Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 4 uppsatser.

Issued also as the author's dissertation, Paris, 1799. / Also available online.

Thesis (M.D.)--Aberdeen University, 2008. / Title from web page (viewed on Aug. 26, 2009). Includes bibliographical references.

As part of the background literature search for this thesis a systematic review comparing rubber band ligation (RBL) and excisional surgery was undertaken. Excisional haemorrhoidectomy (EH) was demonstrated to be more effective in treating grade III haemorrhoids. This greater effectiveness appears to be achieved at the expense of an increased risk of procedure-related potential complications, including haemorrhage, prolonged post-operative pain, extended time off work, anal stenosis and disturbance of continence. No significant difference was seen in the efficacy of the two procedures in the treatment of grade II haemorrhoids. A variety of studies have proved the efficacy and safety of stapled haemorrhoidopexy (SH) compared with other treatment modalities (RBL, EH). Most published comparative trials of SH have evaluated the new procedure against EH. The fundamental difference in the mechanism of action of these two procedures limits the validity of such a comparison. In view of the reported relatively high recurrence rate for symptoms following RBL a procedure frequently adopted for grade II haemorrhoids and the lack of comparative studies against SH, a study was conducted in the form of a randomized controlled trial to compare these two techniques. This thesis is based on the results of this randomised controlled trial which aimed to evaluate the utility of SH, with respect to objective and subjective symptom control, compared to rubber band ligation for grade II circumferential symptomatic haemorrhoids. The relevant introductory topics on ambryology, anatomy and physiology of the ano-rectum will be discussed along side the aetiology, pathophysiology, clinical features and various treatment options for haemorrhoids. The results of the systematic review comparing RBL with surgical haemorrhoidectomy carried out during the same period has been added to this thesis in order to comprehensively cover the comparison of RBL with commonly practiced surgical treatment for haemorrhoidal disease.

Homoeopathy is a system of medicine used in obstetric prescribing to reduce the minor common complications of pregnancy (Cure, 1999). One such complication is haemorrhoids. Haemorrhoids are varicosities of the haemorrhoidal plexus in the rectum, and are often complicated by inflammation, thrombosis and haemorrhage (Beers & Berkow, 1999). The aim of the study was to determine the effect of homoeopathic similimum treatment on haemorrhoids in pregnant women. This was a quantitative, interventive and descriptive study spanning one month. The research method used homoeopathic similimum treatment and a participant administered questionnaire in a panel longitudinal, in-depth case study. Non-probability purposive sampling was used to select 12 primigravida or multigravida pregnant females, aged 18-35, from the 12th to 35th week of gestation, presenting with haemorrhoids, who met the inclusion criteria. The sample was obtained by advertisements placed in antenatal classes, private clinics and pharmacies; and by pamphlets handed out at Baby City shops and baby expositions to pregnant women; and referrals from health care providers. The similimum medicine was selected after an initial consultation and physical examination. The symptoms of the initial consultation were noted on a case taking form. The similimum medicine was prescribed in potency between 5CH and 200CH. Dosage was determined by the laws of similimum prescribing. Questionnaires relating to the patients symptoms were completed by the patient daily during the duration of the study. A follow up consultation and physical examination was conducted at the end of the 2nd week of treatment. As indicated by the symptoms at the follow up consultation, a new similimum was prescribed; the original similimum was continued; or it was decided to wait and watch the action of the medicine in the participant if there were signs of improvement. A final consultation and physical examination was conducted at the end of the 4th week of treatment to document the effectiveness of the treatment. The questionnaire was collected. The symptoms of both follow up consultations were noted on a follow up form. Data obtained from the questionnaires were analysed. An ordinal regression, time 1 vs. time t - 1 analysis, regression using sums and a reliability analysis were performed. The data from the individual consultations were used to write up an in depth case study. Eighty three percent (10/12) of the cases of haemorrhoids in pregnancy improved on homoeopathic similimum treatment. Homoeopathic similimum medicine had a significant effect on decreasing the severity of the pain (p < 0.00) and protrusion (p < 0.00). Besides the improvement to the haemorrhoids, there were also signs of improvement to some of the concomitant symptoms experienced by the participants. In conclusion, homoeopathic similimum treatment within a clinical setting is effective in relieving the symptoms of haemorrhoids in pregnant women. Further research needs to be conducted in order to verify these findings. / Dr. Candice Bodkin Dr. Elizabeth Solomon