Comparison of transvaginal sacrospinous ligament fixation with abdominal sacrocolpopexy in treatment of post-hysterectomy vault prolapse-a prospective randomized study

Background: Vaginal vault prolapse is a common condition following abdominal or vaginal hysterectomy causing negative impact on women’s quality of life. The study compares the efficacy of abdominal and vaginal route surgery in correcting post-hysterectomy vault prolapse by postoperative assessment and at least twelve months follow up.Methods: A prospective comparative study among post-hysterectomy patients attending the GOPD of Midnapore Medical College diagnosed as vaginal vault prolapse at least stage2 between January 2013 to December 2019. The study population included 31 women divided into two groups-group A included 16 women underwent unilateral sacrospinous ligament fixation (SSF) and group B included 15 women underwent abdominal sacrocolpopexy (ASC).Results: There was no significant difference between the two groups in terms of mean age, mean weight, mean parity and BMI, hence both groups are comparable. The mean operating time was 117±19.68 min in ASC group and 83.25±11.28 min in SSF group (p<0.005); significant mean blood loss was reported in ASC group (373±97.79 ml in ASC group versus 193.125±98.97 ml in SSF group, p<0.005), more hospital stays in ASC group (p<0.005) and more post operative complications in ASC group than SSF group. At follow up, the mean vaginal length showed significantly longer for ASC group than that of SSF group (p<0.005).Conclusions: ASC and SSF, both techniques are effective in management of vault prolapse in hands of an expert though recovery time is much quicker in SSF group.

Studies on Molecular Mechanisms Associated with Narcotic Addiction

The term addiction is used in many contexts to describe an obsession, compulsion or excessive psychological dependence. Addiction is the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, to such an extent that its cessation causes severe psychological or physical discomfort. According to definition by the Diagnostic and statistical manual of mental disorders, 4th edn. [DSM-IV-TR], American Psychiatric Association (1994), addiction is assumed to be identical to the syndrome of substance dependence. Nestler, the pioneer of work on addiction, defines addiction as a “complex phenomenon with important psychological and social causes and consequences’ [Nestler and Aghajanian, 1997]. According to the definition related to the use of opioids for the treatment of pain, jointly issued by ‘The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine in 2001’, addiction is a “neurobiological, compulsive disorder in which an individual becomes preoccupied with obtaining and using a substance-- and experiences a lack of control over using that substance -- despite continued use that results in a decreased quality of life and significant adverse consequences.” Addiction can be broadly classified into two major forms, namely substance and process. Substance addiction constitutes addiction to substances or drugs like nicotine, alcohol, opioids, stimulants etc. Process or behavioural addiction occurs where a person is repeatedly engaged to a typical activity, like video game, work, computer, shopping, gambling, social networking, etc. It is increasingly clear from recent studies that many of these behavioural addiction phenomenons in individuals have similar symptoms of substances addiction and undergo the same consequences brought about by addiction to alcohol and drugs. Surprisingly, “non-substance related behavioral addiction” was not listed in either of the two internationally used diagnostic manuals of mental disorders, DSM-IV-TR and International Classification of Disease