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Veszprém, Hungary

van Rensburg K.J.,County Hospital | Atkins E.,Society of Orthopaedic Medicine
International Musculoskeletal Medicine | Year: 2012

Aim: This pilot study was designed to assess the effect of thoracic manipulation on shoulder range and function in patients with subacromial impingement syndrome (SIS). Methods: Patients attending a National Health Service physiotherapy department with SIS were considered for inclusion. Participants were randomized into one of two groups. Both groups received weekly physiotherapy for a maximum of 6 weeks. In addition, the experimental group received thoracic spinal manipulation. Outcome measures were shoulder range and function measured by a goniometer and the Disability of the Arm, Shoulder and Hand Score, respectively. Results: Nine participants were recruited; eight completed the study. Both groups improved, but numbers were inadequate for statistically significant conclusions. Conclusions: This pilot study confirms the practicality of the study design used: a longer recruitment period and multicentre involvement is recommended together with a cost-benefit analysis. © W.S. Maney & Son Ltd. and the British Institute of Musculoskeletal Medicine 2012. Source

Latic F.,County Hospital
Medicinski arhiv | Year: 2010

Diaphragm injuries are diagnosed in the acute phase of blunt trauma only in 10% of cases--more often they are presented as hernia. Traumatic diaphragmatic hernia presents unique obstacles to a minimal invasive approach. However, with the proper training and equipment, most of these hernias are amenable to laparoscopic approach. These patients can expect the same well-known benefits of laparoscopic approach. We report here the case of a 56-year-old man, admitted to hospital with symptoms of vomiting, abdominal pain and dispnea who sustained blunt abdominal trauma in a high speed motor vehicle accident nine months ago. X-ray and CT scans confirmed suspected strangulated diaphragmatic hernia which contained stomach, colon, majoromentum and spleen in left hemithorax. The urgent laparoscopic procedure was performed--omentum, colon and stomach were taken backthrough diaphragmatic defect but the spleen was tightly fixed in thoracal cavity and splenectomy was performed. The diaphragmatic defect was repaired with interruptured sutures. This case proves that laparoscopic repair of diaphragmatic hernia is effective, but this should be carried out with caution, sometimes it needs additional complex procedure in emergency setting like splenectomy in this case. Source

Minutolo R.,The Second University of Naples | Gabbai F.B.,University of California at San Diego | Agarwal R.,Indiana University | Chiodini P.,The Second University of Naples | And 6 more authors.
American Journal of Kidney Diseases | Year: 2014

Background We investigated the effect of having clinic and/or ambulatory blood pressures (BPs) not at goal on cardiorenal risk in patients with non-dialysis-dependent chronic kidney disease (CKD).Study Design Multicenter prospective study.Setting & Participants 489 consecutive hypertensive patients with CKD (stages 1-5) with concomitant assessment of ambulatory and clinic BPs followed up in tertiary nephrology clinics.Predictors Achievement of goal for ambulatory (day- and night-time BPs < 135/85 and <120/70 mm Hg, respectively) and clinic (<140/90 mm Hg) BPs was used to create 4 BP groups: clinic and ambulatory BPs at goal (group 1), clinic BP above goal and ambulatory BP at goal (group 2), clinic BP at goal and ambulatory BP above goal (group 3), and clinic and ambulatory BPs above goal (group 4).Outcomes Composite cardiovascular event outcome (fatal and nonfatal myocardial infarction, congestive heart failure, stroke, revascularization, peripheral vascular disease, and nontraumatic amputation) and a composite renal outcome (maintenance dialysis therapy or death).Measurements Clinic and 24-hour ambulatory BPs.Results Mean age was 64.4 ± 14.2 (SD) years; 41% were women, and diabetes and previous cardiovascular disease were present in 36% and 30%, respectively. Groups 1-4 contained 16.8%, 22.1%, 14.5%, and 46.6%, respectively, of the overall number of participants. Median follow-up was 5.2 years. Compared to group 1, the adjusted risk of the composite cardiovascular outcome was higher in groups 3 (HR, 3.17; 95% CI, 1.50-6.69) and 4 (HR, 2.83; 95% CI, 1.50-5.34), but not in group 2 (HR, 1.55; 95% CI, 0.75-3.19). Similarly, the risk of the composite renal outcome was higher in groups 3 (HR, 3.59; 95% CI, 2.05-6.27) and 4 (HR, 2.96; 95% CI, 1.83-4.78), but not group 2 (HR, 1.24; 95% CI, 0.67-2.27). Sensitivity analyses confirmed that these results were independent from the thresholds used for defining groups.Limitations Only white patients were enrolled. Observational design does not allow for causality to be established.Conclusions In patients with treated CKD, clinic BP above goal and ambulatory BP at goal identify a low-risk condition, whereas clinic BP at goal and ambulatory BP above goal are associated with higher cardiorenal risk, similar to that observed in patients with both clinic and ambulatory BPs above goal. © 2014 National Kidney Foundation, Inc. © 2014 by the National Kidney Foundation, Inc. Source

Eriksson L.,County Hospital | Tegelberg A.,Malmo University
Oral and Maxillofacial Surgery | Year: 2013

Introduction: This study aims to compare two routine procedures of sedation, with and without intravenous adjunct analgesia, in third molar surgery regarding postoperative pain and consumption of analgesics. Material and methods: In a randomized, controlled, single-blinded procedure, 87 men and women aged 18-44 years were divided into two treatment groups, midazolam + tramadol (M + T) and midazolam + saline (M + S), and one control group (C), with no additional medication. After removal of a third lower molar, patients recorded postoperative pain on a visual analog scale (VAS) and consumption of analgesics during the first day after surgery. Results: Time from the end of operation until first rescue pill (400 mg Ibuprofen tablet) differed significantly between the M + S group (193 min) and the C group (110 min) (p = 0.001) as well as the M + T group (157 min) and the C group (p = 0.049). The study did not show any significant reduction of postoperative pain, VAS, after third molar surgery in patients who received adjunct pre-emptive intravenous administration of 1 mg/kg tramadol under midazolam sedation. Discussion and conclusion: The lack of significant difference between the study and placebo groups indicates that tramadol at 1 mg/kg might be an insufficient dose, though the suitability for tramadol in oral and maxillofacial surgery has already been settled in other studies. © 2012 Springer-Verlag. Source

Szakacs A.,County Hospital | Szakacs A.,Gothenburg University | Darin N.,Gothenburg University | Hallbook T.,Gothenburg University
Neurology | Year: 2013

Objectives: To assess the incidence of narcolepsy between January 2000 and December 2010 in children in western Sweden and its relationship to the Pandemrix vaccination, and to compare the clinical and laboratory features of these children. Methods: The children were identified from all local and regional pediatric hospitals, child rehabilitation centers, outpatient pediatric clinics, and regional departments of neurophysiology. Data collection was performed with the aid of a standardized data collection form, from medical records and telephone interviews with patients and parents. The laboratory and investigational data were carefully scrutinized. Results:We identified 37 children with narcolepsy. Nine of themhad onset of symptoms before the H1N1 vaccination and 28 had onset of symptoms in relationship to the vaccination. The median age at onset was 10 years. All patients in the postvaccination group were positive for human leukocyte antigen (HLA)-DQB1*0602. Nineteen patients in the postvaccination group, compared with one in the prevaccination group, had a clinical onset that could be dated within 12 weeks. Conclusion: Pandemrix vaccination is a precipitating factor for narcolepsy, especially in combination with HLA-DQB1*0602. The incidence of narcolepsy was 25 times higher after the vaccination compared with the time period before. The children in the postvaccination group had a lower age at onset and a more sudden onset than that generally seen. © 2013 American Academy of Neurology. Source

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