Postoperative topical analgesia of hemorrhoidectomy with policresulen and cinchocaine: a prospective and controlled study / Analgesia tópica com policresuleno e cinchocaína no pós-operatório de hemorroidectomias: um estudo prospectivo e controlado

OBJECTIVE: To evaluate the effects of topical policresulen and cinchocaine in the postoperative pain behavior of open hemorrhoidectomy. METHODS: We conducted a prospective, double-blinded, controlled study. The control group received the usual guidelines with oral medications. The topical treatment group received, in addition, the application of the ointment and was comprised of two subgroups (policresulen + cinchocaine, and placebo). Pain intensity was recorded with the visual analogue scale. RESULTS: 43 patients were operated on: control group - n = 13, one excluded; placebo - n = 15; and policresulen + cinchocaine - n = 15. The mean age was 45.98 years and 37.2% were men. The average pain intensity was 4.09 (immediate postoperative), 3.22 (hospital discharge), 5.73 (day 1) , 5.77 (day 2), 5.74 (day 3), 5.65 (day 7), 5.11 (day 10), 2.75 (day 15) and 7.70 (first bowel movement), with no difference between groups in all periods. CONCLUSION: This study showed no reduction in pain after hemorrhoidectomy with the use of topical policresulen and cinchocaine. .

OBJETIVO: avaliar a ação do policresuleno e cinchocaína tópicos no comportamento da dor no pós-operatório de hemorroidectomias abertas. MÉTODOS: estudo prospectivo, duplo cego e controlado. O grupo controle recebeu as orientações usuais com medicações de uso oral. O grupo de tratamento tópico recebeu, adicionalmente, a aplicação de pomada e foi composto de dois subgrupos (policresuleno + cinchocaína; e placebo). A intensidade da dor foi registrada a partir da escala visual analógica. RESULTADOS: foram operados 43 pacientes: grupo controle (n=13; um excluído), placebo (n=15) e policresuleno + cinchocaína (n=15). A média de idade foi 45,98 anos e 37,2% foram homens. A média da intensidade da dor foi 4,09 (PO imediato), 3,22 (alta hospitalar), 5,73 (dia 1), 5,77 (dia 2), 5,74 (dia 3), 5,65 (dia 7), 5,11 (dia 10), 2,75 (dia 15) e 7,70 (primeira evacuação), sem diferença entre os grupos em todos os períodos estudados. CONCLUSÃO: este estudo não demonstrou redução da dor após hemorroidectomias como o uso do tratamento tópico. .

Synergistic effect of iontophoresis and chemical enhancers on transdermal permeation of tolterodine tartrate for the treatment of overactive bladder

Purpose The objective of the study was to evaluate the synergistic transdermal permeation effect of chemical enhancers and iontophoresis technique on tolterodine tartrate (TT) transdermal gel and to evaluate its pharmacokinetic properties. Materials and Methods Taguchi robust design was used for optimization of formulations. Skin permeation rates were evaluated using the Keshary-chein type diffusion cells in order to optimize the gel formulation. In-vivo studies of the optimized formulation were performed in a rabbit model and histopathology studies of optimized formulation were performed on rats. Results Transdermal gels were formulated successfully using Taguchi robust design method. The type of penetration enhancer, concentration of penetration enhancer, current density and pulse on/off ratio were chosen as independent variables. Type of penetration enhancer was found to be the significant factor for all the responses. Permeation parameters were evaluated when maximum cumulative amount permeated in 24 hours (Q24) was 145.71 ± 2.00µg/cm2 by CIT4 formulation over control (91.89 ± 2.30µg/cm2). Permeation was enhanced by 1.75 fold by CIT4 formulation. Formulation CIT4 containing nerolidol (5%) and iontophoretic variables applied (0.5mA/cm2 and pulse on/off ratio 3:1) was optimized. In vivo studies with optimized formulation CIT4 showed increase in AUC and T1/2 when compared to oral suspension in rabbits. The histological studies showed changes in dermis indicating the effect of penetration enhancers and as iontophoresis was continued only for two cycles in periodic fashion so it did not cause any skin damage observed in the slides. Conclusion Results indicated that iontophoresis in combination with chemical enhancers is an effective method for transdermal administration of TT in the treatment of overactive bladder. .

Effectiveness of tolterodine in nonneurogenic voiding dysfunction.

The efficacy of tolterodine was analysed in children with non-neurogenic voiding dysfunction, using dysfunctional voiding symptom score (DVSS). Of 44 patients (mean age 9.3 yrs; M:F = 25:19), 36 received long acting tolterodine tartrate at a dose of 2mg OD and 8 at a dose of 4mg OD. The mean (SD) DVSS before and after the treatment was 17.1 (2.8) and 12.0 (2.4). There was a significant improvement in the mean DVSS score at the end of the treatment (Students t test P < 0.01). The dysfunctional symptoms were cured in 28(63.6 %), improved in 14(31.8 %) and failed to show improvement in 2 (4.6 %). Over all 95 % were compliant with the single daily medication. Our results demonstrate that long acting tolterodine is effective in children with voiding dysfunction. The single daily dose has good compliance and minimal side effect profile.

Tratamento näo-cirúrgico das fístulas de ducto mamário / Non-surgical treatment of mamary duct fistula

Pacientes com fístula mamária foram tratadas de modo näo cruento pela injeçäo local de soluçäo a 1:1 de Lugol + polímero ácido metacresolsufônico a 36%, mediante cateterizaçäo do trajeto fistuloso. Foram estudadas 18 pacientes. Expöem-se a técnica utilizada, analisam-se os resultados baseado no seguimento e conclui-se pela validade deste novo método terapêutico