Psoas abscess in obstetrics.

Psoas abscess is rarely encountered in obstetric practice. This condition may be primary or secondary resulting from extension of an infectious process near the psoas muscle. We report a series of three patients with psoas abscess that were encountered in our obstetric practice. Two of these patients had a primary and one a secondary abscess. Two patients underwent laparotomy and drainage of abscess while one received medical treatment. All patients recovered uneventfully.

Liver metastasis in a case of adenoid cystic carcinoma of the Bartholin's gland: a rare presentation.

INTRODUCTION: Adenoid cystic carcinoma of the Bartholin's gland accounts for a minority of all Bartholin's gland malignancies. Although local recurrences commonly occur distant metastasis is rare. CASE REPORT: We present the first reported case of Adenoid cystic carcinoma of the Bartholin's gland with metastasis to the liver. DISCUSSION: There is no consensus on the treatment of adenoid cystic carcinoma of the Bartholin's gland. Wide local excision and/or vulvectomy and radiotherapy are advocated for treatment of this cancer. There is not much data on treatment of metastasis and it varies according to site.

Know the name: acute epiploic appendagitis-CT findings and review of literature.

Epiploic appendages are normal pedunculated peritoneal fat containing outpouchings bordering tenia coli on the anti-mesenteric surface of the colon, extending from caecum to the rectosigmoid. Functions are currently unknown, though some postulate them a blood reservoir. The epiploic appendages can become inflamed, with clinical presentations mimicking that of diverticulitis or acute appendicitis. However, unlike acute diverticulitis or appendicitis, epiploic appendagitis are treated conservatively with antibiotics. Currently, the estimated rate of correct preoperative diagnosis of epiploic appendagitis is 2.5%, but due to benign nature of epiploic appendagitis, it is important to appropriately diagnose it preoperatively and thus preventing unnecessary surgical interventions. Clinical features include focal area of pain, often with normal white blood cell count, that often is common in other differential diagnoses. CT scan plays a crucial role in diagnosis and shows an oval fatty density solid lesion along anterior colonic wall surface, surrounded by a rim of fat stranding. Treatment is conservative and involves use of anti-inflammatory medication.

Post-sterilization regrets in Indian women.

BACKGROUND: Tubal ligation is the most common form of contraception in India. We conducted this study to assess the factors associated with post-sterilization regrets. AIMS: This study was designed to assess risk factors that are likely to cause regret following female sterilization in Indian women. SETTINGS AND DESIGN: Questionnaire-based study. MATERIALS AND METHODS: This was a questionnaire-based study to assess the level of satisfaction after tubal ligation in women attending family planning clinic at the hospital over a period of 1 year. Evaluation of data obtained through questionnaire from 236 women who had undergone tubal ligation was done. STATISTICAL ANALYSIS: Univariate analysis to determine crude odds ratio was carried out. Subsequently, multiple regression analysis was used to find the adjusted odds ratio (and 95% confidence intervals) for each variable. RESULTS: We found a strong co-relation between regrets and young age (less than 30 years), fewer number of children, few or no male children and lack of partner motivation prior to sterilization. Menstrual irregularities and dysmenorrhoea did not influence regret to a large extent. CONCLUSION: Fertility-related factors, namely, age at sterilization, family size, number of male offspring, timing of sterilization and non-involvement of partner in decision making played a greater role in post-sterilization regrets than menstrual factors (menstrual irregularities and dysmenorrhoea).

Different Sonographic Faces of Ectopic Pregnancy.

Vaginal bleeding in the first trimester has wide differential diagnoses, the most common being a normal early intrauterine pregnancy, with other potential causes including spontaneous abortion and ectopic pregnancy. The incidence of ectopic pregnancy is approximately 2% of all reported pregnancies and is one of the leading causes of maternal mortality worldwide. Clinical signs and symptoms of ectopic pregnancy are often nonspecific. History of pelvic pain with bleeding and positive ß-human chorionic gonadotropin should raise the possibility of ectopic pregnancy. Knowledge of the different locations of ectopic pregnancy is of utmost importance, in which ultrasound imaging plays a crucial role. This pictorial essay depicts sonographic findings and essential pitfalls in diagnosing ectopic pregnancy.

Pregnancy in a patient of Glanzmann's thrombasthenia.

Glanzmann's thrombasthenia is a congenitally acquired platelet disorder with an autosomal recessive mode of inheritance. Though, quantitatively normal, the aggregation ability of platelets is reduced in this condition. Pregnancy and delivery are rare in these patients and have been associated with a high risk of severe post-partum hemorrhage. We describe a primigravida, who was diagnosed to have Glanzmann's thrombasthenia during adolescence. She developed secondary post-partum hemorrhage after an elective caesarean section, which was successfully managed by single donor platelet transfusion.

Comparison of perinatal outcome of growth-restricted fetuses with normal and abnormal umbilical artery Doppler waveforms.

AIMS: To evaluate the role of umbilical artery Doppler in growth- restricted fetuses. MATERIALS AND METHODS: In a prospective observational study, 70 pregnant women with growth-restricted fetuses confirmed by ultrasound, were followed up with Doppler studies of the umbilical artery. The study group consisted of 35 women, where the Doppler waveform in the umbilical artery was compromised (either absent end diastolic flow [AEDF] or reversed end diastolic flow [REDF]). These were compared with an equal number of controls, where growth- restricted fetuses had normal doppler waveforms. Outcome measures were evaluated in both groups and analyzed. RESULTS: The periods of gestation at delivery were 27.2 +/- 3.5 weeks in group 1 and 37 +/- 3.3 weeks in-group II, respectively. Perinatal morbidity and mortality was significantly increased in the group with compromised umbilical artery blood group. Birth weight in group I was 742 +/- 126 grams and in group II was 1680 +/- 259 grams. This difference was statistically significant (P=0.0001). In comparison to AEDF, REDF fetuses had more morbidities. Perinatal mortality was also significantly increased in this group (P=0.001). CONCLUSION: Umbilical artery Doppler should be used in the management of growth-restricted fetuses. In those fetuses in normal Doppler, pregnancy can be prolonged. REDF is an indication for termination of pregnancy.

Bilateral ovarian krukenberg tumor in a full-term pregnancy.

Objective. Krukenberg tumors in pregnancy are very rare and their management can present a dilemma for the obstetrician gynecologist. Case Report. We present the case of a G3P2002 who presented to us and the 38 weeks gestation with bilateral massive Krukenberg tumors. Despite at surgery and chemotherapy she died 3 months postpartum. Conclusion. Early detection followed by surgery and chemotherapy could possibly result in a favorable outcome with such patients.

Pregnancy-associated myocardial infarction: a report of two cases and review of the literature.

BACKGROUND: Myocardial infarction in pregnancy carries high morbidity. Spontaneous coronary artery dissection is one etiology of infarction, and up to one third of cases may arise in the third trimester of pregnancy or within three months postpartum. CASE: We report two cases of spontaneous coronary artery dissection, one at 34 weeks gestation and one postpartum. Both patients were diagnosed with angiography and treated medically and one required percutaneous coronary intervention, with good obstetric outcome and return of cardiac function. CONCLUSION: Myocardial infarction, and particularly spontaneous coronary artery dissection, should be in the differential diagnosis of pregnant women presenting with cardiac-type symptoms, despite perceived lack of risk factors. Angiography will aid in diagnosis, and multiple therapeutic modalities exist.

Silent rupture of unscarred uterus: an unusual presentation at second trimester abortion.

Rupture of unscarred uterus during the second trimester is rare. A case of ruptured uterus in a multiparous woman is presented. To our knowledge, this might be the first reported case in the English literature of uterine rupture during second trimester termination of pregnancy using ethacridine lactate. This case is also rare as uterine rupture is presented with an insidious course rather than acute, thus delaying the diagnosis.

To compare the efficacy of two doses of intraperitoneal bupivacaine for pain relief after operative laparoscopy in gynecology.

AIM: To evaluate the effect of two doses of intraperitoneal bupivacaine administration for pain relief after operative gynecological laparoscopy. DESIGN: Prospective randomized study. MATERIALS AND METHODS: The study group comprised 52 women undergoing gynecological laparoscopic surgery. A dose of either 0.125% bupivacaine 10 ml (50 mg) or 0.25% bupivacaine (100 mg) was instilled intraperitoneally at the end of the procedure. Pain scores were recorded in the postoperative period on a scale of 0-10 at 2, 4, 6 and 8 h intervals after the surgery. Any other side effect and the time and dose of analgesia required were noted. The results were compared in the two groups. RESULTS: One hundred milligrams of bupivacine provided pain relief for a longer duration (8 h), as compared to 50 mg of the drug (4-6 h). This difference was statistically significant. Analgesic requirement was also less in the 100 mg group. CONCLUSION: One hundred milligrams of intraperitoneal bupivacaine is much better than 50 mg in relieving pain after laparoscopic surgery.

Pregnancy followed by caesarean delivery in a patient with tracheostomy and gastrostomy after corrosive acid ingestion.

Corrosive acid ingestion in pregnancy is rare. We present a rare case of corrosive acid ingestion during pregnancy. The patient subsequently had tracheal stenosis and had to undergo a tracheostomy. Feeding gastrostomy was created for nutritional support of both mother and fetus. The patient delivered at term by an elective caesarean section.

Comparative efficacy of two regimens in syndromic management of lower genital infections.

AIM: The aim of this study was to compare the efficacy and safety of two combination regimens in the syndromic management of lower genital infection. Seventy-two non-pregnant women presenting with symptoms of lower genital infection diagnosed as vaginitis on clinical examination and lacking obvious upper genital infection were enrolled to one of the two treatment regimens as a syndromic treatment. No investigations were performed to cut the cost and to avoid the loss of patients on follow-up. Thirty-seven women (group I) were prescribed a course of clotrimazole (Imidil, Lyka) 100 mg vaginal pessaries for 6 days. Along with their partners they were prescribed 2 gm secnidazole (Secnil forte) and 150 mg fluconazole (Syscan) as a single therapy. Thirty-five women (group II) were prescribed vaginal clotrimazole as mentioned above. A combination kit containing 150 mg fluconazole, 2 gm secnidazole and 1 gm azithromycin (FAS-3 kit, Lyka) was also prescribed to both partners with the advice to take azithromycin on empty stomach, and the other three tablets after food. RESULTS: All women in both groups were seen after 1 week for relief of symptoms and after 1 month for any recurrence. Mean parity was 2.7 and 3.0, respectively. The total symptomatic relief was observed in 67.6 and 94.3% cases, partial relief in 27 and 5.7% cases and no relief was observed in 5.4% and nil cases, respectively, in the two groups. Recurrence was seen in two and nil cases, respectively, in the two groups. Most women tolerated both the treatments well with no major side effect in any case. Treatment cost was higher in group II (Rupees 120) than in group I (Rupees 65). CONCLUSIONS: Both combination kits with local clotrimazole were reasonably effective and safe in the syndromic approach for lower genital infections. The combination kit with azithromycin, secnidazole and fluconazole was more effective with better symptomatic relief and less recurrence rate and may be routinely recommended in all cases of lower genital infection as a cost effective, safe and effective strategy.

Successful pregnancy outcome with elective caesarean section following two attempts of surgical excision of large giant cell tumor of the lower limb during pregnancy.

CASE REPORT: A 21 year old woman presented at 27 weeks of gestation with history of curettage of large giant cell tumor of distal left femur at 18 weeks of gestation with residual tumor. Repeat excision and bone grafting was performed with isoxsupine tocolysis. An elective caesarean was performed at term and a 3-kg healthy baby boy was delivered. Decision to perform an elective section was taken to avoid fracture of bone and also due to limited abduction of limb. Both mother and baby were discharged from the hospital on the fifth postoperative day. CONCLUSION: Surgical excision of giant cell tumor with tocolysis followed by elective caesarean delivery is recommended for successful pregnancy outcome.

Cavernous hemangiomatous polyp: an unusual case of perimenopausal bleeding.

INTRODUCTION: Significant vascular malformations of uterus are rare but can cause serious menorrhagia. CASE REPORT: We present the case of a 40-year-old multiparous woman who presented with perimenopausal bleeding due to cavernous hemangiomatous polyp successfully treated by polypectomy. CONCLUSION: Cavernous hemangioma can be a rare cause of perimenopausal bleeding. The same found in a polyp may be treated successfully by polypectomy.

Post-sterilization regrets in Indian women.

BACKGROUND: Tubal ligation is the most common form of contraception in India. We conducted this study to assess the factors associated with post-sterilization regrets. AIMS: This study was designed to assess risk factors that are likely to cause regret following female sterilization in Indian women. SETTINGS AND DESIGN: Questionnaire-based study. MATERIALS AND METHODS: This was a questionnaire-based study to assess the level of satisfaction after tubal ligation in women attending family planning clinic at the hospital over a period of 1 year. Evaluation of data obtained through questionnaire from 236 women who had undergone tubal ligation was done. STATISTICAL ANALYSIS: Univariate analysis to determine crude odds ratio was carried out. Subsequently, multiple regression analysis was used to find the adjusted odds ratio (and 95% confidence intervals) for each variable. RESULTS: We found a strong co-relation between regrets and young age (less than 30 years), fewer number of children, few or no male children and lack of partner motivation prior to sterilization. Menstrual irregularities and dysmenorrhoea did not influence regret to a large extent. CONCLUSION: Fertility-related factors, namely, age at sterilization, family size, number of male offspring, timing of sterilization and non-involvement of partner in decision making played a greater role in post-sterilization regrets than menstrual factors (menstrual irregularities and dysmenorrhoea).

Comparison of Ofloxacin & Ornidazole with Probiotic versus Doxycycline & Metronidazole for the Outpatient Treatment of Pelvic Inflammatory Disease

The aim of the study was to compare the efficacy and cost effectiveness of ofloxacin, ornidazole, serratiopeptidase and Saccharomyces Boulardii combination with traditional doxycycline and metronidazole combination with serratiopeptidase in the outpatient management of pelvic inflammatory disease. A total of one hundred and ninety three women presenting with symptoms of pelvic inflammatory disease (PID) confirmed to be a case of PID on clinical examination were randomized to one of the two treatments. No investigations were performed to cut the cost and to avoid loss of follow up. A total of 98 women (Group I) were prescribed ofloxacin (400mg), ornidazole (500mg), Serratiopeptidase (10mg), Lactic acid bacillus 60 million spores and Saccharomyces Boulardii 2 million spores once a day for 10 days while a total of ninety five women (group II) were given a 10 day course of doxycycline (100 mg BD) with metronidazole (400mg TDS) along with 10mg of serratiopeptidase once daily. All women were seen after 2 weeks for relief of symptoms and possible side effects. The results were then analyzed. It was found that although the efficacy of both drug regimens was similar. The incidence of gastrointestinal side-effects mainly were less in group I. This was probably due to the addition of probiotic Saccharomyces Boulardii and lactic acid bacillus. The once daily administration led to better compliance in the first group.

Pregnancy in a patient of Glanzmann's thrombasthenia.

Glanzmann's thrombasthenia is a congenitally acquired platelet disorder with an autosomal recessive mode of inheritance. Though, quantitatively normal, the aggregation ability of platelets is reduced in this condition. Pregnancy and delivery are rare in these patients and have been associated with a high risk of severe post-partum hemorrhage. We describe a primigravida, who was diagnosed to have Glanzmann's thrombasthenia during adolescence. She developed secondary post-partum hemorrhage after an elective caesarean section, which was successfully managed by single donor platelet transfusion.