Journal Issue: Volume: 41, No. 1 (2019) April
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Volume
Number
Issue Date
2019
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Comparison of Percutaneous Dilatational Tracheostomy with Open Tracheostomy in Intensive Care Unit
(Institute of Medicine, 2019) Shrestha, Pramesh S; Marhatta, Moda N; Acharya, Subhash P; Shrestha, Ninadini
ABSTRACT
Introduction
Tracheostomy is one of the frequent surgical procedure carried out in intensive care unit. Percutaneous tracheostomy is becoming increasingly popular compared to conventional open surgical tracheostomy in ICU.
Methods
A prospective randomized trial with twenty patients in each group was conducted to compare the outcomes of percutaneous and surgical tracheostomy. Percutaneous tracheostomy was performed using Ciaglia Blue Rhino technique and surgical tracheostomy was performed using established technique. The outcomes were compared in relation to randomization to tracheostomy, completion of procedure, intra operative and post-operative complications, hospital length of stay and cost.
Results
There were no major complications in either group. Most variables studied were not statistically significant. The two groups did not differ in terms of basic demographics or APACHE II score. The only variables to reach statistical significance were time duration from tracheostomy randomization to start of procedure and time taken for completion of procedure. It was mean 31.85±15.35 hours in Percutaneous Tracheostomy group and in Surgical Tracheostomy group it was mean 49.10±23.61 hours respectively (p<0.009). Time taken to perform percutaneous tracheostomy was mean 15.50±3.22 minutes and for surgical tracheostomy it was mean 20.30±3.38 minutes. (p<0.001).
Conclusion
Percutaneous dilatational tracheostomy is simple, faster to perform and can be done at bedside to avoid considerable delay in the performance of open tracheostomy where there is high demand for elective and emergency procedures in operating room.
Keywords: Complications, intensive care unit, percutaneous tracheostomy, surgical tracheostomy
Early Laparotomy: A Necessity for Postoperative Intraperitoneal Hemorrhage
(Institute of Medicine, 2019) Rawal, Suniti; Paudyal, Pooja
ABSTRACT
Introduction
Haemorrhage is considered the dreaded complications following any surgery. “Relaparotomy” is a better described terminology for a repeat case postoperative haemorrhage in gynecological surgeries. With increased awareness and early detection and subsequent rise in gynaecological operations have led additional incidence of relaparotomies and further in morbidity and mortality.
Methods
The study was conducted from April 2006 - March 2017 including cases of re/laparotomy for intraperitoneal bleeding at TUTH, Nepal.
Results
There were 27 cases of intraperitoneal hemorrhage majorly from 20 abdominal surgeries comprising 12(44.4%) abdominal hysterectomies, 6 (22.2%) laparotomy, 1(3.7%) each of diagnostic laparoscopy and abdomino perineal approach and 7(26%) vaginal hysterectomies. Features of hypovolaemic shock in 14(51.8%), marked abdominal distention in 9(33.3%) and blood loss of 400 to 3000 ml was observed.Five (18.5%) cases of active bleeding from pedicales were secured. Oozing from various sites (10, 37%) cured with haemostatic sutures. Generalised oozing post diagonistic laproroscopy, subtotal hysterectomy was done (1, 3.7%). In 2 (7.4%) cases bleeding from fallopian tube and mesosapinx were sutured. Six (22.2%) hematomas were evacuated and bleeders secured. Dissection of left uterosacrial ligament and tearing of infundibulopelvic ligaments (1, 3.7%) were reinforced and sutured. Sputter in the vault (1, 3.7%) were ligated and isolated rise in PT (1, 3.7%) with FFP transfusion.Two succumbed to death, one following diagnostic laparoscopy from adult respiratory distress syndrome and next from VH with PFR anesthetic complications.
Conclusion
Proper closure of surgical incision with the right technique, appropriate ligature, careful tying of the blood vessel, monitoring pulse rate and blood pressure in postoperative cases can minimize the morbidity and mortality.
Keywords: Hemoperitoneum, intraperitoneal bleeding, relaparotomy
Prevalence of Chronic Cor Pulmonale in Chronic Obstructive Pulmonary Disease Patients in a Teaching Hospital in Nepal
(Institute of Medicine, 2019) Sayami, Matina; Baral, Suman; Shrestha, Rakshya; Karki, Dambar B
ABSTRACT
Introduction
Chronic obstructive pulmonary disease (COPD) is the most common cause of cor pulmonale. Cor pulmonale in COPD is associated with decreased survival, increased hospitalization and mortality. In this study we aim to find out the prevalence of chronic cor pulmonale in COPD patients which would help in prevention of right sided heart failure and improve patients’ quality of life.
Methods
This was a cross sectional observational study done in Kathmandu Medical College Teaching Hospital, Nepal. 50 COPD patients above the age of 30 years attending the outpatient department or admitted in wards were included. All COPD patients diagnosed by pulmonary function test (PFT) were assessed for cor pulmonale by echocardiography (ECHO). The demographic data, chest X-ray, PFT, electrocardiography (ECG) and ECHO findings were recorded, entered and analyzed using SPSS software, version 17.
Results
Most of the patients enrolled in the study were between age group of 51-60 with female preponderance. 68% of the COPD patients had chronic cor pulmonale. Out of 21 male, 76.2% and out of 29 female COPD patients, 62.06% had cor pulmonale. Cor pulmonale was present in 53.12% and 94.4% of patients who had COPD for < 10 years and ≥10 years duration respectively. Cor pulmonale was present in 76% patients with severe COPD, 75% of patients with moderate COPD, 64.2% patients with very severe COPD and none of the patients with mild COPD. Pulmonary hypertension (PH) was present in 67.64% of cor pulmonale patients.
Conclusion
The prevalence of chronic cor pulmonale in COPD patients was 68%. It was more in male patients, highest in patients with severe COPD, and the prevalence increased with duration of COPD. PH was present in 67.64% of cor pulmonale patients.
Keywords: Chronic obstructive pulmonary disease, chronic cor pulmonale
Measurement of Subcarinal Angle: A Cadaveric study
(Institute of Medicine, 2019) Shrestha, Anusuya; Ranjit, Nirju; Bhandari, Rosha; Adhikari, Bidur; Gautam, Jyoti
ABSTRACT
Introduction
The bifurcation of trachea into two primary bronchi at the level of fourth thoracic vertebra creates an angle at the bifurcation. This angle can be seen clearly in routine chest X-rays where the measurement can throw light on many medical conditions within the mediastinum. This study aimed at finding the subcarinal angle, which is the angle formed by inferior borders of two primary bronchi.
Methods
The measurements were taken from photographs of tracheal specimen of 92 cadavers, 63 male and 29 female. Angle was measured by photographic software and analysis of subcarinal angle was done in the study population.
Results
The mean subcarinal angle was found to be 41.090 with standard deviation of 17.140. This measurement was found to be significantly more in males (68.02± 15.720) than in females (60.14 ± 17.710).
Conclusion
The subcarinal angles in the study population were seen to be different among sexes. Also, the mean subcarinal angles from other studies, radiological or on specimen were close to the observations made in this study.
Keywords: Bronchus, subcarinal angle, trachea
Clinical and Etiological Profile of Patients with Optic Disc Edema in Tertiary Care Centre of Nepal
(Institute of Medicine, 2019) Shah, Ritesh K
ABSTRACT
Introduction
sible in most cases using tests like visual acuity, color vision, visual field and suitable radiological imaging. Study in Nepalese population with regard to optic disc edema is scarce. Hence this study aims to act as a guideline for evaluation of such cases and help in further studies in this regard.
Methods
A descriptive, cross-sectional study was conducted in all cases of optic disc edema presenting to neuro-ophthalmology clinic of B.P. Koirala Lions Centre for Ophthalmic Studies from January 2011 to June 2012. A detailed history was obtained and proper ocular and nervous examination was done by ophthalmologist and neuro-physician. Assessment of visual acuity, color vision, contrast sensitivity and visual field along with radiological tests were done in all possible cases.
Results
Out of all the cases evaluated, 38 cases where causes of optic disc edema could be established were included in the study. The commonly affected age group was 31 to 40 years (26.3%) and most of them were males. The commonest cause observed was optic neuritis (36.8%). Others were papilledema, idiopathic intracranial hypertension, toxic optic neuropathy, non-arteritic anterior ischemic optic neuropathy (NA-AION), compressive and traumatic optic neuropathy.
Conclusion
Optic neuritis and papilledema should be considered as common differential diagnosis in patients with optic disc edema. NA-AION is a relatively uncommon disease among Nepalese population.
Keywords : NA-AION, optic disc edema, optic neuritis, papilledema