Objective: The aim of this study was to evaluate the trans-axillary surgical approach in patients with thoracic outlet syndrome. Results: There were a total of 139 patients. The female: male ratio was about 6:1. Pain was the most common presenting symptom followed by weakness and parasthesia. Nerve conduction velocity was abnormal in 111 patients. Twenty-eight patients had abnormal Doppler study of subclavian vessels. Preoperative symptoms persisted in 13 patients. Overall, 126 patients showed improvement in symptoms and no recurrence or persistence of symptoms on follow-up examination. Conclusion: Trans-axillary approach provides a good exposure and cosmesis in patients with thoracic outlet syndrome. It should be considered as the gold standard in the management of thoracic outlet syndrome.

Background: Acute appendicitis is one of the most common cause of acute abdomen surgery. Several scoring systems have been adopted by physicians to aid in the diagnosis and decrease the negative appendicectomy rate. Tzanakis scoring system is one such score. Objective of present study was the validation of this scoring system in our population and compare its accuracy with histopathological examination (HPE).Methods: A retrospective study was carried out at the Department of Surgery at Mohammad Afzal Beigh Memorial Hospital Anantnag India. Tzanakis score was calculated in 288 patients who underwent appendicectomy from September 2016-2018 and HPE results were analysed.Results: 276 patients were eligible for the study. The sensitivity and specificity of Tzanakis score in diagnosing appendicitis was 90.66% and 73.68% respectively. The overall diagnostic accuracy was 86.23% with positive predictive value of 97.89% and negative predictive value of 36.84%.Conclusions: Tzanakis scoring system is an accurate modality in establishing the diagnosis of acute appendicitis and preventing a negative laparotomy.

Introduction: Management of infected wounds is not always simple and easy. Vacuum-assisted closure (VAC) is a wound healing therapy that utilizes a dressing system that continuously or intermittently applies a negative pressure to the wound surface. Our aim was to assess the Feasibility and advantages of simplified version of otherwise costly VAC, or simple suction drainage in selected cases. Material and methods: This prospective study was conducted in the unit 2 nd of department of surgery at SMHS hospital, an associated hospital GMC Srinagar, over a period of 3 years from January 2014 to December 2016. During this period, 32 patients were subjected to vacuum suction treatment and were included in this study. Results: Wall suction (VAC) was used in 26 patients. Mini Vac drain (USG guided) was used in 5 cases. In one patient of scalp infection conventional large size suction drain was used. The time taken for the wounds to become healthy was 3 to 7(average 3.5) days of VAC dressing or suction drainage. No antibiotics were given during suction drainage in 21 patients. Need for grafting by split skin grafting method was felt in only 2 patients. Mild discomfort (abnormal sensation) was reported in 21 patients. Hospital stay for patients managed by suction therapy ranged from12 hours (breast abcess) to 16 days with an average of 7 days. The total cost incurred in the patients undergoing VAC for a period of 15 days per patient was Rs. 800 ($ 12). Conclusion: VAC seems to have revolutionary potential in the management of the difficult to treat infected wounds as far as its safety, speed and cost-effectiveness are considered.

Background: Although malrotation of gut presenting in adolescents and adults is rare, but exists. Also its presentation is nonspecific. Hence its diagnosis needs high index of suspicion. Methods: This prospective study was done in the department of surgery at SMHS hospital (GMC Srinagar) over a period of 5.5 years from July 2012 to December 2017. The patients included all the adolescent and adult patients who proved to be the cases of malrotation of gut on intraoperative visualisation. Results: During the study period, 14 patients with malrotation of gut (belonging to adolescent and adult age group) were recorded. Age of the patients ranged from 16 to 54 years with an average of 26.21±11.15years. Majority of the patients belonged to adolescent age group. Preoperatively CT (computed tomography) scan was done only in 4 patients, thereby making the diagnosis of malrotation preoperatively in these 4 patients. In all other patients, the diagnosis was made only after laparotomy (for acute abdomen) and intraoperative visualisation. Ladd´s procedure was done successfully in majority of patients with two patients requiring resection of gangrenous small bowl and stoma formation. Conclusions: Malrotation of gut presenting in adolescents and adults is a rare phenomenon and also the symptoms are similar to several other abdominal pathologies, hence it represents a diagnostic challenge. Hence a high index of suspicion is needed to diagnose this rare entity early without undue delay. Threshold for CT scan should be kept a little low in suspicious cases so as to diagnose and intervene in time.

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