How hairfall saved the patient from cancer twice - A postmenopausal patient with synchronous endometrial and endocervical carcinomas presenting with endocrine symptoms.

Ovarian stromal hyperthecosis is an uncommon nonneoplastic cause of ovarian hyperandrogenism mainly in postmenopausal women. Here, we present a case of a postmenopausal woman who presented with features of virilization like alopecia and hirsutism. During its workup, two malignancies were diagnosed at a very early stage. Microscopic focus of endometrial adenocarcinoma in a polyp and similar focus of endocervical adenocarcinoma in the subsequent hysterectomy specimen were noted. Presence of synchronous malignancies in the uterus is very rare and it being detected in a patient who presented with a non-related symptom of hairfall makes it an interesting case scenario.

Enhanced Recovery Pathway as a Tool in Reducing Post-operative Hospital Stay After Caesarean Section, Compared to Conventional Care in COVID Era-A Pilot Study.

OBJECTIVES: To study the implementation of ERAS (Enhanced recovery after surgery) pathway and its effect on duration of post-operative hospital stay and various phases of post-operative care in comparison with conventional care group. MATERIALS AND METHOD: Prospective study conducted in Amrita institute of medical sciences, Kochi, Kerala. Women planned for elective and scheduled caesarean section were included in the study from September 2020 to October 2020 and compared with women who underwent caesarean section in the same period receiving standard perioperative care. Women who underwent emergency and urgent caesarean section and patients with medical or surgical comorbidities were excluded. Surgical procedure was the same in both arms. Intravenous hydration was goal directed. Oral feeding was started with liquids after 2 hours, solids were given after 4 hours. Intravenous paracetamol and diclofenac were given routinely. Intravenous tramadol and fentanyl were given if needed apart from these analgesics. Foleys catheter was removed after 12 hours. Conventional care group observed 6 h of fasting pre- and post-operatively. Catheter was retained for 24 h, 2500 ml IV fluids were infused on the first day followed by 1000 ml on the second day. The duration of hospital stay was based on clinical criteria and care providers decision. RESULTS: In ERAS arm, post-operative hospital stay was significantly reduced in comparison with conventional care group. (53.91 vs 77.71 h-p = 0.00) Early feeding, early ambulation, early catheter removal, multimodal and preemptive analgesia all contributed to early recovery of the patient. CONCLUSION: In ERAS pathway length of post-operative stay was significantly reduced as compared to conventional care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13224-021-01461-6.

Symptomatology and Surgical Perspective of Scar Endometriosis: A Case Series of 16 Women.

AIM: The prevalence of scar endometriosis is increasing with the increasing caesarean deliveries and laparoscopic procedures done for pelvic endometriosis. To analyse the symptomatology and surgical perspective of scar endometriosis. MATERIALS AND METHODS: Retrospective review of 16 women who underwent surgery for scar endometriosis in the period of 4 years in Amrita institute of medical sciences. RESULTS: Mean age of the patients is 35.19 years. Mean interval from the index surgery to the presentation is 4.56 years. Mean size of the swelling is 2.84 cm. In 68.8% of the patients, caesarean section was the inciting surgery. 18.7% had port site endometriosis. Cyclical pain and swelling at the scar site was present in 93.8% of the women. 18.9% had concurrent pelvic endometriosis. All women had involvement of the subcutaneous tissue followed by 11 women with the involvement of rectus sheath. There was no recurrence of the lesion in the operated patients in the mean follow-up period of 11.91 months. CONCLUSION: In all women presenting with cyclical scar site pain and swelling, scar endometriosis should be considered. It commonly follows caesarean section and laparoscopic surgeries done for endometriosis. Wide local excision with or without reconstruction is the method of choice for this condition. Role of tumescent solution during surgery and postoperative medical management to reduce recurrence needs further prospective studies.

Clinical Study of Endometrial Polyp and Role of Diagnostic Hysteroscopy and Blind Avulsion of Polyp.

INTRODUCTION: Endometrial polyp is one of the common causes of Abnormal Uterine Bleeding (AUB) in the reproductive age group as well as postmenopausal age group. AIM: To study the clinical features of endometrial polyp and the safety and feasibility of blind polypectomy following diagnostic hysteroscopy. MATERIALS AND METHODS: Total of 256 women who were diagnosed to have endometrial polyp by transvaginal ultrasound and underwent diagnostic hysteroscopy and blind polypectomy by simple avulsion in the period of January 2008 to December 2014 were included in our study. Polyp was confirmed by the histopathology. RESULTS: The prevalence of polyp among women who underwent diagnostic hysteroscopy and blind polypectomy was more common in the age group of 40-49years. Polyps manifested as AUB in 45.6% of our study population. The mean size of the polyp was not significantly different between premenopausal and postmenopausal women and single and multiple polyps. Histopathological study of the polyp showed two malignant polyps in our study population. Premalignant lesions i.e., endometrial hyperplasia without atypia and with atypia was found in 33 women. There was one uterine perforation, one cervical tear; one false passage and one patient had mild bleeding after the procedure. In our study, in the mean follow-up period of 37.57±28.12 months, 3.9% (7 women) had recurrence. In the follow-up period of 16.56±18.96 months, 78.9% women didn't have recurrence. CONCLUSION: Diagnostic hysteroscopy and blind polypectomy has low complication rate and recurrence rate and technically feasible for the practicing gynaecologists which don't need much training and is cost-effective also.