Pattern of Syringomyelia in Presumed Idiopathic and Congenital Scoliosis

Methods@#We analyzed the radiological records of 44 consecutive patients with scoliosis and syringomyelia. Of these 44 patients, 13 had IS, 12 had CM1, and 19 had congenital scoliosis. The radiographs were evaluated to determine the curve magnitude, sagittal alignment, side of convexity, and type of vertebral anomaly, if any. T1- and T2-weighted magnetic resonance imaging of the whole spine was analyzed to determine the presence of craniovertebral anomalies, syrinx length, syrinx diameter, and syrinx-cord ratio (SCR). @*Results@#The frequency of left convex curves was 26.1%, with no significant differences across the three groups. The mean length of the syrinx was 7.2±4.9 vertebral levels, and the mean SCR was 0.39±0.2. The mean syrinx length was significantly higher in patients with CM1 and IS, compared to patients with congenital scoliosis. The mean SCR was highest in patients with CM1. In congenital scoliosis, syringomyelia was seen most frequently in patients with a failure of formation, and 63.2% had concomitant cord anomalies. @*Conclusions@#Syrinxes were smaller in size and length in patients with congenital scoliosis, and are distinct from those seen in IS and CM1.

Fertility outcomes following myomectomy in infertile patients at our centre: a retrospective analysis

Background: Fibroids have been known to cause infertility due to multiple factors. However, the role of myomectomy in patients with intramural and subserosal fibroids has been a topic of debate. This study evaluates outcomes following myomectomy in patients seeking treatment for infertility at study centre.Methods: This was hospital based retrospective study which evaluated 92 infertile patients who took treatment for infertility.Results: A total 41.3% patients conceived within one year of myomectomy. Pregnancy rates were better in patients with intramural combined with submucous fibroids, age between 30 and 35 years, size of largest fibroid between 3 and 6 cm and when number of fibroids were between 3 and 6 and conception was maximum after ovulation induction.Conclusions: Pregnancy rates after myomectomy are better in young patients with large fibroids. Active management for infertility needs to be done after myomectomy.

Obstetric and perinatal outcomes in pregnancies occurring as a result of Fresh and Thawed frozen embryo transfer

Background: In vitro fertilization is a known independent risk factor for adverse perinatal outcomes. To explore obstetric and perinatal outcomes in pregnancies occurring as a result of fresh and thawed frozen embryo transfer.Methods: Retrospective observational study with 208 patients. A period of 2 years from October 2015 to October 2017. Tertiary care Fertility, Laparoscopy and research centre. All pregnancies conceived by IVF (n= 208) between the study period were included. The patients were grouped by fresh (n= 108) versus frozen (n= 100) embryo transfer. Patients conceived with donor embryo transfer were excluded. Primary outcomes were missed abortions, ectopic pregnancy, live births. Incidence singleton pregnancies and multiple gestations, preterm delivery, birth weight, an obstetric complication includes gestational hypertension, preeclampsia, gestational DM, placenta previa.Results: A total 208 patient analyzed who conceived with IVF treatments, among them 108 patients were in Fresh ET group and 100 were in Frozen ET group. The incidence of Ectopic Pregnancy was more in fresh ET as compared to Frozen ET (14.8%, 02% respectively, p value <0.05) whereas that of missed abortions were more in Frozen ET (22% versus 11.1%, p value 0.03). There were no significant differences in obstetric and perinatal outcomes in both groups.Conclusions: In this study of IVF pregnancies, adverse obstetric and neonatal outcomes did not differ between fresh and frozen embryo transfers. Literature tells that there may be an increased risk of preeclampsia and large for gestational age babies in pregnancies conceiving after frozen embryo transfer. So freeze all policy should be applied to only indicated cases and not to all because both the groups having similar outcomes.

Prognostic factors in diffuse proliferative lupus nephritis.

BACKGROUND: Patients with diffuse proliferative lupus nephritis (DPLN) can have variable clinical course. Identification of the predictors of outcome would help to improve the management. We have studied the prognostic significance of clinical, laboratory and histological parameters in patients with DPLN. METHODS: Twenty nine patients diagnosed to be having DPLN seen between 1987 and 1991 were followed up for over 57 months. Parameters assessed for prognostic significance included serum creatinine, urine protein at the time of biopsy, blood pressure, type of immunosuppression, composite scores and individual components of activity index (AI) and chronicity index (CI). Kaplan-Meier survival curves were plotted and the results were compared using log rank test. Fishers' exact test was used to study the risk factors. RESULTS: End stage renal failure developed in 7/29 (24.1%) patients; 7/19 (36.8%) who had hypertension and 7/16 (43.8%) who had nephrotic proteinuria developed renal failure, while none who had normal blood pressure or nonnephrotic proteinuria, developed renal failure (p < 0.01). Three patients had high activity index (> 12) and all three developed renal failure. Other parameters such as age, gender, serum creatinine, type of immunosuppression, CI and individual components of AI failed to predict the outcome (p > 0.05). CONCLUSION: Hypertension, nephrotic proteinuria and high AI were predictive of progression to end stage renal failure in patients with diffuse proliferative lupus nephritis.

Treatment of diffuse proliferative lupus nephritis: an Indian experience.

BACKGROUND: Immunosuppressive therapy has improved the prognosis in lupus nephritis. However, infectious complications may contribute to morbidity. There is also debate on the best form of therapy. We, therefore, compared the results of two different forms of therapy. METHOD: Twenty-nine patients diagnosed to have diffuse proliferative lupus nephritis were followed up over 54 months. The treatment consisted of azathioprine (1.5 mg/kg/day) or pulse intravenous cyclophosphamide (500 mg/m2 body surface area monthly) along with prednisolone (2 mg/kg on alternate days). RESULTS: Seventeen patients received azathioprine (group A) and 12 received cyclophosphamide (group B). The mean (SD) follow up in groups A and B were 54.35 (33.6) and 52 (35.8) months, respectively. Apart from the higher number of males in group B, both groups were comparable for age, presence of hypertension, renal function, 24-hour urinary protein excretion and composite scores for histological activity and chronicity indices (p > 0.05). The renal survival estimated by the Kaplan-Meier method was similar in both groups (p > 0.05). Four patients had renal failure requiring replacement therapy in group A and 3 in group B. Major infective episodes were more common in group B than in group A (p = 0.03). CONCLUSION: Azathioprine was as effective as pulse intravenous cyclophosphamide in preserving renal functions up to 54 months. Major infective episodes were more common with pulse intravenous cyclophosphamide.