No abstract

Parecoxib sodium, the injectable prodrug of valdecoxib, is a cyclooxygenase-2-specific inhibitor that is effective in the treatment of postoperative pain. In this randomized, double-blind, placebo-controlled study, we compared the efficacy of a single dose of parecoxib sodium 40 mg IM with single doses of morphine 6 and 12 mg IM in treating postoperative pain after gynecologic surgery requiring a laparotomy incision. By nearly all efficacy measures (including total pain relief and patient's global evaluation of study medication), parecoxib sodium 40 mg IM demonstrated pain relief and a decrease in pain intensity that was statistically similar to that with morphine 12 mg IM and superior to that with morphine 6 mg IM. Parecoxib sodium 40 mg IM-treated patients also demonstrated a longer time to use of rescue medication than patients treated with both morphine doses, and this dose provided sustained pain relief over the 12-h study period. The incidence of adverse events in the active treatment groups was similar to that observed with placebo. Parecoxib sodium, 40 mg IM, has been shown to be as effective as clinically relevant doses of morphine in patients after gynecologic laparotomy surgery.

No abstract

suie. Spleen pulpy aud dark. Stomach and intestinos not opened. The coecum was adherent to the abdominal wall and to the omentum. In this mass of adhesions was pua. Ovaries normal. Broad ligaments both riddled with pus sinuses, on the right side evidently connecting with the abscess next the oxcum. The uterus was honeycombed, and its tissue soaked with ichorous pus ; but its cavity was clean and well lined with iodoform.Casio II. Puerperal peritonitis; operation; death.Mrs. L. M. E., a delicate little woman, during her fourth pregnancy fell through a cesepool-cover, striking her abdomen. She was severely bruised and lamed.But her pregnancy terminated in an easy labor at the proper time, May 18, 1890. She was attended by Dr.C. M. Ilutchiusoii, of Walthain, to whom I am indebted for this history. There was considerable haemorrhage following the delivery which was controlled by ergot and hot intrauterine douching.The next day her temperature in the morning was normal ; she had passed a good night. That afternoon sho had a chill. In the evening her temperature was 102°, her pulse 140. There waa abdominal tenderness, especially on the left side. She passed urine freely, and her bowels moved naturally. Thero was no unusual odor from the lochia. She was restless that night.May 20th, the third day, the temperature waa lower, perhaps from the use of antifobrine, the highest being 101.8°. She complained of pain. The abdomen was slightly distended. The uterus was fixed in the left side and very tender. Turpentine stupes employed.One large, loose dejection that afternoon.May 21st. In more pain. Temperature 103.8°, pulse 130. Abdomen more distended.Such was her condition when 1 first saw her in consultation. Although her bowels were moving loosely several times daily, we decided to employ the salts treatment, and she was given half an ounce of Epsom salta, and a few hours afterwards an enema containing half a fluid ounce of turpentine. There was no improvement in her condition that day or ever after. Morphine soon had to be giveii for the pain ; and only by the free use of whiskey and of tincture of digitalia could she be kept from failing. The abdomen grow more and more distended ; she kept belching gas, and finally could be giveii food and stimulants only by enema.In this terrible condition an operation waa assented to by the family. With the assistance of Drs. Hutchinson and II. A. Wood, I incised the abdominal walls in tho median line. As much as a quart of sero-purulent fluid escaped, with abundant flakes of lymph.There was considerable pus collected in the loft iliac fossa, set free by finger examination. Thero was only time for flushing out the cavity, so bad was her condition. A drainage-tube was left in Douglas's fossa. She hardly rallied from the operation, and died the following night.In briefly reporting this case at the meeting of the Obstetric Section of the Massachusetts Medical Society in .lune, 1890, I stated my belief that, had tho operation been performed when it should have been -at the commencement of the...

conceivable when it is realized that the part of the articular process which bars the way to reduction is only about six millimetres in height, perhaps less. The advisability of using ether in all attempts at reduction is too apparent to require mention. With regard to the method usually advised and followed, Lidell says (loc cit.) p. 723 : " Had I this case now to treat, I should, as soon as it became clear that the man would not recover under an expectant line of treatment, that is, on the second