Suture versus vessel sealer in vaginal hysterectomy: an observational study

Background: Vaginal route is considered to be the method of choice for removal of uterus and, in the absence of gross pelvic disease, can be carried out in most patients. Recent studies have shown that less than one-third of hysterectomies are performed vaginally. This could be due to technical difficulties occurring while operating in the narrow surgical field. This study was taken up to find out the easier alternatives in securing pedicles by using Electrosurgical Bipolar Vessel Sealer in Vaginal Hysterectomy.Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, BRD Medical College, Gorakhpur over a period of one year i.e. July 15 to June 16. A total of 62 patients posted for vaginal hysterectomy for benign conditions were enrolled after informed consent. Results were recorded under headings of procedure time (min), blood loss (ml), major intra-operative complications and post operative complications, post-operative pain (on VAS) and duration of hospital stay.Results: Mean procedure time in suture method was found to be 55.66min, whereas, in sealer group it was 27.75 min. Mean blood loss in the sealer group was 83.78ml, while, in suture group it was 156.62ml. Mean pain score on Visual Analogue Scale on POD 1 was 8.44±1.1522 for suture group and 6±1.325 for sealer group. Mean pain score on POD2 in sealer group was 3.48±1.325 and in the suture group it was 5.31±1.754 (P200ml was observed in 29.03% of suture cases, none in the sealer group (P-value .0006). Labial burn occurred in 2 out of 32patients in sealer group.Conclusions: From above study, we conclude that bipolar vessel sealer has shown a significant reduction in intra-operative blood loss, procedure time, immediate post-operative pain (POD1,2&3), mean length of stay in hospital, major intra-operative blood loss>200ml which was found in significant number of cases in suture group

Calcified amorphous tumor of the heart in an adult female: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cardiac calcified amorphous tumor is a rare, non-neoplastic intra-cavity cardiac mass composed of calcium deposits in a background of amorphous degenerating fibrinous material. Only a few cases of this rare lesion have been reported in the available literature. Clinico-pathological differentiation of this lesion from calcified atrial myxoma, calcified thrombi or other cardiac neoplasms is extremely difficult; hence pathologic examination is the mainstay of diagnosis. To the best of our knowledge this entity has not been reported in the Indian literature.</p> <p>Case presentation</p> <p>A 40-year-old woman of Indian origin presented with progressive dyspnea, fatigue and cough. She was diagnosed as having a calcified right atrial mass. The mass was excised. Histologic examination revealed the mass to be composed of amorphous eosinophilic fibrin with dense calcification. No myxomatous tissue was seen and a final diagnosis of calcified amorphous tumor of the heart was rendered.</p> <p>Conclusions</p> <p>Calcified amorphous tumor is a rare cardiac lesion with an excellent outcome following complete surgical removal. Since clinico-radiologic differentiation from other cardiac masses is not possible in most cases, histopathological examination is the only modality for diagnosis. Hence, histopathologists should be aware of this rare entity in the differential diagnoses of cardiac mass.</p

Population distribution analyses reveal a hierarchy of molecular players underlying parallel endocytic pathways.

Single-cell-resolved measurements reveal heterogeneous distributions of clathrin-dependent (CD) and -independent (CLIC/GEEC: CG) endocytic activity in Drosophila cell populations. dsRNA-mediated knockdown of core versus peripheral endocytic machinery induces strong changes in the mean, or subtle changes in the shapes of these distributions, respectively. By quantifying these subtle shape changes for 27 single-cell features which report on endocytic activity and cell morphology, we organize 1072 Drosophila genes into a tree-like hierarchy. We find that tree nodes contain gene sets enriched in functional classes and protein complexes, providing a portrait of core and peripheral control of CD and CG endocytosis. For 470 genes we obtain additional features from separate assays and classify them into early- or late-acting genes of the endocytic pathways. Detailed analyses of specific genes at intermediate levels of the tree suggest that Vacuolar ATPase and lysosomal genes involved in vacuolar biogenesis play an evolutionarily conserved role in CG endocytosis

Outcomes and Recommendations of an Indian Expert Panel for Improved Practice in Controlled Ovarian Stimulation for Assisted Reproductive Technology

. Purpose. To improve success of in vitro fertilization (IVF), assisted reproductive technology (ART) experts addressed four questions. What is optimum oocytes number leading to highest live birth rate (LBR)? Are cohort size and embryo quality correlated? Does gonadotropin type affect oocyte yield? Should &quot;freeze-all&quot; policy be adopted in cycles with progesterone &gt;1.5 ng/mL on day of human chorionic gonadotropin (hCG) administration? Methods. Electronic database search included ten studies on which panel gave opinions for improving current practice in controlled ovarian stimulation for ART. Results. Strong association existed between retrieved oocytes number (RON) and LBRs. RON impacted likelihood of ovarian hyperstimulation syndrome (OHSS). Embryo euploidy decreased with age, not with cohort size. Progesterone &gt; 1.5 ng/dL did not impair cycle outcomes in patients with high cohorts and showed disparate results on day of hCG administration. Conclusions. Ovarian stimulation should be designed to retrieve 10-15 oocytes/treatment. Accurate dosage, gonadotropin type, should be selected as per prediction markers of ovarian response. Gonadotropin-releasing hormone (GnRH) antagonist based protocols are advised to avoid OHSS. Cumulative pregnancy rate was most relevant pregnancy endpoint in ART. Cycles with serum progesterone ≥1.5 ng/dL on day of hCG administration should not adopt &quot;freeze-all&quot; policy. Further research is needed due to lack of data availability on progesterone threshold or index

A Massive Ovarian Mucinous Cystadenoma: A Rare Case Report

Ovarian mucinous cystadenoma is a benign tumour that arises from the surface epithelium of the ovary. It tends to be huge in size if not detected early. We describe a 32 year old woman (para 1+0) presented with marked abdominal distension, discomfort and vague pain in the abdomen with dyspepsia, anorexia, nausea, vomiting and irregular menstruation for last three months with the suspicion of pregnancy. On examination no findings were in favour of pregnancy, rather an ill defined abdominal mass about 30 weeks pregnancy size was found. Transabdominal USG revealed a big multiloculated ovarian cyst of about 25x20 cm. On laparotomy a huge cystic mass was noticed arising from left ovary. The cyst wall was smooth, intact and without any external projection though adherent with the left fallopian tube and left salpingo-oophorectomy was done. Histopathological examination revealed an ovarian cyst compatible with mucinous cystadenoma. Such giant ovarian tumours have become rare in current practice. This case report emphasizes the significance of thorough evaluation of all women presented with non specific complaints like vague abdominal pain or simple dyspepsia. Although the condition is rare, it is potentially dangerous in the massive form if not timely diagnosed and managed properly. With the increasing awareness of such conditions, more and more cases could be detected and reported early

Anti-mullerian hormone cut-off values for predicting poor ovarian response to exogenous ovarian stimulation in in-vitro fertilization

Objectives: (a) To establish the cut-off levels for anti-Mullerian hormone (AMH) in a population of Indian women that would determine poor response. (b) To determine which among the three ie.,: age, follicle stimulating hormone (FSH), or AMH, is the better determinant of ovarian reserve. Study Design: Prospective observational study. Setting: In vitro fertilization (IVF) unit of a tertiary hospital. Materials and Methods: The inclusion criterion was all women who presented to the center for in-vitro fertilization/Intracytoplasmic sperm injection (IVF/ICSI). The exclusion criteria were age >45 years, major medical illnesses precluding IVF or pregnancy, FSH more than 20 IU/L, and failure to obtain consent. The interventions including baseline pelvic scan, day 2/3 FSH, luteinizing hormone (LH), estradiol estimations, and AMH measurement on any random day of cycle were done. Subjects underwent IVF according to long agonist or antagonist protocol regimen. Oocyte recovery was correlated with studied variables. The primary outcome measure was the number of oocytes aspirated (OCR). Three categories of ovarian response were defined: poor response, OCR ≤ 3; average response, OCR between 4 and 15; hyperresponse, OCR > 15. Results: Of the 198 patients enrolled, poor, average, and hyperresponse were observed in 23%, 63%, and 14% respectively. Correlation coefficient for AMH with ovarian response was r = 0.591. Area under the curve (AUCs) for poor response for AMH, subject′s age, and FSH were 0.768, 0.624, and 0.635, respectively. The discriminatory level of AMH for prediction of absolute poor response was 2 pmoL/l, with 98% specificity and 20% sensitivity. Conclusions: AMH fares better than age and FSH in predicting the overall ovarian response and poor response, though it cannot be the absolute predictor of non-responder status. A level of 2 pmol/l is discriminatory for poor response