Introduction:The spleen plays an important role in immune-surveillance and haematopoiesis. Its role in the fight against infection, especially infection of encapsulated organisms, is particularly significant. It also removes intracellular inclusions (pitting) and filters aged blood cellular elements from circulation. Aim: This study aims at the indications for elective splenectomy and the outcomes at a tertiary care centre. Materials and Methods: We conducted a Prospective observational study done for 3 years. Total 42 patients who underwent splenectomy, both emergency and elective were included for data collection. Inclusion criteria for the study were all the patients undergoing splenectomy. The spleen was approached via an upper midline or left subcostal incision. Results: In 42 patients with splenectomy M=mean age of the patients was 37.9 ±15.42 years, of which 23(54.8%) are males and 19(45.2%) were females. A majority of the patients were in the age group of 18-45 years. Most common indication was haematological in 42 patients, of which 20 (47.6%). traumatic Idiopathic Thrombocytopenic Purpura (ITP) cause have 8 patients (19%).Most of the patients 3 (60%) patients have complications after trauma. Conclusions: Most cases of splenectomy in our centre caused by trauma, and among the different types of trauma, blunt trauma is the dominant cause. splenectomy must be undertaken only after anticipating both, short-and long-term risks and potential benefits to the patient.

Background: Perforations of peptic ulcer are third in frequencies, acute appendicitis and acute intestinal obstruction being more common. Prompt recognition of the condition is very important and only by early diagnosis and treatment it is possible to reduce the still relatively    high mortality. The aim of this study was to review and study the factors influencing, the outcome of the duodenal perforations. Subjects and Methods: A clinical study was conducted in 50 cases of diagnosed duodenal ulcer perforation that was established by the admitting surgeon, based on clinical features and supposed by radiological evidence and confined at operation. This study comprises of 50 cases of duodenal ulcer perforation admitted in period from January 2017 to January 2020. Results: In present study, out of total 50 patients with duodenal ulcer 46(92%) males and 5(8%) females, with male predominance. Highest incidence was found between 41-50 years followed by 21-29 years. Most of the patients admitted by 12-24 hours, common site of ulcer is prepyloric in presentation. Duodenal ulcer perforations were single perforation, while two cases of ileal perforations were multiple. Smoking is main predisposing cause of ulcer. ARDS were 14% (7 patients) and it was observed that 32 percent (16 patients) having wound complication, 2 percent (‘1 patient) having mortality and 46% (23 patients) have no complications. In this present study, 60% of patients had h/o Peptic ulcer. On X- ray, 90% of patients had finding of air under diaphragm. Conclusion: The mortality in perforated duodenal ulcer has been reduced owing to early approach to hospital, diagnosis, prompt surgical treatment and appropriate and adequate antibiotics. Smoking and alcohol consumption and life style modification may reduce morbidity and mortality in patients with duodenal perforation.

In this article, we develop a new method of construction of E-optimal generalized group divisible designs through group testing designs. Keywords: Balanced Incomplete Block Design (BIBD); Group Divisible (GD); Generalized Group Divisible Design (GDD); E-optimality. © 2009 JSR Publications. ISSN: 2070-0237 (Print); 2070-0245 (Online). All rights reserved. DOI: 10.3329/jsr.v1i1.1697

Background: Major hepato-biliary surgeries carry a high risk for post-operative sepsis. Recent therapeutic advances both medical and surgical have improved early post-operative outcome. Considering the difficulties in diagnosis of infection in critically ill patients an early sensitive  and specific marker for sepsis would be of interest. Studies have shown that C - reactive protein (CRP) and pro calcitonin (PCT) are acute phase reactants and good independent early markers of post-operative sepsis, severe or septic shock. This aspect has not been evaluated in     the hepatobiliary surgeries. More over there is no data available from the Indian sub-continent in this aspect. This study aims to evaluate the efficacy of serum CRP and PCT levels after hepatobiliary surgery for diagnosis of postoperative complication. Subjects and Methods: This is a cross-sectional diagnostic study has conducted in 42 patients who all are satisfying the inclusion criteria. Study duration was From August 2017 to July 2019, conducted on patients between 18-80yrs of age undergoing hepato-biliary surgery, in surgical wards of PK Das Institute     of Medical Sciences. Study variables include age, sex, pre-operative serum albumin level, pre and post-operative S.CRP AND S.PCT levels. On post-operative day 4 and day 7 S.CRP and S.PCT are monitored and its predictability also measured. . Descriptive statistical analysis will be carried out using SPSS (IBM). The p-value of less than 0.05 will be taken as significant. Results: out of 42 patients studied, 30 patients developed post-operative complications. Pre-operative serum C - reactive protein and serum procalcitonin measured compared with pre-operative serum albumin was significant identifying post-operative complications (P-value 0.02). On post-operative day 4 and 7value was significant in post-operative patients with P-value of 0.04 vs. 0.046 respectively. Similarly serum procalcitonin values also were significant on postoperative day (POD) 4 and 7 with P-value of 0.02 and 0.03. Sensitivity and specificity of S.PCT was more compared to S.CRP (92 vs 90% in sensitivity and 100% vs 80% in specificity respectively. This study shows those who were clinically septic post operatively have statistically elevated levels of serum CRP and Procalcitonin. Conclusion: S.PCT is more sensitive and specific as a marker of post operative infection following hepato biliary surgery. Early identification of patients with insidious septic illness allows early therapeutic intervention which may favorably influence outcome.

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