Three-Day Treatment of Acute Lower Urinary Tract Infections in Women

The aim of this study was to determine if a three-day treatment of lower urinary tract infection (UTI) is effective. 215 women with symptoms of lower UTI, seen in general practice, were randomly allocated to a double-blind study and given either amoxycillin 1000 mg twice a day for three days or trimethoprim 90 mg/sulphadiazine 410 mg (co-trimazine) 2 tablets initially, then one tablet twice daily for three days. 157 women (73%) had significant bacteriuria. Therapeutic efficacy was evaluated in 146 patients. One week after treatment had started, 88 % of the women in the amoxycillin group and 100% in the co-trimazine group were cured (p<0.01). After a follow-up period of four weeks, the cumulative relapse frequencies were 19% and 9% respectively. Adverse reactions were mild in most cases. Two patients, both on co-trimazine, had to discontinue treatment because of nausea and vomiting. Vulvovaginal irritation was more often reported by women treated with amoxycillin (n=8) than by those treated with co-trimazine (n = 1) (p<0.05). It is concluded that a three-day course of amoxycillin or co-trimazine in lower UTI is safe, causes few adverse reactions, is simple to administer and comfortable for the patient. Co-trimazine seems to be more effective than amoxycillin.     

Why did I get chronic fatigue syndrome? A qualitative interview study of causal attributions in women patients

OBJECTIVES: To explore causal attributions among women with chronic fatigue syndrome (CFS). DESIGN: Qualitative study where data from individual semi-structured interviews were analysed according to Malterud's systematic text condensation. SETTING: Bergen, Norway. SUBJECTS: A purposeful sample of eight women aged 25-55, recruited among members of a self-help organization. MAIN OUTCOME MEASURES: Accounts of causal attribution for CFS among the informants, focusing on gender. RESULTS: The participants agreed that their way of living could have increased the vulnerability of their resistance resources. Pressure they put upon themselves, workload burdens without subsequent relaxation, emotional conflicts, or preparing for assumed problem-solving were mentioned as gendered dimensions. They presented different explanations regarding potential triggers encountering their fragile immune systems, most often a virus infection. The participants thought women might have a weaker immune system than men, or that CFS was caused by a virus that women are more likely to catch. In their experience, their symptoms were activated when people put pressure on them, such that they might be nervous as to whether they could live up to the demands of their surroundings, and in the case of emotional strain related to family and work. CONCLUSION: More studies are needed exploring hypotheses concerning the complex interplay between molecular predispositions and more or less gendered lifestyle issues in CFS. Doctors need to challenge their strong beliefs regarding medically unexplained conditions, where facts still remain unresolved. Recognizing this, the doctor may provide realistic support and advice, and contribute to the establishment of common ground for understanding and managing the condition.     

In situ fixation of slipped capital femoral epiphysis with Steinmann pins

Background and purpose

Slipped capital femoral epiphysis (SCFE) is often treated by surgical fixation; however, no agreement exists regarding technique. We analyzed the outcome of in situ fixation with Steinmann pins.

Patients and methods

All 67 subjects operated for slipped capital femoral epiphysis at Haukeland University Hospital during the period 1990–2007 were included. All were treated by in situ fixation with 2 or 3 parallel Steinmann pins (8 mm threads at the medial end). The follow-up evaluation consisted of clinical examination and hip radiographs. Radiographic outcome was based on measurements of slip progression, growth of the femoral neck, leg length discrepancy, and signs of avascular necrosis and chondrolysis.

Results

67 subjects (41 males) were operated due to unilateral slips (n = 47) or bilateral slips (n = 20). Mean age at time of diagnosis was 13 (7.2–16) years. Mean age at follow-up was 19 (14–30) years, with a mean postoperative interval of 6.0 (2–16) years. The operated femoral neck was 9% longer at skeletal maturity than at surgery, indicating continued growth of the femoral neck. At skeletal maturity, 12 subjects had radiographic features suggestive of a previous asymptomatic slip of the contralateral hip. The total number of bilateral cases of SCFE was 32, i.e half of the children had bilateral SCFE. 3 subjects required additional surgery and mild avascular necrosis of the femoral head was seen in 1 patient. None had slip progression or chondrolysis.

Interpretation

In situ pinning of SCFE with partly threaded Steinmann pins appears to be a feasible and safe method, with few complications. The technique allows further growth of the femoral neck.Slipped capital femoral epiphysis (SCFE) is a disease of unknown etiology, but mechanical, biological and hereditary factors are likely to play a role (Barrios et al. 2005, Murray and Wilson 2008). The rationale for treatment of SCFE is to restore hip function, prevent further slip, and to reduce the risk of subsequent degenerative changes. Several surgical techniques have been recommended such as cannulated screws (Chen et al. 2009), hook-pins (Hansson 1982), specially constructed screws (Wensaas and Svenningsen 2005), and most recently surgical hip dislocation with subcapital correction osteotomy (Leunig et al. 2007). However, currently there is no evidence to support the superiority of one particular technique over another.In situ fixation is advocated by most authors (Boyer et al. 1981, Carey et al. 1987, Givon and Bowen 1999) since peroperative reduction may increase the risk of avascular necrosis (Ordeberg et al. 1983, Carney et al. 1991, Lim et al. 2007). Physiodesis to prevent further growth—thus stabilizing the physis—is recommended by some authors (Carey et al. 1987, Aronsson and Karol 1996). Slip of the contralateral hip is reported in more than half of the cases (Hägglund et al. 1988, Castro et al. 2000) and controversies exist regarding prophylactic fixation of the contralateral hip. According to Jerre et al. (1994), more than two-thirds of the contralateral slips are asymptomatic and are therefore only detected at close follow-ups including hip radiographs at short intervals. Immediate prophylactic fixation of the contralateral hip has been advocated by several authors (Hägglund et al. 1988, Schultz et al. 2002, Krauspe et al. 2004).In this paper, we present clinical and radiographic results of a novel, simple technique for in situ fixation of the femoral head with partially threaded Steinmann pins to enable further growth of the femoral neck.     

Late in‐the‐bag intraocular lens dislocation in eyes with pseudoexfoliation syndrome

Purpose:  To assess preoperative features, frequency, surgical approaches and outcomes of late in‐the‐bag dislocation of posterior chamber intraocular lenses (IOLs) in eyes with pseudoexfoliation syndrome. Methods:  Seventy‐seven patients (81 eyes) were enrolled. Inclusion criteria were patients with pre‐existing pseudoexfoliation syndrome who underwent surgery for late in‐the‐bag IOL dislocation between March 2004 and April 2010. Medical records were reviewed. Data from before and after secondary surgery were analysed. Results:  Mean time between cataract extraction and secondary surgery for late in‐the‐bag dislocation of posterior chamber IOLs was 8.5 years. The increase in frequency within the reviewed period was statistically significant, ranging from six patients in the first year to 25 patients in the final year (p = 0.004). When surgical correction was performed within 1 month of referral, deterioration of the dislocation occurred in only one of 23 patients (4.3%). Complications, especially vitreous loss, occurred significantly more frequently during exchange surgery (n = 23) when compared with scleral suturing (n = 50) (p < 0.0001). After surgery, however, no differences in complications (p = 0.98) or best‐corrected visual acuity (p = 0.74) was found. In general, following secondary surgery, there was a statistically significant improvement in best‐corrected visual acuity (p < 0.0001). Conclusion:  The frequency of late in‐the‐bag dislocation of posterior chamber IOLs in eyes with pseudoexfoliation syndrome increased during the observation period. Our study suggests that surgical repair should not be delayed beyond 1 month and that scleral suturing is preferable to exchange surgery, because of less intraoperative complications.     

Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)--a case study

OBJECTIVE: To explore obstructions for quality care from experiences by patients suffering from chronic fatigue syndrome (CFS). METHODS: Qualitative case study with data drawn from a group meeting, written answers to a questionnaire and a follow-up meeting. Purposeful sample of 10 women and 2 men of various ages, recruited from a local patient organization, assumed to have a special awareness for quality care. RESULTS: CFS patients said that lack of acknowledgement could be even worse than the symptoms. They wanted their doctors to ask questions, listen to them and take them seriously, instead of behaving degrading. Many participants felt that the doctors psychologized too much, or trivialized the symptoms. Participants described how doctors' lack of knowledge about the condition would lead to long-term uncertainty or maltreatment. Even with doctors who were supportive, it would usually take months and sometimes years until a medical conclusion would be reached, or other disorders were ruled out. Increased physical activity had been recommend, but most of the informants experienced that this made them worse. CONCLUSION: Current medical scepticism and ignorance regarding CFS shapes the context of medical care and the illness experiences of CFS patients, who may feel they neither get a proper assessment nor management. PRACTICE IMPLICATIONS: CFS patients' reports about patronizing attitudes and ignorance among doctors call for development of evidence based strategies and empowerment of patients, acknowledging the patients' understanding of symptoms and the complex nature of the disease. The NICE guidelines emphasize the need of patient participation and shared decision-making.