Congenital Absence of the Vagina—Simple Surgical Procedure for Its Relief

A modified method of treatment of congenital absence of the vagina with the use of amnion graft has been explained with illustrations. Follow-up of 20 patients treated with this method showed successful results without any postoperative cicatrization provided the marital relationship was started within 6-8 weeks.     

Premature ovarian failure

Premature ovarian failure (POF) causing hypergonadotrophic hypogonadism occurs in 1% of women. In majority of cases the underlying cause is not identified. The known causes include: (a) Genetic aberrations, which could involve the X chromosome or autosomes. A large number of genes have been screened as candidates for causing POF; however, few clear causal mutations have been identified. (b) Autoimmune ovarian damage, as suggested by the observed association of POF with other autoimmune disorders. Anti-ovarian antibodies are reported in POF by several studies, but their specificity and pathogenic role are questionable. (c) Iatrogenic following surgical, radiotherapeutic or chemotherapeutic interventions as in malignancies. (d) Environmental factors like viral infections and toxins for whom no clear mechanism is known. The diagnosis is based on finding of amenorrhoea before age 40 associated with FSH levels in the menopausal range. Screening for associated autoimmune disorders and karyotyping, particularly in early onset disease, constitute part of the diagnostic work-up. There is no role of ovarian biopsy or ultrasound in making the diagnosis. Management essentially involves hormone replacement and infertility treatment, the only proven means for the latter being assisted conception with donated oocytes. Embryo cryopreservation, ovarian tissue cryopreservation and oocyte cryopreservation hold promise in cases where ovarian failure is foreseeable as in women undergoing cancer treatments.     

Adolescence: myths and misconceptions

Adolescence is the period of physical and psychological growth between childhood and adulthood. The author is a practicing obstetrician and gynecologist in New Delhi. Over the course of her medical career, she has identified many myths and misconceptions about adolescents and adolescence. With regard to male adolescents, masturbation-related myths may be the most frequently harbored. Male adolescents have a hormone-driven need to have sexual intercourse, frequently. Masturbation is a healthy, no-cost way to relieve sexual tension. There is neither need to pay a prostitute nor fear of contracting a sexually transmitted disease. A young man can masturbate virtually whenever he wants. Despite the guilt and misinformation implanted by adults that masturbation causes weakness, boys masturbate rather frequently. Also contrary to popular myth, the nocturnal emissions which may result in growing boys as a result of sexual excitement during a dream are completely normal and no reason for concern. Further, boys should not worry about penis size, for, when erect, they all work just fine. People grow at different rates. Menstruation starts when 17% of a woman's body weight is fat. The onset of menstruation may therefore start earlier in well-fed girls compared to in girls who are more lean. The frequency and duration of menses are not constant. Menstrual irregularity therefore does not necessarily mean that a young woman is pregnant or that professional medical treatment is required. Breasts, like penises, serve their intended function irrespective of size. The hymen is a membrane at the opening of the vagina. It may have a hole in the center or the side for the escape of menstrual blood. There are myths that an intact hymen is indicative of virginity, the hymen should be intact until marriage, and the first sexual experience should be painful for a woman. The hymen is elastic and even some prostitutes have been found to have intact hymens. The hymen also may tear due to a fall, cycling, or horse riding. Furthermore, myths exist that kissing can cause pregnancy or AIDS, homosexuality is abnormal and incompatible with heterosexual relationships later in life, and different positions of coitus may adversely affect physical health. Adolescents sorely need sources of sound scientific factual information to dispel their myths.     

An amazing case of working wrist watch in the esophagus

Foreign bodies in the esophagus are commonly seen in otolaryngologic practice. We report the successful removal of a working wrist watch dial lodged for one month in the esophagus of an adult schizophrenic patient, which is a rare incident.     

Determinants of lymph node resolution in patients of tubercular lymphadenitis treated with anti tuberculous chemotherapy: A hospital based longitudinal study

IntroductionThe variable course of illness in patients of Tubercular lymphadenitis remains a therapeutic challenge to treating physicians in a significant proportion of patients. This study was aimed to explore the possible determinants which could predict the outcome of this subgroup of patients.MethodologyThis was a prospective cohort study where 94 patients of TB lymphadenitis were enrolled who could be followed up till the end of treatment. They were evaluated in the beginning and monitored till the end of treatment keeping into account the clinical behaviour of lymph nodes during the course of Anti tubercular chemotherapy.ResultsOut of 94 patients, 60 had their lymph nodes resolved at the end of prescribed treatment duration wheras 34 were classified as partial responders. Another 26 amongst them had their nodes resolved by an extension of continuation phase by 3–6 months. Presence of bilateral and multiple lymph nodes, necrosis on Fine needle aspiration at initial diagnosis and occurrence of Paradoxical upgrading reaction were associated with the partial resolution of lymph nodes at the end of stipulated ATT duration.ConclusionTreatment duration should be individualized by the treating physicians. Certain parameters mentioned above can be taken as warning signals of patients ending up as partial responders and hence the need of a prolonged extension phase.     

Molecular identification of enteroviruses associated with aseptic meningitis in children from India

We identified and characterized enteroviruses associated with aseptic meningitis in children between April 2009 and March 2010. Enterovirus RNA was detected in 51 (45.5 %) of 112 CSF samples. Molecular typing by RT-PCR and sequencing of a partial VP1 region revealed the predominance of echovirus (ECV) 32 (n = 20), followed by ECV 11 (n = 10), ECV 13 and ECV 14 (n = 5 each), coxsackievirus (CV) B3 and CV B6 (n = 3 each), CV A2, CV A10 and ECV 30 (n = 1 each). Phylogenetic analysis of ECV 32 showed 0 to 4 % sequence divergence among strains of the present study and 20-23 % from the prototype Puerto Rico strain at the nucleotide level. This is the first report of ECV 32 associated with an aseptic meningitis epidemic and identification of seven different enterovirus serotypes (CV A2, CV A10, CV B3, CV B6, ECV 13, ECV 14 and ECV 32) in meningitis cases from India.