Conservative surgical management of immediate post-caesarean uterine dehiscence and pelvis abscess due to proteus mirabilis infection: a rare complication of puerperal endomyometritis

Cesarean delivery is the most commonly performed major abdominal operation in women with prevalence ranging from 12% in public sectors to 28% in private sectors in India (DLHS-3 survey). Parallel to this, the complications of surgery are increased. Among these complications, uterine dehiscence and pelvic hematoma with abscess collection is rare but serious complication which might end in hysterectomy. We hereby describe the conservative surgical management of a case of infected uterine incisional necrosis and dehiscence after primary cesarean delivery. We encountered a 25-years-old woman presenting to our emergency department (ED) with severe suprapubic pain and high-grade fever. She had an emergency cesarean delivery performed 14 days prior to presentation due to non-reassuring fetal heart rate. At the ED, ultrasonography revealed collection with septation around uterus with communication into uterine cavity. CT scan of pelvis was ordered and showed an intraperitoneal collection anterior to the uterus at the level of the uterine cesarean scar. Exploratory laparotomy showed a uterine rupture at the previous incision site. We performed resection of necrotic edges, peritoneal lavage, approximation of uterine edges with separate interrupted sutures, placement of a suction drain in the cul-de-sac. During postoperative follow up, patient was stable with no symptoms or signs of uterine/pelvic infection. Conservative management by drainage and resection of necrotic edges in addition to intravenous antibiotics may be considered as an option before resorting to hysterectomy in selected young patients.

Matrix metalloproteinase-9 is elevated and related to interleukin-17 and psychological stress in male infertility: A cross-sectional study

Background: Matrix metalloproteinase-9 (MMP-9), interleukin-17 (IL-17) and psychological stress are known to play a role in the pathogenesis of male infertility. Objective: To assess the association of MMP-9 with IL-17 and psychological stress in infertile men. Materials and Methods: In this cross-sectional study, 39 men with infertility diagnosed based on semen analysis and 39 subjects with normal semen analysis were included in the study. MMP-9 and IL-17 were estimated in both groups by ELISA. Perceived stress scale was used to assess psychological stress in controls and cases. Results: In infertile cases, MMP-9 and IL-17 were significantly increased when compared with controls (p = 0.046, p = 0.041 respectively). A significant association of MMP-9 was observed with IL-17 (r = 0.335, p = 0.037) and perceived stress scale (r = 0.329, p = 0.041). Conclusion: IL-17 and stress increase MMP- 9 levels in infertile men. Key words: Infertility, Interleukins, Peptide hydrolase

Feasibility of total laparoscopic hysterectomy as a day care procedure

Background: Aim of current study was to evaluate the feasibility of Total Laparoscopic Hysterectomy (TLH) as a day care procedure and compare its outcome in relation to uterine size.Methods: A retrospective cohort study of all patients who underwent total laparoscopic hysterectomy for benign pathologies between March 2010 to April 2011 at Akola endoscopy centre, Akola, Maharashtra, were included in the study. Demographic and surgical data like estimated blood loss, operating time, rate of complications were analysed. Re-admission and re-operation rate were also analysed. A comparison between uterine height <12 weeks and uterine height >12 weeks were performed. Analysis was performed by SPSS version 15 and chi-square test.Results: The mean age of the patients was 43.05 years (range 32-66 years). The mean parity was 2.1 (range 1-4). The mean operating time was 52.83 minutes (range 40- 115), which varied according to the uterine sizes, with a mean 52.4 (range 40-68) for smaller uterus <12 weeks and for a uterus >12 weeks mean operative time was 68.23 (range 55-115 minutes) which was statistically significant (P = 0.000). The mean estimated blood loss was significantly less in patients with small uteri at 40.20 ml (range 15-80) than in patients with uterus >12 weeks, at 62.50 ml (range 40-250). (P = 0.001). There were no major intraoperative/post-operative complications. Minor post-operative complication rate was 7%. The Mean hospital stay was 8.2 hours (5 hours - 12 hours).The re-admission rate was 4%.Conclusions: These preliminary data suggests that day care laparoscopic hysterectomy is feasible, safe with greater efficacy; however the skill of the surgeon matters. With better understanding of the technique, the advent of better anaesthetic agent, increased surgical experience and patient awareness has helped Day care surgery in to an art and which can be considered as a speciality

Leiomyosarcoma of the ovary associated with leiomyoma of uterus: a case report

Leiomyosarcoma of the ovary is a rare disease accounting for <1% of all sarcomas. It occurs mainly in post-menopausal women with aggressive behaviour and poor prognosis. Surgery is the cornerstone of treatment, while the role of chemotherapy and radiotherapy is still not clear. This paper presents the case of a post-menopausal woman who is diagnosed with primary leiomyosarcoma of the ovary along with multiple leiomyoma of the uterus, and who receives a surgical approach and currently achieving 25 months free from disease

Assessment of metabolic syndrome in infertile women with polycystic ovary syndrome in a rural population of South India: A crosssectional study

Background: Polycystic ovary syndrome (PCOS) is known to be associated with metabolic syndrome (MS). It is characterised by insulin resistance, hyperinsulinemia, dyslipidemia, obesity and hypertension. Data related to MS in infertile women with PCOS are limited in Indian populations. Objective: This study aims to compare the prevalence of MS in infertile women with and without PCOS in a rural population in South India. Materials and Methods: 130 women with PCOS and 130 women without PCOS were enrolled in this cross-sectional study. A detailed history was taken and a physical examination was done for all women. Anthropometric parameters, a glucose tolerance test, fasting glucose / insulin levels, trigylcerides, high-density lipoprotein cholesterol and blood pressure were assessed in all participants. The International Diabetes Federation criteria were applied for assessment of MS. Results: MS was more prevalent in infertile women with PCOS (42.3%) compared to women without PCOS (19.3%). 56.9% of women with PCOS had low high-density lipoprotein cholesterol levels, 46.2% had high triglycerides, 71.5% had a high waist circumference, 31.5% had high blood pressure and 37.7% had high blood glucose levels. 26.0% of the women with PCOS had a healthy weight, and MS was seen in 6.9% of these women. Conclusion: The prevalence of MS was higher in women with PCOS in comparison to women without PCOS. Among the women with PCOS, the prevalence of MS increased with age (> 27 yr), body mass index and waist circumference (71.5%), and even healthy women with PCOS contributed to 7% of MS. Hence it becomes necessary to screen all women with PCOS for metabolic profile risk factors at young age itself to prevent long term cardiovascular complications. Key words: Polycystic ovary syndrome, Metabolic syndrome, Hyperandrogenism, Hormones

Matrix Metalloproteinase-9 is Elevated and Related to Interleukin-17 and Psychological Stress in Male Infertility: A Cross-sectional Study

Background: Matrix metalloproteinase-9 (MMP-9), interleukin-17 (IL-17) and psychological stress are known to play a role in the pathogenesis of male infertility. Objective: To assess the association of MMP-9 with IL-17 and psychological stress in infertile men. Materials and Methods: In this cross-sectional study, 39 men with infertility diagnosed based on semen analysis and 39 subjects with normal semen analysis were included in the study. MMP-9 and IL-17 were estimated in both groups by ELISA. Perceived stress scale was used to assess psychological stress in controls and cases. Results: In infertile cases, MMP-9 and IL-17 were significantly increased when compared with controls (p = 0.046, p = 0.041 respectively). A significant association of MMP-9 was observed with IL-17 (r = 0.335, p = 0.037) and perceived stress scale (r = 0.329, p = 0.041). Conclusion: IL-17 and stress increase MMP- 9 levels in infertile men. Key words: Infertility, Interleukins, Peptide hydrolase