BACKGROUND It is recommended that greater use of imaging of the pelvis and tumour markers preoperatively is essential for evaluation of adolescent ovarian masses. There should be greater use of conservative expectant management or ovarian-sparing surgery in view of the low risk of malignancy in adolescent age group. The practice of removing ovaries for benign cysts may be overcome by appointing more gynaecologists with advanced training skills training in paediatric and adolescent gynaecology. The objectives of the study are-1. To study the age related proportion, clinical and sonographic morphology of various ovarian masses in adolescence. 2. To correlate clinical, sonographic with Doppler velocimetry, tumour marker status, operative findings and the histopathology. 3. To identify the role of preoperative sonographic evaluation in deciding on the management. 4. To study the role of sonography in morphologic characterisation of benign versus malignant tumours of ovary and the extent to which it has influenced the management. MATERIALS AND METHODS The study which is an observational case series study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College, Kottayam, during the period from January 2011-June 2014. The age, sex and IP no. of adolescents of age 10-19 yrs. presenting at OPD and casualty with sonological evidence of ovarian masses are noted. If found with suspicious features, then only tumour markers and Doppler velocimetry are mentioned. The conservative or surgical managements done for them are recorded. If surgically managed, HPR are collected and analysed. RESULTS A total of 46 patients were included in the study. More number of cases fall in the age group of 17-19 yrs. and the most common presenting complaint was pain abdomen. 50% of the study group has a mass abdomen. Majority are benign masses and the commonest type was serous cystadenoma, which appear as simple cystic in USG. 87% of the solid and cystic masses in sonography came out as malignancy. Multiloculated cyst in USG turned out to be teratoma (60%) and mucinous type (30%). Only 50% of dermoid cyst correlated with ultrasound. Doppler was done in 33.3% of malignancies and was abnormal. Only 66.7% of abnormal results of tumour markers depicted malignancies. The intraoperative and pathological report correlate most in endometriotic cyst and yolk sac tumour (50%) and least with serous tumours (20%). 54.3% of them were benign epithelial tumours. All malignant tumours were germ cell tumours. Yolk sac tumours and mucinous tumours were distributed in early adolescence and teratoma and serous in late period. CONCLUSION Sonography is a simple, quick and non-invasive investigation found to be most accurate among the other tests for accounting the type of tumours. Most common histologic type in my study is serous cystadenoma. Clinical examination can clinch the diagnosis only to some extent in this age group.

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BACKGROUND Surgical site infections are the most common nosocomial infections. Postoperative complications, especially surgical site infections can double the length of time a patient stays in hospital and increase the cost of healthcare. Antibiotic prophylaxis before surgery has evolved over last twenty years and is definitely valuable to reduce postoperative wound infection. Obstetric surgeries are considered as clean contaminated wounds where antibiotic prophylaxis has proven beneficial in preventing postoperative complications, antibiotic resistance and economic burden. But, in countries like India, even a large group of obstetricians are reluctant to follow it. Hence, this study was conducted. The aim of the study is to study the effectiveness of single-dose cefazolin prophylaxis in preventing postoperative complications in patients undergoing elective cesarean compared to postoperative antibiotics. MATERIALS AND METHODS This was a prospective observational study conducted in the Department of Obstetrics and Gynaecology, Medical College, Kottayam, from January 2014-December 2014. After obtaining permission from the hospital ethical committee for research, hundred patients undergoing elective cesarean in our hospital were selected for the study using strict inclusion and exclusion criteria of which fifty patients received injection cefazolin 2g intravenously one hour before surgery. Remaining fifty patients who were matched for age, parity and body mass index were given cefotaxime and metronidazole pre and postoperatively. All these patients were followed up postoperatively for complications, antibiotic change and duration of hospital stay. Statistical analysis done using suitable software. RESULTS Complications were comparable in those receiving prophylactic cefazolin and those receiving postoperative antibiotics. Both groups required antibiotic change for complications. Patients requiring prolonged hospital stay was comparable in both the groups. Surgical site infections was the commonest cause of prolonged hospital stay. CONCLUSION Antibiotic prophylaxis with cefazolin is as effective as postoperative antibiotics in preventing postoperative complications in a major referral centre in India. Hence, antibiotic prophylaxis should be preferred in uncomplicated surgeries as it reduces patient's morbidity, antibiotic resistance and workload of hospital staff.