Prevalence of Gall Stones in Liver Cirrhosis

INTRODUCTION

Increased incidence and prevalence of gallstones in liver cirrhosis has already been reported by many studies. This study aimed to investigate the prevalence of gallstone disease in Nepali patients with LC and to identify risk factors for gallstone formation.

METHOD

Consecutive patients of LC presenting to liver clinic from January, 2010 to December, 2012 were evaluated for GS by ultrasonography at their first visit. Liver cirrhosis was diagnosed on the basis of clinical features, laboratory parameters, ultrasonography, and/or histopathology.

RESULT

Two hundred and twenty four LC patients were studied. Male to female ratio was 2.3:1. Alcohol was the major etiological factor for LC followed by hepatitis B, alone or in conjunction with alcohol. Seventy-four patients (33%) were found to have GS. Incidence of GS was more in advance stage of cirrhosis. There was no significant correlation between formation of GS and etiology of LC, except for the HCV related liver cirrhosis, in which it was present in 39% of the patients. More the advance disease,more was the incidence as 57% of Child-C patients had GS. Portal vein diameter was also associated with GS formation. When portal vein diameter was more than 13 mm, there was more GS formation.

CONCLUSIONS

One third of the patients of LC showed GS at the presentation. Patients with HCV related cirrhosis are more prone to develop GS than other. Severity of the disease and portal vein diameter was found to be associated with GS formation.

Hormonal profile and efficacy of long pulse Nd-YAG laser in treatment of hirsutism

BACKGROUND

Hormones, particularly androgens play a vital role in hair growth, differentiation and distribution. Hirsutism is a common entity among Nepalese population with skin types III, IV and V. Long pulsed lasers are commonly used for hair removal.

METHODS

This is a prospective analytical study done in Dhulikhel Hospital Kathmandu University Hospital, Kavre, Nepal from November 2010 to November 2011. Patients were first subjected to hormonal evaluation. Androgens, their tropic hormones, insulin resistance markers and endocrine components were measured and compared. Subjects were then categorized into two groups according to androgen levels: group A (n=30) with significantly high androgen (total testosterone and dehydroepiandrosterone sulfate) or elevated luteinizing hormone: follicle stimulating hormone ratio, consistent with Polycystic Ovarian Syndrome (PCOS) and group B (n=30). Adrenal tumour was ruled out in all patients. All patients received long pulse Nd-YAG laser (50J/cm²; 50 msec pulse duration) therapy at four weeks interval to achieve at least 50% hair reduction.

RESULTS

Among group A patients, average 8.1 treatment sessions were required for substantial hair reduction, whereas, average 5.7 sessions produced similar results in group B patients (p-value <0.05).

CONCLUSIONS

Patients with high androgen level and elevated LH: FSH ratio requires more treatment sessions for hair removal with long pulsed ND-YAG laser than patients with normal or low hormone level.

Renal impairment among patients with pelvic organ prolapse in a tertiary care center

BACKGROUND

Pelvic organ prolapse is a multidimensional phenomenon. The manifestations of renal involvement following pelvic organ prolapse ranges from acute to chronic renal failure and may also lead to end stage renal failure. Prolonged duration and its severity in pelvic organ prolapse are responsible for renal impairment.

OBJECTIVES

This study will find out the incidence of renal impairment among women with pelvic organ prolapse undergoing surgical management. It will also help to establish the association of renal impairment with degree and duration of pelvic organ prolapse.

METHODS

This prospective study includes cases of pelvic organ prolapse who underwent surgical management from the year 2009-2012 in Dhulikhel hospital. Total 140 cases were assessed with age, duration and different symptoms. Clinical examination was done to find out the degree of prolapse and graded according to Baden Walker classification. Urine routine and microscopic examination, renal function test and abdominopelvic sonography were performed routinely. Renal impairment was assessed using hydronephrosis and creatinine clearance. Creatinine clearance was calculated using patient's weight and serum creatinine value by Cockcroft and Gault formula.

RESULTS

Among 140 cases, 8 (5.7%) patients had procedentia, 106 (75.7%) had third degree, 22 (15.7%) had second degree, and four (2.8%) patients had first degree uterine prolapse. The mean duration of prolapse was found to be 11.47 years. Total 5 (3.57%) patients had hydronephrosis. Four had moderate and one had severe hydronephrosis. Total 49 (34.1%) patients had moderate to severe renal failure. Forty six (32%) in stage III moderate reduction in creatinine clearance, 2 (1.4%) with severe reduction and 1(0.7%) in end stage renal failure.

CONCLUSION

Renal impairment is a common entity among women with pelvic organ prolapse. Both hydronephrosis and degree renal impairment correlates correspondingly with the duration and severity of prolapse.

Dimensions of global population projections: what do we know about future population trends and structures?

The total size of the world population is likely to increase from its current 7 billion to 8–10 billion by 2050. This uncertainty is because of unknown future fertility and mortality trends in different parts of the world. But the young age structure of the population and the fact that in much of Africa and Western Asia, fertility is still very high makes an increase by at least one more billion almost certain. Virtually, all the increase will happen in the developing world. For the second half of the century, population stabilization and the onset of a decline are likely. In addition to the future size of the population, its distribution by age, sex, level of educational attainment and place of residence are of specific importance for studying future food security. The paper provides a detailed discussion of different relevant dimensions in population projections and an evaluation of the methods and assumptions used in current global population projections and in particular those produced by the United Nations and by IIASA.

Solitary rectal ulcer syndrome: uncommon cause of rectal bleeding in children

Rectal polyp and hemorrhoids are common causes of bleeding per rectum in pediatric age group. However, there are some other causes which should be considered in differential diagnosis. We have acquainted a case of rectal bleeding due to solitary rectal ulcer in a child of 10 year. Colonoscopic examination was required for diagnosis as proctoscopic examination and digital rectal examination missed the diagnosis, probably due to poor co-operation by the patient and rare nature of the disease. Although well recognized in the adult population, the pediatric experience with this condition is limited.

Multiple granular cell tumor of the esophagus treated endoscopically

Granular cell tumor (GCT) of esophagus is a rare lesion, usually found incidentally during upper gastrointestinal endoscopic examination undertaken for another reasons. The origin of this neoplasm is still unclear but no organ seems to be immune to this neoplasm. Although most of the lesions are benign, few reports of malignant GCT, synchronous as well as metachronous, are also reported. It can occur at any age, but are most commonly observed in fourth and fifth decade of life. We herein report a case of multiple GCT treated by endoscopic mucosal resection and review the relevant literatures.