The British journal of surgery
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Randomized Controlled Trial Clinical Trial
Randomized clinical trial of granisetron, droperidol and metoclopramide for the treatment of nausea and vomiting after laparoscopic cholecystectomy.
Patients undergoing laparoscopic cholecystectomy (LC) may be especially at risk of experiencing postoperative nausea and vomiting (PONV). This study was undertaken to evaluate the efficacy of granisetron, droperidol and metoclopramide for the treatment of PONV after LC. ⋯ A high dose of granisetron (40 microg/kg) was more effective than droperidol 20 microg/kg or metoclopramide 0.2 mg/kg for the treatment of established PONV after LC.
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Multicenter Study
Epidemiology of lower extremity amputation in centres in Europe, North America and East Asia.
This study was established to enable a comparison of lower extremity amputation incidence rates between different centres around the world. ⋯ Apart from the Navajo centre, differences in the known prevalence of diabetes could not account for the differences in overall incidence of amputation. Differences in the prevalence of peripheral vascular disease are likely to be important, but this and the role of other factors, including availability of health care, are worthy of further investigation.
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One hundred and thirty-two patients with reflux symptoms underwent a primary Lind fundoplication between April 1986 and February 1994; all operations were supervised or performed by one surgeon. The median age at operation was 47 (range 17-77) years. All patients attended for follow-up in the early postoperative period. It was possible to conduct a telephone interview to assess long-term symptom control, at a median time of 9.5 (range 5-13) years following operation, in 112 of the 124 patients who were still alive. ⋯ Open Lind fundoplication appears to be effective in the long-term control of gastro-oesophageal reflux in 95 per cent of patients and represents a standard against which the long-term results of laparoscopic surgery will need to be compared.
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A postal questionnaire was sent to 357 consultant surgeons who were thought to be involved in a general surgical on-call rota, to ascertain their current management of patients with acute cholecystitis. Replies were received from 250 consultants (70 per cent) of whom 242 (68 per cent) were involved in a general surgical take. Sixteen of these consultants, however, handed their patients with acute cholecystitis on to a different team the following day for further management. ⋯ Despite evidence to support the increased use of emergency cholecystectomy, this practice is routinely carried out by only 12 per cent of consultants. However, of the consultants who treat their patients conservatively, 28 per cent are prepared to undertake emergency cholecystectomy if an unexpected space appears on the theatre list.