Background: Prostate Specifi c Antigen (PSA) has been widely used in the diagnosis and management of patients with prostate cancer. It may be elevated in other prostatic diseases and surgical procedures. PSA exists in two forms, a major bound form (cPSA) and a free form (fPSA). Objectives: The objective of the study was to determine the relationship between serum fPSA levels and histologic fi ndings in biopsy specimens of men with prostatic disease. Material and methods:This study includes 91 patients planned for transurethral resection of prostate (TURP). Blood samples were collected before TURP and tested for fPSA. Histology of the tissue samples collected after TURP were studied and the relationship with fPSA analysed using SPSS 11.5. Results:The median values for benign, premalignant and malignant lesions were 1.8ng/ml, 4.5ng/ml and 13.20ng/ml respectively (p<0.001). Most cases of benign prostatic hyperplasia(BPH) without infl ammation had fPSA levels <2ng/ ml, while most with active infl ammation had levels >5ng/ml. Low grade prostatic intraepithelial neoplasia (LGPIN) saw levels <5ng/ml while high grade intraepithelial neoplasia (HGPIN) and prostate cancer (PCa) had levels > 5ng/mL (p<0.05). For detection of high grade lesions (HGPIN and PCa), the sensitivity and specifi city of fPSA level > 5ng/ml was found to be 88.8% and 90.2% respectively. Conclusions: Serum fPSA is elevated marginally in patients with BPH without infl ammation. Active infl ammation and high grade lesions are associated with fPSA level more than 5 ng/ml.

Gastric volvulus is defined as an abnormal rotation of the stomach. Classical textbook presentation may not always be present. Meticulous assessment and broadened differential diagnosis are thus crucial. Various types have been described in literature. Low threshold for detection with aggressive resuscitation and immediate surgical exploration on suspected incarceration or perforation are mandatory. We report a case of 16-years-female who had atypical presentation of mesenteroaxial gastric volvulus. Emergency exploratory laparotomy with wedge resection and primary repair of stomach with anterolateral gastropexy was performed. She had uneventful recovery with discharge on fifth postoperative day.

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Introduction: Androgenetic alopecia, also known as as male pattern baldness, affects up to 50% of men and 10% females worldwide. Patients with baldness seem to have a great impact on quality of life including their self-esteem, confidence, relationship as well as work. Methods: This is a cross-sectional descriptive study on dermatology quality of life index in patients with androgenetic alopecia who came for hair transplantation surgery at Aavaran Skin Clinic Pvt Ltd, Battisputali, Kathmandu between 15th July 2017 to 15th February 2018. Ethical clearance was taken from ERB of Nepal Health Reasearch Council Reg No 113/2017. All cases enrolled for transplant surgery during the study period and meeting the inclusive criteria were included. Results: A total of 120 patients participated in the study. Age of the patients ranged from 19 to 49, mean age being 31.87±6.8. Maximum number of patients was in age group 25 to 34. Mean dermatology quality of life index score was 2.79. Maximum score was 14 & minimum score was 0. Maximum effect was seen in question number 2 of self-consciousness, which had impact on 58 (48.33%) patients at some level. Minimum impact on quality of life was seen in sexual activity where only 4 (3.33%) of patients were affected. Conclusions: Androgenetic alopecia had a small effect on quality of life of our patients, but for some it had a great psychological impact not only with their personal feelings but also with the social response towards their problems.

Background: Natural portosystemic shunt ligation practices in liver transplant vary widely across transplant centres and are frequently undertaken to prevent the serious consequence of portal steal phenomenon. No concrete indications have so far been convincingly identified for their management in living donor liver transplant. Methods: We retrospectively studied the outcome of 89 cirrhotic patients who either did (n = 63) or did not (n = 25) undergo shunt ligation during living donor liver transplantation between 2017 and 2020. Results: The incidence of early allograft dysfunction/nonfunction (P = 1.0) and portal venous complications (P = 0.555) were similar between the two groups. Although overall complications, biliary complications, and the composite of Grade III and IV complications were significantly higher in the nonligated group (P = 0.015, 0.052 and 0.035), 1year graft and patient survival were comparable between them (P = 0.524). Conclusion: We conclude that shunt ligation in living donor liver transplantation may not always be necessary if adequate portal flow, good vascular reconstruction, and good graft quality have been ensured. ( J CLIN EXP HEPATOL xxxx;xxx:xxx)

Introduction: Acute abdominal pain is a common condition presenting to both the emergency department and surgical admission unit. Increase in serum amylase levels are found in much gastrointestinal pathology. Serum amylase level is consistently high in acute pancreatitis though high values are not pathognomonic of pancreatitis .The aim of this study to assess the level of serum amylase in various diseases presenting with acute abdominal pain and to evaluate the role of routine measurement of serum amylase in the screening of patient with acute abdominal pain for the diagnosis of acute pancreatitis in a prospective series. Methods: A prospective observational study was performed from 15th May 2014 – 15th Nov 2014 (6 months) at Department of Surgery of Kathmandu medical College Teaching Hospital; Kathmandu. All consecutive patients presented at emergency department and required admissions in surgical ward were included. A multivariate analysis was performed to assess the level of serum amylase in various diseases presenting with acute abdominal pain including acute pancreatitis. Results: Overall, 318 patients were included during a period of 6 months among them 48 patients were excluded. 34 cases (12.6 %) were diagnosed of acute pancreatitis. three cases (1.1%) of non pancreatic pathology with raised serum amylase level (> 1000 U\L). Conclusions: Routine assessment of serum amylase is helpful in excluding differential diagnosis of patient presenting with acute abdomen and this study identified serum amylase as a good screening tool if done in cases with clinical suspicion.  Keywords: acute abdominal pain; acute pancreatitis; serum amylase.

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Introduction: