Abstract : ABSTRACT To evaluate the diagnostic accuracy of transvaginal sonography (TVS) with Doppler compared to histopathological examination in diagnosing endometrial pathology in patients with postmenopausal bleeding; to determine whether the number of diagnostic dilatation and curettage (invasive) can be reduced by TVS (non-invasive) examination. 100 women were selected by Simple Random Sampling method, satisfying the inclusion criteria from January 2015 to June 2016. After obtaining written informed consent and detailed clinical examination TVS with doppler followed by dilatation and curettage were done and specimen were sent for histopathological examination. Patients with postmenopausal bleeding were included and those on Hormone Replacement Therapy, with bleeding disorders, known cases of malignancies, cervical polyp were excluded from the study. Statistical analysis was done for these parameters. TVS with Doppler parameters had sensitivity of 72.92% and specificity of 57.69% as a diagnostic tool in order to detect endometrial hyperplasia and endometrial carcinoma in such patients. It had a positive predictive value of 61.40% and negative predictive value of 69.77% with capability of diagnosing endometrial pathology with an accuracy of 65%. 48 patients had endometrial atrophy. There is a high incidence of endometrial atrophy in patients presenting with postmenopausal bleeding. The relatively good sensitivity and accuracy of TVS with doppler in detection of endometrial pathology encourage us to suggest that it can be utilized as a first line investigation in these patients to rule out endometrial hyperplasia or endometrial cancer. Keywords: Transvaginal Sonography, doppler, postmenopausal bleeding, endometrial pathology or cancer

Keyword : Transvaginal Sonography, doppler, postmenopausal bleeding, endometrial pathology or cancer

Abstract : ABSTRACT A comparative study was conducted for evaluating the efficacy of two different class of drugs in patients undergoing lower abdominal surgery with spinal anesthesia. A total 50 patients belonging to ASA grade I & II were randomly divided into 2 groups with each group comprised of 25 patients. After obtaining clearance from the department’s ethical committee, the patients were explained about the study and a written informed consent was obtained from all the participants. For Group I patients Midazolam was administered in 100 ml saline whereas Group II subjects were supplied with intravenous Dexmedetomidine 5 μg per Kg in 100 ml normal saline infused over 20 minutes. Continuous data was represented as mean, median and standard deviation. Independent ‘t test’ or Mann Whitney U test was used as test of significance to identify the mean difference between two groups. Paired ‘t test’ or Wilcoxon Signed Rank test was used as test of significance to determine paired data such as before and after surgery. P value < 0.05 was considered as statistically significant. The mean age of study subjects supplied with Midazolam and Dexmedetomidine group were found to be 41.32 ± 8.46 and 37.76 ± 12.16 respectively. Majority of the subjects in both the groups were females with the mean weight found in Midazolam and Dexmedetomidine group were 68.6 ± 12.12 and 64.16 ± 7.94 respectively. Dexmedetomidine was found to be superior in all aspects except for the fact that it produced biphasic response and bradycardia. Keywords: Comparative study; Spinal anaesthesia; Preoperative Anxiety; Midazolam; Dexmedetomidine; Sedation.

Keyword : Spinal anaesthesia; Preoperative Anxiety; Midazolam; Dexmedetomidine; Sedation

Abstract : ABSTRACT Milrinone is commonly used during cardiac surgeries to decrease pulmonary arterial pressure. When it is used in inotropic doses it decreases systemic vascular resistance (SVR) and leads to systemic vascular hypotension. This may lead to initiation of vasoconstrictor drugs such as nor-adrenaline, vasopressin or terlipressin. The aim of the present study was to evaluate and compare the effect of vasopressin versus terlipressin in prevention of milrinone induced hypotension and to see the effect on pulmonary vascular resistance. After obtaining informed written consent & approval of ethics & research committee patients who were scheduled for mitral valve replacements (MVR), Aortic valve replacement (AVR), or Dual valve replacement (DVR) with pulmonary arterial hypertension (PAH) were included in the study. Patients were divided into two groups randomly by using a computer generated randomized block design namely group A (n=20) Terlipressin group & group B (n=20) vasopressin group. 10 minutes after initiation of milirinone after rewarming and weaning from CPB group A patients were started on terlipressin infusion at a rate of 2ug/kg/hr & group B patients were started on vasopressin infusion at a rate of 0.02u/min. Infusions in both the groups were continued for 24 hrs in the post-operative period. Hemodynamic measurements were taken at induction of anesthesia, 10 min after start of milrinone infusion, at the end of surgery before shifting the patient to ICU. In the post-operative period these hemodynamic parameters were measured every 6 hourly in the first 24 hrs. At baseline both the systemic & pulmonary hemodynamic variables were similar in both the groups after the induction of anesthesia, 10 minutes after the initiation of milrinone injection the mean arterial pressure in group A decreased from 77.56± 4.5 to 53.21±2.1 & in group b it decreased from 76.46±3.3 to 52.11±1.1 (p≤0.05) which was statistically significant in both groups 10 min after initiation of milrinone which was statistically significant (p≤0.05). When the duration of mechanical ventilation, duration of ICU stay and duration of hospital stay were compared between the two groups there was no significant statistical difference between the groups From our study we concluded that when terlipressin is used to treat milrinone induced hypotension it reverses the systemic hypotension with lesser effect on pulmonary vascular resistance when compared to vasopressin Keywords: SVR: systemic vascular resistance, PVR: Pulmonary vascular resistance, MVR: mitral valve replacement, AVR: Aortic valve replacement, DVR: Dual valve replacement PAH: pulmonary arterial hypertension

Keyword : SVR: systemic vascular resistance, PVR: Pulmonary vascular resistance, MVR: mitral valve replacement, AVR: Aortic valve replacement, DVR: Dual valve replacement PAH: pulmonary arterial hypertension