Driving ability after acute and sub-chronic administration of levocetirizine and diphenhydramine: a randomized,double-blind,placebo-controlled trial

Rationale Sedation following antihistamine use poses a danger to ambulant patients involved in daily activities such as driving. Objective To investigate effects of levocetirizine (5 mg), diphenhydramine (50 mg), and placebo on driving ability during normal traffic. Methods Forty-eight healthy volunteers participated in a double-blind, placebo-controlled, randomized clinical trial. Treatments were administrated on days 1, 2, 3 and 4, exactly 1.5 h before the start of the standardized driving test (performed on day 1 and day 4). In the standardized driving test, subjects were instructed to drive with a steady lateral position, while maintaining a constant speed (95 km/h). Primary parameter was the standard deviation of lateral position (SDLP; cm). Statistical analyses were performed separately for day 1 and day 4, using analysis of variance and an equivalence test. Equivalence to placebo was evidenced if the 95% confidence interval lay between −2.6 cm and +2.6 cm. Results SDLP after levocetirizine was equivalent to placebo on both day 1 (−0.66 cm; +1.12 cm) and day 4 (−0.37 cm; +1.28 cm). In contrast, SDLP after diphenhydramine differed significantly from placebo on both day 1 (P<0.0001) and day 4 (P<0.0003). On day 1, the 95% confidence interval of diphenhydramine (+1.85 cm; +3.63 cm) was partially above the upper equivalence limit (+2.6 cm), indicating clinically relevant driving impairment. On day 4, however, the 95% confidence interval of diphenhydramine (+0.74 cm; +2.38 cm) was contained within the acceptance range. Conclusion In contrast to diphenhydramine, driving performance was not significantly affected while using 5 mg levocetirizine once daily.     

Detection of visual change: mismatch or rareness?

How do we detect changes in our visual environment? By continuously comparing visual inputs to templates of experiences in the immediate past? Or by determining their rareness, how infrequently a visual event occurred previously? Recent results from event-related potentials have been interpreted in favour of the first hypothesis, as in the case of the auditory mismatch negativity. Here we demonstrate that rareness, rather than mismatch with a template, underlies visual change detection. Such rareness is detected through a dedicated mechanism in human visual cortex about 100 ms after the rare event occurs, reflected in the rareness-related negativity (RRN).     

Problem behavior of internationally adopted adolescents: a review and meta-analysis

In this paper we examine the prevalence of problem behaviors in samples of adolescents who were adopted from a foreign country as infants or young children. We reviewed ten studies and performed a meta-analysis, comparing 2317 internationally adopted adolescents with 14,345 nonadopted adolescents. Results indicate that internationally adopted adolescents exhibit more behavior problems than do nonadopted adolescents (d = 0.08; p = 0.02), with the difference seen in externalizing (d = 0.11; p = 0.00), but not in internalizing (d = 0.05; p = 0.12), behavior problems. Significantly more total behavior problems were seen in adopted than in nonadopted girls (d = 0.10; p = 0.03), but not in adopted boys compared to nonadopted ones (d = 0.07; p = 0.22). All differences, however, were small. The differences between adopted and nonadopted adolescents were somewhat larger when we considered behavior problems in the clinical range. The majority of the adopted adolescents are well adjusted and do not display significantly more problem behaviors than do their nonadopted peers.     

Ruling out clinically suspected pulmonary embolism by assessment of clinical probability and D-dimer levels: a management study

D-dimer test combined with clinical probability assessment has been proposed as the first step in the diagnostic work-up of patients with suspected pulmonary embolism (PE). In a prospective management study we investigated the safety and efficiency of excluding PE by a normal D-dimer combined with a low or moderate clinical probability. Of the 202 study patients this combination ruled out PE in 64 (32%) patients. The 3-month thromboembolic risk in these patients was 0% (95% CI, 0.0-5.6%). The prevalence of PE in the entire cohort was 29% (59 patients), whereas in the low, moderate and high clinical probability groups this was 25%, 26% and 50%, respectively. We conclude that ruling out suspected PE by a normal D-dimer combined with a low or moderate clinical probability appears to be a safe and efficient strategy. The accuracy of the clinical probability assessment is modest.     

Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy: A Feasible and Effective Option for Colorectal Cancer Patients After Emergency Surgery in the Presence of Peritoneal Carcinomatosis

Background

When peritoneal carcinomatosis (PC) is diagnosed during emergency surgery for colorectal cancer (CRC), further treatment with curative intent may seem futile given the known poor prognosis of both PC and emergency surgery. The aim of the current study was to investigate the feasibility and effectiveness of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for CRC patients who previously underwent emergency surgery in the presence of PC.

Methods

All patients with synchronous PC of CRC referred to two tertiary centers between April 2005 and November 2013 were included in this study. Operative, postoperative and survival details were compared between patients presenting in an emergency or elective setting.

Results

In total, 149 patients with synchronous PC underwent CRS and HIPEC. Amongst these patients, 36 (24.2 %) initially presented with acute symptoms requiring emergency surgery. Acute presentation did not result in a longer interval between the initial operation and HIPEC (2.2 vs. 2.1 months; P = 0.09). When comparing operative outcomes, no significant differences were found in blood loss (P = 0.47), operation time (P = 0.39), or completeness of cytoreduction (P = 0.97). In addition, complication rates, degree and types of complication did not differ between the groups. Median survival was 36.1 months for emergency presentation compared with 32.1 in the elective group (P = 0.73).

Conclusion

CRS + HIPEC may be performed safely in patients with PC of colorectal origin presenting with acute symptoms requiring emergency surgery. More importantly, the 5-year survival rate in these patients was equal to elective cases. This should be regarded as promising and therefore considered for these patients.     

Brain CT perfusion improves intracranial vessel occlusion detection on CT angiography

Background and purpose

To evaluate whether brain CT perfusion (CTP) aids in the detection of intracranial vessel occlusion on CT angiography (CTA) in acute ischemic stroke.

Ki-67 and p53 in T2 laryngeal cancer

Objective: To study the relationship between the proliferative capacity, represented by the immunohistochemical labeling index (LI) of proliferation marker Ki-67, and the p53 status, as in theory an intact p53 cell cycle checkpoint system should result in a lower proliferative capacity. Study Design: From a group of 128 patients with a T2 laryngeal carcinoma, presented from 1989 to 1993 at the University Hospital Utrecht, 20 patients with recurrent disease and 16 patients without recurrent disease were randomly selected. All patients received primary irradiation. Methods: Denaturing gradient gel electrophoresis and immunohistochemistry determined the p53 status. MIB-1 staining was used to determine the Ki-67 LI. Results: In 36% of specimens we found a p53 mutation with overexpression (LI, 31%). In 8% a p53 mutation without p53 overexpression was found (LI, 18%). Forty-two percent showed no mutation but, nevertheless, overexpression (LI, 35%). Neither mutation nor overexpression was found in 14% (LI, 38%). No correlation exists between p53 status and proliferative capacity of tumors (analysis of variance [ANOVA]; P = .104). The proliferation rate as established with Ki-67 LI positively correlates with response to radiotherapy (P = .006). Conclusions: 1. Overexpression of wild-type p53 protein does not result in cell cycle arrest measurable by a lower Ki-67 LI in comparison with cases overexpressing mutant type p53 protein. 2. A high Ki-67 LI correlates with a favorable response to radiotherapy. Laryngoscope, 108:1548–1552, 1998