A double-blind crossover study is described of the effect of beclomethasone dipropionate aerosol spray in patients with recurrent (minor) aphthous oral ulceration. Patients included in the study had normal haematological parameters of haemoglobin, ferritin, vitamin B12 and corrected whole blood folate. The design of the study incorporated a washout period and duration of effect was evaluated up to six months. Beclomethasone dipropionate significantly reduced ulcer pain severity and ulcer frequency, but had no significant effect on recurrence of oral ulceration. The preparation was associated with a high patient compliance and has benefit in relieving symptoms in patients with recurrent minor aphthous ulceration.
Water and methanol extracts of ninety weed and crop species were bioassayed at 3,30 and 300 ppm by weight for their effect on turnip (Brassica rapa L. 'Purple Top') root growth. Eighteen species were significantly inhibitory and six species were significantly stimulatory to turnip root growth. Several species showing activity were chosen for further chemical and biological investigation. Coumarin, o-coumaric acid and melilotic acid were found to be the major active compounds in white sweet clover (Melilotus alba Desr.). Investigation of related compounds showed that activity was inhanced by increasing the side chain length and by inserting ortho-substituted hydroxyl groups, while blockage of the ortho-hydroxyls decreased activity. Rhizome exudates and pure compounds identified in johnsongrass (Sorghum halapense (L.) Pers.) were active against radish (Raphanus soliocus L.) and tomato (Lycopersicon asculentum Miller) root growth as well as growth of nine bacterial species. Leaf extracts and leachates of Illinois bundleflower (Desmanthus illinoensis (Michaux) MacM.) were active against radish and tomato root growth, bacterial growth and tobacco and tomato root growth, bacterial growth and tobacco budworm (Heliothis virescens F.) larval growth. Leaf extract activity varied widely due to the physiological age of the plant.Ninety weed and crop species common to the southeastern U. S. were tested for phytotoxin content to discover candidates for an allelopathy testing program. Plants were collected in the spring, summer and fall in a three county area of northeastern Mississippi. Plants were maintained in sealed plastic ^Current address: Ciba-Geigy AG, CH-04002, Basel, Switzerland This chapter not subject to U.S.
A 77-year-old South Asian man presented to the acute admissions service with a one-month history of progressive, left-sided facial weakness and left-sided mandibular and pre-auricular pain. A diagnosis of Bell's palsy was made. He was receiving ongoing treatment for ipsilateral otitis externa with topical tri-adcortyl ointment. His medical history included end-stage renal disease (ESRD) of uncertain cause, treated with hospital haemodialysis; poorly controlled insulin-treated type 2 diabetes mellitus; ischaemic heart disease; and gout.Unfortunately, the patient's symptoms continued to deteriorate and he was admitted to renal services from the haemodialysis unit. On examination he had periauricular tenderness and purulent discharge from the left auditory canal and associated conductive hearing loss. There was a left lower motor neurone facial palsy, with grade III upper division involvement and grade IV lower division involvement (House-Brackmann classification).1 Other cranial nerves were spared. Inflammatory markers were mildly elevated with a C-reactive protein of 71 mg/l. Glycosylated haemoglobin (HbA1c) of 10.7% reflected recent poor glycaemic control. Left-sided otoscopy revealed posteroinferior perforations of the tympanic membrane, with debris and mucopurulent discharge on the left, and pure-tone audiometry confirmed conductive deafness. A contrast-enhanced computerised tomography (CT) scan demonstrated soft tissue thickening in the external auditory canal and a 2.7 x 1.3 cm mass below the left skull base, engulfing the carotid artery and severely compressing the internal jugular vein. The mass extended through the parapharyngeal space onto the lateral pterygoid and deep temporalis muscles (Figure 1). Auricular swabs grew Aspergillus flavus and Proteus mirabilis.A diagnosis of necrotising (malignant) otitis externa (NOE) was made. The patient was treated for a total of six weeks with systemic agents and localised intraauricular ribbon gauze. He completed four weeks of intravenous meropenem (1 g once daily), combined with oral ciprofloxacin (250 mg twice daily) and voriconazole (400 mg mane, 200 mg nocte). Thereafter he continued with a further two weeks of oral ciprofloxacin and voriconazole. Doses were adjusted for the renal impairment and haemodialysis requirements. Topical ribbon gauze soaked with amphotericin and nystatin was administered daily over this period. The initial treatment was based upon the likelihood that Pseudomonas is the usual causative agent, and that resistant strains of Pseudomonas are increasingly prevalent. Culture results guided treatment thereafter.Two months later the facial nerve palsy was improving so that the lower division involvement had reduced to grade II weakness. Otoscopy confirmed reduced suppurative discharge with ongoing dry perforation of the tympanic membrane. Follow-up CT scans at three months and then seven months from diagnosis showed continuing improvement (Figure 2). DISCUSSIONThis case highlights a number of key learning points. The ESRD and diabetic populat...
BACKGROUND: It is estimated that one third of women in the United States opt for permanent tubal sterilization at the time of cesarean delivery. Evidence suggests that ovarian cancer begins in the fallopian tubes. Ovarian cancer has the highest mortality of all gynecologic malignancies. There is no proven effective screening for ovarian cancer. In view of this, the Royal College of Obstetricians & Gynecologists and the American College of Obstetricians and Gynecologists recommend considering counseling patients about prophylactic salpingectomy as an effective method of sterilization. There are limited well designed clinical trials that compare the safety and feasibility of total salpingectomy to that of traditional partial salpingectomy for tubal sterilization at the time of cesarean delivery. METHODS: We conducted a non-inferiority randomized controlled trial at the Mayo Clinic, Rochester, Minnesota. Women age 21 years and older who were undergoing cesarean delivery and desired concomitant sterilization were enrolled between May 17, 2017 and July 16, 2018. Stratified randomization was performed based on number of previous cesarean deliveries and their Basal Metabolic Index, into a bilateral total salpingectomy group and bilateral partial salpingectomy group. All salpingectomies were performed using clamps and suture. The primary outcome was to compare the mean peri-operative hemoglobin change for both groups. Secondary objectives included sterilization completion time, postoperative length of stay, estimated blood loss, postoperative pain and adverse events. RESULTS: Of the 111 women screened, 40 were enrolled and randomized. Of these, 38 underwent the assigned procedure (18 BTS, 20 BPS). There were no demographic differences between groups. No difference in Mean ±SD hemoglobin drop between groups (1.4±0.7 g/dl for the BTS group and 1.8±1.0 g/dl for the BPS group, p=0.08). Mean time to completion of sterilization procedure was significantly longer in the BTS group (16.3±5.6 minutes for the BTS group vs 5.1±1.6 minutes for the BPS group, p < .01). No significant differences for other outcome measures.CONCLUSIONS: Bilateral total salpingectomy at the time of cesarean delivery does not increase the risk for blood loss and has similar peri-operative outcomes, with a small increase in operative time when compared to traditional bilateral partial salpingectomy. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03135431, 27/04/2017
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