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Bombay experienced a violent outbreak of communal rioting in January 1993. Four hundred and thirteen casualties were treated in the KEM hospital from January 7 to January 15, of which 194 required admission and further management. Twenty-seven were brought dead on arrival. The large influx of casualties sustained over a period of 9 days tended to overwhelm the medical facilities. The data of the admitted patients are analyzed to identify the frequency of admissions, cause and nature of injuries sustained, management and prognosis of casualties in such a catastrophe. An attempt is also made to identify the problems faced during such a crisis and a few suggestions made for their solution.

On 13th March 1993 consequent to a series of explosions in the city a large number of casualties were attended to at this hospital. A total of 248 patients were treated for various injuries which included 85 minor and 34 major operations. Seventy-nine patients were brought in "dead on arrival". There were 12 deaths after admission out of which 6 patients died after surgery. The cause of death was hemorrhagic shock in 5 patients, burns in 2, severe head injury in 2, and shock lung in 3 patients.

The fine needle aspiration cytology (FNAC) and ultrasound radiologic features of a solitary retroperitoneal angiofollicular lymph node hyperplasia (AFLNH), hyaline vascular type are described. Based on a combination of the two, this diagnosis can be suggested in the differential diagnosis of a retroperitoneal mass.

Classical Freyer′s method was modified in which, prostatic fossa was packed after the enucleation of the gland for hemostatic purpose; and the pack and suprapubic drain were brought out laterally. The pack was removed after 48-72 hours postoperatively and catheter was introduced per urethrum for early closure of suprapubic ostomy. Fifty such cases of Modified Freyer′s prostatectomy were compared with cases of classical Freyer′s prostatectomy (n = 25) and Millin′s prostatectomy (n = 25). The duration of surgery and requirements for perioperative blood transfusion were found to be less with our method.

Pneumatic dilatation is one of the more recent methods in the management of achalasia cardia. Fifty dilatations were done in 42 patients with achalasia cardia over 5 years. There was a significant decrease in the maximum diameter of the oesophagus and a significant increase in diameter in the narrowed lower oesophageal segment in all the patients. Of the patients studied, 95.23% were relieved of their symptoms after only one to two sessions. There were no immediate complications. Out of the 38 patients on long term follow up, 8 (21.05%) had recurrence of symptoms. On repeat dilatations, 4 (50%) of them had good response. Late complication like reflux oesophagitis was observed in only 1 patient over a median follow up period of 22 months. It was thus concluded that pneumatic dilatation is a safe, simple and effective procedure in managing patients with achalasia cardia.

A case of suspected chronic cholecystitis who underwent laparotomy, was found to have agenesis of gall bladder. Standard investigative modalities which are done for chronic cholecystitis might be fallacious and baffling. Agenesis of gall bladder should be kept in mind whenever the gall bladder is improperly visualised in routine imaging methods.

Stress is known to depress the immune system severely. This study was done to evaluate whether surgical stress influenced polymorphonuclear (PMN) and monocyte functions in association with serum cortisol and the anxiety score as measured on the HARS Rating Scale. We found that surgery (irrespective of whether it was major or minor) significantly depressed PMN and monocyte functions and increased serum cortisol levels. PMN phagocytosis correlated significantly (p < 0.05) with the rise in serum cortisol. In spite of these changes, postoperative clinical recovery was uneventful. No major alterations in the HARS scores were noted pre and post operatively. This study demonstrates that surgical stress depresses the immune system with a concomitant rise in cortisol.

Thyroid abscess arising from Acute Suppurative Thyroiditis (AST) is a rare clinical disorder. The ability of the thyroid gland to resist infection is well known and infection in the thyroid gland is rare, particularly so with the advent of widespread usage of antibiotics. An internal pharyngeal fistula (Pyriform sinus fistula) is the most common underlying abnormality in patients with AST. We report a case of an adult male who presented with a thyroid abscess. The causal organism was found to be Staphylococcus aureus. Intravenous antibiotics and, incision and drainage of the abscess led to an uncomplicated recovery.

334 consecutive cases of thyroid swellings operated by a single surgical unit over 9 years have been analysed prospectively. There was a female preponderence (4.39:1). The swellings were clinically differentiated into uninodular (39.52%), multinodular (47.31%) and diffuse (13.17%). Hyperthyroidism was manifested in 49 cases (14.67%). Pressure symptoms were present in only 1.5% cases. FNAC detected malignancy in 14 of 162 cases (8.64%). The initial 100 cases were operated upon by standard Lahey′s technique and the latter 234 by modified technique described by Bapat et al for benign thyroid disease. Operations performed included nodulectomies (5.39%), hemithyroidectomies (41.92%), partial thyroidectomies (25.75%), subtotal (25.45%) and near total thyroidectomies (1.5%). Post-operative complications were higher in the first group and included unilateral cord palsies-5 (5%). hypocalcemia-4 (4%) hypoparathyroidism-1 (1%) haemorrhage-1 (1%) and mortality-1 (1%) vis a vis cord palsies-2 (0.85%), hypocalcemia-3 (1.28%), hypoparathyroidism-1 (0.43%) and there was no mortality. Histopathology revealed 83 (24.85%) colloid goiters, 193 (57.78%) nodular goiters, 21 (6.29%) follicular adenomas, 7 (2.10%) cases of thyroiditis and 30 (8.98%) malignancies. This study reveals the lower incidence of RLN palsy after modified thyroidectomies, and a low incidence of malignancy.

We consider the two-person zero-sum game in which the strategy sets for Players I and II consist of the vertices and the edges of a directed graph respectively.If Player I chooses vertex v and Player II chooses edge e; then the payoff is zero if v and e are not incident and otherwise it is 1 or _1 according as e originates or terminates at v: We obtain an explicit expression for the value of this game and describe the structure of optimal strategies.A similar problem is considered for undirected graphs and it is shown to be related to the theory of 2-matchings in graphs.