Satish Shukla

Jejunal diverticulae: reports of two cases with review of literature.

IntroductionJejunal diverticulosis (JD) is a rare disease of elderly people. Majority of diagnosed individuals are asymptomatic and found incidentally. The disease is clinically significant because of associated potential risk of serious complications. Due to the rarity and variable presentation of this clinical entity, diagnosis is often difficult and delayed, resulting in unnecessary morbidity and mortality. Clinical presentations, signs, diagnosis, complications and treatment of JD are discussed through a review of the literature and report of two cases.MethodsA literature review was done for analysis of diagnosis, treatment and complications of JD. Two cases of JD diagnosed and treated in our institution are also presented.ConclusionJD is a rare disease which has variable presentations and thus poses a challenge to our diagnostic skills. Awareness about complications and presentation of the condition is needed for early detection and avoiding unnecessary mortality.

Surgeon’s-Virtues and Commandments: a Lesson Learnt from a Human Cell

Cell plasma membrane is a protector and controls movement of metabolites and fluids. Organelles (organs of a cell) and nucleus contain all genetic information. Organelles have (1) mitochondria—powerhouse and has its own genetic structure, (2) ribosome—synthesizer of protein, and (3) liposome disposes the garbage. All organs of cell work in coordinated manner to keep it healthy. In case of exhaustion or damage, such organelles redefine its functions and help in its repair to work normally. Do we as physicians understand cell’s basic functions and respect its physiological actions to keep a human body healthy? Its metabolic process is very balanced to keep its functions going and work at different stages of cell physiology including at genome level. The same is true in disease disorders to fight through various metabolic cycles and proteins. Disciplined function of a cell is a lesson to learn to live a disciplined life and keep healthy. Disciplined work of different components in a cell is a lesson to learn, a process continuously going on to keep cell functioning well. Body cell does its best to keep the body healthy, but human factors do not care and develop disorders. Different components work in harmony and help others in their functions when a need arises. Functions are distributed among various components of a cell gets redesigned in case of cellular damage and repair it. This is an example of disciplined work and cooperative responsibility to keep cell healthy. Total process is metabolic in nature. Few genes are also identified in this process of autophagy but act with the help of enzymes and metabolic processes in fighting many disorders. Surgeons are highly qualified and maturated persons doing his medical responsibility without caring for his own health and family care. Disciplined work of different component in a cell is a lesson to learn to discipline his life. He should care for his health as well as of his family members to be happy for better output in his surgical work. Similarly, fulfill your other responsibilities by systematic distribution of work among colleagues and other staff, guide each one for its successful completion and enjoy with credit to everyone. To get more from an individual and more so from a surgeon, many virtues and commandments are necessary to guide his professional work coordinated with social and family relationship to make him a good and successful human being. A surgeon is a part of society. Successful does not mean keeping away from the society. Involve yourself. See other aspects of life and analyse it for better perception and better understanding of others around you. Involve family members and friends to achieve self-satisfaction and fulfillment of your responsibilities. The money you get as a surgeon is always sufficient for good life and should not be the main factor in doing your duties. Do free services through surgical and social organization as a part of your social obligation and responsibility to get self-satisfaction. Surgeon has a unique position in the field of medicine, and as his hands and mind’s coordinated efforts relieve patients’ sufferings, you get all the credit and feeling of achievement and respect from everyone. These virtues of dedicated involvement and caring of a patient with touch of love make him highly respected in the society. Healing touch doctor’s hands are supposed to have healing touch following years of meditated surgical work, medical knowledge with purity of mind and true desire to give * Sumit Shukla drsatishkshukla@gmail.com

Believe in Yourself to Remove Improbable

Oscar Wild said “We need to believe in impossible and remove improbable”. A surgeon always feels that nothing is impossible, and you need a truthful determination and knowledge to back it up. Make it “I am possible” by understanding the reality of patient care where uncertainties always come in your way. Train yourself to deal with all probabilities to achieve your goal and remove the fear of the improbable. The Association of Surgeons of India (ASI) is completing 75 years of its journey to its present position and has seen many ups and downs but stood well above circumstances with head up high. Our mentors have laid a sound foundation with wisdom to promote academics of high standard involving surgeons from all over the world, to give a platform to show our ability to others and learn to improve ourselves fromworld leaders. Many such Speciality Sections are doing excellent work and putting example to teach other nations on newer techniques. A new generation is grooming with high hopes and looking forward to ASI to spread its wings to teach peripheral surgeons and be a part of the system to improve surgical services in order to give better care to our society. It is a government duty to provide such medical care to its citizens, but it cannot do so alone as evident from various reports. ASI should come forward to be a partner and help in implementing various schemes of surgical oriented programmes and improve quality of work. We have members with high devotion and determination. What is needed is to collaborate on the right direction and develop a joint system and promote it with good result. ASI wishes to be a partner with State Chapters and Speciality Sections to guide them and take their help in promoting various workshops, symposiums and teaching programmes at various parts of the country and develop 10 to 15 skill centres. Similarly, arranging education programme of CME, P.G. teaching and focused symposium on practical basis in each state at periphery with local and other resource persons will help to freshen the knowledge and also gain teaching hours for the purposes of the Medical Council of India (MCI). We have talents unparallel in each state, to be identified and involved to teach our young generation and be a part of the ASI responsibility. A high-quality skill centre at Chennai ASI building is our priority. Plenty of space is available, and we are looking for a partner to help us in developing it into a skill course round the year on minimal cost. SAARC cooperates on equal terms to entertain surgeons from our neighbour countries and give a good atmosphere of learning from each other’s resources—to develop a S. K. Shukla (*) LakshmiMemorial Hospital and Research Centre, Near Nehru Nagar Bridge, Indore 452001, India e-mail: drsatishkshukla@gmail.com

Surgery–Passion, Proficiency, Perfection and Profession

Surgery is scientific unfolding of regions, parts of body suffering from disease, ending in its removal or repair to give objective continuity of tissue plain or otherwise for healthy living. It is a passion with glamour, attracts young students studying medicine. Medical students as such are already a motivated group, brilliant, and selected from thousands of aspirants by tough examination. High profile jobs with high payments (IT section and business management) attract good students, still a large number, equally intelligent are attracted to medicine and later to surgical specialities. This group has a vision, dedication and commitment to medicine in spite of long period of education, and very hard training during residency. These students, turned young doctors have passion to fulfill their dream to adopt Surgery as a Career, learning even in late ages with satisfaction. When their friends and contemporary colleagues in other professions are at its top position, Surgeon is busy in perfecting himself to give his 100 %. He is passing through a hard/tough training to come out like gold comingout offlamewithbrightshine,whichglittersinhis/her life through out. This is unparallel motivation to serve society to give the best to relief suffering.

I.J.S.—Vision to Step in Future

I.J.S. journey started in early 1940’s as a Journal to highlight Indian Surgical Scenario and bring Surgeons together to exchange their knowledge to improve Surgical Care and teaching. In 50’s the journal was indexed and one of few recognized Indian Journals in Medical Science but got derecognized due to irregular publication. 70’s and 80’s period saw an era of modern development of Surgical technique in Metropolitan Cities, development of Medical Institutions and Gradual spread of Surgical procedures in two tier cities. ASI membership increased and active participation of young surgeons coming from all parts of the country made it more vibrant academically. ASI represented all speciality of surgical discipline and started speciality sections. ASI annual conference a popular event among members is an academic feast with Surgeons exchanging scientific knowledge and motivation to many to learn advance techniques, management of difficult problems and refresh basic in surgery. More Sections started developing with focused scientific development and raised the standard of scientific deliberations with participation by foreign delegates and invited speakers. Speciality sections/States Chapters became more active with its activities covering peripheral areas involving Surgeons working in primary health centers and remote hospitals. ASI achievement is appreciable to unite Surgeons of all parts of the country and gradual improving surgical care is unprecedented but unnoticed by Government. . In this era of gradual development and spreading wings all over the country to improve surgical care , somehow I.J. S. lost its way and became irregular in its publication, when Dr R.K. Gandhi took its command to improve it. Dr. (Mrs.) Deshmukh took over from Dr. R.K. Gandhi in 1995 and tried to improve with regular publication. Dr. T. Udawadia took as Chairman in 1998 and was also the first elected Chairman/Editor in 2001. He has a vision to take the help of a private publisher and improve it scientifically as publishing journal became a speciality in itself, leaving editing only to the Editorial Board. I am involved with I.J. S. since 1992, as a member of Editorial Board till 2000 and then Joint Editor from 2001 to 2003 and Chairman/Editor 2004 onwards. Journey is long with lots of high tides and turbulences in its smooth running, but Dr. R.K. Gandhi, Dr. (Mrs.) Deshmukh and Dr. Udawadia worked hard to get it published with available sources and contents. Medknow Publications started publication in 2002 and helped IJS to develop systematic working with modern electronic and I.T. techniques developing I.J.S. website working module. It changed the editorial processing dramatically with excess to different parts and smooth timely publication of IJS. This S. Shukla (*) Indian Journal of Surgery, Indore, India e-mail: drsumit_shukla2003@yahoo.co.in

Recognition — IJS indexed in SCI expanded!

Nature is a beautiful creation of God in his own way, blossoms to give colour and fragrance, with wind blowing to enthril everyone and life gets its touch with happiness. Hundred and millions of years has laid the living creatures, developing into different forms and gradually humanity came into existence. Out of all creations/creatures, human life developed with the power of understanding, expression, analysis and reaction. Humans developed the present scenario gradually with two main feelings of competitiveness and recognition. Society is thus striving hard from the basic of survival of the fi ttest to survival to recognition and achieve the best. This holds good in all spheres including scientifi c developments. Medical science is progressing very fast and so also the development in the medical publication. Competitiveness has given quality publication and recognition by Scientist and Scientifi c Associations. Various agencies and houses have come together for this purpose and few are in demand to enhance its image and in turn better quality production. Electronic media has grown many bounds in last decade and so is the case in scientifi c publication to cover wide areas and large target population. This has advanced knowledge effi ciently in no time. Similarly monitoring and guiding facilities have come up to judge the publication and academic qualities of the journal. Institute of Scientifi c Information (ISI) currently known as Thomson scientifi c with the help of their librarians and information scientists have been evaluating journals for the past 75 years. The advent of the ISI citation indexes made it possible to do computer compiled statistical reports not only on the output of journals but also in term of citation frequency, made possible by advanced electronic information system. Thomson scientifi c analyses the datas and invented a system of impact factor of a journal and report is published in their Journal Citation Reports (JCR). Indian Journal of Surgery (IJS) is now a privileged journal indexed with the ISI and been cited in JCR. This is the fi rst big achievement of IJS in indexing process with international organisation beside more than 20 other indexing agencies. It has given an international recognition to IJS and ASI, and an international open fi eld to our surgeons for their work to be RECOGNISED by universal scientifi c fraternity. Why this indexing is important? Is it because we get wide open fi eld to show our academic profi ciency and untouched clinical material? Yes it is true but more so ISI, studies the journal, analyses its data inputs, calculates impact factor and guide regarding its true universal acceptability. The impact factor is directly proportional to number of citation of its author and articles. More the impact factor, more high is the journal grading and more number of scientists and institutions value the journal. It has its own commercial value also in terms of electronically accepted procedure of downloading the articles/journal. This is the beginning of IJS recognition and all of us to work hard to grow better academically, maintain timely publication and emphasis on original and review articles. Many high profi le institutions and associated scientist/ surgeons – known as hot spots and hot authors, in our country, do not subscribe to National Journals because of limited exposure to their achievements and their worldwide recognition. IJS and its board assures everyone to have a national outlook with international vision. IJS is a platform to project yourself. Why not be part of this great journal IJS and be proud of it. Your one contribution will take us way ahead of others and be proud of yourself. Has IJS come up to your expectation? Your answer to this and your critical evaluation will help us in improving the journal. International faculties have approved of its quality and insist on maintaining it and suggests to improve further. You are the one to come forward with your vast academic resources around you, to give it a shape in terms of words and sentences to form an article. IJS will help you to write a good article. What is needed is your desire to write and recognise IJS as universally accepted journal. Springer (India) and its present body Springer (International) of more than 150 years of publishing experience, have people of high knowledge in this fi eld to guide us to take steps further to get RECOGNITION by other indexing agencies also. Right steps in right direction to boost our image are already taken. Time will give our efforts RECOGNITON we deserve. S. Shukla ( ) Retired Professor & HOD Surgery, M.G.M. Medical College & M.Y. & Associated Hospital, Indore, India Director of Lakshmi Memorial Hospital & Research Centre, Indore (M.P.), India Editor/Chairman, Indian Journal of Surgery

Change and challenge.

Change is inevitable and is the only constant feature of our life. It is a law of nature and we have to accept it as a phenomenon that allows us to evolve. Time guides the change and takes it to the height it deserves. Change is a law of nature and many a time, its effect is unnoticed. Human desire is ever growing and so also its passion to do something big and bright. That is what we see every where. 60 years of independence has taken its deep roots in binding the country and understanding each other through nationalism. Our country is progressing and visible change is seen in every sector, not only in the economy but also in the minds of the youth, who are energetic and intelligent, and are enthusiastic to take command. In this 21st century challenges must be treated as chances for the best. Indian Journal of Surgery is being published since more than fi ve decades. Our stalwarts had taken up the enormous challenge of uniting the surgeons of India, develop academically, guide them, and through the journal give a platform to the members to illustrate their work and share their experiences. IJS has seen its ups and downs and carried its duty truthfully to publish articles and encourage surgeons. The last two decades have seen a dramatic development in the medical fi eld such as multi speciality hospitals giving world class care and even gradual increase in medical tourism. Is this not a change with challenge that provides chance to fulfi ll the aspiration of our society? The vibrant era of high skilled activities in all fi eld of medicine has arrived in a great way, and will continue to grow and attract people from other countries and giving valuable care to our own citizen. New research laboratories at various levels have started operating in India dealing with specialized fi elds such as stem cell or pharmokinetics, giving substantial new revelation to the world. This change took only sixty years, because youth has taken the challenge to change the face of the country from poverty to power, and from follower to leader. Research of high quality has started coming from our Institutions. IJS has to come forward to attract those high skilled surgical scientists and give them confi dence that this can be a journal of international standard. We understand that work done by anyone is to be recognized universally, and since we are not indexed in Medical Index System, we loose out on a good number of original and interesting articles to the foreign journals. However, IJS is recognized by more than 20 other international agencies and electronic monitoring sites, and we are continuously working towards achieving universal acceptance through all indexing and abstracting agencies. The efforts are continuing for the past few years and a change is visible in all aspects of IJS, including the published academic material. The numbers of articles were more then 550 in 2006 and has already crossed 300 this year. Quality articles are still less in number, which is a challenge to IJS gaining international acceptance. Our Surgeons should come forward and contribute their best work to IJS. For the change and to accept challenge of time, Association of Surgeons of India and IJS have signed a contract with Springer, a world renowned publishing company of more then 150 years of experience that publishes worldwide through offi ces in various countries, including China, and India. Springer’s aim is to offer excellence and more than 150 Nobel prize-winners have published with Springer to the present date. The company has highly trained professionals working in various fi elds of publication, and would be helping IJS at each step to improve its quality. There are many renowned surgeons and medical professionals associated with Springer, who are helping in the publication of more then 329 medical journals worldwide. IJS will be a part of this larger fraternity, however with its own individuality. We are sure to develop and are accepting the challenge and change for the good of IJS, in its transition to becoming a high quality journal. Springer’s guidance will help us in achieving the goal, and in due course of time, attract high class articles from our colleagues in India, and abroad. Publication of IJS by private publisher was fi rst raised in G.C. of 1994 and later on discussed many times till 1998. A.E. Morgan offered to publish it on the same terms as accepted now by Springer. Dr. S.Vittal, Past President ASI, the then Secretary ASI and myself visited Morgan’s offi ce Indian J. Surg. (August 2007) 69:120–121