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Introduction: Ingestion of corrosive substances remains an important public health issue in Western countries despite education and regulatory efforts to reduce its occurrence. These injuries are still increasing in developing countries, related to the social, economic, and educational variables and mainly to a lack of prevention. This is record based study to see various clinical characters and differences in the two groups. Aims and Objective: To study the various clinical characters of Cauticinjuiry of upper Gastrointestinal tract, and to see any differences observed in early (<5yr) and Late Group (>5Yr) Methodology: This is ten years retrospective study in this all the patients (N=65) ( of caustic injury within 10 years were studied , in that these patients were divided into two group based upon within 5yrs –Early group and more than 5yrs –Late group Result: significantly more number males and female were there from early group, Significantly more no of co-morbid conditions like Diabetes, Depression, No any Co-morbid condition, Other social illness were found in Early ingestion group. While no any significant difference found in Co-morbid conditions like Hypertension, Other medical illness. In purpose of ingestion of caustic in that there was significantly more trend of suicide by caustic ingestion in late group as compared to early group, but other purposes in early and late group were not significantly different. Conclusion: The caustic injury is mostly due to suicidal tendency, so early detection of this tendency and proper psychiatric counseling can reduce the incidence of this poisoning.

1. Ghelardini C, Malmberg-Aiello P, Giotti A, Malcangio M, Bartolini A. Investigation into atropine-induced antinociception.Br J Pharmacol1990; 101: 49-54 [PMID: 2282466 DOI:10.1179/2046905512Y.00000000074] 2. Ekpe EE, Ette V. Morbidity and mortality of caustic ingestionin rural children: experience in a new cardiothoracic surgery unit in Nigeria. ISRN Pediatr2012; 2012: 210632 [PMID: 22778986 DOI: 10.5402/2012/210632] 3. Contini S, Swarray-Deen A, Scarpignato C. Oesophageal corrosive injuries in children: a forgotten social and healthchallenge in developing countries. Bull World Health Organ 2009; 87: 950-954 [PMID: 20454486 DOI: 10.2471/BLT.08] 4. Sarioglu-Buke A, Corduk N, Atesci F, Karabul M, KoltuksuzU. A different aspect of corrosive ingestion in children:socio-demographic characteristics and effect of family functioning. Int J PediatrOtorhinolaryngol2006; 70: 1791-1798 [PMID: 16839614] 5. Christesen HB: Ingestion of caustic agents. (1993): Epidemiology, patho-genesis, course, complications and prognosis. Ugeskr laeger;155(31): 2379–2382. 6. Baskin D., Urganci N., Alkim C. (2004): A standardised for the manage-ment of corrosive ingestion in children; PediatrSugrInt.Dec; 20(11–12): 824–8. 7. Bronstein AC, Spyker DA, Cantilena LR, Jr, Green J, Rumack BH, Heard SE. 2006 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS) ClinToxicol (Phila). 2007; 45: 815-917. 8. Litovitz TL, Swartz WK, White S, et al.: 2000 Annual report of the American Association of Poison Control Centers. Am J Emerg Med. 2001; 19: 337–395 9. Ramanasov K, Gumaste VV. Corrosive Ingestion in Adults, Clinical ReviewsJClinGastroenterol. 2003; 37: 119-124. 10. Kardon E. Caustic ingestion, Emergency Medicine Toxicology. [updated 2010 may ; cited june 2010]. Available from: emedicine.medscape.com 11. Poley JW, Steyerberg EW. Ingestion of acid and alkaline agents:outcome and prognostic valve of early upper endoscopy. Gastrointest Endosc. 2004; 60: 372-377. 12. Yoon KW, Park MH, Park GS, et al. A clinical study on the upper gastrointestinal tract injury caused by corrosive agent. Korean J GastrointestEndosc 2001;23:82-87 13. Kim YS, Choi SM, Kim HM, Youn CS, Park KN. The clinical characteristics and risk factors of upper digestive lesions that are due to ingestion of caustic material. J Korean SocClinToxicol 2009; 7:113-120.

Aim: To analyze the various factors affecting the outcome of external dacryocystorhinostomy (DCR). Materials and methods: Prospective study of forty five cases of chronic dacryocystitis, underwent planned external DCR without silicon tube intubation under local anesthesia (LA) by single surgeon. All the patient followed up post operatively for one and half years. During follow up periods patients were evaluated by syringing. Results: Syringing was freely patent in all the cases. Two patients developed post operative bleeding which was effectively controlled by fresh adrenaline soaked nasal pack. Conclusion: Proper pre operative evaluation and medications, investigations, ideal size bony ostium, adequate size flaps and suturing of both the flaps, surgeon skills and post operative medications are the main factors which influences the outcome of the external DCR.

1. Deka A, Saikia SP, Bhuyan SK. Combined posterior flap and anterior suspended flap dacryocystorhinostomy: A modification of external dacryocystorhinostomy. Oman J Ophthalmol. 2010;3(1):18-20. 2. Leong SC, Macewen CJ, White PS. A systematic review of outcomes after dacryocystorhinostomy in adults. Am J Rhinol Allergy. 2010;24(1):81-90. 3. Chaume A, Maalouf T, Thirion B, Angioi K, George JL. External dacryocystorhinostomy under local anesthesia and sedation. J Fr Ophtalmol. 2010;33(2):77-83. 4. Leong SC, Karkos PD, Burgess P, Halliwell M, Hampal S. A comparison of outcomes between nonlaser endoscopic endonasal and external dacryocystorhinostomy: single-center experience and a review of British trends. Am J Otolaryngol. 2010;31(1):32-37. 5. Saiju R, Morse LJ, Weinberg D, Shrestha MK, Ruit S. Prospective randomized comparison of external dacryocystorhinostomy with and without silicone intubation. Br J Ophthalmol. 2009;93(9):1220-22. 6. Besharati MR, Rastegar A. Results and complications of external dacryocystorhinostomy surgery at a teaching hospital in Iran. Saudi Med J. 2005;26(12):1940-44. 7. Yazici B, Meyer DR. Selective antibiotic use to prevent postoperative wound infection after external dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2002;18(5):331-35. 8. Linberg JV, McCormick SA. Primary acquired nasolacrimal duct obstruction. A clinicopathologic report and biopsy technique. Ophthalmology. 1986;93(8):1055-63. 9. Roper M.j, Hall. Stallards eye surgery fifth edition chapter 4, 64-72.

Aim: Adverse Drug Reactions are a global problem. The incidence of oral cancer is 2% worldwide. In India, the higher incidence (30% of all cancers) of oral cancer is due to tobacco, betal chewing and alcohol. Cancer chemotherapy is more helpful in advanced stages of oral cancer. But, these drugs themselves can cause adverse drug reactions affecting the patients’ health. Objective: To study the pattern of adverse drug reactions of anticancer drugs used in patients with oral cancer in a tertiary care hospital. Materials and Methods: This study was conducted in Stanley Medical College Hospital, Chennai-01 from August’2014 to February’2015 among 60 oral cancer patients receiving anticancer drugs in Dept of Oncology. This was a hospital based, prospective, observational study. ADRs were documented in suspected ADR reporting forms designed by CDSCO; causality assessment was done using Naranjo’s algorithm and severity assessment by Modified Hartwig Siegel Scale. Result: Cisplatin, 5-Fluorouracil, Paclitaxel, Gemcitabine were the common anticancer drugs used in various combinations. The most common combinations used are 5FU + Cisplatin, Gemcitabine + Cisplatin, 5FU+ Paclitaxel+Carboplatin. ADRs were reported among 54 patients taking treatment. Causality assessment – Probable 5.6% ,Possible 94.4% ; Severity assessment – Mild 94.4%,Moderate 5.6%. Conclusion: The anticancer drug combinations used in the treatment of oral cancer were associated with varied adverse effects. But, the early detection of drug toxicity may be helpful in modifying the doses to minimize the toxic effects.

1. S.K. Gupta. Text book of Pharmacovigilance. 1st edition p-1-2 2. Smith, D.L 1993. The effect of patient non-compliance on health care costs. Med Interface. 6,74-84 3. Adithan C. National pharmacovigilance programme. Indian J Pharmacology. 2005; 37:347. 4. Harrison’s Principles of Internal Medicine 18th edition Mc Graw Hill chap-88 5. K.D.Tripathi., Essentials of Medical Pharmacology 7th edition; Jaypee brothers., p-859-866 6. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clinical Pharmacology Therapeutics. 1981; 30:239–45. 7. Hartwig SC, Siegel J, Schneider PJ. Preventability and severity assessment in reporting adverse drug reactions. Am J Hosp Pharm. 1992; 49:2229–32. 8. Jordan K, Sippel C, Schmoll HJ. Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: Past, present, and future recommendations. Oncologist. 2007; 12:1143–50. 9. The NCCN Cancer- and Chemotherapy-induced Anemia Clinical Practice Guidelines in Oncology (Version 1.2013). National Comprehensive Cancer Network, Inc.2013, http://www.nccn.org/professionals/physician_gls/pdf/anemia.pdf. 10. Amsytz U,Froehlich TK,Largiader CR. Dihydropyrimidine dehydrogenase gene as a major predictor of severe 5 FU toxicity. Pharmacogenomics 201; 12:1321-1336. 11. Stacy S.Shord, Patrick J.Medina, Joseph T.Dipiro; Pharmacotherapy- A pathophysiologic Approach 9th edition p- 2094-2095 12. HL Sharma, KK Sharma Principles of Pharmacology 2nd edition p-860-861 13. Katzung GB., Edward Chu., Trevor JA. Basic and Clinical Pharmacology 13th edition. New York: Mc Graw Hill Medical; London: Mc Graw Hill, p-926-927 14. Touraine F, Sainte Laudy J, Boumediene A, Ndikumwenayo F, Decroisette C, Melloni B, et al. Investigation of allergic reactions to platinum salts. Rev Mal Respir. 2006; 23:458–62. 15. Keefe DM, Schubert MM, Etling LS et al. Updated clinical practice guidelines for the prevention and treatment of Mucositis. Cancer 2007; 109:820-831.

Introduction: Vitiligo is an acquired pigmentary disorder presenting as hypopigmented or depigmented macules and affects 0.5-2% of the population worldwide. Segmental vitiligo has depigmented macules arranged in a dermatomal or quasi-dermatomal distribution, which does not cross the midline and is usually unresponsive to medical treatment. There are two clinically recognized distinct variants of vitiligo based on distribution of depigmented areas; generalized and localized. Generalized or bilateral symmetrical form of vitiligo is a disease that destroys skin and mucosal membranes melanocytes progressively, and in some cases could involve ears and eyes Aims and Objective: To study effect of follicle auto graft in the treatment of segmental vitiligo. Methodology: After approval from Institutional Ethical committee This clinical trial was carried out at tertiary care hospital in 30 patients Diagnosed of segmental vitiligo who suffered from persistent form of segmental vitiligo for more than 3 years in the year 2014. The patients were not in the progressing phase of their disease at the time of enrollment. Patients were enrolled after their informed written consent. Result: In this study was no re pigmentation around the segmental vitiligo but this re pigmentation after the treatment goes on increasing at, 2 wks. Mean repigmentation area was 1±0.93mm, 4 wks. -2±1.12mm,8wks-4±1.23mm,12wks-5±1.54mm,16wks-6±.94,20wks-8±1.21,24wks-9±1.32 which were highly significant if compared between previous and after weeks mean re-pigmentation area. (P<0.001,t=9.78,df=29, P<0.001, t=6.585,df=57, P<0.001, t=3,df=47, P<0.001,t=7.14,df=54 respectively) Conclusion: As repigmentations was significantly higher at the end of six month and more than the before the treatment so this method is useful for regimentation in segmental vitiligo, so this method should be used whereEver possible in the treatment of segmental vitiligo.

1. Lerner AB. Vitiligo. J Invest Dermatol 1959;32:285-310 2. Hann SK. Clinical features of segmental Vitiligo. In: Hann SK, Nordlund JJ, editors. Vitiligo, 1 st ed. Oxford: Blackwell Science; 2000. p. 49-60. 3. Mulekar SV. Long-term follow-up study ofsegmental and focal vitiligo treated by autologous,noncultured melanocyte-keratinocyte cell transplantation.Arch Dermatol.2004; 140: 1211-5. 4. Turk- Arycan O, Koc K, Ersoy L. Clinical characteristics in 113 Turkish vitiligo patients. ActaDermatovenerol Alp PanonicaAdriat.2008; 17: 129-32. 5. Lerner AB, Nordlund JJ. Vitiligo: the loss of pigment in the skin, hair and eyes. J Dermatol.1978; 1: 1-8. 6. Zaima H, Koga M. Clinical course of 44 cases of localized type vitiligo. J Dermatol. 2002; 29:15-9. 7. Kathuria S, Khaitan BK, Ramam M, Sharma VK. Segmental vitiligo: A randomized controlled trial to evaluate efficacy and safety of 0.1% tacrolimus ointment vs 0.05% fluticasone propionate cream. Indian J DermatolVenereolLeprol.2012; 78:68-73. 8. Hann SK, Lee JH. Segmental vitiligo: clinical findings in 208 patients. J Am AcadDermatol. 1996; 35: 671-4. 9. Behl PN. Treatment of vitiligo with homologous thin Thiersch's skin grafts.Curr Med Pract.1964; 8: 218-21. 10. Falabella R. Repigmentation of segmental vitiligo by autologous minigrafting. JAmAcad Dermatol.1983; 9: 514-21. 11. MirHadi Aziz Jalali, BabakJafari, Mansour Isfahani, Mohammad Ali Nilforoushzadeh. Treatment of segmental vitiligo with normal-hair follicleAutograft.MJIRI.2013; 27(4):210-214. 12. Lerner AB, Nordlund JJ. Vitiligo: the loss of pigment in the skin, hair and eyes. J Dermatol.1978; 1: 1-8. 13. Staricco RG. Mechanism of the migration ofthe melanocytes from the hair follicle into the epidermis followingdermabrasion. J Invest Dermatol. 1964; 36:99-104. 14. Cui J, Shen L, Wang G. Role of hair follicles in the repigmentation of vitiligo. J Invest Dermatol. 1991; 97:410-6. 15. Na GY, Seo SK, Choi SK. Single hair grafting for the treatment of vitiligo. JAmAcadDermatol.1998; 38: 580-4. 16. Malakar S, Dhar S. Repigmentation of vitiligopatches by transplantation of hair follicles. Int J Dermatol.1999; 38:237-8. 17. Sardi JR. Surgical treatment for vitiligo through hair follicle grafting: How to make it easy. Dermatol Surg. 2001; 27: 685-6. 18. Arrunategui A, Arroyo C, Garcia L, Covelli C, Escobar C, Carrascal E, Falabella R. Melanocyte reservoir in vitiligo. Int J Dermatol. 1994; 33:484-7.

Introduction: Gallbladder disease represents a major health problem worldwide and has been known since the time of the Egyptian dynasty. More than 98% of all gallbladder and biliary track disorders are one way or another connected to cholelithiasis, and calculus diseases constitutes most of the cases that seek surgical attention. It may present as acute chole-cystitis which many progress to empyema, chronic calculus cholecystitis or mucocele. Carcinoma of the gallbladder (GBC), although it has a low overall prevalence, is the most common cancer of the biliary tree and one of the most highly malignant tumors with poor prognosis Aims and Objective: To study the clinico epidemiological factors responsible for gall bladder disease presenting as lump. Methodology: All the cases presenting with gall bladder disease over the period of 12 months from 30 June 2007 till 29 June 2008 in the Surgery Out patient Department and Casualty at Gauhati Medical College And Hospital, Guwahati were included in this prospective study. Out of 149 cases, 56 were included in this study. Result: Overall the presentations of acute cases of gall bladder was more, than chronic and malignant, 29 (44.62%), 23(41.07%), 4 (40%). Maximal incidence in females was seen in the fifth decade, whiles the maximum incidence in males was seen in the fourth decade. The male to female ratio was 1:4.09 but in the malignant group the ratio is 1:3. Gallbladder disease with palpable lumps was maximally seen housewives, which is around 66.07%. Next common occupation was male cultivators constituting 10.71%. 32.2% of the case belonged to the lower middle class of society Conclusion: As the cases were more common in Females in forty and in middle and low socio economic groups patients so special attention should be given for prevention and in the diagnosing these cases.

1. Pavlidis TE, Pavlidis ET, Symeonidis NG, Psarras K, Sakantamis AK (2012). Current curative surgical management of gallbladder cancer: a brief review. J CurrSurg, 2, 81-3 2. Mishra R, Goda C, Arora M, et al (2012). Treatment of Gall Bladder Cancer: a Review. Indo Global J Pharm Sci, 2, 54-62. 3. Tyagi BB, Manoharan N, Raina V (2008). Risk factors for gallbladder cancer: a population based case-control study in Delhi. Ind J Med and PaedOncol, 29, 16-26. 4. Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? CurrGastroen-terol Rep 2005;7:132-14 5. Schirmer BD, Winters KL, Edlich RF. Cholelithiasis and cholecys-titis. J Long Term Eff Med Implants 2005; 15:329-338. 6. Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroen-terology 1999; 117:632-639. 7. Tazuma S. Gallstone disease: epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahe-patic). Best Pract Res ClinGastroenterol 2006;20:1075-1083 8. Sandler RS, Everhart JE, Donowitz M, et al. The burden of se-lected digestive diseases in the United States. Gastroenterology 2002; 122:1500-1511. 9. Singh V, Trikha B, Nain C, Singh K, Bose S. Epidemiology of gallstone disease in Chandigarh: a community-based study. J GastroenterolHepatol 2001; 16:560-563. 10. Chen CY, Lu CL, Huang YS, et al. Age is one of the risk factors in developing gallstone disease in Taiwan. Age Ageing 1998; 27:437-441. 11. Everhart JE. Gallstones and ethnicity in the Americas. J Assoc Acad Minor Phys 2001; 12:137-143. Gilat T, Feldman C, Halpern Z, Dan M, Bar-Meir S. An increased familial frequency of gallstones.Gastroenterology 1983; 84:242-246. 12. Mallik IA (2003) Clinicopathological features and management ofgall bladder cancer in Pakistan. A prospective study of 233 cases. JGastroenterol Hepatol 18(8):950–953 13. Dutta U, Nagi B, Garg PK, Sinha SK, Singh K, Tandon RK (2005) Patients with gallstones develop gall bladder cancer at an early age. Eur J Cancer Prev 14(4):381–385

Introduction: Gallbladder disease represents a major health problem worldwide and has been known since the time of the Egyptian dynasty. More than 98% of all gallbladder and biliary track disorders are one way or another connected to cholelithiasis, and calculus diseases constitutes most of the cases that seek surgical attention. It may present as acute chole-cystitis which many progress to empyema, chronic calculus cholecystitis or mucocele. Carcinoma of the gallbladder (GBC), although it has a low overall prevalence, is the most common cancer of the biliary tree and one of the most highly malignant tumors with poor prognosis Aims and Objective: To study the clinico epidemiological factors responsible for gall bladder disease presenting as lump. Methodology: All the cases presenting with gall bladder disease over the period of 12 months from 30 June 2007 till 29 June 2008 in the Surgery Out patient Department and Casualty at Gauhati Medical College And Hospital, Guwahati were included in this prospective study. Out of 149 cases, 56 were included in this study. Result: Overall the presentations of acute cases of gall bladder was more, than chronic and malignant, 29 (44.62%), 23(41.07%), 4 (40%). Maximal incidence in females was seen in the fifth decade, whiles the maximum incidence in males was seen in the fourth decade. The male to female ratio was 1:4.09 but in the malignant group the ratio is 1:3. Gallbladder disease with palpable lumps was maximally seen housewives, which is around 66.07%. Next common occupation was male cultivators constituting 10.71%. 32.2% of the case belonged to the lower middle class of society Conclusion: As the cases were more common in Females in forty and in middle and low socio economic groups patients so special attention should be given for prevention and in the diagnosing these cases.

1. Pavlidis TE, Pavlidis ET, Symeonidis NG, Psarras K, Sakantamis AK (2012). Current curative surgical management of gallbladder cancer: a brief review. J CurrSurg, 2, 81-3 2. Mishra R, Goda C, Arora M, et al (2012). Treatment of Gall Bladder Cancer: a Review. Indo Global J Pharm Sci, 2, 54-62. 3. Tyagi BB, Manoharan N, Raina V (2008). Risk factors for gallbladder cancer: a population based case-control study in Delhi. Ind J Med and PaedOncol, 29, 16-26. 4. Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? CurrGastroen-terol Rep 2005;7:132-14 5. Schirmer BD, Winters KL, Edlich RF. Cholelithiasis and cholecys-titis. J Long Term Eff Med Implants 2005; 15:329-338. 6. Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroen-terology 1999; 117:632-639. 7. Tazuma S. Gallstone disease: epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahe-patic). Best Pract Res ClinGastroenterol 2006;20:1075-1083 8. Sandler RS, Everhart JE, Donowitz M, et al. The burden of se-lected digestive diseases in the United States. Gastroenterology 2002; 122:1500-1511. 9. Singh V, Trikha B, Nain C, Singh K, Bose S. Epidemiology of gallstone disease in Chandigarh: a community-based study. J GastroenterolHepatol 2001; 16:560-563. 10. Chen CY, Lu CL, Huang YS, et al. Age is one of the risk factors in developing gallstone disease in Taiwan. Age Ageing 1998; 27:437-441. 11. Everhart JE. Gallstones and ethnicity in the Americas. J Assoc Acad Minor Phys 2001; 12:137-143. Gilat T, Feldman C, Halpern Z, Dan M, Bar-Meir S. An increased familial frequency of gallstones.Gastroenterology 1983; 84:242-246. 12. Mallik IA (2003) Clinicopathological features and management ofgall bladder cancer in Pakistan. A prospective study of 233 cases. JGastroenterol Hepatol 18(8):950–953 13. Dutta U, Nagi B, Garg PK, Sinha SK, Singh K, Tandon RK (2005) Patients with gallstones develop gall bladder cancer at an early age. Eur J Cancer Prev 14(4):381–385

Patent ductusarteriosus is one of the most common congenital heart disease1and is often associated with other cardiac defects e.g. ventricular septaldefect, Tetrology of Fallot, Transposition of Great Vessels. An isolated PDA is usually corrected by either surgical interruption or coil embolisation in cath lab. PDA with severe valvular stenosis and VSD is very rare. A review of literature revealed very few articles stating information on anaesthetic management of a large PDA with severe aortic stenosis with VSD.

1. Schwartz,A.J. Campbell,F.W. Pathophysiological approach to congenital heart disease. in: C.L.Lake (Ed)Pediatric Cardiac Anesthesia.Appleton and Lange,Stamford,CT;1998:7-20 2. Bonham-Carter, R.E.Walker, C.H.M., Mathews, M.B.etel, Patentductusarteriosus with an abnormal aortic valve.Br Heart J.1955; 255-261. 3. NEEMA P.K. et al,surgical interruption of pda in sevas;Journal of Cardiovascular and Vascular Anesthesia;2005 vol19,Issue 6,pg 784-785 4. Sarveshsingh; Annals of Cardiac Anaesthesia year2010/vol13/issue;3pg;263-264 5. Anaesthetic management of a child with sev aortic stenosis and mild pulmonary stenosis for ophthalmic surgery;rsinha, jvinothini,jpunj, rpandey; the internet journal of anesthesiologyvol 19 no.2 6. Anesthetic management of a child with rubella syndrome for ophthalmic surgery: anesthesiapediatrica e neonate, vol10, n.2, November-december2012. 7. Journal of interventional cardiology-concurrent transcatheter therapy of valvular aortic stenosis and patent ductusarteriosus. 8. Kirklin textbook of ;cardiacsurgery,J.W.Barretboys,B.G.Patentductusarteriosus.in;ChurchillLivingstone,New York,NY;1993;841-859 9. Stoelting, R.K. Dierdoef, S.F. Congenital heart disease. Anesthesia and coexisting Disease.New York, NY; 1993; 37-55.

Introduction: It is well known that keloids are “Confused scars that do not know when to stop growing”. The basic pathology is an imbalance between anabolic (proliferation) and catabolic (apoptotic) phases of the healing process. The various treatment modalities so far described in managing keloids aresurgical excision, intraregional steroidal injections, compression therapy with silicon sheets, cryotherapy, laser, α-2b interferon and chemotherapeutic agents like 5 fluorouracil. Surgical excision totally eliminates the lesion but the main disadvantage is ≥50% recurrence if used alone. Aims and Objective: To study the effectiveness of Intraoperative Plus Two Post-Operative Injections of Triamcinolone versus Once Intraoperative Triamcinolone in Wedge Excision of Keloid. This was a randomized controlled trial was conducted at the Department of Plastic Surgery at tertiary care health Centre. All the patients diagnosed and want operations or treatment during the complete year 2014 was included into the study those who does not give consent were excluded from the study. There were 70 patients in this study. The study protocol was approved by the institutional ethics committee. Patients fulfilling the inclusion criteria were picked up using consecutive sampling. Patients were randomly allocated into two groups by using computer-generated random number table; Group A having patients who were given single per-operative injection of triamcinolone, and Group B. Result: Most common site affected was Ear pinna followed by Chest, Wrist, Back, Buttock, and Face. Mean size of Keloid Preoperatively was 2.54 ±0.516 and 2.61±0.569 respectively in Group A and Group B but the observed difference was not statistically significant (t=0.539,df=68,p>0.05). But the Recurrence was 10 (28.57%) in Group A was significantly higher than that of the Group B i.e. 3(8.57%) (z= 2.15.p<0.03). Mean size of Keloid Post-operatively was 2.64± 0.495 significantly higher in Group A as compared to Group B i.e. 1.23±0.521 (t=11.60,df=68,p<0.001). Conclusion: It is better to use Two Post-Operative Injections of Triamcinolone in Wedge Excision of Keloid than single use of injection Triamcinolone alone to prevent the not only the recurrence but the size of keloid those in who it was recurred.

1. Luo S, Benathan M, Raffoul W, Panizzon RG, Egloff DV. Abnormal balance between proliferation and apoptotic cell death in fibroblasts derived keloid lesions. PlastReconstr Surg. 2001; 107:87–96. [PubMed] 2. Berman B. Departments of Dermatology and Internal Medicine, University Of Miami School of Medicine eMedicine - Keloid and hypertrophic scar. Available from: http://www.emedicine.com/derm/topic205.htm - 105k. 3. Al-Attar A, Mess S, Thomassen JM, Kauffman CL, Davison SP. Keloid pathogenesis and treatment. PlastReconstr Surg. 2006; 117:286–300. [PubMed] 4. Ogawa R, Mitsuhashi K, Hyakusoku H, Miyashita T. Postoperative electron-beam irradiation therapy for keloids and hypertrophic scars: Retrospective study of 147 cases followed for more than 18 months. PlastReconstr Surg. 2003; 111:547–53. [PubMed] 5. Ragoowansi R, Cornes PG, Moss AL, Glees JP. Treatment of keloids by surgical excision and immediate postoperative single-fraction radiotherapy. PlastReconstr Surg. 2003; 111:1853–9. [PubMed] 6. Chaudhry MR, Akhtar S, Duvalsaint F, Garner L, Lucente FE. Ear lobe keloids, surgical excision followed by radiation therapy: A 10- year experience. Ear Nose Throat Jr. 1994; 73:779–81. [PubMed] 7. Aköz T, Erdoğan B, Görgü M, Deren O. Combined approach to the treatment of earlobe keloids. PlastReconstr Surg. 1998; 101:857–8. [PubMed] 8. Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids.PlastReconstSurg 2010; 2:557-68. 9. Jung JY,Roh MR, Kwon YS, Chung KY. Surgery and perioperative intralesion corticosteroid injection for treating ear lobe keloids; A Korean experience. Ann Dermatol 2009; 3: 221-5. 10. Mustoe TA, Cooter RD, Gold MH, Hobbs FD, Ramelet AA, Shakespeare PG, et al. International Advisory Panel on Scar Management. International clinical recommendations on scar management.PlastReconstrSurg 2002; 110:560-71. 11. Rosen DJ, Mitesh K, Freeman K. A Primary Protocol for the managenment of Ear keloids: Results of Excision Combined with Intraoperative and Postoperative Steroid Injections. PlastReconstrSurg 2007; 120:1395. 12. Burd A. So what is a keloid scar? J PlastReconstAesthet Surg2008; 6:1-3.

The retrohepatic segment of inferior vena cava and hepatic vein openings were studied in 30 adult livers. Altogether 322 hepatic vein openings were observed .The openings were classified into large, medium and small according to the size of the opening. The position of the ostia was studied by dividing the posterior wall of retrohepatic segment of inferior vena cava into 16 areas. The large openings were right, left and middle hepatic veins. The large openings showed different pattern of combinations. The anatomical knowledge of retrohepatic segment of Inferior vena cava and hepatic vein openings are important in preoperative evaluation, in liver resections and transplantation procedures.

1. Williams PL, Bannster LH, Martin, Berry, et al. Cardiovascular system. Grey’s Anatomy.38th edn. London: Churchill living stone, 1996; 1600-1602. 2. Camargo AMSR, Teixeira GG, Ortale JR. Anatomy of ostia venae hepaticae and retrohepatic segment of Inferior vena cava. J.Anat 1995 May; 188: 59-64. 3. Sagoo MG, Agnihotri G. The Retrohepatic segment of inferior vena cava and the ostia venae hepaticae in a northwest Indian population. Braz.J.Morphhol.Sci., 2010 Jan;26(3-4):141-144. 4. Change RWH, Shan-Quan S, Yen WWC. An applied anatomical study of the ostia venae hepaticae and retrohepatic segment of inferior vena cava .J.Anat, 1989; 41-47. 5. Sahni D, Harjeet, Chawla YK, Indarjit. Gross anatomy of the retrohepatic segment of the inferior vena cava in northwest Indians. Indian J Med.Res., 2006 July; 124:63-70. 6. Nakamura S, Tsuhiharu T. Surgical anatomy of hepatic veins and the inferior vena cava. Surgery, Gynecology and Obstetrics. 1981Jan; 152:43-50. 7. Radtke A, Schroeder T, Sotiropoulos GC, Molmenti E, Schenk A , Paul A et al.Anatomical and physiological classification of hepatic vein dominance applied to liver transplantation.Eur J Med Res,2005 May; 10;187-194. 8. Singh D, Agnihothri G, Singh S, Singh R. Patterns of tributaries of major hepatic veins by dissection and radiology. Anatomy journal of Africa, 2012 Sep; 1(1):17-19. 9. Yu HC, Lee H, Jin ZW, Cho BH. Anatomical study of the ostia venae hepaticae in the Korean cadaver. Journal of korean surgical society, 2003; 64(4):321-326.

Introduction: perinatal asphyxia, neonatal asphyxia partum factor or birth asphyxia is a medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the process to cause physical harm, PROM, Cord accidents usually to the brain. And it is almost all neonatal deaths occur in our rural and urban area, where the majority is delivered at homes with negligible antenatal care and poor prenatal services. Methods: In this collaborative study conducted prospective, descriptive study. As a case of 150 newborn babies and as a control 1190 newborn babies are fulfilled the selection criteria for prenatal and birth asphyxia. Results: Incidence of birth asphyxia in relation to ante partum and intra partum factors. And shows that mother with complication like eclampsia, APH, PROM, cord accidents, failed progress of labor, obstructive labor and prolong 2nd stage of labor, etc were more likely to deliver asphyxiated baby, and analysis of maternal risk factors for birth asphyxia. Many pathological, biochemical and metabolic changes occurs as a result of birth asphyxia. And the data were analyzed by slandered statistical test, namely, Z test, Chi square test, and uniovariate and ultivariate logistic regression analysis of risk factor. Conclusion: In our study it was observed that, Pregnancy related complication in rural and urban population of Kishanganj district was mostly Eclampsia, pre-eclamptic toxaemia, Oligohydramnios, PROM(M24hr) etc.To prevent birth asphyxia trained personal and neonatal resuscitation equipment should be mandatory in all maternity home/hospital because prevention is the best and be only option to reduce the Pre natal andbirth asphyxia.

1. Adamson ST, Alessendri LM, Badauji N, Bwiton PR, Pemberton P, J Stainley F. Predictors of neonatal encephalopathy in full term infants. BMJ 1995; 311 598- 602. 18. Suguna Bai NS< Mathews E, Nair PMC, Sabribathn K, Hari Kumar C. Perinatal mortality rate in south Indian Population. J Indian Medical Assoc, 1991; 89 : 97-8. 2. “Brain damage from perinatalasphyxia : correlation of MR findings with gestational age – Barkovich and Truvit 11(6) : 1087 – American journal of neuroradiology” Retrived 2008-03-27 3. Costello AM de L,Manandhar DS. Perinatal asphyxia in less developed countries. Arch Dis Chld 1994;36:167-169. 4. Davis, PG; Tan, A; O'Donnell, CPF; Schulze, A (2004). "Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis". The Lancet 364: 13291333. 5. Daga SR, Fernandes CJ, Rao A. Sarnat HBClinical profile of severe birth asphyxia. Indian Pediatr 1991; 28 : 485-488. 6. Finer NN, Robertson CM. Hypoxic ischemic encephalopathy in term neonates : perinatal factors and outcomes. J Pediatr 1991; 98 : 112-117. 7. Jayshree G, Dutta AK, Saina MS. Acute renal failure in asphyxiated newborns. Indian pediatrics, 1991; 28 : 19-23. 8. Kutzsche, S; Ilves, P; Kirkeby, OJ; Saugstad, OD (2001). "Hydrogen peroxide production in leukocytes during cerebral hypoxia and reoxygenation with 100% or 21% oxygen in newborn piglets". Pediatric Research 49: 834–842. 9. Kumar G, Kapur S, Mammen KG, Mathew KC. Asphyxia Neonatorum. Indian Pediatr 1969; 216-361. 10. Neonatal morbidity and mortality : Repot of the National Neonatal perinatal database. Indian pediatr 1999;36:167-169. 11. Periman JM, Talk ED, Martin T. Acute systemic organ injury in term neonates after birth asphyxia. American J of disease of Children, 1989; 143(5) : 617- 20. 12. Rajeshwar Reddy A, Praveen Kumar. Follow up of Neonates with perinatal asphyxia. J Neonatal 2004; 18:22-27. 13. Stoll BJ, fetal and neonatal infants JN;Behrman RE, Kligman RM, Jenson HB, Nelson textbook of paediatrics 18th edition ; WB saunders company 2007;718-720. 14. Shankaran S,Laptook AR,Clin obstet.gynecol 2007;50-624-635 and malcom 1. Levane and lindade vries. Hypoxic ischemic encephalopathy 2006;938-955.

Introduction: Nosocomial infections are threat to patients, especially in high-risk areas such as intensive care units (ICU). Urinary tract infections are the most common among them. Aim: To study the occurrence, spectrum and antibiotic resistance profile of urinary tract infections in high risk areas. Methods: A study was carried out for six months during Feb-July, 2012 in 819 urine samples received from ICU department. Allurinary samples were collected under sterile conditions. Culture was done on Blood agar and MacConkey Agar. Isolates were identified by standard biochemical tests. Antibiotic sensitivity testing was done on Muller Hilton Agar (MHA) by disk diffusion method and interpreted using CLSI guidelines. Results: Out of 819 urine samples from ICU patients, 93(11.4%) had significant bacteriuria. Candida spp. 30(32.3%), was the most common followed by Enterococcus spp. 19(20.4%), and Escherichia coli 12(12.9%). Nitrofurantoin (66.7%) and Piperacillin-tazobactum (58.3%) was mostly sensitive and second generation Cephalosporins, Ampicillin and Amoxicillin clavulanate were the most resistant among all. ThreeImipenem resistant bacteria were isolated. Above 90% resistance was seen in aminoglycosides and fluroquinolone group of drugs. Vancomycin was resistant in 8(42.1%) isolates of Enterococcus spp. whereas all isolates were sensitive to Linezolid. Conclusion: The Spectrum of uro-pathogens and their resistant pattern to common antimicrobial agents is changing and must be taken into account when selecting treatment strategies.

Introduction: Nosocomial infections are threat to patients, especially in high-risk areas such as intensive care units (ICU). Urinary tract infections are the most common among them. Aim: To study the occurrence, spectrum and antibiotic resistance profile of urinary tract infections in high risk areas. Methods: A study was carried out for six months during Feb-July, 2012 in 819 urine samples received from ICU department. Allurinary samples were collected under sterile conditions. Culture was done on Blood agar and MacConkey Agar. Isolates were identified by standard biochemical tests. Antibiotic sensitivity testing was done on Muller Hilton Agar (MHA) by disk diffusion method and interpreted using CLSI guidelines. Results: Out of 819 urine samples from ICU patients, 93(11.4%) had significant bacteriuria. Candida spp. 30(32.3%), was the most common followed by Enterococcus spp. 19(20.4%), and Escherichia coli 12(12.9%). Nitrofurantoin (66.7%) and Piperacillin-tazobactum (58.3%) was mostly sensitive and second generation Cephalosporins, Ampicillin and Amoxicillin clavulanate were the most resistant among all. ThreeImipenem resistant bacteria were isolated. Above 90% resistance was seen in aminoglycosides and fluroquinolone group of drugs. Vancomycin was resistant in 8(42.1%) isolates of Enterococcus spp. whereas all isolates were sensitive to Linezolid. Conclusion: The Spectrum of uro-pathogens and their resistant pattern to common antimicrobial agents is changing and must be taken into account when selecting treatment strategies.

Introduction: There are numbers of people in India suffering from common skin Problems. They are found in children, young and adults as well as in old persons. The common skin problems are Acne, Burn scars, Hyperhidrosis, Psoriasis, Scabies, Skin grafting, Vitiligo, Pediculosis, Herpes simplex infection, Varicella, Herpes Zoster, Erythema, Urticaria etc. Dermatological problem in India manifests as primary and secondary cutaneous complaints. Among them, allergy and itches are widely observed in most of the patients. Aims and Objectives: To study Distribution of Cases and Outcome at Dermatology and Venereal Disease Inpatient Department of a Tertiary Care Hospital Methodology: This was cross sectional, hospital based study during the period of Jan 2013 to Jan 214 in All the patients with dermatological illness admitted to tertiary care hospital . All the information necessary was collected by using pretested, semi-structured questionnaire. During this year total 296 patients were included into the study. Result: Overall the Scabies, Skin infections like Fungal ,Bacterial and Viral, Auto-immune, Auto-immune UTI/STDs are more common in Males but Acne found to be more common In Female .Also it is clear that Scabies was more common in <10 and 10-20 years age group, Skin infections like Fungal, Bacterial and Viral were more common in 20-30, 30-40 yrs., age group, Acne was more common in the 20-30 and 30-40 years age group. Auto immune diseases were common in 30-40 and 40-50 yrs. age group. UTI/STDs were more common in 30-40 and 20-30 yrs. age group. mean duration of time to improvement required was highest for UTI/STDs 12±4.5 followed by Acne 9±2.1, Skin infections like Fungal ,Bacterial and Viral 6±3.1, Auto-immune 5±3.1, Scabies3±2, Others,4.5±3.1. Conclusions: Knowledge of various prevalence patterns of specific dieses of Dermatology and Venereology as per the age, sex, should be considered while diagnosing and management of patients.

1. Michael DR, Karen EN. Diseases management, 413. 2. Roger Walker, Clive Edwards; Clinical pharmacy and Therapeutics; 3rd edition: 843. 3. Taplin D, Lansdell L, Allen AA, Rodriguez R, Corets A. Prevalence of streptococcal pyoderma in relationto climate and hygiene. Lancet 1973; i:501-3 4. Mahé A, Prual A, Konaté M, Bobin P. Skin diseases of children in Mali: a public health problem. Trans R Soc Trop Med Hyg 1995; 89:467-70. 5. Masawe AEJ, Nsanzumuhire H, Mhalu F. Bacterial skin infections in preschool and school children in 6. Sharrett AR, Finklea JF, Potter EV, Poon-King T, Barle DP. The control of streptococcal skin infections in South Trinidad. Am J Epidemiol 1974;99:408-13 7. Luby S, Agboatwalla M, Schnell BM, Hoekstra RM, Rahbar MH, Keswick BH. The effect of antibacterialsoap on impetigo incidence, Karachi, Pakistan. Am J Trop Med Hyg. 2002;67:430-5 8. Kapil U, Sood AK. Morbidity pattern in children below three years attending a rural health centre in Haryana. Indian Pediatr 1989; 26:550-2. 9. Zaman S, Jalil F, Karlberg J, Hanson LA. Early child health in Lahore, Pakistan: VI. Morbidity. ActaPaediatr (Suppl) 1993; 390:63-78. 10. Nelson KE, Bisno AL, Brunt J, Moses VK, Haque RU. The epidemiology and natural history ofstreptococcal pyoderma: an endemic disease of the rural southern United States. Am J Epidemiol 1976;103: 270-83 11. Porter MJ. Seasonal change and its effect on the prevalence of infectious skin disease in a Gambianvillage. Trans R Soc Trop Med Hyg 1979;74:162-8 12. Belcher DW, Afoakwa SN, Osei-Tutu E, Wurapa FK, Osei L. Endemic pyoderma in Ghana: a survey inrural villages. Trans R Soc Trop Med Hyg 1977;71:204-209 13. Kristensen JK. Scabies and pyoderma in Lilongwe, Malawi.Prevalence and seasonal fluctuation.Int JDermatol 1991; 30:699-702. 14. Suleman M. Patterns of health-care utilization and morbidity in a rural community near Lahore, Pakistan.Ann Trop Med Parasitol 1996; 90:79-85. 15. Luby S, Agboatwalla M, Schnell BM, Hoekstra RM, Rahbar MH, Keswick BH. The effect of antibacterialsoap on impetigo incidence, Karachi, Pakistan. Am J Trop Med Hyg. 2002;67:430-5 16. Taplin D, Arrue C, Walker JG, Roth WI, Rivera A. Eradication of scabies with a single treatmentschedule. J Am AcadDermatol 1983; 9:546-50. 17. Stanton B, Khanam S, Nazrul H, Nurani S, Khair T. Scabies in urban Bangladesh. J Trop Med Hyg1987; 90:219-26. 18. Mahé A, Prual A, Konaté M, Bobin P. Skin diseases of children in Mali: a public health problem. Trans R Soc Trop Med Hyg 1995; 89:467-70. 19. Masawe AEJ, Nsanzumuhire H, Mhalu F. Bacterial skin infections in preschool and school children incoastal Tanzania. Arch Dermatol 1975;111:1312-6 20. Al-Amin A, Rasul CH, Siddique SI. Scabies and its complications in relation to socio-economic status.Bangladesh J DermatolVenereolLepr 1997; 14:13-5. 21. Perera A. Atukorale ON, Sivayogan S, Anyaratne VS, and Karunaratne Lde A. Prevalence of skin diseases in suburban SriLanka.Ceylon Medical Journal. 2000; 45:123-128. Available at: http://www.slmaonline.org/cmj/CMJ4503/123.ht 22. NegiKS .KandpalSO .andParsad D. Pattern of Skin Diseases in Children in Garhwal Region of Uttar Pradesh. Indian Pediatric 2 0 0 1; 3 8: 7 7-8 0 . A v a i l a b l e from URL:htto://www indianpediatrics. Netljan200 1/jan-77-80. him

Hearing outcome in tympanoplasty depends on many variables, one of them being the type of graft used. A number of materials like skin, vein, periosteum, perichondrium and fat have been used as grafts to seal the perforation, each having some advantages as well as disadvantages. Over past three decades temporalis fascia continues to be the graft of choice for tympanoplasty. However with the advent of endaural/endomeatal incision and cosmetic awareness, fascia lata an autologous free fascia graft from the thigh is gaining importance as graft in tympanoplasty. At Dr. D Y Patil Medical College Hospital, Kolhapur, we conducted a prospective randomized controlled trial on 100 subjects with inactive mucosal type of chronic suppurative otitis media and central perforation, with the aim to evaluate the comparative efficacy of temporalis fascia and fascia lata graft in type I tympanoplasty. In 50 patients temporalis fascia was used as a graft and in remaining 50 fascia lata was used. In this study surgical success was evaluated in terms of intact drum, average gain in hearing threshold and average hearing gain in audiometric frequency spectrum (low frequency-250, 500 and 1000Hzand high frequency-2, 4 and 6 kHz) at 3 months post-operatively. Temporalis fascia and fascia lata both achieved a graft uptake of 96%. Statistical analysis was done by using Z-test for proportion by using Graph pad quickcal software. The means of threshold gains, high frequency gains were significantly better at specific frequencies in the fascia lata group, and low frequency gains were better in temporalis fascia group and significantly much better in fascia lata group. However by Z-test for proportion this difference was statistically not significant. Except for residual perforation in two patients of each group and thigh wound infection in two patients of fascia lata group, no other complications were encountered. Thus we conclude that fascia lata may also be a preferred graft material in tympanoplasty.

1. Umar AS, Ahmed Z (2008) Anatomical and functional outcome following type tympanoplasty in chronic tubotympanic suppurative otitis media. Pak Armed Forces Med J 1:1—5. 2. Singh BJ, Sengupta A, Das S, Ghosh D, Basak B (2009) A comparative study of different graft materials used in myringoplasty. Indian J Otolaryngol Head Neck Surg 61:131—134. 3. Karela M, Sandeep B, Watkins A, Phillips J (2008) Myringoplasty: surgical outcomes and hearing improvement: is it worth performing to improve hearing? Eur Arch Otorhinolaryngol 265: 1039—1042. 4. Glasscock ME III (1973) Tympanic membrane grafting with fascia: overlay vs. undersurface technique. Laryngoscope 83:754—770. 5. Guo M, Huang Y, Wang J (1999) Report of myringoplasty with interlay method in 53 ears perforation of tympani. Lin Chuang Er Bi Yan Hou Ke Za Zhi J Clin Otorhinolaryngol (4):147—149. 6. Shabbir Indorewala, Tai wo Olugbemiga Adedeji, Abuzar Indorewala, Gaurav(2015) Tympanoplasty Outcomes: A Review of 789 Cases. Iranian Journal of Otorhinolaryngology, Vol.27 (2), Serial No. 79, Mar 2015. 7. Sergi B, Galli J, De Corso E, Parrilla C, Paludetti G (2011) Overlay versus underlay myringoplasty: report of outcomes considering closure of perforation and hearing function. Acta Otorhinolaryngol Ital 31 (6): 366-371. 8. Mishra P, Sonkhya N, Mathur N (2007) .Prospective study of 100 cases of underlay tympanoplasty with superiorly based circumferential flap for subtotal perforations. Indian J otolaryngol Head Neck Surg 59:225—228. 9. Stage J, Bak—Pedersen K (I992) Underlay tympanoplasty with the graft lateral to the malleus handle. Clin Otolaryngol Allied Sci 17(1):6—9. 10. Kshitij Patil, Nitish Baisakhiya, PT Deshmukh (2014) Evaluation of different graft material in type I tympanoplasty. Indian Journal of Otology Vol 20, Issue 3:106-114. 11. 228 Singh M, Raj A, Bandyopadhyay S, Gupta SC (2003) Comparative study of underlay and overlay techniques of myringoplasty in large and subtotal perforations of the tympanic membrane. J Laryngol Otol 117(6):444-448. 12. Kotecha B et al 1999. Myringoplasty: A prospective Audit Study. Clinical Otolaryngology, 24: 126-129. 13. Anirban Biswas; Clinical Audio-Vestibulometry. 3rd edition, Chapter Audiovestibulometric profile in some common clinical conditions. Page 163. 14. C L Bhusal et al. (2005) Correlation of Hearing impairment in Tympanoplasty with site of tympanic membrane perforations. Journal of Institute of Medicine. Vol27, No. 2. 15. Jyoti Dabolkar et al (2007). Comparative study of underlay tympanoplasty with temporalis fascia and tragal perichondrium. Indian Journal of Otolaryngology and Head and Neck Surgery. 57:116-119. 16. Fateh Oktem et al. (2007). Study of vibration response of tutoplast allografts. Turkey; Cerrahposa. Dept of Otolaryngology, School of Medicine. (Internet article).

Aim: The objectives were to study the morphology of the foramen magnum in dry skulls and to evaluate its antero-posterior diameter, transverse diameter and morphological variants of the shapes of foramen magnum. Materials and Methods: The foramen magna of 61 dry human cadaver skulls that were obtained from Department Anatomy IIMSR Warudi, Badnapur Different shapes of the foramen magnum were macroscopically noted and classified. The antero-posterior and transverse diameters were measured. Results: The foramen magnum shapes were determined as a round shape in 29.50% of cases, tetragonal in 18.03%, oval in 31.14%, irregular in 11.47%, hexagonal in 8.19% and pentagonal in 1.63% of the cases. The mean antero-posterior and transverse diameter of the foramen magnum was determined as 39± 2.2 mm and 37.5 ± 2.5 mm respectively. Conclusion: The present study has determined the various shapes of foramen magnum and its morphometry. The data obtained may be of useful to the neurosurgeon in analyzing the morphological anatomy of craniovertebral junction. The findings are also enlightening for the Anthropologists, morphologists and clinical anatomists.

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Aims: To study the common symptoms at presentation, prevalence of target organ damages and the effect of risk factors like obesity, alcoholism, smoking, diabetes mellitus and dyslipidemia in producing these complications among elderly hypertensives. Methods: This was a cross sectional study conducted in two hundred adult patients with hypertension who were aged above or equal to60years, admitted to the medical wards of Travancore Medical College hospital, Kollam. Statistical analysis was done using chi square test and Gaussian test wherever required. Results: In our study, among the elderly hypertensives, headache was the chief commonest complaint (36%).The commonest target organ damage involved were of cardiovascular system (35%).The prevalence of target organ damage among elderly hypertensives with risk factors like obesity, alcoholism, smoking, diabetes mellitus and dyslipidemia were higher, compared to elderly hypertensives without these risk factors. Conclusion: Headache was the common symptom of presentation among the elderly hypertensives. Of the target organ damages, those involving cardiovascular system were the most common. Although the prevalence of target organ damage among elderly hypertensives with risk factors, were higher thanelderly hypertensives without these risk factors, statistical significance was present only for dyslipidemia

1. Turner ST, Boerwinkle E. Genetics of hypertension, target organ complications and response to therapy. Circulation 2000; 102(20 suppl. 4):IV40-IV45. 2. Paul A. James, Suzanne Oparil, Barry L. Carter, William C. Cushman et al.2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311(5):507-520. 3. Roman MJ, Saba PS et al. Impact of arterial stiffening on left ventricular structure. Hypertension 2000; 36: 489-494. 4. Klatsky AL, Gerald MJ. Alcohol consumption and Blood pressure. New England journal of Medicine 1977; 296: 1194-1200. 5. Bastos1, Filipa S, Joana S, Raquel F, Polonia J The prognostic value of ambulatory arterial stiffness index as a predictor of cardiovascular events in resistant hypertensive patients.J Hypertens. 2015; 33:24-27. 6. Kjellgren K, Ahlner J, et al. Perceived symptoms amongst hypertensive patients in routine clinical practice. J Intern Med 1998; 244: 325-332. 7. Stewart I et al. Headache and Hypertension. Lancet 1953; 1: 1261-1266. 8. Kannel WB. Blood pressure as a cardiovascular risk factor. JAMA 1996;275: 1571-1576 9. Vrinda Kulkarni, N. Bhagwat. Hypertensionin the elderly, JAPI 2001;49 :873-875 10. Harts JT, Edwards C, Jones J. Screening detected Hypertension under 40.British Medical Journal.1993; 306(6875):437-40. 11. 11.Woo j, Lau E.Elderly hypertensives have different risk factors for ischemic and haemorrhagic strokes compared to younger subjects.J Am Geriatr soc.1992.feb:40(2):124-9.

Introduction: Breast cancer is one of the commonest cancers in females and causes extensive morbidity and mortality. The incidence of carcinoma breast is high in USA, North America and Northern Europe and is low in most Asian and African Countries. Breast health awareness has resulted in increasing detection of early breast cancer and corresponding decrease in breast cancer morbidity. About 80% of breast biopsies result in benign pathology. Symptomatic breast lesions are traditionally evaluated by clinical, radiologic and cytological methods. Aims and Objectives: To evaluate the diagnostic accuracy and value of ultrasonography in as assessment of breast disease Methodology: All the cases underwent a thorough clinical examination followed by anultrasonography of both breasts and fine needle aspiration cytology(FNAC).If surgery was indicated, Histopathology of the specimen was done and there port compared with the ultrasonography reports SOURCE OF DATA: This study was a prospective study from October 2011 to October 2013 done at YMCH, Deralakatte and Mangalore. Result: Most common way of presentation of the tumor was Lump i.e. 90% and Pain 10%. Most common diagnosis by USG were Ca-breast, Fibroadenosis, Indeterminate. Most common diagnosis by Histopathology were Infiltrating lobar carcinoma, infiltrating ductal carcinoma with Neuroendocrine differentiation, Fibroadenoma. The sensitivity of the test (USG) is 90%, the specificity of the Test is also 90% and Positive predictive value is 85.71%. Conclusion: However from this study it can be concluded that ultrasonography can be highly accurate in differentiating benign from malignant disease. Ultrasound may even avoid unnecessary FNAC’s which in turn reduces the pain and the cost burden to the patient.

1. Collaco et al. ActaCytol 1999; 43:587-59 2. Reinikainen et al Contribution of Ultrasonography and fine-needle aspiration cytology to the differential diagnosis of palpable solid breast lesions. Department of Diagnostic Radiology, Oulu University Central Hospital, Finland. ActaRadiol. 1999 Jul; 40(4):383-9. 3. Hagensen et al. Hagensen book of breast disease W.B. Saunders Philedelphia 4. Shahid R et al .Role of grey scale ultrasound in benign and malignant breast lesions, J Coll PhysiciansSurg Pak. 2005. Apr; 15(4):193-5. Department of Radiology, PNS Shifa, [email protected]. 5. Sainsbury RC. The Breast. In: Russell RCG, Williams NS, Bulstrode CJK, Editors. Bailey and Love’s Short Practice of Surgery.24th Edn. London: Arnold; 2004: p. 824-8 6. Haagensen CD. Disease of the breast.Philadelphia : WB Saunders, 1971 7. Wild JJ, Neal D. Further pilot echographic studies of the histologic structures of tumors of living intact human breast.American J Pathol 1952; 28: 839-61. 8. Kopans DB, Meyer JE and Lindfors KK. Whole breast ultrasound imaging: four year follow-up. Radiology 1985;157: 505-07 9. Mansoor T, Ahmed A, HH Syed et al. Role of Ultrasonographic in the differential diagnosis of palpablebreastlumps.Ind J Surgery 2002; 64 (6): 499-501 10. Durfee SM, Selland DL, Smith D.N, et al. Sonographicevaluation of clinically palpable breast cancers invisible onmammography. Breast J 2000; 6: 247-51 11. Fleishcher AC, Muhletaler CA, Reynolds VH, et al. Palpable breast masses: evaluation by high frequency hand held real-time sonography and xero-mammography. Radiology1983;148: 813-17 12. Hayashi N, Tamaki N, Yonekura Y, et al. Real time sonography of palpable breast masses. British J Radiology1985; 58: 611- 15 13. Rahbar G, Sie AC, Hansen GC et al. Benign versus malignantsolid breast masses: US differentiation. Radiology 1999;213: 889-9412.Pande AR, Lohani B, Sayami P, Pradhan S. 14. Predictive value of ultrasonography in the diagnosis of palpable breast lump. KathmanduUniv Med J (KUMJ)2003;1(2):78-84 15. Harvey JA. Sonography of palpable breast masses. Semin Ultrasound CT MR2006 ;27(4):284-97 16. Park YM, Kim EK, Lee JH, et al. Palpable Breast Masses with Probably Benign Morphology at Sonography: Can Biopsy Be Deferred. ActaRadiol 2008;14:1-8

Introduction: Gallbladder disease represents a major health problem worldwide and has been known since the time of the Egyptian dynasty. More than 98% of all gallbladder and biliary track disorders are one way or another connected to cholelithiasis, and calculus diseases constitutes most of the cases that seek surgical attention. It may present as acute chole-cystitis which many progress to empyema, chronic calculus cholecystitis or mucocele. Carcinoma of the gallbladder (GBC), although it has a low overall prevalence, is the most common cancer of the biliary tree and one of the most highly malignant tumors with poor prognosis. Aims and Objectives: To see the clinic epidemiological factors responsible for gall bladder disease. Methodology: All the cases presenting with gall bladder disease over the period of 12months from 30 June 2007 till 29 June 2008 in the Surgery Outpatient Department and Casualty at Gauhati Medical College And Hospital, Guwahati were included in this prospective study. Out of 149 cases, 56 were included in this study. Result: Overall the presentations of acute cases of gall bladder was more, than chronic and malignant i.e. 29 (44.62%), 23 (41.07%) and 4 (.40%) respectively. Maximal incidence in females was seen in the fifth decade, whiles the maximum incidence in males was seen in the fourth decade. The male to female ratio was 1:4.09 but in the malignant group the ratio is 1:3. Gallbladder disease with palpable lumps was maximally seen in housewives, which is around 66.07%. Next common occupation was male cultivators constituting 10.71%. 32.2% of the case belonged to the lower middle class of society. Conclusion: As the cases were more common in Females in fourth decade and in middle and low socio economic groups patients so special attention should be given for prevention and diagnosis these groups.

1. Pavlidis TE, Pavlidis ET, Symeonidis NG, Psarras K, Sakantamis AK (2012). Current curative surgical management of gallbladder cancer: a brief review. J CurrSurg, 2, 81-3 2. Mishra R, Goda C, Arora M, et al (2012). Treatment of Gall Bladder Cancer: a Review. Indo Global J Pharm Sci, 2, 54-62. 3. Tyagi BB, Manoharan N, Raina V (2008). Risk factors for gallbladder cancer : a population based case-control study in Delhi. Ind J Med and PaedOncol, 29, 16-26. 4. Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? CurrGastroen-terol Rep 2005;7:132-14 5. Schirmer BD, Winters KL, Edlich RF. Cholelithiasis and cholecys-titis. J Long Term Eff Med Implants 2005; 15:329-338. 6. Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroen-terology 1999; 117:632-639. 7. Tazuma S. Gallstone disease: epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahe-patic). Best Pract Res ClinGastroenterol 2006;20:1075-1083 8. Sandler RS, Everhart JE, Donowitz M, et al. The burden of se-lected digestive diseases in the United States. Gastroenterology 2002; 122:1500-1511. 9. Singh V, Trikha B, Nain C, Singh K, Bose S. Epidemiology of gallstone disease in Chandigarh: a community-based study. J GastroenterolHepatol 2001; 16:560-563. 10. Chen CY, Lu CL, Huang YS, et al. Age is one of the risk factors in developing gallstone disease in Taiwan. Age Ageing 1998; 27:437-441. 11. Everhart JE. Gallstones and ethnicity in the Americas. J Assoc Acad Minor Phys 2001; 12:137-143. Gilat T, Feldman C, Halpern Z, Dan M, Bar-Meir S. An increased familial frequency of gallstones.Gastroenterology 1983; 84:242-246. 12. Mallik IA (2003) Clinicopathological features and management ofgall bladder cancer in Pakistan. A prospective study of 233 cases. JGastroenterolHepatol 18(8):950–953 13. Dutta U, Nagi B, Garg PK, Sinha SK, Singh K, Tandon RK (2005) Patients with gallstones develop gall bladder cancer at an early age.Eur J Cancer Prev 14(4):381–385

Background: Chronic urticaria can be caused by a number of known and unknown allergens. Some of these allergens can be identified by prick tests. Objectives: To assess the positivity of skin prick test (SPT) in patients with chronic urticaria Patients and Methods: Forty patients diagnosed with chronic urticaria attending Skin department of our institute were included in the study and evaluated by prick testing. Results: Among the 40 patients, 33 patients showed positive reactions to various allergens tested i.e 82.5%. The mean age of the patients was 30 years. Female to male ratio was 1.6:1. On SPT, number of patients with 1-5 positive reactions were13, 6-10 were 15 and more than 10 were 5 patients. Ten most common allergens in order of their frequency include mite D-farinae (52), mite D-pteronyssinus (48), cockroach (32), prawn(28), housefly (25), chicken (22), cyanodon (22), parthenium (20),mosquito (20), crab (16). The five most common food allergen positivity include prawn (29%), chicken (24%), wheat (18%), crab (16%), black pepper(13%). Conclusions: A greater proportion of patients with chronic urticaria demonstrate sensitivity to house dust mites, cockroach, pollens along with food. Thus, SPT is an important diagnostic procedure in cases of chronic urticaria, It is also important to perform SPTs among patients suffering from chronic urticaria not only for food allergens but also for pollens, house dust mites.

1. Rasool R, Shera IA, Nissar S, Shah ZA, Nayak , Siddiqui MA et al. Role of skin prick test in allergic disorders: A prospective study in Kashmiri population in light of review. Indian J Dermatol 2013;58: 12-7 2. Nath AK, Adityan B, Thappa DM. Prick testing in chronic idiopathic urticaria: A report from a tertiary care centre in south India. Int J Dermatol. 2008;6:10 3. Parasuramalu BG, Balaji R, Sharath Kumar BC. Implication of pollen sensitivity among patients suffering from chronic urticaria: Current scenario. International Journal of Health and Allied Sciences; 2014; 3:4-8 4. Caliskaner Z, Ozturk S, Turan M, Karaayvaz M. Skin test positivity to aeroallergens in the patients with chronic urticaria without allergic respiratory disease. J Invest Allergol Clin Immunol 2004; 14: 50-4 5. Hari Sai Priya V, Anuradha B, Vijayalakshmi V V, Latha G S, Murthy K J R. Profile of food allergens in urticaria patients in Hyderabad. Indian J Dermatol 2006; 51:111-4 6. Bains P, Dogra A. Skin Prick Test in Patients with Chronic Allergic Skin Disorders. Indian Journal of Dermatology. 2015;60:159-64. 7. Kulthanan K, Wachirakaphan C. Prevalence and Clinical Characteristics of Chronic Urticaria and Positive Skin Prick Testing to Mites. Acta Derm Venereol 2008; 88: 584–8 8. Hosseini S, Shokouhi Shoormasti R, Akramian R, Movahedi M, Gharagozlou M, Foroughi N, Saboury B, Kazemnejad A, Mahlooji Rad M, Mahdaviani AR, Pourpak Z, Moin M. Skin Prick Test Reactivity to Common Aero and Food Allergens among Children with Allergy. Iran J Med Sci. 2014;39:29-35

Objective: To determine the awareness and use of contraception by women seeking termination of pregnancy in MGM Medical College, Aurangabad. Materials and Methods: The study is a cross sectional opinion survey of patients attending OBGY OPD of MGM Medical College, Aurangabad using a pretested questionnaire. Results: Mean age of respondents was between 20-30yrs. 86% women were Hindus. Most of the women were multiparous.42% women were not aware of contraceptives.2% were aware of emergency contraception Conclusion: Among users, most common method of contraception was condom. Females in young age group were more vulnerable to unwanted pregnancy. More than 3/4th (84%) of females had completed their family. These unwanted pregnancies which were getting terminated had real need of awareness of contraception.

1. A Study on socio-demographic and obstetric profile of MTP seekers at Guru Govind Singh Hospital, Jamnagar Shipra Gupta, Viral Dave, Kishor Sochaliya, Sudha Yadav. ISSN 2229-337X Volume 3 Issue 1 January-June 2012 2. Survey of the Attitude to, Knowledge and Practice of Contraception and Medical Abortion in Women Attending a Family Planning Clinic, Suneeta MITTAL, Anupama BAHADUR, Jai Bhagwan SHARMA. J Turkish-German Gynecol Assoc, Vol. 9(1); 2008. 3. Awareness and use of contraception by women seeking termination of pregnancy in south eastern Nigeria. Echendu Dolly Adinma, JosephI feanyi Brian-D Adinma, Nkermakolam Obinna Eke. Asian pacific Journal Of tropical disease (2011) 71-75 4. Abortion in India: Emerging Issues from the Qualitative Studies Leela Visaria, Vimala Ramachandran, Bela Ganatra, Shveta Kalyanwala 5. Awareness about emergency contraceptives pill in women who came for medical termination of pregnancy. Preti Yadav, Anita Sinha, Jaykaran, Purva Mody. National Journal of physiology, pharmacy and pharmacology, (2011) vol 1 issue 2,68-78 6. Contraceptive knowledge, practice and acceptance among women seeking termination of pregnancyat a secondary level hospital in southern Karnataka Parvati V. Bhat, Ashwini Prabhu, Pratap Kumar, and Sreekumaran Nair Health and Population Perspectives and Issues Vol. 31 (3), 157-162, 2008 7. Comparative analysis of knowledge,Attitudes and Perceptions about Induced Abortions among Medical and Non-Medical Students of Karachi. R. Kumar S, S. Malik A. Qureshi, I.M. Khurram, K.S. Chaudhary. 8. R.Ramasubban and S.J. Jejeebhoy, eds., Women’s Reproductive Health in India. Jaipur: Rawat Publications. Vols. 186-235. 9. Khokhar A., Gulati N. Profile of Induced Abortions in Women from an Urban Slum of Delhi. Indian Journal of Community Medicine. 2000, Vols. 25 (4): 10-12. 10. Patnaik A, P.K.Ganatyat, L.Patnaik, T.Sahu. socio clinical profile of septic abortion cases - A hospital based study. Indian journal of community medicine.2007, Vol. 3(1).

In the era of laparoscopic management of Cholelithiasis, chloledocholithiasis is not routinely managed by laparoscopically because laparoscopic management of CBD stones demands skills and equipment, and is therefore used by few surgeons. Therefore open surgery is still a treatment of choice in many hospitals. The classical performance of bile duct exploration is associated with the problem of an incised bile duct closure. Choledochotomy followed by T-tube drainage is a traditional surgical treatment for chloledocholithiasis but it is not exempt from complications, which are present in up to 10% of patients. The most frequent of these is bile leakage after removal, which is reported to occur in 1–19% of cases. Primary closure of the CBD after exploration is not new. Halstead first described the advantages of primary closure. In our hospital, open CBD exploration is still the treatment chosen for CBD stones. In this study, our aim was to assess the outcome of primary closure of common bile duct over feeding tube after choledochotomy.

1. Petelin J (2003) Laparoscopic approach to common bile duct exploration. SurgEndosc 17:1705–1715 2. Cuschieri A, Lezoche C, Morino M, Croce E et al (1999) E.A.E.S. multicenter prospective randomized trial comparing two stage vs single-stage management of patients with gallstone disease and ductal calculi. SurgEndosc 13:952–957 3. Rhodes M, Susmon L, Cohen L, Lewis MP (1998) Randomized trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 351:159–161. 4. Perez G, Escalona A, Jarufe N, et al. Prospective randomized study of T-tube versus biliary stent for common bile duct decompression after open choledochotomy. World J Surg 2005; 29:869–72. 5. Ahrendt SA, Pitt HA. Biliary tract. In: Townsend M, ed. Sabiston Text book of Surgery. Philadelphia: WB Saunders, 2004:486–92. 6. Tu Z, Li J, Xin H, et al. Primary choledochorrhaphy after common bile duct exploration. Dig Surg 1999; 16:137–9. 7. Paganini AM, Guerrieri M, Sarnari J, et al. Long-term results after laparoscopic transverse choledochotomy for common bile duct stones. SurgEndosc 2005; 19:705–9. 8. Yamazaki M, Yasuda H, Koide Y, et al. Primary closure of the common bile duct in open laparotomy for common bile duct stones. J HepatobiliaryPancreatSurg 2006; 13:398–402. 9. Martin IJ, Bailey IS, Rhodes M, et al. Towards T-tube free laparoscopic bile duct exploration. A methodologic evolution during 300 consecutive procedures. Ann Surg 1998; 228:29–34. 10. Tokumura H, Umezawa A, Cao H, et al. Laparoscopic management of common bile duct stones: transcystic approach and choledochotomy. J HepatobiliaryPancreatSurg 2002; 9:206–12. 11. Wills VL, Gibson K, Karihaloo C, et al. Complications of biliary T-tubes after choledochotomy. ANZ J Surg 2002; 72:177–80. 12. Tapia A, Llanos O, Guzman S, et al. Resultados de la coledocotomiaclasicaporcoledocolitiasis: un punto de comparacionparatecnicasaltetnativas. Rev Chil Cir 1995; 47:563–8. [In Spanish] 13. Gharaibeh KIA, Heiss HA. Biliary leakage following T-tube removal. IntSurg 2000; 85:57–63. 14. Robinson G, Hollinshead J, Falk G, et al. Technique and results of laparoscopic choledochotomy for the management of bile duct calculi. ANZ J Surg 1995; 65:347–9. 15. Williams JAR, Treacy PJ, Sidey P, et al. Primary duct closure versus T-tube drainage following exploration of the common bile duct. ANZ J Surg 1994; 64:823–6. 16. Placer G. Bile leakage after removal of T-tube from the common bile duct. Br J Surg 1990; 77:1075. 17. Seale AK, Ledet WP Jr. Primary common bile duct closure. Arch Surg 1999; 134:22–4. 18. Miguel Angel Mercado, Carlos Chan, Hector Orozco, et al. Bile duct injuries related to misplacement of “T tubes”. Ann Hepatol 2006; 5:44–8. 19. Chen SS, Chou FF. Choledochotomy for biliary lithiasis: is routine T-tube drainage necessary? ActaChirScand 1990;156: 387–90 20. Sorenson VJ, Buck JR, Chung SK, et al. Primary bile duct closure following exploration: an effective alternative to routine biliary drainage. Am J Surg 1994;60:451–5. 21. Perez G, Escalona A, Jarufe N, et al. Prospective randomized study of T-tube versus biliary stent for common bile duct decompressionafter open choledochotomy. World J Surg2005; 29:869–72. 22. Yamazaki M, Yasuda H, Koide Y, et al. Primary closure of thecommon bile duct in open laparotomy for common bile duct stones. J HepatobiliaryPancreatSurg2006; 13:398–402. 23. Tokumura H, Umezawa A, Cao H, et al. Laparoscopic managementof common bile duct stones: transcystic approach and choledochotomy. J HepatobiliaryPancreatSurg2002; 9:206–12. 24. Tapia A, Llanos O, Guzman S, et al. Resultados de la coledocotomiaclasicaporcoledocolitiasis: un punto de comparacionparatecnicasaltetnativas. Rev Chil Cir 1995; 47:563–8. 25. Joshi MR, Singh DR. T-tube vs primary common bile duct closure.JNMA J Nepal Med Assoc. 2010 Jul-Sep; 49(179):199-203. 26. Ambreen M, Shaikh AR, Jamal A, Qureshi JN, Dalwani AG, Memon MM. Primary closure versus T-tube drainage after open choledochotomy. Asian J Surg. 2009 Jan; 32(1):21-5. 27. M. H. Thompson and S. E. Tranter, “All-comers policy for laparoscopic exploration of the common bile duct,” British Journal of Surgery, vol. 89, no. 12, pp. 1608–1612, 2002

Background: Acne scarring has lifelong sequelae and are extremely disturbing to patients, both physically and psychologically. The use of ablative fractional lasers for the treatment of acne scars is becoming increasingly popular. But studies regarding the efficacy and safety of the same in the Indian skin is limited. Objective: To evaluate the efficacy and safety of Erbium-doped Yttrium Aluminium Garnet (Er: YAG) 2940 nm fractional laser resurfacing in the treatment of acne scars in 10 patients at a tertiary care teaching hospital Methodology: All 10 patients received four treatment sessions with Er: YAG fractional laser at 1-month interval. Subjective assessment in percentage of improvement was documented after four sessions. Subjects were instructed to report any cutaneous side-effects including erythema, oozing, crusting, dyschromia, scarring or secondary infection and about interference with daily activities in the post-treatment period. Photographs were taken before each treatment session and 1 month after the final session. A clinical assessment by comparing the photographs was done. Patient's satisfaction of improvement was noted at the end of four sessions. Conclusion: Er- YAG laser resurfacing is both effective and safe in the treatment for acne scars.

1. Holland DB, Jeremy AH, Roberts SG, Seukeran DC, Layton AM, Cunliffe WJ. Inflammation in acne scarring: A comparison of the responses in lesions from patients prone and not prone to scar.Br J Dermatol 2004; 150:72-81. 2. Lee SJ, Kang JM, Chung WS, Kim YK, Kim HS. Ablative non-fractional lasers for atrophic facial acne scars : a new modality of erbium: YAG laser resurfacing in Asians. Lasers Med Sci 2014;29:615-9 3. Holland DB, Jeremy AH, Roberts SG, Seukeran DC, Layton AM, Cunliffe WJ. Inflammation in acne scarring: A comparison of the responses in lesions from patients prone and not prone to scar.Br J Dermatol 2004; 150:72-81. 4. Ahmad TJ, Muzaffar F, Nabi H, Malik S, Noreen A, Rabiya Hayat. Efficacy and safety of ablative fractional carbon dioxide laser for acne scars Journal of Pakistan Association of Dermatologists 2012;22:41-4 5. Brightman LA, Brauer JA, Anolik R, Weiss E, Karen J, Chapas A, et al. Ablative and fractional ablative lasers. Dermatol Clin 2009; 27:479-89. 6. Anderson RR, Parrish JA. Selective photothermolysis: Precise microsurgery by selective absorption of pulsed radiation. Science 1983; 220:524-7. 7. Nirmal B, Pai SB, Sripathi H, Rao R, Prabhu S, Kudur MH, et al. Efficacy and safety of Erbium-doped Yttrium Aluminium Garnet fractional resurfacing laser for treatment of facial acne scars. Indian J Dermatol Venereol Leprol 2013; 79:193-8. 8. Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: A new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med 2004; 34:426-38. 9. Saryazdi S, Mohebbi A. Evaluation of Efficacy of Fractional CO2 Laser in Acne Scar: J Lasers Med Sci 2012; 3:56-60