Single Blind, Randomised Study Regarding the Treatment of the Telangiectasia of the Lower Limbs (C1EAP) Using Polidocanol 0,5%, 1%, and Nd:YAG Laser.

The treatment of leg telangiectasias could be done with liquid sclerotherapy or Nd:YAG laser. We evaluated randomly, in a simple blind, the efficacy of the treatment with 0,5% polidocanol (POL-0,5), 1% polidocanol (POL-1) and Nd:YAG laser (LAS) on 132 patient (264 limbs) with telangiectasia of the lower limbs with less than 2mm diameter (C1EAP). The main objective was to evaluate the efficacy of the sclerotherapy (chemical compared with Nd:YAG-LAS). Secondary objectives were: possible major complications (deep thrombosis, severe burns, ischemic complications, etc.), the percentage of the local complications, the cosmetic aspect-evaluated by both the patient and the doctor and the grade of discomfort of the patient during and after the procedure. Comparing the treatment with Nd:YAG laser (LAS), polidecanol-0.5% (POL-0.5), polidecanol 1% (POL-1), it was noticed that telangiectasias smaller than 1mm led to good and very good results in all the cases treated with Nd:YAG laser and the same outcome was obtained in one third of the subjects treated with POL-0.5, vs. 47.81% of patients treated with POL-1. When telangiectasias were larger than 1mm diameter, good and very good results occurred in 86.36% of patients treated with LAS and 100% of the cases treated with POL-0.5 and POL-1. In conclusion, we consider that leg telangiectasias can be treated with good results using Nd:YAG laser or sclerotherapy with polidocanol, Nd:YAG laser being reccomended for telangiectasia under than 1 mm diameter while sclerotherapy in larger vessels.

Comparative study in leg telangiectasias treatment with Nd:YAG laser and sclerotherapy.

Telangiectasias and reticular veins of the lower extremities are common lesions. Sclerotherapy is considered the gold standard for treatment. The aim of our prospective randomized study was to compare the efficacy and safety of hypertonic 20% saline/2% lignocaine (HS) versus polidocanol 0.5% (POL) versus long-pulsed neodymium:ytrium aluminium garnet (Nd:YAG) laser (LAS) treatments of leg telangiectasias in women, using each patient as her own control. We included in this study 285 women with primary leg telangiectasias and reticular veins (C1AEpAS1PN) in order to be treated with sclerotherapy or laser. One leg was treated with either LAS, POL or HS. The other leg received, randomly, one other of these treatments. At the end there were 190 legs treated with each method. There were two sessions at 8-week interval. Assessment of vessel clearing and complications was conducted 2 months after each session using before and after photographs of the leg vessels using a six-point scale from 0 (no change) to 5 (100% cleared). For telangiectasias under 1 mm diameter LAS was better (RR=9.72, P<0.0001) than HS and also POL was better (RR=2.70, P=0.003); for telangiectasias over 1 mm diameter LAS and POL were better too (RR=2.70, P=0.003) respectively (RR=1.44, P=0.00756). For telangiectasias under 1 mm LAS treatment is clearly superior to POL treatment. For telangiectasias over 1 mm the hazard regression model showed a hazard ratio of 3.97 (P=0.047) for LAS and 4.96 (P=0.486) for POL vs. HS treatment. In conclusion, telangiectasias and reticular veins of the lower extremities can be successfully treated with Nd:YAG laser or sclerotherapy. Nd:YAG laser is recommended in treating small telangiectasias (under 1 mm diameter) while sclerotherapy with polidocanol is more efficient as long as telangiectasias diameter is growing.

Vocational training and employability: Evaluation evidence from Romania.

This study evaluates the direct effects of vocational training, which is a popular active labour market policy in a European developing country such as Romania. Since the available official statistical microdata were insufficient to conduct reliable impact evaluations, the main findings were obtained through a counterfactual impact evaluation using newly produced micro survey data. Moreover, the research provides a heterogeneity analysis of groups of trainees, in order to identify the categories for which the programme performs best. The main results reveal that the training measure has a positive, but modest impact upon employability in Romania: participation increases employment chances properly controlled by 15%. It is most successful for women and for people living in urban areas. Measures for increasing the impacts of the vocational training programme in Romania are identified in terms of better targeting and profiling the trainees and closer adjustment of the programme to the specific needs of the labour market.

Proposed score for the self-assessment of an endoscopy department performance in colonoscopy screening.

The aim of the paper was to propose a score for performance evaluation in colonoscopy units. METHOD: We proposed a score (CDCD score - Cecal intubation, polyp Detection rate, Cleansing and Documentation of cecal intubation) based on the following parameters that assess the quality of colonoscopy units: total colonoscopies rate, polyp detection rate, rate of cecal intubation photo record, rate of recorded Boston bowel preparation scale (BBPS) (rated 1 to 5 stars). The mean score obtained based on the above mentioned criteria was used as a quality parameter of the endoscopy unit. We applied and calculated this score in all screening colonoscopies performed in our Endoscopy Department during the last 4 years. RESULTS: The study group included 856 screening colonoscopies. The rate of total colonoscopies was 92.1% (789/856 cases) and the polyp detection rate was 23.9%. Regarding the quality of bowel preparation, the BBPS was recorded in 51.1% cases. The cecal intubation was photo recorded in 44% of cases. We considered that of the 4 parameters, the highest weight for an excellent quality belonged to the cecal intubation rate, followed by the polyp detection rate, because they evaluate the endoscopic technique, while the other 2 are more administrative. Thus, for the unit's assessment we used the following equation: UNIT'S QUALITY CDCD SCORE = (3×cecal intubation rate+3×polyp detection rate+1×photo documentation+1×BBPS documentation)/8. Thus, the CDCD Score for our unit was ≈4 stars (3.7 stars). CONCLUSION: The proposed CDCD score may be an objective tool for the quality assessment in different endoscopy units.

Aspects of renal function in patients with colorectal cancer in a gastroenterology clinic of a county hospital in Western Romania.

Colorectal cancer represents the third cause of cancer. Since its detection in due time is important resolution, appropriate monitoring is mandatory. The present study deals with the relationship between colorectal cancer and renal function, as well as other associated risk factors. Chronic kidney disease (CKD) represents a risk factor of cancer, both in non-dialysed patients and especially in dialysed patients and in patients with renal transplant. It can get aggravated with cancer in general and particularly with colorectal cancer, partly related to the toxins that cannot be appropriately eliminated because of renal functional disturbances. At the same time, immunosuppressive therapy used for treating glomerular or secondary nephropathies represents an important risk factor of cancer. Some patients with colorectal cancer were found to present also impaired renal function, a fact whose significance is still little known. The object of the present paper is an analysis of the case records of a clinic of gastroenterology on the relationship between colorectal cancer and renal functional impairment. We found in the patients with colorectal cancer under study a glomerular filtration rate (GFR calculated with the EPI formula) of < 60 ml/min/1.73m2 in 31/180 patients, respectively 17.22% of the cases, a value that is similar to that in specialised literature. We also analysed associated risk factors that could be related to renal function impairment in these patients: age, gender, anaemia, diabetes mellitus and hypertension. These could represent, together with the colorectal cancer of the investigated patients, risk factors affecting on the one hand renal function, and on the other hand, potentially increasing the risk of cancer. Correction of these risk factors would have beneficial effects on patients. The relationship between renal functional impairment, respectively CKD, and colorectal cancer is to be regarded from the point of view of complex reciprocity: the impairment of the renal function is a factor of risk of colorectal cancer and colorectal cancer can influence renal function of these patients. This report of reciprocity based on important pathogenic mechanisms also interrelates with factors of risk consecutive to both renal function impairment and colorectal cancer.

How many measurements are needed for liver stiffness assessment by 2D-Shear Wave Elastography (2D-SWE) and which value should be used: the mean or median?

AIM: To analyze how many measurements are needed for non-invasive assessment of liver stiffness (LS) by means of 2D-Shear Wave Elastography (2D-SWE) and if the use of mean of median values of 2D-SWE measurements is needed. METHODS: We evaluated 449 consecutive subjects (with or without chronic liver disease) by means of Transient Elastography (TE) and 2D-SWE. We compared the correlation of LS assessed by TE with 2D-SWE measurements when using either the median of 5 valid 2D-SWE measurements or the mean of 3 or 5 valid 2D-SWE measurements. RESULTS: We obtained reliable LS measurements by TE in 330/449 subjects (73.5%). From these, in 281 subjects we obtained 5 valid 2D-SWE measurements. The correlation of LS assessed by TE with 2D-SWE values was similar when we used the median value of 5 valid 2D-SWE measurements, the mean value of 5 valid 2D-SWE measurements or the mean value of 3 valid 2D-SWE measurements: r =0.683, r=0.711 and r=0.691, respectively. There were no significant differences between the median value of 5 valid 2D-SWE measurements; the mean value of 5 valid 2D-SWE measurements; or the mean value of 3 valid 2D-SWE measurements: 7.6 kPa, 7.7 kPa and 7.6 kPa, respectively. CONCLUSIONS: Our study showed that it is enough to perform 3 valid 2D-SWE measurements and to use the mean value of these measurements.

Does experience play a role in the ability to perform liver stiffness measurements by means of supersonic shear imaging (SSI)?

UNLABELLED: The aim of this study was to identify if the experience of the examiner does plays a role in the ability to perform liver stiffness (LS) measurements by means of supersonic shear imaging (SSI) due to the lack of recommendation regarding this issue. MATERIAL AND METHODS: The study included 371 consecutive subjects (42% men and 58% women, with a median age of 48 years, ranging between 17-85 years) with or without hepatopathies, in which LS was evaluated with an AixplorerTM ultrasound system (SuperSonic Imagine S.A., Aix-en-Provence, France). Reliable LS measurements by means of SSI were defined as the median value of 5 LS measurements expressed in kilopascals (kPa). The SSI measurements were performed by a novice (with less than 300 abdominal ultrasound examinations performed) or by a more experienced operator (with approximately 500 ultrasound examinations performed). The results of both operators were compared. RESULTS: The novice performed 57.4% and the more experienced operator 42.6% of the SSI measurements. The more experienced operator had a higher rate of reliable examinations as compared with the novice: 87.4% vs. 72.8% (p =0.001). The rate of reliable measurements was similar for novice and experienced operator in patients with a normal weight (BMI < 25 kg/m2) and in overweight patients (BMI between 25.1 - 29.9 kg/m2), 92.3% vs. 97.5%, p=0.24, respectively 71.1% vs 80.4%, p=0.39. For obese patients (BMI ≥ 30 kg/m2) the rate of reliable LS measurements was significantly higher for the more experienced operator as compared with the novice: 73.4% vs 45.9%, p=0.03. CONCLUSIONS: It seems that experience in liver ultrasonography plays a role in the ability to perform LS measurements by means of SSI and leads to achieving more reliable LS measurements especially in obese subjects.

In vivo optical imaging using quantum dots for the management of brain tumors.

The surgical management of brain tumors requires the precise localization of tumor tissues within normal brain parenchyma in order to achieve accurate diagnostic biopsy and complete surgical resection. Quantum dots are optical semiconductor nanocrystals that exhibit stable, bright fluorescence. The intravenous injection of quantum dots is accompanied by reticuloendothelial system and macrophage sequestration. Macrophages infiltrate brain tumors and phagocytize intravenously injected quantum dots, optically labeling the tumors. Macrophage-mediated delivery of quantum dots to brain tumors may represent a novel technique to label tumors preoperatively. Quantum dots within tumors may be detected with optical imaging and optical spectroscopy tools, providing the surgeon with real-time optical feedback during the resection and biopsy of brain tumors.