It is also important to note here that there is no such thing as an exact cost or true cost because no figure of cost is true in all circumstances and for all purposes. Most of the costing information is based on estimates; for example, the amount of overheads is generally estimated in advance; it is distributed over cost units, again on an estimated basis using different methods. Many items of cost of production are handled in an optional manner which may give different costs for the same product without going against the accepted principles in any way. Depreciation is one such item, the amount of which will vary in accordance with the method of depreciation being used. Thus, to arrive at an absolutely correct cost may be quite difficult unless one waits for a long time by which time the costing information may lose all its value

41 What drugs cause Budd-Chiari syndrome?

42 I recently saw a patient with pyrexia of unknown origin (PUO). He was not particularly unwell and not jaundiced. But 1 week later he was found to have a liver abscess on ultrasound. How can one make the diagnosis earlier?

43 What is the most recent management of HCC (hepatocellular carcinoma)? What is radiofrequency ablation? What is its role in the management of HCC and its prognosis?

44 How do you differentiate haemorrhagic ascitic fluid due to malignancy and accidental rupture of blood vessel while withdrawing the fluid?

45 Is there any place for the medical treatment of gallstones with ursodeoxycholic acid?

46 In a case of common bile duct stones, where it is acknowledged that spontaneous passage within 24 hours is observed in approximately 50% of patients provided the stone is small, and that in these cases there is no need for a sphincterotomy, is the use of antispasmodics, e.g. Buscopan (active ingredient hyoscine-N-butylbromide), recommended? Surely these will reduce the pain and improve the chance of a spontaneous release of obstruction without surgical procedure?

47 What is sphincter of Oddi dysfunction?

48 I would like to know: what is the role of lysosomal hydrolases (cathepsin B) in the pathogenesis of acute pancreatitis?

49 What is the role of octreotide in management of acute pancreatitis?

50 Why does paralytic ileus occur in pancreatitis?