scholarly journals Stapled hemorrhoidectomy: present status

2005 ◽  
Vol 42 (3) ◽  
pp. 191-194 ◽  
Author(s):  
Antônio Lacerda-Filho ◽  
Rodrigo Gomes da Silva
Keyword(s):  
Clinical Trials ◽  
Return To Work ◽  
Randomized Clinical Trials ◽  
Recovery Period ◽  
Conventional Technique ◽  
Stapled Hemorrhoidectomy ◽  
Large Size ◽  
Conventional Hemorrhoidectomy ◽  
Long Term Follow Up

AIM: To evaluate cost-effectiveness of stapled hemorrhoidectomy comparing its results with conventional technique. SOURCE OF DATA: We retrospectively analyzed the MEDLINE data basis from 2000 to 2004 studying randomized clinical trials which compared pain intensity, recovery period, return to work and occurrence of anal incontinence, in addition to postoperative complications and costs evaluation between stapled and conventional hemorrhoidectomy during different periods of follow-up. CONCLUSIONS: Stapled hemorrhoidectomy provides lesser postoperative pain and earlier return to work than conventional hemorrhoidectomy. However, its efficacy could not be determined, since rigorous prospective and randomized clinical trials with long-term follow-up periods and large size samples are not available at this time.

Abstract 2140: Differential Efficacy and Safety of Drug-Eluting Stents With Short Versus Long Term Follow-up: A Meta-Analysis of Randomized Clinical Trials

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Henri Roukoz ◽  
Anthony A Bavry ◽  
Michael L Sarkees ◽  
Dharam J Kumbhani ◽  
Mark G Rabbat ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Stent Thrombosis ◽  
Randomized Clinical Trials ◽  
Drug Eluting Stents ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Drug Eluting ◽  
Q Wave

Introduction: Drug eluting stents (DES) significantly reduce target lesion revascularization (TLR) compared to bare metal stents (BMS) within 1 year of follow-up, however they increase late stent thrombosis. The effect of DES on the need for late revascularization is unclear. Hypothesis: We sought to evaluate the safety and efficacy of DES compared to BMS early after intervention (< 1 year) and late (> 1 year) among both stable patients and acute coronary syndromes. Methods: We searched the Medline database for randomized clinical trials with long-term follow-up, from 2000 to 2007. We also searched relevant journal supplements for abstracts and obtained trial presentations from cardiology meetings. Results: We identified 24 trials (17% acute coronary syndrome patients) with a total of 10,278 patients. The weighted mean duration of follow-up was 28 months. For early outcomes (< 1 year); the incidence of all-cause mortality for DES vs. BMS was 2% vs. 2.1%, RR=0.95, 95%CI (0.70–1.27), p=0.7, cardiovascular mortality was 1.4% vs. 1.5%, RR=0.95 (0.73–1.24), p=0.72, Q-wave myocardial infarction (MI) was 0.8% vs. 0.6%, RR= 1.24 (0.7–2.2), p=0.45, non-Q-wave MI was 3% vs. 4%, RR=0.73 (0.55–0.96), p=0.024, TLR was 5.9% vs. 17.8%, RR=0.29 (0.24–0.34), p<0.001, and stent thrombosis was 0.94% vs. 1.1%, RR=0.83 (0.55–1.27), p=0.4. For late outcomes (>1 year); the incidence of all-cause mortality for DES vs. BMS was 3.9% vs. 3.8%, RR=1.04 (0.79–1.38), p=0.7, cardiovascular mortality 1.4% vs. 1.5%, RR=0.95 (0.73–1.24), p=0.72, Q-wave MI was 0.7% vs.0.6%, RR=1.05 (0.54–2.05), p=0.87, non-Q-wave MI was 1.6% vs. 1.2%, RR=1.39 (0.87–2.21), p=0.16, TLR was 2.6% vs. 3.2%, RR=0.82 (0.59–1.13), p=0.23, and stent thrombosis was 0.59% vs. 0.15%, RR=3.2 (1.22–8.36), p=0.018. Conclusions: Within 1 year of follow-up, DES appears to be safe and efficacious with similar mortality, similar stent thrombosis, decreased TLR, and decreased non-Q-wave MI compared to BMS. After 1 year, DES still has similar mortality compared to BMS, however TLR, while low, is no longer reduced, stent thrombosis is increased, and there is a numerical excess of non-Q-wave MI.

Safety and efficacy of balloon-mounted stent in the treatment of symptomatic intracranial atherosclerotic disease: a multicenter experience

2021 ◽  
pp. neurintsurg-2021-017818
Author(s):  
Mahmoud H Mohammaden ◽  
Raul G Nogueira ◽  
Wondwossen Tekle ◽  
Santiago Ortega-Gutierrez ◽  
Mudassir Farooqui ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Medical Management ◽  
Randomized Clinical Trials ◽  
Recurrent Stroke ◽  
Atherosclerotic Disease ◽  
Anterior Circulation ◽  
Safety And Efficacy ◽  
Intracranial Atherosclerotic Disease ◽  
Long Term Follow Up

BackgroundRandomized clinical trials have failed to prove that the safety and efficacy of endovascular treatment for symptomatic intracranial atherosclerotic disease (ICAD) is better than that of medical management. A recent study using a self-expandable stent showed acceptable lower rates of periprocedural complications.ObjectiveTo study the safety and efficacy of a balloon-mounted stent (BMS) in the treatment of symptomatic ICAD.MethodsProspectively maintained databases from 15 neuroendovascular centers between 2010 and 2020 were reviewed. Patients were included if they had severe symptomatic intracranial stenosis in the target artery, medical management had failed, and they underwent intracranial stenting with BMS after 24 hours of the qualifying event. The primary outcome was the occurrence of stroke and mortality within 72 hours after the procedure. Secondary outcomes were the occurrence of stroke, transient ischemic attacks (TIAs), and mortality on long-term follow-up.ResultsA total of 232 patients were eligible for the analysis (mean age 62.8 years, 34.1% female). The intracranial stenotic lesions were located in the anterior circulation in 135 (58.2%) cases. Recurrent stroke was the qualifying event in 165 (71.1%) while recurrent TIA was identified in 67 (28.9%) cases. The median (IQR) time from the qualifying event to stenting was 5 (2–20.75) days. Strokes were reported in 13 (5.6%) patients within 72 hours of the procedure; 9 (3.9%) ischemic and 4 (1.7%) hemorrhagic, and mortality in 2 (0.9%) cases. Among 189 patients with median follow-up time 6 (3–14.5) months, 12 (6.3%) had TIA and 7 (3.7%) had strokes. Three patients (1.6%) died from causes not related to stroke.ConclusionOur study has shown that BMS may be a safe and effective treatment for medically refractory symptomatic ICAD. Additional prospective randomized clinical trials are warranted.

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