Introduction: A detailed knowledge of normal branching pattern of intrahepatic bile duct and their variations is of utmost importance for any liver or biliary tract surgery to avoid severe post-surgery complications and morbidity. The objective of this study was to evaluate variations of intrahepatic bile ducts in Magnetic Resonance Cholangiopancreatography (MRCP) examinations in Nepalese population.Methods: This quantitative, cross sectional study was performed in patients referred for MRCP examinations for various clinical indications to Tribhuvan University Teaching Hospital, Maharajgunj, Nepal. Data were collected for a period of four months from August to November 2019 after IRB approval. Convenience sampling was employed and a total of 90 examinations were included. Data were obtained from the 1.5T Magnetom Amira Siemens MRI scanner. The 3D MRCP images were visually analyzed and classified into 7 Types according to the classification given by Choi et al.Results: In our study 47.8% patients had Type 1/normal IHBD (n=43). 20% had Type 2 (n=18), 3.3% had Type 3A (n=3), 5.6% had Type 3B. Type 5A (n=5), 7.8% had 5B (n=7), 3.3% had Type 6 (n=3) and 6.7% had Type 7 (n=6). No patients were found to have Type 3C and Type 4 IHBD variation. Among the total number of Type 1 cases, 67.44% (n=29) were female and rest were male.Conclusions: Typical IHBD was only found in a 47.8% patients and common other variations were also noted in our population. Type 2 and Type 5B were found in 20% and 7.8% patients respectively.
The prospective cross-sectional study of human brain was conducted to establish the range of size of ventricular system in normal human brain of Nepalese population (irrespective of race) by using magnetic resonance imaging (MRI) at Institute of Medicine, Department of Radiology and Imaging, Tribhuvan University Teaching Hospital (TUTH) on 150 subjects (75 male and 75 female) of age between 10 - 80 years with 0.3 Tesla static magnetic field. The bifrontal diameter, bihemispheric diameter, frontal horn ratio, transverse dimension of third ventricle, anterior - posterior dimension and width of fourth ventricle were observed to be 32.7 mm and 31.0 mm, 105.1 mm and 101.2 mm, 0.31 and 0.31, 4.7 mm and 4.4 mm, 9.9 mm and 9.4 mm, 12.3 mm and 11.7 mm in case of male and female respectively with overall average of 31.9 mm, 103.1 mm, 0.31, 4.6 mm, 9.7 mm, and 12.0 mm respectively. The measurement of ventricular dimension was observed to be statistically significant between male and female except transverse dimension of third ventricle and was greater in male than in female in all cases.Journal of Institute of Science and Technology, 2015, 20(1): 6-14
IntroductionCardiac catheterization is widely considered the “gold standard” for the diagnosis of pulmonary hypertension. However, its routine use is limited due to its invasive nature. Therefore, the aim of this study was to evaluate the correlation between pulmonary artery pressures obtained by various parameters of transthoracic echocardiography and cardiac catheterization.MethodsThis study includes 50 consecutive patients with intracardiac shunt lesions diagnosed with severe pulmonary hypertension on echocardiography and admitted for cardiac catheterization at the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan. Cardiac catheterization and transthoracic echocardiography were performed in all patients simultaneously and systolic (sPAP) and mean pulmonary artery pressure (mPAP) were assessed with both modalities. Correlations and agreement, in terms of Bland-Altman plot, were computed between both modalities for sPAP and mPAP.ResultsOut of 50 patients, 46% (23) were male and mean age was 7.49 ± 4.45 years. On cardiac catheterization, sPAP was 93.92 ± 17.91 mmHg and mPAP was 67.0 ± 14.28 mmHg. Correlation between cardiac catheterization and echocardiography for the assessment of sPAP was 0.917 (p<0.001), and mPAP was 0.832 (p<0.001) for mean gradient of tricuspid regurgitation (PGTRmean), 0.749 (p<0.001) for peak gradient of pulmonary regurgitation (PGPRpeak), 0.691 (p<0.001) for Acceleration time across right ventricular outflow tract (RVOT), and 0.752 (p<0.001) for end gradient of pulmonary regurgitation (PGPRend). Bland-Altman plot showed moderate agreement between two modalities.ConclusionA positive but modest correlation was observed between hemodynamic parameters of transthoracic echocardiography and cardiac catheterization for assessment of pulmonary artery pressures. Transthoracic echocardiography can reliably be used as an initial non-invasive modality for the assessment of pulmonary artery hypertension and can obviate the need of right heart catheterization in some patient especially with mild pulmonary hypertension.
Introduction: The deformity of the sella turcica is often a major clue that an abnormality exists within the cranium, hence a familiarity with the sella turcica anatomy and radiological appearance is important. The aim of this study was to assess the dimension of sella turcica of normal Nepalese people by using computed tomography scan of head and to correlate the dimension with the patient’s age and gender. Methods: This prospective study was performed in a tertiary hospital in Kathmandu. Data were collected over the period of 4 months from June to September 2018 with the total of 73 patients who underwent CT of head. The age and gender of the patients were noted. The dimensions of sella turcica were measured at the predefined three directions: length, depth and antero-posterior diameter of the sella turcica. Results: The sella turcica had a mean length of 8.375mm, AP diameter of 7.029mm, and depth of 10.13mm.The dimensions of the sella turcica increased with age till the age of 80 years and then decreased. Conclusions: This study concluded that the length, AP diameter and depth of the sella turcica vary with respect to age group. The length and depth of sella turcica were higher in males while AP diameter in females.
Background Left ventricular (LV) dysfunction in patients with aortic valve stenosis (AVS) is seen in two scenarios: in neonates and in elderly patients. Neonatal AVS may present as a congestive cardiac failure (CCF), while older children rarely present with CCF if they have not been diagnosed early. Only a few reports of LV dysfunction with AVS have been described in the literature. However, there is a paucity of data regarding the safety and effectiveness of balloon aortic valvuloplasty (BAV) in children with AVS with LV dysfunction. Therefore, the aim of this study was to evaluate outcomes to establish the safety and effectiveness of BAV in children with AVS and LV dysfunction in improving LV function and survival. Methods A total of 160 BAVs were performed from 2004 to 2017; of these, 41 (25.6%) patients had LV dysfunction. We reviewed these cases, and data were obtained on clinical features, echocardiographic parameters including LV ejection fraction (LVEF) and LV dimensions, LV posterior wall, interventricular septal thickness, pressure gradient across the valve, aortic valve morphology and annulus and aortic insufficiency (AI), and angiographic parameters such as aortic and LV pressures, AI and annulus size, and balloon size. Echocardiography was done before the procedure, one day after intervention, at three months, at six months, and on regular follow-up. Mortality during and after the procedure and at follow-up was reported.
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