Comparative efficacy of low-molecular-weight heparins in orthopedic surgery

The low-molecular-weight heparins (LMWHs) have been evaluated in the prevention of postoperative thromboembolic disease and have been found to be clinically efficacious and safe. Studies conducted in similar surgery settings have resulted in significantly different reductions in the incidence of deep-vein thrombosis, making an analysis of grouped studies complex. Only two studies have reported head-to-head comparisons of two different LMWHs and showed no difference in clinical end points between enoxaparin and either reviparin or tinzaparin. Our study at the Aalborg hospital in Denmark, comparing two different dosage regimens of LMWH tinzaparin, supported the conclusions of the head-to-head comparative studies. LMWHs are distinct drug entities that cannot be interchanged at equivalent anti-Xa dosages, and the interpretation of their relative efficacy and safety may be biased by the degree of clinical experience of the individual investigators.     

Colposcopic genital findings in prepubertal girls assessed for sexual abuse

After the introduction of the colposcope for the examination of children suspected of being sexually abused in Leeds, a study was undertaken to describe the findings in detail. A total of 109 consecutive prepubertal girls, mean age 70.4 months were assessed including colposcopic genital and anal examination, and peer group review of reports and photographs. Fifty nine children had signs consistent with blunt force penetrating trauma (hymenal transection/major notch, scar, or hymenal attenuation). Transections were encountered most commonly at 6 o'clock (directly posterior). In 46 the hymenal orifice was gaping with thigh abduction only and in 47 the hymenal orifice transverse diameter was greater than 4 mm on labial separation. Overall, physical findings were commonly present and in only two cases were no signs recorded. Non-specific and frequent findings included patterns of labial and introital reddening. Supportive hymenal signs including swelling, rounding of edge, thickening, distortion, and loss of symmetry were common. Labial fusion was present in 20. Urethral dilatation with labial separation was noted in 14. Physical findings including normality are consistent with abuse and even minor anogenital signs as well as negative findings should be documented. Colposcopy and photography are valuable tools in peer review, teaching, and case management.     

Radiological evidence of constipation in urinary tract infection

Little objective evidence has been published to support the claim that constipation is an important contributory factor in recurrent urinary tract infection (UTI) in childhood. Using a radiological scoring system, two observers assessed faecal loading from abdominal radiographs of children with proved UTIs. There was a significant increase in the degree of faecal loading in children with UTI when compared with controls (r = 0.237). This difference was mainly accounted for by girls with recurrent (greater than five) UTIs. This study confirms an association between recurrent UTI and faecal loading. Further studies are needed to establish if there is a causal relationship and benefits from treatment.     

Superiority of cisplatin or carboplatin in combination with teniposide and vincristine in the induction chemotherapy of small-cell lung cancer. A randomized trial with 5 years follow up

PURPOSE:: The introduction of platinum compounds and epipodophyllotoxinsin combination with vincristine as induction chemotherapy insmall-cell lung cancer (SCLC) was investigated in order to:(1) compare the efficacy of cisplatin with that of carboplatinin combination with teniposide and vincristine as inducers ofremission over three cycles; (2) compare the toxicity patternof carboplatin and of cisplatin when given in combination regimens;and (3) compare a chemotherapeutic regimen consisting of threealternating combinations with that of regimens consisting offour alternating combinations. PATIENTS AND METHODS:: From November 1985 to September 1991, 484 consecutive, previouslyuntreated patients with SCLC, performance status 0–4,entered a three armed randomized trial with three cycles ofcisplatin (arm I) or carboplatin (arm II) in combination withteniposide and vincristine alternating with three treatmentblocks of cyclophos phamide, etoposide, lomustine and vincristine(block A), doxorubicin and vincristine (block B) and cisplatin,hexa methylmelamine and vindesine (block C) versus alternatingtreatment with block A, B and C (arm III). RESULTS:: No difference in efficacy or toxicity was found between cisplatinand carboplatin at the present dosages. Induction chemotherapywith teniposide plus cisplatin or carboplatin did not resultin higher complete response rates (objective response rates63%, 72% and 65%, respectively) or in significantly greatertoxicity, but overall survival was superior compared with thearm [ (log-rank test, P = 0.02) The median survival differencewas 7 weeks, and two year survival 15% versus 9%. The Cox regressionanalysis identified the arm III, poor performance status andelevated LDH as factors with statistically significant negativeimpact on survival. CONCLUSION:: Cisplatin and carboplatin produced similar response and survivalrates and similar toxicity. Induction with platinum and epipodophyllotoxinsdid not improve objective response rates, but significantlyimproved survival without increasing the toxicity. carboplatin, cisplatin, platinuminduction, smallcell lung cancer     

Evaluation of a simple dosage scheme for transition from phenprocoumon to warfarin in oral anticoagulation

Phenprocoumon, whose elimination half-time is 144 hours, has been the traditional oral anticoagulant of choice in Europe. However, today's most widely used drug is warfarin, whose elimination half-time is 40 hours. This study aims to evaluate a method for safe transition from phenprocoumon to warfarin, which is sometimes required. Hence, the large difference in their elimination rates may on occasion lead to serious overdosage upon transition from one drug to the other. According to average equipotent doses, a stepwise increase in warfarin dose was calculated based on the elimination half-times of the two drugs. The dosage scheme was subsequently tested in a pilot study including 35 patients. The conversion scheme was then adjusted based on the results from the pilot study. The new scheme was tested in 69 patients. The transition factor was 2.3, which implies that equipotency was achieved when the warfarin dose was 2.3 times larger than the phenprocoumon dose (in mg). This scheme proved optimal for 75% of the patients. However, the dose had to be adjusted individually in the remaining 25% of the patients to a level corresponding to the measured international normalised ratios. No patients experienced haemorrhages or thromboembolic complications during the period of changeover. In conclusion, the proposed scheme for changing medication from phenprocoumon to warfarin is safe and convenient.     

Breast cancer risk associated with different HRT formulations: a register-based case-control study

Background  

Previous epidemiological studies have inconsistently shown a modestly increased breast cancer risk associated with hormone replacement therapy (HRT). Limited information is available about different formulations - particularly concerning different progestins.     

转院行直接经皮冠状动脉介入治疗的患者中自发性及介入治疗相关ST段改变的潜在意义：急性心肌梗死ST段监测研究（MONAMI研究）

目的:在拟行直接经皮冠状动脉介入(PCI)治疗的ST段抬高型心肌梗死(STEM I)患者中,急性风险分层可能有助于冠状动脉介入术中辅助治疗的决策。本研究旨在量化介入治疗前、中、后的ST段改变,评价ST段监测分级是否提供了介入治疗术前、术中的潜在预后信息,并比较介入治疗后分别来自     

An evaluation of alcohol attendances to an inner city emergency department before and after the introduction of the UK Licensing Act 2003

Background  

The Licensing Act 2003 (The Act) was implemented on the 24th November 2005 across England and Wales. The Act allowed more flexible and longer opening hours for licensed premises. We investigated the effect of The Act on alcohol related attendances to an inner city emergency department in Birmingham, UK.