Analysis of Lung Cancer Cases Presenting in Outpatient Department of University Hospital of Nepal.

Background Lung cancer is one of the leading cause of cancer related death. Most common histopathology of lung cancer is non-small cell carcinoma of which adenocarcinoma is the most common. There are limited number of studies done in Nepal to know different aspects of lung cancer.

Solving the Mystery of Giant Intrathoracic Mass.

Intrathoracic schwannoma are highly vascular nerve sheath benign tumors arising from neural crest derived schwann cells of the intercostal nerves. Common clinical presentation is palpable mass but in our case patient presented with shortness of breath which is rare presentation in Schwannoma. Imaging studies of the patient showed the lesion in left lung, however surgical finding showed mass to arise from chest wall and it was confirmed to be schwannoma by histopathological examination.

Initiation of Liver Transplant in Nepal: A Milestone.

Background: The incidence of chronic liver disease is increasing in the Nepalese population. Liver transplantation (LT) is the best option for patients with end-stage liver disease (ESLD). Nepal's first liver transplant was performed in 2016 in an international collaborative effort at Shahid Dharmabhakta National Transplant Centre (SDNTC), Bhaktapur, Nepal.

Kidney transplantation from brain-dead donors in Nepal: Report of first six cases.

Introduction: and importance: Kidney transplantation is one of the best treatment options for patients with end-stage renal disease. More than 90% of patients awaiting renal transplantation die without getting the kidney for transplantation. Brain dead donor kidney transplantation can bridge this gap proficiently.

Impact of society and national guidelines on patient selection for lung cancer surgery in the United Kingdom.

Objectives: We sought to evaluate the impact of different national clinical guidelines (with consistent and conflicting recommendations) on clinician's practice in the UK.

Methods: In this cohort study, we analysed data from National Lung Cancer Audit comprising all patients diagnosed with lung cancer between 2008 and 2013 within England and Wales for consistent (British Thoracic Society and National Institute of Clinical Excellence) recommendations for lower/more permissive lung function but opposing stage (N2) selection parameters for surgery.

Results: From 2008 to 2013, data from 167 192 patients with primary lung cancers were included.

Open Surgical Management of Abdominal Aortic Aneurysm at a Community Based University Hospital in Nepal.

Aortic aneurysms are abnormal dilatation of aorta. The risk factors include male sex, age > 65, smoking, coronary artery disease and hypertension. Here we report a case of infra-renal abdominal aortic aneurysm (AAA) of diameter 6 cm.

A case of thymoma in myasthenia gravis: Successful outcome after thymectomy.

Introduction: Thymic abnormalities occur as hyperplasia and thymoma. Myasthenia gravis is commonly present in thymoma. Thymectomy possesses risk due to anatomical proximity with vital thoracic structures and myasthenia crisis.

Factors Affecting Recanalisation after Optimal Management of Deep Vein Thrombosis; A single institution based study.

Background Presence of recanalisation will favour for better physiological recovery after medical management of Deep Vein Thrombosis (DVT) along with lesser chances of post thrombotic syndrome. Rate of recanalisation is varied and can range from 43-57% and the factors that affect recanalisation are still a dilemma. Objective To know the factors for recanalisation following Deep Vein Thrombosis.

Abnormal Venous Dilatation other than Typical Varicose Vein, Rare Encounters.

Varicose vein, one of the common vascular illnesses is usually a disease in lower limb. This is due to reflux of blood from deep venous system to superficial venous system. Rarely, this disease can also happen in veins in different location.

Chest Trauma Requiring Admission: Differences in Earthquake Victims and other Modes of Injury.

Background The April 25, 2015 Nepal earthquake (7.8 Richter scale) followed by May 12, 2015 major aftershock (7.3 Richter scale) killed more than 9,000 people and injured more than 23,000 people.

Optimal Starting Dose of Warfarin for Treatment of Deep Vein Thrombosis in Nepalese Context, A Retrospective- Prospective Institutional Review.

Background Deep vein thrombosis (DVT) requires an early establishment of effective anticoagulation in order to reduce harms and cost of concomitant treatments. Selection of the right warfarin dose at the start of treatment is important. Objective To know ideal starting dose of warfarin in adult with Deep Vein Thrombosis of our population.

Initial Experience of Complex Peripheral Bypass Surgery at Dhulikhel Hospital, Kathmandu University Hospital.

Peripheral arterial disease is seemingly silent yet is a major pubic health problem with limb threatening and life threatening consequences. This condition can initially be asymptomatic and gradually may progress to intermittent claudication and finally to critical ischemia. When conservative management is not sufficient and there is option of surgical management, peripheral bypass surgery is an established modality of treatment of peripheral arterial disease.

Short Term Fate of Great Saphenous Vein after Radiofrequency Ablation for Varicose Veins.

Background Radiofrequency ablation of varicose vein have gained popularity compared to conventional surgery due to comparable long term results in addition to definite immediate superiorities. This modality has been started in Nepal since August 2003 and the study on short term fate of ablated vein segment confirms the anatomical benefit in addition to the clinical benefit. Objective To analyze short term fate of segment of great saphenous vein that has been treated by Radiofrequency ablation in terms of occlusion of saphenofemoral junction and absence of recanalisation on Doppler ultrasonography finding done at 3-6 months postoperative period.

Results of surgery for chronic pulmonary Aspergillosis, optimal antifungal therapy and proposed high risk factors for recurrence--a National Centre's experience.

Background: Surgery for pulmonary aspergillosis is infrequent and often challenging. Risk assessment is imprecise and new antifungals may ameliorate some surgical risks. We evaluated the medical and surgical management of these patients, including perioperative and postoperative antifungal therapy.

Is type and screen only policy safe for patients undergoing elective lobectomy?

Objective: The purpose of this study was to establish the safety and feasibility of a recently adopted policy to type and screen (TS) (group and save) only for selected patients who had low likelihood of transfusion requirement.

Methods: The TS only policy was applied to patients undergoing first-time elective lobectomy with Hb of >11 g/dl, aged <70 years, with no clotting abnormality and no history of neoadjuvant therapy. A retrospective analysis of prospectively collected data was made of 208 consecutive patients undergoing elective lobectomy from November 2009 to October 2010.

Aortic valve replacement: is porcine or bovine valve better?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'Is porcine or bovine valve better for aortic valve replacement?' Altogether, 562 papers were found using the reported search, of which 15 represented the best evidence to answer the question. All papers represent either level 1 or 2 evidence.

What is the impact of providing a transcatheter aortic valve implantation service on conventional aortic valve surgical activity: patient risk factors and outcomes in the first 2 years.

Objectives: To assess the impact of introducing a transcatheter aortic valve implantation (TAVI) service on aortic valve surgical activity and outcomes.

Design: A retrospective analysis of prospectively collected data.

Setting: University hospital of south Manchester.

Active treatment rates for lung cancer in south Manchester: are we doing enough?

In an effort to improve the current lung cancer treatment outcomes in Britain, National guidelines were published followed by the introduction of National Lung Cancer Audit (LUCADA) project. LUCADA has defined active treatment as any therapeutic intervention with the aim of improving the quality or length of patients' survival irrespective of whether it is curative or palliative. From August 2003 to December 2006, all patients diagnosed to be new primary lung cancer referrals were enrolled into a prospective study.

Emergency redo mitral valve replacement and caesarean section in a patient with previous atrioventricular septal defect repair in childhood.

A 19-year-old primigravida, with a history of mechanical mitral prosthesis at the age of six years following previous repair of an atrioventricular septal defect, presented at 26 weeks' gestation with cardiogenic shock secondary to obstruction of the mitral prosthesis. She underwent successful emergency redo mitral valve replacement and caesarean section. At operation the prosthesis was found to be virtually completely obstructed with pannus.

Implications of a negative bronchoscopy on waiting times to treatment for lung cancer patients: results of a prospective tracking study.

Objective: To ascertain the causes of delays in treatment to all patients presenting to our centre with a working diagnosis of lung cancer. All were entered prospectively into a 'tracking study'.

Methods: Of 342 consecutive confirmed cases of newly diagnosed lung cancer presenting between September 2003 and December 2005, 193 were general practitioner referrals and 149 presented through casualty and internal referrals.

Long-term event-free survival with an embolised prosthetic valve leaflet in the thoracic aorta.

We report the case of a patient who underwent a redo surgery for a leaflet escape from a Bjork-Shiley tilting disc mitral prosthesis inserted 18 years previously. The escaped disc remained lodged in the thoracic aorta without any complication. She ultimately died of terminal heart failure 13 years after the second operation.

Cardiac compression following cardiac surgery due to unrecognised hiatus hernia.

A 76-year-old man who had undergone a routine coronary artery bypass grafting operation developed severe haemodynamic instability in the early postoperative period in spite of multiple inotropic supports. Due to persistent instability of haemodynamics and worsening acidosis his chest was re-explored with detection of no obvious abnormality. An intra-aortic balloon pump (IABP) was inserted for additional support.

Lung cancer resection rate in south Manchester: is it comparable to international standards? Results of a prospective tracking study.

The UK has been reported to have the lowest resection and survival rates for lung cancer patients. These reports were based largely on retrospective data from the cancer registry and are now outdated. To monitor the present day surgical resection rate at our institution all newly diagnosed cases of lung cancer presenting to us were enrolled into a prospective tracking study.

Missing washer of the rib approximator? An easily overlooked foreign body.

Iatrogenic Foreign bodies especially Gauze swab following surgery are well reported. We report a very unusual case of a loose washer from SELLARS rib approximator, which came out loose in a thoracotomy wound. It was not recognised till reported missing by the central surgical supply department.

Primary cardiac sarcoma: reports of two cases and a review of current literature.

Primary cardiac sarcomas are rare tumors with an unfavourable prognosis. Complete surgical resection is currently the only mode of therapy proven to show any benefit. We report the cases of two patients presenting with features of obstruction and embolism and a presumed diagnosis of left atrial myxoma.