Background: Lower gastrointestinal endoscopy requires adequate bowel preparation. However there is no unanimous recommendation on choice of agent of bowel preparation for the purpose of screening flexible sigmoidoscopy.Objective: To compare the quality of bowel preparation and patient’s tolerance between Enema (Solution of Glycerin 15% w/v and Sodium Chloride 15% w/v)and Polyethylene glycol for screening flexible sigmoidoscopy.Methodology: All consecutive patients undergoing screening flexible sigmoidoscopy were included in the study. We prospectively divided the patients into two groups. Group A received per rectal enema and group B received oral bowel preparation with polyethylene glycol. Adequacy of bowel preparation and patient’s tolerance between two groups was graded. Data were analysed using Microsoft Excel 2010.Results: Results were comparable regarding quality of bowel preparation between two groups (A and B), excellent in 20% and 33.33% and good in 60% and 50% respectively. Almost all patients could tolerate the preparation agent in Group A (n=28). In-group B, eight patients (26.66%) considered the oral preparation agent difficult to tolerate and two patients (6%) were unable to complete the preparation.Conclusion: Enema (Solution of Glycerin 15% w/v and Sodium Chloride 15% w/v) and Polyethylene glycol have similar quality of bowel preparation and for screening sigmoidos copy. Enema is adequate and much easily tolerable compared to polyethylene glycol. Journal of Kathmandu Medical College,Vol. 7, No. 2, Issue 24, Apr.-Jun., 2018, page: 50-54

Introduction: Surgical simulator is a computer based technology used to educate and train medical students and practitioners without the need for a patient, cadaver or an animal model. Touch surgeryTM(TS) is a free of cost smartphone based application used for teaching surgical procedures. The participants in this study were specifically assessed on the increase of their knowledge in the key steps of laparoscopic cholecystectomy after practicing on the smartphone simulator, TS.Methods: A non-randomized controlled trial (uncontrolled longitudinal study) was carried out among 20 final year medical students. Their knowledge on surgical procedure was assessed through a questionnaire prepared regarding the steps of laparoscopic cholecystectomy before and after exposure to TS. Study Variable was the scores to a questionnaire before and after exposure to the surgical simulation.Results: Mean pre-practice score was 25.85 ± 11.05 and mean post practice score was 80 ± 10.62 (p<0.001). Conclusion: This study suggests that the use of TS can increase the knowledge of the students about laparoscopic cholecystectomy. This can definitely be used for teaching students, other surgical procedures.

Primary hyperhidrosis is a disorder in which there is an excessive amount of sweating more than required for the body’s thermoregulation. It is due to excessive function of the sudomotor sweat control system in the absence of a sweating trigger. We had a 25-year-old engineer, who presented with complaints of profuse sweating in both his palms, feet and axillae for more than 10 years. He had distressing symptoms disabling his daily activities and causing negative impact in his social, professional, recreational and quality of life. He took medical treatments including topical agents, anticholinergics, iontophoresis and even botulinum toxin injection. All these not only failed to give relief but only aggravated his disappointment. Endoscopic thoracic bilateral sympathectomy was performed from T2 to T4 level. Drastic improvement was seen in immediate post-operative period. Pre-operative palmar temperature of 90° Fahrenheit increased to 96.5° Fahrenheit in immediate post-operative period. His post-operative period was uneventful and was discharged on the second postoperative day. On follow-up after 30 days, the patient was asymptomatic, fully satisfied with the surgery and without any complications. Endoscopic thoracic sympathectomy is a safe, effective, fast and minimally invasive surgical modality of treatment for primary hyperhidrosis.

Laparoscopic pancreaticoduodenectomy was described in 1994. It is considered the most challenging abdominal surgery. Although the procedure was found to be feasible in initial reports, the benefits were not considered favorable. In recent days, with the increasing experience of surgeons, acceptable outcomes are being observed and have been found to be technically beneficial and oncologically safe in selective cases in experienced hands. We performed the procedure in a 42-year-old gentleman with good operative and post-operative outcomes. The patient’s follow-up for six post-operative months seems satisfactory. The operation took 840 minutes with minimal blood loss. The resected specimen was adequate and satisfactory from an oncological and technical point of view. The patient developed some inherent complications of the procedure in the post-operative period. He recovered well. Details of the case and technical aspects are being discussed.

Background: Deep Venous Thrombosis is a common yet difficult problem to prevent in neurosurgical patients. Recent trials did not find sufficient evidence to support use of graduated compression stockings, however we believe, this inefficiency may be due to the method of application which needs to be modified. We have been following a patient specific mechanical prophylaxis protocol, nicknamed WeMPiC. This study aims to evaluate the effectiveness of WeMPiC protocol. Methods: An observational cohort study was performed including consecutive patients admitted to neurosurgical ICU who were bedridden for >7 days between April 2014 and September 2017. We developed WeMPiC protocol of early weaning off, early mobilization, limb physiotherapy and alternate two hours on and off application of thigh length graduated compression stockings. Lower limbs compression ultrasound studies were performed on alternate days. Results: One hundred thirty-one patients were included in the study. Mean age of patients was 53.7+ 20.6 years. Of these patients, 52.7% had stroke (91% had hemorrhages), 32.1% had head injury and 7.6% each had spine problem and brain tumor each. five (3.8%) developed deep venous thrombosis on the 4th and 6th day of ICU stay, mainly in popliteal veins (2.3%) and femoral veins (1.5%). Deep venous thrombosis was associated with younger age (47 years, p=0.005), ICU stay (13 days, p=0.014), Wells’ score (4.6, p<0.0001) and Poor Glasgow Coma Score at presentation (9, p=0.004). Power of study calculated for the cohort incidence of 3.8% was 100%. Cost benefit of $336 with WeMPiC protocol was seen as compared to the Low molecular weight heparin prophylaxis over four weeks. Conclusions: Compared to incidence of 12.1% in CLOTS 3 trial among the unexposed patients, we report a risk reduction of 8.3% with WeMPiC protocol which is cost effective and highly applicable in resource constraint scenarios.