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PubMedDate not supplied

[Phonosurgical treatment of benign lesions of the vocal cords (10 years' experience)].

UNLABELLED: The aim of phonosurgery is to improve the state of voice and speech, while surgical treatment of benign vocal fold lesions belongs to the category of extirpation phonosurgery. Excellent functional results can be achieved with the aid of modern light sources and monitoring systems [8-19]. The aim of this study was to stress the advantages and shortcomings of direct suspension microlaryngoscopy, indirect microstroboscopy and indirect videostroboscopy, as well as indications for their use. METHOD: Over a 10-year period 1550 patients with benign lesions of the vocal folds were operated by direct microlaryngoscopy, indirect microstroboscopy and indirect videostroboscopy. Basic parameters which influence the selection of a particular surgical method were established, while a comparison was made among these various surgical techniques. RESULTS: Our surgical experience led us to conclusion that indirect procedures should be used in the majority of functional benign lesions of the vocal fold (Table 1). Selection of a particular surgical technique depends on several parameters (Table 2). Indirect procedures are indicated for small lesions with narrow base and with a distinct demarcation to the vocal tissue. Other cases are better approached by direct microlaryngoscopy, which is also indicated for submucosal lesions, sulcus vocalis etc., when bimanual instrumentation is required. Unfavourable local anatomy and "difficult" localization of a lesion (anterior commissure and posterior glottis) are better approached by indirect videostroboscopy. Indirect surgery is also required for cases when direct microlaryngoscopy is contraindicated and vice versa (contraindication for general anaesthesia or insufficient effect of epimucous anaesthesia). The patient should be allowed to express his preference for a particular surgical technique. DISCUSSION: Binocular vision and bimanual procedure are significant advantages of direct microlaryngoscopy, related to indirect procedures. However, some inadequacies of this technique and advantages of indirect procedures with modern light sources, magnification and videostroboscopic control make, in our experience, indirect videostroboscopy a procedure of choice for about two thirds of functional benign lesions of the vocal fold. Indirect videostroboscopy is technically simpler in relation to indirect microstroboscopic surgery, while indications for direct microlaryngoscopic and indirect videostroboscopic surgery are complementary. Laser surgery should be avoided in functional benign lesions of the vocal fold for its inferior functional results [25, 26].

Humans↗
PubMed1987

Pathfinding by pioneer neurons in isolated, opened and mesoderm-free limb buds of embryonic grasshoppers.

The Ti1 afferent neurons are the first neurons to undergo axonogenesis in limb buds of embryonic grasshoppers. Their growth cones pioneer a stereotyped pathway through the limb which becomes the route of one of the major leg nerve trunks. The growth cones appear to be oriented by several kinds of guidance cues, including guidepost neurons, a developing limb segment boundary, and an additional proximally orienting cue(s). In the experiments reported here, we have investigated the possible nature and source of proximally orienting and segment boundary cues by surgical manipulations of the limb. Before the onset of pioneer axonogenesis, limbs were isolated from the body, opened longitudinally and pinned out flat, or stripped of mesoderm. Pioneer axon routes in cultured, surgically manipulated limb buds were compared to routes in cultured control limbs. The results indicate that proximal extension of pioneer growth cones along the limb axis does not require (during the period of growth) tissue extrinsic to the limb, contact guidance by the limb contour, an axial electrical field, a diffusion gradient generated by a localized source, mesodermal cells, or guidepost neurons; adequate guidance information for proximal growth apparently can be provided by the limb epidermal epithelium (including the basal lamina) and/or by internal polarity of the pioneer neurons. Adequate guidance information for the segment boundary portion of the pioneer route apparently can be provided by the limb epithelium.

Animals↗
PubMed1977

Plasma levels of a viral protein as a diagnostic signal for the presence of mammary tumor: the effect of tumor removal.

We have previously shown (1, 2) that mice with mammary tumors can always be identified by their very high plasma levels of gp52, a 52,000 mol wt glycoprotein of the mouse mammary tumor virus (MMTV). The present investigation demostrates that the tumor is the principal source of the plasma gp52 since surgical excision is invariably followed in the first 9 days by a sharp decreasing (10-100-fold) of the gp52 levels. Control animals in which the tumors were left in place by a "sham" surgical procedure maintained their high level of gp52, which continued to increase as the disease progressed. The behavior of the gp52 after surgical removal suggests that gp52 plasma concentrations are diagnostically and prognostically informative, as indicated by the following finding: (a) All tumor recurrences were correctly diagnosed by increases in gp52 levels, and some were detected 4-7 days before they were found by palpation. (b) Tumor regrowths were accompanied by continued increases in plasma gp52 concentrations at rates that usually matched the speed of tumor development. (c) The only animals that remained tumor free at the termination of the experiment were those that maintained their gp52 levels at or below 15 ng/ml. (d) The probability of a tumor-free animal relapsing within 2 wk is much higher if its gp52 level is above the mean. (e) More remarkably, the plasma levels of gp52 at the time of surgery are superior to the size of the tumors removed as prognostic indicators of eventual surgical "cures". The availability of a specific and sensitive systemic measure of disease status should augment the usefulness of the murine mammary tumor model by catalyzing a more rapid acquisition of information on the therapeutic effectiveness of the new and varied drug combinations being tested for adjuvant chemotherapy.

Animals↗
PubMed1996

Procedural and strain-related variables significantly affect outcome in a murine model of focal cerebral ischemia.

The recent availability of transgenic mice has led to a burgeoning number of reports describing the effects of specific gene products on the pathophysiology of stroke. Although focal cerebral ischemia models in rats have been well described, descriptions of a murine model of middle cerebral artery occlusion are scant and sources of potential experimental variability remain undefined. We hypothesized that slight technical modifications would produce widely discrepant results in a murine model of stroke and that controlling surgical and procedural conditions could lead to reproducible physiological and anatomic stroke outcomes. To test this hypothesis, we established a murine model that would permit either permanent or transient focal cerebral ischemia by intraluminal occlusion of the middle cerebral artery. This study provides a detailed description of the surgical technique and reveals important differences among strains commonly used in the production of transgenic mice. In addition to strain-related differences, infarct volume, neurological outcome, and cerebral blood flow appear to be importantly affected by temperature during the ischemic and postischemic periods, mouse size, and the size of the suture that obstructs the vascular lumen. When these variables were kept constant, there was remarkable uniformity of stroke outcome. These data emphasize the protective effects of hypothermia in stroke and might help to standardize techniques among different laboratories to provide a cohesive framework for evaluating the results of future studies in transgenic animals.

Animals↗
PubMed2001

[Parapharyngeal and peritonsillar infection following mandibular third molar extraction].

Numerous complications following impacted third molar extractions have been described previously. Among these are swelling, infection, subdermal hematomas, nerve injuries, injuries to adjacent teeth and mandibular fractures. The parapharyngeal space is a funnel-shaped space with its base located at the base of the skull and its apex near the hyoid bone. It is bounded medially by the superior constrictor muscle and the tonsillar fossa and laterally by the medial pterygoid muscle, the mandibular ramus, the deep lobe of the parotid gland and the posterior belly of the digastric muscle. The junction of the buccinator and superior constrictor muscles at the pterygomandibular raphe forms the anterior border. The posterior border is formed by the vertebral column and the prevertebral muscles. Infratemporal and peritonsillar space infections following third molar extractions are relatively rare because of anatomical barriers that exist in that area, but complications of such infections are considered to be highly severe and sometimes even life threatening. These complications include septic thrombophlebitis of the internal jugular vein, septic aneurysms of the internal carotid artery and mediastinitis. This article presents a parapharyngeal and peritonsillar space abscess resulting from a third molar extraction. Several articles reviewed in this paper revealed similar signs and symptoms in parapharyngeal abscesses. The main radiological finding was soft tissue swelling in the prevertebral area. Cultures have demonstrated Klebsiella pneumoniae as the dominant microorganism in these infections. Early identification and correct diagnosis of parapharyngeal and peritonsillar abscesses are necessary to avoid life-threatening complications that may accompany such infections. Airway control should receive top priority in treatment, followed by extensive surgical drainage and administration of high dose organism-specific antibiotics as well as removal of the source of infection.

Adult↗
PubMed2004

Kidney transplantation from organ donors following cardiopulmonary death using extracorporeal membrane oxygenation support.

Extracorporeal membrane oxygenation (ECMO) has the ability to provide normal organ perfusion and oxygenation in the absence of cardiac function and thus has the potential to improve viability of subsequently transplanted kidneys. In addition, ECMO support allows the donation following cardiopulmonary death (DCD) process to occur in a controlled manner that is acceptable to staff unfamiliar with DCD. In 1999 our center implemented a controlled DCD program that incorporates post-mortem ECMO support of the organs. Arterial and venous cannulae are placed following consent to donate, but prior to withdrawal of support. ECMO circulation is initiated immediately following declaration of death. Following a brief period where the donor family is allowed to grieve, the donor is moved to the operating room where organ recovery occurs. We reviewed the results of 20 kidney transplants from 13 ECMO supported donors that occurred between October 2000 and August 2003. One renal allograft was lost due to surgical complications, all 19 remaining grafts functioned. An 11% (2/19) delayed graft function rate was observed. Kidneys donated from "controlled" ECMO supported CPD donors are a viable source of organs for renal transplantation. This recovery method warrants further investigation.

Cadaver↗
PubMedDate not supplied

Failure of enforcement controlled substance laws in health policy for prescribing opiate medications: a painful assessment of morbidity and mortality.

Controlled substances can be used for legitimate medical purposes to relieve pain and suffering, and allow management of medical and surgical conditions, whether acute or chronic in duration. However, because these are attractive, addicting drugs, diversion from sources such as physicians and pharmacists can lead to serious health problems. Of importance is that addiction to opiate medications can interfere with treatment of the original pain condition, and can lead to life threatening states because of poor judgment and depressed mood in the users. Consequently, the public has a vested interest in protecting the medical uses of these medications on the one hand, although reducing the morbidity and mortality from their diversion and addictive use. The controlled substance laws contain 3 sources of policy framework that governs the medical use and diversion of controlled substances: (1) international treaties, (2) federal laws and regulations, and (3) state laws and regulations. These laws are aimed at balancing the need to controlling use with adverse consequences against the therapeutic benefits opiate medications provide the public.

Analgesics, Opioid↗
PubMed2002

The introduction of a paediatric anaesthesia information leaflet: an audit of its impact on parental anxiety and satisfaction.

BACKGROUND: A paediatric anaesthesia information leaflet was produced to address preoperative parental anxiety and to facilitate informed parental consent. METHODS: An audit was undertaken to assess the impact of introducing the leaflet. This addressed the information needs and expectations of parents of children undergoing anaesthesia, parental satisfaction with information provision and parental preoperative anxiety. RESULTS: The audit revealed that parents expect to be provided with information, although not necessarily in written form. However, the majority who received the information leaflet concluded that verbal information alone would not have been sufficient. The information leaflet was found to be accessible, informative and useful and those who received it reported greater satisfaction with information provision than a control group. Many parents perceived that it resulted in lower levels of preoperative anxiety CONCLUSIONS: A decision was therefore undertaken that routine use of the leaflet would continue on all of the paediatric surgical wards. However, the study also indicated that leaflets should not replace verbal communication with nursing and medical staff, who remain important sources of information.

Adult↗
PubMed1990

Facial muscle reanimation using the trigeminal motor nerve: an experimental study in the rabbit.

Surgical repair of facial nerve deficits may be marred by lack of muscle control and donor region paresis. Using New Zealand white rabbits, a study was undertaken to evaluate facial muscle reanimation with a donor source not previously used: the motor division of the trigeminal nerve. The results were compared with the severed facial nerve and hypoglossal-facial coaptation. An atrophy scale was calibrated for facial muscles of the rabbit. Clinical, electromyographic, and histomorphometric findings confirmed that the trigeminal nerve was a suitable donor source. The neurorrhaphy produced an exponential rate of repair.

Anastomosis, Surgical↗
PubMedDate not supplied

Areolar connective tissue grafts in pediatric tympanoplasty: a pilot study.

PURPOSE: To compare the surgical and audiologic success rates of areolar connective tissue with temporalis fascia in pediatric tympanoplasty. METHODS: Retrospective case series review of 10 patients younger than 18 years who underwent primary tympanoplasty between December 1997 and December 2000 using areolar connective tissue grafts. Tympanoplasty patients receiving temporalis fascia grafts during this period were used as a control group. Surgical and audiometric results were gathered after a minimum follow-up of 1 year. RESULTS: Both groups were similar in their clinical characteristics (P <.05). The surgical success rates for areolar and temporalis fascial groups were 90% and 91%, respectively. Closure of the air bone gap to within 25 dB was achieved in 90% and 91% of the areolar and temporalis fascial groups, respectively. CONCLUSIONS: This study showed equivalent surgical and audiometric success rates between areolar connective tissue and temporalis fascia. Both are excellent sources of graft material in pediatric patients.

Case-Control Studies↗
PubMed1992

Changes in dorsoventral but not rostrocaudal regionalization of the chick neural tube in the absence of cranial notochord, as revealed by expression of engrailed-2.

Notochord has been implicated in previous studies in both the dorsoventral and rostrocaudal patterning of the developing neural tube. This possibility has been further explored by analyzing the expression of Engrailed-2 in chick embryos developing with cranial notochord defects. Control embryos containing intact notochords expressed Engrailed-2 protein within the neural tube and in a subset of the neural crest and overlying surface ectoderm at the future mesencephalon and cranial metencephalon levels. Within the neural tube, expression was confined to cell nuclei in the roof plate and lateral walls; floor plate nuclei directly overlying the notochord typically failed to show expression. After surgical removal of Hensen's node, the source of notochord precursor cells, embryos were cultured through neurulation and assayed for expression of Engrailed-2 protein. All embryos that partially or completely lacked cranial notochord expressed Engrailed-2 in a pattern similar to that of control embryos containing intact notochords, except that when notochord and floor plate were absent, Engrailed-2 was also expressed in the most ventral part of the neural tube. These results indicate that 1) Engrailed-2 expression is suppressed in the most ventral neural tube owing to induction of the floor plate by the notochord, and 2) that the presence of an underlying notochord is not required for correct rostrocaudal expression, suggesting that multiple pathways act in the patterning of the rudiment of the central nervous system.

Animals↗
PubMed1996

Duration of antibiotic treatment in surgical infections of the abdomen. Forum statement: a plea for selective and controlled postoperative antibiotic administration.

Excessive duration of antibiotics appears to be the principal reason for their inappropriate use in current surgical practice. The main factors to blame are the inability of the clinician to distinguish between contamination and infection, infection and inflammation, and failure to stratify the latter. Consequently, and unnecessarily, prophylactic drugs are carried through into the postoperative period and treatment is continued for long periods. Most experts who contributed to this Discussion Forum favour a trend away from the use of therapeutic courses of fixed duration, and towards attempts to stratify the infective processes, minimising administration by tailoring the duration to the clinical findings. As a consensus of this forum specific recommendations are: Contamination (gastroduodenal peptic perforations operated within 12 hours, traumatic enteric perforations operated with 12 hours, peritoneal contamination with bowel contents during elective or emergency procedures, early or phlegmonous appendicitis or phlegmonous cholecystitis): single dose prophylaxis. Resectable infection (appendicectomy for gangrenous appendicitis, cholecystectomy for gangrenous cholecystitis, bowel resection for ischaemic or strangulated dead bowel without frank perforation): 24 hours postoperative antibiotics. Advanced infection (intra-abdominal infection from diverse sources): 48 hours to 5 days, based on operative findings and patient's condition. Severe intra-abdominal infection with the source not easily controllable (infected pancreatic necrosis, postoperative intra-abdominal infection): longer courses may be necessary.

Anti-Bacterial Agents↗
PubMed1995

An outbreak of handscrubbing-related surgical site infections in vascular surgical procedures.

OBJECTIVE: To investigate an outbreak of surgical site infections (SSI) in a vascular surgery unit. SETTING: A 60-bed unit of vascular surgery, where surgeons performed an average of 30 operations per month at the Hospital do Servidor Público Estadual, a 1,000-bed tertiary care hospital in São Paulo, Brazil. DESIGN: We included in the case group nine patients who had limb amputations or arterial reconstructions, October 16 through 23, 1992. We included in the control group patients whose operations were performed within 30 days of the outbreak period. Control patients were matched for sex and type of operation. RESULTS: Six of 9 case patients experienced SSI, as compared with 3 of 18 control patients (P = .026) and 28 of 244 patients in the pre-epidemic period (P = .0002). Risk factors were identical for case and control groups. Factors assessed were American Society of Anesthesiology (ASA) status, duration of surgery, wound class, emergency status, remote site infections, preoperative length of stay, use of prophylactic antibiotics, and underlying diseases. Possible common sources also were analyzed. No differences were observed concerning hair removal, preoperative shower, wound dressing, and surgical team present in the operating room. During the outbreak period, the operating room was not provided with povidone-iodine, used in our hospital for skin cleansing and handscrubbing. Surgeons from all departments, including vascular surgery, used 2% iodine with 70% alcohol for skin cleansing. Surgeons from other departments used this iodine solution for handscrubbing, but the vascular surgeons used plain soap for handscrubbing. No increases in SSI rates were reported in other services. Comparison of case and control groups for handscrubbing was statistically significant (P < .00001). After reinstitution of povidone-iodine, only one SSI was diagnosed in 13 vascular procedures. CONCLUSIONS: Although we could not demonstrate definitely that scrubbing with plain soap was related to SSI, we found a strong suggestion of this association.

Age Factors↗
PubMed1996

Vascular endostapler as aid to hepatic vein control during hepatic resections.

Significant hemorrhage during hepatic resections for malignancies can result in increased mortality due to liver failure or acute blood loss. Massive hemorrhage is often related to loss of control or injury to the hepatic veins or inferior vena cava. Prevention or reduction of intraoperative blood loss, through improved surgical techniques and increased operator experience, can significantly reduce postoperative morbidity and mortality. Although the use of continuous or intermittent clamping of the portal triad structures (Pringle maneuver) has reduced the incidence of bleeding during hepatic transections, the hepatic vein ligation step of liver resections continues to be a possible source of major blood loss. Because of its safety, rapidity, and ease of application, the EndoGIA 30V vascular stapler is presented as an efficient means for controlling and dividing the major hepatic veins. In skilled hands, this stapling device can contribute to a reduction in incidence and risk of major intraoperative bleeding during hepatectomy. The critical factor to ensuring postoperative morbidity reduction, however, is the surgeon's experience in major hepatic resection procedures.

Blood Loss, Surgical↗
PubMedDate not supplied

Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Ilorin, Nigeria.

BACKGROUND: Nosocomial infections caused by methicillin-resistant strains of Staphylococcus aureus constitute significant epidemiologic problems. Defining an outbreak requires the use of rapid and highly discriminatory epidemiologic methods to determine the epidemic strains involved in such outbreak. STUDY DESIGN: A descriptive laboratory based surveillance study for MRSA was undertaken. One hundred and forty seven Staphylococcus aureus isolates from clinical specimens were screened for methicillin resistance at the University of Ilorin Teaching Hospital between January and December 2001. Fifty one (34.7%) methicillin resistant strains recovered were epidemiologically characterized using Eco R1 restriction enzyme analysis of their plasmid DNAs. RESULT: Forty five (88.2%) MRSA isolates were associated with infections and 6 (11.8 %) were colonizing strains; 36 (70.6%) and 15 (29.4%) were hospital and community acquired respectively. Skin and soft tissues were sites of infection in 36 (70.6 %) cases and surgical, emergency and ICU accounted for 33 (64.7%) isolates. All isolates were resistant to more than two antibiotics but sensitive to vancomycin. Forty two (82.4 %) isolates contained plasmids including 9 (21.4 %) that contained more than one plasmid. Restriction Enzyme Analysis of the Plasmid DNA (REAP) divided the isolates into 9 Eco R1 profiles, with profile 2 accounting for 41.7% of all nosocomial infections in the wards, implying that it is endemic. The remaining nosocomial profiles occurred less frequently, suggesting that they are sporadic strains originating from outside the hospital. The community strains showed diverse digestion pattern indicating that they are from different clones. CONCLUSION: The spread of MRSA can be controlled through reinforcement of appropriate use of antibiotics, hand washing and laboratory surveillance for MRSA, particularly in the surgical wards and intensive care units, in order to identify sources of outbreaks.

Cross Infection↗
PubMed2000

The effectiveness and cost-effectiveness of prophylactic removal of wisdom teeth.

BACKGROUND: Removal of wisdom teeth is one of the most common surgical procedures performed in the UK. Little controversy surrounds the removal of impacted third molars when they are associated with pathological changes such as infection, non-restorable carious lesions, cysts, tumours, and destruction of adjacent teeth and bone. However, the justification for prophylactic removal of impacted third molars is less certain and has been debated for many years. OBJECTIVES: To provide a summary of existing evidence on prophylactic removal of impacted wisdom teeth, in terms of the incidence of surgical complications associated with prophylactic removal, and the morbidity associated with retention. METHODS: A systematic review of the research literature was undertaken. METHODS - DATA SOURCES: An existing review formed the basis of this report, and additional literature searches were undertaken, including searches of electronic databases (MEDLINE, 1984-99; EMBASE, 1984-99; Science Citation Index, Cochrane Controlled Trials Register, National Research Register; Database of Abstracts of Reviews of Effectiveness), paper sources (including Clinical Evidence), and web-based resources. Relevant organisations and professional bodies were contacted for further information. METHODS - STUDY SELECTION: Studies were selected for inclusion if they met the following criteria: (1) design - randomised controlled trials (RCTs), literature reviews, or decision analyses; (2) participants - people with unerupted or impacted third molars, or those undergoing surgical removal of third molars either as prophylaxis or due to associated pathological changes; (3) reported outcomes - either the pathological changes associated with retention of third molars, or post-operative complications following extraction. There were no language restrictions on study selection. METHODS - DATA EXTRACTION AND SYNTHESIS: Data from included studies were extracted into structured tables and individual study validity was assessed against methodological checklists. Data were summarised descriptively. Decisions relating to study selection, data extraction and validity assessment were made by two independent reviewers, and disagreements were resolved by discussion. For non-English papers, translators were recruited to assist with study selection and data extraction. RESULTS: Forty studies were included in the review: two RCTs, 34 literature reviews, and four decision analysis studies. One RCT in the UK focused on the effects of retained third molars on incisor crowding (predominantly a cosmetic problem) in patients who had previously undergone orthodontic treatment. The results of this trial suggested that the removal of third molars to prevent late incisor crowding cannot be justified. Another on-going RCT in Denmark compares the effects and costs of prophylactic removal of third molars with removal according to morbidity. So far, this trial has recruited 200 participants, and preliminary results indicate that watchful waiting may be a promising strategy. However, more data and longer follow-up of patients are needed to conclude which treatment strategy is the most cost-effective. It is also known that a trial is on-going in the USA but no results are available so far. The methodological quality of the literature reviews was generally poor, and none of the reviews was systematic. Conclusions from nine reviews on anterior crowding suggested that there was only a weak association between retention of third molars and crowding. Six out of 21 reviews with a more general scope also concluded that the prophylactic removal of third molars was unjustified. Twelve general reviews did not conclude with a clear message about the management of third molars. Three reviews suggested that prophylactic removal of third molars is appropriate, but these reviews were of poorer methodological quality than the majority of other reviews. Three out of four papers focusing on surgical management expressed

Cost-Benefit Analysis↗
PubMed1998

Evaluation of the transprofessional model of home health care for HIV/AIDS.

OBJECTIVE: To determine if a Transprofessional care-management approach (experimental group) produces savings in service delivery dollars when compared to a Traditional treatment approach (control group). The care-management approach utilizes an interdisciplinary mix of allied health professionals who adhere to a service delivery protocol based on active, medical, surgical treatment (curative services) as well as on pain, symptoms, and emotional care (palliative services). DATA SOURCES AND STUDY SETTING: Data were collected from 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). Demographic and disease-specific data were collected from admitting records; service-utilization data were collected from the VNA-LA's computerized data system. STUDY DESIGN: Upon admission for home-care services, patients were randomly assigned to an experimental (Transprofessional) or control (Traditional) treatment group. Service levels were comparable. PRINCIPLE FINDINGS: Post-test measures indicate an 8 percent reduction in labor delivery costs for an average experimental patient's entire episode of home-care versus for an average control patient's. CONCLUSIONS: An integrated model of service delivery, which is based on interdiscriplinary, care-management and blended modalities of service, provides a cost-effective method in the provision of home-care services for terminally ill AIDS patients.

Adult↗
PubMed2006

Standards of reporting of randomized controlled trials in general surgery: can we do better?

OBJECTIVE: To evaluate the quality of reporting of surgical randomized controlled trials published in surgical and general medical journals using Jadad score, allocation concealment, and adherence to CONSORT guidelines and to identify factors associated with good quality. SUMMARY BACKGROUND DATA: Randomized controlled trials (RCTs) provide the best evidence about the relative effectiveness of different interventions. Improper methodology and reporting of RCTs can lead to erroneous conclusions about treatment effects, which may mislead decision-making in health care at all levels. METHODS: Information was obtained on RCTs published in 6 general surgical and 4 general medical journals in the year 2003. The quality of reporting of RCTs was assessed under masked conditions using allocation concealment, Jadad score, and a CONSORT checklist devised for the purpose. RESULTS: Of the 69 RCTs analyzed, only 37.7% had a Jadad score of > or =3, and only 13% of the trials clearly explained allocation concealment. The modified CONSORT score of surgical trials reported in medical journals was significantly higher than those reported in surgical journals (Mann-Whitney U test, P < 0.001). Overall, the modified CONSORT score was higher in studies with higher author numbers (P = 0.03), multicenter studies (P = 0.002), and studies with a declared funding source (P = 0.022). CONCLUSION: The overall quality of reporting of surgical RCTs was suboptimal. There is a need for improving awareness of the CONSORT statement among authors, reviewers, and editors of surgical journals and better quality control measures for trial reporting and methodology.

General Surgery↗