Background:Laparoscopic cholecystectomy (LC) is accepted as the gold standart treatment of gallstones. Various methods have been developed to close the cystic duct (CD) and cystic artery (CA), but titanium clip application is currently the most frequently used technique. High-tech electrosurgical instruments, such as Harmonic Scalpel (HS), have been used both for dissection of the cystic artery and Cystic duct. The present study was conducted to observe and establish efficacy of clipless cholecystectomy, by use of harmonic scalpel as an alternative, for division and sealing of cystic artery and cystic duct. Methods:This study was a hospital based, retrospective study, conducted in Govt. Medical College, Srinagar, using medical records. A total of 114 patients included in the study, having been operated by a single surgeon over time period of 5 years from February 2014 to january 2019. Results:In our study of 114 patients 82 (71.92%) were females and 32 (28.07%) were males with average age of 41.4years (16-72 yr). No patient was converted to open with average operating time of 24.2 minutes (18-46 minutes). Mean hospital study was 1.42 days (1-8 days) with no mortality. Postoperative complications were found in 6 (5.2%) patients with bile leak from duct of Lushka in 1 (0.8%) patient, port site infection in 2 (1.7%) patients and fever in 3 (2.6%) patients.Gallbladder perforation intraoperatively was seen in 7 (6.2%) patients.Conclusions:Use of harmonic scalpel is an excellent option for the cystic duct closure with less time consumption and less complications.

BACKGROUND About 60-70% of ganglion cysts are found in dorsal part of the wrist. This study compared aspiration followed by intra-lesional steroid (triamcinolone acetate) injection and surgical excision in the management of dorsal wrist ganglion. METHODS From Aug 2016 to Aug 2018 in Department of General Surgery, Government Medical College Srinagar, India, 86 Patients with dorsal wrist ganglions were enrolled. The patients were divided to two groups undergoing two different treatment modalities including 68 patients of aspiration with intralesional triamcinolone acetonide injected into the cyst (group A) and 18 patients with surgical excision (group B). Follow up time was 1, 3, 6 and 12 months. RESULTS Successful treatment was noticed in 59 patients of group A (86.8%), and in 15 patients of group B (83.3%). CONCLUSION Aspiration followed by intra-lesional steroid injection was better managed in comparison to surgical excision.

Background: Nose contributes as a very important and prominent part of the face; and occupies the most visible position on normafrontalis. There is an anthropometric harmony between different structures of face including nose, lips, eyes, forehead, chin and cheek. Our study was aimed to determine sexual and ethnic differences in external nose measurements of young adult Kashmiri population and to provide baseline data for reconstructive cosmetic surgeons and forensic experts.Methods: This study was conducted among 300 healthy participants (150 males and 150 females) belonging to Kashmiri population. Nasal height, length and breadth were measured using a vernier caliper. Then, the nasal index was determined for each subject. The obtained data was subjected to statistical analysis.Results: In case of males, mean nasal index was 83.31±12.31 mm, mean nasal length was 57.28±4.51 mm, mean nasal breadth was 48.41 mm and mean nasal height was 36.17±20.9 mm, while in case of females mean nasal index was 226.83±46.41 mm, mean nasal length was 50.16±3.54 mm, mean nasal height was 13.97±2.01 mm and mean nasal breadth was 31.02 mm.Conclusions: Nasal type among the Kashmiri male population is predominantly mesorrhine while in females it is hyperplatyrrine or very wide nose.

Background: Hemorrhoids are symptomatic anal cushions containing arteriovenous anastomosis. Patient with haemorrhoids can present as bleeding per rectum, something (mass) coming out per rectum, perianal itching, Anaemia due to occult blood loss. Various modalities of treatment have been developed to treat symptomatic haemorrhoids. This study was undertaken to determine the efficacy of rubber band ligation in the management of haemorrhoids.Methods: This study was a prospective study conducted in the Department of Surgery, Government Medical College, Srinagar from June 2015 to June 2018. Patients at any age with first, second- or third-degree internal haemorrhoids were included in the study. Patients with fourth degree, complicated haemorrhoids, previous anorectal surgery or anorectal pathology, and chronic liver disease were excluded. A total of 212 patients were included in the study. Rubber band ligation was done as an OPD procedure. The patients were followed at 2 weeks, 4 weeks, 3-month, 6 month and 1 year after the procedure.Results: In this study, out of 212 patients, 154(72.6%) were males and 58(27.4%) females. The mean age of this study was 38.7 yr. (Range 17-73 yr.). Patients presented with the complaints of bleeding (184, 86.8%), prolapse (114, 53.7%), constipation (116, 54.7%), priuritis ani (36, 17.0%), pain (12, 5.6%). Band ligation was successful in 188(88.8%) patients, 169(79.7%) patients were cured and in 19(8.9%) improvement was obtained. Various complications occurred after band ligation including vasovagal syncope (2, 0.9%), bleeding per anum (6, 2.8%), pain (12, 5.6%), fissure in ano (1, 0.5%). Recurrence after one year was seen in 9(4.2%) patients.Conclusions: Author concluded in this study that RBL is an effective outpatient treatment for grade II and III internal haemorrhoids without much complications.

Introduction:- Cervical dysfunction either due to disruption of intact cervical epithelial barrier or mechanical incompetence of the cervix has been associated as one of the risk factors for preterm premature rupture of membranes and preterm birth. Our aim was to study second trimester cervical length as a predictor of preterm labour in our population. Methodology:-This hospital based prospective study was conducted in a tertiary care hospital over a period of one and a half year (2019-2021). The relationship of cervical length between the 16th and 24th week of pregnancy and preterm delivery was evaluated for the 82 women after inclusion and exclusion criteria. Data was analyzed using SPSSversion 11.0. Results:- The mean age of study patients was 29.3±2.52 years, with 52.4% (most common) being in the age group of 28-31 years. 26.8% patients had a cervical length of ≤2.5 cm while 73.2% had cervical length of >2.5 cm at the time of examination. 45.1% women delivered at <37 weeks of gestation while 54.9% delivered at term. Most of the patients i.e., 64.6% delivered by normal vaginal delivery and 35.4% delivering by Cesarean section. 72.7% patients with short cervical length delivered at <37 weeks while only 35% of those with normal cervical lengths delivered at <37 weeks. This difference was statistically signicant (p<0.0002). Conclusion:- We concluded that a short cervical length of< 2.5 is a risk factor for development of spontaneous preterm labour and that ≤ 2.5mm is an optimum threshold for it.

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Objective: - This research aimed to determine how useful high-resolution ultrasonography is for diagnosing Achilles tendinopathy. 35 consecutive patients and 50 healthy volunteers made up the study's Methodolgy: - case-control, crosssectional design. The thickness, echogenicity, brillar pattern, and presence of calcications of tendons were evaluated by ultrasound. The vascularity of the tendons was measured by power Doppler imaging. Cross-sectional area and anteropos Results: - terior diameter were both greater in tendinopathic tendons compared to healthy tendons. More often than not, patients' ultrasounds would reveal hypoechoic regions inside the tendon. Fibrillar pattern disruption, increased tendon vascularity, and heightened echogenicity in the Kager's fat pad were seen in patients. Because of the inammation and irritation caused by Achilles tendinopathy, the tendon swells, especially in the middle and end regions, and the brillar pattern is disrupted, and the vascularity of the tendon increases. Increased echogenicity of Kager's fat pad, tendon calcication, alterations in retrocalcaneal bursae, and calcaneal shape are other symptoms. Our research shows that the most prominent Conclusion: - sonographic features of Achilles tendinopathy are an enlarged mid and distal tendon, a disrupted brillar pattern, and an increase in tendon vascularity.

Background: Bronchiolitis is the commonest lower respiratory tract infection in children < 2 years of age and is responsible for the majority of their pediatrician visits and hospital admission during the winter season. The aim of this study was to describe the epidemiological data, seasonal trends, clinical characteristics, and outcomes of children admitted with bronchiolitis in pediatric hospital GMC Srinagar. Methods: This was a retrospective observational study in children less than 2 years of age admitted in department of pediatrics in GMC Srinagar. Data were collected through review of the medical records of patients with a diagnosis of bronchiolitis on discharge and analyzed through SPSS 20. Results: A total of 228 infants were enrolled in the study. The majority were males (60.08%). The median age on admission was 5.5 months, exclusive breastfeeding was the mode of feeding in majority and 8.77% were ex-preterm. Respiratory syncytial virus (RSV) was identified in majority (103) and admission peak was from October to March. Most of the patients presented on day 3 of the illness. Most patients 45.17% were having feeding difficulties and chest auscultation was normal in about 22% of the children. Oxygen supplementation was administered to 85.52% of the children. The 32 children (14.03%) required admission to PICU. Mechanical ventilation was required in 6 children (18.75%). No death occurred in infants while in the hospital. Conclusions: RSV has been found to be the main responsible virus. Management of bronchiolitis is usually symptomatic as recommended by most of the guidelines.