BACKGROUND:Incisional hernia is a common surgical problem. Anatomical repair of hernia is now out of vogue. Polypropylene mesh repair has now become accepted. In open mesh repair of incisional hernia cases the site of placement of mesh is still debated. Some surgeons favour the onlay repair and others use sublay or retro-rectus plane for deployment of the mesh. AIM: The aim of the study is to examine the pros and cons of both the techniques and find the better one. METHODS: A prospective study was conducted of 37 cases of incisional hernia admitted in Govt. General Hospital Guntur from Jan 2012 to Dec 2013. 20 of the cases underwent open mesh repair by onlay method whereas 17 cases underwent open mesh repair by the sublay i.e. retrorectus placement of the mesh. Observations were made regarding time taken for both types of repairs, post-operative complications like flap necrosis, wound seroma, wound infecton, postoperative ileus etc., after discharge from the hospital the cases were followed up in the OPD upto Dec. 2014 and any complications and recurrences were noted. OBSERVATIONS AND RESULTS: Most of the cases (75%) were female and the incisional hernias were in the lower abdomen. The time taken for the surgery is more in the sublay group and the postoperative pain score is also more in the sublay group. But the wound complications like wound infection and flap necrosis were more (25-30%) in the onlay group. Also one case (5%) developed recurrence. Though the time taken for the surgery and the skill needed is more for the sublay group the wound complications are acceptable in the sublay group. Also there are no recurrences observed in the sublay group. But no statistically significant difference (p<0.7) is detected when all the post-operative complications are taken together between the sublay and onlay repair techniques. CONCLUSIONS: Although it can be argued, theoretically and by the wound complication rate, in favour of sublay placement of the mesh, still the quest continues for the ideal technique of hernia repair in the Indian scenario. A well-constructed randomised clinical trial is needed to find the best method of incisional hernia repair.

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As Anesthesia for the children undergoing cleft lip and palate repairs surgeries are associated with a variety of airway related problems, we have to study in detail about this kind of morbidity in the study group. OBJECTIVES: 1.To identify the demographic profiles of the study group. 2. To know the various airway complications developed among the study subject during intra and post-operative periods. STUDY DESIGN: It is an observational study. STUDY AREA: Department of Anesthesiology, Govt. General Hospital, Guntur. STUDY SUBJECT: Patients (Children) of cleft lip and cleft palate admitted in Govt. General Hospital for surgery. SAMPLE SIZE: 100 cleft lip and cleft palate patients. STUDY PERIOD: March 2012 to August 2013 Results: Among total study sample the mean age of the study group was 24.42 months, range 3-180 months with a median age of 19.8 months was observed and among all the study group 49% had primary cleft lip (CL), 47% had cleft Palate (CP) and about 4% had combined cleft lip and palate (CLP). In this study the mean age and mean weight with reference to cleft lip 15.08 months and 8.2 kg, cleft palate 34.06 months and 13.2 kg, both cleft lip and palate 31.75 months and 13.5 kgs respectively was observed. Related to air way complications about 4.7% of the patients developed desaturation followed by 4% ET tube Disconnection, 2.2% difficult intubation, 1.5% ET Tube compression, 1.8% airway edema, 0.5% laryngospasm and 0.5% Brochaspasm was observed in this study. It is observed that maximum 25% of air way complications were observed among the patients of both cleft lip and cleft palate followed by 15% in only, cleft palate and 10% only in cleft lip. Regarding air way complications in association with age about 15.7% were observed among preschool children followed by 13.6% observed in infants (<1 Year). CONCLUSION: Cleft lip and palate deformities had relatively more airway complications the common complications are desaturation, endotracheal disconnection and difficult intubation. This can be reduced by anesthesia expertise, meticulous monitoring and postoperative care.

BACKGROUND:The incidence of traumatic brain injury is increasing day by day and it is the major cause of morbidity & mortality in our country. So we have to study in detail about this kind of morbidity, mortality in the study group. OBJECTIVES: (1) To study traumatic brain injury in age and sex wise distribution. (2) To know the nature of the injury (3) To know the modified Glasgow coma scale score analysis in TBI. (4) To know the Traumatic Brain Injury patients out come by grading in Glasgow outcome scale. STUDY DESIGN: It is an observational study. STUDY AREA:

BACK GROUND:To study and compare the efficacy and safety of intra vaginal misoprostol versus intra cervical dinoprostone gel for cervical ripening and induction of labour. Objectives: 1. To study and compare efficacy and safety of misoprostol and dinoprostone gel. 2. To study the success rate and outcome of induction 3. To Study the average induction -delivery interval 4. To study the side effects during induction with these drugs. DESIGN: It is a prospective study. STUDY AREA: Department of Obstetrics & Gynecology, Government General Hospital, Guntur, affiliated to Guntur Medical College. STUDY SUBJECT: Antenatal Women. SAMPLE SIZE: 100 Antenatal women who were admitted in Antenatal ward in Department of Obstetrics. STUDY PERIOD: September 2013 to September 2014. RESULTS: 100 antenatal women requiring induction of labour were followed 50 received 25 g misoprostol 4 th hourly, 0.5 mg of intracervical dinoprostol gel 12 hourly. The result of the study shows induction delivery interval was significantly shorter in misoprostol group than dinoprostone group. Caesarean section rate is low in misprostol group compared to dinoprostone group. With the lower dosage of misoprostol, no maternal complications were observed and foetal complication i.e., meconium stained liquor was seen in 8% of misoprostol group, but Apgar score was good in both group. CONCLUSION: On basis of our study misoprostol is an effective and safe drug to mother and foetus, easy to administer, and stable at room temperature, and misoprostol is a cheaper drug better and effective alternate to dinoprostone gel in a women belonging to resource constrained developing countries.