Objective: To highlight the significance of endoscopic retrograde cholangio-pancreatography, its indications, findings and complications. Material and methods: This is a prospective study conducted on the patients admitted in the gastroenterology department of Sir Ganga Ram Hospital Lahore. Study period was of six months from July 2021 to December 2021. Main outcomes in this study were technical safety, indications of ERCP and complications. Study sample was calculated using WHO sample size formula. Results: Total 200 cases were included in this study including 116 (58%) male and 84(42%) female. CBD cannulation was done in 184(192%) cases. CBD stone was found in 35(17.5%), CBD stricture in 44(22%) and CBD stricture with stone found in 17(8.5%) cases. 11(5.5%) cases developed acute pancreatitis out of which 2(01%) cases had severe pancreatitis with collection of fluid. One case (0.5%) had retroperitoneal perforation which was managed conservatively. 03(1.5%) cases had bleeding after the procedure and hemostasis achieved by re-scope with adrenal injection at the bleeding point. Conclusion: ERCP procedure has a high success rate with minimum complications. Keywords: ERCP, Findings, Complications, CBD stone, Pancreatitis

Aim: To emphasize on the importance of reverse radial forearm flap (RRF flap) in the coverage of soft tissue defects of hand and wrist. Study design: This is a descriptive experimental study. Study place and duration: Study was comprised on the period of six months from January 2022 to June 2022. It was conducted in the plastic surgery department of Allama Iqbal Memorial Teaching Hospital Sialkot Methodology: Patients with the soft tissue defects of hand and wrist due to road traffic accidents, industrial or mechanical trauma and firearm injury were admitted to the plastic surgery ward. After achieving healthy wound with wound debridement, soft tissue coverage was done using reverse radial fasciocutaneous forearm flap. Patients with amputation of thumb and those with partial or complete bone loss were excluded from the study. Ages of the patients were 17-50 years with mean age of 31.42±5.3 years. Donor site of the flap was covered with split thickness skin graft and follow-up of the patients was done for at least three months. Results: 20 cases were included in this study including 16(80%) male and 04(20%) female cases. 15(75%) cases had soft tissue defect on the dorsum of hand, 04(20%) cases had palmar defect and in 01(5%) case there was amputation at transmetacarpal level and flap coverage of the stump was done. Partial loss of the flap happened in one 01(5%) case and it was treated with debridement and skin coverage. In one case superficial epidermolysis was found and managed conservatively. Practical implication Conclusion: Reverse radial forearm fasciocutaneous flap is an excellent option for the coverage of soft tissue defects of hand and wrist due to its greater arc of rotation which makes it easy to apply to the recipient site. Key words: Hand trauma, Soft tissue defects of hand, Reverse Radial Forearm Flap, Flap Coverage of Hand

Aim: To study diversity in position and length of vermiform appendix in human body to manage the patients properly presenting with acute appendicitis. Methods: This is a cross sectional study conducted on 240 bodies. Study was conducted in anatomy department of Dow University of health sciences. Study was completed in one year duration from January 2021 to December 2021. Site and length of vermiform appendix was observed in dead bodies undergoing autopsy. Sample size was calculated using WHO sample size calculator. Consecutive sampling technique was used for sample selection. Data was analyzed using SPSS software (version-20) and chi-square test was applied on the collected data. Result: Total 240 bodies were studied for the anatomical position of appendix, including 156(65%) males and 84(35%) females. Mean age was 34.6 ± 5.2 years with the range of ages as 8-65 years. Mean length of the appendix was 92.6 ± 2.5 mm in men and 85.3 ± 4.7 mm in women. Pelvic position was the most common position of appendix found in 122(50.8%) bodies. Conclusion: High incidence of anterior position of appendix in Pakistani population describe that diagnosis of acute appendicitis can be made sooner and easier in our population with less complications like missed diagnosis, gangrene and perforation as compared to other populations. Key words: Vermiform appendix, Pakistani population, Appendicitis, Anatomical position