Hemorrhoidal artery ligation procedure with or without Doppler transducer in grade II and III hemorrhoidal disease: a blinded randomized clinical trial.

OBJECTIVE: The aim of this study was to compare the outcome of the hemorrhoidal artery ligation procedure for hemorrhoidal disease with and without use of the provided Doppler transducer. BACKGROUND: Hemorrhoidal artery ligation, known as HAL (hemorrhoidal artery ligation) or THD (transanal hemorrhoidal dearterialization) procedure, is a common treatment modality for hemorrhoidal disease in which a Doppler transducer is used to locate the supplying arteries that are subsequently ligated. It has been suggested that the use of the Doppler transducer does not contribute to the beneficial effect of these ligation procedures. METHODS: The authors conducted a single-blinded randomized clinical trial and assigned a total of 82 patients with grade II and III hemorrhoidal disease to undergo either a HAL/THD procedure without use of the Doppler transducer (non-Doppler group, 40 patients) or a conventional HAL/THD procedure (Doppler group, 42 patients). Primary endpoint was improvement of self-reported clinical parameters after both 6 weeks and 6 months. This study is registered at trialregister.nl and carries the ID number: NTR2139. RESULTS: After 6 weeks and 6 months in both the non-Doppler and the Doppler group, significant improvement was observed with regard to blood loss, pain, prolapse, and problems with defecation (P < 0.05). The improvement of symptoms between both groups did not differ significantly (P > 0.05), except for prolapse, which improved more in the non-Doppler group (P = 0.047). There were more complications and unscheduled postoperative events in the Doppler group (P < 0.0005). After 6 months, 31% of the patients in the non-Doppler group and 21% in the Doppler group reported completely complaint free (P = 0.313). CONCLUSIONS: The authors' findings confirm that the hemorrhoidal artery ligation procedure significantly reduces signs and symptoms of hemorrhoidal disease. The authors' data also show that the Doppler transducer does not contribute to this beneficial effect.

Current perspectives on management of congenital jugular vein aneurysms.

True aneurysms of the internal jugular vein are relatively rare. This study describes 3 cases and the current management of congenital internal jugular vein aneurysms.

Endovascular therapy for recurrent type III endoleak.

We report a case in which an aortouniiliac revision for a type IIIb endoleak of a primarily implanted AneuRx bifurcation endograft for infrarenal aortic aneurysm repair caused a renewed type IIIa endoleak 2 months after revision. The type IIIa endoleak was successfully repaired with a bridging endoprosthesis. In this report, we discuss the pitfalls that should be considered when aortouniiliac revision procedures are performed for type III endoleaks in bifurcated endografts.

Do pressure ulcers influence length of hospital stay in surgical cardiothoracic patients? A prospective evaluation.

AIM AND OBJECTIVE: The aim and objective of this study was to determine whether the occurrence of pressure ulcers following cardiothoracic surgery increases the length of hospitalisation. BACKGROUND: Literature suggests that a pressure ulcer extends the length of hospital stay. The impact of pressure ulcers on length of hospital stay after cardiothoracic surgery is yet undetermined. DESIGN: Prospective follow-up study. METHODS: Two hundred and four patients admitted for elective cardiothoracic surgery and with an intensive care unit stay of >48 hours were included in a prospective cohort study. The course of the skin condition in relation to pressure ulcers was monitored during their stay in a teaching hospital. Length of hospital stay was compared between the group with and without pressure ulcers. RESULTS: Hospital stay for cardiothoracic patients with and without pressure ulcers did not differ significantly (p = 0.23). Patients that developed pressure ulcers had a median hospital stay of 13 days (interquartile range: 9-19) vs. 12 days (interquartile range: 7-15) for patients without pressure ulcers. However, we observed that length of stay in the intensive care unit was significantly (p = 0.005) longer for patients with pressure ulcers. This was not associated with the occurrence of complications. However, the occurrence of pressure ulcers was significantly correlated with length of intensive care support in postoperative care. CONCLUSION: Non-complicated pressure ulcers in postsurgery patients do not significantly increase the length of total hospital stay. RELEVANCE TO CLINICAL PRACTICE: Health professionals need to recognise that patients who have undergone major surgery (such as cardiothoracic surgery) are prone to develop pressure ulcers. Despite the fact that pressure ulcers do not necessarily extend hospital stay, monitoring the skin condition remains of crucial importance for prevention and early detection as well as treatment of pressure ulcers and to minimise patient discomfort. Moreover, as pressure ulcers often originate in the operating room, prevention in the operating room should receive more attention.

Renal artery pseudoaneurysm caused by a complete stent fracture: a case report.

We report the case of a 71-year-old man with acute back and left flank pain caused by a large pseudoaneurysm of the left renal artery. The pseudoaneurysm resulted from a complete fracture of a stent that had been placed at the origin of this vessel 10 months earlier. Because the left kidney had no residual function, the patient was treated by percutaneous occlusion of the left renal artery with a vascular plug. The symptoms rapidly subsided, and he remained symptom free at the 6-month follow-up. Stent fractures, their complications, and management are discussed.

Economic evaluation of pressure ulcer care: a cost minimization analysis of preventive strategies.

The purpose of this study was to determine the cost for prevention and treatment of pressure ulcers from a hospital perspective and to identify the least resource-intensive pressure ulcer prevention strategy. Cost analyses were examined from a hospital perspective using direct costs. The study was carried out alongside a prospective cohort study on the incidence and risk factors for pressure ulcers. Two large teaching hospitals in the Netherlands with (partly) opposing approaches in prevention, a technological versus a human approach, were analyzed. The main outcome measures were resource use, costs of preventive measures and treatment, and pressure ulcer incidence in both hospitals. Pressure ulcer prevention through a predominantly technical approach resulted in a similar incidence rate as prevention through a predominantly human approach. However, the technical approach was considerably less expensive.