A randomized comparison of three post-tonsillectomy diets*

Traditionally, soft cold foods have been recommended after tonsillectomy to aid comfort and haemostasis but, more recently, rougher foods have been advocated to promote physiologically normal deglutition. This trial was designed to discover whether post-tonsillectomy dietary advice has any influence on recovery. 150 patients due to undergo tonsillectomy were prospectively randomized to 1 of 3 diets: mainly rough food, mainly soft food, and no advice except to eat regularly. Food consumption, analgesia intake and pain levels were recorded daily by each patient. Tonsillar fossa slough and secondary haemorrhage were evaluated 1 and 2 weeks after surgery. Results of 137 patients were obtained. There were no significant differences between the diets regarding post-operative pain, analgesic required, healing rates or secondary haemorrhage. Specific post-tonsillectomy dietary advice need not be given, other than to encourage regular eating.     

Inappropriate ICD Discharges in Single-Chamber Versus Dual-Chamber Devices in the Pediatric and Young Adult Population

Background: Implantable cardioverter defibrillator (ICD) use is increasing in young patients and is frequently complicated by inappropriate device discharges (IDs), leading to discomfort, anxiety and, potentially, proarrhythmia. Dual-chamber (DC) ICDs may decrease IDs by improving rhythm discrimination, but are associated with increased size, expense, and implant complications. We examined whether the frequency of IDs was the same in dual- and single-chamber (SC) ICDs in young patients.
Methods: A multicenter review of patients ≤30 years of age with ICDs was performed. Demographic data and number of appropriate discharges (ADs) and IDs were collected. ADs and IDs were categorized after review of the episode by the primary electrophysiologist.
Results: Of 168 subjects (SC = 52; female = 76), 41 patients received 139 ADs, while 35 patients received 159 IDs. There were no differences related to gender or primary diagnosis, but patients with SC versus DC devices were younger (12.3 ± 5.0 years vs 14.9 ± 4.4 years, P < 0.0001) at implant. SC and DC devices were implanted with the same frequency for primary and secondary prevention. There were no significant differences in the incidence of IDs or ADs between the patients with SC or DC devices (AD: 12/52 SC vs 29/116 DC, P = 0.79; ID 7/52 SC vs 28/116 DC, P = 0.13).
Conclusion: In this cohort of young patients, DC ICDs did not provide added protection from IDs. Hence, the added complexity and cost of an atrial lead appear unwarranted if used solely for assistance with rhythm discrimination in young patients.     

AN EMPIRICAL COMPARISON OF STATISTICAL TESTS FOR ASSESSING THE PROPORTIONAL HAZARDS ASSUMPTION OF COX'S MODEL

In the analysis of survival data using the Cox proportional hazard (PH) model, it is important to verify that the explanatory variables analysed satisfy the proportional hazard assumption of the model. This paper presents results of a simulation study that compares five test statistics to check the proportional hazard assumption of Cox's model. The test statistics were evaluated under proportional hazards and the following types of departures from the proportional hazard assumption: increasing relative hazards; decreasing relative hazards; crossing hazards; diverging hazards, and non-monotonic hazards. The test statistics compared include those based on partitioning of failure time and those that do not require partitioning of failure time. The simulation results demonstrate that the time-dependent covariate test, the weighted residuals score test and the linear correlation test have equally good power for detection of non-proportionality in the varieties of non-proportional hazards studied. Using illustrative data from the literature, these test statistics performed similarly. © 1997 by John Wiley & Sons, Ltd.     

Delusions of Pregnancy in the Elderly

We present five case reports of elderly ladies with delusions of pregnancy. This symptom is discussed with reference to the cases and a review of the literature. © 1997 by John Wiley & Sons, Ltd.     

Review article: optimizing SVR and management of the haematological side effects of peginterferon/ribavirin antiviral therapy for HCV – the role of epoetin,G‐CSF and novel agents

Aliment Pharmacol Ther 31 , 929–937

Summary

Background Chronic hepatitis C is one of the leading causes for chronic liver disease globally. The past two decades have seen many advances in hepatitis C treatment. Despite these advances, side effects of treatment are common. Haematological complications of treatment can result in treatment cessation and suboptimal results. Recent data have suggested a role for epoetin/granulocyte colony stimulating factor (G‐CSF) in optimizing sustained virological response (SVR). Aim To investigate the nature, frequency and management of haematological side effects in the treatment of chronic hepatitis C infection. Methods The terms hepatitis C, hepatitis C virus (HCV), treatment, side effects, interferon, peginterferon, ribavirin, anaemia, haemoglobin, neutropenia, thrombocytopenia, haematological, growth factor, erythropoietin and G‐CSF were searched on MEDLINE for the period 1991–2009. References from selected articles were also included. Results Haematological side effects such as anaemia, neutropenia and thrombocytopenia are frequent in anti‐HCV treatment. The off‐label use of haematological growth factors is common and effective. Conclusions Erythropoietic agents are effective in treating anaemia, preventing ribavirin dose reduction, improving patients’ quality of life, but the effect on SVR is not fully elucidated. G‐CSF is effective in raising absolute neutrophil count; however, neutropenic HCV‐infected patients on combination treatment may not experience increased bacterial infections. Eltrombopag, a new oral thrombopoietin mimetic, may allow combination treatment in patients with thrombocytopenia.