International journal of clinical practice
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In a previous report the effectiveness of intraperitoneal bupivacaine in reducing pain following laparoscopic cholecystectomy was demonstrated. Other methods of pain relief are commonly used but none has been compared following laparoscopic cholecystectomy. In two further studies we have compared the analgesic effect of intraperitoneal bupivacaine against wound infiltration with bupivacaine, and against intraperitoneal bupivacaine with the addition of a non-steroidal anti-inflammatory drug (NSAID) in patients undergoing laparoscopic cholecystectomy. ⋯ There was no difference in pain scores in the two groups in either study. Intraperitoneal bupivacaine is as effective as wound infiltration. The addition of an NSAID makes no difference in the reduction of postoperative pain following laparoscopic cholecystectomy.
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Desmoids of the neck are histologically benign but locally aggressive fibrous tumours with a strong propensity to recur. Surgical excision is the treatment of choice, with patients requiring long-term follow-up. We present such a case and review the treatment of such tumours.
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An anonymous questionnaire-based study was devised to examine the role of preoperative assessment of patients by pre-registration surgical house officers. One hundred and eight patients awaiting elective surgery were entered into the study. ⋯ More than 25% of patients who stated that the benefits of their operation had been explained cited the PAC as the source; 45% of patients who believed the risks of their surgery had been provided felt the PAC had been the only source of this explanation. It was concluded that preoperative assessment clinics are an efficient and effective means of providing patients with valuable information about their operation.
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Int. J. Clin. Pract. · Sep 1997
Randomized Controlled Trial Clinical TrialCyclical etidronate increases lumbar spine bone density in patients on long-term glucocorticosteroid therapy.
To determine whether cyclical etidronate modifies bone density in patients on chronic glucocorticosteroid therapy, annual bone density measurements were performed on 55 patients receiving glucocorticosteroids who were randomised to either continuous calcium supplementation or cyclical etidronate plus calcium supplementation in this secondary prevention study. Median L1-L4 lumbar spine bone density decreased by 0.7% in the calcium treated group after one year but increased by 3.1% in the group treated by calcium and etidronate (p = 0.00116). ⋯ There were no significant effects of treatment on femoral neck density. Cyclical etidronate and calcium increased lumbar spine bone density in patients established on prednisolone treatment over a two-year period but had no effect on femoral density.