Latest & greatest articles for surgery

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Top results for surgery

3601. Prospective randomised trial of tamoxifen versus surgery in elderly patients with breast cancer. (Abstract)

Prospective randomised trial of tamoxifen versus surgery in elderly patients with breast cancer. 116 patients aged 70 or over who were judged to have surgically resectable cancer of the breast were prospectively randomised to tamoxifen 20 mg daily or surgical resection. At a median follow-up of three years, local relapse or progression was seen in 15 (25%) of 60 patients in the tamoxifen group and 21 (37.5%) of 56 in the surgical arm. Distant metastases occurred in 8 (13%) in the tamoxifen

1988 Lancet Controlled trial quality: uncertain

3602. Twelve-year follow-up of survival in the randomized European Coronary Surgery Study. (Abstract)

Twelve-year follow-up of survival in the randomized European Coronary Surgery Study. We studied survival rates among 767 men with good left ventricular function who participated in the European Coronary Surgery Study, 10 to 12 years after they were randomly assigned to either early coronary bypass surgery or medical therapy. At the projected five-year follow-up interval, we observed a significantly higher survival rate (+/- 95 percent confidence interval) in the group that was assigned (...) , the gradually diminishing difference between the two survival curves still favored surgical treatment after 12 years (P = 0.04), despite the fact that 136 patients in the medically treated group had coronary bypass surgery and 23 in the "surgically treated" group did not. The benefit of surgical treatment tended to be greater, but not significantly so, as assessed by interaction analysis in the subgroups of patients who were older or who had signs of ischemia or previous infarction on the resting

1988 NEJM Controlled trial quality: uncertain

3603. Urinary-bladder management after total joint-replacement surgery. (Abstract)

Urinary-bladder management after total joint-replacement surgery. We conducted a randomized study of 100 patients to examine the efficacy and risks of two methods of urinary-bladder management after total joint-replacement surgery. Patients who had hip or knee replacement were randomly assigned either to Group I, in which indwelling catheters were placed during the operation and removed the next morning, or Group II, in which urinary retention was treated by intermittent catheterization (...) vs. 15 percent). We could not identify patients at high risk for retention or infection on the basis of preoperative urinary symptoms, previous urinary tract surgery, previous urinary tract infection or urinary retention, high-risk medical conditions, sex, type of anesthesia, or age (in the absence of prophylactic treatment). We conclude that the short-term use of an indwelling catheter after extended surgery, such as joint replacement, reduces the incidence of urinary retention and bladder

1988 NEJM Controlled trial quality: uncertain

3604. Influence of postoperative anticoagulant treatment on patient survival after femoropopliteal vein bypass surgery. (Abstract)

Influence of postoperative anticoagulant treatment on patient survival after femoropopliteal vein bypass surgery. To examine whether anticoagulants given after autologous saphenous bypass surgery influenced patient survival 119 patients who received such a graft for obliterative arterial disease were recruited for a controlled clinical trial. Patients were randomly assigned to start, in the second postoperative week, phenprocoumon (60 patients) or no treatment (59 patients). The median duration

1988 Lancet Controlled trial quality: uncertain

3605. Economic evaluation of cataract surgery: a comparison between IOL and non-IOL techniques

Economic evaluation of cataract surgery: a comparison between IOL and non-IOL techniques Economic evaluation of cataract surgery: a comparison between IOL and non-IOL techniques Economic evaluation of cataract surgery: a comparison between IOL and non-IOL techniques Tuominen R, Immonen I, Raivio I Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions (...) visit, operation, hospital stay, polyclinic, complications, travel, sick leave, home health care following operation, spectacles and contact lenses, lens cleaning, post-operative consultations, and private fees. Price information related to 1986. Currency Finnish Marks (FIM). Sensitivity analysis No sensitivity analysis was carried out. Estimated benefits used in the economic analysis From the literature, the authors assumed that IOL surgery presents optical advantages. Cost results Inclusion

1988 NHS Economic Evaluation Database.

3606. Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery: effects on the stress response. (Abstract)

Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery: effects on the stress response. In a randomised controlled trial, preterm babies undergoing ligation of a patent ductus arteriosus were given nitrous oxide and d-tubocurarine, with (n = 8) or without (n = 8) the addition of fentanyl (10 micrograms/kg intravenously) to the anaesthetic regimen. Major hormonal responses to surgery, as indicated by changes in plasma adrenaline, noradrenaline, glucagon, aldosterone (...) . The findings indicate that preterm babies mount a substantial stress response to surgery under anaesthesia with nitrous oxide and curare and that prevention of this response by fentanyl anaesthesia may be associated with an improved postoperative outcome.

1987 Lancet Controlled trial quality: uncertain

3607. Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery: effects on the stress response. (Abstract)

Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery: effects on the stress response. In a randomised controlled trial, preterm babies undergoing ligation of a patent ductus arteriosus were given nitrous oxide and d-tubocurarine, with (n = 8) or without (n = 8) the addition of fentanyl (10 micrograms/kg intravenously) to the anaesthetic regimen. Major hormonal responses to surgery, as indicated by changes in plasma adrenaline, noradrenaline, glucagon, aldosterone (...) . The findings indicate that preterm babies mount a substantial stress response to surgery under anaesthesia with nitrous oxide and curare and that prevention of this response by fentanyl anaesthesia may be associated with an improved postoperative outcome.

1987 Lancet Controlled trial quality: uncertain

3608. Effect of aprotinin on need for blood transfusion after repeat open-heart surgery. (Abstract)

Effect of aprotinin on need for blood transfusion after repeat open-heart surgery. Of 22 patients undergoing repeat open-heart surgery through a previous median sternotomy wound 11 were randomised to receive the serine proteinase inhibitor aprotinin in high dosage (about 700 mg intravenously from the start of anaesthesia to the end of operation, depending on the length of the surgical procedure). Their mean blood loss was 286 ml compared with 1509 ml in the 11 control patients (p less than

1987 Lancet Controlled trial quality: uncertain

3609. A cost-effectiveness analysis of prophylaxis against deep-vein thrombosis in major orthopedic surgery

A cost-effectiveness analysis of prophylaxis against deep-vein thrombosis in major orthopedic surgery A cost-effectiveness analysis of prophylaxis against deep-vein thrombosis in major orthopedic surgery A cost-effectiveness analysis of prophylaxis against deep-vein thrombosis in major orthopedic surgery Oster G, Tuden R L, Colditz G A Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary (...) of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Stockings, heparin sodium, warfarin sodium, dihydrergotamine mesylate and intermittent pneumatic compression. Type of intervention Primary prevention. Economic study type Cost-effectiveness analysis. Study population Patients undergoing orthopaedic surgery. Setting The study was carried out in the USA. Dates to which data relate Price related

1987 NHS Economic Evaluation Database.

3610. Prevention of venous thromboembolism after general surgery: cost-effectiveness analysis of alternative approaches to prophylaxis

Prevention of venous thromboembolism after general surgery: cost-effectiveness analysis of alternative approaches to prophylaxis Prevention of venous thromboembolism after general surgery: cost-effectiveness analysis of alternative approaches to prophylaxis Prevention of venous thromboembolism after general surgery: cost-effectiveness analysis of alternative approaches to prophylaxis Oster G, Tuden R L, Colditz G A Record Status This is a critical abstract of an economic evaluation that meets (...) the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Stockings, intermittent pneumatic compression, heparin and dihydroergotamine for the prevention of DVT after surgery. Type of intervention Primary prevention. Economic study type Cost-effectiveness analysis. Study population Patients undergoing abdominothoracic

1987 NHS Economic Evaluation Database.

3611. Economic evaluation of six scenarios for the treatment of stones in the kidney and ureter by surgery or extra-corporeal shock wave lithotripsy

Economic evaluation of six scenarios for the treatment of stones in the kidney and ureter by surgery or extra-corporeal shock wave lithotripsy Economic evaluation of six scenarios for the treatment of stones in the kidney and ureter by surgery or extra-corporeal shock wave lithotripsy Economic evaluation of six scenarios for the treatment of stones in the kidney and ureter by surgery or extra-corporeal shock wave lithotripsy Patel M S, Blacklock N J, Rao P N Record Status This is a critical (...) abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Extra-corporeal shock wave lithotripsy or surgery for the treatment of stones in the kidney and ureter. Type of intervention Treatment. Economic study type Cost-utility analysis. Study population Patients affected

1987 NHS Economic Evaluation Database.

3612. Prospective controlled trial of transhepatic biliary endoprosthesis versus bypass surgery for incurable carcinoma of head of pancreas. (Abstract)

Prospective controlled trial of transhepatic biliary endoprosthesis versus bypass surgery for incurable carcinoma of head of pancreas. 53 patients with obstructive jaundice due to incurable carcinoma of the head of the pancreas were randomly allocated to percutaneous transhepatic placement of a permanent biliary endoprosthesis (PTE) or bypass surgery. After exclusions 25 patients in each group were treated. Technical success was achieved in 21 patients (84%) in the PTE group and 19 (76 (...) %) in the surgery group. The incidence of postprocedural complications (PTE 7, surgery 8) and 30-day mortality (PTE 2, surgery 5) were similar. Recurrent jaundice occurred more often in the PTE (8/21) than the surgery group (3/19). Duodenal obstruction developed in 3 patients in the PTE group. Although the initial median postprocedural hospital stay was significantly shorter in the PTE than the surgery group, the difference was no longer significant when readmissions for blocked endoprosthesis and gastric

1986 Lancet Controlled trial quality: uncertain

3613. Treatment with desmopressin acetate to reduce blood loss after cardiac surgery. A double-blind randomized trial. (Abstract)

Treatment with desmopressin acetate to reduce blood loss after cardiac surgery. A double-blind randomized trial. Bleeding after cardiopulmonary bypass remains a cause for concern, requiring reexploration of the chest in approximately 3 percent of patients who have had operations on the heart. We examined the possibility that this problem might be alleviated by desmopressin acetate (DDAVP), which increases the plasma level of von Willebrand factor and improves hemostasis in mild hemophilia

1986 NEJM Controlled trial quality: uncertain

3614. A randomized controlled trial of a low-molecular-weight heparin (enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery. (Abstract)

A randomized controlled trial of a low-molecular-weight heparin (enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery. There is experimental evidence that low-molecular-weight fractions of heparin are as effective as the standard form but cause less bleeding. We therefore performed a double-blind, randomized trial comparing PK10169 low-molecular-weight heparin with placebo for the prevention of venous thrombosis in patients undergoing elective hip surgery

1986 NEJM Controlled trial quality: predicted high

3615. Transfusion-associated cytomegalovirus infections in seropositive cardiac surgery patients. (Abstract)

Transfusion-associated cytomegalovirus infections in seropositive cardiac surgery patients. To determine whether reinfection with an exogenous strain of cytomegalovirus (CMV) or reactivation of endogenous CMV is responsible for post-transfusion CMV infections in patients previously infected with the virus, seropositive patients were randomised preoperatively to receive red blood-cells (RBCs) from CMV seronegative donors (group A) or from random donors (group B). Each group B patient received

1985 Lancet

3616. A randomized trial of coronary artery bypass surgery. Survival of patients with a low ejection fraction. (Abstract)

A randomized trial of coronary artery bypass surgery. Survival of patients with a low ejection fraction. The Coronary Artery Surgery Study (CASS) was designed to compare medical and surgical treatment of selected patients with chronic, stable coronary artery disease. This report concerns a subset of patients with reduced ventricular function. Of 780 patients randomly assigned to medical or surgical treatment, 160 had ejection fractions above 0.34 but below 0.50 at base line and have been (...) followed for an average of seven years. Eighty-two patients were assigned to medical therapy, and 78 to surgery; the two groups were comparable at base line with regard to prognostically important variables. At seven years, 84 per cent of patients in the surgical group were alive, as compared with 70 per cent of the medical group (P = 0.01). Nearly half the patients with impaired ventricular function had triple-vessel disease at entry; at seven years, observed survival in this group was 88 and 65 per

1985 NEJM Controlled trial quality: uncertain

3617. Eleven-year survival in the Veterans Administration randomized trial of coronary bypass surgery for stable angina. The Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group. (Abstract)

Eleven-year survival in the Veterans Administration randomized trial of coronary bypass surgery for stable angina. The Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group. We evaluated long-term survival after coronary-artery bypass grafting in 686 patients with stable angina who were randomly assigned to medical or surgical treatment at 13 hospitals and followed for an average of 11.2 years. For all patients and for the 595 without left main coronary-artery disease (...) , cumulative survival did not differ significantly at 11 years according to treatment. The 7-year survival rates for all patients were 70 per cent with medical treatment and 77 per cent with surgery (P = 0.043), and the 11-year rates were 57 and 58 per cent, respectively. For patients without left main coronary-artery disease, the 7-year rates were 72 and 77 per cent in medically and surgically treated patients, respectively (P = 0.267), and the 11-year rates were 58 per cent in both groups

1984 NEJM Controlled trial quality: uncertain

3618. Prophylactic sulfamethoxazole and trimethoprim in ventriculoperitoneal shunt surgery. A double-blind, randomized, placebo-controlled trial. (Abstract)

Prophylactic sulfamethoxazole and trimethoprim in ventriculoperitoneal shunt surgery. A double-blind, randomized, placebo-controlled trial. We conducted a randomized, double-blind, placebo-controlled study during a 30-month period to determine whether sulfamethoxazole and trimethoprim would decrease the incidence of infections occurring after ventriculoperitoneal shunt surgery. Of the 120 patients who completed the study according to protocol, 55 received sulfamethoxazole and trimethoprim (...) infection, history of recent myelomeningocele repair, and type and duration of shunt surgery. The incidence of shunt malfunction was similar in uninfected patients receiving antibiotic prophylaxis (18/51) compared with that of patients receiving placebo (23/60). We did not find that the perioperative use of sulfamethoxazole and trimethoprim reduced the incidence of shunt infection or malfunction.

1984 JAMA Controlled trial quality: predicted high

3619. Myocardial infarction and mortality in the coronary artery surgery study (CASS) randomized trial. (Abstract)

Myocardial infarction and mortality in the coronary artery surgery study (CASS) randomized trial. The long-term benefit of coronary bypass surgery in terms of longevity and prevention of major ischemic events in patients who have mild angina is not well defined. The randomized Coronary Artery Surgery Study (CASS) was designed to evaluate this issue; it consists of 780 patients who were considered operable and who had mild stable angina pectoris or who were free of angina after infarction (...) and free of infarction was 82 per cent in the patients assigned to medical therapy and 83 per cent in the patients assigned to surgery (not significant). There were no statistically significant differences in the survival rate or in the myocardial-infarction rate between subgroups of patients randomly assigned to medical and to surgical therapy when they were analyzed according to initial group assignment, number of diseased vessels, or ejection fraction. Therefore, as compared with medical therapy

1984 NEJM Controlled trial quality: uncertain

3620. Physicians' reasons for not entering eligible patients in a randomized clinical trial of surgery for breast cancer. (Abstract)

Physicians' reasons for not entering eligible patients in a randomized clinical trial of surgery for breast cancer. We studied the reasons surgical principal investigators chose not to enter patients in a large, multicenter trial sponsored by a cooperative group. In 1976 the National Surgical Adjuvant Project for Breast and Bowel Cancers (NSABP) initiated a clinical trial to compare segmental mastectomy and postoperative radiation, or segmental mastectomy alone, with total mastectomy. Because

1984 NEJM