Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment.

BACKGROUND: According to the "vascular" theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. A 980-nm diode laser-pulsed shot causes shrinkage of tissue. The depth of shrinkage can be regulated by the power and duration of the laser beam. Through a 1000-micron conic fiber, five laser shots generated at a power of 13 W with duration of 1.2 s each and a pause of 0.6 s caused shrinkage of tissues to the depth of approximately 5 mm. Terminal branches of the superior hemorrhoidal artery in the anal canal, if precisely identified through a Doppler signal, can be closed with the use of this laser. METHODS: A specially designed proctoscope has a small window that allows introducing a Doppler probe whose function is to identify hemorrhoidal arteries. Approximately 3 cm above the dentate line, the terminal branches of the superior hemorrhoidal artery (usually 8-12) are recognized through a clockwise rotation of the proctoscope and progressively fulgurated through a laser optic fiber. The procedure does not require anesthesia and can be performed as an ambulatory treatment. RESULTS: Thirty patients (16 men) with second to third grade symptomatic hemorrhoids have been treated with the described technique. The procedure proved to be successful at 3 months' follow-up in 92% of cases. No major adverse effects or complications were reported. Bleeding was observed in four cases. In two cases surgical hemostasis was necessary. Minor pain that required medication was reported in three cases. CONCLUSIONS: The hemorrhoidal laser procedure (HeLP) represents a new nonexcisional, mini-invasive treatment for patients suffering from second and third degree hemorrhoids without severe mucosal prolapse. Thermal occlusion of the hemorrhoidal arteries causes a progressive shrinkage of hemorrhoidal cushions. The procedure does not require anesthesia, is technically easy, repeatable, and can be performed as an office treatment.

A mild synthesis of vinyl halides and gem-dihalides using triphenyl phosphite-halogen-based reagents.

A new application of (PhO)3P-halogen-based reagents to the synthesis of vinyl halides and gem-dihalides is described. Vinyl halides were prepared in good to excellent yields from enolizable ketones, whereas aldehydes afforded the corresponding gem-dihalides. The halogenation proceeded smoothly under mild conditions.

Electron and electrospray ionization mass spectrometry in the characterization of some 1-allyl-3-phenylaziridines.

A series of cis- and trans-isomeric aziridines has been studied under electron impact (EI) and electrospray ionization (ESI) conditions. The fragmentation patterns of the examined compounds have been elucidated by means of sequential product ion fragmentation experiments (MS(n)) performed using an ion trap mass spectrometer. Particular attention has been paid to isomer characterization in these precursors of azetidinones, that in turn are precursors of new beta-lactam antibiotics.