Straining at stool is found in patients with haemorrhoids, rectal prolapse and neurogenic (idiopathic) faecal incontinence. In the latter two conditions perineal descent and pudendal neuropathy occur. We have carried out anal manometry, measurement of perineal descent, pudendal nerve terminal motor latency (PNTML) and single fibre EMG in the external anal sphincter in 16 patients with haemorrhoids and 20 matched control subjects to determine whether patients with haemorrhoids have pudendal nerve damage. There was no significant difference in resting or voluntary contraction pressures or in the incidence of slow waves or ultra-slow waves between the patients with haemorrhoids and controls. There was a significant difference between the groups in the position of the perineum with respect to the ischial tuberosities at rest (p less than 0.025) and on defaecation straining (p less than 0.005). The mean PNTML was higher in the haemorrhoid group but this did not reach statistical significance (p = 0.07). The mean fibre density was significantly higher in the haemorrhoid group (p less than 0.025). These findings show that patients with haemorrhoids are more likely to have abnormal perineal descent with pudendal neuropathy.
IntroductionNot infrequently, patients undergoing dual antiplatelet therapy for a recent cardiac stent develop a need for a non-cardiac surgery. Most of these surgeries can be delayed while the antiplatelet treatment is stopped and normal platelet function returns in order to avoid potential surgical complications and excessive bleeding. However, there are a number of patients who require urgent surgery where the procedure cannot be postponed. To date, no agents have been proven to bridge the patient off dual-antiplatelet therapy.MethodsA 46-year-old man was admitted to the hospital with an acute anterior wall myocardial infarction. He was urgently taken to the catheterization lab where he was found to have a totally occluded proximal left anterior descending coronary artery (LAD). He was successfully stented with a drug-eluting stent of the LAD, but subsequently developed a sarcoma 2 months later that required urgent surgery. The novel direct-acting, reversible P2Y12 receptor inhibitor cangrelor was used to bridge this patient followed by ongoing antiplatelet treatment, allowing surgery for the removal of a soft tissue sarcoma.ResultsCangrelor was successfully used to bridge a patient with a recent stent placement and current antiplatelet treatment undergoing the removal of a soft tissue sarcoma.ConclusionThis case report demonstrates the use of a novel, now currently available, short-acting antiplatelet agent that can be used for bridging patients undergoing non-cardiac surgery who had a recent myocardial infarction and stent placement.
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