Browsing by Author "Tuladhar, SM"
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Publication Abnormal Venous Dilatation other than Typical Varicose Vein, Rare Encounters(Kathmandu University, 2018) Karmacharya, RM; Shrestha, B; Shrestha, BK; Devbhandari, M; Tuladhar, SM; Hodde, A; Thermann, FABSTRACT Varicose vein, one of the common vascular illnesses is usually a disease in lower limb. This is due to reflux of blood from deep venous system to superficial venous system. Rarely, this disease can also happen in veins in different location. Four such rare encounters are mentioned in this case series. KEY WORDS Superficial veins, Unconventional sites, Varicose veinPublication Factors Affecting Recanalisation after Optimal Management of Deep Vein Thrombosis; A single institution based study(Kathmandu University, 2019) Karmacharya, RM; Shrestha, B; Devbhandari, M; Tuladhar, SM; Pradhan, AABSTRACT Background Presence of recanalisation will favour for better physiological recovery after medical management of Deep Vein Thrombosis (DVT) along with lesser chances of post thrombotic syndrome. Rate of recanalisation is varied and can range from 43-57% and the factors that affect recanalisation are still a dilemma. Objective To know the factors for recanalisation following Deep Vein Thrombosis. Method This is a single institution based retrospective-prospective analytical study encompassing all ultrasonologically diagnosed cases of Deep Vein Thrombosis in adults from January 2015 to November 2017. All the cases were admitted with oral warfarin bridged by Heparin/ Enoxaparin and were discharged once International Normalization Ratio was in therapeutic range. The patients were followed up for three months with minimal of three outpatient followup. Best finding in the doppler ultrasonography (done by Acuson P500, Seimens) in relation to recanalisation was taken for the study. Result There were 67 cases of Deep Vein Thrombosis. Of these cases male to female ratio was 0.91. The mean age was 48.07. Most common extent was up to common femoral vein (47.8%) followed by upto popliteal vein (40.3%). Remaining 11.9% had extension upto iliac veins. There was no recanalisation in 2 cases (3%). Partial recanalisation was seen in 23 cases (34.3%) while complete recanalisation was seen in 42 cases (62.7%). Recanalisation is more in DVT involving popliteal vein while it decreases as the extension goes up. In contrast to 79.4% complete recanalisation in popliteal vein, that in common femoral vein is 62.5% while in iliac vein is only 37.5%. Mean age in no recanalisation group is much younger than partial or complete recanalisation groups. Conclusion Recanalisation following Deep Vein Thrombosis distal to popliteal vein is more than that in proximal Deep Vein Thrombosis. The information on recanalization can be considered to use to decide upon the duration of medical management of Deep Vein Thrombosis. KEY WORDS Deep vein thrombosis, Doppler ultrasonography, RecanalisationPublication Initial Experience of Complex Peripheral Bypass Surgery at Dhulikhel Hospital, Kathmandu University Hospital(Kathmandu University, 2017) Karmacharya, RM; Shrestha, B; Devbhandari, M; Tuladhar, SM; Hodde, A; Thermann, FABSTRACT Peripheral arterial disease is seemingly silent yet is a major pubic health problem with limb threatening and life threatening consequences. This condition can initially be asymptomatic and gradually may progress to intermittent claudication and finally to critical ischemia. When conservative management is not sufficient and there is option of surgical management, peripheral bypass surgery is an established modality of treatment of peripheral arterial disease. We present our initial cases of peripheral arterial bypass surgery all of which are technically demanding surgeries. All the cases have resulted into limb salvage until current follow-up. KEY WORDS Claudication, critical ischemia, peripheral arterial bypass, peripheral arterial diseasePublication Optimal Starting Dose of Warfarin for Treatment of Deep Vein Thrombosis in Nepalese Context, A Retrospective- Prospective Institutional Review(Kathmandu University, 2017) Shrestha, BK; Karmacharya, RM; Devbhandari, M; Tuladhar, SMABSTRACT Background Deep vein thrombosis (DVT) requires an early establishment of effective anticoagulation in order to reduce harms and cost of concomitant treatments. Selection of the right warfarin dose at the start of treatment is important. Objective To know ideal starting dose of warfarin in adult with Deep Vein Thrombosis of our population. Method This is a retrospective-prospective single institution based analytical study including Deep Vein Thrombosis in adults from January 2015 to November 2017. On the first half (January 1, 2015 to July 31, 2016) of the study period, the cases were given 3mg of warfarin as initial dose (Group 1); while in the second half (August 1, 2016 to November 31, 2017) cases were given 5mg as the initial dose (Group 2). Two sequential International Normalisation Ratio (INR) within therapeutic range is considered as target attained. Result There were total of 63 patients (M:F=1:1.03) of which 85.7% (n=54) cases were acute deep vein thrombosis and 14.3% were chronic cases. Mean final dose of warfarin was 6.03 mg; where it was 6.50 mg in group 1 and 5.63 mg in group 2, p=0.11. Difference between final dose and starting dose it was found to be 3.5 mg in Group 1 while that was only 0.63 mg in Group 2 (p<0.01). Conclusion Lesser change in dose of warfarin from its initial starting dose (5 mg) was noticed in group 2. Warfarin 6 mg as ideal starting dose can be recommended but larger, multicentric and follow up studies are essential to substantiate the findings. KEY WORDS Deep vein thrombosis, International normalisation ratio, Warfarin