ABSTRACT
Meniere's disease is recognised by frequent periods of remissions. The available wisdom about the disease and treatment reflects the openion of experienced clinicians, rather than scientific facts. To determine the efficacy of vasodilator and diuretic therapies in the prophylaxis of Meniere's disease. A randomized controlled trial. The study was carried in the ENT Department, Combined Military Hospital, March 2007 to Dec 2009. Subjects and Methods: All new patients [N=120] of clinically diagnosed Meniere's disease were included by consecutive non-probability sampling. Demographic characteristics of the patients were noted and the patients were divided into three groups irrespective of age and sex. Group A was placed on amiloride 5 mg and hydrochlorthiazide 50 mg combination, one tablet daily, the Group B on tablet betahistine hydrochloride 48 milligram in three divided doses and Group C patients on tab multivitamin once daily respectively. The patients were reviewed after 06 weeks. Improvement in vertigo was seen in 77% in group A, in 68% patients in group B and in 45% in group C [p=0.021]. Hearing thresholds improved in 54% in group A, 63% in group B and in 36% in group C [p=0.067]. There was subjective improvement in tinnitus in 54% in group A, 80% in group B and in 37% in group C. Diuretic and vasodilator had a definitive and significant effect in Meniere's disease, in controlling vertigo and tinnitus, when compared with placebo [p<0.05]. Diuretics and vasodilators do have a significant role in the prophylaxis of Meniere's disease
ABSTRACT
Percutaneous endoscopic gastrostomy [PEG] refers to insertion of a tube into the stomach percutaneously, aided by endoscope and was first described in 1980 by Gauderer. This was devised for feeding the patients who have swallowing problems due to any reason especially neurodisability. There is an enhanced need for greater selectivity in patient referral. Retrospective, single-institution case series. The study was performed in Waterford Regional Hospital, Waterford, Ireland. Jan 2003 to Dec 2007. A total of 203 consecutive patients referred for nutritional support underwent PEG tube insertion during this period. Written informed consent was taken from all the participants or their attendants and the procedure was performed with prophylactic antibiotic and under intravenous sedation. Standard PEG set was used for the procedure. Feeding was started 12 hours after tube placement and care instructions were given. The parameters of study included indications, annual frequency, and overall outcome. A total of 203 patients having a male to female ratio 1:0.7 underwent PEG tube insertion. The age ranged from 26 to 96 years [mean 79+5.17. The mean duration of PEG feeding was 93 [3-785] days. The annual frequency of insertion increased from 19 [9.3%] patients in 2003 to 64 patients [31.5%] in 2007. The length of stay ranged from 1 to 350 days [median 93]. In this cohort, 32 [15.7%] patients died during the same admission. A total of 79 [38.9%] were discharged for home, 92 [45.3%] were discharged back to nursing home care. This study underscores the need for enhanced awareness and protocol-driven selectivity in patient referral for PEG tube insertion