ST-recovery loop of exercise-induced ST deviation in the identification of coronary artery disease: which parameters should we measure?

This study aimed to characterize the ST-recovery loop and assess which range of heart rates (HRs) best discriminates between patients with and without significant coronary artery stenosis. Bicycle exercise tests were undertaken in 44 men and 18 women with coronary artery disease (CAD) and in 59 controls (26 men, 33 women) in the same age range with no signs of CAD. The ST level and the ST-segment slope were continuously monitored, and changes from rest to peak exercise and to 4 min after exercise, respectively, were calculated. Plotting the ST level against HR gives the STHR loop, characterized by the normalized area (NA(alpha)) circumscribed by the ST level during and after exercise from alpha% to 100% of the HR range. Eight values of alpha between 20% and 90% were investigated, and chest and extremity leads were investigated separately. Optimal alpha was found to be < or =70% in men and < or =30% in women. Change in ST-segment slope was the only parameter that gave significant additional discriminating power in both men and women once the area had been taken into account. We conclude that NA(alpha) for extremity and chest leads have similar weights, and that a substantial part of the STHR loop should be taken into consideration, especially in women. NA(30) was superior to end-exercise ST-depression and STHR loop orientation (as defined by the sign of NA(90)) in both men and women, and to ST/HR index in men, in identifying CAD.     

Evaluation of phenoxymethylpenicillin treatment of acute otitis media in children aged 2-16

OBJECTIVE: To study the clinical recovery from acute otitis media (AOM) in children, 2-16 years of age, managed with or without treatment with phenoxymethylpenicillin (PcV). DESIGN: An open, prospective randomized trial. Children aged between 2 and 16 years, presenting with one- or double-sided AOM (without perforation) with symptom duration of less than four days, were included. The children were randomized to PcV for five days or to no primary antibiotic treatment. A health score and compliance were registered on a daily basis for seven days. SETTING: A total of 32 health centres and 72 GPs in south-east Sweden. Subjects. Children aged 2-16 presenting with earache. MAIN OUTCOME MEASURES: Recovery time, symptom duration, frequency of complications (up to three months) and consumption of healthcare services independent of treatment with or without antibiotics. RESULTS: A total of 179 patients carried out the trial; 92 were randomized to PcV, 87 to no primary antibiotic treatment. The median recovery time was four days in both groups. Patients who received PcV had less pain (p <0.001) and used fewer analgesics. There were no significant differences in the number of middle-ear effusions or perforations at the final control after three months. Children randomized to PcV treatment consulted less (p <0.001) during the first seven days. CONCLUSIONS: Our investigation supports that PcV treatment of AOM does not affect the recovery time or complication rates. PcV provided some symptomatic benefit in the treatment of AOM in otherwise healthy children, aged 2-16 years.     

A comparison between flow cytometric assessment of S-phase fraction and Nottingham histologic grade as prognostic instruments in breast cancer

Flow cytometric DNA analysis with assessment of S-phase fraction and DNA ploidy was compared to Nottingham histologic grade. The study population consisted of 654 patients who presented between 1987 and 1996 with primary operable breast cancer and whose tumours had been analysed for S-phase fraction and DNA ploidy at the time of surgery. Grade, tumour size, node status, steroid receptor status, age, S-phase fraction and DNA ploidy were analysed univariately and multi-variately in a Cox proportional hazard analysis. In the univariate analyses all parameters were statistically significantly associated with breast cancer mortality during the follow-up period of 2–11 years. The most powerful predictor of death from breast cancer in the multiple regression analysis was grade. Patients with grade 1 tumours have excellent prognosis. We conclude that tumour grade is a strong prognostic indicator applicable to all breast cancer patients, regardless of size and nodal status, and advocate its general use.     

Late psychological symptoms after awareness among consecutively included surgical patients

BACKGROUND: Awareness during general anesthesia can cause late psychological symptoms. Selection bias may have affected the results in previous retrospective studies. The authors used prospective consecutive collection to recruit patients with previous awareness. METHODS: In a cohort of 2,681 consecutive patients scheduled to undergo general anesthesia, 98 considered themselves to have been aware during previous surgery. Six patients died before inclusion, and another 13 were excluded (4 cases of stroke or dementia, 7 declined to participate, and 2 could not be located). Seventy-nine patients were interviewed by telephone, and medical records were checked in uncertain cases. The interview followed a structured protocol, including seven late symptoms (anxiety, chronic fear, nightmares, flashbacks, indifference, loneliness, and lack of confidence in future life). Three persons independently assessed the interviews for classification, to determine whether awareness had occurred. RESULTS: Four cases were performed using regional anesthesia, and another 29 were not considered as awareness by the assessors. Therefore, the final analyses included 46 patients. Twenty (43%) had experienced pain, and 30 (65%) described acute emotional reactions during the awareness episode. Fifteen (33%) patients had experienced late psychological symptoms afterward. In 6 of those cases, the symptoms lasted for more than 2 months, and 1 patient had a diagnosis of post-traumatic stress disorder. Acute emotional reactions were significantly related to late psychological symptoms (P<0.05). CONCLUSION: The method for recruiting awareness cases in studies on late psychological symptoms may affect the result. The authors found fewer and milder problems, despite a similar degree of initial problems as in previous studies.