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Background: The aim of this study is to explore the treatment strategies being followed for patients with obstructing colorectal cancer (OCRC) at our institute and to know the management outcomes.Methods: This study included 28 patients who were diagnosed with obstructing colorectal cancer (OCRC) either preoperatively or intraoperatively over a period of 5 years.Results: Most were in the younger age group with mean age of 49.78 ± 15.96 years with 1/4th of the patients being younger than 40. There was no difference in incidence of OCRC among genders. It was found to be common in rural areas of the eastern Nepal, 16(57%) patients from such areas. 21.4% patients had complete bowel obstruction at presentation. The investigating modalities used were abdominal X-ray, ultrasonoghraphy of abdomen/pelvis, abdominal CT-scan, colonoscopy, serum CEA, punch biopsy and Faecal occult blood test. The anatomical shift to the right was observed with 54% lesions in the proximal colon. Majority were in advanced stage (stage 3:53.6%, stage 4:32.1%) with histologically adenocarcinoma (100%) and a higher incidence of synchronous lesion (28.6%). Patients averaged 13.82 days in the hospital with post-operative mortality rate of 3.6%. The 1-year and 2-years disease free survivals were 89.3% and 82.1% while overall survivals were 92.8% and 82.1% respectively.Conclusion: In developing countries like ours, relatively younger patients present to health center with obstructive colorectal cancer with anatomical shift to the right sided lesions. The treatments provided at our center and their outcomes are not inferior to that of the developed world. [ABSTRACT FROM AUTHOR]

An echocardiographic investigation is one of the key modalities of diagnosis in patients suffering from COVID 19, especially if they are elderly, have associated comorbid conditions, and pregnant. Hence, it is becoming extremely essential to look into the correct safety precautions, health-care professionals must take while conducting an echo investigation. At the same time, a focused echo examination aimed at correct imaging view acquisition in the shortest possible time is the need of the hour. The decision matrix formulated for conducting an echocardiographic evaluation is based on the presence or absence of cardiological comorbidity vis-a-vis positive or suspected for COVID- 19. The safety measures and image acquisition have been constructed keeping in mind the current safety precautions by the World Health Organization, the Centers for Disease Control and Prevention, and the Ministry of Health and Family Welfare, India. [ABSTRACT FROM AUTHOR]

Background: Subclinical hyperthyroidism is an increasingly recognized entity that is defined as normal serum free thyroxine and free triiodothyronine levels with thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. Subclinical hyperthyroidism may be related only in part to Graves' disease or multi nodular goitre. The burden of thyroid disease in the general population is enormous. Here, we critically study the prevalence of subclinical hyperthyroid disease in the population of Central Nepal. Materials and Methods: The study was carried out at National Medical College and Teaching Hospital, Birgunj, Nepal Anthropometric data were collected including thyroid function profile (free T3 and free T4). Results: Of the 680 patients in the study group, 165 were males and 515 were females, ranging from 21 to 60 years of age. Status of euthyroid, overt hyperthyroid, subclinical hyperthyroid, and low free T3 & T4 levels were seen in 70.74%, 12.65%, 10.44%, and 6.18% respectively in cases. The prevalence of subclinical thyroid disease was found to be 10.44%, with 2.4% in males and 8.04% in females; and being more prevalent in age group 21-40 years age compared to other age groups (p<0.05). Conclusion: The prevalence of subclinical hypethyroidism amongst the suspected cases was 10.44 % which is much higher compared to the other parts of the world, with higher prevalence seen in females as compared to males. The reason(s) for such a high prevalence of hyperthyroidism in central Nepal needs to be studied further. [ABSTRACT FROM AUTHOR]

Background: Pancreaticoduodenectomy is a complex high-risk surgical procedure usually done for malignant disease carrying significant postoperative morbidity and mortality. An audit and analysis of rate of postoperative morbidity and mortality and the impact of case volume can provide information about the lacunas in patient care and methods to improve it for safe and early discharge of patients. This study was conducted to find out demographic profile, the rate of perioperative morbidities, mortality, and impact of case volume on patients undergoing pancreaticoduodenectomy for malignant disease which may serve as a guide to uplift the patient care in our center., Methods: Retrospective analysis of prospectively collected data of patients undergoing pancreaticoduodenectomy from 2015 to 2019 was performed. A total of 62 patients were included in the study. Patient's clinic-demographic details and intraoperative and postoperative events were recorded. The rate of various postoperative morbidities and mortality and year-wise trend of these factors were analyzed., Results: Most of the patients were in the sixth decade of life (38.7%) with male preponderance (61.3%). Pancreatic cancer was most commonly seen followed by cholangiocarcinoma (46.8%). SSI (32.3%), intraabdominal collection (25.8%), anastomotic leak (14.5%), pancreatic fistula (22.6%), and postpancreatectomy hemorrhage (8.1%) were the major postoperative events. Mortality was found in 12.9% patients., Conclusion: There has been a decrease in rate of all these postoperative adverse events and improvement in the intraoperative blood loss and surgical duration with advancing years and increasing number of cases., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Cholelithiasisis is a common surgical problem worldwide. Gall bladder perforation is a rare life-threatening complication with considerable mortality. This study aims to find the etiology, demography, type of perforation, and outcome of gall bladder perforation., Methods: This descriptive cross-sectional study was done on patients above 18 years of age visiting the department of surgery of B. P. Koirala Institute of Health Sciences (BPKIHS) who were diagnosed with isolated gall bladder perforation. The study was done from 1st January 2006 till 30 December 2016. Ethical approval was obtained from the Institutional Review Committee (reference number. 34/074/075). The convenient sampling method was used. Data were entered in excel sheets and analyzed., Results: Out of 49 patients included in the study, 28 (57.14%) were females and the commonest age group was 36 to 50 years 22 (44.9%) followed by 51 to 65 years 16 (32.6%). Most of the patients presented in emergency with pain in their abdomen. Diabetes mellitus was the commonest co-morbidity present in 10 (20.41%) patients. Operative management was done in 45 (91.84%) of the patient and conservative management in 4 (8.16%). After surgery of 45 patients, 43 (95.56%) improved and 2 (4.44%) expired. The most common type of perforation was Niemeier Type I in 21 (46.67%) followed by Type III 14 (31.11%). The most common histopathological diagnosis was acute cholecystitis 20 (44.44%)., Conclusions: Isolated gall bladder perforation is not an uncommon complication. The most common etiological factor was acute cholecystitis with a slight female predominance. Most of the patients needed surgical intervention and they had good outcomes when diagnosed and managed on time.

Objective: The objectives were to review adult intussusception (AI), its diagnosis and treatment., Background Data: Intussusception is a different entity in adults than it is in children. AI represents 1% of all bowel obstructions, 5% of all intussusceptions., Methods: The records of all patients, 18 years and older, with the postoperative diagnosis of intussusception at the B.P.K.I.H.S during the years 2003-2009 were reviewed retrospectively., Results: In six years, there were thirty-eight patients of surgically proven AI. The patients' mean age was 49.6 years, M:F ratio was 1.3:1. Intestinal obstructions of various extents were the commonest presentation in twenty-seven patients (71%). There were 42% enteric, 32% ileocolic and 26% colonic AI. The diagnostic accuracy of the ultrasonography was 78.5%, CT scan was 90% and colonoscopy was 100%. The pathological lesions were found in 94% of AI. Among the pathological lesion, enteric have 62% benign, 38% malignant, ileocolic have 50% benign, 50% malignant, and in colocolic 70% malignant, 30% benign. In enteric AI, 68% were reduced successfully, 25% reduction was not attempted. Of ileocolic AI, 58.3% were reduced successfully, 41.6% had resection without reduction. Of colocolic AI, 30% of them were reduced successfully before resection, 70% had resection without reduction., Conclusions: AI is a rare entity and requires a high index of suspicion. CT scanning proved to be the most useful diagnostic radiologic method. Colonoscopy is most accurate in ileocolic and colonic AI. The treatment of adult intussusception is surgical. Our review supports that small-bowel intussusception should be reduced before resection if the underlying etiology is suspected to be benign or if the resection required without reduction is deemed to be massive. Large bowel should generally be resected without reduction because pathology is mostly malignant., (Copyright © 2010 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

Objectives: With increasing surgeon experience, laparoscopic cholecystectomy has undergone many refinements including reduction in port number and size. Three-port laparoscopic cholecystectomy has been reported to be safe and feasible in various clinical trials. However, whether it offers any additional advantages remains controversial. This study reports a randomized trial that compared the clinical outcomes of 3-port laparoscopic cholecystectomy versus conventional 4-port laparoscopic cholecystectomy., Methods: Seventy-five consecutive patients who underwent elective laparoscopic cholecystectomy were randomized to undergo either the 3-port or the 4-port technique. Four surgical tapes were applied to standard 4-port sites in both groups at the end of the operation. All dressings were kept intact until the first follow-up 1 week after surgery. Postoperative pain at the 4 sites was assessed on the first day after surgery by using a 10-cm unscaled visual analog scale (VAS). Other outcome measures included analgesia requirements, length of the operation, postoperative stay, and patient satisfaction score on surgery and scars., Results: Demographic data were comparable for both groups. Patients in the 3-port group had shorter mean operative time (47.3+/-29.8 min vs 60.8+/-32.3 min) for the 4-port group (P=0.04) and less pain at port sites (mean score using 10-cm unscaled VAS: 2.19+/-1.06 vs 2.91+/-1.20 (P=0.02). Overall pain score, analgesia requirements, hospital stay, and patient satisfaction score (mean score using 10-cm unscaled VAS: 8.2+/-1.7 vs 7.8+/-1.7, P=0.24) on surgery and scars were similar between the 2 groups., Conclusion: Three-port laparoscopic cholecystectomy resulted in less individual port-site pain and similar clinical outcomes with fewer surgical scars and without any increased risk of bile duct injury compared with 4-port laparoscopic cholecystectomy. Thus, it can be recommended as a safe alternative procedure in elective laparoscopic cholecystectomy.