Do circulating leucocytes and lymphocyte subtypes increase in response to brief exercise in children with and without asthma?

BACKGROUND: Exercise can alter health in children in both beneficial (eg reduced long-term risk of atherosclerosis) and adverse (eg exercise-induced asthma) ways. The mechanisms linking exercise and health are not known, but may rest, partly, on the ability of exercise to increase circulating immune cells. Little is known about the effect of brief exercise, more reflective of naturally occurring patterns of physical activity in children, on immune cell responses. OBJECTIVES: To determine whether (1) a 6-min bout of exercise can increase circulating inflammatory cells in healthy children and (2) the effect of brief exercise is greater in children with a history of asthma. METHODS: Children with mild-moderate persistent asthma and age-matched controls (n = 14 in each group, mean age 13.6 years) performed a 6-min bout of cycle-ergometer exercise. Spirometry was performed at baseline and after exercise. Blood was drawn before and after exercise, leucocytes were quantified and key lymphocyte cell surface markers were assessed by flow cytometry. RESULTS: Exercise decreased spirometry only in children with asthma, but increased (p<0.001) most types of leucocytes (eg lymphocytes (controls, mean (SD) 1210 (208) cells/microl; children with asthma, 1119 (147) cells/microl) and eosinophils (controls, 104 (22) cells/microl; children with asthma, 88 (20) cells/microl)) to the same degree in both groups. Similarly, exercise increased T helper cells (controls, 248 (60) cells/microl; children with asthma, 232 (53) cells/microl) and most other lymphocyte subtypes tested. By contrast, although basophils (16 (5) cells/microl) and CD4+ CD45RO+ RA+ lymphocytes (19 (4) cells/microl) increased in controls, no increase in these cell types was found in children with asthma. CONCLUSIONS: Exercise increased many circulating inflammatory cells in both children with asthma and controls. Circulating inflammatory cells did increase in children with asthma, but not to a greater degree than in controls. In fact, basophils and T helper lymphocyte memory transition cells did not increase in children with asthma, whereas they did increase in controls. Even brief exercise in children and adolescents robustly mobilizes circulating immune cells.

Human papillomavirus type 18 in colorectal cancer.

Human papillomaviruses (HPVs) have been recognized as the etiological agent of warts, and they may also be associated with many cancers. HPV-18 is very common both in genital papillomas and in large bowel cancer. The relation between HPV-18 infection and natural course of colorectal cancer has not been fully defined. In this study, normal mucosa and colorectal cancer tissue were evaluated for the presence of HPV gene to determine whether or not HPV was involved in the development of colon neoplasm. The DNA extracted from colon tissue was screened for HPV by polymerase chain reaction (PCR) to amplify the viral gene fragment. These PCR products were digested with restriction enzyme, and Southern blotting was then performed to confirm the existence of HPV-18. The nucleotide sequence related to HPV-18 DNA was detected in 53% (10/19) of the normal mucosa specimens and in 84% (16/19) of the colorectal cancer specimens. The correlation between cancer samples and positive rate of HPV-PCR was statistically significant by chi-square test (p < 0.01). These data indicate that HPV-18 can infect the normal mucosa of the colon, and that this infection may be a risk factor for the development of colorectal cancer. The presence of HPV-18 DNA in patients with colorectal cancer suggests that the pathogenesis of colorectal cancer includes viral involvement.

Examining prognostic factors and patterns of failure in nasopharyngeal carcinoma following concomitant radiotherapy and chemotherapy: impact on future clinical trials.

PURPOSE: Concomitant chemotherapy and radiotherapy (CCRT), followed by adjuvant chemotherapy, has improved the outcome of nasopharyngeal carcinoma (NPC). However, the prognosis and patterns of failure after this combined-modality treatment are not yet clear. In this report, the prognostic factors and failure patterns we observed with CCRT may shed new light in the design of future trials. METHODS AND PATIENTS: One hundred forty-nine (149) patients with newly diagnosed and histologically proven NPC were prospectively treated with CCRT followed by adjuvant chemotherapy between April 1990 and December 1997. One hundred and thirty-three (89.3%) patients had MRI of head and neck for primary evaluation before treatment. Radiotherapy was delivered either at 2 Gy per fraction per day up to 70 Gy or 1.2 Gy per fraction, 2 fractions per day, up to 74.4 Gy. Chemotherapy consisted of cisplatin and 5-fluorouracil. According to the AJCC 1997 staging system, 32 patients were in Stage II, 53 in Stage III, and 64 in Stage IV (M0). RESULTS: Univariate analysis revealed that WHO (World Health Organization) Type II histology, T4 classification, and parapharyngeal extension were poor prognostic factors for locoregional control. Multivariate analysis revealed that T4 disease was the most important adverse factor that affects locoregional control, the risk ratio being 5.965 (p = 0.02). Univariate analysis for distant metastasis revealed that T4 and N3 classifications, serum LDH level > 410 U/L (normal range, 180-460), parapharyngeal extension, and infiltration of the clivus were significantly associated with poor prognosis. Multivariate analysis, however, revealed that T4 classification and N3 category were the only two factors that predicted distant metastasis; the risk ratios were 3.994 (p = 0.02) and 3.390 (p = 0.01), respectively. Therefore, based on the risk factor analysis, we were able to identify low-, intermediate-, and high-risk patients. Low-risk patients were those without the risk factors mentioned above. They consisted of Stage II patients with T2aN0, T1N1, and T2aN1 categories and of Stage III patients with T1N2 and T2aN2 categories. Their risk of recurrence is low (4%). Intermediate-risk patients were those with at least one univariate risk factor. They are Stage II patients with T2bN0 and T2bN1 categories and Stage III patients with T2bN2 and T3N0-2 categories. The risk of recurrence is modest (18%). High-risk patients have risk factors by multivariate analysis. They are stage T4 or N3 patients. Their risk of recurrence is high (36%). CONCLUSION: Low-risk patients have an excellent outcome. Future trials should focus on reducing treatment-associated toxicities and complications and reevaluate the benefit of sequential adjuvant chemotherapy. The recurrence in treatment of intermediate-risk patients is modest; CCRT and adjuvant chemotherapy may be the best standard for them. Patients with T4 and N3 disease have poorer prognosis. Hyperfractionated radiotherapy may be considered for the T4 patients. Future study in these high-risk patients should also address the problem of distant spread of the disease.

Unique features of breast cancer in Taiwan.

Between April 1990 and December 1997, 811 consecutive patients with 830 newly diagnosed breast cancers having their primary treatments in our institution were included in this study. Sixty three percent of breast cancer patients were premenopausal. The early-onset breast cancer (age < or = 40) composed 29.3% of all patients. The five-year survival rate of all patients was 80.4% (95% confidence interval [CI], 76.2-84.6%). The five-year overall survival rate for stage 0 was 95.7% (95% CI, 87.3-100%), stage I, 93.9% (95% CI, 88.9-98.9%), stage II, 88.5% (95% CI, 82.0-95.1%), stage III, 65.0% (95% CI, 54.0-75.9%), and stage IV, 18.5% (95% CI, 3.4-33.7%). Multivariate analysis of primary operable breast cancer revealed that axillary lymph node involvement, high nuclear grade and early-onset breast cancer (age < or = 40) were poor prognostic factors. The early-onset breast cancer had a more aggressive clinical behavior than that of the older age group, their five-year disease-free survival rates for stage I, stage II and stage III diseases being only 64.7%, 66.5%, and 43.3%, respectively. In these patients the only meaningful prognostic factor was extensive axillary lymph node metastasis (> or = 10). In summary, breast cancer patients in Taiwan tend to be younger than their counterpart in western countries. The early-onset breast cancer had poorer prognostic features for all stages comparing to the older age group. Standard pathologic factors are not good predictors of their outcome. For these patients new biologic markers need to be sought to distinguish between high and low risk and the treatment strategy for them should be guided by the aggressive characteristics of the disease.

Long-term survival of nasopharyngeal carcinoma following concomitant radiotherapy and chemotherapy.

PURPOSE: The purpose of this study is to demonstrate long-term survival of nasopharyngeal carcinoma treated with concomitant chemotherapy and radiotherapy (CCRT) followed by adjuvant chemotherapy. METHODS AND PATIENTS: One hundred and seven patients with Stage III and IV (American Joint Committee on Cancer, AJCC, 1988) nasopharyngeal carcinoma (NPC) were treated with concomitant chemotherapy and radiotherapy (CCRT) followed by adjuvant chemotherapy between April 1990 and December 1997 in Koo Foundation Sun Yat-Sen Cancer Center, Taipei. The dose of radiation was 70 Gray (Gy) given in 35 fractions, 5 fractions per week. Two courses of chemotherapy, consisting of cisplatin and 5-fluorouracil, were delivered simultaneously with radiotherapy in Weeks 1 and 6 and two additional monthly courses were given after radiotherapy. According to the AJCC 1997 staging system, 32 patients had Stage II disease, 44 had Stage III, and 31 had Stage IV disease. RESULTS: With median follow-up of 44 months, the 5-year overall survival rate in all 107 patients was 84.1%, disease-free survival rate was 74.4%, and locoregional control rate was 89.8%. The 3-year overall survival for Stage II was 100%, for Stage III it was 92.8%, and for Stage IV, 69. 4% (p = 0.0002). The 3-year disease-free survival for Stage II was 96.9%, for Stage III it was 87.7%, and for Stage IV it was 51.9% (p = 0.0001). CONCLUSION: CCRT and adjuvant chemotherapy is effective in Taiwanese patients with advanced NPC. The prognosis of AJCC 1997 Stage II and III disease is excellent, but, for Stage IV (M0), it is relatively poor. Future strategies of therapy should focus on high-risk AJCC 1997 Stage IV (M0) cohort.

Incidence of and predictors for chronic disability in activities of daily living among older people in Taiwan.

OBJECTIVES: To estimate the incidence of chronic activities of daily living (ADL) disability and to analyze the sociodemographic, health status, adverse lifestyle, and leisure-time physical activity predictors for chronic ADL disability. DESIGN: We recruited a cohort of community-dwelling older people in Taipei, Taiwan, who were not ADL disabled in August 1993, and we followed them until August 1996. SETTINGS AND PARTICIPANTS: The study subjects were 1321 community-dwelling people aged 65 years or older who were ADL intact at the initial interview in August 1993. The study sample was a subset of a probability sample (n = 1583) randomly selected from household registrations in the four districts of the Taipei metropolitan area. MEASUREMENTS: Baseline information regarding various factors potentially associated with the development of chronic ADL disability was assessed and collected at the beginning of the study. Study participants were assessed annually for ADL function by a structured home interview using a six-item scale. Participants who were unable to perform independently at least one of the six items--eating, bathing, dressing, toileting, transfers, and walking inside the house--for more than 3 months were considered chronically ADL disabled. Cox proportional hazard regression models were utilized to examine the independent effect of the potential predictors on risk of chronic ADL disability. RESULTS: During the 3-year study period, 145 (11.0%) participants developed chronic ADL disability, 58 (4.4%) participants were lost to follow-up, and 83 (6.3%) participants died. Multiple hazard regression analysis showed that individuals aged 70 to 79 years or older than age 80 had increased risk of ADL disability (relative risk: 2.05 (95% confidence interval (CI), 1.35-3.11) and 3.89 (95%CI, 2.33-6.50), respectively) compared with those participants younger than age 70. Risk of chronic ADL disability was inversely associated with routine exercise (RR = 0.52; 95% CI, 0.39-0.68). CONCLUSIONS: Age is the most significant predictor of chronic ADL disability. Lack of routine exercise is also a significant predictor of ADL disability in older adults.

Preoperative concurrent chemotherapy and radiotherapy in rectal cancer patients.

The management of rectal cancer has changed significantly in recent years. The key end-point is no longer survival but rather preservation of sphincter function with improved quality of life. Preoperative radiation can not only render a low-lying rectal tumor amenable to sphincter-preserving surgery but has also been reported to give better local control and lower toxicity than postoperative radiotherapy. From October 1991 through July 1996, 46 patients with local advanced or low-lying rectal cancer were treated with preoperative high-dose radiotherapy and concurrent chemotherapy. All patients underwent pelvic radiotherapy with 5,000 to 5,400 cGy in 25 to 27 fractions. Chemotherapy was given concomitantly and consisted of two courses of 5-fluorouracil (5-FU) at 1,000 mg/m2 for 4 days in week 1 and week 5 plus mitomycin C 10 mg/m2 single bolus on day 1 of week 1. In 30 patients, postoperative adjuvant chemotherapy with 5-FU and levamisole weekly was also given, for a total of 12 months. The most common acute toxicity was grade 1 to 2 diarrhea and tenesmus during radiation or soon afterward. Only five of the 46 patients experienced symptomatic grade 3 acute toxicity. Forty-two patients underwent subsequent surgery 6 to 8 weeks after concurrent chemoradiotherapy. Pathologic examination disclosed complete tumor regression in eight patients and microscopic residual disease in 13 patients after preoperative chemoradiation. Of the 42 patients who completed the intended treatments, only one had local recurrence. The sphincter was preserved in 21 of the 26 patients in whom the tumor was located within 5 cm above the anal verge. Twelve of the 16 evaluable patients had good to excellent sphincter function. The 2-year overall survival rate was 93% and the disease-free survival was 81%. Our findings indicate that preoperative concurrent chemoradiotherapy not only allows low-lying rectal tumors to be resected while preserving sphincter function but also results in good local control and acceptable toxicity.

Correlates of recurrent wheezing in school-age children. The Physicians of Raleigh Pediatric Associates.

Correlates of recurrent wheezing were examined in a case-control study involving 343 children ranging from 7 to 12 yr of age and recruited from a general pediatric practice. Positive skin tests for allergy were observed in 35% of a random sample of children without recurrent wheezing, and in 77% and 90% of children who had experienced from two to four episodes and five or more episodes, respectively, of recent wheezing. By logistic regression analysis, sensitization to dust mite (odds ratio [OR]: 5.2; 95% CI: 3.0 to 9.0), cat (OR: 15.5; 95% CI: 3.4 to 70.8), and Alternaria (OR: 6.8; 95% CI: 2.1 to 21.5) antigens was consistently associated with recurrent wheezing. Sensitization to pollen antigen(s), observed in 60% of allergic children, was not associated with wheezing. A family history of asthma was a significant predictor of recurrent wheezing (OR: 3.2; 95% CI: 1.7 to 5.9) after adjusting for its association with positive skin tests. Environmental tobacco smoke (ETS) exposure was associated with an increased risk of recurrent wheezing in nonallergic children and in allergic females, but not in allergic males. ETS exposure was not associated with positive skin tests for allergy. A history of wheezing with respiratory illness before 2 yr of age was associated with a modest risk of recurrent wheezing between 7 and 12 yr of age (OR: 2.3; 95% CI: 1.2 to 4.6), a risk that did not differ by allergic status or gender. Theoretically, the prevalence of recurrent wheezing in this population could be reduced approximately 65% by controlling exposure to indoor allergens and ETS.

Colonoscopic screening for first degree relatives of patients with colorectal cancer.

BACKGROUND: In addition to identifying and eradicating premalignant lesions, and detecting early cancer before the development of life-threatening consequences, new concepts and technological advances have stimulated a hightened interest in the secondary prevention of colorectal cancer. METHODS: People whose first degree relatives have had colorectal cancer are considered to run a higher risk of developing colorectal carcinoma. A screening program was carried out for 358 first degree relatives of colorectal cancer patients using colonoscopic screening. RESULTS: The mean age of these first degree relatives was 44 years, ranging from 13 to 78 years. Two hundred and eleven (58.9%) of them were asymptomatic. Totally 73 polyps were detected in 53 subjects (14.9%). Two cancer lesions were identified. Thirty polyps (41.1%) measured between 0.5 cm and 2.0 cm. The polyps were mostly located in the rectum and sigmoid colon (63%). One polyp was found in a subject below 30 years of age. Over the age of 30, the incidence of polyp increased dramatically. CONCLUSIONS: Our results confirmed that the screening program for the first degree relatives of patients with colorectal cancer is worthwhile. The program would have a more significant impact if the screening could start from subjects around the age of 30.

The application of laparoscopy in colorectal surgery: a preliminary report of twelve cases.

BACKGROUND: With the development of video camera imaging system and the improvement of laparoscopic manipulation instruments, laparoscopic surgery has become applicable to many abdominal surgeries. Having completed the feasibility studies of animal model over 10 dogs, we began to apply this new technique in the field of colorectal surgery. METHODS: From March to July 1993, 12 cases of large bowel resection were performed with laparoscopy. Operations performed included seven cases of laparoscopy-assisted right colectomy (LARC), three cases of laparoscopic abdominal-perineal resection (LAPR), one case of laparoscopic low anterior resection (LLAR) and one case of laparoscopy-assisted subtotal colectomy. Five cases received operation due to diverticular disease, three due to rectal carcinoma, three due to broad villous adenoma and one due to lipoma over ileocecal region. RESULTS: The average operation time for LARC was 4 hours and 50 minutes, and for LAPR was 6 hours and 35 minutes. Operation time required decreased substantially as the number of laparoscopic surgery performed increased. The average post-operative length of stay was 5.5 days for LARC and 11.5 days for LAPR. Most of the patient started diet intake on the third day after surgery. There was no major complication. Only two cases developed minor complications of subcutaneous hematoma over trocar insertion site and minor wound infection. CONCLUSIONS: Laparoscopic technique can feasibly be employed in certain cases of colorectal surgery, although it is rather complicated and requires longer learning curve than other laparoscopic procedures. Therefore, surgeons should take it most caution while carrying out this procedure. Experimental trials over animal model is also highly recommended before clinical practice.

A method for testing the nonrandomness of chromosomal breakpoints.

Testing the nonrandomness of breakage at a chromosome band is an essential step fo identifying a fragile site. In this paper, we propose a method derived by using the relationship between the binomial and F distributions for testing nonrandomness. The method is simple in calculation. It was applied to the detection of fragile sites for Chinese patients with colorectal carcinoma.

Clinical significance of arginase in colorectal cancer.

Arginase, a potent immune inhibitor, existed in much greater abundance in the cytoplasm of cancer cells than in normal cells. Serum arginase levels from 31 patients with colorectal adenocarcinoma were determined by using enzyme immunoassay (mean +/- standard error = 18.96 +/- 4.83 ng/ml) and showed to be significantly higher than levels from control subjects (n = 115, 3.09 +/- 0.22 ng/ml) (P less than 0.005). Surgical samples of 15 patients were individually homogenized and assayed by the same method and revealed that the arginase level in tissues with colorectal cancer was two times greater than the level found in normal mucosal tissues (1.74 +/- 0.31 micrograms/g tissue versus 0.77 +/- 0.09 micrograms/g tissue, P less than 0.005). However, the serum arginase levels in patients with colorectal cancer were independent of their carcinoembryonic antigen (CEA) levels (n = 27, arginase 11.81 +/- 1.88 ng/ml, CEA 17.31 +/- 4.24 ng/ml, r = 0.084, P = 0.666). The results suggested that serum arginase level can be a valuable criterion for preoperative evaluation and possibly postoperative follow-up study. It can also combine with CEA determination to intensify the clinical assessment for colorectal cancer.

Trend of large bowel tuberculosis and the relation with pulmonary tuberculosis.

From 1965 to 1989, 60 cases of large bowel tuberculosis among 116 cases of abdominal tuberculosis are reviewed and analyzed. Lesions located in the cecum or ileocecal region were found in 49 of the 60 cases. Most of the patients (50/60) received surgical intervention, but the definite diagnoses had never been proved until surgery. The diagnoses were proved by histopathologic examination in these 50 cases. Antituberculosis medications were given for at least nine months in all patients. Twenty-nine of the 50 patients who received operations had primary anastomosis during the operations, and no leakage occurred. Evidence of pulmonary tuberculous lesions could be found in 40 of the 60 cases. Positive findings of tubercle bacilli in sputum smear or culture were noted in 13 cases. The positive rate of sputum examinations decreased during 1980 to 1989; 25.6 percent (10/39) were positive from 1965 to 1979 and 14 percent (3/21) were positive from 1980 to 1989. In the meantime, there was a steady decline in the cases of large bowel tuberculosis in the most recent few years. An antituberculosis program has been carried out in the past 40 years with remarkable effect in the Taiwan area, but the possibility of intestinal tuberculosis still exists. The authors suggest that surgeons keep tuberculosis in mind when they are dealing with patients who suffer from intestinal obstruction of unknown origin with the suspected findings of pulmonary tuberculosis in chest x-ray films.

Chromosome analysis on two long-term established human colorectal carcinoma cell lines.

A chromosomal analysis was carried out on two colorectal carcinoma cell lines (WiDr and COLO 205), which were established 15-20 years ago in the US and were collected by the Cell Bank of the Veterans General Hospital in Taipei. Among the 200 cells counted, 65.5% of WiDr (male) had 68-73 chromosomes, while 74% of the COLO 205 (female) had 70-76 chromosomes per cell. The Y chromosome was absent in the 30 WiDr metaphases analyzed. None of the other chromosomes, including X and the autosomes of both WiDr and COLO 205, revealed such a numerical deficiency. Over half of the autosomes had an average number per cell above 2.0. The existence of 5 or 6 normal homologues for certain autosomes was not rare in either line. Numerous structural abnormal marker chromosomes were present in the cells. As compared with the original chromosome findings which were done over 10 years ago, we noted that the range of chromosome counts was wider and the number of marker chromosomes increased in these long-term cultivated cell lines.

[Two-phase test of fecal occult blood screening for colorectal cancer].

The detection of colorectal cancer in an early curable stage has become the focus of considerable interest recently. A two-phase test using both guaiac test and Hemolex latex immuno-agglutination test was applied for fecal occult blood screening of colorectal cancer. A total of 4,725 veterans aging 60 to 69 years were registered, and 2,176 persons (average age 66 years) completed the test giving a compliance rate of 46%. The positive rates of both tests were accounted 20.5% and 6.7% respectively. Five hundred and forty five persons had positive reaction for at least one of the tests. Of these, 90 had a follow up diagnosis with colonoscopy or combined with barium enema. Three rectal adenocarcinomas were detected, of which only one was positive by guaiac test, but two by Hemolex test. A rectal carcinoid was found by rectodigital examination. It was negative by both tests. Nineteen cases were detected to have one or more polyps in colon or rectum, of which only 6 were positive by guaiac test, but 18 by Hemolex test. Hemolex test using antibody against human hemoglobin is based on latex agglutination reaction. It is more sensitive and specific than guaiac test. Moreover, no dietary restriction is required. In the view point of cost-effectiveness, mass screening for colorectal cancer in general public is not recommended, but hospital-based screening for high risk group is still worthwhile to study.

Reconstruction of anorectal angle after abdominoperineal resection of rectum and anus--an animal model.

Voluntary control of the bowel movements is a social necessity. Lack of control relegates one to psychological debility and the possible need for a permanent colostomy. Anorectal angle plays an important role in fecal continence. In the normal individual, this angle lies in the range of 60 to 105 degrees. Perineal colostomy, once proposed for patients who had received abdominoperineal resection (APR), has been abandoned because of frank incontinence. This study used a canine model. The anorectal angle, external sphincter, internal sphincter, and the puborectalis were all destroyed after APR. The colon was pulled through the perineal defect. Enteropexy, gracilis muscle transfer, and perineal colostomy were performed to restore the anorectal angle. Barium enema was performed preoperatively and postoperatively. The anorectal angle was reconstructed within normal ranges after abdominoperineal resection of the rectum and anus.

Evaluation of rapid colon preparation with Golytely.

The traditional cleansing method of the large bowel usually involves dietary restrictions, purgatives and enema. They are time consuming and uncomfortable, and may result in dehydration. Though Golytely, an oral lavage solution, has been developed since 1980 as an alternative for cleansing the colon and much literature has favored it, it has not been widely used in Taiwan. In this study, we used Golytely without enema for rapid colon cleansing in a consecutive series of 48 patients. The efficacy, change of vital signs, body weights, electrolytes, and urine specific gravity were evaluated. Patient's acceptance of this method was compared with that of 32 patients who received castor oil as cleansing method. The average amount of Golytely used in this preparation was 3.16 liters, and the average time was 8 hours and 43 minutes. About 87% of patients receiving Golytely achieved a good to excellent preparation. There were no significant changes in vital signs, body weights, electrolytes and urine specific gravity. The patient's acceptance of Golytely was better than that of castor oil.

The roles of hemorrhoidectomy and lateral internal sphincterotomy in the treatment of hemorrhoids--clinical and manometric study.

To compare the clinical effect of lateral internal sphincterotomy with hemorrhoidectomy and to examine the change of anal pressure before and after these two treatments, manometric study and clinical symptoms were assessed in 56 patients with hemorrhoids. These patients were randomly allocated to one of the two treatment groups. Another twenty-seven persons with sex and age match were also studied as the normal control. There was no significant difference between the mean resting anal pressure (RAP) of the controls (72.56 +/- 11.93 mmHg) and the hemorrhoid group (75.82 +/- 8.38 mmHg). Thirty-one patients received hemorrhoidectomy and there was no significant reduction of RAP postoperatively. The mean resting anal pressure of the 25 patients receiving lateral internal sphincterotomy was reduced postoperatively (75.1 +/- 9.85 mmHg VS. 70.24 +/- 7.77 mmHg). Although lateral internal sphincterotomy did reduce the anal pressure, the clinical outcome was better in hemorrhoid group. We consider hemorrhoidectomy as the optimal choice in these two kinds of treatment. Change of anal pressure may not play such an important role in the pathogenesis of hemorrhoids.