BACKGROUND Gallstones occur when there is an imbalance in the chemical constituents of bile that result in precipitation of one or more of the components. This disease is, however, a worldwide medical problem, even though there are geographical variations in gallstone prevalence. In most cases, they do not cause symptoms and only 10% and 20% will eventually become symptomatic within 5 years and 20 years of diagnosis. Thus, the average risk of developing symptomatic disease is low and approaches 2.0-2.6% year in all populations of the world regardless of overall gallstone prevalence. Women during their fertile years are almost twice as likely as men to experience cholelithiasis. Treatment of gallstones depends partly on whether they are causing symptoms or not. This study was conducted at government KAPV Medical College Hospital in patients who had undergone cholecystectomy to delineate their age and sex distribution, symptomatology and to find out the fraction of patients with incidental malignancy in the gallbladder. The aim of the study is to-1. Study the clinical presentation of gallstone diseases-symptomatology and acuteness of presentation. 2. Study the gender and age, distribution of patients presenting with gallstone diseases and compare with given standards. 3. Study the prevalence of concomitant CBD stones in patients with gallstone diseases. 4. Study the prevalence of gallbladder carcinoma in patients with gallstone diseases. 5. Study the surgical management of patients with gallstone diseases/CBD stone and outcome. MATERIALS AND METHODS An analysis of patients presenting with gallstone diseases at Government KAPV Medical College Hospital between 2014-2016 was made with regard to the prevalence, age distribution, clinical presentation and the surgical management and outcome. RESULTS In our study, the male-to-female ratio is 1:1.61. The prevalence of symptomatic gallstone diseases in our study is highest in the 40-49 years age group. Acute cholecystitis occurred in the 13.5% of patients in the study. 5.8% of patients with gallstones disease presented with concomitant CBD stones. CONCLUSION Gallbladder stones are more prevalent in India with female preponderance. Patients with acute and chronic cholecystitis were managed by cholecystectomy and the specimen was sent for histopathological examination to look for malignant changes.

Background: Incisional hernia is a common surgical condition encountered in day to day practice. Based on national operative statistics, incisional hernias account for 15 to 20% of all abdominal wall hernias. Of all hernias encountered incisional hernias can be the most frustrating and challenging to treat. This prospective study aims to assess the efficacy of preperitoneal mesh repair technique using polypropylene mesh in the management of incisional hernia.Methods: A total of 40 patients with incisional hernia undergone open preperitoneal polypropylene mesh repair. It had evaluated for post-operative complications and recurrence for six months to one-year post-surgery. The results had tabulated statistically analysed and compared with other published reports in the literature.Results: Out of 40 patients, the size of the defect, 10 patients had less than 2 cm, 28 patients had between 2.1-4 cm, 1 patient between 4.1-6 cm and 1 patient between 6.1-8 cm. The type of hernia, 32 patients had infra umbilical hernia, and 8 patients had a supraumbilical hernia. Post-operative complication 3 patients had seroma, 1 patient had edge necrosis, 1 patient had post-op ileus, and 1 patient had chronic pain. Based on follow up, 4 patients had followed until 6 months, 10 patients till 9 months and 26 patients till one year.Conclusions: Post-operative complications following open preperitoneal polypropylene mesh repair are considerably less compared to other techniques of mesh repair and showed no recurrence among its subjects during the follow-up period, and longer follow-up is required to draw a definitive conclusion.

BACKGROUNDAn injured spleen is a well-known entity to those involved in trauma care. The majority of individual with a splenic injury now receive nonoperative intervention and therapy. This shift from operative to nonoperative treatment over the past several decades is a tremendous success story in which clinical judgment and reason triumphed over standard surgical dogma. In emergency room, restoration of airway, breathing and circulation should be focussed on. A careful history is the most important one. Nevertheless, the severity of the splenic injury plays a dominant part in determining whether nonoperative management is appropriate or-if-not-whether splenorrhaphy or splenectomy will be the more appropriate surgical option. As a general rule, younger, healthier patients with lower grade splenic injuries and fewer associated injuries and comorbidities are usually managed nonoperatively or with splenic repair, whether unstable, actively bleeding patients with more severe splenic trauma and/or multiple associated injuries require splenectomy.

BACKGROUND Acute appendicitis is one of the most common surgical emergencies with a lifetime presentation of approximately 1 in 7. Its incidence is 1.5-1.9/1000 in males and females. Surgery for acute appendicitis is based on history, clinical examination and laboratory investigations (e.g. WBC count). Imaging techniques add very little to the efficacy in the diagnosis of appendix. A negative appendicectomy rate of 20-40% has been reported in literature. A difficulty in diagnosis is experienced in very young patients and females of reproductive age. The diagnostic accuracy in assessing acute appendicitis has not improved in spite of rapid advances in management. MATERIALS AND METHODS The modified Alvarado score was applied and assessed for its accuracy in preparation diagnosis of acute appendicitis in 50 patients. The aim of our study is to understand the various presentations of acute appendicitis including the age and gender incidence and the application of the modified Alvarado scoring system in our hospital setup and assessment of the efficacy of the score. RESULTS Our study shows that most involved age group is 3 rd decade with male preponderance. On application of Alvarado score, nausea and vomiting present in 50% and anorexia in 30%, leucocytosis was found in 75% of cases. Sensitivity and specificity of our study were 65% and 40% respectively with positive predictive value of 85% and negative predictive value of 15%. CONCLUSION This study showed that clinical scoring like the Alvarado score can be a cheap and quick tool to apply in emergency departments to rule out acute appendicitis. The implementation of modified Alvarado score is simple and cost effective.

Background: About 15% of diabetic patients will develop a chronic ulcer, and about 25% of those will have to undergo foot amputation. Despite evidence of the effectiveness of autologous protein C (PC) in diabetic ulcers, efficacy and feasibility of this treatment in the general population remain unclear. Aim of the study was to compare the efficiency of management of diabetic ulcer with platelet-rich plasma (PRP) and conventional dressing.Methods: A total of 40 patients who divided into two groups: group I comprising 20 patients received homologous platelet concentrate and group II comprising 20 patients received conventional wound dressing, and the results had statistically discussed.Results: Out of total 40 patients, 20 received homologous platelet dressings, and the 20 patients received conventional moist wound dressings. 7 patients had operated for split skin grafting, 7 patients had 0-10% of the area covered with necrotic tissue, mean duration of hospital stay was 18 days, mean duration of wound debridement was 3 days and mean number of wound dressing was 6. In conventional wound dressing group, 15 patients had operated for split skin grafting, 4 patients had 0-10% of the area covered with necrotic tissue, mean duration of hospital stay was 39 days, mean duration of wound debridement was 18 days and mean number of wound dressing was 48.Conclusions: Patients operated for split skin grafting, number of wound debridement, duration of hospital stay, and duration of wound debridement, necrotic tissue coverage was less in platelet group compared to the conventional wound dressing.