A comparison of opiate- and epidural-induced alterations in splanchnic blood flow using intra-operative gastric tonometry

Several methods are available to measure splanchnic blood flow and gut ischaemia. Tonometry is most practical for peri-operative use. Epidural blockade from T5 to T11 causes mesenteric arteriovenous vasodilation and may increase splanchnic blood flow. This study assesses the ability of tonometry to measure differential effects of opiate and epidural analgesia on splanchnic blood flow. Forty patients for elective colorectal surgery were randomly allocated to receive epidural infusion or intravenous morphine. Gastric mucosal PCO2, pHi, standard pHi, PCO2 gap and pH gap were measured after induction and on termination of surgery. These parameters were within normal limits at the end in most cases and there was no significant difference between the groups. The complication rate was similar in both groups and was not correlated with low pHi, but was correlated with blood loss. We were unable to demonstrate a difference in splanchnic perfusion, as assessed by gastric tonometry, between the two groups

How and when amnesty during conflict affects conflict termination

In the difficult process of ending civil wars, granting amnesty during conflict is seen as a useful option, with an underpinning assumption that trading justice for peace is effective. However, is the case? This article tries to bring some clarity to when and how amnesty given during conflict has an impact. Amnesty should have different effects on diverse conflict endings: negotiated settlement, rebel victory, government victory or conflict reduction. The article also disaggregates amnesties to test direct impacts as an incentive or through reducing the commitment problem, and indirect effects that give military advantage to the government. Using a cross-national dataset of amnesties in dyadic conflicts from 1975 to 2011, the research finds that amnesty’s strongest effect is, surprisingly, not as an incentive but rather to reduce commitment problems. It can lead to negotiated settlements but also government military advantage. The results have implications for negotiations and conflict resolution

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease