A Study on Reconstructive Options for Vaginal Agenesis

INTRODUCTION: Congenital absence of vagina occurs in 0.001 to 0.025 percent of population. Incidence is 1:5000 to 1:10000 live births. It is the main noticeable manifestation of Rokitansky sequence. The primary defect is the disturbance in the development of the caudal end of paramesonephric ducts. With normal development of all secondary sexual characteristics, these females with congenital utero- vaginal agenesis must face the cruel fact of being unable to bear children and enjoy sexual satisfaction, affecting both their mates and themselves. Considering these functional and psycho social impacts to womanhood, there is no reason for not making any endeavor in pursuing excellent results in neovaginal reconstruction. The scientific literature indicates that there have been more than 100 methods for vaginal reconstruction and still we are looking for a more effective method. Surgeons often say that if there is more than one operation for a condition then the ideal procedure does not exist. In our study we have tried to compare various techniques and arrive at better understanding of this rare but complicated disease. AIM OF THE STUDY: This study on reconstructive options for vaginal agenesis was done with following aims. 1) To study various clinical features of vaginal agenesis. 2) To study the effectiveness of VCUAM classification in the diagnosis and management of vaginal agenesis. 3) To study the various reconstructive options and treatment methods for vaginal agenesis. 4) To compare the effectiveness and complications of various treatment methods for vaginal agenesis. MATERIALS AND METHODS: All the vaginal agenesis patients who attended our department during the period from August 2004 to April 2007 were included in our study. Only vaginal agenesis cases were included in our study, other cases such as testicular feminization syndrome, ambiguous genitalia, intersex and androgen insensitivity syndrome were excluded from our study. Thorough history taking and physical examination were done to find the cause of primary amenorrhea and associated anomalies. Then the necessary investigations such as Karyotyping, ultra sonogram of abdomen, kidneys and pelvis were done to confirm the diagnosis and to find associated anomalies. The diagnostic laparoscopy was done. Then the patients were given counseling regarding the diagnosis and possible treatment outcomes. After the investigations for the anesthetic assessment, surgery was done. In our institution we perform three surgical procedures namely Abbe Mc Indoe, Neuro vascular pudendal thigh flaps and Horse shoe shaped labia minora flaps. Patient’s abdomen, perineum and thighs were shaved. Lower bowel preparation was given the night before and the morning of the surgery. Under spinal anesthesia patient was placed in the lithotomy position. The whole abdomen perineum and both thighs were prepared, bladder was catheterized. DISCUSSION: A total of 24 patients underwent our study. In our study the youngest patient was aged 12 years and the oldest was aged 30 years (mean age 20 years). The commonest age group was 16 to 20 years. John A Rock describes the commonest presentation are usually at the age of 14 to 15 years by the gynecologist. Lisa Jane describes the commonest age of presentation is 15 to 18 years. The average of discovery is 17 years in other studies. Whatever may be the age of presentation, the referral to plastic surgeon is usually from the gynecologist as in our study. Previously the opinion regarding the ideal age for surgery was considered as just before marriage or when regular sexual activity was anticipated. The introduction of flap procedures had changed the management to an earlier age, probably during her teenage itself so as to psychologically adjust to the world and also to improve the self esteem of the patients. CONCLUSION: After this study the following conclusions were made. 1. Our patients present little later than the western world and a considerable number of patients present late even after marriage. 2. All the patients were phenotypically and genetically 46XX females with normal secondary sexual characters. 3. The renal anomalies were not detected as frequently as in the literature. 4. The terminology used for diagnosis by the primary referring physicians was not consistent. 5. The VCUAM classification gives better diagnosis and useful in the management. 6. Only 79.2% of patients accepted surgical treatment, the remaining 20.8% patients did not accept surgical treatment or dilation therapy. 7. The Abbe-McIndoe procedure was simple, safe procedure with good aesthetic results and had least complication rate. 8. The pudendal thigh flap procedure was simple, safe procedure with fair aesthetic results and had acceptable complication rate. 9. The Horse shoe flap procedure was technically difficult procedure with fair aesthetic results and had high contraction rate. 10. Most of our patients were very irregular in follow up and stent usage. So, flap procedure especially pudendal thigh flaps which has the least contraction rate is the preferable treatment option for such patients

Culture and conflict management style of international project managers

The management of culture has become increasingly important to many organisations and business disciplines, particularly multicultural and international project management. Cultural differences often result in varying degrees of conflict and require careful consideration. This study surveys 116 Project Managers using the Thomas-Kilmann Conflict Mode Instrument to determine their approach toward managing conflict. Indian, French and UK Project Managers’ conflict management style are correlated with Hofstede’s description of their cultural characteristics. We find that significant links between the cultural dimensions of Individualism and Masculinity with the propensity for Project Managers to adopt a Competitive style of conflict management. We also find Uncertainty Avoidance correlates with a tendency for Project Managers to adopt an Avoiding approach to conflict management. Other relationships are found between Hofstede’s cultural dimensions and conflict management styles in Project Managers but their meaning requires further study

Sigmoid volvulus in pregnancy: a rare case

Sigmoid volvulus in pregnancy is an extremely uncommon condition, with only 84 cases to have been reported in the English literature. Sigmoid volvulus is the most common cause of bowel obstruction complicating pregnancy, accounting for up to 44 per cent of cases. Overall bowel obstruction in pregnancy varies from 1 in 1500 to 1 in 66,431 deliveries. Intestinal obstruction in pregnancy can be caused by many factors including congenital or postoperative adhesions, volvulus, intussusceptions, hernia and appendicitis, history of intestinal tuberculosis. Patient presented with acute onset abdominal distension associated with multiple episodes of vomiting. When history and clinical examination was suggestive of acute abdomen, diagnosis was confirmed with imaging modalities like abdominal ultrasound, CT (Computerized tomography) scan. Sigmoid volvulus is a surgical emergency and is to be treated promptly. Here we presented a case report on sigmoid volvulus in third trimester pregnancy which was managed by emergency exploration

Physical volcanology and geochemistry of Palaeoarchaean komatiite lava flows from the western Dharwar craton, southern India: implications for Archaean mantle evolution and crustal growth

Palaeoarchaean (3.38–3.35 Ga) komatiites from the Jayachamaraja Pura (J.C. Pura) and Banasandra greenstone belts of the western Dharwar craton, southern India were erupted as submarine lava flows. These high-temperature (1450–1550°C), low-viscosity lavas produced thick, massive, polygonal jointed sheet flows with sporadic flow top breccias. Thick olivine cumulate zones within differentiated komatiites suggest channel/conduit facies. Compound, undifferentiated flow fields developed marginal-lobate thin flows with several spinifex-textured lobes. Individual lobes experienced two distinct vesiculation episodes and grew by inflation. Occasionally komatiite flows form pillows and quench fragmented hyaloclastites. J.C. Pura komatiite lavas represent massive coherent facies with minor channel facies, whilst the Bansandra komatiites correspond to compound flow fields interspersed with pillow facies. The komatiites are metamorphosed to greenschist facies and consist of serpentine-talc ± carbonate, actinolite–tremolite with remnants of primary olivine, chromite, and pyroxene. The majority of the studied samples are komatiites (22.46–42.41 wt.% MgO) whilst a few are komatiitic basalts (12.94–16.18 wt.% MgO) extending into basaltic (7.71 – 10.80 wt.% MgO) composition. The studied komatiites are Al-depleted Barberton type whilst komatiite basalts belong to the Al-undepleted Munro type. Trace element data suggest variable fractionation of garnet, olivine, pyroxene, and chromite. Incompatible element ratios (Nb/Th, Nb/U, Zr/Y Nb/Y) show that the komatiites were derived from heterogeneous sources ranging from depleted to primitive mantle. CaO/Al2O3 and (Gd/Yb)N ratios show that the Al-depleted komatiite magmas were generated at great depth (350–400 km) by 40–50% partial melting of deep mantle with or without garnet (majorite?) in residue whilst komatiite basalts and basalts were generated at shallow depth in an ascending plume. The widespread Palaeoarchaean deep depleted mantle-derived komatiite volcanism and sub-contemporaneous TTG accretion implies a major earlier episode of mantle differentiation and crustal growth during ca. 3.6–3.8 Ga

Pregnancy in rudimentary horn of unicornuate uterus: a rare case

Congenital malformations of the female genital tract result from embryological maldevelopment of Mullerian or paramesonephric ducts. Mullerian duct anomalies (MDAs) are due to agenesis, defective fusion or resorption during embryological development. Unicornuate uterus results due to defective lateral fusion of Mullerian duct. This report discussed a case of pregnancy in rudimentary horn of unicornuate uterus which resulted in rupture of the horn. A patient 35 year old G2A1 with spontaneous conception with 4 months pregnancy came to emergency room with complaints of pain in abdomen and giddiness. On examination her general condition was moderate with pulse rate of 128 bpm, blood pressure of 90/60 mmHg, pallor was present. On per abdomen examination guarding, rigidity and diffuse tenderness was present. On per vaginum examination, uterus size could not be appreciated. Her haemoglobin level was 6 gm%. Ultrasonography of abdomen showed presence of unicornuate uterus with ruptured right horn with fetus in the abdominal cavity and presence of hemoperitoneum. Immediate resuscitative measures were performed, blood transfusion was started and simultaneously patient was shifted to operation theatre for exploratory laparotomy. Intraoperatively hemoperitoneum with unicornuate uterus with non communicating ruptured accessory horn on right side was present and foetus in peritoneal cavity was seen. Ruptured horn was excised and uterus was repaired. The accessory horn and foetus were sent for histopathology examination which was suggestive of placenta increta with gestational hypertrophy and hyperplasia of myometrium with normal tube and ovary. Patient tolerated the procedure well

DESIGN, DEVELOPMENT, CHARACTERIZATION AND COMPARISON OF CALCIUM SILICATE AND CHOLESTYRAMINE BASED ELETRIPTAN HYDROBROMIDE FLOATING MICROSPHERES

Studies were carried out to develop, characterize and compare oral floating microspheres for Eletriptan Hydrobromide using Ion exchange resin like Cholestyramine and low density porous carrier like calcium silicate so as to provide extended gastric retention. The prepared resinates were studied for the effect of pH and drug resin ratio on drug loading and is similar with calcium silicate. Both the formulations were evaluated for drug entrapment, in vitro floating behavior, in vivo buoyancy and in vitro drug release studies. Dissolution study of Eletriptan hydrobromide microspheres with both the calcium silicate and cholestyramine was able to sustain the release of the drug. The study suggests that the floating microspheres of Eletriptan hydrobromide provide sustained release over 24 h and also showed in vivo buoyancy for more than 10 h in rabbit

Effects of Disorder in FeSe : An Ab Initio Study

Using the coherent-potential approximation, we have studied the effects of excess Fe, Se-deficiency, and substitutions of S, Te on Se sub-lattice and Co, Ni and Cu on Fe sub-lattice in FeSe. Our results show that (i) a small amount of excess Fe substantially disorders the Fe-derived bands while Se-deficiency affects mainly the Se-derived bands, (ii) the substitution of S or Te enhances the possibility of Fermi surface nesting, specially in FeSe$_{0.5}$Te$_{0.5}$, in spite of disordering the Se-derived bands, (iii) the electron doping through Co, Ni or Cu disorders the system and pushes down the Fe-derived bands, thereby destroying the possibility of Fermi surface nesting. A comparison of these results with the rigid-band, virtual-crystal and supercell approximations reveals the importance of describing disorder with the coherent-potential approximation.Comment: Redone VCA calculations, and some minor changes. (Accepted for publication in Journal of Physics:Condensed Matter