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Background:Liver abscess is a burning problem in tropical nations, with often lethal consequences and diagnostic/therapeutic challenges. We have determined etiopathology, clinical, radiological, and bacteriological characteristics of this condition and review its management strategies.Materials and Methods:During the period of the month from May 2007 to September 2009, a prospective study was performed involving 125 patients admitted to the in-patient ward of the Department of General Surgery of N.R.S Medical College their diagnosis was made on the basis of clinical features (such as right upper abdomen pain, and fever), laboratory investigations and radiological evidence of liver abscess.Results:Amoebic liver abscess was the most common (88%) type of liver abscess among the study groups. There was a strong correlation with the occurrence of liver abscesses and addiction to alcohol, history of diabetes mellitus and low socioeconomic status. The most common etiology of pyogenic liver abscess was Escherichia coli. Ultrasonography (USG) of the abdomen was accurate and cost-effective in diagnosis of liver abscesses. Percutaneous catheter drainage was the most effective method of treatment (with a 100% success rate).Conclusion:Most patients in our study had liver abscess of amoebic origin and had temporal relationship with diabetes, alcoholism, and staggering socioeconomic status. We suggest early recognition of clinical features and prompt abdominal USG as cost-effective means for treatment initiation and reducing complications.

Aims:We assessed the impact of detecting anti-thyroid peroxidase antibodies (anti-TPO-Ab) in the first trimester of pregnancy on pregnancy outcomes and maternal thyroid function during the postpartum period.Materials and Methods:In a prospective study consisting 400 pregnant women (8-12 weeks pregnant) were screened for their thyroid profile and followed-up to 12 weeks postpartum. Patients with abnormal thyroid function at 12 weeks postpartum were further followed-up with repeated assessment of thyroid stimulating hormone (TSH) and serum-free thyroxine-4 levels at 8 weeks interval up to 12 months postpartum.Results:11.5% of the subjects were positive for anti-TPO-Ab who had mean TSH level of 2.31 μIU/ml, which was significantly (P- 0.0001) higher than pregnant women negative for anti-TPO-Ab (1.73 μIU/ml). Increased incidence of miscarriage was observed in anti-TPO positive mothers when compared to antibody negative mothers. Postpartum thyroid dysfunction developed in 4.7% cases at 12 weeks, among them antibody positivity was observed in 81.25% of subjects. In 18.75% mothers positive for anti-TPO-Ab, the thyroid dysfunction persisted up to 12 months postpartum.Conclusions:Thyroid antibodies detected in early pregnancy seems to be predicting pregnancy complications and later maternal thyroid disease related morbidity.

BACKGROUND AND AIMS: Laryngeal mask airway (LMA), an alternative airway device, provides and maintains a seal around the laryngeal inlet for spontaneous ventilation as well as modest level of positive pressure ventilation. But LMA requires a sufficient depth of anaesthesia& depression of airway reflexes to avoid adverse reactions like gagging, coughing, head & limb movements etc. We intended to test the efficacy of Thiopentone and Midazolam combination as an effective alternative to Propofol for insertion of LMA. MATERIALS AND METHODS: One hundred twenty patients (18-34 years) posted for different minor procedure (<45 min) under general anaesthesia were divided into 2 equal groups (Group TM & P) in a randomized, double-blind fashion. In group TM (n=60) Thiopentone 5mg/kg+ Midazolam 0.05 mg/kg and group P (n=60) Propofol 2.5 mg/kg was administered prior to insertion of LMA. Then the inserting condition (jaw relaxation, gagging, coughing, hiccup, laryngospasm & head and limb movement) were evaluated into 3 point scale. The response will be graded as Mild (Transient and minimal), Moderate (Response lasted not >20 sec) and Severe (Sustained >20sec or needed Propofol to allow LMA insertion). RESULTS: Propofol is superior to combination of thiopentone-midazolam, in terms of achieving conditions like jaw relaxation, coughing & suppression of gagging during LMA insertion but regarding other variables like laryngospasm, hiccup & patient movement, which are equally important prerequisites for successful LMA insertion, there was not much statistically significant difference found between propofol and combination of thiopentone-midazolam. CONCLUSION: Combination of thiopentonemidazolam effectively blunts airway reflexes and adequately facilitates laryngeal mask airway insertion which can be comparable to propofol.

Objective The purpose of this study was to analyze the line of treatment and its outcome in cases of endometriosis presenting with infertility and pelvic pain at a tertiary center having facilities of operative endoscopy and assisted reproductive technology. Methods All cases of Infertility and pelvic pain over a period of two years were subjected to laparoscopy. Patients who were diagnosed with endometriosis were classified into categories. Different system of classification was used for patients of Infertility and pelvic pain. A large number of patients were subjected to expectant management. Selected cases underwent IUI, IVF-ET and ICSI. The numbers of pregnancies were recorded in these cases. Patients with pelvic pain were treated with hormonal therapy. Results 1038 patients were studied over a period of 2 years out of which 983 presented with Infertility and 55 with pelvic pain. 294 cases of infertility were detected and biopsy proven to be having endometriosis and 20 of the 55 cases of pelvic pain were also detected to have endometriosis. In the infertility group 76 patients were found to have bilateral tubal block. 215 patients were detected to have various grades of lesions but with patent bilateral/unilateral tubes. 6 patients with blocked tubes and 11 patients with patent tube/tubes also were associated with male factor infertility. 88 patients with blocked tubes and/or male factor received treatment with IVF-ET/ICSI. 178 patients underwent ovulation induction and 28 were simply observed. There were 42.8% pregnancies in the observation group, 49.4% in the ovulation induction-IUI group and 45.4% in IVF-ET/ICSI group. Conclusion 30% of the cases of Infertility had endometriosis. Following operative endoscopy treatment for all cases, the occurrence of pregnancy was similar in patients who were simply observed and those who received treatment with ovulation induction-IUI. Those with mechanical problems of sperm-egg union are best treated with IVF-ET where facilities exist.