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Aim: Milligan-Morgan haemorrhoidectomy is considered the best treatment for haemorrhoidal disease. The major drawback is severe post-operative pain. We postulate that using the LigaSure™ vessel sealing system to divide the haemorrhoidal pedicle may cause less postoperative pain. Methods: This was a double-blinded randomised controlled trial in a single institution. Consecutive patients undergoing elective day-case haemorrhoidectomy were recruited. Patients were randomised into the diathermy (D) group or the LigaSure™ (L) group. The haemorrhoidal pedicle was coagulated with monopolar diathermy in D group or the LigaSure vessel sealing system in L group. Patients were seen in post-operative weeks 1, 3, 6 and 12 for assessment. Primary outcome was post-operative pain by 10cm visual analog pain score. Secondary outcomes include operative time, complications and day discharge rate. Results: 68 patients were recruited in this study (n=33 in D group versus n=35 in L group) with comparable demographic data. There was no significant difference in VAS pain score (median postoperative one-week cumulative pain score: D group = 40.2 versus L group = 39, p=0.93). More complications were observed in D group (5 versus 2, p=0.25) but this was not statistically significant. Day discharge rate was similar in the two groups at about 88%. Conclusion: Ligasure-assisted haemorrhoidectomy is not superior to diathermy haemorrhoidectomy. Day case haemorrhoidectomy is feasible and safe with both techniques. [ABSTRACT FROM AUTHOR]

The endoscopic healing rates and factors related to healing of two cimetidine regimens designed to reduce respectively postprandial and nocturnal acid secretions were studied in a randomised trial of cimetidine 200 mg tds with meals, vs 600 mg at bedtime, vs 200 mg tds with meals plus 400 mg at bedtime in 246 patients with duodenal ulcer. The respective healing rates were 62.3%, 63.1%, 77.5% at four weeks and 86.6%, 83.3%, 91.2% at eight weeks. The healing rates at four weeks of both meal time and bedtime regimens were inferior (p less than 0.05) to that of the standard regimen. Analysis of 45 prospectively obtained factors showed that (i) habitual cigarette smoking adversely affected healing with the meal time regimen but not with the others, indicating that its adverse effect disappeared once nocturnal acid secretion was reduced, (ii) habitual use of analgesics impaired and their abstinence favoured healing by both meal time and bedtime regimens but these effects were lost with the standard regimen, suggesting that if analgesics cannot be withdrawn during ulcer treatment, a reduction of both meal time and night time acid secretions should be ensured, (iii) responders with the meal time and bedtime regimens had respectively significantly higher postprandial serum gastrin and higher basal acid output than the corresponding non-responders suggesting that these responders had different pathophysiology, and (iv) high maximal acid output and large ulcers healed less well by any regimen. [ABSTRACT FROM PUBLISHER]

Of 212 patients with duodenal ulcer treated with four weeks of one gram daily cimetidine, 25 had ulcers which underwent no reduction in size despite treatment. The effects of tripotassium dicitrato bismuthate (TDB) tablet four times a day or cimetidine 1.6 g daily on the healing of these cimetidine resistant ulcers were compared in a randomised crossover trial. Ten of 12 patients on tripotassium dicitrato bismuthate and five of 13 patients on high dose cimetidine had complete healing (p less than 0.02). On crossing over, seven of the eight ulcers not healed by high dose cimetidine completely healed with TDB in another four weeks, and one of the two ulcers not healed by TDB healed with high dose cimetidine. Overall, TDB healed 85% of cimetidine resistant ulcers, whereas high dose cimetidine healed 40% (p less than 0.006). Tripotassium dicitrato bismuthate is recommended for cimetidine resistant duodenal ulcers. [ABSTRACT FROM PUBLISHER]

Talent is the key to economic development and the network built among talents is the resource crucial for national competitiveness. Talent is highly mobile and a more talented individual tends to show higher tendency to move on and respond to better economic opportunities. Therefore, managing talent is a challenging job. This paper examines the evolution of brain drain to talent mobility and also analyses talent networking for a special group of talent, that is, academics. The purpose of this paper is to explore the nature and patterns of academic networking, and the challenges in forming and maintaining this network.