A comparison of ondansetron and P6 point acupuncture stimulation in prevention of carboprost induced nausea and vomiting in patients undergoing cesarean section under subarachnoid block

Objective: Carboprost is used to prevent postpartum hemorrhage in pregnant patients but is associated with severe nauseaandvomiting. This a study was done to compare ondansetron and P6 point acupuncture stimulation for prevention of carboprost induced nauseaandvomiting. Methodology: Fifty ASA class I and II full term pregnant patients scheduled for elective cesarean section were r and omly allocated into Group-O [n=25] and Group-P [n=25]. Subarachnoid block [SAB] was administered in both groups using inj.0.5% hyperbaric bupivacaine in L3-L4 interspace to achieve a level between T4 to T6. Inj.carboprost 250 mcg was given intramuscularly after the delivery of anterior shoulder in both groups. In addition Group-O inj. Ondansetron was given and in Group-P acupuncture was applied at P6 acupoint. Mean arterial pressures were maintained within 20% of baseline. Both groups were observed for nauseaandvomiting for two hours postoperatively. Results: Overall incidence of nauseaandvomiting was significantly less in Group-P than in Group-O, however, there was no significant difference in incidence of nauseaandvomiting among the two groups when considered individually. Conclusion: We conclude that stimulation of P6 point by acupuncture in comparison to ondansetron decreases the overall incidence of carboprost induced nauseaandvomiting in the immediate postoperative period. Key words: Carboprost, Cesarean section, Nauseaandvomiting, P6 acupuncture, Ondansetron

Endorectal coil MRI and MR-spectroscopic imaging in patients with elevated serum prostate specific antigen with negative trus transrectal ultrasound guided biopsy

The aim of this study was to see the efficacy of endorectal coil MRI and MR spectroscopic imaging in patients with elevated serum PSA and negative transrectal ultrasonography [TRUS]-guided biopsy. This study was conducted on 87 patients presented with: Elevated prostatic specific antigen levels >5 ng/ml. Symptoms and signs of prostatic carcinoma. Patients with negative TRUS-guided biopsy. Suspicious lesion on TRU. All the patients were subjected to TRUS and followed by TRUS-guided biopsy of the lesion identified on endorectal coil MRI and MR-Spectroscopy. TRUS-guided biopsy of prostate was done with a Siemens Sonoline Adana Scanner. The scanning was performed by mechanical probe 5-7.5 MHz. Out of 87 patients, 43 [49.4%] had hypointense lesion, 11 [12.6%] had hyperintense lesion. Out of 87 patients, MR-spectroscopy showed peak choline-creatine in 74 patients. Normal citrate peak was seen in 13 patients. Patients who had choline-creatine peak, among them 28 [37.8%] had peak in left peripheral zone, 23 [31.1%] had peak in the right peripheral zone, 2 [2.7%] had peak in the central zone, 17 had [23%] peak bilaterally. Four patients [5.4%] had peaks in right and central zones. The difference was statistically significant [P < 0.001]. Prostatic biopsy directed with endorectal coil MRI and MR-spectroscopic imaging findings in patients with elevated serum PSA and prior negative biopsy, improves the early diagnosis of prostatic carcinoma and accurate localization of prostate cancer within the gland.

evaluation of use of Trans-Obturator Tape [TOT] sling procedure in the current surgical management of female stress urinary incontinence

To assess the role of TOT sling procedure in current surgical management of female Stress Urinary Incontinence [SUI] in terms of post-operative results, cost effectiveness, pt acceptance and complications. From June 2006 to September 2008, 30 patients of SUI were treated surgically by TOT-sling procedure. Pre-operatively the patients were evaluated by thorough history taking, clinical examination and different diagnostic test depending upon the individual clinical scenario. Patients were explained in their own language the nature of procedure and the principle behind it. Any complication[s] [intra/postoperative] were noted. After discharging the patients they were followed up by at least 3 visits [follow-up visits] at 1,3 and 6 month interval. Any complications of the procedure and patient acceptance were evaluated at each follow-up. The mean age of the total patients [n=30] was 39.5 yrs and 28 [93.33%] were multiparous. Involuntary loss of urine on straining was the most common complaint present in 25 [83.33%] patients and 22 [73.33] patients were having duration of symptoms less than 3 yrs. 9 [30%] patients were having mild cystocele pre-operatively which resolved after surgery. All the 30 [100%] patients were continent post-operatively while 7 [23.33%] were having lower urinary tract symptoms [LUTS]. No major intra/post-operative complication was seen but, urgency, dysuria, fever and haematuria was seen post-operatively which resolved after few days. The operative time was 24 +/- 3.8 months and catheter was removed on 2.7 +/- 1.7 days post-operatively. Hospital stay was 6 +/- 2.4 days [3-11] and app. Cost of the treatment was Rs 3253 +/- 360 [2700,3900]. TOT Sling procedure is currently the Gold Standard for management of female SUI. It is very important to diagnose SUI and rule out other causes of incontinence because only the former one [Genuine SUI] is improved by TOT sling and other types may be even worsened by this procedure