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Successful Intubation with McCoy Laryngoscope in a Patient with Ankylosing Spondylitis

Wed, 01 Jan 2014 00:00:00 GMT

Title: Successful Intubation with McCoy Laryngoscope in a Patient with Ankylosing Spondylitis Authors: Subedi, A; Tripathi, M; Bhattarai, B; Pokharel, K; Dhital, D Abstract: Abstract Involvement of cervical spine in ankylosing spondylitis limits neck movement resulting in difficult intubation. We report a case of 45-yr-old lady of ankylosing spondylitis with restricted neck movement planned for emergency laparotomy. Grade 3 Cormack and Lehanelaryngoscopic view was observed with Macintosh laryngoscope and gum elastic bougie could not be negotiated. At second attempt with McCoy blade, the posterior commissure of the vocal cord could be visualized and intubation was successful. Thus, in absence of flexible laryngoscopes and when awake intubation is not feasible, McCoy blade should be considered an alternative than Macintosh blade to attempt intubation in patients of ankylosing spondylitis with restricted neck movement. Â Keywords: ankylosing spondylitis; McCoy laryngoscope; restricted neck movement Description: Case Report

Intestinal Type Borderline Mucinous OvarianTumour

Wed, 01 Jan 2014 00:00:00 GMT

Title: Intestinal Type Borderline Mucinous OvarianTumour Authors: Shakya, B Abstract: Abstract A 26 years old para 4 lady presented with abdominal distension following a home delivery 18 months back and lactationalamenorrhoea following since. Examination and investigation findings revealed a large ovarian tumour(28X28 cm) occupying the whole of the abdomen. Tumour markers were normal except for a slightly raised lactate dehydrogenase enzyme. Patient underwent staging laparotomy- left salpingoophorectomy, right tubal ligation with omental biopsy and peritoneal fluid cytology. Histopathology report revealed borderline mucinous ovarian tumour of intestinal type. Her postoperative period was uneventful and she was advised for follow-up. Borderline ovarian tumours are uncommon tumours. In the younger age with stage I, fertility sparing surgery is enough and has excellent prognosis, but follow up is important. Â Keywords: borderline ovarian tumour; follow-up, prognosis Description: Case Report

MRI Evaluation of Knee Injury with Arthroscopic Correlation

Wed, 01 Jan 2014 00:00:00 GMT

Title: MRI Evaluation of Knee Injury with Arthroscopic Correlation Authors: Gupta, M K; Rauniyar, R K; Karn, N K; Sah, P L; Dhungel, K; Ahmad, K Abstract: Abstract Background: Magnetic Resonance Imaging has emerged as the primary investigation for evaluation of the knee injury because of its high resolution and accuracy and it has often been regarded as the noninvasive alternative to diagnostic arthroscopy. The objective of this study was to find out the various types of traumatic lesions of the knee on MRI, to correlate the results with arthroscopy, and to establish the accuracy of MRI in detecting ligament and meniscal injury. Â Methods: This cross sectional study was conducted on 40 patients with knee injury over a period of one year. MRI of the knee followed by arthroscopy was performed in each case. Arthroscopy was done within 30 days of MRI examination and was considered as gold standard. Â Results: Various types of lesion seen on MRI were as follows: joint effusion 27 (67.5%), anterior cruciate ligament tear 23 (57.5%), medial meniscus tear 20 (50%), bone contusion 18 (45%), lateral meniscus tear 16 (40%), medial collateral ligament injury 16 (40%), lateral collateral ligament injury 14 (35%) and posterior cruciate ligament tear 14 (35%). Sensitivity, specificity and accuracy of MRI in detecting meniscal and cruciate ligament injury were as follows: medial meniscus: 85.7%, 89.4%, 87.5%; for lateral meniscus: 83.3%, 95.4%, 90%; for anterior cruciate ligament: 91.3%, 88.2%, 90%; and for posterior cruciate ligament: 92.8%, 96.1%, 95% respectively. Â Conclusions: MRI is a noninvasive, useful and reliable diagnostic tool for evaluating knee injury and it can be used as a first line investigation in patients with knee injury. Â Keywords: arthroscopy; knee injury; MRI. Description: Original Article

Hormonal Profile and Efficacy of Long Pulse Nd-YAG Laser in Treatment of Hirsutism

Wed, 01 Jan 2014 00:00:00 GMT

Title: Hormonal Profile and Efficacy of Long Pulse Nd-YAG Laser in Treatment of Hirsutism Authors: Karn, D; KC, S; Timalsina, M; Gyawali, P Abstract: Abstract Background: Hormones, particularly androgens play a vital role in hair growth, differentiation and distribution. Hirsutism is a common entity among Nepalese population with skin types III, IV and V. Long pulsed lasers are commonly used for hair removal. Â Methods: This is a prospective analytical study done in Dhulikhel Hospital Kathmandu University Hospital, Kavre, Nepal from November 2010 to November 2011. Patients were first subjected to hormonal evaluation. Androgens, their tropic hormones, insulin resistance markers and endocrine components were measured and compared. Subjects were then categorized into two groups according to androgen levels: group A (n=30) with significantly high androgen (total testosterone and dehydroepiandrosterone sulfate) or elevated luteinizing hormone: follicle stimulating hormone ratio, consistent with Polycystic Ovarian Syndrome (PCOS) and group B (n=30). Adrenal tumour was ruled out in all patients. All patients received long pulse Nd-YAG laser (50J/cm2; 50 msec pulse duration) therapy at four weeks interval to achieve at least 50% hair reduction. Â Results: Among group A patients, average 8.1 treatment sessions were required for substantial hair reduction, whereas, average 5.7 sessions produced similar results in group B patients (p-value <0.05). Â Conclusions: Patients with high androgen level and elevated LH: FSH ratio requires more treatment sessions for hair removal with long pulsed ND-YAG laser than patients with normal or low hormone level. Â Keywords: hair removal; hormones; Nd-YAG laser; polycystic ovary syndrome. Description: Original Article