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Selected AbstractsRandomized double-blind placebo-controlled crossover study of caffeine in patients with intermittent claudication,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2010A. H. Momsen Background: Intermittent claudication is a disabling symptom of peripheral arterial disease for which few medical treatments are available. This study investigated the effect of caffeine on physical capacity in patients with intermittent claudication. Methods: This randomized double-blind placebo-controlled crossover study included 88 patients recruited by surgeons from outpatient clinics. The participants abstained from caffeine for 48 h before each test and then received either a placebo or oral caffeine (6 mg/kg). After 75 min, pain-free and maximal walking distance on a treadmill, perceived pain, reaction times, postural stability, maximal isometric knee extension strength, submaximal knee extension endurance and cognitive function were measured. The analysis was by intention to treat. Results: Caffeine increased the pain-free walking distance by 20·0 (95 per cent confidence interval 3·7 to 38·8) per cent (P = 0·014), maximal walking distance by 26·6 (12·1 to 43·0) per cent (P < 0·001), muscle strength by 9·8 (3·0 to 17·0) per cent (P = 0·005) and endurance by 21·4 (1·2 to 45·7) per cent (P = 0·004). However, postural stability was reduced significantly, by 22·1 (11·7 to 33·4) per cent with eyes open (P < 0·001) and by 21·8 (7·6 to 37·8) per cent with eyes closed (P = 0·002). Neither reaction time nor cognition was affected. Conclusion: In patients with moderate intermittent claudication, caffeine increased walking distance, maximal strength and endurance, but affected balance adversely. Registration number: NCT00388128 (http://www.clinicaltrials.gov). Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Randomized clinical trial of short-term outcomes following purse-string versus conventional closure of ileostomy wounds ,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2010K. Reid Background: Ileostomy closure is an operation with an underappreciated morbidity, including surgical-site infection, small bowel obstruction and anastomotic leakage. Surgical-site infections, in particular, are a frequent occurrence following closure of contaminated wounds. This randomized controlled trial compared a purse-string closure technique with conventional linear closure. Methods: Sixty-one patients were randomized to conventional or purse-string closure of ileostomy wounds. The primary endpoint was the incidence of surgical-site infection, including infections requiring hospital or community treatment. Results: Purse-string closure resulted in fewer surgical-site infections than conventional closure: two of 30 versus 12 of 31 respectively (P = 0·005). Conclusion: The purse-string method results in a clinically relevant reduction in surgical-site infections after ileostomy closure. Registration number: ACTRN12609000021279 (Australian New Zealand Clinical Trials Registry: http://www.anzctr.org.au/). Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Australasian Laparoscopic Colon Cancer Study shows that elderly patients may benefit from lower postoperative complication rates following laparoscopic versus open resection,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2010R. A. Allardyce Background: A retrospective analysis of age-related postoperative morbidity in the Australia and New Zealand prospective randomized controlled trial comparing laparoscopic and open resection for right- and left-sided colonic cancer is presented. Methods: A total of 592 eligible patients were entered and studied from 1998 to 2005. Results: Data from 294 patients who underwent laparoscopic and 298 who had open colonic resection were analysed; 266 patients were aged less than 70 years and 326 were 70 years or older (mean(s.d.) 70·3(11·0) years). Forty-three laparoscopic operations (14·6 per cent) were converted to an open procedure. Fewer complications were reported for intention-to-treat laparoscopic resections compared with open procedures (P = 0·002), owing primarily to a lower rate in patients aged 70 years or more (P = 0·002). Fewer patients in the laparoscopic group experienced any complication (P = 0·035), especially patients aged 70 years or above (P = 0·019). Conclusion: Treatment choices for colonic cancer depend principally upon disease-free survival; however, patients aged 70 years or over should have rigorous preoperative investigation to avoid conversion and should be considered for laparoscopic colonic resection. Registration number: NCT00202111 (http://www.clinicaltrials.gov). Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysmsBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2007H. A. Ashton Background: Long-term benefits of screening for abdominal aortic aneurysm (AAA) are uncertain. These are the final results of a randomized controlled screening trial for AAA in men, updating those reported previously. Benefit and compliance over a median 15-year interval were examined. Methods: One group of men were invited for ultrasonographic AAA screening, and another group, who received standard care, acted as controls. A total of 6040 men aged 65,80 years were randomized to one of the two groups. Outcome was monitored in terms of AAA-related events (surgery or death). Results: In the group invited for screening, AAA-related mortality was reduced by 11 per cent (from 1·8 to 1·6 per cent, hazard ratio 0·89) over the follow-up interval. Screening detected an AAA in 170 patients; 17 of these died from an AAA-related cause, seven of which might have been preventable. The incidence of AAA rupture after an initially normal scan increased after 10 years of follow-up, but was still low overall (0·56 per 1000 person-years). Conclusion: Screening with a single ultrasonography scan still conferred a benefit at 15 years, although the results were not significant for this population size. Fewer than half of the AAA-related deaths in those screened positive could be prevented. Registration number: ISRCTN 00079388 (http://www.controlled-trials.com). Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Excess use of coercive measures in psychiatry among migrants compared with native DanesACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2010M. Norredam Norredam M, Garcia-Lopez A, Keiding N, Krasnik A. Excess use of coercive measures in psychiatry among migrants compared with native Danes. Objective:, To investigate differences in risk of compulsory admission and other coercive measures in psychiatric emergencies among refugees and immigrants compared with that among native Danes. Method:, A register-based retrospective cohort design. All refugees (n = 29 174) and immigrants (n = 33 287) who received residence permission in Denmark from 1.1.1993 to 31.12.1999 were included and matched 1 : 4 on age and sex with native Danes. Civil registration numbers were cross-linked to the Danish Psychiatric Central Register and the Registry of Coercive Measures in Psychiatric Treatment. Results:, Refugees (RR = 1.82; 95%CI: 1.45; 2.29) and immigrants (RR = 1.14; 95%CI: 0.83; 1.56) experienced higher rates of compulsory admissions than did native Danes. This was most striking for refugee men (RR = 2.00; 95%CI: 1.53; 2.61) and immigrant women (RR = 1.73; 95%CI: 1.45; 2.60). Moreover, refugees and immigrants experienced higher frequencies of other coercive measures during hospitalisation compared with native Danes. Conclusion:, Coercive measures in psychiatry are more likely to be experienced by migrants than by native Danes. [source] | ||||||||||