Background: Cholelithiasis (gall stone disease) is a well-known disease worldwide. Ultrasonography is the most common screening test for cholecystitis and cholelithiasis. Laparoscopic Cholecystectomy is considered the treatment of choice for symptomatic gall stone disease. It is important to know the different clinical, radiological parameter and specific predictor that give some prediction of difficult LC. The aim of this study was to predict the difficulty of LC and the possibility of conversion to OC before surgery using the clinical and ultrasonographic criteria in our set up.Methods: The present study was carried out in the Department of surgery, Sarojini Naidu Medical College Agra, from November 2014 to October 2016. A total of 210 patients were enrolled for the laparoscopic cholecystectomy. All patients who were included in the study were undergone detailed history and clinical examination. A number of clinical and ultrasonographical parameters were noted.Results: Amongst the 210 patients admitted for laparoscopic cholecystectomy, 21 (10%) were male and 189 (90%) female, with age ranging from 12–60 years. The conversion rate in our study was 4.5% (9 of 210). In our study significant pre-operative factors which increased the conversion rate to open cholecystectomy includes male gender, obesity, abdominal scar of previous surgery, contracted and thickened gall bladder and patients having stone impacted at the neck of gall bladder.Conclusions: From this study, we conclude that preoperative ultrasonography is a good predictor of difficult laparoscopic cholecystectomy in the majority of cases and should be used as a screening procedure.
Objective- Endometrial thickness <7 mm accepted as a reliable sign of suboptimal implantation potential. Clomiphene citrate (CC) has some negative effects on the endometrium. We evaluated the effect of concomitant administration of oral sildenal and estradiol valerate on endometrial thickness Aim- To compare the combined effect of oral sildenal and estradiol valerate to estradiol valerate alone in patients with clomiphene induced cycles in infertile women on endometrial thickness. Material And Method- This randomized study was conducted on infertile women attending infertility OPD in SN Medical College, Agra over a period of 2 years from January 2019 to December 2020. Infertile patients were randomly divided into two equal groups. In control group, 50 patients were given clomiphene citrate 50 mg daily from D2 to D6 along with estradiol valerate 2 mg thrice daily from 2nd day of the cycle till the day of trigger of ovulation. In study group, 50 patients were given clomiphene citrate 50 mg daily from D2 to D6 along with estradiol valerate 2mg 12 thrice daily plus oral sildenal citrate 25mg every 8 h from 2nd day of the cycle till the day of hCG trigger. Results- The results in this study conrm the superiority of using oral sildenal with estradiol for improving endometrial thickness, vascularity and pregnancy rates. Conclusion- Addition of oral sildenal citrate to estradiol valerate in ovulation induction cycles has better results in improving endometrial thickness, endometrial blood ow and pregnancy outcome as compared to estradiol valerate alone in women with anovulatory infertility
A 25 years old women presented in labour room with 30 weeks’ pregnancy in labour with breech with previous two caesarean section and scar tenderness with foetal bradycardia (FHR 90) and jaundice. After caesarean section in emergency hour she started bleeding in abdominal drain while uterus was well contracted. On investigation and examination diagnosed as HELLP syndrome, managed promptly by medical teams of three departments (obstetrician, anaesthesia and medicine).
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