Pregnancy Following Surgery Of Multiple Pelvic Hydatid Cysts.

Abstracts: Background: Hydatid cyst in pelvic region is very rare. A patient was admitted in Gynaec ward with complaints of , lump and pain in lower abdomen and, constipation since, five months. General examination was normal. Abdominal and gynaecological examination lead to diagnoses as ovarian cyst ? Multiple uterine subserous fibroids? Ultra sonography diagnosis was Hydatid cysts abdomen / Mucininious cystadenoma ovaries . CT Scan abdomen and pelvis confirmed USG findings of Hydatid cysts. On Laprotomy multiple hydatid removed from pelvic region , omentum , ileocaecal junction and liver . Patient put on chemotherapy and follow up was satisfactory.

Ovarian Pregnancy.

Primary ovarian pregnancy is a rare type of extra-uterine pregnancy, and occurs in 1:7000 to 1: 40,000 deliveries. This is a case that occurred in a 26 years old multiparous woman. She had presented with pain abdomen and bleeding per vaginum and was hemodynamically stable, negative pregnancy test, but vaginal examination showed painful cervical movements, slight bleeding through external os, uterus just bulky, tender mass felt in right adnexa. Ultrasonography revealed—Right tubo-ovarian mass with fluid in peritoneal cavity. Laparotomy showed Right Ovarian Pregnancy. Managed by Right Ovariectomy.

An Unusual Presentation of Choriocarcinoma.

Gestational choriocarcinoma is a highly malignant tumor of trophoblastic cells with a propensity to metastasize to various sites including lungs, vagina, brain, liver, kidney, and gastrointestinal tract, in descending order of frequency. Usually it is treated by chemotherapy but rarely hysterectomy is indicated if bleeding is heavy, or if tumor is resistant to chemotherapy A 45-year-old woman presented to the hospital as an emergency with heavy bleeding per vagina since 4 days preceded by abdominal pain. H/O spontaneous abortion of 5months pregnancy 2 yrs back and was asymptomatic since 2years. Investigations showed severe anemia and high level of β-hCG. She underwent Total abdominal Hysterectomy for heavy bleeding and Histopathology revealed it to be a case of gestational choriocarcinoma. Chemotherapy was given pre and postoperatively and resulted in complete cure.

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.

Comparative Evaluation of Hystero-Salpingography and Laparoscopy For Determination of Tubal Patency.

Objective: To find out whether Hysterosalpigography (HSG), can be used as initial method for assessing tubal factor of infertility, instead of more invasive method like diagnostic laparoscopy. Methods: Retrospective analysis of 75 cases, who had attended infertility Clinic at Medical College, Ujjain, and underwent HSG as initial test followed by Laparoscopy from November 2005 to December 2010. Results: Primary infertility was the major cause of tubal factor of infertility (75%) and majority of women were between 20-25 years (60%). In comparison to laparoscopy, HSG has 80.8% sensitivity & 100% specificity for determination of tubal patency. HSG also has a high sensitivity (100%) for determination of unilateral or bilateral blockage with specificity of 100% & 85.3% respectively. HSG can detect only endo-tubal and intrauterine pathology, whereas laparoscopy can detect pelvic pathology. Conclusion: HSG should be used as initial test to assess tubal patency whereas laparoscopy should be limited to selected cases.

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.

Study of primary caesarean section in multiparous women.

Background: This prospective study was carried out to assess, indication, maternal & fetal outcome of primary caesarian in multiparous women. Materials & Methods: 50 women with primary CS (caesarean section) studied in multiparous women studied and analysed. Results: Most of women belonged to >25yrs age group, rural, & low socio-economic group, Malpresentation, Low AFI (amniotic fuid index), Fetal Distress were most common indications. Post operative uneventful in majority of cases. Conclusion: Antenatal care in multigravida, USG (ultra-sonography) Analysis Close monitoring can reduce CS(caesarean section) in multipara.

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.

Vanishing twin, natures choice.

A surprising finding at emergency Caesarean Section of an empty sac, along with fetus & placenta , was observed. Retrospectively, when USG reports were reviewed it was a case of Vanishing Twin after 20 wks of gestation. This syndrome is diagnosed more frequently since the use of USG has become a common investigation. Probably the twin which vanishes may be chromosomally abnormal. Prognosis of the surviving twin is generally excellent but depends on the etiology of the death of the dead twin.

Role of yoga for better outcome of pregnancy.

Introduction:The present study was undertaken to document if Yoga provides solution for many pregnancy induced problems, antenataly, during labour, and peurparium. Method: Group of 50 women taking antenatal care were included in the study, a questionnaire was designed to assess the effect of regular Yoga exercises, on the mode of labour and outcome. Results: Regular yoga exercises and follow up had a positive impact on results regarding outcome improvement and reduced complication rate. Conclusion: Regular yoga exercises gives an opportunity to create a world for the baby that is healthy and peace full by coordinating movement, breath and awareness, addresses health and wellbeing on several levels: physical, emotional, psychological and spiritual. Because of its many benefits, yoga is becoming increasingly accepted everywhere as part of self-care during pregnancy and preparation for childbirth and motherhood.

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.

Abdominal tuberculosis--a study of 25 cases.

Abdominal tuberculosis is one of the common extra pulmonary tubercular infections. Its clinical presentation is protean and it has diagnostic dilemma, as most of the investigations are non-specific and less sensitive. Therefore this study was undertaken to define the most suggestive clinical features of abdominal tuberculosis, to find out the efficacy of most commonly available investigations and also to evaluate the response of abdominal tuberculosis to conventional antitubercular therapy. Twenty five cases of either sex were studied in department of gastroenterology in BSMMU (earlier IPGMR), Dhaka from January 2001 to June 2003. All patients were clinically evaluated and were investigated by available tests. Eighteen patients were diagnosed by investigations (One by detecting AFB, 9 with caseating granuloma in biopsy specimen and 8 with suggestive radiological findings). Diagnosis of 7 patients were made from the common clinical features (fever, weight loss, altered bowel habit, abdominal pain and distension, positive non-specific findings and from response by antitubercular therapy. All patients received conventional 9 month anti-tubercular treatment with Rifampicin, Isoniazide and Pyrazinamide and were followed up clinically during and one year after completion of treatment. All patients were improved with minimum side effects of drug. Therefore, it is observed that a representative tissue biopsy (when approachable) and radiological findings are good method of diagnosis of abdominal tuberculosis. Strongly suggestive clinical features with positive non specific investigation findings are also an indication for anti tubercular treatment in all endemic countries like Nepal, Bangladesh and India. Treatment of abdominal tuberculosis is in no way different from that of other conventional anti-TB therapy.

High frequency shoot regeneration from nodal and shoot tip explants in Holarrhena antidysenterica L.

Shoot tip and nodal segment explants of Holarrhena antidysenterica when cultured on MS medium containing BAP (1.0-3.0 mg/l) with NAA (0.2-1.0 mg/l) and BAP (1.0-3.0 mg/l) with Kn. (0.2-1.0 mg/l) produced multiple shoots. Maximum multiple shoots was found in MS medium supplemented with BAP (2.0 mg/l) and NAA (0.5 mg/l). Subculture on the same medium resulted in rapid shoot multiplication at an average rate of 16 new shoots per subculture. Addition of urea (100 mg/l) in the medium increased the number of shoots up to 22 per culture. For best rooting, the shoots were excised from the culture flask and implanted individually on half strength MS medium with 0.5 mg/l each of IBA, IAA and NAA. After 20 days of transfer on root induction medium 95% rooting was achieved. Regenerated plantlets were successfully acclimatized and established in soil. About 90% of plantlets survived under open field conditions.

Cholesterol side-chain cleavage by immobilized cells of Rhodococcus equi DSM 89-133.

Side-chain cleavage of sterol and extracellular cholesterol oxidase activity were investigated using viable cells of R. equi DSM 89-133 immobilized in polyacrylamide gel. In batch culture, immobilized cells were active in side-chain cleavage of cholesterol for more than 30 days. Free or immobilized cells were incapable of side-chain cleavage in the absence of 2,2' dipyridyl; cholesterol oxidase was, however, produced in both the cases. Maximal activity of the immobilized cells was 60 to 70% of the free cells.

Transformation of sitosterol to androsta-1, 4-diene-3, 17-dione by immobilized Mycobacterium cells.

Transformation of sitosterol to androsta-1, 4-diene-3, 17-dione was studied with Mycobacterium cells entrapped in various polymeric matrices. Of the three supports viz. alginate, carageenan, agarose and polyacrylamide, studied, the polyacrylamide immobilized cells showed optimum catalytic stability and reusability.

Stroke in patients having inadequate or irregular antihypertensive therapy.

One hundred consecutive hypertensive patients with stroke admitted to the medicine units of Dhaka Medical College Hospital were studied. The main objective was to study the extent of drug compliance and control of blood pressure in hypertensive patients who had suffered a stroke. Detailed history and clinical examinations were performed in all patients and outcome was recorded. Of the 100 patients studied there were 73(73%) males, 27 (27%) patients had no formal schooling and 53 (53%) had some education. 48 (48%) patients were from middle class and 36 (36%) were poor, 66 (66%) patients were aware that they were hypertensive though only 8 (12.9%) were taking anti-hypertensive drugs regularly. 62% of the patients had suffered from stroke within 5 years of detection of hypertension, and 15 (15%) patients died in the hospital.

Correlation of percutaneous transhepatic cholangiogram with operative findings.

Percutaneous transhepatic cholangiography (PTC) diagnosis of extrahepatic biliary obstruction was correlated with laparotomy findings. Out of a total of 55 cases who had PTC, 28 underwent laparotomy. PTC diagnosis of the cause of obstruction was correct in 93 percent of them. The differentiation of benign from malignant lesion was accurate in all the cases. It is concluded that PTC is valuable in the diagnosis of the cause of extrahepatic obstruction.