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Background: Anal operations may be useful surgical procedures in major ambulatory surgery. The selection of anaesthetic technique may influence the duration of hospital stay. The use of local anaesthesia in anal surgery is supposed to be associated with advantages, such as shorter hospital stay and high satisfaction rates. The aim of this retrospective study is to prove the feasibility of local anaesthesia in anal operations as day cases. Patients and methods: A total of 218 patients with various proctologic disorders were consented to anal operations under general, spinal or local anaesthesia. The data including anaesthetic technique, postoperative information, duration of hospitalisation and degree of satisfaction, were collected respectively in a computerised database. 71 patients underwent anal surgery under general anaesthesia (group 1), 73 under spinal anaesthesia (group 2), and 74 under local anaesthesia (group 3). Results: The mean hospital stay for the three groups was 2.5, 3.0 and 0.5 days respectively. The difference in duration of hospitalisation of group 3 in comparison to groups 1 and 2 was statistically significant (P<0.01), while the overall satisfaction rate during the post-operative evaluation was not significantly different between the three groups. Conclusion: Local anaesthesia is a suitable technique for anal surgery with a high degree of acceptance among patients. It can be used in most proctologic procedures and is a simple, fast, safe and easy method, with high satisfaction rates among patients. Local anaesthesia is associated with shorter hospital stay and faster return to full social activities. It seems to be the ideal anaesthetic technique for anal procedures as day cases. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor concerning electrocoagulation as an alternative treatment for rectal cancer.

A rare case of thyroid storm induced by thyroid gland injury because of penetrating neck trauma is reported. The injury was the result of a spear-fishing gun trident impaction in the neck. The diagnosis of thyroid gland injury was suspected by preoperative clinical examination and established during neck exploration in the theatre. The gland injury led to thyroid storm owing to the rupture of acini and liberation of thyroxine (T4) into the bloodstream. Withdrawal of the impacted trident along with subtotal thyroid lobectomy and repair of soft tissue damage in addition to supported treatments, which corrected the hyperthyroid state, led to uneventful recovery.

Retractile mesenteritis is a rare benign inflammatory disease of the mesentery. Computed tomographic findings usually suggest the diagnosis, which is confirmed by surgical biopsies. Conservative treatment is empirical, based on corticosteroids, colchicine, immunosuppressive agents and progesterone. Surgical resection is sometimes attempted for definitive therapy, although the surgical approach is often limited. This report describes a 62-year old man with histologically proven retractile mesenteritis presenting with malabsorbtion syndrome, who presented pulmonary tuberculosis after initial therapy with corticosteroids. He was subsequently treated with oral pentoxifylline (800 mg/day), with substantial clinical and radiological improvement.

Isolated thyroid gland injury due to blunt neck trauma is uncommon and rarely complicated by thyroid storm in patients without known hyperthyroidism. The aim of this study was to report our experience on blunt thyroid gland injury followed by massive gland hemorrhage, acute airway obstruction, and symptoms of thyroid storm. Among 231 patients with neck trauma, four patients appeared with isolated thyroid gland injury. In two of them, the diagnosis of simultaneous thyrotoxic crisis was made on the basis of clinical findings and confirmed on emergency laboratory tests. The diagnosis of thyroid gland injury was supposed by the history and physical examination and established after neck exploration. Therapy was directed at stabilizing the patients by correcting the hyperthyroid state, followed by operative treatment. Left lobectomy and total thyroidectomy were performed and, along with postoperative medical measures, led to uneventful recovery. This study demonstrates that thyroid gland injury due to blunt neck trauma, although uncommon, may result in potentially life-threatening thyroid storm due to rupture of acini and liberation of thyroid hormones into the bloodstream. This may occur in patients without known hyperthyroidism.

We present our experience with proctologic operations under local posterior perianal block (LPPB), along with short- and medium-term results of this technique. A total of 72 patients with proctologic disorders consented to operation under LPPB for stapled hemorrhoidectomy, Milligan-Morgan hemorrhoidectomy, subanodermal fistula resection, perianal abscess revision, and anal tumor electrocoagulation. The anesthetic technique, postoperative complications, the pain score, and follow-up were recorded and analyzed retrospectively. Almost all patients were pain-free during surgery. The pain score in visual analog scale (VAS) during the first 24 hours was 1.6 to 3.4 and varied with the type of surgery performed. At follow-up 1-2 weeks later, the patients were satisfied with LPPB (mean level of satisfaction, 8.6 +/- 1.2 on the VAS). Seventy of 72 patients (97.2%) would willingly have surgery again under LPPB if it was required. This study shows that LPPB can be widely and safely applied in proctologic surgery.

A rare case of multiple small bowel ruptures due to ischemic enteritis (ISE) is reported. The patient was admitted to the hospital with acute abdominal pain followed by bloody diarrhoeas. Preoperative colonoscopic findings were similar to those presented in Crohn's disease. Intraoperatively, ischemic lesions and multiple ruptures were localized at the jejunum and the proximal ileum. Histopathological examination of the resected bowel segment established the diagnosis of ISE. Although ISE is not common, concurred multiple ruptures of the small bowel is a rare but actual complication.

Stapled hemorrhoidectomy--a new, evolving technique--is considered to be safe and painless. General and spinal anesthesia are the "gold standard" anesthetic techniques for the procedure. The stapled hemorrhoidectomy under local anesthesia is described. Emphasis is given in few tips and tricks for safe and successful application of the local anesthesia.