ABSTRACT
Uterine leiomyosarcomas are rare aggressive tumors, with high recurrence rates, even when confined to the uterine corpus at the time of diagnosis. It arises from smooth muscle of uterus and is a rare tumor that accounts for 2-5% of all uterine malignancies. These tumors typically spread hematogenously. Patients present with vague symptoms similar to those of patients with leiomyomas. Most patients are diagnosed with leiomyosarcoma postoperatively. Although prognosis remains dismal, various ongoing studies are investigating the role of advanced imaging, multimodality treatment, prognostic nomograms, and unique biomedical pathways to increase understanding of leiomyosarcoma and improve therapeutic options for patients. 46 years old para2 live2 postmenopausal (since 1.5 year) female presented to outpatient clinic with complaints of bleeding per vaginum, foul smelling discharge, unquantified weight loss and something coming out of vagina since 1.5 months. On abdominal examination, an irregular midline mass arising from pelvis corresponding to 20 weeks gestational size of uterus was present. On vaginal examination, 3 infected vaginal growths were present in vagina maximum 4x4cm. Intra-operatively, uterus was nearly 20 weeks size with irregular surface. A 3×3 cm subseroal fibroid with necrotic surface was present on posterior wall of uterus. Cut section of the operative specimen showed myohyperplasia which was compressing the uterine cavity, some necrotic areas were also present. Vaginal growths - 4×4 cm on left vaginal wall near introitus with necrotic surface, 3×3 cm on right vaginal wall, 1×1 cm on right upper vaginal wall present. Excision of vaginal growth was done and was sent for histopathology. Histopathologic examination of sections of uterus showed all features were suggestive of leiomyosarcoma uterus.
ABSTRACT
Background: The oral glucose tolerance test (OGTT) is considered the current standard for diagnosis of gestational diabetes mellitus (GDM). International association of diabetes and pregnancy study groups (IADPSG) recommends OGTT, with fasting, one-hour and two-hour venous blood samples drawn after intake of 75g oral glucose. In the Indian context, diabetes in pregnancy study group in India (DIPSI) recommends glucose challenge test (GCT), where 75 g glucose is given irrespective of the fasting state, and a single venous sample is drawn after two-hour. Diagnosis of GDM is made, if any cut-off value is met or exceeded. This prospective study was conducted to compare the DIPSI and IADPSG criteria for diagnosis of GDM.Methods: Pregnant women between 24 to 28 weeks of gestation were subjected to non-fasting GCT. Capillary sample were also drawn simultaneously using Accu check active glucometer. These women were counselled to undergo a standard 75gram OGTT, within a week of recruitment.Results: According to IADPSG criteria, 17.6% (18/102) of our participants had GDM, as compared to 19.6% (20/102) by DIPSI criteria using venous samples, and 25.3% (25/99) by capillary sample method. Sensitivity and specificity of GCT using venous sample was 72.22% and 91.67%, and using capillary sample was 70.59% and 84.15% respectively. DIPSI criteria using venous samples wrongly labelled 8.3% women as GDM, and capillary samples wrongly labelled 15.9% women as GDM. More importantly DIPSI criteria using venous samples labelled 27.8% women as false-negative and capillary samples labelled 29.4% women as false-negative for GDM. Almost one quarter of women with GDM will be missed if DIPSI criteria is used as a universal screening modality.Conclusions: We suggest that the IADPSG criteria be used for diagnosis of GDM in antenatal women in India.
ABSTRACT
@#Traumatic orbital haemorrhage is an unfortunate complication with potential vision-threatening consequences.[1-3] The collection of blood can occur anywhere along the potential free orbital spaces,[4] but the subperiosteal collection of the blood is an important clinical variant where careful and timely intervention can give commendable rewards to the surgeon as well as to the patient.[1,2] Subperiosteal hematoma could be traumatic or non-traumatic, in turns, the non-traumatic cases may be due to bleeding tendency as in cases of leukaemia, blood dyscrasia and haemophilia or could be due to vascular malformation, venous congestion, infection, inflammation and neoplastic and non- neoplastic causes.[4] Here in this report, we elaborate the advantage of continuous ultrasound-guided needle drainage of the post-traumatic subperiosteal hematoma to enhance the clinical accuracy and to avoid the untoward complications.
ABSTRACT
Objective: The objective of this study was to evaluate effectiveness of two psychological intervention techniques (reading – writing therapy vs. games – narrative therapy) using motivational intervention alone as a control among tobacco addicts. Materials and Method: This randomized control trial was conducted over a period of 6 months from April to September 2013 at a de-addiction center in Madhya Pradesh, India. Patients with moderate-to-high levels of dependence as determined by Fagerstrom Test for Nicotine Dependence (FTND) admitted for treatment in a de-addiction center were recruited. A cluster randomization technique was used for allocation of participants to three different groups. Group allocation was concealed from investigator and done by coordinator. Three interventions were group A – motivational intervention alone, group B – games and story therapy along with motivational intervention, and group C – reading and writing therapy along with motivational intervention. Interventions were applied for 1 month. Two postintervention follow-ups (one at the time of discharge and one after 1 month following discharge) were done to assess level of dependence using FTND besides undertaking urine cotinine analysis among three randomly selected participants in each group. Results: A total of 82 participants (28 in group A, 27 each in groups B and C) completed the study. Eighty-one (98.8%) participants had complete abstinence at the end of 1 month with no significant difference in the success rate between different categories (P = 0.357). At the end of 1 month following discharge from center, only 7 participants (8.5%) had complete abstinence and 51 participants (62.2%) had partial reduction and remaining 24 participants (29.3%) were considered failures with no difference between three groups (P = 0.768). Conclusion: Although overall abstinence was low (8.5%), all intervention techniques were equally effective in at least reducing level of dependence with no significant difference in their efficacy.
ABSTRACT
Background: Intraductal papilloma is characterized by proliferation of epithelial and myoepithelial cells overlying fibro-vascular stalks creating an arborescent structure within the lumen of duct. Some times multiple papillomas with florid proliferation of epithelium may be confused with malignancy. A case of multiple intraductal papillomas of breast with ulceration of overlying skin and large lump leading to clinical diagnosis of malignancy is documented here. Case Report: A 45-year-old female presented with ulcerated mass of six months duration in the left breast. On examination, a firm, immobile lump of 8× 10 cm in size involving nipple with excoriation of surrounding skin and serosanguinous discharge from nipple was present. There was no axillary lymphadenopathy. No family history of carcinoma breast was present. Fine needle aspiration smears showed benign cellular changes with apocrine metaplasia. Biopsy from an area adjacent to nipple showed intraductal papilloma. Simple mastectomy showed lobulated dirty white mass with well circumscribed nodules below the nipple and areola. On histology with immunohistochemistry a diagnosis of multiple intraductal papillomas was made. Patient is on regular follow-up and doing well. Conclusion: The case highlights the problem in differentiating marked papillomatosis from a malignant lesion of breast and importance of biopsy with immunohistochemistry in such cases for proper management.