Characteristics of gestational diabetic mothers and their babies in an Indian diabetes clinic.

AIMS AND OBJECTIVES: To compare clinical and metabolic features of mothers with gestational diabetes (GDM) and their offspring with those in non-diabetic pregnancies at the King Edward Memorial Hospital, Pune, India. MATERIALS AND METHODS: Antenatal information was obtained from hospital records. GDM was diagnosed by 75 g OGTT (Oral Glucose Tolerance Test) in clinically high-risk women. Anthropometric measurements of mother and the babies were recorded within 24h of delivery and a maternal blood sample collected for hematological and biochemical measurements. RESULTS: Between the period Jan 1998 to December 2003,265 women with gestational diabetes were treated in our Unit. Forty nine percent had first-degree relatives with diabetes. Compared to non-diabetic mothers (n=215) GDM mothers were older (29.0 vs. 26.0y, p<0.001), more obese (body mass index- BMI 26.0 vs. 22.0 kg/m2, p<0.001), centrally obese (Waist hip ratio-WHR 0.89 vs 0.86, p<0.001), adipose (sum of 4 skinfolds 98.4 vs. 61.4 mm, p<0.001) and had higher blood pressure (127/80 vs. 122/70 mmHg, p<0.001). GDM mothers had higher concentrations of plasma triglycerides (195.0 vs. 153.0 mg/dl, p<0.01); blood hemoglobin (11.7 vs 10.9 g/dl, p<0.001) and higher platelet count but lower concentration of HDL cholesterol and albumin. Sixty percent GDM mothers and 34% of non-diabetic mothers were delivered by caesarean-section, 23% of GDM mothers delivered pre term (<37 wk). Despite the smaller gestation, babies of GDM mothers were heavier (BW 2950.0 vs. 2824.0g, p<0.001, adjusted for gender), longer (48.9 vs. 48.0 cm, p<0.01) and more adipose (sum of 2 skinfolds 10.5 vs. 8.5 mm). Only 5% of babies born to GDM mothers weighed > 4000 g but 30% were >90th centile of birth weight of babies born to non-diabetic mothers. Babies of GDM mothers suffered higher neonatal morbidity. CONCLUSIONS: GDM mothers in urban India are more obese and more adipose than non-diabetic mothers, frequently have a family history of diabetes and show metabolic features of insulin resistance syndrome, suggesting high cardiovascular risk. Neonates of GDM mothers are heavier, longer and more adipose than those born to non-diabetic mothers, and suffer higher neonatal morbidity.

Nonfunctioning islet cell tumor presenting with ascites and portal hypertension.

Nonfunctioning islet cell tumors commonly cause no symptoms. A 22-year-old woman presented with lump in the left hypochondrium, refractory high-protein ascites and evidence of left-sided portal hypertension. At exploratory laparotomy, a 30 cm x 15 cm mass was seen at the splenic hilum, with large collateral vessels around. Distal pancreatectomy with splenectomy was done. Histology of the mass showed malignant islet cell tumor infiltrating the spleen. The patient died in the postoperative period.

Ruptured splenic abscess presenting as pneumoperitoneum.

Spontaneous pneumoperitoneum follows perforation of hollow viscus; rarely, it may arise from pulmonary interstitial emphysema or intestinal inflammatory disease. We report a 30-year-old man with ruptured splenic abscess who presented with acute abdomen and had pneumoperitoneum. He was treated with splenectomy and is asymptomatic 2 months later.

Iatrogenic gastric fistula due to inappropriate placement of intercostal drainage tube in a case of traumatic diaphragmatic hernia.

A 26-year-old, 30 weeks primigravida presented with a gastric fistula through a left intercostal drain, which was inserted for drainage of suspected haemopneumothorax following minor trauma. It was confirmed to be a diaphragmatic hernia, with stomach and omentum as its contents. On exploratory laparotomy, disconnection of the tube and fistulous tract, with reduction of herniated contents and primary suturing of stomach was carried out. Diaphragmatic reconstruction with polypropylene mesh was also carried out. Post-operative recovery was uneventful with full lung expansion by 3rd postoperative day. Patient was asymptomatic at follow-up 6 months.

Laparoscopic repair of Morgagni hernia in adult.

Foramen of Morgagni hernias require surgical treatment; laparoscopic repair is another option with lower morbidity. We describe a 35-year-old man with Morgagni hernia treated successfully by laparoscopy.

Leiomyosarcoma of third part of duodenum with perforation.

Malignant stromal cell tumors of the duodenum present with pain or bleed. We report a patient with leiomyosarcoma of the third part of the duodenum that presented with perforation.

Ruptured true aneurysm of the splenic artery: an unusual cause of haemoperitoneum.

True aneurysm of the splenic artery is rare. Two cases of ruptured true splenic artery aneurysms are presented. The first patient was a 62-year-old female who presented within 6 hours of the onset of symptoms. The other was a 27-year-old non-alcoholic male patient who was admitted in a state of shock after 2 days of observation in a peripheral hospital. Both patients had haemoperitoneum and were subjected to exploratory laparotomy. Aneurysmectomy was performed in both the patients in addition to left splenopancreatectomy in the first case and splenectomy in the second. However, due to the prolonged preoperative shock, the second patient succumbed on the third postoperative day.

Laparoscopic management of hydatid cyst of liver.

We describe the laparoscopic excision of a hydatid cyst in the liver. During the procedure, done after treatment with the scolicidal agents praziquantel and albendazole, care was taken to prevent spillage of scolices during evacuation of contents and to excise the entire germinal epithelium. The patient had no immediate or short-term complications and is asymptomatic 3 months later.

Active contrast extravasation in spontaneous rupture of hepatocellular carcinoma: a rare CT finding.

Spontaneous rupture of hepatocellular carcinomas are uncommon but constitute a critical and life threatening condition. Diagnosis is important so that either surgery or emergency arterial embolisation can be considered for hepatic haemostasis. We describe active extravasation of intravenous contrast medium on CT in a patient who presented with intraperitoneal haemorrhage secondary to spontaneous rupture of hepatocellular carcinoma.