ABSTRACTaIM: To study Clinical , microbiological and radiological profile of pyogenic brain abscess patients along with modes of treatment and their outcome. MaterIaL and MetHOds:This retrospective as well as prospective study included One hundred and fourteen patients of Brain Abscess who were admitted and evaluated in the Department of Neurosurgery over a period of ten years .This study had a retrospective component from resuLts: It was observed that majority of the patients in our study were males numbering 83(72.8%) where as there were only 31 females (27.2%). It was observed that among the underlying factors CSOM predominated with 57 patients ie (50%).

BACKGROUND:To evaluate the outcome of cardiopulmonary resuscitation (CPR) in out-ofhospital cardiac arrests (OHCA) in India and factors infl uencing the outcome. METHODS:The outcome and related factors like demographics, aspects of the OHCA event, return of spontaneous circulation (ROSC) and survival to discharge, among the 80 adult patients presenting to emergency department experiencing OHCA considered for resuscitation between January 2014 to April 2015, were analyzed, according to the guidelines of the Utstein consensus conference. RESULTS:The survival rate to hospital admission was 32.5%, the survival rate to hospital discharge was 8.8% and with good cerebral performance category (CPC1) neurological status was 3.8%. Majority of OHCA was seen in elderly individuals between 51 to 60 years, predominately in males. Majority of OHCA were witnessed arrests (56.5%) with 1.3% bystander CPR rate, 92.5% arrests occurred at home, 96% presented with initial non-shockable rhythm and 92.5% with presumed cardiac etiology but survival was better in those who experienced OHCA at public place, in witnessed arrests, in patients who had shockable presenting rhythm and in those where CPR duration was ≤20 minutes. CONCLUSION:Witnessed arrests, early initiation of CPR by bystanders, CPR duration ≤20 minutes, initial presenting shockable rhythm, OHCA with non-cardiac etiology are associated with a good outcome. To improve the outcome of CPR and the low survival rates after an OHCA event in India, focused strategies should be designed to set up an emergency medical system (EMS), to boost the rates of bystander CPR and education of the lay public in basic CPR.

The efficacies of two different surgical approaches, aspiration and excision, were investigated for the management of large solitary encapsulated pyogenic brain abscess located in superficial non-eloquent areas, and the impact on length of hospital stay, duration of postoperative antibiotic use, improvement in neurological status, and morbidity and mortality were compared. This retrospective study at Sher-iKashmir Institute of Medical Sciences included 47 patients with pyogenic brain abscess from a total of 114 patients evaluated in the Department of Neurosurgery over a period of 10 years from October 2001 to October 2011. Comparisons were made between aspiration and excision in terms of duration of antibiotic use, length of hospital stay, and overall treatment cost. Aspiration was performed in 29 patients (61.7%), of whom 7 patients needed second aspiration, and 18 patients underwent excision (38.3%) of the abscess capsule. The mean duration of antibiotic use in the excision group was significantly shorter at 2.7 weeks (standard deviation [SD] ± 1.1) compared to the aspiration group at 3.8 weeks (SD ± 1.3) (p ＝ 0.006). Similarly, mean length of hospital stay was significantly shorter in the excision group at 18.1 days (SD ± 7.7) compared to the aspiration group at 24.9 days (SD ± 6.6) (p ＝ 0.002). In addition, significantly earlier improvement in neurological function (p ＝ 0.025) and significantly lower rate of re-surgery (p ＝ 0.0238) were found in the excision group compared to the aspiration group. Excision is better than aspiration as far as duration of antibiotic use, length of hospital stay, and overall cost of treatment is concerned, with no significant difference in morbidity and mortality.

A young female presented with classical complaints suggestive of peptic ulcer disease leading to signs of peritonitis. The said patient after being subjected to baseline workup was subjected to laparotomy which proved to be a surgical surprise. A live ascaris lumbricoides worm was seen pouting out of a duodenal perforation.

Objective: To compare the outcomes of laparoscopic pyelolithotomy and open pyelolithotomy at a single center in terms of operative time, blood loss, intra-and post-operative complications, analgesia requirements, hospital stay, convalescence and cosmesis. Material and methods:This prospective randomized study was conducted in the Department of Surgery of the Government Medical College Srinagar between May 2008 and September 2010. Sixty patients underwent pyelolithotomy during this period, including both open pyelolithotomy (n=30) and laparoscopic retroperitoneal pyelolithotomy (n=30). All patients (age >14 yr) with large (>1.5 cm) renal pelvic stones who met the inclusion criteria were included in the study. The decision to perform open or laparoscopic pyelolithotomy was made randomly by a computer program. Results:The majority of our patients in both study groups were in the 21-40 yr age group. The mean operative time was significantly less (p<0.001) in the open group than in the laparoscopic group (74.83 min vs. 94.43 min). The mean blood loss was less in the laparoscopic group than in the open group (73 mL vs. 103 mL); however, this difference was not statistically significant. In the laparoscopic group, both the resumption of oral intake (10.33 hrs vs. 15.60 hrs) and the drain removal (2.7 days vs. 3 days) occurred earlier, although these differences were not significant. Intraoperative complications occurred more frequently in the laparoscopic group (16% versus 6.66%); however, all of the complications were minor and were managed intraoperatively in the same sitting. There was no statistically significant difference in the postoperative pain scores or analgesia requirements, and postoperative complications were only slightly more frequent in the laparoscopic group in our study. The mean hospital stay in the open group was 5.2 days, while the mean stay of the laparoscopic group was 3.8 days (p<0.03). Patients in the laparoscopic group returned to their routine activities significantly earlier (1.78 vs. 3.83 wks) than did patients in the open group (p<0.001). Conclusion:Laparoscopic retroperitoneal pyelolithotomy for upper urinary tract calculi is superior to open surgery because of the significantly reduced hospital stays and cosmetic outcomes of patients who underwent the laparoscopic surgery. Although the reductions of analgesia requirements and blood loss were not statistically significant in our study, the data still favored the laparoscopic procedure. Disadvantages of retroperitoneal laparoscopy include the decreased working space, the cost of equipment and the availability of a trained surgeon.