Gluten-free diet: a new strategy for management of painful endometriosis related symptoms?

Pelvic pain affects 4% to 39% of women and accounts for 10-40% of all outpatient gynecologic visits. The etiology of painful endometriosis-related has not been fully delineated. No studies have been published concerning gluten-free diet administered to achieved relief of painful symptoms endometriosis-related. The aim of this retrospective study was to evaluate the effectiveness for the outcomes of endometriosis-related pain and quality of life of gluten-free diet in a follow-up of 12 months in patients with chronic pelvic pain endometriosis-related

MEDICAL AND SURGICAL TREATMENT OF CHRONIC ANAL FISSURE: PROSPECTIVE LONG-TERM RESULTS

Background: we previously assessed the efficacy of different medical and surgical treatments for chronic anal fissure (CAF). In this prospective audit we present longer-term results of this study in a larger series.Patients and Methods: From 01/04 to 09/08, 294 patients with typical CAF were enrolled. All patients were treated with 0.2% nitroglycerin ointment (GTN) or anal dilators (DIL) for 8 weeks. Those patients in which no improvement in symptoms was observed after 8 weeks were crossed to the other treatment (GTN or DIL) or switched to a combination of the two. Persisting symptoms after 12 weeks or recurrence were indications for either botulinum toxin injection into the internal sphincter and fissurectomy (BTX) or LIS. Primary end-point was fissure healing at last follow-up. Secondary end-points were symptomatic improvement, need for lateral internal sphincterotomy (LIS), and side effects. Differences between treatment groups were evaluated by chi square test. Results: patients' demographics, fissure characteristics and treatment results are resumed in Table 1. Mean follow-up was 36±17 months. Recurrence rate after 12 weeks treatment was similar between GTN and DIL (11.5% vs 9.3%). Overall fissure healing after medical treatment was 69.7% without significant differences between GTN (57.2%), DIL (66.9%) or a combination of the two (59.5%). Side effects (GTN) or severe discomfort (DIL) were observed in 13.2% of the patients. Thirty patients were treated with BTX and 64 underwent LIS (including BTX failures). At the end of the follow-up healing rates were 83.3% after BTX and 100% after LIS. No morbidity or postoperative incontinence were observed in both surgical groups.Conclusions: This study confirms that LIS is far more effective than medical treatments for CAF. However, BTX injection/fissurectomy as first line treatment may significantly increase the healing rate while avoiding any risk of incontinence. Table 1: patients' demographics, fissure characteristics and treatment results. GTN DIL GTN/DIL BTX/Fissurectomy LIS Number 173 121 42 30 64 Mean Age (years) 41 43 43 38 45 Sex (M/F) 80/93 52/69 28/14 11/19 27/32 Fissure position Ant 19 18 8 2 15 Post 145 97 32 26 47 Both/other 9 6 2 2 2 Single treatment (12 weeks) success N/% 95/173 (54.9%) 75/121 (61%) NA NA NA Recurrence 11/95 (11.5%) 7/75 (9.3%) NA NA NA After cross-over healing N/% 20/50 (40%) 16/32 (50%) 17/42 (40.4%) NA NA Recurrence 5/20 (25%) 3/16 (18.7%) 4/17 (23.5%) NA NA Overall success N/% 99/173 (57.2%) 81/121 (66.9%) 25/42 (59.5%) 25/30 (83.3%) 64/64 (100%) NA= not applicabl

Early (1 hour) post-operative parathyroid hormone (PTH) measurement predicts hypocalcaemia after thyroidectomy: a prospective case-control single-institution study

The aim of the study was to evaluate the efficacy of parathyroid hormone 1-hour assay for the early prediction of hypoparathyroidism after thyroidectomy. Candidates for total, subtotal, completion thyroidectomy or lobectomy were entered into the study. Pre- and postoperative calcium and parathyroid hormone (1 hour and postoperative day 1 after thyroidectomy) levels and clinical hypocalcaemia were recorded. Patients were divided into 3 groups and 2 subgroups: 1. patients who underwent lobectomy (control group); 2. patients who underwent total thyroidectomy with postoperative hypocalcaemia (2A: asymptomatic patients, 2B: symptomatic patients); 3. asymptomatic patients with normal calcium levels after total thyroidectomy. Of 119 patients, 109 underwent total thyroidectomy and 10 lobectomy. Of the 109 patients submitted to total thyroidectomy, 35 (32.11%) developed postoperative transient hypocalcaemia. Twenty-one patients (19.27%) were asymptomatic and 14 (12.84%) were symptomatic. Parathyroid hormone levels decreased after 1 hour in group 3 (32.98 pg/dl), 2A (9.84 pg/dl) and 2B (7.46 pg/dl). There was no significant difference in parathyroid hormone levels at 1 hour between group 2A and 2B (p = 0.06), but were significantly lower compared to groups 3 and 1 (p < 0.05). Parathyroid hormone levels at 1 hour after total thyroidectomy is a good predictor of early hypocalcaemia. It might be more useful than serum calcium monitoring for the early identification of patients requiring postoperative calcium supplementation