INTRODUCTIONVaricocele has first been described as early as first century B.C.1 Celsus wrote "when the disease has spread over the testicle and its cord, the testicle sinks a little lower and becomes smaller than its fellow, in as much as its nutrition has become defective". The earliest description of varicocele in the modern literature was in 1885 by Barwell.1 Varicocele is a very common finding in young men. It is an abnormal enlargement and tortuosity of the pampiniform plexus of veins in the spermatic cord.2 The prevalence of varicocele is approximately 15% in general population, 25%-40% among men with primary infertility and 45% to 81% among men with secondary infertilty.2 Isolated left-sided lesions are seen in 78% to 93% of varicocele patients, ABSTRACTBackground: Despite various studies published in the recent years, efficacy of varicocelectomy and its influence on semen parameters, particularly sperm count, motility and morphology has not yet been determined. Conflicting results obtained in different studies, accounts for sparked interest in varicocele management and its effects on seminal parameters. Therefore, present study was designed in an attempt to evaluate the effect of varicocelectomy on the semen parameters by analyzing reports that included men with varicoceles who had both preoperative and postoperative semen examination done. Methods: The present prospective study enrolled fifty patients. Varicocele was graded by Dubin grading system by palpation in standing and during Valsalva maneuver under adequate exposure and illumination. Macro and microscopic assessment of semen samples was carried out according to WHO guidelines. The surgical approach used for varicocelectomy was inguinal (Modified Ivanissevich procedure). Results: Significant improvement in semen parameters viz sperm counts/ml, sperm counts/ejaculate and sperm motility were observed after varicocelectomy. We noted no effect of patient's age on the degree of improvement in semen parameters post operatively. Preoperatively, men with Grade III varicoceles had lower sperm counts and sperm motility, but significant improvement was observed post-operatively compared to men with Grades I and II varicoceles. Conclusions: Our study supports the fact that, varicocele exerts a deleterious effect upon sperm motility, concentration and repair of varicocele leads to improvement in these seminal parameters. The repair of larger varicocele seems to be a predictor for better post-repair semen parameters. Varicocele is a treatable cause of male infertility (primary and secondary), so patients undergoing varicocelectomy should have a pre-operative and postoperative semen examination done routinely.

Pseudocyst is one of the commonest complications following pancreatitis. However, a mediastinal pseudocyst is a rare entity which demands a high index of suspicion for diagnosis. We report a case of a 42 years old male who presented to the emergency with cough, retro-sternal chest pain, progressive dysphagia and vomiting. He was a chronic alcoholic with multiple hospitalisations in past 4 years for recurrent episodes of severe acute pancreatitis. There was left sided pleural effusion on chest radiograph and extrinsic compression of distal oesophagus and proximal stomach from posterior aspect on endoscopy. Abdominal computed tomography (CT) revealed a large pseudocyst abutting the body of pancreas and extending superiorly into the mediastinum. Patient was treated conservatively and given total parenteral nutrition followed by Ryle's tube feeding. He improved, started accepting orally and was discharged. Patient was asymptomatic on follow up and repeat CT scan after 6 weeks showed signicant decrease in the size of collection

Background: GM-CSF has been demonstrated to be effective in reducing the incidence of infection in patients who receive myelosuppressive anticancer chemotherapy or patients who are neutropenic and agranulocytic. We study the role of GM-CSF in non-neutropenic patients with Systemic Inflammatory Response Syndrome (SIRS), infections and sepsis with impaired neutrophil function to access the current rationale for administering GM-CSF in addition to standard antibiotic therapy to critically ill patientsMethods: All patients undergoing surgery for peritonitis due to gastrointestinal perforations were included in this study and were divided into two groups alternatively to avoid any bias i.e. Group A 1, 3, 5 etc. and Group B 2, 4, 6 etc. Group A - all patients received GM-CSF along with standard antibiotics. Group B patients received antibiotics only. Course of patient in immediate postoperative period, time to improvement, duration of hospital stay, antibiotic therapy, rate of complications were compared.Results: Patients in group A had a lower duration of antibiotic therapy and hospital stay. Patients in group A took less time to show clinical improvement compared to patients in Group B. Group A also had a much lower rate of infectious and systemic complications compared to group B. Conclusions: Results of the present study show that GM-CSF is an important molecule when used as adjunct to antibiotics in cases of abdominal sepsis. Use of this growth factor is associated with less incidence of septic complications and morbidity, a shorter duration of antibiotic therapy and hospital stay without significantly compromising the cost. The results of present study help in identifying its role in non-neutropenic patient groups who are most likely to benefit from its administration.

Oil cysts of breast are rare benign breast disorders resulting from fat necrosis.  Oil cysts are rare mammographic findings encountered. Here, we describe a case of 35 years female with history of breast trauma who presented with a small breast lump which was later diagnosed as oil cyst.

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