001432   Jose P E A;David J;Yeragani V K;Kulkarani C (NO, Clinical Pharmacology St.John's Medical College, Bangalore-560 034, Email: dr_chanda_k@hathway.com) : Valproate-induced "wet dog shakes"-A reproducible animal model of human compulsive behavior: effect of antidepressants. Ann Neurosci 2007, 14(4), 93-5.

Effect of serotonin re-uptake inhibitor, clomipramine (CMI) and selective serotonin re-uptake inhibitor, fluoxetine (FLX) (10 mg/ kg) administered intraperitoneally were tested on valproic acid (VPA) (300 mg/kg)-induced 'wet dog shakes' (WDSs) in rats, on day 1 and 29 (single and chronic administration of VPA). Single dose and chronic administration of VPA resulted in similar increase in the number of WDSs, demonstrating it's reproducibility. CMI and FLX pretreatment resulted in significant decreases in WDSs from day 1 to 29, where as the combination of FLX and CMI did not. Single dose CMI resulted in significant reduction in WDSs on day 1 compared to FLX and VPA conditions and chronic CMI produced significant reduction in WDSs compared to FLX, VPA and FLX plus CMI (p < 0.0005). Acute administration of FLX produced small but significant reduction of WDSs compared to VPA condition but chronic administration of FLX resulted in a substantial and significant decrease in WDSs. The profound decrease in WDSs with CMI suggests a predominant role for both serotonergic and anticholinergic activity, while more significant decrease of WDS on day 29 after CMI and FLX suggests a chronic receptor down regulation with either drug. The implications of these have been discussed in relation to mechanism of action of antidepressants in valproate-induced stereotyped behaviour in rats, representing a model of compulsive phenomenon seen in humans.

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001431   Jha M S;Srivastava A;Dubey D;Gupta A;Sharma R K (Urology and Renal Transplantation Dep, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226 014, Email: anees772000@yahoo.com) : Clinical evaluation of efficacy and safety of cyclosporine (Imusporin) in renal transplant patients with stable graft function maintained on neoral or bioral. Indian J Urol 2007, 23(2), 130-2.

Previous pharmacokinetic studies have demonstrated bioequivalence of Imusporin (microemulsion preparation of cyclosporine, Cipla) to the innovator product Neoral (Novartis, Switzerland). This study was done to evaluate the clinical efficacy and safety of Imusporin in patients who have already undergone renal transplant and have stable graft function maintained on cyclosporine preparation other than Imusporin. Materials and Methods: Twenty-two renal allograft recipients (mean age of 31.7) years, range 18-53 years), with stable graft function, previously on Neoral or Bioral were switched over to Imusporin after recording their relevant baseline clinical and biochemical parameters. These were repeated on 1, 4, 7, 15, 30 and 90 days after the start of therapy. Change in dosage required to maintain C₂ levels at each visit were analyzed by paired sample t-test Safety of the drug was assessed by the type and severity of adverse events developed during the therapy. Cost analysis was done assuming an average maintenance immunosuppression dose of 150 mg/day of cyclosporine. Twenty-one patients completed the study. One patient was lost to follow-up. Mean C₂ value before switchover was 894 ± 208 ng/ml, which was not significantly different from the mean values of C₂ after switchover therapy (P> 0.30). Change in dosage required to maintain C₂ levels was not significantly different from the baseline dose of 2.34 mg/kg body weight (P>0.1). No patient developed graft rejection after switchover therapy at a median follow-up of 16 months (14-18 months). Mean baseline SCr was similar to SCr at day 90 (1.38 vs. 1.37 mg/dl, P=0.930). No severe adverse events were reported. Mild side-effects included headache (4), somnolence (2), dry mouth (5) and generalized fatigue (6). Use of Imusporin (Cipla, India) results in an annual savings of Rs. 19892 over Neoral (Novartis, Switzerland) and Rs. 2263 over Bioral (Panacea Biotech, India). Imusporin is clinically as safe and efficacious as other cyclosporine preparations available while significantly reducing the cost of treatment.

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001430   Jha M S;Gupta N;Aggrawal S;Ansari M S;Dubey D;Mandhani A;Srivastava A;Anant Kumar;Kapoor R (Urology and Renal Transplantation Dep, Sanjay Gandhi Post Graduate Intitute of Medical Sciences, Lucknow-226 014, Email: rkapoor@sgpgi.ac.in) : Single-centre experince of laparoscopic nephrectomy: impact of learing curve on outcome. Indian J Urol 2007, 23(3), 253-6.

Between January 2000 and September 2006, 396 laparoscopic nephrectomies were performed at our institute for various benign and malignant conditions. These included 250 simple nephrectomies, 48 nephroureterectomies, 95 radical nephrectomies, two partial nephrectomies and one hemi-nephrectomy. For the purpose of self-evaluation, we have divided our experience into two groups. Group 1 (learning phase) comprised the first 100 cases; Group 2 (consolidation phase) comprised cases performed after the initial learning phase. Retrospective evaluation of the case records was done to evaluate the differences in the operative and postoperative outcome. Demographic profile of the patients and relative indications of procedures performed were similar in the two groups. Mean operative time in Group 1 was 262 ± 37 min, which reduced to 184 ± 44 min in Group 2 (P < 0.001). Mean operative blood loss was 310 ± 58 ml and 198 ± 88 ml (P<0.001); and blood transfusion was required in 38% and 13.5% of patients (P<0.001) of Group i and Group 2 respectively. There was a significant reduction in the intraoperative and postoperative complications from 16% in Group i to 3.4% in Group 2 (P<0.001). Similarly, conversion to an open procedure was required in 17% cases of Group i and 5.4% cases of Group 2 (P<0.01). Laparoscopic nephrectomy is a viable option which can be performed safely with increasing experience.

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001429   Jaka R C;Shankar M (Surgery Dep, SDU Medical College and RLJ Hospital and Research Centre, Tamaka, Kolar, Karnataka-563 101, Email: rajjaka@yahoo.com) : Hernia uterine inguinale with Transverse testicular ectopia and mixed germ cell tumor. Indian J Urol 2007, 23(1), 75-6.

Persistent mullerian duct syndrome is a rare disorder characterized by the presence of uterus and fallopian tube in 46XY phenotypic males and is ascribed to defects in the synthesis or action of anti-mullerian hormone. We report a rare case of hernia uterine inguinale, transverse testicular ectopia associated with mixed germ cell tumor of the testis with metastasis. Transverse testicular ectopia should be suspected preoperatively in patients who have unilateral inguinal hernia associated with contralateral nonpalpable testis. In such cases ultrasonography should be done prior to repair of hernia to evaluate the possible presence of mullerian structures and testicular malignancy, for better management.

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001428   Jain P;Shah H;Parelkar S V;Borwankar S S (Pediatric Surgery Dep, KEM Hospital, Parel, Mumbai-400 012, Email: drsarikaprashant@rediffmail.com) : Posterior urethral polyps and review of literature. Indian J Urol 2007, 23(2), 206-7.

Urethral polyp is a rare finding in young children. Fibroepithelial polyps of the urethra are usually diagnosed during the first decade of life. They present with obstruction, voiding dysfunction and hematuria. They can be associated with other congenital urinary tract anomalies. They are usually benign fibroepithelial lesions with no tendency to recur and are treated by surgical ablation, fulguration or laser therapy.

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001427   Jain A;Bhatnagar M (Zoology Dep, Univ College of Science, M.L. Sukhadia Univ, Udaipur, Rajasthan-313 001, Email: mbhatnagar@yahoo.com) : Melatonin-a "magic biomolecule". Ann Neurosci 2007, 14(4), 108-14.

Melatonin is the pineal hormone and its activity is associated with the two known receptors-ML1 and ML2. Melatonin is an indoleamine and has found potent role in the biological regulation of circadian rhythms, sleep-mood disorders, cancer, neurodegenerative disorders and aging. Melatonin passively diffuses into bloodstream showing its maximum effectiveness. Melatonin preserves mitochondrial homeostasis, increases gene expression for antioxidant enzymes and enhances quality of life. It has proved to be a powerful antioxidant and its efficacy is particularly exhibited in neurodegenerative disorders like Alzheimer's, Parkinson's disease whose pathogenesis is associated with the cytotoxic effect of oxygen free radicals. Therapeutic trials with melatonin have been effective in slowing down the progression of some neurodegenerative disorders. Studies suggest that melatonin may have a clinical potential for the treatment of neurodegenerative disorders and many other incurable ailments.

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001426   Iyer D;Uma Devi P (Faculty, Shri Ram Institute of Technology, Near ITI, Madhotal, Jabalpur-482 002, Email: deepa2183@yahoo.com) : Phyto-pharmacology of Murraya koenigii (L.). Pharmacog Rev 0000, 2(3), 180-4.

Herbs have always been the principal form of medicine in India. Medicinal plants have curative properties due to the presence of various complex chemical substances of different composition, which are found as secondary plant metabolites in one or more parts of these plants. Murraya fcoemgii (L.) commonly known as Meethi neem, family Rutaceae, is used traditionally as antiemetic, antidiarrhoeal, febrifuge and blood purifier. The whole plant is considered to be a tonic and stomachic. The leaves are used extensively as a flavoring agent in curries and chutneys. The oil derived from the leaves is also applied externally to bruises and eruptions. The oil is also used in the perfume and soap industries. Studies indicate that it possesses antioxidant, antibacterial, anticarcinogenic, anti-lipid peroxidative, hypoglycemic and hypolipidemic properties. The pteseot-review aims to update information on its phytochemistry and pharmacological activities.

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001425   Inamdar S;Inamdar S;Patel M;Archana G (Consultant Geneticist and Specialist Fetal Diagnosis and therapy, , C-64, Sector A, Mahanagar, Email: archanasgpgi@yahoo.com) : Ambiguous genitalia: A spectrum from iatrogenic to genetic disorder, report of two cases. J Obstet Gynec India 2007, 57(3), 265-7.

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001424   Hooja N;Mital P;Gehlot M;Jindal A;Sharma U; Mahla R (NO, , A-29, Lal Bahadur Nagar, Malviya Nagar, Opp Hotel Clarks Amer, Jaipur-302 017) : Germ cell tumor of ovary. J Obstet Gynec India 2007, 57(3), 268-70.

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001423   Harnafi H;Amrani S (Laboratory of biochemistry, Biology Dep, Faculty of Sciences, 60 000 Oujda, Morocco, Email: hicham.harnafi@etu.univ-lille2.fr.) : Spectrophotometric methods for determination of plant polyphenols content and their antioxidant activity assesment: an overview. Pharmacog Rev 2008, 2(3), 20-2.

Medicinal plants, as source of remedies, are widely used as alternative therapeutic tool for the prevention or treatment of many diseases. On the other hand, despite the remarkable progress in synthetic organic chemistry, over 25% of prescribed medicines in industrialized countries derived directly or indirectly from medicinal plants. Polyphenols, are the major plant secondary metabolites and represent the most studied phytochemicals. This family includes three major classes different by their specific chemical structure, we note: tannins, flavonoids, and anthocyanins. Many epidemiological and experimental studies have shown that flavonoid intake is inversely correlated with cancer, cardiovascular and cerebrovascular disease events. In this field, a number of polyphenols from medicinal plants have been shown to protect body against effects of oxidative stress. These phytochemicals react as free radical scavenging, reducing, and metal chelating substances. In this paper we present the major colorimetric techniques used to determine polyphenol content in medicinal plant extracts and the spectrophotometric assays employed to measure their antioxidant power.

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001422   Haghdoost A A;Alexander N (NO, Kerman University of Medical Science, Physiology Research Centre, Jomh, Kerman, Iran) : Systematic review and meta-analysis of the interaction between Plasmodium falciparum and Plasmodium vivax in humans. J Vector Borne Dis 2007, 44(1), 33-43.

This study aimed to quantify the interaction between Plasmodium falciparum and P. vivax and the sources of heterogeneity between studies. Systematically reviewed three databases: Medline (1966-2001), Embase (1980-2001) and CAB-health (1976-2001). Random effects meta-analysis was applied to the data of 62 selected populations. Meta-regression was used to assess the following potential sources of heterogeneity: age-group, presence of fever, continent, temporal and spatial span of studies, and endemicity level. The summary odds ratio (OR) between P. falciparum and P. vivax was 0.6 (95% CI: 0.49-0.79). The minimum and maximum observed ORs were 0.01 and 10.9, respectively, and the heterogeneity test was highly significant (τ²= 0.92, p<0.0001) - the ORs varied over a very wide range. The ORs in longer studies and in those from areas with higher prevalence yielded smaller, more strongly negative association. This is consistent with the idea that any difference in the species' temporal patterns should decrease the OR, and more so over longer periods of time. Although such odds ratios between Plasmodium species may be partly due to missed mixed infections when reading blood slides, the negative association between the OR and prevalence supports the existence of biological interactions such as suppression or cross-immunity between species.

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001421   Gupta N P;Kumar A;Hemal A K;Dogra P N;Seth A; Kumar R (Urology Dep, All India Institute of Medical Sciences, New Delhi-110 029, Email: narmadagupta@hotmail.com) : Open nephron-sparing surgery in renal tumors with normal contralateral kidney: A single centre experience of 8 years. Indian J Urol 2007, 23(1), 18-22.

Open nephron-sparing surgery (NSS) in renal tumors with contralateral normal kidney to assess its oncological efficacy and safety. Materials and Methods: Thirty-six patients undergoing open NSS for small localized renal tumors with normal contralateral kidney from January 1998 to August 2006 were studied regarding demographic, clinical and pathological characteristics along with long-term follow-up. Results: The mean age was 48.28 ± 9.5 years. The mean tumor size was 3.72 cm (range 1.5-6], The following surgeries were performed: Wedge resection-13, partial polar nephrectomy-15, segmental resection-eight. The following techniques were used for vascular control; clamping and cooling-eight, warm ischemia-12, a novel technique of serial, encirclage-16. The mean warm ischemia time was 23.2 ± 3.2 min. The mean operating time was 190.07 ± 11.3 min. The mean estimated blood loss was 331 ± 17.4 ml. The majority of renal tumors were renal cell carcinoma (97.22%). There were no positive surgical margins. There were no major intraoperative and postoperative complications. The mean follow up was 52.1 months (range 4-80) with no case showing progression to renal insufficiency (defined as serum creatinine > 2 mg/dl). There was only one local recurrence. However, four distant metastases were reported. The five-year cancer-specific survival, recurrence-free survival and overall survival were 94.4%, 88.88% and 86.11% respectively. In patients with solitary, small localized, unilateral renal tumors with normal contralateral kidney, elective open NSS is feasible, safe and provides excellent long-term local control and oncological efficacy with functional benefits.

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001420   Gupta G;Santosh Kumar;Panicker J;Korula A (Urology Dep, Christian Medical College & Hospital, Vellore-632 004, Email: uro2@cmcvellore.ac.in) : Mixed epithelial stromal tumor of the kidney: a recently reconized entity. Indian J Urol 2007, 23(3), 326-7.

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001419   Grover S;Singh J C;Kekre N S (Urology Dep, Christian Medical College, Vellore, Email: chandrasingh@cmcvellore.ac.in) : Temsirolimus, interferon alfa or both in advanced renal-cell carcinoma: one plus one does not always equral two. Indian J Urol 2007, 23(3), 332-3.

This Phase 3 multicenter randomized trial^[1]compared interferon alone, temsirolimus alone or the combination of both for the treatment of newly diagnosed metastatic renal-cell carcinoma. From July 2003 to April 2005, a total of 626 patients were randomly assigned to one of the three study groups. Two hundred and seven were assigned to receive three million units of interferon alfa (with an increase to 18 million units subsequently) thrice weekly, 209 to receive 25 mg of intravenous temsirolimus weekly and 210 to receive a combination of interferon and temsirolimus with 15mg of temsirolimus weekly plus six million units of interferon alfa thrice weekly. Those with histologically confirmed advanced renal-cell carcinoma (Stage IV or recurrent disease) and a Karnofsky performance score of 60 or more, with no previous systemic therapy and at least three of the six predictors of short survival were included. Patients were stratified according to the geographic location of the center and whether they had undergone nephrectomy. Treatment was continued as long as there was no disease progression, symptomatic deterioration or intolerable adverse events. Required imaging studies were done before treatment and were repeated at eight-week intervals to evaluate rumor size. The primary end point was overall survival, calculated on an intention-to-treat basis. This report was the second interim analysis conducted after 446 patients had died. Median survival was 7.3 months in the interferon group, 10.9 months in the temsirolimus group and 8.4 months in the combination therapy group and the median progression-free survival times in the interferon, temsirolimus and combination therapy groups were 1.9, 3.8 and 3.7 months, respectively. The objective response rates were 4.8%, 8.6% and 8.1% among patients receiving interferon, temsirolimus and combination therapy, not differing significantly. The effect of temsirolimus on overall survival was greater among patients under 65 years of age than among older patients and among patients with a serum lactate dehydrogenase level of more than 1.5 times the upper limit of the normal range than among those with lower levels.

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001418   Groth C G (NO, Karolinska Institute, Stockholm, Sweden, Email: carl.groth@ki.se) : Potential advantages of transplanting organs from pig to man: a transplant surgeon view. Indian J Urol 2007, 23(3), 305-9.

Once pig organs can be transplanted into humans, transplantation will move into a new era. There will he unlimited access to undamaged organs and cells for transplantation and, eventually, donation from deceased or live human beings will become obsolete. Furthermore, it will be possible to alleviate graft rejection, at least in part, by genetic modification of the source animal. Currently, there are three major obstacles to performing transplantations from pig to man: i) a powerful immune barrier, 2) a potential risk of transmitting microorganisms, particularly endogenous retrovirus and 3) ethical issues related to the future recipients and to society at large. Discusses ongoing work with regards to overcoming the current obstacles. The many potential advantages of using pig organs are listed. The criteria for selecting the first patients for transplantation with pig organs, are briefly discussed. Finally, some promising observations made in the context of early attempts at transplanting porcine cells to patients, are mentioned.

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001417   Goyal N K;Abhay Kumar;Acharya R L;Dwivedi U S;Trivedi S;Singh P B;Singh T N (Urology Dep, Institute of Medical Sciences, Banaras Hindu Univ, Varansi, Email: bhuurology@yahoo.com) : Prediction of biochemical failure in localized carcinoma of prostate after radical prostatectomy by neuro-fuzzy. Indian J Urol 2007, 23(1), 14-17.

To predict biochemical failure in localized prostate cancer after radical prostatectomy using preoperative variables. Twenty-six patients of early carcinoma of prostate underwent open retropubic radical prostatectomy from June 2002 to June 2006. Preoperative variables included age, family history, digital rectal examination, serum prostatic specific antigen (S. PSA], prostate biopsy Gleason score, MRI of pelvis variables like periprostatic extension, seminal vesical invasion, weight of gland and pathological stage. With application of neuro-fuzzy, these variables were fed into system as input and output, that is S. PSA at six months (predicted value) was calculated. Neuro-fuzzy system is a system to combine fuzzy system with learning techniques derived from neural networks. Here, we applied Takagi Sugeno Rang model (TSK) due to its close solution to our aim. All the patients were followed up for a minimum of six months. At six month S. PSA of all patients was done (observed value). Predicted and observed values were compared. Predicted and observed values were plotted on 1:1 slop line. Coefficient of correlation was 0.9935. Coefficient of correlation is close to one. It indicates that the neuro-fuzzy is accurate in predicting biochemical failure in localized carcinoma of prostate after radical prostatectomy.

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001416   Gopalakrishnan G;Gouabathini S P (Urology Dep, Chrisitan Medical College, Vellore 632-004, Email: ganeshgopalkrishnan@yahoo.com) : Marginal kidney donor. Indian J Urol 2007, 23(3), 286-93.

Renal transplantation is the treatment of choice for a medically eligible patient with end stage renal disease. The number of renal transplants has increased rapidly over the last two decades. However, the demand for organs has increased even more. This disparity between the availability of organs and waitlisted patients for transplants has forced many transplant centers across the world to use marginal kidneys and donors. Performes a Medline search to establish the current status of marginal kidney donors in the world. Transplant programs using marginal deceased renal grafts is well established. The focus is now on efforts to improve their results. Utilization of non-heart-beating donors is still in a plateau phase and comprises a minor percentage of deceased donations. The main concern is primary non-function of the renal graft apart from legal and ethical issues. Transplants with living donors outnumbered cadaveric transplants at many centers in the last decade. There has been an increased use of marginal living kidney donors with some acceptable medical risks. Our primary concern is the safety of the living donor. There is not enough scientific data available to quantify the risks involved for such donation. The definition of marginal living donor is still not clear and there are no uniform recommendations. The decision must be tailored to each donor who in turn should be actively involved at all levels of the decision-making process. In the current circumstances, our responsibility is very crucial in making decisions for either accepting or rejecting a marginal living donor.

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001415   Gokhroo R K;Murthy T V;Gokhroo K (Cardiology Dep, J.L.N. Medical College, Ajmer) : Negative PQRST deflexions in lead I in a case of severe emphysema. Indian J Cardiol 2006, 9(3-4), 56-8.

A case of negative PQRST deflexion complexes in lead-I in a case of severe Emphysema. Presence of negative deflexion in lead I has not been reported in the literature in cases of Emphysema.

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001414   Gohel M;Patel P;Gupta A;Desai P (NO, , 23/A, Hastinapur Society, Karelibag, Baroda-390 018, Email: patel_purvi_k@hotmail.com) : Efficacy of tranexamic acid in decreasing blood loss during and after cesarean section: A randomized case controlled prospective study. J Obstet Gynec India 2007, 57(3), 227-30.

To study the efficacy and safety of tranexamic acid in reducing blood loss during and after the lower segment cesarean section. A randomized, case controlled, prospective study was conducted on 100 women undergoing lower segment cesarean section (LSCS). Fifty of them were given tranexamic acid immediately before LSCS were compared with 50 others to whom tranexamic acid was not given. Blood loss was collected and measured during two periods. The first period was from placental delivery to end of LSCS and second from the end of LSCS to 2 hours postpartum. Hemoglobin, urine analysis, liver and renal functions were tested in both the groups. Tranexamic acid significantly reduced the quantity of blood loss from the end of LSCS to 2 hours postpartum: 75.71 ml in the study group versus 133.03 mL in the control group (p=0.001). It also significantly reduced the quantity of blood loss from placental delivery to 2 hours post-partum: 372.71 mL in the study group, versus 469.70 ml in the control group. (P=0.003). No complications or side effects were reported in either group. Tranexamic acid significantly reduced the amount of blood loss during and after the lower segment cesarean section and its use was not associated with any side effects or complication like thrombosis. Tranexamic acid can be used safely and effectively in women undergoing LSCS.

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001413   Goel T;Thomas J;Garg S;Rao A C K (Urology Dep, KMC, Manipa, Email: drjosephthomas@yahoo.co.in) : Adrenal oncocytoma masquerading as a functional tumor. Indian J Urol 2007, 23(1), 77-8.

Adrenal oncocytoma is a rare entity, with 20 cases reported in literature. A functional oncocytoma is extremely rare. We present a case of adrenal oncocytoma in a hypertensive male who had elevated catecholamine levels, which improved after adrenalectomy with decrease in daily antihypertensive requirement.

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001412   Goel T;Reddy S;Thomas J (Urology Dep, KMC, Manipal-576-104, Email: drjosepthomas@yahoo.co.in) : Emphysematous pyelonphritis with calculus: management strategies. Indian J Urol 2007, 23(3), 250-2.

Emphysematous pyelonephritis (EPN) with calculus is well recognized but with very few reports on its treatment. Our aim is to elucidate our experience in its successful management. Over four years, authors diagnosed seven cases (eight renal units) of EPN, out of which two patients (three renal units) had EPN with urinary calculi. After the initial conservative management of EPN, the stones were tackled appropriately. EPN was initially managed effectively with antibiotics and supportive care. Once the patient was stable, the stones were cleared in a step-wise fashion. The associated postoperative complications were also tackled efficiently with preservation of renal function. In EPN with stones, ncphrectorny is not the sole option available and they can be effectively managed with open/endoscopic measures.

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001411   Godara R;Vashist M G;Singla S L;Garg P;Sen J; Mathur S K;Gupta A (NO, , 58/9J, Medical Enclave, Rohtak, Haryana-124 001, Email: drrajeshgogara@yahooi.co,uk) : Adrenal angiomyolipoma: a rare entity. Indian J Urol 2007, 23(3), 319-20.

Angiomyolipoma is apparently a part of a family of neoplasms that derive from perivascular epitheloid cells. It is a rare mesenchymal tumor, usually found in the kidney. Extrarenal angiomyolipoma is uncommon and the most common extrarenal site is the liver. Only two cases of adrenal angiomyolipoma are reported in English literature. Adds one more case to world literature. Because of its large size and symptomatic presentation of extremely rare tumor merits documentation.

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001410   Glinski R W;Siegel S (Center for Continence Care and Female Urology, Metro Urology Specialists, 2550 Univ Avenue West, Suite, 240N, St. Paul, MN 55114, Email: rglinski@mn.rr.com) : Refractory overactive bladder: beyond oral anticholinergic therapy. Indian J Urol 2007, 23(2), 166-73.

In this review, we discuss the treatment of refractory overactive bladder (OAB) that has not adequately responded to medication therapy and proposes an appropriate care pathway to the treatment of OAB. Also attempt to address the cost of OAB treatments. A selective expert review of the current literature on the subject of refractory OAB using MEDLINE was performed and the data is summarized. We also review our experience in treating refractory OAB. The role and outcomes of various treatment options for refractory OAB are discussed and combined therapy with oral anticholinergics is explored. Emerging remedies including intravesical botulinum toxin injection and pudendal neuromodulation are also reviewed, along with conventional surgical options. In general behavioral therapy, pelvic floor electrical stimulation, magnetic therapy and posterior tibial nerve stimulation (PTNS), have shown symptom decreases in 50-80% of patients with OAB. Depending on the study, combination therapy with oral anticholinergics seems to improve efficacy of behavioral therapy and PTNS in approximately 10-30%. In multicenter, long-term randomized controlled trials, sacral neuromodulation has been shown to improve symptoms of OAB and OAB incontinence in up to 80% of the patients treated. Studies involving emerging therapies such as pudendal serve stimulation suggest that there may be a 15-20% increase in efficacy over sacral neuromodulation, but long-term studies are not yet available. Another emerging therapy, botulinum toxin, is also showing similar success in reducing OAB symptoms in 80-90% of patients. Surgical approaches, such as bladder augmentation, are a last resort in the treatment of OAB and are rarely used at this point unless upper tract damage is a concern and all other treatment options have been exhausted. The vast majority of OAB patients can be managed successfully by behavioral options with or without anticholinergic medications. When those fail, neuromodulation or intravesical botulinum toxin therapies are successful alternatives for most of the remaining group. We encourage practitioners responsible for the care of OAB patients to gain experience with these options. More research is needed to assess the cost-effectiveness of various OAB treatments

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001409   Girling J S;Whitaker H C;Mills I G;Neal D E (Oncology Dep, School of Clinical Medicine, Gambridge Univ, P O Box 193, Addenbrooke's Hospital, Gambridgeshire CB2 2QQ, Email: den22@medschl.cam.ac.uk) : Pathogenesis of prostate cancer and hormone refractory prostate cancer. Indian J Urol 2007, 23(1), 35-42.

Prostate cancer is the second most common malignancy in males and the leading cause of cancer death. Prostate cancer is initially androgen dependent and relies upon the androgen receptor (AR) to mediate the effects of androgens. The AR is also the target for therapy using antiandrogens and LHRH analogues. However, all cancers eventually become androgen independent, often referred to as hormone refractory prostate cancer. The processes involved in this transformation are yet to be fully understood but research in this area has discovered numerous potential mechanisms including AR amplification, over-expression or mutation and alterations in the AR signaling pathway. This review of the recent literature examines the current knowledge and developments in the understanding of the molecular biology of prostate cancer and hormone refractory prostate cancer, summarizing the well characterized pathways involved as well as introducing new concepts that may offer future solutions to this difficult problem.

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001408   Gautam G;Rajeev Kumar (Urology and Renal Transplant Dep, Fortis Flt.Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi, Email: rajeev02@gmail.com) : Tl bladder cancer on restaging transurethral resection should be treated with immediate cystectomy. Indian J Urol 2007, 23(2), 218.

In order to evaluate the impact of pathological findings at restaging transurethral resection (TUR) on tumor recurrence and stage progression, a cohort of 352 patients with T1 bladder cancer underwent a second or restaging TUR after a two to four-week interval. All patients received induction bacillus Calmette-Guerin (BCG) therapy and 88% were followed for five years or more. Maintenance regime for BCG was not instituted in any of the patients. The median (range) follow-up was 7.5 (1-14) years. Pathological findings on restaging TUR were correlated with tumor features, recurrence rates, stage progression frequency and progression-free survival. Of the 352 patients with T1 tumors 203 (58%) had residual tumor on restaging TUR, including 92 (26%) with residual non muscle-invasive (T1) cancer. During the first five years, 66% of cases recurred and 35% progressed in stage. Recurrence and progression rates were 48% and 8% for patients with no residual tumor on restaging TUR, 69% and 37% for those with carcinoma in situ (CIS), 79% and 16% in cases with residual TaG3 tumor and 88% and 82% in patients with residual T1 tumor. Therefore, of the 92 patients with residual T1 cancer on restaging TUR, 75 (82%) progressed to muscle invasion within five years compared to 49 of 260 (19%) who had no or non T1 tumor detected on restaging transurethral resection. In a multivariate analysis of risk factors, restaging TUR pathology was the most important single determinant associated with tumor progression (Hazard ratio, HR - 6.7, P-0.000) followed by the presence of complete response to BCG at first cystoscopy performed three to six months after TUR (HR-2.7, P-0.001), presence of multiple tumors (HR-3.3, P-0.04) and high-grade tumors (HR-3.1, P-0.05). The authors concluded that restaging transurethral resection identifies patients with T1 bladder cancer who are at high risk for early tumor progression and that this finding justifies an immediate cystectomy in this group of patients to prevent an adverse outcome in the long term.

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001407   Gautam G;Khera R (Urology and Renal Transplant Dep, Fortis Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi-110 070, Email: gagangg@gmail.com) : Vaginal mucosal vaccine for recurrent urinary tract infections. Indian J Urol 2007, 23(3), 335-6.

The authors conducted a randomized double-blind placebo-controlled study to assess the clinical efficacy of vaginal mucosal immunization with a multivalent bacterial vaccine in women with recurrent urinary tract infections (UTIs). A total of 75 patients who had suffered three or more UTIs in the past one year, were randomly assigned to receive placebo only (n = 25), primary immunization without boosters (n = 24) or primary immunization plus boosters (n = 26) using vaginal suppositories containing placebo or vaccine. Vaccine suppositories contained 10 strains of heat-killed uropathogenic bacteria (a total of 10⁹ organisms from six strains of E. coli and one each of Proteus, Morganella, Klebsiella and E. fecalis in a polyethylene glycol base) and placebo suppositories had no vaccine organisms. Primary immunization consisted of three suppositories given at weekly intervals while boosters were given in three doses at monthly intervals after completion of the primary doses. All women were monitored for six months to record the number of infections and adverse events. Analysis of data on UTIs caused by any bacteria showed the greatest difference in infection rates between patients in the vaccine plus boosters protocol compared to those receiving placebo only (P = 0.100). The proportion of patients remaining infection-free during the study was 16.7% in the placebo only arm, 25% in the vaccination without boosters arm and 46% in the vaccination with boosters arm. When only E. coli UTIs were considered in the analysis, UTI recurrence rates were significantly less in women given booster immunizations compared to placebo (P= 0.0015) and vaccination without boosters as compared to placebo (P = 0.038). Thirty per cent of patients in the placebo protocol, 57% in the vaccine without boosters protocol and 72.5% in the vaccine with boosters protocol remained free of E. coli infection. When a subgroup analysis of sexually active women was performed, it was found that 72.7% (16/22) women receiving vaccine with boosters remained free of E. coli infection as compared to 17.6% (3/17) of those receiving placebo only (P = 0.0002). Furthermore, statistically significant lower E. coli infection rates were observed in vaccine-treated women with age < 52 years (P= 0.002), absence of a history of recurrent childhood UTIs (P = 0.003), greater than five UTIs in the previous year (P = 0.009), no history of a hysterectomy (P = 0.001), use of estrogen (P = 0.002) and oral contraceptive pills (P= 0.0001). A quantitative analysis of anti E. coli IgA and IgG antibodies in the urine and vaginal fluid samples collected during the course of the study did not reveal any significant differences between the three groups. There were no significant adverse events associated with vaccine treatment. The authors concluded that vaginal mucosal immunization with a multivalent vaccine is safe and efficacious in reducing recurrence of E. coli UTIs with maximal benefit seen in sexually active women in the 20 to 50-year-old age group.

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001406   Gautam G;Arora N (Urology and Renal Transplant Dep, Fortis Flt.Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi, Email: gagangg@gmail.com) : Transurethral ethanol ablation for symptomatic benign prostatic hyperplasia. Indian J Urol 2007, 23(2), 219-20.

A prospective randomized multicenter trial was conducted to assess the safety and efficacy of transurethral ethanol ablation of the prostate (TEAP) as a treatment for men with symptomatic benign prostatic hyperplasia (BPH). Seventy-nine men with a mean (range) age of 64 (50-79) years, who had drug refractory voiding symptoms (International Prostate Symptom Score, IPSS > 12) and prostate volumes of 30-80 cc as recorded by preoperative transrectal ultrasound (TRUS) were recruited. Patients with a predominant median lobe hyperplasia and those with a history of a surgical/minimally invasive procedure for BPH were excluded from the study. Ethanol was injected transurethrally into the lateral lobes of the prostate with a curved cystoscopic needle in men randomly assigned to one of the three doses: 15% (low dose), 25% (medium dose) or 40% (high dose) of prostate volume by TRUS. The mean volume of ethanol injected and the mean operating time was 14.0 ± 5.11 ml and 25 min respectively. Foley's catheter was placed after the procedure and was retained for a minimum of three days after which more than 98% of the subjects were able to void. On follow-up till six months, statistically significant improvements were seen in terms of the IPSS, quality of life (QpL) score, peak flow rate (PFR) and prostate volume reduction across all groups. In the low-dose group, IPSS, QpL score, PFR and prostatic volume improved from 22.7 ± 5.21, 4.5 ± 0.89, 8.3 ± 2.55 ml/min and 46.1 ± 15.36 cc to 12.1 ± 7.80, 2.2 ± 1.74, 11.5 ± 5.07 ml/ min and 39.8 ± 16.20 cc respectively at six months follow-up. Similar improvements were also seen in the medium-dose (IPSS 24.4 ± 5.22 to 11.0 ± 8.61, QoL 4.4 ± 1.03 to 2.2 ± 1.63, PFR 8.1 ± 2.22 to 13.5 ± 6.57 ml/min, TRUS volume 44.3 ± 13.27 to 38.7 ± 18.32cc) and high-dose (IPSS 23.7 ± 5.03 to 11.2 ± 4.88, QpL 4.2 ± 0.89 to 2.1 ± 1.19, PFR 8.6 ± 2.11 to 16.69 ± 10.73 ml/min, TRUS volume 45.2 ± 12.67 to 34.0 ± 15.98 cc) treatment groups. These improvements were consistently observed across the three groups without an apparent dose effect. Adverse events were recorded at each visit and included hematuria (41.8%), irritative voiding symptoms (39.2%), pain/discomfort (27.8%), urinary retention (21.5%) and urinary incontinence (13.9%). Of these events 75% were reported shortly after the procedure, were mostly mild to moderate in severity and typically resolved within the first four weeks, including complaints of irritative voiding. One patient required a transurethral resection (TURP) for persistent obstructive voiding symptoms while another underwent cystoscopy to extract the broken tip of œ cystoscopic needle one month after the primary procedure Prostate volume and ethanol dose did not exert any influence on the incidence and type of adverse events in this study. The authors concluded that transurethral ethanol ablation of the prostate was safe and effective in the short term and held promise as a minimally invasive treatment modality for BPH in the future.

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001405   Gaur A;Bhattacharjee A;Anupurba S;Prakash P; Sen M R;Mohapatra T M (Infection Control Unit, Microbiology Dep, Institute of Medical Sciences, Banaras Hindu Univ, Varanasi) : Clinical significance and epidemiology of multi drug resistant Acinetobacter species isolated from nosocomial infection. Indian J Prev Soc Med 2007, 38(1-2), 5-11.

The aggressive and empirical therapeutic regimen of antibiotics in the hospital settings has resulted in selection of Acinetobacter species as an important nosocomial pathogen especially with multi drug resistant (MDR) strains. In the present study, Acinetobacter spp was found to be third leading nosocomial pathogen after Pseudomonas aeruginosa and Escherichia coli. Acinetobacter species can be a causal agent of diseases like pneumonia, bacteremia, meningitis, soft tissue and urinary tract infection, associating to high mortality. An isolation rate of Acinetobacter species from nosocomial infection were found to be highest in ICU followed by post-operative ward and urology. Most of these isolates were found to be resistant to almost all available antimicrobials. The treatment of choice is carbapenems but Cefoperazone/sulbactam may be considered as an acceptable alternative. Although, other antimicrobials such as Colistin is being considered as an alternative in treating MDR Acinetobacter spp, regular surveillance along with prudent use of available antibiotics are essential to reduce the number of outbreaks in endemic situations.

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001404   Ganpule A P;Desai M R;Manohar T;Bapat S (Urology Dep, Muljibhai Patel Urological Hospital, Dr. V.V. Desah Road, Nadiad, Gujarat, Email: mrdesai@mpuh.org) : Age-specific prostate specific and prostate specific antigen density values in a community-based Indian population. Indian J Urol 2007, 23(2), 122-5.

Determines the distribution of serum prostate specific antigen (PSA) levels in a community-based population in the state of Gujarat in India. Community screening of subjects residing in Kheda and Anand districts of Gujarat was done with digital rectal examination (DRE), uroflowmetry and transabdominal sonography and serum PSA. In three villages transrectal sonography was done in addition to transabdominal sonography. All patients with a PSA of more than 4 ng/ml and/or abnormal DRE were evaluated. Biopsy-proven prostatic malignancy was detected in 20 patients. Subjects who did not follow up and who had biopsy-proven malignancy were excluded from the analysis, 1899 subjects were analyzed. One thousand seven hundred and eighty-seven (89.17%) had a PSA of < 4 ngml, 180 (8.9%) had a PSA between 4-10 ng/ml, while 37 (1.8 %) had a PSA more than long/ml. There was a statistically significant correlation between age and prostate volume (correlation coefficient 0.33) and between prostate volume and PSA (correlation coefficient 0.50). The age-specific PSA values derived as the 95th percentile value were as follows, 40-49 years (0-2.1), 50-59 years (0-3.4), 60-69 years (0-4.2) and more than 70 years (0-5.0). The 95th percentile value for PSAD was 0.19. Indians need to have separate PSA reference ranges. The age-specific PSA ranges for men in the present study population are on the lower side and the prostate specific antigen density on the higher side.

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001403   Feroze S;Singh B;Gojwari T;Manjeet S;Athar B; Hamid H (Radiodiagnosis Dep, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar-190 001, Email: hamidbanday73@yahoo.co.in) : Role of non-contrast spiral computerized tomography in acute ureteric colic. Indian J Urol 2007, 23(2), 119-21.

Evaluates the sensitivity and specificity of noncontrast helical computerized tomography (CT) in ureteric colic with comparative evaluation of KUB and ultrasonography (USG). One hundred patients aged between 20 and 75 years referred from the emergency department as acute ureteric colic were evaluated with KUB and USG followed by noncontrast helical CT. Noncontrast helical CT was 91% sensitive and 98% specific in detecting urolithiasis compared to a sensitivity of 20% and 30% for KUB and USG and specificity of 94% and 98% respectively: Noncontrast helical CT is a very sensitive and specific investigation for evaluation of acute flank pain due to urolithiasis, besides helping in the detection of nonrenal causes of pain.

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001402   El-Hazmi M M;Al-Majid F M (Pathology/Microbiology Dep, College of Medicine, King Saud University, King Khalid University Hospital, PO Box 2925, Riyadh 11461, Saudi Arabia, Email: malak_elhazmi@hotmail.com) : Needle stick and sharps injuries among health care workers: a 5-year surveillance in a teaching centre in Saudi Arabia. Biomed Res 2008, 19(2), 133-40.

Despite being recognized for many years, needle stick and sharps injuries (NSSIs) continue to present a risk of occupational exposure to blood-borne pathogens for health care works (HCWs). This study was conducted to investigate the epidemiological characteristics of needle stick and sharps injuries (NSSIs) among healthcare workers (HCWs), their follow-up and immunization status for hepatitis B virus (HBV) among injured workers in a tertiary teaching hospital in Saudi Arabia. It was a retrospective survey of all self-reported documents related to NSSIs, during the period of 5 years from 2001 to 2005. This study included 133 HCWs who reported NSSIs, nurses (45%) sustained the highest number of injuries followed by physician (26%). The majority of injuries occurred during the procedures. Analysis of the source of injuries revealed that known sources accounted for 97 injuries and unknown sources accounted for 36 injuries, most of them from garbage bags and devices left inappropriately. For injuries from known sources, 14,15 and 1 were positive for Hepatitis B surface antigen (HBsAg), antibody to hepatitis C virus (anti-HCV), antibody to human immunodeficiency virus (anti-HIV), respectively. No seroconvention to HBV, HCV or HIV infection was observed among followed-up HCWs. This data emphasized the importance of selected training and education programs for specific practicing according to the nature and area of work should be directed to each specific group of HCWs for prevention of NSSIs, in addition to have effective sero-protection against HBV through vaccination.

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001401   Dwivedi S;Avasthi R;Aggarwal A;Singh D (Medicine Dep, UCMS-GTB Hospital, Delhi-110 095) : Pregnancy associated with paroxysmal supraventricular tachycardia and electrical alternans. Indian J Cardiol 2006, 9(3-4), 52-3.

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001400   Dhar N B;Jones J S (NO, , Desk A100, 9500 Euclid Avenue, Cleveland, OH 44195, USA, Email: Nivedita.Dhar@insel.ch ) : Vasectomy: A simple ship?. Indian J Urol 2007, 23(1), 6-8.

Vasectomy is one of the most common forms of permanent sterilization methods currently in use and has a failure rate of < 1% in most reported series. Since failure of vasectomy may result in pregnancy, adequate counseling is essential. Couples are advised that an analysis of a semen specimen after vasectomy is required to confirm success before the use of alternative contraception is abandoned. However, measuring the success of vasectomy is complicated by a lack of consistency with regards to both the number and timing of tests and the end points accepted. A Medline search was used to identify manuscripts dealing with vasectomy, with specific attempts to identify protocols designed to confirm sterility. Vasectomy is one of the most reliable permanent methods of contraception. However, despite its popularity, certain issues pertaining to the procedure remain unresolved. Debate continues over the relative merits of the various techniques of isolating and sealing the vasal ends. Postoperative complication rates remain minimal regardless of the technique used, and no single strategy attempting to maximize patient compliance with postoperative semen analysis has enjoyed unmitigated success. Long-term consequences, other than regret, are rare.

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001399   Dhar M;Dwivedi S;Agarwal M P;Rajpal S; Vidholia A (Medicine Dep, UCMS-GTB Hospital, Delhi-95) : Clinical profile of coronary artery disease in women. Indian J Cardiol 2006, 9(3-4), 18-23.

Coronary artery disease (CAD) is the most common cause of morbidity and death in elderly women. Various steps have been suggested to reduce its incidence and modify its consequences. There is lack of published data on CAD in females in our country. It was therefore planned to assess the clinical profile, the risk factors, co-morbidities and short term mortality in 200 females suffering from acute coronary syndromes admitted in GTB Hospital during the period Jan 2005- June 2005. A detail clinical workup, incorporating age, smoking, socioeconomic status, ethnicity, pedigree chart, consanguinity in parents, menopause, parity, body mass index, waist hip ratio (WHR), hypertension, diabetes and dyslipidemia was made. Site of infarction and type of presentation, i.e.; ST elevation MI (STEMI), non ST elevation MI (NSTEMI), unstable angina and ECG diagnosis was recorded. The mean age of presentation of CAD in females was 59.17+10.67 years. 20(10%) females were ≥ 45 years and 27(13.5%) were premenopausal. 174(87%) were Hindus, 22(11%) Muslims and 4(2%) belonged to other ethnic groups. Mean parity among Hindus was 3.5±0.71 and that among Muslims was 7.05+2.3. Central obesity (WHR>0.85) was observed in 165(82.5%), hypertension in 117(58.5%), diabetes in 59(29.5%) and diabetes with hypertension in 37(18.5%) of cases. Increased triglyceride or decreased HDL was the dominant type of dyslipidaemia. 39(19.5%) females were smokers. Anterior wall involvement was seen in 64(32%), inferior wall in 60(30%), both territories in 10(5%), RVMI in 7(3.5%) and Non STEMI in 6(3%) of cases. Comorbid conditions like chronic obstructive airway disease, dilated cardiomyopathy and tuberculosis were found in 55(27.5%) of cases. 138(69%) were fresh cases and 62(31%) presented with recurrence. 13(6.5%) patients died within 48 hours of their initial presentation. These findings indicate that hypertension, diabetes, central obesity and smoking are important modifiable risk factors among women. Hypertension needs to be tackled more aggressively. Link between multiparity, ethnicity and CAD needs to be explored in greater depth.

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001398   Dhabalia J V;Nelivigi G G;Suryavanshi M; Kakkattil S;Singh V K (Urology Dep, KEM Hospital, Parel, Mumbai-400 012, Email: drgirishgn@yahoo.co.in) : Unusual complication of silver nitrate therapy for chyluria. Indian J Urol 2007, 23(2), 203-04.

Chyluria is a common disorder in the tropics. In our country it is most commonly managed by instillation of silver nitrate. We report a patient who developed severe perinephric hematoma due to pseudoaneurysm of renal artery following silver nitrate instillation. He was managed by angioembolisation followed by drainage of infected perinephric hematoma. Discuss various modalities of treatment of chyluria including complications of silver nitrate therapy.

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001397   Deshkar N;Tilloo S;Pande V (NO, Gurunanak College of Pharmancy, Khasra No.81/1, Mauza Nari, Behind C P Foundry, Near Dixit Nagar, Kamptee Road, Nagpur-440 026) : Comprehensive review of Rubia cordifolia Linn.. Pharmacog Rev 2008, 2(3), 124-34.

Rubia cordifolia Linn, (manjishtha) is popularly known as 'Indian Madder'. Roots are traditionally used as anti-inflammatory, astringent, tonic, antiseptic, deobstruent, antidysenteric, blood purifier. It is an important ingredient of many ayurvedic preparations. The roots are natural red dye and are very effective in purifying blood. Various chemical constituents like anthraquinones, iridoid glycoside, naphthoic acid esters, bicyclic hexapeptides, and triterpenes have been isolated and identified from Rubia cordifolia Linn. Focuseses on phytochemical, pharmacological and other important aspects of manjishtha.

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001396   Desai P (NO, , Guru Krupa, Opp. Alnkar Apartment, Dandia Bazzar, Baroda-390 001, Email: drpankajdesai@gmail.com) : Cytokines in obstetrics and gynaecology. J Obstet Gynec India 2007, 57(3), 205-9.

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001395   Deo D S;Ghattargi C H (NO, S.R.T.R. Medical College, Ambajogai-431 517) : Menstrual problems in adolescent school girls: A comparative study in urban and rural area. Indian J Prev Soc Med 2007, 38(1-2), 64-8.

Premenstrual, menstrual symptoms and disorders of menstruation were studied in 88 urban and 70 rural adolescent school girls in this cross sectional study. Loss of work hours in the form of school absenteeism due to these conditions was evaluated. Significantly more number of rural girls were free from premenstrual and menstrual symptoms. The average number of premenstrual and menstrual symptoms was almost same in both urban and rural girls. The commonest premenstrual symptom was fullness in breast and abdomen while the commonest menstrual symptom was abdominal pain. The menstrual disorders were significantly more in urban as compared to rural girls. Dysmenorrhoea was the commonest menstrual disorder. 8.33% girls remained absent from school due to some or other menstrual disorders during last menstrual period. Dysmenorrhoea was commonest menstruation related reason for school absenteeism.

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001394   Dave P K (NO, , Rockland Hospital, B-33-34, Qutab Institutional Area, New Delhi-110 016, Email: rocklandhospital@yahoo.co.in) : Spinal surgery in India : present, past and future. Ann Natn Acad Med Sci 2007, 43(3), 75-88.

During the last few decades, a lot of recent advances in spinal surgery have taken place. Spinal fusion is an extremely useful procedure to stabilize the unstable spine due to traumatic, neoplastic, congenital or degenerative conditions. Spinal instrumentation corrects deformity and reduces pseudarthrosis rates at the price of slightly increased operative complication rates. In future new implants system will continue to involve with emphasis on improved fixation, precision of insertion and safety. Prevention of deformities by education, careful screening programmes and early treatments would go a long way in proper treatment of congenital scoliosis in children.

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001393   Dasari P (Obstetrics and Gynaecology Dep, JIPMER, Pundicherry, Email: pdasari@jipmer.edu) : Vaginal delivery in large cephaloceles with good perinatal out-come. Biomed Res 2008, 19(1), 19-21.

One may encounter Cephaloceles at term or in labour especially in developing countries where a second trimester USG is not feasible for most of the women. Two such cases are reported here. Diagnostic difficulties were encounterd in both cases. In the second case the Ul-trasonographic picture resembled that of a cystic hygroma. In both cases the cephalocele was the leading part during labour and as the cephalocele was very large rupture was prevented by careful cephalocentesis in the first case. As the prognosis was guarded and chromosomal anomalies could not be ruled out, vaginal delivery was undertaken. As there is controversy regarding the mode of delivery in literature, the outcome of vaginal delivery in these two cases is reported.

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001392   Das S (NO, , 1890 Via Ferrari, Lafayette, CA 94549, USA, Email: saktidas@sbcglobal.net) : Urology in ancient India. Indian J Urol 2007, 23(1), 2-5.

The practice of medical and surgical measures in the management of urological ailments prevailed in ancient India from the Vedic era around 3000 BC. Subsequently in the Samhita period, the two stalwarts - Charaka in medicine and Susruta in surgery elevated the art of medicine in India to unprecedented heights. Their elaboration of the etiopathological hypothesis and the medical and surgical treatments of various urological disorders of unparalleled ingenuity still remain valid to some extent in our contemporary understanding. The new generation of accomplished Indian urologists should humbly venerate the legacy of the illustrious pioneers in urology of our motherland.

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001391   Dangle P P;Harrison S C W (Urology Dep, Pinderfields General Hospital, Aderford Road, Wakefield WF1 4DG, United Kingdom) : Stress urinary incontinece after male to female gender reassignment surgery: successful use of a pubo-vaginal sling. Indian J Urol 2007, 23(3), 311-13.

The case of a 50-year-old patient who had undergone male to female gender reassignment surgery is presented. She presented with mixed incontinence with symptoms of stress incontinence predominating. Initial conservative treatment was unsuccessful and subsequent videourodynamic assessment demonstrated urodynamic stress incontinence in association with a partially open bladder neck at rest. Also noted during the study was cough-induced detrusor overactivity. The option of inserting a pubo-vaginal sling using autologous rectus sheath was chosen. The procedure proved to be straightforward to perform and was uncomplicated. Subsequent follow-up demonstrated a resolution of her stress incontinence.

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001390   Dalal S J;Pandit S N;Rao S B (NO, , 9, Shree Krishna Ashish 137, Garodia Nagar, Ghatkopar (East), Mumbai-400 077, Email: sachirag@radiffmail.com) : Asymptomatic levotorsion of a gravid uterus. J Obstet Gynec India 2007, 57(3), 259-60.

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001389   Chopade V V;Phatak A A;Upaganlawar A B;Tankar A A (NO, Modern College of Pharmacy, Sector No-21, Yamuna Nagar, Nigdi Pune-411 044, Email: vi_research@rediffmail.com) : Green tea (Camellia sinensis): chemistry, traditional, medicinal,uses and its pharmacological activities. Pharmacog Rev 2008, 2(3), 157-62.

Green tea is obtained from the tea plant Camellia sinensis (L.) Kuntze (Common names: Green tea extract, Chinese tea) which belongs to the family Theaceae. Itis a widely used medicinal plant by the tribals throughout India, China and popular in various indigenous system of medicine like Ayurveda, Unani and Homoeopathy Green tea has been consumed throughout the ages in India, China, Japan, and Thailand. Following the various traditional claims on utility of this plant in curing number of diseases, considerable efforts have been made by researchers to varify its utility through scientific pharmacological screenings. In traditional Chinese and Indian medicine, practitioners used green tea as a stimulant, diuretic (to promote the excretion of urine), astringent (to control bleeding and help heal wounds), and to improve heart health. Other traditional uses of green tea include treating flatulence (gas), regulating body temperature and blood sugar, promoting digestion, and improving mental processes.

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001388   Chauhan P;Sharma R;Ashok Kumar (Chemistry Dep, School of Chemical Science, St. Johan's College, Agra-282 002) : Head hair as an indicator for assessing adverse effect of heavy metals on human health in Mainpuri region of India. Oriental J Chem 2007, 23(1), 321-4.

The Analysis of human head hair is recognized for the evaluation of one's exposure to Xenobiotics: drugs of abuse, Pharmaceuticals and pollutants. Hair analysis is a simple diagnostic technique based on the idea that hair provides vital clues about nutritional imbalances in human body. Human head hair concentrations of heavy metals from 175 subjects (92 male and 83 female) aged from 11 to 51 year in Mainpuri region has been studied by flame atomic absorption spectrophotometer. The concentrations of iron and nickel in alcoholic, smoking, vegetarian and non-tobacco consumer subjects have been found higher than that of the non-alcoholic, nonsmoking, nonvegetarian and tobacco chewer subjects. Cadmium concentrations in alcoholic, smoking, vegetarian and tobacco chewer subjects have been found higher than that of the nonalcoholic, non-smoking, non -vegetarian and non-tobacco subjects. The concentration of lead and copper in non-alcoholic, smoking, vegetarian and tobacco chewer subjects have been found higher than that of alcoholic, non-smoking, nonvegetarian and non-tobacco subjects. Zinc concentrations in non-alcoholic, non-smoking, vegetarian and non-tobacco subjects have been found higher than that of alcoholic, smoking, nonvegetarian and tobacco chewer subjects.

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001387   Chauhan A;Desai A;Patel S;Kapadia A;Garg S; Dave K (Obstetrics and Gynaecology Dep, , G/8, Sagar Apartments, Opp. Hotel Sarathi, Opp Amaltas Bunglows, Near Sandesh Press, Bodakdev Road, Ahmedabad-380 054, Email: mailto:anjanascad1@sancharnet.in) : High risk gestational trophoblastic tumors. J Obstet Gynec India 2007, 57(3), 221-6.

To evaluate the results of chemotherapy in high-risk gestational trophoblastic tumors. This is a retrospective analysis of 48 cases of high-risk gestational trophoblastic tumors (WHO scoring system) evaluated for 7 years from 1995 to 2002. All women received either EM A only/EMA+CO regimen as first-line chemotherapy (EMA only = etoposide, methotrexate, actinomycin; EMA+CO = etoposide, methotrexate, actinomycin+ cyclophophamide and vincristine). Intrathecal methotrexate was given to patients suspected of brain metastasis and as prophylaxis in women having pulmonary metastasis. Second line chemotherapy EMA+CO/EMA-EP/PVB (i.e.CP-cisplatin, etoposide, PVB-cisplatin,vinblastine,bleomycin) was given to women having poorer response to primary chemotherapy or showing progression of disease. Only 39 women could be evaluated because nine women were lost to follow-up. Of these, 24(61.5%) achieved remission with the first line chemotherapy and an additional eight (20.5%) achieved remission with second line chemotherapy. Thus complete response rate was 32/39 (82%). Toxicities of chemotherapy were evaluated. Gestational trophoblastic tumors are curable if properly scored and treated. The preferred primary chemotherapy in high-risk gestational trophoblastic tumors is EMA-CO regimen.

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001386   Chaudhary B L;Meel Veena;Tirpude B H (Forensic Medicine & Toxicology Dep, A.I.I.M.S., New Delhi) : Potassium concentration in vitreous humor in relation to time since death. Indian Internet J Forensic Med Toxicol 2007, 24(1), 26-30.

The study was carried out in the Department of Forensic Medicine and Toxicology of M.G.I.M.S., Sewagram, Wardha, Maharastra from July 2002 to March 2004. The study comprising of 106 medico-legal cases i.e. 212 ocular examinations was carried out to determine the time since death. The pilot study consisted of 62 cases where exact time since death was known and the Prof. series (test series) consisted of 44 cases. In the pilot study the 42 were male and 20 were females and in Prof series the 27 cases were males and the 17 were females. Out of 106 cases 69 cases were males and 37 were females. The male: female ratio was 1.8: 1. It is seen in both the study groups that the vitreous humor potassium concentration increase is directly proportional to the increase in postmortem interval (linear arithmetic relationship).

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001385   Cain J H;Baggott C;Tilghman J I;Rajpal S; Mirapuri G S;Resnick D K (Neurological Surgery Dep, Univ of Wisconsin School of Medicine and Public Health K4/834 Clinical, 600 Highland Ave Madison, WI 53792, Email: resnick@neurosurg.wisc.edu) : Recent developments in the study of spinal cord injury and neuropathic pain. Ann Neurosci 2007, 14(4), 96-107.

Spinal cord injury (SCI) represents a profound clinical problem for which there exists limited effective therapy. The clinical management of SCI is frequently complicated by the subsequent development of chronic neuropathic pain syndromes. The pathogenesis of central neuropathic pain following SCI is unclear, although evidence exists for the involvement of a diverse range of factors. Key mediators of neuropathic pain include the inflammatory process, excitatory neurotransmitters, opioid and cannabinoid receptors, and ion channel activity. Recent studies conducted in animal models have yielded promising results for the development of neuropathic pain therapies that target these mediators, but clinical results have been disappointing. Provides an overview of current animal models of SCI and neuropathic pain, discusses recent advances in the study of the aforementioned neuropathic pain mediators, and reviews the current clinical treatment of neuropathic pain with emphasis on areas that show promise for future investigation.

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001384   Buckshee K;Parveen S;Roy P K;Banerjee K (NO, , Woman Clinic, House No. 46, Sec 15A, Noida-201 301, Email: kamalb@del6.vsnl.net.in) : Pursuit of obstetrics and gynecology over two decades. Ann Natn Acad Med Sci 2007, 43(3), 103-14.

In the pursuit of fetus as a patient we designed instruments, developed new techniques and evaluated their feasibility, safety and efficacy in patients seeking MTP and in cases referred for prenatal diagnosis in late 80's. at AIIMS. Percutaneous ultrasound guided needle aspiration of umbilical cord vessel aided in the diagnosis of various fetal disorders, infections, karyotyping and enzyme deficiency. As it provided access to fetal circulation it was used for intrauterine intravascular blood transfusion for Rh isoimmunized pregnancies and in cases of non-immune hydrops fetalis. A minimally invasive unreported method of percutaneous ultrasound guided fine needle system was used to obtain fetal skin biopsies for diagnosis and management of several devasting skin disorders. Technique of ultrasound guided transabdominal chorion villus sampling was also developed and evaluated. These new techniques provided direct access to the fetus and were of immense value in assessing and managing the unborn fetus. Uterine balloon therapy was evaluated for the first time in India on hysterectomy specimens, patients undergoing hysterectomy for menorrhagia and those not responding to drugs. Our study indicated that UBT is simple, safe and effective and reduced uterine bleeding in 92.3% of patients with menorrhagia. Invitro tissue culture and sensivity test was carried out to predict response of human ovarian cancer and choriocarcinoma cells to select the right anticancer drug on an individual basis. The invitro tissue culture and sensivity test provided the choice of the best drug(s) and the overall prognoses of patients with advanced malignancy could be improved. A new minimally invasive technique for the termination of a pregnancy associated with large and multiple fibroids was also developed. Therapeutic evaluation of Aldactone, Cimetidine and Cyperoterone acetate, and OCP was undertaken for the treatment of hirsutism. Our study on effectiveness of the various drugs in the treatment of hirsutism indicated that hair growth decreased substantially by > 6 points for inpatients treated with Cyperoterone acetate alone or with Aldactone.

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001383   Buchler T;Harland S J (Oncology Dep, , 1st Floor Central, UCLH, 250, Euston Road, London, NW1 2PG, Email: stephen.harland@uclh.nhs.uk) : Chemotherapy for hormone-resistant prostate cancer: where are we today?. Indian J Urol 2007, 23(1), 55-60.

Significant progress has been achieved in chemotherapy for hormone-resistant prostate cancer (HRPC) in the last five years. Although the disease was long considered to be chemoresistant, docetaxel-based regimens in particular have been shown to both palliate symptoms and prolong survival in HRPC patients. Docetaxel is now considered the best available chemotherapy for prostate cancer progressing on first-line hormonal treatment. Other cytotoxics including mitoxantrone, anthracyclines, vinorelbin and vinblastine can alleviate symptoms and improve progression-free survival in HRPC without affecting overall survival. The survival benefit from chemotherapy seen in randomized studies has been small or nonexistent. Results of a recent trial suggest that the survival benefit may have been underestimated as a result of crossover from the less active to the active arm.

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