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Malignant effusions are a common presenting sign of malignancy and reflect dissemination. A retrospective study of all fluid samples accessioned at the Department of Pathology, TUTH from April 2000 to October 2002 were done. Over the study period, a total of 584 specimens were examined- 324 peritoneal fluid, 224 pleural fluid, 19 pericardial fluid, 9 knee joint effusion and 8 Cerebro-Spinal Fluid (CSF). One hundred and nine (18.66%) out of 584 cases were found to have malignancy, 57 were male and 52 were female. The age group of the adult male ranged from 42-78 years and female ranged from 43-62 years. Three patients were children with age ranging from 8-11 years. Adenocarcinoma was the commonest that comprised 89%, followed by Non Hodgkin’s lymphoma 6.5% squamous cell carcinoma 2.7% and small cell carcinoma comprised 1.8 %. Exfoliative cytology is cheap, rapid and highly effective tool for the evaluation of body fluid and should be advised in all effusion cases. Key Words: Cytology, malignant effusion, cytocentrifuge.

Aspergillosis is the commonest fungal infection of nose and paranasal sinuses. Its invasive form is rare in a healthy patient. A case of fungal multisinusitis with intracranial extension with characteristic computerized tomographic finding is reported. Key Words: Aspergillosis, intracranial extension, CT scan, external frontoethmoidectomy.

Cough is one of the most common symptom for which patients seek medical attention from primary care physicians and pulmonologists. Although tuberculosis and other lung infections are common throughout the developing world, they are not among the most common causes of chronic cough. We report a case of a 23 years old male who presenting to the outpatient clinic with chronic cough not responding to regular and symptomatic treatment that was diagnosed to have thymoma. After all the common causes for chronic cough have been ruled out, unusual causes should also be considered in the differential diagnosis. KEYWORDS: Chronic cough, Thymoma, Anterior Mediastinum.

Abstract

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A hospital based cross-sectional study was conducted from March 2005 to April 2006 to evaluate the distribution of various respiratory diseases by spirometry. A total of 228 consecutive cases referred for spirometry were included of which 65% were male and 35% female. COPD was the commonest referral diagnosis (40%) followed by the diagnosis of shortness of breath (22%). After spirometry the prevalence of COPD was 42%, Asthma 23.5%, Restrictive disease 3.1% and mixed obstructive and restrictive disease 3.5%. 25% of the sample population was smokers and 22% ex-smokers. Hence we conclude that spirometry is a very useful diagnostic tool for preliminary diagnosis of respiratory diseases and should be used more by general practitioners and physicians to make their diagnosis and therapy more scientific.

Functional Endoscopic sinus surgery (FESS) is a minimally invasive surgical procedure that opens up the sinus air cells and the sinus ostia with an endoscope. The use of FESS as a sinus surgical method has now become widely accepted and the term functional is meant to distinguish this type of endoscopic surgery from the nonendoscopic more conventional sinus procedure. Functional Endoscopic sninus surgery is being done regularly at TU Teaching Hospital from 2003. Total number of cases done from March 2003 till December 2005 were 94. Maximum number of FESS was done for nasal polyps, which was carried out in 80 patients, out of which, FESS for ethmoidal polyp was done in 47 patients and for antrochoanal polyps in 33 patients. Other conditions where FESS was carried out were chronic maxillary sinusitis in 8 patients, fungal sinusitis in 5 patients, and endoscopic medial maxillectomy for inverted papilloma in 1 patient.

Transesophageal echocardiography (TEE) was performed in 114 patients with rheumatic mitral valvular disease and its results were compared with those of transthoracic echocardiography (TTE). Of 114 patients, LA thrombus was detected in 32 patients by TEE whereas TTE could detect LA thrombus in only 4 of them. Out of 32 cases, thrombus was located in left atrial appendage (LAA) in 20 (62%). TTE could detect LAA thrombus in only one patient. The procedure of TEE was well tolerated and there was no complication. We conclude that TEE is superior to TTE in detection of LA cavity and LA appendage thrombus. Hence, TEE should be a routine procedure to detect LA thrombus in patients with rheumatic mitral valvular disease prior to any surgical intervention. Key Words: Left atrial appendage (LAA), Transthoracic echocardiography (TTE), Transesophageal echocardiography (TEE)

A retrospective study was conducted among out-patient and in-patient in Kathmandu medical college Teaching hospital of one month from the duration 2060-11-15 to 2060-12 -15. Mid-stream urine [MSU] of 300 patient were cultured. Out of these, 75 patients’ urine were found to have significant bacterial growth. Total of five species of bacterial species isolated were viz.E.coli 37(33.3%), Proteus species 25(27.7%), Klebsiella species 15(16.6%), Staphylococcus aureus 8(8.8%) and Pseudomonas aureginosa 1(1.1%). Regarding their antibiotic sensitivity pattern, E. coli were sensitive to Nitrofurantoin 31 (83.8% ), Norfloxacin 25 (67.5%), Ofloxacin 30(81.0%), Amoxycillin 16(43.2%), Nalidixic acid 15 (40.5%).proteus species were sensitive to Nitrofurantoin 15 (60.0%), Norfloxacin 15 (60.0%), Ofloxacin 12(48.0%), Amoxycillin 13(52.0%), Nalidixic acid 10 (40.0%), Ciprofloxacillin 12(48.0%). Klebsiella species were sensitive to Nitrofurantoin 9 (60.0%), Norfloxacin 5 (33.3%), Oflaxin 6(40.0%), Amoxycillin 5(33.3%), Nalidixic acid 4 (26.6%), ciprofloxacillin 6(40.0%). Staphylloccus aureus were sensitive to Nitrofurantoin 8(100.0%), Norfloxacin 6(75.0%), Oflaxin 8(100.0%), Amoxycillin 7(87.5%), Nalidixic acid 6(75.0%), Ciprofloxacillin 8(100 %). And Pseudomonas aureginosa were resistant to all antibiotics which we are using in this research work. Key Words: Urine sample, Identification, Sensitivity pattern.

This retrospective study was carried out in the Department of ORL and Head & Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu. Three hundred patients having atticoantral type of chronic suppurative otitis media underwent emergency or routine mastoid exploration from 14 April 1997 to 12 April 2000. Of the 300 patients, 64 (21.33%) had complications. Age of the patients with complications ranged from 5-38 years. Thirty eight (59.38%) patients were male while 26 (40.62%) were female. Forty eight (75%) had extracranial and 15 (23.44%) had intracranial complications while 1 (2.08%) had both extra and intracranial complications. Cholesteatoma was present in 233 (77.66%) patients and of these 48 (20.60%) had complications. Sixty seven (22.33%) patients had granulation tissue, of these 16 (23.88%) had complications.In cholesteatomatous cases 34 (70.83%) had extracranial complications. Intracranial complications were present in 14(29.17%) cholesteatomatous cases. In patients with granulation tissue extracranial complication was present in 14 (87.50%) patients and only one patient had intracranial complication.Combination of extra and intracranial complications were found in 1 patient with granulation tissue. When compared with types of pathology extracranial complications were higher in patients with granulation tissue (87.50% vs 70.83%) and intracranial complications were found more in cholesteatomatous cases (29.17% vs 6.26%). Both these findings were , however, statistically not significant. Reasons behind these findings may be presence of granulation tissue beneath the epithelium of choleateatoma, and association of both types of pathology with infection and inflammatory process. Key Words: Chronic Suppurative Otitis Media, Atticoantral Type, Mastoid Exploration, Complications.

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Abstract