Efficacy and safety of sclerotherapy with polidocanol foam in comparison with fluid sclerosant in the treatment of first-grade haemorrhoidal disease: a randomised, controlled, single-blind, multicentre trial.

PURPOSE: Sclerotherapy is the treatment of choice for first-grade haemorrhoidal disease. Numerous studies have shown that sclerotherapy with foamed sclerosants is more efficacious than liquid in the treatment of varicose veins. The aim of this study was to assess the efficacy and safety of polidocanol foam in comparison with liquid for haemorrhoidal disease. METHODS: A total of 130 patients were randomised to foam or liquid sclerotherapy (polidocanol 3%). Patients with first-grade haemorrhoidal disease were included and blinded to treatment assignment. The primary endpoint was the stopping of perianal bleeding after one sclerotherapy session. Sclerotherapy was repeated until patients were free of bleeding (2-week intervals). The final follow-up was 12 weeks after the last sclerotherapy session. RESULTS: In the foam group, significantly more patients (88%) were treated successfully after one sclerotherapy session compared to the liquid group (69%; p = 0.01). There was high patient satisfaction in both groups, but significantly more patients were satisfied with their treatment in the foam group than in the liquid group (99 vs. 84%; p = 0.009). Additionally, in the foam group, significantly less treatment sessions were required (p < 0.001), and the total amount of injected polidocanol was reduced (p < 0.001). CONCLUSION: In the therapy of first-grade haemorrhoidal disease, polidocanol 3 % foam is more effective and equally safe compared to liquid polidocanol. The results of this trial show that foam sclerotherapy is a new, innovative, effective and safe non-surgical treatment option for haemorrhoidal disease.

[Anal fissure]. / Analfissur.

Anal fissures are present in about 10-15% of proctological patients. The cause of the illness is unknown, but is probably multifactorial. Cardinal symptoms are pain during and after defecation, as well as persistent sphincter spasm. In most cases an acute anal fissure heals spontaneously or with adequate conservative therapy. Chronic anal fissures can be cured in some cases by conservative treatment. Where there is treatment resistance, surgical cleansing is necessary.

[Outpatient surgery in proctology]. / Ambulante Operationen in der Proktologie.

Proctological surgery can be carried out increasingly on an outpatient basis and thus more cost-effectively. The reasons for this are, in addition to modern anaesthetic procedures, short operation times and low complication rates in numerous proctological operations. Fissurectomies, individual haemorrhoidectomies, operations on uncomplicated fistulae and benign anal tumours only rarely need to be carried out nowadays under inpatient conditions. The conditions for successful outpatient surgery are: appropriate diagnosis of the indication, selection of the patients with respect to their suitability for surgery and standardised follow-up care.

Development and evaluation of parental occupational exposure questionnaires for a childhood leukemia study.

OBJECTIVES: This paper presents the results of a pilot study of job-specific modules developed for use in the study questionnaire of the Northern California Childhood Leukemia Study (i) to estimate the variability in response between people administered the same module and (ii) to estimate the number of modules required per family. METHODS: For 63 participants in the pilot study, between-person variability was assessed by comparing reported job tasks among the respondents administered the same job-specific module. Within-respondent variability was assessed by examining changes in the timing and frequency of the job tasks and product use across critical time segments from 12 months before the child's birth to 3 years of age. Parental occupational histories were reviewed to estimate the expected number of job-specific modules required per family. RESULTS: Considerable variability was identified for the tasks performed by the respondents with similar jobs and in the timing of tasks and products used across critical time windows. Parents' occupational histories indicated that detailed exposure information could be obtained for 95% of the families with a maximum of two job-specific modules added to the study interview. CONCLUSIONS: The job-specific modules captured individualized exposure information for the parents of cases and controls and thus reduced the potential for nondifferential misclassification when compared with the use of a job title approach, while avoiding an exposure checklist approach. These improvements in exposure estimation may increase the statistical power for identifying any true association between parental occupational exposures and childhood leukemia.