A Comparative Study To Assess Blood Loss During Abdominal Myomectomy By Tourniquet Application Versus Intramyometrial Vasopressin Injection

Objective: The objective of this study was to determine the efficacy of applying uterine artery tourniquet and intramyometrialvasopressin injection to reduce intraoperative blood loss during abdominal myomectomy.Methods: A comparative interventional study comparing parameters in the two groups of patients containing 24 each whereone received tourniquet application and other received intramyometrial vasopressin.Results: Pre-operative hemoglobin (Hb) was comparable in both mean 10.5 ± 0.50 g/dl in tourniquet group and 10.5 ± 0.47 g/dlin vasopressin group. Pre-operative hematocrit (Hct) was also comparable in both mean 31.8 ± 1.44% in tourniquet groupand 31.7 ± 1.51% in vasopressin group. Mean operative time was 49.0 ± 10.33 min in tourniquet group and 48.8 ± 9.62 min invasopressin group which was statistically indifferent. Amount of mean blood loss in the tourniquet group was 467.9 ± 74.50 cc and356.45 ± 58.35 cc in vasopressin group which is significantly higher in former. Post-operative day 3 Hb was lower in tourniquetgroup 8.94 ± 0.52 g/dl than 9.45 ± 0.52 g/dl in vasopressin group. Reduction in Hb postoperatively was more in tourniquetgroup 1.43 ± 0.45 g/dl than vasopressin group 0.92 ± 0.20 g/dl. Reduction in Hct postoperatively was more (4.82 ± 1.4%) intourniquet group than in vasopressin group (2.74 ± 0.62%). Blood transfusion was required 5 (20.83%) cases in tourniquetgroup, but only in 2 (8.33%) cases of vasopressin group though it was statistically indifferent between both groups.Conclusion: Application of tourniquet had more mean operative time, intraoperative blood loss, and requirement of bloodtransfusion. There is more reduction in Hb and Hct postoperatively in tourniquet application.

Evaluation of Clinical Outcome of Patients Undergoing Emergency Laparotomy with the Help of Portsmouth Predictor Equation for Mortality (P-Possum Score)

Introduction: Emergency laparotomy, though lifesaving, mayresult in significant morbidity and mortality. In an attempt toclinically evaluate patients undergoing emergency laparotomyand predict their mortality using the worldwide acceptedPortsmouth Predictor equation for mortality (P POSSUM), thepresent study was undertaken in the Surgery department of atertiary care hospital in eastern India.Material and methods: This observational cross-sectionalstudy included 60 patients aged between 15 to 75 years,undergoing emergency laparotomy during the specified studyperiod of one and half years.Results: It was observed that out of 60 patients, 63.3%were male, and mean age was 40.60 (16.67) years. Pepticperforation was the most common indication for laparotomy.Mean P POSSUM predicted mortality risk was 40.617%(Range-0.8 to 99.7). Twenty-four patients died during hospitalstay. ROC curve analysis of P POSSUM scores revealed thatif a cut off value of P POSSUM score of 42.45% was selected,mortality could be predicted with a sensitivity of 70.80% anda specificity of 83.30%.Conclusion: Thus, P POSSUM might be a useful tool inpredicting risk of short-term mortality following emergencylaparotomy

A study to evaluate the outcome following Anderson Hynes pyeloplasty in hydronephrosis patients with cummings stent and D-J stent

Background: Uretero-Pelvic Junction Obstruction (UPJO) is an important cause of hydronephrosis in pediatric age group. The choice of treatment could be conservative or surgical. Commonly Anderson-Hynes pyeloplasty is practiced with internal, external or partly internal partly external stent.Methods: This was a prospective study of 40 patients with UPJO, divided into 2 groups consecutively, each consisting of 20 patients. All patients underwent open Anderson-Hynes pyeloplasty. Cummings stent were given in one group for drainage and conventional DJ stent were used for another group.Results: The mean hospital stay was lesser in DJ stent group (8.4±2.13) compared to Cummings stent group (11.4±0.68), not only in respect to primary admission, but also including readmission for cystoscopic stent removal. The incidence of complications was also fewer in Cumming stent group. Stent migration and urinary tract infection (UTI) were more associated with DJ stent (2 each) than Cumming stent (0 each). However, dysuria was more in case of cumming stent (2 patients) than DJ stent (1 patient).Conclusions: The mean hospital stay in DJ stent insertion is less even if duration for cystoscopic removal is considered. The complication of stent removal and UTI are more with DJ stent though dysuria is more in case of Cummings stent.

A novel approach to meet the unmet need for family planning

Background: Post-partum intra-uterine contraceptive device is one of the important methods of spacing to meet up the unmet need of family planning. The low complication rate, ease and certainty of insertion and one-time adoption advantages made it an option of family planning by Government of India. In the background of recent trends in family planning, the study aims to establish the efficacy and draw-backs of PP-IUCD among the clients in a tertiary care hospital of West Bengal.Methods: Prospective observational study on 1680 women during January 2016 to December 2016, where the PP-IUCD was given to the patients after vaginal delivery or Cesarean section and were followed up to 3 months.Results: During the study 1.37% patients did not turnup in either follow-up. The most common complication encountered was missing thread (4.64% at 6th week follow-up and 6.67% at 3rd month follow-up). Expulsion rate was much lower (2.02% at 6th week and 2.5% at 3rd month). Heavy bleeding per-vagina was in 1.55% at 6th week and 2.08% at 3rd month. Pain abdomen was .83% at 6th week and 1.67% at 3rd month. Incidence of perforation and failure was both nil at either follow-up. Dysmenorrhea was complained 2.44% at 6th week and 3.33% at 3rd month. Overall satisfaction rate at 6th week (86.05%) was higher than non-satisfaction (13.95%). This was also true for 3rd month where satisfaction rate (77.85%) was higher than non-satisfaction rate (22.15%).Conclusions: PP-IUCD appears to be a safe, efficacious, acceptable and accessible method of contraception.

An Observational Study on Uterine Myoma in Search of Factors Contributing to its Symptoms

Introduction: Uterine fibroid, the most common benign tumor,contributes significantly on quality of life if symptomatic.The study evaluates the factors which possibly contribute tothe symptoms. Objective: To identify the parameters whichpossibly play a role in symptoms of myoma.Material and Methods: An observational study on 48 subjectsafter taking written informed consent selected randomly fromwomen of reproductive age group attending at GynaecologyOut Patient Department.Results: Different age groups had comparable incidencesof fibroids. Most of the patients complained of Menorrhagia(54.2%). Metrorrhagia was complained in 6.2%, dysmenorrheain 10.4% patients, infertility and pain abdomen each wascomplained in 14.6% subjects. Most of the study subjectshad myoma of 14-week of gestation (39.6%) and 31.2% had16-week size myoma. The commonest location is found tobe fundo-anterior (33.3%), type is intramural (54.2%). Mostfibroids had volume of 95.1-125 cc (54.2%). One or twomyomas are more common than three or more myomas.Conclusion: Myoma is common in reproductive ages andthroughout the reproductive period incidences in differentage groups are comparable. Commonest symptom of myomais menorrhagia. Most myomas had volume of 95.1-125 cc,situated in fundo-anterior position, are of intramural type.Most myomas, if present as an abdominal lump, are of 14-week gravid uterus size. One or two myomas in uterus aremore common than number of myomas more than that