Annals of surgery
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Randomized Controlled Trial Clinical Trial
Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants.
To investigate risk factors associated with aneurysm rupture using patients randomized into the U.K. Small Aneurysm Trial (n = 1090) or monitored for aneurysm growth in the associated study (n = 1167). ⋯ Within this cohort of patients, women had a threefold higher risk of aneurysm rupture than men. Effective control of blood pressure and cessation of smoking are likely to diminish the risk of rupture.
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Randomized Controlled Trial Comparative Study Clinical Trial
Analysis of regression of postoperative carotid stenosis from prospective randomized trial of carotid endarterectomy comparing primary closure versus patching.
Recurrent stenosis after carotid endarterectomy (CEA) has been reported to vary between a few percent and 30%. Regression of recurrent stenosis has been reported sporadically in the literature, but studies analyzing the factors affecting regression are lacking. This study analyzed factors affecting the regression of postoperative stenosis from a prospective randomized trial of CEA comparing primary closure (PC) versus patching. ⋯ Regression of recurrent stenosis was associated more strongly with patching than with PC. There was no association between regression and other factors.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective, randomized comparison of epidural versus parenteral opioid analgesia in thoracic trauma.
To evaluate systemic versus epidural opioid administration for analgesia in patients sustaining thoracic trauma. ⋯ Epidural analgesia significantly reduced pain with chest wall excursion compared with PCA. The route of analgesia did not affect the catecholamine response. However, serum levels of IL-8, a proinflammatory chemoattractant that has been implicated in acute lung injury, were significantly reduced in patients receiving epidural analgesia on days 2 and 3. This may have important clinical implications because lower levels of IL-8 may reduce infectious or inflammatory complications in the trauma patient. Also, tidal volume and maximal inspiratory force were improved with epidural analgesia by day 3. These results demonstrate that epidural analgesia is superior to PCA in providing analgesia, improving pulmonary function, and modifying the immune response in patients with severe chest injury.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome.
This prospective, randomized, single-institution trial was designed to evaluate the end points of mortality, morbidity, and survival in patients undergoing standard versus radical (extended) pancreaticoduodenectomy (including distal gastrectomy and retroperitoneal lymphadenectomy). ⋯ These data demonstrate that radical pancreaticoduodenectomy (with the addition of a distal gastrectomy and extended retroperitoneal lymphadenectomy to a standard pancreaticoduodenectomy) can be performed with similar morbidity and mortality to standard pancreaticoduodenectomy. However, the survival data are not sufficiently mature and the numbers of patients enrolled are not adequate to allow firm conclusions to be drawn regarding survival benefit.
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Randomized Controlled Trial Clinical Trial
Muscle protein catabolism after severe burn: effects of IGF-1/IGFBP-3 treatment.
To determine the effects of recombinant human insulin-like growth factor-1 (IGF-1) complexed with its principal binding protein, IGFBP-3, on skeletal muscle metabolism in severely burned children. ⋯ IGF-1/IGFBP-3 at doses of 1 to 4 mg/kg/day attenuates catabolism in catabolic burned children with negligible clinical side effects.