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PubMed1998

Comparison of clinically directed, disease specific, and syndromic protocols for the management of genital ulcer disease in Lesotho.

OBJECTIVE: To evaluate two protocols for the syndromic management of genital ulcer disease (GUD) in Lesotho, southern Africa and to compare the performance of these protocols with that of a conventional disease specific approach. METHODS: A cross sectional study was conducted among consecutive patients with GUD attending an STD clinic in Maseru, Lesotho. The clinical diagnoses were made by using predefined criteria at the initial visit before the performance of laboratory tests. Attempts were made to detect the specific aetiology of the genital ulcers using PCR assays and syphilis serology. The results of PCR assays and syphilis serology were used as the gold standard against which the performance of the management approaches were applied. RESULTS: Of 100 patients initially recruited into the study, Haemophilus ducreyi infection was detected in 56%, herpes simplex virus in 26%, Treponema pallidum in 23%, and lymphogranuloma venereum in 7%. No pathogens were detected in 6% of patients. 17% of patients had mixed infections. Sensitivity, specificity, positive and negative predictive values of the three management protocols for GUD were compared after applying each to the study population. Theoretically, the lowest correct treatment rate would have been obtained by using the disease specific protocol (62%) compared with more than 90% in both syndromic management protocols. Considerable overtreatment for primary syphilis would occur following application of both syndromic protocols. This would be the result of the overdiagnosis of chancroid, in particular the misdiagnosis of genital herpes as chancroid, which would receive treatment for syphilis unnecessarily. The HIV seroprevalence among these patients was 36%. A significantly higher rate of HIV seropositivity was detected among the patients with herpes simplex virus infection when compared with those patients having other causes of genital ulcer disease (58% v 27%; odds ratio 3.73; 95% CI 1.26-11.26; p = 0.01). CONCLUSIONS: Poor sensitivity, specificity, and predictive values were recorded when the disease specific protocol was applied to the study population. In contrast, the syndromic management protocols provided adequate treatment for more than 90% of patients with GUD. Protocol C, which identified a minority of cases of genital herpes, was found to have an advantage when compared with protocol B (all patients with genital ulcer disease treated for both syphilis and chancroid) in that 29% of genital herpes cases would receive appropriate counselling.

Chancroid↗

PubMed1984

[Protocols for the treatment of leukemia and lymphoma: toward escalation or toward reduction of degree?].

The present AML protocol which only applies one anthracycline associated with arabinosyl-cytosine gives a first remission plateau of 65% and a 75% survival plateau at five years. Contrary to other teams, we do not apply the allogenic bone marrow graft at the first remission but at the second one. The new protocol comprises application of two anthracyclines, adriamycin and aclacinomycin, a possible autologous bone marrow graft at first remission upon reinforcement, a combination of methotrexate and thioguanine as maintenance chemotherapy and immunotherapy with bestatine. The two protocols respectively applied to the ALL good prognosis and reserved prognosis, give 85% global survival. The autologous bone marrow graft is added at first remission to B or T forms or voluminous CALLA + types. The advantage of CNS radiotherapy is compared with its disadvantages. Bestatine is employed in immunotherapy. The immunoprevention protocol applied to CML blastic crisis (vaccination with a pool of CB blasts) from the second year has prolonged survival of patients suffering from this affection and also treated by splenectomy and hydroxyurea. Allogeneic or autologous bone marrow graft is added to the protocol. The same protocol is applied to not very aggressive LLC and LNH (lymphocytic and centrofollicular with small cleaved nucleus cells) and includes maximum remission induced by chemotherapy followed by immunotherapy (by thymuline and then, if immunity disorders are not corrected, by zinc, then bestatine and finally tuftsin). A similar sequence was applied to the myeloma, comprising MLP-PDN-CPM chemotherapy to induce remission, combination of MLP-PDN and CPM and, if there is resistance, CLB, 6-TG, PDN and TNP. Interferon is appropriate with certain cytopenic forms. A protocol comprising VCR, ADM, PDN, CPM and TNP is applied to centrofollicular NHL with small non cleaved nucleus cells or large cells. As Hoerni and Jones have obtained significant benefits with BCG, its terminal application is compared with that of bestatine. Finally a less mutagenic protocol than MOPP and/or ABVD is proposed for Hodgkin's disease. In this protocol, two cycles alternate, and they combine: a) firstly VCR, PDN, THP-ADM and VPS, and b) secondly VLB, DXM, ACM and TNP with alternatively BLM and PPM between the cycles. This chemotherapy is followed by the same immunorestoration protocol as that applied to LLC and myeloma.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1993

Pharmacy-managed, weight-based heparin protocol.

A revised protocol for heparin therapy, in which dosing was based on the patient's weight and the pharmacy staff assumed responsibility for management of the treatment protocol, was evaluated. A fixed-dose protocol for heparin therapy, in which an initial loading dose and infusion rate were specified by physicians and partial thromboplastin times (PTTs) were determined every 12 hours, was revised to determine dosing based on patient weight and diagnosis and to include more levels of dose adjustment and additional laboratory tests. Data on demographic characteristics of patients, heparin therapy, laboratory monitoring, conversion to warfarin therapy, and protocol management were collected for the patients receiving heparin under the revised protocol. Results were compared with those obtained for the old, fixed-dose protocol, which was managed by nursing staff. The revised protocol showed improvements in heparin therapy according to commonly accepted treatment criteria, including dosages, time to achieve a PTT associated with therapeutic anticoagulation, and the time a patient was in the target PTT range. The new protocol was also significantly more effective in avoiding low as well as high PTT ratios. The laboratory monitoring mandated by the revised protocol enhanced the monitoring of heparin therapy, and pharmacy management improved the accuracy and documentation of heparin therapy. Under the revised protocol, anticoagulation goals were attained more rapidly, and dosing changes were more likely to be correct and appropriately documented.

Adult↗

PubMed2002

Publishing protocols of systematic reviews: comparing what was done to what was planned.

CONTEXT: Publication of research protocols minimizes bias by explicitly stating a priori hypotheses and methods without prior knowledge of results. METHODS: We conducted a retrospective comparative study to assess the extent to which the content of published Cochrane reviews had changed compared with their previously published protocols and to assess any potential impact these changes may have had in introducing bias to the study. We identified previously published protocols for new Cochrane reviews appearing in The Cochrane Library; 2000, issue 3. The texts of published protocols and completed reviews were compared. Two raters independently identified changes to the different sections of the protocol and classified the changes as none, minor, or major. RESULTS: Of the 66 new Cochrane reviews, we identified a previously published protocol for 47 reviews. Of these, 43 reviews had at least 1 section that had undergone a major change compared with the most recently published protocol. The greatest variation between protocols and reviews was in the methods section, in which 68% of reviews (n = 32) had undergone a major change. Changes made in other sections that may have resulted in the introduction of bias included narrowing of objectives, addition of comparisons or new outcome measures, broadening of criteria for the types of study design included, and narrowing of types of participants included. CONCLUSIONS: Research protocols, even if published, are likely to remain, at least to some extent, iterative documents. We found that a large number of changes were made to Cochrane reviews, some of which could be prone to influence by prior knowledge of results. Even if many of the changes between protocol and review improve the overall study, the reasons for making these should be clearly identified and documented within the final review.

Evidence-Based Medicine↗

PubMed2002

The effect of measurement protocol on active cervical motion in healthy subjects.

BACKGROUND AND PURPOSE: Although the assessment of cervical motion is routinely performed in clinical practice, no standard protocol for this procedure has ever been established formally. The specific aim of the present study was to select from four different measurement protocols the one which was most stable in terms of reproducibility and was appropriate for clinical and/or medicolegal applications. METHOD: A repeated measurement, test-retest of cervical motion study design using an ultrasound-based system for three-dimensional (3D) motion analysis; cervical range of motion was measured along the six primary directions: flexion; extension; right and left rotation; and right and left lateral flexion, in 20 healthy subjects who were tested twice over a period of lasting from one to four weeks. 'Protocol A' (reciprocal--intermittent testing) consisted of moving the head along a given primary direction, return to the neutral position, a pause and then motion to the opposite primary direction and return to neutral position. These movements were repeated three times. 'Protocol B' (reciprocal--continuous testing) was identical to Protocol A, but without the pause between the primary directions. 'Protocol C' consisted of three repetitions of the same primary direction with a break between two consecutive primary directions. Three sets of six randomly ordered primary directions constituted 'Protocol D'. RESULTS: Protocol D was associated with a significantly smaller range of motion and with the least intra-test reproducibility, as indicated by the coefficient of variation. The differences between the other protocols were largely negligible. CONCLUSION: In routine clinical practice, either of protocols A, B or C may be applied.

Adult↗

PubMed2004

Hormonal responses to three training protocols in rowing.

The aim of this study was to examine the acute responses of serum growth hormone, testosterone, and cortisol to three training protocols in rowing. Six young rowers, members of the national team, carried out three frequently used protocols in rowing, i.e., an endurance, a moderate interval, and a resistance protocol, on separate days in a counterbalanced design. Blood samples were collected before, immediately after, and 4 h after exercise for the determination of growth hormone, testosterone, cortisol, and creatine kinase. All three protocols caused marked increases in growth hormone, the most spectacular being that immediately after the endurance protocol. The change in testosterone concentration immediately after the endurance protocol was significantly higher than the changes after the other two protocols. Cortisol concentration was significantly higher immediately after the endurance protocol than after the other two protocols, but remained relatively low in all cases, suggesting that these protocols did not considerably promote catabolism in muscle tissue. Based on these data, endurance training caused greater responses of the three hormones studied compared to interval or resistance training. In fact, resistance training (at intensities above 85% of 1RM) did not cause any significant changes in the three hormones. We therefore propose that evaluation of training programmes designed for elite athletes should include measurements of hormonal changes in order to ascertain that the programmes do cause the expected adaptations.

Adaptation, Physiological↗

PubMed1994

In situ and suspension protocols for chemically-induced mutation at the tk locus in L5178Y MOLY cells: dose response and colony size distribution.

We used EMS up to concentrations of 0.25 microliters/ml (292 micrograms/ml) to induce mutations at the tk locus in L5178Y MOLY cells, measured the cellular response by the in situ mutation assay protocol and compared these results to those obtained in a concomitant suspension assay. EMS induced mutagenic responses with both protocols. The mutant fraction for the solvent control was 89 mutants per million viable colonies for the suspension protocol and 426 mutations per million viable cells plated for the in situ protocol. These numbers increase to 447 and 2073 respectively, with 0.25 microliter/ml EMS treatment. Sizing curves indicated that the in situ protocol detected a greater proportion of smaller colonies than did the suspension protocol. Not only were the number of small colonies greater than large colonies in the in situ protocol, but their rate of increase was also slightly higher than that of the large colonies. The in situ protocol also reduces the time and cost of experimentally performing the assay compared to the suspension protocol. In this paper we compare the use of the suspension and in situ protocols to measure chemically-induced mutations and demonstrate that the latter method detects a larger fraction of induced mutations at the tk locus in L5178Y MOLY cells.

Animals↗

PubMed1999

Exercise testing: improving performance with a ramped Bruce protocol.

BACKGROUND: The standard Bruce protocol was compared with a ramped Bruce protocol in stress testing of a general population of patients. METHODS: We examined hemodynamic responses, test duration, and patient comfort with each exercise protocol. Twenty-three patients completed the study, 14 men and 9 women with a mean age of 51 +/- 12 years. Each patient completed the 2 treadmill protocols in a random manner. RESULTS: Mean peak heart rate, systolic blood pressure, and rating of perceived exertion according to the revised Borg scale were equivalent in both protocols, measuring 157 +/- 15 beats/min, 170 +/- 22 mm Hg, and 8 +/- 1 for the Bruce and 158 +/- 17 beats/min, 175 +/- 20 mm Hg, and 8 +/- 1 for the ramp protocol (P = NS). Duration of test and metabolic equivalents (METs) were greater with the ramp than with the Bruce protocol. For the Bruce duration and METs were 8:25 +/- 3:00 min and 9.6 +/- 3.1, and for the ramp 10:01 +/- 2:32 min and 11.4 +/- 2.7 (P <.0001 for both). Subjective rating of difficulty was assessed on a scale of 1 to 5, 1 being the most difficult and 5 being the easiest. Rating for the Bruce protocol was 2.5 +/- 0.9 and for the ramp 4.1 +/- 0.9 (P <.0001). CONCLUSION: We propose that a ramped modification of the Bruce protocol achieves equivalent hemodynamic goals but with better duration. Patients preferred the ramp with respect to comfort, and exercise data can be correlated easily with standard protocols.

Adult↗

PubMed1999

Maternal and neonatal infection rates with three different protocols for prevention of group B streptococcal disease.

OBJECTIVES: We compared maternal and neonatal infection rates under 3 different group B streptococcal prevention strategies and also evaluated reasons for each protocol's failures in preventing neonatal disease. STUDY DESIGN: Women who were delivered at our center from August 1, 1991, through April 30, 1998, were managed by 1 of 3 protocols for prevention of early-onset neonatal group B streptococcal infection: a selective screening protocol, The American College of Obstetricians and Gynecologists protocol, and the Centers for Disease Control and Prevention-recommended universal screening strategy. We compared maternal infection rates and neonatal group B streptococcal infection rates under each protocol. We also compared reasons for each protocol's failures in preventing neonatal infection. RESULTS: Clinical chorioamnionitis rates were 7.4% with selective screening, 7.7% under The American College of Obstetricians and Gynecologists' protocol, and 5.2% with universal screening (relative risk 0.7, 95% confidence interval 0.6-0.8). Endometritis rates were 4.0% with selective screening, 4.6% with The American College of Obstetricians and Gynecologists protocol, and 2. 8% with universal screening (relative risk 0.7, 95% confidence interval 0.6-0.8). Overall neonatal group B streptococcal infection rates were lower under the 2 more recent strategies, but not significantly so. Despite the ability of universal screening to find more women at risk for group B streptococcal transmission, half of the neonatal infections under this protocol occurred when the mothers were not considered candidates for prophylaxis. CONCLUSIONS: The Centers for Disease Control and Prevention-endorsed universal screening strategy for group B streptococcal infection prevention was associated with significantly lower rates of clinical chorioamnionitis and endometritis than were the other strategies. We were unable to document statistically significant improvement in neonatal outcome under the universal screening protocol.

Anti-Bacterial Agents↗

PubMed1998

Effect of anticoagulation protocol on outcome in patients undergoing CABG with heparin-bonded cardiopulmonary bypass circuits.

BACKGROUND: We have demonstrated that the use of heparin-bonded cardiopulmonary bypass circuits (HBCs) combined with a lower anticoagulation protocol as an adjunct to an integrated blood conservation strategy decreases the incidence and magnitude of homologous transfusion and improves clinical outcome in patients undergoing primary coronary artery bypass grafting. It is not known whether it is the lower anticoagulation protocol that influences outcome in patients treated with HBCs. Furthermore, the thrombogenic risk of using lower anticoagulation with HBCs still is debated. METHODS: To answer these questions, a prospective randomized study was conducted in which 244 patients undergoing primary coronary artery bypass grafting were treated with HBCs and randomized to undergo either a full (activated clotting time, > 450 seconds) or a lower (activated clotting time, > 250 seconds) anticoagulation protocol. In addition to clinical outcome, levels of thrombin generation markers during and after cardiopulmonary bypass were assessed in a consecutive subset of 58 patients (full anticoagulation profile = 28, lower anticoagulation profile = 30) by measuring thrombin-antithrombin complexes and prothrombin fragment 1.2. Levels of these markers also were correlated with the activated clotting time during cardiopulmonary bypass. RESULTS: Preoperative and intraoperative risk profiles and other characteristics were similar in both groups, with more than 60% of patients undergoing nonelective operation. Compared with the full anticoagulation protocol group, patients in the lower anticoagulation protocol group were less likely to require blood products (24.2% versus 35.8%, respectively; p = 0.047) and received substantially fewer homologous donor units (0.50 +/- 0.92 versus 1.08 +/- 2.10 U, respectively; p = 0.005). Clinical outcomes were uniformly outstanding (but similar) in both treatment groups, with a modest reduction in the length of the hospital stay in the lower anticoagulation protocol group (5.26 +/- 1.23 versus 5.63 +/- 1.73 days, respectively; p = 0.05). The use of HBCs with a lower anticoagulation protocol was not associated with any adverse clinical events. Thrombin generation increased during cardiopulmonary bypass in both treatment groups, but was unrelated to the anticoagulation protocol or the activated clotting time (r2 = 0.03). No differences between the full and lower anticoagulation protocol groups were noted in the number of microemboli detected by transcranial Doppler analyses during cardiopulmonary bypass (n = 40) or in the postoperative neurologic and neuropsychologic outcomes (n = 30). CONCLUSIONS: This study definitively demonstrates that, when used appropriately, patients who are treated with HBCs and a lower anticoagulation protocol have a lower incidence and magnitude of homologous transfusion and are not at any added risk for clinical, hematologic (thrombin-antithrombin complex and fragment 1.2 measurements), or microscopic (transcranial Doppler analyses) thromboembolic complications or for neurologic or neuropsychologic deficits.

Aged↗

PubMed2000

A prospective, randomized controlled trial comparing the efficacy of recombinant follicle-stimulating hormone in three different in vitro fertilization protocols.

OBJECTIVE: To compare the following IVF protocols: a short protocol and long protocols starting on day 2 or day 21. All protocols used recombinant FSH (rFSH) for ovarian stimulation. DESIGN: Prospective, randomized study. SETTING: An assisted reproduction unit at a university center. PATIENT(S): Patients undergoing IVF (n = 150) were treated according to one of the three treatment protocols allocated by a random method. INTERVENTION(S): All patients used buserelin acetate and rFSH. Patients began the long protocol on day 2 (group 1) or day 21 (group 2) of the cycle. Patients in group 3 began the short protocol on day 2 of the cycle. MAIN OUTCOME MEASURE(S): Ovarian response, implantation rates, and pregnancy rates (PRs). RESULT(S): Patients treated with the short protocol (group 3) were stimulated in a shorter time, required less rFSH, and achieved higher E(2) levels. The numbers of follicles, oocytes, and embryos were similar in all three groups. The implantation rates were similar in groups 1 and 2 (11.8% and 13.3%, respectively), and both were higher than in group 3 (4.1%). Clinical PRs per oocytes retrieved were 19.6%, 18.6%, and 8.3% in groups 1, 2, and 3, respectively. CONCLUSION(S): The implantation rate was significantly higher with the long protocols than with the short protocol, with a tendency for a higher PR as well.

Adult↗

PubMed2000

Assessing the value of structured protocols for forensic interviews of alleged child abuse victims.

OBJECTIVE: To evaluate the effectiveness of a structured interview protocol (NICHD Investigative Interview Protocol) operationalizing universally recommended guidelines for forensic interviews. METHOD: The NICHD Investigative Protocol was designed to maximize the amount of information obtained using recall memory probes, which are likely to elicit more accurate information than recognition memory probes. Forensic investigators were trained to use the NICHD protocol while conducting feedback-monitored simulation interviews. The utility of the protocol was then evaluated by comparing 55 protocol interviews with 50 prior interviews by the same investigators, matched with respect to characteristics likely to affect the richness of the children's accounts. The comparison was based on an analysis of the investigators' utterance types, distribution, and timing, as well as quantitative and qualitative characteristics of the information produced. RESULTS: As predicted, protocol interviews contained more open-ended prompts overall as well as before the first option-posing utterance than non-protocol interviews did. More details were obtained using open-ended invitations and fewer were obtained using focused questions in protocol interviews than in non-protocol interviews, although the total number of details elicited did not differ significantly. In both conditions, older children provided more details than younger children did. CONCLUSION: The findings confirmed that implementation of professionally recommended practices affected the behavior of interviewers in both the pre-substantive and substantive phases of their interviews and enhanced the quality (i.e., likely accuracy) of information elicited from alleged victims.

Adolescent↗

PubMed2003

Development of a job-specific FCE protocol: the work demands of hospital nurses as an example.

Musculoskeletal disorders often result in employee disability leaves and sickness-related absenteeism in the workplace. Professional evaluations of an employee's capacity to work require additional support by means of Functional Capacity Evaluation (FCE) methods. However, most FCE methods assess general physical capacity and, because of fixed test procedures, testing times range between 4 and 6 h for up to several days. For return to work (vocational rehabilitation), the tests need to reflect the employees' specific work demands more precisely. This study aims to develop a job-specific FCE protocol on the Ergos Work Simulator for hospital nurses. In developing the contents of this specific protocol, hierarchical task analyses were performed with 20 nurses in four departments of a university medical center. A job-specific test protocol was developed that consisted of five steps. In this process, the original test protocol was analyzed first. Secondly, categorization of physical risk factors for work-related musculoskeletal disorders revealed 16 possible combinations of activity, posture, and load. Finally, duration and frequencies during one working day of these combinations were coupled to the Ergos test panels. The nurse-specific test protocol lasts 90 min. It was possible to develop a job-specific protocol, using on-site observations as the input. Compared to the original Ergos protocol, the external validity of the new job-specific protocol has improved: it simulates the functional capacity that nurses need to perform their job in a realistic way. The testing time of the original Ergos protocol is four times longer compared to the new job-specific protocol.

Computer Simulation↗

PubMed1999

Reliable noninvasive genotyping based on excremental PCR of nuclear DNA purified with a magnetic bead protocol.

A new protocol for extraction of DNA from faeces is presented. The protocol involves gentle washing of the surface of the faeces followed by a very simple DNA extraction utilizing the wash supernatant as the source of DNA. Unlike most other protocols, it does not involve the use of proteinase K and/or organic extraction, but is instead based on adsorption of the DNA to magnetic beads. The protocol was tested by microsatellite genotyping across six loci for sheep and reindeer faeces. Comparison with DNA extracted from blood demonstrated that the protocol was very reliable, even when used on material stored for a long time. The protocol was compared with another simple, solid-phase DNA-binding protocol, with the result that the bead-based protocol gave a slightly better amplification success and a lower frequency of allelic drop-outs. Furthermore, our experiments showed that the surface wash prior to DNA extraction is a crucial step, not only for our protocol, but for other solid-phase protocols as well.

Animals↗

PubMed2005

Serum luteinizing hormone, follicle-stimulating hormone and oestradiol pattern in women undergoing pituitary suppression with different gonadotrophin-releasing hormone analogue protocols for assisted reproduction.

Gonadotrophin-releasing hormone analogues (GnRH-a) are used widely in controlled ovarian stimulation (COS) cycles for assisted reproduction. At present, there is great debate about the influence of exogenous hormone activity on the hypothalamus-pituitary axis following pituitary desensitization. The objective of this comparative study was to investigate the pattern of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and oestradiol in women undergoing ovarian stimulation with different GnRH-a preparations. We retrospectively analysed 201 women, aged between 27 and 43 years, who were referred consecutively to our infertility clinic between January 2002 and January 2003. All women had no endocrinopathies or occult ovarian failure as assessed by day-3 hormone profile. Women were enrolled in one of the following COS protocols: depot triptorelin long protocol (n = 38), buserelin long protocol (n = 101) or buserelin short protocol (n = 62). Recombinant FSH was used to induce ovulation. Treatment was monitored by transvaginal ultrasound scan and serum measurement of FSH, LH and oestradiol. Among the women initially included, 30 had cancelled cycles due to poor ovarian response. Serum LH levels were significantly higher in the short-protocol group compared with the long-protocol groups (p < 0.001). The number of follicles, oocyte yield, number of grade-I embryos and fertilization rate were significantly lower in the short-protocol group than in the long-protocol groups. These findings showed that LH concentrations are significantly higher in women undergoing reversible medical hypophysectomy with a GnRH-a short protocol than in women treated with a long protocol. The hypothesis of an LH ceiling is confirmed.

Adult↗

PubMed1997

Gas exchange and neurohumoral response to exercise: influence of the exercise protocol.

Maximal oxygen uptake varies with the exercise protocol, but the extent to which hormonal and metabolic responses to exercise are influenced by the exercise protocol has not been precisely defined. Twelve healthy subjects underwent maximal exercise testing using two incremental bicycle tests with individualized, identical work rate increments between 40 and 70 W. One protocol employed a 1-min and the other a 3-min duration per stage. Expiratory gas and venous blood were sampled at regular intervals for metabolic and hormonal analysis. Exercise duration for the 1-min and 3-min protocols was 6.0 +/- 0.1 and 14.3 +/- 0.3 min, respectively (P < 0.001). Significantly higher values were observed for peak VO2 and maximal ventilation during the 3-min protocol compared with the 1-min protocol (41.1 +/- 1.8 vs 38.3 +/- 1.6 ml.kg-1.min-1, P < 0.001; and 104.9 +/- 8.0 vs 97.2 + 5.7 l.min-1, P < 0.05, for peak VO2 and peak ventilation, respectively). However, the maximal workload achieved was higher during the 1-min versus the 3-min protocol (330 + 24 vs 280 + 21 W, P < 0.01). No differences were observed for maximal heart rate or blood pressure, whereas maximal plasma lactate was roughly twice as high during the 3-min compared with the 1-min protocol (7.5 +/- 0.8 vs 3.8 +/- 0.5 mmol.l-1, P < 0.001). Norepinephrine, epinephrine, dopamine, and growth hormone levels were generally higher throughout exercise during the 3-min compared with the 1-min protocol. When expressed as a percentage of peak VO2, however, differences in catecholamine levels were not observed. Endothelin levels did not change. We conclude that the exercise protocol profoundly influences exercise capacity as well as the metabolic and hormonal response to exercise and should be considered when using these variables to evaluate an intervention.

Adult↗

PubMedDate not supplied

Multidetector CT urography: comparison of two different scanning protocols for improved visualization of the urinary tract.

The goal of this study was to evaluate different CT scanning protocols on the depiction of the urinary tract by multidetector CT. The authors retrospectively reviewed 55 consecutive patients who underwent CT scanograms. Two groups of patients were included: renal donors (n=29) and hematuria patients (n=26). For the renal donor protocol, 120 mL of iodinated contrast was injected and a CT scanogram was obtained after a 5-minute delay. For the hematuria CT urography protocol, 100 mL of contrast was followed by a 250 mL normal saline drip and CT scanograms acquired after an 8-minute delay. Urinary tracts from both imaging protocols were then divided into four segments and evaluated by consensus reading of two experienced radiologists rated on a scale of 0 to 2. Complete visualization of the renal pelvis and the proximal, middle, and distal ureter for the renal donor protocol was noted to be 86%, 57%, 45%, and 52% and for that of the CT urography protocol to be 75%, 65%, 40%, and 44%, respectively. Comparing scanograms of the renal donor protocol and the CT urography protocol, there was no statistically significant difference in the depiction of renal pelvis or the proximal, middle or distal ureteral region (P=0.1625, 0.3226, 0.8636, and 0.6145, respectively). The study demonstrates that there is no significant difference between the CT urography protocol and the renal donor protocol in the depiction of the urinary tract.

Contrast Media↗

PubMed2004

Comparison of three different diuretic renal scintigraphy protocols in patients with dilated upper urinary tracts.

PURPOSE: To compare 3 different diuretic renal scintigraphy protocols in patients with dilated upper urinary tract. MATERIALS AND METHODS: Three diuresis renography protocols were performed in 22 adult patients (28 kidneys) with upper urinary tract dilatation. The diuretic was given 20 minutes after (F+20), at the same time as (F+0), and 15 minutes before (F-15) radionuclide administration. The mean age was 29.8 years (range, 18-43 years). The 3 protocols were identical, except for the time of injection of furosemide. The F+0 protocol could not be performed in 1 and F-15 in 2 of the patients. Each of the 3 protocols was performed for the rest of the patients. The results were classified as nonobstructive, equivocal, and obstructive according to the renogram images and curves. RESULTS: None of the patients showed equivocal results in both F+0 and F-15 protocols. In the F+20 studies, 7 of the 28 kidneys were evaluated as equivocal. Of these, 5 kidneys showed nonobstructive and 2 kidneys revealed obstructive renogram patterns with the other 2 protocols (F+0 and F-15). Moreover, one kidney, which was evaluated as nonobstructive in the F+20 protocol, showed an obstructive pattern in both F+0 and F-15 protocols. All of the kidneys showing obstructive patterns in the F+20 study also revealed obstruction in the F+0 and F-15 investigations. We could not find any difference between the renogram patterns of F+0 and F-15 investigations. CONCLUSIONS: F+0 and F-15 protocols allow clarification in cases of equivocal F+20 studies. Because the F+0 study is more practical and shorter, we suggest the F+0 method when equivocal results are obtained by an F+20 study or as a single test when there is only one opportunity to confirm or exclude the presence of obstruction.

Adolescent↗