Pentazocine suppositories for post-operative pain: intramuscular pentazocine injections versus suppositories in a controlled trial in 588 patients.

A between-patient comparison of the analgesic effect of pentazocine 50 mg by suppository and 30--45 mg by intramuscular injection was made in 558 postoperative patients, 54% within 24 hours of operation. The suppositories proved acceptable overall, even though effectiveness was less at half an hour after administration (particularly in those patients with severe initial pain) and there was greater need for further analgesia at one hour. The cost of treatment with suppositories is less than with injections. After the suppositories there were half as many patients asleep at one hour than after injections, and fewer possible side-effects (7 compared to 24).

Pentazocine suppositories versus pethidine injections in 500 patients with post-operative pain.

Pentazocine (Fortral) suppositories (50 mg) were compared with pethidine (100 mg) by injection in 500 patients after general and gynaecological surgery. Pain was assessed by patients using a pain thermometer, (a modification of a visual analogue scale), and by observers using an adjectival scale. There was a good relationship between these methods. Good pain relief was obtained with both drugs and there was little difference between the treatments in moderate pain. Pethidine was faster and more effective, particularly in severe pain. There were fewer side-effects with pentazocine suppositories. They are a useful alternative to injections, especially in moderate pain.

A cross-over comparison of the effect of morphine, pethidine, pentazocine, and phenazocine on biliary pressure.

The effects on biliary pressure of pentazocine, morphine, pethidine, and phenazocine were compared by direct measurement through a ;T' tube after choledochotomy. In two within-patient comparisons, the mean increases in biliary pressure following intramuscular morphine were significantly greater than those following pentazocine. When pethidine and phenazocine were compared with pentazocine, the mean increases were lower following pentazocine but not to a statistically significant extent. Pentazocine appears to be the most appropriate strong analgesic in biliary and pancreatic disease.

The value of routine peroperative cholangiography--a report of 4000 cholecystectomies.

A total of 4000 consecutive cholecystectomies performed over a period of 25 years has been analysed to determine whether routine peroperative cholangiography (PC) has influenced overall mortality. The patients have been divided into four cohorts of 1000, the first cohort before the introduction of PC, two covering the period of introduction of PC and the final cohort when PC was an established routine. A significant fall in overall mortality has been demonstrated, but when the patients are divided into simple cholecystectomy and the group undergoing additional choledochotomy there is no significant fall in the mortality rate. The mortality rate for the latter group is three or four times greater than that for the cholecystectomy alone group. The main contribution to the lower mortality is the reduced duct exploration rate following the introduction of PC. The stone recovery rate has improved from 34 to 71 per cent. The use of routine PC during cholecystectomy is recommended.

Results of a screening program for multiple endocrine neoplasia type II.

After the diagnosis of MEN IIa syndrome in five members of a British family, a further 180 members were identified, 167 of whom were still alive. From death certificates, a further three were found to have been affected. Of these eight patients, only two were diagnosed and survived. Over the next four years, these two survivors and 90 others (those over the age of ten years) attended a screening program using alcohol or pentagastrin stimulated plasma calcitonin for MCT or urinary catecholamines for pheochromocytoma. The two surviving patients and 12 others were thought to have abnormal screening tests. One patient with an abnormal catecholamine excretion level had bilateral pheochromocytomas removed. Of the 13 patients with abnormal stimulated plasma calcitonin levels, five underwent total thyroidectomy, but MCT was found in only two. One of these patients and two of those in whom no tumor was found had persistently elevated stimulated plasma calcitonin levels postoperatively, suggesting the presence of C cells and, thus, persisting risk of MCT. In all patients, plasma calcitonin concentrations were variable, and an established normal range of values is essential if unnecessary surgical treatment is to be avoided. Pheochromocytoma proved difficult to diagnose, and pentagastrin stimulated plasma catecholamines deserves evaluation as a screening test. Despite the large effort involved, permanent screening of all family members is recommended as the only means of reducing mortality. Following any treatment, screening should continue because new disease or recurrence is possible.