New Indian Journal of Surgery

Background: Dyspepsia is defined as persistent or recurrent pain and /or discomfort which is centered in the upper abdomen, May or may not be related to meals may be associated with other symptoms1. In the early stages, gastric cancer symptoms are covert and do not differ from those found in dyspepsia. Early detection and treatment will improve favorable outcome. The role of lifestyle and dietary factors are being investigated and have proved to be pivotal in causing gastric cancer.

Aims: The aim of this study is to evaluate the role of gastroscopy in peptic dyspepsia for early detection of carcinoma of stomach and its impact on increasing the proportion of early and operable gastric cancers and role of dietary factors, alcohol & smoking as its etiological factors.

Methodology: During the study period Sep 2014 to Sep 2016, a total of 468 patients with dyspepsia who fit into the inclusion and exclusion criterion underwent upper GI endoscopy.

Results: Among the 468 patients with dyspepsia 20 patients were diagnosed with gastric malignancy with an incidence of 4.2%. Maximum incidence of patients with malignancy was seen in the age group of 50 – 70 years with a Male: Female ratio of 3:3.6. Salt intake of more than 10 gm/day, fruits and vegetable intake of less than 200 gm/day and consumption of tobacco were found to be risk factors for gastric malignancy. No association was found between alcohol consumption and gastric cancer. 8 patients underwent curative resection, 7 underwent palliative procedures and 6 patients were administered chemotherapy. The percentage of operable gastric cancer following upper GI endoscopy in our study was 40.9%.

Conclusion: We conclude that upper GI endoscopy has a specific role in patients with peptic dyspepsia, for early detection of carcinoma of the stomach and thatthe role of dietary factors is imperative in the prevention of this deadly disease.

Introduction: Carcinoma of the rectum is not only a medical but a social problem. Adenocarcinoma of the rectum accounts for 30% of these cancers. Locally advanced cancers of the rectum i.e., stage 2 and 3 diseases prove to be a challenge with respect to its management. Present guidelines state that the use of neoadjuvant chemoradiotherapy to downstage the locally advanced carcinomas of the rectum to have a positive impact on not only the survival but also the quality of life posttreatment viz., by allowing better resection margins to preserve the sphincter mechanism by performing a coloanal anastomosis.

Objectives: To assess the locoregional response rates determined by the measurement of margin of clearance from the anal verge, organ preservation (sphinctersaving operations), and histopathological findings in post CRT surgical specimen.

Materials and Methods: This study included a total of 33 patients which were diagnosed with locally advanced rectal cancer who presented in the department of General Surgery, Vydehi Hospital, Bangalore. The patients in this series were subjected to preoperative CRT, locoregional response rates and the number of sphincterpreserving surgeries performed were assessed.

Results: Downstaging of the tumor was achieved in 91% of the cases Conclusion: From this study, an interpretation can be made that following CRT there is a significant downstaging and increased ability to perform sphinctersaving procedures.

Background: Loss of skin has a direct bearing on the various facets of health of the individual, hence, restoration of the skin ‘loss’ becomes an objective of paramount importance, which can be accomplished by various means, However, split skin grafting is the most commonly employed procedure because of its ease, better ‘take’ even in adverse conditions, ability to cover large areas and the possibility of reharvesting from donor site. Tourniquet is used following exsanguination to produce a relatively bloodless operative field.

Aims and Objectives: To compare the effectiveness of splitthickness skin grafting under tourniquet as compared with splitthickness skin grafting without tourniquet.

Materials and Methods: The cases for the study were taken from 100 subjects admitted to K.R. Hospital attached to Mysore medical college and research institute, Mysore during the study period from June 2016 to May 2017. All splitskin grafting of the extremities (arms and legs) were included in study, whereas Graft sites of less than 2cm in greatest diameter, subjects who may require a combination of grafts (splitthickness and full thickness grafts), Children below the age of 12 years, Graft sites where pneumatic tourniquet will be difficult, subjects with Deep Venous Thrombosis and Peripheral Vascular Disease were excluded from study.

Results: Of the 50 subjects who were randomized in the Tourniquet group, 2 (4%) subjects had to undergo regrafting due to displacement of the graft, but on the overall outcome the tourniquet group held the advantage over Non Tourniquet group in terms of Lower intra operative loss of blood (p 0.034) and lower incidence of seroma formation (p 0.026). While the Non tourniquet method had a lesser operating time (p 0.04) as compared to tourniquet.

Conclusion: Split thickness Skin grafting done under the application of tourniquet held advantage over grafting without the application of tourniquet in terms of lesser intraoperative blood loss, lesser incidence of seroma formation under the graft.

Background: In laparoscopic surgery, establishment of pneumoperitoneum is the important step for the continuation of surgery. There are several techniques for the creation of pneumoperitoneum Veress needle, hasson’s cannula, direct trocar insertion and optical trocars. Aim: This is a prospective study for comparing the differences between the veress needle (VNI) and the direct trocar (DTI) insertion techniques, regarding the time, safety and complications.

Methods: In the department of general surgery, Govt. medical college, Omandurar govt. estate, Chennai, India, 306 cases of laparoscopic surgeries were operated from Nov 2016 to Dec 2017. Patient’s clinical data was recorded in a specially prepared proforma. The technique of pneumoperitoneum creation was alternately changed for every successive patient. Patients were followed up for immediate postoperative complications. The two groups were compared using appropriate statistical tests.

Results: Pneumoperitoneum was successfully created in all 306 cases. The mean access time was significantly lesser in the DTI (136.41 sec vs. 211.86 sec in VNI). Two cases of bowel injury that occurred in the DTI technique wasn’t statistically significant. Minor complications such as omental injury and extraperitoneal insufflation were significantly higher in the VNI. Multiple attempts were also needed for pneumoperitoneum creation in the VNI.

Conclusion: DTI is a safe, rapid and efficient alternative to VNI and other techniques of laparoscopic entry. And with expertise, it also has lower incidence rates of both major and minor laparoscopic entry complications.

Background: Thyroid cancer is the most common endocrine malignancy and its incidence continues to rise. Thyroid carcinoma in most cases presents clinically as a solitary nodule or as a dominant nodule within a multinodular thyroid gland. In general population, thyroid nodules are very common with reported prevalence of 47% of adults. The challenge to clinicians is to identify the minority of thyroid nodules that harbour malignancy from the majority which can be managed conservatively. There are a number of well established of predictors of malignancy in thyroid nodules. More recently a few studies have suggested that higher concentration of TSH, even within the normal range are associated with subsequent diagnosis of thyroid cancer in patients with thyroid nodules and even higher serum TSH levels have been found associated with advanced stages of thyroid cancer.

Aims And Objectives: To evaluate the association between Serum Thyroid stimulating hormone (TSH) concentration and Thyroid cancer and also to assess whether Serum TSH levels are of value in predicting malignancy in patients with thyroid swellings. Materials And Methods: A both prospective and retrospective study was designed, including total of 90 cases of thyroid cancer. Age, sex, serum TSH concentration, nodule size and pathology were evaluated. The association between serum TSH concentrations and thyroid cancer was analysed.

Results: In our study maximum number of thyroid cancer patients (79 out of 90) had Serum TSH concentrations ranging 1.71 mIU/L5.5mIU/ L i.e. within normal range but towards higher range. Even mean serum TSH concentrations in our study was found to be high in advanced stages of carcinoma had mean serum TSH concentration of 5.27 mIU/L.

Conclusion: The higher rate of thyroid malignancy observed in patients with higher serum TSH concentration is caused by tropic effect of TSH on thyroid tissue that promotes neoplasia and carcinogenesis. Baseline serum TSH concentration can be used as a biochemical predictor of thyroid cancer in patients with thyroid nodule. High serum TSH concentration in patients with thyroid cancer patients can signifies more aggressive and advanced cancer stage, at diagnosis.

Construction of the ostomy is one of the routinely performed diversion procedure. End ostomies (ileostomy /colostomy) are being constructed for emergency abdominal conditions which requires resection of the bowel but reestablishment of its continuity may not be feasible at that situation. Termination of the loop ostomy is simple and it usually doesn’t require formal laparotomy. Whereas termination of end ostomy needs formal laparotomy and bowel mobilisation, adhesionolysis which is associated with increase intra and postoperative morbidities. This can be avoided by undertaking the procedure at appropriate time based on primary aetiology, that is for Traumaticconditions as primary cause end ostomy can be terminated safely at early stage (810 weeks). Where as in case infective and inflammatory conditions are the primary causes one should safely wait at least 16 weeks before taking up for the procedure.

Background: Perforative peritonitis is one of most important infectious problems that a surgeon faces on a day to day basis. Despite advances in surgical techniques, antimicrobial therapy and intensive care support its management continues to be highly demanding. Early and objective classification of the severity of peritonitis using the Mannheim peritonitis index (MPI) and the Multiple Organ failure (MOF) scoremay help in selecting patients for aggressive surgical approach.

Aim: Evaluating the prognostic value of Mannheim Peritonitis Index and Multiple Organ Failure score in patients with perforative peritonitis and predicting their outcome.

Methods: Prospective evaluation of the MPI and MOF score was performed in 82 patients with peritonitis who underwent uniform surgical treatmentfrom December 2013 to December 2014 in the Department of General Surgery, KIMS Hubli. Patients were followed up until death or discharge.

Results: Overall inhospital mortality rate was 18 %. Patients with MPI scores of  20, 2129, 30 had a mortality of 5%, 28%, and 60% respectively with a mean MPI of 19.9 in the survivors and 29.06 among the expired patients. When Multiple Organ Failure score was analysed, it showed that mortality was only 5% if the score was less than or equal to 3. But, when it becomes more than 3, mortality reached 90%.

Conclusion: The combined MPI and MOF score have a great impact on the prognosis of patients in perforative peritonitis. They help stratifying the patients according to risk category to minimise the complications postoperatively.

Background: Elevation in serum bilirubin is reported to have a predictive potential for the diagnosis of complicated appendicitis, the pro inflammatory mediators tend to reach liver via superior mesenteric vein and may directly or indirectly produce liver dysfunction thus implying a credibility of serum bilirubin as the biological marker to predict and differentiate Appendicitis.

Aims & Objectives: To Study the relationship between hyperbilirubinemia and acute appendicitis and to evaluate whether elevated bilirubin level are of predictive value in diagnosis of complicated appendicitis.

Methods: This comparative clinical study of 100 patients who attended surgical outpatient department/admitted to tertiary care hospital presenting with pain at RIF region with fever & vomiting were included. After admission, the data collected regarding clinical history, examination, diagnosis, investigations, and details of previous operative procedure. Post operative follow up done to note the complications both in hospital and after discharge for 3 months. Result: Out of 100 patients, 69 patients had raised bilirubin levels (>1.0 mg/dL). 32 patients diagnosed as complicated appendicitis. Among them 29 patients (90.62%) had raised bilirubin levels (>1.0 mg/dL). 40 (58.82%) patients of the total patients diagnosed with Acute uncomplicated appendicitis were found to have elevated bilirubin levels (>1.0 mg/dL).

Conclusion: We concluded that Hyperbilirubinemia found to b a new predictor of acute appendicitis, also found that Bilirubin level significantly (>1.0) raised in acute Uncomplicated Appendicitis & Complicated Appendicitis.

Background: Cholecystectomy is the most common abdominal procedure performed for removal of gall bladder in cholelithiasis. Various advances have been made in the laparoscopic cholecystectomy procedures.

Objective: To compare safety and efficacy of clipless laparoscopic cholecystectomy by bipolar cautery versus traditional method using titanium clips.

Material and Methods: This was Prospective Randomized study conducted on 100 patients undergoing elective cholecystectomy. Patients were recruited with study to treat after satisfying inclusion and exclusion criteria and divided into two groups of 50 each. Both Groups undergoes elective laparoscopic cholecystectomy, in group titanium clips were used to reseal and ligate cystic duct and artery and in group B bipolar cautery was used. The preoperative, intraoperative and postoperative parameters were collected and analysed using statistical methods.

Results: The mean age in group A was 41.7±4.2 years and in group B was 41.6±4.0 years. There were 36 females in group A and 38 in group B. Duration of surgery was 30.9±7.3 and 37.0±7.5 in group A and Group B respectively. Intraoperative blood loss was 9.3±2.9 ml in group A and 6.9±1.6 ml in group B. There was significant difference between two groups in relation to duration of surgery and intraoperative blood loss. Number of clips applied varies from 45 in group A and no clip was applied in group B. Amount of post operative drainage in Group A was 22.4±13.6 ml and in group B was 3.6±3.9 ml and there was significant difference between the two. 

Conclusion: Bipolar cautery is a safe alternative to standard clips to ligate and seal cystic duct and artery. It provides less cost and amount of intraoperative blood loss is less.

Objective: Themain objective of the present study was to investigate the severe traumatic injury and its association with age and gender. Sample: The study was conducted at the trauma center under the department of general surgery, Pt. J.N.M. Medical College & Associated Dr. B.R. Ambedkar Memorial Hospital, Raipur, C.G. A total number of 77 cases presenting to the acute trauma ward were included in the present study.

Research Design: Observational study design was used in the present study.

Result: The present study shows that the 2130 years of age group is highly affected with severe traumatic injury than other groups. Male were affected more (83.31%) with a severe traumatic injury compared to female (11.68%). The mortality was higher in male (91.66%) than the female (11.11%).

Conclusion: Finding of the present study concluded that the people with age group of 2130 years and male gender was exceedingly affected with a severe traumatic injury.

Background: Pediatric Circumcision is a common surgical procedure performed all over our country. Penile block is very useful for post operative analgesia in circumscion.Using penile block with Intravenous ketamine and midazolam patients can be managed smoothly without any major complication and it is a costeffective technique in pediatrics patients.

Aim: of this study is to evaluate the role of Intravenous (IV) Ketamine, and Penile Block in children undergoing circumscion.

Materials and Methods: This is an observational prospective study carried out in Department of surgery and Anesthesia Chirayu Medical college and hospital Hospital during the period from January 2011 to December 2016.During this period total 120 cases of circumcision were done. Children with American Society of Anesthesiologists (ASA) Grades I & II, between 15 days and 15 years of age were selected for this study. Patient was sedated using Ketamine 1 mg/kg plus midazolam 0.1 mg/kg and penile nerve block was given prior to circumscion with 1.5mg/kg lidocaine 2% mixed with 0.5mg/kg bupivacaine 0.5% without epinephrine to a maximum dose of 5 ml using a fine 26 guage needle. Close observation and monitoring was done clinically as well as with the help of pulse oximeter and sphygmomanometer.

Results: Among 120 patients ,11 patients had complications subcutaneous hematoma was seen in 5 cases . Partial block was observed in 2 cases,.There was transient fall in spo2 seen in 2 patients and cough and breathing difficulty in 2 patients.

Conclusion: Circumcision with low dose intravenous Ketamine and with penile block is a safe and costeffective anesthetic technique in children in a day care setting.

Background: Necrotizing fasciitis is a rapidly progressing mono/ polymicrobial skin infection that spreads to underlying tissues leading to life threatening situations. Immediate surgical debridement together with i.v antibiotic administration is required to avoid fatal outcome. Early diagnosis is often delayed due to underestimation or confusion with cellulitis. The laboratory risk indicator for necrotizing fasciitis (LRINEC) is useful for early recognition of necrotizing fasciitis.

Objective: To validate the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system for the diagnosis of necrotizing fasciitis among patients presenting with soft tissue infections.

Materials and Methods: This is a Hospital based Diagnostic Evaluation Study. All patients presenting with soft tissue infections during the period of 18 months (1st September 2015 to 28th February 2017) were included in the study and LRINEC scoring system was applied. Parameters included are Haemoglobin, Total WBC count, Serum Creatinine, Serum Sodium, Random Blood Glucose value and CRP at the time of admission. A score 6 was found to be highly suspicious of Necrotising Fascitis. The confirmatory diagnosis for necrotising fasciitis was done with histopathology.

Results: A total of 112 patients were evaluated during the study period of 18 months. Of this 41 patients had necrotising fasciitis and 71 had Cellulitis. The LRINEC score  6 had a sensitivity of 63.4%, specificity of 73.2%, positive predictive ratio of 57.7% and negative predictive ratio of 77.6%.

Conclusion: The LRINEC score is a very useful diagnostic tool which can be used to distinguish necrotizing fasciitis from soft tissue infections.

Introduction: Strangulation is the most dreaded complication of bowel obstruction and has a great bearing on morbidity and mortality. Early diagnosis remains great concern to a surgeon, as strangulation carries considerable mortality. Aims & Objectives: To evaluate efficacy of various parameters in predicting strangulation obstruction.

Material and Methods: Present study was a prospective, hospital based study involving 100 patients admitted for acute bowel obstruction. All patients were classified into strangulated and nonstrangulated bowel obstruction. The incidence of 4 parameters: fever, tachycardia, rigidity and leucocytosis were calculated in all patients. The sensitivity, specificity, positive and negative predictive value of these parameters was calculated and results were analyzed.

Results: Of the total 100 cases, 31% had strangulated bowel. The evidence of strangulated bowel due to obstructed hernia was seen in 36.84% cases and 29.62% cases of adhesive obstruction. Fever was present in 54% cases, tachycardia in 46%, leucocytosis in 36% and rigidity in 32% cases. These individual parameters were not statistically significant. If a combination of 2 parameters is used instead of single parameter, then rate for predicting strangulation increases to 20% and it rises to 71.42% when all the 4 parameters are considered.

Conclusion: Amongst the clinical parameters for strangulation (tachycardia, fever, rigidity, and leucocytosis), none is sensitive or specific for prediction of strangulated bowel obstruction. Preoperative definitive diagnosis of strangulation cannot be made reliably by any clinical and laboratory parameters included in the present study. However, a reasonable prediction about strangulation can be made if all parameters are considered together.

Background: Chronic non healing ulcers are challenging problems faced by reconstructive surgeons. And treating these problems are huge economical burden and consuming more manpower to take care them in hospital setting. The aim of this paper is to share our experience of an economical and effective technique of wound care.

Materials and Methods: This is a retrospective hospital based study of chronic non healing ulcers treated in JIPMER hospital from 2012 to 2014. The study consists of 11 patients of all age groups and both genders. Wounds were treated with periodic wound debridement done in hospital followed by home based negative pressure therapy for all cases. SSG was also done in few patients after wound bed preparation. Follow up done for 6 months.

Results: 11 patients were taken for the study consisted of 7 males and 4 females. Ulcers involving upper and lower limbs are treated. End results were analysed by healing of the wound and maintaining the stable scar. Wound healing achieved by secondary intention in 9 patients and SSG was done in 2 patients. Number of hospital visits averaged 7. Average duration of treatment is 43 days. 3 patients are admitted only after skin grafting.

Conclusion: Economical and effective wound care can be achieved by home care based negative pressure wound therapy with using simple appliances and proper education of patients and relatives.

Background: Role of Ddimer assay in suspected high risk obese patients has not been explored much. Therefore, purpose of this study is to ascertain the place of Ddimer assay in diagnosis of Deep vein thrombosis (DVT) in obese patients.

Methods: Patients attending outdoor or admitted in surgery ward of hospital, presenting with history and examination suggestive of DVT, at high risk of developing DVT and having Body Mass Index >25 kg/m2 were included. Ddimer assay and ultrasonography (USG) was done at the time of admission, ultrasound was repeated at one week (if the first examination was negative for DVT) and at one month. Out of total 70 suspected cases, Ddimer levels were compared in relation to cases which were finally diagnosed as DVT by USG and those in whom DVT was excluded. Sensitivity, specificity, positive predictive value, and negative predictive value for the Ddimer test were calculated.

Results: 70 suspected cases of DVT (32 males & 38 females) were included with mean age of 55.59±13.59 y and with mean BMI of 27.7±1.7. No statistical difference between vital parameters of diagnosed and excluded cases of DVT was found. The sensitivity and specificity of D dimer were found to be 100.0% & 35.5% respectively. Positive predictive value was 46.29% and Negative predictive value was 100.0%.

Conclusions The sensitivity and negative predictive value of semiquantative latex Ddimer assay for deep venous thrombosis are high. Deep vein thrombosis in obese individuals can be ruled out on the basis of Ddimer assay.

Introduction: The GSV can be identified by the tibiogastrocnemius angle sign between the distal third of thigh and proximal third of calf on duplex venous ultrasound. Incidence of duplication of GSV varies between 1 and 52 percent. Present study was undertaken to note the incidence of bifid GSV.

Materials and Methods: A prospective nonrandomized study of hundred patients was carried out between June 2016 and May 2017. Preoperative venous mapping of GSV was carried out. The occurrence of duplicated GSV was recorded. Bifid GSVs were followed up to their origin. Diameter of GSV < 2.5 mm was considered as narrow calibre GSV and diameter >5 mm was considered as dilated one. All patients underwent trendelenburg’s operation. Descriptive statistics were calculated. P < 0.05 was considered as statistically significant.

Results: The mean age of patients was 47. The number of tributaries varied from 2 to 6 at SFJ. Venous duplex ultrasound preoperatively showed that there was bifid GSV in 4%, narrow calibre GSV in 4% and dilated GSV in 6% patients. Intraoperatively, bifid GSV was present in 6% patients. Two patients had narrow calibre GSV. Intraoperatively we found that in 3 patients GSV’s were draining into the SFJ as a common trunk and in remaining patients it was draining in to the junction individually. Maximum frequency of GSV duplication was seen in the thigh region (66.7%) patients followed by in the ankle region in (33.3%) patients.

Conclusion: True incidence of bifid GSV is difficult to estimate. It is surely less than the available literature suggests. Our study showed no statistical difference in incidence of bifid GSV on preoperative duplex ultrasound and its subsequent confirmation as intraoperative finding; hence, duplex ultrasound marking of GSV preoperatively is advisable. One should emphasise that the success rate of surgery is relevant to the anatomical variation of GSV and knowledge of same will decrease the recurrence rates of varicose veins.

Background: Benign breast diseases is usually seen in female reproductive life accounting for more than 90% of the cases with benign breast lumps on presentation. Fibroadenoma is a common cause of benign breast lumps in premenopausal women. Fibrocystic disease of breast is a histological term presenting as lump or lumpiness. Triple assessment by clinical, pathological and radiological examination is a standard approach in the evaluation of breast lumps. This study was aimed to establish a clinicopathologic and radiological correlation and subsequent management in patients with benign breast diseases.

Materials and Methods: A prospective study was conducted at IMS & SUM Hospital, Bhubaneswar, India during the period of October 2015 to September 2017. In this study, 102 females with benign breast lumps were evaluated by clinical breast examination, ultrasonography (USG) and Fine needle aspiration cytology (FNAC) methods. All patients underwent excision biopsy of lump. Final histopathological report was taken as reference standard.

Results: Surgical excision was an effective treatment for most of the benign breast diseases. Clinical breast examination and USG showed good sensitivity but less specificity than FNAC. FNAC showed both good sensitivity and specificity.

Conclusions: Fibroadenoma and Fibroadenosis are the most common benign breast diseases. Triple assessment by clinical, pathological and radiological examination is a standard approach in the evaluation of breast lumps. Surgical excision was an effective treatment for most of the benign breast diseases.

Background and Objectives: To identify difficult cholecystectomy is often subjective, because itcan be established by the operator in an arbitrary manner.The followingparameters allow defining cholecystectomy as “difficult”: difficult identification and isolation of the cystic artery and duct, scarring of Calot’striangle, inflammation, Adhesions,a short cysticduct, difficult dissection of the gallbladder wall from the hepatic bed etc. MRCP being an excellent, easily available, safe, noninvasive modality in delineating anatomy of extra hepatic as well as intra hepatic biliary system can be used prior to everycholecystectomy to detect the exact pathology and presence of any anatomical variations. This will preclude the surgeon from coming across any unexpected variations which can lead to serious complications.

Methods: In this study, 50 cases of gallbladder disease are examined preoperatively for difficult cholecystectomy based on MRCP findings in Sir T. Hospital, Bhavnagar from December2015 to September2017.

Results: In this study, difficult cholecystectomy is more found in age group of 4160 years 64.28%, more in male patients 69.23% and more common with jaundice and other associated factors like Hypertension, Diabetes and IHD. Out of 50 patients MRCP of total 41patients were done and can identify the possibility of difficult cholecystectomyin 20 patients.

Conclusion: MRCP preoperatively helps in identifying the difficultcholecystectomy. So we can preoperatively explain the patient regarding complications and methods of operations. We can minimize the intraoperativecomplications, reduce operative time and also we can prevent intraoperativemorbidity of the patients.

Prostate Specific Antigen has been widely used in diagnosis and management of patients with prostate cancer. It may be elevated in other prostatic diseases. The objective of this study was to evaluate its efficacy to diagnose and differentiate between benign and malignant enlargements. Study also determines relationship between serum prostate specific antigen levels and histopathologic findings in prostatic biopsies. Materials and Methods: Study was done at a tertiary care hospital in Telangana over 6 years. A total of 500 patients were included in the present study. Prior to surgery serum prostate specific antigen levels were determined for all the cases and the biopsies were sent for histopathology. Results: In the present study mean age of presentation was 64.24 years. Amongst the 500 cases, 451 (90.2%) were of Benign Prostatic Hyperplasia, 32 (6.4%) were of Prostatic Intraepithelial Neoplasia and 17 (3.4%) were of Prostatic Adenocarcinoma. Serum prostate specific antigen levels range distribution was considered into 3 groups as: 04 ng/ml included 404 (80.8%) cases, 59 ng/ml with 44 (8.8%) cases and 10 ng/ml included 52 (10.4%) cases. Present study revealed sensitivity 70%, specificity 91%, diagnostic accuracy 91%, positive predictive value 23%, and the negative predictive value 98%. Conclusion: PSA is specific for prostate but not for prostate cancer. PSA is raised in cancer, prostatic infection, urinary retention & Nodular Prostatic Hyperplasia. There is need of a more reliable and precise serum marker that reflects prostate cancer.

Clefts of the lip and/or palate are among the most common birth defects worldwide [1]. The majority are nonsyndromic where cleft lip and palate occurs in isolation of other phenotypes. Where one or more additional features are involved, clefts are referred to as syndromic. Collectively cleft palate has a major clinical impact requiring surgical, dental, orthodontic, speech, hearing and psychological treatments or therapies throughout childhood. The etiology of cleft palate seems complex, with genetics playing a major role. Several genes causing syndromic cleft palate have been discovered. The etiological complexity of nonsyndromic cleft lip and palate is also exemplified by the large number of candidate genes and loci. To conclude, although the etiology of nonsyndromiccleft palate is still largely unknown, mutations in candidate genes have been identified in a small proportion of cases. We present a case of syndromic cleft palate with ankyloglossia