Atul Kumar

A Simple Technique to Reduce Fluid Intravasation During Endometrial Resection

The rate of fluid intravasation may abruptly and alarmingly increase during endometrial resection. Left unchecked, this may lead to complications of fluid overload. In 20 patients, temporary cessation of surgery in the form of a 10-minute glycine-free interval reduced the rate of fluid intravasation by 38.75% to 85.81% (mean 67.09%) in the later part of surgery. This was possibly due to hemostatic sealing of open blood vessels which prevented further intravasation of distending medium into systemic circulation.

Hysteroscopic findings of starry sky appearance and impregnated cobwebs in endometrial tuberculosis.

Hysteroscopy is a useful technique to detect endometrial tuberculosis [1–3]. Past studies have described the hysteroscopic findings of tubercular endometritis as thin, dirty-looking, pale, irregular endometriumwith whitish deposits attached to the endometrial surface [1–3]. However, these signs may not all be present in the same case or may be mild so that, even at hysteroscopy, the diagnosis may be doubtful or missed. Whitish deposits overlying the endometrium are usually indicative of a tubercular pathology. The aim of the present study is to describe additional hysteroscopic appearances of tubercular deposits that are seen only after vital staining with methylene blue dye or are impregnated in flimsy adhesions without being directly attached to the endometrium. A 38-year-old woman with primary infertility of 16 years duration was referred to theWomen’s Health Center in Jaipur, India, for hysteroscopic evaluation. The left cornu was well visualized, the left ostium was surrounded by multiple small adhesions, and the endometrium appeared otherwise unremarkable (Fig. 1A). The hysteroscope was removed and chromopertubation was done with methylene blue dye, followed by reintroduction of the hysteroscope. A glistening white, highly reflective deposit situated lateral to the left ostium over the lateral margin of the left cornu was observed against the background of a dark blue-stained endometrium resembling a “starry sky” appearance (Fig. 1B). The whitish deposit aroused suspicion for endometrial tuberculosis. A targeted biopsywas taken from the region of thewhitish deposit and endometrial tuberculosis was confirmed by BACTEC culture (BD, Franklin Lakes, NJ, USA). We have observed the starry sky appearance and used it to diagnose endometrial tuberculosis on multiple occasions over a 21-year period. It appears that the methylene blue dye is not taken up by the caseous tubercular deposit but is taken up by the surrounding endometrium. International Journal of Gynecology and Obstetrics 126 (2014) 280–285

Broken Tip of Karman Cannula Removed at Hysteroscopy

gled cutting loop. A 22-year-old woman underwent suction curettage of a missed abortion at 6 weeks of gestation. The tip of the Karman cannula, a 6-mm flexible plastic cannula, broke during the procedure. After multiple unsuccessful attempts to remove the cannula tip via mechanical means under ultrasound guidance, the patient was ultimately referred to us for hysteroscopic intervention. Hysteroscopic view from

Mirror Lesion at Hysteroscopy

A 50-year-old woman with menometrorrhagia was referred for hysteroscopy. A 20-mm polyp was seen arising from the anterior uterine wall. The polyp was unremarkable except that its external surface appeared bright red (Fig. 1). However, an area over the posterior uterine cavity wall, which was in apposition with the polyp, appeared bright red in a well-circumscribed area (Fig. 2), and for the sake of illustration this area is termed as ‘‘mirror lesion.’’ ‘‘Mirror lesion’’ was rounded, confirming to the shape of the polyp, it had well-defined sharp margins, and its bright red texture differentiated it from the surrounding endometrium. The entire polyp