normal value, four male and three female. Two had higher level of T4 above 2.0 ng/dl and all were male, while five had abnormally low level of T4 with three male and two female. There were seven vitiligo patient with increased T3 level and three with decreased T3 level, among them six were males and four were females, the age group was ranged from seven to 68 years old. The T4 level were found abnormal in seven vitiligo patients among which five were males and two were females with the age group ranging from 7 to 51 years. Conclusions There has been significant association of thyroid disorder in the patient with vitiligo. Therefore, patient with vitiligo need to undergo thyroid function test to rule out the thyroid disorder and prevent from long-term complications. KEYWORDS thyroid, thyroxin, thyroid function test, vitiligo