Neuroendocrine differentiation can be identified in a subset of human breast carcinomas, either as scattered cells or as a predominant neuroendocrine component. Clinically, there are no notable or specific differences in presentation from other type of breast tumors. The diagnosis of neuroendocrine breast carcinoma relies mainly on histopathological examination and immunohistochemistry marker study. Treatment modalities are not different from those for the other conventional types. We report a case of primary neuroendocrine carcinoma of breast with relevant discussion on neuroendocrine tumor.

Background: The most essential component of laparoscopic appendectomy is the closure of appendicular stump. Failure of which can result in catastrophic complications including intra-abdominal and surgical site infections and rarely faecal fistula. The aim of this study was to verify the effectiveness of preformed catgut endoloop and extracorporeal polyglactin 910 for appendicular stump closure.Methods: This prospective study was carried out in 64 patients. We compared patient demographics, duration of surgery, intra and post-operative complications, hospital stay and cost of surgery between the two groups.Results: A total of sixty-four patients were finally included in the analysis, catgut group (n=34), polyglactin 910 group (n=30). The demographics between the two groups were similar. The mean age in catgut group was 23.94 years and polyglactin 910 groups was 23.33 years. Mean duration of surgery was 41.6 and 41.8 minutes in catgut and endoloop group respectively. Mean hospital stay was 3 days. There was no mortality but complications were seen in 6 patients. However, there was no statistical significance in between the two groups with any of the parameters studied.Conclusions: Multiple studies have demonstrated safety and effectiveness of various techniques of appendicular stump. The use of extracorporeal single polyglactin 910 extracorporeal suture knot is safe and cost-effective technique for closure of appendicular stump in rural and resource poor regions.

INTRODUCTIONTotal thyroidectomy is one the most common surgeries performed worldwide. Surgeons prefer a total thyroidectomy to subtotal or Dunhill thyroidectomy. With increase in the number of thyroidectomies, the incidence of post-operative hypocalcaemia has seen a rise as well.1 Risk factors for post-operative hypocalcaemia are older age group, female sex, Grave's disease and inadvertent excision of parathyroid glands. Hormonal risk factors include pre-operative low levels of serum calcium, paratharmone and vitamin D levels. 2,3Deficiency of vitamin D has long been debated as a risk factor for post thyroidectomy hypocalcemia. The advantage of using vitamin D as a predictor for postoperative hypocalcaemia is (i) easy to estimate (ii) any deficiency can be easily corrected. 1,4,5 However, the association between low vitamin D and post-operative hypocalcaemia has not been demonstrated regularly.6-8 METHODSA prospective study which includes patients treated with total thyroidectomy with or without neck dissections. All the patients underwent estimation of serum calcium, serum albumin and vitamin D levels preoperatively. Serum calcium was repeated at the occurrence of symptoms of hypocalcaemia, at post-operative day 3 and at three months. Patients who had persistent hypocalcaemia at the end of three months were excluded from the study. Other exclusion criteria were abnormal serum albumin, patients taking calcium supplements preoperatively and patients with renal diseases. ABSTRACT Background:With increase in the number of thyroidectomies, the incidence of post-operative hypocalcaemia has seen a rise as well. Deficiency of vitamin D has long been debated as a risk factor for post thyroidectomy hypocalcaemia. The advantage of using vitamin D as a predictor for post-operative hypocalcaemia is (i) easy to estimate (ii) any deficiency can be easily corrected. Methods: A prospective study with total of sixty one patients who underwent total thyroidectomy irrespective of the pathology. Serum calcium and vitamin D were investigated preoperatively. Serum calcium was repeated in postoperative period. The association between vitamin D and hypocalcaemia was evaluated using Fischer's exact test. Results: Hypocalcaemia was seen in 14.28% of patients with lower vitamin D levels. When Fischer's exact test was applied, two tailed 'p' value is 0.5195, which is not statistically significant. Conclusions:Though vitamin D estimation can be an easy method in predicting post thyroidectomy hypocalcaemia, our study does not indicate the same.

Spigelian hernia is protrusion of the viscera through the spigelian fascia. They account for only 2% of all abdominal wall hernias and are relatively associated with higher risk of complications. It was first reported by Klinkosch in 1764. The treatment of choice is open hernioplasty. Here we report a case of 65 yrs. old lady who underwent laparoscopic transabdominal underlay repair for spigelian hernia concluding that minimal assess surgery is a viable modality of treatment of spigelian hernia.

Gastrointestinal perforation is a common surgical emergency encountered. Patients with peritonitis are among the most complex patients encountered in surgical practice. Thus there is a need to stratify the various determinants which can help us to plan the treatment strategy. 1 Various studies have accessed the association of various risk factors with the outcome, but either with the single risk factor or an isolated post-operative complication. But there are additional risk factors that influence the outcome. Known since the days of Hippocrates, transmigration of bacteria from the gut causes peritonitis, which may be fatal or cause profound morbidity. Contamination of peritoneal cavity can cause sepsis, multisystem organ failure and death if not treated timely. Objectives: The objectives are to establish an association between various risk factors and the possible outcomes in gastrointestinal perforations either independently or in synergism. The secondary objective was to correlate the results with existing Mannheim peritonitis prognostic index.