Acute abdomen with adnexal masses in the reproductive age group: diagnosis and management

Background: Women with adnexal masses can present with acute symptoms such as abdominal pain, nausea and vomiting. As there is insufficient evidence on the frequency, presentation and management of adnexal masses we conducted this study to evaluate the clinical profile, surgical findings and histopathology of adnexal masses in women presenting with acute abdomen and needing surgical intervention.Methods: In this prospective observational study, history, examination, investigations and ultrasound of abdomen and pelvis were evaluated in women presenting with acute abdomen with adnexal mass and needing surgical intervention. Diagnosis was confirmed from the operative findings and histopathology. Etiology and its correlation with clinical symptoms and signs and radiological diagnosis formed the primary objective of the study.Results: Of the 79 patients enrolled in the study, the mean age was 30.82±6.69 years. Younger women were likely to have ectopic pregnancy while older women (>35 years) other tubal pathologies. Pain abdomen (n=70) and nausea (n=53), bleeding per vagina(n=33), menstrual irregularities (n=18), fever (n=10) abdominal distension (n=10) and dysuria (4) were the common symptoms. Etiology of the adnexal mass was ectopic pregnancy (57%), ovarian mass (34%), tubal mass (7.5%), tube and ovary (2.5%) in 46, 25, 6 and 2 patients respectively. 61% (n=48) of the women underwent laparoscopic management. Women with ruptured ectopic pregnancy were more likely to have abdominal distension, pallor, hypotension, cervical motion tenderness and need for blood transfusions.Conclusions: In women from reproductive age group with adnexal mass and needing surgery, ectopic pregnancies and benign ovarian tumours were the common etiologies. Urine pregnancy test and ultrasound are useful tests to differentiate ectopic from ovarian and tubal pathology.

Cardiovascular autonomic responses to whole body isotonic exercise in normotensive healthy young adult males with parental history of hypertension.

The objective of this study was to assess blood pressure and autonomic activity during rest and recovery in young adult normotensives offsprings of hypertensives. A total of 49 healthy normotensive males with BMI of 18.5–24.9 kg/m2 chosen for the study and classified into two groups based on their parental history of hypertension underwent a sub maximal cycle ergometry exercise test. ECG and heart rate were recorded at baseline, during the exercise test and during recovery period of ten minutes while blood pressure was recorded at baseline and during recovery. Spectral analysis of HRV was performed. The basal systolic blood pressure and the recovery systolic blood pressures at the 1st and 3rd minute of recovery after exercise test were significantly higher in the study group than the control group. The basal LFnu and LF/HF ratio were significantly higher while the basal HFnu was significantly lower in the study group than the control group. A difference in basal systolic blood pressure, a higher LFnu and a lower HFnu found in offspring of hypertensive parents may be an early marker of cardiovascular change in subjects with a genetic predisposition to hypertension.