No abstract

We have performed coeliac plexus block by standard percutaneous technique for disabling pain in 36 patients (13 with cancer and 23 with chronic pancreatitis). Eleven of the 13 cancer patients had complete pain relief initially and 7 remained pain free at the time of death. By contrast, only 12 of the 23 patients with pancreatitis had complete pain relief, 6 had partial relief and there was no effect in 5. The mean pain-free period in the chronic pancreatitis patients was only 2 months, and the longest 4 months. Benefit was least in patients with previous pancreatic surgery and repeat blocks were unhelpful. Transient postural hypotension occurred in most patients; two had nerve root pain and one developed persistent weakness and anaesthesia of the left leg, with bladder disturbance. These results warrant the continuing use of coeliac plexus block in pancreatic cancer, but rarely in chronic pancreatitis.

Puerperal sepsis is one of the five leading causes of maternal mortality worldwide, and accounts for 15% of all maternal deaths. The WHO defined puerperal sepsis in 1992 as an infection of the genital tract occurring at any time between the rupture of membranes or labour and the 42nd day post partum; in which, two or more of the following are present: pelvic pain, fever, abnormal vaginal discharge and delay in the reduction of the size of the uterus. At the same time, the WHO introduced the term puerperal infections, which also include non-genital infections in the obstetric population. Recent epidemiological data shows that puerperal sepsis and non-genital tract infections are a major area of concern. In puerperal sepsis, group A streptococcus (GAS) is the most feared pathogen. Up to 30% of the population are asymptomatic carriers of GAS. GAS commonly causes throat infections. Women who died from GAS-positive sepsis all had signs of a throat infection themselves or one of their family members suffered from a throat infection. The pathway of infection is from the hands of the pregnant women or the mother to her perineum. In non-genital tract infections, influenza viruses and the HIV pandemic in the developing part of the world are responsible for many maternal deaths, and demand our attention. The physiological changes of pregnancy and the puerperium can obscure the signs and symptoms of sepsis in the obstetric population. A high level of suspicion is, therefore, needed in the care for the sick pregnant patient. If sepsis is suspected, timely administration of antibiotics, sepsis care bundles, multidisciplinary discussion and early involvement of senior staff members are important to improve outcome.