Vascular complications arise in uremic patients in the absence of clinically significant atherosclerotic disease. Elevated serum parathyroid hormone (PTH) and abnormal calcium (Ca) and phosphorus (P) balance have been implicated in vascular damage in chronic kidney disease (CKD) patients, but there is lack of histo-pathological studies. Patients with CKD stage 5 and 5D who underwent arterio-venous fistula were included in this study. Baseline and laboratory parameters including assessment of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, uric acid, albumin, calcium, phosphorus, intact PTH (iPTH) and vitamin D level were documented. The specimens of the arterial wall were obtained during the procedure and were analyzed. Patients were divided into two groups iPTH <400 (Group A) and iPTH >400 (Group B). Mean intimal thickness (IT) was significantly high in patients of Group B (60.4 ± 24.1 μ m) as compared with patients of Group A (37.8 ± 14.9 μm) (P = 0.003). Vascular calcification was comparable in both groups. The iPTH level was found to be an independent risk factor for high intima thickness (correlation coefficient 0.653) (P-value <0.01). Patients with high (≥ 400 pg/mL) iPTH have 8.93 times the risk of developing intimal thickness of ≥ 60 μ m as compared with patients with low (<400 pg/mL) iPTH (P-value <0.05), with 95% confidence interval of 1.27, 62.61. The mean IT of the radial artery significantly correlated with the iPTH level, while vascular calcification was independent of the iPTH level. Hyperparathyroidism is an important cause of ongoing vascular damage and may contribute to higher vascular events in CKD patients.

Thromboangiitis obliterans (Bureger’s disease) is a vascular disease characterized by a segmental, non-atherosclerotic inflammation of the small and medium-sized arteries and veins of the distal extremities mostly affecting young male smokers and rarely females. Only a few cases with histologic proof of the disease in females have ever been recorded in literature. We report a rare case of Buerger’s disease in a 55 years old female.

Background: The establishment of pneumoperitoneum is a prerequisite for all laparoscopic surgeries. The standard techniques of creating pneumoperitoneum are open and closed technique. Recent studies showed, complications associated with Veress needle insufflation such as gas embolism, sub cutaneous emphysema etc. Hasson’s method has shown to minimise vascular injuries but doesn’t reduce bowel injuries along with gas leak and port instability. The present study was conducted to assess the safety and efficacy of direct trocar insertion in patients undergoing elective laparoscopic procedures.Methods: The present study was conducted prospectively on 476 patients undergone various laparoscopic abdominal procedures using direct trocar access to create pneumo peritoneum during a period from May 2014 to July 2017 in unit 1 of Department of Surgery, RIMS, Imphal, India.Results: All patients age varying from 14 to 70 years are included. The average time taken from skin incision to create pneumoperitoneum was 1 mt. However, author is unable to use this technique in 4 patients having central obesity and switched on to conventional Veress needle for creating pneumoperitoneum. No injuries to bowel, vessels and other insufflation related complication were encountered.Conclusions: No technical difficulty was encountered while inserting trocar directly. No intra-abdominal injuries of bowel, mesentery or vessel were detected. Intra operatively all patients were found to be stable hemodynamically. Post-operatively and on follow up no port site complication such as infection, granuloma formation, induration and herniation were encountered.

BACKGROUND Peritonitis developing as a result of hollow viscus perforation is a common condition in a developing country like India. Even if the patient reaches the hospital in time and is operated, the postoperative period is still unpredictable. Secondary peritonitis is the consequence of contamination of the peritoneal cavity due to contents of a hollow viscus within the peritoneal cavity. As peritonitis following hollow viscus perforation is a life threatening condition commonly encountered in our hospital, a uniform scoring system is good to judge the efficacy of the health care as well for prognostic purposes. It helps in selecting patients at high risk who may require intensive management. Thus there has been a search for accurate risk scoring system that can be used to compare patient's outcome. POSSUM scoring system with its 12 physiological score and 6 operative score was used to predict the expected morbidity and mortality. METHODS: The present study was a cross sectional study where cases diagnosed as perforative peritonitis undergoing laparotomy in the Department of Surgery, RIMS, Imphal, Manipur, India were studied. RESULTS Out of the 100 patients in the study, 5 died and 28 had some form of morbidity. There were no patients with predicted morbidity score of less than 25. The minimum score is 6 and maximum is 48. CONCLUSIONS POSSUM scoring is a good tool to predict morbidity and mortality in patients undergoing laparotomy following hollow viscus perforation provided risk stratification is done.