Dan Med Bull
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Prevention of injury-induced functional alterations in the central nervous system by pre-emptive analgesia or other techniques is a fascinating working hypothesis based on substantial scientific evidence. Although experimental data may provide a rationale for this concept, translation into clinical practice has led to some debate, especially about interpretation of results from studies in postoperative patients (Katz et al. 1992a, 1993; Dahl et al 1992a, 1993b; Dahl & Kehlet 1993a). This may partly be due to a difference in experimental versus clinical benefits from pre-emptive analgesia and furthermore, clinicians may ask if preoperative administration of morphine or other opioids is really a "novel approach" (Katz 1993) to the management of postoperative pain. ⋯ Thus, the idea originates from experimental studies, often with anaesthetized or decerebrated animals, and with nociceptive stimuli which did not involve severe ongoing tissue damage. The various types of noxious stimuli (C-fiber stimulation, heat-, chemical-, inflammatory- and neuronal lesions) may differ from the surgical injury, and the time-scale of the experiments, and the profiles of analgesic effects and efficacy may differ from the clinical situation. In a study of patients undergoing gynaecological laparotomy, increased sensitivity to noxious electrical stimulation of the sural nerve was observed postoperatively, with a corresponding trend in the nociceptive flexion reflex.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Plasma cholecystokinin in obese patients before and after jejunoileal bypass with 3:1 or 1:3 jejunoileal ratio--no role in the increased risk of gallstone formation.
Jejunoileal bypass surgery for obesity increases the risk of gallstone formation, and, contrary to expectations, the incidence is greater in patients with a long as compared to a short ileum left in continuity. Impaired gallbladder motility due to reduced cholecystokinin (CCK) stimulation could be an explanation. The aim of this study was to investigate the CCK levels in such patients. ⋯ Postoperative changes in plasma CCK levels neither explain the increased risk of gallstone formation after bypass surgery nor the higher incidence with a long compared to a short ileum left in continuity in the bypass.