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PubMed1988

[Croton oil-induced hemorrhoid model in rat: comparison of anti-inflammatory activity of diflucortolone valerate with other glucocorticoids].

A hemorrhoid model was prepared by means of application of croton oil onto the recto-anus of rats. Cotton swab soaked with the inducer, which consisted of water, pyridine, diethylether and 6% croton oil in diethylether, was inserted into the anus. The following conditions were found to be optimal for preparing the model: cotton swab containing 0.16 ml of the inducer solution was applied to the anus of a 6 week-old rat (body wt. about 140 g) for 10 sec. The edema developed linearly until 7-8 hr after application, and the severity of the edema was sustained almost constantly for more than 24 hr. Macroscopic observations at 6 hr p. a. revealed homogeneous and consistent inflammation in the recto-anus applied region. Histological observation showed appearance of edema, infiltration of fibrin, inflammatory cells, vasodilation, blood congestion and medium to high degrees of necrosis in the mucosal epithelium. Thus this model was useful for evaluating the effect of anti-hemorrhoidal drugs on intumescence and vasodilatation. The efficacy of diflucortolone valerate, hydrocortisone caproate and hydrocortisone was evaluated in this model. Wet weight and vasopermeability increased by the inducer was suppressed strongly by simultaneous application of the corticoids, and the degree of suppression was parallel with the potency of the glucocorticoid activity. Compared to Scheriproct, Posterisan forte, Posterisan and Borraginol N, Neriproct showed the strongest effects in the protection against and treatment of the experimental hemorrhoid. Scheriproct, which was less active than Neriproct, was also found to have higher efficacy than the others.

Animals↗
PubMed1988

[Neriproct: its anti-inflammatory effect on an experimentally induced hemorrhoid model in the rat].

Several glucocorticoids as a cream formulation were applied to the recto-anus of the croton-oil-induced hemorrhoid rat. Among the steroids tested, i.e. diflucortolone valerate (DFV), prednisolone (PS), hydrocortisone caproate (HC), and hydrocortisone (H), DFV was found to suppress inflammation most effectively. The effect of DFV was not affected by combination with lidocaine. In this model, the analgesic effect of lidocaine was apparently prolonged by an increase of the threshold for pain by the anti-inflammatory effect of DFV. This additive effect is regarded as a merit of the combination in Neriproct. Therapeutic effects of Neriproct and several anti-hemorrhoid drugs were also examined by using a hemorrhoid model with abrasive irritation compared to those obtained by the croton-oil model. In both models, efficacy of Neriproct was superior to that of the other drugs such as Scheriproct, Proctosedyl, Posterisan forte, Borraginol N, Posterisan and Borraza G. Microscopic observation showed that destruction of the mucus epithelium, necrosis of the mucus layer, infiltration of inflammatory cells and vasodilatation in the croton-oil model were also suppressed markedly by Neriproct application. No difference was observed in the efficacy between the cream and suppository formulation of Neriproct. Suppression of wound healing was found with a dosage of DFV lower than those of PS, HC and H. However, the efficacy ratio of the wound-healing suppression and anti-inflammation of DFV was the largest among the steroids tested.

Animals↗
PubMed2005

Sclerosing effect of OC-108, a novel agent for hemorrhoids, is associated with granulomatous inflammation induced by aluminum.

OC-108 is a novel sclerosing agent for hemorrhoids, containing aluminum potassium sulfate (alum) and tannic acid as its main ingredients. In clinical studies, OC-108 injection therapy for severe internal hemorrhoids proved to be highly effective, not only on bleeding but also for prolapse, and the effects were comparable to hemorrhoidectomy. The aim of this study was to elucidate the mode of action by administrating the agent s.c. to mice and rats. In response to OC-108 injection, inflammation with necrosis developed at an early stage followed by granuloma formation with fibrosis at the injection site. Necrotic debris with aluminum was observed in the granuloma for a long period. Alum, as well as OC-108, induced vascular permeability, leukocyte infiltration, and granuloma formation; however, tannic acid did not. On the other hand, tannic acid inhibited leukocyte infiltration induced by alum but did not inhibit granuloma formation. These results indicate that OC-108 causes sclerosis and retraction of hemorrhoids through fibrosis associated with granulomatous chronic inflammation induced by the main active ingredient alum and that the adjunct ingredient tannic acid reduces excessive acute inflammation induced by alum.

Aluminum↗
PubMed2002

[Endoscopic hemorrhoidal ligation from the rectum].

Endoscopic hemorrhoidal ligation with a rubber band was carried out on 40 patients with internal hemorrhoids. All the patients were treated in the outpatient ward. Seven patients complained of mild to moderate aches in the early postoperative days, which were easily controlled by medication. One week after the treatment, no patient complained of pain. None of the patients had any postoperative bleeding. The results of this treatment were classified as good (no complaint or symptoms after the treatment), fair (at least some improvement), or poor (no change or worse than before the treatment). Twenty-nine of the 40 patients were classified as good, and the remaining 11 patients were fair. No patients were classified as poor. EHL is a harmless and painless procedure and is easily performed in the outpatient ward. When internal hemorrhoids of operative indication are detected by colonoscopy, EHL can be easily and simultaneously carried out.

Adult↗
PubMed2003

Infrared coagulation versus rubber band ligation in early stage hemorrhoids.

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.

Adult↗
PubMed2005

[PHLEBODIA (diosmine): a role in the management of bleeding nonprolapsed hemorrhoids].

The aim of this study is to describe a role of diosmine in the management of bleeding nonprolapsed hemorrhoids. From November 2003 to January 2004, 60 patients were treated with Phlebodia (diosmine). Total colonoscopy was performed at the discretion of the authors according to the age, symptoms and genetic factors of the patient. Patients were treated with Phlebodia (diosmine, 3x1, 5 days) and in addition a bulk agent (3,26 g plantago ovata sachet, twice daily, for the period of next three months). Hemorrhoidal bleeding stopped after 3,2 days. Diosmine, used with fiber supplements, rapidly and safely stops bleeding from nonprolapsed hemorrhoids.

Adult↗
PubMedDate not supplied

[Infrared photocoagulation in the treatment of hemorrhoids].

PURPOSE: The aim of this study was to determine the efficacy of infrared photocoagulation in the treatment of grades I and II of hemorrhoidal disease. MATERIAL AND METHODS: 60 patients with hemorrhoidal disease grades I and II were included, each one with transanal bleeding as the only symptom, without any other ano-rectal pathology. They were 30 male and 30 female patients, with 39.9 years as median age. Each had 1 to 4 photocoagulation sessions, according to the results obtained in each one. TECHNIC: Each application was 1.5 seconds duration, once every two weeks, in diamond or rainbow shape; 1 to 4 sessions were required. Follow up was 24 months. RESULTS: Good results were obtained in 66.6% since the second application, and in 93.4% at the end of the study; 4 (6.6%) patients were failures and had to be operated on. CONCLUSION: Treatment of hemorrhoidal disease grades I and II with infrared photocoagulation is an excellent alternative; it is painless, suitable as an outpatient procedure and its cost is low.

Adult↗
PubMed2000

[Hemorrhoidectomy in muco-hemorrhoidal prolapse using mechanical stapler].

BACKGROUND: The treatment of hemorrhoids has changed throughout the latter years. In selected cases hemorrhoidectomy with circular stapler, in personal opinion, is the best surgical technique. The goal of the present study is to evaluate the therapeutic results of hemorrhoidectomy by means of the above technique in 150 consecutive cases. METHODS: From March 1997 to November 1999, 150 patients were surgically treated, 84 women and 66 men with a median age of 57 years. 130 patients had III degree, thus with a reducible prolapse, 10 IV degree and 10 patients with II degree hemorrhoids resistant to ambulatory banding and/or sclerotherapy. Every patient was operated with the circular stapler in Day Surgery regimen, and the patients were discharged after 24 hours. RESULTS: Eight immediate hemorrhages were seen, four of which were surgically treated; 10 patients had urinary retention which required an urinary catheter. Healing was complete in the 15-20th day. The follow-up after one month was performed on 140 patients, at 3 months and at one year, on 100 patients. No suture stenosis and no recurrences of the hemorrhoid prolapse were observed. Follow-up after 6, 12 and 24 months on 100 patients was also considered in order to evaluate the results after surgery and late complications or sequelae. Fifteen patients were reevaluated after one and two months with anorectal manometry which did not demonstrate important alterations of the continence. CONCLUSIONS: The advantages of this technique is to carry out a radical surgical procedure in a single event, by means of a rapid and mini-invasive technique, with an earlier physical recovery, with the absence of medication in the postoperative period, and an early social and working reestablishment.

Adult↗
PubMedDate not supplied

[Activity of purified diosmin in the treatment of hemorrhoids].

Several theories on the etio-pathogenesis and physio-pathology of hemorrhoids have been up to now proposed. From the fisio-pathological viewpoint, particular importance is retained by the vascular factor, which in its turn is influenced by mechanical and sphinceric factors, that impair the venous back-flow. In the evidence of an hemorrhoidal crisis, characterized by local oedema, pain and bleeding, the use of bioflavonoid drugs is deemed to be the first choice. We investigated the use of purified diosmin, given at a dose of two 450 mg tablets bid for the first 7 days, then at 1 tablet bid for up to 2 months, in a group of 66 patients suffering from primitive hemorrhoids of grade 1-4. Our results confirmed diosmin efficacy in decreasing both pain and bleeding: reduction rates of 79% and 67%, respectively, were reached in the first treatment week. In the second week, figures were 98% and 86%, respectively. Diosmin tolerability was excellent: this characteristic makes the drug very easy to handle by the general practitioner and also useful to the proctologist in the preparation of patient to further treatments.

Adolescent↗
PubMedDate not supplied

[X-ray endovascular embolization of the superior rectal artery: New potentialities in the surgical management of chronic hemorrhoids].

Based on the concept of occurrence and development of hemorrhoids from pathologically altered groups of cavernous bodies of the anal submucosa, the author used dearterialization of hyperplastic cavernous tissue for the treatment of hemorrhoids. The treatment involves superselective catheterization and material embolization of the superior rectal artery. The characteristics of 86 remedial embolizations of the superior rectal artery and routine treatments (sclerotherapy, latex-ring ligation, cryotherapy, and surgical hemorrhoidectomy) for chronic hemorrhoids. Emphasis is placed on the advantages of embolization methods over conventional low-invasive and surgical treatment.

Arteries↗
PubMed2001

[Hemorrhoidal disease. Current surgical treatment and the place of Whitehead's operation].

In the presented material a review of the current data and comprehensions of the anatomy and physiology of the hemorrhoids is made, as like of the ethiology and pathogenesis of the disease. The new conceptions of the surgical treatment of the disease are pointed out. An attempt was made to differentiate the operative methods in patogenetical principal. The operative results of the General Surgery Clinic by the University Hospital "St. Ann", Sofia for the period 1991-2000 of 157 treated patients with hemorrhoidal disease are presented. Based on these results the authors come to a conclusion, that the Whitehead's operation remains "the golden standard" as a choice of an operative method for the treatment of the hemorrhoidal disease in advanced stages (III-d or IV-th).

Adult↗
PubMed2002

The new classification of hemorrhoids: PATE 2000-Sorrento. History of the scientific debate.

BACKGROUND: The history of our proposal for a new classification of hemorrhoids is very old: 7 years of scientific debate had a big impact for the study and the definition of hemorrhoids. METHODS: Nowadays many things have changed mainly in the field of treatment of hemorrhoids. New medical and surgical tools are available for the modern proctologist. RESULTS: The new classification of the disease seems to fit the necessity of introducing these modern opportunities. Many authors recognize the fundamental role and claim for the routine use of a new classification, named PATE 2000 Sorrento. Nevertheless many problems are on debate. Their resolution needs the cooperation of all the experts in order to choose the best version of the classification. CONCLUSIONS: For these reasons the authors analyse all the work carried out till now in order to see what we still need to introduce a new classification of the disease.

Ambulatory Surgical Procedures↗
PubMed2002

[Hemorrhoids].

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.

Female↗
PubMed2003

Anal cushion resection versus Milligan-Morgan hemorrhoidectomy for circular hemorrhoids: randomized controlled trial.

OBJECTIVE: To compare the clinical effect of anal cushion resection with Milligan-Morgan hemorrhoidectomy for the third- or fourth-degree circular hemorrhoids. METHODS: Forty-eight patients with third- or fourth-degree circular hemorrhoids were randomly assigned into two groups to receive either anal cushion resection or Milligan-Morgan hemorrhoidectomy. Comparison of the two approaches were conducted in terms of postoperative pain scores, operation time, wound healing time, mean hospital stay, incidence of postoperative complications and the curative effect. Results No significant difference was found in view of postoperative pain scores according to visual analogue scale between the 2 groups. The operative time of anal cushion resection was significantly longer than that of the other group, however, its wound healing time, mean hospital stay and incidence of postoperative complications were significantly less. Follow-up study for 3 months after operation found that anal cushion resection had significantly better curative effect than Milligan-Morgan hemorrhoidectomy. Conclusion Anal cushion resection is a safe and practical approach for third- or fourth-degree circular hemorrhoids.

Adult↗
PubMed2003

[Therapeutical effect of Zhiranxiao tablets on internal hemorrhoid hemorrhage: a clinical observation in 569 cases].

OBJECTIVE: To investigate the therapeutic effect of Zhiranxiao tablets derived from compound Zhiranxiao decoction, a preparation from traditional Chinese medicine, on internal hemorrhoid hemorrhage. METHODS: The treatment group consisted of 596 patients with internal hemorrhoid hemorrhage who received oral Zhiranxiao tablets in a course of 6 d for treatment, and another 60 such patients were given a different preparation from traditional Chinese medicine, Zhining tablets, to serve as the control group. The volume of hemorrhage was recorded and scored before and after the treatment to evaluate the therapeutic effect of the tested dosage forms. RESULTS: The scores for hemorrhage in both groups were significantly decreased after the administration of the two dosage forms, but no statistical difference was observed (P > 0.05) between the two groups. CONCLUSION: Zhiranxiao tablets are also effective in the treatment of internal hemorrhoid hemorrhage.

Adolescent↗
PubMed1992

Thrombosed hemorrhoid mimicking rectal carcinoma at CT.

A 46-year-old man with cirrhosis and portal hypertension complained of lower pelvic pain. CT of the rectum raised a strong suspicion of a rectal tumor. However, rectal examination, anoscopy, direct rectoscopy, and, unfortunately, post-mortem dissection, failed to confirm its existence. Nevertheless, large flat hemorrhoids were evident. Review of the patient's chart disclosed the presence of large thrombosed hemorrhoids detected by rectal examination prior to the CT examination. It is suggested that rectal hemorrhoids be included in the differential diagnosis of rectal tumor shown by CT in patients with portal hypertension.

Diagnosis, Differential↗
PubMed1992

Optimal nonsurgical treatment of hemorrhoids: a comparative analysis of infrared coagulation, rubber band ligation, and injection sclerotherapy.

Despite an abundance of nonsurgical hemorrhoid therapies, none has been consistently more efficacious. By combining data from multiple clinical trials in a meta-analysis, the present study compared the efficacy and complications of infrared coagulation, injection sclerotherapy, and rubber band ligation to determine the optimal nonoperative hemorrhoid treatment. All published clinical trials comparing the three methods were identified by computer search and review of appropriate English language journals. Five trials studying 863 patients satisfied all inclusion criteria. Results demonstrated that similar numbers of patients were asymptomatic 12 months after treatment, regardless of initial therapy. However, significantly fewer patients undergoing rubber band ligation required additional treatment because symptoms had recurred. Although rubber band ligation demonstrated greater long-term efficacy, it was associated with a significantly higher incidence of posttreatment pain. In contrast, infrared coagulation was associated with both fewer and less severe complications. Thus, when all factors are considered, infrared coagulation may in fact be the optimal nonoperative hemorrhoid treatment.

Hemorrhoids↗
PubMed1992

[Pressure of the anal canal in patients with hemorrhoids or with anal fissure. Effect of the topical application of an anesthetic gel].

The pressure measurements and clinical sensation of 11 patients with hemorrhoids and 8 patients with posterior and fissure were analyzed before and after the topical administration of an anesthetic gel containing tetracaine in the anal canal. A significant increase of the maximal basal pressure (p less than 0.01) was observed in comparison with a control group of the same age and sex. No differences in the maximal pressure of voluntary contractions. The anesthetic gel produced a significant decrease of the maximal basal pressure in subjects with hemorrhoids, as well as a lessening of pain in 37% of patients with anal fissure and in 55% of those with hemorrhoids. This symptomatic improvement was not correlated with changes in pressure. Therefore we conclude that the hypertonicity of the anal canal is not secondary to pain and must be evaluated as a disturbance related to the subjacent lesion.

Administration, Topical↗