Journal Issue: Volume: 20, No 3, Issue 83, JULY-SEPTEMBER, 2023
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Volume
Number
Issue Date
2023
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Simple Oncoplastic Breast Conserving Surgery for Breast Cancer in a University Hospital
(Kathmandu University, 2023) Khanal, S; Singh, N; Singh, YP
ABSTRACT
Background
The principle of oncoplastic surgery is the removal of tumors with negative margins
as well as maintaining the contour of the breast. The goals are to achieve local control
and best cosmesis.
Objective
The objective of this study was to assess patients’ satisfaction with different
techniques of simple oncoplastic breast conserving surgery (BCS) for early breast
cancer.
Method
This was a retrospective study of early breast cancer cases operated during the period
2009 to 2017. All the patients were under regular follow up for at least five years
after surgery. Original Harvard/NSABP/RTOG scale was used to evaluate cosmesis at
one year after surgery.
Result
Median age of the patients was 43 years with median size of tumor being 2.5 cm.
All of the patients had good to excellent cosmetic outcome. One patient (4.5%) had
margin positivity. All patients were disease free and happy with the cosmesis at five
years although one patient did not have whole breast radiotherapy.
Conclusion
Simple oncoplastic breast conserving surgery techniques in upper part of breast are
simple, feasible and improve cosmetic outcome with low margin positivity and good
disease-free five-year survival.
KEY WORDS
Breast cancer, Breast conserving surgery, Mammaplasty
Does Choice of Different Surgical Intervention Play a Role in the Recurrence of Pterygium?
(Kathmandu University, 2023) Yadav, R; Das, SS; Gupta, S; Agrawal, N
ABSTRACT
Background
There are a wide range of pterygium excision techniques in practice. However,
choosing the best possible option is an important factor to prevent its recurrence.
Objective
To compare the recurrence rate of different excision techniques and understand if a
surgeon can alter the recurrence rate.
Method
A retrospective data of pterygium surgeries operated by a surgeon at Sagarmatha
Choudhary Eye Hospital, Nepal from the year 2016 to 2018 was investigated for
recurrence. The recurrence was measured by an independent Optometrist with
the help of clinical photo and slit-lamp examination. A telephonic directory was
maintained for every patient’s follow up reminder.
Result
Altogether 916 individuals with mean age 56.20 years had undergone pterygium
excision. Bare Sclera 280 (30.56%), Pterygium Extended Conjunctival Transplantation
(PERFECT) 305 (33.29%), Conjunctival auto graft (CAG) 262 (28.60%), Simple
Pterygium excision 60 (6.55%) and Amniotic Membrane Graft (AMG) 9 (0.98%),
jointly formed the total study sample and surgical techniques. Recurrence for Bare
sclera was 172 (61.42%), simple pterygium excision 34 (56.66%), Pterygium extended
conjunctival transplantation 0 (0%), and conjunctival auto graft 2 (0.76%). Compared
conjunctival auto graft with pterygium extended conjunctival transplantation and
simple pterygium with bare sclera revealed similar recurrence rate comparatively.
The p-value obtained were p = 0.2148 and p = 0.8152 (p > 0.05, 95% CI) respectively.
Conclusion
The loss of limbal stem cells in Bare sclera technique acts as stimulant for pterygium
recurrence, in addition the remains of pterygial matter in simple pterygium excision
acts as precursor for recurrence. Pterygium extended conjunctival transplantation
indeed acts as barrier but needs fine surgical skills to perform. Conjunctival auto
graft can be opted as an alternative technique for minimal recurrence as compared
to Pterygium extended conjunctival transplantation.
KEY WORDS
Bare sclera, Conjunctival auto graft, Pterygium surgery, Recurrence
Ultrasound Guided Estimation of Skin to Subarachnoid Space Depth in Patients Scheduled for Elective Surgeries under Subarachnoid Block
(Kathmandu University, 2023) Devkota, S; Baral, BK; Poudel, PR
ABSTRACT
Background
Subarachnoid block is one of the commonly used techniques of regional anesthesia
and accurate placement of spinal needle is crucial. A conventional spinal needle
may be too long for a lean patient or too short in obese patients leading to multiple
attempts, inadvertent nerve injuries and patient discomfort. So a pre-procedural
estimation of the skin to subarachnoid space depth may be beneficial.
Objective
To estimate the skin to subarachnoid space depth using ultrasound and correlate it
with the length of spinal needle to be inserted during subarachnoid block.
Method
This was a prospective, observational study conducted at Bir Hospital, Kathmandu in
patients undergoing elective surgeries under subarachnoid block. A pre-procedural
ultrasound of lumbo-sacral spine using 2-5 Hz curvilinear probe was done to measure
skin to subarachnoid space depth (SSD) at the level of L3-L4 interspace. Then under
all aseptic precautions, subarachnoid block was performed and the length of spinal
needle outside the skin was measured and that length was subtracted from the
standard length of needle to get the inserted length of spinal needle. These two
measurements were compared.
Result
In the fifty patients included in the study, ultrasound estimated skin to subarachnoid
space depth was found to be 4.24 ± 0.48 cm and the inserted length of spinal needle
was 4.24 ± 0.46 cm. A significant correlation r=0.96 (p < 0.05) was found between the
two measurements in the study population.
Conclusion
Ultrasound estimated skin to subarachnoid depth in the study population was found
to be 4.24 ± 0.48 cm which correlated with the inserted length of spinal needle. So,
use of ultrasound can be very helpful in performing subarachnoid block.
KEY WORDS
Skin to subarachnoid space depth, Spinal needle, Subarachnoid block, Ultrasound
Outcomes of Microvascular Free Flap Reconstruction after Major Head and Neck Ablative Surgery at a Tertiary Teaching Hospital in Eastern Nepal
(Kathmandu University, 2023) Sah, BP; Paudel, D; Sarraf, DP
ABSTRACT
Background
Reconstruction with free flaps has significantly changed the outcome of patients with
head and neck cancer. Microsurgery is still considered a specialized procedure and
is not routinely performed in the resource-constrained environment of developing
country like Nepal.
Objective
To evaluate the clinical outcomes in patients who underwent different microvascular
free flap reconstructions of head and neck defects after major ablative surgery.
Method
A retrospective study was conducted to review and analyze the data of patients with
head and neck cancer who underwent microvascular free flap reconstruction after
major ablative surgery from November 2017 to April 2021. The descriptive statistics
were calculated using Microsoft Excel 2010.
Result
Out of 207 patients, 129 (62.32%) were males. Mean age was of 55.17±13.44 years.
About 133 (64.25%) tumors were on gingivobuccal complex. Anterolateral thigh flap
was the most common flap 112, (54.11%) used for the reconstruction. Facial artery
was used in 174 (84.06%) patients for anastomosis. The overall success rate was
97.5%. Re-exploration was done in 22 (10.63%) cases out of which 11 (50%) cases
were having flap compromise. Delayed flap failure occurred in 5 cases (2.5%) and
salvage surgery was done with pectoralis major myocutanuos flap with a salvage rate
of 54%. Minor complications were observed in 39 cases (18.84%) out of which donor
site graft loss was observed in 19 (9.18%) patients.
Conclusion
In spite of advanced set up, with trained dedicated manpower the microvascular free
flap reconstruction of head and neck defects is safe with high success rate even in
resource constrained country like Nepal.
KEY WORDS
Free flap, Head and neck cancer, Microsurgery, Reconstruction