Use of Condom Tamponade to Manage Massive Obstetric Hemorrhage at a Tertiary Center in Rajasthan.

INTRODUCTION: Conventionally postpartum hemorrhage (PPH) has been defined as blood loss of more than 500 ml following vaginal delivery and 1000 ml following a cesarean section [Pritchard et al. in Am J Obstet Gynecol 84(10):1271-1282, (1962)]. Another definition labels PPH as any blood loss which causes a 10 % drop in hematocrit [Combs et al. in Obstet Gynecol 77:69-76, (1991)] or which threatens the hemodynamic stability of the patient and necessitates blood transfusion [Prendiville et al. in Cochrane Database Syst Rev 2:CD000007, (2000)]. The purpose of this study was to evaluate the effectiveness of condom tamponade in the management of massive obstetric hemorrhage. OBJECTIVE: To evaluate the efficacy of a condom as a tamponade for intrauterine pressure to stop massive PPH. METHODS: This prospective study was done in the Obstetrics and Gynecology Department of NIMS Medical College and Hospital, Jaipur, between December 2013 and February 2015. With aseptic precautions, a sterile rubber catheter fitted with a condom was introduced into the uterus. The condom was inflated with 250-500 ml normal saline according to need. Vaginal bleeding was observed, and further inflation was stopped when bleeding ceased. RESULTS: In all but 2 (94.44 %) the cases, postpartum bleeding was stopped within 10 min of creation of tamponade. On an average, 350 ml of normal saline was required to create adequate tamponade to stop the bleeding. CONCLUSION: Use of condom tamponade can effectively help in reducing both maternal morbidity and mortality associated with PPH. Our study encourages use of condom tamponade which is efficient, cost-effective, easily available and requires lesser skills as compared to the traditional surgical procedures.

Proteomic analysis of HEK293 cells expressing non small cell lung carcinoma associated epidermal growth factor receptor variants reveals induction of heat shock response.

In view of the fact that certain non small cell lung carcinoma associated epidermal growth factor receptor mutations keep the receptor constitutively active, the downstream effectors of altered activity of mutant receptors are largely unknown. By 2D gel electrophoresis and MALDI-TOF/MS analysis, we showed that increased activity of EGFR mutants, L858R, L861Q and A871G induce heat shock proteins such as Hsp70, Hsp60, Hsp90B1, Hsp5a, Hsp71 and few transcriptional factors. Of which, Hsp70 was observed to be regulated more selectively to L861Q mutant. Our results suggest the possible role of heat shock proteins in lung tumor progression considering EGFR mutations.

Nonoccupational anthracofibrosis/anthracosilicosis from Ladakh in Jammu and Kashmir, India: A case series.

BACKGROUND: Nonoccupational anthracosis and silicosis has been reported from various parts of the world including Ladakh in Jammu and Kashmir, India; however, anthracosilicosis has only been reported in industrial workers till date. MATERIALS AND METHODS: Six cases from the Ladakh region in Jammu and Kashmir, India with similar clinico-radiological-pathological features, i.e., anthracosilicosis/anthracofibrosis have been analyzed. Of these, four were analyzed retrospectively and two prospectively. RESULT: All the patients were homemakers and resided in Ladakh in Jammu and Kashmir, India since birth with an age range of 42-62 years and an average age of 56 years. Their average duration of symptoms was 4 years. Spirometry showed small and/or large airway disease in 5/6 cases. On computed tomography (CT), 4/6 cases showed progressive massive fibrosis (PMF) with calcified mediastinal lymph nodes. There were random or centrilobular nodules in all the six cases. Bronchoscopy in 5/6 cases showed multiple anthracotic pigments with narrowing and distortion of the bronchus (anthracofibrosis). Malignancy was suspected clinico-radiologically in four cases and pathologically in two cases. On histopathology, anthracosis was demonstrated in all and silicosis in three cases. CONCLUSION: Anthracosilicosis can occur due to environmental exposure. Ladakh in Jammu and Kashmir, India is the only place across the globe with unique environmental features having the presence of both free silica and biomass fuel. The disease was observed predominantly in older women. Awareness would prevent unnecessary investigation for malignancy. Treatment with the bronchodilator is useful as it has evidence of airway disease. Finally, environmental measures and a proper study need to be undertaken for knowing the relative role of silica versus soot in causing the lung disease and preventing this irreversible condition.

Mediastinal Teratoma with Coexisting Adenocarcinoma and Carcinoid Tumor (Somatic-Type Malignancy): A Case Report with a Review of the Literature.

Germ cell tumors constitute 10% to 15% of anterior mediastinal neoplasms. Of these, mature teratoma is the most common. Somatic malignant transformation in mature teratoma is a very rare phenomenon. In the anterior mediastinum, few cases of malignant transformation in the form of carcinoma, sarcoma, or neuroendocrine tumors have been described. We present the case of a mature mediastinal teratoma in a 24-year-old female, diagnosed on computed tomography, where both carcinoid tumor and adenocarcinoma were seen. To the best of our knowledge, this is the first report of such a case. Malignant transformation in a mature teratoma confers a significantly worse prognosis and is difficult to diagnose only on clinical and radiological evaluation. As these lesions are so rare, the treatment options for these lesions are also not clearly defined. Extensive sampling and careful microscopic examination are needed when teratomas are submitted for pathological evaluation.

Pulmonary Tumourlets: Case Report and Review of Literature.

We report a case of tumourlets of the lung associated with carcinoid and neuroendocrine cell hyperplasia, found incidentally in a 30-year-old woman, who underwent bullectomy for pneumothorax. These lesions are histologically similar to carcinoid, but differ in molecular pathogenesis about which little is known. Their nature and significance is debated. Here, we point out the importance of histological, clinical, and diagnostic aspects and follow-up to have evidence of eventual malignant evolution.

Metastatic thymic carcinoid: does surgeon have a primary role?

Thymic carcinoids are rare mediastinal tumours. These are aggressive tumours that often present late and have poor prognosis. Primary surgical treatment is recommended even in metastatic tumours since the role of adjuvant therapy is not well established. We present a case of metastatic thymic carcinoid managed with surgical excision.

Adenocarcinoma (somatic-type malignancy) in mature teratoma of anterior mediastinum.

Mature teratoma is a common anterior mediastinal tumour. However, occurrence of transformed malignant component within it is very rare. We report a case of a 32-year-old female presenting with dry cough and chest pain. Contrast-enhanced computed tomography (CT) showed a large thin-walled cystic lesion measuring 11.4 cm x 10.6 cm x 10.0 cm in the anterior mediastinum. Right postero-lateral thoracotomy was performed and the tumour was completely excised. Histopathological examination of the excised specimen was suggestive of mature teratoma with transformed malignant component, adenocarcinoma (somatic-type malignancy).

Pulmonary malakoplakia: a report of two cases.

Malakoplakia of lung is an unusual condition that has been reported to occur in association with immunocompromised state, particularly in those with acquired immunodeficiency syndrome. We present two cases of pulmonary malakoplakia in immunocompetent individuals. The diagnosis was made on histopathological examination of surgically resected specimen.

A case of Hodgkin's disease presenting as lymphocytic interstitial pneumonitis.

Lymphoproliferative disorders of lung have a broad clinical and pathologic spectrum. The clinical and radiographic features are non-specific. Accurate diagnosis is required to initiate appropriate therapeutic intervention. We report a case of Hodgkin's disease mimicking lymphocytic interstitial pneumonitis in a 21-year-young male.

Microfilariae in association with other diseases. A report of six cases.

BACKGROUND: Lymphatic filariasis is a major public health problem in tropical countries. Earlier reports have reported microfilariae as an incidental finding in body fluids and fine needle aspiration smears from various sites. CASES: The findings of body fluid cytology and fine needle aspiration smears from six patients with microfilariae in association with other conditions--tubercular pleural effusion/lymphadenitis, pregnancy and non-Hodgkin's lymphoma--are presented. Three patients demonstrated an associated eosinophilic cellular exudate. Adherence of inflammatory cells to microfilariae was seen in two patients. CONCLUSION: Although microfilariae in cytologic smears are considered incidental findings, the association of microfilariae with debilitating conditions suggests that it is an opportunistic infection and needs further study.