Background: Peptic perforation is an emergency and requires urgent surgical treatment. Many modalities of treatment are available ranging from conservative treatment to laparoscopic repair. There is no consensus on treatment of perforated pylorodudenal ulcer which can be treated with conservative treatment, simple closure of ulcer, closure of ulcer with free omentum, closure of perforation with use of pedicled omentum, definitive treatment with truncal vagotomy and drainage procedures or parietal cell vagotomy. However best treatment is still to be decided.Methods: This study was conducted in department of surgery 60 patients presenting with peptic perforation in last three years. All patients with duodenal perforation in first part (D1) were included in the study. Pyloric perforations, multiple perforations, traumatic perforations and severe co-morbid condition were excluded from study. A pedicled omentum was used in the repair of duodenal perforation. Immediate and late postoperative complications were recorded. The patients were followed for three months.Results: Out of 60 cases there were 50 male patients and 10 female patients. The majority of male patients were in the middle age group between 35 to 45 years of age and the female patients were of older age group between 40 to 65 years of age. These patients presented with history of acute pain abdomen in the epigastric region. All the patients underwent modified Graham’s patch repair. In postoperative period, two patients had burst abdomen on fourth postoperative day. Biliary fistula formation occurred in 2 patients. Wound infection occurred in 4 patients and the hospital stay was 5 to 9 days. There was no mortality recorded in this series.Conclusions: In summary, the surgery for perforated peptic ulcer should use modified Graham’s repair using pedicled omentum giving excellent results in terms of healing, morbidity and mortality.

Background: Epididymal cysts are common in teenagers and young adults. They can present as unilocular or multilocular swelling. These cysts are generally present on one side but can be bilateral. Small epididymal cyst are asymptomatic but are detected on ultrasound examination of scrotum. This study was done with aim of treating epididymal cyst with different modalities based on size of the epididymal cyst. Methods: A total of 124 patients of epididymal cyst were included in this study. Scrotal ultrasonography was done in these patients. The clinical presentations of these patients were asymptomatic detected on ultrasound, orchialgia, scrotal swelling and physical examination. Based on the size of epididymal cyst patients were divided into three groups. The treatment modalities used these were natural involution, aspiration, aspiration and sclerosing agent and surgical excision. Results: The group I consisted of cyst size less than 10mm having 73 patients. The group II consisted of patients with cyst size 11-20mm having 39 patients; and group III patients were with cyst size 21-50mm having 12 patients. Natural involution was most effective treatment modality in group I and group II. Aspiration was the second was most effective. Only a few patients required aspiration and sclerosing agent. Surgical excision was done in majority of group III patients and failed aspiration in group II. Conclusions:The results of present study show that asymptomatic and small epididymal cyst can be cured by natural regression in 77.42%. The cysts 11 to 20mm are amenable to aspiration alone, only a few need repeat aspiration and instillation of a sclerosing agent. These conservative approaches save the cost. Excision should be reserved for very large cysts and in which conservative approach fails.

We construct a stress p53-Mdm2-p300-HDAC1 regulatory network that is activated and stabilised by two regulatory proteins, p300 and HDAC1. Different activation levels of observed due to these regulators during stress condition have been investigated using a deterministic as well as a stochastic approach to understand how the cell responds during stress conditions. We found that these regulators help in adjusting p53 to different conditions as identified by various oscillatory states, namely fixed point oscillations, damped oscillations and sustain oscillations. On assessing the impact of p300 on p53-Mdm2 network we identified three states: first stabilised or normal condition where the impact of p300 is negligible, second an interim region where p53 is activated due to interaction between p53 and p300, and finally the third regime where excess of p300 leads to cell stress condition. Similarly evaluation of HDAC1 on our model led to identification of the above three distinct states. Also we observe that noise in stochastic cellular system helps to reach each oscillatory state quicker than those in deterministic case. The constructed model validated different experimental findings qualitatively.

Pancreatic ductal adenocarcinomas are characterized by a complex and robust tumor microenvironment (TME) consisting of fibrotic tissue, excessive levels of hyaluronan (HA), and immune cells. We utilized quantitative multi-parametric magnetic resonance imaging (mp-MRI) methods at 14 Tesla in a genetically engineered KPC (KrasLSL-G12D/+, Trp53LSL-R172H/+, Cre) mouse model to assess the complex TME in advanced stages of tumor development. The whole tumor, excluding cystic areas, was selected as the region of interest for data analysis and subsequent statistical analysis. Pearson correlation was used for statistical inference. There was a significant correlation between tumor volume and T2 (r = −0.66), magnetization transfer ratio (MTR) (r = 0.60), apparent diffusion coefficient (ADC) (r = 0.48), and Glycosaminoglycan-chemical exchange saturation transfer (GagCEST) (r = 0.51). A subset of mice was randomly selected for histological analysis. There were positive correlations between tumor volume and fibrosis (0.92), and HA (r = 0.76); GagCEST and HA (r = 0.81); and MTR and CD31 (r = 0.48). We found a negative correlation between ADC low-b (perfusion) and Ki67 (r = −0.82). Strong correlations between mp-MRI and histology results suggest that mp-MRI can be used as a non-invasive tool to monitor the tumor microenvironment.

Background: The liver is the most common solid viscera injured in motor vehicle accidents. Advances in radiological diagnostic techniques and critical care have increasing trend towards the nonoperative management. Still operative management is needed if there is continuous bleed or haemodynamic instability. The omentum commonly known as policeman of abdomen as it reaches intra-abdominal injury site. It is known to adhere to the site of injury and seals it. It increases the vascularity and starts neoangiogenesis. This produces haemostasis and promotes wound healing.Methods: In this study 24 patients were managed by this technique of pedicled omentoplasty. These patients were in the age group of 22 to 42 years. There was male dominance, 22 patients were males (91.7%) while only 2 patients were females (8.3%). The use of omentum in packing is described here. The omentum is converted to a pedicled flap based on right omental artery by tailoring it. The active bleeding vessels can be ligated. The whole length of pedicled omentum is packed in liver cavity. Using liver sutures two or more sutures are applied for stabilization.Results: On exploration, the hepatic injury was assigned grade as per AAST liver injury scale. Out of 24 patients included in this study; two (8.33%) were grade I patients, three (12.5%) were grade II patients, nine (37.5%) were grade III patients and ten (41.67%) were grade IV patients. Patients with grade V and grade VI were dealt by perihepatic packing as damage control surgery were excluded from this study.Conclusions: Pedicled omentoplasty in blunt hepatic trauma can be used irrespective of the grade of liver injury. It should be used in combination with other procedures like debridement, segmental or unsegmental resection, control of active bleeding vessels, use of Pringles manoeuvre, selective hepatic artery ligation and even with deep mattress suturing. This helps in haemostasis, early healing and rapid recovery with minimum complications.