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[Propofol for sedation during postoperative mechanical ventilation. A comparative study with Lytic Mixture].

Propofol infusion was found to provide excellent sedation and rapid recovery in intensive care. The present study compared Propofol with lytic solution (lytic solution = mixture of 100 mg Pethidine, 50 mg Promethazine and 0.6 mg Dihydroergotamine) during 6 hours of postoperative artificial ventilation. 60 patients after major abdominal surgical procedures were studied with ethical committee approval and informed consent. Patients were randomly allocated to receive either Propofol or lytic solution. We aimed at a sedation level of stage 5 according to the Ramsey score. The mean drug dosages were 3.9 mg/kg/h of Propofol and 4.2 ml/h of lytic solution. Hemodynamic values, blood gases as well as various biochemical measures did not show any difference between the groups. At the end of the sedation period triglyceride concentrations were significantly higher in patients receiving Propofol (166 + 79 mg/dl) compared to the control group (97 + 60 mg/dl). Significant and relevant differences were found for the times of recovery after discontinuation of the sedative. These times were very short in the Propofol group. Furthermore, in view of a longer recovery time after lytic solution in this group the respiratory rate was significantly slower up to the end of the observation period. We conclude that a major advantage of Propofol in the present study was the rapid recovery after 6 hour sedation. Patients gain vigilance rapidly and sufficient spontaneous respiration within minutes. Not at least thanks to these facts patient's safety can be improved in the recovery period.

Abdomen

Percutaneous and open surgical repairs of Achilles tendon ruptures. A comparative study.

A comparative study between percutaneous repair and open surgical repair of acute spontaneous Achilles tendon ruptures in young athletic patients is presented. Twenty-seven patients with acute Achilles ruptures were evaluated objectively and with subjective questionnaires. Fifteen of the patients were treated by reconstruction with a gastrocsoleus fascial graft (followup, 4.6 years) and 12 treated by percutaneous repair (followup, 1.8 years). Subjectively, both groups were very satisfied with the results of their treatment. Cybex II dynamometer measuring strength, power, and endurance revealed no statistical significant differences between groups, even in light of the shorter followup of the percutaneous group. The percutaneous repairs demonstrated significantly more symmetry in injured/uninjured tendon size than did the open surgical repairs. Two reruptures occurred in the percutaneous group. No other complications were noted. After evaluation of both subjective and objective data we recommend percutaneous repair in the recreational athlete and in patients concerned with cosmesis. Open repair is recommended for all high-caliber athletes who cannot afford any chance of rerupture.

Achilles Tendon

Methods for measuring the renal uptake rate of 99mTc-dimercaptosuccinic acid (DMSA): a comparative study.

A comparative study of the renal uptake rate of 99mTc-dimercaptosuccinic acid (DMSA) was performed using a phantom study and clinical data from 100 patients (200 kidneys) with a variety of renal diseases. The measurement methods for renal uptake rate studied here include a posterior-view method, a conjugate-view method, and a method using single photon emission computed tomography (SPECT). The renal uptake rates obtained by the posterior-view method significantly (P less than 0.001) depended on kidney depth correction. With the SPECT method, the cut-off level for delineating the kidney was changed according to the background count ratio using the results of the phantom study. The renal uptake rates obtained by the SPECT method correlated significantly (P less than 0.001) with those obtained by other methods, and there were no significant differences as compared with those obtained by the conjugate-view method. An analysis of error with the above methods indicated that the error relating to the sensitivity to body thickness was smallest for the SPECT method and greatest for the posterior-view method. In terms of measurement of renal uptake rate only, the conjugate-view method is considered the most useful because it needs no kidney depth correction and requires very little additional effort or examination time.

Female

GSR feedback and Schultz relaxation in tension headaches: a comparative study.

A comparative study of the use of GSR feedback (n = 16) and Schultz relaxation (n = 15) with patients presenting tension headaches showed that there was no significant improvement in the group treated by relaxation at the end of the treatment whereas the group treated by GSR feedback showed significant improvements with respect to frequency and intensity of headaches and to anxiety as measured by subjects' self-evaluation (P less than 0.05). Intergroup comparison demonstrated a greater improvement in headache intensity for the GSR feedback group than for the relaxation group (P less than 0.05) at the post-treatment stage. Likewise, the percentage of patients showing at least 50% improvement as to headache frequency was significantly higher (P less than 0.05) in the GSR feedback than in the relaxation group. High pre-treatment EMG and high pre-treatment weekly pain level indicate a good prognosis of improvement with respect to post-treatment headache frequency and intensity respectively in the case of the GSR feedback group. We found no prognostic factor for post-treatment clinical improvement in the relaxation group.

Adult

The treatment of uraemic hyperphosphataemia with calcium acetate and calcium carbonate: a comparative study.

A comparative study of long-term haemodialysis patients investigated the effects of calcium acetate and calcium carbonate on concentrations of serum phosphate, calcium, and parathyroid hormone. It was demonstrated that both substances led to a significant decrease in phosphate and serum parathyroid hormone. Administration of calcium acetate reduced the serum phosphate concentration in 7 weeks from an initial value of 2.08 +/- 0.53 mmol/l to 1.51 +/- 0.39 mmol/l (P less than 0.01). Following a 1-week wash-out period, calcium carbonate reduced the serum phosphate concentration in the same patients from 1.99 +/- 0.62 mmol/l to 1.34 +/- 0.40 mmol/l (P less than 0.01). Of particular significance, however, is the fact that in relation to daily elementary calcium intake, calcium acetate was a considerably more effective binder of intestinal phosphate than calcium carbonate. During administration of calcium acetate only 1.02 g of elementary calcium were required daily in order to reduce the serum phosphate concentration. The same patients, however, required 1.88 g of elementary calcium during calcium carbonate therapy. Complementary studies investigated the influence of an accompanying calcitriol medication. In this instance, too, calcium acetate was shown to be more effective; although the patients developed hypercalcaemia with calcium acetate, this happened more often with calcium carbonate. In summary it can be said that daily calcium loading of the uraemic organism under calcium acetate therapy is reduced by nearly half as compared to calcium carbonate therapy, and that this can be achieved with the same effective decrease of the serum phosphate concentration.

Acetates

Freeze-fracture of Langerhans granules. A comparative study.

A comparative study of freeze-fracture replicas and thin sections of Langerhans granules has proved that the effects of conventional tissue processing on the inner structure of the granule are negligible, and the study has confirmed the validity of the previously proposed tridimensional models. The paracrystalline quality of the substance contained between the limiting membranes of the disc-shaped area of the granules seems to suggest it protein nature. In replicas, no particle organizations attributable to intercellular junctions were observed on the plasma membranes of Langerhans cells.

Cell Membrane

The response of poorly differentiated prostatic tumors to staining for prostate specific antigen and prostatic acid phosphatase: a comparative study.

A comparative study was done of the usefulness of immunohistochemical stains for prostate specific antigen and prostatic acid phosphatase in 20 poorly differentiated prostatic tumors. The stain for prostatic acid phosphatase was preferable to the prostate specific antigen stain not only because it was more intense and, therefore, more visible but also because it often was positive in areas in which an equivocal or negative stain was obtained with prostate specific antigen.

Acid Phosphatase

Fiber-optic versus microtip transducers in simultaneous urethrocystometry. A comparative study.

A comparative study of a new fiber-optic transducer versus a microtip transducer was performed in 13 females. A good correlation was found on bladder pressure. The urethral pressure diverged considerably, as the pressures measured with the fiber-optic transducer were about two thirds of the pressures found with the microtip. The functional urethral length measured with the fiber-optic transducer was also shorter.

Adult

Management and outcome of vertex-breech and vertex-vertex presentation in twin gestation: a comparative study.

A comparative study of twin pregnancies with vertex-breech and vertex-vertex presentation was undertaken to evaluate the effect of mode of delivery on perinatal outcome. During the years 1978-1984 there were 89 cases of vertex-breech deliveries at our institution and a control group of 89 cases of vertex-vertex presentation were chosen. The cesarean section rate was 11.2% for both twins in vertex-breech, and 20.2% for the first twin and 23.6% for the second in vertex-vertex presentation. The primary indications for cesarean section were not related to the type of presentation. The perinatal mortality was 22.4/1000 in the study group and 89.8/1000 in the control population. There were no statistically significant differences in 5-min Apgar scores and perinatal morbidity between the two types of presentation. We found that the high perinatal morbidity and mortality of both twins is related to prematurity and intrauterine growth retardation and not associated with the type of presentation of the second twin. Therefore, routine cesarean section for vertex-breech presentation is not necessarily indicated.

Apgar Score

[Short-term outcome of a 1st myocardial infarct preceeded or not by a premonitory sign. Comparative study].

A comparative study of two groups of patients after their first myocardial infarction, distingusihed by the presence (group A, 149 cases) or absence (group B, 184 cases) of premonitory signs has shown no difference between the two groups in the short-term (5 weeks). The only differences were in the age (younger patients and in the larger number of anteriorly situated infarcts in the 45% of patients in this series who had premonitory signs.

Angina Pectoris

Role of technetium-99m diphosphonate and gallium-67 citrate bone scanning in the early diagnosis of infectious spondylodiscitis. A comparative study.

A comparative study of the parts played by technetium-99m diphosphonate and gallium-67 citrate bone scanning in the early diagnosis of infectious spondylodiscitis is presented. Nineteen patients were included in the study. All patients (11 men aged 19-70 years and eight women aged 18-72 years) had a history of back pain varying in duration from one to 15 weeks. A 99mTc diphosphonate bone scan was positive in 17 patients. The two patients with negative results had less than two weeks of back pain. The 67Ga citrate bone scan showed uptake in all patients.

Adult

[HBV status and expression of ets-2, IGF-II, C-myc and N-ras in human hepatocellular carcinoma and adjacent nontumorous tissues--a comparative study].

A comparative study on HBV status and ets-2, IGF-II, C-myc and N-ras expression in 12 pairs of human primary hepatocellular carcinoma (PHC) and adjacent non-tumorous tissues (NT) showed that integrated forms of HBV DNA were present in 91.5% PHC and 75% NT. No specific integration sites were detected. Three PHC and 4 NT were found to have free forms of HBV DNA, which were defective in 2 PHC and 3 NT, i. e., being able to replicate but not to be secreted into the blood. At least one of four oncogenes studied was overexpressed in the 12 pairs of samples. IGF-II was expressed as 5.0 and 2.0 Kb fetal transcripts in 3 pairs of samples and 1 NT. Six NT had more than one of the four oncogenes that was expressed higher than PHC. This was commonly encountered in tissues with free forms of HBV DNA. The relation between HBV status, expression of ets-2, IGF-II, C-myc and N-ras and carcinogenesis of PHC is discussed.

Carcinoma, Hepatocellular

Nasopharyngeal carcinoma. A comparative study.

A comparative study of Ghanaian and Saudi hospital cases of nasopharyngeal carcinoma (NPC) shows a higher occurrence among younger subjects in the Ghanaian group, with the peak age incidence in the Saudi group being similar to those reported from other parts of the world. In view of the known high prevalence of Burkitt's lymphoma among Ghanaian children, it is suggested that the much higher proportion of younger Ghanaian subjects with NPC may be related to early exposure to the Epstein-Barr virus which is known to be associated with both malignancies.

Adolescent

Effectiveness of peroral and intranasal immunization of school children with live allantoic influenza vaccine- and comparative study.

A comparative study of two preparations of allantoic live influenza vaccine, one for intranasal and the other for peroral immunization of children of school age, was peformed under conditions of a blind epidemiological trial. Previously obtained data on the safety and high immunogenicity of the intranasal vaccine variant, prepared from extremely attenuated cold-adapted strains, were confirmed. The peroral administration of the live influenza vaccine, in use in the USSR for active immunization of the adult population, also stimulated influenza immunity without producing postvaccinal reactions. Peroral and intranasal immunization with the above variants of live allantoic influenza vaccine markedly lowered in the frequency of influenza disease during an influenza epidemic, the mean index of effectiveness being equal to a factor of 2. Evidence of prospectiveness of influenza prophylaxis among school children was obtained.

Administration, Intranasal

Cytokine-associated tissue injury and lethality in mice: a comparative study.

A comparative study was performed to examine the lethal effects of several cytokines injected into mice sensitized with actinomycin D (Act-D). Consistent with published data, human tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) (0.2-5 micrograms) caused the death of the animals within 8-12 hr after injection. Human interleukin-6 (IL-6) and interleukin-8 (IL-8) (0.6-6 micrograms) known to be induced by TNF-alpha did not show any lethal effects, indicating that TNF-alpha-associated lethality is not mediated by IL-6 or IL-8. Human tumor necrosis factor-beta (TNF-beta) (also called lymphotoxin), which shares structural and functional properties with TNF-alpha, was as potent as TNF-alpha in its lethal effects. Murine interferon-gamma (IFN-gamma) (0.04-5 micrograms) was also tested and showed no lethal effects in this model. In addition, a synthetic peptide corresponding to amino acid residues 163-171 of IL-1 beta, and which has been shown to lack the inflammatory effects of IL-1 beta, also caused no lethality among Act-D sensitized mice. The pretreatment of mice with IL-6, IL-8, or IFN-gamma had no protective effects on TNF-alpha or IL-1 beta-induced lethality in contrast to the protection observed by a pretreatment with TNF-alpha/IL-1 beta themselves or with endotoxin. Histopathologic data showed that severe tissue injury in vital organs is associated with the rapid lethality among sensitized mice.

Animals

A comparative study of nicardipine and pindolol as second-line treatments in essential hypertension.

A controlled, randomized, single-blind, parallel-group study compared the effects of nicardipine hydrochloride/hydrochlorothiazide (HCTZ) with those of pindolol/HCTZ in treatment of essential hypertension. The study included 43 patients aged 30-64 years with supine diastolic blood pressures between 95 and 125 mmHg at baseline. Patients initially received 50 mg/day HCTZ for 6 weeks and those patients whose diastolic blood pressure remained at or above 90 mmHg at week 6 (n = 29) completed a 6-week comparative phase in which they were given, in addition, either 30 mg nicardipine hydrochloride or 5 mg pindolol three times daily. Nicardipine was more effective than pindolol as a second-line treatment in controlling blood pressure but, because patients who were treated with nicardipine/HCTZ had higher baseline blood pressures, significance was lost when results were adjusted for the baseline blood pressure values. Treatment was described as 'very good' by 71.4% of patients in the nicardipine/HCTZ group and by 53.9% of those in the pindolol/HCTZ group; thus, both second-line antihypertensives were well accepted. Although 45% of patients in of each treatment group reported treatment-related adverse events, none experienced postural hypotension and no adverse event was unexpected.

Adult

The timing of epiphysiodesis. A comparative study between the use of the method of Anderson and Green and the Moseley chart.

This retrospective study compares two groups of patients who underwent an epiphysiodesis for leg length discrepancy. In group A (47 patients) the timing of the epiphysiodesis was calculated using the method of Anderson and Green; in group B (36 patients) the Moseley chart was used. A leg length discrepancy of 1.5 cm or less at maturity was considered a satisfactory result. Group A showed 51% good results, group B 63.9%. In both groups, an important source of the poor results was error in calculation and prediction: 30.4% in group A (or 15% of the total), 61.5% in group B (or 22% of the total). The percentage of patients presenting too late was also considerable and accounted for 34.8% of the poor results in group A and for 23.1% in group B. The unpredictability of growth rate is a lesser problem in group B (15.4% of the poor results) than in group A (30.4%). If the uncontrollable causes of poor results are omitted, only 18% of the poor results in the total group of patients could be accounted for by miscalculation.

Adolescent

Comparative studies on immunity to EBV-associated antigens in NPC patients in North America, Tunisia, France and Hong Kong.

This study compared the relative antibody titers to EBV-related antigens in patients with nasopharyngeal carcinoma (NPC) and controls from a high-incidence (Hong Kong), an intermediate incidence (Tunisia), and two low-incidence (France, North America) areas to determine which of several EBV antibodies best differentiated NPC patients from controls. Antibodies measured include anti-virus capsid antigen (VCA), anti-early antigen (EA), anti-soluble antigen by complement-fixation (CF) and antibody-dependent lymphocyte cytotoxicity (ADLC). A matched pair analysis showed that significantly more NPC patients had higher VCA and EA but not CF or ADLC antibody titers than their matched cancer controls. The comparison of geometric mean titers between NPC cases and controls was more than seven-fold (816 vs 11.5) for EA antibody and more than three-fold (359.7 vs 95.4) for VCA anti-body (p less than 0.01). A two-fold difference was seen for CF antibody to soluble antigens (27.3 vs 12.9, p less than 0.01) and a three-fold difference (2657.7 vs 870.9, p less than 0.05) was observed for ADLC. Our finding of significant differences between NPC patients from four countries and their matched controls suggest that if EBV is the etiological agent of NPC in Chinese, it is quite likely to cause the majority of NPC cases in other ethnic groups living in other countries as well.

Antibodies, Viral