Australia ; General Surgery ; education ; Internship and Residency ; Job Satisfaction ; New Zealand

The treatment of haemorrhoids remains challenging: multiple treatment options supported by heterogeneous evidence are available, but patients rightly demand a tailored approach. Evidence for newer surgical techniques that promise to be less painful has been conflicting. We review the current evidence for management options in patients who present with varying haemorrhoidal grades. A review of the English literature was performed utilizing MEDLINE/PubMed, Embase, and Cochrane databases (31 May 2019). The search terms (haemorrhoid OR haemorrhoid OR haemorrhoids OR haemorrhoids OR “Hemorrhoid”[Mesh]) were used. First- and second-degree haemorrhoids continue to be managed conservatively. The easily repeatable and cost-efficient rubber band ligation is the preferred method to address minor haemorrhoids; long-term outcomes following injection sclerotherapy remain poor. Conventional haemorrhoidectomies (Ferguson/Milligan-Morgan/Ligasure haemorrhoidectomy) still have their role in third- and fourth-degree haemorrhoids, being associated with lowest recurrence; nevertheless, posthaemorrhoidectomy pain is problematic. Stapled haemorrhoidopexy allows quicker recovery, albeit at the costs of higher recurrence rates and potentially serious complications. Transanal Haemorrhoidal Dearterialization has been promoted as nonexcisional and less invasive, but the recent HubBLe trial has questioned its overall place in haemorrhoid management. Novel “walk-in-walk-out” techniques such as radiofrequency ablations or laser treatments will need further evaluation to define their role in modern-day haemorrhoid management. There are numerous treatment options for haemorrhoids, each with their own evidence-base. Newer techniques promise to be less painful, but recurrence rates remain an issue. The balance continues to be sought between long-term efficacy, minimisation of postoperative pain, and preservation of anorectal function.

PURPOSE: Indoor risk factors for allergic diseases in low-income households in Korea have been characterized only partially. We evaluated the prevalences of atopic dermatitis, asthma, and allergic rhinitis in Seoul, Korea, to identify key housing and behavioral risk factors of low-income households. METHODS: Statistical analysis of the prevalence of these diseases and various risk factors was conducted using data from a 2010 Ministry of Environment household survey. Logistic regression models were generated using data from 511 low-income household apartments in districts of Seoul. RESULTS: In general, housing factors such as renovation history (P<0.1) and crowding status (P<0.01) were associated with allergic rhinitis, whereas behavioral factors such as frequency of indoor ventilation (P<0.05) and cleaning (P<0.1) were inversely correlated with atopic dermatitis. Indoor smoking was a major trigger of asthma and atopic dermatitis in low-income households (P<0.05). The presence of mold and water leakage in houses were the most important risk factors for all three diseases (P<0.05). CONCLUSIONS: Various risk factors play a role in triggering allergic diseases among low-income households in Seoul, and health or environmental programs mitigating allergic diseases should be tailored to address appropriate housing or behavioral factors in target populations.
Asthma ; Crowding ; Dermatitis, Atopic ; Family Characteristics* ; Fungi ; Health Services Needs and Demand ; Housing ; Korea ; Logistic Models ; Poverty ; Prevalence* ; Rhinitis ; Risk Factors* ; Seoul ; Smoke ; Smoking ; Ventilation ; Water

Since its discovery 50 years ago, Epstein-Barr virus (EBV) has been linked to the development of cancers originating from both lymphoid and epithelial cells. Approximately 95% of the world's population sustains an asymptomatic, life-long infection with EBV. The virus persists in the memory B-cell pool of normal healthy individuals, and any disruption of this interaction results in virus-associated B-cell tumors. The association of EBV with epithelial cell tumors, specifically nasopharyngeal carcinoma (NPC) and EBV-positive gastric carcinoma (EBV-GC), is less clear and is currently thought to be caused by the aberrant establishment of virus latency in epithelial cells that display premalignant genetic changes. Although the precise role of EBV in the carcinogenic process is currently poorly understood, the presence of the virus in all tumor cells provides opportunities for developing novel therapeutic and diagnostic approaches. The study of EBV and its role in carcinomas continues to provide insight into the carcinogenic process that is relevant to a broader understanding of tumor pathogenesis and to the development of targeted cancer therapies.
B-Lymphocytes ; Carcinoma ; Epithelial Cells ; Epstein-Barr Virus Infections ; complications ; Herpesvirus 4, Human ; Humans ; Lymphoma, B-Cell ; Nasopharyngeal Neoplasms ; virology ; Stomach Neoplasms

Purpose: To evaluate the therapeutic effects and safety of oral spironolactone (SPRL) in patients with central serous chorioretinopathy (CSC). Methods: Medical records and imaging data from consecutive patients diagnosed with CSC and treated with SPRL were reviewed. Changes in central macular thickness (CMT), subretinal fluids (SRF), subfoveal choroidal thickness (SFCT), and best corrected visual acuity (BCVA) were measured at baseline and follow-up visits. Follow-up visits were performed at 1, 3, 6, and 12 months after treatment. The patients were divided into two groups; acute and chronic, and the therapeutic outcomes were compared. The occurrence of side effects and recurrence after complete resolution of SRF were also assessed. Results: A total of 42 patients with 45 eyes were included. CMT and SRF after using SPRL improved significantly at 1, 3, 6, and 12 months and SFCT improved at 3, 6, and 12 months. However, BCVA showed no significant change at any time. Acute patients showed similar results. However, in chronic patients, CMT showed significant differences at 1 and 3 months, SRF at 1 and 6 months, and SFCT at 6 months. A total of 15.6%, 38.2%, 45.8%, and 50.0% of eyes showed complete resolution of SRF at each follow-up period, respectively, and 8.9% of eyes showed recurrence after complete resolution. Two male patients experienced gynecomastia and one patient showed mild elevation of serum creatinine. Conclusions Our study supported the therapeutic benefits of SPRL in patients with CSC, especially in anatomical structures. However, careful observation is required because of side effects and recurrence after complete resolution.

Purpose: To evaluate the therapeutic effects and safety of oral spironolactone (SPRL) in patients with central serous chorioretinopathy (CSC). Methods: Medical records and imaging data from consecutive patients diagnosed with CSC and treated with SPRL were reviewed. Changes in central macular thickness (CMT), subretinal fluids (SRF), subfoveal choroidal thickness (SFCT), and best corrected visual acuity (BCVA) were measured at baseline and follow-up visits. Follow-up visits were performed at 1, 3, 6, and 12 months after treatment. The patients were divided into two groups; acute and chronic, and the therapeutic outcomes were compared. The occurrence of side effects and recurrence after complete resolution of SRF were also assessed. Results: A total of 42 patients with 45 eyes were included. CMT and SRF after using SPRL improved significantly at 1, 3, 6, and 12 months and SFCT improved at 3, 6, and 12 months. However, BCVA showed no significant change at any time. Acute patients showed similar results. However, in chronic patients, CMT showed significant differences at 1 and 3 months, SRF at 1 and 6 months, and SFCT at 6 months. A total of 15.6%, 38.2%, 45.8%, and 50.0% of eyes showed complete resolution of SRF at each follow-up period, respectively, and 8.9% of eyes showed recurrence after complete resolution. Two male patients experienced gynecomastia and one patient showed mild elevation of serum creatinine. Conclusions Our study supported the therapeutic benefits of SPRL in patients with CSC, especially in anatomical structures. However, careful observation is required because of side effects and recurrence after complete resolution.

Purpose: Stapled anastomotic techniques to the distal rectum have gained widespread acceptance due to their procedural advantages. Various modifications in the stapling techniques have evolved since their inception. The triple-staple technique utilizing stapled closure of both the proximal colon and distal rectal stump provides a rapid and secure colorectal anastomosis. The aims of this study were to determine the safety and efficacy of the triple-staple technique and to compare the clinical outcomes with a historical control group for which the conventional double-staple technique had been performed. Methods: One hundred consecutive patients operated on by a single surgeon were included in the study; 50 patients who underwent a double-staple (DSA) procedure and 50 patients undergoing triple-staple anastomosis (TSA). Results: The most common indication for surgery in both groups was rectal cancer followed by diverticular disease and distal sigmoid cancer. There was no significant difference in number of patients requiring loop ileostomy formation in the groups (TSA, 56.0% vs. DSA, 68.0%; P = 0.621). The mean operating time for the TSA group was significantly shorter compared to that of the DSA group (TSA, 242.8 minutes vs. DSA, 306.1 minutes; P = 0.001). There was no significant difference in complication rate (TSA, 40% vs. DSA, 50%; P = 0.315) or length of hospital stay between the two groups (TSA, 11.3 days vs. DSA, 13.0 days; P = 0.246). Postoperative complications included anastomotic leak, prolonged ileus, bleeding, wound infection, and pelvic collection. Conclusion The triple-staple technique is a safe alternative to double-staple anastomosis after anterior resection and effectively shortens operating time.

Purpose: Rectocele can be associated with both obstructed defecation and fecal incontinence. There exists a great variety of operative techniques to treat patients with rectocele. The purpose of this study was to evaluate the clinical outcome in a consecutive series of patients who underwent transperineal repair of rectocele when presenting with fecal incontinence as the predominant symptom. Methods: Twenty-three consecutive patients from April 2000 to July 2015 with symptomatic rectocele underwent transperineal repair by a single surgeon. Results: All patients had a history of vaginal delivery, with or without evidence of associated anal sphincter injury at the time. The median age of the cohort was 53 years (range, 21–90 years). None were fully continent preoperatively. However, continence improved to just rare mucus soiling or loss of flatus in all patients 6 months after their surgery. There was no operative mortality. Postoperative complications including urinary retention and wound dehiscence occurred in 3 patients. Conclusion Fecal incontinence associated with rectocele is multifactorial and may be caused by preexisting anal sphincteric damage and attenuation. Our experience suggests that transperineal repair provides excellent anatomic and physiologic results with minimal morbidity in selected patients presenting with combined rectocele and anal sphincter defect.

BACKGROUND: In most cases of a foreign body in the esophagus, an ENT specialist is consulted, which may be time consuming if not evaluated in a timely fashion. The patients are admitted to the hospital and sent to the operating room, where they are placed under anesthesia and the object is removed by using an esophagoscope. METHODS: A prospective randomized trial was conducted during the period from January 1998 to June 2000. All patients presenting to emergency department with blunt objects in the esophagus were included. In one group, with fluoroscopic guidance, a Foley catheter was placed to remove the blunt foreign bodies. And in the other group, we removed them by using the esophagoscpe. We used the t-test for statistical analysis in this study. RESULTS: Total number of patients enrolled in this study was 38. 22 patients were enrolled in the Foley Catheter removal group, and the remaining 16 were enrolled in the esophagoscope removal group. The success rate for the Foley catheter was 21/22(95.5%), and that for the esophagoscope was 15/16(93.8%). The average time of removal for the Foley catheter group was 0.70+/-0.28 hours while that for the esophagoscope group was 5.96+/-2.22 hours. One side effect, nonfatal hypoxia, was noted in the Foley catheter removal group. The average cost for the Foley catheter group were 78,800 won(approximately 60 US dollars) while that for the esophagoscope group took 722,800 won(approximately 600 US dollars). CONCLUSION: In our study, we found that the success rate for removing blunt foreign bodies from the esophagus by using a simple Foley catheter was high, also the Foley catheter was a time saving and cost effective procedure with an excellent safety profile.
Anesthesia ; Anoxia ; Catheters* ; Emergencies* ; Emergency Service, Hospital* ; Esophagoscopes ; Esophagus ; Foreign Bodies* ; Humans ; Operating Rooms ; Prospective Studies ; Specialization

Treatment of rainbow trout macrophages with glycyrrhizin (GL), an aqueous extract of licorice (Glycyrrhiza glabra), enhanced their respiratory burst activity. Maximal effects were seen using concentrations of 10-100 ug/ml. GL also modulated trout lymphocytes, increasing proliferation responses to the mitogen phytohemagglutinin two-fold over a range of GL concentrations. In addition, GL elicited the release of a macrophage activating factor (MAF) kom head kidney leukocytes, as assessed by the ability of generated supernatants to increase respiratory burst activity of target macrophages. MAF activity was most apparent using 100 ug/ml GL to induce MAF release and a 48 h incubation period with the target macrophages. Finally, GL was shown to enhance the release oF MAF in response to the mitogen concanavalin A. The results suggest that GL might modulate the innate defences in fish.
Concanavalin A ; Glycyrrhiza ; Glycyrrhizic Acid* ; Head Kidney ; Leukocytes* ; Lymphocytes ; Macrophages ; Oncorhynchus mykiss* ; Oncorhynchus* ; Respiratory Burst ; Trout