iosr-JDMS   Volume-13 ~ Issue-11 ~ November-2014

Abstract: The anastomoses between radial and ulnar arteries in the palm play a significant role in diseases of the palm through collateral circulation. During routine dissection of the upper limb of a 45-year-old male cadaver, we observed the superficial palmar arch (SPA) formed exclusively by the superficial branch of the ulnar artery. The superficial palmar branch of the radial artery entered the hand above the thenar muscles and provided palmar digital branches to the radial side of the index finger and the ulnar side of the thumb, without any contribution to the SPA. However, the radial side of the thumb was supplied by a branch from the deep palmar arch. The superficial branch of the ulnar artery gave origin to three common palmar digital arteries to supply the contiguous sides of the index, middle, ring and little fingers. It also provided origin to a digital branch to the ulnar side of the little finger.

Keywords: Radial artery, Superficial palmar arch, Ulnar artery

[1]. Willams PL, Bannister LG, Berry MM. Gray's Anatomy. 38th ed. New York: Churchill Livingstone; 2000. p. 1544.

[2]. Moore KL, Dalley AF. Clinically Oriented Anatomy. 10th ed. Philadelphia: Lippincott, Williams and Wilkins; 1999. p. 751.

[3]. Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet. 1961; 113:409–24.

[4]. Ikeda A, Ugawa A, Kazihara Y, Hamada N. Arterial patterns in the hand based on a three-dimensional analysis of 220 cadaver hands. J Hand Surg Am. 1988;13:501–9.

Abstract: Background: different methods like clipping, ligation and cauterization were used to control the cystic artery during laparoscopic cholecystectomy, each of them has its own advantages and disadvantages in this prospective study we focused on the use of monopolar diathermy to control the cystic artery. Patient and methods: prospective study of 142 case of laparoscopic cholecystectomy due to gall stones non of them was complicated, done by 2 surgeons in Al-Imamain Al-Kadhumien medical city basically we tried to control the cystic artery by monopolar diathermy of its small branches adjacent to the wall of gall bladder without need to dissection of calot's triangle to control the main cystic artery. Results :the cystic artery (all varieties)and its branches was found in calot's triangle , effective control of the artery by the cautery alone was possible in 103 cases while classical clipping needed in 39 cases. Conclusion :careful use of diathermy is a safe and efficient method to control the cystic artery during laparoscopic cholecystectomy.

Key words: laparoscopic cholecystectomy , monopolar diathermy .

[1]. Hu¨ scher CG, Lirici MM, Di Paola M, Crafa F, Napolitano C,Mereu A, Recher A, Corradi A, Amini M. Laparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature. SurgEndosc 2003; 17:442–451.
[2]. Bessa SS, Al-Fayoumi TA, Katri KM, Awad AT. Clip less laparoscopic cholecystectomy by ultrasonic dissection. JLaparo endosc AdvSurg Tech a 2008; 18:593–598.
[3]. Kandil T, El Nakeeb A, El Hefnawy E. Comparative study between clip less laparoscopic cholecystectomy by harmonic scalpel versus conventional method: A prospective randomized study. J Gastro intest Surg 2010; 14:323–328.
[4]. Lichten JB, Reid JJ, Zahalsky MP, Friedman RL .Laparoscopic cholecystectomy in the new millennium.SurgEndosc2001; 15:867–872.
[5]. Grace PA, Quereshi A, Coleman J, Keane R, McEntee G, BroeP, Osborne H, Bouchier-Hayes D. Reduced post operative hospitalization after laparoscopic cholecystectomy. Br J Surg1991; 78:160–162.

Abstract: OBJECTIVE: In this study, we aimed to evaluate maternal & foetal outcome in cases of pre-labour rupture of membranes. STUDY DESIGN: This was a prospective study of 200 cases of pre-labour rupture of membranes coming to the Dept. of Obst & Gynae, SMS Medical College, Jaipur METHOD: The cases included were singleton pregnancies with gestational age of 28 weeks or more with spontaneous rupture of membranes. Cases with severe PIH / Eclampsia / severe anemia, with any medical disorder and absolute indication of LSCS were excluded from study. Mother observed for maternal morbidity i.e. PPH, retained placenta, puerperal pyrexia, subinvolution of uterus, wound infection, phlebitis& endometritis

Keywords: Maternal, Morbidity, PROM, Puerperal pyrexia, Vaginal swab.

[1]. Gunn G.G., Mischell Morton: "PROM A review", AM. J. Obstet. Gynaecol 1970; 106:409.
[2]. Duff P. Premature rupture of membranes at term. N Eng. J Med. 1996; 334:1053.
[3]. Honnah ME, Ohlsson A, Farine D, Hewson SA, Hodnett ED, MyGr TL et. al. Induction of labour with expectant management of PROM at term. N Eng. J. Med. 1996; 334: 1005-10.
[4]. Pandey Swati, DavaAnupama, Bandi S. "Maternal and Foetal Outcome in cases of PROM". J. of Obstet. and Gynaecol India 2000; 50: 63.
[5]. Vermillion ST, SoperDE,Chasedunn-Roark J. Neonatal sepsis after betamethasone administration to patients with preterm premature rupture of membranes. Am J Obstet Gynecol 1999; 181: 320-327.

Abstract: Lateral end clavicle fractures in children are relatively rare which due to the displacement are often considered for surgical management Distal third fractures with posterior displacement which entraps trapezius often requires open reduction to realign the fragment by removing the interposed soft tissue .We report an injury in a 7 years old child after fall on to outstretched hand which resulted in posteriorly displaced and rotated distal third junction clavicle fracture with trapezius interposition. Considering the age, and significant deformity ,open reduction without internal fixation was done under general anaesthesia.

Keywords: lateral end clavicle , trapezius

[1]. Sarwark JF, King EC, Luhmann SJ. Proximal humerus, scapula and clavicle. In:Rockwood Jr CA, Wilkins KE, editors. Fractures in children. 6th ed., Philadelphia:Lippincott, Williams & Wilkins; 2006. p. 724–8.
[2]. M Itokazu, M Yoshida, Y Itoh, M Hukuta, K Kikuike.Trapezius interposition of a distal third clavicular fracture in a child: A case report.Journal of Orthopaedic Surgery 2001, 9(1): 67–69
[3]. Havranek P. Injuries of distal clavicular physis in children. J Pediatr Orthop
[4]. 1989;(9):213–5.

Abstract: Aims:
o Discuss imaging features of giant cell tumor of bone and giant cell reparative granuloma
o Discuss the role of different imaging modalities in diagnosis of giant cell tumor and giant cell reparative granuloma.
o Explain the pathologic basis for radiologic features of giant cell tumor and giant cell reparative granuloma
o Discuss types of malignant giant cell tumors with their imaging features.
o Describe the traditional treatment of giant cell tumors and list the common post operative complications
Materials and Methods: This retrospective study of 10 patients was conducted in Shri M.P.SHAH Medical college and GURU GOBIND Singh hospital, Jamnagar.

Key Words: Giant cell tumor, giant cell reparative granuloma, histopathological correlation, imaging, treatment Abbreviations used: GCT-giant cell tumor, GCRG- giant cell reparative granuloma

[1]. Cooper A, Travers B. Surgical essays 3rd ed. London, England: Cox & Son, 1818.
[2]. Manaster BJ, Doyle AJ. Giant cell tumors of bone. Radiol Clin North Am 1993; 31:299-323. [Medline][Medline]
[3]. Unni KK. Dahlin's bone tumors: general aspects and data on 11,087 cases 5th ed. Philadelphia, Pa: Lippincott-Raven, 1996.
[4]. Larsson SE, Lorentzon R, Boquist L. Giant cell tumor of bone. J Bone Joint Surg [Am] 1975; 57:167-173. [Medline][Medline]
[5]. Resnick D, Kyriakos M, Greenway GD. Tumors and tumor-like lesions of bone: imaging and pathology of specific lesions Diagnosis of bone and joint disorders. 3rd ed.
[6]. Philadelphia, Pa: Saunders, 1995; 3628-3938.

Abstract: Pemphigus Vulgaris (PV) is chronic autoimmune mucocutaneous disease that initially manifests as intraoral lesions, which may later spread to skin. Dental professionals must be efficient to recognize the clinical features of pemphigus vulgaris to ensure early diagnosis and treatment, so that it determines the favorable prognosis and course of the disease. This paper reports a case of pemphigus vulgaris and review of literature.

Key Words: Pemphigus Vulgaris, Nikolsky's sign.

[1]. Sreeshyla H S, Usha Hedge, Vidya G D. Oral pemphigus vulgaris – report of a case with review on it‟s etiopathogenesis. Archives of oral sciences and research
[2]. J Golchai, Shams Gilani. A familial case of pemphigus vulgaris. Medical journal of islamic republic of Iran. Vol 6.feb 1993.
[3]. Dr Jigar M, Dr Grishma Doria. Pemphigus vulgaris case report. Journal of dental sciences vol 2, issue 2.
[4]. Fadi Ata Ali, Javier Ata Ali. Pemphigus Vulgaris and Mucous Membrane Pemphigoid : Update On Etiopathogenesis, Oral Manifestations And Management. J clin exp dent. 2011;3(3):e246-50.
[5]. Shams ul Nisa, Nalini Ashwath. Pemphigus vulgaris : a case report and review of literature. JP journals 10011-1341.
[6]. Seema kapoor, pranav sikka, geet priya kaur. Pemphigus vulgaris of oral cavity: A Case report with it‟s management strategies. International journal of nutrition, pharmacology, neurological diseases. April –june 2013,vol 3, issue 2.

Abstract: Aims: Foodborne diseases are multifactorial in origin and are major cause of death worldwide. This study was aimed at detecting the presence of bacterial pathogens in already prepared vended foods in Vom. Methodology and results: Two hundred (200) cooked food (ready-to-eat) samples were subjected to bacteriological examinations using differential, selective and enriched culture media. A total of 228 bacterial isolates were obtained. These includes Aeromonas hydrophila (3)1.5%, Bacillus species (32)16%, Citrobacter freundii (18)9%, Citrobacter braekii (9)4.5%, Citrobacter youngae (1)0.5%, Chryseomonas luteola (1)0.5%, Enterobacter cloacae (28)14%, Escherichia coli (14)7%, Klebsiella pneumoniae (6)3%, Kluyvera species (1)0.5%, Morganella morganii (3)1.5%, Providencia species (4)2%, Pseudomonas aeruginosa (5)2.5%, Proteus mirabilis (2)1%, Salmonella species (12)6%, Staphylococcus aureus (34)17%, coagulase negative Staphylococcus (49)24.5%, Streptococcus faecalis (5)2.5% and Vibrio hollisae (1)0.5%, twenty one (21) samples had no bacterial growth. The identification of the Gram-negative organisms were confirmed using API 20E. These isolates were further subjected to antimicrobial sensitivity testing using the Abtex commercial disc. Most isolates were resistant to Amoxycillin, Cloxacillin, Cotrimoxazole and Erythromycin. Ciprofloxacin had about 99% activity against all the isolates. Conclusion: The isolation of bacterial pathogens is indicative of bacterial contamination in vended foods in Vom within the period of the study.

Keywords: Bacteria -Vended Food -Vom, Nigeria

[1]. Adak, G. K., long, S. M. and O'Brein, S. J. C. (2002). Trends in indigenous foodborne disease and deaths. England and Wales. 1992 to 2000. GUT. 151: 832-841.
[2]. Beach, J. C., Murano, E. A. and Acuff, G. R (2002). Prevalence of Salmonella and Campylobacter in beef cattle from transport to slaughter. J. Food Prot. 65:1687- 1693.
[3]. Bergdoll, M. S. (1979). Staphylococcal Intoxication In Foodborne infections and intoxications" 2nd ed., Ed. H. Rieman and F. L Bryan, Pp. 443 Academic press, N. Y
[4]. Cheesbrough M (2002). District Laboratory Practice in Tropical countries. Part 2. Pg. 9-13 Cambridge.
[5]. Danladi Makut Makwin, Ify Ogbonna Abigail, Joseph Okwori Ameh Eleyi and Eleojo AbubakarAisha (2014). Antibiotic susceptibility pattern of bacteria isolated from Zobo drinks sold in Keffi, Nigeria. Malaysian Journal of Microbiology, Vol 10(3)pp. 169-173

Abstract: Synchronous carcinoma of the colon is rare but not infrequent. The incidence ranges from 2-5% . Synchronous primary carcinoma of the colon is defined as two or more primary colonic cancers are identified at the same time and confirmed by histological evaluation. The significance of synchronous primaries is not to miss second lesion, patients needs complete screening of the colon and excision of all the lesions. Patient may go for extended colectomy. We came across one such case who presented with pain abdomen for one month and abdominal distension with vomiting for two days. On abdominal examination a hard lump was present in the right upper abdomen after upper gastro intestinal decompression was done by nasogastric tube aspiration.USG abdomen revealed thickening and narrowing of ascending colon and splenic flexure areas of the colon. Colonoscopy could not be negotiated beyond upper end of the descending colon. Exploratory laparotomy was done and two growths one at just above the caecum and another is just below the splenic flexure. Extended right hemicolectomy was done followed by end to end ileo-colostomy was done. Post operative period was uneventful. We are presenting this case because of its rarity which demands complete evaluation of the colon by colonoscopy. if colonoscopy does not yield any result exploratory laporotomy and meticulous palpation of the colon is advised. We also reviewed the literature to freshen our knowledge regarding synchronous primary of colon.

Key words: Synchronous Primary Carcinoma of the Colon, Colonoscopy, Ultrasonogram (USG) abdomen and Extended right hemi colectomy.

[1]. Takeuchi H, Toda T, Nagasaki S, Kawano T, Minamisono Y, Maehara Y, Sugimachi K. Synchronous multiple colorectal adenocarcinoma. J Surg Oncol 1997; 64:304-7.
[2]. Chen HS, Sheen-Chen SM. Synchronous and "early" meta- chronous colorectal adenocarcinoma. Dis Colon Rectum 2000; 43:1093-9.
[3]. Wang HZ, Huang XF, Wang Y, Ji JF, Gu J. Clinical features, diagnosis, treatment and prognosis of multiple primary co- lorectal carcinoma. World J Gastroenterol 2004; 15:2136.
[4]. Papadopoulos V, Michalopoulos A, Basdanis G, et al. Synchronous and metachronous colorectal carcinoma. Tech Coloproctol 2004; 8:S97-100.
[5]. Kaibara N, Koga S, Jinnai D. Synchronous and metachronous malignancies of the colon and rectum in Japan with special reference to a coexisting early cancer. Cancer 1984;54: 1870-

Abstract: Crigler Najjar Syndrome (CNS) a congenital non hemolytic hyperbilirubinemia is very rare with an incidence of around 1 in 1,000,000 births associated with a complete hepatic deficit of bilirubin glucoronosyltransferase activity. Herein we present a study of four cases: three siblings from the same family and one independent case. All the three siblings of the same family had history of persistent neonatal unconjugated hyperbilirubinemia, out of which the eldest female sibling died of seizures with severe hyperbilirubinemia giving a high suspiscion of kernicterus. Second eldest and the youngest son had congenital unconjugated hyperbilirubinemia. The third born male child was normal. The independent case had history of persistent mild hyperbilirubinemia since twelve years of age.

Key words: Unconjugated hyperbilirubinemia, Uridine diphosphate glucoronosyltransferase deficiency, severe jaundice, phototherapy, phenobarbitol, liver transplantation.

[1]. Analysis of Bilirubin uridine 5 -1 diphosphate(UDP) glucuronosyl transferase gene mutatins.[J Human gene1998]
[2]. Spectrum of UGT1A1 mutations in C N S patients.[Hum Mutat.2005]
[3]. Genetic polymorphism of bilirubin uridine diphospha te gluronosyl transferase.[J Gast roe nterology,Hepa tology 2004]
[4]. (Review)Genetic lesion of bilirubin uridine diphosphate glucuronosyl transferase.[Human Mutat.2000]
[5]. UDP-glucuronosyl transferases: gene structures of UGT1 and UGT2 families. Methods Enzymol.2005,400:1-22.OwensIS,Basu NK,BanerjeeR

Abstract: Background: Post-operative pain is a major concern for patients undergoing surgery. The fear of pain keeps on preying on their minds leading to various stress related dysfunctions. The present study was designed to compare the efficacy and safety of Levobupivacaine & Ropivacaine in preventing post-operative pain in patients undergoing lower limb surgery. Patients and Methods: 60 ASA I and II patients undergoing lower limb surgery were randomly assigned to two groups of thirty patients each, receiving either 50mg Tramadol with 20mg Ropivacaine (Group A) or 50mg Tramadol with15mg Levobupivacaine (Group B) epidurally. Total volume injected was 10ml in each case. Epidural top-ups were given every 8 hourly for post-operative analgesia till 48 hrs after surgery. VAS was used to assess analgesia. Results: Demographic data and baseline parameters were comparable in both the groups. Analgesia, as measured by the VAS score was comparable in the two groups. Hypotension was seen more in Group B. Other side-effects were similar in both the groups. Conclusion: Levobupivacaine or Ropivacaine combined with Tramadol provide good analgesia in lower limb surgery without significant side-effects.

Key Words: Ropivacaine, Tramadol, VAS, Post-operative Analgesia.

[1]. Morgan Jr. GE, Mikhail MS, Murray MJ : Clinical Anesthesiology. Lange 2002 ; Third Edition : 160-347.
[2]. Prys-Roberts C, Black AMS : Management of postoperative pain. In "International Practice of Anaesthesia‟. Butterworth-Heineman 1996; Volume 2 : 2/140/1-11.
[3]. Royal College Of Surgeons Of England / College Of Anaesthetists : Commission on the provision of surgical services : Report of the working party on pain after surgery. London : Royal College Of Surgeons Of England / College Of Anaesthetists, 1990.
[4]. Bajwa SS, Kaur J. Clinical profile of levobupivacaine in regional anesthesia: A systematic review. J Anaesthesiol Clin Pharmacol 2013; 29: 530-539.
[5]. Stoelting R: Basics of Anesthesia. Elsevier 2010; 289.

Abstract: Empyema thoracis is defined as the collection of pus in the pleural cavity. Mycobacterium tuberculosis as an etiological agent accounts for only 2% of the tuberculous pleurisy cases. History of contact and absence of Bacillus Calmette-Guerin(BCG) vaccination scar are usually seen. We are hereby reporting, a 4 year old male child with left sided tuberculous empyema who had been adequately immunized. There was no history of tuberculosis in the family, past infection or contact with an adult case.Our case was managed conservatively with a favourable outcome.

Keywords: Tuberculous Empyema, Pediatrics, hypersensitivity reaction.

[1]. A Kumar, D Gupta, S B Nagaraja, V Singh, GR Sethi, J Prasad. Updated National Guidelines for Pediatric Tuberculosis in India, 2012. Indian Pediatr 2013;50: 301-06.

[2]. M Zampoli, H J Zar. Empyema and parapneumonic effusions in children: an update. SAJCH.Oct 2007; 1: 121-128.

[3]. Intan HI, Othman N, Alsiddiq M FMF, Wan-Afza F WZ, Lokman MN. The unexpected bilateral tuberculous empyema: a case report in a child. Int J Health Res 2008; 1:40-4.
[4]. Light RW. Parapneumonic effusions and empyema. In:Pleural Diseases, 3rdedn. Ed. Light RW. Baltimore, Williams and Wilkins, 1995; pp 129-153.
[5]. Lima DM, Colares KJB, da Fonseca BAL.Combined use of the polymerase chain reaction and detection of adenosine deaminase activity on pleural fluid improves the rate of diagnosis of pleural tuberculosis Chest. 2003; 124:909-14.

Abstract: Purpose of the study was to find out the relation between HbA1c which is an useful indicator of long term glycemic control and the qualitative and quantitive activity of precorneal tear film with the help of Tear Film Break up Time(TBUT) and Schirmer's test respectively.40 type 2 diabetic patients and 20 age and sex matched healthy controls undergone HbA1c level, TBUT estimation and Schirmer's test after proper consent and explanation. Statistically significant (p value <0.05) decrease in TBUT and Schirmer's test values were observed in diabetic patients when compared to control group which further deteriorates with increase in HbA1c level. Our finding lead us to conclude that long term glycemic control can modify the qualitative and quantitative properties of tearfilm thus HbA1c level can be considered as one of the important predictor of dry eye syndrome among the diabetic patients.

Keywords: HbA1C, TBUT, Schirmer's test, Dry eye

[1] Sicree R, Shaw J, Zimmet P.Diabetes and impaired glucose tolerance. In:Gan D editor. Diabetes Atlas. International Diabetes Federation. 3rd ed. Belgium: International Diabetes Federation;2006 p. 15-103
[2] Scultz RO, Horn DLV, Peters MA, Klewin KM, Schutten WH. Diabetic keratopathy. Trans Am Ophthalmol Soc. 1981; 79:180–199.
[3] Martin Goebbels Tear secretion and tear film function in insulin dependent diabetics Br J Ophthalmol 2000; 84:19-21
[4] Fujishima H, Shimazaki J, Yagi Y, Tsubota K. Improvement of corneal sensation and tear dynamics in diabetic patients by oral aldose reductase inhibitor, ONO-2235: a preliminary study. Cornea. 1996; 15:368–372.
[5] Janjetović Ţ, Vuković-Arar Š, Bešlić R, Vajzović-Dalipi V, Marinić M, Samardţić K. The dry eye syndrome and diabetes. Institute: Opća bolnica "Dr. Josip Benčević", Slavonski Brod;

Abstract: Background: Demonstration of alpha adrenoreceptors in the peripheral nervous system has made to study the effects of various alpha adrenergic drugs with local anesthetics in peripheral nerve blocks. This study is designed to compare the efficacy of clonidine and epinephrine when added to bupivacaine in brachial plexus block. Methods: Forty ASA 1 and 2 patients undergoing upper limb surgeries under supraclavicular brachial plexus block were divided into two groups in a randomized double blinded fashion. Group BA received 5 mcg/ml of adrenaline and group BC recieved mcg/ kg of clonidine along with 30 ml of 0.375% bupivacaine. Onset of sensory and motor blockade, duration of analgesia, hemodynamic stability were studied in both the groups. Results: Onset of sensory and motor blockade were 6.25+1.33 minutes and 3.80+0.834 minutes respectively in group BA and 5.85+1.26 minutes and 3.55+1.05 minutes respectively in group BC which were not statistically significant between the two groups. Duration of analgesia was 7.12+0.63 hours in group BA and 12.69+1.28 hours in group BC which was statistically significant (p value 0.001). There were no significant difference in the hemodynamic parameters between the two groups. Conclusion: Addition of clonidine to bupivacaine in supraclavicular brachial plexus block provides a significant advantage over epinephrine to bupivacaine in terms of postoperative analgesia without any significant side effects.

Keywords: adrenaline,bupivacaine, clonidine, supraclavicular brachial plexus block, upper limb surgeries

[1] Techniques of regional anesthesia in Lee's Synopsis of anesthesia 2006:13:419-428
[2] John E Tetzzlaff. Peripheral nerve blocks in Morgan Clinical anesthesiology 2006: 329-337
[3] Cheryl et al. A comparative study of 0.25% bupivacaine and 0.25% ropivacaine for brachial plexus block. Regional anesthesia and pain medicine.: 75(40): 1992: 604-611.
[4] Vester-Anderson T, Christiansen C, Sorensen M, Eriksen C. Perivascular axillary Blockade following 40 ml of 1% mepivacaine with adrenaline. Acta Anaesthesiol Scand 1982; 26: 519-23.
[5] Vester-Anderson T, Husum B, Lindeburg T, Borrits L, Gothgen I. Perivascular axillary block IV: Blockade following 40, 50 or 60 ml of mepivacaine 1% with adrenaline. Acta Anaesthesiol Scand 1984;28:99-105.

Abstract: More than 200 different operations have been described for the treatment of recurrent anterior dislocation of shoulder. The Latarjet procedure employs rerouting of the osteotomised coracoid process with its attached conjoined tendon through a split in the substance of subscapularis and fixed to the antero inferior aspect of glenoid rim. Since 2011 Latarjet procedure was performed on 30 patients, who presented with recurrent dislocation of shoulder (28 men and 2 women). Patients were evaluated using ROWE instability score, Oxford Shoulder Instability index Score at the last follow up. There was no single episode of recurrence of dislocation or subluxation , all the patients regained preoperative range of motion. Mean ROWE score is 90(excellent) & mean oxford shoulder instability index is 38(good). Latarjet procedure is an excellent surgical option for recurrent shoulder instability associated with glenoid bone deficiency with or without engaging hillsachs lesion.

Keywords: Recurrent shoulder dislocation, Latarjet procedure, Corocoid process, ROWE Score, Oxford Shoulder Instability Score.

[1]. Oudard M. La luxation récidivante de l'épaule, procédé opératoire. J Chir 1923;23: 13-25 (in French).
[2]. Latarjet M. Treatment of recurrent dislocation of the shoulder. Lyon Chir 1954;49: 994-1003.
[3]. Helfet AJ. Coracoid transplantation for recurring dislocation of the shoulder. J Bone Joint Surg [Br] 1958;40-B:198-202.
[4]. Patte D, Bernageau J, Rodineau J, et al. Unstable painful shoulders. Rev Chir Orthop Reparatrice Appar Mot 1980;66:157-65 (in French).
[5]. Torg JS, Balduini FC, Bonci C, et al. A modified Bristow-Helfet-May procedure for recurrent dislocation and subluxation of the shoulder: report of two hundred and twelve cases. Latarjet M. A propos du traitement des luxations re´ cidivantes de l'e´paule. Lyon Chir 1954;49:994–1003.

Abstract: The present study was conducted to compare the efficacy of Two hand sewn techniques of gut anastomosis (i.e. single and double layer). This prospective study was conducted in department of Surgery, JA Group of Hospitals, G.R.M.C Gwalior. 80 patients requiring intestinal anastomosis were included in this study from October 2011 to October 2012. In this study 43 single layer extramucosal and 37 conventional double layered anastomosis were observed and Comparison was made in terms of time required for anastomosis, anastomotic leak and other complications, and the cost incurred. Single layer anastomosis was performed with a continuous 2-0 polyglycolic acid suture & two layer anastomosis was constructed using 2-0 silk lembert suture for the outer layer & a continuous 2-0 polyglycolic acid suture for inner layer. 80 patients were subjected to intestinal anastomsis either single or double layer in emergency or electively by senior surgeon (Registrar or consultant). In 43 cases single layer anastomsis was done (18 emergency + 25 elective). In 37 cases double layer anastomosis was done (14 in emergency + 23 elective). In our study single layer anastomosis took 16-22 minutes whereas double anastomosis took 26-36 minutes. The average postoperative stay in hospital was 11.45 days for single layer and 13.45 days for double layer. The study shows that there was low incidence of anastomotic failure and setpic complications in single layer as compared with the double conventional methods of gut anastomosis. Hence the single layer anastomosis is safe and cost effective.

Key words: interrupted single layer, anastomosis, gastrointestinal.

[1]. Shaukat mahmood mirza, Kamran Khalid and faisal hanif. Single layer serosubmucosal intestinal anastomosis- an eqully safe alternative.JCPSP 2002;12(10):583.

[2]. Khoury GA, Waxman BP. Large bowel anastomosis: Br.J Surg 1983; 70:61

[3]. Carty NJ, Keating J, Campel J, Karanjia N. prospective audit of an extramucosal technique for intestinal anastomosis. Br.J Surg. 1991;78:1439.

[4]. Lembert A. Memoire sur l'enteroraphie avec la description d'un procede nouveau pour pratiquer cette operation chirurgicale. Rep Gen Anat Physiol Path. 1826;2:100.

[5]. Travers B. Enquiry into the process of nature in repairing injuries of the intestine. London: Longman, Rees, Orme, Brown, and Green; 1812.

Abstract: Objective:To determine the prevalence of geriatric population who usesself-medication. To evaluate the most common illnesses for which self-medication is being used and to know what are the common drugs which are by the geriatric population for self-medication. Methodology:It was a descriptive cross-sectional study which was conducted in Karachi on geriatric population over the age of 60 years. The study was done in May and August 2014.A total of 124 participants were selected for the study by non-probability purposive sampling. Data was analyzed using SPSS 17. Written informed consent was obtained from each and every participant. Confidentiality and anonymity of the data was ensured. Results:Results show that 55.6% of the respondents were between the age of 61 to 65 years old, males respondents were predominant in the study group, all kinds of work status people were included in the study, 84.68% respondents indicated that they use self-medication in our study population, 70.5% of them used self-medication on their own rather than on someone else's advice.Most of the population preferred to use self-medication because of two reason, 32.4% because of their previous experience and 28.6% used self-medication as per their convenience. The most common symptoms to use self-medication are headache (46.0%) and pain elsewhere (37.1%). Pain killers are the most commonly used self-medication(64.5%) followed by herbal medications.
Conclusion:In our study the prevalence of self-medication was high as compared to other studies conducted in Pakistan, in this study it was found that most common symptoms for which self-medication was used are headache and pain elsewhere, and pain killers are the most common drugs which are being used by the old age people.
Keywords: Self-medication, Geriatric population, Head ache, Analgesics

[1]. Hughes CM, McElnay JC, Fleming GF. Benefits and risks of self medication. Drug Safety. 2001;24(14):1027-37.
[2]. Gul H, Omurtag G, Clark PM, Tozan A, Ozel S. Nonprescription medication purchases and the role of pharmacists as healthcare workers in self-medication in Istanbul. Medical Science Monitor. 2007;13(7):PH9-PH14.
[3]. Bertoldi AD, Camargo AL, Silveira MPT, Menezes A, Assuncao MCF, Goncalves H, et al. Self-medication among adolescents aged 18 years: the 1993 Pelotas (Brazil) Birth Cohort Study. Journal of Adolescent Health. 2014;55(2):175-81.
[4]. Auta A, Banwat SB, Sariem CN, Shalkur D, Nasara B, Atuluku MO. Medicines in Pharmacy Students' Residence Self-medication Practices. Journal of Young Pharmacists. 2012;4(2):119-23.
[5]. Osemene KP, Lamikanra A. A study of the prevalence of self-medication practice among university students in Southwestern Nigeria. Tropical Journal of Pharmaceutical Research. 2012;11(4):683-9.

Abstract: Objective: To determine the sensitivity, specificity and diagnostic accuracy of fine needle aspiration cytology in the management of thyroid lesions. Material and Methods: A prospective study of Fine needle aspiration cytology of the thyroid gland was undertaken to evaluate its diagnostic utility, during the period from June 2011 to December 2013 in the Department of Pathology, S.P. Medical College Bikaner. A total of 52 patients presenting with palpable thyroid nodule was included in the study. All the patients underwent fine needle aspiration of the nodule. Among 52 cases, 37 were biopsied subsequently and subjected to histopathological study. A comparison of FNA cytology and biopsy results was made.

Keywords: Palpable thyroid lesions, Fine Needle Aspiration Cytology, Histopathology, Sensitivity, Specificity

[1]. Mitra A, Abbas AK. The endocrine system. In: Robbins and Cotran Pathologic Basis of Disease, 8th edn. Kumar V, Abbas AK, Fausto N, Aster JC (eds). Philadelphia: Saunders 2010; 1097- 1164.
[2]. Thyroid. In : Fine needle aspiration cytology, 4th edn. Orell SR, Sterrett GF, Whitaker D. Philadelphia: Churchill Livingstone; 2005; 125-164.
[3]. Miller JM, Hamburger JI, Kimi SR. Diagnosis of thyroid nodule by fine needle aspiration and needle biopsy. JAMA 1979; 241:481-486.
[4]. Boyd LA, Earnhardt RC, Dunn JT. Preoperative evaluation and predictive value of fine needle aspiration and frozen section of thyroid nodules. J Am Coll Surg 1998; 187:494-502.
[5]. Sabel MS, Staren ED, Gianakakis LM. Use of fine needle aspiration biopsy and frozen section in the management of the solitary thyroid nodule. Surgery 1997; 122:1021-1027.

Abstract: Oral cancer is one of the ten most common cancers worldwide and accounts for 30-40% of all cancers detected in India. In normal circumstances, the process of apoptosis effectively eliminates genetically damaged cells from tissues to guard against their continued growth and progression toward malignancy. Dysregulation of apoptosis has been involved in carcinogenesis. Hence oral cancer tissues were examined and markers (bcl-2 and bax expression along with p53) were analysed using immunohistochemistry. In the present study we observed overexpression of p53 and bcl2 and decreased expression of bax in patients with oral squamous cell carcinoma. Thus altered apoptotic mechanism can be accounted for oral carcinogenesis.

Key words: P53, immunohistochemistry, apoptosis, bcl2, bax

[1] Moore SR, Johnson NW, Pierce AM, Wilson DF. The epidemiology of mouth cancer: a review of global incidence. Oral diseases 2000; 6: 65-74.

[2] Gale N, Pilch BZ, Sidransky D, Barnes L, Eveson JW, Reichart P, Sidranski D. Epithelia precursor lesions in Pathology and genetics Head and Neck tumours. World Health Classification of Tumours eds Lyon 2005; 177-179.

[3] Scully C, Sudbo J, Speight PM. Progress in determining the malignant potential of oral lesions. J Oral Pathol Med 2003; 32: 251-256.

[4] Cruz I, Snijders PJ, Van Houten V, Vosjan M, Van der Waal I, Meijer CJ. Specific p53 immunostaining patterns are associated with smoking habits in patients with oral squamous cell carcinomas. J Clin Pathol 2002; 55: 834-840.

[5] Oren M. Decision making by p53: life death and cancer. Cell death differ 2003; 10: 431-442.

Abstract: Abnormal uterine bleeding (AUB) generally describes all abnormal patterns of bleeding that may result from a variety of causes including anovulation, pregnancy, uterine pathology and coagulopathies (1).The prevalence of AUB is estimated to be 11-13% in the general population and increases with age (2), significantly impacting quality of life and imposing financial burden. Moreover, postmenopausal bleeding is usually the first symptom of endometrial cancer (3) and active intervention can lead to its early detection. So, there is need of a diagnostic tool with high accuracy for detection of endometrial pathology in most efficient and least invasive method possible. Although several invasive and non-invasive methods like dilatation and curettage, hysteroscopy, transvaginal sonography (TVS) and power Doppler have been proved to be clinically useful for early detection of endometrial abnormality in women with AUB (4,5), still there is insufficient data comparing the diagnostic accuracies of all three modalities. The purpose of this study was to evaluate the endometrium in women with AUB using TVS, power Doppler and hysteroscopy and to compare their diagnostic accuracies.

[1.] Fritz M and Speroff L. Clinical Gynaecologic Endocrinology And Infertility 2010. Eighth edition; chapter 15: 592.
[2.] Marret H, Fauconnier A, Chabbert-Buffe. Clinical practice guidelines on menorrhagia: management of abnormal uterine bleeding before menopause. Eur J Obstet Gynecol Reprod Biol. 2010 Oct; 152(2):133-7.
[3.] Alcazar JL, Castillo G, Minguez JA, Galan MJ. Endometrial blood flow mapping using transvaginal power Doppler sonography in women with postmenopausal bleeding and thickened endometrium. Ultrasound Obstet Gynaecol 2003; 21: 583-588.
[4.] Yarandi F, Izadi-Mood N, Eftekhar Z, Shojaei H, Sarmadi S. Diagnostic accuracy of dilatation and curettage for abnormal uterine bleeding. J Obstet Gynaecol Res. 2010 Oct; 36(5):1049-52.
[5.] Ozdemir S, Celik C, Gegine K, Kirese D. Evaluation of endometrial thickness with transvaginal sonography and histopathology in premenopausal women with abnormal vaginal bleeding. Arch Gynecol Obstet. 2010 oct; 282(4): 395-9

Abstract: Odontogenic myxomas are tumors derived from embryonic mesenchymal elements of dental anlage. Although benign, odontogenic myxomas draw great attention because of their invasive nature into the surrounding tissues, which make the tumour amenable to recur especially after conservative treatment. We present a case of odontogenic myxoma with a displaced maxillary molar in the sinus, an unusual radiographic finding reported in literature.

Key words: Odontogenic, Myxoma, Mesenchymal, Tumor, Benign

[1]. Spencer K R. Odontogenic myxoma: Case report with reconstructive considerations. Australian Dental Journal 1998;43:(4):000-000.

[2]. Rani V, Masthan K, Kadar M, Babu A, Sankari L, Krishnasamy G. Odontogenic myxoma diagnostic dilemma: A case report and review of literature. J Cranio Max Dis. 2014;3:163-7.
[3]. Leiser Y, Abu-El-Naaj I, Peled M. Journal of Cranio-Maxillofacial Surgery. 2009;37:206-209.
[4]. Altug H A, Gulses A, Sencimen M. Clinico-radiographic examination of odontogenic myxoma with displacement of unerupted upper third molar: review of the literature. Int. J. Morphol. 2011;29(3):930-933.

[5]. Friedrich RE, Scheuer HA, Fuhrmann A, Zustin J, Assaf AT. Radiographic findings of odontogenic myxomas on conventional radiographs. Anticancer Res. 2012 May;32(5):2173-7.