HighlightsEndometriosis of the appendix is an uncommon finding which can present similar to acute appendicitis.A key feature of the history will be ongoing menstruation in a reproductive aged female.We recommend removal of the appendix should be based on history and symptoms rather than appearance during laparoscopy.

Background: Surgical site infections (SSI’s)are the major risk factors of postoperative morbidity and mortality. The incidence of these SSI’scan be minimized by taking prophylactic measures such as using effective preoperative antiseptics such as chlorhexidine (CHG) or povidone-iodine (PVI). The aim of the present study was to compare the efficacy of 2.5% chlorhexidine-alcohol with that of 10% povidone iodine for preventing SSI’sin clean contaminated elective surgeries.Methods: This prospective study included 100 patients who were undergoing for clean contaminated elective surgeries at Government Medical College, Kottayam from April 2014 to September 2015. Group A included 50 patients in which 2.5% chlorhexidine alcohol (chlorhexidine 2.5% in 70% ethanol) was used for preoperative skin cleansing and Group B included 50 patients in which 10%povidone-iodine aqueous was used. Incidence of SSI’s in terms of efficacy was compared between the groups.Results: Female preponderance was seen in both the groups, but the difference was not significant statistically. The SSI’swere seen in 5 patients in group A and in 12 patients in group B and this difference was found statistically significant (p=0.0084).Out of 5, in group A, 3 sites were culture positive showing the presence of S. aureus culture in 1 case and E. coli in 2 cases and in group B, out of 12, 6 sites were culture positive consisting of S. aureus and E. coli in 3 cases each.Conclusions: Chlorhexidine (2.5%) significantly reduced the risk of postoperative SSIs and colonization of bacteria in elective surgeries when compared to 10% povidone iodine.

BACKGROUNDVenous ulcers cause great disability and reduced quality of life if not managed appropriately. Venous leg ulcers significantly affect patients' physiologic and psychosocial well-being. Reducing the ambulatory limb venous pressure is the cornerstone for the management of venous leg ulcers. For venous ulcers, compression therapy has been called the gold standard of wound healing. Objective of this study was to compare the effectiveness of four-layer compression bandage with conventional single layer bandage in the treatment for venous ulcer in terms of healing status, reduction in size of ulcer area at follow up points and time taken for healing.

BACKGROUND Appendicitis, one of the most common causes of acute surgical abdomen, presents with a myriad of symptoms and signs resulting in a potential for delay in diagnosis or misdiagnosis. As a result, timely diagnosis is of paramount importance to avoid potential complications. However, appendicectomy based on mere clinical suspicion results in an increased incidence of negative appendicectomies. In this context, modified Alvarado score and ultrasound examination can aid in confirming suspected acute appendicitis. We conducted this study to find out the diagnostic accuracy of ultrasound examination and modified Alvarado scoring system. MATERIALS AND METHODS This prospective study of 150 patients was conducted in department of General Surgery, Govt. Medical College, Kottayam. Study involves application of modified Alvarado scoring system and performing ultrasound scan inside Kottayam Medical College Hospital in all cases. Modified Alvarado Score (MAS) is obtained by proper history taking, clinical examination and laboratory values. Following emergency appendicectomy of all cases the specimen was sent for histopathological diagnosis. RESULTS This study included 150 consecutive patients diagnosed with acute appendicitis undergoing emergency appendicectomy. There were 96 (64%) male patients and 54 (36%) female patients. As per the modified Alvarado scoring, 125 (83.3%) of the patients were diagnosed to have acute appendicitis. However, only 104 (69.3%) of the patients were diagnosed as acute appendicitis by sonological findings. This study showed rebound tenderness as the most common MAS factor, it was present in 147 cases (98%). It was followed by 'Migratory pain' which was present in 129 cases (86%). The area under the curve for the ROC for total modified Alvarado scoring was 0.77 (CI 0.62-0.92) figure-3. The sensitivity of USG was 73.4% whereas that of Modified Alvarado score was 86.3%. Specificity of USG was 81.8% and that of Modified Alvarado score was 54.5%. Positive predictive value was 98.1% and 96% respectively. The negative predictive value was 19.6% and 24% for USG and Alvarado scores. CONCLUSION From the present study, it can be concluded that modified Alvarado score is a better diagnostic tool than ultrasonography alone. However, neither modified Alvarado score nor ultrasonography is an absolute tool in reducing negative laparotomy. Both when used together have reduced negative appendicectomy rate by a large number.