Open surgery for haemorrhoids in persons with spinal cord injury.

STUDY DESIGN: Pilot retrospective study on the outcome of open surgery for grade III and IV haemorrhoids in patients with SCI. OBJECTIVE: Haemorrhoids and anal fissures are common in patients with spinal cord injury (SCI). Grade I to III haemorrhoids are usually managed medically or by surgical ligation. Grade III and IV haemorrhoids are treated with surgical haemorrhoidectomy in the general population, but not in patients with SCI, most probably due to fear of complications. SETTING: Fondation Hopale, Berck-sur Mer, France. METHODS: The surgical database was searched for open haemorrhoidectomies performed between 2007 and 2016. Seventeen patients were included. There were mostly males with complete paraplegia, mean age: 50 years and mean time since injury: 15.9 years. Open haemorrhoidectomy (Milligan and Morgan) was performed for isolated haemorrhoids (n = 4), and combined with Leopold Bellan procedure (posterior anoplasty and internal sphincterotomy) for associated anal fissures (n = 13). Short-term follow-up was performed by the surgeon (post-operative weeks 2 and 6), long-term follow-up by telephone interview (mean 5.7 years, SD 1.9). RESULTS: At 6-weeks post-operative, no significant complications had occurred and all wounds had healed, however 1 patient had recurrence of anal fissure. At long-term follow-up, 75% of patients reported a significant improvement in anorectal symptoms. Recurrences were reported by 5 patients: 3 haemorrhoids (18%) and 2 anal fissures (25%). Anal incontinence occurred in 1 patient who required an anal plug. All patients maintained the same bowel programs as pre-operative. CONCLUSIONS: Open surgery procedures were well tolerated and should be considered in persons with SCI.

[Assessment of severity of neurogenic bowel dysfunction in chronic patients with a simple 1-item questionnaire (PGI-S)]. / Sévérité des troubles colorectaux associés aux maladies neurologiques et évaluation pratique par questionnaire à un item (PGI-S).

INTRODUCTION: Bowel symptoms (constipation and incontinence) are frequent in patients with a neurologic disease, but rarely assessed in rehabilitation centres. AIM: To study the prevalence of neurogenic bowel dysfunction (NBD) in those patients, and to assess its severity with the Patient Global Impression of Severity (PGI-S). MATERIAL: Prospective study by questionnaires, with the Neurogenic Bowel Dysfunction Score (0-47) and the PGI-S, a 1-item questionnaire (absent, mild, moderate, severe) for the severity of the bowel symptoms, and the Bristol Stool Chart for stool consistency. All patients presenting a chronic (>2months) neurological disease were included. RESULTS: Inclusion of 169 patients, 97 with spinal cord injury, 42 with multiple sclerosis and 30 with hemiplegia. In each population, prevalence of constipation was 67 %, 45 % and 17 %, of pelvic floor dyssynergia 82 %, 45 % and 27 %, and leakages (gas or stools) de 74 %, 48 % and 43 %, respectively. Moderate to severe bowel symptoms were seen in 61 % of spinal cord injury, 43 % of multiple sclerosis and 23 % of hemiplegic patients, with NBD scores of 11.9±6.5, 5.7±4.9 and 3.7±4.2, respectively (P<0.01). There was a significant relation between PGI-S and NBD score (P<0.01). Significant lower NBD scores were associated with normal stool consistency (Bristol type 3 or 4) (P<0.01). In case of severe bowel symptoms, the use of transanal irrigation was hampered by patients' motivation and acceptation, and their autonomy. CONCLUSION: PGI-S and Bristol Stool Chart are reliable tools to assess the presence of bowel symptoms in clinical practice.

[Radioguided surgery for primary hyperparathyroidism: 100 cases]. / Chirurgie radioguidée de l'hyperparathyroïdisme primaire.

One hundred patients with primary hyperparathyroidism underwent radioguided surgery within 90 to 180 minutes following IV injection of a diagnostic dose of MIBI and after parathyroid scanning with planar and oblique views. Exclusion criteria were thyroid pathology requiring surgery and suspicion of multiple endocrine neoplasia. A>20% step-up between the background noise and tissue uptake was the diagnostic threshold for parathyroid hyperfunctionning tissue, and this was observed in only 15% of cases overall all cured, but two. This method of detection is technically demanding and various angles of application of the probe can result in significant discrepancies of recorded uptake for the same spot. Our results demonstrate a physiological step-up between the ipsilateral unaffected upper and lower quadrants of the neck (range: - 34% to - 5%), seemingly because of the proximity of supra-aortic vessels (upper neck-upper mediastinal gradient: - 57% to - 21%). Therefore, significant ratios are meaningful only between either the symmetrical left and right controlateral quadrants, 8% of pre-operative scannings were non-contributory, and probe detection was contributory in 3/8 cases only. Benefit of the technique is limited in routine, but it can be helpful in redo cases if the offending gland is not located in close surroundings of tissues physiologically taking up the radio pharmaceutical (salivary glands, great vessels and heart).

Nephrotic syndrome cured by removal of malignant gastric stromal tumor.

Malignant tumors have been associated with the development of nephrotic syndrome. We report a 73-year-old man with nephrotic syndrome who had a malignant stromal gastric tumor. Curative resection of the sarcoma resulted in remission of the nephrotic syndrome.