British medical journal (Clinical research ed.)
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Br Med J (Clin Res Ed) · Aug 1983
Randomized Controlled Trial Clinical TrialAcyclovir prophylaxis against herpes virus infections in severely immunocompromised patients: randomised double blind trial.
Twenty patients undergoing allogeneic bone marrow transplantation and 39 patients receiving remission induction chemotherapy for acute leukaemia were entered into a double blind, placebo controlled stratified trial of acyclovir prophylaxis against herpes group virus infections. Within the transplant group intravenous acyclovir 5 mg/kg twice daily given throughout the period of granulocytopenia completely prevented oropharyngeal herpes simplex virus infection compared with a 50% incidence in the placebo arm (p = 0.033). The acyclovir group also had fewer days of fever during the trial and a shorter duration of leukopenia, possibly because of the prevention of herpes simplex virus infections. ⋯ One patient (transplant group) developed a cytomegalovirus infection while receiving acyclovir. Acyclovir provides effective prophylaxis against oropharyngeal and oesophageal herpes simplex virus infection in severely immunocompromised seropositive (greater than or equal to 1/8) patients. In patients given bone marrow transplants this may have the additional benefit of reducing the time to recovery of an adequate blood count and the number of days of fever.
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Criteria for transferring head injured patients to a regional neurosurgical unit were changed to enable a larger proportion of patients admitted to primary surgical wards to have a CT scan. The yearly number of transfers doubled, more intracranial haematomas were detected, and mortality from this complication was reduced. To operate such a policy requires seven neurosurgical beds per million for head injuries, given the Glasgow practice of early return of patients to primary surgical wards.