lokesh jaiswal - Academia.edu (original) (raw)

Papers by lokesh jaiswal

Indian Journal of Vascular and Endovascular Surgery

Introduction: Pseudoaneurysms are false aneurysm where disruption in the arterial wall forms a lo... more Introduction: Pseudoaneurysms are false aneurysm where disruption in the arterial wall forms a localized pulsatile hematoma connecting the artery. The common causes are intravenous drug abuse (IVDA), iatrogenic (vascular interventions and surgery), trauma, and infections. Aims: The aim of this study was to analyze the etiology, management, and outcome of patients with pseudoaneurysms of peripheral arteries. Materials and Methods: This is a retrospective analysis of prospectively maintained database of 32 patients with peripheral artery pseudoaneurysms over 45 months at a community-based hospital of Eastern Nepal. Results: The most common site involved was femoral artery (56.3%) followed by brachial (15.6%), radial (6.3%), anterior tibial (6.3%), and others (15.5%). The common etiologies were iatrogenic (46.9%), IVDA (31.3%), trauma (18.7%), and infection (3.1%). Operative intervention was performed in 29 (90.6%) patients as follows: ligation of artery and debridement (46.9%), primary repair (28.1%), and venous graft bypass (15.6%). Three patients (9.4%) with noninfected iatrogenic pseudoaneurysms of <3 cm were managed conservatively. Infected pseudoaneurysms were seen in 14 (43.7%) patients. Staphylococcus aureus was the most common isolate in the culture. There was no reoperation, amputation, or any in-hospital mortality. At follow-up, one patient developed leg claudication pain following a femoral artery ligation and one of the five patients developed a graft thrombosis after an autologous reversed saphenous vein bypass graft without any sequelae. Conclusion: Although repair with distal revascularization is an ideal approach, debridement and simple ligation of pseudoaneurysms is a safer alternative especially in IV drug abusers.

Annals of Medicine & Surgery

ANZ Journal of Surgery, 2021

Nepalese Heart Journal, 2020

Intravenous leiomyoma is a rare, benign smooth muscle tumor arising from intrauterine venules or ... more Intravenous leiomyoma is a rare, benign smooth muscle tumor arising from intrauterine venules or the myometrium. It can rarely present as intracardiac mass long after hysterectomy. In this case report we describe a 40-year-old female with previous history of hysterectomy, presenting with an intracardiac mass which was successfully managed with single stage tumor resection under cardiopulmonary bypass. Subsequent histopathology showed features of leiomyoma. The diagnosis of intravenous leiomyoma with cardiac extension should be kept in a female patient presenting with intracardiac mass with previous history of myomectomy or hysterectomy.

Tropical Doctor, 2020

Oesophageal perforation is rare, associated with diagnostic dilemma, delayed presentation and hig... more Oesophageal perforation is rare, associated with diagnostic dilemma, delayed presentation and high mortality rate (36%). Early diagnosis and treatment are crucial for a good outcome. Treatment is by non-operative methods (antibiotics, drainage of collections, oesophageal stenting and nutritional support) or by surgery, depending on the condition of the patient, timing of presentation and expertise. During a five-year period (2015–2019), we managed seven cases of oesophageal perforation due to a foreign body. Of them, 4 (57%) received operative intervention, while 3 (43%) were managed non-operatively. One postoperative mortality ensued; there was a mean hospital stay of 20 days.

Journal of Society of Surgeons of Nepal, 2019

Achalasia cardia is a rare primary esophageal motility disorder with an incidence of about 1 in 1... more Achalasia cardia is a rare primary esophageal motility disorder with an incidence of about 1 in 100,000 individuals. If left untreated or inappropriately treated, the disease may progress to end-stage achalasia characterized by megaesophagus or sigmoid esophagus. The presentation as severe malnutrition, anemia, hypoalbuminemia, and asymptomatic tracheal compression has not been described in the setting of the sigmoid esophagus, in absence of underlying malignancy. Here we report an interesting case of a young male, who presented with the above features and managed excellently by open Heller’s myotomy under epidural anesthesia due to the poor performance status.

Tropical Doctor, 2020

The management of late-stage empyema thoracis requires surgical intervention. We performed a retr... more The management of late-stage empyema thoracis requires surgical intervention. We performed a retrospective descriptive analysis of open pleural decortication for late stage empyema thoracis in 55 children (age ≤ 15 years; median age = 6 years; age range = 1–15 years; 40 [72.7%] boys) over 42 months. The median time to thoracotomy from the onset of symptoms was 24 days, and the median duration of hospital stay before and after surgery was 15 and 4 days, respectively. Three (5.5%) patients had necrotising pneumonia, requiring debridement; 4 (7.3%) patients had superficial surgical site infection; 12 (21.8%) patients had perioperative pus culture positive for bacteria; and 3 (5.5%) patients had tubercular aetiology. There was no operative mortality. At median follow-up of 18 months, all patients are in good general health. Open pleural decortication leads to rapid resolution of symptoms and reduces hospital stay in paediatric late-stage empyema thoracis.

Indian Journal of Vascular and Endovascular Surgery, 2018

Pseudoaneurysm of brachial artery following whole blood donation is a very rare complication due ... more Pseudoaneurysm of brachial artery following whole blood donation is a very rare complication due to inadvertent arterial puncture. There are only a few cases reported in literature. Here, we describe this rare event in a young male whole blood donor presenting 2 months after blood donation with pulsatile swelling in the right antecubital fossa and paresthesia of hand. He was successfully managed with surgical intervention.

The Annals of Thoracic Surgery, 2018

The Indian journal of surgery, 2018

A 60-year-old lady presented with symptoms of chronic iron deficiency anaemia. On evaluation with... more A 60-year-old lady presented with symptoms of chronic iron deficiency anaemia. On evaluation with routine chest X-ray, it surprisingly revealed an irregular mass-like opacity in proximal part of stomach suggesting gastric cancer. The diagnosis was later confirmed with upper GI endoscopy and CT scan abdomen. Hence, in modern era of advanced diagnostics, chest X-ray findings should not be overlooked.

Asian Cardiovascular and Thoracic Annals

Objective Data collected from various institutions around the country was analyzed to assess the ... more Objective Data collected from various institutions around the country was analyzed to assess the current status of cardiovascular and thoracic surgery in the country. Methods We collected data from institutions performing cardiovascular and thoracic surgery from all over the country through direct correspondence for the year 2019. Individual institution data on the number of surgeries performed for cardiac, vascular, and thoracic surgery and its outcome in terms of mortality were compiled. The data were further evaluated depending on the type of procedures performed. Results Overall, a total of 2264 cardiac surgeries were performed in the country in the year 2019. The majority of the surgeries were for valvular heart surgery accounting for 34.3%, followed by congenital surgeries (32.8%) and surgeries for coronary artery disease (25.9%). A total of 649 thoracic surgeries were documented, which is probably marginally less than the actual numbers because we were unable to include an ad...

Indian Journal of Vascular and Endovascular Surgery

Introduction: Pseudoaneurysms are false aneurysm where disruption in the arterial wall forms a lo... more Introduction: Pseudoaneurysms are false aneurysm where disruption in the arterial wall forms a localized pulsatile hematoma connecting the artery. The common causes are intravenous drug abuse (IVDA), iatrogenic (vascular interventions and surgery), trauma, and infections. Aims: The aim of this study was to analyze the etiology, management, and outcome of patients with pseudoaneurysms of peripheral arteries. Materials and Methods: This is a retrospective analysis of prospectively maintained database of 32 patients with peripheral artery pseudoaneurysms over 45 months at a community-based hospital of Eastern Nepal. Results: The most common site involved was femoral artery (56.3%) followed by brachial (15.6%), radial (6.3%), anterior tibial (6.3%), and others (15.5%). The common etiologies were iatrogenic (46.9%), IVDA (31.3%), trauma (18.7%), and infection (3.1%). Operative intervention was performed in 29 (90.6%) patients as follows: ligation of artery and debridement (46.9%), primary repair (28.1%), and venous graft bypass (15.6%). Three patients (9.4%) with noninfected iatrogenic pseudoaneurysms of <3 cm were managed conservatively. Infected pseudoaneurysms were seen in 14 (43.7%) patients. Staphylococcus aureus was the most common isolate in the culture. There was no reoperation, amputation, or any in-hospital mortality. At follow-up, one patient developed leg claudication pain following a femoral artery ligation and one of the five patients developed a graft thrombosis after an autologous reversed saphenous vein bypass graft without any sequelae. Conclusion: Although repair with distal revascularization is an ideal approach, debridement and simple ligation of pseudoaneurysms is a safer alternative especially in IV drug abusers.

Annals of Medicine & Surgery

ANZ Journal of Surgery, 2021

Nepalese Heart Journal, 2020

Intravenous leiomyoma is a rare, benign smooth muscle tumor arising from intrauterine venules or ... more Intravenous leiomyoma is a rare, benign smooth muscle tumor arising from intrauterine venules or the myometrium. It can rarely present as intracardiac mass long after hysterectomy. In this case report we describe a 40-year-old female with previous history of hysterectomy, presenting with an intracardiac mass which was successfully managed with single stage tumor resection under cardiopulmonary bypass. Subsequent histopathology showed features of leiomyoma. The diagnosis of intravenous leiomyoma with cardiac extension should be kept in a female patient presenting with intracardiac mass with previous history of myomectomy or hysterectomy.

Tropical Doctor, 2020

Oesophageal perforation is rare, associated with diagnostic dilemma, delayed presentation and hig... more Oesophageal perforation is rare, associated with diagnostic dilemma, delayed presentation and high mortality rate (36%). Early diagnosis and treatment are crucial for a good outcome. Treatment is by non-operative methods (antibiotics, drainage of collections, oesophageal stenting and nutritional support) or by surgery, depending on the condition of the patient, timing of presentation and expertise. During a five-year period (2015–2019), we managed seven cases of oesophageal perforation due to a foreign body. Of them, 4 (57%) received operative intervention, while 3 (43%) were managed non-operatively. One postoperative mortality ensued; there was a mean hospital stay of 20 days.

Journal of Society of Surgeons of Nepal, 2019

Achalasia cardia is a rare primary esophageal motility disorder with an incidence of about 1 in 1... more Achalasia cardia is a rare primary esophageal motility disorder with an incidence of about 1 in 100,000 individuals. If left untreated or inappropriately treated, the disease may progress to end-stage achalasia characterized by megaesophagus or sigmoid esophagus. The presentation as severe malnutrition, anemia, hypoalbuminemia, and asymptomatic tracheal compression has not been described in the setting of the sigmoid esophagus, in absence of underlying malignancy. Here we report an interesting case of a young male, who presented with the above features and managed excellently by open Heller’s myotomy under epidural anesthesia due to the poor performance status.

Tropical Doctor, 2020

The management of late-stage empyema thoracis requires surgical intervention. We performed a retr... more The management of late-stage empyema thoracis requires surgical intervention. We performed a retrospective descriptive analysis of open pleural decortication for late stage empyema thoracis in 55 children (age ≤ 15 years; median age = 6 years; age range = 1–15 years; 40 [72.7%] boys) over 42 months. The median time to thoracotomy from the onset of symptoms was 24 days, and the median duration of hospital stay before and after surgery was 15 and 4 days, respectively. Three (5.5%) patients had necrotising pneumonia, requiring debridement; 4 (7.3%) patients had superficial surgical site infection; 12 (21.8%) patients had perioperative pus culture positive for bacteria; and 3 (5.5%) patients had tubercular aetiology. There was no operative mortality. At median follow-up of 18 months, all patients are in good general health. Open pleural decortication leads to rapid resolution of symptoms and reduces hospital stay in paediatric late-stage empyema thoracis.

Indian Journal of Vascular and Endovascular Surgery, 2018

Pseudoaneurysm of brachial artery following whole blood donation is a very rare complication due ... more Pseudoaneurysm of brachial artery following whole blood donation is a very rare complication due to inadvertent arterial puncture. There are only a few cases reported in literature. Here, we describe this rare event in a young male whole blood donor presenting 2 months after blood donation with pulsatile swelling in the right antecubital fossa and paresthesia of hand. He was successfully managed with surgical intervention.

The Annals of Thoracic Surgery, 2018

The Indian journal of surgery, 2018

A 60-year-old lady presented with symptoms of chronic iron deficiency anaemia. On evaluation with... more A 60-year-old lady presented with symptoms of chronic iron deficiency anaemia. On evaluation with routine chest X-ray, it surprisingly revealed an irregular mass-like opacity in proximal part of stomach suggesting gastric cancer. The diagnosis was later confirmed with upper GI endoscopy and CT scan abdomen. Hence, in modern era of advanced diagnostics, chest X-ray findings should not be overlooked.

Asian Cardiovascular and Thoracic Annals

Objective Data collected from various institutions around the country was analyzed to assess the ... more Objective Data collected from various institutions around the country was analyzed to assess the current status of cardiovascular and thoracic surgery in the country. Methods We collected data from institutions performing cardiovascular and thoracic surgery from all over the country through direct correspondence for the year 2019. Individual institution data on the number of surgeries performed for cardiac, vascular, and thoracic surgery and its outcome in terms of mortality were compiled. The data were further evaluated depending on the type of procedures performed. Results Overall, a total of 2264 cardiac surgeries were performed in the country in the year 2019. The majority of the surgeries were for valvular heart surgery accounting for 34.3%, followed by congenital surgeries (32.8%) and surgeries for coronary artery disease (25.9%). A total of 649 thoracic surgeries were documented, which is probably marginally less than the actual numbers because we were unable to include an ad...