BACKGROUND Parosteal lipoma is an extremely rare benign tumour accounting for 0.3% of all lipomas. They are composed mainly of mature adipose tissue with a bony component. Parosteal lipomas often induce a periosteal reaction. The most frequently affected sites are the diaphysis and metaphyseal regions of long bones. They are usually asymptomatic and affecting mainly adults aged over 40. We are presenting a 47-year-old gentleman who presented to us with complaints of an asymptomatic swelling over his right thigh gradually progressive in size. On evaluation, he was diagnosed to have a 12 x 8 x 6 cm sized parosteal lipoma arising from the right femur. He underwent excision of the lipoma. Postoperative period was uneventful.

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BACKGROUND Comparing the diagnostic accuracy of RIPASA score over Alvarado score in diagnosing acute appendicitis. The accuracy of Alvarado score in the diagnosis of acute appendicitis is disappointingly low in Asian population and RIPASA scoring has been designed for the diagnosis of acute appendicitis in the Asian population. MATERIALS AND METHODS A cross-sectional study of 109 patients diagnosed to have acute appendicitis with the aim of comparing RIPASA and Alvarado scoring. A score of 7.5 is the optimal cut off threshold for RIPASA and 7 for Alvarado scoring system. Sensitivity, specificity, positive predictive value and negative predictive for RIPASA and Alvarado system were done. RESULTS The sensitivity and specificity of RIPASA score were 95.5% and 65%, respectively. The sensitivity and specificity of Alvarado score were 65.16% and 90%, respectively. The positive predictive value of RIPASA was 92.39% and negative predictive value 76.47%. The positive predictive value for Alvarado was 96.6% and negative predictive value was 36.73%. RIPASA score correctly classified 89.9% of all patients confirmed with histological acute appendicitis to the high probability group (RIPASA score greater than 7.5) compared with 69.73% with Alvarado score (Alvarado score greater than 7.0; p-value is 0.002). CONCLUSION RIPASA scoring system is more convenient, accurate and specific scoring system for Indian population than Alvarado scoring system.

Results: Out of the 378 cases, 246 cases (65.1%) had normal finding and 132 cases (34.9%) had abnormal findings. Among the 132 abnormal finding 85 cases had oesophageal, 50 cases had gastric and 11 had duodenal pathologies. Among these cases, 14 cases had both oesophageal and gastric diseases. Conclusion: In our study, the commonest pathology in patients with upper gastrointestinal symptoms was esophageal followed by gastric and duodenal diseases. We therefore conclude that upper GI endoscopic evaluation is a must in all patients who present with upper gastrointestinal tract symptoms.

BACKGROUND: Small bowel tumours occur rarely with an average annual incidence rate of 9.9 per million people. (1) Jejunum accounts for only 20-30% of all small bowel cancers. Jejunum cancer is rare accounting for only 3% of all gastrointestinal cancers. (1) We report this case of Jejunal adenocarcinoma for the rarity. We discuss the diagnosis and management of this case briefly.