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A double-blind study of 43 patients undergoing excision of haemorrhoids under spinal anaesthesia was carried out to compare the analgesic effects of diflunisal (DFL, 21 patients) and dextropropoxyphene napsylate (DPN, 22 patients) on post-operative pain. Eleven patients (25%) reported no significant pain during the study indicating that they had needed no analgesic medication (4 in the DFL group and 7 in the DPN group). Thus 17 patients in the DFL group and 15 patients in the DPN group contributed to the analysis data. Seven patients in the DFL group and 9 patients in the DPN group needed additional analgesic therapy on the day of surgery. After the day of surgery the analgesic effect of both of the test medications was sufficient but DFL proved to provide slightly better pain relief than DPN. Two patients in each study group had mild adverse reactions including vomiting and epigastric pain, which were probably drug related. It is concluded that both DFL and DPN are safe and sufficiently effective treatments for pain after haemorrhoidectomy but not until one day after surgery.
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PMID:Comparison of diflunisal and dextropropoxyphene napsylate in the treatment of post-operative pain. 286 31

An anthropological examination is made of the Esan population living in Ekpoma, Egoro-Haoko, OkhuEsan, and Ubiaja in Edo State, Nigeria, during 1988-89. The focus is on the Esan perception of illness, the Esan health behavior, and the treatment of illness. The sample areas are not densely populated due to migration to urban areas. Traditional or Christian religions are practiced. Piped water, good roads, and electricity are inadequate. Polygyny is widely practiced. The Esan people believe illness is caused by people or natural or supernatural forces. The most common illnesses among children are measles, convulsions, and headache, which are attributed to supernatural factors. Diarrhea, vomiting, malaria, smallpox, chicken pox, pneumonia, and tetanus are thought to be due to natural factors. Child mortality due to witchcraft is reduced through the taking of oaths at shrines. Christianity has helped to protect people from the power of witches and wizards. In traditional times, natural illnesses were attributed to poor sanitation, poor nutrition, and lack of good water. Presently, women believe that natural illnesses occur from environmental factors such as overgrown weeds or poor water drainage. Many health programs have improved the situation for prevention and treatment. Adult male illnesses are reported as back and waist pains, sugar disease, hemorrhoids, blindness, and sudden swelling of the body, legs, and knees. Blindness occurs due to supernatural forces caused by a lack of maintaining traditional customs, such as adultery of a wife. When a husband dies of a supernatural illness, the wife is frequently held accountable. Adult females report illnesses from pregnancy, childbirth, and postpartum. Miscarriage, hemorrhage, retention of the placenta, and obstructed labor are considered to be due to supernatural factors subsequent to such behaviors as having sex in the afternoon or in the fields. Traditional treatment is dispensed according to the type of illness and is mainly used by adults. Children are treated more quickly than adults. Cost and distance from health services affects use of modern medicine. Mixes of modern and traditional practices are common.
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PMID:The socio-cultural context of health behaviour among Esan communities, Edo State, Nigeria. 1014 69

A 53-year-old male was admitted with a two-day history of abdominal pain, anal bleeding, fever, diarrhea, vomiting, and mental confusion. A diagnosis of thrombosis of very large hemorrhoids (Grade 4) was made. On the day of admission, he underwent an exploring laparotomy followed by abdominoperineal resection. The peritoneal cavity was filled with pus and blood clots. Because rectal necrosis was involved, sigmoid colostomy was imperative. Twenty-eight hours after surgery, the patient demonstrated signs of soft-tissue perineal necrosis associated with progressive pain and fever. He developed a rapidly progressive gangrene of the lower limbs and scrotum followed by acute renal and respiratory failure, and he died of sepsis. At autopsy, the cadaver showed jaundice and a large gangrene of the perineum and lower limbs. The internal organs showed features secondary to sepsis complications. To the best of our knowledge, this is the first autopsy study of a patient who died because of complications of hemorrhoids.
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PMID:Death resulting from fournier gangrene secondary to thrombosis of very large hemorrhoids: report of a case. 1784 38

A total of 121 Japanese patients scheduled for prostate biopsy were randomly and double-blindly assigned to be given a single oral dose of 100 mg Tramadol mixed with 20 ml of sugar syrup or placebo, 30 minutes before the procedure. Pain severity was measured by verbal rating scale (VRS) and visual analog scales (VAS). We also analyzed cardio-respiratory parameters and complications. Of 121 patients, 117 replied validly to VRS and VAS ; and 91 of 117 patients replied to the cohort questionnaire for analysis of the late disorder, patient's impression, prolonged pain and past history of hemorrhoid treatment. Tramadol showed no significant effect on pain severity indicated by VRS and VAS, and no change in cardiorespiratory parameters. Furthermore, 70 patients without a history of hemorrhoid treatment, showed no significant analgesic benefits of Tramadol during the biopsy. In total, 3 patients had side effects of vomiting (CTCAE : grade 1)6), which subsided spontaneously. The oral administration of a single dose of 100 mg Tramadol 30 minutes before a transrectal needle biopsy of the prostate was safe, but was not effective to calm down the pain severity.
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PMID:[Analgesic effect of oral tramadol on transrectal ultrasound-guided needle biopsy of the prostate in a randomized double-blind study]. 2189 78

In Africa, up to 80% of the population relies on herbal concoctions for their primarily health care. In Togo, western Africa, Tem tribe is a population with old knowledge of medicinal plants, however, still very little is known about their medical practices. The present study was conducted to access for the apprehension of adverse effects of traditional remedies by Tem traditional healers (TH). Enquiry was performed by interviews with healers from August to October 2007 in Tchaoudjo prefecture (Togo). The study allowed us to interview 54 TH including 41(75.93%) males and 13(24.07%) females, who cited 102 recipes assumed to have adverse effects. The recipes were used alone to cure several diseases including haemorrhoids (22.55%), female sexual disorders and infertility (21.57%), gastrointestinal disorders (18.63%), and malaria (6.86%). A total of 34 plants belonging to 21 families were cited to be components of the recipes. Euphorbiaceae and Mimosaceae families were the most represented, however, Nauclea latifolia, Khaya senegalensis, Pseudocedrela kotschyi and Xeroderris stuhlmannii were the main components of recipes linked to adverse effects. A total of 20 adverse effects were linked to the administration of theses drugs, and among them; diarrhoea, abdominal pains, polyuria, general weakness and vomiting were the most frequently encountered. These findings were in accordance with several reports of the literature concerning medicinal plants, although they were based on empirical observations. Laboratory screenings are needed to access for the effectiveness as well as the possible toxic effects of the recipes.
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PMID:Herbal remedies and their adverse effects in Tem tribe traditional medicine in Togo. 2223 83

Bowel problems occur in 27% to 62% of patients with spinal cord injuries (SCI), most commonly constipation, distention, abdominal pain, rectal bleeding, hemorrhoids, bowel accidents, and autonomic hyperreflexia. The acute abdomen, with a mortality of 9.5%, does not present with rigidity or absent bowel sounds but rather with dull/poorly-localized pain, vomiting, or restlessness, with tenderness, fever, and leukocytosis in up to 50% of patients. Fecal impaction may present with anorexia and nausea. Methods used for bowel care include laxatives, anal massage, manual evacuation, and enemas. Randomized, double-blind studies demonstrated the effectiveness of neostigmine, which increases cholinergic tone, combined with glycopyrrolate, an anticholinergic agent with minimal activity in the colon that reduces extracolonic side-effects. Improved bowel function occurs with anterior sacral root stimulators which may be combined with an S2 to S4 posterior sacral rhizotomy which interrupts the reflex arc by cutting the posterior roots carrying the spasticity-causing sensory nerves. For severe constipation, a colostomy reduces time for bowel care, providing a clean environment so decubitus ulcers may heal. Gallstones occur in 17% to 31% of patients, and acalculous cholecystitis in 3.7% of patients with acute SCI. A high index of suspicion is needed to properly diagnose bowel problems in SCI.
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PMID:Gastrointestinal involvement in spinal cord injury: a clinical perspective. 2245 63

Bee's honey is one of the most valued and appreciated natural substances known to mankind since ancient times. There are many types of bee's honey mentioned in Ayurveda. Their effects differ and 'Makshika' is considered medicinally the best. According to modern scientific view, the best bee's honey is made by Apis mellifera (Family: Apidae). In Sri Lanka, the predominant honey-maker bee is Apis cerana. The aim of this survey is to emphasize the importance of bee's honey and its multitude of medicinal, cosmetic and general values. Synonyms, details of formation, constitution, properties, and method of extraction and the usages of bee's honey are gathered from text books, traditional and Ayurvedic physicians of Western and Southern provinces, villagers of 'Kalahe' in Galle district of Sri Lanka and from few search engines. Fresh bee's honey is used in treatment of eye diseases, throat infections, bronchial asthma, tuberculosis, hiccups, thirst, dizziness, fatigue, hepatitis, worm infestation, constipation, piles, eczema, healing of wounds, ulcers and used as a nutritious, easily digestible food for weak people. It promotes semen, mental health and used in cosmetic purposes. Old bee's honey is used to treat vomiting, diarrhea, rheumatoid arthritis, obesity, diabetes mellitus and in preserving meat and fruits. Highly popular in cosmetic treatment, bee's honey is used in preparing facial washes, skin moisturizers, hair conditioners and in treatment of pimples. Bee's honey could be considered as one of the finest products of nature that has a wide range of beneficial uses.
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PMID:Medicinal and cosmetic uses of Bee's Honey - A review. 2355 86

Medicinal plants are part and parcel of human society to combat diseases from the dawn of civilization. Terminalia chebula Retz. (Fam. Combretaceae), is called the 'King of Medicine' in Tibet and is always listed at the top of the list of 'Ayurvedic Materia Medica' because of its extraordinary power of healing. The whole plant possesses high medicinal value and traditionally used for the treatment of various ailments for human beings. Some of the folklore people used this plant in the treatment of asthma, sore throat, vomiting, hiccough, diarrhea, dysentery, bleeding piles, ulcers, gout, heart and bladder diseases. The plant has been demonstrated to possess multiple pharmacological and medicinal activities, such as antioxidant, antimicrobial, antidiabetic, hepatoprotective, anti-inflammatory, antimutagenic, antiproliferative, radioprotective, cardioprotective, antiarthritic, anticaries, gastrointestinal motility and wound healing activity. But no systematic updated information on the therapeutic effectiveness of Terminalia chebula, a popular herbal remedy in India and South-East Asia has so far been reported. This review highlights an updated information particularly on the phytochemistry and various pharmacological and medicinal properties of Terminalia chebula Retz. and some of its isolated compounds, along with their safety evaluation. This may provide incentive for proper evaluation of the plant as medicinal agent against the human diseases and also to bridge the lacunae in the existing literature and future scope which may offer immense opportunity for researchers engaged in validation of the traditional claims and development of safe and effective botanical medicine.
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PMID:The development of Terminalia chebula Retz. (Combretaceae) in clinical research. 2362 Aug 47

End stage renal disease (ESRD) population account for 1.9 per patient year of hospital admissions annually. ESRD population are at increased risk of bleeding secondary to use of anticoagulation during hemodialysis and uremia induced platelet dysfunction. Gastrointestinal bleeding accounts for 3-7% of all deaths in ESRD population. Lower gastrointestinal bleeding refers to blood loss from a site in the gastrointestinal tract distal to the ligament of Treitz. It is usually suspected when a patient complains of hematochezia. It is different from patients presenting with hematemesis that suggests bleeding from upper gastrointestinal tract. Common causes of lower gastrointestinal bleed include diverticulosis, ischemia, hemorrhoids, neoplasia, angiodysplasia, and inflammatory bowel disease. ESRD patients are known to retain phosphate alone or in combination with calcium which has been associated with high mortality. Sevelamer is a phosphate binder used widely in ESRD population. The known side effects of sevelamer include metabolic acidosis, vomiting, nausea, diarrhea, dyspepsia, abdominal pain, constipation, flatulence, fecal impaction, and skin rash. We are reporting a unique case of a 56-year-old female with end stage renal disease on sevelamer hydrochloride who presented with gastrointestinal bleeding and underwent a right hemicolectomy found to have sevelamer-induced mucosal ulceration and crystal deposition in the colonic mucosa. This case report highlights the fact that, with widespread use of this medication in the patients with chronic kidney diseases, physicians should be aware of this underrecognized entity in the differential diagnosis of gastrointestinal bleed in ESRD patients.
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PMID:Colonic Mucosal Ulceration and Gastrointestinal Bleeding Associated with Sevelamer Crystal Deposition in a Patient with End Stage Renal Disease. 2968 71