Investigating the Follow-up Period after ALTA Sclerotherapy Using Transanal Ultrasonography.

Objectives: This study aims to clarify the appropriate follow-up period after aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for internal hemorrhoids by transanal ultrasonography. Methods: Forty-four patients (98 lesions) who underwent ALTA sclerotherapy were analyzed. Transanal ultrasonography was performed pre and post-ALTA sclerotherapy to observe the thickness and the internal echo image of hemorrhoid tissue. Patients who developed complications were excluded. Results: No recurrence in 12 months was observed in 44 patients. After 1-3 months of ALTA sclerotherapy, hemorrhoids were observed in the low-echo imaging region. During this period, hemorrhoidal tissue was observed thickest by granulation. Moreover, hemorrhoid tissue contracted by fibrosis formed 5-7 months post-ALTA sclerotherapy, with a thinner hemorrhoid. Furthermore, hemorrhoids hardened and regressed with intense fibrosis 12-months after the therapy and eventually became thinner than pre-ALTA sclerotherapy. Conclusions: After ALTA sclerotherapy, the suggested follow-up period with and without the development of complications is ～6 and ～3 months, respectively.

Ultrasonography and C-reactive protein can predict the outcomes of voiding cystography after the first urinary tract infection.

AIM: This study evaluated whether sex, clinical variables, laboratory variables or ultrasonography predicted the presence of vesicoureteric reflux during the first episode of urinary tract infection in paediatric patients. We also aimed to define the criteria that indicated the need for voiding cystography testing. METHODS: We used voiding cystography to investigate 200 patients who experienced their first urinary tract infection at our institution between 2004 and 2013 and retrospectively analysed the data by reviewing their medical records. RESULTS: Sex (p = 0.001), peak blood C-reactive protein levels (p < 0.001), the duration of fever after antibiotic administration (p = 0.007) and the ultrasonography findings grade (p < 0.001) were significantly different between patients with and without vesicoureteric reflux. Grade IV-V ultrasonography findings and C-reactive protein levels of ≥80 mg/L predicted vesicoureteric reflux with a sensitivity, specificity and odds ratio of 47.8%, 87.8% and 6.59 (95% confidence interval = 3.26-13.33), respectively (p < 0.001). CONCLUSION: Voiding cystography should be performed for patients with C-reactive protein levels of ≥80 mg/L and grade IV-V ultrasonography findings, but is not necessary in patients with C-reactive protein levels of <80 mg/L and grade I-III ultrasonography findings.