Most patients who come to a general hospital in a developing country are poor. The most important prohibiting factor for use of polypropylene mesh in hernia repair is its exorbitant cost. Hence, research workers have been on the lookout for an equally effective but economically affordable mesh. Worldwide, surgical repair of inguinal hernia is the most common general surgery procedure performed at the present. Lifetime risk of groin hernia is 15% in males and 5% in females. Most of the patients who visit a general hospital are from either lower middle class or poor socioeconomic strata. The most important prohibiting factor for use of polypropylene mesh in hernia repair for the common man is its exorbitant cost. The aim of this study is to document the feasibility, safety and cost-effectiveness of the use of polyethylene mesh. A single blind, prospective, randomized controlled study, comparing 35 patients of two groups was conducted in a tertiary teaching hospital over a period of 5 years. The patients in both groups underwent inguinal hernioplasty, and were administered similar antibiotics and analgesics. The postoperative course with regard to pain, seroma formation, infection, hospital stay, recurrence and scar quality was evaluated and compared. Statistical analysis was performed with Chi square test. The properties of both meshes were the same with respect to ease of handling, pain score, seroma formation, infection rate, resumption of daily activities, scar quality and mesh rejection. Recurrence rate was zero for both groups. Polyethylene mesh was 2,808 times cheaper than the commercially available polypropylene mesh. This study proved the safety, simplicity, efficacy and cost-effectiveness of polyethylene mesh for inguinal hernia meshplasty, insuring economical, accessible health care for the financially weak section of the population.

Carbuncles are debilitating skin infections commonly seen in diabetic patients. Excision of these infective lesions leads to large defects that require prolonged hospital stay and repeated dressings with ensuing pain and bleeding. This study is an attempt to cover the wounds resulting from excision of carbuncle with primary skin grafting so as to decrease the hospital stay and frequency of dressings.

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Mercury (Hg) is a toxic heavy metal, and the reported effects of exposure on liver function continue to be inconsistent. The objective of our study was to identify correlations between high blood Hg levels and liver enzymes in a pan-India population including adults ≥19 years of age. This retrospective study analyzed the data from 95,398 individuals tested for blood Hg levels and liver enzymes in our national laboratory. Testing for blood Hg was done by inductively coupled plasma-mass spectrometry, while testing for liver enzymes—aspartate aminotransferase (AST/SGOT), alanine aminotransferase (ALT/SGPT), and gamma-glutamyl transferase—was done by automated photometry systems. Data from all the individuals inclusive of 52,497 males and 42,901 females were studied. The frequency of high blood Hg levels (>5 µg/L) was found to be 0.6%, and the difference between males and females was not found to be significant. Further correlation by linear regression analysis found no relationship between high blood Hg levels and liver enzymes among females. However, among males, there was a significant correlation between high blood Hg levels, and increased AST as well as ALT. Our report suggested that for males but not females, Hg exposure may be one of the differentials for elevated liver enzymes.

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A 26-year-old female presented to the gynaecology Outpatient Department (OPD) with complaint of infertility. She was admitted and was being worked up for the same. Incidentally, a left breast lump was found for which she was referred to surgery OPD. Patient gave a history of lump being present since one year, which had gradually increased in size. She did not have any family history of similar lump in breast. She was married since three years and had not conceived till presentation. Patient gave history of irregular menstrual cycle associated with pain in abdomen on and off since four years. Magnetic Resonance Imaging (MRI) pelvis was done which was suggestive of bilateral multicystic ovarian lesion with haemorrhage within-chocolate cysts/endometriomas.On examination, a well defined lump of around 10 cm x 8 cm x 6 cm size was palpable in the left breast below the nipple areola complex. It was mobile, firm and non tender on palpation. Patient did not have any axillary lymphadenopathy. Rest of the physical examination were unremarkable. Provisional diagnosis on clinical examination was either a giant fibroadenoma or a phylloides tumour.On investigation, biochemical parameters were within normal limits. Ultrasonography (USG) of left breast showed a large, oval, hypoechoic lesion measuring 12.8 cm x 4.9 cm in size, wider than taller with smooth margins, in upper outer quadrant of right breast. It appeared benign.Core needle biopsy of the lump was performed and the histopathology report showed few benign acini in sclerosed stroma, suggestive of benign breast tissue.Patient underwent wide local excision of the lump using an inframammary incision [Table/ Fig-1], which revealed a 15 cm x 12 cm x 6 cm well encapsulated, smooth lump, with regular margins, weighing 600 grams in the left breast [Table/ Fig-2]. Procedure was uneventful, subcutaneous drain was placed after closure, and patient was discharged after removal of subcutaneous drain after three days.Patient was regularly followed up after excision for six months and had no significant complaints. Histopathology, report of the lump revealed mammary hamartoma with PASH with no evidence of malignancy [Table/ Fig-3-5]. DISCUSSIONPASH of the breast is a rare condition typically found incidentally. It typically occurs in pre-menopausal women but is also reported to be found in 24-47% of men with gynaecomastia [1]. Histologically, it resembles a low grade angiosarcoma or a phylloides tumour, from which it needs to be differentiated. Most of the patients are asymptomatic and are found to have a palpable, mobile, firm, painless lump in the breast while presenting with some other chief complaint, as in this case.The differential diagnosis include fibroadenoma, especially in a young patient and a phylloides tumour in older women [ AbSTRACTPseudoangiomatous Stromal Hyperplasia (PASH) of the breast is a rare benign proliferating breast condition. We report a case of a 26-year-old female who was being worked up for infertility and was incidentally noted to have a well defined l...

A 14-year-old boy presented with a painful swelling topped by a bruise overlying the skin of the right inguinal region without peritonitis. This was the area of impact of bicycle handlebar while riding 6 days ago. On contrast-enhanced CT scan, we found a traumatic abdominal wall hernia (handlebar hernia) near the right deep ring without any solid organ, bowel or urinary bladder injury. Inguinal exploration revealed a defect in transversus abdominis and internal oblique muscle which was repaired and meshplasty was done.Delayed presentation and ignorance towards ‘handlebar sign’ is associated with visceral injury (haematoma/perforation) will incur the risk of rising morbidity and mortality. With CT scan we can assess the abdominal cavity to rule out associated visceral or vascular injury. Surgical repair for restoring disrupted anatomy with or without meshplasty is the preferred approach.