BACKGROUND AND AIMS: Laryngeal mask airway (LMA), an alternative airway device, provides and maintains a seal around the laryngeal inlet for spontaneous ventilation as well as modest level of positive pressure ventilation. But LMA requires a sufficient depth of anaesthesia& depression of airway reflexes to avoid adverse reactions like gagging, coughing, head & limb movements etc. We intended to test the efficacy of Thiopentone and Midazolam combination as an effective alternative to Propofol for insertion of LMA. MATERIALS AND METHODS: One hundred twenty patients (18-34 years) posted for different minor procedure (<45 min) under general anaesthesia were divided into 2 equal groups (Group TM & P) in a randomized, double-blind fashion. In group TM (n=60) Thiopentone 5mg/kg+ Midazolam 0.05 mg/kg and group P (n=60) Propofol 2.5 mg/kg was administered prior to insertion of LMA. Then the inserting condition (jaw relaxation, gagging, coughing, hiccup, laryngospasm & head and limb movement) were evaluated into 3 point scale. The response will be graded as Mild (Transient and minimal), Moderate (Response lasted not >20 sec) and Severe (Sustained >20sec or needed Propofol to allow LMA insertion). RESULTS: Propofol is superior to combination of thiopentone-midazolam, in terms of achieving conditions like jaw relaxation, coughing & suppression of gagging during LMA insertion but regarding other variables like laryngospasm, hiccup & patient movement, which are equally important prerequisites for successful LMA insertion, there was not much statistically significant difference found between propofol and combination of thiopentone-midazolam. CONCLUSION: Combination of thiopentonemidazolam effectively blunts airway reflexes and adequately facilitates laryngeal mask airway insertion which can be comparable to propofol.

BACKGROUND: The last several decades have witnessed significant advances in the surgical management of carcinoma breast. Many have embraced breast conservation as the procedure of choice in carefully selected patients. It provides excellent cosmetic results side by side being oncologically safe. Recent evidences have shown that involvement of nipple areola complex in breast cancer have been over estimated in the past based on older concept of occult tumor in the region of nipple and areola. Preservation of nipple and areola improves the quality of life and reduces the feeling of mutilation and thus is a logical step in conservative management of breast carcinoma. AIMS: (a) To investigate the actual involvement of nipple areola complex clinically and histopathologically. (b) To determine the associated risk factors like site, size, distance, grading and lymph node status. MATERIALS AND METHODS: This was a prospective study over a period of 2008-2011 carried out at Department of General Surgery of a tertiary care centre. Total number of patients included in the study was 54. All patients included in the study had undergone mastectomy for carcinoma of breast (excluding those patients who had clinical involvement of nipple areola complex). RESULTS: Among the patients of the study group majority of breast cancer occurred in age group 41-60 years (42.6%) while incidence of nipple areola involvement was highest in age group 20-40 years. Majority of the patients detected with breast cancer were in stage II (44.4%) while incidence of nipple areola involvement was highest in stage IV in our study. Mean largest dimension of the tumor was between 2-5cms while nipple areola involvement was found to be highest when the tumor is >5cms in largest dimension. Among the cases mean nipple tumor margin distance was between 0-4cms while nipple areola involvement was found to be highest when the nipple tumor margin distance was < 2cms. CONCLUSION: It can be concluded that nipple areola complex sparing mastectomy is an attractive and safe procedure for early breast cancer

Physiological consequences are inherent to the procedure of bronchoscopy. Sixty patients who underwent bronchoscopy at the Medical College Hospitals, Calcutta, India, were studied to determine the changes that occur during bronchoscopy. Of these twenty were consecutive adult patients who underwent rigid bronchoscopy under general anaesthesia (Group I). Twenty were consecutive adult patients who had flexible bronchoscopy under local anaesthesia (Group II). Ten consecutive paediatric patients underwent rigid bronchoscopy with spontaneous ventilation under General Anaesthesia (Group III) and ten were operated with controlled ventilation (Group IV). Heart Rate, Blood Pressure SpO 2 and ECG were monitored during and upto 60 minutes after the procedure.Heart Rate changes were minimal in Group I but maximum in Groups II and III. Procedures like suctioning & Bronchoalveolar Lavage (Bal) were associated with fall of SpO 2 , SpO 2 was best maintained in the fourth group. Three patients out of forty adults patients had Electrocardiogram (ECG) changes. Significant Mean Arterial Pressure (MAP) rise was seen in adults, but this was not significant in children. General Anaesthesia failed to modify the rise of MAP observed in adults.

Tuberculosis is a prevalent disease entity in India, but its occurrence beyond ileocaecal junction is rare. We present a middle aged male patient with a fleshy nodular mass around anus which was clinically suspected as carcinoma of anal canal. Surgical biopsy revealed caseating granulomata and acid fast stain of the section demonstrated the presence of numerous acid fast bacilli. Pulmonary tuberculosis was detected as the primary lesion. Tuberculosis must be included as a differential diagnosis in recurrent nodular and ulcerated lesions of anal canal.