Malignant pleural effusion (MPE) denotes an advanced malignant disease process. Most of the MPE are metastatic involvement of the pleura from primary malignancy at lung, breast, and other body sites apart from lymphomas. The diagnosis of MPE has been traditionally made on cytological examination of pleural fluid and/or histological examination of pleural biopsy tissue that still remains the initial approach in these cases. There has been tremendous advancement in the diagnosis of MPE now a day with techniques i.e. characteristic Ultrasound and computed tomography features, image guided biopsies, fluorodeoxyglucose-positron emission tomography imaging, thoracoscopy with direct biopsy under vision, tumor marker studies and immunocytochemical analysis etc., that have made possible an early diagnosis of MPE. The management of MPE still remains a challenge to pulmonologist and oncologist. Despite having various modalities with better tolerance such as pleurodesis and indwelling pleural catheters etc., for long-term control, all the management approaches remain palliative to improve the quality of life and reduce symptoms. While choosing an appropriate management intervention, one should consider the clinical status of the patient, life expectancy, overall cost, availability and comparative institutional outcomes, etc.

Background: Laparoscopic cholecystectomy is one of the most common operations performed by general surgeon. This study was performed to evaluate pre-operative factors predicting difficult laparoscopic cholecystectomy.Methods: A prospective study was carried out at Jawaharlal Nehru Medical College Hospital, Ajmer, a tertiary care centre in Middle East Rajasthan, India. In present study we included 100 patients diagnosed with symptomatic gallstones disease on the basis of history, clinical examinations and USG findings and underwent laparoscopic cholecystectomy in our hospital by a single surgeon during the period of July 2014 to July 2016. These all patients were evaluated for a group of risk factors and preoperatively these risk factors were given a score between 0-5 labeled as easy, 5-10 as difficult and 11-15 as very difficult. Statistical analysis was done by Fischer’s test and chi square test.Results: BMI >30, previous medical disease like DM, palpable gall bladder, prior hospitalization pericholecystic collection and impacted stone are significant risk factors to predict difficult laparoscopic cholecystectomy.Conclusions: The studied scoring system had a positive prediction value for easy prediction of 94% and for difficult prediction of 100%.

Background: Laparoscopic Cholecystectomy [LC] has become the gold standard for treatment of benign gall bladder disease. Pain after laparoscopic cholecystectomy though primarily visceral, often affecting sub diaphragmatic region and often referred to the right shoulder region, also has a parietal component which occurs at the trocar site.Aim: This study was conducted to compare postoperative pain control with use of 0.5 % bupivacainesoaked sheet of regenerated oxidized cellulose in the gallbladder bed versus port site infiltration of 0.5 % bupivacaine after laparoscopic cholecystectomy.Material and Method: Total patients were 75, which were divided in three groups -Group A (n=25) bupivacaine-soaked sheet of regenerated oxidized cellulose was placed in the gall bladder bed, Group B (n=25) bupivacaine was infiltrated at trocar site before skin suturing, Group C (n=25) was the control group. Nature of painvisceral, parietal or shoulder was assessed on VAS at 3,6 & 24hrs after surgery. Results: All patients demonstrated different intensities of visceral and parietal pain in all groups. No patient had shoulder pain. Visceral pain at 3, 6 & 24hr was significantly less in group A (2.04±1.71, 1.56±1.68 & 0.40±0.57) as compare to group B (3.08±0.70, 2.56±1.29 &1.28±0.54) & group C (4.32±0.62, 3.84±0.85 & 3.08±0.91) (p< 0.05). Parietal pain at 3,6 & 24hrs for group B (2.28±1.45, 1.36±1.22& 0.60±0.50) was less than group A (2.76±0.66, 2.28±0.54 & 1.12±0.44) & group C (4.64±0.86, 3.68±0.90 &3.16±0.80) (p<0.05). Postoperative analgesic requirement was 16% in Group A, 20% in Group B and 100% in Group C. Conclusion: Bupivacaine (0.5%) soaked sheet of regenerated oxidized cellulose (ROC) in the gall bladder bed is safe, increases postoperative comfort and decreases postoperative analgesics requirement after laparoscopic cholecystectomy as compare to trocar site infiltration.

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Background: Liver is an important and vital organ of the body. This organ is subjected to numerous systemic infections viral, bacterial and parasitic and lies at the distal end of the portal circulation; it is therefore bathed with portal blood containing viruses, bacteria parasites, ova, products of digestion and other antigens. Methods: This study was a cross sectional study of patients attending surgery department in J L N Medical College, Ajmer Rajasthan. The study was conducted over a period of 1 year on 100 patients of liver abscess. Results: 3 mortalities were found in amoebic liver abscess patients who had ruptured liver abscess and was undertaken for surgical intervention Conclusion: We suggest early recognition of clinical features and prompt abdominal USG as cost-effective means for treatment initiation and reducing complications. Keywords: Amoebic liver abscess, Pyogenic liver abscess, Treatment.