Belgian consensus guideline on the management of hemorrhoidal disease.

Introduction: Hemorrhoidal disease is a common problem that arises when hemorrhoidal structures become engorged and/or prolapse through the anal canal. Both conservative and invasive treatment options are diverse and guidance to their implementation is lacking. Methods: A Delphi consensus process was used to review current literature and draft relevant statements. These were reconciliated until sufficient agreement was reached. The grade of evidence was determined. These guidelines were based on the published literature up to June 2020. Results: Hemorrhoids are normal structures within the anorectal region. When they become engorged or slide down the anal canal, symptoms can arise. Every treatment for symptomatic hemorrhoids should be tailored to patient profile and expectations. For low-grade hemorrhoids, conservative treatment should consist of fiber supplements and can include a short course of venotropics. Instrumental treatment can be added case by case : infrared coagulation or rubber band ligation when prolapse is more prominent. For prolapsing hemorrhoids, surgery can be indicated for refractory cases. Conventional hemorrhoidectomy is the most efficacious intervention for all grades of hemorrhoids and is the only choice for non-reducible prolapsing hemorrhoids. Conclusions: The current guidelines for the management of hemorrhoidal disease include recommendations for the clinical evaluation of hemorrhoidal disorders, and their conservative, instrumental and surgical management.

Under-estimation of self-reported occupational exposure by questionnaire in hospital workers.

OBJECTIVES: The aim of the study was to determine whether self-reported occupational exposure to cleaning/disinfecting agents in hospital workers is accurate, in comparison to expert assessment, taken to be the gold standard. METHODS: In the Epidemiological Study of the Genetics and Environment of Asthma (EGEA), participants were interviewed on occupation with a specific questionnaire for hospital workers regarding tasks and cleaning/disinfecting agents. Two estimates of exposure were available: self-report and expert assessment. The expert assessment involved a standardised procedure to estimate intensity, frequency and probability of exposure for each job. The present analysis focused on eight exposures: formaldehyde, glutaraldehyde, bleach/chlorine, alcohol, quaternary ammonium components, ammonia, sprays and latex gloves. Agreement and differences between self-reported and expert estimates were studied by kappa and phi coefficients and McNemar tests, respectively. RESULTS: In the survey of 1571 adults, 176 ever hospital workers (327 occupations) with both self-reported and expert exposure assessments were studied. An underestimation of self-reported exposure was observed especially for formaldehyde (26.5% vs 32.7%, p=0.01), ammonia (7.4% vs 18.8%, p<0.0001), alcohol (64.9% vs 93.0%, p<0.0001) and quaternary ammonium components (16.6% vs 70.9%, p<0.0001), compared to expert assessment. CONCLUSION: Occupational exposure to disinfecting/cleaning agents is common and high in hospitals. A large underestimation of self-reported exposure and a lack of knowledge of product components was observed. Our results show the relevance of expert assessment in epidemiological studies to limit measurement bias. This work underlines the need for health education programmes on the occupational risks induced by these types of products.

[Chronic inflammatory bowel disease: Crohn's disease and ulcerative colitis]. / Les maladies inflammatoires chroniques de l'intestin: maladie de Crohn et rectocolite ulcero - hemorragique.

Inflammatory bowel diseases comprise Crohn's disease, ulcerative colitis and indeterminate colitis, generally beginning in young subjects and increasing in frequency in Western countries. Despite their still unknown aetiologies, some pathogenic mechanisms have been elucidated after the recent discovery of numerous susceptibility genes and rare environmental factors. These diseases have a course consisting of episodes of flare-up alternating with periods of remission. Medical treatment for induction of a remission comprises besides aminosalicylates, corticosteroids including budesonide and immunosuppressive drugs, anti-TNF-alpha drugs (infliximab, adalimumab) indicated in case of failure of previous therapies. Surgery is indicated for complications and failure of medical treatment.With current therapy, most of the patients are able to fulfil their familial, social and professional projects.

Increased response of blood eosinophils to various chemotactic agents in quiescent Crohn disease.

BACKGROUND: The number of eosinophils is increased in the mucosae of the digestive and the respiratory tracts in Crohn disease, even clinically quiescent. The mechanisms underlying this panmucosal eosinophilia are unknown. METHODS: The response of blood eosinophils to various chemotactic agents was assessed in 15 patients with clinically quiescent Crohn disease. The results were compared with 15 healthy controls. After purification, eosinophils were placed in Boyden microchambers and the chemotactic effect of PAF (10(-7) M), RANTES (50 ng/ml), IL-5 (0-20 ng/ml), IL-8 (0-50 ng/ml), Eotaxin (0-50 ng/ml) was evaluated. The number of eosinophils in induced sputum of these Crohn disease patients and controls was also assessed and the correlation between chemotaxis and eosinophil count in induced sputum was studied. RESULTS: PAF and RANTES induced a chemotactic effect both in Crohn disease patients and controls. The chemotactic index was significantly higher in Crohn than controls for PAF (2.09+/-0.24 versus 1.37+/-0.14; P < 0.05) but not RANTES. With IL-5, IL-8 and Eotaxin, there was no detectable chemotactic effect in controls while in Crohn, we observed a significant dose-dependent chemotactic effect. Furthermore, with Eotaxin 50 ng/ml, the chemotactic index was significantly higher in Crohn disease patients than controls (2.42+/-0.18 versus 1.56+/-0.28; P < 0.05). A significant increase in sputum eosinophil count and a significant decrease in sputum macrophage count in Crohn disease were observed. However, there was no correlation between eosinophil chemotaxis and sputum eosinophil count in individual patients. CONCLUSION: There is an increased response of blood eosinophils to various chemotactic agents, mainly PAF and Eotaxin, in clinically quiescent Crohn disease. This may participate in the mucosal infiltration by eosinophils in this disease.

[Phenotypes of essential arterial hypertension in Caribbean women]. / Phénotypes de l'hypertension artérielle essentielle chez les femmes antillaises.

UNLABELLED: The characterisation of phenotypes of patients with essential hypertension (EH) is an important pre-requisite for genetic research. The present study compares clinical and renal function parameters in 2 groups of patients from different origins. METHOD: Out of a cohort of essential hypertensives disclosed on routine work medical examinations, 21 caucasian (CC) women were paired with 21 Caribbean (CB) women. In the 2 groups we recorded family history of hypertension (FHH), duration of hypertension, BMI, salt intake based on 24 h urinary sodium excretion, microalbuminuria, and blood pressure (BP). Glomerular filtration rate (GFR) and renal plasma flow (RPF) were measured with inulin and para-amino-hippuric acid clearances. Plasma active renin (AR) and aldosterone (Aldo) levels were measured by immuno-assays. White coat (WC) effect was assessed on the difference between BP values measured on medical visits and by the nurses on clearance measurements. Anova and t-test were used for analysis, statistical significance was assumed for p < 0.05. RESULTS: Casual BP values were 150/94 mmHg in CB and 153/95 mmHg in CC. There were no significant differences on BMI (CB 30.6 kg/m2 vs CC 27.1 kg/m2). AR (CB 6.6 pg/mL vs CC 8.7 pg/mL) and Aldo (CB 195.1 pmol/L vs CC 202.8 pmol/L) provided an equivalent dietary salt intake (CB 11.2 g/d vs CC 10.7 g/d). Mother FHH was found predominantly in CB women (60% vs 30% in CC, p < 0.05), whereas paternal FHH was more frequent in CC women (21% vs 8% in CB, p < 0.05). At the same age, duration of hypertension was longer by 1 year in CB. White coat effect was more marked in CC (BP > 30 mmHg: 40% in CC vs 5% in CB, p < 0.05). GFR values were normal and similar in CB and CC women. But a significantly lower RPF was measured in CB (489 vs 542 mL/min/1.73 m2 in CC, p < 0.05). Higher filtration fraction and microalbuminuria were also observed in CB women. CONCLUSION: Essential hypertension occurs at younger ages in Caribbean women. The decrease in RPF could be genetically determined and is likely to participate in early onset of hypertension, as previously described in young normotensive subjects. In paired women, we did not found significant differences in active renin and aldosterone levels. The ongoing longitudinal study should contribute to assess the consequences of these findings on renal prognosis and the effects of antihypertensive therapy.

Breast conservation for early stage breast cancer

Approximately 80 percent of women with breast cancer are candidates for breast conservation, but national statistics suggest that more than half of the women treated in the United States of America continue to be treated with mastectomy. This therapeutic option is grossly underutilized in the West Indies. The results of many large scale multi-institutional clinical trials have demonstrated the equivalence of "Breast Conserving Therapy" (conservative surgery and post operative radiation) with mastectomy. The aim of the conservative approach is to eradicate disease, reduce local recurrence at the primary site with minimal complications, and without a negative impact on quality of life or survival, while achieving acceptable cosmesis. Factors influencing patient selection, recent clinical trials, optimal surgical and radiation techniques and potential morbidity associated with breast conservation therapy will be discussed. Adjuvant therapy (cytotoxic chemotherapy and/or hormone therapy), recommendations for follow up care and the management of complications and recurrence will be reviewed.(AU)