Comparison of anal dilatation versus no dilatation with a standardized dilator in reducing pain after hemorrhoidectomy: a randomized control trial.

BACKGROUND: Post-operative pain is the main problem of hemorrhoidectomy. An adequate pain management can promote early mobilization, fast recovery, and reduce hospitalization costs. This study aimed to investigate the role of preoperative anal dilatation using a standardized anal dilator in reducing post-operative pain. METHOD: This study was conducted using randomized prospective trial with a total of 40 subjects, who were divided into 2 groups. The first group received preoperative anal dilatation using a 33 mm anal dilator for 20 min, while the second group did not. The post-operative anal pain, edema, bleeding, and incontinence were observed in the first, second, and seventh day. RESULT: The post-operative pain was significantly lower in the preoperative anal dilatation group for all days of observation (p < 0.05). The difference of post-operative bleeding and edema between groups were not significant. Fecal incontinence was initially significantly higher in the preoperative anal dilatation group, but the difference was insignificant at the seventh day (p = 0.500). CONCLUSION: Preoperative anal dilatation significantly reduced post-operative pain. The side effect of fecal incontinence was only temporary until the seventh day after surgery. Trial Registration This trial was registered on Thai Clinical Trials Registry (TCTR) with TCTR identification number TCTR20220314002, on 14/03/2022 (retrospectively registered).

A rare adult morgagni hernia mimicking lobar pneumonia.

Morgagni hernia is the rarest form of congenital diaphragmatic hernia and is commonly found either in the first few hours of life or in antenatal period. It is less common in adult and is mostly diagnosed incidentally in an asymptomatic patient. Symptomatic adult cases are even rarer with a wide variety of symptoms. Here we report a patient with a one year history of chronic recurrent cough and dyspnea, who had been misdiagnosed as recurrent pneumonia before being recognized and treated as Morgagni hernia.

A new technique for surgical haemorrhoidectomy without post-operative complication: A case series.

Introduction: Hemorrhoids are a common coloproctology problem and among 10% of cases need surgical intervention. However, the established surgical interventions still have many complications. Case presentation: We reported three female patients, who presented with circular 3rd degree internal hemorrhoids. The surgical treatment was performed with pre-operative anal dilatation using a 33 mm dilator for 20 minutes, followed by triangle incision above the dentate line. The hemorrhoid excision was performed, and the wound was sutured with simple interrupted radial sutures using a multifilament absorbable 3-0 thread. There were neither complaints of pain, bleeding, anal incontinence, anal stenosis, wound dehiscence, nor recurrence at the first, second, and fourth weeks of follow-ups in all patients. Discussion: Post-operative bleeding, pain, and anal incontinence are common after an open hemorrhoidectomy, while suture breakage and anal stenosis were reported after the old technique of closed hemorrhoidectomy. Stapled hemorrhoidectomy had less complications but requires a relatively more expensive cost for the device itself. We performed a combination of preoperative anal dilatation, above dentate line triangle incision, and simple interrupted radial sutures to treat the patients with 3rd degree internal hemorrhoids, which resulted in no post-operative complications within the first month of follow-up. Conclusion: A combination of preoperative anal dilatation, above dentate line triangle incision, and radial suture technique is a simple and effective surgical option for treating a 3rd degree hemorrhoid.

A rare adult morgagni hernia mimicking lobar pneumonia.

Morgagni hernia is the rarest form of congenital diaphragmatic hernia and is commonly found either in the first few hours of life or in the antenatal period. It is less common in adults and is mostly diagnosed accidentally in asymptomatic patients. Symptomatic adult cases are even rarer with a wide variety of symptoms. We report a patient with a 1-year history of chronic recurrent cough and dyspnea who had been misdiagnosed with recurrent pneumonia before being recognized and treated for Morgagni hernia.

Role of pulmonary hemodynamics in determining 6-minute walk test result in atrial septal defect: an observational study.

BACKGROUND: The presence of altered pulmonary hemodynamics in adult patients with atrial septal defect (ASD) is common. However, there are no observational studies which evaluate the impact of altered pulmonary hemodynamics on the 6-min walk test (6MWT) result. This study aimed to investigate the role of pulmonary hemodynamics in determining 6MWT result of patients with ASD. METHOD: Forty-six consecutive adult patients with ASD were included in this study. Right heart catheterization was performed to obtain the pulmonary hemodynamics profile. Meanwhile, 6MWT was presented as high or low with cut-off point 350 m. Receiver operating characteristic (ROC) was used for analytical methods. RESULT: Abnormal functional capacity was indicated by ROC result of mPAP cut-off value of > 24 mmHg (p = 0.0243; AUC = 0.681). The value of PVR > 3.42 woods unit (WU) showed high specificity in determining abnormal functional capacity (p = 0.0069; AUC = 0.713). Flow ratio with cut-off point ≤4.89 had the highest sensitivity (100%) (p = 0.8300; AUC = 0.520). CONCLUSION: Pulmonary hemodynamics can serve as an indicator of 6MWT result in adult ASD patients with values of mPAP> 24 mmHg and PVR > 3.42 WU.

Predictive Model for Secundum Atrial Septal Defect Closure with Pulmonary Artery Hypertension in Adult: When to Close.

BACKGROUND: Secundum atrial septal defect (SASD) closure is contraindicated in the presence of severe pulmonary artery hypertension (PAH). However, there is no consensus on the threshold of severe PAH, in terms of mean pulmonary artery pressure (mPAP), which would contraindicate for defect closure surgery in adults. Furthermore, PAH can persist, or even increase in severity, after the closure. The aim of this study was to produce a predictive model correlating mPAP in adult SASD patients with PAH after defect closure surgery. Methods: Between January 2014 and March 2017, 29 consecutive adult SASD patients who had PAH and underwent defect closure surgery were included in the study. Age, right atrium (RA) dimension, right ventricle (RV) dimension, and mPAP before surgery were analyzed using multiple regression to produce the model. RESULTS: Multiple regression produced the following model: mPAP prediction = (0.24)(Age) + (0.06)(mPAP before surgery) + (0.17)(RA dimension) + (0.47)(RV dimension) - 13.79 (P = .0008). The mPAP prediction was compared to mPAP of the patients six to nine months after surgery, and showed no significant difference (P = .9562). Conclusion: In adult SASD patients with PAH, our model can significantly predict the mPAP after the closure. If the predicted mPAP is within its normal range, the closure is indicated.

An Unusual Foreign Body in the Heart: A Case Report.

Penetrating foreign bodies in the heart is rare and may lead to life-threatening complications. Early diagnosis and removal are crucial for these rare cases. We report a case of accidental penetrating sewing needle in the right ventricle. The needle was successfully removed without open heart surgery and cardiopulmonary bypass (CPB), after accurate localization using transthoracic echocardiography (TTE).

Large Atrial Septal Defect Closure in a Patient with Severe Pulmonary Arterial Hypertension.

Patients with an atrial septal defect (ASD) and severe pulmonary arterial hypertension (PAH) are considered ineligible for defect closure surgery because of the risk of right ventricular decompensation and death after the operation. We report the case of a patient with large ASD and severe PAH who was able to undergo defect closure surgery successfully following long-term use of combined oral sildenafil and beraprost.