Role of a Micronized Purified Flavonoid Fraction as an Adjuvant Treatment to Rubber Band Ligation for the Treatment of Patients With Hemorrhoidal Disease: A Longitudinal Cohort Study

PURPOSE: Nonsurgical treatment of hemorrhoidal disease (HD) includes medical and instrumental techniques. We aimed to compare the efficacy of the most frequently used nonsurgical strategies, either alone or in combination, applied in an ambulatory setting.METHODS: Patients who received nonsurgical treatment for HD by proctology appointment at the Gastroenterology Department of Braga Hospital were evaluated. Isolated rubber band ligation (RBL) and a combination of RBL with a micronized purified flavonoid fraction (MPFF) were the 2 most frequently used strategies. Symptoms of HD (bleeding, pruritus, pain at rest, pain at defecation and prolapse) were assessed at days 0, 7, and 28 by using a severity grading scale (0 to 4/5). A Global Symptom score was constructed to assess the overall severity and compare the overall improvements of the HD symptoms between the 2 most frequently used strategies.RESULTS: Nineteen patients underwent the combined treatment (RBL + MPFF group) and 25 the RBL treatment (RBL group). A comparison of the 2 treatment groups showed significant improvements in the combined treatment group in terms of bleeding at days 7 (P = 0.001) and 28 (P = 0.002) and in the pruritus intensity during the first week (P < 0.001). A trend toward clinical benefit was also verified in the combined treatment group for all other HD symptoms (pain at rest, pain at defecation and prolapse).CONCLUSION: A combined treatment approach with MPFF and RBL significantly reduced the intensity of bleeding during the first month and the pruritus during the first week.

Anormalidades sensoriais: olfato e paladar / Sensorial abnormalities: smell and taste

INTRODUÇÃO: Anormalidades do paladar e do olfato comprovaram ser um tema bem mais complexo do que se reconhecia anteriormente. Diversas entidades nosológicas cursam com alterações olfatórias e gustatórias, podendo ser congênitas ou adquiridas. OBJETIVO: Analisar os principais aspectos das disfunções olfatórias e gustatórias. MÉTODO: Foram utilizadas as bases de dados informatizados para a coleta de dados, tendo como palavras-chave "alteração", "olfato" e "paladar". Realizou-se também busca não-sistemática em publicações científicas e livros médicos. REVISÃO DA LITERATURA: Disfunções olfatórias e gustatórias possuem etiologia variada, destacando-se as doenças nasais e sinusais obstrutivas, infecções do trato respiratório superior, traumatismo cranioencefálico, envelhecimento, exposição a tóxicos e algumas medicações, neoplasias nasais ou intracranianas, patologias psiquiátricas e neurológicas, iatrogenia, causas idiopáticas e congênitas. Anamnese detalhada, exame físico atencioso e exames complementares adequados são importantes para o diagnóstico dessas alterações. CONCLUSÃO: Disfunções olfatórias e gustatórias frequentemente ocorrem juntas. A detecção precoce de tais disfunções pode levar a um tratamento mais efetivo, retardando a progressão das doenças que as ocasionam e atenuando a severidade dos sintomas. Em muitos casos o tratamento dessas alterações não é fácil e é necessária uma cooperação interdisciplinar entre o otorrinolaringologista, endocrinologista, neurologista, psiquiatra entre outros.

INTRODUCTION: Taste and smell abnormalities have proven to be an extremely more complex subject than previously regarded. Wide-ranging nosologic entities arise along with smell and taste alterations, and they can be congenital or acquired. OBJECTIVE: Analyze the main features of smell and taste dysfunctions. METHOD: Automated databases were used to collect data, by searching keywords like 'alteration', 'smell', and 'taste'. A non-systematic search was also made in scientific printings and medical books. LITERATURE REVIEW: Smell and taste dysfunctions have a vast etiology, the most significant of which are obstructive nasal and sinusal disease, infections of the upper respiratory tract, cranioencephalic trauma, aging, exposure to toxics and some drugs, nasal or intracranial neoplasias, psychiatric and neurological pathologies, iatrogenic disease, idiopathic and congenital causes. A detailed anamnesis, a careful physical examination and supplementary evaluations are important for the diagnosis of these alterations. CONCLUSION: As a rule, smell and taste dysfunctions occur in a combined way. The early discovery of such dysfunctions can lead to a more efficient treatment, making the progress of diseases causing them retard and the symptoms less severe. In many cases, treating these alterations is not easy and there needs to be a multidisciplinary cooperation among the otorhinolaryngologist, endocrinologist, neurologist, psychiatrist, among others.