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Introduction: First bite syndrome is a potential complication of surgery involving the infratemporal fossa, deep lobe of the parotid gland, parapharyngeal space, carotid body tumors, and various head and neck malignancies. It is described as acute and intense pain in the parotid region caused by the rst bite of each meal which gradually improves with the subsequent bites. Various treatment strategies have been employed with no signicant therapeutic benet. This study brings out our experience of rst bite syndrome at a tertiary care center. Materials and Methods: A retrospective study was conducted to identify the patients who developed rst bite syndrome with or without Horner's syndrome at a tertiary care hospital from Jan 2020 to Dec 2022. Patient records were accessed to gather data on patient demographics, presenting symptoms, and surgical history. Atotal of 80 patients were included in the study. Patients were operated by Head and Neck Oncosurgeon, assisted by Vascular Surgeon. 51 of them were males while 29 were females. Once the diagnosis of FBS was made, the time of onset since surgery, duration of symptoms, and associated symptoms of Horner's syndrome were noted. Results:Atotal of 80 patients were included in the study. 51 of them were males while 29 were females. The mean age of patients was 43 years. 16.25 % of the total patients developed FBS. Out of the 80 patients, seven patients underwent excision of vagal schwannoma, two of them developed only rst bite syndrome while the rest ve developed rst bite syndrome with Horner's syndrome. Total parotidectomy was indicated for four patients for mucoepidermoid carcinoma. Two patients underwent excision of paraganglioma and branchial stula respectively. The remaining patients who did not develop FBS underwent excision of the carotid body tumor (8), supercial parotidectomy (23), and total parotidectomy (36). Discussion: The cause of FBS is largely unknown, however, Netterville et al have proposed that FBS is caused by the loss of sympathetic innervation to the parotid gland–– . Netterville et al proposed that FBS is due to the damage or removal of cervical sympathetic with loss of sympathetic innervations to the parotid gland. It is interesting to note that in our study out of the 40 patients who underwent total parotidectomy only four patients developed rst bite syndrome. Given the extreme rarity of this syndrome compared to the relatively high rate of external carotid artery and/or parotid gland surgery with ligation or resection of the external carotid artery, sympathetic parasympathetic conict on myoepithelial cells of the parotid gland is probably not the only mechanism involved in the pathogenesis of this syndrome, whose pathophysiology has not yet been fully understood– . Various treatment strategies have been proposed to relieve the pain of rst bite syndrome. Non-steroidal anti-inammatory drugs, acupuncture, anesthetic sprays or local anesthetic block and oral analgesics such as paracetamol, codeine, or narcotics, and tympanic neurectomy or auriculotemporal neurectomy have remained ineffective. Conclusion: The rst bite syndrome is a relatively rare condition occurring as a result of a sympathetic-parasympathetic imbalance in the innervations to the parotid gland. Although most of the studies support this hypothesis there may be other factors in play owing to the rarity of this syndrome as compared to the number of neck surgeries performed. Various treatment options have been tried but none has shown a signicant therapeutic benet

Background: Diagnostic accuracy of intra-operative frozen section (FS) depends largely on quality of tissue sections backed by good clinical communication and experience of reporting pathologist. Periodic audit of this consultation in surgical pathology help in assessing the efficiency of procedure and addressing the pitfalls. In this study authors have analysed the spectrum, indications and assessed the accuracy of FS consultation in their institution.Methods: A retrospective study of 212 consequent tissue specimens submitted for FS over two years in study centre was conducted. The FS and corresponding formalin fixed paraffin embedded (FFPE) tissue section with their final histopathological examination (HPE) reports were studied and analyzed. The results were classified in concordant, discordant and deferred categories. Accuracy rates and discordant frequencies were calculated and comparison with other similar studies was done. Reasons for inaccuracies were deduced.Results: A total of 212 tissue specimens for FS were reported over two years in this study institute, six of which showed discordant results. Most common site of FS in this study centre was from central nervous system (CNS) lesions (28.77%). Indications for intra-operative consultation were mainly for establishment of tumor diagnosis (66.51%) and status of margins (29.25%). The accuracy rate was found to be 97.17% with error rate of 2.83%. On analysis of discordant cases; the reason for inaccuracy was mainly due to interpretation error (83.33%).Conclusions: The audit of FS consultation established that accuracy rates of this study institution are comparable with most international quality control statistics for FS. The discordant cases were mostly false positive hence emphasising that a variable degree of reservation is required while interpreting and communicating the FS results. The closest possible diagnosis should be communicated on FS and definitive diagnosis should be deferred to HPE in case of doubt.

Introduction: Existing methodologies and risk stratification indices for predicting peri-operative cardiac complications in vascular surgery patient lack sufficient predictive value and therefore cannot be recommended for risk stratification. There are no Indian studies for preoperative cardiac risk scores for patients who undergo vascular and endovascular procedures. Therefore, an attempt was made to risk stratify and compare two existing cardiac risk indices (i.e., Detsky's modified cardiac risk index vs. Revised cardiac risk index [RCRI]) to predict peri-operative morbidity and mortality due to cardiac causes. The aim of this study: (a) To compare Detsky's modified cardiac risk index and RCRI to predict perioperative cardiovascular outcome in patients with peripheral vascular disease undergoing surgical intervention. (b) To predict perioperative cardiovascular outcome based on cardiac risk index in patients with peripheral vascular disease undergoing surgical intervention. Materials and Methods: This is an observational, prospective, longitudinal, controlled cohort study, which assessed 103 patients admitted at vascular centre for a period of 2 years. All patients undergoing vascular surgical procedure and evaluated by a cardiologist in the preoperative period were included in the study. Results: Eighteen patients (17.4%) had cardiac complications. The Detsky's index was found to be a satisfactory predictor of postoperative cardiac events (P < 0.001) as compared to RCRI which had a P < 0.003. There were a total of 10 mortalities (9.7%). Detsky's model and RCRI had positive predictive value (PPV) of 73.3% and 31.4%, specificity of 94.1% and 72.7%, respectively. Discussion: The overall sensitivity, specificity, PPV, negative predictive value of the Detsky's risk index, and RCRI in the prediction of cardiac events were 31.4%, 94.1%, 73.3%, 72.7% and 73.3%, 72.7%, 31.4%, 94.1%, respectively. In our study, the area under ROC for Detsky class was 0.76 versus 0.75 and superior to C statistic. However, the area under ROC for RCRI class was 0.72 versus 0.75 and inferior to C statistic. One important inference from the study was that 77.6% patients were smoker in the study group which emphasize the direct relation of peripheral vascular disease with smoking. Conclusion: The study concluded that patients with good surgical risk and profile undergoing minor vascular procedures can be operated without further testing. For other patients, the next step would be to incorporate the Detsky index. A Detsky score of 20 or more is comparable to a major clinical predictor in the American College of Cardiology/American Heart Association scheme.