Study of route of hysterectomy

Background: The objective is to study complication rate, advantages and outcome of different route of hysterectomy.Methods: A prospective study of 175 women over a period of 1 year i.e. from 01/01/2011 to 31/12/2011 SSG hospital, Vadodara. Depending on the patient profile, experience of surgeon optimum route of hysterectomy was decided.Results mean operating time in AH group was 68.4±14.4min, which was 80±10.3min, 115.8±40.6min and 148.8±25.5min in NDVH, LAVH and TLH group respectively. TLH was performed by consultants. Febrile morbidity was significantly high in AH (23%). Bladder and ureteral injuries were seen in 4% and 3% cases of NDVH and AH group. Wound complications were seen in AH (10%), whereas vault complications were higher in TLH. The hospital stay was shortest in TLH. Women with TLH had early ambulation, early resumption to normal diet, early return to routine work and better sexual function.Conclusions: Women with excessively enlarged uteri, significant pelvic pathology, or cancer are obvious candidates for AH. On the other hand, VH is frequently chosen for the small uterus in a multiparous woman with a large pelvis and no prior pelvic inflammatory disease or surgery. Although TLH, LAVH have significantly lower complication rate than AH, but overall cost is higher owing to the high operating room charges. The final selection of hysterectomy route should be based on surgeon’s experience and indication for surgery.

Impact of socio-cultural aspects on parity.

Objectives : To study socio-cultural aspects for 3 or more pregnancy after 2 live issues. Methods : it is a prospective study of 1321 cases that had third or more pregnancy after having two live issues done over a period of 1 year(01/01/2009 to 31/12/2009) at SSGH, Vadodara. Two groups of women were included – the group of women who came for the termination of the pregnancy after having two live issues (57.15%) and the other group who came in the labor room either for delivery or spontaneous abortion. Women were interviewed in detail. Results: the incidence of the study cases was 23.46% with 57.15% cases for termination. 89.63% were from lower socio economic. In MTP group husband was decision maker in 65.96%, where in laws were decision maker in 59.36% cases in second group. Mistimed conception was seen in 63.29% cases and the most common reason being negligence of contraception(33.97%) against planned conception in only 36.71%. 63.70% cases had wanted pregnancy for son preference. Conclusion: a small planned family has many advantages. Unintended and unwanted pregnancies add to population’s burden or the need for pregnancy termination. Every pregnancy should be planned and every baby should be wanted. The solution of all women’s problems lies in empowering them by education, employment and better health care & informed choice of contraception.

The acceptance rate of contraception.

Objectives : To study acceptance rate of contraception after 3 or more pregnancy after 2 live issues. Methods : It is a prospective study of 1321 cases that had third or more pregnancy after having two live issues done over a period of 1 year(01/01/2010 to 31/12/2010) at SSGH, Vadodara. Two groups were included – women who came for the termination of the pregnancy after having two live issues (57.15%) and women who came in the labour room either for delivery or spontaneous abortion. Results : incidence of the study cases was 23.46% with 57.15% cases for termination. 89.63% were from lower socio economic. Mistimed conception was seen in 63.29% cases and the most common reason being negligence of contraception(33.97%) against planned conception in only 36.71%. 64.35% accepted contraception at the time of hospitalization, but 36.73% came for accepting contraception. Conclusion : A small planned family has many advantages. Every pregnancy should be planned and every baby should be wanted. Capsule: The most common reason for unwanted pregnancy is the non use of contraception or contraceptive failure. Unintended and unwanted pregnancies add to population’s burden or the need for pregnancy termination. Every pregnancy should be planned and every baby should be wanted.

Effect of malnutrition on the digestive enzymes of the upper gastrointestinal tract of young rhesus monkeys.

The present study was planned to observe the effect of protein-energy malnutrition on the gastric and duodenal mucosa. The activities of digestive enzymes (i.e. lactase, sucrase, maltase, trehalase, glucoamylase, leucine aminopeptidase, alkaline phosphatase and gamma-glutamyl transpeptidase) from the gastric (fundus, body and antrum) and duodenal mucosa [i.e. first (D1) and second (D2) part of the duodenum] were determined in 6 control, 6 protein-energy malnourished (PEM) and 6 rehabilitated young rhesus monkeys. There was a significant increase in the activity of the lactase enzyme in the antrum, and D1 and D2 portions of the duodenum of PEM monkeys, while the activity of all other enzymes was significantly increased in the D1 and D2 portions only. The increase in the activity of the above-mentioned enzymes became normal upon rehabilitation. There was no change in the enzyme activities of the gastric mucosa in mild-to-moderate PEM states. This study demonstrates that even mild-to-moderate malnutrition states affect the activity of enzymes in the gastric and duodenal mucosa. Enzyme activity recovers on rehabilitation.