Low levels of immunoglobulins were found in patients with epilepsy treated with LTG or CBZ. As our group of patients consisted of otherwise healthy young adults, one should be especially aware of a possible effect of AEDs on immunoglobulin levels when treating selected patient groups, for example immunocompromised patients. Immunoglobulin concentrations should be measured in patients treated with LTG or CBZ who experience recurrent infections, and a change in medication should be considered.

Introduction: Laparoscopy has revolutionised Surgery with its widespread acceptance as predominantly minimally invasive to intraabdominal surgical procedures. Creation of pneumoperitoneum is indispensable primary step of the procedure as it allows creation of operative field. It can be achieved by various techniques viz Classical open method as described by Hasson. The aim of the study was to ascertain safety of direct trocar insertion in creation of pneumoperitoneum in laparoscopic surgeries and adopt the same as an alternative to veress technique. Material and methods: A total of 576 patients were included in the study, Group A comprised of patients in whom we created pneumoperitoneum by classical veress needle insertion and included 327 patients. Group B comprised of 249 patients in whom we created pneumoperitoneum by direct trocar insertion method. Results: The mean age of patients was 47.54 years SD 11 with a male female ratio of 1:1.56. Laparoscopic cholecystectomy (52.08%) was most frequent followed by laparoscopic appendectomy (13.02%). Group A patients witnessed omental emphysema (7.95%) as commonest complication followed by preperitoneal insufflation(5.19%) while as the most common complication in group B was omental emphysema (0.81%). Port site infection (4.28%) and subcutaneous emphysema (3.36%) predominated in group A and port site infection (1.2%) and seroma formation (1.2%) were common in group B. Conclusion: There are many methods to create pneumoperitoneum. The closed technique modified to direct trocar insertion versus classical method by Veress were compared in patients undergoing laparocopic procedures at SMHS hospital for a period of one and a half year. The results are fascinating as the modified technique overshadows its classical version in terms of feasibility, efficacy and consumption of time.

Background: Acute pancreatitis is significant reason for intense abdominal torment. The job of diagnostic markers (pancreatic enzymes like amylase and lipase) as prognostic pointers has been a disappointment. C-reactive protein (CRP) assessment is modest and effective option. In this concentrate we have endeavored to check whether a solitary and early assessment of CRP levels is a viable indicator of morbidity and mortality in acute pancreatitis.Methods: This was a prospective observational study done at Government Medical College Srinagar Kashmir for a period of three years from May 2015 to April 2018. Fifty patients diagnosed to have acute pancreatitis were included in this study. Their CRP levels were sent on second day of admission and computed tomography (CT) scan done after 72 hours of admission. Demographic variables were recorded along with local and systemic complications and compared with CRP levels.Results: In this study of 50 patients, we found that most of the patients of pancreatitis were young to middle aged males, a majority of whom belonged to fourth decade of life. We found that levels of CRP rise as age and severity progresses. CRP levels also remains on higher side in various local complications like necrosis, acute fluid collection etc., however a statistical significance could not be ascertained.Conclusions: Acute Pancreatitis is a life-threatening disease with a wide spectrum of clinical symptoms. C Reactive Protein as a prognostic marker has shown promising results in earlier studies. There is an need to further study its role so as to reduce the mortality and morbidity associated with acute pancreatitis.

Background: Stapled hemorrhoidectomy, popularly known as Longo technique is in use for the treatment of hemorrhoids since its first description to surgical fraternity in the world congress of endoscopic surgeons in 1998. Objectives: To evaluate the feasibility, patient acceptance, recurrence and results of stapled haemorrhoidectomy in our early experience. Methods: Between Jan 2012 and Dec 2013, 42 patients with symptomatic GRADE III and IV hemorrhoids were operated by stapled hemorrhoidectomy by a single surgeon at our surgery department. The evaluation of this technique was done by assessing the feasibility of the surgery; and recording operative time, postoperative pain, complications, hospital stay, return to work and recurrence. Results: All the procedures were completed successfully. The mean (range) operative time was 30 (20-45) min. The blood loss was minimal. Mean (range) length of hospitalization for the entire group was 1 (1-3) days. Only 3 patients required more than 1 injection of diclofenac (75 mg) while as rest of the patients were quite happy switching over to oral diclofenac (50 mg) just after a single parenteral dose. All the patients returned to their routine work in less than a week's time. The mean (range) follow-up was 6 (4-12) months. There were no major intraoperative or postoperative complications except for retention of urine in 8 patients. The patients are still on regular follow-up and have not had recurrence as yet. Conclusion: Stapled hemorrhoidectomy technique is a safe alternative to the traditional Milligan-Morgan technique. It can be performed as an office procedure, is well tolerated by patients and is cost effective than conventional surgical therapy.

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