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Background: An impacted tooth is a tooth which does not reach the occlusal plane even after two-thirds root formation. Conditions associated with impacted teeth include trismus, cystic lesions, and cervical caries of second molars. The objective of this study was to evaluate the occurrence of carious lesions in the distal aspect of the mandibular second molar and its association with the presence of mandibular third molars., Methods: A cross-sectional study was conducted from September 2018 to September 2020. Approval was taken from the Institutional Review Committee with reference number 90/77/78. Orthopantomograms of patients aged 18 years or older were studied. Information on age, gender, mandibular second and third molars were recorded. Convenient sampling was done. Statistical analysis was done using Statistical Package for Social Sciences version 21., Results: A total of 626 radiographs were studied of which mesioangular impaction (35.3%) was the most prominent type and followed by horizontal impaction, causing distal caries in second molars. The age group between 20-40 years and female gender had the higher prevalence of distal caries in second molar teeth. There was a significant correlation between gender and cavity existence (p=0.00), between impaction and existence of decay (p=0.00), and depth of impaction with cavity formation (p=0.004)., Conclusions: A total of 31.8% of the patients with impacted mandibular third molars had distal cervical caries in second molars. Mesioangular type, female gender, type A were the prominent factors associated with distal caries in second molar teeth due to impacted third molars.

Background: To review our early experience to determine the feasibility, efficacy and clinical outcomes of retroperitoneoscopic surgery in benign renal diseases., Methods: This is a prospective observational study carried out between December 2014 to March 2018. Among 14 patients enrolled in the study, 9 cases of nonfunctioning kidney underwent retroperitoneoscopic simple nephrectony, 4 cases of benign renal cortical cysts underwent decortication of cysts and one case of pelviureteric junction obstruction underwent Anderson Hynes pyeloplasty., Results: Retroperitoneoscopic nephrectomy, renal cyst decortication and A-H pyeloplasty were performed in 13 patients successfully. The procedure in one patient of RP nephrectomy converted to open surgery due to dense perinephric and hilar adhesions. Which resulted to failure to progress. The mean operative time of RP nephrectomy, decortications and pyeloplasty were 206.4 (150-248), 67.5 (60-80) and 275 minutes, average blood loss was 96.7 (50-120), 27.5 (20-30) and 70 ml, and the mean hospital stay were 3.5 (3-4), 2 (2-2) and 4 days respectively. The perioperative period was uneventful., Conclusions: Retroperitoneoscopic surgery is feasible and safe in benign renal diseases. Because of reduced post operative pain and less chances of bowel injury, retroperitoneoscopic surgery is gaining more popularity.

Background: The gold standard of quick and definitive treatment of Abdominal compartment syndrome (ACS) is surgical decompression by opening the abdomen and leaving it open until intra-abdominal pressure decreases. Temporary abdominal closure techniques are used to postpone definite closure until predisposing factors causing pathologic elevation of intra-abdominal pressure are resolved.This study aim to analyze feasibility of Bogota Bag placement as a way of temporary abdominal closure., Methods: Cases admitted in the period of eight years that were diagnosed to have or at risk to develop ACS and managed with 'Bogota Bag', irrespective of primary diagnosis were reviewed retrospectively. Cause of ACS, reasons to place Bogota bag, its complications and final outcome in terms of mortality related or not related with Bogota Bag placement were assessed., Results: Total of ten patients had placement of Bogota Bag in the period of eight years. Laparotomy for bowel perforation with peritonitis was the most common primary condition contributing to ACS. Bogota bag was placed in two cases after emergency decompression as a therapeutic measure whereas others were done as prophylactic measure. There were two mortalities (20%) which were not directly related to abdominal compartment syndrome., Conclusions: Abdomen closure with Bogota Bag for patients with ACS or likely to develop ACS is a feasible technique with minimal procedure related morbidities.

Background: Cancer of the breast is the second most common cause of cancer in women. Mass in the breast, whether benign or malignant is a cause of anxiety to the patients and the family members. All breast lumps are considered to be carcinomas until proved otherwise and are the causes of concern both for the patient and surgeon., Methods: This is a retrospective study conducted in Kathmandu Model Hospital for a total duration of three years from August 2007 to August 2010., Results: 114 sample of breast tissue sent for histopathology were studied. Peak incidence of benign lesion was in between 21-30 years and malignant lesions in between 31-50 years. No breast lesions were seen in the first decade of life. Cancer of the breast was seen in 12.28% of cases. Fibroadenoma and fibrocystic disease were the commonest benign lesion and infiltrating ductal carcinoma was the commonest malignant lesion. Specimens from 10 male breasts were received. Gynaecomastia was the most common lesion encountered in males. Infiltrating ductal carcinoma was seen in a 70 year old male., Conclusions: Breast cancer is one of the commonest causes of breast lump particularly in women and is growing public health problem in Nepal.

Background: The reported prevalence of biliary tract disruption following laparoscopic cholecystectomy has ranged from 0% to 7% in early reports. Bile leaks are the most common biliary complication of laparoscopic cholecystectomy., Methods: Total 530 patients who had undergone laparoscopic cholecystectomy from January 2004 to November 2006 at Kathmandu Medical College Teaching Hospital were studied for biliary complications after laparoscopic cholecystectomy., Results: We reviewed 500 laparoscopic cholecystectomies performed at our institution and found 13 cases of bile extravasation and/or biloma formation and/or bile duct injuries (prevalence, 2.6%). One bile duct transection was acutely recognized and treated with hepaticojejunostomy. Three lateral bile duct injuries were also acutely recognized, two of them were managed with primary repair of CBD without T tube and the other was managed with repair and T-tube drainage. Two patients had postoperative generalized biliary peritonitis, one of whom was undergone exploratory laparotomy and found to have lateral injury on CBD which was managed with repair and T-tube drainage, whereas the other was undergone diagnostic laparoscopy with clipping of duct of Lushka. Two patients presented within seven days with biloma, one was treated with percutaneous drainage alone, the other treated with percutanous drainage was found to be complete transection of CBD on subsequent ERCP and managed with late hepaticojejunostomy. One patient with continued bile leak from surgical drainage tube for more than one week was managed with ERCP, diagnosed to be bile leak from duct of Lushka, managed by sphincterotomy and bile duct stenting. One patient presented with obstructive jaundice 6 months after laparoscopic cholecystectomy was found to have Bismuth type II bile duct stricture and was undergone hepaticojejunostomy. The remaining three had bile leak from surgical drainage which resolved within one week without further complication., Conclusions: Laparoscopic cholecystectomy appears to be associated with a higher incidence of bile duct injury than previous reports of open cholecystectomy. Possible explanations include variant anatomy plus failure to obtain an operative cholangiogram, inadequate dissection, injudicious use of cautery or clip placement, inherent limitations of the procedure, or the learning curve associated with a new technology.