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At least 793 records · Page 44Linked to original sources

A randomized trial of the use of cocaine spray to provide pain relief during laser vaporization of the cervix.

In a double-blind trial, 50 patients undergoing laser vaporization of the cervix for cervical intraepithelial neoplasia were randomly allocated to one of two groups. One group had the cervix sprayed with 3-4 ml of a solution containing 10% cocaine, the other a placebo solution during the laser treatment. Women in the cocaine group had significantly less pain as assessed by a visual analogue scale (P less than 0.001) and by a verbal rating scale (P = 0.002). The cocaine group also had less blood loss (P = 0.001) as assessed subjectively by the operator.

Adult↗

Cyclosporine therapy for steroid-resistant nephrotic syndrome. A controlled study.

We have conducted a controlled trial on the efficacy of cyclosporine in eight patients with steroid-resistant nephrotic syndrome (four with idiopathic minimal lesion nephrotic syndrome and four with focal segmental glomerulosclerosis). Patients were randomly allocated to a cyclosporine (5 mg/kg/d) or a control group. After eight weeks of therapy and one month without cyclosporine therapy, patients in the control group were given cyclosporine for eight weeks and those in the cyclosporine group became controls. Before the initiation of treatment, there was no difference between the groups with regard to proteinuria and serum albumin levels. Proteinuria remained unchanged in the cyclosporine group, while there was a significant increase in proteinuria in the control group. There were no significant changes in serum albumin levels in either group during the trial. This study does not support the use of cyclosporine at the dose of 5 mg/kg/d in patients with steroid-resistant minimal lesion nephrotic syndrome or focal segmental glomerulosclerosis.

Adolescent↗

Approach to ingrowing toenails: the wedge resection/segmental phenolization combination treatment.

One hundred and seventy procedures were performed on one hundred and forty patients with ingrowing toenails. Each patient was randomly allocated to one of three treatment groups. There were 55 wedge resections (WR), 53 segmental phenolizations (SP) and 62 wedge resection/segmental phenolization combination treatments (WR/SP). All patients were followed up for 6 months. The duration and intensity of postoperative pain was assessed and the recurrence rate monitored. Postoperative pain was less in the WR/SP group (9.4 +/- 13.5 h) than in the WR group (30.0 +/- 37.6 h, P less than 0.001). There were seven recurrences in the WR group, four in the SP group, and none in the WR/SP group. The results in the WR/SP group were statistically significant when compared with the WR group (P less than 0.01) and with the SP group (P less than 0.05). We conclude that the WR/SP combination procedure is a superior form of treatment for ingrowing toenails.

Adolescent↗

A comparative study of conventional versus high-frequency jet ventilation with relation to the incidence of postoperative morbidity in thoracic surgery.

Sixty-five patients undergoing a thoracic procedure were randomly allocated to one of two groups. The first group received a conventional method of ventilation (double-lumen endobronchial tube and collapse of one lung) and the second, high-frequency jet ventilation (HFJV). The incidence of postoperative chest infections (clinical and bacteriological), the chest drain volumes, and the length of postoperative stay in the hospital were recorded. Results showed the jet ventilator group had a significantly reduced mean hospital stay (p less than 0.01), which could be attributed to a lower incidence of postoperative chest infections (p less than 0.001) and significantly improved arterial blood O2 tensions at 4 hours (p less than 0.05), 24 hours, and 7 days postoperatively (p less than 0.001).

Blood Gas Analysis↗

Cimetidine, 800 mg at night, in the treatment of duodenal ulcers.

One hundred and eight patients with endoscopically proven duodenal ulcers were randomly allocated to treatment with cimetidine, either 400 mg twice daily or 800 mg at night for 4 to 8 weeks in a double-blind study. There was no significant difference between the healing rates of the two groups. Thus, 45 of 52 (87%) healed on cimetidine twice daily and 43 of 51 (84%) healed on 800 mg at night after 4 weeks' treatment. The corresponding healing rates after 8 weeks were 51 of 52 (98%) and 50 of 51 (98%). The intensity of pain decreased more rapidly in the group treated with 800 mg cimetidine at night. These results indicate that 800 mg cimetidine at night is as good as 400 mg given twice daily.

Adolescent↗

Long-term controlled trial with diphosphonate in patients with osteolytic bone metastases.

Thirty-four normocalcaemic women with multiple osteolytic bone metastases from breast cancer were randomly allocated to treatment with disodium dichloromethylene diphosphonate (Cl2MDP) 1600 mg/day orally (17) or placebo (17) for 3-9 months. Fasting urinary hydroxyproline/creatinine and calcium/creatinine ratios declined in the Cl2MDP group but not in the placebo group. Four patients in the placebo group died from hypercalcaemia. New bone metastases were more common in patients on placebo and these patients also required more analgesic drugs than those on Cl2MDP. Cl2MDP seemed to reduce bone pain and bone resorption and prevent the development of hypercalcaemia caused by osteolytic metastases. The formation of new bone metastases and the growth of old ones seemed to be retarded by Cl2MDP.

Adult↗

A controlled study of the nephrotoxicity of mezlocillin and amikacin in the neonate.

The nephrotoxicity of the aminoglycoside amikacin sulfate was evaluated in an open, controlled study of newborns with presumed neonatal sepsis. One hundred twelve neonates were randomly allocated to receive either amikacin-ampicillin or mezlocillin, a semisynthetic penicillin. Neonates receiving amikacin, in contrast to those receiving mezlocillin, showed significant nephrotoxicity as evidenced by a delayed postnatal fall in mean serum creatinine level (82 to 80 mumol/L [0.93 to 0.90 mg/dL] vs 84 to 72 mumol/L [0.95 to 0.82 mg/dL]) and a delayed postnatal rise in mean creatinine clearance per kilogram of body weight (12% vs 38%). Furthermore, 40% of neonates receiving amikacin-ampicillin compared with 19% of neonates receiving mezlocillin had a decline in creatinine clearance (greater than 25%). There was no relationship between amikacin nephrotoxicity and either peak or trough amikacin levels. In summary, in a controlled study of the use of amikacin and mezlocillin in neonates, the combination of amikacin and ampicillin proved more nephrotoxic to the newborn kidney.

Amikacin↗

Cotreatment with human growth hormone and gonadotropins for induction of ovulation: a controlled clinical trial.

A randomized, double-blind, placebo-controlled trial of cotreatment with biosynthetic, human sequence, growth hormone (GH), and human menopausal gonadotropins (hMG) for induction of ovulation was performed in 16 women with amenorrhea and anovulatory infertility. Patients were randomly allocated to treatment with hMG + GH (24 IU on alternate days, total dose 144 IU) or hMG + placebo. Those who received placebo were given GH in a subsequent course of treatment. On cotreatment with GH compared with placebo, there was a significant reduction in the required dose of hMG, duration of treatment, and the daily effective dose of gonadotropins. Serum insulin-like growth factor-I (IGF-I) rose during treatment with GH but not with placebo. We conclude that growth hormone augments the response of the human ovary to stimulation by gonadotropins. These results suggest a role for the use of GH in induction of ovulation.

Adult↗

Comparison of the effects of muzolimine and a fixed combination of diuretics in essential hypertension.

The efficacy and tolerance of the loop diuretic muzolimine were compared with those of a fixed combination of hydrochlorothiazide and amiloride in patients with mild to moderate hypertension. After a placebo lead-in period, patients whose supine diastolic blood pressure was between 90 and 115 mm Hg were randomly allocated either to muzolimine, 20 mg/day, or to hydrochlorothiazide, 50 mg/day, and amiloride, 5 mg/day. The mean duration of follow-up was 4.7 months in both groups. Both muzolimine and the combination significantly decreased the mean blood pressure. The two treatments were similar in efficacy. The incidence of side effects during the trial was similar with both treatments, and no serious adverse reactions occurred. Eleven subjects in the muzolimine group were entered into an open long-term study. In all these subjects the blood pressure remained adequately controlled throughout the 4 to 6 months of additional follow-up and no side effects were reported. Muzolimine appears to be an effective and safe antihypertensive agent.

Administration, Oral↗

Circulatory responses to laryngoscopy: the comparative effects of placebo, fentanyl and esmolol.

The circulatory response to a 30-second laryngoscopy followed by orotracheal intubation was recorded in 60 patients of ASA physical status III or IV undergoing a variety of non-cardiac surgical procedures. Patients were randomly allocated to either the placebo, esmolol (500 micrograms.kg-1.min-1 X 6 minutes, followed by 300 micrograms.kg-1.min-1 X 9 minutes), or fentanyl (0.8 microgram.kg-1.min-1 X 10 minutes) group, and the observer was blinded to the infusion administered. Esmolol blunted the heart rate (HR) response, while fentanyl decreased it below the baseline and maintained it there, in spite of laryngoscopy. Similarly, fentanyl decreased the systolic (SBP), mean (MBP) and diastolic blood pressures (DBP) significantly below the baseline, while these pressures were either retained at or elevated slightly above control in the esmolol group. In these doses, the HR response to laryngoscopy was more effectively blocked by fentanyl, while esmolol better retained perfusion pressure. There were no complications or ischaemic electrocardiographic changes in any patient.

Adrenergic beta-Antagonists↗

The risk of infection related to radial vs femoral sites for arterial catheterization.

To evaluate risk factors for infections associated with indwelling arterial catheters, 186 catheters were randomly allocated for either femoral or radial insertion in 155 critically ill patients. Femoral catheters were easier to insert and it was easier to obtain blood specimens from them. Rates of local infection at the insertion sites and rates of positive catheter-tip cultures were similar for femoral and radial catheters. Evidence of local infection was not predictive of a positive catheter-tip culture. Percutaneously inserted femoral and radial artery catheters had a similarly low incidence of catheter-associated infections. There was only one catheter-related infection, and no cultured catheter was judged the cause of bacteremia. Routine prophylactic replacement of arterial catheter systems may be unnecessary in critical care units where rates of arterial catheter-associated infections are low.

Adult↗

Experience with the third generation cephalosporins, cefoperazone and cefotaxime: report.

The efficacy of the third generation cephalosporins, ceforperazone and cefotaxime, was evaluated in a provincial hospital in a small group of patients with severe infections. In one study, patients with severe sepsis were randomly allocated to a group receiving either cefoperazone or ampicillin (ticarcillin or cloxacillin) and gentamicin. In the other trial, a selected group of ill patients was given cefotaxime. Clinical and laboratory analyses showed that these two drugs are safe, well tolerated and effective in the blind treatment of severe infections.

Adolescent↗

Effect of aspirin on renal function and the prostaglandin-kallikrein systems early after myocardial infarction.

Using a double-blind procedure, 29 patients with a recent myocardial infarction were randomly allocated to a placebo group (n = 14) and to a group receiving aspirin, 300 mg three times a day (n = 15) over 7 days. No change in renal function was observed in either treatment group. Compared with the placebo group, the 24-h urinary excretion of prostaglandin E2 (PGE2) was significantly suppressed in the aspirin group, but the urinary kallikrein activity was unchanged. These results contrast with our previous study of similar patients, in which sulfinpyrazone decreased renal function, as well as the urinary PGE2 and kallikrein excretions. These divergent effects of aspirin and sulfinpyrazone on urinary kallikrein activity could explain the different trends in renal function observed early after myocardial infarction.

Aged↗

Enterococcus lactic acid bacteria strain SF68 and lactulose in hepatic encephalopathy: a controlled study.

Forty cirrhotic patients with non-advanced hepatic encephalopathy were randomly allocated into groups which were given orally either two capsules three times daily of a preparation of Enterococcus lactic acid bacteria strain SF68 or 30 ml lactulose four times daily. The patients were evaluated over a 10-day course of treatment and for 10 days post-treatment. The Enterococcus SF68 preparation proved to be as effective as lactulose in lowering blood ammonia, and in improving mental state and psychometric performance. Moreover, the effects of Enterococcus SF68, contrary to that of lactulose, persisted longer after treatment withdrawal. Some patients reported diarrhoea and abdominal pain with lactulose. Lactulose is a standard therapy in the treatment of patients with hepatic encephalopathy. In this study, however, the use of the Enterococcus SF68 preparation was shown to offer advantages over lactulose in these patients.

Adult↗

Proguanil daily or chlorproguanil twice weekly are efficacious against falciparum malaria in a holoendemic area of Tanzania.

The prophylactic efficacy of proguanil 100 mg (Paludrine) daily was compared to that of chlorproguanil 20 mg (Lapudrine) twice weekly in school children from Nyamisathi village, in a coastal area of Tanzania, 160 km south of Dar es Salaam. A total of 80 children were randomly allocated to three groups after radical treatment with a curative dose of mefloquine (Lariam). Seventy-six children were then followed up with daily prophylaxis and/or placebo for 13 weeks. All children in the group taking placebo prophylaxis were reinfected within 10 weeks whereas no parasites were detected in the children taking proguanil or chlorproguanil for prophylaxis. We conclude that both regimens were efficacious and that chlorproguanil represents an important alternative for chemoprophylaxis if taken at least twice weekly instead of the recommended once weekly regimen.

Adolescent↗

Spironolactone and cimetidine in treatment of acne.

In an open therapeutic trial, 50 patients with acne vulgaris were randomly allocated to one of two groups. One group received spironolactone 100 mg daily and the other cimetidine 1.6 g daily for 12 weeks. Clinical severity of acne and sebum excretion decreased significantly at the end of the trial with both drugs, but significantly more with spironolactone. Mean serum levels of testosterone, androstenedione and dehydroepiandrosterone-sulfate decreased significantly with spironolactone but showed no change with cimetidine. Our data suggest that spironolactone may be useful as antiandrogen in the short term therapy of acne vulgaris.

Acne Vulgaris↗

Antidepressive effect of amitriptyline treatment with plasma drug levels controlled within three different ranges.

Seventy-four depressed patients were treated with amitriptyline for 4-6 weeks. Their doses were individually adjusted to maintain the sum of the plasma levels of amitriptyline (AT) and nortriptyline (NT) within one of three different ranges, randomly allocated. Allowance was made for individual plasma binding of the drugs. In the 50 patients between 25 and 65 years of age, the antidepressive response at low plasma drug levels was somewhat poorer than at medium or high levels, which were equally effective. In this age group an association was found between outcome and the individual rate of AT metabolism, expressed as "reciprocal clearance" (RC), the steady-state plasma concentration of AT plus NT divided by the daily AT dose. Good antidepressive outcome was associated with high RC. The implications of these findings for patient treatment and for the interpretation of other studies are discussed. The 18 patients between 65 and 80 years of age showed no significant differences between the effectiveness of treatment at different plasma drug levels, and no significant associations between outcome and RC.

Aged↗

Long-term interferon therapy for thrombocytosis in myeloproliferative diseases.

31 patients with thrombocytosis associated with myeloproliferative disorders were included in a prospective trial of long-term interferon therapy. 6 patients (19%) had side-effects which required withdrawal of interferon within one year. 22 patients (71%) achieved and maintained a complete response (platelet count less than 440 x 10(9)/l) for at least twelve months, with reduction or abolition of symptoms associated with thrombocytosis and a significant fall in bone-marrow megakaryocytes. At twelve months, 25 patients were randomly allocated to maintenance or withdrawal of interferon. Thrombocytosis recurred rapidly when treatment was stopped, but a second remission could be achieved by resumption of interferon therapy.

Aged↗