Vaccination against hepatitis A virus (HAV) has been recommended in patients with chronic liver disease to prevent any decompensation due to superinfection. This may not hold good in high endemic areas for hepatitis A like India. The aim of this study was to find out the seroprevalence of anti-HAV antibodies in patients with chronic liver disease and to justify the need for vaccination against hepatitis A virus in these patients. One hundred and thirty three consecutive patients with cirrhosis of liver attending Gastroenterology department of our Institute between June 2004 and June 2005 were enrolled. Seventy-five healthy persons were taken as controls. The diagnosis of cirrhosis was based on clinical profile, biochemical, radiological (ultrasound abdomen) and endoscopic findings. The etiology of cirrhosis was based on presence of viral markers, history of significant alcohol consumption, autoimmune and metabolic workup. All patients and controls were tested for antiHAV (total) antibodies using commercially available enzyme-linked immunosorbent assay kits. Data from patients and control group were compared by unpaired 't' test and Chi square test. All subjects were in the age group 11 to 75 years. Etiology of chronic liver disease was as follows: HBV- 29.3%, HCV - 14.28%, HBV+HCV dual -1.5%, alcohol- 21.8%, Cryptogenic -23.3%, Wilson"s Disease -1.5% and Budd chiari -1.5%. The prevalence of HAV was 93.2% in patients with cirrhosis of liver and 94.6% in controls. The prevalence was almost similar irrespective of the etiology. In view of high seroprevalence of HAV antibodies among cirrhotic patients in our study and the high cost of the vaccine, the hepatitis A vaccination may not be routinely required in this part of the world.

Drug-coated balloon first followed by cobalt chromium stent deployment versus a reverse sequence is not associated with statistically significantly different 6-month angiographic or 12-month clinical outcomes.

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We were interested to read Professor Baraka's description of the value of differential lung ventilation in preventing the hypoxaemia associated with one-lung ventilation (Anaesthesia 1994; 4 9 881-2). He describes the use of a screw clamp to partially occlude one limb of the double-lumen catheter mount. The lung of the operated side is therefore ventilated with small tidal volumes and a degree of expiratory resistance. Oxygenation is maintained, but lung movement is reduced to a level which does not interfere with surgery.Two years ago, we briefly described the usefulness of this technique during thoracoscopic ligation of pulmonary bullae [ 11. Full deflation of the operated lung is not desirable in such cases, since a degree of ventilation allows bullae to be more easily identified, and the site of an air leak can occasionally be verified by visual inspection. The associated reduction in lung movement facilitates the snaring of bullae. With the patient anaesthetised and a double-lumen endobronchial tube in place, carbon dioxide is insufflated into the pleural cavity to generate an intrapleural pressure of 6-8 mmHg (0.8-1 kPa), and the thoracoscopic telescope is introduced. A gate-clamp is then used to gradually compress the limb of the double-lumen catheter mount which is connected to the operated lung. The surgebn and anaesthetist observe the effects on the video screen and the degree of compression is adjusted until a satisfactory result is achieved. We tind that effects vary markedly from patient to patient, presumably influenced by the intrinsic resistance and compliance of the affected lung. However, it should be stated that with increasing surgical expertise at snaring bullae, this procedure is generally now performed in our hospital with full ventilation to both lungs.

Background: Fistula in ano is a common problem. Surgical techniques such as fistulectomy, fistulotomy were associated with complications like excessive bleeding, infection, recurrence etc. The employment of cyano acrylate glue is one of the newer promising techniques. The aim of this study was to evaluate the efficacy of cyanoacrylate glue in the treatment of anal fistulas.Methods: Study was conducted on patients with fistula-in-ano admitted to various surgical units in hospitals attached to Bangalore Medical College and Research Institute from November 2016 to May 2018. A total of 30 patients fulfilling the criteria were included in the study. Under spinal anesthesia, patients were posted for the procedure. Post operatively the patients were examined every 2 weeks for the first 2 months, and then once every 3 months. If the fistula failed to heal with primary treatment at a 4-week interval, a second glue treatment was performed. Post-treatment the success of the procedure was assessed by the incidence of infection and recurrence.Results: Twenty two patients got healed with primary application with stoppage of any discharge from the fistulous track. Two patients required one more application, and one patient required fistulotomy. One patient developed complex fistulas and had to be treated with colostomy and fistulectomy. 4 patients developed purulent discharge after application of glue and were treated with IV antibiotics and healed completely.Conclusions: Cyanoacrylate glue can be offered as a sphincter sparing alternative to fistulectomy in patients with anal fistulas.