Altitude mountain sickness among tourist populations: a review and pathophysiology supporting management with hyperbaric oxygen.

In the mountain climbing community, conventional prevention of altitude mountain sickness (AMS) relies primarily on a formal acclimatization period. AMS symptoms during mountaineering climbs are managed with medication, oxygen and minor recompression (1524-2438 m altitude) using a portable chamber, such as the Gamow Bag. This is not always an acceptable therapy alternative in a predominantly elderly tourist population. The primary problem with reduced pressure at high altitude is hypoxaemia, which causes increased sympathetic activity, induces pulmonary venous constriction, while increasing pulmonary blood flow and regional perfusion. Rapid assents to altitude contribute to an increased incidence of decompression sickness (DCS). The treatment of choice for DCS is hyperbaric oxygenation, thus, treatment of high-altitude induced hypoxaemia using hyperbaric oxygenation (HBO(2)) is logical. Life Support Technologies group and the Center for Investigation of Altitude Medicine (CIMA, in Cusco, Peru) propose a comprehensive and multidisciplinary approach to AMS management. This approach encompasses traditional and advanced medical interventions including the use of a clinical HBO(2) chamber capable of recompression to three times greater than sea level pressure (3 atmosphere absolute (ATA)). The system uses a series of AMS hyperbaric treatment profiles that LST has previously developed to the US military and NASA, and that take greater advantage of vasoconstrictive effects of oxygen under true hyperbaric conditions of 1.25 ATA. These profiles virtually eliminate AMS rebound after the initial treatment often seen in conventional AMS treatment, where the patient is either treated at altitude, or does not recompress back to sea level or greater pressure (1.25 ATA), but returns directly to the same altitude where AMS symptoms first manifested.

Role of thrombelastograph haemostasis analyser in detection of hypercoagulability following surgery with and without use of intermittent pneumatic compression.

The effect of using intermittent pneumatic compression on incidence of postoperative thromboembolic events was studied, and hypercoagulability following various kinds of surgery with or without use of intermittent pneumatic compression was evaluated with the use of a thrombelastograph. The study included 317 male patients undergoing various surgical procedures; 193 patients used intermittent pneumatic compression after surgery and 124 did not use intermittent pneumatic compression. Their ages ranged between 52 and 75 years. Thrombelastograph was used to detect hypercoagulability. Results showed that in patients using intermittent pneumatic compression, 67% of the hip surgery patients had hypercoagulability one to three days postoperatively, as did 34% having major thoracic or abdominal procedures and 18% in the remaining general surgery. Of 18 hip surgery patients who did not use intermittent pneumatic compression, 10 sustained thromboembolic complications following operation. Three deaths resulted from pulmonary embolism. For the remaining 106 patients who did not use intermittent pneumatic compression, seven patients manifested Deep venous thrombosis (DVT) and pulmonary embolism, and three deaths resulted from pulmonary embolism. There was no incident of thromboembolic complications for the 24 patients with hip surgery who used the intermittent pneumatic compression. There were no complications following various surgical procedures in the 169 patients who used intermittent pneumatic compression. It might be concluded that the thrombelastograph is useful to detect hypercoagulability postoperatively, and intermittent pneumatic compression is useful for thromboembolic prophylaxis.

Isolation of Mycobacterium bolletii from human omentum after laparoscopic gastric banding.

Mycobacterium bolletii infection with band erosion complicating laparoscopic gastric banding is reported. A 33-year-old man developed right upper quadrant pain and an epigastric discharging lesion 4 weeks after revision of gastric banding for morbid obesity. Investigation revealed band erosion with infection of the omentum and the abdominal wall. The band was removed and M. bolletii was isolated and identified after DNA sequence analysis. To the best of our knowledge, this is the first case in which M. bolletii was isolated from a human omentum after complicated gastric banding surgery.

Possible application of hyperbaric oxygen technology in the management of urogenital and renal diseases.

The purpose of this report is to explore possible therapeutic use of hyperbaric oxygen (HBO(2)) technology on renal and urogenital diseases. HBO(2) reduces inflammation, immunity and inflammatory cytokines, stimulates wound repair and angioneogenesis, maintains tissue oxygenation, increases antioxidant enzymes and heals tissue hypoxia and radionecrosis. A literature review of peer-reviewed articles that address HBO(2), genitourological diseases, renal disease, and dialysis was performed. The paper reviews complications of renal diseases, dialysis, clinical applications of HBO(2), and effect of HBO(2) on renal and urogenital diseases. HBO(2) was used successfully to treat calcific uraemic arteriolopathy, and in many cases of acute renal failure. This technique is particularly useful in the treatment of intractable haemorrhagic cystitis secondary to pelvic radiation therapy and Fournier's gangrene. Clearly HBO(2) might play a role in the management of urogenital diseases, urinary bladder dysfunction and diseases, testicular pathology, renal diseases, and post-traumatic ischaemic injury and/or impaired wound healing and infections. The possible role of HBO(2) for autoimmune diseases, uraemic osteodystrophy or neuropathy due to chronic renal diseases is discussed. The clinical application of this technology is expanding and the various biological influences of HBO(2) encourage testing its possible benefit in renal and urological diseases.

Clinical and mycological benefits of topical application of honey, olive oil and beeswax in diaper dermatitis.

Twelve infants suffering from diaper dermatitis were treated four times daily for 7 days with a mixture containing honey, olive oil and beeswax. The severity of erythema was evaluated on a five-point scale. Three infants had severe erythema and ulceration, four had moderate erythema, and five had moderate erythema with maceration. The initial mean lesion score of 2.91 +/- 0.79 declined significantly (p < 0.05) to 2.0 +/- 0.98 (day 3), 1.25 +/- 0.96 (day 5) and 0.66 +/- 0.98 (day 7). Candida albicans was isolated initially from four patients, but from only two patients after treatment. This topical treatment was safe and well-tolerated, and demonstrated clinical and mycological benefits in the treatment of diaper dermatitis.

An alternative treatment for pityriasis versicolor, tinea cruris, tinea corporis and tinea faciei with topical application of honey, olive oil and beeswax mixture: an open pilot study.

OBJECTIVE: To evaluate the possible role of honey, olive oil and beeswax in the treatment of skin fungal infections. PATIENTS AND METHODS: Thirty-seven patients with pityriasis versicolor, tinea cruris, tinea corporis and tinea faciei were studied. After clinical evaluation of redness, scaling, pruritus and burning/pain sensation and mycological assessment, honey mixture containing honey, olive oil and beeswax (1:1:1) was applied to the lesions three times daily for a maximum of 4 weeks. RESULTS: Clinical response was obtained in 86% of patients with pityriasis versicolor, 78% of patients with tinea cruris and in 75% of patients with tinea corporis. Mycological cure was obtained in 75, 71 and 62% of patients with PV, tinea cruris and tinea corporis, respectively. The patient with tinea faciei showed clinical and mycological cure 3 weeks after commencement of therapy. CONCLUSION: Honey mixture may have place in the management of these skin conditions and rigorous, controlled trials are justified.

Intrapulmonary administration of natural honey solution, hyperosmolar dextrose or hypoosmolar distill water to normal individuals and to patients with type-2 diabetes mellitus or hypertension: their effects on blood glucose level, plasma insulin and C-peptide, blood pressure and peaked expiratory flow rate.

Safety and effect intrapulmonary administration (by inhalation) of 60 % honey solution, 10% dextrose or distill water on blood sugar, plasma insulin and C-peptide, blood pressure, heart rate, and peaked expiratory flow rate (PEFR) in normal or diabetic subjects were studied. - Twenty-four healthy subjects, 16 patients with type 11 diabetes mellitus and six patients with hypertension were entered for study. They were underwent complete physical examination and laboratory investigations. Twelve healthy subjects were subjected for distill water inhalation for 10 min, and after one week they received inhalation of honey solution (60% wt/v) for 10 min. Another 12 healthy subjects received inhalation of 10% dextrose for 10 min. Blood glucose level, plasma insulin and C-peptide, blood pressure, heart rate and PEFR were estimated before inhalation and during 2-3 hrs after inhalation, at 30 min intervals. Random blood glucose level was estimated in eight patients with poorly controlled diabetes mellitus, and repeated 30 min after honey inhalation. One week later, fasting blood glucose level was estimated in each patient and blood glucose level was re-estimated during three hrs after honey inhalation, at 30 min intervals. Glucose tolerance test was performed in another eight patients with type-2 diabetes mellitus, and after one week the procedure was repeated with inhalation of honey, which was started immediately after ingestion of glucose. Six hypertensive patients received honey inhalation for 10 min; supine blood pressure and heart rate were measured before and after inhalation. - Results showed that in normal subjects distill water caused mild elevation of blood glucose level, mild lowering of plasma insulin, and significant reduction of plasma C-peptide. 10% dextrose inhalation caused mild reduction of plasma insulin and C-peptide and unremarkable changes in blood glucose level. No significant changes were obtained in blood pressure, heart rate or PEFR after distill water or 10% dextrose inhalation. Honey inhalation caused lowering of blood glucose level and elevation of plasma insulin and C-peptide, mild reduction of blood pressure and up to 11 and 16 percent increase in PEFR. Honey inhalation significantly reduced random blood glucose level from 199 +/- 40.9 mg/dl to 156 +/- 52.3 mg/dl after 30 min (p = 0.0303). Fasting blood glucose level was reduced after honey inhalation during three hr post-inhalation, which was significant at hr three (p<0.05). Intensity of hyperglycemia was significantly lowered in glucose tolerance test when patients received honey inhalation. Systolic and diastolic blood pressure was reduced by honey inhalation in hypertensive patients; significant changes were obtained at 60 and 120 min after inhalation. No adverse effects were observed with inhalation of distill water, 10% dextrose and 60% honey solution except for nasal watery discharge experienced by all subjects and mild cough that was experienced by seven subjects after honey inhalation. - The results demonstrated that honey inhalation was safe and effective in reducing blood glucose level, in normal and diabetic subjects, it could improve glucose tolerance test, elevate plasma insulin and C-peptide and PEFR, and reduce elevated blood pressure in hypertensive patients.

Increased urinary nitrite excretion in primary enuresis: effects of indomethacin treatment on urinary and serum osmolality and electrolytes, urinary volumes and nitrite excretion.

OBJECTIVE: To assess urinary nitrite excretion, a stable end product of nitric oxide (NO), in patients with enuresis and in normal controls, and to evaluate the effects of indomethacin (a potent prostaglandin synthesis inhibitor) on urinary nitrite excretion, other urinary variables and bladder capacity. PATIENTS AND METHODS: The study comprised 10 patients with primary enuresis and 10 normal comparable controls (age range 6-14 years). Nitrite was assayed in 'spot' morning urine samples in both the enuretics and normal controls. Enuretics were then given 50 mg indomethacin suppositories each night; urine volume, urinary osmolality and electrolytes, serum osmolality and electrolytes and urinary nitrite were assayed before indomethacin treatment and after 15 days of treatment. RESULTS: The mean (sd) urinary nitrite excretion was 24.4 (19.6) micromol/L in normal children and 275.9 (111.2) micromol/L in enuretics (P<0.05). With indomethacin, the urinary nitrite concentration was significantly decreased to 141 (45.1) micromol/L (P<0.05) and associated with a significant reduction in bed-wetting episodes and voiding frequency. The functional bladder capacity was <70% of the predicted value for age in six of the patients; they had significant improvements on indomethacin, to values similar to those in patients with a nearly normal functional bladder capacity. Indomethacin decreased the 24-h urinary volume by 41%, the night volume by 40%, clearance of free water by 46% and increased the day : night urinary volume ratio by 55%. The absolute amounts of urinary calcium, magnesium, phosphorus, urea, creatinine, and glucose were lower on indomethacin, although not statistically significantly so. Indomethacin decreased the 24-h urinary and 'spot' morning osmolality and osmotic clearance. There were no significant changes in serum osmolality and electrolyte concentrations. Indomethacin also decreased the absolute amount of urinary sodium, chloride and potassium, fractional sodium and potassium excretion, and filtered sodium. Creatinine clearance was decreased by 20% (P>0.05) and normal 24-h urinary protein was significantly lower, by 47%, after indomethacin treatment (P<0.05). CONCLUSION: Urinary nitrite excretion increased significantly in patients with primary nocturnal enuresis; indomethacin markedly reduced bed-wetting episodes and decreased the frequency of voiding in enuretics with small or normal functional bladder capacity, which was associated with a significant decrease in urinary nitrite excretion. Indomethacin reduced bed-wetting by decreasing the urine volume, clearance of free water and urinary electrolytes, and through possible effects on bladder and urethral contraction, by inhibiting NO and prostaglandin synthesis. NO and prostaglandins might be important in the pathogenesis of primary enuresis.

Therapeutic and prophylactic effects of crude honey on chronic seborrheic dermatitis and dandruff.

Honey has antibacterial, antifungal and antioxidants activities and has high nutrient value. In this study we investigated the potential use of topical application of crude honey in the management of seborrheic dermatitis and dandruff. Thirty patients with chronic seborrheic dermatitis of scalp, face and front of chest were entered for study. Twenty patients were males and 10 were females, their ages ranged between 15 and 60 years. The patients had scaling, itching and hair loss. The lesions were scaling macules, papules and dry white plaques with crust and fissures. The patients were asked to apply diluted crude honey (90% honey diluted in warm water) every other day on the lesions with gentle rubbing for 2-3 mins. Honey was left for 3 hr before gentle rinsing with warm water. The patients were followed daily for itching, scaling, hair loss and the lesions were examined. Treatment was continued for 4 weeks. The improved patients were included in a prophylactic phase, lasting six months. Half patients were treated with the topical honey once weekly and the other half served as control. All the patients responded markedly with application of honey. Itching was relieved and scaling was disappeared within one week. Skin lesions were healed and disappeared completely within 2 weeks. In addition, patients showed subjective improvement in hair loss. None of the patients ( 15 patients) treated with honey application once weekly for six months showed relapse while the 12/15 patients who had no prophylactic treatment with honey experienced a relapse of the lesions 2-4 months after stopping treatment. It might be concluded that crude honey could markedly improve seborrheic dermatitis and associated hair loss and prevent relapse when applied weekly.

Isolation, purification and partial characterization of early pregnancy factor (EPF) from sera of pregnant women.

Early pregnancy factor (EPF) is a pregnancy protein, which is secreted into the maternal serum 12-16 hours after fertilization. It is thought to be an immunosuppressive molecule. EPF is detected in pregnant woman's serum by the rosette inhibition assay (RIA). In this study, EPF was purified from the pregnant woman's sera by using ion exchange chromatography and analyzed by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). The proteins which showed a positive result with the RIA, were found to be 35 kDa and 17 kDa molecular weights. The biological activities of these proteins were stable upon heat treatment at 56 degrees C for 30 min. Proteins isolated and purified in this study might be of great significance to the field of human reproduction with particular reference to pregnancy and recurrent abortion.

Efficacy and safety of repeated postoperative administration of intramuscular diclofenac sodium in the treatment of post-cesarean section pain: a double-blind study.

BACKGROUND: Analgesic drugs, either opioids or non-opioids, are required and useful for controlling postoperative pain after cesarean section. METHODS: The analgesic and opioid-sparing effects of repeated intramuscular (i.m.) injections of 75 mg of diclofenac sodium given immediately after the experiencing of pain following cesarean section under general anesthesia were studied and compared with placebo in a double-blind trial. One hundred twenty patients 18-40 years of age undergoing elective lower segment cesarean section were treated with either 75 mg diclofenac sodium i.m. (60 patients) or identical placebo (60 patients), once patients awakened from anesthesia and experienced wound pain. Their initial responses to either treatment during the first hour after administration of medications were studied. The analgesic, sedative, and opioid-sparing effects of the medications were also studied during the next 48 h. Side effects including uterine relaxation and bleeding were compared between patients administered placebo and diclofenac. RESULTS: Results showed that 55/60 patients showed significant pain relief within the first 1 h after administration of diclofenac sodium and their mean pain score decreased from 7.09 +/- 1.06 to 0.85 +/- 0.8 (p <0.05). Within the same period, 10/60 patients responded to placebo injections and mean pain score decreased from 6.6 +/- 0.96 to 0.8 +/- 0.78 (p <0.05). During the first postoperative 48 h, 45 patients showed complete pain relief with use of diclofenac alone while 15 patients required 2,800 mg of pethidine in addition to diclofenac treatment. All patients using placebo required pethidine injection; the total amount of pethidine used was 22,700 mg per 48 h. Verbal scores for sedation were lower in patients treated with diclofenac than in patients treated with placebo at 6 and 12 h postoperatively (p <0.05). There were no significant differences in the proportions of patients who required oxytocin infusion due to uterine relaxation in the diclofenac-treated and the placebo-treated groups (7/60 vs. 12/60, p >0.05). CONCLUSIONS: It might be concluded that repeated i.m. injections of 75 mg diclofenac sodium (maximum two injections per day) could relieve postoperative pain after cesarean section and significantly reduce opioid analgesic requirements without significant effects on uterine relaxation or bleeding during the first postoperative 48 h.

Treatment of menstrual migraine with prostaglandin synthesis inhibitor mefenamic acid: double-blind study with placebo.

The therapeutic effect of mefenamic acid, prostaglandin synthesis inhibitor, on pain of acute menstrual migraine and at the following days during menstrual bleeding period was studied and compared with placebo. 24 patients, 18 to 35 years old, with menstrual migraine were entered for study. They had regular menstrual cycles and they had been diagnosed as experiencing menstrual migraine without aura for more than one year. The patients were treated for 2 consecutive menstrual cycles, one cycle with 500 mg mefenamic acid and one cycle with placebo. Each drug was given at beginning of complaint and similar dose was repeated 8 hourly at following days during the menstrual bleeding period (Total dosage used 1500 mg per day). The use of medication was double blind. Pain intensity was rated by means of a 4 points scale and functional disability was rated from 0 to 3. Results showed that 79.16% of the patients showed significant pain relief with mefenamic acid as compared to 16.6% with placebo. The mean pain score of the mefenamic acid treated attacks decreased significantly from 2.46 +/- 0.5 to 0.62 +/- 1.0 at 2hr postdose. 83.3% of patients treated with mefenamic acid was able to function with or without little effort whereas 12.4% restored their activities with placebo. All the patients (100%) who showed significant initial responses to placebo experienced headache recurrence as compared to 26.3% with mefenamic acid. When considering mean pain scores, percentage of patients with pain free at 2h postdose, percentage of patients required rescue treatment, percentage of patients with headache recurrence and percentages of patients restored full activities, mefenamic acid is significantly superior to placebo in treatment of acute menstrual migraine. It might be concluded that mefenamic acid is safe and effective for treatment of acute menstrual migraine.

Carbamazepine to treat primary nocturnal enuresis: double-blind study.

Carbamazepine is chemically related to imipramine. It can reduce prostaglandin E2-like activity in inflammation. It caused overflow urinary incontinence, increased bladder capacity, sensitized renal tubules to antidiuretic hormone and leading to antidiuresis. This encouraged to use carbamazepine to treat primary enuresis. Twenty-six patients of either sex with a history of enuresis from birth were included in study. Their age ranged between 7 and 15 years (mean 9.3 years). They were assessed by history, physical examination, blood glucose, renal function tests, intravenous urogram and videocystourethrography. 30 days drug-free observation was performed to establish baseline voiding pattern. This was followed by two, 30 day treatment periods of either placebo or carbamazepine (200 mg) tablets, in a randomized, double-blind cross-over design. There was one week washout period between medications. The patients or their parents received calendar sheet to record wet and dry nights and offered subjective opinions concerning changes in sleep patterns, occurrence of nocturia and appearance of side-effects. A tablet was given to each patient before retiring. Those patients who showed no response to carbamazepine and placebo would be treated with 100 mg of indomethacin suppositories. The results show that of 26 patients 20 had 7 to 30 of 30 dry nights with carbamazepine, while 6 had 0 to 5 of 30 dry nights. The latter 6 patients reacted in the same manner with placebo, 4 of them showed better response with use of indomethacin. Six patients had 10 to 15 of 30 dry nights during placebo therapy and 20 had 0 to 6 of 30 dry nights. The mean number of dry nights was 3.92 +/- 5.22 with placebo and was 18.8 +/- 8.82 with carbamazepine. The difference in response to placebo and carbamazepine was statistically significant (p < 0.001). All the patients who responded sufficiently to indomethacin slept until the morning. No side effect was noticed with either treatment and repeated serum electrolytes and other laboratory tests were normal after treatment. It might be concluded that carbamazepine is useful for treatment of primary nocturnal enuresis.

Sublingual human insulin for hyperglycaemia in type I diabetes.

OBJECTIVE: To investigate the hypoglycaemic effects of repeated sublingual doses of human insulin for the treatment of hyperglycaemia in type I diabetes. DESIGN: Clinical trial. SETTING: A Private clinic. METHOD: Eight insulin dependent diabetic males with a mean age of 27 years (range 18-32 years) presenting with hyperglycaemia were given 1 U/Kg body weight of human soluble insulin in 5 equally divided doses at 15 min intervals, sublingually. Plasma glucose was estimated at 0, 15, 30, 45, 60, 90, 120 and 150 min. Urine examination for glucose was done at 45 min intervals. RESULTS: The results showed that the mean plasma glucose before treatment was 19.93 + 2.1 mmol/L Hypoglycaemic effect was recorded at 15 min and reached a peak at 120 min when plasma glucose dropped to 10.9 + 1.2 mmol/L (p < 0.001). No side effect was reported and insulin was tolerated well. CONCLUSION: We concluded that sublingual human insulin in repeated doses has a hypoglycaemic effect and could be used to control hyperglycaemia in type I diabetes.

Efficacy of sublingual verapamil in patients with severe essential hypertension: comparison with sublingual nifedipine.

Ninety patients, 50 males and 40 females, and their ages ranged between 42 and 70 years, with severe hypertension were treated by either sublingual verapamil tablets 40 mg (30 patients) or 80 mg (30 patients) or sublingual nifedipine capsules 10 mg (30 patients). Blood pressure and heart rate were measured before and 15, 30, 60, 90 and 120 mins after administration of the drugs. - Results showed that sublingual verapamil 40 mg caused significant drop of blood pressure after 60 min (200 +/- 11.6 / 127 +/- 8.7 to 177 +/- 13.8 / 95.4 +/- 11.8, P <0.05) and in 10/30 patients blood pressure was less than 150/90 mmHg. Verapamil 40 mg decreased heart rate in 16 patients, elevated in 5 patients and unchanged heart rate in 9 patients. Verapamil 80 mg caused significant reduction of blood pressure after 30 min (201 +/- 16 / 129 +/- 7.5 to 182 +/- 13 / 105 +/- 10.7, P <0.05) and the blood pressure was dropped to less than 150/90 mmHg in 18/30 patients. Sublingual verapamil 80 mg caused significant decrease in heart rate in 21/30 patients and peak decrease was recorded at 90 min (92.6 +/- 7.2 beats/min to 82 +/- 9, P <0.05). It alleviated headache in 8 patients including 2 patients with migraine. Sublingual nifedipine caused significant drop of elevated blood pressure at each time intervals and the peak drop was at 60 min (from 199 +/- 13.8 / 126 +/- 13.2 to 142.8 +/- 15 / 80. 9 +/- 9, P <0.05). In 22/30 patients blood pressure dropped to less than 150/90 mmHg after 60 min. Nifedipine elevated heart rate in 22/30 patients and peak elevation was at 30 min (from 91.6 +/- 7.8 to 105.6 +/- 6.1 beats/min, P <0.05). It caused headache in 8 patients and flushing in other 2 patients. Therefore, as compared to sublingual verapamil, sublingual nifedipine caused rapid lowering of elevated blood pressure and elevation of heart rate in most of the patients treated. The differences in proportions of patients whom blood pressure was dropped to less than 150/90 mmHg between nifedipine group and verapamil 40 mg group and between verapamil 80 mg and verapamil 40 mg groups were significant (P <0.05). - It might be concluded that sublingual verapamil caused significant lowering of blood pressure in hypertensive patients, decreased heart rate in most of the treated patients and alleviated headache in symptomatic hypertensive patients.

Effects of topical honey on post-operative wound infections due to gram positive and gram negative bacteria following caesarean sections and hysterectomies.

The possible therapeutic effect of topical crude undiluted honey in the treatment of severe acute postoperative wound infections was studied. Fifty patients having postoperative wound infections following caesarean sections or total abdominal hysterectomies with gram positive or gram negative bacterial infections were allocated in two groups. Twenty-six patients (group A) were treated with 12 hourly application of crude honey and 24 patients (group B) were treated with local antiseptics: spirit (70% Ethanol) and povidone-iodine. Both groups received systemic antibiotics according to culture and sensitivity. Results showed that eradication of bacterial infections was obtained after 6 +/- 1.9 days (mean +/- SD) in group A and after 14.8 +/- 4.2 days in group B (p <0.05). Period for antibiotics use was 6.88 +/- 1.7 days in-group A and 15.45 +/- 4. 37 in-group B (p <0.05). Complete wound healing was evident after 10. 73 +/- 2.5 days in group A and after 22.04 +/- 7.33 in group B (p <0. 05). Size of postoperative scar was 3.62 +/- 1.4 mm after using topical honey and was 8.62 +/- 3.8 mm after local antiseptics (p <0. 05). The mean hospital stay was 9.36 +/- 1.8 days in group A and 19. 91 +/- 7.35 days in group B (p <0.05). After using honey, 22/26 patients (84.4%) showed complete wound healing without wound disruption or need for re-suturing and only 4 patients showed mild dehiscence. In group B, 12/24 patients (50%) showed complete wound healing and 12 patients showed wound dehiscence, six of them needed re-suturing under general anesthesia. We concluded that topical application of crude undiluted honey could (1) faster eradication of bacterial infections, (2) reduce period of antibiotic use and hospital stay, (3) accelerate wound healing, (4) prevent wound dehiscence and need for re-suturing and (5) result in minimal scar formation.

Intramuscular piroxicam versus intramuscular diclofenac sodium in the treatment of acute renal colic: double-blind study.

To study the therapeutic effects of a single 40 mg intramuscular dose of piroxicam versus a single 75 mg intramuscular dose of diclofenac sodium for treatment of acute renal colic. - The study comprised 64 patients (52 men and 12 women, mean age 28 years, range 18 - 42) who presented with acute renal colic and were diagnosed by IVU, a general urine examination and ultrasonography. The patients were randomly assigned to receive either 40 mg of piroxicam i.m (34 patients) or 75 mg of diclofenac sodium i.m (330 patients). The severity of pain was assessed on Visual Analogue Scale. - Results showed that thirty-two patients (94.1%) markedly improved within 1h of receiving piroxicam and 26 patients (86.6%) improved within 1h of receiving diclofenac sodium (P <0.05). Within 30 min, 25 patients (73.5%) markedly improved after piroxicam and 15 patients (50%) markedly improved after diclofenac sodium (P <0.05). After piroxicam, none of the patients showed pain relapse over a period of 24 h while 9 patients had relapse within 24 h after their initial response to diclofenac sodium. No side effects were reported with use of either treatment. - We concluded that piroxicam can be used successfully to treat acute renal colic and it has earlier onset of action and prolong effect as compared with diclofenac sodium.

The analgesic effect of intravenous tenoxicam in symptomatic treatment of biliary colic: a comparison with hyoscine N-butylbromide.

This was conducted to evaluate the analgesic effect of intravenous tenoxicam (non-steroidal anti-inflammatory drug) in the treatment of biliary colic pain and compared with spasmolytics. Thirtytwo patients (26 women, 6 men, mean age 47, range 38-55 years) with acute biliary colic were entered for study. They were allocated randomly to receive either tenoxicam 20 mg i.v. or hyoscine N-butylbromide 20 mg i.v. The patients recorded their pain severity on 5 point scale. The results showed that tenoxicam caused significant pain relief in 10 out of 16 patients at 30 min (mean pain score decreased from 2.75 +/- 0.93 to 0.49 +/- 0.51, p < 0.05) and in other 4 patients at 60 min (mean pain score decreased to 0.58 + 5.7, p < 0.05). None of these patients developed acute cholecystitis or pain relapse over a period of 24 h follow up. With use of hyoscine N-butylbromide, 7 out 16 patients had significant pain relief at 30 min (mean pain score decreased from 2.62 +/- 1.01 to 0.57 +/- 0.53, p < 0.05) and 3 other patients relieved at 60 min (mean pain score decreased to 0.66 +/- 0.57, p < 0.05). Four patients showed pain relapse within 24 h and needed pethidine-rescue treatment, two of them developed acute cholecystitis. Three out of 6 patients who showed no response to hyoscine N-butylbropmide and treated with 100 mg pethidine progressed to acute cholecystitis. We concluded that intravenous tenoxicam has rapid and prolong analgesic effects in the treatment of acute biliary colic as compared to hyoscine N-butylbroimde and it prevents the progression to acute cholecystitis.

Intravenous tenoxicam to treat acute renal colic: comparison with buscopan compositum.

Forty-seven patients with acute renal colic were treated with either tenoxicam 20 mg i.v. or buscopan compositum (hyoscine butylbromide 20 mg and dipyrone 2.5 g) i.v. in a double blind study. Renal colic was diagnosed with use of a general urine examination, intravenous urogram, ultrasonography or voiding of calculus. The severity of symptoms were assessed by a verbal six point scale. Results demonstrated that 80% of patients treated with tenoxicam and 72.7% of patients treated with buscopan compositum showed significant improvement after 1 hour. Sixty-two percent of the patients who showed initial response to buscopan compositum had pain relapse during next 24 hours and required rescue treatment with pethidine 100 mg i.m. None of the patients treated with tenoxicam i.v. had pain relapse. No side effects were reported with use of tenoxicam. It is concluded that tenoxicam i.v. was more effective than antispasmodics and has rapid onset of analgesia and prolonged action in the treatment of acute renal colic.