Statistical Difference In Change Research Articles

Fentanyl Buccal Tablet vs. Oral Morphine in Doses Proportional to the Basal Opioid Regimen for the Management of Breakthrough Cancer Pain: A Randomized, Crossover, Comparison Study

ContextFentanyl products have shown superiority to oral opioids for the management of breakthrough cancer pain (BTcP). However, these studies did not use appropriate patient selection, and drugs have been compared by using different rationales. ObjectivesThe aim of this randomized, crossover, controlled study was to compare efficacy and safety of fentanyl buccal tablets (FBTs) and oral morphine (OM), given in doses proportional to opioid daily doses. MethodsCancer patients with pain receiving ≥60 mg or more of oral morphine equivalents per day and presenting with ≤3 episodes of BTcP per day were included. In a randomized, crossover manner, patients received FBT or OM at doses proportional to the daily opioid regimen in four consecutive episodes of BTcP. Pain intensity was measured before (T0) and 15 (T15) and 30 minutes (T30), after study drugs. ResultsIn total, 263 episodes of BTcP were treated. A statistical difference in changes in pain intensity—decrease of ≥33% and ≥50%—between the two groups was observed at T15 and T30 (P < 0.0005). No severe adverse effects after study drug administration were observed. ConclusionWhen used in doses proportional to the basal opioid regimen, FBT showed a clear superiority and was well tolerated when compared with OM during the first 30 minutes, which is the approximate target for a timely intervention required for a BTcP medication.

Standard-Dose Versus High-Dose Acyclovir in Children Treated Empirically for Encephalitis: A Retrospective Cohort Study of Its Use and Safety

Intravenous acyclovir is the treatment of choice for herpes simplex virus encephalitis. In 2006, the American Academy of Pediatrics updated its dosing recommendations for children aged 3 months to 12 years to receive high-dose acyclovir (60 mg/kg/day). The association between acyclovir dose and toxicity is unclear. The purpose of our study was to review our institution's experience with standard- and high-dose acyclovir for the empiric treatment of encephalitis. This retrospective cohort study included patients aged 1 month to 18 years who received acyclovir as empiric treatment for encephalitis between 2005 and 2009 at a tertiary care children's hospital. We excluded patients with baseline renal impairment and those without serum creatinine measurements prior to and during treatment. The main outcome measure of this study was to compare the occurrence of renal injury or failure between children who received the standard- versus high-dose regimen. Sixty-one patients were included (n = 32 standard-dose; n = 29 high-dose). There was no statistical difference in change in serum creatinine from baseline between children who received standard- versus high-dose acyclovir (0 vs. 5.1 %; p = 0.79). One child in the standard-dose group and three children in the high-dose group developed renal injury or failure during treatment (3.1 vs. 10.3 %; p = 0.34). Children with renal injury or failure were older, had a longer length of stay, and longer duration of therapy than children without. The incidence of renal injury or failure was similar between children who received standard-dose and high-dose acyclovir.

The Effects of Diverse Warm-up Exercises on Balance.

[Purpose] To examine how stretching, plyometric, and treadmill exercises influence the dynamic balance necessary for sports activities. [Subjects and Methods] Twenty-two healthy subjects participated in this study. The subjects conducted stretching, plyometric exercises, and treadmill walking for set times over a period of three days. The subjects’ dynamic balance was then measured. The measurements were taken prior to the intervention, immediately after the intervention, and 20 minutes after the intervention. All the intervention times were set at 16 minutes, excluding resting times. The data were analyzed with using the two-way ANOVA. [Results] There was no interaction between exercises and time. There were no statistical differences among the exercises and no statistical differences in changes over time. [Conclusion] This study found that warm-up exercises such as plyometric exercises, stretching, and treadmill walking have no effect on the dynamic of balance in healthy subjects.

Treatment Effects of Ultrasound Guide Selective Nerve Root Block for Lower Cervical Radicular Pain: A Retrospective Study of 1-Year Follow-up

ObjectiveTo compare the long-term effects and advantages of ultrasound (US)-guided selective cervical nerve root block with fluoroscopy (FL)-guided transforaminal block.MethodsFrom March 2009 to November 2012, 162 patients received steroid injections for lower cervical radicular pain. A total of 114 patients fulfilled the inclusion criteria. All procedures were performed by using US or FL. We compared the intravascular injections during the procedure with the effects and functional scales at 3, 6, and 12 months after the procedure between the two groups. Successful treatments occurred when patients obtained significant pain reliefs (as measured by >50% improvements in the verbal numerical scale [VNS] score and >40% improvements in the neck disability index [NDI] score) and reported a patient satisfaction score of 3 or 4 points at 12 months after the injection. Image analysis of intravascular injection and chart review were performed. Logistic regression was performed to reveal the correlations between successful treatments and variables (patient's age, gender, duration of the disease, cause, injection method, and radiologic finding).ResultsThe VNS and NDI improved 3 months after the injection and continued to improve until 12 months for both groups. But there were no statistical differences in changes of VNS, NDI, and effectiveness between these two groups. The proportion of patients with successful treatment is illustrated as 62.5% in US-guided group and 58% in FL-guided group at 12 months. There were no significant differences between the groups or during follow-up periods. Three cases of the intravascular injections were done in FL-guided group.ConclusionThe US-guided selective cervical nerve root blocks are facilitated by identifying critical vessels at unexpected locations relative to the foramen and to protect injury to such vessels, which is the leading cause of reported complications from FL-guided transforaminal blocks. On treatment effect, significant long-term improvements in functions and pain reliefs were observed in both groups after the intervention. However, significant differences were not observed between the groups. Therefore, the US-guided selective cervical nerve root block was shown to be as effective as the FL-guided transforaminal block in pain reliefs and functional improvements, in addition to the absence of radiation and protection vessel injury at real-time imaging.

Does the length of station record influence the warming trend that is perceived by mongolian herders near the Khangai Mountains?

Temperatures changes can be difficult to infer from changes in vegetation patterns or other ecological changes, yet warming can be inferred through changes in the habits of people who live in close connection with their natural environment. Herders near the Khangai Mountains of central Mongolia have perceived a warming trend in recent years. Since it is difficult to determine the exact time period over which perceived warming has occurred, we examined the statistical difference in changes based on the length of data and the specific period of record used in the analysis. We used temperature data from five meteorological stations for up to 50 years (1961-2010). We examined varying lengths of record from 15 to 50 years with varying start periods (1961 through 1986), based on the length of record. We found that the most statistically significant changes occurred for the longest time periods and for the annual average minimum temperatures. We also found that one very cold winter, in particular 2009-2010 decreased the warming trend and for shorter periods of record reduced the statistical significance.

Health-related quality of life for men with prostate cancer—an evaluation of outcomes 12–24 months after treatment

ObjectiveTo determine the health-related quality of life (HRQoL) impact of prostate cancer interventions at 2 years post-treatment, and between the 12- and 24-month interval, to better characterize this measure. Materials and methodsPatients treated at the Center for Prostate Disease Research between June 2003 and February 2010 were offered enrollment into a HRQoL study that entailed a baseline evaluation before prostate biopsy and at 3, 6, 9, 12, 18, 24, and 30 months thereafter. The instruments used were the Expanded Prostate Cancer Index Composite (EPIC), EPIC Demographic, and Medical Outcomes Study Short-Form 36 (SF-36). A Student's t-test and ANOVA were used to examine the association between HRQoL scores, patient demographic, and disease features. Multivariable regression models were used to analyze change over time. Estimates of risk, corresponding confidence intervals, and P values are presented for these longitudinal findings. ResultsThe study group was comprised of 595 patients. African Americans (AA) had slightly lower baseline raw scores in all EPIC and SF-36 HRQoL domains, but on bivariate analysis, there was no statistical difference in change of scores over time. Radical prostatectomy (RP) led to the greatest decline in urinary function. Bowel function significantly worsened with the addition of hormone therapy (HT) to external beam radiation therapy (EBRT). Sexual bother and function had a marked decline in all active treatment options. Despite these changes, there were no differences in overall satisfaction. SF-36 domains were not affected by RP, whereas EBRT and EBRT + HT had universal impact. For the 12- to 24-month interval, specifically, patients who underwent EBRT fared worse over this time period, showing continued worsening of urinary bother, hormonal function, physical role, physical component summary, and overall satisfaction. Patients who underwent RP did not show any further decline in the 12- to 24-month interval, but instead showed improvement. ConclusionsBecause of the protracted nature of recovery after surgery, delayed onset of effects from radiation, potential interval decline secondary to age-related symptoms, and longevity of patients with prostate cancer, determination of long-term HRQoL outcomes is integral. Counseling with regard to these outcomes should be balanced with oncologic expectations from treatment.

A Pilot Study of Darbepoetin Alfa for Prophylactic Neuroprotection in Aortic Surgery

Descending aortic (DA) surgery poses a high risk for spinal and cerebral infarction and routine use of lumbar drains allows for measurement of CSF markers of neurologic injury. Erythropoiesis medications have extensive preclinical data demonstrating neuroprotection. We hypothesized that prophylactic darbepoetin alfa (DARB) given before surgery reduces neurologic injury in patients undergoing DA repair. We performed a prospective adaptive dose-finding trial of prophylactic DARB ( www.clinicaltrials.gov NCT00647998) that terminated prematurely following publication of an erythropoietin stroke study showing possible harm. Enrollment halted before dose adjustments; nine patients each received 1 mg/kg IV DARB immediately before surgery. A prospective cohort of nine untreated patients was subsequently obtained for comparison. The primary outcome of death or neurologic impairment at discharge occurred in 1/9 (11 %) DARB patients and 3/9 (33 %) controls (p = 0.58). There were no statistical differences in changes of CSF biomarkers from baseline to 48 h comparing DARB patients to controls: S100β, median 214 versus 260 ng/ml (p = 0.69); glial fibrillary acidic protein (GFAP), median 0.022 versus 0.58 ng/ml (p = 0.45). In patients with early perioperative neurologic ischemia, there were greater changes in CSF biomarkers, compared to those without ischemia: S100β, median 2301 versus 124 ng/ml (p = 0.04); GFAP, median 31.78 versus 0.31 ng/ml (p = 0.34). There were no significant effects of prophylactic DARB on clinical outcome or CSF markers of neurologic injury in this pilot study, although all point estimates favored treatment. DA repair is a promising model of prophylactic neuroprotection.

Comparison of Sono-guided Capsular Distension with Fluoroscopically Capsular Distension in Adhesive Capsulitis of Shoulder

ObjectiveTo investigate the short-term effects and advantages of sono-guided capsular distension, compared with fluoroscopically guided capsular distension in adhesive capsulitis of shoulder.MethodIn this prospective, randomized, and controlled trial, 23 patients (group A) were given an intra-articular injection of a mixture of 0.5% lidocaine (9 ml), contrast dye (10 ml), and triamcinolone (20 mg); they received the injection once every 2 weeks, for a total of 6 weeks, under sono-guidance. Twenty-five patients (group B) were treated similarly, under fluoroscopic guidance. Instructions for the self-exercise program were given to all subjects, without physiotherapy and medication. Effects were then assessed using a visual numeric scale (VNS), and the shoulder pain and disability index (SPADI), as well as a range of shoulder motion examinations which took place at the beginning of the study and 2 and 6 weeks after the last injection. Incremental cost-effective ratio (ICER), effectiveness, preference, and procedure duration were evaluated 6 weeks post-injection.ResultsThe VNS, SPADI, and shoulder motion range improved 2 weeks after the last injection and continued to improve until 6 weeks, in both groups. However, no statistical differences in changes of VNS, SPADI, ROM, and effectiveness were found between these groups. Patients preferred sono-guided capsular distension to fluoroscopically guided capsular distension due to differences in radiation hazards and positional convenience. Procedure time was shorter for sono-guided capsular distension than for fluoroscopically guided capsular distension.ConclusionSono-guided capsular distension has comparable effects with fluoroscopically guided capsular distension for treatment of adhesive capsulitis of the shoulder. Sono-guided capsular distension can be substituted for fluoroscopic capsular distension and can be advantageous from the viewpoint of radiation hazard mitigation, time, cost-effectiveness and convenience.

Comparison between graded unilateral and bilateral medial rectus recession for esotropia

AimsTo compare the postoperative surgical outcomes and the changes in deviation achieved per millimetre of recession in patients treated by graded unilateral medial rectus (UMR) or bilateral medial rectus (BMR)...

Driving Habits and Risk Exposure in Older Drivers: Lessons Learned From the Implementation of a Self-Regulation Curriculum

Objective: This article describes the development and pilot testing of Seniors on the MOVE (Mature Operators Vehicular Education), a safe driving education program for older adults. The study aims are to describe driving experiences and habits of a community sample of older drivers and to determine whether the program reduces their driving risk exposures. Methods: A 2-group randomized design was used. Fifty-eight participants with an average age of 70 were randomly assigned to the MOVE program or a no treatment control group. MOVE is a 4-session program designed to help older drivers better understand and utilize self-regulation skills for safer driving. Baseline and 4-week follow-up questionnaires were completed by both groups, after which the control group received the MOVE program. Results: In the total sample, 14 percent reported having ever been in a traffic crash where someone was injured, and 10 percent reported having received a traffic citation in the past 6 months. Almost one half of the sample (47%) reported thinking about reducing the amount of driving done at night. Nearly one third were thinking about reducing the amount of driving done in unfamiliar places (32%) and the number of miles driven each week (30%). Participants reported most frequently driving between 2 to 10 miles from home, on local roadways, and between 9:00 am and 4:00 pm. Based on responses to items that measured such driving habits, a risk exposure score was created by combining driving exposure variables. Participants were categorized into lower and higher driving risk exposure groups at baseline and follow-up. There were no statistical differences in changes in higher or lower risk driving exposure variables when comparing the 2 groups. Conclusions: Although the impact of this program on reported driving behaviors yielded null results, descriptions of older drivers’ habits and plans are informative. Because many participants were thinking about making changes to their driving habits, and many already had, the need for more effective self-regulation driving safety programs to help with this process is clear.

Kambin's Triangle Approach of Lumbar Transforaminal Epidural Injection with Spinal Stenosis

ObjectiveTo compare the short-term effect and advantage of transforaminal epidural steroid injection (TFESI) performed using the Kambin's triangle and subpedicular approaches.MethodForty-two patients with radicular pain from lumbar spinal stenosis were enrolled. Subjects were randomly assigned to one of two groups. All procedures were performed using C-arm KMC 950. The frequency of complications during the procedure and the effect of TFESI at 2 and 4 weeks after the procedure between the two groups were compared. Short-term outcomes were measured using a visual numeric scale (VNS) and a five-grade scale. Multiple logistic regression analyses were performed to evaluate the relationship between possible outcome predictors (Kambin's triangle or subpedicular approach, age, duration of symptoms and sex) and the therapeutic effect.ResultsVNS was improved 2 weeks after the injection and continued to improve until 4 weeks in both groups. There were no statistical differences in changes of VNS, effectiveness and contrast spread pattern between these two groups. No correlation was found between the other variables tested and therapeutic effect. Spinal nerve pricking occurred in five cases of the subpedicular and in none of the cases of the Kambin's triangle approach (p<0.05).ConclusionThe Kambin's triangle approach is as efficacious as the subpedicular approach for short-term effect and offers considerable advantages (i.e., less spinal nerve pricking during procedure). The Kambin's triangle approach maybe an alternative method for transforaminal epidural steroid injection in cases where needle tip positioning in the anterior epidural space is difficult.

E0361 Effect on electrolytic to combining application of calcium channel blocker (CCB) and diuretic for general hypertensives

IntroductionTo evaluate the effects of low-dose applications of dihydrochlorothiazede (DHCT) or DHCT and nitrendipine on blood pressure, heart rate, and serum electrolytes in hypertensives in Xinjiang agriculture-pasture region.MethodAdminister low dose...

Switching from Transdermal Drugs: An Observational “N of 1” Study of Fentanyl and Buprenorphine

The aim of this study was to confirm that the concomitant presence of transdermal fentanyl (TTS FE) and buprenorphine (TTS BU) may be feasible without important consequences, using doses presumed to be equianalgesic. A prospective “N of 1” study was carried out in a sample of volunteers with cancer pain receiving stable doses of TTS FE or TTS BU, with adequate pain and symptom control. In the study design, each patient provided data before and after a switch from one opioid to the other and then back to the previous one. Sixteen patients receiving daily stable doses of 0.6 or 1.2 mg of TTS FE were switched to TTS BU using an FE-BU ratio of 0.6–0.8. After three days, the TTS BU patch was removed and TTS FE patch was placed for another three days. Six patients receiving TTS BU were switched to TTS FE and then rotated back to TTS BU with the same dosing considerations. No statistical differences in changes in pain and symptom intensity during switching and between the two different sequences were observed. No significant changes in rescue doses of oral morphine were reported at the same intervals. Cancer patients receiving stable doses of TTS FE or TTS BU can be safely switched to the alternative transdermal opioid. Further studies should be performed to gather data about the use of TTS BU with other opioids, at different doses, and in different clinical conditions.

The effect of unselected post-operative nutritional supplementation on nutritional status and clinical outcome of orthopaedic patients

Background and aims: Nutritional supplements are widely administered in hospitals and can benefit clinical outcome. The aim here was to determine the effect of routine post-operative nutritional supplementation on the nutritional status and clinical outcome of adult orthopaedic patients. Methods: A prospective controlled study was conducted on two adult orthopaedic wards. Patients in the study group were prescribed two nutritional supplements/day post-operatively. Nutritional and biochemical indices and incidence of clinical complications were observed. Results: Of 181 patients studied, 14 in the supplemented group and 34 in the control ( P=0.005) developed major complications. There were 22 occurrences of major complications in the supplemented group and 55 in the control ( P=0.0002). There was no significant difference in the number of minor complications between the two groups ( P=0.2). There was no statistical difference in changes in nutritional parameters or in albumin or CRP between the two groups. There were significantly greater reductions in transferrin ( P=0.002) and in haemoglobin ( P=0.002) in the control group at week 1. The median costs of hospital stay were £2068 in the supplemented group and £2199 in the control. The median cost of additional treatments was £30.16 in the supplemented group and £46.23 in the control. Conclusion: A significant reduction in major complications and in number and costs of additional treatments was seen in the supplemented group.

A Randomized, Clinical Trial Comparing Oral Celecoxib 200 mg, Celecoxib 400 mg, and Ibuprofen 600 mg for Acute Pain

Abstract Objective: Celecoxib is a selective cyclooxygenase‐2 (COX‐2) inhibitor used to treat pain. The objective of this study was to compare the efficacies of celecoxib and ibuprofen for the treatment of acute pain. The null hypothesis was that no difference between celecoxib and ibuprofen exists. Methods: The study was a prospective, randomized, double‐blind, controlled clinical trial. After consent, patients rated their pain on a 100‐mm visual analog scale (VAS) and categorical intensity pain scale. Patients were then randomized to receive 200‐mg or 400‐mg celecoxib or 600‐mg ibuprofen (all orally). Patients were contacted 5 hours after receiving study medication when a second VAS score was recorded, along with categorical pain intensity, pain relief score, side effects, and number of rescue medications taken. The main outcome measures were change in visual analog pain and categorical pain intensity scores, and pain relief scores, at five hours. Results: One hundred ten patients were evaluated and 105 were enrolled. Thirty‐four received celecoxib 200 mg, 32 received celecoxib 400 mg, and 39 received ibuprofen 600 mg. Ninety‐one were available for the five‐hour VAS and 88 for the five‐hour categorical pain intensity and pain relief analysis: The two patients who were unable to read a VAS were excluded, and two enrolled patients withdrew prior to medication. One patient was excluded because his injury was a fracture, and therefore did not meet the inclusion criteria. There was no statistical difference among the treatment groups in age, time from injury to medication, initial VAS score, percent lost to follow‐up, or treatment with adjunctive therapy. There was no statistical difference in change of VAS among the groups at five hours: ibuprofen 600 mg (‐23.8 mm [95% CI = ‐31.56 mm to ‐16.1 mm] [n = 32]), celecoxib 200 mg (‐16.1 mm [95% CI = ‐24.3 mm to ‐7.98 mm] [n = 31]), and celecoxib 400 mg (‐12.4 mm [95% CI = ‐23.1 mm to ‐1.8 mm] [n = 30]) (p = 0.16). There was no significant difference between the groups, at five hours, in change of categorical pain intensity (p = 0.11) or pain relief scores (p = 0.059), though the pain relief scale approached significance favoring ibuprofen. Conclusions: No significant difference exists among emergency department (ED) patients treated for acute pain, at five hours, with celecoxib 200 mg, celecoxib 400 mg, or ibuprofen 600 mg, though the power of the study to detect a change was low, 36%. However, the magnitude of pain relief for celecoxib, coupled with the cost of the medication, questions its use in the immediate ED setting.

Comparative study of the efficacy of a self-help group for women following mastectomy using an investigator-generated attitude scale

s from C-L Forum visits to a medium. Further study is warranted to understand the relationship between nontraditional and traditional care and to identify ways of meeting patients’ cultural expectations within the traditional system. Comparative Study of the Efficacy of a Self-Help Group for Women Following Mastectomy Using an Investigator-Generated Attitude Scale S. Pimentel, 1. Romero, M. C. Cuevas National Cancer Instittlfe, Mexico City, DF Studies have shown the importance of an adequate rehabilitation program during the pre-, transand posttreatment phases of breast cancer. However, there are very few studies showing the efficacy of the role of patients as part of a therapeutic team through a self-help group. This study examined the efficacy of a mastectomy self-help group (RETO) through positive attitudinal changes. We examined statistical differences in attitudes between two groups of women after mastectomy: an experimental group that actively participated through RET0 and a control group that did not participate in RETO. To monitor changes in attitudes, we developed an instrument that measured attitudes using a semantic differentiation in seven specific attitudinal areas. The development of the instrument took 2 years, beginning with 250 items. Through five trials, we obtained a total of 56 items which covered the seven areas, with an internal consistency that makes the instrument reliable for our Mexican population. A group of 60 patients with breast cancer who were scheduled to undergo surgery was chosen, age range 20-80. Two groups of 30 each were randomly selected. The same questionnaire was applied twice to the patients at different intervals: immediately after the diagnosis and a month after surgery. Only the experimental group participated in the regular meetings once a week and had the opportunity to be assisted by a member of RETO. Results to be presented are the statistical differences in change of attitudes in both groups in six of the seven areas studies. Impaired Cognitive Functions in Chronic Pain Conditions: Comparing Common “Whiplash” with Nontraumatic Cervical Spine Syndrome B. P. Radanov, G. DiStefano, 1. Hirlinger Department of Psychiatry, University of Bern, Bern, Switzerland Fifty-eight patients suffering from common “whiplash” (group wp) were compared with 35 patients complaining of cervical pain caused by rheumatism (group rh). Groups were comparable in regard to age, sex, and educational attainment, but differed regarding the length of the painful condition; the rh group suffered much longer. Patients underwent clinical psychiatric interview and formal testing which included personality profile, self-rating of cognitive impairment, and well-being. Tasks assessing divided attention and speed of information processing were administered. Clinical diagnosis revealed a relatively high incidence of adjustment disorder with mixed emotions (DSM-III-R 309.28) in group wp. Results on formal testing indicated marked reduction in divided attention in both groups, whereas the speed of information processing was almost unaffected. Differences between the groups were found with regard to self-rated cognitive impairment and well-being. In both tests, group rh indicated no particular problems whereas group wp suffered from gross impairment. On personality profile, group wp scored high on dimension “nervousness,” indicating considerable somatic discomfort. On other personality dimensions no differences were found between the groups, both groups also being comparable to statistical normals. Results indicated a significance of cervical spine pathology for attentional functioning for which the pain might be the central issue. Despite comparable results on formal testing of cognitive functions, groups differed in subjective cognitive impairment and in well-being. This difference could be assumed to reflect the mode in which the compared conditions developed: In group rh, the cervical pathology causing pain (and attentional impairment) developed gradually, giving the patient the possibility to adapt. In group wp, cervical pathology emerged abruptly by the impact injury. An adaptation was not possible, and thus led to problems in coping with the impairment, explaining in particular psychopathological changes.

Outcome of Pregnancy in Patients With Systemic Lupus Erythematosus

A prospective study was performed to investigate the outcome and complications of pregnancy in patients with systemic lupus erythematosus. Twenty-nine pregnancies occurred in 22 patients. There were 12 abortions, two spontaneous and 10 induced. Fifteen women had 17 live-born neonates. Neonatal complications included nine premature deliveries, two cases of intrauterine growth retardation, and one of Treacher Collins syndrome. Obstetric complications included threatened abortion (two), placenta previa (two), and preeclampsia (three). Cesarean sections were necessary in five patients. There was no maternal or neonatal mortality. Thirteen episodes of systemic lupus erythematosus relapses were detected by incidents of increasing proteinuria (six), arthritis (four), and vasculitic rash (two). There were no statistical differences in changes in hemoglobin level, erythrocyte sedimentation rate, albumin level, antinuclear antibody titer, or C3 or C4 level between the patients who relapsed and those who did not. Pregnancy could induce a flare of systemic lupus erythematosus in previously normal patients or patients with previously inactive disease. The overall neonatal and maternal survival was good, even in patients who presented during pregnancy. Spontaneous fetal loss was low (2/29 [6.9%]); both cases occurred in mothers with inactive lupus. (<i>Arch Intern Med.</i>1991;151:269-273)

Outcome of pregnancy in patients with systemic lupus erythematosus. A prospective study

A prospective study was performed to investigate the outcome and complications of pregnancy in patients with systemic lupus erythematosus. Twenty-nine pregnancies occurred in 22 patients. There were 12 abortions, two spontaneous and 10 induced. Fifteen women had 17 live-born neonates. Neonatal complications included nine premature deliveries, two cases of intrauterine growth retardation, and one of Treacher Collins syndrome. Obstetric complications included threatened abortion (two), placenta previa (two), and preeclampsia (three). Cesarean sections were necessary in five patients. There was no maternal or neonatal mortality. Thirteen episodes of systemic lupus erythematosus relapses were detected by incidents of increasing proteinuria (six), arthritis (four), and vasculitic rash (two). There were no statistical differences in changes in hemoglobin level, erythrocyte sedimentation rate, albumin level, antinuclear antibody titer, or C3 or C4 level between the patients who relapsed and those who did not. Pregnancy could induce a flare of systemic lupus erythematosus in previously normal patients or patients with previously inactive disease. The overall neonatal and maternal survival was good, even in patients who presented during pregnancy. Spontaneous fetal loss was low (2/29 [6.9%]); both cases occurred in mothers with inactive lupus.

Convulsive syncope in blood donors.

Syncope with and without convulsion was studied in unselected blood donors in a community blood center. Convulsive syncope occurred in 0.03% of all blood donors and was more commonly observed when nursing personnel were alerted to its possible occurrence. It was more common in men. Although tonic extensor spasm was the most common convwithout convulsion was studied in unselected blood donors in a community blood center. Convulsive syncope occurred in 0.03% of all blood donors and was more commonly observed when nursing personnel were alerted to its possible occurrence. It was more common in men. Although tonic extensor spasm was the most common convwithout convulsion was studied in unselected blood donors in a community blood center. Convulsive syncope occurred in 0.03% of all blood donors and was more commonly observed when nursing personnel were alerted to its possible occurrence. It was more common in men. Although tonic extensor spasm was the most common convulsive movement, other complex convulsive phenomena occurred, some simulating epileptic seizure. No statistical difference in changes of pulse or blood pressure was found between subjects with convulsive versus nonconvulsive syncope. Similarly, no difference was found between subjects with tonic spasm and those with other convulsive phenomena, nor between those with "early" and those with "delayed" reactions. Marked individual variation may exist in the susceptibility of the central nervous system to ischemia. Some individuals appear to be predisposed to development of seizures in situations of global cerebral ischemia such as occur in hypotension and bradycardia.