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  • 1
    ISSN: 1248-9204
    Keywords: Inguinal hernia ; Randomised controlled trial ; Health status measures
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The objective was to compare laparoscopic with open groin hernia repair in respect of patient-assessed outcome up to three months post-operatively. As part of a multicentre pragmatic trial 716 patients were recruited in 13 UK hospitals and randomly assigned to receive laparoscopic or open repair. Most participants were men (95%) with unilateral hernias (92.5%) which were inguinal (98.5%). Questionnaires were completed one week, one month, and three months after surgery. The principal endpoints were groin pain and return to usual social activities. The other outcomes were herniaspecific questions and the SF-36, EQ-5D and HADS measures. All analyses were by intention to treat. At one week and one month, respectively 10.3% and 13.9% fewer people in the laparoscopic group had groin pain and 27.7% and 37.2% fewer had numbness (all P 〈 0.001). Return to usual social activities was quicker in the laparoscopic group (P = 0.01). The laparoscopic group also had significantly more favourable scores at one week in five SF-36 subscales (physical functioning (P 〈 0.001), social functioning (P = 0.004), role physical (P 〈 0.001), role mental (P = 0.003) and pain (P 〈 0.001)), the EQ-5D utility score (P = 0.003) and the depression subscale of HADS (P = 0.001), and at one month in two SF-36 subscales (physical functioning (P = 0.01) and role physical (P = 0.01)). There was no detectable advantage by three months. Our findings that short-term outcome was better for patients allocated laparoscopic repair are consistent with other trials.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1459
    Keywords: Key words HLA ; Rheumatic ¶fever ; Sydenham’s chorea ; Carditis ; Arthritis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Sydenham’s chorea (SC) may occur in rheumatic fever (RF) patients without arthritis and carditis. In this study we typed HLA antigens and alleles in patients presenting with the distinct major clinical manifestations of RF, i.e., chorea, carditis, or arthritis, in population and family studies. We evaluated 91 patients with RF for HLA-A, HLA-B, and HLA-DR antigens; of these, 33 had pure chorea, 26 pure carditis, 16 pure arthritis, and 16 carditis plus arthritis. We also typed 24 SC patients and their unaffected siblings for HLA-DRB1 and HLA-DQB1 alleles using molecular methods. HLA-B49 and HLA-DR1 antigens were overrepresented in the total group of patients with RF and in all the subgroups studied, excluding the SC subgroup in which the frequency of HLA-DR1 antigen was not increased. The frequencies of the HLA-DRB1 and HLA-DQB1 alleles in patients with pure chorea were not significantly different from those observed in controls. Similarly, the frequencies of HLA class II alleles in SC patients did not differ significantly from those observed in unaffected siblings. These findings show that immunogenetic susceptibility to RF varies according to the major clinical manifestation presented by the patient.
    Type of Medium: Electronic Resource
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