31 October 1989. After the birth of her son the mother had used barrier contraceptives. She used a vaginal cream containing triple sulfa drugs to heal cervical inflammation from the fifth to the twelfth day of the menstrual cycle during which she conceived. She had a severe attack of influenza during the fourth month of pregnancy, but did not recall high fever, skin rash, or use of medications during the illness. There was no other known exposure to drugs or radiation. Fetal activity was described as very feeble.The infant's birth weight was 2180 g, length 42 cm, (both below the 10th centile), and head circumference 32 cm. At birth her appearance was described as abnormal. Her neonatal course was marked by difficulty in sucking and swallowing, requiring intermittent tube feeding, and failure to thrive.Examination at 5 weeks of age found the infant very jittery on handling. Moro and,grasp reflexes were abnormal. There was slight asymmetry of the head; the left frontotemporal area appeared flatter than the right (fig la). The cranial hair was very sparse (fig lb). The fontanelles were normal. Both ears were low set and the left was posteriorly rotated and had a deficient antihelix. The facial features included normal eyes with clear corneas and pupils, coarse facies, thick eyebrows and long eyelashes, hirsutism of the forehead, low, flat nasal bridge, wide, upturned nose tip, and long philtrum. The palate was highly arched and the distal frenulum of the tongue was short. Other abnormal findings included bilateral inguinal hernia, small patellae, contractures at the first interphalangeal joints of the fourth finger of the right hand, small fifth fingers without nails (fig 2a), overlapping second over first and fourth over fifth toes, absence of the fifth toenails (fig 2b), moderate hypotonia, and persistent cutis marmorata. External genitalia, heart sounds, and the remainder of the examination were normal.Radiographical evaluation of the hands and feet showed bilateral absence of the terminal phalanges of the fifth fingers (fig 3a) and middle and distal phalanges of the third to fifth toes (fig 3b). Chest radiograph, electrocardiogram, echocardiogram, and sonograms of the kidneys and head were normal.Chromosome analysis performed on peripheral blood lymphocytes after G and R banding showed a normal 46,XX karyotype The results of blood chemistry and screens for amino acids and thyroid function were normal.

We report a new case of RubinsteinTaybi syndrome with a hypoplastic right kidney, persistent pulmonary hypertension, and mitral valve regurgitation.

AIMS:To confirm that, the ligation of hernial sac during orchiopexy is not mandatory to prevent postoperative development of hernia. METHODS: This prospective study was conducted in 40 children with an age range of six months to 12 years with a diagnosis of undescended testis. Of the 40 cases, 30 were unilateral and 10 bilateral cases. Of the 30 unilateral undescended testis, 18 were right-sided and 12 left-sided. All children underwent standard orchiopexy without the ligation of the hernia sac. RESULTS: All the patients were followed up regularly up to a period ranging from 18 months to 24 months. No inguinal hernia was detected during the regular follow-up in any child. CONCLUSION: Ligation of herinal sac is not mandatory during orchipexy. KEYWORDS: Undesended testes, inguinal hernia, orchidopexy. INTRODUCTION:Herniotomy is performed along with orchidopexy for the closure of associated patent processus vaginalis. The conventional technique for undesended testis repair is high ligation of the hernial sac after proper dissection upto the deep ring, Mohta et al. [1] Observed that there is no untoward effect on the early complications and recurrence rate, if hernia sac is not ligated during herniotomy. During laparoscopic orchidopexy performed for contralateral testicle it was found that despite nonligation, the previous de peritonalized site got reperitonalized by itself and the sac which is dissected and left open deep to deep ring is not having hernia later in life. This is probably due to the closer of peritoneal defect within 24 hours by metamorphosis of the in situ mesodermal cells. [2] We done a study on non-ligation of hernia sac during conventional orchiopexy in our institute to see the results and it's long term untowards effects and advantages over standard orchiopexy.

Background: Osteoarthritis [OA] of the knee is a chronic, progressive degenerative disease with accompanying joint pain, stiffness, and deformity. Varus deformities of the knee, characterized by a femorotibial axis of less than 180° on full-leg standing AP radiographs and narrowed medial joint space, are common in patients with knee OA. There is a growing need for Proximal Fibular Osteotomy (PFO) in LMIC, since it is simple, safe and affordable. PFO may delay or replace TKA in a subpopulation of patients with knee osteoarthritis and pain relief after surgery occurs in almost all patients. Method: We have taken 30 patients coming to our orthopaedic OPD with predominantly medial compartment OA knee at Mahatma Gandhi Medical College & Hospital. Preoperative and postoperative weight-bearing and whole lower extremity radiographs were obtained to analyse the alignment of the lower extremity and the knee joint space. Knee pain was assessed using a visual analogue scale, and knee ambulation activities were evaluated using the American Knee Society score preoperatively and postoperatively. Result:The preoperative KSS score was 53.56±4.606 while postoperatively it was 72.16±8.07. The preoperative KSS score was 42.16±14.72 while postoperatively it was 72.23±9.98 at functional score. Preoperatively the mean VAS score was 7.53 which significantly decreased to 3 in the postoperative period. We also noted decrease in the femoro-tibial angle from preoperative (182.73±1.79) to postoperative period (178.23±2.09) whereas in the medial joint space it was increased from 1.69±0.96 mm to 3.43±1.21 in the postoperative period. Conclusion:The PFO is a promising surgical option in countries that lack financial and medical resources. As compared to TKA or HTO, the PFO is a simple, safe, fast and affordable surgery that does not require insertion of additional implants leading to less complications and a shorter recovery period.

Background: Inguinal hernia is the most common diversity accounting for roughly 75% of all hernia. The etiology of an inguinal hernia is clearly not understood. The technique of hernia repair is usually based on custom rather than evidence.4 According to data there is a good observation that open mesh repair is better than suture repair in terms of recurrences. The aim of this study to evaluated the effectiveness of prolene mesh rapair in incisional hernia.Subjects and Methods:A prospective hospital based study done on 30 cases in department of general surgery at RVRS medical college & associated group of hospitals, Bhilwara, Rajasthan. We randomly assigned 30 patients to suture repair or mesh repair of an incisional hernia. The patients were followed up by local physical examination at 1 month & 3 months were done as per standard protocol. Factors related to the operation including the surgical technique, presence or absence of seroma, hematoma, infection, dehiscence were recorded. Follow-up of cases was done at 1 month & 3 months after surgery on an outpatient basis for recurrence of hernia.Results:Our study showed that the majority of cases (43.33%) were seen in 40-49 years of age group. Small (0-5cm) gap size 90% cases and 10% cases have medium gap size in our study. Pain present in 26.66% patients in group A and 20% in group B at 1 month. The recurrence of hernia was present in 28% cases in group A and 4% in group B. It was statistically significant (P=0.0488*) at 3 months and the mostly were well built and have 27.27% wound infection present in these type of patients. Mostly infection occurred in obese patients (40%).Conclusion: We concluded that restoration with polypropylene mesh is superior to suture repair group with concern to the recurrence of hernia.