Inflammation of the appendix determines the type of hernia repair and surgical approach. Incidental appendicectomy in the case of a normal appendix is not preferred.

Aggressive angiomyxoma is a rare and locally aggressive mesenchymal tumour, predominantly occurring in women of reproductive age group. The term aggressive is attributed to the infiltrative nature and frequent local recurrences. They arise commonly from the vulvovaginal region, perineum or pelvis and are usually misdiagnosed as other common entities in these regions. Radiological investigations aid in the diagnosis and planning of surgery. However, the final diagnosis in most of the cases is established by histopathological examination. We herein report a case of a middle-aged woman presenting with recurrent large right vulvar mass highlighting the surgical challenges posed by its intrapelvic extension.

Breast cancer accounts for the highest number of cases of cancer in females worldwide including India. Triple negative breast cancer is a very aggressive and heterogeneous variant of breast cancer. They present early in young females with large sized lumps, high histological grade, and advanced stage at the time of diagnosis. They have increased tendency to metastasize with frequent relapses. It forms a large proportion of breast cancer patients in India and its tumor biology and behavior is poorly understood. There is lack of a hormonal or targeted therapy due to absence of hormone receptors with early recurrences despite of timely medical and surgical intervention. This review provides a general overview and understanding of the triple negative breast cancer and the future challenges it poses in Indian scenario.

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Gossypiboma is a mass of foreign body with cotton matrix accidentally left inside the body after a surgical procedure. It is a surgeon's nightmare and has a varied presentation ranging from asymptomatic cases to the formation of an abscess, mass, intestinal obstruction/perforation, malabsorption, gastrointestinal hemorrhage, and various internal and external fistulization. Genital tract fistulas are one of the most distressing conditions for women of reproductive age that not only hamper their day-to-day work but also impair their social life and psychological state. Colouterine fistula is a rare pathology and has been mainly reported as a complication of diverticulitis in the elderly. We present here a case of gossypiboma presenting as colouterine fistula in a young lady following lower segment cesarean section. The case highlights a rare complication of gossypiboma, probably the first of its kind, and the diagnostic challenges that it presents.

There are many methods for closing the perforated peptic ulcer. The technique of closure of perforation by figure of 8 stitch method has been found to be very effective in managing patients with this common problem. MATERIAL AND METHOD: The present study was conducted in Unit III of Department of General Surgery, Government Medical College and Dr. Susheela Tiwari Government Hospital Haldwani, from January 2012 to December 2013 on the cases of peptic ulcer perforation peritonitis. All patients with clinical and radiological features and intraoperative findings suggestive of perforated peptic ulcer were included in the study. RESULTS: A total of 153 patients were included in the study. Out of these, 128 patients (84%) were males and 25 patients (16%) were females. In 120 patients (78%) there was duodenal perforation and in 33 patients (22 %) gastric perforation was present. Out of these 33 patients, 6 patients had posterior gastric perforation. 140 patients were managed with midline laparotomy and 13 with laparoscopic method, with one converted to open due to presence of posterior gastric perforation. The average time of patient reporting to the emergency was3-4 days, with earliest reporting time of 2-3 hours and late reporting up to 7-8 days. Age ranged from 15 years to 90 years (average 35 -45 years). In the postoperative period, 3 patients had leakage from repair site, 7 patients died, rest showed good outcome. CONCLUSION: Figure of 8 stitch method showed very good and acceptable result. Therefore, in our opinion this method should be promoted for surgery of perforated peptic ulcer.

Developing new therapeutic methods and exploring other possible future strategies in Triple Negative Breast Cancer (TNBC) is an area of interest. Angiogenesis is one such sought for area that can even serve as a targeted therapy in this subset of breast cancer. The objective of the study was to evaluate the prognostic factors in TNBC patients with emphasis on angiogenesis. Prospectively 120 patients with histologically confirmed breast cancer from June 2015 to July 2019 were included. The Colour Doppler evaluation of breast lump and axilla in terms of RI, PI and Vmax was done. Patients were categorized as having 'high' or 'low' RI, PI and Vmax on the basis of their mean value. Immunohistochemistry (IHC) was performed on viable tumour blocks obtained from mastectomy specimen using CD31 vascular endothelial staining. The idea was to obtain Microvascular Density (MVD) by counting all immunostained vessels at magnification of 400x. The association between TNBC and non TNBC with well-known Doppler parameters, tumour size, clinical lymph node status, number of positive lymph nodes, tumour grade, stage of disease and hormonal receptor status was investigated. Also the association between high and low MVD with these prognostic parameters were evaluated. A total of 120 patients were included in the study with the mean age of 42.43±7.73 years (range 30-65 years). The mean RI, PI and Vmax were 0.92±0.26, 2.19±1.84 and 16.52±10.70 respectively. The comparison between TNBC and non-TNBC with prognostic parameters showed significant association with age of patients, duration of disease, use of oral contraceptive pills (>1 year), tumour size, histological grade, RI and MVD (p=0.041, p=0.011, p=0.002, p=0.029, p=0.026, p=0.014 and p=0.007 respectively). The MVD value >13.17 (high) was found in 45 (37.5%) patients while 75 (62.5%) patients had low MVD value (<13.17). The high MVD (>16.52) was significantly associated with tumour size (p<0.001), axillary lymph node (p=0.022), clinical stage (p=0.015), histological grade (p<0.001), RI (p<0.001), ER status (p<0.001) and HER2 over expression (p=0005). TNBC is a subset of breast cancer showing aggressive biological behaviour as seen by presence of poor prognostic marker and increased vascularity.

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