Massive Ovarian Cyst - Is Surgery the Only Option?

Reproductive age group women face many challenges and disorders including ovarian masses. Ovarian cyst diagnosed in the reproductive age group are generally benign.1 Benign ovarian cysts, if diagnosed early when small (< 5 cm diameter), usually resolve spontaneously and do not require surgical intervention whereas very large cysts (> 10 cm in size) usually require surgical removal.2 A case of massive benign ovarian cyst in a reproductive age group woman, treated without a major surgical intervention is being reported.Ovarian tumours like simple benign cysts (thin-walled cysts with no solid structures or calcifications) less than 5 cm diameter usually resolve over 2 menstrual cycles, out of which 10 percent of patients may undergo surgical intervention at some point during their lifetime,2 because of pain or perceived risk of torsion. But, on the other hand giant ovarian cysts undergo surgical removal by laparotomy or by endoscopy. Laparoscopy for removal of giant cysts (> 10 cm) has gained importance. On its flipside, laparoscopic surgery has a few morbidities like formation of post-operative adhesions, which can compromise future fertility, although, less than laparotomy.In the present case, a young unmarried childbearing age woman underwent ultrasound guided needle drainage of benign massive ovarian cyst for over 5 hours and 7.5 liters of fluid was removed with shorter duration of hospital stay and follow up was done in OPD. After 3 months of follow up, the patient has no symptoms, cyst size had not increased, and she was leading a normal life. In young women, it is also desirable to avoid unnecessary surgery as much as we can, to avoid complications and risks, keeping future fertility in mind. The management rationale is to do conservative management where possible and prevent or reduce patient morbidity by avoiding surgical methods like laparotomy and laparoscopic operations wherever possible after proper patient selection.

Bicornuate Uterus with Unilateral Fibroid - Surgical Procedure or LNG-IUS - A Conservative Approach in a Patient Who Opted LNG as Contraception

Bicornuate uterus with leiomyoma is rare. A 30 - year - old patient with bicornuate uterus with fibroid presented with abnormal - uterine - bleeding and was treated non - surgically with LNG - IUS. Uterine fibroids and AUB affect the quality of life and remain a leading indication for hysterectomy. In young women, uterine preservation approaches should be preferred as far as possible.Abnormalities in fusion or formation of Mullerian duct results in uterine structural and functional abnormalities.1 One of the Mullerian duct anomalies, bicornuate uterus, occurs due to incomplete fusion of utero-vaginal horns at the level of fundus. Bicornuate uterus is the most common Mullerian duct anomaly (25 % of cases )2,3 and association of bicornuate uterus with leiomyoma is very rare and there have been very few cases reported till now.4,5 A case of bicornuate uterus with unilateral fibroid is being reported who presented with abnormal uterine bleeding and pelvic pain and was treated non-surgically with LNG - IUS.

Evaluation of endometrial causes of postmenopausal bleeding with it's correlation with endometrial thickness and hysteroscopy findings and endometrial tissue histopathology

Background: Postmenopausal bleeding (PMB)accounts for 5% of gynecology visit. All with unexpected uterine bleeding should be evaluated for endometrial carcinoma since this potentially lethal disease is the cause of bleeding in approximately 10 percent patients (range 1 to 25 percent, depending upon risk factors). The aim of the study was to evaluate endometrial causes of postmenopausal bleeding (PMB) with it's correlation with endometrial thickness (ET)and hysteroscopy findings and endometrial tissue histopathology.Methods: A total 50 consecutive cases of PMB fulfilling the inclusion and exclusion criteria and giving informed consent were selected. Each patient was subjected to transvaginal sonography (TVS) in which uterus, adnexa and endometrial thickness (ET) was assessed. Then hysteroscopy and/or dilation and curettage was scheduled at subsequent visit. Endometrial sample was sent for histopathological examination. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy was calculated for ET by TVS and hysteroscopy findings, considering histopathological diagnosis as the gold standard.Results: Most common endometrial cause of PMB was atrophic endometrium (44%). The other causes were endometrial carcinoma (18%), endometrial hyperplasia (18%), endometrial polyp (12%), endometritis (4%), and leiomyoma (4%). The diagnostic accuracy of ET by TVS at a cut-off point of 5 mm was 94% with sensitivity 89.3%, specificity 100%, PPV 100% and NPV 88%. The diagnostic accuracy of hysteroscopy was 98% with sensitivity 96.4%, specificity 100%, PPV 100% and NPV 95.7%.Conclusions: Being relatively cheap, easily accessible, non-invasive, TVS with ET measurement should first line investigation in the evaluation of women with postmenopausal bleeding with suspected endometrial pathology. Although hysteroscopy is more specific and sensitive, in poor resource settings it should be limited to cases with ill-defined endometrial lining, recurrent/ persistent bleeding and cases with endometrial thickness greater than 5 mm irrespective of endometrial echotexture.

A comparative study of various types of intravenous fluids on the changes during induction of general anaesthesia

Background: The induction and endotracheal intubation is the most risky and initial process of general anaesthesia. Without induction and endotracheal tube placement one cannot imagine the general anaesthesia. Propofol and fentanyl are the commonly used drugs for induction of general anaesthesia. These drugs produce hypotension and other cardiorespiratory disturbances. These hazardous and sometimes fatal effects can be reduced and eliminated by preloading the patients with colloid or crystalloid solutions.Methods: We selected 90 patients who visited our hospital in the last 2 years from June 2017 to May 2019. All the investigations and pre-anaesthetic check-up was done routinely. These patients had to undergo different surgical procedures under general anaesthesia. The induction of anaesthesia was done with propofol and fentanyl. These patients were divided in three groups A, B and C. Group A patients did not receive any preloading. Group B was given colloids (3.5% gelatins) and group C received crystalloids (Ringer’s lactate solution). The haemodynamic changes were noted and analysed statistically.Results: The study showed that IV fluids given before induction of general anaesthesia blunts the adverse cardiovascular response.Conclusions: We concluded that preload with fluids whether colloids or crystalloids are beneficial to counter the detrimental effects of propofol and fentanyl for induction of general anaesthesia. The preload fluids stabilise the patient haemodynamically. When compared the two, colloids were better to blunt the cardiovascular changes.

Prevalence of mental retardation in urban and rural populations of the goiter zone in Northwest India.

Background: The existence of an endemic goiter belt along the southern slopes of the Himalayas has been known for a long time. Prevalence of neonatal hypothyroidism is high and there has been little work on the prevalence of mental retardation in this part of India. Objective: The study was conducted with the aim to know the prevalence of mental retardation in the urban and rural populations of Himachal Pradesh, India and to generate a hypothesis on the differential distribution (geographical) of mental retardation. Methods: This cross-sectional study was conducted in the rural and urban areas of the district of Kangra, Himachal Pradesh, India among children of 1-10 years of age. In the first phase, the children in the age group of 1-10 years were screened for mental retardation using the Ten Questions Screen, whereas in the second phase the suspects were evaluated clinically. Results: The prevalence of mental retardation was found to be 1.71% in the study population with higher prevalence (3.3%) in the 73-120 months age group. The prevalence was higher among the males in all study populations [rural: 1.9%, urban (nonslum): 1.6%, and urban slum: 7.14%). The prevalence was similar among the urban (nonslum) (1.75%) and rural (1.11%) populations, whereas it was higher (4%) in the urban slum population. A prevalence of 2% was seen in families from the lower middle class and 1.8% among families from the lower class in the rural population, whereas a prevalence of 2% was seen among lower middle class families of urban (nonslum) areas. Conclusion: The prevalence of mental retardation was higher in our study than in other parts of the country. The study concludes with the hypothesis that the prevalence of mental retardation is differentially distributed geographically with socioeconomic factors being important predictors.