No abstract

Background: The majority of parotid tumours are benign. Nealy 80 % of parotid tumour involve the superficial lobe. Parotidectomy was first introduced into the world literature by Berard in 1823 who removed first parotid tumor. Parotidectomy has well-documented post-operative complications. Aims & Objectives:The aim is to study the postoperative complications and its management after parotidectomy. Methods: This prospective study was conducted on 60 patients who underwent parotidectomy by antegrade technique from July 2014-july 2019 for parotid tumours. Patients were submitted to careful history taking, complete clinical examination, and examination of facial nerve integrity before surgery.48 patients underwent superficial parotidectomy (44 patients for pleomorphic adenoma,4 patients for warthin ' s tumour) and 12 patients underwent Total conservative parotidectomy (9 patients for parotid malignancy and 2 patients for pleomorphic adenoma recurrence and 1 patients for pleomorphic adenoma involving deep lobe of parotid). Results: In our study, out of 48 patients underwent superficial parotidectomy 18 patient developed complications and 12 patients underwent Total conservative parotidectomy 10 patients developed complication. Several complications have been reported in parotid surgery. Temporary facial nerve paresis was the most common postoperative complication followed by hypoesthesia of greater auricular nerve. Most patient regained normal facial nerve function within 2 months after surgery. Conclusion: Parotid tumours are the most common salivary gland tumours. Majority of parotid tumours are benign and involve the superficial lobe. Parotidectomy is the defenite procedure for parotid tumours. Parotidectomy is challenging procedure because of the intraparenchymal course of the facial nerve and has its own complications. Surgical complications are higher in total conservative parotidectomy than in superficial parotidectomy. Complications are reduced by proper dissection technique and treated carefully if complication arises.

Avascular necrosis of the metacarpal head is very rare compared to that of femoral head, talus, or scaphoid. Mauclaire disease also known as Dietrich's disease is a rare condition that refers to osteonecrosis of the metacarpal head. It can be multifactorial, usually associated with systemic lupus erythematosus (SLE), steroid use, or trauma. We present a case of 13-year-old boy, an amateur volleyball player presented with pain and swelling of the right index finger for 3 months. Initial X-rays were normal but subsequent X-rays revealed a mild flattening of the second metacarpal head; blood investigations were normal. The MRI revealed osteonecrosis with mild flattening of the second metacarpal head with synovial effusion. The patient was misdiagnosed as tuberculosis of the metacarpal head before presenting to us. The patient was treated conservatively with good functional outcome. Though several cases of Dietrich's disease have been reported in the literature but none in a volleyball player, just to stress that repeated microtrauma could also be an etiological factor and a rare differential diagnosis in patients with the painful metacarpophalangeal (MCP) joint. Most of the patients can be managed conservatively with good functional outcome. Curettage and bone grafting, transfer of metatarsal head, osteotomies, arthroplasty (excision or prosthesis), or arthrodesis have been described as various surgical means of treatment.

Background: Acute pancreatitis is an acute inflammation of the pancreas resulting from an auto-digestion of the gland. Acute pancreatitis represents a spectrum of disease ranging from a mild, self-limited course to a rapidly progressive, severe illness. In 20–25% of acute pancreatitis are severe, characterized by the development of pancreatic or peri-pancreatic necrosis, resulting in general and local complications responsible for a high mortality rate. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the treatment of infected walled off necrosis. Aims: The aim is to study the intervention to surgery and its outcome in managing severe acute pancreatitis and its complications. Methods: A total of 36 patients with severe acute pancreatitis with its complications not responding to conservative treatment were studied. In this prospective observational study, patients were divided based on the mode of treatment received: percutaneous drainage with pigtail catheterisation, endoscopic cystogastrostomy/drainage procedure and necrosectomy (in patient failed to respond by other intervention). Results: In our study, out of 36 patient 22 patient are treated with percutanous drainage with pig tail catheterization,8 patient are treated with endoscopic cystogastrostomy,6 patient underwent necrosectomy (3 patient underwent minimally invasive laparoscopic necrosectomy and 3 underwent open necrosectomy).Higher complication occured in patient underwent surgical intervention.Mortality occurred in 80% of patient who underwent necrosectomy. Most common cause of death is sepsis with multi organ failure. Conclusion: Surgeons have an important contribution to make in the multidisciplinary care of patients with complicated acute pancreatitis .Patients with acute pancreatitis should be managed conservatively in a step up approach. Early surgical intervention is not recommended even for necrotizing pancreatitis. Infected..