BackgroundA variety of effective methods for treatment of hemorrhoids has been proposed. In recent years, there has been an increasing number of studies comparing transanal hemorrhoidal dearterilization (THD) and conventional hemorrhoidectomy (CH), but the focus of most studies has been about the early postoperative results. The data about long-term outcomes is still limited. We aimed to compare Doppler-guided THD and CH with regard to early and long-term postoperative results.MethodsThe conducted prospective research included 287 patients who underwent CH (167 cases) or Doppler-guided THD with mycopexy (120 patients) between November 2010 and December 2015. Information on hemorrhoidal stage, demographic data, presenting symptoms, complications, duration of hospital stay, postoperative pain, patients’ satisfaction and follow-up were obtained. Statistical tests were performed by SPSS 19.0.ResultsThere was no significant difference between the studied groups according to gender, mean age, preoperative prolapse, pain and pruritus, hemorrhoidal stage and postoperative complications. Preoperative bleeding was more frequent in THD group (p = 0,002). The mean visual analog scale (VAS) pain scores in CH and THD groups on days 1, 2 and 7 were 7.01 vs 5.03, 5.07 vs 2.98, 2.39 vs 0,57 (p = 0,000). Practically, there was no difference in VAS on day 30 and patients’ satisfaction at the 18th month. Mean hospital stay was 5,13 (CH) and 3,38 days (THD), p = 0,000. The postoperative follow-up was between 18 and 78 months (mean 46 ± 16 months). During this stage, 5 patients (2,99%) in CH group required surgery for recurrence. In THD group, 3 patients (2,5%), all with 4th-degree hemorrhoids underwent additional procedures (p 0,802).ConclusionsDoppler-guided THD seems to be an efficient and safe option for treatment of hemorrhoids, related to lower postoperative pain and excellent, similar long-term outcomes compared to CH. For advanced grades of hemorrhoids, Doppler-guided THD could be a valuable alternative, but there is a need for patients’ selection.Trial registration(retrospectively registered) researchregistry3090.

Purpose-The purpose of this paper is to provide an example of Lean Six Sigma (LSS) application in research and development (R&D) organizations to eliminate waste and improve systems based on available data that in turn improves the innovative environment. Manufacturing R&D involves designing and testing innovative concepts and taking them into high-volume manufacturing. The infrastructure associated with such organizations involves experimental manufacturing lines with the ability to evaluate the result under statistical process control and configuration control. The integration of LSS process improvement methodology into the R&D organization infrastructure and operations can have a dramatic effect on reducing cost and time related to the development and delivery of new technologies and products. Design/methodology/approach-The LSS methodology was systematically implemented to eliminate waste and improve the existing process of Intel's configuration control during the development and ramp phases. The steps included an assessment of the current state through walking the process and collecting baseline data, preparing the process map to quantify waste and inefficiencies, defining the ideal state along with a realistic target, selecting and implementing the improvement actions together with realizing and documenting the improvements and finally developing and putting into place a control plan to ensure the new process is sustained. The LSS approach resulted in an efficiency improvement exceeding the target, i.e. 60 per cent reduction in idle time and waste (non-value-added activities) versus a target of 40 per cent reduction. The results also showed an increase in the stakeholder satisfaction without compromising the technical rigor of the manufacturing configuration control. Findings-The LSS case study presented in this paper provides experiences to LSS practitioners in manufacturing R&D environment where the operational excellence is to be sought in new technology and product development. Originality/value-Project leaders can use the study to help formulate strategies to cater to customer/ stakeholder satisfaction and eliminate waste while maintaining the technical rigor of the R&D environment.

Neurofibromatosis (NF) is a term that has been applied to a variety of related syndromes, characterized by neuroectodermal tumors arising within multiple organs and autosomal-dominant inheritance. Neurofibromatosis type I (NF-1), known as well as Recklinghausen's disease, is the most common type of the disease accounting 90% of the cases. We present a case of 52-year-old men with NF-1. The disease started in childhood with the appearance of multiple hyperpigmented skin macules. At the age of 46 a lot of cutaneous tumors appeared and started growing bigger all over the body surface. Because of a vision problem due to an upper left eyelid neurofibroma, the patient came for a clinical examination at the age of 52 years.

The aim of the study was to evaluate the possible relationship of the hemorheological disturbances with the clinical symptoms and some risk factors (RF) for cerebrovascular diseases (CVD). The study included 68 patients with CVD, 29 with transient ischemic attacks (TIA) and 39 with chronic unilateral cerebral infarctions (UCI) and 47 healthy control subjects. A questionnaire for RF for CVD was filled. Hemorheological variables: leucocytes, hemoglobin, hematocrit, fibrinogen (Fib), plasma (PV) and whole blood viscosity (WBV) at different shear rates by Couette rotational viscometer Contraves Low Shear 30 were investigated and the hemorheological indices of erythrocyte aggregation (IEA), erythrocyte deformability (IED) and of oxygen transport to tissues (TO 2 ) were calculated. The arterial hypertension was the most frequent RF in the examined patients'. The hemorheological investigation showed significant increase of Fib in the patients with TIA and of PV and WBV in both patients' groups. The comparative study of the hemorheological variables with the RF for CVD showed predominating significant correlations with blood pressure (systolic, diastolic and mean) values, with age, cholesterol, physical activity and the body mass index. Our study confirms the possibility the hemorheological variables to be accepted as RF for development of stroke and for its recurrences. I. Velcheva et al. / Hemorheological disturbances in cerebrovascular diseasesdementia [2,16,17,20]. In these studies the abnormal changes of the hemorheological parameters correlated with the presence of arterial hypertension, hyperlipidemia, diabetes mellitus and others [1]. Subjects and methods SubjectsA total of 68 patients with CVD, 39 with chronic unilateral cerebral infarctions (UCI) and 29 with TIA and 47 presumed healthy subjects were included in the study. All patients underwent somatic and neurological examination, ultrasound duplex scanning of the common and internal carotid arteries, CT, MRI. Also a questionnaire for risk factors for CVD was filled. The systolic (SBP) and diastolic blood pressure (DBP) in mmHg were registered. The mean arterial blood pressure (MBP) by the Wiggers formula and the body mass index (BMI) in kg/m 2 were calculated (Table 1).

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The cohort prospective comparative study investigated the efficacy of mifepristone use in patients after surgical treatment of uterine myoma. It was shown that the use of mifepristone at a dose of 50 mg/day in a continuous mode for 3 months after surgical treatment for proliferating uterine myoma led to the absence of recurrences of the disease for 2 years after the drug withdrawal. The use of mifepristone after embolization of uterine arteries allowed to significantly reduce the size of the node by 25% during 12 months and by 50% (p<0.05) after 24 months. Complex treatment of uterine myoma, including myomectomy and drug therapy with mifepristone, allowed to realize reproductive function in 46% of patients, and delivery through the natural birth canal occurred in 24% of patients.