Increased use of bipolar diathermy during the performance of a tonsillectomy is associated with a statistically significant increased amount of postoperative pain. The dose-response relationship between diathermy energy and postoperative bleeding is less clear. This suggests that there could be other important factors such as surgical instrument characteristics and degree of tonsillar adherence that have an additional influence and are therefore possible areas for future research.

In the UK patients who undergo common ear, nose and throat (ENT) operations, and are employed, are advised to take 2 weeks sick leave before returning to their employment. A retrospective postal questionnaire survey (of adult patients who had undergone four common specific ENT operations) was conducted, to validate whether this preoperative advice given, was appropriate, and to attempt to assess the patient factors, which influenced the amount of postoperative absence from work. Among 218 questionnaires sent, 156 (71.6%) responses were returned and 132 (60.6%) were used. Analysis of the data for absence from work, showed that 58.3% had taken 2 weeks. The majority of patients (70.5%) stated that 2 weeks absence following their surgery was appropriate, whereas 5.3% reported that the period was excessive and 24.2% felt that it was inadequate. Postoperative pain (30.3%), infection (30.3%), bleeding (7.6%) and other causes (15.2%) were reported as the reasons for the delay to return to work. Nearly 31% of men and 55% of women had taken > 2 weeks of sick leave. In conclusion, the current practice of advising employed adults to take 2 weeks time off work following routine ENT surgery is appropriate. However, nearly 42% had taken > 2 weeks to return to their employment. Patients who underwent tonsillectomy and laser palatoplasty in general, required more time to recuperate prior to returning to work, when compared to those who had undergone septoplasty and functional endoscopic sinus surgery (FESS). Postoperative pain and infection were reported to be the main reasons for the delay in returning to work. Men, and self-employed patients returned to work earlier than women and other employed groups.

Most of the arborescent Croton species in the New World were treated by Webster as belonging either to C. sect. Cyclostigma Griseb. or C. sect. Luntia (Neck. ex Raf.) G.L. Webster. The circumscription of C. sect. Cyclostigma has been treated recently. In this paper we focus on C. sect. Luntia, which was subdivided by Webster into two subsections, C. subsect. Matourenses and subsect. Cuneati. Using chloroplast trnL‐F and nuclear ITS DNA sequence data, morphology and a broader sampling of additional Croton lineages, we found that the two subsections are not closely related and form distinct monophyletic groups. Substantial morphological differences support the molecular data. A taxonomic recircumscription of the two subsections, elevated to sectional level, is proposed. A key and taxonomic revision, with new synonyms, is provided for C. sect. Cuneati; together with the description of a new species from the coastal mountains of Venezuela, Croton domatifer. The new species is the only one in the genus known to possess leaf domatia. We infer that species in the Cuneati clade have lost the typical Croton caruncle, and some of them have evolved a different, specialized type of aril. We hypothesize that the arillate seeds are an adaptation to dispersal by fish in the Orinoco and Amazon river basins.

BackgroundThe leaves of Annona purpurea have yielded several alkaloids with anti-aggregation activities against rabbit platelets. This is promising in the search for agents that might act against platelets and reduce the incidence of cardiovascular diseases. Since significant differences in platelet function have been reported between human and animal platelets, a study focusing on the effect of A. purpurea extracts against human platelet activation is necessary.MethodsThe compounds in an A. purpurea ethanolic extract underwent bio-guided fractionation and were used for in vitro human platelet aggregation assays to isolate the compounds with anti-platelet activity. The bioactive compounds were identified by spectroscopic analysis. Additional platelet studies were performed to characterize their action as inhibitors of human platelet activation.ResultsThe benzylisoquinoline alkaloid norpurpureine was identified as the major anti-platelet compound. The IC50 for norpurpureine was 80 μM against platelets when stimulated with adenosine 5′-diphosphate (ADP), collagen and thrombin. It was pharmacologically effective from 20 to 220 μM. Norpurpureine (220 μM) exhibited its in vitro effectiveness in samples from 30 healthy human donors who did not take any drugs during the 2 weeks prior to the collection. Norpurpureine also gradually inhibited granule secretion and adhesion of activated platelets to immobilized fibrinogen. At the intra-platelet level, norpurpureine prevented agonist-stimulated calcium mobilization and cAMP reduction. Structure–activity relationship analysis indicates that the lack of a methyl group at the nitrogen seems to be key in the ability of the compound to interact with its molecular target.ConclusionNorpurpureine displays a promising in vitro pharmacological profile as an inhibitor of human platelet activation. Its molecular target could be a common effector between Ca2+ and cAMP signaling, such as the PLC-PKC-Ca2+ pathway and PDEs. This needs further evaluation at the protein isoform level.Electronic supplementary materialThe online version of this article (10.1186/s11658-018-0082-4) contains supplementary material, which is available to authorized users.

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