JNMA; journal of the Nepal Medical Association
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JNMA J Nepal Med Assoc · Feb 2021
Caesarean Myomectomy among Patients Undergoing Lower Segment Caesarean Section in a Tertiary Care Center.
Pregnancy with uterine myoma increases the risk of abortion, fetal malpresentation, placenta previa, postpartum hemorrhage, hysterectomy and risk to neonate and mother. Caesarian myomectomy is a safe and cost-effective procedure especially when performed by an experienced surgeon only in selected cases. Here, we present our experiences of cesarean myomectomy on ten patients presenting to our center in a period of one year. ⋯ Despite prophylactic measures, two cases had a postpartum hemorrhage of 2000ml and 700ml, respectively and one even received a blood transfusion. No cases of hysterectomy, neonatal morbidity and mortality were noted in these cases. In our experience, cesarean myomectomy in uterine fibroids has been a safe procedure with limited intraoperative and postoperative complications.
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JNMA J Nepal Med Assoc · Feb 2021
Orthopedic Implant Removal in the Department of Orthopedics of a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study.
Implant removal surgery is one of the common surgical procedures done in orthopedics. Studies report that a major portion of orthopedic surgeries carried out in different institutions comprises implant removal procedures. This can be challenging in limited manpower and infrastructure availability scenarios, like in developing countries like Nepal. This study aims to study the prevalence of orthopedic implant removal procedures carried out among overall surgical procedures in the orthopedic department of a tertiary care center in Nepal. ⋯ Implant removal procedures cover a major fraction of overall orthopedic operations carried out by the department, most of which are elective procedures. In limited-resource settings, this can be challenging, and a proper evaluation with counseling could be done before implant removal surgery.
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JNMA J Nepal Med Assoc · Feb 2021
Case ReportsUnusual Presentation of Extruded Disc: A Case Report.
A 38-year male presented with severe low back pain radiating towards right lower limb which was progressively increasing with decrease in motor power of the ipsilateral ankle dorsiflexion and toe extension. Magnetic Resonance study with gadolinium suggested dorsal epidural migration of the extruded disc at L4-L5 level compressing the thecal sac, which mimics the differential diagnosis epidural abscess, epidural hematoma, synovial cyst and extradural space-occupying lesion. Open lumbar discectomy was done, and the large, herniated disc was found dorsal to the thecal sac adhering dura mater, which was removed meticulously and the patient was symptomatically better postoperatively. The power of his lower limb gradually increased by physiotherapy in subsequent follow-up.
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Idiopathic Intracranial Hypertension is a rare occurrence in young, physically fit male and a diagnosis of exclusion among most patients presenting with signs and symptoms of raised intracranial pressure. Here we describe a case of a young male in the ideal weight range with no previous exposure to offending chemicals presented with a history of headache, obscuration of vision, and photopsia. On examination, there were no positive neurological findings. ⋯ Magnetic resonance imaging scan of the brain and orbits were normal. The patient was diagnosed and managed in primary care setting after neurosurgical consultation. Though rare, we should suspect idiopathic intracranial hypertension in ideal body weighted male if the headache is persistent after other causes of headache have been ruled out.
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JNMA J Nepal Med Assoc · Feb 2021
Case ReportsAdenosarcoma of Uterus- Rare Biphasic Malignant Tumor: A Case Report.
Uterine adenosarcoma is a rare variant of mixed Mullerian tumors comprised of neoplastic glands with the benign appearance and sarcomatous stroma. The epithelium most often consists of endometrium- like cells, while the sarcomatous component usually shows low-grade homologous uterine sarcoma. These tumors present as a pelvic mass or an enlarged uterus with abnormal vaginal bleeding. Here, we present a case of 61 years old postmenopausal female patient with chief complaints of excessive vaginal bleeding and urine retention.