The European journal of surgery = Acta chirurgica最新文献

Objective: To evaluate the efficacy and safety of ramosetron (a 5-hydroxytryptamine type 3 receptor antagonist) for the prevention of nausea and vomiting after laparoscopic cholecystectomy.

Design: Prospective, randomised, double-blind, placebo-controlled study.

Setting: University and university-affiliated hospitals, Japan.

Subjects: 100 patients, 65 women and 35 men, who had laparoscopic cholecystectomy.

Interventions: Patients were given either placebo or ramosetron at 3 different doses (0.15 mg, 0.3 mg, 0.6 mg) intravenously at the completion of operation. The general anaesthetic technique and postoperative analgesia were standard.

Main outcome measures: Vomiting and safety were assessed for 0 to 24 hours and 24 to 48 hours after anaesthesia.

Results: The number of patients who had a complete response (no nausea, no retching, no vomiting) during 0 to 24 hours after anaesthesia was 15/25 with placebo, 17/25 with ramosetron 0.15 mg, 23/25 with ramosetron 0.3 mg, and 23/25 with ramosetron 0.6 mg; The corresponding numbers from 24 to 48 hours were 16, 17, 23, and 23. No serious adverse events were observed in any of the groups.

Conclusions: Ramosetron 0.3 mg was the minimum effective dose for preventing postoperative nausea and vomiting during 0 to 48 hours after anaesthesia in patients undergoing laparoscopic cholecystectomy.

Objective: To examine correlation between number of total gastrectomies done by each of 21 surgeons and the early outcome of these operations.

Design: Retrospective case series.

Setting: University hospital, Japan.

Patients: 136 patients treated by total gastrectomy for gastric cancer during a 4-year period.

Intervention: Univariate and multivariate analyses of the effect of each surgeon's volume on the early outcome of total gastrectomy.

Main outcome measures: Differences in the morbidity and mortality after total gastrectomy between high-volume and low-volume surgeons.

Results: There was a significant difference in the incidence of major complications of total gastrectomy between high-volume (7/66, 11%) and low-volume (17/70, 24%) surgeons (p = 0.04).

Conclusion: Possible reasons for differences in outcome between high-volume and low-volume surgeons should be investigated in an attempt to define and describe the methods that are associated with the best outcome.

Objectives: To assess the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in detecting common bile duct stones in the preoperative investigation of patients electively referred for gallstone disease, to find out the incidence of asymptomatic common duct stones, and to correlate clinical symptoms and history and liver function tests (LFT) with the actual occurrence of common duct stones.

Design: Prospective study.

Setting: General hospital, Denmark.

Patients: 180 consecutive non-jaundiced patients referred with symptomatic gallstones for elective cholecystectomy.

Interventions: LFT, abdominal ultrasonography, MRCP, endoscopic retrograde cholangiopancreatography (ERCP), questionnaire.

Main outcome measures: Positive and negative predictive values and accuracy of MRCP, number of patients with asymptomatic stones, and correlation of symptoms with the presence of stones.

Results: 26/180 patients had common duct stones (14%). Only one (<1%) had an asymptomatic stone. For detection of such stones, MRCP's positive predictive value was 0.95 (95% confidence interval (CI): 0.86 to 1.00), negative predictive value 0.96 (0.93 to 0.99), and accuracy 0.85 (0.93 to 0.99). MRCP missed 5 stones 1-4 mm in size in 5 patients; 17/64 patients with raised LFTs had stones (27%). The probability of stones was highest when the patients had both raised LFTs and a dilated common (>7 mm) bile duct (82%). There were no readmissions with ductal stones in the 6-month postoperative period.

Conclusions: The predicive values of MRCP were fairly good, but MRCP misses some small stones <5 mm in size. Asymptomatic stones in the common duct are not common in this population and should not be screened for. The probability of stones increases with the number of predictive factors. Patients should be questioned carefully about signs of biliary obstruction, and only be offered preoperative MRCP should they have a suspicious history, raised LFTs, or a dilated common duct.

Objective: To find out whether there is any benefit from venous resection during pancreaticoduodenectomy for ductal pancreatic adenocarcinoma.

Design: Retrospective study.

Setting: University Hospital Mannheim/Heidelberg, Germany.

Interventions: 271 patients had resections for ductal adenocarcinoma of the pancreatic head between 1980 and 2001. The outcome of patients who did (n = 68) and who did not (n = 203) have simultaneous resection of major veins (portal vein and/or superior mesenteric vein) were compared.

Main outcome measurement: 5 year survival.

Results: The groups differed significantly regarding stage, perineural infiltration, lymphangiosis carcinomatosa, operating time, blood loss, and blood transfusion. However, there was no difference in perioperative morbidity (27% and 22%), mortality (4% and 3%), and long-term survival (at 5 years 23% and 24%). Subgroup analysis of patients with margins free of tumour (R0 resections) showed that those patients who had venous resections in whom histological examination did not show infiltration of tumour had the most favourable outcome.

Conclusion: There is no reason to exclude patients with suspected venous infiltration from radical pancreaticoduodenectomy including venous resection.

Objective: To find out how injections of botulinum A toxin influence the healing of anal fissures.

Design: Retrospective study.

Setting: Medical University of Lodz, Poland.

Subjects: 13 patients (6 women, 7 men), mean age 49 (range 31-78), treated with injections of botulinum A toxin 50 units on either side of the anal fissure into the internal anal sphincter from May to December 1999.

Main outcome measures: Complications and relapse.

Results: Seven fissures had healed by one month and four by two months. Two remained unhealed but asymptomatic. There was no incontinence of flatus or faeces after three months of treatment. Resting anal pressure was significantly lower in 10 of 13 patients compared with before treatment (p < 0.05). One fissure relapsed after 4 months and this patient had a successful anal stretch.

Conclusion: Injection of botulinum A toxin gives good results in the treatment of anal fissures.

Objective: To establish the influence of the peritoneal sampling technique on the measurement of fibrinolytic capacity.

Design: Clinical study.

Setting: University hospital, Germany.

Subjects: 40 peritoneal biopsy specimens were taken from 10 patients who were having elective colorectal resections.

Interventions: Peritoneal biopsy specimens were taken either with a biopsy punch (n = 20) or manually with forceps and scissors (n = 20).

Main outcome measures: Extent of agreement in fibrinolytic activities between specimens taken with biopsy punch and manually. Major endpoint-peritoneal tissue plasminogen activator (t-PA) activity. Minor endpoints-peritoneal tissue plasminogen activator concentration, and concentration and activity of plasminogen activator inhibitior type 1 (PAT-1).

Results: Intra-assay agreement and the extent of agreement between the groups were evaluated by the method of Bland and Altman. Correlation of repeated measurements of t-PA and PAI-1 concentrations and activities from the same sample using the same ELISA kit was high (r = 0.93-0.99, p < 0.01). t-PA activities and concentrations between the groups correlated poorly (r= 0.60 and 0.66, p < 0.01) while no correlation at all was seen for PAI-1 concentration and activity between the groups (r = 0.6 and 0.1, p = 0.2 and 0.9). The mean differences between the groups ranged from -27% to -4.8%.

Conclusion: The sampling technique considerably affects the measurement of peritoneal fibrinolytic activity.

Objective: To investigate the effect of thalidomide given intraperitoneally on the formation of adhesions after colonic resection in rabbits.

Design: Controlled, randomised prospective study.

Setting: University hospital, Germany.

Animals: 40 female New Zealand White rabbits.

Interventions: After an end-to-end colonic anastomosis the animals were given thalidomide 200 mg/kg in 1% carboxymethylcellulose intraperitoneally or carboxymethylcellulose alone (n = 20 in each group).

Outcome measures: The adhesion score according to Tyrell on day 3 (n = 20) and day 7 (n = 20) postoperatively, weight, behaviour, and white cell count (WCC).

Results: There was no difference in behaviour or weight. On the third postoperative day WCCs and on the seventh postoperative day WCCs and adhesion scores, were lower in the thalidomide group (p < 0.01).

Conclusion: The number of postoperative adhesions was reduced in the group given thalidomide intraperitoneally. Our results suggest that thalidomide may be helpful in the prevention of postoperative adhesions.