INTRODUCTIONThe aim of this review was to systemically analyse trials evaluating the efficacy of routine on-table cholangiography (R-OTC) versus no on-table cholangiography (N-OTC) in patients undergoing cholecystectomy.METHODSRandomised trials evaluating R-OTC versus N-OTC in patients undergoing cholecystectomy were selected and analysed.RESULTSFour trials (1 randomised controlled trial on open cholecystectomy and 3 on laparoscopic cholecystectomy) encompassing 860 patients undergoing cholecystectomy with and without R-OTC were retrieved. There were 427 patients in the R-OTC group and 433 patients in the N-OTC group. There was no significant heterogeneity among trials. Therefore, in the fixed effects model, N-OTC did not increase the risk (p=0.53) of common bile duct (CBD) injury, and it was associated with shorter operative time (p<0.00001) and fewer peri-operative complications (p<0.04). R-OTC was superior in terms of peri-operative CBD stone detection (p<0.006) and it reduced readmission (p<0.03) for retained CBD stones.CONCLUSIONSN-OTC is associated with shorter operative time and fewer peri-operative complications, and it is comparable to R-OTC in terms of CBD injury risk during cholecystectomy. R-OTC is helpful for peri-operative CBD stone detection and there is therefore reduced readmission for retained CBD stones. The N-OTC approach may be adopted routinely for patients undergoing laparoscopic cholecystectomy providing there are no clinical, biochemical or radiological features suggestive of CBD stones. However, a major multicentre randomised controlled trial is required to validate this conclusion.

BackgroundEpidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement.MethodsSixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded.ResultsThe transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor.ConclusionsThe midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom.

Objectives:The objective of the following study is to evaluate the usefulness of ultrasonography (USG) in comparison with conventional radiography and computed tomography (CT) scan in the diagnosis of zygomatic arch and mandibular fractures.Materials and Methods:A total of 40 patients with suspected fracture of the zygomatic arch and/or mandibular fractures were included in the study. Two groups (one for zygomatic arch fractures and the other for mandibular fractures) of 20 patients each were designed for the study. Ultrasonographic examinations were performed using small linear probe (LA435, Siemens Acuson Antares) with 10 MHz frequency. Data from CT and conventional radiography were compared with that of USG.Results:Sensitivity and specificity of USG in assessing zygomatic arch fractures were 100% and 100%, respectively; and that of mandibular fractures were 94.74% and 100%, respectively. Overall sensitivity, specificity, positive predictive value, and negative predictive value of USG against CT in diagnosing zygomatic arch and mandibular fractures were found out to be 97.4%, 100%, 100%, and 66.7%, respectively.Conclusion:USG is a very reliable tool in detection of fractures involving zygomatic arch and mandible. It can be used for screening of suspected fractures of zygomatic arch and mandible to avoid unnecessary radiation exposure from conventional radiography and CT scans.

Contrast enhancement simulating an abscess or residual tumor has been described in postoperative cranial computed tomography (CT) scans. This study was undertaken to determine the cause of this contrast enhancement by using canine brain as an experimental model. Sequential CT scanning was performed with and without contrast enhancement following partial resection of the right hemisphere, and the CT findings were correlated with the histological changes. Findings indicate that enhancement of the surgical margin is related both temporally and spatially to the neovascularity following surgery. The ring-like enhancement around the surgical margin is seen best at two to four weeks after surgery, and may simulate an abscess. However, edema seen around an abscess in adjacent brain is absent or minimal in the case of postoperative enhancement during this period, and this feature should help differentiate these entities.

BackgroundPharmacovigilance is the "science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems". Nepal joined the international pharmacovigilance programme as a full member in 2007. KIST Medical College, Lalitpur, Nepal joined the national programme as a regional centre from mid-July 2008. Currently, the pattern and scope of adverse drug reactions (ADRs) in Nepal remains unexplored. Aims To observe and analyse the pattern of ADRs at KIST Medical College, Lalitpur, Nepal. Method A retrospective analysis of all ADRs reported to the centre from mid July 2008 to July 2011 was performed. Data was analysed for ADR severity, causality, and preventability. Results A total of 113 ADR reports were obtained from various clinical departments. The maximum number of reactions was due to antimicrobials, followed by anti-hypertensives and NSAIDs. Conclusion Antimicrobials were the commonest group of drugs causing ADRs and the most commonly seen ADR was maculopapular rash followed by diarrhea and vomiting.