QJM : monthly journal of the Association of Physicians
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Randomized Controlled Trial Clinical Trial
A pilot study of streptokinase for acute cerebral infarction.
We evaluated intravenous streptokinase in the treatment of cerebral infarction. Following neurological assessment and cerebral computed tomography (CT), patients aged 40-80 years with symptoms of anterior circulation acute ischaemic stroke were given 1.5 M units streptokinase or saline placebo in a double-blind randomized study. Twenty patients (10 streptokinase, 10 placebo), 11 males, 9 females, aged 57-79 years, were treated out of 512 consecutive admissions to the acute stroke unit over a 2-year period. ⋯ There were three deaths in each treatment group, all within the first 14 days. Patients with acute stroke can be evaluated with CT and treated with streptokinase within 6 h, but the opportunity for treatment is currently limited to few patients. Streptokinase treatment is not without risk, but potential clinical benefit justifies ongoing multicentre randomized trials.
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Pruritus is a challenging clinical problem which often complicates chronic cholestatic liver disease. For practical purposes, cholestasis may be defined as impaired hepatocellular secretion of bile and is a feature of a wide variety of liver diseases. Cholestasis is usually suspected clinically when a patient presenting with jaundice or pruritus is found to have an elevation in serum alkaline phosphatase activity disproportionate to increases in serum aminotransferase levels. ⋯ The majority of patients who develop problematic pruritus due to chronic cholestasis will have one of several diseases: primary biliary cirrhosis, primary sclerosing cholangitis, drug-induced cholestasis, autoimmune chronic active hepatitis, or alcoholic liver disease. Specific aetiological diagnosis is usually possible when history and physical examination are complemented, as appropriate, by serological testing, hepatobiliary imaging, and liver biopsy. This review does not address issues in diagnosis, but concentrates upon the management of pruritus, a potentially disabling complication of prolonged cholestasis.
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Randomized Controlled Trial Comparative Study Clinical Trial
A double-blind comparison of bisoprolol and atenolol in patients with essential hypertension.
We compared the beta 1-selective adrenoceptor antagonists bisoprolol and atenolol in a double-blind, randomized crossover study. After 4 weeks placebo phase, 59 patients with essential hypertension received either 10 mg bisoprolol or 50 mg atenolol once daily for 8 weeks, increased if necessary (target BP < or = 150/90 mmHg) to 20 and 100 mg, respectively, after 4 weeks. After a second placebo phase, crossover occurred to the alternative drug. ⋯ Bisoprolol reduced heart rate significantly more than atenolol (p < 0.01), but systolic and diastolic blood pressure changes were not different between the two drugs. There was no difference in patient acceptability of the drugs as assessed by visual analogue scale. Despite theoretical and circumstantial evidence to suggest superiority of bisoprolol over atenolol, no significant difference between the two was found except for greater heart rate reduction with bisoprolol.