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BACKGROUND: The aim of the present study was to evaluate the efficacy of 10 % sucralfate ointment in the reduction of acute postoperative pain after open hemorrhoidectomy. METHODS: A total of 48 patients (24 men and 24 women) between 20 and 70 years of age who underwent open hemorrhoidectomy were included in this prospective, double-blind, randomized, controlled trial and were randomly divided into two groups (24 in each group), receiving either sucralfate ointment or placebo immediately after surgery and then every 12 h for 14 days. The primary outcome measure was pain intensity measured by a visual analogue scale at different time points after hemorrhoidectomy. RESULTS: The sucralfate group had significantly less pain than the placebo group at 24th h and the 48th h after hemorrhoidectomy (4 ± 1.14 vs 5.08 ± 0.97; P = 0.001 and 3 ± 0.72 vs 4.41 ± 0.8; P < 0.001, respectively), and they consumed lower amounts of analgesics at the same time intervals (12.50 ± 16.48 vs 21.87 ± 15.30 mg of pethidine; P = 0.047 and 152 ± 23 vs 172 ± 29 mg of diclofenac; P = 0.009, respectively). The same trend continued until the end of the trial. CONCLUSIONS: Sucralfate ointment reduced the acute postoperative pain after hemorrhoidectomy.

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BACKGROUND: The aim of the present study was to evaluate the efficacy of cholestyramine ointment (15 %) in reducing postoperative pain at rest and during defecation after open hemorrhoidectomy. METHODS: A total of 91 patients with third and fourth degree hemorrhoids undergoing open hemorrhoidectomy were included in this prospective, double-blind, randomized controlled trial. The patients were randomly assigned to either cholestyramine ointment or placebo immediately after surgery, 12 h after surgery, and then every 8 h for 14 days. The primary outcomes were intensity of pain at rest and during defecation, measured with a visual analog scale, and the analgesic requirement, measured by amount of tramadol consumption. RESULTS: The cholestyramine group had less postoperative pain than the placebo group at the 24th hour (1.84 ± 2.54 vs. 4.07 ± 3.35; P = 0.001) and 48th hour (0.18 ± 0.88 vs. 3.57 ± 3.45; P < 0.001) and less pain during defecation starting at the 48th hour (2.28 ± 2.96 vs. 4.77 ± 4.09; P = 0.001). Similarly, the average tramadol consumption at hours 24 and 48 was significantly lower for the cholestyramine group (5.32 ± 21.45 vs. 43.18 ± 61.56 mg at 24 h, and 4.48 ± 16.65 vs. 57.63 ± 65.47 mg at 48 h; P < 0.001). The only adverse event was pruritus, which had a lower frequency in the cholestyramine group but the difference was not significant until postoperative week 4 (P < 0.001). CONCLUSIONS: Compared with placebo, cholestyramine ointment (15%) reduced postoperative pain at rest and on defecation, and consequently lowered the analgesic requirement after open hemorrhoidectomy.

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We report a 41 years old man with rapidly growing and tender lump on the anteromedial surface of tibia. The patient had the history of gastrectomy and gastrojejunostomy due to gastric carcinoma. On admission, the Simple X-ray of lower extremity disclosed a slight thinning of the anterior cortex of tibia without cortical destruction. The whole-body bone scan with (99m)TC MDP revealed activity of lesion in all 3 phases. The histopathological evaluation showed an infiltration of bone with tumor cells. Review No the literature revealed in previous cases of skeletal metastasis from gastric cancer in the tibia like this.

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OBJECTIVE: Aloe vera is an herbal medicine, which has wound healing effects in burn injury. This study assessed the effects of Aloe vera cream in reducing postoperative pain, postdefection pain, and its promotion of wound healing after open hemorrhoidectomy. DESIGN: A prospective, randomized, double-blind, placebo-controlled trial was conducted comparing the effects of a cream containing Aloe vera versus a placebo cream on posthemorrhoidectomy pain. The study preparations were applied by patients to the surgical site 3 times per day for 4 weeks after hemorrhoidectomy. Pain was assessed with a visual analog scale immediately postoperatively and at hours 12, 24, and 48 after surgery and at weeks 2 and 4. Wound healing was examined and evaluated at the end of 2 and 4 weeks. The use of analgesics was recorded. RESULTS: Forty-nine (49) patients were randomly assigned to receive aloe (n = 24) or placebo (n = 25). Patients in the topical aloe cream group had significantly less postoperative pain at hours 12, 24, and 48 hours and at 2 weeks. Aloe cream reduced the pain after defecation in 24 and 48 hours postsurgery (p < 0.001). Wound healing at the end of the second postoperative week was significantly greater in the aloe group compared with the placebo group (p < 0.001). Patients required fewer additional analgesics posthemorrhoidectomy (p < 0.001). CONCLUSIONS: Application of Aloe vera cream on the surgical site is effective in reducing postoperative pain both on resting and during defecation, healing time, and analgesic requirements in the patients compared with the placebo group.

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BACKGROUND: Magnetic resonance cholangiography (MRC) is a non-invasive method for imaging biliary ducts. When used to exclude common bile duct (CBD) stones, MRC may obviate the need for intra-operative cholangiography (IOC). In this prospective study, MRC and IOC were compared for the diagnosis of suspected stones of the CBD. METHODS: Thirty patients with gallstones and suspected CBD lithiasis (abnormal serum liver tests and CBD >7 mm on ultrasound) had MRC followed by open cholecystectomy and IOC. MR imaging was done using a 1.5-T whole body scanner (Signa, General Electric Medical Systems). A torso phased-array coil with a 4-channel receiver was used for data acquisition. RESULTS: Over a period of 18 months, 30 patients (average age 53.9+/-13.3 years; range 38-76 years) were enrolled in this study. Eleven patients were male (36.7%) and 19 female (63.3%). MRC revealed CBD stones in 19 patients, while IOC revealed CBD stones in 22. The sensitivity of MRC in detecting CBD stones was 81.8%, and the specificity was 87.5%. The positive predictive value was 94.7%, and the negative predictive value was 63.3%. CONCLUSIONS: Pre-operative MRC may obviate the need for IOC. MRC reduces operative time, is less invasive, and may also alleviate damage to the CBD that can occur during IOC. MRC can identify CBD stones pre-operatively and can help surgeons plan safe procedures. Pre-operative MRC should be done routinely in patients whose clinical or biochemical findings suggest the possibility of CBD stones.

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BACKGROUND: Topical metronidazole (10 percent) has been previously demonstrated to decrease postoperative pain after hemorrhoidectomy. The aim of this study was to evaluate the effect of topical metronidazole (10 percent) in reducing postoperative and after-defecation pain of hemorrhoidectomy. MATERIALS AND METHODS: A double-blind, randomized trial was conducted to compare posthemorrhoidectomy pain with use of topical metronidazole (10 percent) vs. placebo carrier, applied to surgical site. Forty-seven patients were randomly allocated to receive metronidazole (n=25) or placebo (n=22). Pain was assessed using a visual analog scale preoperatively and on postoperative hours 6 and 12 and at days 1, 2, 7, and 14. The use of narcotic, additional analgesics, and complications were recorded. (Pain scores were calculated and compared with baseline values and control group (t test, SPSS ver.10). RESULTS: Patients in the topical metronidazole group had significantly less postoperative pain than those in the placebo group up to day 14 (P

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