Does calcium score in great pelvic vessels predict colorectal anastomotic leakage? A prospective study of one hundred anastomoses.

BACKGROUND: Anastomotic leakage is one of the most severe surgical complications following surgery. This prospective study was designed to investigate an association between the calcification in the descending aorta and its major branches using a calcium-scoring software and colorectal anastomotic leakage. METHODS: From January 2012 to March 2013, one hundred patients underwent surgeries involving colorectal anastomosis procedures. Calcium score in descending aorta and great pelvic vessels was measured using the Syngo-CT 2006G-W software. A questionnaire was completed containing demographic and underlying risk factors suspicious to be associated with anastomotic leakage, in addition to surgical characteristics data. RESULTS: 55 males and 45 females entered the study with the mean age of 63.70±7.17 years. The average duration time of surgery was 149.30±20.24 minutes. The type of surgery was elective for 90 patients and emergency for 10 others. The mean calcium score was higher in greater arteries as in abdominal aorta and common iliac arteries in comparison to the other pelvic vessels. Comparing two groups of patients with and without anastomotic leakage, the calcium score was higher in descending aorta and all great pelvic vessels of patients with colorectal anastomotic leakage (P<0.001). One patient (1%) died due to postoperative anastomotic leakage two weeks after the surgery. CONCLUSIONS: Atherosclerotic calcification in the descending aorta and its major branches can be considered as a risk factor in the development of colorectal anastomotic leakage. (Acta gastroenterol. belg., 2016, 79, 415-420).

A randomized, prospective, double-blind, placebo-controlled trial of the effect of topical diltiazem on posthaemorrhoidectomy pain.

AIM: Spasm of the internal anal sphincter plays a role in haemorrhoidal disease and may be a source of anal pain after haemorrhoid surgery. In this study, we investigated the effect of topical diltiazem (DTZ) on postoperative pain following Milligan-Morgan haemorrhoidectomy. METHOD: After haemorrhoidectomy, 33 patients were randomly assigned to receive DTZ ointment (2%; n = 16) or a placebo ointment (n = 17). Ointments were applied to the perianal region three times daily for 7 days. A Visual Analogue Scale was used to assess postoperative pain. The primary end-point was reduction in postoperative pain. RESULTS: Patients using the DTZ cream had significantly less pain and greater benefit than those in the placebo group throughout the first postoperative week, and total and daily narcotic analgesic use was higher in the placebo group. There were no differences in morbidity between the two groups. CONCLUSION: Perianal application of DTZ cream after haemorrhoidectomy significantly reduces postoperative pain and is perceived as beneficial, with no increase in associated morbidity.

Morphine analgesia in patients with acute appendicitis: a randomised double-blind clinical trial.

BACKGROUND: The administration of analgesics to patients with acute abdominal pain due to acute appendicitis is controversial. A study was undertaken to assess the analgesic effect of morphine in patients with acute appendicitis. METHODS: A randomised double-blind clinical trial was conducted in Sina hospital, a general teaching hospital, from January 2004 to March 2005. Patients scheduled for appendectomy were randomised to receive 0.1 mg/kg morphine sulfate or saline (0.9%) to a maximum dose of 10 mg over a 5 min period. Patients were examined by surgeons not involved in their care before and after drug administration and their pain intensity and signs were recorded at each visit. The physicians were also asked to indicate their own treatment plan. The main outcome measures were pain intensity using a visual analogue scale (VAS) and signs of acute appendicitis. A favourable reduction in VAS score was defined as a change of >13 mm. RESULTS: Of the 71 patients enrolled in the study, 35 were allocated to receive morphine and 36 to receive placebo. One patient left the hospital before receiving morphine. No significant differences were seen between the two groups with regard to age, sex and initial VAS score. A more favourable change in VAS score was reported in the morphine group with a significantly greater reduction in the median VAS score than in the placebo group. Morphine administration did not cause significant changes in patients' signs or in the physicians' plans or diagnoses. No adverse events were seen in either group. CONCLUSION: Morphine can reduce pain in patients with acute appendicitis without affecting diagnostic accuracy. TRIAL REGISTRATION NUMBER: NCT00477061.