Terapéutica de la fluxión hemorroidal / Therapeutics of hemorrhoidal fluxion

Introducción: La fluxión hemorroidal es una complicación severa de la enfermedad hemorroidaria. Combinando el tratamiento conservador con el quirúrgico, puede resultar en una cirugía menos amputativa. Objetivos: Analizar los resultados en pacientes con fluxión hemorroidal y evaluar los beneficios del tratamiento combinado médico-quirúrgico. Pacientes y Métodos: Estudio observacional retrospectivo de 35 hemorroidectomías por fluxión, operados entre mayo de 2010 y mayo de 2015. Resultados: El sexo masculino fue más frecuente con 68,5%, con una proporción hombre/mujer de 2,2 a 1. El rango etario general varió desde los 20 a 75 años. El motivo de consulta más frecuente fue la tumoración anal en 29 (82,8%). En 22 pacientes (65,7%) que se les completó más de 48hs de tratamiento médico, se le denominó grupo A, a quienes se realizaron 2 Buie bilateral (9%), 7 Hemi Buie con S/A asociada (31,8%), 10 Salmon Allingham (45,4%) y 3 Ferguson (13,6%). Mientras que los restantes 13 (31,4%) fueron denominados como grupo B, donde existieron 2 Buie bilateral (15,3%), 4 Hemi Buie con S/A asociada (30,7%), 5 Salmon Allingham (38,4%) y 2 Ferguson (15,3%). La estadía hospitalaria varió en el rango de 2 a 7 días, con una media de 2,8 días, no hubo diferencia en los grupos de pacientes. Conclusión: Los resultados son buenos, sin recidivas o secuelas. El tratamiento combinado podría beneficiar reduciendo la magnitud de la cirugía.

Introduction: The hemorrhoidal fluxion is a severe complication of hemorrhoidal disease. Combining conservative surgical treatment, it may result in a less amputative surgery. Objectives: Analyzing the results in patients with hemorrhoidal fluxion and evaluate the benefits of combined medical-surgical treatment. Patients and Methods: The retrospective observational study of 35 hemorrhoidectomies by fluxion operated between May 2010 and May 2015. Results: Males were more frequent with 68.5%, with a male / female ratio of 2.2 to 1. The general age range varied from 20 to 75 years. The most frequent symptom was the anal tumor in 29 (82.8%). Group A was conformed by 22 patients (65.7%), who underwent 48 hours of medical treatment, and after that the surgical treatment: Buie in 2 (9%), 7 Hemi Buie were performed using S / A associated (31.8 %), 10 Salmon Allingham (45.4%) and 3 Ferguson (13.6%). The remaining 13 (31.4%) were designated as Group B, where there were 2 Buie (15.3%), 4 Hemi Buie with S / A associated (30.7%), 5 Salmon Allingham (38, 4%) and 2 Ferguson (15.3%). Hospital stay varied from 2 to 7 days, with a medium 2.8 days. There was no difference between both groups. Conclution: The results are good, without recurrence or sequelae. The combination therapy could benefit by reducing the extent of the surgery.

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

AIM: To compare the efficacy and safety of recombinant streptokinase (rSK) vs hydrocortisone acetate-based suppositories in acute hemorrhoidal disease. METHODS: A multicenter (11 sites), randomized (1:1:1), open, controlled trial with parallel groups was performed. All participating patients gave their written, informed consent. After inclusion, patients with acute symptoms of hemorrhoids were centrally randomized to receive, as outpatients, by the rectal route, suppositories of rSK 200000 IU of one unit every 8 h (first 3 units) and afterwards every 12 h until 8 administrations were completed (schedule A), one unit every 8 h until 6 units were completed (schedule B), or 25 mg hydrocortisone acetate once every 8 h up to a maximum of 24 administrations. Evaluations were performed at 3, 5, and 10 d post-inclusion. The main end-point was the 5(th)-day response (disappearance of pain and bleeding, and ≥ 70% reduction of the lesion size). Time to response and need for thrombectomy were secondary efficacy variables. Adverse events were also evaluated. RESULTS: Groups were homogeneous with regards to demographic and baseline characteristics. Fifth day complete response rates were 156/170 (91.8%; 95%CI: 87.3-96.2), 155/170 (91.2%; 95%CI: 86.6%-95.7%), and 46/170 (27.1%; 95%CI: 20.1%-34.0%) with rSK (schedule A and B) and hydrocortisone acetate suppositories, respectively. These 64.6% and 63.9% differences (95%CI: 56.7%-72.2% and 55.7%-72.0%) were highly significant (P < 0.001). This advantage was detected since the early 3(rd) day evaluation (68.8% and 64.1% vs 7.1% for the rSK and active control groups, respectively; P < 0.001) and was maintained even at the late 10(th) day assessment (97.1% and 93.5% vs 67.1% for rSK and hydrocortisone acetate, respectively; P < 0.001). Time to response was 3 d (95%CI: 2.9-3.1) for both rSK groups and 10 d (95%CI: 9.3-10.7) in the hydrocortisone acetate group. This difference was highly significant (P < 0.001). All subgroup stratified analyses (with or without thrombosis and hemorrhoid classification) showed a statistically significant advantage for the rSK groups. Thrombectomy was necessary in 4/251 and 14/133 patients with baseline thrombosis in the rSK and hydrocortisone acetate groups, respectively (P < 0.001). There were no adverse events attributable to the experimental treatment. CONCLUSION: rSK suppositories showed a significant advantage over a widely-used over-the-counter hydrocortisone acetate preparation for the treatment of acute hemorrhoidal illness, as well as having an adequate safety profile.

Evolución alejada de los pacientes operados por hemorroides complejas o más de tres paquetes con técnicas no hemorroidopexia / Remote evolution of patients operated by complex hemorrhoids or more than three packages with non-hemorrhoidopexy techniques

Introducción: Las hemorroides son una patología muy frecuente. La mayor parte de los pacientes son tratados con modificaciones en la dieta, aquellos que no responden al tratamiento son pasibles de tratamientos ambulatorios y los casos más avanzados quirúrgicos. Objetivos: Estudiar la evolución alejada de los pacientes con patología hemorroidal severa. Diseño: Estudio retrospectivo con encuesta telefónica. Material y Métodos: La serie estudiada son 304 pacientes operados entre 1980 y 2012, correspondiendo 124 a casos con más de 50% de la circunferencia comprometida por trombosis, gangrena o casos de importante prolapso, a quienes se efectuó la exéresis de las zonas afectadas y la reconstrucción del canal anal utilizando colgajos cutáneos, y 180 fueron tratados de tres o más paquetes con técnica de Ferguson. Resultados: En el período considerado consultaron por hemorroides 1832 pacientes, de los cuales a 180 (9,8%) se utilizó la técnica de Ferguson para tres o más paquetes y 124 (6,8%) fueron casos complejos. Presentaron complicaciones post operatorias el 13,71% de las complejas y el 6,11% de tres paquetes o más (n s). Por medio de la encuesta encontramos en los casos denominados complejos un 93% de asintomáticos y en los de más de 3 Paquetes un 81%, resultando esta diferencia significativa. Los síntomas más frecuentes, sangrado y dolor, fueron muy esporádicos en el 71,4% vinculado a constipación o transgresiones alimentarias manifestando el 93,5% sentirse mejor que antes de operados. Conclusiones: Tanto los resultados inmediatos como el seguimiento alejado en la serie presentada han sido muy satisfactorios.

Introduction: Hemorrhoidal disease is a very frequent pathology. Most hemorrhoids are medically treated with diet changes. Those who do not respond satisfactorily can receive office-based treatments and the most advanced cases require surgical intervention. Aims/objectives: Study of the long-term evolution of patients with severe hemorrhoidal pathology. Design: Retrospective study with telephonic survey. Material and Methods: The studied series comprises 304 patients operated on between 1980 and 2012, corresponding 124 cases to patients with more than 50% of the anal circumference compromised by thrombosis, gangrene or cases of significant prolapse. These cases underwent exeresis of the affected areas and reconstruction of the anal canal utilizing cutaneous flaps, and 180 cases, which presented more than three bundles, were treated with Ferguson´s technique. Results: In the referred period, 1832 patients consulted about hemorrhoids. Ferguson´s technique was used on 180 patients (9,8%) and 124 patients (6,8%) corresponded to complex cases. Post-surgical complications were seen in 13, 71% of the complex cases and in 6.11% of the cases with three or more hemorrhoidal bundles (n s). The survey showed that 93% of the complex cases were asymptomatic, in comparison to 81% of those with three of more hemorrhoidal bundles, resulting in a significant difference. The most frequent symptoms: bleeding and pain, were very sporadic in 71, 4% corresponding to constipation or dietary transgressions; 93, 5% stated feeling better than before being operated on. Conclusions: The immediate results as well as the long-term follow up of the presented series have both been very satisfactory.

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

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

Recombinant streptokinase suppositories in the treatment of acute haemorrhoidal disease. Multicentre randomized double-blind placebo-controlled trial (THERESA-2).

AIM: A four-arm multicentre randomized double-blind placebo-controlled trial was undertaken to assess the effect and safety of suppositories containing recombinant streptokinase (rSK) at two dose levels (100,000 IU and 200,000 IU) with sodium salicylate (SS) compared with placebo and SS for the treatment of acute haemorrhoidal disease. METHOD: Patients with acute symptoms of haemorrhoids were randomized to four treatment groups: (I) placebo, (II) SS, (III) SS + rSK 100,000 IU and (IV) SS + rSK 200,000 IU per suppository. Inpatient treatment was by four suppositories given every 6 h to discharge at 24 h. Evaluations were made at the time of discharge (24 h) and at 3, 5 and 20 days later. The main end-point was the degree of relief of pain, oedema and reduction in the size of the lesion by 90% on day 5. Adverse events and the occurrence of anti-SK antibodies were also determined. RESULTS: Eighty patients were included. Respective response rates in the four groups were 16%, 30%, 25% and 52%. In the last group there was a significant difference (36.8%) compared with control (95% CI 7.0-58.4%). The time to response was significantly shorter (median 5 days) in the 200,000 IU rSK group with respect to the others. There were no adverse events attributable to the treatment. No increase in anti-SK antibodies was detected 20 days after treatment. CONCLUSION: Suppositories with 200,000 IU rSK showed a significant improvement in symptoms of acute haemorrhoids, with an adequate safety profile.

Constipation, haemorrhoids, and heartburn in pregnancy.

INTRODUCTION: Constipation, heartburn, and haemorrhoids are common gastrointestinal complaints during pregnancy. Constipation occurs in 11-38% of pregnant women. Although the exact prevalence of haemorrhoids during pregnancy is unknown, the condition is common, and the prevalence of symptomatic haemorrhoids in pregnant women is higher than in non-pregnant women. The incidence of heartburn in pregnancy is reported to be 17-45%. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent or treat constipation in pregnancy? What are the effects of interventions to prevent or treat haemorrhoids in pregnancy? What are the effects of interventions to prevent or treat heartburn in pregnancy? We searched: Medline, Embase, The Cochrane Library and other important databases up to July 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found five systematic reviews, RCTs or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: Acid-suppressing drugs, anaesthetic agents (topical), antacids with or without alginates, bulk-forming laxatives, compound corticosteroid and anaesthetic agents (topical), corticosteroid agents (topical), increased fibre intake, increased fluid intake, osmotic laxatives, raising the head of the bed, reducing caffeine intake, intake of fatty foods, and the size and frequency of meals, rutosides, sitz baths, and stimulant laxatives.

[Analytical review of multicenter studies with polycresulene for hemorrhoidal pathologies]. / Revisión analítica de estudios multicéntricos con policresuleno en patología hemorroidal.

Seven centres investigated the therapeutic efficacy and tolerability of policresulene associated to cinchocaine administered locally as ointment, suppositories or both formulations in 2287 patients with hemorrhoid pathology. The studies were conducted with a standardised protocol and case report forms and with the same score criteria for rating efficacy and tolerability according to the physicians and the patients. Highly satisfactory results were achieved in 1904 patients (83.2%) according to the investigators criteria. Patients rated the outcome most satisfactory for 1881 cases (82.2%). The following were found to be the principal indications: external and internal hemorrhoids associated with bleeding, acute anal fissures, rhagades and perforated or incised perianal thrombosis, anal eczema and anal pruritus, proctitis and wound treatment after proctologic surgery. None of the investigators found any serious adverse event. Mild to moderate adverse reactions in 10% of the patients were local discomfort, pruritus, burning or irritation. Such symptoms occurred at the beginning of treatment. The favourable effects of policresulene are attributed to its unique mechanism of action. The highly acid characteristics of the substance causes a selective coagulation of the necrotic tissues leaving healthy tissues unaffected. The desquamation and remotion of the necrotic tissues induces rapid wound cleansing, and a reactive hyperemia of the treated area enhancing epithelization. Its highly acid pH produces a marked bactericidal action on the most common pathogens and C. albicans as well. Policresulene has hemostyptic properties producing vasoconstriction of the myofibrils of the blood vessels arresting profuse bleeding from large areas. The local anesthetic cinchocaine contributes to the initial pain relief. None of the formulations contains corticosteroids which makes this preparations also suitable for long term treatment periods.

Revisión analítica de estudios multicéntricos con policresuleno en patología hemorroidal / Analytical review of multicenter studies with polycresulene for hemorrhoidal pathologies

Seven centers investigated the therapeutic efficacy and tolerability of policresulene associated to cinchocaine administered locally as ointment, suppositories or both formulations in 2287 patients with hemorrhoid pathology. The studies were conducted with a standardised protocol and case report forms and with the same score criteria for rating efficacy and tolerability according to the physicians and the patients. Highly satisfactory results were achieved in 1904 patients (83.2 per cent) according to the investigators criteria. Patients rated the outcome most satisfactory for 1881 cases (82.2 per cent). The following were found to be the principal indications: external and internal hemorrhoids associated with bleeding, acute anal fissures, rhagades and perforated or incised perianal thrombosis, anal eczema and anal pruritus, proctitis and wound treatment after proctologic surgery. None of the investigators found any serious adverse event. Mild to moderate adverse reactions in 10 per cent of the patients were local discomfort, pruritus, burning or irritation. Such symptoms occurred at the beginning of treatment. The favourable effects of pol icresulene are attributed to its unique mechanism of action. The highly acid characteristic of the substance causes a selective coagulation of the necrotic tissues leaving healthy tissues unaffected. The desquamation and remotion of the necrotic tissues induces rapid wound cleansing, and a reactive hyperemia of the treated area enhancing epithelization. Its highly acid pH produces a marked bactericidal action on the most common pathogens and C. albicans as well. Policresulene has hemostyptic properties producing vasoconstriction of the myofibrils of the blood vessels arresting profuse bleeding from large areas. The local anesthetic cinchocaine contributes to the initial pain relief. None of the formulations contains corticosteroids which makes this preparations also suitable for long term treatment periods. (Au)

Revisión analítica de estudios multicéntricos con policresuleno en patología hemorroidal / Analytical review of multicenter studies with polycresulene for hemorrhoidal pathologies

Seven centers investigated the therapeutic efficacy and tolerability of policresulene associated to cinchocaine administered locally as ointment, suppositories or both formulations in 2287 patients with hemorrhoid pathology. The studies were conducted with a standardised protocol and case report forms and with the same score criteria for rating efficacy and tolerability according to the physicians and the patients. Highly satisfactory results were achieved in 1904 patients (83.2 per cent) according to the investigators criteria. Patients rated the outcome most satisfactory for 1881 cases (82.2 per cent). The following were found to be the principal indications: external and internal hemorrhoids associated with bleeding, acute anal fissures, rhagades and perforated or incised perianal thrombosis, anal eczema and anal pruritus, proctitis and wound treatment after proctologic surgery. None of the investigators found any serious adverse event. Mild to moderate adverse reactions in 10 per cent of the patients were local discomfort, pruritus, burning or irritation. Such symptoms occurred at the beginning of treatment. The favourable effects of pol icresulene are attributed to its unique mechanism of action. The highly acid characteristic of the substance causes a selective coagulation of the necrotic tissues leaving healthy tissues unaffected. The desquamation and remotion of the necrotic tissues induces rapid wound cleansing, and a reactive hyperemia of the treated area enhancing epithelization. Its highly acid pH produces a marked bactericidal action on the most common pathogens and C. albicans as well. Policresulene has hemostyptic properties producing vasoconstriction of the myofibrils of the blood vessels arresting profuse bleeding from large areas. The local anesthetic cinchocaine contributes to the initial pain relief. None of the formulations contains corticosteroids which makes this preparations also suitable for long term treatment periods.

[Effectiveness and innocuousness of the association of calcium dobesilate, dexamethasone acetate and lidocaine versus prednisolone capronate with dibucaine clorohydrate in the treatment of hemorrhoids-]. / Effectividad e inocuidad de la asociacion de dobesilato de calcio con acetato de dexametasona y lidocaina con capronato de prednisolona con clorhidrato de dibucaina, en el tratamiento de las hemorroides.

The objective of the present study was to compare properties of two associations in the topical treatment of hemorrhoids. They were included 40 patient with diagnosis of internal hemorrhoids grade 1 or 2, which was indicated topic treatment after the realization of an interrogatory and anoscopy. The treatment received according to a randomized and double blind design: A = dobesilate of calcium with acetato of dexamethasone and lidocaine or B = Capronato of Prednisolone with Clorhidrato of dibucaina, applied twice a day. They were carried out controls every 7 days. In each control was carried out interrogatory and respective anoscopy. There was a prevalence of the females, and the age corresponded to the 5t decade of the life. Patients of the treatment. A presented greater number of predisponents factors, but minor percentage of previous treatments. As for the evaluation of the punctuation of symptoms and of the grade of Hemorrhoids, comparing beginning and final, they didn't show significant difference interproduct confirming the effectiveness and similar inocuity. In both products was observed a important improvement concerning to the symptoms and grade of hemorrhoids but the patients of the treatment A precipitated the greater speed. As for the evaluation made by the phisicians, the treatment A (88%) and B (85.7%) the got successful outputs. The opinion of the patients was a 100% of marked goods or moderated beneficial. Both treatments were successful so much in effectiveness like in inocuity although the treatment A were always got the best efectiveness outputs.

El aloe barbadensis (sábila) en el tratamiento de las hemorroides / Aloe barbadensis (sabila) in the treatent of hemorrhooides

Se presenta una comunicación preliminar sobre el posible uso terapéutico del Aloe barbadensis Mill. (sábila) en su forma natural, en 10 pacientes con várices hemorroidales de diferentes grados

El aloe barbadensis (sábila) en el tratamiento de las hemorroides / Aloe barbadensis (sabila) in the treatment of hemorrhooides

Se presenta una comunicación preliminar sobre el posible uso terapéutico del Aloe barbadensis Mill. (sábila) en su forma natural, en 10 pacientes con várices hemorroidales de diferentes grados

Daflon na crise hemorroidária / Daflon in hemorrhoidal crisis

O autor estudou ambulatorialmente 30 pacientes portadores de hemorróidas sob efeito de Daflon na dose diária de 12 comprimidos, durante o tempo médio de 28 dias. Obteve 90% de resultados positivos com referência à sintomatologia. Quanto à tolerabilidade, dois pacientes apresentaram náuseas e vômitos, que desapareceram com a continuaçäo do tratamento