Safety of cesarean myomectomy with huge myoma compared with uncomplicated cesarean section in Indian scenario

Background: Myomectomy with cesarean section has traditionally been discouraged due to risk of intractable hemorrhage and increased post-operative morbidity. In recent years, many studies have demonstrated safety of performing myomectomy with cesarean section even for large fibroids. The aim of this study was to find out the safety and clinical outcome of cesarean myomectomy in case of large myoma to encourage routine combination of both procedures.Methods: 15 term women undergoing cesarean myomectomy constituted the study group and were compared with control group of 15 pregnant women matched on basis of gestational age and parity without myoma or any other high risk factor. Outcomes studied were duration of surgery, change in hemoglobin from pre-operative to post-operative period, need for blood transfusion, and duration of hospital stay, post-operative complications and follow up of patients up to 6 weeks postpartum.Results: Mean age was higher in study group than control group which could be attributed to increased incidence of fibroids with increasing age. Both the groups were comparable for pre-operative hemoglobin, post-operative hemoglobin, change in hemoglobin, neonatal outcome, post-operative complications, duration of hospital stay and follow up to 6 weeks postpartum. Duration of surgery was significantly increased in study group as compared to control group. Blood transfusion was required only in study group.Conclusions: Myomectomy may be done with cesarean section safely even for large fibroids by expert person in tertiary care setting

Azathioprine versus betamethasone for the treatment of parthenium dermatitis: A randomized controlled study

Background: Parthenium hysterophorus is the commonest cause of airborne contact dermatitis in India. Azathioprine has been shown to be effective and safe in parthenium dermatitis, but there are no reports of comparison of steroids and azathioprine in this condition. Aims: To study the therapeutic efficacy of azathioprine versus betamethasone in patients having contact dermatitis to parthenium and compare the side effects of the drugs. Methods: Fifty-five patients of airborne contact dermatitis to parthenium were randomly assigned to treatment with azathioprine 100 mg daily (group A) or betamethasone 2 mg daily (group B), for 6 months in a blinded manner. The patients were evaluated every month for 6 months to determine the response to treatment and side effects and then further followed up for another 6 months to determine any relapse. Results: There were 26 patients in group A and 29 in group B, of which 20 patients of group A and 21 of group B completed the study. Nineteen (95%) patients in group A and all 21 (100%) patients in group B had an excellent response (complete remission) to treatment (P = 0.0156 vs. 0.0005). The patients in group B, however, had more adverse effects (Fisher exact, P≤0.05). Nine (45%) patients in group A and 14 (67%) patients in group B relapsed during the post-treatment follow-up. Conclusions: Azathioprine and betamethasone appear to be almost equally effective (P = 0.0156 vs. 0.0005) in the treatment of parthenium dermatitis. However, adverse effects and relapses were observed to be more frequent in patients treated with betamethasone