from the midline extending 5 cm above and below the ABSTRACT Umbilical hernia is one of the commonest ventral hernias constituting ten percent of all hernias. It affects obese individuals and has a high recurrence rate if repaired by suture techniques. Incarceration of the colon in an umbilical hernia is quite rare. A case of colonic incarceration in an umbilical hernia is presented to highlight the diagnostic and technical challenges in managing such a hernia. Contrast enhanced computerized tomography is essential to ascertain the contents. Open surgery is the main stay of treatment especially in such rare cases. A combined tissue and mesh repair provides excellent results.

Sacrococcygeal pilonidal sinus is a common presentation to the office of both the General Surgeon and Coloproctologist. Over time various treatment modalities have evolved for the same. Older methods such as excision with or without closure have been associated with higher complications in the post-operative period, recurrence rates and hospital stay. Flap procedures have a longer operative period and a steep learning curve but a better overall post-operative course and lower recurrence rates. Our study was done to compare the outcomes of primary excision and closure to a Limberg flap for treatment of sacrococcygeal pilonidal sinus. The objective of the study was to determine whether Limberg flap was superior to excision and primary closure for treatment of pilonidal sinus. 30 patients presenting with chronic pilonidal sinus where randomly assigned to two groups of 15 patients each. Both the groups were compared in terms of age of presentation, sex prediliction, duration of surgery, post-operative resumption of work, complications and recurrence. We concluded that Limberg flap is superior to excision and primary closure for treatment of pilonidal sinus.

Fifty smear-negative pulmonary tuberculosis patients underwent fibreoptic bronchoscopy. Bronchial aspirate smears of twelve patients and post-bronchoscopic sputum smears of fourteen patients were positive for acid-fast bacilli (AFB). Bronchial biopsy provided the diagnosis in 9 out of 30 patients. Brush smears were positive in 28 patients, being the only positive sample in ten cases. A high yield from brush smears was obtained due to their preparation from caseous material wherever visible in the bronchi. With these results a rapid diagnosis was established in 36 of the 50 patients. When culture results were available, a definite diagnosis of tuberculosis was made in 45 of the patients. The yield from brush smears was found to be significantly better when compared to bronchial aspirate smears (p less than 0.01) and post-bronchoscopic sputum smears (p less than 0.01).

Background: Although there is considerable evidence to suggest that varicose veins are less common in developing countries like ours, the absence of adequate epidemiological data leaves the question open. The objective of the study was to assess the risk factors and clinical features of patients with varicose veins in urban patients visiting surgical OPD.Methods: The present cross-sectional observational study was carried out in 60 patients having varicose veins. Clinical features and diagnosis were assessed and analysed using SPSS software.Results: Maximum number of patients 29 (48%) presented in the 31-50 years age group. 88.3% were males and 11.7% were females. 68.3% of patient’s belong to the group whose occupation involved prolonged standing. In 18.3% of patients, both legs were involved. Involvement of great saphenous vein was seen in 51 cases i.e. 85% and in remaining 9 cases (15%), small saphenous vein was involved. In majority of our patients, Doppler study revealed incompetency of perforators i.e. 26 (43.3%) followed by sapheno-femoral as well as sapheno-femoral with popliteal in 16 each i.e. 26.7%.Conclusions: The varicose veins occur in third and fifth decades of life. The occupations involving prolonged standing and violent muscular efforts are more prone for developing varicose veins. Presence of prominent swellings in lower limb and pain were the commonest presenting symptoms. Colour doppler ultrasonography is the investigation of choice in the management of varicose veins. Combined valvular incompetence is more common.

Cholesterolosis of the gall bladder or cholesterol polyps of the gall bladder have always been a contentious issue with respect to the role of prophylactic surgery in view of its asymptomatic state. Symptomatic cholesterol polyps behave similar to gall stones. There is therefore a need for a surgical algorithm to manage these lesions. A case of symptomatic cholesterol polyps of the gall bladder is reported to highlight the clinical presentation, imaging modalities and management strategies. Symptomatic cholesterol polyps of the gall bladder necessitate cholecystectomy. However, surgical intervention for asymptomatic polyps is guided by their size. Increased diameter is highly suspicious of a malignant potential requiring pre-operative staging and radical surgery.