Journal of Lumbini Medical College (JLMC)
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Significance of Computed Tomography in the Diagnosis of Cerebrovascular Accidents
Get PDFIntroduction: Cerebrovascular Accident (CVA) is defined as abrupt onset of a neurological deficit that is attributable to a focal vascular cause. CT scan is a widely available, affordable, non-invasive and relatively accurate investigation in patients with stroke and is important to identify stroke pathology and exclude mimics. Aim of this study is to establish the diagnostic significance of computed tomography in cerebrovascular accident and to differentiate between cerebral infarction and cerebral haemorrhage with CT for better management of CVA.
Methods: A one year observational cross sectional study was conducted in 100 patients that presented at the department of radiodiagnosis from emergency or ward within the one year of study period with the clinical diagnosis of stroke, and had a brain CT scan done within one to fourteen days of onset.
Results: A total of 100 patients were studied. 66 were male and 34 were female with a male/female ratio of 1.9:1. Maximum number of cases (39%) was in the age group of 61-80 yrs. Among 100 patients, 55 cases were clinically diagnosed as hemorrhagic stroke and 45 cases were clinically diagnosed with an infarct. Out of the 55 hemorrhagic cases, two cases were diagnosed as both hemorrhage and infarct by CT scan, one case had normal CT scan findings and one had subdural haemorrhage. These four cases were excluded while comparing the clinical diagnosis with CT scan finding. Among 51 clinically diagnosed cases of hemorrhagic stroke, 32(62.7%) cases were proved by CT scan as hemorrhagic stroke and among clinically diagnosed cases of infarct, 39(86.7%) cases were proved by CT scan as infarct which is statistically significant (p <0.001). A significant agreement between clinical and CT diagnosis was observed as indicated by kappa value of 0.49. Sensitivity, specificity, positive predictive value and negative predictive value of clinical findings as compared to CT in diagnosing hemorrhage were 84.2%, 67.2%, 62.8% and 86.7% respectively. The accuracy of clinical diagnosis is 74%.
Conclusion: This study showed that CT scan is a useful diagnostic modality to identify stroke pathology and to exclude mimics
Tracheal Resection and Anastomosis for Postintubation Tracheal Stenosis: A Case Report
Get PDFIntroduction: Tracheal stenosis is one of the dreaded complication of tracheal intubation. Tracheal resection and anastomosis is an established definitive treatment for stenosis more than one cm. Here, we present a case of postintubation tracheal stenosis managed by resection and anastomosis, first of its kind in our centre.
Case Report: We present a case of 26-year female who underwent tracheal intubation during her treatment of tubercular meningitis. Two weeks later, she returned with respiratory difficulty. A diagnosis of post-intubation tracheal stenosis was made. Tracheal resection and anastomosis was done. Recovery was uneventful and she was discharged on 14th post-operative day.
Conclusion: Post-intubation tracheal stenosis is still a dreaded complication even after the introduction of high volume low pressure cuff. They can be successfully managed. Care personnel in intensive care unit (ICU) should perform to prevent this complication
Smoking and Depression among Healthcare Workers
Get PDFIntroduction: Healthcare workers are a special public icon for the community because people would like to adopt and implement their knowledge, skill, attitude and behaviour for improving quality of health. People respect them for their knowledge and health behavior. It is believed that the level of health status of health workers as well as community should go ahead parallel but many researchers have noted that high risk behaviours (smoking, tobacco use, alcoholism, irregular diet intake, lack of exercise etc.) are prevalent among health workers. The result of this will be physical, psychological, familial and social disturbance, which might have an impact on health care delivery system of the country. The study was concerned to assess health status (body mass index, smoking and depression) of healthcare workers and its impact on social adjustment in Banke district of Nepal.
Methods: A cross sectional study design was applied to conduct the research. One hundred and eight respondents were selected through random sampling from the purposive group. Data wa collected through interview by using interview schedule. SPSS-16 windows process was used to analyze data.
Results: Most of the respondent (81.40%) were under the age group less than 30 years (M = 27.35, SD = 9.24 years). More than 57.40% of respondents were female. Most of them (68.50%) were unmarried. Maximum (82.20%) responders had normal Body Mass Index (18.5-24.99). Near about forty percent (38.9%) healthcare worker had faced social problems in their working area.
Conclusion: Age (above 20 years) and male healthcare workers were more likely to smoke cigarettes. Depressed health workers were more likely to smoke cigarette. Depression could be observed as a determinant for social adjustment
Solitary Osteochondroma Arising from the Dorsal Vertebral Spinous Process: a case report
Get PDFIntroduction: Osteochondroma are benign tumors which arise from aberrant cartilage nodules within the periosteum. They can be either pedunculated or sessile and are more common in the extremities and rarely seen in spine. En-bloc excision is the preferred treatment.
Case Report: We present a case of 20 year female, who came with a swelling and pain in lower back for two years which was diagnosed to be thoracic vertebra(D11) osteochondroma on x-ray and computed tomography. Excision biopsy was done and confirmed it to be osteochondroma. There has been no recurrence even after 16 months of follow up.
Conclusion: Although rare, osteochondroma of the vertebra should be kept in mind as a differential diagnosis when evaluating mass in spine. En bloc excision should be performed
Upper Gastrointestinal Endoscopy in Lumbini Medical College and Teaching Hospital: A retrospective study of two years
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Introduction: Upper gastrointestinal (UGI) endoscopy includes visualization of the oropharynx, esophagus, stomach, and proximal duodenum, with real time assessment and interpretation of the findings encountered. An upper endoscopy is indicated in the diagnostic evaluation of signs and symptoms of a wide variety of gastrointestinal disorders. Besides there are some therapeutic implication of the endoscopy. This study was conducted to study the spectrum of diseases found during the upper gastrointestinal endoscopy in patient presenting in Lumbini Medical College and Teaching Hospital (LMCTH).
Methods: This was a retrospective observational study carried out in LMCTH. The endoscopic record book of the patients who underwent UGI endoscopy for various reasons from February 2011 to 2013 was analysed. The risk factor of smoking and alcohol was also included and analysed in the study.
Results: All together 550 upper GI endoscopy was performed in the two years. There were 290 males (52.72%) and females were 260 (47.38%). The mean age was 45.7 years (SD=17.9). Most of the patient belonged to the age group 41 to 80 years (71%). Among total patients, 209 (38%) of them were found to be macroscopically normal. Of those who had positive endoscopic findings; 165 (48.4%) had gastritis and 36 (10.6%) had duodenal ulcer, esophageal varices was in 30 (8.8%), gastric carcinoma in nine (2.6%) of cases. Cigarette smoking was significantly associated with the presence of peptic ulcer disease (p=0.01) and malignancy of gastrointestinal tract (p=0.03). Alcohol intake was non-significantly related to peptic ulceration (p=0.07) and malignancy of gastrointestinal tract (p=0.09).
Conclusion: Upper gastrointestinal endoscopy is a safe and useful procedure for investigating patients with gastrointestinal complains. Gastritis was the most common finding among the patients who had abnormal endoscopy followed by duodenal ulcer and esophageal varices
Initial Experience of Percutaneous Nephrolithotomy at Lumbini Medical College
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Introduction: Renal stone disease is a challenging problem in urologic practice especially in our locality because of large stone burden and recurrence. Since ,the early 1980s when percutaneous nephrolithotomy (PCNL) was established for management of renal stones, open surgical procedures have virtually been replaced. PCNL is a safe, effective and minimally invasive approach compared to open surgery for patients with large single, multiple or staghorn stones. The aim of this prospective study was to evaluate and to review our experience with PCNL in management of renal and upper ureteric stones.
Methods: Prospective study carried out at Lumbini Medical College and Teaching Hospital during 1stJanuary 2011 to 31st October 2011. Sixty patients were evaluated and subjected to PCNL. After clinical investigations like ultrasonography (USG) and intravenous urography (IVU), once patients were found to have renal or upper ureteric stones they were informed and explained about PCNL, its likely complications, probable hospital stay, the cost of treatment and data were recorded along with the operative time, estimated blood loss, stone burden, stone-free rate, length of hospitalization and complications .Patients were followed up after three months to rule out recurrence of stones by plain abdominal x-ray of kidney, ureter and bladder and USG.
Results: Out of 60 patients 35 were male and 25 were female (M: F=1.4:1) with mean age of 37 years and were subjected to PCNL monotherapy. With the average stone size of 3.26cm, the mean operative time was 78 minutes. Complete stone removal achieved by PCNL alone in 60 cases, with insignificant residual small stones we achieved 97% stone clearance rate. The mean hospital stay was 3.7 days. No Serious complications were encountered, 9 (15%) patients required blood transfusion and 3 (5%) patients developed transient post-operative pyrexia.
Conclusion: PCNL is the first line treatment option for management of large renal stones which as monotherapy has advantages in removal of renal and upper ureteric stones and achieving excellent results with minimal morbidity
Hemodynamic Changes During Laproscopic Cholecystectomy at Lumbini Medical College
Get PDFBackground: Laparoscopic cholecystectomy is preferred to open cholecystectomy for several reasons. Patients can be discharged home earlier. They have less pain in comparision to open cholecystectomy. Objectives: To investigate the pneumoperitoneum-induced haemodynamic and ventilatory changes in patients undergoing laproscopic cholycystectomy (LC). Methods: It was a prospective study of the age 15 years to 75 years of both sex (males n=80 and females n =320) were included in the study. The study was conducted in Lumbini Medical College Palpa over the two year period in Jan 2010 and Dec 2012. The variables recorded were: Mean arterial pressure (MAP), End- dal CO2, Peak and plateau airway pressures and heart rate. Data were collected immediately after induction of anesthesia at 5 min , after peritoneal insufflations and tilting the table into 30° head-up position at 10 min and finally at 10 min after exsufflation. Results: There was decrease in MAP after head up position but there was little change after pneumoperitoneum. More the weight more the increased in airway pressure was observed. The end tidal CO2 ramained increased after pneumoperitoneum. Conclusion: Peritoneal insufflation of CO2 to create the pneumoperitoneum and tilting the patient to the head-up position necessary for laparoscopy induces intraoperative ventilatory and hemodynamic changes that complicate anesthetic management of laparoscopy
Ender’s Nail fixation in paediatric femoral shaft fractures.
No full textIntroduction: Femoral shaft fractures are among the most common major pediatric injuries treated by orthopaedic surgeons. Treatment ranges from strictly nonsurgical methods to surgical stabilization. Operative treatment of femoral shaft fractures in children with intramedullary nails (Ender’s and titanium elastic nails) is increasing because it has advantage of early mobilization, rapid healing and better control of alignment. Objectives: We evaluated the results of Ender’s nails fixation in femoral shaft fractures in children. Method: We studied 40 children with 40 femoral shaft fractures in age group 5-15 years. There were twenty four fractures in middle third, 7 in distal third and 9 in proximal third. Twenty fractures were transverse, 8 were oblique and 6 were spiral. Communition was seen in 6 cases. They were treated by closed reduction andEnder’s nail fixation. Retrograde fixation was done in 38 cases, in 2 cases antegrade fixation was done. Result: The mean follow up was 7.5 months. The average time to partial weight bearing was 3.8 weeks (2 to 6wks). The average time to full weight bearing was 8 weeks (6 to 12 wks). Union was achieved in all patients within a mean of 11 weeks (8 to 16 wks). Two patients had varus angulation of 8° and 6° each, whereas one had valgus angulation of 8°and one had anterior angulations of 10°. Lengthening of 1.2 cm was observed in one patient. In one case skin irritation due to nail was observed and that subsided without intervention. According to theFlynn criteria 34 had excellent and 6 had satisfactory results. No poor results were seen. Conclusion: Ender’s nail fixation can be preferred method of treatment for femoral shaft fractures in age group 5 -15 years as the results are excellent and satisfactory. It is technically simple and can be done in a closed manner. It spares the vascularity and growth plate
Evaluation of biochemical marker for bone turnover in post menopausal women
Get PDFIntroduction: Menopause is the permanent cessation of menses resulting from reduced ovarian hormone secretion that occurs naturally or is induced by surgery, chemotherapy, or radiation. Aims and objectives: To evaluate the risk of accelerated bone loss by assessing bone markers like alkaline phosphatase (ALP) and calcium in postmenopausal women. Material and methods: The present study was carried out on 100 total subjects out of which experimental group consists of 50 subjects i.e Post menopausal women. Control group consists of 50 subjects Pre menopausal women. Results: The result of the present study suggest that the serum calcium level were signifi cantly reduced but the serum alkaline phosphatase (ALP) levels had a slightly raise in post menopause group when compared to the pre menopause groups. Conclusion: In normal post menopausal women, an increase in bone turnover accelerates the reduction in bone mass, whereas decrease in bone turnover is associated with preservation of bone mass
