[ Plasma separation combined with CVVHF in septic and SIRS patients ] . In a prospective non-randomized trial , 59 patients with sepsis ( n = 43 ) and SIRS ( n = 16 ) were treated on a surgical intensive care unit . In 22 patients plasmapheresis in combination with continuous venovenous hemofiltration ( CVVHF ) was administered . Lethality was 56 % in the sepsis group ; in the therapy group lethality was significantly lower in patients with plasmapheresis , even though in this population the organic failure rate was higher . Finally the dependency of lethality and age was similar in both groups . Lethality at 22 % in the plasmapheresis group with double organ failure was significantly lower ( P > 0.01 ) than in controls . Reduction of lethality seemed to be as high as 18 % in patients with sepsis , while patients with SIRS did not profit from the additional therapy . A prospective randomized trial in sepsis and double organic failure should be projected .

Plasma separation

CVVHF

plasmapheresis

Lethality

was

56 %

in the sepsis group

lethality

Lethality

at

22 %

in the plasmapheresis group

septic and SIRS

sepsis

SIRS


[ Intra-arterial ( 5-FU/FA and FUDR ) versus systemic chemotherapy ( 5-FU/FA ) of non-resectable colorectal liver metastases ] . The relative efficacy of HAI FUDR , HAI 5-FU/FA , and i.v . 5-FU/FA chemotherapy for the treatment of unresectable colorectal liver metastases was compared in a prospective randomized clinical trial . The response rate after HAI treatment was significantly higher as compared to i.v . treatment with no statistical benefit regarding survival and time to progression . HAI FUDR treatment was inferior as compared to HAI or i.v . 5-FU/FA . i.v . 5-FU/FA-therapy is therefore the method of choice outside clinical trials .

Intra-arterial ( 5-FU/FA

and

FUDR

systemic chemotherapy ( 5-FU/FA )

HAI FUDR

HAI 5-FU/FA

, and

i.v . 5-FU/FA chemotherapy

HAI

HAI FUDR

HAI

5-FU/FA .

relative efficacy

response rate

survival

time to progression

inferior


Videotaped training in alcohol counseling for obstetric care practitioners : a randomized controlled trial . OBJECTIVE To determine the feasibility of videotaped training for obstetric care practitioners in motivational interviewing skills that could be used in brief patient consultations on problem drinking . METHODS Thirty health care practitioners participated in a clinical trial using a 20-minute videotape to instruct them in motivational interviewing . Participants engaged in a pretest roleplay with an actress playing a drinking pregnant woman . Those randomly assigned to the experimental condition watched the motivational interviewing videotape . Control condition participants watched a 20-minute docudrama of a pregnant problem drinker . Both groups then engaged in a post-test roleplay similar to the pretest . Behavioral ratings of the roleplays and participant evaluations of the motivational interviewing video constituted the outcome measures . RESULTS Participant evaluations indicated that the training video was clear in explaining and demonstrating the principles and skills of motivational interviewing . Change in behavioral ratings from pretest to post-test showed significant differences in motivational interviewing skills between the experimental and control groups . Obstetric care practitioners who viewed the training video were rated as showing greater empathy , minimizing patient defensiveness , and supporting women 's beliefs in their ability to change . CONCLUSION Obstetric care practitioners can improve their alcohol intervention skills through the use of a 20-minute videotaped instruction in motivational interviewing . Clinicians who improve their skills in motivational interviewing can intervene more effectively with their drinking pregnant patients . Using motivational interviewing with this population holds promise for helping prevent alcohol-related health problems .

20-minute videotape

motivational interviewing videotape

Control

20-minute docudrama

training video

motivational interviewing

Behavioral ratings of the roleplays

empathy

patient defensiveness

obstetric care practitioners :

obstetric care practitioners


Erythropoiesis after therapy with recombinant human erythropoietin : a dose-response study in anemic cancer surgery patients . BACKGROUND AND OBJECTIVES Preoperative treatment with 600 U/kg of recombinant human erythropoietin ( r-HuEPO ) effectively increases erythropoiesis in cancer patients . The aim of this study was to evaluate the erythropoietic response after different doses of r-HuEPO in order to find the minimum effective dose . MATERIALS AND METHODS Twenty anemic sideropenic patients ( hemoglobin < /=110 g/l ; serum iron < 600 microg/l ) with cancer of the gastrointestinal tract were randomly allocated to two groups : the first ( n = 10 ) received 400 U/kg of r-Hu EPO divided in 4 doses ( 100 U/kg each , every 4 days ) ; the second ( n = 10 ) received 200 U/kg of r-HuEPO ( 50 U/kg each , every 4 days ) . Both groups were given intravenous iron gluconate ( 125 mg ) every day for 15 days . RESULTS After treatment , the serum iron level significantly rose in both groups . The production of new red blood cells was 176.3+/-90.8 ml in the 200 U/kg group and 268.4+/-79.4 ml in the 400 U/kg group ( p = 0.036 ) . The increase of hemoglobin was significantly higher in the 400 U/kg group ( 22.3+/-2.0 g/l ) than in the 200 U/kg group ( 14.1+/-2.7 g/l ) ( p = 0.017 ) . CONCLUSION The r-HuEPO dose of 400 U/kg appears significantly more effective than the 200 U/kg to stimulate erythropoiesis in anemic sideropenic cancer patients .

recombinant human erythropoietin

r-HuEPO

400 U/kg of r-Hu EPO divided in 4 doses

received 200 U/kg of r-HuEPO

intravenous iron gluconate

erythropoiesis

erythropoietic response

serum iron level significantly rose

new red blood cells

increase of hemoglobin

effective

anemic cancer surgery patients

Twenty


The influence of ventricular fibrillation duration on defibrillation efficacy using biphasic waveforms in humans . OBJECTIVES The purpose of this study was to prospectively investigate the influence of ventricular fibrillation ( VF ) durations of 5 , 10 and 20 s on the defibrillation threshold ( DFT ) during implantable cardioverter-defibrillator ( ICD ) implantation . BACKGROUND Although the DFT using monophasic waveforms has been shown to increase with VF duration in humans , the effect of VF duration on defibrillation efficacy using biphasic waveforms in humans is not known . METHODS Thirty patients undergoing primary ICD implantation or pulse generator replacement were randomly assigned to have the DFT determined using biphasic shocks at two durations of VF each ( 5 and 10 s , 10 and 20 s or 5 and 20 s ) . RESULTS There was no statistically significant difference in the mean DFT comparing VF durations of 5 s ( 9.5+/-6.0 J ) and 10 s ( 10.8+/-7.0 J ) ( p=0.4 ) . The mean DFT significantly increased from 10.9+/-6.1 J at 10 s of VF to 12.6+/-5.6 J ( p=0.03 ) at 20 s of VF , and from 7.0+/-3.5 J at 5 s of VF to 10.5+/-6.3 J ( p=0.04 ) at 20 s of VF . An increase in the DFT was observed in 14 patients as VF duration increased . There were no clinical characteristics that differentiated patients with and without an increase in the DFT . CONCLUSIONS Defibrillation efficacy decreases with increasing VF duration using biphasic waveforms in humans . Ventricular fibrillation durations greater than 10 s may negatively affect the effectiveness of ICD therapy .

DFT determined using biphasic shocks

defibrillation efficacy

defibrillation threshold ( DFT )

DFT using monophasic waveforms

mean DFT

DFT

DFT

DFT

Defibrillation efficacy

effectiveness of ICD therapy

Thirty


Morphological onset and early diagnosis in apical hypertrophic cardiomyopathy : a long term analysis with nuclear magnetic resonance imaging . OBJECTIVES A long-term follow-up study with nuclear magnetic resonance ( NMR ) imaging was undertaken to detect the morphological onset and to establish the early diagnosis in apical hypertrophic cardiomyopathy ( HCM ) . BACKGROUND A spadelike configuration on left ventriculogram ( LVG ) is regarded as a diagnostic criterion for the classical apical HCM . There also exists a segmented hypertrophy at the apical level without indicating the spadelike features ( a nonspade configuration ) . To detect the hypertrophied myocardium of the nonspade configuration , circumferential scrutiny of the apex is required . Although both configurations can be underlying causes of giant negative T waves , etiological relationship between the two is not clarified . METHODS The criteria for the spadelike configuration defined on left ventricular short-axis NMR images were as follows : ( apical maximal thickness > or = 15 mm ) , ( apical anterior thickness over basal anterior thickness > or = 1.3 ) and ( apical posterior thickness over basal posterior thickness > or =1.3 ) . Thirteen patients who had predominant hypertrophy ( > or = 15 mm ) at the apical level without the spadelike configuration underwent NMR imaging twice before and after 54+/-10 months ' follow-up . RESULTS Apical hypertrophy that had been confined to the lateral wall in four , the anterior-lateral wall in two , and the septal-anterior wall in one developed to become circumferential hypertrophy that fulfilled the criteria for the spadelike configuration after the follow-up period . CONCLUSIONS The spadelike configuration can begin with the nonspade configuration and therefore , both can constitute a single disease entity of apical HCM . The early diagnosis of apical HCM can be achieved by identifying the hypertrophy frequently confined to the lateral wall at the apical level .

nuclear magnetic resonance imaging

NMR images

left ventriculogram ( LVG )

Apical hypertrophy

circumferential hypertrophy

apical HCM

hypertrophy

apical hypertrophic cardiomyopathy :


Active specific immunotherapy for stage II and stage III human colon cancer : a randomised trial . BACKGROUND Colon cancer is curable by surgery , but cure rate depends on the extent of disease . We investigated whether adjuvant active specific immunotherapy ( ASI ) with an autologous tumour cell-BCG vaccine with surgical resection was more beneficial than resection alone in stage II and III colon cancer . METHODS In a prospective randomised trial , 254 patients with colon cancer were randomly assigned postoperative ASI or no adjuvant treatment . ASI was three weekly vaccinations starting 4 weeks after surgery , with a booster vaccination at 6 months with 10 ( 7 ) irradiated autologous tumour cells . The first vaccinations contained 10 ( 7 ) BCG organisms . We followed up patients for time to recurrence , and recurrence-free and overall survival . Analysis was by intention to treat . FINDINGS The 5.3 year median follow-up ( range 8 months to 8 years 11 months ) showed 44 % ( 95 % CI 7-66 ) risk reduction for recurrence in the recurrence-free period in all patients receiving ASI ( p=0.023 ) . Overall , there were 40 recurrences in the control group and 25 in the ASI group . Analysis by stage showed no significant benefit of ASI in stage III disease . The major impact of ASI was seen in patients with stage II disease , with a significantly longer recurrence-free period ( p=0.011 ) and 61 % ( 18-81 ) risk reduction for recurrences . Recurrence-free survival was significantly longer with ASI ( 42 % risk reduction for recurrence or death [ 0-68 ] , p=0.032 ) and there was a trend towards improved overall survival . INTERPRETATION ASI gave significant clinical benefit in surgically resected patients with stage II colon cancer . ASI has minimal adverse reactions and should be considered in the management of stage II colon cancer .

Active specific immunotherapy

active specific immunotherapy

postoperative ASI

no adjuvant treatment

autologous tumour cells

ASI

ASI

recurrence-free period

risk reduction for recurrences

Recurrence-free survival

overall survival


A randomized , double-masked , placebo-controlled parallel study of loteprednol etabonate 0.2 % in patients with seasonal allergic conjunctivitis . OBJECTIVE To evaluate the effects of loteprednol etabonate ( LE ) 0.2 % in reducing the signs and symptoms of seasonal allergic conjunctivitis . DESIGN Randomized , double-masked , placebo-controlled , parallel group multicenter study of 6 weeks duration . PARTICIPANTS A total of 135 patients with signs and symptoms of seasonal allergic conjunctivitis participated . INTERVENTION All patients received either LE 0.2 % or placebo ( vehicle ) four times a day in both eyes for 42 days . MAIN OUTCOME MEASURES Bulbar conjunctival injection ( primary sign ) and itching ( primary symptom ) over the first 2 weeks of treatment was measured . RESULTS A reduction in severity was seen in both LE and placebo groups for bulbar conjunctival injection ( 1.5 vs. 1.0 units on a 0-3 scale ) and itching ( 3.4 vs. 3.0 units on a 0-4 scale ) over the first 2 weeks . The treatment effect by these measures was -0.5 and -0.4 units in favor of LE ( P < or = 0.008 ) . Resolution ( i.e. , the proportion of patients with signs or symptoms no longer present ) at day 14 strongly favored LE-treated patients ( 36 % and 15 % ; 58 % and 38 % , for injection and itching , respectively ) . Both treatments were well tolerated . One patient in each treatment group ( 1 of 67 and 1 of 68 , respectively ) had an elevation of intraocular pressure of 10 mmHg or greater during the 6 weeks of treatment . CONCLUSIONS Loteprednol etabonate 0.2 % was more effective than placebo in the treatment of seasonal allergic conjunctivitis . Loteprednol etabonate 0.2 % had a safety profile comparable to placebo .

loteprednol etabonate

loteprednol etabonate ( LE )

placebo-controlled

LE 0.2 %

placebo

seasonal allergic conjunctivitis .

reduction in severity

bulbar conjunctival injection

tolerated

elevation of intraocular pressure

seasonal allergic conjunctivitis

seasonal allergic conjunctivitis


Adequacy of vitamin B6 supplementation during pregnancy : a prospective study . This prospective study assesses the effect of 2.5 , 4 , and 10 mg of pyridoxine supplementation during pregnancy on maternal and fetal plasma levels of pyridoxal 5'-phosphate ( PLP ) and on the degree of coenzyme saturation ( activation factor ) of aspartate aminotransferase and alanine aminotransferase ( alphaEGOT and alphaEGPT ) in maternal erythrocytes . More than 4 mg of pyridoxine supplementation daily was required for most pregnancies to maintain maternal plasma PLP levels within the range observed during the first trimester and in the nonpregnant state . The plasma PLP concentrations in maternal and cord blood were highly correlated and indicated a dependence of fetal vitamin B6 nutrition on maternal circulating PLP . Measurements of alphaEGOT and alphaEGPT were not as reproducible as plasma PLP assays and were less sensitive and quantitative indicators . In the majority of subjects , the changes in alphaEGOT and alphaEGPT with time correlated poorly with the changes in plasma PLP . However , when the data were analyzed without regard for their dependence on time , they demonstrated a negative , linear correlation between alphaEGOT and log plasma PLP and between alphaEGPT and log plasma PLP for the group on 2.5 mg of pyridoxine and for all the subjects combined . Finally , the dietary records showed that most of the subjects consumed less than 2 mg of vitamin B6 daily from their food . The results indicate that the current Recommended Dietary Allowance for vitamin B6 during pregnancy ( 2.5 mg ) is too low and that supplementation of this vitamin in an amount more than 4 mg daily is recommended .

vitamin B6 supplementation

pyridoxine supplementation

pyridoxine

vitamin B6

vitamin B6

maternal plasma PLP levels

Measurements of alphaEGOT and alphaEGPT

plasma PLP assays

changes in alphaEGOT and alphaEGPT

plasma PLP

alphaEGOT

plasma PLP

alphaEGPT

log plasma PLP

pregnancy

pregnancy


[ The efficacy of psychotherapy with biofeedback in the rehabilitation of hypertension patients ] . 85 females with borderline mental disorders in essential hypertension were followed up for a month and 6 months after the treatment ( hypotensive drugs + psychotherapy with biofeedback or hypotensive drugs only -- 45 patients and 40 controls , respectively ) . The addition of psychotherapy to hypotensive drugs contributed to a higher hypotensive effect , long-term improvement of psychic condition , more active attitude to the treatment process and psychic adaptation . Better quality of life was achieved .

psychotherapy with biofeedback

-- 45

controls

higher hypotensive effect

psychic adaptation

Better quality of life

hypertension

females

borderline mental disorders

essential hypertension


Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes : randomised trial . BACKGROUND Groin pain is common among athletes . A major cause of long-standing problems is adductor-related groin pain . The purpose of this randomised clinical trial was to compare an active training programme ( AT ) with a physiotherapy treatment without active training ( PT ) in the treatment of adductor-related groin pain in athletes . METHODS 68 athletes with long-standing ( median 40 weeks ) adductor-related groin pain -- after examination according to a standardised protocol -- were randomly assigned to AT or PT . The treatment period was 8-12 weeks . 4 months after the end of treatment a standardised examination was done . The examining physician was unaware of the treatment allocation . The ultimate outcome measure was full return to sports at the same level without groin pain . Analyses were by intention to treat . FINDINGS 23 patients in the AT group and four in the PT group returned to sports without groin pain ( odds ratio , multiple-logistic-regression analysis , 12.7 [ 95 % CI 3.4-47.2 ] ) . The subjective global assessments of the effect of the treatments showed a significant ( p=0.006 ) linear trend towards a better effect in the AT group . A per-protocol analysis did not show appreciably different results . INTERPRETATION AT with a programme aimed at improving strength and coordination of the muscles acting on the pelvis , in particular the adductor muscles , is very effective in the treatment of athletes with long-standing adductor-related groin pain . The potential preventive value of a short programme based upon the principles of AT should be assessed in future , randomised , clinical trials .

active physical training

active training programme ( AT )

AT

PT

groin pain

adductor-related groin pain

athletes

adductor-related groin pain

adductor-related groin pain

athletes

adductor-related groin pain