Endovascular treatment of intractable epistaxis — results of a 4-year local audit

Objective. Transcatheter embolisation is an accepted and effective treatment for intractable epistaxis. We analysed our success and complication rates and compared these with results from other published series. Design. Retrospective review. Setting. Unitas Interventional Unit, Centurion. Methods. Case record review (57 procedures) and telephonic interviews (36 traceable respondents). Outcome measures. A numerical audit of the success and complication rates for embolisation procedures performed during the 4-year period between July 1999 and June 2003. Results. A total of 57 endovascular embolisation procedures were performed for intractable epistaxis in 51 patients during this period. Eight patients (15.7%) developed a re-bleed between 1 and 33 days after embolisation, of whom 5 were reembolised, giving a primary short-term success rate of 86.3% and secondary assisted success rate of 94.1%. Thirty-five of 36 respondents (97.2%) reported no further epistaxis during the long-term follow-up period of 1 - 47 months. The mortality rate was 0%, the major morbidity rate was 2% (1 stroke) and the minor morbidity rate was 25%. Conclusion. Our success and complication rates are acceptable and compare favourably with those reported in other large series. S Afr Med J 2004; 94: 373-378

Float or sink: modelling the taphonomic pathway of marine crocodiles (Mesoeucrocodylia, Thalattosuchia) during the death–burial interval

A taphonomic model is erected for a dataset of 19 Steneosaurus (Mesoeucrocodylia; Thalattosuchia) from the Toarcian Posidonienschiefer Formation (Lower Jurassic) of Germany. These were deposited in a quiet-water, marine, basin. Their taphonomy is compared with that of an additional seven thalattosuchians from other Jurassic localities (Peterborough and Yorkshire, UK; Nusplingen, Germany). The skeletal taphonomy of the specimens is assessed in terms of the articulation and completeness of nine skeletal units. Steneosaurus from the Posidonienschiefer Formation exhibit variable levels of articulation in the nine units. Completeness also varies but the head, neck and dorsal units are complete in all specimens. Carcasses reached the sediment–water interface shortly after death. Loss of fidelity occurred primarily as individuals lay on the sediment, and disarticulated elements tended to remain in the vicinity of the carcass. Those elements absent from specimens are the smaller, more distal, bones of the limbs and tail; these were removed preferentially by weak bottom currents. Smaller specimens are consistently less complete. Specimens from other localities broadly follow the same taphonomic pathway, suggesting a consistent pattern for the skeletal taphonomy of the carcasses of marine crocodiles. Loss of completeness in some specimens is more exacerbated, the result of stronger current activity at the sediment–water interface

INTERBED: internet-based guided self-help for overweight and obese patients with full or subsyndromal binge eating disorder. A multicenter randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Binge eating disorder (BED) is a prevalent clinical eating disorder associated with increased psychopathology, psychiatric comorbidity, overweight and obesity, and increased health care costs. Since its inclusion in the DSM-IV, a few randomized controlled trials (RCTs) have suggested efficacy of book-based self-help interventions in the treatment of this disorder. However, evidence from larger RCTs is needed. Delivery of self-help through new technologies such as the internet should be investigated in particular, as these approaches have the potential to be more interactive and thus more attractive to patients than book-based approaches. This study will evaluate the efficacy of an internet-based guided self-help program (GSH-I) and cognitive-behavioral therapy (CBT), which has been proven in several studies to be the gold standard treatment for BED, in a prospective multicenter randomized trial.</p> <p>Methods</p> <p>The study assumes the noninferiority of GSH-I compared to CBT. Both treatments lasted 4 months, and maintenance of outcome will be assessed 6 and 18 months after the end of treatment. A total of 175 patients with BED and a body mass index between 27 and 40 kg/m² were randomized at 7 centers in Germany and Switzerland. A 20% attrition rate was assumed. As in most BED treatment trials, the difference in the number of binge eating days over the past 28 days is the primary outcome variable. Secondary outcome measures include the specific eating disorder psychopathology, general psychopathology, body weight, quality of life, and self-esteem. Predictors and moderators of treatment outcome will be determined, and the cost-effectiveness of both treatment conditions will be evaluated.</p> <p>Results</p> <p>The methodology for the INTERBED study has been detailed.</p> <p>Conclusions</p> <p>Although there is evidence that CBT is the first-line treatment for BED, it is not widely available. As BED is still a recent diagnostic category, many cases likely remain undiagnosed, and a large number of patients either receive delayed treatment or never get adequate treatment. A multicenter efficacy trial will give insight into the efficacy of a new internet-based guided self-help program and will allow a direct comparison to the evidence-based gold standard treatment of CBT in Germany.</p> <p>Trial Registration</p> <p>Current Controlled Trials ISRCTN40484777</p> <p>German Clinical Trial Register DRKS00000409</p