Early and midterm results of radiofrequency ablation (Rafaelo® procedure) for third-degree haemorrhoids: a prospective, two-centre study.

BACKGROUND: The aim of this study was to evaluate the safety and efficacy of radiofrequency ablation (RFA) for treating third degree haemorrhoids, with a follow-up over 2 years. METHODS: We conducted a prospective, two-centre study to assess RFA of third-degree haemorrhoids in an outpatient setting. Treatment was performed under local anaesthesia, optionally in combination with sedation. The primary endpoint was analysis of a proctological symptom score ([PSS] bleeding, itching, pain, soiling) and proctological examination to detect recurrence at 1, 6, 12 and 24 months after surgery. The secondary endpoints were postoperative complications, incidence of postoperative pain, including administration of analgesics and time to return to daily routine. RESULTS: Ninety-eight patients were included in the study. The mean age of the patients was 49.1 ± 10.9 (mean ± SD). 83 patients (84.7%) were male and 15 patients (15.3%) were female. The follow-up involved 100% (1 month), 95% (6 months), 86% (12 months) and 74% after 24 months. The individual symptom scores and overall PSS score decreased significantly in comparison to the initial score at each time point assessed. Prolapsed haemorrhoids decreased in comparison to the initial situation (100%) to 7.2% (1 month), 3.5% (6 months), 13.1% (12 months) and 13.7% (after 24 months). Thirteen patients (12.7%) required repeat haemorrhoid therapy during the 2-year follow-up period. The mean maximum pain score after the procedure was 2.5 ± 2.7 (determined with the visual analogue scale), while 33 (33.7%) patients reported having no pain. 59 (60.2%) patients did not take analgesics after the procedure. Eleven patients (11.2%) experienced minor complications (bleeding, fever, cramps, diarrhoea, anal venous thrombosis) but did not require additional treatment. Eight cases (8.2%) of major complications (infection, bleeding, severe pain) required treatment with antibiotics, a second intervention, analgesics or hospitalization. CONCLUSIONS: RFA is safe and effective for treatment of third-degree haemorrhoids. The main advantages of this new method are its use on an outpatient basis under local anaesthesia, a very low level of postoperative pain and significant control of haemorrhoid symptoms over 2 years.

Cost-effectiveness of hip protector use on a geriatric ward in Germany: a Markov model.

UNLABELLED: In this study, we determined the cost-effectiveness of hip protector use compared with no hip protector on a geriatric ward in Germany. From both the societal and the statutory health insurance (SHI) perspectives, the cost-effectiveness ratios for the provision of hip protectors were below 12,000/quality-adjusted life year (QALY) even if unrelated costs in added life years were included. INTRODUCTION: The aim of this study is to determine the cost-effectiveness of the provision of hip protectors compared with no hip protectors on a geriatric ward in Germany. METHODS: A lifetime decision-analytic Markov model was developed. Costs were measured from the societal and from the statutory health insurance (SHI) perspectives and comprised direct medical, non-medical and unrelated costs in additional life years gained. Health outcomes were measured in terms of quality-adjusted life years (QALYs). To reflect several levels of uncertainty, first- and second-order Monte Carlo simulation (MCS) approaches were applied. RESULTS: Hip protector use compared with no hip protector results in savings (costs, -5.1/QALYs, 0.003) for the societal perspective. For the SHI perspective, the incremental cost-effectiveness ratio was 4416 /QALY (costs, +13.4). If unrelated costs in life years gained were included, the cost-effectiveness ratio increases to 9794/QALY for the societal perspective and to 11,426/QALY for the SHI perspective. In the MCS, for the societal perspective without unrelated costs, 47 % of simulations indicated hip protectors to be cost saving (i.e. lower costs and higher effects). CONCLUSION: Although the gain in QALYs due to the provision of providing hip protectors to patients on geriatric wards is small, all scenarios showed acceptable cost-effectiveness ratios or even savings.

Everolimus and mycophenolate mofetil sensitize human pancreatic cancer cells to gemcitabine in vitro: a novel adjunct to standard chemotherapy?

BACKGROUND/AIMS: Gemcitabine improves survival in pancreatic adenocarcinoma. A variety of drugs have been tested to potentiate gemcitabine treatment for pancreatic cancer cells. Two major immunosuppressive drugs, mycophenolate mofetil (MMF) and everolimus (RAD001) have been shown to exert an anti-tumoral effect, but their ability to sensitize human pancreatic cell lines during gemcitabine treatment remains unclear. We examined the effects of everolimus and MMF on gemcitabine-treated MiaPaCa and Panc-1 cell lines. METHODS: MiaPaCa and Panc-1 human pancreatic tumor cell lines were subjected to everolimus (0.001-1 microg/ml) or MMF (0.1-100 microg/ml) treatment in combination with gemcitabine (1-10(6) nM). Western blot analysis was performed for Panc-1 cells in the presence or absence of TGF-beta1 and different treatments: 0.1-100 muicro/ml MMF and 0.1-100 microg/ml everolimus. The antiproliferative effect of the treatment was assessed by BrdU test. The results were evaluated by two-way analysis of variance followed by post-hoc tests, and nonlinear regression analysis for dose-response rates. RESULTS: As expected, standard treatment doses of gemcitabine decreased proliferation dose-dependently. Everolimus increased the actual EC(50) response to gemcitabine treatment (1-10(3) nM) to as much as 83.1 and 82.1% in MiaPaCa and Panc-1 cell lines, respectively. Likewise, concomitant administration with MMF altered the EC(50) of gemcitabine treatment in MiaPaCa cell lines to values between 76.8 and 85.2% for doses of >or=1 microg/ml. Even the minor dose of MMF (0.1 microg/ml) increased the antiproliferative effect of gemcitabine by 43.5% for MiaPaCa and 42.4% for Panc-1 cells. In addition, treatment of Panc-1 cells with MMF (0.1-100 microg/ml) dose-dependently inhibited TGF-beta1-induced collagen expression. CONCLUSION: We found an overadditive antiproliferative effect of both MMF and everolimus in gemcitabine-treated MiaPaCa and Panc-1 cells in vitro, and an additional inhibitory effect of MMF on TGF-beta1-induced collagen type I expression. Interestingly, both the sensitizing effect of pancreatic cancer cells to gemcitabine treatment and the inhibition of collagen type I expression could be achieved by clinically feasible doses of everolimus and MMF. The use of these drugs is promising as a novel adjunct to standard chemotherapy.

[Controversial rotation function of certain muscles in the hip joint]. / Die umstrittene Rotationswirkung ausgewählter Muskeln im Hüftgelenk.

The disputed rotating function of certain muscles in the hip joint. A device constructed for that study allows to determine the rotating function of the iliopsoas muscle as well as of the uniarticular adductor muscles of the thigh in every position of the hip joint by the method of threads. The iliac muscle rotates the thigh inward in every position of flexion/extension or abduction/adduction of the hip joint. The adductor magnus muscle always is a lateral rotator by those fibres which are inserted into the medical edge of the linea aspera, while the fibres attached to the adductor tubercle rotate the thigh inward. The psoas major, pectineus, adductor longus and adductor brevis muscles are able to rotate the thigh inward as well as outward. Their rotating function depends on the specific position of flexion/extension and abduction/adduction of the hip joint: Flexion and abduction intensify the lateral rotating function of these muscles, extension and adduction intensify the medial rotating function.

Emotionality and interference with color-naming in anxiety.

The source of interference with color-naming emotional words in clinical anxiety was investigated using word sets that were varied in valence and in their judged relationship to the concerns of anxious patients. Results showed that neither valence nor general emotionality was of critical importance in predicting extent of interference. In contrast, words that were judged to be highly related to likely concerns or relevant threats caused more interference than those which were not, irrespective of their positive or negative valence. These results suggest the need to modify earlier formulations of emotional Stroop effects, and may help to explain the variable results obtained in previous investigations.

Seroprevalence of Echinococcus granulosus infection in a Uruguayan rural human population.

Serological tests using hydatid cyst fluid (HCF) are useful as a primary screen for detecting asymptomatic infections due to Echinococcus granulosus in human populations. An enzyme-linked immunosorbent assay (ELISA) performed with whole sheep HCF was used to determine the prevalence of hydatid antibodies in a rural human population in Uruguay. In order to eliminate cross-reactions with sheep proteins in HCF, 1% normal sheep serum was added to each human serum before testing. ELISA seropositives were further tested using the double diffusion test (DD5) and confirmed where possible by ultrasound and X-ray examination. Serum samples were obtained from 420 individuals inhabiting rural areas in the Department of Paysandu (160), Rivera (21) and San José (239). An overall seroprevalence of 1.24% was obtained. Two of 17 seroreactors were subsequently proven to have hydatidosis. These results confirm and extend previous studies indicating an unusually high prevalence of E. granulosus infection in the Uruguayan population.