Successful conservative surgical management of ovarian mucinous cystadenoma with silent torsion in pregnancy: a case report

To report the successful conservative surgical management of Ovarian mucinous cystadenoma with silent torsion in a 24 years old pregnant woman in a tertiary care center in Delhi. An antenatal woman came for a routine visit to the OPD of the hospital at 13 weeks gestation. She had a vague, mild pain in lower abdomen since the last four weeks. A cystic mass was discovered during an abdominal examination. Further on sonography, a multisepatated cystic mass was seen, likely to be mucinous cystadenoma. Routine tumor markers came out to be negative. A laparotomy was planned at 15 weeks. On laparotomy a 20 × 15 cm multiloculated cyst with one and half turns of torsion was found. Detorsion, cystectomy of the intact cyst followed by ovarian reconstruction was done after due consent. On histopathological examination the cyst was found to be Benign mucinous cystadenoma. The pregnancy continued without any adverse effects. The woman delivered vaginally at 38 weeks without any feto-maternal complications. She was able to conceive again spontaneously at 18 months post-delivery. After 16 weeks of gestation in the second pregnancy she went to her home town and no further follow-up was possible. This case emphasizes the importance of a thorough examination in all pregnant woman to rule out any adnexal mass separate from the gravid uterus. Big ovarian masses in pregnancy, if not diagnosed can cause growth retardation, preterm deliveries, acute abdomen due to infection, rupture or torsion. Sonography, MRI and tumor markers can facilitate diagnosis before surgery. Torsion and rupture of mucinous cystadenoma need prompt surgery. Wherever possible conservative surgery (detorsion and cystectomy) should be done especially in young women

Analyzing the sensitivity of a flood risk assessment model towards its input data

The Small Island Developing States are characterized by an unstable economy and low-lying, densely populated cities, resulting in a high vulnerability to natural hazards. Flooding affects more people than any other hazard. To limit the consequences of these hazards, adequate risk assessments are indispensable. Satisfactory input data for these assessments are hard to acquire, especially in developing countries. Therefore, in this study, a methodology was developed and evaluated to test the sensitivity of a flood model towards its input data in order to determine a minimum set of indispensable data. In a first step, a flood damage assessment model was created for the case study of Annotto Bay, Jamaica. This model generates a damage map for the region based on the flood extent map of the 2001 inundations caused by Tropical Storm Michelle. Three damages were taken into account: building, road and crop damage. Twelve scenarios were generated, each with a different combination of input data, testing one of the three damage calculations for its sensitivity. One main conclusion was that population density, in combination with an average number of people per household, is a good parameter in determining the building damage when exact building locations are unknown. Furthermore, the importance of roads for an accurate visual result was demonstrated

Analysis of success of vaginal birth after cesarean in relation to indication of primary caesarean section: a tertiary care experience

Background: Apprehensions related to vaginal birth after caesarean (VBAC) has reduced rates of successful vaginal trials over last decade. The objective of this study was to identify the indications of first caesarean section that can lead to a successful trial of labour in subsequent pregnancy.Methods: Retrospective cohort study was done between November 2014 and October 2017. Data from the case records was analysed.Results: Study over 3 years from 2014 to 2017 revealed fetal distress (82.7%),  breech (72.2%), transverse lie (66.7%), antepartum haemorrhage (56.2%) and twins with first non-cephalic (57.9%) have successful outcome of VBAC whereas obstructed labour (19.2%) and failed induction (18.4%) in previous pregnancy have poor outcome for VBAC.Conclusions: Attempts to allow trial of labour after one previous caesarean section with fetal distress, malpresentation and twins as indications of caesarean in previous pregnancy are safe and should be encouraged

Torsion in a massive hematosalpinx with a functional rudimentary horn: a rare cause of acute abdomen in adolescence, managed laparoscopically

Congenital anomalies of the female genital tract may remain undiagnosed till adolescence. Unicornuate uterus with a rudimentary horn is rare and found in 1 in 100000 women. A functional rudimentary horn may cause hematometra, hematosalpinx, endometriosis and its complications. This is a case of a 13-year-old girl who had a hematometra in a functional rudimentary horn and a hematosalpinx with torsion giving rise to an acute abdomen and a 16-week mass abdomen. Laparoscopy was done followed by detorsion, salpingectomy and transection of the rudimentary horn. This article should sensitize the need to correct the anomaly while preserving the reproductive potential of the girl. A review of the salient points of laparoscopy in such cases have been further discussed

Successful vaginal delivery of spontaneously conceived twins in each horn of a bicornuate uterus with previous caesarean: a case report

Mullerian duct fusion anomalies resulting in uterine malformations have prevalence of 3-4%. Among this, bicornuate uterus has a rare incidence of 0.4%. Uterine malformations pose significant threat in terms of obstetric outcomes. We report an extremely rare case of spontaneous conception of twin pregnancy with the fetus occupying each horn of a bicornuate uterus (bicornis unicollis), in a woman with a history of previous caesarean section. She was booked at our hospital and the pregnancy remained uneventful. At 35 weeks she went into spontaneous labour and delivered vaginally without any maternal-fetal complications. The case is unique and the management is worth discussing as till date no protocols or guidelines have been proposed for the mode of delivery of bicornuate uterus with twins with previous cesarean.  Only 12 cases of twins with bicornuate uterus have been reported till date. This is the first case in literature in which a successful VBAC has been conducted in a woman with bicornuate uterus with twins with previous caesarean

Huge Abdominopelvic Mass Arising From Cervical Fibroid Around an Infected Cervical Diverticulum: A Very Rare Case and a Review of Literature

Primary uterine diverticula are a very rare congenital anomaly of the uterus with only 21 reported cases. Even rarer is the occurrence of primary cervical diverticula with only six cases reported so far. This is a unique case of a huge abdominopelvic mass arising from cervical fibroid around an infected cervical diverticulum. A 44 year-old, P4L4 came to the OPD with a eighteen weeks size abdomino-pelvic mass. She had a failed surgery 6 months back, attempted to remove the mass. Magnetic resonance imaging revealed a cervical diverticulum which possibly had a pus collection. Relaparotomy was done. It revealed a huge cervical fibroid with dense adhesions all around the mass. A pan hysterectomy was done. In the postoperative period, she developed high-grade fever owing to the development of a pelvic collection, which had to be drained by dilating the vault sutures. Histopathology report confirmed a cervical fibroid with an infected diverticulum within. Primary uterine or cervical diverticula are a very rare anamoly which possibly arise because of a weakness in the area where the two mullerian ducts fuse. Women with this rare condition may suffer from infertility, fever and pain abdomen, acute abdomen owing to torsion or hemoperitoneum, pregnancy complications, and menorrhagia. Diverticulectomy and cervical/uterine reconstruction can be done on nulliparous women while hysterectomy can be offered to perimenopausal women. To conclude, unless known by the gynecologists, radiologists, and the pathologists, this diagnosis can be easily missed out, leading to multiple preventable complications

Real-time measurements of PNA:DNA hybridization kinetics with silicon nanowire biosensors

Real-time electronic detection of peptide nucleic acid (PNA):DNA hybridization is demonstrated with silicon nanowire (Si-NW) biosensors. A stable baseline platform is crucial for obtaining the Si-NW response for biosensing applications. An integrated Si-NW auto-sampler is demonstrated and used for kinetic molecular binding measurements. The equilibrium association constant is determined to be KA≈7×106 M-1 in 1 mM ionic strength buffer. The surface density of hybridized DNA is determined to be ~1012 molecules/cm2 with a radiolabeled DNA-P32 assay. A 30× reduction in the measurement drift in Si-NW sensor response is obtained from 1.6 nA/hr to 0.04 nA/hr by using a differential measuremen