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

Purpose: The objective of this study was to evaluate the effects of Polyhexanid+poloxamer, Sodium pentaborate pentahydrate and Diphenylhydantoin, in the treatment of 3rd degree burn wounds.M ethods: Twenty eight Wistar albino rats were divided into 4 groups, each containing 7 animals. The experimental groups received every other day treatment with (A) Polyhexanid+poloxamer, (B) Sodium pentaborate pentahydrate (C) Diphenylhydantoin, (D) Control. In dorsum of all rats, third degree skin burn was performed. Three days later burn eschar was removed by fascial excision and skin substitude Nevelia® was applied to the wound. Then the wounds were applied locally with agents embedded in the dressing. In (Group A) %0,1 Polyhexanid+poloxamer, (Group B) %2 Sodium pentaborate pentahydrate, (Group C) Diphenylhydantoin and (Group D) Control-Saline solution. These treatments were performed every other day for 12 days. At the end of treatments, burn wounds were obtained and processed for immunohistochemical and histopathologic analysis. Results: Histologic evaluation of the Polyhexanide+poloxamer, Sodium pentaborate pentahydrate and Diphenylhydantoin-treated wound regions revealed an increased collagen deposition, fibroblast number, epithelization, and vascularization when compared to control group (P＜0.05). In all treatment groups wound regions demonstrated a strong immunostaining for Vascular Endothelial Growth Factor, Transforming Growth factor-β, and Basic fibroblast Growth factor according to control group. Conclusion Results of this study showed that treatment of burn wounds with Polyhexanid+poloxamer, Sodium pentaborate pentahydrate and Diphenylhydantoin enhanced collagen deposition, epithelization, and vascularization in healing of 3rd degree burn wounds.

In patients who have severe burn injuries with a large surface area, inflammatory response of the immune system, which is subsequently followed by anti-inflammatory response, results in immune dysregulation and this makes burn victims vulnerable to infection. With the disruption of skin integrity, the body becomes vulnerable to infection. Thermal injury disrupts cellular integrity, and eschar forms over the wound bed. Successive escharotomy procedures performed as part of treatment also lead to increased susceptibility to infection. The cytokine adsorber is a treatment modality that can be useful in preventing the transition to infection by removing inflammatory mediators from the blood. In our case series, we wanted to present the patients who were followed up for a prolonged period in our hospital’s burn intensive care clinic due to 75~90% 4th degree burns as a result of an explosion in a coal mine and periodically received cytokine adsorbents.

In patients who have severe burn injuries with a large surface area, inflammatory response of the immune system, which is subsequently followed by anti-inflammatory response, results in immune dysregulation and this makes burn victims vulnerable to infection. With the disruption of skin integrity, the body becomes vulnerable to infection. Thermal injury disrupts cellular integrity, and eschar forms over the wound bed. Successive escharotomy procedures performed as part of treatment also lead to increased susceptibility to infection. The cytokine adsorber is a treatment modality that can be useful in preventing the transition to infection by removing inflammatory mediators from the blood. In our case series, we wanted to present the patients who were followed up for a prolonged period in our hospital’s burn intensive care clinic due to 75~90% 4th degree burns as a result of an explosion in a coal mine and periodically received cytokine adsorbents.

In patients who have severe burn injuries with a large surface area, inflammatory response of the immune system, which is subsequently followed by anti-inflammatory response, results in immune dysregulation and this makes burn victims vulnerable to infection. With the disruption of skin integrity, the body becomes vulnerable to infection. Thermal injury disrupts cellular integrity, and eschar forms over the wound bed. Successive escharotomy procedures performed as part of treatment also lead to increased susceptibility to infection. The cytokine adsorber is a treatment modality that can be useful in preventing the transition to infection by removing inflammatory mediators from the blood. In our case series, we wanted to present the patients who were followed up for a prolonged period in our hospital’s burn intensive care clinic due to 75~90% 4th degree burns as a result of an explosion in a coal mine and periodically received cytokine adsorbents.

In patients who have severe burn injuries with a large surface area, inflammatory response of the immune system, which is subsequently followed by anti-inflammatory response, results in immune dysregulation and this makes burn victims vulnerable to infection. With the disruption of skin integrity, the body becomes vulnerable to infection. Thermal injury disrupts cellular integrity, and eschar forms over the wound bed. Successive escharotomy procedures performed as part of treatment also lead to increased susceptibility to infection. The cytokine adsorber is a treatment modality that can be useful in preventing the transition to infection by removing inflammatory mediators from the blood. In our case series, we wanted to present the patients who were followed up for a prolonged period in our hospital’s burn intensive care clinic due to 75~90% 4th degree burns as a result of an explosion in a coal mine and periodically received cytokine adsorbents.

OBJECTIVE: To assess the prognosis of surgically-staged non-invasive uterine clear cell carcinoma (UCCC), and to determine the role of adjuvant therapy. METHODS: A multicenter, retrospective department database review was performed to identify patients with UCCC who underwent surgical treatment between 1997 and 2016 at 8 Gynecologic Oncology Centers. Demographic, clinicopathological, and survival data were collected. RESULTS: A total of 232 women with UCCC were identified. Of these, 53 (22.8%) had surgically-staged non-invasive UCCC. Twelve patients (22.6%) were upstaged at surgical assessment, including a 5.6% rate of lymphatic dissemination (3/53). Of those, 1 had stage IIIA, 1 had stage IIIC1, 1 had stage IIIC2, and 9 had stage IVB disease. Of the 9 women with stage IVB disease, 5 had isolated omental involvement indicating omentum as the most common metastatic site. UCCC limited only to the endometrium with no extra-uterine disease was confirmed in 41 women (73.3%) after surgical staging. Of those, 13 women (32%) were observed without adjuvant treatment whereas 28 patients (68%) underwent adjuvant therapy. The 5-year disease-free survival rates for patients with and without adjuvant treatment were 100.0% vs. 74.1%, respectively (p=0.060). CONCLUSION: Extra-uterine disease may occur in the absence of myometrial invasion (MMI), therefore comprehensive surgical staging including omentectomy should be the standard of care for women with UCCC regardless of the depth of MMI. Larger cohorts are needed in order to clarify the necessity of adjuvant treatment for women with UCCC truly confined to the endometrium.
Adenocarcinoma, Clear Cell ; Chemotherapy, Adjuvant ; Cohort Studies ; Disease-Free Survival ; Endometrium ; Female ; Humans ; Neoplasm Invasiveness ; Omentum ; Prognosis ; Retrospective Studies ; Standard of Care ; Uterine Diseases

No abstract available.
Isotretinoin ; Purpura, Schoenlein-Henoch

No abstract available.
Isotretinoin ; Purpura, Schoenlein-Henoch

BACKGROUND AND OBJECTIVES: QRS complex fragmentations are frequently seen on routine electrocardiograms with narrow or wide QRS complex. Fragmented QRS complex (fQRS) is associated with increased morbidity and mortality, sudden cardiac death and recurrent cardiovascular events. In this study, we aimed to interrogate the relationship of systemic inflammation with the presence of fQRS in patients with acute coronary syndromes (ACS). SUBJECTS AND METHODS: Two-hundred and twenty eligible patients with ACS that underwent coronary angiography were enrolled consecutively in this study. Patients with significant organic valve disease and those with any QRS morphology that had a QRS duration > or =120 ms as well as patients with permanent pacemakers were excluded from this study. RESULTS: Patients with fQRS were of a higher age (p=0.02), had increased C-reactive protein (CRP) levels (p<0.001), prolonged QRS time (p<0.001), extent of coronary artery disease (CAD) (p<0.001), creatine kinase-MB (CK-MB) levels (p=0.006) and Q wave on admission electrocardiography (p<0.001) in comparison to patients with non-fragmented QRS. When we performed multiple logistic regression analysis, fQRS was found to be related to increased CRP levels {odds ratio (OR): 1.2, 95% confidence interval (CI): 1.045-1.316, p=0.007}, QRS duration (OR: 1.1, 95% CI: 1.033-1.098, p<0.001), extent of CAD (OR: 1.5, 95% CI: 1.023-2.144, p=0.037), Q wave (OR: 2.2, 95% CI: 1.084-4.598, p=0.03) and CK-MB levels (OR: 1.0, 95% CI: 1.001-1.037, p=0.04) independently. CONCLUSION: In our study, we found that fQRS was independently related to increased CRP. Fragmented QRS that may result as an end effect of inflammation at cellular level can represent increased cardiac risk by different causative mechanisms in patients with ACS.
Acute Coronary Syndrome ; C-Reactive Protein ; Coronary Angiography ; Coronary Artery Disease ; Creatine ; Death, Sudden, Cardiac ; Electrocardiography ; Humans ; Inflammation ; Logistic Models ; Risk Assessment