Nopadol Saropala

Topical Application of Honey in Treatment of Abdominal Wound Disruption

EDITORIAL COMMENT: We accepted this paper for publication because it should interest all readers, some of whom may decide they have the occasional patient suitable for this method of honey wound care. The healed wound shown in figure (d) would be cosmetically unacceptable to most women but perhaps resuture would have had a similar result. In the editors experience, sew sanguineous discharge from a wound postoperatively invariably means dehiscence best treated by resuture once any precipitating ileus has resolved; when the skin sutures are removed the wound falls apart in these women and usually loops of bowel are adherent to the edges of the wound (figures A and B). In the case illustrated in this paper the peritoneum appears to be intact as if the problem was an infected haematoma which is an unusual cause of wound disruption in the editors experience; yet the authors encountered 15 cases in 19 months, and quoted no case of the complete wound dehiscence referred to above!

The outcome of the first VBAC program in Thailand.

While trends of cesarean deliveries have stabilized in many developed countries partly due to the successful introduction and use of vaginal birth after cesarean section (VBAC) the level of such deliveries continues to rise rapidly in Thailand from 15% in 1990 to 22% in 1996. Almost all obstetricians in Thailand believe that once a section always a section. During 1994-96 all 650 nonprivate patients with previous cesarean section were counseled chosen and given the option to participate in the authors VBAC program. 66 of the eligible women underwent trials of labor of whom 64 were admitted in established labor with cervical dilatation of 3-5 cm. The mean admission to delivery time was 6.5 +or- 1.5 hours with the mean duration of the second stage being 29 +or- 12.5 minutes. Oxytocin was used in 24% of cases. 50 women (76%) achieved vaginal delivery of which 20 required instrumentation. There were no maternal or fetal complications. The rather high instrumental delivery rate of 40% of which half was due to poor maternal effort reflected a fear of uterine rupture. The subject was often discussed openly and negatively in front of patients. Additional studies and trials are needed to determine whether VBAC can be safely implemented.

The use of low-dose aspirin to prevent preeclampsia.

Patients who develop preeclampsia exhibit a smaller increase in vasodilator prostacyclin (PGIJ biosynthesis than vasoconstrictor thromboxane (TxA,). This functional imbalance between vasodilator and vasoconstrictor eicosanoid products appears to be of major importance in causing the loss of vascular refractoriness. Early studies suggested that low-dose aspirin could redress this imbalance by reducing the production of TxAz via platelet-derived cyclooxygenase and prevent the development of preeclampsia [ 11. All normal nulliparous pregnant women conlined at Ramathibodi Hospital under the age of 30 years were selected after undergoing routine ultrasound at 18-22 weeks of gestation to confirm gestational age and to exclude anomalies. One thousand five hundred were recruited according to the calculated sample size needed to test the hypothesis. The subjects were randomized to receive either 60 mg of aspirin or an identical placebo tablet at 18-24 weeks of gestation. A total of 651 patients in the aspirin group and 697 patients in the placebo group were analyzed.