OBJECTIVE: To evaluate utility and outcome of emergency bilateral internal iliac artery ligation (BIIAL), as life saving measure in severe post partum hemorrhage (PPH). MATERIAL AND METHOD: Between June2003 to May 2012, a total of twenty four patients of severe PPH were managed with emergency BIIAL with or without hysterectomy. All patients were in shock and we were called directly in operation theatre (O T). The Patients were managed post operatively in obstetric intensive care unit (ICU) with ventilator and inotropic supports. RESULT: We had one (4.16%) mortality with successful outcome in 23(95.83%) patients. In 8 patients (33.33%) hysterectomy has already been performed before we could intervene. One (4.16%) patient develop pulmonary embolism but was saved. CONCLUSION: Emergency BIIAL is an life saving procedure and should be learned and managed by all surgeon in severe PPH KEY WORDS: Post Partum hemorrhage (PPH), Bilateral internal iliac artery ligation (BIIAL), Obstetric ICU INTRODUCTION: Ligation of internal iliac artery was first performed by Kelly for carcinoma uterus with success rate of 95% , without any major complication. (1) In 1952, Waters (2) reported BIIAL as anatomically sound, physiologically rational and surgically possible method to control PPH. Severe PPH is one of the most common cause of morbidity and mortality related to child birth. More than one third of maternal mortality has been attributed to it. Prompt identification of the cause and initiation of treatment is the best way of effective management. Oxytocin, Prostaglandins, hysterectomy, selective vascular embolisation has been performed as treatment of choice. We prefer BIIAL as simple effective and life saving procedure in all cases of severe PPH.

AIMS AND OBJECTIVE:To evaluate demographics, management and outcome of life threatening penetrating neck injuries (PNI). MATERIAL AND METHOD: A total of thirty four patients of severe PNI were referred to us between August 2003 and Feb.2013. Simple emergency investigations like hemogram and X rays or in few cases CT scan were enough to decide emergency exploration. Patients who were in shock required resuscitation. RESULT: Out of 34 patients, males in active phase of life (24 patients, 70.59%) predominate. Road traffic accident (RTA) (11 Patients, 32.35%), bullet injuries (10 patients, 29.41%) and sharp object (11 patients, 32.35%) were most common cause of injuries. Homicidal injuries predominates .Bleeding was the most common presentation seen in all cases from neck vessels. Aero digestive, neurological, lung and pleura involvement were other injuries encountered. Patients have maximum injuries at Zone I region (19 patients, 55.88%) and managed by supraclavicular approach (16 patients, 47.06%).We had 1 (2.94%) mortality. CONCLUSION: Emergency surgical exploration and ICU management saved life of most of life threatening PNI .We recommend time should not be delayed in detail diagnosis and evaluation of such injuries.

Background: Varicose veins are a common condition affecting the lower limbs. Apart from having cosmetic problem, if not treated in time it can have some serious complications and are difficult to treat. Multiple modes of surgical management exist for the disease.Methods: This is a prospective clinical study, done over a period of 5-years, from February 2015 till February 2020. Patients were divided into 2 groups: group I (n=103) included those who underwent open surgical treatment with venous stripping. Group II (n=104) included those who subjected to Radiofrequency ablation (RFA). Groups were selected with comparable physical parameters. Various parameters like bleeding, hematoma, blood requirement, postoperative inflammation, pain, numbness, mobilization, date of discharge and resuming duties were compared. All patients were followed up for 1year.Results: Majority of our patients belongs to age group 20-40 years with mean age of 35year in both groups. Male has dominance over female with male to female ratio 4:1. Noticed significant complication in group I than group II, such as bleeding (20:1), hematoma (5:0), inflammation (60:1) and blood requirement (1:0). In group II, noticed early mobilization of patient (1day v/s 3 days), discharge from hospital (1day v/s 5 days) and resuming duties (5 days v/s 2 weeks).Conclusion: RFA keeps an edge over open surgical treatment with venous stripping.

Repair of the mitral valve should be the primary goal in the surgical management of acute mitral regurgitation following valvotomy. The earlier the repair is done, the better it is because the preoperative haemodynamics affect the overall outcome. The disadvantages and anticoagulation of prosthetic valves are avoided. Besides, it is economical to avoid the high cost of the prosthetic valves in a poor socio-economic group of patients. With good patient selection and additional effort by the surgeon to acquire the necessary expertise to reproduce the techniques of mitral valve repair, a superior quality of life can be offered to these patients. The present study is a retrospective analysis of 14 patients who required emergency open heart surgery following balloon or closed mitral valvotomy. The valve was successfully repaired in 8 patients. The medium term follow-up indicates that repair is reproducible, safe, reliable, and a stable procedure free of complications.

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