The British journal of surgery
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Randomized Controlled Trial Clinical Trial
Effects of low dose perioperative interferon on the surgically induced suppression of antitumour immune responses.
General surgical procedures are followed by a period of generalized immunosuppression that may favour the deposition of metastases seeded at operation in patients with malignant disease. In an attempt to prevent the suppression of host-antitumour immune mechanisms following surgery we have studied the immunological effects of low-dose perioperative interferon-alpha (r-HuIFN alpha). Patients were randomly allocated pre-operatively to the control (n = 15) or treatment group (n = 15). ⋯ Treatment with r-HuIFN alpha did not prevent the postoperative impairment of interleukin 2 production or lymphokine activated killer cell cytotoxicity. However it prevented the fall in natural killer cell activity normally observed following surgery. This may have important consequences in controlling metastatic dissemination of tumour in this vulnerable period.
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Randomized Controlled Trial Clinical Trial
Assessment of the analgesic efficacy of nefopam hydrochloride after upper abdominal surgery: a study using patient controlled analgesia.
A randomized, double-blind, placebo-controlled study was performed to assess the analgesic efficacy of intramuscular nefopam hydrochloride after upper abdominal surgery. Patients received either 20 mg nefopam (n = 23) or matching placebo (n = 26), 90 min before surgery, immediately after surgery, and 6, 12 and 18 h after the end of surgery. The 24-h morphine requirements were measured using a patient-controlled analgesia system delivering on-demand intravenous bolus doses of morphine. ⋯ After 24 h the consumptions were 44.1 +/- 7.2 mg and 62.5 +/- 6.9 mg respectively (P less than 0.05). The pain scores in both groups were similar. This study confirms that nefopam hydrochloride has significant analgesic effects and would be a useful supplement to morphine in the management of postoperative pain.
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Randomized Controlled Trial Clinical Trial
Prophylactic antibiotics in elective colorectal surgery.
A randomized prospective study was conducted on 194 patients who underwent elective colorectal surgery for carcinoma. All patients received the same mechanical bowel preparation. In addition, patients in group A received oral neomycin and erythromycin base; patients in group B received systemic metronidazole and gentamicin, while patients in group C received both oral and systemic antibiotics. ⋯ The incidence of sepsis in groups B and C was almost identical. Patients who received oral antibiotics alone (group A) had significantly higher risks of postoperative sepsis when compared with patients in either group B or group C (P less than 0.05). As there is no additional advantage of combining oral and systemic antibiotics, we recommend systemic metronidazole and gentamicin to be used with mechanical bowel preparation in elective colorectal surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Hydroxyethyl starch: an alternative to plasma for postoperative volume expansion after cardiac surgery.
Hydroxyethyl starch (HES) is a recently developed synthetic volume expander. Forty patients undergoing coronary artery surgery were randomized to receive either HES or plasma protein fraction (PPF) as non-blood volume replacement according to standard haemodynamic criteria. The two groups were comparable in all respects. ⋯ There was no difference between the two groups in thrombin time, prothrombin time, activated partial thromboplastin time, or fibrinogen concentration. Similarly, tests of platelet function and Factor VIII and von Willebrand Factor activity showed no difference between the two groups. We conclude that HES is a safe and effective volume expander, and its relative lack of expense and ease of availability make its routine use after cardiac surgery an attractive proposition.
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Randomized Controlled Trial Comparative Study Clinical Trial
Use of a lipid containing medium chain triglycerides in patients receiving TPN: a randomized prospective trial.
Lipid emulsions which contain long chain triglycerides (LCTs) provide a valuable energy source for patients requiring total parenteral nutrition (TPN). We have investigated the use of a new lipid emulsion containing both long and medium chain triglycerides (MCTs) in a randomized prospective trial. ⋯ The MCT/LCT emulsion was found to be as safe and as effective a source of calories as LCT but the differences in metabolic parameters did not differ significantly between the two groups of patients. A lipid emulsion containing MCTs may have important advantages for seriously ill patients, but appears to have no obvious advantages for the majority of patients receiving TPN who are not severely stressed.