The British journal of clinical practice最新文献

The efficacy and tolerability of nisoldipine coat-core (nisoldipine CC 10, 20, 40 mg) and atenolol (50, 100 mg) were compared in 230 patients with mild to moderate essential hypertension. Treatment was titrated at two-weekly intervals as necessary to control blood pressure. After eight weeks of active therapy, the two treatments proved to be equally effective in reducing sitting diastolic blood pressure (13.7 +/- 8.3 mmHg and 14.2 +/- 9.1 mmHg for nisoldipine CC and atenolol, respectively), and provided equivalent reduction in systolic blood pressure and identical response rates (69%). Heart rate was reduced from baseline in the atenolol group but remained unchanged in the nisoldipine CC group (p < 0.001 difference between the two groups). Both nisoldipine CC and atenolol were well tolerated and had no detectable metabolic effects. Adverse events were minor and of the type commonly associated with drugs of these classes.

Cough mixture is the third most commonly abused substance in Hong Kong. Over the last two years, ten cases of cough mixture-induced psychosis were admitted to a University hospital. All of them were clinically indistinguishable from paranoid schizophrenia, but the psychotic symptoms often resolved promptly with the cessation of cough mixture use or a small dose of haloperidol. A representative case is described. The possible underlying aetiological mechanism and the treatment principle are discussed.

A case of pseudoephedrine toxicity is reported in a man with chronic renal failure. The effects of renal impairment on the metabolism of pseudoephedrine are discussed and the implications of the widespread availability of the drug in proprietary cold remedies are highlighted.

Traumatic rupture of the diaphragm is an uncommon injury which can be missed unless there is a high index of suspicion. In the interval between rupture of the diaphragm and herniation of abdominal contents, signs and symptoms are nonspecific and the chest X-ray may be normal.

The recent availability of portable ion selective electrodes (ISE) for clinical applications has enabled lithium estimations to be performed instantly and at close proximity to patients. The significance of this is, not in the accuracy of the determination, but in the speed of the feedback provided to doctor and patient, and hence the promotion of compliance. The impact of this on lithium therapy can only be described as a clinical revolution in the making.

The aim of this pilot study was to evaluate the efficacy and safety of lansoprazole plus clarithromycin for eradication of Helicobacter pylori. A total of 26 patients with H. pylori infection were randomised to receive clarithromycin, 500 mg t.i.d. for 14 days, plus either lansoprazole, 30 mg o.m., (group L30, n = 13) or lansoprazole, 30 mg b.i.d., (group L60, n = 13). H. pylori status was determined pre-treatment and four to six weeks after completion of the study medication by histology and 13C-urea breath test. Two patients were unable to complete the course of medication. Of the remaining 24 patients, 14 (58%) successfully eradicated H. pylori--8/12 (67%) patients in group L30 and 6/12 (50%) in group L60. Side-effects were experienced by 17/26 (65%) of patients, most commonly a taste disturbance. The results from this pilot study suggest that dual therapy with lansoprazole plus clarithromycin is only a moderately effective regimen for eradicating H. pylori.

A total of 7438 patients suffering from a wide variety of painful conditions was included in the final analysis of a post-marketing surveillance (PMS) study monitoring the use of Voltarol 75 mg SR in a primary care setting. Follow-up data were collected at visits conducted one, four and 12 months after the initial consultation. Improvement of symptoms was the most common reason for discontinuation of treatment (47% of patients who discontinued). Adverse events led to the withdrawal of 18% of patients overall. The rate of serious gastrointestinal complications was low (0.4%) and deleterious hepatic or renal effects were not apparent. There were significantly more events experienced by female patients and there was a significant effect of age on severe gastrointestinal events. In this PMS study Voltarol 75 mg SR was used successfully once or twice daily without any unexpected adverse effects in a manner consistent with current recommendations for the use of non-steroidal anti-inflammatory drugs.

Reflex sympathetic dystrophy is one of the important complications effecting the rehabilitation programmes of hemiplegic patients in a negative manner by causing pain and function loss. In this study, the aim was to investigate the effects of salmon calcitonin treatment in reflex sympathetic dystrophy that develops in hemiplegia. Forty-one patients with hemiplegia resulting from cerebrovascular events and stage 1-2 reflex sympathetic dystrophy were included in the study. Salmon calcitonin, 1 x 100 IU/day intramuscularly for 4 weeks, was administered to 25 of these patients (calcitonin group) to the other 16 patients physiological saline, 1 ml/day intramuscularly for 4 weeks, was administered (control group). At the end of the fourth week of treatment the pain score of the calcitonin group was significantly lower than that of the control group. Shoulder abduction and external rotation, wrist flexion and metacarpophalangeal extension of the calcitonin group were found to be significantly better than those of the control group. In the calcitonin group the significant decrease in pain and tenderness resulted in improvement of range of motion and motor functions.

To evaluate possible differences in efficacy and safety between budesonide and beclomethasone dipropionate when used intranasally in the treatment of perennial non-allergic rhinitis, a 12-month open study was undertaken in 24 patients suffering from perennial non-allergic rhinitis. Both drugs were applied intranasally from pressurised aerosols at a daily dosage of 400 micrograms. On entry and at visits after 1, 2, 4, 6, 9 and 12 months, rhinoscopy was performed and the severity of nasal symptoms graded according to a four-point rating scale. All nasal symptoms were reduced from baseline during the treatment period in both groups. Tachyphylaxis was not observed. No clinically significant changes in haematology or blood chemistry parameters were observed in either group, and analysis of plasma cortisol levels revealed no influence of either drug on the hypothalamic-pituitary-adrenal axis. Local adverse reactions were uncommon and mild. Budesonide and beclomethasone dipropionate used intranasally at 400 micrograms per day were found to be safe, and budesonide was found to have a significantly higher (p < 0.05) efficacy than beclomethasone dipropionate in alleviating symptoms of perennial non-allergic rhinitis.