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Granular Cell Tumor of Breast: Rare Tumor Masquerading as Malignancy
(Institute of Medicine, 2020) Hirachan, Suzita; Singh, Yogendra P; Jha, Anamika; Manandhar, Usha
ABSTRACT Granular cell tumor (GCT) is a rare soft tissue tumor that arises from the Schwann cells of peripheral nerves. It was first postulated by Abrikossoff in 1926 as Myoblastoma. About 5-15% of these tumors occur in the breast and less than 1% has the potential to be malignant. Here we present a case of 41 years old premenopausal woman with Benign GCT of the right breast, having clinically malignant features. The clinical and radiological features of GCT are similar to malignant lump. However, histology showing presence of sheets of polygonal cells with abundant granular eosinophilic cytoplasm with round nuclei and granules with Periodic acid–Schiff (PAS) positive, diastase resistant and S-100 antigen positive are confirmatory. Treatment of Granular cell tumor is wide local excision. There is apparently no role of chemotherapy and radiotherapy. The presence of GCT in the breast is quite rare and clinically as well as radiologically it may mimic malignancy, however with histopathology and appropriate immunohistochemistry, proper diagnosis can be made. Keywords: Breast cancer, excision, granular cell tumor
Low Grade Appendiceal Mucinous Neoplasm: A Report of Three Cases
(Institute of Medicine, 2020) Sharma, Nisha; Karna, Alina; Jha, Abhimanyu
ABSTRACT Low-grade appendiceal mucinous neoplasm (LAMN) is an uncommon malignancy with varied clinical features. The most alarming complication of this neoplasm is seeding of mucin into the adjacent peritoneum leading to pseudomyxoma peritonei (PMP). We report three cases of LAMN. Two cases were seen post appendicectomy in 23-year old and 36-year old females. The third case was seen in 53-year-old male post Whipple procedure and hemicolectomy. LAMNs are often diagnosed incidentally, as clinical presentation is barely specific and resembles acute appendicitis. Hence it is imperative to examine all appendicectomy specimens not to miss cases of appendiceal mucinous neoplasm which can have implications on the further management of the patient. Keywords: Appendectomy, mucinous appendiceal neoplasm, pseudomyxoma peritonei
Adnexal Torsion in Ovarian Hyperstimulation Syndrome in Early Pregnancy: A Diagnostic Challenge
(Institute of Medicine, 2020) Regmi, Pradeep R; Amatya, Isha; Poudel, Atit
ABSTRACT Adnexal torsion in ovarian hyperstimulation syndrome (OHSS) is rare but serious complication in pregnancy. It is more common in assisted reproductive techniques. Delay in diagnosis and treatment results in functional loss of ovary as well as termination of pregnancy. In this report, we are presenting a case of 27 years female with subfertility who conceived after ovulation induction presented at 7 weeks 6 days period of gestation with ovarian hyperstimulation associated with adnexal torsion. Later, she was treated with laparoscopic salpingo-oophorectomy. Keywords: Adnexal torsion, ovarian hyperstimulation syndrome, pregnancy
Anesthetic Management of a Case of Hemophagocytic Lymphohistiocytosis
(Institute of Medicine, 2020) Shrestha, Gentle S; Gulati, Harmeet; Acharya, Binita; Poudyal, Bishesh S
ABSTRACT Hemophagocytic Lymphohistiocytosis (HLH) is characterized by an overwhelming activation of histiocytes and T lymphocytes leading to fulminant hemophagocytosis and organ damage. Anesthetic management of patients with HLH is associated with challenges such as pancytopenia, hemodynamic instability and infections. In addition to sepsis, metabolic acidosis, disseminated intravascular coagulation, multi-organ involvement with an exacerbation of symptoms with the use of anesthetic agents poses significant risk perioperatively. We present a case planned for excision of pilonidal sinus. The surgery was performed after thorough workup and with the patient in remission. Elective procedures should ideally be performed with patients in remission. Cases receiving concurrent therapy with immunomodulators and steroids require special attention due to possible interaction with anesthetic agents and the need for perioperative steroid supplementation. Keywords: Anesthetic management, hemophagocytic lymphohystiocytosis, pancytopenia, steroids
Comparison of Graft Uptake and Postoperative Hearing Results between Butterfly-Cartilage and Temporalis-Fascia Myringoplasty
(Institute of Medicine, 2020) Sah, Amiya K; Rayamajhi, Pabina; Bhattarai, Hari
ABSTRACT Introduction: Myringoplasty is one of the commonest surgeries done in Otology for chronic otitis media- mucosal type (COM-mucosal type). The objective of this study was to compare the graft uptake and post-operative hearing status between butterfly-cartilage and temporalis-fascia myringoplasty. Methods: Patients of age ≥15 years with COM-mucosal type with dry, small to medium sized central perforation of pars tensa with clearly visible perforation margin were randomized into two groups of butterfly-cartilage myringoplasty and temporalis-fascia myringoplasty. Graft uptake and hearing results were assessed after six weeks and results were compared within and between the groups. Results: Thirty-one patients in butterfly cartilage group and twenty-nine patients in temporalis fascia group were analysed. Graft uptake rate was 93.5% (29/31) in butterfly group and it was 86.2% (25/29) in temporalis fascia group with no statistically significant difference (p= 0.34) between the two groups. The mean pre and post-operative air bone gap in butterfly cartilage group were 20.65dB±8.35 dB; 12.86dB±7.39dB and that in the temporalis fascia group were 19.72±6.14dB, 13.16dB±6.26dB respectively. The difference of preoperative and postoperative hearing status, obtained within the two groups was statistically highly significant (p< 0.001). However, there was no statistically significant difference in hearing results between the two groups (p= 0.54). Conclusion: The graft uptake rate and hearing results of butterfly-cartilage group and temporalis-fascia group were statistically significant within the group after myringoplasty but there was no statistically significant difference in between the two methods. Keywords: Air bone gap, air conduction threshold, butterfly cartilage, myringoplasty
Effect of Preoperative Nebulized Ketamine on Incidence and Severity of Postoperative Sore Throat in Patient Undergoing General Anaesthesia with Endotracheal Intubation
(Institute of Medicine, 2020) Bhatta, Prajjwol D; Shakya, Bigen M; Bista, Navindra R; Marhatta, Moda N; Shrestha, Ninadini
ABSTRACT Introduction: Postoperative sore throat (POST) has a reported incidence of up to 62% following general anaesthesia. POST was rated by patients as the eighth most undesirable outcome in the postoperative period. The objective of this study was to compare the incidence and severity of postoperative sore throat after saline and ketamine nebulization in patients undergoing general anaesthesia with endotracheal intubation. Methods: The study was prospective double blinded randomized controlled trial . One hundred patients belonging to American Society of Anesthesiologists physical status I–II undergoing surgery under general anaesthesia with endotracheal intubation were randomized into two groups; group Saline (S) received nebulization with 5 ml of normal saline and group Ketamine (K) received nebulization with 1 ml of ketamine of concentration 50 mg/ml mixed with 4 ml saline. POST was assessed at zero hour, two hour, four hour, six hour, eight hour and 24 hour. Results: The overall incidence of POST was 28%. Twenty two (44%) patients in group S and six (12%) patients in group K had postoperative sore throat at some point of the study. The POST was significantly reduced in group K at zero hour 3(6%), two hour 3(6%), four hour 4(8%), six hour 5(10%) and eight hour 3(6%) with p value <0.05 . The severity of POST was also significantly decreased in group K at zero hour, two hour, four hour, six hour, eight hour with p value <0.05. Conclusion: Preoperative nebulization with ketamine reduces the incidence and severity of POST after general anaesthesia with endotracheal intubation. Keywords: Endotracheal intubation, ketamine nebulization, post-operative sore throat
Variation of Arteries Forming Circle of Willis in Adult Human Cadavers
(Institute of Medicine, 2020) Gautam, Jyoti; Adhikari, Bidur; Bhandari, Rosha; Shrestha, Anusuya; Ranji, Nirju
ABSTRACT Introduction: Circle of Willis is a large arterial anastomosis between internal carotid and vertebrobasilar arterial system. It is the principal collateral channel for constant blood flow to brain. Any changes in its morphology may cause vascular insufficiency of variable severity. Knowledge about its anomalies may elucidate occurrence of cerebrovascular disorders, its presentation, treatment, prognosis and prevention. Methods: An observational study on 107 fresh cadavers was conducted at Maharajgunj Medical Campus from September 2016 to August 2017. After dissection of the scalp and removal of the vault and dura mater, the brain was obtained. Then the Circle of Willis was identified and observed for its completeness, symmetry, presence, origin and number of arteries forming it and the obtained data were documented, photographed and analyzed. Results: Out of 107 cadavers, variations were noted among 15 (14%): out of which 10 were male and 5 female. Twelve cadavers had single variation while 3 had two variations. Accessory anterior cerebral artery was found in 7 (38.90%), fetal origin of right posterior communicating artery in 2 (11.10%), fetal origin of left posterior communicating artery in 4 (22.20%), early bifurcation of left posterior cerebral artery in 1 (5.60%), variant anterior communicating artery in 2 (11.10%), fused anterior cerebral artery in 1 (5.60%) and aneurysm in 1(5.60%) subjects were found. Conclusion: Variations were noted among 15 cadavers (14%), 12 cadavers had single variation while 3 had two variations. The most common variation seen was accessory anterior cerebral artery found in 7 cadavers (38.90%). Most of the variations were found in midline anteriorly followed by right side. Keywords: Aneurysm, cerebrovascular disorder, circle of Willis, stroke, variant
Fracture Nasal Bone: Causes, Presentation and Management in a Tertiary Care Center in Nepal
(Institute of Medicine, 2020) Mahaseth, Rajeev K; Gurung, Urmila; Thapa, Narmaya; Pradhan, Bibhu; Kharel, Bijaya
ABSTRACT Introduction: Fracture of nasal bone, the commonest facial fracture is frequently encountered in ENT practice. This study was conducted to assess the causes, presentation and management of fracture nasal bone in a tertiary care center. Methods: A retrospective chart review was done of patients admitted from August 2017 to July 2019 for management of isolated nasal bone fracture in the department of ENT and Head and Neck Surgery, Tribhuvan University Teaching Hospital. Results: Thirty-five patients (31 males and 4 females) of 13 to 86 years (mean age 26 years) underwent closed reduction of fracture nasal bone. The injury was sustained following physical assault in 13/35 (37%), fall from height in 10/35 (29%), road traffic accident in 8/35 (23%) and sports injury in 4/35 (11%). Pain, epistaxis, swelling over nasal dorsum, nasal deformity and wound were the presenting symptoms which most often occurred in combination. Close reduction was done under local anesthesia in 28/35 (80 %) and under general anesthesia in 7/35 (20%). The time between trauma and closed reduction ranged from 1 to 16 days with a mean of 6.2 days. Conclusion: Nasal bone fracture needing reduction was common following physical assault in males predominently of 21 to 30 years. A combination of pain, epistaxis and nasal deformity was the commonest presentation. Closed reduction of fracture under local anesthesia within 16 days of trauma was the usual practice. Keywords: Closed reduction, facial trauma, local anesthesia, nasal bone fracture
Experience of Hydatid Cyst Management in a Tertiary Care Center in Kathmandu Nepal
(Institute of Medicine, 2020) Joshi, Bijendra D; Koirala, Udaya; Joshi, Arbin; Dhital, Saroj P; Dhoubadhe, Prativa
ABSTRACT Introduction: Hydatid cyst is a common disease in Asian subcontinent produced by the larval stage of Echinococcus granulosus. The most common site of involvement is the liver. The mode of presentation can vary. The management of hydatid cyst includes medical treatment with albendazole, ultrasound guided aspiration and instillation of scolicidal agents as well as surgical treatment. Surgery can be perfomed by open or laparoscopic approach. The aim of this study is to analyze the cases of hydatid cyst of liver managed in our set up. Methods: This is a retrospective study of 45 patients with hydatid cyst managed in Kathmandu Model Hospital over the last five years. Data were collected from the patients hospital records. Demographic parameters, chief complains, radiological findings, anti echinococcal immunglobulin findings, mode of management,complications of surgery were evaluated. Results: Majority of our patients were female (66.7%). Mean age of the patients were 39±17.2 years (16 to 89 years).Most common symptom of presentation was pain in right upper quadrant of abdomen.Most common site of involvement was liver (93.33%)followed by spleen (4.4%). There was one case of ruptured pulmonary hydatid cyst which was referred.Operative management was done in patients (17.77%) out of which five patients (62.5%) underwent laparoscopic partial pericystectomy and omentoplasty.No major complications were encountered in any of the cases managed surgically. Conclusion: Majority of cases occured in liver. Most cases were managed conservatively. Laparoscopic management of hydatid cyst is effective. Keywords: Hydatid cyst, laparoscopic surgery, liver
Comparison of Outcomes of Open versus Laparoscopic Living Donor Nephrectomy in Nepal
(Institute of Medicine, 2020) Sigdel, Prem R; Gnyawali, Diwas; Rai, Bipendra D K; Dhital, Pawan; Parajuli, Purushottam; Chudal, Sampanna; Dhakal, Niraj; Pradhan, Manish; Poudyal, Sujeet; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Sharma, Uttam K; Gyawali, Prem R
ABSTRACT Introduction: Laparoscopic donor nephrectomy is the gold standard for kidney retrieval in live donors. Until recently, donor nephrectomies were performed only by open technique in Nepal. There is no information on the experience and outcomes of laparoscopic donor nephrectomy in Nepal. The study was done to compare the outcomes among donors undergoing open and laparoscopic nephrectomies, and to compare the graft related outcomes between the two groups receiving these kidneys. Methods: In this retrospective study, 44 kidney donors from March 2019 to October 2019 were analyzed. Donors were divided into 2 groups: open donor nephrectomy (ODN) and laparoscopic donor nephrectomy (LDN). Parameters for analysis included demographic data, warm ischemia time, surgery time and length of hospital stay. Data on early graft function and complications in recipients till 30th post-operative day were compared. Results: There were 22 donors each in the ODN and LDN groups. Baseline characteristics of the donors were comparable between two groups. Mean surgery duration (183.55±43.31 minutes vs 117.73±18.75 minutes) and first warm ischemia time (11.22±4.34 minutes vs 2.3±0.8 minutes) was significantly high in LDN. Hemoglobin drop, post-operative complications in donors, creatinine of donors at discharge, mean hospital stay, graft function at one month and complications in recipients were comparable among ODN and LDN. Pain score in 1st post-operative day was comparable between two groups, however, pain was significantly less in second post-operative day in LDN. Conclusion: Laparoscopic donor nephrectomy is feasible in Nepal and associated with acceptable morbidity and graft function when compared to ODN. Keywords: Laparoscopic donor nephrectomy, open donor nephrectomy, renal transplantation
Diagnostic Evaluation of Patients Presenting with Rectal Bleeding by Colonoscopy
(Institute of Medicine, 2020) Malla, Bala R; Simkhada, Suyog
ABSTRACT Introduction: Rectal bleeding indicates the bleeding from lower gastro-intestinal tract occurring distal to ligaments of Treitz. Annual incidence of per rectal bleeding has been estimated to be 20% . Colonoscopy is the examination of choice for investigation. The objective of this study is to know the diagnostic yield of colonoscopy in cases with per rectal bleeding and to know the common causes of per rectal bleeding in adults Methods: One hundred and twenty-nine adult patients, age more than 18years, who presented to Surgical OPD and ward of Dhulikhel Hospital during the year 2018 and 2019 were taken for the study irrespective of their sex. All the patients were subjected to fibre-optic colonoscopy after necessary preparation and the findings were recorded. Diagnosis was based on colonoscopic and histopathologic findings. Results: A total of 129 (77 male and 52 female )patients with per rectal bleeding were evaluated with colonoscopy. The age ranged from 18 years to 79 years with the mean age 42.25 (SD+/- 15.29). Colonoscopy showed abnormalities in 102 patients (79.06%). The most common finding was hemorrhoids in 36 patients (27.90%) followed by colorectal malignant mass in 20 patients (15.50%). Polyps were diagnosed as the cause of rectal bleeding in 14 patients (10.84%). Conclusion: Colonoscopy has good diagnostic yield at evaluating cases with per rectal bleeding. Hemorrhoids, colorectal malignant mass and polyps are the common causes producing PR bleeding in Nepalese adult population . Keywords: Colonoscopy, hemorrhoids, per rectal bleeding,
Pediatric Ventriculoperitoneal Shunt: Outcome Analysis in a Tertiary Care Center in Nepal
(Institute of Medicine, 2020) Phuyal, Suman; Rajbhandari, Binod; Pradhanang, Amit B; Sedain, Gopal; Shilpakar, Sushil K; Sharma, Mohan R
ABSTRACT Introduction: Ventriculoperitoneal (VP) shunt is a commonly performed neurosurgical procedure in pediatric surgical practice. It results in a dramatic improvement in patient survival and neurological function but is associated with several complications requiring multiple shunt revisions throughout a patient’s lifetime. The main aim of the study was to evaluate the outcome especially complications of shunt surgery at our center. Methods: A single-institutional, retrospective observational study was conducted in 60 operated cases of congenital hydrocephalus with a minimum follow-up for up to 6 months. Parameters for analysis included demographic data, etiology of hydrocephalus, surgery time, and type of complications. Results: Out of 86 patients, 60 patients who fulfilled the inclusion criteria were enrolled in the study. The mean age of the patients at the time of VP shunt placement was 3 months, range from 8 days to 15 years with male preponderance. The majority of the patients belonged to the 0-1-year age group (76.8%). The commonest etiology of hydrocephalus was congenital aqueduct stenosis. Fifteen patients (25%) developed complications within six months follow-up period. Eight patients (13.3%) developed clinical shunt infection with four cases having culture positive. Four (6.67%) had mechanical complications in the form of shunt obstruction. Three patients had ascites, subdural collection, and shunt extrusion from the anus. The shunt related mortality was 1.67%. Conclusion: The shunt infection and obstruction still remain the most important complications. Despite inherent problems, shunt surgery is the procedure of choice until a safer effective alternative is available. Keywords: Complications congenital hydrocephalus, ventriculoperitoneal shunt
Outcomes of Children Presenting with Button Battery in Esophagus: A Retrospective Review
(Institute of Medicine, 2020) Gyawali, Bigyan R; Guragain, Rajendra P Sharma; Neupane, Yogesh; Dutta, Heempali; Shrestha, Lava; Pradhananga, Rabindra B
ABSTRACT Introduction: Foreign body in esophagus is a common ENT emergency. Button batteries tend to have more grievous outcomes due to caustic mucosal injury to the esophagus. The objective of our study was to review the clinical profile and outcomes of the paediatric population in our center who presented with button battery in esophagus following accidental ingestion. Methods: This was a retrospective study conducted in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Hospital records of all the patients who presented with button battery esophagus and underwent rigid oesophagoscopic removal from January 2013 to January 2019 were reviewed and analyzed for patient demographics, time interval between ingestion and presentation, site of impaction, status of oesophageal mucosa at the time of rigid oesophagoscopic removal of the battery, early post-operative complications, outcomes at the time of discharge and on follow-up. Results: Our final sample size was 11 and all cases were <15 years. The average duration from time of ingestion to presentation to our hospital ranged from 1 day to 2 months. Variable oesophageal mucosal findings such as superficial mucosal erosion, superficial ulcer with slough and granulations with deep discrete ulcer were seen at the site of impaction of the button battery. One case was diagnosed with bilateral abductor palsy on 10th post-operative day following rigid oesophagoscopic removal of the battery. All other cases didn’t develop any significant complications. Conclusion: Button battery in esophagus results in oesophageal ulceration and thus warrants an early endoscopic removal. Delayed removal can also cause bilateral abductor palsy from the caustic damage to recurrent laryngeal nerve. Keywords: Alkaline button battery, esophagus, rigid oesophagoscopy
Frequency of ABO Blood Group and its Association with Acute Coronary Syndrome in Patients Presenting in a Tertiary Care Center of Nepal
(Institute of Medicine, 2020) Pathak, Surya R; Jha, Sunil C; Gajurel, Ratna M; Poudel, Chandra M; Shrestha, Hemant; Thapa, Sanjeev; Sahi, Ravi; Thapa, Shovit; Koirala, Paras
ABSTRACT Introduction: Coronary artery disease is the major cause of death all over the world. There are studies suggesting association between blood group and coronary artery disease. We attempted to study the frequency of ABO blood group and its association with acute coronary syndrome (ACS) in our hospital. Methods: This is a retrospective, cross sectional study carried out in Manmohan Cardiothoracic Vascular and Transplant Centre from March 2018 to February 2019. Patients who were admitted with diagnosis of ACS were enrolled in the study. Data were recorded and analyzed using SPSS 20. Association between blood group and ACS was analyzed using chi square test and logistic regression. Results: Total 430 patients were admitted with diagnosis of ACS during the study period, of which 307 (71.4 %) were male and Mean age was 61.22 years (±10.75). Blood group O was the most common type of blood group observed in 207 (48%) patients. ACS was significantly higher in blood group O compared to other groups after adjusting for normal ABO blood group prevalence in general population: blood group O vs. A (OR: 3.45, 95% CI: 2.48- 4.79, p- <0.001), blood group O vs. B (OR: 5.08, 95% CI: 3.53-7.33, p- <0.001), blood group AB vs. O (OR: 0.65, 95% CI: 0.41- 1.02, p- 0.064). Individuals with blood group O and B had increased risk of having STEMI and NSTEMI where as those with blood group A had increased risk of having unstable angina. Conclusion: There was association between ABO blood group and coronary artery disease. Individuals with blood group O have increased incidence of ACS. Keywords: ABO blood group, acute coronary syndrome, coronary artery disease
Profile and Outcome of Adult Spine Pathologies Managed in a Neurosurgical Tertiary Care Center in Nepal
(Institute of Medicine, 2020) Sah, Hemant K; Shrestha, Dipendra K; Rajbhandari, Binod; Sedain, Gopal; Pradhanang, Amit B; Shilpakar, Sushil K; Sharma, Mohan R
ABSTRACT Introduction: Spine pathology involves a wide spectrum of diseases and needs a multidisciplinary approach including surgery, rehabilitation and psychological support. It increases the burden to the family and society. This study describes diseases related to spine and spinal cord from a neurosurgical department of a tertiary hospital in Nepal. Methods: This is a retrospective study of all spinal cases admitted between April 2019 to February 2019, in the Department of Neurosurgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. All adult patients of ≥16 years, diagnosed with various spinal diseases were included. Based on the spectrum of causative pathologies, the study population was broadly categorized into trauma, degenerative, tumor, vascular and infection. Demographics, other variables, and outcome at 1 month were assessed. Results: A total of 71 patients were included in this study. Male preponderance was observed in all categories. Twenty three patients (32.4%) had traumatic spine injury and fall from height was the most common mode of injury, accounting for two-third of the total spinal trauma patients. Cervical segment was involved in two-third patients. More than one-third of the spinal patients (36.6%) had a degenerative disorder involving lumbar (57.7%) and cervical regions (42.3%). Spinal infection was diagnosed in 11.2% of the patients with 62.5% diagnosed as Pott’s spine. Overall complications were seen in 20%. Pain improved in all patients while overall good outcome was noted in 63.2% of the patients. Conclusion: Our study demonstrated a large patient burden and a clinical profile dominated by preventable causes such as RTA and fall injury. With early treatment and rehabilitation, significant improvement can be achieved. Further large scale multicenter studies are required to generalize the findings of this study to the whole population of Nepal. Keywords: Burden, Nepal, spine trauma, spine pathology
Japan: What to Do with Dead Bodies? A Burning Issue
(Institute of Medicine, 2020) Crump, Andy
ABSTRACT Death, the passing of a loved one, friend, colleague or just someone we may have known, is virtually always sad and often traumatic. However, it is a part of life and has to be coped with. Each year around 60 million people worldwide die from a wide and diverse number of causes. The problem of what to do with all those dead bodies is becoming a major conundrum for the families involved as well as for policy makers and governments. Natural and anthropogenic disasters, together with increasing incidence of major pandemics of infectious diseases is making finding a solution ever more difficult. A problem which is made worse by ever-increasing draconian rules about what can and cannot be done when disposing of a body.Currently, there are two basic choices, either bury the body in the ground where such action is permitted or cremate it and dispose of the ashes in a culturally and legally acceptable fashion. Generally, both options are becoming prohibitively expensive. The cost of land and the burgeoning demand for land to be used for industry, agriculture, urbanised centres or leisure activities is making burial no longer an option for most people. Japan has long led the world in incineration technology and it has also led the world for many years in cremating its dead. Virtually all Japanese are now cremated, the funeral process involving a mixture of high technology and unique routines steeped in history. Despite widespread concerns that cremation can cause environmental pollution and may damage public health as a result, it is still deemed less polluting than burial. It is likely that countries around the globe will increasingly adopt a policy of cremating their deceased citizens and would do well to follow the lead in this respect being shown by Japan. Keywords: Cremation, dead bodies, incineration, Japan
Lancet Commission on Global Surgery - A Public Health Initiative
(Institute of Medicine, 2020) Kurlberg, Göran
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Initial Experience with Simple Oncoplastic Breast Conserving Surgery in Nepal: A Case Report
(Institute of Medicine, 2020) Singh, Yogendra P; Khanal, Suman
ABSTRACT Oncoplastic breast conserving surgery is increasingly used in the management of early breast cancer. Though its use in Nepal is increasing, it is still under-utilized. We present a case of upper outer quadrant early breast cancer located away from nipple-areola complex managed with radial ellipse segmentectomy 10 years back and under regular follow up. We recommend its usage in upper outer quadrant lesions because of its simplicity, access for sentinel lymph node biopsy and good cosmetic outcome. Keywords: Early breast cancer, lumpectomy, simple oncoplastic surgery
Giant Ocular Surface Squamous Neoplasia Wrapping Almost the Whole Cornea: A Case Report
(Institute of Medicine, 2020) Shrestha, Poonam; Pandey, Mukesh
ABSTRACT Ocular surface squamous neoplasia (OSSN) includes the dysplastic lesions involving the epithelium of conjunctiva and cornea with various clinical pictures. Histopathological examination of the excised tissue is the benchmark for diagnosis. Surgery, chemotherapy, immunotherapy are the various treatment modalities which in combination shows promising result. We present here a case of 83 years old female patient with history of fleshy mass covering the cornea and the patient was diagnosed clinically as ocular surface squamous neoplasia. Patient underwent surgical excision of the mass followed by cryotherapy. Histopathological examination revealed conjunctival intraepithelial neoplasia of grade 3. Six months after treatment the patient is completely tumor free with no recurrence. Keywords: Conjunctival intraepithelial neoplasia, ocular surface squamous neoplasia
Leigh Syndrome in an Adolescent Girl: A Case Report
(Institute of Medicine, 2020) Shrestha, Merina; Bajracharya, Luna; Basnet, Sudha
ABSTRACT Leigh syndrome (LS) is a disorder of infancy and rarely late childhood. It presents with regression of mental and motor skills. Here, we present LS in an adolescent girl who presented with generalized dystonia and cognitive decline. Her infective, metabolic, endocrinal and autoimmune work up was normal. The neuroimaging showed progressive symmetric involvement of basal ganglia with focal intensity over bilateral lentiform nucleus and thalamic region. The cerebrospinal fluid (CSF) lactate level was elevated. Genetic test could not be performed; however the history of neuro-regression with extrapyramidal involvement with CSF and neuroimaging finding led to the diagnosis of Leigh’s syndrome. Keywords: neuro-metabolic, regression, MRI

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