Cauda equina syndrome after repeated spinal attempts: a case report and review of the literature

Spinal and epidural blocks are widely used for cesarean section. Spinal hematoma causing cauda equina syndrome is a rare complication after spinal anesthesia [SA], but can lead to severe neurological deficit. It is usually associated with difficult SA and requires surgical decompression in most of the cases

Ovarian ectopic pregnancy: a 10 years' experience and review of literature

Primary ovarian pregnancy is one of the rarest forms of ectopic pregnancy having incidence of 1/7000-1/40,000 in live births and 0.5-3% of all ectopic gestations. Intrauterine contraceptive device [IUCD], salpingitis, infertility, and assisted reproductive techniques are the important risk factors. Approximately, 75% terminate in first trimester and are often misdiagnosed as corpus luteum haemorrhage. Preoperative diagnosis by ultrasonography [USG] in early pregnancy can help in conservative medical/ surgical management. The aim of the present study was to find the incidence, risk factors, role of USG in pre-operative diagnosis, feasibility of conservative management with medical method or minimal invasive surgery in developing countries like India. We did a retrospective cross-sectional study of ovarian pregnancies managed at Government Medical College and Hospital Chandigarh between July 2000 to July 2010. We analyzed the incidence, risk factors, clinical presentation, management of ovarian pregnancy, and reviewed the literature. Incidence of ovarian pregnancy was 4.9% of all ectopic pregnancies [14/523]. Thirteen [93%] patients presented in first trimester with acute pain abdomen and of these ten patients had bleeding per vaginum. One [7%] patient referred from peripheral hospital at term gestation with ultrasonographic diagnosis of breech presention with plecenta previa. Pre-operative diagnosis was made only in two cases [11%]. All cases were managed by laparotomy. Excision of the sac with conservation of the ovary was done in eleven cases [78%] and oophorectomy was done in two cases [14%]. Incidence of ovarian pregnancy is on the rise. Although ultrasonography can detect ovarian gestations in unruptured cases but cannot easily differentiate ovarian from other tubal gestation in ruptured state. Medical management is usually not feasible it most of the patients present in ruptured state. Conservative surgical approach is the management of choice

unusual case of vaginal myoma presenting with postmenopausal bleeding

Vaginal leiomyomas are uncommon benign tumour with variable clinical presentation. These tumours arise most commonly from anterior vaginal wall. We report a case of 50-year old postmenopausal woman who presented with urinary retention, profuse vaginal bleeding and mass protruding into vagina. Local examination revealed a pedunculated mass attached to the posterior vaginal wall with vascular stalk one cm below the cervix. Mass was hanging outside vulva and vascular pedicle was profusely bleeding. The pedicle was ligated and tumour was excised. Subsequent histopathology revealed a vaginal myoma