Background: Laparoscopic cholecystectomy (LC) can be the easiest or the most difficult laparoscopic operation. Conversion to open surgery has been a traditional marker of difficult LC. Recent studies have shown that C-reactive protein (CRP) may be helpful to surgeon in knowing the pathological condition of gall bladder before removal. Aim of this study was to evaluate the role of CRP as a predictor of difficult LC or its conversion.Methods: This study was done from 1 march 2016 to may 2017 in department of general surgery, SMS hospital Jaipur, under single unit. All patients with cholelithiasis admitted in single unit of SMS hospital undergoing LC were included in this study. Exclusion criteria were high BMI (>35), proven congenital anomaly of gall bladder, previous abdominal surgery, any conditions increasing CRP and immunocompromised patients.  CRP was done for each patient.Results: Mean age of our 148 patients was 50.41 years. Female to male ratio was 4.28:1. Mean CRP was 22.2±18.2 mg/dl for simple cholecystectomy, 46.5±32.0 mg/dl for difficult cholecystectomy and 83.6±22.4 mg/dl for laparoscopic converted to open cholecystectomy, which was statistically significant (p value 0.0002).Conclusions: CRP is a potent predictor of difficult laparoscopic cholecystectomy and its conversion preoperatively. Patients with preoperatively high CRP have higher chance of complication intraoperative and high chances of conversion to open.

Background: 1% 2-Chloroprocaine could have been an ideal local anaesthetic for ambulatory procedures but it has been neglected in past years and even after re introduction with its preservative and antioxidant free form. Aim: To compare the anaesthetic effect of intrathecal 2-Chloroprocaine with or without fentanyl in patients undergoing short duration lower abdominal and lower limb surgeries regarding hemodynamic parameters, mean duration of block, time to ambulation and side effects.

Background: Tetanus is an acute neurological fatal disorder caused by anaerobic spore forming bacillus Clostridium tetani, which produced an exotoxin (Tetanospasmin) in a wound. Purpose of this study was to find out the clinico-epidemiological factors of tetanus and how we can modify or minimize the outcome of this disease.Methods: This prospective, observational study was conducted in isolation ward in department of general surgery, SMS hospital Jaipur (Rajasthan) from 1 March 2016 to October 2017. Two hundred patients with clinical diagnosis of tetanus, who were admitted in single unit of SMS hospital, recruited in this study. Patients with age less than 1 yr were excluded. After admission, patient’s detailed history and thorough clinical examination done. The day to day progress of the cases was followed till the time of their discharge from the hospital. Outcome variables were age, gender, geographical area, causes of tetanus and site of injury, precipitating factors, role of baclofen, morbidity, cured and mortality.Results: In this study, mean age of patients were 17 years and male to female ratio was 2.44:1. Most of patients were from rural backgrounds with rural to urban ratio of 6.14:1. Overall mortality in present study was 16.5%. The severity of disease directly related with mortality. The mortality for mild, moderate and severe tetanus was 0%, 1.9% and 68.1% respectively.Conclusions: Though tetanus is a vaccine preventable illness, its prevalence is high in our country. The incidence of tetanus can be reduced by: strengthening of primary immunization programme; proper wound management and giving prophylactic tetanus immune globulins along with tetanus vaccine.

Aim:Theaimof studywas toassess theroleofhyperbilirubinemiaasapredictorofgangrenousorperforated appendicitis. Introduction: Appendicitis is characterised by means of infection and inflammation of the appendix. It was hypothesized that an association exists between the presence of appendiceal perforation and hyperbilirubinemia.The present study has been designed to evaluate the association between hyperbilirubinemia in cases of acute appendicitis and its complications. Methods: This study was conducted at SMS hospital Jaipur as a prospective observational study. One hundred twenty patients of appendicitis were enrolled from 1 March 2017 to 30 November 2018 according sample size. Patients underwent appendectomy after confirmation of diagnosis by USG and other investigations and biopsy was sent for histopathological examination. Results: Total 120 patients were analysed In our study as per inclusion criteria. Hyperbilirubinemia (>1.2 mg/dL) was found in gangrenous appendicitis and perforated appendicitis (91.67% and 100% respectively) as compared to in acute appendicitis (15.63%) cases (P<0.001). most of the acute (84.37%) and some gangrenous appendicitis (8.33%) patients had normal TSB but all perforated appendicitis patients had hyperbilirubinemia (>1.2 mg/dL). Liver enzymes were normal in most of cases or slightly elevated in some cases.Alvarado Score and CRP were also significantly elevated in complicated appendicitis than acute appendicitis. Conclusion: Our study concluded that isolated hyperbilirubinemia is a predictor of perforated or gangrenous appendicitis.High Alvarado Score and CRP level are also indicating complicated appendicitis.