Search

Background Pancreatic cancer is one of the most lethal diseases with an incidence almost equal to the mortality. In addition to having genetic causes, cancer can also be considered an epigenetic disease. DNA methylation is the premier epigenetic modification and patterns of aberrant DNA methylation are recognized to be a common hallmark of human tumor. In the multistage carcinogenesis of pancreas starting from precancerous lesions to pancreatic ductal adenocarcinoma (PDAC), the epigenetic changes play a significant role. Data sources Relevant studies for this review were derived via an extensive literature search in PubMed via using various keywords such as pancreatic ductal adenocarcinoma, precancerous lesions, methylation profile, epigenetic biomarkers that are relevant directly or closely associated with the concerned area of our interest. The literature search was intensively done considering a time frame of 20 years (1998–2018). Result In this review we have highlighted the hypermethylation and hypomethylation of the precancerous PDAC lesions (pancreatic intra-epithelial neoplasia, intraductal papillary mucinous neoplasm, mucinous cystic neoplasm and chronic pancreatitis) and PDAC along with the potential biomarkers. We have also achieved the early epigenetic driver that leads to progression from precancerous lesions to PDAC. A bunch of epigenetic driver genes leads to progression of precancerous lesions to PDAC (ppENK, APC, p14/5/16/17, hMLH1 and MGMT) are also documented. We summarized the importance of these observations in therapeutics and diagnosis of PDAC hence identifying the potential use of epigenetic biomarkers in epigenetic targeted therapy. Epigenetic inactivation occurs by hypermethylation of CpG islands in the promoter regions of tumor suppressor genes. We listed all hyper- and hypomethylation of CpG islands of several genes in PDAC including its precancerous lesions. Conclusions The concept of the review would help to understand their biological effects, and to determine whether they may be successfully combined with other epigenetic drugs. However, we need to continue our research to develop more specific DNA-demethylating agents, which are the targets for hypermethylated CpG methylation sites.

Pancreatic Ductal AdenoCarcinoma (PDAC) is one of the most lethal malignancies of all solid cancers. Precancerous lesions for PDAC include PanIN, IPMNs and MCNs. PDAC has a poor prognosis with a 5-year survival of approximately 6%. Whereas Periampulary AdenoCarcinoma (PAC) having four anatomic subtypes, pancreatic, Common Bile Duct (CBD), ampullary and duodenum shows relative better prognosis. The highest incidence of PDAC has been reported with black with respect to white population. Similarly, incidence rate of PAC also differs with different ethnic populations. Several lifestyle, environmental and occupational exposures including long-term diabetes, obesity, and smoking, have been linked to PDAC, however, for PAC the causal risk factors were poorly described. It is now clear that PDAC and PAC are a multi-stage process resulting from the accumulation of genomic alterations in the somatic DNA of normal cells as well as inherited mutations. Approximately 10% of PDAC have a familial inheritance. Germline mutations in CDKN2A, BRCA2, STK11, PALB2, PRSS1, etc., as well as certain syndromes have been well associated with predisposition to PDAC. KRAS, CDKN2A, TP53 and SMAD4 are the 4 “mountains” (high-frequency driver genes) which have been known to earliest somatic alterations for PDAC while relatively less frequent in PAC. Our understanding of the molecular carcinogenesis has improved in the last few years due to extensive research on PDAC which was not well explored in case of PAC. The genetic alterations that have been identified in PDAC and different subgroups of PAC are important implications for the development of genetic screening test, early diagnosis, and prognostic genetic markers. The present review will provide a brief overview of the incidence and prevalence of PDAC and PAC, mainly, increased risk in India, the several kinds of risk factors associated with the diseases as well as required genetic alterations for disease initiation and progression.

Diabetes insipidus is a disease charaterised by increased urine production and thrist. Neurogenic diabetes insipidus following head trauma,autoimmune disease and infection is quite common but diabetes insipidus following thermal burn injury is a rare complication.We should know about this complication as its management need a comprehensive approach for satisfactory outcome. Thermal burn can cause different complications in early post burn period like electrolyte imbalance, dehydration, acute renal failure, but diabetes insipidus is a very rare and unusual complication that may come across in thermal burn. We should be aware about this condition to prevent and treat mortality and morbidity in burn patients. We have reported a case of transient diabetes insipidus in a patient of thermal burn in early post burn period. Patient was treated accordingly, leading to complete recovery.

A MEMS-based impedance biosensor was designed, fabricated, and tested to effectively detect the presence of bacterial cells including E. coli O157:H7 and Salmonella typhimurium in raw chicken products using detection region made of multiple interdigitated electrode arrays. A positive dielectrophoresis based focusing electrode was used in order to focus and concentrate the bacterial cells at the centerline of the fluidic microchannel and direct them toward the detection microchannel. The biosensor was fabricated using surface micromachining technology on a glass substrate. The results demonstrate that the device can detect Salmonella with concentrations as low as 10 cells/mL in less than 1 h. The device sensitivity was improved by the addition of the focusing electrodes, which increased the signal response by a factor between 6 and 18 times higher than without the use of the focusing electrodes. The biosensor is selective and can detect other types of pathogen by changing the type of the antibody immobilized on the detection electrodes. The device was able to differentiate live from dead bacteria.

This paper reports the design, fabrication, and testing of a microfluidic MEMS biosensor for rapid sensing of low concentration Escherichia coli O157:H7. It consists of a specially designed focusing and sensing region, which enables the biosensor to detect low concentration of bacterial cells. The focusing region consists of a ramped vertical electrode pair made of electroplated gold along with tilted thin film finger pairs (45°) embedded inside a microchannel. The focusing region generates positive dielectrophoresis force, which moves the cells towards the edges of the tilted thin film electrode fingers, located at the center of the microchannel. The fluidic drag force then carries the focused cells to the sensing region, where three interdigitated electrode arrays (IDEAs) with 30, 20, and 10 pairs, respectively, are embedded inside the microchannel. This technique resulted in highly concentrated samples in the sensing region. The sensing IDEAs are functionalized with the anti-E. coli antibody for specific sensing of E. coli 0157:H7. As E. coli binds to the antibody, it results in an impedance change, which is measured across a wide frequency range of 100 Hz–10 MHz. The biosensor was fabricated on a glass substrate using the SU8 epoxy resist to form the microchannel, gold electroplating to form the vertical focusing electrode pair, a thin gold film to form the sensing electrode, the finger electrodes, traces and bonding pads, and polydimethylsiloxane to seal the device. The microfluidic impedance biosensor was tested with various low concentration bacterial samples and was able to detect bacterial concentration, as low as 39 CFU/ml with a total sensing time of 2 h.

Gallbladder carcinoma (GBC) is the most common malignant tumor of the biliary tract throughout the world with marked ethnic and geographical variations. GBC is the highly fatal disease with poor prognosis. GBC appears to develop dysplastic mucosa that progress to carcinoma in situ and then to invasive carcinoma. The incidence of GBC varies geographically with higher rates in certain areas of Latin America (Columbia, Peru and Ecuador), North America (Hispanic and American Indian populations) Eastern Europe (Poland, the Czech Republic, Slovakia, Hungary, and the former East Germany) and Japan. Mapuche Indians of Chile show the highest incidence and mortality of GBC. In India, GBC is more common in women in the North, North-East and East compared to the Southern part, The incidence of GBC is very high in the northern cities like Uttar Pradesh, Bihar, Orissa, West Bengal and Assam (e.g. in Delhi it is 4.5 per 100,000 for men and 10.1 per 100,000 for women) compared with the southern cities (in Chennai, Mumbai, Trivandrum, and Bangalore) incidence is 1.2 per 100,000 for men and 0.9 per 100,000 in women. Cholelithiasis/gallstones are found in 65-90% of patients with GBC. Apart from gallstones and gender biasness, a number of other risk factors favor the development of GBC like obesity, reproductive factors, genetic susceptibility, ethnicity, chronic infections and inflammations and environmental exposures to specific chemicals. Elucidating such risk factors not only provides insight into its pathogenesis accounting for its geographic and ethnic variances, but more importantly should yield strategies to prevent and treat this unusual malignancy.

Introduction: Pancreatic Ductal Adenocarcinoma (PDAC), the most common primary malignant disease of the pancreas and the periampullary region, accounts for about 75% of all nonendocrine tumors arising in this region. It is 4th most lethal malignancies. The 5 year survivability rate is below 5%. At the beginning of the 21st century, the estimated number of PC worldwide was 110,000, with an estimated global mortality rate of 98%. Incidence of periampullary adenocarinoma (PACs) is low, approximately 0.5-2% of all gastrointestinal malignancies and 20% of all tumors of the extrahepatic biliary tree. Aims & Objectives: To identify the somatic single nucleotide variants (SNV’s) in 412 cancer related genes in PDAC & PAC’s. To identify possible altered biological pathways enriched in these cancers. Methodology: DNA samples from Tissue and blood were sequenced for exon sequencing of 412 cancer related genes (NIMBLGNE panel, Custom). Raw fastq files processed using GATK tools and variants identified by Varscan2, & MuTect. Altered pathways identified by KEEG. Result: A total 105 Somatic exonic Single Nucleotide Variants (SNV’s), 9 somatic exonic Indels, 22 LOH mutations (both Indel and SNV’s) were identified in our sample set. Among the candidate genes of PDAC somatic SNV’s were found in TP53, SMAD4 in some patient whereas frequency of KRAS mutation was less frequent. Fourteen SNV’s were reported in cosmic database which includes 5 pathogenic variants, whereas 91 SNV’s were novel. A total 75 non-synonymous, 6 stopgain, and 24 synonymous SNV’s were observed among 105 SNV’s. Fifty eight percent of transversion and 52% of transition observed from all SNVs. Among all transversion fifty five percent SNV’s were C>T, G>T. PI3-Akt, Proteoglycans in cancer, Transcription misregulation, Rap1, ErbB, Neurotrophin pathways were found to be most commonly enriched in our patient population. Our data strongly suggest PI3-Akt, Proteoglycans in cancer pathways play a critical role in the disease. Conclusion: This study implicates a landscape of somatic SNV’s in PDAC’s and PAC’s and alteration of biological pathways in our patient population. We also observeed ERBB2 and KMT2C genes are predominantly alerted in PDAC’s and PAC’s. P53, KRAS and SMAD4 are the known mutated genes contributes very similar mutational pattern. Citation Format: Nilabja Sikdar, Gourab Saha, Richa Singh, Dhiraj Anchlia, Paromita Roy, Supriyo Ghatak, Sudeep Banerjee, Sumit Gulati, Shibajyoti Ghosh. Somatic genomic alteration of 412 cancer-targeted genes of periampullary and pancreatic ductal adenocarcinoma in Indian patient population [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4395. doi:10.1158/1538-7445.AM2017-4395

Penetrating trauma to neck resulting in arteriovenous (AV) fistula and aneurysms involving the carotid system are uncommon injuries with life-threatening consequences. We report here a case of a young factory worker who developed a traumatic AV fistula with false aneurysm, with however, no other complications. He was successfully operated when he presented to us two months after the injury and is doing well in follow-up.

Plexiform angiomyxoid myofibroblastic tumour (PAMT) has recently emerged as a new entity among gastrointestinal mesenchymal tumours. All of the 27 cases reported until now originated from the stomach. We report the first case of a duodenal PAMT arising from the first part of the duodenum in a 19-year-old woman presenting with upper abdominal pain and an abdominal lump.

Background: The purpose of this study was to examine the feasibility of single-stage resection and anastomosis for acute left-sided colonic obstruction due to acute sigmoid volvulus without intraoperative lavage. Mechanical bowel preparation has been shown to be unnecessary for elective colorectal surgery. Colonic decompression without intraoperative lavage may simplify operations in acute left-sided colorectal obstruction. Methods: Emergency resection of acute sigmoid volvulus was performed. This was followed by primary anastomosis without on-table lavage after closed bowel decompression. Results: A total of 197 patients underwent bowel decompression, resection and primary colonic anastomosis. Two patients developed anastomosis leak, requiring re-laparotomy, Hartmann's procedure and delayed closure. Two deaths occurred postoperatively; these were unrelated to the nature of the surgery. The mean hospital stay was 9.8 days. Conclusion: Primary colonic anastomosis can be safely done for obstructed left colon due to acute sigmoid volvulus without intraoperative colonic lavage.

We report a rare case of a primary adrenal cortical malignancy presenting with spontaneous retroperitoneal haemorrhage in a young adult. To the best of our knowledge, this is the thirteenth such case to be reported in the English literature.

Feeding jejunostomy is a procedure of tremendous importance in our day-to-day practice of gastrointestinal surgery. Like any other surgical procedure, it is also associated with some common complications such as pain, infection, intra peritoneal leakage, dislodgment, strangulation, and small bowel necrosis. Small bowel intussusception is a complication of feeding jejunostomy, which is very rare and unique. We report the case of a 30-year-old female who presented with small bowel intussusceptions following feeding jejunostomy.

To study the feasibility of acute appendicectomy in patients with an appendicular mass.Department of Surgery, Bankura Sammalani Medical College (BSMCH), Bankura, West Bengal, India.From January 1998 to May 2001. 87 patients were diagnosed and operated for appendix mass within 24 h of admission. None of the patients had any associated complications.A McBurney's incision with Rutherford-Morrison extension was made in most patients.48 patients presented with a classical appendix mass. 25 patients (28.7%) had classical features of appendix abscess, and in 14 (16.1%) a loculated collection of pus (10 to 50 ml) was found. Operative time ranged from 45 to 90 min (mean 65). Pathologic evidence of appendicitis was present in all patients. 71 patients were discharged on the seventh postoperative day. 15 patients developed minor wound infection. One patient developed band obstruction, which subsided spontaneously on conservative treatment. Rest of the patients are doing well.Low morbidity, reduced hospital stay, low cost and patient compliance favour operative management of appendicular mass by experienced surgeons thus obviating the old practice of conservative treatment followed by interval appendicectomy.