Comparison of effects of preoperatively administered lornoxicam and tenoxicam on morphine consumption after laparoscopic cholecystectomy.

BACKGROUND AND OBJECTIVE: The efficacy, tolerability and the morphine-sparing effects of lornoxicam were compared with those of tenoxicam when used preoperatively in patients undergoing laparoscopic cholecystectomy. METHODS: In this prospective, double-blind study, 60 ASA I-II patients undergoing laparoscopic cholecystectomy were randomized equally to receive intravenous tenoxicam 40 mg (Group T) or lornoxicam 16 mg (Group L), preemptively. Three patients withdrew from the study, so 57 patients were included in the analysis. In the postoperative period, the first morphine demand times, pain scores, side-effects and cumulative morphine consumptions were evaluated during the first 24 h. RESULTS: The patient characteristics data and the duration of surgery were similar between two groups, except for body weights (P = 0.002). The first morphine demand time was significantly longer in Group L (P = 0.037), but the pain levels did not differ. The mean pain scores were higher in Group T in the 15 min (P = 0.036), 1 h (P = 0.020), 2 h (P = 0.001) and 4 h (P = 0.0042) after extubation. A statistically significant difference between two groups was found in calculated cumulative morphine consumptions per kilogram in the 15 min (P = 0.037), 30 min (P = 0.016), and 1 h (P = 0.004) and 2 h (P = 0.013) between two groups. There was no difference in the severity of nausea but 13 patients in Group T and five patients in Group L had vomiting (P = 0.018). Patient satisfaction was similar in the two groups. CONCLUSIONS: Preoperatively administered lornoxicam 16 mg significantly prolonged the first morphine demand time, reduced postoperative morphine consumption during the first 4 h and caused significantly fewer adverse effects when compared with tenoxicam after laparoscopic cholecystectomy.

[Value of intravesical ultrasound tomography and computer tomography in the evaluation of the depth of infiltration of bladder tumors]. / Die Wertigkeit von intravesikaler Ultraschalltomographie und Computertomographie zur Ermittlung der Infiltrationstiefe von Blasentumoren.

In 83% of cases the tumour could be correctly staged by intravesical sonography. Computed tomography gave a correct staging in 80%. By a combination of both methods the depths of tumour infiltration could be established exactly in 90%. Both methods are supplementary since the lower stages are better assessable by intravesical ultrasonic tomography whereas in the advanced stages computer tomography combined with pneumocystography permits a more exact evaluation of the depth of tumour infiltration.

[Computer tomographic findings in vascular malformations of the cerebral arteries (author's transl)]. / Computertomographische Befunde bei Gefässmissbildungen der Hirnarterien.

Basing on a retrospective study of the CT scan findings in vascular malformations of the cerebral arteries, compared with the angiographic findings, the article shows the diagnostic possibilities offered by computed tomography in subarachnoid haemorrhages. Localization of an aneurysm via computed tomography depends on the size of the aneurysm. Proof of an intracerebral haemorrhage is definitely a pointer towards lateral localization of the vascular malformation. This means that in severely ill patients, panangiography need not be effected for the purpose of diagnosis. Attention is drawn to the pathological emergence of the contrast medium after intravenous administration in subarachnoid haemorrhages. The authors considers this a sign of a disturbance of the blood-brain barrier, although the pathogenetic mechanism remains unknown. Computed tomography is a valuable complement to angiography in subarachnoidal haemorrhage. However, it is pointed out by means of a few examples that it may well be that an accurate diagnosis can be arrived at only via biopsy, i.e. by the histological approach only.

[Embolisation of malignant renal tumours (author's transl)]. / Embolisation maligner Nierentumoren

We have carried out embolisation of malignant renal tumours using homogenised muscle in a number of patients. Since October 1974, this has been done 22 times; in six cases the tumour was inoperable. Pre-operative embolisation of resectable renal tumours makes the operative procedures easier and reduces operative risks in older patients. Haematuria, which can cause bladder obstruction, is considered a particular indication in the presence of an inoperable tumour. Tumour growth can be reduced or there may even be regression. There were no significant complications as a result of embolisation of renal tumours with autologous homogenised muscle.