Study of validity of risk of malignancy index in perimenopausal women with ovarian mass in a tertiary care hospital in India

Background: Ovarian carcinoma is a silent killer because it presents in advanced stage. In India, it ranks third after carcinoma cervix and breast. Incidence of ovarian cancer is 5.4-8.0 per 100,000 in India. Various versions of risk of malignancy index have been studied to show its validity in different settings. We have studied third version of risk of malignancy index in a resource poor setting in India.Methods: In this prospective observational study 74 perimenopausal and postmenopausal women with ovarian mass were recruited. Menopausal score (M), Ultrasonography score (U) and CA-125 are components of Risk of Malignancy Index 3. Patients underwent preoperative ultrasonography and CA-125 level was assessed. Scores of M 1-3, U 1-3 and absolute value of CA-125 was multiplied. This product was value of Risk of Malignancy Index 3. If it is less than 250 it suggests absence of malignancy and more than 250 strongly suggests malignancy. Results were confirmed by histopathology.Results: Fifty six percent women were cancer positive. Ovarian malignancy was more common in postmenopausal age group. Ultrasonography and CA-125 had high sensitivity of 90% but poor specificity. Risk of malignancy index 3 had a sensitivity, specificity, positive predictive value and negative predictive value of 90%, 91%, 78% and 96% respectively at a cut off value of 250.Conclusions: Risk of malignancy index was concluded to be a multimodal approach with better diagnostic scoring index in preoperative stage in women of ovarian masses. It is simple and easily applicable clinical tool in resource poor setting.

Validity of Clinical Signs and Symptoms in Diagnosis of Ovarian Mass.

Objective: The main aim for undertaking this study was to find out what was the appropriateness of clinical diagnosis of benign ovarian tumor and compare the results after Histopathological study. Material And Methods: Retrospective files study of 240 cases was carried out to analyze the clinical signs and symptoms and evaluation done of clinical findings, tumour marker study, ultrasonography, and the plan of treatment. Results: Laparotomy was done in 200 cases, clinically ovarian masses were diagnosed as benign in 75%, by Tumor marker i.e. CA125 in 80%, by sonography in 70% and by histopathology in 83%. The study was statistically analyzed. The values in diagnosis of ovarian mass clinically and comparing with other parameters was significant p value<0.05. Conclusion: Clinical signs and symptoms are still important predictors in reaching the diagnosis of benign Ovarian Mass.

Twin to twin transfusion endangering the mother.

There was a case of Twin to twin transfusion syndrome (T.T.T.S.) with one dead monster baby and other alive low birth weight baby, leading to early Disseminated Intravascular Coagulation(D.I.C) in mother, in Obstetric ward of C.R. Gardi Hospital Ujjain, (M.P) India.

Primary internal iliac artery ligation – an effective technique for surgical hemostasis in wertheim’s hysterectomy.

Objective: Lessening intra-operative blood loss by the technique of bilateral internal iliac artery ligation as 1st step in Wertheim’s Hysterectomy. Methods: 20 cases of early Stage Cancer Cervix, who underwent Wertheim’s hysterectomy over period June 09 to Dec 12 in CRG Hospital, Ujjain and Base Hospital Delhi Cantonment, were studied. The demographic data, hemoglobin before and after surgery, and requirement of intra-operative blood transfusion, were studied. Results : 80% patients had less than 200ml intra-operative blood loss. Conclusion : Alleviating troublesome bleeding during dissection of lymph nodes and ureteric tunnel by primary ligation of internal iliac artery is a statistically proven optimum technique of Wertheim’s Hysterectomy.

Endometrial thickness as a test for endometrial cancer in women with abnormal postmenopausal and perimenopausal vaginal bleeding & its histopathological correlation.

Introduction: The menopausal & perimenopausal age are characterized by a deficiency of progesterone and relative hyperestrogenism leading to increased risk of carcinoma endometrium. Transvaginal ultrasonography is used to evaluate the thickness of endometrium in perimenopausal & postmenopausal women presenting with abnormal bleeding per vaginum & its histopathological classification was done. Material & Methods: This retrospective study was carried out in R D Gardi Medical College and Hospital, Ujjain. Seventy five cases were selected from May 2010 - May 2012 and studied in respect to age,parity,socio-economic status, and endometrial thickness in women with abnormal bleeding per vaginum & its relation to histopathology findings of endometrium obtained through D & C. Results:Out of seventy five cases, 49(65.5%) were in perimenopausal age group, and 26(34.5%) in postmenopausal age group. Endometrial thickness greater than 12mm was in 73.4% of perimenopausal and 25.3% of postmenopausal women. In perimenopausal women with abnormal bleeding,histopathology showed‘Benign Hyperplasia’in 51%, ‘Proliferative endometrium’in 26.5%, ‘Secretary endometrium’ in 4.08%, ‘Atrophic endometrium’ in 2.04%, ‘Atypical Hyperplasia’ in 10.2%, andcarcinoma in 6.12%.Whereas in postmenopausal women, Atypical Hyperplasia in 11.4%, carcinoma in 46.12%,benign hyperplasia in 7.6%, proliferative endometrium in 15.33%, secretary endometrium in 7.69%, and atrophic in 11.4%. Conclusion: In majority endometrial thickness by TVS may be helpful in planning investigation protocol and further management.