Case series

See also Example 23.1 to account for the voltage rise due to series reactor in case series reactors are used. 

Other sedative-hypnotic medications, such as barbiturates, may play a useful role in severe withdrawal from this group of drugs. For example, in a case series of GBL withdrawal, use of intravenous pentobarbital in the range of 1-2 mg/kg/hour lowered the total requirement for intravenous lorazepam (Sivilotti et al. 2001). Antipsychotic medications are often used to reduce psychotic agitation. However, because antipsychotic medications lower the seizure threshold and may contribute to loss of central control of temperature leading to hyperthermia or neuroleptic malignant syndrome (NMS), they are not indicated as first-line medications for GHB withdrawal delirium (Dyer and Roth 2001 McDaniel and Miotto 2001 Sharma et al. 2001). If anti-... 

Weiner AL, Vieira L, McKay CA, et al Ketamine abusers presenting to the emergency department a case series. J Emerg Med 18 447-M51, 2000... 

Case Series—Describes the experience of a small number of individuals with the same disease or exposure. These may suggest potential topics for scientific research but are not actual research studies. 

Ison MG, Gubareva LV, Atmar RL, Treanor J, Hayden EG (2006a) Recovery of drug-resistant influenza virus from immunocompromised patients a case series, J Infect Dis 193 760-764 Ison MG, Mishin VP, Braciale TJ, Hayden EG, Gubareva LV (2006b) Comparative activities of oseltamivir and A-322278 in immunocompetent and immunocompromised murine models of influenza virus infection, J Infect Dis 193 765-772... 

Much like the experience with IV thrombolysis, the majority of the early work in lAT has been reported in nonrandomized case series. Reports of successful lAT go back to the late 1950s, when Sussmann and Fitch described the recanalization of an acutely occluded ICA with an intra-arterial injection of plasmin. Nonetheless, it was not until the early 1990s that this approach was studied in a more systematic manner. 

Lindsberg and Mattle ° recently analyzed published case series reporting on the outcome of basilar artery occlusion (BAO) after lAT or IV thrombolysis. In 420 BAO patients treated with IV thrombolysis (76) and lAT (344), death or dependency was equally common 78% (59 of 76) and 76% (260 of 344). Recanalization was achieved more frequently with lAT (225 of 344 65%) than with IV thrombolysis (40 of 76 53% p = 0.05), but survival rates after IV thrombolysis (38 of 76 50%) and lAT (154 of 344 45%) were equal (p = 0.48). A total of 24% of patients treated with lAT and 22% treated with IV thrombolysis reached good outcomes (p = 0.82). Without recanalization, the likelihood of achieving a good outcome was close to nil (2%). The authors conclude that recanalization occurs in more than half of BAO patients treated with lAT or IV thrombolysis, and 45-55% of survivors regain functional independence. They advised that hospitals not equipped for lAT should consider setting up IV thrombolysis protocols for BAO since the effect of IVT did not appear to be much different from the effect of lAT. 

The GP Ilb-IIIa complex inhibitor Tirofiban has been used as an adjunct to thrombolysis in a number of small case series reports." A small transcranial Doppler (TCD) study suggests that it reduces microembolization from unstable carotid plaque." In an open pilot smdy, Tirohban administered within 9 hours after stroke onset blocked the conversion of ischemic penumbra to mature infarction." A phase III study (SETIS) has started recruiting patients to investigate its efficacy versus aspirin within the 6-hour window. 

Acute anticoagulation is widely used in the acute setting of arterial dissection. Once again, the rationale is to prevent propagation of local thrombosis and formation of new thrombus at the site of the injured arterial wall, which is beheved to reduce the likelihood of early stroke recurrence. This practice, while rational, is based on anecdotal evidence and case series, as randomized controlled trials have... 

For patients who demonstrate continued neurological deterioration despite anticoagulation, local intrathrombus thrombolysis may be beneficial. In case series in which most patients received urokinase, favorable outcome with no major therapeutic morbidity has been described.In one study, 29 patients with angiogram-proven CVST were reviewed retrospectively. Of the 18 who received local urokinase, 17 recovered completely, and 1 was left with a mild neurological deficit. Heparin was given to four patients, three of whom made a complete recovery. Six presented in a comatose state with severe CVST and only supportive measures were used. It is difficult to draw conclusions from these data, as only patients with mild or moderately severe disease were selected for thrombolytic treatment. 

Level III Lower level of evidence. Prospective case series with concurrent or historical cohort or post hoc analyses of large RCTs. 

Level IV Undetermined level of evidence. Small uncontrolled case series of general agreement despite lack of evidence. 

Sertraline Case series demonstrating efficacy in hot flash reduction 25-50 mg daily Nausea, dizziness, somnolence... 

Richer, S. (1999). Part II ARMD-pilot (case series) environmental intervention data. J. Am. Optom. Assoc. 70(1) 24-36. 

Liappas I. A., Malitas P. N., Dimopoulos N. P., Gitsa O. E., Liappass Ch. K. (2003). Zolpidem dependence case series possible neurobiological mechanisms and clinical management. J. Psychopharmacol. 17, 131-5. 

A case series of workers in a furniture factory in the Bronx, New York, illustrates the typical clinical presentation of -hexane neurotoxicity (Herskowitz et al. 1971). This report describes the cases of... 

Effect of Dose and Duration of Exposure on Toxicity. No studies were located where -hexane concentration was measured in workplace air before workers became ill, so no dose-response relationship can be defined for human neurotoxicity as the result of -hexane exposure. Information on duration of exposure leading to toxicity is available from some case series reports. An occupational exposure caused sensory disturbances in the lower extremities after approximately 2 months (Herskowitz et al. 1971). A case of peripheral neuropathy after 7 months of exposure was reported among press-proofing workers in Taipei (Wang et al. 1986) a serious case resulting in quadriplegia after 8 months of exposure was reported among sandal workers in Japan (Yamamura 1969). Based on case reports, it can be estimated... 

Psychosurgery. Case series have been reported of patients with severe treatment resistant social anxiety disorder undergoing surgical procedures including capsu-lotomy and endoscopic transthoracic sympathectomy. Given the limited evidence... 

Types of descriptive studies include case reports or case series, and ecological studies. 

Cross-sectional smdies (surveys) These examine the relationship between a disease or other health-related characteristic in a population at a given time. The presence or absence (or the level) of a characteristic is examined in each member of the smdy population or in a representative sample. These smdies are used to obtain information not routinely available from surveillance or case series. Cross-sectional studies provide no information on the temporal sequence of cause and effect. In surveys examining the association between an exposure and an outcome, both are measured at the same time and it is often hard to determine whether the exposure preceded the outcome or vice versa. In general, surveys measure the simation at a given moment (prevalence) rather than the occurrence of new events (incidence). 

Epstein, J. B., and Gorsky, M. (1999). Topical application of vitamin A to oral leukoplakia A clinical case series. Cancer 86, 921-927. 

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