bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of cancer antigen 19-9 in complex ovarian tumors
Authors: Thomas Dhanya S. , Sebastian Ajit , Thomas Vinotha , Thomas Anitha , Chandy Rachel , Peedicayil Abraham 
Published: February 2021

Background: Cancer antigen 19-9 (CA 19-9) is a tumor-associated mucin glycoprotein antigen that may be elevated in healthy individuals as well as in patients with benign and malignant tumors. It is useful in the management of pancreatic and other gastrointestinal tumors. CA 19-9 is also elevated in benign and malignant ovarian tumors.
Aim: To study the pattern of serum CA 19-9 in complex ovarian tumors.
Methods: The study design was descriptive, based on data collected from medical records. Patients with a complex ovarian mass, who were investigated with CA 19-9 and had undergone surgery, were included in the study. The study duration was 2 years from January 2014 to December 2015. A total of 273 patients (119 benign and 154 malignant) with complex ovarian mass and elevated CA 19-9 underwent surgery during the study period.
Results: CA 19-9 was elevated in 55 patients (20%). Of these, 23 patients had benign tumors while 32 had malignant tumors. Among patients with benign tumors, 21 had dermoid, 23 had mucinous tumors and 75 had other types of tumors. CA 19-9 was elevated in 10 (47.6%) of the dermoids, 7 (30.4%) of the mucinous tumors and 6 (8%) of the other benign tumors. Among patients with malignant tumors, 138 were epithelial and 16 were non epithelial tumors. Of the epithelial tumors, 31 were mucinous and 107 were nonmucinous types. Overall, 29 (21%) had elevated CA 19-9. Of the epithelial tumors, 22.6% of the mucinous type and 20.6% of the non mucinous type had elevated CA 19-9. Among the non-epithelial tumors, 3 (18.8%) had elevated CA19-9.
Conclusion: CA 19-9 is elevated in several conditions but most likely to be raised in dermoid cysts and mucinous tumours. CA19-9 levels need to be interpreted along with clinical and radiological findings.
Unusually high serum Ca 19-9 in a benign ovarian tumor
Authors: Pandey Divya , Pruthi Neha , Salhan Sudha 
Published: February 2021

Introduction: Ovarian tumors have a varied spectrum of presentation. Tumors which look malignant clinico-biochemically can ultimately turn out to be benign. Tumor markers help in diagnosing various malignancies. Carbohydrate antigen 19-9 is one such marker seen to be elevated in some ovarian tumors.
Case: A 55 year old, lean and thin postmenopausal female presented to Gynae OPD with abdominal mass, anorexia and weight loss developing over last 6 months. During workup, she was found to have unusually high Ca 19-9 along with MRI findings suggestive of ovarian tumor. Staging laparotomy followed by total abdominal hysterectomy with bilateral salpingoophorectomy was performed. Per operative findings were suggestive of benign nature of ovarian tumor of size 18× 20 cm. Patient was kept under follow up. Histopathology report showed benign mucinous cystadenoma. The serum levels of Ca19-9 returned to normal 8 weeks following surgery. This case report shows a rare and significant elevation of Ca19-9 levels with benign mucinous cystadenoma of the ovary, thus showing that women with unusually elevated tumor markers and even symptoms suggesting malignancy may actually harbour a benign disease.
Conclusion: Unusually high Ca 19-9 may be associated with benign mucinous cystadenoma but thorough workup to rule out malignancy is a must in every case.
Comparison of MRI findings with actual HPE findings in case of carcinoma endometrium
Authors: Gupta Shaveta 
Published: February 2021

Objectives: The objectives of this study is to investigate the correlation of magnetic resonance imaging (MRI) in predicting the depth of myometrial invasion, cervical involvement and lymph node involvement and actual histopathological findings in the women with endometrial cancer.
Methods: This is a reterospective study of the patients of endometrial cancer from Nov 2011 to Jan 2016 who underwent Surgery (Total abdominal Hystrectomy with B/l salpingoophorectomy with peritoneal washings with b/l pelvic lymphadenectomy with or without para aortic lymphadenectomy) at our centre Max Superspeciality Hospital. CE MRI Pelvis has been done pre operatively in every patient. After the surgery Histopathological reports of the specimen checked and compared with MRI findings of that case. The purpose of the study is to evaluate the validity of MRI findings of endometrial cancer in comparison to final histopathological findings.
Results: For the detection of myometrial invasion, overall sensitivity of MRI is 93.9%, specificity is 66.6%, for cervical involvement Senstivity is 60% and specificity 1s 93.75% and for detection of lymph node involvement sensitivity is 66.6% and specificity is 93.5%. Most common Finding on MRI is thickened endometrium with disruption of Junction jone.
Conclusions: Preoperative pelvic MRI is a sensitive method of identifying invasion to the myometrium in endometrial cancer. MRI Is a sensitive noninvasive modality in predicting locoregional spread in ca endometrium. Senstivity in detecting Myometrial invasion is high but sensitivity is less in detecting cervical involvement and lymph node involvement is less.
Vulvar cancer: Patterns of recurrence and clinicopathological prognostic factors involved in recurrent cases
Authors:   Kanika
Published: February 2021

Objective: Vulvar cancer is a rare disease, with an incidence of 0.6% of all female malignancies. With the advances in management of carcinoma vulva to individualisation of treatment to reduce the psychosexual impact an aggressive treatment can have, it is imperative to understand the patterns of recurrence and the common prognostic factors involved. The aim of this study was to determine prognostic variables for recurrence and survival and to identify patterns of recurrence in patients with vulvar cancer.
Materials and Methods: All patients (n=87) with primary vulvar cancer treated at the Rajiv Gandhi Cancer Institute between January, 2006 to January, 2015 who underwent surgery were retrospectively analysed regarding the prognostic relevance of different clinicopathological variables. Recurrences were evaluated with regard to their characteristics and localisation and the variables associated with them were analyzed.
Results: Age, stage of tumor, size of tumor, location of tumor (central or lateral), lymph node metastasis, depth of invasion and involvement of resection margins, associated intraepithelial abnormality predicted disease-free and overall survival. In multivariate analysis, lymph node status and positive margin status was the most important independent prognostic factor (p = 0.002). Irrespective of the initial nodal involvement, recurrences occurred primarily in the vulvar region.
Conclusion: Inguinofemoral lymph node status and adequate margins at initial diagnosis is of critical prognostic importance for patients with vulvar cancer. Further tumour biological characteristics need to be identified to stratify patients with nodal involvement for adjuvant radiotherapy of the vulva to prevent local recurrences.
Oral Abstract
Authors: Hematbhai Satodiya Mohit 
Published: February 2021

Objective: To compare the incidence, maternal and fetal outcomes of gestational diabetes mellitus using one step vs. two step as a screening procedure.
Methodology: A prospective randomized trial involving screening of 1000 pregnant women for gestational diabetes mellitus was conducted. Women were divided in two groups (500 each). Group A comprised of patients screened with two step approach (ACOG recommendation), Group B comprised of women screened by one step method (IADPSG criteria). Women diagnosed with ‘gestational diabetes’ were followed in antenatal clinic and incidence of GDM, maternal and fetal outcome between two groups were analyzed using SPSS.
Results: The incidence of GDM was almost double using one step approach versus two step which was 19.2% and 11.8%respectively. Maternal outcomes were comparable in both the groups except the risk of preterm delivery which was 2.5 times more in group A than group B (odds ratio = 2.43 95% CI = 1.01-5.79). Further fetal outcomes were also comparable except neonatal hypoglycemia which was seen in 29.31% in group A vs. 7.4% in group B. In the group B 15 patients (15.8%) patients with GDM (based on FBS ≥ 92 mg/dl at 1st ANC visit) showed clinical symptoms and blood sugars in hypoglycemic range on MNT requiring resumption of normal diet.
Conclusion: The incidence of GDM using IADPSG criteria was almost double versus ACOG criteria. Maternal and fetal outcomes were comparable except in 15.8% women diagnosed as GDM (using FBS ≥ 92 mg/dl at 1st ANC visit as per IADPSG) suffered from hypoglycemia. A large trial is being proposed before these criteria are adopted.
Prevalence of abnormal PAP smears in antenatal women in a tertiary hospital in India
Authors: Shamsunder Saritha , Gautam Akriti , Khanna Geetika , Malik Sunita 
Published: February 2021

Background: Pregnancy provides a good time for opportunistic screening of our women who rarely attend for cervical screening. The prevalence of abnormal PAP smear in pregnant women in developed countries was 5-6%, however, no literature was available from India.
Aim: To determine the prevalence of abnormal PAP smears in antenatal women presenting to our antenatal clinic.
Methods: Women attending the antenatal clinic with gestation of <28 weeks were recruited after an informed consent and had a PAP smear by Ayre spatula and cytobrush or a broom type of cytobrush. The comfort level during smear taking & any problems noted were recorded using a pain score. The smears were stained using the PAP stain, were categorized as adequate or inadequate & classified as per Bethesda classification.
Results: We had 150 women participating, the mean age was 24.2 yrs, the mean period of gestation was 17 weeks; 43.9% were nulliparous. Smear adequacy rate was 71.5% overall. Pain during procedure was reported in 2.9% of women, 18.3% had minor discomfort; 78.6% were comfortable. Minor bleeding during smear taking was noted in 15%; this was more with the cytobrush & broom than the Ayre spatula alone. Abnormal smears were seen in three women; two had AGC & one had LSIL.
Conclusions: Opportunistic cervical screening during pregnancy is safe and well tolerated. Abnormal Cervical smears were seen in 2% of our pregnant women.
Massive peripheral giant cell granuloma associated with pregnancy
Authors: Jain Vikas 
Published: February 2021

Peripheral giant cell granuloma (PGCG) is a relatively Common reactive exophytic lesion of the oral cavity. The influence of hormones has been suggested as contributory factor in PGCG development and predominance of these lesions in young females as well as some previously reported pregnancy related cases support this belief. It has been observed that majority of lesions present in the 4th decade of life, when hormonal changes are more pronounced. Cailluette and Mattar in their study found that peripheral giant cell granuloma are under the influence of the ovarian hormones. However Chambers and Spector suggested peripheral giant cell granuloma to be enhanced by pregnancy rather than being pregnancy dependent. The responsiveness of gingiva to these hormones along with the immunosuppressive actions of the hormones contributes to the growth of the lesion. Clinically, PGCGs may present as polypoid or nodular lesions, predominantly bluish red with a smooth shiny or mamillated surface.This poster will review the literature available on the association of Massive Peripheral Giant Cell Granuloma With Pregnancy with focus on possible causes of PGCG during pregnancy.
Synchronous malignancy of ovary and cervix
Authors: Malhotra Vani , Nanda Smiti , Chauhan Meenakshi , Bhuria Vandana 
Published: February 2021

Background: Synchronous primary malignancies of the female genital tract constitute 1.7% of all genital malignancies.
Case: A 45-year-old para 5 woman presented with loss of appetite and abdominal distention. Provisional diagnosis of ovarian malignancy was made. Final histopathology of the specimen revealed ovarian papillary serous cystadenocacinoma with cervical leiomyosarcoma. She received chemotherapy.
Results: Patient is on regular follow-up.
Conclusion: The coexistence of primary neoplasms in the ovary and cervix are rare. A normal appearing organ may have a hidden malignancy. So, every surgical specimen should be subjected to detailed histopathological examination. Also, the possibility of synchronous malignancy elsewhere in body should be kept in mind while working on a genital malignancy.
Distant pedicled musculocutaneous/fasciocutaneous flaps; a novel approach for reconstruction of large vulvar defects
Authors: Mishra Kripa Shanker 
Published: February 2021

Introduction: Postablative reconstruction of vulvar defects is a difficult challenge. Local flaps carry a high incidence of delayed wound healing as local flaps may redistribute but not eliminate local wound tension. Repair of defect with distant pedicled flaps may avert local complications by minimising tension to the skin and increasing the initial biomechanical strength of wound. The aim of this study was to determine the clinical outcome of distant musculocutaneous & fasciocutaneous flaps used for postablative reconstruction of large vulvar defects.
Methods: Between January 2015 to December 2015 total three patients underwent vulvectomy and immediate reconstruction with distant pedicled flaps for vulvar carcinoma. Postoperative complications were recorded and clinical outcomes were evaluated.
Results: Two of the three flaps healed primarily. One flap was complicated by minor wound dehiscence, which healed with conservative treatment. Hospital stay and clinical course was shorter in comparison to local flaps and split skin graft.
Conclusions: Distant musculocutaneous and fasciocutaneous flaps provide excellent design flexibility and can be tailored to reconstruct postablative vulvar defects with good outcomes and minimal morbidity.
To compare the effects of dexmedetomidine versus propofol infusion on various parameters intraoperatively and their effects on the recovery profile postoperatively in patients undergoing laparoscopic assisted robotic pelvic surgeries
Authors: Jaggi Tejinder Singh 
Published: February 2021

Methods: 80 ASA physical status I-II patients, 30-65 years, BMI ≤30 undergoing surgery for 120-180 minutes. Computer randomisation, 40 each, in dexmedetomidine group D and in propofol group P. Induction with fentanyl 1.5 mcg mkg−1 and propofol 2 mg kg−1. Maintained with desflurane 3-5% with air 50% and O2 50%. In D group (bolus 0.5 mcg mkg−1 for 10 minutes then maintenance 0.2-0.5 mcg mkg−1 hr−1) and in P group (propofol @ 50-150 mcg kg−1 min−1) started. At docking of robotic arms single dose morphine @ 0.075 mg kg−1 in both groups is given. Hemodynamic stability (MAP and HR) is adjusted within 20% of base line values.
Results: Early and intermediate recovery was fast in D group and total fentanyl requirement intraoperatively was less in D group.
Discussion: Dexmedetomidine is known to decrease sympathetic outflow and circulating catecholamine’s levels therefore has caused decrease in both MAP and HR similar to propofol. Dexmedetomidine has analgesia sparing effect hence less total fentanyl dose both intraoperatively. Patients with dexmedetomidine are early aroused, so early and intermediate recoveries were faster with dexmedetomidine than propofol. Thus dexmedetomidine may prove to be useful adjuvant for robotic surgeries.
Conclusion: Dexmedetomidine more effective for both intraoperative and postoperative analgesia. Recoveries both early and intermediate are faster in dexmedetomidine group.
A rare case report of incidental solitary uterine metastasis in primary invasive lobular carcinoma of breast
Authors: Gupta Vivek , Mishra Amita , Kalra Namit , Narula Bhawna 
Published: February 2021

Introduction: Infiltrating Lobular carcinoma (ILC) of the breast is second most common cancer of breast next only to Infiltrating ductal carcinoma (IDC). It has a different metastatic pattern as compared to the IDC. Breast cancer is the most frequent primary site which spreads to gynaecologic organs.
Case Presentation: A 40 yrs old Iraqi lady presented as a diagnosed case of lobular carcinoma of left breast. She had already undergone a lumpectomy at Iraq a month back and now had come for completion of treatment. On metastatic workup with PETCT scan, we found a multicentric residual disease in the left breast along with some ipsilateral axillary LN with significant uptake. The concurrent CECT done showed a uterine leiomyomam also. As she was strongly hormone receptor positive, had completed her family and was having mennorhagia probably attributable to uterine fibroids. She was offered hysterectomy with B/L salpingo-oophorectomy. She was keen for breast preservation but in view of her multicentricity of disease on the left breast she was counselled for mastectomy with upfront whole breast reconstruction with TRAM flap. She underwent left modified radical mastectomy with hysterectomy with BSO and TRAM flap reconstruction. The histopathological examination revealed a multicentric, multifocal ILC, grade II with heavy nodal involvement including extracapsular extension. The leiomyoma of uterus also showed tumor deposits from lobular carcinoma breast.
Conclusion: We report a very rare case of metastatic pattern of carcinoma of breast. On literature review we found that it is common for the lobular carcinomas of breast to metastasise to gynaecologic organs. Uterine corpus is a very rare site of metastasis for extragenital cancers including breast. All the patients of primary lobular carcinoma of breast should be screened for gynaecologic secondaries in the preoperative workup with high degree of suspicion.
All-Inside PCL Reconstruction
Authors: Therrien Erik , Pareek Ayoosh , Song Bryant M. , Wilbur Ryan R. , Stuart Michael J. , Levy Bruce A. 
Published: February 2021

AbstractMany different techniques with multiple graft types have been described for the reconstruction of the injured posterior cruciate ligament (PCL); autograft versus allograft, single- versus double-bundle, open inlay versus arthroscopic inlay versus arthroscopic transtibial, and recently described the arthroscopic “all-inside” socket technique. Reported clinical outcomes have demonstrated no significant difference in any of these PCL reconstruction techniques, likely because of the heterogeneity in injury characteristics and patient population. The ideal surgical technique should be safe, simple, and reproducible while allowing treatment of concomitant knee injuries resulting and return to function.
A Flexible Intramedullary Guide Can Reduce the Anteroposterior Oversizing of Femoral Components Used in Total Knee Arthroplasty in Patients with Osteoarthritis and Severe Distal Femoral Sagittal Bowing
Authors: Lee Do Weon , Lee Joonhee , Lee Junpyo , Ro Du Hyun , Lee Myung Chul , Han Hyuk-Soo 
Published: February 2021

AbstractTraditionally, a rigid intramedullary rod has been used as the reference guide for femoral cutting in total knee arthroplasty (TKA). However, correct positioning of this rigid rod is difficult, especially in the knees with severe distal femoral sagittal bowing. A flexible intramedullary rod has been developed to address this problem. This study was performed to compare the sagittal alignment and clinical outcomes of TKAs performed with flexible and rigid femoral intramedullary guides. Thirty-eight knees that underwent primary TKAs with flexible intramedullary rods as femoral cutting guides were matched according to patient height and sex with 38 knees that underwent TKAs using conventional rigid rods. Clinical outcomes, including the range of motion and functional scores, and radiological variables, including the distal femoral bowing angle (DFBA), femoral component flexion angle (FFA), and mediolateral overhang and anteroposterior (AP) oversizing of femoral components, were evaluated. Clinical and radiological outcomes did not differ significantly between the flexible rod and conventional rigid rod groups. A subgroup analysis of knees with severe distal femoral sagittal bowing (DFBA >4 degrees) showed that the FFA was significantly larger in the flexible rod group than in the rigid rod group, with an average difference of 3 degrees (5.2 ± 2.4 vs. 2.2 ± 1.6 degrees, respectively, p = 0.022). In addition, the incidence of AP oversizing of femoral components was lower in the flexible rod group than in the rigid rod group (11.1 vs. 60.0%, respectively, p = 0.027). Relative to TKA with a rigid rod, TKA performed with a flexible femoral intramedullary guide resulted in more flexed sagittal alignment of femoral components in patients with severe distal femoral sagittal bowing. This greater flexion of the femoral component resulted in less AP oversizing. However, the use of a flexible rod had no impact on short-term clinical outcomes.
Pulmonary Embolism in Pregnancy
Authors: Bates Shannon M. 
Published: February 2021

AbstractEven though venous thromboembolism is a leading cause of maternal mortality in high-income countries, there are limited high-quality data to assist clinicians with the management of pulmonary embolism in this patient population. Diagnosis, prevention, and treatment of pregnancy-associated pulmonary embolism are complicated by the need to consider fetal, as well as maternal, well-being. Recent studies suggest that clinical prediction rules and D-dimer testing can reduce the need for diagnostic imaging in a subset of patients. Low-molecular-weight heparin is the preferred anticoagulant for both prophylaxis and treatment in this setting. Direct oral anticoagulants are contraindicated during pregnancy and in breastfeeding women. Thrombolysis or embolectomy should be considered for pregnant women with pulmonary embolism complicated by hemodynamic instability. Treatment of pregnancy-associated pulmonary embolism should be continued for at least 3 months, including 6 weeks postpartum. Management of anticoagulants at the time of delivery should involve a multidisciplinary individualized approach that uses shared decision making to take patient and caregiver values and preferences into account.
Cord-Blood High-Sensitivity Troponin-I Reference Interval and Association with Early Neonatal Outcomes
Authors: Ryan Paul M. , Mondal Tapas , Gupta Kaaran , Radovanovic George , Pugh Edward , Chan Anthony K. C. , Hill Stephen 
Published: February 2021

Objective This study was aimed to establish a reference interval for high-sensitivity cardiac troponin I (hs-cTnI) in umbilical cord blood of infants and to assess its association with the risk of predetermined early neonatal outcomes in a high-acuity tertiary care hospital.
Study Design Umbilical cord-blood samples were collected and hs-cTnI was measured in all infants born between August 2015 and September 2015 at McMaster Children's Hospital (n = 256). Gestational age, birth weight, Apgar's scores, age in days at which feeding was established, neonatal intensive care unit (NICU) admission, and discharge in days after birth were recorded.
Results The 90th, 95th, and 99th percentiles for the term infant subcohort were 19.75, 41.45, and 166.30 ng/L, respectively. We observed decreased mean gestational ages and birth weights in both the 90th (37.7 weeks; 2,961.4 g) and 95th percentiles (37.1 weeks; 2,709.9 g) when compared with the remaining infants. Moreover, levels of hs-cTnI were significantly higher in infants with respiratory distress requiring intervention (p < 0.05), low birth weight infants (p < 0.01), preterm infants (p < 0.001), and those requiring NICU admission (p < 0.01). Multiple linear regression of the recorded demographic factors revealed prematurity (gestational age <35 weeks: coefficient 0.346 ± 0.160, p < 0.05; gestational age <37 weeks: coefficient 0.253 ± 0.105, p < 0.05) and male sex (coefficient 0.138 ± 0.047; p < 0.01) to be most predictive of log-hs-cTnI levels.
Conclusion This study establishes the reference values for cord-blood hs-cTnI in infants at a tertiary care center. Premature and sick infants requiring NICU admission had significantly higher levels of hs-cTnI.
Key Points