Gastro pleural fistula is an infrequently seen lesion. Here, a case of stab injury to the chest that led to the formation of a gastro pleural fistula has been presented. An intercostal drainage (ICD) tube was inserted after haemothorax was identified on this chest X-ray. The patient noticed the presence of ingested food particles at the site of ICD tube twelve days following the stab injury. The diagnosis of gastro pleural fistula was subsequently confirmed after a contrast enhanced computed tomography (CECT) of the chest and abdomen. Intraoperatively, a defect in the left hemi diaphragm with a fistulous tract between stomach and the left pleural cavity was identified. Closure of the gastric fundal perforation, excision of the fistulous tract and repair of the diaphragmatic defect was done.

Background. Chronic postherniorrhaphy groin pain is defined as pain lasting >6 months after surgery, which is one of the most important complications occurring after inguinal hernia repair, which occurs with greater frequency than previously thought. Material and Methods. Patients undergoing elective inguinal hernioplasty in Victoria Hospital from November 2011 to May 2013 were included in the study. A total of 227 patients met the inclusion criteria and were available for followup at end of six months. Detailed preoperative, intraoperative, and postoperative details of cases were recorded according to proforma. The postoperative pain and pain at days two and seven and at end of six months were recorded on a VAS scale. Results. Chronic pain at six-month followup was present in 89 patients constituting 39.4% of all patients undergoing hernia repair. It was seen that 26.9% without preoperative pain developed chronic pain whereas 76.7% of patients with preoperative pain developed chronic pain. Preemptive analgesia failed to show statistical significance in development of chronic pain (P = 0.079). Nerve injury was present in 22 of cases; it was found that nerve injury significantly affected development of chronic pain (P = 0.001). On multivariate analysis, it was found that development of chronic pain following hernia surgery was dependent upon factors like preoperative pain, type of anesthesia, nerve injury, postoperative local infiltration, postoperative complication, and most importantly the early postoperative pain. Conclusions. In the present study, we found that chronic pain following inguinal hernia repair causes significant morbidity to patients and should not be ignored. Preemptive analgesia and operation under local anesthesia significantly affect pain. Intraoperative identification and preservation of all inguinal nerves are very important. Early diagnosis and management of chronic pain can remove suffering of the patient.

A 73-year-old male patient presented to the casualty with history of pain abdomen since 3 days, abdominal distension, inability to pass flatus and vomiting since 2 days and fever since 1 day. Patient had history of surgery 6 years ago. He had undergone a laparotomy for drainage of appendicular abscess. However, patient was unsure whether an appendectomy was done and there were no records of previous surgery. No other significant history could be elicited. On examination, patient was tachycardic, tachypnoeic and mildly dehydrated. Patient's abdomen was distended and there was a right paramedian and drain scar in the right iliac fossa. His bowel sounds were exaggerated. Ryle's tube was inserted and aspirate had feculent material. Patient was resuscitated with intravenous fluids and routine investigations were sent. Patient's erect abdominal X-ray had multiple air-fluid levels and features were suggestive of small bowel obstruction [Table/ Fig-1]. Ultrasound of the abdomen showed dilated small bowel loops with to and fro motion and appendix could not be visualized. With a preoperative diagnosis of small bowel obstruction secondary to postoperative adhesions, patient was posted for an exploratory laparotomy after taking an informed and written consent. Intraoperatively, no significant adhesions were found but the appendix was inflamed and had curled around the terminal ileum. The appendix was acting as a tourniquet around the terminal ileum about 8-10 cm from the ileocaecal junction and was causing the obstruction [Table / Fig-2,3]. Appendectomy and a mid-ileal enterotomy to empty the small bowel content were performed. Postoperatively, the patient recovered well and was sent home six days after surgery.Histopathological examination of the specimen revealed confluent mucosal ulceration and replacement of the mucosal layer by purulent debris. There was a transmural inflammation noted consisting of neutrophils and occasional eosinophils. These microscopic findings confirmed the intraoperative finding of acute appendicitis. Intestinal obstruction is one of the common surgical emergencies seen in daily practice. Postoperative adhesions are notorious for being the most common cause for intestinal obstruction. Occasionally, laparotomy findings do come as a surprise to surgeons. Here one such case is discussed. A patient was operated on with suspicion of intestinal obstruction secondary to postoperative adhesions. However, laparotomy revealed the appendix to be inflamed, curled around the terminal ileum and acting as a tourniquet. Surgery Section

Occlusal plane is an essential consideration when multiple long-span posterior restorations are designed. When restorations are added to an existing tooth arrangement characterized by rotated, tipped, or extruded teeth, excursive interferences may be incorporated, resulting in detrimental squeal. The curve of Spee, which exists in the ideal natural dentition, allows harmony to exist between the anterior tooth and condylar guidance. This curve exists in the sagittal plane and is the best viewed from a lateral aspect. It permits total posterior disclusion on mandibular protrusion, given proper anterior tooth guidance. It is unclear that whether the curve of Spee is a description of the occlusal surface of each arch separately or in maximal intercuspation. The purpose of this study was to examine the differences in the depth of curve of Spee between the class I, class II, class III and to investigate the relationship of depth of curve of Spee with over jet, over-bite.