Background: Traumatic avulsion injury poses severe risk as the overlying protective covering is lost and the raw tissue is exposed to the environment. Avulsion injuries involving the scalp are even more complicated to treat because of significant cosmetic concern involved. Aim of the study was to find a better solution than the existing method, we conducted a prospective study involving 13 patients with isolated traumatic scalp avulsion injury.Methods: This prospective study was conducted in Motilal Nehru Medical College and associated Swaroop Rani Nehru Hospital, Prayagraj, after taking written and informed consents from the patients, between June 2017 and June 2019.These were divided into two groups (A and B) based on whether the underlying periosteum was intact or not.Results: Patients with intact periosteum (Group A) underwent primary thin thickness skin grafting within a few hours of their admission while the other group (Group B) was treated with a traditional conservative approach. We compared the results of both the groups and found that Group A patients not only had satisfactory graft uptake (≥85 TBSA) but also had significant decreased risk of infection, lesser hospital stay, overall decreased healthcare cost, better cosmoses and early return to routine activity.Conclusions: For the surgeon, this single step procedure is safe and technically easy. Thus this approach was found to be superior than the current traditional approach.

Background: Subtotal laparoscopic cholecystectomy has been in practice to treat difficult gall bladder for 100s of years. It keeps the benefit of being a minimally invasive and single-stage procedure. Thus, it remains a better option over conversion to open cholecystectomy as well as cholecystostomy which was a two-stage surgery practiced in earlier days.Methods: It was a prospective study focusing on indications, type and complications of subtotal laparoscopic cholecystectomy. It also compared the per-operative and post-operative outcomes of all cases of subtotal laparoscopic cholecystectomy (48) with cases of laparoscopic cholecystectomy that were converted to open procedure (30) performed over a period of 1 year. Patients were followed for 12 months post-surgery.Results: Acute cholecystitis is one of the most common indication of subtotal cholecystectomy. Also, it was associated with lesser mean operative time, postoperative hospital stays and postoperative complications when compared with conversion (to open) cholecystectomy.Conclusions: Subtotal cholecystectomy is a better option than open cholecystectomy in cases of difficult gall bladder.

BACKGROUND-Abdominal tuberculosis is an increasingly common disease with variable presentations. In GIT, the most common site for tuberculosis is ileocecal region with gastro-duodenal involvement seen in only 1 to 2% of all cases. Narrowing of the third part of duodenum, which is the most common site of duodenal tuberculosis, may give the impression of Superior Mesenteric Artery Syndrome. We report here two unusual cases of duodenal tuberculosis that presented as Superior Mesenteric Artery Syndrome. CASE SUMMARY-Two females of 22 and 25 years of age presenting with the chief complaints of pain all over abdomen and multiple episodes of vomiting for about 4 months along with a history of bloating, early satiety and weight loss. Multiple enlarged hypodense necrotic periportal, portocaval and mesenteric lymph nodes were noted in one case while a duodenal stricture was noted in the other. Both the patients were successfully managed by laparoscopic duodenojejunostomy followed by anti-tubercular treatment for a period of one year with a complete recovery and no post-operative complications.

Successful repair of the rectovaginal fistula with gracilis muscle interposition - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2019.113, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol Res

Background: Surgical Site Infections (SSIs) contributing to substantial rate of mortality, significant morbidity, considerable prolongation in length of hospitalization and added treatment expenses. The Centers for Disease Control and Prevention (CDC) has classified Surgical site infections (SSI) into superficial, deep, or organ/space SSIs. The objective of study was to evaluate pattern of surgical site infection in various abdominal surgeries.Methods: All patients who admitted in surgical OPD/emergency and undergoing abdominal surgical procedures were included in study. Patients were observed in wards and during follow up to assess signs and symptoms of surgical site infection.Results: Result were analysed in terms of etiology, distribution of cases based on case scenario, wound type, clinical features, number of re-explorations done after development of SSI, type of surgery (laparoscopic v/s open), type of organisms cultured, mortality, co-morbid condition, number of extra days in hospital after SSI and average amount spent after SSI.Conclusions: Surgical site infection is associated with high incidence of morbidity in terms of treatment cost and hospital stay. Average hospital stay, expenditure, co-morbidities and mortality were more in organ/space SSI. Superficial SSI is most common in both laparoscopy and open procedures. Deep and organ/space SSI not seen with laparoscopy. Superficial SSI were more common in clean and clean contaminated cases while superficial SSI was more common in contaminated and dirty cases. In superficial and deep SSI staphylococcus aureus was more common whereas in organ/space SSI E. coli and pseudomonas were common bacterial isolates.

Background: After emergency laparotomy due to some intestinal pathology patient are kept fasting to rest the bowel so that repaired pathology could get the proper time for healing. And during this period body’s nutritional requirement are replenished either by total parenteral nutrition or other intravenous fluids containing glucose and electrolytes. The major complication of TPN is liver disease that most commonly include steatosis, cholestasis, Cholelithiasis. Development of cholestasis, biliary sludge, and gall stone are due to loss of enteric stimulation and not directly linked to TPN. The effect of fasting on the composition of hepatic and gall bladder bile in humans has already been studied and this shows gall bladder bile is significantly supersaturated after fasting and can lead to sludge formation.Methods: A prospective study was conducted in department of general surgery, a rural tertiary care centre in north india (UPUMS, Saifai, Etawah, Uttar Pradesh, India) between January 2016 to May 2017. Study included all the patients in emergency who were planned for emergency laparotomy based on inclusion and exclusion criteria.Results: Of the 116 patients 83 (71.5%) were male patients and 33 (28.4%) were female patients, aged between (23 - 64 years). Total no. of sludge positive patients after 7 days was 39 (33.6%). Sludge positive female patients were 17 in 33 (51.1%) and sludge positive male patients were 22 out of 83 male patients (26.5%). Out of 53 patients of duodenal and gastric surgery 28 patients (52.8%) developed sludge formation. Out of other 63 surgeries only 10 (15.8%) patients developed sludge. Out of 39 sludge positive patients 28 (71.7%) were alone from group of duodenal and gastric surgery.Conclusions: our study supports that the prolonged restriction of oral food intake in patient operated on the gastrointestinal tract that results in decreased contractility due to absence of food stimulated gall bladder contraction, may be an important cause to sludge development in our group of patients.

Background: Firearm injuries are associated with substantial emotional, physical and financial burden on community and hospital resources leads to profound morbidity. It is a global public health problem and pose therapeutic challenges to surgeons. Proper management of firearm wounds requires a working knowledge of physical factors involved in the creation of such injuries. Regional variations of the parameters of medico legal aspects of firearm injuries are still lacking. Objective is to analyse pattern of firearm injuries managed at rural tertiary hospital.Methods: All firearm injury cases brought to the emergency department of Hospital, from January 2016 to December 2016 were included in the study.Results: In this study 108 (83.7%) victims were males and 21 (16.3%) were female. Most common age group victimized was 20-29 year (33.3%). Most cases occurred in winter season.113 cases (87.3%) victim were unemployed.81 cases (62.8%) had below intermediate education. 110 (85.3%) cases were of homicidal motive. Shotgun/ ‘kattas’ outnumbered the rifled firearm injuries (109) cases (84.5%). Trunk was involved in 45 cases (34.8%) and lower extremity in (32.6%) 42 cases,) Exit wound found in 93(72.2%) cases only. The fatality rate was 3.9% (5 cases). . Wound debridement was performed for 48 cases (37.2%) of patients, while emergency exploration was done for 30 cases (23.3%). The hospital stay of 49 cases (37.9%) of patients was more than one week. 111 cases (86.1%) were discharged.Conclusions: Addressing the root causes of violence such as poverty, unemployment, substance abuse will reduce the incidence of firearm injuries in our environment. Establishment of efficient emergency health care services for pre-hospital care and effective ambulance system for rapid transport of injured victims to hospital will reduce morbidity and mortality. Management requires knowledge ATLS protocols, mode, presentation and ballistic of firearm. Authorities issuing license for possession of firearms need to be more strict and vigilant.

Background: Noise induced hearing loss (NIHL) is hearing impairment resulting from exposure to loud sound. People may have a loss of perception of a narrow range of frequencies, impaired cognitive perception of sound, or other impairment, including sensitivity to sound or ringing in the ears. NIHL is 2nd most common cause of hearing loss, next to presbycusis. Most of the population of developing countries is ignorant of the hazards of excessive noise exposure. 1) To describe the socio-demograpic profile of patients in the young age group (18-35 years) with noise induced hearing loss in Rajendra Institute of Medical Sciences (RIMS), Ranchi during June 2015- November 2016. 2) To study the major presenting complaints. 3) To categorize the patients on the basis of degree of hearing loss. Methods: Data for study was collected from RIMS Out Patient Department (OPD) register during period June 2015 – November 2016 (18 months).Total sample size for this period was 50. Templates were generated in MS excel sheet and data analysis was done using SPSS software (version 20). Results: Study showed NIHL was more common in urban (82%) and male (72%) population. More than half (54%) patients presented with hearing loss and 24% with tinnitus. Most of the patients had bilateral mild hearing loss (70%). Conclusions: NIHL is more common in urban males, mostly in age group (26-35 years). More than 2/3rd (68% ) of patients had history of exposure to loud noise.

Background: A child’s normal speech and language development depends on the ability to hear. Early detection of hearing loss by screening at or shortly after birth and appropriate intervention are critical to speech, language and cognitive development. Objectives were to describe socio-epidemiological profile of newborns for hearing loss screening by transient evoked oto-acoustic emissions (TEOAE) and brainstem evoked response audiometry (BERA) in Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India during 18 months period (June 2015- November 2016), and to study association between hearing loss and risk factors.Methods: This prospective study was done on 4356 newborns for hearing screening by TEOAE in maternity ward and NICU and BERA in those noted “refer” on retest TEOAE at RIMS, Ranchi, Jharkhand, India during the period of 18 months (June 2015 - November 2016). Follow- up done by visits and phone calls. Templates were generated in MS excel sheet and data analysis was done using SPSS software (version 20).Results: Study showed 3.90/1000 newborns were noted “refer” on retest TEOAE. Hearing loss (BERA- Fail) is slightly more common in males (2.20/1000 newborns), of rural areas (2.44/1000 newborns), tribal ethnicity (2.75/1000 newborns) and those delivered by lower section caesarean section (LSCS) (4.47/1000 newborns). Hearing loss noted in 2.07/1000 newborns. Among high risk newborns 21.41/1000 newborns were noted “refer” on retest TEOAE and 11.53 were found BERA fail.Conclusions: Hearing loss was 21.71 times more common in newborns associated with high risk factors, mainly low birth weight and preterm newborns.

A Giant cell tumor (GCT) of bone arising from a phalanx is extremely rare. We hereby report a case of GCT arising from a phalanx of left ring finger. She initially had presented with swelling over the proximal phalanx of ring finger. She was diagnosed as GCT and was managed primarily by curettage and bone graft. After 6 weeks the patient presented with aggressive recurrence for which ray excision was done. Giant cell Tumour of phalanx is aggressive and highly recurrent tumor so primary aim of treatment should been ray excision to prevent recurrence.

INTRODUCTION:The severe long bone defects usually follow high-energy trauma and are often associated with a significant soft-tissue injury. The goal of management of these open long bone defects is to provide stable fixation with maintenance of limb length and soft-tissue coverage. The purpose of this article is to present the clinic-radiological outcome, complications and treatment of post-traumatic long bone defect with vascularised fibula transfer.MATERIALS AND METHODS:Retrospective records of 28 patients were analysed who presented with post-traumatic long bone defects and in whom reconstruction with vascularised free fibula was done. Demographic data were recorded and clinical and radiological assessment was done.RESULTS:Out of 28 patients in whom vascularised free fibula transfer was carried out three flaps were lost while non-union occur in three patients. Three patients developed a stress fracture of transferred free fibula in the post-operative period. Few of the patients experienced some problems in the donor leg; however, all of them improved in subsequent follow-up.DISCUSSION:It is clearly evident from this study that timing of surgery plays an important role in the micro-vascular reconstruction in trauma cases. All the complication like flap loss, non-union or delayed union occur in patients in whom reconstruction was delayed.CONCLUSION:The free vascularised fibula graft is a viable method for the reconstruction of skeletal defects of more than 6 cm, especially in cases of scarred and avascular recipient sites or in patients with combined bone and soft-tissue defects. Results are best when the reconstruction is done within 1 week of trauma.