Biomedical subjects
Publications and source records attributed to Sudha Rani.
We report herein the case of a 10-year-old child with small bowel obstruction caused by jejunojejunal intussusception of a juvenile polyp. To the best of our knowledge, this is only the third case reported of a juvenile polyp in the small intestine and the first case to be documented in the English literature.
Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue caused by dematiaceous fungi. The first case, a 67-year-old male farmer, presented with itchy hyperkeratotic, scaly plaques with scarring and black dots on the lateral aspects of his left arm and dorsum of his left hand of 28 years duration. The case was clinically diagnosed as chromoblastomycosis. The second case, a 75-year-old farmer, presented with erythematous, crusted, scaly plaques on the dorsum of the left foot of 30 years duration. Initially, a clinical diagnosis of lupus vulgaris was made, but treatment with anti tuberculosis therapy showed no improvement. On the basis of histopathological examinations of skin biopsies and isolation of fungus on culture, both cases were diagnosed as chromoblastomycosis. To the best of our knowledge, these two cases are the first case reports of chromoblastomycosis from Nepal and are presented for their academic interest.
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Two cases of visceral leishmaniasis (VL), one in a 51-year-old man with accelerated-phase chronic myeloid leukemia and another in a 35-year-old woman with acute myeloblastic leukemia, are reported. Incidental finding of Leishman-Donovan (LD) bodies in patients with leukemia highlights VL as a potent opportunistic infection in immunosuppressed patients.
A 15-year-old girl with Duke's B mucinous carcinoma of the rectosigmoid was treated with surgical resection and adjuvant chemotherapy. The patient is alive and has been disease-free for 15 months. Colorectal carcinoma is extremely rare in children and adolescents. Adenocarcinoma of colon is a virulent disease in children and has a poor prognosis. This is because of the poor histological characteristics and difficulty in diagnosis.
Inflammatory fibroid polyp (IFP) of jejunnum is a rare nonneoplastic lesion of gastrointestinal tract. We report a case of a 45-year-old man presenting with small bowel obstruction due to jejuno-jejunal intussusception of an inflammatory fibroid polyp. To the best of our knowledges, this is the eighth reported case with such a presentation in English medical literature. Segmental resection of the jejunum was performed and histopathology confirmed the diagnosis.
Nasal cerebral heterotopia (nasal glioma) are rare congenital benign masses of neurogenic origin with intranasal location, or both. An extranasal case is reported in a 2-year-old-boy without any bony defect or connection with brain. Histology and immunohistochemistry confirmed the diagnosis.
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The parameters that indicate the quality of patient care in acute appendicits (AA) were evaluated. One hundred sixty-four patients, who underwent emergency appendectomy (EA) at the B.P. Koirala Institute of Health Sciences, Dharan, Nepal were studied prospectively. The mean duration of the symptoms was 42.2 +/- 69.5 hours (range 2-720 hours, median 24 hours). The mean waiting period in the hospital was as 12.7 +/- 21.8 hours (range 1-188 hours, median 7 hours). Special investigations' such ultrasonography, computed tomography or laparoscopy, were not used for diagnosis. The perforation rate was 39%. The histopathology report of 79% of the patients was available. Diagnostic accuracy in histologically evaluated patients was 91.5%. One patient (0.6%) died. The mean hospital stay was 3.2 +/- 2.0 days (range 1-17 days). Patients who had to wait in hospital for < 24 hours before surgery had a longer duration of symptoms, underwent exploratory laparotomy through a mid-line incision more frequently, had a higher incidence of perforated/gangrenous appendix and longer hospital stay. The mean medical expenditure for patients treated in the general ward was Nepali Rupees (NR) 2485 +/- 504 (range NR 1372-4500). The majority of patients/guardians (88%-97%) were satisfied with the medical expenditure incurred, promptness of service, behaviour of the hospital staff and the facilities available in the hospital. The diagnostic accuracy and cost of treatment were favourable. The longer duration of symptoms, non-utilization of special investigations for diagnosis, high perforation rate and less than cent-per cent biopsy rate are the aspects that require attention to improve the quality of surgical care.