Mastalgia is a distressing symptom and may be severe enough to interfere with usual daily activities. Breast pain is either cyclical or noncyclical. Currently; multiple options are available for the treatment of mastalgia including hormonal and nonhormonal agents. This study was conducted to evaluate the role of centchroman as a nonhormonal first-line treatment for moderate to severe mastalgia. To accomplish this; a prospective open-label, single-arm study was done using the Pretest-Posttest Design. A total of 100 women suffering from mastalgia were grouped according to the characteristic pattern of breast pain (cyclic and noncyclic) and received centchroman 30 mg/day for 12 weeks followed by observation for 12 weeks. The efficacy analysis of centchroman was done by comparing median Visual Analog Scale score, median pain duration and side effects over time among the two groups. Centchroman significantly alleviates mastalgia with minimal side effects. The median pain score was significantly reduced over successive visits (1, 4, 12, and 24 weeks). The median pain duration decreased remarkably over time in comparison to the baseline (p = 0.001). Overall the response rate was 88% at the end of 12 weeks and 85% at the end of 24 weeks. The drug was found more effective with a quicker response in cyclic pattern of matalgia. Complete response was observed in 66% of cyclic mastalgia and 40% of noncyclic mastalgia patients at 1 week of therapy. The response was improved over time in both groups and at completion of treatment (12 weeks) 92% patients in cyclic group and 80% patients in noncyclic group were pain free. The effect of the drug persisted till the completion (24 weeks) of the study (p = 0.001). These results imply that centchroman is very effective in treating breast pain and can be prescribed as drug of first choice for mastalgia.

Tuberculosis of stomach and duodenum is very uncommon even in patients with pulmonary and intestinal tuberculosis. Its preoperative diagnosis still remains a challenging problem for surgeons. Herein, we report the case of isolated duodenal tuberculosis in a 42 year old male presenting with gastric outlet obstruction symptoms. Oesophago-gastro-duodenoscopy (UGIE) revealed fold thickening at D3 segment but endoscopic biopsy was inconclusive, CECT abdomen showed ill-defined soft tissue thickening involving the 3rd part of duodenum with mesenteric fat stranding. Exploratory laparotomy was done which showed growth at 3rd part of the duodenum and peritoneal seedlings, tissue biopsy was taken and gastro-jejunostomy with jejuno-jejunostomy was done. Histopathological examination was consistent with the features of gastrointestinal tuberculosis. Patient was started on anti-tubercular therapy and was cured of the disease.

A 16-year-old boy presented with intestinal obstruction with left lumbar mass. On evaluation with ultrasonography and contrast-enhanced CT of abdomen he was found to have left colo-colic intussusception. On exploratory laparotomy he was found to have invagination of necrosed distal transverse colon and splenic flexure with omentum into descending colon with enlarged mesenteric lymph nodes for which left hemicolectomy was performed. Histopathology and immunohistochemistry was suggestive of submucosal infiltration by immature myeloid precursors with few metamyelocytes and occasional eosinophils and the cells showed cytoplasmic granular positivity with myeloperoxidase stain suggestive of granulocytic sarcoma (chloroma-extra-medullary manifestation of acute myeloid leukaemia). Our patient received three cycles of cytarabine+daunorubicin chemotherapy in the postoperative period and is doing well at 12 months of follow-up. Granulocytic sarcoma (chloroma) presenting as colo-colic intussusception is very rare and has not been reported in literature so far.

Background: To compare the effectiveness of the two different methods of inguinal hernia repairs viz. The Lichtenstein hernioplasty and Rutkow-Robbins method of hernioplasty. To compare the results of these two techniques and complications if any, and to arrive at a conclusion as to the better modality of treatment in the present setup. Methods: Total 50 patients of uncomplicated direct and indirect inguinal hernia were included in the study, they were randomly chosen for two different surgeries-The Lichtenstein hernioplasty and Rutkow-Robbins method of hernioplasty, 25 cases each. The relevant data regarding age/sex incidence, mode of presentation, surgical treatment and postoperative complications were recorded on predesigned proforma and analysed. The patients were followed up after 7 days, 15 days, 1 month, 3 months and 6 months thereafter. Results: The mean operative time for Lichtenstein hernioplasty group was 57 minutes, and 47 minutes for the Rutkow-Robbins hernioplasty group. Rest of the observational findings were comparable without any significant difference. Conclusion: The Rutkow-Robbins method of hernioplasty can be completed easily and more quickly with significant reduction in the operative time than Lichtenstein hernioplasty. Incidences of Intra operative and post operative complications as well as overall results of procedures were all comparable without any significant difference.

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