Study of Estradiol, Testosterone and DHEA-S Status in Women After Surgical Menopause.

Aims and Objectives : The study was done to assess the hormones namely Estradiol, Testosterone, and Dehydroepiandrosterone-sulphate (DHEAs) one day before operation and on ninth post-operative day following surgical menopause. Materials and Methods : This is a cross sectional observational study. The study was done amongst the thirty four women aged between 40-48 years with functioning uterus and at least one ovary, not using any exogenous hormone preparations affecting ovarian function for last three months and having at least one menstrual period in three previous months were included in this study. They had under gone hysterectomy with bilateral salpingooophorectomy due to non-ovarian pathology. Fasting venous blood samples were taken one day before operation and on ninth post-operative day of surgical menopause Serum concentration of estradiol, testosterone, and DHEAS were determined. Results : The circulating estradiol level decreased significantly (p = 0.043) from 161 pg/ml preoperatively to 108 pg/ml. on ninth post-operative day after surgical menopause. In spite of reduction in mean testosterone level from 0.11 ng/ml. to 0.09 ng/ml. following surgical menopause, which is statistically insignificant (p = 0.247).There was no significant difference between the serum DHEA-S level before and after surgical menopause. A significant positive correlation was observed between pre-operative circulatory levels of DHEA-S with that of estradiol while there was absence of any significant co-relations corelations between any of the other pairs of values. Conclusion : The circulating estradiol level decreased significantly on ninth day after surgical menopause and significant positive correlation between pre-operative circulatory levels of DHEA-S with that of estradiol, but there was no significant co-relation between post-operative circulating estradiol with that of DHEA-S. Testosterone did not show any significant relation with estradiol neither in pre-operative period nor in post-operative condition.

Level of Maternal Awareness Amongst Mothers who had Undergone Elective C/S.

Caesarian section (C/S) is a very common obstetric procedure. It had many advantages and disadvantages. In this age of consumer awareness, patient has to give an informed consent before the procedure – means merits and demerits of the procedure shall be known to the patient. She also has the right to choose between different procedures, type of incision and anesthesia, where possible. We have studied that status amongst 100 such patients, only 7% of them being illiterate, who had undergone elective C/S in SNP Hospital, a two tier hospital of Kolkata. The result was shocking. 65% of the mothers did not have any idea regarding the procedure they are undergoing. 1/3rd of the patients even did not know why they are having C/S. None of them was given any choice regarding anesthesia and only 9% regarding incision. A detail of the study is presented.

Agenesis of Gall Bladder: Its Emryological Basis and Clinical Significance.

Congenital absence of the gall bladder is a rare anomaly which may occur alone or with other malformations with incidence ranging from 0.01-0.05%. Awareness of this entity by clinicians and radiologists is essential because many of these patients present with biliary symptoms and have unnecessary operations. This presentation, coupled with the inability of standard abdominal ultrasonography to convincingly diagnose agenesis of the gallbladder, can put the surgeon in a diagnostic and intraoperative dilemma. Here we report a suspected case of chronic cholecystitis who underwent a laparoscopic cholecystectomy and was found to have a congenital absence of gall bladder and cystic duct. Standard pre-operative investigative modalities which were fallacious and misleading. The embryological basis and clinical significance have been discussed.