Plus ca change...

Og and Nyp sat by the fire outside the cave. Og, the older ofthe two medicine men, chewed hungrily at a metatarsal takenfrom the mammoth that the clan had hunted down the previousday. Nyp sat quietly, staring into the dying embers of the fire. ‘Medicine?’ Og said with scorn in his voice. ‘Itisn't medicine as I remember it. In the old days, if a man waspossessed by a evil spirit, you knew what a medicine man hadto     

Abortive Migraine Therapy With Oral Naproxen Sodium Plus Metoclopramide Plus Ergotamine Tartrate With Caffeine

The oral tablet combination, (550 mgs. of naproxen sodium plus 10 mgs. of metoclopramide plus 1 mg. of ergotamine tartrate plus 100 mgs. of caffeine), was retrospectively studied in 63 patients who used it to abort migraine headaches. On the average, 84% of the headaches were totally aborted; minor side effects occurred in 40% of the patients, and 87% of the patients considered the combination superior to all prior treatments.     

伊立替康联合顺铂(IP)方案与EP方案治疗小细胞肺癌的观察及护理

目的: 观察伊立替康联合顺铂(IP)方案治疗小细胞肺癌(SCLC)的近期疗效和毒副反应,探讨其化疗护理措施.方法: 将61例SCLC患者随机分两组,接受IP或EP(依托泊苷 顺铂是治疗SCLC的标准方案)方案化疗2个周期以上评价疗效及毒副作用.护理要点:加强化疗相关知识教育,重视急性胆碱能综合征及延迟性腹泻的护理.结果: ①有效率IP组(66.7%)高于EP组(61.3%)(P＞0.05).②IP组血液学毒性反应比EP组轻(P＜0.05);腹泻IP组(36.7%)多于EP组(6.5%)(P＜0.01);胆碱能综合征IP组(13.1%)多于EP组(0%)(P＞0.05).肝、肾功异常、周围神经炎、脱发、静脉炎等均少见.结论: IP方案是治疗SCLC有效的方案,血液学毒性较EP方案轻,而IP方案的腹泻较明显,可以通过对症治疗控制.     

Comparison of BD Vacutainer SST Plus Tubes with BD SST II Plus Tubes for common analytes

Serum separator tubes were introduced 25 years ago and are widely used in the clinical laboratory today for routine collection of blood. These tubes have gained widespread acceptance due to the advantage of the barrier gel that facilitates rapid separation of serum from cellular constituents of blood and thus reduces hemolysis. However, there are some limitations associated with gel tubes (i.e., gel stability and analyte incompatibilities). The serum separator BD SST tubes manufactured by BD are widely used in clinical laboratories. Recently, BD has developed a new barrier gel, which is superior to the existing gel. We studied the stability of common analytes when serum specimens were stored in the new BD SST II tubes by comparing the performance with the existing BD SST tubes. We did not observe any significant reduction in concentrations of 42 commonly ordered analytes using the new BD SST II tubes. Significant differences were noted at low serum volumes for estradiol in both tube types over time. We conclude that the new BD SST II tubes are suitable for collection of blood and storage of serum for commonly ordered laboratory tests.     

Lidocaine Plus Morphine Versus Lidocaine Plus Paracetamol for Bier Block: A Double-Blind Randomized Controlled Trial

PurposeIntravenous regional anesthesia (Bier block) is widely used as an anesthetic technique for operations of short duration of the distal upper or lower extremities. We compared the efficacy of intravenous regional anesthesia with lidocaine plus paracetamol versus lidocaine plus systemic morphine for short-duration hand and forearm surgeries.DesignA double-blind randomized controlled trial with two parallel arms: lidocaine plus morphine (control) and lidocaine plus paracetamol were carried out at a University hospital.MethodsWe included men and women aged 20 to 70 years scheduled for short surgical procedures (30-60 minutes) distal to the elbow. Intravenous regional anesthesia was carried out by injecting 45 cc lidocaine 0.5% plus 300 mg paracetamol for the paracetamol group; or 45 cc lidocaine 0.5% plus 4 mg intravenous morphine for the control group. The primary outcome was postoperative pain-free period in minutes since deflation of proximal tourniquet. The secondary outcome was the highest intensity of postoperative pain on the visual analog scale within 2 hours after deflating the proximal tourniquet.FindingsThere was no significant difference between morphine and paracetamol in the duration of postoperative pain-free period (P = .078) and the mean intensity for maximum pain (P = .106). However, severe pain was significantly more frequent in the morphine group (P = .001). Paracetamol seemed to be safer than morphine as an adjuvant to lidocaine.ConclusionsWe recommend using 2 cc paracetamol (300 mg Apotel) as the adjuvant to lidocaine for intravenous regional anesthesia.     

A Double-Blind, Randomized Comparison of Aztreonam Plus Clindamycin with Tobramycin Plus Clindamycin in Abdominal Infections

Seventy patients with intraabdominal infections were randomly assigned in double-blinded fashion to receive either the combination of tobramycin plus clindamycin (TM/C) or aztreonam plus clindamycin (AZ/C). Thirty-four patients received AZ/C and 36 were given TM/C. Average ages were 62 years (TM/C) and 66 years (AZ/C). In approximately one-half of both groups, the source of infection was perforated colon or perforated appendix. There were no significant differences in demographic factors between these groups, although those given AZ/C had a more serious long-term prognosis due to underlying diseases. The average lengths of treatment were 10 days (TM/C) and 9 days (AZ/C). Clinical response to therapy did not differ, as 84% of the TM/C patients and 78% of the AZ/C patients had satisfactory clinical responses. The two regimens differed in adverse effects, as an elevated PT/PTT was more frequently (p < 0.05) observed in AZ/C. All PT/PTT elevations responded to injections of vitamin K, and no serious bleeding occurred. Choice between these regimens depends on differences in cost and the risk of adverse effects, as both regimens appear equally effective for treatment of abdominal infections in conjunction with appropriate surgical intervention.     

XELOX方案与PF方案治疗老年进展期食管癌的对比研究

目的 比较奥沙利铂联合卡培他滨与顺铂联合氟尿嘧啶治疗老年进展期食管癌的效果与安全性.方法 对我院2005年1月-2010年12月应用奥沙利铂联合卡培他滨或顺铂联合氟尿嘧啶治疗老年进展期食管癌的疗效与毒性反应进行回顾性对比分析.结果 本研究共计55例纳入统计,28例接受奥沙利铂联合卡培他滨化疗(XELOX组),27例接受顺铂联合氟尿嘧啶化疗(PF组).XELOX组化疗结束后最终确认达完全缓解(CR)3例,部分缓解(PR)14例,稳定(SD)8例,有效率60.71％,疾病控制率89.29％;PF组达CR 1例,PR 9例,SD 12例,有效率37.04％,疾病控制率81.48％,组间比较差异均无统计学意义(P＞0.05).PF组Ⅲ、Ⅳ度毒性反应中白细胞减少、血小板减少、恶心、呕吐发生率明显高于XELOX组,差异有统计学意义(P＜0.05).结论 奥沙利铂联合卡培他滨治疗老年进展期食管癌效果确切,毒性及不良反应相对较轻.     

Zofenopril Plus Hydrochlorothiazide and Irbesartan Plus Hydrochlorothiazide in Previously Treated and Uncontrolled Diabetic and Non-diabetic Essential Hypertensive Patients

Introduction

In most treated patients with hypertension, a two or more drug combination is required to achieve adequate blood pressure (BP) control. In our study we assessed whether the combination of zofenopril + hydrochlorothiazide (HCTZ) was at least as effective as irbesartan + HCTZ in essential hypertensives with at least one additional cardiovascular risk factor, uncontrolled by a previous monotherapy.

Methods

After a 2-week placebo washout, 361 treated hypertensive patients [office sitting diastolic BP (DBP), ≥90 mmHg], aged 18–75 years, were randomized double blind to 18-week treatment with zofenopril 30 mg plus HCTZ 12.5 mg or irbesartan 150 mg plus HCTZ 12.5 mg once daily, in an international, multicenter study. After the first 6 and 12 weeks, zofenopril and irbesartan doses could be doubled in non-normalized subjects. The primary study end point was the office sitting DBP reduction after 18 weeks of treatment. Secondary end points included office systolic BP (SBP), ambulatory BP and high sensitivity C-reactive protein (hs-CRP).

Results

The between-treatment difference for office DBP averaged to +1.0 (95% CI ?0.4, +0.8) mmHg (P = 0.150), the upper limit of the 95% confidence interval being inferior to the protocol-defined non-inferiority limit (3 mmHg). In the subset of patients with valid ambulatory BP, no difference in 24-h average DBP [n = 181; 6.7 (8.7, 4.6) zofenopril + HCTZ vs. 6.3 (8.8, 3.7) mmHg irbesartan + HCTZ, P = 0.810] and SBP reductions [11.7 (15.4, 8.0) vs. 12.6 (17.2, 8.0) mmHg, P = 0.758] were observed between the two treatment groups. hs-CRP was reduced by zofenopril + HCTZ [?0.52 (?1.05, 0.01) mg/L], while it was increased by irbesartan plus HCTZ [0.97 (0.29, 1.65) mg/L, P = 0.001 between treatments].

Conclusion

In previously monotherapy-treated, uncontrolled patients with hypertension, zofenopril 30–60 mg + HCTZ 12.5 mg is as effective as irbesartan 150–300 mg plus HCTZ 12.5 mg, with the added value of a potential protective effect against vascular inflammation.     

BACTEC树脂需氧瓶与树脂厌氧瓶临床应用评价

目的评价BACTEC树脂需氧瓶和树脂厌氧瓶对血液中病原菌的检测能力。方法回顾性分析1241例BACTEC树脂需氧瓶、树脂厌氧瓶配对血液培养结果,比较分离病菌的种类及不同培养瓶报阳时间。结果 1 241份血液标本有138份报阳,分离病原菌141株(3份标本为复数菌感染)。需氧瓶和厌氧瓶分离病原菌126株和122株,107株病原菌可同时在两种血培养瓶生长,另有19株和15株分别只能在需氧瓶或厌氧瓶中生长。50%的肠杆菌和60%的阳性球菌的在厌氧瓶中生长迅速而先于需氧瓶报阳。结论厌氧树脂瓶检测菌血症有一定优势,联合使用需氧、厌氧瓶进行血培养能更有效、更快速诊断菌血症。     

丙泊酚加曲马多麻醉行无痛人工流产术的观察与护理

目的　探讨两种不同静脉麻醉用药对无痛人工流产术的效果。方法　将 12 0例 4 5～ 6 0d的孕妇随机分为两组各 6 0例 ,麻醉方式 :观察组曲马多 2mg/kg静注 ,10min后静注丙泊酚 1.5mg/kg ;对照组单纯用丙泊酚 2 .5mg/kg静注 ,比较两组镇痛效果、宫颈松弛度、出血量、人流综合征发生、患者自动离院时间。结果　观察组的镇痛效果及术后自动离院时间与对照组有显著差异 (P <0 .0 1) ;但两组的宫颈松弛度、并发症和出血量无显著差异 (P >0 0 5 )。结论　丙泊酚加曲马多静脉麻醉用于无痛人流术 ,有良好的镇痛效果。     

云南白药加食醋治疗带状疱疹

1998年 1月— 2 0 0 0年 10月共收治带状疱疹病人 30例 ,均采用云南白药、食醋 ( 5 %醋酸 )治疗 ,疗效显著 ,现介绍如下。1　治疗方法　　首先用 3 %过氧化氢及灭菌生理盐水冲洗带状疱疹区域 ,再用无菌针头刺破水疱使疱内液体流出 ,并用棉签将破溃的坏死组织轻轻擦去 ,直至露出新鲜组织且有少量渗血为止。然后用消毒的压舌板将云南白药与食醋调匀的糊状物涂于创面( 1ｍｍ厚 ) ,每日 2次 ,直到创面愈合。2　典型病例　　 [例 1 ]　 男 ,6 4岁。右侧腰部有一 8ｃｍ× 2 0ｃｍ的疱疹创面 ,部分疱疹已溃破 ,有脓性分泌物。先用 3 %过氧化氢、生…     

Clinical efficacy of Comfeel Plus Transparent Dressing

Hydrocolloid dressings have been in use for more than 20 years. They are indicated for the treatment of granulating, superficial wounds with low to moderate exudates. There are a number of hydrocolloid dressings available, one of which is Comfeel Plus Ulcer Dressing. This differs from the others by combining a hydrocolloid with calcium alginate in its formation to increase the absorptive capacity. This article examines another product of the Comfeel Plus range, Comfeel Plus Transparent Dressing (Coloplast A/S) and describes a small evaluation of the product. The conclusion is that Comfeel Plus Transparent Dressing performs well in terms of healing, compliance, adherence and flexibility. Furthermore, it is transparent and it is therefore possible to follow the wound healing process without removing the dressing.