Background and Purpose: Percutaneous Nephrolithotomy (PCNL) is not a popular procedure in smaller sized calculi due to its invasive nature, complications and need for anesthesia. Small sized lower caliceal calculi are generally treated by ESWL but have significantly less clearance rate in spite of several sittings. Here we want to study the efficacy and safe of both procedures in 11 to 15 mm lower caliceal calculi.

The uncommon cystic exocrine pancreatic tumor known as solid pseudopapillary epithelial neoplasm (SPEN) most frequently affects young females. We provide a case study of a 17-year-old female who experienced intermittent vomiting and epigastric pain. Her laboratory results were within normal ranges, and a clinical abdominal exam revealed pain in the region of epigastrium. A 40×3×31 mm iso-hyperdense minimally enhancing solid mass with well-defined borders was detected on her CECT scan. Nothing calcified. neither localized lymphadenopathy nor fat stranding. It was just next to the splenic vein, which was completely opaque. Her histopathology revealed a solid pseudopapillary pancreatic tumor after she underwent a spleen preserving distal pancreatectomy. Beta-catenin and vimentin IHC assays were significantly positive, confirming the diagnosis and she was on a regular follow-up. As of now, the patient is asymptomatic and has not experienced a recurrence. In contrast to other forms of pancreas tumors, SPEN is treatable with early identification and full surgical resection.

INTRODUCTIONVoice changes due to laryngeal dysfunction after thyroid surgery is a very common complication. However, very few data in the literatures are available which highlights the impact of thyroidectomy and effects of factors, such as patient age, sex, operation type, surgeons experience, laryngeal nerve injury and orotracheal intubation on voice of patients undergoing thyroid surgery. ABSTRACTBackground: An study the voice changes and to evaluate the impact of thyroidectomy and effects of factors such as patient age, sex, operation-type, surgeons-experience, laryngeal nerve injury and orotracheal intubation on voice of patients undergoing thyroidectomy. Methods: Author prospectively analyzed 364 cases of multinodular goiter (MNG) and neoplastic thyroid disorders, undergoing sub-total/total-thyroidectomy and completion-thyroidectomy in the department of surgery, during the study period of June 2016 to December 2016. Results: The study comprised of 364 patients, with 298 females and 66 males. Voice changes were seen in 216(59.34%) patients. Transient voice changes were seen in 212(98.15%) patients and permanent in 4(1.85%) patents. Out of 216 patents, age group ≥65 years were 128(59.25%) and age group <65 years were 88(40.75%) patients(p:0.012324). Out of 216 patients in which voice changes were seen,165(76.39%) patients were females and 51(23.61%) patients were males(p:0.001046). Voice changes were seen in 190(88%) patients in which sub-total/totalthyroidectomies were performed and in 26(12%) patients completion-thyroidectomies were performed. Voice changes were statistically significant in which completion-thyroidectomies were performed(p:0.002102). Voice changes were seen in 205(68.56%) cases and 11(16.92%) cases which were performed by post-graduate-trainee and experiencedsurgeon respectively. Voice changes were seen in 122(67.77%) cases in which orotracheal intubation was performed and in 94(51.65%) cases cervical-epidural anaesthesia was given (p:0.00281). RLN palsy was seen in 2(0.60%) cases in which sub-total/total-thyroidectomy were performed and 2(6.25%) cases in which completion-thyroidectomy was performed (p:0.003426). Conclusions: Voice changes is common after thyroid surgery but usually transient and sometimes, permanent. So, patients must be informed about the risk of voice-impairment after thyroid surgery. Present study is novel as it investigates not only laryngeal neve injury but also highlights patient age, sex, types of operation, surgeons experience and laryngeal complications during orotracheal intubation.

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Background: Increasing understanding and literature regarding the management of Necrotizing Pancreatitis has laid paths for surgical and conservative management. Although a conservative approach is increasingly used, this study depicts the importance of surgical management in today’s era. The objective was to evaluate the surgical role in patients of documented Necrotizing Pancreatitis, with or without organ failure and debilitating symptoms by putting conservative management on a complementary part.Methods: Sixteen consecutive patients were reviewed with Necrotizing Pancreatitis managed at DVVPF’s Medical college and hospital, Ahmednagar between January 1, 2014, and July 1, 2017 documented by contrast-enhanced computed tomography (CECT).Results: Out of sixteen patients of Necrotizing Pancreatitis recruited for the study, 13 (81%) patients were surgically managed; among which death rate was 7%. Of the other 3(19%) patients which were conservatively managed, there was 1 (33%) death. Patient who died while conservative management would have been candidate for earlier surgical intervention.Conclusions: The results suggest that surgical approach can be applied successfully to manage most patients with Necrotizing Pancreatitis, still further evaluation being required for indication and timing of surgery.