Studies on the Action of Ethamsylate (Dicynene) on Haemostasis

Twelve healthy subjects received ethamsylate or a placebo by mouth over a 48 h period in a randomized double-blind trial. The template bleeding time (including estimation of amount of blood loss), platelet aggregation studies, and plasma levels of plasminogen, alpha2-antiplasmin and fibronectin were carried out before and during treatment. The effect of a single dose (600 mg) of aspirin, given 24 h after commencement of treatment, was also determined.

Neither ethamsylate nor placebo caused a significant change in the basal values of any of the variables monitored but both the prolongation of the bleeding time and the amount of blood loss induced by aspirin were significantly less during ethamsylate treatment than with placebo. Ethamsylate failed to prevent the aspirin-induced elimination of the secondary wave of platelet aggregation.

We conclude that ethamsylate may reduce the haemorrhagic symptoms associated with mild functional platelet defects.

Lithium for the control of aggressive and self-mutilating behaviour

Lithium has been used for many years in the treatment and prophylaxis of affective disorders. Since 1969, evidence has been accumulating in relation to its effectiveness in the control of aggressive behaviour. This review summarizes the published evidence.

A review of post-episiotomy pain and its treatment

The authors review the frequency of reporting and severity of perineal pain in the post-partum period after episiotomy. The usage and efficacy of available analgesia is discussed.

Lithium versus placebo in acute depression: a clinical trial

Thirty-one patients suffering from a major depressive illness were entered into a placebo-controlled double-blind study to determine the effectiveness of lithium carbonate in acute depression. Patients were allocated by minimization to receive either lithium or placebo for 6 weeks in 2 parallel groups without crossover. For ethical reasons patients who showed no satisfactory response could be withdrawn at the discretion of the investigator but this was done without breaking the treatment code. More patients were withdrawn from the placebo group than from the lithium group as treatment failures, but in spite of this there was a significant difference in the depression ratings between the 2 groups at weeks 4 and 5 in favour of the active treatment group (p less than 0.04 and p less than 0.03 respectively).

Studies on the action of ethamsylate (Dicynene) on haemostasis

Twelve healthy subjects received ethamsylate or a placebo by mouth over a 48 h period in a randomized double-blind trial. The template bleeding time (including estimation of amount of blood loss), platelet aggregation studies, and plasma levels of plasminogen, alpha 2-antiplasmin and fibronectin were carried out before and during treatment. The effect of a single dose (600 mg) of aspirin, given 24 h after commencement of treatment, was also determined. Neither ethamsylate nor placebo caused a significant change in the basal values of any of the variables monitored but both the prolongation of the bleeding time and the amount of blood loss induced by aspirin were significantly less during ethamsylate treatment than with placebo. Ethamsylate failed to prevent the aspirin-induced elimination of the secondary wave of platelet aggregation. We conclude that ethamsylate may reduce the haemorrhagic symptoms associated with mild functional platelet defects.

Is routine episiotomy necessary?

One hundred and eighty one primigravid women delivering vaginally in July and August 1982 in the Rotunda Hospital, Dublin, were randomly allocated to one of two groups. Patients in one group were to undergo episiotomy. Those in the other group were not to undergo episiotomy unless it was considered to be essential. The outcome was compared with that of the clinical practice over the previous six months at the hospital. Of the 92 patients allocated not to undergo episiotomy, seven (8%) had one done for medical reasons compared with 507 (89%) in the previous six months. First degree tears occurred in 23 (25%) and second degree tears in 43 (47%). Nineteen (21%), however, retained an intact perineum compared with only 35 (6%) of the women who had delivered in the preceding six months. Assessments of perineal pain, bruising, swelling, and healing and records of ingestion of analgesics were made for the first four days after delivery, and again at a check up six weeks after delivery, in patients who had had spontaneous vertex deliveries. Forty patients who underwent episiotomy and 37 who sustained a second degree tear formed two comparable groups. There was no difference in outcome between them. Data were also evaluated for 19 women who retained an intact perineum, 22 who sustained a first degree tear, and 11 who underwent episiotomy and epidural anaesthesia; all 52 of these women had spontaneous vertex deliveries. Despite severe soft tissue injury in two patients those who fared best were those who retained an intact perineum. First degree tears were associated with symptoms similar to those associated with second degree tears. Those who fared worst were women who underwent episiotomy after epidural anaesthesia. The value of routine episiotomy in primigravid patients is questioned, but the final decision can be made only by the accoucheur at the time of imminent delivery.

Lithium treatment and preoperative fluid deprivation

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