Int Surg
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Randomized Controlled Trial Comparative Study Clinical Trial
Devascularization procedure and DSRS: a controlled randomized trial on selected haemodynamic portal flow pattern in schistosomal portal hypertension with variceal bleeding.
The use of duplex studies for the portal tree has revolutionized the concepts of haemodynamic pathophysiology in the case of portal hypertensive bleeders. The identification of possible haemodynamic patterns in schistosomal bleeders, and the effects of devascularization procedure and distal lienorenal shunts on a selected haemodynamic pattern, are the aim of this work. ⋯ DSRS proved to be ideal for schistosomal patients with hepatopedal flow and splenic vein flow exceeding portal vein flow; since in addition to eliminating the high splenic flow out of portal circulation, it decreased the pressure in the gastroesophageal region. Other patterns with their frequencies and the suggested surgical procedures were also presented.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural analgesia attenuates the systemic stress response to upper abdominal surgery: a randomized trial.
The effects of combined general anaesthesia and epidural analgesia in various endocrine and metabolic parameters were studied before, during, at the end, and 72 h after upper abdominal surgery, in an effort to further elucidate the role of epidural analgesia in the endocrine and metabolic response. 50 patients were randomly assigned into groups A and B, which received general anaesthesia alone and combined general anaesthesia and epidural analgesia, respectively. The effects of surgical stress in the plasma concentration of ACTH (P <0.001), cortisol (P <0.01), aldosterone (P <0.05), FFA (P <0.05) and glucose (P <0.01) were significantly less pronounced in the group of patients who received combined general anaesthesia and epidural analgesia. However, there were no significant differences between the two groups in regard with plasma TSH, T3, T4, glucagon or Na+ concentration. These results indicate that the combination of general anaesthesia and epidural analgesia attenuate, but does not inhibit, the endocrine and metabolic response to upper abdominal surgery.
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Randomized Controlled Trial Clinical Trial
Randomized prospective study of local transdermic anesthetic in fine needle aspiration biopsy for breast lumps.
To evaluate the use of local transdermic anesthetics in fine needle aspiration biopsy (FNAB) in breast lesions. ⋯ Both the quantification and the type of pain referred to were similar in all three groups. However, there was a tendency of the patient to refer to less pain when the active substance or the placebo were used, when results were compared to the control group.
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of ketorolac tromethamine and extrapleural intercostal nerve block on post-thoracotomy pain. A prospective, randomized study.
Post-thoracotomy pain causes severe impairment of the respiratory function. Epidural analgesia is effective in the treatment of post-thoracotomy pain but may give rise to significant side-effects. Other low-risk and cost-effective analgesic treatments are therefore required. ⋯ Ketorolac tromethamine was effective in the treatment of post-thoracotomy pain. Extrapleural intercostal nerve block allowed a significant reduction in the consumption of opioids. These analgesic techniques could be useful as low-risk, cost-effective and reproducible treatments when more effective techniques, such as epidural analgesia, are contraindicated.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cholecystectomy: comparison of minilaparotomy and laparoscopy.
Laparoscopic cholecystectomy (LC) has become the most popular method of removing the gallbladder. Because it is an expensive operation requiring special training for the team, LC has been challenged by other methods of minimal-access surgery, e.g. by minilaparotomy (MC). This study was planned to be a single-surgeon prospective random study to compare minilaparotomy cholecystectomy (MC) and laparoscopic cholecystectomy (LC), but was never done over the pilot phase. ⋯ In the MC group three patients (37%) had complications versus no complications in the LC group (p = 0.028). Postoperative hospital stay was longer in the MC group (median three days) than in the LC group (median one day), even when the patients with complications were excluded. Due to these discouraging experiences the extended random study was never done, and MC was abandoned.