The American journal of medicine
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Randomized Controlled Trial Clinical Trial
The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping.
To delineate the pathogenesis and epidemiology of catheter-related infection with Swan-Ganz pulmonary artery (PA) catheters, a prospective clinical study of hospitalized adult medical and surgical patients was done. Role of catheter material was assessed by randomizing insertions to heparin-bonded PA catheters made of polyvinylchloride or polyurethane. Sources of infection and pathogenesis were studied by culturing skin, the introducer, the PA catheter tip, all hubs, infusate from each lumen, and the extravascular portion of the PA catheter beneath the external protective plastic sleeve. ⋯ Swan-Ganz catheters are vulnerable to contamination from multiple sources, but the patient's skin is the single most important source of organisms causing invasive infection, which in most cases involves the introducer rather than the PA catheter. Heavy colonization of the insertion site, percutaneous insertion in the internal jugular vein rather than subclavian vein, catheterization longer than 3 days, and insertion with less stringent barrier precautions significantly increase the risk of catheter-related infection. These findings hold promise for application to management of Swan-Ganz catheters and research in catheter design to reduce the risk of catheter-related infection.
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Randomized Controlled Trial Comparative Study Clinical Trial
Risk factors for stroke in patients with nonrheumatic atrial fibrillation: a case-control study.
Randomized controlled trials have demonstrated that anticoagulant therapy is very effective at preventing stroke among patients with nonrheumatic atrial fibrillation. However, these trials have reported too few strokes for powerful risk factor analysis. Observational studies may provide additional information. The purpose of this study was to identify risk factors in a larger number of patients with stroke and nonrheumatic atrial fibrillation, using case-control methodology. ⋯ Our analysis suggests that age and hypertension should be considered when deciding upon long-term anticoagulant therapy to prevent stroke in patients with nonrheumatic atrial fibrillation.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of labetalol versus enalapril as monotherapy in elderly patients with hypertension: results of 24-hour ambulatory blood pressure monitoring.
This study compared the safety and efficacy of labetalol and enalapril as antihypertensive therapy for elderly patients. ⋯ The results indicate that labetalol and enalapril are equally effective in lowering supine diastolic BP in the elderly, but labetalol is more effective in lowering ambulatory BP and heart rate throughout the day.
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Randomized Controlled Trial Clinical Trial
Intravenous ciprofloxacin and ceftazidime in serious infections. A prospective, controlled clinical trial with third-party blinding.
Oral ciprofloxacin has been shown to be effective in the treatment of infections due to gram-positive cocci and gram-negative rods. The efficacy and safety of intravenous ciprofloxacin was compared with that of intravenous ceftazidime in the treatment of 59 patients with well-documented serious infections in a prospective, controlled, randomized study with a third-party blinding. Thirty-three patients were treated with intravenous ciprofloxacin (200 mg every 12 hours, plus a daily extra placebo dose); 26 patients were treated with ceftazidime (1 g every eight hours). ⋯ Superinfections occurred in five patients: enterococcal septicemia (zero/two) and urinary tract infections (one/two). The results presented suggest that intravenous ciprofloxacin is an effective and safe antimicrobial agent for the treatment of serious infections, with an efficacy comparable with that of ceftazidime, a broad-spectrum cephalosporin. An additional advantage seems to be a lower rate of superinfections.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prazosin versus hydrochlorothiazide as initial antihypertensive therapy in black versus white patients.
A randomized, drug-controlled trial was conducted to evaluate the comparative efficacy of hydrochlorothiazide versus prazosin in controlling mild diastolic hypertension in black and white patients. Serum lipid and lipoprotein levels were also studied. Overall, 22 men and 14 women, of whom 50 percent were black, aged 21 to 69 years, were randomly assigned to treatment with either of these two agents. ⋯ Prazosin therapy reduced total cholesterol levels by 20.5 mg/dl and low-density lipoprotein cholesterol levels by 19.0 mg/dl, and hydrochlorothiazide increased total cholesterol levels by 11.4 mg/dl and increased low-density lipoprotein levels by 9.3 mg/dl; but no differences in triglyceride, high-density lipoprotein, plasma high-density lipoprotein2, or high-density lipoprotein3 levels were noted. Both agents were well tolerated in black and white patients. The combination of effective blood pressure control with no adverse effects on the serum lipid profile may make prazosin preferable to hydrochlorothiazide for treating mild diastolic hypertension in black as well as white patients.