Introduction: Benign prostatic hyperplasia (BPH) is a progressive condition characterized by prostate enlargement accompanied by lower urinary tract symptoms (LUTS). Benign prostatic hyperplasia arises in the periurethral and transition zones of the prostatic gland and represents an inevitable phenomenon for the ageing male population. An estimated 75% of men>50 years of age have symptoms arising from benign prostatic hyperplasia, and 20–30% of men reaching 80 years of age require surgical intervention for the management of BPH. Prostate specific antigen (PSA) is a serine protease produced by the prostate epithelium and periurethral glands in male. Serum PSA elevation occurs as a result of disruption of normal prostatic architecture that allows PSA to diffuse into prostatic tissue and gain access to the circulation. Benign prostatic hyperplasia, prostatic carcinoma and prostatitis are three common diseases where PSA in the serum is raised. Aims and objectives: To evaluate the PSA level and To find out the relationship between serum PSA level and the volume of prostate in Benign hyperplasia of prostate. Material and Methods: This is a Hospital based prospective study which was conducted in the Department of Surgery at Nepalgunj Medical College Teaching Hospital, th th Kohalpur, for a duration of 1 year from 13th July 2015 to 12th July 2016. A total of 30 cases were studied. Patients were chosen for the study on the basis of clinical history and DRE. Patient with LUTS symptoms and enlarged Prostate on DRE were further subjected to PSA screening through blood examination and Transabdominal ultrasound for measuring prostatic volume. Patients were explained about procedure and following consent, patients were subjected for TURP under spinal anesthesia/general anesthesia. Specimen was sent to the Department of Pathology, Nepalgunj Medical College for Histopathological evaluation. Results: Out of 30 patients, one patient was of 44 years of age, rest of them were above 50 years of age and the mean age was 63.9±8.64 years. All the patients had voiding problems, of which 28 patients (94%) had obstructive symptoms and 27 patients (90%) had irritative symptoms. Most patients had history of nocturia which was present in 24 patients (83%). Mean PSA level was 6.36 ng/ml with a range of 3.2-12 ng/ml. Mean prostate volume measured by TAUS was 60.30 ml. and that by DRE was 38.33 ml. There was statistically significant positive correlation between PSA level and prostate volume measured by TAUS with Pearson's correlation coefficient (r=0.679). Conclusion: The analysis of present study consisting of 30 patients showed that mean PSA and prostate volume increased with advancing age, and the correlation between PSA and prostate volume estimated by TAUS in BPH as found to be statistically significant (p< 0.05). DRE underestimated the volume of prostate with a mean difference 21.97 ml. The correlation of age of the patient with PSA and prostate volume are (r=0.128) and (r=0.036) respectively. The above value shows that both are statistically weekly positive but the association between age of patient and PSA seems to be higher in comparison to age of the patient and prostate volume.

Introduction: Peptic ulcer is an insult to the mucosa of the upper digestive tract. Helicobacter pylori infection, long term use of non-steroidal anti-inflammatory drugs or steroids, excessive alcohol ingestion and smoking are common etiological factors. A number of scoring systems for prediction of outcomes in perforated peptic ulcer patients have been developed such as Predictive score of mortality in perforated peptic ulcer score and Boey score. Aims: To evaluate Predictive score of mortality in perforated peptic ulcer score and Boey Score in predicting accuracy of mortality in patients with peptic ulcer perforation. Methods: A hospital based study was conducted from June 2021 to May 2022 in the department of Surgery, Nepalgunj Medical College, Kohalpur. The Predictive score of mortality in perforated peptic ulcer and Boey score were recorded after history taking, physical examination, basic pre-operative investigations and radiological imaging. The patients were classified into high risk and low risk categories based on scores and followed up to predict the mortality within 30 days post operatively. Results: 80 patients were included in the study. 53 were male and 27 female. Peptic ulcer perforation was seen more in age groups of 45 to 60 years. In Boey score 8 patients out of 27 high risk patients died whereas in Predictive score of mortality in perforated peptic ulcer score 8 patients died out of 12 high risk patients. When compared, predictive score of mortality in perforated peptic ulcer was found to be more accurate than Boey score (p-<0.05) score. Conclusion: Predictive score of mortality in perforated peptic ulcer is easy to use and more accurate in predicting mortality in peptic ulcer perforation than Boey score.

Introduction: Acute pancreatitis a disorder that has numerous causes and an obscure pathogenesis. It can be a serious abdominal emergency associated with significant morbidity and mortality. Cholelithiasis is most common cause of acute pancreatitis and excessive alcohol consumption is second most frequent cause which together account for approximately 80% of underlying etiology. The detection of biliary etiology is crucial to delivery of definitive therapy to prevent repeated attacks of acute pancreatitis. During an attack of acute pancreatitis, elevation of alanine aminotransferase to >150 IU/L is a predictive factor for biliary cause of acute pancreatitis. Aims: To investigate the predictive value of raised alanine aminotransferase in determining biliary etiology in patients presenting with acute pancreatitis. Methods: A prospective study was done among 70 patients who were admitted in surgery department over a period of one year with diagnosis of acute pancreatitis. Peak alanine aminotransferase within 48 hours of presentation was recorded. The diagnosis was based on typical clinical presentation of acute pancreatitis combined with an increase in serum amylase levels ≥ 3 times the upper limit of the laboratory reference value. All biliary cases were confirmed by abdominal ultrasonography. Results: The mean age of the patients was 47.9 ±15.7 years (19-88 years). Acute pancreatitis was common in 31-40 years of age group. Among them, 40(57.1%) were male and 30(42.9%) were female. Forty two (60%) patients had biliary pancreatitis, 20(28.5%) had alcoholic pancreatitis, 2(2.8%) patients had drug induced pancreatitis and 6(8.5%) patients had idiopathic pancreatitis. Mean alanine aminotransferase for biliary pancreatitis was 205.9U/L, while cases with other etiologies (alcoholic 58.4U/L; drug induced 62.6 U/L; and idiopathic 48.3 U/L) showed significantly lower values (p=0.001). Conclusion: An elevated alanine aminotransferase strongly supports a diagnosis of gallstones in acute pancreatitis.

Introduction: Wound closure after midline laparotomy is an essential part of surgery to produce a healthy and a strong scar. There is an alternative interrupted method of closure as compared to conventional continuous method of closure. Many comparative studies have shown different outcomes. So, we wanted to evaluate the outcome of different techniques in our setting. Aims: To compare the outcome of Interrupted abdominal closure and continuous abdominal closure in midline laparotomy wound. Methods: This was a prospective comparative study conducted in the Department of Surgery of Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal for a duration of 1 year. A total of 60 patients were selected randomly to receive either continuous or interrupted abdominal closure in midline laparotomy wound. Wound was evaluated in terms of wound discharge, infection and wound dehiscence. Results: The mean age of the patients was 38.38 years. Most commonly, the patients presented with duodenal ulcer perforation with peritonitis. The average time taken for abdomen closure in group A (16.77 minutes) was significantly less as compared to group B (27.77 minutes). The average cost of sutures for group B (Rs 1322.97) was higher than that of sutures for group A (Rs 1118) with p value of <0.01. Wound infection and incidence of burst abdomen were similar in both groups after one month, suture sinus was seen in three patients of group A and four patients of group B (p = 1.0). Incisional hernia was seen in one patient of group A and in none of the patients of group B at three month’s follow-up (p = 1.0). Conclusion: Continuous technique of midline laparotomy wound closure is better in terms of time required for wound closure and costing of suture materials, while showing no difference in terms of wound infection, burst abdomen and late wound complications

Introduction: Acute Pancreatitis is a common disease in our region. It can range from mild to severe disease with high mortality rate. It is critical to identify patients who are at high risk for a severe disease course, since they require close monitoring and immediate aggressive treatment. Aims: To compare the effectiveness of Harmless Acute Pancreatitis Score with Ranson’s scoring system in predicting the severity of Acute Pancreatitis. Methods: A prospective cross sectional study was done among 45 patients who were admitted in surgery department over a period of one year with diagnosis of acute pancreatitis. If haematocrit was less than39% in female and less than43% in male, serum creatinine less than two miligram /deciliter and no sign of peritonitis, it was assigned as Harmless Acute Pancreatitis Score Zero. If at least one parameter was abnormal it was assigned as Harmless Acute Pancreatitis Score +. Severe pancreatitis (poor prognosis) was considered in those who required Intensive Care Unit care, who had in hospital mortality and who had hospitalization of more than five days. Patients with on admission Ranson’s score of more than three were suspected to have severe Pancreatitis. Results: There were total 45 patients, 18 females and 27 males. Twenty four patients were assigned as Harmless Acute Pancreatitis Score zero and 21 patients were assigned as Harmless Acute Pancreatitis Score +. Harmless Acute Pancreatitis Score was able to predict correctly in 18 out of 26 patients who fulfilled the criteria of poor prognosis (p<0.001). Conclusion: Harmless Acute Pancreatitis Score proved to be a better screening tool compared to on admission Ranson’s scoring system to predict the severity of Acute Pancreatitis, which may help predict the prognosis of the patient.