A prospective randomized comparative study of vicryl rapide versus chromic catgut for episiotomy repair.

BACKGROUND AND OBJECTIVES: A significant number of women experience perineal trauma following vaginal deliveries and they require stitches. This may result in perineal pain, dyspareunia and faulty healing. The type of suture material which is used, will influence these factors. This study was conducted to compare the impact of two absorbable suture materials which were used for episiotomy repair, namely vicryl rapide and chromic catgut in relation to a short term maternal morbidity, in terms of the perineal pain and the wound healing. METHODS: This was a prospective, randomized study which was conducted in the hospitals which were attached to JJMMC, Davangere. Four hundred women with episiotomies were randomly allocated to repair with either vicrylrapide or chromic catgut (200 each). The outcome measures which were assessed were perineal pain and wound healing at 24-48 hours, 3-5 days and 6 weeks postpartum. RESULTS: The two groups were similar at the trial entry. As compared to the chromic catgut group, the vicryl rapide group was associated with less pain (32.5% vs 57%) and a less need for analgesia (15.5% vs 0.5) at 3-5 days. There was also a signifi- cant reduction in the wound indurations, uncomfortable stitches and wound dehiscence (4% vs 13.5%) and a better wound healing (p<0.05 significant) in the vicrylrapide group. No significant difference was noted in the perineal pain at 6 weeks postpartum. Wound infections (3.5%) and wound resuturing (2%) were seen in the chromic catgut group and they were absent in the vicrylrapide group. INTERPRETATION AND CONCLUSION: So, this study concluded that vicrylrapide was the ideal suture material for episiotomy repair, which resulted in less perineal pain and a better wound healing.

Premature Rupture of Membranes at Term: Immediate Induction With PGE(2) Gel Compared With Delayed Induction With Oxytocin.

OBJECTIVES: To compare the effectiveness, safety of immediate induction with PGE(2) gel and expectant management in terms of maternal and fetal outcome in term PROM. METHODS: 100 women were randomized to group A, immediate induction and group B expectant management. RESULTS: Spontaneous vaginal deliveries were more in group B. CS and operative vaginal deliveries were more in group A. CONCLUSION: Expectant management followed by delayed induction with oxytocin is better than immediate induction with PGE(2) gel in term PROM. A good number of women go into spontaneous labor and deliver vaginally with out increase in the Cesarean section rate and infectious morbidity for mother and fetus.

Magnetic resonance imaging (MRI) in evaluation of left atrial masses: an in vitro and in vivo study.

Thirty patients, 15 each of suspected of left atrial myxoma and clot were studied in a prospective study to assess the role of magnetic resonance imaging (MRI) in evaluation of left atrial masses. Upon clinical and echocardiographic suspicion of a left atrial mass, patients were subjected to ECG-gated MRI (in vivo study) and subsequently all of them underwent surgery for the removal of mass and/or mitral valve replacement/repair. Within 6 hours of its removal the mass was subjected to in vitro MRI study and subsequently to histopathological examination. During the study T1, T2 gated images were obtained and tissue characterization was done. A magnetic dye Gd-DTPA was used for contrast enhancement. Cine-display of the images was obtained to demonstrate dynamic movement of the mass across the mitral valve. MRI was found to be highly useful in delineating the exact anatomical details of left atrial masses. Results of MRI diagnosis with illustrations are discussed.

Dimensions of potential arterial grafts for coronary artery bypass grafting in Indians--an autopsy evaluation study.

Total revascularization of the heart using as many arterial grafts as possible is the trend of the day. We have chosen two commonly used arterial grafts to evaluate their efficiency in myocardial revascularization in Indian subjects. An autopsy study was conducted in 25 cases. Both internal mammary arteries with their branches and the right gastroepiploic artery were harvested. These arteries were distended with heated Gelatin, deep frozen and their diameters were measured. In 56% of subjects diameter of internal mammary artery was 1.5 to 2.0 mm (n = 14). However 36% of subjects had diameter above 2.0 mm (n = 9). Musculo-phrenic and superior epigastric arteries had 1.85 and 1.65 mm internal diameters respectively. The mean internal diameter of right gastro-epiploic artery was 2.3 mm. When these diameters were indexed to the body surface area, they were comparable with similar figures from western subjects.