Clinicopathological study of hysterectomised specimens

Background: Hysterectomy is the commonest major surgical procedure performed in gynecology. It can be done by abdominal or vaginal route and with the help of laparoscopy. Hysterectomy is an effective treatment option for many conditions like fibroid, abnormal uterine bleeding, endometriosis, adenomyosis, uterine prolapse, pelvic inflammatory disease and cancer of reproductive organ when other treatment options are contraindicated or have failed, or if the woman no longer wishes to retain her menstrual and reproductive. The aim and objective of the study was to correlate indications of hysterectomy with histopathological findings in hysterectomised patients.Methods: A retrospective study was carried on 113 hysterectomised cases over a period of one year from June 2015 to May 2016. The data regarding the patient’s age, parity, clinical diagnosis, type of hysterectomy and histopathological diagnosis were reviewed by the records and analyzed.Results: A total of 113 cases of hysterectomies were studied. Hysterectomies were distributed over a wide age ranging from 20 years to 75 years. Most common age group was 41-50 years. Among hystectomies majority were done through vaginal route 86 (76.1%) and 26 (23%) cases were done through abdominal route. Most common clinical diagnosis was fibroid uterus in 44(38.9%) cases. Most of the hysterectomies were done for benign conditions. In final histopathological report most common diagnosis was fibroid uterus in 45(39.8%) hysterectomy specimens. It was correlated well with clinical diagnosis. Next most common histopathological diagnosis was Adenomyosis.Conclusions: Histopathological analysis correlated well with preoperative clinical diagnosis in majority of cases. The commonest indication and histopathological finding in our study was fibroid uterus. Next most common histopathological finding was Adenomyosis. Most commonly hysterectomies were done through vaginal route in our study

Nondescent vaginal hysterectomy: analysis of indications and complications

Background: Hysterectomy is the commonest major surgical procedure performed in gynecology. It can be done by abdominal or vaginal route and with the help of laparoscopy. Laparoscopic assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) although gaining more popularity now a days, though it is associated with higher cost, longer duration of operation, and need general anaesthesia. The latest value study concluded that major haemorrhage, hematoma, ureteric injury, bladder injury, and anesthetic complications were more in laparoscopic assisted hysterectomy (LAVH) group when compared to abdominal and vaginal hysterectomies. In addition LAVH was accomplished in twice the time required for vaginal hysterectomy.The objective of the study was to analyse the indication and to study the complications of nondescent vaginal hysterectomy.Methods: This is a retrospective cohort study.  60 women who underwent nondescent vaginal hysterectomy in the department of OBG, B.G.S. Global Institute of Medical Sciences, Banglore, India were included in the study. Patients’ records were retrieved. Data regarding patient’s age, parity, indications for hysterectomy, uterine size in weeks, previous surgeries in the past, duration of surgery and complications were recorded. Data collected on a semi structured proforma and the same was analysed using suitable statistical analysis.Results: A total of 60 cases were operated for different indications. Among the study participants majority were in the age group of 41-45 years with 28 (46.7%). Most common indication for hysterectomies were dysfunctional uterine bleeding (DUB) with 27 (45%), followed by fibroid uterus 15 (25%). The mean duration of surgery time taken was 50+10minutes. Majority of the women who underwent hysterectomies had bulky uterus with 42 (70%).  Complications were very few. Fever, UTI (urinary tract infection) and headache were seen in 3 (5%) cases. There was one case of vault sepsis and one case of upper respiratory tract infection (URTI). In one patient vaginal hysterectomy could not be completed and abdominal hysterectomy was carried out. Mean hospital duration was 4 days.Conclusions: Vaginal hysterectomy is the least invasive with fewer complications and most economical route for hysterectomy. Nondescent vaginal hysterectomy should be the gynaecologists first choice for hysterectomy

Study of demographic features in retropositive pregnant women

Background: Study of demographic features like age, educational status of the patient and her husband, occupation of the patient and her husband and religion of the retropositive pregnant women compared to controls.Methods: In this prospective study patients were selected from Vani Vilas Hospital attached to Bangalore Medical College attending the antenatal Clinic of Obstetrics and Gynaecology. The study period was for 2 years. The study group comprised of 100 HIV seropositive patients. The control group comprised of 100 HIV seronegative patients. At enrollment, data collection of demographic features like age, educational status of the patient and her husband, occupation of patient and her husband, and religion of the retropositive pregnant women compared to controls.Results: The minimum and maximum age in the study group was 18 and 36 years respectively and in the control group 17 and 35 years respectively. Around 73% of pregnant women in the study group were below 25 years of age. 89% of pregnant women in the study group were Hindus. Around 36% of women in the study group were illiterate compared to 21% in the control group. Around 45% of women in the control group have studied till secondary school. In this study, most of the women in both the groups were housewives. There was one commercial sex worker and 8 women had polygamous relationship in the study group. The occupational pattern of the husbands was analyzed and 34% of the husbands of HIV positive women were drivers. 56% of the husbands in the study group admitted to have had multiple sexual partners, whereas only 9% admitted so, in the control group.Conclusions: Retropositive pregnant women were younger; most of them were house wives. Husbands of retropositive pregnant women were drivers and most of them had multiple sexual partners

A study of uterine balloon tamponade for the management postpartum haemorrhage using Bakri balloon

Background: PPH is the most common cause of maternal morbidity and mortality around the world. Incidence of PPH is 2-4% following vaginal delivery and 6% following cesarean delivery in India. Uterine atony is the most common cause of PPH. Treatment of PPH involves medical treatment and surgical management. In between medical and surgical management of PPH comes uterine balloon tamponade which is simple, less invasive and can be managed with minimal training.Methods: A retrospective cohort study was done for 2 years at Vanivilas hospital, Bangalore medical college and research centre, Bangalore, Karnataka. Cases of atonic PPH managed using Bakri balloon were included in the study. The objective of the study was to study the effectiveness of uterine balloon tamponade using Bakri balloon in the management of atonic PPH and to study the maternal outcome.Results: In this study total of 50 cases were included. Women were in the age group of 18 to 33years. Regarding obstetric history, 22 (44%) were primigravida and 28 (56%) was multigravida. Among these 50 cases 8 (16%) women had undergone caesarean delivery and 42(84%) had vaginal delivery. All women received blood transfusion, 17 (34%) received blood and blood components (like PRBC, FFP AND platelets) and 33 (66%) cases received only PRBC transfusion. In these 50 cases, 32 (64%) required ICU admission for monitoring, remaining 18 (36%) were monitored in the labor-room. Bakri balloon was effective in 49 cases among 50. Success rate was 98%.Conclusions: Intrauterine balloon tamponade using Bakri balloon is effective for control of atonic PPH in majority of cases.

Evaluation of various factors in secondary infertility by diagnostic laparoscopy

Background: Infertility is defined as one year of unprotected conception. It affects approximately 10-15% of couples in reproductive age group. Secondary infertility implies that at least one previous pregnancy has occurred, regardless of the outcome. Of the various factors responsible, the brunt of the problem in secondary infertility is born by tuboperitoneal factor, ovulation factor, uterine factor and past obstetric outcomes. This lead to the emergence of diagnostic laparoscopy for evaluation of pelvic pathology in secondary infertility. The objective of the study was to secondary infertility by diagnostic laparoscopy is undertaken for following purpose. Evaluation of different causes using laparoscopy. Detecting the commonest cause of secondary infertility in our place of study.Methods: This study was conducted in the Department of Obstetrics and Gynaecology at 50 married women who presented with secondary infertility at the outpatient department Sri Adichunchanagiri Hospital and Research Centre, B.G nagar, Mandya district were recruited in this study. Study was done for 2 years. Detailed clinical history with respect to duration and nature of infertility, detailed menstrual history, past obstetric history, a complete medical, surgical and gynaecological history, medications, sexual history, personal history and habits, details of previous tests and therapy for infertility if any taken. Patients were subjected to a general physical, abdominal and pelvic examination to detect any obvious pathology. The laparoscopic procedure was planned in the premenstrual period. With the help of the laparoscope, the pelvic organs are visualized and studied. Chromopertubation done with methylene blue. Later dilatation and currettage done and endometrium sent for HPE.Results: Most common age group was 25-29 years. There were 27 Cases (54%) of secondary infertility. In our study, the cases recruited for diagnostic laparoscopy had to be infertile for a minimum period of 12 months, following their recent past obstetric outcome. 23 cases (50%) of secondary infertility had a duration between 7-9 years. Of the 50 cases of secondary infertility, 24 cases (48%) had definite tubal involvement. Of the 50 cases of secondary infertility, 8 cases (16%) had ovarian involvement. In our study, tubal factors contributed largely to infertility as evidenced by the fact that it was present in 24 cases (48%). This is followed by peritoneal factor in 10 cases (20%). Ovarian factor in 8 cases (16%) and uterine factor in 5 cases (10%).Conclusions: Diagnostic Laparoscopy is now a universally accepted procedure for evaluating the intraperitoneal and peritubal causes of infertility in the female. The work up of every secondary infertile female must involve a laparoscopic evaluation after meticulously excluding the male factor

Study of demographic features in retropositive pregnant women

Background: Study of demographic features like age, educational status of the patient and her husband, occupation of the patient and her husband and religion of the retropositive pregnant women compared to controls.Methods: In this prospective study patients were selected from Vani Vilas Hospital attached to Bangalore Medical College attending the antenatal Clinic of Obstetrics and Gynaecology. The study period was for 2 years. The study group comprised of 100 HIV seropositive patients. The control group comprised of 100 HIV seronegative patients. At enrollment, data collection of demographic features like age, educational status of the patient and her husband, occupation of patient and her husband, and religion of the retropositive pregnant women compared to controls.Results: The minimum and maximum age in the study group was 18 and 36 years respectively and in the control group 17 and 35 years respectively. Around 73% of pregnant women in the study group were below 25 years of age. 89% of pregnant women in the study group were Hindus. Around 36% of women in the study group were illiterate compared to 21% in the control group. Around 45% of women in the control group have studied till secondary school. In this study, most of the women in both the groups were housewives. There was one commercial sex worker and 8 women had polygamous relationship in the study group. The occupational pattern of the husbands was analyzed and 34% of the husbands of HIV positive women were drivers. 56% of the husbands in the study group admitted to have had multiple sexual partners, whereas only 9% admitted so, in the control group.Conclusions: Retropositive pregnant women were younger; most of them were house wives. Husbands of retropositive pregnant women were drivers and most of them had multiple sexual partners

Effect of Short-Term Pranayama and Meditation on Cardiovascular Functions in Healthy Individuals

Context: Asana, pranayama, and meditation are three main techniques of yoga practiced in India over thousands of years to attain functional harmony between the body and mind. Recent studies on long-term yogic practices have shown improvements in cardiovascular functions. Aim: The present study was conducted to ascertain if a short-term practice of pranayama and meditation had improvements in cardiovascular functions in healthy individuals with respect to age, gender, and body mass index (BMI). Settings and Design: This interventional study was conducted in the Department of physiology of S.N. Medical College, Bagalkot. Patients and Methods: Fifty healthy subjects (24 males and 26 females) of 20−60 years age group, fulfilling the inclusion and exclusion criteria underwent two hours daily yoga program for 15 days taught by a certified yoga teacher. Pre and post yoga cardiovascular functions were assessed by recording pulse rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure. Statistical analysis used: The parameters were analyzed by Student′s t test. Results: There was significant reduction in resting pulse rate, systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure after practicing pranayama and meditation for 15 days. The response was similar in both the genders, both the age groups, 40 yrs and both the groups with BMI, 25 kg/m2 . Conclusion: This study showed beneficial effects of short term (15 days) regular pranayama and meditation practice on cardiovascular functions irrespective of age, gender, and BMI in normal healthy individuals