Decreased Foetal Movements Secondary to Uterine Septum: A Case Report and Proposed Algorithm of Management.

Congenital uterine anomaly has been well established as cause of infertility and recurrent pregnancy loss. However, only few studies have reported the association of mullerian anomalies and adverse pregnancy outcome in third trimester. We are hereby reporting a case of 25-year- old female second gravida who presented at 36 weeks six days pregnancy with complaint of decreased foetal movements for the past two weeks. The female had previous history of multiple admissions on account of decreased foetal movements in the third trimester. Ultrasonography for biophysical profile and cardiotocography were done on each admission which revealed normal findings. Decision to terminate the pregnancy was taken because of persistent decreased foetal movements. She was induced with dinoprostone gel 0.5 mg intracervically; however she underwent lower segment caesarean section on account of non reassuring cardiotocography. Peroperative findings confirmed the presence of partial uterine septum.

A Prospective Study of Altered Inflammatory Response and Its Clinical Outcome following Laparoscopic and Open Cholecystectomy.

BACKGROUND: Inflammatory response following surgical trauma has long been a matter of study. Results, however, have been varied. We sought to assess changes in the levels of proinflammatory and anti-inflammatory cytokines in patients undergoing laparoscopic and open cholecystectomy and their impact on the clinical outcome of patients concerning the postoperative pain score. METHODS: The study involved 90 cholecystectomies (55 laparoscopic and 35 open) for chronic cholecystitis. Blood samples were collected 2 hours preoperatively and at 4 and 24 hours post surgery. Sera were evaluated for the levels of interleukin-1ß, interleukin-10, and tumor necrosis factor-alpha. The independent sample t-test was used to compare the means of a variable between the 2 groups. Statistical analysis was done using SPSS, version 17. RESULTS: The rise in the levels of interleukin-1ß, interleukin-10, and tumor necrosis factor-alpha was significantly more in the open cholecystectomy group at 4 hours (P<0.00). At the 24th postoperative hour, the levels of all 3 cytokines were also higher in the open cholecystectomy group (P<0.001 for interleukin-1ß, P=0.185 for interleukin-10, and P<0.001 for tumor necrosis factor-alpha). At the 4th postoperative hour, the patients in the laparoscopic cholecystectomy group had a significantly lower pain score (P<0.001) than the open group. CONCLUSION: Both laparoscopic and open cholecystectomy procedures altered the inflammatory milieu of our patients in the postoperative period. Inflammation caused by the laparoscopic procedure was significantly less. More research is needed to target specific inflammatory and anti-inflammatory cytokines to reduce surgical stress and improve patient outcomes.

Aberrant right subclavian artery presenting as tracheoesophagial fistula in a 50-year-old lady: Case report of a rare presentation of a common arch anomaly.

A 50-year-old, woman with a 2-year history of progressive dysphagia and 2-month history of chronic cough was referred to our center in a state of generalized sepsis. Provisional diagnosis of carcinoma esophagus with tracheoesophagial fistula was made. Evaluation of the patient revealed an aberrant right subclavian artery with retroesophageal course with compression of the esophagus and trachea with fistulous communication in between. The patient was managed with medical stabilization and with feeding jejunostomy, but she succumbed to underlying severe sepsis. This presentation of aberrant subclavian artery at this advanced age rare and is therefore reported.

Successful Resuscitation of a Cardiac Arrest following Slit Neck and Carotid Artery Injury: A Case Report.

Carotid artery injuries constitute a specific and relatively small group of vascular trauma among the traumatic injuries to neck. They have the potential of killing the patients within minutes to hours due to haemodynamic instability if not managed by the specialist team within time. Central Neurologic deficit from cerebral hypoxia either resulting primarily from trauma or secondarily from surgery is a major concern. We hereby present a case of a 22-year-old man who presented to emergency department with alleged assault and vascular trauma to neck in a state of cardiac arrest. On exploration patient had injuries to external and internal carotid arteries and external jugular vein. Combined effort of trauma team lead to successful resuscitation and saved the life of the patient.

Chronic Uterine Inversion Presenting as a Painless Vaginal Mass at 6 Months Post Partum: A Case Report.

Uterine inversion is an abnormal protrusion of internal surface of relaxed uterus through the vaginal orifice. Its causes can be broadly classified as puerperal and non-puerperal with puerperal uterine inversion more common than non-puerperal uterine inversion. Acute inversions occurring immediately, or within 24 hours post-partum are the most common type. Chronic Uterine Inversions (CUI) occurring more than four weeks after the delivery are rare identities. There differential diagnosis includes prolapsed fibroids and endometrial polyp. Chronic nature of these inversions makes the restoration of the normal position of the uterus per vaginal difficult contrary to acute inversions which can be reposited more easily. We hereby present a case of 28-year-old lady who presented with a painless vaginal mass at 6 months post-partum. She was diagnosed as a case of CUI based on clinical and sonographic examination. Inverted uterus was successfully restored through per abdominal approach. The presentation of CUI as a painless vaginal mass at delayed post-partum period is rare and therefore reported.

Fetal vascular adaptation before and after treatment of severe maternal anemia in pregnancy.

OBJECTIVES: To use color Doppler ultrasonography indices to study the effects on fetal circulation of treating severe maternal anemia. METHODS: A prospective cohort study enrolled patients who were at 30-34weeks of pregnancy and had hemoglobin levels below 70g/L between November 1, 2011 and March 31, 2013 at a hospital in New Delhi, India. A control group consisting of patients with the same duration of pregnancy and with hemoglobin levels above 110g/L was included. Umbilical artery and middle cerebral artery velocimetry were performed using color Doppler ultrasonography at admission and after 4weeks and 6weeks of treatment. RESULTS: The maternal anemia cohort demonstrated a significantly lower middle cerebral artery resistance index and middle cerebral/umbilical artery resistance ratio (P<0.001) at admission. Following 4weeks of treatment for maternal anemia, significant increases in these parameters were observed (P<0.001). CONCLUSION: Fetuses of individuals with severe maternal anemia demonstrated altered cerebral and umbilical artery flows. Normal flows were restored following treatment of maternal anemia.