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Background: The prostatic abscess is difficult to diagnose because in the initial days of it, prostatic abscess mimic several others diseases of the lower urinary tract. Objectives: The present study was done with an objective to discuss the pathogenesis, diagnostic methods and treatment of the prostatic abscess. Materials and methods: The present study is the retrospective record based study of 30 patients diagnosed and treated for prostatic abscess. We assessed the age of the cases, associated disease and other symptoms and therapeutic methods. Results: Mean age of the cases was 55.2 years. Transrectal ultrasound of the prostate confirmed the diagnosis of prostatic abscess in all 30 cases in which it was performed. All cases received antibiotic and other symptomatic treatment. Surgical intervention was required in 72% of the cases. 9 patients required perineal catheter drainage, 5 patients required transurethral resection of the prostate (TURP), and one patient required both procedures. Mean hospitalization time was 11.2 days. The most frequent bacterial agent was S. aureus. All patients were discharged from the hospital, and there was no death in this series. Conclusions: Prostatic abscess should be treated with broad-spectrum antibiotics and surgical drainage (perineal puncture or TURP). Microabscess may heal without surgery.

Introduction: The diagnosis of acute appendicitis particularly in children is often challenging, occasionally taxing the skill of most experienced surgeon. It is difficult to obtain a clear history in children. Objectives: The present study was planned with an objective to see the utility of Alvarado score in diagnosis of acute appendicitis. Methods: Children in the age group of 5-15 yrs were enrolled in the study. All the patients were scored as early as possible. The decision of operation was made by the surgeon himself independent of the score. Finally the scores were correlated with subsequent clinical and operative findings of the patients and the histo-pathological examination of the removed appendix. Results: A total of 64 patients were included, of these 48 patients were operated and remaining 16 patients improved rapidly with the start of the treatment. Of the 64 patients 38 were male, mean age was 11.4 years. Alvarado score were done all 64 patients. Out of 48 patients having appendisectomy 4 had normal appendix as proved on histopathology. Other 44 had complicated pathological report of appendix. It was found that patients with low Alvarado score have little chance to suffer from acute appendicitis. Conclusion: The Alvarado score can be used as an aid in diagnosing acute appendicitis in children. Patients with score ≤5 are unlikely to need an emergency operation and can be observed as outpatient with little risk.

Background: Being a carpal bone scaphoid has an important role in wrist movements. Wrist joint is a synovial modified ellipsoid joint where movements like flexion, extension and adduction, abduction take place around two axes (transverse and antero-posterior). These movements at the wrist joint are associated with considerable range of movements at the mid carpal joint, as same group of muscles act on both of these joints. Methodology: A study has been done amongst 120 persons at the tertiary care hospital during the period from 2006-07 to detect the important movements of scaphoid bone specially during the abduction and adduction of wrist joint (which occur in association with the intercarpal joints) and also to detect whether such movements have any speciality in the population. Results: In fully abducted position, it was 45o among 53.3% subjects and the average among all the subjects was 60o. So, the degree of abduction was 30o. The extent of movement was more in adduction (ie, 1.90 cm - 1.03 cm = 0.87 cm) than in abduction (ie, 1.03 cm - 0.72 cm = 0.31cm). Conclusion: It was found in this study that the scaphoid acts as a link bone between the two rows of carpal bones and prevents the buckling of midcarpal joint especially of the capitato- lunate joint interface.

Background: In the recent past, the use of computerized axial tomography and magnetic resonance imaging has helped to differentiate spinal tuberculosis from radiologically similar lesions. Objective: The objectives of the study was to assess how dependable clinical and radiological features are in establishing a diagnosis of spinal tuberculosis; and to identify other conditions which may have clinical and radiological features similar to those seen in patients with spinal tuberculosis. Methodology: Two hundred and sixty-seven consecutive patients with clinical and radiological features suggestive of tuberculosis of the spine treated over a period of five years were analysed. This retrospective case series analysis was done in a tertiary care hospital. The clinical presentation, radiological features and the erythrocyte sedimentation rate were correlated with the histopathological diagnosis on tissue obtained by open biopsy in 130 cases during surgery and in 137 cases by closed vertebral biopsy. Results: One hundred sixty-six cases were histologically proved as tuberculosis and 74 proved to be non-tuberculous lesions. Twenty-seven cases in which the biopsy was inconclusive were excluded from the study. The study demonstrated that tuberculous lesions were commoner in younger patients and the lesion was more often in the paradiscal region as compared to non-tuberculous lesions. However, all other clinical and radiological variables were not significantly different to enable reliable identification of tuberculous lesions on the basis of clinical and radiological features alone. Conclusion: It is recommended that all vertebral lesions suspected to be of tuberculous origin not responding to empirical antituberculosis therapy should have a definitive histopathological diagnosis and radiological investigation to facilitate appropriate treatment.

Objective: The aim of this study was to determine the feasibility of using the Prolene (polypropylene) Hernia System for open tension-free repair on inguinal hernias, and study the results in terms of operation time, patient comfort, hospital stay, return to normal activity and postoperative complications. Material and Methods: From February 2002 through April 2003, we performed 50 open tension-free hernia repairs on 47 patients (46 men, 1 woman) with a mean age of 55.8 years. There were 26 right and 18 left hernias, and 3 were bilateral. Of these, 39 were direct, 10 were indirect and 1 was femoral type. All were primary hernias. Results: The duration of surgery averaged 35 minutes (range 20 to 90 min). There was no perioperative mortality. Four patients developed mild self-limiting neuralgias. There were no subcutaneous wound infections, no haematomas, no seromas and no testicular atrophy. The average duration of postoperative hospitalisation was 3.5 days. The length of follow-up ranged from 1 month to 15 months (mean= 6.24 months). We have had no recurrences so far. Conclusion: The Prolene Hernia System is a novel approach in the management of inguinal hernias, with encouraging initial results. Its long-term efficacy needs to be studied with larger, prospective double-blind randomized trials, with longer follow-up.

Purpose: To establish whether the rates of surgical site infection (SSI) in gastrointestinal surgery are affected by the type of intra-abdominal suturing: sutureless, absorbable material (polyglactin: Vicryl), and silk. Methods: We conducted SSI surveillance prospectively in our hospitla. Results: The overall SSI rate was 14.4% (13/90). The SSI rates in the sutureless, Vicryl, and silk groups were 4.8, 14.8, and 16.4%, respectively, without significant differ-ences among the groups. In colorectal surgery, the SSI rate in the Vicryl group was 13.9%, which was significantly lower than that of the silk group (22.4%; P = 0.034). The incidence of deeper SSIs in the Vicryl group, including deep incisional and organ/space SSIs, was significantly lower than that in the silk group (P = 0.04). The SSI rates did not differ among the suture types overall, in gastric surgery, or in appendectomy. Conclusion: Using intra-abdominal absorbable sutures instead of silk sutures may reduce the risk of SSI, but only in colorectal surgery.

A 69 years old male presented with features of acute intestinal obstruction. At exploratory laparotomy, a mass was felt in jejunum. The growth with adequate margin and mesenteric lymph nodes were removed. The jejunal growth was diagnosed as adenocarcinoma on histopathology, which is a rare tumour of small intestine. He was planned adjuvant chemotherapy. He is in complete remission 6 months after follow-up.

Introduction: Sigmoid volulus is by far the most common type of volvulus, accounting for 75 to 90 % of all volvulus. Most common presenting symptom is abdominal pain and constipation. . It may be initially managed by sigmoidoscopy or rectal tube insertion but where fear of compromised vascular supply of the sigmoid colon is associated, immediate laparotomy after resuscitation must be undertaken to avoid gangrene and septic shock. The primary objective of the study is to demonstrate the most suitable procedure for management of patients with sigmoid volvulus needing emergency surgery. Methodology: All patients presenting with volvulus and needing emergency operative intervention during 1 years duration from January 2010 to December 2011 were included in this study. Total 41 patients were included in the study of which 25 presented with gangrenous sigmoid colon on laparotomy and viable sigmoid colon was present in the remaining 16 cases. Comparison is done with respect to mortality and early morbidity associated with different operative procedures. Results: Highest mortality i.e. 33.3% observed among patients who underwent primary resection and anastomosis without proximal colostomy. Wound infection was more common following all forms of stoma procedure. Conclusion: Hartmann’s procedure goes a long way in decreasing mortality due to sigmoid volvulus in the emergency setting.