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PubMed1992

Postoperative radiotherapy in head and neck carcinoma with extracapsular lymph node extension and/or positive resection margins: a comparative study.

In head and neck carcinoma, the finding of extracapsular lymph node extension and/or positive resection margins portends poor locoregional control and survival. The effectiveness of postoperative radiotherapy in these patients has been controversial due to insufficient studies comparing resected patients with those also receiving radiation. Between 1982 and 1988, 441 radical head and neck resections were performed at the Medical College of Virginia. Pathologic review of these cases identified 125 with extracapsular lymph node extension and/or positive resection margins. Of these, 43 had extracapsular lymph node extension only, 24 had both positive resection margins and extracapsular lymph node extension, and 58 demonstrated positive resection margins only. Surgery alone was performed in 71 of these patients while 54 cases received surgery and postoperative radiotherapy, (combined modality treatment) CMT. Radiotherapy doses ranged from 50 to 70 Gy. The surgery alone and combined modality treatment groups were comparable with respect to the distribution of positive resection margins and extracapsular lymph node extension. Slightly more CMT patients had clinical T4 disease compared with the surgery alone group (22% vs 14%). Slightly fewer combined modality treatment patients had clinical N0 necks than the surgery alone group (20% vs 29%). Multivariate analysis was performed with the variables T, N stages, radiotherapy, margin status, primary tumor sites, microscopic and macroscopic extracapsular lymph node extension, number of positive lymph nodes, number of nodes with extracapsular lymph node extension. Locoregional control was maintained at 5 years in 59% of the combined modality treatment group and 31% of the surgery alone group (p.0001). Subgroup analysis likewise reveals significant differences favoring the combined modality treatment group for positive resection margins only (49% vs 41%; p = .04), extracapsular lymph node extension only (66% vs 31%; p = .03) and extracapsular lymph node extension+positive resection margins (68% vs 0%; p = .001). Adjusted survival also shows a significant benefit of combined modality treatment vs surgery alone for the entire group (72% vs 41%; p = .001). Multivariate analysis revealed that the use of radiotherapy is a strongly favorable variable for local control and adjusted survival. Macroscopic extracapsular lymph node penetration and positive resection margins are unfavorable independent variables for local control. T-stage is the only variable predicting local control in the combined modality group. Extracapsular extension remains an important negative prognostic variable for survival in both treatment groups. In conclusion, this study demonstrates a locoregional control and survival benefit for postoperative radiotherapy in patients with the high risk pathologic findings of extracapsular lymph node extension and positive resection margins.

Carcinoma, Squamous Cell↗

PubMed1986

Neodymium YAG and dye laser iridotomy--a comparative study.

A prospective, randomised study compared Neodymium:Yttrium Aluminium Garnet (Nd:YAG) and dye laser iridotomy in 100 eyes of 61 patients for the relief of pupil block glaucoma. Nd:YAG laser iridotomy was accompanied by less severe complications at the time of iridotomy--failure to produce full-thickness iridotomy, post-laser hypertensive response, bleeding, dissemination of pigment throughout the anterior chamber and posterior synechiae formation--than the dye laser. Nd:YAG laser iridotomy initially achieved relief of pupil block in all the eyes undergoing this procedure. However, the overall success rate of Nd:YAG iridotomies over the 3 months' follow-up period fell to 78 per cent due to inability of small iridotomies to relieve pupil block (4 eyes), and closure of iridotomies by iris pigment epithelial proliferation (3 eyes) and/or stromal healing (3 eyes). In patients with narrow angle glaucoma severe, and in cases prolonged elevations of intraocular pressure occurred following iridotomy with both lasers. Significant lens damage occurred in 5 eyes following dye laser iridotomy.

Adult↗

PubMed1990

Comparative studies of pharmacotherapy for school refusal.

Two studies compared alprazolam and imipramine in the treatment of school refusal. In an open label study (N = 17), two-thirds of the subjects completing a trial in both the alprazolam and imipramine groups showed moderate to marked global improvement in symptoms of anxiety and depression. In the double-blind, placebo-controlled study (N = 24), posttreatment scores calculated as change from baseline on the Anxiety Rating for Children were significantly different (p = .03) among the three treatment groups, with the active medication groups showing the most improvement. Additionally, on all depression rating scales, similar trends were evident with the alprazolam and imipramine groups demonstrating greater improvement than the placebo group. However, analyses of covariance (with pretreatment scores as the covariates) showed no significant differences among the three treatment groups on change in anxiety and depression scales. Thus, additional research is needed to determine whether trends in this study are explained by drug effect or baseline differences on rating scales.

Adjustment Disorders↗

PubMed1991

A comparative study between Michel and Proximate clips for the closure of neck incisions.

A prospective study comparing two types of surgical clip, the Proximate II (Ethicon) staple and the Michel clip, was performed on 30 thyroidectomy (horizontal) and 50 carotid endarterectomy (vertical) incisions with reference to their ease of handling, patient comfort, complication rate, cosmetic result and cost. In each patient half of the wound was approximated with one type of clip and half with the other. The Proximate II staple was more comfortable for the patient in the vertical wounds (P less than 0.02), easier to remove as judged by the nurse in both horizontal (P less than 0.001) and vertical (P less than 0.02) wounds, and by the patient in the horizontal wounds (P less than 0.02) only. The incidence of inflammation was significantly higher with the Michel clip (P less than 0.001). In both the horizontal (P less than 0.05) and the vertical (P less than 0.001) wounds, when the scar was assessed at the time of discharge from hospital, the Proximate II staple achieved a significantly better result. However, assessment of the wounds by patient and researcher 6 weeks postoperatively, revealed no significant difference between the wounds with regard to cosmetic outcome. The Proximate II design, however, costs between seven and ten times more than the Michel clip depending on the size of the dispenser used, and since the late cosmetic result offers no advantage over the latter design, we feel these financial variables deserve consideration.

Adult↗

PubMed1990

Prospective comparative study of cefotetan with piperacillin for prophylaxis against infection in elective colorectal surgery.

This study compared one dose of cefotetan with three doses of piperacillin as prophylaxis against wound infection in 153 patients undergoing elective colorectal surgery. The patients were randomized into two groups: the first received 2 g cefotetan intravenously with induction of anaesthesia (n = 75), and the second received three doses of 2 g piperacillin (n = 78). Wound infection was defined as the presence of an abscess or discharging pus from the wound. In the cefotetan group there were 14 (19%) wound infections and 13 (17%) in the piperacillin group. There were three septic deaths, one in the cefotetan group and two in the piperacillin group. Both groups were comparable with regard to age, sex, nature of pathology and pre- and perioperative risk factors. No significant haematological or biochemical abnormalities were detected. The only adverse reaction was one patient who had an allergic reaction (rash) to piperacillin. These data suggest that single-dose cefotetan is as effective as triple-dose piperacillin in prophylaxis against infection in elective colorectal surgery.

Cefotetan↗

PubMed1992

Information flow in the hospital: a comparative study of the Hungarian and the Dutch situation using a two axes model of hospital information flow.

This study compares the organization and structure of information flow in a Dutch and in a Hungarian hospital. The study was carried out as a field orientation part of a Health Care Management project of the Hogeschool van Amsterdam. The host of the field orientation was the BAZIS Foundation, the Central Development and Support Group Hospital Information System, Leiden. The visited hospitals were equipped with the BAZIS Hospital Information System. The method of study consisted of series of formalized interviews with all-level actors of a hospital; the interpretation of data was enhanced by a two axes (patient and management) model of information flow defined by the authors. In summary, Dutch hospitals show a more elaborate information flow system, with more information flow channels sideways among equal levels, less bureaucracy in organization of information flow, and significantly more benefits of automation, compared to the Hungarian situation.

Computer Systems↗

PubMed1990

[Comparative studies on several indices of nuclear damage in human peripheral lymphocytes].

In order to use appropriately NAT and explore possibility of use of the test in human cells, the authors used gamma-rays as mutagenic and carcinogenic irradiated whole blood in vitro, prepared directly smears of isolated lymphocytes, and studied comparatively dose-response relationship of 4 types of nuclear damage. Main results of the study are given as follows: 1. In doses from 0 to 3 Grays MNF (Frequency of micronucleus), INF (Frequency of irregular nucleus), KNF (Frequency of karyorrhetic nucleus), and PNF (Frequency of pyknotic nucleus) increase along with increase of irradiated doses. At 5 grays INF still increases, but MNF, KNF and PNF decrease. 2. In doses from 0 to 3 grays regression equation of 4 indices of nuclear damage are as follows (D means dose, r means correlative coefficient): MNF: y = 0.3433 + 0.1052D, r = 0.9128, p less than 0.05; INF: y = 7.2178 + 2.1817D, r = 0.8846, p less than 0.05; KNF: y = 0.6462 + 0.2014D, r = 0.7286, p greater than 0.05; PNF: y = 0.2774 + 0.0728D, r = 0.5484, p greater than 0.05. 3. In doses from 0 to 3 grays MNF is linear with INF and KNF. Regression equation are as follows (x means MNF): MNF-INF: y = 2.0598 + 16.6545x, r = 0.778 p greater than 0.05; MNF-KNF: y = 0.2235 + 1.426x, r = 0.5945, p greater than 0.05. Finally according to synthetic analysis of correlative coefficient, intercept, regression coefficient and feasibility of indices of nuclear damage, we could consider it suitable that nuclear anomalies in human peripheral lymphocytes include micronucleus, irregular nucleus and karyorrhexis.

Adolescent↗

PubMed1991

Intraoperative surgical specimen evaluation: frozen section analysis, cytologic examination, or both? A comparative study of 206 cases.

Having recently become aware of the merits of cytologic preparations, histopathologists are focusing their attention on cytologic examination as a means of intraoperatively evaluating surgical specimens. This study compares the diagnostic accuracy and quality of frozen-section (FS) and cytologic preparations from 206 surgical specimens. The quality of cytologic preparations was significantly superior to that of FSs (P = 0.0001). With the use of a three-level accuracy scale suited to the practical demands of intraoperative evaluation, there was no significant difference between the accuracy of diagnosis by FS analysis compared with that achieved by cytologic examination (P = 0.35). More importantly--except in one case--whenever one technique did not correctly distinguish benign from malignant disease, the other technique yielded an essentially correct diagnosis. With the use of both techniques, 99.5% of cases were interpreted correctly, at least in regard to benign versus malignant diagnoses. Because significant additional time, equipment, stains, laboratory space, or personnel are not needed to implement intraoperative cytologic studies in a routine anatomic pathology laboratory, the authors advocate the simultaneous use of FS and cytologic studies in the specified context.

Diagnostic Errors↗

PubMed1986

Activation of platelets by microfibrils and collagen. A comparative study.

Previous works demonstrated that microfibrils stimulate blood platelets to aggregate. The present study compares the activation of platelets by human placental and bovine aortic microfibrils and by type III collagen. We studied the morphological changes occurring in in platelets during their activation and aggregation, as well as the kinetics of the release reaction and thromboxane B2 formation. As for collagen, the microfibrils-induced platelet aggregation followed a lag phase, during which progressive emission of pseudopodes and centralization of organelles occurred. Aggregation was associated with secretion of beta-thromboglobulin and adenylic adenylic nucleotides, and with formation of thromboxane B2; it was established that the kinetics of secretion and the aggregation curve were parallel. Microfibrils-induced aggregation was also inhibited by ethylenediamine tetraacetic acid, creatine phosphate-creatine phosphokinase, and aspirin, showing that it was calcium-dependent and required a secretion of ADP and formation of endoperoxide and thromboxane. The response to microfibrils was much more rapid than to collagen; placental microfibrils reacted faster than aortic microfibrils. The requirement of plasma in the microfibrils platelets interaction was confirmed: 10 microliters is the minimal amount of plasma necessary for an aggregation of platelets in 400 microliters of buffer. This fact supports the idea of the existence of two different pathways in the interaction between platelet and the subendothelium, depending on the vascular structure (microfibrils or collagen) involved, even though the sequence of events leading to the formation of an aggregate is similar.

Adenosine Diphosphate↗

PubMedDate not supplied

[Current role of the Zeiss extractor catheter. Comparative study with other methods. Presentation of 80 personal cases and a comprehensive review].

The present study compared the Zeiss and Dormia type extractors for ureteral calculi with the new methods of treatment (shock waves and laser) to determine the place of these extractors in our urological armamentarium today. The results and the complications in our series comprised of 80 cases are presented and the literature available on this subject reviewed. We discuss briefly the methods commonly used today, i. e., shock waves and laser, with special reference to the good results and scant complications. We can conclude from this study that these catheters continue to be useful in current urological practice.

Adolescent↗

PubMed1976

Pass/fail versus A-F grading: a comparative study.

This study compared achievement when one half of a class was assigned to take a course on a pass/fail basis and the other half received a letter grade. The unique characteristics were as follows: (1) students were assigned to A-F and pass/fail groups rather than allowed to choose the grading system, (2) virtually no other course competed for study time, and (3) the course constituted a major field of study for the student. The results showed no significant difference between the two groups in achievement on three separate examinations.

Education, Dental↗

PubMed1992

A comparative study of controlled-release morphine (CRM) suspension and CRM tablets in chronic cancer pain.

This study compared the efficacy and the adverse effects of controlled-release morphine (CRM) suspension (SAR 213) and CRM tablets (Moscontin) in the treatment of cancer pain. This multicenter, randomized, double-blind, double-dummy, crossover study was carried out on 52 patients. Each patient received both study treatments given at an equivalent dosage of morphine during each of two 7-day periods. The primary outcome variable was the severity of pain assessed three times daily by means of a visual analogue scale. Secondary criteria of efficacy were the severity of pain assessed by verbal rating scale, the need for "rescue" doses of immediate-release morphine, treatment preference, and indices of quality of life (activity, mood, sleep). There were no statistically significant differences in the parameters assessed when comparing the two groups. This study shows that, when prescribed at the same doses, CRM suspension and CRM tablets have similar efficacy and adverse effects, as well as the same duration of action. The results of this first clinical study carried out on CRM suspension are especially relevant for patients with cancer pain who have difficulty swallowing.

Delayed-Action Preparations↗

PubMedDate not supplied

Prevalence of craniomandibular dysfunction in white children with different emotional states: Part III. A comparative study.

This study compared the prevalence of CMD between white children classified by the parents as calm and not calm, with twenty-six boys and twenty girls in each group (total, ninety-two children). They had been selected from a total of 386 white children examined for this study. The children were interviewed for symptoms, examined clinically for signs of CMD and malocclusion, and assigned to the study groups based on parents' responses to a questionnaire. The study showed significant differences in the prevalence of muscle and TMJ tenderness between children with different emotional states.

Child↗

PubMed1988

A randomized, comparative study of buserelin with DES/orchiectomy in the treatment of stage D2 prostatic cancer patients.

This multicenter, randomized study compared the LH-RH agonist buserelin with diethylstilbestrol (DES)/orchiectomy in the treatment of patients with stage D2 prostatic carcinoma. Subjects were randomized to treatment with buserelin or DES/orchiectomy in a 2:1 ratio. Data from 160 subjects were available for analysis: 105 buserelin subjects (89 s.c. and 16 i.n.), 41 DES-treated subjects, and 14 orchiectomized subjects. Either subcutaneous (200 micrograms q.d.) or intranasal (400 micrograms t.i.d.) maintenance doses of buserelin suppressed serum testosterone values to below castrate levels (less than 100 ng/dl) by week 3 and maintained suppression for over 24 months. Times to treatment failure for specific reasons were analyzed and compared between treatment groups. There was a significant difference between treatment groups in favor of buserelin in the time to treatment failure due to an adverse event (p less than or equal to 0.05). There were no statistically significant differences between the treatment groups in the progression-free survival, best response, and life survival analyses. In addition, buserelin treatment improved quality of life parameters such as pain, performance status, and genitourinary symptoms. With the exception of symptoms of androgen deficiency, few side effects were reported in the buserelin subjects and most were of a minor nature. The incidence of severe side effects was significantly higher among the DES/orchiectomy subjects.

Administration, Intranasal↗

PubMed1992

A comparative study of 0.25% ropivacaine and 0.25% bupivacaine for brachial plexus block.

The present study compares the effectiveness of 0.25% ropivacaine and 0.25% bupivacaine in 44 patients receiving a subclavian perivascular brachial plexus block for upper extremity surgery. The patients were assigned to two equal groups in this randomized, double-blind study; one group received ropivacaine 0.25% (112.5 mg) and the other, bupivacaine 0.25% (112.5 mg), both without epinephrine. Onset times for analgesia and anesthesia in each of the C-5 through T-1 brachial plexus dermatomes did not differ significantly between the two groups. The mean onset time for analgesia ranged from 11.2 to 20.2 min, and the mean onset time for anesthesia ranged from 23.3 to 48.2 min. The onset of motor block differed only with respect to paresis in the hand, with bupivacaine demonstrating a shorter onset time than ropivacaine. The duration of sensory and motor block also was not significantly different between the two groups. The mean duration of analgesia ranged from 9.2 to 13.0 h, and the mean duration of anesthesia ranged from 5.0 to 10.2 h. Both groups required supplementation with peripheral nerve blocks or general anesthesia in a large number of cases, with 9 of the 22 patients in the bupivacaine group and 8 of the 22 patients in the ropivacaine group requiring supplementation to allow surgery to begin. In view of the frequent need for supplementation noted with both 0.25% ropivacaine and 0.25% bupivacaine, we do not recommend using the 0.25% concentrations of these local anesthetics to provide brachial plexus block.

Adult↗

PubMed1988

Treatment of urinary tract infections in Hong Kong: a comparative study of norfloxacin and co-trimoxazole.

The study compared the efficacy and safety of norfloxacin to those of co-trimoxazole in the treatment of urinary tract infections (UTI). A total of 172 adults, 42 men and 130 women were recruited and randomly allocated to norfloxacin or co-trimoxazole using a double-blind study design. Patients with lower UTI received norfloxacin 200 mg or co-trimoxazole (160 mg of trimethoprim plus 800 mg of sulphamethoxazole) b.i.d. for seven days. In patients with upper UTI, the norfloxacin dose was 400 mg b.i.d. for seven days. Eleven to 14 days after treatment, the bacteriological cure rates were 96.8% and 83.3% and the clinical cure rates were 96.9% and 89.9% for norfloxacin and co-trimoxazole, respectively. A few patients complained of gastrointestinal symptoms but there were few other side-effects and the treatments were well tolerated. In conclusion, both norfloxacin and co-trimoxazole were well tolerated but norfloxacin gave higher cure rates.

Adult↗

PubMed1991

Clinical features of breast cancer--Anglo-Japanese comparative study.

A comparative study was undertaken at Guy's Hospital in the UK and the Aichi Cancer Center in Japan of the clinical picture of breast cancer in the UK and Japan. Target patients were 221 UK and 200 Japanese primary operable patients who were recruited from April 1979 through August 1980. No difference was seen between the two countries in the side and site of the lesion and the size of the lesion. The localized tenderness of the tumor site was higher in Japanese patients than in UK patients (25.5% vs 0%). Difference was observed in tumor characteristics: breast cancers of the UK patients were irregular, ill-defined, and not so mobile, whereas those of the Japanese patients were round or oval, well-defined, and mobile. Skin fixation was higher in Japanese patients (71.0% vs 44.8%). Clinical node involvement was higher in UK patients (32.5% vs 19.0%).

Age Factors↗

PubMed1992

A comparative study of intramuscular ketorolac and pethidine in labour pain.

A single dose block randomised double-blind study comparing intramuscular ketorolac, 50 mg of pethidine and 100 mg pethidine was carried out in multiparous women. Pain intensity and sedation effect were recorded at inclusion to the study, half hourly for the first 2 h, then hourly until 6 h after delivery. Maternal and neonatal side effects were noted including the Apgar scores and the baby's requirements for resuscitation. All three treatments are relatively ineffective in relieving labour pain. There was no difference in the analgesic efficacy between the two doses of pethidine but both doses of pethidine were statistically more effective compared with ketorolac. There was no difference in the retrospective assessment of the three groups or when comparison was made with the previous labour. A similar number of patients required further analgesia in each group. In all three groups, no adverse effect occurred in the mother or fetus. Maternal sedation and fetal depression were statistically less in the ketorolac group. Although ketorolac had inferior analgesic effect, its use was not associated with clinically significant sequelae and it showed a superior safety profile compared with either dose of pethidine. The study was not powerful enough to detect a difference between 50 mg and 100 mg of pethidine.

Adolescent↗