The effect of intravenous ranitidine and metoclopramide on behavior, cognitive function, and affect.

Both ranitidine and metoclopramide produce neuropsychiatric side effects. Concomitant use of these drugs preoperatively may produce adverse behavioral and emotional changes. Therefore, in 123 unpremedicated patients undergoing tubal occlusion, behavior, cognitive function, and affect were studied before and after a 2-min intravenous injection of placebo (n = 30), ranitidine 50 mg (n = 32), metoclopramide 10 mg (n = 30), or both ranitidine 50 mg and metoclopramide 10 mg (n = 31). Cognitive function was evaluated by the responses to 11 statements devised to assess attitude toward anesthesia and surgery. Affect was assessed by the word chosen out of 11 word-pairs as best describing the feelings at the time. After ranitidine injection, one patient seemed restless and five seemed drowsy. The changes were associated with subjective feelings of agitation (P < 0.05) and restlessness (P < 0.05). After metoclopramide injection, 6 (20%) developed akathisia, 13 (43.3%) seemed restless, and 8 (26.7%) seemed drowsy. The changes were associated with subjective sensation of jumpiness (P < 0.01) and discomfort (P < 0.05). When both ranitidine and metoclopramide were injected, 10 (32.3%) developed akathisia, 4 (12.4%) seemed restless, and 11 (35.5%) seemed drowsy. The changes were associated with subjective feelings of agitation (P < 0.05), jumpiness (P < 0.05), restlessness (P < 0.01), and upset (P < 0.05). Akathisia, a side effect of metoclopramide, seemed to be more prominent when ranitidine was added.

[Laparoscopic treatment of extrauterine pregnancy]. / Laparoskopski tretman vanmatericne trudnoce.

This study presents 45 consecutive cases of ectopic pregnancies, of which twenty six cases were managed by pelviscopic surgery and 19 by laparotomy. Laparoscopy failed in six of the nineteen laparotomy patients, probably due to poor hemostasis or an excessive hemoperitoneum. There was a significantly shorter hospital stay of 1.07 days for the laparoscopy group vs. 4.2 days for the group treated by laparotomy. Also a higher treatment cost was observed in the laparoscopy vs. laparotomy group. The operating time was not statistically different in the two groups, averaging 96 minutes in both groups. There were no complications in the laparoscopy group.

Transuterine insertion of Veress needle in laparoscopy.

A pneumoperitoneum separating the anterior abdominal wall from the intraperitoneal organs is essential to view the pelvic organs and to perform laparoscopic surgery. A Veress needle was inserted through the uterine fundus to establish a pneumoperitoneum in 100 women undergoing laparoscopy for sterilization or diagnostic purposes. The transuterine approach was chosen for 86 women because of obesity and for 14 because a previous abdominal insertion had been unsuccessful. There were no complications associated with the transuterine Veress needle placement. This method should be considered for obese patients and for those women in whom the transabdominal approach is unsuccessful.

A teaching model for endoscopic surgery: hysteroscopy and pelviscopic surgery.

The tissue model described is readily available and can be manipulated in many ways to stimulate intraoperative conditions that may be approached by gynecologic endoscopic surgery. The value in using the sow uterus and bladder is that details of tissue management can be induced in the instructional course. The student can learn where and how to make incisions, to remove tissue from the cavity (abdomen or uterus), and to perform endoscopic suturing when indicated. The student can observed what happens to tissue under the influence of various energy forms such as bipolar or monopolar electrosurgery and lasers. The range of actual simulations is limited only by the imagination of the instructors and can probably be adapted to many other procedures not described in this report.

Peripheral prostaglandin metabolite levels in women undergoing therapeutic abortions in the first trimester with and without treatment with prostaglandin synthetase inhibitor.

The levels of 11-deoxy-13,14-dihydro-15-keto-11 beta, 16 xi-cyclo prostaglandin E2 (bicyclo PGEM), 13,14-dihydro-15 keto-prostaglandin F2 alpha (PGFM) and prolactin were measured in four serial plasma samples collected from thirty women undergoing therapeutic abortions in the first trimester by a suction curettage procedure. Eleven of these women received a preoperative loading dose of sodium meclofenamate, a PG synthetase inhibitor, before the abortion procedure was started and the rest received this medication after the last blood samples were drawn. Prolactin levels increased significantly during the procedure. Sodium meclofenamate treatment had no effect on this increase. Bicyclo PGEM levels did not increase during the procedure in untreated or treated women, whereas PGFM levels increased but only in untreated women. The lack of increase in treated women apparently was not a treatment effect because PGFM levels in corresponding samples of untreated and treated women were similar. Treatment significantly reduced the bicyclo PGEM levels immediately after completion of the procedure as compared to untreated women. This differential PG response to treatment is unprecedented and may be due to sodium meclofenamate inhibition of PGE2 and not PGF2 alpha synthesis. Nevertheless, these data demonstrate that sodium meclofenamate treatment of patients undergoing first trimester therapeutic abortion to relieve pain involves selective suppression of PGE2 synthesis.

Peripheral plasma levels of prostaglandin metabolites, cortisol and prolactin in women undergoing falope ring application and tubal cautery.

The levels of 11-deoxy-13,14-dihydro-15-keto-11 beta, 16 xi-cyclo PGE2 (bicyclo PGEM), 13,14-dihydro-15-keto PGF 2 alpha (PGFM), cortisol and prolactin were measured by radioimmunoassays in five serial plasma samples collected from fourteen patients undergoing falope ring application and three patients undergoing tubal electrocautery. Bicyclo PGEM, PGFM and cortisol levels were unchanged regardless of the type of tubal occlusion procedure or the type of anesthesia administered (7 received general and 10 local anesthesia). Prolactin levels, on the other hand, markedly increased. The increase was greatest in women that received general anesthesia. The lack of change in bicyclo PGEM and PGFM in peripheral plasma would suggest a local transfer of PGs produced by injured tubal tissue to other parts of the tube and the uterus resulting in increased contractions and pelvic pain.

Effects of meclofenamate and acetaminophen on abdominal pain following tubal occlusion.

To test the hypothesis that the postoperative abdominal pain of tubal occlusion is mediated by prostaglandins, the effects of meclofenamate, a potent inhibitor of cyclooxygenase, on postoperative analgesia and incidence of abdominal pain were compared with those of acetaminophen, a weak inhibitor of prostaglandin activity. One hundred patients undergoing tubal occlusion under local anesthesia were studied. The patients were randomly divided into four equal groups: control; acetaminophen, 1300 mg; meclofenamate, 100 mg; meclofenamate, 200 mg. The fallopian tubes were occluded by electrocautery in 47 patients and by application of Falope rings in 53 patients. Both acetaminophen and meclofenamate provided substantial analgesia for 4 hours after the operation (p less than 0.05). Meclofenamate reduced the incidence of abdominal pain by one half (p less than 0.02), but acetaminophen did not. These results suggest that a portion of pain relief achieved by meclofenamate may be due to suppression of myosalpingian and/or myometrial contractions, a process mediated by prostaglandins.

PIP: To test the hypothesis that the postoperative abdominal pain of tubal occlusion is mediated by prostaglandins, the effects of meclofenamate, an analgesic and a potent inhibitor of cyclooxygenase, on postoperative analgesia and incidence of abdominal pain were compared with those of acetaminophen, a weak inhigitor of prostaglandin activity. 100 patients undergoing tubal occlusion under local anesthesia in a Kentucky health facility were studied. Tge patients were randomly divided into 4 equal groups: 1) control; 2) acetaminophen, 1300 mg; 3) meclofenamate, 100 mg; 4) meclofenamate, 200 mg. The fallopian tubes were occluded by electrocautery in 47 patients and by application of Falope rings in 53 patients. Both acetaminophen and meclofenamate provided substantial analgesia for 4 hours after the operation (p0.05). Meclofenamate reduced the incidence of abdominal pain by 1/2 (p0.02), but acetaminophen did not. These results suggest that a portion of pain relief achieved by meclofenamate may be due to suppression of myosalpingian and/or myometrial contractions, a process mediated by prostaglandins.

Tubal sterilization in an indigent population. Report of fourteen years' experience.

PIP: Clinical data on 790 women who underwent tubal sterilization over a 14 year period (1955-1968) were analyzed. Incidence was 2.1 percent of all deliveries. Median age was 29, median parity was seven. Indications were multiparity, previous caesarean section and socioeconomic reasons. All patients were at high risk of subsequent gynecologic disease. Most operations were performed during the puerpurium and a number were done at the time of caesarean section. Standard and modified Pomeroy and Madlener techniques were used as well as Uchida, Irving and some atypical techniques. Among the 489 patients who were followed longer than 3 1/2 years there were 10 failures of the operation, most of them following Madlener type operations, and 178 patients underwent some form of gynecologic operative procedure, 63 of whom required total hysterectomy. Fifteen patients developed carcinoma of the cervix, two died. This study as well as data reviewed in the literature are used to support hysterectomy as the method of choice for sterilization rather than caesarean section and tubal ligation in patients who are at high risk of subsequent gynecologic disease, in general, and of carcinoma of the cervix, in particular, and who require abdominal delivery.^ieng