Reduction in the risk of abdominal dehiscence with application of interrupted method of laparotomy closure and comparison with risk of burst with continuous method of closure. Three hundred forty eight patients undergoing laparotomy (114-elective gynecology, 114-emergency gynecology, 120-emergency surgery) were randomized into three arms to undergo closure with continuous, interrupted-X, and Modified Smead-Jones suturing techniques. Burst abdomen occurring up to 4 weeks of operation. Twenty-nine (8.33 %) of 348 patients developed burst in the post-operative period. 19 (15.70 %) of 121 patients in continuous arm developed burst. Five of 110 (4.55 %) patients in Interrupted-X arm and 5 of 117 (4.27 %) patients in Modified Smead-Jones arm developed burst. Interrupted suturing was associated with significant reduction in risk of burst when compared with continuous closure. Important predictors of burst were Intraperitoneal sepsis, cough, uremia, and surgical site infection.

Caroli’s disease is a rare congenital hepatobiliary disease characterized by multifocal segmental dilatation of intrahepatic bile ducts affecting all or parts of the liver. It predisposes to biliary stasis and consequent lithiasis, cholangitis, abscesses, and septicemia. Sometimes it is difficult to diagnose and differentiate it from other similar disease conditions. 60-year-old female presented with features of recurrent cholangitis with hepatolithiasis and multiple cyst in liver, cholelithiasis was planned for cholecystectomy and drainage procedure. Patient underwent open cholecystectomy with common bile duct (CBD) exploration with T-tube placement due to intraoperative instability. Post-operative T tube cholangiogram was done. Post-operative T tube cholangiogram showed bilobar major duct cystic dilatation with predominant left lobe involvement, with few cysts containing calculi. Patient was planned for left hepatectomy with bile duct excision but patient refused to undergo aforementioned surgery. Therefore ERCP and sphincterotomy was done in view of poor performance status.Caroli’s disease being a rare disease is sometimes difficult to diagnose and treat in an old age patient with bilobar involvement and poor general conditions.

BackgroundImpalement injury is an uncommon presentation in the emergency department (ED), and penetrating thoraco-abdominal injuries demand immediate life-saving measures and prompt care. Massive penetrating trauma by impalement in a pediatric case represents a particularly challenging presentation for emergency providers in non-trauma center settings.Case presentationWe report a case of 10 year old male who presented in our ED with an alleged history of fall from an approximately 15 foot tall coconut tree, landing over an upright bamboo stake approximately 50 centimeter long, resulting in a trans-abdomino, trans-thoracic injury. In addition to prompt resuscitation and hospital transfer, assessment of damage to vital structures in conjunction with surgical specialty consultation was an immediate goal.ConclusionThis article describes a case study of an impalement injury, relevant review of the available literature, and highlights the peculiar strategies required in the setting of a resource limited ED.

Introduction: Stress is a normal response of an organism to any threat which can be physical, emotional or psychological. Positive stress is called eustress whereas negative stress is distress. Neuronal plasticity is a term which indicates the changes in brain. There can be structural and functional neuroplasticity. Aim: To study the neuronal plasticity (dendritic branching pattern and their lengths) of pyramidal neurons in Prefrontal Cortex (PFC) of female wistar rats after immobilised stress. Materials and Methods: It was an experimental study conducted in Nepalese Army Institute of Health Sciences, Kathmandu, Nepal from May 2021 to July 2022. Based on the age, 24 female rats were divided into three groups, group A>12 weeks, group B 8 to 12 weeks and group C 3 to 7 weeks. Each group contained eight rats, of which four were control and four were experimental. Experimental rats underwent immobilised stress. After stress protocol, rats were sacrificed and PFC was taken out and stained. The images of neurons were taken by confocal microscope. The neuronal reconstruction was done using IMARIS software for dendritic lengths. The parameters in apical dendrite category-length of principal dendrite, branch points and lengths of different branches were compared between control and stressed groups. In basal dendrite category-number of basal dendrites, lengths of different basal dendrites and branch points were compared between control and stressed groups using unpaired t-test. The data was analysed with Statistical Package for Social Sciences (SPSS) version 20.0. Results: It was observed that there was a statistically significant increase in all basal dendrite parameters in experimental category as compared with controls in group A with p-value<0.001, and in group B, significant increase in branch points with a p-value<0.001 in experimental category, and significant increase in branch length of basal dendrites in group C of experimental rats with p-value<0.001. The parameters related to apical dendrites of pyramidal neurons also showed significant shrinkage in experimental rats as compared to control groups. Especially in group C all the apical dendrite parameters were significantly decreased compared with control group (p-values 0.013, 0.001 and 0.006 for principal dendrite’s length, branch points and branch lengths, respectively). Conclusion: Stress induces neuronal plasticity in pyramidal neurons of PFC of rats. Findings of this study suggest stress induces significant increase in the basal dendrite parameters of pyramidal neurons of PFC of all age group of rats, especially in the rats of more than 12 weeks age and significant shrinkage of apical dendrites was seen in all age group of rats and more so in the rats between 3 to 7 weeks of age.

Background: Dried human bones are essential to conduct osteology teaching learning sessions for health professional education, but its scarcity has been felt severely due to lack of simple and easy bone extraction method. Although several methods are practiced; they have their own fallacies. Hence, this study was conducted to explore simple and short method. Methods: A cross-sectional study was conducted in Nepalese Army Institute of Health Sciences (NAIHS) from April 2021 to October 2021 after obtaining ethical clearance from Institutional Review Committee, NAIHS (Reg. No- 424). Formalin fixed cadavers were used to obtain the bones by burial, maceration and chemical methods. In burial method, 600 bones were buried in the ground at 2 feet depth for six months just before monsoon. In maceration method, 200 bones were dipped in a bucket containing cow dung and water and left in the sun for 15 days. In chemical method, 50 bones were treated with washing soda for 19 hours. Remaining soft tissue was scraped, cleaned and bones were dried for 2 to 3 days. Results: Bones obtained by burial method were of good quality without any cracks but few soft tissue and mud was present which had to be cleaned manually. Bones obtained by maceration method was initially black in color. On chemical method, clean bones were obtained with few cracks. Conclusions: Among the above mentioned three methods, maceration method was less time consuming. Chemical method was faster but concentration of chemical should be proper to prevent cracks.