Background:Flupirtine is a centrally-acting, nonopioid analgesic that interacts with N-methyl-D-aspartate receptors.Aim:The present study was designed to compare analgesic efficacy and adverse effects of orally administered flupirtine and diclofenac sodium for postoperative pain relief.Settings and Design:In a prospective, randomized double-blind study, 100 patients of American Society of Anesthesiologist grade I and II in the age group of 18–65 years of either sex undergoing elective abdominal surgeries were included after taking informed consent.Materials and Methods:The present study started after 12 h of surgery and patients were randomly divided into two groups of 50 each. For postoperative analgesia, group A received flupirtine 100 mg orally and group B received diclofenac sodium 50 mg orally and study drugs were repeated every 6 hourly for 5 days postoperatively. Vital parameters and visual analogue scale (VAS) scores for pain were recorded at 0, 1, 2, 4, 6, 8, 12, 16 and 24 h, and adverse effects were noted for 48 h of the study period.Statistical Analysis:Data were compiled and analyzed statistically using Chi-square test and two-tailed Student's t-test.Results:Visual analogue scores decreased more rapidly in diclofenac group during 1st h, hence there was rapid onset of analgesia in this group as compared to flupirtine group but later on VAS was comparable in both groups at all measured intervals (P > 0.05). Patients in diclofenac group experienced significantly more heartburn (P = 0.00), impaired taste sensation (P < 0.001) and dizziness (P = 0.004) as compared to flupirtine group.Conclusion:Oral flupirtine and diclofenac sodium were equally effective for postoperative analgesia. There was faster onset of analgesia with diclofenac sodium, but flupirtine was better tolerated by the patients because of its minimal adverse effects.

Nodular fasciitis is a rare benign soft tissue tumor. The similarity in the cytological appearance of nodular fasciitis to that of pleomorphic adenoma makes it difficult to diagnose preoperatively that adds to its peculiarity. We report here a case of a middle-aged female with swelling in the neck that was diagnosed as pleomorphic adenoma on cytology. Surgical excision of the swelling was done and histopathological examination revealed it to be nodular fasciitis. This case is presented to highlight the challenge of correctly diagnosing nodular fasciitis.

Background:Soft-tissue infections vary widely in their nature and severity. A clear approach to the management must allow their rapid identification and treatment as they can be life-threatening.Objective:Clinical presentation of soft-tissue infections and its management.Materials and Methods:A prospective study based on 100 patients presenting with soft-tissue infections was done. All the cases of soft-tissue infections were considered irrespective of age, sex, etiological factors, or systemic disorders. The findings were evaluated regarding the pattern of soft-tissue infections in relation to age and sex, clinical presentation, complications, duration of hospital stay, management, and mortality.Results:The most commonly involved age group was in the range of 41–60 years with male predominance. Abscess formation (45%) was the most common clinical presentation. Type 2 diabetes mellitus was the most common associated comorbid condition. Staphylococcus aureus was the most common culture isolate obtained. The most common complication seen was renal failure. Patients with surgical site infections had maximum duration of stay in the hospital. About 94% of the cases of soft-tissue infections were managed surgically. Mortality was mostly encountered in the cases of complications of cellulitis.Conclusion:Skin and soft-tissue infections are among the most common infections encountered by the emergency physicians. Ignorance, reluctance to treatment, economic constraints, and illiteracy delay the early detection and the initiation of proper treatment. Adequate and timely surgical intervention in most of the cases is of utmost importance to prevent the complications and reduce the mortality.

Background:Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. At times, it is difficult and takes longer time or has to be converted to an open procedure. This study is undertaken to determine the predictive factors for difficult LC.Aim:The aim was to evaluate a scoring method to predict difficult LC preoperatively.Materials and Methods:There were 30 cases operated by a single experienced surgeon. There are total 15 score from history, clinical and sonological findings. Score up to 5 predicted easy, 6–10 difficult and >10 are very difficult.Results:Prediction came true in 76.4% for easy and 100% difficult cases; there were no cases with a score above 10. The factors like previous history of hospitalization (P - 0.004), clinically palpable gallbladder (GB) (P - 0.009), impacted GB stone (P - 0.001), pericholecystic collection (P - 0.04), and abdominal scar due to previous abdominal surgery (P - 0.009) were found statistically significant in predicting difficult LC.Conclusion:The proposed scoring system is reliable with a sensitivity of 76.47% and specificity of 100%.

A 28-year-old male patient presented with a recurrent swelling in the left lateral chest wall just below the left axilla since seven years. Patient was operated for the same swelling eight years back and its biopsy report showed hydatid cyst. Patient had not taken any antihelminthic post operatively. Based on this, diagnosis of recurrent subcutaneous hydatid cyst was made and total cystectomy was done. Post operatively patient was started on albendazole. On follow up of one year there is no recurrence. Hydatid cyst is caused by the larval stage of Echinococcus. Four species of the Echinococcus tapeworm can produce infection in humans. E. granulosus and E. multilocularis are the most common, causing cystic and alveolar echinococcosis respectively, while E. vogeli and E. oligarthrus have rarely been associated with human infection. Hydatid cyst of the subcutaneous is extremely rare. This case report highlights the rare location of the hydatid cyst as well its recurrence in rare location.