The British journal of surgery
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Clinical Trial Controlled Clinical Trial
Helium pneumoperitoneum for laparoscopic cholecystectomy: ventilatory and blood gas changes.
Laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum may result in hypercarbia and acidosis in patients with cardiorespiratory disease. The aim of the present study was to assess helium as an alternative to carbon dioxide for creating the pneumoperitoneum. Ventilation requirements and carbon dioxide levels were assessed at the beginning and end of laparoscopic cholecystectomy using helium (n = 30) and carbon dioxide (n = 30) pneumoperitoneum. ⋯ Four patients with helium pneumoperitoneum had surgical emphysema for 5 days. Helium may be a suitable alternative to carbon dioxide for creating pneumoperitoneum in patients with severe cardiorespiratory disease. However, because of its low water solubility helium has a lower safety margin than carbon dioxide in the rare event of gas embolism.
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Over a 16-year period 34 patients underwent surgery for idiopathic megarectum or megacolon; 18 had megarectum with or without megasigmoid, one megacolon only and 15 megarectum and total megacolon (nine with a previous colectomy). Ten patients underwent low rectal or anal anastomosis without pouch formation (colodistal proctostomy, eight; coloanal anastomosis, two), eight had colonic pouch-anal anastomosis (J pouch) and 14 had an ileal J pouch after restorative proctocolectomy; one underwent subtotal colectomy with ileorectal anastomosis and one loop ileostomy alone. ⋯ Three of 18 had a poor result after resection for megarectum because of recurrent constipation. One of 14 patients became incontinent after restorative proctocolectomy for megacolon and megarectum and in a further four persistent abdominal distension and pain was treated by pouch excision.
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Randomized Controlled Trial Clinical Trial
Randomized placebo-controlled double-blind study of three aprotinin regimens in primary cardiac surgery.
The serine proteinase inhibitor aprotinin significantly reduces postoperative blood loss in patients requiring cardiac surgery using cardiopulmonary bypass. This study compared two low-dose regimens with administration of high-dose aprotinin and a control protocol to determine whether the dose of aprotinin could be greatly decreased but still maintain efficacy after primary cardiac surgery. ⋯ There was an even greater reduction in measured median postoperative haemoglobin loss within the chest drains in the treated compared with the control patients (high-dose 15 g, prime 24 g, patient 14 g versus control 47 g; P < 0.001). These decreases were statistically the same for all the treated groups; it is possible to lower the dose of aprotinin to approximately one-third of the currently recommended dosage and still obtain significantly reduced postoperative blood loss in primary cardiac surgery.
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Randomized Controlled Trial Clinical Trial
Triple therapy and incidence of de novo cancer in renal transplant recipients.
Some 27 (5.5 per cent) of 492 renal transplant recipients developed de novo cancer between January 1975 and December 1991. Patients administered triple therapy of prednisolone, cyclosporin A and azathioprine had a significantly higher incidence of cancer (seven of 40 patients; 17.5 per cent) than those given prednisolone with cyclosporin (14 of 319; 4.4 per cent) and azathioprine with prednisolone (six of 133; 4.5 per cent) (P = 0.005). ⋯ The incidence of cancer in patients receiving low-dose cyclosporin, azathioprine and prednisolone was three of 45, in those given high-dose cyclosporin and prednisolone none of 23 and in those administered high-dose cyclosporin, nifedipine and prednisolone one of 29. The addition of azathioprine to ongoing maintenance cyclosporin and prednisolone therapy is useful in a subgroup of patients with graft dysfunction, but there are possibly higher risks in the development of de novo carcinoma.
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Jejunoileal bypass for morbid obesity was performed on 182 patients between 1971 and 1982. At 19 years' follow-up 60 (33 per cent) have had to undergo reversal. The compelling reasons for reversal were life-threatening malnutrition, immune complex disease, renal oxalate stones, osteomalacia and severe electrolyte disturbance. ⋯ Twelve patients had an associated vertical gastroplasty: ten regained their previous weight and only two stayed within normal weight. Patients were generally free from bypass-associated symptoms and complications apart from arthralgia and arthritis. This report concludes a series of articles published by the authors on jejunoileal bypass over the past 20 years describing the rise and fall of this surgical procedure.