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Goyal P.,Swami Dayanand Hospital | Agrawal D.,Tughlakabad Institutional Area | Ghosh S.,Swami Dayanand Hospital | Sehgal S.,Swami Dayanand Hospital | And 2 more authors.
Journal of Gynecologic Surgery | Year: 2014

Background: Lipoleiomyomas are uncommon benign neoplasms composed of various mixtures of long intersecting bundles of bland smooth-muscle cells and mature adipocytes. These neoplasms are predominantly located in uteri and commonly occur in asymptomatic perimenopausal and postmenopausal women. Although radiologic examination is important for preoperative diagnosis and discerning the exact location of a lipoleiomyoma, the final pathologic examination confirms this diagnosis. This case of lipoleiomyoma of the uterus in a premenopausal woman is reported because because of this patient's rare presentation. Case: A 40-year-old, gravida 3, para 3, premenopausal woman presented with pain in her abdomen and dyspepsia for 45 days. Contrast-enhanced computed tomography scan results were suggestive of a possible mitotic etiology of ovarian origin. An exploratory laparotomy was performed and the neoplasm was examined histologically. Results: During the operation, the mass was found to be a large subserosal cervical fibroid growth, but the patient had healthy ovaries. The histopathology was distinctive and typical of a lipoleiomyoma. Conclusions: It is important to differentiate a lipoleiomyoma from an ovarian neoplasm that requires surgical excision. (J GYNECOL SURG 30:24) © Copyright 2014, Mary Ann Liebert, Inc. 2014.

Chufal K.S.,Tughlakabad Institutional Area | Rastogi M.,P.A. College | Singh S.,University of Lucknow | Pant M.C.,University of Lucknow | And 2 more authors.
Journal of Cancer Research and Therapeutics | Year: 2010

Background: To study the long term results of two phase II concurrent chemoradiotherapy protocols and conduct pooled data analysis with special emphasis on nodal density.Materials and Methods: In the period from April 2001 to May 2003, phase II Mitomycin C (MMC) and late chemo-intensification (LCI) protocols were started in the same institute, enrolling 69 and 74 patients respectively. Long term results for these individual trials are reported along with pooled data analysis.Results: Median follow-up time for whole group, MMC protocol and LCI protocol was 43.8 months (SD619.8), 55 months (SD 618.5) and 47.5 months (SD 620.9) respectively. LRFS, DFS and OS at five years for whole group was 59.4, 43.5 and 47.1% respectively, for MMC protocol was 59.9, 45.5 and 49.5% respectively and for LCI, protocol was 53.6%, 41.5% and 44.4% respectively. Subgroup analysis revealed that MMC protocol was more effective than LCI protocol in terms of DFS and OS in patients with hypo dense nodes while opposite was true for Isodense nodes. Multivariate analysis revealed nodal density as an independent variable that had an impact on treatment outcome. Risk of death in patients with hypo dense nodes was 2.91 times that of Isodense nodes.Conclusions: Innovative and pragmatic approach is required to address locally advanced head neck cancer. Long term results for MMC and LCI protocols are encouraging. Integrating the basic concepts of these protocols may help develop new protocols, which will facilitate the search for the optimal solution.

Goyal P.,Swami Dayanand Hospital | Agrawal D.,Tughlakabad Institutional Area | Kailash J.,Dr. Kailash Clinic | Singh S.,Swami Dayanand Hospital
Indian Journal of Hematology and Blood Transfusion | Year: 2014

Cold agglutination of erythrocyte or platelet aggregation in vitro due to cold agglutination are well recognized and extensively studied. Aggregation of leucocyte is a rare hematological phenomenon resulting in a spurious low leucocyte count performed using automated hematology analyzers. Aggregation of leucocyte may relate to malignancy, lymphoproliferative disorders, infection, liver diseases, or autoimmune disorders. It is believed that the mechanism of leucocyte aggregation is mainly related to the use of ethylene diamine tetraacetic acid (EDTA) anticoagulant or is temperature-mediated. Leucoagglutination is associated with either a spurious leucopenia or an underestimation of leucocytosis. This can adversely affect management decisions in terms of unnecessary management of leucopenia or ignoring a leucocytosis that may be indicator of an underlying serious disease. To our knowledge, we report here for the first time the occurrence of pseudoneutropenia due to temperature-mediated, EDTA-independent neutrophil agglutination in adult with human immunodeficiency virus infection. © 2013, Indian Society of Haematology & Transfusion Medicine.

Haritwal A.,Tughlakabad Institutional Area | Makhija B.,Tughlakabad Institutional Area | Arora M.,Tughlakabad Institutional Area | Agrawal D.,Tughlakabad Institutional Area | Goyal P.,Swami Dayanand Hospital
International Journal of Women's Health and Reproduction Sciences | Year: 2014

Objective: Borderline ovarian tumors (BOT) constitute 15% of all epithelial ovarian cancers. The aim of this study is to analyze and discuss the management dilemmas associated with BOT. The purpose of this article was to collect and review the data on management dilemmas of BOT from numerous articles published since 1995. Additionally, the data of four patients with BOT, who were treated in our Institute, are presented and analyzed.Materials and Methods: For literature review we performed a literature search of relevant articles that were based on management dilemmas. Additionally, the data of 4 patients with BOT, who were treated in our Institute, are reported and reviewed by medical data information and patient interview, to establishing a database for a better understanding of the management dilemmas of BOT.Results: All the four cases were of reproductive age group. In three cases conservative fertility sparing surgery was done and in one patient radical surgery was done. All the four cases did not require adjuvant therapy. BOTs did not affect the outcome of pregnancy. Follow up of all the four cases is uneventful with no evidence of recurrence.Conclusion: Surgical management to excise all visible tumor tissue remains the keystone of therapy. Fertility being an important issue; conservative laparoscopic surgery is also a viable treatment option. Progression free survival is not influenced by the type of surgical approach (laparoscopic v/s laparotomy). Overall survival does not depend on the type of surgery (fertility sparing v/s nonsparing surgery). Even in advanced disease there is no proven benefit of adjuvant chemotherapy or radiotherapy. © 2014 The Author(s).

Makhija B.,Tughlakabad Institutional Area | Haritwal A.,Tughlakabad Institutional Area | Arora M.,Tughlakabad Institutional Area | Agrawal D.,Tughlakabad Institutional Area
International Journal of Women's Health and Reproduction Sciences | Year: 2014

Objectives: To report the authors’ experience in suction and evacuation with cannula followed by maintenance of negative pressure in the uterine cavity by keeping the cannula inside for 20-30 minutes, which was performed for controlling intractable postpartum hemorrhage (PPH) in a tertiary care hospital.Materials and Methods: This is a retrospective observational study carried out from July 2011 to December 2012 at Batra Hospital and Medical Research Centre, New Delhi, India. Nine patients who delivered either vaginally or via caesarian section and developed primary PPH refractory to conventional medical treatment, were included in the study. Suction and evacuation of the uterine cavity was done and then the cannula was kept inside the uterine cavity for 20-30 minutes thereby maintaining negative pressure (400-600 mmHg) in the cavity. Data were retrieved from patients’ hospital records.Results: Intractable primary hemorrhage was encountered in 9 patients of whom 6 had bleeding after caesarian section and 3 after vaginal deliveries. Uterine atony due to prolonged labour was the commonest cause. Hemorrhage was effectively controlled in 8 out of 9 cases (88.9%) and hysterectomy was avoided. In one patient (11.1%) the procedure failed and life saving hysterectomy was done to control the bleeding. This approach not only controls PPH but also preserves the woman’s reproductive functions and avoids hysterectomy and its related complications and consequences.Conclusion: This is a simple conservative surgical method to treat PPH in low resource settings. It requires minimal training, conserves the uterus, and is technically less challenging and associated with less blood loss than hysterectomy. © 2014 The Author(s).

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