Curative effect of Amorphophallus paeoniifolius tuber on experimental hemorrhoids in rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Amorphophallus paeoniifolius (Dennst.) Nicolson (Family- Araceae) is a crop of south East Asian origin. In India, its tuber is widely used in ethnomedicinal practices by different tribes for the treatment of piles (hemorrhoids). AIM: The present study evaluated the effect of methanolic and aqueous extract of Amorphophallus paeoniifolius tuber on croton oil induced hemorrhoids in rats. MATERIALS AND METHODS: The methanolic extract was standardized with the major phenolic compound, betulinic acid, by HPLC. The hemorrhoids were induced by applying 6% croton oil preparation in the ano-rectal region. Rats were orally administered methanolic and aqueous extract at doses of 250 and 500mg/kg, each for 7 days. Pilex (200mg/kg) was used as reference anti-hemorrhoidal drug. Hemorrhoids were assessed on eighth day by measuring hemorrhoidal and biochemical parameters along with histology of ano-rectal tissue. RESULTS: Croton oil application caused induction of hemorrhoids as indicated by significant (p<0.001) increase in plasma exudation of Evans blue in ano-rectal tissue, macroscopic severity score and ano-rectal coefficient as compared to normal rats. It significantly (p<0.001) elevated lactate dehydrogenase and cytokines (TNF-α and IL-6) levels in serum and increased myeloperoxidase activity and lipid peroxidation in ano-rectal tissue along with marked histological damage as compared to normal rats. Treatment with tuber extracts and pilex significantly (p<0.05-p<0.001) ameliorated Evans blue exudation, hemorrhoidal parameters and other biochemical parameters with attenuation of tissue damage compared to hemorrhoid control rats. The results indicate that tuber extracts exhibited curative action on hemorrhoids. The aqueous extract showed more pronounced effect than methanolic extract. The effects may be attributed to anti-inflammatory and antioxidant properties. CONCLUSION: Results indicate that tuber of Amorphophallus paeoniifolius exhibited curative action on hemorrhoids through anti-inflammatory and antioxidant properties. The study validates the ethnomedicinal use of tuber in hemorrhoids and implicates its therapeutic potential as an anti-hemorrhoidal agent.

Matrix metalloproteinases in pathogenesis of hemorrhoidal disease.

The aim of this study is to investigate the accuracy of serum matrix metalloproteinase (MMP) levels in an effort to find a reliable factor that may play an important role in pathogenesis of hemorrhoidal disease. Twenty control subjects and 21 Grade I, 19 Grade II, 20 Grade III, and 21 Grade IV patients with internal hemorrhoid were included in this prospective study. The mean ages of control subjects were 47.65 ± 6.71 standard deviation (SD) years (range, 37 to 60 years). The mean age of internal Grade I, Grade II, Grade III, and Grade IV patients with internal hemorrhoid were 48.85 ± 6.44, 47.20 ± 6.75, 44.90 ± 6.13, and 42.95 ± 3.49 SD years (ranges, 38 to 58, 38 to 60, 34 to 55, and 38 to 50 years), respectively. Ten milliliters of blood was taken from all subjects. Enzyme-linked immunosorbent assay (ELISA) for MMP-1, -2, -7, and -9 levels were performed using an ELISA kit (R&D Systems) following the manufacturer's instructions. There was an important difference between Grade I and Grade II groups in the serum levels of MMP-9 (P < 0.01). Patients with Grade III hemorrhoidal disease had significantly higher serum levels of all MMP than patients with Grade I and Grade II hemorrhoidal disease (P < 0.001). Also, patients with Grade 4 hemorrhoidal disease had higher serum levels of MMP-7 and -9 according to Grade I, II, and III groups (P < 0.01, 0.001). High serum levels of MMP are present in patients with hemorrhoids, suggesting the possible mechanism in the pathogenesis of hemorrhoids.

[Minimal bright red rectal bleeding: what should be considered?]. / Blut auf dem Stuhl. Woran ist bei der Differenzialdiagnose zu denken?

Blood in faeces or stains of blood on the surface or toilet paper are common problems among all age groups. Too few patients seek medical consultation because of these symptoms. The differential diagnosis is quite large. Most cases are caused by benign anorectal diseases like hemorrhoids. On the other hand neoplasias of the anus and intestine or inflammatory bowel disease are important diagnoses to be considered. We emphasize that every patient should be seen by a doctor and endoscopic investigation should be discussed.

Soluble CD26 levels and its association to epidemiologic parameters in a sample population.

INTRODUCTION: Previous studies have suggested the use of soluble CD26 (sCD26) as a tumour marker for the detection of colorectal cancer (CRC) and advanced adenomas. The aim of this study was to assess the sCD26 concentration in a large cohort to evaluate its association to epidemiologic parameters and CRC-related symptoms/pathologies. SUBJECTS AND METHODS: Serum samples were collected from 2,754 putatively healthy individuals with ages ranging from 30-65 years, and with personal or familial history of polyps, CRC and/or CR symptoms. sCD26 levels were measured by ELISA. RESULTS: No association was found between the sCD26 concentration and age (< 50 and 50), the personal or familial history of polyps or CRC, rectal bleeding, haemorrhoids or diverticula. However, sCD26 was related to non-inflammatory benign pathologies (excluding rectal bleeding, changes in bowel habits, haemorrhoids, diverticula) and to inflammatory benign pathologies. DISCUSSION: Our results confirm that the sCD26 can be easily offered and evaluated in a large cohort. Additionally, the validation of sCD26 as a tumour marker for screening and case-finding purposes requires a further comparison with an established non-invasive test like the faecal occult blood.

Blood loss is a stronger predictor of iron status in men than C282Y heterozygosity or diet.

OBJECTIVE: To determine the relative importance of HFE gene, diet, lifestyle, and blood loss characteristics for predicting iron status in a sample of men aged 40 years or over. DESIGN: Iron status (serum ferritin, transferrin saturation, soluble transferrin receptor) was measured in 44 C282Y heterozygote and 85 age- and BMI-matched wildtype men aged 40 years or over. Dietary intake of iron (total, heme and non-heme), and components known to influence iron bioavailability, was determined using a validated Meal-Based Intake Assessment Tool. Information on lifestyle and blood loss was obtained by questionnaire. Height and weight were measured to determine Quetelet's body mass index. Linear mixed models were used to determine the extent to which these variables predicted iron status. RESULTS: C282Y heterozygosity was associated with 17% higher transferrin saturation (95% CI: 6%, 29%) but no difference in serum ferritin or soluble transferrin receptor concentrations. Blood donation was negatively associated with transferrin saturation (-13% (- 3%, -22%)) and serum ferritin (-58% (-44%, -68%)), and had a marginally significant positive association with soluble transferrin receptor concentration. Self-reported fecal blood loss was negatively associated with serum ferritin concentration (-35% (-54%, -7%)). Alcohol was the only dietary variable associated with iron status and was associated with all three of the iron status indices. Serum ferritin concentration was positively associated with body mass index (10% per unit increase (6%, 15%)). CONCLUSIONS: Blood loss was a stronger predictor of iron status than either C282Y heterozygosity or diet in this population of men aged 40 years and over.

[Hemorrhoidal thrombosis. A clinical and therapeutical study on 22 consecutive patients]. / Trombosi emorroidaria. Studio del profilo emocoagulativo e riflessioni terapeutzche su 22 pazienti consecutivi.

Hemorrhoidal thrombosis (HT) represents one of the most frequent complication of hemorrhoids. The two main modalities of clinical presentation are thrombosed of a single external pile or as massive thrombosis (MT), both representing an harmfull condition for the patient which can be usually treated with surgical intervention on an outptient basis. The etiopathogenesis of the disease is nowadays obscure and few investigated till now in the international literature. The Authors performed a prospective study on 22 patients with HT aimed at clarifying the ethiopathogenesis of the disease through the evaluation of the emocoagulative profile of these patients. All the main coagulopathy indexes such as aPT, APTT, Fibrinogen, AT III, XDP, aPCR and LAC resulted normal, while the products of prothrombin degradation (F1 + F2) showed higher values in respect of the control group (p < 0.0001). Our study seems to highlight that HT could not be considered a sistemic or local coagulopathy, so far surgical management of the disease remains the gold standard, as confirmed in our series.

[Rheological parameters in hemorrhoid pathology]. / Etude des paramètres rhéologiques dans la pathologie hémorroïdaire.

The authors studied erythrocyte aggregation in 62 patients suffering from hemorrhoidal disease, distributed on the basis of proctoscopy findings between three groups (recent uncomplicated congestive attack, recent thrombosed hemorrhoid, stage IIb or III chronic prolapse). This hemorheological parameter is a sensitive marker of circulatory stasis. Values measured were compared with those obtained in 21 healthy subjects. Erythrocyte aggregation index was significantly higher in patients than in controls (31.6 +/- 6.8 versus 27.7 +/- 4.4) (p < 0.05). This difference was due essentially to increased values in patients with acute hemorrhoid problems. A parallel increase in blood fibrinogen was found in these same patients. Hemorheological changes could predispose to worsening of venous stasis in the hemorrhoidal circulation and participate in the onset or spread of thrombotic processes.

High-molecular-mass alkaline phosphatase as a tumor marker for colorectal cancer: comparison of two test methods.

We measured high-molecular-mass alkaline phosphatase (HiMwALP) in serum samples from patients with colorectal cancer by polyacrylamide gel electrophoresis (PAGE) and by column chromatography on diethylaminoethyl (DEAE)-cellulose. Determination of carcinoembryonic antigen (CEA) by an enzyme immunoassay, a frequently used cancer assessment method, was used for comparison. We studied patients with primary colorectal cancer (n = 72), using others with hemorrhoids (n = 38) for a comparison group. HiMwALP activities twice those of pooled normal sera were adopted as cutoff values. The diagnostic sensitivity of the PAGE method for 72 colorectal cancer patients was 63% vs 36% for the DEAE method and 50% for the CEA method. The diagnostic specificities of the PAGE, DEAE, and CEA methods were 89%, 79%, and 95%, respectively. Using both HiMwALP (PAGE method) and CEA for the detection of primary colorectal cancer increased the sensitivity to 72% but decreased specificity to 87%.

Quantitative determination of high molecular weight alkaline phosphatase in patients with colorectal cancer by polyacrylamide gel electrophoresis.

We present a new method for the quantitative determination of high molecular weight alkaline phosphatase (ALP). This method consists of electrophoretic separation on polyacrylamide, incubation of the ALP isoenzymes with substrate, gel drying and quantitative evaluation by densitometric measurement. This method separates high molecular weight ALP from the other isoenzymes. Precision of the method is calculated by the coefficient of variation ranging from 1.2 to 9.5% for samples with different high molecular weight ALP values. The diagnostic sensitivity for detecting colorectal cancer is 60%.

[Results of a study of the resorption of bufexamac following rectal administration]. / Ergebnisse einer Untersuchung über die Resorption von Bufexamac nach rektaler Anwendung.

12 patients suffering from hemorrhoidal complaints were treated with hemorrhoidal suppositories containing Proctoparf-bufexamac. Using the HPCL method, we measured the concentrations of bufexamac in the serum after 30, 45 and 60 minutes as well as after 2, 3, 6, 7.5 and 20 hours. Neither bufexamac nor its major metabolite (4-butoxyphenyl acetic acid) could be detected in concentrations above 0.2 micrograms/ml and 0.5 micrograms/ml, respectively. These results prove that the application of Proctoparf suppositories is not associated with any significant systemic absorption of bufexamac.

[Changes in blood serum proteins and blood electrolytes in patients with rectal fistulas and hemorrhoids]. / Izmeneniia belkov syvorotki i elektrolitov krovi u bol'nykh so svishchami priamoi kishki i gemorroem

Changes in blood serum and electrolytes were studied in 113 patients with rectal fistulas and hemorrhoid. The data obtained provided the opportunity for estimating objectively the intensity of inflammatory and destructive processes in pararectal cellular tissue.