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Background:Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, but not adequately studied in India.Objectives:To study clinical tests, nerve conduction studies (NCS), ultrasonography (USG), and magnetic resonance imaging (MRI) in diagnosing CTS.Materials and Methods:We diagnosed CTS in 54 patients (93 hands) out of 60 screened patients with symptoms compatible with CTS, including 19 control patients (23 hands). We conducted provocative tests and calculated Boston Carpal tunnel Questionnaire (BCTQ) symptom (S) and function (F) scores. NCS positive patients were classified into mild, mild-to-moderate, moderate, severe, and all-CTS groups. Median nerve anteroposterior, transverse, circumference (CIR), and cross-sectional area (CSA) at inlet (I), middle (M), and outlet (O) each was measured by USG in all patients. MRI was done in 26 patients (39 hands).Results:Phalen, hand elevation and pressure provocation tests had higher sensitivity, Tinel's test had higher specificity and tethered median nerve and tourniquet tests had low sensitivity and moderate specificity. USG had low sensitivity but high specificity, and MRI had moderate sensitivity. USG in patients compared to controls was significantly abnormal in CSA-I, CIR-I, and CSA-O. Significant correlation was found between BCTQ-S and NCS and BCTQ-S and CIR-O. CIR-M, CIR-O, CSA-M, and CSA-I had correlation with NCS. MRI was significant in moderate and in moderate + severe groups combined and associated pathologies were detected in 59% patients.Conclusion:NCS remain gold standard but USG and MRI help increase sensitivity and detect mass lesions amenable to surgery.

Central venous catheter placement has been routinely employed for anesthetic and intensive care management. Despite proper technique used and expertise complications do occur; some of which are related to catheter misplacements. We report a case in which subclavian artery was accidently catheterized during attempted internal jugular venous cannulation.

BACKGROUND Cholecystectomy is the universally accepted method to manage symptomatic uncomplicated cholelithiasis and other benign gallbladder diseases, because it can cure the disease and has low morbidity and mortality. The most frequent complication in patients undergoing cholecystectomy is surgical site infection. Cholecystectomy is considered clean-contaminated if the biliary tract is entered without significant spillage during the procedure. Some randomised clinical trials have confirmed that antibiotic prophylaxis in open cholecystectomy is decreasing the risk of surgical site infection. MATERIALS AND METHODS Randomised studies have failed to demonstrate the effectiveness of routinely administered perioperative antibiotics on SSI in these low and moderate risk groups and there is growing consensus against it. Many authors believe that antibiotic prophylaxis may not be necessary for low-risk patients undergoing elective cholecystectomies. RESULTS The present study was aimed to observe if antibiotic prophylaxis is necessary to prevent SSIs in the patients undergoing elective below-risk cholecystectomies. CONCLUSION Our study found no significant difference in the rates of SSI in low-risk laparoscopic cholecystectomies with or without the use of perioperative antibiotics.

A trapped penile ring is a urological emergency rarely seen. An impacted ring in penis is a real emergency uncommonly faced by a urologist. Emergent removal of the penile ring is indicated to prevent gangrene and damage to the penis. The insertion of these rings for autoerotic purposes is not uncommon. However, this can lead to impacted, stuck articles, rings in the penis. These patients present with symptoms ranging from mild penile pain, swelling to gangrenous changes in the penis. The removal of ring constricting penis is a penile-saving procedure. We describe a patient with a stuck ring in the penis and the technique of removal of the impacted penile ring by a household device plier. In case of emergency, the pliers are a useful tool for removing a strangulating penile ring