[ prospective study comparing ligasure and open hemorrhoidectomy]

Hemorrhoid is among the most common anorectal diseases and patients with high-grade disease conditions need surgical treatment. Many surgical procedures are available to treat the disease. The aim of this study was to compare the operative time and outcomes, [post-operative pain and complications] of Ligasure hemorrhoidectomy with those of the open conventional method. This randomized single-blind clinical trial included 57 patients [28 in Ligasure and 29 in the open group]. The primary variable was the operative time for the excision of a single hemorrhoidal packet. The other variables were post-operative pain measured by morphine doses administered to control pain, scores of visual analogue scale [VAS] used to measure pain severity, pain during home stay measured by doses of oral ibuprofen and the mean daily VAS scores, early complications including bleeding and urinary retention, longer-term complications and time to return to work. The demographic data were comparatively the same between the two groups. The average time to excise a single packet of hemorrhoid was significantly shorter in the Ligasure group [8.91 min vs. 17.35 min, P<0.001]. Post-operative pain measurements [morphine doses and VAS scores] were lower in the Ligasure group, but the differences were not statistically significant [P=0.055 and 0.077, respectively]. Complications of the two procedures were also comparable. Neither of the groups returned to work in a shorter time. Ligasure hemorrhoidectomy seems to be a safe method and it can reduce the operative time significantly. It may also have a modest effect on post-operative pain

[Pre-hospital delay among patients with acute myocardial infarction]

To determine the prevalence and predictors of patient delay among patients with myocardial infarction. In this cross-sectional study, a sample of 95 admitted patients with confirmed diagnosis of myocardial infarction were included. They were asked about symptoms, the time from presentation to admission and the reason for delay, if any. Delay was defined as arrival to hospital after 3 hours from initiation of symptoms. The mean age of patients was 60.4 +/- 1.1 years and mostly were male [76.8%]. Half of the patients had visited the doctor 9 hours after the pain started or later [median]. About 70 percent of patients had delayed seeking medical care after myocardial infarction. The risk factors for delay in the descending order of importance [OR] were: lacking sweat as a symptom, heart attack at midnight, lacking previous history of heart disease, visiting a general practitioner, gradual onset and lower educational level. Education of the general public especially individuals with lower educational status can lead to better recognition of symptoms and decrease patient delay