This study was conducted at the Forensic Medicine Department of Dhaka Medical College covering an eight year period from 1st Jan 2002 to 31st Dec 2009. The objective of the study was to find out the number of deaths due to Road Traffic Accidents (RTA) over an eight year period. The autopsy reports of the year 2002 to 2009 were analyzed and the deaths due to road traffic accidents were counted and tabulated year wise. The study revealed that the number of deaths due to RTA were 1129 in 2002, 1056 in 2003, 952 in 2004, 945 in 2005, 1064 in 2006, 1083 in 2007, 813 in 2008 and 652 in 2009. The total number of autopsy reports from 2002 to 2009 was 23373 out of which the number of deaths due to RTA was 7496 (32.92%). Analysis of the above data showed a declining trend in the number of autopsies on cases of death due to RTA which were brought to the mortuary of the Forensic Medicine Department from Police Stations situated within the metropolitan area of Northern Dhaka during the study period of 2002 to 2009 with minor exception in 2006 and 2007. It is the observation of this study that this decline is significant and points towards certain measures and campaigns taken by the concerned authorities and social groups on mad safety. The objective of this study was to highlight the various reasons for this improvement and suggest further areas of possible improvement whereby the situation could improve significantly in the future.

Ectopic pregnancy (EP) is a dramatic life threatening event in a woman’s reproductive life, especially after a long, expensive and difficult course of treatment for infertility. EP accounts around 1–2% of all natural conceptions, and this prevalence increases following assisted reproductive techniques, to range between 2.1% and 8.6% and it can reach up to 11% in women with tubal factors infertility history. A 32 year old female, primigravida presented at emergency department of Apollo Hospitals, Ahmedabad with complaints of amenorrhoea 2 months, severe pain abdomen associated with vomiting, difficulty in breathing and bleeding per vagina on and off. She was a case of primary infertility with polycystic ovary syndrome (PCOS) who had conceived after difficulty with in vitro fertilization (IVF), resulted in ruptured right tubal ectopic pregnancy. She underwent exploratory laparotomy followed by removal of right ectopic pregnancy, right salpingectomy and peritoneal lavage. Early diagnosis, timely intervention and prompt surgical management could save the patient’s life. Later on she conceived spontaneously and had an eventful and complicated pregnancy. She presented at 35 weeks of pregnancy with preterm labour pain and underwent emergency caesarean section for fetal distress. She delivered a healthy male child and had a successful obstetric outcome. Diagnosis of ruptured tubal ectopic pregnancy is made based on patient’s history, clinical acumen, serum beta human chorionic gonadotropin (hCG) levels and pelvic ultrasound. Ectopic pregnancy should be suspected in patients with an adnexal mass even in absence of risk factors. Clinicians must be alert to the fact that assisted reproductive techniques as a treatment for infertility can result into ectopic pregnancy. This case highlights the fact that patient who underwent IVF treatment resulting in ruptured tubal ectopic pregnancy can have spontaneous conception and a successful obstetric outcome.

Cancer of the vulva is the fourth most common malignancy of the female genital tract. Vulvar carcinoma is a rare and aggressive gynecological malignancy. It affects elderly females, with the mean age at diagnosis being 55-60 years. Regional metastasis to inguinal lymph nodes is common. There is a high incidence of pelvic node involvement, especially in those with pathologically positive inguinal nodes. Surgery appears to be the only curative treatment option in the early stages of the disease. But in most patients, surgery is associated with considerable morbidities and psychosexual issues. Hence, in the quest for a less morbid form of treatment, multimodality approaches with various combinations of surgery, chemotherapy, and radiation therapy have been suggested for advanced vulvar cancers. Due to the low incidence of the disease, the level of evidence for the success of these treatment modalities is poor. Mrs. X, a 54-year-old female, P2L2 A0 presented at Apollo hospitals, Ahmedabad with a giant vulvar tumor of about 8x7 cm in size arising from anterior half of vulva involving clitoris and both labia minora. The vulval growth was initially small and had attained present size in last 15 days. She had complaints of postmenopausal bleeding per vaginum for 8 days, foul smelling discharge and itching vulva on and off for 1 month. Biopsy revealed moderate to well differentiated squamous cell carcinoma (SCC). MRI pelvis with contrast found suspicious lymph node in bilateral iliac vessel region and bilateral inguinal region. She underwent radical vulvectomy with bilateral inguinal lymph node dissection, and bilateral pelvic lymph node dissection. Early diagnosis, timely intervention and prompt surgical management could save the patient’s life. Histopathological report showed well differentiated SCC of vulva with no lymphnodes involvement. Depth of tumor was 12 mm and there was no lymphovascular and perineural invasion. All surgical margins and base of growth were free of tumor. According to TNM stabilization patient had SCC vulva stage IB (T1bN0M0). This patient was disease free after 18 months of follow-up. Vulvar cancer incidence is significantly high in post-menopausal and multiparous women. The most important prognostic factors are tumor stage and lymph node status. Oncological resection should be equated with functional outcome. The multidisciplinary team approach should be sought for this rare gynecological malignancy.

Androgenic alopecia is a patterned hair loss occurring due to systemic androgens and genetic factors. It is the most common cause of hair loss in both genders. The appearance of this condition is the cause of significant stress and psychological problems, making appropriate management important. A 68-year-old postmenopausal female presented with complaints of increased hair loss from scalp, excessive hair growth at undesired sites and hirsutism not corrected with medications. On thorough investigations, CT scan whole abdomen and endocrinological workup, a clinical diagnosis of alopecia and hirsutism due to hyperandrogenemia secondary to ovarian tumor made. Abdominal hysterectomy with B/L salpingo-oophorectomy was done. Histopathological examination revealed an encapsulated tumor in right ovary-sex cord stromal tumor consistent with Leydig cell tumor in right ovary, no evidence of malignancy. Left ovary was normal. Patient showed significant regression of clinical signs and symptoms on follow up after 1 month. All women with severe hirsutism or androgenic alopecia needs further work up to locate the source of androgen over production.

Uterine myomas are being observed in pregnancy more frequently now than in the past, because many women are delaying child bearing till their late thirties, which is the time for the greatest risk of the myoma growth. Traditionally, obstetricians are trained to avoid myomectomies during caesarean sections as severe haemorrhages can occur, which may often necessitate hysterectomies. Pedunculated fibroids which can be easily removed are an exception. A 38-year-old, elderly female, G3 A2, 37 weeks pregnancy with bad obstetric history and multiple fibroids was admitted in Apollo Hospitals, Ahmedabad. She underwent high risk caesarean section followed by myomectomy. Four large and one small fibroid were removed. One posterior wall intramural fibroid 6×5 cm was lower down, hence not removed. Histopathological examination showed leiomyomata with degenerative changes, infarct and calcification. She didn’t have any intraoperative haemorrhage or any postpartum complications. On follow up after 6 weeks, patient was healthy, had no complaints. Caesarean scar was healthy. Ultrasound scan showed normal uterus with one posterior wall intramural fibroid 3×3 cm. With the advent of better anaesthesia, easy availability of blood and blood components, caesarean myomectomy is a safe surgical procedure when performed by experienced obstetrician in carefully selected patients. Intraoperative assessment of fibroids is important in decision making for caesarean myomectomy.