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OBJECTIVE To demonstrate word-finding distinctions between visual , auditory , and reading modalities during CSM and the percentage of modality-specific language sites within dominant hemisphere subregions . |
METHODS Twenty-eight patients with epilepsy underwent CSM by the use of visual , auditory , and sentence-completion tasks . |
METHODS Hierarchical logistic regression analyzed errors to identify language sites and provide modality-specific percentages within subregions . |
RESULTS The percentage of sites classified as language sites based on auditory naming was twice as high in anterior temporal regions compared with visual naming , marginally higher in posterior temporal areas , and comparable in parietal regions . |
RESULTS Sentence completion was comparable to visual and auditory naming in parietal regions and lower in most temporal areas . |
RESULTS Of 470 sites tested with both visual and auditory naming , 95 sites were distinctly auditory , whereas 48 sites were distinctly visual . |
RESULTS The remaining sites overlapped . |
CONCLUSIONS Distinct cortical areas were found for distinct input modalities , with language sites in anterior tip regions found most often by using auditory naming . |
CONCLUSIONS The vulnerability of anterior temporal tip regions to resection in this population and distinct sites for each modality suggest that a multimodality approach may be needed to spare crucial language sites , if sparing those sites can be shown to significantly reduce the rate of postoperative language deficits without sacrificing seizure control . |
###8532270 |
OBJECTIVE To determine if suppressive acyclovir therapy given to term gravidas experiencing a first episode of genital herpes simplex virus ( HSV ) - infection during pregnancy decreases the need for cesarean delivery for that indication . |
METHODS Forty-six pregnant women with first episodes of genital herpes during pregnancy were randomly assigned to receive oral acyclovir 400 mg or placebo , three times per day , from 36 weeks ' gestation until delivery as part of a prospective , double-blind trial . |
METHODS Herpes simplex virus cultures were obtained when patients presented for delivery . |
METHODS Vaginal delivery was permitted if no clinical recurrence was present ; otherwise , a cesarean was performed . |
METHODS Neonatal HSV cultures were obtained and infants were followed-up clinically . |
RESULTS None of the 21 patients treated with acyclovir and nine of 25 ( 36 % ) treated with placebo had clinical evidence of recurrent genital herpes at delivery ( odds ratio [ OR ] 0.04 , 95 % confidence interval [ CI ] 0.002-0 .745 ; P = .002 ) . |
RESULTS No woman treated with acyclovir had a cesarean for herpes , compared with nine of 25 ( 36 % ) of those treated with placebo ( OR 0.04 , CI 0.002-0 .745 ; P = .002 ) . |
RESULTS No patient in either treatment group experienced asymptomatic genital viral shedding at delivery . |
RESULTS No neonate had evidence of herpes infection or adverse effects from acyclovir . |
CONCLUSIONS Suppressive acyclovir therapy reduced the need for cesarean for recurrent herpes in women whose first clinical episode of genital HSV occurred during pregnancy . |
CONCLUSIONS Suppressive acyclovir treatment did not increase asymptomatic viral shedding and was not harmful to the term fetus . |
###1458072 |
OBJECTIVE To compare the tolerance , efficacy , and pharmacokinetics of amphotericin deoxycholate ( Fungizone ) prepared in a parenteral fat emulsion ( Intralipid 20 % ) or glucose in HIV patients with candidiasis . |
METHODS Non-blind randomised controlled trial . |
METHODS University hospital ; tertiary clinical care . |
METHODS 22 HIV positive patients with oral candidiasis . |
METHODS Amphotericin 1 mg/kg/day given on four consecutive days as a one hour infusion dissolved in either 5 % glucose ( amphotericin-glucose ) or parenteral fat emulsion at a final concentration of 2 g/l fat emulsion ( amphotericin-fat emulsion ) . |
METHODS Clinical tolerance ( fever , chills , sweats , nausea , arterial pressure , and pulse rate ) ; biological tolerance ( serum creatinine , electrolyte , and magnesium values ) ; clinical score of candidiasis ; and serum concentrations of amphotericin . |
RESULTS 11 patients were enrolled in each group . |
RESULTS All the amphotericin-fat emulsion infusions were given without serious problem whereas four amphotericin-glucose infusions were stopped because of renal impairment ( n = 3 ) or severe chills ( n = 2 ) , or both . |
RESULTS For patients completing the amphotericin-glucose treatment creatine concentration increased by 42 mumol/l ; four of seven patients had at least one creatinine value > or = 133 mumol/l versus one of 11 receiving amphotericin-fat emulsion . |
RESULTS Magnesium concentration fell significantly with amphotericin-glucose but not with amphotericin-fat emulsion . |
RESULTS Clinical side effects were noted in 36/38 infusions with amphotericin-glucose but 10/44 with amphotericin-fat emulsion . |
RESULTS Oral candidiasis score was reduced similarly in both groups . |
RESULTS Serum amphotericin concentrations were significantly lower and the volume of distribution of the drug higher after infusion of amphotericin-fat emulsion than after amphotericin-glucose . |
CONCLUSIONS Clinical and renal toxicity of amphotericin are reduced when the drug is prepared in fat emulsion . |
CONCLUSIONS Preparation is simple and cost effective . |
CONCLUSIONS Its efficacy is similar to that of conventional amphotericin . |
###24135831 |
OBJECTIVE Rate control of atrial fibrillation ( AF ) has become a main treatment modality , but we need more knowledge regarding the different drugs used for this purpose . |
OBJECTIVE In this study , we aimed to compare the effect of four common rate-reducing drugs on exercise capacity and levels of N-terminal pro-B-type natriuretic peptide ( NT-proBNP ) in patients with permanent AF . |
RESULTS We included 60 patients ( mean age 71 9 years , 18 women ) with permanent AF and normal left ventricular function in a randomized , cross-over , investigator-blind study . |
RESULTS Diltiazem 360 mg , verapamil 240 mg , metoprolol 100 mg , and carvedilol 25 mg were administered o.d. for 3 weeks . |
RESULTS At baseline and on the last day of each treatment period , the patients underwent a maximal cardiopulmonary exercise test and blood samples were obtained at rest and at peak exercise . |
RESULTS The exercise capacity ( peak VO2 ) was significantly lower during treatment with metoprolol and carvedilol compared with baseline ( no treatment ) or treatment with diltiazem and verapamil ( P < 0.001 for all ) . |
RESULTS Compared with baseline , treatment with diltiazem and verapamil significantly reduced the NT-proBNP levels both at rest and at peak exercise , whereas treatment with metoprolol and carvedilol increased the levels ( P < 0.05 for all ) . |
CONCLUSIONS Rate-reducing treatment with diltiazem or verapamil preserved exercise capacity and reduced levels of NT-proBNP compared with baseline , whereas treatment with metoprolol or carvedilol reduced the exercise capacity and increased levels of NT-proBNP . |
###11467142 |
BACKGROUND Post-exposure prophylaxis for rabies with cell culture vaccines by the conventional intramuscular regimen is very expensive . |
BACKGROUND The World Health Organization has advocated two cost-effective intradermal regimens with cell culture vaccines for use in developing countries . |
BACKGROUND We evaluated these two regimens -- the 2-site and the 8-site regimens -- in terms of immunogenicity , safety and tolerance in people with category I exposure to rabies . |
METHODS Eighty-two subjects who had mild category I exposure to rabies were immunized using a purified chick embryo cell vaccine . |
METHODS The first regimen given to 43 subjects , consisted of intradermal administration of 0.2 ml of vaccine at 2 sites on days 0 , 3 and 7 and at one site on days 28 and 90 . |
METHODS The second regimen , given to 39 subjects , consisted of intradermal administration of 0.1 ml of vaccine at 8 sites on day 0 , at 4 sites on day 7 and at one site on days 28 and 90 . |
METHODS The mouse neutralization test was used to estimate titres of rabies neutralizing antibody in these subjects on different days after vaccination . |
METHODS The subjects were followed up for 1 year . |
RESULTS Both regimens produced adequate neutralizing antibody titres from day 14 onwards , though the second regimen produced a more rapid antibody response and significantly higher titres ( p < 0.001 ) on all days tested . |
RESULTS There were minimal side-effects and both regimens were well tolerated . |
CONCLUSIONS Both the 2-site and 8-site intradermal regimens with purified chick embryo cell vaccine produce adequate levels of neutralizing antibodies but the 8-site regimen appears to be more immunogenic . |
CONCLUSIONS The feasibility of using these cost-effective regimens in routine practice needs to be further evaluated under the field conditions prevalent in India . |
###21766893 |
BACKGROUND Discrete-choice experiments are based on the premise that any good or service can be described by its characteristics ( or attributes ) , and the extent to which an individual values a good or service depends on the levels of these characteristics . |
BACKGROUND Little is known about patient preferences for treatment of chronic musculoskeletal pain such as Achilles tendinopathy . |
METHODS A discrete-choice experiment was conducted in 58 adults with a history of Achilles tendon pain at the conclusion of a three-arm randomized clinical trial . |
METHODS Participants were asked to complete a questionnaire consisting of ten hypothetical treatment scenarios and some sociodemographic questions . |
METHODS For each scenario , participants were asked to choose which option they would prefer if seeking treatment for their painful Achilles tendon . |
METHODS A mixed logit model was estimated to quantify subject preferences and marginal willingness to pay for the treatment attributes . |
RESULTS A response rate of 62 % was achieved . |
RESULTS A significant positive impact on utility was observed for chance of treatment success . |
RESULTS A significant negative impact on utility was observed for cost , weeks before exercise can be completed free of pain , chance of side effects ( p = 0.06 ) , and injections as a stand-alone treatment . |
RESULTS Respondents were willing to pay Australian dollars ( $ A ) 238 ( 95 % CI -312 , 788 ) for a 10 % increase in the chance of treatment success . |
CONCLUSIONS Study participants with Achilles tendon pain who had either participated or expressed an interest in participating in a randomized trial prefer a treatment that costs less , has a greater chance of success , has a shorter duration before being able to exercise free of pain , and has less likelihood of side effects . |
CONCLUSIONS On average , participants preferred exercises over injections as a stand-alone treatment . |
CONCLUSIONS Further research is required to confirm the findings in patients outside of the trial setting . |
CONCLUSIONS Nevertheless , this study contributes to an area that is deficient in research by identifying priorities and marginal willingness to pay for attributes related to Achilles tendinopathy . |
###24816809 |
OBJECTIVE Whether prasugrel plus bivalirudin is a superior strategy to unfractionated heparin plus clopidogrel in patients with ST-segment elevation myocardial infarction ( STEMI ) undergoing primary percutaneous coronary intervention ( PCI ) has never been assessed in specifically designed randomized trials . |
RESULTS The Bavarian Reperfusion Alternatives Evaluation ( BRAVE ) 4 study is an investigator-initiated , randomized , open-label , multicentre trial , designed to test the hypothesis that in STEMI patients with planned primary PCI a strategy based on prasugrel plus bivalirudin is superior to a strategy based on clopidogrel plus heparin in terms of net clinical outcome . |
RESULTS Owing to slow recruitment , the trial was stopped prematurely after enrolment of 548 of 1240 planned patients . |
RESULTS At 30 days , the primary composite endpoint of death , myocardial infarction , unplanned revascularization of the infarct related artery , stent thrombosis , stroke , or bleeding was observed in 42 patients ( 15.6 % ) randomized to prasugrel plus bivalirudin and 40 patients ( 14.5 % ) randomized to clopidogrel plus heparin [ relative risk , 1.09 ; one-sided 97.5 % confidence interval ( CI ) 0-1 .79 , P = 0.680 ] . |
RESULTS The composite ischaemic endpoint of death , myocardial infarction , unplanned revascularization of the infarct-related artery , stent thrombosis , or stroke occurred in 13 patients ( 4.8 % ) in the prasugrel plus bivalirudin group and 15 patients ( 5.5 % ) in the clopidogrel plus heparin group ( relative risk , 0.89 ; 95 % CI 0.40-1 .96 , P = 0.894 ) . |
RESULTS Bleeding according to the HORIZONS-AMI definition was observed in 38 patients ( 14.1 % ) in the prasugrel plus bivalirudin group and 33 patients ( 12.0 % ) in the clopidogrel plus heparin group ( relative risk , 1.18 ; 95 % CI 0.74-1 .88 , P = 0.543 ) . |
RESULTS Results were consistent across various subgroups of patients . |
CONCLUSIONS In this randomized trial of STEMI patients , we were unable to demonstrate significant differences in net clinical outcome between prasugrel plus bivalirudin and clopidogrel plus heparin . |
CONCLUSIONS Neither the composite of ischaemic complications nor bleeding were favourably affected by prasugrel plus bivalirudin compared with a regimen of clopidogrel plus unfractionated heparin . |
CONCLUSIONS However , the results must be interpreted in view of the premature termination of the trial . |
BACKGROUND Unique identifier NCT00976092 ( www.clinicaltrials.gov ) . |
###12551795 |
OBJECTIVE To evaluate the long-term recurrence rates and complication of different techniques of cervical ablation . |
METHODS A randomized trial of three techniques of conization ( cold knife , laser , and loop electrosurgical excisional procedure ( LEEP ) ) for cervical intraepithelial neoplasia ( CIN ) in which 110 patients had been recruited . |
RESULTS Eighty-six patients were followed-up for more than 3 years . |
RESULTS Of these 28 had been treated with the cold knife , 29 with LEEP and 29 by laser . |
RESULTS Five recurrences were observed , one in the cold knife group , two in the LEEP group and two in the laser group ( P = NS ) . |