Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Mar 1988
Randomized Controlled Trial Comparative Study Clinical TrialComparative evaluation of general, epidural and spinal anaesthesia for extracorporeal shockwave lithotripsy.
The results of a prospective randomised evaluation of general anaesthesia (GA), epidural anaesthesia (EA) and spinal anaesthesia (SA) for extracorporeal shockwave lithotripsy are presented. GA provided speed and reliability but resulted in a high incidence of postoperative nausea, vomiting and sore throat. ⋯ A major drawback associated with the use of SA was a 42% incidence of postspinal headache. All three techniques were associated with hypotension on placement in the hoisl; bath immersion resulted in significant rises in blood pressure in the EA and SA groups and a more variable (overall non-significant) response in the GA group.
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Ann R Coll Surg Engl · Mar 1988
The correlation between gross appearance of the appendix at appendicectomy and histological examination.
A retrospective review of patients with a preoperative diagnosis of appendicitis or thought to have appendicitis at laparotomy showed a discrepancy between the surgeons' opinion of the macroscopic appearance of the appendix and the pathologist's opinion (which was assumed to be the most accurate) in 14.5% of cases. All cases were false positive diagnoses. Using the surgeons' descriptions of the appendix at appendicectomy, a sub-group can be identified with an 80% error rate. ⋯ We recommend that only the terms 'normal' 'inflamed' or 'gangrenous or perforated' should be used to describe the appendix. If there is any doubt, it should be classed as normal. These recommendations will improve diagnostic accuracy at operation.
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A prospective study was carried out in one District Health Authority over a twelve month period to investigate the principal reasons for the postponement of operations on the advice of anaesthetic staff. A mean of 1.4% of all cases listed for general anaesthesia were postponed. The clinical indications for this are described and possible methods for reducing this figure are discussed.
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Ann R Coll Surg Engl · Sep 1987
Clinical Trial Controlled Clinical TrialTo tunnel or not to tunnel catheters for parenteral nutrition.
The effect of subcutaneous catheter tunnelling on the incidence of catheter sepsis and on catheter life span in the absence of a nutrition team was determined in a prospective controlled clinical trial. Eighty one patients who received 92 courses of parenteral nutrition had 110 catheters inserted. Alternate catheters were tunnelled. ⋯ Mean life span of tunnelled catheters was 21 days (range 5-37 days) compared to 12.6 days for non-tunnelled (range 3-19 days) (P less than 0.05). Six non-tunnelled catheters became displaced, a complication which did not occur with tunnelled catheters (P less than 0.01). In conclusion subcutaneous tunnelling of silicone catheters prolongs catheter life span but does not significantly influence catheter sepsis.
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Ann R Coll Surg Engl · Sep 1987
Historical ArticleThe treatment of breast cancer: a study in evolution.