BACKGROUNDFor decades, there has been discussion whether thyroid disorders could cause gallstone disease. Gallstone formation is a complex process involving various mechanisms affecting the flow of bile and bile content. Hypothyroid patients are found to have biliary stasis because of slowed emptying of bile from the biliary tract into the duodenum. This is attributed to the decreased pro-relaxing action of thyroxine on sphincter of Oddi in hypothyroid individuals. The hallmark laboratory investigation to detect hypothyroidism and also a sensitive indicator for diagnosing early thyroid dysfunction is serum TSH level. Serum TSH level is the most accurate indicator of thyroid function. This study attempts to know the prevalence of hypothyroidism in cholelithiasis. MATERIALS AND METHODSA cross-sectional study was done between April 2014 to September 2014. 50 patients diagnosed as cholelithiasis in Department of General Surgery, Government Royapettah Hospital, were included in the study. Full history, clinical examination, ultrasound abdomen and laboratory blood test for free T3, free T4 and TSH were done for every patient. Data was analysed statistically using SPSS version 19.0. RESULTSOut of 50 patients of cholelithiasis, 29 (58%) were females and 21 (42%) were males. Thyroid disorder in form of hypothyroidism was found in 19 (38%) patients. In that, 11 (22%) patients presented with subclinical hypothyroidism and 8 (16%) patients with clinical hypothyroidism. CONCLUSIONThere is an increase in prevalence of hypothyroidism in cholelithiasis in this study. The prevalence was more among >40 years age group. This increase in prevalence could have an effect on the diagnostic and therapeutic workup of cholelithiasis patients.

BACKGROUND Acute appendicitis is one of the most common cause of acute abdominal pain and emergency appendicectomy is the most common emergency surgery. The diagnosis of appendicitis is confirmed by histopathological examination that is not possible before appendicectomy. The negative exploration remains high in the rate of about 15-30%. 1 Scoring systems based on history, clinical examination and basic investigations are there in aiding the diagnosis of acute appendicitis and decreasing negative exploration. This study compares RIPASA and ALVARADO scoring systems in diagnosing acute appendicitis. 2 MATERIALS AND METHODS A comparative study was done between November 2014 to June 2015. Patients diagnosed as acute appendicitis in Department of General Surgery, Government Royapettah Hospital. 100 of them are to be selected on the basis of nonprobability (purposive) sampling method. After considering the inclusion and exclusion criteria, 96 were enrolled into the study. A full history, clinical examination and both scoring systems were done on the patients.

Ancient schwannomas are a rare entity of benign cutaneous nerve sheath tumor in patients without von Recklinghausen disease. Head and neck, mediastinal, retroperitoneal ancient schwannomas have been reported and has high degree for malignant transformation. Ancient schwannoma of the peripheries have been reported in only few cases and in hand only two cases have been reported. We present this case for its rarity and the diagnostic dilemma occurring with FNAC. Thus these tumors if present in periphery and in non-neurofibromatosis patient can masquerade as malignant tumors but still can safely are treated with excision biopsy alone and with almost nil recurrence.

BACKGROUND Acute scrotal swellings though commonly encountered, many a times an accurate diagnosis is not made and the precious testis is sacrificed. In this study we find out the incidence of etiological factors which cause acute scrotal swelling, correlation of clinical features with operative findings, distribution among different occupation and age groups, different modalities of management of different aetiologies. MATERIALS AND METHODS Patients reporting to outpatient department of surgery with acute swelling and pain in scrotum, patients admitted as inpatient for same complaints or any other patients presenting with similar complaints during some other ailment from April, 2014 to September 2014. Age, occupation, clinical features, duration, investigations, different etiologies, operative findings, postoperative complications will be documented and analyse. RESULTS Epididymo-orchitis was found in 32 cases, followed by Epididymitis (10) and Pyocele (10). The maximum incidence occurred in the first 3 decades. Similar past complaints and urinary symptoms are predominant predisposing factors. The average duration of symptoms in case of epididymo-orchitis was 6.06 days, whereas in Fournier's gangrene it was 3 days. Urine analysis and haemogram were inconclusive but supportive. Ultrasound of scrotum was diagnostic in most cases. The average period of hospitalisaton was found to be more in Fournier's gangrene (21.75 days). CONCLUSION The commonest etiology leading to acute scrotal condition is epididymo-orchitis followed by epididymitis and pyocele. Similar past complaints and urinary symptoms are the predominant predisposing factors. Investigations are not conclusive but supportive. Acute scrotal swellings affect the whole life of the patient in the aspect of sterility. So, it needs meticulous examinations, proper evaluation and aggressive management.

BACKGROUND Ventral hernia in the anterior abdominal wall includes both spontaneous and most commonly incisional hernias after an abdominal operation. Mesh repair can be preperitoneal or onlay. Hernia recurrence is distressing to patient and embarrassing to surgeons. Controversy exists among the surgeons regarding the use of type of either mesh repair due to differences in ease in performing the surgery, time of surgery, complications occurring in the postoperative period and the recurrence. The study aimed to study the different techniques of repair of ventral hernia with special emphasis on preperitoneal mesh repair and onlay mesh repair and their outcome. MATERIALS AND METHODS In our study, 50 patients with ventral hernia attending and admitted to Royapettah Hospital and Kilpauk Medical College Hospital from November 2014 to April 2015 treated with preperitoneal and onlay mesh repair were analysed. 50 patients presenting with ventral hernia admitted were preoperatively assessed clinically and by ultrasonography to confirm the diagnosis. 30 patients each underwent preperitoneal and onlay mesh repair after obtaining consent and satisfying the inclusion criteria. RESULTS Results were analysed based upon the factors like ease of operation, time taken for the surgery, associated factors, complications and recurrence. We observed seroma formation, wound infection and flap necrosis in 36%, 32%, 16% patients respectively in onlay mesh repair group and in 12%, 8%, 0% patients respectively in preperitoneal mesh repair group. Recurrence was seen in 16% patients in onlay group. No recurrence was encountered in the preperitoneal mesh repair group. Associated factor morbidity was also found to be higher in onlay group. CONCLUSION Considering the burden of surgeries especially in third world countries with limited number of surgeons, it could provide valuable alternative over preperitoneal repair. Ease of the procedure in performing onlay mesh repair over preperitoneal repair gives it the points over preperitoneal, but associated complications limits its use. Based upon the above results, we observed preperitoneal mesh repair is superior than onlay mesh repair in ventral hernia.