ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121177.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121178.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveTo test the efficacy and possible side effects of a single 20 mg dose of methotrexate injected at the time of laparoscopy, in the treatment of tubal ectopic pregnancy.DesignThe study was a non‐randomised non‐blinded prospective clinical trial.SettingThe study was carried out at two tertiary referral hospitals.PatientsEighteen patients with unruptured tubal ectopic pregnancies and in a stable haemodynamic condition were offered entry into the study and all of these agreed.InterventionsAt diagnostic laparoscopy, 20 mg of methotrexate in 0.8 mL was injected by fine needle in or around the ectopic gestation.Main outcomePatients were followed up as outpatients by serial blood tests until resolution of the ectopic pregnancy was demonstrated by a return of the level of β‐human chorionic gonadotrophin to the normal range.ResultsThere was one failure of treatment. The ectopic pregnancy resolved in the remaining 17 patients. There were no side effects attributable to methotrexate and tubal patency was demonstrated in the eight patients tested by hysterosalpingography.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121179.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveThe aim of this study was to investigate the effect of nicotine, in the form of Nicorette tablets, on aphthous ulcers in non‐smoking patients. The study was prompted by the observations that smokers are less likely to suffer from mouth ulcers, that some smokers on quitting develop them, and that patients on nicotine replacement therapy are less likely to develop ulcers than those having other types of smoking cessation therapy.Clinical featuresThe three non‐smoking patients who were selected for the study each had a long history of recurrent aphthous ulcers with no remissions.Intervention and outcomeEach patient was given up to four 2 mg Nicorette chewing tablets per day. After one month of this regimen each patient was weaned off the tablets. In each case the ulcers healed and new ulcers did not appear during Nicorette therapy. Two of the patients relapsed when weaned off the tablets.ConclusionsThis preliminary trial shows that nicotine may have a beneficial effect on aphthous ulcers. Further studies are necessary to elucidate the mechanism.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121180.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

A 1986 study found that coronary risk factors were receiving insufficient attention in patients who had recently undergone cerenary artery bypass grafting. This issue was readdressed in a like group of 100 patients from the same surgical unit three and a half years later, in 1990, to ascertain whether risk factor management had improved over the period. An increased proportion of patients in 1990 were undergoing active management of hypertension and hyperlipidaemia. Only 25% of patients in 1990 manifested hyper‐cholesterolaemia (cholesterol levels 2 ≥ 6.5 mmol/L) compared with 60% in 1986. Five per cent of patients in 1990 manifested diastolic hyp, rtension (diastolic pressure ≥ 95 mmHg) compared with 23% In 1986. Such patients appear better managed In 1990 than they were in 1986.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121181.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121182.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveTo estimate the effects of prolonged antiplatelet therapy on the primary and secondary incidence of vascular disease.Data sourcesTwenty‐five randomised trials in 29 000 patients with a history of vascular disease (the Antiplatelet Trialists' Collaboration) and two randomised trials in 27 000 individuals without a history of vascular disease (the British doctors' and American physicians' studies).Study selectionThe Antiplatelet Trialists' Collaboration obtained data from all randomised trials of secondary prevention completed before January 1988. The British doctors' and American physicians' studies are the only two completed randomised trials of primary prevention.Data extractionData from the secondary prevention trials were provided by the Antiplatelet Trlalists' Collaboration. Data from the primary prevention trials were extracted from the final published reports of these studies.Data synthesisIn the secondary prevention trials, antiplatelet therapy reduced the rate of vascular disease by about 15% and the incidence of non‐fatal myocardial infarction and stroke by about 30%. In the American physicians' study, but not the British doctors' study, the incidence of non‐fatal myocardial infarction was also reduced. In neither primary prevention trial was there evidence of reduced rates of non‐fatal stroke or vascular death; overall, fatal or disabling strokes were slightly more frequent among those assigned aspirin.ConclusionsFor patients with a history of vascular disease, the benefits of antiplatelet therapy appear to outweigh any risks. Among 100 such patients, antiplatelet therapy for two years would prevent one death and two major non‐fatal events. The balance of benefits and risks for individuals without a history of vascular disease is less clear because there is no firm evidence of a net reduction in either vascular death or disabling non‐fatal vascular events among those treated with aspirin.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121183.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121184.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveTo identify some factors contributing to the development of pyomyositis in patients with the acquired immunodeficiency syndrome (AIDS) by a report of two cases and a review of the literature.Clinical featuresA 36‐year‐old man with AIDS presented with tenderness of the left adductor longus muscle; a 28‐year‐old man with AIDS presented with fever and left leg pain. Both men had a history of severe neutropenia induced by drug treatment and opportunistic infections requiring treatment in hospital. The pyomyositis was defined by a gallium‐67 scan (and, in one case, by a computed tomography scan). In one case Staphylococcus aureus was cultured from blood; in the other it was cultured from pus from the pyomyositic abscess.InterventionsBoth patients had their abscesses drained. The first patient was treated with flucloxacillin (2 g every four hours, given intravenously) and rifampicin (450 mg by mouth each day). The second patient was treated with flucloxacillin (2 g every four hours, given intravenously) and ticarcillin (3 g every six hours, given intravenously).OutcomeAfter their symptoms abated, both patients were discharged from hospital, taking flucloxacillin by mouth as ongoing treatment.ConclusionsStaphylococcal infections are increasingly common in neutropenic patients. Neutropenia is likely to have contributed to the development of pyomyositis in these patients.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121185.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveRecently, Gardner and colleagues inferred, from a case‐control study of leukaemia incidence in young people near the Sellafield nuclear facility in West Cumbria, that an increase near Sellafield was real, and was probably caused by occupational exposure of the father to ionising radiation at the Sellafield plant. The intent of this paper is to dispute that attribution, and to suggest that confirmation of such an alarming and prejudicial conclusion should precede its dissemination.Material consideredCritical comment is limited to the paper by the Gardner group presenting their results, the accompanying paper outlining their methods, a review from Mathews that provides some support for the Gardner proposal by suggesting a pathogenetic mechanism, and some observations on inherited tumours by Nomura that are quoted by Gardner et al. and Mathews in support of their beliefs. Other material quoted Is from the general medical literature of the past 20 years relating to radiation biology, mutagenesis and carcinogenesis with some relevance to the Gardner contention; it is not exhaustive.Main resultsStatistical arguments suggest that it is almost impossible to be sure that a specific leukaemia “cluster”, such as that near Sellafield, is not a chance finding. The study by Gardner et al. provides only weak statistical evidence for an association between leukaemia in children and parental occupational radiation exposure at Sellafield. The postulate of a causal relation between parental exposure at Sellafield and leukaemia in progeny is incompatible with what is known of the role of genetic mechanisms in leukaemia, with current views on the quantitative relation between radiation dose and mutagenetic effect, and with observations on the children of people exposed to radiation by the nuclear bombs used in Japan in 1945.ConclusionsThe suggestion that occupational exposure to ionising radiation of a father may be responsible for an increased risk of leukaemia in his children cannot be substantiated. It would be proper to seek confirmation from other groups of occupationally exposed persons before undertaking precipitous, and ineVitably disturbing, action to remedy the supposed problem.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121186.x

出版商:Wiley    

年代:1991

数据来源: WILEY