A rare case of pregnancy in the rudimentary horn of unicornuate uterus (on table diagnosis): a case report

A rudimentary horn with a unicornuate uterus results due to failure of the complete development of one of the Mullerian ducts and incomplete fusion with the contralateral side. Pregnancy in non-communicating rudimentary horn of unicornuate uterus is a rare form of ectopic gestation and it carries grave consequences for mother and the fetus. The most dreaded complication is rupture during pregnancy which can be life threatening to the mother. The continuation of pregnancy is rare till 3rd trimester and usually ruptures in 2nd trimester. The primary strategy of the management is surgical excision of the rudimentary horn. Here is a case of 24year old, gravida1 with unruptured rudimentary horn pregnancy at gestational age 28 weeks diagnosed on table. IOL (induction of labour) was done with misoprostol for fetal demise and later cesarean section done in view of failed induction. Laparotomy was done and dead fetus with placenta delivered followed by excision of the rudimentary horn. The post-operative period was uneventful. This highlights the need   of an increased awareness of this condition especially in developing countries where most pregnancy are unbooked and uninvestigated as in present case.

Comparative study to assess the outcome of omitting bladder flap formation from caesarean delivery

Background: The aim of this study is to evaluate the effects of omitting the step of bladder flap formation at lower-segment caesarean delivery.Methods: It is a RCT (randomised control trial), non-blinded study conducted in a tertiary care hospital. A total of 104 women who underwent caesarean delivery (elective or emergency) were prospectively randomized to one of the two groups. In the study group (n= 54), caesarean was performed without formation of a bladder flap. In the control group (n=50), caesarean was performed with the formation of a bladder flap before the uterine incision.Results: There were differences of median skin incision to delivery interval (5 versus 6.5 minutes, P <0.0001), median total operating time (35 versus 44.5 minutes, P 0.0002), and median blood loss (haemoglobin 0.5 versus 1g/dl, P 0.0001) in favor of the study group. Postoperative incidence of urinary tract infection was reduced in the study group (1% versus 9%, P <0.0006) and bowel function returned early in the study group (day 2 versus 3, P<0.0001).  Bladder flap formation step was successfully omitted in (11/18, 61.11%) of previous CS (caesarean section) patients in the study group and (7/12, 58.33%) in control group illustrating that unless required, BF (bladder flap) formation step can even be omitted in previous CS patients.Conclusions: Omission of the bladder flap provides short term advantages such as reduction of total operating time, incision-delivery interval, and reduced blood loss and that this technique can even be applied in previous caesarean section patients.

Recurrent decidual cast with membranous dysmenorrhea

Decidual cast is the entire sloughed endometrium that takes the form of the endometrial cavity. It causes membranous dysmenorrhea because the intact cast passes through an undiluted cervix. It may be associated with ectopic pregnancy, incomplete abortion, non-pregnant state with use of progesterone, Depot medroxyprogesterone acetate (DMPA), rarely with oral contraceptive pills. Authors are reporting a case of recurrent decidual caste formation with membranous dysmenorrhoea in 33 years old women P3L3 who was on norethisterone acetate treatment for a typical uterine bleed (AUB). She presented with heavy menstrual bleeding with severe dysmenorrhea in Gynae causality of ESI Basaidarapur medical college, Delhi. She expelled decidual caste and required therapeutic Dilation and Curettage (D and C) to control bleeding per vaginum. Her histopathology report showed marked decidua like change of the stroma but no villi suggestive of endometrial caste.

Evaluation of cytotoxic activity of protein extracts from the leaves of Morinda pubescens on human cancer cell lines

ABSTRACT Biologically active proteins isolated from plant species can be used in traditional medicine as prolific resources for new drugs Morinda pubescens Sm., Rubiaceae, is a promising medicinal plant which is widely used in folk medicine to treat fever due to primary complex, ulcer and glandular swellings. In this study, proteins were extracted from the leaves of M. pubescens, and precipitated with ammonium sulphate at various saturation concentrations ranging from 20 to 80%. The precipitated protein sample obtained with 80% saturation was further purified using ultrafiltration membrane (<10 kDa). SDS-PAGE analysis identified the presence of crude and ultrafiltered protein bands. FTIR spectrum of the ultrafiltered protein fractions depicted the presence of hydroxyl and carbonyl groups of proteins. The ultrafiltered proteins exhibited increased cytotoxic activity on A549 cells at the concentrations ranging from 15 to 100 µg/ml. About 98% cell viability was also observed in Vero cells treated with the maximum concentration of 100 µg/ml of ultrafiltered protein extract. DNA fragmentation was observed in A549 cells treated with 10 µg/ml of ultrafiltered proteins, indicating the onset of apoptosis.

Choriocarcinoma with negative urinary and serum beta human chorionic gonadotropin (betaHCG)--a case report.

This was a rare case where a patient presented clinically as a case of post abortal sepsis and ultrasound showing the picture of an intramural degenerating fibroid. Her serum and urine both were negative for beta human chorionic gonadotropin (betaHCG). Patient succumbed to choriocarcinoma 1 month later. Failure to detect urinary and serum betaHCG lead to maternal mortality due to the choriocarcinoma. The failure to detect, certain degradation products of HCG which may predominate in gestational trophoblastic neoplasia, by many common HCG testing kits lead to the error of diagnosis. Only 3 of the 7 common commercial serum HCG tests appropriately detects nicked HCG and its free betaHCG, DPC immulite assay, being the most sensitive method. Though of rare occurrence, this awareness is important for diagnosis and follow-up of gestational trophoblastic neoplasia and could have been life saving in our case.