In patients with acute abdominal pain seen in the emergency department, a negative dipstick test for urinary trypsinogen-2 rules out acute pancreatitis with a high degree of probability. A positive test usually identifies patients in need of further evaluation.
Vascular endothelial growth factor (VEGF) is an important regulator of angiogenesis and vascular permeability. Many types of malignant human tumors have been shown to produce VEGF. Recently, increased serum concentrations of VEGF (S-VEGF) have been reported in patients with various types of cancer, and high S-VEGF levels have also been associated with unfavorable prognosis. We have now measured S-VEGF in sera taken from 105 patients with a benign breast tumor or breast cancer. None of the women with a benign breast tumor had S-VEGF higher than 328 pg/ml (median, 57 pg/ml) whereas S-VEGF levels in metastatic breast cancer ranged from 7 to 1347 pg/ml (median, 186 pg/ml; P = 0.0018), and in locoregional breast cancer from 11 to 539 pg/ml (median, 104 pg/ml; P = 0.13). S-VEGF was higher in patients with locoregional ductal cancer (median, 107 pg/ml) than in those with locoregional lobular cancer (median, 44 pg/ml; P = 0.029) or in patients with benign breast tumor (median, 57 pg/ml; P = 0.033). Patients with metastatic cancer undergoing therapy had lower S-VEGF than those who had symptomatic treatment only (P = 0.021). The results indicate that dissemination of breast cancer may be accompanied by an elevation of circulating VEGF and that primary ductal cancers are associated with higher S-VEGF levels than lobular cancers or benign breast lesions.
Purpose: To compare the postoperative analgesic effects of 50 mg diclofenac po before surgery and intra-articular ropivacaine injected after diagnostic day-case knee arthroscopy performed under spinal anesthesia.Methods: In a randomized, double-blind investigation, 200 ASA physical status 1-2 outpatients, age 18-60 yr, received either 50 mg diclofenac po or placebo one hour before operation (100 patients per group), and intraarticular injections of either 20 ml of ropivacaine 0.5% or 20 ml of saline 0.9% (50 patients in each premedication groups). Patients received 50 mg diclofenac po prn and, if needed, 0.1 mg·kg -1 oxycodone im for postoperative pain relief. Patients were discharged home with a supply of 50 mg diclofenac tablets and were given a sheet of paper with knee pain VAS scales and a questionnaire of analgesics taken. Patients rated their VAS scores eight hours after surgery and in the morning and at the end of the first and the second postoperative days, respectively.Results: The only statistically significant difference was found when the diclofenac groups were combined and compared with the combined placebo premedication groups. The VAS scores of knee pain at eight hours after the operation were 19 ± 22 in the two diclofenac premedication groups and 32 ± 28 in the two placebo groups (P=0.001).Conclusions: Diclofenac premedication po reduced the VAS scores at eight hours postoperatively while intraarticular ropivacaine did not.Objectif : Comparer les effets analgésiques postopératoires de 50 mg de diclofénac po, administrés avant l'opération, à la ropivacaïne intra-articulaire, donnée après l'arthroscopie diagnostique sous rachianesthésie.Méthode : Lors d'une étude randomisée et en double aveugle, 200 patients d'état physique ASA I-II, âgés de 18-60 ans, ont reçu 50 mg de diclofénac po ou un placebo une heure avant l'opération (100 patients par groupe), et une injection intra-articulaire de 20 ml de ropivacaïne 0,5 % ou 20 ml de solution salée 0,9 % (50 patients dans chaque groupe de prémédication). Les patients ont reçu 50 mg de diclofénac po prn et, si nécessaire, 0,1 mg·kg -1 d'oxycodone im pour soulager la douleur postopératoire. À leur départ, ils ont reçu des comprimés de 50 mg de diclofénac, un questionnaire concernant la prise d'analgésiques et une feuille de papier où inscrire le niveau de douleur au genou selon l'EVA. Les patients ont estimé leurs scores à l'EVA huit heures après l'opéra-tion et au début et à la fin du premier et du deuxième jours postopératoires, respectivement.Résultats : La seule différence statistique significative a été trouvée en combinant les groupes de diclofénac et en les comparant aux groupes combinés de prémédication placebo. Les scores postopératoires de l'EVA ont été de 19 ± 22 dans les deux groupes qui ont reçu une prémédication de diclofénac et de 32 ± 28 dans les groupes qui ont reçu le placebo (P=0,001). Conclusion :La prémédication au diclofénac po a réduit les scores postopératoires de l'EVA à huit heures, mais non pas la ropivacaïne intra-articulaire.
Background and ObjectivesWe wanted to establish a permanent national database system, which can be utilized to study transfusion recipients and blood use in Finland. Materials and MethodsA regularly updated register for permanent use was developed. To study the usability of the database, years 2002 and 2003 were further analysed. Database included all transfused patients in major blood-transfusing hospitals from four university and five central hospital districts managing altogether 63% of Finnish inpatient hospital episodes.Results Audit of gathered data reveal 96·8% match in adult blood components with Finnish Red Cross, Blood Service sales figures. Model data set includes 59 535 transfused patients (44·3% men and 55·7% women) having received 529 104 blood components. Half of all blood units were transfused in connection with surgical operations. Most of the blood recipients were elderly (51·6% are over 64 years of age). Blood-component use and transfusion-related costs varied widely between hospitals.Conclusion Hospital data managing systems can be useful for creating a populationbased database system to monitor and compare transfusion practices. This record provides information about transfusion epidemiology for transfusion professionals, hospital management, and hospital administration.
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