Period Of Incapacity For Work Research Articles

Use of laser technologies in the treatment of hemorrhoids (Literature review)

Hemorrhoids are one of the most common diseases of the anorectal region, representing a serious medical and socio-economic problem that significantly affects the quality of life of patients. Surgical treatment of this pathology is necessary in cases where the patient complains of bleeding and prolapse of internal hemorrhoids, which cannot be treated with conservative methods. Traditional methods of surgical treatment of this pathology, despite their effectiveness, have a number of significant disadvantages, such as severe pain after surgery, prolonged healing of anal canal wounds, a long period of incapacity for work, as well as possible complications in the form of strictures of the anal canal, insufficiency of the rectal obturator, and anal fistulas. Recently, due to the active development of medical technology in the surgical treatment of hemorrhoids, many new minimally invasive treatment methods have appeared, including the use of lasers with different wavelengths, which have demonstrated high efficiency along with such advantages as reducing the intensity of postoperative pain syndrome, decreasing the frequency of intraoperative and early postoperative complications, as well as the possibility of outpatient implementation of these techniques. Depending on the stage of hemorrhoidal disease, as well as the type of laser radiation, various methods that affect one or both (vascular and mechanical) links in the pathogenesis of the disease are used. This article provides a review of modern literature data and analyzes the experience of using various lasers in the treatment of hemorrhoidal disease.

Radioelectronic wireless systems for non-invasive diagnostics of tubular bone fractures during body osteosynthesis

During the rehabilitation of the patient, accidental and shock loads are the main cause of aseptic loosening and damage to the elements of the fixing structure (FC). The lack of control over the formation of cartilaginous callus in the fracture zone causes an increase in the period of incapacity for work and an increase in material costs associated with the patient's stay in the hospital.The partial load on the bone is simulated, which is 25% of the calculated value and is equal to the average body weight of the patient. On the basis of the obtained data, a new method and device were developed for non-invasive detection of the initial moment of weakening or fracture of the fixing structure, detection of improper fracture fusion, diagnosis of the formation and control of cartilage callus growth, detection of the appearance of the initial moment of the inflammatory process in the patient's body and diagnosis of the causes of this process. The requirements for a possible method of non-invasive diagnosis of the condition of a tubular bone fracture are formulated. Criterion dependencies of the controlled parameters were established. The effect of random loads, which are the cause of failures of the fixing structure, has been proven. Wireless transmission of electricity and information made it possible to develop a method of non-invasive control and diagnosis of fracture of tubular bones and to establish criterion dependencies between controlled parameters. For a comprehensive diagnosis of the patient's recovery, it is sufficient to monitor the pressure at three points, the bending moment at the site of the bone fracture, the temperature of the periosteum and the temperature of any other point of the body.

Injuries after Forklift Trucks Accidents - Injury Patterns, Therapy and Outcome in the Context of the Statutory Accident Insurance.

The use of forklift trucks during work has a high accident potential. The aim of this study is to describe injury patterns, treatment and outcome after forklift truck accidents in the context of the employers' liability insurance association. Retrospective data collection of all cases between 2004 and 2019. Excluded were patients < 18 years, without follow-up or with definitive external treatment. Trauma mechanism, injury patterns and distribution, treatment, complications, time of incapacity for work, return to work and impairment of earning capacity were recorded. Of 109 patients with 110 injuries, 52.7% showed isolated injuries and 47.3% combined injuries, which affected the lower extremity in 95 cases. There were fractures in 85.5%, including 32.7% in open form. The mean length of stay was 29.1 days (range 1 - 129); an indication for surgery was seen in 80.9%. Surgical treatment required an average of 3 interventions, with significantly more operations for soft tissue closure than for the fractures (p ≤ 0.023). Amputations were necessary in 8 cases; complications occurred in 29.1%. Return to work was possible in 90%, after a mean period of incapacity for work of 33.6 weeks. A total of 40% showed a pensionable impairment of earning capacity. Accidents with forklift trucks result in complex lower extremities injuries with the need of multi-stage treatment and show relatively high complication rates. A return to work is often possible after a long period of convalescence, and a pensionable impairment of earning capacity often persists.

Comparison of Limberg Flap and Karydakis Flap Surgery for the Treatment of Patients With Pilonidal Sinus Disease: A Single-Blinded Parallel Randomized Study.

Purpose Pilonidal sinus disease is a common condition, which mostly affects young men. While various surgical techniques have been introduced for treating intergluteal pilonidal disease (IPD), controversies still exist regarding the best surgical approach. The purpose of this study was to compare the efficiency and the short-term outcomes of Limberg flap and Karydakis flap surgeries for the treatments of patients with IPD.Methods A total of 80 patients with IPD who had underwent either Karydakis flap (KF group: n = 37) or Limberg flap (LF group: n = 27) surgery between January 2015 and January 2016 at Imam Khomeini Hospital of Sari in the North of Iran were recruited for inclusion in this randomized, single-blind study.Results Compared to the KF group, the LF group showed faster complete wound healing, longer duration of surgery and hospital stay, larger wound size, and shorter period of incapacity for work. The overall patient satisfaction in the LF group was significantly higher than that in the KF group. The visual analogue scale score of pain was lower in the LF group than in the KF group. Also, the overall frequency of postoperative complications was higher in the KF group than in the LF group. Recurrence was reported in one patient from the KF group.Conclusion Given the lower rate of postoperative complications and greater cosmetic satisfaction of patients, the Limberg flap procedure should be selected, instead of the Karydakis flap procedure, as the standard technique for treating patients with IPD.

EU Directives on maternity leave

The EU Directives on maternity leave adopt a single social risk approach, focusing primarily on the protection of the delivering worker’s incapacity to work during pregnancy and after giving birth. They justify maternity leave on the basis of the vulnerability of these workers and provide for a leave of at least 14 weeks. However, recent case law of the CJEU questions whether maternity leave is consistent with this approach and respects the principle of non-discrimination on grounds of sex. This article challenges the EU Directives on maternity leave and seeks to find out to what extent they are based on a coherent single social risk approach, by examining not only EU and national legal sources but also medical literature. It concludes that the approach adopted by these Directives is not sufficiently consistent because for most women the period of incapacity for work will not last longer than 6 weeks after childbirth (puerperium), much shorter than the minimum 14-week period. The fact that maternity leave is a right of mothers and that in most instances a substantial part of the leave is only devoted to the care of the newborn is creating unsatisfactory effects on both mothers and fathers.

Pilonidal sinus: Secondary wound closure vs. Limberg flap

After excision of a pilonidal sinus, several treatment options are possible, but no gold standard has been established. A literature review revealed no study comparing the costs and time off work after either secondary wound closure or treatment with a Limberg transposition flap. The aim of this study was to focus on these aspects by analysing the patients treated at the KlinikumStadtSoest.Sixty patients with pilonidal sinus after excision were treated either by secondary wound closure or Limberg transposition flap at the KlinikumStadtSoest between 2011 and 2012. The authors analysed retrospectively the patients' demographics, cost, and satisfaction with both techniques and compared them.For secondary wound closure (group 1) 19 out of 31 patients and for Limberg transposition flap (group 2) 21 out of 29 met the inclusion criteria. Time off work following the final surgery (group 1: 69 day vs. group 2: 30 days, p = 0.046) and the number of dressing changes (group 1: 107 times vs. group 2: 16 times, p = 0.000) were significantly lower in the group of Limberg transposition flap (group 2) as well as the associated costs. The surgery-related costs were lower when treated by secondary wound closure.Plastic reconstruction with Limberg transposition flap (group 2) provides a chance to reduce the period of incapacity for work due to a shorter treatment period. With that said, patients should nonetheless be offered both techniques as the current literature does not reveal a clear benefit for either procedure.

Outpatient Phlebosurgery — a Vector of the Effective Development of Medical Assistance for the Patients Presenting with Primary Varicosie veins?

Aim — the objective of the present study was to elucidate the tendencies in the development of the surgical treatment of primary varicose veins of the lower extremities (PVVLE) in the residents of a large industrial city during the past 5 years. Material and methods. We undertook the analysis of the statistical data on the patients presenting with PVVLE and operated in a round-the-clock clinic of Ekaternburg during the period from 2009 to 2013. In addition, similar data concerning the patients with the same pathology treated at an outpatient basis in the periods between 2005 and 2007 and from 2011 to 2013 were available for analysis. Results. The total number of conventional phlebectomies performed annually varied from 1627 to 1957 (mean 1815±165). The number of open interventions for the treatment of primary varicose veins showed no tendency toward a decrease for the last 5 years. One third of the patients presenting with PVVLE have undergone the surgical treatment based at the departments of general surgery. The number of sclerotherapeutic (CT) procedures increased and reached11,777 (or 80.4% of all ambulatory interventions performed in the medical centers (MC) in 2013. The number of endovasal thermal obliterations in 2013 amounted to 2585; 74.6% of them were laser-assisted procedures. The number of minimally invasive phlebectomies performed based at one-day clinics was 340 per year. The number of surgical interventions for the treatment of decompensated or complicated cases of primary varicose veins did not decrease. Traditional phlebectomy performed in a round-the-clock clinic was followed by a 40 day-long (on the average) period of incapacity for work. On the city-wide scale, the number of inability-to-work days amounted to 72,600 per year. The one-day clinics were more efficacious in this respect even though the total period of incapacity for work after surgery based at these facilities was as long as 7,400 days per year on the city-wide scale. It is concluded that the ambulatory interventions for the treatment of primary varicose veins during the last three years made it possible to save for the city 304,400 productive work days.

Radiowave ablation and mucopexy for prolapsing hemorrhoids – A pilot study

Objective The author proposes a technique of radiowave ablation and mucopexy of hemorrhoids for patients having symptomatic and prolapsing hemorrhoids and enumerates the events in such patients over 10 years. Material and method From May 1997 through December 2007, 3148 patients were included in the study. The hemorrhoids were ablated using radiowaves through a Ellman radiowave generator and were followed by suture ligation with absorbable suture material under vision. Operating time, postoperative complications, time to return to work, and outcome of the procedure were analyzed. Results The mean procedure time was 8 ± 0 min (range, 5–14 min). The mean total analgesic dose and duration of pain control using analgesics was 17 ± 5 tablets, and 10 ± 4 days respectively. The mean period of incapacity for work was 6 days [range 4–17 days]. Complications were identified in 4.8% patients. The postoperative follow-up after 4 weeks revealed therapeutic success in 3013 patients (95.7%), who presented with hemorrhoidal bleeding. Prolapse was no longer observed in 3085 (98%) of patients and 3022 (96%) patients experienced no pain after defecation. Up to December 2006, a total of 2897 patients were treated with this method. 2246 patients responded to our inquiry conducted at the beginning of 2008. Ninety-six percent of these patients confirmed that they no longer experienced any bleeding or pain during defecation and ninety-two percent patients did not had any prolapse. Conclusions This study shows that radiowave ablation followed by suture ligation of hemorrhoids is a simple, cost effective and convenient modality in treating prolapsing hemorrhoids.

Radiofrequency haemorrhoid surgery: An alternative to newer treatment of haemorrhoids

Background: The author describes his experience of treatment of advanced haemorrhoidal disease using a technique called radiofrequency ablation and plication of haemorrhoids.Patients and Methods: Both male and female patients presenting with prolapsing haemorrhoids with indications for surgery were enrolled for the study. An Ellman radiofrequency generator was used for ablation of haemorrhoids. The surgical technique and clinical follow up of patients operated by this technique is presented. Patients were initially called at 7, 14 and 30 postoperative days and then at least 2 years after the procedure. Results in terms of mean hospital stay, postoperative pain, postoperative complications, period of incapacity for work and effectiveness of the procedure are presented.Results: 1260 patients operated with this technique were assessed. The average duration of operation was 7 min (range 5–9 min). Mean hospital stay was 11 h (range 6–23 h). The immediate postoperative complication included secondary bleeding, retention of urine and perianal thrombosis. The mean period of incapacity for work was 8 days (range 6–14 days). The mean analgesic requirement was 20 tablets of Tramadol (range 14–33). At the last follow up, 2% of patients had recurrence of bleeding and 6% developed anal skin tags.Conclusion: The procedure of radiofrequency ablation and plication of haemorrhoids shows promising results in patients with advanced haemorrhoidal disease. Being safe, effective, and a swift technique, it can be proposed as an alternative to conventional surgical procedures.

Hemorrhoidal Ablation and Fixation: An Alternative Procedure for Prolapsing Hemorrhoids

Background: Many new techniques have been evolved to curb the problem of post-operative pain after hemorrhoidectomy. Stapler hemorrhoidopexy and Doppler-guided hemorrhoidal artery ligation are the two methods gaining popularity amongst proctologists. The author proposes another technique called radiofrequency ablation and fixation of hemorrhoids to add to this list. Patients and Methods: The surgical technique and clinical follow-up of 410 patients operated by this technique are presented. An Ellman radiofrequency generator was used for hemorrhoidal ablation at the output power intensity of 80. Post-defecation pain and pain at rest were assessed using a visual analogue scale. Patient satisfaction score was calculated at the mean follow-up of 60 months (range 48–72). The results in terms of mean hospital stay, post-operative pain, post-operative complications, and period of incapacity for work were compared with the published data of results of stapled hemorrhoidopexy and Doppler-guided hemorrhoidal artery ligation. Results: Pain score at first evacuation was 6. The post-defecation pain score in the first week was 4 (range 3–6) and it was 3 (range 2–5) in the second week. The mean pain score at rest in the first week was 2 (range 1–4) and 1 (range 0–2) in the second post-operative week. In the long-term follow-up at a mean of 60 months, this procedure was found in most of the cases to control prolapse, discharge, and bleeding, with no stenosis or incontinence. The recurrence rate was less than 2%. The patient satisfaction score was high. Conclusion: The results of this technique of radiofrequency ablation and fixation of hemorrhoids hold positive promises in terms of less post-operative pain, early discharge from the hospital and faster return to work. The results are comparable to stapled hemorrhoidopexy and are better than Doppler-guided hemorrhoidal artery ligation in terms of effectiveness and symptomatic relief on a long-term basis.

Treatment of hemorrhoids with circular stapler, a new alternative to conventional methods: a prospective study of 140 patients

Background: Surgical hemorrhoidectomy has a reputation for being a painful procedure. The aim of this study was to determine the efficacy and safety of a new procedure for surgical treatment of hemorrhoid disease. Study Design: From April 1998 to August 1998, 140 patients (83 men and 57 women) with an average age of 43.8 years (range 19 to 83 years) underwent hemorrhoidectomy using a circular stapler. Operative times, peri- and postoperative complications, mean hospital stay, assessment of the postoperative pain, period of incapacity for work, and functional results were collected. All patients were evaluated at 2 weeks, 2 months, and 18 months after operation. Results: The average length of the operation was 18 minutes (range 8 to 60 minutes). There were no perioperative complications. The postoperative complication rate was 6.4% (n = 9). Mean hospital stay was 36 hours (range 8 to 72 hours). Paracetamol was the only analgesic used. Eighty-three patients (59.3%) required analgesic for less than 2 days, 45 patients (32.1%) between 2 and 7 days, and 12 patients (8.6%) more than 7 days. No patients had anal wound care. One hundred four patients had professions. The period of incapacity for work was less than 3 days for 22 patients (21.1%), between 3 and 7 days for 13 patients (12.5%), between 7 and 14 days for 62 patients (59.6%), and more than 14 days for 7 patients (6.8%). At 18 months, 95.7% of patients were fully satisfied with the results, 3.6% were somewhat satisfied (n = 4), and 0.7% were unsatisfied. Conclusions: Treatment of hemorrhoids with a circular stapler appears to be safe, effective, and rapid, causing few postoperative complications and minimal postoperative pain. At 18 months, 95.7% of the patients were fully satisfied with the results.