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BACKGROUND Diabetic patients have reduced ability to metabolize glucose resulting in elevated blood sugar levels which further burdens the wound healing process. This leads to non-healing chronic ulcers. The sufferers of chronic diabetic foot ulcers are increasing globally due to lack of preventive and control measures. Sucralfate has been demonstrated in molecular studies to enhance the granulation tissue proliferation and thus promoting ulcer healing in the skin. Various clinical studies have also showed the efficacy of sucralfate in complete healing of the wound and in reducing the size of the wound. The purpose of this study was to compare the efficacy of topical sucralfate with that of povidone iodine dressing, in the healing of diabetic ulcers. METHODS This is a randomized comparative study. Among 100 patients, 50 patients received treatment in the form of povidone iodine dressings and 50 took treatment with sucralfate dressing. The patient underwent a detailed clinical examination. Relevant investigations were also done. The initial wound area was recorded after thorough debridement by measuring length x width. Both the groups underwent dressings once daily. The patients were followed up daily for a period of 3 weeks in both the groups. RESULTS In this study, the mean ± SD area of reduction of the ulcer was observed to be higher in sucralfate group 54.17 ± 10.08 than the povidone iodine group 16.07 ± 4.19. There was a statistically significant difference between the groups for the mean of area reduction (P < 0.0001, significant). CONCLUSIONS The ulcers in subjects treated with sucralfate dressing (S group) contracted more than the ulcers in the patients treated with povidone iodine (P group) (54.17 % Vs 16.07 %; P = < 0.0001, significant) which points out that sucralfate dressing is an effective modality in helping the reduction of wound area in patients with diabetic foot ulcers. KEYWORDS Diabetic, Sucralfate, Area of Reduction

Background: The aim of the present study was to predict difficult laparoscopic cholecystectomy by clinical and radiological parameters.Methods: All consecutive patients undergoing laparoscopic cholecystectomy and conversion to open surgery. Clinico-radiological laboratory parameters and imaging features were collected from patient. The study was categorized into Group 1 in which easy laparoscopic cholecystectomy case defined by total time taken for surgery less than 60 mins and no intra operative (surgical) and post-operative complications with postoperative hospital stay 4 mm. Majority of patients in difficult case group had calculi size >25 μm. History of previous attacks of cholecystitis, history of previous upper abdominal surgery, gall bladder wall thickness >4 mm and pericholecystic collection can be taken as predictors for difficult laparoscopic cholecystectomy.Conclusions: Preoperative prediction of a difficult cholecystectomy and explaining advantages and disadvantages of conversion are of great help both to the patient who can plan his work and the surgeon who can also schedule his time and team accordingly.

Background: This study aimed to identify various factors influencing occurrence of post-operative pancreatic fistula.Methods: Only those patients who underwent standard pancreatojejunostomy anastomosis in duct to mucosa technique using vicryl 4-0 sutures (double layer- interrupted fashion) were included in the study. Patients who had duct size ≤3 mm underwent papillary like main pancreatic duct invaginated technique of pancreaticojejunostomy (fish mouth type).Results: In 40 patients, 10 patients (25%) developed postoperative pancreatic fistula. 5 (12.5%) patients had grade A pancreatic fistula and 5 patients had CR–POPF [grade B–3(7.5%), grade C–2(5%)]. Pancreatic fistula in relation with duct size has attained statistical significance. When all the four factors were put together and given fistula risk score, it correlated well with the occurrence of fistula. Fistula risk score has high negative predictive value. Of 40 patients, 13 patients fall into low risk zone, out of which 1 patient developed grade A fistula. 26 patients fall into moderate risk zone, out of which 4 patients developed grade A, 3 patients developed grade B and 1 patient developed grade C fistula. One patient fall into high risk zone and developed grade C fistula.Conclusions: We found in our study that, post-operative pancreatic fistulae could be modestly predicted using fistula risk score. However, the latter had high negative predictive value and thus could be used to prognosticate risk of non-development of fistula than predicting its severity.

Background: Acute pancreatitis is the most terrible of all the calamities that occur in connection with the abdominal viscera. The suddenness of its onset, the illimitable agony which accompanies it, and the mortality attendant upon it, all render it the most formidable of catastrophes. Aim of the study is to evaluate the treatment outcome in acute pancreatitis.Methods: All the patients who underwent surgery for chronic pancreatitis were included in the study. initial APACHE II score at admission and CT severity index was evaluated.Results: Edematous pancreatitis accounts for 80–90% of acute pancreatitis and remission can be achieved in most of the patients without receiving any special treatment. Necrotizing pancreatitis occupies 10–20% of acute pancreatitis and the mortality rate is reported to be 14-25%. Alcohol (45.8%) was the most common causes of acute severe pancreatitis in this study. Males were predominately affected (Male: Female = 29:5). Complication rate or morbidity is 50%. The initial APACHE II score at admission and CT severity index in the first scan were high in patients who underwent necrosectomy and the patients who died. The overall mortality in this study was 30.6%.Conclusions: In conclusion, one reason attributed to high mortality was due to the subgroup of patients who underwent PCD alone and failed to show any change in the recovery nor deterioration and lead to gross nutritional depletion and death, secondly those patients who underwent step up approach and ultimately needed surgery have more aggressive disease evidenced by high APACHE II score, CT severity index and % of necrosis.