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21.09.2005:
   21.09.2005

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INDICATION OF NATURAL METABOLITES IN ANORECTAL ZONE DISORDERS TREATMENT.

Khokhlov A.P. M.D., Professor;
Chirchov O.N., Cand. Sc. (Med.), surgeon
2000

Introduction

Anorectic zone disorders (haemorrhoid and fissures) still remain most common with people. Up to 60% of world population suffer from this diseases at different stages. Haemorrhoid and fissures occur in 150-200 people per 1000. Their share in colono-proctological diseases fluctuates between 34 to 45% (G.I.Vorobiov, 1999).
The reason for haemorrhoid development is inborn or acquired pathology of cavernous bodies at submucous level of distal part of rectus. The main part in pathogenesis is played by organic as well as functional aspects.Morphologic disorders are based on the disorders connected with the dystrophy of muscles of submucous level and ligaments apparel (Parks ligament), located between sphincters of anal ring. It provokes haemorrhoid prolapsed from rectum.Among hemodynamic disorders there is dysfunction of anorectic zone vessels when arterial blood flow exceeds the venous blood outflow from cavernous bodies that results in their enlargement and development of haemorrhoid.

A fissure is a new injury or a chronic ulcer in the distal part of anal canal. This pathology is caused by work discoordination of anal sphincter as a result of venous congestion and tissue hypoxia in this zone, as well as of anoderma trauma by hard stool (scybalum).

Personal experience and scientific data confirm that haemorrhoid and fissure are common variant of chronic inflammatory processes (macrophage) where a vicious circle with mutual deterioration of different aspects of pathogenesis is created.

Traditionally administrated preservative treatment is efficient only at the early stages of haemorrhoid and acute fissure.

In neglected cases surgical interference is administrated. But in 25-30 % cases side effects and consequences in early post operational and later periods (disjunction of the wound, anal neuralgia, incontinence of faeces) complicate surgery.

At the medical centre PRIMAVERA MEDICA a new alternative method of haemorrhoid and fissures treatment was developed and implemented into practice. The method is based on the application of natural metabolites (and thus pathogenic approach) and helps to achieve satisfactory results in majority of clinical cases without surgical interference.

Materials and methods

508 patients with anorectic diseases have been under our observation and have undertaken our treatment.Among them there were 44.3% women and 55.7% men. The majority of patients were of middle age from 30 to 60.Only 3 % of patients were persons younger than 30 years old, mainly women (haemorrhoids and fissures developed soon after labour).

TABLE # 1. Age and sex of patients

Age of patients

Sex of patients

Total

Women

Men

20 - 30

12

3

15 (3 %)

31 - 40

47

37

84 (16,5 %)

41 - 50

65

74

139 (27,3 %)

51 - 60

79

125

204 (40,2 %)

More than 60

22

44

66 (13 %)

Total

225 (44,3 %)

283 (55,7 %)

508 (100 %)

Two nosologic forms of diseases were observed haemorrhoid (293 or 57.7% of patients) the first group and fissure (215 or 42.3%) the second group. (Tbl.2)

Moreover 69 (13.6%) of patients revealed combination of the diseases. In the first group chronic forms of haemorrhoids dominated, and 61.1% of cases were of the 3rd-4th stages. (Classification by G.I.Vorobiov, 1997)

28 patients (9.6%) had the acute haemorrhoid of the 1st and 2nd. Thrombosis of haemorrhoid was observed in 22 patients. In 6 cases there was necrosis of prolapsed and strangulated internal haemorrhoid.

203 patients (69,2%) had external haemorrhoids, 72 patients (24.5%) internal, 18 patients (6.2%) combination of both forms.

TABLE # 2. Nosological forms of anorectal diseases

Nosological forms

Haemorrhoids

Fissure

1st stage

2nd stage

3rd stage

4th stage

Acute

Chronic

47

67

93

86

82

133

293(57,7 %)

215(42,3 %)

Chronic form of disorder dominated with patients with fissure (133 patients, 61.9%). The square of fissure was 2.6+0.32-sq. sm. in average.

It is essential to mention, that more than in a half of cases (292, 57.1%) the disorders existed more than 12 months, and 122 patients (24%) have been suffering from those diseases for more than 5 years. (Tbl. 3)

TABLE # 3. Duration of the disease.

Forms

Duration

less than 6 months

6-12 months

1-3 years

3-5 years

more than 5 years

Haemorrhoid

14

25

79

72

103

Fissure

12

43

87

54

19

Total

26 (5,1 %)

68 (13,4 %)

166 (32,3 %)

128 (24,8 %)

112 (24 %)

Thus one can state that non-compensated phase of disease with prolonged chronic inflammation was observed with 2/3 of patients and this condition even more complicated the implementation of traditional methods of treatment.

The character of clinical symptoms varied greatly, but correlated by quantity and quality with national and foreign authors` data. Bleeding after defecation (57.1%) and prolapsed haemorrhoid (44.4%) dominated with patients with haemorrhoid. (Tbl.4)

TABLE # 4. Clinical symptoms of anorectal diseases.

Symptoms

Forms

Haemorrhoid

Fissure

Bleeding

167 (5,7 %)

45 (20,1 %)

Prolapsed haemorrhoid

130 (44,4 %)

24 (11,2 %)

Pain syndrome

16 (5,5 %)

183 (85 %)

Anal itching

64 (2,2 %)

52 (40 %)

Mucus discharges

72 (24,6 %)

67 (31,2 %)

Pain (85%), anal itching (40%), mucus discharge from anal ring (31.2%) dominated with patients with fissure. Symptoms typical for both diseases were observed in case of patients with combined pathology.

It is to be mentioned that symptoms of disorders reappeared with 362 patients (71.3%) less than 2-4 weeks after treatment with traditional methods. 62 patients (28.8%) had such complications as non-healing operational wound and relapses of fissure after operation.

All patients with haemorrhoid and fissure have undergone outpatient treatment with preparations created at Medical centre "PRIMAVERA MEDICA". Suppositories IMMOUNOLUM and micro-enemas with medicine SEVIT were administrated.

Dosage and prescriptions varied according to the age of the patient, his special pathology and how serious and prolonged the disease was.

Subjective anamnestic data and objective weekly check with the help of recto-anoscopy controlled the efficiency of the chosen treatment.

Results of treatment

Analysis of the treatment of patients with haemorrhoid and fissure proves advantages of implementations of the metabolic therapy comparatively to traditional methods. These advantages are pathogenic proprieties of medical preparations and their simple (plain) implementation.

Bleeding stops during the first 3 days in case of almost half of patients with haemorrhoid syndrome (79, 47.3%), and with the rest of patients it stops during 4-12 days. Frequency of haemorrhoid prolapse dropped or stopped by the end of the first beginning of the second week of treatment in 48.5% of cases. The frequency of prolapsed did not change in 13 cases but patients subjectively mentioned ease of defecation and lack of pain.

Remarkable fact is that during the first week of treatment any pain was stopped in case of 73.6% of patients, suffering from pronounced pain syndrome. Only in 2.1% of cases pain syndrome became less pronounced. Anal itching and mucus discharge was cut off in all cases during 1-2weeks of treatment.

TABLE # 5. Dynamics of arresting of clinical symptoms.

Symptoms

Days of treatment

4 - 7

8 - 10

11 - 15

>16

No effect

Bleeding

79

54

32

2

-

Prolapsed haemorrhoid

-

-

29

88

13

Pain syndrome

45

167

49

21

6

Anal itching

86

13

11

6

-

Mucuse discharge

-

75

58

69

-


The objective test after the first week of treatment confirmed that haemorrhoid reduced more than by one third and during the further treatment it became less than of the initial size in case of 53.6% of patients. All signs of inflammation (hyperaemia, hyperthermia, and oedema) disappeared with all patients with haemorrhoids and fissure to the end of 7th day.

To the 7th 8th day of treatment marginal epithelisation and decrease of fissure by more than 1/3 of Initial Square was noticed in 163 cases.

It is worth to mention; that in cases of acute haemorrhoids the signs of acute thrombosis were totally eliminated on the 5th-8th day, and demarcation of damaged zones without further development of necrosis was observed in 6 patients with necrosis of internal strangulated haemorrhoid.

According to our research data the duration of treatment of patients with haemorrhoid and fissure depends on how prolonged the disease was, on age of patient and on special pathology. (Tbl.6)

TABLE # 6. Duration of treatment.

Forms

Duration

less than 7 days

7-14 days

more than 14 days

Haemorrhoid (n=293)

210

76

7

Fissure (n=215)

115

86

14

Total

325 (64 %)

162 (32 %)

21 (4 %)

The majority of patients (96%) needed 7-14 days treatment to achieve stable results. In cases of complicated haemorrhoid (thrombosis and necrosis) or long existed fissure (more than 3 years) treatment was extended longer than 14 days.

Three scales system was admitted to estimate results: unsatisfactory, satisfactory, good. (Tbl.7)

TABLE # 7. Results of treatment of patients with haemorrhoid and fissure.

Forms

Results

satisfactory

unsatisfactory

good

Haemorrhoid

12

89

192

Fissure

6

36

173

Total

18 (3,5 %)

125 (24,6 %)

365 (71,9 %)

The results were considered unsatisfactory when pain was significantly eased but did not disappear, prolapsed of haemorrhoid remained and the treatment was not finished.

Satisfactory result means total elimination of some clinical symptoms (anal itching, mucus discharges and bleeding) and remaining of some others (pain and prolapsed of haemorrhoid). These results were achieved with 125 patients (24.6%).

Good results were achieved with 365 patients (71.9%). All symptoms were eliminated, fissure was epithalised, and haemorrhoid was reduced by more than twice and did not show any signs of inflammation.

Analysis of remote results of treatment proves that treatment of haemorrhoid and fissure has pronounced positive effect.(Tbl.8)

Table 8 demonstrates that during 6 months after the treatment no patients seek for help again.

After 6 months 9 patients complained that clinical symptoms of disorder reappeared. Moreover all of them continue working in the same regime (hard physical labour, constant sedentary work). None of them followed the recommended diet.

TABLE # 8. Dynamics of repeated appeals after one course of treatment.

Forms

Period

Total

in one month

in 3 months

in 6 months

in 8 months

Haemorrhoid (n=293)

-

-

7 (2,4 %)

12 (4,1 %)

19 (6,5 %)

Fissure (n=215)

-

-

2 (1 %)

9 (4,2 %)

11 (5,1 %)

Total (n=508)

-

-

9 (1,8 %)

21 (4,2 %)

30 (5,9 %)

After 8 months 21 persons (4.2%) appealed, but only 8 of them had clinical symptoms of disease. Others were asking for prophylactic check before the beginning of country season.

Conclusions

The use of metabolic preparations in treatment of patients with haemorrhoid and fissures is highly effective and substituted method. It can be regarded as alternative to existing traditional methods.
This treatment is especially indicative for patients with non-compensated and long existing forms of diseases, when traditional preservative treatment gives no results and surgical interference is to be administrated.
The large share of good and sufficient results of treatment, duration of positive ? can be explained by elimination of chronic macrophage inflammation process and vicious circle of this disorders due to the implementation of metabolic preparations.
It is impossible to cure haemorrhoids, but apparent and prolonged remission can be achieved nowadays only with implementation of metabolic treatment.


 
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