Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial A Furlan, R Higashida, L Wechsler, et al JAMA 1999;282:2003–11 Randomised, controlled, multicentre, open label trial with blinded follow up determining the clinical eYcacy of intra-arterial prourokinase in patients with acute stroke caused by occlusion of the middle cerebral artery. Only those patients for whom treatment could be initiated within six hours of the onset of symptoms were included. A total of 180 patients were recruited, all of whom passed computed tomography (CT) and cerebral angiography criteria, and were randomised to receive either intra-arterial prourokinase and intravenous heparin or intravenous heparin alone. A second angiogram was performed at two hours and CT scans were performed at baseline, 24 hours and 7 to 10 days after initial treatment. The primary outcome, defined by a modified Rankin score (a score of disability), was the proportion of patients with slight or no neurological disability at 90 days. Secondary outcomes included MCA recanalisation, frequency of intracranial haemorrhage and mortality. Results showed better neurological outcome in the treatment group with 40% of prourokinase patients and 25% of controls having a modified Rankin score of 2 or less at 90 days. Intracranial haemorrhage with neurological deterioration occurred in 10% of prourokinase patients and 2% of controls, but overall mortality was essentially equal, with 25% and 27% in the respective groups. Critique—There is a great deal of interest in the role of thrombolysis in acute ischaemic stoke. The evidence so far seems to indicate that neurological outcome can be improved if the treatment is given early but with a real increased risk of intracranial haemorrhage. Intravenous thrombolysis seems to have benefit only if given within three hours of onset of symptoms. The PROACT II trial achieved its goal of demonstrating the possibility of extending the therapeutic window to six hours by the use of intra-arterial injection. This study screened over 12 000 stroke patients to leave a study population of 180. A total of 4000 were excluded as longer than six hours had elapsed since onset of symptoms. The great exclusion rate does question the utlility of this treatment even in the USA where there is much easier access to cerebral angiography expertise. It would not be practical in the UK. The benefits, even in this trial remain marginal against a background of much increased risk of significant intra-cranial bleeding. This is an area where research will continue but there is not enough present evidence to recommend widespread use of thrombolysis in stroke.
急性缺血性脑卒中动脉内灌注尿激酶。a Furlan, R Higashida, L Wechsler, et al JAMA 1999; 282:2003-11随机、对照、多中心、开放标签的盲法随访试验，确定动脉内灌注proprokinase在大脑中动脉闭塞引起的急性卒中患者中的临床疗效。只包括那些在症状出现后6小时内可以开始治疗的患者。总共招募了180名患者，所有患者都通过了计算机断层扫描(CT)和脑血管造影标准，并被随机分配接受动脉内尿激酶和静脉注射肝素或单独静脉注射肝素。在初始治疗后2小时进行第二次血管造影，并在基线、24小时和7至10天进行CT扫描。主要结局，由改良的Rankin评分(残疾评分)定义，是90天轻度或无神经功能障碍的患者比例。次要结局包括MCA再通、颅内出血频率和死亡率。结果显示，治疗组的神经系统预后较好，40%的尿激酶患者和25%的对照组在90天的改良Rankin评分为2或更低。10%的尿激酶患者和2%的对照组发生颅内出血并神经功能恶化，但总体死亡率基本相等，分别为25%和27%。在急性缺血性中风中溶栓的作用引起了很大的兴趣。迄今为止的证据似乎表明，如果早期进行治疗，但颅内出血的风险确实会增加，那么神经系统的预后可能会得到改善。静脉溶栓似乎只有在症状出现后3小时内才有疗效。PROACT II试验实现了通过动脉内注射将治疗窗口延长至6小时的可能性。这项研究筛选了超过12000名中风患者，研究人群为180人。由于症状出现时间超过6小时，总共有4000人被排除在外。巨大的排除率确实质疑这种治疗的实用性，即使在美国，那里更容易获得脑血管造影专业知识。这在英国是不现实的。即使在本试验中，在显著颅内出血风险大大增加的背景下，获益仍然微乎其微。这是一个将继续研究的领域，但目前没有足够的证据推荐在卒中中广泛使用溶栓。
{"title":"Journal scan","authors":"J. Wardrope, S. Rothwell","doi":"10.1136/emj.17.4.289","DOIUrl":"https://doi.org/10.1136/emj.17.4.289","url":null,"abstract":"Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial A Furlan, R Higashida, L Wechsler, et al JAMA 1999;282:2003–11 Randomised, controlled, multicentre, open label trial with blinded follow up determining the clinical eYcacy of intra-arterial prourokinase in patients with acute stroke caused by occlusion of the middle cerebral artery. Only those patients for whom treatment could be initiated within six hours of the onset of symptoms were included. A total of 180 patients were recruited, all of whom passed computed tomography (CT) and cerebral angiography criteria, and were randomised to receive either intra-arterial prourokinase and intravenous heparin or intravenous heparin alone. A second angiogram was performed at two hours and CT scans were performed at baseline, 24 hours and 7 to 10 days after initial treatment. The primary outcome, defined by a modified Rankin score (a score of disability), was the proportion of patients with slight or no neurological disability at 90 days. Secondary outcomes included MCA recanalisation, frequency of intracranial haemorrhage and mortality. Results showed better neurological outcome in the treatment group with 40% of prourokinase patients and 25% of controls having a modified Rankin score of 2 or less at 90 days. Intracranial haemorrhage with neurological deterioration occurred in 10% of prourokinase patients and 2% of controls, but overall mortality was essentially equal, with 25% and 27% in the respective groups. Critique—There is a great deal of interest in the role of thrombolysis in acute ischaemic stoke. The evidence so far seems to indicate that neurological outcome can be improved if the treatment is given early but with a real increased risk of intracranial haemorrhage. Intravenous thrombolysis seems to have benefit only if given within three hours of onset of symptoms. The PROACT II trial achieved its goal of demonstrating the possibility of extending the therapeutic window to six hours by the use of intra-arterial injection. This study screened over 12 000 stroke patients to leave a study population of 180. A total of 4000 were excluded as longer than six hours had elapsed since onset of symptoms. The great exclusion rate does question the utlility of this treatment even in the USA where there is much easier access to cerebral angiography expertise. It would not be practical in the UK. The benefits, even in this trial remain marginal against a background of much increased risk of significant intra-cranial bleeding. This is an area where research will continue but there is not enough present evidence to recommend widespread use of thrombolysis in stroke.","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 1","pages":"289 - 292"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.4.289","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64230397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Topical anaesthesia use in the management of children's lacerations, a postal survey.","authors":"S Bush","doi":"10.1136/emj.17.4.310-a","DOIUrl":"https://doi.org/10.1136/emj.17.4.310-a","url":null,"abstract":"","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 4","pages":"310-1"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.4.310-a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21761677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A diagnosis of tension pneumothorax is usually only considered within the context of trauma, incorrect chest drain insertion or positive pressure ventilation. Four patients are presented who developed spontaneous tension pneumothorax with no precipitating factors. In three of these instances, the diagnosis was only made radiologically and in every case the treating physician was unaware that a spontaneous tension pneumothorax could occur. Previously, emphasis has been placed on tracheal deviation in a tension pneumothorax. However, this is an inconsistent finding as one of the cases highlights. Patients may appear surprisingly clinically well until they decompensate. These cases are highlighted to raise awareness of this potentially life threatening condition.
{"title":"Spontaneous pneumothorax: is it under tension?","authors":"V J Holloway, J K Harris","doi":"10.1136/emj.17.3.222","DOIUrl":"https://doi.org/10.1136/emj.17.3.222","url":null,"abstract":"<p><p>A diagnosis of tension pneumothorax is usually only considered within the context of trauma, incorrect chest drain insertion or positive pressure ventilation. Four patients are presented who developed spontaneous tension pneumothorax with no precipitating factors. In three of these instances, the diagnosis was only made radiologically and in every case the treating physician was unaware that a spontaneous tension pneumothorax could occur. Previously, emphasis has been placed on tracheal deviation in a tension pneumothorax. However, this is an inconsistent finding as one of the cases highlights. Patients may appear surprisingly clinically well until they decompensate. These cases are highlighted to raise awareness of this potentially life threatening condition.</p>","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 3","pages":"222-3"},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.222","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ultrasound is widely used in the US and continental Europe in the immediate assessment of patients after blunt abdominal trauma. There are also now other recognised "primary" indications for ultrasound in emergency medicine. In this paper current evidence supporting the implementation and use of emergency ultrasound in these primary conditions and possible other indications are assessed. The issues surrounding introduction of the technology into the practice of emergency medicine in this country are considered. It is accepted that further debate is necessary but the establishment of a robust evidence base in the UK will help to clarify the place of ultrasound.
{"title":"Echoes of things to come. Ultrasound in UK emergency medicine practice.","authors":"J Brenchley, J P Sloan, P K Thompson","doi":"10.1136/emj.17.3.170","DOIUrl":"https://doi.org/10.1136/emj.17.3.170","url":null,"abstract":"<p><p>Ultrasound is widely used in the US and continental Europe in the immediate assessment of patients after blunt abdominal trauma. There are also now other recognised \"primary\" indications for ultrasound in emergency medicine. In this paper current evidence supporting the implementation and use of emergency ultrasound in these primary conditions and possible other indications are assessed. The issues surrounding introduction of the technology into the practice of emergency medicine in this country are considered. It is accepted that further debate is necessary but the establishment of a robust evidence base in the UK will help to clarify the place of ultrasound.</p>","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 3","pages":"170-5"},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aorto caval fistula is one of the less well recognised complications of abdominal aortic aneurysm seen in accident and emergency departments. It presents in a number of different ways the commonest of which is high output congestive cardiac failure with warm peripheries. Initial diagnosis is based on the index of suspicion of the clinician. However, early diagnosis by the emergency physician and early surgery can markedly improve the patients prognosis.
{"title":"Aorto caval fistula--the \"bursting heart syndrome\".","authors":"S Leigh-Smith, R C Smith","doi":"10.1136/emj.17.3.223","DOIUrl":"https://doi.org/10.1136/emj.17.3.223","url":null,"abstract":"<p><p>Aorto caval fistula is one of the less well recognised complications of abdominal aortic aneurysm seen in accident and emergency departments. It presents in a number of different ways the commonest of which is high output congestive cardiac failure with warm peripheries. Initial diagnosis is based on the index of suspicion of the clinician. However, early diagnosis by the emergency physician and early surgery can markedly improve the patients prognosis.</p>","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 3","pages":"223-5"},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.223","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To evaluate and refine an assault patient questionnaire to facilitate the contribution of accident and emergency (A&E) departments to Crime and Disorder Act local crime audits.
Method: A brief nine item questionnaire was devised in collaboration with the authors of the Home Office British Crime Survey. A prospective sample of 46 consecutive assault patients who attended Cardiff Royal Infirmary A&E department were interviewed by either reception staff or triage nurses. The questionnaire was revised appropriately.
Results: The collection of information in A&E departments about the circumstances of violence was straightforward. Questions about motive for violence and about relationships between the injured and their assailants were problematic.
Conclusion: The collection of information relevant to Crime and Disorder Act crime audits was possible without extra resource. Receptionists were found to be the most appropriate staff to record information.
目的:评估和完善一份攻击患者问卷，以方便事故和急诊(A&E)部门对《犯罪与混乱法》(Crime and Disorder Act)地方犯罪审计的贡献。方法:与英国内政部犯罪调查的作者合作设计了一份简短的九项问卷。对参加卡迪夫皇家医院急诊科的46名连续性侵犯患者进行前瞻性样本，由接待人员或分诊护士进行访谈。问卷作了适当的修订。结果:急诊科对暴力情况的信息收集较为直观。暴力的动机以及伤者和攻击者之间的关系都是有问题的。结论:在没有额外资源的情况下，可以收集与《犯罪与混乱法》犯罪审计有关的信息。接待员被认为是最适合记录信息的员工。
{"title":"The development of an assault patient questionnaire to allow accident and emergency departments to contribute to Crime and Disorder Act local crime audits.","authors":"V Goodwin, J P Shepherd","doi":"10.1136/emj.17.3.196","DOIUrl":"https://doi.org/10.1136/emj.17.3.196","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate and refine an assault patient questionnaire to facilitate the contribution of accident and emergency (A&E) departments to Crime and Disorder Act local crime audits.</p><p><strong>Method: </strong>A brief nine item questionnaire was devised in collaboration with the authors of the Home Office British Crime Survey. A prospective sample of 46 consecutive assault patients who attended Cardiff Royal Infirmary A&E department were interviewed by either reception staff or triage nurses. The questionnaire was revised appropriately.</p><p><strong>Results: </strong>The collection of information in A&E departments about the circumstances of violence was straightforward. Questions about motive for violence and about relationships between the injured and their assailants were problematic.</p><p><strong>Conclusion: </strong>The collection of information relevant to Crime and Disorder Act crime audits was possible without extra resource. Receptionists were found to be the most appropriate staff to record information.</p>","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 3","pages":"196-8"},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.196","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Report by Paul Wallman, Clinical Fellow Search checked by Kevin Mackway-Jones, Consultant A 40 year old man is involved in a road traffic accident. He has bony disruption at C7/T1 with acute spinal cord injury. He has no associated head injury and no other life threatening …
{"title":"Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Corticosteroids in acute spinal cord injury.","authors":"P Wallman, K Mackway-Jones","doi":"10.1136/emj.17.3.215","DOIUrl":"https://doi.org/10.1136/emj.17.3.215","url":null,"abstract":"Report by Paul Wallman, Clinical Fellow Search checked by Kevin Mackway-Jones, Consultant \u0000\u0000A 40 year old man is involved in a road traffic accident. He has bony disruption at C7/T1 with acute spinal cord injury. He has no associated head injury and no other life threatening …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 3","pages":"215"},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.215","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An unusual cause of pilonidal sinus.","authors":"J P Sloan, J Brenchley","doi":"10.1136/emj.17.3.232","DOIUrl":"https://doi.org/10.1136/emj.17.3.232","url":null,"abstract":"","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 3","pages":"232"},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.232","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Report by Katrina Richell-Herren, Research Fellow Search checked by Sue Maurice, Consultant A 50 year old man attends the emergency department with a 12 hour history of chest pain that may be cardiac in origin. His ECG is normal. You want to …
{"title":"Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Troponin T to rule out myocardial damage in chest pain.","authors":"K Richell-Herren, S Maurice","doi":"10.1136/emj.17.3.213","DOIUrl":"https://doi.org/10.1136/emj.17.3.213","url":null,"abstract":"Report by Katrina Richell-Herren, Research Fellow Search checked by Sue Maurice, Consultant \u0000\u0000A 50 year old man attends the emergency department with a 12 hour history of chest pain that may be cardiac in origin. His ECG is normal. You want to …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 3","pages":"213-4"},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.3.213","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21665065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：