This study was aimed to assess the effect of pre-freeze addition of cysteine hydrochloride and glutathione (GSH) on post-thaw sperm functional parameters and field fertility. The experimental bulls (n = 6) aged 4-6 years were used for this study. A total of 36 ejaculates (six ejaculates per bull) were collected and divided into three groups, group I (control), group II (5 mm cysteine hydrochloride) and group III (5 mm GSH). The extended semen samples with and without additives were filled in mini straw using automatic filling and sealing machine and cryopreserved in liquid nitrogen. Post-freeze seminal traits were recorded after thawing at 37°C for 30 s. The curvilinear velocity (VCL) and amplitude of lateral head displacement values were significantly (p < 0.05) higher in GSH than the cysteine and control groups. Post-thaw plasmalemma integrity was significantly (p < 0.01) higher in GSH group when compared to cysteine and control groups. The loss of acrosomal integrity was significantly (p < 0.01) lower in GSH than in cysteine and control groups. Addition of GSH non-significantly (p = 0.1) improved mitochondrial membrane potential (MMP) (per cent) than control group. This study indicates that the addition of cysteine and GSH suggestive (p = 0.08) of reducing lipid peroxide levels. The conception rate (%) in glutathione group was significantly (p < 0.05) higher than that in cysteine (68 vs 58) and control (49) groups. The post-thaw sperm progressive forward motility (r = 0.4) had moderate, but no significant correlation with conception rate. However, post-thaw straight-line velocity (r = 0.7), loss of acrosomal integrity (r = -0.8) and MMP (r = 0.9) had significant (p < 0.05) correlation with field fertility. This study indicates that the use of glutathione as semen additive may be used for improving post-thaw semen quality and overall augmentation of pregnancy in cows.

PurposeThis randomized clinical trial was conducted to compare a fistulectomy and a fistulotomy with marsupialization in the management of a simple anal fistula.MethodsForty patients with simple anal fistula were randomized into two groups. Fistulous tracts were managed by using a fistulectomy (group A) while a fistulotomy with marsupialization was performed in group B. The primary outcome measure was wound healing time while secondary outcome measures were operating time, postoperative wound size, postoperative pain, wound infection, anal incontinence, recurrence and patient satisfaction.ResultsPostoperative wounds in group B healed earlier in comparison to group A wounds (4.85 ± 1.39 weeks vs. 6.75 ± 1.83 weeks, P = 0.035). No significant differences existed between the operating times (28.00 ± 6.35 minutes vs. 28.20 ± 6.57 minutes, P = 0.925) and visual analogue scale scores for postoperative pain on the first postoperative day (4.05 ± 1.47 vs. 4.50 ± 1.32, P = 0.221) for the two groups. Postoperative wounds were larger in group A than in group B (2.07 ± 0.1.90 cm2 vs. 1.23 ± 0.87 cm2), however this difference did not reach statistical significance (P = 0.192). Wound discharge was observed for a significantly longer duration in group A than in group B (4.10 ± 1.91 weeks vs. 2.75 ± 1.71 weeks, P = 0.035). There were no differences in social and sexual activities after surgery between the patients of the two groups. No patient developed anal incontinence or recurrence during the follow-up period of twelve weeks.ConclusionIn comparison to a fistulectomy, a fistulotomy with marsupialization results in faster healing and a shorter duration of wound discharge without increasing the operating time.

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Introduction: Management of non-traumatic perforation of the small intestine has always been a consideration for surgeons because of associated enormous morbidity and mortality. There is a paucity of data on the management of non-traumatic perforation of the small intestine. Methodology: A retrospective study was conducted which involved analysis of 192 patients treated for non-traumatic perforation of small intestine in a tertiary care teaching hospital in North India. The clinical profile and management of the patients were studied. Results: The most common cause of non-traumatic perforation of small intestine was typhoid (46.4%), followed by non-specific inflammation (39.2%), tuberculosis (12.8%) and malignant neoplasm (1.6%). Primary repair was the most frequent procedure (44.0%), followed by ileostomy (25.5%) and resection-anastomosis (19.3%). Superficial wound infection was the most frequent postoperative complication (46.8%), followed by wound dehiscence (31.3%). The wound infection rate was reduced significantly following delayed primary closure of skin incision. Enterocutaneous fistula/leak developed in 11.5% patients. Salvage ileostomy for post-operative intestinal leak resulted in a better survival rate as compared to conservative treatment (85.7% vs. 50.0%). The overall mortality rate was 16.6%.   Conclusion: Operative procedures undertaken for the management of non-traumatic perforation of small intestine can be classified into two groups: procedures that leave an intestinal suture line inside the peritoneal cavity and procedures that do not. The no suture line-in procedure seems to be better option in adverse patient conditions.

A 15-year-old girl presented with features suggestive of sub-acute intestinal obstruction (SAIO) with a palpable abdominal lump. Contrast-enhanced computed tomogram (CECT) abdomen revealed congregated small gut loops confined to a single area and encased in a thick membrane suggestive of abdominal cocoon. On laparotomy, a thick white membrane was found encasing most of the small gut. The cocoon was excised releasing the encased small bowel. The patient was relieved of her symptoms following surgery. Histopathology of excised cocoon membrane revealed granulomatous inflammation consistent with tuberculosis. The patient was discharged on ninth postoperative day with advice to take anti-tuberculosis drugs for 6 months. The possibility of abdominal cocoon should be considered in patients with SAIO and abdominal lump. Abdominal cocoon being a rare condition, CECT is useful in clinching the diagnosis and planning elective surgery in experienced hands.

Primary tuberculotic osteomyelitis (TBOM) of the rib is rare. We report our experience of seven patients presenting with primary TBOM of rib. Over a period of eight years, otherwise healthy patients presenting with discharging sinus on the chest wall were managed. Patients included four males and three females, aged between 4 and 18 years. Following history and examination, radiological and histological investigations were performed. After confirming osteomyelitis of rib, excision of the sinus tract along with subperiosteal resection of the affected part of the rib was done. Tuberculosis was confirmed on histological examination of the resected specimens. Oral anti-tubercular therapy (ATT) was given for a period of one year. Patients were followed for 5-8 years. The lesion was demonstrable in all the patients on plain X-ray. Histological confirmation of tuberculosis (TB) before surgery could be done in one patient. The anterio-lateral part of the rib was most commonly affected. Mean operative time was 35 min. Mean postoperative hospital stay was four days. There were no wound complications. No recurrence or relapse was seen. Resection of affected part of the rib with the sinus tract followed by oral ATT for one year is an effective modality of treatment for TBOM of rib.

Abdominoscrotal hydrocele is an hourglass hydrocele with both an inguinoscrotal and abdominal component. It is a rare surgical entity with few cases reported in the literature. We report a case of abdominoscrotal hydrocele that gives an insight into its pathogenesis.

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