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Colorectal Dis. 2001 Jul;3(4):238-44.
Peri-operative management of patients having external anal sphincter repairs: temporary prevention of defaecation does not improve outcomes.

Ingham Clark CL, Wilkinson KH, Rihani HR, McDonald PJ, Northover JM, Phillips RK.

St Mark's Hospital, Harrow, UK.

OBJECTIVE: To determine whether there was any detectable difference in outcomes of external anal sphincter repair depending on whether patients were managed routinely with a covering stoma, a constipating dietary regimen or a laxative dietary regimen in the early postoperative period. PATIENTS AND METHODS: A consecutive retrospective series of 299 anal sphincter repairs undertaken on 286 patients within a single institution was studied. Patients were divided into three groups depending on the peri-operative regimen followed: routine use of a covering stoma (group 1), routine use of a postoperative constipating dietary regimen (group 2) and routine use of a laxative dietary regimen (group 3). Choice of peri-operative regimen depended on surgeon preference alone. Short-term outcomes (length of stay, complications) and long-term outcomes (functional reported degree of continence, anal ultrasound and physiology test results) were assessed in relation to peri-operative group as well as aetiology of sphincter damage. RESULTS: Short-term results (complications of surgery) were obtainable in all patients; long-term results were available for 89% of patients. Length of stay was similar for all 3 groups (excluding re-admission for stoma closure). Complication rates were not significantly different between the three groups. Functional improvement in continence was reported by 68% of group 1, 69% of group 2 and 79% of group 3 (differences not statistically significant). An anatomical sphincter defect was detected postoperatively in 8% of patients in group 1, 9% in group 2 and 7% of group 3. Poorer outcomes were achieved in older patients and in patients with previous ileo-anal pouch formation. Early faecal impaction and repair breakdown were independently associated with poor long-term outcomes. CONCLUSIONS: Neither routine use of a covering stoma nor a postoperative constipating regimen produced better results following external anal sphincter repair than did the use of a postoperative laxative regimen which encouraged early passage of loose stool without the need for straining.


online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12790966&dopt=Abstract [PubMed]



compuserve.com

Irritable bowel syndrome (IBS) is characterized by a number of clinical features and probably comprises a cluster of different conditions. The most frequent symptom reported by IBS patients is abdominal pain, although for a number of patients, bowel disturbances are the most prominent symptoms. Diarrhetic patients are seen in referral centres in continental Europe less frequently than in the United Kingdom or the United States. On the contrary, patients with constipation-prone IBS may comprise up to 80% of the IBS population referred to these centres. The pathophysiology of IBS is based on multiple factors. Most of the therapeutics proposed for the management of patients with IBS have been developed on the assumption that motility disorders of the gut are the most reliable pathological findings among these patients. Consequently, antispasmodics and motility regulatory agents have been widely used, alone or in association with intestinal adsorbents (clay-derived preparations), and laxatives or antidiarrhetic agents. Most of these drugs were developed several decades ago, and studies showing their efficacy have not reached the level of quality that is now required of randomized controlled trials. Therefore, following a complete and detailed review published in 1989, these drugs have not been used extensively in the United Kingdom or the United States. Large inquiries have also shown that the duration of prescription is quite different among countries. In European countries, maintenance therapy is frequently prescribed for several weeks to attempt to decrease the number of acute episodes. In contrast, psychotropic drugs are less popular among European gastroenterologists than among American gastroenterologists. However, multidisciplinary approaches to the treatment of these patients are frequent, and such drugs are often prescribed by home physicians. The results of large surveys estimated the yearly cost of such treatments to be around US$850. Patients with constipation and elderly patients with chronic disease receive more expensive treatments.


online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10202214&dopt=Abstract



Colorectal Dis. 2001 May;3(3):165-8.
A double-blind randomized placebo-controlled trial of oral indoramin to treat chronic anal fissure.

Pitt J, Dawson PM, Hallan RI, Boulos PB.

Department of Surgery, West Middlesex University Hospital, Isleworth Department of Surgery, University College London Medical School, Hertfordshire, UK Department of Surgery, Hemel Hempstead Hospital, Hertfordshire, UK.

BACKGROUND: Indoramin is an alpha1-adrenoceptor antagonist and has been shown to reduce anal resting pressure. Its therapeutic potential has not been explored. The aim of this study was to determine the outcome of treatment with oral indoramin on patients with chronic anal fissure in the setting of a double-blind randomized placebo-controlled trial. METHODS: Twenty-three patients with chronic anal fissure were computer randomized to receive a 6-week course of oral indoramin (20 mg) or placebo in identical capsules, twice daily and with bulk-forming laxatives. Pain was assessed by a visual analogue scale from 0 to 10. Anal resting pressure, heart rate and blood pressure were recorded. Patients were reviewed 1 h after taking the capsule and at 2, 6 and 12 weeks thereafter. RESULTS: Fourteen patients were randomized to indoramin and 9 to placebo. Maximum anal resting pressure was reduced from a mean of 96.4 cm H2O (+/- 32) to 67.6 cm H2O (+/- 26), 1 h after indoramin (P=0.02) and there was no significant change after placebo. There were no significant changes in heart rate or blood pressure. Pain was reduced in the placebo group from a score of 4.9 to 2.0 after 6 weeks (P < 0.01) but not in the indoramin group. After 6 weeks, healing had occurred in one (7%) patient in the indoramin group and in 2 (22%) in the placebo group (P > 0.1). After 3 months, the chronic anal fissure in the indoramin group had recurred. The trial was terminated early because of poor healing rates. CONCLUSION: An oral dose of indoramin (20 mg) administered twice daily reduced anal resting pressure by 30% compared with pretreatment levels but was ineffective in healing chronic anal fissures.


online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12790983&dopt=Abstract [PubMed]







Natural Herbal Supplement: Hair Million


Hair loss alone does not pose significant health problems. In fact, there are people who opt for baldness as an alternative hair style. However, in general, however, hair loss is not considered desirable.

The most ostensive feature that distinguishes us human from chimps and other primates is the lack of bodily hair. During evolutionary process, we have lost the majority of hair. Hair is no longer a biologically essential part of our body, just like appendix. The hair we still have on our scalp and a few other bodily parts is still regarded as significant for reasons other than biological necessity. Hair loss is naturally accompanied by aging process, although the extent of hair loss and the timing of onset vary widely among individuals. Thus, loss of hair and baldness is considered as a symbol of maturity or old age. Like winkles and other signs of aging, hair loss is not welcome by most people, because we don't welcome aging, and being perceived as an aging person. However, it is alopecia, or premature hair loss that especially concerns certain people.

While the hair loss and resulting baldness in general have not been proven to be related to underlying health problems, there are certain correlations between hair loss and health problems. For instance, premature hair loss could suggest premature aging or nutritional and hormonal imbalance, stressful life, use of drugs that cause hair loss as a side effect, skin disease, or heart disease. The balding appearance could also impart a subdued impression of integrity in bodily health and youthfulness.












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