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Background: Transurethral resection of the prostate (TURP) is the gold standard for benign prostatic enlargement; however, hemorrhage still remains one of the major complications. Objective: The primary aim of this study was to evaluate the effect of tranexamic acid (TXA) in reducing intraoperative blood loss and need for blood transfusion. Secondary parameters compared were operating time, volume of irrigation fluid used, and reduction in hemoglobin concentration. Subjects and Methods: A total of 70 eligible patients undergoing TURP were randomized based on computer generated table into two groups. The study group (1) received IV TXA 500 mg after induction of anesthesia and 500 mg in each irrigation fluid bottle (dual mode) and the control group (2) received none. Results: The mean age (68.20 vs. 66.5 years), prostate size (57 vs. 51 g), and preoperative hemoglobin (13.3 vs. 13.5 g/dl) were similar between the groups. Intraoperative blood loss in the TXA group was found to be significantly reduced (174.60 ± 125.38 ml vs. 232.47 ± 116.8; P = 0.04). Blood transfusion was required in 2.8% of cases as compared to 14.2% in controls. Operating time, volume of irrigation fluid, and postoperative reduction of hemoglobin were not significant between the groups. No complications were observed in both groups. Conclusion: In this study, we observed that TXA, when used as a combination of Intravenous and topical route, effectively reduced intra-operative blood loss and the need for transfusion.

Background It is well known that urinary calculi are associated with urinary tract infections. Post-operative sepsis is one of the major complications after various endourological procedures for stone surgeries. These episodes of sepsis occur even in negative urine cultures. Stones have been found to harbour bacteria which on fragmentation causes bacteremia and sepsis. Thus, usual practice of pre-operative urine culture cannot truly predict the occurrence of post-operative sepsis. It also seems logical that intra-operative stone cultures could guide us for early management of such episodes of sepsis. The purpose of this study was to determine if there exists any association between urine and stone cultures in patients undergoing endourological stone surgeries. Methods This is a prospective comparative observational study, in patients undergoing endoscopic procedures for calculus in urinary tract. Mid-stream urine cultures were obtained 3 to 5 days prior to surgery and crushed stone culture during the surgery. Comparison was then made between the two with respect to positivity, location of calculus and bacterial flora. Results A total of 122 cases of urolithiasis were included, in which 30 (24.59%) cases had a positive urine culture, whereas 62 (50.82%) patients were positive for stone culture. This significant difference was maintained only in renal stones on subset analysis (p value Conclusion The results of our study suggests that pre-operative urine cultures have a poor predictive value and accuracy for infective organism in the renal stone. Therefore, stone culture should be included in routine protocols during renal endourologic surgery for stones.

Cholelithiasis is a disease of the hepatobiliary system. The impaired metabolism of cholesterol, bile acids and bilirubin are characterized by gallstone formation. Data was collected from the information available in bed head tickets of patients diagnosed as a case of cholelithiasis. Detailed history, clinical examination, investigations, procedure, operative findings, complications and biopsy reports were recorded. Significant observations were: USG showed gall stones in all cases. Derranged bilirubin was found in 20.21% cases. 46.77% underwent laparoscopic & 50.54% underwent open cholecystectomy with 2.69% laparoscopic to open conversion mostly due to adhesions (52%). Gall stone alongwith CBD stone was the most common complication (4.62%). Intra operatively hemorrhage was the most common complication in laparoscopic (3.26%) and open cholecystectomy (2.76%). In post operative period wound infection and bile leak was found in 5.25% and 1.81% respectively in open cholecystectomy and 1.84% each in laparoscopic cholecystectomy. Chronic cholecystitis was the most common histopathological finding (83.79%).

An optimal precoder design is conceived for the decentralized estimation of an unknown spatially as well as temporally correlated parameter vector in a multiple-input multiple-output (MIMO) orthogonal frequency division multiplexing (OFDM) based wireless sensor network (WSN). Furthermore,exploiting the temporal correlation present in the parameter vector, a rate-distortion theory based framework is developed for the optimal quantization of the sensor observations so that the resultant distortion is minimized for a given bitbudget. Subsequently, optimal precoders are also developed that minimize the sum-MSE (SMSE) for the scenario of transmitting quantized observations. In order to reduce the computational complexity of the decentralized framework, distributed precoder design algorithms are also developed which design precodersusing the consensus based alternating direction method of multipliers(ADMM), wherein each SN determines its precoderswithout any central coordination by the fusion center. Finally,new robust MIMO precoder designs are proposed for practicalscenarios operating in the face of channel state information (CSI)uncertainty. Our simulation results demonstrate the improvedperformance of the proposed schemes and corroborate ouranalytical formulations.

This paper investigates the simultaneous wireless information and power transfer (SWIPT) precoding scheme for K-user multiple-input-multiple-output (MIMO) interference channels (IC), for which interference alignment (IA) schemes provide optimal precoders to achieve full degrees-of-freedom (DoF) gain. However, harvesting RF energy simultaneously reduces the achievable DoFs. To study a trade-off between harvested energy and sum rate, the transceiver design problem is suboptimally formulated in literature via convex relaxations, which is still computationally intensive, especially for battery limited nodes running on harvested energy. In this paper, we propose a systematic method using chordal distance (CD) decomposition to obtain the balanced precoding, which improves the trade-off. Analysis shows that given the nonnegative value of CD, the achieved harvested energy for the proposed precoder is higher than that for perfect IA precoder. Moreover, energy constraints can be achieved, while maintaining a constant rate loss without losing DoFs via tuning the CD value and splitting factor. Simulation results verify the analysis and add that the IA schemes based on max-SINR or mean-squared error are better suited for SWIPT maximization than subspace or leakage minimization methods.

Necrotizing fasciitis (NF) is potentially lethal bacterial infection characterized by widespread necrosis of the skin, subcutaneous tissue and superficial fascia. Retrospective data was collected from the information available in bed head tickets of patients diagnosed as a case of necrotizing fasciitis. Detailed history and clinical examination was done and recorded. Pus was sent for culture and findings were recorded. Significant observations were: Necrotising fasciitis was seen more in males (62.22%) from rural areas (66.67%) with mean age at presentation of 47.13 years, trauma being the most common cause (66.67%) involving mostly extremities (72.22%) with swelling being the most common symptom (94.45%). Local tenderness was the most common sign (92.22%). Polymicrobial infection was found in all the patients with Staphylococcus aureus as the most common isolate (82.22%).

Scrotal swelling is one of the common problem in all age groups and are commonly encountered in surgical outdoor. In our study 100 patients were included who presented with scrotal swelling in surgical outdoor.Factors such as age, presenting complaint, laterality were analysed, a definite diagnosis was made on the basis of USG and histology. Collected data was then analysed and compared to previous studies. In this study hydrocele forms the most common cause of scrotal swelling consisting of 33%.Next common cause was epididymoorchitis (31%).Other causes include 12% cases of varicocele,6% cases each of epididymal cyst and scrotal abscess, 5% cases of testicular tumour, 3% cases of sebaceous cyst and testicular torsion each and only 1% of spermatocele.

The purpose of this study was to compare the serum Folic Acid (FA) levels in patients with Erectile Dysfunction (ED) and healthy controls and whether levels vary with its severity. The study was carried out on 77 sexually active individuals, out of which 41 complained of ED and 36 were apparently normal. Patients were excluded if they had any diseases known to cause ED. The severity was further categorised based on IIEF-5 scores. Blood serum levels of testosterone, lipid profile, random blood sugar, liver function test, renal function test and FA levels were obtained in each patient. Independent-samples t test of significance was used when comparing between two means. Pearson's correlation coefficient (r) test was used for correlating data. All clinical and biochemical parameters except FA were comparable in both the groups. FA levels were significantly decreased in ED group (5.29 vs. 10.8; p value = .004). Smoking habits were comparable between the groups, and FA levels did not vary among smokers and nonsmokers (p value = .46). Serum FA levels significantly declined with increasing severity of ED (8.28 vs. 5.56 vs. 4.37 vs. 3.5; p value < .001). Thus, decreased FA might possibly be one of the novel risk factors for ED.

This paper presents two analog precoder feedback (PFB) schemes namely the simple PFB (SPFB) scheme and the reduced PFB (RPFB) scheme for interference channels. In the first scheme, each destination transmits full precoder, while in the second one, the size of the precoder to be fed back is reduced by removing the redundant rows of the precoder matrix. This reduced feedback is particularly useful in the systems, where the number of transmit antennas are more than the number of receive antennas. These schemes have been analyzed for the cases where time slots in the feedback duration are independent of the number of users and where the time slots scale linearly with the number of users. For both these schemes, the precoder reconstruction methods are investigated using the chordal distance. For interference alignment, the rate loss upper bound analysis shows that the rate loss increases with signal-to-noise-ratio (SNR) at low SNR, while it remains constant in high SNR range. Simulation results verify that the linear sum rate scaling is preserved at high SNRs. The full precoder feedback dominates, when the source cooperation is assumed, while RPFB yields improvements over SPFB scheme, when no source cooperation is assumed and $Kd$ time slots are utilized in either orthogonal or independent transmission case.

Bladder cancer is a growing health problem with the second most common urological malignancy. It accounts for around 7% of a new cancer diagnosis. Tobacco smoking is the most important risk factor accounting for around 50% of cases. Tobacco smokes contain aromatic amines and polycyclic hydrocarbons which are excreted through kidneys. The goal of transurethral biopsy in NMIBC(non-muscle invasive bladder cancer) is to make the correct diagnosis and completely remove all visible lesions which can be either resected piecemeal or en bloc. The presence of detrusor muscle in the specimen is an important factor for planning treatment and prognosis. Here we share our experience of EBRT using monopolar cautery describing the feasibility, safety, and adequacy of the procedure in the management of small urinary bladder tumors. The study was conducted in the Department of Urology, SMS Medical College, and attached hospitals. All the patients with clinical NMIBC during study duration were admitted and a total of 25 patients above the age of 18yrs, having papillary bladder tumors less than 3 cm were included in the study. Complete resection by the en bloc technique was achieved in all 25 cases with no requirement of conversion to conventional TURBT. Our study also shows the presence of detrusor muscle in 22 specimens out of 25. And only two patients developed severe bleeding which needed a blood transfusion. Thus, ERBT using monopolar cautery is safe and feasible for the complete resection of NMIBCs with a high rate of detrusor-positive specimens in the selected patient population.

Paget’s disease of breast is also known as Paget’s disease of the nipple & mammary Paget’s disease, involving the skin of nipple & areola. It is rare type of cancer with tumors inside the same breast which may be either ductal carcinoma in-situ or invasive breast cancer. We report a case with Paget’s disease of breast which is not only involving the nipple-areola complex but also involving surrounding skin of breast.

Telementoring as a subset of telemedicine has evolved over the past few years, but it is yet to be utilized to its full potential. The technology holds promise in bridging divides of distance and enables far-flung areas to be mentored in operative advances. It thus has a special bearing in countries like India where health care is short staffed and many areas lack availability of quality care. We describe the setting up of a telementoring facility at our centre. As against a ‘routine’ facility with dedicated equipments which cost heavily, our facility was set up using mostly equipments commonly available in an operating room. The facility is presently functional and allows telementoring through an encrypted Web-based service. Our set-up design can be emulated in centres with financial constraint and can help raise the standard of surgical care.

BACKGROUND The urinary stone disease is one of the most common afflictions of the modern society and it has been described since antiquity with the westernisation of global culture. It has led to a lot of distress physically, mentally and financially to the affected individuals. Mini-invasive techniques like ESWL and ureteroscopy have their own negative aspects with discomfort to the patient being the prime in it. Hence, a need for conservative management in the form of pharmacotherapy has arisen in the past years and here we are investigating the same. The aim of the study is to compare the efficacy of silodosin (8 mg) vs. tamsulosin (0.4 mg) both in terms of the stone expulsion rate and the time to stone expulsion. MATERIALS AND METHODS A study comprising of 120 patients between the age group of 18-50 years with sonography-proven unilateral, uncomplicated lower ureteric calculus was undertaken from January 2015 to November 2015. Exclusion criteria were calculus more than or equal to 1 cm. Patients were divided in 2 Groups; Group A received silodosin 8 mg once daily for a month while Group B received tamsulosin 0.4 mg once daily. The patients were followed up weekly or biweekly with imaging studies. The endpoint was the stone expulsion rate and time, the rate of the interventions and the side effects. Settings and Design- With ethical committee clearance, a prospective study was conducted in the Department of Urology, Mahatma Gandhi Medical College and Hospital, Jaipur, India. Statistical Analysis- The SPSS-16 software was used for the statistical analysis of the data. RESULTS Results of our analysis showed that Group A (silodosin) patients were benefited more than Group B (tamsulosin) and it was also backed by the data showing a statistical significance for spontaneous stone expulsion in favour of the silodosin group. CONCLUSION Hence, we concluded that silodosin’s efficacy in treating patients with distal ureteric calculus was much better when compared to tamsulosin.

Primary testicular leiomyosarcomas (LMS) are very rare tumours, with only 20 cases reported so far in the literature (Abdullazade et al. Turk Patoloji Derg 29:227–230, 2013; Komeya et al. Indian J Urol 28:343–346, 2012). We present a case of a 70-year-old male patient who presented with recurrence in the right hemiscrotum 10 weeks after right inguinal orchidectomy for a testicular mass which diagnosed as primary intratesticular leiomyosarcoma. He was treated with wide local excision and adjuvant radiotherapy.

Internet of Things (IoT) is a system where the machines involved in a system or an infrastructure can be monitored and certain activities can be controlled with the help of sensors and actuators. This research presents the model for controlling remote devices with the help of hand gestures. The gestures are recognized using template matching algorithms to identify the hand gestures and control remote things accordingly using the Internet of Things. The microcontrollers and the remote units which are involved in the architecture are connected to the Internet either via LAN or Wi-Fi module. The proposed system will help those who generally forget to switch off the power when not in use, as an example. It is a contribution to the body of knowledge in the field of home automation using a microcontroller.

The demand for the recovery of valuable metals and the need to understand the impact of heavy metals in the environment on human and aquatic life has led to the development of new methods for the extraction, recovery, and analysis of metal ions. With special emphasis on environmentally friendly approaches, efforts have been made to consider strategies that minimize the use of organic solvents, apply micromethodology, limit waste, reduce costs, are safe, and utilize benign or reusable materials. This review discusses recent developments in liquid- and solid-phase extraction techniques. Liquid-based methods include advances in the application of aqueous two- and three-phase systems, liquid membranes, and cloud point extraction. Recent progress in exploiting new sorbent materials for solid-phase extraction (SPE), solid-phase microextraction (SPME), and bulk extractions will also be discussed.

In this paper, we have modeled underlaying multiple D2D networks into interference channel and used interference alignment (IA) in two different ways. In the first IA design, all the cell and D2D users (CUs & eNB and DUs & DRs) are considered in mitigating the interference, while in the second design, the group of CUs and eNB is omitted in IA design to reduce the overhead of channel state information (CSI). To show the distance or location dependence, the cross channel variance (τ) between DUs-eNB group and the CUs-DR groups has been varied. The rate loss upper bound between the two IA schemes is calculated that shows, the rate difference increases with increase in SNR and is proportional to cross channel variance. The simulation results show that for small values of τ, the second IA scheme gives almost similar sum rates. For large values of τ, the DU sum rates are low and show a constant rate loss. Thus, second IA technique can be utilized to reduce overhead in D2D communication.

the oldest and most widespread biometric identification system are commonly used for criminal investigation in forensic Science; there is minute statistical theory on the Rareness of fingerprint minutiae. A critical step in studying the statistics of Fingerprint minutiae is to reliably extract minutiae from the fingerprint images. However, fingerprint images are rarely of perfect quality. They may be degraded and corrupted due to variations in skin and impression conditions. Thus, image Enhancement techniques are employed prior to minutiae extraction to obtain a more reliable estimation of minutiae locations.

Acute appendicitis poses a significant diagnostic challenge to the surgeon. Despite modern advances, the diagnosis of appendicitis remains essentially clinical. Ultrasonography is effective in supplementing the clinical diagnosis.This study aims to evaluate the negative appendicectomy rate in patients subjected to appendicectomy and to assess the usefulness of ultrasound in improving the diagnostic accuracy.It is a retrospective review of prospectively collected data on 118 patients operated for suspected acute appendicitis in a single surgical unit between May 2001 and December 2002.The detailed history, clinical examination and preoperative investigations according to protocol were recorded on a proforma. All patients underwent an ultrasonography of whole abdomen including pelvis. Each patient with suspected acute appendicitis was subjected to surgery and appendix was submitted for histopathological examination. The negative rate of appendicectomy, sensitivity and specificity of ultrasonography and positive and negative predictive value of ultrasound were calculated.The negative appendicectomy rate was 23.72%. In males it was 13.43% and in females 37.25%. Ultrasonography had a sensitivity of 63.33 % and a specificity of 82.14 %. The predictive value of a positive test was 91.93% and the predictive value of a negative test was 41.07%.The clinical diagnosis of acute appendicitis when supplemented with an ultrasonography, can achieve a reasonable degree of diagnostic accuracy with resultant low negative exploration rates thereby reducing the financial burden and morbidity by avoiding unnecessary appendicectomy and keeping the cost of treatment affordable.

Secretory carcinoma of the breast is an extremely rare subtype of breast cancer characterized by intracellular or extracellular secretion and granular eosinophilic cytoplasm of the neoplastic cells. The disease which was considered to be predominant in younger age group has been recognized in adult population too and tends to show slow growth and indolent behavior. The disease occurs preferentially in females and only 27 cases have been reported amongst males. An optimal treatment for the disease subtype has been debated because of the paucity of data. We report two cases (one female and one male) of this rare disease that underwent treatment at our institution.

Wireless relaying has attracted dramatic attention in the last few years due to its advantage in multi-hop communication systems. Cooperation among nodes in a network enhances the overall system performance. Power allocation schemes have been discussed with respect to optimization of signal to noise ratio (SNR) without considering the interference. The contribution of our present approach is to allocate power to relay nodes in presence of interference, for cluster-based cooperative wireless sensor networks (WSNs). In this paper, we consider optimization of the signal-to-interference plus noise ratio (SINR) and allocating the power to relay nodes by using the difference of two convex functions (dc) algorithm. The best relay is selected based on the comparisons of power allocated to relay nodes. Such schemes would be typically applicable to a network where allocation of orthogonal channels to sensor nodes will not be feasible such as marine WSNs, border sensor networks etc. Numerical and simulation results are also provided. Comprehensive analysis and extensive simulations show our scheme to be highly effective and flexible in balancing the cost and quality of service (QoS) performance.

Interest in the area of Mobile Ad-hoc Network (MANET) is growing since last few years because of its practical applications and requirement of communication in mobile devices. However, in comparison to wired network or infrastructure-based wireless network, MANET is particularly vulnerable to security attacks due to its fundamental characteristics, e.g., the open medium, dynamic network topology, autonomous terminal, lack of centralized monitoring and management. The black hole attack is one of such security risks. In this attack, a malicious node falsely advertise shortest path to the destination node with an intension to disrupt the communication. In this paper, we propose a solution to the black hole attack in one of the most prominent routing algorithm, ad-hoc on demand distance vector (AODV) routing, for the MANETs. The proposed method uses promiscuous mode to detect malicious node (black hole) and propagates the information of malicious node to all the other nodes in the network. The simulation results show the efficacy of the proposed method as throughput of the network does not deteriorate in presence of the back holes.

To know the clinical and epidemiological characteristics & management strategies for the patients who underwent surgery for oral Squamous Cell Cancer (SCC) in a medical college hospital. Data pertaining to clinico-epidemiological factors & surgical management for oral cancer were analyzed in patients admitted to a tertiary level medical college hospital. Records of 139 patients admitted over a period of 10 years (January 1998 to December 2007) were used for data analysis. Only patients with complete records were included in the analysis. M: F ratio was 2.2:1 with average age of patients being 50.4 years. Tobacco chewing & smoking were major predisposing factors identified. Oral ulcer was the most common symptom while buccal mucosa, tongue & lower alveolus were three most common primary tumor sites. Majority of tumors were stage IV at presentation (52 %). Wide excision of tumor was done in 46 % of cases while in 54 % cases commando procedure was done. Reconstruction after either commando or wide excision was done in half of the patients. Pectoralis major myocutaneous (PMMC) flap was used in majority of cases for reconstruction. Neck dissection was done in 67 % patients. Majority (85 %) of these were radical neck dissection (RND). Per operative blood transfusions were required in 64 % patients while 19 % patients needed post operative transfusion. Post operative complications were noted in 34 % of the patients. Of these majority were related to wound infection & orocutaneous fistula formation. Hospital stay varied from 7 to 105 days with the mean duration of 30 days. Two year follow up revealed a recurrence rate of 36 %. Majority of the patients presented at an advanced stage due to self as well as professional delay in diagnosis. This leads to difficulty in resection of the primary tumor as well as reconstruction of the defect. A higher rate of recurrence after surgery is also seen. Post operative complications increase the morbidity which is reflected by an increase in the hospital stay (19 days Vs 46 days).

Song-selection and mood are interdependent. If we capture a song's sentiment, we can determine the mood of the listener, which can serve as a basis for recommendation systems. Songs are generally classified according to genres, which don't entirely reflect sentiments. Thus, we require an unsupervised scheme to mine them. Sentiments are classified into either two (positive/negative) or multiple (happy/angry/sad/...) classes, depending on the application. We are interested in analyzing the feelings invoked by a song, involving multi-class sentiments. To mine the hidden sentimental structure behind a song, in terms of "topics", we consider its lyrics and use Latent Dirichlet Allocation (LDA). Each song is a mixture of moods. Topics mined by LDA can represent moods. Thus we get a scheme of collecting similar-mood songs. For validation, we use a dataset of songs containing 6 moods annotated by users of a particular website.

An obturator hernia is a rare variety of abdominal hernia that presents with a confusing clinical picture. We present a case of 74-year-old woman who admitted to our hospital because of abdominal distention, abdominal pain, and vomiting for 3 days. Incarcerated intestinal obstruction due to the right-sided obturator hernia was found preoperatively. Perforation of the small bowel due to incarceration was noted during laparotomy. Bowel resection and anastomosis were done. She was recovered after 15 days of postoperative care. In this case report, we emphasize that preoperative high index of suspicion is required for diagnosis and treatment.

Introduction Anomalies of the femoral vessels occur in only 0.02% of the population, most of them being asymptomatic. The study highlights the anomalies of femoral vessels in the femoral triangle and the importance of their recognition intra-operatively to prevent injuries. Materials & methods Here we present a case of bilateral transposition of femoral vessels in the femoral triangle, which was detected during groin dissection in a case of carcinoma penis with inguinal lymph node metastasis. Observation We detected the anomalous transposition intra-operatively during groin dissection on the left side and the right sided anomaly postoperatively by CT angiography. Conclusion The importance of this anomaly lies in procedures for which vascular access is need through the femoral vessels and groin surgeries like Trendelenburg operation for varicose veins where not appreciating these anomaly could lead to inadvertent vascular injury or bleeding.

INTRODUCTION Pulsatile systems are achieving a lot of interest as they deliver the drug at the right site of action at the right time and in the right amount, thus providing spatial and temporal delivery and increasing patient compliance. These systems are designed based on the circadian rhythm of the body. The principle rationale for the use of pulsatile release is for the drugs where a constant drug release, i.e., a zero-order release is not desired. Products available as once-a-daily formulation based on Pulsatile release like Pulsincap®, Ritalin®, and Pulsys®. In these systems, a most important and widely used pulsincap system is described here.

Erythrocyte aldehyde dehydrogenase (ALDH) activity in a normal reference population from North India was determined from results of 22 healthy subjects (12 male and 10 female). We compared these data with results of 19 alcoholic patients (13 male and 6 female). The mean erythrocyte ALDH activity of male and female alcohol abusers was 16.2% and 20.9% lower than the mean values for healthy subjects, respectively (P

e12014 Background: Cancer is not a notifiable disease in India. Cancer data in India is derived mainly from Population & Hospital based cancer registries which pursue active data collection. Rajasthan, which is the largest state of India, has no established Cancer registry. Therefore, cancer data from this region is limited. This study was done to put the Cancer data from Eastern Rajasthan region in proper perspective Methods: A retrospective analysis of histopathology records of 5 years was done by studying the proportion & site wise distribution of malignancy cases which were reported at major hospitals & pathology centers in the region. Approximately 200,000 histopathology & cytology reports were analyzed & 34,486 new cancer cases were identified. Cases were classified according to the WHO International Classification of Disease (ICD) coding. Results: Of the 34,486 new cases of cancer that were recorded in five years, 58.58% were (20202) males and 41.42% (14284) females, with the male to female ratio being 1.41:1. Organ wise, Lung (13.25%), Larynx (5.35%), Oropharynx (5.09%), Brain (4.84%), Tongue (4.62%) and Prostate (4 %) were the most common sites involved in males, whereas Breast (25.6%), Cervix (10.26%), Ovary (5.4%), Brain (3.68%), Esophagus (3.4%), Lung (3.01%) & Gall Bladder (2.35%) were common sites of malignancy in females. System wise distribution of cancers revealed that Head & Neck (24.93%), Pulmonary (13.25%), Gastrointestinal (12.01%), Hematological (10.6%) & Genitourinary tract (10.5%) were the most common systems involved in males, where as, in females, Breast cancer was the most common (25.6%) followed by Genitourinary tract (20.27%), Gastrointestinal cancers (11.2%) and Head and Neck cancers (8.11%). Conclusions: A high frequency of tobacco related cancers i.e. Lung cancer and Head & Neck cancer in males, and screening detectable cancers (Breast & Cervix) in females was observed. Frequency of Lung cancer in females was noted to be high in comparison to previous studies from the region. An unusually high frequency of Gall Bladder Cancers especially among the female population in this region is also a cause of concern.

Highlights • Iatrogenic pneumothorax should be anticipated during and after a CT guided transthoracic needle biopsy and actively treated. • Chest tube malposition is a common complication of tube thoracostomy. • Chest tubes should always be inserted in the triangle of safety described by the British thoracic society. • Debilitating subcutaneous emphysema which causes distress, anxiety, palpebral closure, dyspnoea or dysphagia requires intervention. • High negative pressure subcutaneous suction drains provide immediate and sustained relief in extensive and debilitating SE., Introduction Subcutaneous emphysema is a common complication of tube thoracostomy. Though self-limiting, it should be treated when it causes palpebral closure, dyspnea, dysphagia or undue disfigurement resulting in anxiety and distress to the patient. Presentation of case A 72 year old man who was a known case of COPD on bronchodilators developed a large pneumothorax and respiratory distress after a CT guided transthoracic lung biopsy done for a lung opacity (approx. 3 × 3 cm) at the right hilar region on Chest X-ray. Within 24 h of an urgent tube thoracostomy, patient developed intractable subcutaneous emphysema with closure of palpebral fissure and dyspnea unresponsive to increasing suction on chest tube. A subcutaneous fenestrated drain was placed mid-way between the nipple and clavicle in the mid-clavicular line bilaterally. Continuous negative suction (-150 mmHg) resulted in immediate, sustained relief and complete resolution within 5 days. Discussion Extensive and debilitating SE (subcutaneous emphysema) has to be treated promptly to relieve patient discomfort, dysphagia or imminent respiratory compromise. A variety of treatment have been tried including infraclavicular blow-hole incisions, subcutaneous drains +/− negative pressure suction, fenestrated angiocatheters, Vacuum assisted dressings and increasing suction on a pre-existing chest tube. We describe a high negative pressure subcutaneous suction drain which provides immediate and sustained relief in debilitating SE. Conclusion Debilitating subcutaneous emphysema which causes distress, anxiety, palpebral closure, dyspnoea or dysphagia requires intervention. High negative pressure subcutaneous suction drain provides immediate and sustained relief in extensive and debilitating SE.