The British journal of surgery
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Pain present for at least 3 months after a surgical procedure is considered chronic postsurgical pain (CPSP) and affects 10-50 per cent of patients. Interventions for CPSP may focus on the underlying condition that indicated surgery, the aetiology of new-onset pain or be multifactorial in recognition of the diverse causes of this pain. The aim of this systematic review was to identify RCTs of interventions for the management of CPSP, and synthesize data across treatment type to estimate their effectiveness and safety. ⋯ There is a need for more evidence about interventions for CPSP. High-quality trials of multimodal interventions matched to pain characteristics are needed to provide robust evidence to guide management of CPSP.
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Biography Historical Article
Case study of Berengario da Carpi and Lorenzo de' Medici.
Jacopo Berengario da Carpi (c.1460-c.1530) made several important advances in anatomy, being universally considered the founder of 'animated anatomy' (anatomia animata). In addition to being a famous anatomist, Berengario was also a highly regarded surgeon. One of his famous clients was Lorenzo de' Medici, Duke of Urbino (1492-1519). ⋯ His corpse was exhumed in 1875 and 1947. The casts of his skull made on those occasions are now preserved in the museums of Florence University, and clearly show evidence of the wound. Read more about the stories behind this masterpiece in an essay online.
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Randomized Controlled Trial
Randomized clinical trial of psychological support and sleep adjuvant measures for postoperative sleep disturbance in patients undergoing oesophagectomy.
Major surgery such as oesophagectomy requires a postoperative stay in intensive care. Painful stimuli lead to sleep disturbance and impairment in quality of life. The aim of this study was to evaluate the effect of psychological counselling and sleep adjuvant measures on postoperative quality of sleep and quality of life. ⋯ Perioperative psychological support reduces impairment in quality of life and quality of sleep after oesophagectomy. Registration number: NCT01738620 (http://www.clinicaltrials.gov).
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A critical appraisal of the benefits of minimally invasive surgery (MIS) is needed, but is lacking. This study examined the associations between MIS and 30-day postoperative outcomes including complications graded according to the Clavien-Dindo classification, unplanned readmissions, hospital stay and mortality for five common surgical procedures. ⋯ MIS was associated with significantly fewer 30-day postoperative complications, unplanned readmissions and deaths, as well as shorter hospital stay, in patients undergoing colectomy, prostatectomy, hysterectomy or appendicectomy. No benefits were noted for inguinal hernia repair.
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Preoperative imaging and prediction of oesophageal conduit necrosis after oesophagectomy for cancer.
Oesophageal conduit necrosis following oesophagectomy is a rare but life-threatening complication. The present study aimed to assess the impact of coeliac axis stenosis on outcomes after oesophagectomy for cancer. ⋯ This study suggests that oesophageal conduit necrosis after oesophagectomy for cancer may be due to pre-existing coeliac axis stenosis.