Browsing by Author "Thakur, DK"
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Publication Anatomical Variations of Renal Artery in Nepalese Live Kidney Donors(Institute of Medicine, 2015) Thakur, DK; Sedhain, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PRAbstract Introduction: Donor nephrectomy is unique surgery to predispose the surgeon on stress as healthy donors have major surgery purely for others’ benefit. Renal vessels are known with the wide range of variations which can lead to major complications or life threatening events if unrecognized. A thorough knowledge of anatomic variations in renal artery facilitates surgeons to anticipate and manage these potential risks and prevent the complications. Here we present anatomical variations in RA in Nepalese live kidney donors. Methods: This prospective observational study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Live kidney donors over a period of 17 months (From June 2013 to October 2014) presenting for donation were evaluated for renal vasculature with 64- slice multidetector computed tomography and the findings were correlated with intraoperative findings during donor nephrectomy. Results: Sixty three donors were enrolled in the study. Male & female ratio was 1:2.1. Age ranged from 18 years to 64 years (Mean 44.58 years).Anomalous RA was seen in 25 cases (39.7%). Fifty six percentages of anomalies were seen in female and 44% in male. Majority of anomalies were on left side (22.2%). The most common anomaly was supernumerary RA seen in 16 cases (25.5%) Accessory RA was seen in 11 cases (17.5%). Prehilar bifurcation was seen in 11 cases (17.5%). Aberrant RA was seen in 5 cases (8%). Preoperative CT angiographic findings correlated with intraoperative findings in all cases (r = 1, p = 0). Polar branch was transected accidentally in two cases which were repaired at bench surgery. Conclusion: Anatomical variations of renal artery in Nepalese donors are comparable with other populations. Thorough knowledge of the variations can minimize complications and improve outcome during nephrectomy. Keywords: CT renal angiography, Donor nephrectomy, Renal arteryPublication Correlation of Coagulopathy of Trauma and Revised Trauma Score in Predicting Outcome in Trauma Patients(Institute of Medicine, 2016) Thakur, DK; Sharma, MR; Lohani, IAbstract Background: Trauma is a major worldwide public health problem. It is one of the leading causes of death and disability in both industrialized and developing countries. Coagulopathy is present immediately at admission in 25% of trauma patients and is associated with a 5-fold increase in mortality. The Revised Trauma Score (RTS) is a physiological scoring system, with high inter-rater reliability and demonstrated accuracy in predicting death. The purpose of this study was to correlate coagulopathy of trauma and RTS in predicting outcome in trauma patients. Methods: In this prospective study, 75 traumatic patients were studied over a period of one year (May 2010 to April 2011) in The Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Patients were evaluated on arrival in emergency room (ER) and data was collected on patients' demography, time from injury to arrival in ER, fluid administered before referral, vital signs, GCS and RTS was calculated.Coagulation profile was determined by measuring prothombin time(PT) and activated partial thromboplastin time(aPTT). Results: Of 75 patients studied, 84% (63) were male and 16% (12) were female with 47%(35) in the 21-40 year age group. Road traffic accident was most common type of injury (60%) followed by fall from height (29%). The median time after injury was 8 hours and fluid administration before referral was 1000ml. Traumatic coagulopathy was present in 24%(18) of patients and mortality was 16% (12). Coagulopathy was significantly associated with time of presentation in ER following injury (P=0.01),GCS(P=0.012), SBP(P<0.001), respiratory rate(P=0.001), RTS(P<0.001),PT(P<0.001), aPTT(P<0.001). But there was no significant association of coagulopathy with amount of fluid received at scene (P=0.886) and age of the patient(P=0.617). There was negative linear correlation between RTS and PT (r =-.623) and aPTT (r=-.596). Conclusion: There is clinically significant traumatic coagulopathy which correlates with RTS and it has effect on poor outcome in traumatic patients Keywords: Trauma, Coagulopathy, Revised Trauma Score (RTS), Outcome IntroductionPublication Open Anderson Hynes Pyeloplasty in Ureteropelvic Junction Obstruction: An Institutional Experience(Institute of Medicine, 2015) Subedi, PP; Chapagain, S; Thakur, DK; Poudyal, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PR; Shrestha, GKAbstract Introduction: Ureteropelvic junction obstruction (UPJO) is one of the common causes of hydronephros is in children and adults. The cause may be congenital or acquired. The standard management of UPJO has classically been an open Anderson-Hynes (A-H) dismembered pyeloplasty. This study is an audit of A-H pyeloplasty done for patients with UPJO presenting to our institution. Methods: A retrospective analysis was done in the Urology unit, Tribhuvan University Teaching Hospital from July 2013 to November 2014. All patients undergoing A-H pyeloplasty were included for review. Preoperative data regarding the demographics, presentation, diagnostic tools used, details of the surgery, postoperative complications, duration of hospital stay and follow up findings were reviewed. Initial follow up was scheduled at two weeks, then at three months and at one year. At 3 months, DTPA renogram was obtained to assess the function and clearance of the treated kidney. Results: The age of the patients ranged from 5 months to 69 years. Flank pain was the most common presenting complain. Most of the patients were males and left sided obstruction was common. The most common diagnostic modality used was USG and excretory urography. CT urography was done in cases of secondary UPJO. DTPA scan was used in select cases for baseline documentation of the function of the involved kidney. The average duration of surgery was 2 hours and 30 minutes. The mean duration of hospital stay was 5 days. The most common complication was urinary tract infection. Conclusion: Open A-Hpyeloplasty is the most common surgery done for UPJO at our institution. The outcome can be improved by attention to the principles of A-H pyeloplasty. Keywords: hydronephrosis, A-H pyeloplasty, ureteropelvic junction obstruction