Congenital rubella syndrome and rubella in Vellore, South India.

Rubella, a mild, vaccine-preventable disease, can manifest as congenital rubella syndrome (CRS), a devastating disease of the fetus. To emphasize the inadequacy of the existing rubella vaccination programme in India, we evaluated epidemiological evidence of rubella virus activity with data available from a tertiary-care centre. The proportion of suspected CRS cases that were laboratory confirmed increased from 4% in 2000 to 11% in 2008. During the same period, 329 clinically suspected postnatal rubella cases were tested of which 65 (20%) were laboratory confirmed. Of women (n=770) of childbearing age, 12·5% were susceptible to rubella.

Cervical embryonal rhabdomyosarcoma and ovarian Sertoli-Leydig cell tumour: a more than coincidental association of two rare neoplasms?

A case in which an embryonal rhabdomyosarcoma of the cervix and an ovarian Sertoli-Leydig cell tumour of intermediate differentiation occurred in a 13-year-old girl is described. Although initially considered as a chance association, a review of the literature showed the co-occurrence of these two uncommon neoplasms in three previous cases. The reason for this association, which is thought to be more than coincidental, is not known, although an underlying genetic abnormality is a possibility. The ovarian tumour in this case was characterised by the presence of foci of cells with extremely pleomorphic nuclei, which initially raised the possibility of metastatic rhabdomyosarcoma. These were interpreted as foci of bizarre nuclei within the Sertoli-Leydig cell tumour.

Occult stress incontinence in women with pelvic organ prolapse.

OBJECTIVES: To study the prevalence of occult stress urinary incontinence (SUI) among Indian women with genitourinary prolapse, and determine the risk of developing SUI after vaginal hysterectomy and pelvic floor repair in Indian women with occult SUI. METHODS: A prospective cohort study of 78 women with significant genitourinary prolapse without symptoms of SUI was conducted at Christian Medical College, Vellore, India. Before the surgical intervention, the prolapse was repositioned using a pessary and a Pyridium (Parke Davis, Morris Plains, NJ, USA) pad test was performed to detect occult SUI. The primary outcome studied was the risk of developing postoperative urinary incontinence. RESULTS: Preoperatively, 67.9% of women were found to have occult SUI. The prevalence of SUI was 43.6% postoperatively, and 64.2% of the women with a positive result to the preoperative Pyridium pad test after pessary insertion were found to have urinary incontinence postoperatively. Postmenopausal women had twice the risk of developing occult SUI. CONCLUSION: Preoperative testing is useful to identify women with genitourinary prolapse who have occult SUI. Women with a positive result may need a systematic clinical evaluation and urodynamic studies to characterize the incontinence. They can be then counseled preoperatively regarding concomitant anti-incontinence procedures.

Iatrogenic secondary post-partum haemorrhage: apropos of two uncommon cases.

In this article we would like to highlight uterine pseudoaneurysm as a cause of secondary post-partum haemorrhage following Caesarean section. We would like to stress Doppler ultrasound scan as the initial screening modality for this condition. We also describe angioembolization as the prudent treatment option for this condition rather than resorting to surgery.

Tamoxifen-induced endometrial changes in postmenopausal women with breast carcinoma.

OBJECTIVES: To assess the effects of tamoxifen (TAM) on the endometrium in postmenopausal women. METHODS: A case control study of postmenopausal women with breast carcinoma, who were undergoing treatment in the Department of Radiotherapy and Surgery at the Christian Medical College Hospital, Vellore, India was done. Thirty-five women who were on tamoxifen (20 mg/day) for a period of at least 6 months formed the study group. Thirty-three women who were not receiving tamoxifen, formed the control group. Subjects in both groups had a pelvic examination and transvaginal sonogram followed by endometrial biopsy. RESULTS: There was a statistically significant difference in the mean endometrial thickness between the study group and control group (7.8+/-6.4 mm vs. 4.0+/-2.0 mm, respectively) More women in the tamoxifen group had an endometrial thickness of >5 mm but the number of women with polyps or hyperplasia of the endometrium did not differ significantly between the two groups. There were no women with endometrial carcinoma in either group. CONCLUSION: All patients on tamoxifen need to be evaluated by clinical examination annually. A transvaginal sonogram and endometrial biopsy/hysteroscopy may be performed on patients with abnormal vaginal bleeding, bloody discharge, staining or spotting.

See & treat protocol for evaluation & management of cervical intraepithelial neoplasia.

BACKGROUND & OBJECTIVES: The incidence of cervical cancer in India remains high, largely due to ineffective screening and poor patient compliance for follow up. A one step procedure where evaluation and treatment are performed at the same sitting may be a good strategy. Therefore the present study was undertaken to evaluate the feasibility of a see and treat protocol for cervical intraepithelial neoplasia in a hospital population. METHODS: A prospective study was carried out on 285 women with using cytology and colposcopy followed by large loop excision of the transformation zone when indicated as a one step procedure. RESULTS: There was a concordance between colposcopic and cytologic diagnosis. Eighteen women underwent large loop excision. Over treatment rate was 61 per cent but 80 per cent of them occurred in the low grade squamous intraepithelial lesions. The over treatment rate in high grade lesions was 20 per cent. INTERPRETATION & CONCLUSION: A single step see and treat protocol is a feasible management strategy for high grade squamous intraepithelial lesions. However, patient education is essential before undertaking the procedure.

Transvaginal sonography of the endometrium in south Indian postmenopausal women.

Endometrial carcinoma is not commonly seen in India as in the West. Nevertheless, the diagnosis has to be entertained in women presenting with postmenopausal bleeding. The aim of the study was to compare the transvaginal sonographically-measured endometrial thickness with the histopathological diagnosis in postmenopausal women. Eighty postmenopausal women were studied prospectively. All of them underwent transvaginal sonography followed by either an office dilatation and curettage and/or a hysterectomy. Eight women had endometrial carcinoma and their mean endometrial thickness was 12.6 +/- 5 mm (mean +/- SD). Taking 4 mm endometrial thickness as cut off the sensitivity of transvaginal scan to detect endometrial pathology was 97%, specificity 98%, positive predictive value 97% and negative predictive value 94%. Hence, we conclude that measurement of endometrial thickness by transvaginal scan is a good screening test in postmenopausal women for differentiating endometrial pathology from those who do not have an endometrial lesion.

Spontaneous rupture of the urinary bladder in the puerperium.

Spontaneous rupture of the urinary bladder in the puerperium is extremely rare. The patient usually presents with acute abdominal pain. Awareness on the part of the treating surgeon that bladder rupture is a possibility will lead to an early diagnosis. Immediate exploration, removing urine from the peritoneal cavity or retropubic space, closing the rupture and securing good vesical drainage, results in resumption of vesical function, and thereby decreases the mortality and morbidity.