When to stop a clinical trial.
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Biomedical subjects
Publications and source records attributed to E J Neale.
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Clinical flow charts or algorithms are becoming an increasingly popular means of summarizing the management of a given clinical situation. However they vary greatly in complexity between authors, making comparisons difficult, and detracting from their overall usefulness to medical personnel. We have therefore reviewed the strengths and weaknesses of many published algorithms. As a result of both this and our own experience with clinical algorithms we have identified seven essential elements of clinical management. We believe that acceptance of these elements would improve the efficiency of clinical algorithms, both as a teaching format and as an aid to clinical management.
Two patients with obstructive uropathy as a result of post menopausal endometriosis are reported. They both illustrate the potential problems of hormone replacement therapy after bilateral salpingo-oophorectomy and hysterectomy in patients who have had extensive endometriosis. It is suggested that in such patients the potential of reactivation of the disease with hormone-replacement therapy should be recognised and ureteric involvement be excluded by intravenous urography or renograms.
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The serum haptoglobin concentration was measured by rate nephalometry in 56 patients with invasive carcinoma of the cervix, and in 24 women with no evidence of cervical pathology who served as control subjects. There was a significant difference in the mean serum haptoglobin concentration (p less than 0.005) between the 2 groups of patients. However there was no significant correlation between the serum haptoglobin concentration and the clinical stage of the disease. From our data we propose that a serum haptoglobin concentration greater than 96 mg/dl is suggestive of invasive carcinoma of the cervix, and that this may be used as additional investigation in the initial assessment of such patients.
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