Transanal repair of rectocele with high frequency radio scalpel.

AIM: This is a prospective randomized study to analyze results obtained in two groups of patients, affected by stage 2 rectocele and treated with rectum anterior wall repair and strength, performed with standard or modified Khubchandani technique, using High Frequency (HF) Radio Scalpel. MATERIALS AND METHODS: A cohort of 24 patients with stage 2 rectocele (Mellgren's classification) have been included. Twelve (group A) underwent surgery with standard technique and twelve (group B) underwent surgery using the HF Radio Scalpel, which cuts and coagulates tissues without damage thanks to its low working temperature (45-70°C). Each patient underwent proctolo-gical examination and anoscopy in 7th, 15th, 45th POD and after 6 and 12 months. RESULTS: During post-operative follow-up 5 patients from group A and 1 from group B didn't show up so that they drop out the study. As a result, group A is composed by 7 patients and group B by 11 patients. Mean operating time was significantly favourable in group B (51 vs 33 minutes, p< 0.01). The differences between other parameters weren't statistically significant, even if post-operative course was less difficult in HF Radio Scalpel group. CONCLUSIONS: The surgical technique to repair and reinforce anterior rectal wall is easier and faster if performed with HF Radio Scalpel respect to the standard procedure described by Khubchandani. Post-operative course was less painful and, even more importantly considering the patient age, surgical time was shorter. Therefore, the results obtained cast positive light on using this technique to treat uncomplicated grade 2 rectocele.

Ambulatory therapy with combined hemorrhoidal radiocoagulation.

BACKGROUND: This is a prospective randomized study to analyze results obtained in two groups of patients affected of grade II hemorrhoids and treated with Radiofrequency Coagulation (RFC) or Combined Hemorrhoidal Radiocoagulation (CHR). PATIENTS AND METHODS: The study comprehended 30 patients of which 27 had at least 6 months of follow-up. Two groups of patients were considered: group A, represented by 12 individuals treated with RFC, and group B, consisting of 15 patients treated with CHR. Our purpose was to determine: grade of pain felt immediately after procedure and at first evacuation (score from 1 to 10), bleeding, patient's satisfaction 15 days and 6 months after treatment (score from 1 to 10) and incidence of failures. RESULTS: Mean pain score reported immediately after procedure was 2.08 ± 0.9 for group A and 2.40 ± 1.5 for group B (p = NS). At first evacuation, mean pain score for group A and for group B was 2.16 ± 1.1 vs 2.33 ± 1.17, respectively (p = NS). Satisfaction score during first 15 days was 6.75 ± 2.76 for patients treated with RFC and 6.08 ± 2.20 for patients who received CHR (p = NS), while mean score of overall satisfaction after 6 months was 6.33 ± 1.96 (group A) vs 7.83 ± 2.05 (group B) (p < 0.05). At 6 months of follow-up, we observed 8 patients free from pain in group A (66.7%) and 13 patients in group B (86.7%). CONCLUSIONS: Results reported in both groups of patients confirm validity and efficacy of the two techniques used in this study, even if later in time CHR showed better results than RFC.        

The role of radiofrequency surgery in the treatment of hemorrhoidal disease.

BACKGROUND: In this article we reported results obtained in our previous studies concerning application of radiofrequency (RF) in proctology and in particular for hemorrhoids treatment. METHODS: We compared radiofrequency submucosal hemorrhoidectomy (RSH) and conventional Parks' hemorrhoidectomy (CPH) (group 1), radiofrequency open hemorrhoidectomy (ROH) and Milligan-Morgan hemorrhoidectomy (MMH) (group 2), radiofrequency closed hemorrhoidectomy (RCH) and Ferguson hemorrhoidectomy (FH) (group 3), combined hemorrhoidal radiocoagulation (CHR) and rubber band ligation (RBL) (group 4). In this work primary endpoints were determined as evaluation of the grade of pain felt immediately after the procedure and at the first evacuation, bleeding, operation time, readmission to work, incidence of failures and patient's satisfaction. RESULTS: Group 1 - In comparison to Parks' technique, use of radiofrequency scalpel reduced mean operation time (61.2 min, range 50-75, vs. 37.4 min, range 30-51; p < 0.05), first postoperative day pain score (5.9, range 3-10, vs. 4.0, range 1-10; p < 0.05), pain score at first evacuation (5.7, range 2-10, vs 4.2, range 1-8; p < 0.05) and pain score on postoperative days (3.6, range 1-9, vs. 2.8, range 1-8; p < 0.05). Group 2 - Results show a substantial similarity between these techniques, however the procedure lasted 7 minutes less with RF scalpel (18.6 min, range 16-21, vs. 25.55 min, range 20-30; p < 0.05). Group 3 - Patients treated with RF showed significant reduction in surgical time (23 min, range 21-31, vs. 33 min, range 24-35; p < 0.01), in pain at 1st post-operative day (VAS score 3.4 +/- 1.3 vs. 4.8 +/- 1.0; p < 0.05) and at the first evacuation (3.4 +/- 1.0 vs. 5.0 +/- 0.8; p < 0.05). Group 4 - The study confirmed validity of both the used techniques, however CHR seems to allow a reduction in incidence of failures. CONCLUSIONS: Results obtained from radiofrequency surgery compared with those achieved with classic surgery for hemorrhoidal disease show in the majority of cases that radiosurgery facilitates, accelerates and improves surgical procedures.

Prospective randomised comparison of rubber band ligation (RBL) and combined hemorrhoidal radiocoagulation (CHR).

BACKGROUND: In this prospective randomized study we compared two groups of patients with grade II hemorrhoids treated with standard Rubber Band Ligation (RBL) and Combined Hemorrhoidal Radiocoagulation (CHR), respectively. METHODS: Out of 90 patients initially randomized, a total of 75 patients regularly returned to visit controls at least for 6 months of follow-up. Consequently, two groups of patients were considered: Group A, represented by 36 individuals treated with RBL, and Group B, consisting of 39 patients treated with CHR. In this study primary endpoints were determined as evaluation of the grade of pain felt immediately after the procedure and at the first evacuation (score from 1 to 10), bleeding, patient's satisfaction after 15 days and after 6 months from the treatment (score from 1 to 10), appearance of failures. RESULTS: Comparing two techniques, the mean pain score reported immediately after the procedure was 2.08 +/- 1.1 for Group A and 2.13 +/- 1.26 or Group B. At the first evacuation, the mean pain score for Group A and for Group B was 2.69 +/- 1.12 vs. 2.38 +/- 1.18, respectively. The satisfaction score during the first 15 days from the procedure was 6.61 +/- 2.35 for patients treated with RBL and 6.72 +/- 2.28 for patients who received CHR, while the mean score on overall satisfaction after 6 months was 7.11 +/- 2.11 (Group A) vs. 7.31 +/- 2.04 (Group B). At 6 months of follow-up, we observed remission of symptoms in 25 patients in Group A (69.4%) and 31 patients in Group B (79.5%). CONCLUSIONS: Satisfactory results were reported in both groups of patients after different treatments, which confirm the validity and efficacy of the two techniques used in this study. At least all patients reported positive results in terms of immediate and long-term comfort after both procedures. CHR showed better results than standard RBL, but further studies are required to evaluate the validity of these methods.

A rare case of cystic variety of angiomatoid fibrous histiocytoma.

A rare case of cystic angiomatoid fibrous histiocytoma of the thigh in a 13-years-old girl is reported. Final diagnosis was made only after surgical excision. A review of the literature with a discussion of the particularity of this case are also examined in order to achieve the best surgical strategy and the lower risk of recurrence.

Radiofrequency Y-V anoplasty in the treatment of anal stenosis.

BACKGROUND: Anal stenosis is a common proctologic disease often caused from hemorrhoids surgery. Treatments adopted are many and varied. In this study we applied radiofrequencies to the classic Y-V anoplasty operation and reported results obtained. METHODS: Eligibility criteria consisted of patients affected by anal stenosis. Exclusion criteria were those with contraindications to the surgical operation: pregnant patients or American Society of Anaesthesiologists Score III or IV. RESULTS: From January 2002 to December 2004 we operated 7 patients, 4 of them were males. Mean age at the time of diagnosis was 46 years. All patients referred obstructive defecation, painful evacuation or bleeding. Mean values for operative time were 30 min. Postoperative pain was 3.9 at day 1 and 3.0 at 7th day (VAS scale). Patient satisfaction rate was 6.6 at three weeks and 8.3 at 6 and 12 months. No recurrences were observed after 1 year. CONCLUSION: Radiofrequency Y-V anoplasty is a feasible and effective for the treatment of anal stenosis. The radiofrequency bistoury easies the procedure, lessens operating times and the healing process of surgical wounds.

Clinical applications of radiofrequency in proctology: a review.

The radiofrequency scalpel is an innovative instrument which allows to cut and coagulate tissues in an atraumatic manner, conversely to the electric scalpel. The authors describe the use of radiofrequencies in proctology by making a literature review for every major proctologic disease (hemorrhoids, anal fistulas, anal fissure, sinus pilonidalis, hypertrophied anal papillae). Many techniques have been developed with radiofrequencies in hemorrhoids treatment: coagulation, ablation with plication, Milligan Morgan and Parks hemorrhoidectomy. In the treatment of anal fissures, radiofrequency subcutaneous lateral internal sphincterotomy has been described. For anal fistulas, both radiofrequency fistulotomy and fistulectomy. Finally, radiofrequency sinotomy for sinus pilonidalis and coagulation for hypertrophied anal papillae are present in literature. The analysis of the results obtained with radiofrequency surgery compared with those of the "classic" surgery for proctologic disease shows that in most of them radiosurgery facilitates, accelerates and improves the surgical procedure.

A retrospective analysis of 1.011 percutaneous liver biopsies performed in patients with liver transplantation or liver disease: ultrasonography can reduce complications?

OBJECTIVE: In the last decades, liver biopsy was the reference procedure for the diagnosis and follow-up of liver disease. Aim of present retrospective analysis was to assess the prevalence of complications and risk factors after Percutaneous Liver Biopsy (PLB) performed for diagnosis and staging in patients with chronic liver disease and for monitoring the graft in liver transplanted patients PATIENTS AND METHODS: Data were collected from a total of 1.011 PLB performed with the Menghini technique between January 2004 and December 2014 at the Hepatology and Transplant Units of the University of Rome Tor Vergata. The indications for biopsy were: follow-up of liver transplantation, chronic Hepatitis B Virus (HBV) or Hepatitis C Virus (HCV), with or without Human Immunodeficiency Virus (HIV) and alcohol-related liver disease. Our patients were divided into two groups according to the biopsy indication: follow-up of liver transplantation (Group A) and chronic liver disease (Group B). All the procedures were performed in Day Hospital regimen. After the biopsy, patients remained in bed for about 4-6 hours. In the absence of complications, they were then discharged on the same day. RESULTS: The most frequent complication after biopsy was pain (Group A n. 57, 8.8%; Group B n. 105, 29.0%), hypotension as a result of a vasovagal reaction resolved spontaneously (Group A n. 7, 1.1%; Group B n. 6, 1.7%), and intrahepatic bleeding resolved with conservative therapy (Group A n. 1, 0.2%; Group B n. 6, 1.7%). Two cases of pneumothorax in the Group A (0.3%) were treated with a chest tube. Other complications did not have a significant impact. Also, we did not observe statistically significant differences in patients who underwent PLB without and with ultrasound guidance. CONCLUSIONS: Liver biopsy is not a replaceable tool in diagnosis and follow-up of several chronic liver diseases. The Menghini technique with the percutaneous trans costal approach, might be preferred because less traumatic and related with a low occurrence of minor and major complications. According to our case load and comparing our findings with the previous published data, we speculate that ultrasound guidance is not crucial in the prevention of major complications.

A prospective randomized trial betwen subcutaneous lateral internal sphincterotomy with radiofrequency bistoury and conventional parks' operation in the treatment of anal fissures.

BACKGROUND: Anal fissure is a frequent proctologic disease. There are many and various treatments adopted to cure this disease. In this study we applied radiofrequencies to the subcutaneous lateral internal sphincterotomy and we compared the techniques in a randomised trial. METHODS: Patients have been randomized in two groups: in group A 18 patients underwent subcutaneous lateral internal sphincterotomy using radiofrequency bistoury while in group B 17 patients underwent the conventional lateral internal sphincterotomy described by Parks. RESULTS: The mean values for operative time were 6.6 min for group A and 9.1 min for group B. According to pain score, patients' mean values were 1.8 for group A and 1.9 for group B. Healing of the wound was faster in group A than group B, while healing of the anal fissure was approximately the same. CONCLUSION: Lateral subcutaneous sphincterotomy is the most advantageous operation for the treatment of the idiopathic anal fissure. The radiofrequency bistoury easies the procedure, lessens operating times and healing process of the surgical wounds.

Physics of radiofrequency in proctology.

Radiosurgery is a new technique that utilizes an instrument, the radiofrequency bistoury, which is able to simultaneously cut and coagulate tissues with the emission of radiofrequencies. The first experiments about the utilization of radiofrequency currents on man were conducted between the end of the 19th century and the beginning of the 20th century. The first medical field of application was in oncology leading to the development of hyperthermia as an anticancer treatment. During the 80's the radiofrequencies have been introduced in cardiology to thermally ablate stable arrhythmic foci. Actually ear, nose, and throat surgery, dermatology, plastic surgery, vascular surgery, orthopaedics, neurosurgery and minimally invasive surgery use this new tool in their practice. The authors show the classification of radio fre quencies in the electromagnetic field, describe their historic development, their physics and their initial clinical applications by making a systematic review of the literature.

Beneficial effects of Flavonoids after ambulatory therapy with Combined Hemorrhoidal Radiocoagulation (CHR).

BACKGROUND: Phlebotropic activity, protective effect on the capillaries and anti-inflammatory properties of the Flavonoids have been reported in literature. Recently, we evaluated the effect of these drugs in controlling postoperative symptoms of proctologic surgery. In this randomized study we compared the results obtained in two groups of patients, with grade II haemorrhoids, submitted to radiofrequency coagulation of the hemorrhoidal nodule with radiofrequency scalpel (CHR), to verify the effects of Flavonoids to reduce further symptoms after treatment. PATIENTS AND METHODS: Out of 70 patients initially randomized, a total of 59 patients regularly returned to outpatient visit at least for 1 month of follow-up. Consequently, two groups of patients were considered: Group A, represented by 28 individuals treated with Flavonoids, and Group B, consisting of 31 patients as a control group. Our purpose was to determine: grade of pain after procedure and at first evacuation (score from 1 to 10), bleeding, incidence of failures and complications, patient's satisfaction after 30 days from the treatment (score from 1 to 10). RESULTS: We observed that the results obtained regarding the pain reported at the end of procedures (2.51 ± 1.4 for group A and 2.54 ± 1.15 for group B) and at the first evacuation (2.6 ±.1.52 for group A and 2.7 ± 1.18 for group B) are similar in both study groups. Instead, the mean score on overall satisfaction at 30 days from the treatment showed a statistical significance (8.32 ± 1.72 for group A and 6.64 ± 1.78 for group B; p < 0.05). There were no reported other important issues. CONCLUSIONS: Our results confirm the usefulness of Flavonoids to make more comfortable the post-treatment period.

Complications and risk factors of a large series of percutaneous liver biopsies in patients with liver transplantation or liver disease.

OBJECTIVE:   Liver biopsy is a very important investigation in Hepatology. The aim of this retrospective study was to assess the prevalence of complications after Percutaneous Liver Biopsy (PLB), performed in two groups of patients with liver transplantation or with liver disease. We compared our results with those most representative of the literature and discussed about indications, advantages and disadvantages in relation to the different modes for the execution of this procedure, with particular regard to the use of ultrasound guidance. PATIENTS AND METHODS: We analyzed the results of 847 PLB performed with the Menghini technique between January 2004 and December 2013 at the Transplant Unit of the University of Rome Tor Vergata. The indications for biopsy were: follow-up liver transplantation, HBV, HCV and HBV/HCV related liver disease, alcohol related liver disease and HIV coinfected with HBV or HCV. Our patients were classified into two groups according to specific indication: patients with liver transplantation (group A) and patients with liver disease (group B). The procedure was always performed in the Day Hospital regimen. After the biopsy, the patients remained in bed for about 4-6 hours. In absence of complications, they were then discharged in the same day. RESULTS: The most frequent complication was pain after biopsy (group A n. 45, 7.9%; group B n. 85, 30.9%), requiring analgesics administration, hypotension as a result of a vasovagal reaction resolved spontaneously (group A n. 6, 1.0%; group B n. 6, 2.2%), and bleeding (group A n. 1, 0.2%; group B n. 6, 2.2%), which, however, has never necessitated surgery, except in one case of hemothorax. Two cases of pneumothorax were resolved with chest tube. Other complications did not have a significant impact. CONCLUSIONS: Liver biopsy is not replaceable investigation to diagnose several liver diseases and their course and also to monitor the condition of the hepatic parenchyma after transplantation. Among the various methods we preferred the Menghini technique with percutaneous transcostal approach, because less traumatic. This procedure presents low occurrence of various problems. We reviewed the literature regarding the major complications related to the technique and the use of ultrasound guidance. Based on our case series and data reported by the main Authors, we believe that ultrasound guidance is not decisive in the prevention of major complications. It is useful if done in the days or weeks prior to biopsy only in order to know any anatomical abnormalities or rather diseases that may pose a specific indication for the procedure with ultrasound guidance.

Radiofrequency fistulectomy vs. diathermic fistulotomy for submucosal fistulas: a randomized trial.

BACKGROUND: Anal fistula represents one of the most frequent anorectal disease. Fistulotomy is considered the gold standard treatment but related problems are numerous (postoperative pain, bleeding, delayed or impaired wound healing). Fistulectomy lowers the recurrences but is less feasible with longer operating time and healing process. We applied the radiofrequencies to fistulectomy and compared the early and late results with those obtained from traditional fistulotomy. METHODS: Twenty patients were randomized to undergo radiofrequency fistulectomy (10 patients, Group A) or conventional fistulotomy (10 patients, Group B). We analysed the first postoperative day pain, intra- and postoperatory bleeding, operating time, complications (impaired or delayed wound healing, fecal incontinence) and any recurrences. RESULTS: The mean values for operative time have been 18.3 min for group A (range 15-26 min) and 17.9 min for group B (range 13-21 min). According to VAS scale, first postoperative day pain mean values were 2.8 for group A (range 2-4) and 4.1 for group B (range 3-5). Intra- and post-operative bleeding has always been negligible and faecal incontinence was never observed. Healing time mean values have been 3.5 weeks for group A (range 3-5) and 5.9 weeks for group B (range 4-8 weeks). Long-term results did not evidence complications or recurrences for both groups. CONCLUSIONS: The application of radiofrequencies to fistulectomy renders more feasible and easies the operation. Postoperative pain is smaller than traditional fistulotomy because of the lower temperatures used and for the shorter time spent in coagulating. This gives a faster wound healing. In conclusion we think that radiofrequency fistulectomy is technically more advantageous than traditional fistulotomy and furnishes better results.

A randomised trial comparing submucosal haemorrhoidectomy with radiofrequency bistoury vs. diathermic haemorrhoidectomy.

BACKGROUND: Haemorrhoid disease has become more and more frequent during the past years among western populations. Great attention has been paid in development of surgical procedures, in order to reduce post-operative pain (the main adverse effect of surgical treatment for haemorrhoids) and shorten execution time and hospital stay. This randomised clinical study compares the results obtained using submucosal haemorrhoidectomy with radiofrequency vs. diathermic haemorrhoidectomy. METHODS: Thirty-one patients were randomised to undergo submucosal haemorrhoidectomy with radiofrequency bistoury (16 patients, Group A) or diathermic haemorrhoidectomy (15 patients, Group B). The operating time, amount of pain and postoperative analgesic requirement, intra and post-operative complications and patient satisfaction were documented. RESULTS: The mean values for operative time have been 35.8 min for group A and 23.2 min for group B. According to pain score, patients' mean values for first day postoperative pain were 3.8 (A) and 5.8 (B). Pain at first evacuation 4.7 (A) and 6.5 (B). Pain at 7th postoperative day was 2.3 (A) and 3.7 (B). Patient's postoperative satisfaction rate was 6.0 (A) vs. 5.2 (B) at 3rd day and 6.7 (A) and 5.7 (B) at 6 months. CONCLUSIONS: In spite of relatively difficult execution and longer operating times, submucosal haemorrhoidectomy with radiofrequency bistoury appears to be the most precise and accurate treatment for IV degree haemorrhoids. Performing submucosal haemorrhoidectomy with radiofrequency bistoury allows us to reduce postoperative pain, bleeding and shorten hospital stay.

Evidence of drug interaction between cyclosporin A and H2-receptor antagonists (cimetidine, ranitidine and famotidine) in Sprague-Dawley rats.

H2-receptor antagonists, such as cimetidine (C), ranitidine (R) and famotidine (F) seem to be effective in the prevention and treatment of stress ulcer in transplant recipients receiving cyclosporin A (CyA). The aim of this study was to detect the possible synergistic nephro- and hepato-toxicity of these drugs, assaying the serum creatinine (SC), ALT, AST levels, and the histological features of 45 young male Sprague-Dawley rats, divided into nine groups of five rats each. After 10 days of treatment the results showed: (i) serum CyA levels were increased in the group receiving daily CyA (5 mg/kg) + R(5 mg/kg) (2430 +/- 403 ng/ml; p less than 0.05 vs. controls) and in the group receiving daily CyA (5 mg/kg) +/- C (10 mg/kg) (2440 +/- 265 ng/ml; p less than 0.01 vs. controls); (ii) ALT and AST levels were increased in this latter group (ALT 223 +/- 133 UL, AST 114.67 +/- 39 UL; p less than 0.01 vs. controls); (iii) SC levels were normal; and (iv) steatosis of the liver was observed in these two groups. These findings suggest that C and R, but not F, may inhibit the hepatic cytochromes P-450 which are involved in the oxidative metabolism of the drugs. Furthermore, the high serum CyA levels seem to play a major role in the appearance of biochemical and histological damage to the liver.

Reduced nephrotoxicity and hepatoxicity in cyclosporin A therapy by enalapril and spironolactone in rats.

The aim of the study was to define a therapy to be combined with an immunosuppressive drug such as cyclosporin A, in order to partially reduce the nephrotoxic and hepatotoxic effects in the treated rats. Two drugs were considered: enalapril, which is an inhibitor of the angiotensin-converting enzyme, and spironolactone, which is an antagonist of aldosterone. These two drugs interrupt the renin-angiotensinogen-angiotensin chain after this has been activated by cyclosporin A, preventing peripheral vasoconstriction and more specifically the constriction of both glomerular arterioles and hepatic vessels from occurring, thus diminishing the cyclosporin A toxicity in both liver and kidney.

Drug interaction between cyclosporin A and nizatidine in Sprague-Dawley rats.

The H2-receptor antagonists seem to be effective in prevention and treatment of stress ulcer in transplant recipients. In a previous study on rats, an increase was observed in cyclosporinaemia and hepatotoxicity after administration of cimetidine or ranitidine in association with cyclosporin A (CyA). On the contrary, famotidine does not influence the blood CyA levels. The aim of the study was to detect the possible synergistic nephro- and hepatotoxicity of nizatidine administered in association with CyA, assaying the serum creatinine, the ALT and AST levels, and histological features of thirty young male Sprague-Dawley rats, divided into 6 groups of five animals each. After 10 days, all the rats were sacrificed, their blood was collected to assay serum creatinine, ALT, AST and serum CyA levels: kidneys and livers were processed for light microscopy. The results obtained demonstrated that, while the level of creatinine was normal in each group, the average level of transaminase and the serum levels of CyA were significantly higher in the animals receiving the association of CyA and nizatidine. Furthermore, this group demonstrated a mild infiltrate of the liver characterized in some cases with eosinophilic polymorphonuclear cells. In light of the results obtained, it is probable that the increase of cyclosporinaemia is the consequence of an enhanced hepatotoxicity due to administration of CyA in association with nizatidine.

[Effects of cyclosporin on blood gastrin after kidney transplant]. / Effetti della ciclosporina sulla gastrinemia dopo trapianto di rene.

Fifteen patients who underwent kidney transplant were studied in order to evaluate the effects of CyA on the gastrointestinal hormonal pattern. Eight patients followed traditional therapy while seven were treated with CyA. The basal gastrinemia values were high only in those patients treated with CyA. This might be due to: an increase in hormone secretion and/or release; a decreased hormone elimination probably due to nephro-hepatic toxicity of CyA; an increase in prostaglandins, caused by CyA, which inhibit secretion of gastri acids.

[Cyclosporin (CyA) and H2 antagonists]. / Ciclosporina (CyA) ed H2-antagonisti.

An experimental study on rats in order to discovery any possible interaction between Ciclosporin (CyA) and H2-receptor antagonists has been carried out. The results obtained demonstrated that the serum levels of CyA were higher in rats treated with CyA and Cimetidine or Ranitidine, but not Famotidine. It is probable that the increase of ciclosporinaemia is the consequence of an increased hepatotoxicity due to administration of Cya in association with Cimetidine or Ranitidine.

[Submucosal hemorrhoidectomy with a radiofrequency bistoury]. / Emorroidectomia sottomucosa con bisturi a radiofrequenze. Note di tecnica.

The authors describe submucosal hemorrhoidectomy by radiosurgery. They operated on 60 patients with IV degree hemorrhoids with this technique and they present why they did it and the good results obtained.