Long-term efficacy and safety of cap-assisted endoscopic sclerotherapy with long injection needle for internal hemorrhoids

BACKGROUNDHemorrhoids are a common anal condition and can afflict an individual at any age. Epidemiological survey results in China show that the prevalence of anorectal diseases is as high as 50.1% among which 98.08% of patients have hemorrhoid symptoms.AIMTo assess long-term efficacy and safety of cap-assisted endoscopic sclerotherapy (CAES) with long injection needle for internal hemorrhoids.METHODSThis study was retrospective. Data from patients with symptomatic internal hemorrhoids treated with CAES using endoscopic long injection needle from April 2016 to December 2019 were collected. Patients were telephoned and followed at two time points, December 2020 and 2021, to evaluate the improvements in symptoms, complications, recurrence, and satisfaction.RESULTSTwo hundreds and one patients with internal hemorrhoids underwent CAES with the long needle. The first median follow-up was performed 33 mo post-operatively. Symptoms improved in 87.5% of patients after the first CAES. Efficacy did not decrease with treatment time extension. Fifty-four patients underwent colonoscopy after the first CAES treatment of which 21 underwent CAES again, and 4 underwent hemorrhoidectomy. At the first follow-up, 62.7% of patients had both improved hemorrhoid grades and symptoms, and 27.4% had a significant improvement in both parameters. At the second follow-up, 61.7% of the patients showed satisfactory improvement in their hemorrhoid grade and symptoms when compared with pre-surgery values. 90% of patients reported CAES was painless, and 85% were satisfied/very satisfied with CAES treatment outcomes.CONCLUSIONThe present study based on the largest sample size reported the long-term follow-up of the treatment for internal hemorrhoid with the CAES using endoscopic long injection needle. Our findings demonstrate that CAES should be a micro-invasive endoscopic technology yields satisfactory long-term efficacy and safety.     

Outcomes of lumbar facet syndrome treated with oral diclofenac or methylprednisolone facet injection: a randomized trial

Purpose

This prospective randomized trial is to determine the effectiveness of treating lumbar facet syndrome with oral diclofenac, methylprednisolone facet joint injection or both.

Methods

We enrolled lumbar facet syndrome patients treated at Srinagarind Hospital. Enrolled patients were randomly assigned to receive 100 mg/day oral diclofenac, an 80 mg injection of methylprednisolone into each symptomatic facet joint, or both. Endpoints were the Oswestry disability index (ODI) and visual analogue scale (VAS) before treatment, and at four and 12 weeks after treatment.

Results

Of the 99 patients, the mean age was 46.4 years and 48 were men. The initial ODI (mean?±?SD) for the diclofenac, methylprednisolone and combined treatment was 45.1?±?9.3, 42.9?±?15.6, and 42.2?±?11.5, respectively. The respective four week ODI was 30.1?±?8.1, 20.2?±?8.0, and 15.1?±?5.5. The 12-week ODI was 42.4?±?9.0, 32.2?±?15.6, and 26.2?±?11.7. The initial VAS was 7.1?±?1.2, 7.6?±?1.1, and 7.3?±?1.0. The four week VAS was 5.3?±?1.4, 3.6?±?0.7, and 3.3?±?1.1. The 12-week VAS was 6.1?±?1.1, 5.8?±?1.4, and 5.1?±?0.9. The four week ODI and VAS for the combined treatment and the methylprednisolone treatment were significantly less than the diclofenac alone. The combined treatment also showed better scores than the methylprednisolone injection. Within each treatment, the best treatment effect was found at four weeks after which the ODI and VAS gradually increased but were still less than the initial scores.

Conclusions

The combined treatment was more effective in reducing lumbar facet pain and improving the functional index than either treatment alone. This approach should be the preferred treatment.

     

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目的 评价5%石炭酸麻油注射治疗内痔的效果。方法 采用5%石炭酸麻油单次大剂量注射治疗内痔2450例,其中I度346例,Ⅱ度1275例,Ⅲ829例。结果 270例随访平均16个月,对出血和脱垂的有效率分别为85.9%和34.2%,无一例发生出血、坏死、感染等并发症。结论 5%石炭酸麻油单次大剂量注射治疗内痔安全有效。     

Outcomes of laparoscopic colorectal surgery in obese and nonobese patients: a case-matched study of 180 patients

Background

Because it has been suggested that obese patients may be at higher risk of morbidity and mortality after surgery, we conducted a prospective case-matched study to compare outcomes of elective laparoscopic colorectal surgery in obese and nonobese patients.

Methods

Sixty-two consecutive nonselected obese patients (body mass index ≥30 kg/m²) were matched with 118 nonobese patients. Postsurgical mortality and morbidity were defined as in-hospital death and complications.

Results

Cardiopulmonary comorbidities were significantly more frequent in obese compared with nonobese patients (44% vs 24%, P < .01). Obesity was significantly associated with increased mean operating time (268 ± 74 min vs 232 ± 59 min, P < .001), and conversion rate (32% vs 14%, P < .01). The mortality rate was nil. The overall postsurgical morbidity rate (31% vs 19%, P = not significant) and mean hospital stay (11 ± 10 days vs 9 ± 8 days, P = not significant) were similar in obese and nonobese patients.

Conclusions

The results of this large case-matched study suggest that laparoscopic approach for colorectal surgery is feasible and safe in obese patients.     

聚桂醇治疗老年患者出血性痔病的临床疗效观察

目的探讨聚桂醇在老年患者出血性痔病中的临床应用价值。方法选择江苏省苏北人民医院肛肠科老年出血性痔病患者40例,观察患者术后(1～24周)的症状与体征变化,并记录术中、术后的并发症。结果痊愈40例,随访4～24周,平均随访17.5周,无复发病例。结论聚桂醇硬化注射术治疗老年患者出血性痔病是一种低创伤性的痔病微创治疗方法,具有安全,有效,少痛,微创等优点,适合临床不能耐受传统手术的老年出血性痔病患者。     

A transparent over-tube for endoscopic injection sclerotherapy and results in patients with esophageal varices

This report describes our data regarding repeated injection sclerotherapy using a newly designed over-tube. We treated 17 consecutive patients with esophageal varices, (3 acute, 6 elective and 8 prophylactic). An intravariceal injection of 5 per cent ethanolamine oleate was administered, using a newly designed transparent over-tube containing a second lumen for a flexible injection needle. This over-tube provides an easier, safer, shorter-in-time method of sclerosing esophageal varices. One of the 17 patients died as a result of liver failure associated with advanced cirrhosis and a concomitant hepatoma. Eradication of esophageal varices was attained in the remaining 16 patients, after an average of 5.0 injections over an average period of 5.8 weeks (range: 3–7 injections during 3–11 weeks). No complications, such as esophageal perforation or aspiration pneumonia were encountered. Recurrent variceal bleeding has not occurred during the 9 months follow-up.     

A transparent over-tube for endoscopic injection sclerotherapy and results in patients with esophageal varices

This report describes our data regarding repeated injection sclerotherapy using a newly designed over-tube. We treated 17 consecutive patients with esophageal varices, (3 acute, 6 elective and 8 prophylactic). An intravariceal injection of 5 per cent ethanolamine oleate was administered, using a newly designed transparent over-tube containing a second lumen for a flexible injection needle. This over-tube provides an easier, safer, shorter-in-time method of sclerosing esophageal varices. One of the 17 patients died as a result of liver failure associated with advanced cirrhosis and a concomitant hepatoma. Eradication of esophageal varices was attained in the remaining 16 patients, after an average of 5.0 injections over an average period of 5.8 weeks (range: 3-7 injections during 3-11 weeks). No complications, such as esophageal perforation or aspiration pneumonia were encountered. Recurrent variceal bleeding has not occurred during the 9 months follow-up.     

Outcomes of open bicondylar tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation

This study was conducted to evaluate the outcome of treatment for open fractures of the tibial plateau using external circular fixation combined with or without limited internal fixation. Twenty-five patients (16 males and 9 females) with open fracture tibial plateau were treated with circular external fixator with minimal internal fixation. The mean age of the patients was 36 years (range between 23 and 62 years). According to AO classification system, there was six (24 %) C1, eleven (44 %) C2, and eight (32 %) C3. According to Gustilo and Anderson classification, seven (28 %) were grade 1; nine (36 %), grade 2; six (24 %), grade 3b; and three (12 %), grade 3c. According to ASAMI score, Italy, the results were excellent in 8 (32 %) cases, good in 12 (48 %) cases, and fair in five (20 %) patients. The patients’ satisfaction was significantly related to the functional results (p < 0.05). Complications included skin gaping in one case 10 days postoperatively. Pin tract infection was seen in 20 % of cases, one case showed deep infection and no cases of septic arthritis. There is no correlation between the final outcome and articular depression (p > 0.05). Ilizarov external fixator provides acceptable outcomes but with a high rate of complication rate, typical of this type of fracture. It avoids extensive soft tissue dissection.     

Outcomes of cytoreductive operations for peritoneal carcinomatosis with or without liver cytoreduction in patients with small bowel neuroendocrine tumors

BackgroundThis study determines how much cytoreduction for small bowel neuroendocrine tumors with peritoneal carcinomatosis and liver metastases can be achieved and the corresponding survival benefits of different levels of clearance.MethodsRecords of patients with small bowel neuroendocrine tumors with peritoneal carcinomatosis were reviewed and scored using the Lyon Stage system. Kaplan-Meier survival was calculated and compared by log-rank analysis.ResultsAmong 323 patients with small bowel neuroendocrine tumors identified, 98 (30%) had peritoneal carcinomatosis. At laparotomy, 82% had Lyon Stage ≥3 compared with 78% who had Lyon Stage ≤2 after debulking (P < .00001). Median overall survival for Lyon Stage = 0 was 132 months and 51 months for Lyon Stage ≥1 (P = .026). For incomplete clearance, overall survival was 76 months for Lyon Stage ≤1 compared with 32 months for Lyon Stage ≥3 (P = .037). Seventy-nine (81%) patients had liver metastases, and 57 underwent >70% liver metastases cytoreduction. Overall survival was 76 months for Lyon Stage ≤1 and >70% liver metastases cytoreduction, 38.5 months for Lyon Stage ≥3 and >70% liver metastases cytoreduction, 22 months for Lyon Stage ≤1 and liver metastases not cytoreduced, and 20 months for Lyon Stage ≥3 and liver metastases not cytoreduced (P = .018).ConclusionA majority of patients with peritoneal carcinomatosis from small bowel neuroendocrine tumors can be cytoreduced. Best survival times are seen with complete clearance; however, there are improved survival times for Lyon Stage ≤1. In patients with liver metastases, best survival after cytoreduction is seen when both Lyon Stage ≤1 and liver metastases >70% are achieved.     

Foam sclerotherapy with Fibrovein (STD) for the treatment of hemorrhoids, using a flexible endoscope

AIM: This case study was designed to evaluate foam sclerotherapy of hemorrhoidal disease using a flexible endoscope. METHODS: We treated 250 patients of grade II-IV hemorrhoids with Sotradecol foam. To obtain sclerosing foam, we used a special foam kit, which produced a stable and standardized sclerosing foam. The quantity of foam injected into the hemorrhoids was 1 to 2 cc with a total of 6 cc for each session. Variables to assess efficacy of treatment were: pain, bleeding and prolapse. RESULTS: Generally, bleeding and hemorrhoidal prolapse were resolved with at most two sclerotherapy sessions. However, pain usually had disappeared after the first session. No complications such as mucosal erosions at the foam injection site, formation of abscesses, bacteraemia, or fistulas occurred. CONCLUSION: The advantages of sclerosing foam are its adhesiveness and compactness, its greater volume, its increased spasm generation, and the greater sclerosing power. Sclero-therapy with foam makes it possible to reach optimal results with small amounts of sclerosing agent and fewer risks of complications.     

Temporary deterioration of pulmonary functions after injection sclerotherapy for cirrhotic patients with esophageal varices

In 34 cirrhotic patients with esophageal varices, a significant but temporary deterioration in pulmonary function tests occurred 24 h after endoscopic injection sclerotherapy using 5% ethanolamine oleate. Included were vital capacity, forced expiratory volume in 1 s, closing volume/vital capacity and arterial oxygen content. Twenty-four hours after the sclerotherapy, the patients complaining of postinjection retrosternal pain had a larger fall in vital capacity and forced expiratory volume in 1 s than did the patients without pain. Before the injection sclerotherapy, 11 of 34 patients had an arterial hypoxemia (PaO2 less than 80 mm Hg). In these patients, there was a significantly (p less than 0.001) higher value of closing volume before sclerotherapy and there were larger changes in both closing volume (p less than 0.01) and arterial oxygen content (p less than 0.01) 24 h after the injection sclerotherapy than in the patients without hypoxemia. Reversion to a state before sclerotherapy was attained 7 days after the sclerotherapy. Thus, patients undergoing sclerotherapy for bleeding esophageal varices should be closely monitored with regard to pulmonary function.     

Serum aluminum levels in dialysis patients after sclerotherapy of internal hemorrhoids with aluminum potassium sulfate and tannic acid

Purpose

Aluminum potassium sulfate and tannic acid (ALTA) is an effective sclerosing agent for internal hemorrhoids. However, it is contraindicated for patients with chronic renal failure on dialysis, because the aluminum in ALTA can cause aluminum encephalopathy when it is not excreted effectively. We conducted this study to measure the serum aluminum concentrations and observe for symptoms relating to aluminum encephalopathy in dialysis patients after ALTA therapy.

Methods

Ten dialysis patients underwent ALTA therapy for hemorrhoids. We measured their serum aluminum concentrations and observed them for possible symptoms of aluminum encephalopathy.

Results

The total injection volume of ALTA solution was 31 mL (24–37). The median serum aluminum concentration before ALTA therapy was 9 μg/L, which increased to 741, 377, and 103 μg/L, respectively, 1 h, 1 day, and 1 week after ALTA therapy. These levels decreased rapidly, to 33 μg/L by 1 month and 11 μg/L by 3 months after ALTA therapy. No patient suffered symptoms related to aluminum encephalopathy.

Conclusions

Although the aluminum concentrations increased temporarily after ALTA therapy, dialysis patients with levels below 150 μg/L by 1 week and thereafter are considered to be at low risk of the development of aluminum encephalopathy.     

Treatment of simple renal cysts with single-session percutaneous ethanol sclerotherapy without drainage of the sclerosing agent

PURPOSE: To evaluate percutaneous single-session sclerotherapy with ethanol without drainage of the sclerosing agent in symptomatic simple renal cysts that require treatment. PATIENTS AND METHODS: A prospective series of 30 consecutive patients with symptomatic simple renal cysts with volume of 280.3 +/- 365.23 mL (range 28-1700 mL) estimated by ultrasonography were treated between July 1999 and July 2003. The cysts were punctured with an 18-gauge, 20-cm needle under ultrasound guidance and local anesthesia. A volume of ethanol equivalent to one third of the aspirated volume, up to a maximum of 100 mL, was injected into the cyst and left there. The patients were reassessed at 1, 3, and 6 months. RESULTS: The procedure was technically feasible in all patients. The aspirated volume was 259.8 +/- 265.2 mL (range 30-1900 mL). After 1, 3, and 6 months, the average volume was 52.7 +/- 71.4 mL, 22.7 +/- 43.2 mL, and 11.6 +/- 30.7 mL, respectively. After this period, 28 patients (93%) were asymptomatic, showing total remission of the cyst (17 cases) or at least a 90% decrease (10 cases) or a 50% decrease (1 case) in the initial volume. One patient (3%) had a 50% reduction of the cyst and persistent symptoms, and one patient (3%) had persisting symptoms despite the total remission of the cyst. CONCLUSION: Single-session percutaneous sclerotherapy with ethanol is a good option for the treatment of symptomatic renal cysts, as it is highly effective and offers the benefits of a less-invasive procedure.     

Long-term results in patients with metastatic renal cell carcinoma treated with interferon with or without vinblastine

Summary From 1983 to 1987, recombinant interferon-alpha (IFN, 18–36×10⁶ units i.m.) with (57 patients) or without (30 patients) vinblastine (VB) was given to 87 patients with measurable metastatic renal cell carcinoma (MRCC). Of the 80 evaluable patients, 17 patients achieved an objective response (2 complete response, 15 partial response). Four additional patients were rendered tumour-free by surgery or radiotherapy following IFN treatment. The combination of IFN plus VB did not seem to be more effective than IFN alone. The 5-year survival for all 87 patients was 14.1%, which was superior to that of a historical control group of Phase II patients who received chemotherapy (P=0.02). IFN is today's drug of choice in routine treatment of patients with MRCC who are candidates for systemic therapy. Its role in the prolongation of life compared with no treatment, chemotherapy, or other biological response modifiers has to be proven in randomized trials.     

Spinal cord blood flow after intrathecal injection of ropivacaine and bupivacaine with or without epinephrine in rats

Background: Ropivacaine is a new local anaesthetic available for spinal and epidural anaesthesia. When new drugs are being introduced for spinal application, their effect on spinal cord blood flow (SCBF) should be studied for safety and toxicological aspects. In the present study, SCBF was studied after intrathecal (i. t.) application of ropivacaine and bupivacaine with and without epinephrine.
Method: SCBF was measured continuously in spontaneously breathing, enflurane/N₂O anaesthetized rats, using laser-Doppler flowmetry technique. The spinal cord was exposed by laminectomy at the L₁-L₂ level, and a laser-Doppler probe was placed over the dorsal horn, allowing on-line registration of SCBF in a tissue hemisphere of 1–2 mm. Relative changes in SCBF were then measured on-line after i. t. administration of increasing doses of ropivacaine, bupivacaine or bupivacaine with epinephrine.
Results: Ropivacaine and bupivacaine decreased SCBF in a dose-dependent manner. In contrast, the reduction in SCBF produced by bupivacaine + epinephrine (Bupi+Epi) was equal for all doses of bupivacaine. The order of magnitude of SCBF decreases was Bupi + Epi >ropivacaine>bupivacaine. The maximal decrease in SCBF at the highest concentration given (10 mg/ml) was 37±6% for ropivacaine, 27±7% for bupivacaine and 40 ±6% for bupivacaine + epinephrine.
Conclusion: Ropivacaine and bupivacaine produce a dose-related, transient decrease in SCBF following i. t. administration in anaesthetized rats. However, the decrease in SCBF produced by both ropivacaine and bupivacaine was less than that produced by bupivacaine, when epinephrine was added in a concentration of 5 μg/ml. These results suggest that ropivacaine, like bupivacaine, may be used for spinal anaesthesia without important effects on SCBF.     

Effectiveness of neutralizing antibody cocktail in hemodialysis patients: a case series of 20 patients treated with or without REGN-COV2

Clinical and Experimental Nephrology - The number of patients with SARS-CoV-2 infection continues to increase, and it has become a global pandemic. Although there is an urgent need to establish an...     

Complications and outcome of tibial lengthening using the Ilizarov method with or without a supplementary intramedullary nail: a case-matched comparative study

We compared the complications and outcome of tibial lengthening using the Ilizarov method with and without the use of a supplementary intramedullary nail. In a retrospective case-matched series assembled from 176 patients with tibial lengthening, we matched 52 patients (26 pairs, group A with nail and group B without) according to the following criteria in order of importance: 1) difference in amount of lengthening (± 2 cm); 2) percentage difference in lengthening (± 5%); 3) difference in patient's age (± seven years); 4) aetiology of the shortening, and 5) level of difficulty in obtaining the correction. The outcome was evaluated using the external fixator index, the healing index and an outcome score according to the criteria of Paley. It was found that some complications were specific to group A or B respectively, but others were common to both groups. The outcome was generally better in lengthenings with a nail, although there was a higher incidence of rectifiable equinus deformity in these patients.