Hemorrhoids - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

HEMORRHOIDS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N...

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HEMORRHOIDS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2003 by ICON Group International, Inc. Copyright 2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Hemorrhoids: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83625-6 1. Hemorrhoids-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on hemorrhoids. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON HEMORRHOIDS ......................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Hemorrhoids................................................................................ 11 The National Library of Medicine: PubMed ................................................................................ 12 CHAPTER 2. NUTRITION AND HEMORRHOIDS ............................................................................... 51 Overview...................................................................................................................................... 51 Finding Nutrition Studies on Hemorrhoids ................................................................................ 51 Federal Resources on Nutrition ................................................................................................... 55 Additional Web Resources ........................................................................................................... 55 CHAPTER 3. ALTERNATIVE MEDICINE AND HEMORRHOIDS ......................................................... 57 Overview...................................................................................................................................... 57 National Center for Complementary and Alternative Medicine.................................................. 57 Additional Web Resources ........................................................................................................... 60 General References ....................................................................................................................... 69 CHAPTER 4. PATENTS ON HEMORRHOIDS ...................................................................................... 71 Overview...................................................................................................................................... 71 Patents on Hemorrhoids .............................................................................................................. 71 Patent Applications on Hemorrhoids........................................................................................... 97 Keeping Current ........................................................................................................................ 100 CHAPTER 5. BOOKS ON HEMORRHOIDS ....................................................................................... 101 Overview.................................................................................................................................... 101 Book Summaries: Federal Agencies............................................................................................ 101 Book Summaries: Online Booksellers......................................................................................... 106 The National Library of Medicine Book Index ........................................................................... 107 Chapters on Hemorrhoids .......................................................................................................... 108 CHAPTER 6. MULTIMEDIA ON HEMORRHOIDS ............................................................................. 111 Overview.................................................................................................................................... 111 Video Recordings ....................................................................................................................... 111 Bibliography: Multimedia on Hemorrhoids ............................................................................... 112 CHAPTER 7. PERIODICALS AND NEWS ON HEMORRHOIDS .......................................................... 115 Overview.................................................................................................................................... 115 News Services and Press Releases.............................................................................................. 115 Newsletter Articles .................................................................................................................... 117 Academic Periodicals covering Hemorrhoids............................................................................. 118 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 121 Overview.................................................................................................................................... 121 NIH Guidelines.......................................................................................................................... 121 NIH Databases........................................................................................................................... 123 Other Commercial Databases..................................................................................................... 126 APPENDIX B. PATIENT RESOURCES ............................................................................................... 127 Overview.................................................................................................................................... 127 Patient Guideline Sources.......................................................................................................... 127 Finding Associations.................................................................................................................. 134 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 137 Overview.................................................................................................................................... 137 Preparation................................................................................................................................. 137 Finding a Local Medical Library................................................................................................ 137 Medical Libraries in the U.S. and Canada ................................................................................. 137

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Contents

ONLINE GLOSSARIES................................................................................................................ 143 Online Dictionary Directories ................................................................................................... 145 HEMORRHOIDS DICTIONARY............................................................................................... 147 INDEX .............................................................................................................................................. 187

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with hemorrhoids is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about hemorrhoids, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to hemorrhoids, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on hemorrhoids. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to hemorrhoids, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on hemorrhoids. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON HEMORRHOIDS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on hemorrhoids.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and hemorrhoids, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “hemorrhoids” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Is It Hemorrhoids, or Rectal Cancer? Source: Primary Care and Cancer. 21(4):23-26, April 2001. Summary: A physician discusses the diagnosis of patients with anal symptoms, including symptoms and diagnosis of rectal cancer and hemorrhoids. There should be no difficulty with diagnosing people with anal symptoms if the physician does a digital rectal examination and a proctoscopic examination on any patient with anal complaints and on patients undergoing a complete physical examination. Periodic examinations are the best way to identify early cancers and precancerous lesions and offer the best prognosis when the diagnosis is cancer. Symptoms and signs of cancer of the rectum are more likely to be present the lower the cancer is in the rectum and the larger it is in size. Tumors may shed blood onto the stool surface, though the stool will be passed before mixing of blood can occur. Rectal urges or the sensation of the presence of a mass may

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be felt, depending on the ability of the rectum to recognize a tumor as a luminal mass. If the tumor is large enough, or if it involves a significant length of the rectal wall, there may be bowel habit changes. Symptoms and signs of hemorrhoids may be similar. Symptoms such as weight loss, anorexia, and ill health occur after widespread dissemination, which is unusual for rectal cancer. Hemorrhoids rarely cause general health problems unless anemia occurs. While cancers can often be recognized on sight, biopsy confirmation is necessary before planning treatment. The earlier the stage of the cancer, the fewer symptoms there will be and the more favorable the treatment outcome. Regular examinations and a surveillance program for polyp detection are recommended, since most cancers of the bowel are probably benign polyps for at least 5 years prior to becoming neoplasms. Proctosigmoidoscopic and anoscopic examinations allow for visualization of the entire rectum and anus. If these examinations are done regularly, it is unlikely that cancer will develop in the rectum, since polyps can be seen and destroyed prior to becoming cancer. 2 figures, 11 references. •

Hemorrhoids and More: Common Causes of Blood in the Stool Source: Digestive Health and Nutrition. 3(4): 24-26. July-August 2001. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. Email: [email protected]. Summary: Most rectal bleeding is caused by hemorrhoids, which usually can be simply and effectively treated. This article reviews the many other conditions, including some serious disorders, that can cause blood in the stool. The author reminds readers that bleeding from any part of the nearly 40 foot long digestive tract can cause blood in the stool. Accurate and timely diagnostic tests are important to determine the cause of any bleeding. Bleeding higher up in the gut, from the esophagus or stomach, can result in stools with a black, tarry appearance. Bleeding from the lower end, such as the colon, or in large amounts, can appear as pure blood, blood clots, or as blood mixed with or streaking the stool. Another kind of blood, occult or hidden blood, may not be visible at all. A number of prescription and over the counter (OTC) medications can cause bleeding in the stomach and small intestine. The blood thinning drug warfarin also can induce bleeding in the intestine, as can some antibiotics. Other causes of bleeding can include ulcers, gastritis (inflammation of the stomach lining), ulcerative colitis, Crohn's disease, polyps (small growths inside the intestine), diverticular disease, abnormalities in the blood vessels (vascular anomalies), anal fissures (tears) and fistulas (abnormal openings between the anal canal and other organs, such as the bladder), and abscesses (pockets of infection. The author reiterates the importance of timely diagnosis, including a thorough patient history and evaluation of symptoms. Diagnostic tests can include blood tests, digital rectal examination, endoscopy, colonoscopy, sigmoidoscopy, fecal occult blood test, barium x rays, angiography (x rays of blood vessels), and nuclear scanning. Treatment depends on the source and extent of the bleeding.

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Quest for Painless Surgical Treatment of Hemorrhoids Continues Source: Journal of the American College of Surgeons. 193(2): 174-178. August 2001. Contact: Available from Journal of the American College of Surgeons. P.O. Box 2127, Marion, OH 43306-8227. (800) 214-8489 or (740) 382-3322. Fax (740) 382-5866. Summary: This editorial discusses the quest for painless surgical treatment of hemorrhoids. The author notes that pain after hemorrhoidectomy (removal of hemorrhoids) is to be expected. The reasons for this pain are related to the anatomy and

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intended function of the anus. The lining of the anal canal is certainly among the most richly innervated (filled with nerves) tissue in the digestive tract; it has the ability to sense temperature, vibration, stretch, noxious stimuli, and to, importantly, differentiate among gas, liquid, and solid material. The author reviews the historical treatments for hemorrhoidectomy, including the various instruments that have been used. The author notes that, thus far, the various techniques have not resulted in significant reductions in postoperative pain. The techniques described have in common that they excise, destroy, or ablate the hemorrhoidal tissue, removing or ligating (tying off) the arterial and venous supplies. The author then comments on an accompanying article in this Journal issue, in which the researchers (Arnaud et al) use the technique of stapling for hemorrhoids. While this is not a new technique (indeed the research article includes a table summarizing three other studies), it is coming back into interest with a current research project. The commentary author reports on an initial pilot study of 10 patients who underwent a stapling procedure. While early symptom control (including pain management) and functional outcomes appear normal, longterm symptomatic and functional outcomes require further study. Certainly the possibility of an increased rate of recurrence (compared to traditional surgery for hemorrhoids) is a possibility. The author concludes that the stapling technique could finally offer patients suffering from third degree hemorrhoids a painless or relatively painless method of treatment. 37 references. •

Treatment of Hemorrhoids with Circular Stapler, a New Alternative to Conventional Methods: A Prospective Study of 140 Patients Source: Journal of the American College of Surgeons. 193(2): 161-165. August 2001. Contact: Available from Journal of the American College of Surgeons. P.O. Box 2127, Marion, OH 43306-8227. (800) 214-8489 or (740) 382-3322. Fax (740) 382-5866. Summary: Surgical hemorrhoidectomy (removal of hemorrhoids) has a reputation for being a painful procedure. This article reports on a study undertaken to determine the efficacy and safety of a new procedure for the surgical treatment of hemorrhoid disease. From April 1998 to August 1998, 140 patients (83 men and 57 women) with an average age of 43.8 years (range 19 to 83 years) underwent hemorrhoidectomy using a circular stapler. Operative times, peri and postoperative complications, mean hospital stay, assessment of the postoperative pain, period of incapacity for work, and functional results were collected. All patients were evaluated at 2 weeks, 2 months, and 18 months after operation. The average length of the operation was 18 minutes (range 8 to 60 minutes). There were no perioperative complications. The postoperative complication rate was 6.4 percent (n = 9). Mean hospital stay was 36 hours (range 8 to 72 hours). Paracetamol was the only analgesic (painkiller) used. Eighty three patients (59.3 percent) required analgesic for less than 2 days, 45 patients (32.1 percent) between 2 and 7 days, and 12 patients (8.6 percent) for more than 7 days. No patients had anal wound care. The period of incapacity for work was less than 3 days for 22 patients (21.2 percent), between 3 and 7 days for 13 patients (12.5 percent), between 7 and 14 days for 62 patients (59.6 percent), and more than 14 days for 7 patients (6.8 percent). At 18 months, 95. 7 percent of the patients were fully satisfied with the results, 3.6 percent were somewhat satisfied (n = 4), and 0.7 percent were unsatisfied. The authors conclude that treatment of hemorrhoids with a circular stapler appears to be safe, effective, and rapid, causing few postoperative complications and minimal postoperative pain. 2 figures. 1 table. 17 references.

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Hemorrhoids, Genital Warts, and other Perianal Complaints Source: JAAPA. Journal of the American Academy of Physician Assistants. 14(9): 37-39, 43-44, 47. September 2001. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: Reluctance to discuss a perianal problem may cause a patient to delay seeking medical attention. Although anorectal symptoms account for 10 percent of visits to a medical provider, 80 percent of patients who have symptoms of benign anorectal disease do not seek medical attention. Yet 75 percent of Americans will be given a diagnosis of hemorrhoids during their lifetime. This article helps physician assistants learn about hemorrhoids, genital warts, and other perianal complaints and how to help patients who present with these complaints. The authors describe the components of a thorough rectal examination and the diagnosis and treatment of the five most common causes of perianal discomfort or pain: hemorrhoids, anal fissure, anorectal abscess, pruritus ani (itching), and condylomata acuminata (genital warts). Although most conditions prove benign, the differential diagnosis can include neoplasia (including cancer). Readers can qualify for continuing medical education credit by completing the posttest printed in the journal. 3 figures. 34 references.

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Coping with the Pain and Annoyance of Hemorrhoids Source: Digestive Health and Nutrition. p. 20-23. January-February 2000. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. Email: [email protected]. Summary: This article helps readers understand and cope with hemorrhoids. The author describes how to distinguish between types of hemorrhoids, how to recognize the possible symptoms, and what treatment options are available. Following is a description of typical hemorrhoidal bleeding (bright red blood on the toilet tissue or in the toilet water); readers are encouraged to consult with a health care provider for even relatively minor rectal bleeding. Hemorrhoids are then defined in terms of their location. Internal hemorrhoids arise from blood vessels that lie up to 2 inches inside the anus, and external hemorrhoids form under the anal skin. Internal hemorrhoids, which are not usually seen or felt unless they protrude downward outside the anus, can cause other symptoms, including a feeling of fullness in the rectum (particularly after passing stool) or deep itching (pruritus). The author explores possible reasons why some people develop hemorrhoids, including certain working conditions (such as lots of sitting), weak muscles within the bowels, low fiber diets (which can result in straining with defecation), and pregnancy. Diagnostic tests can rule out other possible causes of rectal bleeding, including anal fissure, Crohn's disease or ulcerative colitis (inflammatory bowel diseases), Meckel's diverticulum, and cancer or noncancerous polyps in the bowel. Treatment options are reviewed, from lifestyle and dietary changes to topical therapy, to surgical treatments (rubber band ligation, laser treatment, and sclerosing injections).

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Triple Rubber Band Ligation for Hemorrhoids: Prospective, Randomized Trial of Use of Local Anesthetic Injection Source: Diseases of the Colon and Rectum. 42(3): 363-366. March 1999.

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Contact: Available from Williams and Wilkins. 352 West Camden Street, Baltimore, MD 21201-2436. Summary: Rubber band ligation is a common office procedure for hemorrhoids. Triple rubber band ligation in a single session has been shown to be a safe, economical way of treating hemorrhoids. However, postligation discomfort after triple rubber band ligation is not uncommon. This article reports on a study undertaken to evaluate the effectiveness of injecting local anesthetic into the banded hemorrhoidal tissue to reduce postligation discomfort. Patients attending an outpatient clinic for symptomatic hemorrhoids suitable for triple rubber band ligation were randomly assigned to two groups. In the treatment group, rubber band ligation was performed on three columns of hemorrhoids, and 1 to 2 mL of 2 percent lignocaine was injected into the banded hemorrhoidal tissue. In the control group, triple rubber band ligation was performed in a similar manner, but local anesthetic was not given. Patients were followed up by telephone in the second week and in the clinic after 6 weeks. In all, 101 patients entered the study; 62 received the injection of local anesthetic and 39 were in the control group. Overall, good to excellent results occurred in 89 percent of patients, and there was no difference between the two groups. Postligation pain occurred in 26 and 20 percent of patients in the treatment and control groups, respectively. Postligation tenesmus (pain on defecation) occurred in 32 and 41 percent of patients in the treatment and control groups, respectively. No patients suffered from septic complications or bleeding that required transfusion. The authors conclude that injecting local anesthetic into the banded hemorrhoidal tissue did not help reduce postligation discomfort. 3 tables. 13 references. (AA-M). •

Necrotizing Fascitis After Injection Sclerotherapy for Hemorrhoids: Report of a Case Source: Diseases of the Colon and Rectum. 42(3): 419-420. March 1999. Contact: Available from Williams and Wilkins. 352 West Camden Street, Baltimore, MD 21201-2436. Summary: This article presents a case report of a patient who underwent submucosal injection sclerotherapy for hemorrhoids. The patient subsequently developed necrotizing fascitis of the anorectum, perianal region, and scrotum that necessitated emergency debridement and defunctioning colostomy. Necrotizing fascitis is a term used to describe a rapidly progressive inflammation and necrosis of subcutaneous tissue, superficial fascia, and the superficial part of the deep fascia, with secondary necrosis of the overlying skin. It is caused by the mixed growth of aerobic and anaerobic organisms, and underlying systemic disease (such as diabetes or immune disorders) may predispose people to this disorder. Postoperatively, the patient developed septicemia and renal failure requiring an extended hospital stay. Restoration of bowel continuity was done after 3 months. The authors provide a brief review of known complications of this technique (sclerotherapy) and note that necrotizing fascitis should be added to the list. 5 references.

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Local Injection of Bupivacaine After Rubber Band Ligation of Hemorrhoids: Prospective, Randomized Study Source: Diseases of the Colon and Rectum. 42(2): 174-179. February 1999. Contact: Available from Williams and Wilkins. 352 West Camden Street, Baltimore, MD 21201-2436.

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Summary: This article reports on a study to determine if local injection of bupivacaine after hemorrhoidal banding causes a decrease in pain and in the incidence of associated symptoms. After hemorrhoidal banding, patients were randomly assigned to receive a local injection of bupivacaine with 1:200,000 epinephrine, an injection of normal saline, or no injection, just superior to each band. Pain was graded by the patient and by the study nurse within 30 minutes, and any associated symptoms were recorded. At intervals of 6, 24, and 48 hours postbanding, the patient record pain, limitation of activities, and analgesic requirements. Associated symptoms at home were also recorded. Of 115 patients studied, 42 received bupivacaine, 42 received normal saline injection, and 31 received no injection. In patients receiving bupivacaine compared with no injection, within 30 minutes postbanding there was a significant reduction in pain graded by the patient and by the nurse and a significant reduction in incidence of nausea and shaking. However, in the bupivacaine group compared with the other two groups, at the intervals of 6, 24, and 48 hours postbanding there was no sustained reduction in the severity of pain and no reduction in analgesic requirements or limitation of normal activities. In the week after banding, there was no difference between groups in symptoms of nausea, shaking, lightheadedness, urinary retention, or bleeding. The authors conclude that bupivacaine injection may be useful for reducing pain and associated symptoms long enough to tolerate a trip home from the outpatient department, but does not show a sustained effect. 1 figure. 5 tables. 8 references. •

Hemorrhoids, Anal Fissure, and Carcinoma of the Colon, Rectum, and Anus During Pregnancy Source: Surgical Clinics of North America. 75(1): 77-88. February 1995. Contact: Available from W.B. Saunders Company, Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 654-2452. Summary: In this journal article, from a special issue on surgery in the pregnant patient, the authors review the problems of hemorrhoids, anal fissure, and carcinoma of the colon, rectum, and anus during pregnancy. The chapter covers the etiology, symptoms, complications, conservative therapy, and surgery for hemorrhoids; the etiology and treatment of anal fissures; colorectal carcinoma, including presenting symptoms and signs, treatment considerations, and outcome; and anal carcinoma. The authors stress the need for open discussions between patient and physician about the pros and cons of operative and nonoperative approaches. 3 tables. 33 references.

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Nonsurgical Treatment Options for Internal Hemorrhoids Source: American Family Physician. 52(3): 821-834, 839-841. September 1, 1995. Summary: In this article, the authors summarize the nonsurgical treatment options for internal hemorrhoids. They note that hemorrhoids are the most common etiology for the complaints of rectal pain and/or bleeding, but the family physician should always be alert to other pathologic explanations, such as fissure, abscess, fistula, condyloma, or cancer. Topics include feelings of embarrassment or apprehension about surgery that may make patients reluctant to discuss anorectal symptoms with their physician; the anatomic origin and grade of disease; the etiologies of hemorrhoids; symptoms; patient history and physical examination; indications and contraindications for treatment; preparation for treatment; treatment modalities for internal hemorrhoids, including rubber band ligation, infrared coagulation, bipolar electrocoagulation, low-voltage direct current, sclerotherapy and cryotherapy, and laser therapy; postoperative care; and treatment complications. The author concludes that proper anal hygiene and correction

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of chronic constipation or diarrhea are essential to prevent recurrence of hemorrhoids. The article concludes with a reproducible patient education handout on the nonsurgical treatment of hemorrhoids. 11 figures. 1 table. 20 references. (AA-M). •

No Strain No Pain: The Bottom Line in Treating Hemorrhoids Source: FDA Consumer. 26(2): 31-33. March 1992. Summary: This article presents an overview of hemorrhoids. Topics covered include the types of hemorrhoids, the importance of a thorough physical examination to rule out non-hemorrhoidal causes of bleeding, and treatment for hemorrhoids. Treatment options discussed include a high-fiber diet, increased fluid intake, over-the counter remedies, and surgical options, including rubber band ligation, infrared photocoagulation, laser coagulation, and sclerotherapy. 2 figures.

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Hemorrhoids: Introduction to the Series Source: Practical Gastroenterology. 15(6): 35-36. June 1991. Summary: This article, the introduction for a series of articles on hemorrhoids, considers the question of whether hemorrhoids are a single entity or a syndrome, and reviews the implications of each answer. The author stresses that a critical analysis of each component of the hemorrhoidal syndrome will result in a better understanding of the application of various therapeutic modalities. The author also considers the safety of various treatment modalities and the efficacy of present methods of examination, including inspection, palpation, and anoscopy. 2 references.

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Hemorrhoids: Etiology, Pathogenesis, Classification, and Medical Therapy Source: Practical Gastroenterology. 15(9): 21-24. October 1991. Summary: This article presents a discussion of the etiology, pathogenesis, classification, and medical therapy of hemorrhoids. Recent studies indicate that hemorrhoids should be considered normal anatomic structures that can become enlarged and displaced. This enlargement and displacement causes the symptoms attributed to hemorrhoids. The author discusses theories regarding etiology and pathogenesis, examination of the patient, differential diagnosis, and noninvasive therapy. 6 references.

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Office Management of Hemorrhoids: Nonoperative Procedures Source: Practical Gastroenterology. 15(10): 28-29, 33-35. November-December 1991. Summary: This article details the nonoperative procedures available as modes of therapy in the office management of hemorrhoids. Independent of the ethics of advertising such options, some nonoperative procedures, properly selected, do afford great relief, usually with considerably less morbidity than surgical excision. The author discusses in detail the ethical issues of mixing medicine and commerce. Other topics covered include basic principles and anatomy, indications for invasive treatment, hemorrhoid ligation, the costs of rubber band ligation, thermal therapies, injection treatment, and the role of endoscopy in the treatment of hemorrhoids. 1 figure. 7 references. (AA-M).

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Hemorrhoids: A Practical Approach to an Aggravating Problem Source: Postgraduate Medicine. 89(1): 149-152. January 1991.

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Summary: Although hemorrhoids are considered a minor medical problem, they may cause considerable discomfort and anxiety. In this practical article, the author describes internal and external hemorrhoids, a classification system, and treatment choices based on the degree of involvement. Symptomatic hemorrhoids can be treated by simple methods, including avoidance of chronic constipation and straining at stool and use of bulk-forming agents and stool softeners, sitz baths, and anal emollients. The author concludes that surgical therapy may be indicated when these methods fail and when external hemorrhoids are symptomatic. •

Hemorrhoids: A Common Condition Source: Medical Times. 118(7): 39-41. July 1990. Summary: Hemorrhoids are defined as overstretched and enlarged veins in the lower rectum. The condition is common and is caused by increased pressure on the veins of the lower digestive system. Two types of hemorrhoids observed are internal and external. A doctor's visit is recommended if bleeding occurs, since the condition may or may not be a result of hemorrhoids, and could indicate colon cancer or other intestinal problem. To ease the discomfort associated with hemorrhoids, sitz baths and over the counter hemorrhoid preparations are recommended on a short-term basis. Exercise, a high-fiber diet, and the taking of laxatives under a doctor's care are suggested as means to help control and relieve pressure on the veins. Treatments to eliminate hemorrhoids such as banding, cryosurgery, or injection are discussed. The type of treatment is usually dictated by the type of hemorrhoid encountered.

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Life-Threatening Retroperitoneal Sepsis After Hemorrhoid Injection Sclerotherapy: Report of a Case Source: Diseases of the Colon and Rectum. 42(3): 421-423. March 1999. Contact: Available from Williams and Wilkins. 352 West Camden Street, Baltimore, MD 21201-2436. Summary: This article reports a case of life threatening retroperitoneal sepsis after injection sclerotherapy for first degree hemorrhoids. A 50 year old man with symptomatic first degree hemorrhoids was seen in the outpatient department. An experienced surgical registrar injected three internal hemorrhoids with 3 to 5 mL of 5 percent oily phenol. Four days later, the patient was admitted as an emergency, complaining of tight central chest pain. For 6 hours he had experienced chills and pelvic pain radiating to his lower abdomen and the backs of his thighs. Anorectal instrumentation was not attempted, because the patient was reporting severe pelvic pain. Investigation revealed leukocytosis, raised creatinine kinase, and electrocardiographic changes suggestive of anteroseptal myocardial infarction. Streptokinase, cefotaxime, and metronidazole were administered. Later that day, his pelvic pain worsened. He remained pyrexial (having a fever), developed tachycardia (rapid heartbeat), and went into urinary retention. Computed tomography revealed extensive retroperitoneal fluid but no localized abscess. Blood culture isolated gram negative bacilli, but exploratory laparotomy found no colonic lesion. The fecal stream was diverted with an end sigmoid colostomy and the rectal stump was oversewn. Hyperbaric oxygen, antibiotics, and intensive inotropic and ventilatory support were continued in the postoperative period. The patient eventually made a good recovery. The authors note that life threatening sepsis after injection sclerotherapy for hemorrhoids has been reported only once previously. One table summarizes the cases of

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life threatening complications after rubber band ligation of hemorrhoids. 1 table. 9 references. •

Effect of Transcutaneous Electrical Nerve Stimulation for Pain Relief on Patients Undergoing Hemorrhoidectomy: Prospective, Randomized, Controlled Trial Source: Diseases of the Colon and Rectum. 42(2): 180-185. February 1999. Contact: Available from Williams and Wilkins. 352 West Camden Street, Baltimore, MD 21201-2436. Summary: Pain control after hemorrhoids have been surgically removed (hemorrhoidectomy) remains a challenging problem. This article reports on a study that investigated the effect of transcutaneous electrical nerve stimulation (TENS) on pain relief in patients undergoing hemorrhoidectomy. Sixty patients with symptomatic hemorrhoids were randomly allocated into two groups, the acupoint group and the nonpoint control group. TENS was applied to those patients who received hemorrhoidectomy, and patient controlled analgesia was achieved by injection of morphine through ambulatory infusion pumps. The measures included pain score, analgesic doses administered by the patients, and postoperative complications. Pain scores from 0 (no pain) to 10 (agonizing pain) were evaluated 8, 12, 16, and 24 hours after hemorrhoidectomy. The means for the control group and the acupoint group, respectively, were 5.9 and 4.1 at 8 hours, 5.7 and 3.5 at 12 hours, 4.1 and 2.3 at 16 hours, and 3.2 and 1.9 at 24 hours. There was a significant difference between treatment groups in morphine use, with 11.6 mg in the control groups and a mean of 6.2 in the acupoint group. The acupoint group tended to have less postoperative acute urinary retention and less need for analgesics than the control group. The authors conclude that TENS is effective for pain relief in patients receiving hemorrhoidectomy. Its efficacy and safety could assist outpatient pain management after hemorrhoidectomy. 3 figures. 2 tables. 23 references.

Federally Funded Research on Hemorrhoids The U.S. Government supports a variety of research studies relating to hemorrhoids. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to hemorrhoids. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore hemorrhoids.

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

12 Hemorrhoids

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with hemorrhoids, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “hemorrhoids” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “hemorrhoids” (hyperlinks lead to article summaries): •

A matter of semantics: hemorrhoids are a normal part of human anatomy and differ from hemorrhoidal disease. Author(s): Cirocco WC. Source: Gastrointestinal Endoscopy. 2000 June; 51(6): 772-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10840328&dopt=Abstract

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A modern look at the problem of hemorrhoids. Author(s): Turell R. Source: American Journal of Surgery. 1972 March; 123(3): 245-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5011925&dopt=Abstract

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A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. Treatment of hemorrhoids: report of a technique. Author(s): Shafik A. Source: American Journal of Surgery. 1984 September; 148(3): 393-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6476232&dopt=Abstract

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A new look at hemorrhoids. Author(s): Thomson H. Source: Med Times. 1976 November; 104(11): 116-23. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=994774&dopt=Abstract

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PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A new method of evaluating hemorrhoids with the retroflexed fiberoptic colonoscope. Author(s): Sadahiro S, Mukai M, Tokunaga N, Tajima T, Makuuchi H. Source: Gastrointestinal Endoscopy. 1998 September; 48(3): 272-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9744603&dopt=Abstract

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A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Author(s): Morinaga K, Hasuda K, Ikeda T. Source: The American Journal of Gastroenterology. 1995 April; 90(4): 610-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7717320&dopt=Abstract

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A personal experience in comparing three nonoperative techniques for treating internal hemorrhoids. Author(s): Zinberg SS, Stern DH, Furman DS, Wittles JM. Source: The American Journal of Gastroenterology. 1989 May; 84(5): 488-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2719004&dopt=Abstract

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A randomized comparison of infrared photocoagulation with bipolar diathermy for the outpatient treatment of hemorrhoids. Author(s): Dennison A, Whiston RJ, Rooney S, Chadderton RD, Wherry DC, Morris DL. Source: Diseases of the Colon and Rectum. 1990 January; 33(1): 32-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2403905&dopt=Abstract

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A randomized trial comparing direct current therapy and bipolar diathermy in the outpatient treatment of third-degree hemorrhoids. Author(s): Hinton CP, Morris DL. Source: Diseases of the Colon and Rectum. 1990 November; 33(11): 931-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2226079&dopt=Abstract

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A randomized trial of photocoagulation or injection sclerotherapy for the treatment of 1 degree and 2 degrees hemorrhoids. Author(s): Leicester RJ. Source: Diseases of the Colon and Rectum. 1986 January; 29(1): 83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3510111&dopt=Abstract

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A randomized trial of photocoagulation or injection sclerotherapy for the treatment of first- and second-degree hemorrhoids. Author(s): Ambrose NS, Morris D, Alexander-Williams J, Keighley MR. Source: Diseases of the Colon and Rectum. 1985 April; 28(4): 238-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3884297&dopt=Abstract

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A report on 102 rubber-band ligations of internal hemorrhoids. Author(s): An HK. Source: Med J Malaysia. 1977 December; 32(2): 161-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=614485&dopt=Abstract

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A rubberband ligation for internal hemorrhoids. Author(s): Wantz GE. Source: Med Times. 1977 October; 105(10): 47-50, 54. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=909380&dopt=Abstract

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A surgical treatment of thrombosed external hemorrhoids. Author(s): Grosz CR. Source: Diseases of the Colon and Rectum. 1990 March; 33(3): 249-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2311472&dopt=Abstract

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Acute thrombosed external hemorrhoids. Author(s): Oh C. Source: The Mount Sinai Journal of Medicine, New York. 1989 January; 56(1): 30-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2784180&dopt=Abstract

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Advanced technology in the management of hemorrhoids: stapling, laser, harmonic scalpel, and ligasure. Author(s): Fleshman J. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2002 May-June; 6(3): 299-301. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12022977&dopt=Abstract

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Aerobic and anaerobic microbiology of infected hemorrhoids. Author(s): Brook I, Frazier EH. Source: The American Journal of Gastroenterology. 1996 February; 91(2): 333-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8607502&dopt=Abstract

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An assessment of anesthetic-steroid suppositories: a controlled trial following rubber-band ligation of hemorrhoids. Author(s): Williams JA, Evans JC. Source: Diseases of the Colon and Rectum. 1972 January-February; 15(1): 66-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4550805&dopt=Abstract

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An epidemiological investigation of hemorrhoids. Author(s): Hyams L, Philpot J. Source: Am J Proctol. 1970 June; 21(3): 177-93. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5425245&dopt=Abstract

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An improved technique of rubber band ligation of hemorrhoids. Author(s): Nivatvongs S, Goldberg SM. Source: American Journal of Surgery. 1982 September; 144(3): 378-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7114386&dopt=Abstract

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An unusual complication of rubber band ligation of hemorrhoids. Author(s): Shiller M, Reshef R. Source: Gastrointestinal Endoscopy. 1988 November-December; 34(6): 490. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3234694&dopt=Abstract

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An unusual complication of rubber band ligation of hemorrhoids. Author(s): Wechter DG, Luna GK. Source: Diseases of the Colon and Rectum. 1987 February; 30(2): 137-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3803121&dopt=Abstract

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Anal cancer incidence: genital warts, anal fissure or fistula, hemorrhoids, and smoking. Author(s): Holly EA, Whittemore AS, Aston DA, Ahn DK, Nickoloff BJ, Kristiansen JJ. Source: Journal of the National Cancer Institute. 1989 November 15; 81(22): 1726-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2810388&dopt=Abstract

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Anal carcinoma or “just hemorrhoids”? Author(s): Winburn GB. Source: The American Surgeon. 2001 November; 67(11): 1048-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11730221&dopt=Abstract

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Anal dilatation versus rubber band ligation for internal hemorrhoids. Method of treatment in outpatients. Author(s): Hood TR, Williams JA. Source: American Journal of Surgery. 1971 October; 122(4): 545-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5098663&dopt=Abstract

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Anal fissure and thrombosed external hemorrhoids before and after delivery. Author(s): Abramowitz L, Sobhani I, Benifla JL, Vuagnat A, Darai E, Mignon M, Madelenat P. Source: Diseases of the Colon and Rectum. 2002 May; 45(5): 650-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12004215&dopt=Abstract

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Anal fissures, fistulas, abscesses, and hemorrhoids in a tropical population. Author(s): Ajayi OO, Banigo OG, Nnamdi K. Source: Diseases of the Colon and Rectum. 1974 January-February; 17(1): 55-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4810715&dopt=Abstract

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Anal hemorrhoids. Author(s): Smith LE. Source: The Netherlands Journal of Medicine. 1990 August; 37 Suppl 1: S22-32. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2234232&dopt=Abstract

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Anal manometric findings in symptomatic hemorrhoids. Author(s): Hiltunen KM, Matikainen M. Source: Diseases of the Colon and Rectum. 1985 November; 28(11): 807-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4053891&dopt=Abstract

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Anal manometric studies in hemorrhoids and anal fissures. Author(s): Lin JK. Source: Diseases of the Colon and Rectum. 1989 October; 32(10): 839-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2791768&dopt=Abstract

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Anal manometric studies in hemorrhoids and anal fissures. Author(s): Lin JK, Liang CL, Hsu H, Wang FM. Source: Zhonghua Yi Xue Za Zhi (Taipei). 1989 April; 43(4): 249-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2804776&dopt=Abstract

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Anal melanoma: an aggressive malignancy masquerading as hemorrhoids. Author(s): Felz MW, Winburn GB, Kallab AM, Lee JR. Source: Southern Medical Journal. 2001 September; 94(9): 880-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11592745&dopt=Abstract

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Anal pressures in hemorrhoids and anal fissure. Author(s): Arabi Y, Alexander-Williams J, Keighley MR. Source: American Journal of Surgery. 1977 November; 134(5): 608-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=920890&dopt=Abstract

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Anatomy, pathogenesis and treatment of hemorrhoids and related anorectal conditions. Author(s): Nesselrod JP. Source: Rev Surg. 1966 July-August; 23(4): 229-53. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5328762&dopt=Abstract

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Anorectal pressure in patients with symptomatic hemorrhoids. Author(s): el-Gendi MA, Abdel-Baky N. Source: Diseases of the Colon and Rectum. 1986 June; 29(6): 388-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3709317&dopt=Abstract

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Approach to the treatment of anorectal disease, with special reference to hemorrhoids. Author(s): Lord PH. Source: Surg Annu. 1977; 9: 195-211. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=882893&dopt=Abstract

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Ask the midwife. Prevention and care of hemorrhoids, including homeopathic remedies. Author(s): Goldstein L. Source: The Birth Gazette. 2000 Spring; 16(2): 13-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11899340&dopt=Abstract

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Associations between hemorrhoids and other diagnoses. Author(s): Delco F, Sonnenberg A. Source: Diseases of the Colon and Rectum. 1998 December; 41(12): 1534-41; Discussion 1541-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9860335&dopt=Abstract

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Autonomic dysreflexia resulting from prolapsed hemorrhoids. Report of a case. Author(s): Hawkins RL Jr, Bailey HR, Donnovan WH. Source: Diseases of the Colon and Rectum. 1994 May; 37(5): 492-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8181413&dopt=Abstract

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Bleeding hemorrhoids: an unusual sign of mesenteric arterial occlusion. Author(s): Bowersox JC. Source: Journal of Vascular Nursing : Official Publication of the Society for Peripheral Vascular Nursing. 1992 December; 10(4): 26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1472425&dopt=Abstract

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By the way, doctor...I've had small amounts of blood in my bowel movements from time to time for years. My doctor has done a pretty thorough evaluation and has ruled out colon cancer or anything serious: what I have is plain old hemorrhoids. I've heard of an operation using rubber bands that can get rid of them. Should I go ahead and have this procedure done? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2000 June; 25(8): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10810052&dopt=Abstract

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Clinical trial of oral diosmin (Daflon) in the treatment of hemorrhoids. Author(s): Thanapongsathorn W, Vajrabukka T. Source: Diseases of the Colon and Rectum. 1992 November; 35(11): 1085-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1425054&dopt=Abstract

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Colonoscopic findings in patients with hemorrhoids, rectal bleeding and normal rectoscopy. Author(s): Bat L, Pines A, Rabau M, Niv Y, Shemesh E. Source: Isr J Med Sci. 1985 February; 21(2): 139-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3872288&dopt=Abstract

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Combined ligation-injection treatment of hemorrhoids. Author(s): Slezak FA, Thow GB. Source: Diseases of the Colon and Rectum. 1987 February; 30(2): 147-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3803124&dopt=Abstract

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Combined traditional Chinese and western medicine sclerosing therapy in internal hemorrhoids. Author(s): Ren CP. Source: Chin Med J (Engl). 1977 March; 3(2): 137-42. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=408110&dopt=Abstract

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Comparative study between multiple and single rubber band ligation in one session for bleeding internal, hemorrhoids: a prospective study. Author(s): Chaleoykitti B. Source: J Med Assoc Thai. 2002 March; 85(3): 345-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12117024&dopt=Abstract

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Complications of rubber band ligation of symptomatic internal hemorrhoids. Author(s): Bat L, Melzer E, Koler M, Dreznick Z, Shemesh E. Source: Diseases of the Colon and Rectum. 1993 March; 36(3): 287-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8449135&dopt=Abstract

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Conservative management of hemorrhoids. Author(s): Nadler LH. Source: Gastrointestinal Endoscopy. 1991 November-December; 37(6): 653-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1805847&dopt=Abstract

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Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Author(s): Perrotti P, Antropoli C, Molino D, De Stefano G, Antropoli M. Source: Diseases of the Colon and Rectum. 2001 March; 44(3): 405-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11289288&dopt=Abstract

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Constipation is not a risk factor for hemorrhoids: a case-control study of potential etiological agents. Author(s): Johanson JF, Sonnenberg A. Source: The American Journal of Gastroenterology. 1994 November; 89(11): 1981-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7942722&dopt=Abstract

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Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy. Author(s): Wald A. Source: Gastroenterology Clinics of North America. 2003 March; 32(1): 309-22, Vii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635420&dopt=Abstract

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Controversies, dilemmas and dialogues. Is there a need to perform full colonoscopy in a middle-age person with episodic bright red blood per rectum and internal hemorrhoids? Author(s): Forde KA, Waye JD. Source: The American Journal of Gastroenterology. 1989 October; 84(10): 1227-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2801670&dopt=Abstract

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Conventional vs. triple rubber band ligation for hemorrhoids. A prospective, randomized trial. Author(s): Poon GP, Chu KW, Lau WY, Lee JM, Yeung C, Fan ST, Yiu TF, Wong SH, Wong KK. Source: Diseases of the Colon and Rectum. 1986 December; 29(12): 836-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3539557&dopt=Abstract

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Cryosurgery for hemorrhoids. Author(s): Goligher JC. Source: Diseases of the Colon and Rectum. 1976 April; 19(3): 213-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1269347&dopt=Abstract

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Cryosurgery for hemorrhoids. Author(s): Wegryn SP. Source: J Med Soc N J. 1975 December; 72(12): 1019-20. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1059775&dopt=Abstract

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Cryosurgery for life-threatening bleeding hemorrhoids in the elderly. Author(s): Mashiah A, Mashiah T. Source: Journal of the American Geriatrics Society. 1984 January; 32(1): 62-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6606660&dopt=Abstract

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Cryosurgical treatment of hemorrhoids in Japan. Author(s): Tanaka S. Source: Int Surg. 1989 July-September; 74(3): 146-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2606614&dopt=Abstract

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Current concepts in the treatment of hemorrhoids. Author(s): Foote RF. Source: Int Surg. 1968 August; 50(2): 112-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5662339&dopt=Abstract

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Dealing with hemorrhoids. Author(s): Meade V. Source: Am Pharm. 1992 March; Ns32(3): 64-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1561968&dopt=Abstract

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Delivery in breech presentation--a cause of hemorrhoids in a newborn. Author(s): Kleiner O, Cohen Z, Akkerman A, Mares AJ. Source: The Journal of Pediatrics. 2000 October; 137(4): 588. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11035846&dopt=Abstract

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Digital dilatation for hemorrhoids treatment. Author(s): Lord PH. Source: Int Surg. 1989 July-September; 74(3): 144-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2606613&dopt=Abstract

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Direct current electrotherapy of internal hemorrhoids: an effective, safe, and painless outpatient approach. Author(s): Norman DA, Newton R, Nicholas GV. Source: The American Journal of Gastroenterology. 1989 May; 84(5): 482-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2785755&dopt=Abstract

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Disposable device and a minimally invasive technique for rubber band ligation of hemorrhoids. Author(s): O'Regan PJ. Source: Diseases of the Colon and Rectum. 1999 May; 42(5): 683-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10344695&dopt=Abstract

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Diverse methods of managing hemorrhoids: dilatation. Author(s): Lord PH. Source: Diseases of the Colon and Rectum. 1973 May-June; 16(3): 180-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4703164&dopt=Abstract

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Diverse methods of managing hemorrhoids: ligation with cryotherapy. Author(s): Barron J. Source: Diseases of the Colon and Rectum. 1973 May-June; 16(3): 178-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4703163&dopt=Abstract

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Diverse methods of managing hemorrhoids: surgical treatment. Author(s): Ferguson JA. Source: Diseases of the Colon and Rectum. 1973 May-June; 16(3): 173-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4703161&dopt=Abstract

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Doppler sonographic diagnostics and treatment control of symptomatic first-degree hemorrhoids. Preliminary report and results. Author(s): Jaspersen D. Source: Digestive Diseases and Sciences. 1993 July; 38(7): 1329-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8325192&dopt=Abstract

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Double-blind, placebo-controlled evaluation of clinical activity and safety of Daflon 500 mg in the treatment of acute hemorrhoids. Author(s): Cospite M. Source: Angiology. 1994 June; 45(6 Pt 2): 566-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8203789&dopt=Abstract

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Double-blind, randomized clinical trial of troxerutin-carbazochrome in patients with hemorrhoids. Author(s): Squadrito F, Altavilla D, Oliaro Bosso S. Source: Eur Rev Med Pharmacol Sci. 2000 January-April; 4(1-2): 21-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11409185&dopt=Abstract

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Editorial: Hemorrhoids. Author(s): Warren R. Source: Archives of Surgery (Chicago, Ill. : 1960). 1974 June; 108(6): 762. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4829798&dopt=Abstract

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Edmund Andrews 1824-1904. The treatment of hemorrhoids by injection. Author(s): Andrews E. Source: Diseases of the Colon and Rectum. 1988 April; 31(4): 331-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3282844&dopt=Abstract

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Effect of esophageal variceal band ligation on hemorrhoids, anorectal varices, and portal hypertensive colopathy. Author(s): Misra SP, Misra V, Dwivedi M. Source: Endoscopy. 2002 March; 34(3): 195-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11870568&dopt=Abstract

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Effect of esophageal variceal sclerotherapy on hemorrhoids, anorectal varices and portal colopathy. Author(s): Misra SP, Misra V, Dwivedi M. Source: Endoscopy. 1999 November; 31(9): 741-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10604617&dopt=Abstract

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Effect of fiber supplements on internal bleeding hemorrhoids. Author(s): Perez-Miranda M, Gomez-Cedenilla A, Leon-Colombo T, Pajares J, MateJimenez J. Source: Hepatogastroenterology. 1996 November-December; 43(12): 1504-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8975955&dopt=Abstract

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Elastic band ligation of internal hemorrhoids. Author(s): Abramson DJ. Source: Military Medicine. 1980 January; 145(1): 11-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6768009&dopt=Abstract

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Evaluation of Barron ligation treatment of internal hemorrhoids and associated rectal diseases. Author(s): Boggs HW, Slagle GW. Source: J La State Med Soc. 1966 November; 118(11): 450-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5922302&dopt=Abstract

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Evaluation of hemorrhoids with the retroflexed fiberoptic colonoscope. Author(s): Fernandez-Bermejo M, Mate-Jim nez J. Source: Gastrointestinal Endoscopy. 1999 August; 50(2): 305-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10425511&dopt=Abstract

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Evaluation of ligation of hemorrhoids as an office procedure. Author(s): Salvati EP. Source: Diseases of the Colon and Rectum. 1967 January-February; 10(1): 53-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6018351&dopt=Abstract

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Experience with Peter Lord's treatment for hemorrhoids. Author(s): Georgoulis B. Source: Diseases of the Colon and Rectum. 1971 March-April; 14(2): 147-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5558215&dopt=Abstract

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Experiences of Lord's procedure for the treatment of hemorrhoids. Author(s): Sames P. Source: Proc R Soc Med. 1972 September; 65(9): 782-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5085064&dopt=Abstract

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Fatal hemorrhage following rubber band ligation of hemorrhoids. Author(s): Dixon AR, Harris AM, Baker AR, Barrie WW. Source: Diseases of the Colon and Rectum. 1988 February; 31(2): 156. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3257436&dopt=Abstract

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He/Ne laser treatment of hemorrhoids. Author(s): Trelles MA, Rotinen S. Source: Acupuncture & Electro-Therapeutics Research. 1983; 8(3-4): 289-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6145304&dopt=Abstract

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Hemorrhoidal diseases and office ligation of hemorrhoids. Author(s): Keighley DG. Source: Am J Proctol Gastroenterol Colon Rectal Surg. 1979 May-June; 30(3): 34-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=525689&dopt=Abstract

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Hemorrhoidectomy for thrombosed external hemorrhoids. Author(s): Zuber TJ. Source: American Family Physician. 2002 April 15; 65(8): 1629-32, 1635-6, 1639. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11989640&dopt=Abstract

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Hemorrhoidectomy in the patient with multiple or circumferential hemorrhoids. Author(s): Pello MJ, Spence RK, Alexander JB, Camishion RC. Source: Diseases of the Colon and Rectum. 1988 March; 31(3): 245-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3349881&dopt=Abstract

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Hemorrhoids and anal fissures. Common problems, current solutions. Author(s): Bubrick MP, Benjamin RB. Source: Postgraduate Medicine. 1985 February 1; 77(2): 165-9, 172-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2982135&dopt=Abstract

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Hemorrhoids and varicose veins: a review of treatment options. Author(s): MacKay D. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 2001 April; 6(2): 126-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11302778&dopt=Abstract

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Hemorrhoids as a source of bacteremia. Author(s): Kirkland LR. Source: Hosp Pract (Off Ed). 1989 May 15; 24(5): 14. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2497117&dopt=Abstract

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Hemorrhoids or rectal varices: defining the cause of massive rectal hemorrhage in patients with portal hypertension. Author(s): Weinshel E, Chen W, Falkenstein DB, Kessler R, Raicht RF. Source: Gastroenterology. 1986 March; 90(3): 744-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3484711&dopt=Abstract

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Hemorrhoids, anal fissure, and carcinoma of the colon, rectum, and anus during pregnancy. Author(s): Medich DS, Fazio VW. Source: The Surgical Clinics of North America. 1995 February; 75(1): 77-88. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7855720&dopt=Abstract

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Hemorrhoids, fissures, and pruritus ani. Author(s): Mazier WP. Source: The Surgical Clinics of North America. 1994 December; 74(6): 1277-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7985064&dopt=Abstract

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Hemorrhoids, fistulae and fissures: office and hospital management--a critical review. Author(s): Ferguson JA, MacKeigan JM. Source: Adv Surg. 1978; 12: 111-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=735938&dopt=Abstract

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Hemorrhoids, genital warts, and other perianal complaints. Author(s): Gerdom LE, Dixon D, Dipalma JA. Source: Jaapa. 2001 September; 14(9): 37-9, 43-4, 47. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11599281&dopt=Abstract

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Hemorrhoids, varicose veins and deep vein thrombosis: epidemiologic features and suggested causative factors. Author(s): Burkitt DP. Source: Canadian Journal of Surgery. Journal Canadien De Chirurgie. 1975 September; 18(5): 483-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1175115&dopt=Abstract

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Hemorrhoids. Author(s): Sardinha TC, Corman ML. Source: The Surgical Clinics of North America. 2002 December; 82(6): 1153-67, Vi. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12516845&dopt=Abstract

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Hemorrhoids. Author(s): Hulme-Moir M, Bartolo DC. Source: Gastroenterology Clinics of North America. 2001 March; 30(1): 183-97. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11394030&dopt=Abstract

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Hemorrhoids. Author(s): Hussain JN. Source: Primary Care. 1999 March; 26(1): 35-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9922293&dopt=Abstract

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Hemorrhoids. Author(s): Gricar JA, Goodwin SA, Cave DG. Source: Manag Care Interface. 1998 June; 11(6): 50-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10181558&dopt=Abstract

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Hemorrhoids. Author(s): Leff E. Source: Postgraduate Medicine. 1987 November 15; 82(7): 95-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3671219&dopt=Abstract

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Hemorrhoids. Author(s): Gorlin RJ, Clift L. Source: Diseases of the Colon and Rectum. 1986 May; 29(5): 368. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3516604&dopt=Abstract

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Hemorrhoids. Author(s): Kaufman HD. Source: Compr Ther. 1981 August; 7(8): 47-52. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7273685&dopt=Abstract

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Hemorrhoids. Author(s): Donelson M Jr. Source: Va Med Mon (1918). 1967 February; 94(2): 101-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6038200&dopt=Abstract

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Hemorrhoids. A practical approach to an aggravating problem. Author(s): Cocchiara JL. Source: Postgraduate Medicine. 1991 January; 89(1): 149-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1985307&dopt=Abstract

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Hemorrhoids. A review of current techniques and management. Author(s): Smith LE. Source: Gastroenterology Clinics of North America. 1987 March; 16(1): 79-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3298057&dopt=Abstract

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Hemorrhoids. Measuring the constrictive force of rubber bands. Author(s): Katchian A. Source: Diseases of the Colon and Rectum. 1984 July; 27(7): 471-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6745020&dopt=Abstract

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Hemorrhoids. Nonoperative management. Author(s): Dennison AR, Wherry DC, Morris DL. Source: The Surgical Clinics of North America. 1988 December; 68(6): 1401-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3057666&dopt=Abstract

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Hemorrhoids. Total ligation in one session. Author(s): Katchian A. Source: Am J Proctol. 1976 April; 27(2): 65-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1258998&dopt=Abstract

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Hemorrhoids: a plea for nonsurgical treatment. Author(s): Deutsch AA, Kaufman Z, Reiss R. Source: Isr J Med Sci. 1980 September-October; 16(9-10): 649-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7429800&dopt=Abstract

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Hemorrhoids: associated pathologic conditions in a family practice population. Author(s): Trilling JS, Robbins A, Meltzer D, Steinbardt S. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 1991 November-December; 4(6): 389-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1767689&dopt=Abstract

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Hemorrhoids: how to care when it's simple. Author(s): Carbary LJ. Source: J Pract Nurs. 1975 November; 25(11): 28-30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1042145&dopt=Abstract

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Hemorrhoids: injection, ligation or operation. Author(s): Fick TE. Source: Neth J Surg. 1982 May; 34(2): 76-80. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7099456&dopt=Abstract

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Hemorrhoids: revisited. Author(s): Turell R. Source: N Y State J Med. 1979 November; 79(12): 1840-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=292833&dopt=Abstract

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Hemorrhoids: what the dermatologist should know. Author(s): Orkin BA, Schwartz AM, Orkin M. Source: Journal of the American Academy of Dermatology. 1999 September; 41(3 Pt 1): 449-56. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10459121&dopt=Abstract

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Hemorrhoids--alternative treatments. Author(s): Faulconer HT. Source: J Ky Med Assoc. 1988 November; 86(11): 617-20. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3057097&dopt=Abstract

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Hemorrhoids--diagnostic and treatment options. Author(s): Birkett DH. Source: Hosp Pract (Off Ed). 1988 January 30; 23(1A): 99-102, 105, 108. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3123506&dopt=Abstract

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High-fiber diet reduces bleeding and pain in patients with hemorrhoids: a doubleblind trial of Vi-Siblin. Author(s): Moesgaard F, Nielsen ML, Hansen JB, Knudsen JT. Source: Diseases of the Colon and Rectum. 1982 July-August; 25(5): 454-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6284457&dopt=Abstract

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How to treat hemorrhoids: five nonsurgical alternatives. Author(s): Smith LE. Source: Geriatrics. 1978 October; 33(10): 43-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=700361&dopt=Abstract

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Ileosigmoid volvulus and acute external hemorrhoids: a new entity? Author(s): Olowofoyeku BV, Callender CO. Source: Journal of the National Medical Association. 1982 March; 74(3): 281-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7120465&dopt=Abstract

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Immunochemical fecal occult blood test is not suitable for diagnosis of hemorrhoids. Author(s): Nakama H, Kamijo N, Fujimori K, Horiuchi A, Abdul Fattah S, Zhang B. Source: The American Journal of Medicine. 1997 June; 102(6): 551-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9217670&dopt=Abstract

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In defense of cryotherapy for hemorrhoids. A modified method. Author(s): MacLeod JH. Source: Diseases of the Colon and Rectum. 1982 May-June; 25(4): 332-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6979469&dopt=Abstract

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Infrared coagulation: a new treatment for hemorrhoids. Author(s): Leicester RJ, Nicholls RJ, Mann CV. Source: Diseases of the Colon and Rectum. 1981 November-December; 24(8): 602-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7318625&dopt=Abstract

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Infrared photocoagulation of hemorrhoids. Author(s): O'Holleran TP. Source: Nebr Med J. 1990 November; 75(11): 307-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2259388&dopt=Abstract

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Infrared-photo-coagulation for hemorrhoids treatment. Author(s): Neiger A. Source: Int Surg. 1989 July-September; 74(3): 142-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2606612&dopt=Abstract

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Initial experience with stapled anoplasty in the operative management of prolapsing hemorrhoids and mucosal rectal prolapse. Author(s): Orrom W, Hayashi A, Rusnak C, Kelly J. Source: American Journal of Surgery. 2002 May; 183(5): 519-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12034384&dopt=Abstract

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Injection treatment of hemorrhoids in patients with acquired immunodeficiency syndrome. Author(s): Scaglia M, Delaini GG, Destefano I, Hulten L. Source: Diseases of the Colon and Rectum. 2001 March; 44(3): 401-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11289287&dopt=Abstract

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Injection treatment of internal hemorrhoids: a forgotten art. Author(s): Massey CC Jr. Source: Southern Medical Journal. 1972 September; 65(9): 1058-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5055520&dopt=Abstract

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Internal anal sphincterotomy plus free dilatation versus anal stretch with special criticism of the anal stretch procedure for hemorrhoids: The recommended modern approach to hemorrhoid treatment. Author(s): Eisenhammer S. Source: Diseases of the Colon and Rectum. 1974 July-August; 17(4): 493-522. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4852515&dopt=Abstract

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Internal hemorrhoids coexisting with chronic anal fissure: new nonsurgical modalities. Author(s): Madalinski M, Labon M, Adrich Z, Kryszewski A. Source: Endoscopy. 1998 October; 30(8): S96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9865581&dopt=Abstract

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Internal hemorrhoids: diagnosis with double-contrast barium enema examinations. Author(s): Levine MS, Kam LW, Rubesin SE, Ekberg O. Source: Radiology. 1990 October; 177(1): 141-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2399313&dopt=Abstract

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Lateral internal sphincterotomy in the treatment of hemorrhoids. A clinical and manometric study. Author(s): Schouten WR, van Vroonhoven TJ. Source: Diseases of the Colon and Rectum. 1986 December; 29(12): 869-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3792169&dopt=Abstract

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Letter: Hemorrhoids. Author(s): Nesselrod JP. Source: Archives of Surgery (Chicago, Ill. : 1960). 1974 September; 109(3): 458. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4852804&dopt=Abstract

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Ligation and cryosurgery of all hemorrhoids. An office procedure. Author(s): Rudd WW. Source: Int Surg. 1989 July-September; 74(3): 148-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2606615&dopt=Abstract

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Ligation apparatus for internal hemorrhoids. Author(s): Wenhui Y. Source: Lancet. 1983 July 9; 2(8341): 105. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6134939&dopt=Abstract

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Ligation of hemorrhoids as an office procedure. Author(s): Rudd WW. Source: Can Med Assoc J. 1973 January 6; 108(1): 56-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4682639&dopt=Abstract

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Ligation of internal hemorrhoids by the Barron band technic. Author(s): Boggs HW Jr, Slagle GW. Source: Southern Medical Journal. 1967 September; 60(9): 1009-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6048130&dopt=Abstract

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Ligation treatment of internal hemorrhoids. Author(s): McGivney J. Source: Tex Med. 1967 May; 63(5): 56-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6047546&dopt=Abstract

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Local injection of bupivacaine after rubber band ligation of hemorrhoids: prospective, randomized study. Author(s): Hooker GD, Plewes EA, Rajgopal C, Taylor BM. Source: Diseases of the Colon and Rectum. 1999 February; 42(2): 174-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10211492&dopt=Abstract

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Long-term follow-up of concomitant band ligation and sclerotherapy for internal hemorrhoids. Author(s): Choi J, Freeman JB, Touchette J. Source: Canadian Journal of Surgery. Journal Canadien De Chirurgie. 1985 November; 28(6): 523-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4063892&dopt=Abstract

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Long-term results of large-dose, single-session phenol injection sclerotherapy for hemorrhoids. Author(s): Santos G, Novell JR, Khoury G, Winslet MC, Lewis AA. Source: Diseases of the Colon and Rectum. 1993 October; 36(10): 958-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8404389&dopt=Abstract

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Lord procedure for treatment of postpartum hemorrhoids and fissures. Author(s): O'Connor JJ. Source: Obstetrics and Gynecology. 1980 June; 55(6): 747-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7383462&dopt=Abstract

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Lord's procedure for treatment of hemorrhoids at Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. Author(s): Fasawe TO. Source: Isr J Med Sci. 1976 July; 12(7): 686-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=972023&dopt=Abstract

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Management of hemorrhoids by rubber band ligation. Author(s): Oueidat DM, Jurjus AR. Source: J Med Liban. 1994; 42(1): 11-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7629828&dopt=Abstract

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Management of hemorrhoids: a new approach. Author(s): Sikirov BA. Source: Isr J Med Sci. 1987 April; 23(4): 284-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3623887&dopt=Abstract

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Metastatic renal cell carcinoma presenting as a hemorrhoid. Author(s): Sawh RN, Borkowski J, Broaddus R. Source: Archives of Pathology & Laboratory Medicine. 2002 July; 126(7): 856-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12088459&dopt=Abstract

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Micronized flavonoid therapy in internal hemorrhoids of pregnancy. Author(s): Buckshee K, Takkar D, Aggarwal N. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1997 May; 57(2): 145-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9184951&dopt=Abstract

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Micronized purified flavonidic fraction compared favorably with rubber band ligation and fiber alone in the management of bleeding hemorrhoids: randomized controlled trial. Author(s): Ho YH, Tan M, Seow-Choen F. Source: Diseases of the Colon and Rectum. 2000 January; 43(1): 66-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10813126&dopt=Abstract

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Modern management of hemorrhoids. Author(s): Buls JG, Goldberg SM. Source: The Surgical Clinics of North America. 1978 June; 58(3): 469-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=675462&dopt=Abstract

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Modern management of hemorrhoids. Author(s): Kratzer GL. Source: American Family Physician. 1972 September; 6(3): 82-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5056840&dopt=Abstract

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Modified pile suture in the outpatient treatment of hemorrhoids. A preliminary report. Author(s): Awojobi OA. Source: Diseases of the Colon and Rectum. 1983 February; 26(2): 95-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6337036&dopt=Abstract

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Necrotizing fascitis after injection sclerotherapy for hemorrhoids: report of a case. Author(s): Kaman L, Aggarwal S, Kumar R, Behera A, Katariya RN. Source: Diseases of the Colon and Rectum. 1999 March; 42(3): 419-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10223766&dopt=Abstract

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New device for rubber band ligation of hemorrhoids. Author(s): Gaj F, Trecca A, Carboni M. Source: Diseases of the Colon and Rectum. 1994 May; 37(5): 494-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8181414&dopt=Abstract

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Nonoperative ligation treatment of internal hemorrhoids. Author(s): Frink NW, Duckler L. Source: Jama : the Journal of the American Medical Association. 1968 April 29; 204(5): 375-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5694449&dopt=Abstract

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Nonoperative management of hemorrhoids: evolution of the office management of hemorrhoids. Author(s): Salvati EP. Source: Diseases of the Colon and Rectum. 1999 August; 42(8): 989-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10458119&dopt=Abstract

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Nonoperative therapy for hemorrhoids. Author(s): Fay MR, Snider WR. Source: Aorn Journal. 1976 September; 24(3): 448-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=60913&dopt=Abstract

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Nonsurgical treatment of hemorrhoids. Author(s): Johanson JF. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2002 May-June; 6(3): 290-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12022975&dopt=Abstract

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Nonsurgical treatment of hemorrhoids. Author(s): Jacob JE. Source: J S C Med Assoc. 1987 August; 83(8): 425-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3478517&dopt=Abstract

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Nonsurgical treatment options for internal hemorrhoids. Author(s): Pfenninger JL, Surrell J. Source: American Family Physician. 1995 September 1; 52(3): 821-34, 839-41. Review. Erratum In: Am Fam Physician 1996 February 15; 53(3): 866. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7653423&dopt=Abstract

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Novel technique: radiofrequency coagulation--a treatment alternative for early-stage hemorrhoids. Author(s): Gupta PJ. Source: Medgenmed [electronic Resource] : Medscape General Medicine. 2002 July 31; 4(3): 1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12466744&dopt=Abstract

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Of heliotropes and hemorrhoids. St. Fiacre, patron saint of gardeners and hemorrhoid sufferers. Author(s): Bonello JC, Cohen H, Gorlin RJ. Source: Diseases of the Colon and Rectum. 1985 October; 28(10): 702-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3902408&dopt=Abstract

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Office evaluation and treatment of hemorrhoids. Author(s): Alonso-Coello P, Castillejo MM. Source: The Journal of Family Practice. 2003 May; 52(5): 366-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12737769&dopt=Abstract

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Office ligation of hemorrhoids. Author(s): Blaisdell PC. Source: Jama : the Journal of the American Medical Association. 1968 November 18; 206(8): 1793. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5754835&dopt=Abstract

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Office ligation of internal hemorrhoids: a 10 year report, with simplified technic. Author(s): Blaisdell PC. Source: Am J Proctol. 1966 April; 17(2): 125-32. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5907919&dopt=Abstract

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Office management of internal hemorrhoids and rectal prolapse. Author(s): Solomon DI. Source: Am J Proctol. 1966 June; 17(3): 209-12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5932708&dopt=Abstract

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Operative treatment of hemorrhoids-long term evaluation. Author(s): Cieszynski T, Witek R, Kalemba J, Lazarkiewicz B, Gzarnieck L, Koczorowski S, Zembala M. Source: Mater Med Pol. 1981 January-March; 13(1): 63-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7321589&dopt=Abstract

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Outpatient management of hemorrhoids. Author(s): Schussman LC, Lutz LJ. Source: Primary Care. 1986 September; 13(3): 527-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3538088&dopt=Abstract

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Outpatient treatment of hemorrhoids with a combined technique: results in 7850 cases. Author(s): Accarpio G, Ballari F, Puglisi R, Menoni S, Ravera G, Accarpio FT, Cariati A, Zaffarano R. Source: Techniques in Coloproctology. 2002 December; 6(3): 195-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12525916&dopt=Abstract

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Outpatient treatment of hemorrhoids: using a new and simple ligator. Author(s): Rudd WW. Source: Postgraduate Medicine. 1981 August; 70(2): 224, 226. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7255297&dopt=Abstract

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Over-the-counter gastro-intestinal drugs: part four, anti-hemorrhoids medications. Author(s): Brown MS. Source: The Nurse Practitioner. 1976 November-December; 2(2): 17-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1049398&dopt=Abstract

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Photostudies of urethral varices “hemorrhoids”: a forgotten lesion. Author(s): Arnold SJ, Goode R, Ginsburg A. Source: Urology. 1978 January; 11(1): 19-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=622756&dopt=Abstract

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Portal hypertensive colopathy and hemorrhoids in cirrhotic patients. Author(s): Leone N, Debernardi-Venon W, Marzano A, Garino M, DePaolis P, Grosso M, Fronda GR, Rizzetto M. Source: Journal of Hepatology. 2000 December; 33(6): 1026-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11131443&dopt=Abstract

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Prevalence and factors influencing hemorrhoids, anorectal varices, and colopathy in patients with portal hypertension. Author(s): Misra SP, Dwivedi M, Misra V. Source: Endoscopy. 1996 May; 28(4): 340-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8813499&dopt=Abstract

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Prevention of hemorrhoids by controlled defecation. Author(s): Marx FA. Source: Diseases of the Colon and Rectum. 1993 November; 36(11): 1084. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8223064&dopt=Abstract

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Prevention of hemorrhoids: a matter of logic? Author(s): Marx FA. Source: Diseases of the Colon and Rectum. 1988 October; 31(10): 832. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3168675&dopt=Abstract

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Primary Kaposi's sarcoma simulating hemorrhoids in a patient with acquired immune deficiency syndrome. Author(s): Khan AA, Ravalli S, Vincent RA, Chabon AB. Source: The American Journal of Gastroenterology. 1989 December; 84(12): 1592-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2596470&dopt=Abstract

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Procedures in family practice. Band ligation of internal hemorrhoids. Author(s): Volpe PA. Source: The Journal of Family Practice. 1976 April; 3(2): 205-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1262810&dopt=Abstract

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Proctoscopic Doppler ultrasound in diagnostics and treatment of bleeding hemorrhoids. Author(s): Jaspersen D, Koerner T, Schorr W, Hammar CH. Source: Diseases of the Colon and Rectum. 1993 October; 36(10): 942-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8404386&dopt=Abstract

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Prolonged ambulant assessment of anorectal function in patients with prolapsing hemorrhoids. Author(s): Waldron DJ, Kumar D, Hallan RI, Williams NS. Source: Diseases of the Colon and Rectum. 1989 November; 32(11): 968-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2806026&dopt=Abstract

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Prolonged rectal bleeding associated with hemorrhoids: the diagnostic contribution of colonoscopy. Author(s): Pines A, Shemesh E, Bat L. Source: Southern Medical Journal. 1987 March; 80(3): 313-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3493539&dopt=Abstract

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Proper principles and practices in the surgical management of hemorrhoids. Author(s): Eisenhammer S. Source: Diseases of the Colon and Rectum. 1969 July-August; 12(4): 288-305. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4896175&dopt=Abstract

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Prospective randomized comparative study of bipolar electrocoagulation versus heater probe for treatment of chronically bleeding internal hemorrhoids. Author(s): Jensen DM, Jutabha R, Machicado GA, Jensen ME, Cheng S, Gornbein J, Hirabayashi K, Ohning G, Randall G. Source: Gastrointestinal Endoscopy. 1997 November; 46(5): 435-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9402118&dopt=Abstract

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Prospective randomized comparative study of bipolar versus direct current electrocoagulation for treatment of bleeding internal hemorrhoids. Author(s): Randall GM, Jensen DM, Machicado GA, Hirabayashi K, Jensen ME, You S, Pelayo E. Source: Gastrointestinal Endoscopy. 1994 July-August; 40(4): 403-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7926528&dopt=Abstract

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Prospective study of factors affecting postoperative pain and symptom persistence after stapled rectal mucosectomy for hemorrhoids: a need for preservation of squamous epithelium. Author(s): Correa-Rovelo JM, Tellez O, Obregon L, Duque-Lopez X, Miranda-Gomez A, Pichardo-Bahena R, Mendez M, Moran S. Source: Diseases of the Colon and Rectum. 2003 July; 46(7): 955-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847373&dopt=Abstract

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Prospective, randomized trial comparing pain and clinical function after conventional scissors excision/ligation vs. diathermy excision without ligation for symptomatic prolapsed hemorrhoids. Author(s): Seow-Choen F, Ho YH, Ang HG, Goh HS. Source: Diseases of the Colon and Rectum. 1992 December; 35(12): 1165-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1473420&dopt=Abstract

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Radiofrequency coagulation: a treatment alternative in early hemorrhoids. Author(s): Gupta PJ. Source: Indian J Gastroenterol. 2002 July-August; 21(4): 167. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12385556&dopt=Abstract

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Radiofrequency coagulation: an alternative treatment in early grade bleeding hemorrhoids. Author(s): Gupta PJ. Source: Techniques in Coloproctology. 2002 December; 6(3): 203-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12561810&dopt=Abstract

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Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Author(s): Boccasanta P, Capretti PG, Venturi M, Cioffi U, De Simone M, Salamina G, Contessini-Avesani E, Peracchia A. Source: American Journal of Surgery. 2001 July; 182(1): 64-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11532418&dopt=Abstract

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Randomized, prospective trial of direct current versus bipolar electrocoagulation for bleeding internal hemorrhoids. Author(s): Yang R, Migikovsky B, Peicher J, Laine L. Source: Gastrointestinal Endoscopy. 1993 November-December; 39(6): 766-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8293898&dopt=Abstract

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Rational approach to treatment of hemorrhoids based on a theory of etiology. Author(s): MacLeod JH. Source: Archives of Surgery (Chicago, Ill. : 1960). 1983 January; 118(1): 29-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6848072&dopt=Abstract

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Rectal perforation, retropneumoperitoneum, and pneumomediastinum after stapling procedure for prolapsed hemorrhoids: report of a case and subsequent considerations. Author(s): Ripetti V, Caricato M, Arullani A. Source: Diseases of the Colon and Rectum. 2002 February; 45(2): 268-70. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11852343&dopt=Abstract

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Recurrent epistaxis from Kiesselbach area syndrome in patients suffering from hemorrhoids: fact or fiction? Author(s): Mladina R, Cavcic J, Subaric M. Source: Archives of Medical Research. 2002 March-April; 33(2): 193-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11886721&dopt=Abstract

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Recurrent rectal bleeding from portal hypertensive colopathy in a patient with hemorrhoids. Author(s): Ohta M, Hashizume M, Kishihara F, Kawanaka H, Tanoue K, Sugimachi K. Source: The American Journal of Gastroenterology. 1995 September; 90(9): 1531-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7661188&dopt=Abstract

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Relationship of portal pressure, anorectal varices and hemorrhoids in cirrhotic patients. Author(s): Wang TF, Lee FY, Tsai YT, Lee SD, Wang SS, Hsia HC, Lin WJ, Lin HC, Lai KH, Chan CY, et al. Source: Journal of Hepatology. 1992 May; 15(1-2): 170-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1506636&dopt=Abstract

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Removal of hemorrhoids. Author(s): Marino AW Jr, Marino AW, Mancini HW. Source: Jama : the Journal of the American Medical Association. 1968 August 5; 205(6): 469. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5694990&dopt=Abstract

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Resolution of chronic anal fissures after treatment of contiguous internal hemorrhoids with direct current probe. Author(s): Machicado GA, Cheng S, Jensen DM. Source: Gastrointestinal Endoscopy. 1997 February; 45(2): 157-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9041002&dopt=Abstract

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Results obtained in the treatment of hemorrhoids by extirpation with diathermic loop. Author(s): Lentini J. Source: Am J Proctol. 1970 February; 21(1): 23-35. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5435029&dopt=Abstract

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Retroflexed endoscopic band ligation of bleeding internal hemorrhoids. Author(s): Berkelhammer C, Moosvi SB. Source: Gastrointestinal Endoscopy. 2002 April; 55(4): 532-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11923767&dopt=Abstract

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Retroperitoneal abscess following sclerotherapy for hemorrhoids. Author(s): Ribbans WJ, Radcliffe AG. Source: Diseases of the Colon and Rectum. 1985 March; 28(3): 188-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3882366&dopt=Abstract

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Role of hemorrhoids in the pathogenesis of recurrent bacteriuria with a new approach for treatment. Author(s): Shafik A. Source: European Urology. 1985; 11(6): 392-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3910441&dopt=Abstract

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Routine anal cleansing, so-called hemorrhoids, and perianal dermatitis: cause and effect? Author(s): Rohde H. Source: Diseases of the Colon and Rectum. 2000 April; 43(4): 561-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10789760&dopt=Abstract

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Routine pathological examination of hemorrhoids. Author(s): Barnett RN. Source: Jama : the Journal of the American Medical Association. 1985 April 26; 253(16): 2363. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3920410&dopt=Abstract

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Rubber band ligation of hemorrhoids and rectal mucosal prolapse in constipated patients. Author(s): Mattana C, Maria G, Pescatori M. Source: Diseases of the Colon and Rectum. 1989 May; 32(5): 372-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2714126&dopt=Abstract

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Rubber band ligation of hemorrhoids. Author(s): Wrobleski DE. Source: R I Med. 1995 June; 78(6): 172-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7626817&dopt=Abstract

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Rubber band ligation of hemorrhoids. Author(s): Frey KA. Source: American Family Physician. 1984 May; 29(5): 187-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6731237&dopt=Abstract

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Rubber band ligation of hemorrhoids. Author(s): Corman ML. Source: Archives of Surgery (Chicago, Ill. : 1960). 1977 October; 112(10): 1257-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=907472&dopt=Abstract

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Rubber band ligation of hemorrhoids. Convenient and economic treatment. Author(s): Bayer I, Myslovaty B, Picovsky BM. Source: Journal of Clinical Gastroenterology. 1996 July; 23(1): 50-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8835901&dopt=Abstract

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Rubber band ligation of hemorrhoids: relapse as a function of time. Author(s): Savioz D, Roche B, Glauser T, Dobrinov A, Ludwig C, Marti MC. Source: International Journal of Colorectal Disease. 1998; 13(4): 154-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9810517&dopt=Abstract

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Rubber band ligation of symptomatic internal hemorrhoids: results of 500 cases. Author(s): Komborozos VA, Skrekas GJ, Pissiotis CA. Source: Digestive Surgery. 2000; 17(1): 71-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10720835&dopt=Abstract

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Rubber band ligation of three primary hemorrhoids in a single session. A safe and effective procedure. Author(s): Lau WY, Chow HP, Poon GP, Wong SH. Source: Diseases of the Colon and Rectum. 1982 May-June; 25(4): 336-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6979470&dopt=Abstract

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Sclero-therapy of hemorrhoids. Author(s): Laurisin E. Source: Am J Proctol. 1971 August; 22(4): 241-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5160997&dopt=Abstract

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Sclerotherapy of internal hemorrhoids using newly devised transparent disposable anorectoscope. Author(s): Inoue H, Takemura K, Hori H, Itoh K, Muraoka Y, Yoneshima H, Endo M. Source: Surgical Endoscopy. 1992 May-June; 6(3): 125-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1502679&dopt=Abstract

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Severe complication of rubber band ligation of internal hemorrhoids. Author(s): Shemesh EI, Kodner IJ, Fry RD, Neufeld DM. Source: Diseases of the Colon and Rectum. 1987 March; 30(3): 199-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3829863&dopt=Abstract

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Single session ligation treatment of bleeding hemorrhoids. Author(s): Alemdaroglu K, Ulualp KM. Source: Surg Gynecol Obstet. 1993 July; 177(1): 62-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8322152&dopt=Abstract

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Single session treatment for bleeding hemorrhoids. Author(s): Weinstein SJ, Rypins EB, Houck J, Thrower S. Source: Surg Gynecol Obstet. 1987 December; 165(6): 479-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3500523&dopt=Abstract

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Stapled hemorrhoidectomy in patients with prolapsed irreducible hemorrhoids. Author(s): Godevenos D. Source: Diseases of the Colon and Rectum. 2001 August; 44(8): 1224. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11535869&dopt=Abstract

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Staplers and hemorrhoids. Author(s): O'Connor JJ. Source: Diseases of the Colon and Rectum. 2000 January; 43(1): 118-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10813139&dopt=Abstract

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Stapling procedure for hemorrhoids versus conventional haemorrhoidectomy. Author(s): Helmy MA. Source: J Egypt Soc Parasitol. 2000 December; 30(3): 951-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11198392&dopt=Abstract

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Strangulated internal hemorrhoids: office treatment with “lisotomy” and single session ligation. Author(s): Katchian A. Source: Am J Proctol. 1977 June; 28(3): 71-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=869025&dopt=Abstract

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Studies on etiopathogenesis of hemorrhoids. Author(s): Prasad GC, Prakash V, Tandon AK, Deshpande PJ. Source: Am J Proctol. 1976 June; 27(3): 33-41. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=937530&dopt=Abstract

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Surgery for symptomatic hemorrhoids and anal fissures in Crohn's disease. Author(s): Wolkomir AF, Luchtefeld MA. Source: Diseases of the Colon and Rectum. 1993 June; 36(6): 545-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8500370&dopt=Abstract

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Surgical management of hemorrhoids. Author(s): Senagore AJ. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2002 May-June; 6(3): 295-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12022976&dopt=Abstract

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Surgical management of hemorrhoids. Author(s): Howard GT Jr. Source: Am J Proctol. 1966 June; 17(3): 213-20. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5932709&dopt=Abstract

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Surgical treatment of circumferential hemorrhoids. Author(s): Selvaggi F, Scotto di Carlo E, Silvestri A, Notaroberto A, Maffettone V. Source: Diseases of the Colon and Rectum. 1990 October; 33(10): 903-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2209283&dopt=Abstract

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Surgical treatment of hemorrhoids: prospective, randomized trial comparing closed excisional hemorrhoidectomy and the Harmonic Scalpel technique of excisional hemorrhoidectomy. Author(s): Khan S, Pawlak SE, Eggenberger JC, Lee CS, Szilagy EJ, Wu JS, Margolin M D DA. Source: Diseases of the Colon and Rectum. 2001 June; 44(6): 845-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11391146&dopt=Abstract

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Symptomatic hemorrhoids and anorectal varices in children with portal hypertension. Author(s): Heaton ND, Davenport M, Howard ER. Source: Journal of Pediatric Surgery. 1992 July; 27(7): 833-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1640328&dopt=Abstract

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Symptomatic hemorrhoids: current incidence and complications of operative therapy. Author(s): Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG. Source: Diseases of the Colon and Rectum. 1992 May; 35(5): 477-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1568400&dopt=Abstract

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Symptomatic internal hemorrhoids. What are your options? Author(s): Smith LE. Source: Postgraduate Medicine. 1983 June; 73(6): 323-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6856539&dopt=Abstract

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Techniques for diagnosis and treatment of bleeding hemorrhoids. Author(s): O'Connor JJ. Source: Diseases of the Colon and Rectum. 1994 July; 37(7): 732-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8026244&dopt=Abstract

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Temporal changes in the occurrence of hemorrhoids in the United States and England. Author(s): Johanson JF, Sonnenberg A. Source: Diseases of the Colon and Rectum. 1991 July; 34(7): 585-91; Discussion 591-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1820756&dopt=Abstract

44 Hemorrhoids

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The biblical plague of “hemorrhoids”. An outbreak of bilharziasis. Author(s): Dirckx JH. Source: The American Journal of Dermatopathology. 1985 August; 7(4): 341-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3939579&dopt=Abstract

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The gastroenterologist and the treatment of hemorrhoids: is it about time? Author(s): Schapiro M. Source: The American Journal of Gastroenterology. 1989 May; 84(5): 493-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2719005&dopt=Abstract

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The laser treatment of hemorrhoids: results of a study on 1816 patients. Author(s): Iwagaki H, Higuchi Y, Fuchimoto S, Orita K. Source: Jpn J Surg. 1989 November; 19(6): 658-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2607689&dopt=Abstract

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The ligature treatment of hemorrhoids (Barron). Influence on the practice of office proctology. Author(s): Lahvis P. Source: Am J Proctol. 1971 August; 22(4): 245-50. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5160998&dopt=Abstract

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The management of hemorrhoids. Author(s): Dennison AR, Whiston RJ, Rooney S, Morris DL. Source: The American Journal of Gastroenterology. 1989 May; 84(5): 475-81. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2655433&dopt=Abstract

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The management of hemorrhoids: update 1987. Author(s): Kingsley AN. Source: Nebr Med J. 1987 June; 72(6): 190-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3600864&dopt=Abstract

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The new classification of hemorrhoids: PATE 2000-Sorrento. History of the scientific debate. Author(s): Gaj F, Trecca A, Busotti A, Brugiotti C, Carboni M. Source: Minerva Chir. 2002 June; 57(3): 331-9. English, Italian. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12029228&dopt=Abstract

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The pathogenesis of hemorrhoids and their treatment by anorectal bandotomy. Author(s): Shafik A. Source: Journal of Clinical Gastroenterology. 1984 April; 6(2): 129-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6715850&dopt=Abstract

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The pathogenesis of hemorrhoids. Author(s): Haas PA, Fox TA Jr, Haas GP. Source: Diseases of the Colon and Rectum. 1984 July; 27(7): 442-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6745015&dopt=Abstract

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The prevalence of confusion in the definition of hemorrhoids. Author(s): Haas PA. Source: Diseases of the Colon and Rectum. 1992 March; 35(3): 290-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1740081&dopt=Abstract

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The prevalence of hemorrhoids and chronic constipation. Author(s): Haas PA, Haas GP. Source: Gastroenterology. 1990 December; 99(6): 1856-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2227308&dopt=Abstract

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The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Author(s): Johanson JF, Sonnenberg A. Source: Gastroenterology. 1990 February; 98(2): 380-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2295392&dopt=Abstract

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The prevalence of hemorrhoids. Author(s): Haas PA, Haas GP, Schmaltz S, Fox TA Jr. Source: Diseases of the Colon and Rectum. 1983 July; 26(7): 435-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6861574&dopt=Abstract

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The quest for painless surgical treatment of hemorrhoids continues. Author(s): Wexner SD. Source: Journal of the American College of Surgeons. 2001 August; 193(2): 174-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11491448&dopt=Abstract

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The relationship between carcinoma of the rectum and hemorrhoids. Author(s): Gooszen HG. Source: Arch Chir Neerl. 1978; 30(4): 223-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=736578&dopt=Abstract

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The relationship of hemorrhoids to portal hypertension. Author(s): Jacobs DM, Bubrick MP, Onstad GR, Hitchcock CR. Source: Diseases of the Colon and Rectum. 1980 November-December; 23(8): 567-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6970115&dopt=Abstract

46 Hemorrhoids

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The role of cryotherapy in management of anorectal disease: Whate are hemorrhoids? Author(s): Slack WW. Source: Diseases of the Colon and Rectum. 1975 May-June; 18(4): 282-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1126261&dopt=Abstract

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The role of Daflon in the treatment of acute hemorrhoids. Author(s): Panijayanond P, Chotiprasidhi P. Source: J Med Assoc Thai. 1985 February; 68(2): 72-80. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4009089&dopt=Abstract

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The roles of hemorrhoidectomy and lateral internal sphincterotomy in the treatment of hemorrhoids--clinical and manometric study. Author(s): Chen WS, Leu SY, Wang FM. Source: Zhonghua Yi Xue Za Zhi (Taipei). 1989 April; 43(4): 255-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2804777&dopt=Abstract

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The significance and importance of associated anorectal diseases with hemorrhoids. Author(s): Weinstein JJ. Source: Med Ann Dist Columbia. 1971 January; 40(1): 4-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5276269&dopt=Abstract

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The sliding skin-flap graft operation for hemorrhoids: a modification of the Whitehead procedure. Author(s): Rand AA. Source: Diseases of the Colon and Rectum. 1969 July-August; 12(4): 265-76. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4896172&dopt=Abstract

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The Whitehead operation for advanced hemorrhoids. Author(s): Hodedadi J, Kurgan A, Jersky J. Source: Diseases of the Colon and Rectum. 1979 May-June; 22(4): 238-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=467176&dopt=Abstract

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Three year follow-up study on the treatment of first and second degree hemorrhoids by sclerosant injection or rubber band ligation. Author(s): Sim AJ, Murie JA, Mackenzie I. Source: Surg Gynecol Obstet. 1983 December; 157(6): 534-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6648773&dopt=Abstract

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Thrombosed hemorrhoids: a clinicopathologic study. Author(s): Ganchrow MI, Bowman HE, Clark JF. Source: Diseases of the Colon and Rectum. 1971 September-October; 14(5): 331-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5096008&dopt=Abstract

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Treatment of acute strangulated internal hemorrhoids by topical application of isosorbide dinitrate ointment. Author(s): Briel JW, Zimmerman DD, Schouten WR. Source: International Journal of Colorectal Disease. 2000 August; 15(4): 253-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11008728&dopt=Abstract

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Treatment of bleeding hemorrhoids by injection sclerotherapy and rubber band ligation. Author(s): Rabau MY, Bat L. Source: Isr J Med Sci. 1985 July; 21(7): 569-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4044217&dopt=Abstract

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Treatment of hemorrhoids and application of cryotechnique. Author(s): Oh C. Source: The Mount Sinai Journal of Medicine, New York. 1975 May-June; 42(3): 179-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1079309&dopt=Abstract

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Treatment of hemorrhoids with circular stapler, a new alternative to conventional methods: a prospective study of 140 patients. Author(s): Arnaud JP, Pessaux P, Huten N, De Manzini N, Tuech JJ, Laurent B, Simone M. Source: Journal of the American College of Surgeons. 2001 August; 193(2): 161-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11491446&dopt=Abstract

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Treatment of hemorrhoids. Author(s): Denniston GC. Source: The Journal of Family Practice. 1990 March; 30(3): 360. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2307951&dopt=Abstract

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Treatment of hemorrhoids. Author(s): Nigro ND. Source: Geriatrics. 1969 September; 24(9): 120-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5811743&dopt=Abstract

48 Hemorrhoids

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Treatment of hemorrhoids. Author(s): Marino AW Jr, Marino AW, Mancini HN. Source: Jama : the Journal of the American Medical Association. 1969 March 31; 207(13): 2440. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5818452&dopt=Abstract

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Treatment of thrombosed hemorrhoids by excision. Author(s): Sakulsky SB, Blumenthal JA, Lynch RH. Source: American Journal of Surgery. 1970 October; 120(4): 537-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5507343&dopt=Abstract

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Trihydroxyethylrutosides in the treatment of hemorrhoids of pregnancy: a doubleblind placebo-controlled trial. Author(s): Titapant V, Indrasukhsri B, Lekprasert V, Boonnuch W. Source: J Med Assoc Thai. 2001 October; 84(10): 1395-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11804247&dopt=Abstract

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Triple rubber band ligation for hemorrhoids: prospective, randomized trial of use of local anesthetic injection. Author(s): Law WL, Chu KW. Source: Diseases of the Colon and Rectum. 1999 March; 42(3): 363-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10223757&dopt=Abstract

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Update on hemorrhoids. Author(s): Montorsi W. Source: Int Surg. 1989 July-September; 74(3): 139-41. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2606611&dopt=Abstract

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Urethral discharge, constipation, and hemorrhoids. New syndrome with report of 7 cases. Author(s): Shafik A. Source: Urology. 1981 August; 18(2): 155-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7269018&dopt=Abstract

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Use of the Nd-YAG laser improves quality of life and economic factors in the treatment of hemorrhoids. Author(s): Zahir KS, Edwards RE, Vecchia A, Dudrick SJ, Tripodi G. Source: Conn Med. 2000 April; 64(4): 199-203. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10812765&dopt=Abstract

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Varicose veins, deep vein thrombosis, and hemorrhoids. Author(s): Burkitt DP. Source: American Heart Journal. 1973 April; 85(4): 572-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4689510&dopt=Abstract

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What are hemorrhoids and what is their relationship to the portal venous system? Author(s): Bernstein WC. Source: Diseases of the Colon and Rectum. 1983 December; 26(12): 829-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6605842&dopt=Abstract

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Who me? Reduce hemorrhoids? It's not my job! Author(s): Chance B. Source: Adv Clin Care. 1990 January-February; 5(1): 19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2297380&dopt=Abstract

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Work in progress. The anal canal: distinction of internal hemorrhoids from small cancers by double-contrast barium enema examination. Author(s): Thoeni RF, Venbrux AC. Source: Radiology. 1982 October; 145(1): 17-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7122875&dopt=Abstract

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Zeroid: alternative treatment of hemorrhoids. Author(s): Rudd WW. Source: Can Med Assoc J. 1978 September 9; 119(5): 408. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=688140&dopt=Abstract

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Zeroid: alternative treatment of hemorrhoids. Author(s): Paloschi GB. Source: Can Med Assoc J. 1978 February 4; 118(3): 235. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=630481&dopt=Abstract

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CHAPTER 2. NUTRITION AND HEMORRHOIDS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and hemorrhoids.

Finding Nutrition Studies on Hemorrhoids The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “hemorrhoids” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

52 Hemorrhoids

The following information is typical of that found when using the “Full IBIDS Database” to search for “hemorrhoids” (or a synonym): •

A prospective crossover trial of direct current electrotherapy in symptomatic hemorrhoidal disease. Author(s): Division of Gastroenterology/Hepatology, University of Louisville, Kentucky 40292. Source: Wright, R A Kranz, K R Kirby, S L Gastrointest-Endosc. 1991 Nov-December; 37(6): 621-3 0016-5107

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Ask the midwife. Prevention and care of hemorrhoids, including homeopathic remedies. Source: Goldstein, L Birth-Gaz. 2000 Spring; 16(2): 13-6 0890-3255

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By the way, doctor...I've had small amounts of blood in my bowel movements from time to time for years. My doctor has done a pretty thorough evaluation and has ruled out colon cancer or anything serious: what I have is plain old hemorrhoids. I've heard of an operation using rubber bands that can get rid of them. Should I go ahead and have this procedure done? Source: Lee, T H Harv-Health-Lett. 2000 June; 25(8): 8 1052-1577

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Clinical experience of low-dose epidural morphine as a post-operative analgesic in patients undergoing hemorrhoidectomy. Source: Ng, H F Hui, Y L Tan, P P Ma-Zui-Xue-Za-Zhi. 1987 June; 25(2): 89-92 0254-1319

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Clinical trial of oral diosmin (Daflon) in the treatment of hemorrhoids. Author(s): Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Source: Thanapongsathorn, W Vajrabukka, T Dis-Colon-Rectum. 1992 November; 35(11): 1085-8 0012-3706

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Daflon 500 mg in the treatment of hemorrhoidal disease: a demonstrated efficacy in comparison with placebo. Author(s): Hopital Rothschild, Paris, France. Source: Godeberge, P Angiology. 1994 June; 45(6 Pt 2): 574-8 0003-3197

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Doppler sonographic diagnostics and treatment control of symptomatic first-degree hemorrhoids. Preliminary report and results. Author(s): Second Department of Internal Medicine, Stadtisches Klinikum Fulda, Academic Hospital of the University of Marburg, Germany. Source: Jaspersen, D Dig-Dis-Sci. 1993 July; 38(7): 1329-32 0163-2116

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Double-blind, placebo-controlled evaluation of clinical activity and safety of Daflon 500 mg in the treatment of acute hemorrhoids. Author(s): Dipartimento di Scienze Chirurgiche e Anatomiche, Universita di Palermo, Italy. Source: Cospite, M Angiology. 1994 June; 45(6 Pt 2): 566-73 0003-3197

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Double-blind, randomized clinical trial of troxerutin-carbazochrome in patients with hemorrhoids. Author(s): Istituto di Farmacologia, Servizio di Farmacologia Clinica, Universita degli Studi di Messina, Italy. Source: Squadrito, F Altavilla, D Oliaro Bosso, S Eur-Rev-Med-Pharmacol-Sci. 2000 JanApril; 4(1-2): 21-4

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Effect of fiber supplements on internal bleeding hemorrhoids. Author(s): Gastroenterology Department, Hospital de Ia Princesa, Universidad Autonoma de Madrid, Spain.

Nutrition 53

Source: Perez Miranda, M Gomez Cedenilla, A Leon Colombo, T Pajares, J Mate Jimenez, J Hepatogastroenterology. 1996 Nov-December; 43(12): 1504-7 0172-6390 •

Effect of transcutaneous electrical nerve stimulation for pain relief on patients undergoing hemorrhoidectomy: prospective, randomized, controlled trial. Author(s): Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, and Department of Surgery, Veterans General Hospital, Taipei, Taiwan. Source: Chiu, J H Chen, W S Chen, C H Jiang, J K Tang, G J Lui, W Y Lin, J K Dis-ColonRectum. 1999 February; 42(2): 180-5 0012-3706

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Efficacy of calcium dobesilate in treating acute attacks of hemorrhoidal disease. Author(s): Public Health, Gazi University Medical School, Ankara, Turkey. Source: Mentes, B B Gorgul, A Tatlicioglu, E Ayoglu, F Unal, S Dis-Colon-Rectum. 2001 October; 44(10): 1489-95 0012-3706

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Formulation and manufacturing of some herbal antihemorrhoidal dosage forms. Source: Vuleta, G.M. Tamburic, S.D. Sekulovic, D.Volume Acta-hortic. Wageningen : International Society for Horticultural Science. November 1993. (344) page 529-537. 0567-7572

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Hemorrhoidectomy in a hemophiliac with factor VIII inhibitors. Source: Murali, M S Jager, R M Indiana-Med. 1987 April; 80(4): 332-3 0746-8288

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Hemorrhoidectomy with lasers and other contemporary modalities. Author(s): Division of Colon and Rectal Surgery, George Washington University, Washington, D.C. Source: Smith, L E Surg-Clin-North-Am. 1992 June; 72(3): 665-79 0039-6109

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Hemorrhoids and varicose veins: a review of treatment options. Author(s): Thorne Research, 4616 SE 30th, Portland, OR 97202, [email protected] Source: MacKay, D Altern-Med-Revolume 2001 April; 6(2): 126-40 1089-5159

USA.

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Hemorrhoids. A review of current techniques and management. Source: Smith, L E Gastroenterol-Clin-North-Am. 1987 March; 16(1): 79-91 0889-8553

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Khat induced hemorrhoidal disease in Yemen. Author(s): Department of Surgery, Faculty of Medicine, Sana'a University, Sana'a, Republic of Yemen. [email protected] Source: Al Hadrani, A M Saudi-Med-J. 2000 May; 21(5): 475-7 0379-5284

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Laxatives after hemorrhoidectomy. Author(s): Department of Surgery, Southmead Hospital, Bristol, United Kingdom. Source: Johnson, C D Budd, J Ward, A J Dis-Colon-Rectum. 1987 October; 30(10): 780-1 0012-3706

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Local infiltration with ropivacaine improves immediate postoperative pain control after hemorrhoidal surgery. Author(s): Department of Surgery, Centre Hospitalier Intercommunal Leon Toubladjian, Poissy, France. Source: Vinson Bonnet, Beatrice Coltat, Jean Claude Fingerhut, Abe Bonnet, Francis DisColon-Rectum. 2002 January; 45(1): 104-8 0012-3706

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Local treatment of hemorrhoidal disease and perianal eczema. Meta-analysis of the efficacy and safety of an Escherichia coli culture suspension alone or in combination with hydrocortisone. Author(s): University Hospital, Aachen, Germany. [email protected] Source: Wienert, V Heusinger, J H Arzneimittelforschung. 2002; 52(7): 515-23 0004-4172

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Long-term results of large-dose, single-session phenol injection sclerotherapy for hemorrhoids. Author(s): University Department of Surgery, Royal Free Hospital and School of Medicine, London, United Kingdom. Source: Santos, G Novell, J R Khoury, G Winslet, M C Lewis, A A Dis-Colon-Rectum. 1993 October; 36(10): 958-61 0012-3706

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Management of hemorrhoidal disease in patients with chronic spinal cord injury. Author(s): Division of Proctology, Department of Surgical Oncology, The Sheba Medical Center, Tel Aviv University Medical School, Tel Hashomer, Ramat Gan, Israel. [email protected] Source: Scott, D Papa, M Z Sareli, M Velano, A Ben Ari, G Y Koller, M Tech-Coloproctol. 2002 April; 6(1): 19-22 1123-6337

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Micronized flavonoid therapy in internal hemorrhoids of pregnancy. Author(s): Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India. Source: Buckshee, K Takkar, D Aggarwal, N Int-J-Gynaecol-Obstet. 1997 May; 57(2): 14551 0020-7292

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Micronized purified flavonidic fraction compared favorably with rubber band ligation and fiber alone in the management of bleeding hemorrhoids: randomized controlled trial. Author(s): Department of Colorectal Surgery, Singapore General Hospital, Singapore. Source: Ho, Y H Tan, M Seow Choen, F Dis-Colon-Rectum. 2000 January; 43(1): 66-9 0012-3706

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Nonsurgical treatment of hemorrhoids. Author(s): University of Illinois College of Medicine at Rockford, Rockford, IL, USA. [email protected] Source: Johanson, John F J-Gastrointest-Surg. 2002 May-June; 6(3): 290-4 1091-255X

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Parenteral troxerutin and carbazochrome combination in the treatment of posthemorrhoidectomy status: a randomized, double-blind, placebo-controlled, phase IV study. Author(s): Surgery Unit, University of Chieti-Pescara, Pescara Regional Hospital, Italy. Source: Basile, M Gidaro, S Pacella, M Biffignandi, P M Gidaro, G S Curr-Med-Res-Opin. 2001; 17(4): 256-61 0300-7995

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Postoperative intramuscular dextromethorphan injection provides postoperative pain relief and decreases opioid requirement after hemorrhoidectomy. Author(s): Department of Anesthesiology, Tri-Service General Hospital, Taipei, Taiwan, R.O.C. Source: Chang, F L Wu, C T Yeh, C C Lin, T C Ho, S T Wong, C S Acta-Anaesthesiol-Sin. 1999 December; 37(4): 179-83 0529-5769

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Premedication with dextromethorphan provides posthemorrhoidectomy pain relief. Author(s): Section of Anesthesia, Armed Forces Sung-Shang Hospital, Taipei, Taiwan, Republic of China. Source: Liu, S T Wu, C T Yeh, C C Ho, S T Wong, C S Jao, S W Wu, C C Kang, J C DisColon-Rectum. 2000 April; 43(4): 507-10 0012-3706

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Safety and security of Daflon 500 mg in venous insufficiency and in hemorrhoidal disease. Author(s): Service de Rhumatologie, Hopital Bichat, Paris, France. Source: Meyer, O C Angiology. 1994 June; 45(6 Pt 2): 579-84 0003-3197

Nutrition 55

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Subcutaneous morphine pump for postoperative hemorrhoidectomy pain management. Author(s): Department of Colon & Rectal Surgery, Orlando Regional Medical Center, Florida. Source: Goldstein, E T Williamson, P R Larach, S W Dis-Colon-Rectum. 1993 May; 36(5): 439-46 0012-3706

•

Trihydroxyethylrutosides in the treatment of hemorrhoids of pregnancy: a doubleblind placebo-controlled trial. Author(s): Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Source: Titapant, V Indrasukhsri, B Lekprasert, V Boonnuch, W J-Med-Assoc-Thai. 2001 October; 84(10): 1395-400 0125-2208

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

56 Hemorrhoids

•

Healthnotes: http://www.healthnotes.com/

•

Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

The following is a specific Web list relating to hemorrhoids; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation (some Web sites are subscription based): •

Vitamins Vitamin C and flavonoids Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,935,00.html

•

Minerals Iron Source: Healthnotes, Inc. www.healthnotes.com Sulfur Source: Integrative Medicine Communications; www.drkoop.com Zinc Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10071,00.html Zinc/copper Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,938,00.html

•

Food and Diet Blackberries Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,142,00.html

57

CHAPTER 3. ALTERNATIVE MEDICINE AND HEMORRHOIDS Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to hemorrhoids. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to hemorrhoids and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “hemorrhoids” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to hemorrhoids: •

A prospective crossover trial of direct current electrotherapy in symptomatic hemorrhoidal disease. Author(s): Wright RA, Kranz KR, Kirby SL. Source: Gastrointestinal Endoscopy. 1991 November-December; 37(6): 621-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1661696&dopt=Abstract

•

Ask the midwife. Prevention and care of hemorrhoids, including homeopathic remedies. Author(s): Goldstein L. Source: The Birth Gazette. 2000 Spring; 16(2): 13-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11899340&dopt=Abstract

•

Can micronized flavonoid treat hemorrhoidal disease better than rubber band ligation? Author(s): Mentes BB.

58 Hemorrhoids

Source: Diseases of the Colon and Rectum. 2000 November; 43(11): 1638-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11089608&dopt=Abstract •

Combined traditional Chinese and western medicine sclerosing therapy in internal hemorrhoids. Author(s): Ren CP. Source: Chin Med J (Engl). 1977 March; 3(2): 137-42. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=408110&dopt=Abstract

•

Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy. Author(s): Wald A. Source: Gastroenterology Clinics of North America. 2003 March; 32(1): 309-22, Vii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635420&dopt=Abstract

•

Daflon 500 mg in the treatment of hemorrhoidal disease: a demonstrated efficacy in comparison with placebo. Author(s): Godeberge P. Source: Angiology. 1994 June; 45(6 Pt 2): 574-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8203790&dopt=Abstract

•

Direct current electrotherapy of internal hemorrhoids: an effective, safe, and painless outpatient approach. Author(s): Norman DA, Newton R, Nicholas GV. Source: The American Journal of Gastroenterology. 1989 May; 84(5): 482-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2785755&dopt=Abstract

•

Direct current electrotherapy of symptomatic hemorrhoid disease. Author(s): Norman DA. Source: Gastrointestinal Endoscopy. 1992 July-August; 38(4): 519-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1511835&dopt=Abstract

•

Double-blind, placebo-controlled evaluation of clinical activity and safety of Daflon 500 mg in the treatment of acute hemorrhoids. Author(s): Cospite M. Source: Angiology. 1994 June; 45(6 Pt 2): 566-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8203789&dopt=Abstract

•

Effect of transcutaneous electrical nerve stimulation for pain relief on patients undergoing hemorrhoidectomy: prospective, randomized, controlled trial. Author(s): Chiu JH, Chen WS, Chen CH, Jiang JK, Tang GJ, Lui WY, Lin JK.

Alternative Medicine 59

Source: Diseases of the Colon and Rectum. 1999 February; 42(2): 180-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10211493&dopt=Abstract •

Efficacy of calcium dobesilate in treating acute attacks of hemorrhoidal disease. Author(s): Mentes BB, Gorgul A, Tatlicioglu E, Ayoglu F, Unal S. Source: Diseases of the Colon and Rectum. 2001 October; 44(10): 1489-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11598479&dopt=Abstract

•

He/Ne laser treatment of hemorrhoids. Author(s): Trelles MA, Rotinen S. Source: Acupuncture & Electro-Therapeutics Research. 1983; 8(3-4): 289-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6145304&dopt=Abstract

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Hemorrhoids and varicose veins: a review of treatment options. Author(s): MacKay D. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 2001 April; 6(2): 126-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11302778&dopt=Abstract

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Hemorrhoids, varicose veins and deep vein thrombosis: epidemiologic features and suggested causative factors. Author(s): Burkitt DP. Source: Canadian Journal of Surgery. Journal Canadien De Chirurgie. 1975 September; 18(5): 483-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1175115&dopt=Abstract

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High-fiber diet reduces bleeding and pain in patients with hemorrhoids: a doubleblind trial of Vi-Siblin. Author(s): Moesgaard F, Nielsen ML, Hansen JB, Knudsen JT. Source: Diseases of the Colon and Rectum. 1982 July-August; 25(5): 454-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6284457&dopt=Abstract

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Khat induced hemorrhoidal disease in Yemen. Author(s): Al-Hadrani AM. Source: Saudi Med J. 2000 May; 21(5): 475-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11500685&dopt=Abstract

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Micronized purified flavonidic fraction compared favorably with rubber band ligation and fiber alone in the management of bleeding hemorrhoids: randomized controlled trial. Author(s): Ho YH, Tan M, Seow-Choen F.

60 Hemorrhoids

Source: Diseases of the Colon and Rectum. 2000 January; 43(1): 66-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10813126&dopt=Abstract •

Nonsurgical treatment of hemorrhoids. Author(s): Johanson JF. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2002 May-June; 6(3): 290-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12022975&dopt=Abstract

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Safety and security of Daflon 500 mg in venous insufficiency and in hemorrhoidal disease. Author(s): Meyer OC. Source: Angiology. 1994 June; 45(6 Pt 2): 579-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8203791&dopt=Abstract

•

Symposium on outpatient anorectal procedures. Alternatives to surgical hemorrhoidectomy. Author(s): Cohen Z. Source: Canadian Journal of Surgery. Journal Canadien De Chirurgie. 1985 May; 28(3): 230-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2986805&dopt=Abstract

•

The biblical plague of “hemorrhoids”. An outbreak of bilharziasis. Author(s): Dirckx JH. Source: The American Journal of Dermatopathology. 1985 August; 7(4): 341-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3939579&dopt=Abstract

•

The role of Daflon in the treatment of acute hemorrhoids. Author(s): Panijayanond P, Chotiprasidhi P. Source: J Med Assoc Thai. 1985 February; 68(2): 72-80. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4009089&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

•


•

Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html


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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to hemorrhoids; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation (some Web sites are subscription based): •

General Overview Colorectal Cancer Source: Integrative Medicine Communications; www.drkoop.com Hemorrhoids Source: Healthnotes, Inc. www.healthnotes.com Hemorrhoids Source: Integrative Medicine Communications; www.drkoop.com Hemorrhoids Source: Prima Communications, Inc.www.personalhealthzone.com Iron-Deficiency Anemia Source: Healthnotes, Inc. www.healthnotes.com Peripheral Vascular Disease Source: Healthnotes, Inc. www.healthnotes.com Varicose Veins Source: Healthnotes, Inc. www.healthnotes.com Varicose Veins Source: Prima Communications, Inc.www.personalhealthzone.com

•

Alternative Therapy Ayurveda Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,672,00.html

62 Hemorrhoids

Colon therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,682,00.html Hydrotherapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,705,00.html Osteopathy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,724,00.html •

Chinese Medicine Diyu Alternative names: Garden Burnet Root; Radix Sanguisorbae Source: Chinese Materia Medica Huaihua Alternative names: Pagodatree Flower; Flos Sophorae Source: Chinese Materia Medica Huaijiao Wan Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Huaijiao%20Wan&mh=10&sb =---&view_records=View+Records Huanglian Alternative names: Golden Thread; Rhizoma Coptidis Source: Chinese Materia Medica Huhuanglian Alternative names: Figwortflower Picrorhiza Rhizome; Rhizoma Picrorhizae Source: Chinese Materia Medica Jiguanhua Alternative names: Cockcomb Flower; Flos Celosiae Cristatae Source: Chinese Materia Medica Lianfang Alternative names: Lotus Receptacle; Receptaculum Nelumbinis Source: Chinese Materia Medica Machixian Alternative names: Purslane Herb; Herba Portulacae


Source: Chinese Materia Medica Madouling Alternative names: Dutohmanspipe Fruit; Fructus Aristolochiae Source: Chinese Materia Medica Mangxiao Alternative names: Sodium Sulfate; Natrii Sulfas1 Source: Chinese Materia Medica Mubiezi Alternative names: Cochinchina Momordica Seed; Semen Momordicae Source: Chinese Materia Medica Quanshen Alternative names: Bistort Rhizome; Rhizoma Bistortae Source: Chinese Materia Medica Weilingcai Alternative names: Chinese Cinquefoil; Herba Potentillae Chinensis Source: Chinese Materia Medica Wubeizi Alternative names: Chinese Gall; Galla Chinensis Source: Chinese Materia Medica •

Homeopathy Aesculus hippocastanum Source: Healthnotes, Inc. www.healthnotes.com Aloe Source: Healthnotes, Inc. www.healthnotes.com Arnica Source: Healthnotes, Inc. www.healthnotes.com Calcarea fluorica Source: Healthnotes, Inc. www.healthnotes.com Graphites Source: Healthnotes, Inc. www.healthnotes.com Hamamelis Source: Healthnotes, Inc. www.healthnotes.com Ignatia Source: Healthnotes, Inc. www.healthnotes.com Pulsatilla Source: Healthnotes, Inc. www.healthnotes.com

64 Hemorrhoids

Sulphur Source: Healthnotes, Inc. www.healthnotes.com •

Herbs and Supplements Achillea millefolium Source: Integrative Medicine Communications; www.drkoop.com Aesculus Alternative names: Horse Chestnut; Aesculus hippocastanum L. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Agrimony Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,833,00.html Aloe Alternative names: Aloe vera, Aloe barbadensis, Aloe ferox , Aloe Vera Source: Integrative Medicine Communications; www.drkoop.com Aloe Vera Source: Integrative Medicine Communications; www.drkoop.com Aortic Glycosaminoglycans Source: Prima Communications, Inc.www.personalhealthzone.com Bilberry Alternative names: Vaccinium myrtillus, European Blueberry, Huckleberry Source: Integrative Medicine Communications; www.drkoop.com Bilberry Source: Prima Communications, Inc.www.personalhealthzone.com Bilberry Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10007,00.html Blackberry Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,837,00.html Bromelain Source: Prima Communications, Inc.www.personalhealthzone.com Bupleurum Alternative names: Bupleurum chinense, Bupleurum falcatum Source: Healthnotes, Inc. www.healthnotes.com


Butcher's Broom Source: Prima Communications, Inc.www.personalhealthzone.com Butcher's Broom Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Butcher's broom Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10010,00.html Calendula Source: Prima Communications, Inc.www.personalhealthzone.com Cascara sagrada Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10013,00.html Chamaemelum nobile Source: Integrative Medicine Communications; www.drkoop.com Chamomile, German Alternative names: Matricaria recutita Source: Integrative Medicine Communications; www.drkoop.com Chamomile, Roman Alternative names: Chamaemelum nobile Source: Integrative Medicine Communications; www.drkoop.com COLLINSONIA Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Equisetum Alternative names: Horsetail; Equisetum arvense L. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org European Blueberry Source: Integrative Medicine Communications; www.drkoop.com Evening Primrose Alternative names: Oenothera biennis, Sun Drop Source: Integrative Medicine Communications; www.drkoop.com Fiber Source: Healthnotes, Inc. www.healthnotes.com Fiber Source: Integrative Medicine Communications; www.drkoop.com

66 Hemorrhoids

Flavonoids Source: Healthnotes, Inc. www.healthnotes.com Flavonoids Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,782,00.html German Chamomile Alternative names: Matricaria recutita Source: Integrative Medicine Communications; www.drkoop.com Gotu Kola Source: Prima Communications, Inc.www.personalhealthzone.com Horse Chestnut Source: Healthnotes, Inc. www.healthnotes.com Horse Chestnut Source: Prima Communications, Inc.www.personalhealthzone.com Horse chestnut Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10037,00.html Huckleberry Source: Integrative Medicine Communications; www.drkoop.com Hypericum perforatum Source: Integrative Medicine Communications; www.drkoop.com Ispaghula Source: Integrative Medicine Communications; www.drkoop.com Klamathweed Source: Integrative Medicine Communications; www.drkoop.com Matricaria recutita Source: Integrative Medicine Communications; www.drkoop.com Mullein Source: Prima Communications, Inc.www.personalhealthzone.com Mullein flower Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,865,00.html


Nettle Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10048,00.html Oak Alternative names: Quercus spp. Source: Healthnotes, Inc. www.healthnotes.com Oak bark Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10108,00.html Oenothera biennis Source: Integrative Medicine Communications; www.drkoop.com OPCs (Oligomeric Proanthocyanidins) Source: Prima Communications, Inc.www.personalhealthzone.com Passiflora incarnata Source: Integrative Medicine Communications; www.drkoop.com Passionflower Alternative names: Passiflora incarnata Source: Integrative Medicine Communications; www.drkoop.com Plantago isphagula Source: Integrative Medicine Communications; www.drkoop.com Plantago psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Plantain Alternative names: Plantago lanceolata, Plantago major Source: Healthnotes, Inc. www.healthnotes.com Plantain Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Potentilla Alternative names: Cinquefoil, Silverweed; Potentilla sp. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Psyllium Source: Healthnotes, Inc. www.healthnotes.com

68 Hemorrhoids

Psyllium Alternative names: Plantago ovata, Plantago ispaghula Source: Healthnotes, Inc. www.healthnotes.com Psyllium Alternative names: Ispaghula,Plantago isphagula Source: Integrative Medicine Communications; www.drkoop.com Psyllium Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,814,00.html Red Elm Source: Integrative Medicine Communications; www.drkoop.com Roman Chamomile Alternative names: Chamaemelum nobile Source: Integrative Medicine Communications; www.drkoop.com Slippery Elm Alternative names: Ulmus fulva, Red Elm, Sweet Elm Source: Integrative Medicine Communications; www.drkoop.com Slippery Elm Source: Prima Communications, Inc.www.personalhealthzone.com St. John's Wort Alternative names: Hypericum perforatum, Klamathweed Source: Integrative Medicine Communications; www.drkoop.com St. John's wort Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,824,00.html Sun Drop Source: Integrative Medicine Communications; www.drkoop.com Sweet Annie Alternative names: Artemisia annua Source: Healthnotes, Inc. www.healthnotes.com Sweet Elm Source: Integrative Medicine Communications; www.drkoop.com Ulmus fulva Source: Integrative Medicine Communications; www.drkoop.com Vaccinium myrtillus Source: Integrative Medicine Communications; www.drkoop.com


Witch Hazel Alternative names: Hamamelis virginiana Source: Healthnotes, Inc. www.healthnotes.com Yarrow Alternative names: Achillea millefolium, Milfoil Source: Integrative Medicine Communications; www.drkoop.com Zanthoxylum Alternative names: Prickly Ash; Zanthoxylum sp. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. PATENTS ON HEMORRHOIDS Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.5 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “hemorrhoids” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on hemorrhoids, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Hemorrhoids By performing a patent search focusing on hemorrhoids, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 5Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

72 Hemorrhoids

example of the type of information that you can expect to obtain from a patent search on hemorrhoids: •

Analgesic lotion for hemorrhoids and method of making such lotion Inventor(s): Payne; Curtis Emery (Smith County, TX), Burda; Christopher Dominic (Caddo Parish, LA), Ivy; Jeffery Wade (Van Zandt County, TX) Assignee(s): Au Pharmaceuticals, Inc. (Tyler, TX) Patent Number: 5,720,962 Date filed: October 4, 1995 Abstract: This invention relates to an externally applied lotion that causes irritation or mild inflammation of the skin or mucous membranes for the purpose of relieving pain in hemorrhoids and the method of making such lotion. The formulation of the present invention contains ingredients to perform the five functions of vasoconstrictor, astringent, analgesic, antipruritic, and anesthetic. An alternate embodiment of the invention provides a formulation of the invention having a suitable viscosity to enable the lotion to be applied by a spray applicator directly to the site of application. Excerpt(s): This invention relates to externally applied lotions that cause irritation or mild inflammation of the skin or mucous membranes for the purpose of relieving pain in hemorrhoids and other anorectal inflammation.... This invention provides an externally applied lotion for relieving pain in hemorrhoids and other anorectal inflammation and the method of making such lotion. The active ingredients of the invention perform the five functions of vasoconstrictor, astringent, analgesic, antipruritic, and anesthetic. An alternate embodiment of the invention provides a formulation of the invention having a suitable viscosity to enable the lotion to be applied by a spray applicator directly to the site of application.... It is an object of the present invention to provide an analgesic lotion containing a number of ingredients to relieve pain in hemorrhoids and a method of making such lotion. Web site: http://www.delphion.com/details?pn=US05720962__

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Aqueous compositions containing quaternary ammonium salts for treatment of rectal itching and lessening of irritation and swelling of prolapsed and of irritated and swollen external hemorrhoids Inventor(s): Waldstein; David A. (622 Bergen Ave., Jersey City, NJ 07304) Assignee(s): none reported Patent Number: 3,950,541 Date filed: November 1, 1973 Abstract: Aqueous compositions containing quaternary ammonium polyalkoxy(C2-3) alkyl(C10-25) alkyl(C1-6) salts and a method of using such compositions for relieving rectal itching and lessening irritation and swelling of prolapsed and of irritated and swollen external hemorrhoids by topical application. Excerpt(s): An aqueous composition containing a quaternary ammonium polyalkoxy(C2-3) alkyl(C10-25) alkyl(C1- 6) salt and a method of topically applying such a composition to a person's rectum for relieving itching and for lessening irritation and swelling of external hemorrhoids.... Heretofore, rectal itching has been alleviated to

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some extent by laving and cleansing affected part with water, and soap and water solutions with or without rectal irrigation. It also has been proposed to use various prescribed medicated suppositories and salves including, for example, cortisone, and to hypodermically inject prescribed medication into hemorrhoids. In addition, many proprietary remedies have been sold over-the-counter. However, none of the foregoing treatments and materials have proven to be fully acceptable because of failure to satisfactorily alleviate the symptoms or correct the cause or because of the inability of the sufferer to practice the suggested regime on himself.... It is an object of the invention to provide an aqueous composition containing a quaternary ammonium polyalkoxy(C23) alkyl(C10-25) alkyl(C1-6) salt from the group consisting of quaternary ammonium bis polyalkoxy(C2-3) monoalkyl(C10-25) monoalkyl(Cl1-6) salts, quaternary ammonium mono polyalkoxy(C2-3) dialkyl(C10-25) monoalkyl(C1-6) salts, and quaternary ammonium mono polyalkoxy(C2-3) monoalkyl(C10-25) dialkyl(C1-6) salts, and a method of topically applying such a composition to a person's rectum for relieving itching and for lessening irritation and swelling of external hemorrhoids. Web site: http://www.delphion.com/details?pn=US03950541__ •

Aqueous compositions containing tertiary amine oxides for treatment of rectal itching and lessening of irritation and swelling of prolapsed and swollen external hemorrhoids Inventor(s): Waldstein; David A. (622 Bergen Ave., Jersey City, NJ 07304) Assignee(s): none reported Patent Number: 3,950,540 Date filed: November 1, 1973 Abstract: Aqueous compositions containing compounds from the group consisting of bis polyalkoxy (C2-3) monoalkyl (C10-25) tertiary amine oxides and mono polyalkoxy (C23) dialkyl (C10-25) tertiary amine oxides, and a method of using such compositions for relieving rectal itching and lessening irritation and swelling of prolapsed and of irritated and swollen external hemorrhoids by topical application. Excerpt(s): An aqueous composition containing a polyalkoxy alkyl tertiary amine oxide selected from the group consisting of bis polyalkoxy(C2-3) monoalkyl(C10-25) tertiary amine oxides and mono polyalkoxy (C2-3) dialkyl(C10-25) tertiary amine oxides, and a method of topically applying such a composition to a person's rectum for relieving itching and lessening irritation and swelling of external hemorrhoids.... Heretofore, rectal itching has been alleviated to some extent by laving and cleansing affected parts with water, and soap and water solutions with or without rectal irrigation. It also has been proposed to use various prescribed medicated suppositories and salves including, for example, cortisone, and to hypodermically inject prescribed medication into hemorrhoids. In addition, many proprietary remedies have been sold over-the-counter. However, none of the foregoing treatments and materials has proven to be fully acceptable because of failure to satisfactorily alleviate the symptoms or correct the cause or because of the inability of the sufferer to practice the suggested regime on himself.... It is an object of the invention to provide a novel aqueous composition including a compound selected from the group consisting of bis polyalkoxy(C2-3) monoalkyl(C1025) tertiary amine oxides and mono polyalkoxy(C2-3) dialkyl(C2-25) tertiary amine oxides to be used for the alleviation of rectal itching and the lessening of irritation and swelling of external hemorrhoids.

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Web site: http://www.delphion.com/details?pn=US03950540__ •

Composition and method for treatment of hemorrhoids Inventor(s): Breskman; Joseph S. (733 Spring Mill Rd., Villanova, PA 19085) Assignee(s): none reported Patent Number: 4,265,887 Date filed: December 11, 1979 Abstract: A composition and a method for treatment of hemorrhoids are disclosed. The composition comprises a combination of thiamin, riboflavin, pyridoxine, cobalamin, niacinamide, and pantothenic acid, preferably in liquid form. In preferred embodiments, the composition may also contain whole liver and/or yeast or their extracts. The method comprises oral administration of the composition to a person suffering from hemorrhoids. Excerpt(s): Hemorrhoids are anorectal swellings composed of varicosities of one or more veins in and around the rectal opening. Stretching of the rectal muscular wall during a bowel movement, particularly during constipation, results in repeated stretching of the thin walls of the veins in the rectal area. This repeated stretching may weaken the veins, and result in permanent stretching and stressing of the veins to form hemorrhoids. Once hemorrhoidal conditions become established, the condition usually becomes more acute because the stool is forced through the rectal canal so that it pushes the already swollen veins outward, stretching them even more. The bulging veins may become prolapsed, descending below the anorectal line and outside the anal sphincter. The prolapsed veins may become thrombosed with blood clots and further distend the hemorrhoidal vein, to produce excrusiating pain and exquisite tenderness.... Prolapsed hemorrhoids are quite painful and remain so until the prolapse is reduced. Bleeding frequently occurs with hemorrhoids. Depending on the severity of the hemorrhoidal condition, difficulty may be encountered in sitting and walking.... Typical treatment of hemorrhoids is nonspecific, tending to deal only with the symptoms of pain, itching, bleeding and inflammation. Surgical procedures are resorted to for the most critical conditions. Corrective treatment frequently involves improvement of bowel function through administration of mild laxatives and/or stool softeners to reduce constipation. Web site: http://www.delphion.com/details?pn=US04265887__

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Composition for a dietary supplement for the treatment of hemorrhoids Inventor(s): Pruthi; Som C. (2001 N. Ocean Blvd., #1602, Boca Raton, FL 33431) Assignee(s): none reported Patent Number: 5,591,436 Date filed: March 10, 1995 Abstract: A composition for a dietary supplement for use in treating hemorrhoids includes: 60% to 95% Indian Barberry by weight; 4.8% to 38% Nagkesar by weight; and 0.2% to 2% Margosa Tree Leaves by weight. Excerpt(s): The present invention relates to a dietary supplement, and more particularly, to a dietary supplement for alleviating the symptoms associated with hemorrhoids.... Presently, there are millions of people around the world who suffer from hemorrhoids.

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A common condition, characterized by a mass of dilated tortuous veins in swollen tissue situated at the anal margin, hemorrhoids can be a source of extreme discomfort and pain to both men and women. Depending on the severity of the condition, there are various treatments and medical procedures which are presently used to alleviate the pain or to remove hemorrhoidal veins and swollen tissue. People suffering from minor hemorrhoids are ordinarily advised to use laxatives or stool softeners to reduce pain. Additionally, less severe cases are typically treated with topical ointments, such as petroleum jelly based products, to lubricate and, in some instances, numb the inflamed hemorrhoidal mass. In more severe cases, it may be necessary to reduce pain and inflammation by injection of cortisteroid drugs or other medicinal drugs having the effect of reducing swelling and pain. Otherwise, banding may be required in order to push the hemorrhoids back into the rectal cavity. All of these treatment methods are generally useful to reduce the pain and discomfort of hemorrhoids. However, all of these treatment methods set forth above provide only temporary relief and must be repeated during and throughout flare-ups of the hemorrhoidal condition.... The most severe cases of hemorrhoids often require cryosurgery or a hemorrhoidectomy to surgically remove the hemorrhoids. These procedures, while generally effective, are painful and considerably expensive. For this reason, surgical removal of hemorrhoids is a last resort performed only on those patients having severe, chronic hemorrhoidal flareups. Web site: http://www.delphion.com/details?pn=US05591436__ •

Composition for relief and treatment of hemorrhoids Inventor(s): Vasiliou; Athanasios (450 East 800 S., Salt Lake City, UT 84111), Vasiliou; Anna (450 East 800 S., Larisa, GR) Assignee(s): Vasiliou; Athanasios (Salt Lake City, UT) Patent Number: 4,761,285 Date filed: October 28, 1986 Abstract: A composition comprising Leptandra Culver's root, chick-peas and grape seeds. The composition can be enhanced with honey, cinnamon and/or oil. The composition is useful for the relief and treatment of hemorrhoids and hemorrhoidal symptoms. The composition can also be used as an herbal food supplement for dietary and nutritional purposes. Excerpt(s): This invention relates to a composition for the relief and treatment of hemorrhoids and hemorrhoidal symptoms. Hemorrhoids are a common affliction of the anorectal area of the human body. Hemorrhoids are soft, irregular venous abnormalities occurring in the anorectal area. Hemorrhoids often cause bleeding, itching, soreness and other discomfort. This invention is applicable to both external hemorrhoids and internal hemorrhoids.... In addition to its usefulness for the relief and treatment of hemorrhoids, the composition of this invention can also be used to relieve constipation or as an herbal food supplement eaten for dietary and nutritional purposes.... It is an objective of this invention to provide an edible composition that can be taken orally for the relief and treatment of internal hemorrhoids and hemorrhoidal symptoms. It is another objective of this invention to provide a composition that can be applied to external hemorrhoidal areas for the relief and treatment of external hemorrhoids and hemorrhoidal symptoms. It is a further objective of this invention to provide a composition that can be used to relieve constipation. It is yet a further objective of this invention to provide an herbal food supplement that can be eaten for dietary and nutrition purposes. These objectives

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and other objectives, aspects and advantages of this invention will be clear to a person of ordinary skill in the art upon reading this disclosure. Web site: http://www.delphion.com/details?pn=US04761285__ •

Compositions and methods of treating hemorrhoids and wounds Inventor(s): Packman; Elias W. (Merion, PA) Assignee(s): Oskman; Norman H. (Baltimore, MD) Patent Number: 5,196,405 Date filed: February 27, 1990 Abstract: Hemorrhoidal compositions containing disaccharide polysulfate-aluminum compounds such as sucralfate, above or in combination with other hemorrhoidal products, as an agent effective for alleviating the symptoms of anorectal disease when topically applied to the human skin. Method for alleviating the symptoms of hemorrhoids in humans. Compositions containing disaccharide polysulfate-aluminum compounds such as sucralfate, alone or in combination with antibiotics, antifungal agents, anti-acne agents, or local anesthetics as an active agent effective in promoting the healing of wounds which are not anorectal when topically applied to the surface of a wound. Method for promoting healing at the surface of a wound in humans. Excerpt(s): This invention relates to a method and medication for the treatment of wounds and lesions. It further relates to a method and medication for the treatment of the symptoms of anorectal disease or irritation and in particular relates to a method and medication for the treatment of hemorrhoids.... Anorectal disease is an annoying and uncomfortable disorder. Hemorrhoids is a common ailment of the anorectal area and may be either or both internal and external. Anorectal disorders are characterized by the signs and symptoms of itching, burning, pain, bleeding, seepage, protrusion, inflammation, irritation, swelling general discomfort and changes in bowel pattern or any combination thereof. Many remedies have been suggested and tried for the alleviation of these ailments with varying degrees of success. Anorectal disease, though rare in other animals, is very common in. humans. No human is immune. The vast majority of adults suffer from one or more anorectal symptoms at some time in their life. Anorectal disease has caused an unaccountable number of man-hours to be lost annually in the work place.... Compositions have previously been developed which generally relieve either the itching or inflammation but few have been successful in reducing or completely eliminating both. Thus, the efficacy of these compositions in relieving or curing the symptoms of such diseases is uncertain. Web site: http://www.delphion.com/details?pn=US05196405__

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Cooling cylindrical device for therapeutic treatment of hemorrhoids Inventor(s): Popov; Sergay (Ofakim, IL), Baybikov; Boris (Mahale Edomim, IL), Mazor; Gedalya (Metar, IL), Kushelvesky; Avraham (Metar, IL), Trop; Moshe (Brooklyn, NY) Assignee(s): Trop Life Ltd. (Ofakim, IL) Patent Number: 5,800,485 Date filed: February 22, 1995

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Abstract: A cooling cylindrical insert device to aid in the removal of pain and for the therapeutic treatment of hemorrhoids and anal fissures. The device includes a hollow insert, finger or bulb contoured for insertion into the anus. At least one inlet and/or outlet opening is provided in the insert at its base, with one or two tubes connected to the openings. A container of cold liquid is provided connected to the inlet and outlet tubes. Thus, cold liquid is circulated from the container, through the inlet tube and inlet opening, through the cylindrical insert device, through the outlet opening and outlet tubes back into the container. A pump is provided to circulate the liquid. Excerpt(s): The present invention relates to a cooling cylindrical device for therapeutic treatment of hemorrhoids. More specifically, said invention relates to a cooling cylindrical finger adapted in its contour for insertion into the anus, wherein said cylindrical finger is cooled by cold water or ice or by expansion of gas or by thermoelectric cooler component.... Commonly known as piles, hemorrhoids are varicose veins in the anal area. They are similar to the twisted and swollen veins that are frequently noticeable on a person's legs, especially in older women who have had several children. When these varicosities occur high in the anal canal they are referred to as internal hemorrhoids. Many people with internal hemorrhoids are unaware of their presence. External hemorrhoids are those near the anal opening; sometimes they prolapse and bulge outside the anus. When a person complains of having hemorrhoids, they are usually referring to the external type.... The most frequent cause of hemorrhoids is straining at stools, which is most likely to happen when a person is constipated, obese or pregnant. People with liver disease such as cirrhosis may also develop hemorrhoids due to increased pressure in the veins of the intestine. Web site: http://www.delphion.com/details?pn=US05800485__ •

Device for reducing symptoms of prolapsed hemorrhoids Inventor(s): Majlessi; Heshmat (233 Purchase St., Rye, NY 10580) Assignee(s): Majlessi; Heshmat (Rye, NY) Patent Number: 5,924,423 Date filed: April 22, 1997 Abstract: The device for reducing the symptoms of prolapsed hemorrhoids has a continuous contour and a bulbous portion between leading and trailing ends of the device. The bulbous portion has a leading inclined surface and a trailing inclined surface which meet at an intermediate point of maximum radial dimensions. A rounded tip is provided at the leading end and a stop plate at the trailing end to control the extent of insertion. Excerpt(s): The invention generally relates to medical devices and, more specifically to a device for reducing the symptoms of prolapsed hemorrhoids.... Forty million Americans suffer from hemorrhoids. Yet there is no effective device to relieve symptoms other than surgery. At this time prolapsed hemorrhoids are pushed back into the rectum manually, patients being instructed to use a glove to accomplish this task. Certain commercial preparations, such as "Anusol" and "Preparation H", improve the symptoms briefly but have no effect on congestion and actual treatment of the condition itself.... It is an object of the invention to provide a device for relieving the symptoms of hemorrhoids. Web site: http://www.delphion.com/details?pn=US05924423__

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Dietary supplement composition for the treatment of hemorrhoids Inventor(s): Pruthy; Jasvant Rai (25675 Meadow View Ct., Salinas, CA 93908), Pruthy; Puneet (25675 Meadow View Ct., Salinas, CA 93908), Pruthi; Som C. (25675 Meadow View Ct., Salinas, CA 93908) Assignee(s): none reported Patent Number: 6,264,982 Date filed: September 23, 2000 Abstract: A composition for a dietary supplement for use in treating hemorrhoids (bleeding and non-bleeding) includes: 30%-80% Indian Barberry extract by weight; 15%67% Karchi seeds by weight; 2%-9% Margosa tree leaves by weight; and 1%-10% Soap Nut fruit shells by weight. Excerpt(s): The present invention relates to an ayurvedic composition, and more particularly, to a composition comprised of natural ingredients for the treatment of hemorrhoidal symptoms including bleeding, itching, burning, swelling and pain.... Presently, there are millions of people around the world who suffer from hemorrhoids. A common condition, characterized by a mass of dilated tortuous veins in swollen tissue situated at the anal margin, hemorrhoids can be a source of extreme discomfort and pain to both men and women. Depending on the severity of the condition, there are various treatments and medical procedures which presently used to alleviate the pain or to remove hemorrhoidal veins and swollen tissue. People suffering from minor hemorrhoids are ordinarily advised to use laxatives or stool softeners to reduce pain. Additionally, less severe cases are typically treated with topical ointments, such as petroleum jelly based products, to lubricate and, in some instances, numb the inflamed hemorrhoidal mass. In more severe cases, it may be necessary to reduce pain and inflammation by injection of cortisteriod drugs or other medicinal drugs having the effect of reducing swelling and pain. Otherwise, banding may be required in order to push the hemorrhoids back into the rectal cavity. All of these treatment methods are generally useful to reduce the pain and discomfort of hemorrhoids. However, all of these treatment methods set forth above provide only temporary relief and must be repeated during and throughout flare-ups of the hemorrhoidal condition.... The most severe cases of hemorrhoids often require cryosurgery or a hemorrhoidectomy to surgically remove the hemorrhoids. These procedures, while generally effective, are painful and considerably expensive. For this reason, surgical removal of hemorrhoids is a last resort performed only on those patients having severe, chronic hemorrhoidal flareups. Web site: http://www.delphion.com/details?pn=US06264982__

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Dual crowned hemorrhoid support seat cushion Inventor(s): Shaktman; Donald H. (1800 NE. 114th St., Apt. 910, Miami, FL 33181) Assignee(s): none reported Patent Number: 4,709,431 Date filed: December 2, 1985 Abstract: A hemorrhoid relief cushion is constructed with aligned, elongated, convexly elevated portions of different size to reduce inventory requirements by half and also

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reduce the number of fabrication molds needed for making a complete inventory of cushion sizes in half. Excerpt(s): This invention relates to cushions that support the buttocks of people suffering from hemorrhoids.... Many solutions have been proposed to relieve the pain and discomfort of hemorrhoids. These include the use of suppositories and other preparations that must be applied to the vicinity of the hemorrhoids. Not only are these messy and difficult to apply, but the alleged comfort they provide is only temporary, if any, and applications must be made frequently to renew any relief available from their use.... Special pads have been provided to relieve the pressure on the hemorrhoids. One type of pad in the form of a doughnut supports the buttocks in an elevated position above the seat on which the pad is mounted so that no pressure is applied against the hemorrhoids when a patient is seated thereon. However, this type of seat is unsuitable for use in autos where there is limited room beneath the steering wheel. Also, such doughnut shaped seats do not offer any back pressure to counteract the pressure of the blood vessels in the anus on hemorrhoids, which pressure causes discomfort. Web site: http://www.delphion.com/details?pn=US04709431__ •

Dual doppler artery ligation and hemorrhoid treatment system Inventor(s): D'Angelo; John M. (6510 1st Ave. S., St. Petersburg, FL 33710), Teigman; Jack (120 1st St. E., #105, St. Petersburg, FL 33715) Assignee(s): none reported Patent Number: 6,506,157 Date filed: September 5, 2001 Abstract: A dual Doppler artery ligation and hemorrhoid treatment system has a probe. The probe has a disposable cylinder with a cone-shaped cap at the distal end and a support adjacent to the proximal end. A series of white light emitting diodes is mounted within the support. The support has a backing plate proximally and an opening to the cylinder and cone distally. The cylinder has an opening adjacent to its distal end and a pair of ultrasonic transducers secured on the cylinder laterally spaced on the center line proximal side of the opening. An echo analyzer is operatively coupled to the probe and is adapted to emit signals and to detect and analyze received signals as a function of the blood flow there adjacent to produce an output which varies as a function of the arterial blood flow of a hemorrhoid extending through the aperture. Excerpt(s): The present invention relates to a dual Doppler artery ligation and hemorrhoid treatment system and more particularly pertains to locating, ligating and reducing hemorrhoids in an accurate and convenient manner.... The use of devices of known designs and configurations for locating hemorrhoids and for removing them is known in the prior art. More specifically, devices of known designs and configurations for locating hemorrhoids and for removing them previously devised and utilized for the purpose of locating and removing hemorrhoids through conventional methods and apparatuses are known to consist basically of familiar, expected, and obvious structural configurations, notwithstanding the myriad of designs encompassed by the crowded prior art which has been developed for the fulfillment of countless objectives and requirements.... By way of example, U.S. Pat. No. 5,570,692 to Morinaga discloses an ultrasonic Doppler blood flow detector for hemorrhoid artery ligation. Also, U.S. Pat. No. 5,413,583 to Wohlers discloses a force limiting arrangement for needle holder for endoscopic surgery.

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Elastic band ligation device for treatment of hemorrhoids Inventor(s): O'Regan; Patrick J. (912-750 West Broadway, Vancouver, B.C., CA) Assignee(s): none reported Patent Number: 5,741,273 Date filed: March 8, 1996 Abstract: An elastic band ligation device for treatment of hemorrhoids permits a doctor to band hemorrhoidal tissue without an assistant and does not have to be attached to an aspirator. The device has the capability of suctioning tissue into a tubular member before banding. A plastic inner tubular member retains a stretched elastic band over a front end of an inner tubular member which extends for a sufficient length for insertion into the rectum of a patient. A plunger in the tubular member may be slid backwards to draw a suction in the tubular member to draw tissue in through the front end. A plastic outer pusher sleeve fits over the tubular member and is adapted to push the elastic band off the front end of the tubular member to capture the hemorrhoidal tissue drawn into the tubular member. Excerpt(s): The present invention relates to the treatment of hemorrhoids by elastic band ligation, sometimes referred to as rubber band ligation, and more specifically to an elastic band ligation device that may be used by a single operator.... The treatment of hemorrhoids by elastic band ligation is credited to Blaisdell who described this technique in Diseases of the Colon and Rectum in 1963. The technique involves placing an elastic band on tissue in the rectum above the area of the hemorrhoid where there is little sensation. The tissue trapped in the band being cut off from its blood supply degenerates and is sloughed, and the elastic band along with the sloughed tissue is passed with the bowel motions. More importantly, however, the resulting healing process causes the tissue in the vicinity to become fixed and prolapse of the hemorrhoidal tissue is minimized. Furthermore, the elastic band ligation technique has been found to give relief of hemorrhoidal symptoms.... Many devices exist on the market today utilizing the elastic band ligation technique. Examples are U.S. Pat. No. 5,203,863 to Bidoia, U.S. Pat. No. 5,122,149 to Broome and U.S. Pat. No. 5,158,563 to Cosman. The devices disclosed in these patents are generally designed to be used in conjunction with an instrument such as a proctoscope or anoscope to directly see the area to be banded. In some cases it is necessary to have an assistant to hold the proctoscope or anoscope and the use of these scopes, which are generally larger in diameter than the banding apparatus, can cause considerable discomfort to a patient and more specifically to one who is suffering symptoms of hemorrhoids. Web site: http://www.delphion.com/details?pn=US05741273__

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Hemorrhoid bandage Inventor(s): Golden; Theodore A. (755 W. Big Beaver Rd., Troy, MI 48084) Assignee(s): none reported Patent Number: 4,331,151 Date filed: September 8, 1980

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Abstract: A hemorrhoid bandage or cold pack, for positioning within a human anal canal, is formed of a hollow, thin wall, roughly cylindrically shaped body having an inner end and an outer end. The body is transversely divided into two parts by a central panel extending longitudinally from the outer end towards the inner end, but having an open area adjacent the inner end. A tube, which is coaxial with the body, extends from the inner to the outer end and opens exteriorly of the body at each end. A fluid inlet continuously supplies fluid of a predetermined temperature into one body part through the outer end, which fluid flows through the panel open area at the inner end, and then out of the other body part through a fluid drain opening communicating therewith. The two interior parts may be further subdivided by transverse ribs extending between the panel and the body exterior wall to form longitudinally extending channels for controlling the direction of the fluid flow through the body. By using a relatively cool fluid, such as cool water, the bandage may be used to provide a controlled temperature, for extended periods of time, within the rectal area in connection with treatment of hemorrhoids. Excerpt(s): The invention herein relates to a thermally controlled bandage or pack useful for providing a controlled temperature within the human anus or rectal area for either post operative treatment or other care or treatment of hemorrhoid conditions. The device is useful for maintaining a predetermined cool temperature within the treated area for extended periods of time without interfering with the expulsion of the human body gases and body fluids.... Thermally controllable bandages or packs for application to exterior surfaces of the human body are disclosed in my prior U.S. Pat. No. 4,098,279 issued July 4, 1978 for a therapeutic thermal pack unit and in my prior U.S. Pat. No. 4,108,146 issued Aug. 22, 1978 for a bendable thermal pack unit. Each of these prior patented devices contemplate bandages or packs which are hollow and made of thin material. Thermally controlled fluid, such as cool water at a predetermined temperature is flowed through the pack. Consequently, the exterior surfaces of the pack are maintained at a steady cool temperature for long periods of time so that the human body portion covered by the pack is cooled, generally for post operative care to control swelling, bleeding, and the like.... With this type of thermal pack, the temperature can be controlled to the point where it is comfortable or if not comfortable, at least acceptable, to the user as contrasted with ice packs and other cold packs which are usable only for short periods of time before exceeding the limits of comfort and tolerance of the user. Web site: http://www.delphion.com/details?pn=US04331151__ •

Hemorrhoid inflammation reducing device Inventor(s): Tuffel; Judith S. (97 Cedarhurst Ave., Cedarhurst, NY 11516) Assignee(s): none reported Patent Number: 4,938,221 Date filed: March 2, 1989 Abstract: A hemorrhoid inflammation reducing device is disclosed. The device has a hollow flexible housing that is shaped to be inserted into and removed from the anus of the rectum of a person having internal/external hemorrhoids. The housing has an enlarged head portion to fit into the rectum, a reduced neck portion that extends from the head portion so that the neck portion can bear against the internal/external hemorrhoids, and an oversized body portion which extends from the neck portion so that the body portion can stick out from the anus allowing the person to grip the body portion for insertion into and removal from the anus of the rectum. A coolant is

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disposed within the housing for shrinking the internal/external hemorrhoids. A closure is provided for sealing the coolant within the housing after the coolant is placed within the housing. The closure has a pair of handle-like extensions and an aperture formed in the distal end of the body portion opposite the neck portion of the housing. The extensions are tied together sealing the coolant in the housing. The extensions are initially untied to allow the coolant to be initially filled through the aperture contained in the housing when first using the device. Excerpt(s): The present invention relates to a treatment for hemorrhoids.... More particularly, the present invention relates to a hemorrhoid inflammation reducing device.... Hemorrhoids are simply varicose veins in the anal canal. They may come and go and almost everyone has them at one time or another. They are very common in pregnancy and occur in two locations. Web site: http://www.delphion.com/details?pn=US04938221__ •

Hemorrhoid removing device Inventor(s): Taylor; Jerry W. (1825 King Rd., Mechanicsville, MD 20659) Assignee(s): none reported Patent Number: 5,578,047 Date filed: August 16, 1994 Abstract: A hemorrhoid ligature element including an elongated cylindrical elastic body having a central bore. The outside of the body and the inner surface of the bore may have circumferential grooves for gripping tissue. The length of the element is substantially longer than the radius making the element roll-resistant. Excerpt(s): The present invention relates to improvements in a ligature device used in removing hemorrhoids and the like from the colon by means of the so-called "throttling" surgery. The device, a ring like ligature element, is applied to the neck of the hemorrhoid until the hemorrhoid necrotizes and falls away due to the occlusion of blood supply pathways. The popularity of this type of surgery has increased in recent years because of its simplicity and cost savings.... Among the several objects of this invention is to increase the success rate for this common method of removing hemorrhoid and the like tissue from the colon. The increased success rate of this invention stems from improvements to its shape.... Unlike the design of the ligature already in use, this improved ligature element resists rolling or sliding away from the place where it is installed to remove hemorrhoid or the like tissue. Even when this invention is installed with the surface of the central opening accidentally reversed with the peripheral surface, it will perform the intended function, insuring that hemorrhoid or the like tissue is removed as planned, said improvements are beyond the abilities of the ligature element already in use which rolls or slides away from its installed location more easily. Web site: http://www.delphion.com/details?pn=US05578047__

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Hemorrhoid retainers Inventor(s): Becklin; Wallace W. (10510 Holly La., Maple Grove, MN 55369), Gianopoulos; Thomas J. (8070 12th Ave. South, Bloomington, MN 55420) Assignee(s): none reported Patent Number: 4,702,237 Date filed: August 27, 1986 Abstract: A flexible yet strong member having an adhesive on one side which can be secured to the anal area to physically hold the hemorrhoids within the anal orifice with the member including means such as orifices to permit bowel gas or flatulence to rapidly escape therethrough without dislodging the hemorrhoid retainer from the anal area. Excerpt(s): This invention relates primarily to medical devices and, more specifically, to disposable hemorrhoid retainers that can be quickly applied to securely and firmly hold hemorrhoids within the anal orifice.... External protruding hemorrhoids generally cause pain and discomfort. In addition, if the hemorrhoids become bruised, they may bleed which may cause the person alarm and concern. Bleeding hemorrhoids may eventually require surgery since the available ointments, creams, jells and the like offer only temporary relief to the pain and itching and do not protect the hemorrhoid membranes from further bruising and bleeding. Typically, when external protruding hemorrhoids become bothersome, one must push the hemorrhoids into the anal area with one's fingers. However, insertion of the hemorrhoids into the anal area does not prevent the hemorrhoids from coming out again particularly if the person moves about. If the hemorrhoids continually protrude, usually the only option is to have surgery to remove them.... A disadvantage of available hemorrhoid preparations is that many people are hesitant about using them because they are, to some extent, invasive since some of the hemorrhoid preparations have to be placed inside the anal orifice. Web site: http://www.delphion.com/details?pn=US04702237__

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Hemorrhoid seat cushion Inventor(s): Jay; Eric C. (Boulder, CO) Assignee(s): Jay Medical, Ltd. (Boulder, CO) Patent Number: 4,761,843 Date filed: April 24, 1987 Abstract: A hemorrhoid supporting pad assembly comprises a pad on a supporting surface which may be a seat cushion assembly. The pad is formed from a flexible envelope partially filled with a fluid. The pad is positioned on the supporting surface beneath a seated person. Lateral portions of the envelope containing the fluid extend beneath the seated person. The weight of the seated person causes the fluid in the lateral portions of the envelope to flow toward the central region of the envelope, where the fluid is forced upwardly, beneath the anus, to support the hemorroid. Excerpt(s): This invention relates in general to a hemorrhoid supporting assembly for a human body. More particularly, this invention is directed to a comfortable supporting seat cushion assembly that is specifically designed to alleviate discomfort and pain associated with hemorrhoids and similar afflictions. The present invention also relates to a pad which may be used by a hemorrhoid sufferer on any seating support without the

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need for a specially designed cushion assembly.... It has long been recognized that hemorrhoids are overly stretched varicose veins in the region around the anus. Swollen hemorrhoidal veins are comparable to varicose veins in the legs.... Hemorrhoids are very common--up to half of all adult Americans have hemorrhoids at one time or another. Often the hemorrhoids cause little or no discomfort and go unnoticed. Frequently, heavy internal pressure caused by heavy lifting, sitting, pregnancy and other factors causes the hemorrhoids to swell and become very painful. Increase in pressure can cause hemorrhoids to rupture which result in the passage of blood during a bowel movement. Web site: http://www.delphion.com/details?pn=US04761843__ •

Hemorrhoid treatment system Inventor(s): Lockhart; Alonzo E. (12012 S. Compton Ave. #6-217, Los Angeles, CA 90059) Assignee(s): none reported Patent Number: 5,101,520 Date filed: September 14, 1990 Abstract: A hemorrhoid treatment system including a tank for storing fluid, a dispenser located in a toilet seat for ejecting the fluid, and a pump for pumping fluid from the tank through the dispenser. In more specific embodiments, the dispenser is positioned to spray any of several fluids on the affected area. The dispenser is pivotally mounted within the seat to allow for storage in convenient location. A switch is provided within the handle of the dispenser for activating a motor associated with the pump. A valve is provided for selecting for ejection water or a fluid from the tank. Excerpt(s): The present invention relates to medical systems. More specifically, the present invention relates to techniques for treating hemorrhoids.... While the present invention is described herein with reference to illustrative embodiments for particular applications, it should be understood that the invention is not limited thereto. Those having ordinary skill in the art and access to the teachings provided herein will recognize additional modifications, applications, and embodiments within the scope thereof and additional fields in which the present invention would be of significant utility.... A hemorrhoid is a protrusion of the internal intestinal mucosa into the lumen of the rectum and, at times, outside the body. If untreated, a hemorrhoid can be painful and can cause irritation, discomfort, and a soiling of clothing (typically underwear). Further, the untreated hemorrhoid can become thrombose, ulcerate and prone to infection. Web site: http://www.delphion.com/details?pn=US05101520__

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Hemorrhoid-treatment rod Inventor(s): Gebhardt; Bernd (Memelstr. 19, 4900 Herford-deutsche Staatsburger, DE), Bruhl; Wilhelm (Rontorfer Str. 3, 4973 Vlotho-Steinbrundrof, DE) Assignee(s): none reported Patent Number: 4,906,239 Date filed: February 22, 1985

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Abstract: A hemorrhoid-treatment rod that is shaped like a cone in order to dilate the anus. The outside of the cone may have elevations and depressions. It also has lateral outlets, each of which extends from an interior supply channel to the outside, preferably into one of the depressions. Ointment is forced into the depression and can be massaged into the area to be treating by rotating the rod without being wiped off prematurely. Excerpt(s): The present invention relates to a hemorrhoid-treatment rod in the form of a cone-shaped anal dilator.... Hemorroidal complaints normally originate in the anal canal, which contains extremely fine longitudinal slits and pockets that resemble swallows' nests and are open at the top and that are known as the anal sinuses. Since the slits dilate along with the anal sphincter during defecation, feces can get established inside them. Feces can also penetrate into the sinuses during passage.... Although hemorrhoidal ointments exist that are in themselves effective, really successful treatment can be expected only when the ointment can be applied into the slits and, if necessary, into the anal sinuses as well. Web site: http://www.delphion.com/details?pn=US04906239__ •

Instrument for resectioning hemorrhoids Inventor(s): Burgard; Gunther (Fasanenweg 7, D-66424 Homburg, DE) Assignee(s): none reported Patent Number: 6,419,683 Date filed: February 28, 2000 Abstract: The present invention relates to an instrument for resectioning hemorrhoids for the minimal invasive subanodermal removal of hemorrhoidal tissue. In order to reduce surgical intervention to an absolute minimum and to subject a patient suffering from hemorrhoids to an operation which is as gentle as possible, the invention provides for an instrument for resectioning hemorrhoids, comprising a narrow, elongated carrier device, a vibrating surgical device which reduces the size of tissue so that hemorrhoidal tissue can be prepared and fragmented, and at least one milling unit for removing said tissue. Excerpt(s): The present invention relates to an instrument for resectioning hemorrhoids for the minimal invasive subanodermal removal of hemorrhoidal tissue.... Hemorrhoidal ailments account for the most frequent rectal disease found in the Western civilized world; the disease frequency is said to be 50% among the population over 50 years. Hemorrhoids are vessel convolutes covered with mucous membrane, which are noticed by bleeding, pressure sensation or protrusion. Starting from a hemorrhoidal enlargement of the third and fourth degree, a surgical intervention in which tissue is removed manually is required for providing relief.... As a rule, hemorrhoidal tissue is formed below the anoderm, i.e. below the transitional skin which is located at the end of the anal canal between the mucous membrane of the rectum and the external skin of the buttock. The anoderm has an extremely high nerve density which ensures sensory continence, i.e. the ability to distinguish gas, liquid or feces and to retain the same. Web site: http://www.delphion.com/details?pn=US06419683__

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Instrument for the ligation of hemorrhoids or the like Inventor(s): Bidoia; Gianfranco (Via Bressanone, 3/A, 35100 Padova, IT) Assignee(s): none reported Patent Number: 5,203,863 Date filed: March 2, 1992 Abstract: The instrument for the ligation of hemorrhoids or the like includes a substantially cylindrical container with a coupling for the connection of an air aspiration apparatus and a grip handle for the operator. The container is suitable for internally accommodating a hemorrhoid or the like aspirated through its open end, on which a dilated ring-like elastic ligature, to be transferred so as to throttle the "neck" of the hemorrhoid or the like, is arrangeable externally and circumferentially. The instrument is characterized in that the container is provided with a thumb-actuated hole for adjusting the pressure inside it while the aspiration apparatus is operating. Excerpt(s): The present invention relates to an instrument for the ligation of hemorrhoids or the like.... Various methods for the therapy of hemorrhoids are currently used when said hemorrhoids no longer respond to strictly medical cures or when their size becomes such that any non-surgical therapy would produce no result or even negative results.... A first method is the strictly surgical one, which is irreplaceable in case of considerable internal and external prolapses. Web site: http://www.delphion.com/details?pn=US05203863__

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Medical device for use in the treatment of hemorrhoids Inventor(s): Hudock; Harriet (259 White Oak Ridge Rd., Short Hills, NJ 07078) Assignee(s): none reported Patent Number: 5,178,627 Date filed: January 13, 1992 Abstract: A device for treating hemorrhoids is formed from a hollow member having integral insertion and collar portions. Controlling means located within the member and running from the collar to at least partially the length of the insertion portion serve to control the maximum transverse section of the device. Reduction of the cross section eases insertion and extraction of the device. Release of the controlling means allows the device to resiliently return to its normal condition. Excerpt(s): The present invention relates to a medical device for use in the treatment of hemorrhoid problems.... The veins of the internal rectal plexus often become excessively dilated and inflamed in a condition commonly known as hemorrhoids or piles. This inflammation and swelling of the veins located in the rectum and anus region is due to several factors. One is the vessels are contained in very loose connective tissue. Therefore, the rectal veins receive less support from surrounding tissues and are less able to resist increased blood pressure. Constipation, often the result of poor eating habits, further exacerbates the condition.... While the condition is generally not serious, in a life threatening sense, it is very common and can cause moderate to severe discomfort in patients during episodes in which the veins are particularly swollen. In fact, the defeat of Napoleon by Wellington at Waterloo in 1815 has been attributed, at least in part, to Napoleon's alleged inattention to the battle caused by his suffering from hemorrhoid problems.

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Method for treating hemorrhoids Inventor(s): Farley; Brian E. (Los Altos, CA), Laufer; Michael D. (Menlo Park, CA) Assignee(s): Vnus Medical Technologies, Inc. (Sunnyvale, CA) Patent Number: 6,135,997 Date filed: November 16, 1998 Abstract: A catheter delivers an electrode within a vein for a minimally invasive treatment of hemorrhoids using RF energy. The catheter is introduced into a patient and positioned within the section of the vein to be treated. The electrode radiates high frequency energy towards the vein, and the surrounding venous tissue becomes heated and begins to shrink. The catheter includes a controllable member for limiting the amount of shrinkage of the vein to the diameter of the member. The electrode remains active until there has been sufficient shrinkage of the vein. The extent of shrinkage of the vein can be detected by fluoroscopy. After treating one section of the vein, the catheter and the electrode can be repositioned within the hemorrhoidal venous system to treat different sections until all desired venous sections and valves are repaired and rendered functionally competent. Shrinkage of the vein further thickens and stiffens the vein wall which reduces the potential for the hemorrhoid vein to dilate. Excerpt(s): This invention relates to the treatment and correction of hemorrhoids, and more particularly to a minimally invasive procedure using a catheter-based system to intravenously deploy one or more electrodes for providing radio frequency (RF) energy, microwave energy, or thermal energy to shrink a dilated vein in order to change the fluid flow dynamics and to restore the competency of the venous valve and the proper function of the vein.... Incompetent valves in the venous system can occur with vein dilation. Separation of the cusps of the venous valve at the commissure may occur as a result thereby leading to incompetence. Another cause of valvular incompetence occurs when the leaflets are loose and elongated. Loose leaflets of the venous valve results in redundancy, which allows the leaflets to fold on themselves and leave the valve open. These loose leaflets may prolapse, resulting in reflux of blood in the vein. When the venous valve fails, there is an increased strain and pressure on the lower venous sections and overlying tissues sometimes leading to additional valvular failure.... Hemorrhoids are a common ailment involving dilated veins which can result in bleeding, itching, and pain. Hemorrhoids are dilated veins in and around the anus and lower rectum. Dilation may result from an increased pressure in the hemorrhoidal vein. Constipation, including the frequent straining to pass hard stools increases pressure in hemorrhoidal veins, is a common cause of hemorrhoids. Other contributing factors include pregnancy, a low fiber diet, and obesity. As the hemorrhoidal vein becomes more dilated from the increased pressure, the venous valves of the hemorrhoidal vein may begin to fail and become incompetent. This can exacerbate the dilation of the hemorrhoidal vein as reflux of blood is allowed in the vein by the open incompetent valve. The vein may eventually form a sac-like protrusion if the condition is allowed to persist. Hemorrhoids are generally classified as being either internal or external, depending on their location relative to the dentate line. The dentate line is easily identified as the demarcation between the pink mucosa that form the anoderm. The dentate line separates the internal and external hemorrhoid systems. Internal hemorrhoids are located inside the anus above the dentate line. External hemorrhoids are located below the dentate line. Either can extend out of the anus.

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Methods of treating hemorrhoids and anorecial disease Inventor(s): Gallina; Damian J. (Erie, PA) Assignee(s): Patent Biopharmaceutics, Inc. (Erie, PA) Patent Number: 5,234,914 Date filed: November 27, 1991 Abstract: A method of treating hemorrhoids and anorectal disease which includes applying to the hemorrhoids and anorectal tissues an effective amount of a composition including a pharmaceutically acceptable carrier and hyaluronic acid or pharmaceutically acceptable salts thereof. Excerpt(s): The present invention relates to methods of treating hemorrhoids and diseases of the anorectum employing novel pharmaceutical compositions. In particular, the present invention relates to topical applications of hyaluronate preparations as rectal bonding and adhesion agents, anti-inflammatory agents and bio-repair materials. The use of hyaluronate preparations employs their properties to reduce the inflammation, pain, swelling, and sequelae of injured, irritated, diseased, strained, or traumatized anorectal tissues while adhering to and protecting sensitive tissues of the anorectum. The source of the hyaluronate used in the treatment compositions may be a hyaluronic acid or any acceptable salt form of hyaluronic acid. The term "hyaluronate" is often used to mean "hyaluronic acid equivalent" which equates to hyaluronic acid of varying molecular weights and any of their salt forms.... Hyaluronic acid is a naturally occurring mucopolysaccharide with a molecular weight generally ranging between about 50,000 and 8,000,000 (or possibly higher), depending on the sources of the hyaluronate and the analytical methods used in its determination.... Methods of obtaining highly-pure or ultra-pure hyaluronic acid and its salt forms, isolation techniques, and analytical methods for testing purity are provided, for example, in the U.S. Pat. Nos. 3,396,081, 4,141,973, 4,517,295, 4,736,024, 4,784,990 and 4,808,576. Web site: http://www.delphion.com/details?pn=US05234914__

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Pharmaceutical preparation for the treatment of gastrointestinal ulcers and hemorrhoids Inventor(s): Niazi; Sarfaraz K. (Deerfield, IL) Assignee(s): Gulf Pharmaceutical Industries (AE) Patent Number: 6,365,198 Date filed: January 28, 2001 Abstract: A pharmaceutical preparation for the treatment of gastrointestinal ulcers and hemorrhoids in humans and animals and a method of preparation for this composition are provided here. The preferred composition consists of an alcoholic extract of Huangqin, Huanglian, Huangbo, Opuntia and Pheretima dissolved in vegetable oil from where alcohol is essentially removed by evaporation. The composition is then packaged in a soft gelatin capsule for oral administration or mixed with wax to make an ointment suitable for rectal administration.

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Excerpt(s): This invention relates to a pharmaceutical preparation mainly for treating gastrointestinal wounds, ulcers and rectal inflammation conditions such as hemorrhoids. An alcoholic extract of natural ingredients in dried powdered state consisting of Huangqin (baikal skullcap), Huanglian (rhizome of Chinese goldthread or rhizoma Coptidis), Huangbo (cortex phellodendri), Pheretima (dilong) and Cactus (opuntia ficus indica) is used in an oily medium such that the quantity of each ingredient in its dried form represents less than 2% of the final amount of preparation. In the foregoing assertion, efforts have been made to find a suitable palliative and/or curative agent for the treatment of gastrointestinal ulcer conditions and hemorrhoids from medicinal plants and other natural ingredients.... Peptic ulcer is defined as a benign lesion of gastric or duodenal mucosa occurring at a site where the mucosal epithelium is exposed to acid and pepsin. It is a gastrointestinal problem that has been prevalent throughout the world population. It is estimated that approximately 10% of most populations globally will develop severe peptic ulcer conditions at some time during their lifetime. The lesions occur at all ages and affect both sexes. It is estimated that at least five million people suffer from active peptic ulcers each year, and approximately 350,000 to 500,000 new cases are diagnosed annually in the U.S. alone. More than 600,000 patients are hospitalized in the U.S. each year for severe episodes. In approximately one-third of these cases serious complications occur, including intestinal obstruction, upper gastrointestinal hemorrhage and perforation. Furthermore, each year, over 6,000 deaths in the U.S. are directly caused by ulcer disorders. In addition, peptic ulcer conditions have been implicated as an indirect contributing factor in an additional 11,000 deaths each year.... The occurrence of the disease has been associated with over-indulgence, inappropriate habits, anxiety and stress. Considerable energy and resources have been expended towards relieving symptoms of peptic ulcer, which usually manifests as an excruciating pain, especially in the upper abdomen. Peptic ulceration reflects an imbalance between the aggressive action of acid peptic secretions and the defensive forces that protect the mucosa. Gastric ulcers result from lowered defensive mechanisms and duodenal ulcers are the consequence of the destructive action of increased acid-peptic secretions. Web site: http://www.delphion.com/details?pn=US06365198__ •

Pharmaceutical preparation for treating hemorrhoids and anal fissures Inventor(s): Williams; Glenn L. (Lafayette Hill, PA) Assignee(s): Stoelker; Charles V. (Philadelphia, PA) Patent Number: 4,118,480 Date filed: August 9, 1974 Abstract: A pharmaceutical preparation for treating hemorrhoids and anal fissures comprising 0.6 gr phenol, 0.3 gr menthol, 10 gr bismuth subnitrate, 10 gr pulverized starch, and 50 gr of 1% by weight dibucaine in an ointment base of lanolin and petrolatum. Excerpt(s): There are presently available pharmaceutical preparations for treating hemorrhoids and anal fissures. One of these is NUPERCAINAL ointment, which is described in the Physicians' Desk Reference To Pharmaceutical Specialities And Biologicals, published by Medical Economics, Inc., a subsidiary of Chapman-Reinhold, Inc., Oradell, New Jersey, Twenty-Second Edition, 1968, page 623, as an ointment containing dibucaine in an ointment base of lanolin and petrolatum. NUPERCAINAL ointment is a product of Madison Laboratories, a division of Ciba Pharmaceutical

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Company, Summit, New Jersey, and is described as a soothing and long-acting local anesthetic. The high potency of NUPERCAINAL ointment permits therapeutic effectiveness with low concentration. NUPERCAINAL ointment is recommended for relief of pain and itching in hemorrhoids, anal fissures, etc.... However, NUPERCAINAL ointment is a very thin, slippery ointment that melts easily under body heat and disappears into the tissues, and does not provide a coating or cover for the treated tissue.... It is an object of the present invention to provide a pharmaceutical preparation for the treatment of hemorrhoids, anal fissures, etc. which acts as a long-lasting quickacting and low sensitizing local anesthetic, which provides a protective coating for the treated tissues, which relaxes spasms to a great extent and improves blood circulation and healing, which has an astringent effect that shrinks the treated tissues to encourage healing, and that has a cooling, soothing effect when applied to the treated tissue. Web site: http://www.delphion.com/details?pn=US04118480__ •

Physical therapeutic instrument for prevention and treatment of hemorrhoids Inventor(s): Lee; Hyung Jun (29-1 Shinsul-dong, Dongdaemoon-Ku, Seoul, KR) Assignee(s): none reported Patent Number: 5,676,637 Date filed: December 8, 1994 Abstract: A physical therapeutic instrument for treatment of hemorrhoids is disclosed. The instrument treats existing hemorrhoids through a nonoperative method and prevents possible anal diseases. The instrument has a rectal insert having a shape agreeable to the anal anatomy of the human body. The rectal insert is carried on a carriage and is movably orthogonally received in a through hole of a seat of the instrument. The rectal insert is lifted and inserted into the rectum by a lifting unit and vibrated vertically and/or horizontally by a vibration unit. The rectal insert also heats the rectum at about 36.degree.-60.degree. C., thus providing a heating effect for the rectum. Insertion of the rectal insert into the rectum also pushes up drooping anal sphincter muscles, thus strengthening the anal muscles. The instrument thus maintains and strengthens active contractible motion of the anal muscles. Excerpt(s): The present invention relates in general to the prevention and treatment of hemorrhoids and, more particularly, to a physical therapeutic instrument for the prevention and treatment of hemorrhoids by stimulating good circulation of blood in the human anal area by producing a smooth massage and heating effect.... Hemorrhoids or piles are swollen varicose veins in the mucous membrane inside or just outside the rectum.... Excessive pressure due to constipation can cause a fold of the membranous rectal lining to slip down, thus pinching and irritating the veins. Many pregnant women experience hemorrhoidal problems because of pressure in the veins of the lower body area. Diseases of the digestive tract resulting in anal infection, and cirrhosis of the liver which obstructs blood circulation, can cause a hemorrhoidal problem. Web site: http://www.delphion.com/details?pn=US05676637__

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Preparation for treating wounds or hemorrhoids Inventor(s): Nakamura; Tsutomu (Kyoto, JP), Okuda; Toshiaki (Kyoto, JP), Okumura; Makoto (Kyoto, JP), Yajima; Motoyuki (Kyoto, JP) Assignee(s): Kaken Pharmaceutical Co., Ltd. (JP), Toray Industries Inc. (JP) Patent Number: 5,852,050 Date filed: July 9, 1997 Abstract: The present invention relates to a preparation, particularly a topical preparation, for the therapy of wounds or hemorrhoids, which contains, as an active ingredient, at least one of prostaglandin I.sub.2, prostaglandin E.sub.1 and derivatives of these, particularly beraprost, a derivative of prostaglandin I.sub.2, or a salt thereof, and a method of the therapy of wounds or hemorrhoids, which comprises administering the above active ingredient. Excerpt(s): Prostaglandin I.sub.2 (PGI.sub.2) and prostaglandin E.sub.1 (PGE.sub.1) are known to have a broad range of pharmacological activities such as high inhibition activity of platelet aggregation and high stimmulatory activity of vasolidating angiotelectasis, and it has been expected to apply these as a drug against peripheral blood circulation impairments. Since, however, PGI.sub.2 and PGE.sub.1 per se are chemically unstable, they are poor in retaining their pharmacological effects and it is difficult to apply them to practical use.... Beraprost which is a derivative of PGI.sub.2 is chemically stable, and it has been therefore developed as an oral preparation for treating peripheral bloodstream impairments and is commercially available as a drug for the therapy of ischemic diseases caused by chronic arterial occlusion.... Meanwhile, it is known that most of wounds such as intractable skin ulcer including bedsore are caused by a failure in peripheral blood circulation. It is therefore desired to develop a drug for topical use since the topical administration thereof, if such is possible, causes lower side effects than systemic administration. However, there is not yet known any topical preparation for the therapy of wounds containing at least one of PGI.sub.2, PGE.sub.1 and derivatives thereof as an active ingredient. Web site: http://www.delphion.com/details?pn=US05852050__

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Process and device for the therapeutic treatment of hemorrhoids Inventor(s): Connor; Gerald I. (Spokane, WA), Estes; Roger Q. (Spokane, WA), Latenser; James S. (Spokane, WA) Assignee(s): Bio-Tronics, Inc. (Spokane, WA) Patent Number: 4,142,529 Date filed: June 20, 1977 Abstract: A process and device is described for therapeutically treating hemorrhoids extending from the anal canal wall of a patient. The device includes a stable, anal canal suppository appliance for intimately contacting the anal canal wall and hemorrhoids. The appliance has sufficient length to extend from the anus to the rectum and sufficient diameter to intimately contact the wall tissues without overly stretching the sphincter muscles. The appliance contains an internal electrical resistor for generating heat in response to the application of electrical energy. The device has a portable case containing an electrical energy storage battery and a control circuit for controlling the

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application of the electrical energy to the resistor to maintain the temperature of the appliance above body temperature and below 45.degree. C. Excerpt(s): This invention relates to processes and devices for the therapeutic treatment of hemorrhoids. It has been estimated that approximately one third of the adults in the United States shall at one time or another have a hemorrhoidal condition that is discomforting and quite painful. It appears that hemorrhoids are more numerous in high stress societies.... Anatomically, hemorrhoids are caused by the swelling and thrombosis of a large plexus of veins in the anal canal followed by edema. Frequently hemorrhoids are considered primarily as varicose veins and their associated affects and disruptions in the anal-rectal canal. In the formation of hemorrhoids, the veins become varicose and the valves of the veins become incompetent through mechanical or vascular hydraulic stresses in excess of the elastic limits of the veinal structure. Causes of hemorrhoids are generally attributed to chronic constipation, irregularity of bowel evacuation, poor dietary habits and pregnancy-induced interference with the venous return flow due to fetal pressures against the pelvic area.... Occasionally hemorrhoids may be accompanied by fissures or cracks in the anal cavity, the base of which becomes secondarily infected causing bleeding and substantial pain. Web site: http://www.delphion.com/details?pn=US04142529__ •

Proctologic device for the therapeutic treatment of hemorrhoids Inventor(s): Connor; Gerald I. (Spokane, WA) Assignee(s): Bio-Tronics, Inc. (Spokane, WA) Patent Number: 4,227,535 Date filed: April 2, 1979 Abstract: A proctologic device is described for therapeutically treating hemorrhoids extending from the anal canal wall of a patient. The device includes an anal canal appliance for intimately contacting the anal canal wall and hemorrhoids. The appliance has sufficient length to extend from the anus to the rectum and sufficient diameter to intimately contact the wall tissues without overly stretching the sphincter muscles. The appliance contains an internal electrical resistor for generating heat in response to the application of electrical energy and a temperature transducer for sensing the temperature of the appliance in the anal canal. The device has a portable case containing an electrical energy storage battery and a control circuit for controlling the application of the electrical energy to the resistor to maintain the temperature of the appliance above body temperature. The control circuit has safety network for discontinuing the application of heat to the appliance should the sensed temperature fall below a preset low temperature or go above a preset elevated temperature. Excerpt(s): This invention relates to devices for the therapeutic treatment of hemorrhoids. It has been estimated that approximately one third of the adults in the United States shall at one time or another have a hemorrhoidal condition that is discomforting and quite painful. It appears that hemorrhoids are more numerous in high stress societies.... Anatomically, hemorrhoids are caused by the swelling and thrombosis of a large plexus of veins in the anal canal followed by edema. Frequently hemorrhoids are considered primarily as varicose veins and their associated effects and disruptions in the anal-rectal canal. In the formation of hemorrhoids, the veins become varicose and the valves of the veins become incompetent through mechanical or vascular hydraulic stresses in excess of the elastic limits of the veinal structure. Causes

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of hemorrhoids are generally attributed to chronic constipation, irregularity of bowel evacuation, poor dietary habits and pregnancy-induced interference with the venous return flow due to fetal pressures against the pelvic area.... Occasionally hemorrhoids may be accompanied by fissures or cracks in the anal cavity, the base of which becomes secondarily infected, causing bleeding and substantial pain. Web site: http://www.delphion.com/details?pn=US04227535__ •

Remedy for treatment of hemorrhoids Inventor(s): Homan; John D. (115 Gilbert Ave., Ada, OH 45810) Assignee(s): none reported Patent Number: 3,935,310 Date filed: March 24, 1975 Abstract: The present invention relates to a process for the treatment of hemorrhoids and to a composition therefor which comprises the product resulting from heating to a temperature of the order of 100.degree. - 240.degree.F, for a period of time of the order of 2 - 15 minutes, a mixture of the powdered or chipped limbs or roots of the shrub Celastrus scandens, commonly known as bittersweet, and an animal or vegetable fat. The preferred form of the composition is then strained to remove solid particles and mixed with a topical anesthetic, such as celery seed extract, and benzoin to retard the rancidity of the fat. Excerpt(s): The present application relates to the treatment of hemorrhoids and to a composition suitable therefor. More particularly, it relates to a composition suitable for the treatment of hemorrhoids and for the reduction and elimination of anoral inflammation caused thereby and comprising the product resulting from heating to a temperature of the order of 100.degree.-240.degree.F, for a period of time of the order of 2-15 minutes, a mixture of the powdered or chipped limbs or roots of the shrub Celastrus scandens.... Hemorrhoids is a rather common ailment of the anorectal area and may be either or both internal and external, causing in particular inflammation of the veins of the anorectal area and frequesntly accompanied by itching of varying degrees of intensity. Many remedies have been suggestied and tried for the alleviation of these ailments with varying degrees of success. Some have been partially effective in either reducing the inflammation or itching but few have been successful in reducing or completely eliminating both. Frequently, undesirable side-effects have resulted from such treatments and which have appreciably increased the difficulties in obtaining satisfactory relief.... In accordance with the present invention, the drawbacks and disadvantages of previous methods of treating hemorrhoids have been effectively overcome to a very large degree, both the inflammation and itching normally present in such disorders being effectively overcome after only a relatively short period of treatment, and without any unfavorable side-effects of the type experienced with previously used remedies and treatments. Web site: http://www.delphion.com/details?pn=US03935310__

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Roll-type toilet tissue having hemorrhoid-treating medication therein Inventor(s): Parris; Michael (39 Wilder Rd., Monsey, NY 10952) Assignee(s): none reported Patent Number: 5,004,636 Date filed: July 20, 1989 Abstract: A roll-type toilet tissue is formed of three layers, with one layer being formed by a hemorrhoid-treating medication and being sandwiched between two other layers. Excerpt(s): The present invention relates to the general art of paper products, and to the particular field of toilet tissue.... There are numerous people who suffer from hemorrhoids. This affliction can range from mild cases having mild discomfort associated therewith to extreme cases requiring surgical intervention.... Hemorrhoids can be extremely painful, and thus, there have been several medications proposed for treating such problem. These medications are often in the form of creams and ointments which are often odious to apply. Therefore, such forms of medication have not achieved full acceptance in the market. Web site: http://www.delphion.com/details?pn=US05004636__

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Suction-assisted hemorrhoid ligator Inventor(s): Lurz; Karl-Heinz (Kunzell, DE), Schneider; Gerhard (Alta, SE), Goltner; Ewald (Fulda, DE) Assignee(s): Mo och Domsjo Aktiebolag (Ornskoldsvik, SE) Patent Number: 4,257,419 Date filed: December 14, 1978 Abstract: A ligator is provided for pinching off hemorrhoids and similar body tissues, comprising, in combination, a tubular housing; a suction tube fixedly mounted on the housing; and an actuator sleeve slidably mounted for reciprocable movement within the housing along the suction tube; a suction cup defining an open suction cavity facing outwardly and fixedly attached to and in flow communication with the suction tube for sucking a hemorrhoid into the suction cavity, the suction cup having means for receiving an elastic ring about the periphery of the open suction cavity; and means for ejecting said ring from the cup and onto the body portion link of a hemorrhoid sucked into the suction cavity and projecting from the cavity; said ejecting means being movable by reciprocation of the actuator tube between nonactuated passive and actuated ring-ejecting positions. Excerpt(s): A common method for destroying hemorrhoids without surgery pinches off the hemorrhoid from the body in a manner such that the hemorrhoid has its blood supply cut off, dies, and is sloughed off by the body. To do this, an extremely small elastic band or ring is placed around the body link to the hemorrhoid. This requires that the ring be stretched out sufficiently to be passed over the hemorrhoid, and then released, and this is quite difficult to do manually.... A typical manual operation suitable for excrescent hemorrhoids is carried out with a proctoscope, through which a forceps can be inserted to grasp the hemorrhoid, and pull it through the stretched elastic band or ring. It is however difficult to place the band or ring around the hemorrhoid in this way, and the method cannot really be used for surface hemorrhoids, which do not project any significant distance from the body. Accordingly, various types of devices

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have been designed to do this mechanically.... U.S. Pat. No. 3,382,873 to Banich and Jordan, patented May 14, 1968, provides a surgical instrument for placing a rubber band around a hemorrhoid, comprising a first cylindrical member having a longitudinal axis; a second cylindrical member movably positioned with the first cylindrical member to move from a first to a second position; in the first position, the second member having a lip portion extending beyond the first cylindrical member, and in the second position the lip portion is within the first member; a support member affixed to the first cylindrical member; an actuator arm affixed to the second cylindrical member; a bearing surface in the support member; a guide member on the actuator arm; and a means including a trigger for biasing the actuator arm and the guide member against the support member and the bearing surface and for moving the second cylindrical member along the axis to remove a rubber band on the lip. Web site: http://www.delphion.com/details?pn=US04257419__ •

Treatment of hemorrhoids with 5-HT.sub.2 antagonists Inventor(s): Amer; Moh. Samir (3177 Padaro La., Carpinteria, CA 93013) Assignee(s): none reported Patent Number: 5,266,571 Date filed: January 9, 1992 Abstract: This invention relates to a method for treating or preventing hemorrhoids, comprising administering to a susceptible animal a 5-hydroxytryptamine.sub.2 (5HT.sub.2) receptor antagonist at an anti-hemorrhoidally effective therapeutic dose. Excerpt(s): This invention relates to a method and a class of pharmaceutical agents for treating hemorrhoids. The method comprises administering to a susceptible animal a 5hydroxytryptamine-.sub.2 receptor antagonist (5-HT.sub.2) at an anti-hemorrhoidally effective therapeutic dose.... Serotonin or 5-hydroxytryptamine or 5-HT is a vasoconstrictor and a powerful stimulant of a variety of smooth muscles and nerves. A derivative of the amino acid tryptophan, 5-HT is formed predominantly in enterochromaffin or argentaffin cells of the intestinal tract. It is transported in the blood by platelets and is present in the brain and other tissues. Its pharmacological actions result in a variety of responses involving, inter alia, the cardiovascular, respiratory, and gastrointestinal systems, smooth muscles, exocrine glands, carbohydrate metabolism, sensory nerve endings, autonomic ganglia, the adrenal medulla, and the central nervous system.... Receptors are molecules embedded in outer cell membranes, the main function of which are to recognize and interact with hormones that come in contact with the cell. They act as locks, while the hormones act as keys. Each key (hormone) fits the lock (receptor) that interacts with it and with it alone. Once the key (hormone) fits the lock (receptor), the reaction to the hormone is triggered within the cell. Cellular reaction is therefore determined by the type and number of receptors on the outer membrane of the cells. Consequently, one hormone can trigger different responses in different cells because it may have different receptors. Thus, the same hormone that can contract one smooth muscle cell, can also relax a skeletal muscle cell having a different receptor to the same hormone. This is true for 5-HT. Web site: http://www.delphion.com/details?pn=US05266571__

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Treatment of viral tumors and hemorrhoids with artemisinin and derivatives Inventor(s): Thornfeldt; Carl R. (Ontario, OR) Assignee(s): Dermatologic Research Corporation (Novato, CA) Patent Number: 5,219,880 Date filed: March 29, 1991 Abstract: Hemorrhoids and viral-induced skin tumors such as warts and molluscum contagiosum are successfully treated with topical administration of artemisinin, dihydroartemisinin, its semisynthetic derivatives and its synthetic analogs. Excerpt(s): This invention relates to the topical and/or systemic treatment of viralinduced skin tumors and hemorrhoids with a class of compounds having sesquiterpene structures, including artemisinin, dihydroartemisinin, and derivatives and analogs of these compounds.... Currently known treatments of viral-induced tumors such as warts and molluscum contagiosum suffer from being sometimes ineffective and usually painful. The wart (papova) virus produces hypertrophic viable cells in the tumor mass and suppresses skin cellular immunity against the virus.... Hemorrhoids are the end result of swelling and inflammation of anorectal veins. Current treatments consist of topical analgesics and antiinflammatory agents as well as cathartics. Surgery often is curative but is extremely painful and requires prolonged convalescence. Web site: http://www.delphion.com/details?pn=US05219880__

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Ultrasonic doppler blood flow detector for hemorrhoid artery ligation Inventor(s): Morinaga; Kazumasa (Fukuoka, JP) Assignee(s): Hayashi Denki Co. Ltd. (Kawasaki, JP) Patent Number: 5,570,692 Date filed: May 19, 1995 Abstract: An ultrasonic doppler blood flow detector used for hemorrhoid artery ligation having a hollow insertion cylinder which is enclosed at the distal end and open at the near end, and can be inserted through the anus; the cylinder has an ultrasound transducer in its interior wall, for detecting blood flow in the affected artery, and a ligation hole next to the transducer, through which the detected artery is ligated with ligation device, such as a curved needle or a wire for cautery. Excerpt(s): This invention relates to an ultrasonic blood flow detector and, more particularly, to an ultrasonic doppler blood flow detector for hemorrhoid artery ligation.... There are numerous treatments for hemorrhoids, and the ligature resection surgery (the ligation of the artery and removal of hemorrhoids) is considered the best treatment for serious hemorrhoids. While the use of ligation surgery is effective, it is an extensive procedure involving many steps, such as an enema, anesthesia, opening of the anal region, artery palpation, and ligation. It requires hospitalization, surgical anesthesia, and recovery. It is characterized by post-operative patient discomfort.... Outpatient procedures without anesthesia include "Rubber band ligation" and "Infrared coagulation therapy". While these are effective there can be technical problems in determining and reaching the best treatment point. Web site: http://www.delphion.com/details?pn=US05570692__

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Patent Applications on Hemorrhoids As of December 2000, U.S. patent applications are open to public viewing.6 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to hemorrhoids: •

Apparatus For Treating Hemorrhoids And Similar Ailments Inventor(s): Gomez, Rebecca; (New York, NY) Correspondence: FISH & NEAVE; 1251 AVENUE OF THE AMERICAS; 50TH FLOOR; NEW YORK; NY; 10020-1105; US Patent Application Number: 20030144715 Date filed: February 12, 2001 Abstract: Methods and apparatus for treating hemorrhoids and similar ailments are disclosed in which one or more piece of material are used to separate swollen, inflamed tissue from non-swollen tissue. material may be included within an undergarment that may be worn for the treatment of ailments such as hemorrhoids or an episiotomy. The material incorporated into the undergarment has elastic properties that, in the case of hemorrhoids, acts to separate the buttocks. The undergarment may also include one or more pocket enclosures to hold cold compresses, ice packs, pain ointment, etc. directly upon, or in close proximity to, the affected area. Alternately, the material may be one or more single-use strips that include adhesive such that the strips act to separate the affected area from the non-affected area. Excerpt(s): This invention relates to the treatment of ailments in which there is swelling of a particular area of a person's body, such as with hemorrhoids or as a result of an episiotomy. More particularly, this invention relates to belts and belt attachments that act to alleviate the discomfort and pain caused from swollen body tissue.... There are numerous ailments that cause significant discomfort and pain as a result of swollen body tissue. Hemorrhoids, for example, are swollen blood vessels in and around the anus and lower rectum that have been stretched from the pressure of normal bodily functions. These swollen blood vessels, which can bleed, itch and/or cause great pain and discomfort, are classified as either internal or external. Internal hemorrhoids lie within the rectum, but can sometimes grow large enough so that they protrude outside the anal sphincter. External hemorrhoids lie within the anus area and, likewise, are often quite painful. Once swollen, additional discomfort can be caused by such simple tasks as walking, when friction causes rubbing of the swollen area.... Similar discomfort and pain often occur as a result of an episiotomy--a procedure often used by physicians to attempt to prevent tearing of the vaginal area during childbirth. The incision made during an episiotomy often results in very swollen tissue in and around the area of the episitomy. In addition to the pain and discomfort caused by the incision itself, pain and discomfort may also result from friction when other parts of the body, such as the thighs, rub against the swollen area. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

6

This has been a common practice outside the United States prior to December 2000.

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Hemorrhoid relief and anal hygiene device Inventor(s): Toth, Joseph; (Dearborn, MI) Correspondence: Kaardal & Associates, PC; Attn: Ivar M. Kaardal; 3500 S First Avenue Circle, Suite 250; Sioux Falls; SD; 57105-5807; US Patent Application Number: 20010003157 Date filed: December 18, 2000 Abstract: A hemorrhoid relief and anal hygiene device is provided including a pressure member for placement between opposing buttock surfaces in the natal cleft adjacent to the anus of the user. The pressure member has opposite side faces for each positioning against one of the opposing buttock surfaces of the user. Each of the side faces of the pressure member is substantially planar. Each of the side faces of the pressure member lie in substantially parallel planes. The pressure member has a perimeter wall that extends between the opposite side faces. The perimeter wall has a first section, a second section, and a third section. The first and second sections of the perimeter wall has inboard ends converging at a protruding crest adapted for partial insertion in the anus of the user. The first and second sections are concave for abutting opposite areas of the surface of the anus. The third section extends between outboard ends of the first and second sections. In a second embodiment of the invention, the device includes a bulbous central portion having a substantially spherical shape. A pair of elongate side members is coupled to and extends outwardly from opposed sides of the central portion. Each of the elongate side members has a length between a base end mounted on the central portion and a free end. Each of the elongate side members has a substantially circular cross section. A diameter of the each of the elongate side members increases from the free end toward the base end. Excerpt(s): This application is a continuation-in-part patent application of patent application Ser. No. 09/258,340, filed Nov. 6, 2000.... The present invention relates to hemorrhoid relief devices and more particularly pertains to a new hemorrhoid relief and anal hygiene device for providing a user with hemorrhoid relief and promoting anal hygiene.... The use of hemorrhoid relief devices is known in the prior art. Devices have been proposed which employ belts and straps, but these devices can be uncomfortable and may be unsanitary if not disposable. Other devices have been proposed that, while avoiding the use of belts and straps, are highly invasive for the purpose of applying pressure to the affected area, which requires insertion through an often painfullyinflamed anus. These known devices and apparatuses have thus been less than desirable for those desiring a sanitary and minimally invasive solution to the problem of hemorrhoids. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method and device for treating hemorrhoids Inventor(s): Eveland, Winsor; (Englewood, FL) Correspondence: LAURA G. BARROW ESQ. P. O. BOX 215; ESTERO; FL; 33928-0215; US Patent Application Number: 20020071879 Date filed: December 7, 2000

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Abstract: A method and device for treating hemorrhoids is described and illustrated herein comprising, in part, the application of external heat to the affected rectal area of a person suffering from hemorrhoids. Excerpt(s): Hemorrhoids are caused by the swelling and thrombosis of a large plexus of veins in the anal canal followed by edema. Conditions that frequently cause the formation of hemorrhoids include chronic constipation, irregularity in bowel movements, poor diet, and pregnancy-induced interference with the venous return flow due to fetal pressures against the pelvic area. Hemorrhoids can be quite painful and on occasion may be accompanied by cracks in the anal cavity, resulting in bleeding and infection.... Current treatments for hemorrhoids include sitz baths three to four times daily in water as hot as the patient can tolerate comfortably. Patients often consume bulk stool formers to aid in bowel movements while acute hemorrhoids often require surgical intervention.... The present invention is directed to a method of treating external hemorrhoids by applying externally to the rectal area a stream of hot air at least once a day until shrinkage of the hemorrhoids results. Certain aspects of the present invention include a hot air blower specifically designed for applying a stream hot air to the rectal area with greater ease. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Therapeutic patch useful for the treatment of hemorrhoids Inventor(s): Rolf, David; (Eden Prairie, MN), Buseman, Teri; (Minnetonka, MN) Correspondence: SCHWEGMAN, LUNDBERG, WOESSNER & KLUTH, P.A. P.O. BOX 2938; MINNEAPOLIS; MN; 55402; US Patent Application Number: 20020192273 Date filed: April 10, 2002 Abstract: The present invention provides an adhesive patch that includes a flexible backing having a front side and a back side. A therapeutic formulation is positioned on at least a portion of the front side of the backing, in at least a portion of the front side of the backing, or on and in at least a portion of the front side of the backing. The therapeutic formulation includes a vasoconstrictor, a solvent that dissolves the vasoconstrictor, and a pressure sensitive adhesive. The present invention also provides methods of medical use that employ the patch of the present invention. Such uses include, e.g., treating or preventing hemorrhoids in a mammal, providing relief from the discomfort associated with hemorrhoids, providing post-operative relief from discomfort associated with the surgical treatment of hemorrhoids, treating or preventing a bacterial infection associated with hemorrhoids, preventing a bacterial infection associated with the surgical treatment of hemorrhoids, absorbing exudate, blood, or a combination thereof from the region of the anus of a mammal inflicted with hemorrhoids, and absorbing exudate, blood, or a combination thereof from the region of the anus of a mammal during the post-operative treatment of hemorrhoids. Excerpt(s): Hemorrhoids are a varicosity in the lower rectum or anus caused by congestion in the veins of the hemorrhoidal plexus. Hemorrhoids are an enlarged, swollen or dilated (varicose) vein situated at or near the anus. Mosby's Medical, Nursing, & Allied Health Dictionary, Kenneth Anderson, 5th Ed., St. Louis, Mo. (1998); and Stedman's Medical Dictionary, Illustrated, (25th Ed.), Williams & Wilkins: Baltimore (1990).... Hemorrhoids can be internal or external. Internal hemorrhoids occur higher up in the anal canal, beginning above the internal opening of the anus.

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http://www.hemcare.com/what.htm; and Mosby's Medical Encyclopedia, CD-Rom version 2.0 (1997). If they become large enough to protrude from the anus, they become squeezed and painful. Mosby's Medical Encyclopedia, CD-Rom version 2.0 (1997). Small internal hemorrhoids may bleed with bowel movements. Mosby's Medical Encyclopedia, CD-Rom version 2.0 (1997). Bleeding is the most common symptom of internal hemorrhoids, and often the only symptom in mild cases. http://www.hemcare.com/what.htm. Sometimes, internal hemorrhoids will come through the anal opening if straining occurs by the patient when making bowel movements. http://www.hemcare.com/what.htm. This is called a prolapsed internal hemorrhoid and when this occurs, it is often difficult to ease the hemorrhoidal tissue back into the rectum and is usually painful to the patient. http://www.hemcare.com/what.htm.... External hemorrhoids are visible hemorrhoids occurring outside the anal opening. http://www.hemcare.com/what.htm; Mosby's Medical Encyclopedia, CD-Rom version 2.0 (1997). External hemorrhoids are basically skin-covered veins that have ballooned and which appear blue. http://www.hemcare.com/what.htm. Usually, external hemorrhoids appear without any symptoms. http://www.hemcare.com/what.htm. When inflamed, however, external hemorrhoids become red and tender. http://www.hemcare.com/what.htm. External hemorrhoids are usually not painful, and bleeding does not occur unless a hemorrhoidal vein breaks or becomes blocked. Mosby's Medical Encyclopedia, CD-Rom version 2.0 (1997). If a blood clot forms inside an external hemorrhoid, the thrombosed external hemorrhoid can be felt as a firm, tender mass in the anal area, about the size of a pea that often causes the patient severe pain. http://www.hemcare.com/what.htm. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with hemorrhoids, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “hemorrhoids” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on hemorrhoids. You can also use this procedure to view pending patent applications concerning hemorrhoids. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 5. BOOKS ON HEMORRHOIDS Overview This chapter provides bibliographic book references relating to hemorrhoids. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on hemorrhoids include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “hemorrhoids” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on hemorrhoids: •

Handbook of Colon and Rectal Surgery Source: Philadelphia, PA: Lippincott Williams and Wilkins. 2002. 931 p. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax (301) 223-2365. PRICE: $79.00 plus shipping and handling. ISBN: 0781725860. Summary: This handbook provides a more portable version of the larger textbook with the same title: Colon and Rectal Surgery, 4th Edition. The coverage addresses the entire range of diseases affecting the colon, rectum, and anus. A stepwise approach to treatment guides physicians from evaluation to follow up with incisive coverage of symptoms, testing and diagnosis, preparation, medical and surgical management, and postoperative care. Thirty-three chapters cover anatomy and embryology of the anus, rectum, and colon; physiology of the colon; diet and drugs in colorectal surgery; evaluation and diagnostic techniques; flexible sigmoidoscopy and colonoscopy; setting

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up a colorectal physiology laboratory; analgesia (pain killing) in colon and rectal surgery; hemorrhoids; anal fissure; anorectal abscess; anal fistula; rectovaginal and rectourethral fistulas; anal incontinence; colorectal trauma; management of foreign bodies; disorders of defecation; rectal prolapse, solitary rectal ulcer, syndrome of the descending perineum, and rectocele; pediatric surgical problems; cutaneous conditions; colorectal manifestations of acquired immunodeficiency syndrome (HIV); polypoid diseases; carcinoma (cancer) of the colon; carcinoma of the rectum; malignant tumors of the anal canal; less common tumors and tumorlike lesions of the colon, rectum, and anus; diverticular disease; laparoscopic-assisted colon and rectal surgery; vascular diseases; ulcerative colitis; Crohn's disease and indeterminate colitis; intestinal stomas; enterostomal therapy; and miscellaneous colitides. The handbook includes the same illustrations as the larger text. A subject index concludes the volume. •

Digestive Diseases and Disorders Sourcebook Source: Detroit, MI: Omnigraphics. 2000. 300 p. Contact: Available from Omnigraphics, Inc. 615 Griswold, Detroit, MI 48226. (800) 2341340. Fax (800) 875-1340. PRICE: $48.00 plus shipping and handling. ISBN: 0780803272. Summary: This sourcebook provides basic information for the layperson about common disorders of the upper and lower digestive tract. The sourcebook also includes information about medications and recommendations for maintaining a healthy digestive tract. The book's 40 chapters are arranged in three major parts. The first section, Maintaining a Healthy Digestive Tract, offers basic information about the digestive system and digestive diseases, information about tests and treatments, and recommendations for maintaining a healthy digestive system. The second section, Digestive Diseases and Functional Disorders, describes nearly 40 different diseases and disorders affecting the digestive system. These include appendicitis, bleeding in the digestive tract, celiac disease, colostomy, constipation, constipation in children, Crohn's disease, cyclic vomiting syndrome, diarrhea, diverticulosis and diverticulitis, gallstones, gas in the digestive tract, heartburn (gastroesophageal reflux disease), hemorrhoids, hernias, Hirschsprung's disease, ileostomy, indigestion (dyspepsia), intestinal pseudoobstruction, irritable bowel syndrome (IBS), IBS in children, lactose intolerance, Menetrier's disease, rapid gastric emptying, short bowel syndrome, ulcerative colitis, ulcers, Whipple's disease, and Zollinger Ellison syndrome. The final section offers a glossary of terms, a subject index and a directory of digestive diseases organizations (which includes website and email addresses as available). Material in the book was collected from a wide range of government agencies, nonprofit organizations, and periodicals.

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ABC of Colorectal Diseases. 2nd ed Source: London, UK: BMJ Publishing Group. 1999. 120 p. Contact: Available from BMJ Publishing Group. BMA Books, BMA House, Tavistock Square, London WCIH 9JR. Fax 44 (0)20 7383 6402. E-mail: [email protected]. Website: www.bmjbooks.com. PRICE: Contact publisher for price. ISBN: 0727911058. Summary: Colorectal diseases are common and patients may present to doctors in almost any sphere of medical practice. This atlas is a reference to all the major colorectal diseases, covering signs and symptoms, initial diagnoses, and patient care management, as well as advice on when to refer for specialist treatment. The editor notes that minor anorectal problems, such as hemorrhoids, may be regarded by doctor and patient as being of little consequence, but they can cause considerable distress and may indicate

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serious underlying pathology. Fortunately, most anorectal conditions are easily diagnosed and can be effectively treated. The atlas includes 26 chapters, covering anatomy and physiology, investigation of colorectal disorders, constipation, diarrhea, lower gastrointestinal hemorrhage, irritable bowel syndrome (IBS), hemorrhoids, anal fissures and fistulas, pilonidal sinus, pruritis (itching) ani, rectal prolapse, fecal incontinence, appendicitis, diverticular disease, inflammatory bowel disease (IBD), colorectal neoplasia (benign tumors and bowel cancer), anal cancer, intestinal stomas, large bowel volvulus, colorectal trauma, sexually transmitted diseases and papillomas, tropical colonic diseases, pediatric problems, and drugs in the management of colorectal diseases. Each chapter includes full color photographs and illustrations, sidebars that summarize the information presented, and patient care management algorithms. A subject index concludes the text. •

PDR for Herbal Medicines. 1st ed Source: Montvale, NJ: Medical Economics Company. 1998. 1244 p. Contact: Available from Medical Economics Publishing Inc. P.O. Box 10689, Des Moines, IA 50336. (800) 922-0937. Fax (515) 284-6714. Website: www.medecbookstore.com. PRICE: $59.99. ISBN: 1563632926. Summary: Most of today's herbal remedies exhibit varying degrees of therapeutic value. Some, such as ginkgo, valerian, and saw palmetto, seem genuinely useful, while others, such as ephedra, tansy, and nightshade, can actually be dangerous. As the use of unfamiliar botanicals spreads, the need to steer patients toward the few truly useful preparations and warn them away from ineffective, dangerous alternatives is becoming an increasingly significant priority. This volume, from the publishers of Physicians Desk Reference, brings together the findings of the German Regulatory Authority's herbal watchdog agency (commonly caused Commission E). This agency conducted an intensive assessment of the peer-reviewed literature on some 300 common botanicals, weighing the quality of the clinical evidence and identifying the uses for which the herb can reasonably be considered effective. This reference book contains profiles of over 600 medicinal herbs. Each entry contains up to 9 standard sections: name(s), description, actions and pharmacology, indications and usage, contraindications, precautions and adverse reactions, overdosage, dosage, and literature. The entries have also been indexed by scientific and common name, indications, therapeutic category, and side effects. To assist in identification, the reference book includes a section of full-color plates of the plants included. The book concludes with a glossary of the specialized botanical nomenclature and other unfamiliar terminology, a list of poison control centers, and a list of drug information centers. Some of the herbs are listed for use for abdominal cramps or distress, acid indigestion, appetite stimulation, rectal bleeding, various bowel disorders, stomach cancer, cholelithiasis (gallstones), colic, colitis, constipation, dehydration, diarrhea, digestive disorders, dysentery, enteritis, anal fissure, flatulence (intestinal gas), gastritis, gastroenteritis, gastrointestinal disorders, gout, helminthiasis, hemorrhage, hemorrhoids, hepatitis, hypercholesterolemia, jaundice, liver and gall bladder complaints, liver disorders, malaria, nausea, abdominal pain, and vomiting.

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Healthwise Handbook: A Self-Care Manual for You. 13th ed. [La Salud en Casa: Guia Practica de Healthwise] Source: Boise, ID: Healthwise, Incorporated. 1997. 354 p.

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Contact: Available from Healthwise, Incorporated. 2601 North Bogus Basin Road, P.O. Box 1989, Boise, ID 83702-1989. (800) 706-9646 or (208) 345-1161. Fax (208) 345-1897. Website: www.healthwise.org. PRICE: $9.95 per copy plus shipping and handling; bulk copies available. ISBN: 1877930296 for English version; 1877930474 for Spanish version. Summary: This self-care handbook includes basic guidelines on how to recognize and cope with more than 180 of the most common health problems. These guidelines are based on medical information from leading medical and consumer publications, with review and input from doctors, nurses, pharmacists, and other health professionals. The book is divided into five sections: Self-Care Basics, which covers what a wise medical consumer should know and how to deal with first aid and emergencies; Health Problems, which discusses the prevention, treatment, and decisions on when to call a doctor for more than 180 common illnesses and injuries; Men's and Women's Health; Staying Healthy, which offers tips and techniques for fitness, nutrition, stress management, and mental health; and Self-Care Resources, including how to manage medications and what should be kept in the home to cope with health problems. Other topics include how to make the most of doctor's visits, how to improve quality and lower the cost of necessary health care, what immunizations and screening tests are important, and which medications, supplies, equipment, and resources to have on hand. Sections related to digestive system diseases include abdominal wounds, choking, poisoning, appendicitis, constipation, dehydration, diarrhea, heartburn, hemorrhoids, hernia, irritable bowel syndrome, nausea and vomiting, stomach flu and food poisoning, ulcers, mouth and dental problems, eating disorders, and nutrition. A subject index concludes the volume. •

Power of Your Plate: A Plan for Better Living Source: Summertown, TN: Book Publishing Company. 1995. 255 p. Contact: Available from Book Publishing Company. Mail Order Catalog, P.O. Box 180, Summertown, TN 38483. (800) 695-2241. Wholesale orders available from Book Publishing Company. P.O. Box 99, Summertown, TN 38483. (615) 964-3571. PRICE: $12.95 plus $2.50 shipping. ISBN: 157067003X. Summary: This book provides detailed information on how food choices can improve health, emphasizing the benefits of a vegetarian diet. Eleven chapters cover topics including cholesterol, food, and the heart; tackling cancer; new strategies for weight control; foodborne illness; common health problems that are related to diet; food and the mind; the evolution of the human diet; lessons from Asia; recommendations; will power; and food ideas and recipes. The book also includes an interview with Dr. Michael DeBakey, a cardiovascular surgeon and pioneer in heart transplants. The chapter on common health problems covers constipation, hemorrhoids, hiatus hernia, diabetes, osteoporosis and kidney disease as problems related to food. A brief discussion of Dr. Denis Burkitt's work with dietary fiber is included. 83 references.

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Instructions for Patients. 5th ed Source: Philadelphia, PA: W.B. Saunders Company. 1994. 598 p. Contact: Available from W.B. Saunders Company. Book Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522. Fax (800) 874-6418. PRICE: $49.95. ISBN: 0721649300 (English); 0721669972 (Spanish). Summary: This paper-bound book presents a number of patient instruction fact sheets. Each fact sheet includes three sections: basic information on signs and symptoms,

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causes, risk factors, etc. treatment; and when to contact one's health care provider. Digestive system topics include food allergy, anal fissure, celiac disease, appendicitis, Crohn's disease, constipation, ulcerative colitis, cirrhosis of the liver, cholecystitis or cholangitis, diarrhea, diverticular disease, gallstones, gastritis, hiatal hernia, hemorrhoids, heartburn, irritable bowel syndrome, and lactose intolerance, among others. The fact sheets are designed to be photocopied and distributed to patients as a reinforcement of oral instructions and as a teaching tool. The book is available in English or Spanish. •

Current Therapy in Colon and Rectal Surgery Source: Philadelphia, PA: B.C. Decker, Inc. 1990. 440 p. Contact: Available from C.V. Mosby Company. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 426-4545. PRICE: $99; plus shipping and handling (as of 1994). ISBN: 1556640439. Summary: This book, comprised of 81 papers by surgeons, provides specific information and guidelines concerning current surgical practices in the treatment of colorectal diseases. The papers cover disease processes occurring proximal to or outside the large intestine, but within the domain of the abdominal or colorectal surgeon. Medical management of certain conditions commonly encountered by surgeons, such as inflammatory bowel disease, also is covered. In certain cases, information which is not readily available is provided on complications of common specific procedures and methods of management. In some sections, such as those dealing with ulcerative colitis and rectal cancer, surgical options are discussed. The 81 papers are grouped among five general categories: anal and perianal region (anatomy and physiology of the anorectum; hemorrhoids; anal fissure and fistula; pruritus ani; Bowen's, Paget's and Hirschsprung's disease; and anal carcinoma); rectal and pararectal region (rectal stricture, prolapse, and trauma; tumors; and rectal cancer); the colon (medical and surgical alternatives for and complications of ulcerative colitis; Crohn's disease; diverticulitis of the colon; vascular ectasia; large bowel obstruction; volvulus of the colon; colorectal cancer, tumors, and polyps; and constipation); the small bowel (small bowel obstruction, short bowel syndrome, Crohn's disease, and small bowel and carcinoid tumors); and other complications (stapling techniques in rectal surgery, nutritional support, urologic complications of colorectal surgery, stoma complications, and enterostomal therapy). Selected tabular data and numerous illustrations are presented throughout the text.

•

Advanced Therapeutic Endoscopy Source: New York, NY: Raven Press, Ltd. 1990. 379 p. Contact: Available from Raven Press. 1185 Avenue of the Americas, Dept. 5B, New York, NY 10036. (800) 777-2836 or (212) 930-9500. Fax (212) 869-3495. PRICE: $139 plus shipping (as of 1995). ISBN: 0881676810. Summary: This medical textbook is designed to provide the experienced endoscopist with information about the newest and most innovative techniques in the therapeutic use of endoscopy. Thirty chapters, each authored by specialists in the field, are organized into sections considering the esophagus, the stomach, the colon, the small bowel and liver, the biliary system, general considerations, and pediatric endoscopy. Specific topics include dilation of benign esophageal strictures; foreign bodies and bezoars of the upper gastrointestinal tract; sclerotherapy of esophageal varices; therapy for upper gastrointestinal hemorrhage; hemorrhoids; dilatation of colonic strictures; anorectal manometry; enteroscopy; endoscopic sphincterotomy; endoscopic retrograde

106 Hemorrhoids

cholangiopancreatography; biliary and pancreatic manometry; the use of antibiotic prophylaxis; and gastroscopy and colonoscopy in children. Each chapter includes diagrams and charts, black-and-white photographs, and numerous references. A subject index concludes the volume.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “hemorrhoids” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “hemorrhoids” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “hemorrhoids” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

A Cure for Hemorrhoids by Joseph Bartanus; ISBN: 0806254181; http://www.amazon.com/exec/obidos/ASIN/0806254181/icongroupinterna

•

Bottom Line: About Hemorrhoids, Fissures and Fistulas by John Egerton; ISBN: 0939838184; http://www.amazon.com/exec/obidos/ASIN/0939838184/icongroupinterna

•

Crohn's, Colitis, Hemorrhoids, and Me: Kathy's Journal by Kathlene J. O'Leary (1995); ISBN: 0964757133; http://www.amazon.com/exec/obidos/ASIN/0964757133/icongroupinterna

•

Hemorrhoids : a cure & preventative : the problem, personal treatment, medical treatment by Robert Lawrence Holt; ISBN: 0930926013; http://www.amazon.com/exec/obidos/ASIN/0930926013/icongroupinterna

•

Hemorrhoids : A Guide for Patients by Larry C. Carey (Editor), et al; ISBN: 1885274262; http://www.amazon.com/exec/obidos/ASIN/1885274262/icongroupinterna

•

Hemorrhoids a Cure and Preventive by Michael Mitchell; ISBN: 0930926250; http://www.amazon.com/exec/obidos/ASIN/0930926250/icongroupinterna

•

Hemorrhoids: A Book for Silent Suffers by Jagar Rama, et al; ISBN: 0962529508; http://www.amazon.com/exec/obidos/ASIN/0962529508/icongroupinterna

•

Hemorrhoids: A Cure and Preventive by Robert Lawrence. Holt; ISBN: 0688035841; http://www.amazon.com/exec/obidos/ASIN/0688035841/icongroupinterna

•

Hemorrhoids: An Evaluation of Methods of Treatment by C.G.M.I. Baeten; ISBN: 9023221281; http://www.amazon.com/exec/obidos/ASIN/9023221281/icongroupinterna

•

Hemorrhoids: Current Concepts on Causation and Management by Olive Wood (Editor) (1979); ISBN: 0127949186; http://www.amazon.com/exec/obidos/ASIN/0127949186/icongroupinterna

•

How I Prevented Hemorrhoids by Mike Tecton (1999); ISBN: 0922070369; http://www.amazon.com/exec/obidos/ASIN/0922070369/icongroupinterna

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•

Human Hemorrhoids: Guidebook for Medicine, Reference and Research by Hasu Deway El-Aman; ISBN: 0881641340; http://www.amazon.com/exec/obidos/ASIN/0881641340/icongroupinterna

•

Living with Your Colitis and Hemorrhoids and Related Disorders [CLV] by Theodore Berland (Author); ISBN: 0312490704; http://www.amazon.com/exec/obidos/ASIN/0312490704/icongroupinterna

•

Put Hemorrhoids and Constipation Behind You: New Treatment and Technology for 2 of Today's Most Common Yet Least Talked-About Problems by Kenneth Yasny, Kenneth Yasney; ISBN: 1884820220; http://www.amazon.com/exec/obidos/ASIN/1884820220/icongroupinterna

•

Relief from Chronic Hemorrhoids by Barbara Becker, Steven Z. Brandeis (Contributor); ISBN: 0440210747; http://www.amazon.com/exec/obidos/ASIN/0440210747/icongroupinterna

•

The Book of Hemorrhoids and Other Pains in the Ass; ISBN: 0880090057; http://www.amazon.com/exec/obidos/ASIN/0880090057/icongroupinterna

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The Hemorrhoids by Sidney E. Wanderman, et al; ISBN: 0890434468; http://www.amazon.com/exec/obidos/ASIN/0890434468/icongroupinterna

•

The Lowdown on Hemorrhoids, Piles & Other Lowdown Disorders by Stanley Berkowitz; ISBN: 0917746015; http://www.amazon.com/exec/obidos/ASIN/0917746015/icongroupinterna

•

The Official Patient's Sourcebook on Hemorrhoids: A Revised and Updated Directory for the Internet Age by Icon Health Publications (2002); ISBN: 059783279X; http://www.amazon.com/exec/obidos/ASIN/059783279X/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “hemorrhoids” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:7 •

A pathological and clinical consideration of hemorrhoidal disease. Author: Malmgren, George Erland,; Year: 1960; [Minneapolis] 1930

•

Hemorrhoids, by Marion C. Pruitt... with 73 illustrations, including 7 in color. Author: Pruitt, Marion Columbus,; Year: 1958; St. Louis, The C. V. Mosby company, 1938

7

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

108 Hemorrhoids

•

Hemorrhoids, the injection treatment, and pruritus ani, by Lawrence Goldbacher... illustrated with 31 half-tone and line engravings, some in color. Author: Goldbacher, Lawrence,; Year: 1967; Philadelphia, F. A. Davis company, 1930

•

Hemorrhoids, the injection treatment, and pruritus ani, by Lawrence Goldbacher... illustrated with 31 half-tones and line engravings, some in colors. Author: Goldbacher, Lawrence,; Year: 1962; Philadelphia, F. A. Davis company, 1931

•

Injection treatment of internal hemorrhoids, by Marion C. Pruitt... Author: Pruitt, Marion Columbus,; Year: 1930; St. Louis, The C. V. Mosby company, 1929

•

Living with your colitis and hemorrhoids, and related disorders Author: Berland, Theodore,; Year: 1958; New York: St. Martin's Press, c1975

•

On hemorrhoids [electronic resource] Author: Hippocrates.; Year: 1972; [United States]: D.C. Stevenson, Web Atomics, c2000

•

Outpatient hemorrhoidectomy: ligation technique. Author: Eastman, Peter F.,; Year: 1966; New York, Medical Examination Pub. Co., 1970; ISBN: 874887526

•

Proctoscopic examination and the treatment of hemorrhoids and anal pruritus, by Louis A. Buie... with 72 illustrations. Author: Buie, Louis Arthur,; Year: 1967; Philadelphia and London, W. B. Saunders company, 1931

•

The injection treatment of hemorrhoids, by Dr. Charles Conrad Miller. Author: Miller, Charles Conrad,; Year: 1931; Chicago, Modern surgery publications, 1929

•

The modern treatment of hemorrhoids, by Joseph Franklin Montague... foreword by Harlow Brooks... 116 illustrations. Author: Montague, Joseph Franklin,; Year: 1966; Philadelphia and London, J. B. Lippincott company [c1934]

•

Tumours: their nature and treatment, by new remedies, and by operations different from those usually performed by the knife or caustics; to which are added remarks on hemorrhoids and fistula in ano, with new and comparatively painless operations for their cure. Author: Pattison, John.; Year: 1968; London, Turner, 1869

Chapters on Hemorrhoids In order to find chapters that specifically relate to hemorrhoids, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and hemorrhoids using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “hemorrhoids” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on hemorrhoids: •

Hemorrhoidal Symptom Complex Source: in Stein, E. Anorectal and Colon Diseases: Textbook and Color Atlas of Proctology. New York, NY: Springer-Verlag. 2003. p. 71-106. Contact: Available from Springer-Verlag New York, Inc. 175 Fifth Avenue, New York, NY 10010. (800) SPRINGER or (212) 460-1500. Fax (800) 777-4643 or (201) 348-4505. Email: [email protected]. Website: www.springer-ny.com. PRICE: $199.00 plus shipping and handling. ISBN: 3540430393.

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Summary: Hemorrhoids are found on proctoscopic examination in about 70 percent of adults over 30 years of age. This high percentage makes clear that the vast majority of individuals with hemorrhoids are asymptomatic. However, when there is impaired blood flow in the sinusoidal cushions associated with inflammation and spread to adjacent tissues, then pain, discharge, bleeding, and other symptoms may occur (the hemorrhoidal symptom complex). This chapter on the hemorrhoidal symptom complex is from a multidisciplinary reference book and atlas that covers all aspects of anorectal and colon disease (proctology). Topics in this chapter include hemorrhoids, anal tags, perianal thrombosis (clotting), anal prolapse, rectal prolapse, cryptitis and papillitis, hypertrophic anal papillae, anal rhagades and erosions, anal fissure, anorectal abscess, and fistulas. For each condition, the author discusses etiology, clinical features, diagnosis, and therapy. The chapter includes full-color and black-and-white illustrations and photographs, to support the heavily-visual aspects of proctology. Each section concludes with a list of references. 20 figures. 1 table. 157 references.

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CHAPTER 6. MULTIMEDIA ON HEMORRHOIDS Overview In this chapter, we show you how to keep current on multimedia sources of information on hemorrhoids. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on hemorrhoids is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “hemorrhoids” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “hemorrhoids” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on hemorrhoids: •

Bottom Line on Hemorrhoids Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1996. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. PRICE: $19.95 plus shipping and handling; bulk copies available. Order number 051997A. Summary: Straining when going to the bathroom, constipation, prolonged sitting, and infection can all contribute to hemorrhoids, defined as enlarged veins around the anus. This videotape is one in a series of health promotion programs called 'Picture of Health,' produced by the University of Wisconsin. In this program, moderated by Mary Lee and featuring gastroenterologist John Wyman, the common symptoms, diagnosis, and management of hemorrhoids are covered. Dr. Wyman explains the difference between internal and external hemorrhoids (merely an anatomical distinction), and prolapsed

112 Hemorrhoids

hemorrhoids, which are enlarged internal hemorrhoids that drop (prolapse) outside the anus. Symptoms include pain and bleeding; pain because of blood clots and bleeding due to trauma to the thin walled veins in that area. The causes of hemorrhoids include straining during defecation, pregnancy, prolonged sitting, constipation, childbirth, and obesity. Dr. Wyman recommends that anyone over the age of 40 who experiences rectal bleeding should consult a physician; younger people who experience recurrent bleeding should also see their physician (to rule out inflammatory bowel disease). Treatment options for hemorrhoids include changes in habits, such as not straining, not wiping vigorously, softening the stool with dietary changes (usually the addition of dietary fiber), and not prolonging sitting on the toilet. Surgery is used for external hemorrhoids, to remove the veins and tributaries; for internal hemorrhoids, rubber band ligation is very effective. The program also explores the problem of perianal dermatitis, including its risk factors and treatment options (which focus on keeping the area clean and dry, and not using over the counter creams that are petroleum based). The program reiterates the importance of having any rectal bleeding investigated by one's health care provider. The program concludes by referring viewers to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Bibliography: Multimedia on Hemorrhoids The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in hemorrhoids (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on hemorrhoids (for more information, follow the hyperlink indicated): •

Alternatives in the treatment of hemorrhoids [sound recording] Source: American College of Surgeons; Year: 1976; Format: Sound recording; Chicago, Ill.: The College, c1976

•

Anorectal anatomy, proctectomy, intestinal stomas and management of hemorrhoids, fistulas, fissures, and pruritis [i.e. pruritus] ani [sound recording] Source: American College of Surgeons; Year: 1977; Format: I.e. pruritus; [Chicago]: The College, 1977

•

Hemmorhoid [i.e. hemorrhoid] treatment by infrared coagulation [videorecording] Source: produced by Ciné-Med; Year: 1990; Format: I.e. hemorrhoid; [United States]: Redfield Corp., c1990

•

Hemorrhoidectomy [videorecording] Source: sponsored by University of Miami, School of Medicine, Department of Surgery; through an educational grant from Glaxo Pharmaceuticals; Year: 1990; Format: Videorecording; Research Triangle Park, NC: Glaxo Pharmaceuticals, c1990

•

On hemorrhoids [electronic resource] Source: by Hippocrates; translated by Francis Adams; Year: 2000; Format: Electronic resource; [United States]: D.C. Stevenson, Web Atomics, c2000

•

Outpatient hemorrhoidectomy [motion picture]: ligation technique Source: a Billy Burke production; by Peter F. Eastman; presented by Southern California Permanente Medical Group and Kaiser Foundation Hospital, Harbor City, California; Year: 1969;

Multimedia 113

Format: Motion picture; United States: Southern California Medical Group: Kaiser Foundation Hospital, [1969] •

Treatment of hemorrhoids with laser [videorecording] Source: with Howard J. Eddy; Year: 1985; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1985

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CHAPTER 7. PERIODICALS AND NEWS ON HEMORRHOIDS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover hemorrhoids.

News Services and Press Releases One of the simplest ways of tracking press releases on hemorrhoids is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “hemorrhoids” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to hemorrhoids. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “hemorrhoids” (or synonyms). The following was recently listed in this archive for hemorrhoids: •

Stapling method less painful than conventional hemorrhoidectomy Source: Reuters Medical News Date: December 24, 2002 http://www.reutershealth.com/archive/2002/12/24/professional/links/20021224clin0 24.html

116 Hemorrhoids

•

Stapling hemorrhoids less painful than removal Source: Reuters Health eLine Date: April 11, 2002

•

Less pain, disability documented after hemorrhoidectomy by stapler than excision Source: Reuters Medical News Date: April 10, 2002

•

Sutureless closed hemorrhoidectomy outperforms conventional procedure Source: Reuters Medical News Date: August 13, 2001

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Stapled hemorrhoidectomy associated with high rate of persistent pain Source: Reuters Medical News Date: August 25, 2000

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Hemorrhoid 'stapling' linked to long-term pain Source: Reuters Health eLine Date: August 25, 2000

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Stapled hemorrhoidectomy minimally painful, allows fast return to normal activities Source: Reuters Medical News Date: March 03, 2000

•

New hemorrhoid removal surgery is less painful Source: Reuters Health eLine Date: March 03, 2000

•

Nitro for Hemorrhoids Source: Reuters Health eLine Date: June 24, 1997 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name.

Periodicals and News 117

Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “hemorrhoids” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “hemorrhoids” (or synonyms). If you know the name of a company that is relevant to hemorrhoids, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “hemorrhoids” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “hemorrhoids” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on hemorrhoids: •

Hemorrhoids: Managing This Harmless but Bothersome Problem Source: Mayo Clinic Health Letter. 14(2): 1-3. February 1996. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037. Summary: This newsletter article presents information on managing hemorrhoids. Topics include how hemorrhoids develop, constipation as a common cause of hemorrhoids, symptoms of different types of hemorrhoids (internal, prolapsed, external), self-care steps to manage hemorrhoidal flareups, medical treatments (rubber

118 Hemorrhoids

band ligation, infrared coagulation, bipolar electrocoagulation, and laser therapy), surgery, and suggestions to avoid hemorrhoids. 2 figures.

Academic Periodicals covering Hemorrhoids Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to hemorrhoids. In addition to these sources, you can search for articles covering hemorrhoids that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

121

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute8: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

8

These publications are typically written by one or more of the various NIH Institutes.

122 Hemorrhoids

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources 123

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.9 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:10 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

9

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 10 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “hemorrhoids” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “hemorrhoids” (or synonyms) into the “For these words:” box. The following is a sample result: •

Hemorrhoids (Piles) Source: in Griffith, H.W. Instructions for Patients. 5th ed. Philadelphia, PA: W.B. Saunders Company. 1994. p. 213. Contact: Available from W.B. Saunders Company. Book Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522. Fax (800) 874-6418. PRICE: $49.95. ISBN: 0721649300 (English); 0721669972 (Spanish). Summary: This fact sheet provides basic information on frequent signs and symptoms, causes, risk factors, preventive measures, etc. treatment, medication, and diet; and when to contact one's health care provider. The fact sheet is designed to be photocopied and distributed to patients as a reinforcement of oral instructions and as a teaching tool. The book in which the fact sheet appears is available in English or Spanish.

The NLM Gateway11 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.12 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “hemorrhoids” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category.

11 12

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).

Physician Resources 125

Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 3567 190 32 2 0 3791

HSTAT13 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.14 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.15 Simply search by “hemorrhoids” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists16 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.17 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.18 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

13

Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.

14

The HSTAT URL is http://hstat.nlm.nih.gov/.

15

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 16 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 17

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 18 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

126 Hemorrhoids

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on hemorrhoids can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to hemorrhoids. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to hemorrhoids. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “hemorrhoids”:

128 Hemorrhoids

•

Guides on hemorrhoids Hemorrhoids http://www.nlm.nih.gov/medlineplus/hemorrhoids.html

•

Other Guides Colonic Polyps http://www.nlm.nih.gov/medlineplus/colonicpolyps.html Colorectal Cancer http://www.nlm.nih.gov/medlineplus/colorectalcancer.html

Within the health topic page dedicated to hemorrhoids, the following was listed: •

General/Overviews Hemorrhoids Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00096 Hemorrhoids: Reducing the Pain and Discomfort Source: American Academy of Family Physicians http://familydoctor.org/healthfacts/090/

•

Diagnosis/Symptoms Elimination Problems: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/532.html

•

Treatment Hemorrhoid Surgery http://www.nlm.nih.gov/medlineplus/tutorials/hemorrhoidsurgeryloader.html

•

Nutrition Fiber: How to Increase the Amount in Your Diet Source: American Academy of Family Physicians http://familydoctor.org/handouts/099.html

•

From the National Institutes of Health Hemorrhoids Source: National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/ddiseases/pubs/hemorrhoids/index.htm

•

Organizations American Gastroenterological Association http://www.gastro.org/ National Digestive Diseases Information Clearinghouse

Patient Resources 129

http://digestive.niddk.nih.gov/ You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on hemorrhoids. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Hemorrhoids: Steps to Finding Relief Source: San Bruno, CA: StayWell Company. 1999. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. E-mail: [email protected]. Website: www.staywell.com. PRICE: $17.95 for pack of 50; plus shipping and handling. Summary: This patient education brochure describes hemorrhoids and their treatment. Written in nontechnical language, the brochure first defines hemorrhoids as cushions of swollen veins in the anal canal. Hemorrhoids are a very common problem and can affect all kinds of people, including those who sit for long periods, pregnant women, and others. Symptoms of hemorrhoids can include pain, itching, irritation, burning, and bleeding of the rectal area. Constipation (dry, hard to pass stool) is a major cause of hemorrhoids. Other causes include heavy lifting, lack of exercise, too much strenuous exercise, chronic cough, and poor bowel habits (such as sitting on the toilet for long periods of time). Diagnosis is important to rule out more serious diseases and will include the patient's medical history and some diagnostic tests, such as sigmoidoscopy. Most treatment plans focus on steps that the patient can follow at home, including sitz baths, nonprescription medications, and good bowel habits. The brochure reminds readers that steps to ease constipation include increasing fluid intake and undertaking regular exercise. One section of the brochure illustrates and describes the physiology of the anal canal and the types of hemorrhoids that can occur (external or internal). The last page of the brochure summarizes the recommendations for increasing dietary fiber. The brochure is illustrated with full color line drawings. 6 figures.

•

Hemorrhoid Book: A Look at Hemorrhoids, How They're Treated and How You Can Prevent Them from Coming Back. [Folleto de las Hemorroides: Information Sobre las Hemorroides: Tratamiento y Prevencion] Source: San Bruno, CA: StayWell Company. 1999. 15 p.

130 Hemorrhoids

Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. PRICE: $1.25 per copy; plus shipping and handling. Summary: This patient education brochure describes hemorrhoids and problems that can occur with swollen hemorrhoids. Written in nontechnical language, the brochure first defines hemorrhoids as normal cushions of tissue that swell gently to aid in the process of elimination (defecation). Hemorrhoids become a problem only when they swell too much, at which point they may cause pain, itching, irritation, burning, and bleeding. The primary cause is a low fiber diet, leading to constipation and straining on the toilet. Other causes include a sedentary lifestyle, too much strenuous exercise, pressure on the rectum from pregnancy or from standing a lot, regulating bowel habits by the clock, and medications that cause diarrhea or constipation. Because symptoms of hemorrhoids can mimic symptoms of a more serious disease such as colorectal cancer, prompt evaluation and diagnosis is important. Once the doctor confirms a diagnosis of bleeding or swollen hemorrhoids, treatment options can be explored. For many people, a change in diet and level of activity is the only treatment that may be needed. For others, treatment at the doctor's office or surgery may be necessary. Maintaining a healthy, high fiber diet, which relieves constipation and eases the digestive process, is the best way to prevent bleeding or swollen hemorrhoids. The brochure describes and illustrates external and internal hemorrhoids, and other anal problems, including fissures and fistulae. Treatment options reviewed include injection therapy, infrared coagulation, banding, cryosurgery, laser therapy, and hemorrhoidectomy (surgical removal of the hemorrhoids). The brochure is illustrated with full color line drawings and is available in English or Spanish. 27 figures. •

Hemorrhoids Source: Fort Worth, TX: Konsyl Pharmaceuticals, Inc. 1998. [2 p.]. Contact: Available from Konsyl Pharmaceuticals, Inc. 4200 South Hulen Street, Suite 513, Fort Worth, TX 76109-4912. (800) 356-6795 or (817) 763-8011. Fax (817) 731-9389. Website: www.konsyl.com. PRICE: Single copy free. Summary: This brochure provides basic information about hemorrhoids, vascular tissue pads in and about the anus. The symptoms of hemorrhoids can include rectal pain, protrusion, occasional itching, or bleeding on toilet tissue or in the toilet bowl. The brochure discusses the problems encountered with internal and external hemorrhoids, then outlines the options for the nonsurgical treatment of the condition. This treatment can include an increase in dietary fiber and an increase in water intake, regular exercise, and a decrease in dietary fats. The brochure also briefly outlines surgical treatments for hemorrhoids, including sclerotherapy, infrared coagulation, and banding procedures. The author emphasizes the use of fiber supplements, such as Konsyl (the manufacturer of which is the producer of this brochure). The author also reminds readers that they should have any rectal problems appropriately diagnosed, to rule out a more serious problem, such as polyps, colitis, or cancer. The brochure is illustrated with full color drawings and photographs. 4 figures.

•

Hemorrhoids. [Hemorroides] Source: Camp Hill, PA: Chek-Med Systems, Inc. 1996. 2 p. Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011. (800) 451-5797. Fax (717) 761-0216. PRICE: $22 per pack of 50 pamphlets for


order of 3-10 packs; 3 packet minimum. Discounts available for larger quantities and complete kits of gastroenterology pamphlets. Summary: This patient brochure, available in English and Spanish, provides information about the causes, complications, and treatment of hemorrhoids ('piles'). Hemorrhoids alone are rarely serious. They can, however, mask a more serious disorder, such as colon or rectal cancer, and require proper diagnosis and treatment by a physician. The complications of hemorrhoids include thrombosis and pain, bleeding, and itching and irritation. Practical guidelines are included for treating hemorrhoids, involving both hygienic measures and dietary considerations. Treatment requiring surgical and nonsurgical approaches also are discussed. Steps for preventing hemorrhoids are listed. It is noted that hemorrhoids are an especially common disorder, and often reduce by themselves or with minimal treatment. •

Hemorrhoids: A Guide for Patients Source: San Ramon, CA: HIN, Inc., The Health Information Network. 1996. 25 p. Contact: Available from HIN, Inc. 231 Market Place, Number 331, San Ramon, CA 94583. (800) HIN-1121. Fax (925) 358-4377. Website: www.hinbooks.com. PRICE: $36.25 plus shipping per set of 25 booklets; quantity discounts available. Order Number 0204. ISBN: 1885274262. Summary: This patient education brochure familiarizes readers with hemorrhoids and their treatment. The brochure is written in nontechnical language and discusses what hemorrhoids are; symptoms; nonhemorrhoid conditions; determining when to consult a health care provider; treatment options, including treatment at home and treatment at the doctor's office, and surgery; recovery after surgery; and preventing recurrence of hemorrhoids. The brochure is illustrated with simple line drawings and figures and includes a glossary.

•

Hemorrhoids: Questions and Answers Source: Arlington Heights, IL: American Society of Colon and Rectal Surgeons. 1996. [4 p.]. Contact: Available from American Society for Colon and Rectal Surgeons (ASCRS). 85 West Algonquin Road, Suite 550, Arlington Heights, IL 60005. (800) 791-0001 or (847) 290-9184. Website: www.fascrs.org. PRICE: Single copy free. Summary: This brochure describes hemorrhoids, enlarged bulging blood vessels in and about the anus and lower rectum. There are two types of hemorrhoids: external and internal. External (outside) hemorrhoids develop near the anus and are covered by very sensitive skin. Internal (inside) hemorrhoids develop within the anus beneath the lining. Painless bleeding and protrusion during bowel movements are the most common symptom. The exact causes are not known, but contributing factors include the upright posture of human beings, aging, chronic constipation or diarrhea, pregnancy, heredity, faulty bowel function, and spending long periods of time (e.g., reading) on the toilet. There is no relationship between hemorrhoids and cancer; however, the symptoms are similar to those of colorectal cancer and other diseases of the digestive system and therefore call for investigation by a health care provider. Mild symptoms can be relieved frequently by increasing the amount of fiber and fluids in the diet. Eliminating excessive straining reduces the pressure on hemorrhoids and helps prevent them from protruding. Severe hemorrhoids require treatment, much of which can be performed on an outpatient basis. The brochure describes treatment options, including ligation (rubber

132 Hemorrhoids

band treatment), injection and coagulation, hemorrhoidectomy, and other treatments, including cryotherapy (freezing). The brochure concludes with a brief description of the specialty of colon and rectal surgeons. 4 figures. •

Relief from Hemorrhoids: Recognizing Symptoms, Relieving Discomfort Source: Cincinnati, OH: Procter and Gamble. 1994. 12 p. Contact: Available from Metamucil-Procter and Gamble. P.O. Box 9032, Cincinnati, OH 45209-9970. PRICE: Single copy free; bulk copies available. Summary: This brochure provides a general overview of hemorrhoids and gives readers recommendations on how to manage the condition. Topics include symptoms; causes; treatment options; prevention, including the role of a high fiber diet; and the use of fiber supplements, including the product Metamucil. The brochure is produced by the manufacturer of Metamucil. The brochure includes a reply card to obtain more information about Metamucil products. 2 figures. 1 table.

•

Hemorrhoids: Reducing the Pain and Discomfort Source: Kansas City, MO: American Academy of Family Physicians. 1994. 4 p. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. PRICE: $22.00 for 100 copies for members, $33.00 for 100 copies for nonmembers. Summary: This patient education brochure helps readers understand hemorrhoids and what to do to reduce the pain and discomfort they may cause. Hemorrhoids are swollen veins in the rectum or anus. Internal hemorrhoids involve the veins inside the rectum; external hemorrhoids involve veins in the skin outside the anus. One of the main things that can lead to hemorrhoids is straining while trying to have a bowel movement. Other risk factors for hemorrhoids include genetics (inherited tendency to have hemorrhoids), pregnancy, obesity, and standing or lifting too much. A health care provider should be consulted for any rectal bleeding, in order to rule out more serious causes and possibly to treat the hemorrhoids. One sidebar provides suggestions for preventing constipation, including increasing dietary fiber, drinking plenty of fluids, and exercising regularly. Strategies for the home care management of hemorrhoids are also outlined. These include: soaking in a warm bath, cleaning the anus carefully after each bowel movement, using ice packs to relieve swelling, using acetaminophen or aspirin to relieve pain, and using a cream or ointment to sooth and numb itching and pain. The brochure concludes with a brief description of the surgical treatments for hemorrhoids and the indications for surgery. 1 figure. 2 tables. (AA-M).

•

Understanding: Hemorrhoids Source: Pittsburgh, PA: SmithKline Beecham Consumer Brands. 1991. 4 p. Contact: Available from SmithKline Beecham. Consumer Brands, P.O. Box 1467, Pittsburgh, PA 15230. (800) 245-1040. PRICE: Single copy free. Bulk orders available to physicians by calling (800) 233-2426. Summary: This patient education brochure provides basic information about hemorrhoids. Topics include a definition of hemorrhoids; causes and incidence; the lack of dietary fiber in the typical Western diet; treatments, including a high fiber diet; and prevention. The brochure concludes with a section summarizing facts about fiber. The brochure, produced by the manufacturers of CITRUCEL, a fiber product, describes the


use of CITRUCEL as part of a therapeutic program to prevent hemorrhoids. 3 references.

The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “hemorrhoids” (or synonyms). The following was recently posted: •

Surgical management of hemorrhoids Source: Society for Surgery of the Alimentary Tract, Inc - Medical Specialty Society; 1996 (revised 2000); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2171&nbr=1397&a mp;string=hemorrhoids Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Hemorrhoids Summary: Basic information for consumers about the causes and treatment of hemorrhoids. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1449

•

Hemorrhoids: Reducing the Pain and Discomfort Summary: The information presented on this page includes a general description of hemorrhoids along with information about the care and treatment of this disorder. Source: American Academy of Family Physicians http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6130

•

Patient Brochures: Colon and Rectal Disorders Summary: Consumer health education information about colon and rectal disorders, including rectal prolapse, diverticular disease, hemorrhoids, polyps of the colon & rectum, and surgical options for related Source: American Society of Colon and Rectal Surgeons http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4298

134 Hemorrhoids

•

Questions and Answers About Hemorrhoids Summary: A general overview about hemorrhoids -- includes causes, symptoms, prevention, prognosis and management. From this page users can also link to a search engine to locate colorectal surgeons locally. Source: American Society of Colon and Rectal Surgeons http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6129 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to hemorrhoids. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources

A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •


•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to hemorrhoids. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with hemorrhoids. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about hemorrhoids. For more information, see


the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “hemorrhoids” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “hemorrhoids”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “hemorrhoids” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “hemorrhoids” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.19

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

19

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

138 Hemorrhoids

libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)20: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

20

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries 139

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

140 Hemorrhoids

•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries 141

•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

142 Hemorrhoids

•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

143

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on hemorrhoids: •

Basic Guidelines for Hemorrhoids Hemorrhoid surgery Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002939.htm Hemorrhoids Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000292.htm

•

Signs & Symptoms for Hemorrhoids Blood in the stool Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003130.htm Constipated Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003125.htm Constipation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003125.htm

144 Hemorrhoids

Incontinence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003142.htm Itching Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003217.htm Problems breathing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Pruritus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003217.htm Sleepy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003208.htm Swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm •

Diagnostics and Tests for Hemorrhoids Anoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003890.htm Digital rectal exam Web site: http://www.nlm.nih.gov/medlineplus/ency/article/007069.htm Proctoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003885.htm Sigmoidoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003885.htm Stool guaiac Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003393.htm

•

Nutrition for Hemorrhoids Fiber Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002470.htm Fiber diet Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002470.htm High-fiber Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002470.htm

•

Surgery and Procedures for Hemorrhoids Hemorrhoidectomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002939.htm

Online Glossaries 145

Laser surgery Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002958.htm •

Background Topics for Hemorrhoids Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Blood clots Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

147

HEMORRHOIDS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Cramps: Abdominal pain due to spasmodic contractions of the bowel. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Ablate: In surgery, is to remove. [NIH] Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Acquired Immunodeficiency Syndrome: An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive Tlymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the CDC in 1993. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the

148 Hemorrhoids

stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Aluminum Compounds: Inorganic compounds that contain aluminum as an integral part of the molecule. [NIH] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [NIH] Anal Fistula: A channel that develops between the anus and the skin. Most fistulas are the result of an abscess (infection) that spreads to the skin. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [NIH]

Dictionary 149

Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Angina: Chest pain that originates in the heart. [NIH] Anginal: Pertaining to or characteristic of angina. [EU] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Anogenital: Pertaining to the anus and external genitals. [EU] Anomalies: Birth defects; abnormalities. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anoscopy: A test to look for fissures, fistulae, and hemorrhoids. The doctor uses a special instrument, called an anoscope, to look into the anus. [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibiotic Prophylaxis: Use of antibiotics before, during, or after a diagnostic, therapeutic, or surgical procedure to prevent infectious complications. [NIH] Antibiotics, Antifungal: Antibiotics inhibiting the growth of or killing fungi and used in the treatment of various fungal diseases. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antineoplastic:

Inhibiting or preventing the development of neoplasms, checking the

150 Hemorrhoids

maturation and proliferation of malignant cells. [EU] Antineoplastic Agents: Substances that inhibit or prevent the proliferation of neoplasms. [NIH]

Antipruritic: Relieving or preventing itching. [EU] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Aspartate: A synthetic amino acid. [NIH] Aspiration: The act of inhaling. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Astringent: Causing contraction, usually locally after topical application. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH]

Dictionary 151

Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Barium enema: A procedure in which a liquid with barium in it is put into the rectum and colon by way of the anus. Barium is a silver-white metallic compound that helps to show the image of the lower gastrointestinal tract on an x-ray. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign tumor: A noncancerous growth that does not invade nearby tissue or spread to other parts of the body. [NIH] Benzaldehyde: A colorless oily liquid used as a flavoring agent and to make dyes, perfumes, and pharmaceuticals. Benzaldehyde is chemically related to benzene. [NIH] Benzoin: A white crystalline compound prepared by condensation of benzaldehyde in potassium cyanide and used in organic syntheses. [NIH] Bewilderment: Impairment or loss of will power. [NIH] Bezoars: Concretions of swallowed hair, fruit or vegetable fibers, or similar substances found in the alimentary canal. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Ducts: Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bismuth: A metallic element that has the atomic symbol Bi, atomic number 83 and atomic weight 208.98. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber.

152 Hemorrhoids

Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Regions: Anatomical areas of the body. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU]

Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Dobesilate: A drug used to reduce hemorrhage in diabetic retinopathy. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoid: A type of tumor usually found in the gastrointestinal system (most often in the appendix), and sometimes in the lungs or other sites. Carcinoid tumors are usually benign. [NIH]

Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH]

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Catecholamines: tyrosine. [NIH]

A general class of ortho-dihydroxyphenylalkylamines derived from

Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Cefotaxime: Semisynthetic broad-spectrum cephalosporin. [NIH] Celiac Disease: A disease characterized by intestinal malabsorption and precipitated by gluten-containing foods. The intestinal mucosa shows loss of villous structure. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Cholangitis: Inflammation of a bile duct. [NIH] Cholecystitis: Inflammation of the gallbladder. [NIH] Cholelithiasis: Presence or formation of gallstones. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active

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enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational beliefs with more realistic and functional ones. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collagen disease: A term previously used to describe chronic diseases of the connective tissue (e.g., rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis), but now is thought to be more appropriate for diseases associated with defects in collagen, which is a component of the connective tissue. [NIH] Colloidal: Of the nature of a colloid. [EU] Colonoscope: A thin, lighted tube used to examine the inside of the colon. [NIH] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Colorectal Surgery: A surgical specialty concerned with the diagnosis and treatment of disorders and abnormalities of the colon, rectum, and anal canal. [NIH] Colostomy: An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed. [NIH]

Competency: The capacity of the bacterium to take up DNA from its surroundings. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1,

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IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Condyloma: C. acuminatum; a papilloma with a central core of connective tissue in a treelike structure covered with epithelium, usually occurring on the mucous membrane or skin of the external genitals or in the perianal region. [EU] Condylomata Acuminata: Sexually transmitted form of anogenital warty growth caused by the human papillomaviruses. [NIH] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Continence: The ability to hold in a bowel movement or urine. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH]

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Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Convalescence: The period of recovery following an illness. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Cryosurgery: The use of freezing as a special surgical technique to destroy or excise tissue. [NIH]

Cryotherapy: Any method that uses cold temperature to treat disease. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyclic Vomiting Syndrome: Sudden, repeated attacks of severe vomiting (especially in children), nausea, and physical exhaustion with no apparent cause. Can last from a few hours to 10 days. The episodes begin and end suddenly. Loss of fluids in the body and changes in chemicals in the body can require immediate medical attention. Also called abdominal migraine. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH]

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Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dermatitis: Any inflammation of the skin. [NIH] Dermatologic Agents: Drugs used to treat or prevent skin disorders or for the routine care of skin. [NIH] Dermatologist: A doctor who specializes in the diagnosis and treatment of skin problems. [NIH]

Dextromethorphan: The d-isomer of the codeine analog of levorphanol. Dextromethorphan shows high affinity binding to several regions of the brain, including the medullary cough center. This compound is a NMDA receptor antagonist (receptors, N-methyl-D-aspartate) and acts as a non-competitive channel blocker. It is used widely as an antitussive agent, and is also used to study the involvement of glutamate receptors in neurotoxicity. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Retinopathy: Retinopathy associated with diabetes mellitus, which may be of the background type, progressively characterized by microaneurysms, interretinal punctuate macular edema, or of the proliferative type, characterized by neovascularization of the retina and optic disk, which may project into the vitreous, proliferation of fibrous tissue, vitreous hemorrhage, and retinal detachment. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastolic: Of or pertaining to the diastole. [EU] Diathermy: The induction of local hyperthermia by either short radio waves or highfrequency sound waves. [NIH] Dietary Fats: Fats present in food, especially in animal products such as meat, meat products, butter, ghee. They are present in lower amounts in nuts, seeds, and avocados. [NIH]

Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Digital rectal examination: DRE. An examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities. [NIH] Dilatation: The act of dilating. [NIH]

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Dilate: Relax; expand. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilator: A device used to stretch or enlarge an opening. [NIH] Diosmin: A bioflavonoid that strengthens vascular walls. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Dispenser: Glass, metal or plastic shell fitted with valve from which a pressurized formulation is dispensed; an instrument for atomizing. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuretic: A drug that increases the production of urine. [NIH] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenal Ulcer: An ulcer in the lining of the first part of the small intestine (duodenum). [NIH]

Duodenum: The first part of the small intestine. [NIH] Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include chemical irritants, bacteria, protozoa, or parasitic worms. [EU]

Dyspepsia: Impaired digestion, especially after eating. [NIH] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents (Dorland, 27th ed). [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH]

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Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Emaciation: Clinical manifestation of excessive leanness usually caused by disease or a lack of nutrition. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopic retrograde cholangiopancreatography: ERCP. A procedure to x-ray the pancreatic duct, hepatic duct, common bile duct, duodenal papilla, and gallbladder. In this procedure, a thin, lighted tube (endoscope) is passed through the mouth and down into the first part of the small intestine (duodenum). A smaller tube (catheter) is then inserted through the endoscope into the bile and pancreatic ducts. A dye is injected through the catheter into the ducts, and an x-ray is taken. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Enema: The injection of a liquid through the anus into the large bowel. [NIH] Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Enterocolitis: Inflammation of the intestinal mucosa of the small and large bowel. [NIH] Enteroscopy: An examination of the small intestine with an endoscope. The endoscope is inserted through the mouth and stomach into the small intestine. [NIH]

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Enterostomal Therapy: A nurse who cares for patients with an ostomy. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH] Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Episiotomy: An incision of the posterior vaginal wall and a portion of the pudenda which enlarges the vaginal introitus to facilitate delivery and prevent lacerations. [NIH] Epistaxis: Bleeding from the nose. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Stricture: A narrowing of the esophagus often caused by acid flowing back from the stomach. This condition may require surgery. [NIH] Esophageal Varices: Stretched veins in the esophagus that occur when the liver is not working properly. If the veins burst, the bleeding can cause death. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Evacuation: An emptying, as of the bowels. [EU] Excisional: The surgical procedure of removing a tumor by cutting it out. The biopsy is then examined under a microscope. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH]

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Extraction: The process or act of pulling or drawing out. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Family Practice: A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Fecal occult blood test: A test to check for blood in stool. (Fecal refers to stool; occult means hidden.) [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatulence: Production or presence of gas in the gastrointestinal tract which may be expelled through the anus. [NIH] Flatus: Gas passed through the rectum. [NIH] Fluid Therapy: Therapy whose basic objective is to restore the volume and composition of the body fluids to normal with respect to water-electrolyte balance. Fluids may be administered intravenously, orally, by intermittent gavage, or by hypodermoclysis. [NIH] Fluoroscopy: Production of an image when X-rays strike a fluorescent screen. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Foodborne Illness: An acute gastrointestinal infection caused by food that contains harmful bacteria. Symptoms include diarrhea, abdominal pain, fever, and chills. Also called food poisoning. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the

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gallbladder or bile ducts. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastroesophageal Reflux Disease: Flow of the stomach's contents back up into the esophagus. Happens when the muscle between the esophagus and the stomach (the lower esophageal sphincter) is weak or relaxes when it shouldn't. May cause esophagitis. Also called esophageal reflux or reflux esophagitis. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal Hemorrhage: Bleeding in the gastrointestinal tract. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastroscopy: Endoscopic examination, therapy, or surgery of the interior of the stomach. [NIH]

Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

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Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Gonadal: Pertaining to a gonad. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Government Agencies: Administrative units of government responsible for policy making and management of governmental activities in the U.S. and abroad. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helminthiasis: Infestation with parasitic worms of the helminth class. [NIH]

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Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Hemorrhoidectomy: An operation to remove hemorrhoids. [NIH] Hepatic: Refers to the liver. [NIH] Hepatic Duct, Common: Predominantly extrahepatic bile duct which is formed by the junction of the right and left hepatic ducts, which are predominantly intrahepatic, and, in turn, joins the cystic duct to form the common bile duct. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]

Hiatal Hernia: A small opening in the diaphragm that allows the upper part of the stomach to move up into the chest. Causes heartburn from stomach acid flowing back up through the opening. [NIH] Homeopathic remedies: Small doses of medicines, herbs, or both that are believed to stimulate the immune system. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Human papillomavirus: HPV. A virus that causes abnormal tissue growth (warts) and is often associated with some types of cancer. [NIH] Hydrocephalus: Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial hypertension; headache; lethargy; urinary incontinence; and ataxia (and in infants macrocephaly). This condition may be caused by obstruction of cerebrospinal fluid pathways due to neurologic abnormalities, intracranial hemorrhages; central nervous system infections; brain neoplasms; craniocerebral trauma; and other conditions. Impaired resorption of cerebrospinal fluid from the arachnoid villi results in a communicating form of hydrocephalus. Hydrocephalus ex-vacuo refers to ventricular dilation that occurs as a result of brain substance loss from cerebral infarction and other conditions. [NIH] Hydrocortisone: The main glucocorticoid secreted by the adrenal cortex. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic

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conditions. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydroxides: Inorganic compounds that contain the OH- group. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] Ileum: The lower end of the small intestine. [NIH] Immune response: (antigens). [NIH]

The activity of the immune system against foreign substances

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic effects of foreign microorganisms or to the toxic effect of antigenic substances. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Incision: A cut made in the body during surgery. [NIH] Incisive: 1. Having the power or quality of cutting. 2. Pertaining to the incisor teeth. [EU] Incisor: Anything adapted for cutting; any one of the four front teeth in each jaw. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU]

Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators

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or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Information Centers: Facilities for collecting and organizing information. They may be specialized by subject field, type of source material, persons served, location, or type of services. [NIH] Infuse: To pour (a liquid) into something. [EU] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Infusion Pumps: Fluid propulsion systems driven mechanically, electrically, or osmotically that are used to inject (or infuse) over time agents into a patient or experimental animal; used routinely in hospitals to maintain a patent intravenous line, to administer antineoplastic agents and other drugs in thromboembolism, heart disease, diabetes mellitus (insulin infusion systems is also available), and other disorders. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin Infusion Systems: Portable or implantable devices for infusion of insulin. Includes open-loop systems which may be patient-operated or controlled by a pre-set program and are designed for constant delivery of small quantities of insulin, increased during food ingestion, and closed-loop systems which deliver quantities of insulin automatically based on an electronic glucose sensor. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU]

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Intestinal: Having to do with the intestines. [NIH] Intestinal Obstruction: Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anus. [NIH] Intestinal Pseudo-Obstruction: mechanical. [NIH]

Obstruction of the intestines that is functional, not

Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Intussusception: A rare disorder. A part of the intestines folds into another part of the intestines, causing blockage. Most common in infants. Can be treated with an operation. [NIH]

Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irrigation: The washing of a body cavity or surface by flowing solution which is inserted and then removed. Any drug in the irrigation solution may be absorbed. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Isosorbide: 1,4:3,6-Dianhydro D-glucitol. Chemically inert osmotic diuretic used mainly to treat hydrocephalus; also used in glaucoma. [NIH] Isosorbide Dinitrate: A vasodilator used in the treatment of angina. Its actions are similar to nitroglycerin but with a slower onset of action. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Lacerations: Torn, ragged, mangled wounds. [NIH] Lactose Intolerance: The disease state resulting from the absence of lactase enzyme in the musocal cells of the gastrointestinal tract, and therefore an inability to break down the disaccharide lactose in milk for absorption from the gastrointestinal tract. It is manifested by

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indigestion of a mild nature to severe diarrhea. It may be due to inborn defect genetically conditioned or may be acquired. [NIH] Lanolin: A yellow fat obtained from sheep's wool. It is used as an emollient, cosmetic, and pharmaceutic aid. [NIH] Laparotomy: A surgical incision made in the wall of the abdomen. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laser therapy: The use of an intensely powerful beam of light to kill cancer cells. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukocytosis: A transient increase in the number of leukocytes in a body fluid. [NIH] Levorphanol: A narcotic analgesic that may be habit-forming. It is nearly as effective orally as by injection. [NIH] Library Services: circulation. [NIH]

Services offered to the library user. They include reference and

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lubricants: Oily or slippery substances. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Count: A count of the number of lymphocytes in the blood. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malabsorption syndrome: A group of symptoms such as gas, bloating, abdominal pain, and diarrhea resulting from the body's inability to properly absorb nutrients. [NIH]

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Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations. [NIH] Malaria, Vivax: Malaria caused by Plasmodium vivax. This form of malaria is less severe than malaria, falciparum, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Meat Products: Articles of food which are derived by a process of manufacture from any portion of carcasses of any animal used for food (e.g., head cheese, sausage, scrapple). [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Menthol: An alcohol produced from mint oils or prepared synthetically. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Mesentery:

A layer of the peritoneum which attaches the abdominal viscera to the

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abdominal wall and conveys their blood vessels and nerves. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense

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pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Endings: Specialized terminations of peripheral neurons. Nerve endings include neuroeffector junction(s) by which neurons activate target organs and sensory receptors which transduce information from the various sensory modalities and send it centrally in the nervous system. Presynaptic nerve endings are presynaptic terminals. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neuroeffector Junction: The synapse between a neuron (presynaptic) and an effector cell other than another neuron (postsynaptic). Neuroeffector junctions include synapses onto muscles and onto secretory cells. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurotic: 1. Pertaining to or characterized by neurosis. 2. A person affected with a neurosis. [EU]

Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Niacinamide: An important compound functioning as a component of the coenzyme NAD. Its primary significance is in the prevention and/or cure of blacktongue and pellagra. Most animals cannot manufacture this compound in amounts sufficient to prevent nutritional deficiency and it therefore must be supplemented through dietary intake. [NIH] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful antianginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through

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improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nutritional Support: The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include fluid therapy which normalizes body fluids to restore water-electrolyte balance. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Occult Blood: Chemical, spectroscopic, or microscopic detection of extremely small amounts of blood. [NIH] Office Management: Planning, organizing, and administering activities in an office. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ostomy: Surgical construction of an artificial opening (stoma) for external fistulization of a duct or vessel by insertion of a tube with or without a supportive stent. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overdosage: 1. The administration of an excessive dose. 2. The condition resulting from an excessive dose. [EU] Oxides: Binary compounds of oxygen containing the anion O(2-). The anion combines with metals to form alkaline oxides and non-metals to form acidic oxides. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH]

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Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic Ducts: Ducts that collect pancreatic juice from the pancreas and supply it to the duodenum. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Papilla: A small nipple-shaped elevation. [NIH] Papilloma: A benign epithelial neoplasm which may arise from the skin, mucous membranes or glandular ducts. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Care Management: Generating, planning, organizing, and administering medical and nursing care and services for patients. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pelvic: Pertaining to the pelvis. [EU] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Pepsin A: Formed from pig pepsinogen by cleavage of one peptide bond. The enzyme is a single polypeptide chain and is inhibited by methyl 2-diaazoacetamidohexanoate. It cleaves peptides preferentially at the carbonyl linkages of phenylalanine or leucine and acts as the principal digestive enzyme of gastric juice. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptic Ulcer Hemorrhage: Bleeding from a peptic ulcer. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perianal: Located around the anus. [EU] Perineum: The area between the anus and the sex organs. [NIH] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH]

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Peripheral blood: Blood circulating throughout the body. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Petrolatum: A colloidal system of semisolid hydrocarbons obtained from petroleum. It is used as an ointment base, topical protectant, and lubricant. [NIH] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacists: Those persons legally qualified by education and training to engage in the practice of pharmacy. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physician Assistants: Persons academically trained, licensed, or credentialed to provide medical care under the supervision of a physician. The concept does not include nurses, but does include orthopedic assistants, surgeon's assistants, and assistants to other specialists. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of

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skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Plague: An acute infectious disease caused by Yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Poison Control Centers: Facilities which provide information concerning poisons and treatment of poisoning in emergencies. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures. [NIH] Polyp: A growth that protrudes from a mucous membrane. [NIH] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Portal Pressure: The venous pressure measured in the portal vein. [NIH] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH]

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Postoperative Period: The period following a surgical operation. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potassium Cyanide: Potassium cyanide (K(CN)). A highly poisonous compound that is an inhibitor of many metabolic processes, but has been shown to be an especially potent inhibitor of heme enzymes and hemeproteins. It is used in many industrial processes. [NIH] Potassium hydroxide: A toxic and highly corrosive chemical used to make soap, in bleaching, and as a paint remover. It is used in small amounts as a food additive and in the preparatrion of some drugs. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Presynaptic Terminals: The distal terminations of axons which are specialized for the release of neurotransmitters. Also included are varicosities along the course of axons which have similar specializations and also release transmitters. Presynaptic terminals in both the central and peripheral nervous systems are included. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Proctectomy: An operation to remove the rectum. [NIH] Proctoscope: A short, rigid metal tube used to look into the rectum and anus. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU]

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Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Pruritus Ani: Intense chronic itching in the anal area. [NIH] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psyllium: Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae).

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Plantain seeds swell in water and are used as demulcents and bulk laxatives. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Embolism: Embolism in the pulmonary artery or one of its branches. [NIH] Pupil: The aperture in the iris through which light passes. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quaternary: 1. Fourth in order. 2. Containing four elements or groups. [EU] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radio Waves: That portion of the electromagnetic spectrum beyond the microwaves, with wavelengths as high as 30 KM. They are used in communications, including television. Short Wave or HF (high frequency), UHF (ultrahigh frequency) and VHF (very high frequency) waves are used in citizen's band communication. [NIH] Radioactive: Giving off radiation. [NIH] Radius: The lateral bone of the forearm. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectal Prolapse: Protrusion of the rectal mucous membrane through the anus. There are various degrees: incomplete with no displacement of the anal sphincter muscle; complete with displacement of the anal sphincter muscle; complete with no displacement of the anal sphincter muscle but with herniation of the bowel; and internal complete with rectosigmoid or upper rectum intussusception into the lower rectum. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refractory: Not readily yielding to treatment. [EU]

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Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retroperitoneal: Having to do with the area outside or behind the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Retroperitoneal Space: An area occupying the most posterior aspect of the abdominal cavity. It is bounded laterally by the borders of the quadratus lumborum muscles and extends from the diaphragm to the brim of the true pelvis, where it continues as the pelvic extraperitoneal space. [NIH] Retropneumoperitoneum: retroperitoneal space. [NIH]

Pathological or accidental introduction of air into the

Rhagades: Fissures, cracks, or fine linear scars in the skin, especially such lesions around the mouth or other regions subjected to frequent movement. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH]

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Rod: A reception for vision, located in the retina. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Saline: A solution of salt and water. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Sanitary: Relating or belonging to health and hygiene; conductive to the restoration or maintenance of health. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Scalpel: A small pointed knife with a convex edge. [NIH] Sclerotherapy: Treatment of varicose veins, hemorrhoids, gastric and esophageal varices, and peptic ulcer hemorrhage by injection or infusion of chemical agents which cause localized thrombosis and eventual fibrosis and obliteration of the vessels. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Semantics: The relationships between symbols and their meanings. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH]

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Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Short Bowel Syndrome: A malabsorption syndrome resulting from extensive operative resection of small bowel. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoid Colon: The lower part of the colon that empties into the rectum. [NIH] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Sitz Bath: A special plastic tub. A person sits in a few inches of warm water to help relieve discomfort of hemorrhoids or anal fissures. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Solitary Rectal Ulcer: A rare type of ulcer in the rectum. May develop because of straining to have a bowel movement. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in

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spastic paralysis or in cerebral palsy. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Squamous: Scaly, or platelike. [EU] Squamous Epithelium: Tissue in an organ such as the esophagus. Consists of layers of flat, scaly cells. [NIH] Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strained: A stretched condition of a ligament. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress management: A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control. Stress management may include relaxation exercises, assertiveness training, cognitive restructuring, time management, and social support. It can be delivered either on a one-to-one basis or in a group format. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stump: The end of the limb after amputation. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by

Dictionary 183

clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acid-binding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tachypnea: Rapid breathing. [NIH] Tenesmus: Straining, especially ineffectual and painful straining at stool or in urination. [EU]

Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH] Thrombosed: A localized clot that either forms in the vein of a hemorrhoid or arises from a ruptured hemorrhoidal blood vessel. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot

184 Hemorrhoids

formation. [EU] Time Management: Planning and control of time to improve efficiency and effectiveness. [NIH]

Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transcutaneous: Transdermal. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH]

Dictionary 185

Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Valerian: Valeriana officinale, an ancient, sedative herb of the large family Valerianaceae. The roots were formerly used to treat hysterias and other neurotic states and are presently used to treat sleep disorders. [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Varices: Stretched veins such as those that form in the esophagus from cirrhosis. [NIH] Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Insufficiency: Inadequacy of the venous valves and impairment of venous return (venous stasis) usually from the legs, often with edema and sometimes with stasis ulcers at the ankle. [NIH] Venous Pressure: The blood pressure in a vein. It is usually measured to assess the filling

186 Hemorrhoids

pressure to the ventricle. [NIH] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Video Recording: The storing or preserving of video signals for television to be played back later via a transmitter or receiver. Recordings may be made on magnetic tape or discs (videodisc recording). [NIH] Videodisc Recording: The storing of visual and usually sound signals on discs for later reproduction on a television screen or monitor. [NIH] Villous: Of a surface, covered with villi. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Volvulus: A twisting of the stomach or large intestine. May be caused by the stomach being in the wrong position, a foreign substance, or abnormal joining of one part of the stomach or intestine to another. Volvulus can lead to blockage, perforation, peritonitis, and poor blood flow. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] Wart: A raised growth on the surface of the skin or other organ. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

187

INDEX A Abdomen, 10, 89, 147, 151, 152, 158, 167, 168, 179, 182, 183 Abdominal, 103, 104, 105, 147, 154, 156, 157, 161, 162, 167, 168, 169, 173, 174, 179, 184 Abdominal Cramps, 103, 147 Abdominal Pain, 103, 147, 161, 162, 167, 168, 174, 184 Ablate, 5, 147, 159 Abscess, 6, 8, 10, 39, 102, 109, 147, 148 Acetaminophen, 132, 147 Acne, 76, 147 Acquired Immunodeficiency Syndrome, 29, 102, 147 Acrylonitrile, 147, 180 Adjuvant, 147, 162 Adrenal Cortex, 147, 164, 176 Adrenal Medulla, 95, 147, 160 Adrenergic, 147, 160, 183 Adverse Effect, 147, 181 Aerobic, 7, 14, 147 Affinity, 147, 157, 181 Algorithms, 103, 148, 151 Alimentary, 14, 33, 42, 60, 133, 148, 151, 157, 173 Alkaline, 148, 151, 152, 172 Alkaloid, 148, 170 Allylamine, 148 Alternative medicine, 117, 148 Aluminum, 76, 148, 183 Aluminum Compounds, 76, 148 Amebiasis, 148, 170 Amine, 73, 148 Ammonia, 148 Ampulla, 148, 159 Amputation, 148, 182 Anaerobic, 7, 14, 148 Anal Fissure, 4, 6, 8, 15, 16, 24, 29, 39, 42, 77, 89, 102, 103, 105, 109, 148, 181 Anal Fistula, 102, 148 Analgesic, 5, 8, 11, 52, 72, 147, 148, 153, 168, 170, 172 Analog, 148, 157 Anaplasia, 148 Anatomical, 111, 149, 152, 165 Anemia, 4, 61, 149, 169 Anesthesia, 54, 96, 149

Anesthetics, 76, 149, 160 Angina, 149, 167, 171 Anginal, 149, 171 Angiography, 4, 149 Ankle, 149, 185 Anogenital, 149, 155 Anomalies, 4, 149 Anorexia, 4, 149, 162 Anoscopy, 9, 144, 149 Antibiotic, 106, 149, 152 Antibiotic Prophylaxis, 106, 149 Antibiotics, Antifungal, 76, 149 Antibody, 148, 149, 154, 166 Anticoagulant, 149, 186 Antigen, 147, 149, 154, 166 Anti-inflammatory, 88, 147, 149, 150, 163 Anti-Inflammatory Agents, 88, 149, 150 Antineoplastic, 149, 150, 166 Antineoplastic Agents, 150, 166 Antipruritic, 72, 150 Antipyretic, 147, 150 Antitussive, 150, 157, 172 Anus, 4, 5, 6, 8, 24, 77, 79, 81, 83, 84, 85, 86, 87, 91, 92, 96, 97, 98, 99, 101, 111, 130, 131, 132, 148, 149, 150, 151, 152, 159, 161, 164, 167, 173, 176, 178 Anxiety, 10, 89, 150 Aperture, 79, 82, 150, 178 Appendicitis, 102, 103, 104, 105, 150 Aqueous, 72, 73, 150, 151, 156 Arachidonic Acid, 150, 177 Arterial, 5, 17, 79, 91, 148, 150, 165, 171, 177, 183 Arteries, 150, 152, 156, 170 Arterioles, 150, 152 Aspartate, 150, 157 Aspiration, 86, 150 Aspirin, 132, 150 Astringent, 72, 90, 150 Asymptomatic, 109, 148, 150 Atrial, 150, 186 Atrial Fibrillation, 150, 186 Autonomic, 17, 95, 150 B Bacteremia, 24, 150 Bacteria, 149, 150, 158, 159, 160, 161, 162, 170, 180, 185 Bacterium, 150, 154

188 Hemorrhoids

Bacteriuria, 39, 150 Barium, 4, 29, 49, 151 Barium enema, 29, 49, 151 Base, 77, 89, 92, 93, 98, 151, 157, 167, 174 Benign, 4, 6, 89, 103, 105, 151, 152, 171, 173 Benign tumor, 103, 151 Benzaldehyde, 151 Benzoin, 93, 151 Bewilderment, 151, 155 Bezoars, 105, 151 Bile, 151, 153, 159, 161, 162, 164, 167, 168, 182, 183 Bile Acids, 151, 162, 182 Bile Ducts, 151, 162 Bile Pigments, 151, 167 Biliary, 105, 151, 152 Bilirubin, 151, 161, 165 Biopsy, 4, 151, 160 Biotechnology, 12, 107, 117, 123, 151 Bismuth, 89, 151 Bladder, 4, 103, 151, 165, 171, 185 Bloating, 151, 165, 167, 168 Blood Coagulation, 151, 152 Blood pressure, 86, 151, 165, 170, 171, 181, 185 Blood vessel, 4, 6, 79, 97, 131, 149, 151, 152, 159, 161, 164, 170, 174, 181, 183, 185 Body Fluids, 81, 152, 158, 161, 172, 181 Body Regions, 152, 154 Bowel Movement, 18, 52, 74, 84, 99, 100, 131, 132, 152, 155, 157, 181, 182 Branch, 141, 152, 173, 182 Breakdown, 152, 157, 162 Broad-spectrum, 152, 153 Bronchi, 152, 160 Bupivacaine, 7, 8, 30, 152 C Calcium, 53, 59, 152, 154, 171 Calcium Dobesilate, 53, 59, 152 Calculi, 152, 163 Capsules, 152, 158, 162 Carbohydrate, 95, 152 Carcinogen, 152, 170 Carcinogenic, 152, 182 Carcinoid, 105, 152 Carcinoma, 8, 15, 24, 31, 45, 102, 105, 152 Cardiac, 148, 150, 152, 159, 160, 162, 170, 182 Cardiovascular, 95, 104, 152, 180 Case report, 7, 152 Catecholamines, 147, 153 Caustic, 153

Cecum, 153, 168 Cefotaxime, 10, 153 Celiac Disease, 102, 105, 153 Cell, 31, 95, 147, 150, 151, 153, 155, 156, 157, 160, 167, 168, 171, 174, 175, 177, 178, 180, 184 Cell Division, 150, 153, 175, 180 Cell membrane, 95, 153, 174 Cellulose, 153, 175 Central Nervous System, 95, 153, 162, 164, 170, 180 Cerebral, 153, 160, 161, 164, 169, 182 Chest Pain, 10, 153 Cholangitis, 105, 153 Cholecystitis, 105, 153 Cholelithiasis, 103, 153 Cholesterol, 104, 151, 153, 161, 165, 182 Chronic, 9, 10, 29, 39, 45, 54, 75, 78, 91, 92, 93, 99, 107, 129, 131, 145, 148, 153, 154, 160, 166, 167, 177, 182, 184 Clinical trial, 11, 18, 52, 123, 153, 156, 178 Cloning, 151, 153 Coagulation, 8, 9, 28, 29, 33, 37, 96, 112, 118, 130, 132, 151, 153, 183, 186 Codeine, 153, 157, 172 Coenzyme, 153, 171 Cofactor, 154, 177 Cognitive restructuring, 154, 182 Colic, 103, 154 Colitis, 102, 103, 105, 106, 107, 108, 130, 154, 167 Collagen, 154, 162, 164, 175 Collagen disease, 154, 164 Colloidal, 154, 174 Colonoscope, 13, 23, 154 Colonoscopy, 4, 19, 36, 101, 106, 154 Colorectal, 8, 41, 47, 54, 61, 101, 102, 105, 128, 130, 131, 134, 154 Colorectal Cancer, 61, 105, 128, 130, 131, 154 Colorectal Surgery, 54, 101, 105, 154 Colostomy, 7, 10, 102, 154 Competency, 87, 154 Complement, 154, 155 Complementary and alternative medicine, 57, 69, 155 Complementary medicine, 57, 155 Computational Biology, 123, 155 Concomitant, 31, 155 Condyloma, 8, 155 Condylomata Acuminata, 6, 155 Cone, 79, 85, 155, 183

Index 189

Confusion, 45, 155, 158, 185 Congestion, 77, 99, 155 Connective Tissue, 86, 154, 155, 161, 162, 180 Connective Tissue Cells, 155 Consciousness, 148, 155, 156 Consumption, 155, 162 Continence, 85, 155 Contraindications, ii, 8, 103, 155 Control group, 7, 11, 156 Convalescence, 96, 156 Coronary, 156, 170, 172 Coronary Thrombosis, 156, 170 Cortex, 89, 156, 161 Cortisone, 73, 156 Cost Savings, 82, 156 Creatinine, 10, 156 Cryosurgery, 10, 19, 20, 30, 75, 78, 130, 156 Cryotherapy, 8, 21, 28, 46, 132, 156 Curative, 89, 96, 156, 171 Cutaneous, 102, 156, 167 Cyclic, 102, 156, 177 Cyclic Vomiting Syndrome, 102, 156 Cytoplasm, 153, 156 D Databases, Bibliographic, 123, 156 Defecation, 6, 7, 12, 35, 85, 102, 112, 130, 156 Degenerative, 156, 164 Dehydration, 103, 104, 156 Dementia, 147, 156 Density, 85, 157, 172, 181 Dermatitis, 40, 112, 157, 158 Dermatologic Agents, 157 Dermatologist, 27, 157 Dextromethorphan, 54, 157 Diabetes Mellitus, 157, 164, 166 Diabetic Retinopathy, 152, 157, 174 Diagnostic procedure, 71, 117, 157 Diaphragm, 157, 164, 179 Diarrhea, 9, 19, 58, 102, 103, 104, 105, 130, 131, 148, 157, 161, 167, 168 Diarrhoea, 157, 162 Diastolic, 157, 165 Diathermy, 13, 37, 157 Dietary Fats, 130, 157 Dietary Fiber, 104, 112, 129, 130, 132, 157 Diffusion, 157, 166 Digestion, 148, 151, 152, 157, 158, 165, 167, 168, 173, 182 Digestive system, 10, 102, 104, 105, 131, 157, 162

Digestive tract, 4, 5, 90, 102, 157, 181 Digital rectal examination, 3, 4, 157 Dilatation, 15, 20, 21, 29, 105, 157, 176 Dilate, 85, 87, 158 Dilation, 87, 105, 158, 164 Dilator, 85, 158, 171 Diosmin, 18, 52, 158 Diploid, 158, 175 Direct, iii, 8, 13, 20, 37, 38, 39, 52, 57, 58, 158, 163, 175, 178 Disorientation, 155, 158 Dispenser, 84, 158 Distal, 79, 82, 96, 158, 159, 162, 176, 177 Diuretic, 158, 167 Diverticula, 158 Diverticulitis, 102, 105, 158 Diverticulum, 6, 158 Dosage Forms, 53, 158 Drug Tolerance, 158, 184 Duct, 148, 153, 158, 159, 160, 164, 172, 180 Duodenal Ulcer, 89, 158 Duodenum, 151, 158, 159, 162, 173, 182 Dysentery, 103, 148, 158 Dyspepsia, 102, 158, 165 E Eating Disorders, 104, 158 Eczema, 53, 158 Edema, 92, 99, 157, 158, 185 Efficacy, 5, 9, 11, 52, 53, 58, 59, 76, 159, 184 Electrocoagulation, 8, 37, 38, 118, 153, 159 Electrode, 87, 159 Electrolyte, 159, 161, 172, 176, 181 Electrons, 151, 159, 167, 178 Emaciation, 147, 159 Emboli, 159, 186 Embolism, 159, 178, 186 Embolization, 159, 186 Embryology, 101, 159 Emollient, 159, 168, 172 Endemic, 159, 169 Endoscope, 159 Endoscopic, 39, 79, 105, 154, 159, 162, 181 Endoscopic retrograde cholangiopancreatography, 106, 159 Endoscopy, 4, 9, 12, 13, 15, 19, 22, 23, 29, 35, 37, 38, 39, 41, 57, 58, 105, 159 Enema, 96, 159 Enteritis, 103, 159 Enterocolitis, 159 Enteroscopy, 105, 159 Enterostomal Therapy, 102, 105, 160 Environmental Health, 122, 124, 160

190 Hemorrhoids

Enzymatic, 152, 155, 160, 179 Enzyme, 154, 160, 167, 170, 173, 183 Epidemiological, 15, 160 Epidural, 52, 160 Epinephrine, 8, 147, 160 Episiotomy, 97, 160 Epistaxis, 38, 160 Epithelial, 160, 164, 173 Epithelial Cells, 160, 164 Epithelium, 89, 155, 160, 162 Erythrocytes, 149, 160 Esophageal, 22, 105, 160, 162, 180 Esophageal Stricture, 105, 160 Esophageal Varices, 105, 160, 180 Esophagitis, 160, 162, 183 Esophagus, 4, 105, 157, 160, 162, 163, 168, 174, 178, 182, 185 Evacuation, 92, 93, 155, 160, 162 Excisional, 43, 160 Exhaustion, 156, 160, 169 Exocrine, 95, 160, 173 Exogenous, 158, 160 Extracellular, 155, 160, 181 Extracellular Matrix, 155, 160 Extraction, 86, 161 Exudate, 99, 161, 172 F Family Planning, 123, 161 Family Practice, 27, 34, 36, 47, 161 Fat, 93, 150, 159, 161, 168 Fatty acids, 161, 177 Fecal Incontinence, 103, 161, 165 Fecal occult blood test, 4, 28, 161 Feces, 85, 155, 161, 182 Fibrosis, 148, 161, 180 Fissure, 8, 16, 161 Fistula, 8, 15, 105, 108, 161 Flatulence, 83, 103, 161 Flatus, 161, 162 Fluid Therapy, 161, 172 Fluoroscopy, 87, 161 Fold, 87, 90, 161, 169 Foodborne Illness, 104, 161 Forearm, 152, 161, 178 Friction, 97, 161 Fungi, 149, 161, 170, 185 G Gallbladder, 147, 151, 153, 157, 159, 161, 162 Gallstones, 102, 103, 105, 153, 161 Ganglia, 95, 162, 171

Gas, 5, 77, 83, 85, 102, 103, 148, 157, 161, 162, 165, 167, 168, 171, 183, 185 Gastric, 89, 102, 158, 162, 163, 173, 180 Gastric Emptying, 102, 162 Gastric Juices, 162, 173 Gastric Mucosa, 162, 173 Gastrin, 162, 164 Gastritis, 4, 103, 105, 162, 183 Gastroenteritis, 103, 162 Gastroenterologist, 44, 111, 162 Gastroenterology, 9, 13, 14, 19, 20, 24, 25, 26, 36, 38, 40, 44, 45, 52, 58, 131, 162 Gastroesophageal Reflux, 102, 162 Gastroesophageal Reflux Disease, 102, 162 Gastrointestinal Hemorrhage, 89, 103, 105, 162 Gastrointestinal tract, 105, 151, 161, 162, 167, 180 Gastroscopy, 106, 162 Gelatin, 88, 162, 183 Gene, 107, 151, 162, 180 Genetics, 132, 163 Genital, 6, 15, 25, 163 Giardiasis, 163, 170 Gland, 147, 156, 163, 173, 182 Glomerular, 163, 179 Glucocorticoid, 163, 164 Glutamate, 157, 163 Gluten, 153, 163 Gonadal, 163, 182 Gout, 103, 163 Governing Board, 163, 176 Government Agencies, 102, 163, 176 Grade, 8, 37, 163 Graft, 46, 163 Growth, 7, 149, 151, 155, 163, 164, 169, 171, 175, 184, 186 H Haploid, 163, 175 Health Education, 133, 163 Health Promotion, 111, 163 Heartbeat, 10, 163 Heartburn, 102, 104, 105, 163, 164, 165 Helminthiasis, 103, 163 Hemoglobin, 149, 160, 164 Hemorrhage, 23, 24, 103, 152, 157, 159, 164 Hepatic, 159, 164 Hepatic Duct, Common, 159, 164 Hepatitis, 103, 164 Hepatocytes, 164 Heredity, 131, 162, 163, 164 Hernia, 104, 164

Index 191

Hiatal Hernia, 105, 164 Homeopathic remedies, 17, 52, 57, 164 Hormone, 95, 156, 160, 162, 164, 166, 176 Human papillomavirus, 155, 164 Hydrocephalus, 164, 167 Hydrocortisone, 53, 164 Hydrogen, 148, 151, 152, 165, 170 Hydroxides, 165 Hygienic, 131, 165 Hyperbilirubinemia, 165, 167 Hypercholesterolemia, 103, 165 Hypertension, 24, 35, 43, 45, 164, 165 Hyperthermia, 157, 165 Hyperuricemia, 163, 165 I Id, 55, 60, 128, 133, 134, 140, 142, 165 Ileostomy, 102, 165 Ileum, 153, 165 Immune response, 147, 149, 156, 165, 186 Immune system, 164, 165, 168 Immunity, 96, 147, 165 Immunodeficiency, 147, 165 Impairment, 151, 165, 167, 185 Incision, 97, 160, 165, 167, 168 Incisive, 101, 165 Incisor, 165 Incompetence, 87, 162, 165 Incontinence, 102, 144, 164, 165 Indicative, 106, 165, 173, 185 Indigestion, 102, 103, 165, 168 Induction, 157, 165 Infarction, 164, 166 Infection, 4, 84, 90, 99, 111, 147, 148, 161, 162, 163, 165, 166, 168, 172, 182, 184 Infiltration, 53, 166 Inflammatory bowel disease, 6, 103, 105, 112, 166 Information Centers, 103, 166 Infuse, 166 Infusion, 11, 166, 180, 184 Infusion Pumps, 11, 166 Ingestion, 166, 175 Inhalation, 166, 175 Inotropic, 10, 166 Insulin, 166 Insulin Infusion Systems, 166 Internal Medicine, 52, 162, 166 Interstitial, 166, 179 Intestinal, 10, 35, 84, 89, 95, 102, 103, 112, 153, 159, 167, 168 Intestinal Obstruction, 89, 167 Intestinal Pseudo-Obstruction, 102, 167

Intestine, 4, 77, 152, 154, 159, 167, 168, 186 Intracellular, 166, 167, 176, 177 Intramuscular, 54, 167 Intravenous, 166, 167 Intussusception, 167, 178 Invasive, 9, 21, 83, 85, 87, 98, 165, 167 Involuntary, 161, 167, 170 Ions, 151, 159, 165, 167 Irrigation, 73, 167 Irritable Bowel Syndrome, 102, 103, 104, 105, 167 Irritants, 158, 167 Isosorbide, 47, 167 Isosorbide Dinitrate, 47, 167 J Jaundice, 103, 165, 167 K Kb, 122, 167 Kidney Disease, 104, 112, 122, 133, 167 L Lacerations, 160, 167 Lactose Intolerance, 102, 105, 167 Lanolin, 89, 168 Laparotomy, 10, 168 Large Intestine, 105, 153, 154, 157, 167, 168, 178, 181, 186 Laser therapy, 8, 118, 130, 168 Lesion, 10, 35, 89, 168, 184 Leukocytes, 168 Leukocytosis, 10, 168 Levorphanol, 157, 168 Library Services, 140, 168 Ligament, 168, 182 Ligation, 6, 7, 8, 9, 11, 13, 14, 15, 18, 19, 21, 22, 23, 27, 30, 31, 32, 33, 34, 36, 37, 39, 40, 41, 42, 46, 47, 48, 54, 57, 59, 79, 80, 86, 96, 108, 112, 118, 131, 168 Lip, 95, 168 Liver, 74, 77, 90, 103, 105, 147, 150, 151, 157, 160, 161, 162, 164, 168, 179 Localized, 10, 166, 168, 175, 180, 183, 184 Locomotion, 168, 175 Loop, 39, 164, 165, 166, 168 Lower Esophageal Sphincter, 162, 168 Lubricants, 168, 174 Lumen, 84, 168 Lymphatic, 166, 168, 175 Lymphocyte, 147, 149, 168 Lymphocyte Count, 147, 168 M Malabsorption, 153, 168, 181 Malabsorption syndrome, 168, 181

192 Hemorrhoids

Malaria, 103, 169 Malaria, Falciparum, 169 Malaria, Vivax, 169 Malignancy, 16, 169 Malignant, 102, 147, 150, 169, 171, 180 Malignant tumor, 102, 169 Manometry, 105, 169 Meat, 157, 169 Meat Products, 157, 169 Medicament, 169, 183 MEDLINE, 123, 169 Medullary, 157, 169 Melanocytes, 169 Melanoma, 16, 169 Membrane, 85, 90, 95, 153, 155, 160, 169, 170, 172, 174, 175, 178, 179 Memory, 149, 156, 169 Meninges, 153, 169 Mental Health, v, 11, 104, 122, 125, 169 Menthol, 89, 169 Mesenteric, 17, 169, 175 Mesentery, 169, 174 Metabolic disorder, 163, 170 Metastasis, 170 Metronidazole, 10, 170 MI, 47, 80, 98, 102, 145, 170 Microbiology, 14, 150, 170 Mitochondrial Swelling, 170, 171 Modification, 46, 170, 178 Molecular, 88, 123, 125, 148, 151, 155, 170, 180 Molecule, 148, 149, 151, 153, 155, 170, 178 Monitor, 156, 170, 172, 186 Morphine, 11, 52, 55, 153, 170, 172 Motion Sickness, 170 Mucosa, 84, 87, 89, 153, 159, 162, 170, 183 Mucus, 158, 170, 184 Mydriatic, 158, 170 Myocardial infarction, 10, 156, 170, 186 Myocardium, 170 N Narcotic, 168, 170 Nausea, 8, 103, 104, 156, 158, 162, 165, 170, 185 Necrosis, 7, 166, 170, 171 Need, 3, 8, 11, 19, 37, 84, 101, 103, 108, 111, 117, 124, 135, 147, 171, 184 Neoplasia, 6, 103, 171 Neoplasm, 171, 173, 180 Neoplastic, 148, 164, 171 Nephropathy, 167, 171

Nerve, 11, 53, 58, 85, 95, 147, 149, 171, 179, 182, 184 Nerve Endings, 95, 171 Nervous System, 153, 171, 176, 183 Neuroeffector Junction, 171 Neurogenic, 171, 185 Neurons, 162, 171 Neurotic, 171, 185 Neurotoxicity, 157, 171 Niacin, 171, 184 Niacinamide, 74, 171 Nifedipine, 19, 171 Nitrogen, 148, 171, 184 Nitroglycerin, 167, 171 Nuclear, 4, 159, 171, 172 Nucleus, 156, 172 Nursing Care, 172, 173 Nutritional Support, 105, 172 O Occult, 4, 161, 172 Occult Blood, 172 Office Management, 9, 33, 172 Ointments, 75, 78, 83, 85, 94, 158, 172 Opacity, 157, 172 Opium, 170, 172 Opportunistic Infections, 147, 172 Osmotic, 167, 170, 172 Osteoporosis, 104, 172 Ostomy, 160, 172 Outpatient, 7, 8, 10, 11, 13, 20, 32, 34, 35, 58, 60, 96, 108, 112, 131, 172 Overdosage, 103, 172 Oxides, 73, 172 P Palliative, 89, 172 Palpation, 9, 96, 172 Pancreas, 147, 157, 162, 166, 173 Pancreatic, 106, 159, 162, 173 Pancreatic Ducts, 159, 173 Pancreatic Juice, 162, 173 Papilla, 159, 173 Papilloma, 155, 173 Parasitic, 158, 163, 173 Patch, 99, 173 Pathogenesis, 9, 17, 39, 44, 45, 173 Pathologic, 8, 27, 151, 156, 165, 173, 175, 185 Patient Care Management, 102, 173 Patient Education, 9, 129, 130, 131, 132, 138, 140, 145, 173 Pelvic, 10, 92, 93, 99, 173, 179 Pepsin, 89, 173

Index 193

Pepsin A, 173 Peptic, 89, 173, 180, 183 Peptic Ulcer, 89, 173, 180 Peptic Ulcer Hemorrhage, 173, 180 Perception, 155, 173 Perforation, 38, 89, 150, 173, 186 Perianal, 6, 7, 25, 40, 53, 105, 109, 112, 155, 173 Perineum, 102, 173 Perioperative, 5, 173 Peripheral blood, 91, 174 Peritoneum, 169, 174, 179 Peritonitis, 174, 186 Petrolatum, 89, 174 Petroleum, 75, 78, 112, 174 Pharmaceutical Preparations, 89, 153, 162, 174 Pharmaceutical Solutions, 158, 174 Pharmacists, 104, 174 Pharmacologic, 149, 174, 184, 185 Pharynx, 162, 174 Phospholipids, 161, 174 Phosphorus, 152, 174 Photocoagulation, 9, 13, 28, 153, 174 Physical Examination, 3, 8, 9, 174 Physician Assistants, 6, 174 Physiologic, 174, 177, 178 Physiology, 12, 101, 103, 105, 129, 162, 174 Pigment, 151, 169, 174 Pilot study, 5, 175 Plague, 44, 60, 175 Plants, 89, 103, 148, 175, 180, 184 Plasma, 153, 162, 164, 175 Platelet Aggregation, 91, 175 Platelets, 95, 175, 180, 183 Platinum, 168, 175 Plexus, 86, 92, 99, 175 Poison Control Centers, 103, 175 Poisoning, 104, 161, 162, 171, 175, 180 Policy Making, 163, 175 Polyp, 4, 175 Polyposis, 154, 175 Portal Pressure, 39, 175 Portal Vein, 175 Posterior, 148, 160, 173, 175, 179 Postmenopausal, 172, 175 Postoperative, 5, 8, 10, 11, 37, 53, 54, 55, 101, 175, 176 Postoperative Complications, 5, 11, 175 Postoperative Period, 10, 176 Potassium, 151, 176 Potassium Cyanide, 151, 176

Potassium hydroxide, 176 Practicability, 176, 184 Practice Guidelines, 125, 133, 176 Precancerous, 3, 176 Precursor, 150, 160, 176, 184 Premalignant, 176 Presynaptic, 171, 176 Presynaptic Terminals, 171, 176 Prevalence, 35, 45, 176 Probe, 37, 39, 79, 176 Proctectomy, 112, 176 Proctoscope, 80, 94, 176 Progesterone, 176, 182 Progressive, 7, 156, 158, 163, 171, 176, 179 Prolapse, 38, 40, 74, 77, 80, 87, 105, 109, 112, 177 Prone, 84, 177 Prophylaxis, 177, 186 Prospective study, 18, 37, 47, 177 Prostaglandin, 91, 177 Prostaglandins A, 177 Protein S, 107, 151, 177 Proteins, 149, 153, 154, 170, 171, 173, 175, 177, 184, 185 Protozoa, 158, 177, 185 Proximal, 79, 105, 158, 176, 177 Pruritic, 158, 177 Pruritus, 6, 24, 105, 108, 112, 144, 177 Pruritus Ani, 6, 24, 105, 108, 177 Psychogenic, 177, 185 Psyllium, 67, 68, 177 Public Policy, 123, 178 Pulmonary, 152, 155, 178, 186 Pulmonary Artery, 152, 178 Pulmonary Embolism, 178, 186 Pupil, 158, 170, 178 Purulent, 147, 178 Q Quality of Life, 48, 178 Quaternary, 72, 178 R Radiation, 165, 170, 178, 186 Radio Waves, 157, 178 Radioactive, 165, 172, 178 Radius, 82, 178 Randomized, 6, 7, 11, 13, 19, 21, 30, 32, 37, 38, 43, 48, 52, 53, 54, 58, 59, 159, 178 Randomized clinical trial, 21, 52, 178 Receptor, 95, 149, 155, 157, 178, 180 Rectal Prolapse, 29, 34, 102, 103, 109, 133, 178 Recurrence, 5, 9, 131, 178

194 Hemorrhoids

Refer, 1, 102, 154, 161, 168, 178 Reflux, 87, 162, 178, 183 Refractory, 159, 178 Regimen, 159, 179 Regurgitation, 162, 163, 179 Relapse, 41, 179 Remission, 178, 179 Renal failure, 7, 179 Resection, 96, 179, 181 Restoration, 7, 179, 180 Retina, 157, 179, 180 Retinal, 155, 157, 179 Retrograde, 179 Retroperitoneal, 10, 39, 179 Retroperitoneal Space, 179 Retropneumoperitoneum, 38, 179 Rhagades, 109, 179 Riboflavin, 74, 179 Rigidity, 175, 179 Risk factor, 19, 105, 112, 124, 132, 177, 179 Rod, 84, 85, 150, 180 S Saline, 8, 180 Salivary, 157, 180 Salivary glands, 157, 180 Sanitary, 98, 180 Saponins, 180, 182 Sarcoma, 36, 180 Scalpel, 14, 43, 180 Sclerotherapy, 7, 8, 9, 10, 13, 22, 31, 32, 39, 41, 47, 54, 105, 130, 180 Screening, 104, 153, 180 Scrotum, 7, 180, 183 Sedative, 153, 180, 185 Sedentary, 130, 180 Segregation, 150, 180 Semantics, 12, 180 Semisynthetic, 96, 153, 180 Senile, 172, 180 Sepsis, 10, 180 Septic, 7, 180 Septicemia, 7, 180 Serotonin, 95, 180, 184 Sexually Transmitted Diseases, 103, 180 Shock, 164, 181, 184 Short Bowel Syndrome, 102, 105, 181 Side effect, 91, 103, 147, 165, 181, 184 Sigmoid, 10, 181 Sigmoid Colon, 181 Sigmoidoscopy, 4, 101, 129, 144, 181 Signs and Symptoms, 76, 102, 104, 124, 179, 181

Sitz Bath, 10, 99, 129, 181 Skeletal, 95, 181 Skeleton, 177, 181 Small intestine, 4, 151, 153, 158, 159, 163, 164, 165, 167, 181 Smooth muscle, 95, 148, 155, 170, 171, 181 Social Environment, 178, 181 Social Support, 181, 182 Sodium, 63, 163, 181 Solitary Rectal Ulcer, 102, 181 Solvent, 99, 172, 174, 181 Sound wave, 157, 181 Spasmodic, 147, 181 Spastic, 167, 181 Specialist, 102, 135, 158, 182 Species, 160, 162, 169, 173, 182 Sphincter, 12, 74, 85, 90, 91, 92, 97, 178, 182 Spinal cord, 54, 153, 160, 169, 171, 182 Squamous, 37, 182 Squamous Epithelium, 37, 182 Stasis, 182, 185 Steroid, 14, 156, 180, 182 Stimulant, 95, 182 Stimulus, 159, 182, 183 Stoma, 105, 172, 182 Stomach, 4, 103, 104, 105, 147, 157, 159, 160, 162, 164, 168, 170, 173, 174, 178, 181, 182, 186 Stool, 3, 4, 6, 10, 74, 75, 78, 99, 112, 129, 143, 144, 161, 165, 167, 168, 182, 183 Strained, 88, 93, 182 Stress, 8, 89, 92, 104, 162, 167, 170, 180, 182 Stress management, 104, 182 Stricture, 105, 182 Stump, 10, 182 Styrene, 180, 182 Subacute, 166, 182 Subclinical, 166, 182 Subcutaneous, 7, 55, 158, 183 Sucralfate, 76, 183 Suction, 80, 94, 183 Suppositories, 14, 73, 79, 162, 183 Sympathomimetic, 160, 183 Symptomatic, 5, 7, 10, 11, 16, 17, 18, 19, 21, 37, 41, 42, 43, 52, 57, 58, 183 Systemic, 7, 91, 96, 152, 154, 160, 166, 180, 183, 186 Systemic disease, 7, 180, 183 Systolic, 165, 183 T Tachycardia, 10, 150, 183

Index 195

Tachypnea, 150, 183 Tenesmus, 7, 158, 183 Testicles, 180, 183 Thermal, 9, 81, 87, 183 Thorax, 147, 183 Threshold, 165, 183 Thrombin, 175, 183 Thrombocytes, 175, 183 Thromboembolism, 166, 183 Thrombosed, 14, 16, 19, 23, 47, 48, 74, 100, 183 Thrombosis, 25, 49, 59, 92, 99, 109, 131, 177, 180, 183 Thrombus, 156, 166, 175, 183, 186 Time Management, 182, 184 Tolerance, 81, 184 Tomography, 10, 184 Topical, 6, 19, 47, 72, 73, 75, 78, 88, 91, 93, 96, 150, 174, 184 Toxic, v, 165, 176, 182, 184 Toxicity, 183, 184 Toxicology, 124, 184 Toxins, 149, 166, 180, 184 Transcutaneous, 11, 53, 58, 184 Transfection, 151, 184 Transfusion, 7, 184 Transmitter, 184, 186 Trauma, 102, 103, 105, 112, 160, 164, 171, 184 Treatment Outcome, 4, 184 Trees, 180, 184 Trichomoniasis, 170, 184 Tryptophan, 95, 154, 180, 184 U Ulcer, 89, 91, 158, 173, 181, 183, 184, 185 Ulceration, 89, 184 Ulcerative colitis, 4, 6, 102, 105, 166, 184 Unconscious, 149, 165, 185 Uremia, 179, 185 Uric, 163, 165, 185 Urinary, 8, 10, 11, 150, 152, 164, 165, 185 Urinary Retention, 8, 10, 11, 185

Urinary tract, 150, 185 Urinary tract infection, 150, 185 Urinate, 185 Urine, 150, 151, 155, 156, 158, 165, 179, 185 V Vaccines, 185, 186 Vagina, 185 Vaginal, 97, 160, 185 Valerian, 103, 185 Valves, 87, 92, 185 Varices, 22, 24, 35, 39, 43, 185 Varicose, 24, 25, 49, 53, 59, 61, 77, 82, 84, 90, 92, 99, 180, 185 Varicose vein, 24, 25, 49, 53, 59, 77, 82, 84, 90, 92, 180, 185 Vascular, 4, 17, 61, 92, 102, 105, 130, 148, 158, 166, 183, 185 Vasoconstriction, 160, 185 Vasodilator, 167, 171, 185 VE, 18, 52, 185 Vein, 25, 49, 59, 74, 87, 99, 167, 172, 175, 183, 185, 186 Venous, 5, 49, 54, 60, 75, 87, 92, 93, 99, 171, 175, 177, 185, 186 Venous Insufficiency, 54, 60, 185 Venous Pressure, 175, 185 Venous Thrombosis, 186 Venules, 152, 186 Vertebrae, 182, 186 Veterinary Medicine, 123, 186 Video Recording, 111, 186 Videodisc Recording, 186 Villous, 153, 186 Viral, 96, 186 Virus, 96, 147, 164, 186 Viscosity, 72, 186 Volvulus, 28, 103, 105, 186 W Warfarin, 4, 186 Wart, 96, 186 X X-ray, 151, 159, 161, 172, 186

196 Hemorrhoids

Index 197

198 Hemorrhoids

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