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Interventional Study (interventional + study)
Selected AbstractsA Prospective Comparison of Ultrasound-guided and Blindly Placed Radial Arterial CathetersACADEMIC EMERGENCY MEDICINE, Issue 12 2006Stephen Shiver MD Abstract Background Arterial cannulation for continuous blood-pressure measurement and frequent arterial-blood sampling commonly are required in critically ill patients. Objectives To compare ultrasound (US)-guided versus traditional palpation placement of arterial lines for time to placement, number of attempts, sites used, and complications. Methods This was a prospective, randomized interventional study at a Level 1 academic urban emergency department with an annual census of 78,000 patients. Patients were randomized to either palpation or US-guided groups. Inclusion criteria were any adult patient who required an arterial line according to the treating attending. Patients who had previous attempts at an arterial line during the visit, or who could not be randomized because of time constraints, were excluded. Enrollment was on a convenience basis, during hours worked by researchers over a six-month period. Patients in either group who had three failed attempts were rescued with the other technique for patient comfort. Statistical analysis included Fisher's exact, Mann-Whitney, and Student's t-tests. Results Sixty patients were enrolled, with 30 patients randomized to each group. Patients randomized to the US group had a shorter time required for arterial line placement (107 vs. 314 seconds; difference, 207 seconds; p = 0.0004), fewer placement attempts (1.2 vs. 2.2; difference, 1; p = 0.001), and fewer sites required for successful line placement (1.1 vs. 1.6; difference, 0.5; p = 0.001), as compared with the palpation group. Conclusions In this study, US guidance for arterial cannulation was successful more frequently and it took less time to establish the arterial line as compared with the palpation method. [source] Estrogen and progesterone receptors in esophageal carcinomaDISEASES OF THE ESOPHAGUS, Issue 4 2008R. Kalayarasan SUMMARY., Information is sparse and contradictory in the literature regarding the role of estrogen receptor (ER) and progesterone receptor (PR) in esophageal carcinoma. This study was conducted over a period of 18 months from September 2004 with the primary aim of determining the PR, ER alpha (ER,) and ER beta (ER,) status of esophageal carcinoma and normal esophageal mucosa (NEM). The receptor status was correlated with tumor type, tumor differentiation and tumor stage. A total of 45 patients with histologically proven squamous cell carcinoma (SCC) (n = 30) and adenocarcinoma (AC) (n = 15) were studied. Receptor status was detected by immunohistochemistry (IHC) and semiquantitative assessment was done by quick score method of endoscopic biopsy specimens. The mean age for SCC and AC were not significantly different. The gender ratio in favor of males was 3 : 2 for SCC and 4 : 1 for AC. None of the specimens from SCC or AC showed positivity for PR both in NEM and tumor tissue. Likewise none of the specimens were positive for ER, by IHC. The mean ER, score for AC was significantly higher than SCC. For SCC it was seen that ER, positivity in tumor cells increases with dedifferentiation and increasing tumor stage. This trend was seen for AC as well. ER, is over-expressed in poorly differentiated SCC and AC compared to NEM. Thus ER, may be a marker for poor biological behavior, that is dedifferentiation or higher stage of disease. In view of these findings we propose a large-scale prospective, longitudinal interventional study using selective estrogen modulators. [source] Surface Cooling for Rapid Induction of Mild Hypothermia After Cardiac Arrest: Design Determines EfficacyACADEMIC EMERGENCY MEDICINE, Issue 4 2010Thomas Uray MD Abstract Objectives:, Recently, a novel cooling pad was developed for rapid induction of mild hypothermia after cardiac arrest. The aim of this study was to evaluate the cooling efficacy of three different pad designs for in-hospital cooling. Methods:, Included in this prospective interventional study were patients with esophageal temperature (Tes) > 34°C on admission. The cooling pad consists of multiple cooling units, filled with a combination of graphite and water, which is precooled to ,18°C (design A) or to ,9°C (designs B and C) before use. The designs of the cooling pad differed in number, shape, and thickness of the cooling units, with weights of 9.7 kg (design A), 5.3 kg (design B), and 6.2 kg (design C). All three designs were tested in sequential order and were changed according to the results found in the previous trial. Cooling was started after admission until Tes = 34°C, when the cooling pad was removed. The target temperature of Tes = 32,34°C was maintained for 24 hours. Data are presented as medians and interquartile ranges (IQRs = 25%,75%) or proportions. Results:, Cooling rates were 3.4°C/hour (IQR = 2.5,3.7) with design A (n = 12), 2.8°C/hour (IQR = 1.6,3.3) with design B (n = 7), and 2.9°C/hour (IQR = 1.9,3.6) with design C (n = 10; p = 0.5). To reach 34°C, the cooling pad had to be exchanged with a new one due to melting and therefore depleting cooling capacity in three patients with design A, in five patients with design B, and in no patient with design C (p = 0.004). Conclusions:, With adequate design and storage temperature, the cooling pad proved to be efficient for rapid in-hospital cooling of patients resuscitated from cardiac arrest. ACADEMIC EMERGENCY MEDICINE 2010; 17:360,367 © 2010 by the Society for Academic Emergency Medicine [source] The Effect of Angiotensin-Converting Enzyme Inhibitors of Left Atrial Pressure in Dogs with Mitral Valve RegurgitationJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 2 2010T. Ishikawa Background: Despite many epidemiological reports concerning the efficacy of angiotensin-converting enzyme (ACE) inhibitors in dogs with mitral regurgitation (MR), the hemodynamic effects of ACE inhibitor administration have not been fully evaluated. Objectives: To document left atrial pressure (LAP) in dogs with MR administered ACE inhibitors, in order to obtain interesting information about daily LAP changes with administration of ACE inhibitors. Animals: Five healthy Beagle dogs weighing 9.8 to 14.2 kg (2 males and 3 females; aged 2 years). Methods: Experimental, crossover, and interventional study. Chordae tendineae rupture was induced, and a radiotelemetry transmitter catheter was inserted into the left atrium. LAP was recorded for 72 consecutive hours during which each of 3 ACE inhibitors,enalapril (0.5 mg/kg/d), temocapril (0.1 mg/kg/d), and alacepril (3.0 mg/kg/d),were administered in a crossover study. Results: Averaged diurnal LAP was significantly, but slightly reduced by alacepril (P= .03, 19.03 ± 3.01,18.24 ± 3.07 mmHg). The nightly drops in LAP caused by alacepril and enalapril were significantly higher than the daily drops (P= .03, ,0.98 ± 0.19 to ,0.07 ± 0.25 mmHg, and P= .03, ,0.54 ± 0.21,0.02 ± 0.17 mmHg, respectively), despite the fact that the oral administrations were given in the morning. Systolic blood pressure (122.7 ± 14.4,117.4 ± 13.1 mmHg, P= .04) and systemic vascular resistance (5800 ± 2685,5144 ± 2077 dyne × s/cm5, P= .03) were decreased by ACE inhibitors. Conclusions and Clinical Importance: ACE inhibitors decrease LAP minimally, despite reductions in left ventricular afterload. ACE inhibitors should not be used to decrease LAP. [source] Influence of Isoflurane General Anesthesia or Anesthesia and Surgery on Thyroid Function Tests in DogsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2009M.A. Wood Background: Anesthesia and surgery affect thyroid function tests in humans but have not been studied in dogs. Hypothesis: Anesthesia and anesthesia with surgery will affect thyroid function tests in dogs. Animals: Fifteen euthyroid dogs. Methods: Prospective, controlled, interventional study. Dogs were assigned to one of 3 groups: control, general anesthesia, and general anesthesia plus abdominal exploratory surgery. Dogs in the anesthesia and surgery groups were premedicated with acepromazine and morphine, induced with propofol, and maintained on isoflurane. Samples for measurement of serum thyroxine (T4), free T4 (fT4) by equilibrium dialysis, triiodothyronine (T3), reverse T3 (rT3), and thyroid-stimulating hormone concentrations were collected from each dog immediately before premedication, at multiple times during anesthesia, surgery, 4, 8, 12, 24, 36, and 48 hours after anesthesia, once daily for an additional 5 days, and once 14 days after anesthesia. Sampling was performed at identical times in the control group. Results: Serum T4 decreased significantly from baseline in the surgery and anesthesia groups compared with the control group at 0.33 (P= 0.043) and 1 hour (P= 0.018), and 2 (P= 0.031) and 4 hours (P= 0.037), respectively, then increased significantly in the surgery group compared with the control group at 24 hours (P= 0.005). Serum T3 decreased significantly from baseline in the anesthesia group compared with the control group at 1 hour (P= 0.034). Serum rT3 increased significantly from baseline in the surgery group compared with the control and anesthesia groups at 8 (P= 0.026) and 24 hours (P= 0.0001) and anesthesia group at 8, 12, 24, and 36 hours (P= 0.004, P= 0.016, P= 0.004, and P= 0.014, respectively). Serum fT4 increased significantly from baseline in the surgery group compared to the control at 24 hours (P= 0.006) and at day 7 (P= 0.037) and anesthesia group at 48 hours (P= 0.023). Conclusions and Clinical Importance: Surgery and anesthesia have a significant effect on thyroid function tests in dogs. [source] Impact of Adenotonsillectomy on Behavior in Children With Sleep-Disordered Breathing,THE LARYNGOSCOPE, Issue 7 2006Hsueh-Yu Li MD Abstract Objectives/Hypothesis: Children with sleep-disordered breathing may experience behavioral and learning problems such as inattentiveness and hyperactivity. The aim of this study was to measure the impact of adenotonsillectomy on sleep-related adverse events and behavioral problems in children with sleep-disordered breathing. Method: This prospective and interventional study enrolled 40 sleep-disordered breathing children (mean age, 8.4 ± 1.6 years) with hypertrophic tonsils and adenoids. All patients completed two polysomnographies, tests of variables of attention (TOVAs), and Child Behavior Checklists, one at baseline and the other 6 months after adenotonsillectomy. Results: The apnea,hypopnea index (P < .001), TOVA scores (P < .001), and 8 of 9 individual domains of the Child Behavior Checklist scores (P < .05) significantly improved after surgery. However, the change in the apnea,hypopnea index was not negatively correlated with TOVA score (r = ,0.17, P = .38). Conclusion: Adenotonsillectomy could significantly improve behavior (TOVA) scores, but the improvement may not simply be attributable to changes in sleep apnea events. [source] P1.34: Effectiveness of acupuncture treatment for chronic low back pain , a randomised interventional studyBIOMETRICAL JOURNAL, Issue S1 2004Claudia Becker-Witt No abstract is available for this article. [source] Efficacy of systemic ganciclovir as a therapeutic strategy for cytomegalovirus-associated anterior uveitis in immunocompetent patientsACTA OPHTHALMOLOGICA, Issue 2009M ANGI Purpose Cytomegalovirus (CMV)-associated anterior uveitis is a newly recognized entity that accounts for half of patients with Posner-Schlossman syndrome. To date, the therapeutic management of these patients remains controversial. The aim of this study was to assess the efficacy of systemic Ganciclovir as a treatment for PCR-proven CMV-associated hypertensive anterior uveitis. Methods Retrospective interventional study of 27 consecutive patients treated in a single centre between 2002 and 2008. Main outcome measures included intraocular pressure (IOP) and anterior chamber inflammation. Results All patients responded to systemic Ganciclovir, with mean IOP dropping from 32 to 14 mmHg (p<0,05). Relapses occurred in 50% of cases within one year from the first antiviral course. Repeated treatment allowed control of the disease in 75% of cases (follow-up range: 12-78 months). Conclusion Ganciclovir is effective but remains a suspensive therapeutic strategy. [source] | ||||||||||