Yogendra Singh - Academia.edu (original) (raw)
Papers by Yogendra Singh
Innovative Surgical Sciences
Objectives Iliopsoas abscess (IPA) is an uncommon clinical disease and is often missed to diagnos... more Objectives Iliopsoas abscess (IPA) is an uncommon clinical disease and is often missed to diagnose due to vague clinical presentation. Early treatment with drainage and appropriate antibiotic therapy is necessary before sepsis sets in and become lethal. We conducted this study to evaluate clinical features, etiology, management strategies, and outcomes in patients with IPA from a University Teaching Hospital in Nepal. Methods A retrospective analysis of 32 consecutive IPA cases managed at Tribhuvan University Teaching Hospital, Nepal for the period of January 2019 to February 2022 was carried out. Results The mean age was 42.5 ± 19.1 years (range, 19–75 years) and the male: female ratio was 2.2:1. Two-thirds or more patients presented with fever, limp, fixed flexion deformity and/or low back pain. Ultrasonography (US) was diagnostic in 27 (84.4%) patients. Eighteen (56.3%) patients had primary IPAs, and 14 (43.7%) had secondary IPAs. Thirty (93.7%) patients were managed with US guid...
Journal of Institute of Medicine, 2020
IntroductionGranular cell tumor (GCT) is a rare soft tissue tumor that arises from the Schwann ce... more IntroductionGranular cell tumor (GCT) is a rare soft tissue tumor that arises from the Schwann cells of peripheral nerves. It was first postulated by Abrikossoff in 1926 as Myoblastoma. About 5-15% of these tumors occur in the breast and less than 1% has the potential to be malignant. Here we present a case of 41 years oldpremenopausal woman with Benign GCT of the right breast, having clinically malignant features. The clinical and radiological features of GCT are similar to malignant lump. However, histology showing presence of sheets of polygonal cells with abundant granular eosinophilic cytoplasm with round nuclei and granules with Periodic acid–Schiff (PAS) positive, diastase resistant and S-100 antigen positive are confirmatory. Treatment of Granular cell tumor is wide local excision. There is apparently no role of chemotherapy and radiotherapy. The presence of GCT in the breast is quite rare and clinically as well as radiologicallyit may mimic malignancy, however with histopat...
Journal of Institute of Medicine Nepal, 2019
Pregnancy-associated breast cancer is less common and often presents in advanced stage. Managemen... more Pregnancy-associated breast cancer is less common and often presents in advanced stage. Management is similar to non-pregnant cases with trimester-specific considerations. In this case report, we present a case of worrisome mother with locally advanced multifocal pregnancy-associated breast cancer who was so much concerned about effects of neoadjuvant chemotherapy on fetus leading to its delayed initiation, and show why targeted therapy is still not within reach in a developing economy like Nepal. Short term data of chemotherapy though reveal relative safety, long term data are lacking. This may be a hindrance in counselling, when patients are more anxious and worrisome.
Journal of Institute of Medicine, 2020
Corona Virus Disease-2019 (COVID-19) is a global viral respiratory outbreak, known to everyone in... more Corona Virus Disease-2019 (COVID-19) is a global viral respiratory outbreak, known to everyone in society. Nepal is not an exception for this pandemic and we are learning how to live with COVID-19. The pandemic has changed vigorously our daily activities affecting every aspects of the society. In low–middle income countries like ours, we don’t have definite answer to deal with the pandemic, rather we are learning how to live amid COVID-19. We are experiencing something new every day. Despite so many limitations, we need to learn to live with COVID-19.
Introduction Colorectal cancer (CRC) is common with wide variation in incidence. However, the inc... more Introduction Colorectal cancer (CRC) is common with wide variation in incidence. However, the incidence in younger adults is showing an increasing trend with rectal preponderance. Such cases appear to present in advanced stage with poorly differentiated histopathology and the trend is stronger in developing countries. The aim of the study was to compare the MLH1 and in matched mucosa and tumor samples obtained from the large gut of Nepalese and Swedish patients with CRC.
Introduction In Nepal, half of the breast cancer patients presented in advanced stage III (IIIA 1... more Introduction In Nepal, half of the breast cancer patients presented in advanced stage III (IIIA 18%, IIIB 22%), and stage IV (10%). Delayed presentations are due to lack of awareness, reluctancy and poor accessibility to health care services often leads to local complications like sloughing of fungating breast lesions, secondary infection and bleeding. The aim of this study was to analyze the advanced breast cancer (ABC) patients who underwent palliative toilet mastectomy. Methods Retrospective review of all patients presenting with ABC who underwent palliative toilet mastectomy in the breast unit of Tribhuvan University Teaching Hospital Kathmandu, Nepal from January 2016 to December 2018, was done. The data included were demographic profile, histopathological and immunohistochemistry report, indication of surgery, adjuvant therapy, timing of surgery, and quality of life after surgery. Results Total number of breast carcinoma patients was 155 within the duration of 3 years. There were 7 (4.5%) cases of breast cancer treated with palliative toilet mastectomy with mean age of 57.9±12.7 years. The mean tumor size was 4.3±1.3cm. The indications of palliative mastectomy were fungation-2 (28.5%), bleeding-2 (28.5%), ulceration-1 (14.3%), malodorous discharge with secondary infection-1 (14.3%) and hemiplegic patient with infection in 1 (14.3%). Luminal A molecular subtype was seen in 1 out of 7 patients (14.3%) with basal like subtype in 6 out of 7 patients (85.7%). Lympho-vascular invasion were seen in 4 out of 7 (57.14%). One patient underwent bilateral palliative mastectomy for progressive disease and margins were positive for tumor and remaining six patients had tumor free margins. Conclusion Advanced breast cancers are treated with neoadjuvant therapy prior surgery but the delayed presentation of these with fungating, ulcerative, infective and bleeding lesions make the initial palliative toilet mastectomy a useful option.
Journal of Institute of Medicine Nepal
Oncoplastic surgical techniques are seeing widespread use for excision of large volume breast les... more Oncoplastic surgical techniques are seeing widespread use for excision of large volume breast lesions. Batwing technique is one of the volume displacement techniques that can be used to manage lesions in central quadrant of the breast. Such techniques are still underused in Nepal. Here we present three cases with large volume benign breast lesions managed with simple, easy-to-learn technique of Batwing oncoplasty.
Journal of Nepal Medical Association
EHPVO in individual with solitary left kidney is rare occurance. Though there is no etiological a... more EHPVO in individual with solitary left kidney is rare occurance. Though there is no etiological association between EHPVO and solitary left kidney but the solitary left kidney decides the modality of treatment. Eighteen year lady referred to our institute with menorrhagia for 5 years and ultrasonography finding of splenomegaly and atretic right kidney. Investigations revealed Extra Hepatic Portal Vein Obstruction with multiple cavernoma formation with oesophagogastric varices with right renal agenesis. She successfully underwent splenectomy with devascularisation. Patient with EHPVO present mainly with recurrent episodes of variceal bleeding, splenomegaly and hypersplenism. Splenectomy and esophagogastric devascularisation is an effective modality of treatment for patient with EHPVO with solitary kidney.
Journal of Society of Surgeons of Nepal
Introduction: Hematological malignancies are not uncommon and all ages and genders are affected. ... more Introduction: Hematological malignancies are not uncommon and all ages and genders are affected. Hematological malignancies are a group of cancers that arise from a malignant transformation of cells of the bone marrow or lymphatic system. There are several classification systems for Hematological Malignancies. The WHO classification was the first worldwide consensus classification on hematological tumors. Methods: We retrospectively collected data from the Department of Pathology and Hematology Unit of Internal medicine from 2015 to 2016. Hematological malignancies were analyzed clinically and with laboratory parameters. They were initially analyzed with complete blood counts and peripheral smear and diagnosed on the basis of Bone marrow morphological assessment, Immunophenotyping and cytogenetic and molecular markers and histopathology and Immunohistochemistry of Excised lymph node when applicable. Plasma cell dyscrasias were assessed clinically for features of CRAB (hypercalcemia,...
Journal of surgical case reports, 2018
Hemangiomas of nipple of the breast are rare lesions and are limited to case reports in the liter... more Hemangiomas of nipple of the breast are rare lesions and are limited to case reports in the literature. Such pathology in a lactating mother are clearly a hindrance preventing the child from breastfeeding with its benefits. We report a rare case of a bleeding nipple hemangioma in a 24 years old lactating mother with the clinical, imaging and histopathological findings.
Cancer research and treatment : official journal of Korean Cancer Association, Jan 9, 2017
The Symposium on "Oncology Leadership in Asia" was held as part of the official program... more The Symposium on "Oncology Leadership in Asia" was held as part of the official program of the 42nd Annual Meeting of the Korean Cancer Association. Given the increasing incidence of cancer in all countries and regions of Asia, regardless of developmental stage, and also in light of the recognized need for Asian countries to enhance collaboration in cancer prevention, research, treatment and follow-up, the symposium was held with the aim of bringing together oncology specialists from eight countries and regions in Asia to present the status in their own national context and discuss the key challenges and requirements in order to establish a greater Asian presence in the area of cancer control and research. The task of bringing together diverse countries and regions is made all the more urgent in that while Asia now accounts for more than half of all new cancer cases globally, clinical guidelines are based predominantly on practices adopted in western countries, which may n...
Background Gastric cancer is the second commonest cause of cancer related mortality worldwide. ... more Background
Gastric cancer is the second commonest cause of cancer related mortality worldwide.
Though its incidence is more in Eastern Asia, it is increasing in the South Asian
subcontinent. The diagnosis of early gastric cancer (EGC) confined to the mucosa or
submucosa, is an important concern due to a better outcome at this stage where five
year survival rates could increase by 90 percent. Though mass screening is done in
few countries, it has not been applied in developing countries like Nepal. Preoperative
diagnosis of EGC is rare in Nepal. The aim of this study is to analyze the clinicopathological features of postoperative cases of gastric cancer managed in a tertiary care university hospital of Nepal.
Methods
All patients with histological diagnosis of gastric cancer admitted in the Department
of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal during the
three year period (September 2010 to August 2013) were analyzed retrospectively.
Results
Ninety two patients with endoscopic diagnosis of gastric cancers were admitted
during the past three years. The mean age was 60 years ranging from 28 years to
85 years with the male to female ratio of 2.8:1. Five patients were younger than 40
years and all were in advanced stage. Thirty five percent of the patients belonged
to Janajatis (Hill) community though they comprise only 23% of the population and
about 65% of them belonged to an area involving 25% of the country.
Seventy six cases were operated. Out of 92 patients, 4 patients were diagnosed as
early gastric cancer postoperatively. All patients with early gastric cancer were above
50 years with CT Scan abdomen revealing focal thickening without lymphadenopathy.
Conclusion
Over the years, the incidence of gastric cancer is increasing in Nepal. Though 92%
are advance gastric cancers, few have been diagnosed and treated early. A screening
program in a country like Nepal with diverse ethnicity and difficult terrain might be
helpful if it targets high risk people in high risk areas.
KEY WORDS
Advanced gastric cancer, early gastric cancer, ethnicity, low risk
Breast cancer is the second most common malignancy among women in Nepal. It is more common in you... more Breast cancer is the second most common malignancy among women in Nepal. It is more common in young premenopausal women. Breast cancer continues to increase in incidence due to lifestyle changes in Nepalese women despite constant remarkable development in the management of this disease over the past three decades. Breast cancer was diagnosed solely clinically and surgery was the only treatment option until fi fty years ago. Multidisciplinary approach has been adopted for diagnosis and treatment of breast cancer in Nepal. Imaging is required for the diagnosis, appropriate treatment decision and proper follow up. Treatment modality depends upon the extent of the disease and tumor biology. However, there is a strong need for standard guidelines for the proper management of breast cancer in Nepal so that surgeries, chemotherapy, hormone therapy and radiotherapy are standardized in the country. Palliative care has been initiated to provide to some patients with metastatic breast cancer recently. The breast cancer management in Nepal is a little different when compared with the centers in the developed countries. The reasons are socioeconomic status, lack of education and lack of facilities. Although cancer care is on the rise in Nepal, the optimal facility for centers managing breast cancer has to be improved signifi cantly.Cancer education, screening and early detection are the key elements to infl uence the diagnosis, treatment and prognosis of breast cancer in Nepal. Breast cancer awareness and clinical breast examination are important tools for early detection in our resource limited context. Breast cancer can be cured in majority of the cases if diagnosed in early stages. This review will focus on relevant patient data along with future recommendation regarding breast cancer treatment in Nepal.
Journal of Institute of Medicine Nepal
Oncoplastic breast conserving surgery is increasingly used in the management of early breast canc... more Oncoplastic breast conserving surgery is increasingly used in the management of early breast cancer. Though its use in Nepal is increasing, it is still under-utilized. We present a case of upper outer quadrant early breast cancer located away from nipple-areola complex managed with radial ellipse segmentectomy 10 years back and under regular follow up. We recommend its usage in upper outer quadrant lesions because of its simplicity, access for sentinel lymph node biopsy and good cosmetic outcome.
Cervical cancer is the commonest cancer among women in Nepal. Human papilloma virus (HPV) infecti... more Cervical cancer is the commonest cancer among women in Nepal. Human papilloma virus (HPV) infection, a recognized cause of cervical cancer, is very common in sexually active women and HPV vaccination has been recommended as a prophylactic therapy. If HPV infection is prevented by the HPV vaccination to the adolescent girls, cervical cancer is also prevented. We received 3,300 vials of quadrivalent human papilloma virus (types 6, 11, 16, 18) recombinant vaccine (Gardasil; Merk & Co.) as a gift from the Australian Cervical Cancer Foundation (ACCF) which has a mission to provide life-saving HPV cervical cancer vaccines for women in developing countries, who cannot otherwise afford vaccination. HPV vaccine was offered to 1,096 of 10 to 26 year aged girls attending 17 secondary schools. In total, 1,091 (99.5%) received the second dose and 1,089 (99.3%) received the third dose of the vaccine. The remaining 5 girls at second dose and 2 girls at third dose remained unvaccinated. No serious ...
Journal of Institute of Medicine, 2021
Methods This was a retrospective observational study. Patients undergoing pancreaticoduodenectomy... more Methods This was a retrospective observational study. Patients undergoing pancreaticoduodenectomy at Tribhuvan University Teaching Hospital (TUTH) between January 2017 to December 2017 were included in the study. Variables were recorded from case sheets of the patients. The “Risk Score” was calculated using the pancreatic duct diameter and body mass index (BMI). Association of risk score and severe postoperative complications were analyzed.
Journal of Institute of Medicine, 2020
IntroductionBreast cancer is the second commonest cancer in Nepalese women. In most of the low in... more IntroductionBreast cancer is the second commonest cancer in Nepalese women. In most of the low income countries including Nepal, breast cancer is commonly diagnosed at late stage. The Binaytara Foundation Cancer Center (BTFCC), a 25 bed cancer hospital was established in Province 2, the most densely populated province, of Nepal in December 2018. We describe our experience of breast cancer surgery at the cancer hospital.MethodsSurgical service was started from April 2019 after establishing an equipped operating room and postoperative and ICU wards. Total 51 surgeries were performed for both benign and malignant diseases by the end of 2019. The commonest surgery was breast surgery in 18 patients. Retrospective analysis of all six patients who were operated for breast cancer at the cancer center was done.ResultsSix female patients of this province were operated for breast cancer during this period. Age ranged from 40 to 56 years. Four patients were presented with locally advanced disea...
Introduction According to GLOBOCAN 2018, gastric carcinoma is the fifth most common cancer (5.7%)... more Introduction According to GLOBOCAN 2018, gastric carcinoma is the fifth most common cancer (5.7%) and third most common cause of cancer related death (8.2%) worldwide. Delayed presentation and advanced disease at diagnosis, owing to the overlapping symptoms, can be attributed to its high mortality. Gastrectomy is one of the most commonly performed surgery at our centre. This study aims to study the role of pre-operative serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as predictors of adverse prognostic pathological features of gastric carcinoma patients who were considered for surgery at our centre. Methods This is a retrospective analysis of prospectively maintained database of all operated gastric carcinoma patients since June 2016 to January 2019. Various pre-operative variables including serum CEA level, serum CA 19-9 level, NLR and PLR were collected. Intra-operative surgical proced...
Asian Pacific Journal of Cancer Care
Background: TNBC (Triple negative breast cancer) subtype (ER-/PR-/HER2-) of breast cancers are kn... more Background: TNBC (Triple negative breast cancer) subtype (ER-/PR-/HER2-) of breast cancers are known for aggressive tumor biology and poor survival prospects, with high early relapse rate. However, little is known about the prevalence and characteristics of TNBC breast cancer in Nepal. Objectives: To clarify the geographical distribution, clinical profile and outcome of TNBC patients when compared with non-TNBC patients managed in tertiary care university hospital in Nepal. Materials and Methods: This is a study on prospective observational analyses of TNBC and non-TNBC patients managed at Tribhuvan University Teaching Hospital, Kathmandu from October 2015-March 2018. We collected and analyzed data on clinical profile, pathological tumor features and outcome of the two patient groups. Results: A total of 108 breast cancer patients were included in our study, 38 (35.2%) of which were TNBCs. Mean age at diagnosis was 49±12 years. Majority of TNBCs (29%) were concentrated in Terai dist...
Journal of Nepal Medical Association
ABSTRACTA 60-years-old, male patient presented with a-tender swelling in the right iliac fossa wi... more ABSTRACTA 60-years-old, male patient presented with a-tender swelling in the right iliac fossa with right hip flexiondeformity suggesting of psoas abscess. Following emergency drainage of faeculant pus, the general conditionof the patient improved. The barium enema showed leaking ascending colonic ulcer and colonoscopicexamination revealed nonspecific ulcerative lesion in the ascending colon. Repeat investigations were alsonon-conclusive except there was a stricture at the ascending colon on colonoscopy. A second operationshowed that there was a huge mass of terminal ileum, cecum and ascending colon and perforation of ascendingcolonic ulcer most likely carcinoma. Right hemicolectomy was performed with uneventful postoperativeperiod. Histopathological examination revealed well differentiated adenocarcinoma limited to the musclelayer of the ascending colon and features suggestive of colonic tuberculosis at the same site. Antituberculartreatment was completed with regular follow-up and...
Innovative Surgical Sciences
Objectives Iliopsoas abscess (IPA) is an uncommon clinical disease and is often missed to diagnos... more Objectives Iliopsoas abscess (IPA) is an uncommon clinical disease and is often missed to diagnose due to vague clinical presentation. Early treatment with drainage and appropriate antibiotic therapy is necessary before sepsis sets in and become lethal. We conducted this study to evaluate clinical features, etiology, management strategies, and outcomes in patients with IPA from a University Teaching Hospital in Nepal. Methods A retrospective analysis of 32 consecutive IPA cases managed at Tribhuvan University Teaching Hospital, Nepal for the period of January 2019 to February 2022 was carried out. Results The mean age was 42.5 ± 19.1 years (range, 19–75 years) and the male: female ratio was 2.2:1. Two-thirds or more patients presented with fever, limp, fixed flexion deformity and/or low back pain. Ultrasonography (US) was diagnostic in 27 (84.4%) patients. Eighteen (56.3%) patients had primary IPAs, and 14 (43.7%) had secondary IPAs. Thirty (93.7%) patients were managed with US guid...
Journal of Institute of Medicine, 2020
IntroductionGranular cell tumor (GCT) is a rare soft tissue tumor that arises from the Schwann ce... more IntroductionGranular cell tumor (GCT) is a rare soft tissue tumor that arises from the Schwann cells of peripheral nerves. It was first postulated by Abrikossoff in 1926 as Myoblastoma. About 5-15% of these tumors occur in the breast and less than 1% has the potential to be malignant. Here we present a case of 41 years oldpremenopausal woman with Benign GCT of the right breast, having clinically malignant features. The clinical and radiological features of GCT are similar to malignant lump. However, histology showing presence of sheets of polygonal cells with abundant granular eosinophilic cytoplasm with round nuclei and granules with Periodic acid–Schiff (PAS) positive, diastase resistant and S-100 antigen positive are confirmatory. Treatment of Granular cell tumor is wide local excision. There is apparently no role of chemotherapy and radiotherapy. The presence of GCT in the breast is quite rare and clinically as well as radiologicallyit may mimic malignancy, however with histopat...
Journal of Institute of Medicine Nepal, 2019
Pregnancy-associated breast cancer is less common and often presents in advanced stage. Managemen... more Pregnancy-associated breast cancer is less common and often presents in advanced stage. Management is similar to non-pregnant cases with trimester-specific considerations. In this case report, we present a case of worrisome mother with locally advanced multifocal pregnancy-associated breast cancer who was so much concerned about effects of neoadjuvant chemotherapy on fetus leading to its delayed initiation, and show why targeted therapy is still not within reach in a developing economy like Nepal. Short term data of chemotherapy though reveal relative safety, long term data are lacking. This may be a hindrance in counselling, when patients are more anxious and worrisome.
Journal of Institute of Medicine, 2020
Corona Virus Disease-2019 (COVID-19) is a global viral respiratory outbreak, known to everyone in... more Corona Virus Disease-2019 (COVID-19) is a global viral respiratory outbreak, known to everyone in society. Nepal is not an exception for this pandemic and we are learning how to live with COVID-19. The pandemic has changed vigorously our daily activities affecting every aspects of the society. In low–middle income countries like ours, we don’t have definite answer to deal with the pandemic, rather we are learning how to live amid COVID-19. We are experiencing something new every day. Despite so many limitations, we need to learn to live with COVID-19.
Introduction Colorectal cancer (CRC) is common with wide variation in incidence. However, the inc... more Introduction Colorectal cancer (CRC) is common with wide variation in incidence. However, the incidence in younger adults is showing an increasing trend with rectal preponderance. Such cases appear to present in advanced stage with poorly differentiated histopathology and the trend is stronger in developing countries. The aim of the study was to compare the MLH1 and in matched mucosa and tumor samples obtained from the large gut of Nepalese and Swedish patients with CRC.
Introduction In Nepal, half of the breast cancer patients presented in advanced stage III (IIIA 1... more Introduction In Nepal, half of the breast cancer patients presented in advanced stage III (IIIA 18%, IIIB 22%), and stage IV (10%). Delayed presentations are due to lack of awareness, reluctancy and poor accessibility to health care services often leads to local complications like sloughing of fungating breast lesions, secondary infection and bleeding. The aim of this study was to analyze the advanced breast cancer (ABC) patients who underwent palliative toilet mastectomy. Methods Retrospective review of all patients presenting with ABC who underwent palliative toilet mastectomy in the breast unit of Tribhuvan University Teaching Hospital Kathmandu, Nepal from January 2016 to December 2018, was done. The data included were demographic profile, histopathological and immunohistochemistry report, indication of surgery, adjuvant therapy, timing of surgery, and quality of life after surgery. Results Total number of breast carcinoma patients was 155 within the duration of 3 years. There were 7 (4.5%) cases of breast cancer treated with palliative toilet mastectomy with mean age of 57.9±12.7 years. The mean tumor size was 4.3±1.3cm. The indications of palliative mastectomy were fungation-2 (28.5%), bleeding-2 (28.5%), ulceration-1 (14.3%), malodorous discharge with secondary infection-1 (14.3%) and hemiplegic patient with infection in 1 (14.3%). Luminal A molecular subtype was seen in 1 out of 7 patients (14.3%) with basal like subtype in 6 out of 7 patients (85.7%). Lympho-vascular invasion were seen in 4 out of 7 (57.14%). One patient underwent bilateral palliative mastectomy for progressive disease and margins were positive for tumor and remaining six patients had tumor free margins. Conclusion Advanced breast cancers are treated with neoadjuvant therapy prior surgery but the delayed presentation of these with fungating, ulcerative, infective and bleeding lesions make the initial palliative toilet mastectomy a useful option.
Journal of Institute of Medicine Nepal
Oncoplastic surgical techniques are seeing widespread use for excision of large volume breast les... more Oncoplastic surgical techniques are seeing widespread use for excision of large volume breast lesions. Batwing technique is one of the volume displacement techniques that can be used to manage lesions in central quadrant of the breast. Such techniques are still underused in Nepal. Here we present three cases with large volume benign breast lesions managed with simple, easy-to-learn technique of Batwing oncoplasty.
Journal of Nepal Medical Association
EHPVO in individual with solitary left kidney is rare occurance. Though there is no etiological a... more EHPVO in individual with solitary left kidney is rare occurance. Though there is no etiological association between EHPVO and solitary left kidney but the solitary left kidney decides the modality of treatment. Eighteen year lady referred to our institute with menorrhagia for 5 years and ultrasonography finding of splenomegaly and atretic right kidney. Investigations revealed Extra Hepatic Portal Vein Obstruction with multiple cavernoma formation with oesophagogastric varices with right renal agenesis. She successfully underwent splenectomy with devascularisation. Patient with EHPVO present mainly with recurrent episodes of variceal bleeding, splenomegaly and hypersplenism. Splenectomy and esophagogastric devascularisation is an effective modality of treatment for patient with EHPVO with solitary kidney.
Journal of Society of Surgeons of Nepal
Introduction: Hematological malignancies are not uncommon and all ages and genders are affected. ... more Introduction: Hematological malignancies are not uncommon and all ages and genders are affected. Hematological malignancies are a group of cancers that arise from a malignant transformation of cells of the bone marrow or lymphatic system. There are several classification systems for Hematological Malignancies. The WHO classification was the first worldwide consensus classification on hematological tumors. Methods: We retrospectively collected data from the Department of Pathology and Hematology Unit of Internal medicine from 2015 to 2016. Hematological malignancies were analyzed clinically and with laboratory parameters. They were initially analyzed with complete blood counts and peripheral smear and diagnosed on the basis of Bone marrow morphological assessment, Immunophenotyping and cytogenetic and molecular markers and histopathology and Immunohistochemistry of Excised lymph node when applicable. Plasma cell dyscrasias were assessed clinically for features of CRAB (hypercalcemia,...
Journal of surgical case reports, 2018
Hemangiomas of nipple of the breast are rare lesions and are limited to case reports in the liter... more Hemangiomas of nipple of the breast are rare lesions and are limited to case reports in the literature. Such pathology in a lactating mother are clearly a hindrance preventing the child from breastfeeding with its benefits. We report a rare case of a bleeding nipple hemangioma in a 24 years old lactating mother with the clinical, imaging and histopathological findings.
Cancer research and treatment : official journal of Korean Cancer Association, Jan 9, 2017
The Symposium on "Oncology Leadership in Asia" was held as part of the official program... more The Symposium on "Oncology Leadership in Asia" was held as part of the official program of the 42nd Annual Meeting of the Korean Cancer Association. Given the increasing incidence of cancer in all countries and regions of Asia, regardless of developmental stage, and also in light of the recognized need for Asian countries to enhance collaboration in cancer prevention, research, treatment and follow-up, the symposium was held with the aim of bringing together oncology specialists from eight countries and regions in Asia to present the status in their own national context and discuss the key challenges and requirements in order to establish a greater Asian presence in the area of cancer control and research. The task of bringing together diverse countries and regions is made all the more urgent in that while Asia now accounts for more than half of all new cancer cases globally, clinical guidelines are based predominantly on practices adopted in western countries, which may n...
Background Gastric cancer is the second commonest cause of cancer related mortality worldwide. ... more Background
Gastric cancer is the second commonest cause of cancer related mortality worldwide.
Though its incidence is more in Eastern Asia, it is increasing in the South Asian
subcontinent. The diagnosis of early gastric cancer (EGC) confined to the mucosa or
submucosa, is an important concern due to a better outcome at this stage where five
year survival rates could increase by 90 percent. Though mass screening is done in
few countries, it has not been applied in developing countries like Nepal. Preoperative
diagnosis of EGC is rare in Nepal. The aim of this study is to analyze the clinicopathological features of postoperative cases of gastric cancer managed in a tertiary care university hospital of Nepal.
Methods
All patients with histological diagnosis of gastric cancer admitted in the Department
of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal during the
three year period (September 2010 to August 2013) were analyzed retrospectively.
Results
Ninety two patients with endoscopic diagnosis of gastric cancers were admitted
during the past three years. The mean age was 60 years ranging from 28 years to
85 years with the male to female ratio of 2.8:1. Five patients were younger than 40
years and all were in advanced stage. Thirty five percent of the patients belonged
to Janajatis (Hill) community though they comprise only 23% of the population and
about 65% of them belonged to an area involving 25% of the country.
Seventy six cases were operated. Out of 92 patients, 4 patients were diagnosed as
early gastric cancer postoperatively. All patients with early gastric cancer were above
50 years with CT Scan abdomen revealing focal thickening without lymphadenopathy.
Conclusion
Over the years, the incidence of gastric cancer is increasing in Nepal. Though 92%
are advance gastric cancers, few have been diagnosed and treated early. A screening
program in a country like Nepal with diverse ethnicity and difficult terrain might be
helpful if it targets high risk people in high risk areas.
KEY WORDS
Advanced gastric cancer, early gastric cancer, ethnicity, low risk
Breast cancer is the second most common malignancy among women in Nepal. It is more common in you... more Breast cancer is the second most common malignancy among women in Nepal. It is more common in young premenopausal women. Breast cancer continues to increase in incidence due to lifestyle changes in Nepalese women despite constant remarkable development in the management of this disease over the past three decades. Breast cancer was diagnosed solely clinically and surgery was the only treatment option until fi fty years ago. Multidisciplinary approach has been adopted for diagnosis and treatment of breast cancer in Nepal. Imaging is required for the diagnosis, appropriate treatment decision and proper follow up. Treatment modality depends upon the extent of the disease and tumor biology. However, there is a strong need for standard guidelines for the proper management of breast cancer in Nepal so that surgeries, chemotherapy, hormone therapy and radiotherapy are standardized in the country. Palliative care has been initiated to provide to some patients with metastatic breast cancer recently. The breast cancer management in Nepal is a little different when compared with the centers in the developed countries. The reasons are socioeconomic status, lack of education and lack of facilities. Although cancer care is on the rise in Nepal, the optimal facility for centers managing breast cancer has to be improved signifi cantly.Cancer education, screening and early detection are the key elements to infl uence the diagnosis, treatment and prognosis of breast cancer in Nepal. Breast cancer awareness and clinical breast examination are important tools for early detection in our resource limited context. Breast cancer can be cured in majority of the cases if diagnosed in early stages. This review will focus on relevant patient data along with future recommendation regarding breast cancer treatment in Nepal.
Journal of Institute of Medicine Nepal
Oncoplastic breast conserving surgery is increasingly used in the management of early breast canc... more Oncoplastic breast conserving surgery is increasingly used in the management of early breast cancer. Though its use in Nepal is increasing, it is still under-utilized. We present a case of upper outer quadrant early breast cancer located away from nipple-areola complex managed with radial ellipse segmentectomy 10 years back and under regular follow up. We recommend its usage in upper outer quadrant lesions because of its simplicity, access for sentinel lymph node biopsy and good cosmetic outcome.
Cervical cancer is the commonest cancer among women in Nepal. Human papilloma virus (HPV) infecti... more Cervical cancer is the commonest cancer among women in Nepal. Human papilloma virus (HPV) infection, a recognized cause of cervical cancer, is very common in sexually active women and HPV vaccination has been recommended as a prophylactic therapy. If HPV infection is prevented by the HPV vaccination to the adolescent girls, cervical cancer is also prevented. We received 3,300 vials of quadrivalent human papilloma virus (types 6, 11, 16, 18) recombinant vaccine (Gardasil; Merk & Co.) as a gift from the Australian Cervical Cancer Foundation (ACCF) which has a mission to provide life-saving HPV cervical cancer vaccines for women in developing countries, who cannot otherwise afford vaccination. HPV vaccine was offered to 1,096 of 10 to 26 year aged girls attending 17 secondary schools. In total, 1,091 (99.5%) received the second dose and 1,089 (99.3%) received the third dose of the vaccine. The remaining 5 girls at second dose and 2 girls at third dose remained unvaccinated. No serious ...
Journal of Institute of Medicine, 2021
Methods This was a retrospective observational study. Patients undergoing pancreaticoduodenectomy... more Methods This was a retrospective observational study. Patients undergoing pancreaticoduodenectomy at Tribhuvan University Teaching Hospital (TUTH) between January 2017 to December 2017 were included in the study. Variables were recorded from case sheets of the patients. The “Risk Score” was calculated using the pancreatic duct diameter and body mass index (BMI). Association of risk score and severe postoperative complications were analyzed.
Journal of Institute of Medicine, 2020
IntroductionBreast cancer is the second commonest cancer in Nepalese women. In most of the low in... more IntroductionBreast cancer is the second commonest cancer in Nepalese women. In most of the low income countries including Nepal, breast cancer is commonly diagnosed at late stage. The Binaytara Foundation Cancer Center (BTFCC), a 25 bed cancer hospital was established in Province 2, the most densely populated province, of Nepal in December 2018. We describe our experience of breast cancer surgery at the cancer hospital.MethodsSurgical service was started from April 2019 after establishing an equipped operating room and postoperative and ICU wards. Total 51 surgeries were performed for both benign and malignant diseases by the end of 2019. The commonest surgery was breast surgery in 18 patients. Retrospective analysis of all six patients who were operated for breast cancer at the cancer center was done.ResultsSix female patients of this province were operated for breast cancer during this period. Age ranged from 40 to 56 years. Four patients were presented with locally advanced disea...
Introduction According to GLOBOCAN 2018, gastric carcinoma is the fifth most common cancer (5.7%)... more Introduction According to GLOBOCAN 2018, gastric carcinoma is the fifth most common cancer (5.7%) and third most common cause of cancer related death (8.2%) worldwide. Delayed presentation and advanced disease at diagnosis, owing to the overlapping symptoms, can be attributed to its high mortality. Gastrectomy is one of the most commonly performed surgery at our centre. This study aims to study the role of pre-operative serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as predictors of adverse prognostic pathological features of gastric carcinoma patients who were considered for surgery at our centre. Methods This is a retrospective analysis of prospectively maintained database of all operated gastric carcinoma patients since June 2016 to January 2019. Various pre-operative variables including serum CEA level, serum CA 19-9 level, NLR and PLR were collected. Intra-operative surgical proced...
Asian Pacific Journal of Cancer Care
Background: TNBC (Triple negative breast cancer) subtype (ER-/PR-/HER2-) of breast cancers are kn... more Background: TNBC (Triple negative breast cancer) subtype (ER-/PR-/HER2-) of breast cancers are known for aggressive tumor biology and poor survival prospects, with high early relapse rate. However, little is known about the prevalence and characteristics of TNBC breast cancer in Nepal. Objectives: To clarify the geographical distribution, clinical profile and outcome of TNBC patients when compared with non-TNBC patients managed in tertiary care university hospital in Nepal. Materials and Methods: This is a study on prospective observational analyses of TNBC and non-TNBC patients managed at Tribhuvan University Teaching Hospital, Kathmandu from October 2015-March 2018. We collected and analyzed data on clinical profile, pathological tumor features and outcome of the two patient groups. Results: A total of 108 breast cancer patients were included in our study, 38 (35.2%) of which were TNBCs. Mean age at diagnosis was 49±12 years. Majority of TNBCs (29%) were concentrated in Terai dist...
Journal of Nepal Medical Association
ABSTRACTA 60-years-old, male patient presented with a-tender swelling in the right iliac fossa wi... more ABSTRACTA 60-years-old, male patient presented with a-tender swelling in the right iliac fossa with right hip flexiondeformity suggesting of psoas abscess. Following emergency drainage of faeculant pus, the general conditionof the patient improved. The barium enema showed leaking ascending colonic ulcer and colonoscopicexamination revealed nonspecific ulcerative lesion in the ascending colon. Repeat investigations were alsonon-conclusive except there was a stricture at the ascending colon on colonoscopy. A second operationshowed that there was a huge mass of terminal ileum, cecum and ascending colon and perforation of ascendingcolonic ulcer most likely carcinoma. Right hemicolectomy was performed with uneventful postoperativeperiod. Histopathological examination revealed well differentiated adenocarcinoma limited to the musclelayer of the ascending colon and features suggestive of colonic tuberculosis at the same site. Antituberculartreatment was completed with regular follow-up and...