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We have carried out a prospective randomised, single blind clinical trial to investigate the effect of continuous passive motion on range of knee flexion, lack of extension, pain levels and analgesic use after total knee replacement surgery. 85 subjects were randomly allocated to control or study group. All subjects followed the existing rehabilitation protocol, which permits immediate active range of motion exercises and mobilisation with the study group using continuous passive motion for 1 h, twice a day. Outcome measures employed were range of motion, pain assessed on a visual analogue scale and analgesic use according to the WHO ladder. Blinded evaluation was carried out preoperatively, at time of discharge from hospital, 6 weeks, 6 and 12 months postoperation. No significant difference was observed between groups at all time intervals for each outcome variable using Wilcoxon Rank sum tests. The results substantiate previous findings that short duration continuous passive motion following total knee arthroplasty does not influence outcome of range of motion or reported pain. 相似文献
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Dmitri Artemov Zaver M. Bhujwalla Ross J. Maxwell John R. Griffiths Ian R. Judson Martin O. Leach Jerry D. Glickson 《Magnetic resonance in medicine》1995,34(3):338-342
The anticancer agent temozolomide labeled with 13C (8-Carbamoyl-3-13C-methylimidazo-[5,1-d]-1,2,3,5-tetrazin-4-(3H)-one), was noninvasively detected in subcutaneous RIF-1 tumors by a selective cross polarization 13C NMR method, at a field strength of 9.4T. Pharmacokinetics of the drug, at a dose of 150 mg/kg, were determined for intravenous and intraperitoneal modes of administration (three animals per mode). The half-life of the drug in the tumors was approximately 60 min. The uptake and clearance of the drug, however, varied significantly between individual hosts, for both modes of administration. These results demonstrate the feasibility of obtaining pharmacokinetics of anticancer agents for individual tumors without the need for a label that might modify drug activity (e.g., fluorine). The variability of the in vivo measurements, even within the same tumor model, demonstrates the necessity of directly monitoring the tumor to evaluate drug pharmacokinetics. 相似文献
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Repair of large midline incisional hernias with polypropylene mesh: Comparison of three operative techniques 总被引:9,自引:0,他引:9
de Vries Reilingh TS van Geldere D Langenhorst BLAM de Jong D van der Wilt GJ van Goor H Bleichrodt RP 《Hernia》2004,8(1):56-59
Polypropylene mesh is widely used for the reconstruction of incisional hernias that cannot be closed primarily. Several techniques have been advocated to implant the mesh. The objective of this study was to evaluate, retrospectively, early and late results of three different techniques, onlay, inlay, and underlay. The records of 53 consecutive patients with a large midline incisional hernia — 25 women and 28 men, mean age 60.4 (range 28–94) — were reviewed. Polypropylene mesh was implanted using the onlay technique in 13 patients, inlay in 23 patients, and underlay in 17 patients. Either the greater omentum or a polyglactin mesh was interponated between the mesh and the viscera. The records of these 53 patients were reviewed with respect to: size and cause of the hernia, pre- and postoperative mortality and morbidity, with special attention to wound complications. Patients were invited to attend the outpatient clinic at least 12 months after implantation of the mesh for physical examination of the abdominal wall. Postoperative complications occurred in 14 (26.4%) patients. The onlay technique had significantly more complications, as compared to both other techniques. Reherniation occurred in 15 (28.3%) patients. The reherniation rate of the inlay technique was significantly higher than after the underlay technique (44% vs 12%, P=0.03) and tended to be higher than the onlay technique (44% vs 23%, P=0.22). Repair of large midline incisional hernias with the use of a polypropylene mesh carries a high risk of complications and has a high reherniation rate. The underlay technique seems to be the better technique. 相似文献
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Relationship between TISS and ICU cost 总被引:3,自引:0,他引:3
H. Dickie A. Vedio R. Dundas D. F. Treacher R. M. Leach 《Intensive care medicine》1998,24(10):1009-1017
Objective: To determine whether the therapeutic intervention scoring system (TISS) reliably reflects the cost of the overall intensive
care unit (ICU) population, subgroups of that population and individual ICU patients. Design: Prospective analysis of individual patient costs and comparison with TISS. Setting: Adult, 12 bedded general medical and surgical ICU in a university teaching hospital. Subjects: Two hundred fifty-seven consecutive patients including 52 coronary care (CCU), 99 cardiac surgery (CS) and 106 general ICU
(GIC) cases admitted to the ICU during a 12-week period in 1994. A total of 916 TISS-scored patient days were analysed Main outcome measures: A variable cost (VC) that included consumables and service usage (nursing, physiotherapy, radiology and pathology staff
costs) for individual patients was measured daily. Nursing costs were calculated in proportion to a daily nursing dependency
score. A fixed cost (FC) was calculated for each patient to include medical, technical and clerical salary costs, capital
equipment depreciation, equipment and central hospital costs. The correlation between cost and TISS was analysed using regression
analysis. Results: For the whole group (n = 257) the average daily FC was £ 255 and daily VC was £ 541 (SEM 10); range £ 23–£ 2,806. In the patient subgroups average
daily cost (FC + VC) for CCU was £ 476 (SEM 17.5), for CS £ 766 (SEM 13.8) and for GIC £ 873 (SEM 13.6). In the group as a
whole, a strong correlation was demonstrated between VC and the TISS for each patient day (r = 0.87, p < 0.001) and this improved further when the total TISS score was compared with the total VC of the entire patient episode
(r = 0.93, p < 0.001). This correlation was maintained in CCU, CS and GIC patient cohorts with only a small median difference between
actual and predicted cost (2.2 % for GIC patients). However, in the individual patient, the range of error was up to ± 65
% of the true variable cost. For the whole group the variable cost per TISS point was £ 25. Conclusion: These results demonstrate that TISS reliably measures overall ICU population costs as well as those of the subgroups CCU,
CS and GIC. However, the relationship between TISS and cost is less reliable for the individual patient.
Received: 4 August 1997 Accepted: 22 March 1998 相似文献
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F Smedley T Hickish M Taube C Yale R Leach C Wastell 《Journal of the Royal Society of Medicine》1988,81(2):92-94
Whilst the association between smoking and peptic ulceration has been reported previously, the relationship between smoking and the complications of ulcers, such as perforation, bleeding or acute painful exacerbation, has not been examined. In a retrospective study comparing 275 emergency admissions for peptic ulcer with 275 controls, cigarette smoking was significantly more common only in those with a perforated duodenal ulcer. Of 128 patients with perforated duodenal ulcers, 110 (86%) were cigarette smokers compared with 65 (51%) of the 128 matched controls (X2, P less than 0.01). Cigarette smoking in patients with bleeding or acutely exacerbated ulcers was not significantly more common than in controls. These findings strongly suggest a particular association between smoking and perforated duodenal ulcer. 相似文献