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Shrestha BM. Comment on: Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and American Hernia Society. Br J Surg 2020; 107:e215. [PMID: 32342489 DOI: 10.1002/bjs.11577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 02/10/2020] [Indexed: 02/05/2023]
Affiliation(s)
- B M Shrestha
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK
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Affiliation(s)
- B M Shrestha
- Department of General Surgery, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
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Jackson A, Smith J, Shrestha BM. Abdominal Wall Scar Endometrioma. Kathmandu Univ Med J (KUMJ) 2017; 17:185-187. [PMID: 34547855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
Abdominal wall scar endometrioma is an uncommon clinical entity, which presents with lump and cyclical abdominal pain during menstruation, which develops after caesarean section or gynaecological procedures. Differential diagnosis includes a haematoma, desmoid tumour, incisional hernia, sarcoma, metastatic malignancies and suture granuloma. Adenocarcinoma developing from abdominal wall scar endometrioma are aggressive and carry poor prognosis. An awareness of this clinical entity is important to establish its diagnosis early and ultrasound scan, magnetic resonance scan, or a computerised tomographic-guided localization followed by surgical excision provides best outcome. Here in, a case of abdominal wall scar endometrioma is reported and review of pertinent literature is presented.
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Affiliation(s)
- A Jackson
- Department of General Surgery, Sheffield Teaching Hospitals NHS Trust, Herries Road, Sheffield S5 7AU, UK
| | - J Smith
- Department of Histopathology, Sheffield Teaching Hospitals NHS Trust, Herries Road, Sheffield S5 7AU, UK
| | - B M Shrestha
- Department of General Surgery, Sheffield Teaching Hospitals NHS Trust, Herries Road, Sheffield S5 7AU, UK
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Affiliation(s)
- B M Shrestha
- Department of General Surgery, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
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Robins J, Shrestha A, Hampton J, Shrestha BM. Management of Acute Lower Gastrointestinal Bleeding: Principles and Current Practice in the United Kingdom. JNMA J Nepal Med Assoc 2015; 53:304-310. [PMID: 27746478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Acute lower gastrointestinal bleeding (ALGIB) is a common cause for hospital admission that results in significant morbidity and mortality. The major objectives of all involved in the management of ALGBI patients are to reduce mortality and the need for major surgery. A secondary objective is to prevent unnecessary hospital admission for patients presenting with bleeding that is not life-threatening. The management of ALGBI has evolved over last decade with the changing modalities of diagnostic facilities. On review of the published literature, there is paucity of randomised control trials in relation to the diagnostic tools and management of ALGBI. The aim of this review is to summarise the principles and current methods available for the diagnosis and treatment of ALGIB and based on the available evidence and the current practice in the United Kingdom, outline an algorithm for the management of ALGIB.
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Affiliation(s)
- J Robins
- Department of General Surgery, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | | | - J Hampton
- Department of Radiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - B M Shrestha
- Department of General Surgery, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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Shrestha BM. The Declaration of Helsinki in relation to medical research: historical and current perspectives. J Nepal Health Res Counc 2013; 10:254-7. [PMID: 23281462 DOI: pmid/23281462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Medical research aims at improving diagnostic, therapeutic and prophylactic measures and understanding of the aetiology and pathogenesis of diseases in humans, and their application to improve the quality of life and survival. The subjects involved are exposed to hazards inherent to the experiments. In order to protect the human subjects and to maintain high ethical standards, the World Medical Association had adopted the "Declaration of Helsinki" in 1964. The aim of this article is to provide a comprehensive review on the historical and current perspectives on the Declaration of Helsinki in relation to medical research on human subjects.
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Pun CB, Aryal G, Basyal R, Shrestha S, Pathak T, Bastola S, Neupane S, Shrestha BM, Thakur BK, Lee MC. Histological pattern of esophageal cancer at BP Koirala memorial cancer hospital in Nepal: a three year retrospective study. J Pathol Nep 2012. [DOI: 10.3126/jpn.v2i4.6877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: The incidence of esophageal adenocarcinoma is increasing in trends. Squamous cell carcinoma is associated with tobacco and alcohol consumption. Adenocarcinoma is often associated with a history of gastroesophageal reflux disease and Barrett's esophagus. The aim of this study was to find out the histological pattern of esophageal cancer in one of the largest Cancer center in Nepal.Materials and Methods: Between January 2008 and December 2011, a total of 106 cases of esophageal cancer were received in the department of pathology, BP Koirala Memorial Cancer Hospital. Relevant clinical data were retrieved from computer database of the hospital.Results: A total of 106 cases of esophageal carcinomas were diagnosed during a three years period. There were 68 (64.15%) cases of squamous cell carcinoma, 33 (31.13%) cases of adenocarcinoma including signet ring cell carcinoma, 4 (3.76%) cases of undifferentiated carcinoma and 1 (0.94%) case of small cell carcinoma. The esophageal cancer was most common in the age group of 61-70 years of age. Distal third of esophagus was the most common site for esophageal carcinoma, followed by middle esophagus and proximal esophagus.Conclusion: The most frequent type of esophageal carcinoma is squamous cell carcinoma followed by adenocarcinoma. Distal esophagus is the most common site with male preponderance.Journal of Pathology of Nepal (2012) Vol. 2, 277-281DOI: http://dx.doi.org/10.3126/jpn.v2i4.6877
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Lamichhane N, Nepal U, Neupane BR, Thakur BK, Shrestha BM. Orthotopic neobladder urinary diversion for carcinoma of urinary bladder. J Nepal Health Res Counc 2012; 10:201-203. [PMID: 23281451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Invasive cancers of urinary bladder need radical cystectomy as an optimal treatment. Urinary diversions of different types are available after the procedure. Orthotopic neo-bladder reconstruction is an emerging technique of diversion in suitable patients. The aim of this study was to see the outcome of this procedure in our set up. METHODS The patient with carcinoma of urinary bladder who underwent radical cystectomy and orthotopic neo- bladder reconstruction during five year period were included in the study from department of surgical oncology in a hospital. Studer type ileal pouches were made in all the patients and their outcomes were studied. RESULTS There were 30 patients among which 28 were male and 2 female. Age ranged from 38-60 years with mean age of 49.6 years. Average operative time was 330 minutes. Average hospital stay was 16 days (range 14-30 days). Majority of patients were transitional cell carcinoma 26 (86.7%) in histology. Majority of cases presented in stage II (53.3%). Post-operative complications were ileus in 30%, urinary leak in 26.6% and pneumonia in 13.3% of patients. Mortality was 1 (3.3%) on 29th postoperative day. Patients were able to micturate with satisfactory stream postoperatively. CONCLUSIONS Orthotopic neobladder has similar complication rates compared with other forms of continent diversions. This method gives less psychological trauma to the patients with higher acceptance. So we recommend transforming the technique from ileal conduits to neobladder in well-established pelvic reconstruction set ups.
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Affiliation(s)
- N Lamichhane
- Department of Surgical Oncology, BP Koirala Memorial Cancer Hospital, Chitwan, Nepal.
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Basra M, Shrestha BM. Acute Ischaemic Colitis- A Case Report. JNMA J Nepal Med Assoc 2012. [PMID: 23279769 DOI: 10.31729/jnma.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Acute ischaemic colitis (AIC) is being increasingly recognised as an uncommon cause of abdominal pain associated with fresh bleeding per rectum. It is paramount to maintain a high index of suspicion and adopt appropriate management strategies to avoid complications and inappropriate interventions. In this paper, we describe a case of AIC and review literature pertinent to the management of this condition.
Keywords: Ischaemic colitis, acute abdomen, management.
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Affiliation(s)
- M Basra
- Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, UK.
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Abstract
Natural orifice transluminal endoscopic surgery (NOTES), which utilises natural anatomical passages for gaining access to the intra-abdominal organs for surgical interventions, that result in scarless surgery, is a recent advancement in the specialty of minimally invasive surgery and has gained significant momentum, It has been postulated as a promising alternative to laparoscopic surgery in the fi eld of minimal invasive surgery. Signifi cant advantages over conventional open surgery, such as less postoperative pain, a shorter hospital stay, early return to activity, avoidance of woundrelated complications and better cosmesis have been demonstrated. This article provides an update in the development, principles, practice and future applications of NOTES.
Keywords: natural orifice, minimally invasive, scarless, endoscopic surgery.
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Shrestha BM. Natural orifice transluminal endoscopic surgery (NOTES): an emerging technique in surgery. JNMA J Nepal Med Assoc 2011; 51:209-12. [PMID: 22922904 DOI: pmid/22922904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Natural orifice transluminal endoscopic surgery (NOTES), which utilises natural anatomical passages for gaining access to the intra-abdominal organs for surgical interventions, that result in scarless surgery, is a recent advancement in the specialty of minimally invasive surgery and has gained significant momentum, It has been postulated as a promising alternative to laparoscopic surgery in the field of minimal invasive surgery. Significant advantages over conventional open surgery, such as less postoperative pain, a shorter hospital stay, early return to activity, avoidance of wound-related complications and better cosmesis have been demonstrated. This article provides an update in the development, principles, practice and future applications of NOTES.
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Joshi BG, Keyal K, Pandey R, Shrestha BM. Clinical Profile and Sensitivity Pattern of Salmonella Serotypes in Children: A Hospital Based Study. J Nepal Paedtr Soc 2011. [DOI: 10.3126/jnps.v31i3.4382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Enteric fever is a systemic infection caused by the bacteria, Salmonella enterica serovar Typhi (S.typhi) and Salmonella enterica serovara Paratyphi (S. paratyphi A, B and C). Most of the burden of the disease is limited to the developing world and the disease still has the issues like wide spectrum of clinical presentation and multidrug resistance. Objectives: This study was done to analyze the clinical profile and antibiotic sensitivity pattern in the cases of culture positive enteric fever. Methods: A prospective cross-sectional study was conducted in Civil Service Hospital from February 2010 to January 2011 in the paediatric population in the age group of 2 to 14 years. Children with Salmonella species isolated in blood culture were included in the study. Results: Out of the 40 children with culture positive enteric fever, male to female ratio was 1.3:1 with common age group between 11-14 years. S typhi was isolated in 25 cases while S. paratyphi in 15 cases. Clinical features of S. typhi and S. paratyphi were indistinguishable. Both S.typhi and S. paratyphi were found to be 100% sensitive to drugs like Ceftriaxone, Cefotaxime, Cefixime and Chloramphenicol. Sensitivity to Ofloxacin was 100% in S. paratyphi and 92% in S.typhi. Similarly sensitivity of Azithromycin was 92% and 93% for S.typhi and S. paratyphi respectively. Conclusion: Salmonella serotype is still 100 % sensitive to third generation cephalosporin. Some percentage of resistance is seen with Ofloxacin in S. typhi and with Azithromycin in both S.typhi and S. paratyphi. Key words: Enteric fever; S.typhi; S.paratyphi; Sensitivity DOI: http://dx.doi.org/10.3126/jnps.v31i3.4382 J Nep Paedtr Soc 2011;31(3): 180-183
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Keyal K, Joshi BG, Pandey R, Shrestha BM. Ectrodactyly: A rare anomaly of limbs. J Nepal Paedtr Soc 2011. [DOI: 10.3126/jnps.v31i3.4429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Split-hand/split-foot malformation (SHFM) is a rare congenital malformation of the limbs with median clefts of the hands and feet and aplasia/hypoplasia of the phalanges, metacarpals and metatarsals. When present as an isolated anomaly, it is usually inherited as an autosomal dominant form. We report a case of nonsyndromic form of ectrodactyly because of its rarity. Key words: Split-hand/split-foot malformation; Nonsyndromic ectrodactyly DOI: http://dx.doi.org/10.3126/jnps.v31i3.4429 J Nep Paedtr Soc 2011;31(3): 235-237
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Wallis S, Durham-hall A, Tondon N, Brotherstone TM, Shrestha BM. Markel Cell Carcinoma. JNMA J Nepal Med Assoc 2010. [DOI: 10.31729/jnma.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine tumour of the skin with high rate of local recurrence and distant metastatic potential leading to poor outcomes. Merkel cells are normally found as innervated clusters of cells around hair follicles in the basal layer of the epidermis and are thought to function as touch receptors. Here, we describe a case of MCC in a 71-year-old female and provide an up-to-date review of the literature pertinent to the management of MCC.
KEYWORDS: merkell cell carcinoma, diagnosis, imunohistochemistry, management.
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Wallis S, Durham-Hall A, Tandon N, Brotherston TM, Shrestha BM. Merkel cell carcinoma. JNMA J Nepal Med Assoc 2010; 49:151-4. [PMID: 21485603 DOI: pmid/21485603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine tumour of the skin with high rate of local recurrence and distant metastatic potential leading to poor outcomes. Merkel cells are normally found as innervated clusters of cells around hair follicles in the basal layer of the epidermis and are thought to function as touch receptors. Here, we describe a case of MCC in a 71-year-old female and provide an up-to-date review of the literature pertinent to the management of MCC.
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Affiliation(s)
- S Wallis
- Northern General Hospital, Sheffield, United Kingdom
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Abstract
Nicorandil is a cardioprotective drug which is used in the prophylaxis and long-term treatment ofangina pectoris. Debilitating perianal ulcer is a rare complication of Nicorandil therapy which cancause diagnostic and management dilemmas. We describe the management of a case of Nicorandilinducedperianal ulcer and review pertinent contemporary literature.Key Words: cardioprotection, ischaemia, Nicorandil, perianal ulcer
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Affiliation(s)
- J P Tiernan
- Department of General Surgery, Sheffield Teaching Hospitals NHS Trust, United Kingdom.
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Shrestha BM. General or Specialist Surgeons? JNMA J Nepal Med Assoc 2009. [PMID: 20795470 DOI: 10.31729/jnma.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
General Surgery is a broad surgical specialty that focuses on diseases related to abdominal organs,skins and hernias, both in elective and emergency settings. With the prevalent trend for increasingsubspecialisation in today's surgical practice, general surgery has lost some of its former glory andscope. This has led to suffering of the image of the general surgeons (GS) in the eyes of trainees,peers, the public and even GS themselves. A comprehensive review of literature is presented toaddress the controversy surrounding the role and future of general and specialist surgeons in thecurrent perspectives.Key Words: emergency, general surgeons, specialists, surgery
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Affiliation(s)
- B M Shrestha
- Sheffield Kidney Institute, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
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Shrestha BM, Prasopshanti K, Matanhelia SS, Peeling WB. Blood loss during and after transurethral resection of prostate: a prospective study. Kathmandu Univ Med J (KUMJ) 2008; 6:329-34. [PMID: 20071814 DOI: 10.3126/kumj.v6i3.1707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Transurethral resection of prostate (TURP) is the gold standard treatment for symptomatic prostatic bladder outlet obstruction. Haemorrhage during and after TURP can lead to significant morbidity and mortality. The purpose of this study was to assess the influence of anaesthesia, operating time, weight of resected prostatic tissue and its histology on blood loss during and after TURP and to revisit the available body of evidence in the literature of urology. MATERIALS AND METHODS This is a prospective study of a cohort of 100 consecutive patients who had undergone TURP over a period of one year, where the data was collected on a performa specifically designed for the study, which included the type of anaesthesia administered, resection time, amount of blood lost during and after TURP, weight of the resected prostatic tissue and histology. RESULTS Sixty seven patients underwent TURP under spinal anaesthesia (SA) and 33 under general anaesthesia (GA). The median intraoperative (SA: 89.95 (5-936); GA: 105.40 (5-517) mls), postoperative (SA: 72.37 (15-387); GA: 136.43 (11-969) mls) and total (SA: 162.32 (29-1200); GA: 241.83 (21-1251) mls) blood losses were not significantly different between the two groups (95% C.I. -9.90 to 19.22, p= 0.46). The total operating time (SA: 29.70 (10-55); GA: 29.80 (10-65) minutes) and weight of resected prostate (SA: 21.90 (3-45); GA: 18.00 (4-60) gms) were similar between the two groups. There was a trend towards increased blood loss when BPH was associated with prostatitis (N=8). Of these, 3 patients required blood transfusion as compared to 1 patient in rest of the group, although this was not statistically significant (95% C.I - 67.2 to 1120.4, p = 0.87). CONCLUSIONS The intraoperative, postoperative and total blood losses related to TURP were not influenced by the type of anaesthesia, resection time, weight of the resected prostate and the histology.
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Affiliation(s)
- B M Shrestha
- Department of Urology, Royal Gwent Hospital, Newport, Gwent, UK.
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Durham-Hall A, Wallis S, Butt I, Shrestha BM. Abdominal wall pseudohernia following video-assisted thoracoscopy and pleural biopsy. Hernia 2008; 13:93-5. [PMID: 18584279 DOI: 10.1007/s10029-008-0401-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 06/03/2008] [Indexed: 02/08/2023]
Abstract
A rare case of pseudohernia of the abdominal wall following video-assisted thoracoscopy (VAT) and pleural biopsy in a 61-year-old male is presented. The patient presented with a recurrent pleural effusion following fractured ribs after a road traffic accident. Computerised tomography (CT) showed thickened pleura, which was biopsied using VAT. Access to the pleural cavity was obtained with two laparoscopic ports inserted at the 8th intercostal space on the posterior chest wall. Following the procedure, the patient experienced sharp pain over the right hypochondrium, which was followed by the development of a diffuse bulge associated with the loss of skin sensation. Ultrasound and CT disclosed no musculofascial defect. Electromyography showed denervation changes affecting the muscles innervated by the 8th intercostal nerve. With expectant treatment over a year, cutaneous sensation recovered partially; however, the size of the pseudohernia remained unchanged. To the authors' knowledge, this is the first report of a pseudohernia in the English literature following VAT and pleural biopsy.
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Affiliation(s)
- A Durham-Hall
- Department of Surgery, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
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Shrestha A, Shrestha A, Vallance C, McKane WS, Shrestha BM, Raftery AT. Quality of life of living kidney donors: a single-center experience. Transplant Proc 2008; 40:1375-7. [PMID: 18589110 DOI: 10.1016/j.transproceed.2008.03.132] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 02/07/2008] [Accepted: 03/11/2008] [Indexed: 02/05/2023]
Abstract
Renal transplantation improves the quality of life (QoL) of patients with end-stage renal disease. The preservation of QoL of living kidney donors is paramount. The aim of this study was to assess the QoL pre- and postdonation using Medical Outcome Survey Short Form-36 (SF-36) and to compare with a control group of potential donors who did not proceed with donation. Over a period of 28 years (1978 to 2006), 82 living donor renal transplantations were performed. Of the 78 eligible donors, 66 (85%) participated in the survey. The median postdonation period was 4.6 years (range, 3 months to 27 years). Thirty eight individuals were assessed in the control group. The postdonation SF-36 scores of the donors were not statistically significantly different from those of the control group except in one out of eight dimensions, which was physical role. However, in 44/66 (66%) donors, the postdonation scores were significantly lower compared to their predonation scores because of development of comorbidities such as musculoskeletal pain, migraine, myocardial infarction, diabetes, and peptic ulcers as the time progressed since kidney donation. The age, sex, time since donation, and relationship to recipient did not affect QoL. Eighty three percentage of the donors would have donated again if possible, and 90.9% wished to encourage living kidney donation. We conclude that the QoL of living kidney donors was not different from the healthy controls, although with the passage of time, there was some deterioration of QoL due to development of comorbidities.
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Affiliation(s)
- A Shrestha
- University of Sheffield, Sheffield, United Kingdom.
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Abstract
A severe insult in the form of infection or trauma primes the host immune system so that a subsequent,relatively trivial insult produces a markedly exaggerated host immune response, which can leadto multiple organ dysfunction syndrome (MODS) and death. This forms the basis of the “two-hithypothesis” (THH), which is being increasingly recognised as an important cause of morbidity andmortality following severe injury and sepsis, particularly in intensive care settings. Appreciation ofthe impact ofrepeatedinsults andpathophysiology of MODS is vital in the prevention of this seriouscomplication. We describe a case which illustrates the concept of THH and MODS and present areview of literature on this subject.Key words: laparotomy, multiple organ dysfunction, sepsis, two-hit hypothesis
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Affiliation(s)
- I Butt
- Sheffield Kidney Institute, Sheffield, UK
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Shrestha BM. Pre-emptive renal transplantation: optimum treatment for end-stage renal disease? JNMA J Nepal Med Assoc 2008. [PMID: 18552893 DOI: 10.31729/jnma.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Renal transplantation (RT) prior to having dialysis or pre-emptive renal transplantation (PRT) has been controversial because of the paucity of clinical evidence to clarify the benefits and risks of PRT. The recent emergence of evidences from major transplant centres in the United Kingdom and United States have confirmed the survival advantages for both renal allografts and RT recipients. Hence an increasing number of transplant centres are adopting the practice of PRT. This article discusses the advantages and disadvantages of PRT and highlights the clinical evidences in support of PRT.
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Tappenden J, Shrestha BM. Colonic Diverticular Disease: Current Perspectives. JNMA J Nepal Med Assoc 2007. [PMID: 18340365 DOI: 10.31729/jnma.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
abstract
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Affiliation(s)
- J Tappenden
- Department of General Surgery, Northern General Hospital, Sheffield, UK
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Abstract
abstract
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Matsuhisa T, Miki M, Yamada N, Sharma SK, Shrestha BM. Helicobacter pylori infection, glandular atrophy, intestinal metaplasia and topography of chronic active gastritis in the Nepalese and Japanese population: the age, gender and endoscopic diagnosis matched study. Kathmandu Univ Med J (KUMJ) 2007; 5:295-301. [PMID: 18604043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The incidence and mortality from gastric cancer is high in Japanese but extremely low in Thailand. It is different among Asian countries. The aim of this study is to investigate the difference of peptic ulcer disease, glandular atrophy, intestinal metaplasia and topography of chronic active gastritis between the Nepalese and Japanese population. MATERIALS AND METHODS Nepalese patients were paired with Japanese patients by age, gender and endoscopic diagnosis in order to compare the prevalence of H. pylori infection (N=309) and the difference of H. pylori related peptic ulcer disease (N=48). Glandular atrophy and intestinal metaplasia scores were also compared between the Nepalese and Japanese population in H. pylori positive cases (N=152) and negative cases (N=145) using paired cases by age, gender and endoscopic diagnosis. Paired H. pylori-positive Nepalese and Japanese population were also used to compare the ratio of corpus gastritis to antrum gastritis (C/A ratio) (N=152). RESULTS Among peptic ulcer diseases, gastric ulcer was frequent in Japanese and duodenal ulcer was frequent in Nepalese. The prevalence of H. pylori infection in the Nepalese and Japanese population were similar. Glandular atrophy and intestinal metaplasia scores in the H. pylori positive Japanese were significantly higher than those of Nepalese in all positions according to triple site biopsy. Furthermore, there were significant differences in glandular atrophy and intestinal metaplasia scores between in the H. pylori-negative Nepalese and Japanese population except intestinal metaplasia score in the greater curvature of the upper corpus. Japanese C/A ratio was significantly higher than that of Nepalese. Corpus predominant gastritis (C/A ratio>1.00) was characteristic in the elderly Japanese. Nepalese was antrum predominant (C/A ratio<1.00) in every age group. CONCLUSIONS Gastric ulcer was a common disease in Japanese, in contrast duodenal ulcer was common in Nepalese. H. pylori infected Japanese patients showed severe atrophic and metaplastic gastritis in comparison with Nepalese. These results may be associated with the high incidence of gastric cancer in Japanese. Corpus predominant gastritis was found in the elderly Japanese and antrum predominant gastritis was found in every age Nepalese.
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Affiliation(s)
- T Matsuhisa
- Department of Gastrointestinal Endoscopy, Tama-Nagayama Hospital, Nippon Medical School, Tokyo, Japan
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Shrestha BM, McKane WS, Raftery AT. Renal transplantation after endovascular repair of abdominal aortic aneurysm. Transplant Proc 2007; 39:1670-2. [PMID: 17580215 DOI: 10.1016/j.transproceed.2007.03.100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2006] [Revised: 01/21/2007] [Accepted: 03/26/2007] [Indexed: 02/05/2023]
Abstract
An increasing number of abdominal aortic aneurysms (AAA) occur in renal failure patients because of strong association between atherosclerosis and chronic kidney disease. Endovascular aneurysm repair (EVAR) has proven to be an effective modality to treat AAA, particularly in patients with renal disease, because of its several advantages over the standard open procedure, including lower morbidity, shorter operative time, and shorter hospital stay. A Medline search showed a single publication on renal transplantation (RT) following EVAR of AAA. In this context, we report our case of successful RT in a patient who had undergone EVAR 2 years prior for a 5.7-cm AAA. No stent-related complications, such as graft occlusion, dislodgement, dissection, or endoleak, were observed in the perioperative period. The transplanted kidney had primary function leading to a stable serum creatinine of 115 micromol/L at 6 months. Although the long-term outcome of RT after endovascular repair of AAA remains unknown, currently available evidence shows favorable outcomes of EVAR in the normal population, in patients with renal diseases, and in RT recipients; hence, RT should not be denied to renal failure patients who have undergone EVAR in the past.
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Affiliation(s)
- B M Shrestha
- Division of Renal Transplantation, Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom.
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Shrestha BM. Patient information leaflets in surgical practice: a contemporary review. JNMA J Nepal Med Assoc 2007; 46:84-9. [PMID: 18094744 DOI: pmid/18094744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Undergoing any surgical procedure, however minor this may be, generates a certain degree of anxiety amongst the patients, which is primarily related to the possible postoperative course and complications. Introduction of Patient Information Leaflets (PIL) in routine surgical practice has helped ameliorate this problem significantly and therefore has become a standard practice in the United Kingdom and elsewhere. This review highlights the evidence available in support of the use of PIL and outlines the process of development of PIL in surgical practice.
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Shrestha BM. Massaging thrombosed PTFE hemodialysis access graft - recipe for disaster. J Vasc Access 2007; 8:120-2. [PMID: 17534799 DOI: pmid/17534799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Early thrombosis of a polytetrafluoroethylene (PTFE) graft used for hemodialysis vascular access can result from technical error or hypotension and hypovolaemia in the immediate postoperative period. Massaging a graft to dislodge a freshly formed thrombus with a view to restoring blood flow can lead to acute limb ischaemia from embolisation of the artery as a result of migration of the thrombus from the arterial end of the graft, hence massaging of thrombosed grafts should be avoided. This report describes the management of a 35-year-old diabetic male who developed acute ischaemia of hand due to embolisation of the radial artery following massage of a thrombosed brachio-basilic forearm PTFE loop graft.
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Affiliation(s)
- B M Shrestha
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK.
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Shrestha BM, Nathan VC, Delbridge MC, Parker K, Throssell D, McKane WS, Karim MS, Raftery AT. Vacuum-assisted closure (VAC) therapy in the management of wound infection following renal transplantation. Kathmandu Univ Med J (KUMJ) 2007; 5:4-7. [PMID: 18603977 DOI: pmid/18603977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Wound infection in the setting of immunosuppressed state such as renal transplantation (RT) causes significant morbidity from sepsis, prolongs hospital stay and is expensive. Vacuum-assisted closure (VAC) therapy is a new technique of management of wound based on the principle of application of controlled negative pressure. The aim of this study was to assess the efficacy of VAC therapy in the management of wound infection following RT. MATERIALS AND METHODS This is a prospective study of a cohort of 180 consecutive RTs performed over a period of 4 years, where the data were retrieved from a prospectively maintained computerised database and case-notes. RESULTS 9 of 180 (5%) patients developed wound infection following RT which led to cavitations and dehiscence with copious discharge, and refused to heal with conventional treatment. All 9 cases were treated with VAC therapy. The VAC system was removed after a median of 9 (range 3-30) days when discharge from the wound ceased. Four patients were discharged home with portable VAC device and managed on an outpatient basis, where the system was removed after a median 5.5 (range 3-7) days. The median hospital stay after initiation of VAC therapy was significantly shorter (5, range 2-12 days) than on conventional treatment prior to VAC therapy (11, range, 5-20 days) (p=0.003). Complete healing was achieved in all cases. CONCLUSIONS The use of VAC therapy is an effective and safe adjunct to conventional and established treatment modalities for the management of wound infection and dehiscence following RT. Key words: Renal transplantation, wound infection, vacuum-assisted closure therapy.
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Abstract
A male patient developed colitis and a thrombotic microangiopathy 3 weeks after renal transplantation. Immunosuppression at the time of presentation was with sirolimus, mycophenolate mofetil, and prednisolone, but without a calcineurin inhibitor. Cytomegalovirus infection was excluded. However, human herpesvirus-6 DNA was detected at high copy number in both blood and colonic epithelium. The patient recovered after reduction in immunosuppression, with nutritional support and ganciclovir therapy.
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Shrestha BM, Darby CR, Moore RH. Ureteric complications following renal transplantation: an eight years experience. Kathmandu Univ Med J (KUMJ) 2006; 4:409-14. [PMID: 18603945 DOI: pmid/18603945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Ureteric complications (UCs) following renal transplantation (RT) cause significant morbidity and ureteric stents are employed to bridge the vesico-ureteric anastomosis with a view to preventing these complications. The purpose of this study was to examine the incidence of UCs and outcomes following RT in both stented (STG) and non-stented groups (NSTG) of RT patients. METHODS This is a retrospective study of a cohort of 650 consecutive RTs [STG (N=267; 41%) and NSTG (N=383; 59%)] performed over a period of 8 years, where the data were retrieved from a prospectively maintained computerised database and case-notes. RESULTS The overall incidence of UCs was 6.5% (42/650), which consisted of ureteric obstruction (UO) in 4.3% (28) and ureteric leak (UL) in 2.2%(14) of patients. The incidence of UO was significantly high in the NSTG compared to the STG (6.3% vs.1.5%; P=0.002). However, the incidence of UL (3.4% vs.1.3%; P=0.1) and post-transplant urinary tract infection (UTI) (44% vs.41%; P=0.57) were not significantly different between the STG and NSTG groups. UO and UL were associated with significantly high incidence of UTI (P=0.001 and 0.01, respectively). All UCs were managed successfully without allograft loss. CONCLUSIONS Routine stenting of ureteric anastomosis resulted in reduced incidence of UO without concomitant increased risk of UTI.
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Affiliation(s)
- B M Shrestha
- Renal Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, UK.
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Wallis S, Macierewicz J, Shrestha BM. Behcet's Disease : report of a case and review of the literature. JNMA J Nepal Med Assoc 2006; 45:362-5. [PMID: 17676073 DOI: pmid/17676073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Behcet's disease (BD) is an autoimmune disease of unknown aetiology with multisystem involvement presenting with relapsing orogenital ulcers and uveitis, involvement of central nervous system, joints, lungs, gastrointestinal tract and major blood vessels leading to myriads of presentations, which requires a multidisciplinary approach for satisfactory outcome. We describe a patient with BD, highlight its pathophysiology and management aspects, and present review of pertinent literature.
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Affiliation(s)
- S Wallis
- Northern General Hospital, Sheffield, UK
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Shrestha BM. Renal transplantation: a global perspective. Kathmandu Univ Med J (KUMJ) 2006; 4:267-8. [PMID: 18603914 DOI: pmid/18603914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Shrestha BM. Simultaneous pancreas and kidney transplantation for end-stage renal failure secondary to diabetic nephropathy : principles and practice. JNMA J Nepal Med Assoc 2006; 45:323-30. [PMID: 17334424 DOI: pmid/17334424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Diabetic nephropathy is the second most common cause of renal failure in the United Kingdom where majority of the patients were managed by renal transplantation and insulin therapy in the past. Over the last three decades, increasing number of patients are undergoing simultaneous pancreas and kidney transplantation (SPKT) because of its advantages, which renders the patient both dialysis and insulin-independent, halts the progression of complications of diabetes, thereby improves the quality of life, survival and has proven to be cost-effective. This article presents a review on the principles and contemporary practice of SPKT worldwide and highlights the future directions.
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Affiliation(s)
- B M Shrestha
- Sheffield Kidney Institute, Herries Road, Sheffield S57AU, UK.
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Shrestha BM. Informed consent: what it is all about. Kathmandu Univ Med J (KUMJ) 2005; 3:205. [PMID: 18650575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Shrestha BM. Safety in anaesthesia--Nepal perspective. Kathmandu Univ Med J (KUMJ) 2004; 2:178-9. [PMID: 16400208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Abstract
The toxic effects of chemotherapy have been noted to cause a range of acute necrotizing colonic inflammatory disorders but until recently these have not been associated with docetaxel chemotherapy. Here we report a case of pancolitis presenting as megacolon following the administration of docetaxel for recurrent breast cancer.
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Affiliation(s)
- E V Williams
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, UK
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Maharjan SK, Shrestha BM. Epidural anaesthesia and analgesia. Kathmandu Univ Med J (KUMJ) 2004; 2:18-23. [PMID: 19780283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Among various methods of providing analgesia during surgery for e.g., parenteral opiates and NSAIDS, epidural anaesthesia and analgesia seem to have beneficial efficacy and less side effect profiles. METHODS This study was conducted in 1.53 patients coming for operation at KMCTH between August 2003 to August 2004. Patients were divided in two groups, one group were operated under sole epidural anaesthesia and the other group received a combination of either general anaesthesia or spinal anaesthesia. RESULTS 39 (25.5%) patients underwent sole lumbar epidurals, 36 (23.5%) patients received a combination with spinal (CSE) and 78 (51.0%) were under Combination with general anaesthesia. The patients were interviewed among whom it was found that satisfactory analgesia was reported by 75 cases and 73 cases reported excellent analgesia. Patchy anaesthesia observed in 5 cases who underwent sole epidural anaesthesia. DISCUSSION & CONCLUSION Patients undergoing major surgery with epidural anaesthesia and analgesia had stable cardiovascular parameters, minimal neuroendocrine response, less respiratory complications including SIRS and sepsis, lower incidence of thromboembolic events, less blood loss, reduced hospital stay and better pain control.
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Affiliation(s)
- S K Maharjan
- Department of Anaesthesiology, Kathmandu Medical College, Sinamangal, KTM
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Shrestha BM, Wilkie M, Raftery AT. Delayed colonic perforation caused by an unused CAPD catheter in a patient presenting with diarrhea. Perit Dial Int 2003; 23:610-1. [PMID: 14703210 DOI: pmid/14703210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Tabedar S, Maharjan SK, Shrestha BR, Shrestha BM. A comparison of 25 gauge Quincke spinal needle with 26 gauge Eldor spinal needle for the elective Caesarian sections: insertion characteristics and complications. Kathmandu Univ Med J (KUMJ) 2003; 1:263-6. [PMID: 16388267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The study was designed to compare the insertion characteristics and incidence of PDPH between 25 gauge Quincke needle and 26 gauge Eldor needle for spinal anaesthesia in elective c/s. METHOD 60 pregnant women (aged 19-35 yrs and weighing 58 -67 kg) undergoing elective caesarean section were randomized into group A (Quincke spinal needle group) or group B (Eldor spinal needle group). Spinal anaesthesia was performed with 2.9 ml 0.5% heavy bupivacaine using 25 gauge Quincke spinal needle in group A and 26 Gauge Eldor spinal needle in group B. Onset, time of first identification of backflow of CSF, number of attempts, level of sensory and motor blockade, failure of anaesthesia, inadequate anaesthesia and incidence of PDPH were recorded. RESULT Quincke spinal needle was found easy at insertion, first attempt was successful in 90% of cases, whereas Eldor spinal needle was successful at first attempt in only 60% of cases. Early identification of CSF was seen in Eldor spinal needle group in 3.5 seconds vs. 5.2 seconds in Quincke spinal needle group. Blood mixed CSF was seen in 8 Quincke spinal needle group vs. none in Eldor spinal needle group. Onset was similar between both groups i.e. in 6 minutes. Failure of anaesthesia was none in Eldor spinal needle group vs. 2 in quincke spinal needle group. Height of sensory block achieved was T4 level in 26 parturients,T6 in 1 ,T8 in 1 and no anaesthesia at all in another 2 parturient as compared to T4 level in 29 and T3 in 1 parturient in Eldor spinal needle group. The degree of motor block with the use of Bromage criteria showed a motor score of 1 or 2 in 26 parturients in Quincke spinal needle group vs. same in all cases in Eldor spinal needle group. The total incidence of PDPH was 8.3 % (5 out of 60 parturient) which occurred all in Quincke spinal needle group. 2 parturient who developed severe PDPH required epidural blood patch. CONCLUSION 26 gauge Eldor spinal needle was found to be better than 25 gauge Quincke spinal needle for caesarian sections to decrease the incidence of PDPH, though not all insertion characteristics were in favour of the Eldor needle.
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Affiliation(s)
- S Tabedar
- Department of Anaesthesia, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
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Lamichhane N, Tan ZB, Neupane PR, Thakur BK, Shrestha BM, Dhakal HP. SURGICAL TREATMENT OF CARCINOMA OESOPHAGUS AT B P KOIRALA MEMORIAL CANCER HOSPITAL, BHARATPUR. JNMA J Nepal Med Assoc 2003. [DOI: 10.31729/jnma.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
To review resectability, lymph node status and post-operative complications in cases of carcinoma ofoesophagus treated surgically at B P Koirala memorial cancer hospital (BPKMCH), we reviewed the medicalrecords of 16 surgically treated cases of carcinoma oesophagus from January 2001 to March 2002. Therewere 5 patients in stage IIa and 9 patients in stage III. Tumor was resectable in 14 out of 16 patients (87.5%).There was no perioperative mortality. Anastomotic leak was seen in one case. Out of 14 resected specimens,7 (50%) of them had lymph node metastasis. Oesophagectomy is a safe procedure if done in a well-selected group of patients. Resectability is considerably high with minimal perioperative complications.Key Words: Carcinoma oesophagus, surgical therapy, lymphnode metastasis.
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Shrestha BM. Radial artery as a conduit for diabetic crural bypass (Br J Surg 2003; 90: 57-58). Br J Surg 2003; 90:593. [PMID: 12734868 DOI: 10.1002/bjs.4226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Shrestha BM. Muscle relaxant in 21st century. Kathmandu Univ Med J (KUMJ) 2003; 1:60-5. [PMID: 16340268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- B M Shrestha
- Department of Anaesthesia, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
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Shrestha BM, Stephenson BM, Davies JP, Sturdy DE. Multiple Primary Carcinomata: Clinical and Genetic Management. JNMA J Nepal Med Assoc 2003. [DOI: 10.31729/jnma.2074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
abstract
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Gongal DN, Shrestha BM, Gurubacharya VL, Shrestha J. Patterns of Post Operative Wound Infection and their Antibiotic Sensitivity in Bir Hospital. JNMA J Nepal Med Assoc 2003. [DOI: 10.31729/jnma.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Abstract
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Shrestha BM. Development of anesthetic Service in Eastern Part of Nepal. JNMA J Nepal Med Assoc 2003. [DOI: 10.31729/jnma.1815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
abstract
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Shrestha BM, Darby C, Fergusson C, Lord R, Salaman JR, Moore RH. Cytomegalovirus causing acute colonic pseudo-obstruction in a renal transplant recipient. Postgrad Med J 1996; 72:429-30. [PMID: 8935605 PMCID: PMC2398516 DOI: 10.1136/pgmj.72.849.429] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A female patient presented with pyrexia and features of large intestinal obstruction, 10 weeks posttransplantation, with biopsy-proven colitis caused by cytomegalovirus (CMV) and positive CMV antigenaemia and IgM tests. The symptoms resolved after treatment with ganciclovir, nasogastric aspiration and intravenous fluid replacement.
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Affiliation(s)
- B M Shrestha
- Renal Transplant Unit, Cardiff Royal Infirmary, UK
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Shrestha BM, Parton D, Gray A, Shephard D, Griffith D, Westmoreland D, Griffin P, Lord R, Salaman JR, Moore RH. Cytomegalovirus involving gastrointestinal tract in renal transplant recipients. Clin Transplant 1996; 10:170-5. [PMID: 8664513 DOI: pmid/8664513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Infection due to cytomegalovirus (CMV) is a substantial cause of mortality and morbidity among renal transplant recipients but the prognosis of the disease has changed dramatically since the introduction of ganciclovir (GAN). During a period of 5 years we treated 54 patients who developed CMV disease. From this group of patients we identified 7 patients with primary gastrointestinal tract (GIT) CMV disease who received treatment with GAN. Tissue diagnosis was made by endoscopy of the upper GIT (6 patients) or sigmoidoscopy (one patient) and histological examination. All patients improved after treatment with GAN; three patients required additional treatment for recurrent CMV disease and recovered, and 1 patient relapsed without GIT involvement (P = 0.014). Recurrent CMV disease was more severe (mean score of 15 in relapse compared to 7 in the first episode). We believe relapse to be more common and the disease to be more severe in the presence of GIT involvement suggesting that a longer duration of treatment with GAN may be required in this clinical manifestation of CMV disease.
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Affiliation(s)
- B M Shrestha
- Renal Transplant Unit of Cardiff Royal Infirmary, University of Glamorgan, Wales
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Abstract
In developing countries like Nepal, anaesthetic compressed gases, especially nitrous oxide, are expensive and in short supply and anaesthetic techniques must equally use oxygen and volatile anaesthetics sparingly. We have designed a non-rebreathing anaesthetic system which meets these requirements. An Ambu-E anaesthetic valve and self-inflating Ambu bag connected to a Bain system form a non-rebreathing system which uses ambient air to supplement a mixture of low flow oxygen and halothane. Over 100 patients have been anaesthetised with this system using a balanced anaesthetic technique. The oxygen flow was 2 l.min-1 and the average halothane consumption was 8 ml.h-1. The average inspired oxygen concentration was 34%, and the air:oxygen dilution ratio was 5:1. A graphical analysis of gas flow predicts that the system is almost 100% efficient, in that almost all of the oxygen and halothane will enter the alveoli. Our experience confirms that this is a safe, simple and economical method for inhalation anaesthesia. We recommend it for locations where anaesthetic machines and mechanical ventilators are lacking, and where medical oxygen is in short supply.
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Affiliation(s)
- B M Shrestha
- Department of Anaesthesia, University of Manitoba, Winnipeg, Canada
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Shrestha BM. Operative lumbar sympathectomy for severe lower limb ischemia: still a valuable treatment option. Ann R Coll Surg Engl 1994; 76:285. [PMID: 8074397 PMCID: PMC2502254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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