Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment.

BACKGROUND: According to the "vascular" theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. A 980-nm diode laser-pulsed shot causes shrinkage of tissue. The depth of shrinkage can be regulated by the power and duration of the laser beam. Through a 1000-micron conic fiber, five laser shots generated at a power of 13 W with duration of 1.2 s each and a pause of 0.6 s caused shrinkage of tissues to the depth of approximately 5 mm. Terminal branches of the superior hemorrhoidal artery in the anal canal, if precisely identified through a Doppler signal, can be closed with the use of this laser. METHODS: A specially designed proctoscope has a small window that allows introducing a Doppler probe whose function is to identify hemorrhoidal arteries. Approximately 3 cm above the dentate line, the terminal branches of the superior hemorrhoidal artery (usually 8-12) are recognized through a clockwise rotation of the proctoscope and progressively fulgurated through a laser optic fiber. The procedure does not require anesthesia and can be performed as an ambulatory treatment. RESULTS: Thirty patients (16 men) with second to third grade symptomatic hemorrhoids have been treated with the described technique. The procedure proved to be successful at 3 months' follow-up in 92% of cases. No major adverse effects or complications were reported. Bleeding was observed in four cases. In two cases surgical hemostasis was necessary. Minor pain that required medication was reported in three cases. CONCLUSIONS: The hemorrhoidal laser procedure (HeLP) represents a new nonexcisional, mini-invasive treatment for patients suffering from second and third degree hemorrhoids without severe mucosal prolapse. Thermal occlusion of the hemorrhoidal arteries causes a progressive shrinkage of hemorrhoidal cushions. The procedure does not require anesthesia, is technically easy, repeatable, and can be performed as an office treatment.

How typhoons trigger turbidity currents in submarine canyons.

Intense turbidity currents occur in the Malaylay Submarine Canyon off the northern coast of Mindoro Island in the Philippines. They start in very shallow waters at the shelf break and reach deeper waters where a gas pipeline is located. The pipeline was displaced by a turbidity current in 2006 and its rock berm damaged by another 10 years later. Here we propose that they are triggered near the mouth of the Malaylay and Baco rivers by direct sediment resuspension in the shallow shelf and transport to the canyon heads by typhoon-induced waves and currents. We show these rivers are unlikely to generate hyperpycnal flows and trigger turbidity currents by themselves. Characteristic signatures of turbidity currents, in the form of bed shear stress obtained by numerical simulations, match observed erosion/deposition and rock berm damage patterns recorded by repeat bathymetric surveys before and after typhoon Nock-ten in December 2016. Our analysis predicts a larger turbidity current triggered by typhoon Durian in 2006; and reveals the reason for the lack of any significant turbidity current associated with typhoon Melor in December 2015. Key factors to assess turbidity current initiation are typhoon proximity, strength, and synchronicity of typhoon induced waves and currents. Using data from a 66-year hindcast we estimate a ~8-year return period of typhoons with capacity to trigger large turbidity currents.

Conservative management of a spleen trauma using radiofrequency.

AIM OF THE STUDY: Conservative operative management of a splenic injury has become more and more employed in order to preserve the immune function of the organ. CASE REPORT: A case of a rupture of the spleen successfully treated with the use of a radiofrequency thermal energy generator is eported. The parenchymal tear was coagulated by a one cooled tip needle electrode. There were no postoperative complications and the function of the spleen was preserved. CONCLUSIONS: The technique cannot be applied in case of lesion of the major vessels or in case of avulsion of the hilum. This technique integrates to the others to make the operative conservative management of a splenic injury more and more feasible.