Introduction: Cholelithiasis is the most common biliary pathology, with prevalence of 10-15%. In 1992, National Institute of Health consensus development stated that laparoscopic cholecystectomy "provides a safe and effective treatment for most patients with symptomatic gallstones" and it is the treatment of choice for cholelithiasis. This study is undertaken to determine the predictive factors for difficult laparoscopic cholecystectomy. Methodology: A prospective open-labeled study was carried out at Padmashree Vasant Dada Patil, Government Hospital Sangli, a tertiary center and teaching hospital in Western Maharashtra that is attached to Government Medical College, Miraj. All patients presenting with upper abdominal pain, or vomiting or dyspepsia or jaundice from January 1, 2011 to December 31, 2013 were screened for cholelithiasis. Ninety-nine cases diagnosed with cholecystitis following exclusion criteria and undergoing laparoscopic cholecystectomy were considered for the study. They were evaluated with following risk factors: age >50 years, male gender, body mass index (BMI) 25.1-27.5 and >27.5, previous surgery, prior hospitalization, palpable gall bladder, gallbladder wall thickening, impacted stone, and pericholecystic collection. Each risk factor was given a score preoperatively. The total score up to five predicted easy, 6-10 difficult and >10 very difficult. Statistical analysis was performed using Fischer's Test for qualitative data and unpaired t-test for quantitative data. Results: BMI >27.5 history of prior hospitalization, palpable gallbladder, impacted stone and pericholecystic collection are significant predictors of difficult laparoscopic cholecystectomy. Conclusion: The proposed scoring system had a positive prediction value for easy prediction of 94.05% and for difficult prediction of 100%.

Introduction: Multiple gestations are considered as high-risk pregnancy due to associated high maternal morbidity and perinatal mortality in comparison with singleton pregnancies. The present study was conducted to determine the frequency and outcomes of multiple births in comparison to single births and to study association of multiple births with sociodemographic variables. Methodology: A retrospective observational study was conducted at Gandhi Memorial Hospital, Rewa, Madhya Pradesh, India. Hospital medical records for the number of deliveries and subsequent details were looked into, for the year 2005. Information was collected on variables such as: sex at birth, birth outcome, and viability of the new-born at birth and birth weight, mode of delivery, residence, educational status, age, occupation and religion of the mother. Statistical analysis was performed using SPSS version 14.0 with all values expressed as percentages or mean and standard deviations. The association of sociodemographic characteristics of the mothers for single deliveries and multiple deliveries were compared using Chi-square test for the categorical variables. The outcome of single and multiple births for various variables were compared using unpaired t-test. A P ≤ 0.05 was considered to be statistically significant. Results: Overall prevalence of 29/1000 births was observed for multiple births out of the total 4170 deliveries for the year 2005. A higher proportion of multiple births (81%) were seen in mothers in the age group 20-29 years. Multiple births were found more at higher birth orders. Proportion of low birth weight (LBW) among multiple births was 29.8% and 19.3% in singleton births. Mean birth-weight was 2638.3 ± 430 g for single births and 2322.4 ± 446.7 g for multiple births. Cesarean mode of delivery was adopted in 14% of multiple births as compared with 11.4% in single births and assisted deliveries 8.3% in multiple births as compared with 3.2% in single births. Conclusion: Higher birth order along with young age of mother to be strongly implicated in the higher incidence of multiple births. Perhaps the outcome of multiple births resulted more LBW babies and accounted for the higher incidence of still births, cesarean and assisted deliveries as compared with single births. Timely detection of multiple births and highly equipped public-sector hospitals are the key to preventing complications and improving outcomes in such pregnancies.

Pulmonary hyalinizing granuloma (PHG) is a rare disorder and is a pertinent differential for lung diseases with multiple pulmonary nodules. Natural history of this disease is not known. Although the usual course is benign, a close follow-up of these cases is necessary. We herein report a case of PHG involving the diaphragm and the heart, detected on autopsy in a 57-year-old male who suffered a road traffic accident.

Clinical manifestations following scorpion envenomation are a result of autonomic outburst and direct actions of toxin on various systems. Involvement of central nervous system (CNS) following scorpion envenomation is rare. Encephalopathy, cerebral edema, subarachnoid hemorrhage, nonhemorrhagic strokes, and cortical necrosis are a few CNS complications described in the medical literature due to scorpion envenomation. We report a rare case of scorpion envenomation in which patient had symmetrical hemorrhages in the thalamus and cerebellum.

Acute myeloid leukemia (AML) is a malignant disease of the bone marrow in which hematopoietic stem cells fail to differentiate. Overproliferation of these abnormal cells results in suppression of the normal components of the bone marrow. Aleukemic leukemia is a type of leukemia in which abnormal (or leukemic) cells are absent in the peripheral blood. We put forth a unique case of aleukemic leukemia presenting as gingival enlargement, that was diagnosed by immunophenotyping and flow cytometery as acute monoblastic leukemia (AML FAB 5a).

Filariasis is a major public health concern in tropical countries like India, presenting with lymphatic dysfunction. We report two cases of filariasis coexisting with intra-abdominal malignancies and present our cytological findings documented with high-resolution images.

Emphysematous cholecystitis is an uncommon variant of acute cholecystitis caused by gas producing organisms. Only 18-20 cases have been reported in English literature until January 2013. Herein, we present images of computed tomographic scans of a 60-year-old female suffering from abdominal pain and was diagnosed as having acute emphysematous cholecystitis with extensive liver parenchymal involvement. The extensive liver involvement our patient with emphysematous cholecystitis urged us to report this case.