DR.MUKESH RAGHAV

Uterine Fibroids - a review

2011-08-12T16:59:00.004+05:30

Uterine Fibroids , also known as fibroid tumors, leiomyomas, fibromas or myomas, are benign (noncancerous) growths on the uterus. Uterine fibroids occur in 25 to 45 percent of all women older than 30 - 35 years of age.

Uterine Fibroids are rubbery nodules that begin as irregular cells in the muscular layers of the uterus and grow slowly into tumor-like masses of connective tissue and smooth muscle.

Fibroids may be as small as a pea or the size of a basketball. A woman can have one or many uterine fibroids. The growth of uterine fibroids is unpredictable. They may remain relatively stable or they may increase in size rapidly. Rarely do uterine fibroids become cancerous (less than 0.1 percent).
Uterine fibroids are unlikely to shrink or disappear on their own until after menopause. After menopause, no new uterine fibroids are likely to develop, and those already present usually shrink in size.

cut section

There are three (3) main types of uterine fibroids - submucous, intramural and subserous.
1. Submucous uterine fibroids grow just beneath the lining of the uterus (called the endometrium).
2. Intramural uterine fibroids grow within the wall of the uterus.
3. Subserous uterine fibroids grow out from the outer wall of the uterus.
If the fibroid has a stalk (called a pedicle) attached, it is called a pedunculated fibroid. The stalk remains attached to the uterine wall, allowing the tumor to move inside the uterus, the abdominal cavity or into the vagina.

The cause of Uterine Fibroids is unknown, but some researchers suspect that the tendency to develop uterine fibroids is:

inherited
attributed to ethnicity (African-American and women of Jewish descent are three times more likely to develop uterine fibroids than Caucasian women)
linked to estrogen level - uterine fibroids may increase in size during pregnancy or when using birth control pills (when estrogen levels are high), and decrease in size after menopause when estrogen levels are low.
prevalent in women with endometriosis - a condition in which fragments of the endometrium are found in other parts of (or on organs within) the pelvic cavity

Uterine Fibroids may be totally symptomless or they may cause problems. The majority of women with uterine fibroids (up to 70 -75 percent) have no symptoms. If symptoms do occur, they may include:

heavier menstrual flow or menstrual period of longer duration
increased menstrual cramping
backache
irregular or unpredictable bleeding
lower-abdominal pressure, often described as an achy or heavy feeling or associated with the need to urinate more frequently
constipation
abdominal bloating
infertility
miscarriage

Symptoms and a pelvic exam are the basis for diagnosing Uterine Fibroids If the doctor finds that the uterus is lumpy, enlarged or irregular in shape, they may suspect uterine fibroids, even if the woman displays no symptoms. However, before they begin additional diagnostic tests, the doctor will do a complete blood profile, paps smear , pregnancy test and an endometrial sampling to rule out other conditions, such as endometrial cancer or pregnancy.

If the woman is having irregular bleeding or her uterus is enlarged, the clinician will probably recommend a dilatation and curettage (D&C) without delay, to be certain that she doesn't have an unrelated malignancy or a simple problem like uterine polyps. A D&C is a procedure in which the endometrium is scraped away.
If uterine fibroids are suspected, the doctor will perform a transvaginal sonogram (ultrasound) to confirm these tumors, their location and size within the uterus.

Most Uterine Fibroids require no treatment at all. If the uterine fibroids are not causing pain, bleeding or discomfort, many doctors recommend leaving them alone and monitoring them over the years.

Uterine fibroids should be surgically removed if:

they are causing uncontrollable, abnormally heavy bleeding
they are too large and causing discomfort
they are rapidly growing
the fibroid grows after menopause
there are difficulties in becoming pregnant
symptoms of urinary tract compression are present
the fibroids make it impossible to evaluate the appendages

cut section showing degeneration

           There are two surgical procedures available to remove uterine fibroids. The procedures are myomectomy (fibroid removal from the uterus) and hysterectomy (uterus removal).
       The several different myomectomy techniques include the following:
   Vaginal, or hysteroscopic, myomectomy. Performed through the vagina and cervix, this procedure uses an instrument called a resectoscope, which allows surgeons to view the uterine fibroids through a small fiber optic device. The surgeons are able to shave off the fibroid growths using a hot electrified wire. This technique is used on small submucous uterine fibroids.
    Laparoscopic myomectomy. A surgeon makes a slit in the navel and inserts a hollow tube and a viewing instrument (called a laparoscope) into the uterus. The doctor then slides a tiny laser or scalpel through the laparoscope, chops up the fibroid and then removes the bits through the laparoscope. This technique is usually reserved for uterine fibroids on the exterior surface of the uterus.
      Abdominal myomectomy. Through an incision in the abdomen, the uterine fibroids are removed (using either a scalpel or laser). This procedure is best for very large intramural and subserous uterine fibroids.
         Myomectomies are recommended for women who want to preserve their fertility, have had repeated miscarriages, experience infertility problems or want to retain their uterus. Unfortunately, up to 40- 45 percent of women who opt for a myomectomy may require a repeat surgical procedure because the uterine fibroids have grown back.
         Hysterectomy, can be performed either vaginally, abdominally or assisted by laparoscopy. There are several different hysterectomy techniques:
        Total abdominal hysterectomy (TAH): Removal of the uterus and cervix through an incision in the lower abdomen. The fallopian tubes and ovaries are not removed.
         Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO): Removal of the ovaries (oophorectomy) and fallopian tubes (salpingectomy) along with the uterus and cervix through an incision in the lower abdomen.
        Vaginal hysterectomy: Removal of the uterus and cervix through an incision inside the vagina. The fallopian tubes and ovaries are usually not removed.
        Subtotal hysterectomy: Removal of the uterus, but not the cervix. The fallopian tubes and ovaries are not removed.

submucus fibroid

     Although a myomectomy or a hysterectomy seem to be the best solution to uterine fibroids, some doctors prescribe gonadotropin-releasing hormone (GnRH) analogs. The GnRH analogs, such as leuprolide (Lupron) and nafarelin (Synarel), are effective in stopping heavy bleeding and shrinking uterine fibroids. The drugs shut down estrogen production by turning off pituitary stimulation of the ovaries, but these do so by first boosting production, causing an initial increase in estrogen levels and a worsening of uterine fibroids.
        After about a month, ovarian hormone production declines and the estrogen-starved tumors shrink dramatically. This treatment can only be used for a limited time. Within four to six months after stopping the treatment, the uterine fibroids will begin to grow back.
          This treatment has been used for premenopausal women, for women who have become anemic due to heavy menstrual flow, for women who do not plan to bear children or before a myomectomy.
         If the patient is not fit or willing for surgery , She can opt for Medical Treatment of Fibroid Uterus .

LAPAROSCOPIC STERILIZATION FAILURE......

2011-07-02T15:05:00.002+05:30

LAPAROSCOPE INSTRUMENT VARIOUS PARTS

Laparoscopic sterilization was once thought to be safe, simple procedure with advantage of minimal hospital stay and potential for further success of Tubal recanalization of late people are loosing confidence in it due to its failure rate. Thus there is a declining curve for Laparoscopic sterilization. In addition, a laparo ligation failure acts as a wet blanket for those planning to undergo sterilization procedure. To evaluate various causes responsible for laparoscopic sterilization failure, the present study was undertaken.

A total of 175 patients of failed laparoscopic sterilization, who came from different places with varying duration of Gestation, were studied. Patients who had become pregnant after previous laparoscopic sterilization were included in the study.

Depending on patients willingness and medical fitness , termination of pregnancy along with Sterilization by modifies Pomeroy’s method was done. Simultaneously the ring applied during previous laparoscopic sterilization was traced and data analyzed.

It was observed that patients were so concerned about the failure of this operation that most came for consultation soon after the missed period. Only33% presented during second trimester of pregnancy. Out of 175 subjects, 6 were against termination or any type of sterilization procedures and continued the unwanted pregnancy. Therefore exact cause of failure could not be ascertained in them. Amongst remaining cases , a few were fit for termination and underwent abdominal sterilization.

Nobody in the failure group was willing for a laparoscopic sterilization again. In the present study failure rate could not be assessed as the denominator was not known. Various cases irrespective of number are having , rings applied partially on fallopian tube , ring was applied on one fallopian tube and other ring could not be traced. In many cases ring was applied on Round Ligament and in remaining it was on mesosalpinx.

On further analysis , the rings were applied on both round ligament and then mesosalpinx and in minority of cases rings were found broken and were hanging loosely along with mesosalpinx and fallopian tube.

VARIOUS METHODS OF TUBAL LIGATION

To sum up in all cases rings application was faulty, hence leading to increase rate of litigation. Mechanical devises usually fails , when they are not properly applied has also been observed in number of studies. Slippage or milking effect on fallope ring can occur if the ring is placed on fatty tube or on oedematous tube. Quality of ring always remains in mind of surgeon , Government supplies of rings are there, hence what ever the ring is there surgeon has to apply. Adherence to strict criteria will minimize the failure rate due to breakage of rings

It can be concluded that a proper identification of anatomical structure is necessary before applying the ring. The ring should be of good quality and should not be applied on oedematous or fatty tube to reduce the failure rate.

DEPRESSION IN WOMEN

2011-06-24T16:03:00.001+05:30

In this era of tension in every field of life , women are unable to cope up with the familial , work , household work and person relation binded by a thin thread .

In Indian culture particularly house wife's are suffering like anything , No one is there is to listen to them particularly in rural population , or in very higher social classes.

Every matter related to any field goes to grey matter, and when there is no solution , the women undergoes in the phase of Depression.

The main causetive factors are :

Stressful event in life
Childbirth ( if abnormal )
Cuclothymic personalities
Bipolar affective disorder
Acute or Chronic Physical illness

The Depression occurs most often in 10 to 15 % of the population. Women are most common sufferer , the male to female ratio is approximately 1:2. It mainly occur in women of rural area ,but affects all social classes ., irrespective of age group , but much more common in old women < 65 years of age .
The main Symptoms are :

Impaired concentration
Change in appetite
Lethargy
Decrease in Sexual drive
In appropriate self blame
Psychotic features
Recurrent throught of suicide or death.

Before giving a label to a women to be depressive Doctors usually exclude :

Parkinson's disease
Myasthenia gravis
Hypothyroidism
Dementia

Unfortunately enough there is no Investigation , by which we can reach to a final diagnosis of Depression ??

The treatment is mainly Psychological., or if the disease is severe anti depressents or SSRIs are often used .

The main thing to thik about by the society in general and thinking minds that to access the suicidal risk, if so immediately hospitalization is required.

Depression is curable , provided drug to be given regularly , giving inadequate dose or stopping therapy is dangerous.

The close relation must give moral boosting and increase the self confidence. , that is quite sufficient to avoid depression and underling patho physiology ., hence forth old age homes also take the old or young , men or women maximum time to boost up their morale. Prevent the disease by keeping the atmosphere of house smooth , avoid certain things , as generation gap will increase this disease and make a commitment that we have to help such of our family members.

VAGINAL DISCHARGE IS NORMAL .......

2011-06-19T15:46:00.001+05:30

One day an adolescent girl presented with the complain of excessive watery discharge from her Vagina. On examination I found that actually there were no secretions and no genital pathology. The girl was both anxious and ignorant . She considered normal vaginal secretions as excessive because of a lack of proper guidance or education about her genital organs.

Most women attending the Gynaecologists come with similar type of complaints. One aspect that should be clarified right away is that the presence of slight vaginal discharge may be considered abnormal.
Vaginal secretions are one of the commonest types of secretions occurring in a normal healthy female body. Since the female genitalia are directly related to the abdominal cavity, infection in the former can spread to the latter, and cause serious complications.
Vaginal secretions are actually nature's way of providing a barrier against infection.

In healthy women the vagina secretes a mucus, which is actually made up of desquamated epithelium, certain bacteria , which are normal inhabitant of the vagina and lactic acid.
Recently a women presented that she was losing weight continuously due to her whitish Vaginal secretions. She seemed to think she was suffering from cancer.
I examined her and found that she was no signs clinically suggestive of cancer., the discharge was only due to a mild infection . I explained the whole thing to her and told her that weight loss was not due to ailment and that she should improve her dietary habits.
In fact , if a women manifests any such symptom, she must consult a doctor without wasting any time , just to discount the possibility of any major illness.
There are certain periods in a woman's life when Vaginal secretions even if they are slightly in excess, are absolutely normal, as during ovulation , when the ovum gets liberated from the ovary., at the time of sexual stimulation , due to pre- menstrual congestion in the female genital tract and during the period of pregnancy.
Why do these Vaginal secretions forms as a big question in thinking minds ??

TRICHOMONAS

The Vulva has three kinds of glands, the sebaceous glands, the apocrine glands and sweat glands. When ever these glands are stimulated either because of some infection or through external or mechanical means, the glands get activated and release Vaginal secretions.
Some women complain that they have a foul smelling discharge . Of course such a complaint does necessitate a visit to the gynaecologist, but generally speaking , there is nothing to worry. Vaginal secretions of the apocrine glands do normally have a peculiar odour.
Leukorrhea is a common manifestation of genital tract disorders. it may occur at any age and affects almost every women at some time or other . the causes may be many but , most often , it is caused by infection in the lower genital tract. the infecting organisms are the protozoas i.e. Trichomonas. sometimes it could also prove to be fungal infection known as ' Moniliasis '.
In the latter type of infection , the secretion is curd like in consistency and in the former kind of infection it is watery. Women who complain of such kind of secretions should consult a doctor immediately. Infection by the Yeast can not be ruled out.
' Trichomonas ' is normally transmitted through the sexual act also. so, once the diagnosis is arrived at both the partners should be treated , otherwise the disease could reoccur.
Leukorrhoea is a debilitating disease , which proves specially difficult to cure in diabetic women. Treatment extending to three or four months may be necessary in such cases , and the patient should take care of to consume her drugs regularly.
The ultimate prognosis is good, however , if a proper diagnosis is made and proper follow-up treatment is continued , this is 100 % curable a disease.

THIS BLOG IS BEING SEEN IN THIRTEEN DIFFERENT COUNTRIES.

2011-06-12T12:32:00.001+05:30

SNORING IN WOMEN......! !

2011-06-10T18:48:00.003+05:30

Once I was travelling in three tier A.C. Coach. One of the Woman passenger started snoring to the extent that almost , I could not sleep at all . It is very easy to blame that fellow passenger , but then I started knowing the causes of Snoring , and asking the person that, you know that in the night you were snoring?? But reply comes in negative shape.

Generally speaking , the structures involved are the uvula and soft palate. The irregular airflow is caused by a passage blockage and usually due to one of the following causes –

Obstruction in the nasal passage way

Mispositioned jaw
Throat weakness
Fat gathering in and around throat
The tissues at the top of airways touching each other causing vibrations
Use of alcohol or any drug relaxing throat muscles
Sleeping in one position of Back
Enlarged Tonsils etc.

Snoring is known to cause sleep deprivation to snorers and those around them, as well as daytime drowsiness, irritability, lack of focus and decreased libido. It has also been suggested that it can cause significant psychological and social damage to sufferers. Multiple studies reveal a positive correlation between loud snoring and risk of heart attack and stroke .

Though snoring is often considered a minor affliction, snorers can sometimes suffer severe impairment of lifestyle. New studies associate loud "snoring" with the development of carotid artery atherosclerosis, the risk of brain damage and of stroke. Researchers hypothesize that loud snoring creates turbulence in carotid artery blood flow closest to the airway. Generally speaking, increased turbulence irritates blood cells and has previously been implicated as a cause of atherosclerosis.

Snoring...Usually, snoring is recognized by a friend or partner who observes the patient sleeping. Besides the "noise" of snoring, more complex conditions such as sleep apnea can be consistent with the symptom of snoring. A sleep study can identify such issues. Patients can also assess their own condition to determine the likelihood of such problems based on the severity of their sleeping difficulties.

Almost all treatments for snoring revolve around clearing the blockage in the breathing passage. This is the reason snorers are advised to lose weight (to stop fat from pressing on the throat), stop smoking (smoking weakens and clogs the throat) and sleep on their side (to prevent the tongue from blocking the throat). A number of other treatment options are also available, ranging from over-the-counter aids such as nasal sprays, nasal strips or nose clips, lubricating sprays, and "anti-snore" clothing and pillows, to such unusual activities as playing the didgeridoo. However, snoring is a recognized medical problem and people who snore should always seek professional medical advice before relying on techniques that may mask symptoms (i.e. snoring) but not treat the underlying condition.

           Specially made dental appliances called mandibular advancement splints, which advance the lower jaw slightly and thereby pull the tongue forward, are a common mode of treatment for snoring. Typically, a dentist specializing in sleep apnea dentistry is to be consulted. Such appliances have been proven to be effective in reducing snoring and sleep apnea in cases where the apnea is mild to moderate. Mandibular advancement splints are often tolerated much better than CPAP machines. Possible but rare side effects include gradual movement of the teeth, temporo mandibular joint disorders , excess salivation and gum irritation.

The professionally fitted devices generally incorporate an adjustment mechanism so that jaw advancement can be easily increased or decreased after fitting. To adjust the "do it yourself" appliances it is necessary to reheat them and mold them again in the desired new position. Alternatively, given the low cost, a new splint can be used.

         A continuous positive airway pressure machine is often used to control sleep apnea and the snoring associated with it. To keep the airway open, a shoebox-sized device pumps a controlled stream of air through a flexible hose to a mask worn over the nose, mouth, or both.

          The Surgery is also available as a method of correcting social snoring. Some procedures, such as uvulo palato pharyngo plasty , attempt to widen the airway by removing tissues in the back of the throat, including the uvula and pharynx.

                    Radio frequency ablation is a relatively new surgical treatment for snoring.

                    The Pillar Procedure is a minimally invasive treatment for snoring and obstructive sleep apnea. This procedure addresses one of the most common causes of snoring and sleep apnea - vibration or collapse of the soft palate (the soft part of the roof of the mouth). If there are other factors contributing to snoring or sleep apnea, such as the nasal airway or an enlarged tongue, it will likely need to be combined with other treatments to be more effective.
             A combination of pseudoephedrine and domperidone shows excellent results in the treatment of severe snoring. The preparation is sold over the counter in some countries.

        There are various natural methods alleged to alleviate snoring. These can be in the form of herbal pills, acupressure devices or specialized acupuncture.

         Change of bed position – There are occasions wherein snoring is the result of wrong sleeping position. Sometimes, sleeping with too many pillows can stretch and narrow the air passage. Use one pillow to avoid it. Also, lying on the back can cause snoring. So, a change in sleeping position can be a good help.

      All natural anti snoring sprays are also available. These can come in over-the-counter products available at pharmacies.

       Also amongst the 'natural' remedies are exercises to increase the muscle tone of the upper airway.

      Try to make a snoring noise. If it is reduced, you are probably a "tongue-base snorer", meaning your tongue is vibrating and causing the problem. If you are a "nose snorer" you snore with a closed mouth, it says.

To summarize , the precautionary measures are :

Sleep on your side

The theory is that when we lie on our backs the tongue and muscles in the throat collapse, constricting the airway and causing snoring.

Higher pillows

This aims to keep the airways open by supporting the neck so the throat is less constricted. It works fairly well until you fall asleep and slump down in the bed.

Breathe Right Nasal Strips

open your nostrils from the outside and they certainly do seem to do this. They can also provide temporary relief from nasal congestion and stuffiness caused by colds and allergies. These are supposed to give relief.

Snoreeze Oral Strips

These dissolving mint-flavoured strips target the main cause of snoring and are ideal if you tend to snore more when lying on your back. They contain a time-release formula, which coats the back of the throat throughout the night and reduces the vibrations of the soft tissues, helping to stop snoring.

Snoreeze Throat Spray

This lubricates and tones the soft tissues at the back of the throat that vibrate and make you snore.

Nozovent

This is a piece of flexible plastic which you push into your nostrils to make them wider and allow easier breathing. It looks like something from the Spanish Inquisition but users report good results.

Somno Guard

This is a bit like the gum shield worn by a rugby player, but it is reported to produce good results. The idea is to bring your lower jaw and tongue forward, making more space for breathing. The drawback is that it takes sometime to get used to and is costly.

Rhynil Herbal Spray

It’s herbal nasal spray shrinks the lining of the nostril, creating more space to breathe. It also tightens the tissue of the roof of the mouth, making it less likely to vibrate. It smells pleasant and a friend who tried it said it reduced snoring significantly.

Abstinence
You should cut down on cigarettes or, better still, give up completely. Also, try to have your last alcoholic drink at least four hours before you go to bed. , and get rid of snoring.

Now have a sound sleep without disturbances !!

MENOPAUSE .....ENJOY IT !!!!

2011-06-07T08:40:00.004+05:30

Life begins after the age of 40., whilst very few of us would so lightly dismiss the joys and achievements of youth. It may fairly be said that for women, new life begins at the time of the cessation of menses or menopause ,as they lay down the possibility of brotherhood and become free to plan their community activities and public life .It is a pity ,therefore ,that for so many women ,this exciting phase should be marred by a great fear of menopause ,rooted in ignorance and uncertainty.

A women’s life naturally divides itself into distinct phases ,and these may be separated by an abrupt transition ,or may merge into one another ,so gradually that the change is hardly noticed .Thus a girl passes from childhood to adolescence ,and then from

adolescence to maturity .The curse of menstruation is accepted and like the burden of shaving in males ,it often becomes a symbol of the achievement of womanhood.

The changes during menopause are many, and varied ,and it is impossible to predict the exact changes any particular woman will experience .While some may come to a doctor complaining of apathy ,headache ,vague aches and pains , some other may be startled out of their wits by a sudden hot flush which they had never experienced before .Anyhow ,besides these physical complaints ,psychological problems in menopause play a great role .

Generally women may complain ,”Doctor ,I think I am going mad!” How often does a doctor have to reassure the frightened patient that insanity is hardly even a concomitant of menopause .This fear of insanity is unfounded, for although at the change of life, some women lose part of their feeling of security, only very few suffer a true mental breakdown thinking that she and her husband are growing too old to be useful and are becoming a hated burden to all, and that the world is harsh. These are the age old and cotemporary manifestations and menopause fear.

About half the number of menopausal women suffer some emotional strain, which may be manifested as a feeling of general inadequacy , depression , irritability or aggressiveness or, conversely, it may cause lethargy and lack of enthusiasm. A common complaint is tiredness and insomnia and if untreated , this leads further to anxiety and thus creating a vicious circle. The phase of despondency may show itself in an increased irritability, so that a woman become exasperated more quickly than usual and is liable to be peevish with her husband or irritable with her children for petty reasons.

In many a women, a tendency for self- sacrifice gets grossly accentuated and she imagine herself to be a martyr and plays this role with a bitter defiance. Sometimes such a woman can even become a terror to her husband and family., she will try to make herself a doormat to be trodden on by inciting people to misbehave with her and then bring to the fore her worst behavior.

Some women come to doctors, asking , “ What will be the effect of menopause on my married life?” It must be remembered that, sexual desires and capacity outlast the period of menstruation and are also much stronger than usually presumed to be the case. There is a deep rooted belief that sexual capacity in women lessens at the change, and this is extremely false.

The ability to enjoy the sex act actually depends on the presence of ovaries and womb. If the sexual response was good before the menopause, it will continue to be so after it, or can even be much better than before.

All these functional or psychological changes which a woman encounters at this time depends much on the level of understanding and tolerance of her husband. His understanding and tolerance of his wife’s difficulties can help her to surmount them. If the husband and the children are willing to help her in the household, it will bring in her a feeling of reassurance and hopefulness.

Apart from the medical treatment for these problems, the management of menopausal mood also requires common sense and sympathy. It is unlikely that immediate relief can be obtained when the mood has lasted many months. One thing is certain and that is, a woman must accept the fact that she has now lost the power of producing the child. But this is no reason for her to assume that she has lost every thing else. Rather she should now turn herself to the hundreds of other activities for which she previously had no time.

For the married women with children, for whom the home is the centre of interest, some way must be found to reduce the burden of daily tasks and for diversion. There are so many things at home as knitting , crocheting, cooking, gardening, decorating, dress making and so on. All of these can be taken up seriously now, for the benefit of herself and her family.

This is no time when she can really get down to her children and grand children, when she can join ladies guilds and societies; When she has the leisure for long walks and previously missed visits. This is an opportunity to her to participate in all these activities, if she has missed them earlier in her youth.

Only in a very limited sense can the menopause be said to be an involution or closing down; in most cases it can be and should be , a late opening out, an “ Autumn efflorescence “, as one can say., hence menopause must be taken as a natural phenomenon which will come in every woman’s life. Enjoy menopause , but do not treat it as a burden.

SIMPLE TECHNIQUE FOR DETECTION OF RUPTURED FOETAL MEMBRANES

2011-06-05T16:38:00.000+05:30

        Status of foetal membranes is of foremost importance for the obstetrician ,mother and foetus .Once in the blue moon there are cases in which history is strongly in favor ruptured membranes ,but physical findings vibrate in other tunes enabling a doubt regarding status of foetal membranes .
       To date a number of tests have been devised viz., Litmus pads test , Presence of Lanugos hairs , fat globules , Amniotic fluid crystallization test and Verni test.

      A low cost simple ,reliable and risk free technique e is being presented based on the color changes on heating the material collected from endocervical canal.

     The present study was carried out .The cases selected were having no history of ruptured membranes , physical findings in favor of presence of membranes ,cervical dilatation was at least 2 cms. and there was no contraindication for artificial rupture of membranes.

              After confirming the presence of membranes by physical findings ,under full aseptic precautions the endocervical material was collected and was spread on the glass slide. Foetal membranes were ruptured and again the endocervical material was collected and spread over the slides. The contra lateral surfaces of both slides were heated for a minute by spirit lamp and color change of the material was noted.

In majority of cases in first slide color of endocervical material , changed to brown color on heating. On heating the second slide no color could be obtained , it turned to white., suggesting that in cases with intact foetal membranes on heating endocervical material , the color of material changed to brown., while in cases with ruptured membranes ( artificially ) the color changed to white.

The brown color that appears on heating endocervical materials from patients having intact foetal membranes is because of carbonization of proteins present in mucus, on the contrary , when membranes were ruptured the mucus get mixed with the amniotic fluid and on heating such a material the water of amniotic fluid evaporates and electrolytes present in amniotic fluid gives white color.

It is very well evident that this technique is so simple and without any risk that it can be used routinely on doubtful cases to assess the integrity of foetal membranes.

Published in: J.of obst. & Gynae. Of India : 37,59;1987

NON-HODGKINS DIFFUSE LYMPHOCYTIC MALIGNANT LYMPHOMA OF OVARY

2011-06-02T22:03:00.000+05:30

        The involvement of the ovary in lymphomatous processes is rare, but ovary is the common site in the female genital tract to be involved by the hematological malignancies.
       The occurrence of lymphomas primarily arising in the ovaries has long been debated since no lymphoid tissue is found in the ovaries. Involvement of the ovary by malignant lymphoma can be primary or secondary and is discovered incidentally during a workup for abdominal or pelvic complaints.
         The Present case of ovarian lymphoma , presented as an ovarian mass with gastrointestinal symptoms with occult extra-ovarian disease. It is unusual to find a tumour of the reticulo endothelial system to present as ovarian neoplasm .With a few exceptions lymphoma of ovary is secondary to a primary lesion in intestines usually. Because of its rarity it is worthwhile to report this case -

Mrs. D.,25 years of age ,3rd para , presents with amenorrhea of one year , pain lower abdomen since one month and gradually increasing swelling since 15 days. Her previous menstrual cycle was normal. She had laparoscopic sterilization one year back. Her general condition was normal. On per abdomen examination spleen was found to be enlarged 4 cm. below costal margin, soft in consistency. There was no lymphadenopathy.
        A mass of about 22-24 weeks gestational uterus size, firm in consistency was palpable. On bimannual examination, cervix was normal, uterus was retroverted, retroflexed parous size, anterior to uterus a firm mass felt filling lower abdomen and appearing to be arising from right angle of Uterus, fornices were free, discharge healthy.
      Her fasting Blood Sugar was 92% , blood Urea 25mg% ,Serum alkaline phosphatase 11.2 , SGOT was 20.0 IU., SGPT 14.0 IU. Serum Total proteins were 6.0 gm% , Total serum Billirubin was 1.4mg% , X-Ray Chest P. A. View Was normal. Barium meal study was normal.

     Abdomen opened ( Laparotomy ) by right para median incision . Uterus , left ovary and fallopian tube were normal. On Right side there was an irregular swelling arising from Ovary, solid in consistency. The capsule of Swelling was having Malignant infiltration involving peritoneum. Tumour was adherent on the posterior surface, same separated. There was frank bleeding from separated area.

HYSTO PATHOLOGICAL VIEW

Sub - Total Hysterctomy with left sided salpingo- oophrectomy with removal of right sided tumour was done. Post operative period was un eventful.

On Histological examination nothing abnormal was detected in uterus and tubes. In both ovaries , picture was suggestive of malignant Lymphoma,

Non Hodgkins diffuse Lymphocytic variety .

Post operatively , patient was given Cyto toxic drugs alone, a complete course. , For follow up after 5 years , patient was doing well.

Struma Ovarii ...

2011-05-30T20:30:00.003+05:30

Struma Ovarii is the condition in women where , there is presence of a thyroid like tissue ,as a major cellular component in the women’s ovary as ovarian tumour , mostly a teratoma. Among the types of ovarian tumors, the proportion of teratomas ranges widely from 1 – 15 %. Struma Ovarii most commonly occurs between the ages of 45 - 65 years. Women suffering from struma ovarii usually have a pelvic mass, or associated with less frequent hyperthyroidism or ascites.
Struma Ovarii can be defined as , an ovarian tumor in a woman that contains thyroid tissue as its predominant cell types, is termed as struma ovarii. Though it typically occurs as a part of a teratoma, occasionally it may also be encountered with mucinous cystadenomas or serous. , hence the final diagnosis depends on the histo pathological examination of the mass.

Even if malignant transformation of this ovarian tumor is rare, it is mostly defined on histological criteria. Benign struma ovarii is a rare type of thyroid tissue implants throughout the peritoneal cavity. Strumal carcinoid or malignant Struma Ovarii can be defined by the presence of carcinoid tissue within a struma, which is exceptionally a rare case.

A case report of Struma Ovarii is being presented herewith –

Mrs. J., 21 years old, female was admitted for the complaint of failure to conceive , gradually increasing painless swelling in lower abdomen with excessive , irregular and painful periods since 9 months. Previous cycles were normal .Her general condition was good ,there was no clinical evidence of thyrotoxicosis . Thyroid glands was not enlarged.

On abdominal examination ,a mass was palpable in the lower abdomen about 7 x 6 cm. in size, oval in shape , cystic in consistency and having considerable mobility.

On bimanual examination the External Os was closed , uterus was anteverted , anteflexed , smaller than normal size , mobile.A cystic mass of about 7 x 6 cm. was palpable through the posterior fornix separate from the uterus. Routine laboratory investigations did not reveal any abnormality.

On Laparotomy ,a cyst was found arising from right ovary ,measuring 6 x 7 cm. in size , the surface was greyish blue and lobulated .Fallopian tube of this side was stretched over it and was adherent to the mass. Left ovary was normal .Right sided salpingo - oophorectomy was done.

On cutting open the tumour ,it was multi-locular containing filled with straw colored ,watery fluid .On microscopic examination thyroid tissue constituted the predominant elements in all the sections. It was in the form of acinii having flattened epithelium with or without reddish pink colloidal material.

The post-operative period was uneventful and patient discharge in satisfactory condition.

- Published in J.of Obst. & Gynae. Of India: 34(1),180.,1984

2011-05-30T04:20:00.002+05:30

9 comments:

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डॉ. कपिल गुप्ता said...: आप को शायद याद होगा , बीकानेर में , मैं आपका शिष्य था , दोस्तों से चर्चा के दौरान यह जानकर बहुत ख़ुशी हुई कि आपने स्त्री एवं प्रसूति विषय पर , अनेकों ब्लॉग अंतर्जाल पर , पर उपलब्ध हँ , जिज्ञासा वश मैंने यह ब्लॉग देखा , तो गुरुदेव मैं अचंभित रह गया , ब्लॉग पर उपलब्ध सामग्री देख कर , काफी ख़ुशी हुई , गुरुदेव आप महोदय के बारे मैं इतना ही कहूँगा कि ईश्वर की कृपा से आप हमारा ज्ञान और बढ़ाएं , सादर . - डॉ. कपिल गुप्ता; May 21, 2011 9:27 AM
Prof. Gayatri Vijay said...: Dear Dr. Mukesh Raghav, While surfing on internet , I got your nice blog. Being your teacher and guide , you can understand my feelings, just as that of Mother and son. I have seen such a blog for the first time in my life of 79 years. Material is very useful for both UG and PG students. I am remembering since student life you were very intelligent and laborious too .I feel proud of you. God bless you. Keep it up.; May 25, 2011 9:02 AM
Prof. Jain , J.C. said...: Dr. Raghav , What a beatiful blog , which I have ever seen , Quite informative from subject point of view., The Faculty must take advantage of the material in the blog. You are the asset for the obstetrics and Gynaecology , faculty as a whole in the world.Thanks a lot.; May 25, 2011 10:45 PM
Dr. Taylor. I said...: I belong to the group of obstetricians and Gynaecologist . In my life career , I have not seen a blog of this kind.....It is remarkable , educational and beautiful too. Full marks Dr. Raghav. Keep it up , I expect a lot from male Gynaecologist in general , but you are on top.Thanks .; May 26, 2011 9:44 AM
Prof. Gupta,O., from Kochi said...: Dr. Mukesh Raghav , I am proud of your beautiful blog, and it is quite informative too.Thanks.; May 26, 2011 10:50 PM
William Josheph said...: I feel comfortable after seing your natural blog, having contents , which are useful., but for hipnotizing us ,you have number of things on the blog.; May 27, 2011 1:49 PM
Mukund Swami said...: Dr. Mukesh Raghav, Being a under graduate student , one of my friend told me to see this blog. Sir, I was thrilled to read it and I am sure this material, if I will go through twice , will help in my practical exams.Regards.; May 29, 2011 11:27 AM
Dr. Manda Singh Gill said...: Dr. Raghav Sir, With due regards , I submit that blog and contents are too much impressive and informative. Why you have not published this blog , when I was your student.Do not mind Sir,Regards Sir.; May 29, 2011 2:46 PM

डॉ. मुकेश राघव

2011-05-20T17:27:00.000+05:30

सभी महानुभावों ( श्री एवं श्रीमती ) को ब्लॉग पर टीका टिपण्णीयां करने के लिए धन्यवाद एवं आभार : डॉ. मुकेश राघव

COMMENT

2011-05-18T22:45:00.001+05:30

HELLO, DR.MUKESH RAGHAV JI AAJ AAPAKABLOG DEKHANE
KA MOUKA MILA ,DIL KHUSHI SE BHAR GAYA KI ETANI
CHHOTI SI JAGAH PAR RAH KAR AAPANE BADI UPLABADIAN
PRAPT KI HAIN,AAPKI KADI MEHANAT SAAF JGALAK RAHI
HAI,I PROUD OF U SIR..
By DR JOGA SINGH KAIT on Post a Comment On:
DR.MUKESH RAGHAV "RAGHAV’S READ... at 10:12 AM

COMMENT

2011-05-18T22:35:00.003+05:30

COMMENT

hi i am surprised by the work...
a knowledge of this aptitutude,

useful for gyno. students
By Harry Jones on DR. MUKESH RAGHAV
on 4/24/09
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Amazing to read a nice blog,
educative one
By DR. KAVIT GOYAL on
DR. MUKESH RAGHAV on 4/23/09

IT IS A NICE BLOG FOR THE STUDENTS
OF OBSTETRICS AND GYNAECOLOGY
By Anonymous on DR. MUKESH RAGHAV
on 4/23/09
Posted by DR.MUKESH RAGHAV at 10:04 AM

2011-05-18T22:29:00.000+05:30

Post a Comment On: DR.MUKESH RAGHAV
"RAGHAV’S READY RECKONER FOR CALCULATING
THE RATE OF SYNTOCINON INFUSION IN MILLI
UNITS PER MINUTE"
1 Comment - Show Original Post
सिद्धार्थ जोशी Sidharth Joshi said...
डॉ. साहब नमस्‍कार
मैं मेडिकल की भाषा या विषय को तो नहीं समझता
लेकिन यह जानकर सुखद आश्‍चर्य हुआ कि बीकानेर
के एसपी मेडिकल कॉलेज से भी एक ब्‍लॉगर है।

April 13, 2009 2:24 AM

RAGHAV’S READY RECKONER FOR CALCULATING THE RATE OF SYNTOCINON INFUSION IN MILLI UNITS PER MINUTE

2009-01-29T23:16:00.002+05:30

DR.MUKESH RAGHAV

Oxytocin infusion for any sake , if proper doses are not infused will lead to mismanagement leading to failure of induction of labour and patient depending on cervical factors and foetal condition ends in un necessary Caeserean section. To prevent un necessary surgery proper monitoring of Syntocinon to be infused depending on Bishop Score and Partogram.Hence for the benefit of Post graduate Students, resident Doctors posted in labour room and faculty members in general here is RAGHAV’S READY RECKONER FOR CALCULATING THE RATE OF SYNTOCINON INFUSION IN MILLI UNITS PER MINUTE.

DR. MUKESH RAGHAV

key words : Syntocinon,dose for infusion,avoid mismanagement

Amount of vehicle	Quantity of Syntocinon ( in IU) Transfusion rate 10-15 drops / minute ( 1ml/mt.)
(in mls.)	0.5	1	1.5	2	2.5	3	3.5	4	4.5	5
500	1.00	2.00	3.00	4.00	5.00	6.00	7.00	8.00	9.00	10.00
450	1.11	2.22	3.33	4.44	5.55	6.66	7.77	8.88	10.00	11.11
400	1.25	2.50	3.75	5.00	6.25	7.50	8.75	10.00	11.25	12.50
350	1.42	2.85	4.28	5.71	7.14	8.57	10.00	11.42	12.85	14.28
300	1.66	3.33	5.00	6.66	8.33	10.00	11.66	13.33	15.00	16.66
250	2.00	4.00	6.00	8.00	10.00	12.00	14.00	16.00	18.00	20.00
200	2.50	5.00	7.50	10.00	12.50	15.00	17.50	20.00	22.50	25.00
150	3.33	6.66	10.00	13.33	16.66	20.00	23.33	26.66	30.00	33.33
100	5.00	10.00	15.00	20.00	25.00	30.00	35.00	40.00	45.00	50.00
50	10.00	20.00	30.00	40.00	50.00	60.00	70.00	80.00	90.00	100.0

Published in the J. of obstetrics and Gynaecology of India, Vol.35(6),1985 pg. 1084