In recent years, laparoscopic surgery has gained popularity in clinical practice. The key element in laparoscopic surgery is creation of pneumoperitoneum and carbon dioxide is commonly used for insufflation. This pneumoperitoneum perils the normal cardiopulmonary system to a considerable extent. Every laparoscopic surgeon should understand the consequences of pneumoperitoneum; so that its untoward effects can be averted. Pneumoperitoneum increases pressure on diaphragm, leading to its cephalic displacement and thereby decreasing venous return, which can be aggravated by the position of patient during surgery. There is no absolute contraindication of laparoscopic surgery, though we can anticipate some problems in conditions like obesity, pregnancy and previous abdominal surgery. This review discusses some aspects of the pathophysiology of carbon dioxide induced pneumoperitoneum, its consequences as well as strategies to counteract them. Also, we propose certain guidelines for safe laparoscopic surgery.

Objectives:Semi-quantitative and quantitative assessment of the effect of bone marrow-derived mononuclear cells (BM-MNC) on early and late phase of nerve regeneration in rat sciatic nerve model.Materials and Methods:Sciatic nerve transection and repair was performed in 50 inbred female Wistar albino rats divided equally in two groups. In the test group the gap was filled with BM-MNCs obtained from the two male rats and fibrin sealant, while in the control group only fibrin sealant was used. Sciatic nerve was harvested at 15 days and at 60 days interval. Parameters of regeneration were assessed at anastomosis (G), intermediate distal (C), and distal site (A). Semi-quantitative (histopathological) and quantitative (morphometric) parameters were analyzed.Results:At 15 days there was a statistically significant difference found in mean axon diameter, mean nerve thickness and myelin thickness at the repair site (P < 0.05). However, in the distal areas, the axons were sparse and myelin rings were very thin in both the groups. At 60 days, the difference in above-mentioned parameters was statistically significant at the distal most sites. FISH assay confirmed the presence of Y chromosome, confirming the presence of BM-MNCs from the male rats.Conclusions:Transplanting BM-MNCS at the site of peripheral nerve injury leads to significantly better recovery. These differences were evident at the repair site and at the intermediate distal site at 15 days and at the distal most sites at 60 days. With practically no ethical issue regarding their isolation and application, they can be easily used for clinical trials.

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Introduction: Inflammatory smears are frequently seen in cervical cancer screening and they have been widely implicated as precursor of premalignancy of cervix. In the present study, attempt has been made to find out correlation between inflammation and different predisposing factors to cervical carcinogenesis in the rural context. Materials and Methods: Cervical cancer screening is in progress in the rural population of West Lucknow, India since May 2013 under the auspices of Era's Lucknow Medical College and Hospital, Lucknow, India and till March 2018, cervical smears of 2563 women have been cytologically examined. Results: The incidence of inflammation was found to be 33.7% in the present series. It was non-specific in 91.3% and was associated with either Candida albicans or Trichomonas vaginalis in 8.2% of cases. The inflammation was associated with low grade squamous intraepithelial lesions of cervix (LSIL) in 176 cases (20.1%) which were mostly asymptomatic (36.1%) and some had cervical lesions on the cervix (11.2%). The inflammatory smears were mostly seen in women complaining of vaginal discharge (47.1%) or vague pain in the lower abdomen (31.9%). The inflammation was more common in younger sexually active women between 21-40 years and was seen rising with increasing parity. Conclusion:The accumulated data points out that the clinical lesions of cervix and multiparity have some impact in the initiation of inflammatory changes in the cervical epithelium. The inflammatory smears, whenever, reported should be adequately treated and smears are repeated after 6 months to rule out any persistence of inflammation or development of any premalignancy.