Effectiveness and tolerability of rectal ointment and suppositories containing sucralfate for hemorrhoidal symptoms: a prospective, observational study.

BACKGROUND AND AIMS: A high number of topical products are available for the treatment of hemorrhoidal symptoms. Sucralfate-based topical products constitute a new treatment alternative that act as a mechanical barrier to facilitate healing. The aim of this prospective, observational study was to determine patient- and physician-assessed effectiveness and tolerability of rectal ointment and suppositories containing sucralfate for the treatment of hemorrhoidal symptoms in routine clinical practice. METHODS: Adult patients with diagnosed, mild-to-moderate, symptomatic non-bleeding hemorrhoids treated with rectal ointment or suppositories containing sucralfate were enrolled. Patients were administered treatment twice per day for at least 1 week until symptom resolution and/or for a maximum of 4 weeks. The primary endpoint was patient-assessed effectiveness on a modified Symptom Severity Score (mSSS, range 0 to 14). Physician-assessed effectiveness (9 symptoms, 0 to 5 Likert scale), hemorrhoid grade, and patient satisfaction were also determined. RESULTS: Five investigators enrolled 60 patients; mean age was 48.4 ± 16.6 years and 72.4% were female. Pain or pressure sensitivity was reported as the most severe symptom by patients, and pressure sensitivity, discharge, soiling, and prolapse by physicians. Mean patient-assessed mSSS at baseline was 6.6 ± 1.9 and was significantly improved overall and in the ointment and suppository groups individually by -4.6 ± 2.0, -4.4 ± 1.8, and -4.8 ± 2.2, respectively (p < 0.0001). Investigator-assessed mean baseline symptom score was 18.1 ± 3.9 and improved by -7.1 ± 4.5, -6.9 ± 5.4, and -7.3 ± 3.5, respectively (p < 0.0001). Investigator-assessed symptoms of pressure sensitivity, swelling, and discharge were improved to the greatest extent. Hemorrhoid grade was improved in 38% of patients at the end of treatment. Compliance with treatment was 97.4% and patient satisfaction with application and onset of action was high (81.3% and 76.2%, respectively). Both the ointment and suppository were well tolerated. CONCLUSIONS: The effectiveness of topical ointment or suppository containing sucralfate on patient- and investigator-assessed hemorrhoidal symptoms in real-life clinical practice was demonstrated. Patient satisfaction was high and treatments were well tolerated. Larger controlled trials are warranted to confirm the results.

[A rare case of gastric outlet syndrome: internal incarceration after removal of gastric banding]. / Teljes gyomorkimeneti elzáródás ritka esete: gyomorgyuru eltávolítását követo belso kizáródás.

The laparoscopically administrated adjustable gastric banding used to be widely practiced as treatment of extreme obesity. As lots of complaints and complications arose sooner or later after this procedure, they had to be removed quite often. Half year after such a removal we observed a 37-year-old female patient with complete gastric outlet obstruction. The patient was operated and cured completely. The cause of gastric obstruction was an internal incarceration of the pyloric region between the plication made at the time of the ring removal and the gastric body. We found no similar case of gastric outlet obstruction in the corresponding literature.

[Breast reconstruction surgery with endoscopic assisted latissimus dorsi muscle flap]. / Azonnali emlorekonstrukció endoszkóposan asszisztált latissimus dorsi izomlebennyel.

The results obtaining with breast reconstruction surgery are not always satisfactory for the patients. Reconstruction with pure latissimus dorsi flap is useful option and due to endoscopic harvest large scar on the back can be avoided. The skin sparing mastectomy and even the sentinel lymph node biopsy or lymphadenectomy can be performed using a single incision in the axilla. Also the immediate reconstruction with endoscopically assisted harvest of the latissimus dorsi muscle flap in selective cases can be done using the same incision. The patient reported high satisfaction with the aesthetic and functional results due to preservation the breast shape and the absence of any scarring on the back.

[A giant myxoid leiomyoma mimicking an inguinal hernia]. / Lágyéksérvet utánzó gigantikus méretu myxoid leiomyoma.

Leiomyoma is a rare, smooth muscle tumour that can occur everywhere in the human body. The authors present the history of a 60-year-old female, who had a giant, Mullerian type myxoid leiomyoma in the inguinal region mimicking acute abdominal symptoms. After examination the authors removed the soft tissue mass in the right femoral region reaching down in supine position to the middle third of the leg measuring 335 × 495 × 437 mm in greatest diameters in weight 33 kg. Reconstruction of the tissue defect was performed using oncoplastic guidelines. During the follow-up time no tumour recurrence was detected and the quality of life of the patient improved significantly.

[Massive localized lymphoedema (MLL) in the mons pubis]. / Masszív lokalizált lymphoedema a mons pubison.

Massive localized lymphoedema (MLL) is a relatively frequent complication in obesity. MLL is present as a giant swelling and associated with characteristic skin changes. Due to the pathologic and morphologic similarity to sarcoma, MLL is also called "pseudosarcoma". MLL can degenerate into angiosarcoma without surgery. We present a case of MLL of the mons pubis in a 54-year-old man with a BMI of 48.6.

[Evaluation of patients' satisfaction after breast reconstruction with latissimus dorsi myocutaneous flap and immediate permanent breast implant]. / Betegelégedettségi vizsgálat latissimus dorsi musculocutan lebennyel és azonnali permanens implantátummal végzett emlorekonstrukciós mutétek után.

Current surgical treatment modalities for breast reconstruction include latissimus dorsi mycotaneous flap with immediate permanent breast implant (LDI). The aim of the present study was to analyze reconstruction with LDI in terms of quality of life, cosmesis and patient satisfaction. A chart analysis was carried out with the first ten patients who underwent breast reconstruction with LDI. The patients were interviewed and self-assessment quality of life was administered. They also underwent assessment of satisfaction and cosmesis. The high satisfaction and cosmesis scores in the breast reconstruction group indicate the superior results that can be achieved with breast reconstruction.

[Medial sural artery perforator fasciocutaneous flap for the reconstruction of tongue and mouth base]. / Arteria suralis medialis perforator fasciocutan lebeny alkalmazása a nyelv és a szájfenék rekonstrukciójában.

BACKGROUND: Despite the well-known high donor site morbidity of the radial forarm flap, it has still remained the first option for the reconstruction of the tongue and the floor of mouth. However, a desire for an alternative, thin fasciocutaneous flap has led to the use of the median sural artery perforator flap. METHODS: Three patients had reconstructive surgery used MSAP flaps, after radical tumor excision. RESULTS: The flap was based in all cases on a dominant perforator vessel. The size of the skin paddles ranged between 20-32 cm2, and the length of the vascular pedicle between 8.2-11 cm. The mean thickness of the flap was 6.5 mm. CONCLUSION: MSAP flap is an ideal solution for surgical reconstruction in the oral cavity.

[Perineal soft-tissue reconstruction with vertical rectus abdominis myocutan (VRAM) flap following extended abdomino-perineal resection for cancer]. / Kiterjesztett abdominoperinealis rectumexstirpatiót követo gáttájéki rekonstrukció verticalis rectus abdominis myocutan (VRAM) lebennyel.

Perineal wound healing problems following extended abdomino-perineal resection of ano-rectal cancer represent a great challenge to the surgeon. Perineal soft-tissue reconstruction with a myocutan flap was thought to reduce surgical wound healing complications. A review of the relevant literature was carried out on perineal soft-tissue reconstruction with rectus abdominis myocutan (VRAM) flap following extended abdomino-perineal rectal resection for cancer. The more commonly used neoadjuvant chemo- and radiotherapy as well as extended surgical radicality resulted in increased perioperative risks, therefore combined procedures between the colorectal and plastic surgical teams are inevitable. This case report illustrates the above trend.

[Double DIEP flaps for unilateral breast reconstruction]. / Kettos DIEP lebenyek egyoldali emlorekonstrukcióban.

DIEP flap is a reliable option for autologous breast reconstruction after mastectomy. Previously performed lower median laparotomy can cause some difficulties in cases when more volume is needed than the DIEP flap harvested from one side can provide. We performed breast reconstruction using double hemi-DIEP flaps in three of the cases discussed. All patients recovered without complications and had a good aesthetic outcome. This method offers a safe opportunity and broadens the spectrum of breast reconstruction.

[Retroareolar breast cancer: oncoplastic resection technique with central quadrantectomy and reconstruction with Grisotti's inferior dermo-glandular flap]. / Retroareolarisan elhelyezkedo emlotumorok onkoplasztikai mutéte: centrális quadrantectomia és Grisotti-féle inferior dermoglandularis lebennyel való rekonstrukció

Centrally located breast cancers account for 5-20% of all breast cancer cases. Historically, patients with central breast cancers were not offered breast conservation surgery but conventional mastectomy only. The relatively frequent nipple-areola-complex involvement and consequent nipple-areolar resections with an adequate safety margin around the tumor usually result in an unacceptable cosmetic result. However, breast conservation surgery can be offered to these patients applyingoncoplastic surgical techniques. In this study, central quadrantectomy and breast reconstruction with Grisotti's dermo-glandular flap is evaluated.