Feasibility of laparoscopy in management of ectopic pregnancy: experience from a tertiary care hospital

Background: Ectopic pregnancy is an important cause of maternal morbidity and mortality. For surgical management, laparoscopy is preferred option. In developing world for ruptured ectopic pregnancy laparotomy is done at most of places. In this study we have assessed feasibility of laparoscopic management in both ruptured and unruptured ectopic pregnancy.Methods: A prospective study, conducted over period of 1 year from July 2014 to July 2015 in Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi. In 110 patients of ectopic pregnancy parameters studied were age and parity, symptoms, risk factors, diagnostic methods, site of ectopic, management and its outcome. Primary objective was to evaluate management outcome of ectopic pregnancy and to assess feasibility of laparoscopy in ectopic pregnancy. Ruptured ectopic pregnancy with massive hemoperitoneum were analyzed separately. Secondary objective was to study demographic characters and risk factors of ectopic pregnancy.Results: Surgical management was required in 93.6% patients, out of which 86.4% were managed laparoscopically. Unruptured ectopic pregnancy was managed successfully by laparoscopy in 96.6% (29/30) patients. Ectopic was ruptured in 73 (66.3%) cases, laparoscopy was attempted in 91.7% (67/73). In 10.4% (7/67) patients laparoscopy had to be converted to laparotomy and it was successful in 89.5%. Out of 16 patients with massive hemoperitoneum, 12(75%) were managed laparoscopically. There was no mortality.Conclusions: In most of cases laparoscopy is safe and successful. Laparoscopy is feasible in ruptured ectopic cases including selected cases with massive hemoperitoneum thus avoiding unnecessary laparotomy and associated morbidity. Timely diagnosis and management prevents mortality

Successful Pregnancy Outcome by Caesarean Section in Woman with Arthrogryposis Multiple Congenita (AMC)

Arthrogryposis Multiplex Congenita (AMC) is a symptom complex of congenital joint contractures associated with neurogenic and myopathic disorders. It is diagnosed at birth and often progresses to a state of significant disability. Pregnancy in a woman with AMC is at high risk due to diminished pulmonary reserve, increased risk of thromboembolism and anesthesia. Successful pregnancy in patients with AMC is very rare and only five cases have been reported in literature. Present case is being reported due to its rarityL'arthrogrypose congénitale multiple (ACM) est un symptôme complexe des contractures articulaires congénitales liées aux troubles neurogènes et myopathiques. Il est diagnostiqué à la naissance et progresse souvent jusqu'à un état d'incapacité significative. La grossesse chez une femme qui souffre de l'ACM est à haut risque dû au réserve pulmonaire réduit, un risque élevé de la thromboembolie et de l'anesthésie. La grossesse réussite chez les patientes atteintes de l'ACM est très rare et il n'y a que cinq cas qui ont été signalés dans la littérature. Ce cas présent est signalé à cause de sa raret

Tin oxide nanocrystals: controllable synthesis, characterization, optical properties and mechanistic insights into the formation process

A novel, surfactant-free, solution-phase method has been successfully developed for the synthesis of SnO2 nanocrystals using a solvothermal route. The nanocrystals having average diameters in the range 4–8 nm, have been synthesized by a non-aqueous sol–gel reaction using tin(IV) bis(acetylacetonate)dichloride, [(Sn(acac)2Cl2)] with benzyl alcohol as the reaction medium at 200 °C. The crystal structure, morphology, and sizes of the SnO2 nanocrystals have been determined by X-ray diffraction (XRD), transmission electron microscopy (TEM) and Raman studies. Raman peaks at 627, 768 cm−1 characteristic of the rutile phase of bulk SnO2 are observed along with broad surface vibration modes in the range 400–600 cm−1. Optical properties of the nanocrystals have been explored by optical absorption and photoluminescence (PL). A blue shift of the optical band gap of the nanocrystals is observed due to size effects. The estimated band gap of the SnO2 nanocrystals from optical absorption data is found to be 3.81 eV. The photoluminescence spectrum showed broad UV as well as visible emission. Based on the GC-MS and carbon-13 NMR analysis of the final reaction solution, a formation mechanism encompassing the ether elimination and solvolysis of acetylacetonate ligand is proposed

Cytomorphologic significance of marginal vacuoles in diffuse thyroid enlargements

Background: Fine needle aspiration cytology (FNAC) of the thyroid is an established first-line test for thyroid lesions. Marginal vacuoles (MVs) have been associated with hyperactivity of the thyroid, but some studies have pointed towards their nonspecific status. Aims: To assess the presence of MVs in diffuse thyroid enlargements and evaluate the strength of correlation between MVs, levels of thyroid hormone and cytological diagnosis. Materials and Methods: Ninety-seven cases of diffuse thyromegaly were studied. Cytomorphological features were examined with special attention to MVs. MVs were graded as scant, moderate and abundant. Hormonal status of the patients was recorded. The presence and grading of MVs was correlated with cytological diagnosis and hormonal status. The strength of association was studied by applying the Chi-square test and test of proportion; a P ? 0.05 was considered significant. ≤ 0.05 was considered significant. Results: Abundant MVs were not associated with hypothyroidism in this study; 79% of these cases were hyperthyroid. The correlation between moderate/insignificant MVs and functional status of the thyroid gland was inconclusive. Further, abundant MVs in thyroid FNACs were seen in cases of primary hyperplasia and Hashimoto′s thyroiditis. There was a significant correlation between the presence of abundant/moderate MVs and primary hyperplasia and their absence in colloid goiter (P = 0.01 and 0.004, respectively). Conclusions: A significant association was found between abundant MVs and a hyperthyroid state. Moderate/absent MVs in diffuse goiters were not found to correlate with thyroid function. Thus, all diffuse goiters with prominent MVs require hormonal evaluation to rule out hyperfunction of the thyroid

Indwelling pleural drain for mobile management of malignant pleural effusion-combining benefits of both methods

Malignant pleural effusion is a leading cause of morbidity in lung cancer patients requiring repeated pleural aspirations or persistent intercostal drainage tube. Using an indigenous method of putting icd tube of smaller size with subcutaneous tunneling would allow draining fluid from lungs easily and painlessly when needed and avoid the need for repeated injections and chest tube insertion every time the fluid is to be drained

Synthesis and characterisation of mono- and binuclear palladium and platinum complexes with organochalcogenides

Singhal, Anshu ; Jain, Vimal K. ; Varghese, Babu ; Tiekink, Edward R.T

Feasibility of laparoscopy in management of ectopic pregnancy: experience from a tertiary care hospital

Background: Ectopic pregnancy is an important cause of maternal morbidity and mortality. For surgical management, laparoscopy is preferred option. In developing world for ruptured ectopic pregnancy laparotomy is done at most of places. In this study we have assessed feasibility of laparoscopic management in both ruptured and unruptured ectopic pregnancy.Methods: A prospective study, conducted over period of 1 year from July 2014 to July 2015 in Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi. In 110 patients of ectopic pregnancy parameters studied were age and parity, symptoms, risk factors, diagnostic methods, site of ectopic, management and its outcome. Primary objective was to evaluate management outcome of ectopic pregnancy and to assess feasibility of laparoscopy in ectopic pregnancy. Ruptured ectopic pregnancy with massive hemoperitoneum were analyzed separately. Secondary objective was to study demographic characters and risk factors of ectopic pregnancy.Results: Surgical management was required in 93.6% patients, out of which 86.4% were managed laparoscopically. Unruptured ectopic pregnancy was managed successfully by laparoscopy in 96.6% (29/30) patients. Ectopic was ruptured in 73 (66.3%) cases, laparoscopy was attempted in 91.7% (67/73). In 10.4% (7/67) patients laparoscopy had to be converted to laparotomy and it was successful in 89.5%. Out of 16 patients with massive hemoperitoneum, 12(75%) were managed laparoscopically. There was no mortality.Conclusions: In most of cases laparoscopy is safe and successful. Laparoscopy is feasible in ruptured ectopic cases including selected cases with massive hemoperitoneum thus avoiding unnecessary laparotomy and associated morbidity. Timely diagnosis and management prevents mortality

Carotid intima-media thickness and oxidative stress markers for assessment of atherosclerosis in children with β thalassemia major

The present study evaluates carotid intimamedia thickness (CIMT) in children with β thalassemia major to assess atherosclerosis and its relation to the underlying proposed causative mechanisms via lipid peroxidation product malondialdehyde (MDA), oxidized lowdensity lipoproteins (LDL), total antioxidant level, and lipid profile. A cross sectional study was conducted on 62 children (31 cases and 31 controls). CIMT by high resolution ultrasound and biochemical parameters i.e., total cholesterol, triglycerides, high-density lipoproteins, LDL, Oxidized LDL, lipoprotein (a), lipid peroxidation product MDA and total antioxidant were measured in enrolled subjects and compared. In our study, CIMT was significantly increased in β thalassemia major patients’ as compared to healthy controls. Mean CIMT in cases was 0.69±0.11 mm and in controls 0.51±0.07 mm. Mean oxidized LDL (EU/mL) in cases 39.3±34.4 (range 14.4 to 160) was significantly raised (P=0.02, t test) as compared to controls 23.9±13.4 (range 12 to 70). In our study we found MDA levels (nmol/mL) to be increased in β thalassemia patients as compared to controls. Mean MDA was 10.0±3.27 (4.41 to 17.48) in cases while in controls was 6.87±4.55 (1.5 to 17.9). Our study results show CIMT as an early marker of atherogenesis in β thalassemia major. Oxidative stress markers are also increased in β thalassemia major patients and lipoprotein (a) shows a positive correlation with CIMT. The present study points towards various atherogenetic mechanisms in β thalassemia major. 本研究评价β重型地中海贫血患儿颈动脉内膜中层厚度（CIMT），以评估动脉粥样硬化，以及与潜在通过血脂过氧化反应产物丙二醛（MDA）、氧化低密度脂蛋白（LDL）、总抗氧化水平和血脂谱所提出致病机制之间的关系。 在62名儿童（31例病例和31例对照）中进行了一项横断面研究。 在入组受试者中通过高分辨率超声和生化指标（即总胆固醇、甘油三酯、高密度脂蛋白、LDL、氧化LDL，脂蛋白（a）、血脂过氧化产物MDA和总抗氧化剂）测量CIMT并进行比较。 在我们的研究中，CIMT在β重型地中海贫血患者中比健康对照组显著增加。 病例组中的平均CIMT为0.69±0.11 mm，对照组0.51±0.07 mm。病例组中平均氧化LDL（EU/mL）为39.3±34.4（从14.4到160的范围）与对照组的23.9±13.4（12至70的范围）相比显著升高（P = 0.02，t检验）。 在我们的研究中，我们发现β地中海贫血患者中的MDA水平（nmol/mL）比对照组更高。 病例组中的平均MDA为10.0±3.27（4.41至17.48），而对照组为6.87±4.55（1.5到17.9）。 我们的研究结果表明，CIMT是β重型地中海贫血动脉粥样硬化的早期标记物。 氧化应激标记物在β重型地中海贫血患者中也有增加，脂蛋白（a）显示出与CIMT呈正相关。 本研究针对β重型地中海贫血中的各种动脉粥样硬化机制。</p

Copper(I) oxide nanocrystals - one step synthesis, characterization, formation mechanism, and photocatalytic properties

We report here two different simple, one-pot, and low cost chemical synthetic routes for the preparation of Cu<SUB>2</SUB>O nanocrystals: (a) thermal decomposition of copper–organic precursors copper(II) acetate or copper(II) acetylacetonate in long chain organic solvents oleyl alcohol and trioctylamine, respectively, at 170 °C and (b) a surfactant-free solvothermal approach involving the reaction of copper(II) acetylacetonate in acetone at 140 °C. The structure and morphology of the nanocrystals have been characterized in detail by XRD, FTIR spectroscopy, Raman spectroscopy, and high-resolution transmission electron microscopy (HRTEM). The optical properties of the nanocrystals have been explored by diffuse-reflectance spectroscopy (DRS) and a blueshift of the optical band gap of the nanocrystals is observed owing to size effects. Based on the FTIR, GC–MS, and <SUP>13</SUP>C{<SUP>1</SUP>H} NMR studies of post-reaction solutions, different formation mechanisms for the Cu<SUB>2</SUB>O nanocrystals, which depend on the synthetic approach, have been proposed. Oleyl alcohol and trioctylamine play dual roles as solvents and mild reductants and reduce Cu<SUP>II</SUP> species to Cu<SUP>I</SUP> species during the course of the thermal decomposition reactions. The solvothermal reaction of copper(II) acetylacetonate in acetone possibly proceeds by acetylacetone-mediated reduction of Cu<SUP>2+</SUP> to Cu<SUP>+</SUP> in the absence of any reducing agent. The potential of Cu<SUB>2</SUB>O nanocrystals as photocatalytic materials for hydrogen generation from water/methanol (2:1) mixtures under UV/Vis irradiation has also been evaluated. The results show that all the nanocystalline Cu<SUB>2</SUB>O samples generate H<SUB>2</SUB>