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Limberg flap as a Primary Treatment for Pilonidal Sinus at Nepal Mediciti Hospital: A Single Unit Experience Limberg皮瓣作为尼泊尔Mediciti医院治疗毛毛窦的主要方法:单个单位的经验
Pub Date : 2021-12-08 DOI: 10.3126/nmmj.v2i2.41277
S. Ghimire, Sunil Dhakal, P. Rai, Nirvan Rai
INTRODUCTION: Pilonidal Sinus is a common condition with estimated incidence of 260 per million population with more male predilection and is often seen in sacrococcygeal area but has also been described in other areas with hair. The Limberg rhomboid flap was designed by Limberg in 1946 for the closure of a sixty degree rhombus shaped defect with a transposition flap. We would like to share our single unit experience of Rhomboid Limberg flap for Pilonidal sinus in our hospital. METHODS: This is an ongoing prospective descriptive study in the Department of General Surgery and Digestive Diseases of Nepal Mediciti Hospital from October 2018. The demographic of the patients, presenting symptoms, duration of symptoms and previous interventions are recorded and the Rhomboid Limberg flap surgery is done under regional or general anesthesia in prone position. The patient is given intravenous antibiotic and is instructed to sleep laterally or in prone position for 24 hours. The dressing is removed and the wound is inspected for flap status in the next morning. The patient is discharged on 1st post-operative day on oral antibiotics for 7 days and is followed on 7th post-operative day for removal of suction drain and alternate sutures in the skin and remaining sutures are removed on 10th post-operative day. RESULTS: We have done 28 cases of Limberg flap for Pilonidal Sinus from October 2018 to December 2020 of which 24 were male patients. None of our patients had flap necrosis. One patient presented with accidental removal of suction drain on 5th postoperative day, however he didn’t develop any wound related complication. One patient had superficial wound dehiscence on 10th post-operative day which healed on its own with dressing. One patient developed seroma from 5th postoperative and was managed with dressing and antibiotics and it healed in 2 weeks. None of our patients have developed recurrence and their wounds have healed satisfactorily with minimal scarring and pain. All the patients were able to resume their regular activities within 21 days. All except 2 patients were satisfied with cosmetic outcome. CONCLUSION: The Limberg flap is ideal treatment for pilonidal sinus with minimal postoperative pain, short hospital stay, few complications, rapid return to normal activities, good cosmesis, and a low recurrence rate with short learning curve for young surgeons. Hence, Limberg flap should be routinely used as primary treatment for pilonidal sinus.
摘要:毛窦是一种常见的疾病,估计发病率为260 /百万人,男性发病率更高,通常见于骶尾骨区域,但也见于其他有毛发的区域。Limberg菱形皮瓣是由Limberg于1946年设计的,用于用转位皮瓣关闭60度菱形缺损。在此,我们想与大家分享我院使用菱形皮瓣治疗毛窦的经验。方法:这是一项正在进行的前瞻性描述性研究,于2018年10月在尼泊尔梅迪迪尼医院普通外科和消化疾病科进行。记录患者的人口学特征、症状、持续时间和既往干预情况,并在区域或全身麻醉下俯卧位进行菱形Limberg皮瓣手术。给予静脉注射抗生素,并指示患者侧卧或俯卧24小时。取下敷料,第二天早上检查伤口皮瓣状态。患者于术后第1天出院,口服抗生素治疗7天,术后第7天拔除皮肤上的吸液引流管和备用缝线,术后第10天拔除剩余缝线。结果:2018年10月至2020年12月,我院共完成林堡皮瓣修复毛窦28例,其中男性24例。我们的病人都没有皮瓣坏死。1例患者在术后第5天出现意外拔出吸引管,但未出现任何伤口相关并发症。1例术后第10天创面表面裂开,敷料自行愈合。1例术后5日出现血肿,经敷料及抗生素治疗,2周愈合。我们所有的病人都没有复发,他们的伤口愈合得很好,疤痕和疼痛都很小。所有患者均能在21天内恢复正常生活。除2例外,其余患者均满意美容效果。结论:Limberg皮瓣术后疼痛小,住院时间短,并发症少,恢复活动快,美观性好,复发率低,学习曲线短,是年轻外科医生治疗毛突窦的理想方法。因此,Limberg皮瓣应常规作为治疗毛突窦的主要方法。
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引用次数: 0
Safe Contact Lens Practices during Coronavirus (COVID-19) Pandemic 冠状病毒(COVID-19)大流行期间隐形眼镜的安全操作
Pub Date : 2021-12-08 DOI: 10.3126/nmmj.v2i2.41286
S. Bhattarai
World is threatened by different variants of Coronavirus to an extent that life has been jeopardized in all services including eye care facility. Contact lenses which are one of the preferred modes of vision correction are not an exception to COVID-19 infection. Recently there is confusion among practitioners and patients regarding the safety of contact lens use during COVID-19. This review article summarizes the current recommendations and findings regarding contact lens use during COVID-19. Though eye health professionals and contact lens users are at risk to contract Coronavirus, with proper care, maintenance and disinfection techniques, it would be safe to continue wearing contact lenses. There is currently no strong evidence to suggest that contact lenses are not safe to wear during COVID 19 times. Eye care practitioners responsible for contact lens application must wear special surgical masks, protective glasses or visors and disposable waterproof gloves. Regarding soft contact lenses, preferably daily disposable lenses should be used from the sterile packages. Similarly for rigid gas permeable lenses, lenses made up of fluoropolymer contained in sealed packages must be motivated for the individuals. Since the infected hands can bring the virus to the eyes, contact lens users should avoid touching the nose, mouth and eye unnecessarily. Contact lens after each use must be disinfected with hydrogen peroxide solutions with a special catalyst container. In the case of eye redness and Flu like symptoms, contact lens trial and wearing practices should be suspended or postpone till the condition becomes normal. To minimize the contact time between the patient and examiner soft copy of the instruction sheet, teleconsultation should be motivated. Though the eye is an unlikely site for Coronavirus infection, eye doctors should warn the contact lens wearers to follow scrupulous contact lens hygiene rules.
世界受到不同冠状病毒变种的威胁,包括眼科保健机构在内的所有服务机构的生命都受到了威胁。隐形眼镜是首选的视力矫正方式之一,感染COVID-19也不例外。最近,医生和患者对COVID-19期间使用隐形眼镜的安全性感到困惑。这篇综述文章总结了目前关于COVID-19期间使用隐形眼镜的建议和发现。虽然眼科保健专业人员和隐形眼镜使用者有感染冠状病毒的风险,但通过适当的护理、维护和消毒技术,继续佩戴隐形眼镜是安全的。目前没有强有力的证据表明在COVID - 19期间佩戴隐形眼镜不安全。负责隐形眼镜应用的眼科医生必须佩戴特殊的外科口罩、防护眼镜或护目镜和一次性防水手套。对于软性隐形眼镜,最好使用无菌包装的日用一次性隐形眼镜。同样,对于刚性透气性镜片,由密封包装中的含氟聚合物制成的镜片必须对个人有激励作用。由于受感染的手可以将病毒带入眼睛,隐形眼镜使用者应避免不必要地接触鼻子、嘴巴和眼睛。隐形眼镜每次使用后必须用特殊催化剂容器中的双氧水溶液消毒。如果出现眼睛发红和流感样症状,应暂停或推迟佩戴隐形眼镜的试验和练习,直到病情恢复正常。为了尽量减少患者与审查员之间的接触时间,应鼓励远程会诊。虽然眼睛不太可能感染冠状病毒,但眼科医生应该提醒隐形眼镜佩戴者严格遵守隐形眼镜卫生规定。
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引用次数: 0
Laparoscopic Cholecystectomy for Large/Giant Gallstones: Case Report and Brief Review of Literature. 腹腔镜胆囊切除术治疗大/巨胆结石:病例报告及文献综述。
Pub Date : 2021-06-14 DOI: 10.21203/RS.3.RS-618682/V1
A. Shrestha, S. Bhattarai, S. Shrestha, M. Chand, A. Bhattarai
Background Gallstones disease (GSD) is the most common biliary pathology. GSD is one of the common surgical problems in which lead people admit to the hospital in Nepal. Its prevalence is found to be 4.87%. The size of a gallstone is important, as giant/large gallstones have a higher risk of complications and present technical difficulties during laparoscopic cholecystectomy (LC). Open cholecystectomy is preferred in most cases with giant gallstones. With the availability of experienced laparoscopic surgeons and modern laparoscopic equipment LC is also feasible in large/giant gallstones. In this case report, we report 2 cases of one large and one giant gallstone each which were successfully done laparoscopically.Case Presentation Case 1 A 51 years old female presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty food with no significant past medical and surgical history.Ultrasound abdomen showed normal gallbladder with multiple gallstones, largest measuring approximately 4cms. She was planned for elective LC. The gallbladder was removed out after extension of the infra-umbilical incision. On the cut section, we found multiple gallstones with one large gallstone measuring 4*3.3*3 cm and weighted 23.2 gm. Her post-operative period was uneventful. Case 2 A 39 years old female, known case of hypertension under calcium channel blocker(CCB) and angiotensin receptor blocker(ARBs) presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty foods with non-significant surgical history. Ultrasound abdomen showed a normal gallbladder with a single large gallstone (approximately 4.7 cm). Elective LC was performed and the gallbladder was removed out after extension of infraumbilical incision. On the cut section, we found a single giant gallstone measuring 5* 3*2.8 cm and weighted 24.7 gm. Her post-operative period was uneventful.Conclusion Large/giant gallstones are associated with a high risk of complications and cholecystectomy is warranted in symptomatic and asymptomatic patients. Even for large/giant gallstones, LC appears to be the treatment of choice over open cholecystectomy and should be performed by an experienced laparoscopic surgeon, taking into consideration the possibility of conversion to open in case of inability to expose the anatomy and any intraoperative technical difficulties.
胆结石病(GSD)是最常见的胆道疾病。在尼泊尔,GSD是导致人们入院的常见外科问题之一。其患病率为4.87%。胆结石的大小很重要,因为巨大/较大的胆结石有较高的并发症风险,并且在腹腔镜胆囊切除术(LC)中存在技术困难。大多数巨大胆结石患者首选开腹胆囊切除术。随着经验丰富的腹腔镜外科医生和现代腹腔镜设备的可用性,LC在大/巨大胆结石中也是可行的。在这个病例报告中,我们报告了2例一个大的和一个巨大的胆结石,每个都成功地在腹腔镜下完成。病例1,51岁女性,有5个月的间歇性右上腹绞痛病史,与高脂肪食物有关,无明显的既往病史和手术史。腹部超声示胆囊正常,伴多发胆结石,最大约4cm。她计划当选立法会议员。延长脐下切口后取出胆囊。在切面上,我们发现多发胆结石,其中一颗较大的胆结石,尺寸为4*3.3* 3cm,重量为23.2 gm。病例2:一名39岁女性,已知在钙通道阻滞剂(CCB)和血管紧张素受体阻滞剂(ARBs)治疗下的高血压患者,有5个月的间歇性右上腹绞痛病史,与脂肪性食物有关,无明显手术史。腹部超声显示胆囊正常,伴一大块胆结石(约4.7厘米)。择期行胆囊切除术,延长脐下切口后取出胆囊。在切面上,我们发现一颗巨大的胆结石,尺寸为5* 3*2.8 cm,重量为24.7 gm。术后顺利。结论大/巨型胆结石并发症风险高,有症状和无症状患者均应行胆囊切除术。即使对于大/巨大的胆结石,LC似乎是开放胆囊切除术的首选治疗方法,应由经验丰富的腹腔镜外科医生进行,并考虑在无法暴露解剖结构和任何术中技术困难的情况下转换为开放的可能性。
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引用次数: 1
Relationship between Nonalcoholic Fatty Liver Disease and Vitamin D in Nepal 尼泊尔非酒精性脂肪肝与维生素D的关系
Pub Date : 2021-05-21 DOI: 10.3126/NMMJ.V2I1.37217
M. Sah, R. Shrestha, B. Shrestha, D. Khadka
Background and Aims: Vitamin D deficiency has been frequently reported in many causes of chronic liver disease and has been associated with the development and evolution of non-alcoholic fatty liver disease (NAFLD).The study was done to explore associations between serum vitamin D concentrations among obesity, diabetes mellitus, hypothyroidism, and metabolic syndrome and its effects on liver fibrosis by ultra-sonogram and 2 d shear wave elastography in patients with non-alcoholic fatty liver disease (NAFLD). Methods: A hospital based prospective observational study was conducted from May 2019 for twelve months period in Gastroenterology Unit, NAMS, Nepal. Seventy patients with known fatty liver identified by Ultrasonogram criteria were enrolled. All patients were evaluated by different fibrosis scores (NAFLD Fibrosis, FIB4, APRI, AST/ALT ratio) and 2d shear wave score. Patients were evaluated for Vitamin D level and its effects on obesity, diabetes mellitus, thyroid related disease, dyslipidemias and NAFLD. Results: Among 70 patients, 39 (55.7%) were male and 31 (44.3%) were female with mean age of 44.3 years. Most of the patients were overweight with mean BMI of 28.2 kg/m2; among them 51 (72.9%) were more than 25.kg/m2. About 41.4% had diabetes mellitus, 77.1% had hypertension, 30% had hypothyroidism and 25.9% had metabolic syndrome. Majority of patients on ultrasound grading were mild with 64.28%; 25.72% were moderate and only 10 % were in severe groups. A study of 2 d shear wave elastography showed mean fibrosis of 7.07 kpa for mild grade, 8.22 kpa for moderate grade and 18.16 kpa for severe grade. The mean value of vitamin D was 22.61iu/ml for mild grade, 24.89 iu/ml for moderate grade and 17.4 iu/ml for severe grade. Conclusion: The results of this study showed high prevalence of serum 25(OH) vitamin D inadequacy in individuals with obesity, diabetes mellitus, hypothyroidism and metabolic syndrome which worsens as the stage of liver disease progresses.  
背景和目的:维生素D缺乏在慢性肝病的许多病因中经常被报道,并与非酒精性脂肪性肝病(NAFLD)的发展和演变有关。本研究通过超声像图和二维横波弹性成像,探讨非酒精性脂肪性肝病(NAFLD)患者血清维生素D浓度与肥胖、糖尿病、甲状腺功能减退和代谢综合征之间的关系及其对肝纤维化的影响。方法:从2019年5月起,在尼泊尔NAMS消化内科进行了一项为期12个月的基于医院的前瞻性观察研究。本研究纳入70例经超声诊断为脂肪肝的患者。通过不同的纤维化评分(NAFLD fibrosis、FIB4、APRI、AST/ALT ratio)和2d剪切波评分对所有患者进行评估。评估患者的维生素D水平及其对肥胖、糖尿病、甲状腺相关疾病、血脂异常和NAFLD的影响。结果:70例患者中,男性39例(55.7%),女性31例(44.3%),平均年龄44.3岁。大多数患者体重超重,平均BMI为28.2 kg/m2;其中大于25 kg/m2的51个(72.9%)。41.4%有糖尿病,77.1%有高血压,30%有甲状腺功能减退,25.9%有代谢综合征。超声分级以轻度为主,占64.28%;中度组占25.72%,重度组仅占10%。一项二维横波弹性成像研究显示,轻度纤维化平均为7.07 kpa,中度纤维化为8.22 kpa,重度纤维化为18.16 kpa。轻度、中度和重度的维生素D平均值分别为22.61iu/ml、24.89 iu/ml和17.4 iu/ml。结论:血清25(OH)维生素D缺乏在肥胖、糖尿病、甲状腺功能减退和代谢综合征患者中普遍存在,并随着肝病的进展而加重。
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引用次数: 1
Perforated Appendicitis Treated By Open Versus Laparoscopic Surgery- A Comparative Study 开放与腹腔镜手术治疗穿孔性阑尾炎的比较研究
Pub Date : 2021-05-21 DOI: 10.3126/NMMJ.V2I1.37215
B. Timilsina, O. Karki, B. Subedi
Background: Acute appendicitis is the most common surgical emergency of the abdomen. Perforated appendicitis often has higher morbidity and mortality. Laparoscopic Appendectomy (LA) is safe and effective procedure for the simple appendicitis compared to Open Appendectomy (OA) but it is not considered as the first line approach in case of perforated appendicitis and its role is still controversial and is under investigation. Hence this study was carried out to compare the outcomes of LA over OA in proven cases of perforated appendicitis. Methods: A hospital based comparative study was conducted among 60 patients with the diagnosis of perforated appendicitis who underwent LA and OA, for a duration of 18 months in Manipal Teaching Hospital, Pokhara. Data were collected using semi-structured questionnaire and were analyzed by descriptive and inferential statistics with SPSS version 25.0. Results: The study showed no significant statistical difference in operative time in LA compared to OA (66±18.11 minutes vs. 66.67±25.269 minutes, p = 0.9). Moreover it shows less post-operative pain (p = 0.003), shorter length of hospital stay (5.3±1.8 days vs. 7.3±3.31 days, p = 0.005), faster return of peristalsis (1.43±0.504 days vs 1.80±0.805 days, p = 0.037) and faster reinstitution of liquid diet(1.43±0.504 days vs 1.80±0.805 days, p = 0.037), less incidence of wound infection (5 in 30 = 16.66% vs. 12 in 30 = 40%, p = 0.042) and faster subjective full recovery(1.9±0.759 weeks vs. 2.9±0.89 weeks, p ˂ 0.0001) of LA patient compared to OA which is statistically significant. Conclusion: LA is safe and effective procedure than OA for perforated appendicitis.  
背景:急性阑尾炎是最常见的腹部外科急症。穿孔性阑尾炎通常有较高的发病率和死亡率。腹腔镜阑尾切除术(LA)相对于开放式阑尾切除术(OA)是治疗单纯性阑尾炎安全、有效的方法,但它不被认为是治疗穿孔性阑尾炎的首选方法,其作用仍有争议,尚在研究中。因此,本研究旨在比较经证实的穿孔性阑尾炎病例中LA与OA的结果。方法:以医院为基础,对60例诊断为穿孔性阑尾炎并行LA和OA手术的患者进行为期18个月的比较研究。采用半结构化问卷收集资料,采用SPSS 25.0版本的描述统计和推理统计进行分析。结果:LA与OA的手术时间差异无统计学意义(66±18.11 min vs 66.67±25.269 min, p = 0.9)。术后疼痛更少(p = 0.003),住院时间更短(5.3±1.8天比7.3±3.31天,p = 0.005),肠蠕动恢复更快(1.43±0.504天比1.80±0.805天,p = 0.037),恢复流食更快(1.43±0.504天比1.80±0.805天,p = 0.037),伤口感染发生率更低(30组5例= 16.66%比30组12例= 40%,p = 0.042),主观完全恢复更快(1.9±0.759周比2.9±0.89周)。p小于0.0001),与OA患者相比具有统计学意义。结论:手术治疗穿孔性阑尾炎安全有效。
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引用次数: 0
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Nepal Mediciti Medical Journal
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