Medical management versus surgical management in fibroid uterus

Background: Uterine fibroids (leiomyomas) are most common tumours of the uterine smooth muscles, appear to increase in incidence with age during reproductive years, with a peak in incidence between 35 to 40 years. Signs and symptoms of uterine fibroids include heavy or prolonged menstrual bleeding, pain and pregnancy complications. Current management strategies mainly involve surgical interventions, but choice of treatment is guided by patient’s age and desire to preserve fertility or avoid ‘radical’ surgery such as hysterectomy.Methods: It is the prospective observational study conducted in inpatients of department of OBGY at tertiary care hospital, admitted during the period of June 2019 to May 2021. Outcome measured in terms of relief of symptoms, decrease in size of fibroid, requiring subsequent surgery, quality of life, blood transfusion requirements, length of stay in hospital, successful pregnanciesResults: Of patients treated with ulipristal, 78.57% had improved quality of life, in patients treated with leuprolide, 57.14% showed improved quality of life, with mifepristone 80% patients showed improved quality of life and with LNG 100% patients responded to it. All patients treated surgically, showed relief of symptoms.Conclusions: Medical line of management is best for patients in younger age group, small size fibroid, desire for future fertility. Uterus sparing option like myomectomy is done in patients not responding to medical line of management and desire for future fertility. Hysterectomy is definitive line of management for patients with fibroid uterus.

Clinical Study of Lens Induced Glaucoma at a Tertiary Eye Care Centre

BACKGROUND Lens induced glaucomas are common in India. There were different types of lens induced glaucomas based on clinical features and morphological features. This study was undertaken to evaluate the various characteristics and presentations of glaucomas, to define the risk factors and to evaluate as to how they influence the post-operative visual acuity, intra ocular pressure, inflammation and optic disc changes. METHODS This longitudinal study included 90 cases of lens induced glaucoma admitted in the ophthalmic wards of the Great Eastern Medical School and Hospital, Srikakulam, during the period March 2018 to March 2020. All consecutive patients diagnosed as lens induced glaucoma on the basis of clinical symptoms and signs were included. At presentation, visual acuity, IOP, inflammation including corneal changes were recorded, which were repeated after institution of medical line of treatment and postoperatively patients were followed up regularly at 2, 4 and 6 weeks intervals and the same parameters were evaluated including optic disc changes. RESULTS Occurrence of lens induced glaucoma in the hospital during the study period was 1.72 %. The mean age of presentation of various types of glaucomas was 60.57 years and the female to male ratio was 2:1. The most frequent type of lens induced glaucoma was phacomorphic glaucoma (70 %). In 34.4 % patients best corrected visual acuity was found to be better than 6 / 18. In 14.4 % of cases, visual acuity was found be worse than 6 / 60. In patients who presented with symptoms of less than two weeks duration, better visual acuity of 6 / 12 or more was noted (76.2 %, P < 0.01). In 60 % patients who presented with IOP levels of less than 35 mmHg, better visual acuity of 6 / 12 or more was noted in 76.2 %. The mean IOP noted in patients with symptoms of 2 to 4 weeks duration was found to be 40.33 ± 9.36 mmHg. Inflammation was more severe in patients who were symptomatic for more than 2 weeks (37.50 %, P < 0.05) and also in cases with IOP more than 35 mmHg (40 %). Optic disc of the presented eye was found to be damaged in 35.5 % of cases and in patients presenting with symptoms of more than 2 weeks’ duration it was 62.5 % (P < 0.01). CONCLUSIONS Presentation with intraocular pressure value greater than 35 mm of Hg and with symptoms of more than two weeks would result in severe inflammation further affecting the cornea and causing optic nerve damage which would ultimately jeopardize vision. This can be prevented by early presentation and regular screening of people above 60 years of age. KEYWORDS Lens-Induced, Glaucoma, Cataract

Bilateral total conservative parotidectomy: a tale behind an aesthetic surgery

Any facial swelling is associated with stress for the patient due to cosmesis. Especially when one has bilateral symmetrical enlarged parotids, having exhausted all available conservative management, surgery becomes the last resort; which in such cases pose specific challenges. A 29-year-old man presented with problems of bilateral symmetrical enlarged parotid lesion for 5 years, which did not have an adequate response to medical line of management. He underwent proposed surgery and was diagnosed to have chronic sclerosing parotitis (CSS). The challenges faced during surgery of this non-neoplastic inflammatory lesion, with significant fibrosis, is being described. He recovered completely without any complications related to surgery. CSS rarely affects bilateral parotid glands. Surgery, results of which are outstanding, must be considered in cases where these lesions do not respond to medical line of management. Bilateral total conservative parotidectomy with sternocleidomastoid flap reconstruction provides excellent aesthesis and improves quality of life.

ASSESSMENT OF ADD-ON-EFFECT OF ANJANA BY HARIDRADI GHRIT IN THE MANAGEMENT OF DRY EYE SYNDROME

In todays life, due to change in environment , food habits and life style it gives rise to different eye diseases. Now a days we see there is exess use of computers and over exposure to visual display terminals, which lead to birth hazard named Dry eye syndrome. In modern science there is not effective treatment for Dry Eye Syndrome. Recently there is increase in number of patients coming in OPD having complaints of foreign body sensation, feeling of dryness, burning sensation, itching, photophobia, tired eye, redness,discomfort etc commonly. In modern science the group of above mentioned symptoms is named as Dry eye syndrome.It is disorder of tear film due to tear deficiency or excessive tear evaporation which leads to damage to outer occlar surface. Incidence of dry eye is 14.3% in Clinical practice (pub med medical line index). In modern pharmacology the available regimen for the dry eye is using lubricating. But this gives only temporary relief. While in Ayurveda these symptoms are seen in vitilated vata pitta doshas in eye and will be taken into consideration of title Netrashushkta. In Ayurveda some preparations are there, which can be used as local external application in eye. Ghrit is one of the drug among them which is chakshusya, easily available and more economical to patients. Taking into consideration snehan property of ghrit and vata- pittaghna properties of Haridra and Daruharidra I thought use it in Dry eye syndrome. Hence, I take this topic for research work under the title - To Study The Effect Of ‘Haridradi Ghrit Anjana’ In The Management Of ‘Dry Eye Syndrome’.

Case report on toxicity of methotrexate in tubal ectopic pregnancy

Ectopic pregnancy is defined as pregnancy outside uterine cavity. Of all ectopic pregnancy, tubal ectopic is most common. Most cases today are diagnosed early and hence timely treatment is possible. In stable patients, medical line of management with methotrexate can be used. With early diagnosis and medical line of treatment, use of injectable methotrexate is on rise. Being aware of characteristics of methotrexate like mechanism, dosage, side effects and contraindications, appropriate patient selection and watchful monitoring will help reduce methotrexate induced toxicity.

Cryptococcus neoformans infection in a post-operative mastoid cavity of an immunocompetent individual: a rare case report

<p class="abstract">This is a case report of isolated cryptococcosis in the operated mastoid cavity of an immunocompetent individual. A 24 year old immunocompetent male who underwent modified radical mastoidectomy presented to the OPD with complaints of otalgia and recurrent otorrhoea, not responding to regular medical line of treatment and aural toileting. Microscopy and culture of the ear dischrage revealed <em>Cryptococcus</em> <em>neoformans</em>. The patient was treated with oral and topical fluconazole and recovered completely. Although rare, cryptococcal mastoiditis should be considered even in an immunocompetent patient, as any delay in diagnosis and treatment can lead to fatal complications.</p>

Percutaneous lung abscess drainage: revisiting the old gold standard

Lung abscess is defined as the necrosis of lung tissue with cavity formation due to varied etiology. The treatment of lung abscesses is medical involving antibiotics and chest physiotherapy. The failure of medical line of management requires an invasive surgical or percutaneous approach for drainage and control of infection. While the literature is ample regarding the surgical approach, it is rather scarce on the percutaneous approach. The percutaneous drainage has been most studied with computed tomography guidance. With our case series we describe to the treatment of lung abscesses non-responsive to medical management, by a bedside minimally invasive ultrasound or fluoroscopy guided percutaneous drainage approach.

Second New Primary PNET of Kidney in a Treated Case of Carcinoma Breast: A Case Report

Primitive Neuroectodermal Tumour (PNET) is a member of small round cell “Blue tumour” family. The overall incidence of PNET is <1%. PNET of kidney is uncommon and was first reported in 1975. Since the first report around 150 cases have been published in medical literature. It exhibits highly aggressive behaviour. It usually affects young adults and has a male predominance of 3:1. Only six cases of PNET of kidney have been reported in older patients and PNET of kidney as a second new primary has rarely been reported, only three cases of renal PNET with history of an earlier or synchronous primary cancer were reported in literature from the USA, Germany and China. Here, the author reported a case of renal PNET in a 48-year-old female who has been treated for right breast cancer by surgery, adjuvant chemotherapy and radiotherapy three years (July 2015) prior to diagnosis of PNET of left kidney. Upon diagnosis, patient underwent left nephrectomy. Postoperatively, patient was started on Ewing’s Family of Tumours (EFT) 2001 protocol. Patient completed induction therapy followed by radiation to tumour bed with concurrent weekly single agent vincristine and was planned for maintenance chemotherapy. After one cycle of maintenance chemotherapy, patient developed severe febrile pancytopenia and was admitted in the ICU, even after aggressive medical line of management, patient could not be revived. Although, the patient tolerated the treatment protocol for breast malignancy well and the primary was under control but after three years, with the diagnosis of a very rare second new primary PNET of left kidney which has a very aggressive nature and poor prognosis, the patient could not tolerate the multimodality treatment which was required.

Anterior abdominal wall endometrioma: a diagnostic dilemma

The presence of functioning endometrium outside the uterine cavity is often encountered in gynaecological practice but an extremely rare entity is its extra pelvic variant is seen sometimes around the umbilicus, anterior rectus sheath vesical region, also rarely seen around the kidney’s nasal mucosa, lungs and the pleura. The incidence of this condition is as low as 0.03% to 0.15%. Endometrioma of the anterior rectus sheath is well documented in literature but because of its rarity may pose a diagnostic dilemma. Reporting herewith a case of anterior rectus sheath endometrioma where medical line of treatment failed and surgical excision was required.

Successful management of a triplet heterotropic caesarean scar pregnancy in spontaneous conception

A cesarean scar ectopic pregnancy -CSEP is a fairly uncommon presentation wherein the conceptus is implanted at the exact scar site of the previous cesarean section deep in the myometrium. Given the relatively rare incidence of CSEP establishing a diagnosis of CSEP can be challenging current standards of therapy have been derived from data obtained from a limited number of patient’s management options for CSEP range from medical line of treatment to surgical interventions such as sonography guided injections to laparoscopic excision or laparotomy or combination of these modalities. Herein we report a rare case of triplet pregnancy with one gestation sac implanted at the site of lower segment scar diagnosed on transvaginal ultrasonography along with MRI who was managed successfully with systemic methotrexate.