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, a total of 695 patients with hernia and intestinal obstruction were considered retrospectively. Of these, 545 patients were hernia cases (both elective and emergency), and the rest were intestinal obstruction cases, from other causes. Among the hernias most were inguinal hernias (397 patients) and internal hernias were constituted by 6 cases. All of them presented as acute intestinal obstruction, constituting 1.8% of acute intestinal obstruction cases [Table/ Fig-1].CASE 1: Patient presented to our emergency department with features of intestinal obstruction. History of similar complaints were present previously which had subsided on its own. He was dehydrated and tachycardia was present. Abdomen was distended with diffuse tenderness and guarding. X ray abdomen showed multiple air fluid levels and dilated bowel loops. He was posted for emergency exploratory laparotomy. Intraoperatively ileum was found herniating through the left paraduodenal fossa with constricting band formed by inferior mesenteric vein and the proximal small bowel was found dilated [Table/ Fig-2]. The contents of the hernia were reduced and the inferior mesentric vein was preserved. Defect was closed with the free peritoneum to the lateral border of duodeno-jejunal flexure, retroperitonialising the inferior mesenteric vein. Postoperative period was uneventful and he was discharged on day 7. CASE 2: Patient presented to our casualty with features of intestinal obstruction. He was febrile and dehydrated, tachycardia was present. Abdomen was distended, with diffuse tenderness, guarding and rebound tenderness. X ray abdomen showed multiple air fluid levels and dilated small bowel loops. He was posted for emergency exploratory laparotomy. During laparotomy ileum was found herniated in the left paraduodenal fossa with 50 cm of ileum found gangrenous within it and proximal segment dilated 4]. The constriction band was formed by inferior mesenteric vein. The contents were reduced, gangrenous bowel was resected and an end to end ileo-ileal anastomosis was done in two layers. The defect was closed with peritoneum to the DJ flexure after preserving the inferior mesenteric vein. Postoperative period was uneventful and he was discharged on postoperative day 9.CASE 3: A chronic liver disease patient admitted in medicine ward presented to emergency department with features of intestinal obstruction. X ray abdomen showed multiple air fluid levels and Contrast Enhanced Computerized Tomography (CECT) abdomen showed encapsulation of distended bowel loops in an abnormal location in the left hypochondrium, with hepatomegaly and ascites [Table /Fig-5]. She was transferred to the surgery department for emergency exploratory laparotomy. Intraoperatively ascites was present. Liver was massively enlarged and ileum was found herniating through the left paraduodenal fossa and covered by peritoneal sac and the constricting band was formed by the inferior mesenteric vein causing obstruction [Table/ Fig-6]. Sac was opened, contents were reduced and the defect was closed w...

BACKGROUNDCritical Limb Ischaemia (CLI) was defined for the first time in 1982 by P. R. F. Bell as a manifestation of peripheral artery disease, which describes patient with typical chronic ischaemic rest pain or ischaemic skin ulcers or gangrene. 1 This term of CLI should only be used in patients with chronic ischaemic disease defined as presence of recurring rest pain that persists for more than two weeks requiring regular analgesics and with ulceration or gangrene of the foot or toes. These criteria correspond to stage 3 and 4 of Fontaine's classification of POVD. Observational studies have shown that one year after diagnosis of CLI, 25% of patients experience a major amputation, 25% had died and only 50% survived without requiring a major amputation, though some have rest pain, ulcer or gangrene persisting. The primary goals in treating CLI are to relieve claudication pain and rest pain, to heal the ulcer, to prevent amputation of limbs, to improve quality of life and to prolong survival.The aim of the study is to study the improvement of claudication pain, rest pain and improvement of the level of amputation in patients with diffuse peripheral arterial disease (CLI) after administration of PGE1. MATERIALS AND METHODSFrom June 2013 to November 2014, a total of 45 patients having advanced CLI (Fontaine's grade III and IV) not suitable for angioplasty and stenting or bypass procedures received different courses of PGE1. 20 patients (44.44%) received 6 full courses of PGE1,3 patients (6.66%) received 5 courses, 5 patients (11.11%) received 4 courses, 4 patients (8.8%) received 3 courses, 4 patients (8.8%) received 2 courses and 9 patients (20%) received one course. PGE1 was administered through intravenous infusion (alprostadil 100mcg) over 10 hours a day for 5 days in one month (1course). The reduction in claudication and rest pain, improvement in level of amputation and complications were assessed.

Background: Surgeons and patients prefer absorbable sutures for surgical wound closure in breast surgeries which are usually continuous subcuticular sutures so that patients can skip a hospital visit for suture removal. But in case of breast biopsies authors usually put circumareolar incisions. Here authors find it difficult to put continuous subcuticular sutures. In this contest authors thought of interrupted subcuticular sutures where authors can tackle the above-mentioned limitations; while actually reducing the financial burden of the patients.Methods: In this randomized case controlled study authors included elective general surgical procedures for benign breast diseases that was being carried out in the department of General Surgery Govt. Medical College, Kottayam for a period of 6 months starting from January 2017. Total number of cases taken are 20; 10 each in each group.Results: The mean rank for interrupted method was 14.20 and conventional method was 6.80. Mann-Whitney U statistic was 13.000 and p value was 0.03. Since p value was less than 0.05, authors had clear evidence to reject the null hypothesis. Therefore, authors concluded that both the methods were dissimilar and based on mean rank interrupted method seemed to be better method.Conclusions: Authors recommended interrupted absorbable subcuticular suturing technique in general surgical procedures for benign breast diseases, especially where authors used circumareolar incisions, which saved time of the surgeon and the patient. This can lead to considerable cost savings for the government without compromising clinical effectiveness or safety.

BACKGROUND Hospital-associated infections are an important cause of patient morbidity and mortality. Cell phones and pens are ubiquitous accessories of doctors and other Healthcare Workers (HCWs) in a hospital as well as outside for various purposes. But, they may serve as reservoirs of infection allowing the transportation of the contaminating bacteria to many different clinical environments. The aim of the study is to find out the prevalence of various bacteria in mobile phones and pens of doctors and other staff working in operation theatres of Government Medical College, Kottayam, Kerala, for a period of one year. MATERIALS AND METHODS 400 samples of microbiological swabs were collected from pens and mobile phones of medical personnel working in the operation theatres of Government Medical College, Kottayam, for one year. If growth was present in cultures, identification of organisms and sensitivity to routine antibiotics was checked by disc diffusion method according to the organism isolated. RESULTS About 2/3rd of mobile phones and pens carried by healthcare workers inside operation theatres contained bacteria, of which, skin commensals prevailed in number. Presence of faecal microflora and multidrug-resistant bacteria detected in some of the samples are alarming. CONCLUSION This study emphasises the need for creating awareness among healthcare workers regarding the role of mobile phones and pens as carriers in transmission of nosocomial infections.