HighlightsCholedocholithiasis can be treated by endoscopic extraction with or without stenting or by surgery.Stents cam form nidus for development of stones in CBD,may lead to cholangitis.Patients should be informed about ill effects of stent in-situ and advised to review for stent removal after 6 weeks.

Background: Circumcision has been the traditional treatment for phimosis, but with some controversies due to complications. The current study was undertaken to evaluate the effectiveness of topical steroid therapy as primary treatment for childhood phimosis. Methods: A prospective observational study was conducted and a total of 100 patients (age-3 to 12 years) of phimosis were enrolled. The management consisted of topical application of 0.05% betamethasone Ointment for 4 weeks. Those with partial response were advised additional 2 weeks of therapy. Failure to treatment cases were subsequently subjected to circumcision. Results: Total 100 patients were enrolled in the study. Out of 100 patients, 9 were excluded because of noncompliance and remaining 91 patients were studied and followed up. 85 cases out of 91 (93.4%) were declared a 'success'; while remaining 6 (6.6%) were declared 'failure' and were subjected to circumcision. Of the 85 successfully treated; majority (70, 82.3%) responded within 4 weeks of treatment and 15 (17.6%) responded in 6 weeks. The highest number of patients who responded to treatment within 4 weeks were < 5 years of age (54, 93.1%) (p<0.05). Conclusions: Topical steroid (0.05% betamethasone ointment) is an effective, safe, conservative and non-surgical method of primary treatment of childhood Phimosis, especially when combined with good hygiene practices of foreskin with daily retraction and cleansing.

Background: Peptic ulcer perforation is one the most common and catastrophic maladies that affect mankind. The aim of this study was to compare the surgical techniques of peptic ulcer perforation closure namely omentopexy and figure of 8 stitch with reference to recovery time and complications rate.Methods: Of 80 selected patients, figure of 8 method for closure of peptic perforation was used in 40 patients and 40 by using omentopexy method. Outcomes were compared in view of postoperative recovery time and postoperative complications such as wound complications, respiratory complications, burst abdomen, septicaemia, hospital stay, death.Results: In our study it was noted that age of presentation was in elderly males with risk factors like alcohol, smoking, tobacco chewing, and NSAIDS use in decreasing order. Late presentation was associated with higher complication including one death. In figure of 8 group it was found that RT Removal was early, early oral resumption loss hospital stay in figure of 8 group than in omentopexy group. Complications such as wound complication, burst abdomen , leak, and septicaemia  were more in omentopexy group than figure of 8 group. Only one death occurred in study that was in omentopexy group.Conclusions: We came to conclusion that peptic perforation is more common in males around 50 years with risk factors of smoking and alcohol. Outcomes of surgery with figure of 8 stitch were better than omentopexy with respect to oral resumptions, early discharge, less complications such as wound complications, burst abdomen leak septicaemia and death.

Burn injuries present a major public health problem for children. In India this constitutes about one-fourth of total burn injuries. This article deals with situations that need to be addressed in the care of partial thickness wounds in children to provide optimal conditions for wound protection and repair while minimizing the morbidity and complications. AIM: To compare outcomes for pediatric age group patients who were applied betaglucan collagen or anti-microbial dressing as primary wound covering in respect to pain, infection rate and healing time. DESIGN OF STUDY: Randomized controlled trial. SETTINGS AND DESIGN: Tertiary care hospital of central India from 2008-2010. METHODS: Patients admitted at tertiary care centre with partial thickness burns at first presentation were recruited to randomized controlled trial. Patients in trial were randomly allocated for beta-glucan collagen or anti-microbial dressings. RESULTS: Seventy-two patients were recruited over 28 months. Two were excluded from final analysis due to premature demise. Out of seventy subjects thirty-five were in BGC group while remaining thirty-five were in SSD group. Subjects were in 1-11 age range with majority being in 1-5 age groups. Out of total seventy patients thirty-three were male and thirty-three were females. Flame burns and scald burns were equally distributed in both groups and difference was not significant. Most of the patients presented within 6 hrs of initial injury (54.7%). TBSA% in BGC group was 16.4 while it was 18.2 in control group. Most of the patients in both the groups had burn injury over upper limb followed by anterior trunk. Partial thickness burns in children can be cost effectively treated with BGC with decreased pain, mean healing time and hospital stay with good cosmetic results.

Introduction: The great value of FAST lies in its high sensitivity for detecting intra peritoneal fluid which accumulates in dependent areas around the liver, spleen and pouch of Douglas (pelvic). Material and Methods: Prospective observational study was carried out for the duration of 2.5 years. 300 patients of blunt trauma abdomen admitted in trauma casualty were included in this study. In FAST assessment 255 patients were diagnosed positive for hemoperitoneum; in 50 patient's emergency exploratory laparotomy were done. Conclusion: FAST has sensitivity of 85.26% for detecting free intra-peritoneal fluid in BAT cases.

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Pheochromocytomas are catecholamine-secreting tumors of neuroectodermal origin. Different clinical presentations, various preoperative and intraoperative complications and their potential to become malignant provide a challenge in diagnosing and managing these cases. We report a rare case of bilateral pheochromocytoma with hypertrophic obstructive cardiomyopathy. He was diagnosed with bilateral pheochromocytoma with hypertrophic obstructive cardiomyopathy presenting at the age of 15 years without evidence of multiple endocrine neoplasia type 2 (MEN-2), or any familial syndrome or metastasis and then offered a surgery which was first cancelled due to uncon trolled hypertension. He was then taking alpha blocker for 8 years until he was again admitted to our institute. After prior blood pressure control with alpha and beta blocker drugs, open bilateral adrenalectomy was done without any complications. intraoperative spikes in blood pressure was managed with short acting antihypertensives, such as esmolol and labetalol. Postoperatively, patient is given steroid and under follow-up to rule out malignancy and other complications.