A prospective randomized trial of Duraflo II heparin-coated circuits in cardiac reoperations . BACKGROUND Heparin-coated circuits in cardiopulmonary bypass have been shown to decrease the systemic inflammatory responses associated with cardiopulmonary bypass . Previous clinical studies on low-risk patients who had coronary artery bypass grafting ( CABG ) and received full-dose systemic heparin did not have clearly improved clinical outcomes . We hypothesized that the beneficial effects of heparin-coated circuits might be seen in patients who had cardiac reoperations . METHODS Three hundred fifty patients who had reoperation with CABG only ( 58 % ) , or with valve operations ( 42 % ) were randomly assigned to receive either a heparin-coated ( Duraflo II ; study group ) or uncoated ( control group ) circuit . Clinical outcomes were compared and the variables were analyzed using the following three groups : entire populations of study group and control group , subgroup of patients who had CABG reoperation only , and a subgroup who had valve reoperation or combined valve and CABG reoperation . RESULTS Preoperative variables were the same in both groups . No difference in clinical outcomes could be demonstrated except that the percentage of patients with major bleeding episodes was significantly lower in the study group ( 1.2 % versus 5.4 % , p = 0.035 ) . In the subgroup analysis of patients who had valve reoperations , lower blood transfusion requirements in the intensive care unit ( p = 0.013 ) were found in the study group . When the subgroup of patients who had CABG reoperations was analyzed separately , there was a trend toward less reoperation for bleeding in the study group ( 0 % versus 4.0 % , p = 0.058 ) . CONCLUSIONS We conclude that the use of heparin-coated circuits was safe and imparted protection from reoperations for bleeding and major bleeding episodes . Material-independent blood activation ( eg , blood-air interface and cardiotomy suction ) blunted the total effect of the heparin-coated surface .

Duraflo II heparin-coated circuits

Heparin-coated circuits

heparin

heparin-coated circuits

heparin-coated ( Duraflo II

uncoated

valve reoperations

blood transfusion requirements

reoperation for bleeding

cardiac reoperations .

Three hundred fifty

subgroup

study group


Event-related potential indices of auditory selective attention in dependent amphetamine users . BACKGROUND The aim of the present study was to further investigate a previously reported attention-related impairment in dependent amphetamine users using event-related potential ( ERP ) indices of selective attention . METHODS ERPs were recorded during an auditory selective attention task ( SAT ) that involved detecting infrequent long-duration target tones presented among short-duration tones that varied in location ( left vs. right ear ) and pitch ( low vs. high ) . Amphetamine users ( n = 19 ) were divided into two groups , high dependence ( n = 10 ) and low dependence ( n = 10 ) , based on amphetamine Severity of Dependence Scale scores , and compared to an age-matched control group ( n = 9 ) . RESULTS The high-dependence group showed slowed reaction time and reduced early processing negativity and peak N1 amplitude to location-relevant nontarget stimuli . Poor performance on the SAT was highly correlated with deficits in early processing , which were also related to poor performance on the Wechsler Memory Scale Attention/Concentration index . CONCLUSIONS It is suggested that severely dependent users suffer an inability to selectively enhance the sensory processing of relevant auditory information . This may produce poor automatic preferential processing of relevant information and increase load on limited attentional resources .

event-related potential ( ERP ) indices

slowed reaction time

reduced early processing negativity

peak N1 amplitude

dependent amphetamine

dependent amphetamine


A randomized phase II trial of 5-fluorouracil , with or without human interferon-beta , for advanced colorectal cancer . This study compared the efficacy and safety of 5-fluorouracil ( 5-FU ) monotherapy to that of 5-FU combined with natural human interferon-beta ( IFN-beta ) in patients with unresectable , advanced colorectal carcinoma . Forty-nine chemotherapy-naive patients were randomized to 5-FU alone or to the combination . All patients received 750 mg m ( -2 ) day ( -1 ) 5-FU for 5 days by continuous intravenous ( i.v . ) infusion , followed after day 15 by a weekly i.v . bolus of 750 mg m ( -2 ) . IFN-beta was injected intramuscularly three times weekly at 9 M IU . Treatment continued for 52 weeks , or until disease progression or intolerable toxicity . Clinical endpoints were tumor response , time to progression , survival and toxicity . The addition of IFN-3 to 5-FU significantly improved response rate ( 33.3 % vs 4.5 % for evaluable patients ; P = 0.021 ) , time to progression ( median 7.2 vs 4.2 months ; P = 0.0435 ) , and survival time ( median 15.9 vs 7.2 months ; P = 0.038 ) without significantly increasing toxicity compared to 5-FU alone . Cumulative 5-FU dose was higher with combined therapy ( P < 0.001 ) : more patients receiving monotherapy discontinued treatment because of disease progression . Fever was more frequent with combined therapy ( P = 0.008 ) ; there were no other differences in toxicity . The only grade IV toxicity observed was neutropenia ( two patients per group ) . A randomized phase III trial has been initiated to confirm the synergy between 5-FU and IFN-beta .

human interferon-beta

5-fluorouracil ( 5-FU ) monotherapy

IFN-beta

IFN-3 to 5-FU

IFN-beta

efficacy and safety

disease progression

intolerable toxicity

tumor response

time to progression

survival and toxicity

improved response rate

time to progression

survival time

toxicity

Cumulative 5-FU dose

disease progression

Fever

toxicity

grade IV toxicity

advanced colorectal cancer

advanced colorectal carcinoma

Forty-nine

chemotherapy-naive


Effects of pyridostigmine and naloxone on the abnormal TSH response to TRH during starvation in humans . BACKGROUND Starvation is associated with a blunted TSH response to thyrotropin-releasing hormone ( TRH ) ( peak minus baseline < 5 mIU/L ) , despite basal TSH and thyroid hormone levels within the normal range . In light of the inhibitory effect of somatostatin on TSH secretion , we examined whether this condition is caused by an increased hypothalamic somatostatinergic tone in starving subjects . The possible involvement of endogenous opioids in the mechanism underlying the abnormal TSH response to TRH was also evaluated . METHODS The TSH response to TRH ( 25 micrograms in an intravenous bolus ) , serum total and free T4 and T3 levels , and 24-hour urinary-free cortisol levels were measured in 28 normal men ( age 27-35 years ) within 10 % of their ideal body weight . They were randomly divided into 4 groups of 7 . In 21 subjects ( groups 1 , 2 , and 3 ) , TRH tests were performed after an overnight ( 8 hours ) fast , placebo administrations ( control test ) , and after prolonged ( 56 hours ) starvation . TRH tests after prolonged starvation were performed either after placebos ( in all subjects ) or the administration of pyridostigmine ( 180 mg orally ) ( in 7 subjects , group 1 ) ; naloxone ( 0.8 mg in an i.v . bolus injection ) ( in 7 subjects , group 2 ) ; or the combination of pyridostigmine and naloxone ( in 7 subjects , group 3 ) . The remaining 7 subjects ( group 4 ) were tested at weekly intervals with TRH plus placebo , TRH plus naloxone , TRH plus pyridostigmine , and TRH plus naloxone plus pyridostigmine after a fasting period of 8 hours . RESULTS In all subjects of groups 1 , 2 , and 3 , TRH-induced TSH rise was significantly lower after prolonged starvation than after overnight fast . Neither pyridostigmine nor naloxone , given alone , changed the basal levels of TSH and the TSH response to TRH after prolonged starvation . In contrast , the concomitant administration of naloxone and pyridostigmine significantly enhanced the TRH-induced TSH rise . After overnight fasting , naloxone administration in group 4 subjects did not change the TSH response to TRH , whereas pyridostigmine significantly enhanced the TSH response to TRH . When naloxone was given together with pyridostigmine and TRH the TSH response was similar to that observed in the TRH plus pyridostigmine test . CONCLUSIONS These data indicate that naloxone-sensitive endogenous opioids exert an inhibitory effect on the cholinergic stimulatory control of TSH secretion during prolonged starvation . This suggests that an enhanced hypothalamic somatostatinergic activity is involved in the mechanism underlying the reduced TSH response to TRH .

pyridostigmine

naloxone

TRH

placebo

placebos

pyridostigmine

naloxone

pyridostigmine and naloxone

TRH

placebo

TRH plus naloxone

TRH plus pyridostigmine

TRH

naloxone

pyridostigmine

pyridostigmine

naloxone

pyridostigmine

TRH

blunted TSH response

thyrotropin-releasing hormone ( TRH )

hypothalamic somatostatinergic tone

abnormal TSH response to TRH

TSH response to TRH

serum total and free T4 and T3 levels

24-hour urinary-free cortisol levels

TRH tests after prolonged starvation

TRH-induced TSH rise

basal levels of TSH

during starvation in humans .

starving subjects

normal

age 27-35 years


Effects of a videotape information intervention at discharge on diet and exercise compliance after coronary bypass surgery . BACKGROUND This study evaluated the relative effects on compliance with recommended lifestyle changes of two experimental videotapes that involved different approaches for preparing coronary artery bypass graft ( CABG ) patients for the posthospital recovery period . The tapes differed in the extent to which they portrayed the recovery period as a steady , forward progression versus a series of " ups and downs . " METHODS Two hundred sixteen male and female CABG patients were assigned randomly either to view one of the two videotapes before discharge from the hospital or to receive only the standard discharge preparation provided by the hospital . All patients completed measures of anxiety and self-efficacy at discharge , 1 month and 3 months after discharge from the hospital . Patients also completed measures of dietary fat consumption and activity level 1 and 3 months after discharge . RESULTS Relative to controls , patients who viewed either of the videotapes before hospital release reported higher self-efficacy for adhering to the recommended low-fat diet both at discharge and 1 month after surgery . Viewing either of the videotapes also resulted in significantly less dietary fat intake 1 month after hospital release compared with controls . Patients who viewed the tape that portrayed the recovery period as consisting of ups and downs also reported significantly more frequent moderate exercise at 1 month and more frequent strenuous exercise 3 months after discharge . CONCLUSIONS The experimental videotapes proved to be an effective method for increasing dietary and exercise compliance during the first 3 months after CABG .

videotape information intervention

experimental videotapes

videotapes

videotapes

measures of anxiety and self-efficacy

dietary fat consumption

activity level 1 and 3

moderate exercise at 1 month

strenuous exercise

dietary and exercise compliance

Two hundred sixteen

male

female


Emerging treatment of acute coronary syndromes with platelet glycoprotein IIB/IIIA inhibitors .

acute coronary syndromes


Primary capsulectomy , anterior vitrectomy , lensectomy , and posterior chamber lens implantation in children : limbal versus pars plana . PURPOSE To compare the results of a limbal versus a pars plana approach for primary posterior capsulectomy and anterior vitrectomy in the management of childhood cataract . SETTING Department of Ophthalmology , Labbafinejad Medical Center , Tehran , Iran . METHODS A randomized , controlled , double-masked clinical trial of 45 eyes was conducted . After being matched , 38 eyes were included in the study and were divided into 2 equal groups for data analysis . All eyes had lensectomy and posterior chamber intraocular lens ( PC IOL ) implantation . Primary posterior capsulectomy and anterior vitrectomy were performed through the limbus in half of the eyes and the pars plana in the other half . Main outcome measures included visual acuity , estimated red reflex , postsurgical inflammatory reaction , corneal clarity , posterior synechias , iris capture , IOL position , capsulectomy size , glaucoma , cystoid macular edema , retinal tear , and postoperative refraction . RESULTS No statistically significant differences were found between the 2 approaches in the outcome measures . CONCLUSION The anatomic and visual results were encouraging when posterior capsulectomy and anterior vitrectomy , using a limbal or pars plana approach , were combined with lensectomy and PC IOL implantation in children . The application of these techniques depends on surgeon experience and skill .

primary posterior capsulectomy

anterior vitrectomy

lensectomy

Primary posterior capsulectomy

anterior vitrectomy

posterior capsulectomy

anterior vitrectomy

lensectomy and PC IOL implantation

childhood cataract

children

childhood

cataract

children


Vitamin A supplementation for extremely-low-birth-weight infants . National Institute of Child Health and Human Development Neonatal Research Network . BACKGROUND Vitamin A supplementation may reduce the risk of chronic lung disease and sepsis in extremely-low-birth-weight infants . The results of our pilot study suggested that a dose of 5000 IU administered intramuscularly three times per week for four weeks was more effective than the lower doses given in past trials . METHODS We performed a multicenter , blinded , randomized trial to assess the effectiveness and safety of this regimen as compared with sham treatment in 807 infants in need of respiratory support 24 hours after birth . The mean birth weight was 770 g in the vitamin A group and 769 g in the control group , and the respective gestational ages were 26.8 and 26.7 weeks . RESULTS By 36 weeks ' postmenstrual age , 59 of the 405 infants ( 15 percent ) in the vitamin A group and 55 of the 402 infants ( 14 percent ) in the control group had died . The primary outcome - death or chronic lung disease at 36 weeks ' postmenstrual age - occurred in significantly fewer infants in the vitamin A group than in the control group ( 55 percent vs. 62 percent ; relative risk , 0.89 ; 95 percent confidence interval , 0.80 to 0.99 ) . Overall , 1 additional infant survived without chronic lung disease for every 14 to 15 infants who received vitamin A supplements . The proportions of infants in the vitamin A group and the control group who had signs of potential vitamin A toxicity were similar . The proportion of infants with serum retinol values below 20 microg per deciliter ( 0.70 micromol per liter ) was lower in the vitamin A group than in the control group ( 25 percent vs. 54 percent , P < 0.001 ) . CONCLUSIONS Intramuscular administration of 5000 IU of vitamin A three times per week for four weeks reduced biochemical evidence of vitamin A deficiency and slightly decreased the risk of chronic lung disease in extremely-low-birth-weight infants .

Vitamin A supplementation

Vitamin A supplementation

sham treatment

vitamin A

control group

effectiveness and safety

birth weight

death

chronic lung disease

potential vitamin A toxicity

extremely-low-birth-weight

infants


Inflammatory response in humans exposed to 2.0 ppm nitrogen dioxide . Nitrogen dioxide ( NO2 ) is a common indoor air pollutant , especially in homes with unvented combustion appliances . Epidemiological studies suggest that children living in homes with unvented heating sources are more prone to respiratory infections than children living in homes with lower levels of NO2 . However , experimental studies in which human volunteers were exposed acutely to moderate levels of NO2 ( 0.5-2.0 ppm ) have shown little evidence of lung inflammation or decreased host resistance capacity . In the study reported here , 8 healthy volunteers were exposed to 2.0 ppm NO2 and to filtered air for 4 h while undergoing intermittent moderate exercise . Bronchoalveolar lavage was performed the following morning . The lavage was divided into a predominantly bronchial washing ( first 20 ml of lavage ; BL ) and a predominantly alveolar washing ( BAL ) . In the BL , NO2 exposure caused increases in polymorphonuclear neutrophils ( PMNs ) , interleukin 6 ( IL-6 ) , IL-8 , alpha1-antitrypsin , and tissue plasminogen activator , and decreases in epithelial cells . In the BAL , there were no NO2-induced changes in either cell numbers or soluble mediators . On the other hand , alveolar macrophages from BAL showed a decrease in the ability to phagocytose unopsonized Candida albicans and a decrease in superoxide production . No difference in susceptibility to virus infection was found between the NO2- and air-exposed macrophages . No changes in lung function were observed , but the aerosol bolus recovery technique revealed a statistically significant ( p < .05 ) decrease in the fraction of aerosol recovered following nitrogen dioxide exposure , which is suggestive of small obstructive changes induced by NO2 .

nitrogen dioxide

Nitrogen dioxide ( NO2 )

filtered air

Bronchoalveolar lavage

nitrogen dioxide

NO2 exposure

epithelial cells .

cell numbers or soluble mediators .

superoxide production .

susceptibility to virus infection

exposed to 2.0 ppm nitrogen dioxide

intermittent moderate exercise


Cycle control with oral contraceptives containing 20 micrograms of ethinyl estradiol . A multicenter , randomized comparison of levonorgestrel/ethinyl estradiol ( 100 micrograms/20 micrograms ) and norethindrone/ethinyl estradiol ( 1000 micrograms/20 micrograms ) . A randomized , open-label , multicenter study was undertaken to compare the effects of oral contraceptives ( OC ) containing 100 micrograms levonorgestrel ( LNG ) /20 micrograms ethinyl estradiol ( EE ) ( Aless/Loette ) and 1000 micrograms norethindrone acetate ( NETA ) /20 micrograms EE ( Loestrin Fe 1/20 ) on menstrual cycle control over four cycles of use . A total of 84 evaluable women provided 274 cycles of exposure in the LNG/EE group , and 89 women provided 289 cycles of exposure in the NETA/EE group . Overall , the LNG/EE group achieved a consistently higher percentage of normal menstrual cycles as well as a lower rate of intermenstrual bleeding and amenorrhea than the NETA/EE group . In cycle 4 , 63.8 % of cycles were normal in the LNG/EE group compared with 41.9 % in the NETA/EE group ( p < 0.005 ) . Of the total cycles in the NETA/EE group , 10 % were amenorrheic , compared with 1.1 % in the LNG/EE group . The occurrence of bleeding and/or spotting was significantly lower in cycles 2 and 3 in the LNG/EE group ( 41.7 % and 34.8 % , respectively ) compared with the NETA/EE group ( 62.3 % and 56.3 % ; p < 0.05 ) . Other cycle variables were generally similar between groups , as was the incidence of adverse events . These results demonstrate that good cycle control was achieved with an OC containing 20 micrograms EE and that 100 micrograms LNG/20 micrograms EE produces better cycle control than 1000 micrograms NETA/20 micrograms EE .

levonorgestrel/ethinyl estradiol

norethindrone/ethinyl estradiol

EE

percentage of normal menstrual cycles

amenorrheic

occurrence of bleeding and/or spotting

adverse events

84 evaluable

women

89 women


Sleep patterns in autistic children . Sleep disturbances are regarded as a common clinical feature in autistic children . This concept is based primarily on informal observations or studies conducted with questionnaires . In this study we compared data obtained by questionnaires to that obtained with actigraphy . Among 22 autistic children , 12 were reported as having sleep problems and 8 patients completed 72 hours actigraphy . While the employment of questionnaires disclosed that autistic children had an earlier morning awakening time and multiple and early night arousals , actigraphic monitoring showed that with the exception of an earlier morning arousal time ( p = .045 ) , sleep patterns of autistic children were similar to that of normal children . Parental oversensitivity to sleep disturbances of the autistic children may explain this phenomenon .

questionnaires .

questionnaires

actigraphy .

72 hours actigraphy .

questionnaires

actigraphic

Sleep patterns

Sleep disturbances

earlier morning awakening time

multiple and early night arousals

earlier morning arousal time

sleep patterns

sleep disturbances

autistic children .


Calcitriol for bone disease in patients with cirrhosis of the liver . BACKGROUND Osteoporosis is associated with cirrhosis of the liver , but the effects of therapy for osteoporosis associated with cirrhosis are still controversial . METHODS We evaluated the effects of calcitriol ( 1alpha,25-dihydroxyvitamin D3 ) on bone mineral density ( BMD ) in 76 patients ( 26 men and 50 women ) with cirrhosis who were assigned randomly to receive calcitriol ( 0.5 mg twice per day ) or not . The BMD of the lumbar vertebrae was measured by dual-energy X-ray absorptiometry at least twice , 12-57 months apart . RESULTS For men , the mean annual change in BMD was 1.1 % in the treated group and -0.4 % in the control group . The median ( 25th and 75th percentiles ) annual change in BMD was 0.6 ( -0.1 , 2.1 % ) in the treated group and -1.4 ( -1.9 , 1.6 % ) in the control group . The difference in the median annual change between the two groups was significant ( P = 0.013 ) . For women , the mean annual change in BMD was -0.5 % in the treated group and -2.3 % in the control group . The median ( 25th and 75th percentiles ) annual change in BMD was -0.5 ( -1.8 , 1.3 % ) in the treated group and -1.5 ( -3.8 , -0.7 % ) in the control group . This difference was significant ( P = 0.011 ) . CONCLUSIONS Our results suggest that calcitriol can prevent bone loss and , therefore , may be useful for the treatment of bone disease in patients with cirrhosis of the liver .

Calcitriol

calcitriol

osteoporosis

effects

bone mineral density ( BMD )

BMD of the lumbar vertebrae

dual-energy X-ray absorptiometry

change in BMD

annual change in BMD

change in BMD

BMD

bone loss

patients with cirrhosis of the liver .

76 patients

men

women

men

two groups

women

patients with cirrhosis of the liver


Comparison of the relative efficacy of formoterol and salmeterol in asthmatic patients . Studies performed on airway smooth muscle in vitro have indicated that salmeterol is a partial agonist on the beta2-receptor in comparison to formoterol . In the present study we evaluated whether these pharmacological differences between salmeterol and formoterol also are applicable to asthmatic patients . The protective effects by increasing cumulative doses of formoterol ( 12 , 60 , 120 micrograms ) and salmeterol ( 50 , 250 , 500 micrograms ) on methacholine-induced bronchoconstriction were evaluated in a double-blind , crossover , placebo-controlled design . Patients were regularly treated with salbutamol 200 micrograms twice daily during the study period , to avoid variability in beta2-adrenoceptor tolerance . S-potassium , heart rate corrected Q-T interval ( Q-Tc ) , and tremor score were followed as measures of systemic effects . Formoterol dose-dependently protected against methacholine responsiveness ( 4.6 doubling doses after 120 micrograms ) . Salmeterol , however , showed a flatter dose-response curve , and a significantly weaker maximal protective effect ( 2.8 doubling doses after 250 micrograms ) . Formoterol caused a significantly higher tremor score and a larger drop in S-potassium than salmeterol at the highest doses . These data show that salmeterol is a partial agonist on the beta2-receptor in relation to formoterol in human airways in vivo . Further studies are required to document the clinical consequences of this finding , for example in severe asthmatic patients .

formoterol

salmeterol

Formoterol

efficacy

beta2-adrenoceptor tolerance

S-potassium

tremor score

tremor score

S-potassium

asthmatic

asthmatic

asthmatic


Adjuvant L-arginine treatment for in-vitro fertilization in poor responder patients . The objective of the present study was prospectively and randomly to evaluate the role of L-arginine in improving uterine and follicular Doppler flow and in improving ovarian response to gonadotrophin in poor responder women . A total of 34 patients undergoing assisted reproduction was divided in two groups according to different ovarian stimulation protocols : ( i ) flare-up gonadotrophin-releasing hormone analogue ( GnRHa ) plus elevated pure follicle stimulating hormone ( pFSH ) ( n = 17 ) ; and ( ii ) flare-up GnRHa plus elevated pFSH plus oral L-arginine ( n = 17 ) . During the ovarian stimulation regimen , the patients were submitted to hormonal ( oestradiol and growth hormone ) , ultrasonographic ( follicular number and diameter , endometrial thickness ) and Doppler ( uterine and perifollicular arteries ) evaluations . Furthermore , the plasma and follicular fluid concentrations of arginine , citrulline , nitrite/nitrate ( NO2-/NO3- ) , and insulin-like growth factor-1 ( IGF-1 ) were assayed . All 34 patients completed the study . In the L-arginine treated group a lower cancellation rate , an increased number of oocytes collected , and embryos transferred were observed . In the same group , increased plasma and follicular fluid concentrations of arginine , citrulline , NO2-/NO3- , and IGF-1 was observed . Significant Doppler flow improvement was obtained in the L-arginine supplemented group . Three pregnancies were registered in these patients . No pregnancies were observed in the other group . It was concluded that oral L-arginine supplementation in poor responder patients may improve ovarian response , endometrial receptivity and pregnancy rate .

L-arginine

L-arginine

ultrasonographic

L-arginine

L-arginine

L-arginine

uterine and follicular Doppler flow

ovarian response to gonadotrophin

lower cancellation rate

embryos transferred

Significant Doppler flow improvement

pregnancies

pregnancies

ovarian response


Asthma : communication between hospital and general practitioners . OBJECTIVE To assess whether efforts to actively involve General Practitioners ( GPs ) in the postdischarge care of their paediatric asthma patients improved their satisfaction with communication with hospital staff . METHODOLOGY Randomized controlled trial involving 60 patients admitted to the Royal Children 's Hospital , Melbourne , with acute asthma and an identifiable GP . The GPs of the intervention patients were telephoned during the admission . Intervention patients and their GPs received printed information detailing the care the patient received in hospital and the recommended postdischarge care , as well as standardized educational booklets about asthma . Follow-up appointments were made for intervention patients to attend their GPs . RESULTS The GPs of intervention patients were more satisfied when compared to the GPs receiving a standard level of communication ( 96.4 % vs 48.3 % of the intervention and control GPs , respectively , described the communication as good or extremely good , P = 0.0001 ) . The intervention group GPs believed they were more involved after discharge ( 75.0 % vs 44.8 % , P = 0.005 ) and had greater understanding of their patient 's hospitalisation ( 96.4 % vs 62.1 % , P = 0.005 ) . These differences were noted despite there being no difference in the rate of follow-up attendance with GPs for intervention and control patients ( 85.7 % vs 72.4 % , P = 0.2 ) . Qualitative data supported these findings with GPs expressing approval of the intervention used . CONCLUSION Efforts to actively involve GPs in the postdischarge care of their paediatric patients with asthma resulted in a marked improvement in their satisfaction with the communication with medical staff at the Royal Children 's Hospital , Melbourne . The study had insufficient power to demonstrate a difference in morbidity .

Follow-up appointments

intervention

satisfied

rate of follow-up attendance

approval of the intervention used

general practitioners .

paediatric

acute asthma

paediatric


[ Validity of cardiotocography in the detection of umbilical cord complications ] . OBJECTIVE The purpose of this study was to investigate the validity of cardiotocography for the detection of cord complications . MATERIAL AND METHODS A low-risk population of 4196 cases was selected in which cord complications have been recognized in 34.3 % . Cases with cord complications and controls were paired by parity , gestational age , maternal age and mode of delivery . 25 pairs were randomly selected . 50 tracings were presented twice to 4 obstetricians in a double-blind manner . As parameters for the determination of the validity of fetal monitoring the reliability , positive ( ppv ) and negative predictive value ( npv ) , sensitivity and specificity were used . Inter- and intra-observer variability were also examined . RESULTS Reliability 52 % , ppv 52 % , npv 52 % , sensitivity 46 % , specificity 58 % . Interobserver variability : All 4 obstetricians agreed in 47 of 100 evaluations . The level of agreement was higher in the controls ( 63 % ) than in the cord complication group ( 56 % ) . The intraobserver variability was 25 % . CONCLUSIONS Cardiotocography is not useful for the detection of cord complications . The range of possibilities has not been exploited yet , even for the evaluation of the fetal state .

cardiotocography

cardiotocography

Cardiotocography

umbilical cord complications

cord complications .

Reliability

sensitivity

specificity

level of agreement

intraobserver variability

detection of cord complications .

umbilical cord complications ]


[ Efficacy of combination with granisetron and methylprednisolone for nausea , vomiting and appetite loss in remission induction chemotherapy of acute myeloid leukemia -- a randomized comparative trial between granisetron alone and granisetron plus methylprednisolone ] . The prevention of nausea , vomiting and appetite loss induced by remission induction chemotherapy for acute myeloid leukemia was compared by randomization between granisetron alone and combination with granisetron plus methylprednisolone . Granisetron was administered at 40 micrograms/kg during chemotherapy , and methylprednisolone was administered concomitantly at 125 mg/body for 3 days or more in the combination group . The single and combination groups comprised 14 and 13 patients , respectively , and there was no significant difference between the background of both groups . To evaluate the effect they were scored according to 4 grades , and evaluated every 24 hours from the start of chemotherapy to 5 days after its completion . The complete inhibition rate of vomiting was as high as 71.4 % and 92.3 % in the single and combination groups , respectively , showing no significant difference . The grade of vomiting was mild in both groups . Nausea was noted in 71.4 % and 46.2 % , respectively , and the inhibitory effect tended to be higher in the combination group . Appetite loss developed in 92.9 % and 41.7 % , respectively , and the prevention effect was clearly higher in the combination group . The prevention effects on nausea 7 , 8 and 10 days after the start of chemotherapy , on appetite loss 2-10 days after it , and 2-5 days after its completion , were higher in the combination group . Granisetron revealed an excellent inhibitory effect on vomiting induced by remission induction chemotherapy for acute myeloid leukemia , but combination with granisetron and methylprednisolone was considered useful for nausea in the latter half of the treatment period and for appetite loss during the whole period .

granisetron and methylprednisolone

granisetron alone

granisetron plus methylprednisolone

granisetron alone

granisetron

methylprednisolone

Granisetron

40 micrograms/kg during chemotherapy

methylprednisolone

Granisetron

granisetron and methylprednisolone

nausea

vomiting

appetite loss

nausea

vomiting

appetite loss

complete inhibition rate of vomiting

grade of vomiting

Nausea

Appetite loss

nausea

on appetite loss

inhibitory effect on vomiting

nausea

appetite loss

acute myeloid leukemia


Moderate-intensity exercise training with elements of step aerobics in patients with severe chronic heart failure . OBJECTIVE To evaluate whether a specific program of moderate-intensity step aerobics training may be sufficient to improve the exercise tolerance of patients with severe chronic heart failure . PATIENTS Twenty-six patients ( 22 men , 4 women ; mean +/- SD age , 54 +/- 9yrs ) with a history of severe chronic heart failure ( left ventricular ejection fraction of 18 % +/- 8 % ) . STUDY DESIGN Prospective , randomized , controlled trial . Patients were randomized into exercise and control groups . All patients underwent a clinical examination and a ramp pattern cycle exercise test before and after the observation period . The exercise group underwent a moderate-intensity ( 50 % of peak oxygen uptake ) 12-week training program , progressing to 100 minutes per week of step aerobics and 50 minutes per week of cycling . The control group did not perform a training program . MAIN OUTCOME MEASURES Peak oxygen uptake , peak workload , percent of predicted power ability . RESULTS Significant increases in peak oxygen uptake ( 15 +/- 3.4 to 18.5 +/- 2.9mL/kg/min ; p = .001 ) , peak workload ( 77 +/- 26 to 99 +/- 31 watts ; p = .000 ) , and percent of predicted power ability ( 43 % +/- 10 % to 56 % +/- 13 % ; p = .000 ) were observed in the exercise group . No significant changes in baseline parameters occurred in the control group . There were no critical changes in heart rate or blood pressure in either group . CONCLUSION Moderate-intensity step aerobics training significantly increases peak oxygen uptake and peak workloads in patients with severe chronic heart failure .

Moderate-intensity exercise training

perform a training program

Peak oxygen uptake

peak workload

percent of predicted power ability

peak oxygen uptake

peak workload

percent of predicted power ability

heart rate

blood pressure

peak oxygen uptake

peak workloads


Effects of captopril and enalapril on electroencephalogram and cognitive performance in healthy volunteers . OBJECTIVE Captopril and enalapril have been reported to influence cognitive functions and quality of life in hypertensive patients . METHODS The effects of captopril ( 12.5 mg and 25 mg ) and enalapril ( 5 mg and 10 mg ) administered during 7-day periods on electroencephalogram ( EEG ) , cognitive functions , and subjective assessments were investigated in healthy males . RESULTS Neither captopril nor enalapril influenced EEG and cognitive functions compared with placebo . Captopril 12.5 mg decreased subjective activity compared with placebo . Enalapril did not alter subjective ratings . Both systolic and diastolic blood pressure were significantly lower after administration of captopril 25 mg , whereas blood pressure was unaffected by enalapril compared with placebo . CONCLUSION Our results suggest that central effects of captopril and enalapril were minor and not constant in young healthy men .

captopril

enalapril

Captopril

enalapril

captopril

enalapril

electroencephalogram

Captopril

placebo

Enalapril

captopril

enalapril

captopril

enalapril

cognitive functions

quality of life

electroencephalogram ( EEG )

cognitive functions

subjective assessments

EEG

cognitive functions

subjective activity

subjective ratings

systolic and diastolic blood pressure

blood pressure

healthy

hypertensive

healthy

males

young

healthy

men


Why the prone position is a risk factor for sudden infant death syndrome . INTRODUCTION The laryngeal chemoreflex may explain why prone sleeping increases the risk of sudden infant death syndrome ( SIDS ) . Swallowing and arousal are crucial to prevent laryngeal chemoreflex stimulation . Our aim was to examine these reflexes and breathing responses in healthy neonates after pharyngeal infusion of water in the supine versus the prone position , controlling for sleep state . METHODS A total of 10 term infants were recruited after parental consent and ethics approval . Polygraphic recordings included sleep state ( active and quiet sleep by electroencephalogram , eye movements , breathing , and behavior ) , cardiorespiratory measurements ( nasal airflow , chest wall movements , heart rate , and oxygen saturation ) , swallowing , and esophageal activity ( solid state pressure catheter ) . Initial sleeping position was assigned randomly . Measurements were made for 1 minute before and after 0.4 mL of water was instilled into the oropharynx . To detect a 30 % decrease in swallowing , power analysis indicated that > /=10 babies were required . Analysis , blinded to position , was made using nonparametric statistics . RESULTS Of the 164 infusions , the most commonly evoked airway protective responses to pharyngeal infusion were swallowing ( 95 % ) and arousal ( 54 % ) . After infusion in active sleep , there was a significant reduction in swallowing and breathing when the prone position was compared with the supine position ( prone : 21.3 [ 1.0 ] swallows/min and -9.6 [ 2.1 ] breaths/min ; and supine : 32 ( 2.2 ) and -2 . 9 ( 1.5 ) , respectively ) . However , there was no difference in the occurrence of arousal after water infusion . CONCLUSION These data suggest that airway protection is compromised in the prone sleeping position during active sleep , even in healthy infants exposed to minute pharyngeal fluid volumes of 0.4 mL . This is because swallowing rate is reduced significantly , and there is no compensatory increase in arousal . The reduction in airway protective reflexes when in the prone position and in active sleep may be the mechanism for the increased risk of SIDS in the prone position .

prone position

reflexes and breathing responses

behavior

swallowing

swallowing

arousal

swallowing and breathing

swallows/min

breaths/min

arousal

swallowing rate

arousal

airway protective reflexes

healthy

neonates

infants


Treatment of hypertensive and hypercholesterolaemic patients in general practice . The effect of captopril , atenolol and pravastatin combined with life style intervention . OBJECTIVE To elucidate the effect on blood pressure and blood lipids of an angiotensin converting enzyme inhibitor ( captopril ) , and a beta-receptor blocking agent ( atenolol ) , given alone or in combination with a cholesterol reducing drug , the beta-hydroxy-methylglutaryl-coenzyme A reductase inhibitor pravastatin , in patients who were also encouraged to improve their lifestyle . DESIGN A longitudinal study consisting of three phases . I : Lifestyle intervention alone . II : Continued lifestyle intervention combined with captopril or atenolol . III : Continued lifestyle intervention combined with the same drugs as in phase II and in addition pravastatin or placebo . SETTING Fifty-four general practice surgeries in Norway . PARTICIPANTS Hypertensive patients , 210 females and 160 males , treated or untreated with antihypertensive drugs with a sitting diastolic blood pressure between 95 and 115 mmHg and a serum total cholesterol between 6.5 mmol/l ( 7.0 for those age 60-67 years ) and 9.0 mmol/l . RESULTS The antihypertensive effect of captopril and atenolol was not influenced by concurrent administration of pravastatin . The effect of pravastatin was not limited by concurrent medication with captopril or atenolol . Improvement in lifestyle seemed to reduce the need for supplementary treatment with diuretics . CONCLUSION Pravastatin can be used in combination with captopril or atenolol in the treatment of hypertensive and hypercholesterolaemic patients .

captopril

atenolol

cholesterol reducing drug

Lifestyle intervention alone

Continued

pravastatin

placebo

captopril

atenolol

pravastatin

pravastatin

captopril

atenolol

diuretics

Pravastatin

captopril

atenolol

Improvement in lifestyle

supplementary treatment with diuretics


Preoperative small-dose ketamine has no preemptive analgesic effect in patients undergoing total mastectomy . UNLABELLED We evaluated the preemptive analgesic effect of a small dose of ketamine given before or immediately after surgery in a randomized , double-blinded study performed in 128 women undergoing total mastectomy . Group 1 patients received ketamine 0.15 mg/kg as a 5-mL i.v . injection 5 min before surgery and isotonic saline 5 mL i.v . at the time of skin closure . Group 2 received 5 mL i.v . of isotonic saline , then 0.15 mg/kg i.v . ketamine . A standard general anesthesia procedure including sufentanil was used . In the recovery room , patient-controlled analgesia i.v . morphine was used for postoperative analgesia . Postoperative pain was assessed by measuring morphine consumption and visual analog scale pain scores . No significant intergroup differences were seen in the pain scores . Patient-controlled analgesia morphine consumption was lower during the first 2 h after surgery in patients given ketamine at the time of skin closure . No patient complained of hallucinations or nightmares . The incidence of adverse effects was not different between the two groups . In conclusion , administering ketamine at the end of surgery is more effective in reducing morphine consumption than it is when given before surgery . IMPLICATIONS We administered the same small dose of ketamine before or after surgery . The preoperative administration of 0.15 mg/kg ketamine in patients undergoing total mastectomy did not elicit a preemptive analgesic effect . Ketamine given at closure reduced the patient-controlled analgesia morphine requirement in the first 2 h after surgery .

ketamine

ketamine

ketamine 0.15 mg/kg as a 5-mL i.v .

injection 5 min before surgery

isotonic saline 5 mL i.v .

5 mL i.v . of isotonic saline ,

0.15 mg/kg i.v . ketamine

ketamine

ketamine

ketamine

ketamine

Ketamine

Patient-controlled analgesia

hallucinations

nightmares .

incidence of adverse effects

women

undergoing total mastectomy

undergoing total mastectomy


Phenobarbital compared with phenytoin for the treatment of neonatal seizures . BACKGROUND Seizures occur in 1 to 2 percent of neonates admitted to an intensive care unit . The treatment is usually with either phenobarbital or phenytoin , but the efficacy of the two drugs has not been compared directly . METHODS From 1990 to 1995 , we studied 59 neonates with seizures that were confirmed by electroencephalography . The neonates were randomly assigned to receive either phenobarbital or phenytoin intravenously , at doses sufficient to achieve free plasma concentrations of 25 microg per milliliter for phenobarbital and 3 microg per milliliter for phenytoin . Neonates whose seizures were not controlled by the assigned drug were then treated with both drugs . Seizure control was assessed by electroencephalographic criteria . RESULTS Seizures were controlled in 13 of the 30 neonates assigned to receive phenobarbital ( 43 percent ) and 13 of the 29 neonates assigned to receive phenytoin ( 45 percent ; P=1.00 ) . When combined treatment is considered , seizure control was achieved in 17 ( 57 percent ) of the neonates assigned to receive phenobarbital first and 18 ( 62 percent ) of those assigned to receive phenytoin first ( P=0.67 ) . The severity of the seizures was a stronger predictor of the success of treatment than was the assigned agent . Neonates with mild seizures or with seizures that were decreasing in severity before treatment were more likely to have their seizures end , regardless of the treatment assignment . CONCLUSIONS Phenobarbital and phenytoin are equally but incompletely effective as anticonvulsants in neonates . With either drug given alone , the seizures were controlled in fewer than half of the neonates .

Phenobarbital

phenytoin

phenobarbital

phenytoin

phenobarbital

phenytoin

Phenobarbital

phenytoin

efficacy

Seizure control

Seizures

seizure control

severity of the seizures

mild seizures

seizures

seizures

anticonvulsants

seizures

controlled

neonatal seizures .


Effects of amlodipine and enalapril on platelet function in patients with mild to moderate hypertension . OBJECTIVE The aim of this study was to compare the effect of amlodipine and enalapril on platelet aggregation , and platelet production of malondialdehyde in patients with mild to moderate arterial hypertension . PATIENTS AND METHODS A parallel , double-blind , placebo-controlled study was carried out in 24 patients ( 2 groups of 12 patients each ) . Initially all patients received placebo for four weeks ; then amlodipine , 5 mg daily or enalapril 20 mg daily taken once a day at 7 am . Dosage was doubled after 4 weeks when diastolic blood pressure was > 90 mmHg in sitting position , the treatment was continued for 12 weeks . At the end of placebo and active phases a platelet aggregation test , using adenosine diphosphate , collagen and adrenaline , and a platelet malondialdehyde production test , either in basal conditions ( MDA-basal ) and after the stimulation of arachidonic acid pathway by adding ethylmaleimide ( MDA-activated ) were carried out . RESULTS Blood pressure was reduced by both agents , enalapril and amlodipine . Enalapril controlled 58.3 % of hypertensive patients with an average dosage of 31.7 mg/daily . Amlodipine controlled 75 % of patients with a dosage of 7.1 mg/daily . Platelet aggregation was reduced by amlodipine in 15.9 % for ADP ( 10 microM ) ; 17.4 % for collagen ( 2 microg/ml ) and 19.9 % for adrenaline ( 2 microM ) ( p < 0.025 ) . Meanwhile enalapril slightly increased platelet aggregation by 6.7 % , 1.3 % and 5.6 % for the three agents , respectively ( p > 0.05 , ns ) . Malondialdehyde was reduced by amlodipine in 45.33 % ( p < 0.05 ) for MDA-basal ; 3.76 % ( p > 0.05 ) for MDA-activated ; and the ratio MDA-basal : MDA-activated in 36.79 % ( p < 0.005 ) . Meanwhile enalapril increased MDA-basal in 2.89 % ; MDA-activated in 3.58 % and reduced the ratio MDA-basal : MDA-activated , in 10.34 % ( p > 0.05 ) . CONCLUSION Both agents , enalapril and amlodipine , reduced blood pressure , but only amlodipine reduced platelet aggregation and platelet production of malondialdehyde , indicating its action on the arachidonic acid metabolic pathway .

amlodipine

enalapril

amlodipine and enalapril

placebo-controlled

placebo

amlodipine

or enalapril

enalapril

amlodipine

Enalapril

Amlodipine

amlodipine

enalapril

amlodipine

enalapril

enalapril

amlodipine

amlodipine

platelet function

platelet aggregation

platelet production of malondialdehyde

diastolic blood pressure

Blood pressure

Platelet aggregation

platelet aggregation

Malondialdehyde

MDA-basal

MDA-activated

MDA-basal

MDA-activated

ratio MDA-basal : MDA-activated

blood pressure

platelet aggregation

platelet production of malondialdehyde

hypertension

arterial hypertension

hypertensive


Continued improvement in pressure-flow parameters in men receiving finasteride for 2 years . Finasteride Urodynamics Study Group . OBJECTIVES To assess the long-term effects of finasteride on pressure-flow parameters in men with urodynamically documented bladder outflow obstruction ( BOO ) . METHODS One hundred twenty-one men with benign prostatic enlargement ( BPE ) and lower urinary tract symptoms ( LUTS ) underwent a pressure-flow study ( PFS ) at 1 of 11 clinical centers . The PFS technique was standardized , and all tracings were read by a single reader unaware of the treatment group . Patients who were obstructed according to a modified Abrams-Griffiths nomogram were randomized to 5 mg finasteride ( n = 81 ) or placebo ( n = 40 ) for 12 months ; all patients continuing into an open extension received finasteride during the second 12 months of therapy . Results of the initial 12-month study demonstrated the benefit of finasteride treatment on PFS parameters . To examine the continuing effects over time , an analysis of the data from 54 patients who completed 24 months of treatment with finasteride is provided . RESULTS Detrusor pressure at maximum flow ( PdetQmax ) continued to decrease during the second 12 months of therapy ( decreases of 5.3 and 11.7 cm H2O at months 12 and 24 , respectively ) . The percentage of patients obstructed by Abrams-Griffiths classification decreased from 76.2 % at baseline to 66.7 % at month 12 and 59.6 % at month 24 . An intention-to-treat analysis yielded similar results . CONCLUSIONS Finasteride improves urodynamic measures of obstruction in men with BPE and LUTS , with continued improvement during the second 12 months of therapy .

5 mg finasteride

placebo

finasteride

pressure-flow parameters

pressure-flow parameters

modified Abrams-Griffiths nomogram

PFS parameters

Detrusor pressure

PdetQmax

Abrams-Griffiths classification

men

receiving finasteride for 2 years .

One hundred twenty-one

benign prostatic enlargement

lower urinary tract symptoms


Befriending as an intervention for chronic depression among women in an inner city . 2 : Role of fresh-start experiences and baseline psychosocial factors in remission from depression . BACKGROUND Volunteer befriending promoted remission of chronic depression when clinical and other treatment variables were controlled . AIMS To examine the role of other psychosocial factors relevant for outcome . METHOD Factors measured at baseline interview were examined in multivariate analyses along with psychosocial factors occurring during follow-up , such as 'fresh-start ' experiences and new severe events and difficulties . RESULTS Fresh-start experiences and a standard attachment style were found to enhance chances of remission , with new severe stressors and markedly poor coping strategies liable to prevent it , with volunteer befriending continuing to play a role . CONCLUSIONS The positive result reported in the preceding paper is unlikely to be an artefact . However , fresh-start experiences , absence of new severe stressors and standard attachment style were more important predictors of remission . This knowledge might profitably be incorporated into the evaluation of existing treatments .

Befriending

Volunteer befriending

'fresh-start ' experiences

befriending

'fresh-start ' experiences

new severe events

and

difficulties

Fresh-start experiences

standard attachment style


Delineation of cryptogenic Lennox-Gastaut syndrome and myoclonic astatic epilepsy using multiple correspondence analysis . PURPOSE To distinguish various types of childhood severe cryptogenic/idiopathic generalised epilepsy on the basis of reproducible diagnostic criteria , using multiple correspondence analysis ( MCA ) . METHODS We applied MCA to a series of 72 children with no evidence of brain damage , starting epilepsy between 1 and 10 years , with two or more types of generalised seizures . We excluded patients with infantile spasms or typical absences . MCA was performed on all clinical and EEG parameters , first throughout follow-up , then restricted to the first year of the disease . RESULTS When including all follow-up variables , there were three groups : ( 1 ) Thirty-seven children with male predominance , familial history of epilepsy , simple febrile convulsions , massive myoclonus , tonic-clonic fits . Outcome was favourable , with no seizures and mildly affected cognitive functions . Interictal EEG showed short sequences of irregular 3-Hz spike-waves . ( 2 ) In 18 children , clinical characteristics were similar to those of the first group at the early stage , but 95 % exhibited myoclonic status and vibratory tonic seizures , with persisting seizures on follow-up . EEG showed long sequences of generalised irregular spike and slow waves . Those two groups meet the characteristics of childhood onset myoclonic-astatic epilepsy ( MAE ) with respectively , favourable and unfavourable outcome . ( 3 ) Eleven children had later onset , atypical absences , tonic and partial seizures , and no myoclonus , or vibratory tonic seizures . All had mental retardation and persisting seizures . EEG showed long sequences of slow spike-wave activity and half the patients had spike and slow wave foci . These patients met the major characteristics of Lennox-Gastaut syndrome . Initial parameters failed to distinguish the first two groups , but Lennox-Gastaut syndrome ( the third group ) was distinct from both groups of myoclonic astatic epilepsy from the onset . Within MAE groups combined , clinical and EEG risk factors for mental retardation could be identified . CONCLUSION It is possible to validate statistically the distinction between discrete epileptic syndromes . Myoclonic astatic epilepsy is therefore distinct from Lennox-Gastaut syndrome , and the distinction appears from the first year of the disorder .

multiple correspondence analysis

MCA

EEG

clinical characteristics

myoclonic status

vibratory tonic seizures

persisting seizures

atypical absences

tonic and partial seizures


Effect of spinal versus general anesthesia on bladder compliance and intraabdominal pressure during transurethral procedures . STUDY OBJECTIVE To evaluate the influence of spinal versus general anesthesia on bladder compliance and intraabdominal pressure in elderly males undergoing elective transurethral resection of the prostate . DESIGN Prospective , randomized , open-label study . SETTING Teaching hospital . PATIENTS 21 ASA physical status I , II , and III patients at least 18 years of age , undergoing transurethral surgery . INTERVENTIONS According to a computer-generated randomization schedule , patients were allocated to one of two groups . In Group Spinal ( S ) , 10 mg of hyperbaric tetracaine was administered intrathecally . In Group General Anesthesia ( GA ) , patients received , fentanyl intravenous ( i.v . 1 to 2 micrograms/kg and propofol i.v . 1.0 to 2.0 mg/kg for induction of anesthesia . Thereafter , a laryngeal mask airway was inserted and , with spontaneous ventilation , anesthesia was maintained by administering isoflurane ( end-tidal 0.7 % to 1.2 % ) and 70 % nitrous oxide ( N2O ) in oxygen . Intraabdominal pressure and bladder compliance were recorded prior to the induction of anesthesia and immediately before the onset of the surgical procedure . MEASUREMENTS AND MAIN RESULTS The two groups were demographically comparable . In Group S , mean bladder compliance was significantly ( p = 0.003 ) higher and mean intraabdominal pressure significantly lower ( p = 0.007 ) when compared to baseline preanesthetic values . In Group GA , mean intraabdominal pressure significantly ( p = 0.006 ) decreased when compared to baseline preanesthetic recordings . Following the induction of general anesthesia , a small change in bladder compliance was noted . However , statistical significance was not reached . Data were analyzed and compared using Student 's t-test ( p < 0.05 was considered statistically significant ) . CONCLUSION Both spinal and general anesthesia induced a significant decrease in intraabdominal pressure . While both techniques were associated with an increase in bladder compliance , statistical significance was demonstrated only in the spinal anesthesia treatment group .

spinal versus general anesthesia

spinal versus general anesthesia

transurethral surgery .

hyperbaric tetracaine

General Anesthesia ( GA )

fentanyl intravenous

anesthesia

anesthesia

isoflurane

nitrous oxide ( N2O ) in oxygen

anesthesia

spinal and general anesthesia

spinal anesthesia

bladder compliance

intraabdominal pressure

bladder compliance

intraabdominal pressure

intraabdominal pressure

mean intraabdominal pressure

bladder compliance

elderly

males

at least 18


Trial of prophylactic administration of TXA2 synthetase inhibitor , ozagrel hydrochloride , for preeclampsia . OBJECTIVE In an attempt to investigate the prophylactic effect of a thromboxane A2 ( TXA2 ) synthetase inhibitor on pregnant women with a high risk of preeclampsia , the following clinical study was undertaken . METHODS Forty pregnant women were randomly allocated to control or treatment groups . Ozagrel Hydrochloride ( 400 mg/day , orally ) and placebo were started at 20 weeks of gestation and continued until delivery . RESULTS Seventeen of 20 ( 85 % ) women in the control group developed preeclampsia , whereas 9 of 20 ( 45 % ) in the treatment group developed preeclampsia . Ozagrel Hydrochloride significantly ( p < 0.01 ) reduced the occurrence of preeclampsia , and the incidence of both hypertension ( p < 0.05 ) and proteinuria ( p < 0.01 ) was significantly less in the treatment group compared with the control group . One month after administration , the mean plasma concentration of TXB2 , a metabolite of TXA2 , was significantly decreased ( p < 0.01 ) to 62.4 +/- 13.6 % , whereas that of 6-keto prostaglandin F1 alpha , a metabolite of PGI2 , was significantly increased ( p < 0.01 ) to 206.7 +/- 52.8 % . There were no maternal or fetal side effects observed . CONCLUSIONS It seems likely that Ozagrel Hydrochloride could be used for the prevention of preeclampsia in high-risk pregnant women .

Ozagrel Hydrochloride

placebo

Ozagrel Hydrochloride

preeclampsia

preeclampsia

occurrence of preeclampsia

hypertension

proteinuria

mean plasma concentration of TXB2

a metabolite of TXA2

6-keto prostaglandin F1 alpha

a metabolite of PGI2

maternal or fetal side effects observed

prevention of preeclampsia

preeclampsia

pregnant

women

preeclampsia

Forty

pregnant

women

preeclampsia


Inhibition of the seasonal IgE increase to Dactylis glomerata by daily sodium chloride nasal-sinus irrigation during the grass pollen season .

Inhibition of the seasonal IgE


Assessment of the pain of blood-sugar testing : a randomised controlled trial . Lancet puncture to the side of the thumb resulted in less pain than lancet puncture to the finger or venepuncture at the elbow . Success rates were the same .

less pain


Chemotherapy for operable gastric cancer : results of the Dutch randomised FAMTX trial . The Dutch Gastric Cancer Group ( DGCG ) . The aim of this trial was to investigate whether pre-operative chemotherapy leads to a 15 % higher curative resectability rate in patients with operable gastric cancer . In this randomised trial , patients were allocated to receive either four courses of chemotherapy using 5-fluorouracil , doxorubicin and methotrexate ( FAMTX ) prior to surgery or to undergo surgery only . Patients younger than 75 years of age with a good physical and mental condition and a histologically proven adenocarcinoma of the stomach without clinical or radiographic ( computed tomography scan ) evidence of distant metastases were eligible for this trial . Early gastric cancer or cardia carcinoma were excluded . The response to chemotherapy was evaluated after two and four courses . In case of progressive disease ( PD ) after two courses , patients were operated upon as soon as possible . Otherwise complete response ( CR ) partial response ( PR ) or stable disease ( SD ) , two more courses were scheduled . The standard surgical procedure was a limited lymphadenectomy ( D1 ) with staging biopsy of the para-aortic lymph nodes . Between September 1993 and February 1996 , 56 eligible and evaluable patients were entered : 27 were randomised to receive FAMTX before surgery and 29 to undergo surgery only . In the FAMTX + surgery treatment group , 15/27 ( 56 % ) had curative resections versus 18/29 ( 62 % ) in the surgery only arm . There was no difference in the frequency of TNM stages I + II in both treatment arms : 15/27 versus 15/29 . Due to PD and/or toxicity , 12 patients ( 44 % ) could not complete the planned four courses of FAMTX . Response evaluation after chemotherapy was possible in 25 patients : 2 CR , 6 PR , 8 SD and 9 PD . The difference in curative resectability rate was 6.5 % ( 95 % confidence interval -32 to +19 % ) in favour of surgery only . Downstaging for stages I + II did not occur . PD was more often the reason for not completing the planned four courses than toxicity . More active regimens than FAMTX are required for future randomised trials .

Chemotherapy

chemotherapy

surgery only

chemotherapy

FAMTX

curative resectability rate

curative resections

frequency of TNM stages I + II

toxicity

curative resectability

operable gastric cancer :

Dutch


Gabexate mesilate and antithrombin III for intraoperative anticoagulation in heparin pretreated patients . Thirty patients scheduled for elective myocardial revascularization and having undergone preoperative heparin treatment have been admitted to this prospective , randomized study . The aim of the study was to test two different strategies for preserving circulating antithrombin III ( AT-III ) during cardiopulmonary bypass . Patients in the control group ( group C , n = 10 ) were treated with a standard heparinization ( 300 IU/kg ) . Patients in group A ( n = 10 ) received the same management plus two doses of purified antithrombin III ( 1000 IU each ) . Patients in group GA received 200 IU/kg heparin and a continuous infusion of heparin ( 100 IU/kg/h ) and gabexate mesilate ( 2 mg/kg/h ) plus the same dose of antithrombin III as group A . Both group A and group GA demonstrated a preservation of circulating AT-III when compared to group C ; this effect was more pronounced in group GA . The total heparin dosage was less in group GA than in groups A and C. Purified AT-III administration is recommended in heparin pretreated patients ; the addition of gabexate mesilate to this protocol decreases the heparin requirement and increases the AT-III preservation .

Gabexate mesilate

antithrombin III

standard heparinization

antithrombin III

200 IU/kg heparin

gabexate mesilate

antithrombin III

circulating antithrombin III ( AT-III )

preservation of circulating AT-III

total heparin dosage

heparin requirement

AT-III preservation .

heparin pretreated

Thirty

elective myocardial revascularization

preoperative heparin treatment

heparin pretreated


One-year results from the phase III investigation of the KeraVision Intacs . BACKGROUND Limitations of the surgical correction for myopia include inaccuracy , instability , treatment of the central optical zone , and lack of reversibility . KeraVision Intacs offer an alternative that addresses these shortcomings . METHODS We present 1 year of follow-up information on 95 subjects enrolled in the United States Food and Drug Administration Phase III clinical trials . RESULTS At 1 year , 99 % of patients ( 89 of 90 ) had 20/40 uncorrected vision or better . Ninety-two percent of eyes ( 83 of 90 ) were within 1.00 D of intended correction and 76 % of eyes ( 68 of 90 ) were within 0.50 D of intended correction . Stability was achieved at 3 months , with 96 % of subjects ( 86 of 90 ) having less than 1.00 D of change from their previous examination . In a substudy , 89 % eyes ( 58 of 65 ) varied within +/- 0.50 D over the course of a day . Corneal curvature changed as predicted , resulting in a prolate aspheric shape within the central optical zone . Most complications or adverse events experienced were managed with additional medication or surgical intervention , resulting in a favorable outcome for subjects . CONCLUSIONS KeraVision Intacs are effective , predictable , stable , and safe . This additive technique may also offer reversibility .

investigation of the KeraVision Intacs

KeraVision Intacs

Stability

Corneal curvature

complications or adverse events

myopia

20/40 uncorrected vision or better


Tactile feedback is present during minimally invasive surgery . BACKGROUND The applications of minimally invasive surgery ( MIS ) and laparoscopy are rapidly expanding . Despite this expansion , our understanding of the importance of haptic feedback during laparoscopic surgery is incomplete . Although many surgeons believe that the use of minimally invasive techniques eliminates force feedback and tactile sensation ( haptics ) , the importance of haptics in MIS has not been fully evaluated . There is considerable interest in the development of simulators for MIS even though the importance of force feedback remains poorly understood . This study was designed to determine the ability of experienced surgeons to interpret haptic feedback with respect to texture , shape , and consistency of an object . STUDY DESIGN A randomized , single-blinded study was designed . Twenty surgeons were presented objects in a random order , with participants blinded as to their identity . Inspection by direct palpation , conventional instruments , and laparoscopic instruments was performed on all objects . Statistic analysis of the data was performed using chi-square analysis and , when appropriate , a Fischer exact probability test . RESULTS Direct palpation was associated with the highest accuracy for shape identification and was superior to both conventional instruments ( p < 0.001 ) and laparoscopic instruments ( p < 0.001 ) . Fine texture analysis with either a conventional instrument or a laparoscopic instrument was superior to direct palpation ( p < 0.05 ) . Finally , the three methods of analysis were comparable for consistency analysis . CONCLUSIONS These data indicate that laparoscopic instruments do , in fact , provide surgeons with haptic feedback . Interpretation of the texture , shape , and consistency of objects can be performed . In some situations , laparoscopic instruments appear to amplify the haptic information available . Our ongoing work is directed at further defining force interactions .

minimally invasive surgery

minimally invasive surgery ( MIS )

laparoscopy

laparoscopic surgery

minimally invasive techniques

Inspection by direct palpation

conventional instruments

laparoscopic instruments

conventional instrument

laparoscopic instrument

laparoscopic instruments

Tactile feedback

force feedback

tactile sensation ( haptics )

force feedback

haptic feedback

texture

shape

consistency of an object

Inspection by direct palpation

conventional instruments

laparoscopic instruments

Direct palpation

haptic feedback

Twenty


Ciprofloxacin and rifampicin versus doxycycline and rifampicin in the treatment of brucellosis . The present study was undertaken to evaluate the efficacy , safety , and patient tolerability of two antibiotic regimens for the treatment of brucellosis : rifampicin 600 mg/day and doxycycline 200 mg/day for 45 days ( group 1 ) , versus rifampicin 600 mg/day and ciprofloxacin 1 g/day for 30 days ( group 2 ) . Forty patients were diagnosed with brucellosis based on clinical and microbiological findings . The two groups were comparable regarding age and sex distribution . The average number of days without fever and symptoms was lower in group 2 patients than in group 1 patients ( mean+/-SD : 3.85+/-1.98 for group 1 vs. 2.78+/-1.03 for group 2 , P=0.044 ) . During the 1-year follow-up period , three ( 15 % ) patients in group 2 and two ( 10 % ) patients in group 1 had clinical relapses ; these rates were not significantly different . Ciprofloxacin and rifampicin treatment for brucellosis is as effective as the standard regimen of doxycycline and rifampicin and offers the advantage of a shorter duration of treatment .

Ciprofloxacin and rifampicin

doxycycline and rifampicin

Ciprofloxacin and rifampicin

doxycycline and rifampicin

brucellosis

brucellosis

relapses

brucellosis


Use of the oral neuraminidase inhibitor oseltamivir in experimental human influenza : randomized controlled trials for prevention and treatment . CONTEXT Influenza virus neuraminidase is thought to be essential for virus replication in humans ; however , to date , available neuraminidase inhibitors are limited to zanamivir , which is topically administered . OBJECTIVE To determine the safety , tolerability , and antiviral activity of oral neuraminidase inhibitor oseltamivir ( GS4104/Ro64-0796 ) for prevention and the early treatment of influenza in experimentally infected humans . DESIGN Two randomized , double-blind , placebo-controlled trials conducted between June and July 1997 . SETTING Individual hotel rooms ; 2 large US university medical schools . PARTICIPANTS A total of 117 healthy adult volunteers ( aged 18-40 years ; median age , 21 years ) who were susceptible ( hemagglutination-inhibition antibody titer < or =1:8 ) . INTERVENTIONS All subjects were inoculated intranasally with influenza A/Texas/36/91 ( H1N1 ) virus . For the prophylaxis study , oral oseltamivir ( 100 mg once daily [ n = 12 ] , 100 mg twice daily [ n = 12 ] , or matching placebo [ n = 13 ] , starting 26 hours before virus inoculation ) was administered . For the treatment study , the same drug was given ( 20 mg , 100 mg , or 200 mg twice daily , 200 mg once daily , or matching placebo [ n = 16 ] , in each group starting 28 hours after inoculation ) . All regimens were continued for 5 days . MAIN OUTCOME MEASURES Comparing placebo groups with pooled treatment groups , for prophylaxis , outcomes included frequency of infection and viral shedding ; for treatment , viral shedding in titers . RESULTS In the prophylaxis study , 8 ( 67 % ) of 12 placebo and 8 ( 38 % ) of 21 oseltamivir recipients became infected ( P = .16 ; efficacy , 61 % ) ; 6 ( 50 % ) placebo compared with 0 oseltamivir recipients shed virus ( P < .001 ; efficacy , 100 % ) , and 33 % of placebo but no oseltamivir recipient had infection-related respiratory illness ( P < .01 ) . Among infected subjects in the treatment study ( n = 69 ) , the viral titer area under the curve of the combined oseltamivir groups ( n = 56 ) was lower ( median [ interquartile range [ IQR ] ] , 80 [ 23-151 ] vs 273 [ 79-306 ] log10 tissue culture-infective doses50 per milliliter x hour ; P = .02 ) than the placebo group ( n = 13 ) , and the median ( IQR ) duration of viral shedding with therapy was reduced from 107 ( 83-131 ) to 58 ( 35-59 ) hours ( P = .003 ) . Oseltamivir treatment also reduced symptom scores ( median [ IQR ] score-hours , 225 [ 97-349 ] vs 400 [ 189-645 ] ; P = .05 ) , and nasal proinflammatory cytokine levels . Transient mild to moderate nausea after dosing was observed in 15 ( 17 % ) of 88 oseltamivir and 2 ( 7 % ) of 29 placebo recipients ( 95 % confidence interval for difference , -11 % to 68 % ) , which was largely prevented by ingestion with food . CONCLUSIONS In these trials , prophylaxis and early treatment with oral oseltamivir were both associated with significant antiviral and clinical effects in experimental human influenza .

neuraminidase inhibitor oseltamivir

placebo-controlled

oral oseltamivir

matching placebo

placebo

infected

viral titer area under the curve

symptom scores

nasal proinflammatory cytokine levels

mild to moderate nausea

influenza

influenza


An empirical comparison of the St George 's Respiratory Questionnaire ( SGRQ ) and the Chronic Respiratory Disease Questionnaire ( CRQ ) in a clinical trial setting . BACKGROUND The Chronic Respiratory Questionnaire ( CRQ ) and the St George 's Respiratory Questionnaire ( SGRQ ) are the two most widely used quality of life questionnaires in chronic obstructive pulmonary disease ( COPD ) . A study was undertaken to compare directly the self-administered version of the CRQ and the SGRQ with respect to feasibility , internal consistency , validity , and sensitivity to changes resulting from bronchodilator therapy . METHODS One hundred and forty four patients with moderate or severe COPD were randomly assigned to receive three months of treatment with either salmeterol , salmeterol + ipratropium bromide , or placebo . Quality of life was measured at baseline and after 12 weeks of treatment . RESULTS The proportions of missing values per patient were low for both questionnaires ( 0.54 % for the CRQ and 2 % for the SGRQ ) . The internal consistency was good for both questionnaires ( Cronbach 's alpha coefficients > /= 0.84 for the CRQ and > /= 0.76 for the SGRQ ) . Factor analysis confirmed the original domain structure of the CRQ but not of the SGRQ . Correlations with forced expiratory volume in one second ( FEV ( 1 ) ) % predicted and peak expiratory flow rate ( PEFR ) were low for both questionnaires but better for the SGRQ than for the CRQ . The ability to discriminate between subjects with different levels of FEV ( 1 ) was somewhat better for the SGRQ . The correlations with symptom scores were comparable for both questionnaires . Cross sectionally , the scores of the two questionnaires were moderately to highly correlated ( coefficients ranged from 0.35 to 0.72 ) . Longitudinally , these correlations were lower ( coefficients ranged from 0.17 to 0.54 ) but were still significant . The CRQ total and emotions score and the SGRQ symptoms score were the most responsive to change . The SGRQ symptoms domain was the only domain where the improvement in patients receiving combination treatment crossed the threshold for clinical relevance . CONCLUSIONS Since this analysis of reliability , validity , and responsiveness to change did not clearly favour one instrument above the other , the choice between the CRQ and the SGRQ can be based on other considerations such as the required sample size or the availability of reference values .

salmeterol

salmeterol

ipratropium bromide

placebo

Quality of life

proportions of missing values

internal consistency

( FEV ( 1 ) ) %

peak expiratory flow rate ( PEFR )

FEV ( 1 )

CRQ total and emotions score

and the

SGRQ symptoms score

SGRQ symptoms domain

( COPD ) .


The impact of schizophrenic patient functionality on service utilization and cost . Based on a presentation by Sandra L. Tunis , PhD . With the advent of atypical agents in the treatment of schizophrenia , physicians and policy makers must consider the costs that may accompany greater clinical efficacy . Analyses reveal that olanzapine shows a greater clinical cost effectiveness , as well as a greater functional cost effectiveness , than haloperidol , and that functional outcomes , in particular , show promise as important measures of effectiveness . Functional outcomes can help differentiate medications and can be used to help demonstrate the cost effectiveness of atypical agents . Mental health and physical health functioning , as well as work status , are all measures of functioning that have been used to evaluate treatment strategies . When comparing olanzapine with haloperidol , cost savings are seen throughout the treatment period ( 1 year ) , with physical functioning most highly affected over time . Functional outcomes can therefore serve 2 purposes : to enhance compliance by improving health-related quality of life and to assist in making both treatment and formulary decisions .

olanzapine

haloperidol

olanzapine

haloperidol

service utilization and cost

clinical cost effectiveness

functional cost effectiveness

cost effectiveness

Mental health

physical health functioning

work status

cost savings

physical functioning

health-related quality of life

schizophrenic


Granulocyte-macrophage colony-stimulating factor treatment before doxorubicin and cyclophosphamide chemotherapy priming in women with early-stage breast cancer . PURPOSE To determine if inhibition of stem-cell activity induced by granulocyte-macrophage colony-stimulating factor ( [ GM-CSF ] ; Sargramostim ; Immunex Corporation , Seattle , WA ) withdrawal or priming protects hematopoietic stem cells from the cytotoxic effects of adjuvant chemotherapy for early-stage breast cancer . PATIENTS AND METHODS Serial blood counts were performed in 20 women with early-stage breast cancer receiving four courses of cyclophosphamide and doxorubicin chemotherapy . By a double-blind , placebo-controlled , balanced randomization , subjects received GM-CSF priming on days 5 to 1 for courses 1 and 3 or courses 2 and 4 . RESULTS Compared with before priming , after priming the times to neutrophil nadir ( 12.8 +/- 2.5 days v 14.8 +/- 1.5 days , respectively ; P =.0001 ) and platelet nadir ( mean +/- SD , 10.1 +/- 1.9 days v 11.1 +/- 2.2 days , P < .05 ) were shorter , indicating a shift of cytotoxicity to later progenitors . The neutrophil nadir was similar with and without priming ( mean +/- SD , 490 +/- 310/microL v 550 +/- 350/microL , respectively ; P =.2 ) ; however , on day 16 the mean neutrophil count was higher ( mean +/- SD , 1030 +/- 580/microL v 690 +/- 370/microL , P =.004 ) , and the proportion of patients with a neutrophil count less than 500/microL was lower after priming than before ( six of 35 or 17 . 1 % v 12 of 34 or 35.3 % , respectively ; P =.04 ) . The platelet nadir was higher ( mean +/- SD , 166,000 +/- 51,000/microL after priming v 151,000 +/- 45,000/microL before priming , P =.007 ) , and the duration of thrombocytopenia , ie , a platelet count less than 150,000/microL , was shorter ( 1.5 +/- 2.1 days v 2.8 +/- 2.9 days , P =.0025 ) after priming . Episodes of fever and neutropenia were not observed . CONCLUSIONS GM-CSF priming from days 5 to 1 before doxorubicin and cyclophosphamide chemotherapy was associated with an earlier neutrophil and platelet nadir . On day 16 , a higher mean neutrophil count and a lower proportion of patients with severe ( < 500/microL ) neutropenia were observed . Beneficial effects on the severity and duration of thrombocytopenia were also noted . These observations support the hypothesis that GM-CSF priming protects hematopoietic progenitors from the cytotoxic effects of chemotherapy .

chemotherapy

times to neutrophil nadir

platelet nadir

neutrophil nadir

neutrophil count

neutrophil count

platelet nadir

duration of thrombocytopenia

fever and neutropenia

neutrophil

platelet nadir

neutrophil count

neutropenia

thrombocytopenia

women with early-stage breast cancer .

early-stage breast cancer .


Comparison of nasal deposition and clearance of aerosol generated by nebulizer and an aqueous spray pump .

nebulizer and an aqueous spray pump .


A randomized controlled trial of itraconazole versus fluconazole for the prevention of fungal infections in patients with haematological malignancies . U.K. Multicentre Antifungal Prophylaxis Study Group . Fluconazole is widely used as antifungal prophylaxis but it is ineffective against Aspergillus . Itraconazole has a broader spectrum of activity but the capsules give erratic bioavailability in neutropenic patients . We compared itraconazole oral solution ( which has an improved pharmacokinetic profile ) with fluconazole for antifungal prophylaxis . Adults with haematological malignancies receiving chemotherapy or bone marrow transplants were randomly allocated 5 mg/kg/d itraconazole ( itra ) solution ( 288 episodes ) or 100 mg fluconazole suspension ( flu ) ( 293 episodes ) from before the onset of neutropenia until neutrophil recovery or suspected fungal infection . Outcomes were assessed by independent reviewers unaware of the prophylaxis allocation . More proven systemic fungal infections occurred in flu ( Aspergillus four , Candida tropicalis one , C. krusei one ) than itra ( C. albicans one ) and more of these were fatal ( four versus nil ) . This difference reached statistical significance when first study episodes were considered separately ( six flu versus nil itra , P = 0.03 ) . Significantly more deaths of presumed fungal origin occurred in flu than itra ( seven versus nil , P = 0.024 ) . There were significantly more cases of proven aspergillosis in flu than itra ( six versus nil , P = 0.038 , 5/6 cases were fatal ) if those occurring outside the study period are included . Significantly more patients receiving flu required amphotericin B ( 58 v 39 , P = 0.043 ) but this may have been affected by the fact that the study was not blinded . There were 11 proven mucosal candidal infections in flu and four in itra . Itraconazole solution and fluconazole provide effective prophylaxis against Candida but itraconazole affords greater protection against fatal aspergillosis .

itraconazole

fluconazole

Fluconazole

Itraconazole

itraconazole oral solution

fluconazole

itraconazole ( itra )

fluconazole suspension ( flu )

Itraconazole

fluconazole

prevention of fungal infections

antifungal prophylaxis

proven systemic fungal infections

deaths of presumed fungal origin

aspergillosis

mucosal candidal infections

aspergillosis .

haematological malignancies

Adults


The effect of Cys LT1 receptor blockade on airway responses to allergen . STUDY OBJECTIVE To evaluate the effect of a potent experimental leukotriene receptor antagonist , MK-571 , on airway responses to inhaled allergen . DESIGN Randomized , double-blind , placebo-controlled , crossover trial . SETTING Clinical research center . SUBJECTS Eight male volunteers with allergic asthma . INTERVENTIONS An intravenous loading dose was followed by an 8-hour infusion of MK-571 or placebo , with a 7- to 14-day washout between treatments . Allergen challenge was performed after the loading dose and a histamine challenge was performed before and 24 hours after allergen . MEASUREMENTS AND MAIN RESULTS Forced expiratory volume in 1 second was measured serially . MK-571 provided about 50 % protection during maximum early and late responses compared with placebo ( p=0.005 ) , but airway obstruction persisted 8-24 hours after allergen on both treatment days . Airway responsiveness to histamine was not significantly attenuated at 24 hours . CONCLUSION Blocking Cys LT1 receptors for 8 hours attenuated the early and late responses but did not interrupt the cascade of events leading to subsequent allergen-induced airway obstruction and hyperreactivity .

Cys LT1 receptor blockade

placebo-controlled

8-hour infusion of MK-571

placebo

histamine

placebo

Forced expiratory volume

airway obstruction

Airway responsiveness

to

histamine

Eight

male

allergic asthma


Effect of guided imagery on length of stay , pain and anxiety in cardiac surgery patients .

guided imagery

length of stay

pain

anxiety

cardiac surgery patients


Barriers to hypertension care and control in young urban black men . Barriers to high blood pressure ( HBP ) care and control have been reported in the literature for > 30 years . Few reports on barriers , however , have focused on the young black man with HBP , the age/sex/race group with the highest rates of early severe and complicated HBP and the lowest rates of awareness , treatment , and control . In a randomized clinical trial of comprehensive care for hypertensive young urban black men , factors potentially associated with care and control were assessed at baseline for the 309 enrolled men . A majority of the men encountered a variety of barriers including economic , social , and lifestyle obstacles to adequate BP care and control , including no current HBP care ( 49 % ) , risk of alcoholism ( 62 % ) , use of illicit drugs ( 45 % ) , social isolation ( 47 % ) , unemployment ( 40 % ) , and lack of health insurance ( 51 % ) . Having health insurance ( odds ratio = 7.20 , P = .00 ) and a negative urine drug screen ( odds ratio = .56 , P = .04 ) were significant predictors of being in HBP care . Low alcoholism risk and employment were identified as significant predictors of compliance with HBP medication-taking behavior . Men currently using illicit drugs were 2.64 times less likely to have controlled BP compared with their counterparts who did not use illicit drugs , and men currently taking HBP medication were 63 times more likely have controlled BP compared with men not taking HBP medication . Comprehensive interventions are needed to address socioeconomic and lifestyle issues as well as other barriers to care and treatment , if HBP care is to be salient and effective in this high risk group .

Comprehensive interventions

high blood pressure

no current HBP care

risk of alcoholism

use of illicit drugs

social isolation

unemployment

lack of health insurance

Having health insurance

negative urine drug screen

Low alcoholism risk

employment

using illicit drugs

controlled BP

taking HBP medication

controlled BP

young urban black men .

young black man with HBP


Intra-luminal nicotine reduces smooth muscle tone and contractile activity in the distal large bowel . BACKGROUND Nicotine may be of therapeutic value in ulcerative colitis ( UC ) , although its mechanism of action has not been established . OBJECTIVE To examine the effect of a solution of nicotine on sustained resting pressure ( tone ) and contractile activity in the human colon . METHODS Ten healthy volunteers , and seven with UC in symptomatic remission took part ; all were non-smokers . All 17 subjects were given nicotine or placebo solution on two separate occasions in a randomized sequence . A water-perfused manometry catheter , with openings at 5 , 10 and 15 cm from the tip , was placed by rigid sigmoidoscopy in the recto-sigmoid region . Baseline tone and activity were measured for 15 min prior to instillation of 20 ml of saline alone or with nicotine , 1.2 mg , at pH 4.5 . Observations were made over the subsequent 15-20 min . RESULTS Baseline spontaneous activity in all subjects showed both high- and low-frequency components ; in three patients with UC , the low-frequency activity was of high amplitude . The nicotine reduced both tone and activity in all subjects , with reduction or abolition of the large contractions in UC . Tone in all 17 subjects was reduced significantly at 3 min after nicotine ( P = 0.000015 , sign test ) ; the rate of recovery varied in individuals . Results from normals and UC did not differ significantly from each other . No significant change in tone or activity was observed with the saline solution . CONCLUSION Intra-luminal nicotine significantly reduces both smooth muscle tone and contractile activity in the recto-sigmoid colon in both normal subjects and patients with UC .

nicotine

placebo

water-perfused manometry catheter

sigmoidoscopy

sustained resting pressure ( tone )

contractile activity

Baseline tone

activity

tone

activity

Tone

rate of recovery

tone

activity

ulcerative colitis ( UC )


A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer . Recombinant human TSH has been developed to facilitate monitoring for thyroid carcinoma recurrence or persistence without the attendant morbidity of hypothyroidism seen after thyroid hormone withdrawal . The objectives of this study were to compare the effect of administered recombinant human TSH with thyroid hormone withdrawal on the results of radioiodine whole body scanning ( WBS ) and serum thyroglobulin ( Tg ) levels . Two hundred and twenty-nine adult patients with differentiated thyroid cancer requiring radioiodine WBS were studied . Radioiodine WBS and serum Tg measurements were performed after administration of recombinant human TSH and again after thyroid hormone withdrawal in each patient . Radioiodine whole body scans were concordant between the recombinant TSH-stimulated and thyroid hormone withdrawal phases in 195 of 220 ( 89 % ) patients . Of the discordant scans , 8 ( 4 % ) had superior scans after recombinant human TSH administration , and 17 ( 8 % ) had superior scans after thyroid hormone withdrawal ( P = 0.108 ) . Based on a serum Tg level of 2 ng/mL or more , thyroid tissue or cancer was detected during thyroid hormone therapy in 22 % , after recombinant human TSH stimulation in 52 % , and after thyroid hormone withdrawal in 56 % of patients with disease or tissue limited to the thyroid bed and in 80 % , 100 % , and 100 % of patients , respectively , with metastatic disease . A combination of radioiodine WBS and serum Tg after recombinant human TSH stimulation detected thyroid tissue or cancer in 93 % of patients with disease or tissue limited to the thyroid bed and 100 % of patients with metastatic disease . In conclusion , recombinant human TSH administration is a safe and effective means of stimulating radioiodine uptake and serum Tg levels in patients undergoing evaluation for thyroid cancer persistence and recurrence .

Recombinant human TSH

administered recombinant human TSH

Radioiodine WBS

recombinant human TSH

recombinant TSH-stimulated

recombinant human TSH administration

thyroid hormone therapy

recombinant human TSH

thyroid hormone withdrawal

recombinant human TSH administration

recombinant TSH-stimulated

thyroid hormone withdrawal phases

serum Tg level

thyroid tissue

cancer

Two hundred and twenty-nine

adult


Effect of nitric-oxide-generating system on microcirculatory blood flow in skin of patients with severe Raynaud 's syndrome : a randomised trial . BACKGROUND Patients with Raynaud 's syndrome have abnormal digital vasoconstriction , which may be secondary to impaired synthesis of , or impaired sensitivity to , nitric oxide . We studied the effect on microcirculation of a nitric-oxide-generating system applied topically to the finger and forearm of healthy volunteers and patients with primary Raynaud 's syndrome . METHODS We did a single-blind , randomised , placebo controlled , cross-over study of the microcirculatory response to topical application of a nitric-oxidegenerating gel in 20 patients with severe Raynaud 's syndrome , and ten healthy volunteers . We prepared the nitric-oxide-generating system by mixing a solution of KY jelly and sodium nitrite ( 5 % weight/volume ) , with a solution of KY jelly and ascorbic acid ( 5 % weight/volume ) . About 0.5 mL of each solution was separately applied to the skin of the forearm ( 3 cm2 ) , and then mixed with a sterile cotton bud . A similar procedure was done simultaneously on the other arm with KY jelly only ( placebo ) . The procedure was then repeated on the finger pulps . Changes in skin microcirculatory volume and flux were measured bilaterally by infrared photoplethysmography and laser doppler fluxmetry , respectively . FINDINGS In the forearm , blood flow increased significantly after application of the active gel both in patients with Raynaud 's syndrome ( microcirculatory volume from mean area under the curve 98 [ SE 14 ] to 1024 [ 130 ] ; microcirculatory flux from 5060 [ 462 ] to 74,800 [ 3940 ] ) and in healthy controls ( volume from 85 [ 19 ] to 1020 [ 60 ] ; flux from 4420 [ 435 ] to 84,500 [ 7000 ] ) . In the fingers , although baseline blood flow was lower in patients than in controls , both groups showed increases with application of active gel ( volume from 1100 [ 194 ] to 3280 [ 672 ] and 2380 [ 441 ] to 6160 [ 1160 ] , respectively ; flux from 33,400 [ 4200 ] to 108,000 [ 13,600 ] and 52,000 [ 8950 ] to 185,000 [ 19,500 ] ) . Increases in blood flow with placebo gel were not significant . No adverse effects were reported . INTERPRETATION In primary Raynaud 's syndrome , topical application of a nitric-oxide-generating system can stimulate an increase in both microcirculatory volume and flux .

nitric-oxide-generating system

nitric-oxide-generating system

nitric-oxidegenerating gel

nitric-oxide-generating system

applied to the skin of the forearm

KY jelly only ( placebo )

nitric-oxide-generating system

microcirculatory blood flow

microcirculatory response

blood flow

baseline blood flow

flux

blood flow

microcirculatory volume and flux .


Comparison of antiresorptive activities of ipriflavone , an isoflavone derivative , and elcatonin , an eel carbocalcitonin . Thirty postmenopausal women with reduced bone mineral density were divided randomly into two groups based on the chronological sequence of their first visit to the Osteoporosis Clinic of Katsuragi Hospital . Group I was given 600 mg ipriflavone orally daily and group II was weekly injected intramuscularly with 20 units elcatonin , Asu1-7 eel calcitonin ( carbocalcitonin ) . Lumbar spine BMD was measured by dual-energy X-ray absorptiometry , and trabecular bone mineral density at the distal radius , cortical bone density , and relative cortical volume at the radial diaphysis by peripheral computed tomography before the beginning of the study and at the 4th , 8th , and 12th month . Markers of bone metabolism -- serum total alkaline phosphatase , bone-specific alkaline phosphatase , tartrate-resistant acid phosphatase , osteocalcin , intact osteocalcin , PICP and ICTP , and urinary pyridinoline , deoxypyridinoline , and calcium/creatinine ( Ca/Cr ) -- were also measured at the same interval . Plasma parathyroid hormone ( PTH ) and calcitonin ( CT ) were measured at the same time . Radial trabecular bone density showed a significantly higher rate of increase in group I ( ipriflavone group ) than in group II ( elcatonin group ) at the 4th month , whereas lumbar spine BMD showed more pronounced increase in the elcatonin group than in the ipriflavone group throughout the study period . Bone metabolism markers tended to decline in both groups . Total and intact osteocalcin showed a significant fall from the baseline throughout the study period only in the ipriflavone group . Urine pyridinoline and deoxypyridinoline showed a significant fall from the baseline at the 12th month only in the ipriflavone group . On comparing bone gainers with increase of lumbar spine BMD by 2 % or more with bone losers with a decrease by 2 % or more , only urine Ca/Cr was significantly different , lower in the former than in the latter , despite the general tendency for bone resorption markers to decrease in bone gainers and to increase in bone losers .

ipriflavone

isoflavone

elcatonin

eel carbocalcitonin

ipriflavone

Lumbar spine BMD

trabecular bone mineral density

cortical bone density

relative cortical volume

Radial trabecular bone density

lumbar spine BMD

Bone metabolism markers

Total and intact osteocalcin

lumbar spine BMD

urine Ca/Cr

Thirty

postmenopausal

women

reduced bone mineral density

Osteoporosis


Lack of benefit of a single dose of synthetic human secretin in the treatment of autism and pervasive developmental disorder . BACKGROUND Secretin is a peptide hormone that stimulates pancreatic secretion . After recent publicity about a child with autism whose condition markedly improved after a single dose of secretin , thousands of children with autistic disorders may have received secretin injections . METHODS We conducted a double-blind , placebo-controlled trial of a single intravenous dose of synthetic human secretin in 60 children ( age , 3 to 14 years ) with autism or pervasive developmental disorder . The children were randomly assigned to treatment with an intravenous infusion of synthetic human secretin ( 0.4 microg per kilogram of body weight ) or saline placebo . We used standardized behavioral measures of the primary and secondary features of autism , including the Autism Behavior Checklist , to assess the degree of impairment at base line and over the course of a four-week period after treatment . RESULTS Of the 60 children , 4 could not be evaluated - 2 received secretin outside the study , and 2 did not return for follow-up . Thus , 56 children ( 28 in each group ) completed the study . As compared with placebo , secretin treatment was not associated with significant improvements in any of the outcome measures . Among the children in the secretin group , the mean total score on the Autism Behavior Checklist at base line was 59.0 ( range of possible values , 0 to 158 , with a larger value corresponding to greater impairment ) , and among those in the placebo group it was 63.2 . The mean decreases in scores over the four-week period were 8.9 in the secretin group and 17.8 in the placebo group ( mean difference , -8.9 ; 95 percent confidence interval , -19.4 to 1.6 ; P=0.11 ) . None of the children had treatment-limiting adverse effects . After they were told the results , 69 percent of the parents of the children in this study said they remained interested in secretin as a treatment for their children . CONCLUSIONS A single dose of synthetic human secretin is not an effective treatment for autism or pervasive developmental disorder .

synthetic human secretin

Secretin

secretin

secretin injections

placebo-controlled

synthetic human secretin

saline placebo .

secretin

placebo

secretin

secretin

placebo

secretin

secretin

human secretin

mean decreases in

scores

treatment-limiting adverse effects

not an effective treatment

autism

pervasive developmental disorder

autistic disorders

children

3 to 14 years