Peritonitis is one of the major problems confronting the surgeons in day to day practice. Despite many advances in understanding pathophysiology, mortality rate of diffuse suppurative peritonitis remains high. A prospective study, with prior institutional ethics committee approval, involving 100 patients of perforative peritonitis is done to assess the various prognostic factors in management of generalized peritonitis. Role of age, gender, duration, type of perforation, associated systemic factors are studied in relation to morbidity and mortality in the outcome of management of peritonitis. Elderly age, ileal perforations, delay in presentation of more than 24 hours and associated shock on day one are found to have bad prognosis.

Carcinoma of penis is a tumor with devastating psycho sexual repercussions on the patient. It was reported from different parts of the world with wide variation in incidence. Several factors were considered as inducing agents for cancer of penis. A clinic-pathological study is undertaken to find the incidence, the probable causative factors and the possible treatment methods that can be adapted. Preputial hygiene seems to be an important factor in preventing carcinoma penis. All the cases were of squamous cell carcinoma. Patients are coming for treatment in advanced stage of disease due to lack of awareness about the condition, becoming ineligible for modern conservative surgeries.

BACKGROUND Wet to dry normal saline mechanical debridement is the most common, cost effective debridement method, which is used widely,1 including in our hospital setup in wound care management. Papaya is an enzymatic debriding agent which has been in use for many years.2 We wanted to compare the effectiveness of papaya and normal saline in healing of ulcers and evaluate the role of papaya dressing in wound debridement, granulation tissue formation, reduction in ulcer size, and ulcer healing. METHODS This is a comparative interventional study of 100 patients done at Sri Venkateshwara Medical College, Tirupathi, from December 2017 to December 2018. Patients were selected and randomized into two groups - Group I (treated with papaya) and Group II (treated with normal saline). Patients were clinically assessed at the time of inclusion and daily dressing was done. Patients were assessed weekly for 4 weeks and response noted regarding slough reduction, granulation tissue formation, reduction in ulcer size, and overall response to treatment. Additional treatment and follow, up to 3 months were recorded. RESULTS The disappearance of slough / necrotic tissue was significant in the papaya group in the third and fourth week when compared to the normal saline group. 23 patients in the normal saline group, and 27 patients in the papaya group did not require any additional treatment. 22 patients underwent SSG in the normal saline group and 19 patients in the papaya group. Five patients underwent secondary suturing in the normal saline group and four patients in the papaya group. 23 patients in the normal saline group and 27 patients in the papaya group did not require any additional treatment. CONCLUSIONS Papaya is a better and effective debriding agent in comparison to wet to dry normal saline dressing and it also promotes faster granulation tissue formation. Overall response to treatment with papaya is good. KEYWORDS Papaya Dressing, Normal Saline Dressing, Ulcer Healing

BACKGROUND Necrotising fasciitis lesions are entities not frequently seen in daily surgical practice. These infections are marked by absence of clear local boundaries or palpable limits, which is responsible both for their severity and the frequent delay in recognizing their surgical nature. Necrotising fasciitis continues to challenge the practicing surgeon. MATERIALS AND METHODS 50 patients of necrotising fasciitis were treated during the study period from August 2016 up to one year. Age, sex, associated co-morbid conditions, site of involvement, predisposing factors, addictions, clinical parameters like pyrexia, duration of symptoms, presence of hypotension are studied and compared. RESULTS 50 patients of necrotising fasciitis are treated during the study period. The age ranged from 22 to 71 years, the mean age being 44.5 ± 8.36 years. There were 38 males and 12 females. Male: female ratio is 3.17:1. Among 38 males, 6 patients died. This constitutes about 15.7%. Among 12 number of females 4 died. This constitutes about 33.3% mortality. CONCLUSION Necrotising fasciitis is more common in middle aged males. Diabetes mellitus is the most common co-morbid condition associated with necrotising fasciitis. Type I infection is more common. The presence of multiple co-morbid conditions reduces the survival. Early diagnosis and aggressive surgical debridement reduces mortality.

BACKGROUND Diabetic patients have reduced ability to metabolize glucose resulting in elevated blood sugar levels which further burdens the wound healing process. This leads to non-healing chronic ulcers. The sufferers of chronic diabetic foot ulcers are increasing globally due to lack of preventive and control measures. Sucralfate has been demonstrated in molecular studies to enhance the granulation tissue proliferation and thus promoting ulcer healing in the skin. Various clinical studies have also showed the efficacy of sucralfate in complete healing of the wound and in reducing the size of the wound. The purpose of this study was to compare the efficacy of topical sucralfate with that of povidone iodine dressing, in the healing of diabetic ulcers. METHODS This is a randomized comparative study. Among 100 patients, 50 patients received treatment in the form of povidone iodine dressings and 50 took treatment with sucralfate dressing. The patient underwent a detailed clinical examination. Relevant investigations were also done. The initial wound area was recorded after thorough debridement by measuring length x width. Both the groups underwent dressings once daily. The patients were followed up daily for a period of 3 weeks in both the groups. RESULTS In this study, the mean ± SD area of reduction of the ulcer was observed to be higher in sucralfate group 54.17 ± 10.08 than the povidone iodine group 16.07 ± 4.19. There was a statistically significant difference between the groups for the mean of area reduction (P < 0.0001, significant). CONCLUSIONS The ulcers in subjects treated with sucralfate dressing (S group) contracted more than the ulcers in the patients treated with povidone iodine (P group) (54.17 % Vs 16.07 %; P = < 0.0001, significant) which points out that sucralfate dressing is an effective modality in helping the reduction of wound area in patients with diabetic foot ulcers. KEYWORDS Diabetic, Sucralfate, Area of Reduction