Download Evaluation of Styplon in prevention of excessive bleeding in

[Probe (1980): (XIX), 4, 281-285)]
Evaluation of Styplon in Prevention of Excessive Bleeding in Tonsillectomy
Umeshchandra J. Tawde, M.B., F.C.P.S. (E.N.T.), F.I.C.A. (U.S.A.), F.R.S.H. (London), D.O.R.L. (Bom.)
Honorary E.N.T. Surgeon, Civil Hospital, and Consultant E.N.T. Surgeon,
Aryangla Hospital and Medical College, Satara, Maharashtra.
Styplon is a highly effective indigenous compound which has a remarkable styptic effect. It checks
bleeding by correcting the causative factors. Its various components seem to normalise the complex
process of blood coagulation and also to increase the tone and strength of the capillaries. Clinically,
Styplon has been found useful in arresting bleeding in various haemorrhagic conditions.
COMPOSITION
Each Styplon tablet contains:
Chandrakala
Phyllanthus emblica (Amla)
Mesua ferrea (Nagkeshar)
Ruta graveolens (Somalata)
Boerhaavia diffusa (Punarnava) salts
Raphanus sativus (Moolee) salts
*Praval bhasma
*Lajward bhasma
0.13 g
65 mg
32 mg
16 mg
6 mg
6 mg
65 mg
16 mg
* Processed in Melia azadirachta (Mahaneem), Acorus calamus (Vach), Sphaeranthus indicus
(Gorakhmundi), Mimosa pudica (Lajwanti), Berberis aristata (Daruhaldi), Alpinia officinarum
(Kulinjan), Cynodon dactylon (Hariali), Nelumbium speciosum (Kamal ki phool), Fumaria
officinalis (Pitpapra), Asparagus racemosus (Shatavar).
PHARMACOLOGY AND THERAPEUTIC ACTION
Chandrakala: A complex Ayurvedic compound, its main ingredients are Shilajeet, Triphala, Ras
Sandhur, Abhrak and Vang bhasmas, Giloi and Simul. It is a powerful styptic in its own right that
materially aids the process of coagulation and improves the tone of blood vessels.
Phyllanthus emblica (Amla): This is the richest natural source of vitamin C and plays a very
important role in maintaining the integrity of the capillary endothelium. In large doses, it stimulates
the bone marrow. When administered in large doses in thrombopenia, a sudden increase of blood
platelets results. Deficiency of vitamin C produces scurvy in which periosteal haemorrhages and
bleeding from the gums occur.
Ruta graveolens (Somalata): Rutein is one of active principles of this plant which is known for
reducing capillary fragility. It is useful in hereditary haemorrhagic telangiectasis and is known to
accelerate the onset and completion of blood coagulation.
Praval bhasma: This is calcium in a highly assimilable form. Calcium is essential in the process of
normal coagulation of blood. It acts as a catalyst and its presence is essential for the conversion of
prothrombin into thrombin. Besides, Praval bhasma is prepared in the juices of plants, which are
both antiseptic and styptic in action.
Lajward bhasma: This is also a form of calcium that enhances the antihaemorrhagic action of Praval
bhasma.
Mimosa pudica (Lajwanti), Alpinia officinarum (Kulinjan), Mesua ferrea (Nagkeshar) etc. are all
astringent and styptic in action, useful in controlling bleeding in various clinical conditions.
In laboratory animals it has been observed that the action of dicumerol is appreciably diminished by
the use of Styplon. Similarly in human beings, when bleeding occurs due to an excessive dose of
dicumerol, it can be stopped by the administration of Styplon. Further, Styplon has a vasoconstrictor
action on the microcirculation.
Tonsillectomy has been performed since very early times. Cornelius A. Celsus1 writing early in the
first century A.D. gives a good description of how the operation may be done. “..... being covered
with a thin membrane (they) should be scratched round and torn out by the finger but if they are not
got rid of thus, then one must seize upon them with a hook and cut them with a knife”.
Tonsillectomy is a planned operation which is commonly performed in India and abroad for various
local and systemic indications. In Britain, tonsillectomy has been one of the commonest causes of
hospitalisation in the 5 to 9 years age group, comprising 28.8% of all the discharges for this group in
1968 (Chamberlain, 1972)2.
Studies by Mawson, Adlington and Evans5 (1967) indicated a definite improvement in the patients
after tonsillectomy. Noticeable reduction in sore throats, tonsillitis, clinical adenitis and colds
together with weight gain was found in the operated group.
Major complication of this commonly-performed operation is haemorrhage. In 5 years, 1962-66, the
average death rate in the United Kingdom for all age groups has been about 11 per 2,00,000, a
reduction of about 50% on the previous 5 years. In U.S.A., the rate has been approximately 300
deaths in 2,000,000 operations (Proctor,7 1960). Most of the disasters arise from the haemorrhage or
respiratory obstruction and are theoretically preventable.
Since excessive bleeding during tonsillectomy operation is preventable, in the present paper an
attempt is made to evaluate Styplon (Himalaya Drug Co.) to minimise bleeding during tonsillectomy
operation and to find out whether it shortens the postoperative recovery period.
MATERIAL AND METHODS
This study was carried out in the Department of Otolaryngology of Civil Hospital, Satara. Hundred
cases of either sex of various age groups in whom tonsillectomy was indicated were selected for the
present studies. They were divided into two groups i.e. control group (Group I) and Styplon Group
(Group II) containing 50 cases each. A full history was taken from each patient and detailed local
and general examination was carried out. A specially designed proforma was used to record the
results of special investigations like Hb percentage, bleeding and clotting time and routine urine
examination along with the name, age and sex of the patient.
In the Styplon Group, Styplon tablets were administered 3 days prior to the operation. In patients
below 12 years, 2 tablets twice a day were given, and in patients above 12 years, 2 tablets three times
a day were given. Control Group was not given any tablets.
In both Groups, the amount of bleeding was noted as either mild, moderate or severe. The
postoperative recovery period was also noted in days in each case. The criteria considered for
postoperative recovery were (1) Restoration of swallowing (2) Disappearance of pain in the throat.
OBSERVATIONS AND RESULTS
The distribution of 100 cases according to sex and age has been depicted in Tables I and II. Sixty
males and 40 females within the age group 6 years to 16 years were taken for the present studies. An
equal number of patients were taken as Control Group (Group I) and Styplon Group (Group II), each
group containing 50 patients. Table III shows the extent of bleeding during tonsillectomy operation.
In the Control Group 20 cases (40%) had mild bleeding and 30 cases (60%) had moderate amount of
bleeding. Whereas in the Styplon Group, 40 cases (80%) had mild bleeding while 10 cases (20%)
had moderate bleeding. In the Control Group, average recovery period was 10 days after operation,
while in the Styplon Group, it was found to be 8 days (Table IV).
Table 1: Showing the sex distribution
Male
Female
Total
60
40
100
6-8
30
Table II: Showing age in years
8-10
12-14
14-16
30
20
20
Table III: Showing assessment of amount of bleeding
during tonsillectomy
Group
Amount of Bleeding
Mild
Moderate
Control Group (50)
20
30
Styplon Group (50)
40
10
Table IV: Showing average recovery period in days
Control group - 50 patients
10 days
Styplon Group - 50 patients
8 days
DISCUSSION
From this study it was observed that if Styplon is administered prior to tonsillectomy it minimises
the bleeding and shortens the postoperative recovery period. Mansukhani, N.G.4 (1971) found that
there is definite improvement in post-extraction haemorrhage after the administration of Styplon.
Gharpure et al.3 (1971) proved that Styplon reduced the blood loss from surgical incision in animals
and in man. It appears that the main action of Styplon is to cause contraction of the microcirculation.
After heparin this effect is remarkably clear. Because normally bleeding is arrested by coagulation of
blood sealing the open ends of the capillaries, after heparin administration this mechanism is lost and
bleeding continues. Styplon by its constriction action on the microcirculation effectively arrests
bleeding. Patel, M.C.6 found 87.7% response to Styplon in dysfunctional uterine bleeding.
CONCLUSION
From this study it may be concluded that Styplon (an indigenous preparation of The Himalaya Drug
Co., Bombay) has a definite role in minimising the bleeding during the tonsillectomy operation. In
my opinion, if Styplon is administered 3 days prior to a planned operation like tonsillectomy, it will
help the E.N.T. Surgeon to perform the operation in an almost blood-free field. It will also help the
patient to have an early postoperative recovery period.
SUMMARY
Hundred cases of tonsillectomy were selected for trial; 50 patients were given Styplon tablets prior
to operation. In 50 patients tonsillectomy was performed without giving any tablets. The latter group
was used as Control. Out of 50 patients of the Styplon Group, 80% showed mild amount of bleeding
and 20% moderate amount of bleeding during tonsillectomy. Out of 50 cases of Control Group 40%
showed mild amount of bleeding, and 60% showed moderate amount of bleeding. There were no
side reactions or untoward effects of Styplon.
ACKNOWLEDGEMENTS
The author is grateful to the Civil Surgeon, Satara for permitting the conduct of this trial in Civil
Hospital, Satara. Thanks are also due to The Himalaya Drug Co., Bombay for the generous supply of
Styplon tablets.
REFERENCES
1.
Celsus, A. Cornelius, 1 Century, A.D. ‘De Medicina’ VIII Chapter 12.
2.
Chamberlain, R., Lancet (1972): II, 963.
3.
Gharpure, V.G., Hattangadi, M. and Kulkarni, R.D., Probe (1971): 2, 65.
4.
Mansukhani, N.G., Curr. med. Pract. (1964): 1, 47.
5.
Mawson, S.R., Adlington, P. and Evans, M., J. Lar. Otol. (1967): 81, 777.
6.
Patel, M.C., Probe (1963): 5, 179.
7.
Proctor, D.F., (1960). The Tonsils and Adenoids in Childhood, Springfield III.