Background: Incisional hernia is a frequent complication of abdominal surgery. The reported incidence of incisional hernia following abdominal surgery ranges from 2-20%. It may be caused by flawed operative techniques, by postoperative complications such as wound infection, by increased abdominal wall tension or by a metabolic connective tissue disorder.Methods: The present study was conducted on patients of incisional hernias admitted in various surgical wards of the department of surgery, associated group of hospitals attached to Dr. Sampurnanand Medical College, Jodhpur over a period of 10 years extending from 2005 to 2015. Detailed history and clinical examination of all patients were obtained from the case sheets. Other risk factors like obesity, hypertension, diabetes mellitus and malignant disease were recorded. Routine investigations were also documented. Patients were closely monitored in pre, intra and post-operative periods. The data collected were systemically recorded and statistically analysed.Results: Maximum incidence (67.21%) of incisional hernia seen in 31-60years of age and mean age was 48.54years with twice common in female sex. Abdominal swelling was the commonest (90.57%) presenting symptom. 80% of patients present within 1 year. Of previous surgery, 50% of them were gynaecological. Midline vertical incision (70%) was most notorious to develop in incisional hernia. Wound infection (50%) was major risk factor. Mesh repair (laproscopic 3.68% & open 92%) was the procedure of choice.Conclusions: Incisional hernia is twice common in women than in men with gynaecological procedures mainly caesarean section contributing for half of the cases of incisional hernias. It more frequently develops in vertical midline incision and post-operative wound infection is the most important predisposing factor. Incisional hernia usually appears within 1 year of previous operation. Mesh repair of incisional hernia has of late become popular amongst surgeons.

BackgroundAicardi-Goutières syndrome (AGS) is a genetic inflammatory disorder that presents with early infantile encephalopathy. We report the clinical and molecular details of multiple members of a family with AGS secondary to a novel RNASEH2C mutation, highlighting the evolution of phenotypic abnormalities in AGS.MethodsBetween February 2018 and June 2019, a pedigree tree was constructed for 141 members of a family. The clinical and radiological details of 14 symptomatic children were chronicled and compared with the asymptomatic family members. Genetic analysis was performed on 23 individuals (six symptomatic). This involved whole exome sequencing for one patient and confirmation of the identified indel variant in other family members.ResultsThe symptomatic children were diagnosed as AGS secondary to a novel indel variation in exon 2 of the RNASEH2C gene (chr11:65487843_65487846delinsGCCA). Clinically, between the ages of 2 and 6 months, the symptomatic children developed irritability (14/14), unexplained fever (9/14), chill blains (12/14), sleep irregularities (14/14) and developmental delay (14/14), with deterioration to vegetative state at a median (IQR) age of 10.5 months (9.25–11). In addition, chill blains were observed in 5/17 (29.4%) carrier individuals. Neuroimaging demonstrated a gradual progression of calcification involving basal ganglia, periventricular white matter and dentate nucleus. Three patients also demonstrated presence of subependymal germinolytic cysts.ConclusionThis report highlights a novel founder RNASEH2C mutation and the phenotypic evolution of AGS. In addition, we report chill blains in one-third of RNASEH2C mutation carriers. Neuroradiologically, the report illustrates novel MRI findings and demonstrates a progression pattern of disease. These findings will aid in earlier suspicion and diagnosis of AGS.

Background: Abdominal pain is one of the most common reasons for visit to the emergency room. Acute appendicitis is the commonest cause. An accurate diagnosis is essential for the correct treatment, which in many cases will prevent the death of the patient. Mainstay of diagnosis is history and physical examination. If this information is inadequate to establish a diagnosis and urgent or immediate operation is unnecessary, the periodic re-examination helps document the progression of the disease and often avoids unnecessary surgical intervention. Today the combination of improved diagnostic procedures, antibiotic and better anaesthesia and preoperative and postoperative patient care has led to a decrease in morbidity and mortality of patients with acute abdomen. The objective of this study was to determine the various causes of non-traumatic acute abdominal emergencies, their incidence, management and mortality in both sexes and all age groups >12 years age.Methods: The Study was conducted on 1353 patients of non-traumatic abdominal emergencies admitted in the department of surgery, associated group of hospitals attached to Dr. Sampurnanand Medical College, Jodhpur over a period of 1 year extending from 1st January 2015 to 31st December 2015.Results: Most common cause of acute non-traumatic emergency in our study is acute appendicitis 61.71% of the patients. Out of 1353 cases of non-traumatic acute abdominal emergencies, 217 (16%) were managed conservatively while 1136 (84%) were operated. 96.64% cases of acute appendicitis were operated and only 3.36% underwent conservative management. The rate of operative intervention in acute intestinal obstruction and acute cholecystitis was 89.09% and 85.71% respectively. 81.89% cases of hollow viscus perforation were operated while 18.11% were treated conservatively. Only 18.18% cases of liver abscess underwent operation while all patients of Meckel's Diverculititis were managed operatively. All patients of acute pancreatitis were managed conservatively. Overall mortality in our study of acute non-traumatic abdominal emergencies was 3.39%.Conclusions: It can be concluded that acute non-abdominal emergencies admitted in the hospital constitute a major chunk of surgical patients, majority requiring operative management with limited mortality.

Background: Gall stones have afflicted man kinds since antiquity. Gall stone disease is prevalent, major source of morbidity and costly health problem. Presence of stones in the gallbladder is referred to as cholelithiasis, from the Greek chol-(bile)+lith (stone)+iasis-(process). If gallstones migrate into the ducts of the biliary tract, the condition is referred to as choledocholithiasis.  Methods: It is case control study. Inclusion criteria were, patients aged above 18 years suffering from cholelithiasis confirmed by USG. The exclusion criteria were, patients having hematological disorder, having any systemic disease leading to iron deficiency, on drugs causing gallstones and pregnant females.Results: Study shows females were affected more in case (64%) and control (76%) group with mean age was of case (42.84 years) and control (40.64 years) group. 24% of patients was anaemic in cases. The mean serum cholesterol between cases and control was statistical insignificant (p=0.252). The mean serum ferritin between cases and control was statistical insignificant (p=0.800).Conclusions: The study of 100 cases, based on serum iron, serum cholesterol, serum ferritin and hemoglobin, concludes that the disease is more prevalent in female gender. Serum ferritin association is insignificant as it increases other condition with inflammation also. Low serum iron level associated with high risk of cholelithiasis as this may lead to super saturation of bile.