Hypertension in renal allograft recipients may be conveyed by cadaveric kidneys from donors with subarachnoid haemorrhage

Evidence for hypertension was sought retrospectively in the necropsy records of 37 cadaveric kidney donors who had died of subarachnoid haemorrhage and 41 donors who had died of head injury, cerebral tumour, or (in a few instances) other causes. Mean relative heart weight in the donors with subarachnoid haemorrhage was 0.58 (1 SD = 0.09)% and in the other donors 0.52 (0.09)% (p less than 0.01), a difference unexplained by any factor other than a comparatively higher blood pressure in the donors who had died of subarachnoid haemorrhage. Blood pressure was analysed over 72 months after renal transplantation in 23 recipients with normal or near normal graft function and no evidence of chronic rejection or graft artery stenosis. Twelve patients who had received kidneys from donors with subarachnoid haemorrhage had consistently higher systolic blood pressures (p less than 0.004) and needed more antihypertensive treatment (p less than 0.0004) than the 11 recipients of kidneys from donors who had died of head injury or cerebral tumour. These observations suggest that cadaveric kidneys from donors dying of subarachnoid haemorrhage may induce or sustain hypertension after transplantation.     

Delayed primary closure versus primary closure for wound management in perforated appendicitis: A prospective randomized controlled trial

BackgroundIt is still a matter of debate whether delayed primary closure (DPC) of contaminated abdominal incisions reduces surgical site infections compared with a primary closure (PC). The aim of this study was to determine the optimal method of wound closure for patients with perforated appendicitis.MethodsA total of 70 patients with perforated appendicitis were included. They were randomized to have their surgical incisions (skin and subcutaneous tissue) either PC or left open with Betadine-soaked gauze packing for DPC on the fifth postoperative day or later if the wound conditions were inappropriate for closure. A wound was considered infected if pus discharged from the incision site. The main outcome measures were the incidence of wound infection and the length of hospital stay (LOS).ResultsIn the entire series, wound infection developed after incision closure in 21.4% of the patients. The PC group had a higher incidence of wound infection (38.9% vs. 2.9%, p < 0.001) and longer LOS (8.4 days vs. 6.3 days, p = 0.038).ConclusionDelayed primary closure is the optimal management strategy for perforated appendicitis wounds. It significantly reduces the wound infection rate and length of stay.     

小剂量皮质激素治疗脓毒症休克随机对照研究的Meta分析

目的:评价小剂量皮质激素对脓毒症休克治疗的效果及不良反应发生情况.方法:计算机检索Medline、Embase、ScienceDirect、Ovid、Cochrane图书馆临床随机对照试验资料库(1996年1月至2011年12月)中小剂量皮质激素治疗脓毒症休克的随机对照临床试验,按照标准筛查文献,提取资料,采用Review Manager4.2.9对数据进行Meta分析.结果:共纳入5项随机对照研究,均为英文,共928例患者,其中治疗组共471例,对照组457例.Meta分析结果显示,小剂量皮质激素(氢化可的松用量或相当量＜1 000 mg·d-1)治疗可以明显增加患者的休克逆转率(OR值为1.74,95%CI为1.06 ～2.85,P=0.03),但并不降低患者住院死亡率(OR值为0.77,95%CI为0.50 ～1.19,P=0.25),也不增加患者消化道出血发生率(OR值为1.17,95%CI为0.66 ～2.06,P=0.59).结论:小剂量皮质激素治疗脓毒症休克不能降低患者住院死亡率,但可以提高休克逆转率,且不增加消化道出血发生率.     

Meta-analysis of pancreaticoduodenectomy prospective controlled trials: pancreaticogastrostomy versus pancreaticojejunostomy reconstruction

Background  Pancreaticogastrostomy (PG) has been proposed as an alternative to pancreaticojejunostomy (PJ), assuming that postoperative complications are less frequent. The aim of this research was to compare the safety of PG with PJ reconstruction after pancreaticoduodenectomy.

Methods  Articles of prospective controlled trials published until the end of December 2010 comparing PJ and PG after PD were searched by means of MEDLINE, EMBASE, Cochrane Controlled Trials Register databases, and Chinese Biomedical Database. After quality assessment of all included prospective controlled trials, meta-analysis was performed with Review Manager 5.0 for statistic analysis.

Results  Overall, six articles of prospective controlled trials were included. Of the 866 patients analyzed, 440 received PG and 426 were treated by PJ. Meta-analysis of six prospective controlled trials (including RCT and non-randomized prospective trial) revealed significant difference between PJ and PG regarding postoperative complication rates (OR, 0.53; 95% CI, 0.30–0.95; P=0.03), pancreatic fistula (OR, 0.47; 95% CI, 0.22–0.97; P=0.04), and intra-abdominal fluid collection (OR, 0.42; 95% CI, 0.25–0.72; P=0.001). The difference in mortality was of no significance. Meta-analysis of four randomized controlled trials (RCT) revealed significant difference between PJ and PG regarding intra-abdominal fluid collection (OR, 0.46; 95% CI, 0.26–0.79; P=0.005). The differences in pancreatic fistula, postoperative complications, delayed gastric emptying, and mortality were of no significance.

Conclusions  Meta-analysis of six prospective controlled trials (including randomized controlled trials (RCT) and non-randomized prospective trial) revealed significant difference between PJ and PG regarding overall postoperative complications, pancreatic fistula, and intra-abdominal fluid collection. Meta-analysis of four RCT revealed significant difference between PJ and PG with regard to intra-abdominal fluid collection. The results suggest that PG may be as safe as PJ.

     

Pneumatic retinopexy versus scleral buckling: A randomised controlled trial

Pneumatic retinopexy (PR) is a technique for repairing certain retinal detachments which is easier to perform than conventional sceral buckling (SB) surgery but has comparable results. We performed a prospective, randomised, controlled trial to determine for ourselves whether PR is a safe and acceptable procedure. Twenty patients presenting consecutively with retinal detachments which fulfilled the selection criteria were randomised to have their detachments repaired by either PR or SB, ten patients in each group. The suitable patients had a single retinal break or small group of breaks of not greater than one clock hour in size, situated within the superior eight clock hours of retina. Patients with significant proliferative vitreoretinopathy or other fundus disorders were excluded. All patients in the PR group had local anaesthesia while all those in the SB group had general anaesthesia. Successful reattachment of the retina was achieved with one or more procedures in 90 percent of the PR group and in 100 percent of the SB group. We feel that narrowing the selection criteria for PR may further improve the success rate.     

Promoting prevention in primary care: controlled trial of low technology, low cost approach

A study is described in which three general practices were provided with low cost, low technology support from a "facilitator" and were compared with control practices in the ascertainment of major risk factors for cardiovascular disease in middle aged patients. Patients who were attending for a consultation with their general practitioners were recruited to make an appointment with a practice nurse for a health check, and this was compared with ordinary consultations in the control practices. Practices were helped by the facilitator to develop the nurse's role. During the study the increase between intervention and control practices in blood pressure recording was doubled and in the recording of smoking habit it was quadrupled, and there was a fivefold increase in the recording of weight. This model can be applied to other aspects of prevention and general practice care.     

A 5- versus 3-day course of oral corticosteroids for children with asthma exacerbations who are not hospitalised: a randomised controlled trial

OBJECTIVE: To determine whether a 5-day course of oral prednisolone is superior to a 3-day course in reducing the 2-week morbidity of children with asthma exacerbations who are not hospitalised. DESIGN, SETTING AND PARTICIPANTS: Double-blind randomised controlled trial of asthma outcomes following a 5-day course of oral prednisolone (1 mg/kg) compared with a 3-day course of prednisolone plus placebo for 2 days. Participants were children aged 2-15 years who presented to the emergency departments of three Queensland hospitals between March 2004 and February 2007 with an acute exacerbation of asthma, but were not hospitalised. Sample size was defined a priori for a study power of 90%. MAIN OUTCOME MEASURES: Difference in proportion of children who were symptom-free at Day 7, as measured by intention-to-treat (ITT) and per-protocol analysis; quality of life (QOL) on Days 7 and 14. RESULTS: 201 children were enrolled, and there was an 82% completion rate. There was no difference between groups in the proportion of children who were symptom-free (observed difference, 0.04 [95% CI, - 0.09 to 0.18] by ITT analysis; 0.04 [95% CI, - 0.17 to 0.09] by per-protocol analysis). There was also no difference between groups in QOL (P = 0.42). The difference between groups for the primary outcome was within the equivalence range calculated post priori. CONCLUSION: A 5-day course of oral prednisolone confers no advantage over a 3-day course for children with asthma exacerbations who are not hospitalised. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRN012605000305628.     

一次性包皮切割缝合器在儿童包皮环切术中的疗效：前瞻性随机对照研究

目的探讨一次性包皮切割缝合器在儿童包皮环切术中的优势。方法前瞻性研究入组我院门诊就诊的包茎和包皮过长 并行包皮环切术的儿童,随机分成包皮切割缝合器组和传统包皮环切手术组;共纳入236例男童,其中一次性包皮切割缝合器 组132例,传统手术方式104例。通过评估两种手术方式局部麻醉方式占比,手术时间,术中出血量,术中和术后疼痛评分,术后 阴茎外观满意率,术后并发症发生率,切口愈合时间,术后总体满意率的差异;比较一次性包皮切割缝合器在儿童包皮环切术中 的优势。结果与传统包皮环切术组对比,包皮切割缝合器组具有局麻方式占比高（P<0.001）,手术时间短（P<0.001）,术中出血 少（P<0.001）,术中和术后疼痛更轻（P<0.001）,术后切口愈合时间短（P<0.001）,术后阴茎外观满意率更高（P=0.03）,术后并发 症发生率更低（P=0.04）,切口愈合时间更短（P<0.001）,总体满意度更高（P<0.005）等优点。结论使用一次性包皮切割缝合器 的包皮环切术具有手术时间短、局麻耐受性好,围手术期疼痛轻、恢复快及术后外观漂亮等显著优势,更易于儿童及家长接受, 值得临床广泛应用。     

Acupuncture accelerates recovery after general anesthesia:a prospective randomized controlled trial

BACKGROUND: Acupuncture anesthesia was created in the 1950’s in China and continues to be used there today during most major surgeries. It is widely used in China for such complex operations as brain, heart, and abdominal surgery. It is popular in China because it is economical, practical, and beneficial to the patients. With acupuncture anesthesia there is less bleeding during surgery and there is also quicker post-operative recovery.OBJECTIVE: This randomized prospective study aims at comparing the effect of two acupoints(Yongquan, KI1 and Renzhong, DU26) with sham acupuncture and no acupuncture on the time to recovery of consciousness after general anesthesia by means of the Bispectral Index monitor(BIS).DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This is a prospective randomized controlled study. We randomly assigned 50 patients to 5 groups during recovery from surgical anesthesia. Four groups had acupuncture on KI1(group A), DU26(groups B), both KI1 and DU26(group C), and sham points(group D), and one had no acupuncture(group E).MAIN OUTCOME MEASURES: Bispectral Index(BIS), time to spontaneous eye opening, time to tracheal extubation, and time to following commands were measured as the main outcome measures.RESULTS: Time to spontaneous eye opening differed among groups(P=0.002), as well as time to tracheal extubation(P<0.000 1) and time to following commands(P=0.000 6). BIS values differed significantly among groups both 5 and 10 min after the end of anesthesia(P<0.000 1 and P=0.000 4,respectively). BIS values of groups D and E were lower than those of the other groups and those of group C were higher. The same pattern was observed also 15 and 30 min after the end of anesthesia, although the difference among groups was not significant at these time points(P=0.164 and P=0.104, respectively).CONCLUSION: Acupuncture on DU26 and KI1 accelerates recovery of consciousness after general anesthesia. Moreover, a possible synergistic effect of DU26 and KI1 is suggested. This issue may play a role in the optimization of operating room management and raise interest about the usefulness of acupuncture on unconsciousness states of different nature.     

抗氧化剂和皮质激素治疗重症酒精性肝病的疗效比较：一项随机临床试验

背景与目的：重症酒精性肝病具有较高的发病率和短期死亡率。皮质激素是唯一的广泛应用于各类疾病的治疗药物，但其使用却因已知的禁忌证和严重的不良反应而受到限制。理论上讲，抗氧化剂的治疗效果要较皮质激素更好。该研究对二治疗酒精性肝病的特点进行了一项随机临床试验。方法：选取101例患随机分为皮质激素治疗组和新型抗氧化剂（鸡尾酒）治疗组，然后比较两组患30d后的病死率。结果：治疗30d后，皮质激素组16例（30％）死亡，抗氧化剂组有22例（46％）死亡（P=0．05）。抗氧化剂组于30d后出现病情恶化的存活患数量是皮质激素组的2．4倍（95％CI1．0～5．6）。尽管皮质激素组患的微生物感染率较高（P〈0．01），但抗氧化剂组脓毒血症的发生率却较频繁（P=0．05）。皮质激素组的存活优势在随访1年后消失，但无统计学意义（P=0．43）。     

Melatonin premedication versus placebo in wisdom teeth extraction: a randomised controlled trial

INTRODUCTION

Pain after wisdom teeth surgery can be moderate in severity and is compounded by preoperative anxiety in young patients. We studied the effect of melatonin premedication on postoperative pain and preoperative anxiety in patients undergoing wisdom teeth extractions.

METHODS

This randomised controlled trial recruited 76 patients at Khoo Teck Puat Hospital who were American Society of Anesthesiologists physical status I and II, aged 21 to 65 and scheduled to undergo elective extraction of all four wisdom teeth under general anaesthesia. Patients with a history of long-term use or allergy to melatonin were excluded. The patients received either 6 mg melatonin or a placebo 90 minutes before surgery. Visual analogue scale (VAS) scores at multiple time intervals for postoperative pain and preoperative anxiety, patient satisfaction and first-night sleep quality scores were obtained. Mixed-effects regression models were used for longitudinal analysis of VAS pain, anxiety and satisfaction scores.

RESULTS

Maximum VAS scores for pain and anxiety were 18.6 ± 19.1 mm at 60 minutes postoperatively and 26.2 ± 23.4 mm at 90 minutes preoperatively, respectively. After adjusting for gender, female patients who received melatonin had a faster rate of reduction of VAS pain (p = 0.020) and anxiety scores (p = 0.003) over time compared to the placebo group. No such effect was demonstrated in male patients. There was no significant difference in sleep quality or satisfaction scores.

CONCLUSION

Melatonin use did not consistently contribute to pain and anxiety amelioration in all patients. Our study demonstrated a positive effect in female patients, suggestive of sexual dimorphism.     

Care in a birth room versus a conventional setting: a controlled trial

A controlled clinical trial was carried out to assess whether a birth room setting would influence the care of mothers and newborns. Of the 163 low-risk women enrolled, 49 (30%) manifested some prenatal risk and were excluded. The remaining 114 were allocated by strict alternation to a birth room or a conventional setting. Of the 56 women allocated to the birth room, 63% of the primiparas and 19% of the multiparas were later transferred. The numbers in the two settings who had oxytocin stimulation, epidural anesthesia, forceps delivery or cesarean section did not show statistically significant differences. The episiotomy rates were slightly lower in the birth room than in the conventional setting, and the rates of an intact perineum were higher in the birth room. Neither the Apgar scores nor the morbidity rates of the infants showed statistically significant differences related to the setting to which the mother had been allocated, although more infants from the conventional setting were admitted to a special care unit. Both "experimental" groups of women less often received routine perineal shaving, enemas or intravenous infusions than did an obstetrically similar nonexperimental comparison group. Despite the apparent inability in this setting for the birth room to influence the rate of major obstetric procedures (except for episiotomy) and outcomes, the authors believe that a birth room is desirable in tertiary care centres as well as in community hospitals.     

手部撕裂伤缝合与保守治疗的随机对照试验

目的:评价手部撕裂伤缝合或保守治疗两种方法的临床结局差异。 试验设计:随机对照试验。 试验地点:三级医院急诊室。 入选对象:全部2000年2月16日至11月30日间就诊的不伴有并发症,在正常情况下需要缝合的手部撕裂伤病人(全层裂开<2cm,无肌腱、关节、骨折或神经并发症)。共154例病人合格,其中58例拒绝参与试验,5例失访,91例病人共计有撕裂伤95处纳入本试验。 试验干预:试验对象被随机分为缝合组或保守治疗组。主要结局的评定:主要结局是3月后伤口的外观,按照以前已被验证的可视类比分级进行评定。对治疗周期、治疗过程中的疼痛程度、病人对结局的自我评价、病人恢复正常活动的时间也进行评定。 结果:3月后,由互不知情的医生(单盲法)对伤口外观进行评定,发现缝合组和保守治疗组之间没有显著差别,可视类比分级是83mm:80mm(平均差3mm,95％可信区间-1～8mm)。两组病人恢复正常活动的平均时间相同(3.4天),保守治疗组病人疼痛相对较轻,两组相差18(12～24)mm,治疗时间缩短了14(10～18)分钟。 结论:对于伤口小且没有并发症的手部撕裂伤,在伤口外观和功能上,保守治疗和缝合两种方法结果是相似的,保守治疗处理伤口省时、疼痛轻。     

肛垫切除术治疗Ⅲ、Ⅳ期环状痔

目的比较肛垫切除术和外剥内扎术治疗Ⅲ、Ⅳ期环状痔的临床效果。方法48例Ⅲ、Ⅳ期环状痔患者随机分成两组,分别接受肛垫切除术和外剥内扎术治疗。比较两组患者的术后疼痛评分、手术时间、创面愈合时间、平均住院时间、术后并发症的发生率以及疗效。结果两组患者术后的疼痛评分无显著性差异。肛垫切除术手术时间长于外剥内扎术,但术后创面愈合时间、平均住院时间和术后并发症明显少于对照组。肛垫切除术的疗效明显优于外剥内扎术。结论肛垫切除术治疗Ⅲ、Ⅳ期环状痔的疗效确切,并发症轻,是一种安全有效的手术方式。     

按产妇视觉模拟评分予自控硬膜外分娩镇痛的可行性研究

目的 探讨按产妇视觉模拟评分(VAS评分)给予分娩镇痛的可行性，明确产程早期给予硬膜外自控镇痛(PCEA)对剖宫产率和产程的影响。方法 176例初产妇，在其产程发动后VAS评分≥4分时，随机分为PCEA组84例和对照组92例，两组再按宫口的扩张程度分为≥4cm与＜4cm亚组。PCEA组硬膜外予0．1％布比卡因(含芬太尼2μg／ml)首剂量为8ml，背景量为4ml，自控镇痛剂量为4ml，锁定时间为15min，每小时最大剂量为20ml。对照组给予全程助产士陪护及关怀。结果 两组宫口≥4cm和＜4cm亚组的第一产程、第三产程和活跃期时间的差异均无显著性(P＞0．05)，两组宫口＜4cm亚组第二产程时间的差异亦无显著性(P＞0．05)，但PCEA组宫口≥4cm亚组的第二产程时间长于对照组宫口≥4cm亚组(P＜0．01)。两组宫口≥4cm和宫口＜4cm亚组剖宫产率的差异无显著性(P＞0．05)。但宫口＜4cm产妇的总剖宫产率显著高于宫口≥4cm(P＜0．01)。结论 按产妇VAS评分给予PCEA分娩镇痛是可行的，即使给予镇痛时子宫颈口＜4cm，也不会延长产程及增加剖宫产率。     

Effectiveness of acupuncture versus spinal-epidural anesthesia on labor pain: a randomized controlled trial

Objective

To evaluate the effectiveness of acupuncture analgesia (AA) compared with combined spinal-epidural anesthesia (CSEA) for labor pain relief and labor outcomes.

蔗糖铁注射液治疗血液透析患者肾性贫血的多中心临床研究

目的 比较蔗糖铁与口服琥珀酸亚铁治疗血液透析患者肾性贫血的疗效与安全性.方法 采用同期随机对照的多中心研究.结果 选择维持性血液透析患者中肾性贫血者77例,静脉给药组40例,口服铁剂组37例,除口服组血红蛋白(Hb)均值(90.34 g/L)高于静脉组(84.31 g/L,P＜0.05)外,两组年龄、性别、身高、干体重等基础情况均无显著性差异.治疗后Hb、红细胞压积(HCT)、网织红细胞计数(Ret)两组均有升高,静脉组Hb、HCT比口服组升高更显著(P＜0.001),且Hb上升速度快于口服组;该组血清铁、铁蛋白、转铁蛋白饱和度治疗后均升高(P＜0.001),且升高幅度大于口服组(P＜0.001);静脉组不良反应少于口服组(P＜0.05).结论 静脉用蔗糖铁治疗肾性贫血安全有效.     

醒脑静注射液联合纳洛酮抢救重度乙醇中毒的随机对照试验研究

目的 探讨醒脑静注射液在抢救重度乙醇中毒中的作用.方法 将133例在我院急诊科抢救的重度乙醇中毒患者随机分为治疗组61例(醒脑静注射液联合纳洛酮治疗)和对照组72例(单一纳洛酮治疗),监测并记录呼吸、收缩压、体温恢复时间,清醒时间,治疗1、4、8 h后末梢血氧饱和度(SpO_2)、氧分压(PaO_2)、氧合指数和二氧化碳分压(PaCO_2).结果 治疗组呼吸、收缩压、体温恢复和清醒时间均较对照组短,差异有统计学意义(P＜0.05).治疗1 h后,治疗组SpO_2开始升高,与对照组比较差异有统计学意义(P＜0.05);治疗4 h后,治疗组SpO_2、PaO_2、氧合指数全面升高,PaCO_2下降,与对照组比较差异有统计学意义(P＜0.05);治疗8 h后,两组SpO_2、PaO_2、氧合指数、PaCO_2变化间差异无统计学意义(P＞0.05).结论 醒脑静注射液联合纳洛酮抢救重度乙醇中毒可有效缓解患者中毒症状,明显缩短清醒时间,改善机体氧合能力,疗效比单用纳洛酮迅速、确切,可以在临床急救中推广应用.     

Rofecoxib versus ibuprofen for acute treatment of migraine: a randomised placebo controlled trial

Background: Rofecoxib is a potent cyclo-oxygenase-2 inhibitor with a long duration of action. Its role in migraine has not been systematically evaluated. Aim: To study the efficacy of rofecoxib in migraine. Method: In a randomised placebo controlled trial rofecoxib 25 mg, ibuprofen 400 mg, and placebo were compared regarding their efficacy in relieving acute migraine attack. Migraine patients with 2–6 attacks per month were recruited. Headache severity, functional disability, and severity of associated symptoms were graded on a 0–3 scale. The primary endpoint was pain relief at two hours. Relief of associated symptoms and sustained pain relief for 24 hours were also noted. Result: One hundred and twenty four patients were randomised into rofecoxib (42), ibuprofen (40), and placebo (42) groups. One hundred and one patients were followed up: 33 on rofecoxib, 35 ibuprofen, and 33 placebo. Patients'' ages ranged from 16–62 (mean 31.4) years, and 83 were females. Pain relief at two hours was noted in 45.5% on rofecoxib, 55.6% on ibuprofen, and 9.1% in the placebo group. The associated symptoms at two hours were reduced in 39.4% on rofecoxib, 50% on ibuprofen, and 9.1% in the placebo group. Sustained 24 hour pain relief was noted in 36.4% on rofecoxib, 41% on ibuprofen, and 6.1% in the placebo group. In the ibuprofen group, five patients had abdominal pain but there were no side effects in those on rofecoxib or in the control group. Both rofecoxib and ibuprofen were significantly effective in relieving pain, associated symptoms at two hours, and in sustained pain relief. There was no significant difference between rofecoxib and ibuprofen in aborting acute migraine attacks. Conclusions: Both ibuprofen and rofecoxib were superior to placebo in aborting an acute migraine attack, and there was no significant difference in their efficacy in an acute migraine attack.