Relieving perineal pain after perineorrhaphy by diclofenac rectal suppositories: a randomized double-blinded placebo controlled trial.

BACKGROUND: Perineal pain after episiotomy is a common problem following vaginal birth. The pain affects either physical or mental function negatively. There are many methods in perineal pain relief such as local ice pack and a bath, ultrasound, oral anesthesia, and intravenous anesthesia. Analgesic rectal suppository is one of various methods in pain relief especially in drowsy patients, or when oral preparation causes gastric discomfort, nausea or vomiting. OBJECTIVE: To assess the effectiveness of diclofenac rectal suppositories for relief perineal pain after perineorrhaphy. DESIGN: A randomized double-blinded placebo controlled trial. MATERIAL AND METHOD: Seventy-two term, singleton, pregnant women who gave vaginal birth with second to third degree episiotomy tears were randomized with envelop concealment to either diclofenac or placebo rectal suppositories group. Each group received two tablets of 50 mg diclofenac or two tablets of look-alike placebo rectal suppositories. Visual analogue scale was used for scaling pain score before administration of the medications, and at 30 minutes, 1, 2, 12, and 24 hours after administration. RESULTS: No differences were found in the median pain scores before administration of medications and at 30 min, 1 hour and 2 hour after administration (p > 0.05), while the median pain scores were significantly reduced in the diclofenac group at 12 and 24 hours after administration compared to the control group (4.5 vs. 0.0; p < 0.001 and 2.0 vs. 0.0; p = 0.02 for 12 hours and 24 hours, consecutively). CONCLUSION: The present study suggested that diclofenac suppository was effective on reducing perineal pain after episiotomy, especially at 12 and 24 hours after administration.

Effect of red chillies on small bowel and colonic transit and rectal sensitivity in men with irritable bowel syndrome.

BACKGROUND: Altered motility and threshold for pain have been incriminated in the pathogenesis of the irritable bowel syndrome (IBS). Capsaicin affects visceral sensory perception and chillies, which contain capsaicin, have been shown to accelerate gut transit. AIMS: To evaluate the effect of red chillies on small bowel transit (SBT) and colonic transit (CT) and rectal sensitivity in normal men and men with IBS. METHODS: Twenty-nine men with IBS diagnosed using Manning's criteria, and 21 healthy men, were studied before and after ingestion of 10 g red chilli powder (capsaicin equivalent 14 mg). SBT time was measured as the time taken for 99mTc-sulfur colloid to reach the cecum after leaving the stomach. Total and segmental CT times were assessed using radio-opaque markers. Rectal sensitivity and pain threshold to intrarectal balloon distension were measured. RESULTS: The median (range) bowel frequency in patients and healthy men was 2 (1-6) and 1 (1-3) per day (p=0.03), respectively. After ingestion of chillies, it increased to 3 (1-8) per day and 2 (1-4) per day (p=0.01), respectively. There was no difference in transit times between patients and healthy men; chilli ingestion did not alter SBT time, total or segmental CT time. IBS patients had a lower threshold to balloon distension for both discomfort and pain in the basal state (p<0.01). Chillies increased this threshold in healthy men (p<0.01). CONCLUSIONS: Men with IBS do not have SBT or CT abnormalities, but have a lower rectal balloon sensitivity threshold. Chilli powder does not alter either SBT or CT in men with IBS or healthy men; however, it increases the rectal threshold for pain in the latter.

A randomised bouble-blind placebo controlled trial of lidamidine HCL in irritable vowel syndrome

BACKGROUND: We have previously shown electro-mechanical recto-anal alterations in irritable bowel syndrome patients (Awad R. Neurogastroenterol Motil 1993; 5; 265-271). To assess whether the alpha 2-agonist lidamidine HCL is able to modify these physiological alterations and alleviate clinical symptoms, 50 patients with irritable bowel syndrome were studied in a random, double blind, placebo-controlled trial. METHODS: Lidamidine HCL (4 mg) or placebo was taken orally t.i.d. with food. Fasting and post-prandial electrical and mechanical activities of rectum and internal anal sphincter were recorded before and at the end of treatment. Recto-anal sensitivity was also tested. RESULTS: After treatment, post-prandial duration of spontaneous recto-anal inhibitory reflex diminished in the lidamidine group (18.9 +/- 1 vs. 15.1 +/- 1.3 sec; p < 0.05). Amplitude of induced rectoanal inhibitory reflex decreased after lidamidine (24.6 +/- 2.9 vs 17.3 +/- 3 mmHg; p = 0.02). Rectal electrical activity showed no changes during basal and post-prandial periods in any group. Rectal painful sensation decreased after treatment with lidamidine (54.8 +/- 5.4 vs 43.6 +/- 3.5 ml; p < 0.05) as well as with placebo (p < 0.05). Abdominal distension and requency, severity and duration of pain diminished in both groups (p < 0.05). CONCLUSION: Lidamidine decreased the augmented mechanical response to food, reduced rectal sensitivity, and relieved symptoms. These facts suggest that in spite of the strong placebo response obtained, lidamidine HCL can become a useful alternative for treatment of patients with irritable bowel syndrome.

Estudio Toxicológico de un producto derivado de la Caña de Azúcar / Toxicity study of a product derived from sugar cane

Se presentan los resultados obtenidos en la evaluación toxicológica preclínica de un principio activo formulado en crema con propiedades cicatrizantes y antifúngicas a partir de un producto natural derivado de la caña de azúcar, al cual se le determinó su inocuidad en animales de experimentación mediante la estimación de la dosis letal media en conejos F1 y ratas albinas Wistar, utilizando niveles de dosis elevados. También se estudió el potencial irritante sobre la piel, mucosa ocular, vaginal y rectal, así como su potencial como agente sensibilizante. De forma general los síntomas tóxicos observados no fueron significativos y desaparecieron en un período corto, no se presentó mortalidad y se comprobó la ausencia de efectos irritantes sobre la piel y mucosas evaluadas. Se demostró que el producto no es un agente sensibilizante. Los resultados obtenidos en el estudio realizado permiten clasificar al producto de una baja toxicidad

Reduction of post-prandial motility by pinaverium bromide a calcium channel blocker acting selectively on the gastrointestinal tract in patients with irritable bowel syndrome

Background: Growing evidence points to irritable bowel syndrome physiologically as a disease of the enteric nervous system characterised by hypermotility. The aim of this study was to investigate the action of pinaverium bromide a calcium channel blocker acting selectively on the gastrointestinal tract on basal and post-prandial recto-anal motility of 40 irritable bowel syndrome patients in a random, double blind and placebo controlled trial. Methods: Pinaverium bromide (50 mg) or placebo was taken orally t.i.d with food. Myoelectrical and mechanical activities of the rectum and the internal anal sphincter were recorded before treatment for 2 h in the fasting state and for an additional 2 h post-prandial. Results: Post-prandial rectal spike amplitude and frequency as well as the spontaneous recto-anal inhibitory reflex frequency decreased after pinaverium bromide (P < 0.01) but not after placebo. Conclusions: These results suggest that the calcium channel blockers acting selectively on the gastrointestinal tract may have a therapeutic role in patients with irritable bowel syndrome.

Effect of metoclopramide on the rectosigmoid activity in some systemic diseases

The pattern of the recto-sigmoidt myoelectrical activity [MEA] before and after I.V. injection of metoclopramide [0.15 mg/kg] was investigated in normal subjects, in patients with diabetes mellitus [DM], chronic renal failure [CRF], systemic lupus erythematosus [SLE] and scleroderma. In addition, the effect of the drug on patients with autonomic neuropathy [AN] due to DM and CRF was also studied. Furthermore, serum gastrin and plasma vasoactive intestinal polypeptide [VIP] were also estimated in all groups. The present study demonstrated that the pattern of rectosigmoid MEA in DM [Type I and II] and CRF under conservative treatment was not significantly different from that of the normal subjects. One the other hand, in patients with CRF under peritoneal dialysis and in patients with SLE there was a special pattern of MEA characterized by slow waves [SW] composed only of high frequency rhythm [HFR] and could be differentiated from each other by the significantly higher amplitude of the SW in CRF. Conversely, the pattern of MEA in patients with scleroderma was composed only of SW of LER [low frequency rhyhm]. The serum gastrin level was significantly increased in both types of DM and CRF patients while the plasma VIP was significantly increased in type 1 DM, CRF and scleroderma. Metoclopramide has uniform effect in various groups despite the presence or absence of AN. This effect is manifested by significant increase of the LER on the expense of the HER, significant increase in the amplitude of the SW. In patients with SLE and scleroderma, metoclopramide decreased the number of spikes minute. It is concluded that systemic disease can produce a constant and reproducible pattern of rectosigmoid MEA. Metoclopramide produces uniform changes in this MEA regardless of the presence or absence of AN denoting effectiveness of its use in such cases

Pharmacological screening of few new 2-(substituted acetyl) amino-5-alkyl-1,3,4-oxadiazoles.

Nine new 2-(substituted acetyl) amino-5-alkyl-1,3,4-oxadiazoles were synthesised and confirmed on the basis of IR and nitrogen analysis. These were screened for spasmolytic, anti-inflammatory and their effects on blood pressure after determining ALD50. Compounds GK-4 i.e. 2-(diethylaminoacetyl)- amino-5-methyl-1,3,4-oxadiazole and GK-8 i.e. 2-(din-propylamino acetyl)-amino-5-ethyl-1,3,4-oxadiazole were found to be spasmolytic. Compound GK-6 i.e. 2-(diethylaminoacetyl)-amino-5-n-propyl-1,3,4-oxadiazole was found to be a potent hypotensive agent with the effect lasting for more than two hours.

Presence of acethylcholine in the fruit of Physalis angulata (Solanaceae)

Acetilcolina foi encontrada no fruto da Physalus abgykata (Solanaceae), planta popularmente conhecida como camapu ou baläozinho, sua identificaçäo foi baseada nas seguintes observaçöes: a) contraçäo isotônica no reto anterior do sapo; b) efeito inotrópico e cronotrópico negativo no coraçäo isolado do sapo; c) contraçäo isotônica no jejuno do rato; d) hipertensäo arterial no gato. Essas açöes foram bloqueadas seletivamente pela galamina ou atropina e desapereceram pela incubaçäo do extrato com o plasma a 37-C. Além disso, a presença da acetilcolina no extrato foi confirmada pelo estudo cromatográfico. O valor médio de acetilcolcina foi de 123 µg/g de fruto