Sclerosing therapy of internal hemorrhoids with a novel sclerosing agent. Comparison with ligation and excision.

BACKGROUND AND AIMS: Patients with prolapsing internal hemorrhoids were treated with a novel sclerosing agent (OC-108), and the results were compared with surgery of ligation and excision. PATIENTS AND METHODS: This study included 20 years or older patients with prolapsing internal hemorrhoids who visited ten medical institutions in Japan from October 2000 to October 2002. Investigation on surgery was also performed. RESULTS: Comparing OC-108 and surgery in patients with third- and fourth-degree internal hemorrhoids according to the Goligher's classification, for which surgery has been generally indicated, at 28 days after treatment, the disappearance rate of prolapse was similar between OC-108 and surgery, 94% (75/80 patients) and 99% (84/85 patients), respectively. The 1-year recurrence rate was 16% (12/73 patients) in the OC-108 group, and this value was satisfactory because of its less invasive nature while it was more or less higher compared with 2% (2/81 patients) in the surgery group. The incidences of pain and bleeding were lower in the OC-108 group. CONCLUSIONS: OC-108 is a useful alternative treatment for hemorrhoids.

Identification of genes upregulated in the inflamed colonic lesions of Crohn's disease.

To identify the molecular mechanism which primarily plays a role in the pathogenesis of Crohn's disease (CD) without prior hypothesis, differential display method was employed to detect differentially expressed genes between the inflamed and uninflamed colonic samples from one patient with CD. The mRNA levels of these genes were subsequently semi-quantitated in affected and unaffected tissues from six patients using reverse transcriptase polymerase chain reaction (RT-PCR). Six genes including long form FLICE inhibitory protein (FLIP(L)) were found to be consistently overexpressed in the inflamed colonic CD tissues. Immunohistochemical studies revealed that FLIP(L) expressing cells were lamina propria lymphocytes (LPLs). The present study suggested that overexpression of FLIP(L) in the LPLs may be involved in the pathogenesis of CD through defective activation-induced cell death. In addition, this study provided evidence for a possible role of several previously unsuspected genes in the pathogenesis of CD.

Sphincter-preserving techniques for anal fistulas in Japan.

After the articles by Eisenhammer, Parks, Hanley, and Goligher and the classification system established by Sumikoshi, surgeons in Japan became very active in creating and modifying new sphincter-preserving surgical procedures for low intersphincteric and ischiorectal fistulas. This article reviews the literature, summarizes each procedure, identifies the transitions, and discusses recurrence rates, cures, and subsequent variations. Japanese surgeons favor sphincter-preserving techniques for low intersphincteric fistulas that involve partial or complete coring out of fistula tracts. Common sphincter-preserving procedures for ischiorectal fistulas involve coring-out techniques and muscle-filling procedures. The recurrence rates of sphincter-preserving procedures for low intersphincteric fistulas are between 5 and 6 percent, whereas the recurrence rates for the sphincter-preserving techniques used on ischiorectal fistulas are in the 7 to 10 percent range.

Tacrolimus in corticosteroid-resistant ulcerative colitis.

We report a case of refractory ulcerative colitis treated with tacrolimus. The patient was a 73-year-old woman with a 45-year history of ulcerative colitis. An attack unresponsive to intravenous corticosteroid therapy occurred when she was age 73. Leukocytapheresis therapy was attempted, but was discontinued because of the patient's poor general condition. Cyclosporine A therapy brought about fair control of the disease. A liver injury that was suspected to be associated with this agent, however, occurred within 5 weeks of its initiation. At that time, the cyclosporine A was discontinued and azathioprine treatment was started. Within 6 weeks, signs of exacerbation of the ulcerative colitis became apparent. Tacrolimus administered at that time brought about remission of the disease, and the corticosteroid dose was then reduced. Tacrolimus, like cyclosporine A, appears to be effective for the treatment of attacks of ulcerative colitis.

Muscle-filling procedure for transsphincteric fistulas.

PURPOSE: During transsphincteric fistula surgery, laying open the entire fistula track can cause grave damage. Thus, a surgical procedure that excises the primary abscess only is preferable. However, the primary abscess of a transsphincteric fistula is located in the postanal space. When creating an appropriate drainage wound after excision of the primary abscess, damage to the drainage wound itself can be severe. This article illustrates an alternative procedure. METHODS: We have developed a new method in which we excise only the primary abscess of a transsphincteric fistula and use the muscle flap at the bottom of the wound to fill in the dead space left by the excision. This procedure takes advantage of the availability of the muscle flap and allows for a smaller wound and faster wound healing. RESULTS: During the past 17 years, during which 328 transsphincteric fistula procedures have been performed using the muscle-filling technique, we have experienced a recurrence rate of only 1.5 percent (5 cases). CONCLUSION: The muscle-filling technique is an effective alternative procedure for transsphincteric fistulas.

[Team approach of Crohn's disease therapy].

Under the current conditions that etiologies of Crohn's Disease (CD) are not detected and then no radical therapy existed, it is necessary that the CD patients can be medically managed by not only medical doctors but also other co-medical staffs such as nurses, dietitians, social workers and ET (Enterostomal Therapist) nurses for their cure & care therapy. There are some different therapeutic steps; 1) Nutritional Therapy, 2) Drug Therapy, 3) Surgical Therapy and 4) Psychological (Mental) Support. In Japan, Nutritional Therapy headed by Elemental Enteral Nutrition is recommended as for 1st choice standard therapy for CD patients, who are mainly very young and are required to have themselves acceptable for long-term therapeutic controls. Thus, the medical support team shall be considerable enough to each patient's life back ground in order to give them the whole-mentally therapeutic approach.