Is there a post-PPH syndrome?

BACKGROUND: Despite early studies reporting significant decreases in postoperative pain and morbidity with the procedure for prolapse and hemorrhoids (PPH) compared to traditional hemorrhoidectomy, certain complications and long-term efficacy remain uncertain. This study was performed to assess the prevalence of usage of PPH and the observed postoperative complaints and complications. METHODS: A questionnaire was mailed to national and international members of the American Society of Colon and Rectal Surgeons (ASCRS) and the accumulated data were reviewed. RESULTS: The rate of response to the 2,642 questionnaires was 28.5% (n=754). Of the 754 respondents, 531 (70.4%) had performed PPH and 451 (84.9%) continued to perform PPH. The most commonly reported postoperative complaint was delayed postoperative pain. Pain lasting for months was reported by 15.1% of respondents. Persistent bleeding was reported by 34.5%, and 40.9% felt there is a post-PPH syndrome. CONCLUSIONS: Some long-term studies critically examining PPH have come to fruition. A majority of respondents continued to perform PPH. Nearly half of these agreed that there is a post-PPH syndrome relating to postoperative morbidities. The most disturbing morbidity was lasting perineal pain of unexplained etiology demanding challenging management. Persistent bleeding from hemorrhoidal disease distal to the staple line requires further management and raises the question as to the use of PPH as a permanent remedial procedure

Internal Carotid Artery Redundancy is Significantly Associated With Dissection.

BACKGROUND AND PURPOSE: Redundant internal carotid arteries have been considered a risk factor in tonsillectomy, adenoidectomy, and surgical treatment of peritonsillar abscess and also a potentially treatable cause of stroke. However, an association between internal carotid artery redundancy and spontaneous dissection has not yet been clearly demonstrated. METHODS: We reviewed, for spontaneous carotid artery dissection, records of all patients admitted to our institution during the period from 1986 through 1992 with the diagnosis of stroke or transient ischemic attack. We also reviewed 108 percutaneous cerebral arteriograms performed between September 1992 and December 1992 for presence of carotid artery redundancies. RESULTS: Thirteen patients exhibited spontaneous dissection. Of these, 8 of 13 (62%) patients and 13 of 20 (65%) internal carotid arteries, viewed to the siphon, had significant redundancies, kinks, coils, or loops. Of 108 consecutive arteriograms of patients without dissection, in which 187 internal carotid arteries were viewed to the siphon, there were 20 (19%) patients and 22 (12%) of 187 vessels with significant redundancy. Five patients in the dissection group and 2 in the nondissection group had bilateral internal carotid artery redundancy (P = .0019 and P = .0001, respectively). CONCLUSIONS: We found a significant correlation between internal carotid artery redundancy and dissection, particularly if redundancy is present bilaterally

Abnormal Ocular Pneumoplethysmographic Results in Unilateral Neovascular Glaucoma.

Little is known about the predictive value of ocular pneumoplethysmography in patients with ophthalmic disease. We evaluated eight patients with unilateral increased intraocular pressure due to neovascular glaucoma who did not have evidence of severe extracranial carotid stenosis by duplex scanning and continuous-wave Doppler ultrasound. The ophthalmic systolic pressure measured by ocular pneumoplethysmography was decreased in the affected eye of all eight patients, indicating that neovascular glaucoma may be a cause of abnormal ocular pneumoplethysmographic results. Patients with neovascular glaucoma tended to have larger interocular ophthalmic systolic pressure differences than other patients with false-positive ocular pneumoplethysmographic results by noninvasive criteria

Eliminating Bias in Randomized Cluster Trials With Correlated Binomial Outcomes.

Clustered or correlated samples with binary data are frequently encountered in biomedical studies. The clustering may be due to repeated measurements of individuals over time or may be due to subsampling of the primary sampling units. Individuals in the same cluster tend to behave more alike than individuals who belong to different clusters. This exhibition of intracluster correlation decreases the amount of information about the effect of the intervention. In the analysis of randomized cluster trials one must adjust the variance of estimator of the mean for the effect of the positive intraclass correlation p;. We review selected alternative methods to the typical Pearson\u27s chi2 analysis, illustrate these alternatives, and out line an alternative analysis algorithm. We have written and tested a FORTRAN program that produces the statistics outlined in this paper. The program is available in an executable format and is available from the author on request

Contributions to Adaptive Estimation

There are many statistics which can be used to characterize data sets and provide valuable information regarding the data distribution, even for large samples. Traditional measures, such as skewness and kurtosis, mentioned in introductory statistics courses, are rarely applied. A variety of other measures of tail length, skewness and tail weight have been proposed, which can be used to describe the underlying population distribution. Adaptive statistical procedures change the estimator of location, depending on sample characteristics. The success of these estimators depends on correctly classifying the underlying distribution model. Advocates of adaptive distribution testing propose to proceed by assuming (1) that an appropriate model, say Omega , is such that Omega { Omega , Omega , i i 1 2 … , Omega }, and (2) that the character of the model selection process is statistically k independent of the hypothesis testing. We review the development of adaptive linear estimators and adaptive maximum-likelihood estimators

Meta-Analysis of the Reliability of Noninvasive Carotid Studies.

The author examined those published studies of the consistency (homogeneity) of study outcomes of noninvasive tests that assess the degree of carotid artery disease. Noninvasive tests used to detect carotid artery disease include ocular pneumoplethysmography and duplex ultrasound pulsed Doppler spectral analysis with high-resolution B-mode scan. This meta-analysis showed that all authors had reached essentially the same conclusion: 1) one of these noninvasive tests may be sufficient to determine the clinical management of carotid artery disease, and 2) when two tests are concordant, the test degree of certainty is greatly improved, with anatomic and physiologic information that often matches or surpasses that afforded by the more invasive percutaneous carotid arteriography