Annals of clinical research
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Comparative Study
Effect of the left lateral recumbent position compared with the supine and upright positions on placental blood flow in normal late pregnancy.
The placental blood flow was assessed by the 99mTc accumulation method in 10 normal pregnancies in the left lateral recumbent position accomplished by a 15 degree wedge and in the supine position. The postural change caused a 17% decrease in the mean placental accumulation rate, which was not statistically significant. ⋯ Other haemodynamic variables studied were the maternal heart rate and the systolic and diastolic blood pressures. The clinical significance of the haemodynamic changes produced by alterations in posture are briefly discussed.
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The severity of coronary atherosclerosis at autopsy was studied in two series comprising 169 cases of coronary death and 231 people who died of violent causes. In the former the fatal attack lasted less than 24 hours from the onset of symptoms in 70% of cases. In only three men did the terminal attack last more than 24 hours, while in the remaining 28% of cases, although death was not witnessed these were also likely to have been sudden deaths. ⋯ Raised lesions in coronary patients were calcified to about the same extent as those in persons ten years older in the series of violent deaths. Coronary atherosclerosis was most severe in coronary patients who had had symptomatic heart disease and had an old myocardial infarct and least severe in those in whome sudden death was the first manifestation of coronary heart disease from violent deaths as regards the extent of the raised lesions or prevalence of occlusion. The degree of coronary stenosis in coronary patients was closely related to the total extent of advanced coronary atherosclerosis.
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A study of rheumatic fever in adult patients (diagnosed according to the Jones revised criteria; Circulation 36: 664, 1965) was performed by examining 26 patients during the acute phase of the disease, and by re-examining 22 of them from 6 months to 64 months later (mean 33 months). Polyarthritis and carditis were the most common major manifestations. 23 patients had polyarthritis and 3 monoarthritis. 18 patients had signs of acute cardiac involvement. Carditis appeared to be rather benign: at the acute stage no patient developed congestive heart failure or any other serious complication. ⋯ Of the 22 patients examined in the follow-up study, 4 had persistent signs of cardiac involvement and 15 showed chronic joint manifestations. Yersinia enterocolitica infection was by far the most difficult differential diagnostic problem, since polyarthritis and carditis associated with this enteric infection were very similar to those in patients with rheumatic fever. Current literature on rheumatic fever and the results of this series suggest that the diagnostic criteria of rheumatic fever (Jones) should be re-evaluated, at least in industrial countries.
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
A controlled clinical trial of chlormezanone, orphenadrine, orphenadrine/paracetamol and placebo in the treatment of painful skeletal muscle spasms.
Four hundred patients with painful muscle spasm caused by five common musculoskeletal diseases were included in a double-blind controlled trial of chlormezanone, orphenadrine, orphenadrine/paracetomol and placebo. Patients were treated for one week and then asked for their subjective assessment of the treatment. Fifty-three per cent improved on placebo, 57 percent on chlormezanone, 66 percent on orphenadrine and 71 percent on orphenadrine/paracetamol. There was no significant difference between chlormezanone and placebo, but orphenadrine appeared to have a beneficial effect, presumably because of its muscle relaxant activity.