Parenteral troxerutin and carbazochrome combination in the treatment of post-hemorrhoidectomy status: a randomized, double-blind, placebo-controlled, phase IV study

Flavonoids, such as troxerutin, have been shown to be safe and effective agents for the treatment of chronic venous insufficiency. The fixed combination between troxerutin 150 mg and carbazochrome 1.5 mg (Fleboside ampoules) was previously shown to have a good efficacy and safety profile in non-surgical patients with acute uncomplicated hemorrhoids. The purpose of this randomized, double-blind, placebo-controlled study was to investigate the efficacy and tolerability of the active combination in the treatment of post-hemorrhoidectomy patients. 30 patients were randomized to receive one of two treatments: troxerutin 150 mg and carbazochrome 1.5 mg, or placebo, i.m. 3 ml ampoules twice a day for five consecutive days after the surgical procedure, starting from the day of surgery. Efficacy parameters were assessed as follows: at baseline (T1), after the first administration (T2; day of surgery), the second day after the surgical procedure (T3), and the fifth day after the surgical procedure (T4); hemorrhoidal symptoms based on a visual analogue scale (VAS): pain, discharge, bleeding, inflammation, and pruritus; analgesic intake, if any; time to restore a physiological defecation; edema evaluation (based on a four-point scale: 0 = absent; 1 = mild; 2 = moderate; 3 = severe); camera pictures taken at T1 and T4 (in selected patients); and blood coagulation tests. Analysis between treatment groups revealed a highly significant difference at T3 and T4 for the total VAS score (p = 0.007 and p = 0.001, respectively) in favor of the active combination treatment. A statistically significant difference was also observed for bleeding and pruritus at T3 and for these two parameters and both inflammation and edema at T4 (p < 0.001) in favor of the active combination group. No adverse events were reported. Neither the active combination nor placebo affected blood coagulation tests. We conclude that intramuscular administration of the fixed combination of troxerutin 150 mg and carbazochrome 1.5 mg is effective, well tolerated and superior to placebo in improving hemorrhoidal and post-surgical symptoms during the five days following surgery.

[Modern trends in the treatment of esophageal atresia]

Results in the treatment of oesophageal atresia have greatly improved in the last 20 years. In an increasing number of patients it is possible to practice primary surgical correction at birth. From December '82 to December '95, 64 neonates with oesophageal atresia ranging in weight from 1.2 to 3.8 kg were observed. Fifty-eight neonates had type III atresia, four had type I atresia and two presented a rare membranous atresia with a long longitudinal intramural fistula. Fifty-four associated malformations were present in thirty-five neonates (55%). Congenital cardiopathies were the most frequent malformations followed by ano-rectal, skeletal and urinary malformations. According to the classification proposed by Waterston, 35% of the neonates were Class A, 33% Class B, and 32% Class C. Three neonates with polymalformations died before surgical treatment. Our trend is to attempt, when possible, primary correction using an extrapleural approach, even in the presence of a long gap. Oesophageal anastomosis was performed in 51 patients (80%). Gastrostomy was never performed routinely but only in selected cases. Early post-operative complications occurred in 22.5% of the cases. Gastroesophageal reflux, registered in 11 cases, was treated surgically in 4 cases. All 13 cases of post-anastomotic stenosis were treated with cycles of dilatations. The overall survival rate in 64 patients was 80% (96% in Class A; 86% in Class B, 55% in Class C). Of the 51 patients who underwent oesophageal anastomosis only 3 died, one because of the risk category according to Waterston. Survival is related more to the presence of severe multiple associated malformations, rather than bronchopneumonic complications of birth weight.

[Cystic splenic disease of surgical interest]

Cystic lesions of the spleen include parasitic and nonparasitic cysts. Parasitic cysts are due almost exclusively to echinococcal disease representing 50 to 80 per cent of splenic cysts. However, splenic echinococcosis is not so common as hepatic or pulmonary location (only 3.5 per cent described in literature). Nonparasitic cysts are classified as primary or true cysts, which have an epithelial or endothelial lining, and pseudocysts. True cysts of the spleen are very rare and include epidermoid and dermoid cysts, cystic hemangiomas and cystic lymphangiomas. Pseudocysts are much more common and may be post-traumatic (haemorrhagic or serosal), degenerative (infarction) or inflammatory. Such conditions can be occasionally observed or detected in emergency in case of splenic rupture. Four cases of splenic cystic pathology are reported. Correlated diagnostic problems are analyzed. The four cases (a cystic hydatidosis, a cystic lymphangioma and two post-traumatic haemorrhagic cysts), successfully treated with splenectomy are discussed.

[The bronchogenic carcinoma-laryngeal cancer association: the experience of our school]

In a 20 year period (1974-1995), 3451 patients with bronchogenic carcinoma were observed. Retrospective analysis of these cases allowed to study the relationship between primary pulmonary malignancies and laryngeal tumours. In 32 patients synchronous or metachronous carcinoma of the larynx and lung were found. All laryngeal tumours were curable but only fifteen of these second primary lung tumours were successfully treated. None of unresected patients survived beyond 2 years.