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1.
Stephen F Hughes Beverly D Hendricks David R Edwards Salah S Bastawrous Jim F Middleton 《European journal of medical research》2013,18(1):40
Background
With an aging society and raised expectations, joint replacement surgery is likely to increase significantly in the future. The development of postoperative complications following joint replacement surgery (for example, infection, systemic inflammatory response syndrome and deep vein thrombosis) is also likely to increase. Despite considerable progress in orthopaedic surgery, comparing a range of biological markers with the ultimate aim of monitoring or predicting postoperative complications has not yet been extensively researched. The aim of this clinical pilot study was to test the hypothesis that lower limb orthopaedic surgery results in changes to coagulation, non-specific markers of inflammation (primary objective) and selective clinical outcome measures (secondary objective).Methods
Test subjects were scheduled for elective total hip replacement (THR) or total knee replacement (TKR) orthopaedic surgery due to osteoarthritis (n = 10). Platelet counts and D-dimer concentrations were measured to assess any changes to coagulation function. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured as markers of non-specific inflammation. Patients were monitored regularly to assess for any signs of postoperative complications, including blood transfusions, oedema (knee swelling), wound infection, pain and fever.Results
THR and TKR orthopaedic surgery resulted in similar changes of coagulation and non-specific inflammatory biomarkers, suggestive of increased coagulation and inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in an increase in platelet (P = 0.013, THR) and D-dimer (P = 0.009, TKR) concentrations. Evidence of increased inflammation was demonstrated by an increase in CRP and ESR (P ≤ 0.05, THR and TKR). Four patients received blood transfusions (two THR and two TKR patients), with maximal oedema, pain and aural temperatures peaking between days 1 and 3 postoperatively, for both THR and TKR surgery. None of the patients developed postoperative infections.Conclusions
The most noticeable changes in biological markers occur during days 1 to 3 postoperatively for both THR and TKR surgery, and these may have an effect on such postoperative clinical outcomes as oedema, pyrexia and pain. This study may assist in understanding the postoperative course following lower limb orthopaedic surgery, and may help clinicians in planning postoperative management and patient care. 相似文献2.
Chi-Yang Liao Hui-Ting Chan En Chao Che-Ming Yang Tzu-Chuan Lu 《Singapore medical journal》2015,56(1):58-64
INTRODUCTION
Patients with rheumatoid arthritis (RA) and osteoarthritis (OA) may require total hip replacement (THR) or total knee replacement (TKR). The present study aimed to compare the demographic characteristics and medical costs of RA and OA patients from Taiwan who underwent either THR or TKR.METHODS
The medical records of patients who had undergone THR or TKR from 1 January 1996 to 31 December 2010 were obtained from the Taiwan National Health Insurance Research Database (NHIRD). In all, we found 49 and 146 RA patients who received THR and TKR, respectively, and 1,191 and 6,574 OA patients who received THR and TKR, respectively. The gender, age, Charlson comorbidity index (CCI), hospital grade, age at registration in the catastrophic illness dataset, and medical utilisation costs of the different groups were compared.RESULTS
There were statistically significant differences in age, CCI score, drug costs and surgery costs between RA and OA patients. Joint replacement incidence was lower in RA patients than in OA patients, and among patients who underwent THR, total medical costs incurred were higher for RA patients than OA patients. RA patients who underwent THR incurred a significantly greater total medical utilisation cost in the outpatient department (3 months before surgery and 12 months after surgery) than OA patients who underwent THR.CONCLUSION
Analysis of Taiwan NHIRD with regard to patients who had undergone either THR or TKR indicated that RA patients were younger than OA patients, and that significantly more medical resources were used for RA patients before, during and after hospitalisation for these procedures. 相似文献3.
OBJECTIVE: To determine the prevalence of venous thromboembolism (VTE) after total hip replacement (THR), total knee replacement (TKR) or bilateral TKR in a large sample of patients in a major hospital orthopaedic unit. DESIGN, SETTING AND PATIENTS: The Mater Misericordiae Hospital, North Sydney, NSW, a 195-bed private hospital. All patients who had THR, TKR or bilateral TKR at the hospital between 1 April 1995 and 31 December 2001 had physical prophylaxis (graduated compression elastic stockings or intermittent pneumatic compression, or both) and chemical prophylaxis (anticoagulant) against VTE. All underwent ultrasonography of both legs before discharge, with a small, symptomatic group also undergoing a ventilation/perfusion lung scan (V/Q scan) and computed tomographic pulmonary angiography. MAIN OUTCOME MEASURES: Prevalence of deep-vein thrombosis (DVT) and symptomatic pulmonary embolism (PE) before discharge. RESULTS: Among a total of 5999 patients, the pre-discharge prevalence of DVT after THR, TKR or bilateral TKR was 8.9%, 25.6% and 36.9%, respectively. The prevalence of symptomatic non-fatal in-hospital PE was 1.9%, while the prevalence of fatal in-hospital PE was 0.05%. CONCLUSIONS: Despite short-term chemical and physical thromboprophylaxis, the prevalence of DVT after lower-limb joint replacement, measured by pre-discharge ultrasonography, was high. The rate of symptomatic non-fatal in-hospital PE was moderate, but fatal in-hospital PE was rare. 相似文献
4.
From presentation to publication: the natural history of orthopaedic abstracts in the United Kingdom
Background
Up to 63% of the chapters in major orthopaedic textbooks use the results from abstracts that have been presented at international orthopaedic meetings.Methods
Orthopaedic abstracts were reviewed that were presented at the 1997 and 1998 meetings of the British Orthopaedic Association and other specialist orthopaedic meetings. The number of abstracts that had gone on to a full text publication was assessed and changes in study design or outcome were determined.Results
Of the 415 abstracts 137 (33.0%) went on to full text publication. Abstracts presented at the British Orthopaedic Association were significantly more likely to go on to full text publication than abstracts from the other meetings studied. The mean time to publication was 15.6 months. Sample sizes in unpublished studies were smaller (mean 129.8 subjects compared with a mean of 191.4 subjects for published studies). Of full text papers, 19.0% differed regarding study design from the abstract presented at the initial meeting and 10.9% had published different results. Randomised controlled trials had the highest rate of later full text publication (53.6%) followed by observational studies (32.8%), basic science studies (31.4%), and case reports (6.7%).Conclusions
In comparison with a study from North America, similar numbers of abstracts presented at meetings finally became published as full text articles, the abstracts had fewer authors, more often included randomised controlled trials and follow up data, and had fewer changes to the results. It is questionable whether the inclusion of such results from abstracts presented at international meetings by major orthopaedic textbooks should be undertaken before full text publication. 相似文献5.
Introduction
Characteristics and outcomes of patients undergoing inferior vena cava (IVC) filter insertion are not well reported. Particularly, the role of long term anticoagulation in these patients is unclear.Aims
(1) To describe in a cohort of patients undergoing IVC filter insertion, underlying diseases, indications for filter insertion, complications, and survival. (2) To determine the effect of long term anticoagulant treatment on thromboembolism and patient survival.Study design
A retrospective analysis of 109 consecutive patients undergoing IVC filter insertion in two university hospitals.Results
Average age was 67.4 years. Median duration of follow up was two years. Indications for IVC filter insertion were: contraindication to anticoagulation (n = 61, 56%), prophylactic insertion (n = 29, 27%), thromboembolism while receiving adequate anticoagulation (n = 17, 15%), and non‐compliance with anticoagulation (n = 2, 2%). Insertion related complications were groin haematoma in four patients (3.5%) and localised infection at the puncture site in one patient (0.9%). Fifty six patients (51.4%) died during the study period. Of these, 22 received long term anticoagulants and 34 did not. Overall and thrombosis free survival was greater in the anticoagulant treated group (median survival not reached) than in the untreated group (median survival = 12 months). Patients not receiving long term anticoagulation after IVC filter insertion were nearly 2.5‐fold more likely to die or experience venous thromboembolism.Conclusion
IVC filter insertion was a safe procedure and was performed for appropriate indications in the patients studied. In patients surviving for longer than 30 days, prolonged administration of oral anticoagulants was associated with improved survival with no significant increase in haemorrhagic complications. 相似文献6.
Wadey VM Halpern J Bouchard J Dev P Olshen RA Walker D 《Postgraduate medical journal》2007,83(978):268-272
Objective
To develop a core curriculum for orthopaedic surgery and to conduct a national survey to assess the importance of 281 items in the curriculum. Attention was focused specifically on 24 items pertaining to the curriculum that are pertinent to the spine.Study design
A cross‐sectional survey of a random sample of orthopaedic surgeons whose primary affiliation was non‐academic, representing the provinces and territories of CanadaMethods
A questionnaire containing 281 items was developed. A random group of 131 (out of 156) orthopaedic surgeons whose primary affiliation is non‐academic completed the questionnaire. The data were analysed quantitatively using average mean scores, histograms, the modified Hotelling''s T2 test and the Benjimini–Hochberg procedure.Results
131 of 156 (84%) orthopaedic surgeons participated, in this study. 14 of 24 items were ranked at no less than 3 out of 4 thus suggesting that 58% of the items are important or probably important to know by the end of residency (SD⩽0.07). Residents need to learn the diagnosis and principles of managing patients with common conditions of the spine.Conclusions
The study shows, with reliable statistical evidence, that orthopaedic residents are no longer expected to be able to perform spinal fusions with proficiency on completion of residency. Is the exposure to surgical spine problems and the ability to be comfortable with operating expectations specific to the fellowship level? If so, the focus during residency or increasing accredited spine fellowships needs to be addressed to ensure that enough spine surgeons are educated to meet the future healthcare demands projected for Canada. 相似文献7.
Sivakumar R Wellsted D Parker K Lynch M Ghosh P Khan SA 《Postgraduate medical journal》2006,82(965):220-223
Objective
To evaluate the utility of N terminal pro brain natriuretic peptide (NT‐proBNP) as a diagnostic marker for diastolic dysfunction or failure, systolic dysfunction, and significant valve disorders in patients over 75 years.Design
Cohort study.Setting
Outpatient echocardiography service in a district general hospital.Participants
100 consecutive patients.Main outcome measures
Sensitivity, specificity, positive predictive values, negative predictive values, and area under receiver operating characteristic curve for NT‐proBNP assay in the diagnosis of left ventricular diastolic dysfunction or failure, systolic dysfunction, and significant valve disorders.Results
For diagnosis of systolic dysfunction NT‐proBNP level of 424 pg/ml had a sensitivity of 96%, specificity of 45%, positive predictive value of 36%, and negative predictive value of 96%. The area under the curve was 0.71 (95% confidence intervals: 0.69 to 0.89). In valve heart disease, level of 227 pg/ml had sensitivity of 91%, specificity of 43%, positive predictive value of 40%, and negative predictive value of 92%. Patients with diastolic dysfunction/failure had lower plasma concentrations.Conclusions
This study showed that NT‐proBNP had excellent negative predictive value for systolic dysfunction and significant valve disorders in very elderly patients. It increased significantly in systolic dysfunction, valve heart disease, and atrial fibrillation. NT‐proBNP is not useful in the diagnosis of diastolic dysfunction or diastolic heart failure using standard echocardiography criteria. 相似文献8.
Wong P Murray S Ramsewak A Robinson A van Heyningen C Rodrigues E 《Postgraduate medical journal》2007,83(977):200-205
Objective
To investigate the frequency, diagnosis and outcome of patients admitted to hospital with acute coronary syndrome (ACS) or other conditions associated with raised levels of cardiac troponin T.Design
Observational study.Setting
A large university hospital.Patients
Consecutive patients admitted over an 8‐week period who had a serum troponin T test as part of their clinical assessment were included. Patients were separated into those with raised (⩾0.01 μg/l) or normal (<0.01 μg/l) troponin T levels, and further categorised into those with or without a diagnosis of ACS.Main outcome measures
In‐hospital mortality in all patients; and 6‐month hospital re‐admissions and all‐cause mortality in patients without or with ACS and raised levels of troponin T.Results
Of 1021 patients, 118 patients had no ACS but raised troponin T levels, 195 had ACS with raised troponin T, 80 had ACS with normal troponin T and 628 had no ACS with normal troponin T. Their in‐hospital all‐cause mortalities were 36%, 18%, 0% and 3%, respectively (p<0.001, highest mortality v other groups). 6‐month all‐cause mortality remained higher in patients without ACS and with raised levels of troponin T than in those with ACS and raised troponin T (42% v 29%; p = 0.020).Conclusions
Patients without ACS but with raised levels of troponin T comprised 38% of all hospitalised patients found to have raised troponin T. These patients had worse in‐hospital and 6‐month outcome than those having ACS with raised levels of troponin T. 相似文献9.
Background
In pulmonary thromboembolism (PE), delay to diagnosis is very common. In this study, we examined the role of patients and the socio-demographic characteristics in delayed diagnosis of PE.Patients and methods
We evaluated 156 PE patients for the dates of symptom onset, the dates of first visit to a health institution and diagnosis, signs and symptoms, and the socio-demographic characteristics. Delays were analyzed using the Mann-Whitney U test, and the predictors were analyzed using logistic regression analysis.Results
Of the patients, 60.3% visited a health institution within the first day of the symptoms. Mean time from symptoms to the first admission to a health institution (patient delay) was 2.04 ± 3.89 days (median 0 day, range 0–30). Current smoking, a high level of education, and co-morbidity were associated with longer patient delays. The time interval from first symptom to the diagnosis (total delay) was 7.93 ± 10.05 (median 4 days, range 0–45) days. While hypotension, syncope, and previous surgery/trauma were significantly associated with a shorter total delay, a previous visit to any health institution was associated with longer total delay.Conclusion
In conclusion, although some socio-demographic characteristics of patients such as smoking, educational status, and co-morbid diseases were found to be associated with delayed visit to any health institution, our results showed that physician or health system delays were more prominent in delayed diagnosis of PE. 相似文献10.
Objective
To examine the 21 month clinical outcome and bleeding complications in hospital survivors with non‐ST segment elevation acute coronary syndromes (NSTEACS) who were discharged with combined clopidogrel and aspirin anti‐thrombotic therapy, and compare with those having ST segment elevation myocardial infarction (STEMI) who were discharged with aspirin alone.Design
Observational study.Setting
A large university hospital.Patients
224 patients were admitted to hospital with either NSTEACS or STEMI, and survived to discharge between 1 October 2001 and 31 December 2002.Main outcome measures
Cardiovascular death, total death, new myocardial infarction, unstable angina requiring hospitalisation, stroke or transient ischaemic attack, coronary revascularisation; and fatal, life threatening, major and minor bleeding over 21 months after discharge.Results
Despite having no or small infarct (median maximum creatine kinase 155 v 1295 u/l; p<0.001) and taking more antianginal drugs, patients with NSTEACS had similar rates of cardiovascular death (9.5% v 8.3%; p = NS), new myocardial infarction (9.5% v 6.5%; p = NS) or unstable angina requiring hospitalisation (15.5% v 10.2%; p = NS) when compared with STEMI. Fatal, life threatening or major bleeding were <1% in both groups (p = NS); and minor bleeding occurred in 4.3% NSTEACS and 2.8% STEMI patients respectively (p = NS).Conclusions
Patients with NSTEACS had a similar and unfavourable long term outcome when compared with STEMI. There was no difference in serious bleeding complications between both groups. 相似文献11.
Objective
Adults with hypothalamic‐pituitary disease have increased morbidity and mortality from cardiovascular disease (CVD). Therefore, the prevalence of CVD and adequacy of treatment of cardiovascular risk factors (according to current treatment guidelines) was studied in a large group of patients with hypothalamic‐pituitary disease.Study design
In 2005, 152 consecutive adult patients with hypothalamic‐pituitary disease attending our neuro‐endocrine centre were clinically examined and blood pressure (BP), lipid profile, type 2 diabetes mellitus, body composition and smoking status were assessed.Results
Of the 152 patients, 36.8% had treated hypertension and 28.2% had treated dyslipidaemia. Many of these patients had inadequate BP control (BP >140/85 mm Hg, 44.6%) and undesirable lipid levels (total cholesterol >4.0 mmol/l, 69%). Also, many of the untreated patients had BP and lipid levels which should have been considered for treatment (26 patients (27%) and 83 patients (76%), respectively). Smoking was admitted in 18% of patients. Central adiposity was present in 86% and obesity (body mass index ⩾30) was present in 50%.Conclusions
Cardiovascular risk factors are highly prevalent and often inadequately treated in adult patients with hypothalamic‐pituitary disease. Aggressive treatment of these factors is essential to reduce mortality and morbidity from CVD in these patients. 相似文献12.
Greene SL Shiew CM Streete P Mustchin SJ Hugget D Earl B Dargan PI 《Postgraduate medical journal》2007,83(986):754-758
Objectives
To determine the incidence and character of drink spiking in an urban population of patients within the UK presenting to an emergency department concerned they had consumed a deliberately contaminated drink.Study design
Prospective case series determining the presence and quantity of sedative and illicit drugs, and ethanol in biological samples (blood and urine) obtained from consenting patients >18 years of age presenting to a large inner city London emergency department alleging they had consumed a spiked drink within the previous 12 h.Results
Biological samples were obtained from 67 (blood) and 75 (urine) of 78 study participants. 82% of participants were female, mean age 24 years. Mean time from alleged exposure to biological sampling was 5.9 h (range 1–12 h). Ethanol was detected in 89.7% of participants. Mean serum ethanol concentration was 1.65 g/l (range 0.04–3.1 g/l); 60% of participants had a serum ethanol concentration associated with significant intoxication (>1.5 g/l). Illicit drugs were detected in 12 (15%) participants; 7 denied intentional exposure (3 methylenedioxymethamphetamine, 3 cannabis, 1 γ‐hydroxybutyrate). Medicinal drugs were detected in 13 participants; only 1 exposure was unexplained (benzodiazepine). Overall illicit or medicinal drugs of unexplained origin were detected in 8 (10%) participants. Unexplained sedative drug exposure was detected in only 2 (3%) participants.Conclusions
Use of sedative drugs to spike drinks may not be as common as reported in the mainstream media. A large number of study participants had serum ethanol concentrations associated with significant intoxication; the source (personal over‐consumption or deliberate drink spiking) is unclear. 相似文献13.
Background
There is an increased prevalence of coeliac disease (CD) among relatives of those with the disease.Aims
To compare the clinical features in patients with CD detected via family screening with those in patients diagnosed routinely.Methods
Information on screening was provided to relatives of patients. Those who wished to be screened were tested for endomysial and/or tissue transglutaminase antibodies. Duodenal biopsy was performed in those with positive antibodies. The clinical details of the relative screening group were compared with those of 105 patients diagnosed routinely.Results
183 relatives underwent screening, of whom 32 had positive serology, 24 had histology diagnostic of CD, six had normal biopsies and two declined duodenal biopsy. Patients in the relative screening group were younger with a median age of 33 years (range 17–72 years) compared to the routine group which had a median age of 54 years (range 25–88 years). In the relative screening group, there was a male preponderance (M:F ratio 16:8), anaemia at presentation was significantly less common (13% v 58%; p<0.001) and osteoporosis was less frequent (9% v 22%; p<0.244) compared with the routine group. 65% of the relative screening group had gastrointestinal symptoms or anaemia at diagnosis.Conclusions
Patients detected by family screening are younger with a male preponderance, but fewer had anaemia and osteoporosis. 相似文献14.
Background
Patient understanding of the consent process is often suboptimal and the reasons for this are poorly understood. In particular the role of cognitive function in assessing the level of understanding of consent has not been evaluated.Aims
This study aims to assess the level of patient understanding of the informed consent process and the role of cognitive function in those with low levels of understanding.Methods
The study was prospective, interviewing patients immediately after they had given consent but before undergoing their procedure. Understanding of the reason for the procedure, the risks attendant upon it, details of the procedure itself and post procedure care was scored with the total representing overall level of understanding. A mini mental state examination (MMSE) was then performed with the score recorded.Results
100 patients were interviewed. A low level of understanding was shown in 36%. Ninety two patients had a MMSE score greater than 24. All patients with a high level of understanding had MMSE scores greater then 24 compared with 78% of those with a low level of understanding. All patients (n = 8) who displayed a MMSE score less than 24 had a low level of understanding. Men displayed poorer levels of understanding than women. A subnormal MMSE only identified 22% of those with low levels of understanding.Conclusions
Understanding of the consent process is suboptimal. Adequate cognitive function does not predict a high level of understanding of the informed consent process while cognitive impairment precludes it. It is evident, however that factors other than cognitive dysfunction are at play when attempting to explain low levels of understanding. 相似文献15.
Objective
The aim of this prospective study was to evaluate the proportion of children with delayed recognition of congenital heart disease (CHD).Methods
Of the 744 children with CHD primarily diagnosed during a 10 year period in one hospital, the patients were identified where the diagnosis of CHD was established with a significant delay.Results
Sixty six patients (8.9%) had delayed diagnosis of CHD. Among patients with cyanotic CHD, 10.4% (7 of 67 cases) were referred after they had initially been discharged home from the birth clinic. Among patients with acyanotic CHD, 8.7% (59 of 677) of all children and 35.1% (59 of 168) of the children who required surgery or interventional catheterisation were referred at an age where elective repair should have already been performed or needed immediate treatment because of their haemodynamic status. Of the 66 patients with delayed diagnosis, one infant with cor triatriatum died at admission because of delayed referral and 10 children had severe complications: preoperative cardiogenic shock in seven cases of aortic coarctation and one case of endocardial fibroelastosis, pulmonary hypertensive crisis in one child after delayed repair of a ventricular septal defect, and infectious endocarditis after dental care in a teenager with undiagnosed moderate aortic stenosis, who required Ross operation a few months later.Discussion and conclusion
A substantial proportion of CHD was detected with relevant delay. In all cases of late diagnosis, clinical cardiac findings were present that should have alerted the physician on the possible presence of underlying CHD. 相似文献16.
Objective
To review a 10 year period of temporal artery biopsies, using the American College of Rheumatology (ACR) 1990 criteria: a five point scoring system for the diagnosis of giant cell arteritis (GCA).Design
Population based, retrospective cohort analysis.Setting
One district general hospital in the United Kingdom, over one decade.Participants
All patients who underwent temporal artery biopsy from July 1994 to June 2004.Main outcome measures
ACR score and temporal artery biopsy result.Results
During the 10 year period 111 patients were identified. The median (range) age at presentation was 71 (29–85) years. Seventy five patients had an initial ACR score of three or four at presentation. There were 20 positive biopsy specimens. In 19 of these cases at least three of the other criteria were positive so there was already sufficient clinical information for a confident diagnosis. In only one case did the positive result influence the diagnosis by changing the ACR score from two to three. In our series, corticosteroid treatment before biopsy did not significantly reduce the yield of the biopsy.Conclusions
The ACR score of three or more has a sensitivity of 93.5% and specificity of 91.2% for the diagnosis of GCA. Using these criteria, 68% of patients had sufficient clinical features when referred to make a confident diagnosis of GCA. Temporal artery biopsy was therefore unnecessary in this group. In the remaining group (ACR score ⩽2) there was one positive biopsy. The biopsy only changed the diagnosis in this one case—less than 3% of the uncertain cases and less than 1% of the total cases. Using the ACR criteria and restricting biopsy to those cases in which it might change the diagnosis will reduce the number of biopsies by two thirds without jeopardising diagnostic accuracy. 相似文献17.
Choon Chiet Hong Nazrul Nashi Milindu Chanaka Makandura Lingaraj Krishna 《Singapore medical journal》2016,57(2):69-72
INTRODUCTION
Traumatic displaced femoral neck fractures in the elderly can be treated with cemented or uncemented hemiarthroplasty with good outcomes. Earlier studies reported a higher incidence of deep vein thrombosis (DVT) associated with cemented prostheses in elective total hip or knee arthroplasty. In addition, the hypercoagulable state after a traumatic femoral neck fracture and possible thrombogenic properties of bone cement could put these patients at greater risk for thromboembolism. We aimed to compare the incidence of DVT and progression to pulmonary embolism (PE) or mortality in cemented and uncemented hemiarthroplasty.METHODS
The data of 271 patients treated with cemented or uncemented hemiarthroplasty after a traumatic displaced femoral neck fracture was retrospectively analysed for the incidence of DVT. The level of thrombosis, progression to PE and mortality were compared.RESULTS
There were 133 (49.1%) patients with cemented hemiarthroplasty, while 138 (50.9%) had uncemented hemiarthroplasty. The patients had an average age of 76.6 (range 53–99) years and 11 (4.1%) patients had DVT. There were no significant differences in development of DVT, level of thrombosis, PE and mortality regardless of whether a cemented or an uncemented prosthesis was used.CONCLUSION
Cemented hemiarthroplasty is not associated with higher risks of DVT, PE or mortality in patients with traumatic displaced femoral neck fracture. Cemented prostheses can be safely used for this group of patients. 相似文献18.
Parlak I Erdur B Parlak M Ergin A Turkcuer I Tomruk O Ayrik C Ergin N 《Postgraduate medical journal》2007,83(984):664-668
Objective
To determine the therapeutic effect (alleviation of vascular type headache) and side effects of a slow intravenous metoclopramide infusion over 15 min compared with those effects of a bolus intravenous metoclopramide infusion over 2 min in the treatment of patients with recent onset vascular type headache.Material and methods
All adults treated with metoclopramide for vascular type headache were eligible for entry into this clinical randomised double blinded trial. This study compared the effects of two different rates of intravenous infusion of metoclopramide over a period of 13 months at a university hospital emergency department. During the trial, side effects and headache scores were recorded at baseline (0 min), and then at 5, 15, 30 and 60 min. Repeated measures analysis of variance was used to compare the medication''s efficacy and side effects.Results
A total of 120 patients presenting to the emergency department met the inclusion criteria. Of these, 62 patients (51.7%) were given 10 mg metoclopramide as a slow intravenous infusion over 15 min (SIG group) and 58 patients (48.3%) were given 10 mg metoclopramide intravenous bolus infusion over 2 min (BIG group). 17 of the 58 patients in the BIG group (29.3%) and 4 of the 62 patients (6.5%) in the SIG group had akathisia (p = 0.001). There were no significant differences between the BIG and SIG groups in terms of mean headache scores (p = 0.34) and no adverse reactions in the study period. Metoclopramide successfully relieved the headache symptom(s) of patients in both the BIG and SIG groups.Conclusion
Slowing the infusion rate of metoclopramide is an effective strategy for the improvement of headache and reducing the incidence of akathisia in patients with vascular type headache. 相似文献19.
Background
The diagnosis of spinal tuberculosis (ST) is difficult and it commonly presents at an advanced stage. The management and follow up is complicated by a lack of guidance on the appropriate use and interpretation of spinal magnetic resonance studies (MR).Aims
A retrospective study was performed at a UK centre to identify the demographic and presenting features of a spinal TB population, their response to treatment, and the value of follow up MR studies.Patients and Results
Twenty one patients were identified with mean symptom duration of 11 (1.5–36) months having been assessed by a health practitioner on 3.2 (0–10) occasions before referral for investigation for ST. Twenty were born outside the UK. Their mean duration of residence in the UK was 6.67 (0.75–20) years, and six (32%) were resident for more than 10 years. Most (85.7%) did not have a medical history and one was HIV positive. Back pain, neurological, and constitutional symptoms were found in 100%, 29%, and 38% respectively. Musculoskeletal and neurological signs were found in 29% and 19% respectively. Spinal MR performed between 6 and 12 months suggests that six months of chemotherapy (for a fully sensitive organism) may not be sufficient to achieve disease resolution.Conclusions
Awareness of the demographic, clinical, and laboratory features of an ST population may facilitate earlier diagnosis. Guidance is required on the appropriate use and interpretation of MRI in the follow up of these patients. 相似文献20.
Shibata MC Collinson J Taneja AK Bakhai A Flather MD 《Postgraduate medical journal》2006,82(963):55-59