Fertility and Pregnancy Outcome after Myoma Enucleation by Minilaparotomy under Microsurgical Conditions in Pronounced Uterus Myomatosus

Introduction: Besides the typical complaints and symptoms, myomas can cause sterility, infertility and complications during pregnancy. Laparoscopic interventions reach their limits with regard to organ preservation and the simultaneous desire to have children in the removal of multiple and larger intramural myoma nodes. The aim of this study is to examine fertility status and pregnancy outcome after myoma removal by minilaparotomy (skin incision maximal 8 cm) in women with pronounced uterus myomatosus. Materials and Methods: This retrospective study makes use of the data from 160 patients with an average age of 34.6 years. Factors analysed include number, size and localisation of the myomas, complaints due to the myoma, pre- and postoperative gravidity, mode of delivery, and complications of birth. Results: Indications for organ-sparing myoma enucleation were the desire to have children (72.5 %), bleeding disorders (60 %) and pressure discomfort (36.5 %). On average 4.95 (SD ± 0.41), maximally 46 myomas were removed. The largest myoma had a diameter of 6.64 cm (SD ± 2.74). 82.5 % of the patients had transmural myomas, in 17.5 % the uterine cavity was inadvertently opened. On average the operating time was 163 minutes (SD ± 45.47), the blood loss 1.59 g/dL (SD ± 0.955). 60.3 % of the patients with the desire to have children became pregnant postoperatively. 75.3 % of the pregnancies were on average carried through to the 38th week (28.4 % vaginal deliveries, 71.6 % Caesarean sections). In the postoperative period there was one case of uterine rupture in the vicinity of a previous scar. Discussion: By means of the microsurgical "mini-laparotomy" even extensive myomatous uterine changes can, in the majority of cases, be operated in an organ-sparing manner with retention of the ability to conceive and to carry a pregnancy through to maturity of the infant. The risk for a postoperative uterine rupture in a subsequent pregnancy and during delivery is minimal.

Attitude toward, acceptance of and knowledge about female sterilization as a method of contraception

OBJECTIVE

Surgical sterilization via tubal ligation or the disconnection of the tubes is a method of permanent contraception. The aim of this study was to evaluate the attitude, acceptance and knowledge of women about female sterilization as a method of contraception in terms of the social and cultural backgrounds of those women.

STUDY DESIGN

Prospective study based on an anonymous questionnaire that analyzed background knowledge, attitude, influence factors and motivation regarding sterilization, as well as the reasons for declining. The questionnaire also attempted to evaluate the effects on the self-esteem of the women, as well as the impact of religious dogma and the related beliefs.

RESULTS

One thousand, eight hundred questionnaires were distributed, and 1247 women completed the questionnaire—a response rate of 69.3%. There were mainly positive attitudes toward sterilization as a contraceptive method. Cultural background, including religion and faith; the mother's experiences and point of view; knowledge; family planning and the actual life situation have an influence on the attitudes toward and acceptance of sterilization as a contraceptive method and on the final choice of a contraceptive method.

CONCLUSION

Cultural background and present life situation have a great impact on the attitude toward and acceptance of sterilization as a method of contraception, thus influencing the final choice of a contraceptive method. Detailed counselling about this topic is essential and should be improved.

Cluster spin glass behavior in geometrically frustrated Zn3V3O8

We report the bulk magnetic properties of a yet unexplored vanadium-based multi-valenced spinel system, Zn3V3O8. A Curie-Weiss fit of our dc magnetic susceptibility χ(T) data in the temperature region of 140-300 K yields a Curie constant C = 0.75 cm(3)K mole(-1) V(-1), θCW = -370 K. We have observed a splitting between the zero field cooled (ZFC) and field cooled (FC) susceptibility curves below a temperature Tirr of about 6.3 K. The value of the 'frustration parameter' (|θcw|/T(N) ~ 100) suggests that the system is strongly frustrated. From the ac susceptibility measurements we find a logarithmic variation of freezing temperature (Tf) with frequency ν attesting to the formation of a spin glass below Tf. However, the value of the characteristic frequency obtained from the Vogel-Fulcher fit suggests that the ground state is closer to a cluster glass rather than a conventional spin glass. We explored further consequences of the spin glass behavior and observed aging phenomena and memory effect (both in ZFC and FC). We found that a positive temperature cycle erases the memory, as predicted by the hierarchical model. From the heat capacity CP data, a hump-like anomaly was observed in CP/T at about 3.75 K. Below this temperature the magnetic heat capacity shows a nearly linear dependence with T which is consistent with the formation of a spin glass state below Tf in Zn(3)V(3)O(8).

Stereotactic body radiotherapy in early stage non-small cell lung cancer: first experience from an Indian Centre

BACKGROUND

Surgery is the standard of care for early stage (T1-2, N0, M0) non-small cell lung cancer. A considerable number of these patients are ineligible for surgery due to age and comorbidities. Hypo fractionated high-dose stereotactic body radiotherapy (SBRT) is being performed for these group of patients. There is paucity of literature regarding this novel technique from the Indian subcontinent.

AIMS AND OBJECTIVES

We hereby report the dosimetry, response and outcome of our small cohort of early stage non-small cell lung cancer patients treated with SBRT.

MATERIALS AND METHODS

Between December 2007 and December 2010, 8 patients of early stage (T1-2N0M0) underwent SBRT at our centre. All the patients had undergone whole body PET-CT scan, MRI brain and pulmonary function test (PFT with DLCO). The SBRT schedules included 48 Gy in 6 fractions for peripherally located and 48 Gy in 8 fractions for centrally located tumors. Response and toxicity were assessed in 3 monthly follow up visits.

RESULTS

The median duration of follow up was 18 months (range 8-44 months). The median age of the patients was 70 years (range 63-82 years) and the median tumor diameter was 4 cm (range 2.8-5.0 cm). The mean PTV volume was 165 cc(range 127.3- 193.9 cc). The mean dose to the PTV was 99.5% (range 97.7- 102.1%). After 3 months, 7 patients had complete metabolic response and 1 patient had partial metabolic response. Overall survival at 1.5 years was 87.5%. One patient had grade 2 pneumonitis. No toxicities of grade 3 or higher were identified.

CONCLUSION

SBRT for early stage NSCLC resulted in excellent local control with minimal toxicity and can be considered as a treatment option in properly selected patients.

Association of dietary factors and other coronary risk factors with social class in women in five Indian cities

The association between social classes, food intake and coronary risk factors was determined. Cross-sectional surveys were conducted in 6-12 urban streets in each of five cities, each one from five different regions of India using similar methods of dietary intakes and criteria of diagnosis. We randomly selected 3257 women aged 25-64 years inclusive, from Moradabad (n = 902), Trivandrum (n = 760), Calcutta (n = 410), Nagpur (n = 405) and Bombay (n = 780). All subjects, after pooling of data, were divided into social class 1 (n = 985), class 2 (n = 790), class 3 (n = 774), class 4 (n = 602) and class 5 (n = 206) based on various attributes of socioeconomic status. Social class 1 was the highest and 5 was the lowest social class. Social classes 1-3 had greater intake of pro-atherogenic foods; total visible fat, milk and milk products, meat and eggs, as well as sugar and confectionery, compared to social classes 4 and 5. The consumption of wheat, rice, millets, fruits, vegetables and legume/total visible fat ratio were inversely associated with social class. Mean body mass index (BMI), obesity, overweight, central obesity and sedentary lifestyle were also significantly more common among subjects from higher social classes. Spearman's rank correlation showed that bodyweight, BMI, wheat, rice, millets, total visible fat, milk and milk products, meat, eggs, sugar and jaggery intakes were significantly correlated with social class. Social class 5 subjects had a lower intake of all foods and a lower BMI, suggestive of a higher rate of undernutrition among them. The findings indicate that the consumption of pro-atherogenic foods and other coronary risk factors are more common in higher social classes compared to lower social classes.

TIMP-2 mutant decreases MMP-2 activity and augments pressure overload induced LV dysfunction and heart failure

Pressure overload induces cardiac extracellular matrix (ECM) remodelling and results in heart failure. ECM remodelling by matrix metalloproteinases (MMPs) is primarily regulated by their target inhibitors, tissue inhibitor of matrix metalloproteinases (TIMPs). It is known that TIMP-2 is highly expressed in myocardium and is required for cell surface activation of pro-MMP-2. We and others have reported that imbalance between angiogenic growth factors and anti-angiogenic factors results in transition from compensatory cardiac hypertrophy to heart failure. We previously reported the pro-angiogenic role of MMP-2 in cardiac compensation, however, the specific role of TIMP-2 during pressure overload is yet unclear. We hypothesize that genetic ablation of TIMP-2 exacerbates the adverse cardiac matrix remodelling due to lack of pro-angiogenic MMP-2 and increase in anti-angiogenic factors during pressure overload stress and results in severe heart failure. To verify this, ascending aortic banding (AB) was created to mimic pressure overload, in wild type C57BL6/J and TIMP-2-/- (model of MMP-2 deficiency) mice. Left ventricular (LV) function assessed by echocardiography and pressure-volume loop studies showed severe LV dysfunction in TIMP-2-/- AB mice compared to controls. Expression of MMP-2, vascular endothelial growth factor (VEGF) was decreased and expression of MMP-9, anti-angiogenic factors endostatin and angiostatin was increased in TIMP-2-/- AB mice compared with wild type AB mice. Connexins (Cx) are the gap junction proteins that are widely present in the myocardium and play an important role in endothelial-myocyte coupling. Our results showed that expression of Cx 37 and 43 was decreased in TIMP-2-/- AB mice compared with corresponding wild type controls. These results suggest that genetic ablation of TIMP-2 decrease the expression of pro-angiogenic MMP-2, VEGF and increases anti-angiogenic factors that results in exacerbated abnormal ventricular remodelling leading to severe heart failure.

A Griffiths-like phase in antiferromagnetic R0.5Eu0.5MnO3 (R = Pr, Nd, Sm)

We report a Griffiths-like phase in isovalent doped rare-earth manganites R(0.5)Eu(0.5)MnO(3) (R = Pr, Nd, Sm). Rietveld refinement of the structural data reveals strong orthorhombic and Jahn-Teller distortions. The dc and ac magnetic studies nicely demonstrate aspects of Griffiths phase-like behaviour. The presence of short range ferromagnetically correlated spin clusters is observed above the antiferromagnetic transition temperature. A disorder driven phase inhomogeneity arising from strong structural distortion is the possible origin of this behaviour.

Superparamagnetic state by linear and non-linear AC magnetic susceptibility in Mn0.5Zn0.5Fe2O4 ferrites nanoparticles

The Mn0.5Zn0.5Fe2O4 nanoparticles has been synthesized using citrate-gel-precursor method. The direct mixing of nitrates and acetates yields homogeneous nanoparticles. Phase formation and crystal structure of the synthesized powder were examined through the X-ray diffraction (XRD). Fourier transform infrared (FTIR) spectra of the sample confirm the spinel structure. The average particle size was determined by transmission electron microscopy (TEM) and field emission scanning electron microscopy (FESEM). The average particle size is found to be about 13 nm. Superparamagnetic-like nature of the nanoparticles of Mn0.5Zn0.5Fe2O4 has been revealed through various dc and linear and non-linear ac magnetization measurements. However, the nanoparticles do not behave like ideal non-interacting superparamagnets. The magnetic particle size is found to be about 8 nm with saturation magnetization about 18.1 emu/g. The blocking temperature (T(B)) of the nanoparticle assembly is found to be about 150 K as observed from dc and ac magnetization measurements. The frequency dependence of the blocking temperature (T(B)) is found to follow Vogel-Fulcher law. The associated characteristic time tau0 is found to be 10(-5) s. This value is different from that generally found for non-interacting superparamagnetic (SPM) systems (tau0 = 10(-9)-10(-10) s).

Comparison study of clinicoradiological profile of primary lung cancer cases: an Eastern India experience

CONTEXT

According to the first population-based cancer registry from eastern part of India, Kolkata and its surrounding areas have the highest prevalence of lung cancer in India. However, there is very limited data from this part of the country.

AIMS

The aim of this study is to find out the demographic and clinicoradiological profile of primary bronchogenic carcinoma.

SETTINGS AND DESIGN

This is a retrospective review of lung cancer cases diagnosed in two tertiary institutes of Kolkata over a period of 4 years.

MATERIALS AND METHODS

We have reviewed the cases with proven histological or cytological diagnosis of primary bronchogenic carcinoma and chi-square test is done to calculate statistical significance.

RESULTS

Out of 607 patients, male 489 and female 118, 67.7% are from rural area, 67.2% are smoker and only 9.4% are ≤40 years of age. Smoking is the major risk factor for primary lung cancer (P = 0.000) but no significance could be established with the different histological subtypes (P = 0.207). Though squamous cell carcinoma (SCC) is the most predominant variety (35.1%), adenocarcinoma and undifferentiated type are overrepresented in ≤40 years. SCC occurs at a significantly higher age group (60.84 ± 12.16 years) than other subtypes (P = 0.000). At least 55.2% cases of nonsmall cell lung cancer and 54% of small cell lung cancer presented in very advanced stage.

CONCLUSIONS

SCC is the most common histological subtype of primary bronchogenic carcinoma. The relatively increased frequency of adenocarcinoma in our study as compared to other studies from India is probably due to higher proportion of nonsmokers.