Human ; Female ; Infant ; Dermoscopy ; Sarcoptes Scabiei ; Scabies

OBJECTIVE: The general objective of this meta-analysis was to determine the efficacy of HSS versus mannitol in decreasing cerebral edema. The specific objectives were to compare the magnitude of decrease in intracranial pressure (ICP), the changes in cerebral perfusion pressure (CPP), mean arterial pressure (MAP), serum sodium and serum osmolality, between administrations of mannitol versus HSS.

METHOD: Systematic online search was conducted through MEDLlNE, PubMed and Cochrane Database. Search terms used were (mannitol) AND (hypertonic saline solution OR HSS OR hypertonic) AND (intracranial pressure OR ICP OR cerebral edema) AND (stroke OR cerebrovascular OR brain injury). A free text search was also done via Yahoo and Google search engine. Only randomized clinical controlled trials of adults with cerebral edema, due to traumatic brain injury, ischemic or hemorrhagic stroke were included. Interventions encompassed either mannitol or HSS. The outcomes measured include ICP, CPP, MAP, serum sodium and serum osmolality. Primary outcome measured was the magnitude of decline in ICP after giving the osmotic agents. Secondary outcomes were the effects of treatment to the CPP, MAP, serum sodium and serum osmolality. Analysis was done through mean change from baseline, and reported as Weighted Mean Difference (WMD) and 95% Confidence Interval (CI).

RESULTS: Four randomized clinical trials compared mannitol versus HSS in decreasing cerebral edema. A total of 70 patients and 196 episodes of increased ICP were treated with the either hypertonic saline solution or mannitol. The pooled analysis for the mean change from baseline was statistically significant and favored HSS treatment (p
Humans ; Adult ; Intracranial Pressure ; Saline Solution, Hypertonic ; Mannitol ; Brain Edema ; Arterial Pressure ; Search Engine ; Confidence Intervals ; Brain Injuries, Traumatic ; Brain Injuries ; Cerebrovascular Circulation ; Stroke ; Pubmed ; Osmolar Concentration ; Sodium

Objective: To determine the efficacy of cooled plain lubricant jelly in preventing pain during urethral catheterization compared to plain lubricant jelly at room temperature. Materials and Methods: This study is randomized, single-blind trial conducted at UERMMMC from June 1 to October 1, 2007. The patients were allocated to two groups: group 1 (control)- using plain lubricant jelly at room temperature (22 Ã
Urethral Catheterization ; Visual Analog Scales

INTRODUCTION: Transrectal ultrasound guided needle biopsy of prostate is considered a minor procedure but it is associated with significant discomfort and pain. Rectal administration of lidocaine gel during biopsy is safe, simple and effective with no major morbidity. Tramadol is used for relief of moderate to severe pain and the parenteral preparation has been used prior to prostate biopsy. Since TRUS-guided needle biopsy of the prostate is an outpatient procedure and both parenteral and oral tramadol are effective in moderate to severe pain, it is the purpose of this study to compare the efficacy of oral tramadol with that of rectally instilled lidocaine gel prior to TRUS guided needle biopsy of the prostate.

MATERIALS AND METHODS: All male patients fifty and above who had indications for prostatic biopsy were enrolled in the study. Twenty eight patients were randomized into 2 groups, the control (group 1) and experimental (group 2). In group 1, a placebo capsule was given 1 hour prior to the biopsy and 15cc of 2% lidocaine gel was administered intrarectally 10 minutes before the biopsy. In group 2, the patients received a capsule of tramadol 50mg 1 hour prior to the biopsy and 15cc of K-Y jelly was administered intrarectally 10 minutes prior to the biopsy. The VAS pain was measured during insertion of the probe, during the biopsy and 10 minutes after. The mean difference in pain scores per group were compared using the independent T-test.

RESULTS: Twenty eight patients completed the procedure, fourteen were randomized to receive intrarectal lidocaine gel and the other fourteen received oral tramadol. Results showed that oral tramadol demonstrated less pain during insertion of the ultrasound rectal probe 19.57+/-SD 10.82 versus 34.28 +/- SD 19.31 (p = 0.032). During the biopsy proper the, control group had a mean VAS score of 36.86 +/-SD 21.12 and the tramadol group had a mean VAS score of 32.29 +/-SD 19.01 which was not statistically significant (p=0.528).The VAS scores ten minutes after the biopsy showed that the tramadol group had a lower mean of 10.43 +/-SD 11.65 versus 15.79 +/-SD 16.81 for the lidocaine group which was not statistically significant (p = 0.409). Each group had a 21% (3/14) incidence of adverse events and comparison showed no statistical significant difference (p= 0.645).

DISCUSSION: Tramadol, with its dual mechanism of action provides a kind of combined/adjuvant pain therapy. The advantage of using tramadol is that it is a centrally acting analgesis which effectively decreases the pain during distention of the anal sphincter and insertion of the needle into the prostate gland. Conclusion: Our data confirms that both techniques of non-invasive methods of analgesia duirng prostate biopsy are efficacious in reducing patient pain and discomfort, however oral tramadol significantly decreased the pain during probe insertion and was noted to be cheaper.

Human ; Male ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Prostatic Neoplasms ; Biopsy ; Prostate ; Tramadol

The study retrospectively reviewed 1,029 general surgery operations performed from September 1, 1991 to May 31, 1993 to find out the association between the occurrence of surgical site infection (SSI) and the Centers for Disease Control-National Nosocomial Infection Surveillance (CDC-AWS) surgical patient risk index scores. The index assigned 1 point for each of 3 risk factors: 1) American Society of Anesthesiologists (ASA) preoperative assessment class 3, 4 or 5; 2) an operational classified as either contaminated or dirty-infected; 3) an operation with a duration longer than a specified increased with increasing contamination (p=0.000) as well as increasing index scores (p=0.000). Looking at operations within the same category of contamination, SSI rates also increased with increasing scores among clean operations (p=0.944), clean-contaminated operations (p=0.000), contaminated operations (p=0.559), and dirty operations. SSI rates in this hospital series were compared to the 44-hospital CDC-NNIS report.

Human ; Male ; Female ; Surgical Wound Infection ; Cross Infection ; Anesthesiologists

A total of 38 patients with frozen section slides who underwent parotidectomy from January 1980 to December 1993 were retrieved from the Department of Pathology. The permanent section slides of the resected specimens were used as the gold standard. The frozen section and permanent section slides were reviewed by two independent pathologists and were labeled either as benign or malignant. If malignant, the tumor grade was determined as either high grade or low grade. Kappas correlation of agreement was used to determine inter-observer variability. Of the 38 slides, 16 were correctly labeled as malignant and 20 as benign. One slide was incorrectly labeled as malignant and 1 as benign. Sensitivity was 94.1 and specificity was 95.2 percent. The prevalence of malignant parotid tumors was 44.7 per cent, with a positive predictive value of 94.1 per cent and a negative predictive value of 95.2 per cent. Kappa statistic for the permanent section was 100 per cent, and 85 per cent for the frozen section. Tumor grading revealed that only 35.2 per cent were labeled correctly as high grade or low grade. This study showed that frozen section could reliably diagnose a malignant parotid tumor but could not reliably determine tumor grade. (Author)

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Frozen Sections ; Pathologists ; Prevalence ; Observer Variation ; Neoplasm Grading ; Parotid Neoplasms ; Sensitivity And Specificity

It has been suggested in a number of studies that penetrating abdominal stab wounds may be managed conservatively although only a few local studies support this claim. This study reviews experience based on 483 patients, who underwent celiotomy for a single penetrating abdominal stab wound inflicted by a single bladed knife from Jan. 1989 to June 1991. The cases were divided into two (2) groups, those who underwent celiotomy with indications and those who underwent celiotomy without indications. Tabulation of operative findings according to the location of the stab wound in the nine (9) regions of the anterior abdomen showed that 89% of all patients with indications for surgery had significant injury. In the group who underwent celiotomy without indications, 78% had positive findings. The data for groups A and B stratified into the nine regions did not show any significant difference in the frequency of abdominal injury except in the right lumbar, left lumbar, left iliac and umbilical region. In these last four regions, the frequency of abdominal injury in the group with indications is statistically higher than in the group without indications. Therefore, a trial of observation in these regions is therefore acceptable in the absence of indications for celiotomy.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Adolescent ; Wounds ; Stab ; Abdomen

A retrospective study was undertaken on 103 diabetic patients with foot ulcers who were confined at the UERM Memorial Medical Center from January 1988 to June 1991 with the aim of determining clinical and laboratory criteria which are useful in predicting the need for amputation. Patients were divided into two groups according to treatment modality: Group A, debridement (58 patients) and Group B, amputation (45 patients). Nineteen variables chosen from the patients demographic characteristics, clinical histories and evaluation, and laboratory work-up were reviewed, evaluated, and processed using the normal approximation statistics and logistic regression to obtain a resulting set of predictors. Osteomyelitis, leukocytosis, decreased or absent peripheral pulses, systolic hypertension and smoking history were the five variables found to be significantly associated with the need for an ablative surgical procedure. These quantitated variables are entered into the computed logistic equation to obtain a score which will enable us to determine the appropriate therapeutic intervention tailored to the individuals risk status. If the computed value is greater than or equal to 7, amputation should be the course of action. If the computed value is less than or equal to 3, conservative treatment is advocated. If the value obtained is between 3 and 7, the patient is considered a borderline case and proper management will have to depend on the judgment of the surgeon. With this scoring system as a guide, a definitive operation can be performed at an early stage to prevent the burden of multiple operations and the accompanying high morbidity and post-operative mortality rates.

Human ; Male ; Female ; Foot ; Diabetes Mellitus ; Diabetic Foot ; Amputation