scholarly journals A multicentre randomised trial comparing octreotide and injection sclerotherapy in the management and outcome of acute variceal haemorrhage

Gut ◽  
1997 ◽  
Vol 41 (4) ◽  
pp. 526-533 ◽  
Author(s):  
S A Jenkins ◽  
R Shields ◽  
M Davies ◽  
E Elias ◽  
A J Turnbull ◽  
...  
Keyword(s):  
Relative Risk ◽  
Randomised Trial ◽  
Major Complication ◽  
Injection Sclerotherapy ◽  
Endoscopic Sclerotherapy ◽  
Trial Period ◽  
Variceal Haemorrhage ◽  
Acute Variceal Bleeding ◽  
To Receive

Background—Few studies have compared vasoactive drugs with endoscopic sclerotherapy in the control of acute variceal haemorrhage. Octreotide is widely used for this purpose, but its value remains undetermined.Aims—To compare octreotide with endoscopic sclerotherapy for acute variceal haemorrhage.Patients—Consecutive patients with acute variceal haemorrhage.Methods—Patients were randomised at endoscopy to receive either a 48 hour intravenous infusion of 50 μg/h octreotide (n=73), or emergency sclerotherapy (n=77).Results—Overall control of bleeding and mortality was not significantly different between octreotide (85%, 62 patients) and sclerotherapy (82%, 63 patients) over the 48 hour trial period (relative risk of rebleeding 0.83; 95% confidence interval (CI) 0.38 to 1.82), irrespective of Child’s grading or active bleeding at endoscopy. One major complication was observed in the sclerotherapy group (aspiration) and two in the octreotide group (pulmonary oedema, severe paralytic ileus). During 60 days of follow up there was an overall trend towards an increased mortality in the octreotide group which was not statistically significant (relative risk of dying at 60 days 1.91, 95% CI 0.97 to 3.78, p=0.06).Conclusions—The results of this study indicate that intravenous octreotide is as effective as injection sclerotherapy in the control of acute variceal bleeding, but further controlled trials are necessary to evaluate the safety of this treatment.

Injection Sclerotherapy of Oesophageal Variceal Haemorrhage. A Prospective Long-term Follow-up Study

Endoscopy ◽  
1987 ◽  
Vol 19 (05) ◽  
pp. 181-184 ◽  
Author(s):  
T. Sauerbruch ◽  
M. Weinzierl ◽  
H. Ansari ◽  
G. Paumgartner
Keyword(s):  
Injection Sclerotherapy ◽  
Variceal Haemorrhage ◽  
Follow Up Study ◽  
Long Term Follow Up

scholarly journals Methotrexate effect on immunogenicity and long-term maintenance of adalimumab in axial spondyloarthritis: a multicentric randomised trial

RMD Open ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e001047 ◽  
Author(s):  
Emilie Ducourau ◽  
Theo Rispens ◽  
Marine Samain ◽  
Emmanuelle Dernis ◽  
Fabienne Le Guilchard ◽  
...  
Keyword(s):  
Treatment Duration ◽  
Primary Outcome ◽  
Axial Spondyloarthritis ◽  
Randomised Trial ◽  
Follow Up Study ◽  
Study Completion ◽  
To Receive ◽  
Term Maintenance

ObjectivesAnti-drug antibodies (ADA) are responsible for decreased adalimumab efficacy in axial spondyloarthritis (SpA). We aimed to evaluate the ability of methotrexate (MTX) to decrease adalimumab immunisation.MethodsA total of 110 patients eligible to receive adalimumab 40 mg subcutaneously (s.c.) every other week were randomised (1:1 ratio) to receive, 2 weeks before adalimumab (W-2) and weekly, MTX 10 mg s.c. (MTX+) or not (MTX−). ADA detection and adalimumab serum concentration were assessed at weeks 4 (W4), 8 (W8), 12 (W12) and 26 (W26) after starting adalimumab (W0). The primary outcome was the proportion of patients with ADA at W26. Four years after the study completion, we retrospectively analysed adalimumab maintenance in relation with MTX co-treatment duration.ResultsWe analysed data for 107 patients (MTX+; n=52; MTX-; n=55). ADA were detected at W26 in 39/107 (36.4%) patients: 13/52 (25%) in the MTX+ group and 26/55 (47.3%) in the MTX− group (p=0.03). Adalimumab concentration was significantly higher in the MTX+ than MTX− group at W4, W8, W12 and W26. The two groups did not differ in adverse events or efficacy. In the follow-up study, MTX co-treatment >W26 versus no MTX or ≤W26 was significantly associated with adalimumab long-term maintenance (p=0.04).ConclusionMTX reduces the immunogenicity and ameliorate the pharmacokinetics of adalimumab in axial SpA. A prolonged co-treatment of MTX>W26 seems to increase adalimumab long-term maintenance.

scholarly journals Virtual outpatient clinic as an alternative to an actual clinic visit after surgical discharge: a randomised controlled trial

2018 ◽  
Vol 28 (1) ◽  
pp. 24-31 ◽  
Author(s):  
Paul Healy ◽  
Liam McCrone ◽  
Roisin Tully ◽  
Emer Flannery ◽  
Aoife Flynn ◽  
...  
Keyword(s):  
Outpatient Clinic ◽  
Controlled Trial ◽  
Randomised Trial ◽  
Significant Proportion ◽  
Clinic Visit ◽  
Surgical Service ◽  
Randomised Controlled ◽  
To Receive ◽  
Study Inclusion

BackgroundIt is standard practice to review all patients following discharge at a follow-up clinic but demands on all health services outweigh resources and unnecessary review appointments may delay or deny access to patients with greater needs.AimsThis randomised trial aimed to establish whether a virtual outpatient clinic (VOPC) was an acceptable alternative to an actual outpatient clinic (OPC) attendance for a broad range of general surgical patients following a hospital admission.Patients and methodsAll patients admitted under one general surgical service over the study period were assessed. If eligible for inclusion the rationale, randomisation and follow-up methods were explained, consent was sought and patients randomised to receive either a VOPC or an OPC appointment.ResultsTwo-hundred and nine patients consented to study inclusion, of which 98/107 (91.6%) in the VOPC group and 83/102 (81.4%) in the OPC group were successfully contacted. Only 6 patients in the OPC group and 10 in the VOPC group reported ongoing issues. A further follow-up indicated 78 of 82 (95%) VOPC patients were very happy with their overall experience compared with 34/61 (56%) in the actual OPC group (p<0.001). A significant proportion of both cohorts—68/82 (83%) in VOPC group and 41/61 (67%) in OPC group (p = 0.029)—preferred a VOPC appointment as their future follow-up of choice.ConclusionsThe majority of patients discharged from a surgical service could be better followed up by a virtual clinic with a significant proportion of patients reporting a preference for and a greater satisfaction with such a service.

scholarly journals Two-year outcomes after dextrose gel prophylaxis for neonatal hypoglycaemia

2020 ◽  
pp. fetalneonatal-2020-320305
Author(s):  
Rebecca Griffith ◽  
Joanne Elizabeth Hegarty ◽  
Jane M Alsweiler ◽  
Greg D Gamble ◽  
Robyn May ◽  
...  
Keyword(s):  
Executive Function ◽  
New Zealand ◽  
Relative Risk ◽  
Adverse Effects ◽  
Multiple Dose ◽  
Randomised Trial ◽  
Neonatal Hypoglycaemia ◽  
Health Measures ◽  
Secondary Outcomes

ObjectiveTo determine the effect of prophylactic dextrose gel for prevention of neonatal hypoglycaemia on neurodevelopment and executive function at 2 years’ corrected age.DesignProspective follow-up of a randomised trial.SettingNew Zealand.PatientsParticipants from the pre-hypoglycaemia Prevention with Oral Dextrose (pre-hPOD) trial randomised to one of four dose regimes of buccal 40% dextrose gel or equivolume placebo.Main outcome measuresCoprimary outcomes were neurosensory impairment and executive function. Secondary outcomes were components of the primary outcomes, neurology, anthropometry and health measures.ResultsWe assessed 360 of 401 eligible children (90%) at 2 years’ corrected age. There were no differences between dextrose gel dose groups, single or multiple dose groups, or any dextrose and any placebo groups in the risk of neurosensory impairment or low executive function (any dextrose vs any placebo neurosensory impairment: relative risk (RR) 0.77, 95% CI 0.50 to 1.19, p=0.23; low executive function: RR 0.50, 95% CI 0.24 to 1.06, p=0.07). There were also no differences between groups in any secondary outcomes. There was no difference between children who did or did not develop neonatal hypoglycaemia in the risk of neurosensory impairment (RR 1.05, 95% CI 0.68 to 1.64, p=0.81) or low executive function (RR 0.73, 95% CI 0.34 to 1.59, p=0.43).ConclusionProphylactic dextrose gel did not alter neurodevelopment or executive function and had no adverse effects to 2 years’ corrected age, but this study was underpowered to detect potentially clinically important effects on neurosensory outcomes.

EFFECTIVENESS OF INTRAVENOUS THROMBOLYTIC TREATMENT IN ACUTE MYOCARDIAL INFARCTION:SHORT AND MEDIUM TERM PROGNOSIS

1987 ◽  
Author(s):  
F Mauri
Keyword(s):  
Relative Risk ◽  
Treated Group ◽  
Control Group ◽  
Thrombolytic Treatment ◽  
Medium Term ◽  
Coronary Care ◽  
One Year ◽  
To Receive ◽  
Coronary Care Units

An unblinded trial of intravenous stretokinase in early acute myocardial infarction was planned to study wheter the drug produces a clinically relevant benefit in terms of reduction of in-hospital and one year mortality.11806 pts in one hundred and seventy six coronary care units were enrolled over 17 months.Patients admitted within 12 h after o.nSet of symptons and with no contraindications to SK were randomized to receive SK in addition to usual treatment and complete data were obtained in 11712 for what concerns in hospital prognosis.At 21 days overall hospital mortality was 10.7% in SK recipients versus 13%,in controls,an 18% reduction(p=0.0002,relative risk 0.81).The extent of beneficial effect appears to be a function of time from onset of pain to SK infusion(relative risk 0.74,0.80, 0.87 and 1.19 for the 0-3,3-6,6-9 and 9-12 h subgroups).The data of 1-year follow-up concerning 11605 pts(95.3% of the whole population)were available up to December the 31st.1987.4333 pts out of the SK-treated group(74.0%)and 4219 out of the control one (72.1%)were alive,with a significant difference.These results document that the benefit produced by SK in the hospital period remains substantially unchanged.The differences in mortality in favour of SK vs.C remain highly significant specifically for the 0-3 and 3-6 hrs subgroups and is dramatic for patients treated between one hour from onset of symptoms. 503 out of the 637 treated with SK were alive at 1-year follow-up versus 443 out of 641 control group pts:the amplitude of the benefit seems to be further increased in this particular subgroup.The GISSI results document conclusively that an acute thrombolytic treatment with SK in AMI is effective in reducing mortality not only over the short,but also over the medium period.

scholarly journals Multimodal periarticular cocktail injection using steroid in total knee arthroplasty: a double blind randomised trial

2017 ◽  
Vol 4 (1) ◽  
pp. 41
Author(s):  
Ankit Thora ◽  
Ashok Bhatt ◽  
Nishit Bhatnagar ◽  
Anurag Tiwari ◽  
Mukul Mohindra
Keyword(s):  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Randomised Trial ◽  
Double Blind ◽  
Steroid Group ◽  
Significant Difference ◽  
Total Knee ◽  
The One ◽  
To Receive

<p class="abstract"><strong>Background:</strong> Multimodal periarticular cocktail injection (MPCI) containing local anesthetics, adrenaline, and anti-inflammatory agents such as NSAIDS have been promising in terms of quick functional recovery. This study evaluates the efficiency of steroid as a component of MPCI in knee arthroplasty.</p><p class="abstract"><strong>Methods:</strong> This is a prospective, double-blind, RCT where 36 patients with osteoarthritis were included and randomized to receive MPCI either with steroid or without steroid. Pain was evaluated by visual analogue scale (VAS) at preoperative and postoperatively at rest, and during activity. The range of motion of the knee was looked for in a similar way. The amount of NSAIDs and the duration of NSAID usage were noted till the last follow-up.<strong></strong></p><p class="abstract"><strong>Results:</strong> Both non-steroid and steroid groups were similar with regard to VAS at rest and during activity, or range of motion, at all postoperative observations. The postoperative knee society knee score in the steroid group improved significantly as compared to that in non-steroid group at the one-month (84.1±13.1 and 65.9±12.1; p&lt;0.0045) and three-month follow-up (90.2±16.3 and 72.5±16.6; p&lt;0.0027), but no significant difference was noted at six-month follow up. There was no significant difference in consumption of NSAIDs within 72 hours between the two groups. The duration of piroxicam usage in patients in the steroid group was significantly shorter than that in the non-steroid group, (7.2±0.7) compared with (10.5±1.9) weeks; =0.012.</p><p class="Pa4"><strong>Conclusions:</strong> The Study validates usage of steroid in MPCI due to faster rehabilitation and less consumption of NSAIDs and no additional risk of post-operative complications. </p>

scholarly journals Retrograde Endoscopic Sclerotherapy for Management of Internal Haemorrhoids

2020 ◽  
Vol 7 (51) ◽  
pp. 3122-3125
Author(s):  
Sanjay Gupta ◽  
Bindu Aggarwal
Keyword(s):  
Clinical Practice ◽  
Prospective Study ◽  
Injection Sclerotherapy ◽  
Endoscopic Sclerotherapy ◽  
Limited Data ◽  
Endoscopic Injection Sclerotherapy ◽  
Endoscopic Injection ◽  
Common Cause ◽  
A Prospective Study

BACKGROUND Haemorrhoids are one of the most common anorectal conditions encountered in clinical practice and are recognised as a common cause of rectal bleeding, perianal itching and anal discomfort. Therapeutic treatment of haemorrhoids needs to be tailored according to grades and complication of haemorrhoids, patient preference and expertise of procedure. Very limited data is available regarding effectiveness of retrograde endoscopic injection sclerotherapy for the management of bleeding haemorrhoids. We wanted to study the effectiveness of retrograde endoscopic sclerotherapy (REST) for the management of various grades of bleeding internal haemorrhoids. METHODS A prospective study, included 87 patients with Gr. I, II and Gr. III symptomatic bleeding internal haemorrhoids. They were subjected to retrograde endoscopic sclerotherapy using Inj. Polidocanol to study its effectiveness in controlling bleeding. Effectiveness of the procedure was defined by stoppage of bleeding at 3 months follow up. RESULTS Bleeding stopped in 95.3 % cases after retrograde endoscopic sclerotherapy at 3 months follow up. No significant complications were observed with the procedure during the study period. CONCLUSIONS Retrograde endoscopic sclerotherapy is a safe, well tolerated and effective modality for the management of bleeding internal haemorrhoids. KEYWORDS Haemorrhoids, Retrograde Endoscopic Sclerotherapy

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