Laparoscopic evaluation of pelvic organ in case of subfertility

Background: Globally subfertility affects 10-15% of couple. All these people need proper evaluation and treatment. Now a days laparoscopy considered as a gold standard procedure for evaluation of pelvic organ. The aim of this study was to find out the different causes of female factor infertility with the help of laparoscopy.Methods: This retrospective study was conducted in infertility clinic of BIRDEM hospital, Dhaka, Bangladesh during the period of May, 2007 to October 2007. The study group comprised 100 cases of infertile patients.Results: In this study, among 100 patients 68% had primary and 32% had secondary infertility. In laparoscopy majority (55.0%) had normal ovary, 20.0% had cystic change with thick capsule in right ovary and 22% had in left ovary, 7.0% had endometriosis, 8.0% had adhesion, 10.0% had simple cyst in right ovary and 8% had in left ovary and rest could not be visualized. 79.4% right and 77.9% left fallopian tube patent in primary subfertility cases and 56.3% right and 59.4% left tube normal in secondary subfertility cases. Both fallopian tube patent in 62%, unilateral block 21% and bilateral block in 17% cases in this study peritoneum was normal in 78% cases, 8% cases there was endometriosis and 14% cases there was adhesion of fallopian tube with the ovary, adhesion of uterus with intestine and also with bladder.Conclusions: Laparoscopy is an important tool for diagnosing anatomical and pathological abnormalities of pelvic organ which has a major role in subfertility management.

SINGLE NEEDLE THORACIC PARAVERTEBRAL BLOCK AS AN ALTERNATIVE TO GENERAL ANESTHESIA FOR MODIFIED RADICAL MASTECTOMY OPERATION : A RANDOMISED CONTROL STUDY

Background and Aims: Conventionally, surgery for breast carcinoma is done under general anaesthesia (GA). Recently thoracic paravertebral block (TPVB) is gaining popularity because it produces unilateral block and minimal haemodynamic changes. It also facilitates post-op analgesia, early ambulation, and reduces hospital stay. Aim was to observe effectiveness of single needle TPVB with bupivacaine as the sole anaesthetic technique for Modied radical mastectomy (MRM). Methods: 60 consenting female patients of ASA I & II, aged 18-60 years scheduled for modied radical mastectomy were randomly assigned into two groups: Gr. P (n=30), Gr. G(n=30). For Gr. P: TPVB was given at T4 vertebral level with 18G Tuohy needle and an epidural catheter inserted 2- 3cm inside the paravertebral space. Bupivacaine 0.5% isobaric 15-20ml (not exceeding 2 mg/kg b.w.) injected through the epidural catheter. Dexmedetomidine infusion given for sedation. Gr. G: GA was given with Midazolam, Fentanyl, Propofol and Atracurium. Measured parameters were baseline and intraoperative haemodynamics , induction time, recovery time, fentanyl requirement, average blood loss, post-op pain score by VAS at 0,1/2,1,2,4,8,12,24hrs, duration of analgesia, patient and surgeon satisfaction scores(PSS,SSS),and incidence of post-op nausea vomiting(PONV). RESULTS: Group P patients had prolonged induction ( ) and recovery was faster ( ) in comparison to 12.25±3.66 1.61±0.69 group G. Intraoperatively Group P patients required less Fentanyl & also had less blood loss. Post op VAS score, incidence of PONV were more in group G. Conclusion: TPVB may be used as an alternate anaesthetic technique for MRM as it provides adequate analgesia both in intra and post op period with minimal adverse effects.

Clinical Spectrum of Infertile Couple: a Retrospective Study at Teaching Hospital

Introduction: Infertility has been rising steeply as the prime health issue among women around the world these days. This study aims to investigate the causes, hormonal profi le, and clinical spectrum of infertility.Materials and Methods: This is a descriptive cross-sectional study conducted throughout a one year duration in an infertility clinic. The couples meeting the inclusion criteria were included and a pre-formed proforma was used to collect the data regarding history, examination, and investigations.Results: A total of 118 infertile couples were analyzed. The mean age of the females was 28.3±4.5 years. There were 72.1 %cases of primary infertility and 27.9 %of secondary infertility. Regarding obesity status,35.5% were overweight and 15.2 % were obese. Thirty-one (26.2%) males were smokers, 41 (34.7%) used to consume alcohol, and 14 (11.8%) had a habit of chewing tobacco. Among the different fi ndings of semen analysis, 21.1% asthenozoospermia, 9.3% oligoasthenozospermia,7.6% oligospermia, 1.6% azoospermia. Female factor accounted for 45.3%, the malefactor for 28% and in 19.3% the defi nite factor was not determined. The ovulatory disorder was diagnosed in 38.6% of females and hysterosalpingography (HSG) revealed that around 10% had a unilateral block and 1.7% had a bilateral block.Conclusions: Infertility is becoming a global issue affecting a signifi cant number of young couples. About forty-six percent were female aging more than thirty years. The female factor for infertility was more common than the male factor among which ovulatory disorder was the commonest one. Asthenozoospermiawas the commonest abnormal fi nding on semen analysis in a male partner.

Comparative study of tubal patency by sonosalpingogram hysterosalpingography and diagnostic laparoscopy

Background: Sonosalpingography has been suggested as the first-line method to study tubal patency. This study is to bring into focus the value of pelvic sonogram in accessing tubal patency in order to overcome the radiation hazard associated with hysterosalpingogram reduce the cost of examination and encourage it at first-line office. Objective of this study was to compare the diagnostic efficacy of sonosalpingogram, hysterosalpingography and diagnostic laparoscopy for tubal patency as a cause for female infertility.Methods: It is a prospective study in 100 patients attending for evaluation of infertility for a period of 2 years were chosen for this study. All cases with primary and secondary infertility who have attended infertility clinic for tubal causes.Results: 68 cases were found to have bilateral patency as per SSG while 58 cases had bilateral patency as HSG. Similarly 24 cases had bilateral block as per SSG while 28 cases had bilateral block as per HSG. 8 cases had unilateral block as per SSG while 14 cases had unilateral block as per HSG. This difference in observations may probably attribute to tubal spasm in HSG. Bilateral patency was observed in 68 cases as against 64 cases in laparoscopy. Out of these 68 cases 9 cases were false positive as bilaterally patent. However bilateral blocks were shown to be 24 in both methods. Out of 12 cases of unilateral block as per laparoscopy 8 cases were detected by SSG. There was false negative rate of 5%. There was false negative rate of 10% for tubal patency with HSG.Conclusions: For low risk subjects for tubal factors in infertility, sonosalpingogram can be employed as a screening test of choice and for high risk subjects HSG and laparoscopy can be used.

Repeated Epidural Anesthesia and Incidence of Unilateral Epidural Block

Background: Epidural block is today the most common method of pain relief during labor. Nowadays, facing a multiparus parturient requiring epidural for the second or third time is common due to increased frequency of using epidural analgesia during labor. Objectives: Examination of the performance and outcome of women receiving their first versus repeated epidural block. Methods: The study included 140 American Society of Anesthesiologists (ASA) Physical Status II parturients (age range 20 to 40 years) and scheduled for normal vaginal delivery. The parturients were divided randomly into two equal groups. Group (A) in which 70 women primipara subjected to their first epidural block, while group (B) in which 70 women multipara subjected to their repeated epidural block. Our primary outcome of the study is the incidence of a unilateral block and secondary outcomes include Visual Analogue Scale (VAS) before the epidural and 30 minutes after injection of local anesthetic and details of labor as gestation and cervical dilatation. Results: The results showed that there was a statistically significant decrease in the incidence of a unilateral block in the group (A) when compared to the corresponding values in the group (B) (P-value < 0.05). Moreover, group (A) showed a statistically significant decrease in Visual Analogue Scale (VAS) values 30 minutes after the injection of local anesthetic (P-value < 0.05). Conclusion: The conclusion of our study is that there is a higher incidence of unilateral block amongst women receiving their repeated epidurals for labour than those receiving their first epidural block.

Endoscopic approach to the frontal sinus with modified Lothrop technique. Outcomes in a large Argentinean center

Objectives: To determine the permeability of the frontal drainage obtained by the modified Lothrop surgical technique. Study design: Descriptive and retrospective. Methods: Patients treated with modified Lothrop technique to widening the frontal recess drainage pathway which was obstructed by inflammatory or tumor diseases in the Rhinology section of the Hospital Italiano in Buenos Aires were included between April 2011 and December 2017. Patients with minor permeabilizations were excluded (Draf I-II). Results: 16 patients were treated, 7 women and 9 men, the youngest was 24 and the oldest 90. The average age was 56 years. The etiologies of diseases affecting the frontal sinus were allergic fungal sinusitis (2/16), recurred frontal mucocele with a history of Draf 2 (3/16), recurred frontal mucocele to external surgery with obliteration (1/16), frontal mucocele, nasal polyposis and cystic fibrosis (1/16), previous frontal sinusitis surgery (4/16), frontal mucopioceles (2/16) and malignant tumors originating in the ethmoid and frontal sinus (3/16). An unilateral block drainage of the frontal by mucosal hyperplasia was diagnosed in a patient, caused by her allergic fungal rhinosinusitis 5 years after Lothrop surgery. Moreover the patient was operated again by transnasal approach permeabilizing the frontal sinus. Another patient had a total obstruction of the frontal drainage and was successfully repeated with the same surgical technique. The other patients had permeable frontal drainage and were asymptomatic during the average follow-up of 3.5years. Conclusion: The obtained permeability of the frontal sinus drainage with Lothrop modified technique was 87.50% (14/16). With rescue endonasal assisted surgery, frontal sinus patency was 100%.

Laparoscopic findings of infertile women at Bangabandhu Sheikh Mujib Medical University

<p><strong>Background:</strong> Laparoscopy is an important component of infertility work up. It is the gold standard for evaluation of pelvic pathology and assessment of tubal patency.<strong> Objective:</strong> The objective of the study was to analyze the laparoscopic findings of infertile women presenting at Infertlity unit of Bangabandhu Sheikh Mujib Medical University. <strong>Method:</strong> We had a retrospective cross-sectional study on Japaroscopic findings of 110 women. <strong>Results:</strong> Out of all patients 22.7% women had endometriosis. Various degrees of adhesion of pouch of Douglus was present in 16.4 %. Regarding tubal pate:1cy , 26.4% had unilateral block and 28.2% had bilateral block.<strong> Conclusion:</strong> A significant number of infertile women at the Infertility unit of BSMMU has tuboperitoneal disease and bilateral tubal block and ultimately need in vitro fertilization.</p>

Laparoscopic Evaluation of Tubal Factors in Case of Patients With Sub Fertility

In this prospective study was carried out in the department of Obstetrics and Gynaecology (infertility) Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during the period of September 2010 to February 2011. For this purpose total number of 80 female partner of subfertile couples undergoing laparoscopy in the above centre. Patients have been evaluated in the infertililty out patient department with the detailed history of both husband and wife and also evaluated clinically. Patient suffering from both primary and secondary subfertility have been included in this study with the inclusion criteria women age 20-40 years. Male partners having normal semen analysis. Female partner tried unsuccessfully for 1 year and female partner having any pelvic pathology suggest by history and physical examination. They are selected for the diagnostic laparoscopy. Laparoscopy findings will be carefully recorded and showing in primary subfertility normal looking 30 (55.5%), peritubal adhesion 8(14.8%), signs of endometriosis 10 (18.5%), hydrosalphinx 6(11.1%) and in secondary subfertility normal looking 10(38.5%), peritubal adhesion 4(15.4%), signs of endometriosis 4(15.4%), hydrosalphinx 8(30.8%). In this study normal looking fallopian tube is more common in primary subfertility and hydrosalphinx is more common in secondary subfertility. Laparoscopic evaluation of fallopian tube among the patient with primary subfertility showing the condition of the fimbria normal looking 50 (92.6%), indrowing 2(3.7%), not visualized fimbria 2(3.7%) and in secondary subfertility normal looking 18(69.2%), indrowing 6 (23.1%), not visualized fimbria 2(7.7%). Fimbria normal looking more in primary subfertility and indrawing more in secondary subfertility. In peritubal adhesion 34pt among them 30(88.2%) are dye test negative. In endometriosis 30 patients among them 12(40%) are dye test negative. In pulmonary TB, salphingitis and ectopic pregnancy (100%) are dye test negative. In tubal patency test of the study patients were observed in case of primary and secondary subfertility. In primary subfertility both tube patent 24(44.4%), unilateral block 20(37%) and bilateral block 10 (18.5%) and in secondary subfertility both tube patent 12 (46.2%), unilateral block 8 (30.8%), bilateral block 6 (23.1%). Bilateral block more in secondary subfertility. No difference in case of both tube patent. JCMCTA 2012; 23(1): 17-20

UNILATERAL SPINAL ANAESTHESIA

Objectives: To see the effects of adding pethidine to intrathecal bupivacaine on duration of post operative analgesia inpatients undergoing hip surgery. Design: A randomized placebo controlled observational study. Setting C M H Multan: Period: From March2006 to April 2007. Patient and Methods: A total of 90 male patients of age 60-75 years of comparable weight and height and ASAstatus II, III were selected. Patients were divided into two groups, group A and group B. Each group consisted of 45 patients. All patients wereassessed pre operatively a day before surgery and were briefed about the procedure. Results: All the patients were prepared before givingspinal anaesthesia. Patients in Group- A were given a mixture 01 ml of 0.75 bupivacaine and 0.2 ml of normal saline in lateral decubitus positionwith operating side down by using 23 G spinal needle. Patients in Group-B were given a mixture of 01 ml of 0.75 % bupivacaine and 0.2 mlof inj. pethidine 10mg in lateral decubitus position with operating side down by using 23 G spinal needle. All the patients were kept in lateraldecubitus position for 10 minutes to achieve unilateral block. Intra operative adverse effects like hypotension, nausea, vomiting, pruritis anddelayed respiratory depression and effective duration of post operative analgesia was recorded. Conclusion Addition of 10 mg pethidine tointrathecal hyperbaric bupivacaine is associated with prolonged postoperative analgesia and minimal side effects like hypotension, pruritis, anddelayed respiratory depression. However incidence of nausea and vomiting was much more