K. Roy

High prevalence of Fitz-Hugh-Curtis Syndrome in genital tuberculosis.

Perihepatitis with violin string adhesions between the liver and the anterior abdominal wall in association with gonococcal or chlamydial salpingitis constitutes Fitz-Hugh-Curtis Syndrome (FHCS). It manifests as pain and tenderness in the right upper quadrant of abdomen pleuritic pain exacerbated by breathing coughing laughing and movement probably due to irritation of Glissons capsule of the liver. There are two phases of the syndrome; acute and chronic. In the acute phase perihepatitis and focal peritonitis result from the transport of inflammatory peritoneal fluid either directly or by lymphatic vessels to the subphrenic and subdiaphragmatic spaces. In the chronic phase violin string adhesions are observed between the anterior surface of the liver and the anterior abdominal wall. Recently genital and abdominal tuberculosis has been observed to be associated with FHCS in a report of three cases. From June 2004 to December 2006 a total of 82 women were found to have genital tuberculosis.The ages ranged between 19 to 46 years (mean age 25.6 years). Most women were from rural areas (n=60 75.6%) with the majority of poor or low socioeconomic status (n=72 87.8%). (excerpt)

Laparoscopic removal of translocated retroperitoneal IUD.

IUDs represent a safe and effective method of contraception and are widely used in various countries. This article reports the case of a 42-year-old female patient who had undergone a laparoscopic removal of translocated retroperitoneal IUD. Local examination demonstrated a complete perineal tear which occurred during her last childbirth and for which she had not sought any treatment. Pelvic examination revealed a normal-sized uterus and her rectal examination was also normal except for a complete perineal tear. On ultrasonography the IUD was not seen in the uterine cavity or buried in the myometrium. Plain X-ray of the abdomen revealed the IUD lying just above the right ureter and pelvic vessels and it was successfully removed laparoscopically. This case demonstrates that laparoscopic removal of a misplaced IUD from this difficult site is safe and effective. It also highlights the need to inspect the abdominal walls and retroperitoneum carefully when a translocated IUD is not found in the pelvic or abdominal cavity.

Prenatal detection of aneuploidies using fluorescence in situ hybridization: A preliminary experience in an Indian set up

Fluorescencein situ hybridization (FISH) is a powerful molecular cytogenetic technique which allows rapid detection of aneuploidies on interphase cells and metaphase spreads. The aim of the present study was to evaluate FISH as a tool in prenatal diagnosis of aneuploidies in high risk pregnancies in an Indian set up. Prenatal diagnosis was carried out in 88 high-risk pregnancies using FISH and cytogenetic analysis. Multicolour commercially available FISH probes specific for chromosomes 13, 18, 21, X and Y were used. Interphase FISH was done on uncultured cells from chorionic villus and amniotic fluid samples. FISH on metaphase spreads was done from cord blood samples. The results of FISH were in conformity with the results of cytogenetic analysis in all the normal and aneuploid cases except in one case of structural chromosomal abnormality. The hybridization efficiency of the 5 probes used for the detection of aneuploidies was 100%. Using these probes FISH assay yielded discrete differences in the signal profiles between cytogenetically normal and abnormal samples. The overall mean interphase disomic signal patterns of chromosomes 13, 18, 21, X and Y were 94.45%; for interphase trisomic signal pattern of chromosome 21 was 97.3%. Interphase FISH is very useful in urgent high risk cases. The use of FISH overcomes the difficulties of conventional banding on metaphase spreads and reduces the time of reporting. However, with the limited number of probes used, the conventional cytogenetic analysis serves as a gold standard at present. It should be employed as an adjunctive tool to conventional cytogenetics

The effect of tuberculosis on ovarian reserve among women undergoing IVF in India

To assess ovarian reserve in infertile women with genital tuberculosis planning to undergo in vitro fertilization and in women of proven fertility, and compare the findings.

Pregnancy following tubal sterilization: an 11-year survey.

This paper reports the findings of an 11-year survey which examined post-sterilization pregnancy among women who underwent sterilization at the All India Institute of Medical Sciences from March 1986 to March 1997. Out of the 6639 patients who were followed up for a minimum of 2 years 25 came back with post-sterilization pregnancy. All these patients underwent repeat laparoscopic tubal sterilization (LTS) with Falope ring and minilaparotomy tubal sterilization (MTS) using Pomeroys technique. Of the 25 post-sterilization pregnancies 21 (84%) were intrauterine pregnancies and 4 (16%) were ectopic pregnancies. LTS failure due to misidentification of tubes recanalization and fistula formation occurred in 19 patients while MTS failure caused by recanalization and fistula formation occurred in 6 patients. The rate of method failure following LTS ranges from 0.09% to 0.6 % while the failure rate following minilaparotomy sterilization varies from 0.4% to 0.7%. The findings suggest that there is no 100% effective method of sterilization.

Removal of an intrauterine foreign body retained for 12 years

A 36-year-old woman from a rural area presented with secondary amenorrhea and an offensive vaginal discharge intermittent during the preceding 12 years. The woman developed these symptoms following a termination of pregnancy at 8 weeks gestation performed by an untrained practitioner who inserted a piece of Ayurvedic tree root inside the vagina. That procedure was followed by excessive vaginal bleeding and the passage of the products of conception for 4 days. The patient developed low-grade fever for 7 days following the procedure and subsequently continued to be amenorrheic failing to conceive despite the lack of use of contraception. Treatment with several antibiotics by local doctors failed to provide relief from the offensive discharge. No abnormality was detected upon general physical and abdominal examination. A vaginal examination however revealed partial cicatrization of the upper part of the vagina. The cervical opening was viewed with a minimal serious discharge. On palpation the uterus was normal in size with slightly restricted mobility. Transvaginal sonography of the uterus identified a 5 cm hyperechoic area inside the cavity diagnosed as an intrauterine foreign body. Panoramic hysteroscopy found the foreign body to be deeply embedded at the fundus. There were no intrauterine adhesions. The foreign body was dislodged by grasping forceps inserted through the operating channel of the hysteroscope. The foreign body was then grasped with a curved Kellys clamp under ultrasound guidance and removed. It was found to be an irregularly frayed hard wooden stick 5 cm long.

Diffuse peritoneal calcification — a rare manifestation of abdominal tuberculosis

This paper presents the case of a 25-year-old woman diagnosed with diffuse peritoneal calcification a rare manifestation of abdominal tuberculosis. The patient complained of primary infertility for 4 years and chronic abdominal pain for a year. Upon diagnostic laparoscopic examination in view of infertility and chronic abdominal pain it revealed adhesions in the pelvis and a diffusely studded peritoneum with calcified deposits varying from 0.5 to 1.5 cm. Moreover the surface of the uterus was shaggy and there was hyperemia of the tubes with thickening at the communal ends. The patient was also found positive for tuberculosis using the secretory endometrium and polymerase chain reaction tests. A biopsy of the peritoneal deposits showed only fibro-fatty tissue with calcification and an absence of granulomas. Because of the absence of granulomas it was assumed that the lesions were indeed of tuberculous origin which could only be supported by the clinical presentation as well as the response to antitubercular treatment.

Prenatal diagnosis and management of a new autosomal recessive skeletal dysplasia

We present a rare case of bilateral absence of fibula, hypoplastic femurs, ankylosis of knee joints and talipes equinovarus in a woman who had a previously affected offspring with similar defects. Antenatal diagnosis, management and a short review of the literature are presented.

Prenatal diagnosis and assessment of fetal malformations by ultrasonography in India

A multicentre study to assess the status of prenatal diagnosis of fetal malformation in India was conducted. Questionnaires were sent to the teaching hospitals and to centres in the private sector involved with ultrasonography in all the four zones. Data were obtained from 13 centres. Basic level scans were performed on all pregnant women in 64% centres, whereas level II or targeted scans were performed as routine in 42% centres. Obstetricians performed level II scans in only 35% of cases while rest were performed by radiologists.Malformations of the central nervous system were commonest, accounting for 35–69% of all malformations, followed by genitourinary and gastrointestinal malformations. Malformations of the cardiovascular system were detected in 9. 3% as abnormal four chamber view and outlet tract abnormalities, subsequently confirmed on fetal echocardiography. Invasive prenatal diagnosis by fetal blood sampling, chorion villus sampling and amniocentesis for chromosomal analysis of malformed fetuses was performed at 40% centres.At the All India Institute of Medical Sciences, approximately 11, 042 ultrasound scans were performed by obstetricians as routine in all pregnant women. A total of 543 malformations were detected accounting for a 4. 9% incidence of structural anomalies. A total of 98 cardiovascular malformations were detected in high and low risk pregnant women on fetal echocardiography.No database or registry exists in India to give an actual insight into the problem of congenital malformation and their prenatal diagnosis. It is important to train obstetricians in level I and II ultrasonography, to recognise centres and institutions at national and regional level, and to integrate a network of diagnostic testing. Close liaison between geneticists, radiologists, pediatric surgeons, pediatricians and obstetricians is a must for prenatal diagnosis and management of fetal malformations.

O620 OUTCOME OF TENSION FREE TRANSVAGINAL-OBTAPE (TVT-O) FOR URODYNAMIC STRESS URINARY INCONTINENCE

both types of facilities. Logistic regression analysis was conducted to calculate the odds of a maternal death by facility type. Results: On almost all indicators of health system quality, the private health facilities fared better than the public facilities. Shortages of doctors and Clinical Officers existed at both types of facilities, however, private facilities performed better in spite of human resource constraints. Shortages of drugs and equipment were more common in public facilities. Providers were more overworked and less satisfied at public facilities. Private facilities were more likely to have a blood bank, laboratory and ambulance on site and offer cesarean deliveries. Public health facilities were more likely to have experienced problems in handling maternity patient load. The case-fatality rate for obstetric complications was higher at public facilities (2.8 percent) as compared to private facilities (1.5 percent). The odds of a maternal death was also higher at public facilities (OR 1.90, p < 0.000) after controlling for the case mix of complications. Conclusions: The private health system in Malawi, particularly the faith-based health system provided a better quality of maternal health care and reported higher rates of survival among maternity patients. A greater emphasis on scaling up private health systems is needed to improve maternal health outcomes and achieve gains in maternal survival in Malawi.