Evaluation of the efficacy of mifepristone/misoprostol and methotrexate/misoprostol for medical abortion.

BACKGROUND: Unsafe abortion is a major cause of mortality among women in India accounting for 12% of all maternal deaths. In developing countries, annually, up to 200,000 women die of complications after illegal abortion. Medical abortion is potentially a simple and a safe method for use in developing countries. We conducted a prospective controlled trial to compare the efficacy of low-lose mifepristone and methotrexate for medical abortion. OBJECTIVE: To find out the efficacy of low-dose mifepristone and methotrexate for inducing abortion. METHOD: In this prospective clinical study, 100 women opted for a medical method of abortion. Out of these, 50 patients were given 50 mg/m2 of methotrexate intramuscularly followed by 800 micro gm of intravaginal misoprostol, and 50 patients were given 200 mg of mifepristone orally followed by 800 micro gm of intravaginal misoprostol. MAIN OUTCOME MEASURES: Complete abortion was the principal outcome measure. Secondary outcome measures were side effects and acceptability data. RESULTS: The rate of expulsion by first week after initiation of treatment was 58% in methotrexate and 98% in mifepristone group (P <0.001). CONCLUSION: Low-dose mifepristone and intravaginal misoprostol is safe, effective, and well tolerated as compared to methotrexate and misoprostol.

Cesarean section in a wedged head.

Cesarean section many a times, has to be done late in labour when the head is deeply wedged in the pelvis. The techniques described in standard text books, usually result in extension of the incision either laterally into the broad ligament or vertically upwards into the upper segment or downwards posterior to the bladder from the centre of the incision line. In this study we have reviewed the Patwardhan's technique for the extraction of baby and fetomaternal outcome was compared with cases where this technique was not used. There was no extension of the incision either laterally into broad ligament or upwards or downwards. Haemorrhage due to extension of incision requiring blood transfusion occurred in 24% of patients in group II as compared to nil in group I.

Epileptic seizures in supratentorial gliomas.

Two hundred patients with supratentorial glioma; astrocytoma (pilocytic, fibrillary, gemistocytic) 82, mixed glioma (oligoastrocytoma) 46, oligodendroglioma 8, malignant (anaplastic) astrocytoma 33 and glioblastoma multiforme 31, surgically treated for the tumours and followed up for one to sixteen years, were retrospectively analysed for the incidence of pre and postoperative epileptic seizures. 122 patients (61%) had seizures preoperatively. 62 (50.8%) of them had at least one or more seizures during follow up. Seizures were persistent in 22 patients. Doubtful, or one or two minor seizures occurred in 19 cases. Six patients in this group had seizure only at the time of CT confirmed recurrence, after a seizure free interval of one to nine years. Amongst 78 patients who did not have seizures preoperatively, 24 (30.6%) developed seizures during the postoperative follow up period. Recurrent attacks were reported only by 5 patients while 15 patients had seizure(s) only at the time of recurrence of tumour. Two patients had a few seizures in the early postoperative period and none thereafter, while doubtful seizures were reported by two patients.

Foreign body in vagina--an uncommon cause of vaginitis in children.

An intravaginal foreign body of long duration can pose diagnostic dilemma in children. We present a case of eight and a half years old girl who was suffering from blood stained vaginal discharge for 3 years for which she was treated by few gynaecologists. A vaginal examination performed under general anaesthesia revealed a foreign body (lead pencil). In cases of pediatric vaginitis one should always look for foreign body in vagina.

Solitary intracranial plasmacytoma of the skull base.

Two cases of extradural solitary plasmacytoma (SIP) with infiltration of the dura, destruction of the skull base, multiple cranial nerve palsies and proptosis are presented. The cases were treated aggressively with surgery and radiotherapy and showed no signs of progressing to multiple myeloma after 15 months and four and a half years respectively.

Extensive CT scan abnormality in Wilson's disease.

A case of Wilson's disease with extensive white matter hypodensity, including in the basal ganglia, on CT scan is presented. Such extensive CT scan abnormality has not been described in Wilson's disease.

Primary gastric lymphoma: role of computed tomography.

Computed tomography (CT) has been suggested as an alternative to surgery for predicting the stage and resectability of primary gastric lymphoma. It is our policy to perform CT scan on all patients and the decision to explore is based upon CT findings. We reviewed our experience to see if any changes were warranted. 12 patients with primary gastric lymphoma underwent CT scanning. The CT findings were compared with the pathological findings available for 10 patients. CT correctly staged 90 per cent of the patients and it obviated unnecessary exploratory surgery in 42 per cent of the patients. It permitted the planning of non-excisional therapy in 75 per cent of the patients and was useful as an indicator of response to therapy and as a follow up measure.

Primary malignant hepatic tumors in children--a clinicoradiological profile.

A retrospective analysis of clinicoradiological records of 14 patients with primary malignant tumors of liver (12 hepatoblastomas, 2 embryonal sarcomas) was done. High levels of alpha feto protein were found in four out of six patients and plain X-ray calcification was seen in 33% of patients with hepatoblastoma. Hepatoblastoma was predominantly (80%) a right lobar, illdefined, heterogenous solid mass, which was mixed attenuating on CT scan with areas of patchy enhancement. Angiography was useful in vascular mapping for surgery. A rare association of congenital dysplastic kidney with hepatoblastoma was noted. The imaging protocol for a malignant hepatic tumor and possible differentiating features from the rare entity of embryonal sarcoma are discussed.

Clinical evaluation of cyanoacrylate glue in corneal perforations.

Our experience of the use of Cyanoacrylate glue in 50 cases of perforation or impending perforation of cornea has been presented. The method of application has been described. Quite encouraging and useful results have been obtained.