The prevalence of hemorrhoids in adults.

PubMed

Riss, Stefan; Weiser, Friedrich Anton; Schwameis, Katrin; Riss, Thomas; Mittlböck, Martina; Steiner, Gottfried; Stift, Anton

2012-02-01

Exact data on the prevalence of hemorrhoids are rare. Therefore, we designed a study to investigate the prevalence of hemorrhoids and associated risk factors in an adult general population. Between 2008 and 2009, consecutive patients were included in a prospective study. They attended the Austrian national wide health care program for colorectal cancer screening at four medical institutions. A flexible colonoscopy and detailed examination were conducted in all patients. Hemorrhoids were defined according to a standardized grading system. Independent variables included baseline characteristics, sociodemographic data, and health status. Potential risk factors were calculated by univariate and multivariate analysis. Of 976 participants, 380 patients (38.93%) suffered from hemorrhoids. In 277 patients (72.89%), hemorrhoids were classified as grade I, in 70 patients (18.42%) as grade II, in 31 patients (8.16%) as grade III, and in 2 patients (0.53%) as grade IV. One hundred seventy patients (44.74%) complained about symptoms associated with hemorrhoids, whereas 210 patients (55.26%) reported no symptoms. In the univariate and multivariate analysis, body mass index (BMI) had a significant effect on the occurrence of hemorrhoids with p = 0.0391 and p = 0.0282, respectively. Even when correcting for other potential risk factors, an increase in the BMI of one increased the risk of hemorrhoids by 3.5%. Hemorrhoids occur frequently in the adult general population. Notably, a considerable number of people with hemorrhoids do not complain about symptoms. In addition, a high BMI can be regarded as an independent risk factor for hemorrhoids.

Doppler-guided hemorrhoidal artery ligation does not offer any advantage over suture ligation of grade 3 symptomatic hemorrhoids.

PubMed

Gupta, P J; Kalaskar, S; Taori, S; Heda, P S

2011-12-01

Doppler-guided ligation of hemorrhoidal vessels is being proposed as a treatment of grade 2 and 3 hemorrhoids. Many researchers are coupling this procedure with mucopexy or lifting of hemorrhoids to control the prolapse more effectively. The present study was conducted in patients with 3rd-degree hemorrhoids to determine the usefulness of Doppler-guided hemorrhoidal artery ligation compared to mucopexy of prolapsing hemorrhoids and to compare it with mere mucopexy of the hemorrhoids. A double-blind, randomized controlled study was conducted on 48 consecutive patients with grade III hemorrhoids requiring surgery. The patients were randomized into two groups. Half of them were treated with ligation and mucopexy [SL], while the remaining patients underwent a Doppler-guided hemorrhoidal artery ligation followed by ligation and mucopexy [DSL]. The patients were examined by a blinded independent observer at 2, 4, and 6 weeks and at the end of 1 year after the operation to evaluate postoperative pain scores, amount of analgesics consumed, and complications encountered. The observer also assessed recurrence of hemorrhoids after 1 year. Operative time was significantly longer in the DSL group (31 min vs. 9 min P < 0.003). The postoperative pain score was significantly higher in the Doppler group [4.4 vs. 2.2, P < 0.002 (visual analogue scale)]. The mean total analgesic dose and duration of pain control using analgesics were greater and longer for the Doppler group than for the SL group (17 vs. 11 tablets, and 13 days vs. 9 days, respectively; P < 0. 01). Complications were similar in both the groups. At 1-year follow-up, the recurrence of hemorrhoids was not statistically significant in either group (4 patients in SL group and 3 patients in DSL group; P < 0.93). Suture ligation of hemorrhoids is a simple, cost-effective, and convenient modality for treating grade 3 hemorrhoids. Doppler assistance in ligating the hemorrhoidal vessels prior to hemorrhoidal

Pharmacological treatment of hemorrhoids: a narrative review.

PubMed

Altomare, Donato F; Giannini, Ivana

2013-12-01

Hemorrhoid disease is the cause of most proctologic complaints and hundreds of medical and surgical therapies have been proposed to relieve symptoms. However, the role and the correct indication of medical treatments are still controversial. Further, the utility of conservative measures are rarely scientifically supported by adequate trials. This narrative review is based on the search and analysis of full papers in English language selected from PubMed in the past 30 years using the following MeSH Editing: hemorrhoids, conservative treatment, medical treatment and hemorrhoids, pregnancy and hemorrhoids, thrombosed hemorrhoids, randomized trials and hemorrhoids, postoperative pain and hemorrhoids. Early stages (I/II degrees) of this disease could be effectively managed conservatively with several approaches as lifestyle changes, fiber supplement, topical ointments and phlebotonic drugs. The more advanced hemorrhoid stages (III/IV degrees) need some type of surgery, but medical therapy is still useful to minimize anal symptoms as a bridge-to-surgery treatment. Further, post-hemorrhoidectomy pain, hemorrhoidal crisis even in pregnancy could benefit from the adjunct of local and systemic medical treatment. This expert opinion, based also on long-lasting clinical practice, also supports the use of medical treatment in symptoms relief in patients with hemorrhoid disease.

[Surgical treatment of hemorrhoids].

PubMed

Polovinkin, V V; Savchenko, Iu P; Khmelik, V I

2002-01-01

Since 1994 in addition to standard operations for chronic and acute hemorrhoids in Krasnodar military hospital the device for suturing in removal of internal hemorrhoids has been applied. From 1994 to 2000 examination and treatment of 240 patients with hemorrhoids were carried out. In the study group (128 patients) hemorrhoidectomy was performed by the developed method, in control (112 patients)--by standard techniques. In early postoperative period significantly smaller quantity of complications were seen in the study group (8.4%) compared with control group (29.8%). Decrease of hospital stay and out-patient treatment was also seen. Relapses of the disease were not revealed in terms from one to six years after surgery. The device may be employed in simultaneous operations when concomitant anorectal diseases are present. The above results justify one-stage operations in combination of chronic hemorrhoids with anorectal diseases. The proposed device makes this surgery easier.

Pycnogenol® in postpartum symptomatic hemorrhoids.

PubMed

Belcaro, G; Gizzi, G; Pellegrini, L; Dugall, M; Luzzi, R; Corsi, M; Ippolito, E; Ricci, A; Cesarone, M R; Ledda, A; Bottari, A; Errichi, B M

2014-02-01

The aim of this registry study was to evaluate the efficacy of Pycnogenol® (Horphag Research Ltd.), a standardized extract from the French maritime pine bark, to control signs/symptoms and prevent complications associated with hemorrhoids in the months after delivery in healthy women. Women with hemorrhoids after their second pregnancy were included within the third month after pregnancy. Pycnogenol dosage was 150 mg/day for 6 months. Symptoms for 4th and 3rd degree hemorrhoids were evaluated. The registry groups were comparable. For 4th degree hemorrhoids, main symptoms were reduced after 6 months in all patients, but the group using Pycnogenol in addition to standard best management showed more improvement. In patients with 3rd degree hemorrhoids, symptoms were reduced in both management groups at 6 months; with Pycnogenol the reduction in symptoms scores was significantly better. At 6 months 18/24 subjects (75%) in the Pycnogenol group were symptom-free in comparison with 14/25 (56%) in controls. In the 4th degree hemorrhoid group, 7/10 patients (70%) in the Pycnogenol group were symptom-free at 6 months in comparison with 4/11 subjects (36%) in the best management group. No significant side effects were observed. Pycnogenol appears to positively affect hemorrhoid signs and symptoms in the months after pregnancy.

21 CFR 884.5200 - Hemorrhoid prevention pressure wedge.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hemorrhoid prevention pressure wedge. 884.5200... Devices § 884.5200 Hemorrhoid prevention pressure wedge. (a) Identification. A hemorrhoid prevention... hemorrhoids associated with vaginal childbirth. (b) Classification. Class II (special controls). The special...

21 CFR 884.5200 - Hemorrhoid prevention pressure wedge.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hemorrhoid prevention pressure wedge. 884.5200... Devices § 884.5200 Hemorrhoid prevention pressure wedge. (a) Identification. A hemorrhoid prevention... hemorrhoids associated with vaginal childbirth. (b) Classification. Class II (special controls). The special...

21 CFR 884.5200 - Hemorrhoid prevention pressure wedge.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hemorrhoid prevention pressure wedge. 884.5200... Devices § 884.5200 Hemorrhoid prevention pressure wedge. (a) Identification. A hemorrhoid prevention... hemorrhoids associated with vaginal childbirth. (b) Classification. Class II (special controls). The special...

Clinical features of hemorrhoidal disease in renal transplant recipients.

PubMed

Tallarita, T; Gurrieri, C; Cappellani, A; Corona, D; Gagliano, M; Giuffrida, G; Caglià, P; Fiamingo, P; Giaquinta, A; Sinagra, N; Zerbo, D; Virzì, G; Veroux, P; Veroux, M

2010-05-01

Hemorrhoidal disease is a frequent cause of morbidity among the general population with a reported incidence of 4.4%, but little is known about its incidence and clinical features in kidney transplant recipients. Among 116 patients who had undergone kidney transplantation and were evaluated for hemorrhoidal disease, 82 had no hemorrhoids (70.6%), 28 (24%) had grade I hemorrhoids, and 6 (5.4%) had grade II hemorrhoids at the pretransplantation evaluation. Twenty-seven out of 116 recipients (22.4%) developed grade III or IV hemorrhoids after transplantation and underwent surgery. Hemorrhoidal disease was more frequent in patients with a pretransplantation history of hemorrhoids, with a rapid weight increase in the posttransplantation period, or who were aged between 30 and 50 years. Immunosuppressive therapy may play an important role in the worsening of hemorrhoidal disease among kidney transplant recipients. A prompt diagnosis and surgical treatment, whenever necessary, is mandatory for patients with clinical signs of worsening of hemorrhoids. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Operative management of internal hemorrhoids.

PubMed

Kline, Rochelle Paris

2015-02-01

An estimated 50% of the population over age 50 years have experienced hemorrhoidal symptoms at some point in their lives. Improved surgical techniques for internal hemorrhoids can reduce postoperative pain and facilitate a quicker recovery.

Hemorrhoids: from basic pathophysiology to clinical management.

PubMed

Lohsiriwat, Varut

2012-05-07

This review discusses the pathophysiology, epidemiology, risk factors, classification, clinical evaluation, and current non-operative and operative treatment of hemorrhoids. Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions. The most common symptom of hemorrhoids is rectal bleeding associated with bowel movement. The abnormal dilatation and distortion of the vascular channel, together with destructive changes in the supporting connective tissue within the anal cushion, is a paramount finding of hemorrhoids. It appears that the dysregulation of the vascular tone and vascular hyperplasia might play an important role in hemorrhoidal development, and could be a potential target for medical treatment. In most instances, hemorrhoids are treated conservatively, using many methods such as lifestyle modification, fiber supplement, suppository-delivered anti-inflammatory drugs, and administration of venotonic drugs. Non-operative approaches include sclerotherapy and, preferably, rubber band ligation. An operation is indicated when non-operative approaches have failed or complications have occurred. Several surgical approaches for treating hemorrhoids have been introduced including hemorrhoidectomy and stapled hemorrhoidopexy, but postoperative pain is invariable. Some of the surgical treatments potentially cause appreciable morbidity such as anal stricture and incontinence. The applications and outcomes of each treatment are thoroughly discussed.

The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids.

PubMed

Giamundo, Paolo; Salfi, Raffaele; Geraci, Maria; Tibaldi, Livio; Murru, Luisa; Valente, Marco

2011-06-01

Hemorrhoid laser procedure is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by means of Doppler-guided laser coagulation. Our aim was to compare the hemorrhoid laser procedure with rubber band ligation for outpatient treatment of symptomatic hemorrhoids with moderate mucosal prolapse. This was a randomized controlled trial with balanced allocation to hemorrhoid laser procedure or rubber band ligation, with stratification by study center. This study was conducted at 2 teaching hospitals in Italy. Patients with symptomatic grade II or grade III hemorrhoids with minimal mucosal prolapse were eligible for the study. In the hemorrhoid laser procedure operation, a Doppler probe was inserted into the anal canal through a dedicated disposable proctoscope to identify the terminal branches of superior hemorrhoidal arteries approximately 3 cm above the dentate line. Five pulsed laser shots were delivered to each identified artery through the proctoscope to close the terminal branches. The procedure was repeated for each artery through clockwise rotation of the proctoscope. Absence of a Doppler signal after treatment confirmed arterial coagulation. Rubber band ligation was performed by positioning rubber bands at the base of left lateral, right anterior, and right posterior piles. No anesthesia was given for either technique. Operative time, complications, postoperative pain (visual analog scale), postoperative downgrading of hemorrhoids, resolution of symptoms, and quality of life were evaluated. A total of 60 patients (35 women, 25 men; mean age, 46 years) entered the trial and were analyzed. No significant differences between rubber band ligation and hemorrhoid laser procedure were observed in operative time or intraoperative morbidity. The median postoperative pain score was 2.9 (range, 1-5) with rubber band ligation vs 1.1 (range, 0-2) for hemorrhoid laser procedure (P < .001

21 CFR 876.4400 - Hemorrhoidal ligator.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4400 Hemorrhoidal ligator. (a... of a ligature or band placed around the hemorrhoid. (b) Classification. Class II (performance...

Hemorrhoids: From basic pathophysiology to clinical management

PubMed Central

Lohsiriwat, Varut

2012-01-01

This review discusses the pathophysiology, epidemiology, risk factors, classification, clinical evaluation, and current non-operative and operative treatment of hemorrhoids. Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions. The most common symptom of hemorrhoids is rectal bleeding associated with bowel movement. The abnormal dilatation and distortion of the vascular channel, together with destructive changes in the supporting connective tissue within the anal cushion, is a paramount finding of hemorrhoids. It appears that the dysregulation of the vascular tone and vascular hyperplasia might play an important role in hemorrhoidal development, and could be a potential target for medical treatment. In most instances, hemorrhoids are treated conservatively, using many methods such as lifestyle modification, fiber supplement, suppository-delivered anti-inflammatory drugs, and administration of venotonic drugs. Non-operative approaches include sclerotherapy and, preferably, rubber band ligation. An operation is indicated when non-operative approaches have failed or complications have occurred. Several surgical approaches for treating hemorrhoids have been introduced including hemorrhoidectomy and stapled hemorrhoidopexy, but postoperative pain is invariable. Some of the surgical treatments potentially cause appreciable morbidity such as anal stricture and incontinence. The applications and outcomes of each treatment are thoroughly discussed. PMID:22563187

Diagnosis and management of symptomatic hemorrhoids.

PubMed

Sneider, Erica B; Maykel, Justin A

2010-02-01

Hemorrhoidal disease is a common problem that is managed by various physicians, ranging from primary care providers to surgeons. This article reviews the pathophysiology, clinical presentation, and updated treatment of hemorrhoids, including nonoperative options, office-based procedures, and surgical interventions from standard excision to stapled hemorrhoidopexy and Doppler-guided ligation. The article also covers complications and provides guidance for special circumstances, such as pregnancy, hemorrhoidal crisis, and inflammatory bowel disease. Copyright 2010 Elsevier Inc. All rights reserved.

Hemorrhoids and fistulas: new solutions to old problems.

PubMed

Rakinic, Jan; Poola, Venkateswara Prasad

2014-03-01

Symptoms thought related to hemorrhoids must be carefully considered before intervention. The first line of therapy for any hemorrhoidal complaint remains conservative management with increased fluid and fiber intake and appropriate modification of toileting behavior. Bleeding in grades 1 and 2 hemorrhoids that does not respond to this can be satisfactorily and safely managed with office-based therapies; some grade 3 hemorrhoids would also respond to this, though more treatment sessions would likely be required. Operative therapy is the best choice for management of persistently symptomatic grade 2 disease and for grades 3 and 4 symptomatic hemorrhoids as well. With proper patient selection and preparation, along with a familiarity with instrumentation and techniques, good results can be obtained with newer operative interventions for internal hemorrhoids. Outcomes must always be compared with those obtained with classic excisional hemorrhoidectomy.

A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids.

PubMed

Elmér, Solveig E; Nygren, Jonas O; Lenander, Claes E

2013-04-01

Doppler guidance in hemorrhoidal surgery has become more frequent during the past decade. The method is mainly studied in nonrandomized trials. Data from randomized controlled trials are lacking. The aim of this study was to compare early and midterm results of transanal hemorrhoidal dearterialization with anopexy to open hemorrhoidectomy. DESIGN, SETTINGS, PATIENTS, AND INTERVENTIONS: Forty patients with grade 2 to 3 hemorrhoids were randomly assigned to transanal hemorrhoidal dearterialization with anopexy (group A, n = 20) or open hemorrhoidectomy (group B, n = 20). A diary was used during the first 2 postoperative weeks. A self-reported symptom questionnaire was answered, and a clinical examination was performed preoperatively, after 2 to 4 months, and after 1 year. The main outcome measure was postoperative pain. Postoperative peak pain was lower in group A during the first week than in group B (p < 0.05), whereas no difference in overall pain was noted. More patients expressed normal well-being in group A (p = 0.045). Pain, bleeding, and the need for manual reduction of the hemorrhoids were all improved in both groups after 1 year (p < 0.05). Soiling had decreased after both methods at early follow-up. After 1 year, soiling was significantly decreased only after open hemorrhoidectomy. The grade of hemorrhoids was significantly reduced after 1 year for both methods, but there was a trend to more patients with remaining grade 2 hemorrhoids in group A (p = 0.06). There was no blinding, the sample size was small, and follow-up was for only 1 year. The questionnaire was not validated. The difference in postoperative pain between transanal hemorrhoidal dearterialization with anopexy and open hemorrhoidectomy may be less than expected based on previous literature.

Hemorrhoid laser procedure for second- and third-degree hemorrhoids: results from a multicenter prospective study.

PubMed

De Nardi, P; Tamburini, A M; Gazzetta, P G; Lemma, M; Pascariello, A; Asteria, C R

2016-07-01

The aim of our study was to assess the outcome of hemorrhoidal dearterialization, achieved by a dedicated laser energy device. From November 2012 to December 2014, 51 patients with second- or third-degree hemorrhoids were studied. The primary end point was a reduction in the bleeding rate; secondary end points were: postoperative complications, reduction in pain and prolapse, resolution of symptoms, and degree of patient's perception of improvement. The procedure was carried out as 1-day surgery. A diode laser device was employed to seal the terminal branches of the hemorrhoidal arteries, detected by a Doppler-equipped proctoscope. Follow-up was scheduled at 1 and 4 weeks, 3, 12, and 24 months. The rate and degree of symptoms was assessed with a four-point verbal rating scale. The rate of subjective symptomatic improvement was also evaluated with the Patient Global Improvement (PGI) Scale. Mean bleeding and pain scores at baseline were 2 and 0.57. All the patients were discharged on the day of surgery. Postoperative complications were bleeding (n = 4) and external hemorrhoidal thrombosis (n = 4). Mean bleeding and pain scores at 3, 12, and 24 months were significatively reduced. After 24 months, complete resolution of bleeding was observed in 28/29 patients (96.7 %), resolution of pain in all patients, and resolution of the mucosal prolapse in 15/18 patients (76.9 %). At 12-month follow-up, 86.3 % of patients reported improvement with the PGI Scale. The hemorrhoid laser procedure was effective in improving bleeding and pain symptoms in patients with grade II and III hemorrhoids.

Results of 244 consecutive patients with hemorrhoids treated with Doppler-guided hemorrhoidal artery ligation.

PubMed

Pol, Robert A; van der Zwet, Wil C; Hoornenborg, Daniel; Makkinga, Babbeth; Kaijser, Miriam; Eeftinck Schattenkerk, M; Eddes, Eric-Hans

2010-01-01

This study was designed to determine the effect of treating hemorrhoids with the Doppler-guided hemorrhoidal artery ligation (DG-HAL) procedure. From June 2005 to March 2008, 244 consecutive hemorrhoidal patients underwent hemorroidal artery ligation performed with the DG-HAL system from AMI. All patients were evaluated postoperatively with a proctologic examination and interview. Further follow-up was performed by telephone with a standardized questionnaire. When indicated, patients revisited the clinic for further examination and treatment. 244 patients were treated with DG-HAL. The mean follow-up time was 18.4 months (range 1.4-37.2). Sixty-seven percent of the patients had an improvement of symptoms after one treatment. Fifty-three patients (22%) underwent a second procedure because of persisting symptoms. Thirteen patients (25%) underwent a second DG-HAL and 40 (75%) underwent rubber band ligation. In total, 69% of the patients had a good response using the DG-HAL technique. Multivariate logistic regression analysis revealed prolapse to be an independent risk factor for persistent symptoms (OR = 2.38, 95% CI 1.10-5.15). Patients with grades 3 and 4 hemorrhoids had a higher risk of developing recurrent disease (OR = 4.94, 95% CI 0.67-36.42). DG-HAL seems to be an effective procedure for treating low-grade hemorrhoids. A resection procedure should be the treatment for patients with recurrent disease. Copyright 2010 S. Karger AG, Basel.

Risk Factors for Hemorrhoids on Screening Colonoscopy.

PubMed

Peery, Anne F; Sandler, Robert S; Galanko, Joseph A; Bresalier, Robert S; Figueiredo, Jane C; Ahnen, Dennis J; Barry, Elizabeth L; Baron, John A

2015-01-01

Constipation, a low fiber diet, sedentary lifestyle and gravidity are commonly assumed to increase the risk of hemorrhoids. However, evidence regarding these factors is limited. We examined the association between commonly cited risk factors and the prevalence of hemorrhoids. We performed a cross sectional study of participants who underwent a colonoscopy in a colorectal adenoma prevention trial and who had a detailed assessment of bowel habits, diet and activity. The presence of hemorrhoids was extracted from the subjects' colonoscopy reports. We used logistic regression to estimate odds ratios and 95% confidence intervals while adjusting for age and sex. The study included 2,813 participants. Of these, 1,074 had hemorrhoids recorded. Constipation was associated with an increased prevalence of hemorrhoids (OR 1.43, 95% CI 1.11, 1.86). Of the fiber subtypes, high grain fiber intake was associated with a reduced risk (OR for quartile 4 versus quartile 1 = 0.78, 95% CI 0.62, 0.98). We found no association when comparing gravid and nulligravida women (OR 0.93, 95% CI 0.62-1.40). Sedentary behavior was associated with a reduced risk (OR 0.80, 95% CI 0.65-0.98), but not physical activity (OR 0.83, 95% CI 0.66-1.03). Neither being overweight nor obese was associated with the presence of hemorrhoids (OR 0.89, 95% CI 0.72-1.09 and OR 0.86, 95% CI 0.70-1.06). Constipation is associated with an increased risk of hemorrhoids. Gravidity and physical activity do not appear to be associated. High grain fiber intake and sedentary behavior are associated with a decreased risk of hemorrhoids.

Matrix metalloproteinases in pathogenesis of hemorrhoidal disease.

PubMed

Kisli, Erol; Kemik, Ahu; Sümer, Aziz; Kemik, Özgür

2013-11-01

The aim of this study is to investigate the accuracy of serum matrix metalloproteinase (MMP) levels in an effort to find a reliable factor that may play an important role in pathogenesis of hemorrhoidal disease. Twenty control subjects and 21 Grade I, 19 Grade II, 20 Grade III, and 21 Grade IV patients with internal hemorrhoid were included in this prospective study. The mean ages of control subjects were 47.65 ± 6.71 standard deviation (SD) years (range, 37 to 60 years). The mean age of internal Grade I, Grade II, Grade III, and Grade IV patients with internal hemorrhoid were 48.85 ± 6.44, 47.20 ± 6.75, 44.90 ± 6.13, and 42.95 ± 3.49 SD years (ranges, 38 to 58, 38 to 60, 34 to 55, and 38 to 50 years), respectively. Ten milliliters of blood was taken from all subjects. Enzyme-linked immunosorbent assay (ELISA) for MMP-1, -2, -7, and -9 levels were performed using an ELISA kit (R&D Systems) following the manufacturer's instructions. There was an important difference between Grade I and Grade II groups in the serum levels of MMP-9 (P < 0.01). Patients with Grade III hemorrhoidal disease had significantly higher serum levels of all MMP than patients with Grade I and Grade II hemorrhoidal disease (P < 0.001). Also, patients with Grade 4 hemorrhoidal disease had higher serum levels of MMP-7 and -9 according to Grade I, II, and III groups (P < 0.01, 0.001). High serum levels of MMP are present in patients with hemorrhoids, suggesting the possible mechanism in the pathogenesis of hemorrhoids.

THD Doppler procedure for hemorrhoids: the surgical technique.

PubMed

Ratto, C

2014-03-01

Transanal hemorrhoidal dearterialization (THD) is an effective treatment for hemorrhoidal disease. The ligation of hemorrhoidal arteries (called "dearterialization") can provide a significant reduction of the arterial overflow to the hemorrhoidal piles. Plication of the redundant rectal mucosa/submucosa (called "mucopexy") can provide a repositioning of prolapsing tissue to the anatomical site. In this paper, the surgical technique and perioperative patient management are illustrated. Following adequate clinical assessment, patients undergo THD under general or spinal anesthesia, in either the lithotomy or the prone position. In all patients, distal Doppler-guided dearterialization is performed, providing the selective ligation of hemorrhoidal arteries identified by Doppler. In patients with hemorrhoidal/muco-hemorrhoidal prolapse, the mucopexy is performed with a continuous suture including the redundant and prolapsing mucosa and submucosa. The description of the surgical procedure is complemented by an accompanying video (see supplementary material). In long-term follow-up, there is resolution of symptoms in the vast majority of patients. The most common complication is transient tenesmus, which sometimes can result in rectal discomfort or pain. Rectal bleeding occurs in a very limited number of patients. Neither fecal incontinence nor chronic pain should occur. Anorectal physiology parameters should be unaltered, and anal sphincters should not be injured by following this procedure. When accurately performed and for the correct indications, THD is a safe procedure and one of the most effective treatments for hemorrhoidal disease.

[Latex ligation in treatment of chronic hemorrhoids].

PubMed

Ektov, V N; Somov, K A

2015-01-01

We analyzed the results of treatment of 432 patients with chronic hemorrhoids using different variants of latex ligation. New technique including ligation of mucosa and submucosa of low-ampullar rectum providing ligation of hemorrhoidalvessels, lifting and recto-anal repair is developed and suggested. This method is advisable to use in case of chronic internal hemorrhoids stages I and II. The authors recommend simultaneous combined ligation of mucosa of low-ampullar rectum and internal hemorrhoids for stages III and IV. Different variants of latex ligation with external hemorrhoids excision were used in 103 patients. Pointed variants of latex ligation preserve important advantages including mini-invasiveness, simplicity and wide availability, low cost. Good remote results were obtained after these procedures in 87.3% of observations. Suggested tactics extends use of latex ligation and increases its effectiveness in treatment of different stages and forms of chronic hemorrhoids.

Risk Factors for Hemorrhoids on Screening Colonoscopy

PubMed Central

Peery, Anne F.; Sandler, Robert S.; Galanko, Joseph A.; Bresalier, Robert S.; Figueiredo, Jane C.; Ahnen, Dennis J.; Barry, Elizabeth L.; Baron, John A.

2015-01-01

Background Constipation, a low fiber diet, sedentary lifestyle and gravidity are commonly assumed to increase the risk of hemorrhoids. However, evidence regarding these factors is limited. We examined the association between commonly cited risk factors and the prevalence of hemorrhoids. Methods We performed a cross sectional study of participants who underwent a colonoscopy in a colorectal adenoma prevention trial and who had a detailed assessment of bowel habits, diet and activity. The presence of hemorrhoids was extracted from the subjects’ colonoscopy reports. We used logistic regression to estimate odds ratios and 95% confidence intervals while adjusting for age and sex. Results The study included 2,813 participants. Of these, 1,074 had hemorrhoids recorded. Constipation was associated with an increased prevalence of hemorrhoids (OR 1.43, 95% CI 1.11, 1.86). Of the fiber subtypes, high grain fiber intake was associated with a reduced risk (OR for quartile 4 versus quartile 1 = 0.78, 95% CI 0.62, 0.98). We found no association when comparing gravid and nulligravida women (OR 0.93, 95% CI 0.62–1.40). Sedentary behavior was associated with a reduced risk (OR 0.80, 95% CI 0.65–0.98), but not physical activity (OR 0.83, 95% CI 0.66–1.03). Neither being overweight nor obese was associated with the presence of hemorrhoids (OR 0.89, 95% CI 0.72–1.09 and OR 0.86, 95% CI 0.70–1.06). Conclusions Constipation is associated with an increased risk of hemorrhoids. Gravidity and physical activity do not appear to be associated. High grain fiber intake and sedentary behavior are associated with a decreased risk of hemorrhoids. PMID:26406337

Doppler-guided hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) for the treatment of grade IV hemorrhoids: long-term results in 100 consecutive patients.

PubMed

Faucheron, Jean-Luc; Poncet, Gilles; Voirin, David; Badic, Bogdan; Gangner, Yves

2011-02-01

Doppler-guided hemorrhoidal artery ligation is a minimally invasive technique for the treatment of symptomatic hemorrhoids that has been applied successfully for grade II and III hemorrhoids but is less effective for grade IV hemorrhoids. Development of a special proctoscope enabled the combination of hemorrhoidal artery ligation with transanal rectoanal repair (mucopexy), which serves to lift and then secure the protruding hemorrhoids in place. The purpose of this study was to describe our experience with this combined procedure in the treatment of grade IV hemorrhoids. Prospective observational study. Outpatient colorectal surgery unit. Consecutive patients with grade IV hemorrhoids treated from April 2006 to December 2008. Hemorrhoidal artery ligation-rectoanal repair. Operating time, number of ligations, number of mucopexies and associated procedures, and postoperative symptoms were recorded. Pain was graded on a visual analog scale. Follow-up was at 2, 6, and 12 months after surgery, and then annually. A total of 100 consecutive patients (64 women, 36 men) with grade IV hemorrhoids were included. Preoperative symptoms were bleeding in 80 and pain in 71 patients; 19 patients had undergone previous surgical treatment for the disease. The mean operative time was 35 (range, 17-60) minutes, with a mean of 9 (range, 4-14) ligations placed per patient. Eighty-four patients were discharged on the day of the operation. Nine patients developed early postoperative complications: pain in 6, bleeding in 4, dyschezia in 1, and thrombosis of residual hemorrhoids in 3. Late complications occurred in 4 patients and were managed conservatively. Recurrence was observed in 9 patients (9%), with a mean follow-up of 34 (range, 14-42) months. The 2 main weaknesses of the study were the lack of very long-term follow-up and the absence of a comparison with hemorrhoidectomy or hemorrhoidopexy. Doppler-guided hemorrhoidal artery ligation with rectoanal repair is safe, easy to perform

[Comparison of anorectal pressure after procedure for prolapse and hemorrhoids versus Doppler-guided hemorrhoidal artery ligation for grade III hemorrhoids].

PubMed

Dong, Xiao-ni; Tang, Ying-chun

2013-12-01

To compare the long-term anorectal manometry of patients with grade III hemorrhoids treated by procedure for prolapse and hemorrhoids (PPH) or Doppler-guided hemorrhoidal artery ligation (DGHAL). A total of 114 patients with grade III hemorrhoids in our department in 2010 were prospectively enrolled, and divided into PPH group (63 cases) and DGHAL group (51 cases) according to patient preference. Patients received anorectal pressure examination 2, 6, 12, 18 months after operation, including rectal resting pressure, anal resting pressure, maximal anal contractive pressure and length of high-pressure band. Anorectal manometries between two procedure groups were compared. In every time point of follow-up, as compared to PPH group, DGHAL group presented higher anal resting pressure[postoperative 2 months: (56.2±2.6) mmHg vs. (43.2±3.1) mmHg, postoperative 6 months: (55.2±2.1) mmHg vs. (45.1±2.5) mmHg, postoperative 12 months: (53.2±3.0) mmHg vs. (40.2±3.2) mmHg, postoperative 18 months: (55.3±2.6) mmHg vs. (43.2±2.5) mmHg, all P<0.01], and longer length of high-pressure band [postoperative 2 months: (3.45±0.14) cm vs. (2.95±0.22) cm, postoperative 6 months: (3.46±0.12) cm vs. (2.94±0.26) cm, postoperative 12 months: (3.45±0.12) cm vs. (3.01±0.21) cm, postoperative 18 months: (3.56±0.12) cm vs. (3.02±0.23) cm, all P<0.01]. While no significant differences of maximal anal contractive pressure and rectal resting pressure were found between the two groups. Both PPH and DGHAL are safe procedures and have similar efficacy in the treatment of grade III hemorrhoids, while DGHALpossesses better efficacy in the time of anal function recovery and the maintenance of anal function.

Long-term outcome and efficacy of endoscopic hemorrhoid ligation for symptomatic internal hemorrhoids

PubMed Central

Su, Ming-Yao; Chiu, Cheng-Tang; Lin, Wei-Pin; Hsu, Chen-Ming; Chen, Pang-Chi

2011-01-01

AIM: To assess the long-term outcome of endoscopic hemorrhoid ligation (EHL) for the treatment of symptomatic internal hemorrhoids. METHODS: A total of 759 consecutive patients (415 males and 344 females) were enrolled. Clinical presentations were rectal bleeding (593 patients) and mucosal prolapse (166 patients). All patients received EHL at outpatient clinics. Hemorrhoid severity was classified by Goligher’s grading. The mean follow-up period was 55.4 mo (range, 45-92 mo). RESULTS: The number of band ligations averaged 2.35 in the first session for bleeding and 2.69 for prolapsed patients. Bleeding was controlled in 587 (98.0%) patients, while prolapse was reduced in 137 (82.5%) patients. After treatment, 93 patients experienced anal pain and 48 patients had mild bleeding. Patient subjective satisfaction was 93.6%. Repeat treatment or surgery was performed if symptoms were not relieved in the first session. In the bleeding group, the recurrence rate was 3.7% (22 patients) at 1 year, and 6.6% and 13.0% at 2 and 5 years. In the prolapsed group, the recurrence rate was 3.0%, 9.6% and 16.9% at 1, 2 and 5 years, respectively. CONCLUSION: EHL is an easy and well-tolerated procedure for the treatment of symptomatic internal hemorrhoids, with good long-term results. PMID:21633644

Surgical Management of Hemorrhoids

PubMed Central

Agbo, S. P.

2011-01-01

Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding. PMID:22413048

Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids.

PubMed

Tanaka, Shinwa; Toyonaga, Takashi; Morita, Yoshinori; Hoshi, Namiko; Ishida, Tsukasa; Ohara, Yoshiko; Yoshizaki, Tetsuya; Kawara, Fumiaki; Umegaki, Eiji; Azuma, Takeshi

2016-07-21

To evaluate the feasibility and safety of endoscopic submucosal dissection (ESD) for lower rectal lesions with hemorrhoids. The outcome of ESD for 23 lesions with hemorrhoids (hemorrhoid group) was compared with that of 48 lesions without hemorrhoids extending to the dentate line (non-hemorrhoid group) during the same study period. Median operation times (ranges) in the hemorrhoid and non-hemorrhoid groups were 121 (51-390) and 130 (28-540) min. The en bloc resection rate and the curative resection rate in the hemorrhoid group were 96% and 83%, and they were 100% and 90% in the non-hemorrhoid group, respectively. In terms of adverse events, perforation and postoperative bleeding did not occur in both groups. In terms of the clinical course of hemorrhoids after ESD, the rate of complete recovery of hemorrhoids after ESD in lesions with resection of more than 90% was significantly higher than that in lesions with resection of less than 90%. ESD on lower rectal lesions with hemorrhoids could be performed safely, similarly to that on rectal lesions extending to the dentate line without hemorrhoids. In addition, all hemorrhoids after ESD improved to various degrees, depending on the resection range.

Segmentation of Dilated Hemorrhoidal Veins in Hemorrhoidal Disease.

PubMed

Díaz-Flores, Lucio; Gutiérrez, Ricardo; González-Gómez, Miriam; García, Pino; Sáez, Francisco J; Díaz-Flores, Lucio; Carrasco, José Luis; Madrid, Juan F

2018-06-18

Vein segmentation is a vascular remodeling process mainly studied in experimental conditions and linked to hemodynamic factors, with clinical implications. The aim of this work is to assess the morphologic characteristics, associated findings, and mechanisms that participate in vein segmentation in humans. To this end, we examined 156 surgically obtained cases of hemorrhoidal disease. Segmentation occurred in 65 and was most prominent in 15, which were selected for serial sections, immunohistochemistry, and immunofluorescence procedures. The dilated veins showed differently sized spaces, separated by thin septa. Findings associated with vein segmentation were: (a) vascular channels formed from the vein intima endothelial cells (ECs) and located in the vein wall and/or intraluminal fibrin, (b) vascular loops formed by interconnected vascular channels (venous-venous connections), which encircled vein wall components or fibrin and formed folds/pillars/papillae (FPPs; the encircling ECs formed the FPP cover and the encircled components formed the core), and (c) FPP splitting, remodeling, alignment, and fusion, originating septa. Thrombosis was observed in some nonsegmented veins, while the segmented veins only occasionally contained thrombi. Dense microvasculature was also present in the interstitium and around veins. In conclusion, the findings suggest that hemorrhoidal vein segmentation is an adaptive process in which a piecemeal angiogenic mechanism participates, predominantly by intussusception, giving rise to intravascular FPPs, followed by linear rearrangement, remodeling and fusion of FPPs, and septa formation. Identification of other markers, as well as the molecular bases, hemodynamic relevance, and possible therapeutic implications of vein segmentation in dilated hemorrhoidal veins require further studies. © 2018 S. Karger AG, Basel.

Myofibrotic malformation vessels: unique angiodysplasia toward the progression of hemorrhoidal disease

PubMed Central

Li, Sheng-Long; Jing, Fang-Yan; Ma, Li-Li; Guo, Li-Li; Na, Feng; An, Sheng-Li; Ye, Yan; Yang, Jun-Ming; Bao, Ming; Kang, Dong; Sun, Xiao-Lan; Deng, Yong-Jian

2015-01-01

Background The etiology and pathogenesis of hemorrhoids is unclear, although hemorrhoids are a worldwide disease in men and women, with peak prevalence at 45–65 years of age. Hemorrhoidal cushions as the anal venous plexi are normal anatomical structures from infancy. This study attempts to reveal the angiodysplasia and other pathological changes in association with different degrees of symptomatic hemorrhoids. Materials and methods A total of 281 patients with internal hemorrhoids from degree I to IV underwent hemorrhoidectomy. The vascular changes were analyzed by microscopic assessment and software analysis, with Masson’s trichrome, CD34, and smooth muscle actin. Results The hemorrhoidal tissues exhibited abnormal vessels in the mucosae and submucosae that we termed them as myofibrotic malformation vessels (MMVs). MMVs are not ascribed to arteries or veins because they exhibit enlarged and tortuous lumens with smooth muscle dysplasia and fibrotic deposition in the walls without overlying mucosal ulceration. The muscularis mucosae also showed smooth muscle dysplasia and fibrosis, even if it were interrupted by the intruding MMVs. The statistical data indicated that the severity of all the changes correlate positively with the progression of hemorrhoids (P<0.001). Hemorrhoidal patients are prone for reoccurrence even with prolapsing hemorrhoid when compared with the conventional hemorrhoidectomy. Multiple logistic regression analysis showed that MMVs in mucosal propria, mean thickness of mucosal muscularis layer, and fibrotic changes in MMV were independent risk factors for MMVs in hemorrhoidal disease. Conclusion MMVs and muscularis mucosae dysplasia reciprocally contribute to hemorrhoidal exacerbation. The novel findings of this study propose that the characteristic features of MMVs and muscularis mucosae dysplasia of the anorectal tube ultimately cause symptomatic hemorrhoids, which could affect the clinical management of hemorrhoidal disease through the

Myofibrotic malformation vessels: unique angiodysplasia toward the progression of hemorrhoidal disease.

PubMed

Li, Sheng-Long; Jing, Fang-Yan; Ma, Li-Li; Guo, Li-Li; Na, Feng; An, Sheng-Li; Ye, Yan; Yang, Jun-Ming; Bao, Ming; Kang, Dong; Sun, Xiao-Lan; Deng, Yong-Jian

2015-01-01

The etiology and pathogenesis of hemorrhoids is unclear, although hemorrhoids are a worldwide disease in men and women, with peak prevalence at 45-65 years of age. Hemorrhoidal cushions as the anal venous plexi are normal anatomical structures from infancy. This study attempts to reveal the angiodysplasia and other pathological changes in association with different degrees of symptomatic hemorrhoids. A total of 281 patients with internal hemorrhoids from degree I to IV underwent hemorrhoidectomy. The vascular changes were analyzed by microscopic assessment and software analysis, with Masson's trichrome, CD34, and smooth muscle actin. The hemorrhoidal tissues exhibited abnormal vessels in the mucosae and submucosae that we termed them as myofibrotic malformation vessels (MMVs). MMVs are not ascribed to arteries or veins because they exhibit enlarged and tortuous lumens with smooth muscle dysplasia and fibrotic deposition in the walls without overlying mucosal ulceration. The muscularis mucosae also showed smooth muscle dysplasia and fibrosis, even if it were interrupted by the intruding MMVs. The statistical data indicated that the severity of all the changes correlate positively with the progression of hemorrhoids (P<0.001). Hemorrhoidal patients are prone for reoccurrence even with prolapsing hemorrhoid when compared with the conventional hemorrhoidectomy. Multiple logistic regression analysis showed that MMVs in mucosal propria, mean thickness of mucosal muscularis layer, and fibrotic changes in MMV were independent risk factors for MMVs in hemorrhoidal disease. MMVs and muscularis mucosae dysplasia reciprocally contribute to hemorrhoidal exacerbation. The novel findings of this study propose that the characteristic features of MMVs and muscularis mucosae dysplasia of the anorectal tube ultimately cause symptomatic hemorrhoids, which could affect the clinical management of hemorrhoidal disease through the use of surgery to target the malformed vessels.

Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids

PubMed Central

Tanaka, Shinwa; Toyonaga, Takashi; Morita, Yoshinori; Hoshi, Namiko; Ishida, Tsukasa; Ohara, Yoshiko; Yoshizaki, Tetsuya; Kawara, Fumiaki; Umegaki, Eiji; Azuma, Takeshi

2016-01-01

AIM: To evaluate the feasibility and safety of endoscopic submucosal dissection (ESD) for lower rectal lesions with hemorrhoids. METHODS: The outcome of ESD for 23 lesions with hemorrhoids (hemorrhoid group) was compared with that of 48 lesions without hemorrhoids extending to the dentate line (non-hemorrhoid group) during the same study period. RESULTS: Median operation times (ranges) in the hemorrhoid and non-hemorrhoid groups were 121 (51-390) and 130 (28-540) min. The en bloc resection rate and the curative resection rate in the hemorrhoid group were 96% and 83%, and they were 100% and 90% in the non-hemorrhoid group, respectively. In terms of adverse events, perforation and postoperative bleeding did not occur in both groups. In terms of the clinical course of hemorrhoids after ESD, the rate of complete recovery of hemorrhoids after ESD in lesions with resection of more than 90% was significantly higher than that in lesions with resection of less than 90%. CONCLUSION: ESD on lower rectal lesions with hemorrhoids could be performed safely, similarly to that on rectal lesions extending to the dentate line without hemorrhoids. In addition, all hemorrhoids after ESD improved to various degrees, depending on the resection range. PMID:27468216

Sonographic appearance of anal cushions of hemorrhoids

PubMed Central

Aimaiti, Adilijiang; A Ba Bai Ke Re, Ma Mu Ti Jiang; Ibrahim, Irshat; Chen, Hui; Tuerdi, Maimaitituerxun; Mayinuer

2017-01-01

AIM To evaluate the diagnostic value of different sonographic methods in hemorrhoids. METHODS Forty-two healthy volunteers and sixty-two patients with grades I-IV hemorrhoids received two different sonographic examinations from January 2013 to January 2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way. We analyzed the ultrasonographic findings of these participants and evaluated the outcomes. Resected grades III and IV hemorrhoid tissues were pathologically examined. The concordance of ultrasonographic results with pathology results was assessed with the Cohen’s kappa coefficient. RESULTS All healthy volunteers and all patients had no particular complications related to sonography. There were no statistically significant differences between the participants regarding age (P = 0.5919), gender (P = 0.4183), and persistent symptoms (P > 0.8692). All healthy control participants had no special findings. However, 30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography. When grades I and II hemorrhoids were analyzed, there were no significant differences between transrectal ultrasound (TRUS), transperianal ultrasound (TPUS), and transvaginal ultrasound (TVUS) (P > 0.05). Grades III and IV hemorrhoids revealed blood flow with different directions which could be observed as a “mosaic pattern”. In patients with grades III and IV hemorrhoids, the number of patients with “mosaic pattern” as revealed by TRUS, TPUS and TVUS was 22, 12, and 4, respectively. Patients with grades III and IV disease presented with a pathologically abnormal cushion which usually appeared as a “mosaic pattern” in TPUS and an arteriovenous fistula in pathology. Subepithelial vessels of resected grades III and IV hemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina. Some parts of the Trietz’s muscle showed hypertrophy and distortion

Sonographic appearance of anal cushions of hemorrhoids.

PubMed

Aimaiti, Adilijiang; A Ba Bai Ke Re, Ma Mu Ti Jiang; Ibrahim, Irshat; Chen, Hui; Tuerdi, Maimaitituerxun; Mayinuer

2017-05-28

To evaluate the diagnostic value of different sonographic methods in hemorrhoids. Forty-two healthy volunteers and sixty-two patients with grades I-IV hemorrhoids received two different sonographic examinations from January 2013 to January 2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way. We analyzed the ultrasonographic findings of these participants and evaluated the outcomes. Resected grades III and IV hemorrhoid tissues were pathologically examined. The concordance of ultrasonographic results with pathology results was assessed with the Cohen's kappa coefficient. All healthy volunteers and all patients had no particular complications related to sonography. There were no statistically significant differences between the participants regarding age ( P = 0.5919), gender ( P = 0.4183), and persistent symptoms ( P > 0.8692). All healthy control participants had no special findings. However, 30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography. When grades I and II hemorrhoids were analyzed, there were no significant differences between transrectal ultrasound (TRUS), transperianal ultrasound (TPUS), and transvaginal ultrasound (TVUS) ( P > 0.05). Grades III and IV hemorrhoids revealed blood flow with different directions which could be observed as a "mosaic pattern". In patients with grades III and IV hemorrhoids, the number of patients with "mosaic pattern" as revealed by TRUS, TPUS and TVUS was 22, 12, and 4, respectively. Patients with grades III and IV disease presented with a pathologically abnormal cushion which usually appeared as a "mosaic pattern" in TPUS and an arteriovenous fistula in pathology. Subepithelial vessels of resected grades III and IV hemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina. Some parts of the Trietz's muscle showed hypertrophy and distortion. Arteriovenous fistulas and

Are Hemorrhoids Associated with False-Positive Fecal Immunochemical Test Results?

PubMed

Kim, Nam Hee; Park, Jung Ho; Park, Dong Il; Sohn, Chong Il; Choi, Kyuyong; Jung, Yoon Suk

2017-01-01

False-positive (FP) results of fecal immunochemical tests (FITs) conducted in colorectal cancer (CRC) screening could lead to performing unnecessary colonoscopies. Hemorrhoids are a possible cause of FP FIT results; however, studies on this topic are extremely rare. We investigated whether hemorrhoids are associated with FP FIT results. A retrospective study was conducted at a university hospital in Korea from June 2013 to May 2015. Of the 34547 individuals who underwent FITs, 3946 aged ≥50 years who underwent colonoscopies were analyzed. Logistic regression analysis was performed to determine factors associated with FP FIT results. Among 3946 participants, 704 (17.8%) showed positive FIT results and 1303 (33.0%) had hemorrhoids. Of the 704 participants with positive FIT results, 165 had advanced colorectal neoplasia (ACRN) and 539 had no ACRN (FP results). Of the 1303 participants with hemorrhoids, 291 showed FP results, of whom 81 showed FP results because of hemorrhoids only. Participants with hemorrhoids had a higher rate of FP results than those without hemorrhoids (291/1176, 24.7% vs. 248/2361, 10.5%; p<0.001). Additionally, the participants with hemorrhoids as the only abnormality had a higher rate of FP results than those experiencing no such abnormalities (81/531, 15.3% vs. 38/1173, 3.2%; p<0.001). In multivariate analysis, the presence of hemorrhoids was identified as an independent predictor of FP results (adjusted odds ratio, 2.76; 95% confidence interval, 2.24-3.40; p<0.001). Hemorrhoids are significantly associated with FP FIT results. Their presence seemed to be a non-negligible contributor of FP results in FIT-based CRC screening programs.

Are Hemorrhoids Associated with False-Positive Fecal Immunochemical Test Results?

PubMed Central

Kim, Nam Hee; Park, Jung Ho; Park, Dong Il; Sohn, Chong Il; Choi, Kyuyong

2017-01-01

Purpose False-positive (FP) results of fecal immunochemical tests (FITs) conducted in colorectal cancer (CRC) screening could lead to performing unnecessary colonoscopies. Hemorrhoids are a possible cause of FP FIT results; however, studies on this topic are extremely rare. We investigated whether hemorrhoids are associated with FP FIT results. Materials and Methods A retrospective study was conducted at a university hospital in Korea from June 2013 to May 2015. Of the 34547 individuals who underwent FITs, 3946 aged ≥50 years who underwent colonoscopies were analyzed. Logistic regression analysis was performed to determine factors associated with FP FIT results. Results Among 3946 participants, 704 (17.8%) showed positive FIT results and 1303 (33.0%) had hemorrhoids. Of the 704 participants with positive FIT results, 165 had advanced colorectal neoplasia (ACRN) and 539 had no ACRN (FP results). Of the 1303 participants with hemorrhoids, 291 showed FP results, of whom 81 showed FP results because of hemorrhoids only. Participants with hemorrhoids had a higher rate of FP results than those without hemorrhoids (291/1176, 24.7% vs. 248/2361, 10.5%; p<0.001). Additionally, the participants with hemorrhoids as the only abnormality had a higher rate of FP results than those experiencing no such abnormalities (81/531, 15.3% vs. 38/1173, 3.2%; p<0.001). In multivariate analysis, the presence of hemorrhoids was identified as an independent predictor of FP results (adjusted odds ratio, 2.76; 95% confidence interval, 2.24–3.40; p<0.001). Conclusion Hemorrhoids are significantly associated with FP FIT results. Their presence seemed to be a non-negligible contributor of FP results in FIT-based CRC screening programs. PMID:27873508

Curative effect of Amorphophallus paeoniifolius tuber on experimental hemorrhoids in rats.

PubMed

Dey, Yadu Nandan; Wanjari, Manish M; Kumar, Dharmendra; Lomash, Vinay; Jadhav, Ankush D

2016-11-04

Amorphophallus paeoniifolius (Dennst.) Nicolson (Family- Araceae) is a crop of south East Asian origin. In India, its tuber is widely used in ethnomedicinal practices by different tribes for the treatment of piles (hemorrhoids). The present study evaluated the effect of methanolic and aqueous extract of Amorphophallus paeoniifolius tuber on croton oil induced hemorrhoids in rats. The methanolic extract was standardized with the major phenolic compound, betulinic acid, by HPLC. The hemorrhoids were induced by applying 6% croton oil preparation in the ano-rectal region. Rats were orally administered methanolic and aqueous extract at doses of 250 and 500mg/kg, each for 7 days. Pilex (200mg/kg) was used as reference anti-hemorrhoidal drug. Hemorrhoids were assessed on eighth day by measuring hemorrhoidal and biochemical parameters along with histology of ano-rectal tissue. Croton oil application caused induction of hemorrhoids as indicated by significant (p<0.001) increase in plasma exudation of Evans blue in ano-rectal tissue, macroscopic severity score and ano-rectal coefficient as compared to normal rats. It significantly (p<0.001) elevated lactate dehydrogenase and cytokines (TNF-α and IL-6) levels in serum and increased myeloperoxidase activity and lipid peroxidation in ano-rectal tissue along with marked histological damage as compared to normal rats. Treatment with tuber extracts and pilex significantly (p<0.05-p<0.001) ameliorated Evans blue exudation, hemorrhoidal parameters and other biochemical parameters with attenuation of tissue damage compared to hemorrhoid control rats. The results indicate that tuber extracts exhibited curative action on hemorrhoids. The aqueous extract showed more pronounced effect than methanolic extract. The effects may be attributed to anti-inflammatory and antioxidant properties. Results indicate that tuber of Amorphophallus paeoniifolius exhibited curative action on hemorrhoids through anti-inflammatory and antioxidant

[Efficacy comparison of tissue selecting therapy stapler and procedure for prolapse and hemorrhoids in the treatment of severe hemorrhoids].

PubMed

Ruan, Ning; Chen, Zhi-hua; Lin, Xia-bing

2013-07-01

To compare the efficacy and complication of tissue selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) in the treatment of severe hemorrhoids. Clinical data of 542 cases of severe hemorrhoids undergoing TST (258 cases) or PPH (284 cases) in The First Affiliated Hospital of Fujian Medical University from November 2010 to January 2012 were analyzed retrospectively. Operative parameters, efficacy and complication 3 months after operation were assessed and compared. No significant difference in cure rate between TST and PPH (96.5% vs. 95.4%) was found, while the operation time and hospital stay after operation in TST group were significantly shorter urgency [(20.6±4.7) vs. (26.4±6.3) min, (2.9±0.5) vs. (3.5±0.7) d, both P<0.05]. Incidences of postoperative pain, bleeding, anal urgency and urinary retention in TST group were significantly lower than those in PPH group (all P<0.01). No anal stenosis was observed in TST group, and 5 cases developed anal stenosis in PPH group (P<0.05). Hemorrhoid recurrence did not differ significantly between the two groups. The efficacy of TST and PPH is comparable for severe hemorrhoids patients, while TST is associated with faster postoperative recovery and less complications.

Hemorrhoids.

PubMed

Hussain, J N

1999-03-01

Hemorrhoids are one of the most frequent anorectal disorders encountered in the primary care setting. They are the most common cause of hematochezia, and are responsible for considerable patient suffering and disability. With the techniques of diagnosis and office-based interventions described in this article, the primary care provider can effectively relieve most patients' symptoms and ensure that more significant bowel disease is not overlooked.

[Necessary and unnecessary treatment options for hemorrhoids].

PubMed

Zindel, Joel; Inglin, Roman; Brügger, Lukas

2014-12-01

Up to one third of the general population suffers from symptoms caused by hemorrhoids. Conservative treatment comes first unless the patient presents with an acute hemorrhoidal prolapse or a thrombosis. A fiber enriched diet is the primary treatment option, recommended in the perioperative period as well as a long-term prophylaxis. A timely limited application of topical ointments or suppositories and/or flavonoids are further treatment options. When symptoms persist interventional procedures for grade I-II hemorrhoids, and surgery for grade III-IV hemorrhoids should be considered. Rubber band ligation is the interventional treatment of choice. A comparable efficacy using sclerosing or infrared therapy has not yet been demonstrated. We therefore do not recommend these treatment options for the cure of hemorrhoids. Self-treatment by anal insertion of bougies is of lowrisk and may be successful, particularly in the setting of an elevated sphincter pressure. Anal dilation, sphincterotomy, cryosurgery, bipolar diathermy, galvanic electrotherapy, and heat therapy should be regarded as obsolete given the poor or missing data reported for these methods. For a long time, the classic excisional hemorrhoidectomy was considered to be the gold standard as far as surgical procedures are concerned. Primary closure (Ferguson) seems to be superior compared to the "open" version (Milligan Morgan) with respect to postoperative pain and wound healing. The more recently proposed stapled hemorrhoidopexy (Longo) is particularly advisable for circular hemorrhoids. Compared to excisional hemorrhoidectomy the Longo-operation is associated with reduced postoperative pain, shorter operation time and hospital stay as well as a faster recovery, with the disadvantage though of a higher recurrence rate. Data from Hemorrhoidal Artery Ligation (HAL)-, if appropriate in combination with a Recto-Anal Repair (HAL/RAR)-, demonstrates a similar trend towards a better tolerance of the procedure at the

Doppler-guided hemorrhoidal artery ligation (DG-HAL): a safe treatment of II-III degree hemorrhoids for all patients. Could it be potentially also good prophylaxis?

PubMed

Testa, A; Torino, G

2010-06-01

Doppler-guided hemorrhoidal artery ligation (HAL Doppler) is an innovative hemorrhoid treatment mainly utilised for II-III degree where bleeding is a predominant symptom. This procedure aims at dearterialization of the internal hemorrhoidal plexus by ligation of the terminal branches of the superior rectal artery detected using a special proctoscope and ultrasound system; the procedure is performed entirely above the dentate line, so it is genuinely painless. The aim of this study was to evaluate the efficacy, safety and invasivity of HAL Doppler technique to treat II and III degree hemorrhoids. The authors treated 148 patients, from May 2002 to December 2007, principally affected by II-III degree hemorrhoids characterized by bleeding and pain at evacuation. These patients were examined in a retrospective observational study of 128 patients, 86% of the group. Follow-up varied from 5 up to 72 months with an average observation time of 36.5 months. Success was registered in 90% of patients affected by II-III degree hemorrhoids and the absence of major complications (hemorrhage, incontinence, stenosis, perforation, sepsis). The authors suggest the safety, efficacy and low invasity of HAL Doppler for treatment of II-III degree hemorrhoids, which also found in the literature, and highlight its use in treating patients with unhealthy conditions which are a contraindication to the usual surgical treatments. Moreover, they suppose the use of HAL Doppler in low degree hemorrhoids as a therapeutic and also prophylactic rule of advanced degree.

Distal Hemorrhoidectomy With ALTA Injection: A New Method for Hemorrhoid Surgery

PubMed Central

Abe, Tatsuya; Hachiro, Yoshikazu; Ebisawa, Yoshiaki; Hishiyama, Houhei; Kunimoto, Masao

2014-01-01

Aluminum potassium sulfate and tannic acid injection (ALTA) is a useful and less-invasive treatment for internal hemorrhoids. However, it is not a treatment option for external hemorrhoidal diseases, including mixed hemorrhoids. Distal hemorrhoidectomy with ALTA injection involves surgical resection of external piles, followed by injection therapy on internal piles. We report technical details and the short-term results of this procedure in patients with mixed hemorrhoids. Seventy-two patients with mixed hemorrhoids treated between 2010 and 2011 were included. The main outcome measures were the short-term response and complication rates. At 28 days after surgery, the disappearance rate of prolapse was 100%. Three patients (4%) had postoperative complications, all minor in nature. No prolapse recurrence was observed within a median follow-up period of 6 months. Distal hemorrhoidectomy with ALTA injection appears to be a promising treatment option for patients with mixed hemorrhoids. PMID:24833156

[Study on the tectology change of rectum wall above the hemorrhoids].

PubMed

Zhang, Li; Yang, Bin; Zhang, Yu-Chao; Fu, Yu-Ru; Chen, Shuang

2009-06-15

To investigate the histomorphological characteristics and its significance of rectum wall above hemorrhoids. Tissues of rectum wall above hemorrhoids were obtained after stapled hemorrhoidopexy from 21 patients with grade III-IV internal hemorrhoids. Seven macroscopically normal rectal tissues collected from upper rectal cancer patients without a history of hemorrhoids served as control. Masson trichrome staining was performed for detecting smooth muscles and collagen in the tissues. The expression of type III collagen was detected by using immunohistochemical staining in the two groups. Morphological abnormalities, such as fragment, rupture, disorganization were found in smooth muscle of proximal rectal tissues above the piles, and it was statistically different from the distal rectal tissues above the piles and control tissues (all P < 0.05). Moreover, hyperplasia of type III collagen in both muscularis mucosa and rectum wall in tissues above hemorrhoids were observed, no such changes was found in the control tissues. The range of pathological changes in hemorrhoids is beyond the anal cushions. The pathological changes of the smooth muscle and the type III collagen in the tissues above the piles are the pathological basis of hemorrhoids.

ALTA injection sclerosing therapy:non-excisional treatment of internal hemorrhoids.

PubMed

Miyamoto, Hidenori; Asanoma, Michihito; Miyamoto, Hideyuki; Shimada, Mitsuo

2012-01-01

Aluminum potassium sulfate and tannic acid (ALTA) is a new sclerosing therapy for internal hemorrhoids. This injection therapy is a four-step direct injection sclerosing procedure intended to shrink and harden internal hemorrhoids to eliminate hemorrhoidal prolapse and bleeding. The aim of this study was to assess the short term efficacy of this treatment. The procedure was conducted using a four-step injection process under perianal local anesthesia. The entry point for the four-step injection of ALTA is the submucosa of the superior pole, the submucosa in the central part, the mucous lamina propria in the central part and the submucosa at the inferior pole of hemorrhoid. From January 2009 to March 2010, we performed the ALTA sclerosing therapy on 28 patients (14 men and 14 women; mean age, 64.6 years), including 5 second-degree, 16 third-degree and 7 fourth-degree hemorrhoids. There were 6 postoperative complications (2 cases of low grade fever, 2 anal pains, 1 necrosis at injection site and 1 perianal dermatitis). All symptoms of prolapse or bleeding disappeared after 29 postoperative days. There were 3 recurrent cases (10.7%). ALTA sclerosing therapy is a useful and less invasive treatment for internal hemorrhoids.

Infrared coagulation: a new treatment for hemorrhoids

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leicester, R.J.; Nicholls, R.J.; Mann, C.V.

Many methods, which have effectively reduced the number of patients requiring hospital admission, have been described for the outpatient treatment of hemorrhoids. However, complications have been reported, and the methods are often associated with unpleasant side effects. In 1977 Neiger et al. described a new method that used infrared coagulation, which produced minimal side effects. The authors have conducted a prospective, randomized trial to evaluate infrared coagulation compared with more traditional methods of treatment. The authors' results show that it may be more effective than injection sclerotherapy in treating non-prolapsing hemorrhoids and that it compares favorably with rubber band ligationmore » in most prolapsing hemorrhoids. No complications occurred, and significantly fewer patients experienced pain after infrared coagulation (P . less than 0.001).« less

[Therapy of hemorrhoidal disease].

PubMed

Herold, A

2006-08-01

Hemorrhoidal disease is one of the most frequent disorders in western countries. The aim of individual therapy is freedom from symptoms achieved by normalisation of anatomy and physiology. Treatment is orientated to the stage of disease: haemorrhoids 1 are treated conservatively. In addition to high-fibre diet, sclerotherapy is used. Haemorrhoids 2 prolapse during defecation and return spontaneously. First-line treatment is rubber band ligation. Haemorrhoids 3 that prolapse during defecation have to be digitally reduced, and the majority need surgery. For segmental disorders, haemorrhoidectomy according to Milligan-Morgan or Ferguson is recommended. In circular disease, Stapler hemorrhoidopexy is now the procedure of choice. Using a therapeutic regime according to the hemorrhoidal disease classification offers high healing rates and low rates of complications and recurrence.

[Rubber band ligation in treatment of hemorrhoids: our experience].

PubMed

Gaj, F; Biviano, I; Sportelli, G; Candeloro, L

2015-01-01

Hemorrhoids are a very common condition. The treatment depends upon persistence and severity of symptoms. For hemorrhoids of II and III grade the rubber band ligation may be therapeutic. Our aim is to report the outcomes of rubber band ligation of hemorrhoids, with a follow up of 6 months. A total of 50 patients underwent rubber band ligation for symptomatic hemorrhoids (grade II and III) without prolapse, between June 2012 and June 2014. All patients underwent plug test to rule out presence of rectal mucosal prolapse and were classified according to PATE classification (1). Each hemorrhoid was ligated with one rubber band through a ligator. All patients were evaluated immediately at the end of the procedure, after ten days and six months after the treatment. Patient's demographic and operative data were collected and analyzed. The mean patients age was 47.6±12.3 years (range 24-72). All procedures were performed without complications. Before rubber band ligation, 42 patients had rectal bleeding, 38 had perineal discomfort and 27 had itching. Ten days after the treatment, 12 patients presented self-limited rectal bleeding, but 10 of these had more hemorrhoids and underwent a second rubber band ligation. No patients complained perineal discomfort, and 8 patients had itching; 78% and 16% of patients respectively, experienced feeling of a foreign body inside the canal anal and anal pain. After 6 months, only 13 patients were occasionally symptomatic: 4 patients had rectal bleeding, 2 had perineal discomfort and 4 had itching. Three more patients presented both perineal discomfort and hitching. None had the feeling of a foreign body in anal canal or anal pain. Rubber band ligation is an efficacious, cost-effective and simple treatment for the second and third degree hemorrhoids without rectal mucosal prolapsed. In our hands, no severe complications developed and minor complications could be handled with ease.

Partial stapled hemorrhoidopexy: a minimally invasive technique for hemorrhoids.

PubMed

Lin, Hong-Cheng; He, Qiu-Lan; Ren, Dong-Lin; Peng, Hui; Xie, Shang-Kui; Su, Dan; Wang, Xiao-Xue

2012-09-01

This study was designed to assess the safety, efficacy, and postoperative outcomes of partial stapled hemorrhoidopexy (PSH). A prospective study was conducted between February and March 2010. PSH was performed with single-window anoscopes for single isolated hemorrhoids, bi-window anoscopes for two isolated hemorrhoids, and tri-window anoscopes for three isolated hemorrhoids or circumferential hemorrhoids. The data pertaining to demographics, preoperative characteristics and postoperative outcomes were collected and analyzed. Forty-four eligible patients underwent PSH. Single-window anoscopes were used in 2 patients, and bi- and tri-window anoscopes in 6 and 36 patients. The blood loss in patients with single-window, bi-window, and tri-window anoscopes was 6.0 ml (range 5.0-7.0 ml), 5.0 ml (range 5.0-6.5 ml), and 5.0 ml (4.5-14.5 ml) (P = 0.332). The mean postoperative visual analog scale score for pain was 3 (range, 1-4), 2 (range 1-4), 3 (range 2-6), 1 (range 0-3), 1 (range 0-2) and 2 (range 2-4) at 12 h, days 1, 2, 3, and 7, and at first defecation. The rate of urgency was 9.1%. No patients developed anal incontinence or stenosis. The 1-year recurrence rate of prolapsing hemorrhoids was 2.3%. Partial stapled hemorrhoidopexy appears to be a safe and effective technique for grade III-IV hemorrhoids. Encouragingly, PSH is associated with mild postoperative pain, few urgency episodes, and no stenosis or anal incontinence.

Hemorrhoids and varicose veins: a review of treatment options.

PubMed

MacKay, D

2001-04-01

Hemorrhoids and varicose veins are common conditions seen by general practitioners. Both conditions have several treatment modalities for the physician to choose from. Varicose veins are treated with mechanical compression stockings. There are several over-the-counter topical agents available for hemorrhoids. Conservative therapies for both conditions include diet, lifestyle changes, and hydrotherapy which require a high degree of patient compliance to be effective. When conservative hemorrhoid therapy is ineffective, many physicians may choose other non-surgical modalities: injection sclerotherapy, cryotherapy, manual dilation of the anus, infrared photocoagulation, bipolar diathermy, direct current electrocoagulation, or rubber band ligation. Injection sclerotherapy is the non-surgical treatment for primary varicose veins. Non-surgical modalities require physicians to be specially trained, own specialized equipment, and assume associated risks. If a non-surgical approach fails, the patient is often referred to a surgeon. The costly and uncomfortable nature of treatment options often lead a patient to postpone evaluation until aggressive intervention is necessary. Oral dietary supplementation is an attractive addition to the traditional treatment of hemorrhoids and varicose veins. The loss of vascular integrity is associated with the pathogenesis of both hemorrhoids and varicose veins. Several botanical extracts have been shown to improve microcirculation, capillary flow, and vascular tone, and to strengthen the connective tissue of the perivascular amorphous substrate. Oral supplementation with Aesculus hippocastanum, Ruscus aculeatus, Centella asiatica, Hamamelis virginiana, and bioflavonoids may prevent time-consuming, painful, and expensive complications of varicose veins and hemorrhoids.

Aluminum Potassium Sulfate and Tannic Acid Injection for Hemorrhoids

PubMed Central

2012-01-01

A quick hemostatic effect, as well as sclerosing and shrinkage of hemorrhoids, can be attained when internal hemorrhoids are treated by using injection therapy with aluminum potassium sulfate and tannic acid (ALTA), the outcomes of treatment may be similar to those of a hemorrhoidectomy. However, if the type of hemorrhoid or the method of injection is not appropriate for ALTA treatment, complications peculiar to ALTA or recurrence may develop. Accordingly, sufficient understanding of the treatment mechanism of ALTA injection and repeated training for injection are required for effective use of the ALTA treatment. PMID:22606645

Outcome of stapled hemorrhoidopexy versus doppler-guided hemorrhoidal artery ligation for grade III hemorrhoids.

PubMed

Avital, S; Itah, R; Skornick, Y; Greenberg, R

2011-09-01

To evaluate the long-term results, early and late complication rates, and overall satisfaction of patients with grade III hemorrhoids treated by stapled hemorrhoidopexy (SH) or Doppler-guided hemorrhoidal artery ligation (DGHAL). Operative and follow-up patients' data were prospectively collected for patients undergoing either SH or DGHAL by a single surgeon during a 2-year period. A retrospective comparison between patients' outcome operated by one of the two methods was made based on this data. Clinical data on postoperative pain, analgesic requirements, time to first bowel movement and functional recovery were collected at five postoperative follow-up visits (1 and 6 weeks, 6, 12, and 18 months). Data on patient satisfaction, recurrence of hemorrhoidal symptoms and further treatments were obtained by a standardized questionnaire that was conducted during the last visit 18 months postoperatively. A total of 63 patients underwent SH (aged 52 ± 3.2 years) and 51 patients underwent DGHAL (aged 50 ± 7.3 years). DGHAL patients experienced less postoperative pain as scored by pain during bowel movement (2.1 ± 1.4 vs. 5.5 ± 1.9 for SH), and required fewer analgesics postoperatively. Hospital stay, time to first bowel movement, and complete functional recovery were also significantly shorter for the DGHAL patients. Nine DGHAL patients (18%) suffered from persistent bleeding or prolapses and required additional treatment compared with 2 (3%) patients in the SH group. SH patients reported greater satisfaction compared with DGHAL patients at 1 year postoperatively. Both SH and DGHAL are safe procedures and have similar effectiveness for treating grade III hemorrhoids. DGHAL is less painful and provides earlier functional recovery, but is associated with higher recurrence rates and lower satisfaction rates compared with SH.

Effectiveness of hemorrhoidal treatment by rubber band ligation and infrared photocoagulation.

PubMed

Linares Santiago, E; Gómez Parra, M; Mendoza Olivares, F J; Pellicer Bautista, F J; Herrerías Gutiérrez, J M

2001-04-01

To demonstrate the effectiveness of the treatment of internal hemorrhoids with rubber band ligation (RBL) and infrared photocoagulation (IRC). From march 1996 to december 1999, we prospectively studied 358 patients with a total of 817 hemorrhoid groups and a follow-up period of 36 months. Distribution according to gender and age was: 210 men with a mean age of 46 years and 148 women with a mean age 45.8 years. The mean number of hemorrhoids treated per patients was 2.3. All of them had complete a follow-up protocol at 15, 30, 60 and 180 days and at 12, 24 and 36 months. Rubber band ligation was performed with McGown ligator and suction pump, placing the band at the base of the hemorrhoid. For the infrared coagulation we used a Lumatec coagulation system, applying at least four shoots around each hemorrhoid, with an exposition time ranging between 1 and 1.5 seconds. Treatment was considered effective when patients became asymptomatic (relief of pain, bleeding or anal itching) and the obliteration of hemorrhoids after the treatment was confirmed by anal inspection and anoscopy. Two hundred ninety five of 358 patients were treated with RBL (82.4%), this treatment being effective in 98% of the patients after 180 days and very good after 36 months. There were 6/295 relapses at 36 months (2%). All minor and major complications were observed within the first 15 days of treatment: rectal tenesmus in 96/295 patients (32.5%), mild anal pain in 115/295 (38.9%), self-limited and mild bleeding after the detachment of the bands in 30/295 (10%), and febricula in one patient. Sixty three of 358 patients were treated with IRC (17.6%). In this group, relapses were observed in 6/63 patients (9.5%) at 36 months, all of them with grade III hemorrhoids that required additional treatment with RBL. All the complications (inherent to the technique) were observed within the first days: mild anal pain in 40/63 patients (63.4%) and mild bleeding in 1/63 (1.6%). The treatment with RBL or IRC

Findings of 2-fluoro-2-deoxy-d-glucose positron emission tomography in hemorrhoids.

PubMed

Tsai, Shih-Chuan; Jeng, Long-Bin; Yeh, Jun-Jun; Lin, Cheng-Chieh; Chen, Jin-Hua; Lin, Wan-Yu; Kao, Chia-Hung

2011-10-01

Hemorrhoids are very common in adults. The data regarding the incidence of high 2-fluoro-2-deoxy-D: -glucose (FDG) uptake in hemorrhoids is incomplete. In this study, we evaluated FDG uptake in hemorrhoids and calculated the rate of high FDG uptake in these lesions. One hundred and seventy six subjects who undertook whole body FDG-PET for health screening examination were investigated retrospectively. All patients had colonoscopy and 156 subjects were found to have hemorrhoids and 20 had no hemorrhoids. Quantitative analysis of FDG uptake in the anal region was performed by calculating the maximum standard uptake value (SUV(max)). The SUV(max) ranged from 1.8 to 4.1 (2.8 ± 0.6) for normal subjects and ranged from 1.4 to 8.3 (2.9 ± 0.8) for patients with hemorrhoids. No statistical difference was noted between these two groups using a Student's t-tests. If the highest SUV(max), which was 4.1 in normal subjects, was used as a cutoff, 5.1% (8/156) hemorrhoid patients had a SUV(max) greater than 4.1. Hemorrhoids can be one possible cause of focal high FDG uptake in the rectum.

YAG laser in the treatment of hemorrhoids: a report of 700 cases

NASA Astrophysics Data System (ADS)

Liu, Jian-xun; Zhang, Xinrong

1993-03-01

The results of treating hemorrhoids in 700 cases with a YAG laser knife is reported. Since 1988, the author introduced the YAG laser into the treatment of various kinds of hemorrhoids. The satisfactory results were achieved with 100% cure rate. Some related problems also are discussed in this paper. Hemorrhoid is a kind of common disease. It usually appears in the superior or inferior rectal venous plexus covered with mucosa. The hemorrhoids are divided into internal, external, and mixed types according to their location and origination. The internal hemorrhoid is superior to the dentate line and caused by varicosity of superior rectal venous plexus covered with mucosa, the most common presentation is a bleeding and prolapse mass out of the anus. The external hemorrhoid arises from varicosity of inferior rectal venous plexus, the most important clinical finding is a painful mass covered with skin of the anal canal. The characteristics of mixed type are the combination of the two types as mentioned above.

Nonsurgical treatment of actively bleeding internal hemorrhoids with a novel endoscopic device (with video).

PubMed

Kantsevoy, Sergey V; Bitner, Marianne

2013-10-01

Internal hemorrhoids often present with bleeding, prolapse, and other symptoms. Currently used nonsurgical treatment modalities have limited effectiveness and usually require several treatment sessions. To evaluate effectiveness and safety of a novel endoscopic device for nonsurgical treatment of internal hemorrhoids. Retrospective study. Single center. This study involved 23 patients with actively bleeding internal hemorrhoids. The HET Bipolar System is a modified anoscope, with a treatment window, light source, and tissue temperature monitor. The device is inserted into the rectum under direct observation. The tissue carrying superior hemorrhoidal branches and the apex of the internal hemorrhoid is positioned inside the treatment window, clamped with incorporated tissue forceps, and treated with bipolar energy to ligate hemorrhoidal feeding vessels. Rate of hemorrhoidal bleeding after the treatment. The mean age of the patients was 64.3 ± 9.9 years (range 44-79 years). Eleven patients (47.8%) had grade I hemorrhoids and 12 patients (52.2%) had grade II hemorrhoids. In 18 patients (78.3%), treatment with the HET System was performed with the patient under conscious sedation. Five patients (21.7%) were treated without sedation. All patients tolerated treatment without complaints. The average follow-up period was 11.2 ± 4.7 months. No bleeding or prolapse occurred after the procedure in any of the treated patients. Retrospective study. The newly developed HET System is easy to use, safe, and highly effective in eliminating bleeding in grade I and II internal hemorrhoids and prolapse in grade II internal hemorrhoids. Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Single session treatment for bleeding hemorrhoids

DOE Office of Scientific and Technical Information (OSTI.GOV)

Weinstein, S.J.; Rypins, E.B.; Houck, J.

1987-12-01

Fifty consecutive outpatients with bleeding internal hemorrhoids were prospectively treated with a single application of rubber band ligation or infrared coagulation. Complete follow-up observation was obtained in 48 patients (23 underwent rubber band ligation and 25 underwent infrared coagulation). At one month after treatment, 22 patients who underwent rubber band ligation and 16 who underwent infrared coagulation, were symptomatically improved (p less than 0.05). At six months, 15 patients who had undergone rubber band ligation and ten who had infrared coagulation treatment, remained improved (p less than 0.05). There was no statistical difference in the discomfort experienced by either groupmore » during or after the procedure as determined by a self-assessment scale. Two patients who underwent rubber band ligation experienced complications--a thrombosed external hemorrhoid developed in one patient and another had delayed rectal bleeding. Although associated with occasional complications after treatment, rubber band ligation is more effective than in infrared coagulation for single session treatment of bleeding internal hemorrhoids.« less

Surgical treatment of hemorrhoids: a critical appraisal of the current options.

PubMed

Cerato, Marlise Mello; Cerato, Nilo Luiz; Passos, Patrícia; Treigue, Alberto; Damin, Daniel C

2014-01-01

Surgical treatment of hemorrhoids is still a dilemma. New techniques have been developed leading to a lower rate of postoperative pain; however, they are associated with a greater likelihood of recurrence. To review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease. A systematic search of the published data on the options for treatment of hemorrhoids up to December 2012 was conducted using Medline/PubMed, Cochrane, and UpToDate. Currently available surgical treatment options include procedure for prolapse and hemorrhoids (PPH), transanal hemorrhoidal dearterialization (THD), and conventional hemorrhoidectomy techniques. Excisional techniques showed similar results regarding pain, time to return to normal activities, and complication rates. PPH and THD were associated with less postoperative pain and lower complication rates; however, both had higher postoperative recurrence rates. Conventional surgical techniques yield better long-term results. Despite good results in the immediate postoperative period, PPH and THD have not shown consistent long-term favorable results.

Hemorrhoids detected at colonoscopy: an infrequent cause of false-positive fecal immunochemical test results.

PubMed

van Turenhout, Sietze T; Oort, Frank A; Terhaar sive Droste, Jochim S; Coupé, Veerle M H; van der Hulst, Rene W; Loffeld, Ruud J; Scholten, Pieter; Depla, Annekatrien C T M; Bouman, Anneke A; Meijer, Gerrit A; Mulder, Chris J J; van Rossum, Leo G M

2012-07-01

Colorectal cancer screening by fecal immunochemical tests (FITs) is hampered by frequent false-positive (FP) results and thereby the risk of complications and strain on colonoscopy capacity. Hemorrhoids might be a plausible cause of FP results. To determine the contribution of hemorrhoids to the frequency of FP FIT results. Retrospective analysis from prospective cohort study. Five large teaching hospitals, including 1 academic hospital. All subjects scheduled for elective colonoscopy. FIT before bowel preparation. Frequency of FP FIT results in subjects with hemorrhoids as the only relevant abnormality compared with FP FIT results in subjects with no relevant abnormalities. Logistic regression analysis to determine colonic abnormalities influencing FP results. In 2855 patients, 434 had positive FIT results: 213 had advanced neoplasia and 221 had FP results. In 9 individuals (4.1%; 95% CI, 1.4-6.8) with an FP FIT result, hemorrhoids were the only abnormality. In univariate unadjusted analysis, subjects with hemorrhoids as the only abnormality did not have more positive results (9/134; 6.7%) compared with subjects without any abnormalities (43/886; 4.9%; P = .396). Logistic regression identified hemorrhoids, nonadvanced polyps, and a group of miscellaneous abnormalities, all significantly influencing false positivity. Of 1000 subjects with hemorrhoids, 67 would have FP results, of whom 18 would have FP results because of hemorrhoids only. Potential underreporting of hemorrhoids; high-risk individuals. Hemorrhoids in individuals participating in colorectal cancer screening will probably not lead to a substantial number of false-positive test results. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Factors Associated with Hemorrhoids in Korean Adults: Korean National Health and Nutrition Examination Survey

PubMed Central

Lee, Jong-Hyun; Kim, Hyo-Eun; Kang, Ji-Hun

2014-01-01

Background Although hemorrhoids are one of the most common anal diseases among Koreans, risk factors for hemorrhoids have not been well identified. Methods We analyzed the data from the 4th Korean National Health and Nutrition Examination Survey (KNHANES) between 2007 and 2009. Study subjects were 17,228 participants of KNHANES who were aged 19 years or older. Logistic regression analysis was conducted to evaluate associations between hemorrhoids and probable risk factors. Results Overall prevalence of hemorrhoids among study subjects was 14.4%, being more prevalent among women (15.7%) than among men (13.0%). Obesity and abdominal obesity were associated with a higher risk of hemorrhoids with odds ratio (OR) (95% confidence intervals, 95% CI) of 1.13 (1.01 to 1.26) and 1.16 (1.04 to 1.30), respectively. Both self-reported depression (OR, 1.83; 95% CI, 1.62 to 2.08) and physician diagnosed depression (OR, 1.71; 95% CI, 1.35 to 2.17) were associated with significantly higher risk of hemorrhoids. No regular walking (OR, 1.11; 95% CI, 1.00 to 1.23) and experience of pregnancy (OR, 1.62; 95% CI, 1.17 to 2.25) for women were also associated with higher risk of hemorrhoids. However, educational level, alcohol consumption, physical activities, diabetes mellitus, hypertension, fiber, fat intake, and energy intake were not associated with a risk of hemorrhoids. Low quality of life assessed with EuroQol-5 Dimension and EuroQol-Visual Analogue Scale was significantly associated with hemorrhoids. Conclusion This nationwide cross-sectional study of Korean adults suggests that obesity, abdominal obesity, depression, and past pregnancy may be risk factors for hemorrhoids and hemorrhoids affect quality of life negatively. PMID:25309703

A Randomized Controlled Trial Comparing Suture-Fixation Mucopexy and Doppler-Guided Hemorrhoidal Artery Ligation in Patients with Grade III Hemorrhoids

PubMed Central

Zhai, Min; Zhang, Yong-An; Wang, Zhen-Yi; Sun, Jian-Hua; Wen, Jie; Zhang, Qi; Li, Jin-De; Wu, Yi-Zheng; Zhou, Feng; Xu, Hui-Lei

2016-01-01

Background. We aimed to evaluate the effectiveness of a suture-fixation mucopexy procedure by comparing with Doppler-guided hemorrhoidal artery ligation (DGHAL) in the management of patients with grade III hemorrhoids. Methods. This was a randomized controlled trial. One hundred patients with grade III hemorrhoids were randomly assigned to receive suture-fixation mucopexy (n = 50) or DGHAL (n = 50). Outcome assessments were performed at 2 weeks, 12 months, and 24 months. Assessments included resolution of clinical symptoms, postoperative complications, duration of hospitalization, and total costs. Results. At 2 weeks, one (2%) patient in suture-fixation group and four (8%) patients in DGHAL group had persistent prolapsing hemorrhoids. Postoperative bleeding was observed in two patients (4%) in suture-fixation group and one patient in DGHAL group. There was no significant difference in short-term recurrence between groups. Postoperative complications and duration of hospitalization were comparable between the two groups. Rates of recurrence of prolapse or bleeding at 12 months did not differ between groups. However, recurrence of prolapse at 24 months was significantly more common in DGHAL group (19.0% versus 2.3%, p = 0.030). Conclusions. Compared with DGHAL, the suture-fixation mucopexy technique had comparable short-term outcomes and favorable long-term outcomes. PMID:27066071

SURGICAL TREATMENT OF HEMORRHOIDS: A CRITICAL APPRAISAL OF THE CURRENT OPTIONS

PubMed Central

CERATO, Marlise Mello; CERATO, Nilo Luiz; PASSOS, Patrícia; TREIGUE, Alberto; DAMIN, Daniel C.

2014-01-01

Introduction Surgical treatment of hemorrhoids is still a dilemma. New techniques have been developed leading to a lower rate of postoperative pain; however, they are associated with a greater likelihood of recurrence. Aim To review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease. Methods A systematic search of the published data on the options for treatment of hemorrhoids up to December 2012 was conducted using Medline/PubMed, Cochrane, and UpToDate. Results Currently available surgical treatment options include procedure for prolapse and hemorrhoids (PPH), transanal hemorrhoidal dearterialization (THD), and conventional hemorrhoidectomy techniques. Excisional techniques showed similar results regarding pain, time to return to normal activities, and complication rates. PPH and THD were associated with less postoperative pain and lower complication rates; however, both had higher postoperative recurrence rates. Conclusion Conventional surgical techniques yield better long-term results. Despite good results in the immediate postoperative period, PPH and THD have not shown consistent long-term favorable results. PMID:24676303

Comparative Analysis of Doppler Guided Hemorrhoidal Artery Ligation (DG-HAL) & Infrared Coagulation (IRC) in Management of Hemorrhoids.

PubMed

Ahmad, Arshad; Kant, Rama; Gupta, Avneet

2013-08-01

Both Doppler-guided hemorrhoidal artery ligation (DG-HAL) and infrared coagulation (IRC) are well-established techniques in the management of hemorrhoids. The aim of the study is to compare the clinical outcomes of DG-HAL and IRC in the patients with grade 1 and 2 hemorrhoids. A total of 296 patients were registered for the study, but 51 patients were lost in follow-up; hence, finally 245 patients were included in the analysis. Patients were randomized into two groups (mean age, 42 years; range, 19-60 years). Group A (n = 116) was treated with DG-HAL and group B (n = 129) was treated with IRC. Patients were examined at 1 week, 1 month, and 6 months after the procedure. Mean time taken for HAL was 21 min and for IRC, 12 min. The cost of the DG-HAL procedure was 1,440 rupees ($31.53) and that of IRC was 376 rupees ($8). The mean duration of hospital stay after HAL was 6 h and after IRC, 2 h. Control of symptoms with HAL was 96 %, whereas with IRC, 81 %. Postoperative complication rate for HAL was 2 %, whereas for IRC, 13 %. Requirement of repeat procedure with HAL was 9 % and with IRC, 28 %. Both the procedures are minimally invasive, associated with minimal discomfort, and suitable for day care surgery. IRC requires lesser procedure time, lesser postoperative hospital stay, and has lower procedure cost, whereas DG-HAL is more effective in controlling symptoms of hemorrhoids, has lower post operative complication rate, and has lesser requirement of repeat procedure.

Hemorrhoids and matrix metalloproteinases: A multicenter study on the predictive role of biomarkers.

PubMed

Serra, Raffaele; Gallelli, Luca; Grande, Raffaele; Amato, Bruno; De Caridi, Giovanni; Sammarco, Giuseppe; Ferrari, Francesco; Butrico, Lucia; Gallo, Gaetano; Rizzuto, Antonia; de Franciscis, Stefano; Sacco, Rosario

2016-02-01

An association between hemorrhoidal disease and matrix metalloproteinases (MMPs) has been described previously. MMPs regulate extracellular structural proteins and tissue remodeling. Neutrophil gelatinase-associated lipocalin (NGAL) is involved in the regulation of MMP activity. The aim of this work was to study the relationship between tissue immunoreactive levels of MMPs and NGAL and different stages of hemorrhoids. In a multicenter, open-label, prospective study, the population under investigation consisted of 2 groups: group I (with symptomatic hemorrhoids; Goligher grade I-IV) and group II (healthy volunteers). We enrolled 97 patients with hemorrhoids: 21 with grade I hemorrhoids, 37 with grade II, 14 with grade III, and 25 with grade IV. Finally, 90 healthy volunteers (53 males and 37 females; age range, 19-70 years; median, 56) were enrolled in group II. Enzyme-linked immunosorbent assay and Western blot analysis revealed greater levels of immunoreactive MMPs and NGAL in all patients with hemorrhoids. We recorded significantly greater levels of MMP-1 and MMP-3 in grade I and II patients compared with control, and greater levels of MMP-3, MMP-7, MMP-8, and MMP-9 in grade III compared with grade II. MMP-9 and NGAL were particularly increased in patients with grade IV especially in case of thrombosed hemorrhoids. These results provide potentially important insights into the understanding of the natural history of hemorrhoids. MMPs and NGAL play a role in development of disease and may represent molecular markers for the complications such as hemorrhoidal thrombosis. Copyright © 2016 Elsevier Inc. All rights reserved.

Banding hemorrhoids using the O'Regan Disposable Bander. Single center experience.

PubMed

Paikos, Dimitrios; Gatopoulou, Anthie; Moschos, John; Koulaouzidis, Anastasios; Bhat, Shivram; Tzilves, Dimitrios; Soufleris, Konstantinos; Tragiannidis, Dimitrios; Katsos, Ioannis; Tarpagos, Anestis

2007-06-01

Hemorrhoids are the most common anorectal disorder in the Western World and are a major cause of active, relapsing or chronic rectal bleeding. Many treatment options have been proposed and tried for early-stage hemorrhoids. There is general agreement that rubber banding ligation (RBL) is safe and effective. To evaluate the effectiveness and complications associated with RBL performed in outpatients for symptomatic hemorrhoids using the O'Regan Disposable Bander device. Sixty consecutive patients underwent hemorrhoid banding with the O'Regan Disposable Bander. The mean time required for one session was 6.2 min; the longest was 10 min. No major complications were noted. Minor early and late bleeding was reported in 10% and 6.7% respectively, but none was severe. Pain occurred in 6.7% but was not severe. In all cases, clinical and endoscopic (range and form scores) improvement was observed and patients of all ages, including the elderly, were found to be tolerant to the procedure. RBL performed in outpatients for symptomatic hemorrhoids using the O'Regan Disposable Bander device is associated with a good response and low complication rate. We recommend the technique as a safe and reliable treatment option.

LigaSure Hemorrhoidectomy for Symptomatic Hemorrhoids: First Pediatric Experience.

PubMed

Grossmann, Ole; Soccorso, Giampiero; Murthi, Govind

2015-08-01

Hemorrhoids are uncommon in children. Third and fourth degree symptomatic hemorrhoids may be surgically excised. We describe the first experience of using LigaSure (Covidien, Mansfield, Massachusetts, United States) to perform hemorrhoidectomies in children. LigaSure hemorrhoidectomy has been well described in adults and is found to be superior in patient tolerance as compared with conventional hemorrhoidectomy. Georg Thieme Verlag KG Stuttgart · New York.

Efficacy and safety of a polyherbal formulation in hemorrhoids

PubMed Central

Tripathi, Raakhi K.; Bolegave, Somesh S.; Shetty, Parvan A.; Uchil, Dinesh A.; Rege, Nirmala N.; Chawda, Mukesh B.; Rege, Sameer A.

2015-01-01

Background: The medical management of hemorrhoids should include an integrated approach. This integrated approach can be achieved by polyherbal formulations containing anti-inflammatory, styptics, analgesics, and laxative effect which reduce inflammation, pain, and bleeding, and increase gastro-intestinal motility and soften stools. One such polyherbal kit is “Arshkeyt™, a 7 day kit,” which consists of oral tablets and powder along with topical cream. Objective: Efficacy and safety of Arshkeyt™, a 7 day kit, a marketed polyherbal formulation was evaluated in comparison with conventional therapy practiced in surgery outpatient departments. Materials and Methods: Patients (n = 90) with hemorrhoids were randomly allocated to receive either Arshkeyt™ or standard therapy (combination of oral Isabgul powder and 2% lidocaine gel) for 14 days. Assessment on the basis of rectal symptoms and proctoscopic examination was done on day 0, 7, and 14 to derive a “composite score” which ranged from 0 to 25 by a blinded evaluator. The primary endpoint was number of patients achieving composite score 0 at the end of therapy (day 14). Inter-group analysis was done using Chi-square test. Results: On day 14, the composite score of 0 was achieved in 15 patients of Arshkeyt™ group versus 6 patients receiving standard therapy. The symptoms and signs which showed significant improvement in Arshkeyt™ group compared to standard treatment group were the tenesmus (visual analog score) score (P = 0.047), anal sphincter spasm (P = 0.0495) and a decrease in the grade of hemorrhoids (P = 0.0205) on day 14. Arshkeyt™ was also more beneficial in case of bleeding hemorrhoids as compared to nonbleeding hemorrhoids (P < 0.05). The incidence of adverse drug reactions in both groups was comparable and no patient required any treatment for the same. Conclusion: “Arshkeyt™, a 7 day kit,” was effective in the treatment of hemorrhoids and had a good safety profile. PMID:26834421

[First experience in surgical treatment of hemorrhoidal disease using the PPH stapler].

PubMed

Morales-Olivera, José Martín; Velasco, Liliana; Bada-Yllán, Orlando; Vergara-Fernández, Omar; Takahashi-Monroy, Takeshi

2007-01-01

Haemorrhoidal disease is a frequent entity worldwide. The surgical management is indicated in third or fourth degree internal hemorrhoidal disease. The conventional hemorrhoidectomy has showed good results but the severe postoperative pain is an important complain. Currently diverse surgical alternatives have been described, mainly to avoid the postoperative pain that follows surgical hemorrhoidectomy. One of these new options is the stapled hemorrhoidectomy using the PPH stapler. This procedure may produce less postoperative pain, with a shorter inpatient stay and faster return to work. The aim of this paper is to analyze the results of using the Procedure for Prolapsed Hemorrhoids (PPH) as treatment in Hemorrhoidal Disease. This is an observational and descriptive study, where 17 patients underwent stapled hemorrhoidectomy with PPH procedure, between March 2000 and August 2003. 52.8% of this patients presented grade three internal hemorrhoids and 47.2% grade four; 52.9% presented mild postoperative pain; 41.2% moderate and 5.9% severe pain. In a short and median follow up, due to the persistence of hemorrhoidal disease symptoms two patients required surgical re-intervention. Two more patients presented incontinency. One patient presented stenosis in the line of staples treated satisfactory with an anal dilatation session. The use of PPH is a feasible and safe procedure and it could be a surgical alternative in the treatment of hemorrhoidal disease, even before than conventional hemorrhoidectomy.

The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist.

PubMed

Guttenplan, Mitchel

2017-07-01

Hemorrhoid disease is extremely common, and seldom requires surgical intervention. The vast majority of patients can be cared for in the office setting and by the gastroenterologist. This piece aims to summarize the epidemiology and pathophysiology of hemorrhoid disease, along with the proper evaluation and office-based treatment of these patients. Most GI fellowship training programs spend little time on these topics, and the recommendation has been made to include anorectal care in the GI's "core curriculum." The use of the anoscope and a proper anorectal examination are keys to evaluating these patients, and the techniques available to treat these patients are described. Often overlooked in these patients are other anorectal issues that occur alongside hemorrhoidal issues very commonly-the most common being anal fissure. Comprehensive management of all of these issues will allow all but the most severely affected patients to avoid the expense and morbidity of surgical intervention. The anatomy, etiology, pathophysiology, diagnosis, and non-surgical treatment of hemorrhoid disease are presented with the gastroenterologist in mind.

Bilateral Deep Peroneal Nerve Paralysis Following Kerosene Self-Injection into External Hemorrhoids

PubMed Central

Rostami, Khalil; Farzaneh, Esmaeil; Abolhassani, Hassan

2010-01-01

Along with conventional therapies, some abrogated traditional treatment had been used for hemorrhoids like local Kerosene injection especially for extremely irritated external hemorrhoids. We report a rare case of Kerosene self-injection into the hemorrhoid. Despite antibiotics therapy, extent debridement, and colostomy, the patient died after 24 hours because of heart attack. Moreover, we discuss here the case with contact or injection of hydrocarbon materials and early care action to decrease the extensions of injury and side effects. PMID:20936130

Hemorrhoids and anal fissures in inflammatory bowel disease.

PubMed

D'Ugo, S; Stasi, E; Gaspari, A L; Sileri, P

2015-12-01

Perianal disease is a common complication of inflammatory bowel disease (IBD). It includes different conditions from more severe and potentially disabling ones, such as abscesses and fistulas, to more benign conditions such as hemorrhoids, skin tags and fissures. Most literature has been focused on anal sepsis and fistulae, as they carry the majority of disease burden and often alter the natural course of the disease. Hemorrhoids and anal fissures in patients with IBD have been overlooked, although they can represent a challenging problem. The management of hemorrhoids and fissures in IBD patients may be difficult and may significantly differ compared to the non-affected population. Historically surgery was firmly obstructed, and hemorrhoidectomy or sphincterotomy in patients with associated diagnosis of IBD was considered harmful, although literature data is scant and based on small series. Various authors reported an incidence of postoperative complications higher in IBD than in the general populations, with potential severe events. Considering that a spontaneous healing is possible, the first line management should be a medical therapy. In patients non-responding to conservative measures it is possible a judicious choice of surgical options on a highly selective basis; this can lead to acceptable results, but the risk of possible complications needs to be considered. In this review it is analyzed the current literature on the incidence, symptoms and treatment options of hemorrhoids and anal fissures in patients with Crohn's disease and ulcerative colitis.

[Trans-anal disarterization of internal hemorrhoids under Doppler control with mucopexy and lifting in treatment of stage III-IV hemorrhoids].

PubMed

Zagriadskiĭ, E A

2009-01-01

85 patients at age of 27-68 years (44.78+/-9.02) with stage III-IV hemorrhoids were treated. Trans-anal disarterization of internal hemorrhoids under Doppler control with mucopexy and lifting was carried out using modified Moricorn proctoscope. Operation duration amounted 24-45 minutes (32+/-5.21). Postoperative pain syndrome amounted on average 33.2+/-0.52 mm (range 20-50 mm) on the first day and 16.5+/-0.10 (0-40 mm) during 5 days which didn't require usage of narcotic analgesics. Patients returned to labor activity after 2-4 days (2.79+/-0.81). They were investigated after 6 months after operation. Bleeding stopped in 96.5% of patients, prolapsed piles were not observed in 91.8% of patients. Repeated bleedings were not registered. Complications (perianal hematoma-like external node thrombosis) were revealed in 7 (8.2%) patients. Trans-anal disarterization of internal hemorrhoids under Doppler control with mucopexy and lifting is a safe and effective alternative to hemorrhoidectomy. This method is ideal for "one-day" hospital.

High-grade hemorrhoids requiring surgical treatment are common after laparoscopic ventral mesh rectopexy.

PubMed

van Iersel, J J; Formijne Jonkers, H A; Verheijen, P M; Draaisma, W A; Consten, E C J; Broeders, I A M J

2016-04-01

To describe patients developing grade III and IV hemorrhoids requiring surgery after laparoscopic ventral mesh rectopexy (LVMR) and to explore the relationship between developing such hemorrhoids and recurrence of rectal prolapse after LVMR. All consecutive patients receiving LVMR at the Meander Medical Centre, Amersfoort, the Netherlands, between 2004 and 2013 were analyzed. Kaplan-Meier estimates were calculated for recurrences. A total of 420 patients underwent LVMR. Sixty-five of these patients (actuarial 5-year incidence 24.3, 95 % confidence interval (CI) 18.6-30.0) developed symptomatic grade III/IV hemorrhoids requiring stapled or excisional hemorrhoidectomy. Re-do surgery for recurrent grade III/IV hemorrhoids was required for 15 of the 65 patients (actuarial 5-year recurrence rate 40.6, 95 % CI 23.2-58.0) after the primary hemorrhoidectomy. Three of the 65 patients developed an external rectal prolapse (ERP) recurrence and eight an internal rectal prolapse (IRP) recurrence. This generated a 5-year recurrence rate of 25.3 % (95 % CI 0-53.9) for ERP recurrence and 24.4 % (95 % CI 9.1-39.7) for IRP recurrence. The rest of the LVMR cohort not receiving additional surgery for hemorrhoids (n = 355) showed significantly lower actuarial 5-year ERP (0.8 %, p = 0.011) and IRP (11 %, p = 0.020) recurrence rates. High-grade hemorrhoids requiring surgery may be common after LVMR. The development of high-grade hemorrhoids after LVMR might be considered a predictor of rectal prolapse recurrence.

Association of chronic obstructive pulmonary disease and hemorrhoids

PubMed Central

Lin, Lih-Hwa; Siu, Justin Ji-Yuen; Liao, Po-Chi; Chiang, Jen-Huai; Chou, Pei-Chi; Chen, Huey-Yi; Ho, Tsung-Jung; Tsai, Ming-Yen; Chen, Yung-Hsiang; Chen, Wen-Chi

2017-01-01

Abstract According to traditional Chinese medicine (TCM) theory, a specific physiological and pathological relationship exists between the lungs and the large intestine. The aim of this study is to delineate the association of chronic obstructive pulmonary disease (COPD) and hemorrhoids in order to verify the “interior–exterior” relationship between the lungs and the large intestine. A retrospective cohort study is conceived from the National Health Insurance Research Database, Taiwan. The 2 samples (COPD cohort and non-COPD cohort) were selected from the 2000 to 2003 beneficiaries of the NHI, representing patients age 20 and older in Taiwan, with the follow-up ending on December 31, 2011. The COPD cohort (n = 51,506) includes every patient newly diagnosed as having Chronic Obstructive Pulmonary Disease (COPD, ICD-9-CM: 490–492, 494, 496), who have made at least 2 confirmed visits to the hospital/clinic. The non-COPD cohort (n = 103,012) includes patients without COPD and is selected via a 1:2 (COPD: non-COPD) matching by age group (per 5 years), gender, and index date (diagnosis date of COPD for the COPD cohort). Compared with non-COPD cohorts, patients with COPD have a higher likelihood of having hemorrhoids and the age-, gender- and comorbidies-adjusted hazard ratio (HR) for hemorrhoids is 1.56 (95% confidence intervals [CI]:1.50–1.62). The adjusted HR of hemorrhoids for females is 0.79 (95% CI: 0.77–0.83), which is significantly less than that for males. The elderly groups, 40 to 59 years and aged 60 or above, have higher adjusted HRs than younger age groups (20–39 years), 1.19 (95% CI: 1.14–1.26), and 1.18 (95% CI: 1.12–1.24), respectively. Patients with COPD may have a higher likelihood to have hemorrhoids in this retrospective cohort study. This study verifies the fundamental theorem of TCM that there is a definite pathogenic association between the lungs and large intestine. PMID:28272246

Adequate dietary fiber supplement and TONE can help avoid surgery in most patients with advanced hemorrhoids.

PubMed

Garg, Pankaj; Singh, Pratiksha

2017-06-01

The root cause of hemorrhoids resides in three deranged defecation habits (DDH), namely increased straining, prolonged defecation-time, and frequent bowel-motions. These DDH are responsible for the development of new hemorrhoids, progression of existing one and hemorrhoidal rupture (bleeding). DDH can be corrected with the help of the "TONE" mnemonic. TONE entails specifying exact treatment goals: T, three minutes at defecation; O, once-a-day defecation frequency; N, no straining during passing motions; E, enough fiber. TONE can be implemented by proper counseling and by prescribing fiber supplement appropriately (5-6 teaspoonfuls of psyllium husk with 600 mL of water daily. Corrected DDH would prevent the progression of hemorrhoids and bleeding episodes. An office procedure may be done to further downgrade the hemorrhoids. Patients with advanced hemorrhoids (grades III and IV) who were referred for surgery were prescribed fiber supplement and were counseled to follow TONE. The outcome parameters evaluated were improvement in prolapse, bleeding episodes, satisfaction levels. A total of 102 patients (75 males and 10 females, mean age 46.0±13.5 years, 17 lost to follow-up) with advanced hemorrhoids (41 with early grade III, 38 with late grade III, and 6 with grade IV) were included in the study. All patients had symptoms of prolapsed hemorrhoids and bleeding episodes were present in 71.8% (61/85) of patients. After the follow-up of 40 (12-96) months, 68.2% (58/85) patients were highly satisfied, 12.9% (11/85) were moderately satisfied and 18.9% (16/85) were not satisfied with treatment. Prolapse improved in 56.5% (48/85), did not progress over time in 25.9 (22/85) and continued to progress in 4.7% (4/85) patients. 12.9% (11/85) underwent operation for hemorrhoids. Bleeding episodes decreased from 71.8% (61/85) to 29.4% (25/85) (P<0.0001). Adequate fiber supplement combined with the TONE method can correct DDH, thus stopping the progression of hemorrhoids and

Recurrent epistaxis from Kiesselbach area syndrome in patients suffering from hemorrhoids: fact or fiction?

PubMed

Mladina, Ranko; Cavcic, Josip; Subaric, Marin

2002-01-01

It has been found that >90% of patients suffering from recurrent epistaxis from Kiesselbach area syndrome (REKAS) simultaneously suffered from hemorrhoids. To clarify this, the authors decided to investigate in the opposite direction, i.e., to find out whether or not REKAS occurs in patients suffering primarily from hemorrhoids. The study group included 53 randomly selected hospitalized patients with hemorrhoidal disorder (31 males and 22 females: age range 18-57 years). A search for essential clinical signs of REKAS was performed in each patient. Incidence was not high, although all clinical parameters were nearly the same: dilated vessels in Kiesselbach venous plexus (83.01%) and a positive hereditary factor (92.7%). The only missing factor in patients with hemorrhoids was anterior septal deformity, so frequent in REKAS patients. CONCLUSIONS; The authors conclude that REKAS and hemorrhoidal syndrome are separate clinical entities that are characterized by dilated vessels of similar venous plexus and simultaneous appearance in the same patient or close relatives.

[Pathologic change of elastic fibers with difference of microvessel density and expression of angiogenesis-related proteins in internal hemorrhoid tissues].

PubMed

Han, Wei; Wang, Zhen-jun; Zhao, Bo; Yang, Xin-qing; Wang, Dong; Wang, Jian-pin; Tang, Xiu-ying; Zhao, Fa; Hung, Yan-ting

2005-01-01

To investigate the pathological variations in internal hemorrhoid and evaluate the expression of nitric- oxide synthase(NOS),vascular endothelial growth factor(VEGF),matrix metalloproteinase- 2(MMP2) and MMP9. Normal anal cushion and internal hemorrhoids tissue samples were obtained from 24 patients with iii degree hemorrhoids after procedure for prolapse and hemorrhoids(PPH) procedure. The expression of NOS, VEGF, MMP2, MMP9 and CD34 were detected by immunohistochemical staining; the microvessel density (MVD) was counted by anti- CD34 antibody; the elastic fibers were detected by orcein staining. There were statistically significant differences in the expression of MVD, VEGF, MMP9 between internal hemorrhoid tissue and normal anal cushions(P< 0.05). iNOS was significantly increased in hemorrhoid tissue, but no significant difference between normal anal cushions and hemorrhoid tissue. Morphological abnormalities such as breaking, distortion, mortality, hyaline degeneration were found in elastic fibers of internal hemorrhoid tissue, but not in normal anal cushions. Angiogenesis is evident in hemorrhoid tissue, suggesting the possible mechanism in the pathogenesis of hemorrhoids. The direct degeneration effect of MMP9 on supporting structure elastic fibers in anal cushion is another important mechanism. The high expression of iNOS suggests the inflammatory factors involve in the pathogenesis of hemorrhoids, and NO may be involve in pathological effect on hemorrhoids.

An Evidence-Based Study on Medicinal Plants for Hemorrhoids in Medieval Persia

PubMed Central

Hashempur, Mohammad Hashem; Khademi, Fatemeh; Rahmanifard, Maryam; Zarshenas, Mohammad M.

2017-01-01

Hemorrhoids is one of the most common gastrointestinal diseases. There are several therapeutic options associated with some complications. Therefore, researchers look for traditional medicines as a potential resource for introduction of new natural drugs. The current study reports an evidence-based review of herbal remedies for hemorrhoids in traditional Persian medicine. A comprehensive survey about hemorrhoids on the most important manuscripts of traditional Persian medicine was done. Then, scientific data banks were searched for possible related properties of each herb in the conventional medicine. We reported some historical aspects of traditional Persian medicine view on classification, examination, and predisposing factors of hemorrhoids. In addition, we have reported 105 medicinal plants belonging to 51 families. More than half of the reported herbs exhibited anti-inflammatory and analgesic effects. Although lack of human studies regarding the mentioned herbs is noted, positive results from experimental findings can be considered for new drug discovery supported by traditional and medieval experiences. PMID:29228790

Cap-assisted endoscopic sclerotherapy for hemorrhoids: Methods, feasibility and efficacy

PubMed Central

Zhang, Ting; Xu, Li-Juan; Xiang, Jie; He, Zhi; Peng, Zhao-Yuan; Huang, Guang-Ming; Ji, Guo-Zhong; Zhang, Fa-Ming

2015-01-01

AIM: To evaluate the methodology, feasibility, safety and efficacy of a novel method called cap-assisted endoscopic sclerotherapy (CAES) for internal hemorrhoids. METHODS: A pilot study on CAES for grade I to III internal hemorrhoids was performed. Colon and terminal ileum examination by colonoscopy was performed for all patients before starting CAES. Polypectomy and excision of anal papilla fibroma were performed if polyps or anal papilla fibroma were found and assessed to be suitable for resection under endoscopy. CAES was performed based on the requirement of the cap, endoscope, disposable endoscopic long injection needle, enough insufflated air and sclerosing agent. RESULTS: A total of 30 patients with grade I to III internal hemorrhoids was included. The follow-up was more than four weeks. No bleeding was observed after CAES. One (3.33%) patient claimed mild tenesmus within four days after CAES in that an endoscopist performed this procedure for the first time. One hundred percent of patients were satisfied with this novel procedure, especially for those patients who underwent CAES in conjunction with polypectomy or excision of anal papilla fibroma. CONCLUSION: CAES as a novel endoscopic sclerotherapy should be a convenient, safe and effective flexible endoscopic therapy for internal hemorrhoids. PMID:26722615

Doppler-Guided Transanal Hemorrhoidal Dearterialization (DG-THD) Versus Stapled Hemorrhoidopexy (SH) in the Treatment of Third-Degree Hemorrhoids: Clinical Results at Short and Long-Term Follow-Up.

PubMed

Leardi, S; Pessia, B; Mascio, M; Piccione, F; Schietroma, M; Pietroletti, R

2016-11-01

The stapled hemorrhoidopexy (SH) and the Doppler-guided transanal hemorrhoidal dearterialization (DG-THD) are minimally invasive procedures for the surgical treatment of hemorrhoids. This study aims to verify the efficacy of the DG-THD versus the SH in the treatment of third-degree hemorrhoids. One hundred consecutive patients were causally allocated to either procedure, obtaining two groups of 50 pts. A clinical examination was performed at 3, 7, 15, and 30 days after the operation. Quality of life, anal symptoms, recurrence of hemorrhoids, and reoperation were assessed by means of a questionnaire and of a clinical examination at long-term follow-up (7.0 year average). At short-term follow-up, the median postoperative pain score was significantly lower in DG-THD group compared to SH group, (V.A.S 2 vs 6; t = 2.65, p < 0.01). The morbidity rate and the return to normal life and work were similar after the two procedures. At long-term follow-up, the incidence of piles was not statistically different between the two groups (DG-THD 10.0 %; SH 14.0 %). No differences were reported by patients in terms of satisfaction for surgery. SH and DG-THD procedures do not show significantly different results with regard to the patients outcome. However, considering the lower p. o. pain, the DG-THD might be proposed as the first line treatment in third-degree hemorrhoids.

[Efficacy of retained rectal posterior mucosa in procedure for prolapse and hemorrhoids].

PubMed

Zheng, Chenguo; Jin, Chun; Lian, Shaoxiong; Jin, Dingguo

2014-12-01

To evaluate the efficacy and necessity of retained rectal posterior mucosa in procedure for prolapse and hemorrhoids (PPH). Clinical data of 260 cases with severe hemorrhoids in our hospital from January 2010 to May 2012 were analyzed retrospectively. A total of 132 cases with severe hemorrhoids excluding in rectal posterior wall were enrolled in retained rectal posterior mucosa in PPH (improvement group), other 128 cases of severe hemorrhoids were assigned to PPH (conventional group). Operative parameters, efficacy and complication after operation were compared. Two groups of patients received successful operations. Postoperative pain duration, frequency of analgesic drugs and postoperative hospital stay in improvement group were significantly reduced [(1.3 ± 0.5) d vs. (4.8 ± 0.7) d, 1.1 ± 0.3 vs. 5.9 ± 0.6, (5.2 ± 0.8) d vs. (5.8 ± 0.5) d, all P<0.01]. Incidence of anastomotic stenosis, heavy feeling in the anus and delayed bleeding in improvement group were significantly lower than those in conventional group (0 vs. 7.8%, 0.8% vs. 14.1%, 0 vs.7.8%, all P<0.01). The application of retained rectal posterior mucosa in PPH to patients with severe hemorrhoids excluding in rectal posterior wall can significantly reduce postoperative complications. But long-term efficacy needs further observation.

Tribenoside and lidocaine in the local treatment of hemorrhoids: an overview of clinical evidence.

PubMed

Lorenc, Z; Gökçe, Ö

2016-06-01

The combination of tribenoside+lidocaine (Procto-Glyvenol®) is a medical preparation for the local treatment of hemorrhoids, delivered as a suppository or rectal cream. This product has been used for decades in the therapy of hemorrhoids. This review discusses available evidence on the use of tribenoside/lidocaine in clinical practice. Papers were retrieved by a PubMed search, using different combinations of pertinent keywords (e.g. tribenoside AND hemorrhoids), without any limitations in terms of publication date and language. Documents from Authors' personal collection of literature could also be considered. Papers were selected for inclusion according to their relevance for the topic, as judged by the Authors. The efficacy of the combination of tribenoside+lidocaine in relieving symptoms caused by hemorrhoids and its safety have been assessed in several clinical studies on patients of either gender, either versus its two individual components (tribenoside and lidocaine) or versus steroids in the same setting. Five studies compared the combination treatment with each of its single components, and of these, three studies compared tribenoside+ lidocaine with a tribenoside-free semi-placebo preparation containing only lidocaine, and two studies compared this combination with lidocaine-free preparations containing only tribenoside. Tribenoside+lidocaine was compared with steroid-containing preparations in six studies. Last, two studies evaluated the efficacy and tolerability of the tribenoside+lidocaine combination in women with hemorrhoids as a consequence of pregnancy or delivery. All the above-mentioned studies were well-conducted and can provide a comprehensive evaluation of tribenoside+lidocaine in the treatment of hemorrhoids. Enough evidence exists to recommend the use of this combination therapy as a fast, effective and safe option for the local treatment of low-grade hemorrhoids.

[Clinical study of Ruiyun procedure for hemorrhoids combined with Xiaozhiling injections in treatment of hemorrhoids complicated with human immunodeficiency virus infection].

PubMed

Wei, Guo; Hua, Xin; Zhao, Yong; Hu, Minghui; Gou, Fang; Liu, Lin; Cai, Lin; He, Yong; He, Shenghua

2014-12-01

To explore the efficacy of Ruiyun procedure for hemorrhoids (RPH) combined with Xiaozhiling injection in the treatment of hemorrhoids complicated with human immunodeficiency virus (HIV) infection and its influence on cellular immune function. Clinical data of 76 hemorrhoid patients, including 36 positive HIV and 40 negative HIV, undergoing RPH combined with Xiaozhiling injections in our center from January 2010 to December 2012 were retrospectively analyzed. Clinical efficacy and cellular immune function preoperative day 1, postoperative day 7, 30 were compared between positive and negative groups. Recurrence rates of positive group and negative group postoperative 6 months were 22.2% (8/36) and 22.5% (9/40), postoperative 1 year were 30.6% (11/36) and 30.0% (12/40) without significant differences (all P>0.05). Morbidity of postoperative complication was also not significantly different between two groups (P>0.05). According to HIV classification, peripheral lymph cell ratio, CD4 count, CD4/CD8, white blood cell count and neutrophil ratio were not significantly different between preoperative day 1 and postoperative day 7 in both groups (all P>0.05). Decreasing velocity and amplitude of CD4 in both groups from high to low was HIV III, HIV II, HIV I, HIV-, while after 30 days the increase of CD4 from high to low was HIV-, HIV I, HIV II, HIV III, which were significantly different as compared to postoperative day 7 (all P<0.05). RPH combined with Xiaozhiling injection in the treatment of hemorrhoids complicated with HIV infection is effective and safe. Postoperative inhibited cellular immune function can recover quickly.

The efficacy of Euphorbia prostrata in early grades of symptomatic hemorrhoids--a pilot study.

PubMed

Gupta, P J

2011-02-01

The medical treatment for hemorrhoids has undergone significant changes on introduction of new pharmaceutical agents in the last decade. Euphorbia Prostrata is a new molecule used for grade I and II hemorrhoids. Beneficial effects of the Euphorbia prostrata in hemorrhoids have multiple mechanisms that are due to its active constituents flavonoids, tannins and phenolic acid. This pilot study was performed to assess the effectiveness of this molecule in early grades of symptomatic hemorrhoids. In the present retrospective study, the effect of Euphorbia prostrata on patients with hemorrhoids was observed over a follow up period of 12 weeks. In all, 120 patients were studied. This included 63 males and 57 females. Patients with grade 1 and 2 were prescribed with one tablet of Euphorbia prostrata (Tab Sitcom, Panacea Biotec, India) to be consumed on empty stomach every morning for two weeks. Follow-up was carried out at 2, 4 and 12 weeks after commencement of treatment. The primary end point of the study was control of bleeding and secondary end points were regression of hemorrhoid mass, pruritus and discomfort in the anus. Ninty-nine patients (82%) had complete cessation of bleeding at the end of two weeks. Six patients needed another 2 week's treatment to achieve complete relief, amounting to a success rate of 87%. Anal itch was relieved in 73% of patients, while anal discomfort subsided in 90% of patients. None of the patient had reported any adversity with consumption of the drug. At the follow-up after 3 months of treatment, no patient reported with symptomatic recurrence. However, 37 of the 79 patients (46%) still had residual hemorrhoids on anoscopic examination. This pilot study shows that Euphorbia prostrata can be used as an effective and well-tolerated pharmaceutical agent in the treatment of early grades of hemorrhoids. Long-term follow-up and randomized control trials by comparing with other established formulations is necessary to justify reliance on this

Treatment of uncomplicated hemorrhoids with a Hemor-Rite® cryotherapy device: a randomized, prospective, comparative study

PubMed Central

Guindic, Luis Charúa

2014-01-01

Hemorrhoids are one of the most common ailments known. Often described as “varicose veins of the anus and rectum”, hemorrhoids are enlarged, bulging blood vessels in, and about the anus and lower rectum. About 75% of people will have hemorrhoids at some point in their lives. This paper shares the results from the clinical evaluation conducted to study effects of cryotherapy in treating uncomplicated hemorrhoids. The device used in the study is based on topically-applied cold therapy which can produce vasoconstriction in the tissues, tissue hypoxia, analgesia, and muscle relaxation. Cryotherapy was shown to be statistically similar or superior to proctology ointment in some of the parameters studied such as reduction of pain and hemorrhage. Overall it was observed that cryotherapy device contributes to improving the quality of life of patients with hemorrhoids. PMID:24474845

Improvement of the technique in treatment of internal hemorrhoids with Nd:YAG laser

NASA Astrophysics Data System (ADS)

Bao, Xiao-qing; Zhu, Jing; Shi, Hong-Min

2005-07-01

Objective: To observe and study the improvement of the technique in treatment of internal hemorrhoids with Nd:YAG laser and evaluate the effective rate. Methods: 60 patients of internal hemorrhoids were treated with Nd:YAG laser (10-15mw) irradiating on the mucosa of the lesions. Results: Among 60 patients, 57 patients were primarily cured with one treatment, 3 patients were primarily cured with two treatments. The effective rate was 95% with one treatment, and it reached to 100% with two treatments. Conclusions: the improvement of the technique in treatment of internal hemorrhoids with Nd:YAG laser is effective and easy to operate.

Transanal hemorrhoidal dearterialization with mucopexy versus open hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials.

PubMed

Xu, L; Chen, H; Lin, G; Ge, Q; Qi, H; He, X

2016-12-01

The aim of this study was to analyse the outcomes of transanal hemorrhoidal dearterialization with mucopexy (THDm) versus open hemorrhoidectomy (OH) in the management of hemorrhoids. Randomized controlled trials in English were found by searching PubMed, Web of science, EMBASE, and the Cochrane Library database. Trials that compared THDm with OH were identified. Data were extracted independently for each study, and a meta-analysis was performed using fixed and random effects models. Four trials, including 316 patients, met the inclusion criteria. No statistically significant differences were noted in either total complications or postoperative bleeding, incontinence, recurrent prolapse, and urinary retention rate. Operative time was significantly longer for THDm with Doppler guidance than for THDm without Doppler guidance. Patients returned to normal activities faster after THDm than after OH. No statistically significant differences between THDm and OH were noted with regard to recurrence and reoperation rates. Our meta-analysis shows that THDm and OH are equally effective and can be attempted for the management of hemorrhoids. However, for THDm with Doppler guidance, more instruments and a longer operative time are required. Future large-scale, high-quality, multicenter trials with long-term outcomes are needed to prove these results and determine whether Doppler guidance in THD is truly necessary or not.

Management of internal hemorrhoids by Kshara karma: An educational case report.

PubMed

Mahapatra, Anita; Srinivasan, A; Sujithra, R; Bhat, Ramesh P

2012-07-01

A 66-year-old male patient came to the anorectal clinic, Outpatient department, AVT Institute for Advanced Research, Coimbatore, Tamil Nadu, with complaints of prolapsing pile mass during defecation and bleeding while passing stool. The case was diagnosed as "Raktarsha" - 11 & 7 'o' clock position II degree internal hemorrhoids, deeply situated, projecting one and caused by pitta and rakta; with bleeding tendency. Kshara karma (application of caustic alkaline paste) intervention was done in this case to internal hemorrhoids under local anesthesia. The pile mass and per rectal bleeding resolved in 8 days and the patient was relieved from all symptoms within 21 days. No complications were reported after the procedure. The patient was followed up regularly from 2004 onward till date and proctoscopic examination did not reveal any evidence of recurrence of the hemorrhoids.

Aluminum potassium sulfate and tannic acid (ALTA) injection as the mainstay of treatment for internal hemorrhoids.

PubMed

Hachiro, Yoshikazu; Kunimoto, Masao; Abe, Tatsuya; Kitada, Masahiro; Ebisawa, Yoshiaki

2011-06-01

Aluminum potassium sulfate and tannic acid (ALTA) induce noninvasive sclerosis and the involution of hemorrhoids by initiating an inflammatory reaction. We assessed the mid-term outcome after ALTA sclerotherapy for symptomatic hemorrhoids. Between May 2006 and July 2009, 1210 patients with grade III or IV hemorrhoids underwent surgery at Kunimoto Hospital. Our treatment strategy for internal hemorrhoids is first establishing whether ALTA therapy is possible for the type of hemorrhoid, and then performing either ALTA therapy or alternatively, ligation and excision (LE) for those types unsuitable for ALTA therapy. A total of 448 patients were treated with ALTA therapy alone (Group A), 706 patients were treated with a combination of ALTA and LE therapy (Group B), and 56 patients were treated with LE alone (Group C). The overall recurrence rates were 3.6% (16/448) and 0.3% (2/706) in Groups A and B, respectively. There was no recurrence in Group C. Rectal ulcers developed at the injection site in four (0.9%) patients from Group A, but they healed within a few months with conservative therapy. ALTA sclerotherapy is a simple and safe treatment for symptomatic hemorrhoids, with few complications.

Management of internal hemorrhoids by Kshara karma: An educational case report

PubMed Central

Mahapatra, Anita; Srinivasan, A.; Sujithra, R.; Bhat, Ramesh P.

2012-01-01

A 66-year-old male patient came to the anorectal clinic, Outpatient department, AVT Institute for Advanced Research, Coimbatore, Tamil Nadu, with complaints of prolapsing pile mass during defecation and bleeding while passing stool. The case was diagnosed as “Raktarsha” - 11 & 7 ‘o’ clock position II degree internal hemorrhoids, deeply situated, projecting one and caused by pitta and rakta; with bleeding tendency. Kshara karma (application of caustic alkaline paste) intervention was done in this case to internal hemorrhoids under local anesthesia. The pile mass and per rectal bleeding resolved in 8 days and the patient was relieved from all symptoms within 21 days. No complications were reported after the procedure. The patient was followed up regularly from 2004 onward till date and proctoscopic examination did not reveal any evidence of recurrence of the hemorrhoids. PMID:23125506

A comparative study of Barron's rubber band ligation with Kshar Sutra ligation in hemorrhoids

PubMed Central

Singh, Rakhi; Arya, Ramesh C.; Minhas, Satinder S.; Dutt, Anil

2010-01-01

Despite a long medical history of identification and treatment, hemorrhoids still pose a challenge to the medical fraternity in terms of finding satisfactory cure of the disease. In this study, Kshar Sutra Ligation (KSL), a modality of treatment described in Ayurveda, was compared with Barron's Rubber Band Ligation (RBL) for grade II and grade III hemorrhoids. This study was conducted in 20 adult patients of either sex with grade II and grade III hemorrhoids at two different hospitals. Patients were randomly allotted to two groups of 10 patients each. Group I patients underwent RBL, whereas patients of group II underwent KSL. Guggul-based Apamarga Kshar Sutra was prepared according to the principles laid down in ancient Ayurvedic texts and methodology standardized by IIIM, Jammu and CDRI, Lucknow. Comparative assessment of RBL and KSL was done according to 16 criteria. Although the two procedures were compared on 15 criteria, treatment outcome of grade II and grade III hemorrhoids was decided chiefly on the basis of patient satisfaction index (subjective criterion) and ability of each procedure to deal with prolapse of internal hemorrhoidal masses (objective criterion): Findings in each case were recorded over a follow-up of four weeks (postoperative days 1, 3, 7, 15 and 30). Statistical analysis was done using Student's t test for parametric data and Chi square test & Mann-Whitney test for non-parametric data. P < 0.05 was considered significant. RBL had the advantages of being an OPD procedure requiring no anesthesia and was attended by significantly lesser postoperative recumbency (P < 0.001 ) and significantly lesser pain (P < 0.005 on day 1) as compared to KSL. However, Group II (KSL) scored better in terms of treatment outcome. In Group II, there was significantly high (P < 0.05) patient satisfaction index as compared to Group I. Group II reported 100% 'cure' (absence of hemorrhoidal masses even on proctoscopy) of internal hemorrhoidal prolapse as against 80

Comparison between Ultroid and rubber band ligation in treatment of internal hemorrhoids.

PubMed

Azizi, Rasoul; Rabani-Karizi, Behzad; Taghipour, Mohammad Ali

2010-01-01

Hemorrhoid is one of the most common surgical diseases and different methods are available for its treatment. This study is a comparison between two methods of treatment of internal hemorrhoid, Monopolar low voltage instrument (Ultroid) and Rubber Band Ligation. This method has been carried out prospectively in which 50 patients who were treated with rubber band ligation and 50 patients with Ultroid were compared according to the incidence of complications, post-operative pain and treatment response. According to this study complete success rate with Ultroid was 82% and partial success rate was 10% and no response to treatment was seen in 8%. In Rubber Band method the complete response rate was 94% (P=0.2). With Ultroid, 74% of patient reported no postoperative pain, 24% reported mild and moderate pain and 2% of patients complained of severe pain. With Rubber band ligation, 72% of patients reported no post-operative pain, 26% reported mild and moderate pain and 1% complained of severe pain (P=0.00). Rubber Band ligation and Ultroid are both considered as outpatient procedures for treatment of hemorrhoids. Both methods are mostly used for grade 1, 2 and sometime grade 3 hemorrhoids. In Ultroid method the operator is required to hold the probe for a period of time, and in most cases, the surgeon should spend between 20-25 minutes for the coagulation of three piles. Some surgeons do not have patience for this modality of internal hemorrhoid treatment. In this study we achieved acceptable results comparable with those of other techniques.

A prospective, randomized trial comparing the short- and long-term results of doppler-guided transanal hemorrhoid dearterialization with mucopexy versus excision hemorrhoidectomy for grade III hemorrhoids.

PubMed

De Nardi, Paola; Capretti, Giovanni; Corsaro, Antonino; Staudacher, Carlo

2014-03-01

Few randomized trials have compared the results of Doppler-guided transanal hemorrhoid dearterialization with mucopexy and excisional open hemorrhoidectomy. Few studies have reported long-term results. The aim of this study is to evaluate the results of Doppler-guided transanal hemorrhoid dearterialization with mucopexy compared with excisional open hemorrhoidectomy in patients with grade III hemorrhoids. This is a prospective randomized study registered at clinicaltrials.gov (NCT01263431). A power analysis assessed the study's sample size. Patients were randomly assigned to undergo either hemorrhoidectomy or Doppler-guided hemorrhoid dearterialization plus mucopexy. The χ test, Mann-Whitney U test, Student t test, and a regression model were used, as appropriate. This study was conducted at the Department of Surgery, San Raffaele Scientific Institute, Milan, Italy. Fifty consecutive patients were treated for grade III hemorrhoids from July to November 2010. The primary outcome was postoperative pain. The secondary outcomes included postoperative morbidity, the resumption of social and/or working activity, patient satisfaction, and the relapse of symptoms at 1 and 24 months. No major complications occurred in either group. The median visual analog scale scores for pain in the hemorrhoidectomy and Doppler-guided dearterialization plus mucopexy groups on days 1, 7, 14, and 30 were 7 vs 5.5, 3 vs 2.5, 1 vs 0, and 0 vs 0 (p> 0.05). The median work resumption day was the 22nd in the hemorrhoidectomy group and the 10th in the Doppler-guided dearterialization plus mucopexy group (p = 0.09). Patient satisfaction at 1 and 24 postoperative months, with the use of a 4-point scale, was 3 vs 4 and 4 vs 4 (p > 0.05). During the follow-up, 2 patients in the dearterialization group required ambulatory treatment, and 1 patient in each group required further surgery for symptom relapse. Nonvalidated questionnaires were used in the follow-up. Cost analysis was not performed

Aluminum potassium sulfate and tannic acid sclerotherapy for Goligher Grades II and III hemorrhoids: Results from a multicenter study

PubMed Central

Miyamoto, Hidenori; Hada, Takenori; Ishiyama, Gentaro; Ono, Yoshito; Watanabe, Hideo

2016-01-01

AIM: To show that aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy has a high success rate for Grade II and III hemorrhoids. METHODS: This study was based on the clinical data of 604 patients with hemorrhoids who underwent ALTA sclerotherapy between January 2009 and February 2015. The objective of this study was to assess the efficacy of this treatment for Grades II and III hemorrhoids. Preoperative and postoperative symptoms, complications and success rate were all assessed retrospectively. Follow-up consisted of a simple questionnaire, physical examination and an anoscopy. Patients were followed-up at one day, one week, two weeks, one month, one year, two years, three years, four years and five years after the ALTA sclerotherapy. RESULTS: One hundred and sixty-nine patients were diagnosed with Grade II hemorrhoids and 435 patients were diagnosed with Grade III hemorrhoids. The one year, three year and five year cumulative success rates of ALTA sclerotherapy for Grades II and III hemorrhoids were 95.9% and 93.1%; 89.3% and 83.7%; and 89.3% and 78.2%, respectively. No significant differences were observed in the cumulative success rates after ALTA sclerotherapy between Grades II and III hemorrhoids (P = 0.09). There were forty-seven post-operative complications (low grade fever; anal pain; urinary retention; rectal ulcer; and others). No serious or life-threatening complications occurred and all cases improved through conservative treatment. At univariate analysis there were no predictive factors of failure. CONCLUSION: ALTA sclerotherapy has had a high success rate for Grade II and III hemorrhoids during five years of post-operative treatment. However, additional studies are needed to evaluate the efficacy of this ALTA sclerotherapy in the management of hemorrhoidal disease. PMID:27458504

Comparison of Electrotherapy, Rubber Band Ligation and Hemorrhoidectomy in the Treatment of Hemorrhoids: A Clinical and Manometric Study

PubMed Central

Izadpanah, A; Hosseini, SV; Mahjoob, M

2010-01-01

BACKGROUND Treatment of hemorrhoid disease is one of the most challenging fields in general surgery in which different methods are used to treat this condition. In this study, we compared the manometric and clinical results of three treatment methods for hemorrhoids. METHODS A total of 150 patients with symptomatic grades II or III internal hemorrhoids were randomly assigned to three groups. Group A underwent Ferguson hemorrhoidectomy, group B were treated with rubber band ligation (RBL) and group C were treated with direct current electrotherapy. RESULTS Preoperatively, grade III hemorrhoids had significantly higher mean resting pressure and mean squeezing pressure in comparison to grade II hemorrhoids. After hemorrhoidectomy, patients in group A had a significant decrease in the maximum resting pressure (90.8 to 77.7 mmHg) and maximum squeezing pressure (130.6 to 114.8 mmHg) with a significant raise in the volume of the first sensation. However there was no significant change in manometric indexes after RBL and electrotherapy. Group A patients had more postoperative pain and itching compared to groups B and C. CONCLUSION We conclude that electrotherapy is a safe, effective and simple method of treating grades II and III uncomplicated internal hemorrhoids. This procedure is associated with little postoperative pain and complications, and has the least changes in anorectal manometric characteristics. Therefore electrotherapy may be recommended as a treatment of choice for grades II and III uncomplicated internal hemorrhoids. PMID:25197506

Hemorrhoidal artery ligation (HAL) and rectoanal repair (RAR): retrospective analysis of 408 patients in a single center.

PubMed

Scheyer, M; Antonietti, E; Rollinger, G; Lancee, S; Pokorny, H

2015-01-01

Rectoanal repair (RAR), which combines doppler-guided hemorrhoidal artery ligation (HAL) and mucopexy via lifting of the hemorrhoidal prolapse, offers a minimally invasive alternative to conventional hemorrhoidectomy. Patients with grade II hemorrhoids were treated with HAL, and patients with grade III and IV hemorrhoids were treated with the RAR procedure by two surgeons. Postoperative follow-up was performed clinically and by proctoscopy after 8 weeks routinely, and long-term follow-up was performed using a standardized postal questionnaire. The overall complication rate was 29% (n = 118). After short-term follow-up, 26% (n = 106) of patients reported recurrent or persistent prolapsing piles, while 21% (n = 86) of patients had recurrent bleeding. After long-term follow-up, 24% (n = 98) of patients reported prolapsing piles, 3% (n = 12) bleeding, 3% (n = 12) pruritus, and 2% (n = 8) anal pain, while 20% (n = 82) complained of persistent mixed symptoms. HAL and RAR provide prolonged relief for patients with hemorrhoidal disease whose main symptoms are bleeding, pruritus and pain but not for patients with prolapse as an initial indication.

Efficacy of a standardized herbal preparation (Roidosanal®) in the treatment of hemorrhoids: A randomized, controlled, open-label multicentre study

PubMed Central

Aggrawal, Kapil; Satija, Naveen; Dasgupta, Gita; Dasgupta, Partha; Nain, Parul; Sahu, Aditya R.

2014-01-01

Background: Catechins and epicatechins are monomers of naturally occurring proanthocyanidins, which have been reported with free radical scavenging, antioxidant, antiinflammatory, antiallergic, and vasodilatory properties. Plant parts rich in proanthocyanidins have been used for years in treatment of various ano-rectal diseases. This study compares the efficacy of two herbal preparations, Daflon® 500 mg and Roidosanal®, in ameliorating the signs and symptoms associated with hemorrhoids. Objective: To evaluate the safety and to compare the efficacy of a herbal preparation, Roidosanal® versus Daflon® 500 mg, on signs and symptoms of hemorrhoidal disease. Materials and Methods: In this pilot, active controlled, open-labeled multicentre study, 73 patients with proctoscopy proven hemorrhoids (Grade I to III) were randomly assigned to receive either Roidosanal® (Gr R; n = 37) or Daflon® 500 mg (Gr D; n = 36), for 15 days, at three centers in India. Assessment of hemorrhoidal symptoms was carried out in all patients at different time points. Intent-to-treat analysis was performed for both primary and secondary endpoints. Results: Baseline characteristics were comparable between the two groups. Both products were found to be equally effective in improving the ano-rectal conditions in Grade I and Grade II hemorrhoids; however, Roidosanal® demonstrated better efficacy in patients with Grade III hemorrhoids. Hemorrhoids associated symptoms like bleeding, pain, etc., improved in both groups, although intergroup comparisons were comparable. Conclusion: Both Roidosanal® and Daflon® 500 mg were equally effective in resolving signs and symptoms of hemorrhoids. Roidosanal® can be tried as a safe and effective treatment option for treatment of hemorrhoids. Further randomized, double-blind and large multicentre studies are recommended. PMID:24948863

Guidelines for the treatment of hemorrhoids (short report).

PubMed

Higuero, T; Abramowitz, L; Castinel, A; Fathallah, N; Hemery, P; Laclotte Duhoux, C; Pigot, F; Pillant-Le Moult, H; Senéjoux, A; Siproudhis, L; Staumont, G; Suduca, J M; Vinson-Bonnet, B

2016-06-01

Hemorrhoids are a common medical problem that is often considered as benign. The French Society of Colo-Proctology (Société nationale française de colo-proctologie [SNFCP]) recently revised its recommendations for the management of hemorrhoids (last issued in 2001), based on the literature and consensual expert opinion. We present a short report of these recommendations. Briefly, medical treatment, including dietary fiber, should always be proposed in first intention and instrumental treatment only if medical treatment fails, except in grade ≥III prolapse. Surgery should be the last resort, and the patient well informed of the surgical alternatives, including the possibility of elective ambulatory surgery, if appropriate. Postoperative pain should be prevented by the systematic implementation of a pudendal block and multimodal use of analgesics. Copyright © 2016. Published by Elsevier Masson SAS.

A retrospective analysis of short and long term efficacy of RBL for hemorrhoids.

PubMed

Lu, L Y; Zhu, Y; Sun, Q

2013-10-01

Rubber band ligation is an effective treatment for hemorrhoids. A retrospective analysis was performed to evaluate its short and long-term efficacy. From 2000 to 2008, 254 outpatients with II- degree and 114 with III-degree hemorrhoids underwent rubber band ligation. Two or three hemorrhoids were ligated per session. Each haemorrhoid was ligated with two rubber bands through a ligator. All patients were visited after two months and followed up through a telephone after two and eleven years. Twenty-four or forty-eight hours post treatment, 41% of patients had mild-moderate pain. Four patients showed severe pain and required for haemorrhoidectomy within a few days. Only 2% of patients experienced self-limiting rectal bleeding after one week and 6% of patients had an additional ligation within two months. Two months later, 92% of II-degree patients and 76% of III-degree patients showed no residual symptoms. After two and eleven years, the history of 314 patients (85%) were obtained, of them, 70% was asymptomatic, 27% had some residual symptoms of occasional bleeding and prolapse, and 3% needed further surgery. Rubber band ligation is an efficient, cost-effective and simple outpatient procedure for the second and third degree hemorrhoids with minimal complications.

Safety and efficacy of superior rectal artery embolization with particles and metallic coils for the treatment of hemorrhoids (Emborrhoid technique).

PubMed

Zakharchenko, A; Kaitoukov, Y; Vinnik, Y; Tradi, F; Sapoval, M; Sielezneff, I; Galkin, E; Vidal, V

2016-11-01

The purpose of this study was to comprehensively evaluate the short-term outcomes after percutaneous embolization of the superior rectal artery (SRA) with metallic coils and particles for the management of hemorrhoids. Forty patients (15 men, 25 women) with a mean age of 35±5 years (SD) (range: 25-65 years) were prospectively enrolled. All patients had symptomatic hemorrhoids. The distribution of internal hemorrhoids was as follows: grade I (n=6, 16%); grade II (n=28, 69%) and grade III (n=6; 15%). All patients had percutaneous embolization of the SRA with metallic coils and synthetic polyvinyl alcohol particles. Follow-up evaluation included clinical examination, rectoscopy, histopathological analysis of rectal mucosa, duplex Doppler blood flow quantification, electromyography, sphincterometry of the anal sphincter and analysis of patient satisfaction. No immediate complications were observed and no patients had anal pain syndrome after embolization. Hemorrhoids showed a 43% size reduction after embolization (P<0.05). Taking into account the symptom resolutions such as irritation, discomfort, bloody discharge and pain, satisfaction was observed in 5/6 (83%) patients with grade III hemorrhoids and 32/34 patients (94%) with grades I-II hemorrhoids. One month after embolization, anal sphincter contractility normalized and no changes in anal electromyography were observed. Blood flow in the hemorrhoidal plexus dropped from 109±1.2ml/min/100g (SD) before treatment to 60.2±4.4ml/min/100g (SD) (P<0.05) the day after embolization and remained unchanged one month after embolization. Our study demonstrates that embolization of SRA with particle and coils does not lead to ischemia in patients with symptomatic hemorrhoids. Short-term results with regard to symptom management for hemorrhoidal disease are very encouraging and should stimulate further prospective and multicenter studies. Copyright © 2016 Editions françaises de radiologie. Published by Elsevier Masson SAS

Hemorrhoids in pregnancy

PubMed Central

Staroselsky, Arthur; Nava-Ocampo, Alejandro A.; Vohra, Sabina; Koren, Gideon

2008-01-01

QUESTION One of my patients is in the third trimester of her first pregnancy. She has recently experienced spotting during her bowel movements. She has hemorrhoids. What medications are safe? ANSWER The treatment is mainly symptomatic for most patients. Most forms of the condition can be treated by increasing fibre content in the diet, administering stool softeners, increasing liquid intake, and training in toilet habits. Although none of the topical antihemorrhoidal agents commonly used have been assessed for safety in pregnancy, it is unlikely that the constituent parts (anesthetic, corticosteroids, and anti-inflammatory agents) will harm the third-trimester infant. In most women, most symptoms of the condition will resolve spontaneously soon after giving birth. PMID:18272631

Hemorrhoids in pregnancy.

PubMed

Staroselsky, Arthur; Nava-Ocampo, Alejandro A; Vohra, Sabina; Koren, Gideon

2008-02-01

One of my patients is in the third trimester of her first pregnancy. She has recently experienced spotting during her bowel movements. She has hemorrhoids. What medications are safe? The treatment is mainly symptomatic for most patients. Most forms of the condition can be treated by increasing fibre content in the diet, administering stool softeners, increasing liquid intake, and training in toilet habits. Although none of the topical antihemorrhoidal agents commonly used have been assessed for safety in pregnancy, it is unlikely that the constituent parts (anesthetic, corticosteroids, and anti-inflammatory agents) will harm the third-trimester infant. In most women, most symptoms of the condition will resolve spontaneously soon after giving birth.

Association of chronic obstructive pulmonary disease and hemorrhoids: A nationwide cohort study.

PubMed

Lin, Lih-Hwa; Siu, Justin Ji-Yuen; Liao, Po-Chi; Chiang, Jen-Huai; Chou, Pei-Chi; Chen, Huey-Yi; Ho, Tsung-Jung; Tsai, Ming-Yen; Chen, Yung-Hsiang; Chen, Wen-Chi

2017-03-01

According to traditional Chinese medicine (TCM) theory, a specific physiological and pathological relationship exists between the lungs and the large intestine. The aim of this study is to delineate the association of chronic obstructive pulmonary disease (COPD) and hemorrhoids in order to verify the "interior-exterior" relationship between the lungs and the large intestine. A retrospective cohort study is conceived from the National Health Insurance Research Database, Taiwan. The 2 samples (COPD cohort and non-COPD cohort) were selected from the 2000 to 2003 beneficiaries of the NHI, representing patients age 20 and older in Taiwan, with the follow-up ending on December 31, 2011. The COPD cohort (n = 51,506) includes every patient newly diagnosed as having Chronic Obstructive Pulmonary Disease (COPD, ICD-9-CM: 490-492, 494, 496), who have made at least 2 confirmed visits to the hospital/clinic. The non-COPD cohort (n = 103,012) includes patients without COPD and is selected via a 1:2 (COPD: non-COPD) matching by age group (per 5 years), gender, and index date (diagnosis date of COPD for the COPD cohort). Compared with non-COPD cohorts, patients with COPD have a higher likelihood of having hemorrhoids and the age-, gender- and comorbidies-adjusted hazard ratio (HR) for hemorrhoids is 1.56 (95% confidence intervals [CI]:1.50-1.62). The adjusted HR of hemorrhoids for females is 0.79 (95% CI: 0.77-0.83), which is significantly less than that for males. The elderly groups, 40 to 59 years and aged 60 or above, have higher adjusted HRs than younger age groups (20-39 years), 1.19 (95% CI: 1.14-1.26), and 1.18 (95% CI: 1.12-1.24), respectively. Patients with COPD may have a higher likelihood to have hemorrhoids in this retrospective cohort study. This study verifies the fundamental theorem of TCM that there is a definite pathogenic association between the lungs and large intestine.

Comparing topical hydrocortisone cream with Hai's Perianal Support in managing symptomatic hemorrhoids in pregnancy: a preliminary trial.

PubMed

Lim, Soo Soo; Yu, Chye Wah; Aw, Lin Da

2015-02-01

The prevalence of hemorrhoids among pregnant women is high in late pregnancy. This study was to evaluate the efficacy between drug treatment with Procort (topical hydrocortisone cream 1%) and mechanical treatment with a Hai's Perianal Support (HPS) toilet seat device in managing symptomatic hemorrhoids during the third trimester of pregnancy. A prospective randomized controlled study was conducted on 23 pregnant women with gestation above the 28th week and presented with symptomatic hemorrhoids. Pre- and post-interventional assessment was carried out to obtain data on symptoms of pain, itching, swelling, discomfort and bleeding associated with hemorrhoids. The control group was treated with topical hydrocortisone cream 1% and the test group was provided and taught to use a HPS, a posterior perineal support toilet seat device (Colorec). The results showed improvement in symptoms of pain, swelling, bleeding, itching and discomfort in both the test and control groups. However, statistically significant differences were found on symptoms of pain, swelling and discomfort between the test and control groups. There was also a statistically significant difference in well-being and overall improvement between the test and control groups. HPS has to a certain extent significantly reduced the symptoms of hemorrhoids in pregnancy and improved the well-being of pregnant women in comparison with topical treatment with hydrocortisone cream. However, more clinical trials need to be carried out to recomfirm the role of HPS in hemorrhoids in pregnancy. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Protocol for the development of a Core Outcome Set (COS) for hemorrhoidal disease: an international Delphi study.

PubMed

van Tol, R R; Melenhorst, J; Dirksen, C D; Stassen, L P S; Breukink, S O

2017-07-01

Over the last decade, many studies were performed regarding treatment options for hemorrhoidal disease. Randomised controlled trials (RCTs) should have well-defined primary and secondary outcomes. However, the reported outcome measures are numerous and diverse. The heterogeneity of outcome definition in clinical trials limits transparency and paves the way for bias. The development of a core outcome set (COS) helps minimizing this problem. A COS is an agreed minimum set of outcomes that should be measured and reported in all clinical trials of a specific disease. The aim of this project is to generate a COS regarding the outcome of treatment after hemorrhoidal disease. A Delphi study will be performed by an international steering group healthcare professionals and patients with the intention to create a standard outcome set for future clinical trials for the treatment of hemorrhoidal disease. First, a literature review will be conducted to establish which outcomes are used in clinical trials for hemorrhoidal disease. Secondly, both healthcare professionals and patients will participate in several consecutive rounds of online questionnaires and a face-to-face meeting to refine the content of the COS. Development of a COS for hemorrhoidal disease defines a minimum outcome-reporting standard and will improve the quality of research in the future.

Conventional (CH) vs. stapled hemorrhoidectomy (SH) in surgical treatment of hemorrhoids. Ten years experience.

PubMed

Manfredelli, Simone; Montalto, Gioacchino; Leonetti, Giovanni; Covotta, Marco; Amatucci, Chiara; Covotta, Alfredo; Forte, Angelo

2012-01-01

Interest about hemorrhoids is related to its high incidence and elevated social costs that derive from its treatment. Several comparative studies are reported in Literature to define a standard for ideal treatment of hemorrhoidal disease. Radical surgery is the only therapeutic option in case of III and IV stage haemorrhoids. Hemorrhoids surgical techniques are classified as Open, Closed and Stapled ones. We report our decennial experience on surgical treatment focusing on early, middle and late complications, indications and contraindications, satisfaction level of each surgical procedure for hemorrhoids. Four hundred forty-eight patients have been hospitalized in our department fom 1st January to 31st December 2008. Of these 241 underwent surgery with traditional open or closed technique and 207 with the SH technique according to Longo. This retrospective study includes only patients with symptomatic hemorrhoids at III or IV stage. There were no differences between CH and SH about both pre and post surgery hospitalization and intraoperative length. Pain is the most frequently observed early complication with a statistically significant difference in favour of SH. We obtain good results in CH group using anoderma sparing and perianal anaesthetic infiltration at the end of the surgery. In all cases, pain relief was obtained only with standard analgesic drugs (NSAIDs). We also observed that pain level influences the outcome after surgical treatment. No chronic pain cases were observed in both groups. Bleeding is another relevant early complication in particular after SH: we reported 2 cases of immediate surgical reintenvention and 2 cases treated with blood transfusion. Only in SH group we report also 5 cases of thrombosis of external haemorrhoids and 7 perianal hematoma both solved with medical therapy There were no statistical significant differences between two groups about fever, incontinence to flatus, urinary retention, fecal incontinence, substenosis and anal

An optimal painless treatment for early hemorrhoids; our experience in Government Medical College and Hospital

PubMed Central

Singal, R; Gupta, S; Dalal, AK; Dalal, U; Attri, AK

2013-01-01

Objective - To evaluate the efficacy of Infrared Coagulation Therapy (IRC) for hemorrhoids. IRC is a painless, safe and successful procedure. Place and duration of study - Department of Surgery, Government Medical College and Hospital, Sector-32, Chandigarh, India, from August 2006 to October 2008. The choice of procedure depends on the patient's symptoms, the extent of the hemorrhoidal disease, and the experience of the surgeon along with the availability of the techniques/instruments. Materials and methods - This is a prospective study done from August 2006 to October 2008. Total number of 155 patients was included in the study. Infrared Coagulation Therapy (IRC) was performed through a special designed proctoscope. Patients excluded were with coagulopathy disorders, fissure in ano, and anal ulcers. Results - It is an outpatient Department (OPD), non-surgical, ambulatory, painless and bloodless procedure, without any hospital stay. Early recovery and minimal recurrence of hemorrhoids were noted without any morbidity or mortality. We have studied 155 patients, treated with IRC on OPD basis. Surgery was required in few patients in whom IRC failed or was contraindicated. Out of the total 155 patients, 127 came for follow up. After the 1st sitting of IRC therapy: out of 127; 43 patients got a total relief, mass shrinkage was of > 75% in 57 cases and < 50% in 14 cases. Twenty-eight cases did not come for follow-up. In the 2nd sitting, out of 84/127; 58 patients got a total relief, >75% relief in 15 cases and >50 % relief in 11 patients. In the 3rd sitting out of 26/84 cases: 13 cases got a total relief and 13 cases refused to take the third sitting; however, in 7 cases the hemorrhoidal mass shrank up to 50% after the two sittings. These 14 were operated as there was no relief from bleeding after giving two sittings of IRC. Our opinion is that, in the above 14 cases, the patient might have not followed the instructions properly for dietary habits. Conclusion - IRC is a

An optimal painless treatment for early hemorrhoids; our experience in Government Medical College and Hospital.

PubMed

Singal, R; Gupta, S; Dalal, A K; Dalal, U; Attri, A K

2013-09-15

To evaluate the efficacy of Infrared Coagulation Therapy (IRC) for hemorrhoids. IRC is a painless, safe and successful procedure. Department of Surgery, Government Medical College and Hospital, Sector-32, Chandigarh, India, from August 2006 to October 2008. The choice of procedure depends on the patient's symptoms, the extent of the hemorrhoidal disease, and the experience of the surgeon along with the availability of the techniques/instruments. This is a prospective study done from August 2006 to October 2008. Total number of 155 patients was included in the study. Infrared Coagulation Therapy (IRC) was performed through a special designed proctoscope. Patients excluded were with coagulopathy disorders, fissure in ano, and anal ulcers. Results - It is an outpatient Department (OPD), non-surgical, ambulatory, painless and bloodless procedure, without any hospital stay. Early recovery and minimal recurrence of hemorrhoids were noted without any morbidity or mortality. We have studied 155 patients, treated with IRC on OPD basis. Surgery was required in few patients in whom IRC failed or was contraindicated. Out of the total 155 patients, 127 came for follow up. After the 1st sitting of IRC therapy: out of 127; 43 patients got a total relief, mass shrinkage was of > 75% in 57 cases and < 50% in 14 cases. Twenty-eight cases did not come for follow-up. In the 2nd sitting, out of 84/127; 58 patients got a total relief, >75% relief in 15 cases and >50 % relief in 11 patients. In the 3rd sitting out of 26/84 cases: 13 cases got a total relief and 13 cases refused to take the third sitting; however, in 7 cases the hemorrhoidal mass shrank up to 50% after the two sittings. These 14 were operated as there was no relief from bleeding after giving two sittings of IRC. Our opinion is that, in the above 14 cases, the patient might have not followed the instructions properly for dietary habits. IRC is a safe, simple and effective procedure for early hemorrhoids without any

Novel endoscopic delivery modality of infrared coagulation therapy for internal hemorrhoids.

PubMed

McLemore, Elisabeth C; Rai, Rudra; Siddiqui, Junaid; Basu, P Patrick; Tabbaa, Mousab; Epstein, Michael S

2012-11-01

A novel endoscopic delivery system for infrared coagulation therapy (IRC) has been designed recently. IRC is a well-established treatment for symptomatic internal hemorrhoids. Patients frequently undergo lower endoscopy before hemorrhoid treatment to eliminate other sources of bleeding. Current treatment options are difficult to perform without an anal retractor, adequate lighting, and specialized instruments. Endoscopic IRC is an attractive alternative to standard IRC, because it can be performed during the lower endoscopy. Endoscopic IRC utilizes infrared radiation generated by a control box, which is applied to the tissue through a flexible, fiber optic light guide (Precision Endoscopic Infrared Coagulator™). The light guide is placed through the colonoscope or flexible sigmoidoscope in the same chamber as other endoscopic instruments. A retrospective review was performed using a prospectively collected database. A standardized protocol was utilized in all patients. Patients graded their symptoms before and after therapy by using the visual analog symptom severity scoring system (range, 0-10). These results were analyzed by using the nonparametric Wilcoxon signed-rank test. Exact P values were computed by using the R function wilcox.exact. A total of 55 patients underwent endoscopic IRC for predominately grade II and grade III symptomatic internal hemorrhoids (71 %). There were 22 (40 %) female patients. Posttherapy results indicated a significant improvement in global symptoms (pretreatment average global score = 2.24 vs. posttreatment average global score = 0.28; P < 0.0001). There have been no adverse events reported to date. Endoscopic IRC provides improved visibility and efficiency, allowing simultaneous treatment of symptomatic internal hemorrhoids at the time of lower endoscopy. Patients experienced significant improvement in their symptoms after a single session of endoscopic IRC. There are a variety of additional endoscopic IRC therapeutic utilities

Early Experience With a Partial Stapled Hemorrhoidopexy for Treating Patients With Grades III–IV Prolapsing Hemorrhoids

PubMed Central

Jeong, Hyeonseok; Ryu, Kil O; Lim, Jiyong; Kim, Hyun Tae; Yu, Hye Mi; Yoon, Jihoon; Lee, Ju-Young; Kim, Hyoung Rae; Choi, Young Gil

2017-01-01

Purpose Circular stapled hemorrhoidopexy (CSH) is widely used to treat patients with grades III–IV hemorrhoids because of less pain and short hospital stay. However, this procedure is associated with some complications, such as urge to defecate, anal stenosis, staple line dehiscence, abscess and sepsis. To avoid these complications, surgeons perform a partial stapled hemorrhoidopexy (PSH). The aim of this study is to present our early experience with the PSH. Methods We retrospectively reviewed the medical records of 58 patients with hemorrhoids who were treated with a PSH at Busan Hang-Un Hospital from January 2016 to June 2016. A specially designed tri-window anoscope was used, and a purse string suture was made at the mucosae of the protruding hemorrhoids through the window of the anoscope. The hemorrhoidopexy was done by using a circular stapler. Results Of the 58 patients included in this study, 34 were male and 24 were female patients (mean age, 50.4 years). The mean operation time was 12.4 minutes, and the mean postoperative hospital stay was 3.8 days. Three patients experienced bleeding (5.1%) 5 urinary retention (8.6%) and 5 skin tags (8.6%). Urge to defecate, tenesmus, abscess, rectovaginal fistula, anal stricture, incontinence, and recurrence did not occur. Conclusion PSH is a minimally invasive, feasible, and safe technique for treating patients with grades III–IV hemorrhoids. A PSH, instead of a CSH, can be used to treat certain patients with hemorrhoids. PMID:28289661

Emborrhoid: A New Concept for the Treatment of Hemorrhoids with Arterial Embolization: The First 14 Cases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vidal, V., E-mail: vincent.vidal@ap-hm.fr; Sapoval, M., E-mail: marc.sapoval@gmail.com; Sielezneff, Y., E-mail: igor.sielezneff@ap-hm.fr

2015-02-15

PurposeThe ‘emborrhoid’ technique consists of the embolization of the hemorrhoidal arteries. The endovascular arterial occlusion is performed using coils placed in the terminal branches of the superior rectal arteries. The emborrhoid technique has been modeled after elective transanal Doppler-guided hemorrhoidal artery ligation which has been shown to be effective in hemorrhoidal disease. We report the first 14 cases of our experience with emborrhoid technique.Materials and MethodsFourteen patients with disabling chronic rectal bleeding were treated using the emborrhoid technique (3 women, 11 men). The stage of the hemorrhoidal disease was II (10 patients), III (3), and IV (1). This treatment wasmore » decided by a multidisciplinary team (proctologist, visceral surgeon, and radiologist). Seven patients underwent previous proctological surgery. Ten patients had coagulation disorders (anticoagulants or cirrhosis). Superior rectal arteries were embolized with pushable microcoils (0.018).ResultsTechnical success of the embolization procedure was 100 %. Clinical success at 1 month was 72 % (10/14). Of the 4 patients who experienced rebleeding, two underwent additional embolization of the posterior rectal arteries with success. No pain or ischemic complications were observed in 13 patients. One patient experienced a temporary painful and edematous, perianal reaction.ConclusionOur case studies suggest that coil embolization of the superior rectal arteries is technically feasible, safe and well tolerated. Additional studies are needed to evaluate the efficacy of this new ‘emborrhoid’ technique in the management of hemorrhoidal disease.« less

Prospective Case Series of a Novel Minimally Invasive Bipolar Coagulation System in the Treatment of Grade I and II Internal Hemorrhoids.

PubMed

Crawshaw, Benjamin P; Russ, Andrew J; Ermlich, Bridget O; Delaney, Conor P; Champagne, Bradley J

2016-12-01

Background Existing nonsurgical procedures for the treatment of grade I and II internal hemorrhoids are often painful, technically demanding, and often necessitate multiple applications. This study prospectively assessed the safety and efficacy of the HET Bipolar System, a novel minimally invasive device, in the treatment of symptomatic grade I and II internal hemorrhoids. Methods Patients with symptomatic grade I or II internal hemorrhoids despite medical management underwent hemorrhoidal ligation with the HET Bipolar System. Endpoints included resolution or improvement of hemorrhoidal bleeding and/or prolapse from baseline, recurrent or refractory symptoms, and pain. Results Twenty patients were treated with the HET Bipolar System. Two were lost to follow-up. Refractory or recurrent bleeding was present in 8 of 18 (44.4%), 4 of 11 (36.4%), and 4 of 8 (50.0%) patients, and prolapse was reported by 1 of 18 (5.6%), 4 of 11 (36.4%), and 1/7 (14.3%) of patients at 1, 3, and 6 months, respectively. Bleeding improved from baseline in 88.2%, 81.8%, and 87.5% of patients, and resolution of baseline prolapse was seen in 11 of 11 (100%), 4 of 7 (57.1%), and 5 of 5 (100%) patients at the same intervals. Thirteen of 18 (72.2%) patients did not require additional treatment for their symptoms. Conclusions The HET Bipolar System is safe and easy to use with short-term effectiveness comparable to that of currently used techniques for the treatment of symptomatic grade I and II internal hemorrhoids. It may be an effective alternative to rubber band ligation in patients with larger internal hemorrhoids and those with hemorrhoids close to the dentate line in which banding may produce debilitating pain. © The Author(s) 2016.

Clinical Evaluation of Commiphora Mukul, a Botanical resin, in the Management of Hemorrhoids: A randomized controlled trial

PubMed Central

Yousefi, Mahdi; Mahdavi, Mohammad Reza Vaez; Hosseini, Seyed Mousalreza; Bahrami, Abdollah; Davati, Ali; Kamalinejad, Mohammad; Faghihzadeh, Sograt

2013-01-01

Background: Hemorrhoids complaint is one of the most common problems in most society, especially in Asian countries. Current drug treatment protocols cannot cure the disease, and they are palliative. According to Persian traditional medicine, Commiphora Mukul (CM) resin is a medication choice. Aim: This randomized study was undertaken to evaluate the efficacy and safety of crude CM resin compared to a combination of lactolose and anti-hemorrhoid (LandA) in patients with uncomplicated hemorrhoids grade 1 and 2. Materials and Methods: This trial was carried out on 99 patients with hemorrhoids, in Ghaem and Imam Reaza Hospitals of the Mashhad University of Medical Sciences, Iran. They randomly received CM 3 g/d for 4 weeks (as study group) or LandA (Lactolose syrup in laxative dose for 1 month and anti-hemorrhoid suppository daily for 10 days) as control group. Subjective and objectives variables including painful defecation, flatulence, constipation, gastro-esophageal reflux (GER), dyspepsia, proctorrhagia, anal protrusion, and colonoscopic grading were assessed before, immediately after, and 4 weeks after the treatment period. An intent-to-treat analysis was used. Safety was assessed with evaluation of clinical adverse effects by common toxicity criteria version 4.0. Forty-nine patients were assigned randomly to receive LandA and 50 to receive CM. After 4 weeks, flatulence, dyspepsia, GER, and colonoscopic grading scores significantly decreased in study group, whereas in control group constipation, painful defecation, and proctorrhagia showed better but not significant improvement. After 4-weak follow-up, the rate of constipation, and proctorrhagia also showed significantly improvement in study group. Constipation and proctorrhagia in control group recurred significantly in 4-week follow-up than after the treatment, whereas this recurrence in test group was not seen. Conclusion: CM was more effective than LandA in 4-week treatment of patients with uncomplicated

[A multicenter, randomized controlled trial of wheat cellulose particles in the treatment of internal hemorrhoids].

PubMed

Peng, Yunhua; Yang, Wei; Wang, Yehuang; Fan, Xiaohua; Zheng, Xueping; Gai, Juanjuan

2017-07-25

To evaluate the efficacy and safety of wheat cellulose particles (testa triticum tricum purify, Fiberform) in the treatment of internal hemorrhoid. A multicenter randomized controlled clinical trial was adopted. From October 2015 to July 2016, 60 patients with internal hemorrhoid were enrolled from three medical centers, including Department of Anorectum, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Department of Anorectum, The Third Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Anorectum, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine. Enrollment criteria: Patients aging from 18 to 65 years old; being diagnosed with the second or third grade internal hemorrhoid; having good communication skills and being able to complete the records and follow-ups according to the research program requirements. Patients combined with other anal diseases, or whose anus tube or rectum suffering occupying lesions; patients currently using other methods and defecation drugs in the treatment of their hemorrhoids; patients in pregnancy or with diseases of heart, liver, kidney or metabolic disorders; patients suffering from constipation due to other diseases and drugs, and long-term laxatives abusers. According to the random number table method, 60 patients were randomly divided into the combined treatment group [30 cases, wheat cellulose particles 1 bag each time, 2 times per day; Diosmin tablet 2 pills, 2 times per day] and the single treatment group [30 cases, Diosmin tablet 2 pills, 2 times per day]. The treatment courses for both groups were 7 days. According to the four-grade scoring method, the efficacy evaluation would be made on six indicators, which were the degree of hematochezia or bleeding, the degree of pain, hemorrhoid prolapse, the shapes and properties of stool, the defecation frequency and the defecation duration. The higher the score a participant got, the more severe the symptom

[Meta-analysis of randomized controlled trials comparing procedure for prolapse and hemorrhoids with Milligan-Morgan hemorrhoidectomy in the treatment of prolapsed hemorrhoids].

PubMed

He, Ping; Chen, Hongliang

2015-12-01

To compare the safety and efficacy of procedure for prolapse and hemorrhoids (PPH) with Milligan-Morgan hemorrhoidectomy (MMH) in the treatment of prolapsed hemorrhoids. All the randomized controlled trials (RCT) comparing PPH with MMH in the treatment of prolapsed hemorrhoids published between January 1998 and January 2015 were retrieved from PubMed, Embase, Cochrane Library, CBM, CNKI, Wangfang, VIP databases. Hand search was applied in Chinese Journal of Gastrointestinal Surgery, Chinese Journal of Coloproctology and Journal of Colorectal and Anal Surgery from the library of Chengdu University of Traditional Chinese Medicine. Associated reference documents in enrolled trials were reviewed. The methodological quality of enrolled trials was evaluated according to the Cochrane handbook for systematic reviews of interventions. Meta-analysis was performed using RevMan 5.3 software. Sixteen RCTs recruiting 1411 patients were identified. Among them, 702 patients underwent PPH, and other 709 patients MMH. Meta-analysis showed that as compared to MMH, PPH had shorter operating time(WMD=-12.34, 95% CI:-17.87 to -6.80, P=0.000], shorter hospital stay (WMD=-1.48, 95% CI: -1.81 to -1.14, P=0.000) and shorter time to recover normal activity (WMD=-14.11, 95% CI: -24.51 to -3.70, P=0.008). Patients in PPH group experienced less pain at postoperative 24 h, postoperative 1 week and the first postoperative bowel movement (all P<0.01). PPH was more ascendant in terms of the requirement for analgesics(P<0.01). PPH group had higher ratio of wound-healing 2 weeks after surgery (RR=0.19, 95% CI: 0.07 to 0.51, P=0.001), lower ratio of postoperative anal stenosis (RR=0.39, 95% CI: 0.15 to 0.99, P=0.050) and lower ratio of anal incontinence (RR=0.62, 95% CI: 0.38 to 1.01, P=0.050), but higher ratio of recurrent disease after 1 year (RR=2.54, 95% CI: 1.21 to 5.31, P=0.010). No significant differences in ratios of postoperative bleeding, urinary retention, and postoperative morbidity of

Excisional hemorrhoidal surgery and its effect on anal continence

PubMed Central

Li, Yan-Dong; Xu, Jia-He; Lin, Jian-Jiang; Zhu, Wei-Fang

2012-01-01

AIM: To investigate the role of anal cushions in hemorrhoidectomy and its effect on anal continence of the patients. METHODS: Seventy-six consecutive patients (33 men and 43 women) with a mean age of 44 years were included. They underwent Milligan-Morgan hemorrhoidectomy because of symptomatic third- and fourth-degree hemorrhoids and failure in conservative treatment for years. Wexner score was recorded and liquid continence test was performed for each patient before and two months after operation using the techniques described in our previous work. The speed-constant rectal lavage apparatus was prepared in our laboratory. The device could output a pulsed and speed-constant saline stream with a high pressure, which is capable of overcoming any rectal resistance change. The patients were divided into three groups, group A (< 900 mL), group B (900-1200 mL) and group C (> 1200 mL) according to the results of the preoperative liquid continence test. RESULTS: All the patients completed the study. The average number of hemorrhoidal masses excised was 2.4. Most patients presented with hemorrhoidal symptoms for more than one year, including a mean duration of incontinence of 5.2 years. The most common symptoms before surgery were anal bleeding (n = 55), prolapsed lesion (n = 34), anal pain (n = 12) and constipation (n = 17). There were grade III hemorrhoids in 39 (51.3%) patients, and grade IV in 37 (48.7%) patients according to Goligher classification. Five patients had experienced hemorrhoid surgery at least once. Compared with postoperative results, the retained volume in the preoperative liquid continence test was higher in 40 patients, lower in 27 patients, and similar in the other 9 patients. The overall preoperative retained volume in the liquid continence test was 1130.61 ± 78.35 mL, and postoperative volume was slightly decreased (991.27 ± 42.77 mL), but there was no significant difference (P = 0.057). Difference was significant in the test value before and

[A case of laparoscopic surgery for a rectal carcinoid after ALTA therapy for an internal hemorrhoid].

PubMed

Aomatsu, Naoki; Nakamura, Masanori; Hasegawa, Tsuyoshi; Nakao, Shigetomi; Uchima, Yasutake; Aomatsu, Keiho

2014-11-01

We report a case of laparoscopic surgery for a rectal carcinoid after aluminum potassium and tannic acid (ALTA) therapy for an internal hemorrhoid. A 66-year-old man was admitted to our hospital because of bleeding during defecation. He was diagnosed via anoscopy with Goligher grade II internal hemorrhoids. Examination via colonoscopy revealed 2 yellowish submucosal tumors in the lower rectum that were 5mm and 10mm in diameter. A rectal carcinoid tumor was diagnosed based on histopathology. Abdominal computed tomography demonstrated no metastases to the liver or lymph nodes. First, we performed ALTA therapy for the internal hemorrhoids. Two weeks later, we performed laparoscopic-assisted low anterior resection (D2) for the rectal carcinoid. The patient was discharged without complications and has not experienced recurrence during the 2 years of follow-up care.

Circular vs. three-quadrant hemorrhoidectomy for end-stage hemorrhoids: short- and long-term outcomes of a prospective randomized trial.

PubMed

Qarabaki, Maia A; Mukhashavria, Gela A; Mukhashavria, Gia G; Giorgadze, Nodari G

2014-04-01

Circumferential excisional hemorrhoidectomy (CEH) enables the surgeon to remove the encircling hemorrhoids completely. The purpose of this study is to compare the efficacy of CEH with that of Ferguson hemorrhoidectomy (FH) for end-stage hemorrhoids. Between February 1998 and December 2011, a prospective randomized trial was conducted with 688 patients who presented with end-stage hemorrhoids and underwent FH or CEH at our center. The patient demographics, mean operative times, lengths of hospital stay, and cumulative rates of postoperative complications were similar in the study groups. Significant differences were revealed in the incidence of postoperative hemorrhage (9 vs. 0 patients in the FH and CEH groups, respectively; p = 0.002) and in the tendency to form anal stricture (15 vs. 32 patients in the FH and CEH groups, respectively; p = 0.02). However, all cases of anal strictures were easily managed by digital dilatations. At a mean follow-up of 7.4 (range, 1-14) years, accessible patients from the CEH group remained symptom free, whereas 126 of 308 patients in the FH group indicated that they had recurrent hemorrhoidal symptoms. Without increasing postoperative complications, CEH demonstrates an advantage compared with FH, with regard to reducing the rate of recurrence to 0 through complete hemorrhoid removal.

Ligation under vision in the management of symptomatic hemorrhoids: A preliminary experience.

PubMed

Kara, Cemal; Sozutek, Alper; Yaman, Ismail; Yurekli, Semih; Karabuga, Turker

2015-07-01

To evaluate the surgical outcomes of 47 patients who underwent hemorrhoidal arterial ligation under vision (LUV) for symptomatic Grade II and Grade III hemorrhoids. A total of 47 patients who underwent LUV between May 2005 and February 2009 were analyzed retrospectively. The patients were evaluated with regard to demographic data, grade of the disease, symptoms, medical and/or surgical treatment previously received, operation time, pain scores, analgesic requirement, length of hospital stay, and complications related to the procedure. The study population (n = 47) included 31 (65.9%) men and 16 (34.1%) women with a median age of 37.4 ± 11.7 (range, 19-63) years. Of these 47 patients, 18 (38.3%) patients had Grade II hemorrhoidal disease (HD) and 29 (61.7%) patients had Grade III HD. On average, six ligatures (range, 3-8) were used. The mean operation time was 27 ± 4.8 (range, 15-35) minutes. No major complication that required surgical intervention occurred in the early postoperative period for any of the patients except for two patients with rectal submucosal hematoma. The mean hospital stay was 1.2 ± 0.65 (range, 1-4) days. The median follow-up period was 21.5 ± 7.7 (range, 12-44) months. At the last follow-up, 38 (80.8%) patients remained asymptomatic; two (4.2%) patients with Grade II HD and four (8.5%) patients with Grade III HD were still suffering from bleeding but with a reduction in the frequency; prolapsed hemorrhoids were detected only in three (6.3%) patients. LUV is a safe and easily applied alternative technique with low postoperative complications for the surgical treatment of symptomatic Grade II and III HD. Copyright © 2014. Published by Elsevier Taiwan.

A novel technique for the treatment of stages III to IV hemorrhoids

PubMed Central

Lin, Guoqiang; Ge, Qiongxiang; He, Xiaokang; Qi, Haixin; Xu, Li

2017-01-01

Abstract To compare the efficacy of homemade anal cushion suspension clamp combined with harmonic scalpel (ACS) and Milligan–Morgan hemorrhoidectomy combined with electric knife (MMH) in the treatment of stages III to IV hemorrhoids. We conducted a retrospective study of 99 patients with stages III to IV hemorrhoids hospitalized from January to December in 2013. Among them, 51 patients were treated with ACS, while 48 patients received MMH. Data from clinical recording and follow-up included operative time, intraoperative blood loss, hospitalization information, postoperative pain, and postoperative complications. Operative time, intraoperative blood loss and hospitalization time in ACS group were significantly less than those in MMH group (P < .05). Compared with MMH group, ACS group had a lower postoperative static pain score from days 1 to 14 (P < .01). The patients in ACS group exhibited less postoperative defecation pain scores from days 3 to 20 than those of MMH group (P < .05). The incidence of postoperative anal edema and delayed wound healing in ACS group was lower than that in MMH group (P < .05). Compared with MMH, our novel technique ACS was more effective and had fewer postoperative complications in the treatment of stages III to IV hemorrhoids. PMID:28658138

Hemorrhoids screening and treatment prior to LVAD: is it a necessity?

PubMed

Skouri, Hadi; Shurrab, Mohammed; Zahnan, Jad; Deeba, Samer; Sfeir, Pierre; Gharzuddin, Walid; Haj-Yahia, Saleem

2016-04-12

Continuous-flow left ventricle assist devices (CF-LVADs) has become an essential modality in the management of stage D heart failure (HF) with significant improvement in survival and quality of life. Due to the durability of such devices and long term support complications such as bleeding and aortic insufficiency has emerged. Bleeding accounts for more than 20 % with the majority being from the gastrointestinal tract. The increase of bleeding tendency are mainly attributed to the loss of large von Willebrand's Factor (vWF) multimers due to shear stress with the chronic intake of anticoagulants. We are reporting two cases of patients with Stage D HF and history of hemorrhoids presenting for LVAD implantation. Many efforts that decrease bleeding related to CF-LVADs will be discussed with focus on hemorrhoids.

The anal canal as a risk organ in cervical cancer patients with hemorrhoids undergoing whole pelvic radiotherapy.

PubMed

Jang, Hyunsoo; Baek, Jong Geun; Jo, Sunmi

2015-01-01

Tolerance of the anal canal tends to be ignored in patients with cervical cancer undergoing whole pelvic radiotherapy. However, patients with hemorrhoids may be troubled with low radiation dose. We tried to analyze the dose-volume statistics of the anal canal in patients undergoing whole pelvic radiotherapy. The records of 31 patients with cervical cancer who received definite or postoperative radiotherapy at one institution were reviewed. Acute anal symptoms, such as anal pain and bleeding, were evaluated from radiotherapy start to 1 month after radiotherapy completion. Various clinical and dosimetric factors were analyzed to characterize relations with acute anal complications. The anal verge was located an average of 1.2 cm (range -0.6~3.9) below the lower border of the ischial tuberosity and an average of 2.7 cm (range -0.6~5.7) behind the sacral promontory level. The presence of hemorrhoids before radiotherapy was found to be significantly associated with acute radiation-induced anal symptoms (p = 0.001), and the mean induction dose for anal symptoms was 36.9 Gy. No patient without hemorrhoids developed an anal symptom during radiotherapy. Dosimetric analyses of V30 and V40 showed marginal correlations with anal symptoms (p = 0.07). The present study suggests a relation between acute anal symptoms following radiotherapy and acute hemorrhoid aggravation. Furthermore, the location of the anal verge was found to be variable, and consequently doses administered to the anal canal also varied substantially. Our results caution careful radiation treatment planning for whole pelvic radiotherapy, and that proper clinical management be afforded patients with hemorrhoids during radiotherapy.

Infrared coagulation versus rubber band ligation in early stage hemorrhoids.

PubMed

Gupta, P J

2003-10-01

The ideal therapy for early stages of hemorrhoids is always debated. Some are more effective but are more painful, others are less painful but their efficacy is also lower. Thus, comfort or efficacy is a major concern. In the present randomized study, a comparison is made between infrared coagulation and rubber band ligation in terms of effectiveness and discomfort. One hundred patients with second degree bleeding piles were randomized prospectively to either rubber band ligation (N = 54) or infrared coagulation (N = 46). Parameters measured included postoperative discomfort and pain, time to return to work, relief in incidence of bleeding, and recurrence rate. The mean age was 38 years (range 19-68 years). The mean duration of disease was 17.5 months (range 12 to 34 months). The number of male patients was double that of females. Postoperative pain during the first week was more intense in the band ligation group (2-5 vs 0-3 on a visual analogue scale). Post-defecation pain was more intense with band ligation and so was rectal tenesmus (P = 0.0059). The patients in the infrared coagulation group resumed their duties earlier (2 vs 4 days, P = 0.03), but also had a higher recurrence or failure rate (P = 0.03). Thus, we conclude that band ligation, although more effective in controlling symptoms and obliterating hemorrhoids, is associated with more pain and discomfort to the patient. As infrared coagulation can be conveniently repeated in case of recurrence, it could be considered to be a suitable alternative office procedure for the treatment of early stage hemorrhoids.

Application of ‘tying, binding and fixing operation’ in surgical treatment of severe mixed hemorrhoids

PubMed Central

Huang, Hong-Xiang; Yao, Yi-Bo; Tang, Ying

2016-01-01

The aim of the present study was to examine the clinical value of ‘tying, binding and fixing operation’ in treating severe mixed hemorrhoids. A total of 160 patients with severe mixed hemorrhoids were selected and randomly divided into the experimental (n=80) and control (n=80) groups. The groups were treated using ‘tying, binding and fixing operation’ and Doppler ultrasound-guided hemorrhoidal artery ligation (DG-HAL), respectively. The results showed that the average operative time of the experimental group (35.57±6.17) was significantly higher than that of the control group (12.73±4.92). There was no significant difference of blood loss during the operation between the two groups (P>0.05). There was also no significant difference in improving the hemorrhage symptom between the two groups (P>0.05). In addition, concerning improvement of prolapse symptoms and reduction of the volume of hemorrhoids, the experimental group were significantly improved as compared to the control group. No anal function damage in the two groups was identified, and the length of stay in hospital for the two groups was not significantly different (P>0.05). However, the hospitalization cost in the experimental group (5,334.77±875.54) was significantly lower than that of the control group (8,551.81±1,806.54) and satisfaction degree was significantly higher than that of the control group. The incidences of perianal pain, anal edema and dysuria between two groups were not significantly different (P>0.05). There were 10 cases of secondary hemorrhage and 18 cases of infection in the experimental group, and 12 cases of secondary hemorrhage and 14 cases of infection in the control group, although the differences between the two groups were not statistically significant (P>0.05). The incidence rate of local hematoma in the experimental group (1.2%) was significantly lower than that in the control group (15.0%). The recurrence rate of the control group (22.5%) was also significantly

Impact of less invasive treatments including sclerotherapy with a new agent and hemorrhoidopexy for prolapsing internal hemorrhoids.

PubMed

Tokunaga, Yukihiko; Sasaki, Hirokazu

2013-01-01

Conventional hemorrhoidectomy is applied for the treatment of prolapsing internal hemorrhoids. Recently, less-invasive treatments such as sclerotherapy using aluminum potassium sulphate/tannic acid (ALTA) and a procedure for prolapse and hemorrhoids (PPH) have been introduced. We compared the results of sclerotherapy with ALTA and an improved type of PPH03 with those of hemorrhoidectomy. Between January 2006 and March 2009, we performed hemorrhoidectomy in 464 patients, ALTA in 940 patients, and PPH in 148 patients with second- and third-degree internal hemorrhoids according to the Goligher's classification. The volume of ALTA injected into a hemorrhoid was 7.3 ± 2.2 (mean ± SD) mL. The duration of the operation was significantly shorter in ALTA (13 ± 2 minutes) than in hemorrhoidectomy (43 ± 5 minutes) or PPH (32 ± 12 minutes). Postoperative pain, requiring intravenous pain medications, occurred in 65 cases (14%) in hemorrhoidectomy, in 16 cases (1.7%) in ALTA, and in 1 case (0.7%) in PPH. The disappearance rates of prolapse were 100% in hemorrhoidectomy, 96% in ALTA, and 98.6% in PPH. ALTA can be performed on an outpatient basis without any severe pain or complication, and PPH is a useful alternative treatment with less pain. Less-invasive treatments are beneficial when performed with care to avoid complications.

[Clinical study of tissue-selecting therapy in the treatment of mixed hemorrhoids: a single-blind randomized controlled trail].

PubMed

He, Hongyan; He, Ping; Liu, Ning

2014-06-01

To evaluate the clinical efficacy and safety of tissue-selecting therapy (TST) in treatment of mixed hemorrhoids. A single-blind randomized study was carried out. A total of 120 patients with mixed hemorrhoids from January to December 2012 were prospectively enrolled in the study and equally divided into two groups, TST group and procedure for prolapse and hemorrhoids(PPH) group. Surgical data, efficacy and postoperative complications were compared between the two groups. As compared to PPH group, patients in TST group had shorter operation time [(15.9±5.18) min vs. (22.6±7.1) min, P<0.05], lower scores of rectal urgency (0.5±0.2 vs. 1.5±1.4, P<0.05), and shorter hospital stay [(11.2±3.7) d vs. (14.8±3.7) d, P<0.05]. No anastomotic stricture case was found in TST group, while 11 cases(18.3%) developed anastomotic stricture in PPH group. There were no significant differences in effective rate and pain score of first defecation between the two groups. TST is reliable and safe for mixed hemorrhoids with the advantage of simple, rapid recovery and less complications.

A Randomized Multicenter Clinical Trial of RPH With the Simplified Milligan-Morgan Hemorrhoidectomy in the Treatment of Mixed Hemorrhoids.

PubMed

He, Yong-Heng; Tang, Zhi-Jun; Xu, Xiang-Tong; Huang, De-Quan; Zhang, Li-Shun; Tang, Qing-Zhu; Fan, Zhi-Min; Zou, Xian-Jun; Zou, Guo-Jun; Zhang, Chong-Yang; Hu, Fan; Xie, Biao; Li, Yan-Hua; Tong, Yao; Liu, Hong-Chang; Li, Ke; Luo, Yu-Lian; Liu, Fei; Situ, Guang-Wei; Liu, Zuo-Long

2017-12-01

To explore the safety and efficacy of Ruiyun procedure for hemorrhoids (RPH) or RPH with the simplified Milligan-Morgan hemorrhoidectomy (sMMH) in the treatment of mixed hemorrhoids. This is a randomized, controlled, balanced, multicenter study of 3000 patients with mixed hemorrhoids. The outcomes and postoperative complications were compared between 5 types of surgeries. The efficacy rate was the highest in patients who received RPH+sMMH and decreased in the following order: patients who received RPH alone, MMH alone, procedure for prolapse and hemorrhoids (PPH) alone, and PPH+sMMH ( P < .05). The operation time was the shortest in patients who received RPH alone and increased in the following order: patients who received RPH+sMMH, PPH alone, MMH alone, and PPH+sMMH ( P < .01). The duration of postoperative hospitalization stay was the shortest in patients who received RPH alone and increased in the following order: PPH alone, RPH+sMMH, PPH+sMMH, and MMH alone ( P < .01). The incidence of postoperative hemorrhage, uroschesis, anal fissure, crissum hematoma or thrombosis, and anorectal stenosis was significantly lower in patients who received RPH+sMMH than in patients who received the other 4 types of surgical treatments ( P < .05, P < .01). No significant differences in postoperative rectovaginal fistula and anal incontinence were observed between the 5 groups of patients. RPH with or without simplified MMH can reduce the incidence of postoperative complications and improve the curative efficacy in the treatment of patients with mixed hemorrhoids.

Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation.

PubMed

Lu, Ming; Yang, Bo; Liu, Yang; Liu, Qing; Wen, Hao

2015-07-14

To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation. One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study. The patients with rectal prolapse hemorrhoids with outlet obstruction-induced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids (PPH) (n = 54) or conventional surgery (n = 54; control group). Short-term (operative time, postoperative hospital stay, postoperative urinary retention, postoperative perianal edema, and postoperative pain) and long-term (postoperative anal stenosis, postoperative sensory anal incontinence, postoperative recurrence, and postoperative difficulty in defecation) clinical effects were compared between the two groups. The short- and long-term efficacies of the two procedures were determined. In terms of short-term clinical effects, operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group (24.36 ± 5.16 min vs 44.27 ± 6.57 min, 2.1 ± 1.4 d vs 3.6 ± 2.3 d, both P < 0.01). The incidence of postoperative urinary retention was higher in the PPH group than in the control group, but the difference was not statistically significant (48.15% vs 37.04%). The incidence of perianal edema was significantly lower in the PPH group (11.11% vs 42.60%, P < 0.05). The visual analogue scale scores at 24 h after surgery, first defecation, and one week after surgery were significantly lower in the PPH group (2.9 ± 0.9 vs 8.3 ± 1.1, 2.0 ± 0.5 vs 6.5 ± 0.8, and 1.7 ± 0.5 vs 5.0 ± 0.7, respectively, all P < 0.01). With regard to long-term clinical effects, the incidence of anal stenosis was lower in the PPH group than in

Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation

PubMed Central

Lu, Ming; Yang, Bo; Liu, Yang; Liu, Qing; Wen, Hao

2015-01-01

AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation. METHODS: One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study. The patients with rectal prolapse hemorrhoids with outlet obstruction-induced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids (PPH) (n = 54) or conventional surgery (n = 54; control group). Short-term (operative time, postoperative hospital stay, postoperative urinary retention, postoperative perianal edema, and postoperative pain) and long-term (postoperative anal stenosis, postoperative sensory anal incontinence, postoperative recurrence, and postoperative difficulty in defecation) clinical effects were compared between the two groups. The short- and long-term efficacies of the two procedures were determined. RESULTS: In terms of short-term clinical effects, operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group (24.36 ± 5.16 min vs 44.27 ± 6.57 min, 2.1 ± 1.4 d vs 3.6 ± 2.3 d, both P < 0.01). The incidence of postoperative urinary retention was higher in the PPH group than in the control group, but the difference was not statistically significant (48.15% vs 37.04%). The incidence of perianal edema was significantly lower in the PPH group (11.11% vs 42.60%, P < 0.05). The visual analogue scale scores at 24 h after surgery, first defecation, and one week after surgery were significantly lower in the PPH group (2.9 ± 0.9 vs 8.3 ± 1.1, 2.0 ± 0.5 vs 6.5 ± 0.8, and 1.7 ± 0.5 vs 5.0 ± 0.7, respectively, all P < 0.01). With regard to long-term clinical effects, the incidence of anal stenosis was lower in

Treatment of hemorrhoids with individualized homeopathy: An open observational pilot study

PubMed Central

Das, Kaushik Deb; Ghosh, Shubhamoy; Das, Asim Kumar; Ghosh, Aloke; Mondal, Ramkumar; Banerjee, Tanapa; Ali, Seikh Sajid; Ali, Seikh Swaif; Koley, Munmun; Saha, Subhranil

2016-01-01

Aim: Controversies and disagreement exist on conventional treatment strategies of hemorrhoids due to relapse, inefficacy, and complications. We intend to evaluate the role of individualized homeopathic treatment in hemorrhoids. Materials and Methods: In this prospective, open, observational trial, hemorrhoids patients were treated using five standardized scales measuring complaints severity and anoscopic score. It was conducted at two homeopathic hospitals in India, during from mid-July 2014 to mid-July 2015. Patients were intervened as per individualized homeopathic principles and followed up every month up to 6 months. Results: Total 73 were screened, 52 enrolled, 38 completed, 14 dropped out. Intention to treat population (n: = 52) was analyzed in the end. Statistically significant reductions of mean bleeding (month 3: −21.8, 95% confidence interval [CI]: −30.3, −13.3, P: < 0.00001, d = 0.787; month 6: −25.5, 95% CI −35.4, −15.6, P: < 0.00001, d = 0.775), pain (month 3: −21.3, 95% CI −28.6, −14.0, P: < 0.00001, d = 0.851; month 6: −27.6, 95% CI −35.6, −19.6, P: < 0.00001, d = 1.003), heaviness visual analog scales (VASs) (month 3: −8.1, 95% CI −13.9, −2.3, P: = 0.008, d = 0.609; month 6: −12.1, 95% CI −19.1, −5.1, P: = 0.001, d = 0.693), and anoscopic score (month 3: −0.4, 95% CI −0.6, −0.2, P: < 0.0001, d = 0.760; month 6: −0.5, 95% CI −0.7, −0.3, P: < 0.0001, d = 0.703) were achieved. Itching VASs reduced significantly only after 6 months (−8.1, 95% CI −14.6, −1.6, P: = 0.017, d = 0.586). No significant lowering of discharge VASs was achieved after 3 and 6 months. Conclusion: Under classical homeopathic treatment, hemorrhoids patients improved considerably in symptoms severity and anoscopic scores. However, being observational trial, our study cannot provide efficacy data. Controlled studies are required. Trial Reg. CTRI/2015/07/005958. PMID:27757262

Randomized controlled trial to assess the role of raised anal pressures in the pathogenesis of symptomatic early hemorrhoids.

PubMed

Chauhan, Ashutosh; Thomas, Shaji; Bishnoi, Prem Kumar; Hadke, Niladhar S

2007-01-01

Increased maximum resting anal pressures (MRAP) have been found in patients with large prolapsed hemorrhoids undergoing hemorrhoidectomy, but their pathogenic role is controversial especially in view of the sphincteric damage that occurs with open and stapled procedures. This prospective randomized clinical trial was conducted to compare anal pressure changes in early symptomatic hemorrhoidal disease before and after successful treatment with band ligation or injection sclerotherapy, and to compare these pressures with those in normal asymptomatic controls. 32 patients with symptomatic grade II hemorrhoids were randomized to treatment with either band ligation or injection sclerotherapy. Anal manometry was done before treatment and 8 weeks after completion of treatment, and compared with 20 normal age-matched controls. The pretreatment values in both study groups were similar to each other (69.38 cm H(2)O, 95% CI 58.67-80.08, vs. 67.75 cm H(2)O, 95% CI 56.86-78.64; p = 0.790), but were significantly higher (p = 0.0001 in both groups) than in the controls (45.25 cm H(2)O, 95% CI 38.36-52.14). After successful completion of treatment, there was a highly significant drop in the MRAP in both study groups (p = 0.0001 in group A, and p = 0.001 in group B) reaching normal values. Our study shows that even in early-stage hemorrhoids, the anal pressures are significantly raised, but after successful treatment with band ligation or injection sclerotherapy, these pressures return to normal, showing that they do not play a pathogenic role but are secondary to the congested hemorrhoidal cushions. Copyright (c) 2007 S. Karger AG, Basel.

Impact of Less Invasive Treatments Including Sclerotherapy With a New Agent and Hemorrhoidopexy for Prolapsing Internal Hemorrhoids

PubMed Central

Tokunaga, Yukihiko; Sasaki, Hirokazu

2013-01-01

Conventional hemorrhoidectomy is applied for the treatment of prolapsing internal hemorrhoids. Recently, less-invasive treatments such as sclerotherapy using aluminum potassium sulphate/tannic acid (ALTA) and a procedure for prolapse and hemorrhoids (PPH) have been introduced. We compared the results of sclerotherapy with ALTA and an improved type of PPH03 with those of hemorrhoidectomy. Between January 2006 and March 2009, we performed hemorrhoidectomy in 464 patients, ALTA in 940 patients, and PPH in 148 patients with second- and third-degree internal hemorrhoids according to the Goligher's classification. The volume of ALTA injected into a hemorrhoid was 7.3 ± 2.2 (mean ± SD) mL. The duration of the operation was significantly shorter in ALTA (13 ± 2 minutes) than in hemorrhoidectomy (43 ± 5 minutes) or PPH (32 ± 12 minutes). Postoperative pain, requiring intravenous pain medications, occurred in 65 cases (14%) in hemorrhoidectomy, in 16 cases (1.7%) in ALTA, and in 1 case (0.7%) in PPH. The disappearance rates of prolapse were 100% in hemorrhoidectomy, 96% in ALTA, and 98.6% in PPH. ALTA can be performed on an outpatient basis without any severe pain or complication, and PPH is a useful alternative treatment with less pain. Less-invasive treatments are beneficial when performed with care to avoid complications. PMID:23971772

Early rectal stenosis following stapled rectal mucosectomy for hemorrhoids

PubMed Central

Petersen, Sven; Hellmich, Gunter; Schumann, Dietrich; Schuster, Anja; Ludwig, Klaus

2004-01-01

Background Within the last years, stapled rectal mucosectomy (SRM) has become a widely accepted procedure for second and third degree hemorrhoids. One of the delayed complications is a stenosis of the lower rectum. In order to evaluate the specific problem of rectal stenosis following SRM we reviewed our data with special respect to potential predictive factors or stenotic events. Methods A retrospective analysis of 419 consecutive patients, which underwent SRM from December 1998 to August 2003 was performed. Only patients with at least one follow-up check were evaluated, thus the analysis includes 289 patients with a mean follow-up of 281 days (±18 days). For statistic analysis the groups with and without stenosis were evaluated using the Chi-Square Test, using the Kaplan-Meier statistic the actuarial incidence for rectal stenosis was plotted. Results Rectal stenosis was observed in 9 patients (3.1%), eight of these stenoses were detected within the first 100 days after surgery; the median time to stenosis was 95 days. Only one patient had a rectal stenosis after more than one year. 8 of the 9 patients had no obstructive symptoms, however the remaining patients complained of obstructive defecation and underwent surgery for transanal strictureplasty with electrocautery. A statistical analysis revealed that patients with stenosis had significantly more often prior treatment for hemorrhoids (p < 0.01). According to the SRM only severe postoperative pain was significantly associated with stenoses (p < 0.01). Other factors, such as gender (p = 0.11), surgical technique (p = 0.25), revision (p = 0.79) or histological evidence of squamous skin (p = 0.69) showed no significance. Conclusion Rectal stenosis is an uncommon event after SRM. Early stenosis will occur within the first three months after surgery. The majority of the stenoses are without clinical relevance. Only one of nine patients had to undergo surgery for a relevant stenosis. The predictive factor for

Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases

PubMed Central

Nakeeb, Ayman M El; Fikry, Amir A; Omar, Waleed H; Fouda, Elyamani M; Metwally, Tito A El; Ghazy, Hosam E; Badr, Sabry A; Elkhar, Mohmed Y Abu; Elawady, Salih M; Elmoniam, Hisham H Abd; Khafagy, Waiel W; Morshed, Mosaad M; Lithy, Ramadan E El; Farid, Mohamed E

2008-01-01

AIM: To study the results for the treatment of symptomatic hemorrhoids using rubber band ligation (RBL) method. METHODS: A retrospective study for 750 patients who came to the colorectal unit from June, 1998 to September, 2006, data was retrieved from archived files. RBL was performed using the Mc Gown applicator on an outpatient basis. The patients were asked to return to out-patient clinic for follow up at 2 wk, 1 mo, 6 mo and through telephone call every 6 mo for 2 years). RESULTS: After RBL, 696 patients (92.8%) were cured with no difference in outcome for second or third degree hemorrhoids (P = 0.31). Symptomatic recurrence was detected in 11.04% after 2 years. A total of 52 patients (6.93%) had 77 complications from RBL which required no hospitalization. Complications were pain, rectal bleeding and vaso-vagal symptoms (4.13%, 4.13% and 1.33% of patients, respectively). At 1 mo there were a significant improvement in mean SF-36 scores over baseline in five items, while after 2 years there were improvement in all items over baseline, but not significant. No significant manometric changes after band ligation. CONCLUSION: RBL is a simple, safe and effective method for treating symptomatic second and third degree hemorrhoids as an out patient procedure with significant improvement in quality of life. RBL doesn’t alter ano-rectal functions. PMID:19030206

Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases.

PubMed

El Nakeeb, Ayman-M; Fikry, Amir-A; Omar, Waleed-H; Fouda, Elyamani-M; El Metwally, Tito-A; Ghazy, Hosam-E; Badr, Sabry-A; Abu Elkhar, Mohmed-Y; Elawady, Salih-M; Abd Elmoniam, Hisham-H; Khafagy, Waiel-W; Morshed, Mosaad-M; El Lithy, Ramadan-E; Farid, Mohamed-E

2008-11-14

To study the results for the treatment of symptomatic hemorrhoids using rubber band ligation (RBL) method. A retrospective study for 750 patients who came to the colorectal unit from June, 1998 to September, 2006, data was retrieved from archived files. RBL was performed using the Mc Gown applicator on an outpatient basis. The patients were asked to return to out-patient clinic for follow up at 2 wk, 1 mo, 6 mo and through telephone call every 6 mo for 2 years). After RBL, 696 patients (92.8%) were cured with no difference in outcome for second or third degree hemorrhoids (P = 0.31). Symptomatic recurrence was detected in 11.04% after 2 years. A total of 52 patients (6.93%) had 77 complications from RBL which required no hospitalization. Complications were pain, rectal bleeding and vaso-vagal symptoms (4.13%, 4.13% and 1.33% of patients, respectively). At 1 mo there were a significant improvement in mean SF-36 scores over baseline in five items, while after 2 years there were improvement in all items over baseline, but not significant. No significant manometeric changes after band ligation. RBL is a simple, safe and effective method for treating symptomatic second and third degree hemorrhoids as an out patient procedure with significant improvement in quality of life. RBL doesn't alter ano-rectal functions.

Randomized Prospective Study of Endoscopic Rubber Band Ligation Compared With Bipolar Coagulation for Chronically Bleeding Internal Hemorrhoids

PubMed Central

Jutabha, Rome; Jensen, Dennis M.; Chavalitdhamrong, Disaya

2013-01-01

OBJECTIVES: Our purpose was to compare the efficacy, complications, success rate, recurrence rate at 1 year, and crossovers of rubber band ligation (RBL) with those of bipolar electrocoagulation (BPEC) treatment for chronically bleeding internal hemorrhoids. METHODS: A total of 45 patients of mean age 51.5 years, who had rectal bleeding from grade II or III hemorrhoids and in whom intensive medical therapy failed, were randomized in a prospective study comparing RBL with BPEC. Treatment failure was predefined as continued bleeding, occurrence of a major complication, or failure to reduce the size of all internal hemorrhoidal segments to grade I in ≤ 3 treatments. Patients were followed up for 1 year. RESULTS: With similar patients, rectal bleeding and other symptoms were controlled with significantly fewer treatments of RBL than of BPEC (2.3±0.2 vs. 3.8±0.4, P < 0.05), and RBL had a significantly higher success rate (92% vs. 62%, P< 0.05). RBL had more cases of severe pain during treatment (8% vs. 0%, P> 0.05), but significantly fewer failures and crossovers (8% vs. 38%). Symptomatic recurrence at 1 year was 10% RBL and 15% BPEC. CONCLUSIONS: For patients with chronically bleeding grade II or III internal hemorrhoids that are unresponsive to medical therapy, safety and complication rates of banding and BPEC were similar. The success rate was significantly higher with RBL than with BPEC. Symptom recurrence rates at 1 year were similar. PMID:19513028

Liver injury after aluminum potassium sulfate and tannic acid treatment of hemorrhoids.

PubMed

Yoshikawa, Kenichi; Kawashima, Reimi; Hirose, Yuki; Shibata, Keiko; Akasu, Takafumi; Hagiwara, Noriko; Yokota, Takeharu; Imai, Nami; Iwaku, Akira; Kobayashi, Go; Kobayashi, Hirohiko; Kinoshita, Akiyoshi; Fushiya, Nao; Kijima, Hiroyuki; Koike, Kazuhiko; Saruta, Masayuki

2017-07-21

We are reporting a rare case of acute liver injury that developed after an internal hemorrhoid treatment with the aluminum potassium sulfate and tannic acid (ALTA) regimen. A 41-year-old man developed a fever and liver injury after undergoing internal hemorrhoid treatment with a submucosal injection of ALTA with lidocaine. The acute liver injury was classified clinically as hepatocellular and pathologically as cholestastic. We could not classify the mechanism of injury. High eosinophil and immunoglobulin E levels characterized the injury, and a drug lymphocyte stimulation test was negative on postoperative day 25. Fluid replacement for two weeks after hospitalization improved the liver injury. ALTA therapy involves injecting chemicals into the submucosa, from the rectum to the anus, and this is the first description of a case that developed a severe liver disorder after this treatment; hence, an analysis of future cases as they accumulate is desirable.

Comparison of clinical outcomes of multi-point umbrella suturing and single purse suturing with two-point traction after procedure for prolapse and hemorrhoids (PPH) surgery.

PubMed

Jiang, Huiyong; Hao, Xiuyan; Xin, Ying; Pan, Youzhen

2017-11-01

To compare the clinical outcomes of multipoint umbrella suture and single-purse suture with two-point traction after procedure for prolapse and hemorrhoids surgery (PPH) for the treatment of mixed hemorrhoids. Ninety patients were randomly divided into a PPH plus single-purse suture group (Group A) and a PPH plus multipoint umbrella suture (Group B). All operations were performed by an experienced surgeon. Operation time, width of the specimen, hemorrhoids retraction extent, postoperative pain, postoperative bleeding, and length of hospitalization were recorded and compared. Statistical analysis was conducted by t-test and χ2 test. There were no significant differences in sex, age, course of disease, and degree of prolapse of hemorrhoids between the two groups. The operative time in Group A was significantly shorter than that in Group B (P < 0.05). However, the incidence rates of submucosal hematoma and incomplete hemorrhoid core retraction were significantly lower in Group B (P < 0.05), whereas the width of the specimens in Group B was greater than that in Group A (P < 0.05). There were fewer redundant skin tags in Group B at three months follow-up. No significant difference in postoperative pain, postoperative bleeding, and time of hospital stay (P > 0.05 for all comparisons) was observed. The multipoint umbrella suture showed better clinical outcomes because of its targeted suture according to the extent of hemorrhoid prolapse. Copyright © 2017. Published by Elsevier Ltd.

Rubber band ligation of hemorrhoids: A guide for complications

PubMed Central

Albuquerque, Andreia

2016-01-01

Rubber band ligation is one of the most important, cost-effective and commonly used treatments for internal hemorrhoids. Different technical approaches were developed mainly to improve efficacy and safety. The technique can be employed using an endoscope with forward-view or retroflexion or without an endoscope, using a suction elastic band ligator or a forceps ligator. Single or multiple ligations can be performed in a single session. Local anaesthetic after ligation can also be used to reduce the post-procedure pain. Mild bleeding, pain, vaso-vagal symptoms, slippage of bands, priapism, difficulty in urination, anal fissure, and chronic longitudinal ulcers are normally considered minor complications, more frequently encountered. Massive bleeding, thrombosed hemorrhoids, severe pain, urinary retention needing catheterization, pelvic sepsis and death are uncommon major complications. Mild pain after rubber band ligation is the most common complication with a high frequency in some studies. Secondary bleeding normally occurs 10 to 14 d after banding and patients taking anti-platelet and/or anti-coagulant medication have a higher risk, with some reports of massive life-threatening haemorrhage. Several infectious complications have also been reported including pelvic sepsis, Fournier’s gangrene, liver abscesses, tetanus and bacterial endocarditis. To date, seven deaths due to these infectious complications were described. Early recognition and immediate treatment of complications are fundamental for a favourable prognosis. PMID:27721924

Rubber band ligation of hemorrhoids: A guide for complications.

PubMed

Albuquerque, Andreia

2016-09-27

Rubber band ligation is one of the most important, cost-effective and commonly used treatments for internal hemorrhoids. Different technical approaches were developed mainly to improve efficacy and safety. The technique can be employed using an endoscope with forward-view or retroflexion or without an endoscope, using a suction elastic band ligator or a forceps ligator. Single or multiple ligations can be performed in a single session. Local anaesthetic after ligation can also be used to reduce the post-procedure pain. Mild bleeding, pain, vaso-vagal symptoms, slippage of bands, priapism, difficulty in urination, anal fissure, and chronic longitudinal ulcers are normally considered minor complications, more frequently encountered. Massive bleeding, thrombosed hemorrhoids, severe pain, urinary retention needing catheterization, pelvic sepsis and death are uncommon major complications. Mild pain after rubber band ligation is the most common complication with a high frequency in some studies. Secondary bleeding normally occurs 10 to 14 d after banding and patients taking anti-platelet and/or anti-coagulant medication have a higher risk, with some reports of massive life-threatening haemorrhage. Several infectious complications have also been reported including pelvic sepsis, Fournier's gangrene, liver abscesses, tetanus and bacterial endocarditis. To date, seven deaths due to these infectious complications were described. Early recognition and immediate treatment of complications are fundamental for a favourable prognosis.

76 FR 21237 - Medical Devices; Obstetrical and Gynecological Devices; Classification of the Hemorrhoid...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-15

... reasonable assurance of safety and effectiveness of the device. A hemorrhoid prevention pressure wedge... provide reasonable assurance of safety and effectiveness, but there is sufficient information to establish special controls to provide reasonable assurance of the safety and effectiveness of the device for its...

[Effects of electroacupuncture preemptive intervention on postoperative pain of mixed hemorrhoids].

PubMed

Wu, Jing; Zhao, Yu; Yang, Chun-Mei; Xue, Qi-Ming; Li, Ning

2014-03-01

To evaluate clinical efficacy of electroacupuncture at Changqiang (GV 1) and Chengshan (BL 57) 30 min before surgery on postoperative pain and discomforts in patients with mixed hemorrhoids. One hundred and twenty cases of mixed hemorrhoids who received Milligan-Morgan operation were randomly divided into an electroacupuncture group, a sham electroacupuncture group and a blank group, 40 cases in each one. At the same time of basic treatment, the electroacupuncture was applied at Changqiang (GV 1) and Chengshan (BL 57) 30 min before surgery in the electroacupuncture group, while shallow needling without electrical stimulation at sham acupoint (1 cm next to acupoint) was applied 30 min before surgery in the sham electroacupuncture group, while no treatment was given before the surgery in the blank group. The total dose of painkillers in the first 24 h after operation, the number of cases who received additional anesthetic in the operation, the self-score of most severity pain in the first 24 h after operation and sleeping time in the night of surgery were observed. The differences of the numbers of cases who received additional anesthetic in the operation had no statistical significance among the three groups (all P > 0.05), but compared with the sham electroacupuncture group and blank group, the total dose of painkillers in the first 24 h after operation was reduced in the electroacupuncture group [(2.43 +/- 1.08) tablets vs (3.23 +/- 1.33) tablets, (3.10 +/- 1.22) tablets], and the score of most severity pain was also decreased (6.65 +/- 1.00 vs 7.48 +/- 0.96, 7.25 +/- 1.19), besides, the sleeping time in the night of surgery was increased [(220.63 +/- 85.50) min vs (162.00 +/- 92.69) min, (151.50 +/- 80.01) min, all P < 0.05]. The electroacupuncture at Changqiang (GV 1) and Chengshan (BL 57) 30 min before surgery has effects of preemptive analgesia on postoperative pain for patients with mixed hemorrhoids.

Recombinant streptokinase vs hydrocortisone suppositories in acute hemorrhoids: A randomized controlled trial.

PubMed

Hernández-Bernal, Francisco; Castellanos-Sierra, Georgina; Valenzuela-Silva, Carmen M; Catasús-Álvarez, Karem M; Martínez-Serrano, Osmany; Lazo-Diago, Odalys C; Bermúdez-Badell, Cimara H; Causa-García, José R; Domínguez-Suárez, Juan E

2015-06-21

To compare the efficacy and safety of recombinant streptokinase (rSK) vs hydrocortisone acetate-based suppositories in acute hemorrhoidal disease. A multicenter (11 sites), randomized (1:1:1), open, controlled trial with parallel groups was performed. All participating patients gave their written, informed consent. After inclusion, patients with acute symptoms of hemorrhoids were centrally randomized to receive, as outpatients, by the rectal route, suppositories of rSK 200000 IU of one unit every 8 h (first 3 units) and afterwards every 12 h until 8 administrations were completed (schedule A), one unit every 8 h until 6 units were completed (schedule B), or 25 mg hydrocortisone acetate once every 8 h up to a maximum of 24 administrations. Evaluations were performed at 3, 5, and 10 d post-inclusion. The main end-point was the 5(th)-day response (disappearance of pain and bleeding, and ≥ 70% reduction of the lesion size). Time to response and need for thrombectomy were secondary efficacy variables. Adverse events were also evaluated. Groups were homogeneous with regards to demographic and baseline characteristics. Fifth day complete response rates were 156/170 (91.8%; 95%CI: 87.3-96.2), 155/170 (91.2%; 95%CI: 86.6%-95.7%), and 46/170 (27.1%; 95%CI: 20.1%-34.0%) with rSK (schedule A and B) and hydrocortisone acetate suppositories, respectively. These 64.6% and 63.9% differences (95%CI: 56.7%-72.2% and 55.7%-72.0%) were highly significant (P < 0.001). This advantage was detected since the early 3(rd) day evaluation (68.8% and 64.1% vs 7.1% for the rSK and active control groups, respectively; P < 0.001) and was maintained even at the late 10(th) day assessment (97.1% and 93.5% vs 67.1% for rSK and hydrocortisone acetate, respectively; P < 0.001). Time to response was 3 d (95%CI: 2.9-3.1) for both rSK groups and 10 d (95%CI: 9.3-10.7) in the hydrocortisone acetate group. This difference was highly significant (P < 0.001). All subgroup stratified analyses (with or

Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis.

PubMed

Alonso-Coello, Pablo; Mills, Ed; Heels-Ansdell, Diane; López-Yarto, Maite; Zhou, Qi; Johanson, John F; Guyatt, Gordon

2006-01-01

To evaluate the impact of laxatives on a wide range of symptoms in patients with symptomatic hemorrhoids. We searched using the following sources: MEDLINE, EMBASE, CINAHL and CENTRAL, BIOSIS, AMED, Papers First and Proceedings; study authors, industry, and experts in the field. We included all published and unpublished parallel group randomized controlled trials comparing any type of laxative to placebo or no therapy in patients with symptomatic hemorrhoids. Two reviewers independently screened studies for inclusion, retrieved all potentially relevant studies, and extracted data on study population, intervention, prespecified outcomes, and methodology. Seven trials randomized 378 patients to fiber or a nonfiber control. Studies were of moderate quality for most outcomes. Meta-analyses using random effects models suggested that fiber has an apparent beneficial effect. The risk of not improving/persisting symptoms decreased by 47% in the fiber group (RR = 0.53, 95% CI 0.38-0.73) and the risk of bleeding by 50% (RR = 0.50, 95% CI 0.28-0.89). Studies with multiple follow-ups, usually at 6 wk and at 3 months, showed consistent results over time. Results are also compatible with large treatment effects in prolapse, pain, and itching, but even in the pooled analyses confidence intervals were wide and compatible with no effect (RR = 0.79, 95% CI 0.37-1.67; RR = 0.33, 95% CI 0.07-1.65; and RR = 0.71, 95% CI 0.24-2.10, respectively). One study suggested a decrease in recurrence. Results showed a nonsignificant trend toward increases in mild adverse events in the fiber group (RR = 6.0, 95% CI 0.57-64.8). Trials of fiber show a consistent beneficial effect for symptoms and bleeding in the treatment of symptomatic hemorrhoids.

[Results of Longo's stapled hemorrhoidectomy in ambulatory surgery for grade III-IV hemorrhoids].

PubMed

Zaragozá, Cristóbal; García Fadrique, Alfonso; Castaño, Sergio; Villalba, Raúl; Bruna Esteban, Marcos; Redondo Cano, Carlos

2007-03-01

We prospectively evaluated the results of stapled hemorrhoidectomy for grade III-IV hemorrhoids in the ambulatory setting. Eighty-five consecutive patients with grade III-IV hemorrhoids, treated with the stapled technique with PPH01 in the Ambulatory Surgery Service of the General Hospital of Valencia were studied. Symptomatic, ASA I-II patients who agreed to undergo ambulatory surgery (vehicle, an accompanying adult, address with telephone, elevator, and basic hygiene conditions) were included. Thirty-nine percent were women and 61% were men, with a mean age of 47.6 years. A total of 85.9% had grade IV hemorrhoids and 14.1% had grade III. The average surgical time was 29.81+/- 12 minutes with a mean length of hospital stay of 168.88 +/- 88 minutes. Surgical complications consisted of 16 hemorrhages of the staple line (18.8%) and five hemorrhages due to mucous tear (5.9%). During the first 8 days the most frequent complication was pain (45.9%); only 7.1% of the patients required analgesia with opiates, and one patient required admission for 24 hours for analgesic purposes. Bleeding occurred in 10 patients, five of whom reported slight bleeding on defecation that stopped spontaneously; the remaining five required admission for 24 hours after surgical revision. Nine patients (10.6%) were admitted to the hospital for 24 hours, three due to intraoperative hemorrhage, five due to postoperative hemorrhage and one due to pain. A second intervention was required in 8.2%. Stapled hemorrhoidectomy can be applied in an ambulatory regime. Although technically simple with a short learning curve, this technique is not free of complications. Suitable patient selection and adequate perioperative information are indispensable for the ambulatory management of this disorder.

Recombinant streptokinase vs hydrocortisone suppositories in acute hemorrhoids: A randomized controlled trial

PubMed Central

Hernández-Bernal, Francisco; Castellanos-Sierra, Georgina; Valenzuela-Silva, Carmen M; Catasús-Álvarez, Karem M; Martínez-Serrano, Osmany; Lazo-Diago, Odalys C; Bermúdez-Badell, Cimara H; Causa-García, José R; Domínguez-Suárez, Juan E; Investigators, Pedro A López-Saura; THERESA-4 (Treatment of HEmorrhoids with REcombinant Streptokinase Application) Group of

2015-01-01

AIM: To compare the efficacy and safety of recombinant streptokinase (rSK) vs hydrocortisone acetate-based suppositories in acute hemorrhoidal disease. METHODS: A multicenter (11 sites), randomized (1:1:1), open, controlled trial with parallel groups was performed. All participating patients gave their written, informed consent. After inclusion, patients with acute symptoms of hemorrhoids were centrally randomized to receive, as outpatients, by the rectal route, suppositories of rSK 200000 IU of one unit every 8 h (first 3 units) and afterwards every 12 h until 8 administrations were completed (schedule A), one unit every 8 h until 6 units were completed (schedule B), or 25 mg hydrocortisone acetate once every 8 h up to a maximum of 24 administrations. Evaluations were performed at 3, 5, and 10 d post-inclusion. The main end-point was the 5th-day response (disappearance of pain and bleeding, and ≥ 70% reduction of the lesion size). Time to response and need for thrombectomy were secondary efficacy variables. Adverse events were also evaluated. RESULTS: Groups were homogeneous with regards to demographic and baseline characteristics. Fifth day complete response rates were 156/170 (91.8%; 95%CI: 87.3-96.2), 155/170 (91.2%; 95%CI: 86.6%-95.7%), and 46/170 (27.1%; 95%CI: 20.1%-34.0%) with rSK (schedule A and B) and hydrocortisone acetate suppositories, respectively. These 64.6% and 63.9% differences (95%CI: 56.7%-72.2% and 55.7%-72.0%) were highly significant (P < 0.001). This advantage was detected since the early 3rd day evaluation (68.8% and 64.1% vs 7.1% for the rSK and active control groups, respectively; P < 0.001) and was maintained even at the late 10th day assessment (97.1% and 93.5% vs 67.1% for rSK and hydrocortisone acetate, respectively; P < 0.001). Time to response was 3 d (95%CI: 2.9-3.1) for both rSK groups and 10 d (95%CI: 9.3-10.7) in the hydrocortisone acetate group. This difference was highly significant (P < 0.001). All subgroup stratified

The role of radiofrequency surgery in the treatment of hemorrhoidal disease.

PubMed

Filingeri, V; Bellini, M I; Gravante, G

2012-04-01

In this article we reported results obtained in our previous studies concerning application of radiofrequency (RF) in proctology and in particular for hemorrhoids treatment. We compared radiofrequency submucosal hemorrhoidectomy (RSH) and conventional Parks' hemorrhoidectomy (CPH) (group 1), radiofrequency open hemorrhoidectomy (ROH) and Milligan-Morgan hemorrhoidectomy (MMH) (group 2), radiofrequency closed hemorrhoidectomy (RCH) and Ferguson hemorrhoidectomy (FH) (group 3), combined hemorrhoidal radiocoagulation (CHR) and rubber band ligation (RBL) (group 4). In this work primary endpoints were determined as evaluation of the grade of pain felt immediately after the procedure and at the first evacuation, bleeding, operation time, readmission to work, incidence of failures and patient's satisfaction. Group 1 - In comparison to Parks' technique, use of radiofrequency scalpel reduced mean operation time (61.2 min, range 50-75, vs. 37.4 min, range 30-51; p < 0.05), first postoperative day pain score (5.9, range 3-10, vs. 4.0, range 1-10; p < 0.05), pain score at first evacuation (5.7, range 2-10, vs 4.2, range 1-8; p < 0.05) and pain score on postoperative days (3.6, range 1-9, vs. 2.8, range 1-8; p < 0.05). Group 2 - Results show a substantial similarity between these techniques, however the procedure lasted 7 minutes less with RF scalpel (18.6 min, range 16-21, vs. 25.55 min, range 20-30; p < 0.05). Group 3 - Patients treated with RF showed significant reduction in surgical time (23 min, range 21-31, vs. 33 min, range 24-35; p < 0.01), in pain at 1st post-operative day (VAS score 3.4 +/- 1.3 vs. 4.8 +/- 1.0; p < 0.05) and at the first evacuation (3.4 +/- 1.0 vs. 5.0 +/- 0.8; p < 0.05). Group 4 - The study confirmed validity of both the used techniques, however CHR seems to allow a reduction in incidence of failures. Results obtained from radiofrequency surgery compared with those achieved with classic surgery for hemorrhoidal disease show in the majority of cases

Stapled technique for acute thrombosed hemorrhoids: a randomized, controlled trial with long-term results.

PubMed

Wong, J C H; Chung, C C; Yau, K K; Cheung, H Y S; Wong, D C T; Chan, O C Y; Li, M K W

2008-04-01

This study was designed to compare stapled vs. conventional hemorrhoidectomy for patients with acute thrombosed hemorrhoids. Forty-one patients with acute thrombosed hemorrhoids were randomized into: 1) stapled hemorrhoidectomy (PPH group; n = 21), and 2) open hemorrhoidectomy (open group; n = 20). Emergency surgery was performed with perioperative data and complications were recorded. Patients were followed up by independent assessors to evaluate pain, recurrence, continence function, and satisfaction at regular intervals. The median follow-up for the PPH group and open group were 59 and 56 weeks, respectively. There was no significant difference in terms of the hospital stay, complication rate, and continence function; however, the mean pain intensity in the first postoperative week was significantly less in the PPH group (4.1 vs. 5.7, P = 0.02). Patients in the PPH group recovered significantly faster in terms of the time to become analgesic-free (4 vs. 8.5 days, P < 0.01), time to become pain-free (9 vs. 20.5 days, P = 0.01), resumption of work (7 vs. 12.5 days, P = 0.01), and time for complete wound healing (2 vs. 4 weeks, P < 0.01). On long-term follow-up, significantly fewer patients in the PPH group complained of recurrent symptoms (0 vs. 5, P = 0.02). The overall symptom improvement and patients' satisfaction were significantly better in the PPH group (90 vs. 80 percent, P = 0.03 and +3 vs. +2, P < 0.01 respectively). Stapled hemorrhoidectomy is safe and effective for acute thrombosed hemorrhoids. Similar to elective stapled procedure, emergency stapled excision has greater short-term benefits compared with conventional excision: diminished pain, faster recovery, and earlier return to work. Long-term results and satisfaction were excellent.

Comparative clinical evaluation of Kshara Sutra ligation and hemorrhoidectomy in Arsha (hemorrhoids).

PubMed

Gupta, Meva Lal; Gupta, S K; Bhuyan, Chaturbhuja

2011-04-01

Arsha (hemorrhoids) is engorgement of the hemorrhoidal venous plexus, characterized by bleeding per rectum, constipation, pain, prolapse and discharge. It is manifested due to improper diet, prolonged standing and faulty habits of defecation causing derangement of tridosha, mainly vata dosha. Vitiated dosha localizes in guda vali, pradhana dhamani and mansdhara kala and vitiates twak, mansa, meda and rakta, resulting in the annavaha sroto dushti. Modern management of arsha needs, mainly, a surgical approach, i.e. hemorrhoidectomy, wherein the result was found to be less satisfactory. In this regard, to determine a solution for satisfactory cure, the kshara sutra ligation method in arsha was studied in comparison with hemarrhoidectomy. Kshara sutra ligation in arsha was employed in 35 patients, and 26 patients were dealt with hemorrhoidectomy. The study revealed a better result of the kshara sutra ligation-treated group in comparison with hemorrhoidectomy. The observations revealed that maximum advantages like minimum hospital stay, no bleeding during or after operation, no post-operative anal stenosis, a low cost-effective and more acceptable to different categories of people, etc. were recorded in the kshara sutra-treated group. Statistically, kshara sutra ligation for arsha was found to be highly significant and effective management. No adverse effects were noted during the follow-up period.

Comparative clinical evaluation of Kshara Sutra ligation and hemorrhoidectomy in Arsha (hemorrhoids)

PubMed Central

Gupta, Meva Lal; Gupta, S. K.; Bhuyan, Chaturbhuja

2011-01-01

Arsha (hemorrhoids) is engorgement of the hemorrhoidal venous plexus, characterized by bleeding per rectum, constipation, pain, prolapse and discharge. It is manifested due to improper diet, prolonged standing and faulty habits of defecation causing derangement of tridosha, mainly vata dosha. Vitiated dosha localizes in guda vali, pradhana dhamani and mansdhara kala and vitiates twak, mansa, meda and rakta, resulting in the annavaha sroto dushti. Modern management of arsha needs, mainly, a surgical approach, i.e. hemorrhoidectomy, wherein the result was found to be less satisfactory. In this regard, to determine a solution for satisfactory cure, the kshara sutra ligation method in arsha was studied in comparison with hemarrhoidectomy. Kshara sutra ligation in arsha was employed in 35 patients, and 26 patients were dealt with hemorrhoidectomy. The study revealed a better result of the kshara sutra ligation-treated group in comparison with hemorrhoidectomy. The observations revealed that maximum advantages like minimum hospital stay, no bleeding during or after operation, no post-operative anal stenosis, a low cost-effective and more acceptable to different categories of people, etc. were recorded in the kshara sutra-treated group. Statistically, kshara sutra ligation for arsha was found to be highly significant and effective management. No adverse effects were noted during the follow-up period. PMID:22408307

Embolization of a Hemorrhoid Following 18 Hours of Life-Threatening Bleeding

DOE Office of Scientific and Technical Information (OSTI.GOV)

Berczi, Viktor, E-mail: berczi@hotmail.com; Gopalan, Deepa; Cleveland, Trevor J

2008-01-15

Hemorrhoids usually do not pose diagnostic difficulties and they rarely cause massive bleeding. We report a case of massive rectal bleeding over 18 h needing 22 U blood transfusion treated by superselective transcatheter coil embolization 12 h following operative treatment performed in a different hospital. Diagnostic angiography with a view to superselective embolization, following failure of sigmoidoscopy to localize and treat the cause of hemorrhage, might act as a life-saving treatment in massive rectal bleeding, obviating the need for repeated endoscopy or emergency surgery.

Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection for circumferential mixed hemorrhoids.

PubMed

Lu, Ming; Shi, Guang-Ying; Wang, Guo-Qiang; Wu, Yan; Liu, Yang; Wen, Hao

2013-08-14

To identify a more effective treatment protocol for circumferential mixed hemorrhoids. A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group, where they underwent Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection, or the control group, where traditional external dissection and internal ligation were performed. Postoperative recovery and complications were monitored. The time to wound healing was 12.96 ± 2.25 d in the treatment group shorter than 19.58 ± 2.71 d in the control group. Slight pain rate was 58.3% in the treatment group higher than 22.9% in the control group; moderate pain rate was 33.3% in the treatment group lower than 56.3% in the control group severe pain rate was 8.4% in the treatment group lower than 20.8% in the control group. No edema rate was 70.8% in the treatment group higher than 43.8% in the control group; mild local edema rate was 26% in the treatment group lower than 39.6% in the control group obvious local edema was 3.03% in the treatment group lower than 16.7% in the control group. No stenosis rate was 85.4% in the treatment group higher than 63.5% in the control group; moderate stenosis rate was 14.6% in the treatment group Lower than 27.1% in the control group severe anal stenosis rate was 0% in the treatment group lower than 9.4% in the control group. Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection is the optimal treatment for circumferential mixed hemorrhoids and can be widely applied in clinical settings.

Prospective, randomized trial comparing diathermy excision and diathermy coagulation for symptomatic, prolapsed hemorrhoids.

PubMed

Quah, H M; Seow-Choen, F

2004-03-01

This study was designed to compare diathermy excision and diathermy coagulation in the treatment of symptomatic prolapsed piles. Forty-five consecutive patients were randomly assigned to diathermy excision hemorrhoidectomy (Group A, n = 25) and diathermy coagulation (Group B, n = 20) under general anesthesia. The median duration of surgery was ten minutes for both groups. There was no statistical difference in the severity of postoperative pain at rest between the two groups, but Group A patients felt less pain during defecation on the third postoperative day (median, 5 (interquartile range, 3-7) vs. 8 (4-9); P = 0.04) and on the sixth postoperative day (median, 5 (interquartile range, 2-6) vs. 9 (5-10); P = 0.02). There was, however, no statistical difference in postoperative oral analgesics use and patients' satisfaction scores between the two groups. Complication rates were similar except that diathermy coagulation tended to leave some residual skin components of external hemorrhoid especially in very large prolapsed piles. Group A patients resumed work earlier (mean, 12 (range, 4-20) vs. 17 (11-21) days); however, this was not statistically significant ( P = 0.1). Diathermy coagulation of hemorrhoids is a simple technique and may be considered in suitable cases.

A novel technique for the treatment of stages III to IV hemorrhoids: Homemade anal cushion suspension clamp combined with harmonic scalpel.

PubMed

Lin, Guoqiang; Ge, Qiongxiang; He, Xiaokang; Qi, Haixin; Xu, Li

2017-06-01

To compare the efficacy of homemade anal cushion suspension clamp combined with harmonic scalpel (ACS) and Milligan-Morgan hemorrhoidectomy combined with electric knife (MMH) in the treatment of stages III to IV hemorrhoids. We conducted a retrospective study of 99 patients with stages III to IV hemorrhoids hospitalized from January to December in 2013. Among them, 51 patients were treated with ACS, while 48 patients received MMH. Data from clinical recording and follow-up included operative time, intraoperative blood loss, hospitalization information, postoperative pain, and postoperative complications. Operative time, intraoperative blood loss and hospitalization time in ACS group were significantly less than those in MMH group (P < .05). Compared with MMH group, ACS group had a lower postoperative static pain score from days 1 to 14 (P < .01). The patients in ACS group exhibited less postoperative defecation pain scores from days 3 to 20 than those of MMH group (P < .05). The incidence of postoperative anal edema and delayed wound healing in ACS group was lower than that in MMH group (P < .05). Compared with MMH, our novel technique ACS was more effective and had fewer postoperative complications in the treatment of stages III to IV hemorrhoids.

[Effect of preconditioning of thermopaste application at Shenque (CV 8) on stretch reflex induced by procedure for prolapse and hemorrhoids in patients with hemorrhoids].

PubMed

Li, Jun; Wen, Yong; Yue, Chao-Chi; Li, Ya-Ling

2013-08-01

To observe clinical effect, feasibility and security of preconditioning of thermopaste application at Shenque (CV 8) for relieving stretch reflex induced by procedure for prolapse and hemorrhoids (PPH). A total of 100 cases of mixed hemorrhoids (stage III and IV) patients were randomized into 1.0 h, 0.5 h, 0 h and control (no application) groups (n = 25 in each group) according to a random number table. Thermopaste was applied to Shenque (CV 8) 1.0 h and 0.5 h before PPH or conducted simultaneously with PPH. The mean arterial pressure, heart rate, blood oxygen saturation of patients before and after anastomose operation, and the incidence of adverse reactions within 24 hours after the procedure were monitored and recorded. The patient's pain degree was assessed by using visual analogue scale. After the preconditioning, of the 25 patients in the 0.5 h group (0.5 h G), 14 experienced marked improvement (in the stretch reflex during PPH), 10 had an improvement, and 1 was invalid, respectively. The markedly effective rate and the total effective rate were 56% and 96%, respectively. The therapeutic effects for inhibiting stretch reflect being from the better to the poorer were 0.5 h G > 1.0 h G > 0 h G >NG. The heart rate and blood pressure from more stable to lesser stable were 0.5 h G> 1.0 h G > 0 h G > NG. The patients' pain reaction during operation and their adverse effects of nausea, vomiting, abdominal distention and abdominal pain, etc. occurred during operation also presented the same tendency in the 4 groups. Thermopaste application to Shenque (CV 8) can effectively prevent and control visceral reflex in patients undergoing PPH, which effect is significantly better when conducted 0.5 hour before the operation.

Tailored prolapse surgery for the treatment of hemorrhoids with a new dedicated device: TST Starr plus.

PubMed

Naldini, G; Fabiani, B; Menconi, C; Giani, I; Toniolo, G; Martellucci, J

2015-12-01

The aim of the study was to assess the results of the stapled transanal procedure in the treatment of hemorrhoidal prolapse in terms of postoperative complications and recurrence rate using a new dedicated device, TST Starr plus. Patients affected by III-IV degree hemorrhoidal prolapsed that underwent stapled transanal resection with the TST Starr plus were included in the present study. Results of the procedure with perioperative complications, postoperative complications, and recurrence rate were reported. From November 2012 to October 2014, 52 patients (19 females) were enrolled in the study. The main symptoms were prolapse (100 %) and bleeding (28.8 %). Transanal rectal resection was performed with parachute technique in 24 patients (46.2 %) and purse string technique in 23 patients (53.8 %). A mild hematoma at the suture line occurred in one patient (1.9 %). Postoperative bleeding was reported in three patients (5.7 %), in one of which, reoperation was necessary (1.9 %). Tenesmus occurred in one patient (1.9 %), and it was resolved with medical therapy. Urgency was reported in nine patients (17.1 %) at 7 days after surgery. Of these, three patients (5.7 %) complained urgency at the median follow-up of 14.5 months. Reoperation was performed in one patient (1.9 %) for chronic anal pain for rigid suture fixed on the deep plans. Occasional bleeding was reported in four patients (7.7 %). No recurrence of prolapse was reported at a median of 14.5 months after surgery, even if one patient (1.9 %) had a partial recurrent prolapse of a downstaged single pile. TST Starr plus seems to be safe and effective for a tailored transanal stapled surgery for the treatment of III-IV degree hemorrhoidal prolapse. The new conformation and innovative technology of the stapler seems to reduce some postoperative complications and recurrence rate.

Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection for circumferential mixed hemorrhoids

PubMed Central

Lu, Ming; Shi, Guang-Ying; Wang, Guo-Qiang; Wu, Yan; Liu, Yang; Wen, Hao

2013-01-01

AIM: To identify a more effective treatment protocol for circumferential mixed hemorrhoids. METHODS: A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group, where they underwent Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection, or the control group, where traditional external dissection and internal ligation were performed. Postoperative recovery and complications were monitored. RESULTS: The time to wound healing was 12.96 ± 2.25 d in the treatment group shorter than 19.58 ± 2.71 d in the control group. Slight pain rate was 58.3% in the treatment group higher than 22.9% in the control group; moderate pain rate was 33.3% in the treatment group lower than 56.3% in the control group severe pain rate was 8.4% in the treatment group lower than 20.8% in the control group. No edema rate was 70.8% in the treatment group higher than 43.8% in the control group; mild local edema rate was 26% in the treatment group lower than 39.6% in the control group obvious local edema was 3.03% in the treatment group lower than 16.7% in the control group. No stenosis rate was 85.4% in the treatment group higher than 63.5% in the control group; moderate stenosis rate was 14.6% in the treatment group Lower than 27.1% in the control group severe anal stenosis rate was 0% in the treatment group lower than 9.4% in the control group. CONCLUSION: Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection is the optimal treatment for circumferential mixed hemorrhoids and can be widely applied in clinical settings. PMID:23946609

Long-term outcome of stapled transanal rectal resection (STARR) versus stapled hemorrhoidopexys (STH) for grade III-IV hemorrhoids: preliminary results.

PubMed

Zanella, Simone; Spirch, Saverio; Scarpa, Marco; Ricci, Francesco; Lumachi, Franco

2014-01-01

Circular stapled transanal hemorrhoidopexy (STH) was first introduced by A. Longo for the correction of internal mucosal prolapse and obstructed defecation and in 1998, was proposed as alternative to conventional excisional hemorrhoidectomy. More recently, stapled transanal rectal resection (STARR) has gradually gained popularity, as the Longo procedure, in the treatment of hemorrhoids. The aim of our study was to evaluate the usefulness of STARR as alternative to STH in patients with grade III (n=218, 68.1%) and IV (n=102, 31.9%) hemorrhoids. A group of 320 consecutive patients (median age=51 years; range=16-85) underwent STH (n=281) or STARR (n=39) procedure. The rate of postoperative bleeding (53.8% vs. 74.4%, p<0.01) was significantly reduced in patients who underwent STARR procedure, which required a longer (45 ± 22 vs. 26 ± 11 min, p<0.01) operative time. There were no differences between groups with regard to use of painkillers, postoperative pain intensity, short- (three months) and long-term (one and three years) residual pain, soiling, incontinence and urgency. Patients treated with the STARR procedure had lower recurrence rate of hemorrhoids and a lower incidence of prolapse, both at one year (none vs. 1.4%, p=0.593 and 2.6% vs. 5.3%, p=0.396, respectively) and at two years (none vs. 6.8%, p=0.078 and none vs. 13.2%, p=0.012, respectively). The one-year (9.0 ± 1.8 vs. 9.4 ± 0.7, p=0.171) and two-year (9.6 ± 0.8 vs. 9.1 ± 1.7, p=0.072) general satisfaction was similar but higher in STARR patients than in the STH group. In conclusion, according to our preliminary results, the STARR procedure leads to a lower incidence of complications and recurrences and should be considered for patients with grade III or IV hemorrhoids previously selected for stapled hemorrhoidectomy, as a promising alternative to STH. Copyright © 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Transanal anopexy with HemorPex System (HPS) is effective in treating grade II and III hemorrhoids: medium-term follow-up.

PubMed

Basile, M; Di Resta, V; Ranieri, E

2016-06-01

Hemorrhoidal disease is a common proctologic disorder. The HemorPex System(®) (HPS) (Angiologica, S. Martino Siccomario PV, Italy) is an innovative surgical technique based on muco-hemorrhoidopexy without Doppler guidance. The aim of this study was to evaluate the efficacy of HPS in on the treatment of grade II and III hemorrhoids. One hundred patients with grade II and III hemorrhoidal disease were included in the study and operated on using HPS without Doppler guidance. The procedure consists of a mucopexy carried out by means of a dedicated rotating anoscope in the 6 relatively constant positions of the terminal branches of the superior hemorrhoidal artery. A direct follow-up was carried out on 100 patients for up to 3 months. A late analysis (>12 months postoperatively) was conducted by telephone interview. At follow-up the following parameters were considered: pain, bleeding, prolapse, difficulties with hygiene and patient satisfaction with treatment. Operative time was 16 ± 5 min. Three-month follow-up showed significant improvement of symptoms: pain was present in 10 (10 %) patients versus 45 (45 %) preoperatively; bleeding in 13 (13 %) of patients versus 57 (57 %) preoperatively; prolapse in 13 (13 %) of patients versus 45 (45 %) preoperatively and difficulties with hygiene in 1 (1 %) versus 24 (24 %) preoperatively (all p < 0.05). At longer follow-up which was available in 67 patients, 5 patients (7.5 %) had recurrence and were reoperated on at 8, 10, 24, 26 and 36 months, respectively after the first procedure. As regards patient satisfaction, complete satisfaction was reported by 95/100 patients (95 %) at 3 months, 62/67 (92.5 %) at 12 months and 8/56 (85.7 %) at 24 months; partial satisfaction was reported by 3/100 patients (3 %) with intermittent bleeding at 3 months, 3/67 (4.4 %) patients at 12 months and 6/56 (10.7 %) patients at 24 months, all with either intermittent bleeding or prolapse. Dissatisfaction with the

Meta-analysis of randomized controlled trials comparing outcomes for stapled hemorrhoidopexy versus LigaSure hemorrhoidectomy for symptomatic hemorrhoids in adults.

PubMed

Lee, Ko-Chao; Chen, Hong-Hwa; Chung, Kuan-Chih; Hu, Wan-Hsiang; Chang, Chia-Lo; Lin, Shung-Eing; Tsai, Kai-Lung; Lu, Chien-Chang

2013-01-01

This purpose of the meta-analysis was to compare treatment outcomes for adult patients with symptomatic hemorrhoids treated by stapled hemorrhoidopexy or LigaSure hemorrhoidectomy. A search of public medical databases was made to identify randomized controlled trials (RCTs) comparing stapled hemorrhoidopexy (SH) with LigaSure hemorrhoidectomy (LH) for the treatment of adult patients with symptomatic grade 3 and grade 4 hemorrhoids. Postoperative pain as measured using a visual analog scale was the primary outcome, and rate of recurrent prolapse and postoperative bleeding were secondary outcome measures. Four RCTs were identified that met the inclusion criteria. Data for the pooled outcomes were analyzed using odds ratio (OR) analysis. None of the studies in the analysis indicated a significant difference between SH and LH for the outcomes VAS pain score, recurrence rate, or postoperative bleeding. Pooled analysis revealed a significant OR in favor of the SH method for recurrent prolapse (OR = 5.529, P = 0.016) for up to 2 years after surgery. No significant differences between the two methods were identified for VAS pain scores (OR = -1.060, P = 0.149) or postoperative bleeding OR = 1.188, P = 0.871). Pooled analysis of RCT results comparing SH to LH for symptomatic hemorrhoids revealed a significantly greater incidence of recurrent prolapse for SH. The two techniques were associated with similar levels of postoperative pain and postoperative bleeding. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Recombinant streptokinase vs phenylephrine-based suppositories in acute hemorrhoids, randomized, controlled trial (THERESA-3)

PubMed Central

Hernández-Bernal, Francisco; Castellanos-Sierra, Georgina; Valenzuela-Silva, Carmen M; Catasús-Álvarez, Karem M; Valle-Cabrera, Roselin; Aguilera-Barreto, Ana; López-Saura, Pedro A

2014-01-01

AIM: To compare the efficacy and safety of recombinant streptokinase (rSK) and phenylephrine-based suppositories in acute hemorrhoidal disease. METHODS: A multicenter (14 sites), randomized (1:1), open, parallel groups, active controlled trial was done. After inclusion, subjects with acute symptoms of hemorrhoids, who gave their written, informed consent to participate, were centrally randomized to receive, as outpatients, rSK (200000 IU) or 0.25% phenylephrine suppositories, which had different organoleptic characteristics. Treatment was administered by the rectal route, one unit every 6 h during 48 h for rSK, and up to a maximum of 5 d (20 suppositories) for phenylephrine. Evaluations were performed at 3, 5 and 10 d post-inclusion. The main end-point was the 5th-day complete clinical response (disappearance of pain and edema, and ≥ 70% reduction of the lesion size). Time to response and need for thrombectomy were secondary efficacy variables. Adverse events were evaluated too. RESULTS: 5th day complete response rates were 83/110 (75.5%) and 36/110 (32.7%) with rSK and phenylephrine suppositories, respectively. This 42.7% difference (95%CI: 30.5-54.2) was highly significant (P < 0.001). The advantage was detected since the early 3rd day evaluation (37.3% vs 6.4% for the rSK and active control groups, respectively; P < 0.001) and was kept even at the late 10th day assessment (83.6% vs 58.2% for rSK and phenylephrine, respectively; P < 0.001). Time for complete response was significantly shorter (P = 0.031; log-rank test) in the rSK group (median: 4.9 d; 95%CI: 4.8-5.0) with respect to the active control (median: 9.8 d; 95%CI: 9.8-10.0). Thrombectomy was necessary in 1/59 and 8/57 patients with baseline thrombosis in the rSK and phenylephrine groups, respectively (P = 0.016). There were no adverse events attributable to the experimental treatment. CONCLUSION: rSK suppositories showed a significant advantage over a widely used over-the-counter phenylephrine

Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement.

PubMed

Trompetto, M; Clerico, G; Cocorullo, G F; Giordano, P; Marino, F; Martellucci, J; Milito, G; Mistrangelo, M; Ratto, C

2015-10-01

Hemorrhoids are one of the most common medical and surgical diseases and the main reason for a visit to a coloproctologist. This consensus statement was drawn up by the Italian society of colorectal surgery in order to provide practice parameters for an accurate assessment of the disease and consequent appropriate treatment. The authors made a careful search in the main databases (MEDLINE, PubMed, Embase and Cochrane), and all results were classified on the basis of the grade of recommendation (A-C) of the American College of Chest Physicians.

Partial stapled hemorrhoidopexy versus circular stapled hemorrhoidopexy for grade III-IV prolapsing hemorrhoids: a two-year prospective controlled study.

PubMed

Lin, H-C; Ren, D-L; He, Q-L; Peng, H; Xie, S-K; Su, D; Wang, X-X

2012-10-01

Circular stapled hemorrhoidopexy (CSH) is an effective technique for treating prolapsing hemorrhoids; but urgency and anal stenosis are common postoperative complications. The aim of this study was to assess the efficacy and postoperative outcomes of partial stapled hemorrhoidopexy (PSH), compared with CSH. Seventy-two consecutive patients with grade III and IV hemorrhoids who met the inclusion/exclusion criteria were divided in a non-randomized manner to undergo either PSH (n = 34) or CSH (n = 38). Intraoperative and postoperative parameters in both groups were collected and compared. The postoperative visual analog score for pain at first defecation was significantly lower in the PSH group than that in the CSH group (P = 0.001). Fewer patients in the PSH group experienced postoperative urgency, compared with those in the CSH group at 12 h, 1 day, and 7 days after surgery (P = 0.025, P = 0.019, and P = 0.043, respectively). Gas incontinence occurred in 3 patients (7.9%) in the CSH group, but in none of patients in the PSH group (P = 0.242). Postoperative anal stenosis developed in one patient (2.6%) in the CSH group, but in none of the patients in the PSH group (P = 1.0). The 2-year recurrence rate was 2.9 and 5.3%, respectively, in the PSH and CSH groups (P = 1.0). The 2-year recurrence rate is similar in patients with grade III-IV hemorrhoids treated with PSH or CSH. However, PSH is associated with less postoperative pain, fewer episodes of urgency, and no anal incontinence or anal stenosis.

Hemostatic action of OC-108, a novel agent for hemorrhoids, is associated with regional blood flow arrest induced by acute inflammation.

PubMed

Ono, Takashi; Nakagawa, Haruto; Fukunari, Atsushi; Hashimoto, Toshio; Komatsu, Hirotsugu

2006-11-01

Clinically, hemorrhoidal bleeding and prolapse disappeared immediately after injection of the sclerosing agent OC-108 into submucosa of hemorrhoids. The aim of this study was to elucidate the mechanism of action responsible for the immediate hemostatic effect of OC-108 using anesthetized rats. Subcutaneous injection of OC-108 in rats decreased blood flow at the injection site within 5 min. Aluminum potassium sulfate, one of the main ingredients of OC-108, reduced the skin blood flow. However, tannic acid, another main ingredient, did not. By perfusion of OC-108 on the mesenteric surface, microcirculatory blood flow was arrested without remarkable change in blood vessel diameter, accompanied by increased vascular permeability and venous hematocrit. These results indicate that OC-108 induces regional blood flow arrest with rapid onset, this effect being attributed to the action of aluminum potassium sulfate, and that hemoconcentration due to increased vascular permeability (plasma extravasation), an acute inflammatory reaction, is involved in the mechanisms of the immediate hemostatic action of OC-108.

Endoscopic submucosal dissection for anorectal tumor with hemorrhoids close to the dentate line: a multicenter study of Hiroshima GI Endoscopy Study Group.

PubMed

Tamaru, Yuzuru; Oka, Shiro; Tanaka, Shinji; Hiraga, Yuko; Kunihiro, Masaki; Nagata, Shinji; Furudoi, Akira; Ninomiya, Yuki; Asayama, Naoki; Shigita, Kenjiro; Nishiyama, Soki; Hayashi, Nana; Chayama, Kazuaki

2016-10-01

The lower rectum close to the dentate line has distinct characteristics, making endoscopic submucosal dissection (ESD) of tumors challenging. We assessed clinical outcomes of ESD for such patients with hemorrhoids. Sixty-four patients (mean age, 68 years) underwent ESD for anorectal tumors close to the dentate line. We divided patients into those with (Group A, 45 patients) and without hemorrhoids (Group B, 19 patients). We examined en bloc and histological en bloc resection rates, procedure time, complication rates, and postoperative prognosis after ESD. The mean tumor size was 43 mm. Histologic diagnoses were adenoma (42 %, 27/64), carcinoma in situ (44 %, 28/64), and T1 carcinoma (14 %, 9/64). There was no significant difference in en bloc resection (93 %, 42/45 vs. 95 %, 18/19) or postoperative bleeding rates (16 %, 7/45 vs. 11 %, 2/19) between Groups A and B, respectively. The mean procedural durations were 120 and 124 min, respectively, in Groups A and B. No perforations occurred. There was no significant difference in postoperative anal pain rate between Groups A (18 %, 8/45) and B (16 %, 3/19), and it resolved within a few days in all cases. There was one case of stricture in Group B. Two patients with T1 carcinoma underwent additional surgery, one underwent chemotherapy, and five had no additional treatment. No recurrence occurred during the follow-up period of 38 months. ESD is safe and effective for anorectal tumors close to the dentate line in patients with hemorrhoids.

Biological findings from the PheWAS catalog: focus on connective tissue-related disorders (pelvic floor dysfunction, abdominal hernia, varicose veins and hemorrhoids).

PubMed

Salnikova, Lyubov E; Khadzhieva, Maryam B; Kolobkov, Dmitry S

2016-07-01

Pelvic floor dysfunction, specifically genital prolapse (GP) and stress urinary inconsistency (SUI) presumably co-occur with other connective tissue disorders such as hernia, hemorrhoids, and varicose veins. Observations on non-random coexistence of these disorders have never been summarized in a meta-analysis. The performed meta-analysis demonstrated that varicose veins and hernia are associated with GP. Disease connections on the molecular level may be partially based on shared genetic susceptibility. A unique opportunity to estimate shared genetic susceptibility to disorders is provided by a PheWAS (phenome-wide association study) designed to utilize GWAS data concurrently to many phenotypes. We searched the PheWAS Catalog, which includes the results of the PheWAS study with P value < 0.05, for genes associated with GP, SUI, abdominal hernia, varicose veins and hemorrhoids. We found pronounced signals for the associations of the SLC2A9 gene with SUI (P = 6.0e-05) and the MYH9 gene with varicose veins of lower extremity (P = 0.0001) and hemorrhoids (P = 0.0007). The comparison of the PheWAS Catalog and the NHGRI Catalog data revealed enrichment of genes associated with bone mineral density in GP and with activated partial thromboplastin time in varicose veins of lower extremity. In cross-phenotype associations, genes responsible for peripheral nerve functions seem to predominate. This study not only established novel biologically plausible associations that may warrant further studies but also exemplified an effective use of the PheWAS Catalog data.

Cost-effectiveness of New Surgical Treatments for Hemorrhoidal Disease: A Multicentre Randomized Controlled Trial Comparing Transanal Doppler-guided Hemorrhoidal Artery Ligation With Mucopexy and Circular Stapled Hemorrhoidopexy.

PubMed

Lehur, Paul A; Didnée, Anne S; Faucheron, Jean-Luc; Meurette, Guillaume; Zerbib, Philippe; Siproudhis, Laurent; Vinson-Bonnet, Béatrice; Dubois, Anne; Casa, Christine; Hardouin, Jean-Benoit; Durand-Zaleski, Isabelle

2016-11-01

To compare Doppler-guided hemorrhoidal artery ligation (DGHAL) with circular stapled hemorrhoidopexy (SH) in the treatment of grade II/III hemorrhoidal disease (HD). DGHAL is a treatment option for symptomatic HD; existing studies report limited risk and satisfactory outcomes. DGHAL has never before been compared with SH in a large-scale multi-institutional randomized clinical trial. Three hundred ninety-three grade II/III HD patients recruited in 22 centers from 2010 to 2013 were randomized to DGHAL (n = 197) or SH (n = 196). The primary endpoint was operative-related morbidity at 3 months (D.90) based on the Clavien-Dindo surgical complications grading. Total cost, cost-effectiveness, and clinical outcome were assessed at 1 year. At D.90, operative-related adverse events occurred after DGHAL and SH, respectively, in 47 (24%) and 50 (26%) patients (P = 0.70). DGHAL resulted in longer mean operating time (44±16 vs 30±14 min; P < 0.001), less pain (postoperative and at 2 wks visual analogic scale: 2.2 vs 2.8; 1.3 vs 1.9; P = 0.03; P = 0.013) and shorter sick leave (12.3 vs 14.8 d; P = 0.045). At 1 year, DGHAL led to more residual grade III HD (15% vs 5%) and a higher reoperation rate (8% vs 4%). Patient satisfaction was >90% for both procedures. Total cost at 1 year was greater for DGHAL [&OV0556;2806 (&OV0556;2670; 2967) vs &OV0556;2538 (&OV0556;2386; 2737)]. The D.90, incremental cost-effectiveness ratio (ICER) was &OV0556;7192 per averted complication. At 1 year DGHAL strategy was dominated. DGHAL and SH are viable options in grade II/III HD with no significant difference in operative-related risk. Although resulting in less postoperative pain and shorter sick leave, DGHAL was more expensive, took longer, and provided a possible inferior anatomical correction suggesting an increased risk of recurrence.

Psychodynamic and biodynamic analysis of treatment of outlet obstructive constipation (OOC) using Procedure for Prolapse and Hemorrhoids (PPH).

PubMed

Qin, Zhensheng; Pang, Liqun; Dai, Weijie; Yan, Wei; Zhang, Jian; Zhao, Yao; Li, Qianjun; Wu, Kun; Zhou, Baoxiang

2015-07-01

To discuss the possible pathogenesis of outlet obstructive constipation (OOC) and identify the theoretical basis of the Procedure for Prolapse and Hemorrhoids (PPH) used to treat outlet obstructive constipation (OOC). 19 patients diagnosed with outlet obstructive constipation (OOC) form the case group, and 9 healthy volunteers form the control group. Patients, before and after operation, and the control group, were equally given such tests as Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Scale (HAMA) and anorectal dynamics. No significant difference in the functional lengths of anal canals was found between all groups (F = 0.98, p = 0.41). The minimum perception threshold, maximum tolerance threshold, and rectal defecation threshold of Group A, of 15 days after operation, were equally lower than those before operation, and than the control group (P < 0.05). These thresholds rebounded significantly in Group B 90 days after operation. Mentally, HAMA (F = 23.75, p = 0.00) and HAMD (F = 20.99, p = 0.00) total scores, after operation, were equally decreased first and then rebounded. Patients with outlet obstructive constipation (OOC) are subject to anorectal dynamic disorders as well as mental and psychological disorders, which can be remarkably improved using the Procedure for Prolapse and Hemorrhoids (PPH). Copyright © 2015 Elsevier Ltd. All rights reserved.

Serum aluminum levels in dialysis patients after sclerotherapy of internal hemorrhoids with aluminum potassium sulfate and tannic acid.

PubMed

Tsunoda, Akira; Nakagi, Masafumi; Kano, Nobuyasu; Mizutani, Masahiko; Yamaguchi, Kenji

2014-12-01

Aluminum potassium sulfate and tannic acid (ALTA) is an effective sclerosing agent for internal hemorrhoids. However, it is contraindicated for patients with chronic renal failure on dialysis, because the aluminum in ALTA can cause aluminum encephalopathy when it is not excreted effectively. We conducted this study to measure the serum aluminum concentrations and observe for symptoms relating to aluminum encephalopathy in dialysis patients after ALTA therapy. Ten dialysis patients underwent ALTA therapy for hemorrhoids. We measured their serum aluminum concentrations and observed them for possible symptoms of aluminum encephalopathy. The total injection volume of ALTA solution was 31 mL (24-37). The median serum aluminum concentration before ALTA therapy was 9 μg/L, which increased to 741, 377, and 103 μg/L, respectively, 1 h, 1 day, and 1 week after ALTA therapy. These levels decreased rapidly, to 33 μg/L by 1 month and 11 μg/L by 3 months after ALTA therapy. No patient suffered symptoms related to aluminum encephalopathy. Although the aluminum concentrations increased temporarily after ALTA therapy, dialysis patients with levels below 150 μg/L by 1 week and thereafter are considered to be at low risk of the development of aluminum encephalopathy.

Rubber band ligation and infrared photocoagulation for the outpatient treatment of hemorrhoidal disease.

PubMed

Ricci, Maurício Pichler; Matos, Délcio; Saad, Sarhan Sydney

2008-01-01

To compare the results of rubber band ligation and infrared photocoagulation for the treatment of hemorrhoidal disease through the analysis of the incidence of complications after each treatment and respective success rate. Forty-eight patients with first, second or third degree hemorrhoidal disease were randomized to receive treatment with either rubber band ligation (n=23) or infrared photocoagulation (n=25). Each patient was assessed at 1 week and 4 week intervals after treatment. We compared the incidence of complications and efficiency of each treatment modality and Qui-square, Fisher's Exact Test and Student's t Test were used to statistical analysis. Bleeding occured in eight (34,7%) patients treated with rubber band ligation and in four (16,0%) after infrared photocoagulation (p=0,243). Thirteen (52,0%) patients felt pain during infrared photocoagulation and 9 (39,1%) after rubber band ligation (p=0,546). After rubber band ligation, 14 (60,8%) required medication for pain relief. One patient (4,0%) required medication after infrared photocoagulation (p<0,001). Three (13,0%) patients treated with rubber band ligator and 1 (4,0%) treated with infrared photocoagulation had symptomatic mucosal ulcers. Perianal dermatitis occured in two (8,0%) patients treated with infrared photocoagulation and one patient (4,3%) was observed to have prolapsed thrombosed piles after rubber band ligation. One month after treatment, 17 of 23 patients treated with rubber band ligation (73,9%) and 18 of 25 patients treated with infrared photocoagulation were asymptomatic. Rubber band ligation treated bleeding and prolapse in 90,0% and 82,4% respectively. Infrared photocoagulation treats bleeding and prolapse in 93,7% and 87,5% respectively. Those differences are not significant. Rubber band ligation causes significantly more pain than infrared photocoagulation during the first week after the procedures and their success rate are not different after four weeks of treatment.

Implementation of a New High-Volume Circular Stapler in Stapled Anopexy for Hemorrhoidal Disease: Is Patient's Short-Term Outcome Affected by a Higher Volume of Resected Tissue?

PubMed

Grotenhuis, Brechtje A; Nonner, Joost; de Graaf, Eelco J R; Doornebosch, Pascal G

2017-11-02

Stapled anopexy is a safe technique for the treatment of hemorrhoids but carries a higher risk of recurrence, which might be caused due to the limited volume of resected tissue. In this study, we investigated the introduction of a high-volume circular stapling device; in particular whether an increased amount of resected tissue could affect patients' short-term postoperative outcome. Between 2011 and 2015, stapled anopexy was performed for hemorrhoids and/or anal prolapse in 141 patients (n = 25 conventional PPH-3©-stapler versus n = 116 high-volume CHEX©-stapler). In this prospectively collected dataset, operation details and short-term postoperative outcome were compared. With the high-volume stapler, a significantly higher amount of tissue was resected: 9.8 g (range 6.2-11.4) vs. 6.4 g (range 4.9-8.8) with the conventional stapler, p < 0.01. Postoperative short-term outcome did not differ in terms of readmission and complication rates. In all 5 patients who underwent a redo operation for residual hemorrhoids or prolapse, the high-volume stapler was used in the primary operation. A high-volume stapling device for stapled anopexy was introduced safely with a significantly higher amount of resected tissue without a worse short-term outcome. However, it remains unclear whether higher stapling volumes may lead to improved long-term outcome with less reinterventions. © 2017 S. Karger AG, Basel.

Multiple clinical presentations of anal ultra slow waves and high anal pressure: megacolon, hemorrhoids and constipation.

PubMed

Yoshino, Hiroaki; Kayaba, Hiroyuki; Hebiguchi, Tatsuzo; Morii, Mayako; Hebiguchi, Taku; Ito, Wataru; Chihara, Junichi; Kato, Tetsuo

2007-02-01

The physiopathology of idiopathic chronic constipation is complex and yet to be investigated. In the manometric studies of the patients with severe chronic constipation, we noticed that some patients with megacolon show very slow periodical (< 2/min) pressure change in the anal canal, namely ultra slow waves (USWs). USWs are considered to represent the hyperactivity of the internal anal sphincter; however, USW-related clinical presentations have yet to be investigated. We retrospectively re-evaluated the patient records and manometric studies of 85 cases, 51 subjects without defecatory problems and 34 patients with constipation, to elucidate USW-related clinical presentations. USWs were seen in 10 patients, including eight patients with chronic constipation and two subjects without defecatory problems. Out of the eight patients with constipation, one had no organic change in the anorectum, three had hemorrhoids and four exhibited megacolon. Manometric and pathological studies proved that none of the four patients with megacolon was suffering from Hirschsprung's disease. Among the 51 subjects without defecatory problems, only two had USWs. Anal pressure in the USW-positive group (106.0 +/- 37.0 cmH2O) was significantly higher than that in the group without defecatory problems (56.0 +/- 27.0 cmH2O) or constipated patients without USWs (55.0 +/- 26.0 cmH2O). Megacolon and high anal pressure, as well as chronic constipation and hemorrhoids, were the clinical presentations related to USWs. This is the first report to show the clinical relevance of USWs to megacolon. USWs should be recognized as an important manometric finding indicating a possible new clinical entity in chronic constipation.

Expression pattern, ethanol-metabolizing activities, and cellular localization of alcohol and aldehyde dehydrogenases in human large bowel: association of the functional polymorphisms of ADH and ALDH genes with hemorrhoids and colorectal cancer.

PubMed

Chiang, Chien-Ping; Jao, Shu-Wen; Lee, Shiao-Pieng; Chen, Pei-Chi; Chung, Chia-Chi; Lee, Shou-Lun; Nieh, Shin; Yin, Shih-Jiun

2012-02-01

Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) are principal enzymes responsible for metabolism of ethanol. Functional polymorphisms of ADH1B, ADH1C, and ALDH2 genes occur among racial populations. The goal of this study was to systematically determine the functional expressions and cellular localization of ADHs and ALDHs in human rectal mucosa, the lesions of adenocarcinoma and hemorrhoid, and the genetic association of allelic variations of ADH and ALDH with large bowel disorders. Twenty-one surgical specimens of rectal adenocarcinoma and the adjacent normal mucosa, including 16 paired tissues of rectal tumor, normal mucosae of rectum and sigmoid colon from the same individuals, and 18 surgical mixed hemorrhoid specimens and leukocyte DNA samples from 103 colorectal cancer patients, 67 hemorrhoid patients, and 545 control subjects recruited in previous study, were investigated. The isozyme/allozyme expression patterns of ADH and ALDH were identified by isoelectric focusing and the activities were assayed spectrophotometrically. The protein contents of ADH/ALDH isozymes were determined by immunoblotting using the corresponding purified class-specific antibodies; the cellular activity and protein localizations were detected by immunohistochemistry and histochemistry, respectively. Genotypes of ADH1B, ADH1C, and ALDH2 were determined by polymerase chain reaction-restriction fragment length polymorphisms. At 33mM ethanol, pH 7.5, the activity of ADH1C*1/1 phenotypes exhibited 87% higher than that of the ADH1C*1/*2 phenotypes in normal rectal mucosa. The activity of ALDH2-active phenotypes of rectal mucosa was 33% greater than ALDH2-inactive phenotypes at 200μM acetaldehyde. The protein contents in normal rectal mucosa were in the following order: ADH1>ALDH2>ADH3≈ALDH1A1, whereas those of ADH2, ADH4, and ALDH3A1 were fairly low. Both activity and content of ADH1 were significantly decreased in rectal tumors, whereas the ALDH activity remained

Clinical observations on the treatment of prolapsing hemorrhoids with tissue selecting therapy

PubMed Central

Wang, Zhi-Gang; Zhang, Yong; Zeng, Xian-Dong; Zhang, Tie-Hui; Zhu, Qi-Dong; Liu, De-Long; Qiao, Yun-Yu; Mu, Nan; Yin, Zhi-Tao

2015-01-01

AIM: To compare the effects and postoperative complications between tissue selecting therapy stapler (TST) and Milligan-Morgan hemorrhoidectomy (M-M). METHODS: Four hundred and eighty patients with severe prolapsing hemorrhoids, who were admitted to the Shenyang Coloproctology Hospital between 2009 and 2012, were randomly divided into observation (n = 240) and control (n = 240) groups. Hemorrhoidectomies were performed with TST in the observation group and with the M-M technique in the control group. The therapeutic effects, operation security, and postoperative complications in the two groups were compared. The immediate and long-term complications were assessed according to corresponding criteria. Pain was assessed on a visual analogue scale. The efficacy was assessed by specialized criteria. The follow-up was conducted one year after the operation. RESULTS: The total effective rates of the observation and control groups were 99.5% (217/218) and 98.6% (218/221) respectively; the difference was not statistically significant (P = 0.322). Their were significant differences between observation and control groups in intraoperative blood loss (5.07 ± 1.14 vs 2.45 ± 0.57, P = 0.000), pain (12 h after the surgery: 5.08 ± 1.62 vs 7.19 ± 2.01, P = 0.000; at first dressing change: 2.64 ± 0.87 vs 4.34 ± 1.15, P = 0.000; first defecation: 3.91 ± 1.47 vs 5.63 ± 1.98, P = 0.001), urine retention (n = 22 vs n = 47, P = 0.001), anal pendant expansion after the surgery (2.35 ± 0.56 vs 5.16 ± 1.42, P = 0.000), operation time (18.3 ± 5.6 min vs 29.5 ± 8.2 min, P = 0.000), and the length of hospital stay (5.3 ± 0.6 d vs 11.4 ± 1.8 d, P = 0.000). Moreover TST showed significant reductions compared to M-M in the rates of long-term complications such as fecal incontinence (n = 3 vs n = 16, P = 0.003), difficult bowel movement (n = 1 vs n = 9, P = 0.011), intractable pain (n = 2 vs n = 12, P = 0.007), and anal discharge (n = 3 vs n = 23, P = 0.000). CONCLUSION: TST for

Clinical observations on the treatment of prolapsing hemorrhoids with tissue selecting therapy.

PubMed

Wang, Zhi-Gang; Zhang, Yong; Zeng, Xian-Dong; Zhang, Tie-Hui; Zhu, Qi-Dong; Liu, De-Long; Qiao, Yun-Yu; Mu, Nan; Yin, Zhi-Tao

2015-02-28

To compare the effects and postoperative complications between tissue selecting therapy stapler (TST) and Milligan-Morgan hemorrhoidectomy (M-M). Four hundred and eighty patients with severe prolapsing hemorrhoids, who were admitted to the Shenyang Coloproctology Hospital between 2009 and 2012, were randomly divided into observation (n=240) and control (n=240) groups. Hemorrhoidectomies were performed with TST in the observation group and with the M-M technique in the control group. The therapeutic effects, operation security, and postoperative complications in the two groups were compared. The immediate and long-term complications were assessed according to corresponding criteria. Pain was assessed on a visual analogue scale. The efficacy was assessed by specialized criteria. The follow-up was conducted one year after the operation. The total effective rates of the observation and control groups were 99.5% (217/218) and 98.6% (218/221) respectively; the difference was not statistically significant (P=0.322). Their were significant differences between observation and control groups in intraoperative blood loss (5.07±1.14 vs 2.45±0.57, P=0.000), pain (12 h after the surgery: 5.08±1.62 vs 7.19±2.01, P=0.000; at first dressing change: 2.64±0.87 vs 4.34±1.15, P=0.000; first defecation: 3.91±1.47 vs 5.63±1.98, P=0.001), urine retention (n=22 vs n=47, P=0.001), anal pendant expansion after the surgery (2.35±0.56 vs 5.16±1.42, P=0.000), operation time (18.3±5.6 min vs 29.5±8.2 min, P=0.000), and the length of hospital stay (5.3±0.6 d vs 11.4±1.8 d, P=0.000). Moreover TST showed significant reductions compared to M-M in the rates of long-term complications such as fecal incontinence (n=3 vs n=16, P=0.003), difficult bowel movement (n=1 vs n=9, P=0.011), intractable pain (n=2 vs n=12, P=0.007), and anal discharge (n=3 vs n=23, P=0.000). TST for severe prolapsing hemorrhoids is a satisfactory technique for more rapid recovery, lower complication rates, and

Clopidogrel bisulfate (Plavix) does not increase bleeding complications in patients undergoing rubber band ligation for symptomatic hemorrhoids.

PubMed

Hite, Nathan; Klinger, Aaron L; Miller, Peter; Beck, David E; Whitlow, Charles B; Hicks, Terry C; Green, Heather M; Margolin, David A

2018-09-01

The incidence of postprocedural bleeding in patients undergoing rubber band ligation (RBL) for symptomatic internal hemorrhoids while taking clopidogrel bisulfate is unknown. To determine the postprocedural bleeding risk of RBL for patients taking clopidogrel compared with age- and sex-matched controls. This is a retrospective case-controlled cohort study analyzing data from 2005 to 2013 conducted at a single tertiary care academic center. The study included a total of 80 rubber bands placed on 41 patients taking clopidogrel bisulfate and 72 bands placed on 41 control patients not taking clopidogrel matched for age and sex. The 30-d rates of significant and insignificant bleeding events after RBL were recorded. A bleeding event was considered significant if the patient required admission to the hospital, transfusion of blood products, or additional procedures to stop the bleeding. Insignificant bleeding was defined as passage of blood or clots per rectum with spontaneous cessation and no need for additional intervention. There was no significant difference in the number of bleeding events per band placed in the clopidogrel group when compared with the control group (3.75% versus 2.78%, P = 0.7387). The rate of significant (2.5% versus 1.39%, P = 0.6244) and insignificant bleeding events (1.25% versus 1.39%, P = 0.9399) was also similar between the two groups. Two significant bleeding events occurred in the clopidogrel group requiring intervention: cauterization in one patient and colonoscopy and transfusion in the other. The risk of a bleeding complication after RBL for hemorrhoids does not appear to be increased in patients taking clopidogrel. Our results support the practice of continuing clopidogrel bisulfate in the periprocedural period as the associated risk of thrombosis is greater than the risk of bleeding. Copyright © 2018 Elsevier Inc. All rights reserved.

[A severe epicutaneous test reaction to the bufexamac in a hemorrhoidal therapeutic preparation].

PubMed

Bauer, A; Greif, C; Gebhardt, M; Elsner, P

1999-10-08

A 49-year-old woman presented with acute perianal vesicular/bullous contact dermatitis. Other areas were over the trunk, face, neck and wrists. She reported occasional application of an ointment (Mastu S) to treat her hemorrhoids. Patch tests (basic series, anal block, own ointment, local anesthetic, cosmetics) provoked strong vesicular and bullous reactions of persisting crescendo type, spreading far beyond the site of application, to Bufexamac, to a derivative of hydroxxamine acid, and to local applied ointment with mild or moderate antiinflammatory action. A week after the patch tests there was a flare-up of the previous foci of dermatitis. These reactions subsided two days later after intravenous injection of prednisolone. The skin lesions healed after rapid reduction of the systemic treatment and local application of corticosteroids, bathing with tanning substances and basic preparations. While Bufexamac is not absorbed when applied rectally, perianal contamination may not be avoidable on intra-anal application and can produce sensitization.

Linking Brain Arteriovenous Malformations With Anorectal Hemorrhoids: A Clinical and Anatomical Review

PubMed Central

Cuoco, Joshua A.; Hoehmann, Christopher L.; Hitscherich, Kyle; Zakhary, Sherry M.; Leheste, Joerg R.

2017-01-01

ABSTRACT Patients who harbor brain arteriovenous malformations are at risk for intracranial hemorrhage. These malformations are often seen in inherited vascular diseases such as hereditary hemorrhagic telangiectasia. However, malformations within the brain also sporadically occur without a hereditary‐coding component. Here, we review recent insights into the pathophysiology of arteriovenous malformations, in particular, certain signaling pathways that might underlie endothelial cell pathology. To better interpret the origins, determinants and consequences of brain arteriovenous malformations, we present a clinical case to illustrate the phenotypic landscape of the disease. We also propose that brain arteriovenous malformations might share certain signaling dimensions with those of anorectal hemorrhoids. This working hypothesis provides casual anchors from which to understand vascular diseases characterized by arteriovenous lesions with a hemorrhagic‐ or bleeding‐risk component. Anat Rec, 2017. © The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists. Anat Rec, 300:1973–1980, 2017. © 2017 The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists. PMID:28696502

May radiofrequency be the best choice for III-IV degree hemorrhoids?

PubMed

Milito, Giovanni; Lisi, Giorgio; Aronadio, Elena; Campanelli, Michela; Venditti, Dario; Grande, Simona; Grande, Michele

2017-03-01

Hemorrhoidectomy is considered the most efficient method to treat hemorrhoids of III and IV grades. The aim of this study was to compare conventional diathermy hemorrhoidectomy and radiofrequency hemorrhoidectomy based on a large series of patients. Between June 2001 and June 2014, 1000 patients have been treated with radiofrequency hemorrhoidectomy (group A) and 500 patients have been treated with diathermy (group B) as a day-case procedure. Operating time, postoperative pain score, hospital stay, early and late postoperative complications, wound healing time and time to return to normal activities were assessed. The mean follow-up was seven years. The mean operating time for radiofrequency hemorrhoidectomy was shorter than diathermy but not significantly. Patients treated with radiofrequency had significantly less postoperative pain (measured on a Visual Analogue Scale; P=0.001), a shorter wound healing time, less time off work and postoperative complications (P=0.001) than patients who had diathermy. Neither wound healing nor mean hospital stay (day-case surgery) was significantly different. Radiofrequency hemorrhoidectomyis a valid alternative to the conventional diathermy technique, due to the reduction of operative time, postoperative pain, early and late complication rate.

The tissue selecting technique (TST) versus the Milligan-Morgan hemorrhoidectomy for prolapsing hemorrhoids: a retrospective case-control study.

PubMed

Lin, H-C; Luo, H-X; Zbar, A P; Xie, S-K; Lian, L; Ren, D-L; Wang, J-P

2014-08-01

Milligan-Morgan hemorrhoidectomy (MMH) is the procedure of choice in the management of hemorrhoidal disease. However, this procedure is associated with significant postoperative pain. Tissue selecting technique (TST) is a segmental stapled hemorrhoidopexy, which aims to reduce the postoperative pain, rectovaginal fistula (RVF) and rectal stenosis. The aim of the present study was to compare the clinical outcomes between TST and MMH. A case-control study was undertaken to investigate the difference in clinical characteristics between the patients treated with TST and those treated with MMH. Intraoperative and postoperative parameters in both groups were collected and compared. One hundred and ninety-five eligible patients underwent either TST (n = 121) or MMH (n = 74). The pain score was significantly less in the TST group than that in the MMH group at the first defecation and at 12 h, day 3 and day 7 postoperatively (P = 0.001). Further analysis revealed that, at the time point of 12 h, day 3, day 7 and during first defecation, the pain score in the TST group and TST + STE group was less than that in the MMH group (P = 0.001). No patient in either group developed postoperative rectal stenosis. Furthermore, no case of RVF was identified in the TST group. The 1-year recurrence rate was 3.3 % (4/121) and 2.7 % (2/74), respectively, in TST and MMH groups (P = 1.0). The 1-year recurrence rate after TST and MMH for the treatment of patients with grade III-IV hemorrhoids is similar. It is encouraging that TST is associated with less postoperative pain and no RVF or rectal stenosis.

Rectal distensibility and symptoms after stapled and Milligan-Morgan operation for hemorrhoids.

PubMed

Corsetti, Maura; De Nardi, Paola; Di Pietro, Salvatore; Passaretti, Sandro; Testoni, Pier Alberto; Staudacher, Carlo

2009-12-01

In a previous uncontrolled study, a reduction of rectal distensibility and volume thresholds for sensations have been related to the occurrence of fecal urgency and/or increased stool frequency after stapled hemorrhoidopexy. The aim of this study was to compare rectal symptoms and sensory-motor function after stapled hemorrhoidopexy and Milligan-Morgan hemorrhoidectomy. The clinical records of 12 (four women) and ten patients (four women) with third- and fourth-degree hemorrhoids, respectively, who underwent stapled hemorrhoidopexy or Milligan-Morgan's hemorrhoidectomy, were evaluated. One week before and 6 months after surgery, rectal motor and sensory response to distension was assessed by an electronic barostat, and bowel and rectal symptoms were recorded by means of a 7-day diary and Bristol Index scale and psychological symptoms with SCL-90 questionnaire. Rectal distensibility and volume thresholds for sensations were significantly lower after surgery (P < 0.02) in the stapled group. Increased stool frequency and/or fecal urgency arose in 41% of patients in the stapled group and associated with altered rectal distensibility. No difference within and between groups could be demonstrated in SCL-90 score. Rectal distensibility and volume thresholds for sensations decrease after stapled hemorrhoidopexy. Altered rectal distensibility was associated with rectal urgency and/or increased stool frequency.

Comparing the effect of An's Shaobei Injection ([symbols; see text]) with Xiaozhiling Injection ([symbols; see text]) in patients with internal hemorrhoids of grade I-III: a prospective cohort study.

PubMed

An, A-yue; Feng, Da-yong; Wang, Chun-hui; Shi, Yu-ying; Xiang, Jing-jing; Bai, Zhi-yong; Li, Kun-cheng; Liu, Jin-yang

2014-07-01

To compare the effect of An's Shaobei Injection ([symbols; see text]) with Xiaozhiling Injection ([symbols; see text]) in patients with internal hemorrhoids of grade I-III. This cohort study included 1,520 internal hemorrhoids patients with grade I-III who were scheduled for liquid injection treatment from July 2003 to July 2009. The cohort included patients who underwent either An's Shaobei Injection treatment (the treatment group, 760 cases) or Xiaozhiling Injection treatment (the control group, 760 cases). All patients were followed up regularly for 3 years; the observing indices included anal function recovery and clinical response after operation. Among the 1,520 patients, 1,508 (99.2%) completed the 3-year follow-up. The efficacy rate was 97.5% in the treatment group, significantly higher than the control group (91.8%, P<0.01). The recurrence rate in the treatment group was 0.5%, significantly lower than that of the control group (1.3%, P<0.01). In addition, perianal callosity occurred in 8 cases (1.1%) and anorectal stricture in 26 cases (3.5%) after operation in the control group. There was no perianal callosity and anorectal stricture in the treatment group. The treatment with An's Shaobei Injection demonstrated superior clinical effect to Xiaozhiling Injection with fewer adverse effects.

Clinical acceptability study of micronized purified flavonoid fraction 1000 mg tablets versus 500 mg tablets in patients suffering acute hemorrhoidal disease.

PubMed

Shelygin, Yuri; Krivokapic, Zoran; Frolov, S A; Kostarev, I V; Astashov, V L; Vasiliev, S V; Lakhin, A V; Rodoman, G V; Soloviev, A O; Stoyko, Y M; Khitaryan, A G; Nechay, I A

2016-11-01

To compare the clinical acceptability of micronized purified flavonoid fraction (MPFF) 1000 mg with MPFF 500 mg tablets, administered at the same daily dose in patients suffering non-complicated acute hemorrhoids. MPFF is an established treatment for hemorrhoidal disease. This was a double-blind, multi-center, randomized study. Patients took either MPFF 1000 mg or 500 mg tablets for 7 days (daily dose; 3 g over 4 days followed by 2 g over 3 days). Adverse events were recorded in a patient diary. On day 7, anal pain and bleeding were assessed (visual analog scale [VAS] and Dimitroulopoulos scale, respectively). Patients (162) were randomized to MPFF 1000 mg (79) and MPFF 500 mg (83). No serious adverse events (AEs) occurred; 10 emergent AEs were considered treatment-related (6 for MPFF 1000 mg and 4 for 500 mg). Both regimens were associated with significant reduction in anal pain (VAS); -2.37 cm MPFF 1000 mg (P < 0.001) and -2.17 cm 500 mg (P < 0.001), with a slight trend in favor of MPFF 1000 mg (mean global reduction -2.27 cm, P < 0.001). Bleeding improved significantly in both groups of patients, 56% of patients on MPFF 1000 mg versus 61% on MPFF 500 mg. Bleeding ceased after treatment in 47% patients on MPFF 1000 mg versus 54% on 500 mg. After 7 days of treatment with MPFF at the same daily dose, both regimens reduced anal pain and bleeding. MPFF 1000 mg had a comparable safety profile to MPFF 500 mg, with the advantage of fewer tablets. Key limitations: Safety study.

Long-term clinical results of double-pursestring stapled hemorrhoidopexy in a selected group of patients for the treatment of chronic hemorrhoids.

PubMed

Arroyo, Antonio; Pérez-Legaz, Juan; Miranda, Elena; Moya, Pedro; Ruiz-Tovar, Jaime; Lacueva, Francisco-Javier; Candela, Fernando; Calpena, Rafael

2011-05-01

The aim of this prospective controlled trial was to evaluate the long-term clinical and manometric results of stapled hemorrhoidopexy performed by expert surgeons in a selected group of patients for the treatment of chronic hemorrhoids. This study took place in the outpatient clinic and at the Day Surgery Unit attached to the University Hospital of Elche. From March 2003 to May 2005, 200 consecutive patients with third-degree hemorrhoids and treated with double-pursestring stapled hemorrhoidopexy with a PPH33-03 stapler were included in the study. Demographic, manometric, and clinical features were analyzed, as well as the variables related to surgery, postoperative course, and follow-up. Manometry was repeated at the 6-month, 1-year, and 5-year follow-up. Median follow-up was 110 months. Four patients (2%) reported daily rectal bleeding. One patient with active rectal bleeding was taken for reoperation within the first 12 postoperative hours. Seventy percent of patients reported pain ≤ 2 on the first postoperative day, 85% on the fourth postoperative day, and 95% on the seventh postoperative day. Pain was measured with a linear analog scale from 0 to 10 (0 = no pain; 10 = unbearable pain). Seventeen patients (8.5%) reported tenesmus during the first week. Eight patients (4%) reported persistent pain: in 5 patients, the pain resolved within the next 6 months; 2 patients presented with anal fissure; and 1 patient required the removal of the staples. Two patients (1%) reported residual soiling at the 5-year revision. Fourteen patients (7%) experienced recurrence with symptomatic prolapse. Six (3%) underwent further surgery: stapled hemorrhoidopexy was indicated again in 2 patients, and 4 patients underwent a Milligan-Morgan open hemorrhoidectomy, because they did not have a uniform prolapse. Six patients required treatment with rubber band ligation. There were no statistically significant differences between preoperative and postoperative manometric values. The new

Rectal Problems

MedlinePlus

... should always be thoroughly evaluated by your doctor. Hemorrhoids What are hemorrhoids? Hemorrhoids are veins in the ... only 10-20 grams. Endoscopic & Surgical Treatment for Hemorrhoids When hemorrhoids bleed excessively or are very painful ...

Topical Allium ampeloprasum subsp Iranicum (Leek) extract cream in patients with symptomatic hemorrhoids: a pilot randomized and controlled clinical trial.

PubMed

Mosavat, Seyed Hamdollah; Ghahramani, Leila; Sobhani, Zahra; Haghighi, Ehsan Rahmanian; Heydari, Mojtaba

2015-04-01

Allium ampeloprasum subsp iranicum (Leek) has been traditionally used in antihemorrhoidal topical herbal formulations. This study aimed to evaluate its safety and efficacy in a pilot randomized controlled clinical trial. Twenty patients with symptomatic hemorrhoids were randomly allocated to receive the topical leek extract cream or standard antihemorrhoid cream for 3 weeks. The patients were evaluated before and after the intervention in terms of pain, defecation discomfort, bleeding severity, anal itching severity, and reported adverse events. A significant decrease was observed in the grade of bleeding severity and defecation discomfort in both the leek and antihemorrhoid cream groups after the intervention, while no significant change was observed in pain scores. There was no significant difference between the leek and antihemorrhoid cream groups with regard to mean changes in outcome measures. This pilot study showed that the topical use of leek cream can be as effective as a standard antihemorrhoid cream. © The Author(s) 2015.

Stapled hemorrhoidopexy, an innovative surgical procedure for hemorrhoidal prolapse: cost-utility analysis.

PubMed

Ribarić, Goran; Kofler, Justus; Jayne, David G

2011-08-15

To undertake full economic evaluation of stapled hemorrhoidopexy (PPH) to establish its cost-effectiveness and investigate whether PPH can become cost-saving compared to conventional excisional hemorrhoidectomy (CH). A cost-utility analysis in hospital and health care system (UK) was undertaken using a probabilistic, cohort-based decision tree to compare the use of PPH with CH. Sensitivity analyses allowed showing outcomes in regard to the variations in clinical practice of PPH procedure. The participants were patients undergoing initial surgical treatment of third and fourth degree hemorrhoids within a 1-year time-horizon. Data on clinical effectiveness were obtained from a systematic review of the literature. Main outcome measures were the cost per procedure at the hospital level, total direct costs from the health care system perspective, quality adjusted life years (QALY) gained and incremental cost per QALY gained. A decrease in operating theater time and hospital stay associated with PPH led to a cost saving compared to CH of GBP 27 (US $43.11, €30.50) per procedure at the hospital level and to an incremental cost of GBP 33 (US $52.68, €37.29) after one year from the societal perspective. Calculation of QALYs induced an incremental QALY of 0.0076 and showed an incremental cost-effective ratio (ICER) of GBP 4316 (US $6890.47, €4878.37). Taking into consideration recent literature on clinical outcomes, PPH becomes cost saving compared to CH for the health care system. PPH is a cost-effective procedure with an ICER of GBP 4136 and it seems that an innovative surgical procedure could be cost saving in routine clinical practice.

[Prevention of post-operative pain and haemorrhage in PPH (Procedure for Prolapse and Hemorrhoids) and STARR (Stapled Trans-Anal Rectal Resection). Preliminary results in 261 cases].

PubMed

Mongardini, M; Custureri, F; Schillaci, F; Cola, A; Maturo, A; Fanello, G; Corelli, S; Pappalardo, G

2005-04-01

Intra- and early (first week) post-operative haemorrhages are the most common complications in stapled hemorrhoidectomy PPH (Procedure for Prolapse and Hemorrhoids) and in circumferential resection of the rectal prolapse STARR (Stapled Trans Anal Rectal Resection). Performing PPH and STARR we employed a gelatin based haemostatic sealant with thrombin component (FloSeal) to control intra-operative bleeding and to reduce post-operative bleeding avoiding haemostatic stitches on suture line. We report the preliminary results on 197 PPH and 64 STARR; 44 PPH (22.4%) and 27 STARR (42.2%) were treated by FloSeal. No major post-operative bleeding was observed in all patients treated by FloSeal, compared to 1.3% and 2.7% of hemorrhage respectively in PPH and STARR patients treated without sealant. Post-operative pain was less severe in patients treated by FloSeal, without a difference statistically significant. The data are preliminary and must be confirmed in prospective randomized trials in larger series.

[Observation of curative effect of hemorrhoids lotion on pain, edema and bleeding after anorectal surgery].

PubMed

Wang, Yong-jie; Hua, Guo-hua

2015-11-01

The purpose of this study was to evaluate the value of Chinese herbal fumigation in the postoperative anal disease. The authors randomly divided 348 patients into treatment group and control group with 174 cases in each group. The treatment group was given to the Chinese herbal medicine hemorrhoids lotion for fumigation based on conventional anti infective therapy, routine dressing change and relaxing bowel. The control group was given to 1 000 mL 1: 5 000 potassium permanganate solution for sitz bath, fumigation based on conventional anti infective therapy, routine dressing change and relaxing bowel. The pain score, edema score, bleeding score, granulation tissue growth score and wound healing time of two groups were compared after operation. The results showed that the postoperative 6 h pain scores were higher in the two groups, the postoperative 3,5,7 d pain scores gradually decreased, the difference was statistically significant (P < 0.05). The difference of postoperative 6 h pain scores was no significant difference between the two groups, while postoperative 3,5,7 d pain scores in the treatment group were significantly lower than those in the control group (P < 0.05). 7 days after operation, anal margin of edema score and blood in the stool score in the treatment group were lower than those in control group, meat medicine growth score was higher than that of the control group, the difference had statistical meaning (P < 0.05). The healing time of two groups was respectively (13.89 + 2.78), (18.45 + 1.65) d (P < 0.05). This study suggested that Chinese herbal fumigation and washing could reduce the pain degree of patients, the anal margin of edema, and the blood in the stool, also could promote granulation tissue growth and shorten the time of wound healing, deserve the clinical expansion.

Hemorrhoidectomy - making sense of the surgical options

PubMed Central

Yeo, Danson; Tan, Kok-Yang

2014-01-01

While debate continues as to which is the best surgical method for the treatment of hemorrhoids, none of the currently available surgical methods approach the ideal surgical option, which is one that is effective while being safe and painless. In reality, the less painful the procedure, the more likely it is to be associated with recurrence post-op. Where hemorrhoids surgery is concerned, there isn’t a “one size fits all” option. Most of the randomized controlled trials performed to date include hemorrhoids of various grades and with a focus on only comparing surgical methods while failing to stratify the outcomes according to the grade of hemorrhoid. We believe that surgery needs to be tailored not only to the grade of the hemorrhoids, but also to the size, circumferential nature of the disease, and prevailing symptomatology. PMID:25493010

Hemorrhoidectomy - making sense of the surgical options.

PubMed

Yeo, Danson; Tan, Kok-Yang

2014-12-07

While debate continues as to which is the best surgical method for the treatment of hemorrhoids, none of the currently available surgical methods approach the ideal surgical option, which is one that is effective while being safe and painless. In reality, the less painful the procedure, the more likely it is to be associated with recurrence post-op. Where hemorrhoids surgery is concerned, there isn't a "one size fits all" option. Most of the randomized controlled trials performed to date include hemorrhoids of various grades and with a focus on only comparing surgical methods while failing to stratify the outcomes according to the grade of hemorrhoid. We believe that surgery needs to be tailored not only to the grade of the hemorrhoids, but also to the size, circumferential nature of the disease, and prevailing symptomatology.

Effect of hemorrhoidectomy on anorectal physiology.

PubMed

Vyslouzil, Kamil; Zboril, Pavel; Skalický, Pavel; Vomácková, Katherine

2010-02-01

The aim of this study was to determine whether overactivity of the anal sphincter in patients with hemorhhoids is primary or secondary and thus assess indication of lateral internal sphincterotomy to surgical treatment of hemorrhoids. Tonic contraction of the sphincter muscle in patients with advanced stages of hemorrhoids is considered by many authors as a primary cause, and therefore, they complete hemorrhoid surgery with lateral internal sphincteroomy. If hypertension of anal sphincter is secondary during hemorrhoid disease, lateral internal sphincterotomy is not indicated. Although examinations made immediately after sphincterotomy proved no changes of anal continence, certain sequelae of lateral internal sphincterotomy cannot be excluded and may later negatively affect patient's anal continence. The prospective study comprised 385 patients treated in 2002-2006 by Hemoron or surgery according to Milligan-Morgan or Longo. Patients with history of another disease of the anal canal, radiotherapy of pelvis, Crohn's disease or ulcerous colitis were excluded. Manometry was performed before and after surgery at intervals of 1, 3, 6 and 12 months after operation using a perfusion flow method, six-channels catheter with radial arrangement of channel tips. In all three groups (Hemoron, sec. Milligan-Morgan, sec. Longo), there were 60-65% of patients with third degree hemorrhoids. Normal resting anal pressure before surgery was recorded in only 25% of men and 30% of women. Patients with advanced hemorrhoid degrees were found to have significant hypertension of the anal sphincter. The most significantly improved state of sphincter overactivity was observed after surgery according to Longo and application of Hemoron. After surgery, according to Milligan-Morgan, recovery of anal sphincter tension was the longest; even 6 months after operation, a mean increased resting anal pressure persisted (91-110 mmHg) in 25% of men and 19% of women. After 12 months, recovery of anal

Belladonna

MedlinePlus

... asthma. Belladonna is also used as suppositories for hemorrhoids. ... condition. Arthritis-like pain. Asthma. Colds. Hay fever. Hemorrhoids. Motion sickness. Nerve problems. Parkinson's disease. Spasms and ...

Morbidity Rates during a Military Cold Weather Exercise: Empire Glacier 1980.

DTIC Science & Technology

1981-10-28

stomach upset, or pain and hemorrhoids . Flu constituted 9.6% of the GI cases (although more appropriately might have been included with URI). The...COMPLAINTS Eleven-day Totals Ave./Day Rates* 1. Nausea (Upset Stomach) 33 (3.0) .34 2. Stomach Pain 26 (2.4) .27 3. Hemorrhoids 18 (1.6) .18 Flu...Reported that cold usually bothers him, that hemorrhoids are aggravated by the cold. Doesn’t care for cold weather in general. No classroom instruction and

Anal Itching

MedlinePlus

... has many possible causes, such as skin problems, hemorrhoids, and washing too much or not enough. If ... dermatitis. Other medical conditions. These include chronic diarrhea, hemorrhoids, anal tumors and diseases that affect the whole ...

Blueberry

MedlinePlus

... fatigue syndrome (CFS), colic, fever, varicose veins, and hemorrhoids. Blueberry is also used for improving circulation, and ... fatigue syndrome (CFS). Fever. Sore throat. Varicose veins. Hemorrhoids. Bad circulation. Diarrhea. Constipation. Labor pains. Other conditions. ...

Common symptoms during pregnancy

MedlinePlus

... keep your gums healthy Swelling, Varicose Veins, and Hemorrhoids Swelling in your legs is common. You may ... In your rectum, veins that swell are called hemorrhoids. To reduce swelling: Raise your legs and rest ...

Bloody or tarry stools

MedlinePlus

... small intestine Diverticulosis (abnormal pouches in the colon) Hemorrhoids (common cause of bright red blood) Inflammatory bowel ... have an exam even if you think that hemorrhoids are causing the blood in your stool. In ...

[Efficiency of combined methods of hemorroid treatment using hal-rar and laser destruction].

PubMed

Rodoman, G V; Kornev, L V; Shalaeva, T I; Malushenko, R N

2017-01-01

To develop the combined method of treatment of hemorrhoids with arterial ligation under Doppler control and laser destruction of internal and external hemorrhoids. The study included 100 patients with chronic hemorrhoids stage II and III. Combined method of HAL-laser was used in study group, HAL RAR-technique in control group 1 and closed hemorrhoidectomy with linear stapler in control group 2. Сomparative evaluation of results in both groups was performed. Combined method overcomes the drawbacks of traditional surgical treatment and limitations in external components elimination which are inherent for HAL-RAR. Moreover, it has a higher efficiency in treating of hemorrhoids stage II-III compared with HAL-RAR and is equally safe and well tolerable for patients. This method does not increase the risk of recurrence, reduces incidence of complications and time of disability.

[Haemorrhoidal disease: from pathophysiology to clinical presentation].

PubMed

Zeitoun, Jean-David; de Parades, Vincent

2011-10-01

Hemorrhoidal disease is the first cause of proctological consultation although epidemiology is poorly documented. Pathophysiology is complex and involves a fragmentation of supporting tissues as well as vascular changes with hypervascularization and/or impaired venous return. The only complication of external hemorrhoids is thrombosis, which is responsible for acute anal pain irrespective of bowel movements. Internal hemorrhoids most frequently cause prolapse and/or bleeding which is easily recognizable. Physical examination always confirms the diagnosis and a colonoscopy is required after 40 or 45 in order to rule out colorectal cancer. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Hemorrhoids

MedlinePlus

... ice packs to relieve swelling. Use acetaminophen (1 brand name: Tylenol), ibuprofen (1 brand name: Motrin), or aspirin to help relieve pain. ... Childbirth Women Men Seniors Your Health Resources Healthcare Management End-of-Life Issues Insurance & Bills Self Care ...

Hemorrhoids

MedlinePlus

... ensuring high-quality patient care by advancing the science, prevention and management of disorders and diseases of the colon, rectum and anus. These brochures are inclusive but not prescriptive. Their purpose is to provide information on diseases and processes, ...

Hemorrhoids

MedlinePlus

... Process Research Training & Career Development Funded Grants & Grant History Research Resources Research at NIDDK Technology Advancement & Transfer Meetings & Workshops Health Information Diabetes Digestive ...

Herbal haemorrhoidal cream for haemorrhoids.

PubMed

Gurel, Ebru; Ustunova, Savas; Ergin, Bulent; Tan, Nur; Caner, Metin; Tortum, Osman; Demirci-Tansel, Cihan

2013-10-31

Although hemorrhoids are one of the most common diseases in the world, the exact etiology underlying the development of hemorrhoids is not clear. Many different ointments are currently used to treat hemorrhoids; however, there is little evidence of the efficacy of these treatments to support their use. The aim of this study was to compare different herbal creams used for the treatment of hemorrhoids. Twenty-eight male Wistar albino rats, 6-8 weeks old and weighing 160-180 g, were used in this study as 1-control, 2-croton oil, 3-croton oil+fig leaves+artichoke leaves+walnut husks and 4-croton oil+fig leaves+artichoke leaves+walnut husks+horse chestnut fruit. After 3 days of croton oil application, rats were treated with 0.1 ml of cream or saline twice a day for 15 days by syringe. Tissue and blood samples were collected for histological, immunohistochemical and biochemical studies. Statistical significance was determined using one-way ANOVA followed by Tukey's multiple comparison tests. Croton oil administration resulted in severe inflammation. The third group showed partial improvement in inflammation; however, the greatest degree of improvement was seen in the fourth group, and some recovered areas were observed. Myeloperoxidase immunoreactivity was found to be decreased in the third and fourth groups compared to the second group. Additionally, biochemical analyses (Myeloperoxidase, Malondyaldehyde, nitrate/nitrite and nitrotyrosine levels and Superoxide Dismutase activity) were in agreement with the histological and immunohistochemical results. In conclusion, croton oil causes inflammation in the anal area and results in hemorrhoids. Treatment with our herbal hemorrhoid creams demonstrated anti-inflammatory and anti-oxidant effects in this model.

[Comparison of Doppler-assisted dearterialization with mucopexy and hemorrhoidectomy].

PubMed

Titov, A Iu; Abritsova, M V; Mudrov, A A

2016-01-01

To compare two methods of hemorrhoid treatment. This prospective study included 240 patients with hemorrhoids stage III-IVA. Stages III and IVA were diagnosed in 156 (65%) and 84 (35%) patients respectively. Randomization was performed using envelopes method in one to one distribution. In group 1 (n=120) Doppler-assisted dearterialization of internal hemorrhoids with mucopexy was performed (DDM), in group 2 (n=120) - hemorrhoidectomy using harmonic scalpel (HE). Duration of surgery was 17.9±6.1 and 34.5±10.1 minutes in DDM and HE groups respectively (p<0.01). Postoperative pain severity was higher in group 2 (4.8 compared with 2.5 scores of the first group (p<0.01). Narcotic analgesics were used less often in DDM group (1.3 doses compared with 6.1 doses in HE group (p<0.01). Disability period was 14.4±5.2 and 30.3±5.4 days in both groups respectively (p<0.01). Immediate postoperative complications occurred in 9 (7.5%) and 19 (15.8%) patients of DDM and HE groups respectively. Recurrent prolapse of internal hemorrhoids was diagnosed in 2 (1.7%) patients of the 1st group in terms of up to 45 days. DDM is reliable minimally invasive method of hemorrhoids stage III-IVA treatment and has similar efficacy with HE. DDM reduces postoperative pain severity, hospital stay and disability period.

Flavonoid mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) in the treatment of I-III degree hemorroidal disease: a double-blind multicenter prospective comparative study.

PubMed

Corsale, Italo; Carrieri, Paolo; Martellucci, Jacopo; Piccolomini, Alessandro; Verre, Luigi; Rigutini, Marco; Panicucci, Sonia

2018-06-22

We evaluated the efficacy of new flavonoids mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) to reduce bleeding from I-III degrees hemorrhoidal disease in the short and medium time. One hundred fifty-four consecutive patients with hemorrhoidal disease recruited in four colorectal units were enrolled to the study. Exclusion criteria were allergy to the flavonoids, inflammatory bowel disease, obstructed defecation syndrome, pregnancy and puerperium, associated anal disease or hemorrhoidal thrombosis, proctologic surgical procedures within 1 year before recruitment, contemporary cancer or HIV, previous pelvic radiotherapy, patients receiving oral anticoagulant therapy, or contemporary administration of other therapy for hemorrhoids. Patients with inability to understand the study or mental disorders were also excluded. Seventy-eight were randomized to receive the mixture of diosmin, troxerutin, rutin, hesperidin, and quercetin (study group, SG), and 76 a mixture of diosmin in combination with hesperidin, diosmetin, isoroifolin, and linarin in purified micronized fraction (control group, CG). Bleeding, number of pathological piles, and Golligher's grade were assessed at each scheduled visit and compared using the Chi-square test. During the study period, bleeding improved after 1 and 6 months both in the SG (79.5 and 70.5%) and in the CG (80.2 and 75%) without significant differences between two groups. Satisfaction degree after 6 months was greater in the patients of the SG (4.05) towards the CG (3.25): this result was statistical significant (p 0.003). Use of flavonoids mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) is a safe and effective mean of managing bleeding from hemorrhoidal disease and minimal adverse events are reported.

Submucosal reconstructive hemorrhoidectomy (Parks' operation): a 20-year experience.

PubMed

Rosa, G; Lolli, P; Piccinelli, D; Vicenzi, L; Ballarin, A; Bonomo, S; Mazzola, F

2005-12-01

Submucosal reconstructive hemorrhoidectomy has never been a popular operation due to its difficulty and duration, the amount of blood loss, and the risk of incontinence. The main indication for hemorrhoidectomy according to Parks is fourth-degree hemorrhoids with prolapse of the dentate line outside the anus and with simultaneous presence of external hemorrhoids. We report our experience in the treatment of hemorrhoids using submucosal reconstructive hemorrhoidectomy according to Parks. A total of 640 patients (381 men and 259 women) of median age 42 years (range, 18-81) were treated between 1983 and 2002; 80% of patients had fourth-degree, 19% third-degree and 1% second- degree hemorrhoids. All patients underwent rectosigmoidoscopic examination before surgery; patients over 35 years of age or with a suspected inflammatory or neoplastic disease underwent colonoscopy or barium enema. All patients underwent anorectal manometry before operation, to measure anal resting pressure, maximal squeeze and sphincter length, with the purpose of determining if an internal sphincterotomy was also necessary (in case of high anal resting tone). One-third of the patients also had an internal sphincterotomy to correct anal hypertonia. Postoperative bleeding occurred in 19 patients (2.9%), 0.9% requiring a reintervention. Severe pain was reported by 9 patients (1.4%); fecal impaction occurred in 3 cases (0.5%) and suture disruption in 2 patients (0.3%). In 74 patients (11.6%), bladder catheterization was needed due to urinary retention. Of 550 patients who had a minimum follow-up of 3 years and were sent a postal questionnaire, 374 patients responded, with a median 7.3-year follow- up; 176 patients (32%) were lost to follow-up. Eleven patients (2.9% of 374 cases) reported pain during defecation, 6 (1.6%) developed skin tags or recurrence, 3 (0.8%) reported gas incontinence, 2 (0.5%) developed anal fistula and 1 (0.3%) had anal stricture. Submucosal reconstructive hemorrhoidectomy

That's why it's a 5-year program: resident acquisition of anorectal disease management competence.

PubMed

Miller, Seth; Sohn, Vance; Causey, Marlin Wayne; Martin, Matthew; Brown, Tommy; Steele, Scott

2012-04-01

Although surgical residents are expected to be proficient in the diagnosis and management of anorectal pathology upon graduation, there is little data related to the timing and degree of proficiency acquired during training. Prospective study of new patients presenting to a colorectal surgical clinic for evaluation of anorectal complaints over a 3-y period. Trainees performed an initial evaluation and recorded their exam findings, diagnosis, and treatment plan. A separate evaluation by a staff colorectal surgeon was performed, with results compared by an independent reviewer. A total of 236 patient evaluations were included. The accuracy of referral diagnosis was significantly better when originated from a surgeon than from all other referral sources (91.7% versus 59.1%, P = 0.031). The most common conditions were internal hemorrhoids (25%), anal fissures (22%), and external hemorrhoids (19.5%). Internal hemorrhoids were most commonly misdiagnosed as external hemorrhoids (58%). Anal fissures were missed 38% of the time, and were most often given the diagnosis of internal hemorrhoids (45%). Residents also demonstrated difficulty in identifying thrombosis in external hemorrhoids, with a 45% error rate. Medical students and residents had an overall correct primary diagnosis of 69.5%; however, there was a significant improvement in the accuracy of diagnosis from medical students and interns to upper level residents (62.9% versus 81.2%, P = 0.003). Medical treatment plans agreed between resident and staff in 74%, the surgical management agreed in 62%, and overall the residents had the correct diagnosis and corresponding treatment plan in 44%. Additional adjunctive procedures were proposed in 66 patients with residents stating the correct adjunct in 79%. The most frequently missed adjuncts were endorectal ultrasound (34%) and colonoscopy (28%). Surgical trainees demonstrated significant deficiencies in the ability to evaluate and manage anorectal pathology; however

Clinical study on 71 anorectal cases treated by carbon dioxide laser

NASA Astrophysics Data System (ADS)

Li, Gui-hua

1993-03-01

This paper describes the effective result of carbon dioxide laser on type I and II internal hemorrhoids, mixed hemorrhoids, anal fissure or fistula, etc. At present, simple hemorrhoidectomy is less acceptable to patients for its excessive bleeding and severe pain during and after the operation. Therefore, the results of 71 anorectal cases of hemorrhoidectomy using carbon dioxide laser have been observed in our hospital. The rates of effective treatment and cure were 100% and 94.3%, respectively.

Common anorectal disorders.

PubMed

Foxx-Orenstein, Amy E; Umar, Sarah B; Crowell, Michael D

2014-05-01

Anorectal disorders result in many visits to healthcare specialists. These disorders include benign conditions such as hemorrhoids to more serious conditions such as malignancy; thus, it is important for the clinician to be familiar with these disorders as well as know how to conduct an appropriate history and physical examination. This article reviews the most common anorectal disorders, including hemorrhoids, anal fissures, fecal incontinence, proctalgia fugax, excessive perineal descent, and pruritus ani, and provides guidelines on comprehensive evaluation and management.

Common Anorectal Disorders

PubMed Central

Foxx-Orenstein, Amy E.; Umar, Sarah B.; Crowell, Michael D.

2014-01-01

Anorectal disorders result in many visits to healthcare specialists. These disorders include benign conditions such as hemorrhoids to more serious conditions such as malignancy; thus, it is important for the clinician to be familiar with these disorders as well as know how to conduct an appropriate history and physical examination. This article reviews the most common anorectal disorders, including hemorrhoids, anal fissures, fecal incontinence, proctalgia fugax, excessive perineal descent, and pruritus ani, and provides guidelines on comprehensive evaluation and management. PMID:24987313

Visualization of diffusion of the drug solution during aluminum potassium tannic acid injection therapy: a pilot study.

PubMed

Yamamoto, Yutaka; Miwa, Mitsuharu

2013-06-01

Sclerotherapy with aluminum potassium tannic acid (ALTA), which was approved in Japan for the treatment of internal hemorrhoids in July 2004 (Takano et al., Int J Colorectal Dis 21:44-51, 2006), has been widely accepted because of its effectiveness and low invasiveness. More than 200,000 patients have received ALTA injection therapy. ALTA is injected directly into 4 points of an internal hemorrhoid (4-step injection) to induce sclerosis and remission of the hemorrhoids, and consequently, resolution of symptoms such as prolapse and bleeding. The precision of the 4-step injection is considered to be a crucial determinant of the success of this therapy and the risk of complications. However, sufficient evidence has not yet been obtained concerning the diffusion and distribution of the injected drug. A pilot study visualized the real-time diffusion/distribution of the drug solution following the 4-step injection, using the ICG (indocyanine green) fluorescence technique, and an infrared camera (Photodynamic EYE; PDE, Hamamatsu Photonics K.K.).

Manual reduction in acute haemorrhoids.

PubMed

Gaj, F; Candeloro, L; Biviano, I

2016-01-01

In prolapsed internal hemorrhoids exposed outside the anus, manually reducing the prolapse with 48 hours of commencement of anal pain, decreased the progression of thrombosis. The aim of our study was to evaluate the effects of manual reduction of the inflamed piles hemorrhoids. Eleven patients, 7 males and 4 pregnant females (in early post partum) with an average age of 34 years ± 8 (range 23- 52) were enrolled with anal pain cause by haemorrhoidal congestion, but prior to full blown thrombosis. Patients underwent a manual reduction of the external prolapsed haemorrhoidal plexus. In the 48 hours following the procedure, patients were instructed on how to insert any prolapsed hemorrhoid (piles) themselves. Pain intensity was measured using the visual analog scale (VAS) at time of consultation and then 10 days after the reduction. At day 10 following treatment we observed a statistically significant reduction in anal swelling (11 vs 1, n° pzt; p = 0.001), anal pain (11 vs 2, n° pzt; p = 0.001) and VAS score (8.6 ± 0.7 vs 0.4 ± 1.2; p = 0.001). Two patients (18%) underwent surgical haemorrhoidectomy sec. Milligan Morgan and 1 patient (9%) underwent excision of thrombosed external hemorrhoids. 73% of patients did not require surgery. Manual reduction of the prolapsed piles outside the anus decreased pain immediately and it also allows postponement of surgery or any other treatment.

Piles of defeat. Napoleon at Waterloo.

PubMed

Welling, D R; Wolff, B G; Dozois, R R

1988-04-01

Major events of history have frequently turned on seemingly trivial matters. One such situation involves Napoleon Bonaparte at Waterloo. Napoleon was not feeling well on the day of the battle of Waterloo, despite fighting well at Ligny, a few days before the last, dramatic June 18 battle. There is considerable indication that Napoleon was bothered by very painful thrombosed hemorrhoids. Did this affect his generalship that day? What is the evidence that Napoleon was afflicted with thrombosed hemorrhoids? What contribution could this factor have made to the French defeat at Waterloo?

[Treatment tactics of hemorroidal disease stage III-IV].

PubMed

Goncharuk, R A; Stegniĭ, K V; Krekoten', A A; Grossman, S S; Sarychev, V A

2013-01-01

The Miligan-Morgan's operation has long been considered to be the "golden standard" of hemorrhoids' stage I-III treatment. The invention of distal branches of the upper rectal artery' suture ligation with mucopexia and lifting of the anal canal mucosa discovered new possibilities for hemorrhoids surgery, though there are still some questions considering long-term results. 151 cases of recurrence within 1-6 months were analyzed. The use of CT-angiography with 3D reconstruction of the upper rectal artery allowed to chose the operative technique more relevant and thus improve the treatment results.

[Complications of hemorrhoids].

PubMed

Slauf, P; Antoš, F; Marx, J

2014-04-01

The most common and serious complications of haemorrhoids include perianal thrombosis and incarcerated prolapsed internal haemorrhoids with subsequent thrombosis. They are characterised by severe pain in the perianal region possibly with bleeding. In a short history of the perianal thrombosis, acute surgical incision or excision is indicated, which can result in rapid relief of the painful symptoms. In incarcerated prolapsed internal haemorrhoids, emergency haemorrhoidectomy may also be indicated. Segmental haemorrhoidectomy in the most affected quadrants followed by further elective surgery for haemorrhoids in the next stage is preferred.

[Pathophysiology of hemorrhoids].

PubMed

Bruch, H P; Roblick, U J

2001-06-01

It is not easy to define haemorrhoidal complaints precisely since this automatically means the entire aetiology and pathogenesis. What Stelzner describes as a complex compound of arteriovenous links in the rectal mucosa with an interlace of unstriated muscles, elastic fibres and connective tissue forms the anatomic base of the "corpus cavernosum recti". This cavernous vascular padding is a crucial component of the continence organ and ensures a gas-tight seal. According to Thomson's studies, haemorrhoids are to be regarded as a consequence of the disintegration of muscular and elastic components, caused by a distal shift of the vascular padding. The changes can cause growth up to prolapse, as well as haemorrhage or congestion. The reasons have not yet been conclusively clarified. Malfunctioning intestines--in particular constipational changes with hard stool--seem to be causal factors. The mechanisms of function and control of arteriovenous links as well as the influence of hereditary, social and cultural disposition continue to be unclear.

Hemorrhoid removal -- discharge

MedlinePlus

... work you do, you may need to take time off work. As you start feeling better, increase your physical activity. For example, do more walking. You should have a complete recovery in a few weeks. Pain Management Your doctor will give you a prescription for ...

Evaluating the safety, efficacy and complications of electrotherapy and its comparison with conventional method of hemorrhoidectomy

PubMed Central

Nikooiyan, Payam; Mohammadi Sardo, Hamzeh; Poursaeidi, Bahram; Zaherara, Motahareh; Ahmadi, Bijan

2016-01-01

Aim: This study was performed to evaluate the efficacy, safety and complications of electrotherapy compared with conventional hemorrhoidectomy (Ferguson technique). Background: Ferguson hemorrhoidectomy is always associated with considerable pain and postoperative complications. Still, the electrotherapy method in which the hemorrhoidal tissue is not removed may not improve critical complications. Patients and methods: This randomized clinical trial was performed on patients with hemorrhoids referring to hospitals affiliated to the Kerman University of Medical Sciences during 2014-2015. One hundred and twenty patients presented with symptomatic hemorrhoids grade I, II, III, and IV were randomized into two groups. Group 1 (60 patients) underwent electrotherapy using 30 mA direct current and group 2 (60 patients) were submitted to Ferguson hemorrhoidectomy. The groups were compared regarding postoperative pain severity and complications, including recurrent symptoms, infection and recovery time to return to normal activities. The p≤ 0.05 was considered statistically significant. Results: More than 70% of patients in group 2 complained of severe pain, but in group 1, no more than 30% of patients experienced severe pain up to 6 hours post-surgery and 70% complained of mild pain 2-3 days post-surgery. Twenty four-hour hospitalization in group 2 and group 1 were 97% and 78%, respectively, whilst patients in electrotherapy group could be treated as outpatients. The mean return time to usual activities was 15 and 1.5 days for group 2 and 1, respectively. Conclusion: Electrotherapy with a direct current of 30 mA significantly reduce postoperative pain and the recovery period. This method showed a good success rate and less complication than the Ferguson method. As a result, because of more effectiveness, less pain, as well as shorter recovery time and getting back to normal activities, we recommend this procedure for the treatment of symptomatic hemorrhoids grade I, II

Anorectal emergencies.

PubMed

Lohsiriwat, Varut

2016-07-14

Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up.

Anorectal emergencies

PubMed Central

Lohsiriwat, Varut

2016-01-01

Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up. PMID:27468181

LONG TERM RESULTS AFTER STAPLED HEMORRHOIDOPEXY ALONE AND COMPLEMENTED BY EXCISIONAL HEMORRHOIDECTOMY: A RETROSPECTIVE COHORT STUDY

PubMed Central

ARAUJO, Sergio Eduardo Alonso; HORCEL, Lucas de Araujo; SEID, Victor Edmond; BERTONCINI, Alexandre Bruno; KLAJNER, Sidney

2016-01-01

ABSTRACT Background: Stapled hemorrhoidopexy is associated with less postoperative pain and faster recovery. However, it may be associated with a greater risk of symptomatic recurrence. We hypothesized that undertaking a limited surgical excision of hemorrhoid disease after stapling may be a valid approach for selected patients. Aim: To compare long-term results after stapled hemorrhoidopexy with and without complementation with closed excisional technique. Method: In a retrospective uni-institutional cohort study, sixty-five (29 men) patients underwent stapled hemorrhoidopexy and 21 (13 men) underwent stapled hemorrhoidopexy with excision. The same surgeons operated on all cases. Patients underwent stapled hemorrhoidectomy associated with excisional surgery if symptoms attributable to external hemorrhoid piles were observed preoperatively, or if residual prolapse or bulky external disease was observed after the firing of the stapler. A closed excisional diathermy hemorrhoidectomy without vascular ligation was utilized in all complemented cases. All clinical variables were obtained from a questionnaire evaluation obtained through e-mail, telephone interview, or office follow-up. Results: The median duration of postoperative follow-up was 48.5 (6-40) months. Patients with grades 3 and 4 hemorrhoid disease were operated on more frequently using stapled hemorrhoidopexy complemented with excisional technique (95.2% vs. 55.4%, p=0.001). Regarding respectively stapled hemorrhoidopexy and stapled hemorrhoidopexy complemented with excision, there was no difference between the techniques in relation to symptom recurrence (43% and 33%, p=0.45) and median interval between surgery and symptom recurrence (30 (8-84) and 38.8 (8-65) months, p=0.80). Eight (12.3%) patients were re-operated after stapled hemorrhoidopexy and 2 (9.6%), after hemorrhoidopexy with excision (p=0.78). Patient distribution in both groups according to the degree of postoperative satisfaction was similar (p

Gastroparesis

MedlinePlus

... Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Hemorrhoids Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & ... Nerve Damage (Diabetic Neuropathies) Indigestion (Dyspepsia) Related Diagnostic Tests Upper GI Endoscopy Upper GI Series Related Research ...

Inguinal Hernia

MedlinePlus

... Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Hemorrhoids Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & ... medical and family history a physical exam imaging tests, including x-rays Medical and family history. Taking ...

Celiac Disease

MedlinePlus

... Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Hemorrhoids Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & ... Defects Dermatitis Herpetiformis Reproductive Problems Osteoporosis Related Diagnostic Tests Upper GI Endoscopy For Health Care Professionals Dermatitis ...

Gallstones

MedlinePlus

... Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Hemorrhoids Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & ... NASH Understanding Adult Overweight and Obesity Related Diagnostic Tests ERCP Your Digestive System and How it Works ...

Gastrointestinal bleeding

MedlinePlus

... conditions that are not serious, including: Anal fissure Hemorrhoids GI bleeding may also be a sign of ... the bowel Home Care There are home stool tests for microscopic blood that may be recommended for ...

Indigestion

MedlinePlus

... Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Hemorrhoids Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & ... Bowel Syndrome (IBS) Peptic Ulcer Disease Related Diagnostic Tests Upper GI Endoscopy Your Digestive System and How ...

Chronic Diarrhea in Children

MedlinePlus

... Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Hemorrhoids Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & ... Disease IBS in Children Lactose Intolerance Related Diagnostic Tests Colonoscopy Flexible Sigmoidoscopy Upper GI Endoscopy Your Digestive ...

Crohn's Disease

MedlinePlus

... Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Hemorrhoids Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & ... research into many diseases and conditions. Related Diagnostic Tests Colonoscopy Upper GI Series Upper GI Endoscopy Related ...

Anoscopy

MedlinePlus

... What Abnormal Results Mean Abnormal results may include: Abscess Fissures Foreign object in the anus Hemorrhoids Infection ... Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also ...

Hydrocortisone Rectal

MedlinePlus

Rectal hydrocortisone is used along with other medications to treat proctitis (swelling in the rectum) and ulcerative colitis (a ... and swelling from hemorrhoids and other rectal problems. Hydrocortisone is in a class of medications called corticosteroids. ...

Modified Longo's stapled hemorrhoidopexy with additional traction sutures for the treatment of residual prolapsed piles.

PubMed

Chen, Chuang-Wei; Kang, Jung-Cheng; Wu, Chang-Chieh; Hsiao, Cheng-Wen; Jao, Shu-Wen

2008-03-01

Residual prolapsed piles is a problem after the stapled hemorrhoidopexy, especially in large third- or fourth-degree hemorrhoids. We have developed a method using additional traction sutures along with modified Longo's procedure to manage this problem. From January 2005 to October 2005, 30 consecutive patients with symptomatic third- or fourth-degree hemorrhoids who underwent the modified Longo's stapled hemorrhoidopexy with additional traction sutures in a single institution were collected. The demographics, postoperative pain score, surgical features, outcomes, and early and late complications were recorded. All patients were followed for a mean duration of 8.8 (range, 4-15) months. Thirty patients (17 males) with a mean age of 45 (range, 27-63) years were identified. The mean postoperative pain score on the morning of the first postoperative day was 2.8 (range, 1-4). The mean duration of operation was 30.7 (range, 25-37) min. The mean duration of hospital stay was 2 (range, 1-3) days. The mean days for patients to resume normal work was 6.7 (range, 4-9) days. No other procedure-related complications occurred in all patients. There was no early complication except for fecal urgency found in one patient during the first postoperative days. Regarding the late complications, no residual prolapsed piles, persistent anal pain, incontinence, anal stenosis, or recurrent symptoms were found. Our preliminary experiences indicated that this modified procedures truly contributed to reduce the residual internal hemorrhoids and maintained the benefits of stapled hemorrhoidopexy. Randomized trial and long-term follow-up warrant to determine possible surgical and functional outcome.

Effect of zinc oxide on the rheological and mucoadhesive properties of poloxamer 407-based mucoadhesive thermosensitive gel.

PubMed

Park, Tae-Hwan; Kim, Sung Tae; Park, Jeong-Sook; Choi, Han-Gon; Kim, Hyung Tae; Kim, Chong-Kook

2010-12-01

To improve the therapeutic efficacy of drugs for hemorrhoid, mucoadhesive thermosensitive gel (MTG) system was developed. The MTG was prepared using poloxamer 407 (P407, 13% and 14%), polycarbophil (PC, 0.2% w/v), phenylephrine hydrochloride (0.25% w/v), lidocaine hydrochloride (1.88% w/v), and prednisolone acetate (0.05% w/v). Then, zinc oxide (ZnO) was added as an astringent as well as mucoadhesiveness-enhancing agent. Two kinds of poloxamer-based MTGs were compared in aspects of rheology, mucoadhesiveness, syringeability, and in vitro release study. Both the two MTGs (13% and 14% P407) showed Newtonian behavior at 20°C whereas pseudoplastic flow at 37°C. The addition of ZnO into MTGs enhanced the mucoadhesiveness and syringeability and led the drug components to be released in accordance with Fickian mechanism. Taken together, the MTG-containing ZnO can be a more effective and convenient delivery system for the treatment of hemorrhoid with a reduced dosage interval.

Clinical efficacy of Jalaukawacharana (leech application) in Thrombosed piles.

PubMed

Bhagat, Pradnya J; Raut, Subhash Y; Lakhapati, Arun M

2012-04-01

'Arsha' (hemorrhoids) is an ailment that affects all economical groups of population. Though the disease is within the limits of management, it has its own complications like severe hemorrhage, inflammation, and thrombosis, by which a patient gets severe pain and is unable to continue his routine work. Prior to surgical treatment of hemorrhoids, associated conditions like inflammation, strangulation, thrombosis, etc. need to be managed. Thrombosed piles possibly occur due to high venous pressure associated with severe anal pain. Leech (Hirudina medicanalis) application is found to be effective in reducing pain. In thrombosed piles, leech application has shown thrombolytic action, which contributes in re-establishment of circulation. It is observed in the study that, pus and mucous discharge have been reduced after leech application; which may be due to antimicrobial and mucolytic properties of leech. This method of treatment is found to be effective and increase the quality of life in patients suffering with thrombosed piles.

[Detection and analysis of the characteristic expression of microRNAs of anal fistula patients].

PubMed

Qiu, Jianming; Yu, Jiping; Yang, Guangen; Xu, Kan; Tao, Yong; Lin, Ali; Wang, Dong

2016-07-01

To detect and analyze the characteristic miRNAs profile of anal fistula and explore their possible target genes and potential clinical significance. The anal mucosa close to the hemorrhoids were collected from three patients undergoing fistulectomy and hemorrhoidectomy (fistula group) as well as three patients receiving only hemorroidectomy(hemorrhoids group), matching with fistula group in age, gender and body weight. miRNA microarray was used to compare the expression of 1 285 human miRNAs of the anal mucosa between two groups. Cluster analysis was adopted to analyze the accumulation of the differentially expressed miRNAs(P<0.05, fold≥2.0 or ≤0.5) and their target genes were predicted with 10 softwares such as DIANAmT, miRanda, miRDB, miRWalk etc. Comprehensive scoring was performed to identify genes with highest predictive score. Gene ontology (GO) concentration technique was used to analyze the target gene-associated biological process. Immunohistochemistry was used to examine protein expression of genes with the highest score. Among 1285 miRNAs in fistula group, 13 miRNAs were differentially expressed with those in hemorrhoid group, including 2 of up-regulation and 11 of down-regulation. Paired t test showed that in fistula group, miRNA-3609 up-regulation was 5.98 folds(P=0.0231) and miR-181a-2-3p down-regulation was 0.13 folds(P=0.0067) compared to those in hemorrhoid group, which had the greatest differential expression. Cluster analysis suggested that up-regulated miR-3609 and miR-6086 had similar change trend in both groups. Among 11 down-regulated miRNAs, miR-125bp-1-3p and miR-548q had similar expression and other 9 miRNAs had similar expression as well, including miR-1185-1-3p, miR-532-3p, miR-1233-5p, miR-769-5p, miR-149-5p, miR-99b-3p, miR-141-3p, miR-138-5p, and miR-181a-2-3p. Target gene prediction analysis of above 13 genes showed that 7 miRNAs(53.8%) were eligible to predict their potential target genes, yielding totally 104 possible target

Increased diagnostic activity in general practice during the year preceding colorectal cancer diagnosis.

PubMed

Hansen, Pernille Libach; Hjertholm, Peter; Vedsted, Peter

2015-08-01

Accurate diagnostic activity in general practice before colorectal cancer (CRC) diagnosis is crucial for an early detection of CRC. This study aimed to investigate the rates of daytime consultations, hemoglobin (Hb) measurements and medicine prescriptions for hemorrhoids in general practice in the year preceding CRC diagnosis. Using Danish registries, we conducted a population-based matched cohort study including CRC patients aged 40-80 years (n = 19,209) and matched references (n = 192,090). We calculated odds ratios (ORs) using a conditional logistical regression model and incidence rate ratios (IRRs) using a negative binomial regression model. The CRC patients had significantly more consultations from 9 months before diagnosis and significantly increased rates of Hb measurements from up to 17 months before diagnosis compared with references. Furthermore, up to 18 months before diagnosis, CRC patients had significantly higher rates of prescriptions for hemorrhoids; and 2 months before diagnosis, the IRR was 12.24 (95% confidence interval (CI): 10.29-14.55) for men. The positive predictive value (PPV) of CRC for having a first-time prescription for hemorrhoids was highest among men aged 70-80 years [PPV = 3.2% (95% CI: 2.8-3.7)]. High prescription rates were predominantly seen among rectal cancer patients, whereas colon cancer patients had higher rates of consultations and Hb measurements. This study revealed a significant increase in healthcare seeking and diagnostic activity in general practice in the year prior to CRC diagnosis, which indicates the presence of a "diagnostic time window" and a potential for earlier diagnosis of CRC based on clinical signs and symptoms. © 2015 UICC.

SwiftLase: a new technology for char-free ablation in rectal surgery

NASA Astrophysics Data System (ADS)

Arnold, David A.

1995-05-01

We describe layer-by-layer char-free ablation of hemorrhoids and other rectal lesions at very low CO2 laser power levels with a miniature `SwiftLaser' optomechanical flashscanner. Increased speed with excellent control, very shallow thermal damage, and less postoperative pain are the main advantages of the flashscan technology in rectal surgery.

Health Instruction Packages: Consumer--Understanding Your Condition.

ERIC Educational Resources Information Center

Kidd, Audrey E.; And Others

Text, illustrations, and exercises are utilized in this set of three learning modules to inform members of the general public about the causes and treatments of the common medical ailments that they may have. The first module, "Understanding Ligation of Hemorrhoids as an Office Procedure" by Audrey E. Kidd, lists the symptoms of…

Department of the Army Supply Bulletin, Army Medical Department Supply Information, SB8-75-S10

DTIC Science & Technology

2001-10-20

12 BTL FLUORESCEIN NA OPTH STRIPS 1 MG 300s 6505-01-159-1493 91C $125.24 1 PG GUAIFENESIN / DEXTRAMETHORAPHAN COUGH SYRUP 4...oz 6505-01-318-1565 91B $1.00 12 BTL GUAIFENESIN EXTENDED RELEASE TABLETS 600MG 100s 6505-01-238-9443 91C $3.89 3 BTL HEMORRHOIDAL

[Internal and external haemorrhoids].

PubMed

Schuurman, J P; Go, P M N Y H

2011-01-01

In this article, we present 3 cases of patients with different types of haemorrhoidal disease. The first patient is a 27-year-old woman who had been experiencing incidental rectal blood loss without pain during defecation for 3 months. The second patient is a 76-year-old woman who had been bothered by varying degrees of pain from a swelling nearby the anus for 1 year. The third case involves a 31-year-old man who had had continuous severe pain in the anal area for 3 consecutive days. The first patient appeared to have internal hemorrhoids, whereas different forms of external hemorrhoids affected the patients in the other 2 cases. Internal haemorrhoids develop from the intraluminal corpus cavernosum recti; external haemorrhoids from the perianal marginal veins. Patients with internal haemorrhoids present with symptoms that include blood loss and prolaps feeling during defecation. In patients with external haemorrhoids pain is the prominent symptom. Internal haemorrhoids are treated either conservatively or surgically, depending upon their severity. Considering external haemorrhoidal disease surgical treatment provides the most rapid and persistent relief of symptoms.

[Butcher's Broom, in the treatment of venous insufficiency].

PubMed

Bylka, Wiesława; Kornobis, Joanna

2005-08-01

Numerous extracts of the plants, natural compounds and their derivatives, acting on the venous system, including horse-chestnut seed extracts aescin, rutin, troxerutin, diosmin and hesperidine. They have a long tradition in herbal medicine for their venotonic and anti-oedematous properties. This review is concerning Rusci aculeati rhizoma, which recently taken in Poland on the symptoms of chronic venous insufficiency and hemorrhoids.

Acute dysphonia secondary to vocal fold hemorrhage after vardenafil use.

PubMed

Singh, Vikas; Cohen, Seth M; Rousseau, Bernard; Noordzij, J Pieter; Garrett, C Gaelyn; Ossoff, Robert H

2010-06-01

Owing to their vasodilatory effects, the phosphodiesterase-5 inhibitors have become widely used for the treatment of erectile dysfunction. Among the reported adverse events of these agents are epistaxis, variceal bleeding, intracranial hemorrhage, and hemorrhoidal bleeding. We report a case of vocal fold hemorrhage that occurred after vardenafil use in a 31-year-old man who was a professional singer.

The tissue-selecting technique: segmental stapled hemorrhoidopexy.

PubMed

Lin, Hong-Cheng; Lian, Lei; Xie, Shang-Kui; Peng, Hui; Tai, Jian-Dong; Ren, Dong-Lin

2013-11-01

We describe a technique for the management of prolapsing hemorrhoids, with the aim to minimize the risk of anal stricture and rectovaginal fistula and to reduce the impact of the stapling technique on rectal compliance. This modified procedure was successfully applied in China, and preliminary data showed promising outcomes (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A117).

Stapled haemorrhoidectomy in the operative treatment of grade III and IV haemorrhoids.

PubMed

Shrestha, S; Pradhan, G B N; Shrestha, R; Poudel, P; Bhattachan, C L

2014-09-01

Stapled haemorrhoidectomy (SH) is a minimally invasive intervention that uses a stapling device which avoids the need for wounds in the sensitive anal area and reduces the pain after surgery. This study was undertaken in Nepal Medical College Teaching Hospital from January 2010 to December 2012 to evaluate the efficacy of this modality of treatment among patients (32) who presented in the Surgery OPD with grade III and grade IV haemorrhoids. The results of SH were evaluated by the relief of symptoms, severity of post operative pain, and complications of SH. Twenty five (78.1%) patients had grade III and 7 (21.9%) presented with grade IV hemorrhoids. The most frequent presentation reported in our study was bleeding per rectum with perianal prolapse. Mean operating time was 40-60 minutes whereas mean hospital stay was 1.9 days. Urinary retention was the most common complication found in 12 (37.5%) patients in the immediate post operative period. SH is a safe, rapid, and convenient surgical remedy for grade III and grade IV hemorrhoids with low rate of complications, minimal postoperative pain, and shorter hospital stay.

Can 5-aminosalicylic acid suppository decrease the pain after rectal band ligation?

PubMed

Kayhan, Burcak; Ozer, Digdem; Akdogan, Meral; Ozaslan, Ersan; Yuksel, Osman

2008-06-14

To investigate the effect of 5-aminosalicylic acid (5-ASA) suppositories on rectal band ligation-induced pain. Sixty patients were randomized into two treatment groups. Our results showed that there was no difference between 5-ASA suppository group and the control group for pain control. 5-ASA may be an alternative treatment for hemorrhoids; however, it does not affect the rectal band ligation-induced pain.

Projection of Patient Condition Code Distributions for Naval Combat Deployments

DTIC Science & Technology

1999-09-06

Helminthiasis 286 Pancreatitis 287 Cirrhosis 18.97% 13.03% Atlantic Pacific 12.0% 12.0% 12.0% 12.0% 12.0% 12.0% 12.0% 12.0% 1.0% 1.0% 1.0% 1.0... Helminthiasis 0.44% 0.55% 255 Migraine 0.00% 0.00% 256 Hemorrhoidal disease 4.17% 2.87% 258 Hypertension/essential 2.53% 1.67% 259 Ischemic heart/disease

A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up.

PubMed

Cheetham, M J; Cohen, C R G; Kamm, M A; Phillips, R K S

2003-04-01

Hemorrhoidectomy is the most effective long-term treatment for hemorrhoids. Although it is possible to perform hemorrhoidectomy as a day case with a high degree of patient satisfaction, patients take an average of 14 days off work after surgery. Stapled hemorrhoidectomy is believed to be less painful than conventional hemorrhoidectomy and should allow an earlier return to work. The aim of this study was to compare both the immediate and the long-term results of stapled hemorrhoidectomy with diathermy hemorrhoidectomy in patients with prolapsing internal hemorrhoids in an intended day-care setting. Thirty-one patients were randomly assigned to undergo diathermy hemorrhoidectomy (n = 16) or stapled hemorrhoidectomy performed with a purpose-designed endoluminal stapling device, PPH01T (n = 15). All operations were planned as day or short-stay cases. All patients received lactulose, commenced preoperatively, together with postoperative topical glyceryl trinitrate and oral metronidazole. Patients were assessed by structured interview to assess their symptoms before and after surgery, with an intended follow-up of six months. All patients completed a 10-cm visual analog pain scale daily for the first ten days after surgery. The total pain score (sum of all pain scores) was significantly higher in the diathermy group (50 (range, 9.8-79.9) vs. 19.6 (range, 1.3-89.5), P = 0.03). Patients took a median of 14 (range, 3-21) days off work after diathermy hemorrhoidectomy compared with 10 (range, 3-38) days for the patients undergoing stapled hemorrhoidectomy (P = 0.15). At long-term follow-up, three patients (all in the stapled group) developed new symptoms of fecal urgency and anal pain, and three patients required further surgery to remove symptomatic external hemorrhoids after stapled hemorrhoidectomy. Although stapled hemorrhoidectomy is less painful in the short term, this does not lead to a significantly earlier return to work, and some patients develop new symptoms at

Four years Follow-up of Patients with Irritable Bowel Syndrome.

PubMed

Rusu, F; Dumitraşcu, D L

2015-01-01

There is little data on the long term evolution of patients with irritable bowel syndrome (IBS) and of associated conditions. We therefore studied the evolution of IBS patients in a single tertiary center during a long interval of time. We carried out a retrospective study based on the survey of patients records. We analyzed the records of symptoms, therapy, associated diseases, as consigned at follow-up visits for an interval of 4 years in average (2008-2011). A cohort of 114 patients with IBS diagnosed based on Rome III criteria were included (29 men and 85 women), age 19-85 years (mean age: 43.45 years). Urban patients were predominant. The main three symptoms were: abdominal pain, bowel disorders (constipation, diarrhea) and bloating. IBS--constipation (IBS--C) is associated with a favorable course of symptoms (increasing the number of stools, decrease intensity of abdominal pain and bloating) after treatment and IBS--diarrhea (IBS--D) is associated with variable symptoms after treatment (p = 0.031). Using trimebutin or mebeverin in association with other drugs for one month correlates with a favorable evolution of symptoms after treatment and monotherapy is associated with fluctuating symptoms ( p< 0.001). Favorable symptoms are associated with the use of probiotics in combination, but not in monotherapy (p< 0.001). Favorable evolution of symptoms is also associated with the use of anxiolytics in combination. Persistence of symptoms after treatment was correlated with the presence or absence of depression. The absence of depression was correlated with a favorable evolution of symptoms (p = 0.005). IBS-C is associated at limit (marginal significance) with hemorrhoidal disease (p = 0.56). 33 patients (29%)--received monotherapy (trimebutin or mebeverin or probiotics); 81 patients (71%)--received combined therapy: (trimebutin or mebeverin or probiotics) + anxiolytics or proton pump inhibitors (PPI) or nonsteroidal anti-inflammatory (NSAI) or spasmolytics. The

Case-control study of relationship of some biosocial correlates to rectal cancer patients in Belgrade, Yugoslavia.

PubMed

Jarebinski, M; Adanja, B; Vlajinac, H

1989-01-01

This investigation of some biosocial factors such as level of education, profession, tobacco smoking, alcohol and coffee consumption, and previous illnesses, reports on 98 patients with histologically confirmed rectal cancer, and 196 hospitalized and neighborhood-matched controls. Past history of hemorrhoids, polyposis, colitis, diverticulosis and appendectomy, as well as the use of laxatives were significantly more frequent among rectal cancer patients than in their controls. None of the case-control differences related to the other parameters reached statistical significance.

Phytodermatitis caused by Ceratocephalus falcatus (Ranunculacea).

PubMed

Karaca, Semsettin; Kulac, Mustafa; Kucuker, Hudaverdi

2005-01-01

Ceratocephalus falcatus is a member of Ranunculacea family that forms part of the flora of the Sinanpasa and Dinar regions of Afyon city in Turkey. Ceratocephalus falcatus has laxative properties and has been used for treating hemorrhoids, rheumatismal diseases and wounds. Here, a case of phytodermatitis caused by this remedy used for relieving knee pain is presented. This plant should be kept in mind when a case of phytodermatitis with vesicles or bullae presents at clinics.

Surprising finding on colonoscopy.

PubMed

Griglione, Nicole; Naik, Jahnavi; Christie, Jennifer

2010-02-01

A 48-year-old man went to his primary care physician for his annual physical. He told his physician that for the past few years, he had intermittent, painless rectal bleeding consisting of small amounts of blood on the toilet paper after defecation. He also mentioned that he often spontaneously awoke, very early in the morning. His past medical history was unremarkable. The patient was born in Cuba but had lived in the United States for more than 30 years. He was divorced, lived alone, and had no children. He had traveled to Latin America-including Mexico, Brazil, and Cuba-off and on over the past 10 years. His last trip was approximately 2 years ago. His physical exam was unremarkable. Rectal examination revealed no masses or external hemorrhoids; stool was brown and Hemoccult negative. Labs were remarkable for eosinophilia ranging from 10% to 24% over the past several years (the white blood cell count ranged from 5200 to 5900/mcL). A subsequent colonoscopy revealed many white, thin, motile organisms dispersed throughout the colon. The organisms were most densely populated in the cecum. Of note, the patient also had nonbleeding internal hemorrhoids. An aspiration of the organisms was obtained and sent to the microbiology lab for further evaluation. What is your diagnosis? How would you manage this condition?

Diverticular Disease of the Colon in Korea

PubMed Central

Kim, Byoung Ho; Lee, Sung Hoon; Lee, Seung Sei; Oh, Dong Joo; Chung, Eul Soon; Lee, Sang Jong

1987-01-01

This study is designed to determine the relative prevalence and characteristics of diverticular disease of the colon in Korea. We did a retrospective evaluation of 16,964 consecutive barium enemas performed at Koryo General Hospital between January 1971 and October 1986, and found 100 patients with diverticular disease of the colon. The results are as follows: 1) Colonic diverticula were found in 100 patients, and incidence of 0.59% in 16,964 consecutive barium enemas. The male to female ratio was 2.1:1.2) Incidence rose with advancing age from 0.45% in the second decade to 2.5% in the seventh decade.3) Patient age ranged from 19 to 77 years with more than 70% of the patients in the 5th, 6th and 7th decades.4) The greater majority (81%) of the diverticular disease the right colon.5) Fifty percent of the cases were classified as multiple diverticula.6) The mean age of patients with right sided diverticula was 47.5 years and that of patients with left sided diverticula was 57.7 years. The mean age of single diverticular patients was 50.4 years and that of multiple diverticular patients was 48.4 year.7) Associated diseases were hemorrhoids (18%), gall stones (12%) and previous appendectomy (11%). Among the 29 patients who had hemorrhoids and or a previous appendectomy, 28 of those had right sided diverticula. PMID:3154819

Severe constipation associated with extended-release bupropion therapy.

PubMed

Lounsbery, Jody L; Medow, Mitchell A; Green, Christopher G

2008-08-15

A case of bupropion-induced constipation is reported. A 38-year-old man went to a clinic with a chief complaint of depression. He was prescribed extended-release bupropion 150 mg orally daily. Three weeks later, the patient returned to the clinic for a follow-up visit regarding his depression. He reported that his depression symptoms improved, but he complained of constipation and inflamed hemorrhoids from straining with defecation. He used docusate sodium, fiber supplements, and Preparation H(Wyeth) products with some relief. The bupropion was continued for his depression. Recommendations were given to the patient to increase fluids, maintain fiber intake, and add exercise. One week later, the patient complained of rectal pain and minimal bleeding. Prescriptions were given to the patient for hydrocortisone suppositories and 2.5% cream to be used twice daily. Three days later, the patient returned to the clinic complaining of increased pain and no relief from the hydrocortisone suppositories and cream. The rectal examination showed 3- and 5-cm hemorrhoids, one of which was thrombotic. The patient was instructed to continue hydrocortisone products, increase fluids, and continue docusate. Hemorrhoidectomy surgery was eventually performed, as well as a fissurectomy. The patient discontinued bupropion on his own due to the constipation approximately one week before the surgery. The constipation resolved after discontinuation of bupropion. Extended-release bupropion was the probable cause of severe constipation in a man with multiple medical problems.

Constipation in specialized palliative care: factors related to constipation when applying different definitions.

PubMed

Erichsén, E; Milberg, A; Jaarsma, T; Friedrichsen, M

2016-02-01

For patients in palliative care, constipation is primarily a result of opioid treatment. Impacts from other factors related to constipation in palliative care are rarely studied. The aim was to identify factors related to constipation in patients in palliative care, and then to compare these factors between patients with different types of constipation and patients without constipation. Cross-sectional data on constipation was collected with a 26-item questionnaire from 485 patients in 38 specialist palliative care units in Sweden. Three different constipation groups were used; MC ONLY, PC ONLY, and MC & PC. Logistic regression analyses were used to calculate odds ratios. Patients with <3 defecations/week, MC ONLY, (n = 36) had higher odds of being hospitalized, bed-restricted, in need of personal assistance for toilet visits, and of having a poor fluid intake. Patients with the perception of being constipated, PC ONLY, (n = 93) had higher odds of having poor appetite, hemorrhoids, hard stool, more opioid treatment, less laxative treatment and of being more dissatisfied with constipation information. Patients with both <3 defecations/week and a perception of being constipated, MC & PC, (n = 78) had higher odds of having cancer- disease. There were several significant factors related to constipation with higher odds than opioid- treatment, for patients in palliative care, such as; hard stool, cancer diagnosis, dissatisfaction with information, low fluid intake, hemorrhoids, bed restriction, hospitalization, and need of personal assistance for toilet visits.

Direct current electrotherapy for internal haemorrhoids: experience in a tertiary health institution

PubMed Central

Olatoke, Samuel; Adeoti, Moses; Agodirin, Olayide; Ajape, Abdulwahab; Agbola, John

2014-01-01

Introduction Haemorrhoids disease is one of the most frequently occurring disabling conditions of the anorectum. We re-present the method, advantages and results of using direct current electrotherapy in the treatment of haemorrhoids. Methods Symptomatic grades 1, 2 or 3 internal and mixed haemorroids were treated. Exposure and evaluation was with an operative proctoscope which visualized one-eighth of the anal canal at a time. All diseased segments were treated per visit, indicators of successful treatment were, darkening of the treated segment, immediate shrinking of the haemorrhoid and ceasation of popping sound of gas release at the probe tip. Patients were followed up for two weeks. No bowel preparations, medications, anesthesia nor admission was required. Results Four hundred and fifty six segments were exposed, 252(55.3%) were diseased. eight patients with either grades 2 or 3 diseases required two treatment visits. The most common symptom was rectal bleeding (94.7%), followed by prolapsed but manually reduced hemorrhoids (68%). Prolapse of tuft of haemorrhoidal tissue with spontaneous return was seen in 59.6%, anal pain in 29.8%, and itching in 3.5%. the median number treated segments per patient was 4. No complication was encountered. All patients treated remained symptom free at a mean duration of follow up of 16 months. Conclusion Direct current electrotherapy is an effective, painless and safe out-patient treatment method for grades 1 to 3 internal and mixed hemorrhoid disease. PMID:25419283

Direct current electrotherapy for internal haemorrhoids: experience in a tertiary health institution.

PubMed

Olatoke, Samuel; Adeoti, Moses; Agodirin, Olayide; Ajape, Abdulwahab; Agbola, John

2014-01-01

Haemorrhoids disease is one of the most frequently occurring disabling conditions of the anorectum. We re-present the method, advantages and results of using direct current electrotherapy in the treatment of haemorrhoids. Symptomatic grades 1, 2 or 3 internal and mixed haemorroids were treated. Exposure and evaluation was with an operative proctoscope which visualized one-eighth of the anal canal at a time. All diseased segments were treated per visit, indicators of successful treatment were, darkening of the treated segment, immediate shrinking of the haemorrhoid and ceasation of popping sound of gas release at the probe tip. Patients were followed up for two weeks. No bowel preparations, medications, anesthesia nor admission was required. Four hundred and fifty six segments were exposed, 252(55.3%) were diseased. eight patients with either grades 2 or 3 diseases required two treatment visits. The most common symptom was rectal bleeding (94.7%), followed by prolapsed but manually reduced hemorrhoids (68%). Prolapse of tuft of haemorrhoidal tissue with spontaneous return was seen in 59.6%, anal pain in 29.8%, and itching in 3.5%. the median number treated segments per patient was 4. No complication was encountered. All patients treated remained symptom free at a mean duration of follow up of 16 months. Direct current electrotherapy is an effective, painless and safe out-patient treatment method for grades 1 to 3 internal and mixed hemorrhoid disease.

Anal Health Care Basics

PubMed Central

Chang, Jason; McLemore, Elisabeth; Tejirian, Talar

2016-01-01

Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy. The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate. Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area. Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases. In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists. PMID:27723447

Diagnosis and treatment of haemorrhoids.

PubMed

Buntzen, Steen; Christensen, Peter; Khalid, Ali; Ljungmann, Ken; Lindholt, Jan; Lundby, Lilli; Walker, Line Rossell; Raahave, Dennis; Qvist, Niels

2013-12-01

These guidelines provide a review of diagnosis, conservative and surgical treatment of haemorrhoids with primary focus on the surgical treatment. In symptomatic hemorrhoids it is recommended, that conservative treatment is used as basic treatment regardless of grading. The vast majority of grade II haemorrhoids are treated conservatively, but surgery may be considered in a few cases with pronounced symptoms. In these cases chirurgia minor, Doppler guided dearterilization procedures or stapled haemorrhoidopexy are recommended. In grade III and IV Doppler guided dearterilization procedures, stapled haemorrhoidopexy (Grade III) or conventional Milligan Morgan haemorrhoidectomy are recommended.

A review on Balanites aegyptiaca Del (desert date): phytochemical constituents, traditional uses, and pharmacological activity

PubMed Central

Chothani, Daya L.; Vaghasiya, H. U.

2011-01-01

Balanites aegyptiaca Del. (Zygophyllaceae), known as ‘desert date,’ is spiny shrub or tree up to l0 m tall, widely distributed in dry land areas of Africa and South Asia. It is traditionally used in treatment of various ailments i.e. jaundice, intestinal worm infection, wounds, malaria, syphilis, epilepsy, dysentery, constipation, diarrhea, hemorrhoid, stomach aches, asthma, and fever. It contains protein, lipid, carbohydrate, alkaloid, saponin, flavonoid, and organic acid. Present review summarizes the traditional claims, phytochemistry, and pharmacology of B. aegyptiaca Del reported in scientific literature. PMID:22096319

Appendiceal hemorrhage -- an uncommon cause of lower gastrointestinal bleeding.

PubMed

Chiang, Ching-Chung; Tu, Chi-Wen; Liao, Chi-Szu; Shieh, Min-Chieh; Sung, Tien-Chou

2011-06-01

Lower gastrointestinal bleeding is a common disease among elderly patients. The common sources of lower gastrointestinal bleeding include vascular disease, Crohn's disease, neoplasms, inflammatory bowel disease, hemorrhoids, and ischemic colitis. Lower gastrointestinal bleeding arising from the appendix is an extremely rare condition. We report a case of appendiceal hemorrhage in a young male. Diagnosis was made by multidetector computerized tomography during survey for hematochezia. The patient recovered well after appendectomy. The histological finding revealed focal erosion of appendix mucosa with bleeding. Copyright © 2011. Published by Elsevier B.V.

Association between khat chewing and gastrointestinal disorders: a cross sectional study.

PubMed

Nigussie, Tadele; Gobena, Teshome; Mossie, Andualem

2013-07-01

Khat (Catha edulis Forsk) is a psycho-stimulant substance grown in East Africa. But its adverse effects and its prevalence are not well studied. The main aim of the present study is thus to assess the association between khat chewing and GI problems among students in Ambo University. A cross-sectional study was conducted in January 2010 on 1005 Ambo University students. Study subjects were selected using systematic random sampling technique, and data were collected using self-administered questionnaire. Data analysis was made using SPSS version 16.0 for windows package. The mean age of the respondents was 20.79 ± 1.39 ranging from 18-30 years. Seven hundred twenty (71.6 %) of the study participants were males and 994 (98.9%) were in the age group of 15-24 years. The prevalence of gastritis was 580 (57.7%); constipation 235 (23.4%); hemorrhoids 54 (5.4%) and that of dental problems (carries, decay, filling and extraction) was 225 (22.4%) of all study participants. Gastrointestinal disorders were found to be higher among khat chewers, where 64(36.2%) of them had dental problems; 127(71.8%) symptoms of gastritis; 86(48.6%) constipation and 26(14.7%) hemorrhoids which demonstrated statistically significant association with p < 0.001. The prevalence of gastrointestinal disorders was found to be higher among khat chewers, indicating that khat chewing could be a predisposing factor to gastrointestinal disorders. Community-based awareness creation about the adverse effect of khat use is thus recommended.

A clinical study on the role of Ksara Vasti and Triphala Guggulu in Raktarsha (Bleeding piles).

PubMed

Mehra, Raakhi; Makhija, Renu; Vyas, Neera

2011-04-01

Shonitarsha is a common affliction which has been described and treated since the beginning of human civilization. Hemorrhoidal cushions are a part of normal anatomy but become pathological when swollen or inflamed. Treatment of piles in modern medicine is hemorrhoidectomy which results in repeated recurrences. Ayurveda provides a cure and prevents recurrences. Present study was carried out using a combination of Apamarga Kshara Basti and Triphalaguggulu. The results of the clinical assessment of the indigenous formulation on 129 patients with bleeding piles are reported in this paper; 55 patients of a total of 129 showed marked relief.

A clinical study on the role of Ksara Vasti and Triphala Guggulu in Raktarsha (Bleeding piles)

PubMed Central

Mehra, Raakhi; Makhija, Renu; Vyas, Neera

2011-01-01

Shonitarsha is a common affliction which has been described and treated since the beginning of human civilization. Hemorrhoidal cushions are a part of normal anatomy but become pathological when swollen or inflamed. Treatment of piles in modern medicine is hemorrhoidectomy which results in repeated recurrences. Ayurveda provides a cure and prevents recurrences. Present study was carried out using a combination of Apamarga Kshara Basti and Triphalaguggulu. The results of the clinical assessment of the indigenous formulation on 129 patients with bleeding piles are reported in this paper; 55 patients of a total of 129 showed marked relief. PMID:22408301

Common anorectal disorders: diagnosis and treatment.

PubMed

Lacy, Brian E; Weiser, Kirsten

2009-10-01

Anorectal disorders affect men and women of all ages. Their management is not limited to the evaluation and treatment of hemorrhoids. Rather, a spectrum of anorectal disorders ranges from benign and irritating (pruritus ani) to potentially life-threatening (anorectal cancer). Symptoms are nonspecific, which can make the evaluation of patients difficult. In addition, treatment can be frustrating because clinicians are hamstrung by a lack of well-designed, prospective, clinical trials. Some of the most common anorectal disorders include fecal incontinence, pelvic floor dyssynergia, anal fissures, pruritus ani, proctalgia fugax, and solitary rectal ulcer syndrome. This article provides an update on the evaluation and treatment of common anorectal disorders.

The factors associated with negative colonoscopy in screening subjects with positive immunochemical stool occult blood test outcomes.

PubMed

Ting, Po-Hsiang; Lin, Xi-Hsuan; Jiang, Jeng-Kai; Luo, Jiing-Chyuan; Chen, Ping-Hsien; Wang, Yen-Po; Hsin, I-Fang; Perng, Chin Lin; Hou, Ming-Chih; Lee, Fa-Yauh

2018-05-16

The immunochemical fecal occult blood test (iFOBT) is an alternative method to colonoscopy that can be used for colorectal cancer (CRC) screening. If the iFOBT result is positive, a colonoscopy is recommended. In this retrospective study, we identify factors associated with negative colonoscopy and positive iFOBT results obtained during CRC screening. We collected data for subjects who received a colonoscopy at Taipei Veterans General Hospital after receiving a positive iFOBT result during CRC screening from January 2015 to December 2015. Subjects' baseline data, medications, and co-morbidities as well as colonoscopy and histological findings were recorded. A negative colonoscopy result was defined as no detection of any colorectal neoplasia including non-advanced adenoma, advanced adenoma, and adenocarciona. Multivariate logistic regression analysis was conducted to identify the associated factors in screening subjects with positive iFOBT but negative colonoscopy results. 559 (46.3%) out of 1207 eligible study subjects received a colonoscopy with a negative result. Multivariate logistic regression analysis revealed that the use of antiplatelets [odds ratio (OR) = 0.654; 95% confidence interval (CI), 0.434-0.986], occurrence of hemorrhoid (OR = 0.595; 95% CI, 0.460-0.768), and the existence of colitis/ulcer (OR = 0.358; 95% CI, 0.162-0.789) were independent factors associated with negative colonoscopy but positive iFOBT results during CRC screening. The colon clean level, underlying diseases of gastrointestinal bleeding tendency (e.g., chronic kidney disease, cirrhosis), and the use of anticoagulant or nonsteroidal anti-inflammatory agents were not associated with negative colonoscopy and positive iFOBT results. The use of antiplatelet agents and the presence of hemorrhoids and colitis/ulcers were factors associated with negative colonoscopy and positive iFOBT results. Copyright © 2018. Published by Elsevier Taiwan LLC.

A Randomized Trial Comparing Stapled Rectal Mucosectomy Versus Open and Semiclosed Hemorrhoidectomy.

PubMed

Ripetti, Valter; La Vaccara, Vincenzo; Greco, Santi; Arullani, Augusto

2015-11-01

Different results have been reported concerning the postoperative outcomes of different surgical approaches for hemorrhoids. We aimed to determine the postoperative outcome following 3 main surgical techniques. A prospective, randomized trial was designed with 180 patients in 3 arms of 60 patients each. The study was conducted from April 1999 to January 2007 at the University Hospital "Campus Bio-Medico di Roma." All of the patients who were referred for hemorrhoid surgery were enrolled according to inclusion and exclusion criteria (ISRCTN12040297). Treatments according to the open, semiclosed, and stapled techniques were compared. Sample size was calculated to determine a difference in terms of the intensity of postoperative pain at the first week and the days required for return to work activity. After 1 week, patients who underwent semiclosed hemorrhoidectomy reported significantly less pain (p < 0.01) and a significant decrease in analgesic intake from the third postoperative day (p < 0.01) than after the other 2 techniques. The patients resumed work ≈11 days after semiclosed and stapled techniques (11.8 and 11.6 days), which was earlier compared with 21.3 days in the open group (p < 0.05). The high number of patients excluded might be considered a limitation of the study, but our selection criteria including patients living within 50 km of the hospital allowed for a low rate (9.4%) of patients lost to follow-up. This study found an earlier resumption of work and less pain in patients who underwent the stapled and semiclosed procedures rather than open, which was associated with more complications, particularly because of a higher rate of stenosis (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A196).

Investigation of physical and chemical stability of ointment with herbals.

PubMed

Zdoryk, Oleksandr A; Khokhlova, Kateryna O; Georgiyants, Victoriya A; Vyshnevska, Liliia I

2014-01-01

The physical and chemical stability of a stock preparation ointment with active ingredients-herbal tinctures of calendula and arnica-for the treatment of hemorrhoids was studied. Evaluations for physical and chemical stability were performed initially and throughout the storage period. Physical stability of the ointment was assessed by means of visual observation in normal room light. Throughout the study period, the physical appearance of the ointment did not change. The chemical stability of the ointment was evaluated by means of a stability-indicating, thin-layer chromatography analytical technique. The shelf-life was found to be one month at 25 degrees C +/- 2 degrees C/60% RH and two months at 5 degrees C +/- 3 degrees C, when protected from light.

First record of entomopathogenic fungi on autumn leaf Caterpillar (Doleschallia bisaltide)

NASA Astrophysics Data System (ADS)

Dayanti, A. K.; Sholahuddin; Yunus, A.; Subositi, D.

2018-03-01

Caricature plant is one of the medicinal plants in Indonesia to cure hemorrhoids, menstruation, and others. The cultivation constraints of caricature plant is autumn leaf caterpillars (Doleschallia bisaltide). Utilization of synthetic insecticides is not allowed to avoid bioaccumulation of chemical residues. Entomopathogenic fungi is an alternative way to control D. bisaltide. The objective of the research was to obtain isolates of entomopathogenic fungi of D. bisaltide. The research conducted by two steps, which were exsploration of infecfted D. bisaltide. The second step was identification of the fungi. Exploration results of 16 pupae of D. Bisaltide were infected by fungi. Identification done by classify the mcroscopic and microscopic fungi isolate characteristic. One from five fungal isolates were entomopathogenic fungi from Verticillium genera.

C-4 gem-dimethylated oleanes of Gymnema sylvestre and their pharmacological activities.

PubMed

Di Fabio, Giovanni; Romanucci, Valeria; Zarrelli, Mauro; Giordano, Michele; Zarrelli, Armando

2013-12-04

Gymnema sylvestre R. Br., one of the most important medicinal plants of the Asclepiadaceae family, is a herb distributed throughout the World, predominantly in tropical countries. The plant, widely used for the treatment of diabetes and as a diuretic in Indian proprietary medicines, possesses beneficial digestive, anti-inflammatory, hypoglycemic and anti-helmentic effects. Furthermore, it is believed to be useful in the treatment of dyspepsia, constipation, jaundice, hemorrhoids, cardiopathy, asthma, bronchitis and leucoderma. A literature survey revealed that some other notable pharmacological activities of the plant such as anti-obesity, hypolipidemic, antimicrobial, free radical scavenging and anti-inflammatory properties have been proven too. This paper aims to summarize the chemical and pharmacological reports on a large group of C-4 gem-dimethylated pentacyclic triterpenoids from Gymnema sylvestre.

A randomized, prospective, double-blind, placebo-controlled trial of the effect of a calcium channel blocker ointment on pain after hemorrhoidectomy.

PubMed

Silverman, Ralph; Bendick, Phillip J; Wasvary, Harry J

2005-10-01

Spasm of the internal sphincter plays a role in hemorrhoidal disease and may be a source of anal pain after hemorrhoid surgery. We have evaluated the effects of topical diltiazem, a calcium channel blocker, in reducing pain after hemorrhoidectomy. After hemorrhoidectomy, 18 patients were randomly assigned to receive 2 percent diltiazem ointment (n = 9) or a placebo ointment (n = 9). Ointments were applied to the perianal region three times daily for seven days. Patients were prescribed hydrocodone bitartrate (Vicodin) to take as needed. The type and number of prescribed or nonprescribed medications taken during the postoperative period were recorded. Patients maintained a log to measure postoperative pain daily and perceived benefit of the ointment, using a Visual Analog Scale ranging from 0 to 10. Any postoperative morbidity noted during the follow-up period was recorded. Patients using the diltiazem ointment had significantly less pain and greater benefit than those in the placebo group throughout the first postoperative week. Postoperative pain scores in the placebo group averaged 8.8 +/- 1.2 early and diminished to 5.2 +/- 1.7 at the end of one week, compared to the diltiazem group of 5.2 +/- 2.4 early and 2.3 +/- 1.2 at the end of one week (P < 0.001, both time periods). Perceived benefit in the placebo group averaged 2.7 +/- 1.2 vs. 5.6 +/- 1.4 in the diltiazem group (P < 0.001). Total and daily narcotic use was higher in the placebo group, but this was not statistically significant (P = 0.13). No differences in the frequency of use of nonsteroidal anti-inflammatory drugs and acetaminophen were seen between the two groups, and there were no differences in morbidity between the two groups. Perianal application of 2 percent diltiazem ointment after hemorrhoidectomy significantly reduces postoperative pain and is perceived as beneficial, with no increase in associated morbidity. Patients using a placebo ointment tend to take more prescription narcotics for pain

Management of Acute Lower Gastrointestinal Bleeding.

PubMed

Speir, Ethan J; Ermentrout, R Mitchell; Martin, Jonathan G

2017-12-01

Acute lower gastrointestinal bleeding (LGIB), defined as hemorrhage into the gastrointestinal tract distal to the ligament of Treitz, is a major cause of morbidity and mortality among adults. Overall, mortality rates are estimated between 2.4% and 3.9%. The most common etiology for LGIB is diverticulosis, implicated in approximately 30% of cases, with other causes including hemorrhoids, ischemic colitis, and postpolypectomy bleeding. Transcatheter visceral angiography has begun to play an increasingly important role in both the diagnosis and treatment of LGIB. Historically, transcatheter visceral angiography has been used to direct vasopressin infusion with embolization reserved for treatment of upper gastrointestinal bleeding. However, advances in microcatheter technology and embolotherapy have enabled super-selective embolization to emerge as the treatment of choice for many cases of LGIB. Copyright © 2017 Elsevier Inc. All rights reserved.

Malignant Melanoma of the Anus Found during Routine Colonoscopy in Ulcerative Colitis.

PubMed

Seo, Kwang Il; Moon, Won; Kim, Sung Eun; Park, Moo In; Park, Seun Ja

2017-06-25

Inflammatory bowel disease (IBD) is characterized by recurrent or chronic inflammation of the gastrointestinal tract, which results in increased risk of developing cancer. Anorectal malignant melanoma is often misdiagnosed as either hemorrhoids or benign anorectal conditions in inflammatory bowel disease. Therefore, the overall prognosis and survival of IBD are poor. To date, the best treatment strategy remains controversial. Only early diagnosis and complete excision yield survival benefit. Here, we report a 64-year-old woman with ulcerative colitis, who was found to have anal malignant melanoma on routine colonoscopy. The lesion was confined to the mucosa with no distant metastasis. She underwent complete trans-anal excision. There was no recurrence at the four-year follow-up. Physicians should be aware of increased risk of cancer development in IBD patients and remember the importance of meticulous inspection of the anal canal.

Management of Ano-Rectal disorders by Kṣārasūtra: A clinical report

PubMed Central

Kurapati, Vijaya Kumari; Nishteswar, K.

2014-01-01

Background: Ano-rectal complaints are usually benign in origin. Most of the patients suffering with these disorders do not seek medical advice at an early stage due to embarrassment. It results in advancement of the disease and significant disturbance in the quality of life. Among the available treatment modalities of ano-rectal disorders (ARDs), Kṣārasūtra (medicated thread) appears to be the best in terms of relief and nonrecurrence. Aims and Objectives: The aim of this study is to provide evidence-based data about the practical application of Kṣārasūtra (medicated thread) in the management of ARDs. Materials and Methods: An ano-rectal operation theatre was established in September 2012, in association with the Government Ayurvedic Speciality Clinic at District Hospital, Rajahmundry, Andhra Pradesh, to facilitate the AYUSH services in Allopathic Hospitals. Present report includes the details of ARDs treated by Kṣārasūtra (Medicated thread) method during 2012–2013. A total of 127 ano-rectal cases were operated, which included 44 cases of hemorrhoids, 40 cases of fistula-in-ano, 39 cases of fissure-in-ano and three cases of peri-anal abscess. All the cases were analyzed as per the observations, subjective and objective parameters, and follow-up was carried out for a period of 6 months. Results: In the 127 ARDs treated, 45 patients suffering from hemorrhoids, 36 patients got complete relief, marked relief observed in 4 patients, moderate relief observed in 5 patients. In fistula-in-ano, out of 40 patients 29 patients got complete relief, marked relief was seen in 7 patients out of them 4 patients were referred to anti-tubercular treatment center, 4 patients left against medical advice. In fissure-in-ano-out of 39 patients, 32 patients got complete relief, 5 patients got marked relief, moderate relief observed in 2 patients. These results authenticate the effectiveness of Kṣārasūtra, no adverse effects or recurrence observed in any case. Conclusions

Development of a Set of Nomograms to Predict Acute Lower Gastrointestinal Toxicity for Prostate Cancer 3D-CRT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Valdagni, Riccardo; Rancati, Tiziana; Fiorino, Claudio

2008-07-15

Purpose: To predict acute Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) and Subjective Objective Signs Management and Analysis/Late Effect of Normal Tissue (SOMA/LENT) toxicities of the lower gastrointestinal (LGI) syndrome in patients with prostate cancer undergoing three-dimensional conformal radiotherapy using a tool (nomogram) that takes into account clinical and dosimetric variables that proved to be significant in the Italian Association for Radiation Oncology (AIRO) Group on Prostate Cancer (AIROPROS) 0102 trial. Methods and Materials: Acute rectal toxicity was scored in 1,132 patients by using both the RTOG/EORTC scoring system and a 10-item self-assessed questionnaire.more » Correlation between clinical variables/dose-volume histogram constraints and rectal toxicity was investigated by means of multivariate logistic analyses. Multivariate logistic analyses results were used to create nomograms predicting the symptoms of acute LGI syndrome. Results: Mean rectal dose was a strong predictor of Grade 2-3 RTOG/EORTC acute LGI toxicity (p 0.0004; odds ratio (OR) = 1.035), together with hemorrhoids (p = 0.02; OR 1.51), use of anticoagulants/antiaggregants (p = 0.02; OR = 0.63), and androgen deprivation (AD) (p = 0.04; OR = 0.65). Diabetes (p = 0.34; OR 1.28) and pelvic node irradiation (p = 0.11; OR = 1.56) were significant variables to adjust toxicity prediction. Bleeding was related to hemorrhoids (p = 0.02; OR = 173), AD (p = 0.17; OR = 0.67), and mean rectal dose (p 0.009; OR = 1.024). Stool frequency was related to seminal vesicle irradiation (p = 0.07; OR = 6.46), AD administered for more than 3 months (p = 0.002; OR = 0.32), and the percent volume of rectum receiving more than 60 Gy (V60Gy) V60 (p = 0.02; OR = 1.02). Severe fecal incontinence depended on seminal vesicle irradiation (p = 0.14; OR = 4.5) and V70 (p = 0.033; OR 1.029). Conclusions: To the best of our knowledge, this work presents

Surgical Treatment of Anorectal Crohn Disease

PubMed Central

Lewis, Robert T.; Bleier, Joshua I. S.

2013-01-01

Crohn disease involves the perineum and rectum in approximately one-third of patients. Symptoms can range from mild, including skin tags and hemorrhoids, to unremitting and severe, requiring a proctectomy in a small, but significant, portion. Fistula-in-ano and perineal sepsis are the most frequent manifestation seen on presentation. Careful diagnosis, including magnetic resonance imaging or endorectal ultrasound with examination under anesthesia and aggressive medical management, usually with a tumor necrosis factor-alpha, is critical to success. Several options for definitive surgical repair are discussed, including fistulotomy, fibrin glue, anal fistula plug, endorectal advancement flap, and ligation of intersphincteric fistula tract procedure. All suffer from decreased efficacy in patients with Crohn disease. In the presence of active proctitis or perineal disease, no surgical therapy other than drainage of abscesses and loose seton placement is recommended, as iatrogenic injury and poor wound healing are common in that scenario. PMID:24436656

Melastoma malabathricum (L.) Smith Ethnomedicinal Uses, Chemical Constituents, and Pharmacological Properties: A Review

PubMed Central

Joffry, S. Mohd.; Yob, N. J.; Rofiee, M. S.; Affandi, M. M. R. Meor Mohd.; Suhaili, Z.; Othman, F.; Akim, A. Md.; Desa, M. N. M.; Zakaria, Z. A.

2012-01-01

Melastoma malabathricum L. (Melastomataceae) is one of the 22 species found in the Southeast Asian region, including Malaysia. Considered as native to tropical and temperate Asia and the Pacific Islands, this commonly found small shrub has gained herbal status in the Malay folklore belief as well as the Indian, Chinese, and Indonesian folk medicines. Ethnopharmacologically, the leaves, shoots, barks, seeds, and roots of M. malabathricum have been used to treat diarrhoea, dysentery, hemorrhoids, cuts and wounds, toothache, and stomachache. Scientific findings also revealed the wide pharmacological actions of various parts of M. malabthricum, such as antinociceptive, anti-inflammatory, wound healing, antidiarrheal, cytotoxic, and antioxidant activities. Various types of phytochemical constituents have also been isolated and identifed from different parts of M. malabathricum. Thus, the aim of the present review is to present comprehensive information on ethnomedicinal uses, phytochemical constituents, and pharmacological activities of M. malabathricum. PMID:22242040

The epidemiology of anal incontinence and symptom severity scoring

PubMed Central

Nevler, Avinoam

2014-01-01

For many patients, anal incontinence (AI) is a devastating condition that can lead to social isolation and loss of independence, contributing to a substantial economic health burden, not only for the individual but also for the allocation of healthcare resources. Its prevalence is underestimated because of poor patient reporting, with many unrecorded but symptomatic cases residing in nursing homes. Endosonography has improved our understanding of the incidence of post-obstetric sphincter tears that are potentially suitable for repair and those cases resulting from anorectal surgery, most notably after fistula and hemorrhoid operations. The clinical scoring systems assessing the severity of AI are discussed in this review, along with their limitations. Improvements in the standardization of these scales will advance our understanding of treatment response in an era where the therapeutic options have multiplied and will permit a better comparison between specific therapies. PMID:24759339

What every gastroenterologist needs to know about common anorectal disorders

PubMed Central

Schubert, Moonkyung Cho; Sridhar, Subbaramiah; Schade, Robert R; Wexner, Steven D

2009-01-01

Anorectal complaints are very common and are caused by a variety of mostly benign anorectal disorders. Many anorectal conditions may be successfully treated by primary care physicians in the outpatient setting, but patients tend not to seek medical attention due to embarrassment or fear of cancer. As a result, patients frequently present with advanced disease after experiencing significant decreases in quality of life. A number of patients with anorectal complaints are referred to gastroenterologists. However, gastroenterologists’ knowledge and experience in approaching these conditions may not be sufficient. This article can serve as a guide to gastroenterologists to recognize, evaluate, and manage medically or non-surgically common benign anorectal disorders, and to identify when surgical referrals are most prudent. A review of the current literature is performed to evaluate comprehensive clinical pearls and management guidelines for each topic. Topics reviewed include hemorrhoids, anal fissures, anorectal fistulas and abscesses, and pruritus ani. PMID:19598294

Gastrointestinal distress in pregnancy: prevalence, assessment, and treatment of 5 common minor discomforts.

PubMed

Zielinski, Ruth; Searing, Kimberly; Deibel, Megan

2015-01-01

Gastrointestinal discomforts are a very common complaint in pregnancy. In fact, most pregnant women will experience at least one discomfort. This article focuses on 5 common conditions that occur in pregnancy: gastroesophageal reflux disease, diarrhea, constipation, hemorrhoids, and pica. While these conditions do occur in men and nonpregnant women, they occur more frequently in pregnancy because of the anatomic and physiologic changes associated with gestation. The type and severity of symptoms can vary from individual to individual, making treatment a challenge for healthcare providers, particularly when caring for pregnant women because the effects of medications and other treatments on the developing fetus are often not extensively studied. While these discomforts are rarely life-threatening, they can cause significant distress and impair quality of life. The goal of this article was to provide a summary of the anatomic and physiological changes during pregnancy that contribute to the increasing incidence of these discomforts and to provide information about each condition including prevalence, symptoms, and treatment modalities.

Chamomile: A herbal medicine of the past with bright future

PubMed Central

Srivastava, Janmejai K; Shankar, Eswar; Gupta, Sanjay

2010-01-01

Chamomile is one of the most ancient medicinal herbs known to mankind. It is a member of Asteraceae/Compositae family and represented by two common varieties viz. German Chamomile (Chamomilla recutita) and Roman Chamomile (Chamaemelum nobile). The dried flowers of chamomile contain many terpenoids and flavonoids contributing to its medicinal properties. Chamomile preparations are commonly used for many human ailments such as hay fever, inflammation, muscle spasms, menstrual disorders, insomnia, ulcers, wounds, gastrointestinal disorders, rheumatic pain, and hemorrhoids. Essential oils of chamomile are used extensively in cosmetics and aromatherapy. Many different preparations of chamomile have been developed, the most popular of which is in the form of herbal tea consumed more than one million cups per day. In this review we describe the use of chamomile in traditional medicine with regard to evaluating its curative and preventive properties, highlight recent findings for its development as a therapeutic agent promoting human health. PMID:21132119

Perianal pain as a presentation of lumbosacral neurofibroma: a case report.

PubMed

Moghaddasi, Mehdi; Aghaii, Mahboubeh; Mamarabadi, Mansoureh

2014-12-01

Rectal and perianal pain is a common problem. Most people have experienced it at least once in their lifetime. It usually manifests as mild discomfort, but sometimes the pain can be so severe that it is incapacitating. A 59-year-old woman admitted with a 2-year history of paroxysmal perianal pain underwent a full work-up including proctoscopy, sigmoidoscopy, full colonoscopy, and barium enema that were unremarkable. Lumbosacral magnetic resonance imaging with and without gadolinium showed an intradural-extramedullary lesion at the level of L5. The pathologic diagnosis was a neurofibroma. She underwent surgery, and after a few weeks she felt well and medication was no longer needed for her paroxysmal pain. Although one should consider the usual causes of colorectal pain such as hemorrhoids, anal fissure, proctalgia fugax, and chronic perianal pain syndrome, we should keep in mind that some referral pain may mimic local pathologies and should be evaluated properly.

Perianal Pain as a Presentation of Lumbosacral Neurofibroma: A Case Report

PubMed Central

Moghaddasi, Mehdi; Aghaii, Mahboubeh; Mamarabadi, Mansoureh

2014-01-01

Rectal and perianal pain is a common problem. Most people have experienced it at least once in their lifetime. It usually manifests as mild discomfort, but sometimes the pain can be so severe that it is incapacitating. A 59-year-old woman admitted with a 2-year history of paroxysmal perianal pain underwent a full work-up including proctoscopy, sigmoidoscopy, full colonoscopy, and barium enema that were unremarkable. Lumbosacral magnetic resonance imaging with and without gadolinium showed an intradural-extramedullary lesion at the level of L5. The pathologic diagnosis was a neurofibroma. She underwent surgery, and after a few weeks she felt well and medication was no longer needed for her paroxysmal pain. Although one should consider the usual causes of colorectal pain such as hemorrhoids, anal fissure, proctalgia fugax, and chronic perianal pain syndrome, we should keep in mind that some referral pain may mimic local pathologies and should be evaluated properly. PMID:25485211

Health benefits of dietary fiber.

PubMed

Anderson, James W; Baird, Pat; Davis, Richard H; Ferreri, Stefanie; Knudtson, Mary; Koraym, Ashraf; Waters, Valerie; Williams, Christine L

2009-04-01

Dietary fiber intake provides many health benefits. However, average fiber intakes for US children and adults are less than half of the recommended levels. Individuals with high intakes of dietary fiber appear to be at significantly lower risk for developing coronary heart disease, stroke, hypertension, diabetes, obesity, and certain gastrointestinal diseases. Increasing fiber intake lowers blood pressure and serum cholesterol levels. Increased intake of soluble fiber improves glycemia and insulin sensitivity in non-diabetic and diabetic individuals. Fiber supplementation in obese individuals significantly enhances weight loss. Increased fiber intake benefits a number of gastrointestinal disorders including the following: gastroesophageal reflux disease, duodenal ulcer, diverticulitis, constipation, and hemorrhoids. Prebiotic fibers appear to enhance immune function. Dietary fiber intake provides similar benefits for children as for adults. The recommended dietary fiber intakes for children and adults are 14 g/1000 kcal. More effective communication and consumer education is required to enhance fiber consumption from foods or supplements.

A rare chemical burn due to Ranunculus arvensis: three case reports.

PubMed

Kocak, Abdullah O; Saritemur, Murat; Atac, Kenan; Guclu, Sibel; Ozlu, Ibrahim

2016-01-01

Ranunculus arvensis, a plant that is a member of Ranunculaceae family, generally used for local treatment of joint pain, muscle pain, burns, lacerations, edema, abscess drainage, hemorrhoids, and warts among the population. In this case report, we presented three patients who developed chemical skin burns after using R. arvensis plant locally for knee pain. The destructive effect of the plant has been reported previously to be more in fresh plants and less in dried plants. Although protoanemonin, which is considered as the main toxic substance, was reported to be absent in dried or boiled plants, the plant was boiled, cooled, and wrapped over the region with pain in our cases. Therefore, we thought that protoanemonin may be considered to be heat resistant. Also, the burn management proceeded up to surgery by using the flap technique in one of our patients in contrast to the cases found in published reports who were treated by antibiotics and dressings.

Phytochemistry and biological activities of Phlomis species.

PubMed

Limem-Ben Amor, Ilef; Boubaker, Jihed; Ben Sgaier, Mohamed; Skandrani, Ines; Bhouri, Wissem; Neffati, Aicha; Kilani, Soumaya; Bouhlel, Ines; Ghedira, Kamel; Chekir-Ghedira, Leila

2009-09-07

The genus Phlomis L. belongs to the Lamiaceae family and encompasses 100 species native to Turkey, North Africa, Europe and Asia. It is a popular herbal tea enjoyed for its taste and aroma. Phlomis species are used to treat various conditions such as diabetes, gastric ulcer, hemorrhoids, inflammation, and wounds. This review aims to summarize recent research on the phytochemistry and pharmacological properties of the genus Phlomis, with particular emphasis on its ethnobotanical uses. The essential oil of Phomis is composed of four chemotypes dominated by monoterpenes (alpha-pinene, limonene and linalool), sesquiterpenes (germacrene D and beta-caryophyllene), aliphalic compounds (9,12,15-octadecatrienoic acid methyl ester), fatty acids (hexadecanoic acid) and other components (trans-phytol, 9,12,15-octadecatrien-1-ol). Flavonoids, iridoids and phenylethyl alcohol constitute the main compounds isolated from Phlomis extracts. The pharmacological activities of some Phlomis species have been investigated. They are described according to antidiabetic, antinociceptive, antiulcerogenic, protection of the vascular system, anti-inflammatory, antiallergic, anticancer, antimicrobial and antioxidant properties.

A Case Series of Anal Carcinoma Misdiagnosed as Idiopathic Chronic Anal Fissure.

PubMed

Barbeiro, Sandra; Atalaia-Martins, Catarina; Marcos, Pedro; Gonçalves, Cláudia; Cotrim, Isabel; Vasconcelos, Helena

2017-09-01

Chronic anal fissure is a linear ulcer in the anal canal that has not cicatrized for more than 8-12 weeks of treatment. Most anal fissures are idiopathic and are located in the posterior midline. Squamous cell carcinoma of the anus commonly presents as bleeding and anal pain. It may also present as a mass, nonhealing ulcer, itching, discharge, fecal incontinence and fistulae. Not uncommonly, small and early cancers are misdiagnosed as benign anorectal disorders like anal fissures or hemorrhoids. The clinical suspicion of squamous cell carcinoma of the anus is of paramount importance in patients with nonhealing anal fissures, fissures in atypical positions or with indurated or ulcerated anal tags and in patients with risk factors for the development of anal squamous intraepithelial lesions that are precursors of invasive anal squamous cell carcinoma. The authors present 3 cases of squamous cell carcinoma of the anus initially misdiagnosed as benign chronic anal fissure.

Daily Sodium Butyrate Enema for the Prevention of Radiation Proctitis in Prostate Cancer Patients Undergoing Radical Radiation Therapy: Results of a Multicenter Randomized Placebo-Controlled Dose-Finding Phase 2 Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Maggio, Angelo, E-mail: maggio.angelo@gmail.com; Magli, Alessandro; Rancati, Tiziana

2014-07-01

Purpose: To evaluate the efficacy of sodium butyrate enemas (NABUREN) in prostate cancer radiation therapy (RT) in reducing the incidence, severity, and duration of acute RT-induced proctitis. Methods and Materials: 166 patients, randomly allocated to 1 of 4 groups (rectal sodium butyrate 1 g, 2 g, or 4 g daily or placebo), were treated with NABUREN during and 2 weeks after RT. The grade of proctitis was registered in a daily diary. The correlation between NABUREN and proctitis was investigated through χ{sup 2} statistics. The toxicity endpoints considered were as follows: total number of days with grade ≥1 proctitis (≥G1); total number of daysmore » with grade ≥2 proctitis (≥G2); ≥G1 and ≥G2 proctitis lasting at least 3 and 5 consecutive days starting from week 4 (≥G1+3d, ≥G2+3d); damaging effects of RT on rectal mucosa as measured by endoscopy. The relationship between endpoints and pretreatment morbidities, hormonal therapy, presence of diabetes or hypertension, abdominal surgery, or hemorrhoids was investigated by univariate analysis. Results: The patients were randomly allocated to the 4 arms. No difference in the distribution of comorbidities among the arms was observed (P>.09). The mean ≥G1 and ≥G2 proctitis were 7.8 and 4.9 for placebo and 8.9 and 4.7 for the NABUREN group, respectively. No favorable trend in reduction of incidence, severity, and duration of ≥G1 and ≥G2 proctitis was observed with NABUREN use. In univariate analysis, ≥G1+3d toxicity was found to be related to hemorrhoids (P=.008), and a slight correlation was found between ≥G2 proctitis and hormonal therapy (P=.06). The RT effects on rectal mucosa as based on endoscopic assessment were mainly related to diabetes (P<.01). Endoscopy data at 6 week showed no significant difference between the placebo and butyrate arms. The other investigated endpoints were not correlated with any of the clinical risk factors analyzed. Conclusion: There was no evidence of

Anti-inflammatory and analgesic components from "hierba santa," a traditional medicine in Peru.

PubMed

Kawano, Marii; Otsuka, Mayumi; Umeyama, Kazuhiro; Yamazaki, Mikio; Shiota, Tetsuo; Satake, Motoyoshi; Okuyama, Emi

2009-04-01

"Hierba santa," a Peruvian herbal medicine, is used to alleviate many symptoms, including headache, hemorrhoids, fever, and rheumatism. Several Cestrum species are said to be the origin of hierba santa. Three lots of hierba santa: Cestrum auriculatum (herb 1 and herb 2) and C. hediundinum (herb 3), which were purchased from Peruvian markets at Cuzco (Andes area) and Equitos (Amazon area), respectively, were examined for their pharmacological activities and active components. Herbs 1-3 showed anti-inflammatory and analgesic activities in the in vivo writhing inhibition test in mouse and inhibited prostaglandin E(1)-, E(2)-, or ACh-induced contractions of guinea pig ileum in the Magnus method. Activity-based separation of each extract yielded cestrumines A and B, cestrusides A and B, a mixture of (+)- and (-)-pinoresinol glucosides, nicotiflorin, rutin, sinapoyl glucose, ursolic acid, beta-sitosteryl glucoside, and 2-sec-butyl-4,6-dihydroxyphenyl-beta-D: -glucopyranoside. Among them, cestrumine A and cestrusides A and B are new compounds. All three lots of hierba santa do not contain exactly the same active components.

Effect of Transcutaneous Acupoint Electrical Stimulation on Post-Hemorrhoidectomy-Associated Pain, Anxiety, and Heart Rate Variability: A Randomized-Controlled Study.

PubMed

Yeh, Mei-Ling; Chung, Yu-Chu; Hsu, Lun-Chia; Hung, Shuo-Hui

2018-05-01

Hemorrhoidectomy is the current best treatment for severe hemorrhoids, but it causes significant postoperative pain and anxiety, which is associated with heart rate variability (HRV). Transcutaneous acupoint electrical stimulation (TAES) was assumed to alleviate pain and anxiety, and modify the autonomic nervous system. This study aimed to examine the effects of TAES intervention on postoperative pain, anxiety, and HRV in patients who received a hemorrhoidectomy. A randomized-controlled trial with five repeated measures was conducted. The TAES group ( n = 39) received four 20-min sessions of electrical stimulation at chengshan (BL57) and erbai (EX-UE2) after hemorrhoidectomy, whereas the control group ( n = 41) did not. Data were collected using Visual Analogue Scale (VAS), State Anxiety Inventory (STAI), and HRV physiological signal monitor. TAES resulted in a significant group difference in pain scores, anxiety levels, and some HRV parameters. The findings indicate that TAES can help reduce pain and anxiety associated with hemorrhoidectomy. TAES is a noninvasive, simple, and convenient modality for post-hemorrhoidectomy-associated pain control and anxiety reduction.

Antiamnesic and Antioxidants Effects of Ferulago angulata Essential Oil Against Scopolamine-Induced Memory Impairment in Laboratory Rats.

PubMed

Hritcu, Lucian; Bagci, Eyup; Aydin, Emel; Mihasan, Marius

2015-09-01

Ferulago angulata (Apiaceae) is a shrub indigenous to western Iran, Turkey and Iraq. In traditional medicine, F. angulata is recommended for treating digestive pains, hemorrhoids, snake bite, ulcers and as sedative. In the present study, the effects of inhaled F. angulata essential oil (1 and 3%, daily, for 21 days) on spatial memory performance were assessed in scopolamine-treated rats. Scopolamine-induced memory impairments were observed, as measured by the Y-maze and radial arm-maze tasks. Decreased activities of superoxide dismutase, glutathione peroxidase and catalase along with increase of acetylcholinesterase activity and decrease of total content of reduced glutathione were observed in the rat hippocampal homogenates of scopolamine-treated animals as compared with control. Production of protein carbonyl and malondialdehyde significantly increased in the rat hippocampal homogenates of scopolamine-treated animals as compared with control, as a consequence of impaired antioxidant enzymes activities. Additionally, in scopolamine-treated rats exposure to F. angulata essential oil significantly improved memory formation and decreased oxidative stress, suggesting memory-enhancing and antioxidant effects. Therefore, our results suggest that multiple exposures to F. angulata essential oil ameliorate scopolamine-induced spatial memory impairment by attenuation of the oxidative stress in the rat hippocampus.

GNAQ mutation in a patient with metastatic mucosal melanoma.

PubMed

Kim, Chung-Young; Kim, Dae Won; Kim, Kevin; Curry, Jonathan; Torres-Cabala, Carlos; Patel, Sapna

2014-07-16

Mucosal melanomas represent about 1% of all melanoma cases and classically have a worse prognosis than cutaneous melanomas. Due to the rarity of mucosal melanomas, only limited clinical studies with metastatic mucosal melanoma are available. Mucosal melanomas most commonly contain mutations in the gene CKIT, and treatments have been investigated using targeted therapy for this gene. Mutations in mucosal melanoma are less common than in cutaneous or uveal melanomas and occur in descending order of frequency as: CKIT (20%), NRAS (5%) or BRAF (3%). Mutations in G-alpha proteins, which are associated with activation of the mitogen-activated protein kinase pathway, have not been reported in mucosal melanomas. These G-alpha protein mutations occur in the genes GNAQ and GNA11 and are seen at a high frequency in uveal melanomas, those melanomas that begin in the eye. A 59-year old Caucasian male was diagnosed with a mucosal melanoma after evaluation for what was thought to be a hemorrhoid. Molecular analysis of the tumor revealed a GNAQ mutation. Ophthalmologic exam did not disclose a uveal melanoma. Here we report, to our knowledge, the first known case of GNAQ mutation in a patient with metastatic mucosal melanoma.

Effect aquadest-extracted Gloriosa superba seed as mutagen on morphology of Artemisia annua

NASA Astrophysics Data System (ADS)

Rahmawati, S. I.; Susilowati, A.; Yunus, A.; Widyastuti, Y.

2018-03-01

Gloriosa superba is a plant that contains colchicine in all parts of organs, especially in the seeds. Its extract is as a mutagen to produce plants with polyploid cells. Artemisia annua is a plant that produces active ingredients artemisinin as malarial drugs, hemorrhoids therapy, aromatherapy, antiviral, anticancer, and anti-bacterial. The aims of this research was to determine the effect aquadest-extracted Gloriosa superba seed as a mutagen to Artemisia annua morphology. Extraction of Gloriosa superba seeds obtained from Sukoharjo using maceration method with aquadest solvent (1: 1). The extracts were diluted (0, 25, 50, 75 and 100%) for Artemisia annua sprinkling with different times (0, 30, 60 and 90 minutes). Observations of morphology Artemisia annua included height, stem circumference, number of branches, number of leaves, leaf width and leaf length. The treatments did not affect plant morphology observation included height, stem circumference, number of branches, number of leaves, leaf width, and leaf length. The EB treatment (100%, 30 minutes) was higher (120 cm) than other. In all treatments stem circumference about 2.5 cm, number of branches ranged between 40-50, leaves width ranged 9-16c m, and leaf length ranged 8-15 cm.

Clinical outcomes of symptomatic arterioportal fistulas after transcatheter arterial embolization

PubMed Central

Hirakawa, Masakazu; Nishie, Akihiro; Asayama, Yoshiki; Ishigami, Kousei; Ushijima, Yasuhiro; Fujita, Nobuhiro; Honda, Hiroshi

2013-01-01

AIM: To evaluate the complications and clinical outcomes of transcatheter arterial embolization (TAE) for symptoms related to severe arterioportal fistulas (APFs). METHODS: Six patients (3 males, 3 females; mean age, 63.8 years; age range, 60-71 years) with chronic liver disease and severe APFs due to percutaneous intrahepatic treatment (n = 5) and portal vein (PV) tumor thrombosis of hepatocellular carcinoma (n = 1) underwent TAE for symptoms related to severe APFs [refractory ascites (n = 4), hemorrhoidal hemorrhage (n = 1), and hepatic encephalopathy (n = 1)]. Control of symptoms related to APFs and complications were evaluated during the follow-up period (range, 4-57 mo). RESULTS: In all patients, celiac angiography revealed immediate retrograde visualization of the main PV before TAE, indicating severe APF. Selective TAE for the hepatic arteries was performed using metallic coils (MC, n = 4) and both MCs and n-butyl cyanoacrylate (n = 2). Three patients underwent repeated TAEs for residual APFs and ascites. Four patients developed PV thrombosis after TAE. During the follow-up period after TAE, APF obliteration and symptomatic improvement were obtained in all patients. CONCLUSION: Although TAE for severe APFs may sometimes be complicated by PV thrombosis, TAE can be an effective treatment to improve clinical symptoms related to severe APFs. PMID:23494252

Manifestations of gastrointestinal plasmablastic lymphoma: a case series with literature review.

PubMed

Luria, Lynette; Nguyen, Johnny; Zhou, Jun; Jaglal, Michael; Sokol, Lubomir; Messina, Jane L; Coppola, Domenico; Zhang, Ling

2014-09-07

Plasmablastic lymphoma (PBL) rarely occurs in the gastrointestinal (GI) tract with limited studies reported. We reviewed the clinical histories and pathology of four patients with GI PBL at our institute and similar case reports published in peer-reviewed journals. In our first case, a 40 year-old human immunodeficiency virus positive male presented with a hemorrhoid-like sensation, and was diagnosed with PBL via biopsy of a rectal mass. The second case involves a 65 year-old healthy male with bloody diarrhea who was found to have PBL in a resected sigmoid mass. The third patient was a 41 year-old male with a history of Crohn's disease who presented with abdominal pain, diarrhea, and weight loss. A small intestinal mass (PBL) was removed. The fourth patient was a 65-year-old male who was found PBL after surgical resection of bowel for his florid Crohn's disease. He later developed secondary acute myeloid leukemia. Clinical outcome was very poor in 3 out of 4 patients as reported in the literature. One patient survived chemotherapy followed by autologous transplant. The prototypical clinical presentation and variations of PBL can help create a more comprehensive differential diagnosis for GI tumors and establish an appropriate therapeutic guideline.

GNAQ mutation in a patient with metastatic mucosal melanoma

PubMed Central

2014-01-01

Background Mucosal melanomas represent about 1% of all melanoma cases and classically have a worse prognosis than cutaneous melanomas. Due to the rarity of mucosal melanomas, only limited clinical studies with metastatic mucosal melanoma are available. Mucosal melanomas most commonly contain mutations in the gene CKIT, and treatments have been investigated using targeted therapy for this gene. Mutations in mucosal melanoma are less common than in cutaneous or uveal melanomas and occur in descending order of frequency as: CKIT (20%), NRAS (5%) or BRAF (3%). Mutations in G-alpha proteins, which are associated with activation of the mitogen-activated protein kinase pathway, have not been reported in mucosal melanomas. These G-alpha protein mutations occur in the genes GNAQ and GNA11 and are seen at a high frequency in uveal melanomas, those melanomas that begin in the eye. Case presentation A 59-year old Caucasian male was diagnosed with a mucosal melanoma after evaluation for what was thought to be a hemorrhoid. Molecular analysis of the tumor revealed a GNAQ mutation. Ophthalmologic exam did not disclose a uveal melanoma. Conclusion Here we report, to our knowledge, the first known case of GNAQ mutation in a patient with metastatic mucosal melanoma. PMID:25030020

Total colonoscopy detects early colorectal cancer more frequently than advanced colorectal cancer in patients with fecal occult blood.

PubMed

Ozaki, Takuji; Tokunaga, Akira; Chihara, Naoto; Yoshino, Masanori; Bou, Hideki; Ogata, Masao; Watanabe, Masanori; Suzuki, Hideyuki; Uchida, Eiji

2010-08-01

The efficacy of total colonoscopy following a positive result of the fecal occult blood test (FOBT) for the early detection of colorectal cancer and polyps was evaluated. A total of 1,491 patients with positive FOBT results underwent total colonoscopy at the Institute of Gastroenterology, Nippon Medical School, Musashi Kosugi Hospital, from April 2002 through July 2009. Abnormalities were found in 1,312 of the 1,491 patients (88.0%). Ninety-six of the 1,491 patients (6.4%) were found to have early cancer, but 59 patients (4.0%) were found to have advanced cancer. The early cancers were treated with endoscopic mucosal resection or endoscopic submucosal dissection in 81 patients, with laparoscopy-assisted colectomy in 10 patients, and with open surgery in 5 patients. Fifty-one of the 59 patients with advanced colorectal cancer underwent conventional open surgery, and 8 patients underwent laparoscopic surgery. The cancers detected were more likely to be early cancers than advanced cancers. In addition to malignancies, other abnormalities found included inner or external hemorrhoids, diverticula of the colon, ulcerative colitis, ischemic colitis, infectious colitis, and colorectal polyps. Our results show that a high percentage of lesions detected with total colonoscopy following a positive FOBT result are early colorectal cancers and polyps.

Ano-rectal complaints in general practitioner visits: consumer point of view.

PubMed

Pigot, François; Siproudhis, Laurent; Bigard, Marc-André; Staumont, Ghislain

2006-12-01

The perception patients consulting for primary care have of anorectal disorders has never been evaluated. Our aim was to analyze proctological complaints among outpatients consulting general practitioners. Among 1484 physicians who responded to a nationwide mailing in France, 161 enrolled 437 females and 358 males consulting between October 2004 and December 2005. Females were younger than males (46 +/- 15 vs 51 +/- 13 years) (p<0.0001). Intermediate and upper social-occupational categories were overrepresented as compared with the general population. Symptoms were pain (48%), bleeding (37%), swelling (26%) and pruritus (24%). For 76%, these symptoms persisted for less than one month and 58% mentioned earlier visits or prior treatment. The first manifestation was correlated with a pregnancy in 31% of women. Present symptoms were secondary to acute constipation (52%), stress (33%), ingestion of spices (29%) or alcohol (20%), and diarrhea (8%). Symptoms were considered important in 61% or a cause of anxiety in 33% of patients. Treatment was prescribed for all patients: ointments (90%), phlebotonics (66%) or suppositories (51%), in combination for 75% of prescriptions. Patients preferred oral medicines (41%), ointments (30%) and suppositories (7%). Proctological complaints are a reason for repeated visits to the general practitioner and lead to repeated prescriptions. Patients appreciate anti-hemorrhoidal treatments variably.

[Analysis in pulmonary ventilatory function from 100 patients with ano-rectal diseases caused by deficiency of qi].

PubMed

Wang, W

1999-03-01

To explore the pathogenesis of ano-rectal diseases caused by deficiency of Qi, which is correlated with obstruction of pulmonary ventilation. The pulmonary ventilatory function was measured in 100 patients with the internal piles, the interno-external hemorrhoid and prolapse of rectum, the prolapse of anus was the principal symptom of them. Data from the 100 patients showed that 67% of them were diagnosed with the obstruction of pulmonary ventilation, the ratio was far less in the health control group. FEV 1.0 (mean +/- s) (2011.65 +/- 875) ml, MMF (1.84 +/- 1.24) L/s and PEF (2.34 +/- 1.51) L/s in male patients, (1551.54 +/- 514) ml, (1.57 +/- 0.62) L/s and (1.85 +/- 0.92) L/s in female patients, but those values were higher in the control than in the patients. The statistical analysis was performed and the difference was significant between patients and the control group (P < 0.01). The patients with ano-rectal diseases caused by deficiency of Qi accompanied with obstruction of pulmonary ventilation in different degree and varied sorts, it confirmed that the pathogenesis of ano-rectal diseases caused by deficiency of Qi is related with "sinking of pectoral Qi".

A Standardized Composition Comprised of Extracts from Rosmarinus officinalis, Annona squamosa and Zanthoxylum clava-herculis for Cellulite

PubMed Central

Yimam, Mesfin; Lee, Young-Chul; Jiao, Ping; Hong, Mei; Brownell, Lidia; Jia, Qi

2017-01-01

Background: Cellulite, characterized by changes in the skin morphology presented as dimpled or puckered skin appearance, is highly prevalent among postadolescent women. Cellulite management ranges from topical cream applications to invasive procedures. While some interventions showed improvements in physical appearances of affected areas, so far, none have reversed the condition to a full recovery. These unsuccessful measures signify the intricate nature of cellulite etiology highlighting its complexity leading to the possibility for a combination treatment approach to target multiple mechanisms. Materials and Methods: We screened our plant library for extracts that reduce cellular lipid accumulation, improve microcirculation, possess high total antioxidant capacity, significant anti-platelet aggregation, and anti-inflammatory activities using lipid accumulation assay in 3T3-L1 cells, Croton oil-induced hemorrhoid test in rats as a model for microcirculation, anti-platelet aggregation assay, nitric oxide (NO) inhibition assay, and 1,1-diphenyl-2-picrylhydrazyl assay. Results: Three known botanicals such as Rosemary officinalis, Annona squamosa and Zanthoxylum clava-herculis were identified as lead extracts in these tests. Treatment of 3T3 cell with A. squamosa at 1 μg/ml resulted in 68.8% reduction in lipid accumulation. In croton oil-induced hemorrhoid study, Z. clava-herculis reduced the recto-anus coefficient by 79.6% at 6 mg/kg indicating improvement in microcirculations. Similarly, R. officinalis caused inhibition of 82%, 71.8%, and 91.8% in platelet aggregation, NO production and free radical generation at 31.25 μg/ml, 6.2 μg/ml, and 40 μg/ml concentrations suggesting its anti-oxidant, and anti-inflammatory activities. Conclusions: Data depicted here suggest that formulation of these well-known botanicals at a specific ratio perhaps may yield a composition with a much wider spectrum of mechanisms of actions to impact the multiple pathways involved in

CT Colonography with Computer-aided Detection: Recognizing the Causes of False-Positive Reader Results

PubMed Central

Dachman, Abraham H.; Wroblewski, Kristen; Vannier, Michael W.; Horne, John M.

2014-01-01

Computed tomography (CT) colonography is a screening modality used to detect colonic polyps before they progress to colorectal cancer. Computer-aided detection (CAD) is designed to decrease errors of detection by finding and displaying polyp candidates for evaluation by the reader. CT colonography CAD false-positive results are common and have numerous causes. The relative frequency of CAD false-positive results and their effect on reader performance on the basis of a 19-reader, 100-case trial shows that the vast majority of CAD false-positive results were dismissed by readers. Many CAD false-positive results are easily disregarded, including those that result from coarse mucosa, reconstruction, peristalsis, motion, streak artifacts, diverticulum, rectal tubes, and lipomas. CAD false-positive results caused by haustral folds, extracolonic candidates, diminutive lesions (<6 mm), anal papillae, internal hemorrhoids, varices, extrinsic compression, and flexural pseudotumors are almost always recognized and disregarded. The ileocecal valve and tagged stool are common sources of CAD false-positive results associated with reader false-positive results. Nondismissable CAD soft-tissue polyp candidates larger than 6 mm are another common cause of reader false-positive results that may lead to further evaluation with follow-up CT colonography or optical colonoscopy. Strategies for correctly evaluating CAD polyp candidates are important to avoid pitfalls from common sources of CAD false-positive results. ©RSNA, 2014 PMID:25384290

PPH versus THD: a comparison of two techniques for III and IV degree haemorrhoids. Personal experience.

PubMed

Verre, L; Rossi, R; Gaggelli, I; Di Bella, C; Tirone, A; Piccolomini, A

2013-12-01

The aim of our study was to evaluate, through prospective randomized study, the outcome and the immediate and late complications of the two types of surgery most widely used for degree III-IV haemorrhoids. A total of 122 patients with degree III and IV hemorrhoids were elected for surgical intervention and, randomly, underwent surgery for PPH or THD. We assessed the most common immediate postoperative complications. The patients have been followed for three months with a mean follow-up at 1 month and 3 months after surgery. Parameters taken into consideration were: bleeding, pain at rest and after evacuation, soiling, constipation and tenesmus. Five patients in PPH group (7.9%) had a major postoperative bleeding, whereas no such episode occurred in THD group (P=ns). In percentage terms, VAS score was lower in THD group than in PPH group, although the difference was not statistically significant. Finally parameters values observed, during the follow-up, proved to be lower for THD group compared to PPH group. PPH and THD are two surgical treatments for degree III and IV haemorrhoids with low perioperative complications and good results in the short term. However, our experience shows that better results in terms of pain and fewer postoperative complications are obtained after THD surgery, such surgery is less invasive and more adaptable to the needs of day surgery.

A comparative clinical study of Snuhi Ksheera Sutra, Tilanala Kshara Sutra and Apamarga Kshara Sutra in Bhagandara (Fistula in Ano).

PubMed

Lobo, Supreeth Joyal; Bhuyan, C; Gupta, S K; Dudhamal, T S

2012-01-01

Bhagandara (Fistula in Ano) at modern parlance is a common anorectal condition prevalent in the populations worldwide and its prevalence is second highest after Arsha (hemorrhoids). Kshara Sutra (K.S.) is one of the chief modality in the treatment of Bhagandara in Ayurvedic science. Exploration of the new plants for the preparation of Kshara as a better substitute to Apamarga Kshara is the need of the hour. To find out an effective alternative to Apamarga K.S. in view of easy processing, a Snuhi Ksheera Sutra without any Kshara and the Tilanala K.S. were opted for their clinical evaluation. Total 33 cases of Bhagandara were divided randomly into 3 groups, having 11 patients in each group. In Group A, Snuhi Ksheera Sutra; in Group B, Tilanala K.S. and in Group C, Apamarga K.S. were used. Assessment was done on objective (Unit Cutting Time - UCT) and subjective parameters. Statistically insignificant difference was observed in the efficacy of treatment by subjective parameters like pain, discharge, etc. between the three groups. It was found that Tilanala K.S. showed higher UCT (9.76 days) while lower in Snuhi Ksheera Sutra (7.42 days) as compared to Apamarga K.S. (8.82 days). Thus Tilanala K.S. can be used as a substitute for Apamarga K.S. and Snuhi Ksheera Sutra can be employed in the recurrent fibrosed cases of Bhagandara.

Cissus quadrangularis ethanol extract upregulates superoxide dismutase, glutathione peroxidase and endothelial nitric oxide synthase expression in hydrogen peroxide-injured human ECV304 cells.

PubMed

Sapsrithong, Tarat; Kaewprem, Weeraya; Tongumpai, Sarunya; Nusuetrong, Punnee; Meksuriyen, Duangdeun

2012-09-28

Cissus quadrangularis has been widely used in traditional medicine for the treatment of hemorrhoid. However, the detailed mechanism of antioxidant defense of C. quadrangularis in endothelial cells under oxidative stress remains unclear. The present study aims to elucidate the protective role of ethanol extract of C. quadrangularis (CQE) including its constituents, quercetin and resveratrol, on hydrogen peroxide (H(2)O(2))-injured human umbilical vein endothelial ECV304 cells. Viability, genotoxicity and protein expression of ECV304 cells were analyzed by MTT, alkaline comet and Western blot, respectively. Production of intracellular reactive oxygen species (ROS) was determined using dichlorofluorescein fluorescence dye. After exposing cells to CQE containing quercetin and resveratrol, DNA damage was not observed. CQE including quercetin and resveratrol significantly attenuated ROS in H(2)O(2)-injured ECV304 cells in a concentration-dependent manner. The protein expression of superoxide dismutase (Cu/Zn-SOD, Mn-SOD), glutathione peroxidase (GPx) and endothelial nitric oxide synthase (eNOS) increased in the cells treated with CQE, quercetin or resveratrol prior to H(2)O(2) exposure, as compared with control. The results provide a molecular mechanism of C. quadrangularis, which could be partially related to quercetin and resveratrol, in restoring ROS in endothelial cells through the upregulation of Cu/Zn-SOD, Mn-SOD, GPx and eNOS. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Flavonoids to reduce bleeding and pain after stapled hemorrhoidopexy: a randomized controlled trial.

PubMed

Mlakar, Bostjan; Kosorok, Pavle

2005-08-01

Control of postoperative symptoms is of paramount importance in ambulatory surgery. This trial was conducted to evaluate whether a micronized purified flavonoid fraction (MPFF) (Detralex((R))) reduces postoperative bleeding, pain and consumption of analgesics after ambulatory stapled hemorrhoidopexy, as reported in trials after classic hemorrhoidectomy. Phlebotropic activity, protective effect on the capillaries and anti-inflammatory properties of this drug have been reported in several studies. Sixty-three patients with third-degree hemorrhoids had ambulatory stapled hemorrhoidopexy under spinal anesthesia in the period of one year. The patients were randomized, with 30 receiving Detralex 500 mg (2 tablets 3 times daily for 5 days after the operation) and 33 forming the control group. The patients were asked to daily self-assess the presence of blood on defecation, degree of pain and consumption of analgesics for the first week after the operation. There was no significant difference between the two groups in duration of presence of blood, degree of pain or analgesics requirement. No major complications, such as bleeding requiring transfusion or hospitalization, sepsis, anal stenosis or urgent defecation, were noted in the follow-up period. There were no side effects from Detralex treatment. In our study we could not demonstrate any positive effect of prescribing flavonoids after stapler hemorrhoidopexy. This procedure may not be sufficiently aggressive and is associated with too few postoperative complications to show any protective influence of flavonoids.

Anemia Due to Inflammation in an Anti-Coagulated Patient with Blue Rubber Bleb Nevus Syndrome.

PubMed

Bonaventura, Aldo; Liberale, Luca; Hussein El-Dib, Nadia; Montecucco, Fabrizio; Dallegri, Franco

2016-01-01

Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterized by vascular malformations mostly involving skin and gastrointestinal tract. This disease is often associated with sideropenic anemia and occult bleeding. We report the case of chronic severe anemia in an old patient under oral anticoagulation treatment for chronic atrial fibrillation. At admission, the patient also presented fever and increased laboratory parameters of systemic inflammation (ferritin 308 mcg/L, C-reactive protein (CRP) 244 mg/L). A small bluish-colored lesion over the left ear lobe was observed. Fecal occult blood test was negative as well as other signs of active bleeding. Lower gastrointestinal endoscopy revealed internal hemorrhoids and multiple teleangiectasias that were treated with argon plasma coagulation. Videocapsule endoscopy demonstrated multiple bluish nodular lesions in the small intestine. Unexpectedly, chronic severe anemia due to systemic inflammation was diagnosed in an old anticoagulated patient with BRNBS. The patient was treated with blood transfusions, hydration, antibiotic treatment, and long-acting octreotide acetate, without stopping warfarin. Fever and inflammation disappeared without any acute gastrointestinal bleeding and improvement of hemoglobin levels at three-month follow up. This is the oldest patient presenting with chronic anemia, in which BRNBS was also diagnosed. Surprisingly, anemia was mainly caused by systemic inflammation instead of chronic gastrointestinal bleeding. However, we would recommend investigating this disease also in old subjects with mild signs and symptoms.

Dosimetric planning study for the prevention of anal complications after post-operative whole pelvic radiotherapy in cervical cancer patients with hemorrhoids

PubMed Central

Baek, J G; Kim, E C; Kim, S K

2015-01-01

Objective: Radiation-induced anal toxicity can be induced by low radiation doses in patients with haemorrhoids. The object of this study was to determine the dosimetric benefits of different whole pelvic radiotherapy (WPRT) techniques in terms of dose delivered to the anal canal in post-operative patients with cervical cancer. Methods: The planning CT images of 10 patients with cervical cancer undergoing postoperative radiotherapy were used for comparison of three different plans. All patients had been treated using the conventional box technique WPRT (CV-WPRT), and we tried low-margin-modified WPRT (LM-WPRT), three-dimensional conformal techniques WPRT (CF-WPRT) and intensity-modulated WPRT (IM-WPRT) planning for dosimetric comparison of the anal canal, retrospectively. Results: Mean anal canal doses of the IM-WPRT were significantly lower (p < 0.05) than those of CV-WPRT, LM-WPRT and CF-WPRT, and V10, V20, V30 and V40 to the anal canal were also significantly lower for IM-WPRT (p < 0.05). The proportion of planning target volumes (PTVs) that received ≥98% of the prescribed dose for all plans was >99%, and the proportion that received ≥108% of the prescribed dose for IM-WPRT was <2%. Volumes of bladders and rectums that received ≥30 or ≥40 Gy were significantly lower for IM-WPRT than for three of the four-field WPRT plans (p = 0.000). Conclusion: IM-WPRT can significantly reduce radiation dose delivered to the anal canal and does not compromise PTV coverage. In patients with haemorrhoids, IM-WPRT may be of value for the prevention of anal complications. Advances in knowledge: Although tolerance of the anal canal tends to be ignored in patients undergoing post-operative WPRT, patients with haemorrhoids may suffer complications at low radiation doses. The present study shows IM-WPRT can be meaningful in these patients. PMID:26395671

Dosimetric planning study for the prevention of anal complications after post-operative whole pelvic radiotherapy in cervical cancer patients with hemorrhoids.

PubMed

Baek, J G; Kim, E C; Kim, S K; Jang, H

2015-01-01

Radiation-induced anal toxicity can be induced by low radiation doses in patients with haemorrhoids. The object of this study was to determine the dosimetric benefits of different whole pelvic radiotherapy (WPRT) techniques in terms of dose delivered to the anal canal in post-operative patients with cervical cancer. The planning CT images of 10 patients with cervical cancer undergoing postoperative radiotherapy were used for comparison of three different plans. All patients had been treated using the conventional box technique WPRT (CV-WPRT), and we tried low-margin-modified WPRT (LM-WPRT), three-dimensional conformal techniques WPRT (CF-WPRT) and intensity-modulated WPRT (IM-WPRT) planning for dosimetric comparison of the anal canal, retrospectively. Mean anal canal doses of the IM-WPRT were significantly lower (p < 0.05) than those of CV-WPRT, LM-WPRT and CF-WPRT, and V10, V20, V30 and V40 to the anal canal were also significantly lower for IM-WPRT (p < 0.05). The proportion of planning target volumes (PTVs) that received ≥98% of the prescribed dose for all plans was >99%, and the proportion that received ≥108% of the prescribed dose for IM-WPRT was <2%. Volumes of bladders and rectums that received ≥30 or ≥40 Gy were significantly lower for IM-WPRT than for three of the four-field WPRT plans (p = 0.000). IM-WPRT can significantly reduce radiation dose delivered to the anal canal and does not compromise PTV coverage. In patients with haemorrhoids, IM-WPRT may be of value for the prevention of anal complications. Although tolerance of the anal canal tends to be ignored in patients undergoing post-operative WPRT, patients with haemorrhoids may suffer complications at low radiation doses. The present study shows IM-WPRT can be meaningful in these patients.

A comparative clinical study of Snuhi Ksheera Sutra, Tilanala Kshara Sutra and Apamarga Kshara Sutra in Bhagandara (Fistula in Ano)

PubMed Central

Lobo, Supreeth Joyal; Bhuyan, C.; Gupta, S. K.; Dudhamal, T. S.

2012-01-01

Bhagandara (Fistula in Ano) at modern parlance is a common anorectal condition prevalent in the populations worldwide and its prevalence is second highest after Arsha (hemorrhoids). Kshara Sutra (K.S.) is one of the chief modality in the treatment of Bhagandara in Ayurvedic science. Exploration of the new plants for the preparation of Kshara as a better substitute to Apamarga Kshara is the need of the hour. To find out an effective alternative to Apamarga K.S. in view of easy processing, a Snuhi Ksheera Sutra without any Kshara and the Tilanala K.S. were opted for their clinical evaluation. Total 33 cases of Bhagandara were divided randomly into 3 groups, having 11 patients in each group. In Group A, Snuhi Ksheera Sutra; in Group B, Tilanala K.S. and in Group C, Apamarga K.S. were used. Assessment was done on objective (Unit Cutting Time - UCT) and subjective parameters. Statistically insignificant difference was observed in the efficacy of treatment by subjective parameters like pain, discharge, etc. between the three groups. It was found that Tilanala K.S. showed higher UCT (9.76 days) while lower in Snuhi Ksheera Sutra (7.42 days) as compared to Apamarga K.S. (8.82 days). Thus Tilanala K.S. can be used as a substitute for Apamarga K.S. and Snuhi Ksheera Sutra can be employed in the recurrent fibrosed cases of Bhagandara. PMID:23049190

An efficient Bayesian meta-analysis approach for studying cross-phenotype genetic associations

PubMed Central

Majumdar, Arunabha; Haldar, Tanushree; Bhattacharya, Sourabh; Witte, John S.

2018-01-01

Simultaneous analysis of genetic associations with multiple phenotypes may reveal shared genetic susceptibility across traits (pleiotropy). For a locus exhibiting overall pleiotropy, it is important to identify which specific traits underlie this association. We propose a Bayesian meta-analysis approach (termed CPBayes) that uses summary-level data across multiple phenotypes to simultaneously measure the evidence of aggregate-level pleiotropic association and estimate an optimal subset of traits associated with the risk locus. This method uses a unified Bayesian statistical framework based on a spike and slab prior. CPBayes performs a fully Bayesian analysis by employing the Markov Chain Monte Carlo (MCMC) technique Gibbs sampling. It takes into account heterogeneity in the size and direction of the genetic effects across traits. It can be applied to both cohort data and separate studies of multiple traits having overlapping or non-overlapping subjects. Simulations show that CPBayes can produce higher accuracy in the selection of associated traits underlying a pleiotropic signal than the subset-based meta-analysis ASSET. We used CPBayes to undertake a genome-wide pleiotropic association study of 22 traits in the large Kaiser GERA cohort and detected six independent pleiotropic loci associated with at least two phenotypes. This includes a locus at chromosomal region 1q24.2 which exhibits an association simultaneously with the risk of five different diseases: Dermatophytosis, Hemorrhoids, Iron Deficiency, Osteoporosis and Peripheral Vascular Disease. We provide an R-package ‘CPBayes’ implementing the proposed method. PMID:29432419

[Expression of collagen and elastin fibers in the rectum of patients with obstructed defecation syndrome and its significance].

PubMed

Li, Juan; Lin, Hongcheng; Ren, Donglin

2015-12-01

To detect the expression of collagen and elastin fibers in the rectum of patients with obstructive defecation syndrome (ODS), and to explore the possible role of these fibers in the pathogenesis of ODS. The rectum specimens of 20 patients with ODS were collected. These patients had undergone stapled transanal rectal resection (STARR) surgery in our hospital since 2012. Full-thickness rectal specimens were stained with Masson and EVG staining to show collagen and elastin fibers. As the control, rectum specimens of 20 patients with severe prolapsed hemorrhoids also undergoing STARR surgery in our hospital during the same period were collected. Masson staining showed that the structure of collagen fibers in submucosa was slender, area decreased [(13.88±7.02)% vs. (30.98±3.46)%, P<0.01], and the expression level was significantly lower in ODS group compared with control group. EVG staining also showed that collagen fiber area of ODS patients was reduced compared with control group [(17.18±7.24)% vs. (27.04±9.65)%, P<0.01]. Meanwhile EVG staining revealed that elastic fibers were fragmented in ODS group and the expression level was lower compared with control group [(1.20±1.39)% vs. (1.47±1.06)%], whereas the difference was not statistically significant(P>0.05). The expression level of collagen fibers in patients with ODS is significantly reduced, which may play an important role in the pathogenesis of ODS.

Healing with animals in the Levant from the 10th to the 18th century

PubMed Central

Lev, Efraim

2006-01-01

Animals and products derived from different organs of their bodies have constituted part of the inventory of medicinal substances used in various cultures since ancient times. The article reviews the history of healing with animals in the Levant (The Land of Israel and parts of present-day Syria, Lebanon, and Jordan, defined by the Muslims in the Middle Ages as Bilad al-Sham) in the medieval and early Ottoman periods. Intensive research into the phenomenon of zootherapy in the medieval and early Ottoman Levant has yielded forty-eight substances of animal origin that were used medicinally. The vast majority of these substances were local and relatively easy to obtain. Most of the substances were domestic (honey, wax, silkworm, etc.), others were part of the local wildlife (adder, cuttle fish, flycatcher, firefly, frog, triton, scorpion, etc.), part of the usual medieval household (milk, egg, cheese, lamb, etc.), or parasites (louse, mouse, stinkbug, etc.). Fewer substances were not local but exotic, and therefore rare and expensive (beaver testicles, musk oil, coral, ambergris, etc.). The range of symptoms that the substances of animal origin were used to treat was extensive and included most of the known diseases and maladies of that era: mainly hemorrhoids, burns, impotence, wounds, and skin, eye, and stomach diseases. Changes in the moral outlook of modern societies caused the use of several substances of animal origin to cease in the course of history. These include mummy, silkworm, stinkbug, scarabees, snail, scorpion, and triton. PMID:16504024

Healing with animals in the Levant from the 10th to the 18th century.

PubMed

Lev, Efraim

2006-02-21

Animals and products derived from different organs of their bodies have constituted part of the inventory of medicinal substances used in various cultures since ancient times. The article reviews the history of healing with animals in the Levant (The Land of Israel and parts of present-day Syria, Lebanon, and Jordan, defined by the Muslims in the Middle Ages as Bilad al-Sham) in the medieval and early Ottoman periods. Intensive research into the phenomenon of zootherapy in the medieval and early Ottoman Levant has yielded forty-eight substances of animal origin that were used medicinally. The vast majority of these substances were local and relatively easy to obtain. Most of the substances were domestic (honey, wax, silkworm, etc.), others were part of the local wildlife (adder, cuttle fish, flycatcher, firefly, frog, triton, scorpion, etc.), part of the usual medieval household (milk, egg, cheese, lamb, etc.), or parasites (louse, mouse, stinkbug, etc.). Fewer substances were not local but exotic, and therefore rare and expensive (beaver testicles, musk oil, coral, ambergris, etc.). The range of symptoms that the substances of animal origin were used to treat was extensive and included most of the known diseases and maladies of that era: mainly hemorrhoids, burns, impotence, wounds, and skin, eye, and stomach diseases. Changes in the moral outlook of modern societies caused the use of several substances of animal origin to cease in the course of history. These include mummy, silkworm, stinkbug, scarabees, snail, scorpion, and triton.

Src/Syk-Targeted Anti-Inflammatory Actions of Triterpenoidal Saponins from Gac (Momordica cochinchinensis) Seeds.

PubMed

Yu, Jae Sik; Kim, Jun Ho; Lee, Seulah; Jung, Kiwon; Kim, Ki Hyun; Cho, Jae Youl

2017-01-01

Momordica cochinchinensis Spreng (family Cucurbitaceae), also known as gac, or red melon, is an edible Southeast Asian fruit valued for its nutritional and medicinal properties. Specifically, Momordicae Semen, the seeds of the gac fruit, is used in traditional Chinese medicine to treat boils, rheumatic pain, muscle spasm, hemorrhoids, and hemangiomas. In this study, a chemical investigation into a gac seed ethanol (EtOH) extract resulted in the identification of three triterpenoidal saponins (1-3), which were investigated for their anti-inflammatory effects. Among the saponins, momordica saponin I (compound 3) reduced the production of nitric oxide (NO) in LPS-activated RAW264.7 cells without inducing cytotoxicity. The mRNA levels of inducible NO synthase (iNOS) and cyclooxygenase (COX)-2 were decreased by momordica saponin I. Additionally, the translocation of p65 and p50 (subunits of the transcription factor NF-[Formula: see text]B) into the nucleus was remarkably inhibited. Furthermore, the phosphorylation levels of inflammatory signaling proteins (I[Formula: see text]B[Formula: see text], Src, and Syk) known to be upstream regulatory molecules of p65 were decreased under momordica saponin I-treated conditions. The molecular targets of momordica saponin I were confirmed in overexpression experiments and through immunoblot analyses with Src and Syk. This study provides evidence that momordica saponin I could be beneficial in treating inflammatory diseases, and should be considered a bioactive immunomodulatory agent with anti-inflammatory properties.

Proctoscopy should be mandatory in men that have sex with men with external anogenital warts.

PubMed

Mlakar, Bostjan

2009-03-01

The aim of this study was to evaluate anal pathology in men having sex with men (MSM) seen at our proctology outpatient clinics. The charts of 74 MSM treated by the author between January 2002 and April 2006 were reviewed. Three of 74 patients (4%) had proctitis and 96% had anogenital condylomata acuminata (warts). 49 out of 71 (69%) had external anogenital as well as intra-anal warts and 13 (18%) had only intra-anal warts. In 14 an intra-anal dysplasia and in 2 patients intra-anal verrucous carcinomas were detected. The average duration of disease before referral to our institutions was more than 9 months. Half of the patients were previously treated for anogenital warts with ointments and suppositories at other institutions, including 17 that were "treated" with ointments and/or suppositories for hemorrhoids prescribed by family physicians. The patients mostly had widespread disease and sixty-nine of them required surgery. In the follow-up period there was no recurrence of warts and only itching was observed in 31 (44%) patients. Therapy with imiquimod was introduced for 3 months in twenty-two cases with intra-anal dysplasia. No major side effects were noticed despite intra-anal use. Proctoscopy and histological examination of intra-anal lesions in cases of external anogenital warts should be mandatory in MSM patients. I would like to encourage other physicians to use this approach, which enables detection of intra-anal warts, dysplasia, and even carcinoma in the asymptomatic stage.

Different characteristics of circular staplers make the difference in anastomotic tensile strength.

PubMed

Giaccaglia, V; Antonelli, M S; Franceschilli, L; Salvi, P F; Gaspari, A L; Sileri, P

2016-01-01

Anastomotic leak after gastrointestinal surgery is a severe complication associated with relevant short and long-term sequelae. Most of the anastomoses are currently performed with a surgical stapler that is required to have appropriate characteristics in order to guarantee good performances. The aim of our study was to evaluate, ex vivo, pressure resistance and tensile strength of anastomosis performed with different circular staplers available in the market. We studied 7 circular staplers of 3 different companies, 3 of them used for gastrointestinal anastomosis and 4 staplers for hemorrhoidal prolapse excision. A total of 350 anastomoses, 50 for each of the 7 staplers, were performed using healthy pig fresh intestine, then injected saline solution and recorded the leaking pressure. There were no statistically significant differences between the mean pressure necessary to induce an anastomotic leak in the various instruments (p>0.05). For studying tensile strength, we performed a total of 350 anastomoses with 7 different circular staplers on a special strong paper (Tyvek), and then recorded the maximal tensile force that could open the anastomosis. There were statistically significant differences between one brand stapler vs other 2 companies staplers about the strength necessary to open the staple line (p<0.05). In conclusion, we demonstrated that different circular staplers of three companies available in the market give comparable anastomotic pressure resistance but different tensile strengths. This is probably due to different technical characteristics. Copyright © 2015 Elsevier Ltd. All rights reserved.

Should anorectal ultrasonography be included as a diagnostic tool for chronic anal pain?

PubMed

García-Montes, M J; Argüelles-Arias, Federico; Jiménez-Contreras, S; Sánchez-Gey, S; Pellicer-Bautista, F; Herrerías-Gutiérrez, J M

2010-01-01

To assess the efficiency of endorectal ultrasound (ERUS) in the study of chronic idiopathic anal pain (CIAP). This is a prospective and descriptive study in which 40 patients, 18 men and 22 women with an average of 47 years, were included. They had chronic anal pain of at least 3 months duration. A complete colonoscopy was performed in all patients, which found no abnormalities to explain clinical symptoms. Patients with anal fissure and internal hemorrhoids of any degree, perianal suppurative processes, and pelvic surgery were excluded from the study. An ALOKA ProSound SSD-4000 ultrasound console attached to a multifrequency radial transductor ASU-67 (7.5 and 10 MHz) was used. One patient could not tolerate the examination. In 8 patients (20% of cases) alterations were detected during ultrasonography: in 4 patients (10% of the cases; 1 man and 3 women) internal anal sphincter (IAS) hypertrophy, and in 5 patients (4 women and 1 man) a torn sphincter complex. A tear in the upper IAS canal and hypertrophy of the middle anal canal were observed in one patient (1 woman). ERUS is a simple, economic and useful test to study anorectal pathologies. Although in most studied cases no damage to the anal canal or rectal wall was detected, in a considerable number of patients we observed a thickening of the IAS, a probable cause of anal pain. Therefore, we understand that ERUS should be included in the study of CIAP.

Identifying 2 prenylflavanones as potential hepatotoxic compounds in the ethanol extract of Sophora flavescens.

PubMed

Yu, Qianqian; Cheng, Nengneng; Ni, Xiaojun

2013-11-01

Zhixue capsule is a prescription for hemorrhoid commonly used in traditional Chinese medicine. This drug was recalled by the State Food and Drug Administration in 2008 because of severe adverse hepatic reactions. Zhixue capsule is composed of ethanol extracts of Cortex Dictamni (ECD) and Sophora flavescens (ESF). In our preliminary study, we observed the hepatotoxic effects of ESF on rat primary hepatocytes. However, ECD did not exhibit hepatotoxicity at the same concentration range. In this study, ESF was evaluated for its potential hepatotoxic effects on rats. Bioassay-guided isolation was used to identify the material basis for hepatotoxicity. Treatment with 1.25 g/kg and 2.5 g/kg ESF significantly elevated the alanine aminotransferase and aspartate aminotransferase levels in the serum. The changes in the levels of transaminases were supported by the remarkable fatty degeneration of liver histopathology. Further investigations using bioassay-guided isolation and analysis indicated that prenylated flavanones accounted for the positive hepatotoxic results. Two isolated compounds were identified, kurarinone and sophoraflavanone G, using nuclear magnetic resonance and mass spectrometry techniques. These compounds have potent toxic effects on primary rat hepatocytes (with IC50 values of 29.9 μM and 16.5 μM) and human HL-7702 liver cells (with IC50 values of 48.2 μM and 40.3 μM), respectively. Consequently, the hepatotoxic constituents of S. flavescens were determined to be prenylated flavanones, kurarinone, and sophoraflavanone G. © 2013 Institute of Food Technologists®

Integrative review of research on general health status and prevalence of common physical health conditions of women after childbirth.

PubMed

Cheng, Ching-Yu; Li, Qing

2008-01-01

Postpartum mothers experience certain physical health conditions that may affect their quality of life, future health, and health of their children. Yet, the physical health of postpartum mothers is relatively neglected in both research and practice. The purpose of this review is to describe the general health status and prevalence of common physical health conditions of postpartum mothers. The review followed standard procedures for integrative literature reviews. Twenty-two articles were reviewed from searches in scientific databases, reference lists, and an up-to-date survey. Three tables were designed to answer review questions. In general, postpartum mothers self-rate their health as good. They experience certain physical conditions such as fatigue/physical exhaustion, sleep-related problems, pain, sex-related concerns, hemorrhoids/constipation, and breast problems. Despite a limited number of studies, the findings provide a glimpse of the presence of a number of physical health conditions experienced by women in the 2 years postpartum. In the articles reviewed, physical health conditions and postpartum period were poorly defined, no standard scales existed, and the administration of surveys varied widely in time. Those disparities prevented systematic comparisons of results and made it difficult to gain a coherent understanding of the physical health conditions of postpartum mothers. More longitudinal research is needed that focuses on the etiology, predictors, and management of the health conditions most prevalent among postpartum mothers. Instruments are needed that target a broader range of physical conditions in respect to type and severity.

A young man with myelosuppression caused by clindamycin: a case report.

PubMed

Morales, Manuel Polanco; Carvallo, Anna Paola Thome; Espinosa, Karla Adriana Bautista; Murillo, Edgar Enrique Meza

2014-01-05

Clindamycin is used to treat various bacterial infections, but its administration can cause anaphylaxis, liver reactions, pseudomembranous colitis, and peripheral blood cytopenias (anemia, neutropenia, and thrombocytopenia), alone or in combination. We report the case of a patient with a recurrent infection of the tonsils who received clindamycin. Pancytopenia, a previously unreported hematological disorder related to clindamycin use, was observed in conjunction with the infection and clindamycin treatment. One month prior to hospitalization, a 22-year-old man of Hispanic origin had a tonsillar infection and cough and began to have anal pain. These conditions became exacerbated three weeks later, coinciding with a new tonsillar infection, frequent nonproductive cough, and febrile syndrome. He received clindamycin for four days prior to his admission, without improvement. While hospitalized, he was found to have fever, tonsillar abscess, hemorrhoid thrombosis, and anal fissure; the latter was immediately resected under general anesthesia. Before surgery, our patient's blood count showed intense leukoneutropenia and mild thrombocytopenia that increased 12 hours later, along with the establishment of anemia. A bone marrow study showed decreased cell content, micromegakaryocytes, and an interruption of the differentiation of granulocytes and erythroblasts. Post-surgery, our patient received metronidazole, meropenem, and amikacin along with acetaminophen, ketoprofen, omeprazole, and pegfilgrastim, with resulting clinical and hematological improvement. Our experience with this patient establishes that well-documented clinical cases should be the basis for identifying and publicizing unknown or uncommon undesirable effects of drugs. We report that, in some individuals, clindamycin can cause pancytopenia, a complication that in our patient's case was caused by direct injury of his hematopoietic tissue.

[Digestive diseases in the epistolary collection of 16th century].

PubMed

Devesa Jordà, Francesc

2014-01-01

Correspondence is an important source of documentation for studying health and, therefore, the gastrointestinal symptoms of diseases. We studied the gastrointestinal disease described in the Monumenta Borgia collection, which contains documents from the 16th century, mainly letters about Francis Borgia, the last great figure of a family originally from Valencia and with universal significance. Of the 2769 documents examined, 1231 (44.5%) contained some health-related descriptions and 42 items were related to gastrointestinal disease, representing 7.5% of the specific diseases of natural causes. The most frequently mentioned organ in the whole human body was the stomach, with 20 references. The most frequent references were to symptoms related to the upper gastrointestinal tract, with 18 references, and the lower gastrointestinal tract, with 16. The comments made on health related to gastrointestinal disease usually reflect the typical galenism of the medicine of the times. The disorders attributed to the stomach are described in varied terminology and include an acute episode of gastrointestinal bleeding. The most frequently mentioned symptoms and processes are diarrhea, flatulence, hernias, and, among those attributed to the lower gastrointestinal tract, lower gastrointestinal hemorrhages. Also mentioned are hemorrhoids and intestinal colic. Although little mention is made of the liver and spleen, there are various allusions that Francis Borgia was affected by disease or pathogenic alterations in this area. However, the postmortem examination of his corpse, refuted the existence of these anomalies. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

[The relationship between preoperative anxiety levels and vasovagal incidents during the administration of spinal anesthesia].

PubMed

Ekinci, Mürsel; Gölboyu, Birzat Emre; Dülgeroğlu, Onur; Aksun, Murat; Baysal, Pınar Karaca; Çelik, Erkan Cem; Yeksan, Ayşe Nur

It was aimed to investigate the relationship between preoperative anxiety and vasovagal symptoms observed during the administration of spinal anesthesia in patients undergoing surgery in the perianal and inguinal regions. The study included patients with planned surgery for inguinal hernia repair, anal fissure, hemorrhoid and pilonidal sinus excision. The study included a total of 210 patients of ASA I-II, aged 18-65 years. Patients were evaluated in respect of demographic characteristics, smoking and alcohol consumption, ASA grade and educational level. Correlations were evaluated between the number of attempts at spinal anesthesia and anesthesia history with vasovagal symptoms and educational level, gender, smoking and alcohol consumption and anesthesia history with anxiety scores. The instant (transient) state anxiety inventory part of the Transient State/Trait Anxiety Inventory (State Trait Anxiety Inventory - STAI) was used to determine the anxiety levels of the participants. Clinical findings of peripheral vasodilation, hypotension, bradycardia and asystole observed during the administration of spinal anesthesia were recorded. Vasovagal incidences during the administration of spinal anesthesia were seen to increase in cases of high anxiety score, male gender, and an absence of anesthesia history. Educational level and the number of spinal needle punctures were not found to have any effect on vasovagal incidents. The determination of causes triggering vasovagal incidents seen during the application of spinal anesthesia, better patient information of regional anesthesia implementations and anxiety relief with preoperative anxiolytic treatment will help to eliminate potential vasovagal incidents. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

[Working conditions, living conditions and physical health problems declared among penitentiary administration personnel in France].

PubMed

Goldberg, P; Landre, M F; David, S; Goldberg, M; Dassa, S; Marne, M J

1996-06-01

A cross-sectional epidemiological survey was conducted among prison staff in France to investigate the relationships between working conditions and health. The sample included men and women 20 to 64 years old belonging to all categories of prison personnel: prison guards, administrative staff, socioeducational workers, technicians, health care workers, and managers (n = 4587, response rate 45.7%). A mailed self-administered questionnaire was used to assess sociodemographic characteristics, working conditions, and physical and mental disorders. Multiple logistic regression analyses were conducted to determine the effects of working conditions and social relationships on health of prison staff. However, the results reported here only concern 17 health disorders: body mass index, sick leave, medication use, accidents, digestive disorders, lower extremities and back disorders, hypertension, hemorrhoids, arthritis, skin disorders, urinary infections, chronic bronchitis, cholesterol, gastric ulcer, respiratory infections, ocular disorders. The living non professional conditions mostly associated with health disorders were financial difficulties (OR: 1.9 for digestive disorders, 1.8 for gastric ulcer, 1.7 for medication use) and irregularity of meals (OR = 1.5 for digestive disorders, and hypertension). In the occupational environment, the factors most associated with health disorders are seniority (OR = 4.2 for arthritis, 2.3 for cholesterol) and constraints (OR = 1.7 for lower extremities disorders). In spite of some limits associated to this kind of study, relationships between occupational and non occupational factors and physical health conditions were observed; the results also pointed out the protective role of the social relationships for health conditions.

Clinical Holistic Medicine: The Patient with Multiple Diseases

PubMed Central

Ventegodt, Søren; Merrick, Joav

2005-01-01

In clinical practice, patients can present with many different diseases, often both somatic and mental. Holistic medicine will try to see the diseases as a whole, as symptoms of a more fundamental imbalance in the state of being. The holistic physician must help the patient to recover existence and a good relationship with self. According to the life mission theory, theory of character, and holistic process theory of healing, recovering the purpose of life (the life mission) is essential for the patient to regain life, love, and trust in order to find happiness and realize the true purpose of life. We illustrate the power of the holistic medical approach with a case study of an invalidated female artist, aged 42 years, who suffered from multiple severe health problems, many of which had been chronic for years. She had a combination of neurological disturbances (tinnitus, migraine, minor hallucinations), immunological disturbances (recurrent herpes simplex, phlegm in the throat, fungal infection in the crotch), hormonal disturbances (14 days of menstruation in each cycle), muscle disturbances (neck tensions), mental disturbances (tendency to cry, inferiority feeling, mild depression, desolation, anxiety), abdominal complaints, hemorrhoids, and more. The treatment was a combined strategy of improving the general quality of life, recovering her human character and purpose of life (“renewing the patients life energy”, “balancing her global information system”), and processing the local blockages, thus healing most of her many different diseases in a treatment using 30 h of intense holistic therapy over a period of 18 months. PMID:15962199

A comparative study on the antinociceptive and anti-inflammatory activities of five Juniperus taxa.

PubMed

Akkol, Esra Küpeli; Güvenç, Ayşegül; Yesilada, Erdem

2009-09-07

Juniperus L. (Cupressaceae) species have been used to various inflammatory and infectious diseases such as bronchitis, colds, cough, fungal infections, hemorrhoids, gynecological diseases, and wounds in Turkish folk medicine. To evaluate this traditional information, anti-inflammatory and antinociceptive activities of the methanolic and aqueous extracts prepared from different parts (stem, fruit and leaves) of the five Turkish taxa under Juniperus section of the gender; J. drupacea, J. communis var. communis, J. communis var. saxatilis, J. oxycedrus subsp. oxycedrus, and J. oxycedrus subsp. macrocarpa growing were investigated. For the anti-inflammatory activity, carrageenan-induced and PGE(2)-induced hind paw edema models, and for the antinociceptive activity p-benzoquinone-induced writhing and hot plate tests in mice were employed. The methanolic extracts of fruit and leaves from J. oxycedrus subsp. oxycedrus and J. communis var. saxatilis exhibited notable inhibition in carrageenan-induced edema model at a dose of 100mg/kg. The same extracts also displayed significant activity against PGE(2)-induced edema model. While, the remaining extracts were found inactive against these edema models. A similar activity pattern was observed against p-benzoquinone-induced abdominal constriction test without inducing any gastric damage or apparent acute toxicity, whereas all extracts were inactive in hot plate test. The experimental data demonstrated that J. oxycedrus subsp. oxycedrus and J. communis var. saxatilis displayed remarkable anti-inflammatory and antinociceptive activities; however, further studies are warranted to define and isolate the active anti-inflammatory and antinociceptive components from these active species which may yield safe and effective agents to be used in the treatment of inflammatory disorders.

Oral administration of metal chelator ameliorates motor dysfunction after a small hemorrhage near the internal capsule in rat.

PubMed

Masuda, Tadashi; Hida, Hideki; Kanda, Yoshie; Aihara, Noritaka; Ohta, Kengo; Yamada, Kazuo; Nishino, Hitoo

2007-01-01

Cerebral hemorrhage leads to local production of free iron, radicals, cytokines, etc. To investigate whether a decrease of iron-mediated radical production influences functional recovery after intracerebral hemorrhage (ICH), a modified ICH rat model with a small hemorrhage near the internal capsule (IC) accompanied with relatively severe motor dysfunction was first developed. Then clioquinol (CQ), an iron chelator that reduces hydroxyl radical production, was orally administrated. Injection of different doses of Type IV collagenase (1.4 mul 1-200 U/ml) into the left striatum near the IC in Wistar rats showed that injection of 7.5 U/ml collagenase resulted in a small hemorrhoidal lesion near the IC with relatively severe motor dysfunction (IC model). Retrograde labeling of neurons in the sensory-motor cortex and axons in the corticospinal tract using Fluoro-gold (FG) injection into the spinal cord (C3-C4) showed that few labeled neurons in the sensory-motor cortex were detected in the IC model, FG-labeled axons disappeared, and FG-including ED-1-positive cells appeared within 24 hr in the IC. Assessments of behavior and histologic analysis after oral administration of CQ in the IC model indicated that oral administration of CQ prevented a decrease of FG-labeled neurons, and resulted in better motor-function recovery. CQ inhibited hydrogen peroxide-induced cell toxicity in oligodendrocytes in vitro, but not in neurons. Our data suggests that CQ ameliorated motor dysfunction after a small hemorrhage near the IC by a mechanism that is related to reduction of chain-reactive hydroxyl radical production in oligodendrocytes.

Iron deficiency anemia: pregnancy outcomes with or without iron supplementation.

PubMed

Bánhidy, Ferenc; Acs, Nándor; Puhó, Erzsébet H; Czeizel, Andrew E

2011-01-01

To estimate the efficacy of iron supplementation in anemic pregnant women on the basis of occurrence of pregnancy complications and birth outcomes. Comparison of the occurrence of medically recorded pregnancy complications and birth outcomes in pregnant women affected with medically recorded iron deficiency anemia and iron supplementation who had malformed fetuses/newborns (cases) and who delivered healthy babies (controls) in the population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities. Of 22,843 cases with congenital abnormalities, 3242 (14.2%), while of 38,151 controls, 6358 (16.7%) had mothers with anemia. There was no higher rate of preterm births and low birth weight in the newborns of anemic pregnant women supplemented by iron. However, anemic pregnant women without iron treatment had a significantly shorter gestational age at delivery with a somewhat higher rate of preterm births but these adverse birth outcomes were prevented with iron supplementation. The rate of total and some congenital abnormalities was lower than expected and explained mainly by the healthier lifestyle and folic acid supplements. The secondary findings of the study showed a higher risk of constipation-related hemorrhoids and hypotension in anemic pregnant women with iron supplementation. A higher rate of preterm birth was found in anemic pregnant women without iron treatment but this adverse birth outcome was prevented with iron supplementation. There was no higher rate of congenital abnormalities in the offspring of anemic pregnant women supplemented with iron and/or folic acid supplements. Copyright © 2011 Elsevier Inc. All rights reserved.

Fatty acid composition and preclinical resarches on Anthemis wiedemanniana Fisch. & Mey.: Discovery of a new anti-inflammatory agent

PubMed Central

Gönenç, Tuba Mert; Akkol, Esra Küpeli; Süntar, Ipek; Erdoğan, Tuğçe Fafal; Kıvçak, Bijen

2014-01-01

Background: Anthemis species have been used for the treatment of gastrointestinal disorders, hemorrhoid, stomachache and inflammatory diseases in Turkish folk medicine. Anthemis wiedemanniana Fisch. And Mey. is an endemic plant used as painkiller, antispasmodic, sedative and for the treatment of urinary inflammations. Objective: The objective of the present study is to evaluate the anti-inflamatory activity of the extracts of A. wiedemanniana by using in vivo methods. Materials and Methods: Carrageenan-, PGE2- and serotonin-induced hind paw edema, 12-O-tetradecanoyl-13-acetate (TPA)-induced mouse ear edema and acetic acid-induced increase in capillary permeability models were used for the anti-inflammatory activity assessment. Moreover, the fatty acid composition of A. wiedemanniana was investigated by gas chromatography (GC). Results: n-Hexane, diethyl ether and total sesquiterpene lactone extracts exhibited significant inhibition in carrageenan-induced hind paw edema and acetic acid-induced increase in capillary permeability model. n-Hexane and total sesquiterperne lactone extracts showed anti-inflammatory activity in PGE2- and serotonin-induced hind paw edema model. However none of the extracts displayed significant activity in TPA-induced ear edema model in mice. C4:0 (Buthyric acid), C20:0 (Arachidic acid) and C16:1 (Palmitoleik acid) were found to be the major fatty acids in these species. Saturated fatty acids (SFA) were found in higher amounts than monounsaturated fatty acids and polyunsaturated fatty acids. SFAs were determined as 63.17%, UFAs as 20.89% and PuFAs as 15.95%. Conclusion: This study confirms the traditional usage of A. wiedemanniana for inflammatory diseases. PMID:24696546

Randomized controlled trial of bipolar diathermy vs ultrasonic scalpel for closed hemorrhoidectomy

PubMed Central

Tsunoda, Akira; Sada, Haruki; Sugimoto, Takuya; Kano, Nobuyasu; Kawana, Mariko; Sasaki, Tadanori; Hashimoto, Hideki

2011-01-01

AIM: To compare hemorrhoidectomy with a bipolar electrothermal device or hemorrhoidectomy using an ultrasonically activated scalpel. METHODS: Sixty patients with grade III or IV hemorrhoids were prospectively randomized to undergo closed hemorrhoidectomy assisted by bipolar diathermy (group 1) or hemorrhoidectomy with the ultrasonic scalpel (group 2). Operative data were recorded, and patients were followed at 1, 3, and 6 wk to evaluate complications. Independent assessors were assigned to obtain postoperative pain scores, oral analgesic requirement and satisfaction scores. RESULTS: Reduced intraoperative blood loss median 0.9 mL (95% CI: 0.8-3.7) vs 4.6 mL (95% CI: 3.8-7.0), P = 0.001 and a short operating time median 16 (95% CI: 14.6-18.2) min vs 31 (95% CI: 28.1-35.3) min, P < 0.0001 was observed in group 1 compared with group 2. There was a trend towards lower postoperative pain scores on day 1 group 1 median 2 (95% CI: 1.8-3.5) vs group 2 median 3 (95% CI: 2.6-4.2), P = 0.135. Reduced oral analgesic requirement during postoperative 24 h after operation median 1 (95% CI: 0.4-0.9) tablet vs 1 (95% CI: 0.9-1.3) tablet, P = 0.006 was observed in group 1 compared with group 2. There was no difference between the two groups in the degree of patient satisfaction or number of postoperative complications. CONCLUSION: Bipolar diathermy hemorrhoidectomy is quick and bloodless and, although as painful as closed hemorrhoidectomy with the ultrasonic scalpel, is associated with a reduced analgesic requirement immediately after operation. PMID:22110846

The Outlet Patch: Gastric Heterotopia of the Colo-rectum and Anus.

PubMed

Mannan, Abul Ala Syed Rifat; Vieth, Michael; Khararjian, Armen; Khandakar, Binny; Lam-Himlin, Dora; Heydt, David; Bhaijee, Feriyl; Venbrux, Henry J; Byrnes, Kathleen; Voltaggio, Lysandra; Barker, Norman; Yuan, Songyang; Montgomery, Elizabeth

2018-04-18

Gastric heterotopia (GH) has been described throughout the gastrointestinal tract. However, the colorectal region is an extremely rare location for it. We describe the clinicopathologic features of GH of the colon, rectum, and anus. We identified 33 cases in 20 males and 13 females (median age 54 years; range, 4 months to 73 years). Sites included the rectum (N=26), anus (N=4), ileocecal junction (N=1), ascending colon (N=1) and descending colon (N=1). Presenting symptoms(N=27) included hematochezia (41%) and altered bowel habits (4%); 15 patients (55%) were asymptomatic. On colonoscopy (N=31), all appeared as solitary lesions, (median size 6.5 mm, range 2 mm - 55 mm), either as polyps (61%), raised erythematous patches (23%), an ulcer(10%), within a rectal diverticulum (3%), or a hemorrhoid (3%). Patients were managed by polypectomy. One with an associated carcinoma in the area of GH underwent resection. No morbidity related to GH itself was reported following excision. Histologically, heterotopic gastric mucosa was oxyntic type (85%), mixed oxyntic and non-oxyntic type (12%), and not specified (3%). In 5 patients a pyloric gland adenoma (PGA) arose from heterotopic gastric mucosa, two of which contained a focus of invasive adenocarcinoma. One case had associated surface foveolar type low-grade dysplasia. Another had associated adenocarcinoma arising from the heterotopic mucosa. One example harbored Helicobacter pylori organisms. We highlight the features of GH in the distal GIT - the 'outlet patch'. Association with PGA, surface dysplasia and adenocarcinoma suggests that lower tract GH can undergo neoplastic transformation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

A young man with myelosuppression caused by clindamycin: a case report

PubMed Central

2014-01-01

Introduction Clindamycin is used to treat various bacterial infections, but its administration can cause anaphylaxis, liver reactions, pseudomembranous colitis, and peripheral blood cytopenias (anemia, neutropenia, and thrombocytopenia), alone or in combination. We report the case of a patient with a recurrent infection of the tonsils who received clindamycin. Pancytopenia, a previously unreported hematological disorder related to clindamycin use, was observed in conjunction with the infection and clindamycin treatment. Case presentation One month prior to hospitalization, a 22-year-old man of Hispanic origin had a tonsillar infection and cough and began to have anal pain. These conditions became exacerbated three weeks later, coinciding with a new tonsillar infection, frequent nonproductive cough, and febrile syndrome. He received clindamycin for four days prior to his admission, without improvement. While hospitalized, he was found to have fever, tonsillar abscess, hemorrhoid thrombosis, and anal fissure; the latter was immediately resected under general anesthesia. Before surgery, our patient’s blood count showed intense leukoneutropenia and mild thrombocytopenia that increased 12 hours later, along with the establishment of anemia. A bone marrow study showed decreased cell content, micromegakaryocytes, and an interruption of the differentiation of granulocytes and erythroblasts. Post-surgery, our patient received metronidazole, meropenem, and amikacin along with acetaminophen, ketoprofen, omeprazole, and pegfilgrastim, with resulting clinical and hematological improvement. Conclusion Our experience with this patient establishes that well-documented clinical cases should be the basis for identifying and publicizing unknown or uncommon undesirable effects of drugs. We report that, in some individuals, clindamycin can cause pancytopenia, a complication that in our patient’s case was caused by direct injury of his hematopoietic tissue. PMID:24387005

The α-amylase and α-glucosidase inhibitory activities of the dichloromethane extracts and constituents of Ferulago bracteata roots.

PubMed

Karakaya, Songül; Gözcü, Sefa; Güvenalp, Zühal; Özbek, Hilal; Yuca, Hafize; Dursunoğlu, Benan; Kazaz, Cavit; Kılıç, Ceyda Sibel

2018-12-01

Ferulago (Apiaceae) species have been used since ancient times for the treatment of intestinal worms, hemorrhoids, and as a tonic, digestive, aphrodisiac, or sedative, as well as in salads or as a spice due to their special odors. This study reports the α-amylase and α-glucosidase inhibitory activities of dichloromethane extract and bioactive compounds isolated from Ferulago bracteata Boiss. & Hausskn. roots. The isolated compounds obtained from dichloromethane extract of Ferulago bracteata roots through bioassay-guided fractionation and isolation process were evaluated for their in vitro α-amylase and α-glucosidase inhibitory activities at 5000-400 µg/mL concentrations. Compound structures were elucidated by detailed analyses (NMR and MS). A new coumarin, peucedanol-2'-benzoate (1), along with nine known ones, osthole (2), imperatorin (3), bergapten (4), prantschimgin (5), grandivitinol (6), suberosin (7), xanthotoxin (8), felamidin (9), umbelliferone (10), and a sterol mixture consisted of stigmasterol (11), β-sitosterol (12) was isolated from the roots of F. bracteata. Felamidin and suberosin showed significant α-glucosidase inhibitory activity (IC 50 0.42 and 0.89 mg/mL, respectively) when compared to the reference standard acarbose (IC 50 4.95 mg/mL). However, none of the tested extracts were found to be active on α-amylase inhibition. The present study demonstrated that among the compounds isolated from CH 2 Cl 2 fraction of F. bracteata roots, coumarins were determined as the main chemical constituents of this fraction. This is the first report on isolation and characterization of the bioactive compounds from root extracts of F. bracteata and on their α-amylase and α-glucosidase inhibitory activities.

[Martin Luther's seizure disorder].

PubMed

Feldmann, H

1989-01-01

Martin Luther's diseases are well documented, because he used to discuss them freely in his letters. There is also a wealth of evidence through reports by his friends. Most of his diseases were common and well known to the contemporary physicians, who accordingly interpreted them correctly: bladder stones, chronic constipation, hemorrhoids. Luther's death obviously was due to a coronary thrombosis. During the last 19 years of his life, in addition to these "natural diseases", Luther also suffered from recurring attacks of a peculiar symptomatology. Luther himself and his friends considered these seizures to be no "natural disease", but Satan punching his flesh, and he compared them to St. Paul's disease (2. Cor. 12). The first of these attacks occurred on July 6, 1527, when Luther was 43 years of age. It began with a roaring tinnitus in his left ear, which increased dramatically and seemed to occupy the left half of his head. Then a state of sickness and collapse followed, however, consciousness was retained throughout the whole period. After a night's rest all the symptoms had subsided, except the tinnitus, which, from that day on, continued for all the following years in varying intensity. Similar attacks with increase of the tinnitus and vertigo as the leading symptoms, seized Luther at irregular intervals and distressed him extremely. Former investigators of Luther's diseases interpreted these attacks as manifestations of a psychiatric disorder and a chronic inflammatory disease of the middle ear. The present detailed study reveals that it was a typical case of Menière's disease of the left ear manifesting itself more than 330 years before Menière's classical observation.

Colorectal cancer risk factors: a case-control study in Bangkok.

PubMed

Lohsoonthorn, P; Danvivat, D

1995-01-01

A case-control study for colorectal cancer risk factors was conducted in Bangkok, Thailand. A total of 279 incident cases of colorectal cancer were individually matched by sex, age and same hospital to 279 hospital controls with other cancers except gastrointestinal cancer. Each subject was interviewed with regard to bowel pattern information, family history, past history of illness and dietary information. The major findings were elevated risk for those with a history of bowel polyps (OR = 14.69, 95%CI = 2.01-301.46), parent's history of colon cancer (OR = 4.00, 95%CI = 1.39-12.43), anal abscess (OR = 3.78, 95%CI = 0.97-17.24), chronic colitis (OR = 3.61, 95%CI = 1.67-8.00), chronic hemorrhoid (OR = 3.13, 95%CI = 2.03-4.86) and the frequency of stools every three days or more (OR = 2.16, 95%CI = 1.17-4.01). The results also indicated an increased risk for dietary factors; bacon (OR = 12.49, 95%CI = 1.68-269.1) and butter (OR = 2.68, 95%CI = 1.29-5.68). There was a protective effect provided by banana (OR = 0.54, 95%CI = 0.37-0.79) and papaya (OR = 0.58, 95%CI = 0.40-0.84) for colorectal cancer. In unconditional logistic regression analysis, bacon showed the highest risk for colorectal cancer (OR = 8.82, 95%CI = 1.03-75.57), instead of bowel polyps (OR = 4.50, 95%CI = 0.48-42.59). The data suggest that nitrite-treated meat increases colorectal cancer risk while dietary fiber decreases colorectal cancer risk.

Health benefits of geologic materials and geologic processes

USGS Publications Warehouse

Finkelman, R.B.

2006-01-01

The reemerging field of Medical Geology is concerned with the impacts of geologic materials and geologic processes on animal and human health. Most medical geology research has been focused on health problems caused by excess or deficiency of trace elements, exposure to ambient dust, and on other geologically related health problems or health problems for which geoscience tools, techniques, or databases could be applied. Little, if any, attention has been focused on the beneficial health effects of rocks, minerals, and geologic processes. These beneficial effects may have been recognized as long as two million years ago and include emotional, mental, and physical health benefits. Some of the earliest known medicines were derived from rocks and minerals. For thousands of years various clays have been used as an antidote for poisons. "Terra sigillata," still in use today, may have been the first patented medicine. Many trace elements, rocks, and minerals are used today in a wide variety of pharmaceuticals and health care products. There is also a segment of society that believes in the curative and preventative properties of crystals (talismans and amulets). Metals and trace elements are being used in some of today's most sophisticated medical applications. Other recent examples of beneficial effects of geologic materials and processes include epidemiological studies in Japan that have identified a wide range of health problems (such as muscle and joint pain, hemorrhoids, burns, gout, etc.) that may be treated by one or more of nine chemically distinct types of hot springs, and a study in China indicating that residential coal combustion may be mobilizing sufficient iodine to prevent iodine deficiency disease. ?? 2006 MDPI. All rights reserved.

Angiogenesis inhibitors and symptomatic anal ulcers in metastatic colorectal cancer patients *.

PubMed

Bergamo, Francesca; Lonardi, Sara; Salmaso, Beatrice; Lacognata, Carmelo; Battaglin, Francesca; Cavallin, Francesco; Saadeh, Luca; Murgioni, Sabina; Caruso, Antonino; Aliberti, Camillo; Zagonel, Vittorina; Castoro, Carlo; Scarpa, Marco

2018-03-01

Angiogenesis inhibitors are a standard first-line treatment for metastatic colorectal cancer. Anal canal pain is a common adverse event, but its cause has never been described. The aim of the study was to evaluate the association between the use of angiogenesis inhibitors and symptomatic anal ulcer development. This retrospective cohort study included all 601 consecutive metastatic colorectal cancer patients undergoing first line treatment from January 2010 to June 2016 at the Veneto Institute of Oncology. Details about patient characteristics, treatment and proctology reports were retrieved and compared. Vascularization of the anal canal was evaluated with contrast MRI. Fifty out of 601 patients reported perianal complaints during treatment and underwent proctologic evaluation. Among those, 16 were found to have an anal ulcer. Symptomatic anal ulcers occurred only in patients receiving bevacizumab (4.2% vs. 0% with other regimens, p = .009). The peak incidence was 4-8 weeks after treatment start. Vascularization of anal canal was significantly lower in patients treated with bevacizumab (p = .03). Hypertension and hemorrhoids were associated with a lower risk of anal ulcer occurrence (p = .009 and p = .036). Pain intensity was severe. All attempts at symptomatic treatment only led to transient benefit. The absence of symptomatic ulcers was protective against earlier permanent discontinuation of treatment (HR = .22, 95%CI: 0.04-0.62). The development of symptomatic anal ulcers in patients receiving angiogenesis inhibitor is a common adverse event which can compromise the continuation of cancer therapy. We recommend an early proctologic evaluation in case of anal symptoms with the aim to prevent and timely manage such complication.

Is It Time to Tailor the Prediction of Radio-Induced Toxicity in Prostate Cancer Patients? Building the First Set of Nomograms for Late Rectal Syndrome

DOE Office of Scientific and Technical Information (OSTI.GOV)

Valdagni, Riccardo; Radiotherapy, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan; Kattan, Michael W.

Purpose: Development of user-friendly tools for the prediction of single-patient probability of late rectal toxicity after conformal radiotherapy for prostate cancer. Methods and Materials: This multicenter protocol was characterized by the prospective evaluation of rectal toxicity through self-assessed questionnaires (minimum follow-up, 36 months) by 718 adult men in the AIROPROS 0102 trial. Doses were between 70 and 80 Gy. Nomograms were created based on multivariable logistic regression analysis. Three endpoints were considered: G2 to G3 late rectal bleeding (52/718 events), G3 late rectal bleeding (24/718 events), and G2 to G3 late fecal incontinence (LINC, 19/718 events). Results: Inputs for themore » nomogram for G2 to G3 late rectal bleeding estimation were as follows: presence of abdominal surgery before RT, percentage volume of rectum receiving >75 Gy (V75Gy), and nomogram-based estimation of the probability of G2 to G3 acute gastrointestinal toxicity (continuous variable, which was estimated using a previously published nomogram). G3 late rectal bleeding estimation was based on abdominal surgery before RT, V75Gy, and NOMACU. Prediction of G2 to G3 late fecal incontinence was based on abdominal surgery before RT, presence of hemorrhoids, use of antihypertensive medications (protective factor), and percentage volume of rectum receiving >40 Gy. Conclusions: We developed and internally validated the first set of nomograms available in the literature for the prediction of radio-induced toxicity in prostate cancer patients. Calculations included dosimetric as well as clinical variables to help radiation oncologists predict late rectal morbidity, thus introducing the possibility of RT plan corrections to better tailor treatment to the patient's characteristics, to avoid unnecessary worsening of quality of life, and to provide support to the patient in selecting the best therapeutic approach.« less

Documentation and quantitative analysis of local ethnozoological knowledge among traditional healers of Theni district, Tamil Nadu, India.

PubMed

Chellappandian, M; Pandikumar, P; Mutheeswaran, S; Gabriel Paulraj, M; Prabakaran, S; Duraipandiyan, V; Ignacimuthu, S; Al-Dhabi, N A

2014-05-28

This study investigated the use of animals among the traditional healers in Theni district of Tamil Nadu, India. The data regarding the medicinal animals/animal products were documented and their usages were analyzed quantitatively. Based on free list interviews with the traditional healers, we documented the medicinal usage of animals/animal products and calculated the indices such as informant consensus factor (Fic) to determine the consensus over the species for an illness category, as well as the Index Agreement on Remedies (IAR) to determine the extent of potential utilization of each species. In this study, 69 medicinal animals/animal products were documented with the help of standardized questionnaires among the local healers. The results were tabulated and Fic value for each illness category was calculated. Three illness categories viz., jaundice (milk of Capra aegagrus hircus), orthopedics (egg white and meat of Gallus gallus domesticus) and pediatrics (milk of Equus africanus asinus) had got high Fic values. Fifteen illness categories had moderate Fic values. Highly cited animals in these illness categories were: Rusa unicolor (antiemetic), Reticulitermes spp. (diabetes), flesh of Varanus benghalensis (oral ailments), milk (eye ailments, fever) and urine (antidote) of Homo sepians, meat of Trachypithecus johnii (respiratory ailments), various parts of C. aegagrus hircus (blood ailments, coolants, diarrhea, pulmonary and urinary ailments), flesh of Chamaeleon zeyalnica (neural ailments), meat of Passer domesticus (aphrodisiac), curd and dung of Bos primigenius taurus (dermatological ailments), meat of G. domesticus (musculo-skeletal disorders, analgesic), meat of Lissemys punctata (hemorrhoids), and Pherthima posthuma (psychological ailments). Six illness categories had low Fic values. This study indicated that the animals are still being used by the local healers of Theni district, to treat various illnesses. Cross-disciplinary approaches to explore the

Confirmation of diosmetin 3-O-glucuronide as major metabolite of diosmin in humans, using micro-liquid-chromatography-mass spectrometry and ion mobility mass spectrometry.

PubMed

Silvestro, Luigi; Tarcomnicu, Isabela; Dulea, Constanta; Attili, Nageswara Rao B N; Ciuca, Valentin; Peru, Dan; Rizea Savu, Simona

2013-10-01

Diosmin is a flavonoid often administered in the treatment of chronic venous insufficiency, hemorrhoids, and related affections. Diosmin is rapidly hydrolized in the intestine to its aglicone, diosmetin, which is further metabolized to conjugates. In this study, the development and validations of three new methods for the determination of diosmetin, free and after enzymatic deconjugation, and of its potential glucuronide metabolites, diosmetin-3-O-glucuronide, diosmetin-7-O-glucuronide, and diosmetin-3,7-O-glucuronide from human plasma and urine are presented. First, the quantification of diosmetin, free and after deconjugation, was carried out by high-performance liquid chromatography coupled with tandem mass spectrometry, on an Ascentis RP-Amide column (150 × 2.1 mm, 5 μm), in reversed-phase conditions, after enzymatic digestion. Then glucuronide metabolites from plasma were separated by micro-liquid chromatography coupled with tandem mass spectrometry on a HALO C18 (50 × 0.3 mm, 2.7 μm, 90 Å) column, after solid-phase extraction. Finally, glucuronides from urine were measured using a Discovery HSF5 (100 × 2.1 mm, 5 μm) column, after simple dilution with mobile phase. The methods were validated by assessing linearity, accuracy, precision, low limit of quantification, selectivity, extraction recovery, stability, and matrix effects; results in agreement with regulatory (Food and Drug Administration and European Medicines Agency) guidelines acceptance criteria were obtained in all cases. The methods were applied to a pharmacokinetic study with diosmin (450 mg orally administered tablets). The mean C max of diosmetin in plasma was 6,049.3 ± 5,548.6 pg/mL. A very good correlation between measured diosmetin and glucuronide metabolites concentrations was obtained. Diosmetin-3-O-glucuronide was identified as a major circulating metabolite of diosmetin in plasma and in urine, and this finding was confirmed by supplementary experiments with differential ion

Prevalence of colorectal diseases in immunological fecal occult blood test (I-FOBT) positive patients in a tertiary care hospital in Bangladesh.

PubMed

Mollick, S H; Roy, P K; Bhuiyan, M R; Mia, A R; Alam, M S; Mollick, K A; Pervin, S; Hassan, M Q

2014-10-01

Bleeding lesion anywhere in the GI tract can cause positive reaction to Immunological Fecal Occult Blood Test (FOBT). Although any colonic lesion can cause occult lower GI bleeding, relative frequency of this lesion not known. Guaic based tests require prior preparation and dietary restriction and less sensitive and specific than IFOBT for detection of occult bleeding .IFOBT is specific for human hemoglobin and is more sensitive and specific for detection of occult bleeding from any colonic lesion. Aim of this study was to diagnose occult gastrointestinal bleeding with positive IFOBT and the prevalence of colorectal disease in IFOBT positive patients in a tertiary care hospital in Bangladesh. This was a prospective cross sectional study conducted in Department of gastroenterology in collaboration with clinical pathology, BSMMU, Dhaka during the period of January 2009 to December 2009. In this study 200 patients meeting the inclusion criteria were included. Detailed clinical history and physical findings were recorded; FOBT was done on single stool specimen. Positive occult bleeding was confirmed in 90 patients of whom 80 patients underwent colonoscopy. The mean age of study population was 36.73±13.64 (range 16 to 72) years. At colonoscopy lesion were identified in 46(57.50%) patients, of which colonic polyp in12 (15%), colorectal cancer in 11(13.7%), inflammatory bowel disease in 3(3.75%), hemorrhoids and anal fissure in 7(8.75%), tuberculosis in 5(6.25%), and proctitis in 1(1.25%) cases. A positive IFOBT is more sensitive and specific test than other FOBT for detection of occult lower GI bleeding of colonic origin. In this study colorectal diseases were detected in 57.50% of the IFOBT positive patients, so IOBT can be used as an important diagnostic tool for detection of occult lower GI bleeding.

Prospective experimental study of transrectal viscerotomy closure using transanal endoscopic suture vs. circular stapler: a step toward NOTES.

PubMed

Diana, M; Leroy, J; Wall, J; De Ruijter, V; Lindner, V; Dhumane, P; Mutter, D; Marescaux, J

2012-06-01

Endoluminal full-thickness closure of the rectal wall is critical in emerging procedures including endoscopic submucosal dissection and transrectal natural orifice transluminal endoscopic surgery (NOTES). This study aimed to compare manual suture using the transanal endoscopic operation platform (TEO; Karl Storz, Tüttlingen, Germany) with the end-to-end anastomosis hemorrhoid circular stapler (EEA; Covidien, Dublin, Ireland) for closure of the rectal viscerotomy during transrectal NOTES segmental colectomy. A total of 12 swine underwent transrectal hybrid NOTES partial colectomies. Animals were divided into two groups according to the viscerotomy closure technique: 1) TEO manual suture; 2) EEA circular stapler closure. Mean (± SD) viscerotomy closure time was 67.5 ± 59.5 minutes and 31.5 ± 19.6 minutes for TEO and EEA, respectively. There was one conversion to laparoscopy in the TEO group and a misfiring in the EEA group that required a TEO salvage suture. There was one positive air-leak test in each group. Peritoneal fluid collected at the end of the procedure tested positive for bacterial contamination in all cases. A mild stenosis was present in 4 /6 viscerotomies (67 %) in the TEO group and in 1/6 (17 %) in the EEA group on endoscopic control. Inflammatory changes were mild in 3/5 (60 %) and 4/5 (80 %) viscerotomies in the TEO and EEA groups, respectively, whereas severe inflammation was found in 2/5 (TEO) and 1 /5 (EEA). Transrectal viscerotomy closure using the EEA circular stapler technique is feasible, easy to perform, and histologically comparable to suture closure through a TEO platform. It may offer an attractive alternative for NOTES segmental colectomies and endoscopic resections. © Georg Thieme Verlag KG Stuttgart · New York.

The effect of cutting origin and organic plant growth regulator on the growth of Daun Ungu (Graptophyllum pictum) through stem cutting method

NASA Astrophysics Data System (ADS)

Pratama, S. P.; Yunus, A.; Purwanto, E.; Widyastuti, Y.

2018-03-01

Graptophyllum pictum is one of medical plants which has important chemical content to treat diseases. Leaf, bark and flower can be used to facilitate menstruation, treat hemorrhoid, constipation, ulcers, ulcers, swelling, and earache. G. pictum is difficult to propagated by seedling due to the long duration of seed formation, thusvegetative propagation is done by stem cutting. The aims of this study are to obtain optimum combination of cutting origin and organic plant growth regulator in various consentration for the growth of Daun Ungu through stem cutting method. This research was conducted at Research center for Medicinal Plant and Traditional DrugTanjungsari, Tegal Gede, Karanganyar in June to August 2016. Origin of cuttings and organic plant growth regulator were used as treatments factor. A completely randomized design (RAL) is used and data were analyzed by F test (ANOVA) with a confidence level of 95%. Any significant differences among treatment followed with Duncan test at a = 5%. The research indicates that longest root was resulted from the treatment of 0,5 ml/l of organic plant growth regulator. The treatment of 1 ml/l is able to increase the fresh and dry weight of root, treatment of 1,5 ml/l of organic plant growth regulator was able to increase the percentage of growing shoots. Treatment of base part as origin of cuttings increases the length, fresh weight and and dry weight of shoot, increase the number of leaves. Interaction treatment between 1 ml/l consentration of organic plant growth regulator and central part origin of cuttings is capable of increasing the leaf area, whereas treatment without organic plant growth regulator and base part as planting material affects the smallest leaf area.

Predictors for Rectal and Intestinal Acute Toxicities During Prostate Cancer High-Dose 3D-CRT: Results of a Prospective Multicenter Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vavassori, Vittorio; Fiorino, Claudio; Rancati, Tiziana

2007-04-01

Purpose: To find predictors for rectal and intestinal acute toxicity in patients with prostate cancer treated with {>=}70 Gy conformal radiotherapy. Methods and Materials: Between July 2002 and March 2004, 1,132 patients were entered into a cooperative study (AIROPROS01-02). Toxicity was scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale and by considering the changes (before and after treatment) of the scores of a self-administered questionnaire on rectal/intestinal toxicity. The correlation with a number of parameters was assessed by univariate and multivariate analyses. Concerning the questionnaire, only moderate/severe complications were considered. Results: Of 1,132more » patients, 1,123 were evaluable. Of these patients, 375, 265, and 28 had Grade 1, 2, and 3 Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer toxicity, respectively. The mean rectal dose was the most predictive parameter (p = 0.0004; odds ratio, 1.035) for Grade 2 or worse toxicity, and the use of anticoagulants/antiaggregants (p 0.02; odds ratio, 0.63) and hormonal therapy (p = 0.04, odds ratio, 0.65) were protective. The questionnaire-based scoring revealed that a greater mean rectal dose was associated with a greater risk of bleeding; larger irradiated volumes were associated with frequency, tenesmus, incontinence, and bleeding; hormonal therapy was protective against frequency and tenesmus; hemorrhoids were associated with a greater risk of tenesmus and bleeding; and diabetes associated highly with diarrhea. Conclusion: The mean rectal dose correlated with acute rectal/intestinal toxicity in three-dimensional conformal radiotherapy for prostate cancer, and hormonal therapy and the use of anticoagulants/antiaggregants were protective. According to the moderate/severe injury scores on the self-assessed questionnaire, several clinical and dose-volume parameters were independently

Anorectal pathology amongst HIV infected patients attending the Douala General Hospital: a cross-sectional study.

PubMed

Luma, Henry Namme; Eloumou, Servais Albert Fiacre Bagnaka; Fualefeh-Morfaw, Ellis Atemlefeh; Malongue, Agnes; Temfack, Elvis; Lekpa, Fernando Kemta; Donfack-Sontsa, Olivier; Ndip, Lucy; Ditah, Ivo Che

2017-03-01

While gastrointestinal disease is common among HIV infected individuals, the prevalence and distribution of ano-rectal pathology has not been well studied in our setting. The objective of this study therefore was to determine the prevalence and determinants of ano-rectal pathology in HIV infected patients attending the Douala General Hospital HIV treatment centre. A hospital-based cross-sectional study was undertaken. We collected socio-demographic, clinical and laboratory data using a structured questionnaire and patients' files. Each study participant had a full physical and ano-rectal examination. We further studied factors associated with having at least one ano-rectal lesion by logistic regression reporting odds ratios (ORs) and their 95% confidence intervals (CI). We included 390 HIV infected patients. The mean age was 41 (SD: 8) years and 48% were men. Median duration since HIV diagnosis was 3 (interquartile range: 2-5) years and median CD4 cell count was 411 (interquartile range: 234-601) cells/mm 3 . Prevalence of ano-rectal pathology was 22.8% (95% CI: 18.7-27.3). Hemorrhoids and proctitis were most common lesions found; each in 10% of patients. From multivariate logistic regression, factors associated with ano-rectal pathology were CD4 < 350 cells/ml (OR: 2.1, 95% CI: 1.1-4.2), not on highly active antiretroviral therapy (OR: 2.2, 95% CI: 1.1-4.6), inpatient (OR: 2.3, 95% CI: 1.2-4.3), ano-rectal intercourse (OR: 5.0, 95% CI: 1.7-15.1), and more than one sexual partner (OR: 2.4, 95% CI: 1.3-4.2). Ano-rectal pathology is common amongst HIV infected patients. Care givers should actively investigate and treat them as this will improve the quality of life of people living with HIV/AIDS.

Consensus analysis of sastric formulations used by non-institutionally trained siddha medical practitioners of Virudhunagar and Tirunelveli districts of Tamil Nadu, India.

PubMed

Mutheeswaran, S; Pandikumar, P; Chellappandian, M; Ignacimuthu, S; Duraipandiyan, V; Logamanian, M

2014-04-11

Siddha system of traditional medicine has been practiced in Tamil Nadu. This system of medicine has a high number of non-institutionally trained practitioners but studies on their traditional medicinal knowledge are not adequate. The present study is aimed to document and analyze the sastric (traditional) formulations used by the non-institutionally trained siddha medical practitioners in Virudhunagar and Tirunelveli districts of Tamil Nadu, India. After obtaining prior informed consent, interviews were conducted with 115 non-institutionally trained siddha medical practitioners about the sastric formulations used by them for the treatment. Successive free listing method was adopted to collect the data and the data were analyzed by calculating Informant Consensus Factor (Fic) and Informant Agreement Ratio (IAR). The study documented data regarding 194 sastric formulations and they were classified into plant, mineral and animal based formulations. Quantitative analysis showed that 62.5% of the formulations were plant based, while the mineral based formulations had a high mean number of citations and versatile uses. Gastrointestinal (12.0%), kapha (11.3%) and dermatological (10.8%) ailments had a high percentage of citations. Jaundice had a high Fic value (0.750) followed by the dermatological ailments. The illness categories with high Fic values under each type of formulation were as follows: jaundice, aphrodisiac and urinary ailments (plant based); jaundice, cuts & wounds and dermatological ailments (mineral based); and hemorrhoids, kapha ailments and heart ailments (animal based formulations). The scientific studies conducted with important formulations under each illness category are discussed. The present study indicated the importance of some illnesses over the others and inclusion of new illnesses under each formulation. The ingredients used to prepare these formulations have shown varying degrees of scientific evidence; generally limited studies were available

How we can improve patients’ comfort after Milligan-Morgan open haemorrhoidectomy

PubMed Central

ba-bai-ke-re, Ma-Mu-Ti-Jiang A; Huang, Hong-Guo; Re, Wen-Ni; Fan, Kai; Chu, Hui; Ai, Er-Ha-Ti; Li-Mu, Mai-Mai-Ti-Tu-Er-Xun KE; Wang, Yi-Rui; Wen, Hao

2011-01-01

AIM: To demonstrate the value of Diosmin (flavonidic fraction) in the management of post-haemorhoidectomic symptoms. METHODS: Eighty-six consecutive patients with grades III and IV acute mixed hemorrhoids admitted to the Anorectal Surgical Department of First Affiliated Hospital, Xinjiang Medical University from April 2009 to April 2010, were enrolled in this study. An observer-blinded, randomized trial was conducted to compare post-haemorhoidectomic symptoms with use of Diosmin flavonidic fraction vs placebo. Eighty-six patients were randomly allocated to receive Diosmin flavonidic fraction 500 mg for 1 wk (n = 43) or placebo (n = 43). The Milligan-Morgan open haemorrhoidectomy was performed by a standardized diathermy excision method. Pain, bleeding, heaviness, pruritus, wound edema and mucosal discharge were observed after surgery. The postoperative symptoms and hospitalization time were recorded. RESULTS: The mean age of the Diosmin group and controls was 53.2 and 51.3 years, respectively. In Diosmin group, haemorrhoid piles were of the third degree in 33 patients and the fourth degree in 10; and in the control group, 29 were of the third degree and 14 were of the fourth degree. There was no statistically significance in age, gender distribution, degree and number of excised haemorrhoid piles, and the mean duration of haemorrhoidal disease between the two groups. There was a statistically significant improvement in pain, heaviness, bleeding, pruritus from baseline to the 8th week after operation (P < 0.05). Patients taking Diosmin had a shorter hospitalization stay after surgery (P < 0.05). There was also a significant improvement on the proctoscopic appearance (P < 0.001). However, there was no statistical difference between the two groups in terms of wound mucosal discharge. Two patients experienced minor bleeding at the 8th week in Diosmin group, and underwent surgery. CONCLUSION: Diosmin is effective in alleviating postoperational symptoms of haemorrhoids

Ethnobotanical survey of medicinal plants in Bozyazı district of Mersin, Turkey.

PubMed

Ahmet Sargin, Seyid

2015-09-15

This research contributes momentous ethnopharmaceutical information on medicinal plants used by local people who live in the Bozyazı district of Mersin in Turkey. To arrange a list of herbal treatments from the Bozyazı region with their habitual use, plant parts and application methods besides computing some statistical indices. Plant specimens that have been collected by herbalists or local people from Bozyazı for therapeutic purposes were investigated by visiting the villages during the study period, and then conveyed to the laboratory to diagnose the species. In addition, the relative frequency citation (RFC), use values (UV), informant consensus factor (ICF) and fidelity level (FL) were calculated. In this survey conducted between 2013 and 2015, 159 taxa associated with 55 families, excluding 9 edible mushrooms, were detected as they have been utilized for centuries in terms of the healing by visiting 14 villages and 4 herbalist shops in Bozyazı. Lamiaceae, Asteraceae Orchidaceae, Rosaceae, Fabaceae and Geraniaceae have been determined as the most used families for therapeutic purposes. The study revealed that most of the residents concurred on the use of Sideritis erythrantha herba to cure respiratory diseases that demonstrated the highest fidelity level (89). 63 taxa have not matched with any studies conducted in and around the region. Throughout the research carried out Bozyazı district, it has been observed that people living in rural areas have more knowledge and experience about the use and benefits of plants, compared to the people living in the district center. It was detected that the medicinal plants have been used mostly in the therapy of Hemorrhoids. The most information is obtained from the mountain villagers and Yuruk nomads, having average ages of 46.3, during the whole study. In terms of ethnobotanical perspective, the district has stayed valuable due to the winding roads over the mountains and along the coast is very difficult to drive

Phaleria macrocarpa (Boerl.) fruit induce G0/G1 and G2/M cell cycle arrest and apoptosis through mitochondria-mediated pathway in MDA-MB-231 human breast cancer cell.

PubMed

Kavitha, Nowroji; Ein Oon, Chern; Chen, Yeng; Kanwar, Jagat R; Sasidharan, Sreenivasan

2017-04-06

Phaleria macrocarpa (Scheff) Boerl, is a well-known folk medicinal plant in Indonesia. Traditionally, P. macrocarpa has been used to control cancer, impotency, hemorrhoids, diabetes mellitus, allergies, liver and hearth disease, kidney disorders, blood diseases, acne, stroke, migraine, and various skin diseases. The purpose of this study was to determine the in situ cytotoxicity effect P. macrocarpa fruit ethyl acetate fraction (PMEAF) and the underlying molecular mechanism of cell death. MDA-MB-231 cells were incubated with PMEAF for 24h. Cell cycle and viability were examined using flow cytometry analysis. Apoptosis was determined using the Annexin V assay and also by fluorescence microscopy. Apoptosis protein profiling was detected by RayBio® Human Apoptosis Array. The AO/PI staining and flow cytometric analysis of MDA-MB-231 cells treated with PMEAF were showed apoptotic cell death. The cell cycle analysis by flow cytometry analysis revealed that the accumulation of PMEAF treated MDA-MB-231 cells in G 0 /G 1 and G 2 /M-phase of the cell cycle. Moreover, the PMEAF exert cytotoxicity by increased the ROS production in MDA-MB-231 cells consistently stimulated the loss of mitochondrial membrane potential (∆ Ψm ) and induced apoptosis cell death by activation of numerous signalling proteins. The results from apoptosis protein profiling array evidenced that PMEAF stimulated the expression of 9 pro-apoptotic proteins (Bax, Bid, caspase 3, caspase 8, cytochrome c, p21, p27, p53 and SMAC) and suppressed the 4 anti-apoptotic proteins (Bcl-2, Bcl-w, XIAP and survivin) in MDA-MB-231 cells. The results indicated that PMEAF treatment induced apoptosis in MDA-MB-231 cells through intrinsic mitochondrial related pathway with the participation of pro and anti-apoptotic proteins, caspases, G 0 /G 1 and G 2 /M-phases cell cycle arrest by p53-mediated mechanism. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Ethnobotanical study of medicinal plants used by Tai Yai in Northern Thailand.

PubMed

Khuankaew, Sunee; Srithi, Kamonnate; Tiansawat, Pimonrat; Jampeetong, Arunothai; Inta, Angkhana; Wangpakapattanawong, Prasit

2014-02-03

We studied traditional knowledge of medicinal plants used by Tai Yai people in Northern Thailand. We documented traditional medical practices and determined importance among the Tai Yai. This paper reports on knowledge in usage of medicinal plants of the Tai Yai people in Northern Thailand. Interviews were conducted in 4 Tai Yai villages in Mae Hong Son and Chiang Mai provinces whose inhabitants immigrated from Myanmar at different times. Discussions and interviews were held with 126 key-informants (56 males and 70 females) ranging in age from 16 to 80 years in three age groups (age 16-40, 41-60, and 61-80). We calculated the informant consensus factor (ICF) for use category, use value index (UV) for use report of plant. We tested differences between the knowledge of different age groups and locations using principal component analysis (PCA). These Tai Yai people used of 141 medicinal plants belonging to 59 families. Of the medicinal plant species, the highest percentage was in the family Euphorbiaceae: Croton acutifolius and Croton roxburghii. The highest number of Informant consensus factor was for metabolic system disorders. Overall, Tai Yai people use medicinal plants to cure many sicknesses such as hypertension, lumbago, wounds, puerperium, kidney disorders, kidney stones, coughs, fevers, hemorrhoids, flatulence and malaria. There were no significant differences in knowledge of plants usage among villages of different ages. In addition, the knowledge of the plants was not significantly different between men and women. However, we found that the younger had less experience with and knowledge of medicinal plants than older people. The result indicates loss of accumulated knowledge of medicinal plants and traditional use. Although, the medicinal plant knowledge was passed from one generation to the next by word of mouth, the detailed documentation of medicinal plants and their use may effectively prevent the knowledge-loss through time. © 2013 Elsevier Ireland

Effects of Different Anesthetic Techniques on Serum Leptin, C-reactive Protein, and Cortisol Concentrations in Anorectal Surgery

PubMed Central

Buyukkocak, Unase; Daphan, Cagatay; Caglayan, Osman; Aydinuraz, Kuzey; Kaya, Tahsin; Saygun, Oral; Agalar, Fatih

2006-01-01

Aim To compare the effects of intratracheal general anesthesia (ITGA) and regional (saddle block) anesthesia on leptin, C-reactive protein (CRP), and cortisol blood concentrations during anorectal surgery. Methods Fifty-eight patients suffering from hemorrhoidal disease, pilonidal sinus, anal fissure, or anal fistula were included the study. Patients were randomly assigned into one of the two groups (n = 29). Patients in one group received ITGA. After thiopental and fentanyl induction, vecuronium was used as a muscle relaxant. Anesthesia was maintained with sevoflurane. In the other group we applied saddle block, injecting hyperbaric bupivacaine into the subarachnoid space, through the L3-L4 intervertebral space, in the sitting position. Blood samples were collected for leptin, CRP, and cortisol analysis before the induction of anesthesia at 3 and 24 hours postoperatively. Results Preoperative leptin, CRP, and cortisol concentrations were comparable between the groups. There was no significant difference in postoperative levels of leptin and CRP in both groups. Although not significant, leptin and CRP concentrations were lower in the saddle block group at three hours postoperatively (mean ± SD, 6.95 ± 8.59 and 6.02 ± 12.25, respectively) than in the ITGA group (mean ± SD, 9.04 ± 9.89 and 8.40 ± 15.75, respectively). During early postoperative period, cortisol increased slightly in the ITGA group and remained at similar level in the saddle block group, but later decreased in both groups. Cortisol levels in the saddle block group were significantly lower than in the ITGA group at 3 hours postoperatively (343.7 ± 329.6 vs 611.4 ± 569.8; P = 0.034). Conclusion Saddle block, a regional anesthetic technique, may attenuate stress response in patients undergoing anorectal surgery, by blocking afferent neural input during early postoperative period. PMID:17167859

Beneficial effects of Aesculus hippocastanum L. seed extract on the body's own antioxidant defense system on subacute administration.

PubMed

Küçükkurt, Ismail; Ince, Sinan; Keleş, Hikmet; Akkol, Esra Küpeli; Avci, Gülcan; Yeşilada, Erdem; Bacak, Elif

2010-05-04

Seeds of Aesculus hippocastanum L. have long been used in European phytotherapy to treat inflammatory and vascular problems. In Turkish folk medicine, tea prepared from the crushed seeds was used to pass kidney stone and against stomach ache, while a fraction of seed was swallowed to alleviate hemorrhoids symptoms. In order to evaluate the in vivo effects of escin mixture from Aesculus hippocastanum seed on the blood and tissue antioxidant defense systems in standard pellet diet (SPD) and in high-fat diet (HFD) consumed male mice. Escin mixture was obtained from the ethanol extract of seeds. Escin mixture was administered orally to male mice fed either standard pellet diet (SPD) or high-fat diet (HFD) at 100mg/kg doses daily for 5 weeks and the tissue (liver, kidney and heart) and blood samples were collected at the end of experimental period. The effect of escin mixture on the plasma antioxidant activity; blood and tissue malondialdehyde (MDA) and reduced glutathione (GSH) levels; erythrocyte and tissue superoxide dismutase (SOD) and catalase activity (CAT) in SPD and HFD consumed animals were experimentally studied. Escin mixture prohibited the adverse effects of oxidative stress and showed a protective effect on the liver architecture both in SPD and HFD consumed male mice. Escin mixture prohibited the adverse effects of oxidative stress and showed a protective effect on the liver architecture both in SPD and HFD consumed male mice. Combined administration of high-fat diet with escin mixture decreased blood (p<0.01), liver (p<0.01), kidney (p<0.05), and heart (p<0.05) of MDA, liver SOD (p<0.01) and CAT (p<0.05) levels and increased blood (p<0.01) and liver GSH (p<0.001) levels in mice. The present results indicate that Aesculus hippocastanum increase the antioxidative defense system of the body and prevent HFD-induced lipid peroxidation in male mice. (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Standardized flavonoid-rich fraction of Artemisia princeps Pampanini cv. Sajabal induces apoptosis via mitochondrial pathway in human cervical cancer HeLa cells.

PubMed

Ju, Hye-Kyung; Lee, Heon-Woo; Chung, Kyung-Sook; Choi, Jung-Hye; Cho, Jin-Gyeong; Baek, Nam-In; Chung, Hae-Gon; Lee, Kyung-Tae

2012-05-07

Artemisia princeps Pampanini is widely used in Eastern traditional medicine for the treatment of circulatory disorders, such as, dysmenorrhea, hematuria, hemorrhoids, and inflammation, and is also used to treat chronic conditions, such as, cancers, ulcers, and digestive disorders. The purpose of this study is to investigate the effect of a standardized flavonoid-rich fraction of Artemisia princeps Pampanini cv. Sajabal (FRAP) on the induction of apoptosis and the molecular mechanism involved in human cervical cancer HeLa cells. Human cervical cancer HeLa cells were treated with FRAP and apoptosis was detected by cell morphologic observation, annexin-V-PI staning and western blot analysis on the expression of protein associated with cell death. FRAP led to the cleavages of caspase-3, -8, and -9 and the cleavage of poly (ADP-ribose) polymerase (PARP) in HeLa cells. Caspase-3 inhibitor (z-DEVD-fmk), caspase-8 inhibitor (z-IETD-fmk), caspase-9 inhibitor (z-LEHD), and broad caspase inhibitor (z-VAD-fmk) significantly suppressed the FRAP-induced accumulation of annexin V positive cells. Furthermore, it was found that FRAP caused a loss of mitochondrial membrane potential (MMP) and the release of cytochrome c to the cytosol. Furthermore, the overexpression of Bcl-xL significantly prevented FRAP-induced apoptosis, MMP changes, and the activations of caspase-3, -8, and -9. Interestingly, pretreatment with caspase-8 inhibitor significantly reduced the FRAP-induced activation of caspase-3 but not that of caspase-9, whereas the caspase-3 inhibitor, z-DEVD-fmk, markedly attenuated the FRAP-induced activation of caspase-8. In BALB/c(nu/nu) mice bearing a HeLa xenograft, FRAP dosed at 25 or 50mg/kg significantly inhibited tumor growth. Our results indicate caspase-mediated activation of the mitochondrial death pathway plays a critical role in the FRAP-induced apoptosis of HeLa cells and that FRAP inhibits the in vivo tumor growth of HeLa xenograft mice. Copyright © 2012 Elsevier

Risk Factors for Mortality in Lower Intestinal Bleeding

PubMed Central

Strate, Lisa L.; Ayanian, John Z.; Kotler, Gregory; Syngal, Sapna

2009-01-01

Background and Aims Previous studies of Lower Intestinal Bleeding (LIB) have limited power to study mortality. We sought to identify characteristics associated with in-hospital mortality in a large cohort of patients with LIB. Methods We used the 2002 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to study a cross-sectional cohort of 227,022 hospitalized patients with discharge diagnoses indicating LIB. Predictors of mortality were identified using multiple logistic regression. Results In 2002, an estimated 8,737 patients with LIB (3.9%) died while hospitalized. Independent predictors of in-hospital mortality were age (age >70 vs. <50, odds ratio (OR) 4.91; 95% CI 2.45–9.87), intestinal ischemia (OR 3.47; 95% CI 2.57–4.68), comorbid illness (≥ 2 vs. 0 comorbidities, OR 3.00; 95% CI 2.25–3.98), bleeding while hospitalized for a separate process (OR 2.35; 95% CI 1.81–3.04), coagulation defects (OR 2.34; 95% CI 1.50–3.65), hypovolemia (OR 2.22; 95% CI 1.69–2.90), transfusion of packed red blood cells (OR 1.60; 95% CI 1.23–2.08), and male gender (OR 1.52; 95% CI 1.21–1.92). Colorectal polyps (OR 0.26, 95% CI 0.15–0.45), and hemorrhoids (OR 0.42; 95% CI 0.28–0.64) were associated with a lower risk of mortality, as was diagnostic testing for LIB when added to the multivariate model (OR 0.37, 95% CI 0.28–0.48; p<0.001). Hospital characteristics were not significantly related to mortality. Predictors of mortality were similar in an analysis restricted to patients with diverticular bleeding. Conclusions The all-cause in-hospital mortality rate in LIB is low (3.9%). Advanced age, intestinal ischemia and comorbid illness were the strongest predictors of mortality. PMID:18558513

Bladder urothelial carcinoma extending to rectal mucosa and presenting with rectal bleeding

PubMed Central

Aneese, Andrew M; Manuballa, Vinayata; Amin, Mitual; Cappell, Mitchell S

2017-01-01

hemorrhoidal bleeding; the novel mechanism of direct bladder urothelial carcinoma extension into rectal mucosa via the prostate; and the novel aforementioned colonoscopic findings underlying the clinical presentation. PMID:28690772

Pharmacokinetics of escin Ia in rats after intravenous administration.

PubMed

Wu, Xiu-Jun; Cui, Xiang-Yong; Tian, Lian-tian; Gao, Feng; Guan, Xin; Gu, Jing-Kai

2014-10-28

Escin, a natural mixture of triterpene saponins, is commonly utilized for the treatment of chronic venous insufficiency, hemorrhoids, inflammation and edema. Escin Ia is the chief active ingredient in escin and plays key role in mediating its pharmacological effects. Adequate pharmacokinetic data are essential for proper application of escin agent in clinical practice. However, pharmacokinetic properties of escin Ia are still poorly understood and this conflicts with the growing use of escin agent over the years. The goal of this study is to investigate the pharmacokinetic behavior of escin Ia in rats after low, medium and high-dose intravenous administration. Wistar rats were divided into 3 groups (n=6 per group) and escin Ia was administered via the caudal vein at doses of 0.5, 1.0 and 2.0 mg/kg, respectively. Subsequently, the concentrations of escin Ia and its metabolite isoescin Ia, a positional isomer of escin Ia, in rats׳ plasma were measured by an established liquid chromatography tandem mass spectrometry (LC-MS/MS) method at various time points following the administration of the drug. Main pharmacokinetic parameters were calculated by non-compartmental analysis using the TopFit 2.0 software package (Thomae GmbH, Germany). After intravenous administration, the Cmax and AUC of escin Ia increased in a dose-proportional manner at the dose of 0.5 mg/kg and 1.0 mg/kg, while increased in a more than dose-proportional manner at the doses of 1.0 mg/kg and 2.0 mg/kg. The t₁/₂ was significantly longer with increased intravenous doses, while other parameters such as CL and Vd also exhibit disagreement among three doses. Taken together, our data showed dose-dependent pharmacokinetic profile of escin Ia in rats after intravenous administration at the doses of 0.5-2.0 mg/kg. After intravenous administration, escin Ia was rapidly and extensively converted to isoescin Ia. The results suggested dose-dependent pharmacokinetics of escin Ia at the doses of 0.5-2.0 mg

Evaluation of anti-asthmatic and antioxidant potential of Boerhavia procumbens in toluene diisocyanate (TDI) treated rats.

PubMed

Bokhari, Jasia; Khan, Muhammad Rashid

2015-08-22

Asthma is an ailment of airways characterized by activation of the T helper (Th) 2 lymphocytes and subsequent movement of inflammatory cells. Boerhavia procumbens of family Nyctaginaceae is locally used for the treatment of asthma, cough, hemorrhoids, dropsy, cardiac, eyes and kidney problems. We have evaluated its methanol extract (BPM) as a therapeutic candidate for asthma against toluene diisocyanate (TDI) allergic model in rat. The BPM extract was obtained from the whole plant of B. procumbens in methanol. Sprague-Dawley male 36 rats (200-250 g) were categorized into 6 groups having six rats in each category. The animals were provoked (10%) and sensitized (5%) by TDI. Animals of groups I-III were vehicle control (ethyl acetate), diseased control (TDI) and reference control (TDI+dexamethasone {2.5mg/kg bw}), respectively. Animals of group IV (TDI+200mg/kg bw) and group V (TDI+400mg/kg bw) were administered with BPM whereas group VI was administered with 400mg/kg bw alone of BPM. Protective effects of BPM were determined by counting the number of leucocytes and estimation of interleukines in blood, bronchoalveolar lavage (BAL) and in in vitro culture of spleen cells. Estimation of antioxidant enzymes, lipid peroxides and H2O2 and histopathology of lungs were carried out for antioxidant potential of plant extract used. Methanol extract of B. procumbens suppressed the asthmatic symptoms and inhibited the infiltration of eosinophils and lymphocytes in lungs of TDI provoked rats. Administration of BPM to TDI provoked rats, dose dependently, inhibited the release of interleukins (IL)-2 in serum and IL-4, IL-6 interferon gamma (IFN-γ) in bronchoalveolar lavage (BAL) and in in vitro culture of spleen cells, and ameliorated the oxidative stress in lung tissues. Quantitative scoring of the lung histopathology exhibited protective effects of BPM and the inflammation, mucus, thickening of peribronchial smooth muscle layer and subepithelial deposition of collagen induced

Acute and sub-chronic oral toxicity assessment of the aqueous extract leaves of Ficus glumosa Del. (Moraceae) in rodents.

PubMed

Ntchapda, Fidèle; Abakar, Djedouboum; Kom, Blaise; Nana, Paulin; Hamadjida, Adjia; Dimo, Théophile

2014-01-01

Ficus glumosa Del (Moraceae), a plant used in traditional medicine in Cameroon, Senegal, and East Africa for the treatment of edema, hemorrhoid, cardiovascular diseases especially hypertension. The present study evaluated the potential toxicity of the aqueous extract of the leaves of F.glumosa in acute and sub-chronic administration in rodents. Acute toxicity was evaluated on 3 months old mice of both sexes and weighing 20-30 g. A single dose (2-12 g/kg) of F. glumosa was administered orally to mice. Animal behavior, adverse effects, and mortality were determined for 14 days. In sub-chronic toxicity studied in both sexes of 9 weeks old rats and weighing 100-120 g at the start of the experiment, animals were treated orally with a daily dose of 300, 600 and 1200 mg/kg of the aqueous extract of the leaves of F. glumosa for 6 weeks. The body weight change, food, and water consumption, were determined throughout the experimental period, while the relative organ weights, the hematological and biochemical parameters of blood and urine, as well as the histology of tissues kidney and liver, were recorded at the end of the experiment. For acute treatment, no dose used induced critical behavioral changes or death. In sub-chronic treatment, daily oral administration of F. glumosa at the dose of 300, 600, and 1200 mg/kg resulted in a significant increase in body weight relative to food and water consumption in the last week of treatment. The relative organ weights were not affected by treatment. No hematological changes were observed except the significant increase in platelets. Aspartate aminotransferase, alanine transaminase, alkaline phosphatase, total protein, increased while the total cholesterol, triacylglycerol, conjugated bilirubin, and total bilirubin significantly decreased. Index of renal function showed a decrease of creatinine, urea, uric acid and Na(+), Cl(-) and Ca(2+), and inorganic phosphate. The histology of liver and kidney showed no significant alteration of

An ethnobotanical survey of medicinal plants in western part of central Taurus Mountains: Aladaglar (Nigde - Turkey).

PubMed

Özdemir, Ebru; Alpınar, Kerim

2015-05-26

With this study, we aimed to document traditional uses of medicinal plants in the western part of Aladaglar/Nigde. This study was conducted between 2003 and 2005. The research area was in the western part of the Aladaglar mountains. The settlements in Aladaglar (5 towns and 10 villages) were visited during the field work. The plants collected by the help of medicinal plant users. The plants were identified and voucher specimens prepared. These voucher specimens were kept at the Herbarium of Istanbul University Faculty of Pharmacy (ISTE). We collected the information by means of semi-structured interviews with 170 informants (90 men and 80 women). In addition, the relative importance value of the species was determined and the informant consensus factor (FIC) was calculated for the medicinal plants researched in the study. According to the results of the identification, among 126 plants were used by the inhabitants and 110 species belonging to 40 families were used for medicinal purposes. Most of the medicinal plants used in Aladaglar/Nigde belong to the families Lamiaceae (25 species), Asteraceae (16 species), Apiaceae (7 species), Fabaceae (6 species) and Brassicaceae (5 species). The most commonly used plant species were Hypericum perforatumThymus sipyleus var. sipyleus, Rosa canina, Urtica dioica, Malva neglecta, Thymus leucotrichus, Salix alba, Mentha longifolia, Berberis crataegina, Juniperus oxycedrus, Viscum album subsp. abietis, Allium rotundum and Taraxacum stevenii. The most common preparations were infusion and decoction. The traditional medicinal plants have been mostly used for the treatment of cardiovascular diseases (86%), hemorrhoids (79%), urinary diseases (69%), diabetes (68%) and respiratory diseases (61%). The use of traditional medicine was still widespread among the inhabitants of Aladaglar mountains/Nigde region. Due to the lack of medical facilities in the villages of Aladaglar mountains, local people prefer herbal treatment rather than

Comparative pharmacokinetics and bioavailability of escin Ia and isoescin Ia after administration of escin and of pure escin Ia and isoescin Ia in rat.

PubMed

Wu, Xiu-Jun; Zhang, Meng-Liang; Cui, Xiang-Yong; Gao, Feng; He, Qun; Li, Xiao-Jiao; Zhang, Ji-Wen; Fawcett, J Paul; Gu, Jing-Kai

2012-01-06

Escin Ia and isoescin Ia have been traditionally used clinically as the chief active ingredients of escin, a major triterpene saponin isolated from horse chestnut (Aesculus hippocastanum) seeds for the treatment of chronic venous insufficiency, hemorrhoids, inflammation and edema. To establish a sensitive LC-MS/MS method and investigate the pharmacokinetic properties of escin Ia and isoescin Ia in rats and the pharmacokinetics difference of sodium escinate with pure escin Ia and isoescin Ia. The absolute bioavailability of escin Ia and isoescin Ia and the bidirectional interconversion of them in vivo were also scarcely reported. Wister rats were administrated an intravenous (i.v.) dose (1.7 mg/kg) of sodium escinate (corresponding to 0.5mg/kg of escin Ia and 0.5mg/kg of isoescin Ia, respectively) and an i.v. dose (0.5mg/kg) or oral dose (4mg/kg) of pure escin Ia or isoescin Ia, respectively. At different time points, the concentrations of escin Ia and isoescin Ia in rat plasma were determined by LC-MS/MS method. Main pharmacokinetic parameters including t(1/2), MRT, CL, V(d), AUC and F were estimated by non-compartmental analysis using the TopFit 2.0 software package (Thomae GmbH, Germany) and statistical analysis was performed using the Student's t-test with P<0.05 as the level of significance. After administration of sodium escinate, the t(1/2) and MRT values for both escin Ia and isoescin Ia were larger than corresponding values for the compounds given alone. Absorption of escin Ia and isoescin Ia was very low with F values both <0.25%. Escin Ia and isoescin Ia were found to form the other isomer in vivo with the conversion of escin Ia to isoescin Ia being much extensive than from isoescin Ia to escin Ia. Comparison of the pharmacokinetics of escin Ia and isoescin Ia given alone and together in rat suggest that administration of herbal preparations of escin for clinical use may provide longer duration of action than administration of single isomers. The

Massive adrenal vein aneurysm mimicking an adrenal tumor in a patient with hemophilia A: a case report and review of the literature.

PubMed

Sleightholm, Richard; Wahlmeier, Steven; Carson, Jeffrey S; Drincic, Andjela; Lazenby, Audrey; Foster, Jason M

2016-12-01

Visceral venous aneurysms are exceedingly rare, and until now, there have been no reports of this phenomenon in the adrenal vasculature. This report details the first adrenal venous aneurysm reported in the literature. The aneurysm presented as an 18-cm mass that was initially suspected to be a hematoma or tumor on the basis of the complex medical history of the patient, which included hemophilia A and testicular cancer. After surgical excision, pathologic examination confirmed this mass to be a 15.9-cm adrenal vein aneurysm, the largest aneurysm of any type or location recorded in the medical literature. A 58-year-old caucasian male with hemophilia A presented to the emergency room of another institution with abdominal pain, blood in the stool, and a history of diverticulosis and symptomatic hemorrhoids. A large, left-sided adrenal mass was detected by computed tomography, and because of the patient's hemophilia A and imaging consistent with a hemorrhagic mass, a hematoma was initially suspected. The patient was transferred to our institution, monitored for further bleeding with a stable hospital course, and discharged from the hospital under close monitoring. After 7-8 weeks with no change in the size of the mass, concerns grew regarding increasing symptoms of both satiety and mass effects from the large anomaly, as well as about the patient's complicated medical history, which also included cancer. Surgical excision was recommended because of the concerns about increasing symptoms and the possibility of a malignancy. Correction and maintenance of factor VIII levels were incorporated pre-, intra-, and postoperatively, and en bloc surgical resection was performed to minimize bleeding and provide oncologic extirpation of the mass. A bowling ball-sized mass was removed, and careful pathologic examination revealed the mass to be a venous adrenal aneurysm. After a brief hospital stay, the patient made a full recovery. Extensive review of the literature revealed 11

Anal skin tags in inflammatory bowel disease: new observations and a clinical review.

PubMed

Bonheur, Jennifer L; Braunstein, Jared; Korelitz, Burton I; Panagopoulos, Georgia

2008-09-01

The association between intestinal Crohn's disease (CD) and specific perianal abnormalities called anal skin tags (AST) has been recognized but not well defined. Skin tags have been classified into 2 types: 1) raised, broad, or narrow, single or multiple, soft or firm, and painless, often referred to as "elephant ears"; or 2) edematous, hard, often cyanotic, tender or not, and typically arising from a healed anal fissure, ulcer, or hemorrhoid. The aims of this study were to i) better characterize those skin tags identified by the term "elephant ears" and differentiate them from other types of AST; ii) compare their prevalence in patients with CD and ulcerative colitis (UC); iii) observe the relationship of the skin tags to the location of the primary bowel disease; and iv) to discuss the value of these typical AST in making an early diagnosis of CD. Photographs of all AST were taken when present at lower endoscopy in 170 consecutive patients with inflammatory bowel disease (IBD) seen in the private office of the senior investigator and Lenox Hill Hospital. Data was gathered with respect to major differences between the 2 types of AST. The location of the primary bowel disease for these patients was obtained from an extensive IBD computer database and review of details from charts. Specific features of AST were described and served to favor type 1 versus type 2. AST were found more frequently in patients with CD (75.4%) as compared to patients with UC (24.6%), confirming previous observations that they are more diagnostic of CD (P = 0.005). Subset analysis revealed a trend with a greater incidence of AST in patients with colitis (46.9%) as compared to patients with ileitis (36.7%) and ileocolitis (16.3%) (P = 0.067). We provide photographs with the most characteristic features of AST and attempt to separate elephant ears (type 1) from less typical AST (type 2) in CD. Our study confirms previous reports that AST are more commonly found in association with CD as

Late rectal bleeding after 3D-CRT for prostate cancer: development of a neural-network-based predictive model

NASA Astrophysics Data System (ADS)

Tomatis, S.; Rancati, T.; Fiorino, C.; Vavassori, V.; Fellin, G.; Cagna, E.; Mauro, F. A.; Girelli, G.; Monti, A.; Baccolini, M.; Naldi, G.; Bianchi, C.; Menegotti, L.; Pasquino, M.; Stasi, M.; Valdagni, R.

2012-03-01

The aim of this study was to develop a model exploiting artificial neural networks (ANNs) to correlate dosimetric and clinical variables with late rectal bleeding in prostate cancer patients undergoing radical radiotherapy and to compare the ANN results with those of a standard logistic regression (LR) analysis. 718 men included in the AIROPROS 0102 trial were analyzed. This multicenter protocol was characterized by the prospective evaluation of rectal toxicity, with a minimum follow-up of 36 months. Radiotherapy doses were between 70 and 80 Gy. Information was recorded for comorbidity, previous abdominal surgery, use of drugs and hormonal therapy. For each patient, a rectal dose-volume histogram (DVH) of the whole treatment was recorded and the equivalent uniform dose (EUD) evaluated as an effective descriptor of the whole DVH. Late rectal bleeding of grade ≥ 2 was considered to define positive events in this study (52 of 718 patients). The overall population was split into training and verification sets, both of which were involved in model instruction, and a test set, used to evaluate the predictive power of the model with independent data. Fourfold cross-validation was also used to provide realistic results for the full dataset. The LR was performed on the same data. Five variables were selected to predict late rectal bleeding: EUD, abdominal surgery, presence of hemorrhoids, use of anticoagulants and androgen deprivation. Following a receiver operating characteristic analysis of the independent test set, the areas under the curves (AUCs) were 0.704 and 0.655 for ANN and LR, respectively. When evaluated with cross-validation, the AUC was 0.714 for ANN and 0.636 for LR, which differed at a significance level of p = 0.03. When a practical discrimination threshold was selected, ANN could classify data with sensitivity and specificity both equal to 68.0%, whereas these values were 61.5% for LR. These data provide reasonable evidence that results obtained with

The contribution of traditional healers' clinics to public health care system in Addis Ababa, Ethiopia: a cross-sectional study.

PubMed

Birhan, Wubet; Giday, Mirutse; Teklehaymanot, Tilahun

2011-12-02

Ethiopian people have been using traditional medicine since time immemorial with 80% of its population dependent on traditional medicines. However, the documentation of traditional healers' clinics contribution to modern public health system in cosmopolitan cities is scanty. Studies conducted so far are limited and focused on the perceptions and practices of modern and traditional health practitioners about traditional medicine. Thus, a cross sectional study was conducted from February to May 2010 to assess the contribution of traditional healers' clinics to public health care system in Addis Ababa. Ten traditional healers who were willing to participate in the study and 306 patients who were visiting these traditional healers' clinics were interviewed using two types of semi-structured questionnaires. Data were summarized using percentages, tables and bar chart. The diseases mostly treated by traditional healers were wound, inflammation, herpes zoster, hemorrhoids, fracture, paralysis, back-pain, liver diseases, cancer and eczema. This study showed that traditional healers' clinics considerably contribute to public health care in Addis Ababa. Fifty two percent of patients reported that traditional healers' clinics were their first choice when they faced health problems. The reasons for visiting these clinics were 175 (57.2%) efficacy, 109 (35.6%) dissatisfaction with modern medicine, 10 (3.3%) dissatisfaction with modern medicine and efficacy, 6 (2.0%) cost and 6 (2.0%) dissatisfaction and cost. Females (55.2%), young age (20-40 years, 65.0%), never married (56.9%), orthodox (73.9%), Amhara (52.3%), educational status above grade 12 (34.6%) and government employees (29.4%) were frequent visitors. Healers reported that there was no form of cooperation with modern health professionals. The reasons were lack of motivation to collaborate and communicate with modern health service workers. Family based apprenticeship was the sources of knowledge for majority of the

Predictive Parameters of Symptomatic Hematochezia Following 5-Fraction Gantry-Based SABR in Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Musunuru, Hima Bindu; Department of Radiation Oncology, University of Toronto, Toronto, Ontario; Davidson, Melanie

2016-04-01

Purpose: This study identified predictors of high-grade late hematochezia (HH) following 5-fraction gantry-based stereotactic ablative radiation therapy (SABR). Methods and Materials: Hematochezia data for 258 patients who received 35 to 40 Gy SABR in 5-fractions as part of sequential phase 2 prospective trials was retrieved. Grade 2 or higher late rectal bleeding was labeled HH. Hematochezia needing steroid suppositories, 4% formalin, or 1 to 2 sessions of argon plasma coagulation (APC) was labeled grade 2. More than 2 sessions of APC, blood transfusion, or a course of hyperbaric oxygen was grade 3 and development of visceral fistula, grade 4. Various dosimetricmore » and clinical factors were analyzed using univariate and multivariate analyses. Receiver operating characteristic (ROC) curve analysis and recursive partitioning analysis were used to determine clinically valid cut-off points and identify risk groups, respectively. Results: HH was observed in 19.4%, grade ≥3 toxicity in 3.1%. Median follow-up was 29.7 months (interquartile range [IQR]: 20.6-61.7) Median time to develop HH was 11.7 months (IQR: 9.0-15.2) from the start of radiation. At 2 years, cumulative HH was 4.9%, 27.2%, and 42.1% in patients who received 35 Gy to prostate (4-mm planning target volume [PTV] margin), 40 Gy to prostate (5-mm PTV margin), and 40 Gy to prostate/seminal vesicles (5-mm PTV margin), respectively (P<.0001). In the ROC analysis, volume of rectum receiving radiation dose of 38 Gy (V38) was a strong predictor of HH with an area under the curve of 0.65. In multivariate analysis, rectal V38 (≥2.0 cm{sup 3}; odds ratio [OR]: 4.7); use of anticoagulants in the follow-up period (OR: 6.5) and presence of hemorrhoids (OR: 2.7) were the strongest predictors. Recursive partitioning analysis showed rectal V38 < 2.0 cm{sup 3}, and use of anticoagulants or rectal V38 ≥ 2.0 cm{sup 3} plus 1 other risk factor resulted in an HH risk of >30%. Conclusions: Rectal V38

The contribution of traditional healers' clinics to public health care system in Addis Ababa, Ethiopia: a cross-sectional study

PubMed Central

2011-01-01

Background Ethiopian people have been using traditional medicine since time immemorial with 80% of its population dependent on traditional medicines. However, the documentation of traditional healers' clinics contribution to modern public health system in cosmopolitan cities is scanty. Studies conducted so far are limited and focused on the perceptions and practices of modern and traditional health practitioners about traditional medicine. Thus, a cross sectional study was conducted from February to May 2010 to assess the contribution of traditional healers' clinics to public health care system in Addis Ababa. Materials and methods Ten traditional healers who were willing to participate in the study and 306 patients who were visiting these traditional healers' clinics were interviewed using two types of semi-structured questionnaires. Data were summarized using percentages, tables and bar chart. Results The diseases mostly treated by traditional healers were wound, inflammation, herpes zoster, hemorrhoids, fracture, paralysis, back-pain, liver diseases, cancer and eczema. This study showed that traditional healers' clinics considerably contribute to public health care in Addis Ababa. Fifty two percent of patients reported that traditional healers' clinics were their first choice when they faced health problems. The reasons for visiting these clinics were 175 (57.2%) efficacy, 109 (35.6%) dissatisfaction with modern medicine, 10 (3.3%) dissatisfaction with modern medicine and efficacy, 6 (2.0%) cost and 6 (2.0%) dissatisfaction and cost. Females (55.2%), young age (20-40 years, 65.0%), never married (56.9%), orthodox (73.9%), Amhara (52.3%), educational status above grade 12 (34.6%) and government employees (29.4%) were frequent visitors. Healers reported that there was no form of cooperation with modern health professionals. The reasons were lack of motivation to collaborate and communicate with modern health service workers. Family based apprenticeship was the

Medicinal plants of the genus Anthocleista--A review of their ethnobotany, phytochemistry and pharmacology.

PubMed

Anyanwu, Gabriel O; Nisar-ur-Rehman; Onyeneke, Chukwu E; Rauf, Khalid

2015-12-04

The genus Anthocleista of the Gentianaceae family contains 14 species of trees and shrub-like plants distributed in tropical Africa, in Madagascar and on the Comoros. Traditionally, they are commonly used in the treatment of diabetes, hypertension, malaria, typhoid fever, obesity, diarrhea, dysentery, hyperprolactinemia, abdominal pain, ulcer, jaundice, asthma, hemorrhoids, hernia, cancer, wounds, chest pains, inflammations, rheumatism, STDs, infertility and skin diseases. They serve as an anthelmintic, laxative, diuretic and contraceptive. This review aims to provide for the first time a repository of ethnopharmacological information while critically evaluating the relation between the traditional medicinal uses, chemical constituents and pharmacological activities of the Anthocleista species so as to unveil opportunities for future research. A search for relevant information on Anthocleista species was performed on scientific databases (Pubmed, Google Scholar, SciFinder, Web of Science, Scopus, PubChem and other web sources such as The Plant List, Kew Botanical Garden and PROTA) and books, PhD and MSc dissertations for un-published resources. Out of the 14 species of Anthocleista, 6 have been reported in literature to be widely used in traditional medicine for the treatment of various ailments. The six species include: A. djalonensis, A. vogelii, A. nobilis, A. grandiflora, A. schweinfurthii, and A. liebrechtsiana. The chemical compounds isolated from Anthocleista species fall into the class of phytochemicals such as secoiridoids, nor-secoiridoids, xanthones, phytosterols, triterpenes, alkaloids, and others of which majority of the compounds were isolated from A. djalonensis and A. vogelii. The in vitro and in vivo pharmacological studies on the crude extracts, fractions and few isolated compounds of Anthocleista species showed antidiabetic, antiplasmodial, antimicrobial, hypotensive, spasmogenic, anti-obesity, antiulcerogenic, analgesic, anti

Local and traditional uses, phytochemistry, and pharmacology of Sophora japonica L.: A review.

PubMed

He, Xirui; Bai, Yajun; Zhao, Zefeng; Wang, Xiaoxiao; Fang, Jiacheng; Huang, Linhong; Zeng, Min; Zhang, Qiang; Zhang, Yajun; Zheng, Xiaohui

2016-07-01

Sophora japonica (Fabaceae), also known as Huai (Chinese: ), is a medium-sized deciduous tree commonly found in China, Japan, Korea, Vietnam, and other countries. The use of this plant has been recorded in classical medicinal treatises of ancient China, and it is currently recorded in both the Chinese Pharmacopoeia and European Pharmacopoeia. The flower buds and fruits of S. japonica, also known as Flos Sophorae Immaturus and Fructus Sophorae in China, are most commonly used in Asia (especially in China) to treat hemorrhoids, hematochezia, hematuria, hematemesis, hemorrhinia, uterine or intestinal hemorrhage, arteriosclerosis, headache, hypertension, dysentery, dizziness, and pyoderma. To discuss feasible trends for further research on S. japonica, this review highlights the botany, ethnopharmacology, phytochemistry, biological activities, and toxicology of S. japonica based on studies published in the last six decades. Information on the S. japonica was collected from major scientific databases (SciFinder, PubMed, Elsevier, SpringerLink, Web of Science, Google Scholar, Medline Plus, China Knowledge Resource Integrated (CNKI), and "Da Yi Yi Xue Sou Suo (http://www.dayi100.com/login.jsp)" for publications between 1957 and 2015 on S. japonica. Information was also obtained from local classic herbal literature, government reports, conference papers, as well as PhD and MSc dissertations. Approximately 153 chemical compounds, including flavonoids, isoflavonoids, triterpenes, alkaloids, polysaccharides, amino acids, and other compounds, have been isolated from the leaves, branches, flowers, buds, pericarps, and/or fruits of S. japonica. Among these compounds, several flavonoids and isoflavonoids comprise the active constituents of S. japonica, which exhibit a wide range of biological activities in vitro and in vivo such as anti-inflammatory, antibacterial, antiviral, anti-osteoporotic, antioxidant, radical scavenging, antihyperglycemic, antiobesity, antitumor, and

Electrical stimulation in exercise training

NASA Technical Reports Server (NTRS)

Kroll, Walter

1994-01-01

Electrical stimulation has a long history of use in medicine dating back to 46 A.D. when the Roman physician Largus found the electrical discharge of torpedo fishes useful in the treatment of pain produced by headache and gout. A rival Greek physician, Dioscorides, discounted the value of the torpedo fish for headache relief but did recommend its use in the treatment of hemorrhoids. In 1745, the Leyden jar and various sized electrostatic generators were used to treat angina pectoris, epilepsy, hemiplegia, kidney stones, and sciatica. Benjamin Franklin used an electrical device to treat successfully a young woman suffering from convulsive fits. In the late 1800's battery powered hydroelectric baths were used to treat chronic inflammation of the uterus while electrified athletic supporters were advertised for the treatment of male problems. Fortunately, such an amusing early history of the simple beginnings of electrical stimulation did not prevent eventual development of a variety of useful therapeutic and rehabilitative applications of electrical stimulation. Over the centuries electrical stimulation has survived as a modality in the treatment of various medical disorders with its primary application being in the rehabilitation area. Recently, a surge of new interest in electrical stimulation has been kindled by the work of a Russian sport scientist who reported remarkable muscle strength and endurance improvements in elite athletes. Yakov Kots reported his research on electric stimulation and strength improvements in 1977 at a Canadian-Soviet Exchange Symposium held at Concordia University in Montreal. Since then an explosion of new studies has been seen in both sport science and in medicine. Based upon the reported works of Kots and the present surge of new investigations, one could be misled as to the origin of electrical stimulation as a technique to increase muscle strength. As a matter of fact, electric stimulation has been used as a technique to improve

[History of patients with pelvic floor dysfunction].

PubMed

Lopez Gaston, A R; Andrüsch, Adriana; Catuogno, Patricia; Lopez De Luise, G; Vazquez, P

2003-01-01

1) To determine differences between sexes; 2) To determine differences by sex and age groups in symptom onset, time of evolution, clinical forms and probable associated causes. 83 consecutive patients with diagnosed PCP (X age = 50.9 SE 2.21). 25 males (30.1% x 51.2 years-old, SE 4.1) and 58 females (69.9%, X 50.8 years-old, SE 2.2). Patients with organic colon-rectum pathology (with the exception of hemorrhoidal pathology, proctologic surgery and active anus fissure) had been excluded. Colonic Double-contrasted Rx, rectum-sigma endoscopy, and eventually a Colonofibroscopy Historic facts and syndromic protocol. Diagnosis criteria: 1) Perineal inspection: perineal contraction with pujo; 2) Rectal tact; 3) Ano-Rectum manometry with perfused system; 4) 150 ml Rectal balloon expulsion dynamic; 5) Utoreported signs and symptoms from a cuestionnaire ad hoc. Division into evolutive groups (continuous and intermittent). Division by age (< = 5, 5.1-25, > 25 years old). descriptive, comparative, correlation, prospective, simple blind. Levene, descriptive, chi square, ANOVA, Kruskall-Wallis, Kendal tau b. 1) Difference in sex proportion was significative (p = 0.0001); 2) There were not differences between sexes in age media at the moment of the study (p = 0.92; 3) The continue evolutive form represented 77.1%, (p = 0.0001) but there weren't differences between sexes (p = 0.19) There weren't evolutive differences between age groups. (p = 0-78) 4) Age of onsec: x = 24.04 years-old, SE 2.02 (4-80 years-old), without differences between sexes (p = 0.16). 14.5% started before age of 5, 85% after that age, without differences between sexes (p = 0.07); 5) The time of evolution x = 26.7 years, SE 2.21, without differences between sexes (p = 0.25); 6) Potential causes were divides into tree categories: I "the patient doesn't remember associated facts" (30.1%, II: psychological or physical stress (39.8%), III: facts related to sexual trauma (30.1%). The differences (p = 0.0001); 7

[Relationship between the expression of DDX39 protein and prognosis of colorectal cancer].

PubMed

Ma, Jun; Chang, Wenjun; Zhang, Wei

2018-03-25

To investigate the relationship between the expression of DDX39 protein and prognosis in colorectal cancer. Clinical data and paraffin specimens of postoperative tumor tissue from 824 patients with primary colorectal cancer who received first surgical treatment at the Department of Colorectal Surgery of Changhai Hospital of Navy Military Medical University from January 2010 to December 2011 were collected. Paraffin samples of paracancerous tissues of 38 patients were served as controls. At the same time, samples of normal rectal mucous membrane from 37 cases after procedure of prolapse and hemorrhoids, and samples of colorectal adenoma from 33 cases after endoscopic treatment were enrolled in this study. All the specimens were made as the tissue microarray, and the expression of DDX39 protein was detected by immunohistochemistry. The expression of DDX39 in the epithelium and stroma was evaluated with the average staining intensity (H-Score) and the number of positive cells. It was defined as high expression in the epithelium that the H-Score was greater than or equal to 200. It was defined as high expression in the stroma that the number of positive cells was greater than or equal to 50 in 200 times the field of vision. Relationship of different DDX39 expression levels with clinicopathological parameters and prognosis of colorectal cancer was analyzed. The expression of DDX39 in colorectal cancer tissues was lower than that in normal tissues, paracancerous tissues and adenomatous tissues, whether it is in the epithelium or in the stroma [DDX39 expression in the epithelium: normal tissues 253.2±64.1, paracancerous tissues 238.8±79.2, adenomatous tissues 259.4±51.6, colorectal cancer tissues 194.2±76.5 (P=0.000, P=0.005, P=0.000, respectively); DDX39 expression in the stroma: normal tissues 110.1±64.8, paracancerous tissues 106.0±49.2, adenomatous tissues 108.5±79.1, colorectal cancer tissues 54.1±34.7(all P=0.000)]. Among the cases of colorectal cancer