1,721,014 research outputs found
Classification and guidelines of hemorrhoidal disease: Present and future
No full textClassification and guidelines of hemorrhoidal disease are based on the subdivision in Grades of prolapse followed by any aspect related to both the treatment and its technique. When taking the proposals for classification and guidelines issued by prolific scientific societies into consideration, it is evident that strong contradictions and interpretative limits emerge in finding the best treatment to be adopted. After a critical examination of these limitations, a methodological proposal is shared to achieve a new classification, which plays a part in forming a new guideline for hemorrhoidal disease, identifying its evolution, dynamism of the prolapse, symptomatology, enteropathogenesis and gender characteristics
Prospective evaluation of l ocal infiltration with bupivacaine as control of postoperative pain after anorectal day-surgery.
No full textAnalgesia post-hemorrhoidectom
Significance of a single pulmonary nodule in patients with previous history of malignancy
No full textOBJECTIVES: To determine the diagnosis, treatment and follow-up in patients with a solitary lung nodule and a previous primary extrapulmonary neoplasm.
METHODS: The authors evaluated the charts of 45 patients with an extrapulmonary malignant neoplasm and a solitary pulmonary nodule. The histologic characteristics of the nodule were correlated with those of the extrapulmonary neoplasm.
RESULTS: The histology of the nodule was not known preoperatively in 43 cases (93.5%); in the remaining three cases cytologic examination had shown the presence of atypical cells. The majority of pulmonary lesions (73.9%) were found during the follow-up of the previous tumour, but a significant percentage of nodules (17.4%) were found incidentally. Pre- or intraoperative localisation of the nodule was done in 19 cases (41.3%), and was successful in nine cases (47.4%). Thoracoscopy was performed in 44 patients (95.6%). The coincidence between the pathology of the previous tumour and that of the nodule was 41.3% (19/46). The coincidence rate was 100% for the tumours of ovary, prostate, and sarcomas.
CONCLUSIONS: The advent of minimally invasive surgical techniques has made a definitive diagnosis likely, providing also therapy with a less painful engagement for the patient and a less cost for the community
Radio-guided surgery in recurrent renal hyperparathyroidism: Report of a case
No full textBACKGROUND: It has been demonstrated that radio-guided surgery offers several advantages in treating primary hyperparathyroidism. Even if it is considered less helpful in renal hyperparathyroidism, it could be of tremendous advantage in the treatment of persistent or recurrent secondary hyperparathyroidism. METHODS: We report a case of recurrent secondary hyperparathyroidism treated by the use of radio-guided surgery. The preoperative assessment consisting of ultrasonography, magnetic resonance imaging, and 99mTc-sestamibi scintigraphy identified a parathyroid in the upper mediastinum. The patient underwent a radio-guided neck re-exploration that allowed a rapid localization and excision of the ectopic gland, which was located in the anterosuperior mediastinum, in front of the trachea, between the innominant and the left common carotid artery. RESULTS: The operative time was 45 minutes. The patient was discharged on the first postoperative day. A decrease in serum calcium and parathyroid hormone was observed subsequently. A follow-up of 6 months did not show any recurrence. CONCLUSIONS: The case reported indicates that radio-guided surgery can help surgeons detect parathyroid tissue in selected cases of renal hyperparathyroidism
Long stapled haemorrhoidectomy versus Milligan-Morgan procedure: short- and long-term results of a randomised, controlled, prospective trial
No full textThe aim of this study was to assess the short- and long-term results of treatment for haemorrhoids by prospectively comparing two techniques, namely, stapled rectal prolapse mucosectomy according to Longo and open hemorrhoidectomy. One hundred consecutive patients were randomised to stapled (50 patients) or manual hemorrhoidectomy (50 patients). We analysed postoperative pain, preoperative and postoperative anorectal function, intraoperative and postoperative complications, time needed to return to work and to normal social activities, and costs. Long-term follow data were obtained by means of an outpatient visit. The operative time of the stapled technique was less than that of open haemorrhoidectomy (22 vs 35 minutes). Two cases of early postoperative bleeding occurred after the stapled technique. The mean pain score on a visual scale was significantly less in patients undergoing the stapled technique. In addition, the time needed to return to work and to normal social activities was significantly less after the stapled technique, which, however, proved to be a more expensive procedure. Stapled mucosectomy of the prolapsed rectal mucosa is a safe, rapid, and relatively painless technique, which has a low incidence of complications. It can be performed in a day surgery unit. Patient satisfaction, early return to normal activities and good long-term results counterbalance the high cost of the procedure
Impact of office-based surgery for hemorrhoids on clinical outcomes and institutional costs: a prospective controlled study
No full textAim: Transanal hemorrhoidal artery ligation with mucopexy (THAL-m) is a treatment option for symptomatic hemorrhoidal disease (HD). Open hemorrhoidectomy (OH) has stood the test of time in terms of radical cure for HD. Both techniques
can be performed under local anesthesia. The aim of this study was to determine the impact on postoperative outcome and cost-effectiveness of performing these techniques
in ambulatory setting in an Italian academic centre.
Method: A prospective series of grade II /III HD. 100 consecutive patients undergoing ambulatory surgical treatment of hemorrhoids in 2015–2017 (group A) were compared to 100 patients operated at the same institution in the same period (Group H) by hospitalization. The primary outcome was sick leave used as a proxy of clinical outcome. Secondary outcomes included postoperative complications, cost-effectiveness,
and patient satisfaction.
Results: Sick leave was significantly reduced in Group A patients (8 days versus 15) with no increase in postoperative complications, and patient satisfaction was high.
Total mean direct costs per patient were significantly lower in office-based setting versus the hospital stay group (431 euros versus 1320). Conclusion: Implementing ambulatory surgery for hemorrhoids is feasible, efficient, safe, and cost-effective but correct selection of patients is necessary
Hemorrhoidal disease: is it time for a new classification?
No full textThe article is related to the path to organize a trisl for a new classification of Hemorrhoidal diseas
Laser-assisted strategy for reflux abolition in a modified CHIVA approach.
No full textThe aim of this study was to assess feasibility
and efficacy of an endovenous laser (EL) assisted saphenous-sparing strategy in chronic venous disease (CVD)
- …
