INTRODUCTIONBreast abscess is common in lactating females. The incidence of breast abscess ranges from 0.4 to 11% of all lactating mothers.1 Risk factors for the development of breast abscess are milk stasis by duct blockage, stress, sore nipples or infrequent breastfeeding. Other risk factors for abscess formation include maternal age over 30 years, gestational age greater than 41 weeks and a history of mastitis. The pathogen most commonly Staphylococcus aureus enter into breast via cracked nipple specially in primipara due to inexperience, poor feeding technique and poor attachment by baby.2 Breast abscess is common in developing countries due to poor maternal hygiene, decreased nutrition, poor standard of living, delay in antibiotics administration and poor breastfeeding techniques. Patient having breast abscess presents with symptoms of pain, swelling and redness of the involved breast. There may be associated fever, malaise and occasionally rigors.Traditional treatment of breast abscesses is by surgical incision and drainage which is followed by digital disruption of septa, evacuation of contents with occasional placement of surgical drains.Recently ultrasound guided aspiration has been tried for treatment of breast abscesses where a thick needle, preferably 16G, is inserted into the abscess cavity and contents are aspirated until the cavity is collapsed. Breast abscess being a common problem needs further evaluation for its definitive treatment.To go for conventional yet definitive form that is incision and drainage or to go for ultrasound guided aspiration is the question which still needs answering. ABSTRACTBackground: Incidence of breast abscess is 0.4 to 11% of all lactating mothers. Traditionally the treatment of breast abscess has been incision and drainage. Recently aspiration under ultrasound guidance is emerging as another treatment option and rapidly replace incision and drainage Methods: Authors carried out a prospective, randomized study involving 50 lactating women with breast abscess. In group A -25 patients were managed by ultrasound guided needle aspiration and in group B -25 patients were managed by incision and drainage. Results: In patients of group A, most breast abscesses resolved with one or two aspirations only, with early healing and lesser number of hospital visits as compared to patients in group B. There was no surgical scar and early resumption of breastfeeding was seen in group A. Conclusions: Ultrasound guided percutaneous aspiration is an effective modality of treatment of lactational breast abscess and it should be the first line of treatment, especially for smaller and unilocular breast abscesses while incision and drainage should be reserved for larger and multilocular abscesses with imminent skin changes.

INTRODUCTIONVaricocele has first been described as early as first century B.C.1 Celsus wrote "when the disease has spread over the testicle and its cord, the testicle sinks a little lower and becomes smaller than its fellow, in as much as its nutrition has become defective". The earliest description of varicocele in the modern literature was in 1885 by Barwell.1 Varicocele is a very common finding in young men. It is an abnormal enlargement and tortuosity of the pampiniform plexus of veins in the spermatic cord.2 The prevalence of varicocele is approximately 15% in general population, 25%-40% among men with primary infertility and 45% to 81% among men with secondary infertilty.2 Isolated left-sided lesions are seen in 78% to 93% of varicocele patients, ABSTRACTBackground: Despite various studies published in the recent years, efficacy of varicocelectomy and its influence on semen parameters, particularly sperm count, motility and morphology has not yet been determined. Conflicting results obtained in different studies, accounts for sparked interest in varicocele management and its effects on seminal parameters. Therefore, present study was designed in an attempt to evaluate the effect of varicocelectomy on the semen parameters by analyzing reports that included men with varicoceles who had both preoperative and postoperative semen examination done. Methods: The present prospective study enrolled fifty patients. Varicocele was graded by Dubin grading system by palpation in standing and during Valsalva maneuver under adequate exposure and illumination. Macro and microscopic assessment of semen samples was carried out according to WHO guidelines. The surgical approach used for varicocelectomy was inguinal (Modified Ivanissevich procedure). Results: Significant improvement in semen parameters viz sperm counts/ml, sperm counts/ejaculate and sperm motility were observed after varicocelectomy. We noted no effect of patient's age on the degree of improvement in semen parameters post operatively. Preoperatively, men with Grade III varicoceles had lower sperm counts and sperm motility, but significant improvement was observed post-operatively compared to men with Grades I and II varicoceles. Conclusions: Our study supports the fact that, varicocele exerts a deleterious effect upon sperm motility, concentration and repair of varicocele leads to improvement in these seminal parameters. The repair of larger varicocele seems to be a predictor for better post-repair semen parameters. Varicocele is a treatable cause of male infertility (primary and secondary), so patients undergoing varicocelectomy should have a pre-operative and postoperative semen examination done routinely.

Background: There are many challenges in treating patients who engage in deliberate foreign-body ingestion as a method of self-harm. Whereas other forms of mutilation may be dangerous to patients and distressing to their treaters, foreign-body ingestion carries a sense of insidiousness in the lack of outward evidence that harm has been done and in the latent risk of further injury even after a diagnosis has been made. Case Report: Here we report a case of foreign body ingestion in a patient with psychiatric illness and discuss what is known about deliberate foreign-body ingestion and some of the clinical problems they pose, with a focus on medical literature regarding the diagnosis and treatment of such cases. Conclusion: Timely counseling and psychiatric support is essential for foreign body ingestions.

Background: GM-CSF has been demonstrated to be effective in reducing the incidence of infection in patients who receive myelosuppressive anticancer chemotherapy or patients who are neutropenic and agranulocytic. We study the role of GM-CSF in non-neutropenic patients with Systemic Inflammatory Response Syndrome (SIRS), infections and sepsis with impaired neutrophil function to access the current rationale for administering GM-CSF in addition to standard antibiotic therapy to critically ill patientsMethods: All patients undergoing surgery for peritonitis due to gastrointestinal perforations were included in this study and were divided into two groups alternatively to avoid any bias i.e. Group A 1, 3, 5 etc. and Group B 2, 4, 6 etc. Group A - all patients received GM-CSF along with standard antibiotics. Group B patients received antibiotics only. Course of patient in immediate postoperative period, time to improvement, duration of hospital stay, antibiotic therapy, rate of complications were compared.Results: Patients in group A had a lower duration of antibiotic therapy and hospital stay. Patients in group A took less time to show clinical improvement compared to patients in Group B. Group A also had a much lower rate of infectious and systemic complications compared to group B. Conclusions: Results of the present study show that GM-CSF is an important molecule when used as adjunct to antibiotics in cases of abdominal sepsis. Use of this growth factor is associated with less incidence of septic complications and morbidity, a shorter duration of antibiotic therapy and hospital stay without significantly compromising the cost. The results of present study help in identifying its role in non-neutropenic patient groups who are most likely to benefit from its administration.

Background: Duodenum is the second most frequent location for a diverticulum in the digestive tract next to the colon. Duodenal diverticulum occurs in 20% of the general population and is generally asymptomatic. Complications such as perforation are exceedingly rare, with only few cases reported in the literature. Case Report: Here, we present a case of a 70 year old, male patient who was admitted with acute abdomen and intra-operatively diagnosed as perforated duodenal diverticulum. Conclusion: Early diagnosis of perforated duodenal diverticulum is a challenge and clear guidelines for the management of this rare entity is still lacking.