Our study aims to review the literature on the management of pyogenic liver abscess, focusing on the choice of drainage. A case series of our experience with clinicopathological correlation is presented to highlight the indication and outcome of each modality of drainage. Intravenous antibiotic is the first line, and mainstay, of treatment. Drainage is necessary for large abscesses, equal to or larger than 5 cm in size, to facilitate resolution. While percutaneous drainage is appropriate as first-line surgical treatment in most cases, open surgical drainage is prudent in cases of rupture, multiloculation, associated biliary, or intra-abdominal pathology. Percutaneous drainage may help to optimize clinical condition prior to surgery. Nevertheless, in current good clinical practices, the choice of therapy needs to be individualized according to patient's clinical status and abscess factors. They are complementary in the management of liver abscesses.

Background: Even with variety of procedures, typhoid (enteric) perforation still has a high rate of morbidity and mortality. The aim of the present study is to study clinical presentations, to evaluate management pattern of typhoid ileal perforation, to determine mortality and morbidity of perforation and to study the re-exploration rate and causes of re-exploration and its effect on mortality and morbidityMethods: This prospective observational study was conducted in the Departments of Surgery at Surat Municipal Institute of Medical Education and Research, Surat during June 2008 till October 2010. A total 45 patients with typhoid ileal perforation were included in the study. Among them, 32 cases (71%) undergone the simple primary closure of the perforation and peritoneal lavage after refreshing the edge, 7 cases (16%) undergone exploratory laparotomy with proximal loop ileostomy with primary closure and 6 (13%) were operated by exploratory laparotomy with resection anastomosis.Results: Mean duration of the stay for patient undergone PC+PL was 10.20 days and for ileostomy it was 18.4 days and for RA + PL it was 18.6 days. Total 37 incidence of complications were found in 45 cases. Among them wound infection was presented in 16 (43%) and burst abdomen presented in 2 (5%) cases. Fecal fistulae, post-operative collection and pneumonitis were present in 4 (11%) cases each.Conclusion: The overall mortality was found nearly 4 percent in our study. The typhoid ileal perforation should be always treated surgically. There are many operative techniques to deal with, but no one is full proof.

Background: There are lot of work going on AFT procedures. This procedure has been taken recent advances nowadays and very helpful in many conditions to rejuvenate and restoration of damaged tissues. The use of autologous fat for soft tissue augmentation seems attractive because of its relatively ubiquitous availability. Autologous fat transfer is a technique shown to be beneficial as a reconstructive procedure for patients with volume loss of tissue due to disease, trauma, and congenital defects.Methods: In the present study, 20 patients were taken as sample size. It is an intervention study. Whole procedure has been taken as day case which included local anaesthesia and patient received all the standard monitoring, medications, safety precautions and care that is provided for any patient undergoing any surgery, including antibiotics, pain medicine and other supportive care as needed. The Autologous fat was harvested by surgeon via syringe aspiration technique with a long atraumatic cannula. After processing, the material was injected immediately under designated skin grafts/scars using a small needle. Scar was cleansed with normal saline and dry dressing is applied for a day. Then patient was discharged on the same day.Results: Results obtained were efficacious with 60 to 80% improvement in all parameters in 15-20 days after the procedure.Conclusions: AFT procedure was found feasible, efficacious and accepted in patients with scar. It brings scar tissue rejuvenation up to great extent.

Background: Symmetrical peripheral gangrene is a rare condition seen in patients of severe sepsis with hypotension. Gangrene is of dry type, limited to the digits only with all peripheral pulses palpable.  Methods: Seven patients of severe sepsis with various etiologies were admitted in surgical ICU. These patients developed symmetrical peripheral gangrene during their stay in SICU at a variable period. Detailed history and case records were studied, and data was analyzed. Review of literature was done and compared with findings of our cases.  Results: All seven patients had severe sepsis with disseminated intravascular coagulation and all seven required ventillatory support. Administration of inotropes increased the pace of ischemic process.  Conclusions: Anticipation and prompt recognition of this condition can limit the progress of gangrene. Treatment is emphasized on the primary condition with focus on limiting the gangrene by local procedures.