Rectal examination in patients with pain in the right lower quadrant of the abdomen.

OBJECTIVE--To determine whether rectal examination provides any diagnostic information in patients admitted to hospital with pain in the right lower quadrant of the abdomen. DESIGN--Casualty officer or surgical registrar recorded symptoms and signs on admission on detailed forms. Final diagnosis was noted on discharge from hospital. SETTING--District general hospital. PATIENTS--1204 Consecutive patients admitted to hospital with pain in the right lower quadrant of the abdomen as their major complaint; 1028 had a rectal examination on admission. MAIN OUTCOME MEASURES--Odds ratio for each symptom and sign related to final diagnosis. Results of multiple logistic regression analysis for acute appendicitis. RESULTS--Right sided rectal tenderness, present in 309 of those examined, was more common in patients with acute appendicitis (odds ratio 1.34, p less than 0.05). This odds ratio was considerably less than that for other clinical signs--namely, tenderness in the right lower quadrant (odds ratio 5.09), rebound tenderness (3.34), guarding (3.07), and muscular rigidity in the abdomen (5.03). In the logistic regression analysis of patients with acute appendicitis, when allowance was made for the presence or absence of rebound tenderness, rectal tenderness on the right lost its significance. Six patients had masses palpable rectally, of which three were palpable on abdominal examination; the other three patients had acute appendicitis. No other unexpected diagnoses were established, and no useful additional diagnostic information was obtained by routine rectal examination. CONCLUSION--If patients presenting with pain in the right lower quadrant of the abdomen are tested for rebound tenderness then rectal examination does not give any further diagnostic information.     

Incidence and clinical features of liver injury related to Kampo (Japanese herbal) medicine in 2,496 cases between 1979 and 1999: Problems of the lymphocyte transformation test as a diagnostic method

We retrospectively examined the summaries of all admission records of patients from 1979 to 1999 in our department, and selected for further study all liver injuries suspected of being related to Kampo medicines. Among 2,496 summaries, 30 summaries described liver disorders suspected of being related to Kampo medicines. Whether there was a causal relationship between the use of Kampo medication and the occurrence of liver injury was assessed according to the criteria described by Haller and Benowitz (2000), independently of the results of the lymphocyte transformation test (LTT). Among 30 events, we concluded that 9 were definitely unrelated, and 6 were probably unrelated to the use of Kampo medicines. Nine events (0.36% of 2,496 patient admissions and 0.06% of 14,616 outpatients) were considered possibly related, and only 6 events (0.24% of 2,496 patient admissions and 0.04% of 14,616 outpatients) were judged to be definitely or probably related to Kampo medicines. Low-grade eosinophilia was observed in a few patients of these "related" groups, and no fever or rash was observed in these "related" groups. Other clinical features, including type of liver injury, duration of Kampo medicine-use, recovery period and laboratory data, were not different from liver injuries associated with western drugs. Most patients in the definitely "unrelated" group were positive in the LTT for the suspect Kampo medicine, suggesting that the LTT may be unreliable for the diagnosis of Kampo-medicine-induced liver injury. From 1979 to 1999, our use of Kampo medicines to treat patients resulted in a low rate of liver injury and no fatalities.     

Gender differences in self-reported constipation characteristics,symptoms, and bowel and dietary habits among patients attending a specialty clinic for constipation

Objectives: This study assessed gender differences in the frequency of various characteristics of constipation, constipation-specific symptoms, and bowel and dietary habits, as well as the effects of independent but associated risk factors.Methods: A cross-sectional study of patients aged ≥18 years with a primary diagnosis of constipation (ie, constipation, slow-transit constipation, outlet dysfunction constipation) was conducted at a tertiary referral center; patients were excluded if they had a primary diagnosis of fecal incontinence. Patients completed both a clinical questionnaire to obtain information on demographic characteristics and medical history and an unvalidated self-report questionnaire relating to the characteristics and symptoms of constipation as well as various bowel and dietary habits. Likert scales were used to assess 4 characteristics of constipation (frequency of constipation, duration of constipation symptoms of ≥1 month, bowel movement frequency, stool consistency) and the frequency of occurrence of 6 constipation symptoms (abdominal pain, abdominal bloating, incomplete evacuation, unsuccessful attempts at evacuation, pain with evacuation, straining with evacuation). The bowel habits that were evaluated included time spent at each evacuation; frequency of needing to change position to evacuate; use of anal digitation to evacuate; and the use of laxatives, enemas, stool softeners, foods, drinks, or other aids. The dietary habits that were evaluated included use of dietary fiber, use of fiber supplements, and water intake.Results: Of the 518 patients, the majority were female (79.0%), white (76.3%), and employed (62.0%), with a mean (SD) age of 52.4 (16.5) years (range, 18.6–91.5 years). After controlling for a number of related conditions, women were more likely than men to have infrequent bowel movements (adjusted odds ratio [AOR] = 2.97; 95% CI, 1.67–5.28), abnormal stool consistency (ie, hard or pelletlike stools) (AOR = 3.08; 95% CI, 1.80–5.28), and a longer duration of constipation symptoms (AOR = 2.00; 95% CI, 1.05–3.82). In addition, women were more likely to report an increased frequency of occurrence of abdominal pain (AOR = 2.22; 95% CI, 1.22–4.05), bloating (AOR = 2.65; 95% CI, 1.50–4.70), unsuccessful attempts at evacuation (AOR = 1.74; 95% CI, 1.01–3.00), and the use of anal digitation to evacuate stool (AOR = 3.37; 95% CI, 1.15–9.90).Conclusions: The women in this specialty-based clinic study experienced a number of constipation symptoms and abnormal bowel habits more frequently than did men. These findings warrant replication in both population- and specialty clinic-based samples. In addition, the physiologic mechanisms that underlie these gender differences warrant investigation.     

The efficacy of cisapride vs. placebo and diet in patients with chronic constipation

The effects of cisapride (10 mg three times daily) on the stool evacuation characteristics, laxative consumption (symptom diary) and motility pattern (rectoanal manometry) were assessed in patients with chronic idiopathic constipation who fulfilled Rome II criteria. After a 14-day basal period on a diet rich in fiber (phase I), patients were treated with placebo (n = 20) or cisapride (n = 19) (phase II). Anorectal manometry was performed at the end of each phase. The study was controlled, randomized and double blind. Side effects related to the use of cisapride were noted and found to be mild. Cisapride and placebo increased stool frequency from 4 (1-11) to 7 (14-12) (p < 0.001) and from 4 (2-10) to 6 (2-11) (p < 0.05) per week, respectively. Straining was decreased from 69.0% to 39.7% in the cisapride (p < 0.0001) group, and from 79% to 35% (p < 0.0001) in the placebo group. Both cisapride and placebo decreased the feeling of incomplete evacuation from 91.7% to 37.5% (p < 0.0001) and from 82.7% to 39.2% (p < 0.0001), respectively. Cisapride reduced the need of laxatives and showed a tendency to normalize stool consistency but did not influence any other symptom or bowel motility parameter.     

Interaction between Shaoyao–Gancao–Tang and a laxative with respect to alteration of paeoniflorin metabolism by intestinal bacteria in rats

Shaoyao-Gancao-Tang (SGT), a traditional Chinese herbal medicine (Kampo formulation) containing Shaoyao (Paeoniae Radix) and Gancao (Glycyrrhizae Radix), is co-administered with laxative sodium picosulfate as a premedication for relieving the pain accompanying colonoscopy. Paeoniflorin (PF), an active glycoside of SGT, is metabolized into the antispasmodic agent paeonimetabolin-I (PM-I) by intestinal bacteria after oral administration. The objective of the present study was to investigate whether the co-administered laxative (sodium picosulfate) influences the metabolism of PF to PM-I by intestinal bacteria. We found that the PF-metabolizing activity of intestinal bacteria in rat feces was significantly reduced to approximately 34% of initial levels by a single sodium picosulfate pretreatment and took approximately 6 days to recover. Repeated administration of SGT after the sodium picosulfate pretreatment significantly shortened the recovery period to around 2 days. Similar results were also observed for plasma PM-I concentration. Since PM-I has muscle relaxant activity, the present results suggest that repetitive administration of SGT after sodium picosulfate pretreatment might be useful to relieve the pain associated with colonoscopy.     

两种微创术式治疗老年混合痔的临床疗效比较

目的:比较两种微创手术方式治疗老年混合痔的临床疗效和安全性。方法:选取2012年10月至2013年4月在湖南中医药大学第一附属医院肛肠科住院的162例老年混合痔患者并随机分成治疗组82例和对照组80例,治疗组采用自动痔疮套扎(RPH)术+外痔切除术治疗,对照组采用痔上粘膜环切钉合(PPH)术+外痔切除术治疗,观察周期为21天,随访3年。观察并比较分析两组患者术后疼痛积分、手术时间、术中出血量、术后恢复时间、术后并发症情况及远期疗效。结果:治疗组手术时间、术中出血量、术后恢复时间、术后24 h疼痛积分、首次排便疼痛积分及术后并发症(出血、水肿)的发生率均明显短于或低于对照组,差异有统计学意义(P0.05)。两组的远期疗效相当,差异无统计学意义(P0.05)。结论:自动痔疮套扎(RPH)术治疗老年混合痔患者的近期疗效和安全性较粘膜环切钉合(PPH)术+外痔切除术更好,而远期疗效与其相当。     

Umbilical cord clamping and preterm infants: a randomised trial.

OBJECTIVE--To investigate the clinical effects of regulating umbilical cord clamping in preterm infants. DESIGN--A prospective randomised study. SETTING--The Queen Mother''s Hospital, Glasgow. SUBJECTS--36 vaginally delivered infants over 27 and under 33 weeks'' gestation. INTERVENTION--Holding the infant 20 cm below the introitus for 30 seconds before clamping the umbilical cord ("regulated" group, 17 patients), or conventional management ("random" group, 19 patients). MAIN OUTCOME MEASURES--Initial packed cell volume, peak serum bilirubin concentrations, red cell transfusion requirements, and respiratory impairment (assessed by ventilatory requirements, arterial-alveolar oxygen tension ratio over the first day in ventilated infants, and duration of dependence on supplemental oxygen). RESULTS--There were statistically significant differences between the two groups in mean initial packed cell volume (regulated group 0.564, random group 0.509) and median red cell transfusion requirements (regulated group zero, random group 23 ml/kg). 13 infants from each group underwent mechanical ventilation and showed significant differences in mean minimum arterial-alveolar oxygen tension ratio on the first day (regulated group 0.42, random group 0.22) and in median duration of dependence on supplemental oxygen (regulated group three days, random group 10 days). Differences in final outcome measures such as duration of supplemental oxygen dependence and red cell transfusion requirements were mediated primarily through arterial-alveolar oxygen tension ratio and also packed cell volume. CONCLUSIONS--This intervention at preterm deliveries produces clinical and economic benefits.     

Ligation and mucopexy for prolapsing hemorrhoids – a ten year experience

Objective

The aim of this study is to clinically test the efficacy of author's approach of suture ligation and mucopexy for patients having symptomatic and prolapsing hemorrhoids.

Materials and methods

616 patients (255 females) complaining of symptoms of hemorrhoids were included in the study. The hemorrhoids were suture ligated with an absorbable suture material under vision. Operating time, postoperative complications, time to return to work, and outcome of the procedure were analyzed. Follow-up was planned following discharge after 1 month, 6 months and after at least 1 year. Patient satisfaction was also assessed.

Results

The mean procedure time was 8 ± 0 minutes (range, 6–15 minutes), and the total admission period was 12 ± 4 Hours. Perianal thrombosis and skin tags were the commonest post-operative complications. The mean total analgesic dose and duration of pain control using analgesics was 19 ± 4 tablets, and 9 ± 3 days respectively. The postoperative follow up after 4 weeks revealed therapeutic success in 589 patients (95.6%), who presented with hemorrhoidal bleeding. Prolapse was no longer observed in 98% of patients and 96% patients experienced no pain after defecation. 93% patients completed the one-year follow-up and 89 percent of them were asymptomatic. The patient satisfaction scoring was 8.2% on visual analogue scale.

Conclusion

Suture ligation and mucopexy of hemorrhoids is an easy-to-perform technique that is well accepted by patients and has good results for prolapsing hemorrhoids.     

紫草油治疗肛瘘术后的临床研究

目的观察紫草油对肛瘘术后临床疗效改善情况以及血清中TGF-β1、Smad3的含量变化。方法将我院收治的肛瘘术后患者90例采用简单随机法分为紫草油组、凡士林组和肤痔清组各30例,术后第1天至创面愈合,每天分别给予紫草油、凡士林、肤痔清软膏外用,并于术后第1、7、14、21天观察创面疼痛、水肿、出血情况,以及酶联免疫吸附法(ELISA法)检测患者血清中TGF-β1和Smad3含量。结果 3组患者治疗后均能缓解术后水肿、疼痛、出血症状;紫草油组在治疗后第21天与肤痔清组、凡士林组比较,水肿、疼痛、出血的积分差异显著(P0.05)。治疗后第7、14、21天紫草油组与肤痔清组、凡士林组的TGF-β1含量比较,差异具有统计学意义(P0.05);治疗后组内血清Smad3含量均较治疗前明显降低,差异有统计学意义(P0.05),但治疗后第21天紫草油组与肤痔清组、凡士林组的Smad3含量比较,差异无统计学意义(P0.05)。结论紫草油能明显缓解肛瘘术后创面水肿、疼痛、出血情况,且疗效优于肤痔清及凡士林,能有效提高TGF-β1含量及降低血清Smad3含量,促进创面愈合。     

神阙穴帖敷治疗骨科骨折患者术后便秘的疗效观察

目的探讨大黄水蜜贴敷"神阙"穴对骨折术后便秘的治疗效果。方法选取我院骨科骨折术后发生便秘的患者100例,随机分成治疗组和对照组各50例。对照组采用传统的治疗方法,即在骨科常规护理措施上指导患者多饮水,多进食水果、蔬菜,必要时给予缓泻药或开塞露纳肛。治疗组在对照组的基础上加用大黄水蜜贴敷"神阙"穴治疗,并对两组患者的便秘情况和相关症状进行比较。结果治疗组的治疗有效率为90%,对照组为60%,两组比较差异有统计学意义(P0.05);观察组发生便秘的相关症状少于对照组,差异有统计学意义(P0.05)。结论大黄水蜜贴敷"神阙"穴治疗骨科骨折术后便秘的疗效显著,值得临床推广应用。     

PPH与Milligan-Morgan术式治疗环状混合痔的临床效果观察

目的:比较PPH与Milligan-Morgan术式治疗Ⅲ～Ⅳ期环状痔的临床效果,探讨治疗Ⅲ～Ⅳ期环状痔的最佳术式。方法:选择Ⅲ～Ⅳ期环状痔患者130例,随机均分为PPH组和Milligan-Morgan组,两组患者分别采用PPH术式和Milligan-Morgan术式治疗,比较两组患者手术时间、术中出血量、术后疼痛评分、住院时间、住院费用和术后并发症情况。结果:PPH组优于Milligan-Morgan组,两组患者手术时间、术中出血量、术后疼痛评分、住院时间、住院费用及术后发生急性尿潴留、肛门水肿和吻合口感染病例比较,差异具有统计学意义(P<0.05)。结论:应首选PPH术式治疗Ⅲ～Ⅳ期环状痔患者,可显著减轻术后疼痛,加快患者术后恢复,减少术后并发症。     

腹内压值对外科急腹症患者的检测价值研究

目的:评估膀胱压力(BP)测量作为急腹症诊断工具的临床价值。方法:选取在我院外科治疗的患者,根据病情分为两组:一组为325例急腹症患者,对照组为50例进行腹腔镜手术的患者。在治疗前测量患者腹内压力。患者采用仰卧位,将50 m L无菌生理盐水缓慢注射到膀胱中,待排光后检测BP。将导管同水压计连接,以耻骨联合处为参考点。将BP值大于10 cm H2O,作为诊断急腹症的标准。结果:BP诊断急腹症的灵敏度为94.4%,特异性为79%,阳性预测值为95.9%,阴性预测值为71.7%,精确度为92.3%。结论:腹内压(IAP)升高可以作为急性腹痛的诊断工具。BP检测有助于临床医生在试验室检查或影像学检查结果有限时对患者病情进行评估。     

西甲硅油联合枯草杆菌肠球菌对肠易激综合征的疗效观察

目的:探讨西甲硅油乳剂联合枯草杆菌肠球菌二联活菌肠溶胶囊(美常安)在肠易激综合征(IBS)治疗中的临床效果。方法:将2014年1月至2015年10月收治的180例IBS患者随机分为西甲硅油乳剂联合枯草杆菌肠球菌二联活菌治疗组92例和单药枯草杆菌肠球菌二联活菌治疗对照组88例,治疗4周后随访观察两组患者的治疗总有效率、不同胃肠症状的治疗有效率,以及不同型IBS患者的胃肠症状评分。结果:IBS治疗组的治疗总有效率为88.0%,明显高于对照组70.5%(P0.05)。治疗4周后腹胀和排便次数改善的有效率分别为94.6%和78.3%明显高于对照组的77.3%和60.2%(P0.05),但两组在腹痛和排便性状改善方面比较无明显差异(P0.05)。对两组不同胃肠症状评分结果:显示同组同型IBS治疗4周后胃肠症状评分均明显低于治疗前(P0.05)治疗有效。但两组同型IBS患者的治疗后胃肠症状评分比较时,仅在便秘型IBS患者差异明显(P0.05)。结论:西甲硅油乳剂联合枯草杆菌二联活菌肠溶胶囊对肠易激综合征(IBS)患者治疗有效,对缓解腹胀和改善排便次数上治疗效果尤为明显,对IBS便秘型患者的胃肠症状恢复疗效最佳。     

Intestinal coccidia in Cuban pediatric patients with diarrhea

From May to August 1999, we evaluated 401 patients from a pediatric hospital of Havana City. One group was composed of 113 patients with diarrhea admitted to the Gastroenterology ward and a second consisted of 288 patients without diarrhea, admitted for other reasons, and hospitalized within the same time period. Three stool samples were collected from each child and were examined using three parasitological techniques. When we compared the frequency of parasite species between both groups, we found Cryptosporidium spp. and Cyclospora cayetanensis, only in the group of children with diarrhea (P < 0.01). However, no significant differences were found in the occurrence of the other intestinal parasites (P > 0.05). In addition, in those children infected with Cryptosporidium, the diarrhea had a more prolonged duration (P < 0.01), while those infected with Cyclospora, the abdominal cramps or pain, and acute diarrhea were more frequently detected (P < 0.01). Our results showed that emerging intestinal coccidia are pathogens strongly associated in this group of children with diarrhea.     

Efficacy and mode of action of mesalazine in the treatment of diarrhoea-predominant irritable bowel syndrome (IBS-D): study protocol for a randomised controlled trial

Background

Irritable bowel syndrome (IBS) is reported by one in ten of the population accounting for up to 40% of new referrals to gastroenterology outpatients. Patients characteristically have abdominal discomfort and disturbed bowel habit. Diarrhoea-predominant IBS is characterised by frequent loose stools with associated urgency and abdominal cramps. Current symptomatic treatments can reduce bowel frequency but often fail to reduce discomfort. Mesalazine is an anti-inflammatory drug used to treat patients with inflammatory bowel disease. There is one pilot study suggesting it may be beneficial to patients who have diarrhoea-predominant IBS but these findings need to be confirmed in a larger trial. The current study aims to test the effectiveness of mesalazine to reduce symptoms in diarrhoea-predominant IBS patients. The study will also investigate the mode of action of the drug, especially its impact on mast cell activation.

Methods/design

This is a multicentre randomised, double-blind, placebo-controlled trial using a parallel group design. At least 108 participants with diarrhoea-predominant IBS will be recruited through at least six hospitals. The intervention is a 12-week course of 2g mesalazine granules taken up to twice a day. The comparator is a blinded placebo granule formulation. Outcome measures include stool diaries, symptom questionnaires, stool and blood samples together with rectal mucosal biopsies. The daily stool diary will record stool frequency and form, urgency, bloating, abdominal pain and a global satisfaction with control of IBS scored each week. The questionnaires will assess bowel symptoms, while the samples and biopsies will be used to analyse underlying mechanisms of any response. Primary outcome will be the average stool frequency during weeks 11 and 12 of the treatment period and will be compared between treatment arms using an analysis of covariance in the form of a general linear model incorporating baseline characteristics that are thought a priori to strongly predict outcome. The primary efficacy parameter will be the difference in mean frequency between treatment arms.

Discussion

This report describes a randomised controlled trial that will provide evidence of any benefit of treating diarrhoea-predominant IBS patients with mesalazine. The results will be available toward the end of 2013.

Trial registration

ISRCTN76612274     

Distinguishing fibromyalgia from rheumatoid arthritis and systemic lupus in clinical questionnaires: an analysis of the revised Fibromyalgia Impact Questionnaire (FIQR) and its variant, the Symptom Impact Questionnaire (SIQR), along with pain locations

Introduction

The purpose of this study was to explore a data set of patients with fibromyalgia (FM), rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who completed the Revised Fibromyalgia Impact Questionnaire (FIQR) and its variant, the Symptom Impact Questionnaire (SIQR), for discriminating features that could be used to differentiate FM from RA and SLE in clinical surveys.

Methods

The frequency and means of comparing FM, RA and SLE patients on all pain sites and SIQR variables were calculated. Multiple regression analysis was then conducted to identify the significant pain sites and SIQR predictors of group membership. Thereafter stepwise multiple regression analysis was performed to identify the order of variables in predicting their maximal statistical contribution to group membership. Partial correlations assessed their unique contribution, and, last, two-group discriminant analysis provided a classification table.

Results

The data set contained information on the SIQR and also pain locations in 202 FM, 31 RA and 20 SLE patients. As the SIQR and pain locations did not differ much between the RA and SLE patients, they were grouped together (RA/SLE) to provide a more robust analysis. The combination of eight SIQR items and seven pain sites correctly classified 99% of FM and 90% of RA/SLE patients in a two-group discriminant analysis. The largest reported SIQR differences (FM minus RA/SLE) were seen for the parameters "tenderness to touch," "difficulty cleaning floors" and "discomfort on sitting for 45 minutes." Combining the SIQR and pain locations in a stepwise multiple regression analysis revealed that the seven most important predictors of group membership were mid-lower back pain (29%; 79% vs. 16%), tenderness to touch (11.5%; 6.86 vs. 3.02), neck pain (6.8%; 91% vs. 39%), hand pain (5%; 64% vs. 77%), arm pain (3%; 69% vs. 18%), outer lower back pain (1.7%; 80% vs. 22%) and sitting for 45 minutes (1.4%; 5.56 vs. 1.49).

Conclusions

A combination of two SIQR questions ("tenderness to touch" and "difficulty sitting for 45 minutes") plus pain in the lower back, neck, hands and arms may be useful in the construction of clinical questionnaires designed for patients with musculoskeletal pain. This combination provided the correct diagnosis in 97% of patients, with only 7 of 253 patients misclassified.     

Laxative-induced Diarrhoea: A Continuing Clinical Problem

Seven women spent an average of 127 days in hospital and were extensively investigated, including a laparotomy, before their complaints of abdominal pain, diarrhoea, and weight loss were shown to be due to excessive taking of laxatives. All denied taking laxatives and in none were the characteristic features of the effects of cathartics on the colon seen on sigmoidoscopy or radiological examination.Hypokalaemia and other electrolyte abnormalities were common and were thought to be due to a combination of severe diarrhoea and vomiting. The rectal mucosa was seen to be abnormal on biopsy only in the three patients who had taken senna preparations. The diagnosis was not easy and was finally established either by analysis of the urine and stools or by searching the patient''s ward locker.     

Zinc supplementation in children with cholera in Bangladesh: randomised controlled trial

Objective To investigate the impact of zinc supplementation in children with cholera.Design Double blind, randomised, placebo controlled trial.Setting Dhaka Hospital, Bangladesh.Participants 179 children aged 3-14 years with watery diarrhoea and stool dark field examination positive for Vibrio cholerae and confirmed by stool culture.Intervention Children were randomised to receive 30 mg elemental zinc per day (n=90) or placebo (n=89) until recovery. All children received erythromycin suspension orally in a dose of 12.5 mg/kg every six hours for three days.Main outcome measures Duration of diarrhoea and stool output.Results 82 children in each group completed the study. More patients in the zinc group than in the control group recovered by two days (49% v 32%, P=0.032) and by three days (81% v 68%, P=0.03). Zinc supplemented patients had 12% shorter duration of diarrhoea than control patients (64.1 v 72.8 h, P=0.028) and 11% less stool output (1.6 v 1.8 kg/day, P=0.039).Conclusion Zinc supplementation significantly reduced the duration of diarrhoea and stool output in children with cholera. Children with cholera should be supplemented with zinc to reduce its duration and severity.Trial registration Clinical trials {"type":"clinical-trial","attrs":{"text":"NCT00226616","term_id":"NCT00226616"}}NCT00226616.     

复方利多海浮膏对混合痔患者外剥内扎术后肛缘疼痛的临床效果

目的：探讨复方利多海浮膏用于治疗混合痔外剥内扎术后肛缘疼痛和水肿的临床疗效。方法：选择2012 年7月-2014 年12 月在我院接受混合痔外剥内扎术治疗的患者70 例,随机分为治疗组和对照组,每组各35 例。治疗组采用复方利多海浮膏外敷换 药治疗,对照组采用黄连膏换药治疗。观察并比较两组患者治疗前后肛缘疼痛和水肿的变化情况。结果：两组患者术前疼痛评分 及肛缘水肿得分差异无统计学意义（P＞0.05）;治疗组患者治疗后1 天、2 天、3 天、5 天的疼痛评分和肛缘水肿得分均显著低于对 照组,差异有统计学意义（P＜0.05）;治疗组患者治疗总有效率显著优于对照组,差异有统计学意义（P＜0.05）。结论：复方利多海 浮膏外敷换药用于治疗混合痔外剥内扎术后肛缘疼痛和水肿方面的疗效更好。     

Psychologically mediated abdominal pain in surgical and medical outpatients clinics.

Ninety-six patients complaining of recurrent or persistent abdominal pain were referred consecutively to a surgical clinic and a medical clinic, respectively. They were examined psychiatrically after their initial physical investigation. The psychiatric examination included rating scales for depression and anxiety, a personality inventory, life-events schedule, scale of verbal expressivity, and family and personal patterns of pain and invalidism. Only 15 patients (15-6%) had organic disorders that could be responsible for their symptoms. In the remainder, psychiatric factors were considered primarily responsible for their abdominal pain: 31 were depressed; 21 had chronic tension; in 17 hysterical mechanisms were prominent; and 12 were found to be unrecognised alcoholics. Follow-up at three and six months and recognition by 80% of the psychogenic group that a psychological explanation was plausible, confirmed the diagnoses, and over half responded favourably to psychiatric management. Features distinguishing the organic and psychogenic groups were delineated. Psychiatric assessment has a place among the investigations of non-acute abdominal pain; certainly it should not be condisered simply as "a last resort."