Acta chirurgica Scandinavica
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Obstruction of appendix vermiformis causing acute appendicitis. An experimental study in the rabbit.
In an experimental model using the rabbit, the role of obstruction in the pathogenesis of acute appendicitis was studied. Twenty-one animals were anaesthesized and underwent laparotomy. The appendices were obstructed by a balloon catheter introduced via a caecostomy. ⋯ In a total of 15 rabbits, experimental obstruction of the appendix resulted in inflammatory changes in the wall of the appendix, which histologically in all respects were similar to appendicitis in man. In the remaining 6 rabbits, either spontaneous release of obstruction or death early during the experiment occurred. Our experimental data suggest that obstruction is an important agent in the causation of acute appendicitis.
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Extradural haematomas (EH) do not always present with the classical picture of skull trauma followed by a lucid interval, deepening coma, unilateral enlarging pupil and hemiplegia. Symptoms and signs can be puzzling and complex in many cases of EH and may thus lead to dangerous therapeutic delay. ⋯ In this study the variables which from clinical experience seemed to be of main prognostic importance were related to the outcome in 44 patients with EH. A surgical decision-making table was compiled from these relationships in order to facilitate the decision process related to the diagnosis and therapy of EH.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of rubber band ligation and sclerosant injection for first and second degree haemorrhoids-- a prospective clinical trial.
Fifty patients with first or mild second degree haemorrhoids were randomly allocated to sclerosant injection (26) or rubber band ligation (24). One year after treatment 24 injection and 22 rubber band ligation patients were assessed. All patients presented with rectal bleeding; injection relieved 14 and rubber band ligation relieved 17 of this symptom (N. ⋯ Rubber band ligation relieved anal pain in 10 out of 14 patients whereas injection relieved only one patient of this symptom (p less than 0.05). Neither treatment influenced pruritus ani or faecal soiling. Although rubber band ligation caused more treatment discomfort, it is an effective management for first and mild second degree haemorrhoids and it should be considered as the procedure of choice.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative influences of epidural and general anaesthesia on deep venous thrombosis and pulmonary embolism after total hip replacement.
In an investigation on deep venous thrombosis and pulmonary embolism, where neither dextran nor antithrombotic drug prophylaxis were employed, 30 patients undergoing total hip replacement were randomly allotted to one of two groups receiving either epidural or general anaesthesia. The epidural group (n = 15) was given 0.5% bupivacaine with epinephrine (5 micrograms/ml) and this was prolonged into the postoperative period for pain relief. The general anaesthesia group (n = 15) was operated on under artificial ventilation with nitrous oxide/oxygen via an endotracheal tube and intravenously administered fentanyl and pancuronium bromide. ⋯ Further, the frequency of pulmonary embolism, as determined by pulmonary perfusion lung scanning, was lower in patients receiving continuous epidural block (2 of 15) than in the general anaesthesia group (7 of 15). Possible explanations for these findings are discussed, including a hyperkinetic lower limb blood flow and lower fibrinolysis inhibition activity in patients given epidural block. Lower blood transfusion requirements in patients given epidural block might also play a role, as well as a "stabilizing" effect of local anaesthetics on platelets, leukocytes and endothelial cells.
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Comparative Study
Leg haemodynamics during different forms of anaesthesia in patients undergoing reconstructive vascular surgery.
In the present study the effects of three different anaesthetics (halothane, n = 9, enflurane, n = 9, and neurolept, n = 11) on leg circulation were studied during vascular reconstruction with a reversed femoropopliteal saphenous vein bypass graft. Leg vascular resistance showed significant differences between the three anaesthetic groups. Thus, during the pretransfusion period, leg resistance in the neurolept group was significantly higher than in the halothane and enflurane groups, although the blood volume did not differ significantly between the groups. ⋯ Inducing pharmacological vasodilatation caused significant increases in common femoral arterial and bypass blood flows in all groups, but the increases were significantly more pronounced in the neurolept group. It is concluded that leg haemodynamics are influenced in different ways according to the anaesthetic agents used. This, in turn, might contribute to a better understanding and a more correct interpretation of the results of intraoperative flow and pressure measurements, and, consequently, to improvement of the reconstructive procedure.