Background:Laparoscopic cholecystectomy (LC) is normally performed under general anesthesia. But of late this operation has been tried under regional anesthesia successfully without any added complications like epidural anesthesia.Aims:The aim of the study was to study the feasibility of performing LC under epidural anesthesia in normal patients so that the benefits could be extended to those high-risk patients having symptomatic gallstone disease and compromised cardio-pulmonary status where general anesthesia is contraindicated.Materials and Methods:In all, 20 patients with the American Society of Anesthesiologist's class I or II were enrolled in the study. The level of epidural block and satisfaction score, both for the patient and the surgeon, were noted in the study.Results:The LC was performed successfully under epidural anesthesia in all but two patients who had severe shoulder pain in spite of giving adequate analgesia and were converted to general anesthesia.Conclusions:The LC can be performed safely under epidural anesthesia with understanding between patient and surgeon. However, careful assessment of complications in the patients should be done to make the procedure safer.

Introduction: Polycystic ovary syndrome (PCOS) is one of the most important endocrinal diseases in reproductive age group, clinically manifested by hyperandrogenism and anovulation and different other metabolic disturbances that may have important implications for long-term health. Aim and Objective: The aim of this study was to determine the incidence of abnormal luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio in women with polycystic ovary and to assess the influence of prolactin and thyroid-stimulating hormone (TSH) in the elevated LH/FSH ratio. Study Design: Retrospective observational study. Materials and Methods: Eighty-five women in reproductive age diagnosed with PCOS between June 2012 to June 2014 at the Department of Obstetrics and Gynecology in a tertiary care hospital were selected for the study. Serum LH and FSH levels were determined and LH/FHS ratio (normal range ≤2) calculated in the study subjects. They underwent a detailed clinical, hormonal, and metabolic evaluation, which was performed between the second and third days of a natural or induced menstrual period. Results: Elevated LH/FSH ratio was found in 60 women (70.58%). Normal gonadotropin ratio was detected in 25 women (29.41%). Statistically significant differences in serum TSH levels were noted between groups with normal and elevated LH/FSH ratio. However, no statistically significant difference was noted in other endocrine parameters. Further analysis revealed a slight negative correlation of TSH with prolactin in the study subjects of PCOS with an ‘ r ’ value of − 0.3. Conclusions: LH/FSH ratio is one of the characteristic attribute of PCOS women. In the present study, this abnormality was detected in 70% of patients. Hypothyroidism was a common endocrinal abnormality and prolactin was inversely correlated to TSH levels in PCOS patients.

Open Access Original Article

Staghorn calculus in the common bile duct (CBD) is rare. Few reports have described a giant stone measuring 5 cm or more in the CBD [1]. We could find only one published report of staghorn common bile duct calculus [2].A 48-year-old lady presented with chronic pain upper abdomen and mild icterus. Ultrasonography followed by magnetic resonance cholangiopancreaticography (MRCP) showed dilated CBD impacted with stones ( Fig. 1). The patient underwent open cholecystectomy and CBD exploration. At surgery, the stone was tightly impacted in the CBD and extended into both hepatic ducts, measuring approximately 8 cm × 6 cm (Fig. 2). The stone was extracted with difficulty and hepaticojejunostomy was done. The patient recovered uneventfully and was discharged from the hospital on 10th postoperative day.

Post-traumatic diaphragmatic hernia is not an uncommon sequel. But lack of awareness of this condition may delay in diagnosis and result in life-threatening complications. CT scan is regarded as the investigative tool of choice but some prefer Barium studies in delayed cases of diaphragmatic hernia. Chest X-ray and Ultrasonography of the chest and abdomen may also help in arriving at a diagnosis. An awareness of the condition assisted by the radiological investigations will lead to an early diagnosis and treatment which ultimately helps in managing the patients with diaphragmatic hernias better. Keywords Diaphragmatic hernia . Trauma . Radiological investigationsA 30 year old male patient was admitted with h/o severe pain upper abdomen for 3 days which started following lifting of a heavy weight. No associated vomiting or fever. Patient gives history of stab injury left side of the chest wall 3 years back from which the patient had uneventful recovery. On examination the patient had labored and fast breathing, pulse rate of 130/m, B.P. 110/76 mmHg. CXR showed an overtly elevated left hemi-diaphragm (Fig. 1). CT scan abdomen and thorax showed stomach and omentum herniating into the chest (Fig. 2). A diagnosis of diaphragmatic hernia was made. On operation most of the stomach along with greater omentum was found herniated into the chest through a small diaphragmatic defect on the left hemidiaphragm and was almost gangrenous. The hernia defect was closed with non-absorbable suture. A near-total gastrectomy was performed and a Roux-en -Y end to side gastrojejonostomy was done. DiscussionInjuries to the diaphragm may be followed by immediate herniation of abdominal viscera into the chest. However it is widely accepted that herniation may be delayed [1,2]. Males usually outnumber females [1] and only around

A 33-year-old male, chronic alcoholic for 15 years, came to General Surgery OPD with pain upper abdomen radiating to the back for one and half months and upper abdominal fullness for three weeks. Pain was sudden in onset and severe in intensity, relieved on bending forward and aggravated on taking food. On chest X-ray patient had also developed generalized distension of abdomen with upper abdominal fullness of three weeks. The upper abdominal fullness had been increasing over time. Patient also had massive left sided pleural effusion [Table/ Fig-1] and developed respiratory distress for which a left sided Inter Costal Drainage (ICD) was put and about 800ml of blood tinged, amylase rich fluid was drained with relief of symptoms.Patient had similar episodes of pain abdomen on and off for last six years but the intensity was less severe and was relieved by medications. On per abdominal examination, abdomen was distended with tenderness over the epigastrium, left hypochondrium and umbilical regions. A 10x10cm tense, cystic and tender lump was palpable over the epigastrium with well-defined margins however, the upper border could not be felt. The lump had no movement with respiration and showed no side-to-side mobility. There was also free peritoneal fluid as evidenced by shifting dullness. Investigations revealed haemoglobin to be 11.2g%, total leucocyte count, differential leucocyte count, kidney function test, coagulation profile were within normal limits, serum amylase and lipase were raised at 700 and 863U/L respectively and pleural fluid amylase was also high at 223U/L. /Fig-2,3] showed a massive left sided pleural effusion with right mediastinal shift; a large 12x11x11cm sub-capsular collection with wall thickness of 6mm in the left lobe of liver causing scalloping of liver. The spleen also had a sub-capsular collection measuring 7x8x7cm; pancreas was heterodense around the body and tail and the Main Pancreatic Duct (MPD) was mildly dilated. Gallbladder and the extra-hepatic biliary system were normal. Contrast Enhanced Computed Tomography (CECT) abdomen [TablePatient did not have any haematemesis or melaena during the hospital stay but had a drop in haematocrit. Two units of packed red blood cells were transfused and the haemoglobin stabilized at 10g%.As the patient was stable except for severe pain, he was initially managed conservatively by keeping nil per oral, maintaining hydration by IV fluids and adequate analgesia, oxygen inhalation by facemask and SpO 2 monitoring. The pain and epigastric lump size was increasing in size; hence the subcapsular pseudocyst was drained percutaneous by placement of a 10 Fr malecot catheter under USG guidance [Table /Fig-4]. Approximately 500ml of cyst fluid was drained which was dark colored, with clots and high amylase level (6000IU/L). The USG repeated after seven days showed collapse of the cavity and resolution of the pseudocyst with no residual collection. During the two months follow-up, no peripancreatic or subcapsular collection was observed. DisCussion aBstRaCtA...

No abstract

No abstract