Randomized, Placebo-Controlled Trial of Granisetron for Control of Nausea and Vomiting During Cesarean Delivery Under Spinal Anesthesia

Objective(s)

The objective of this study was to evaluate the efficacy and safety of granisetron (5HT₃ receptor antagonist) on the incidence of nausea and vomiting in cesarean deliveries under spinal anesthesia.

Method(s)

In the randomized, double-blind study, 80 parturients received granisetron 40 μg/kg or placebo (n = 40 each) intravenously, immediately after clamping of the fetal umbilical cord. Nausea, vomiting, and adverse events were then observed for 24 h after administration of spinal anesthesia.

Results

A complete response (defined as no postoperative nausea and vomiting) during 0–4 h after administration of spinal anesthesia was achieved in 80 % of patients with granisetron and in 45 % of patients with placebo. The corresponding incidences during (4–24 h) were 82.5 and 55 % (P value <0.05). No difference in adverse events was observed in any of the groups.

Conclusion(s)

Prophylactic use of granisetron is effective for preventing emetic episodes during spinal anesthesia for cesarean delivery.     

Spectrum of ectopic ureters in children

We reviewed the clinicopathological features, diagnosis, and surgical treatment of ectopic ureters (EU) in children in order to evaluate the anatomy, renal function, outcome, and the existence of any racial or regional difference in this abnormality. The records of 27 consecutive patients with 33 EU managed over a period of 7 years were analyzed. There were 25 female and two male patients. Their age ranged from 1 to 13 years, with an average of 4.5 years. The presenting features included history of continuous dribbling of urine with otherwise normal voiding in toilet-trained female patients, incontinence of urine, urinary tract infection, abdominal pain, and renal failure. The diagnostic work-up included ultrasonography (US) in all 27 patients, intravenous pyelography (IVP) in 23, micturating cystourethrogram (MCU) in 19, nuclear imaging (NI) in 16, and computed tomogram (CT) in five patients. All patients underwent examination under anesthesia (EUA) and cystourethrovaginoscopy immediately before the operation. Single-system ectopic ureter (SSEU) was present in 19 patients with 25 ureters (six bilateral), and duplex with ectopic ureter was present in eight cases. The left side was involved in 14 cases, the right side in seven, and the anomaly was bilateral in six cases. Abnormalities noted in the imaging studies were USG 23/27, IVP 23/23, MCU 11/19, NI 13/16, and CT 5/5 cases. EUA and cystourethrovaginocsopy helped in localization of the ectopic site and evaluation of the bladder. The surgical treatment included nephroureterectomy (NUT) for non-functioning kidney in 7 patients, heminephroureterectomy (HNUT) for non functioning upper pole of duplex kidney with EU in 6 patients, ureteric reimplantation (UTR) in 13 patients (19 ureters, 6 bilateral), and ureteropyelostomy (UTP) in one patient. In the follow-up period ranging from 1 to 5 years, 20 patients achieved continence; however, six cases with bilateral SSEU and one case of unilateral SSEU, who also had a patulous bladder neck, continued to dribble urine. SSEU was more common than duplex with ectopic ureter. A large number of functioning renal units associated with SSEU deserved preservation. The success of surgical treatment in terms of achievement of continence was high and depended on the integrity of the bladder neck.     

Isolated post-traumatic right-sided diaphragmatic hernia

A 3-yr-old boy presented with respiratory distress of 2 days duration. There was a history of blunt trauma to the lower chest having occurred 5 days earlier. Although missed initially, serial chest X-rays and a computed tomographic (CT) scan revealed an isolated traumatic right-sided diaphragmatic hernia without any injury to the viscera or the ribcage. Laparotomy with reduction of the herniated right lobe of the liver and the transverse colon was performed. Recovery was uneventful. The presentation, diagnosis and management of this relatively uncommon injury is discussed. The need for a high index of suspicion and critical evaluation of appropriate investigations to prevent diagnostic delay and optimize management in patients with traumatic diaphragmatic injury is emphasized.     

Changing Scenario in Aetiological Profile of Short Stature in India-Growing Importance of Celiac Disease: A Study from Tertiary Care Centre

Objective  

To compare the etiological profile of short stature at a tertiary care hospital of North India over a decade from 1995–2007.     

Facial infiltrating lipomatosis: A case report and review of literature

Infiltrating lipomatosis of the face has been described as a congenital disorder in which mature lipocytes invade adjacent tissues in the facial region. The presentation is always unilateral with hypertrophy of hard and soft structures on the affected side of the face. We present a case of a 27-year-old female who reported with a complaint of recurrent unilateral facial swelling with history of two previous resections, the histopathology or details of these surgeries were not available. The patient underwent resection of tumour and the histopathology confirmed it to be infiltrating lipomatosis. The surgery resulted in a definite improvement in the facial asymmetry and the patient is being closely followed up with no evidence of recurrence. The pathogenesis of the condition is unclear, though it has been postulated that the condition is at one end of a spectrum of overgrowth syndromes with classic Proteus syndrome on the other extreme. Management of this condition involves resection of the tumour which in most cases is subtotal to reduce the risk of damage to facial nerve. There is a controversy regarding both timing and extent of resection in the literature and we think the subtotal resection of tumour in an adolescent or older patient can give good aesthetic outcome without compromising facial nerve function. However, the patients should be informed about high rate of recurrence and increase risk of complications with any subsequent surgery.     

The "missing" link in atrial fibrillation heritability

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, represents a major health burden to individuals and health care system within the Western world. The lifetime risk for the development of AF at age 40 years has been estimated to be approximately 1 in 4. Atrial fibrillation is associated with substantial morbidity and a 2-fold increased risk of mortality. Given its increasing prevalence with age, coupled with the aging population, the number of Americans affected with AF is expected to increase from approximately 2.3 million in the year 2000 to nearly 16 million by 2050. This AF epidemic is further complicated by the lack of highly effective therapies. One reason for the lack of effective therapies for AF stems from incomplete understanding of the complex pathophysiology of the arrhythmia. Atrial fibrillation has often been regarded as a condition that occurs in the context of atrial electrical and structural remodeling that can result from cardiac and systemic disorders. However, up to 30% of patients have no obvious cause and are said to have idiopathic or “lone” AF. Up until recently, AF was considered to be a sporadic, nongenetic disorder, but we and others have shown that lone AF has a substantial genetic basis. Mutations in genes encoding cardiac ion channels (KCNQ1, KCNE1-5, KCNJ2, KCNA5, and SCN5A), gap junctions (GJA5), and signaling molecules (atrial natriuretic peptide, nucleoporins [NUP155]) have been reported in isolated cases and small kindreds. The advent of the human genome and HapMap projects and high-throughput genotyping has fundamentally accelerated our ability to discover the genetic contribution to common variation in human disease. In 2007, a genome-wide association study identified 2 genetic variants that associated with AF. More recently, 2 additional AF loci on chromosomes 16q22 and 1q21 have been identified. It is quite likely, however, that the effects of alleles in many genes contribute to common complex diseases such as AF. The overall AF risk associated with common variants identified by the genome-wide association study approach is small (odds ratios, 1.1-2.5) and explains less than 10% of the heritability in lone AF. This raises the possibility that rare independent variants with large effects strong effects may account for a large fraction of the risk for lone AF.