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Lipomas of the large intestine are uncommon tumour. They are often innocuous and do not cause any clinical problem, particularly if they are small (

Background Heller myotomy (HM) with partial fundoplication is the standard of care for achalasia cardia. However, the choice of partial fundoplication is controversial. In this study, we compared both types of fundoplication concerning subjective and objective parameters. Methodology This prospective comparative study comprised a total of 30 consecutive patients who underwent laparoscopic/robotic HM with either Dor fundoplication (DF) (n = 15) or Toupet fundoplication (TF) (n = 15). Preoperative baseline characteristics, intraoperative details, and postoperative complications were recorded. Patients were followed with Eckardt score, quality of life-related scores, 24-hour pH study, and high-resolution manometry (HRM) at the one-year follow-up. Results There was no significant difference between the two groups regarding preoperative baseline parameters, length of hospital stay, and postoperative complications. The HM+DF group had four (27%) patients with recurrence/failure with none in the HM+TF, but it was not significant (p = 0.79). Symptom scores were similar between the groups at six and 12 months of follow-up. One patient in the HM+DF group and two in the HM+TF group had significant pathological acid reflux (p = 0.483). On HRM, HM+TF showed a trend toward significance in terms of esophagogastric junction (EGJ) relaxation (p = 0.058) with a non-significant difference in median integrated relaxation pressure (p = 0.081). Conclusions The study showed a trend toward lower failure rates and improved EGJ relaxation with similar reflux rates in patients who underwent HM+TF compared to HM+DF. However, long-term follow-up is required to validate our findings with well-defined subjective and objective criteria.

The purpose of the study was to investigate the incidence of pancreatic contour variations on multidetector CT (MDCT) for abdominal examinations. A retrospective analysis of 700 MDCT scans was performed in patients who underwent triple phase CT abdomen between October 2018 and January 2021. After excluding 176 patients, finally total of 524 patients were included in the study. For simplification, we classified the pancreatic contour variations as classified by Ross et al. and Omeri et al. Pancreatic head–neck variations was classified into Type I-anterior, Type II-posterior and Type III-horizontal variety. Pancreatic body–tail variation was divided into Type Ia-anterior projection; Ib-posterior projection and Type IIa-globular, IIb-lobulated, IIc-tapered, and IId-bifid pancreatic tail. The most common type of variation in the head was Type II (n = 112, 21.3%) followed by Type III (n = 37, 7%) and Type I (n = 21, 4%). The most common type of variation in the body of pancreas was Type Ia (n = 33, 6.2%) followed by Type Ib (n = 13, 2.4%). In the tail region of pancreas, the most common variation was Type IIb (n = 21, 4%) followed by Type IIa (n = 19, 3.6%). Pancreatic contour variations are not very uncommon in daily practice. Knowledge of these variations is important for surgeons, radiologists and avoids misjudgement of normal pancreatic tissue as tumor or lymph node especially on unenhanced or single phase MDCT.

Chylothorax, although an uncommon complication of esophagectomy, is associated with high morbidity and mortality if not treated promptly. Consequently, knowledge of the thoracic duct (TD) anatomy is essential to prevent its inadvertent injury during surgery. If the TD is injured, early diagnosis and immediate intervention are of paramount importance; however, there is still no universal consensus about the management of post-operative chylothorax. With increasing advances in the spheres of interventional radiology and minimally invasive surgery, there are now several options for managing TD injury. We review this topic in detail to provide a comprehensive and practical overview to help surgeons manage this challenging complication. In particular, we discuss an appropriate step-up approach to prevent the morbidity associated with open surgery as well as the metabolic, nutritional, and immunological disorders that accompany a prolonged illness.

Leptospirosis is the most emerging zoonotic disease of epidemic potential caused by pathogenic species of Leptospira. The bacterium invades the host system and causes the disease by interacting with the host proteins. Analyzing these pathogen-host protein interactions (PHPIs) may provide deeper insight into the disease pathogenesis. For this analysis, inter-species as well as intra-species protein interactions networks of Leptospira interrogans and human were constructed and investigated. The topological analyses of these networks showed lesser connectivity in inter-species network than intra-species, indicating the perturbed nature of the inter-species network. Hence, it can be one of the reasons behind the disease development. A total of 35 out of 586 PHPIs were identified as key interactions based on their sub-cellular localization. Two outer membrane proteins (GpsA and MetXA) and two periplasmic proteins (Flab and GlyA) participating in PHPIs were found conserved in all pathogenic, intermediate and saprophytic spp. of Leptospira. Furthermore, the bacterial membrane proteins involved in PHPIs were found playing major roles in disruption of the immune systems and metabolic processes within host and thereby causing infectious disease. Thus, the present results signify that the membrane proteins participating in such interactions hold potential to serve as effective immunotherapeutic candidates for vaccine development.

Gall bladder tuberculosis (GB TB) is a very rare disease and scarce data is available on exact incidence and clinicopathogenesis even in endemic areas. The aim is to provide an insight into epidemiology, pathophysiology and management for better understanding of gall bladder tuberculosis. We collected data available from the literature on all histologically proven gall bladder tuberculosis. Case reports with either no article or only abstracts were available excluded from the study. Fifty two case reports and series with total 73 patients were included in this study. Mean age of patients was 48 years (Range 8–86 years) with male: female ratio of 1:1.7. 53 (73%) patient had isolated disease and 18 (24%) had associated abdominal tuberculosis. 3 (4%) of patients had concomitant and 7 (9%) had past history of pulmonary tuberculosis. 39 patients presented as cholecystitis and 25 as gall bladder mass. 44 (60%) patients had gall stones and majority of them (56%) are multiple. Granuloma and caseous necrosis was found in 80% & 60% of patients respectively. In conclusion, Gall bladder tuberculosis is a very uncommon presentation of abdominal tuberculosis. Pre-operative diagnosis is not possible due to lack of specific diagnostic test so increase in awareness and a high index of suspicious is required.

Background Though preoperative biliary drainage (PBD) has been suggested to be linked with increased perioperative morbidity it is still practiced commonly. We studied the association of PBD and positive biliary culture with surgical site infection and also analysed the common pathogens and their antibiotic sensitivity spectrum. Methods Prospectively maintained data of patients who underwent various pancreatobiliary surgeries from 2017 to 2019 was analysed. Patients whose intraoperative bile culture reports were available were included in the study. Various factors associated with surgical site infection (SSI), microbial spectrum of bile culture and their sensitivity pattern were analysed. Results Out of 68 patients whose bile culture report were available, PBD was done in 65% (n = 44). Among patients with infected bile (n = 51), biliary stent was present in 78.4% (n = 40). On univariate analysis, the factors associated with SSI were low albumin level ( 6 h), duration of abdominal drain (>4 days), length of hospital stay, intraoperative bile spillage and infected bile. However, on multivariate analysis, only presence of drain for >4 days (p = 0.04) and positive bile culture (p = 0.02) was linked with increased risk of SSI. Most common organism isolated was E coli (73.2%), with 100% sensitivity to Colistin and Tigecycline shown by gram negative isolates. Conclusion Preoperative biliary stenting alone did not increase the risk of SSI, but the positive bile culture correlated with SSI irrespective of PBD. Most biliary pathogens were resistant to commonly used antibiotics and intraoperative bile culture will aid in providing appropriate antibiotic coverage.

Oesophageal injury following blunt or penetrating injury due to road traffic accidents is a rare cause of morbidity and mortality. The outcome of delayed diagnosis of oesophageal injury is mostly life threatening conditions. A 23-year-old female presented with respiratory distress, fever, chest pain and facial deformity, following road traffic accident 15 days back. After evaluation, the patient was diagnosed with septicaemia due to large thoracic oesophageal perforation with left pyothorax. The patient was managed by Video Assisted Thoracoscopic Surgery (VATS) decortication with feeding jejunostomy followed by diversion cervical oesophagostomy. The patient was planned for oesophageal reconstructive surgery electively in follow-up period. After six weeks in the follow-up period, surprisingly large thoracic oesophagus perforation and cervical oesophagostomy was healed spontaneously which was confirmed by gastrograffin study. Spontaneous closure of large thoracic oesophageal perforation is the rare outcome of this injury.

Endoscopic retrograde cholangiography related duodenal perforation is an infrequent complication and associated with significant morbidity. The management of such perforations, especially in the setting of malignancy, is not standardized given the paucity of literature. We encountered a patient who was diagnosed with periampullary carcinoma and had a perforation in the duodenum during endoscopy. Emergency pancreatoduodenectomy (EPD) was performed considering it to be a resectable disease with minimal contamination. He had a prolonged hospital course due to surgical site infection and hepaticojejunostomy leak, however, which was managed successfully. At one year follow up, he is healthy with no evidence of recurrence. We conclude that EPD can be attempted for selected iatrogenic duodenal perforations with co-existent resectable malignancy in a stable patient. It may help to avoid the morbidity of a second surgery in the setting of a distorted anatomy and simultaneously preventing the probable upstaging of disease due to peritoneal seedling.

Postcholecystectomy duodenal injuries are very rare complications. Early surgical intervention is a common practice due to its fatal consequences. Most of the patients with post laparoscopic cholecystectomy duodenal injury reported in literature have been successfully managed by early surgical repair. We present here a case of a 32-year-old female who underwent open cholecystectomy and had an injury in the second part of the duodenum. She was subsequently managed conservatively.

Inferior vena cava (IVC) and azygos vein anomaly is very rare. Available case studies report difficult esophagectomy in patients with esophageal carcinoma with IVC anomaly. Minimally invasive esophagectomy with preservation of the azygos vein in such patients is technically challenging. We report a case of a 44-year-old woman diagnosed with middle thoracic esophageal carcinoma with double IVC and dilated azygos vein. Thus minimally invasive surgery is feasible in such patients but requires high technical skills and ample experience to carry out this kind of surgery, and it should only be attempted by a multidisciplinary team.

Isolated gallbladder tuberculosis is a rare entity, even in endemic zones. Preoperative diagnosis is usually not possible, with most of the cases being diagnosed either as cholecystitis or malignancy. Histopathological examination of the resected specimen clinches the diagnosis. We present a middle-aged man with obstructive jaundice who was diagnosed to have gallbladder malignancy clinically and radiologically and on microscopy, and was diagnosed as gallbladder tuberculosis with the involvement of the common bile duct.

Corrosive-induced stricture of the digestive tract is a dreaded complication following corrosive ingestion. When surgical reconstruction is needed, esophagectomy helps to avoid the long-term complications related to leaving behind the scarred native esophagus. We tried to ascertain the feasibility and safety of a thoracolaparoscopic-assisted esophagectomy in such a setting. A 32-year-old male presented with corrosive-induced esophageal stricture that lead to progressive dysphagia not amenable for endoscopic dilatation. Thoracoscopic approach was used for mobilization of the scarred esophagus under vision. Laparoscopic approach was used in mobilizing the stomach and creating a conduit. Esophagogastric anastomosis was performed in the neck. The patient had an uneventful recovery postoperatively and was discharged after six days on a semisolid diet. Thoracolaparoscopic-assisted esophagectomy can be safely performed for corrosive strictures of the esophagus. Besides improving the ease of performing the procedure, it also helps mitigate the morbidity associated with conventional open surgery in such cases.

Leptospirosis is the most widespread zoonotic disease, estimated to cause severe infection in more than one million people each year, particularly in developing countries of tropical areas. Several factors such as variable and nonspecific clinical manifestation, existence of large number of serovars and asymptomatic hosts spreading infection, poor sanitation and lack of an effective vaccine make prophylaxis difficult. Consequently, there is an urgent need to develop an effective vaccine to halt its spread all over the world. In this study, an immunoinformatics approach was employed to identify the most vital and effective immunogenic protein from the proteome of Leptospira interrogans serovar Copenhageni strain L1-130 that may be suitable to stimulate a significant immune response aiding in the development of peptide vaccine against leptospirosis. Both B-cell and T-cell (Helper T-lymphocyte (HTL) and cytotoxic T lymphocyte (CTL)) epitopes were predicted for the conserved and most immunogenic outer membrane lipoprotein. Further, the binding interaction of CTL epitopes with Major Histocompatibility Complex class I (MHC-I) was evaluated using docking techniques. A Molecular Dynamics Simulation study was also performed to evaluate the stability of the resulting epitope-MHC-I complexes. Overall, this study provides novel vaccine candidates and may prompt further development of vaccines against leptospirosis.

Leptospirosis is the most emerging zoonotic disease of epidemic potential caused by pathogenic species of Leptospira. The bacterium invades the host system and causes the disease by interacting with the host proteins. Analyzing these pathogen-host protein interactions (PHPIs) may provide deeper insight into the disease pathogenesis. For this analysis, inter-species as well as intra-species protein interactions networks of Leptospira interrogans and human were constructed and investigated. The topological analyses of these networks showed lesser connectivity in inter-species network than intra-species, indicating the perturbed nature of the inter-species network. Hence, it can be one of the reasons behind the disease development. A total of 35 out of 586 PHPIs were identified as key interactions based on their sub-cellular localization. Two outer membrane proteins (GpsA and MetXA) and two periplasmic proteins (Flab and GlyA) participating in PHPIs were found conserved in all pathogenic, intermediate and saprophytic spp. of Leptospira. Furthermore, the bacterial membrane proteins involved in PHPIs were found playing major roles in disruption of the immune systems and metabolic processes within host and thereby causing infectious disease. Thus, the present results signify that the membrane proteins participating in such interactions hold potential to serve as effective immunotherapeutic candidates for vaccine development.

Achalasia cardia is an oesophageal motility disorder characterised by aperistalsis and failure of relaxation of the lower oesophageal sphincter. The management is predominantly palliative with focus on addressing the sphincter that involves either pneumatic dilatation or Heller myotomy which relieves dysphagia in the majority of the cases. End-stage achalasia (ESA) is characterised by failed myotomy, massively dilated and tortuous oesophagus with nutritional deterioration due to progressive dysphagia and vomiting. In these subgroups of patients, oesophagectomy may be the last resort. While oesophagectomy has been described for ESA before, thoracoscopic oesophagectomy has not been reported previously. Hereby, we report our experience of performing minimally invasive oesophagectomy (thoracoscopic) with the gastric pull-up.

This study outlines the biodiversity of mushrooms of India. It reveals the molecular biodiversity and divergence time estimation of basidiomycetes from Gujarat, India. A total of 267 mushrooms were collected from 10 locations across the state. 225 ITS sequences were generated belonging to 105 species, 59 genera and 29 families. Phylogenetic analysis of Agaricaceae reveals monophyletic clade of Podaxis differentiating it from Coprinus. Further, the ancient nature of Podaxis supports the hypothesis that gasteroid forms evolved from secotioid forms. Members of Polyporaceae appeared polyphyletic. Further, our results of a close phylogenetic relationship between Trametes and Lenziteslead us to propose that the genera Trametes may by enlarged to include Lenzites. The tricholomatoid clade shows a clear demarcation for Entolomataceae. However, Lyophyllaceae and Tricholomataceae could not be distinguished clearly. Distribution studies of the mushrooms showed omnipresence of Ganoderma and Schizophyllum. Further, divergence time estimation shows that Dacrymycetes evolved in the Neoproterozoic Era and Hymenochaetales diverged from Agaricomycetes during the Silurian period.

Gall bladder carcinoma is an aggressive malignancy with varied presentation. Liver is most commonly involved initially with distant metastasis in virtually all possible organs. We report a case of middle aged female who presented with pain in upper abdomen and progressive jaundice. Imaging studies were suggestive of gall bladder carcinoma involving hilum with disseminated osteosclerotic lesions and metastasis to Urinary Bladder (UB). Patients of carcinoma gall bladder with disseminated metastatic disease have poor prognosis and are managed with palliative chemotherapy. To the best of our knowledge, this is one of the rare initial presentation of gall bladder carcinoma in the literature.

Natural history of duodenal adenocarcinoma is not well known. Although extremely rare, the incidence of primary small bowel adenocarcinoma has been increasing. Primary duodenal cancer is a very rare, which has accounted for only 0.3% of all gastrointestinal cancers. Isolated ovarian metastasis from duodenal carcinoma is extremely rare entity. We report a case of duodenal carcinoma with isolated bilateral ovarian metastasis in a 39-year-old female patient managed surgically with Whipple’s procedure with bilateral oophorectomy. She presented with complaints of dyspepsia and intermittent vomiting since 1½ years. History of anorexia and weight loss present. Upper gastrointestinal endoscopy was suggestive of circumferential ulcerated friable lesion at duodenum (D1-2) region and histopathology suggestive of moderately differentiated adenocarcinoma. Subsequent imaging studies revealed 6×5 cm duodenal mass in D1 and D2 without IHBRD with right ovarian mass. She underwent staging laparoscopy with open classic Whipple’s procedure with bilateral oophorectomy was done. Intraoperatively 6×6 cm mass involving first and second part of duodenum involving head of pancreas was found with 3×3 cm right ovarian mass. Post-operative period was uneventful and she discharged on POD6. Final biopsy was suggestive of moderately differentiated adenocarcinoma of duodenum with bilateral ovarian metastasis and she received adjuvant chemotherapy. Now at 1 year, on regular follow up she is completely asymptomatic and imaging showed no recurrent disease. Isolated ovarian metastasis may not be a contraindication for radical surgery in selected group of patients with duodenal carcinoma.

Liquid crystals are a state of matter intermediate between that of a crystalline solid and an isotropic liquid. They possess many of the mechanical properties of a liquid, e.g. - high fluidity, inability to support shear, formation, and coalescence of droplets. At the same time they are similar to crystals in that they exhibit anisotropy in their optical, electrical, and magnetic properties. We discuss some physical properties of nematic, cholesteric, and smectic liquid crystals (Specially focused on cholesteric) and some applications in laser due to Cholesteric Liquid Crystal’s resonant cavity which formed spontaneously and intrinsically, in the form of self-assembled chiral nematic helix.

Entamoeba histolytica infection can lead to colitis, peri-colic abscess, ameboma, perforation and rarely colonic stricture. Amebic colitis is usually managed with medical management and rarely needs surgical management. We hereby report a case of colonic amebiasis, presenting as a stricture in transverse colon, mimicking malignancy, and managed successfully.

MicroRNAs (miRNAs) are well-known key regulators of gene expression primarily at the post-transcriptional level. Plant-derived miRNAs may pass through the gastrointestinal tract, entering into the body fluid and regulate the expression of endogenous mRNAs. Camptotheca acuminata, a highly important medicinal plant known for its anti-cancer potential was selected to investigate cross-kingdom regulatory mechanism and involvement of miRNAs derived from this plant in cancer-associated pathways through in silico systems biology approach. In this study, total 33 highly stable putative novel miRNAs were predicted from the publically available 53,294 ESTs of C. acuminata, out of which 14 miRNAs were found to be regulating 152 target genes in human. Functional enrichment, gene-disease associations and network analysis of these target genes were carried out and the results revealed their association with prominent types of cancers like breast cancer, leukemia and lung cancer. Pathways like focal adhesion, regulation of lipolysis in adipocytes and mTOR signaling pathways were found significantly associated with the target genes. The regulatory network analysis showed the association of some important hub proteins like GSK3B, NUMB, PEG3, ITGA2 and DLG2 with cancer-associated pathways. Based on the analysis results, it can be suggested that the ingestion of the C. acuminata miRNAs may have a functional impact on tumorigenesis in a cross-kingdom way and may affect the physiological condition at genetic level. Thus, the predicted miRNAs seem to hold potentially significant role in cancer pathway regulation and therefore, may be further validated using in vivo experiments for a better insight into their mechanism of epigenetic action of miRNA.