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Biomedical subjects

A Kriplani

Publications and source records attributed to A Kriplani.

At least 55 records · Page 3Linked to original sources

Balanced X; 22 translocation in a patient with premature ovarian failure.

A case of balanced X; autosome translocation 46, X, t (X; 22) (q 24; q 13) in a 25-year-old female with secondary amenorrhea and premature ovarian failure (POF) is described. The relationship between balanced X; autosome translocation [t (X; A)] and varied phenotypic expression observed in these women is discussed. This case highlights the importance of early recognition of these women in order to give them the best chance of conception in their oligohypomenorrhic phase before complete loss of gonadal function.

Adult↗

An interesting unusual case of endometrial stromal sarcoma.

An interesting case with an unusual presentation of endometrial sarcoma is described. This patient presented with a history of continuous vaginal bleeding 3 months following a full term caesarean section and perception of an enlarging abdominal mass. The physical examination revealed an enlarged uterus with a leiomyoma though there was no evidence of the same at the time of the caesarean section. A laparotomy was undertaken and the patient was found to have a large tumor with multiple polypoidal growths invading the myometrium through to the serosa. This was proven to be an endometrial stromal sarcoma on histopathology.

Adult↗

Pregnancy in a patient of Glanzmann's thrombasthenia with antiplatelet antibodies.

Glanzmann's thrombasthenia is an autosomal recessive, inherited platelet function disorder. There is an absence of glycoprotein (GP) IIb/IIIa on the platelet membrane which causes reduced platelet aggregation with a defective platelet haemostatic plug formation. The management of bleeding episodes in these patients with platelet transfusions may result in alloimmunization and make the successive transfusions less effective. Pregnancy and delivery is rare in these patients and is associated with a high risk of severe haemorrhage. We describe a primigravida with Glanzmann's thrombasthenia and alloimmunization who developed secondary postpartum haemorrhage and was successfully treated with oral prednisolone.

Adult↗

Complete inversion of the uterus during caesarean section: a case report.

A case of complete inversion of the uterus through the uterine incision at the time of Caesarean section is presented. The possible aetiological factors were a short cord and fundal insertion of the placenta. Disappearance of the lower segment incision and the raw appearance of the endometrial surface of a completely inverted uterus posed a diagnostic dilemma. Prompt understanding and immediate repositioning by a simple technique prevented any further complications. This rare complication of Caesarean section and its easy principles of management are described for the benefit of an unwary obstetrician.

Adult↗

Unexplained absence of both fallopian tubes with ovary in the omentum.

A rare case of unexplained absence of both fallopian tubes and ovaries from their normal position, resulting infertility is presented. On careful search an ectopic ovary containing dermoid cyst was found in the omentum. Possible mechanism and clinical significance of such a rare occurrence is discussed.

Adult↗

Ruptured intracranial aneurysm complicating pregnancy.

Three cases of ruptured intracranial aneurysm during pregnancy are presented. Rupture occurred near term in all three cases. Simultaneous elective cesarean section and clipping of the aneurysm was performed in two cases. Successful maternal and perinatal outcome was achieved in all three patients. The diagnosis and management of the cases are described and discussed.

Aneurysm, Ruptured↗

von Willebrand disease: a rare cause of puberty menorrhagia.

A 13-year-old girl with a family history of epistaxis presented with pubertal menorrhagia necessitating multiple blood transfusions. Her coagulation profile confirmed the diagnosis of Von Willebrand disease. The menorrhagia was controlled by cyclical use of oestrogen progestogen combination drugs. The important clinical implication of this case is that the patient with adolescent menorrhagia may have an underlying coagulation disorder, which can successfully be managed by hormones.

Adolescent↗

Incarcerated procidentia: a rare complication of carcinoma cervix.

A rare case of a huge carcinoma of the cervix leading to sudden uterovaginal prolapse and incarcerated procidentia, in a postmenopausal woman is presented. The woman presented as an emergency with severe distress. The problem was successfully managed by reducing the uterovaginal prolapse under deep sedation and starting radiotherapy as an emergency procedure at the same sitting. The role of immediate radiotherapy in the management of such an emergency situation is discussed.

Carcinoma, Squamous Cell↗

Microcolpohysteroscopy compared with colposcopy in evaluation of abnormal cervical cytology.

Microcolpohysteroscopy (MCH) permits in vivo visualisation of cervical epithelium and is a useful procedure in the diagnostic workup of a patients with abnormal pap smear. Our study compared standard colposcopy with MCH in 45 patients with dysplasia reported on cytology. On comparing with final histopathological diagnosis colposcopy had an accuracy of 95.6 percent in diagnosing cervical intraepithelial neoplasia (CIN) within one grade. MCH had a diagnostic accuracy of 84.4 percent in predicting CIN changes. Further MCH was able to evaluate the endocervical squamocolumner junction in all cases of unsatisfactory colposcopy. Microcolpohysteroscopy is a useful adjunct to colposcopy and is also of value in locating the epicenter of lesions and is diagnosing HPV infection. MCH prior to conisation is of value in tailoring the biopsy to fully include the CIN lesion.

Adult↗

Maternal and perinatal outcome in thyrotoxicosis complicating pregnancy.

In this report we describe 32 pregnancies complicated by hyperthyroidism cared for over a 7-year period at AIIMS, New Delhi. In 6 cases hyperthyroidism was diagnosed during pregnancy; others were diagnosed before conception and were on antithyroid therapy during pregnancy. For control of thyrotoxicosis thiourea derivatives, carbimazole (CMZ) and propylthiouracil (PTU), were both used. The dosage of antithyroid drugs could be decreased or stopped in the third trimester in only 28% cases, while 50% cases did not require any change in the dosage during gestation and 21% required an increase in dosage with advancing gestation to control thyrotoxicosis. Maternal and fetal complications included preterm labour (25%), PIH (22%), thyroid crisis (9%) and intrauterine growth retardation (13%). Thyroid status of neonates was found abnormal in 9% cases, including 1 case (3%) of neonatal thyrotoxicosis with goitre and 2 (6%) cases of neonatal hypothyroidism. One maternal death occurred due to thyroid storm. No case of stillbirth or perinatal death occurred in the present study. In our experience of 32 cases maternal and fetal complications are reported with increased frequency, requiring close surveillance of thyroid status to maintain euthyroidism and intensive fetal monitoring during pregnancy to achieve good maternal and perinatal outcome.

Adult↗

'Forgotten' intrauterine device leading to actinomycotic pyometra--13 years after menopause.

A case of a 'forgotten' intrauterine device (IUD) in a postmenopausal woman leading to Actinomyces israelii infection and pyometra is described. The patient was asymptomatic for 22 years after IUD insertion and developed the complications 13 years after menopause. To prevent such serious complications, it is important to ensure that intrauterine devices, once they have served the purpose and even if they are asymptomatic, are removed.

Actinomycosis↗

Chemotherapy followed by radiotherapy versus radiotherapy alone in locally advanced cervical cancer: a randomized study.

Between August 1990 and January 1992, 184 patients with squamous cell carcinoma of the cervix, FIGO stage IIB-IVA, were randomized to receive either two cycles of bleomycin, ifosfamide-mesna, and cis-platinum (BIP) chemotherapy (CT) followed by radiotherapy (RT) ("CT-RT group," n = 94) or RT alone (RT group, n = 90). In the CT-RT group, of 89 evaluable patients, 64 responded: complete response (CR) 4 (4.5%) and partial response 60 (67.5%). Of the remaining 25 patients, 23 had stable disease and 2 progressed. Eighty of 89 patients completed RT as planned. Following RT 56 (70%) achieved CR, 19 (23.7%) had residual disease, and 5 (6.3%) had progressed. CT responders had a better response to RT: 83% (49/59) vs 33.3% (7/21), P < 0.01). The stage of disease, histologic grade, duration of symptoms, and history of smoking had no influence on the response to CT. Patients aged > 45 years and those with Hb > 10 g/dl had significantly better response. Nausea/vomiting, alopecia, grade I-II myelosuppression, diarrhea, and mucositis were the major side effects of CT. Two patients died of CT toxicity. In the RT group, 88 patients were evaluable: 61 (69.3%) patients achieved CR, 25 had residual disease, and 2 progressed. The side effects of RT were cystitis, proctitis, and local skin reaction. These were equally distributed between the two groups. There was no significant difference in overall and disease-free survival in the two groups.

Adult↗

Results of radical radiotherapy in carcinoma of the uterine cervix stage I-III.

A retrospective analysis is described of 271 diagnosed cases of carcinoma of the uterine cervix who were treated with radical radiotherapy between January 1987 and July 1988 at the Institute Rotary Cancer Hospital. The mean age at presentation was 49 years and 89% of the tumours were FIGO Stage II and III. The median duration of follow-up was 60 months. The early cases were treated with two intracavitary insertions of 34 Gy each to point A with a Selectron LDR intracavitary system, followed by 36 Gy external radiotherapy to the parametrium. Late stage disease was treated with 50 Gy of external radiotherapy, followed by a single intracavitary insertion of 30 Gy to point A. To compensate for the higher dose rate of the Selectron (180 cGy/h) a dose reduction factor of 15% was applied over the intracavitary dose. There were 2.5% and 4.7% of late Grade III bladder and bowel complications, respectively, requiring surgical intervention. There was no relationship between haemoglobin level at diagnosis and the development of late complications. The actuarial 5-year survivals were 65%, 63% and 35% for Stages I, II and III disease, respectively. This study from the Indian subcontinent shows the effectiveness of radiotherapy in Stages I, II and III carcinoma of the uterine cervix, with acceptable morbidity rates.

Actuarial Analysis↗