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Invasive breast carcinoma is the most common cancer among women worldwide. Increase in early detection of breast carcinoma by different diagnostic modalities led to decrease in cancer-related mortality and morbidity. Multiple factors and genes are implicated in breast cancer pathogenesis. Cyclin D1 is an important cell cycle regulatory protein involved in carcinogenesis of various human cancers including breast cancer. Aims of the present study were to evaluate the prognostic importance of cyclin D1 expression in invasive breast carcinoma and its correlation with other prognostic and predictive factors. Patients undergoing mastectomy for breast carcinoma were selected from January 2016 to June 2017 in a tertiary care hospital. Clinical history including demographic parameters was collected in the study pro forma. Immunohistochemical staining for ER, PgR, HER2 and cyclin D1 was performed on all cases. The clinicopathological parameters like age, tumour size, histologic grade, histological type, lymphovascular invasion, axillary lymph node metastasis, ER, PgR and HER2 status were compared and correlated with cyclin D1 expression. Cyclin D1 expression found in 60% cases of breast carcinoma. Expression of cyclin D1 showed a highly significant correlation with histological grade (p = 0.000). Cyclin D1 expression showed significant correlation (p = 0.000) with molecular subtypes. There was also significant correlation between cyclin D1 expression and ER (p = 0.000) and PgR (p = 0.010) status. This study revealed significant cyclin D1 expression in low grade, well-differentiated breast cancer. Therefore, we found cyclin D1 as a favourable prognostic marker in breast carcinoma.

Background: Cytological grading is a useful tool for selection of therapy and prognosis in breast carcinoma. Despite having many cytological grading systems, there is still no agreement among pathologists to accept one of them as a gold standard. Aim: This study was undertaken to evaluate six such three-tier cytological grading systems to determine which system corresponds best to histological grading done by Nottingham modification of Scarff Bloom Richardson (SBR)'s method. Materials and Methods: In a double-blind study, preoperative cytological grades obtained by six systems on fine-needle aspiration cytology (FNAC) smears were compared by testing concordance, association and correlation with histological grade derived postoperatively by the SBR's method in 57 patients of breast carcinoma. Bivariate correlation studies and multiple linear regressions were done to assess the significance of the different cytological parameters to predict final cytological grades. Results: Robinson's system demonstrated the best correlation (ρ = 0.799; P = 0.000 and τ = 0.765; P = 0.000), maximum percent agreement (77.19%) and a substantial kappa value of agreement (κ = 0.62) with the SBR's grading system. All the six cytological grading systems correlated with histological grading strongly and positively. In multiple regression analysis, all of the cytological parameters of Robinson's system except cell size and nucleoli had significance in predicting the final cytological grade. Conclusions: Robinson's grading system is simple, more objective and reproducible, and demonstrated the best concordance with histological grading. So, Robinson's system should be used routinely for breast carcinoma aspirates.

Inflammatory myofibroblastic tumor (IMT) is a rare neoplastic lesion with tendency toward local aggressive behavior and recurrence. It is primarily a visceral and soft tissue tumor; however, involvement of pancreas is extremely unusual. A localization in the pancreas needs differentiation from other tumors and chronic pancreatitis. We report a case of inflammatory myofibroblastic tumor arising in pancreatic head in a 32-year-old female who underwent Whipple's procedure.

Feeding jejunostomy a good way to deliver enteral nutrition in a number of conditions with a very low complication rate and very cost-effective way to deliver nutrition in our part of country where PEG is not widely available. FJ is commonly done with Foley’s catheter, Ryle’s tube, T-tube. In some situations (clogging/expulsion), we have to change the tube through the mature tract. But, it is upmost important that proper lubrication of the tube & gentle attempt should be made and excessive thrust must not be made. Any difficulty while introduction should be thoroughly evaluated. Here we present a rare complication of FJ tube reinsertion leading to jejunal perforation. Keywords: FJ complication, Jejunal perforation, Iatrogenic perforation

Background: Hepatic arterial pseudoaneurysm with hemobilia occurs less frequently as a complication of open cholecystectomy than laparoscopic cholecystectomy; however, given its severe nature, it needs to be managed promptly. Patient should be evaluated with high index of suspicion, presenting with post cholecystectomy pain with jaundice. They should be treated with angiographic coil embolization of hepatic arteries as a first line management, which is successful in the majority of bleedings: in a minority of cases, even a laparotomy is needed. However, proper use of electrocautery may decrease the occurane of psedoaneurysm. Case Presentation: Here we present a case history of a 50 years old female presenting with massive hematochezia & jaundice with hemodynamic instability, 3 months following open cholecystectomy due to leaking pseudoanurysm from right hepatic artert & treated successfully with angiographic coil embolisation.

Introduction: Surgeon's case volume,hospital volume and specialisation improve the outcome of many major surgical procedures gastrectomy, esophagectomy and rectal surgery. The exact role of specialist centers in more common surgical operations like inguinal hernioplasties and varicose vein, is still not so clear. Hernioplasty done by a resident may allow consultant to concentrate on major critical cases. In this study we analysed whether well-trained surgical residents are able to perform Lichtenstein operation with an acceptable immediate and long-term outcome compared to the experienced specialist consultants in hernia surgery. Materials and Methods: Patients were subjected randomly to lichenstein mesh hernioplasty by well trained residents (after assisting 10 operation with consultant) and consultants. Parameters were noted during operation and in follow up accordingly. Hernioplasty done by experienced consultant surgeon (n=51) and by residents (n=53). Results: The mean operating time taken by the residents (66 ± 10 minutes) was significantly higher than that of the consultant surgeons (49 ± 10 minutes). The post-operative infection rates in the current study for surgeries done by residents and consultants were 7.7% and 3.9%, respectively. The occurrence of post-operative wound hematoma, scrotal oedema and hospital stay,resumption to normal activity was not significantly different (P>0.05) between patients operated by residents and consultants. Severity of post-operative pain (based on VAS scores) was also not significantly different (P>0.05) between patients operated by consultants and those operated by residents. Only 1 patient (1%) had recurrence of hernia after 6 months following hernia repair. Conclusion: Open mesh repair under local anaesthesia was a safe operation and the long-term results were acceptable among the patients operated by surgical trainees. There was no statistcally significant difference in the occurrence of post-operative complications except for increased operative time.

Inspite of the tremendous improvement in early diagnosis and treatment of gallstones patients still present with spontaneous cholecystocutaneous fistula. With the introduction of widespread use of ultrasonography for diagnosis & laparoscopic cholecystectomy, it has now become a rare complication. Over the past 50 years fewer than 20 cases has been reported. We report here, a case presenting with discharging opening in anterior abdominal wall with intermittent expulsion of stones.