Journal of Lumbini Medical College (JLMC)
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Pheochromocytoma: A Rare Cause of Secondary Hypertension
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Introduction: Pheochromocytoma is a rare tumor, originating from the chromaffin tissue. Its frequency is approximately 1/100,000. The clinical manifestation is due to catecholamine excess, which includes high blood pressure, palpitation, headache, sweating, nausea, vomiting, trembling, weakness, irritation, abdominal and chest pain, dyspnea, red warm face, constipation, polyuria, and polydipsia.
Case Report: We present a case of 53 years old male, hospitalized for hypertensive crisis following the manipulation of left sided frozen shoulder. He had labile blood pressure ranging from 220/120 systolic- 90/60 diastolic, profuse sweating and tachycardia. Findings of Contrast enhanced CT of abdomen was consistent with right adrenal pheochromocytoma and 24 hours urinary VMA was 17 mg /24 hr (Normal <13.6 mg /24hr). After the clinical, paraclinical investigations and radiological tests, it was proved to be a pheochromocytoma. The surgical intervention was planned. But due to unavailability of required antihypertensive drugs in Nepal (alpha-blockers like phentolamine and phenoxybenzamine), surgeons were reluctant to operate, although blood pressure was well controlled with use of sodium nitroprusside during hypertensive crisis and prazosin, a selective alpha blocker as maintainance therapy. The use of prazosin to control hypertension secondary to pheochromocytoma is limited to case report and case series.
Conclusion: Although rare, pheochromocytoma is a treatable surgical cause of secondary hypertension
Ear Nose Throat (ENT) disorders in Government Schools of Far-Western Nepal
Get PDFBackground: ENT disorders specially hearing impairment negatively impacts students’ development of academic, language and social skills. If left undiagnosed, these conditions may result in significant irreversible damage such as varying degree of hearing loss that can affect the social or professional performance of the individuals in later stages of life. Students going to government school in our country generally come from under privileged society. We investigated the occurrence of ENT diseases among various government school students in Kailali district.
Methods: Nine government school of Kailai district were chosen at random. All students of those school present on the day of examination went routine ENT examinations. Brief history, if any, was recorded and findings were noted. The study was done throughout the month of September, 2013.
Results: There were a total of 2256 students enrolled in the study. There were 1126 male and 1130 female students. Mean age of the students was 9.88 years. Forty One percent of students had ENT problems. Ear wax was the most common (17%) findings followed by suppurative ear diseases, otittis media with effusion as so on in decreasing frequency.
Conclusions: ENT diseases and specially ear diseases are important health problems among school children of Nepal. Regular school health services, screening program, public awareness, improvement of socioeconomic status, timely referral to a specialist doctor can help to reduce the disease-related burden
Study of Thyroid Lesions by Fine Needle Aspiration Cytology and its Correlation with Thyroid Function Test
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Introduction: Fine needle aspiration cytology (FNAC) of the thyroid gland has been widely and successfully utilized for diagnosis. Assessment of thyroid pathology is even more informative if correlated with thyroid function tests (TFT). This study aims to compare the efficacy of fine needle aspiration cytology with thyroid function tests in different thyroid lesions.
Methods: A descriptive study was carried out among the patients who presented with thyroid swellingvisiting Department of Ear Nose Throat (ENT) of Lumbini Medical College and Teaching Hospital (LMCTH) fromJune 2012 to February 2013. The study population were selected on random basis. A total of fifty patients involved in the study and were sent to Department of Pathology for FNAC and TFT.
Results: Most of the cases (44%) of thyroid swelling were from 21 to 40 years of age. Among them, 86% were females. Out of total respondents, 48% were found to be colloid goiter. 70% findings of FNAC and TFT were in accordance.
Conclusions: The findings of FNAC and TFT were found to be significantly associated (P value <0.05)
Maternal Mortality: Sharing Experience from Banke District
Get PDFMaternal mortality is a global burden, with more than 500,000 women during each year due to pregnancy and childbirth related complications¹. Globally, 60-80% of maternal deaths are due to obstetric complications, these are haemorrhage, sepsis (infection), obstructed labour and hypertensive disorder of pregnancy and complications of unsafe abortion.² OBJECTIVE: To identify the causes of maternal mortality. MATERIALS AND METHODS: The study was conducted in Banke district. Descriptive cross-sectional study was adopted, during a period of one year from July 2011 to June 2012 at Banke District in Western Region of Nepal. Non probability purposive sampling method was used for collecting the data. Both primary and secondary sources of data were taken for the study. RESULTS: The maximum number of maternal deaths was from Madheshi and Muslim community, most of them were illiterate. The main cause of maternal deaths was post partum haemorrhage. CONCLUSION: Nepal achieved an impressive reduction in maternal mortality between 2001 and 2006, but maternal deaths remain high. The trends of death from snake bite, suicide, epilepsy and physical assault are the new causes
Laparoscopic Cholecystectomy in Chronic Calculus Cholecystitis
Get PDFIntroduction: Laparoscopic cholecystectomy has clearly become the choice over open cholecystectomy in the treatment of hepatobiliary disease since its introduction by Mouret in 1987. This study evaluates a series of patients with chronic calculus cholecystitis who were treated with laparoscopic and open cholecystectomy and assesses the outcomes of both techniques. Objective: To evaluate the efficacy of laparoscopic vs open cholecystectomy in chronic calculus cholecystitis and establish the out-comes of this treatment modality at Lumbini Medical College and Teaching Hospital. Methods: This was a retrospective analysis over a one-year period (January 1, 2012 to December 31, 2012), per-formed by single surgeon at Lumbini Medical College and Teaching Hospital located midwest of Nepal. 166 patients underwent surgical treatment for chronic calculus cholecystitis. Patients included were only chronic calculus cholecystitis proven histopathologocally and the rest were excluded. Data was collected which included patients demographics, medical history, presentation, complications, conversion rates from laparoscopic. cholecystectomy to open cholecystectomy, operative and postoperative time. Results: Patients treated with laparoscopic cholecystectomy for chronic calculus cholecystitis had shorter operating times and length of stay compared to patients treated with open cholecystectomy for chronic calculus cholecystitis. Conversion rates were 3.54% in chronic calculus cholecystitis during the study period. Complications were also lower in patients who underwent laparoscopic cholecystectomy versus open cholecystectomy for cholelithiasis. Conclusions: Laparoscopic cholecystectomy appears to be a reliable, safe, and cost-effective treatment modality for chronic calculus cholecystitis
Open Reduction of Complex Metacarpo-phalangeal Joint Dislocations
Get PDFThe metacarpophalangeal (MP) joint is resistant to injury due to its strong capsuloligamentous structures, which include the volar plate, deep transverse metacarpal and collateral ligaments. Complex MP joint dislocations are, by definition, irreducible by closed means and require open reduction, as the volar plate becomes entrapped between the metacarpal head and proximal phalanx. Two cases of isolated closed & one case of open complex dislocation of the metacarpophalangeal joint of the three different fingers are presented. Such dislocations require open reduction, and the dorsal approach is simple and effective
Soft-tissue Necrosis Complicating Bone-cement Filling in a Patient with Proximal Tibia Giant cell Tumour and Co-morbid Depressive Illness
Get PDFGiant-cell tumors are common around the knee. Proximal tibia is a challenging location for limb-salvage due to paucity of soft-tissue cover. Bone cement has been used in treatment of giant-cell tumors after curettage. Tissue irritant properties of its monomer and exothermic reaction involved in polymerization may compromise surgical outcome to varying degrees. Preoperative planning and intra-operative positioning during cementing process are of importance to avoid complications. Co-occurrence of psychiatric illness in tumor patients should be managed by psychiatric counselling and drug therapy. This case has been presented to suggest measures for preventing soft-tissue complications during cement filling in proximal tibia, and for dealing with concomitant psychiatric problems for a holistic improvement in tumor patients
Impact of Educational Status and Parity of Mother-in-Laws on Practies of Birth Preparedness and Complication Readiness in Banke District
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Introduction: Pregnancy and childbirth is considered as a physiological process and it is associated with certain risks to the life of mother and newborn baby. Birth-preparedness and complication readiness is a comprehensive strategy to improve maternal and newborn health. This study was done to observe impact of educational status and Parity of mother-in-laws on awareness and practices regarding birth preparedness and complication readiness.
Methods: The study was conducted in Banke district. The duration of study was from August 2011 to August 2012. Descriptive cross-sectional study was followed. One hundred mothers-in-law were selected through simple random procedure. Semi-structure interview schedule was used to collect information.
Results: The mean age of mothers-in-law was 52.33 (SD=8.96) years. Majority (82.0%) mothers-in-law were illiterate with lack of awareness and practice about birth preparedness and complication readiness.
Conclusion: Inadequate practices on birth preparedness and complication readiness were prevalent in illiterate mothers-in-laws
Present potential of exfoliative cytology in detection of cervix cancer: Pattern of epithelial cell abnormality
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Introduction: Conventional Pap smear is the mainstay for cervical cancer screening in developing countries and women should be motivated for cervical screening program to detect early dysplastic cells. This study was carried out to find out the prevalence of abnormalities in Pap smears, particularly pattern of epithelial cell abnormality in women attending Lumbini Medical College in western Nepal.
Methods: A cross-sectional study was carried out and 1066 Pap smears were studied to look for epithelial cell abnormality according to revised Bethesda system 2001.
Results: Out of 1066 patients who underwent Pap smear examination, 71 (6.6%) revealed epithelial cell abnormality; most were low grade squamous intra-epithelial lesions (LSIL) occupying 4.59% at the age between 23 to 29 years. Squamous cell carcinoma was found in 0.37 % of patients at the age 40 years and above. In our scenario, per vaginal discharge was the major finding of the patients who showed premalignant features.
Conclusions: Women above 40 years are at a risk of premalignant as well as malignant lesions and these women should undergo screening for abnormal cells at the age of 18 or when sexual activity starts and as per recommendations to look for early dysplastic cells. Cervical screening program should be motivated by the national policy makers and also by health professionals
Clinico-Pathological Study of ovarian tumors: A two years study at LMC & Teaching Hospital, Tansen – 11, Parvas, Palpa.
Get PDFOvarian neoplasm is the commonest condition observed in gynecology practice. Both non-neoplastic as well neoplastic ovarian tumors are common. In the present study neoplastic ovarian tumors were analyzed for their age of occurrence, site of ovary involved and histological typing. Oophrectomy/Hysterectomy and Oophrectomy was performed on patient suffering from ovarian tumors and the specimens were sent to Pathology department LMC & Teaching Hospital for their histological study. The present study of 40 cases of ovarian neoplasm is from 2068/05/05 B.S. to 2070/05/30 B.S. The mean age of patient was 39 years with S.D of 1.25 years. The size of the tumor varies from 5 cm to 32.9 cm and weight varies from 41 gms to 350 gms. Commonest tumor was mature cystic teratoma (52.5 %) followed by serous cyst adenoma (30%). Not much difference was found for ovarian tumor regarding its site right and left ovary. Only two cases of malignant ovarian neoplasm were found in this study, one case (2.5 %) was of immature cystic teratoma and another (2.5 %) was of serous cyst adenocarcinoma