Effects of short-term isotonic & isometric training on cardiovascular & pulmonary function . A randomised control trial of short-term exercises on specific cardiovascular and respiratory parameters was undertaken in normal male college students . The effects of isotonic training ( 5BX programme ) and isometric training ( a programme of isometric exercises working all major groups of muscles ) were compared with a control group with no specific workout . Both isotonic and isometric training resulted in significant cardiovascular improvement but seemed inadequate to improve vital capacity and flow rates . Isotonic training in addition , improved ventilatory efficiency . It is concluded that such isotonic or isometric training of thrice a week for ten weeks , requiring no equipment , less time and space can be promoted to improve physical fitness .

isotonic & isometric training

short-term exercises

isotonic training ( 5BX programme )

isometric training

control

isotonic

isometric training

Isotonic training

cardiovascular & pulmonary function .

significant cardiovascular improvement

vital capacity and flow rates .

ventilatory efficiency

physical fitness .


Intracapillary glomerular metastases in a nephrectomy specimen removed for ipsilateral renal cell carcinoma . A case of intraglomerular metastases observed in a nephrectomy specimen removed for primary renal cell carcinoma is reported . The intraglomerular metastases arose by dissemination of malignant cells into the systemic circulation via invasion of the renal veins . Intraglomerular metastases are therefore an indicator of malignant dissemination which in turn should be associated with a poor prognosis . It is recommended that in nephrectomies undertaken for primary renal cell carcinoma at least one random block of renal cortex should be examined to confirm or exclude intraglomerular metastases .

Intracapillary glomerular metastases

intraglomerular metastases

intraglomerular metastases

examined

Intracapillary glomerular metastases

nephrectomy

ipsilateral renal cell carcinoma

primary renal cell carcinoma

primary renal cell carcinoma


Bronchodilator treatment in asthma and bronchitis .

Bronchodilator treatment

asthma and bronchitis


Milk production in cows with endotoxin-induced mastitis treated with isotonic or hypertonic sodium chloride solution . Milk production was monitored in 16 cows for 6 milkings after intramammary infusion of 1 mg of endotoxin in a single forequarter . The cows were randomly assigned to 1 of 2 treatment groups ; 8 cows were treated with isotonic saline solution and 8 cows were treated with hypertonic saline solution . Saline solutions were administered IV ( 5 ml/kg of body weight ) 4 hours after infusion of endotoxin . Mean cumulative change in milk yield and interval change in milk yield were greater in cows treated with isotonic saline solution than in cows treated with hypertonic saline solution . Significant differences between treatment groups were not detected .

endotoxin-induced mastitis

endotoxin

isotonic saline solution

hypertonic saline solution

Saline

endotoxin

solution

hypertonic saline solution

Milk production

Milk production

endotoxin-induced mastitis

cows


Intestinal absorption of dietary fat in patients with multiple sclerosis . Fat absorption was studied in 24 patients with clinically definite multiple sclerosis and in 36 healthy control subjects . Beta-carotene and vitamin A in their plasma were also measured . This double-blind and randomized study showed no differences between these two populations with regard to the three parameters . We did not find evidence for fat malabsorption in multiple sclerosis .

Fat absorption

control

Fat absorption

multiple sclerosis

multiple sclerosis

healthy control


[ The anti-ischemic effect of phosphodiesterase III inhibitors ] . When enoximone is acutely administered to patients with stable angina and angiographically proven relevant coronary stenosis i.v . application of 0.75 mg/kg exhibits pronounced antiischemic effects . This could be observed in patients during exercise and in those in whom the ischemia was provoked by rapid cardiac stimulation . The antiischemic effects were documented by relief of symptoms , reduction of ST-depression , improvement of impaired myocardial wall motion , decrease to normalization of pathologically elevated filling pressure , amelioration of coronary blood flow as evidenced by myocard scintigraphy and washout time of an intracoronarily injected echo-contrast medium . There was also a definite improvement of ischemia-caused mitral regurgitation . Similar observations were found when the drug was injected in the diseased coronary arteries in a small dose ( 0.075 mg/kg ) so that peripheral effects were not present . In comparison to the Ca ( ++ ) -blocker Gallopamil the antiischemic effects of Enoximone were more pronounced , a synergistic action was , however , observed . Negative dromotropic effects of Gallopamil could be abolished by Enoximone . With oral administration of the drug over a period of one week antiischemic effects could also be documented with Holter monitoring as well as during exercise . There was a reduction of ST-depression both at spontaneously occurring ischemic episodes and during exercise , in the number and duration of episodes of silent ischemia , particularly , however , a decrease in symptomatic episodes . In none of the patients under study proarrhythmic effects were observed .

enoximone

Gallopamil

Enoximone

Gallopamil

Enoximone

anti-ischemic effect

antiischemic effects

ischemia

antiischemic effects

relief of symptoms

ST-depression

myocardial wall motion

amelioration of coronary blood flow

ischemia-caused mitral regurgitation

peripheral effects

antiischemic effects

synergistic action

Negative dromotropic effects

antiischemic effects

Holter monitoring

ST-depression

symptomatic episodes

proarrhythmic effects


Once versus thrice daily gentamicin in patients with serious infections . Aminoglycosides are usually given in two or three divided doses . A once-daily regimen might be more effective and less toxic . We have conducted a randomised trial in consecutive patients with serious infections for whom an aminoglycoside seemed warranted . Exclusion criteria were neutropenia or severely impaired renal function . 123 patients were enrolled . For efficacy analysis only those patients were considered in whom treatment with the aminoglycoside was not stopped within 72 h ( n = 67 ) ; toxicity was analysed on patients receiving aminoglycosides for more than 48 h and not using other nephrotoxic medication ( n = 85 ) . Gentamicin 4 mg/kg every day ( OD ) or gentamicin 1.33 mg/kg three times daily ( MD ) ( with dose-reduction in case of renal dysfunction ) were given intravenously . In almost all patients intravenous amoxycillin 1 g every 6 h was also started . Baseline characteristics were comparable in both arms . A good clinical response was observed in 32/35 ( 91 % ) of the OD and in 25/32 ( 78 % ) in the MD group ( difference 13 % , 95 % confidence interval -6.4 % to +26.9 % ) . 2 patients in each group died with uncontrolled infection . An insufficient bacteriological response ( persistent positive cultures , resistance , or superinfection ) was observed in 2 patients with OD and 3 patients with MD . In patients treated for more than 48 h duration of therapy and mean doses were 7.0 days ( 1590 mg ) and 7.4 days ( 1672 mg ) in OD and MD respectively . Mean first serum trough/peak levels were 0.6/10.2 mg/L and 1.4/5.2 mg/L . Nephrotoxicity ( a rise in serum creatinine of 45 mumol/L or more ) developed in 2/40 ( 5 % ) in OD and 11/45 ( 24 % ) in MD ( p = 0.016 ) . Risk factors for nephrotoxicity were duration of therapy and baseline creatinine clearance rate . High-tone audiometry was performed when possible ; no significant differences were found in hearing loss ( 3/12 and 3/11 ) or prodromal signs of ototoxicity ( 5/12 and 4/11 ) . A once-daily dosing regimen of gentamicin is at least as effective as and is less nephrotoxic than more frequent dosing .

daily gentamicin

aminoglycoside

aminoglycosides

intravenous amoxycillin 1 g every 6 h

OD

MD

OD

MD

once-daily dosing regimen of gentamicin

Mean first serum trough/peak levels

nephrotoxicity

creatinine clearance rate

High-tone audiometry

hearing loss

prodromal signs of ototoxicity

infections

infections

neutropenia

impaired renal function


Modest antihypertensive effect of epanolol , a beta 1-selective receptor blocker with beta 1 agonist activity : an acute and long-term hemodynamic study at rest and during exercise and double crossover comparison with atenolol on ambulatory blood pressure . Beta-blockers with less cardiodepressive effect than traditional nonselective beta ( 1+2 ) -blocking agents could be useful in the treatment of hypertension , provided the reduction in blood pressure was satisfactory . Epanolol , a selective beta 1-receptor blocker with intrinsic sympathomimetic activity , induced a fall in intraarterial pressure of 8 % at rest sitting and 11 % during 100 W bicycle exercise after the first dose of 200 mg in 12 patients with essential hypertension . Heart rate , stroke index , and cardiac index initially fell by 14 % , 11 % , and 23 % , respectively . The total peripheral resistance index increased by 21 % after 2 hours , and then reverted towards the pretreatment level . After 10 months of epanolol treatment ( mean 300 mg/day ) , the reduction in arterial pressure was 5 % at rest and 10 % during exercise . Cardiac index and heart rate were still reduced 14-21 % , while total peripheral resistance was unchanged or slightly increased ( 2-10 % ) . Twenty-four hour ambulatory blood pressure was higher on epanolol ( 300 mg/day ) than on atenolol ( 150 mg/day ) treatment ( 137/97 vs. 128/91 mmHg ) . Thus , the achieved blood pressure reduction induced by epanolol was moderate , while other characteristics of beta-receptor blockade , in particular , the reduction of heart rate and cardiac output , were maintained . This suggests that the compound may be useful for other cardiovascular disorders , e.g. , angina pectoris in patients without hypertension or cardiac arrhythmia .

epanolol

Epanolol

epanolol

epanolol

atenolol

epanolol

intraarterial pressure

total peripheral resistance index

arterial pressure

Cardiac index and heart rate

total peripheral resistance

blood pressure

heart rate and cardiac output

cardiovascular disorders

hypertension

cardiac arrhythmia


Short-term effects of denopamine on anaerobic threshold and related parameters in patients with chronic heart failure : a double-blind crossover study . BACKGROUND The short-term effects of denopamine , an orally available beta-stimulant , on exercise capacity were studied in patients with chronic heart failure . METHODS AND RESULTS Nineteen patients entered the study . Three patients had ischemic heart disease , 13 had dilated cardiomyopathy , and three had valvular disease ; 16 patients were in New York Heart Association class II , and three patients were in New York Heart Association class III . Symptom-limited exercise testing ( ramp protocol ) on a bicycle ergometer with gas exchange analysis was conducted 1 hour after oral administration of either 20 mg denopamine or placebo . Drug administration sequence was randomly assigned in a double-blind crossover method , with 1 week between drugs . Peak VO2 was 20.4 +/- 3.2 and 21.2 +/- 3.1 ml/min/kg , respectively , for those administered the placebo and the drug , and anaerobic threshold was 13.1 +/- 2.1 and 14.0 +/- 2.0 ml/min/kg . There was a significant increase in peak VO2 ( p < 0.05 ) and anaerobic threshold ( p < 0.01 ) with denopamine , whereas no significant change was observed in peak work rate or exercise time . Denopamine increased heart rate in patients with atrial fibrillation but had little effect on heart rate in patients with sinus rhythm . CONCLUSION Data obtained from gas exchange analysis are more sensitive and potentially more useful in the detection of short-term changes in exercise capacity than data obtained from either exercise time or peak work rate , indexes that are commonly used to assess drug therapy . Patients with mild-to-moderate heart failure with sinus rhythm , but not those with atrial fibrillation because of its frequent induction of tachycardia , may be good candidates for denopamine therapy .

denopamine

denopamine

ergometer

20 mg denopamine

placebo

placebo

denopamine

Denopamine

denopamine

Peak VO2

anaerobic threshold

peak work rate or exercise time .

heart rate

heart rate

exercise capacity

chronic heart failure

Nineteen

Three

ischemic heart disease

dilated cardiomyopathy

valvular disease ;

atrial fibrillation

sinus rhythm

mild-to-moderate heart failure

sinus rhythm

atrial fibrillation

tachycardia


Comparison of the effects of terazosin and enalapril on laboratory stress testing blood pressure in patients with essential hypertension . It is the current opinion that an ideal antihypertensive drug should reduce blood pressure ( BP ) not only at rest but also during stressful situations . The current study was aimed to compare the effects of the selective alpha 1-adrenergic blocker terazosin ( 5 mg once daily ) and of the angiotensin-converting enzyme inhibitor enalapril ( 20 mg once daily ) on cardiovascular response to a set of standardized laboratory stressors , such as mental arithmetic , handgrip test and cycle ergometry , in a group of 16 essential hypertensive patients . The study was a randomized , double-blind , cross-over trial preceded by a placebo run-in period . Terazosin and enalapril had a comparable effect on resting BP , reducing systolic ( SBP ) and diastolic ( DBP ) blood pressure from 159.5 +/- 13.9/101.6 +/- 8.8 mm Hg during placebo by 7.8 % /6.7 % and by 11.3 % /10.2 % , respectively . The " response " rate to the two treatments was approximately the same , being 69 % and 75 % after terazosin and enalapril , respectively . During mental arithmetic , from an average of 181.6 +/- 17.8/118.6 +/- 11.5 mm Hg during placebo , BP was reduced by 11.5 % /7.9 % after terazosin and by 13.6 % /8.5 % after enalapril ; during handgrip test , BP decreased from 207.2 +/- 22.2/142.2 +/- 13.6 mm Hg by 7.3 % /8.4 % after terazosin and by 7.7 % /7.1 % after enalapril ; finally , during cycle ergometry , terazosin and enalapril lowered BP by 5.4 % /6.7 % and 7 % /3.1 % , respectively , from a placebo value of 215.5 +/- 17.3/127.6 +/- 11.2 . No significant difference in antihypertensive efficacy was observed between the two drugs , either at rest and during stress testing . ( ABSTRACT TRUNCATED AT 250 WORDS )

terazosin

enalapril

antihypertensive drug

placebo

Terazosin

enalapril

terazosin

enalapril

placebo

terazosin

enalapril

terazosin

enalapril

placebo

" response " rate

BP

BP

BP

essential hypertension


Citalopram for post-stroke pathological crying . Post-stroke pathological crying is a distressing condition in which episodes occur in response to minor stimuli without associated mood changes . There is preliminary evidence of disturbed serotoninergic neurotransmission in such cases . We investigated the effect of the selective serotonin reuptake inhibitor citalopram on uncontrolled crying in stroke patients in a double-blind placebo-controlled crossover study . 16 consecutive patients ( median age 58.5 years , range 40-83 ) entered the 9-week study a median of 168 days ( range 6-913 ) post stroke and were treated with citalopram 10-20 mg daily for 3 weeks . Crying history was determined from semistructured interviews and from diaries kept by the patients . Psychiatric assessment was made with the Hamilton depression scale ( HDS ) , and unwanted effects were measured with the UKU side-effect scale . In 13 patients in whom frequency of crying could be assessed , the number of daily crying episodes decreased by at least 50 % in all cases during citalopram treatment vs 2 patients during placebo treatment ( p < 0.005 , McNemar 's test ) , the effect being rapid ( 1-3 days ) and pronounced in 11 ( 73 % ) . There was a concomitant significant decrease in depression rating from HDS 8.9 to 5.3 ( p < 0.005 , Wilcoxon 's test ) . Citalopram was well tolerated , the few side-effects being mild and transient . We conclude that serotoninergic neurotransmission plays an important part in post-stroke pathological crying and that citalopram is an effective and well-tolerated treatment .

Citalopram

citalopram

citalopram

uncontrolled crying

Crying history

Psychiatric assessment

Hamilton depression scale

unwanted effects

UKU side-effect scale

frequency of crying

number of daily crying episodes

decrease in depression rating

stroke

58.5 years , range 40-83

Crying history

crying


Primary prophylaxis with pyrimethamine for toxoplasmic encephalitis in patients with advanced human immunodeficiency virus disease : results of a randomized trial . Terry Beirn Community Programs for Clinical Research on AIDS . Pyrimethamine , 25 mg thrice weekly , was evaluated as primary prophylaxis for toxoplasmic encephalitis ( TE ) in a double-blind , randomized clinical trial in patients with human immunodeficiency virus ( HIV ) disease , absolute CD4 lymphocyte count of < 200/microL ( or prior AIDS-defining opportunistic infection ) , and the presence of serum IgG to Toxoplasma gondii . Leucovorin was coadministered only for hematologic toxicity . There was a significantly higher death rate among patients receiving pyrimethamine ( relative risk [ RR ] , 2.5 ; 95 % confidence interval [ CI ] , 1.3-4.8 ; P = .006 ) , even after adjusting for factors predictive of survival . The TE event rate was low in both treatment groups ( not significant ) . Only 1 of 218 patients taking trimethoprim-sulfamethoxazole but 7 of 117 taking aerosolized pentamidine for prophylaxis against Pneumocystis carinii pneumonia developed TE ( adjusted RR for the trimethoprim-sulfamethoxazole group , 0.16 ; 95 % CI , 0.01-1.79 ; P = .14 ) . Thus , for HIV-infected patients receiving trimethoprim-sulfamethoxazole , additional prophylaxis for TE appears unnecessary .

pyrimethamine

Pyrimethamine

Leucovorin

pyrimethamine

trimethoprim-sulfamethoxazole

aerosolized pentamidine

trimethoprim-sulfamethoxazole

trimethoprim-sulfamethoxazole

death rate

TE event rate


Pain relief can reduce hypoxemia in distressed neonates during routine treatment procedures . OBJECTIVE To determine whether the use of opioids could reduce the hypoxemia and hemodynamic instability associated with routine intensive care procedures in neonates with respiratory distress . DESIGN Randomized and placebo-controlled study . METHODS Physiological , plasma beta-endorphin , cortisol , and glucose responses to routine treatment procedures were studied in 84 mechanically ventilated distressed neonates randomized into groups receiving 1 mg/kg meperidine or 0.9 % saline 15 minutes before tracheal suction or routine nursing care . RESULTS The duration of hypoxemia ( transcutaneous partial pressure of O2 < 6.6 kPa ( < 50 mm Hg ) and/or arterial blood oxygen saturation < 80 % ) during treatment procedures was significantly longer in the saline group ( mean 82 vs 36 seconds , P = .001 ) and distress quantified by a novel behavioral scoring method was much higher . Changes in arterial blood pressure , heart rate , or plasma beta-endorphin , cortisol , and glucose concentration did not show any statistically significant differences between the groups . CONCLUSION Newborns with respiratory difficulties often suffer from hypoxemia during essential treatment procedures . The use of opioid analgesia may reduce the duration of hypoxemia and the associated distress and , therefore , may improve the long-term results of neonatal intensive care .

opioids

placebo-controlled

1 mg/kg meperidine

0.9 % saline

tracheal suction

routine nursing care

opioid analgesia

hypoxemia

hypoxemia and hemodynamic instability

arterial blood oxygen saturation

duration of hypoxemia

distress

distressed

neonates

neonates

respiratory distress .

mechanically ventilated distressed

Newborns

respiratory difficulties


Recovery following outpatient anesthesia : use of enflurane versus propofol . STUDY OBJECTIVE To compare the intraoperative conditions and postoperative recovery of patients following the use of either propofol-nitrous oxide ( N2O ) or enflurane-N2O for maintenance of outpatient anesthesia . DESIGN Randomized , single-blind study . SETTING University hospital outpatient surgery center . PATIENTS 61 ASA physical status I and II , healthy female outpatients undergoing laparoscopic surgery . INTERVENTIONS Patients were randomly assigned to one of three anesthetic regimens . Group 1 ( control ) received thiopental sodium 4 mg/kg intravenously ( i.v . ) , followed by 0.5 % to 1.5 % enflurane and 67 % N2O in oxygen ( O2 ) . Group 2 received propofol 2 mg/kg i.v. , followed by 0.5 % to 1.5 % enflurane and 67 % N2O in O2 . Group 3 received propofol 2 mg/kg i.v. , followed by propofol 50 to 160 micrograms/kg/min i.v . and 67 % N2O in O2 . All patients received succinylcholine 1 mg/kg i.v . to facilitate tracheal intubation and atracurium 10 to 20 mg i.v . to provide adequate relaxation during the maintenance period . MEASUREMENTS AND MAIN RESULTS Recovery from anesthesia was assessed by a research nurse who was unaware of the anesthetic technique used . The mean +/- SD time to eye opening was significantly longer in the thiopental-enflurane-N2O group ( Group 1 ) than in the propofol-propofol-N2O group ( Group 3 ) ( 6.1 +/- 2.5 minutes vs. 3.5 +/- 2.8 minutes , respectively ) . In addition , the mean time to respond to verbal commands was significantly shorter in the propofol induction groups compared with the thiopental induction group . However , the use of enflurane versus propofol for maintenance of anesthesia did not significantly prolong the time from arrival in the recovery room to sitting , tolerating oral fluids , walking , or being judged " fit for discharge . " There were no differences among the three groups with respect to postoperative pain or analgesic requirements . Finally , patients who received enflurane for maintenance of anesthesia had a significantly higher frequency of nausea and vomiting than the propofol maintenance group . CONCLUSION Induction of anesthesia with propofol is associated with a more rapid emergence from anesthesia than induction with thiopental . Maintenance of anesthesia with enflurane did not prolong recovery compared with maintenance with propofol , but enflurane was associated with increased frequency of postoperative nausea and vomiting .

outpatient anesthesia

enflurane

propofol

propofol-nitrous oxide ( N2O )

thiopental sodium 4 mg/kg intravenously

0.5 % to 1.5 % enflurane

67 % N2O in oxygen ( O2

Group 2 received propofol 2 mg/kg i.v.

succinylcholine

atracurium

anesthesia

propofol-propofol-N2O group ( Group 3 )

propofol

thiopental

enflurane

propofol

enflurane

propofol

thiopental

enflurane

propofol

enflurane

Recovery from anesthesia

mean +/- SD time to eye opening

mean time to respond to verbal commands

higher frequency of nausea and vomiting

emergence from anesthesia

recovery

outpatient anesthesia

outpatient anesthesia

outpatient

ASA physical status I and II

healthy

female

outpatients

laparoscopic surgery


Peripheral intravenous line survival and phlebitis prevention in patients receiving intravenous antibiotics : heparin/hydrocortisone versus in-line filters . OBJECTIVE To compare the use of in-line filtration with the addition of heparin/hydrocortisone ( hep/hc ) to the infusate for both phlebitis prevention and intravenous ( i.v . ) line survival in peripheral i.v . catheters . This study was specific for a patient group receiving prolonged courses of i.v . antibiotics . Analysis of the two endpoints for conventional short i.v . catheters ( short lines ) versus long ( 30 cm ) i.v . catheters ( long lines ) was also performed . METHODS Patients with cystic fibrosis receiving intermittent i.v . antibiotics were randomly allocated to receive their drugs either through an in-line filter using a drug-free infusate or with no filter and an infusate containing heparin 500 units and hydrocortisone 10 mg/L . Infusion sites were assessed daily . RESULTS Both the hep/hc and filter groups were similar in terms of phlebitis incidence and i.v . line survival when analyzed separately for both short and long lines . Long lines displayed markedly prolonged survival times and reduced phlebitis compared with short lines . CONCLUSIONS The effectiveness of i.v . filters in excluding the large particle load introduced by i.v . antibiotics and hence in reducing the subsequent phlebitis makes them a useful alternative to the use of hep/hc . The use of filters in this patient group may offer advantages in terms of ease of use and a possible decrease in hep/hc-related problems . Long lines offer practical advantages over short lines for patients requiring longer term i.v . access .

antibiotics

heparin/hydrocortisone

i.v

catheters

antibiotics

heparin

hydrocortisone

intravenous line survival

phlebitis

phlebitis incidence

line survival

survival times

phlebitis

hep/hc-related problems

patient group


Effect of entacapone , a peripherally acting catechol-O-methyltransferase inhibitor , on the motor response to acute treatment with levodopa in patients with Parkinson 's disease . Catechol-O-methyltransferase ( COMT ) inhibitors may be useful in the treatment of Parkinson 's disease by improving the bioavailability of levodopa and by prolonging its effects . Entacapone ( OR-611 ) , a novel COMT inhibitor , which does not cross the blood brain barrier , was assessed in 12 patients with Parkinson 's disease and motor fluctuations in a randomised , double-blind , cross-over , single dose study . The magnitude and duration of the therapeutic response to a single dose of 200 mg levodopa/50 mg carbidopa was evaluated after concomitant placebo , or 200 or 800 mg entacapone . A significant increase in the duration of the motor response to levodopa was seen when 200 mg entacapone was given with levodopa/carbidopa . Plasma levodopa concentrations were increased with both doses of the COMT inhibitor . The latency to onset of motor response did not differ significantly between active drug and placebo . Entacapone may prove useful in prolonging the duration of the benefit obtained from individual doses of levodopa .

entacapone

Entacapone ( OR-611 )

novel COMT inhibitor

carbidopa

placebo

entacapone

bioavailability

duration of the motor response

to levodopa

Plasma levodopa concentrations

latency to onset of motor response

prolonging the duration of the benefit

Parkinson 's disease

Parkinson 's disease

motor fluctuations


National Surgical Adjuvant Breast and Bowel Project 's Breast Cancer Prevention Trial . The Breast Cancer Prevention Trial is the largest breast cancer prevention study ever undertaken . Administered by the National Surgical Adjuvant Breast and Bowel Project , it is the first trial seeking to demonstrate whether a drug , tamoxifen , can prevent breast cancer in high-risk women . The objectives of this trial are to determine whether tamoxifen is effective in 1 ) reducing the incidence of invasive breast cancer , 2 ) reducing breast cancer mortality , 3 ) reducing deaths from cardiovascular disease , and 4 ) reducing bone fractures . In addition , the study will evaluate side effects , toxicity , and the quality of life of all study participants .

tamoxifen

tamoxifen

reducing breast cancer mortality

reducing bone fractures

side effects ,

toxicity

quality of life

tamoxifen


Topical anesthesia during infant eye examinations : does it reduce stress ? We studied the effect of topical anesthesia on infant stress and corneal haze during the routine eye examination for retinopathy of prematurity . Using a double-blind protocol , 55 premature infants weighing less than 1501 g at birth were selected randomly to receive normal saline or proparacaine HCl 0.5 % eye drops as a corneal wetting agent at their initial eye examination . Before , during , and after the procedure , infant stress was evaluated by heart rate , respiration rate , blood pressure , and transcutaneous oxygen saturation . Subjective assessment of the infant 's cry intensity and corneal haze also were recorded . Adequate data were collected on 42 patients . Using analysis of variance and chi-square tests , we found no difference in any of these parameters between the two patients groups . These data suggest that topical anesthetic agents offer no advantage over normal saline eye drops during the examination of premature infants .

Topical anesthesia

topical anesthesia

anesthetic


Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke . In order to assess the risk of pneumonia , dehydration , and death associated with videofluoroscopic evidence of aspiration following stroke , the clinical records of 26 patients with aspiration and 33 randomly selected , case-matched , dysphagic controls without videofluoroscopic evidence of aspiration were reviewed . The videofluoroscopic modified barium swallow technique included 5 ml-thin and thick liquid barium , 5 ml barium pudding , and 1/4 cookie coated with barium , plus additional 20 and 30 ml of thin liquid barium . Patients were assessed a mean of 2 +/- 1 SD months poststroke and were followed for a mean of 16 +/- 8 SD months poststroke . The odds ratio for developing pneumonia was 7.6 times greater for those who aspirated any amount of barium irrespective of its consistency ( p = 0.05 ) . The odds ratio for developing pneumonia was 5.6 times greater for those who aspirated thickened liquids or more solid consistencies compared with those who did not aspirate , or who aspirated thin liquids only ( p = 0.06 ) . Dehydration was unrelated to the presence or absence of aspiration . The odds ratio for death was 9.2 times greater for those aspirating thickened liquids or more solid consistencies compared with those who did not aspirate or who aspirated thin liquids only ( p = 0.01 ) . Aspiration documented by modified videofluoroscopic barium swallow technique is associated with a significant increase in risk of pneumonia and death but not dehydration following stroke .

videofluoroscopic

pneumonia

death

aspiration

odds ratio

developing pneumonia

pneumonia

Dehydration

death

risk of pneumonia

stroke

26 patients

poststroke

poststroke .


Treatment with coumarin to prevent or delay recurrence of malignant melanoma . Both coumarin ( 1,2-benzopyrone ) and warfarin ( 4-hydroxycoumarin ) have been shown to prevent the recurrence of malignant melanoma . Their action is macrophage-dependent and the dosage is critical . In 1984 a multicentre , prospective , randomised , double-blind trial of coumarin , given as a daily 50-mg dose for 2 years after surgery in patients with high-risk melanoma , was started . the patients had lesions greater than 1.70 mm thick and TNM stage IB or stage II disease . To date there are 4 recurrences in the coumarin-treated group of 13 patients , and 10 recurrences in the placebo-treated group of 14 patients ( P < 0.01 ) . There were no toxic effects .

coumarin

coumarin

warfarin

coumarin

recurrences

recurrences

toxic effects

malignant melanoma

high-risk melanoma


A controlled trial of intravenous immune globulin to reduce nosocomial infections in very-low-birth-weight infants . National Institute of Child Health and Human Development Neonatal Research Network . BACKGROUND Nosocomial infections are a major cause of morbidity and mortality in premature infants . As a rule , their low serum gamma globulin levels at birth subsequently decline to hypogammaglobulinemic values ; hence , prophylactic administration of intravenous immune globulin may reduce the rate of hospital-acquired infections . METHODS In this prospective , multicenter , two-phase controlled trial , 2416 infants were stratified according to birth weight ( 501 to 1000 g and 1001 to 1500 g ) and randomly assigned to an intravenous immune globulin group ( n = 1204 ) or a control group ( n = 1212 ) . Control infants were given placebo infusions during phase 1 of the study ( n = 623 ) but were not given any infusions during phase 2 ( n = 589 ) . Infants weighing 501 to 1000 g at birth were given 900 mg of immune globulin per kilogram of body weight , and infants weighing 1001 to 1500 g at birth were given a dose of 700 mg per kilogram . The immune globulin infusions were repeated every 14 days until the infants weighed 1800 g , were transferred to another center , died , or were sent home from the hospital . RESULTS Nosocomial infections of the blood , meninges , or urinary tract occurred in 439 of the 2416 infants ( 18.2 percent ) : 208 ( 17.3 percent ) in the immune globulin group and 231 ( 19.1 percent ) in the control group ( relative risk , 0.91 ; 95 percent confidence interval , 0.77 to 1.08 ) . Septicemia occurred in 15.5 percent of the immune globulin recipients and 17.2 percent of the controls . During phase 1 the rate of nosocomial infections was 13.4 percent in the immune globulin group and 17.8 percent in the control group ; the respective rates during phase 2 were 21.0 percent and 20.4 percent . The predominant organisms included gram-positive cocci ( 53.0 percent ) , gram-negative bacilli ( 22.4 percent ) , and candida species ( 16.0 percent ) . Adverse reactions were rarely observed during the infusions . Immune globulin therapy had no effect on respiratory distress syndrome , bronchopulmonary dysplasia , intracranial hemorrhage , the duration of hospitalization , or mortality . The incidence of necrotizing enterocolitis was 12.0 percent in the immune globulin group and 9.5 percent in the control group . CONCLUSIONS Prophylactic use of intravenous immune globulin failed to reduce the incidence of hospital-acquired infections in very-low-birth-weight infants .

immune globulin

immune globulin

intravenous immune globulin group

control group

immune globulin

nosocomial infections

Nosocomial infections

Septicemia

nosocomial infections

Adverse reactions

the duration of hospitalization

mortality

necrotizing enterocolitis

hospital-acquired infections

very-low-birth-weight

infants

premature

infants

infants

Infants

infants


Intraperitoneal distribution imaging prior to chromic phosphate ( P-32 ) therapy in ovarian cancer patients . This study addressed the technique of intraperitoneal distribution imaging ( IDI ) . A literature search ( MEDLINE database ) revealed wide variations in IDI techniques without a basis for comparison . From April 1990 to September 1992 , the authors studied 8 patients ( age 43-65 years ) with ovarian cancer . A total of 1000 ml of normal saline and 1 mCi of Tc-99m SC was infused intraperitoneally for IDI . In one patient loculation was observed , but only 250 ml of normal saline was infused with Tc-99m SC . A repeat study using our standard technique rendered free intraperitoneal distribution in this patient , as well as in the other seven cases . Some investigators recommend low volumes , but in our experience this produced the finding of pseudoloculation , which could change treatment inappropriately . Although the number of patients studied at our institution was small , administration of 1 liter intraperitoneally provided consistent IDI results .

Intraperitoneal distribution imaging

IDI

normal saline

1 mCi of Tc-99m SC

IDI

normal saline

Tc-99m SC

Intraperitoneal distribution

loculation

free intraperitoneal distribution

pseudoloculation

IDI

ovarian cancer


[ A controlled study of treating haemophilia A on an out-patient basis ( author 's transl ) ] . For six months 36 U factor VIII concentrates per kg bodyweight and week were administered to six out-patients with severe haemophilia A . The injection regimen was changed in every patient every two months , from 36 U/kg once to 18 U/kg twice and 12 U/kg three times , intravenously . The six possible combinations of these three dosage schedules were used in the patients in a strictly randomised manner , and all patients were treated during the same period . In the pre-trial period ( treatment as needed ) there were an average of 35 bleedings per two months . On continual treatment there were 21 bleedings on weekly injections of 36 U factor VIII per kg , 14 on twice weekly 18 U/kg and none on 12 U/kg , three times weekly . The differences are statistically significant . The absence of bleeding on the last dosage schedule was achieved during normal working . Days lost from work per patient per month was zero on three times 12 U/kg , 0.4 day on twice 18 U/kg and once 36 U/kg , while it had been five days in the pre-trial period . In addition to freedom from bleeding and no lost days from work , there was increased mobility and physical capacity .

36 U factor VIII concentrates

bleedings

absence of bleeding

freedom from bleeding

lost days

mobility and physical capacity .

six

haemophilia A


Sodium kinetics in white and black normotensive subjects : possible relevance to salt-sensitive hypertension . The hypothesis that sodium ( Na ) kinetics are not a first order process was tested . Twelve normotensive white and 12 normotensive black men were given 10 , 200 , and 400 mmol/d Na as the chloride salt for 7 days in random order . All urine made was collected . No effect of Na intake on blood pressure was identified in either whites or blacks . The half-life ( T1/2 ) with decreasing Na intake to 10 mmol/d was 1.08 days in whites and 1.65 days in blacks ( p = not significant [ NS ] ) . With increasing Na intake , T1/2 increased in both whites and blacks ; at the 400 mmol/d intake , the T1/2 for whites was 2.88 days and for blacks was 5.81 days ( p < 0.05 ) . At that intake , whites accumulated 385 +/- 153 mmol compared with 909 +/- 153 mmol for blacks ( p < 0.05 ) . The data showed that T1/2 increases with increasing Na intake and is , therefore , dose-dependent or " zero " order . The effect of dose is more prominent in blacks than in whites ; blacks accumulate more Na with increasing Na intake than whites . These data may have relevance for the pathogenesis of salt-sensitive hypertension in blacks .

sodium

Na as the chloride salt

blood pressure

half-life ( T1/2 )

T1/2 increased

accumulated

T1/2 increases

effect

accumulate more Na

Twelve normotensive white

12 normotensive black men


Maternal erythropoietin in singleton pregnancies : a randomized trial on the effect of oral hematinic supplementation . OBJECTIVE Our purpose was to study the effect of hematinic supplementation on the maternal erythropoietin response during singleton pregnancy . STUDY DESIGN In a randomized , double-blind trial 97 patients with a first-trimester hemoglobin level > or = 14.0 gm/dl received either iron and folic acid ( hematinic group , n = 53 ) or a placebo ( n = 44 ) . Serial hemoglobin , hematocrit , and serum erythropoietin were recorded from maternal blood and from cord blood on delivery . Serum ferritin was measured in the first trimester , at 36 weeks ' gestation , and in cord blood . RESULTS In both groups ( 1 ) the mean hemoglobin was lower ( p < 0.01 ) at 40 weeks ' gestation than when first examined and ( 2 ) the mean serum erythropoietin was higher ( p < 0.01 ) . The mean serum ferritin was lower ( p < 0.001 ) in both groups at 36 weeks ' gestation than at presentation but higher ( p = 0.04 ) in the hematinic group than in the placebo group . The mean hemoglobin and hematocrit were similar in the two groups until the third trimester but thereafter were higher ( p < 0.05 ) in the hematinic group . The mean maternal serum erythropoietin was higher ( p < 0.05 ) in the placebo group than in the hematinic group after 24 weeks ' gestation . The mean cord blood hematologic values were similar in the two groups . CONCLUSION Maternal serum erythropoietin increased during pregnancy , but this response was reduced in the third trimester in the hematinic-supplemented group .

supplementation

iron and folic acid

placebo

Maternal erythropoietin

maternal erythropoietin response

Serial hemoglobin

hematocrit

serum erythropoietin

Serum ferritin

mean hemoglobin

mean serum ferritin

mean hemoglobin and hematocrit

mean maternal serum erythropoietin

mean cord blood hematologic values

Maternal serum erythropoietin

singleton pregnancies


Risk of aspiration with the laryngeal mask . In order to assess if the use of the laryngeal mask airway is associated with an increased risk of gastric regurgitation during mechanical ventilation , we studied 50 patients allocated randomly to undergo anaesthesia with either artificial ventilation with isoflurane and nitrous oxide in oxygen and atracurium ( group A ) or spontaneous ventilation with isoflurane and nitrous oxide in oxygen ( group B ) . In both groups a laryngeal mask airway was used . Regurgitation was assessed by the patient ingesting a methylene blue capsule 10 min before induction of anaesthesia and examining the oropharynx by direct laryngoscopy at the end of surgery . In one patient in each group , there was staining of the oropharynx with blue dye at the end of surgery . In the patient in group A , dye was present in the trachea and bronchi .

laryngeal

anaesthesia

artificial ventilation

methylene blue capsule

staining of the oropharynx


Antifungal prophylaxis during remission induction therapy for acute leukemia fluconazole versus intravenous amphotericin B . BACKGROUND Fungal infection is a frequent and often fatal complication in patients undergoing remission induction therapy for acute leukemia . Although candidiasis is the most common infection , mold infections are increasing in frequency . Fluconazole ( FLU ) is a new antifungal agent that has been used successfully to treat Candida infections and has modest activity against aspergillosis in animal models . Subtherapeutic doses of amphotericin B ( AMB ) have been considered effective as prophylaxis in these patients . This study was designed to compare the efficacy and toxicity of these agents as antifungal prophylaxis . METHODS Adults with acute leukemia undergoing remission induction chemotherapy randomly were assigned to receive antifungal prophylaxis with AMB ( 0.5 mg/kg three times weekly ) or FLU ( 400 mg daily ) . Trimethoprim-sulfamethoxazole was administered as an antibacterial prophylaxis . Prophylaxis was continued until the patient achieved complete remission or was treated for 8 weeks without antileukemic response . Prophylaxis was discontinued if the patient experienced a possible or proven fungal infection or a serious toxicity . RESULTS Overall , 58 % of the 36 patients assigned to AMB successfully completed prophylaxis compared with 80 % of the 41 patients assigned to FLU ( < 0.05 ) . Proven , probable , or possible fungal infections occurred in 31 % and 17 % of the patients , respectively . The risk of discontinuing prophylaxis due to fungal infection or toxicity increased with time in the study and was significantly greater for AMB ( P = 0.02 ) . CONCLUSIONS At the dose used in this study , AMB was no more effective and was more toxic than FLU for prophylaxis of fungal infections in patients undergoing remission induction chemotherapy for acute leukemia .

versus intravenous amphotericin B

Fluconazole ( FLU )

amphotericin B ( AMB )

FLU

Trimethoprim-sulfamethoxazole

AMB

FLU

AMB

FLU

efficacy and toxicity

fungal infection

toxicity

fungal infections

acute leukemia

acute leukemia

36 patients

41 patients


Cyclosporin versus cyclophosphamide for patients with steroid-dependent and frequently relapsing idiopathic nephrotic syndrome : a multicentre randomized controlled trial . OBJECTIVE To compare the efficacy ( maintenance of remission ) , safety and tolerability of cyclosporin ( CsA ) with those of cyclophosphamide in patients with steroid-dependent or frequently relapsing nephrotic syndrome ( NS ) . DESIGN Open , prospective , randomized , multicentre , controlled study for parallel groups , stratified for adults and children . The setting was in nephrological departments in Italy . SUBJECTS AND INTERVENTIONS Seventy-three patients with steroid-sensitive idiopathic NS admitted to the study were randomly assigned to cyclophosphamide ( 2.5 mg/kg/day ) for 8 weeks or CsA ( 5 mg/kg/day in adults , 6 mg/kg/day in children ) for 9 months , tapered off by 25 % every month until complete discontinuation at month 12 . Seven patients lost to follow up were not considered in the analysis . The remaining 66 patients were followed up for 3-24 months after randomization . MAIN OUTCOME MEASURES Relapse-free survival ; number of N.S . relapses/patient/year ; cumulative dose of prednisone/patient ; laboratory investigations ( kidney and liver functions , haematological parameters ) ; incidence of adverse events . RESULTS At month 9 , 26 of 35 CsA-treated patients were still in complete remission and a further five patients were in partial remission ; 18 of 28 cyclophosphamide-treated patients were in complete remission , and one in partial remission ( P = NS ) . No difference between adults and children was seen with either treatment . The risk of relapse was similar between frequent relapsers ( 19 of 22 ) and steroid-dependent patients ( 8 of 14 ) given CsA , and those given cyclophosphamide ( 5 of 15 and 6 of 15 ) . The mean number of relapses per year and the mean dose of prednisone per year were significantly less ( P < 0.001 ) in both groups for the experimental year than for the year before randomization . At 2 years , 25 % of the patients given CsA ( 50 % adults and 20 % children ) and 63 % of those given cyclophosphamide ( 40 % adults and 68 % children ) had not had any relapse of NS . Tolerance to the two drugs was generally good . The CsA-related side-effects were mild and disappeared after drug discontinuation . CONCLUSIONS This study shows that both treatments are effective and well tolerated ; more patients given cyclophosphamide had stable remissions .

Cyclosporin

cyclophosphamide

cyclosporin ( CsA )

cyclophosphamide

cyclophosphamide

CsA

cyclophosphamide-treated

cyclophosphamide

CsA

cyclophosphamide

CsA-related

cyclophosphamide

Relapse-free survival

number of N.S

cumulative dose of prednisone/patient

incidence of adverse events

complete remission

partial remission

complete remission

partial remission

risk of relapse

mean number of relapses per year

dose of prednisone per year

relapse of NS . Tolerance

CsA-related side-effects

stable remissions .

NS

adults and children

Seventy-three

with steroid-sensitive idiopathic NS


Anticholinergic drugs : effects on oxygen consumption and energy expenditure . Premedication has been shown to affect both oxygen consumption ( VO2 ) and energy expenditure ( EE ) . The metabolic responses to anticholinergic drugs have not been studied . In this study the effects of anticholinergic drugs on VO2 and EE ( calculated from the measured rates of VO2 and carbon dioxide production [ VCO2 ] : EE [ kcal/d ] = 3.581 x VO2 [ L/d ] + 1.448 x VCO2 [ L/d ] - 32.4 ) were measured in six healthy female volunteers . They were given intramuscular atropine ( 15 micrograms/kg ) , glycopyrrolate ( 8 micrograms/kg ) , scopolamine ( 8 micrograms/kg ) , and placebo in a random double-blind cross-over design . The consecutive sessions were at least 1 wk apart for each subject . VO2 and EE were measured using an indirect calorimetry ( Deltatrac ) . Cardiovascular responses were assessed using standard noninvasive monitoring . Plasma drug concentrations were analyzed using a sensitive modification of radioreceptor assay . Subjective responses were measured with visual analog scale ( VAS ) . Atropine and glycopyrrolate induced a significant increase in heart rate with a simultaneous decrease in pressure rate quotient ( PRQ ) , while scopolamine caused a significant decrease in heart rate with a simultaneous increase in PRQ . Scopolamine significantly decreased both VO2 and EE , whereas glycopyrrolate increased VO2 . Atropine had no significant effect on metabolic variables . Only scopolamine induced sedation in this study . In conclusion , atropine , glycopyrrolate , and scopolamine differ not only in their cardiovascular and central nervous system effects , but also in their effects on metabolism .

Anticholinergic drugs

anticholinergic drugs

atropine

glycopyrrolate

scopolamine

placebo

Atropine

glycopyrrolate

Scopolamine

glycopyrrolate

Atropine

atropine

glycopyrrolate

scopolamine

oxygen consumption

energy expenditure

VO2 and EE

Cardiovascular responses

Plasma drug concentrations

visual analog scale ( VAS )

heart rate

pressure rate quotient ( PRQ )

heart rate

increase in PRQ

VO2 and EE

metabolic variables

sedation

six

female


Influence of glyceryl trinitrate on venous and arterial effects of chronic , asymmetric isosorbide dinitrate treatment in patients with ischemic heart disease . Asymmetric dosage regimes have been introduced to circumvent development of nitrate tolerance . This study assessed invasively the hemodynamics during supine rest and exercise before and after 4 weeks treatment with 30 mg isosorbide dinitrate ( ISDN ) or placebo asymmetrically b.i.d . in 14 randomized patients with stable ischemic heart disease in a double-blinded study . An intravenous infusion of glyceryl trinitrate ( GTN ) was used to assess possible nitrate tolerance . During the initial , medication-free exercise all patients had increased pulmonary arterial wedge pressure ( PAWP ) 31.4 +/- 5.56 mmHg ( mean +/- SD ) , showing impaired left ventricular function , while mean arterial pressures ( MAP ) rose from 112 +/- 16.3 mmHg at rest to 141 +/- 15.9 mmHg during exercise . After 4 weeks ISDN treatment , mean exercise PAWP and MAP , 3 h after morning dose , were reduced to 22.4 +/- 7.09 mmHg and 127 +/- 18.2 mmHg , respectively . Before the ISDN treatment , GTN reduced exercise PAWP to 13.9 +/- 5.27 mmHg and MAP to 119 +/- 11.2 mmHg , whereas after 4 weeks ISDN treatment , the addition of GTN did not reduce exercise PAWP and MAP to the same low levels . Thus , the applied ISDN regimen improved the hemodynamics , but induced a definite , partial nitrate tolerance .

glyceryl trinitrate

isosorbide dinitrate treatment

30 mg isosorbide dinitrate ( ISDN ) or

placebo

glyceryl trinitrate ( GTN )

ISDN

ISDN treatment , GTN

ISDN

ISDN

mean arterial pressures ( MAP )

mean exercise PAWP

and

MAP

PAWP

PAWP

and

MAP

ischemic heart disease


Multidose , live attenuated , cold-recombinant , trivalent influenza vaccine in infants and young children . Twenty-two healthy infants and children received either cold-recombinant , trivalent influenza vaccine or placebo in a three-dose vaccine trial . Most ( 82 % ) who received vaccine were seronegative to all three vaccine strains ( 10 ( 6 ) TCID50/dose each ) : A/Kawasaki/9/86 ( H1N1 ) , A/Los Angeles/2/87 ( H3N2 ) , and B/Yamagata/16/88 . Vaccine was administered intranasally at time 0 and 2 and 4 months later . The vaccine was well tolerated and immunogenic when administered in a multidose regimen . The first dose stimulated antibody to H1 , H3 , and B in 59 % , 94 % , and 35 % of vaccinees , respectively , by hemagglutination inhibition ( HAI ) or ELISA . After two doses of vaccine , 93 % , 93 % , and 80 % had antibody by HAI or ELISA to H1 , H3 , and B , respectively . Most vaccinees ( 67 % ) responded to all three viruses after two doses of vaccine . The third dose contributed little to the vaccine 's immunogenicity . Multidose trivalent influenza vaccine is safe and induces an immune response in most vaccinees after two doses .

influenza vaccine

placebo

A/Kawasaki/9/86 ( H1N1

A/Los Angeles/2/87 ( H3N2 )

well

tolerated

and

immunogenic

H1 , H3 , and B

vaccine 's immunogenicity

immune response

infants

young children

Twenty-two

healthy

infants and children


[ No better vigilance after general anesthesia with propofol in colonic surgery . A comparison of three procedures for general anesthesia ( propofol , halothane and midazolam/fentanyl ) in combination with catheter epidural anesthesia ] . Early mental and psychomotor recovery was studied in 67 patients undergoing colorectal surgery under continuous epidural anaesthesia and light general anaesthesia using propofol , halothane , and midazolam/fentanyl . The study was approved by the local ethics committee . All patients received epidural anaesthesia with 0.25 % bupivacaine and were then randomly allocated to one of three groups . In group I ( halothane ) , light general anaesthesia was induced with thiopental 3-5 mg/kg and maintained with halothane . The propofol group ( II ) received 2 mg/kg for induction and a mean continuous infusion of 1.7 mg/kg.h . In group III ( Mi/Fe ) , midazolam and fentanyl were used for induction and maintenance . All patients were intubated , received non-depolarising muscle relaxants , and were manually ventilated with nitrous oxide-oxygen ( 2:1.2 ) . For postoperative analgesia , 0.05 mg/kg morphine was administrated epidurally 30 min before the end of the operation ; 30 , 60 , 90 , and 120 min after arriving in the recovery room , vigilance was assessed using a modified Steward score , the Trieger test , the ability to recall a column of numbers ( KAI test ) , and symbol counting ( CI test ) . Heart rate , blood pressure , arterial oxygen saturation , and blood gases were recorded . RESULTS . The three groups were comparable with regard to age , sex , ASA classification , and duration of anaesthesia and operation ( Table 3 ) . There was no difference between the groups in performance of the recovery tests ( Figs . 2-5 ) , blood pressure , heart rate , arterial blood gas analysis ( Fig . 6 ) , or oxygen saturation . Comparing pre- and postoperative values , we found severe psychomotor and mental impairment in all groups . pCO2 was slightly elevated in all groups , but only 3 patients in the propofol group and 6 in the midazolam/fentanyl group developed hypercapnia above 50 mm Hg . Patients receiving propofol or midazolam/fentanyl had significantly less postoperative nausea and vomiting than those receiving halothane ( Table 5 ) . CONCLUSION . It is concluded that propofol offers no advantage over halothane or midazolam/fentanyl where early postoperative recovery is concerned . Intraoperatively , all three techniques provided good anaesthesia . Propofol and midazolam/fentanyl caused less postoperative nausea and vomiting than halothane anaesthesia .

propofol in

general anesthesia

propofol

halothane

midazolam/fentanyl

continuous epidural anaesthesia

and light general anaesthesia

propofol

halothane

midazolam/fentanyl

epidural anaesthesia

bupivacaine

propofol

midazolam and fentanyl

intubated

non-depolarising muscle relaxants

morphine

epidurally

midazolam/fentanyl

propofol

midazolam/fentanyl

halothane

propofol

halothane

midazolam/fentanyl

Propofol

midazolam/fentanyl

halothane

vigilance

Early mental

psychomotor recovery

recovery tests

psychomotor and mental impairment

hypercapnia

postoperative nausea and vomiting

postoperative recovery

postoperative nausea and vomiting

colorectal surgery

continuous epidural anaesthesia

light general anaesthesia


Ketorolac versus fentanyl for gynaecological day-case surgery . The effectiveness of fentanyl and ketorolac in providing analgesia for day-case gynaecological procedures was evaluated in 55 healthy volunteers in a single blinded fashion . Fentanyl ( 1 mcg/kg iv ) and ketorolac ( 30 mg im ) were administered immediately following induction of anaesthesia . Anaesthesia was standardized with propofol , nitrous oxide and enflurane . Outcome variables assessed were pain , additional analgesic requirements , and incidence of postoperative nausea and vomiting . All variables were recorded at 15 minutes , 2 hours and 24 hours postoperatively . There was no significant difference between the 2 groups with respect to any of the measured variables . Both drugs were ineffective as sole analgesic agents in half of their respective groups . It may be that a combination of these drugs , providing a multireceptor approach to analgesia , will prove to be more effective .

Ketorolac versus fentanyl

fentanyl

ketorolac

Fentanyl

ketorolac

propofol

nitrous oxide

enflurane

pain

additional analgesic requirements

postoperative nausea and vomiting

ineffective

analgesic

gynaecological day-case surgery

day-case gynaecological procedures

healthy volunteers


[ Effects of an intensive therapy program for behaviorally disordered mentally handicapped patients on staff personnel in residential care ] . This study evaluates the effects of an intensive therapy program designed for mentally handicapped persons with severely disturbed or autistic behavior on their staff personal which had an active role in the program . The staff members rated their professional competence , quality of interaction with the client , team culture and work satisfaction before and after being engaged in the program , with additional ratings of their personal aims at the beginning of the program . Three sets of data were obtained with the program being conducted three times in a row . The testings of the related as well as the independent samples show differentiated program effects . The main effect is an increase of the professional competence and quality of interaction , especially by the qualified staff members . Trainees put emphasis on the development of their personal relationship with the client . The results are discussed in terms of the impact of learning processes specific to the roles of the staff members and motivational factors on learning and therapy outcome , along with institutional conditions influencing successful learning . Thus the program facilitates the professional and interpersonal learning process of staff members in a specific way with success as well as with limitations .

intensive therapy program

mentally handicapped

disturbed or autistic behavior


Trimetazidine : a new concept in the treatment of angina . Comparison with propranolol in patients with stable angina . Trimetazidine European Multicenter Study Group . 1 . Trimetazidine has a direct anti-ischaemic effect on the myocardium without altering the rate x pressure product or coronary blood flow . 2 . The effects of trimetazidine ( 20 mg three times daily ) were compared with those of propranolol ( 40 mg three times daily ) in a double-blind parallel group multicentre study in 149 men with stable angina . 3 . Reproducibility of exercise performance was verified during a 3 week run-in placebo washout period . All patients had > 1 mm ST-depression on exercise test . 4 . After 3 months , similar anti-anginal efficacy was observed between the trimetazidine ( n = 71 ) and propranolol ( n = 78 ) groups . No significant differences were observed between trimetazidine and propranolol as regards anginal attack rate per week ( mean difference P-TMZ : 2 ; 95 % CI : -4.4 , 0.5 ) and exercise duration ( mean difference P-TMZ : 0 s ; 95 % CI : -33 , 34 ) or time to 1 mm ST segment depression ( mean difference P-TMZ : 13 s ; 95 % CI : -24 , 51 ) . Heart rate and rate x pressure product at rest and at peak exercise remained unchanged in the trimetazidine group but significantly decreased with propranolol ( P < 0.001 in all cases ) . With both drugs there was a trend to decreased ischaemic episodes in the 46 % patients who experienced ambulatory ischaemia on Holter monitoring . Six patients stopped trimetazidine and 12 propranolol . Of these , five in each group were withdrawn because of deterioration in cardiovascular status . 5 . The results suggest that trimetazidine and propranolol at the doses studied have similar efficacy in patients with stable angina pectoris . ( ABSTRACT TRUNCATED AT 250 WORDS )

Trimetazidine

propranolol

Trimetazidine

trimetazidine

propranolol

trimetazidine

propranolol

trimetazidine

propranolol

trimetazidine

propranolol

trimetazidine

propranolol

anti-ischaemic effect

rate x pressure product

coronary blood flow

anti-anginal efficacy

anginal attack rate per week

exercise duration

ST segment depression

ischaemic episodes

withdrawn

stable angina .

men with stable angina .


[ Perioperative teicoplanin prophylaxis in patients undergoing breast reconstruction with the abdominal wall . A case-control study ] . The authors report the results of a randomized clinical trial of antibiotic prophylaxis of postoperative infection following breast reconstruction by transposition of rectus abdominis myocutaneous flap ( TRAMF ) . The aim was to evaluate the efficacy and tolerability of a short-term parenteral prophylaxis with Teicoplanin and the end-point of the study was the evaluation of wound contamination assessed by means of microbiologic culture of drainage fluid . From October 1990 to March 1992 38 patients were recruited : 20 patients in the antibiotic prophylaxis arm and 18 patients in the control group . Analysis of drainage fluids showed a higher contamination rate ( 15/18 = 83 % ) in the control group as compared to the prophylaxis arm ( 2/20 = 10 % ) ( p < 0.0001 ) . Moreover , 11 patients in the control arm suffered from fever > 37.5 degrees C for at least 3 days as compared to 1 patient in the antibiotic prophylaxis group ; the postoperative stay was 13.3 +/- 4.3 and 9.0 +/- 1.6 in the control and antibiotic arm respectively . No antibiotic related side effects were evidenced through the study . These results seem to confirm the value of parenteral short-term antibiotic prophylaxis of postoperative infection in such kind of " clean " operative procedure .

teicoplanin prophylaxis

parenteral prophylaxis with Teicoplanin

higher contamination rate

fever > 37.5 degrees C

postoperative stay

antibiotic related side effects


Lithium sustains the acute antidepressant effects of sleep deprivation : preliminary findings from a controlled study . Early morning sleep deprivation ( patient awake from 0200 to 2200 hours ) produces a same-day antidepressant effect in approximately one-half of patients with major depression . Unfortunately , these antidepressant effects are short-lived and patients usually relapse to baseline depression levels within 48 hours . Recent work suggests , however , that the use of lithium with early morning sleep deprivation sustains this rapid antidepressant effect and makes it clinically useful . In a 30-day study , we compared the abilities of four different treatments ( lithium plus early morning sleep deprivation , lithium plus a control sleep deprivation procedure , and desipramine with either of the two sleep manipulations ) to induce a rapid ( next-day ) and sustained antidepressant response in 16 depressed patients . Lithium plus early morning sleep deprivation produced a quicker response than lithium with the control sleep deprivation , and the response was sustained for at least 30 days . In this design , however , lithium/early morning sleep deprivation was no faster than either of the two desipramine/sleep deprivation conditions in inducing remission . These results support the results of previous studies and suggest further investigation of this novel sleep/pharmacologic intervention is warranted .

Lithium

lithium

desipramine/sleep deprivation

sleep/pharmacologic intervention

antidepressant effects

antidepressant effect

effects

antidepressant effect

antidepressant response

inducing remission .

acute antidepressant effects

sleep deprivation :

sleep deprivation

major depression .

depressed


How to establish equivalence when data are censored : a randomized trial of treatments for B non-Hodgkin lymphoma . Interest in equivalence trials has been increasing for many years , though the methodology which has been developed for such trials is mainly for uncensored data . In cancer research we are more often concerned with survival . In an efficacy trial , the null hypothesis specifies equality of the two survival distributions , but in an equivalence trial , a null hypothesis of inequivalence H0 has to be tested . The usual logrank test has to be modified to test whether the true value r of the ratio of hazard rates in two treatment groups is at least equal to a limit value r0 . If prognostic factors have to be taken into account , the Cox model provides tests of Ho , and a useful confidence interval for the adjusted relative derived from the regression parameter for the treatment indicator . An equivalence trial of maintenance therapy was carried out in children with B non-Hodgkin lymphoma , and serves as an illustration .

logrank test

maintenance therapy

survival

B non-Hodgkin lymphoma

children

B non-Hodgkin lymphoma


Erythrocyte deformability , endothelin levels , and renal function in cyclosporin-treated renal transplant recipients : effects of intervention with fish oil and corn oil . Twenty nine stable renal transplant recipients , 10 receiving cyclosporin , 10 cyclosporin-prednisolone and nine azathioprine-prednisolone were supplemented in a double blind randomization cross-over study with fish oil and corn oil for a period of 4 months each . Erythrocyte deformability was reduced in the cyclosporin-treated patients and returned to normal values after supplementation of either oil . The oil supplementation resulted in an increased polyunsaturated fatty acid content in the plasma phospholipids . An increased erythrocyte membrane polyunsaturated fatty acid content might correct the lower erythrocyte deformability in cyclosporin treated patients . Therefore , it is probable that these changes are membrane-related . The oil supplementation had no effect on glomerular filtration rate , effective renal plasma flow , filtration fraction or blood pressure , which does not exclude effects of the cyclosporin-induced rigidified erythrocytes in the acute phase of renal transplantation . Decreased erythrocyte deformability could play a role in the cyclosporin-induced deterioration of renal haemodynamics . This may enhance the effects of endothelin , as these patients also had elevated endothelin levels .

cyclosporin-treated

fish oil

corn oil

cyclosporin

10 cyclosporin-prednisolone

azathioprine-prednisolone

fish oil

corn oil

cyclosporin-treated

oil

cyclosporin

oil

cyclosporin-induced

Erythrocyte deformability

endothelin levels

renal function

Erythrocyte deformability

polyunsaturated fatty acid content

glomerular filtration rate

effective renal plasma flow

filtration fraction or blood pressure

erythrocyte deformability

Twenty nine

stable renal transplant recipients

nine


Evaluation of postural stability by computerised posturography following outpatient paediatric anaesthesia . Comparison of propofol/alfentanil/N2O anaesthesia with thiopentone/halothane/N2O anaesthesia . Simple clinical tests , like Romberg 's test or a walking test , have proved to be inadequate guidelines for safe discharge after outpatient anaesthesia . A randomised study was therefore planned to compare postural stability measured by computerised posturography in 31 oral midazolam-atropine premedicated children aged 6.9 ( s.e . 0.4 ) years who had been anaesthetised with either propofol/alfentanil/N2O or thiopentone/halothane/N2O . The sway velocity of the children was measured before premedication and 1 , 2 and 3 h after the end of anaesthesia . Results show that sway velocity had returned to baseline values 3 h after the end of anaesthesia in all children who had received propofol/alfentanil/N2O and in 12 of the 15 children who had received thiopentone/halothane/N2O . The quantified version of the Romberg test performed with eyes open or closed was not impaired after anaesthesia , compared with the control values , indicating that in children poor equilibrium is not compensated by vision . The clinical recovery with respect to the times to eye opening , to responding to command or to being fully awake did not differ between the two anaesthesia methods . On the basis of recovery assessed by postural stability , propofol/alfentanil/N2O anaesthesia was not preferable to thiopentone/halothane/N2O anaesthesia after minor paediatric otolaryngological surgery .

computerised posturography

paediatric anaesthesia

oral midazolam-atropine

anaesthetised

propofol/alfentanil/N2O anaesthesia

thiopentone/halothane/N2O anaesthesia

otolaryngological surgery .

postural stability

safe discharge

sway velocity

sway velocity

Romberg test

eye opening

outpatient

paediatric

anaesthesia .


Analgesia after caesarean section with intramuscular ketorolac or pethidine . We compared , in a double-blind randomised study , intramuscular ketorolac 30 mg ( n = 49 ) and intramuscular pethidine 75 mg ( n = 51 ) for analgesia after elective caesarean section under general anaesthesia . Anaesthesia was induced with thiopentone and suxamethonium and maintained with atracurium , nitrous oxide and isoflurane . Intravenous fentanyl 100 micrograms was given after delivery of the neonate . In the recovery ward , patients who requested analgesia were allocated randomly to receive ketorolac 30 mg or pethidine 75 mg intramuscularly . Analgesia was assessed at intervals up to six hours , using a visual analogue scale and a four-point verbal scale , while duration of analgesia was taken as the time until the patient requested additional analgesia . There was no difference in the duration of analgesia between groups ( Mann-Whitney test P = 0.27 , Mantel-Haentszel test P = 0.17 ) . Twenty-six patients in the ketorolac group and 17 patients in the pethidine group requested further analgesia by 90 minutes . However , four patients in the ketorolac group and six patients in the pethidine group requested no further analgesia within 24 hours . Pain VAS and overall assessment of analgesia was similar between groups , although more side-effects ( nausea , dizziness ) were noted in the pethidine group . Ketorolac 30 mg and pethidine 75 mg provided similar but variable quality of analgesia after caesarean section .

ketorolac

pethidine

intramuscular ketorolac

intramuscular pethidine

analgesia

thiopentone

suxamethonium

atracurium

nitrous oxide and isoflurane

Intravenous fentanyl

ketorolac

Analgesia

analgesia

Analgesia

Mann-Whitney test

Mantel-Haentszel

further analgesia

no further analgesia

Pain VAS

overall assessment of analgesia

nausea

dizziness


Cefprozil versus penicillin V in treatment of streptococcal tonsillopharyngitis . In a randomized multicenter study , the efficacy and safety of cefprozil were compared with those of penicillin in the treatment of group A streptococcal tonsillopharyngitis in children . Of the 409 patients enrolled , 323 were evaluable for their clinical and bacteriological responses ; of these 323 children , 172 received cefprozil and 151 received penicillin V. The clinical responses in patients treated with cefprozil were significantly better than those in patients who received penicillin ( 95.3 versus 88.1 % ; P = 0.023 ) . Eradication of the original serotype of group A streptococci was achieved in 91.3 % of patients treated with cefprozil and 87.4 % of patients treated with penicillin , the difference not being statistically significant ( P = 0.125 ) . However , there were significantly more symptomatic patients among the bacteriological failures in the penicillin group ( 68.4 % ) than in the cefprozil group ( 26.7 % ) . beta-Lactamase-producing Staphylococcus aureus was more frequently isolated from the throat flora during penicillin therapy than during cefprozil treatment . No difference in the incidence of adverse events probably related or of unknown relationship to the study drugs was observed in the two treatment groups ( 5.2 % of those treated with cefprozil and 6.0 % of those treated with penicillin ) . Cefprozil can be considered a safe and reliable drug for the treatment of streptococcal pharyngitis in children .

Cefprozil

penicillin V

cefprozil

penicillin

cefprozil

penicillin V.

cefprozil

penicillin

cefprozil

penicillin

penicillin

cefprozil

penicillin therapy

cefprozil

cefprozil

penicillin

Cefprozil

efficacy and safety

clinical responses

isolated from the throat flora

incidence of adverse events

streptococcal tonsillopharyngitis

streptococcal pharyngitis


High purity factor VIII and immune state in HIV .

High purity factor VIII

HIV


A double-blind comparison of oral ketoprofen 'controlled release ' and indomethacin suppository in the treatment of rheumatoid arthritis with special regard to morning stiffness and pain on awakening . A double-blind , double-dummy , crossover study was carried out in 8 centres to compare the efficacy and tolerability of 'controlled-release ' ketoprofen tablets ( 200 mg ) with that of indomethacin suppositories ( 100 mg ) in out-patients with definite or classical rheumatoid arthritis . Patients were allocated at random to receive a daily bedtime dose of either 1 ketoprofen tablet or 1 indomethacin suppository plus the dummy of the other formulation for a period of 3 weeks . They were then crossed over to the alternative treatment for a further 3 weeks . Daily diary records were kept by patients of the number of night-time awakenings due to pain , pain severity at awakening in the morning and the duration of early morning stiffness . Treatment efficacy was also assessed at the end of each trial period by means of an articular index and by physician 's and patient 's overall evaluation of response . Adverse effects spontaneously mentioned by the patients or elicited by direct questioning using a symptom check-list were recorded . Statistical analysis of the results from 83 evaluable patients showed that the 'controlled-release ' tablet formulation of 200 mg ketoprofen was equally as effective as the 100 mg indomethacin suppository in the treatment of rheumatoid arthritis , especially with regard to pain at awakening and morning stiffness . Side-effects in both groups were those commonly seen with non-steroidal anti-inflammatory drugs and , as expected , gastro-intestinal and CNS disturbances predominated . Overall , side-effects were fewer with ketoprofen than with indomethacin .

oral ketoprofen 'controlled release

indomethacin suppository

indomethacin suppositories

ketoprofen

indomethacin suppository

ketoprofen

indomethacin suppository

ketoprofen

indomethacin

indomethacin suppository

pain at awakening and morning stiffness

gastro-intestinal and CNS disturbances

side-effects

ketoprofen

indomethacin


Increased blood pressure and neural tone in the silent ischemia of hypertension : disparate effects of immediate release nifedipine . OBJECTIVES The aims of this study were 1 ) to evaluate the role of blood pressure and associated neural tonicity in ambient ischemia of a group of hypertensive patients with stable angina , and 2 ) to determine the efficacy of immediate release nifedipine therapy in controlling the total ischemic burden in both office-measured and ambulatory blood pressure . BACKGROUND Low heart rate ischemia , as detected by Holter ambulatory electrocardiographic monitoring , suggests that reduced coronary flow is the major factor leading to ischemia . We previously found that 91 % of the ischemic episodes in our hypertensive patients with stable angina were silent . METHODS We measured plasma norepinephrine content during ischemic events from blood obtained from automatic pump withdrawal with the assistance of a real-time ST segment depression monitor . We then related the norepinephrine content to ischemic episodes assessed by 48-h Holter recording , blood pressure reading by ambulatory blood pressure monitoring and patients ' diaries . Measurements were taken during the placebo period and immediate-release nifedipine therapy in 30 hypertensive patients ( 20 with and 10 without stable angina ) . RESULTS More than half of the patients had ischemic episodes ; 95 % of these were silent . Ischemic episodes peaked in the early morning , and 55 % occurred during routine sedentary activities . There was a 10 % to 15 % increase in heart rate at the onset of ischemia associated with a 30 % higher plasma norepinephrine level . Seventy-five percent of patients had increased norepinephrine after nifedipine therapy . Nifedipine therapy controlled measured blood pressure but not 24-h ambulatory blood pressure . Ischemic episodes were reduced only in patients whose ambulatory blood pressure was controlled . CONCLUSIONS The results suggest that increased neural tone at the time of the ischemic event may play a role in reducing coronary perfusion leading to silent ischemia . Nifedipine therapy ( immediate release ) was effective in control of ischemia only when both ambulatory and office-measured blood pressure were controlled .

nifedipine

nifedipine

real-time ST segment depression monitor

placebo

nifedipine therapy

nifedipine

blood pressure

neural tone

blood pressure

neural tonicity

efficacy

ischemic episodes

Ischemic episodes

heart rate

plasma norepinephrine level

norepinephrine

blood pressure

24-h ambulatory blood pressure

Ischemic episodes

neural tone

control of ischemia

blood pressure

20 with and 10 without stable angina


Veterans Affairs congestive heart failure antiarrhythmic trial . CHF STAT Investigators . This is a prospective , double-blind , placebo-controlled trial to determine the effect of antiarrhythmic drug therapy on mortality in patients with congestive heart failure and ventricular arrhythmia . Patients will be assigned to receive either amiodarone or placebo . Eligible patients include those with ischemic and nonischemic congestive heart failure and with > or = 10 ventricular premature beats per hour . All patients must have shortness of breath with minimal exertion or paroxysmal nocturnal dyspnea , a left ventricular internal dimension ( LVIDd ) by echocardiogram of > or = 55 mm or a cardiothoracic ratio of > 0.5 and an ejection fraction of < or = 40 % . All patients will receive vasodilator therapy , unless they find it intolerable . Patients will be entered into the study for 2.5 years and followed for an additional 2 years . Drug therapy will be continued for all patients throughout the entire study unless adverse reactions occur that necessitate individualized treatment . The expectation is that 674 patients will be entered into the study from 25 participating centers . This sample size will allow for the detection of a 33 % decrease in 2-year mortality ( 20 % vs 30 % ) in the treated patients compared with those in the placebo group , with a power of 0.90 and a 2-sided alpha level of 0.05 . Intermittent Holter monitoring , radionuclide ventriculograms , pulmonary function tests , echocardiograms , and blood tests , including arterial blood gases , will be required for each patient . ( ABSTRACT TRUNCATED AT 250 WORDS )

amiodarone

placebo

mortality

2-year mortality

Veterans

congestive heart failure

congestive heart failure

ventricular arrhythmia

congestive heart failure

ventricular premature beats

shortness of breath

paroxysmal nocturnal dyspnea


Relaxing retinotomy with silicone oil or long-acting gas in eyes with severe proliferative vitreoretinopathy . Silicone Study Report 5 . The Silicone Study Group . In the Silicone Study , 117 of 404 eyes ( 29 % ) with severe proliferative vitreoretinopathy ( > or = C-3 , full-thickness retinal folds in three or more quadrants ) enrolled in the study were treated with vitrectomy , underwent a relaxing retinotomy , and were randomly assigned to treatment with long-acting gas or silicone oil . Forty-six eyes ( 20 % ) had undergone no previous vitrectomy ( group 1 ) ; 71 eyes ( 42 % ) had undergone previous vitrectomy ( group 2 ) with intraocular gas tamponade ( P < .001 ) . Group 1 eyes not undergoing retinotomy had better anatomic ( six months ) and visual ( six and 24 months ) outcomes and less hypotony ( six months ) than eyes that did regardless of tamponade ( P < .05 ) . For eyes undergoing retinotomy , silicone oil decreased the likelihood of hypotony ( six months , P < .05 ) . These differences were not found in group 2 eyes . We conclude that eyes undergoing a vitreous operation for the first time for the treatment of proliferative vitreoretinopathy can in most instances be successfully treated by conventional techniques without the need for relaxing retinotomy . Retinotomy may be required more often in patients undergoing repeat vitreous surgery for proliferative vitreoretinopathy , in which case both silicone oil and long-acting perflouropropane gas appear to be equally effective .

vitrectomy

relaxing retinotomy

perflouropropane

better anatomic ( six months )

visual ( six and 24 months ) outcomes

hypotony

hypotony

proliferative vitreoretinopathy

equally effective

proliferative vitreoretinopathy

proliferative vitreoretinopathy

Forty-six


Femoral vein delivery of contrast medium enhances transthoracic echocardiographic detection of patent foramen ovale . OBJECTIVES We postulated that femoral vein delivery of contrast medium because of streaming , might enhance precordial echocardiographic detection of patent foramen ovale . BACKGROUND Although precordial contrast echocardiography is widely used to diagnose patent foramen ovale , this method is limited by poor sensitivity . Previous investigators have demonstrated enhanced detection of atrial defects by the dye-dilution technique after delivery of contrast medium into the inferior rather than the superior vena cava . METHODS Transthoracic contrast examinations were performed in a randomly selected group of 70 patients ( without previous history of cerebral or systemic embolus ) undergoing cardiac catheterization . Paired contrast agent injections ( 10 ml dextrose in water/0.25 ml air ) were administered from an upper extremity vein and femoral vein in each patient during spontaneous respiration , cough and Valsalva maneuvers . Studies were interpreted by an experienced echocardiographer unaware of the sequence and site of injections . Positive studies were semiquantitatively graded from +1 ( minimal left ventricular opacification ) to +4 ( intense left ventricular opacification ) . Catheterization and echocardiographic assessment of patent foramen ovale were compared in 21 subjects . RESULTS Patent foramen ovale was detected significantly more often during femoral vein versus upper extremity contrast delivery ( 23 of 70 patients [ prevalence 33 % ] vs. 9 of 70 patients [ prevalence 13 % ] , p < 0.001 ) . The intensity of left ventricular opacification was also greater during femoral vein contrast injection . Precordial echocardiography combined with femoral contrast delivery was significantly more sensitive than cardiac catheterization for assessment of patent foramen ovale ( 8 of 21 patients vs. 2 of 21 patients , p < 0.05 ) . CONCLUSIONS Femoral vein contrast delivery significantly enhances the ability of precordial contrast echocardiography to diagnose patent foramen ovale . Physiologic patency of the foramen ovale is more common ( prevalence 33 % ) than previously documented .

Transthoracic contrast examinations

Femoral vein contrast delivery

patent foramen ovale

precordial echocardiographic detection

atrial defects

Catheterization

and

echocardiographic assessment

of patent foramen ovale

sensitive

assessment of patent foramen ovale


A preliminary trial of ascorbic acid as supplemental therapy for autism . 1 . This study presents the results of a 30-week double-blind , placebo-controlled trial exploring the effectiveness of ascorbic acid ( 8g/70kg/day ) as a supplemental pharmacological treatment for autistic children in residential treatment . 2 . Residential school children ( N = 18 ) were randomly assigned to either ascorbate-ascorbate-placebo treatment order group or ascorbate-placebo-ascorbate treatment order group . Each treatment phase lasted 10 weeks and behaviors were rated weekly using the Ritvo-Freeman scale . 3 . Significant group by phase interactions were found for total scores and also sensory motor scores indicating a reduction in symptom severity associated with the ascorbic acid treatment . 4 . These results were consistent with a hypothesized dopaminergic mechanism of action of ascorbic acid .

ascorbic acid

placebo-controlled

ascorbic acid

ascorbate-placebo-ascorbate treatment

ascorbic acid treatment

ascorbic acid

total scores

sensory motor scores

symptom severity

autism .

Residential school children ( N = 18 )


Comparison of outcome of labetalol or hydralazine therapy during hypertension in pregnancy in very low birth weight infants . Ninety-seven women with moderate to severe preeclampsia ( PE ) were allocated at random to labetalol or hydralazine treatment . Of these , 22 women with severe PE gave birth to neonates with VLBW ( very low birth weight < or = 1500 g ) . Seven were allocated to labetalol treatment ( Group A ) , eight to hydralazine treatment ( Group B ) and seven women received both drugs due to poor blood pressure control with a single drug therapy ( Group C ) . No difference in cesarean section rate or in the indication for operative delivery could be seen . Gestational age was 29.9 weeks ( 25.4-32.5 ) in Group A , 28.6 weeks ( 26.6-33.4 ) in Group B and 27.3 weeks ( 26.7-31.1 ) in Group C ( median and range ) . Birth weight did not differ between groups and 13 of the 22 infants weighed below 1000 g. There was a tendency to lower Apgar scores at five minutes in the hydralazine group . Time spent in the neonatal intensive care unit did not differ between groups . Five of the 11 neonates with gestational age ( GA ) < or = 28 weeks and three of the seven neonates in GA 29-30 weeks died . Neither the number of infants requiring intermittent positive pressure ventilation or duration of O2- treatment , nor number of infants with respiratory distress syndrome differed between groups . We did not find any difference in the outcome of the VLBW infants when the hypertensive mother had been treated with either hydralazine or labetalol .

labetalol

hydralazine

labetalol or hydralazine

labetalol treatment ( Group A )

hydralazine treatment ( Group B ) and

hydralazine

labetalol

cesarean section rate

indication for operative delivery

Gestational age

Birth weight

Apgar scores

died

number of infants

duration of O2- treatment

infants


The effects of a 24-h psychological training program on attitudes , communication skills and occupational stress in oncology : a randomised study . The usefulness of psychological training programs ( P.T.P . ) in health care settings devoted to cancer care is beginning to be recognised but their content , form and effectiveness need further investigation . Seventy-two oncology nurses were randomly assigned to a 24-h P.T.P . or to a waiting list period . Attitudes were assessed by a semantic differential questionnaire , occupational stress was assessed by the Nursing Stress Scale and communication skills were assessed by standardised videotaped role-playing exercises . These were used to compare trained ( T.S . ) and control subjects ( C.S. ) . The results show a significant training effect on attitudes ( P = 0.05 ) , especially on those related to self concept ( P = 0.004 ) , and on the level of occupational stress related to inadequate preparation ( P = 0.02 ) . Limited changes were found regarding post-training communication skills . T.S . were significantly more in control of the interview than C.S . ( P = 0.02 ) . The results indicate that 24-h P.T.P . assessed here are effective . The data also demonstrate the need to consolidate the skills acquired by regular post-training sessions .

psychological training program

24-h P.T.P .

or to a waiting list period

P.T.P

Attitudes

occupational stress

the Nursing Stress Scale

communication skills

attitudes

self concept

level of occupational stress

Seventy-two

oncology nurses


Deficiency of serum ionized magnesium in patients receiving hemodialysis or peritoneal dialysis . Serum total magnesium ( TMg ) measurements in dialysis patients are variable , with some groups reporting hypermagnesemia and some hypomagnesemia . It had not been possible to measure the biologically active fraction , ionized magnesium ( IMg2+ ) . The authors utilized an ion-selective electrode to measure IMg in 26 hemodialysis patients and 10 peritoneal dialysis ( CAPD ) patients and compared the results with those from 66 age matched control subjects . Dialysate magnesium was 0.375 mM/L for the hemodialysis and 0.25 mM/L for the CAPD patients . When compared with control subjects , both hemodialysis and CAPD patients had significantly lower IMg2+ ( 0.55 +/- 0.02 and 0.50 +/- 0.02 vs. 0.60 +/- 0.004 mM/L ; p < 0.05 ) and greater or normal TMg values ( 0.99 +/- 0.04 , different at the p < 0.001 level , and 0.85 +/- 0.04 vs. 0.84 +/- 0.008 ) . Ionized calcium ( ICa2+ ) values were similar for all three groups ( 1.15 +/- 0.02 and 1.21 +/- 0.04 vs. 1.17 +/- 0.01 ) , resulting in increased mean ICa2+/IMg2+ ratios ( 2.14 +/- 0.07 and 2.42 +/- 0.06 vs. 1.95 +/- 0.02 for the control subjects ; p < 0.05 ) . The percent of total magnesium that was ionized ( % IMg2+ ) was low in both the hemodialysis and CAPD patients ( 55.6 +/- 0.93 and 59.2 +/- 1.05 ) compared with that of control subjects ( 72 +/- 0.61 ; p < 0.05 ) . IMg2+ values correlated with TMg values in both hemodialysis ( r = 0.93 ; p < 0.0001 ) and CAPD ( r = 0.92 ; p < 0.0001 ) patients did not correlate with age , time on dialysis , weight , fasting cholesterol or triglyceride , albumin , blood urea nitrogen ( BUN ) , creatinine , hematocrit , phosphate , or PTH values . ( ABSTRACT TRUNCATED AT 250 WORDS )

Dialysate magnesium

Deficiency of serum ionized magnesium

IMg

greater or normal TMg values

Ionized calcium ( ICa2+ ) values

ICa2+/IMg2+ ratios

ionized ( % IMg2+ )

dialysis

hemodialysis

peritoneal dialysis ( CAPD )


Ovulation and follicular development associated with three low-dose oral contraceptives : a randomized controlled trial . OBJECTIVE To address the hypothesis that multiphasic oral contraceptives ( OCs ) increase rather than decrease the risk of functional ovarian cysts . METHODS In this single-center , randomized controlled study , women were assigned to a multiphasic pill , a lower-dose monophasic pill , a higher-dose monophasic pill , or nonsteroidal contraception . Forty volunteers were randomized ( ten each ) to three different pill regimens or to nonsteroidal contraception . During 6 months of treatment , follicular development was measured by vaginal ultrasonography and ovulation was indicated by serum progesterone levels . RESULTS The relative risk ( RR ) of developing a follicular structure greater than 30 mm in diameter during a cycle with the higher-dose monophasic pill was 0.5 ( 95 % confidence interval [ CI ] 0.1-1.9 ; P = .49 ) compared with the multiphasic pill . The risk with the lower-dose monophasic pill was comparable to that with the multiphasic pill ( RR 1.3 , 95 % CI 0.5-3.6 ; P = .56 ) . With the multiphasic pill , the maximum ovulation rate over 60 cycles was 1.7 per 100 cycles ( 95 % CI 0.0-8.9 ) . CONCLUSION This multiphasic pill more closely resembled the lower-dose monophasic pill than the higher-dose monophasic pill in its suppression of follicular development .

low-dose oral contraceptives

multiphasic oral contraceptives ( OCs )

multiphasic pill

a lower-dose monophasic pill

higher-dose monophasic pill

nonsteroidal contraception

three different pill regimens

nonsteroidal contraception

monophasic pill

monophasic pill

multiphasic pill

multiphasic pill

multiphasic pill

monophasic pill

monophasic pill

risk of functional ovarian cysts .

follicular development

ovulation

maximum ovulation rate

suppression of follicular development .


Noradrenergic response to intravenous yohimbine in patients with depression and comorbidity of depression and panic . Adrenergic response following infusions of yohimbine or normal saline was evaluated in 9 control subjects , 8 patients suffering from a major depressive episode ( MDE ) , and 12 patients suffering from concurrent MDE and panic disorder ( MDE + P ) . Blood was drawn at -20 , 0 , 5 , 10 , 20 , 45 , and 90 min following the infusions , and assayed for norepinephrine ( NE ) and 3-methoxy-4-hydroxy-phenyl glycol ( MHPG ) . Although the patient groups exhibited higher baseline NE concentrations , and a greater NE area under the plasma concentration versus time curve ( AUC0-90 ) during the yohimbine infusion , the differences were not statistically significant . Baseline NE was significantly correlated with the NE AUC0-90 in all three groups , suggesting that , although the NE system may be dysregulated in the MDE and MDE + P patients , the NE system still appears to respond somewhat predictably following a challenge , even though the actual magnitude of response may vary .

intravenous yohimbine

yohimbine

normal saline

yohimbine

Noradrenergic response

Adrenergic response

baseline NE concentrations

Baseline NE

NE AUC0-90

control subjects ,

major depressive episode ( MDE )


Comparison of tidal volumes obtained by one-handed and two-handed ventilation techniques . OBJECTIVES To compare tidal volumes delivered by one- vs two-handed compressions of a manual resuscitation bag and assess the effects of subject characteristics on those tidal volumes . DESIGN Subjects ( 108 healthcare providers from a 500-bed teaching hospital ) were assigned randomly to one of two procedures : one- followed by two-handed compression or two- followed by one-handed compression . A 1-liter resuscitation bag , lung performance analyzer and Wright spirometer were used to measure tidal volume . Data collection occurred in a simulated situation . RESULTS There was a significant difference in tidal volume delivered by one-handed ( mean = 694 mL , SD = 111 ) vs two-handed compressions ( mean = 827 mL , SD = 113 ) . Hand size , grip strength , height and weight were correlated with tidal volumes generated by one-handed and two-handed procedures . No other subject characteristics were correlated with tidal volumes . CONCLUSIONS Tidal volumes delivered by healthcare providers using one- vs two-handed compressions were found to be significantly different , with those delivered by two hands significantly greater than those delivered by one hand . Strength of hand grip was the best predictor of volume delivered and was more strongly correlated with volumes delivered by one rather than two hands .

one-handed

two-handed compressions

one-handed

two-handed

one-

vs

two-handed compressions

two hands

one hand .

one

two hands .

tidal volume

tidal volumes

tidal volumes .

Tidal volumes

one-handed

two-handed ventilation techniques

simulated


[ Opiate hypothesis in infantile autism ? Therapeutic trials with naltrexone ] . The opioid hypothesis suggests that childhood autism may result from excessive brain opioid activity during neonatal period which may constitutionally inhibit social motivation , yielding autistic isolation and aloofness ( Panksepp , 1979 ) . This hypothesis has now received strong support and is currently based on three types of arguments : ( 1 ) similarity between autistic symptomatology and abnormal behaviors induced in young animals by injections of exogenous opioids , such as increasing social aloofness and decreasing social vocalization ; ( 2 ) direct biochemical evidence of abnormalities of peripheral endogenous opioids being reported in autism and ( 3 ) therapeutic effects of the long lasting opioid receptor blocking agent naltrexone in autism . In this article , we give description of open and double-blind studies of naltrexone in autism . Naltrexone has been tested in several open studies . We performed an open trial with naltrexone in 2 autistic girls , displaying serious self-injurious behavior , reduced crying and a marked preference for salty and spicy foods , symptoms that could be related to a dysfunction of the opioid system . With dosages of 1 mg/kg/day , we observed an immediate reduction of hyperactivity , self-injurious behavior and aggressiveness , while attention improved . In addition , social behaviors , smiling , social seeking behaviors and play interactions increased ( Leboyer , Bouvard et Dugas , 1988 ) . Campbell et al . ( 1988 ) has also reported a tranquilizing and a stimulating effect in 6 out of 8 children with autism . We did confirm these preliminary results in a double-blind study performed on 4 children with autism . In a cross-over double-blind study , three dosages of naltrexone ( 0.5 , 1 and 2 mg/kg/day ) and placebo were compared . ( ABSTRACT TRUNCATED AT 250 WORDS )

naltrexone ]

naltrexone

Naltrexone

naltrexone

tranquilizing and a stimulating effect

infantile autism

autistic

girls

reduced crying

children


Enoxaparin in the prevention of deep venous thrombosis after major surgery : multicentric study . The Italian Study Group . DVT is a very frequent complication of general surgery . Heparin and , more recently , LMWHs can successfully prevent post surgical thromboembolism . One thousand one hundred and twenty-two patients ( 533 males and 589 females ; mean age 62.2 +/- 11.4 yrs ) were enrolled in a multicentre controlled study , to evaluate the efficacy and safety of enoxaparin in comparison to calcium heparin in the prevention of deep venous thrombosis ( DVT ) following general surgery . Patients assigned to the enoxaparin and the calcium heparin groups received 1 daily dose of 20 mg ( 2000 I.U . ) and 2 daily doses of 0.2 ml ( 5000 I.U . ) , respectively starting 2 hours before the operation . Both drugs were given by subcutaneous route . A Doppler or Duplex Scan diagnosis of DVT was made in 3 ( 0.5 % ) patients in the enoxaparin group ( 2 cases during treatment and 1 patient at the end of treatment ) and in 6 ( 1.1 % ) patients in the calcium heparin group ( 5 cases during treatment and 1 , bilateral , after the end of treatment ) . Pulmonary embolism ( PE ) was ascertained by angiography in 1 patient ( 0.18 % ) in the enoxaparin group and in 2 patients ( 0.36 % ) in the calcium heparin one . Hemorrhagic complications occurred in 29 patients ( 5.2 % ) in the enoxaparin group and in 34 ( 6.1 % ) in the calcium heparin group . Haematomas located in the injection site were reported in 16.1 % and 25.3 % in the enoxaparin and calcium heparin groups respectively ( p = 0.0001 ) . Local pain in the injection site at the 5th day of treatment was reported in 8.4 % and 16.6 % in the enoxaparin and calcium heparin groups respectively ( p = 0.0001 ) . ( ABSTRACT TRUNCATED AT 250 WORDS )

Enoxaparin

LMWHs

enoxaparin

calcium heparin

enoxaparin

calcium heparin

enoxaparin

calcium heparin

enoxaparin

calcium heparin

enoxaparin

calcium heparin

enoxaparin

calcium heparin

venous thrombosis

DVT

post surgical thromboembolism .

deep venous thrombosis ( DVT )

DVT

Pulmonary embolism ( PE )

Hemorrhagic complications

Haematomas

major surgery

mean age 62.2 +/- 11.4 yrs