Ultrasound: an extension of clinical examination.

AIMS AND OBJECTIVES: To study the impact the use of portable ultrasound can have for the benefit of the patients when used by doctors other than radiologist, in this case surgeons. METHODS: Ultrasound performed by surgeons in the pre-operative, operative and post-operative period was studied. Patients presenting to the Hospital with acute abdomen was subjected to ultrasound. They were either pre-operative or post-operative patients. Five patients were scanned intraoperatively. The impact of these scans to the patients as well as the clinicians was studied. RESULTS: This is an ongoing study and preliminary results of the scans show two pre-operative diagnosis of acute appendicular collection and one acute hydronephrosis. In the operation room, ultrasound was done on 5 cases. On three occasions, it was to locate renal stones so that it could be extracted with ease. On two of the case, it was t to confirm the adequacy of common bile duct exploration thereby allowing primary closure of the common bile duct. Post-operatively, it was used in four cases of which in two cases post-operative hemorrhage were detected timely within hours. In the other two cases, the surgical team was assured that the patient's complaint was not surgically related. CONCLUSION: Ultrasound should be an extension of the clinical examination when indicated and all clinicians should be proficient in its use in their respective fields.

Ancient cystic pelvic schwannoma presenting as a right iliac fossa mass.

Schwannoma is rare in pelvis. Ancient schwannoma is rarer histological subtype of schwannoma. We report a very rare case of pelvic schwannoma presenting with right sciatica and right iliac fossa pain. Clinical and imaging findings were suggestive of Peritoneal Hydatid cyst. The tumour was resected completely with marked clinical improvement. Histopathological examination showed Ancient cystic schwannoma.

Controversies in the management of acute pancreatits.

INTRODUCTION: Acute pancreatitis accounts for three to five percent of admission to hospital for abdomen pain. Though most are of mild form, the severer form takes a toll of some ten percent. AIMS AND OBJECTIVES: This study aims to make a retrospective analysis of some fifty four admissions for acute pancreatitis admitted to Kathmandu Medical College Teaching Hospital in the past twenty four months. It also aims to highlight some of the controversies that have come up as to its management. RESULTS: Among the 54 admissions for acute pancreatitis, there were thirty nine patients. Sixteen (41%) of them were female and twenty three (51%) male. Their ages ranged from twenty one to ninety years, with an average of forty one years. Surprisingly no patients were between sixty to eighty years bracket. Thirteen (33%) of the patients had gall stones in ultrasound. Two (5%) of the patients were suffering from mumps and Eleven (28%) no causal factors were found. While thirteen (33%) patients suffered from alcoholic pancreatitis. All of them were male. Of the alcoholic group, five (38%) had recurrent attacks. Five (38%) from the biliary and two (18%) from the idiopathic group had recurrent attacks. Four patients were operated on emergency basis. Three with the diagnosis of peritonitis and another eighty four year old lady with features of associated cholangitis were found to have acute pancreatitis at operation. One of them underwent peritoneal toileting; two had cholecystectomy and peritoneal toileting while the eighty four year old lady underwent cholecystectomy, common bile duct exploration and peritoneal toileting. All fared well post-operatively.