Conclusions:Results are comparable with other published studies, but are still unsatisfactory for many splenectomy patients. Vaccination rates must be improved and more information given to patients and GPs to allow for appropriate follow-up care.

BACKGROUND AND OBJECTIVES: Decision making in case of acute appendicitis may be difficult, especially for junior surgeon. Radiological investigations do not appear to be helpful sometime. A decision to operate based on clinical suspicion alone can lead to removal of normal appendix in 15-30% cases. In some studies Modified Alvarado Scoring System (MASS) was helpful in minimizing unnecessary appendectomies. The present study aims to evaluate the efficiency of Modified Alvarado scoring in preoperative diagnosis of acute appendicitis. METHODS: A 100 consecutive patients suspected of acute appendicitis who were admitted, investigated and treated were taken for the study. They were prospectively evaluated using the modified Alvarado scoring (MAS) to determine whether or not they had acute appendicitis they were assigned in three groups they were treated accordingly. The MAS was correlated with operative and histopathological findings. RESULTS: The results of the study showed that high score in men and children (7-9) had a sensitivity of 95.45% and 87.50& respectively, where in females it had a sensitivity of 76%. The score (5-6) in men and females had a sensitivity of 57.14% and 75% respectively. INTERPRETATION AND CONCLUSION: the high score in Modified Alvarado Score Is dependable aid in the early diagnosis of acute appendicitis in men and children but is a less dependable aid as far as women are concerned.

Branchial anomalies are the second most common congenital head and neck masses. Although congenital, all age groups are known to be affected. Branchial anomalies are common congenital pediatric head and neck lesions but are comprised by several diverse anomalies. Treatment must be tailored depending on which branchial arch is involved and whether a cyst mass or sinus/fistula tract is present. KEYWORDS: Branchial anomaly, branchial cleft cyst, branchial fistula, branchial sinus, congenital neck mass, pediatric neck mass INTRODUCTION: Branchial anomalies comprise approximately 20% of pediatric congenital head and neck masses, making them, after thyroglossal duct cysts, the second most common 1. Although the term branchial anomaly encompasses first, second, third and fourth branchial cleft cysts, sinuses and fistulae, all of which are distinct clinical entities and require separate management, all are thought to result from a similar embryologic error: incomplete obliteration of the branchial apparatus during embryogenesis 2. The branchial apparatus consists of six grooves (ectoderm), arches (mesoderm) and pouches (endoderm). When a pouch or groove fails to obliterate, it may communicate with either skin or mucosa of the upper airway, forming a sinus. When both a pouch and a groove fail to obliterate, it may form a communication between the skin and mucosa, which is termed a fistula. When a branchial groove remnant forms an epithelial-lined space without communication to the skin or mucosa, a cyst is formed 1. Each of the six branchial arches (with the exception of the fifth) develops into specific structures in the head and neck. A branchial anomaly and its associated tract typically lies inferior to all the derivatives of its associated arch and superior to all derivatives of the next arch 2. The malformations can, therefore, be divided into first through fourth branchial anomalies. PATIENTS AND METHODS: A retrospective analysis was conducted between Jan 2008 to June 2012, over a period of 54 months in KIMS Bangalore. Total number of 31 cases were analysed. RESULTS: First and second decade was the most common age group affected. (Chart 1). Eighty nine percent of patients were males. Right sided lesions were seen in 68% of patients, left in 22% and bilaterally in 10% of patients. Discharge from the external opening and swelling were the most common symptoms. (Figures 1, 2 and 3). Surgery was performed in all the patients. Elliptical incision was used in the majority of cases; step ladder incision was the next most common incision used. (Figure 4).

BACKGROUND AND OBJECTIVE: Thyroid malignancies account for 90% of endocrinal malignancies. The incidence of thyroid malignancies has increased three fold over the past 3 decades. Many patients present to the surgical outpatient department with a thyroid nodule. However not all there are many methods to diagnose and predict malignancy in a thyroid nodule. A clinical examination is always the first step to assess a nodule. A thyroid profile is also essential. This is accompanied by certain tests which increase the rate of detection. Fine needle aspiration cytology (FNAC) is the present gold standard and primary tool for assessing risk of malignancy. Other tests include ultrasonography, thyroid scintigraphy, CT scan and MRI. Recent studies have found levels of serum TSH to be an independent predictor of malignancy in thyroid nodules. This biochemical marker could be used as a screening test for malignancy. In this study we investigated the utility of TSH in predicting malignancy and the common clinical presentation of thyroid malignancies.

OBJECTIVES: a) To study the different location of the testis in children with imperfect descent of testis, b) To study associated anomalies and complications of imperfect descent of testis, c)To study the various modalities of management of imperfect descent of testis.BACKGROUND DATA: Since the testis originally develops in the abdominal region, its descent may be inhibited anywhere along its normal pathway or it may be diverted from this route in to an ectopic location. This apparently simple developmental anomaly represents one of the more common disorders of the childhood.It affects all races, and there does not seem to be a geographic propensity. undescended testis may be associated with a number of chromosomal and hereditary disorders in which a specific defect can be identified, and complications which are infertility, hernia, trauma are more if left untreated and also interestingis that till today relatively little is known about what cause the testis to migrate from the abdomen in to the scrotum, inspite of research which is going on till now.METHOD: Present study was conducted on 50 patients who presented with complaints of undescended testis and its complications within the age of day 1 of birth to 18 years. It was prospective study and study was done at department of pediatric surgery, Kempegowda institute of medical sciences, Bangalore during study period of December 2011 to May 2013.RESULTS: 1. Imperfect descent of testis is more common in2-5 years of age, 2. Right side is more common followed by left side followed by bilateral, 3. Absence of testis in scrotum with underdeveloped scrotum is the most common complaint, 4. In palpable testis superficial pouch is the most common site where the testis is found. 5. In ectopic femoral is the most common. 6. In impalpable testis most common is canalicular. 6. Gubernacular abnormalities were most common followed by presence of processusvaginalis and hernia sacs. 7. Open orchidopexy for palpable and lap orchidopexy for impalpable testis is the operation performed.CONCLUSION: Many of undescended testis descend within one year of age, hence we should wait till one year of age. Orchidopexy for undescended testis should be done within 2 years of age as histopathological change start from 2 years of age till 16 years where irreversible histopathological changes take place. Retractile testis has no role in surgery and only assurance should be given. Routine preoperative imaging for undescended testis is neither necessary nor helpful. Ultrasound or MRI do not localizes a truenon palpable testis and hence does not alter surgical management. So laparoscopy should be used directly for evaluation of children with impalpable undescended testis.