Rubber band ligation versus haemorrhoidectomy for prolapsing haemorrhoids: a long term prospective clinical trial.
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Clinical Trials as Topic↗
Biomedical subjects
A J Sim
Publications and source records attributed to A J Sim.
The importance of pain, pruritus and soiling as symptoms of haemorrhoids and their response to haemorrhoidectomy or rubber band ligation.
Bowel habit, anal pain or discomfort, pruritus ani and faecal soiling have been assessed in 82 patients with uncomplicated, prolapsing haemorrhoids before and after successful treatment (improvement in rectal bleeding and haemorrhoidal prolapse) by haemorrhoidectomy or rubber band ligation. An age and sex-matched control group of patients without haemorrhoids was similarly assessed. The bowel habit of the haemorrhoid group was not different from that of the control population. Pain or discomfort, pruritus and faecal soiling were much commoner in the pretreatment haemorrhoid group, compared to controls. Treatments designed to abolish rectal bleeding and prolapse (the cardinal symptoms of haemorrhoids) also reduced the incidence of these three symptoms. Only anal pain or discomfort, however, was reduced to the incidence found in the control group. Haemorrhoidectomy and rubber band ligation appeared equally effective in controlling all three symptoms. It is concluded that anal pain or discomfort, pruritus ani and faecal soiling are common symptoms of uncomplicated haemorrhoids and that they are abolished in the majority of patients by successful treatment for rectal bleeding and haemorrhoidal prolapse.
Adult↗
Comparison of rubber band ligation and sclerosant injection for first and second degree haemorrhoids-- a prospective clinical trial.
Fifty patients with first or mild second degree haemorrhoids were randomly allocated to sclerosant injection (26) or rubber band ligation (24). One year after treatment 24 injection and 22 rubber band ligation patients were assessed. All patients presented with rectal bleeding; injection relieved 14 and rubber band ligation relieved 17 of this symptom (N.S.). Three of seven patients with prolapsing haemorrhoids who had sclerosant injections and five of seven who had rubber band ligation were relieved of this prolapse. However, a further six patients in the injection group developed prolapse for the first time during the one year follow-up period (p less than 0.05). Rubber band ligation relieved anal pain in 10 out of 14 patients whereas injection relieved only one patient of this symptom (p less than 0.05). Neither treatment influenced pruritus ani or faecal soiling. Although rubber band ligation caused more treatment discomfort, it is an effective management for first and mild second degree haemorrhoids and it should be considered as the procedure of choice.
Adult↗
The appearance of endotoxin following urethral instrumentation.
The Limulus amoebocyte lysate test was used to detect the presence of endotoxin in the venous blood of 10 patients following urethral instrumentation. The test was negative in all patients before instrumentation, became positive in 9 immediately after instrumentation and in 1 30 min after instrumentation. In 6 patients endotoxin reappeared between 1.5 h and 4.5 h after instrumentation. All blood samples, cultured aerobically and anaerobically, were sterile. Escherichia coli were cultured from one midstream specimen of urine and from one urethral swab in the same patient taken before instrumentation. There were no significant changes in either pulse rate or axillary temperature following instrumentation.
Aged↗
Comparison of rubber band ligation and haemorrhoidectomy for second- and third-degree haemorrhoids: a prospective clinical trial.
One hundred patients with second- or third-degree haemorrhoids were randomly allocated to haemorrhoidectomy (50) or rubber band ligation (50). Forty-two in each group presented with rectal bleeding; haemorrhoidectomy relieved 36 and rubber band ligation relieved 31 of this symptom. All patients had prolapsing haemorrhoids at presentation. One year after treatment 45 haemorrhoidectomy and 43 rubber band ligation patients were assessed. Haemorrhoidectomy relieved 44 of 45 patients and rubber band ligation relieved 34 of 43 (P < 0.05). Haemorrhoidectomy caused pain in all cases, lasting for more than 48 h in 35. Rubber band ligation was painless in 5 and produced pain for more than 48 h in 15. Mean time off work was 32 days for haemorrhoidectomy and 3 days for rubber band ligation (P < 0.001). Rubber band ligation as an outpatient procedure is an effective treatment for second- and third-degree haemorrhoids and should be considered before recourse to surgery.
Adult↗
Glucose promotes whole-body protein synthesis from infused aminoacids in fasting man. Isotopic demonstration.
15N-glycine constant infusion, with plateau urea enrichment as the endpoint, demonstrated a clear increase in whole-body protein synthesis when glucose was added to aminoacid infusion in fasting men. Whole-body protein-breakdown rates remained unchanged. There was an unexpected fall in whole-body nitrogen turnover when the subjects were changed from an oral intake to either of the intravenous programmes: this finding, not previously reported, may be due to the decrease in gastrointestinal enzyme synthesis and intestinal-lining cell-turnover when oral intake is replaced by total parenteral nutrition.
Administration, Oral↗
Substrate interaction in intravenous feeding: comparative effects of carbohydrate and fat on amino acid utilization in fasting man.
Data are presented on the metabolic and endocrine effects of intravenous infusions in normal fasting man observed under highly controlled conditions over a period of six to eight days duration. There are comparative data on a variety of intravenous feeding programs. The data on total starvation are based on studies from the literature, some of which were carried out in this laboratory. The data on low dose glucose, high dose glucose, glycerol, fat emulsion, and amino acids, each given separately, demonstrate changes seen with simple infusion of a single substrate in fasting. These data are now compared with the utilization of amino acid infusions when accompanied by low dose glucose, high dose glucose, glycerol, and fat emulsion. In all, nine experimental intravenous feeding programs are presented, based on data from 35 subjects observed over a total of 370 subject-days. The findings show a strong interaction between glucose or lipid and protein metabolism. In fasting, glucose had protein sparing effect, most evident when given at high dose. Glycerol, in an amount equal to that contained in 2000 ml of ten per cent fat emulsion, had a mild protein sparing effect. Fat emulsion was no more effective. When amino acids were given alone, normal fasting human subjects were always in negative nitrogen balance with the daily nitrogen loss half that seen in starvation alone. Although amino acids given alone have a protein sparing effect, this is accomplished only at the expense of a high nitrogen excretion including an amount equivalent to the entire infusion plus an additional loss from the body's native proteins. The provision of energy yielding non-protein substrates with the amino acids markedly improved nitrogen economy in the following order: glycerol, low dose glucose, fat emulsion and high dose glucose. When caloric provision with glucose approached the isocaloric level for normal diet, the utilization of amino acids was maximized. When given with amino acids, fat emulsion was more effective than the available glycerol alone. THE ACCOMPANYING ENDOCRINE AND BIOCHEMICAL CHANGES SUGGEST THAT THE MILIEU FOR IDEAL UTILIZATION OF INFUSED AMINO ACIDS IS VARIABLE: ketones at low range (carbohydrate) or moderately elevated (fat emulsion); insulin elevated (carbohydrate) or unchanged (fat emulsion). The utilization of the infused amino acids was markedly improved in both endocrine settings, suggesting that it is the provision of energy as substrate as well as the endocrine setting that determines amino acid utilization. There were other changes in plasma intermediates, particularly fatty acids, glucose and urea, all consistent with the concept that when amino acids are given without other substrates, the amino acids must be maximally utilized for gluconeogenesis. When other substrates are provided (particularly glucose at high dose) then this mandate no longer exists and protein synthesis from the amino acids is favored. Several of the plasma amino acid concentrations responded to glucose when added to amino acid infusion. Amino acids alone produced increases in concentration of all the amino acids found in the infusion with the exception of alanine, arginine, and threonine. Many of these increases were abated by the addition of glucose to the amino acid infusion, suggesting an increased utilization rate. Glycerol and fat emulsion, while modulating increases in the plasma amino acid concentration, did so to a lesser extent than did glucose. This lowering of amino acid concentration was unaccompanied by an increase in urinary excretion. The assumption is therefore made that the provision of the added glucose favors the incorporation of amino acid into protein. There is no evidence from these data to suggest that a rising concentration of ketones in the blood favors amino acid utilization or protein synthesis.
Adult↗
Proceedings: The effect of sodium cholate and heparin on gallstone dissolution in vitro.
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Cholelithiasis↗
Hyperkalemia in patients on enteral feeding.
The amount of potassium (K) in proprietary enteral feeds varies considerably from 2.7-9.2 mmol K+/g N. It has been suggested that up to 7 mmol K+/g N is required by the anabolic patient. The aim of this study was to determine the effect of a proprietary feed (Triosorbon MCT), containing 6.9 mmol K+/g N, on serum and urinary K in 13 patients requiring nutritional support. Serum electrolytes in all patients and urinary electrolytes in 7 were measured both before feeding commenced and when they had achieved an intake of between 2.4 and 3.0 liter/day (102-127 mmol K+/day) of full strength feed for a period of 1 wk. Ther serum K rose in all patients from 4.2 +/- 0.5 mmol/liter (mean +/- SD) before feeding to 5.1 +/- 0.5 after feeding for 1 wk (p less than 0.001; pair-difference t-test). The daily urinary K excretion rose from 37.8 +/- 24.2 mmol/day to 61.8 +/- 26.6 over the same period (p less than 0.001) The serum urea rose from 4.7 +/- 2.0 mmol/liter to 6.3 +/- 3.2 (p less than 0.05). No significant change was observed in other serum electrolytes, creatinine, or urinary electrolytes. During the whole course of feeding (range 1-11 wk) it was necessary to discontinue Triosorbon in 2 patients whose serum K concentration became elevated to greater than 6 mmol/liter. We conclude that the recommended levels of K intake may be too high and that serum K should be carefully monitored during enteral feeding.
Blood Urea Nitrogen↗
Vitamin status during total parenteral nutrition.
Plasma concentrations of vitamins A and E, serum and erythrocyte folic acid, serum B12 and erythrocyte enzyme activations (to assess vitamins B1, B2 and B6 status) were measured at the start and finish of 39 courses of total parenteral nutrition (TPN). The daily regimen was standard. Plasma vitamin A, E, and folate concentrations and vitamin B6 status improved significantly during TPN. Three patients developed low levels of vitamin A and two patients developed high transketolase activations (B1 depletion) during therapy. The adequacy of vitamin replacement and the monitoring of vitamin status during TPN is discussed.
Adult↗
Junctional care: the key to prevention of catheter sepsis in intravenous feeding.
Investigation of an outbreak of infection related to intravenous feeding catheters, predominantly with Staphylococcus epidermidis, suggested that the probable origin was the connections in the delivery system. Equipment and policy changes were then instituted: a catheter with integral hub was used, the connections were reduced from two to one, and improved antisepsis at the connection was devised. These actions resulted in a sustained, significant reduction in the catheter sepsis rate, supporting the hypothesis that junctional care is vital to the avoidance of catheter infection.
Catheters, Indwelling↗
Protein and energy metabolism with biosynthetic human growth hormone in patients on full intravenous nutritional support.
Our objective was to examine the effect of biosynthetic human growth hormone (BSHGH) on protein and energy metabolism in patients on full intravenous nutrition (IVN). Fifteen patients who had been established on IVN were allocated at random to receive either BSHGH (0.1 mg/kg/day) or placebo daily for 7 days. All patients received the same feeding regimen which contaminated 14 gN, 1000 kcal of glucose and 1000 kcal of fat (Intralipid) daily. The mean nitrogen balance for days 4 to 7 was significantly more positive with BSHGH (7.0 +/- 0.6 gN/day) than with placebo (4.4 +/- 0.7 gN/day). The BSHGH group were lighter (53 +/- 4.6 kg body weight) than controls (68 +/- 5.1 kg), but the difference was not significant. Resting energy expenditure (expressed as percentage of day 1) increased throughout the study in patients receiving BSHGH (day 7, 120.8 +/- 5.5%), whereas in patients receiving placebo it remained stable (day 7, 98.9 +/- 2.7%). The nonprotein respiratory quotients were similar for BSHGH (mean days 4-7, 0.94 +/- 0.04) and placebo (mean days 4-7, 0.93 +/- 0.01) (p greater than 0.05). This study demonstrates more positive nitrogen balance, which may in part be due to different substrate loads, and an increase in energy expenditure in patients receiving BSHGH.
Adult↗