Large incisional hernias are difficult to treat surgically because of the post-operative respiratory complications and abdominal compartment syndrome. Pre-operative progressive pneumoperitoneum is a technique which has been used in such cases. We describe a case of a large incisional hernia, where this technique was employed by objectively calculating abdominal and hernial sac volumes on the basis of computerized tomography scan of abdomen with a satisfactory outcome. A review of literature and issues involved in pre-operative progressive pneumoperitoneum have been discussed.

Background: Carcinoma breast is the commonest malignancy in females worldwide. Although a disease of postmenopausal age, occurrence in young age is a poor prognostic factor. Hence this study was undertaken to study clinical presentation, extent of disease, treatment modalities, histopathological typing and grading of carcinoma breast in females upto 40 years and to compare tumor characteristics between very young (≤30 years) and young (30- 40 years) patients.Methods: This was a hospital based observational study conducted at Department of Surgery, GMC Nagpur, from July 2009 to November 2011. All cytologically or histologically proven cases of carcinoma breast in females ≤40 years of age giving consent were included. All the patients were evaluated by detailed clinical evaluation and investigated, treated with different modalities according to clinical stage and were followed up for a period of two months. Data was collected and tabulated into a master sheet and statistical tests were applied to test the significance of association.Results: Mean age was 35.24 years (19-40 years), 12 patients being under 30 years (very young). Mean duration of presentation 3.08 months. Mean lump size was 5.32 cm, 56% had lump >5 cm. Only 1/3rd of patients had EOBC, 2/3rd had LOBC/LABC. FNAC was 87% sensitive, ER positivity was low. All patients received multimodality treatment, 84% underwent mastectomy and none underwent BCT. We report two deaths. Very young group showed more incidence of node positivity, advanced stage of the disease and positive margin of resected specimen than young age group but had no significant difference with respect to tumor size and histopathological characteristics. Nulliparity, breast feeding and protective effect of early age at 1st pregnancy when were independently tested in operable and advanced staged cancer groups no statistically significant association was found.Conclusions: Carcinoma of breast in young females, although less common, is an aggressive disease. In India more patients present in advanced stage precluding BCT. Early diagnosis can improve outcome.

Background: Postlaparotomy Abdominal wound dehiscence (AWD) occurs in 0.25% to3%. Many technique are being used to manage AWD like surgical revision with open dressing/closed irrigation, temporary covering with ‘Bagota bag’, saline soak gause dressing, absorbable/permanent mesh. Negative-pressure wound therapy (NPWT) is a recent modality of treatment of wound. It involves controlled application of sub atmospheric pressure to local wound environment, using sealed wound dressing connected to vacuum pump. This study aimed at finding the effectiveness of negative pressure wound therapy in management of abdominal wound dehiscence over conventional methods of wound management.Methods: This was hospital based non randomised comparative prospective interventional study carried between July 2017 to November 2019, includes all patients admitted in GMCH, Nagpur Hospital having post laparotomy AWD, excluding the patients having enter ocutaneous fistula and patient not giving consent for VAC application. Total n=60 cases were included in study. Out of 60, 30 were taken as cases in whom intervention was done by applying vaccum assisted closure (VAC) therapy and 30 were control.Results: All 60 patients had undergone laparotomy of this patients 30 patients was applied NPWT and efficacy plotted on the parameter of, wound sepsis, wound contraction, length of hospital stay and extension of time therapy. It was found that 90% patients had negative c/s post VAC dressing, compared to 26% in post ns dressing, there was MWC of 0.86 cm in post VAC patients compared to 0.14 cm in post NS dressing, MHS was 18.9 days in cases and was 28 days in controls,13 patients had complete fascial closure in cases whereas none in controls.Conclusions: NPWT significantly reduces the hospital stay of patients, it causes faster and higher degree of wound contraction, reduces wound sepsis thereby reducing morbidity of patients.

Schwannoma is a tumor of soft tissue, originating from Schwann cells which rarely appears in the retroperitoneal region. Retroperitoneal ancient schwannomas are rare tumors, more usually found in the head, neck and flexor surfaces of the extremities. Ancient schwannomas are a subtype of classic schwannoma with a predominance of degenerative changes like calcifications, hemosiderin deposition, interstitial fibrosis, vascular hyaline degeneration. We report a case of 60 years old female with complaints of vague pain in upper abdomen with discomfort since 6 months. Following imaging studies, retroperitoneal mass was found. The patient underwent surgery and excision of mass was done. Histopathological examination showed degenerative changes which was consistent with ancient schwannoma. No evidence of recurrence appeared during follow up period.

Penile cancer is rare. Squamous cell cancer usually starts on glans or coronal sulcus as a nodule, foul smelly ulcer or cauliflower like mass, which invades corpora cavernosa as it progresses sparing the urethra until late in the course of the disease.We report a case of 32-year-old male with squamous cell carcinoma of penis in the form of ulcer involving shaft of penis at the base with surrounding inguinoscrotal region managed with en-mass wide local excision of the malignant ulcer taking 1 cm margin from all sides with total penectomy with partial left scrotal skin excision with left orchidectomy with perineal urethrostomy with local scrotal advancement flap reconstruction with bilateral superficial inguinal lymphnode biopsy. Post op period was satisfactory. At discharge, flap was healthy with well-functioning perineal urethrostomy. Patienthad received 6 cycles of adjuvant chemotherapy.Ca penis can be present in any rare form and hence early diagnosis and timely management is the key.