In the 1970s, the radial artery was proposed as a coronary artery bypass graft but then was abandoned due to graft occlusion secondary to spasm during harvesting. Development of new pharmacologic antispasmodic agents and minimal traumatic harvesting techniques has led to the revival of the use of the radial artery in coronary artery bypass procedures. Harmonic Scalpel(Ultracision Inc, Smithfield, RI) offers the surgeon the ability to perform less traumatic, spasm free, and rapid radial artery harvesting.
Coronary Artery Bypass ; Parasympatholytics ; Radial Artery* ; Spasm ; Transplants

OBJECTIVETo investigate the impact of intestinal spasmolytic on colon polyps and adenoma detection rate during colonoscopy.

METHODSLiteratures related to the effect of intestinal spasmolytic on colon polyp or adenoma detection rate were retrieved from PubMed, Medline, EBSCO, High Wire Press, OVID, EMBASE, and the China National Knowledge Articles, etc. published before July 2014. Unified data were extracted by two researchers independently and organized using Jadad scale to evaluate the quality of the enrolled studies through Review manager 5.2 Meta-analysis software.

RESULTSSix articles were enrolled with total 47,509 cases, including 16,867 cases in the scopolamine group and 30,642 cases in the placebo group. Meta analysis showed spasmolytic could increase the detective rate of polyps (OR=1.24, 95% CI:1.19-1.30), adenoma (OR=1.25, 95% CI:1.19-1.30) and high-risk adenoma (OR=1.22, 95% CI:1.16-1.29).

CONCLUSIONUsing colonoscopy spasmolytic scopolamine can increase the detection rate of colonic polyp and adenoma.

Background: Systemic absorption of topical phenylephrine administered during mydriasis may potentially cause hemodynamic changes in patients. Objective: To compare the hemodynamic outcomes between patients given tropicamide+phenylephrine and those given tropicamide alone for mydriasis. Design: Randomized controlled trial. Setting: Ophthalmology Outpatient Clinic, Southern Philippines Medical Center, Davao City, from April to June 2017. Participants: 56 male and female patients aged ≥ 19 years and scheduled for mydriasis. Interventions: Random allocation to either one drop of 0.5% tropicamide plus 0.5% phenylephrine or one drop of 0.5% tropicamide for mydriasis of the examined eye. Main outcome measures: Mean systolic BP, mean diastolic BP, mean arterial pressure, mean heart rate, and at least one episode of tachycardia or bradycardia. Main results: Thirty (53.57%) patients received tropicamide drops, and the rest received tropicamide+phenylephrine drops. The demographic and clinical characteristics of the two intervention groups were comparable at baseline. The mean blood pressures and heart rates at 15, 30, 45, and 60 minutes postmydriasis did not significantly differ between the two groups. Four patients from the tropicamide group, and none from the phenylephrine+tropicamide group had tachycardia (p=0.1153). On the other hand, five patients from the tropicamide group, and four from the phenylephrine+tropicamide group had bradycardia (p=1.0000). Conclusion Hemodynamic outcomes did not significantly differ up to 60 minutes after mydriasis between patients who received tropicamide+phenylephrine drops and those who received tropicamide drops.
Blood Pressure ; Heart Rate ; Sympathomimetics ; Muscarinic Antagonists ; Parasympatholytics

BACKGROUND/AIMS: We conducted a prospective, randomized, double-blinded, placebo-controlled trial to investigate the effect of hyoscine-N-butyl bromide during colonoscopy. METHODS: A total of 133 patients undergoing colonoscopy were randomized to receive either 20 mg of hyoscine-N-butyl bromide (n=70) or normal saline solution (n=63) via intramuscular injection as premedication. RESULTS: The mean cecal intubation time and withdrawal time in the hyoscine-N-butyl bromide group were significantly shorter than those of the control group (5.26+/-2.78 min vs. 6.74+/-4.89 min; p=0.032, 5.42+/-1.54 min vs. 6.18+/-2.54 min; p=0.038, each). The spasm grade in the hyoscine-N-butyl bromide group was significantly lower than that of the control group (p<0.001). No significant differences were found in the polyp detection rate (15.7% vs. 28.6%; p=0.073) and adenoma detection rate (10.0% vs. 15.9%; p=0.311). Difficulty of colonoscopy for the endoscopists and nurses (p=0.853; p=0.732), the patient's comfort (p=0.891) and the patient's willingness to repeat colonoscopy (85.7% vs. 82.5%; p=0.932) were also similar in both groups. CONCLUSIONS: Premedication with intramuscularly administered hyoscine-N-butyl bromide do not demonstrate any additional benefits except reducing the colonoscopy insertion time.
Adenoma ; Colonoscopy ; Humans ; Injections, Intramuscular ; Intubation ; Parasympatholytics ; Polyps ; Premedication ; Prospective Studies ; Scopolamine Hydrobromide ; Sodium Chloride ; Spasm

Recurrent abdominal pain(RAP) occurs in 8-10% of elementary school children. It is suspected that functional causes are about 90% and organic causes about 10% for the recurrent abdominal pain. RAP is treated by antispasmodics or analgesics or antidiarrheal drugs in school health rooms. The purpose of this study was to verify the effect of Koryo-Hand-Acupuncture on recurrent abdominal pain of children. The duration of this study was from April to July, 2001. The subjects were the grade 4th-6th elementary students complaining recurrent abdominal pain. Total subjects were 46 cases; 23 cases of which were placed in experimental and the others in control group. The results of this study were as follows; 1.Numeric-pain-intensity of experimental group received Koryo-Hand-Acupuncture was decreased more than that of control group received mock Koryo-Hand-Acupuncture significantly. 2.Probed current in stomach corresponding point (A12) of experimental received Koryo-Hand-Acupuncture was decreased more than that of control group received mock Koryo-Hand-Acupuncture significantly. 3.Medication requirement rate of experimental group received Koryo-Hand-Acupuncture was decreased more than that of control group received mock Koryo-Hand-Acupuncture significantly. The following suggestions with the results of the study would be made like these; 1.Stimulation implement of Koryo-Hand- Acupuncture should be used independently and each effect should be investigated. 2. With repeated studies for various signs and diseases, the effect of Koryo-Hand- Acupuncture must be verified.
Abdominal Pain* ; Acupuncture ; Analgesics ; Antidiarrheals ; Child* ; Humans ; Parasympatholytics ; School Health Services ; Stomach ; Child Health

Recurrent abdominal pain(RAP) occurs in 8-10% of elementary school children. It is suspected that functional causes are about 90% and organic causes about 10% for the recurrent abdominal pain. RAP is treated by antispasmodics or analgesics or antidiarrheal drugs in school health rooms. The purpose of this study was to verify the effect of Koryo-Hand-Acupuncture on recurrent abdominal pain of children. The duration of this study was from April to July, 2001. The subjects were the grade 4th-6th elementary students complaining recurrent abdominal pain. Total subjects were 46 cases; 23 cases of which were placed in experimental and the others in control group. The results of this study were as follows; 1.Numeric-pain-intensity of experimental group received Koryo-Hand-Acupuncture was decreased more than that of control group received mock Koryo-Hand-Acupuncture significantly. 2.Probed current in stomach corresponding point (A12) of experimental received Koryo-Hand-Acupuncture was decreased more than that of control group received mock Koryo-Hand-Acupuncture significantly. 3.Medication requirement rate of experimental group received Koryo-Hand-Acupuncture was decreased more than that of control group received mock Koryo-Hand-Acupuncture significantly. The following suggestions with the results of the study would be made like these; 1.Stimulation implement of Koryo-Hand- Acupuncture should be used independently and each effect should be investigated. 2. With repeated studies for various signs and diseases, the effect of Koryo-Hand- Acupuncture must be verified.
Abdominal Pain* ; Acupuncture ; Analgesics ; Antidiarrheals ; Child* ; Humans ; Parasympatholytics ; School Health Services ; Stomach ; Child Health

BACKGROUND/AIMS: Antispasmodics such as octylonium are widely used to manage irritable bowel syndrome (IBS) symptoms. However, the efficacy and safety of another antispasmodic, tiropramide, remain uncertain. We aimed to evaluate the efficacy and safety of tiropramide compared with octylonium in patients with IBS. METHODS: In this multicenter, randomized, non-inferiority trial, 287 patients with IBS (143 receiving tiropramide and 144 octylonium) were randomly allocated to either tiropramide 100 mg or octylonium 20 mg t.i.d (means 3 times a day) for 4 weeks. Primary endpoint was the mean change of abdominal pain from baseline assessed by visual analogue scales (VAS) score after 4 weeks of treatment. Secondary endpoints were the changes in abdominal pain from baseline at week 2 and in abdominal discomfort at weeks 2 and 4, using VAS scores, patient-reported symptom improvement including stool frequency and consistency, using symptom diaries, IBS-quality of life (IBS-QoL), and depression and anxiety, at week 4. RESULTS: The VAS scores of abdominal pain at week 4, were significantly decreased in both tiropramide and octylonium groups, but the change from baseline did not differ between the 2 groups (difference,-0.26 mm; 95% CI,-4.33-3.82; P = 0.901). Abdominal pain and discomfort assessed using VAS scores, diaries, and IBS-QoL were also improved by both treatments, and the changes from baseline did not differ. The incidence of adverse events was similar in the 2 groups, and no severe adverse events involving either drug were observed. CONCLUSIONS: Tiropramide is as effective as octylonium in managing abdominal pain in IBS, with a similar safety profile.
Abdominal Pain ; Anxiety ; Depression ; Humans ; Incidence ; Irritable Bowel Syndrome* ; Parasympatholytics ; Weights and Measures

PURPOSE: The aim of this study was to determine the effectiveness of the hot pack as a complementary technique for the treatment of nonspecific abdominal pain or acute gastroenteritis in a hospital emergency department. METHODS: This study was conducted as a prospective case-controlled trial of patients with nonspecific abdominal pain or acute gastroenteritis who visited an emergency department. A total of 166 participants, from 18 to 75 years old, were divided into two groups: patients treated with antispasmodics and hot pack (WH) group (n=83) and patients treated with antispasmodics without a hot pack (WOH) group (n=83). Patients rated their pain using the 10 cm numerical rating scale (NRS). Pain NRS was assessed four times: first on arrival and then at 1, 2, and 3 hours after treatment. The frequency of tramadol use and residence time was also assessed. RESULTS: The two groups did not significantly differ in age or gender distribution. The mean NRS score also did not significantly differ between the groups upon arrival (p=0.847). The NRS scores at 1 hour and 2 hours after treatment in the WH group were significantly lower than NRS scores in the WOH group (p<0.001). There was no significant difference, however in NRS scores after 3 hours for both groups (p=0.091). There was a significant difference in NRS scores between admission and after 1 hour (p=0.005) and a significant difference in NRS scores between 2 hours and 3 hours (p<0.001). The frequency of tramadol use significantly differed between groups (p<0.01) but there was no significant difference in residence time in each group. CONCLUSION: The hot pack is an effective complementary technique for reducing abdominal pain in the hospital emergency department.
Abdominal Pain* ; Case-Control Studies ; Emergencies* ; Gastroenteritis* ; Heating ; Humans ; Pain Management ; Parasympatholytics ; Prospective Studies ; Tramadol

BACKGROUND/AIMS: Cimetropium bromide has been used widely as a premedication for endoscopy; however, there are no subjective data pertaining to the effects of cimetropum bromide as a premedication. Thus, the current study was undertaken to compare the effects of cimetropum bromide with placebo as a premedication for esophagogastroduodenoscopy (EGD). METHODS: Two hundred ninety-nine consecutive outpatients who had undergone EGD were enrolled in this study. Thirty minutes before EGD, the patients were randomly given an intramuscular injection of cimetropium bromide (5 mg) or saline using a placebo-controlled, double-blind, randomized technique. Immediately after EGD, all the patients and endoscopists were requested to fill out the questionnaire form. RESULTS: One-hundred patients were injected with cimetropium bromide and 150 patients were injected with placebo. There was no statistically significant difference in the degree of residual gastric secretions, the peristaltic activity detected by endoscopists, and the comfort experienced by the patients in each study group. CONCLUSIONS: The intramuscular injection of cimetropium bromide (5 mg) as a premedication for EGD was not significantly superior to placebo, at least with respect to subjective parameters, in spite of its broad use.
Endoscopy, Digestive System ; Humans ; Injections, Intramuscular ; Outpatients ; Parasympatholytics ; Premedication ; Scopolamine Derivatives ; Surveys and Questionnaires

BACKGROUND: Ureteral colic due to acute obstruction of urine flow is a frequent and painful condition presenting in the emergency department. Proper control of ureteral colic is important in the management of such a patient. Many drugs, including narcotics, had been used to control ureteral colic, and of them, nonsteroidal anti-inflammatory drugs are most commonly used. This study was carried out to compare the analgesic effect of diclofenac with that of caroverine which is used empirically in ureteral colic. METHODS: We carried out a randomized, prospective clinical trial in the emergency department of a university hospital. Sixty patients in whom ureteral colic had been diagnosed on the basis of physical signs and symptoms were included in this study. Each patients received an IM dose of diclofenac 75 mg, a IV bolus dose of caroverine 20 mg, or a continuous infusion of caroverine 60 mg. An additional dose of medication was added 20 min after the initial medication if needed. RESULTS: The main outcome was measured by using both the visual analogue scale(VAS), four-point categorial pain scale at times of 20, 40, and 60 min after initial medication. The requirement for supplemental medication was also measured. At 40 min, diclofenac was more effective than the other two treatments according to its pain- relieving capacity(p<0.05) and the categorial pain scale. By 60 min, caroverine continuous infusion was less effective than the other two treatments according to visual analogue scale(VAS) and the categorial pain scale(p<0.05). There were no significant differences between the diclofenac group and the caroverine bolus injection group at this time. The diclofenac group needed significantly less rescue medication for pain control(p<0.05). CONCLUSION: IM diclofenac, a non-steroidal antiinflammatory drug, was superior to the spasmolytics, single bolus or continuous intravenous infused, in treatment of ureteral colic.
Diclofenac* ; Emergency Service, Hospital ; Humans ; Narcotics ; Parasympatholytics ; Prospective Studies ; Renal Colic* ; Ureter*