1.Role of a Micronized Purified Flavonoid Fraction as an Adjuvant Treatment to Rubber Band Ligation for the Treatment of Patients With Hemorrhoidal Disease: A Longitudinal Cohort Study
Ana Célia CAETANO ; Catarina CUNHA ; Bruno ARROJA ; Dalila COSTA ; Carla ROLANDA
Annals of Coloproctology 2019;35(6):306-312
PURPOSE: Nonsurgical treatment of hemorrhoidal disease (HD) includes medical and instrumental techniques. We aimed to compare the efficacy of the most frequently used nonsurgical strategies, either alone or in combination, applied in an ambulatory setting.METHODS: Patients who received nonsurgical treatment for HD by proctology appointment at the Gastroenterology Department of Braga Hospital were evaluated. Isolated rubber band ligation (RBL) and a combination of RBL with a micronized purified flavonoid fraction (MPFF) were the 2 most frequently used strategies. Symptoms of HD (bleeding, pruritus, pain at rest, pain at defecation and prolapse) were assessed at days 0, 7, and 28 by using a severity grading scale (0 to 4/5). A Global Symptom score was constructed to assess the overall severity and compare the overall improvements of the HD symptoms between the 2 most frequently used strategies.RESULTS: Nineteen patients underwent the combined treatment (RBL + MPFF group) and 25 the RBL treatment (RBL group). A comparison of the 2 treatment groups showed significant improvements in the combined treatment group in terms of bleeding at days 7 (P = 0.001) and 28 (P = 0.002) and in the pruritus intensity during the first week (P < 0.001). A trend toward clinical benefit was also verified in the combined treatment group for all other HD symptoms (pain at rest, pain at defecation and prolapse).CONCLUSION: A combined treatment approach with MPFF and RBL significantly reduced the intensity of bleeding during the first month and the pruritus during the first week.
Cohort Studies
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Colorectal Surgery
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Defecation
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Flavonoids
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Gastroenterology
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Hemorrhage
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Hemorrhoids
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Humans
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Ligation
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Pruritus
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Rubber
2.Endovascular Thrombectomy Versus Intravenous Thrombolysis of Posterior Cerebral Artery Occlusion Stroke
Silja RÄTY ; Thanh N. NGUYEN ; Simon NAGEL ; Davide STRAMBO ; Patrik MICHEL ; Christian HERWEH ; Muhammad M. QURESHI ; Mohamad ABDALKADER ; Pekka VIRTANEN ; Marta OLIVE-GADEA ; Marc RIBO ; Marios PSYCHOGIOS ; Anh NGUYEN ; Joji B. KURAMATSU ; David HAUPENTHAL ; Martin KÖHRMANN ; Cornelius DEUSCHL ; Jordi Kühne ESCOLÀ ; Jelle DEMEESTERE ; Robin LEMMENS ; Lieselotte VANDEWALLE ; Shadi YAGHI ; Liqi SHU ; Volker PUETZ ; Daniel P.O. KAISER ; Johannes KAESMACHER ; Adnan MUJANOVIC ; Dominique Cornelius MARTERSTOC ; Tobias ENGELHORN ; Anne BERBERICH ; Piers KLEIN ; Diogo C. HAUSSEN ; Mahmoud H. MOHAMMADEN ; Hend ABDELHAMID ; Isabel FRAGATA ; Bruno CUNHA ; Michele ROMOLI ; Wei HU ; Jianlon SONG ; Johanna T. FIFI ; Stavros MATSOUKAS ; Sunil A. SHETH ; Sergio A. SALAZAR-MARIONI ; João Pedro MARTO ; João Nuno RAMOS ; Milena MISZCZUK ; Christoph RIEGLER ; Sven POLI ; Khouloud POLI ; Ashutosh P. JADHAV ; Shashvat DESAI ; Volker MAUS ; Maximilian KAEDER ; Adnan H. SIDDIQUI ; Andre MONTEIRO ; Tatu KOKKONEN ; Francesco DIANA ; Hesham E. MASOUD ; Neil SURYADAREVA ; Maxim MOKIN ; Shail THANKI ; Pauli YLIKOTILA ; Kemal ALPAY ; James E. SIEGLER ; Italo LINFANTE ; Guilherme DABUS ; Dileep YAVAGHAL ; Vasu SAINI ; Christian H. NOLTE ; Eberhart SIEBERT ; Markus A. MÖHLENBRUCH ; Peter A. RINGLEB ; Raul G. NOGUEIRA ; Uta HANNING ; Lukas MEYER ; Urs FISCHER ; Daniel STRBIAN
Journal of Stroke 2024;26(2):290-299
Background:
and Purpose Posterior cerebral artery occlusion (PCAo) can cause long-term disability, yet randomized controlled trials to guide optimal reperfusion strategy are lacking. We compared the outcomes of PCAo patients treated with endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) to patients treated with IVT alone.
Methods:
From the multicenter retrospective Posterior cerebraL ArTery Occlusion (PLATO) registry, we included patients with isolated PCAo treated with reperfusion therapy within 24 hours of onset between January 2015 and August 2022. The primary outcome was the distribution of the modified Rankin Scale (mRS) at 3 months. Other outcomes comprised 3-month excellent (mRS 0–1) and independent outcome (mRS 0–2), early neurological improvement (ENI), mortality, and symptomatic intracranial hemorrhage (sICH). The treatments were compared using inverse probability weighted regression adjustment.
Results:
Among 724 patients, 400 received EVT+/-IVT and 324 IVT alone (median age 74 years, 57.7% men). The median National Institutes of Health Stroke Scale score on admission was 7, and the occluded segment was P1 (43.9%), P2 (48.3%), P3–P4 (6.1%), bilateral (1.0%), or fetal posterior cerebral artery (0.7%). Compared to IVT alone, EVT+/-IVT was not associated with improved functional outcome (adjusted common odds ratio [OR] 1.07, 95% confidence interval [CI] 0.79–1.43). EVT increased the odds for ENI (adjusted OR [aOR] 1.49, 95% CI 1.05–2.12), sICH (aOR 2.87, 95% CI 1.23–6.72), and mortality (aOR 1.77, 95% CI 1.07–2.95).
Conclusion
Despite higher odds for early improvement, EVT+/-IVT did not affect functional outcome compared to IVT alone after PCAo. This may be driven by the increased risk of sICH and mortality after EVT.