Purpose: Real-world evidence comparing surgical techniques for symptomatic hemorrhoidal disease (HD) remains limited, despite the availability of multiple approaches. This study aimed to evaluate short-term, interim outcomes from a prospective, nationwide cohort study that compared the effectiveness of different operative techniques based on patient-reported outcome measures (PROMs) in patients with symptomatic HD. Methods: A prospective, nationwide cohort study was conducted at 20 tertiary care centers across Turkiye between July 2022 and July 2024. Adult patients aged 18 years or older with symptomatic HD (grades I–IV) who underwent surgery during this period were included. The choice of procedure was determined by the operating surgeon, and patients were categorized into excisional, fixative, and ablative groups according to the surgical approach used. The primary outcomes were changes in the Hemorrhoidal Disease Symptom Score, Short Health ScaleHD, visual analog scale for pain, and patient satisfaction, assessed from the preoperative period to postoperative day 7 and postoperative week 6. Results: The study included a total of 315 patients after excluding those who did not fulfil the inclusion criteria. Among them, 239 (78.9%) were male, with a mean age of 43.7±11.7 years. The distribution of patients across surgical groups was 207 (65.7%) in the excisional group, 30 (9.5%) in the fixative group, and 78 (24.8%) in the ablative group. All groups demonstrated significant improvements in PROM scores from preoperative to postoperative assessments. However, no statistically significant differences were observed between groups at any time point for PROM scores or for changes in PROM scores across consecutive evaluations (P≥0.05 for all comparisons). Urinary retention occurred more frequently, and hospital stays were longer in the fixative group (P=0.006 and P<0.001, respectively). The excisional group had a greater need for narcotic use and longer duration of use (P=0.003 and P<0.001, respectively). Conclusion This real-world cohort study shows that all 3 surgical approaches are effective for HD, providing comparable short-term symptomatic relief and patient satisfaction. These techniques appear equally valid treatment options, and the choice of procedure may best be individualized based on patient-specific characteristics and surgeon preference.Trial registration: ClinicalTrials.gov identifier: NCT05429060

BACKGROUND: Although regional anesthesia is the first choice for patients undergoing total knee arthroplasty (TKA), it may not be effective and the risk of complications is greater in patients who are obese or who have spinal deformities. We compared the success of ultrasound-guided femoral and sciatic nerve blocks with sedoanalgesia versus spinal anesthesia in unilateral TKA patients in whom spinal anesthesia was difficult. METHODS: We enrolled 30 patients; 15 for whom spinal anesthesia was expected to be difficult were classified as the block group, and 15 received spinal anesthesia. Regional anesthesia was achieved with bupivacaine 62.5 mg and prilocaine 250 mg to the sciatic nerve, and bupivacaine 37.5 mg and prilocaine 150 mg to the femoral nerve. Bupivacaine 20 mg was administered to induce spinal anesthesia. Hemodynamic parameters, pain and sedation scores, and surgical and patient satisfaction were compared. RESULTS: A sufficient block could not be obtained in three patients in the block group. The arterial pressure was significantly lower in the spinal group (P < 0.001), and the incidence of nausea was higher (P = 0.017) in this group. Saturation and patient satisfaction were lower in the block group (P < 0.028), while the numerical pain score (P < 0.046) and the Ramsay sedation score were higher (P = 0.007). CONCLUSIONS: Ultrasound-guided sciatic and femoral nerve blocks combined with sedoanalgesia were an alternative anesthesia method in selected TKA patients.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, Spinal* ; Arterial Pressure ; Arthroplasty* ; Bupivacaine ; Congenital Abnormalities ; Femoral Nerve ; Hemodynamics ; Humans ; Incidence ; Knee* ; Nausea ; Nerve Block ; Patient Satisfaction ; Prilocaine ; Sciatic Nerve* ; Ultrasonography

PURPOSE: The midline fracture of maxillary complete dentures is a frequently encountered complication. The purpose of this study was to assess the effect of frenulum height on midline strains of maxillary complete dentures. MATERIALS AND METHODS: A removable maxillary complete denture was fabricated and duplicated seven times. Four different labial frenulum heights were tested for stresses occurring on the palatal cameo surface. The strains were measured with strain gauges placed on 5 different locations and the stresses were calculated. To mimic occlusal forces bilaterally 100 N of load was applied from the premolar and molar region. RESULTS: A statistically significant association between the height of the labial frenulum and the calculated stresses and strains was shown (P<.05) predominantly on the midline and especially on the incisive papilla. The results showed that stress on the anterior midline of the maxillary complete denture increases with a higher labial frenulum. CONCLUSION: Within the limitations of this in vitro study, it can be concluded that the stress on the anterior midline of the maxillary complete denture increases with a higher labial frenulum. Surgical or mechanical precautions should be taken to prevent short-term failure of maxillary complete dentures due to stress concentration and low cycle fatigue tendency at the labial frenulum region.
Bicuspid ; Bite Force ; Denture Bases* ; Denture, Complete ; Dentures* ; Fatigue ; Molar ; Palate