Transanal haemorrhoidal dearterialisation with mucopexy versus stapler haemorrhoidopexy: a randomised trial with long-term follow-up.

INTRODUCTION: The present study aimed to compare the long-term results of transanal haemorrhoidal dearterialisation (THD) with mucopexy and stapler haemorrhoidopexy (SH) in treatment of grade III and IV haemorrhoids. METHODS: One hundred and twenty-four patients with grade III and IV haemorrhoids were randomised to receive THD with mucopexy (n=63) or SH (n=61). A telephone interview with a structured questionnaire was performed at a median follow-up of 42 months. The primary outcome was the occurrence of recurrent prolapse. Patients, investigators and those assessing the outcomes were blinded to group assignment. RESULTS: Recurrence was present in 21 patients (16.9%). It occurred in 16 (25.4%) in the THD group and 5 (8.2%) in the SH group (p=0.021). A second surgical procedure was performed in eight patients (6.4%). Reoperation was open haemorrhoidectomy in seven cases and SH in one case. Five patients out of six in the THD group and both patients in the SH group requiring repeat surgery presented with grade IV haemorrhoids. No significant difference was found between the two groups with respect to symptom control. Patient satisfaction for the procedure was 73.0% after THD and 85.2% after SH (p=0.705). Postoperative pain, return to normal activities and complications were similar. CONCLUSIONS: The recurrence rate after THD with mucopexy is significantly higher than after SH at long-term follow-up although results are similar with respect to symptom control and patient satisfaction. A definite risk of repeat surgery is present when both procedures are performed, especially for grade IV haemorrhoids.

Vanadate-induced nitric oxide production: role in osteoblast growth and differentiation.

Nitric oxide (NO) has been shown to act as a mediator of cytokines in bone tissue. We have previously demonstrated that vanadium compounds are insulin- and growth factor-mimetic compounds in osteoblasts in culture, although high doses are toxic to these cells. In this study, we measured NO production in two osteoblast-like cells (UMR106 and MC3T3E1) incubated with different concentrations (2.5-100 microM) of vanadate. Vanadate induced NO release in a biphasic manner, with levels being significantly increased at concentrations over 50 microM. The NO donor, sodium nitroprusside, mimicked the vanadate effect: it inhibited cell growth and alkaline phosphatase activity in a dose-dependent manner. Vanadate enhanced the NO synthases, the endothelial and inducible (eNOS and iNOS) isoforms, in a dose-dependent manner. Experiments performed with the ionophore A23187 and EGTA suggested that vanadate-induced NO production involves Ca(2+)-dependent and -independent mechanisms. Altogether, our results suggest that NO may play a critical role in the bioactivity of vanadium in osteoblast-like cells.

["Acute scrotum" caused by torsion of the hydatid of Morgagni]. / "Scroto acuto" da torsione dell'idatide del Morgagni.

By "acute scrotum" is meant a sudden, painful tumefaction in one or both testicles with local and systemic symptomatologies. It can be caused by spermatic cord torsion in about 50% of cases in paediatric age, while in adults such a cause is much rarer. In addition to the clinical examination, Doppler, eco colour-Doppler and scintigraphy with 99mTc pertecnetate may be of use even though these investigations are not often immediately employable. In addition, as the hours pass, the damage caused to the gonad becomes irreversible; this, of course, influences therapeutic conduct. Starting from the description of a recently observed case of torsion of Morgagni's hydatid, the authors discuss the importance of differential diagnosis to protect the vitality of the testicle and show that surgical exploration, in cases where a definite aetiological diagnosis is missing, is the preferable and most rational therapeutic choice.

[Postoperative chylous ascites: its etiology and treatment]. / Ascite chilosa post-operatoria: etiologia e trattamento.

Postoperative chylous ascites is a rare clinical condition that occurs as a consequence of disruption of the abdominal lymphatics after retroperitoneal dissection. Generally the management is conservative based on a low fat diet and total parenteral hyperalimentation. However, such therapy requires weeks to months before resolution of the ascites. On the other hand, surgical approach is associated with a high failure rate to ligate leaky lymphatics. The Authors, therefore suggest a surgical resolution of the ascite with the use of fibrin glue to occlude rapidly and permanently the lymphatics ruptured.

[Neoplastic thrombosis of the inferior vena cava involving the right atrium caused by adrenal cortical carcinoma. A new indication for vascular exclusion of the liver]. / Thrombose néoplasique de la veine cave inférieure étendue à l'oreillette droite en rapport avec un corticosurrénalome. Une nouvelle indication de l'exclusion vasculaire du foie.

A large malignant adrenocortical carcinoma extending to the inferior vena cava and right atrium presented in the form of hemoptysis. Magnetic resonance imaging allowed precise evaluation without any other invasive procedure. Cardiopulmonary bypass is usually employed in these circumstances to remove the cavo-atrial thrombus. This approach may be advantageously replaced by the use of total vascular exclusion of the liver. The only unusual feature of the procedure is that the upper caval clamp is applied across the right atrium. Major collateral circulation due to caval thrombosis allows complete resection of the inferior vena cava up to the hepatico-caval confluence without the need for prosthetic replacement. After an uneventful postoperative course, malignant spread despite chemotherapy with op'-DDD led to death 4 months after surgery.