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Steen C, Cho YM, Scott M, Jain A, Balakrishnan V, Keck J, An V, Chandra R. Local anaesthetic for pain post rubber band ligation of haemorrhoids: a prospective, single-blinded randomised controlled trial. Tech Coloproctol 2023; 27:867-872. [PMID: 36856913 DOI: 10.1007/s10151-023-02777-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/16/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Rubber band ligation (RBL) is a widely accepted intervention for the treatment of haemorrhoids. However, post procedure pain is a common complaint. The aim of this study was to determine whether the addition of local anaesthetic (LA) to the haemorrhoid pedicle base, post RBL, aids in reducing early post-procedure pain. Additionally, to compare perceived perianal numbness, oral analgesia usage and total consumption, and adverse events. METHODS This study was a prospective, single-blinded randomised controlled trial. Patients were recruited from colorectal clinics in two Australian hospitals between 2018-2019. Patients randomised to the intervention (LA) group received 2mls bupivacaine 0.5% with adrenaline 1:200,000 to each haemorrhoid base. Patients in the control group were not administered LA. Pain scores were recorded over 48 h using visual analogue scales. Analgesia consumption was documented and other secondary objectives were recorded dichotomously (yes/no). RESULTS At 1 h post-procedure, patient reported pain scores were significantly lower in the LA group compared to the control group (p = 0.04). There were no significant differences in pain scores between the groups at 4, 24 or 48 h. Additionally, there were no significant differences between groups with respect to oral analgesia usage, perianal numbness or adverse events. CONCLUSIONS LA to the haemorrhoid pedicle post RBL may significantly reduce early post procedure pain without any increased risk of adverse effects.
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Affiliation(s)
- C Steen
- Department of Colorectal Surgery, Eastern Health, 8 Arnold Street, Box Hill, Victoria, Australia.
- University of Edinburgh, Masters of Surgical Sciences, Edinburgh, UK.
- Adjunct Research Associate, Monash University, Melbourne, Victoria, Australia.
| | - Y M Cho
- Department of Colorectal Surgery, Eastern Health, 8 Arnold Street, Box Hill, Victoria, Australia
| | - M Scott
- Swinburne University, VIC, Melbourne, Australia
| | - A Jain
- Department of Colorectal Surgery, Eastern Health, 8 Arnold Street, Box Hill, Victoria, Australia
| | - V Balakrishnan
- Department of Colorectal Surgery, Eastern Health, 8 Arnold Street, Box Hill, Victoria, Australia
| | - J Keck
- Department of Colorectal Surgery, Eastern Health, 8 Arnold Street, Box Hill, Victoria, Australia
| | - V An
- Department of Colorectal Surgery, Eastern Health, 8 Arnold Street, Box Hill, Victoria, Australia
- Adjunct Senior Lecturer, Monash University, Eastern Clinical School, Box Hill, Victoria, Australia
| | - R Chandra
- Department of Colorectal Surgery, Eastern Health, 8 Arnold Street, Box Hill, Victoria, Australia
- Adjunct Senior Lecturer, Monash University, Eastern Clinical School, Box Hill, Victoria, Australia
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Gollins CE, Carpenter A, Steen C, Bulinski H, Mahendran R. A retrospective analysis of the use of tap water iontophoresis for focal hyperhidrosis at a district general hospital: the patients’ perspective. J DERMATOL TREAT 2019; 30:724-726. [DOI: 10.1080/09546634.2019.1569751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- C. E. Gollins
- Dermatology Department, Croydon University Hospital, Surrey, UK
| | - A. Carpenter
- Dermatology Department, Croydon University Hospital, Surrey, UK
| | - C. Steen
- Dermatology Department, Croydon University Hospital, Surrey, UK
| | - H. Bulinski
- Dermatology Department, Croydon University Hospital, Surrey, UK
| | - R. Mahendran
- Dermatology Department, Croydon University Hospital, Surrey, UK
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D'haeseleer M, Steen C, Hoogduin JM, van Osch MJP, Fierens Y, Cambron M, Koch MW, De Keyser J. Performance on Paced Auditory Serial Addition Test and cerebral blood flow in multiple sclerosis. Acta Neurol Scand 2013; 128:e26-9. [PMID: 23550954 DOI: 10.1111/ane.12129] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND To assess the relationship between performance on the Paced Auditory Serial Addition Test (PASAT) and both cerebral blood flow (CBF) and axonal metabolic integrity in normal appearing white matter (NAWM) of the centrum semiovale in patients with multiple sclerosis (MS). METHODS Normal appearing white matter of the centrum semiovale was investigated with magnetic resonance (MR) imaging in 28 non-depressed individuals (18 patients with MS and 10 healthy controls). CBF was assessed with pseudo-continuous arterial spin labeling. N-acetylacetate/creatine (NAA/Cr) ratios (a metabolic axonal marker) were measured using (1) H-MR spectroscopy. CBF was also measured in frontoparietal cortices and cerebellar hemispheres. RESULTS In subjects with MS, we found a positive correlation between performance on the PASAT and CBF to the left centrum semiovale (P = 0.008), but not with the NAA/Cr ratio. There were no correlations between PASAT scores and CBF to the right centrum semiovale, frontoparietal cortices, and cerebellar hemispheres. There was no correlation between PASAT scores and NAA/Cr ratios. CONCLUSIONS Our preliminary results suggest that performance on the PASAT in subjects with MS correlates with CBF to the left centrum semiovale, which contains left frontoparietal white matter association tracts involved in information processing speed and working memory.
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Affiliation(s)
- M. D'haeseleer
- Department of Neurology; Universitair Ziekenhuis Brussel; Center for Neurosciences; Vrije Universiteit Brussel (VUB); Brussels; Belgium
| | - C. Steen
- Department of Neurology; Universitair Medisch Centrum Groningen; Groningen; The Netherlands
| | - J. M. Hoogduin
- Department of Neurology and Neurosurgery; Universitair Medisch Centrum Utrecht; Utrecht; The Netherlands
| | - M. J. P. van Osch
- Department of Radiology; C. J. Gorter Center for High-field MRI; Leiden University Medical Center; Leiden; The Netherlands
| | - Y. Fierens
- Department of Medical Physics; Department of Radiology; Universitair Ziekenhuis Brussel; Brussels; Belgium
| | - M. Cambron
- Department of Neurology; Universitair Ziekenhuis Brussel; Center for Neurosciences; Vrije Universiteit Brussel (VUB); Brussels; Belgium
| | - M. W. Koch
- Division of Neurology; Department of Clinical Neurosciences; University of Calgary; Calgary; AB; Canada
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Mostert JP, Koch MW, Steen C, Heersema DJ, De Groot JC, De Keyser J. T2 lesions and rate of progression of disability in multiple sclerosis. Eur J Neurol 2010; 17:1471-5. [DOI: 10.1111/j.1468-1331.2010.03093.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Pregnancy has a well-documented effect on relapses in multiple sclerosis (MS), whereas little is known about the impact of pregnancy and childbirth on the risk of secondary progression. OBJECTIVE To investigate the association of parity and secondary progression in women with MS. METHODS The association of the number of births and secondary progression was studied in a hospital-based cohort of 277 women with MS. Data were analysed in a multivariable logistic regression model, with adjustment for possible confounders. RESULTS Parity was not independently associated with secondary progression, while the factors disease duration (OR per year increase: 1.05, 95% CI 1.03 to 1.09) and use of immunomodulatory treatments (OR 0.23, 95% CI 0.08 to 0.65) were independently associated with secondary progression. CONCLUSION We found no evidence that parity influences the risk of secondary progression in MS. Further population-based studies on the association of pregnancy and childbirth on the long-term prognosis of MS are needed.
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Affiliation(s)
- M Koch
- Department of Neurology, University Medical Center Groningen, Postbus 30.001, 9700RB Groningen, The Netherlands.
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Stenberg Y, Muranyi A, Steen C, Thulin E, Drakenberg T, Stenflo J. EGF-like module pair 3-4 in vitamin K-dependent protein S: modulation of calcium affinity of module 4 by module 3, and interaction with factor X. J Mol Biol 1999; 293:653-65. [PMID: 10543957 DOI: 10.1006/jmbi.1999.3139] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Calcium-binding epidermal growth factor (EGF)-like modules are found in numerous extracellular and membrane proteins involved in such diverse processes as blood coagulation, lipoprotein metabolism, determination of cell fate, and cell adhesion. Vitamin K-dependent protein S, a cofactor of the anticoagulant enzyme activated protein C, has four EGF-like modules in tandem with the three C-terminal modules each harbouring a Ca(2+)-binding consensus sequence. Recombinant fragments containing EGF modules 1-4 and 2-4 have two Ca(2+)-binding sites with dissociation constants ranging from 10(-8) to 10(-5) M. Module-module interactions that greatly influence the Ca(2+) affinity of individual modules have been identified. As a step towards an analysis of the structural basis of the high Ca(2+) affinity, we expressed the Ca(2+)-binding EGF pair 3-4 from human protein S. Correct folding was shown by (1)H NMR spectroscopy. Calcium-binding properties of the C-terminal module were determined by titration with chromophoric chelators; binding to the low-affinity N-terminal site was monitored by (1)H-(15)N NMR spectroscopy. At physiological pH and ionic strength, the dissociation constants for Ca(2+) binding were 1.0x10(-6) M and 4. 8x10(-3) M for modules 4 and 3, respectively, i.e. the calcium affinity of the C-terminal site was about 5000-fold higher than that of the N-terminal site. Moreover, the Ca(2+) affinity of EGF 4, in the pair 3-4, was about 9000-fold higher than that of synthetic EGF 4. The EGF modules in protein S are known to mediate the interaction with factor Xa. We have now found modules 3-4 to be involved in this interaction. However, the individual modules 3 and 4 manifested no measurable activity.
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Affiliation(s)
- Y Stenberg
- Department of Clinical Chemistry, Lund University, University Hospital, Malmö, Malmö, S-205 02, Sweden
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Steen C, Baumgartner ER, Duran M, Lehnert W, Suormala T, Fingerhut R, Stehn M, Kohlschütter A. Metabolic stroke in isolated 3-methylcrotonyl-CoA carboxylase deficiency. Eur J Pediatr 1999; 158:730-3. [PMID: 10485305 DOI: 10.1007/s004310051189] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A mildly retarded infant with failure to thrive developed hypoglycaemia, focal seizures, respiratory failure and hemiparesis during a febrile episode at the age of 16 months. A brain scan was initially normal and showed hemilateral focal edema and gliosis at later stages. 3-Methylcrotonyl-CoA carboxylase deficiency was suggested by elevated urinary excretion of 3-hydroxyisovaleric acid and 3-methylcrotonylglycine, and confirmed by enzyme assays. The patient was treated with protein restriction and carnitine and remained stable during the following 5 years. Hemiparesis and some developmental delay persisted. In acute focal brain disease, metabolic disorders must be considered. 3-Methylcrotonyl-CoA carboxylase deficiency adds to the list of possible causes of "metabolic stroke".
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Affiliation(s)
- C Steen
- University Children's Hospital, Department of Neuropaediatrics II, Berlin, Germany
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Abstract
BACKGROUND AND PURPOSE The Barthel Index (BI) and the Modified Rankin Scale (MRS) are commonly used scales that measure disability or dependence in activities of daily living in stroke victims. The objective of this study was to investigate how these scales were used and interpreted in acute stroke trials. METHODS We identified from MEDLINE the major efficacy trials with neuroprotective drugs, thrombolytic drugs, and anticoagulants in acute ischemic stroke published between January 1995 and December 1998. We selected those trials that used the BI and/or MRS as outcome parameters. RESULTS Fifteen trials fulfilling the inclusion criteria were identified. The BI was used in 13 and the MRS in 8. In 4 trials mean and median scores of the BI were used, and in 1 trial median scores of the MRS were compared. Primary end points included the BI in 7, the MRS in 6, and both the BI and MRS in 3. With regard to the BI, a variety of sum scores between 50 and 95 were used as cutoff scores to define favorable outcome. Favorable outcome on the MRS was defined as either </=1 or </=2. CONCLUSIONS Among the efficacy trials in acute stroke, we found remarkable differences in the choice of primary end points and in the definition of favorable outcome on both the BI and MRS. This lack of consensus strongly hinders the design, interpretation, and comparison of acute stroke trials. In general, it may be easier to define poor outcome instead of favorable outcome. Poor outcome could be defined if any of the following end points are reached: death, institutionalization due to stroke, MRS >3, or BI <60.
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Affiliation(s)
- G Sulter
- Department of Neurology, Academisch Ziekenhuis Groningen, Groningen, Netherlands
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Oechsner M, Steen C, Stürenburg HJ, Kohlschütter A. Hyperammonaemic encephalopathy after initiation of valproate therapy in unrecognised ornithine transcarbamylase deficiency. J Neurol Neurosurg Psychiatry 1998; 64:680-2. [PMID: 9598692 PMCID: PMC2170080 DOI: 10.1136/jnnp.64.5.680] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Ornithine transcarbamylase deficiency is an X linked disorder and the most common inherited cause of hyperammonaemia. Fluctuating concentrations of ammonia, glutamine, and other excitotoxic amino acids result in a chronic or episodically recurring encephalopathy. A heterozygous female patient first presented with protein intolerance, attacks of vomiting, and signs of mental retardation in early childhood. At the age of 16 complex partial seizures occurred which were treated with sodium valproate. Seven days after initiation of valproate therapy, she developed severe hyperammonaemic encephalopathy with deep somnolence. The maximum concentration of ammonia was 480 micromol/l. After withdrawal of valproate, three cycles of plasma dialysis, and initiation of a specific therapy for the inborn metabolic disease, ammonia concentrations fell to normal values. The patient remitted, returning to her premorbid state. Valproate can cause high concentrations of ammonia in serum in patients with normal urea cycle enzymes and may worsen a pre-existing hyperammonaemia caused by an enzymatic defect of the urea cycle. Sufficient diagnostic tests for the detection of metabolic disorders must be performed before prescribing valproate for patients with a history of encephalopathy.
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MESH Headings
- Adolescent
- Amino Acid Metabolism, Inborn Errors/complications
- Amino Acid Metabolism, Inborn Errors/diagnosis
- Amino Acid Metabolism, Inborn Errors/enzymology
- Amino Acid Metabolism, Inborn Errors/genetics
- Ammonia/blood
- Anticonvulsants/adverse effects
- Anticonvulsants/therapeutic use
- Brain Diseases, Metabolic/chemically induced
- Brain Diseases, Metabolic/diagnosis
- Brain Diseases, Metabolic/enzymology
- Diagnosis, Differential
- Drug Therapy, Combination
- Epilepsy, Complex Partial/drug therapy
- Epilepsy, Complex Partial/enzymology
- Epilepsy, Complex Partial/genetics
- Female
- Genetic Carrier Screening
- Humans
- Ornithine Carbamoyltransferase Deficiency Disease
- Valproic Acid/adverse effects
- Valproic Acid/therapeutic use
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Affiliation(s)
- M Oechsner
- Department of Neurology, University Hospital Eppendorf, Hamburg, Germany
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Steen C, Rosenblatt DS, Scheying H, Braeuer HC, Kohlschütter A. Cobalamin E (cblE) disease: a severe neurological disorder with megaloblastic anaemia, homocystinuria and low serum methionine. J Inherit Metab Dis 1997; 20:705-6. [PMID: 9323567 DOI: 10.1023/a:1005382627986] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- C Steen
- University Children's Hospital, Hamburg, Germany
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Fay LB, Leaf CD, Gremaud E, Aeschlimann JM, Steen C, Shuker DE, Turesky RJ. Urinary excretion of 3-methyladenine after consumption of fish containing high levels of dimethylamine. Carcinogenesis 1997; 18:1039-44. [PMID: 9163693 DOI: 10.1093/carcin/18.5.1039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The urinary excretion of the DNA alkylation product, 3-methyladenine (3-MeAde), was measured in human volunteers who were on controlled diets and consumed fresh fish, or frozen-stored fish that contained 50-fold higher levels of dimethylamine (DMA), with or without ingested nitrate. DMA potentially could react with nitrosating agents in the diet or within the body, and produce the potent carcinogen N-nitrosodimethylamine (NDMA), which can then react with DNA to form several adducts including 3-MeAde. Our findings show that there was no increase in urinary levels of 3-MeAde after consumption of fish preserved by frozen storage relative to levels after consumption of fresh fish. Furthermore, consumption of 225 mg sodium nitrate (equal to the nitrate content in a large glass of beet juice) at 1 h prior to consumption of the frozen-stored fish did not increase urinary 3-MeAde levels as would be expected if nitrate enhanced endogenous nitrosation of DMA. In contrast, urinary excretion of 3-MeAde from a volunteer who was a moderate cigarette smoker (11 cigarettes per day) was approximately 3- to 8-fold higher than dietary 3-MeAde intake. These findings indicate that consumption of high levels of DMA in fish does not result in detectable levels of NDMA formation and genetic damage as measured by the urinary biomarker 3-MeAde.
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Affiliation(s)
- L B Fay
- Nestle Research Center, Nestec Ltd, Lausanne, Switzerland
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