Twenty-four-hour intragastric acidity in duodenal ulcer patients during dosing with placebo, and 150 mg ranitidine twice or four times daily

Twenty-four-hour intragastric acidity was measured in 10 patients with a past history of duodenal ulcer on the fourth day of dosing with placebo, and either 150 mg ranitidine given twice or four times daily. The order of the treatments was randomized and a double-blind design was employed. Ranitidine (150 mg) b.d. decreased median integrated 24-h intragastric acidity by 65.1%, nocturnal acidity by 89.1%, and daytime acidity by 54.6% (all P less than 0.01 compared to placebo). The corresponding decreases with 150 mg ranitidine q.d.s. were 62.3, 89.9 and 48.8%, respectively (all P less than 0.01) compared to placebo). There were no significant differences between the two dosage regimens of ranitidine (P greater than 0.05). This study shows that giving extra doses of 150 mg ranitidine during the day does not increase the degree of suppression of intragastric acidity.     

COMPARISON OF THE EFFECT OF EMLA CREAM, SUBCUTANEOUS RING ANAESTHESIA AND A DOUBLE CUFF TECHNIQUE IN THE PREVENTION OF TOURNIQUET PAIN

We have examined the effect of EMLA on tourniquet pain and comparedit with those of subcutaneous ring anaesthesia (SRA), a doublecuff technique and a single cuff (control) during i.v. regionalanaesthesia. The durations of analgesia (mean 57.3 (SD 16.6)min) and tolerance (72.3 (13.9) min) to tourniquet inflationin the EMLA group were comparable to those in the SRA group(54.1(16.2) min and 68.3(19.0) min), but significantly (P <0.05) greater than those in the control group (30.0 (10.7) minand 45.6 (14.0) min). The double cuff technique was the mosteffective method, with 91.5 (14.9) min duration of analgesia.We conclude that EMLA provided a significant analgesic effecton tourniquet pain compared with the control group, but a relativelylimited analgesic effect compared with a double cuff technique.(Br. J. Anaesth. 1993; 70: 394–396)     

Clinical trial: percutaneous acetic acid injection vs. percutaneous ethanol injection for small hepatocellular carcinoma – a long-term follow-up study

Background  The long-term outcome of percutaneous acetic acid injection (PAI) and percutaneous ethanol injection (PEI) for treating small hepatocellular carcinoma (HCC) remains unclear.
Aim  To compare the long-term outcome of PAI vs. PEI for treating small HCC.
Methods  From July 1998 to July 2004, 125 patients with small HCC were enrolled. Seventy patients receiving PAI and 55 patients receiving PEI were enrolled. There were no significant differences in the clinical characteristics between the two groups. Tumour recurrence and survival rates were assessed.
Results  Mean follow-up time was 43 months. The local recurrence rate and new tumour recurrence rate were similar between the PAI and PEI groups. The PAI group had significantly better survival than the PEI group ( P  = 0.027). Multivariate analysis revealed that PAI was the significant factor associated with overall survival [PAI vs. PEI, RR: 0.639, 95% CI: (0.419–1.975), P  = 0.038]. The treatment sessions required to achieve complete tumour necrosis were significantly fewer in the PAI group than in the PEI group (2.4 ± 1.0 vs. 2.9 ± 1.3, P  = 0.018).
Conclusion  Percutaneous acetic acid injection required fewer treatment sessions than PEI and provided better survival after long-term follow-up.     

血液透析患者血管通路感染

目的:探讨血液透析患者血管通路感染,了解其发生率和影响因素,为制订防治对策、降低感染的发生提供参考。方法:回顾性分析379例维持性血液透析患者的血管通路感染的情况。结果:自体动静脉内瘘者312例次,1例局部感染,移植血管瘘3例次,未见感染。长期导管感染率为0.836/1000导管日,颈静脉临时管感染率为1.759/1000导管日,而股静脉临时管感染率则为4.929/1000导管日。金黄色葡萄球菌(29.8%)是最常见致病菌,其次为白葡萄球菌(24.6%)、洋葱假单胞菌(10.1%)及大肠杆菌(5.3%)。结论:内瘘感染少见,而导管相关性感染具有特异性,洋葱假单胞菌可能易致隧道感染,拔除导管是治疗的主要措施,但应注意个体化防治。     

Chronic kidney disease care program improves quality of pre-end-stage renal disease care and reduces medical costs

Aim: Multidisciplinary care of patients with chronic kidney disease (CKD) provides better care outcomes. This study is to evaluate the effectiveness of a CKD care program on pre‐end‐stage renal disease (ESRD) care. Methods: One hundred and forty incident haemodialysis patients were classified into the CKD Care Group (n = 71) and the Nephrologist Care Group (n = 69) according to participation in the CKD care program before dialysis initiation. The ‘total observation period’ was divided into ‘6 months before dialysis’ and ‘at dialysis initiation’. Quality of pre‐ESRD care, service utilization and medical costs were evaluated and compared between groups. Results: The mean estimated glomerular filtration rates at dialysis initiation were low in both groups; but the levels of haematocrit and serum albumin of the CKD Care Group were significantly higher. The percentages of patients initiating dialysis with created vascular access, without insertion of double‐lumen catheter and without hospitalization were 57.7%, 50.7% and 40.8%, respectively, in the CKD Care Group, and 37.7%, 29.0% and 18.8% in the Nephrologist Care Group (P < 0.001). Participation in the CKD care program, though with higher costs during the 6 months before dialysis ($US1428 ± 2049 vs US$675 ± 962/patient, P < 0.001), was significantly associated with lower medical costs at dialysis initiation ($US942 ± 1941 vs $US2410 ± 2481/patient, P < 0.001) and for the total period of observation ($US2674 ± 2780 vs $US3872 ± 3270/patient, P = 0.009). The cost‐saving effect came through the early preparation of vascular access and the lack of hospitalization at dialysis initiation. Conclusion: CKD care programs significantly improve quality of pre‐ESRD care, decrease service utilization and save medical costs.