Initial non-opioid based anesthesia in a parturient having severe aortic stenosis undergoing cesarean section with aortic valve replacement.

Pregnancy in presence of severe aortic stenosis (AS) causes worsening of symptoms needing further intervention. In the advanced stages of pregnancy, some patients may even require aortic valve replacement (AVR) and cesarean delivery in the same sitting. Opioid based general anesthesia for combined lower segment cesarean section (LSCS) with AVR has been described. However, the use of opioid may lead to fetal morbidity and need of respiratory support for the baby. We describe successful anesthetic management for LSCS with AVR in a >33 week gravida with severe AS and congestive heart failure. We avoided opioids till delivery of the baby AVR; the delivered neonate showed a normal APGAR score.

Prevalence of hypothyroidism and importance of cholesterol estimation in patients suffering from major depressive disorder.

The coexistence of hypothroidism and depression is already reported and both of these conditions are known to share some common clinical symptoms. Serum cholesterol level is known to be altered in either condition considered separately. But, no report is obtained regarding serum cholesterol level when both the conditions coexist. In this study, 78 patients (61 females and 17 males, age ranged 19 to 67 years) suffering from major depressive disorder were included. Serum T3, T4, TSH and cholesterol levels were estimated in all of them. Sixty-two patients were found to be euthyroid and 16 patients (11 females, 5 males) were found to be hypothyroid. Among female patients, 6 had subclinical hypothyroidism and 5 had overt hypothyroidism. Among male patients 3 had subclinical hypothyroidism and 2 had overt hypothyroidism. The overall prevalence of hypothyroidism in major depressive disorder was estimated as 20.5%. Mean serum cholesterol level in 62 euthyroid patients was found to be 150.9% +/- 16 mg% and that of 16 hypothyroid patients to be 190.7 +/- 12 mg% showing a significant difference (p < 0.01). Thus estimation of cholesterol in major depressive disorder patients may give an idea regarding their thyroid status and vice-versa.

Unruptured postdated pregnancy with a live fetus in a noncommunicating rudimentary horn.

Pregnancy in a noncommunicating rudimentary horn is an extremely rare and a life-threatening condition as it mostly terminates by rupture by the second trimester of pregnancy. Postdated pregnancy and delivery of a live fetus in a rudimentary horn have been rarely reported. A case of noncommunicating unruptured rudimentary horn pregnancy progressing to 41 weeks and 3 days period of gestation where the diagnosis was initially missed at obstetric sonogram at 18 and 34 weeks and then misdiagnosed later as abdominal pregnancy is being reported. Preoperative diagnosis, successful delivery of a live fetus and excision of the rudimentary horn was performed.