The British journal of clinical practice最新文献

In this study we investigated the possible relationship of laryngeal cancer and subclinical lead intoxication, using the depression of aminolevulinic acid dehydratase (ALAD) activity in blood as indicator. Twenty-six patients with laryngeal cancer and 53 normal controls met the criteria to enter the study. Blood ALAD activity values in the patients with laryngeal cancer ranged from 27.1 to 75.3 U/l with a mean of 50.79 U/l. The respective values in the control group ranged from 36.2 to 98 U/l with a mean of 59.76 U/l. There was a statistically significant difference between the two means (0.001 < p < 0.01), whereas blood lead concentrations in all patients were within normal limits. These findings support the hypothesis that low level lead intoxication (subclinical blood lead levels), from cars, industries and products, may contribute to the risk of laryngeal cancer. Further investigation is needed to clarify the exact relationship between lead and cancer of the larynx.

To assess the feasibility of performing an ophthalmic assessment on elderly inpatients, we examined 48 patients over 75 years of age who were consecutively admitted to an acute elderly-care ward. Difficulties were encountered in 35 patients (73%). By employing simple methods to overcome these problems, useful information was obtained in all cases and the time taken to complete the examination ranged from six to 20 minutes (mean 7.5 minutes). Doctors looking after elderly patients should be encouraged to assess visual function and must not be deterred by anticipated logistical difficulties.

The study was designed to test for equivalence of asthma control between a new aerosol formulation of beclomethasone dipropionate (BDP) incorporating a chlorofluorocarbon-(CFC) free, hydrofluoroalkane propellant (HFA-134a) and the conventional beclomethasone aerosol formulated in CFC propellants. Sixty-eight asthmatic patients entered an eight-week, randomised, double-blind crossover study. All patients, previously stabilised on BDP, were randomised to receive the same dose of BDP from each of the study treatments. Statistically significant equivalence was demonstrated between HFA-BDP and CFC-BDP for asthma control parameters: FEV1, morning and evening PEF, sleep disturbance, wheeze and cough, morning breathlessness and bronchodilator use. Such equivalence was also demonstrated for safety parameters. To conclude, it has been demonstrated that HFA-BDP achieves a level of asthma control that is clinically and statistically equivalent to CFC-BDP in terms of efficacy and safety, at total daily doses ranging from 200 micrograms to 600 micrograms in asthma patients previously stabilised on inhaled CFC-BDP.

The comparative efficacy, tolerability and acceptability of calcipotriol ointment (50 micrograms/g) and 5% coal tar/2% allantoin/0.5% hydrocortisone cream were determined in 122 patients with chronic plaque psoriasis affecting at least 100 cm2 of skin. Both preparations were applied twice daily for up to 8 weeks. At the end of treatment, investigators considered calcipotriol significantly more effective in the proportion of patients 'cleared' or 'markedly improved' (calcipotriol 72.3%, coal tar/allantoin/hydrocortisone 49.1%: p < 0.02). Calcipotriol was also superior in reducing the total sign score (p = 0.002), and individual scores for scaliness (p < 0.0001) and thickness (p = 0.001). The proportion of patients with less than 100 cm2 of affected skin at the end of treatment was significantly greater in the calcipotriol group (p < 0.05). Patients considered calcipotriol significantly more effective overall (p < 0.02) and in reducing flakiness/scaliness of skin (p = 0.001). Adverse events, most of which were application related and mild to moderate, were recorded in 15 (23.1%) patients using calcipotriol and in 10 (17.5%) patients using coal tar/allantoin/hydrocortisone (n.s.), and contributed to treatment withdrawal in one (1.5%) and three (5.3%) patients, respectively.

A rare case of simultaneous bilateral tubal pregnancy after natural conception is presented, together with a review of the literature on this topic. Diagnostic aspects and treatment options are discussed.

Long-term venous access lines are commonplace in the management of patients requiring continuous intravenous chemotherapy, intravenous nutrition or simply as a means of avoiding repeated peripheral access lines in patients with difficult venous access. The insertion and maintenance of these lines is not without major complication. Four years' experience with the Hickman catheter in a general surgical oncology setting are reviewed. Thirty-seven lines were inserted in 37 patients with a mean longevity of 107 days (range 2-322) and an overall complication rate of 1.25 per 1000 catheter days. Four catheters were removed prematurely due to late complications. These figures compare favourably with results for long-term venous access from larger specialist units.

Bullous pemphigoid is a rare complication of frusemide therapy. We present two patients in whom the link between frusemide and this condition was not recognised early, and continued frusemide therapy resulted in prolonged leg blistering and ulceration. On withdrawing the drug, all lesions in both patients resolved completely. Although uncommon, this frusemide reaction needs to be borne in mind as it can add to the morbidity of elderly patients with heart failure.

There is increasing awareness that the long-term use of the non-steroidal anti-inflammatory agent tiaprofenic acid (Surgam) is associated with a severe form of cystitis. The condition is usually reversible with complete resolution of symptoms on stopping the drug. We present a case of tiaprofenic acid-induced cystitis resulting in bilateral hydronephrosis suggesting ureteric obstruction. The previous reported cases are reviewed and the risks of delay in withdrawal of the drug and of permanent ureteric damage are discussed.