No clear consensus exists on how to best prevent severe headache from occurring after accidental dural puncture. We conducted a quantitative systematic review to identify all available evidence for the prevention of postdural puncture headache (PDPH) and included 17 studies with 1264 patients investigating prophylactic epidural blood patch (PEBP), epidural morphine, intrathecal catheters, and epidural or intrathecal saline. The relative risk (RR) for headache after PEBP was 0.48 [95% confidence interval (CI): 0.23-0.99] in five non-randomized controlled trials (non-RCTs) and 0.32 (0.10-1.03) in four randomized controlled trials (RCTs). The RR for epidural morphine (based on a single RCT) was 0.25 (0.08-0.78). All other interventions were based on non-RCTs and failed statistical significance, including long-term intrathecal catheters with an RR of 0.21 (0.02-2.65). There are a number of promising options to prevent PDPH, yet heterogeneity between the studies and publication bias towards small non-RCTs with positive results limits the available evidence. Thus, a large multicentre RCT is needed to determine the best preventative practices.

Objective. Aim of this audit was to analyze indications, complications, and correlation of preoperative diagnosis with final histopathology report of all hysterectomies, performed in a premier teaching hospital. Methods. Present study involved all patients who underwent hysterectomy at a premier university hospital in Southern India, in one year (from 1 January, 2012, to 31 December, 2012). Results. Most common surgical approach was abdominal (74.7%), followed by vaginal (17.8%), and laparoscopic (6.6%) hysterectomy. Most common indication for hysterectomy was symptomatic fibroid uterus (39.9%), followed by uterovaginal prolapse (16.3%). Overall complication rate was 8.5%. Around 84% had the same pathology as suspected preoperatively. Only 6 (5 with preoperative diagnosis of abnormal uterine bleeding and one with high grade premalignant cervical lesion) had no significant pathology in their hysterectomy specimen. Conclusion. Hysterectomy is used commonly to improve the quality of life; however at times it is a lifesaving procedure. As any surgical procedure is associated with a risk of complications, the indication should be carefully evaluated. With the emergence of many conservative approaches to deal with benign gynecological conditions, it is prudent to discuss available options with the patient before taking a direct decision of surgically removing her uterus.

Neutron scattering experiments are used to determine scattering profiles for aqueous solutions of hydrophobic and hydrophilic amino acid analogs. Solutions of hydrophobic solutes show a shift in the main diffraction peak to smaller angle as compared with pure water, whereas solutions of hydrophilic solutes do not. The same difference for solutions of hydrophobic and hydrophilic side chains is also predicted by molecular dynamics simulations. The neutron scattering curves of aqueous solutions of hydrophobic amino acids at room temperature are qualitatively similar to differences between the liquid molecular structure functions measured for ambient and supercooled water. The nonpolar solute-induced expansion of water structure reported here is also complementary to recent neutron experiments where compression of aqueous solvent structure has been observed at high salt concentration.Interest in the structural organization of the solvent within the hydration shell of amino acid side chains arises partly from questions related to the thermodynamic and structural explanations of the hydrophobic interaction between nonpolar side chains. Much thermodynamic evidence is conventionally interpreted as indicating a differently organized structure of the water that is in contact with a nonpolar solute as compared with the pure liquid (1, 2). As one example, there is a significant increase in heat capacity when proteins are unfolded or when hydrophobic compounds are dissolved in water, and this change in heat capacity is a linear function of the area of the hydrophobic surfaces (3, 4). The large and positive heat capacity change is normally attributed to the extra heat needed to "melt" the ordered water structure near hydrophobic groups exposed to water. As a second example, departures from ideality in the observed freezing-point depression of aqueous solutions of amino acids support the picture that there are significant structural changes within the hydration shell of amino acid side chains (5). Once again, the observed effect (in this case, nonideality) is a linear function of the exposed surface area.The relationship between water structure and the hydrophobic effect has also been the subject of a number of theoretical studies (6, 7) and computer simulations (8-13) on a number of model side chain solutes. Structural analyses of the simulation data indicate that water retains its hydrogenbonded network by "straddling" the surface of the nonpolar group with three of its four tetrahedral hydrogen bonds, with the fourth bond pointing away from the hydrophobic surface. Neutron scattering experiments have provided confirmation of this view, where water molecules are observed to lie roughly tangential to the surface of the nonpolar solute (14, 15). Further experimental evidence for a hydrogen-bonded hydration shell around hydrophobic groups is found in the x-ray crystal structures of clathrate compounds (16). In these solid, crystalline hydrates, water molecules are organized completely into hydrogen-bonded polygons that ...

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