Articles on Hemorrhoids Research - Misc

Lower gastrointestinal bleeding.

Bounds BC, Friedman LS.

Department of Medicine, Harvard Medical School, Gastrointestinal Unit, Massachusetts General Hospital, 55 Fruit Street, Blake 453C, Boston, MA 02114, USA. bbounds@partners.org

Gastroenterol Clin North Am. 2003 Dec; 32(4): 1107-25.

Lower gastrointestinal bleeding is defined as blood loss that originates from a source distal to the ligament of Treitz and results in hemodynamic instability or symptomatic anemia. Although approximately 10% to 15% of patients presenting with acute severe hematochezia have an upper gastrointestinal source of bleeding identified on upper endoscopy, the most common causes of lower gastrointestinal bleeding are diverticulosis, hemorrhoids, ischemic colitis, and angiodysplasia. As with upper gastrointestinal bleeding, lower gastrointestinal bleeding ceases spontaneously in most cases.

Risk factors for anal cancer: results of a population-based case--control study.

Tseng HF, Morgenstern H, Mack TM, Peters RK.\

Department of Healthcare Administration, Fooyin University, Kaohsiung, Taiwan, ROC. tsenghf2000@yahoo.com.tw

Cancer Causes Control. 2003 Nov; 14(9): 837-46.

OBJECTIVE: Although the incidence of anal cancer is higher in women than in men, the reasons for this gender difference are not clear. The purpose of this study was to identify risk factors for anal cancer in both men and women. METHODS: We conducted in-person interviews with 102 males and 106 females with squamous or transitional cell carcinoma of the anus and 208 individually matched controls. RESULTS: Compared with persons who had never experienced receptive anal intercourse, those who had experienced it more than 130 times were 18 times as likely to develop anal cancer (adjusted odds ratio [OR] = 17.6 (95% confidence interval [CI] = 1.3-234). This elevated risk occurred primarily among males. The adjusted OR for males having more than 10% of their sexual experiences with other men was 5.6 (95% CI = 1.4-22.0). A history of other anogenital or endometrial cancers increased the risk in women but not men. A history of anal warts, syphilis, severe hemorrhoids, physical inactivity, multiple sexual partners who smoked, and current smoking were also associated with increased risk. CONCLUSIONS: The results of this study suggest that both sexual and non-sexual factors are important in the etiology of anal cancer.

Lower gastrointestinal bleeding in elderly patients.

Akhtar AJ.

Division of Gastroenterology, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA. abakhtar@cdrewu.edu

J Am Med Dir Assoc. 2003 Nov-Dec; 4(6): 320-2.

Lower gastrointestinal bleeding (LGIB) is one of the common medical emergencies that can become life-threatening in elderly patients. Increased prevalence of cerebrovascular and cardiovascular diseases, malignancy, polypharmacy, and the use of nonsteroidal anti-inflammatory drugs in elderly patients adversely affects the outcome of LGIB. Diverticular bleeding, vascular ectasia, polyps and hemorrhoids are among the common causes of LGIB in the elderly. In a majority of cases, LGIB stops spontaneously with resuscitation and supportive therapy. In those elderly patients in whom LGIB continues, benefits of endoscopic, angiographic, or surgical intervention should not be withheld because of age alone. However, the timing of tests and the type of intervention should be custom tailored for frail elderly patients. Such a decision should depend upon functional status, its impact on outcome, and the consent process.

Health conditions of bus drivers in a 6 year follow up study.

Costa G, Sartori S, Facco P, Apostoli P.

Institute of Occupational Medicine and Industrial Hygiene, Brescia, Italy.

J Hum Ergol (Tokyo). 2001 Dec; 30(1-2): 405-10.

The bus drivers of a public bus company, working in a fast rotating 4 shift system from 05.00 to 24.30, were examined in 1993 (230 persons) and 1999 (266 persons). The comparison between the two years showed no significant differences for all the parameters evaluated by the Standard Shiftwork Index and medical examination. In both surveys work organisation was considered "efficient-fairly good" by most workers, who were mostly satisfied with their job. Work load was rated significantly higher for "afternoon" and "morning" shifts, during which most accidents at work and "in itinere" occurred. Night sleep was reduced by 3 hours on "early" shift and about 2 hours on "morning" shifts. The most prevalent health troubles dealt with low back pain, gastritis, headache and haemorrhoids. Neuroticism was the trait more correlated with poorer health conditions, whereas shiftwork exposure appeared as a significant predictor of risk of critical Effort/Reward Imbalance and minor psychological disorders. Both extrinsic and intrinsic efforts significantly increased with age, but not reward. The comparison of the same cohort of 108 persons examined both in 1993 and in 1999 showed a significant increase of low back pain, gastrointestinal troubles, haemorrhoids and lipids disorders.

Lycopene in serum, skin and adipose tissues after tomato-oleoresin supplementation in patients undergoing haemorrhoidectomy or peri-anal fistulotomy.\

Walfisch Y, Walfisch S, Agbaria R, Levy J, Sharoni Y.

Department of Clinical Biochemistry, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Br J Nutr. 2003 Oct; 90(4): 759-66.

Lycopene, the main carotenoid found in tomatoes and tomato-based products, has been reported to be protective against several types of cancer. Assessment of changes in plasma concentration of carotenoids following ingestion of lycopene-rich food sources does not necessarily predict changes in lycopene concentration or distribution of its isomers in other body tissues. Our aim was to determine the relationship between concentrations of lycopene and other tomato carotenoids in human serum and body tissues after tomato-oleoresin supplementation. Tomato lycopene oleoresin (30 mg/d) or a placebo was administered for 1 to 7 weeks to seventy-five volunteers undergoing elective haemorrhoidectomy or peri-anal fistulotomy. Carotenoid concentration and isomer distribution in blood and in the surgically removed skin and adipose tissues was measured by HPLC. The serum concentration of lycopene increased after supplementation from 0.26 (SD 0.12) to 0.52 (SD 0.25) micromol/l (n 35; P<0.0001). In the placebo group (n 40), lycopene serum concentration did not change significantly. Serum lycopene concentration after treatment was 2.2-fold greater in the lycopene group than in the placebo group, a slightly higher ratio than that found in skin and adipose tissue (1.6- and 1.4-fold higher than the placebo, respectively). A significant correlation between serum and tissue concentrations was found for both beta-carotene and lycopene in the placebo group, whereas in the lycopene-supplemented group the correlation between serum and tissues remained the same for beta-carotene but for lycopene was weak. Lycopene supplementation did not significantly change the proportion of all-trans v. cis isomers in the serum and tissues, despite the fact that more than 90 % of the supplemented lycopene was in the all-trans form. These results show that tomato-oleoresin supplementation increases lycopene concentrations in serum and in adipose tissue and skin. The ability to increase lycopene levels in tissues is one of the prerequisites for using it as a food supplement with health benefits.

Haemorrhoids--a review.

Orlay G.

Wales Day Centre, Colorectal and Proctology Clinic, Randwick, New South Wales. Orlay@wales.com.au

Aust Fam Physician. 2003 Jul; 32(7): 523-6.

BACKGROUND: Haemorrhoids have plagued humankind since the dawn of history. Hippocrates describes the treatment of anorectal disorders with special exactness. He describes specula to examine patients and he treated patients with suppositories, cautery and even by excision. It seems the fundamentals of haemorrhoid treatment have not changed for thousands of years. OBJECTIVE: This article presents a review of haemorrhoids with particular reference to the general practice setting. DISCUSSION: It has been estimated that 50% of the population has haemorrhoids by the age of 50 years. Although patients often consider the condition to be a single simple disease, this is not so. This article demonstrates that a large variety of closely related conditions are classified as haemorrhoids and it emphasises the dangers of misdiagnosis as haemorrhoids can mimic more important and serious diseases.

Some notes on an early nineteenth century manuscript medical receipt book.

Jackson WA.

Pharm Hist (Lond). 2003 Jun; 33(2): 22-8.

There are 97 remedies listed, including 11 veterinary ones. These numbers include several that are duplicates. The commonest types of medicament are salves or ointments, of which there are ten, but these ten do not include ointments for specific complaints such as haemorrhoids or scurvy. The most frequently found cures are for the itch (10), rheumatism (5), gravel (4), pain (4), and piles (3), all the others having only one or two entries. They were intended to treat 39 human complaints and 9 animal ones. In addition there were formulae for killing lice, making rat poison, and preparing damson wine! The number of different medicaments that were used in the recipes was relatively small, but more than were to be found in the smaller sizes of domestic medicine cabinet. In 1820 Reece's Traveller's Dispensary that was flat and would fit in the pocket of a carriage, only contained ten drugs plus court plaster, lint, scales and weights with a book of directions and cost L3.10s.0d. (L3.50). The Lady's Dispensary which contained twenty medicines, including two pills, with some dispensing equipment and a book of directions cost L5.10s.0d. (L5.50). In all, he listed twenty different cabinets and a sea medicine chest ranging in price from L3.10s.0d. to L32.10s.0d. They included ones suitable for the family, country clergymen, and travellers on the continent and in the tropics. In 1862 Savory and Moore stocked a range of sixty-seven different medicine chests and cases in rosewood, mahogany, walnut, boxwood and leather that were fitted with 'modern appliances and conveniences adapted for the requirements of families, clergymen, officers, owners of yachts, and travellers.' Unfortunately no prices are quoted. I think that we can safely assume that the treatment received at the hands of Evan Jones was likely to be rather rough and ready when compared to the ministrations of a physician, surgeon, clergyman or local 'Lady Bountiful', but, nevertheless, must have been of great value to those who could not afford professional treatment.

[Epidemiology of anal lesions (fissure and thrombosed external hemorroid) during pregnancy and post-partum]

Abramowitz L, Batallan A.

Service de gastro-enterologie et Famya de coloproctologie, hopital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France. laurent.abramowitz@bch.ap-hop-paris.fr

Gynecol Obstet Fertil. 2003 Jun; 31(6): 546-9. [Article in French]

Thrombosed external hemorrhoids (TEH) and anal fissure (AF) are 2 frequent sources of anal pains during childbirth. We are going to define their incidences as available in publications and in our experience in Bichat hospital. Then we will define their risk factors. According to Martin's and Corby's studies, AF was observed in 10% of the delivered women. In Bichat hospital we performed a proctological assessment to 165 pregnant women during the last third of pregnancy and within the 2 months following delivery. We observed 2 AF (1,2%) during the first period and 25 (15,2%) during the second. Rouillon et al. reported an incidence of TEH in 12,2% (20/164), while Pradel and al. reported 34% (18/52) of it. In Bichat hospital, 13 women (7,9%) were presenting with TEH during the last third of pregnancy and 33 (20%) in post-partum period. Two studies looked for a statistical correlation between AF and obstetrical, foetal or maternal factors. Corby et al. only pointed the role of constipation. In our study, terminal constipation was the most important risk factor for AF with 5.7 (2.7-12), odds ratio (95% confidence intervals). Rouillon et al. observed more TEH among women with a prolonged first stage labor and a big baby. In our study, a big baby and mother little lips tears were observed more often among women with TEH (P <0,05). Also, we observed only one TEH among the 25 women with caesarean section (4%). Finally, observation that TEH arise immediately after delivery is another argument to support the role of traumatic delivery. We also demonstrated the role of terminal constipation as risk factor for TEH after delivery. To conclude, 1/3 of pregnant women develop AF or TEH after delivery. These 2 pathologies are strongly correlated to terminal constipation. TEH seems equally furthered by traumatic delivery.

CBP 1011: Colirest, Hematrol.

Adis International Ltd.

Drugs R D. 2003; 4(4): 241-2.

InKine Pharmaceutical Co. is developing an oral compound, CBP 1011, for the treatment of immune thrombocytopenic purpura (ITP) [Hematrol] and for the treatment of inflammatory bowel disorders, ulcerative colitis and Crohn's disease (Colirest).This profile has been selected from R&D Insight, a pharmaceutical intelligence database produced by Adis International Ltd. CBP 1011 or medroxyprogesterone, is a progesterone agonist and inhibits pro-inflammatory mediators such as interleukin-6 and tumour necrosis factor (TNF). CBP 1011 was originally developed by CorBec Pharmaceuticals, which in 1997 was aquired by Panax and then intergrated into InKine Pharmaceuticals. According to a company spokesperson, InKline is pursuing outlicensing opportunities for Hematrol since the company's current commercial focus is on gastrointestinal products. In June 2000, InKine announced the completion of a study comparing the bioavailability of a commercially viable tablet formulation of CBP 1011 to the original capsule formulation that is currently being used in the company's phase III studies in patients with idiopathic thrombocytopenic purpura. Preliminary results from this study indicate that the bioavailability of the tablet formulation does not differ significantly from that of the capsule formulation. The trial enrolled ITP patients (i) who are HIV positive, (ii) who are chronic ITP sufferers despite having had a splenectomy, (iii) who are older, or (iv) who have less severe thrombocytopenia. In preclinical trials, CBP 1011 was shown to decrease lymphocyte infiltration into the bowel compared with the control. Studies also show that it possibly offers safety benefits over steroid therapies. In June 2001, InKine commenced enrolment for a pivotal phase III trial in the treatment of Crohn's disease. This randomised, double-blind trial will enrol approximately 250 patients and will compare two doses of CBP 1011 (400 and 1000mg) with placebo. In April 2003, the US Patent and Trademark Office granted InKine Pharmaceutical a 'Notice of Allowance' for the 'Method of Treating Inflammatory Conditions with Progesterone or Progesterone Analogs'. This patent for medroxyprogesterone (Colirest) provides InKine patent protection for the use of Colirest in treating patients with Crohn's disease, ulcerative colitis, proctitis, microscopic colitis, allergic eosinophilic gastroenteritis, food allergies, drug-induced oesophagitis, coeliac disease, recurrent polyps and haemorrhoids. The patent protection also covers Colirest in a variety of delivery forms such as tablet, enema, suppository, foam, gel, ointment and suspension.

The contemporary management of haemorrhoids.

Beattie GC, Wilson RG, Loudon MA.

Department of Surgery, Royal Infirmary, Edinburgh, UK.

Colorectal Dis. 2002 Nov; 4(6): 450-4.

BACKGROUND: New concepts in the management of haemorrhoidal disease have recently rekindled interest in this common pathology. General and subspecialist colorectal surgeons were surveyed to assess their impact on the current management of haemorrhoids. METHODS: A questionnaire was sent to all members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the Association of Surgeons of Great Britain and Ireland (ASGBI). Regarding indications for surgery, surgical techniques, day case haemorrhoidectomy (DCH) and postoperative treatment regimens. ASGBI members were asked to state their subspecialist interest and estimated time devoted to colorectal practice. RESULTS: There were 406 (71%) ACPGBI respondents and 483 (68%) ASGBI respondents. Eighty-four (12%) ASGBI respondents performed no elective colorectal surgery. One hundred and ninety-nine (35%) of ACPGBI respondents saw between 6 and 10 new haemorrhoid patients per week whereas three hundred (42%) of ASGBI respondents saw between 1 and 5 per week. Non-operative management included routine advice on fluid and diet by the majority of surgeons, with banding carried out in 79% (ACPGBI) and 75% (ASGBI) and injection sclerotherapy in 61% (ACPGBI) and 56% (ASGBI). The Milligan Morgan haemorrhoidectomy was performed in 265 (46%; ACPGBI) and 336 (47%; ASGBI). ACPGBI members used Submucosal diathermy (148, 26%vs 67, 9%; ASGBI (P < 0.01; chi2 test with Yates correction)) and stapled anoplasty (61, 11%vs 14, 2%; ASGBI (P < 0.01; chi2 test with Yates correction)) more often. DCH was performed in 117 (20%; ACPGBI) and in 48 (7%; ASGBI)(P < 0.01; chi2 test with Yates correction). CONCLUSIONS: In this sample of surgeons, operative management varies according to specialist interest. There was a trend towards day case haemorrhoidectomy. Whilst more surgeons have accepted the use of postoperative techniques to reduce pain, only a small minority have, as yet, adopted new surgical techniques such as stapling.

The value of flexible sigmoidoscopy for patients with bright red rectal bleeding.

Choi HK, Law WL, Chu KW.

Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.

Hong Kong Med J. 2003 Jun; 9(3): 171-4.

OBJECTIVE: To review the diagnostic yield of flexible sigmoidoscopy in patients presenting with bright red rectal bleeding. DESIGN: Retrospective study. SETTING: University teaching hospital, Hong Kong. SUBJECTS AND METHODS: Patients who underwent flexible sigmoidoscopy between January 1995 and April 1996 for investigation of bright red rectal bleeding were recruited. The extent of the endoscopic examination, complications, and endoscopic findings were recorded. RESULTS: A total of 1052 patients were included in the study. The mean length of endoscopic examination was 55 cm. There were no complications attributed to the procedure. Thirteen (1.2%) patients aged from 41 to 87 years were found to have malignant tumours that were not palpable on digital examination. All the tumours were moderately differentiated adenocarcinoma. Two patients had synchronous liver metastasis at presentation. Adenomatous polyps were detected in 81 (7.7%) patients, of whom 76 were older than 40 years. The majority of polyps were tubular adenomas associated with mild or moderate dysplasia. Other endoscopic findings included hyperplastic and juvenile polyps, proctocolitis, diverticulosis, irradiation colitis, ischaemic colitis, rectal ulcers, and infective colitis. The overall diagnostic yield was 21.1%. No mucosal lesion was detected by flexible sigmoidoscopy in 78.9% of patients in whom the rectal bleeding was due to either haemorrhoids or anal fissure. CONCLUSIONS: Cancer was detected in 1.2% and adenomatous polyps in 7.7% of patients with bright red rectal bleeding using flexible sigmoidoscopy. All cancers and 94% of adenomatous polyps were detected in patients older than 40 years. Flexible sigmoidoscopy appears to be a valuable initial investigation for bright red rectal bleeding in patients older than 40 years.

Diseases of the rectum and anus: a clinical approach to common disorders.

Gopal DV.

Division of Gastroenterology, Oregon Health & Science University, Portland VA Medical Center, Portland, Oregon, USA.

Clin Cornerstone. 2002; 4(4): 34-48.

Diseases of the rectum and anus are common, and the prevalence in the general population is probably much higher than that seen in clinical practice since most patients with symptoms referable to the anorectum do not seek medical attention. The examination and diagnosis of certain anorectal disorders can be challenging, and the physical examination of the anorectum is often inadequately performed in clinical practice. This article reviews the important features of the anorectal examination and the diagnosis and treatment of benign anorectal disorders such as hemorrhoids, fissures, fistulas, solitary rectal ulcer syndrome, fecal incontinence, and pruritus ani. Approaches to staging and managing malignant neoplasms of the anus and rectum are outlined.

Self-reported stress and subsequent hospital admissions as a result of hypertension, varicose veins and haemorrhoids.

Metcalfe C, Davey Smith G, Macleod J, Heslop P, Hart C.

MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR. chris.metcalfe@mrc-bsu.cam.ac.uk

J Public Health Med. 2003 Mar; 25(1): 62-8.

BACKGROUND: This study examines a cohort in which individuals of privileged socio-economic position report greater psychological stress. We have previously shown in this cohort that stress is unrelated to coronary heart disease as measured by hospital discharge diagnosis and cause-specific death. In contrast, stress and hospitalization for cardiovascular conditions not requiring mandatory admission were associated. We hypothesized that psychosocial factors, in particular reporting tendency, are the likely mediator of this association, and the present study considers this further. METHODS: A total of 5,596 men underwent a health screening during which they completed the Reeder Stress Inventory. Details of hospital admissions were retrieved from the Scottish Morbidity Records over a 21 year follow-up. Relationships between stress and admission were evaluated using proportional hazards regression. RESULTS: Compared with low stress, reported high stress was found to be associated with increased numbers of admissions for each of three most common cardiovascular causes of non-mandatory admission: adjusted hazard ratios were 3.43 for essential hypertension (95 per cent confidence interval (CI) 1.36-8.65), 1.91 for lower limb varicose veins (95 per cent CI 1.12-3.24), and 2.01 for haemorrhoids (95 per cent CI 1.16-3.51). Stress and blood pressure at baseline were not associated. CONCLUSION: The association between stress and admissions as a result of hypertension appears unlikely to be mediated by blood pressure. More likely is a mechanism based upon the reporting of symptoms, or the recording of discharge diagnoses. There is no obvious medical explanation for associations between stress and hospitalization as a result of varicose veins or haemorrhoids, and again it is likely that psychosocial factors provide the mechanism.

[Using a compression method after surgical treatment of hemorrhoids]

Goldin VA, Dedenkov OA, Alfazzaman M.

Vestn Khir Im I I Grek. 2002; 161(5): 92-3. [Article in Russian]

A compression method was used as a final stage of surgical treatment of hemorrhoids which was performed with a specially worked out compressing probe (two latex cuffs were mounted on the three-lumen rubber tube). The internal and external hemorrhoids were compressed after introduction of the probe into the anal canal and blowing up the cuffs. Comparative results of 103 operations are shown: in 67 patients the operation was finished with the introduction of an ointment tampon, in 36--with a compressing probe. Postoperative results judged by such symptoms as postoperative pains, bleedings, adaptation of the operation wound edges, retention of urine etc. showed that the compression method had considerable advantages over the control group.

[Results of ligature of distal branches of the upper rectal artery in chronic hemorrhoid with the assistance of Doppler ultrasonography]

Shelygin IuA, Titov AIu, Veselov VV, Kanametov MKh.

Khirurgiia (Mosk). 2003; (1): 39-44. [Article in Russian]

In October 2000 to February 2002 Doppler ultrasonography assisted suturing and ligation of hemorrhoidal arteries were performed in 102 patients with chronic hemorrhoids (57 men, 45 women, mean age 44 +/- 4.3 years). The mean duration of the disease was 10 +/- 4.6 years. Elimination of scarlet blood and hemorrhoidal prolapse without concomitant proctologic diseases were indications for surgery. Sixty-nine patients were followed up for more than 12 months, the follow-up lasted on the average 12 +/- 4 months. There were no clinical symptoms in 57 (82.6%) on the 69 patients. Combined ligation of arterial branches and nodes with latex rings was performed in 7 patients with stages III-IV hemorrhoids. Sclerotherapy was performed in 2 patients with stage III with occasional elimination of blood on defecation. Hemorrhoidectomy was performed in 3 (2.9%) patients with stage IV hemorrhoid due to ineffective ligation. Suturing and ligation of distal branches of the upper rectal artery decrease the inflow of arterial blood to hemorrhoidal nodes without venous outflow disorders. Fixation of hemorrhoidal nodes to the muscular wall eliminates the symptoms of hemorrhoidal prolapse. These factors lead to elimination of hemorrhoidal symptoms in 82.6% of the patients operated on.

Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy.

Wald A.

University of Pittsburgh Medical Center, Division of Gastroenterology, Hepatology and Nutrition, PUH, Mezzanine Level, C-Wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA. walda@msx.upmc.edu

Gastroenterol Clin North Am. 2003 Mar; 32(1): 309-22, vii.

Constipation, diarrhea, and symptomatic hemorrhoids are disorders common in the general population, particularly in women. These conditions, if mild, often are self-treated with various home remedies or nonprescription preparations. Few of these patients, moreover, are referred to gastroenterologists, as primary care providers generally are confident managing these conditions, unless they are severe, refractory to conventional management, or require additional diagnostic studies.

[Curative effects of basic fibroblast growth factor on anus wound healing]

Ge BJ, Guo SM.

Department of General Surgery, Affiliated Tongji Hospital, Tongji University, Shanghai, P. R. China 200065.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2002 Sep; 16(5): 345-7. [Article in Chinese]

OBJECTIVE: To observe the curative effects of basic fibroblast growth factor (bFGF) on anus wound healing. METHODS: From April 1996 to December 2000, out of 109 patients with anus trauma, hemorrhoidectomy or fistula resection, 68 were treated with bFGF as the experimental group, while 41 were treated routinely as the control group. The healing of the wound, the general and local reaction were observed. RESULTS: The healing time of the experimental group was(17.00 +/- 1.54) days while that of the control group was(20.00 +/- 1.16) days (P < 0.01). Three weeks after operation, the healing rates of the experimental and control groups were 97.1% and 87.8%, respectively (P < 0.01). No general or local detrimental reactions were found in two groups. CONCLUSION: Local application of bFGF can accelerate the healing of anus wound, and the patients have little pain.

Outpatient treatment of hemorrhoids with a combined technique: results in 7850 cases.

Accarpio G, Ballari F, Puglisi R, Menoni S, Ravera G, Accarpio FT, Cariati A, Zaffarano R.

Department of Colorectal Surgery, Villa Scassi Hospital, Sampierdarena (GE), Italy.

Tech Coloproctol. 2002 Dec; 6(3): 195-6.
Comment in:
Tech Coloproctol. 2003 Jul;7(2):122-3; authors reply 123.

A combination of sclerotherapy, rubber band ligation and infrared coagulation was performed in 7850 patients seen an outpatient clinic over a period of 9 years. The most common symptom was bleeding followed by prolapse, pain and itching. Results were considered satisfactory in 7100 patients (90.5%); 750 (9.5%) required a formal hemorrhoidectomy. Complications were mild to moderate pain in 1777 cases (22.6%), severe pain in 157 cases (2.2%), mild hemorrhage in 199 (2.5%) and hemorrhage requiring transfusion in 10 cases (0.1%). In conclusion, non-surgical outpatient treatment has a great impact on patient's perception of the disease and results in considerable savings for the healthcare system.

Hemorrhoids.

Sardinha TC, Corman ML.

Department of Surgery, North Shore-Long Island Jewish Medical Center, New Hype Park, NY 11040, USA.

1Surg Clin North Am. 2002 Dec; 82(6): 1153-67, vi.

Technologic advances have contributed to numerous diverse approaches to the management of hemorrhoid disease over the past centuries. Better understanding of the pathophysiology and anatomy of the anal canal has also added to the increased success in the treatment of hemorrhoids. This article reviews the clinical and pathological aspects of hemorrhoid disease, emphasizing new therapeutic modalities.

[Hemorrhoids]

[Article in Russian]

Rogozina VA.

Central Scientific Research Institute of Gastroenterology, Moscow.

Eksp Klin Gastroenterol. 2002; (4): 93-6, 134.

Hemorrhoids is believed by right to be one of the most widely spread human sufferings ranking first among diseases of the rectum and large intestine. According to the data of numerous studies devoted to this problem, from 2.9 to 27.9%% of population of different countries suffer from hemorrhoids. Most authors agree that men suffer from hemorrhoids more often than women do and that its frequency increases with the aging. For the sake of justice, it is necessary to note that some researchers insist that men and women suffer from this disease equally often but that men ask for medical care 1.5 times more often.

[Endoscopic dilatation of benign colon and rectum stenosis]

Rivera Vega J, Frisancho Velarde O, Cervera Z, Ruiz E, Yoza M, Larrea P.

Departamento del Aparato Digestivo, Hospital Nacional, Lima Peru.

Rev Gastroenterol Peru. 2002 Jul-Sep; 22(3): 206-12. [Article in Spanish]

AIM: To determine the usefulness of endoscopic dilatation in dealing with benign stenosis of the anus, rectum and colon. PATIENTS AND METHODS USED: Thirty six (36) patients with stenosis, anus (8), rectum (22) and colon (6) were given endoscopic treatment using hydroneumatic balloons, electro incision (radiated cuts) or a combination of both. Rigid equipment (metal) was used for distal stenosis. Age ranged between 30 and 82 years. Twelve (12) patients were male and 24 female. The diameter of the stenosis was less than 13 mm in 18 of the patients and 11 patients carried colostomy. RESULTS: All 36 patients were subjected to a total of 113 dilatation sessions. The average number of sessions per patient for patients with anal stenosis was 2.5 and for patients with colorectal stenosis, 3.32. One patient with rectal stenosis required 21 sessions to achieve final objective. The result achieved was good in 31 patients, less than satisfactory in 3 patients and bad in one patient, who presented a stenosis which was over 5 cm long. We lost track of a patient in the follow up stage. Success in closing the colostomy was achieved in 9 patients, while one presented a complication due to the procedure (cervical emphysema) which remitted with medical attention. CONCLUSIONS: Endoscopic dilatation offers, through its different techniques, a safe and efficient method for the treatment of benign stenosis of the anus, rectum and colon and must be considered as a first class tool for the treatment of this kind of pathologies.

Improvement in irritable bowel syndrome following ano-rectal surgery.

Palmer BV, Lockley WJ, Palmer RB, Kulinskaya E.

Lister Hospital, Corey's Mill Lane, Stevenage, SG1 4AB, UK. bernardpalmer@ntlworld.com

Int J Colorectal Dis. 2002 Nov; 17(6): 402-11. Epub 2002 Mar 07.

BACKGROUND AND AIMS: To assess the effect on irritable bowel syndrome (IBS) of treating ano-rectal problems by applying multiple Barron's bands to prolapsing mucosa and excising haemorrhoids, with or without a low lateral sphincterotomy. PATIENTS AND METHODS: 144 patients with IBS whose ano-rectal abnormalities were treated by a single consultant surgeon. A prospective "within person" study of consecutive patients referred with ano-rectal problems who also had IBS symptoms according to the Rome criteria. All patients completed structured questionnaires about anal and IBS symptoms before operation and 6-60 months later. The findings were compared with those from patients who had no abdominal pains. RESULTS: The principal IBS symptoms of abdominal pain, abdominal distension, and altered bowel habit all improved significantly after operation. Those with persistent anal problems had more problems with persistent IBS symptoms, but when the anal problems were corrected, the IBS tended to settle. Posterior anal tenderness is present in 80% of IBS patients and is a useful diagnostic sign. CONCLUSIONS: This work suggests that in many patients with IBS there is a physical ano-rectal disorder amenable to physical treatment. Patients with IBS should all be proctoscoped carefully, with and without the patient straining, looking for abnormalities. Correcting mucosal prolapse and other anal problems produced an improvement in IBS symptoms in 86% of patients. This suggests that ano-enteric reflexes are a significant factor in irritable bowel syndrome, if not the major cause.

CD34+ stromal cells and hyalinized vascular changes in the anal fibroepithelial polyps.

Sakai Y, Matsukuma S.

Department of Pathology, Japan Self Defense Forces Central Hospital, Juntendo University, School of Medicine, Tokyo, Japan. ZWQ04043@nifty.ne.jp

Histopathology. 2002 Sep; 41(3): 230-5.

AIMS: To elucidate the pathogenesis of the anal fibroepithelial polyp, we examined surgically resected lesions histopathologically. METHODS AND RESULTS: Twenty-seven surgically resected anal fibroepithelial polyps were investigated histologically with an additional immunohistochemical examination using anti-CD34. For a control study, the surgical specimens of the anal canal showing non-polypoid lesions, obtained from haemorrhoidectomy (18 specimens) and rectectomy (five specimens) due to rectal cancer without anal canal involvement, were also analysed. We demonstrated characteristic spindle or stellate cells immunohistochemically positive for CD34 in the anal fibroepithelial polyps (24/27, 89%). The number of CD34+ cells was statistically related to the size of anal fibroepithelial polyps, although CD34+ stromal cells were recognized in the non-polypoid anal submucosa and haemorrhoids. We also found hyalinized vascular changes in the base of six anal fibroepithelial polyps examined. These features were not detected in the non-polypoid anal canal. CONCLUSIONS: An increase in CD34+ stromal cells may play a role in the enlargement of anal fibroepithelial polyps. CD34+ stromal cells are suggested to be distinctive mesenchymal cells with a capability for tissue repair and overgrowth. The vascular impairment could be secondary change associated with localized tissue damage by abnormal traction.

Lower gastrointestinal hemorrhage in African-American and Hispanic elderly patients.

Akhtar AJ.

Department of Internal Medicine, Charles R. Drew University of Medicine and Science/King-Drew Medical Center, Los Angeles, California 90059, USA.

Ethn Dis. 2002 Summer; 12(3): 379-82.

OBJECTIVES: To investigate the frequency and etiology of lower gastrointestinal hemorrhage (LGIH) in African-American and Hispanic elderly patients and to determine its natural history and the risks and benefits of therapeutic interventions. SETTING: Inner-city community teaching hospital serving predominantly African-American and Hispanic populations. METHODS: Records of 236 patients, 65 to 103 years of age, with a diagnosis of LGIH were reviewed retrospectively, over a period of 7 years, (9 White and 6 Asian patients were excluded). RESULTS: In 21 patients, the source of bleeding was located in the upper gastrointestinal tract, and these patients were excluded from the study. The source of bleeding remained unidentified in 16 of 200 patients, and they were also excluded. Bleeding was so profuse in 19 patients that satisfactory endoscopy could not be performed and emergency angiography and/or surgery was required. Endoscopic results were available in 165 patients and included: internal hemorrhoids in 60 (active bleeding in 23) patients, diverticular bleeding in 55, angiodysplasia in 50, polyps in 37, cancer in 23, drug-induced (anti-coagulants, non-steroidal anti-inflammatory drugs) lesions in 20, ischemic colitis in 15, ulcerative colitis in 10, solitary rectal ulcer in 9, Crohn's disease in 8, and colonic varices in 6 patients. Forty-eight patients had more than one lesion. Endoscopic therapy was given to 101 patients and was helpful in stopping bleeding and/or delaying surgery in 69 patients. Overall, there were 43 deaths, mostly due to underlying multiple system disease. Mortality rates did not differ by race/ethnicity or gender. Older elderly (76-85 yrs.; P < 0.01) and (> 85 yrs.; P < 0.001) had higher mortality rates. None of the deaths were directly due to endoscopy. CONCLUSIONS: Despite the small number of patients, our study suggests that acute LGIH in African-American and Hispanic elderly patients is a common condition, with the potential to become a life-threatening event. All such patients should be offered the benefits of early endoscopy and therapeutic interventions, unless contraindicated by their advanced directives. A patient's advanced age should not be a deterrent to any of the diagnostic or therapeutic interventions.

[The treatment of "Rybenka": therapies and medical operations on Michal Kazimierz Radziwill, 1702-1762]

Zuba K.

Med Nowozytna. 2001; 8(1): 89-110. [Article in Polish]

The present paper discusses and analyses treatment methods and medical care given to the Voivod of Vilnius, the Grand Hetman of Lithuania M. K. Radziwill throughout all his life. This analysis is not representative for the general medicine of the 18th century. M. K. Radziwill was one of Poland's richest men of the time and only few aristocrats rich like him could afford similar therapies. The paper is based on unpublished archival sources, such as diaries and correspondence. Radziwill was subject to 65 breedings (blood was taken from his leg) which were usually performed in springtime; 30 leech applications (to his haemorrhoids); and he was cupped 13 times. He ws also treated for his bad jaw, broken arm, and received hydrotherapy (drinking water). All in all, the therapies, operations, and medicines preformed and prescribed to him make up a picture of medicine which, according to today's scientific criteria, did more harm than good to the patient. Nonetheless, this does not change the fact that medical care of the time also included treatments which are well evaluated by present-day medical science, such as, for example, recommending comfort and rest to the patients.

[The examination of the digestive tract in patients with iron-deficiency anemia]

Prelipcean CC, Mihai C, Stanciu C.

Clinica a II-a Medicala Gastroenterologie, Spitalul Universitar Sf. Spiridon Iasi.

Rev Med Chir Soc Med Nat Iasi. 2000 Oct-Dec; 104(4): 51-3. [Article in Romanian]

According to literature the gastroenterologic consultations for iron-deficiency anemia are quite frequent. The aim was the evaluation of the part played by gastrointestinal examinations for the diagnosis of iron-deficiency anemia. There were 115 patients admitted in the Medical Clinic between 1998-1999, with iron-deficiency anemia in the absence of macroscopic bleeding who carried out upper or lower endoscopy. A digestive lesion which account for iron deficiency anemia was identified in 35% of the cases. In the upper digestive tract there were 60%, in decreasing order of frequency: peptic ulcer, gastric cancer, erosive gastritis, angiodysplasia. In the lower digestive tract were 35% of the cases (colorectal cancer, polyps, angiodysplasia and hemorrhoids). In 5% of the cases there were found synchronization of the digestive tract lesions. So the digestive tract examination is worth doing because it establishes the diagnosis in 35% of the cases with few symptoms. The digestive tract lesions are more frequent in the upper tract, but they are more severe in the lower digestive tract. The possibility of the synchronization of lesions proves the necessity of carrying out the complete examination of the whole digestive tract.

[The importance of ano-rectal manometry in irritable bowel syndrome]

Drug VL, Bradatan B, Tarasi I, Ciochina AD, Ionescu DL, Filip F, Stanciu C.

Facultatea de Medicina, Clinica II-a Medicala Gastroenterologie, Universitatea de Medicina si Farmacie Gr. T. Popa, Iasi.

Rev Med Chir Soc Med Nat Iasi. 2000 Jul-Sep; 104(3): 43-50. [Article in Romanian]

Irritable Bowel Syndrome (IBS) represents a frequent cause for gastroenterological referral. 50% of all gastroenterological consultations are for functional gastrointestinal disorders (IBS included). Multiple motility abnormalities were described in IBS. The AIM of the study was to evaluate the role of ano-rectal manometry in the diagnosis of IBS. STUDY DESIGN: 24 patients with IBS (mean age 50.8 +/- 15.4) and a control group of 10 subjects with no abdominal symptoms (mean age 48.1 +/- 12.3) had each an ano-rectal manometry examination. RESULTS: After exclusion of constipation predominant IBS subjects, the IBS patients presented lower perception threshold (22.1 +/- 10.9 ml) than the control group (60.2 +/- 11.3 ml) (p < 0.05) and than the constipation predominant group (81.3 +/- 44.0) (p < 0.05). In 44% of constipation predominant IBS concomitant pathology, revealed by manometry, was present: megarectum or hemorrhoids (spasm). CONCLUSION: Anorectal manometry could be a useful tool for the evaluation of IBS patients.

Metastatic renal cell carcinoma presenting as a hemorrhoid.

Sawh RN, Borkowski J, Broaddus R.

Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.

Arch Pathol Lab Med. 2002 Jul; 126(7): 856-8.

Metastatic, noncolorectal carcinoma involving the anal canal is exceptionally rare, with only 3 cases being described in the medical literature. We report the case of a 53-year-old man with an anal mass clinically presenting as a large, thrombosed, internal hemorrhoid. The patient had a history of nephrectomy for renal cell carcinoma 9 years previously. The resected anal lesion was histologically identical to the primary tumor in the kidney, showing features of renal cell carcinoma of the clear cell type. To the best of our knowledge, this is only the fourth reported case of metastatic, noncolorectal carcinoma involving the anal canal and is the first report of a renal cell carcinoma metastasis to this site.

Management of hemorrhoidal disease in patients with chronic spinal cord injury.

Scott D, Papa MZ, Sareli M, Velano A, Ben-Ari GY, Koller M.

Division of Proctology, Department of Surgical Oncology, The Sheba Medical Center, Tel Aviv University Medical School, Tel Hashomer, Ramat Gan, Israel. danscott@netvision.net.il

Tech Coloproctol. 2002 Apr; 6(1): 19-22.

Hemorrhoidal disease is a common pathology in patients with chronic spinal cord injury (SCI). We describe our experience with the primary approach to this problem at the Proctology Division of the Sheba Medical Center. We treated 29 patients (26 men) with paraplegia due to SCI between 1995 and 1999. The mean age was 49 years (range, 22-74 years). All patients had hemorrhoids in stages ranging between II and IV. Main complaints were rectal bleeding (83%), difficulties in evacuation (38%) and discomfort or pain (28%). Eleven patients (38%) were treated conservatively (e. g. diet, hygiene and laxatives), while 18 patients (62%) underwent either banding or sclerotherapy of hemorrhoids or both. No major complication were observed. In 28 of 29 patients (96%), there was a significant reduction or cessation of bleeding and/or relief of symptoms; one patient (3%) required hemorrhoidectomy. Of the 28 successful treatments, 16 (57%) had partial reduction of bleeding or relief of symptoms, while in 12 (43%) response was complete. Of those who were treated conservatively, 9 (82%) had partial and 2 (18%) had complete relief of symptoms. Of those who had banding/sclerotherapy, 7 (41%) had partial and 10 (59%) had complete relief. We also examined the effect of perianal sensation on the treatment outcome. Of 16 patients with complete anesthesia, 11 (69%) had partial and 5 (31%) had complete relief, whereas of the 12 patients with preserved sensation, 5 (42%) had partial and 7 (58%) had complete relief. In conclusion, the approach of banding or sclerotherapy of hemorrhoids in SCI patients is safe and effective. When sensation of the perianal region is preserved, the outcome seems to be better. The cause of SCI has no impact on the treatment results. There was no difference in the outcome of treatment between patients with stage II and stage III hemorrhoids; patients with stage IV hemorrhoids seem to do worse than those with stages II and III.