Jump Technique versus Seton Method for Anal Fistula Repair: A Randomized Controlled Trial.

BACKGROUND: The treatment of anal fistula has been a conundrum for surgeons over the years. Various methods such as fistulotomy, fistulectomy, seton, ligation of the intersphincteric fistula tract (LIFT), advancement flaps, fibrin glue, and plugs are well-known techniques. Yet, they may be followed by several considerable complications, including incontinency and recurrence. METHODS: In this study, the outcomes of the "Jump" and "Seton" techniques are compared. A randomized controlled trial consisting of 130 cases with cryptoglandular anal fistula randomly sorted into two groups was conducted. Group A underwent the "Jump technique" while group B underwent the "Seton technique." Outcomes, incontinency and recurrences in particular, were evaluated after a year of treatment. Data were analyzed by Fisher Exact, Chi-Square and Mann Whitney Tests. RESULTS: Group A with 65 cases underwent the "Jump technique" while group B with 65 cases underwent the "Seton Method." Recurrence was reported in 12 (20%) cases in group A and 10 (15.6%) cases in group B (p=0.687). Overall incontinence was reported in 3 (4.6%) cases in group A and 18 (27.7%) cases in group B (P=0.001). The total St. Mark's scores for incontinency of group A (0.092±0.52) and group B (1.8±02.47) significantly differed (p<0.001). CONCLUSIONS: The "Jump technique", named after a runner who jumped over hurdles, has obviated these complications. The "Jump technique" had satisfactory results and can be utilized as a first-line approach for all types of fistulas. Moreover, it can be redone for cases with recurrences without affecting the continence, paving the way to change the technique during operations.

Evaluation of the effect of elective percutaneous coronary intervention as a treatment method on the left ventricular diastolic dysfunction in patients with coronary artery disease.

BACKGROUND: Although percutaneous coronary intervention (PCI) is an excellent therapy for coronary artery disease, there is a paucity of information on the efficacy of PCI in improving diastolic function, especially in Iran. Because of the high prevalence of left diastolic dysfunction in coronary artery disease patients and its probable progression to heart failure, an evaluation of the role of PCI in improving diastolic function is required. METHODS: Thirty patients scheduled for elective PCI were enrolled in this study providing that their systolic ejection fraction was > 40%. Before PCI and 48 hours and 3 months after PCI, echocardiography was done to evaluate some diastolic values in these patients. RESULTS: The mean age of all the patients was 54 ± 10 year, and 20 patients were male. All the patients had a low degree of left ventricular diastolic dysfunction. Isovolumic relaxation time (115 ± 10 before treatment versus 120 ± 1 and 119 ± 3 respectively 48 hours and 3 months after treatment), mitral E wave velocity in septal (0.70 ± 0.05 before treatment vs. 0.71 ± 0.15 and 0.72 ± 0.12 respectively 48 hours and 3 months after treatment), and the peak velocity of late filling due to atrial contraction (mitral A wave velocity) in septal (0.74 ± 0.02 before treatment vs. 0.73 ± 0.01 and 0.68 ± 0.16 respectively 48 hours and 3 months after treatment) showed improvement after PCI. It is notable that early diastolic mitral annulus velocity (E') wave velocity in the septal part of the mitral annulus improved significantly 48 hours and 3 months after PCI (p value < 0.05). The early-to-late diastolic tissue velocity ratio of the mitral annulus (E/A) ratio of the mitral inflow improved 48 hours after PCI; it was statistically significant (p value = 0.05). Also, mitral A wave velocity in septal and the E/A ratio of the mitral inflow improved significantly 3 months after PCI (p value < 0.05). CONCLUSION: Improvement in some of values related to left ventricular diastolic function followed by PCI shows that this method can be used to improve cardiac diastolic function in patients with symptomatic coronary artery disease.

Efficacy of folic acid therapy for prevention of in-stent restenosis: a randomized clinical trial.

BACKGROUND: It is known that there is an association between elevated total plasma homocysteine level and restenosis after percutaneous coronary angioplasty. OBJECTIVE: To evaluate the effect of lowering plasma homocysteine levels on the rate of restenosis after stent-percutaneous coronary angioplasty. METHODS: Folic acid (1 mg) or placebo was administered to 200 patients (mean +/- SD age of 54 +/- 9 years) for 3 months, after successful coronary angioplasty in a double-blind randomized clinical trial. The primary end point was restenosis within six months, as assessed by quantitative coronary angiography after positive exercise tolerance test. The secondary end point was a composite of major cardiac events. RESULTS: Base line characteristics and initial angiographic results after stent-percutaneous coronary angioplasty were similar in the two study groups. The rate of restenosis showed no significant difference in the two groups (5% in placebo vs. 10% in folic acid groups; P = 0.141), as there was the need for revascularization of the target lesion (4% in both groups; P = 0.766). CONCLUSION: Treatment with folic acid does not decrease the rate of restenosis and need for revascularization of the target lesion after stent-percutaneous coronary angioplasty.

Pulse tissue Doppler analysis of tricuspid annular motion in Iranian children.

BACKGROUND: Quantitative assessment of right ventricular (RV) function has been difficult to assess non-invasively secondary to its non-geometric shape and respiratory-variable filling. With recent improvements in ultrasound equipment we are now able to study myocardial velocity changes, which is known as tissue Doppler imaging. OBJECTIVES: To define normal indices of tricuspid pulse tissue Doppler echocardiography imaging in children and infants. METHODS: We enrolled 100 healthy children with the age of 1 month-15 year old who were referred for echocardiography and had no cardiac lesion in primary echocardiography evaluations. Pulse tissue Doppler images of the lateral tricuspid annular motion were recorded using 4-chamber apical view. Simultaneous electrocardiography was used to correct annular motion time with electrical events. RESULTS: Among our patients 9 were under 1 year, 46 between 10 and 15, 36 between 5 and 10, and 9 between 10 and 15. Infants had decreased peak early diastolic annular velocities and early diastolic annular velocity-to-diastolic annular velocity at atrial contraction ratios compared with the older group. Isovolumic relaxation time difference was not significant between two different groups. In this group of patients, deceleration time and isovolumic contraction time were lower too. CONCLUSION: In this study we found out normal values for systolic and diastolic indices of pulse TDI imaging of tricuspid valve in Iranian healthy children. This can be a basis for RV function studies in different congenital cardiac disease.