Post-operative pain in needlescopic versus conventional laparoscopic cholecystectomy: a prospective randomised trial

BACKGROUND: Needlescopic cholecystectomy (NC) utilises instruments and ports smaller than 3 mm in diameter compared with the 5 mm ones used in conventional laparoscopic cholecystectomy (LC). Post-operative pain control and recovery has been thought to be superior in NC, when compared with historical controls with LC, but has not been proven in a prospective fashion. PATIENTS AND METHODS: A prospective randomised trial of NC versus LC for patients with symptomatic gallstone disease, with standardisation of post-operative analgesia and daily assessment of post-operative pain, using a 5-point visual analogue scale. RESULTS: There were 64 eligible patients randomised into NC (28) and LC (36). Four patients who had NC were converted to LC due to technical problems. Another three and six patients from the NC and LC groups, respectively, had conversion to open surgery. Post-operative pain scores were low in both groups. Mean pain scores for those with successful NC and LC were: 1.24 versus 1.43 for the day of operation (P = 0.49), 0.86 versus 0.83 for the first day post-operatively (P = 0.92) and 0.75 versus 0.81 for the second post-operative day (P = 0.87). The mean number of intra-muscular analgesic injections required were 0.76 versus 0.83 after NC and LC, respectively (P = 0.93). There were no significant differences between the two groups in the time taken to return to feeding, eating a normal diet and discharge from hospital. CONCLUSION: There is no advantage of NC over LC in terms of post-operative pain or recovery. Nevertheless, NC can be performed safely and expediently and has an excellent cosmetic outcome and high patient acceptability.     

Staphylococcus Aureus and Infections on Maternity Wards: III. Bacterical Colonization of the Umbilicus and Exchange transfusions

Bacteriological examinations of the umbilici, blood transfusion-sets and patients' blood were performed at 28 exchange transfusions via the umbilicus 0-7 days after delivery. Most of the umbilici were colonized with bacteria at the time of exchange. No case of septicemia or omphalitis occurred. Nebocetin as powder or lotion did not sterilize the cords but possibly protected sterile cords from becoming infected. Daily spray with Nobecutan did not protect the umbilici from becoming contaminated. The effect on the infection of Nobecutan was not better than that of Xeroform powder. No clinical colonization occurred. Contamination with S. albus may have protected against colonization with S. aureus. Most strains were sensitive to most of the common antibiotics.     

Neutrophil alkaline phosphatase score in chronic granulocytic leukaemia: effects of splenectomy and antileukaemic drugs.

Staining with naphthol AS phosphate and Fast Blue BB salt has been used for the estimation of neutrophil alkaline phosphatase (NAP) scores in patients with chronic granulocytic leukaemia (CGL). The very low scores found at diagnosis rise when the disease is treated, and there is some inverse correlation between the NAP score and the absolute neutrophil count. Patients treated intensively developed high NAP scores. Elective splenectomy performed during the chronic phase of CGL is followed by a pronounced but transient neutrophilia and a concurrent striking rise in the NAP score. Similar changes were observed in patients without CGL who underwent splenectomy. These observations can be explained by assuming that newly formed neutrophils in CGL have a normal content of NAP but are rapidly sequestered in non-circulating extramedullary pools, whereas the circulating neutrophil with a typically low NAP content is a relatively aged cell which has lost enzyme activity. In subjects with or without CGL, removal of the spleen, a major site of such pooling, temporarily permits the circulation of newly formed neutrophils but eventually other organs assume the sequestering functions of the spleen. Thus the aberrations of NAP score seen in CGL might be attributable not to an intrinsic cellular defect but to an exaggeration of the granulocyte storage phenomena which also occur in subjects without CGL.     

Aldosterone receptor antagonists for hypertension: what do they offer?

Aldosterone is an important and independent target for therapeutic intervention in hypertension and hypertension-related diseases. Its actions, once thought to be limited to the distal convoluted tubule of the kidney, are now recognised to be wide-ranging, including interactions with mineralocorticoid receptors in diverse cardiovascular sites to mediate vascular and myocardial remodelling and dysfunction. The latter are referred as non-epithelial actions. Spironolactone, an aldosterone receptor antagonist, is indicated for the treatment of mineralocorticoid hypertension, but its use is limited by an adverse effect profile that includes not only by hyperkalaemia, but also antiandrogenic and progestational effects resulting from its poor specificity for the aldosterone receptor. Eplerenone is the first selective aldosterone receptor antagonist to be developed and recently gained approval from the US FDA for treatment of systemic hypertension. This was based on studies which demonstrated that eplerenone had a blood pressure-lowering profile that was equivalent to existing antihypertensive agents, was useful for treatment of low-renin and systolic hypertension, maintained utility even as add-on therapy to other antihypertensive agents, and exerted beneficial effects on hypertension-related left ventricular hypertrophy and renal impairment. Perhaps most notably, eplerenone was generally well tolerated, and did not cause the antiandrogenic and progestational adverse effects commonly observed with spironolactone.     

Eplerenone. Pharmacia

Pharmacia Corp (formerly GD Searle & Co) is developing eplerenone, an aldosterone receptor antagonist, as a potential treatment for congestive heart failure and systemic hypertension. The compound has been registered for hypertension and Pharmacia plans to submit a supplemental NDA for congestive heart failure in the first half of 2003 based on positive results from a phase III clinical trial.     

Rupture of the lateral ventricle secondary to a fourth ventricle tumour resulting in an indirect nontraumatic cerebrospinal fluid fistula

We present a rare indirect nontraumatic cerebrospinal fluid (CSF) fistula secondary to a fourth ventricle ependymoma. The fistula resulted from rupture of the left temporal horn, distant from the tumour. The fistula was well demonstrated by MRI. High-resolution CT demonstrated a defect in the roof of the sphenoid sinus, but no leakage of CSF was seen on CT cisternography.     

Accuracy of the Australian National Death Index: comparison with adjudicated fatal outcomes among Australian participants in the Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) study

OBJECTIVE: To assess the accuracy of the Australian National Death Index (NDI) in identifying deaths and recording cardiovascular and cancer causes of death. METHODS: Adjudicated mortality data from Australian participants in the Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) study up until September 1999 were used as reference. Nine hundred and eighty deceased subjects and 4,841 surviving subjects were matched to the NDI by name, date of birth, date of death and postcode. Matching rigour was confirmed by manual review. Deaths ascribed to cardiovascular and cancer causes within the NDI were also compared against LIPID-adjudicated causes. RESULTS: The NDI displayed 93.7% sensitivity and 100% specificity for the identification of deaths. Mis-recording of identifiers was responsible for 69% of known deaths not matching to the NDI and, if eliminated, would have increased the sensitivity to 98.0%. Among deceased subjects who matched to the NDI, cause of death was recorded in 96.2%. The sensitivity and specificity for cardiovascular deaths were 92.5% and 89.6%, respectively, and for cancer deaths 95.2% and 99.2%, respectively. CONCLUSION: Much of the inaccuracy of the NDI could potentially be overcome by the use of unique identifiers. Among deaths identified by the NDI, those due to cardiovascular disease are more likely to be inaccurately recorded than cancer-related deaths, probably because less uncertainty surrounds the presence or absence of terminal malignant disease.