Small bowel injuries in general are uncommon after blunt abdominal trauma and are usually due to high-energy deceleration injuries, often in relation to motor vehicle accidents and affect fixed segments such as duodenum, duodeno-jejunal (DJ) flexure, proximal jejunum and terminal ileum. High morbidity and mortality are associated with this type of injury when the diagnosis is delayed. Untimely management of such injuries, especially transection of the DJ flexure, results in high-output entero-cutaneous fistula. In total, eight cases of DJ flexure transection with/without associated multiple injuries were reviewed retrospectively. For DJ flexure transection in all cases, the flexure was adequately mobilised, and end-to-end duodenojejunostomy performed with two-layer interrupted sutures. A large calibre nasojejunal tube was placed through the anastomotic site before completion to protect the anastomotic area from the proteolytic action of large volumes of upper gastrointestinal secretions. In case of associated injuries, appropriate procedures were done. In DJ flexure transection, a timely management by end-to-end anastomosis with administration of nasojejunal tube beyond the site of anastomosis is an alternate, simple and safe procedure in comparison to difficult procedures such as pyloric exclusion and gastrojejunostomy in patients with delayed presentation.

Male breast cancer is an uncommon disease. The incidence of male breast cancer has been found to be gradually but steadily increasing. However, because of rarity of this disease, it is not exhaustively studied and discussed when compared to the female counterpart. The occurrence of a contralateral breast cancer in a male is much rarer. We are reporting a case of contralateral male breast cancer with a positive family history. This is an uncommonly reported entity. The relevant literature has been reviewed and a brief discussion on the current concepts on male breast cancer has been added.

BACKGROUNDDiabetic foot ulcer is very common now a days. It ranges from 15% to 25%. Various methods and dressing agents have been tried for dressing. In this study, silver nitrate in solution form as a dressing agent has been tried. MATERIALS AND METHODSA prospective study was conducted at MKCG Medical College, Berhampur, Odisha. Here, a total of 100 number of patients having diabetic foot ulcer were studied and consent for various procedures were obtained from them. Data regarding granulation tissue formation, pus culture and sensitivity report, skin graft acceptance and hospital stay were analysed in tabular manner. RESULTSAmong 100 study subjects, 50 were taken as control group and 50 as study group. The granulation tissue formation on 14 th day was 95% in study group and 82% in control group. Successful skin graft uptake was 94% in study group and 80% in control group. Hospital stay in study group was 25.6 ± 3.4 days and 35.3 ± 7.2 days. Pus culture sensitivity test on day 14 was positive in 6 cases in study group and 12 cases in control group. CONCLUSIONFoot ulcer is a common problem worldwide, among which diabetic foot ulcer is the commonest one. Various modalities of dressing methods and materials are available, but in my study silver nitrate in the form of solution form is a better option as compared to others. KEYWORDSDiabetic Foot Ulcer, Silver Nitrate, Granulation Tissue, Skin Graft. HOW TO CITE THIS ARTICLE: Bara BK, Pattanayak SP, Malla TK, et al. A study of silver nitrate solution in dressing of diabetic foot ulcer. J. Evid. Based Med.