Kathmandu University medical journal (KUMJ)
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Kathmandu Univ Med J (KUMJ) · Oct 2013
ReviewReview of cesarean section on maternal request in a tertiary care institute; scenario in developing country.
Mother requesting of caesarean reflects a belief among society that elective caesarean safer than vaginal delivery in term of fetus and mother. Although the study data neglecting the facts other skewed part in this issue is consideration of resources, as in developing countries, where maternal mortality is still high due to lack of adequate resources. Mother coming to obstetrician with mother's request should individualize in every case considering mother's argument, society and evidence base guideline.
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Transfusion of blood and blood components is a common practice in obstetric wards but it is not without risk. The incidence of transfusion reactions varies from 4 in every hundred transfusions for non-haemolytic reactions to one in every 40,000 for haemolytic transfusion reactions. The physiological basis of blood transfusion is outlined in this article. ⋯ Acute blood loss in obstetrics is usually due to placenta praevia, postpartum blood loss and surgery related. An early involvement of a consultant obstetrician, anaesthetist, haematologist and the blood bank is essential. There are no established criteria for initiating red cell transfusions and the decision is purely based on clinical and haematological parameters, which have been discussed along with the general principles of blood transfusion in obstetrics and some practical guidelines.
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Kathmandu Univ Med J (KUMJ) · Oct 2013
ReviewClinicoradiologic evaluation of Eagle's syndrome and its management.
Eagle's syndrome (Elongated styloid process) is often misdiagnosed due to its vague symptomatology. The diagnosis relies on detail history taking, palpation of styloid process in tonsillar fossa and imaging modalities. ⋯ Possibility of Eagle's syndrome should always be considered while examining patients with vague neck pain. 3D CT reconstruction is a gold standard investigation which helps in studying the relation of styloid process with surrounding structures along with accurate measurement of its length and medial angulation.
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Kathmandu Univ Med J (KUMJ) · Oct 2013
Randomized Controlled Trial Comparative StudyComparative study of hyperbaric bupivacaine plus ketamine vs bupivacaine plus fentanyl for spinal anaesthesia during caeserean section.
Spinal anesthesia is widely used for caesarean section due to its rapid onset, low failure rate, complete analgesia. Addition of intrathecal ketamine and opioids to local anaesthetics seems to improve the quality of block and prolong the duration of analgesia. ⋯ Addition of preservative free ketamine lead to faster onset of sensory and motor blockade, although it did not prolong the duration of spinal analgesia compared to addition of fentanyl in parturients undergoing caesarean section with spinal anaesthesia.
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Kathmandu Univ Med J (KUMJ) · Oct 2013
The predictive value of pre-operative symptoms including upper gastrointestinal endoscopy before laparoscopic cholecystectomy for elective symptomatic cholecystolithiasis.
It has always been a challenge to distinguish between upper gastrointestinal symptoms due to gall stones or any other causes. The persistence of abdominal symptoms even after cholecystectomy is highly discouraging for surgeons. ⋯ Presence of atypical pain in patients with gall stones is highly likely to have other coexisting upper gastrointestinal pathologies. Hence, upper gastrointestinal endoscopy prior to elective cholecystectomy in patients with gall stones can be clinically helpful.