Effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy

Aim: To determine the effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy. Methods: Consecutive patients who underwent capsule endoscopy during the 16-mo study period were either given 250 mg oral erythromycin, 1 h prior to swallowing the capsule endoscope or nothing. The gastric and small bowel transit time, and the small bowel image quality were compared. Results: Twenty-four patients received oral erythromycin whereas 14 patients were not given any prokinetic agent. Patients who received erythromycin had a significantly lower gastric transit time than control (16 min vs 70 min, P = 0.005), whereas the small bowel transit time was comparable between the two groups (227 min vs 183 min, P = 0.18). Incomplete small bowel examination was found in three patients of the control group and in one patient of the erythromycin group. There was no significant difference in the overall quality of small bowel images between the two groups. A marked reduction in gastric transit time was noted in two patients who had repeat capsule endoscopy after oral erythromycin. Conclusion: Use of oral erythromycin significantly reduces the gastric transit time of capsule endoscopy. © 2005 The WJG Press and Elsevier Inc. All rights reserved.published_or_final_versio

Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures

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Androgen deprivation therapy and fracture risk in Chinese patients with prostate carcinoma

OBJECTIVE: Androgen deprivation therapy (ADT) increases fracture risk in men with carcinoma of the prostate, but little is known about the fracture risk for different types of ADT. We studied the fracture risk amongst Chinese patients with carcinoma of the prostate prescribed different ADT regimens. SUBJECTS AND METHODS: This was a single-centered observational study that involved 741 patients with carcinoma of the prostate from January 2001 to December 2011. RESULTS: After a median follow-up of 5 years, 71.7% of the study cohort received ADT and the incidence rate of fracture was 8.1%. Multivariable Cox regression analysis revealed that use of ADT was significantly associated with risk of incident fracture (Hazard Ratio [HR] 3.60; 95% Confidence Interval [95% CI] 1.41-9.23; p = 0.008), together with aged >75 years and type 2 diabetes. Compared with no ADT, all three types of ADT were independently associated with the risk of incident fracture: anti-androgen monotherapy (HR 4.47; 95% CI 1.47-13.7; p = 0.009), bilateral orchiectomy ± anti-androgens (HR 4.01; 95% CI 1.46-11.1; p = 0.007) and luteinizing hormone-releasing hormone agonists ± anti-androgens (HR 3.16; 95% CI 1.18-8.43; p = 0.022). However, there was no significant difference in the relative risks among the three types of ADT. CONCLUSIONS: Fracture risk increases among all types of ADT. Clinicians should take into account the risk-benefit ratio when prescribing ADT, especially in elderly patients with type 2 diabetes.published_or_final_versio

A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity

Non-steroidal anti-inflammatory drugs (NSAIDs) represent a diverse class of drugs and are among the most commonly used analgesics for arthritic pain worldwide, though long-term use is associated with a spectrum of adverse effects. The introduction of cyclooxygenase-2-selective NSAIDs early in the last decade offered an alternative to traditional NSAIDs with similar efficacy and improved gastrointestinal tolerability; however, emerging concerns about cardiovascular safety resulted in the withdrawal of two agents (rofecoxib and valdecoxib) in the mid-2000s and, subsequently, in an overall reduction in NSAID use. It is now understood that all NSAIDs are associated with some varying degree of gastrointestinal and cardiovascular risk. Guidelines still recommend their use, but little is known of how patients use these agents. While strategies and guidelines aimed at reducing NSAID-associated complications exist, there is a need for evidence-based algorithms combining cardiovascular and gastrointestinal factors that can be used to aid treatment decisions at an individual patient level

Peptic-ulcer disease

The discovery of Helicobacter pylori has greatly changed our approach to peptic ulcer disease. Bacterial, host, and environmental factors all have a role in peptic-ulcer disease. Although the prevalence of uncomplicated peptic ulcers is falling, hospital admissions for ulcer complications associated with non-steroidal anti-inflammatory drugs (NSAIDs) are rising. Evidence suggests that coprescription of NSAIDs with potent antiulcer agents and the use of highly selective cyclo-oxygenase-2 inhibitors reduce gastroduodenal ulceration. Whether these therapeutic advances will translate into clinical benefits remains to be seen. The interaction between H pylori and NSAIDs is one of the most controversial issues in peptic ulcer disease. With the fall in rates of H pylori infection, the proportion of ulcers not related to this organism and NSAIDs has risen, which will affect the management of peptic ulcer.link_to_subscribed_fulltex

Fixation of Distal Humeral Fracture in elderly patients by Locking Compression Plating Technique

Oral PresentationSession: Shoulder and elbow: humerus and elbow fracturesFractures involving the distal part of the humerus are difficult to treat. These fractures are even worse in elderly patients with osteoporotic bone. Stable internal fixation is a pre-requisite for early mobilisation and therefore to have a better functional result. Locking compression plate is thought to be beneficial for fracture fixation with osteoporotic bone. The results of fracture distal humerus fixation by LCP in elderly patients were reviewed. From October 2001 to March 2006, 33 patients older than 60 years old with distal humerus fracture had been treated in our unit by using a locking compression plate. Those fractures involving an isolated capitellum or trochea fracture were excluded from our study. The results of this fixation were evaluated.29 patients were available for review. 34% fracture had intra-articular involvement. The mean time to follow-up was 26 months (12 months to 72 months). The average range of motion was 91 degrees (ranged 60-150 degree). Complications included delay union, wound infection and ulna nerve symptoms were encountered. No implant related problems were noticed.Locking compression plate could provide a stable internal fixation for osteoporotic fracture involving the distal humerus. Good result and low complication rate can be achieved

鎖定加壓鋼板內固定治療老年肱骨遠端骨折(英文)

目的探討鎖定加壓鋼板(locking compression plate,LCP)內固定治療老年肱骨遠端骨折的療效。方法2005年1月-2007年12月,采用切開復位LCP內固定治療肱骨遠端骨折24例。男4例,女20例;年齡60～93歲,平均75.5歲。致傷原因:摔傷22例,交通傷1例,擊打傷1例。其中左側及右側各12例。按AO/ASIF分型:A2型12例,A3型2例,B1型2例,C1型2例,C2型2例,C3型4例。所有患者術前均攝正側位X線片;CT三維重建診斷C型粉碎性骨折。受傷至手術時間1～6d,平均3d。術中經肱三頭肌兩側入路(B型骨折患者除外),切開復位后LCP內固定肱骨遠端骨折;C3型骨折患者行尺骨鷹嘴截骨。觀察術后并發癥發生情況,并于術后12個月行疼痛及肘關節活動度評定,并采用Mayo肘關節功能評分評價肘關節功能。結果術后24例患者均獲隨訪,隨訪時間12～48個月,平均25個月。骨折均于6個月內愈合,平均4個月。術后12個月,20例(83%)無疼痛,4例(17%)中度疼痛;20例(83%)肘關節屈曲>100°;A、B、C型骨折Mayo肘關節功能評分平均分別為97、85、89分;A型骨折與B、C型骨折評分差異有統計學意義(P=0.034)。4例(17%)術后出現并發癥。結論切開復位LCP內固定治療老年肱骨遠端骨折,術后肘關節功能恢復較好,骨折可達骨性愈合。OBJECTIVE: To review the outcomes of geriatric distal humeral fracture fixed with locking compression plate (LCP). METHODS: From January 2005 to December 2007, 24 patients (20 females and 4 males) with distal humeral fracture underwent open reduction and internal fixation with LCP. Their average age was 75.5 years old, ranged from 60 to 93 years old. Fracture was caused by injury from fall in 22 cases, by traffic accident in 1 case, and by direct hit in 1 case. There were 12 cases of type A2, 2 cases of type A3, 2 cases of type B1, 2 cases of type C1, 2 cases of type C2, 4 cases of type C3 fractures according to AO/ASIF classification. X-ray films in AP and lateral view were taken preoperatively. CT scan with three dimensional reconstructions was done in more comminuted fracture only. Open reduction with triceps sparing technique was used in all except type B fracture, and olecranon osteotomy was considered only in more comminuted C3 fracture. The average interval between injury and operation was 3 days (range, 1-6 days). Outcome measures included pain assessment, range of motion, and Mayo elbow performance score and findings at 1 year follow-up. RESULTS: The average length of follow-up was 25 months (range, 12-48 months). All 24 fractures were healed within 6 months with an average of about 4 months. At 1 year follow-up, 83% (n = 20) of patients felt no pain and 17% (n = 4) of patients had mild pain; 83% of patient can gain a flexion range of more than 100 degrees; according to Mayo elbow performance score, the mean scores of type A, B and C fracture groups were 97, 85, and 89, respectively, and the post-operative performance of type A fracture was significantly better than that of type B and C (P = 0.034). Four patients had postoperative complications. CONCLUSION: Open reduction and internal fixation of geriatric distal humeral fracture can achieve relatively good functional result and bony union despite of age.link_to_subscribed_fulltex

Analysis of IEEE 802.11b wireless security for university wireless LAN design

Wireless Local Area Network has been very popular nowadays especially in public places like shopping malls, airports, coffee cafes, hotels and in universities. However, many people that implemented the WLAN have not been concerned with the wireless security issues that expose their network to dangerous intruders. This paper aims to explain the analysis of wireless security issues based on IEEE802.11b standard with practical implementation and attacks with security suggestions. The WLAN test bed was implemented at the Swinburne University iSECURES research lab for further planning and design of the University WLAN