Topically applied anaesthetics for treating perineal pain after childbirth.

BACKGROUND: Perineal trauma is a major problem affecting millions of women around the world each year. The degree of perineal pain and discomfort associated with perineal trauma is often underestimated. Pain often interferes with basic daily activities for the woman such as walking, sitting and passing urine and also negatively impacts on motherhood experiences. OBJECTIVES: To assess the effects of topically applied anaesthetics for relief of perineal pain following childbirth whilst in hospital and following discharge. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (February 2004), CINAHL (1982 to December 2002) and MIDIRS (last searched February 2003). We checked reference lists of trials and review articles. SELECTION CRITERIA: Randomised controlled trials comparing topically applied anaesthetic with no treatment, placebo or alternative treatment. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial eligibility and quality and double-entered the data. We contacted study authors for additional information. MAIN RESULTS: Eight trials made up of 976 women were included in the review. Five of these trials measured pain experienced up to 24 hours after birth but different methods to assess pain were used in each of the studies. All five trials showed no difference in pain relief when the topical anaesthetic was compared with placebo. One of these studies looked at topical anaesthetics compared with indomethacin vaginal suppositories but there was no significant difference in mean pain scores. All trials reported only short-term follow up (up to four days). Two trials looked at additional analgesia taken for perineal pain, with one trial finding that less additional analgesia was required with epifoam use in comparison with placebo (relative risk (RR) 0.58, 95% confidence interval (CI) 0.40 to 0.84, one trial, 97 women). However, lignocaine/lidocaine showed no difference with regard to additional analgesia use. Adverse effects were not formally measured in the studies; however, some studies commented that there were no side-effects severe enough to discontinue treatment. One study found that the women in the treatment group were more satisfied than the placebo group (RR 0.09, 95% CI 0.01 to 0.65, one trial, 103 women). AUTHORS' CONCLUSIONS: Evidence for the effectiveness of topically applied local anaesthetics for treating perineal pain is not compelling. There has been no evaluation for the long-term effects of topically applied local anaesthetics.

Rectal analgesia for pain from perineal trauma following childbirth.

BACKGROUND: Perineal pain from a tear and/or surgical cut (episiotomy) is a common problem following vaginal birth. Strategies to reduce perineal trauma and the appropriate repair of any perineal damage sustained are important for avoiding and alleviating pain. Where pain is present, numerous treatments are used in clinical practice, such as local anaesthetics, oral analgesics, therapeutic ultrasound, antiseptics and non-pharmacological applications such as ice packs and baths. This review assesses the evidence for using rectal analgesia for pain relief following perineal trauma. OBJECTIVES: To assess the effectiveness of analgesic rectal suppositories for pain from perineal trauma following childbirth. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (July 2002), CENTRAL (The Cochrane Library, Issue 2, 2002), CINAHL (May 2002) and MIDIRS (May 2002). SELECTION CRITERIA: Randomised controlled trials comparing analgesic rectal suppositories with placebo or alternative treatment for the relief of perineal pain. DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data independently. MAIN RESULTS: Three trials involving 249 women met the inclusion criteria. Only two of the trials identified for inclusion in this review had data that could be entered in a meta-analysis, with the third not providing data in a useable format. Women were less likely to experience pain at or close to 24 hours after birth if they received non-steroidal anti-inflammatory drugs (NSAID) suppositories compared with placebo (relative risk (RR) 0.37, 95% confidence interval (CI) 0.10 to 1.38, 2 trials, 150 women). Women in the NSAID suppositories group compared with women in the placebo group required less additional analgesia in the first 24 hours after birth (RR 0.31, 95% CI 0.17 to 0.54, 1 trial, 89 women) and this effect was still evident at 48 hours postpartum (RR 0.63, 95% CI 0.45 to 0.89, 1 trial, 89 women). No information was available on pain experienced more than 72 hours after birth or other outcomes of importance to women such as the impact on daily activities, resumption of sexual intercourse and the impact on the mother-baby relationship. REVIEWER'S CONCLUSIONS: NSAID rectal suppositories are associated with less pain up to 24 hours after birth, and less additional analgesia is required. More research is required regarding long-term effects and maternal satisfaction with the treatment.

Rheumatoid arthritis, relapsing polychondritis, and pyoderma gangrenosum evolving into non-Hodgkin's lymphoma.

In human beings, the function of the immune system and of inflammation is to protect the individual against invading organisms such as bacteria, viruses, parasites, and fungi as well as thermal and mechanical injuries. The inflammatory process, initiated to destroy foreign organisms or an inappropriate immune response/target tissue, may lead to injury, the destruction of host tissue, and the development of the disease process. This article describes the history of a patient with four disorders of unknown cause, all of which may have evolved from one immunologic aberration.

Lyme disease.

Lyme disease, a multisystem disorder, has now been reported to the Centers for Disease Control from 43 states of the United States. The disease is a tick-transmitted infectious disorder caused by the spirochete bacterium Borrelia burgdorferi. Lyme disease typically begins with the symptoms of flu associated with a characteristic skin rash, erythema chronicum migrans. The diagnosis of Lyme disease is best made by clinical examination and epidemiologic history, with serologic studies supporting the clinical diagnosis. Prompt diagnosis and early treatment with antibiotics will often lead to the resolution of symptoms and the prevention of late complications, Lyme carditis, neurologic manifestations, and arthritis.

Acrolysis in pachydermoperiostosis. Primary or idiopathic hypertrophic osteoarthropathy.

A 45-year-old black woman was admitted for correction of an equinus deformity of the right lower extremity that resulted from shortening of the Achilles tendon. She exhibited classic findings of pachydermoperiostosis, including clubbing of the digits, periosteal new bone formation, and hypertrophy of skin and its adnexa, associated with several facial acne. In addition, she showed excessive resorption of distal phalanges of the hands and feet, a finding heretofore unreported in pachydermoperiostosis, to our knowledge. Reduced peripheral blood flow has been observed in patients with pachydermoperiostosis; the resorption of distal phalanges observed in our patient may have resulted from this mechanism.

The role of coronary care unit in reduction of mortality rate and sudden death in acute myocardial infarction.

One hundred and seventy consecutive unselected patients suspected of having acute myocardial infarction (AMI) were admitted to our Coronary Care Unit (CCU); 100 of them proved to have AMI (CCU group). These patients were compared with another 100 cases of AMI, which were admitted to our hospital in the period immediately preceding the establishment of CCU (prior group). Criteria of selection used for both groups were the same. The mortality rate in the CCU group was 11% compared to 31% of the prior group. There was no single case of sudden death due to primary ventricular fibrillation, though only one due to ventricular asystole in the CCU groups. Our findings also were compared with those reported of elsewhere and the difference is discussed. The reasons for lower mortality rate and sudden death are explained. In coronary care unit, in addition to try to decrease the total mortality rate, also should try to reduce the incidence of Primary ventricular fibrillation and asystole. The two main causes of sudden unexpected death in AMI.

Profound spontaneous hypoglycaemia in congestive heart failure.

Eleven cases of spontaneous hypoglycaemia in congestive heart failure in adults are reported. There were 5 males and 6 females, aged from 15 to 65 years (mean, 44 years). Blood sugar ranged from 2 to 42 mg/100 ml (mean 21 mg/100 ml). Six patients were in coma on admittance, 1 was confused, and 4 were conscious. The underlying condition was rheumatic valvular heart disease (3), chronic obstructive lung disease (4), cornonary heart disease (3) and cardiomyopathy (1). Five of the 11 patients died. The mechanism of hypoglycaemia is discussed and thought to be a combination of factors such as liver dysfunction, low calorie intake, malabsorption, and increased glusose utilization by ischaemic tissues, including the heart. It is recommended that in patients with congestive heart failure presenting with coma or confusion, blood sugar should be checked for possible hypoglycaemia.

Serum iron, glutamic oxalacetic transaminase and creatine phosphokinase in acute myocardial infarction. A comparative study.

The serum iron was subnormal on the first three days, following acute myocardial infarction in thirty patients. This is significantly less than the incidence of abnormalities demonstrated by assays of creatine phosphokinase (CPK) and glutamic oxalacetic transaminase (SGOT) in serum. Occasional patients had abnormal serum iron concentrations in association with normal CPK activities. For this reason serum iron determination may usefully supplement CPK activity measurements and possibly those of SGOT activity as an aid to the detection of acute myocardial infarction.

Idiopathic enteropathy: an evaluation in rural Iran with an appraisal of nutrient loss.

Idiopathic enteropathy in the rural population of Iran was investigated through evaluation of 100 randomly selected apparently normal subjects. The evaluation included quantitation of the nutrient loss, presence of malabsorption, and small intestinal morphological abnormalities. The results show that: 1) there was no significant loss of major nutrients, 2) severe malabsorption was not present, 3) an enteropathy of unknown etiology was found in nearly one-third of the subjects, and 4) abnormalities in morphology did not necessarily mean presence of malabsorption.