French experience in the management of hemorrhoids by HAL™ Doppler.

OBJECTIVE: The goal of this study was to prospectively evaluate the surgical management of hemorrhoids by Doppler-guided hemorrhoidal artery ligation (Doppler HAL™). PATIENTS AND METHODS: This study was conducted between April 2008 and September 2009. The Doppler HAL™ technique was performed in patients with grades II to IV, irrespective of whether they had previously undergone medical or instrumental management or not. The other demographics of the studied population, the operative and post-operative results as well as the functional outcome at one month and at one year were recorded prospectively and analyzed retrospectively. RESULTS: Sixty-one consecutive patients (mean age 45 [range 28-85]) underwent Doppler HAL™. The mean duration of operation was 26minutes [range 18-45]. The average number of ligations per patient was seven. Three patients left the hospital the same day, 51 patients were discharged on day 1 and five patients on day 2. Post-operative mortality was nil. The post-operative morbidity rate was 4.9%. Functional results evaluated at one month and one year showed that initial symptoms had disappeared in more than 78% of patients. The recurrence rate for hemorrhoidal related disease was 10.5% during the first year. CONCLUSION: Surgical treatment of hemorrhoids by the Doppler-guided hemorrhoidal artery ligation technique is mini-invasive, with low morbidity, and satisfactory short and medium term functional results. This technique represents a reliable surgical alternative to classical hemorrhoidectomy and hemorrhoidopexy in the therapeutic strategy of hemorrhoidal disease.

[Acute superior mesenteric vein thrombosis. A retrospective study of 9 patients]. / Thrombose aiguë de la veine mésentérique supérieure. Etude rétrospective de neuf cas.

AIM OF THE STUDY: To determine diagnostic modalities and both immediate and long-term treatment of superior mesenteric venous thrombosis. PATIENTS AND METHODS: Retrospective study from 1997 to 2004 in two institutions concerning patients with superior mesenteric vein thrombosis. RESULTS: Nine patients (all males, mean age=55 years), were included. Abdominal pain (100%), vomiting (44%), and bowel activity disorders (44%) were the most common symptoms. A personal or familial thrombosis history was present in 67% of patients. A genetic predisposing factor of thrombosis was present in 78% of patients. The diagnosis was established with CT-scan in 8 cases with a mean delay of 8 days. Treatment was exclusively medical in 33% of patients and included surgery in 67%. All operated patients underwent resection for bowel infarction and only one had immediate anastomosis. All enterostomies were subsequently closed. No patient died. CONCLUSION: Diagnosis of superior mesenteric vein thrombosis is frequently delayed and relies on CT-scan with intravenous contrast. Prognosis is globally favourable but depends on early application of anticoagulation therapy. In case of surgery, bowel-sparing resection is indicated and enterostomies are often needed. Genetic disorders predisposing to thrombosis are very frequent, that may indicate prolonged even definitive anticoagulation therapy.

Distribution and partition of heavy metals in surface and sub-surface sediments of Naples city port.

The aim of the study was to delineate the extent of heavy metal pollution in the marine sediments within the port of Naples. Total metal contents from twenty surface sediments were compared with those from a long sediment core representing the natural geochemical baseline. Enrichment factors were computed for each metal and for each site in order to assess the polluting metals and the degree of pollution at each site. Results revealed that heavy metal pollution is mainly localized in the port area devoted to shipbuilding activities and in the south-east sector, which is under the influence of petroleum refineries. Data from sequential extractions indicate that metals from anthropogenic sources are mainly Cd, Zn, Cr and Cu and are potentially more mobile than those inherited from geological parent material.

Spatial distribution of heavy metals in urban soils of Naples city (Italy).

Concentrations of surface and sub-surface soil Cu, Cr, Pb and Zn in the Naples city urban area were measured in 1999. Contourmaps were constructed to describe the metals spatial distribution. In the most contaminated soil samples, metals were speciated by means of the European Commission sequential extraction procedure. At twelve sites, Cu, Pb and Zn levels in soil were compared with those from a 1974 sampling. Many surface soils from the urban area as well as from the eastern industrial district contained levels of Cu, Pb and Zn that largely exceeded the limits (120, 100 and 150 mg kg(-l) for Cu, Pb and Zn, respectively) set for soils of public, residential and private areas by the Italian Ministry of Environment. Chromium values were never above regulatory limits(120 mg kg(-1)). Copper apparently accumulates in soils contiguous to railway lines and tramway. Cu and Cr existed in soil mainly inorganic forms (-68%), whereas Pb occurs essentially as residual mineral phases (77%). The considerable presence of Zn in the soluble, exchangeable and carbonate bound fraction (23%) suggests this element has high potential bioavailability and leachability through the soil. Concentrations of Cu, Pb and Zn have greatly increased since the 1974 sampling, with higher accumulation in soils from roadside fields.

[Black esophagus associated with hypothermia]. / Oesophage noir associé à une hypothermie.

The authors report a clinical case concerning a necrotizing esophagitis following severe hypothermic shock. They recall the usual aetiology of the "black esophagus", emphasize the importance of ischemia and the multispeciality management of this very unfrequent disease.

Performance of two clinical decision rules for knee radiography.

We designed a prospective observational study to attempt to validate two recently described clinical decision rules for knee radiography. Consecutive patients aged > or = 15 yr with acute knee injuries occurring less than 1 wk prior to presentation were included for study. Patients with distracting conditions, open knee injuries, or previous surgery were excluded. Each patient was assessed for 7 historical and 15 physical examination criteria that were recorded on a standardized data collection instrument. Radiographs were ordered at the discretion of the attending physician and were read by two board-certified radiologists. When radiographs were not ordered, structured telephone follow-up was performed after 3 wk. The main outcome parameter was the presence or absence of a clinically significant fracture. There were 351 patients in the study; 26 (7%) had knee fractures. Fractures were significantly associated with an increased prevalence for two of the three criteria in the rule derived by Bauer: inability to weight bear immediately or in the emergency department (ED; 76.9% of patients with a fracture vs. 29.8% of patients without a fracture) and effusion (53.8% vs. 28.9%, respectively). Ecchymosis was not significantly associated with fracture (19.2% with fracture vs. 9% with no fracture). Use of the Bauer rule would have led to a radiographic evaluation of 22 of the 26 patients with knee fractures (sensitivity = 84.6%, specificity = 48.9%). Fractures were associated with a significantly increased prevalence for three of the five criteria in the decision rule proposed by Stiell: isolated patella tenderness (30.8% with fracture vs. 14.5% with no fracture), inability to flex the knee to 90 degrees (42.3% vs. 19.7%, respectively), and inability to weight bear immediately and in the ED (57.7% vs. 18.8%, respectively). Age > or = 55 yr (23.1% vs. 12.0%, respectively) and fibula head tenderness (11.5% vs. 5.5%, respectively) were not significantly associated with fracture. Use of the Stiell rule would have led to radiographic evaluation of 22 of the 26 patients with knee fractures (sensitivity = 84.6%, specificity = 49.8%). We conclude that neither clinical decision rule is 100% sensitive. Further refinement will be necessary to identify all patients with knee fractures.