Lancet
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An association between aortic stenosis and haemorrhage from gastrointestinal angiodysplasia has been recognised for many years, but no explanation for this link has been found. Remarkably, aortic valve replacement, rather than bowel resection, corrects the bleeding. Aortic stenosis can be complicated by acquired von Willebrand's disease type IIA (vWD-IIA), which is corrected after valve replacement, and gastrointestinal angiodysplasia is a common site of bleeding in older patients with acquired or congenital vWD. Could the stenotic aortic valve lead to an acquired, reversible deficiency of the largest multimers of plasma von Willebrand factor (equivalent to vWD-IIA) and thus explain the association with gastrointestinal haemorrhage?
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Randomized Controlled Trial Clinical Trial
Morphine responsiveness of chronic pain: double-blind randomised crossover study with patient-controlled analgesia.
There is controversy about whether the lack of response of some chronic pain to opioid treatment is absolute or relative. It is widely believed that nociceptive pain is responsive to opioids whereas neuropathic pain tends not to be. We have used a method of patient-controlled analgesia (PCA) with simultaneous nurse-observer measurement of analgesia, mood, and adverse effects to address these issues. ⋯ This PCA method is a quick and efficient tool to determine the consistency of the analgesic response. Such consistency can guide the clinician as to whether continued or higher-dose opioid treatment will produce good analgesia. An inconsistent response points to the use of other pain-relieving strategies.
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Randomized Controlled Trial Comparative Study Clinical Trial
Central-nervous-system dysfunction after warm or hypothermic cardiopulmonary bypass.
The increasing popularity of warm heart surgery led us to assess the effect of temperature during cardiopulmonary bypass (CPB) on neuropsychological function after coronary surgery. 34 patients enrolled in a randomised trial of normothermic versus hypothermic CPB were subjected to a battery of psychomotor and memory tests before and after their operations. The mean nasopharyngeal temperature for warm CPB was 34.7 (SD 0.5) degrees C and that for hypothermic CPB was 27.8 (2.0) degrees C. In all seven neuropsychological tests the postoperative scores were better in the warm CPB than in the hypothermic group, although only one difference achieved significance (trial-making test A; p less than 0.023). Thus, neurological function after normothermic CPB seems to be no worse than that after hypothermic procedures.