“
“Objective: To assess real long-term varicose vein recurrence and patient satisfaction following surgical intervention with combined subfascial endoscopic perforator surgery (SEPS) and superficial venous surgery.
Method: Prospective consecutive case study (C3-C4). Patients were included March 1993 to September 1998 and 83/104 legs of 80/100 patients were re-assessed 2008; 71 legs underwent duplex ultrasound scanning (DUS).
Results: The median follow up was 12 years (range 10-14). Twelve patients/legs had undergone
additional vein surgery during follow-up. Incompetent lower leg perforators were noted in 18/71 limbs (25%). Following groin surgery 23/51 (45%) showed a duplex detected groin recurrence, neovascularization dominated 18/23. In legs where primary great saphenous vein (GSV) surgery had ISRIB nmr been performed, groin recurrence was found in 14/37 (38%). Previously unknown deep vein incompetence was detected in 14/71 legs (20%), six had axial reflux. The correlation selleck chemical between DUS-detected recurrence and remaining symptoms and cosmetic result was
low. The overall satisfaction was high, 70/82 (85%). Patient satisfaction did not deteriorate over time (p < .557).
Conclusion: Despite a fair number of DUS-detected recurrences, the overall long-term result, from the patients’ point of view was surprisingly favorable. Technically well performed open venous surgery seems to result in a durable long-term outcome. (C) 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.”
“The question of whether opioid analgesia AZD6738 should be given in patients with undifferentiated acute abdominal pain has been characterized by concerns about its efficacy and that signs used to determine accurate diagnosis may be masked by the drug. The objective of this review is to critically analyze pertinent pediatric randomized controlled studies considering this issue.
A comprehensive literature search was conducted via Medline in October 2007, using the terms ‘abdominal pain’, ‘physical
examination’, ‘analgesics’, ‘opioid’ and ‘appendicitis’. Other articles were identified using the bibliographies of papers found through Medline; alternate databases were searched but did not reveal additional studies.
A total of four trials were identified, and their validity and applicability were reviewed. In all studies, randomization to the analgesia group was associated with significant reduction in pain; one study showing no greater effect with opioid than placebo. All studies used a 10 cm Visual Analogue Scale to assess pain. All studies were only sufficiently powered to consider the primary outcome of opioid efficacy in abdominal pain vs placebo rather than diagnostic accuracy, although they all reported on diagnostic accuracy. Meta-analysis of results for efficacy and accuracy was not possible due to the heterogeneity of study populations.