This review discusses the pathophysiology,epidemiology,risk factors,classification,clinical evaluation,and current non-operative and operative treatment of hemorrhoids.Hemorrhoids are defined as the symptomatic enlarg...This review discusses the pathophysiology,epidemiology,risk factors,classification,clinical evaluation,and current non-operative and operative treatment of hemorrhoids.Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions.The most common symptom of hemorrhoids is rectal bleeding associated with bowel movement.The abnormal dilatation and distortion of the vascular channel,together with destructive changes in the supporting connective tissue within the anal cushion,is a paramount finding of hemorrhoids.It appears that the dysregulation of the vascular tone and vascular hyperplasia might play an important role in hemorrhoidal development,and could be a potential target for medical treatment.In most instances,hemorrhoids are treated conservatively,using many methods such as lifestyle modification,fiber supplement,suppositorydelivered anti-inflammatory drugs,and administration of venotonic drugs.Non-operative approaches include sclerotherapy and,preferably,rubber band ligation.An operation is indicated when non-operative approaches have failed or complications have occurred.Several surgical approaches for treating hemorrhoids have been introduced including hemorrhoidectomy and stapled hemorrhoidopexy,but postoperative pain is invariable.Some of the surgical treatments potentially cause appreciable morbidity such as anal stricture and incontinence.The applications and outcomes of each treatment are thoroughly discussed.展开更多
Background Understanding the characteristics of Chinese dialysis patients and the current practice trends is the first step to evaluate the association between practice pattern and outcome in these populations. In the...Background Understanding the characteristics of Chinese dialysis patients and the current practice trends is the first step to evaluate the association between practice pattern and outcome in these populations. In the present study, we evaluated the status of medical treatment and characteristic features of chronic dialysis patients in China. Methods Through a clustering sampling, we selected 9 centers from the largest dialysis facilities in 6 cities around China. All adult undergoing dialysis in the selected units were screened. A total of 2388 （1775 on hemodialysis （HD） and 613 on peritoneal dialysis （PD）） patients were finally enrolled. All data were collected at enrollment on the bases of review of medical records. Results In this cohort, 1313 （55.0%） were male. The mean age was 54 years old. The median time for dialysis was 26 months （12-51 months）. Seventy-five percent of patients were on HD and 25.0% on PD. Among PD patients, about 21% patients did not receive dialysis adequacy. For HD patients, about 14.0% of them did not achieve dialysis adequacy when the target of kt/V was set as 1.2. Only 44.7% of patients achieved blood pressure target of 140/90 mmHg. About 60% of patients did not reach the hemoglobin target of 110 g/L even though 85.0% of them were treated with erythropoietin. In addition, 48.5% of the patients had uncontrolled mineral metabolism revealed by the high calcium-phosphate product. Compared with HD patients, higher level of serum glucose, triglyceride, and total and low density lipoprotein cholesterol were more common in PD patients. Conclusions This observational study suggests that many Chinese dialysis patients did not achieve the therapeutic target, particularly in blood pressure control, anemia correction, and mineral balance. PD patients were more likely to suffer metabolic disturbance.展开更多
AIM： To investigate the effect of admission hypertriglyceridemia （HTG） on the episodes of severe acute pancreatitis （SAP）. METHODS： One hundred and seventy-six patients with SAP were divided into HTG group （n =...AIM： To investigate the effect of admission hypertriglyceridemia （HTG） on the episodes of severe acute pancreatitis （SAP）. METHODS： One hundred and seventy-six patients with SAP were divided into HTG group （n = 45） and control group （n = 131） according to admission triglyceride （TG） ≥ 5.65 mmol/L and 〈 5.65 retool/L, respectively. Demographics, etiology, underlying diseases, biochemical parameters, Ranson＇ s score, acute physiology and chronic heath evaluation Ⅱ （APACHE Ⅱ） score, Balthazar＇s computed tomography （CT） score, complications and mortality were compared. Correlation between admission TG and 24-h APACHE Ⅱ score was analyzed. RESULTS： SAP patients with HTG were younger （40.8 ± 9.3 years vs 52.6 ± 13.4 years, P 〈 0.05） with higher etiology rate of overeating, high-fat diet （40.0% vs 14.5%, P 〈 0.05） and alcohol abuse （46.7% vs 23.7%, P 〈 0.01）, incidence rate of hypocalcemia （86.7% vs 63.4%, P 〈 0.01） and hypoalbuminemia （84.4% vs 60.3%, P 〈 0.01）, 24-h APACHE Ⅱ score （13.6 ± 5.7 vs 10.7 ± 4.6, P 〈 0.01） and admission serum glucose （17.7 ± 7.7 vs 13.4 ± 6.1, P 〈 0.01）, complication rate of renal failure （51.1% vs 16.8%, P 〈 0.01）, shock （37.9% vs 14.5%, P 〈 0.01） and infection （37.4% vs 18.3%, P 〈 0.01） and mortality （13.1% vs 9.1%, P 〈 0.01）. Logistic regression analysis showed a positive correlation between admission TG and 24-h APACHE Ⅱ score （r = 0.509, P = 0.004）.CONCLUSION： The clinical features of SAP patients with HTG are largely consistent with previous studies, HTG aggravates the episodes of SAP.展开更多
Hemorrhoids is recognized as one of the most common medical conditions in general population. It is clinically characterized by painless rectal bleeding during defecation with or without prolapsing anal tissue. Genera...Hemorrhoids is recognized as one of the most common medical conditions in general population. It is clinically characterized by painless rectal bleeding during defecation with or without prolapsing anal tissue. Generally,hemorrhoids can be divided into two types: internal hemorrhoid and external hemorrhoid. External hemorrhoid usually requires no specific treatment unless it becomes acutely thrombosed or causes patients discomfort. Meanwhile,low-graded internal hemorrhoids can be effectively treated with medication and nonoperative measures(such as rubber band ligation and injection sclerotherapy). Surgery is indicated for highgraded internal hemorrhoids,or when non-operative approaches have failed,or complications have occurred. Although excisional hemorrhoidectomy remains the mainstay operation for advanced hemorrhoids and complicated hemorrhoids,several minimally invasive operations(including Ligasure hemorrhoidectomy,doppler-guided hemorrhoidal artery ligation and stapled hemorrhoidopexy) have been introduced into surgical practices in order to avoid post-hemorrhiodectomy pain. This article deals with some fundamental knowledge and current treatment of hemorrhoids in a view of a coloproctologist- which includes the management of hemorrhoids in complicated situations such as hemorrhoids in pregnancy,hemorrhoids in immunocompromised patients,hemorrhoids in patients with cirrhosis or portal hypertension,hemorrhoids in patients having antithrombotic agents,and acutely thrombosed or strangulated hemorrhoids. Future perspectives in the treatment of hemorrhoids are also discussed.展开更多
基金Supported by Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand
文摘This review discusses the pathophysiology,epidemiology,risk factors,classification,clinical evaluation,and current non-operative and operative treatment of hemorrhoids.Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions.The most common symptom of hemorrhoids is rectal bleeding associated with bowel movement.The abnormal dilatation and distortion of the vascular channel,together with destructive changes in the supporting connective tissue within the anal cushion,is a paramount finding of hemorrhoids.It appears that the dysregulation of the vascular tone and vascular hyperplasia might play an important role in hemorrhoidal development,and could be a potential target for medical treatment.In most instances,hemorrhoids are treated conservatively,using many methods such as lifestyle modification,fiber supplement,suppositorydelivered anti-inflammatory drugs,and administration of venotonic drugs.Non-operative approaches include sclerotherapy and,preferably,rubber band ligation.An operation is indicated when non-operative approaches have failed or complications have occurred.Several surgical approaches for treating hemorrhoids have been introduced including hemorrhoidectomy and stapled hemorrhoidopexy,but postoperative pain is invariable.Some of the surgical treatments potentially cause appreciable morbidity such as anal stricture and incontinence.The applications and outcomes of each treatment are thoroughly discussed.
基金This work was supported by the grants from the National 973 Program （No. 2012CB517703 and No. 2011CB504005）, the National Natural Science Foundation of China （No. U0932002）, and the Public Welfare and Health Sector Research Project （No. 201002010）.
文摘Background Understanding the characteristics of Chinese dialysis patients and the current practice trends is the first step to evaluate the association between practice pattern and outcome in these populations. In the present study, we evaluated the status of medical treatment and characteristic features of chronic dialysis patients in China. Methods Through a clustering sampling, we selected 9 centers from the largest dialysis facilities in 6 cities around China. All adult undergoing dialysis in the selected units were screened. A total of 2388 （1775 on hemodialysis （HD） and 613 on peritoneal dialysis （PD）） patients were finally enrolled. All data were collected at enrollment on the bases of review of medical records. Results In this cohort, 1313 （55.0%） were male. The mean age was 54 years old. The median time for dialysis was 26 months （12-51 months）. Seventy-five percent of patients were on HD and 25.0% on PD. Among PD patients, about 21% patients did not receive dialysis adequacy. For HD patients, about 14.0% of them did not achieve dialysis adequacy when the target of kt/V was set as 1.2. Only 44.7% of patients achieved blood pressure target of 140/90 mmHg. About 60% of patients did not reach the hemoglobin target of 110 g/L even though 85.0% of them were treated with erythropoietin. In addition, 48.5% of the patients had uncontrolled mineral metabolism revealed by the high calcium-phosphate product. Compared with HD patients, higher level of serum glucose, triglyceride, and total and low density lipoprotein cholesterol were more common in PD patients. Conclusions This observational study suggests that many Chinese dialysis patients did not achieve the therapeutic target, particularly in blood pressure control, anemia correction, and mineral balance. PD patients were more likely to suffer metabolic disturbance.
基金National Natural Science Foundation of China, No. 30500684
文摘AIM： To investigate the effect of admission hypertriglyceridemia （HTG） on the episodes of severe acute pancreatitis （SAP）. METHODS： One hundred and seventy-six patients with SAP were divided into HTG group （n = 45） and control group （n = 131） according to admission triglyceride （TG） ≥ 5.65 mmol/L and 〈 5.65 retool/L, respectively. Demographics, etiology, underlying diseases, biochemical parameters, Ranson＇ s score, acute physiology and chronic heath evaluation Ⅱ （APACHE Ⅱ） score, Balthazar＇s computed tomography （CT） score, complications and mortality were compared. Correlation between admission TG and 24-h APACHE Ⅱ score was analyzed. RESULTS： SAP patients with HTG were younger （40.8 ± 9.3 years vs 52.6 ± 13.4 years, P 〈 0.05） with higher etiology rate of overeating, high-fat diet （40.0% vs 14.5%, P 〈 0.05） and alcohol abuse （46.7% vs 23.7%, P 〈 0.01）, incidence rate of hypocalcemia （86.7% vs 63.4%, P 〈 0.01） and hypoalbuminemia （84.4% vs 60.3%, P 〈 0.01）, 24-h APACHE Ⅱ score （13.6 ± 5.7 vs 10.7 ± 4.6, P 〈 0.01） and admission serum glucose （17.7 ± 7.7 vs 13.4 ± 6.1, P 〈 0.01）, complication rate of renal failure （51.1% vs 16.8%, P 〈 0.01）, shock （37.9% vs 14.5%, P 〈 0.01） and infection （37.4% vs 18.3%, P 〈 0.01） and mortality （13.1% vs 9.1%, P 〈 0.01）. Logistic regression analysis showed a positive correlation between admission TG and 24-h APACHE Ⅱ score （r = 0.509, P = 0.004）.CONCLUSION： The clinical features of SAP patients with HTG are largely consistent with previous studies, HTG aggravates the episodes of SAP.
基金Supported by Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand
文摘Hemorrhoids is recognized as one of the most common medical conditions in general population. It is clinically characterized by painless rectal bleeding during defecation with or without prolapsing anal tissue. Generally,hemorrhoids can be divided into two types: internal hemorrhoid and external hemorrhoid. External hemorrhoid usually requires no specific treatment unless it becomes acutely thrombosed or causes patients discomfort. Meanwhile,low-graded internal hemorrhoids can be effectively treated with medication and nonoperative measures(such as rubber band ligation and injection sclerotherapy). Surgery is indicated for highgraded internal hemorrhoids,or when non-operative approaches have failed,or complications have occurred. Although excisional hemorrhoidectomy remains the mainstay operation for advanced hemorrhoids and complicated hemorrhoids,several minimally invasive operations(including Ligasure hemorrhoidectomy,doppler-guided hemorrhoidal artery ligation and stapled hemorrhoidopexy) have been introduced into surgical practices in order to avoid post-hemorrhiodectomy pain. This article deals with some fundamental knowledge and current treatment of hemorrhoids in a view of a coloproctologist- which includes the management of hemorrhoids in complicated situations such as hemorrhoids in pregnancy,hemorrhoids in immunocompromised patients,hemorrhoids in patients with cirrhosis or portal hypertension,hemorrhoids in patients having antithrombotic agents,and acutely thrombosed or strangulated hemorrhoids. Future perspectives in the treatment of hemorrhoids are also discussed.
