ABSTRACT
Operating time for idiopathic hydroceles and epididymal cysts is scarce as these conditions compete with an increasing caseload of more consequential surgical disease. Therapy is often relegated to repeated aspiration. Sclerotherapy appears to be effective in a majority of published trials, but comparative effectiveness, efficacy and safety of most agents, including phenol versus tetracycline, has not been established A deliberate strategy of re-treatment until cure is not universally practised, with surgery still being offered after single-treatment failures. Two trials, the first consisting of 53 scrotal cysts treated with 5% phenol-in-water and the second, 42 cysts treated with tetracycline, are compared for effectiveness, efficacy and safety of sclerotherapy per se and of re-treatment. Intention-to-treat analysis yields similar cure rates (no re-accumulation three months after last injection) for phenol and tetracycline (83% and 81% respectively, p = 0.8). Per-protocol analysis also yields similar cure rates (100% and 97% respectively, p = 0.26) and mean number of injections to cure (1.34 and 1.12 respectively, p = 0.069), with range 1-4 and 1-3 respectively. Severe pain following tetracycline injection required administration of pre-injection cord block. Other complications occurred equally (25% and 25.7% respectively, p = 0.94) and were trivial except for one case of chronic haematocele treated by orchiectomy in the tetracycline group. Phenol (5%) and tetracycline are equally efficacious sclerosants for idiopathic scrotal cysts, achieving almost 100% cure with re-treatment and matching the efficacy of surgery. Concern about post-treatment fertility applies equally to surgery and demands informed consent for both modalities.
El tiempo de operación para los hidroceles y los quistes epididimales es escaso, ya que estas condiciones triviales compiten con una creciente carga de casos de enfermedades quirúrgicas de mayores consecuencias. La terapia es a menudo relegada a una aspiración repetida. La escleroterapiaparece ser efectiva en la mayoría de los ensayos publicados, pero no se han establecido la seguridad, eficacia y efectividad comparativa de la mayor parte de los agentes, incluyendo el fenol, frente a la tetraciclina. No se practica universalmente una estrategia deliberada de re-tratamiento hasta la cura, ofreciéndose todavía la cirugía, luego de fracasos con tratamientos individuales. Dos ensayos, el primero consistente en 53 quistes escrotales tratados con fenol acuoso al 5%, y el segundo, en 42 quistes tratados con tetraciclina, se comparan en cuanto a efectividad, eficacia y seguridad para laescleroterapia per se y para el re-tratamiento. El análisis de intención de tratamiento produce tasas de curación similares (no hay re-acumulación 3 meses después de la última inyección) para el fenol y la tetraciclina (83% y 81% respectivamente, p = 0.8). El análisis por protocolo también produce tasas de curación similares (100% y 97% respectivamente, p = 0.26) y el número medio de inyecciones paracurar (1.34 y 1.12 respectivamente, p = 0.069), con rangos de 14 y 13 respectivamente. El dolor severo tras la inyección de tetraciclina requirió hacer un bloqueo espinal de pre-inyec-ción. Asimismo ocurrieron otras complicaciones (25% y 25.7% respectivamente, p = 0.94) y fueron triviales, con excepción de un caso de hematoceles crónicos tratado mediante orquiectomía en el grupo de tetraciclina. El fenol (5%) y la tetraciclina poseen igual eficacia como esclerosantes de los quistes escrotales idiopáticos, ya que logran una curación de casi 100% con el re-tratamiento, e igualan la eficacia de la cirugía...
Subject(s)
Humans , Male , Sclerotherapy/methods , Spermatocele/therapy , Phenol/pharmacology , Testicular Hydrocele/therapy , Tetracycline/pharmacology , Pain/chemically induced , Sclerotherapy/adverse effects , Spermatocele/complications , Phenol/administration & dosage , Testicular Hydrocele/complications , Sclerosing Solutions , Tetracycline/administration & dosage , Tetracycline/adverse effectsABSTRACT
This study reports the first 13 cases of biopsy-proven low rectal carcinoma treated by transanal electrocoagulation using a locally manufactured instrument. At the University Hospital of the West Indies, over a 16-year period, 9 patients were treated for cure, six of whom have no clinical evidence of recurrence for one to 12 years. Four cases who were offered this procedure for palliation defaulted after a single treatment. Transanal electrocoagulation provides an additional option for treating patients with small, mobile low rectal cancers, following careful screening for evidence of nodal or distant spread. The procedure can also be used in the local control of disease in patients with distant spread or in whom a major operation is not feasible.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Adenocarcinoma/surgery , Electrocoagulation , Rectal Neoplasms/surgery , Electrocoagulation/instrumentation , Electrocoagulation/methodsABSTRACT
The pathological records of appendicectomy specimens from patients with suspected acute appendicitis at the University Hospital of the West Indies during the 5-year period 1984-1988 were studied. The numbers of cases, their ages, sex and seasonal incidence were similar to those of other studies. The over-all false positive diagnosis rate was 25%(16%in males, 38%in females). The main diagnostic difficulty was in young females in whom surgery for suspected appendicitis often proved unnecessary.