Subject(s)
Acetaminophen/therapeutic use , Analgesics, Non-Narcotic/therapeutic use , Arthritis/drug therapy , Hemophilia A/drug therapy , Acetaminophen/metabolism , Alanine Transaminase/blood , Analgesics, Non-Narcotic/metabolism , Dose-Response Relationship, Drug , Hemarthrosis/physiopathology , Hemophilia A/pathology , Humans , Liver/metabolism , Randomized Controlled Trials as TopicABSTRACT
OBJECTIVES: The Rockall risk assessment score was devised to allow prediction of the risk of rebleeding and death in patients with upper GI hemorrhage. The score was derived by multivariate analysis in a cohort of patients with upper GI hemorrhage and subsequently validated in a second cohort. Only 4.4% of patients included in the initial study had esophageal varices, and analysis was not performed according to the etiology of the bleeding. Our aim was to assess the validity of the Rockall risk scoring system in predicting rebleeding and mortality in patients with esophageal varices or peptic ulcers. METHODS: Admissions (n = 358) over 32 months to a single specialist GI bleeding unit were scored prospectively. The distribution of episodes of rebleeding and mortality by Rockall score were statistically analyzed using Fisher's exact test with 99% CIs calculated using a Monte Carlo method. The Child-Pugh score was determined in patients with esophageal varices. RESULTS: The Rockall score was predictive of both rebleeding and mortality in patients with variceal hemorrhage (both ps < 0.0005), as was the Child-Pugh score (p = 0.001 and p < 0.0005, respectively). The initial Rockall score was predictive of mortality in patients with peptic ulcers (p = 0.01), although the complete score was not (p > 0.05). The complete score did, however, predict rebleeding in these patients (p = 0.001). CONCLUSION: This is the first study to validate the Rockall score in specific subgroups of patients with esophageal varices or peptic ulcers and suggests that it is particularly applicable to variceal hemorrhage.
Subject(s)
Esophageal and Gastric Varices/complications , Esophageal and Gastric Varices/mortality , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/mortality , Peptic Ulcer/complications , Peptic Ulcer/mortality , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Predictive Value of Tests , Prospective Studies , Recurrence , Reproducibility of Results , Risk AssessmentABSTRACT
This article provides an overview of normal oropharyngeal swallowing in relation to advanced age, with specific attention to oropharyngeal movement patterns and temporospatial swallowing durations. Swallowing disorders associated with aging are addressed with specific attention to the need for application of normative data to the diagnostic process. Attention is drawn to the need for continued research on swallowing function in the normal adult if efforts to maximize functional independence in eating and swallowing in the institutionalized adult are to be realized.
Subject(s)
Aging/physiology , Deglutition Disorders/physiopathology , Oropharynx/physiopathology , Adolescent , Adult , Age Factors , Aged , Female , Humans , Male , Middle AgedABSTRACT
Paracetamol (acetaminophen) is frequently used by haemophiliacs in the management of acute or chronic pain, primarily due to its lack of adverse effects when taken at therapeutic doses. We describe acute hepatic and renal toxicity of paracetamol in a 36-year-old patient with haemophilia B, chronic hepatitis C and chronic alcohol abuse. Moderate doses of paracetamol (6 g/d for 4 d), taken with therapeutic intent, resulted in life-threatening organ dysfunction which gradually recovered with full supportive care.
