Shirish S. Sheth

Missing female births in India

Prenatal sex selection for non-medical reasons is a heated issue. Prenatal diagnosis involves an early invasive procedure such as chorionic villus sampling between 10 and 12 weeks of gestation or in the later stages ultrasonography or amniocentesis. In todays Lancet Prabhat Jha and colleagues present a large study of 1.1 million Indian households to examine the causes of missing girls at birth. In the UK after a second public consultation the Human Fertilisation and Embryology Authority reaffirmed its position opposing sex selection for nonmedical reasons. In India fetal sex determination and medical termination of pregnancy on the basis of fetal sex have been illegal since 1994. Under the law prenatal diagnostic scans are allowed for the detection of genetic abnormalities but sex determination tests are forbidden. Those caught are subject to a fine imprisonment and suspension of the medical practitioners licence. (excerpt)

Adnexectomy for benign pathology at vaginal hysterectomy without laparoscopic assistance

Of 166 consecutive women with a benign adnexal mass scheduled for vaginal hysterectomy with adnexectomy, the operation was successful in 158 (95%). Preoperatively, attempts were made to ascertain that adnexal mass was benign and either freely mobile or with only slightly restricted mobility. Laparotomy was required in eight women, in five for adhesions and in three for malignancy detected during the operation. No woman required laparoscopic‐assisted surgery. The 158 women who had successful vaginal hysterectomy with adnexectomy were compared with 100 similar women who had a laparotomy performed by same single operator. The vaginal group had a lower morbidity, speedier recovery and shorter hospital stay.

Uterine septum misdiagnosed on hysterosalpingogram

Objective: To evaluate the correctness of diagnosis of bicornuate uterus made on hysterosalpingogram. Method: Thirty‐six women diagnosed on hysterosalpingogram to have bicornuate uterus were subjected to laparoscopy and hysteroscopy. Result: Two out of 36 women had bicornuate uterus whereas the remaining 34 had intrauterine septum. Conclusion: Diagnosis of bicornuate uterus made on hysterosalpingogram by radiologists is often incorrect and needs to be revised.

Management of ovarian dermoids without laparoscopy or laparotomy

OBJECTIVE To report experience of managing ovarian dermoids via the vaginal route. STUDY DESIGN A series of 26 cases managed this way either with or without hysterectomy and for comparison 10 women managed by laparotomy and 6 who underwent laparoscopic ovarian cystectomy or oophorectomy were considered. RESULTS The vaginal approach was successful in all patients, without need for laparoscopic assistance or a switch over to laparotomy. Spill was minimal or absent in the vaginal group and recovery significantly faster in the vaginal and laparoscopic groups compared to the laparotomy group. Hospital stay was slightly shorter in the vaginal than the laparoscopic group. No disposable material or equipment was used in the vaginal or laparotomy group. CONCLUSION For mobile, benign ovarian teratoma, the vaginal route should be strongly considered to minimise invasive surgery, particularly when the operator is an experienced vaginal surgeon or laparoscopic equipment or laparoscopic surgeons are not easily available. Reduced spillage and speedier recovery are important advantages.

Inappropriate use of new technology: impact on women's health.

While medical technology is very useful we need to be aware of its inappropriate use. Examples are given, such as: continuous vs. intermittent electronic fetal monitoring; widespread use of magnetic resonance image technology where simple methods could be as effective; laparoscopically assisted vaginal hysterectomies replacing simple vaginal hysterectomies and increasing the cost; ultrasound to provide the first pictures of the baby or to detect female fetuses for female feticide; use of technology for defensive medicine rather than using it for the patients welfare, and pecuniary indications. Woe betide the doctor who does not make enough money — he may find that his contract is not renewed. We need to empower patients with information, so that they can judge the technology and its appropriateness as it relates to them. Opinion programs have helped to curb the misuse of unnecessary surgery, and audit and peer review programs also provide a check on the misuse of technology. The provision of consensus statements, e.g. by the National Institutes of Health, USA, have helped to clarify issues and to guide doctors as to the appropriateness of the newer technologies, and practice guidelines formulated by experts are also very helpful. We need to teach medical students and residents how to be critical, how to evaluate claims and study the literature, so that they are not hoodwinked by ‘authority’ or misled by manufacturers claims. Gynecology and Obstetrics

Vaginal hysterectomy in women with a history of 2 or more cesarean deliveries

To perform vaginal hysterectomy (VH) safely in women with a history of 2 or more cesarean deliveries (CDs).

A surgical window to access the obliterated posterior cul-de-sac at vaginal hysterectomy

To perform vaginal hysterectomy and adnexectomy without laparoscopic assistance in women with ovarian endometriosis by accessing the posterior cul‐de‐sac via the posterior uterocervical–broad ligament space.

Postoperative Takotsubo cardiomyopathy

Takotsubo cardiomyopathy also known as transient apical ballooning syndrome or stress induced reversible cardiomyopathy is an increasingly reported syndrome generally characterized by transient systolic dysfunction of the apical and/or mid segment of the left ventricle. It is frequently precipitated by severe stress and clinically mimics an acute ST-elevation myocardial infarction, with angiographically normal coronary arteries. A high index of suspicion is needed to diagnose this syndrome. We describe a patient who developed Takotsubo cardiomyopathy in the post-operative period following vaginal hysterectomy.

Pneumo-surgical pack: a preliminary report

Surgical packs made of sponge or gauze towel have been described for more than a thousand years in surgery textbooks and relevant literature but until now without much innovation. This study presents a self-retaining pneumo-surgical pack as an alternative device to the intra-abdominal gauze towel packs used during laparotomy to restrain abdominal contents—to keep the omentum and intestines away from the uterus Fallopian tubes and ovaries and provide satisfactory surgical exposure. The pneumo-surgical pack consists of two layers of inflatable and leak-proof silicone with a long tube incorporated laterally at its lowest part. This tube running from the operative field to the exterior draws attention; it thus prevents the possibility of being left in the abdominal cavity and spares the need for a count. (excerpt)

Prophylactic vaginal hysterectomy for benign hydatidiform mole

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