Uterine myometrial arteriovenous malformations (AVM) are reported on color doppler ultrasonography as mosaic pattern of blood flow with different peak systolic velocities (PSV) at different places. High PSV within the...Uterine myometrial arteriovenous malformations (AVM) are reported on color doppler ultrasonography as mosaic pattern of blood flow with different peak systolic velocities (PSV) at different places. High PSV within the AVM may require arterial embolization as treatment. However, we present a case of traumatic AVM with incomplete abortion managed by hysteroscopic cold knife evacuation. This case report is of a young patient with off and on vaginal bleeding for <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">3 1/2</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> months following 2</span><sup><span style="font-family:Verdana;">nd</span></sup><span style="font-family:Verdana;"> trimester spontaneous abortion. She had undergone dilation and evacuation (D & E) for incomplete abortion. Now the bleeding was heavy and intermittent not responding to medications. The subsequent TVS examination show</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> incomplete abortion with myometrial AVM with high PSV. Hysteroscopic cold knife removal of products of conception resulted in immediate resolution of Uterine AVM.</span></span></span>展开更多
<u>Introduction</u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> Knowledge of change in the duration of stages of labour would be an e...<u>Introduction</u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> Knowledge of change in the duration of stages of labour would be an essential step to reduce the increasing rates of cesarean section reported worldwide.</span><span style="font-family:;" "=""> </span><u><span style="font-family:Verdana;">Objective</span></u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> To study the rate of cervical dilation in the</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> stage of labour in spontaneous and induced labour and in primigravida and multigravida with singleton pregnancy.</span></span><span style="font-family:;" "=""> </span><u><span style="font-family:Verdana;">Methods</span></u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> A prospective observational study conducted at a multispeciality hospital was carried out for a period of 3 years from Jan 2017 to Dec 2019. </span><span style="font-family:Verdana;">A </span><span style="font-family:Verdana;">total </span><span style="font-family:Verdana;">of </span><span style="font-family:Verdana;">640 patients who were admitted with spontaneous and induced labour having singleton pregnancy with cephalic presentation and intact membranes after 34 weeks who delivered vaginally were included for analysis. Progression of labor in </span><span style="font-family:Verdana;">the </span><span style="font-family:;" "=""><span style="font-family:Verdana;">1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> stage of labour was measured by </span></span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">rate of cervical dilation as noted by serial per vaginal examination and findings were plotted in partograph.</span><span style="font-family:;" "=""> </span><u><span style="font-family:Verdana;">Result</span></u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> The difference between mean rate of cervical dilation in </span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">study group is statistically significant between 4</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">6 cm and 6 - 10 cm (P < 0.0001</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;">. When primigravida & multigravida patients were compared for the cervical dilation rate, statistically significant difference was seen between 4 - 6 cm but not in 6 - 10 cm</span><span style="font-family:Verdana;">. </span><span style="font-family:Verdana;">Average rate of cervical dilatation was 3.44 (Standard Deviation (SD</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> = 1.84</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> in spontaneous labor while average rate of cervical dilatation was 2.69 (SD = 1.18</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> in induced labor between 6</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">10</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">cm of cervical dilatation. </span><u><span style="font-family:Verdana;">Conclusion</span></u></span><span style="font-family:Verdana;">:</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> The active </span><span style="font-family:Verdana;">phase of labour starts at 6 cm of cervical dilation in the majority of the patients. </span><span style="font-family:Verdana;">In multigravida, cervix dilates at faster rate before 6 cm. In induced labour cervix dilates at a slower rate than spontaneous labour after 6 cm dilation.</span></span>展开更多
This is a case of primigravida of 35 years of age having spontaneous conception & 14.5 wks. pregnancy with retention of urine and pain in lower abdomen for 5 days. There was history of unsuccessful attempt of corr...This is a case of primigravida of 35 years of age having spontaneous conception & 14.5 wks. pregnancy with retention of urine and pain in lower abdomen for 5 days. There was history of unsuccessful attempt of correction of retroversion one day prior. Transabdominal USG (ultrasonography) confirmed 14.5 wks. live pregnancy with incarceration of uterus. In this case, only GA (general anaesthesia) corrected retroversion & incarceration.展开更多
Background: Word hemi-hysterectomy and removal of rudimentary functional horn may be used interchangeably in published data. The same term may be used when a non-obstructive hemi-uterus is removed when there is an ass...Background: Word hemi-hysterectomy and removal of rudimentary functional horn may be used interchangeably in published data. The same term may be used when a non-obstructive hemi-uterus is removed when there is an associated pathology. The article tries to standardise classification of Mullerian dysgenesis where this procedure is required according to ESHRE ESGE classification, preoperative diagnosis and discuss the operative details. Objective: The objective was to study the demographic profile, symptoms, association of endometriosis, variation in the anatomy, accuracy of preoperative diagnosis, to classify according to ESHRE ESGE classification and to standardize the laparoscopic surgical steps of hemi-hysterectomy. Study Design: This is a retrospective case series of cases of Mullerian dysgenesis with obstructive hemi-uterus or non-obstructive hemi-uterus with pathology treated by laparoscopic hemi-hysterectomy. (Canadian task force classification III). Methods: Data from hospital electronic records of all cases tagged with word laparoscopic hemi-hysterectomy were collected for 9 years from Jan 2009 to Dec 2018. Results: Total 19 patients of hemi-hysterectomy were analysed. Pre-operative diagnosis was made in 100% of patients. 100% patients with obstructive horn had dysmenorrhoea. ESHRE ESGE class U4aC3V0 was more frequently seen followed by U5aC4V4 and U3bC3V2 as obstructive and U4bC3V0, as non-obstructive. Associated endometriosis along with other pathology was seen in 74% of the patients. 3 patients with HWWS had ipsilateral renal agenesis. Laparoscopic hemi-hysterectomy was offered to all such patients. The operative steps & variants were studied. Post-operative outcome was uneventful in all. Conclusion: An experienced surgeon should deal with these problems of Mullerian dysgenesis discussed in this study. The other variants diagnosed also must be treated by an experienced surgeon only. Laparoscopic hemi-hysterectomy is almost the most standard surgical method to treat pelvic pain in cases with rudimentary non-communicating horns or in cases of non-obstructive horns with other associated pathologies. Post-operative recovery is uneventful, and all patients reported pain free periods as well as they are free of chronic pain which they had before surgery.展开更多
This case is of Rh -ve 2nd gravida having antibody titre detected 1:2 at 8 weeks of 2nd pregnancy. Serial antibody titre carried out along with clinical examination. Fetal monitoring was done by assessing MCA-PSV (Mid...This case is of Rh -ve 2nd gravida having antibody titre detected 1:2 at 8 weeks of 2nd pregnancy. Serial antibody titre carried out along with clinical examination. Fetal monitoring was done by assessing MCA-PSV (Middle cerebral artery peak systolic velocity) and CTG (Cardiotocograph) when required. Pregnancy was terminated when the titre reached 1:512 at 34 wks of pregnancy with abnormal MCA-PSV values. Neonate just had begun to show sign of anaemia & haemolysis at birth.展开更多
Introduction<span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: </span></span></span><span st...Introduction<span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">If the direction of the cervical canal is known</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> the commonly performed procedures as sono salpingography, embryo transfer, IUD insertion, cervical dilation etc. will be easier. The reported resultant trauma to the cervical canal and uterus during these procedures also can be avoided. As we know the cervical canal is tortuous in majority of cases, but the exact course is not yet reported or known.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Objective</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">:</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The objective of the present study was to try to identify the various directions of cervical canal while performing routine hysteroscopic surgeries. Methods</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">:</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Four-point cervical canal direction was assessed while performing routine hysteroscopic procedures using 5fr Bettocchi operative assembly with 2.9 mm 12-degree telescope (Karl-Storz). The study group was patients with infertility who required hysteroscopy and laparoscopic evaluation as per infertility treatment protocol or else required hysteroscopy for AUB. The study was carried out at tertiary care referral hospital for minimal access surgeries for a period was of 2 yr. 9 months year from May 2017 to Feb 2020.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Results</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Down-right or left-up-straight combination of movement (DRUS, DLUS) was the most common cervical direction found in 72 % patients. If DURS (down-up-right-straight) movement is added these 3 movements together are seen in about 82% of patients. No cervical dilation is required when 5 fr hysteroscopic assembly was used in study group.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">No operative complications were found.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Conclusion</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">DRUS and DLUS (down-right or left-up and straight) combination of movements are most frequent direction of cervical canal observed in 72% of patients.</span></span></span>展开更多
<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> The use of barbed suture in laparoscopic surgery is ...<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> The use of barbed suture in laparoscopic surgery is increasing ever since 2008. Published reports of use of unidirectional barbed suture for vaginal vault closure following total laparoscopic hysterectomy (TLH), indi</span><span style="font-family:Verdana;">cates it is safe. Despite of this many reports of adhesions and bowel obstruction </span><span style="font-family:Verdana;">are reported. This complication was never assessed in relation to amount of suture exposure at vaginal vault. We thought of quantifying the barbed suture exposure at vaginal vault and assess the risk of post-operative complications. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The objective was to quantify the exposure of barbed suture at vaginal </span><span style="font-family:Verdana;">vault by adopting a uniform technique of vault suturing and assessing p</span><span style="font-family:Verdana;">ost</span><span><span style="font-family:Verdana;">operative risk related to adhesions at vaginal vault. </span><b><span style="font-family:Verdana;">Method: </span></b><span style="font-family:Verdana;">In 30 pati</span></span><span style="font-family:Verdana;">ents who underwent TLH, a uniform new technique of vaginal vault closure using barbed suture was used and the portion of suture exposed at vaginal vault was quantified. The patients were followed up for a period of 6 months to assess post-operative risk of adhesions at vault and sequalae. </span><b><span style="font-family:Verdana;">Result:</span></b><span style="font-family:Verdana;"> Mean length of suture exposed was 2.64 ± 1.65 mm only. Suture exposure at vaginal vault was seen in 23 (76.67%) out of 30 patients. The suture was exposed on average at 1.57 ± 1.20 places at vaginal vault. </span><b><span style="font-family:Verdana;">Conclusion and Recommendations:</span></b><span style="font-family:Verdana;"> The study with an accepted relative error of 5% quantifies barbed suture exposure at vaginal vault. We had adopted a uniform new method of vaginal vault suturing to study and to quantify barbed suture exposure. It was observed that very minimal portion of suture was exposed at vaginal vault. It was exposed at only a couple of places at vaginal vault. Thus, decreasing suture exposure at vaginal vault will reduce its exposure related risk.</span></span></span></span>展开更多
Unicentric Castleman’s disease (UCD) is localized lymphoproliferative disease and has favourable prognosis. Surgery offers complete cure of unicentric Castleman disease. Radiotherapy offers either complete response o...Unicentric Castleman’s disease (UCD) is localized lymphoproliferative disease and has favourable prognosis. Surgery offers complete cure of unicentric Castleman disease. Radiotherapy offers either complete response or variable clinical response and cure in selected patients. The present case report is of a young unmarried obese girl presented with pain in right iliac fossa for 2 months. On pelvic ultrasound and MRI performed for diagnosis only single enlarged right external iliac lymph node was the positive finding. The CT scan guided biopsy was performed and the histopathological finding was lymphoid lesion-reactive lymphoid hyperplasia is favoured over Hodgkin’s lymphoma. Successful laparoscopic complete excisional surgery was performed for this single enlarged external iliac lymph node. The final histopathological report of the lymph node removed was unicentric Castleman’s disease, hyaline vascular type. This is the 16th such reported case of pelvic re</span><span>troperitoneal UCD of hyaline vascular type treated by surgical excision, and 3rd case treated by Laparoscopic excisional surgery. By now at the time of reporting this case 4 months of follow up has been completed and patient does not have any symptom nor not show any sign of residual disease locally on transabdominal ultrasound examination and whole-body PET CT scan is</span><span> also normal.展开更多
文摘Uterine myometrial arteriovenous malformations (AVM) are reported on color doppler ultrasonography as mosaic pattern of blood flow with different peak systolic velocities (PSV) at different places. High PSV within the AVM may require arterial embolization as treatment. However, we present a case of traumatic AVM with incomplete abortion managed by hysteroscopic cold knife evacuation. This case report is of a young patient with off and on vaginal bleeding for <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">3 1/2</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> months following 2</span><sup><span style="font-family:Verdana;">nd</span></sup><span style="font-family:Verdana;"> trimester spontaneous abortion. She had undergone dilation and evacuation (D & E) for incomplete abortion. Now the bleeding was heavy and intermittent not responding to medications. The subsequent TVS examination show</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> incomplete abortion with myometrial AVM with high PSV. Hysteroscopic cold knife removal of products of conception resulted in immediate resolution of Uterine AVM.</span></span></span>
文摘<u>Introduction</u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> Knowledge of change in the duration of stages of labour would be an essential step to reduce the increasing rates of cesarean section reported worldwide.</span><span style="font-family:;" "=""> </span><u><span style="font-family:Verdana;">Objective</span></u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> To study the rate of cervical dilation in the</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> stage of labour in spontaneous and induced labour and in primigravida and multigravida with singleton pregnancy.</span></span><span style="font-family:;" "=""> </span><u><span style="font-family:Verdana;">Methods</span></u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> A prospective observational study conducted at a multispeciality hospital was carried out for a period of 3 years from Jan 2017 to Dec 2019. </span><span style="font-family:Verdana;">A </span><span style="font-family:Verdana;">total </span><span style="font-family:Verdana;">of </span><span style="font-family:Verdana;">640 patients who were admitted with spontaneous and induced labour having singleton pregnancy with cephalic presentation and intact membranes after 34 weeks who delivered vaginally were included for analysis. Progression of labor in </span><span style="font-family:Verdana;">the </span><span style="font-family:;" "=""><span style="font-family:Verdana;">1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> stage of labour was measured by </span></span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">rate of cervical dilation as noted by serial per vaginal examination and findings were plotted in partograph.</span><span style="font-family:;" "=""> </span><u><span style="font-family:Verdana;">Result</span></u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> The difference between mean rate of cervical dilation in </span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">study group is statistically significant between 4</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">6 cm and 6 - 10 cm (P < 0.0001</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;">. When primigravida & multigravida patients were compared for the cervical dilation rate, statistically significant difference was seen between 4 - 6 cm but not in 6 - 10 cm</span><span style="font-family:Verdana;">. </span><span style="font-family:Verdana;">Average rate of cervical dilatation was 3.44 (Standard Deviation (SD</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> = 1.84</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> in spontaneous labor while average rate of cervical dilatation was 2.69 (SD = 1.18</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> in induced labor between 6</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">10</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">cm of cervical dilatation. </span><u><span style="font-family:Verdana;">Conclusion</span></u></span><span style="font-family:Verdana;">:</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> The active </span><span style="font-family:Verdana;">phase of labour starts at 6 cm of cervical dilation in the majority of the patients. </span><span style="font-family:Verdana;">In multigravida, cervix dilates at faster rate before 6 cm. In induced labour cervix dilates at a slower rate than spontaneous labour after 6 cm dilation.</span></span>
文摘This is a case of primigravida of 35 years of age having spontaneous conception & 14.5 wks. pregnancy with retention of urine and pain in lower abdomen for 5 days. There was history of unsuccessful attempt of correction of retroversion one day prior. Transabdominal USG (ultrasonography) confirmed 14.5 wks. live pregnancy with incarceration of uterus. In this case, only GA (general anaesthesia) corrected retroversion & incarceration.
文摘Background: Word hemi-hysterectomy and removal of rudimentary functional horn may be used interchangeably in published data. The same term may be used when a non-obstructive hemi-uterus is removed when there is an associated pathology. The article tries to standardise classification of Mullerian dysgenesis where this procedure is required according to ESHRE ESGE classification, preoperative diagnosis and discuss the operative details. Objective: The objective was to study the demographic profile, symptoms, association of endometriosis, variation in the anatomy, accuracy of preoperative diagnosis, to classify according to ESHRE ESGE classification and to standardize the laparoscopic surgical steps of hemi-hysterectomy. Study Design: This is a retrospective case series of cases of Mullerian dysgenesis with obstructive hemi-uterus or non-obstructive hemi-uterus with pathology treated by laparoscopic hemi-hysterectomy. (Canadian task force classification III). Methods: Data from hospital electronic records of all cases tagged with word laparoscopic hemi-hysterectomy were collected for 9 years from Jan 2009 to Dec 2018. Results: Total 19 patients of hemi-hysterectomy were analysed. Pre-operative diagnosis was made in 100% of patients. 100% patients with obstructive horn had dysmenorrhoea. ESHRE ESGE class U4aC3V0 was more frequently seen followed by U5aC4V4 and U3bC3V2 as obstructive and U4bC3V0, as non-obstructive. Associated endometriosis along with other pathology was seen in 74% of the patients. 3 patients with HWWS had ipsilateral renal agenesis. Laparoscopic hemi-hysterectomy was offered to all such patients. The operative steps & variants were studied. Post-operative outcome was uneventful in all. Conclusion: An experienced surgeon should deal with these problems of Mullerian dysgenesis discussed in this study. The other variants diagnosed also must be treated by an experienced surgeon only. Laparoscopic hemi-hysterectomy is almost the most standard surgical method to treat pelvic pain in cases with rudimentary non-communicating horns or in cases of non-obstructive horns with other associated pathologies. Post-operative recovery is uneventful, and all patients reported pain free periods as well as they are free of chronic pain which they had before surgery.
文摘This case is of Rh -ve 2nd gravida having antibody titre detected 1:2 at 8 weeks of 2nd pregnancy. Serial antibody titre carried out along with clinical examination. Fetal monitoring was done by assessing MCA-PSV (Middle cerebral artery peak systolic velocity) and CTG (Cardiotocograph) when required. Pregnancy was terminated when the titre reached 1:512 at 34 wks of pregnancy with abnormal MCA-PSV values. Neonate just had begun to show sign of anaemia & haemolysis at birth.
文摘Introduction<span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">If the direction of the cervical canal is known</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> the commonly performed procedures as sono salpingography, embryo transfer, IUD insertion, cervical dilation etc. will be easier. The reported resultant trauma to the cervical canal and uterus during these procedures also can be avoided. As we know the cervical canal is tortuous in majority of cases, but the exact course is not yet reported or known.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Objective</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">:</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The objective of the present study was to try to identify the various directions of cervical canal while performing routine hysteroscopic surgeries. Methods</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">:</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Four-point cervical canal direction was assessed while performing routine hysteroscopic procedures using 5fr Bettocchi operative assembly with 2.9 mm 12-degree telescope (Karl-Storz). The study group was patients with infertility who required hysteroscopy and laparoscopic evaluation as per infertility treatment protocol or else required hysteroscopy for AUB. The study was carried out at tertiary care referral hospital for minimal access surgeries for a period was of 2 yr. 9 months year from May 2017 to Feb 2020.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Results</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Down-right or left-up-straight combination of movement (DRUS, DLUS) was the most common cervical direction found in 72 % patients. If DURS (down-up-right-straight) movement is added these 3 movements together are seen in about 82% of patients. No cervical dilation is required when 5 fr hysteroscopic assembly was used in study group.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">No operative complications were found.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Conclusion</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">DRUS and DLUS (down-right or left-up and straight) combination of movements are most frequent direction of cervical canal observed in 72% of patients.</span></span></span>
文摘<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> The use of barbed suture in laparoscopic surgery is increasing ever since 2008. Published reports of use of unidirectional barbed suture for vaginal vault closure following total laparoscopic hysterectomy (TLH), indi</span><span style="font-family:Verdana;">cates it is safe. Despite of this many reports of adhesions and bowel obstruction </span><span style="font-family:Verdana;">are reported. This complication was never assessed in relation to amount of suture exposure at vaginal vault. We thought of quantifying the barbed suture exposure at vaginal vault and assess the risk of post-operative complications. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The objective was to quantify the exposure of barbed suture at vaginal </span><span style="font-family:Verdana;">vault by adopting a uniform technique of vault suturing and assessing p</span><span style="font-family:Verdana;">ost</span><span><span style="font-family:Verdana;">operative risk related to adhesions at vaginal vault. </span><b><span style="font-family:Verdana;">Method: </span></b><span style="font-family:Verdana;">In 30 pati</span></span><span style="font-family:Verdana;">ents who underwent TLH, a uniform new technique of vaginal vault closure using barbed suture was used and the portion of suture exposed at vaginal vault was quantified. The patients were followed up for a period of 6 months to assess post-operative risk of adhesions at vault and sequalae. </span><b><span style="font-family:Verdana;">Result:</span></b><span style="font-family:Verdana;"> Mean length of suture exposed was 2.64 ± 1.65 mm only. Suture exposure at vaginal vault was seen in 23 (76.67%) out of 30 patients. The suture was exposed on average at 1.57 ± 1.20 places at vaginal vault. </span><b><span style="font-family:Verdana;">Conclusion and Recommendations:</span></b><span style="font-family:Verdana;"> The study with an accepted relative error of 5% quantifies barbed suture exposure at vaginal vault. We had adopted a uniform new method of vaginal vault suturing to study and to quantify barbed suture exposure. It was observed that very minimal portion of suture was exposed at vaginal vault. It was exposed at only a couple of places at vaginal vault. Thus, decreasing suture exposure at vaginal vault will reduce its exposure related risk.</span></span></span></span>
文摘Unicentric Castleman’s disease (UCD) is localized lymphoproliferative disease and has favourable prognosis. Surgery offers complete cure of unicentric Castleman disease. Radiotherapy offers either complete response or variable clinical response and cure in selected patients. The present case report is of a young unmarried obese girl presented with pain in right iliac fossa for 2 months. On pelvic ultrasound and MRI performed for diagnosis only single enlarged right external iliac lymph node was the positive finding. The CT scan guided biopsy was performed and the histopathological finding was lymphoid lesion-reactive lymphoid hyperplasia is favoured over Hodgkin’s lymphoma. Successful laparoscopic complete excisional surgery was performed for this single enlarged external iliac lymph node. The final histopathological report of the lymph node removed was unicentric Castleman’s disease, hyaline vascular type. This is the 16th such reported case of pelvic re</span><span>troperitoneal UCD of hyaline vascular type treated by surgical excision, and 3rd case treated by Laparoscopic excisional surgery. By now at the time of reporting this case 4 months of follow up has been completed and patient does not have any symptom nor not show any sign of residual disease locally on transabdominal ultrasound examination and whole-body PET CT scan is</span><span> also normal.
