Triple Assessment of a Palpable Parotid Lump in "One-Stop" Clinics.

Introduction: The National Institute of Clinical Excellence in the UK (NICE) recommended the use of "one-stop" clinics for the assessment and management of head and neck lumps like those established for breast lumps. "One-stop" clinics should follow a triple assessment protocol involving physical examination, radiological imaging and fine-needle aspiration cytology (FNAC). Methods: A retrospective analysis of 144 patients with suspected parotid tumours from 2005 to 2011 was done. Patients were assessed for individual modalities and compared against the final histological diagnosis. Statistical analysis was used for sensitivity and specificity, as well as positive and negative predictive values. All calculations were performed using SPSS version 16 (Statistical Packages for the Social Sciences, Chicago, IL). A p value of < 0.05 was considered to indicate statistical significance. Results: A total of 105 patients underwent all the three modalities. Out of them, 93 had imaging that was considered radiologically benign and 12 were reported to have a malignant lesion. Cytologically, 75 were found to have a benign tumour, 13 were malignant, and 17 were considered to be indeterminate. The most common benign neoplasm was pleomorphic adenoma followed by Warthin's tumour. The sensitivity and specificity of triple assessment were 96% (p value 0.878-0.984) and 73% (p value 0.42-0.904), respectively. The positive predictive value was 96% (p value 0.878-0.984) and negative predictive value came out to be 93% (p value 0.42-0.904). Conclusions: The overall accuracy of triple assessment was found to be 92%. This study concludes that triple assessment is a useful assessment tool to evaluate a patient with parotid lump. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-021-01590-5.

Epidermoid Cyst of the Ear Lobule in Adult.

An epidermoid cyst is one of the most common benign cysts of the skin. The cyst is filled with keratin flakes and its wall is composed of keratinized, stratified, squamous epithelium. Epidermoid cysts can occur anywhere on the body, usually along the lines of embryonic fusion and mostly on the face, scalp, neck, chest, and upper back. Around 80% of the epidermoid cysts are seen in ovaries and testicles whereas, in the head and neck, they account for only about 7% and 1.6% of epidermoid cysts are reported in the oral cavity. The condition can be congenital or acquired. Congenital causes are rare and may be caused by the entrapment of ectodermal elements intradermally or subcutaneously during embryogenesis. Acquired causes of an epidermoid cyst may result from traumatic or iatrogenic implantation of epithelial cells into the dermal layer or from obstruction of a pilosebaceous unit in the hair follicle. Surgical excision completes the treatment.

Effects of treatment with a microRNA mimic or inhibitor on the developmental competence, quality, epigenetic status and gene expression of buffalo (Bubalus bubalis) somatic cell nuclear transfer embryos.

Expression levels of 13 microRNAs (miRNAs) were compared between buffalo blastocysts produced by somatic cell nuclear transfer through hand-made cloning and IVF to improve cloning efficiency. Expression of miR-22, miR-145, miR-374a and miR-30c was higher, whereas that of miR-29b, miR-101, miR-302b, miR-34a, miR-21 and miR-25 was lower, in nuclear transferred (NT) than IVF embryos; the expression of miR-200b, miR-26a and miR-128 was similar between the two groups. Based on these, miR-145, which is involved in the regulation of pluripotency, was selected for further investigation of NT embryos. miR-145 expression was lowest at the 2-cell stage, increased through the 4-cell stage and was highest at the 8-cell or morula stage in a pattern that was similar between NT and IVF embryos. miR-145 expression was higher in NT than IVF embryos at all stages examined. Treatment of reconstructed embryos 1h after electrofusion with an inhibitor of miR-145 for 1h decreased the apoptotic index and increased the blastocyst rate, total cell number, ratio of cells in the inner cell mass to trophectoderm, global levels of acetylation of histone 3 at lysine 18 and expression of Krueppel-like factor 4 (KLF4), octamer-binding transcription factor 4 (OCT4) and SRY (sex determining region Y)-box 2 (SOX2) in blastocysts. Treatment with an miR-145 mimic had the opposite effects. In conclusion, treatment of NT embryos with an miR-145 inhibitor improves the developmental competence and quality, and increases histone acetylation and expression of pluripotency-related genes.

Leptospirosis: An insight into community structure of small mammal's host in urban environment.

Leptospirosis is a zoonotic disease caused by bacteria of the genus Leptospira and most often acquired through contact with environments contaminated with leptospires shed in the urine of infected mammals. In urban environment, rodents are well-known as the main carriers of this bacteria, however there were no intensive study on the population structure of these animals, and how it associated with this disease. Hence, we use a case study from an outbreak in a residential area in Selangor, Malaysia, to investigate how community structure of small mammals, associated with the prevalence of Leptospira. One hundred cage traps were placed randomly in and around these houses in five phases with two months interval for a year. Community structures (species, sex, and age) were assigned for each individual, prior to screening for pathogenic Leptospira, using a partial lipL32 gene from the kidney samples. 185 small mammals from four species were captured, Rattus norvegicus (74.5%, N=138), R. rattus (20%, N=37), Tupaia glis (5%, N=9), and Suncus murinus (0.5%, N=1). From this number, 29 individuals were found PCR positive for pathogenic Leptospira (R. norvegicus, N=20; R. rattus, N=6; T. glis, N=2; S. murinus, N=1). The study shows that Leptospira occurrence in the small mammals were significantly correlated to age category and sampling phases, with Spearman Correlation (rs) p=0.02 and p=0.04 respectively. Adult individuals were significantly more prevalent with Leptospira infection, whereby March and June were found to associate with higher Leptospira prevalent among the small mammals, potentially coincide with low rainfall and relative humidity level. This information is important in designing a specific control method for rodents in Leptospira outbreak areas. In addition, intensive sampling and regular cleaning effort were found to significantly reduce the small mammal Leptospira reservoir, thus should be implemented in intervention strategies in the urban environment.

Leptospirosis: An insight into community structure of small mammal’s host in urban environment

@#Leptospirosis is a zoonotic disease caused by bacteria of the genus Leptospira and most often acquired through contact with environments contaminated with leptospires shed in the urine of infected mammals. In urban environment, rodents are well-known as the main carriers of this bacteria, however there were no intensive study on the population structure of these animals, and how it associated with this disease. Hence, we use a case study from an outbreak in a residential area in Selangor, Malaysia, to investigate how community structure of small mammals, associated with the prevalence of Leptospira. One hundred cage traps were placed randomly in and around these houses in five phases with two months interval for a year. Community structures (species, sex, and age) were assigned for each individual, prior to screening for pathogenic Leptospira, using a partial lipL32 gene from the kidney samples. 185 small mammals from four species were captured, Rattus norvegicus (74.5%, N=138), R. rattus (20%, N=37), Tupaia glis (5%, N=9), and Suncus murinus (0.5%, N=1). From this number, 29 individuals were found PCR positive for pathogenic Leptospira (R. norvegicus, N=20; R. rattus, N=6; T. glis, N=2; S. murinus, N=1). The study shows that Leptospira occurrence in the small mammals were significantly correlated to age category and sampling phases, with Spearman Correlation (rs) p=0.02 and p=0.04 respectively. Adult individuals were significantly more prevalent with Leptospira infection, whereby March and June were found to associate with higher Leptospira prevalent among the small mammals, potentially coincide with low rainfall and relative humidity level. This information is important in designing a specific control method for rodents in Leptospira outbreak areas. In addition, intensive sampling and regular cleaning effort were found to significantly reduce the small mammal Leptospira reservoir, thus should be implemented in intervention strategies in the urban environment.

Treatment of buffalo (Bubalus bubalis) SCNT embryos with microRNA-21 mimic improves their quality and alters gene expression but does not affect their developmental competence.

Application of cloning technology on a wide scale is severely limited by the very low live birth rate obtained with cloned embryos. Embryo quality is an important factor which affects the conception and live birth rate of cloned embryos. microRNA-21 (miR-21) has been implicated in the regulation of apoptosis and the expression level of several important genes which control apoptosis. We examined the effects of treatment of reconstructed buffalo embryos, produced by Hand-made cloning, with miR-21 mimic on developmental competence, quality and gene expression of cloned embryos. Expression level of miR-21, which increased from 2-cell to 8-cell stage and then decreased at the blastocyst stage, showed a similar pattern in cloned and IVF embryos. It was lower in cloned than in IVF embryos at 2-, 4- and 8-cell (P < 0.001) and blastocyst (P < 0.05) stages but not at morula stage. Treatment of reconstructed embryos with miR-21 mimic for 1 h after 1 h of electrofusion, increased (P < 0.05) the total cell number (251.3 ±â€¯10.7 vs 181.5 ±â€¯2.13). Blastocysts produced from miR-21-treated reconstructed embryos had lower (P < 0.05) apoptotic index than controls and IVF blastocysts (2.01 ±â€¯0.17, 5.46 ±â€¯0.26 and 4.19 ±â€¯0.15, respectively). The treatment also improved the inner cell mass:trophectoderm cell number ratio of blastocysts than in controls (0.21 ±â€¯0.01 vs 0.11 ±â€¯0.003) to values observed in IVF blastocysts (0.20 ±â€¯0.008). However, miR-21 mimic treatment did not affect the blastocyst rate, which was similar for treatment, control and negative control groups (36.58 ±â€¯3.64, 36.58 ±â€¯3.64 and 32.2 ±â€¯2.86%, respectively). miR-21 mimic treatment increased (P < 0.01) the expression level of apoptosis- (BCL2 and PTEN), pluripotency- (OCT4 and SOX2) and development-related genes (GLUT1, FGF4 and P53), but not that of CASPASE3 than in untreated controls in blastocysts. These results suggest that treatment of reconstructed embryos with miR-21 mimic improves blastocyst quality, reduces apoptosis and alters gene expression without improving the blastocyst rate.

Case report: coronectomy of an impacted and submerged second deciduous molar.

Coronectomy is a widely-accepted technique available for the treatment of impacted wisdom teeth. The fundamental principle is to prevent trauma to the inferior dental nerve (IDN). Many publications have demonstrated its positive outcomes but there is no literature available regarding coronectomy of deciduous teeth. This case report highlights the complex approach to managing a severely infraoccluded 85 in the mixed dentition of a 10-year-old female. The report demonstrates and discusses the combined orthodontic and oral surgical approach to prevent damage to the IDN and to allow space for orthodontic movement. This case demonstrates how nerve sparing techniques in the mixed dentition are achievable.Clinical relevance statement When managing severely infraoccluded and impacted deciduous second molars, clinicians must be aware that the option of a coronectomy should be considered and may be the difference between sparing the nerve or causing permanent injury.Objective The reader should understand that coronectomy is a suitable treatment option in managing impacted deciduous teeth.

Dotting the Three I's for collaborative TB-HIV activities: evaluation of a pilot programme in Kathmandu, Nepal.

Setting: The three government tertiary care hospitals providing care for people living with the human immunodeficiency virus (PLHIV) in Kathmandu, Nepal. Objectives: To assess 1) the screening cascades for intensified case finding for tuberculosis (TB), 2) isoniazid preventive therapy (IPT), including demographic and clinical factors associated with treatment interruption, and 3) TB infection control (IC) in the health facilities. Design: A cross-sectional study of new PLHIV enrolled from January 2012 to December 2014. Results: Among 572 registered PLHIV, 91% were on antiretroviral therapy. Of those registered, 561 (98%) were screened for TB and 73 (13%) were diagnosed with TB (17 [25%] sputum smear-positive, 17 [25%] smear-negative and 35 [51%] extra-pulmonary). Among the 488 (87%) PLHIV without active TB, 157 (32%) were initiated on IPT, of whom 136 (87%) completed treatment and 17 (11%) interrupted treatment. Those who experienced adverse events were 12 times more likely to interrupt IPT. TB IC showed gaps in personal control measures and supporting structures and policies. Conclusion: The implementation of the Three I's for collaborative TB-HIV activities in pilot sites in Nepal was successful and should be scaled up.

Contexte : Les trois hôpitaux d'état de niveau tertiaire offrant des soins aux personnes vivant avec le virus de l'immunodéficience humaine (PVVIH) à Katmandou, Népal.Objectifs : Evaluer 1) les étapes du dépistage pour une recherche intensifiée de cas (ICF) de tuberculose (TB) ; 2) le traitement préventif par isoniazide (TPI), y compris les facteurs démographiques et cliniques associés à l'interruption du traitement ; et 3) la lutte contre l'infection tuberculeuse (IC) dans les structures de santé.Schéma : Etude transversale auprès des nouveaux PVVIH enrôlés entre janvier 2012 et décembre 2014.Résultats : Parmi 572 PVVIH enregistrés, 91% étaient sous traitement antirétroviral. Parmi les inscrits, 561 (98%) ont eu un dépistage de TB et 73 (13%) ont eu un diagnostic de TB (17 [25%] TB à frottis positif, 17 [25%] TB à frottis négatif et 35 [51%] TB extra-pulmonaire). Parmi les 488 (87%) PVVIH sans TB active, 157 (32%) ont été mis sous TPI, 136 (87%) d'entre eux l'ont achevé et 17 (11%) ont interrompu le traitement. Ceux qui ont eu des effets secondaires ont été 12 fois plus susceptibles d'interrompre le TPI. Les mesures de lutte contre l'infection TB connaissent des lacunes en termes de mesures de protection individuelle et des structures et des politiques de soutien.Conclusion : La mise en œuvre des Trois I pour des activités collaborative TB-VIH dans des sites pilotes au Népal s'est faite avec succès et devrait être étendue.

Marco de referencia: Los tres hospitales públicos de atención terciaria que prestan servicios a las personas aquejadas de infección por el virus de la inmunodeficiencia humana (PVVIH) en Katmandú, Nepal.Objetivos: Evaluar 1) el algoritmo de detección en la búsqueda intensiva de casos de tuberculosis (TB); 2) el tratamiento preventivo con isoniazida (TPI), incluidos los factores demográficos y clínicos que se asocian con su interrupción; y 3) el control de la infección (IC) tuberculosa en los establecimientos de salud.Método: Fue este un estudio transversal de los PVVIH recién inscritos en el programa de enero del 2012 a diciembre del 2014.Resultados: De 572 PVVIH inscritos, el 91% recibía tratamiento antirretrovírico. De los pacientes registrados, en 561 se practicó la detección sistemática de la TB (98%) y se diagnosticaron 73 casos de enfermedad activa (13%) (17 obtuvieron un resultado positivo de la baciloscopia del esputo [25%], 17 un resultado negativo [25%] y ocurrieron 35 casos de TB extrapulmonar [51%]). De los 488 PVVIH sin TB activa (87%), 157 iniciaron el TPI (32%), 136 de ellos lo completaron (87%) y 17 lo interrumpieron (11%). La probabilidad de interrumpir el TPI fue 12 veces mayor en los pacientes que presentaron reacciones adversas. Al evaluar las medidas de control de las infecciones se observaron deficiencias en las medidas personales, las estructuras auxiliares y en las normas.Conclusión: La ejecución de actividades conjuntas, los Tres I's, de atención de la TB-VIH en tres centros piloto en Nepal fue eficaz y sería muy útil ampliar su escala de aplicación.

Amplitude of low-frequency fluctuation (ALFF) and fractional ALFF in migraine patients: a resting-state functional MRI study.

AIM: To evaluate the amplitude of low-frequency oscillations (LFOs) of the brain in migraine patients using amplitude of low-frequency fluctuation (ALFF) and fractional ALFF in the interictal period, in comparison to healthy controls (HCs). MATERIALS AND METHODS: A total of 54 subjects, including 30 migraineurs and 24 gender- and age-matched HCs completed the fMRI. All the data and ALFF, fALFF analyses were preprocessed with the Data Processing Assistant for Resting-State fMRI (DPARSF). All of the statistical analyses were performed using the REST software to explore the differences in ALFF and fALFF between migraine patients and HCs. RESULTS: In contrast to HCs, migraine patients showed significant ALFF increase in the left medulla and pons, the bilateral cerebellum posterior lobe and right insula. The regions showing decreased ALFF in migraine patients included the bilateral cerebellum posterior lobe, left cerebellum anterior lobe, bilateral orbital cortex, right middle frontal gyrus, bilateral occipital lobe, right fusiform gyrus, and bilateral postcentral gyrus. The fALFFs in migraine patients were significantly increased in the bilateral insular and left orbital cortex, but were decreased in the left occipital lobe and bilateral cerebellum posterior lobe. CONCLUSION: These ALFF and fALFF alterations in the brain regions of migraineurs are in keeping with the domains associated with pain and cognition. Such brain functional alteration may contribute to further understanding of migraine-related network imbalances demonstrated in previous studies.

Length of Stay of Orthopaedic Inpatients at a Teaching Hospital in Eastern Part of Nepal.

INTRODUCTION: This study aimed to analyze the average length of stay of all inpatients in the department of Orthopaedics and to compare the variations in hospital stay between age, gender, traumatic and non-traumatic co-morbidities and modality of payment. METHODS: This hospital based retrospective descriptive epidemiological study was based on patients discharged from a tertiary level health care center of eastern Nepal. Registry data of 1 year was used to calculate length of stay and analyze the variations. RESULTS: Average length of stay was 10.5 days. It was 10.7 days for males and 10.1 days for females. It was 10.12 days for patients paying themselves for their treatment whereas 14.98 days for patients receiving reimbursement (third party payment). CONCLUSIONS: Average length of stay was more in elderly and patients of trauma (longest in pelvis injury). It was 1.5 times longer for patients receiving reimbursement for treatment.

Effect of time of harvesting on yield and quality of melissa officinalis L. In doon valley, India.

A field experiment on the effect of time of harvesting on yield and quality of Melissa officinalis L. was conducted under the agroclimatic conditions of Doon valley, Uttarakhand in order to assess the performance of four harvesting times (H1-120 days, H2-140 days, H3-160 days and H4-180 days after planting). The fresh and dry herbage and oil yield of the aerial parts showed greater response in H3 i.e. harvesting at 160 days after planting, followed by H2 harvesting time. The quality of essential oil was evaluated using GC and GC-MS analysis. Geranial (24.53 %) and neral (18.80 %) were the major constituents found in the essential oil followed by trans-caryophyllene (7.70 %).

Prospective comparison study of one-year outcomes for all titanium total temporomandibular joint replacements in patients allergic to metal and cobalt-chromium replacement joints in patients not allergic to metal.

We aimed to ascertain whether there are any early differences in outcome between all titanium temporomandibular joint (TMJ) prostheses in patients allergic to metal and standard cobalt-chromium prostheses in patients not allergic to metal. All patients who had primary TMJ prostheses placed with one-year follow-up between March 2003 and February 2011 were included. We reviewed the basic characteristics of patients. The outcome variables measured included disease, pain, mouth opening, and diet. A total of 55 patients with 77 joint replacements fulfilled the inclusion criteria. Forty patients had standard cobalt-chromium alloy (Co-Cr-Mo) prostheses (20 unilateral and 20 bilateral), and 15 had all titanium prostheses (13 unilateral and 2 bilateral). Osteoarthritis was the most common disease in both groups. There was significant improvement in pain score at reviews at 6 weeks (p=0.001) and 12 months (p=0.03). Values between groups were not significant (p=0.48 at 6 weeks, and p=0.10 at 1 year). Mouth opening in each group improved significantly with continued gains between assessments at 6 weeks and 12 months (p=0.001) but there were no significant differences between groups. Diet scores were significantly improved one year postoperatively in both groups (p=0.001), but differences between groups were not significant (p=0.90). At one year, outcomes for all titanium prostheses in patients allergic to metal were similarly favourable to those in patients who had no hypersensitivity to metal and had standard prostheses. No patient developed a hypersensitivity reaction, and no all titanium prosthesis failed during the one-year follow-up period.

A comparative study on use of 3% saline versus 0.9% saline nebulization in children with bronchiolitis.

BACKGROUND: Bronchiolitis is a common clinical problem in children below 2 years presenting with respiratory symptoms. As there is necrosis and sloughing of epithelial cells, edema, increased secretion of mucus causing obstruction of large and small airways we aim to see the clinical profile and the effect of use of hypertonic (3%) saline nebulization in these children. METHODS: A double blind randomized controlled trial was conducted at department of Pediatrics, in a hospital from July 2012 to August 2013. The computer generated random number was used to select the case and control group. All eligible patients were randomly assigned to one of two groups: receiving inhalation of 4 ml normal (0.9%) saline or hypertonic (3%) saline. Treating physicians, researchers and nurses were all blinded of the solution. Both saline were kept in two identical containers and labeled as solution A and solution B. Patients in each group will receive three treatments on each day of hospitalization and clinical score were obtained 30 minutes before each inhalation session. RESULTS: Bronchiolitis accounted 11.26% of total admissions. Their mean age (±SD) was 8.56 (±5.013) months with range from 45 days to 24 months. A total of 53 (74%) male were enrolled in the study. Fifty-seven (79%) children were less than 12 months and 15 (21%) were 12 months - 24 months. The mean (±SD) for duration of hospital stay was 44.82 (±23.15) and 43.60 (±28.25) for 3% and 0.9% group respectively (p=0.86). Likewise, mean (SD) duration of oxygen supplementation was 32.50 (±20.44) and 34.50 (±26.03) for 3% and 0.9% group respectively (p=0.85). Moreover, time required for normalization of clinical score was 36.79 (±19.53) and 38.34 (±26.67) for 3% and 0.9% group respectively (p=0.80). CONCLUSIONS: There is no advantage of hypertonic saline over normal saline nebulization in the management bronchiolitis.

Drug dosage adjustment of patients with impaired renal function at hospital discharge in a teaching hospital.

BACKGROUND: Inappropriate dosing and the risk of toxicities are common with the patients with impaired renal function. Therefore, appropriate dosing is obligatory to prevent the drug toxicities. The present study was performed to investigate the appropriateness of dosage adjustment of the drugs that are toxic to kidney and/or metabolized or eliminated (TEM) by kidney. METHODS: A retrospective study was performed at the time of hospital discharge in the patients with impaired renal function. All patients with renal clearance ≤50 ml/min/1.73 m² were included for the analysis. Data with respect to patient's clinical, medications and their dosages, laboratory findings were extracted from medical record section. RESULTS: At discharge, there were a total of 848 prescribed drugs in 116 impaired renal function patients. Of them 404 were classified as TEM medication. Dose adjustment according to renal function was judged as necessary in 135 TEM medications and 28 were deemed to be used with caution. Among these, 108 (80% of 135) medications were considered appropriate in dosing, whereas 27 (20%) were inappropriate. Total 14 (10.37%) and 13 (9.63%) times of inappropriate dosing were found in those with moderate and severe renal impairment, respectively. The frequency of inappropriate dosing was not significantly different from moderate than that of the severe renal impairment (p > 0.05). CONCLUSIONS: The results of the study demonstrated that dosage adjustment of TEM drugs in patients with impaired renal function is less than optimum in a considerable number of patients at hospital discharge. Awareness raising and monitoring system for inappropriate dosing is critical to improve the quality of care in patients with renal dysfunction.

Close Versus Limited Open Method of Ender's Nail Fixation in Paediatric Femoral Shaft Fractures.

INTRODUCTION: There are various surgical options for treating fracture of femoral shaft in children. Here we compare the results of close with limited open method of Ender's nails fixation of femoral shaft fractures in children. METHODS: We studied 60 children with femoral shaft fractures in age group 5-15 years. Ender's nail fixation was done by close technique in 40 cases and in 20 cases by limited open technique. RESULTS: The mean operative time was significantly high in limited open group being 64 minutes in comparison to 50 minutes in close group. There was no significant difference between close and limited open groups with respect to time for partial weight bearing and time for full weight bearing. Fracture united sooner in close group as compared to open group. Union was achieved in all patients within a mean of 11 weeks in close group in comparison to 12.4 weeks in open group. According to the Flynn criteria in close group 34 patients had excellent results, 6 had satisfactory and none poor. In limited open group outcome was excellent in 14 patients, satisfactory in 4 patients and 2 had poor result. There was no significant difference in outcome based on Flynn criteria between two groups. CONCLUSIONS: Though operative time is more and healing is delayed in Ender's nail fixation by limited open technique, there is no statistical difference in final outcome as per Flynn criteria between close and limited open technique of Ender's nail fixation of femoral shaft fractures in children.

Bile duct injuries during open and laparoscopic cholecystectomy: management and outcome.

BACKGROUND: The widespread application of laparoscopic cholecystectomy has led to a rise in the numbers of major bile duct injuries (BDI). Perioperative management of these injuries is complex and challenging. There are few published reports locally regarding the perioperative management of BDI. Purpose of this review was to analyze our experience in diagnosis, management and prevention of BDI. METHODS: This study was conducted in department of surgery at B. P. Koirala Institute of Health Sciences. From January 2001 to September 2010, a observational study of all patients with a BDI following cholecystectomy was maintained. Patients' charts were retrospectively reviewed to analyze incidence, type of injury, presentation, and perioperative management of BDI. RESULTS: A total of 92 patients had BDI which occurred during cholecystectomy, were analysed retrospectively. There were 60/92 (65.5%) patients with BDI resulting from the wrong identification of the anatomy of the Calot's triangle during cholecystectomy. Abdominal ultrasonography was diagnostic for BDI in 71/90 (78.8%). Magnetic resonance cholangiography could reveal the site of injury, the length of injured bile duct and variation of bile duct tree with a diagnostic rate 22/23 (95.6%). The most common injury was Strasberg's E2 in 65/92 (70.7%). A transection or stricture of the bile duct was repaired by hepaticojejunostomy (83 cases in this series). Seventy-five (81.5%) patients were followed up. The mean follow-up time was 2.6 years (range 0.16-6). Good results were achieved in 62/75 (82.6%) of the patients. CONCLUSIONS: The high success rate of bile duct repair in the present study can be attributed to the appropriate timing, meticulous technique and the tertiary care experience.

Surgical management of cervical spondylotic myelopathy.

INTRODUCTION: The surgical procedure by the anterior, posterior and combined antero-posterior approaches had applied for the treatment of cervical spondylotic myelopathy. METHODS: During the treatment process, all patients were pre-operatively as well post-operatively graded according to Japanese Orthopaedics Association. Several surgical methods such as anterior approach, posterior approach, and combined antero-posterior approach have been addressed for CSM patients, with the choice based on the pathogenesis of the myelopathy. The main indications for surgery were evidence of myelopathy on physical examinations, a JOA score below 13 points help with spinal cord compression observed on plain X-ray, CT scan, MRI studies. RESULTS: The pre-operative JOA scores were 7.60±1.23 in laminoplasty, 8.30±1.03 in diskectomy and corpectomy and 7.10±1.20 in combined antero-posterior approach patients. At the follow-up after three months the JOA scores were laminoplasty 13.30±1.30, diskectomy and corpectomy 13.55±1.15 and combined antero-posterior 13.50±1.08. The JOA recovery rate averaged, 61.08±11.25% in laminoplasty, 60.67±10.60% in diskectomy and corpectomy and 64.67±10.72% in combined antero-posterior approach. The high-signal intensity changed to normal in 18 out of 28 and no any kyphotic change and instability were found in cervical spine at the follow up. CONCLUSIONS: Patients with OPLL (continuous, segmental and mixed type), stenosis of cervical spinal canal, multilevel cervical spondylosis, large and high ossification of IVDP with stenosis were improved with laminoplasty. Patients with PIVD, CSM with kyphosis, post laminectomy, OPLL herniated type, unstable vertebral alignment, stenosis by osteophytes, were improved with anterior approach. Ossified or deformed OPLL, unstable vertebral with stenosis, OPLL or OYL with cervical meandearing (swan-neck) were improved with Combined anterior and posterior approach.

Virtual panendoscopy--a new tool to help evaluating oral cancer.

Virtual panendoscopy (VP) is a new, non-invasive diagnostic technique available to assess luminal structures. It involves the use of the data obtained from scanning of patients using multidetector CT scanners. The data is manipulated using a software programme to generate 3D models with fly through capability to examine various anatomical tubes. Its use has been studied in colonoscopy and bronchoscopy. However its use in head and neck cancer assessment has not been extensively studied. Therefore this diagnostic tool was used to stage 10 consecutive head and neck cancer patients. The ability of this tool in staging and identification of synchronous primary was assessed. The findings from the VP were also compared with the findings of nasendoscopy. In our pilot study, the virtual panendoscopy has been a useful tool in the assessment of the upper aero digestive tract. Although it has not picked up synchronous primaries, good quality assessment of lumen and the mucosal wall was done in areas not accessed by nasendoscope. It is most useful in areas not accessed by nasendoscope i.e. trachea, bronchus etc. The outcome, its usefulness and shortcomings are discussed.

An unusual case of obstructive jaundice.

Tuberculosis of the pancreas is a rarity, reported in a handful of literature. We enumerate the case of a young girl with high fever, jaundice, and right hypochondrial pain, whose investigations revealed a mass at the head of the pancreas. FNAC from the mass astoundingly proclaimed tuberculosis.

Pattern of occurrence of leukemia at a teaching hospital in eastern region of Nepal - a six year study.

INTRODUCTION: Pattern of leukemia is known to vary widely throughout the world. The characterization of distribution patterns of different subtypes of leukemia in Nepal needs further study. We wanted to study the leukemia pattern in our institute. METHODS: A retrospective study of 196 cases of leukemia, diagnosed at BPKIHS, between January 1997 to December 2002 was done. We analyzed the pattern of leukemia at BPKIHS by morphological subtype, gender, age at diagnosis, time period of diagnosis (seasonality), and geographic distribution. RESULTS: Morphological sub typing showed that 121 cases were of acute leukemia and 75 of chronic leukemia. Chronic myeloid leukemia constituted the single largest group comprising 35.2 % of all cases, followed by acute myeloid leukemia (28.57 %) and acute lymphoid leukemia (19.9 %). Maximum numbers of cases were from the lowlands while least number of cases were from the mountain districts. Results were compared with literature from Nepal and other countries. This is the second series of leukemia from Nepal. CONCLUSIONS: The data published in this study reflects the leukemia pattern in the eastern region of Nepal. The pattern and distribution of AML, CML, ALL was similar to that in the developed western countries while the lesser frequency of CLL was similar to that in Southeast Asian region.