No abstract

Giant Scrotal Lymphoedema is a rare disease. Such Scrotal elephantiasis presents multiple problems both to the patient as well as the treating clinician obstruction, aplasia, or hypoplasia of the lymphatic vessels. The most common cause worldwide is lymphatic Filariasis. A case where the resected scrotal tissue weighed 30kg which is one of the largest so far mentioned in literatures. The lymphedema was progressive over 15 year's duration and the testes were not palpable with the penis deeply buried. There is no effective medical treatment for filariasis. There are different surgical methods for scrotal filariasis in the literature. In this case, the patient was treated by Modified Charles procedure. Once fibrosis sets in resectional therapy will be needed in most cases. Successful reduction scrotoplasty with acceptable cosmetic results can be obtained in giant scrotal lymphedemas weighing as large as 30kg as in this case.

Background: Interstitial lung disease accounts for more than 200 etiology. There has been worldwide increase in diagnosis of interstitial lung disease because of the help of recent advance diagnostic tools.

Background: Abdominal trauma is one of the most common injuries among injuries caused mainly due to road traffic accidents. The rapid increase in motor vehicles and its aftermath has caused rapid increase in the number of victims to blunt abdominal trauma (BAT). Motor vehicle accidents account for 75%-80% of BAT. The knowledge in the management of BAT is progressively increasing due to the inpatient data gathered from different parts of the world. In spite of the best techniques and advances in diagnostic and supportive care, the morbidity and mortality remains at large. The reason of this could be due to the interval between trauma and hospitalization, delay in diagnosis, inadequate or lack of appropriate surgical treatment, postoperative complications, and associated trauma especially to spine, head, thorax, and extremities. Objective: To study the blunt and penetrating abdominal trauma, its various patterns of injuries, and its management. Materials and Methods: After initial resuscitation of the trauma victims, a careful history was taken to document any associated medical problem. Documentation of patients, which included identification, history, clinical findings, diagnostic test, operative findings, operative procedures, and complications during the stay in the hospital and during subsequent follow-up period, was recorded on a Performa specially prepared. The decision for operative or nonoperative management depended on the outcome of the clinical examination and results of diagnostic tests. Patients selected for nonoperative or conservative management were placed on strict bed rest and subjected to serial clinical examinations that included hourly pulse rate, blood pressure, respiratory rate, and repeated examination of abdomen and other systems. Result: The most common age group involved in BAT was between 13 and 20 years, whereas in penetrating abdominal trauma was between 21 and 30 years. This study showed that of 100 cases of abdominal trauma, 19 were presented with shock (blood pressure <100 mm Hg) while 30 had blood pressure between 100 and 110 mm Hg. Following BAT of 75 patients, 48 managed conservatively while 27 undergone operative management. Following penetrating abdominal trauma of 25 patients, only one managed conservative whereas all other required exploration. Conclusion: The best way of reducing the morbidity and mortality from BAT is prevention. There is an acute need of trauma center that is well equipped with all modern facilities in tertiary care center.

Background: Circumcision is a frequently performed surgery in pediatric patient. Objective: Our aim is to compare postoperative analgesia of caudal block versus dorsal penile nerve block (DPNB) and to compare sedation score and complication associated with caudal block and DPNB in children undergoing circumcision. Materials and Methods: This prospective randomized study was performed for more than 50 patients of ASA grade I, aged 3-12 years, scheduled for elective circumcision. Patients were divided into two groups: DPNB for group I and caudal block for group II, using 0.25% 1 mL/kg (2 mg/kg) bupivacaine. Postoperative analgesia was evaluated for 6 hours with the FLACC Pain Scale for five categories: (F) face, (L) legs, (A) activity, (C) cry, and (C) consolability. Sedation was evaluated with Ramsey sedation score. For every child, supplementary analgesic amount and times and probable local or systemic complications were recorded. Results: No significant difference between both the groups was found in mean age, body weight, and surgery duration and sedation scores. Initially, for 2 hours, FLACC pain score was also insignificant; however, on subsequent measurements, a significant difference of FLACC pain score was noted in both the groups. No major complication was found when using either technique. Conclusion: Duration of postoperative analgesia is more in caudal group than that of DPNB. Supplementary analgesic need is also minimized.