Introduction: Low backache is commonly experienced by adults at some time during their lives. Though it is caused by degenerative changes, spinal stenosis, neoplasm, infection and trauma, lumbar ...disc degeneration is the most commonly diagnosed abnormalities associated. As Magnetic Resonance Imaging (MRI) is non invasive imaging technique with excellent spatial and contrast resolution, it has become the investigation of choice in evaluation of patients with low back pain. This study was designed to determine the patterns of degenerative disc disease on MRI in patients with low backache.Methods: A retrospective hospital based study was done by reviewing MRI report of 202 patients who underwent MRI of lumbar spine for complaint of chronic low back pain, radicular pain, neurogenic claudication or various other symptoms and signs suggestive of lumbar degenerative disc disease from January 2014 till June 2014. The patients having MRI findings of acute spinal infection, recent trauma, tumors, spinal dysraphism and metabolic conditions were excluded from the study.Results: Out of the 202 patients included in the study, 116 patients (57.4%) were male and 86 patients (42.6%) were female. The mean age of the study population was 44.26 ±15.61 (13-83) years. Multiple contiguous level disc disease was the most common type of involvement which was noted in 109 (54%) patients. Grade 4 lumbar disc degeneration (graded as per classification given by Pfirrmann et al) was noted in 65.3% (132) cases followed by Grade 2 in 25.2%(51) cases and Grade 1in 5.5% (11) cases. The most common involvement was observed at L4-L5 level (76.7%) and L5-S1 levels (55.9%) followed by L3-L4 (30.6%) in decreasing order of frequency. The most common category was disc bulge note in 46.5% (94) of cases. Nerve root compression was observed in 56% (114) of the total cases. Nerve root compromise was also noted most frequently compressing L5 nerve (28.23% of cases). Annular tear was observed in 14.4% (29) of cases and among them 20% (6) of cases had torn at two intervertebral discs. It is most frequently noted involving L4-L5 intervertebral disc (72.5% of cases), followed by L5-S1 (24.2% of cases).Conclusion: Disc generation is most common at L4-L5 level with multiple contiguous involvement of grade 4. Annular tear though not common can occur and is also common at L4-L5 level.Journal of Society of Surgeons of Nepal, 2015; 18 (2)
Background & Objectives: Ectopic pregnancy is one of the common medical emergencies encountered in the clinical practice. Confirmation of diagnosis is usually done by urine pregnancy test and ...transabdominal sonography. Thus, the present study is carried out to determine the role of transabdominal ultrasonography in the diagnosis of ectopic pregnancy by comparing the ultrasonography findings with that of operative and histopathology and to evaluate clinical profile of the women with confirmed ectopic pregnancy. Materials & Methods: Transabdominal ultrasound record of patients referred for first trimester ultrasound, from January 2008 to December 2015, at radiology department of Kist medial college teaching hospital were reviewed to identify patients with ectopic pregnancy. Among these patients those who underwent surgery and histopathology confirmed ectopic pregnancies were identified and their medical records were retrieved. Ultrasound and clinical profile were recorded and statistically analyzed. Results: There were 19 patients with ultrasound diagnosis of ectopic pregnancy among 1480 first trimester ultrasound record. Among these patients, ectopic pregnancy was confirmed on 18 patients. Ultrasound diagnosis included adnexal mass with pelvic fluid in 15 (83.3%) patients and pelvic fluid without adnexal mass in 4 (16.7%) patients. The study result revealed that sensitivity of transabdominal ultrasonography was 100% and specificity was 99.9%. Positive predictive value and negative predictive value of transabdominal ultrasonography was 94% and 100%.Conclusion: The transabdominal ultrasound accurately diagnose ruptured ectopic pregnancy.JCMS Nepal. 2016;12(1):1-4.
Background: Chronic obstructive pulmonary disease is most common disease entity and third leading cause of mortality worldwide. The presence of bronchiectasis in severe chronic obstructive pulmonary ...disease patients had led to frequent exacerbation requiring hospitalizations. The purpose of this study was to identify the factors associated with bronchiectasis, using routine data collected during medical visits from patients diagnosed with chronic obstructive pulmonary disease.Materials and Methods: This is hospital based cross sectional study conducted on 120 chronic obstructive pulmonary disease patients. All patients were subjected through history, examination, pulmonary function test, sputum samples and imaging of chest.Results: Out of 120 patients among them 67 patients (55.8%) were chronic obstructive pulmonary disease without bronchiectasis while 53 patients (44.1%) had chronic obstructive pulmonary disease with bronchiectasis. Thirty patients (56.6%) having chronic obstructive pulmonary disease with bronchiectasis and 18 patient (26.8%) having chronic obstructive pulmonary disease without bronchiectasis had exacerbation in one year requiring hospitalisation. Most common organisms isolated were Pseudomonas Aeruginosa in 20 patients (55.5%), Klebsillae Pneumoniae in 6 patients (16.6%) among chronic obstructive pulmonary disease with bronchiectasis group.Conclusion: Chronic obstructive pulmonary disease patient with severe airflow limitation, with frequent exacerbation and colonisation with isolation of organisms resulting in bronchiectasis requiring frequent hospitalisation.
Background Ultrasonography is one of the most common imaging modality to measure dimensions of visceral organs in children. However, the normal limit of size of visceral organs according to age and ...body habitus has not been specified in the standard textbooks. This might result in under detection of organomegaly in pediatrics population.Objective The objective of this study was to determine the normal range of dimensions for the liver, spleen, and kidney in healthy children.Method This is prospective cross-sectional, hospital-based study done at Tertiary-care teaching hospital. Participants included 272 pediatric subjects (152 male and 120 female) with normal physical or sonographic findings who were examined because of problems unrelated to the measured organs. The subjects were one month to 15 year (180 months) old. All measured organs were sonographically normal. Relationships of the dimensions of these organs with sex, age, body weight and height were investigated. Limits of normal dimensions of these organs were defined.Result Normal length of liver, kidneys and spleen were obtained sonographically for 272 children (152 male 55.9% and 120 female 44.1%) in the age group from 1 months to 15 (180 months) years. The mean age was 45.78 months (SD, 44.73). The measured dimensions of all these organs showed highest correlation with height and age so the descriptive analysis of the organ dimensions (mean, minimum, and maximum values, SD and 5th and 95th percentiles) were expressed in 10 age groups along with height range of the included children. The mean length of right kidney was shorter than the left kidney length, and the difference was statistically significant (p = 0.001).Conclusion This study provides practical and comprehensive guide to the normal visceral organ dimension in pediatric population. The normal range limit of the liver, spleen, and kidney determined in this study could be used as a reference in daily practice in local radiology clinics.
Introduction: Ultrasonography is cheap, non-invasive, reliable, fast method of diagnostic investigation in the measurement of liver size. Normal range of liver size helps to diagnose hepatomegaly ...sonologically which may be clinically inapparent. Thus warrants further clinical evaluation and other investigations for the prevention of major hepatic comorbidities.
Methods: A prospective, cross-sectional study was conducted on 400 adults with sonographic findings unrelated to liver pathologies. The liver was measured in right midclavicular line from hepatic dome to lower hepatic margin. The correlation between liver size and age, sex, weight, height, body mass index (BMI), and body surface area(BSA) was calculated. The data were properly analyzed in SPSS version 20 software.
Results: Out of 400 patients, a male: female ratio of 1:1.25, and the age group was ranging from 20 years to 83 years with a mean age of 48.10±14.86 years were included. The mean liver length in males was 15.05 ± 0.27 cms, females were 14.32 ± 0.29 cms and the total population was 14.73 ±0.46 cms. There was a strong statistically significant correlation between liver size and height, weight whereas the correlation between liver span and BSA was moderate to weak but significant. Similarly, there was a weak but significant correlation between liver size and BMI with no significant association between liver size and age.
Conclusion: Accurate assessment of liver size is of utmost importance in the evaluation of suspected hepatic pathologies.
Introduction:
Thyroid nodules are commonly encountered pathologies worldwide. High-resolution ultrasonography is the first-line investigation for the evaluation of thyroid nodules as it is a cheap, ...quick, non-invasive, easily accessible modality without radiation hazards. Our major concern is to select suspicious thyroid nodules and early detection of malignancy. Fine needle aspiration cytology (FNAC) when correlated with ultrasonographic imaging features helps inaccurate assessment of categorizing thyroid nodules. USG guided FNAC is a widely practiced procedure because it is a less time-consuming simple procedure and helps to locate suspicious sites more precisely to get a higher yield.
Methods:
Total 70 patients with thyroid nodules detected by ultrasonography dated from October 2020 till September 2021 were enrolled in the study. The enrolled patients had FNAC in the same settings. The ultrasonographic characteristics of thyroid nodules were assessed and correlated with cytology reports.
Results:
Amongst 70 patients, 84.3% were female and 15.7% were male with a male:female ratio of 1:1.8. The mean age was 48.6 ± 13.2 years. Out of 70 patients, 49 patients had benign nodules while 21 patients had malignant nodules. Nodules that have characteristics like ill-defined border, hypoechoic echotexture, having predominantly solid components, microcalcification, increased central vascularity, and absence of halo are good indicators of malignancy. The sensitivity, specificity, positive, negative predictive value, and accuracy of ultrasonography were 72%, 91.8%,78.9%, 88.2%, and 85.7 % respectively.
Conclusion:
Ultrasonography is the most accurate, sensitive, and specific modality in categorizing thyroid nodules. A significant correlation of p< 0.05 was observed between ultrasonography with FNAC resulting in good accuracy. There is less chance of missing malignancy which helps to reduce unnecessary surgeries and promotes surgical intervention.
Introduction: Semi-industrialized countries like Nepal have high mortality and disability rates due to cerebrovascular accident, representing for more than 80% of all stroke deaths globally. ...Stroke is the most common neurological disorder requiring prolonged hospital stay. Aims of our study was to evaluate the role of computerized tomography in evaluation of cerebrovascular accident by differentiating ischemia from hemorrhage and proper identification of negative cases.
Methods: A descriptive cross sectional study of total 155 patients, clinically diagnosed as stroke, referred to our department of radiology for computerised tomography evaluation during six month period, were enrolled into study. The clinical information, proper history, computerised tomography findings were properly documented and analysed in SPSS version 20 software.
Results: Out of total 155 patients, 85 cases (55 %) were males and 70 cases (45 %) were females with male: female ratio of 1.2:1. The mean age of the patients was 63±15 years. There was significant correlation between clinical with neuroradiological findings as evidenced by p value of 0.000. Sensitivity, specificity, positive predictive value, negative predictive value of clinical findings when correlated to CT in diagnosing ischemic infarction were 84.3%, 67.3%, 82.6%, 70%. Similarly, sensitivity, specificity, positive predictive value, negative predictive value in diagnosing hemorrhagic infarction were 67.3%, 84.3%, 70%, 82.6% respectively.
Conclusions: Computerised tomography is the first line reliable imaging modality for diagnosis, management of cerebrovascular accident and exclusion of stroke mimicker lesions. Education regarding prevention and control of modifiable risk factors can minimize the incidence of stroke.
Introduction: Proptosis is defined as bulging of eye anteriorly out of the orbit. Our main objective was to analyze the pattern of computerised tomographic findings in evaluation of proptosis. ...Computerised tomography (CT) is noninvasive, easily accessible, affordable and reliable imaging which helps in early diagnosis and prompt treatment.
Methods: A descriptive cross sectional study of total 58 patients presenting with proptosis referred to our department of radiology for computerised tomography evaluation during one year period were undertaken into study. The clinical information provided by ophthalmologist also helped our study to derive into conclusion. SPSS version 20 software was used for statistical data analysis.
Results: Out of 58 patients, the most common cause of proptosis was neoplasm constituting of 25 cases (43.1%). Retinoblastoma was the commonest orbital tumor. Out of remaining cases, 15 (25.8%) were infective, 14 (24.1%) were inflammatory, two (3.44%) were traumatic and remaining two cases (3.44%) had no definitive cause for proptosis. Bilateral proptosis was commonly associated with thyroid ophthalmopathy. Among the subjects 32 were male, 26 were female. Male: Female ratio was 1:1.23. Age group was ranging from 1 month to 73 years.Mean age was 26.4 ± 22 years.
Conclusions: Computerised tomography has an important role in distinguishing the different types of lesions based on their characteristics, location and extension prior to undertaking definitive surgical and medical treatment. Overall accuracy of CT in our study was 81%, sensitivity of 82.6%, specificity of 80.6%, positive predictive value of 76% and negative predictive value of 86.2%.
Urethral duplication is uncommon with few cases reported in the literature. We report a case in which a patient presented with discharge from proximal part of penis since childhood and recent history ...of infection. The diagnosis of pre‐pubic sinus was made and complete excision of the sinus tract was done.
Intra operative photograph showing complete sinus, a rare entity, which when diagnosed timely and treated will lead to a better quality of life.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Alkaline water electrolysis (AWE) operated by surplus electricity is suitable for producing green hydrogen in Nepal. Simulation models are built using DWSIM software for AWE, multistage compression, ...and the Organic Rankine Cycle (ORC). The AWE system's Capital Expenditure (CAPEX) is determined to be $47 million and Operational Expenditure (OPEX) of $7.65 million/year. The storage system, including the multistage compression system and Type IV cylinders, has a CAPEX of $52 million and an OPEX of $17 million/year. The ORC has a CAPEX of $500,000 and an OPEX of $200,000/year. The thermal power generated from AWE and multistage compression can be converted to electricity by the ORC and supplied to the AWE system. This process decreases the Levelized Cost of Hydrogen (LCOH) from $3.5141/kg over 5 years to $3.4725/kg over 25 years. The techno-economic analysis performed confirms the feasibility of implementing these plants in Nepal.
•A 10 MW AEL and multistage compression model are connected to the ORC.•Hydrogen produced by AEL is compressed by using a multistage compressor.•The ORC's efficiency relies primarily on the quantity of organic compound used.•Values of LCOH decrease with years of operation.•The storage method can be a good option for storing hydrogen produced in Nepal.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
PDF
