BACKGROUND AND OBJECTIVES Anal fissures are commonly encountered in routine colorectal practice. Chronic fissures have traditionally been treated surgically. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment. In this study, we compare topical 2% Diltiazem gel and lateral internal sphincterotomy with respect to symptomatic relief, healing and side effects in the treatment of chronic fissure in ano. METHODS 60 patients with chronic fissure in ano were randomly divided into Diltiazem gel and internal sphincterotomy groups. Patients were followed up at weekly intervals for minimum of eight weeks. Data was recorded accordingly. RESULTS Fissure completely healed in 28(93.33%) out of 30 patients treated with 2% Diltiazem gel between 4-8 weeks. Healing was 100% with internal sphincterotomy. The mean duration required for healing of fissure was 4.86 weeks in Diltiazem gel group and 3.66 weeks in internal sphincterotomy group. 61.5% patients were free from pain after treatment with Diltiazem gel whereas in internal sphicterotomy group 66.66% patients had pain relief at the end of 4 weeks. INTERPRETATION AND CONCLUSION Comparison between Diltiazem gel application and internal sphincterotomy did not show any significant difference in fissure healing and pain relief. No side effects were seen in Diltiazem gel therapy. Topical Diltiazem should be the initial treatment in chronic fissure in ano. It is better to reserve internal sphincterotomy for patients with relapse or therapeutic failure to prior pharmacological treatment.

Background: Gastric outlet obstruction (GOO) mechanically impedes gastric emptying, normal emptying of the stomach. It is a diagnostic and therapeutic challenge for general surgeons in their daily practice. This paper highlights the etiology, clinical presentation and treatment outcome of GOO.Methods: A Prospective study was conducted on patients with GOO treated at Rajarajeswari medical college and hospital, Bangalore during September 2015 to august 2017. Data was tabulated and analyzed using descriptive statistical methodology.Results: Carcinoma stomach with antral growth and cicatrized duodenal ulcer (both 41.5%) were the most common cause of gastric outlet obstruction. Male were more affected than females (2.5:1). Most common symptom was vomiting and abdominal pain (noted among all), followed by loss of appetite (83%) and loss of weight (82.35%). 94.1% patients of Cicatrized duodenal ulcer underwent truncal vagotomy with posterior gastrojejunostomy and 5.9% underwent truncal vagotomy with antrectomy. 58.8% patients of carcinoma stomach, underwent distal gastrectomy with ante-colic Roux-en-Y gastro- jejunostomy, 12.1% patients underwent subtotal gastrectomy with ante-colic and Roux-en-Y gastro jejunostomy and 4.8% patients underwent palliative gastrojejunostomy. In corrosive antral stricture Billroth I gastrectomy was done. Patients of pancreatic malignancy underwent palliative anterior gastrojejunostomy and pseudo- pancreatic cyst was treated by cystojejunostomy. The average hospital stay was 10-14 days and an overall mortality of 5.8% for malignant patients was noted.Conclusions: Study concludes that gastric outlet obstruction is an important and a common surgical condition in tertiary hospital. Malignancy and benign cicatrized duodenal ulcer being the most common cause.

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Breast hypertrophy and sagging of the breast are two different benign disorders of breast that can occur during various stages of women's life from adolescence to menopause. A woman can seek a plastic surgeon for breast reduction for reasons both physical and psychological. Breast reduction surgery or reduction mammoplasty is a plastic surgical procedure by which the sizes of large breasts are reduced. During this procedure, excess skin, fat and breast tissue are removed. The procedure recreates a breast with the desired appearance, contour and volume. Breast lift operation/mastopexy is a procedure where only skin is removed with repositioning of the nipple higher on the chest wall and is the procedure of choice in small but sagging breast.We present a series of five cases, two presenting with virginal hypertrophy, one with gestational hypertrophy and other two with postmenopausal sagging and hypertrophy. Four patients underwent reduction mammoplasty and one patient underwent mastopexy. None of our patients complained of any problems and were satisfied with the results.