Recurrent Pelvic Organ Prolapse

The treatment of recurrent pelvic organ prolapse is challenging. The pelvic floor symptom needs to be treated, a high quality of life has to be ensured and complications have to be minimized. There is a wide range of surgical options that may be used. The surgeon should be able to discuss and offer native tissue procedures for prolapse. In addition, for the clinically challenging situations of recurrent prolapse, mesh augmented procedures may need to be discussed with the patient. A thorough knowledge of mesh and graft options, as well as knowledge of prolapse recurrence and adverse events rate, can help guide clinicians in counseling their patients effectively. Ultimately, this will allow surgeons to choose a personalized treatment option that best align with a woman’s lifestyle and treatment goals. In this chapter the anatomical concepts of supports of vagina are elaborated. The pelvic diaphragm, lateral attachment of vagina to arcus tendineus fascia pelvis, intrinsic and extrinsic sphincter control mechanisms are elaborated. The surgical techniques of suspending the vaginal vault with autologous tissue and synthetic mesh are discussed. Finally, the role of minimally invasive surgery of pelvic floor is discussed as an integral part of management of recurrent vaginal prolapse

Ovarian Reserve

The human ovary is a complex structure that is controlled by endocrine, paracrine, and autocrine mechanisms. The number of eggs retrieved after controlled ovarian stimulation in in vitro fertilization depends on the physiological follicular reserve pool of ovaries. Ovarian reserve is decided genetically and decreases with advancing age and gets affected by ovarian surgery, chemotherapy, radiotherapy, and autoimmune disorders. Environmental influences like chronic smoking, hyperglycemia, and conditions interfering ovarian vascularity also reduce the ovarian reserve. This chapter summarizes the methods to assess the ovarian reserve. This helps in deciding the initiating dose of gonadotropins for controlled ovarian hyper stimulation for optimal follicular response

DETERMINATION OF VOLATILE BIOACTIVE COMPOUNDS FROM EXTRACTS OF BAEL (AEGLE MARMELOS) PLANT PARTS AND THEIR COMPARATIVE ANALYSIS

 Objective: The main objective of this study is to determine the bioactive compounds from the extracts of wildly growing Aegle marmelos plant parts.Methods: A. marmelos root, stem, leaves, bark, fruit peel, and pulp were screened for the presence/absence of phytochemicals. Bioactive compounds in all the plant parts were analyzed by gas chromatography–mass spectrometry (GC/MS) analysis. For evaluation of bioactive compounds first, the column chromatography was done using various solvents and found that the methanolic extracts gave better elution and separation of compounds and hence used further for GC/MS analysis.Result: GC/MS analysis revealed chromatograms of methanol extract of A. marmelos plant parts, and all the plant parts were found to have a number of phytochemicals. Some compounds, namely, benzene, nitro-, benzenepropanoic acid, 3, 5-bis (1, 1-dimethylethyl)-4-hydroxy-, methyl ester, and tetradecene were found in all parts with a varying percentage. Phenol only found in the fruit of the plant with more percentage in fruit peel (4.38%) than in fruit pulp (0.58%). Dibutyl phthalate is the major compound found in Aegle root (10.43%), fruit peel (34.56%), and pulp (13.18%). Other important compounds such as coumarin (2H-1-Benzopyran-2-one, 7-[(3,7-dimethyl-2,6-octadienyl)oxy]-, (E)-), skimmianine (Furo[2,3-b] quinoline, 4,7,8-trimethoxy-), and cyclobarbital were found in plant root.Conclusion: After the GC/MS analysis, it was concluded that all the parts of this wildly growing plant contain a significant amount of pharmaceutically important compounds

EVALUATION OF WOUND HEALING ACTIVITY OF ACACIA AURICULIFORMIS A. CUNN. STEM BARK

Objective: To evaluate in vivo wound healing activity of ointment containing ethanol and aqueous bark extracts of Acacia auriculiformis A. Cunn. (Family: Mimosaceae).Methods: The presence of phytochemicals like carbohydrates, phenols, flavonoids, tannins and saponins was determined by preliminary phytochemical screening. Wound healing effect of ointment containing 5% w/w ethanol and aqueous stem bark extracts was determined by using excision and incision wound models in Swiss albino mice. Hydroxyproline content determination and histopathological studies of treated groups were carried out.Results: The results showed that both formulations possess significant wound healing activity, which was evidenced by decreased period of epithelialization, increased rate of wound contraction, tensile strength, hydroxyproline content, granulation tissue and collagen fibre formation in all treated animals. The activity may be due to presence of phenols, tannins, and flavonoids.Conclusion: The ointment containing ethanol extract showed better wound healing activity than the ointment containing aqueous extract.Keywords: Acacia auriculiformis, excision wound model, hydroxyproline, incision wound model, tensile strength, wound contractio

Total Laparoscopic Hysterectomy

The applications of minimally invasive pelvic surgery continue to grow. This chapter focuses primarily on the preoperative evaluation, surgical technique and post-operative care of total laparoscopic hysterectomy. Since laparoscopic assisted vaginal hysterectomy is a slight modification of the procedure it is not being discussed separately. The major physiologic obstacles to safe laparoscopy include pregnancy, increased intra cranial pressure, abnormalities of cardiac output and gaseous exchange in the lung, chronic liver diseases and coagulation disorders. In a redo surgery there may be problems of laparoscopic port entry

Developmental Genetics and Preimplantation Genetic Diagnosis

The genetic code information programs the embryogenesis. In this chapter the three phases of prenatal development the pre-embryonic, the embryonic and the fetal are elaborated. The role played by transforming growth factor beta related genes in the growth and differentiation of early embryo will be described. The implications of Fibroblast growth factor gene in binding heparin its effect on cell survival and mitogenic pathways is discussed. The orchestrated symphony of Sonic Hedgehog genes in early human embryo development is elaborated. The Homeobox genes (Hox gene) and their role in early human embryogenesis are described. The different tests available for prenatal genetic testing are briefly described. Preimplantation genetic diagnostic procedures are indispensable in clinical embryology. The microsurgical techniques of the Polar body biopsy, Blastomere biopsy and Blastocyst biopsy are discussed at the end of the chapter. A diagrammatic representation of individuals and relationships in clinical genetics is described. A brief description of procedures of invasive fetal tests for collecting the fetal tissue is also discussed

Load Balancing Through Map Reducing Application Using CentOS System

The main aim is to design an algorithm for Map-Reduce application, with a ballot count application, which explains how the big data can be handled by the individual Mappers and how data is split using map() function. The output of Mappers and is given to the Reducer and reduce () function is applied. The execution takes set of input key/value pairs, and gives a set of output key/value pairs. Map, accepts the input from the user, processes it and generates a set of intermediate key/value pairs. The Map Reduce library groups all the intermediate values of the same category and passes it to the Reduce function. The Reduce function takes the intermediate key and a set of values associated with the key. It groups together all the associated values and generates a smaller set of values. Finally, only zero or one output value is generated by the reducer. The iterate is responsible for accepting the intermediate key and its associated value