The British journal of surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized comparison of the neuroendocrine response to laparoscopic cholecystectomy using either conventional or abdominal wall lift techniques.
Increase in plasma renin activity and noradrenaline concentration occur in response to carbon dioxide insufflation during laparoscopic cholecystectomy. In a randomized study the conventional carbon dioxide pneumoperitoneum was compared with the abdominal wall lift method for laparoscopic cholecystectomy, with special reference to neuroendocrine changes and renal function. The total mean(s.d.) volume of carbon dioxide insufflated was 42(23) litres with the conventional method and 9(7) litres with abdominal wall lift (P < 0.001). ⋯ Diuresis was significantly less with conventional pneumoperitoneum during the first 35 min of the operation compared with the abdominal wall lift method (P < 0.001). There were significant increases in plasma noradrenaline concentration in both groups (P < 0.001), but the increase was slightly higher in the conventional group during the first 15 min of insufflation. The abdominal wall lift method with minimal carbon dioxide insufflation was associated with smaller neuroendocrine responses and better preservation of renal function compared with conventional carbon dioxide pneumoperitoneum.
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Clinical desmoid disease affect approximately 10 per cent of patients with familial adenomatous polyposis (FAP); the subclinical rate is unknown. Desmoids are probably neoplastic rather than regenerative in origin and may arise in association with germline or somatic mutations at or beyond codon 1444 of the APC gene. ⋯ Surgical treatment of advanced desmoids is hazardous, but medical treatments have limited success. Chemotherapy with doxorubicin and dacarbazine is currently under evaluation.
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Clinical Trial Controlled Clinical Trial
Laparoscopic ultrasonography during cholecystectomy.
The routine use of intraoperative cholangiography during cholecystectomy has been debated extensively. Intraoperative ultrasonography was a quick, efficient alternative in open cholecystectomy. A prospective controlled trial to evaluate its usefulness in laparoscopic cholecystectomy is reported. ⋯ In group 2, 64 variations were demonstrated in 50 individuals by ultrasonography and 61 variations in 47 patients by cholangiography. Vascular variations were seen with ultrasonography in 22 and 24 patients in groups 1 and 2 respectively. In conclusion, laparoscopic ultrasonography (with either probe) proved as accurate as intraoperative cholangiography in detecting bile duct stones, and the specialized probe detected significantly more variations of the bile duct than the adapted probe.
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The results for 162 patients who underwent curative gastrectomy for gastric cancer from January 1988 to June 1994 were analysed statistically with special reference to the effect of lymph node dissection. Median survival was 69.3 months and the overall cumulative 5-year survival rate was 50.2 (95 per cent confidence interval (c.i.) 41.6-58.1) per cent. By univariate analysis age, histology, depth of tumour invasion, node involvement, number of metastatic lymph nodes and type of lymphadenectomy were found to be significant factors related to survival time. ⋯ With respect to D1 lymphadenectomy, the relative risk associated with D2 and D4 lymphadenectomy was respectively 0.61 (95 per cent c.i. 0.34-1.10) and 0.26 (95 per cent c.i. 0.12-0.60). The 5-year survival rate was 28 per cent for patients who had a D1 dissection, 63 per cent for those who had D2 and 68 per cent for those who had D4. These results suggest that extended lymphadenectomy (D2) and especially superextended lymphadenectomy (D4) can improve survival in patients with gastric cancer.