ABSTRACT
Mixed gonadal dysgenesis (MGD) presents as a unilateral testis, usually intraabdominal, a streak gonad on contralateral side, and persistent mullerian structures. 45X/45XY karyotype is most frequent in such cases with predominance of 45X cells in both peripheral lymphocytes and gonads. We present a rare case of a left undescended testis, normally descended right testis, with penoscrotal hypospadias, who had a normal karyotype and whose histopathological findings were endometrial tissue and fallopian tube in left testicular biopsy. Gonadal dysgenesis should always be kept a possibility in patient with undescended testis and proximal hypospadias. If karyotype reveals a 46XY gonadal dysgenesis, these patients need all the more careful follow-up to screen for gonadoblastoma in remaining normal testis. Subjecting the patients to prophylactic orchidectomy with hormone replacement can be an additional option in such patients.
ABSTRACT
In the present study, we studied the various reasons for conversion in laparoscopic cholecystectomy; and recommended various methods and measures to decrease the incidence of conversion and associated complications with this procedure. One hundred and seventy six patients in age group of 20-55 years, M:F ratio as 1:9 with body weight in range of 45-65 kilogram, who were having cholelithiasis without choledocholithiasis and contraindication for general anaesthesia underwent laparoscopic cholecystectomy between Jan 2002 and Dec 2003. There were a total of ten surgeons performing laparoscopic cholecystectomy out of which two surgeons had experience of more than 200 laparoscopic cholecystectomies. Twenty one patients (11.93%) out of a total of one hundred and seventy six (11.93%) had to be converted to open cholecystectomy for reasons which included dense omental or visceral adhesions- 5(2.84%), postoperative adhesions with parieties and viscera (intestines) - 3 (1.70%), uncontrollable bleeding from liver bed - 3 (1.70%), uncontrollable bleeding from cystic artery - 2(1.14%) unclear anatomy - 2(1.1.4%), cholecysteoduodenal fistula - 1(0.57%), common bile duct injury - 1 (0.57%), cirrhotic liver with shrunken gallbladder - 1(0.57%), spillage of stone - 1(0.57%), pneumoperitoneum related complications - 1(0.57%), instrument/equipment failure - 1 (0.57%). Good Laparoscopic skill, adequate experience and innovations are prerequisites for safe and cost-effective laparoscopic cholecystectomy thereby reducing conversion rate.