The British journal of surgery
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Despite the increasing emphasis that is placed on both pH measurement and oesophageal manometry, there is little consensus about their usefulness in the clinical setting. These tests are far from infallible and it is difficult to support their universal application in patients with gastrooesophageal reflux disease. Nevertheless, these imperfect tests are useful in certain situations and clinicians must strive to use them intelligently for those most likely to benefit.
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Randomized Controlled Trial Clinical Trial
Prospective randomized study of a new method of providing postoperative pain relief following femoropopliteal bypass.
The extensive incision required for femoropopliteal bypass using saphenous vein causes significant postoperative pain, principally within the distribution of the cutaneous branches of the femoral nerve. This prospective randomized study investigated the efficacy of continuous postoperative femoral nerve block in reducing both pain (visual analogue pain score) and the requirement for opiate analgesia. ⋯ Postoperative pain was effectively abolished in the former group. The addition of a nerve block to PCA provides superior pain control after femoropopliteal bypass.
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Between 1947 and 1992, 1403 patients with 1432 salivary gland tumours were treated at the Christie Hospital, Manchester. There were 1194 epithelial neoplasms: parotid, 1082 (91 per cent); submandibular, 47 (4 per cent); minor glands, 65 (5 per cent). The commonest histological diagnoses were pleomorphic adenoma (n = 776) and adenolymphoma (n = 159). ⋯ The recurrence rate following the treatment of 551 new parotid pleomorphic adenomas was 1.6 per cent at median follow-up 12.5 (range 1-34) years, increasing to 15 per cent in the secondarily referred group (n = 170). For patients with definitively treated primary salivary carcinomas (n = 148), the disease-free survival rate at 5, 10 and 15 years was 58, 47 and 45 per cent respectively. Using multivariate analysis, clinical stage was the most important predictor of survival; the 10-year survival rate for stages I-IV was 96, 70, 47 and 19 per cent respectively.
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A total of 159 operations for the excision of a preauricular sinus carried out in 117 patients over an 8-year period were reviewed. Previous excision, the use of a probe to delineate the sinus and operating under local anaesthesia all increased the chance of recurrence. The condition recurred more often in patients who developed post-operative wound sepsis than in those who healed primarily. Means of decreasing the recurrence rate include: (1) meticulous dissection of the sinus by an experienced head and neck surgeon under general anaesthesia; (2) the use of an extended preauricular incision; (3) clearance down to the temporalis fascia to ensure complete removal of all epithelial components; (4) avoidance of sinus rupture; and (5) closure of wound dead space.
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The risk of developing recurrent tumour was assessed in a group of 85 patients with primary colorectal cancer who had a negative intraoperative ultrasonographic examination at the time of primary tumour resection. At a median follow-up of 40 months liver metastases had developed in 14 patients (16 per cent). ⋯ Sixteen patients (19 per cent) presented with extrahepatic recurrence, one of whom also developed liver metastases. A negative intraoperative ultrasonographic examination did not prove to be a favourable prognostic factor which allowed exclusion from follow-up or adjuvant chemotherapy.