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Kojovic M.,University College London | Cordivari C.,FRCP | Bhatia K.,University College London
Therapeutic Advances in Neurological Disorders | Year: 2011

Myoclonus is a sudden, brief, involuntary muscle jerk. It is caused by abrupt muscle contraction, in the case of positive myoclonus, or by sudden cessation of ongoing muscular activity, in the case of negative myoclonus (NM). Myoclonus may be classified in a number of ways, although classification based on the underlying physiology is the most useful from the therapeutic viewpoint. Given the large number of possible causes of myoclonus, it is essential to take a good history, to clinically characterize myoclonus and to look for additional findings on examination in order to limit the list of possible investigations. With regards to the history, the age of onset, the character of myoclonus, precipitating or alleviating factors, family history and associated symptoms and signs are important. On examination, it is important to see whether the myoclonus appears at rest, on keeping posture or during action, to note the distribution of jerks and to look for the stimulus sensitivity. Electrophysiological tests are very helpful in determining whether myoclonus is cortical, subcortical or spinal. A single pharmacological agent rarely control myoclonus and therefore polytherapy with a combination of drugs, often in large dosages, is usually needed. Generally, antiepileptic drugs such as valproate, levetiracetam and piracetam are effective in cortical myoclonus, but less effective in other forms of myoclonus. Clonazepam may be helpful with all types of myoclonus. Focal and segmental myoclonus, irrespective of its origin, may be treated with botulinum toxin injections, with variable success. © The Author(s), 2011.

Leon K.,National Heart Institute | El hadidy A.,Cairo University | Tawfik M.,FRCP | Gamal A.,National Heart Institute | And 2 more authors.
Egyptian Heart Journal | Year: 2014

Objectives: Observational study to assess essential hypertension patient's compliance on Irbesartan, rationale for prescribing Irbesartan, profile of patient for whom it is prescribed, and assess patient/physician satisfaction. Methods: Naïve/uncontrolled patients with essential hypertension; for whom physicians decide to prescribe Irbesartan-based-regimen are followed up for 4. months to assess compliance, tolerability, satisfaction, and identify reasons for prescription. Physicians were required to fill a case-report-form and a simple questionnaire to identify patients' characteristics, give reason(s) for prescription, and persistence/non-persistence of patients/physicians. Satisfaction, safety profile, and blood pressure control were also assessed. Results: Total of 62.1% (n= 3971) of all screened patients (n= 6399, Naïve. = 31.04%, uncontrolled. = 68.96%) were prescribed an Irbesartan based regimen. Efficacy, safety, and cost; in that ranking order, were the main reasons for prescribing specific antihypertensive agent. By the end of the study, satisfaction for Irbesartan 150. mg, 300. mg, and 300. mg/12.5. mg was 95.6%, 96.8%, and 96.5%, respectively; up from 72.6% general patient satisfaction with their current regimen at screening visit. Physicians showed a similar improvement in satisfaction to 96.4%, 97.1%, and 95.8, respectively, up from 27.3% satisfaction with previous regimen. Patient's compliance increased up from 86% at the beginning of the study to a mean of 96.2% by the end of the study. Conclusion: A total of 96%. ±. 0.8 of Irbesartan population were satisfied with their Irbesartan regimen. Reasons for prescribing a specific antihypertensive class were identified as efficacy, safety, and cost. Angiotensin-Receptor-Blockers were the antihypertensive of choice for 68.9% of physicians due to its efficacy (96.5%) and safety (85.9%). The majority (91.49%) of side effects were recorded as being 'mild', no serious adverse events were recorded. © 2012.

The usual management of cancer related breakthrough pain is with supplemental doses of analgesics (commonly opioids) at a dose proportional to the total around-the-clock opioid dose. The aim of this review, undertaken as part of a European Palliative Care Research Collaborative (EPCRC) project, to update the EAPC guidelines on opioid analgesics in cancer pain was to determine the evidence for the utility of opioids in the management of breakthrough pain in patients with cancer. Randomized controlled trials of opioids used as rescue medication were identified using electronic search strategies. Outcome measures sought were reduction in pain intensity measured by an appropriate scale, adverse effects, attrition, and patient satisfaction. The date of the final search was 31 July 2009. Eight studies (790 patients) met the inclusion criteria. Most studies investigated rescue medication delivery via the buccal or nasal transmucosal routes. Intravenous morphine has been compared with the transmucosal route and the two found to be effective. The oral route has not been formally tested although found to be an inferior comparator in one study. Most studies showed no meaningful relationship between the effective dose of transmucosal opioid and the around-the-clock scheduled medication or the previous rescue medication, although one study found a fixed proportion of either intravenous morphine or transmucosal fentanyl to be efficacious. © 2011 The Author(s).

Verdolini R.,FRCP | Simonacci F.,FRCP | Dhoat S.,Royal London Hospital | Clayton N.,Royal London Hospital
Giornale Italiano di Dermatologia e Venereologia | Year: 2015

Aim. Repair following excision of large tumours of the face can be problematic; primary closure may not be achievable and grafting or secondary intention healing carry the risk of necrosis and lengthy healing times. Flaps are usually associated with earlier healing and better cosmetic results, as the skin used for closure is similar to the tissue requiring repair. However, large wound sizes and difficulty in finding a suitable donor area means flaps can be complicated to perform. The aim of this paper was to identify a comparatively quick and simple alternative to standard repair techniques for the closure of large wound defects in critical anatomical areas, when the only realistic alternative would be grafting, offering both good cosmetic results and minimal risk of complications. Results. We have developed a flap, modified from the classic, single lobe transposition flap. Two similar lobes placed symmetrically and perpendicularly to two opposite sides of the surgical wound are incised with fulcra centred on two opposite corners. The flaps are then rotated by approximately 80-90° into position side by side, sutured to the borders of the surgical wound and finally together with a longitudinal suture. The principle behind this flap is the split of the covering surface into 2 small units, rather than using a large single lobe, which, for large wounds, would make closure of the single donor area by first intention impossible. The split of the donor area in 2 smaller subunits makes it easier to close the two donor areas and allows a larger amount of tissue to be harvested. Conclusion. We have developed a twinned symmetric transposition flap to close large wounds on the face when the only realistic alternative would have been the use of grafting. It offers minimal distortion, and is both quick and simple to perform. The use of tissue similar to the original defect ensures good cosmetic results. Healing times were usually very rapid and complications limited to a very few cases of end flap necrosis. This technique is not applicable where donor areas fall in anatomic spots where harvesting of the lobes is impossible, e.g. when the wound is too close to the hair line and transposition of the lobes would cause the transfer of hairy skin to an area where the presence of hair is not desirable.

Arnold M.,Trinity College Dublin | Ghosh A.,Trinity College Dublin | Doherty G.,University College Dublin | Mulcahy H.,University College Dublin | And 3 more authors.
VISAPP 2013 - Proceedings of the International Conference on Computer Vision Theory and Applications | Year: 2013

The quality of individual colonoscopy procedures is currently assessed by the performing endoscopist. In light of the recently reported quality issues in colonoscopy screening, there may be significant benefits in augmenting this form of self-assessment by automatic assistance systems. In this paper, we propose a system for the assessment of individual colonoscopy procedures, based on image analysis and machine learning. The system rates the procedures according to criteria of the validated Direct Observation of Procedure and Skill (DOPS) assessment, developed by the Joint Advisory Group on GI Endoscopy (JAG) in the UK, a system involving expert assessment of procedures based on an assessment form.

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