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Atharvaveda is the fourth and last Veda of Hindu literature. Its oldest name was 'ATHARVANGIRASAH', because it was contributed by two sages, ATHARVAN and ANGIRA. It is also known as 'Bhaishajjvaveda'. Atharvaveda gives information regarding plants, minerals and animal products with their usage for medical purposes. For example, 'Apamarga', a plant is useful for cough, piles, itching and abdominal pain, wherea 'Lavana' is useful for pimples; 'Shankha' useful to protect from diseases and 'Mriga Shringa' is useful for pulmonary consumption and other chronic diseases etc.
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PMID:Atharvaveda and its materia medica. 1257 97

Diseases of the rectum and anus are common, and the prevalence in the general population is probably much higher than that seen in clinical practice since most patients with symptoms referable to the anorectum do not seek medical attention. The examination and diagnosis of certain anorectal disorders can be challenging, and the physical examination of the anorectum is often inadequately performed in clinical practice. This article reviews the important features of the anorectal examination and the diagnosis and treatment of benign anorectal disorders such as hemorrhoids, fissures, fistulas, solitary rectal ulcer syndrome, fecal incontinence, and pruritus ani. Approaches to staging and managing malignant neoplasms of the anus and rectum are outlined.
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PMID:Diseases of the rectum and anus: a clinical approach to common disorders. 1273 25

There are 97 remedies listed, including 11 veterinary ones. These numbers include several that are duplicates. The commonest types of medicament are salves or ointments, of which there are ten, but these ten do not include ointments for specific complaints such as haemorrhoids or scurvy. The most frequently found cures are for the itch (10), rheumatism (5), gravel (4), pain (4), and piles (3), all the others having only one or two entries. They were intended to treat 39 human complaints and 9 animal ones. In addition there were formulae for killing lice, making rat poison, and preparing damson wine! The number of different medicaments that were used in the recipes was relatively small, but more than were to be found in the smaller sizes of domestic medicine cabinet. In 1820 Reece's Traveller's Dispensary that was flat and would fit in the pocket of a carriage, only contained ten drugs plus court plaster, lint, scales and weights with a book of directions and cost L3.10s.0d. (L3.50). The Lady's Dispensary which contained twenty medicines, including two pills, with some dispensing equipment and a book of directions cost L5.10s.0d. (L5.50). In all, he listed twenty different cabinets and a sea medicine chest ranging in price from L3.10s.0d. to L32.10s.0d. They included ones suitable for the family, country clergymen, and travellers on the continent and in the tropics. In 1862 Savory and Moore stocked a range of sixty-seven different medicine chests and cases in rosewood, mahogany, walnut, boxwood and leather that were fitted with 'modern appliances and conveniences adapted for the requirements of families, clergymen, officers, owners of yachts, and travellers.' Unfortunately no prices are quoted. I think that we can safely assume that the treatment received at the hands of Evan Jones was likely to be rather rough and ready when compared to the ministrations of a physician, surgeon, clergyman or local 'Lady Bountiful', but, nevertheless, must have been of great value to those who could not afford professional treatment.
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PMID:Some notes on an early nineteenth century manuscript medical receipt book. 1289 73

The purpose of the present study was to determine the value of circular hemorrhoidectomy (procedure for prolapse and hemorrhoids [PPH]) on the basis of data collected prospectively during the initial experience of a group of Latin American surgeons. Between 2000 and 2001, PPH was performed using a circular stapler in 177 patients who had third- and fourth-degree hemorrhoidal disease. The average age of the patients was 47.7 years (range 26 to 85 years). Anal bleeding was the most common preoperative complaint (93.2%) followed by anal pain (60.2%), anal itching (43%), and constipation (41%). Hemorrhoids were classified as third degree in 132 patients (74%) and fourth degree in 45 patients (25.4%). Skin tags were detected in 86 patients (48.8%) and rectocele in 14 patients (7.9%). Data collected included patient demographics, type of anesthesia, and specific details of the surgery such as duration of the operation, distance from the staple line to the dentate line, need for complementary hemostasis, and any unexpected occurrences. Postoperative data collected included the degree of pain, which was evaluated on the basis of the type and dosage of analgesics required, laxative consumption, and the presence of bleeding, fever, urinary retention, or hematomas. Each patient completed a written questionnaire addressing these events. Patients returned for follow-up visits on days 7, 15, 30, and 90. Responses to pain, bleeding, fever, anal continence, recurrence of hemorrhoids, and level of satisfaction were compiled. The duration of the procedure ranged from 6 minutes to 2 hours (average 23 minutes), and most operations lasted no more than 20 minutes, with the exception of one that lasted 2 hours because of intraoperative bleeding. Intraoperative problems were minor. An additional one or a few sutures were required in 58.7% of patients to achieve perfect hemostasis. In 128 patients (72.3%) the hospital stay was less than 24 hours. Same-day surgery was chosen for 37 patients (20.9%). Pain was controlled with analgesia only using one to six doses of oral dipirona in 126 patients. Five patients were readmitted to the hospital: four for control of bleeding and one for conventional hemorrhoidectomy due to an acute episode of external hemorrhoidal thrombosis. At day 30, patients rated the efficacy of the procedure in alleviating preoperative symptoms as follows: 77.5% excellent; 16% good; 5.3% average, and 1.2% poor. At 3 months postoperatively no patient had had a recurrence of hemorrhoidal prolapse, and there were no instances of stenosis or anal incontinence. Surgeons also rated the efficacy of the procedure as excellent in 75%, good in 19.8%, average in 4.7%, and poor in 0.6%. With proper selection of patients and adequate stapling technique, stapled hemorrhoidectomy may be considered safe; it is easily learned, has a satisfactory degree of pain, and is well accepted by both patients and surgeons.
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PMID:Stapled hemorrhoidectomy: initial experience of a Latin American group. 1312 62

Hemorrhoids are a common cause of perianal complaints and affect 1-10 million people in North-America and with similar incidence in Europe. Symptomatic hemorrhoids are associated with nutrition, inherited predisposition, retention of feces with or without chronic abuse of laxatives or diarrhea. Increased pressure and shearing force in the anal canal may lead to severe changes in topography with detachment of the hemorrhoids from the internal sphincter and fibromuscular network resulting in bleeding, itching, pain and disordered anorectal function, even incontinence. The significance of hemorrhoids for anal continence (corpus cavernosum) is recognized. In most instances, hemorrhoids are treated conservatively; the surgeon is contacted when conservative measures have failed or complications, e.g., thrombosis, have occurred. 4 degrees prolapsed internal hemorrhoids are the main indication for hemorrhoidectomy: high (Parks) or low (Milligan-Morgan) ligation with excision, closed hemorrhoidectomy (Ferguson) or stapler hemorrhoidectomy. Thrombosed external hemorrhoids are primary treated by incision and secondary by excision. Complications after operative treatment of external thrombosed hemorrhoids are rare. After standard hemorrhoidectomy for internal hemorrhoids approximately 10% may have a complicated follow-up (bleeding, fissure, fistula, abscess, stenosis, urinary retention, soiling, incontinence); there may be concomitant disease, e.g., perianal cryptoglandular infection, causing complex fistula/abscess, which is associated with an increased risk (30-80%) for complications, e.g., incontinence. Other treatment options, e.g., sphincterotomy, anal stretch, have been accused to cause more complications, e.g., incontinence in 30-50% of cases. However, incontinence is a complex phenomenon; it is evident that an isolated single injury is normally not a sufficient cause, e.g., injury of the internal sphincter. The majority of patients may present with prior obstetric injury, perianal infection or Crohn's disease and other comorbidity. Therefore all systemic and regional disorders, causing incontinence, should be excluded before starting manometric, neurophysiological and sonographic investigations. Variation and overlap in test results, patient-, instrument- or operator-dependent factors ask for cautious interpretation. There is vast evidence that the demonstration of muscle fibers in hemorrhoidectomy specimens is a normal feature. In conclusion, standard hemorrhoidectomy with proper indication is a safe procedure. If complications occur, it is in the interest of the patient and surgeon to perform a thorough investigation.
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PMID:Hemorrhoidectomy: indications and risks. 1476 36

The application efficacy of Relief and Relief Advance preparations, as pathogenetically directed remedies, was established, basing on the examination and treatment results of 129 patients with anorectal zone diseases (acute and chronic hemorrhoids, anal fissure, the perianal skin pruritus, nonspecific ulcerative colitis, Crohn's disease). For local conservative treatment it is expedient to apply the complex of various pharmacological forms of the preparation. Combined application of Relief and Relief Advance preparations endorectally and locally on the wound surface is indicated after performance of elective and urgent operative interventions for rectal and perianal region diseases.
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PMID:[The application experience of Relief and Relief Advance in practice of the coloproctological patients treatment]. 1549 7

The objective of this study was to determine prospectively the prevalence of anal complaints amongst Nigerians attending the General Out-patient Department (GOPD) of the hospital and review the records of those admitted to the surgical service with related complications. All the 272 patients attending the GOPD of OOUTH in November, 1999 were interviewed using a structured questionnaire. Information concerning age, sex, educational status, present or past history of at least one of the following symptoms viz recurrent bleeding per rectum, anal prolapse, anal/perianal pain, pruritus ani and anal discharge were obtained. Also obtained were reason(s) for current hospital attendance and any previous medical consultation. Those with at least one of the symptoms were classified as symptomatic. The symptomatic group had rectal examination including proctoscopy. The results showed that 82/272 (30.15% ) were symptomatic. Rectal examination on these 82 patients showed that 10(3.7% of 272) had haemorrhoids, 2(0.7% ) had rectal prolapse, 0.7% had peri-anal warts; 15(5.5% ) anal tags, 10(3.7% ) chronic anal fissure, 2 (0.7% ) perianal fistulae. In 29(10.4% ), the examination was normal and in 12 the rectum was too loaded with feaces to permit proctoscopy. However, only 5/272 (1.84% ) attended the clinic for the anal complaint, while 12(4.4% ) had previously consulted a physician for same. Fear of impotence following surgery in 24 males and belief in herbal remedies in 32 patients were the main reasons for not consulting a physician. During the year 1999, out of a total of 558 admissions into our surgical service, only 4(0.6% ) were for complications related to anal complaints. This study indicated the prevalence of anal complaints in the study population of Nigerians as 30.15% , haemorrhoids constitute 3.7% and anal fissure 3.7% , contrary to low rates reported for developing countries. While this result cannot be extended to represent prevalence amongst Nigerians, it may be a pointer to what is to be expected.
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PMID:Anal complaints in Nigerians attending Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu. 1550 55

In this clinical study, the authors refer to a thirty-six month treatment of Grades I and II haemorrhoids (pharmacological treatment) with a group of 75 patients (45 females and 30 males) and treatment for Grades III and IV haemorrhoids (Pharmacological and surgical treatment) on a second group of 23 patients for a total of 98 patients treated and observed. For the pharmacological treatment, a rectal cream containing 0.25% Oxethacaine chlorhydrate (Emoren, produced by Novasorel, srl) was used on all patients. The cream was applied intra-anally and on the external orifice twice a day, morning and evening, for ten days. In order to evaluate the therapeuctic effect, the following symptoms were monitored: pruritus, ematochezia, burning, tenesmus, and pain. The following results were demonstrated: a) in all patients: A reduction in pruritus, pain, blood and mucous loss, Elimination of tenesmus, Absence of peri-anal eczema, b) in 15 patients, haemorrhoids were reduced for 11 months. Therefore the results obtained reconfirm that local treatment with EMOREN demonstrated to be clinically efficient in the treatment of Grades I and II haemorrhoids as well as in post surgical treatment both for the attenuation and elimination of pain and the clinical objectives of the pathology in question.
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PMID:[Clinical study on the pharmacological treatment of hemorrhoids with 0.25% oxethacaine chlorhydrate]. 1570 57

Although stapled anopexy for second and third degree hemorrhoids has been widely used since 1998, there are limited long-term data available. We performed an analysis of a prospectively accrued data set of all patients undergoing stapled anopexy in our practice from 1998 through August 2003. Patients were specifically assessed for early and late complications and long-term reoperation rates for anorectal pathology. We performed stapled anopexy in 654 patients (296 females) during the study period. Mean operation time was 21 min (5-70 min), and the postoperative stay was 3.6 days (1-13 days). Early postoperative complications: urinary retention, 42 patients (6.4%); fecal impaction, 18 (2.8%); postoperative hemorrhage, 26 (4.0%); thrombosed external hemorrhoid, four (0.6%); and fistula/abscess, nine (1.4%). Late postoperative complications: anastomotic dehiscence, 21 patients (3.2%); persistence of prolapse in three (0.5%); submucosal anastomotic cysts in four (0.6%); thrombosed external hemorrhoid in two (0.3%); skin tags in ten (1.5%); fissure in six (0.9%); proctitis in two (0.3%); and fecal incontinence in ten (1.5%). Reoperation was required in 50 patients (7.6%). Reoperation for complications within 30 days occurred in 42 patients (6.4%) for the following reasons: bleeding (23), dehiscence (five), thrombosed external hemorrhoid (three), fecal retention (two), fistula (three), fissure (five), and anal papilla (one). Reoperation for anorectal pathology after 30 days was required in 54 patients (8.3%) and was performed for the following: dehiscence/reprolapse (17), stenosis (two), submucous cyst (two), fistula (four), fissure (six), anal papilla (four), skin tags (five), persistent anal itching (five), and miscellaneous (seven). These data represent the largest series of patients with long-term follow-up following stapled anopexy and confirm that the operation is safe in experienced hands using appropriate patient selection. The early complication rate is low and similar to rates reported for excisional hemorrhoidectomy. Importantly, the procedure is associated with a low 3.4% rate of reoperation for persistence or recurrence of hemorrhoidal prolapse with good patient selection.
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PMID:Complications and reoperations in stapled anopexy: learning by doing. 1682 69

Hemorrhoids are a common condition in adult population with prevalence of about 4%. Only a third of patients with symptomatic hemorrhoids seek medical help. The annual rate of office visits for hemorrhoids is 12 for every 1000 patients in the United States. Hemorrhoids consist of connective tissue cushions surrounding direct arteriovenous communication. They can cause bleeding, pain and itching but other anorectal diseases should be ruled out. Current guidelines recommend a minimum of anoscopy and flexible sigmoidoscopy for bright-red rectal bleeding. Care depends on the extent of hemorroids. First-degree hemorrhoids can be managed with medical treatment. Surgery is reserved for patients with third and fourth-degree hemorrhoids and failure of nonoperative treatment. A new method of the stapled hemorrhoidectomy has been introduced which significantly reduces postoperative pain, hospital stay and use of analgesics with results that are equal to excisional hemorrhoidectomy.
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PMID:[Hemorrhoids--diagnosis and treatment options]. 1628 74


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