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PubMed1984

Acute rupture of the lateral ligament of the ankle. To suture or not to suture?

One hundred patients with acute ruptures of the lateral ligaments of the ankle were randomly allocated either to conservative treatment in a plaster cast or to operative repair. With the aid of stress tenography, the extent of the injury was established. There were 30 patients with isolated anterior talofibular ruptures and 20 with additional calcaneofibular ligament ruptures in each treatment group. Operative repair was associated with a higher incidence of complications in the first weeks, and slightly delayed the patients' return to work. At an independent two-year review there was no evidence that operative repair offered improved symptomatic or functional benefit.

Adolescent↗

PubMed2002

Comparison of three approaches for synchronization of ovulation for timed artificial insemination in Bos indicus-influenced cattle managed on the Texas gulf coast.

Our objectives were to compare the relative efficacies of three protocols designed to synchronize ovulation for timed artificial insemination (AI) of predominantly Brahman-influenced cows and heifers. In Exp. 1, 273 Brahman x Hereford (F1) cows at three locations were stratified by BW, body condition score (BCS), age, and days postpartum and assigned randomly to three treatments: 1) Syncro-Mate-B (SMB), 2) norgestomet-prostaglandin (NP), and 3) Ovsynch. The management goal required that cows have a minimum BCS of 5 and be at least 36 d postpartum (PP) at treatment onset. However, final results included 23 cows (8.4%) whose BCS fell below 5. In Exp. 2, 286 pubertal beef heifers were stratified by BW and BCS and allocated randomly to the three treatments. Heifers were predominantly Brahman crossbred (n = 265; Brahman x Hereford, F1; Santa Cruz) or purebred Brahman-influenced (Santa Gertrudis) with a smaller number (n = 21) of Hereford heifers also included. For both experiments, SMB treatment consisted of a 9-d norgestomet ear implant plus an estradiol valerate/norgestomet injection on d 0. Norgestomet-prostaglandin-treated females were implanted with a SMB implant without the estradiol valerate/norgestomet injection at the time of implant insertion and received 25 mg prostaglandin F2alpha (PGF) i.m. 2 d before implant removal. Ovsynch consisted of 100 microg GnRH i.m. on d 1, 25 mg PGF i.m. on d 8, and a second GnRH injection on d 10. Beginning on d 9, calves were removed for 48 h in Exp. 1. Cattle in SMB and NP groups in both experiments were timed-inseminated 48 to 54 h after implant removal and at 12 to 24 h after the second GnRH injection (Ovsynch). Timed AI conception rates did not differ between the SMB (45.1%) and Ovsynch (42.4%) groups; however, conception rate in the NP group tended (P < 0.12) to be lower overall than in the other groups due to a reduced (P < 0.05) conception rate in cows that were < 60 d PP at treatment onset. Conversely, timed-AI conception was greatest (P < 0.056) in NP (54.7%) compared with SMB (40.4%) and Ovsynch (39.1%) for heifers in Exp. 2. We conclude that in mature, suckled beef cows with Brahman genetic influence, SMB and Ovsynch perform similarly when cow eligibility relies primarily on BCS and minimum days PP. The NP treatment results in lower conception in cows < 60 d PP compared with SMB and Ovsynch. However, in nulliparous Brahman-influenced heifers that are confirmed to be pubertal, NP may be superior to the other two treatments for timed AI.

Age Factors↗

PubMed1981

The treatment of hypertension in older patients: a double-blind, between-patient study, in previously treated patients comparing a diuretic, a beta-receptor antagonist, and their fixed combination.

Six hundred and forty-eight previously treated hypertensive patients, with a mean age of 64 years, were studied. In spite of treatment over a mean period of 18 months, their blood pressure was inadequately controlled, with an initial mean level of 180/108 mm Hg. Previous treatment which had consisted of either a diuretic alone, a beta-receptor antagonist alone or these two drugs in combination was discontinued and patients were randomly allocated, in double-blind manner, to a 6-week treatment course of cyclopenthiazide (Navidrex) or sustained release oxprenolol (Slow-Trasicor) or a fixed combination of these two compounds (Trasidrex) with the aim of lowering the diastolic pressure to less than 100 mm Hg. Blood pressure was substantially reduced in each treatment group, with the lowest final pressures in the group treated with the fixed combination, where 87% of the patients completing the study reached the target level of a diastolic pressure of less than 100 mm Hg. Very few side-effects of treatment were reported with any of these compounds. The results from this study suggest that these compounds in their standard dosage range are useful and safe antihypertensive agents in older patients. In those patients where blood pressure control with a single agent was proving difficult, the transfer to one or two tablets daily of the fixed combination (Trasidrex) produced a very satisfactory outcome in the large majority of cases.

Aged↗

PubMed1986

Augmentin compared with oxytetracycline for chest infections in general practice.

Augmentin and oxytetracycline were compared in the treatment of chest infections in general practice in an investigator-blind study of 748 patients randomly allocated to 7 days' treatment with standard doses of either Augmentin or oxytetracycline. Significantly more patients treated with Augmentin had a good overall response to therapy both at day 7 (P less than 0.001) and at day 14 (P less than 0.01). The differences between treatments were less marked for individual signs and symptoms of lower respiratory tract infections, due to smaller numbers of patients with any particular symptom. Augmentin, however, was significantly more effective than oxytetracycline in the resolution of chest pain at day 7 (P less than 0.025) and cough at day 14 (P less than 0.005). Sputum purulence was also cleared more effectively by Augmentin by day 14 (P less than 0.001). Both treatments were well tolerated, with no significant difference between treatments in the small number of adverse events. Augmentin has been shown to be an effective, well tolerated treatment for chest infections, superior to oxytetracycline in efficacy and possibly in speed of resolution of clinical symptoms.

Adolescent↗

PubMed1986

Iontophoresis of vincristine versus saline in post-herpetic neuralgia. A controlled trial.

Twenty patients with post-herpetic neuralgia (median duration 28.5 months) were randomly allocated to receive transdermal iontophoresis of either vincristine or saline. Although significant improvement in pain by word score and visual analogue scale (P = 0.05) was reported by 6 out of 10 of the vincristine group, none of the patients considered themselves 'cured.' There was no significant change in the saline group. No adverse haematological or neurological side effects were seen, but skin irritation and painless electrical burns were common in both groups. The dramatic relief of pain in patients with post-herpetic neuralgia of 3 months or less reported elsewhere was not seen in our group who had pain of a longer duration. This present trial does not confirm the value of vincristine iontophoresis in the treatment of post-herpetic neuralgia of over 6 months duration.

Aged↗

PubMed1989

Treatment of severe premenstrual syndrome with oestradiol patches and cyclical oral norethisterone.

40 patients with premenstrual symptoms were randomly allocated to receive placebo patches or active treatment with transdermal oestradiol patches (2 x 100 micrograms) to suppress ovulation. Norethisterone 5 mg was given in each group from day 19-26 of the cycle to ensure a regular withdrawal bleed. Treatment was for 6 months with crossover at 3 months. Patients completed the Moos menstrual distress questionnaire (MDQ) and the premenstrual distress questionnaire (PDQ) daily throughout the study. 5 patients withdrew, 4 because of skin reactions and 1 because of considerable improvement with initial (active) treatment. After 3 months, both groups showed improvement in MDQ and PDQ scores. In general, between 3 and 6 months, patients who switched from active treatment to placebo had deteriorating scores while patients who switched from placebo to active treatment maintained or improved upon their initial gains. Significant improvements occurred after changing to active treatment in five of six negative MDQ symptom clusters and in six of ten PDQ symptoms.

Administration, Cutaneous↗

PubMed1986

Prevention of relapse with various antiulcer drugs.

The relative value of maintenance therapy with cimetidine, ranitidine, pirenzepine, and antacids only (when used for symptomatic relief) has been evaluated in 205 patients with a subsequent follow-up period of 2 years. The patients had a completely healed duodenal ulcer after 8 weeks of treatment and were then randomly allocated to four groups, which were as follows: group 1: 60 patients treated with 400 mg cimetidine at night; group 2: 55 patients treated with 150 mg ranitidine at night; group 3: 50 patients treated with 50 mg pirenzepine at night; and group 4: 40 patients treated only with antacids as needed for symptomatic relief. Endoscopy was repeated after 6, 12, 18, and 24 months of treatment, and whenever symptoms suggested recurrence. Although the number of dropouts was high (27 in group 1, 20 in group 2, 18 in group 3 and 12 in group 4), statistical analysis by the life-table method showed that cimetidine, ranitidine, and pirenzepine had similar therapeutic value. After 1 and 2 years the relapse rate of duodenal ulcer was 17.5% and 43.6% respectively, for cimetidine, 21% and 69.3% for ranitidine, 21.7 and 50.2% for pirenzepine, and 49.8% and 77.7% for antacids. The incidence of erosions was lower in those groups with the higher ulcer relapse rate, a point discussed in the present study.

Adult↗

PubMed1998

Self-monitoring of blood pressure at home: how many measurements are needed?

OBJECTIVE: To determine the minimum number of self-measurements of blood pressure at home (HBP) necessary to provide the maximum clinically important benefit. METHODS: Hypertensive patients were randomly allocated to monitor HBP for 2 weeks (6 work days, duplicate measurements, twice daily) or ambulatory blood pressure for 24 h. The alternative measurement was then performed. Clinic blood pressure was measured at the beginning and the end of the study. Criteria for reliability of HBP were the stabilization of mean HBP, its variability (SD) and the correlation coefficient r for relationship of HBP with ambulatory blood pressure. The reproducibility of HBP was quantified using test-re-test correlations and the SD of differences between average HBP values of different days. RESULTS: We studied 189 patients (79 being administered stable antihypertensive treatment). Average HBP (137.5 +/- 16.2/85.9 +/- 9.9 mmHg) was lower than average clinic blood pressure (P<0.001) and higher than 24 h and night-time ambulatory blood pressures (P<0.001). There was no difference between HBP and daytime ambulatory blood pressure. On day 1 HBP was higher than it was on each of days 2-6, with no difference among days 2-6. When data for the initial day for monitoring of HBP were excluded from analysis, average HBP was reduced. Only a modest improvement in the reliability of HBP on day 2 (reductions in mean HBP and its SD and an increase in r with ambulatory blood pressure) was achieved by averaging more readings taken on succeeding days. At least two monitoring days were needed for the reproducibility of HBP to be superior to that of clinic blood pressure. CONCLUSIONS: These results suggest that determining average HBP of the second and third work days, is the minimum programme that provides a reliable estimate of HBP.

Blood Pressure↗

PubMed1981

Comparison of the bisbiguanide antiseptics alexidine and chlorhexidine. II. Clinical and in vitro staining properties.

A blind cross-over trial was carried out to compare the tooth and tongue staining associated with the use of a 0.035% alexidine and a 0.2% chlorhexidine mouthrinse. Twenty-two volunteers were divided into two groups termed "tea drinkers" and "non-tea drinkers". All volunteers were requested to refrain from oral hygiene measures throughout two 10-day periods when they rinsed twice a day with the preparation randomly allocated for the respective period. During both periods the members of the groups excluded coffee, red wine and port from their diet. The tea drinking group consumed seven cups of tea per day. Tooth and tongue staining was recorded for extent and severity at the end of each period. The amount of stain accumulating in the two groups was similar following the use of chlorhexidine and alexidine. However, for both chlorhexidine and alexidine the extent and severity of tooth and tongue staining were significantly increased in the tea drinking group. An in vitro study of tea staining of perspex blocks exposed twice a day to 0.035% solutions of alexidine or chlorhexidine throughout a 5-day period demonstrated significantly more staining with alexidine when measured spectrophotometrically. Visually however, the differences in the specimens were minimal. Saliva treatment of the perspex did not significantly alter the staining by alexidine or chlorhexidine. The results provide further evidence for a dietary aetiology to the staining associated with cationic antiseptics. However, alexidine at the concentration used offered no advantage in reducing the side effect of staining when compared with chlorhexidine.

Biguanides↗

PubMed2006

The effects of transplacental porcine circovirus type 2 infection on porcine epidemic diarrhoea virus-induced enteritis in preweaning piglets.

The effects of transplacental porcine circovirus type 2 (PCV2) infection on porcine epidemic diarrhoea virus (PEDV)-induced enteritis were examined in neonatal piglets. Six pregnant sows were randomly allocated to an infected (n=3) or control group (n=3). Three pregnant sows were inoculated intranasally with 6 mL of tissue culture fluid containing 1.2 x 10(5) tissue culture infective doses 50% (TCID(50))/mL of PCV2 strain SNUVR000470 three weeks before the expected farrowing date. Three control pregnant sows were similarly exposed to uninfected cell culture supernatants. Thirty piglets from PCV2-infected sows were randomly assigned to two groups (A and B) of 15 piglets each. Another 30 piglets from noninfected sows were randomly assigned to two groups (C and D) of 15 piglets each. The piglets in groups A and C were dosed orally at three days of age with 2mL of virus stock (1 x 10(6.5) TCID(50)/mL) of the PEDV strain, SNUVR971496, at the third passage. The mean villous height and crypt depth (VH:CD) ratio in PEDV-infected piglets from PCV2-infected sows (group A) were significantly different from those of the PEDV-infected piglets from PCV2 negative sows (group C) at 36, 48, and 72 h post-inoculation (hpi) (P<0.05). In PEDV-infected piglets from PCV2-infected sows (group A), significantly more PEDV nucleic acid was detected in the jejunal tissues (P<0.05) at 24 hpi than in the same tissues of the PEDV-infected piglets from PCV2 negative sows (group C). Thereafter, at 36, 48, 60, and 70 hpi significantly more PEDV nucleic acid (P<0.05) was detected in the jejunal tissues of the PEDV-infected piglets from PCV2 negative sows (group C) than those of the PEDV-infected piglets from the PCV2-infected sows (group A). It is concluded that the clinical course of PEDV disease was markedly affected by transplacental infection of PCV2.

Animals↗

PubMed1988

Torasemide for diuretic treatment of advanced chronic renal failure.

In a double-blind randomized clinical trial the efficacy and safety of oral high-dose torasemide (1-isopropyl-3- ([4-(3-methyl-phenylamino)pyridine]-3-sulfonyl)urea, T) therapy was compared with that of furosemide (F) in 10 patients with advanced chronic renal failure. The efficacy on edema, fluid and electrolyte balance including the influence on renin-angiotensin-aldosterone system and cochlear function was evaluated. Patients were randomly allocated to either 500 mg F/d (group 1) or 200 mg T/d (group 2). After 14 days of treatment doses were doubled in each group for further 14 days. With respect to the 2.5 times lower dose of T the clinical effect of both drugs on edema, fluid and sodium excretion was equipotent. Significant differences were noted on calciuresis. Serum calcium levels were reduced with F, while T had no influence on calcium balance. A significant increase in plasma renin activity (PRA) was observed after F, whereas T had no raising effect on PRA. No significant alteration of plasma aldosterone concentration occurred with T or F. No adverse effects were noted in both groups. Serial audiometries showed no significant impairment of cochlear function with both drugs. In conclusion, these results indicate that high-dose T is efficient and safe in the treatment of advanced chronic renal failure. The lack of a calciuric effect with T can be regarded as an advantage in patients with hypocalcemia in chronic renal failure.

Adult↗

PubMed1988

Thrombosis prophylaxis with low molecular weight heparin in total hip replacement.

In a randomized prospective trial, the efficacy of low molecular weight heparin (LMWH) (Fragmin) and dextran 70 (Macrodex) in preventing deep vein thrombosis (DVT) in the legs was evaluated in 98 consecutive patients undergoing elective total hip replacement. The patients were randomly allocated to receive either 2500 anti-factor Xa units LMWH twice daily for 7 days, with the first dose given 2 h before surgery; or 500 ml dextran 70 twice during the day of operation, followed by a single infusion of 500 ml on the first and again on the third postoperative day. DVT was assessed by 125I-fibrinogen test for 2 weeks postoperatively, a positive test being followed by phlebography. DVT developed in 22 (45 per cent) of 49 patients receiving dextran 70 and in 10 (20 per cent) of 49 patients in the LMWH group (P less than 0.01). LMWH was thus statistically significantly better than dextran 70 in preventing DVT in the legs. It was not firmly established whether this benefit was also valid in the high ileofemoral region. Two patients with non-fatal pulmonary embolism were found in each group. Per- and postoperative blood loss and blood transfusion requirements were significantly lower in the LMWH group.

Aged↗

PubMed1987

Long-term effect of intra-articular injections of sodium hyaluronate and corticosteroid on temporomandibular joint arthritis.

The long-term effect of intra-articular injections of sodium hyaluronate and corticosteroid (betamethasone) was compared in a sample of 24 patients who had pain and tenderness to palpation in the temporomandibular joint (TMJ arthritis) of at least six months duration, and who had not responded to conservative treatment. The two drugs were randomly allocated to the patients. The drugs, 0.5 ml, were injected twice into the superior joint compartment of the TMJ with a two-week interval between injections. The effect on subjective symptoms, clinical signs, and bite force was assessed. At the one and two-year follow-ups both the hyaluronate-and the corticosteroid-group had significantly reduced subjective symptoms as well as clinical signs, and the maximum voluntary bite force was significantly increased. The differences in effect between treatments were not statistically significant. It was concluded that both drugs have a significant long-term effect on chronic arthritis of the TMJ and that either of the drugs can be helpful; however, sodium hyaluronate might be the best alternative due to the least risk for side effects.

Adult↗

PubMed1986

Humoral and hemodynamic effects of nitrendipine versus clonidine in patients with essential hypertension.

A single-blind, randomized controlled study was conducted to assess and compare the antihypertensive effectiveness and the effects on glucose tolerance and renin-angiotensin-aldosterone balance of nitrendipine (Bay e 5009), a new dihydropyridine calcium antagonist, and clonidine. Twenty-six outpatients with uncomplicated mild to moderate essential hypertension were randomly allocated to receive 20 mg of nitrendipine or 0.25 mg of clonidine (slow-release formulation) daily for five weeks. One patient in the clonidine group dropped out. Both treatments significantly reduced systolic and diastolic blood pressures with negligible modifications in heart rate. However, diastolic blood pressure was reduced significantly more (P less than 0.001) with nitrendipine. Accordingly, 12 of 13 patients given nitrendipine attained the goal of diastolic pressure less than or equal to 90 mmHg, according to criteria of the Hypertension Detection and Follow-up Program, while only three of 12 patients in the clonidine group achieved this goal. Side effects were mild and transient in both treatment groups. No definite trends in plasma renin activity or plasma aldosterone concentration, or in blood glucose or immunoreactive insulin (measured both in fasting conditions and after an oral glucose tolerance test), were evident when baseline and posttreatment values were compared. The results of this study suggest that nitrendipine is an effective and safe antihypertensive agent and is devoid of adverse effects on glucose tolerance and renin-aldosterone homeostasis.

Blood Glucose↗

PubMed1984

A comparison of pivmecillinam/pivampicillin and co-trimoxazole in hospitalized patients with acute exacerbations of chronic bronchitis.

Forty-nine hospitalized patients with acute exacerbations of chronic bronchitis were randomly allocated a ten-day course of either pivmecillinam/pivampicillin or co-trimoxazole. Both treatments were equally effective clinically (pivmecillinam/pivampicillin successful in 72% of cases; co-trimoxazole in 70%) and in their ability to eradicate pus from sputum (pivmecillinam/pivampicillin 84%; co-trimoxazole 74%). One patient taking co-trimoxazole ceased therapy because of persistent nausea and vomiting. No side-effects were observed in the pivmecillinam/pivampicillin group.

Acute Disease↗

PubMed1989

Staples versus sutures in the closure of scalp wounds: a prospective, double-blind, randomized trial.

Over a 6-month period, patients attending the Accident and Emergency Department of the Mater Infirmorum Hospital with scalp wounds were randomly allocated to one of two groups for closure of their wounds with either nylon sutures or metal staples. Each group contained 100 patients. Patients were reviewed at 5 days (95 per cent) after the removal of sutures or staples and again at 3 weeks (61 per cent). The two groups were similar for age, sex, aetiology and wound characteristics. There was no difference in morbidity or rate of wound infection but stapling was significantly faster and less painful. The use of staples carries no risk of accidental needle-stick injury and should therefore be safer than suturing for the user.

Double-Blind Method↗

PubMed1984

A randomized placebo-controlled double-blind trial of nimodipine after SAH in monkeys. Part 1: Clinical and radiological findings.

The authors have developed a method to induce chronic cerebral vasospasm after subarachnoid hemorrhage (SAH) in monkeys. With microsurgical techniques, 33 monkeys had a frontotemporal craniectomy and unilateral opening of the subarachnoid cisterns. Cerebrospinal fluid was drained and a fresh hematoma, obtained from an average of 7 ml of autologous blood, was carefully placed against the major arteries of the anterior circulation on one side. The 30 monkeys studied for 7 to 14 days after the SAH were allocated randomly to two treatment groups of 15: one group received placebo and the other nimodipine, 1 mg/kg every 8 hours. Indices monitored before and after SAH included neurological status, cerebral blood flow, computerized tomography, and angiographic vessel caliber. In the placebo group, delayed ischemic neurological deficit developed in one monkey 4 days after clot placement and was present at sacrifice on Day 14. No such deficit occurred in the nimodipine group. The effect of nimodipine on vessel caliber at this dosage was equivocal. Significant vasospasm (31% to 100% reduction in vessel caliber) developed in 87% (26 of 30) of the animals. Overall, vasospasm was slightly more common in the placebo group: in this group, on Days 7 and 14, the incidence of vasospasm was significantly higher (p less than 0.05) than in the nimodipine group. However, the average percentage reduction in vessel caliber of the maximally constricted vessel in each monkey was not significantly different between the two groups.

Animals↗

PubMed1985

Famotidine versus ranitidine for the short-term treatment of duodenal ulcer.

One-hundred and eight-three patients with endoscopically proven duodenal ulcers, enrolled in this prospective, double-blind study, were randomly allocated to receive famotidine 40 mg once at night, 20 mg twice daily, 40 mg twice daily, or ranitidine 150 mg twice daily for 2-8 weeks. Pretreatment characteristics between the four groups were similar. After 4 weeks of treatment, among the famotidine-treated patients, 38 of 42 (90.5%) healed with the 40 mg once nightly regimen, 35 of 42 (83.3%) with 20 mg twice daily, and 37 of 41 (90.2%) with 40 mg twice daily. In the ranitidine group 40 of 43 patients (93.0%) healed. After 8 weeks of treatment, the respective data were: 97.6, 95.2, 100 and 93.0%. Different results between the famotidine groups and the ranitidine group were not statistically significant. All treatments were well tolerated and severe adverse events were rare. Famotidine 40 mg given once at night appears to be as safe and effective as conventional therapy with ranitidine, indicating the importance of overnight gastric acidity in the pathogenesis of duodenal ulcer disease.

Adolescent↗