To What Extent Can We Trust Home Blood Pressure Measurement? A Randomized,Controlled Trial

Increasingly, patients measure and record their home blood pressure. However, the accuracy with which they report their readings to their physicians is largely unknown. The authors assessed the accuracy and quality of self-reported home blood pressure values in an ambulatory managed care population. Forty-eight hypertensive outpatients were randomly allocated to either receive information about the storage capabilities of a home blood pressure measuring device or not to receive such information. All patients were asked to record the measurement results in a logbook twice daily over a 7-day period. The main outcome measure was the difference in the number of fictional or manipulated reports per group and the difference in missing values. The combined parameter manipulated or fictional registrations occurred significantly less frequently in the informed group than in the noninformed group. (10/728 vs. 29/616; relative risk, 0.292; 95% confidence interval, 0.15-0.57; Pearson chi squared=13.15; p<0.0001). Informed patients had fewer missing registrations than the noninformed (13/728 vs. 41/616 measurements; relative risk, 0.27; 95% confidence interval, 0.15-0.47; Pearson chi squared =20.5; p<0.0001). The mean of the fictional data did not differ systematically from the mean of the correctly reported individual blood pressure values. There was no trend to over- or underestimate blood pressure values in the noninformed group. With this study design, it was possible to identify manipulation of home blood pressure values for the first time. Accuracy and interpretation of home blood pressure measurement may be increased by using devices with a memory function.     

Peripheral arterial balloon angioplasty: effect of short versus long balloon inflation times on the morphologic results

PURPOSE: To evaluate the effect of different balloon inflation times on angiographic results in peripheral angioplasty. MATERIALS AND METHODS: Seventy-four infrainguinal arteriosclerotic lesions were randomized prospectively to undergo balloon dilation for 30 seconds (group I) or 180 seconds (group II). Each group consisted of 37 patients. Postinterventional angiograms were evaluated by two blinded readers. Dissections were graded as follows: 1 = no dissection; 2 = minor flap; 3 = extensive dissection membrane, not flow limiting; or 4 = flow-limiting flap. The rate of major-grade dissections (grades 3 and 4), residual stenosis (>30%), and further interventions were compared with the two-tailed chi(2) test. RESULTS: In group I, major dissections were noted in 16 patients (43%) compared with five patients (14%) in group II (P =.009). Residual stenoses were found in 12 patients (32%) in group I compared with five patients (14%) in group II (P =.096). The rate of additional interventions was significantly higher in group I than in group II (20 of 37 vs nine of 37; P =.017). CONCLUSION: A prolonged inflation time of 180 seconds improves the immediate angioplasty result of infrainguinal lesions compared to a short dilation strategy. Significantly fewer major dissections and a modest reduction of residual stenoses are observed. The requirement of costly and time-consuming further interventions is significantly reduced.     

A phase I study of a new nucleoside analogue, OSI-7836, using two administration schedules in patients with advanced solid malignancies.

PURPOSE: To investigate the safety, tolerability, and pharmacokinetic profile of the novel nucleoside analogue OSI-7836 in patients with advanced solid malignancies. EXPERIMENTAL DESIGN: OSI-7836 was initially given as a 60-minute i.v. infusion on day 1 every 21 days. In view of its dose-limiting toxicities, the administration time was amended to a 5-minute bolus, and subsequently, the schedule was amended to weekly for 4 weeks followed by a 2-week rest. Blood and urine samples were collected for pharmacokinetic studies. Analyses of cytokines and lymphocyte subsets were added later in the study to elucidate a mechanism for the severe fatigue and lymphocyte depletion observed in earlier patients. RESULTS: Thirty patients received a total of 61 treatment cycles. Fatigue was the main dose-limiting toxicity. Maximum-tolerated dose was defined as 300 mg/m2 in the 60-minute infusion, (three times per week) schedule; 400 mg/m2 in the 5-minute bolus infusion, (three times per week) schedule; and 100 mg/m2 in the weekly schedule. Other common toxicities were nausea, vomiting, rash, fever, and a flu-like syndrome. There were no clinically significant hematologic toxicities. Following the initial dose, OSI-7836 was eliminated from plasma with a median (range) elimination half-life of 48.3 minutes (22.6-64.8 minutes). Lymphocyte subset analysis showed a significant drop in B cell counts, which persisted to day 14 and beyond. Cytokine analysis showed significant elevations of interleukin-6 and interleukin-10 in all patients who received > or = 200 mg/m2 OSI-7836. Best response was disease stabilization in seven patients. CONCLUSION: OSI-7836 was associated with excessive fatigue, and despite changes in its schedule and duration of administration, we did not observe an improvement in its tolerability. Its potentially selective effect on B lymphocytes could be exploited in further studies in specific hematologic malignancies.     

Pars plana vitrectomy, phacoemulsification and intraocular lens implantation. Comparison of clinical complications in a combined versus two-step surgical approach

Purpose To report intra-and postoperative complications in pars plana vitrectomy, phacoemulsification and intraocular lens implantation. A comparison of the combined versus two step surgical approach is given.Method Medical records and operative notes of 111 eyes with combined surgery and 50 eyes with sequential surgery were retrospectively analysed. Subgroup analysis was performed to evaluate differences in disease groups, the use of endotamponading or endolaser and cryocoagulation. Postoperative follow-up time was between 3 and 18 months.Results Combined surgery: 64 eyes (57.5%) showed no complications. 17 eyes (15.3%) showed transient intraocular pressure rise, 17 eyes (15.3%) fibrinous exudation in the anterior chamber. Posterior capsule tears occurred in 7 eyes (6,3%), formation of posterior synechia was observed in 7 eyes (6.3%). IOL dislocation was seen in 3 eyes (2.7%), heavy covering of macrophages in 3 eyes (2,7%). Rare complications included silicon oil efflux into the anterior chamber (1.8%), anterior chamber hemorrhage (1,8%) and iris incarceration into the corneoscleral incision (0,9%). One eye needed explantation of the IOL during the follow-up. Sequential surgery: 31 eyes (62%) showed no complication. Transient intraocular pressure rise occurred in 14 eyes (28%), fibrinous exudation in 2 eyes (4%). Formation of posterior synechia was observed in 1 eye (2%), posterior capsule tears occurred in 4 eyes (8%). Dislocation of the IOL was seen in 1 eye (2%). Subgroup analysis revealed fibrinous exudation in the anterior chamber to be significantly more frequent after combined surgery, particularly in cases of proliferative diabetic retinopathy.Conclusion Combined pars plana vitrectomy, phacoemulsification and intraocular lens implantation as well as the two-step procedure are safe and effective. Sequential surgery could be advantageous to minimize the postoperative anterior chamber inflammatory response.     

Büschelartiges Hämangiom (“tufted angioma”) des Unterarms Fallbericht und Literaturübersicht

Background: Tufted angioma represents a benign vascular lesion of the skin. The knowledge of this distinctive entity is important in distinction of clinically more aggressive and malignant neoplasms respectively. Case report. We report a 8-months-old girl who developed a deep seated tufted haemangioma on her right forearm. Sonography and MRI showed a good vascularized tumor with interseptal spreading. Histological examination of the incisional biopsy revealed a cellular capillary haemangioma with morphological features of rare tufted haemangioma. Discussion. Characteristic morphological features of tufted haemangioma allow accurate diagnosis and differential diagnosis to clinically more aggressive and malignant neoplasms of skin and soft tissues, wheras radiological methods are rather unspecific and do not distinguish reliably between these vascular lesions. It is of special clinical importance that tufted haemangioma represents an enlarging but biologically benign vascular neoplasm.     

Complications of cochlear implant surgery in children and adults

BACKGROUND: In a retrospective analysis we evaluated the complication rate in 697 patients after cochlear implantation between 1985 and 1995 (366 children, 331 adults; 604 Nucleus, 50 Clarion and 42 other implants). RESULTS: Intraoperatively in 74 cases (10.6%) total or partial cochlear obliteration was found, a CSF gusher occurred in 7 cases. Minor complications such as seroma (8 adults), wound infections (14 patients), emphysema, and swelling were successfully treated with conservative methods and drugs. Seven (2.1%) adults showed facial nerve palsy postoperatively with incomplete recovery only in 2 of them (0.6%). No permanent facial nerve palsy was observed in children. Cholesteatoma developed in 18 adults (5.4%), which was treated by revision surgery. CONCLUSIONS: In conclusion, cochlear implant surgery is a safe procedure with a low complication rate. However, Cochlear implantation should be performed by well experienced ear surgeons who can properly handle intraoperative and postoperative problems. The patients should be informed about the typical risks of ear surgery including implant removal due to infection or technical defects, facial nerve palsy, vertigo and, especially in adults, increased tinnitus.