An interesting case of Herlyn-Werner-Wunderlich syndrome

Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare congenital anomaly characterized by uterus didelphys with blind hemivagina and ipsilateral renal agenesis. Usually, such patients present with dysmenorrhea shortly after menarche, increasing pelvic pain and a palpable mass due to the obstructed hemivagina. Interestingly in the present case, the patient had her menarche seven years ago, but dysmenorrhea started only 1-year back. She never sought medical help previously as she was mostly asymptomatic all through the years. It was only after she conceived and got investigated for antenatal concerns that she was found to have HWWS. A tortuous history and an unusual clinical presentation made this case an interesting one.

A comparative study to evaluate oral iron and intravenous iron sucrose for treatment of anemia in pregnancy in a poor socioeconomic region of Northeast India

OBJECTIVE

The prevalence of anemia during pregnancy is as high as 80% in some sections of the Indian population. Iron therapy in different forms has been found to alleviate anemia and yield good fetomaternal outcome. This study aims to evaluate the efficacy of intravenous iron sucrose (IVIS) versus oral iron in treating anemia among the antenatal mothers attending a tertiary care center of Northeast India.

MATERIALS AND METHODS

One hundred women between 18 and 28 weeks of gestation with diagnosed iron-deficiency anemia and hemoglobin (Hb) of 7-10.9 g/dL were enrolled to be administered either oral ferrous sulfate 200 mg twice daily or requisite dose of IVIS 100 mg in 100 ml normal saline on alternate days. Hb and hematocrit were measured at the time of enrollment, 4th week, and 8th week of therapy. Acceptability of both the drugs based on like and dislike after interviewing the study participants was recorded. Adverse drug reactions, gestational age at delivery, and neonatal birth weight were also noted in both the groups. The results were analyzed by Student's t-test and Chi-square test.

RESULTS

Hb and hematocrit values were found to be increased in both the groups at 4th and 8th weeks. When both the groups were compared, the rise in the values was higher in the iron sucrose group (at 4th week P = 0.01 and at 8th week P = 0.00). The number of participants who reached target Hb levels at 4 weeks was 41 (82%) with oral iron and 48 (96%) with iron sucrose. In the iron sucrose group, no adverse effects were observed, suggesting its safety, and the acceptability and newborn birth weight were noted to be higher.

CONCLUSION

IVIS was found to be more effective than oral iron therapy in treating antenatal anemia with no serious adverse drug reactions.

An Unusual Case of Defecation Syncope

Syncope is a common cause for emergency room visitations. The common attributable causes are cardiac or orthostatic factors in a majority of cases; however, situational syncope is a lesser known phenomenon and infrequently described in the literature. Here, we present an unusual case of a 55-year-old woman with recurrent hypotension and bradycardia related to defecation due to an unexpected cause.

Endovascular Management of Radiation-Induced Hemorrhagic Cystitis

Radiation-induced hemorrhagic cystitis (HC) is an unpleasant and sometimes life-threatening complication confronted while treating pelvic malignancies. A wide array of treatment modalities such as bladder irrigation, fulguration, hyperbaric oxygen therapy, and surgical methods has been proposed to treat hematuria, but there is no consensus on the optimal therapeutic strategy for the same. Reported here is a successful superselective embolization of the bilateral vesical arteries in a patient with refractory radiation-induced HC. This technique proved to be effective in controlling intractable hemorrhage and can be considered an option for the treatment of HC not amenable to conventional techniques.

A Sinister Gut Feeling

Women are generally spared from abdominal aortic aneurysm (AAA) formation by the immunomodulating effects of estrogen. However, once they develop it, especially in the postmenopausal group, its behavior is more sinister with rapid expansion, a higher tendency to rupture, and higher mortality as compared to the male counterparts. Reported here is a case of AAA in a postmenopausal woman who came to the outpatient department with low backache, vague abdominal pain, and dysuria which initially gave a picture of pelvic inflammation with urinary tract infection but was later found out to be aortic aneurysm.

An eventful journey from menarche to successful motherhood

Herlyn-Werner-Wunderlich syndrome is an uncommon variant of mullerian duct anomaly and the approach to its diagnosis requires a high index of suspicion and vigilant work up. Presented here is a case of a 26-year-old woman who had the aforementioned anomaly and was pursued for nearly 10 years to provide her with a fruitful obstetric outcome after having undergone Strassman's metroplasty at a young age of 15 years.