Objective: The aim was to study the prophylactic effect of tamsulosin on postoperative urinary retention in benign anorectal surgeries. Background: Acute urinary retention (AUR) after anorectal surgeries is essentially a type of postoperative urinary retention (POUR). It is the most common complication of the procedure. Use of tamsulosin, a super selective alpha 1a adrenergic blocker has been found to reduce the risk of POUR. Patients and Methods: Patients who underwent anorectal surgeries for benign anorectal conditions were included in this study. Patients were randomly assigned into two groups. In one, group (cases), patients were given 0.4 mg of oral tamsulosin only 6 h preoperative and 6-8 h postoperatively. Inability/difficulty to pass urine, which necessitated catheterization after following patient for 24 h was labeled as POUR. Results: A total of 626 patients who underwent surgery for benign anorectal condition were included in the study and grouped into two groups with 313 patients in each group, control and case group. In the control group, 56 patients (17.9%) had inability to pass urine and required catheterization and in the case group, only eight patients (2.5%) needed catheterization following POUR. The difference in the requirement of catheterization following POUR was statistically significant (P = 0.04). Hemorrhoidectomy was the most common anorectal surgery associated with POUR. Conclusion: The use of tamsulosin in preoperative and postoperative period has been found effective to reduce the incidence of POUR following surgeries for benign anorectal pathologies.

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Objectives: An endeavor to look for cost effective method for dressing wounds to minimize loss of working hours. Three percent citric acid solution (CA) was used for dressing acute lower limb ulcers with the object of pH modulation of wounds at an early stage and to evaluate its effects on wound healing. This solution was compared with Edinburgh University solution of lime (Eusol) in a randomized double-blinded study. Appearance of healthy granulation was the end point of the study. Materials and Methods: An unicentric randomized double blinded study with a parallel design was used to compare patients treated with 3% CA and Eusol solutions, respectively. The results were analyzed using Chi-square and P value using Microsoft Excel and SPSS 22. Patients having fever, altered consciousness, high initial random blood sugar >350 mg%, positive urinary ketones, hypoproteinemia, signs of septicemia and vascular diseases were excluded. Results: Twenty patients were known diabetic out of which 11 were in the CA group, and the rest were in the Eusol group. It was observed that the average total stay in diabetic patients was 16.36 days in CA group and 31 days in Eusol group whereas it was 15.78 and 24.75 days respectively in the nondiabetic group. The ulcer granulation interval showed that the mean stay in CA group was 10.56 days while it was 20.04 days in the Eusol group. The cost of stay was less in CA group. Conclusions: It is concluded that 3% CA solution forms a good alternative for wound dressings that acts by modulating the wound pH to acidic levels thereby contributing to wound healing by increased fibroblast proliferation and probably increasing local oxygen concentration and reducing microbial growth and virulence.

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Glomus tumors (GT) are cutaneous and soft tissue mesenchymal neoplasms. The malignant variant that is, glomangiosarcomas (GS) are rare and account for <1% of all GT. GS are usually seen in adults with a wide age range of 20-89 years. GS usually have an indolent course with local aggressiveness. The treatment is complete surgical excision with excellent prognosis though metastasis workup is advised. Herein, we report an unusually large GS de novo in a 6-year-old girl. Complete surgical excision was performed. There was no evidence of recurrence or metastasis over the last 15 months of follow-up postoperatively. GS should be considered as one of the differential diagnosis of cutaneous and soft tissue neoplasms.

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Multiple intestinal atresia (MIA) associated with colonic atresia is very rare, especially with almost normal bowel length. This report deals with a case of multiple jejunoileal atresia associated with descending colon atresia, which was managed by multiple resection and primary anastomoses without use of stents and with total parenteral nutrition. Literature on the genesis, management and survival of MIA is reviewed.

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Juvenile ossifying fibroma is a rare benign, but locally aggressive tumor with high recurrence potential. This distinct clinical entity poses a diagnostic challenge because of its rapidly progressive and osteolytic nature mimicking malignant lesion. A 16-year-old young female presented to otolaryngology department of our institute with a history of painless swelling in the left nasal cavity and maxillary region.

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Context: Gastric carcinoma often present with nonspecific gastrointestinal symptoms like dyspepsia making its diagnosis difficult and its later detection in an advance stage. To reduce the mortality and morbidity early diagnosis of gastric carcinoma is of utmost importance. Aims: The aim was to detect gastric carcinoma in patients presenting with dyspepsia symptoms for upper gastrointestinal (UGI) endoscopy and to study the incidence of carcinoma stomach related to factors like age, alcohol and smoking. Design: Surveillance cross section study. Subjects and Methods: Data were collected in all clinically diagnosed cases of dyspepsia undergoing UGI endoscopy at Father Muller Medical College Hospital, with sample size of 119 patients. Multiple (6-8) biopsies from suspected lesions were taken and sent for histopathological examination. Statistical Analysis Used: Frequency, percentage, Chi-square test and Fischer's exact test. Results: Of the 119 patients subjected to UGI endoscopy, 13 (10.9%) of them had gastric carcinoma. Mean age of the patient in the study was 49.76. Majority of the patients were males 58.82% (n - 70) and females were 41.17% (n - 49). Gastric carcinoma was predominantly seen in males - 76% and females - 24%. Alarm symptoms were found present in 53.84% with gastric carcinoma. Gastric carcinoma had strong association with smoking 38.46%, but not significant with alcohol consumption and showed peaking in incidence in the fifth and sixth decade. Conclusions: A high index of suspicion by clinicians and availability of endoscopic facilities may help detect early lesions, especially in elderly patients with alarm symptoms.

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A 32-year-old female patient is presenting with severe right upper quadrant abdominal pain and vomiting. On examination, she had tenderness in the epigastrium, apart from this there were no other positive findings on examination. The clinical diagnosis of acute cholecystitis was made. Her routine investigations were noncontributory. Ultrasound scan of the abdomen revealed thickening of the bowel wall in the region of the hepatic flexure. A contrast enhanced computed tomography of the abdomen was suggestive of ileo-colic intussusception with a lipoma as the lead point. Intraoperatively, she had a colo-colic intussusception involving the ascending colon and the right half of the transverse colon. A pedunculated polyp in the region of the hepatic flexure was the lead point and seen to be obstructing the lumen completely. She underwent a right hemi colectomy with an ileo-transverse anastomosis. Her postoperative recovery was uneventful, and she was discharged on the 5 ^th postoperative day. The histopathological examination confirmed the polyp to be of the submucouslipomatous variety.

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Aim: The aim was to find out the incidence of glove perforation in surgeries using single and double gloves and to compare the various factors affecting glove perforation. Materials and Methods: This study was an open labeled, double arm, prospective study of 200 operations performed, 100 each with the surgical team wearing single and double gloves. Glove perforations were detected by hydroinsufflation (filling each glove with 1000cc of water). The number of glove perforations, site of glove perforations, duration of surgery, type of surgery and elective versus emergency surgery was compared. Results: A total 1031 gloves were used in our study, out of which perforations were detected in 9.12% (n = 94).It was most frequent in a single glove group (12.81%, 46/359), followed by the outer glove of the double glove (11.9%, 40/336) and was seen least in the inner glove of a double glove group (8/336, 2.38%). The incidence of perforation was highest for the operating surgeon (22-25%) when compared to the nurses and the assistants. About one-third of the surgeries had at least one member of the surgical team with perforation. Cases lasting longer than 90 min had a perforation rate of 46.66% when compared to 23% in cases lasting for a lesser duration. The incidence of perforation in elective surgeries was 28.66% as compared with 65% in emergency surgeries. The left index finger of the surgeon had the highest perforation rate, followed by the right thumb of the nurse. Laparotomies had a perforation rate of 65% when compared with 22% in other surgeries. Conclusions: Double gloving is better than using single gloves to prevent glove perforations and cross-infection. The surgeon who is the chief of the surgical team is most prone to have glove perforations. Surgeries lasting for a longer duration, laparotomies and emergency surgeries require extra care. Hence intra-operative glove change is recommended in such cases.

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