Browsing by Author "Uprety, S"
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Publication Diagnosis of Pancreatic Adenocarcinoma in a Case of 25-year-old Female from Nepal(Kathmandu University, 2024) Bhattarai, K; Bhandari, A; Acharya, A; Uprety, SABSTRACT Pancreatic adenocarcinoma is one of the lethal form of malignant change involving the pancreas. The median age of diagnosis is 71 years and is uncommon below 40 years. Here we intend to report an uncommon case of a 25-year-old woman who presented to our institution with complaints of fever, severe abdominal pain. The laboratory workup showed bicytopenia with USG abdomen revealing a bulky pancreas. The Contrast Enhanced Computed Tomography and Magnetic Resonance Cholangiopancreatography suggested malignancy followed by Fine Needle Aspiration Cytology (FNAC) which confirmed the diagnosis of adenocarcinoma. Pancreatic adenocarcinoma is the 14th most common cancer and 7th most common cause of cancer death. Computed tomography is most useful modality of investigation used to diagnose and stage the cancer. This is supported by FNAC and CA19-9 tumor marker. The management includes surgical resection and chemotherapy. Although pancreatic adenocarcinoma is uncommon among the young population, it requires early management protocols. KEY WORDS CA 19-9 antigen, Case report, Nepal, Pancreatic cancer, Risk factorsPublication The Prognostic Value of the Fracture Level in the Treatment of Displaced Supracondylar Humeral Fractures in Children(Kathmandu University, 2020) Gaihre, SK; Uprety, S; Thapa, SSABSTRACT Background Supracondylar fractures are subclassified as high and low type depending on whether they are above or below the isthmus of the distal humerus and it play an important role in determining outcome. Objective To compare the clinical and radiological outcomes of patients with fractures above and below the distal humeral isthmus treated with closed reduction and percutaneous pinning. Method This is a prospective non-randomized analytical study of 40 patients with displaced extension type supracondylar fracture of distal humerus treated by closed reduction and percutaneous pinning. Radiological and functional outcomes was followed up to 6 months postoperatively. The significance of differences between means (baumann angle, carrying angle and time to recovery) were calculated using the independent t-test. Result Twenty-four (60%) patients were high type and 16 (40%) patients were low type. According to Flynn grading, there was no statistical significance between the high type and low type (p = 0.601). The time to recovery for the high type was 15.58 ± 2.95 weeks and for low type was 18.75 ± 2.18 weeks. Hence, the time to recovery for the low type was longer than high type and it was statistically significant (p = 0.001). Conclusion Low type supracondylar fractures require a longer period for the gain of elbow range of motion. However, in long term the prognosis of low type is comparable with that of high type fracture. Hence, the prognostic value of fracture level in the treatment of displaced supracondylar fractures is not statistically significant. KEY WORDS Flynn’s grading, Fracture level, Supracondylar humeral fracturePublication Tibial plateau fractures: four years review at B&B Hospital(Kathmandu University, 2004) Shrestha, BK; Bijukachhe, B; Rajbhandary, T; Uprety, S; Banskota, AKBackground: Tibial plateau fractures involve the articular surface of the tibia resulting from a combination of axial loading with varus or valgus stress. Inadequate and inappropriate treatment may result in significant functional loss. Objective: The purpose of this study was to determine the outcome of our treatment modalities and to compare with the results of comparable studies. Methods: The results of treatment of 81 knees were reviewed over the period of five years (1997 to 2002). There were 62 men and 18 women, with an average age of 37 years (15 years to 75 years) at the time of initial evaluation. One patient had bilateral involvement. Fractures were classified according to Schatzker. Seven patients were treated conservatively. Sixteen patients (17 knees, one had bilateral involvement) were operated with closed reduction and percutaneous cannulated screws fixation. Thirty one patients' required open reduction and internal fixation with cannulated screws. Fifteen fractures were plated, and in eleven cases, external fixators were used. Follow up period ranged from six months to three years. Results: Results were graded as excellent, good, fair and poor on the basis of functional outcome. Forty- three (54%) patients (44 knees) had excellent, twenty-two (26%) had good, five (6%) had fair and ten (14%) had poor results. Poor results were associated with high energy fractures, late presentation, and inadequate physiotherapy follow up. Eight patients (10%) had complications. One had common peroneal nerve palsy, six had wound infection and one patient demonstrated early arthritic changes. Conclusion: Tibial plateau fracture is a challenging fracture to manage. Restoration of articular congruity and early range of motion should be the primary goal. Proper and adequate preoperative planning is mandatory. Well maintained articular congruity with stable fixation helps early mobilization and better functional outcome. Key Words: Plateau, Axial load, Varus, Valgus, Articular congruity, Functional outcome