Introduction: Supracondylar fracture of humerus is one of the common pediatric fractures encountered in our daily clinical practice. The purpose of this study is to determine the pattern of supracondylar fracture operated at rural teaching hospital of Jumla, Karnali Nepal. Methods: A descriptive cross sectional study was conducted at Jumla, Karnali after Institutional Review Committee approval. Operating room notes from 15 May 2017 to 16 November 2019 were retrieved to gather the following information: patients address, age, sex, side, injury mechanism, displacement, neurovascular injury, concurrent injuries, initial management by traditional bone setters, time between injury and surgery, operative technique. Data analysis was done using Statistical Package for Social Sciences version 20. Results: A total of 138 children underwent operative fixation with mean age of 7.47 years and gender ratio of 2:1 boy to girl. Fall from cliff, ladders and rooftops were the prevailing cause of injury 72 (52.8%). Left side predominated with 88 (63.7%) and extension type was common in 135 (97.8%). Thirteen (9.4%) patients were initially managed by traditional bonesetters. Average time between injury and surgery was 5.2 days. Closed reduction was done in 100 (72.4%) patients whereas open reduction was necessary in 38 (27.5%) patients. Conclusions: Closed extension type pediatric supracondylar fracture was common in this study. Fall from cliff, rooftop and ladder are the major cause of fracture. Delayed presentation and initial management of the fracture by the traditional bonesetters makes supracondylar fracture more challenging in resource limited setting like ours.  

Introduction: Gall bladder cancer is the most common cancer of the biliary tree and one of the highly malignant tumors with poor prognosis. Although its incidence is low in west, it is common in our part of the world. There are very few studies regarding gall bladder cancer in Nepal. The incidence of gallstones in patients with gall bladder cancer is high. The aim of the study was to evaluate the clinicopathological aspect of the disease in patients with gallbladder cancer and to Asses the incidence of gallstones in patients with gall bladder cancer.Material and Methods: This was a retrospective study carried out in GI Surgery unit of National Academy of Medical Science, Bir Hospital, Kathmandu, Nepal. All patients diagnosed as gallbladder carcinomas during 12 years period from 2002 to 2014 were included in this study. Their clinical characteristics, laboratory data, tumor histopathology reports were obtained and analyzed using SPSS17.Results: Total of 47 patients who met inclusion criteria were included in the study. Male to Female ratio was 1:1.8. Age ranged from 32 to 72 years with mean age of 54. Most common presenting symptom was Pain abdomen (93.6%) followed by weight loss (51.1%) and Jaundice (46.8%). Most common finding on examination was Icterus (42.6%) followed by palpable gall bladder (34%) and Hepatomegaly (29.8%). Gall Stones were seen in 37 (72.3%) patients. Most common histopathology was Adenocarcinoma (93.6%).Conclusion: Most of the patient with gall bladder cancer remained asymptomatic until late. Pain abdomen was most common presenting symptom and icterus was most common findings. There was strong association between gall bladder cancer and gallstones. There should be high index of suspicion if patient with gallstones has constant pain in right hypochondrium and has jaundice.

Introduction: The Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM) and its modification the Portsmouth POSSUM (P-POSSUM), have been proposed as a method for standardizing patient data so that direct comparisons can be made despite differing patterns of referral and population. In this prospective study, the validity of P-POSSUM was tested in patients undergoing emergency laparotomy and the risk factors for low outcome were noted.Methods: This is the Prospective Study and was conducted in Department of surgery, of a tertiary level hospital. The study period was from April 2014- April 2015 for one year. Patients admitted under department of general surgery scheduled to undergo emergency laparotomy were included and scored according to their physiological and operative findings using a proforma sheet. Physiological scoring was performed just before surgery and operative scoring was carried out intra-operatively. Patients were followed-up for the first 30 days postoperative period. The observed mortality rate was compared with the P-POSSUM predicted mortality rate. Data analysis was done using SPSS 20.Results: A total of 60 patients who met the inclusion criteria were included in this study. On applying linear analysis, an observed to expected ratio of 1.18 was obtained, indicating a significant fit for predicting the post-operative adverse outcome. There was no significant difference between the observed and predicted mortality rates (x2 = 1.467, 4 df., P = 0.833). It was found to be comparable to other studies. In all the risk factors studied, a positive correlation was found between deaths and higher POSSUM scores.Conclusion: Portsmouth POSSUM scoring system serves as a good predictor of post-operative outcome in emergency laparotomy procedures.

IntroductionNeck masses are frequently found in clinical practice. A spectrum of pathological lesions ranging from inflammation to benign and highly malignant manifestation is observed. Fine needle aspiration cytology (FNAC) of neck masses is a quick, easy, safe and cheap technique in the diagnosis which has been a well-accepted procedure in diagnosing various swellings. Histopathology is a gold standard technique in diagnosing any swelling which also provide detail architecture, however it also requires OT setings, more manpower, expensive, time consuming, more traumatic and can sometimes become difficult.ObjectiveThe objective of our study was to evaluate the frequencies of neck swellings and how efficacy FNAC is in diagnosing neck masses by correlating the gold standard histopathological examination.MethodologyA Hospital based descriptive cross sectional prospective study was conducted in 50 patients with neck swellings presenting in the surgery OPD and admitied patient for some other reasons. FNAC and histopathological examinations were done from those lesions and were compared. The sensitivity, specificity and accuracy rates were calculated. Data entry and analysis was performed using SPSS.ResultsA total of 50 patient were subjected to both FNAC and histopathology examination (HPE). Out of 50 cases, 25 were male and 25 were female. The age ranged from 16 to 82 years. Lymph nodes 22 (44%) was the most common case, followed by thyroid 17 (34%), salivary glands 10 (20%) and soft issue 1 (2%).Among all Tubercular lymphadenitis (18%) followed by papillary carcinoma of thyroid (14%),metastatic carcinoma of lymph node, NHL, and pleomorphic adenoma 10% each. The sensitivity of FNAC in diagnosing neck masses is 90.08%, specificity is of 98.53%, and diagnostic accuracy is of 87.64%.ConclusionFNAC is a simple, fast, inexpensive, and minimally invasive technique which can be used as the first line investigation in diagnosing neck swellings.Birat Journal of Health SciencesVol.2/No.1/Issue 2/ Jan - April 2017, page: 206-210

Background: Breast diseases, among the most common diseases in females occur in various pat­terns from benign to malignant. Their identification is crucial as some of the benign disorders pose threat to turn into malignancy. This study was aimed to determine the spectrum of breast diseases. Methods: This was a hospital based retrospective study among all the patients in General Surgery OPD of Karnali Academy of Health Sciences, Teaching Hospital, diagnosed with breast diseases during one year period from August 2019 to July 2020 AD. Data were extracted and entered in SPSS version 16 for further analysis. Results: Out of 110 cases, only 4 (3.96%) were male. Almost half 54 (49.09%) of the cases were in the age group of 21-30 years. Fibrocystic disease, Breast Abscess and fibroadenoma, and cracked nipple were 39 (35.45%), 38 (34.54%, 15 (13.63%) and 8 (7.28%) respectively. The benign diseases were seen mostly in the younger population while malignant breast diseases were seen in the older population. Mastalgia was mostly seen in the twenties (17.3%) and the thirties (10%) while Breast abscess was commonly encountered in the twenties (16.4%) and the teens (11.8%). The gynaecomastia were seen only in four males. Conclusions: Fibrocystic breast diseases, Mastitis with or without abscess, fibroadenoma and cracked nipples were the first four most common breast diseases in females. The younger popula­tion had predilection towards the benign diseases which occurred most frequently in the third decade while the malignant occurred in sixth and seventh decade.