Introduction: Non-descent vaginal hysterectomy has been considered a valid alternative to the abdominal approach and is also preferred for benign uterine diseases without descent of uterus because it is associated with fewer complications. Vaginal vault is the enlargement of the internal end of the vagina which is usually closed during vaginal hysterectomy. This study was done to see the outcome of vault closure versus non-closure in non-descent vaginal hysterectomy in non-prolapsed uterus. Methods: This prospective study was done in Obstetrics and Gynae Department, Sir Salimullah Medical College and Mitford Hospital during the period of July 2011 to December 2011. A total number of 50 patients with benign gynecological disorders without descent of uterus who admitted for hysterectomy were enrolled in this study. Among them, 25 patients had the vault close (group I) whereas 25 patients had an open vault(group11). Indication for hysterectomy, complications, blood transfusion, hospital stay (day) and histopathological findings were assessed for both groups. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-20). Results: Majority of the patients was found in the age group of 41-45 years in both groups, which was 12(48.0%) in Group I and 18(72.0%) patients in Group II. Blood transfusion was needed in 5(20.0%) and in 6(24.0%) in Group I and Group II respectively. Post operative complications after 15 days of follow-up, pelvic abscess was found 4.0% in Group I & not found in Group II. UTI was not found in Group I but 4.0% found in Group II. Conclusion: Outcomes were almost similar in both procedure. Ultimately the study did not show any significant difference between either group. J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 45-49
Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting between 4% and 8% of reproductive aged women. Although the symptoms and signs of PCOS are very heterogeneous, the syndrome usually presents with any combination of the following, menstrual irregularities (usually oligomenorrhea or amenorrhea), signs of hyperandrogenism (hirsutism, acne, alopecia) a characteristic appearance of the ovaries on ultrasound examination and an endocrine disturbance often involving high serum concentrations of LH and androgens. There is a well established association between PCOS, insulin resistance and hyperinsulinemia. Insulin resistance is a pivotal defect in PCOS probably counts as one of the most important advances in the battle to control the disorder. This metabolic abnormality leads to a compensatory increase in circulating insulin and this elevated insulin level directly stimulates the ovary to produce excess androgens. It also decreases hepatic sex hormone binding globulin (SHBG), so increasing biologically available free testosterone concentration in the circulation. This metabolic derangement leads to oligomenorrhea and anovulation. Different insulin sensitizers are used to revert the hyperinsulinemic condition. Metformin is top of them, which proved to enhance ovulation in insulin resistant PCOS when used with different ovulation inducing agents. Metformin reduces insulin resistance of peripheral tissue and allows muscle and adipose cells to take in glucose at normal insulin levels. It inhibits hepatic glucose production, decreases intestinal absorption and promotes glucose uptake, utilization by peripheral tissues at the postreceptor level. In this way it reduces insulin level and subsequently androgen level. It is easily available, safe and no teratogenic or adverse fetal outcome were reported by any researcher. It can be used safely in clomiphene resistant PCOS patients.
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