Journal of the Royal Society of Medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative analgesia following total hip replacement: a comparison of intrathecal morphine and diamorphine.
Sixty patients undergoing elective total hip replacement under spinal anaesthesia were randomly assigned to receive either intrathecal (IT) diamorphine 0.75 mg (n = 30) or IT morphine 1.0 mg (n = 30). Postoperative pain scores, analgesic requirements and side effects were assessed by a blinded observer. Postoperative pain scores were broadly similar and satisfactory for both groups but the amount of additional IV morphine required to achieve this was significantly reduced in the morphine compared with the diamorphine group (P < 0.05). ⋯ There were no differences between the groups in the incidence of side effects such as emesis and pruritus. No significant postoperative respiratory depression was noted. In the doses used intrathecal morphine provided superior postoperative analgesia to that of intrathecal diamorphine.
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As increasing numbers of recipients of renal allografts survive long term, complications of prolonged immunosuppression have become apparent. Of particular concern are the high rates of non-melanoma skin cancer (NMSC) and carcinoma of the cervix, vulva and perineum.
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Randomized Controlled Trial Clinical Trial
Wound drains in proximal femoral fracture surgery: a randomized prospective trial of 177 patients.
We report on the effect of wound drains on wound healing following surgery for proximal femoral fractures. One hundred and seventy-seven patients undergoing AO dynamic hip screw (DHS) or hemiarthroplasty were randomized whether or not to receive wound drainage. Patients who received wound drainage showed statistically better wound healing in terms of the ASEPSIS wound scoring system and a reduced infection rate. This study conflicts with previous smaller studies which failed to show an effect of wound drainage upon wound healing.
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The induction of oral tolerance by oral immunization has been well recognized. Accumulated evidence shows that oral tolerance can be mediated by orally activated humoral and cellular factors. ⋯ Oral tolerance to alloantigen also reduces graft rejection. In spite of these encouraging results, the usefulness of this approach for an alternative immunotherapy in humans needs to be investigated further.