Intra-abdominal Breakage of Laparoscopic Needle Holder Tip and Its Retrieval Under Fluoroscopic Guidance.

BACKGROUND: Intra-operative breakage of laparoscopy instruments is a rare occurrence. It entails a risk of the foreign body being retained in the abdomen and may lead to medico-legal implications. The foreign body migrates due to bowel movements. Therefore, the retrieval of such foreign bodies can be challenging even for a highly skilled and experienced surgeon. Fluoroscopy can guide in locating the missing foreign body. The only preventive measure is the vigilance of the operating team and thorough inspection of all the instruments prior to completion of surgery. CASE REPORT: We present a case report of a 50-year-old lady who underwent total laparoscopic hysterectomy with bilateral salpingoopherectomy at a private nursing home. During the closure of the vault, the tip of the needle holder broke inside the abdomen and the primary surgeon was unable to retrieve it. The missing tip of the needle holder was removed from the right hypochondriac region, by a second laparoscopic surgery by an advanced laparoscopic surgeon under fluoroscopic guidance. CONCLUSION: Intra-operative breakage of laparoscopy instruments can occur, demanding a great deal of expertise for the retrieval of such foreign bodies. Fluoroscopy can guide in locating the missing foreign body which can be retrieved by an expert laparoscopic surgeon.

A randomized control trial to study the effect of integrated yoga on pregnancy outcome in hypertensive disorder of pregnancy.

OBJECTIVE: The study aimed to evaluate the effects of integrated yoga on blood pressure and pregnancy outcome in hypertensive disorder of pregnancy. METHODS: Seventy-nine patients were randomized into study and control groups. The study group received the intervention in the form of integrated yoga for 4 weeks. Final analysis was done on 30 patients each of study and control group. RESULTS: The mean systolic BP declined by 7.43 ± 5.86 mmHg in the study group as compared to 2.50 ± 5.21 mm Hg in the control group (p value 0.002). The mean diastolic BP prior to delivery was 88.00 ± 3.71 mmHg in the study group and 92.20 ± 5.02 mmHg in the control group (p = 0.001). The maternal comfort in labor was significantly higher and the duration of labor significantly reduced in the study group. CONCLUSION: Integrated yoga effectively reduced systolic and diastolic blood pressures and increased maternal comfort during labor in hypertensive disorder of pregnancy.

Urogenital myiasis - An atypical presentation

The infestation of the human body by maggots has been reported worldwide and occurs most commonly in people of lower socioeconomic status and poor personal hygiene. Urogenital is the rarest site of myiasis presentations. Here we report the case of a 20-year-old, sexually inactive female student who presented with a necrotic growth in the paraurethral region infested with numerous maggots. The lesion involved the urethra and the bladder base. She was treated with debridement and bladder irrigation. The cystoscopy and local examination performed 2 weeks after admission, confirmed the complete healing of the urogenital lesion. Managing this patient's unique challenge was to assess the extent of the involvement and removal of all maggots from the deepest wound portion. The female internal and external urogenital myiasis is a very occasional and under-reported health hazard. Reporting such cases increases the public and physician awareness about the mode of presentation, right diagnosis, and available treatment options.

Retrospective Analysis of 32 Cases of Ovarian Granulosa Cell Tumours.

INTRODUCTION: Granulosa cell tumour (GCT) comprises 2-5% of ovarian malignancies. They are hormonally active tumours and may present with menstrual complaints, abdominal distension or infertility. Prognosis is generally favourable because of the early stage at diagnosis and less aggressive behaviour. MATERIALS AND METHODS: Medical records of 32 cases presenting from January 2008 to December 2014 were retrospectively analysed for the patient characteristics, tumour characteristics and the treatment received. RESULTS: The mean age was 42.75 ± 10.25 years (range: 22 to 70 years). The most common presenting symptom was abdominal distension (50.00%) followed by menstrual complaints. The mean tumour diameter was 15.24 cm (range: 4-25 cm). Endometrial pathology was found in 4 patients (12.50%), and all had simple hyperplasia without atypia. Twenty-four patients underwent primary staging surgery; one patient underwent interval debulking surgery after neo-adjuvant chemotherapy. Seven patients had undergone surgery elsewhere of which 4 underwent re-staging and three were given chemotherapy. All patients had the final histopathology of adult granulosa cell tumour except one patient with juvenile granulosa cell tumour. Most patients had stage I disease (81.25%). Post-operative chemotherapy was administered to 22 patients. The most commonly used regimen was paclitaxel and carboplatin. The overall 5-year survival rate was 90%. The mean overall survival was 36.95 ± 34.08 months (range: 0.50 to 112.00 months). Two patients had recurrence at 38 and 44 months, respectively. CONCLUSION: GCT of the ovary is a rare tumour with a tendency for late relapse. Survival is generally excellent as majority of the patients present in early stages.

Urogenital myiasis - An atypical presentation.

The infestation of the human body by maggots has been reported worldwide and occurs most commonly in people of lower socioeconomic status and poor personal hygiene. Urogenital is the rarest site of myiasis presentations. Here we report the case of a 20-year-old, sexually inactive female student who presented with a necrotic growth in the paraurethral region infested with numerous maggots. The lesion involved the urethra and the bladder base. She was treated with debridement and bladder irrigation. The cystoscopy and local examination performed 2 weeks after admission, confirmed the complete healing of the urogenital lesion. Managing this patient's unique challenge was to assess the extent of the involvement and removal of all maggots from the deepest wound portion. The female internal and external urogenital myiasis is a very occasional and under-reported health hazard. Reporting such cases increases the public and physician awareness about the mode of presentation, right diagnosis, and available treatment options.