Preoperative Controlling Nutritional Status Score on Predicting the Postoperative Complications Following Major Hepatopancreatobiliary Surgery.

Introduction The prognostic significance of the controlling nutritional status (CONUT) score in hepatopancreatobiliary (HPB) surgery has been shown by many studies but the clinical significance of the CONUT score for postoperative short-term outcomes remains controversial. This study aimed to investigate the impact of the CONUT score on early postoperative outcomes in patients following major HPB surgery. Method This was a prospective study of 57 patients who underwent major HPB surgery from November 2019 to January 2021 at the Department of Surgical Gastroenterology, Tribhuvan University Teaching Hospital, Nepal. Result A total of 57 patients, 25 males and 32 females, were operated on. The number of patients assigned to the normal, mild, and moderate malnutrition groups was 13, 41, and 3, respectively. The high CONUT group (CONUT ³ 2) consisted of 44 patients (77%) and the low CONUT group (CONUT <2) consisted of 13 patients (33%). The overall complications (Clavien-Dindo classification ³1) and major complications (Clavien-Dindo classification ³3) were present in 37 patients (64.9%) and 14 patients (24.6%), respectively. Increased operative time and intraoperative blood loss were associated with an increased incidence of major (OR: 1.01, p: 0.018) and overall (OR: 1.006, p: 0.039) postoperative complications, respectively, in univariate analysis. A high CONUT score was not associated with a higher incidence of overall and major postoperative complications. Conclusion In our study, the preoperative CONUT score did not predict the postoperative morbidity following hepatopancreatobiliary surgery.

Disseminated appendicular lymphoma presenting as acute appendicitis: a case report.

Introduction and importance: Acute appendicitis is a common surgical emergency marked by appendix inflammation, presenting as acute abdominal pain and typically treated with appendectomy. The authors report a rare case of disseminated appendicular lymphoma presenting as acute appendicitis. Acute appendicitis is a common surgical emergency. Case presentation: This case involved a 75-year-old male patient who underwent appendectomy, revealing an enlarged appendix with lymphomatous nodules. Clinical discussion: Lymphoma involvement in the appendix is extremely rare, and lymphomas presenting as acute appendicitis are even more exceptional. Imaging investigations, including ultrasound and CECT scan of the abdomen, are recommended to aid in diagnosis. On computed tomography, appendiceal lymphoma is characterized by markedly diffuse mural soft-tissue thickening with preserved vermiform morphology and occasional aneurysmal dilatation of the lumen. Conclusion: This case underscores the importance of considering unusual etiologies in atypical appendicitis presentations.

Perioperative Outcomes of Systematic Mesopancreas Dissection for Pancreatic and Periampullary Carcinoma at a Tertiary Referral Center From a Low Middle-Income Country.

Introduction Systematic mesopancreas dissection (SMD) is an emerging surgical approach in pancreatic cancer surgery. There is still debate about early postoperative and pathological outcomes using SMD in pancreatic cancer surgery. This study has been conducted to compare the perioperative outcomes, the lymph node yield, and the margin status in patients who underwent standard pancreaticoduodenectomy (ST-PD) and SMD-PD for pancreatic and periampullary carcinoma. Methods A retrospective comparative study was conducted in patients who underwent PD for pancreatic and periampullary carcinoma in a single unit of gastrointestinal and hepatopancreatobiliary surgery at Tribhuvan University Teaching Hospital, Nepal. Early perioperative and pathological outcomes were compared between the SMD-PD and ST-PD. Results The demographic data of 30 patients who underwent SMD-PD was comparable with the historical data of 40 patients who underwent ST-PD. The intraoperative blood loss and postoperative complications were found to be comparable between ST-PD and SMD-PD. However, the median operative time for SMD-PD was longer than ST-PD (360 minutes [IQR: 90 minutes] vs. 360 minutes [IQR: 60 minutes]). The rate of margin negative resection was similar between both groups. The median lymph node yield was significantly high in patients who underwent SMD-PD (17.5 (IQR: 6.5) vs. 11 [IQR-10.75]; p < 0.05). Conclusion SMD is safe and feasible for treating periampullary carcinoma and is particularly helpful in increasing lymph node yield.

Adenosquamous Carcinoma of Gallbladder with Unusual Prognosis: A Case Report.

The adenosquamous carcinoma of the gallbladder is a rare variant accounting for only 1-4% of all primary gallbladder carcinoma. Regardless of the histological types, all gallbladder carcinomas have silent and rapid progression resulting in delayed diagnosis and poor prognosis. Even with medical and/or surgical interventions, the median survival of patients with adenosquamous carcinoma, one of the histological variants, is less than a year. However, we present a case of adenosquamous carcinoma with an unusually better prognosis. A 70-year-old female patient, after being diagnosed with gallbladder carcinoma was suggested for surgical resection but was lost to follow-up since then. Two years later, the patient presented and was managed with extended cholecystectomy. The slow progression and non-recurrence of the tumour during follow-up for two years after the surgery indicates a better prognosis in this case. Keywords: carcinoma; case reports; cholecystectomy; prognosis.

Performance evaluation and genetic parameters estimation of multi-companies maize hybrids in Lamahi Dang, Nepal.

Selection, a basic and crucial step of breeding, can be made efficient through the estimates of genetic parameters. Ten multi-company's maize hybrids and two Nepalese maize hybrids were used as standard checks and evaluated in a randomized complete block design with three replications. Analysis of variance for different characters revealed significant differences for most of the characters among the genotypes used. The phenotypic coefficient of variation (PCV) was observed to be higher than the genotypic coefficient of variation (GCV) for all traits studied suggesting those traits interacted with the environment. The traits under study showed a wide range of heritability estimates (24%-90%). Among the characters, highest heritability and genetic advance were recorded for grain yield. Path coefficient analysis showed that the plant height, ear weight, number of kernel rows cob-1 and number of kernel row-1 and thousand kernel weight showed positive direct effect on grain yield. Ear weight and number of kernels row-1 had significant and positive correlation with grain yield. Therefore, much attention should be given to ear weight and number of kernels row-1 as these traits are helpful for indirect selection. Star 9, 10V10, and Shrestha were observed as superior and yielded higher than Rampur Hybrid 10 and Khumal Hybrid 2 in terms of grain yield.

Comparative Study of Perioperative Outcomes Between Modified Blumgart Duct to Mucosa and Dunking Pancreaticojejunostomy.

BACKGROUND: Pancreaticojejunostomy (PJ) is the ''Achilles heel" of pancreaticoduodenectomy (PD) which affects perioperative as well as oncological outcomes. However, there is a lack of information about the superiority of the type of anastomosis in terms of overall morbidity and postoperative pancreatic fistula (POPF) after PD. Here, we compare the outcomes of modified Blumgart PJ with the dunking technique of PJ. METHODOLOGY: A case-control study of a prospectively maintained database of 25 consecutive patients undergoing modified Blumgart PJ (study group) and 25 patients who underwent continuous dunking PJ (control group) between January 2018 to April 2021 was done. Between groups, comparisons were made for the duration of surgery, intraoperative blood loss, original fistula risk score, overall complications as graded by Clavien Dindo (CD), POPF, post pancreatectomy haemorrhage (PPH), delayed gastric emptying (DGE), and 30-day mortality at 95% confidence level. RESULTS: Among 50 patients, 30 (60%) were male. The most common indication for PD was ampullary carcinoma (44% in the study group vs. 60% in the control group). The duration of surgery was approximately 41 minutes longer in the study group compared to the control (p = 0.02), while the intraoperative blood loss was similar between the two groups (496.00 ± 226.35 ml vs 508.00 ± 180.67 ml, p = 0.84). While there was no significant difference in mean fistula risk score between the two groups, the POPF (8% vs 32%, p = 0.03), PPH (0% vs 20%, p =0.02), and overall major complications (CD≥ III) according to CD Grading (12% vs 40%, p = 0.02) were significantly lower in the study group. Similarly, the duration of hospital stay in the study group was 4.64 days shorter than the control group (p = 0.001). However, there was no significant difference in the 30-day mortality between the two groups. CONCLUSIONS: Modified Blumgart pancreaticojejunostomy has better perioperative outcomes in terms of procedure-specific complications like POPF, PPH, overall major postoperative complications, and duration of hospital stay.

Retrorectal schwannoma in a middle-aged female: A case report.

INTRODUCTION AND IMPORTANCE: Primary sacral and presacral lesions are uncommon and pose a significant diagnostic dilemma. Retrorectal schwannoma is a benign primary presacral lesion that is extremely rare and presents with non-specific symptoms. CASE PRESENTATION: A 42-years-old, female patient was admitted for lower-back pain for seven days. The retrorectal mass was detected on imaging, and she underwent laparoscopic excision. Pathological examination revealed a rare retrorectal schwannoma. CLINICAL DISCUSSION: Retrorectal location of schwannomas is rare and the preoperative diagnosis is very difficult as the clinical features and the radiological features are non-specific. In addition, these tumors can be found incidentally on routine rectal or pelvic examinations. As these tumors are benign, encapsulated, and non-invasive, this entity has an excellent prognosis. Despite the tumors' rarity and variety, we concur with the literature that surgical management is required to obtain a clear diagnosis and avoid consequences such as malignant transformation. CONCLUSION: Retrorectal Schwannoma presents a diagnostic and therapeutic challenge. Identification is important because surgical excision, either open or laparoscopic, is curative.

Importance of world high altitude Jumli Marshi rice with cultivation practices.

Geographically, Jumla is a Himalayan mountainous region located in the Karnali Province of Nepal. It has a beautiful landscape with abundant plant and animal species and is rich in biodiversity. Jumli Marshi has been cultivated since prehistoric times. Marshi has nutritional, religious, and cultural significance. The Chumchaur of Jumla, a place where rice cultivation is carried out at the highest elevation (3050 m) of the world. In the past, the field at the bank of the Tila river was filled with Jumli Marshi rice; however, its cultivation is currently decreasing day by day due to low productivity and blast susceptibility. Farmers prefer to grow improved varieties such as Chandannath-1 and Chandannath-3 rather than Marshi. Jumla's peasant worked very hard to produce this local variety and the role of women in producing this variety is crucial. The cultivation practice for Marshi production is unique compared with other rice production practices in Nepal. Due to it's richness in fiber (2.01 %), proteins (9.86 %), minerals such as 0.57 mg/100 â€‹g iron, 66.70 â€‹mg/100 â€‹g calcium, and 57.54 â€‹mg/100 â€‹g phosphorous, and low carbohydrates (72.74 %), it is regarded as suitable food for diabetes patients. Furthermore, it contains more nutrients than other rice varieties commonly grown in Nepal. Therefore, conservation and cultivation of Jumli Marshi should be promoted to preserve local diversity and contribute to sustainable local food production systems, agro-ecotourism, and crop improvement programs.

Presacral dermoid cyst in a young female patient: A case report.

Presacral dermoid cysts are rare, benign tumors of developmental origin that primarily affect women. Surgical resection is the mainstay of treatment for these cysts, even if asymptomatic, with the laparoscopic approach being safer and more efficient.

Incidental finding of jejunal diverticula during laparotomy for suspected adhesive small bowel obstruction: A case report.

INTRODUCTION AND IMPORTANCE: Jejunal diverticula are usually asymptomatic and are discovered incidentally. While rare, their complications may be life-threatening. They should be considered as differential diagnoses in undiagnosed complaints of chronic abdominal pain, malabsorption, anemia, gastrointestinal bleed and intestinal obstruction. CASE PRESENTATION: A 66-year lady, known hypertensive and hypothyroidism with history of hysterectomy presented with symptoms suggestive of small bowel obstruction. Intraoperatively adhesions between loops of the small intestine, multiple diverticula with two of them impending perforation were found. Resection of 10 cm of jejunum containing diverticula with end-to-end anastomosis was performed. She had uneventful recovery and on 2 months of follow-up she was doing well. CLINICAL DISCUSSION: Although diverticula can be found anywhere along the gastrointestinal tract, jejunal diverticula are rare. Most patients are asymptomatic, symptoms if present is non-specific that delay diagnosis causing patients to land up with complications. They are diagnosed incidentally on endoscopy or imaging rather than through clinical suspicion. Asymptomatic cases do not mandate treatment while symptomatic cases can be managed conservatively with surgery being reserved for those with complications. CONCLUSION: Small bowel obstruction due to jejunal diverticula is a rare entity, a diagnosis of which can be confirmed only intra-operatively. So it must be borne as a differential in small bowel obstruction. Timely diagnosis and management will prevent life-threatening complications of it.