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Introduction: Laparoscopic Cholecystectomy (LC) has numerous benefits over the open method; still postoperative pain remains an issue. Postoperative pain, requiring injectable analgesics prolong the patient’s hospital stay, and is one of the hurdles in performing LC as a day-case surgery. Aim: To assess the analgesic effect of Intraperitoneal (IP) administration of Inj. Bupivacaine±Inj. Tramadol in patients undergoing LC. Materials and Methods: A total of 100 patients scheduled for LC were enrolled in the study after meeting the inclusion criteria. Patients were randomly divided into 3 groups. Patient allocated to Group A received 30 mL of inj. normal saline IP, Group B received 30 mL of 0.25% inj. bupivacaine and Group C received 30 mL of 0.25% inj. bupivacaine along with 100 mg inj. tramadol. The local anaesthetic/analgesic or placebo solution was sprayed on the upper surface of the liver and on right subdiaphragmatic space and over gall bladder bed. The pain intensity of pain for patients in all the three groups were recorded using VAS at 0, 1, 2, 6, 12 and 24 hours after surgery. The student t-test was used to compare mean pain score between groups. The p-value ≤0.05 was taken as significant. Results: There was statistically significant difference in postoperative pain intensity in group A vs groups B (p

Introduction: Alcoholic Liver Disease (ALD), which consists of three major diseases: (1) fatty liver, (2) alcoholic hepatitis and (3) cirrhosis, is described to be associated with lymphopenia and an altered ratio of lymphocyte subsets but the reported results are not uniform. Aim: To compare the Absolute Lymphocyte Counts (ALC) and its subsets including T-helper 17 (Th17) or Interleukin 17 (IL17) secreting lymphocyte subsets between ALD patients and controls and to correlate these findings with biochemical and radiology findings. Materials and Methods: Forty cases of ALD at various stages of presentation were included in the study along with equal number of age and sex matched healthy controls. Ultrasound abdomen and liver function tests were done in all cases. Peripheral blood was collected and subjected to flow cytometric analysis for estimation of CD3, CD4, CD8 and Th17 cells. Results: On ultrasound, 13, 19 and 8 cases were found to be fatty liver, chronic hepatitis and cirrhosis respectively. With advanced stage of ALD, there was a significant decrease in ALC, CD3, CD4 and CD8 and while Th17 increased markedly. ROC curves were made and Th17% of 2.44 was found to be the optimum level for predicting progression to chronic hepatitis and 6.07 for cirrhosis. Conclusion: Th17 levels increase while ALC, CD3, CD4 and CD8 cells decrease with advancing stage of liver disease. These may be potential markers for staging and prognostication of ALD.

A pancreatic pseudocyst arises as a result of acute or chronic pancreatitis, pancreatic trauma, or obstruction of the pancreatic duct by a neoplasm. Most of the pseudocysts are located within the head and the body of the pancreas but 20% are extra-pancreatic. We report a case of a 33-year-old gentleman presenting with acute on chronic alcoholic pancreatitis with hepatic sub-capsular pseudocyst involving left lobe of liver, with intra-cystic bleed was successfully treated with Ultrasonography (USG) guided drainage. Computed tomography (CT) and high level of amylase in the collection plays an important role in diagnosing this condition. Large hepatic sub-capsular pseudocyst presenting with severe pain due to intra-cystic bleed can be treated with percutaneous drainage to pre-empt rupture.

The incidence of bronchoesophageal fistula in presence of benign pathology of tracheal tree or oesophagus is rare. It is encountered in thoracic diseases like tuberculosis, syphilis or histoplasmosis due to erosion by infected lymph node or abscess to adjoining structures. The source of primary pathology has to be eliminated followed by appropriate steps of fistula tract closure is essential for optimal result. We report a 25-year-old patient with left sided bronchoesophageal fistula. He had a past history of pulmonary tuberculosis. A left lower lobectomy followed by repair of oesophageal fistula opening was performed by primary closure and reinforcement with an intercostal muscle flap based on posterior intercostal artery. Postoperative oesophagogram showed short diverticula, which was occluded with n-butyl cyanoacrylate (NBCA) glue under radiological guidance. Feeding was started one week after application of glue without further complication. Reports on intercostals muscle flap repair and intervention of residual oesophageal diverticula with n-butyl cyanoacrylate (NBCA) glue under radiological guidance are scanty.