Birth weight, cord blood lipoprotein and apolipoprotein levels in Indian newborns.

OBJECTIVES: Primordial prevention of chronic disease is of clinical and public health importance. Considering the fetal onset of atherosclerosis, we aimed to determine the cord blood level of lipoproteins and apolipoproteins as well as their correlation with birth weight and gestational age. METHODS: This cross-sectional study comprised 100 healthy Indian newborns. Ten ml. of cord blood was collected from placental end of umbilical vein. Serum was separated by centrifugation and analyzed on the same day for lipid profile including total cholesterol (TC), triglycerides (TG), high density lipoprotein- cholesterol (HDL-C), very low density lipoproteincholesterol (VLDL) and low density lipoprotein-cholesterol (LDL-C), apolipoproteins A-I and B (ApoA-I, ApoB). Atherogenic index (AI) was calculated as the ratio of ApoB to ApoA-I. RESULTS: Cord blood of female newborns had higher TC, HDL-C, LDL-C, Apo A-I, Apo B and AI as compared to male newborns, whereas TG and VLDL-C were higher in male than in female newborns. Significant positive correlation was observed between cord blood Apo A-I and HDL-C (r= 0.45, p<0.01), and between cord blood Apo-B and LDL-C (r= 0.44, p<0.01). Non-significant inverse correlation was observed between Apo A-I and ApoB with gestational age. There was a significant inverse correlation between TG and gestational age (r= -0.197, p <0.05). Positive non-significant correlation was observed between AI and birth weight (r=0.046, p>0.05). CONCLUSIONS: These findings are another confirmatory evidence for the association of prenatal factors with cord blood lipid profile, and can serve as starting point for studying lipid transport system changes during early life.

Multiple bladder calculi: a rare cause of irreducible uterine prolapse.

BACKGROUND: A vesical calculus in a prolapsed cystocele is rare. OBJECTIVE: To highlight bladder calculi as a cause of irreducible uterine prolapse. CASE REPORT: A case of irreducible total uterine prolapse caused by multiple vesical calculi is presented. Bladder stones were removed through vaginal cystolithotomy followed by vaginal hysterectomy. CONCLUSION: In cases of acute irreducible pelvic organ prolapse, the possibility of bladder stones should be kept in mind and X-ray pelvis including the prolapsed mass should be done to confirm the diagnosis.

Destructive operations in modern obstetrics.

This is a retrospective study carried out over a period of 7 years at a tertiary care hospital to evaluate the indications, types and complications of destructive operations. During this period, 51 destructive operations were performed on women with obstructed labor and intrauterine fetal death. The most common operation performed was craniotomy (68.62%) followed by decapitation (19.60%), evisceration (7.84%) and cleidotomy (3.92%). The most common indication was cephalopelvic disproportion (31.25%). Out of 53 babies delivered (one triplet delivery), two were grossly malformed and 49.05% babies had birth weight between 3.0 kg and 4.0 kg and 9.43% were macrosomic. A total of 45.09% women had complications like atonic PPH, vaginal and perineal tears, puerperal sepsis and urinary tract infection. However, there was no maternal death. It is felt that for the women who belong to poor socio-economic status and have poor compliance and who present late in labor with features of obstruction, intrauterine sepsis and fetal death, destructive operation is still a good option.

Antenatal diagnosis of twin-reversed arterial perfusion sequence (acardiac amorphous) in a triplet pregnancy: case report.

Acardiac twinning is the most extreme form of twin-twin transfusion syndrome occurring in monzygotic twin pregnancies with monochorionic placentation. A case of acardiac amorphous foetus, occurring in association with spontaneously conceived triplet pregnancy, diagnosed on ultrasound in early second trimester is described and its antenatal management and brief review of literature discussed.

Recent onset neurofibromatosis complicating eclampsia with maternal death: a case report.

Neurofibromatosis in pregnancy has been associated with poor perinatal outcome. A 30-year-old multigravida developed peripheral lesions of neurofibromatosis during the third month of pregnancy. She had eclampsia complicated with fatal left-sided massive intracerebral haemorrhage detected on computed tomography at 8.5 months gestation. Investigations were suggestive of HELLP syndrome. A still-born male baby was delivered. In spite of all supportive measures the patient died on the third postpartum day. We conclude that recent onset neurofibromatosis in current pregnancy should be considered as a predictor of potentially adverse maternal and fetal outcome and such pregnancies be managed in tertiary level referral centre.

Leiomyosarcoma of the broad ligament mimicking as ovarian carcinoma--a case report.

A 55-year-old postmenopausal lady presented with signs and symptoms of ovarian malignancy. Laparotomy revealed a 8 x 8-cm degenerated, cystic and haemorrhagic mass arising from left broad ligament which on histopathology proved to be leiomyosarcoma.

Long retained intravaginal foreign body: a case report.

Recurrent vaginal discharge in children may be due to variety of causes. Intravaginal foreign body retained for long duration can be a diagnostic dilemma. This report presents the case of a girl who had an intravaginal foreign body for over four years duration. Recurrent, unremitting, foul-smelling, bloody vaginal discharge in a child should alert the clinician to the possibility of a retained vaginal foreign body.

Cantrell's syndrome - report of two cases with one atypical variant.

Two cases of Cantrell syndrome occurring over a ten year period are described. One was detected following caesarean section at term and the other underwent termination of pregnancy at 20 weeks following antenatal diagnosis by ultrasound.

Successful perinatal outcome following recurrent idiopathic cerebrovascular strokes in pregnancy: a case report.

A 25-year-old gravida 2 had two right cerebral hemispheric infarcts documented on magnetic resonance imaging (MRI) and computed tomography (CT) scan at 23 and 31 weeks of pregnancy. Investigations failed to reveal any cause. She was empirically treated with heparin, aspirin and nimodipine and had a successful perinatal outcome.

324 cases of misplaced IUCD--a 5-year study.

Copper-T remains the mainstay of family planning measures in developing countries but is associated with serious complications like bleeding, perforation and migration to adjacent organs or omentum. Patients with misplaced intrauterine contraceptive device (IUCD) may present with pregnancy or lost strings or may remain asymptomatic for years. In our series of 324 cases with misplaced IUCD1; in 258 (79.93%) cases copper-T was found in the uterine cavity and in 47 cases (14.51%) it was removed from cervical canal. In only 18 cases (5.56%), it was translocated and of these 66.67% were inserted at primary health centres. Laparoscopic retrieval was successful in 61.11% cases. Endoscopy thus helps in the localization and retrieval of misplaced IUCDs. A regular follow up of IUCDs for visible threads would help in earlier detection of misplaced IUCDs. Proper training of paramedical staff is mandatory in developing countries to provide safe and better family planning services.

Effect of oestrogen replacement therapy on serum lipid profile.

BACKGROUND: Oestrogen deficiency in postmenopausal women alters the lipid metabolism unfavourably. AIM: To evaluate the effects of oral and transdermal oestrogen replacement therapy (ORT) on serum lipid profile. METHODS: Ninety hysterectomised and oophorectomised women were randomised into three equal groups (no hormones; oral conjugated equine oestrogen, 0.625 mg/day; transdermal oestradiol patches, 50 microg/day). Serum concentrations of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides were determined at the baseline and after 3 and 6 months of therapy. Student's t-test was used for statistical evaluation. RESULTS: Most of the hysterectomised women had abnormal serum lipid profile, especially HDL cholesterol levels (less than 40 mg/dL in 87%). A significant decline in the levels of serum cholesterol (total) as well as LDL and a significant increase in HDL cholesterol levels were observed following ORT by both modes, the response being comparatively rapid with oral route. After 3 and 6 months, the number of cases with HDL cholesterol levels above 40 mg/dL increased from initial 13 to 63% and 87% (oral) and 30 and 60% (transdermal), respectively. Serum triglyceride levels declined significantly with transdermal therapy but increased with oral ORT. CONCLUSIONS: Oestrogen replacement therapy either via oral or transdermal route has a beneficial effect on serum lipid profile of menopausal women. Whereas the oral route is more effective in increasing HDL cholesterol levels, the transdermal route is better for reducing the serum triglyceride level; hence, the latter should be the route of choice in women with high serum triglyceride levels.