Choledochal cysts are rare cystic dilatations of the biliary tree. Most of them are congenital and usually manifest in early childhood but some may manifest later in adult life. Though, the cause is uncertain, these cysts are usually referred for surgical resection because of their association with recurrent inflammation, infection and malignancy [1]. Traditionally choledochal cysts are classified into 5 main types. Cysts of cystic duct are a rare entity which have been sometimes described as Type VI choledochal cyst according to modified Todani's classification [2]. Till 2009 only 14 such cases have been reported [3]. We describe a rare case of type VI choledochal cyst i.e. cyst of cystic duct, which was treated successfully by laparoscopic resection.

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Colloid cyst of the third ventricle is a rare congenital benign intracranial entity occurring in 0.5 – 3 % of primary brain tumors and 15 – 20 % of intraventricular ICSOLs. Symptoms include headache, memory loss, syncope, gait disturbances, lower limb weakness or urinary incontinence. Diagnosed incidentally or during MRI Brain for other reasons, can present with acute hydrocephalus, herniation and death. Various modalities exist forthe treatment including interhemispheric transcallosal approach, transcortical approach, endoscopic approach and stereotactic approach. All techniques have favorable and comparable outcomes. We present a case report and discussion about various open and endoscopic management options of the patients with colloid cysts.

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Relieving pressure on neural structures constitutes the bulk of neurosurgical work load. We present a snapshot of 4 cases operated in Sep 2013, with varied neurological syndromes, surgical approaches and outcomes. The direction of future neurosurgery practice is hypothesised.

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24 years old male sustained severe head injury with # femur following RTAon 2/09/12. Decompressive Crainectomy was done on the same day followed by cranioplasty with preserved cranial flap after 4 months. Patient showed initial improvement till he developed hydrocephalus on the sixth day following crainioplasty and underwent VP shunt on the right side. The patient became increasingly drowsy one month after cranioplasty. CT showed extradural collection which was evacuated. Following that improvement in the GCS noted with GCS of E4V1M4.

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Underwater environment predisposes a diver to high blood pressure. Although neurologic manifestation after a diving episode are considered to be decompressive illness unless otherwise proved, all medical emergencies are to be considered. Incidence of ICH amongst divers while working underwater is rare and yet to be reviewed in diving literature. We present a 48 year old, exdinerwith C/o Rt. hemiparesis post-dine. NCCT and MRI demonstrated acute intracranial haemorrhage. He was managed conservatively.

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Background: Effects of pressure changes especially by long term stay in high altitude area are well known but effect of high atmospheric pressure on ocular tissue is not studied in detail. This study intends to find out the effect of long term exposure to high pressure due to diving on certain parameters of ocular functions Material and Methods: Single centre study performed during 2010–11, for a group of retired naval divers (actively diving) (52 eyes) and a control group of non-divers (retired surface naval personal) (52 eyes). Both groups were matched for age, sex baseline visual status and various parameter related to diving and their detailed ophthalmologic examination was carried out which consisted of testing of visual acuity, IOP, contrast sensitivity, color vision and visual fields. Results: Mean IOP was higher in the diver group (Diver group: 17.04 mm Hg, Control group: 14.81 mm Hg,p > 0.05) and it was statistically significant. There was a high frequency of red-green axis color vision defects (30.7 %) in the diver group. Visual field assessment also showed some difference in both groups but no conclusive pattern could be determined. No significant difference in visual acuity and contrast sensitivity were found between the two groups. Conclusions: There is a definite effect of long term diving on ocular tissue and visual functions. Mean IOP was found high in the diving group and color vision defects were also found more commonly in divers group though no significant difference in visual acuity and contrast sensitivity was found between the two groups.

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Background: Dengue infection is endemic in most regions of India and is a major cause of morbidity and mortality. There is paucity of data from the Armed Forces. This report on 52 children is from a Zonal Hospital in a dengue-naïve area. Methods: A prospective, observational study of clinical features and laboratory parameters in children up to 15 years with dengue infection confirmed by ELISA for NS1 antigen. Results: Mean age was 9.9 years, male to female ratio 1.08:1. All 52 had Dengue Fever with no hemorrhagic manifestations and all recovered. Leading symptoms were nausea (53.85%), myalgia (51.92%) and vomiting (50%). Significant laboratory findings included leucopenia (<6000/cumm) in 90.38%, thrombocytopenia (<l,00,000/cumm) in 23.08%; elevated aspartateaminotransferase in 45.45% and raised alanineaminotransferase in 36.36%. All abnormalities resolved spontaneously. Conclusion: Lack of serious manifestations of dengue, nausea as the leading symptom, marked leucopenia and relatively less thrombocytopenia and elevation of liver enzymes, are aspects of this study different from reports of other published studies and therefore need further research. Pooling and analyzing data from all Armed Forces hospitals and extension of advanced investigation facilities to all hospitals would provide fresh insights to aid in better management of dengue infections in children.

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Background: The Bankart lesion is the common form of labro-ligamentous injury in patients with traumatic dislocations of the shoulder leading to recurrent shoulder instability. We present a case series of thirteen service personnel with post traumatic recurrent anterior dislocation of shoulder that were managed with arthroscopic Bankart repair using titanium suture anchors. Materials and Methods: Thirteen young service personnel with posttraumatic recurrent anterior dislocation of shoulder were treated by arthroscopic repair from Apr 2012 to Jun 2013. Patients were evaluated after06,12,24 and 52 weeks postoperatively. A result of the group was evaluated on the basis of post-operative pain, range of motion, postoperative function, satisfaction level of patient and return to active service. Results: Six patients who were followed for more than 06 months in this series had good outcome in terms of shoulder stability, range of motion, active forward flexion, satisfaction and cosmesis. Conclusion: Arthroscopic Bankart repair with the use of titanium suture anchors is a reliable treatment method, with good clinical outcomes, excellent postoperative shoulder motion and return to active service.

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Coronary Artery Bypass Grafting (CABG) is the treatment option for Left Main and multi vessel coronary artery disease. Newer techniques and grafting strategies have been introduced in the last two decades to combat the stent surge. Offpump coronary artery bypass (OPCAB or beating heart bypass surgery) is widely performed in corporate hospitals in our country with use of multiple arterial conduits (Total Arterial Revascularisation). This practice of OPCAB has been largely abandoned in the western countries as it is not supported by current available evidence. Newer techniques like robotic surgery, endoscopic bypass surgery (TECAB), anastomotic devices are expensive and have limited application in our country. This article reviews the available current evidence on this subject, highlights the current practice in private hospitals and the reasons thereof in India and outlines the strategy being adopted in AFMS. A retrospective analysis was carried out of 172 patients who underwent CABG at INHS Asvini between 01 Jan 2008 and 31 May 2013.39% had Left Main Coronary artery disease, 85% patient had triple vessel disease, 56% were diabetics, 12% had undergone stenting in recent past. Beating heart strategy was used in 10%, average no of grafts per patient was 2.3 with LIMA and Radial artery being used as a conduit in 84% and 4% respectively. 4.6% patients succumbed in post-operative period.

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Acinetobacter baumannii is a Gram Negative coccobacilli implicated in causation of wide spectrum of nosocomial infections. Multidrug resistant Acinetobacter (MDR Acinetobacter) is emerging as an important cause of hospital acquired infections like urinary tract infection, ventilator associated pneumonia, meningitis, bacteremia and infection in burns patients. The purpose of this study is to determine the prevalence of Acinetobacter infections and ascertain the burden of MDR Acinetobacter in this hospital. This study is a retrospective review of Microbiology laboratory culture reports during the period 01 Jan 2012 to 31 Dec 2012 at INHS Asvini and includes 172 isolates of Acinetobacter baumannii. Multidrug resistant Acinetobacter was defined as resistance to more than three classes of antibiotics. Out of a total of3283 different isolates from various clinical samples during this period, 172 isolates of Acinetobacter baumannii were obtained. Antimicrobial susceptibility patterns for all available antibiotic classes for Acinetobacter were studied. Of all the Acinetobacter baumannii isolated, 38% were found to be Multidrug resistant which were resistant to most of the commonly used antibiotics including Aminoglycosides, Cephalosporins, Carbepenems, Extended Spectrum Penicillins and Fluroquinolones. The data suggests that Acinetobacter infections are a growing threat affecting a considerable proportion of critically ill patients.

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Man has always been exposed to natural radiation arising from the earth as well as from outside the earth. No human activity or practice is totally devoid of associated risks. Radiation should be viewed from the perspective that the benefit from it to mankind is less harmful than from many other agents. In general, the basic principles of radiation protection (justification and optimization of a procedure) need to be respected to help counteract the unjustified exposure in the number of procedures being performed. However ALAR A (As Low as Reasonably Achievable) doses should be the guiding principle in dealing with radiation.

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With recent advances in medicine, the number of prepubertal and adult males surviving cancer treatment has increased dramatically. This has increased the need to improve the existing technology and search for new fertility preservation options. Presently, only sperm cryopreservation has been accepted in standard clinical practices. Fertility preservation options in prepubertal males are still experimental and there are many unresolved issues related to these technologies. Cryopreseravtion of testicular tissue and spermatogonia! stem cell transplantation should only be offered within 1KB approved clinical protocols after thorough counselling.

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Genetic factors are found to play a major role in male infertility. Inf act, it has been suggested that a linear correlation exists between seminal defects and chromosomal abnormalities. Carriers of various mutations are at an increased risk of infertility, spontaneous abortions and chromosomally abnormal offsprings. Chromosomal screening, followed by detailed genetic counselling is highly recommended in all cases of Azoospermia and Severe Oligospermia.

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Despite advances in personal protection, brain and spinal injuries amongst combatants pose significant management challenges. Battle field medical care has evolved over the year. In this article we discuss evolutions of military medicine, study current protocols and outcomes and discuss future perspectives. Mention is also made of some original work by the author.

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41 year old male, serving air warrior sustained blunt abdominal trauma, CECT revealed grade III splenic injury. He was managed conservatively with good clinical outcome. Conservatism is the new approach to splenic trauma.

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The term neurological nihilism stemmed from the deep seated belief that neurological disease could be diagnosed, but not cured. Today, the scenario has been transformed. Neurophysicians, like cardiologists, are more aggressive at interventions than ever before. The prognosis of victims with neurological ailments has undergone a remarkable transformation.

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War wounds are often associated with devastating losses of tissue and function. Restoration of lost function, Rehabilitation and reintegration into society of the wounded soldier are primary concerns of armed forces doctors. Today, restoration is primarily achieved with prosthetic devices. The day is not far when tissue regeneration techniques supplement bioprosthesis for optimal outcomes. The era of stem cells offers this promise.

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Organising medical supplies for forward troops without compromising their scarce manpower resources is a challenge for medical administrators. We present here our experience in the setting up of a forward medical depot.

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