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We herein present 2 cases of adult Bochdalek hernia. Only a total of 51 such cases have been reported since 1958, and we have reviewed these cases and discussed their clinical features, operative treatment and final outcome. The majority of these patients presented as acute surgical emergencies and a lack of awareness of this condition lead to an incorrect diagnosis in 38 per cent. Intestinal obstruction with left lung signs and a non-distended abdomen in an adult patient should arouse suspicion of this condition. A plain X-ray of the chest and contrast studies of the gastrointestinal tract are necessary to confirm the diagnosis. A previous normal chest X-ray does not rule out a diaphragmatic hernia, as the defect may be plugged by the spleen or by the presence of a confining sac. The high incidence of strangulation emphasises the need for early diagnosis and prompt operative management which gives highly satisfactory results.

Surgeons have the highest risk of contact with patients' blood and body fluids, and breaches in gloving material may expose operating room staV to risk of infections. This prospective randomised study was done to assess the eVectiveness of the practice of double gloving compared with single gloving in decreasing finger contamination during surgery.In 66 consecutive surgical procedures studied, preoperative skin abrasions were detected on the hands of 17.4% of the surgeons. In the double gloving pattern, 32 glove perforations were observed, of which 22 were in the outer glove and 10 in the inner glove. Only four outer glove perforations had matching inner glove perforations, thus indicating that in 82% of cases when the outer glove is perforated the inner glove will protect the surgeon's hand from contamination. The presence of visible skin contamination was also higher in perforation with the single gloving pattern (42.1%) than with the double gloving pattern (22.7%).An overwhelming majority of glove perforations (83.3%) went unnoticed. Double gloving was accepted by the majority of surgeons, especially with repeated use. It is recommended that double gloves are used routinely in all surgical procedures in view of the significantly higher protection it provides. (Postgrad Med J 2001;77:458-460) Keywords: gloves; skin contamination; surgery Surgeons and operation room personnel have the highest risk of contact with patients' blood and body fluids. Since medical history and examination cannot reliably identify all patients harbouring blood borne pathogens, universal precautions during exposure to blood and body fluids are now mandatory. Intact surgical gloves will prevent this transmission, but breaches in gloving material may expose the operating room staV to risk of infections, particularly if there are cuts or abrasions on the skin. Breached gloves not only indicate the potential for infection via skin, but also bear witness to the possibility of there having been a needlestick injury and thus potential inoculation of infected blood. Double gloving is generally adopted by surgical teams when operating on high risk cases. There are varying opinions regarding the necessity of wearing double gloves routinely for added protection, and the ability to operate when wearing double gloves. The Center for Disease Control, however, does not recommend routine use of double gloves in surgery, as there are not enough studies to show that double gloves definitely have a higher protection rate. Subjects and methodsThe aim of our present study was to assess the frequency of glove perforation, and subsequent blood or body fluid contact, associated with common general surgical operations, and to assess the eVectiveness of the practice of double gloving in decreasing finger contamination with blood and body fluids during surgery as compared with single gloving.This prospective randomised study was performed in the department of general surgery, Lady Hardinge Medical College and associated Srimati Sucheta Kriplani Hospit...

Objectives To prospectively evaluate and compare the effectiveness of Neocone, Alvogyl and Zinc Oxide Eugenol (ZOE) intra alveolar dressings for the management of dry socket and to study the epidemiological factors associated with the condition. Study Design All the patients who underwent extraction of teeth and who fulfilled our inclusion and exclusion criteria from 1st January 2012 to February 28th 2013 were included in our study. Patients who were diagnosed to suffer from dry socket were randomly allocated to three groups namely Group A (Alvogyl), Group B (ZOE), Group C (Neocone). Pain relief and healing of the socket were compared between these groups. The collected data were subjected to statistical analysis by Chi Square test, Z test of proportionality. Results and Conclusion Alvogyl is superior to the other two medications for providing initial pain relief. Neocone provides complete pain relief and the healing was fastest with Neocone. Neocone emerged as the most suitable dressing material for the management of dry socket by virtue of shorter time required for complete pain relief, fewer visits and faster clinical healing.

Axillary lymph node (ALN) status is considered to be the single most important prognostic indicator in patients with breast cancer. It can be assessed by various radiological, pathological and surgical techniques, the most accurate being histological examination of lymph nodes after axillary lymph node dissection (ALND). This prospective study was conducted to assess the feasibility and diagnostic accuracy of preoperative ultrasound (US) and ultrasound-guided fine-needle aspiration cytology (USG-FNAC) of ALN in patients with breast cancer. Thirty patients with FNAC-proven breast cancer, planned for definitive surgery with axillary clearance, were included in this study. Ultrasonographic evaluation of the axillae of these patients was conducted for alterations in size, shape, contour and cortical morphology of lymph nodes that could reflect presence of underlying metastases. Ultrasound-guided fine-needle aspiration cytology of the ALN was done in 24 of these patients. These findings were evaluated, with the ALN status determined by histological examination after ALND. Out of the 30 patients, eight had T(1), 16 had T(2), five had T(3), and one had T(4) lesions. Ultrasound evaluation of the ALN had a sensitivity of 86.3%, a specificity of 41.6%, a positive predictive value of 79%, a negative predictive value of 50% and a diagnostic accuracy of 73.3%. Sensitivity of USG-FNAC was 78.95%, specificity was 100%, positive predictive value was 100%, negative predictive value was 55.56% and diagnostic accuracy was 83.33%. Our study concludes that preoperative USG-FNAC of ALN is a simple, minimally invasive, easily available and reliable technique for the initial determination of ALN status in patients with breast cancer. Those who are USG-FNAC positive can be directed towards ALND straight away, and only those who are USG-FNAC negative should be considered for sentinel lymph node biopsy. This will save considerable operating time, especially where facilities for sentinel lymph node biopsy (costly dye, gamma camera, nuclear medicine facilities) are restricted or not available.