Hemorrhoids and Fistulas: New Solutions to Old Problems

Hemorrhoid is a common and recurrent proctological disease, which is often accompanied by angiogenesis and edema. MicroRNAs in the DLK1-DIO3 imprinted clusters are involved in the development and pathogenesis of mammalian hemorrhoids. Results of the present study indicated multiple, differential expression of DLK1-DIO3 imprinted cluster microRNA between hemorrhoid and normal tissues, where miR-412-5p expression in hemorrhoid tissue was significantly decreased. Fluorescein reporter assays showed that miR-412-5p silenced Xpo1 mRNA expression by targeting its 3′-UTR. Overexpression of miR-412-5p in human umbilical vein endothelial cells (HUVECs) indicated that proliferation, migration and formation of vascular structures in HUVECs were inhibited in vitro. In addition, overexpression of miR-412-5p significantly inhibited Xpo1 expression and promoted upregulation of the p53 protein and its retention in the nucleus. Simultaneously, expression of p66^SHC and p16 proteins was activated. In summary, downregulation of endogenous miR-412-5p expression in hemorrhoid vascular endothelial cells leads to high expression of the target gene Xpo1 and translocation of the p53 protein out of the nucleus, rendering it unable to activate p66^SHC and p16. This ultimately weakens regulation of the vascular endothelial cell cycle, thereby accelerating the division of hemorrhoid vascular endothelial cells, leading to angiogenesis.

The aim of this study was to evaluate the effectiveness of preoperative planned education about lifestyle modifications on knowledge, anxiety level, and postoperative problems of the patients with benign perianal disease.

The study was a quasi-experimental design.

The sample was a total of 102 patients undergoing surgical procedure for hemorrhoid and fissure in the general surgery unit of a state hospital in Turkey. Data were collected using the Descriptive Characteristics Determination Questionnaire, the Knowledge Determination Questionnaire, the Postoperative Problems Determination Questionnaire, and the State and Trait Anxiety Inventory.

Preoperative written and verbal planned education about lifestyle modifications improved knowledge and decreased anxiety levels of the patients. There were no statistically significant differences between the control and study groups in postoperative problems other than leakage.

Results of the present study showed that nurse-conducted education on lifestyle modification of hemorrhoid and fissure was effective.

Gastrointestinal (GI) physiology describes the normal functions of the digestive tract, particularly that of its hollow organs. Within the oropharynx, oesophagus, stomach, small bowel, colon, and rectum, nutrient solids and fluids are ingested, propelled, mixed, digested, and absorbed while non-absorbable materials are stored and excreted. Critical to the digestive process are the exocrine secretions of the pancreas, liver, and gastrointestinal mucosae. These secretions break and dissolve the large, complex, ingested molecules of food into smaller compounds, which are then ready for absorption into the intestinal epithelium and its circulation. The gastrointestinal wall embedding transporters and mucosal enzymes critically controls the absorption of nutrition and exogenous substances, such as drugs, across GI mucosa. The chapter gives an overview of the three major physiological functions of the gastrointestinal system, i.e., are motility, secretion, and digestion/absorption, influencing the fate of nutrition and pharmaceuticals administered into the GI tract.

We aimed to investigate the MR imaging findings of patients with hematologic malignancies who have symptoms suggesting perianal infection and to demonstrate the importance of imaging.

The study included 36 patients with hematologic malignancies who underwent anorectal MR imaging in our department between September 2011–May 2016. Two radiologists experienced in abdominal radiology viewed the MR images in consensus. Abscesses, fistulous or sinus tracts, signal alterations and contrast enhancement in keeping with an inflammation and edema in the perianal region were recorded.

Perianal abscess was found in 16 of the 36 patients. In 10 of these 16 patients there was also extensive inflammatory signal alterations in perianal and/or perineal soft tissues.

In six of the 36 patients perianal fistula was detected. A sinus tract was seen at the level of subcutaneous external anal sphincter in one patient. Inflammatory signal alterations in the surrounding soft tissues were present in three of these seven patients.

There were abscesses in labium majus in two patients and in one patient there were perineal abscesses with accompanying inflammatory signal alterations.

In six of the 36 patients no abscess or fistula/sinus tract was seen. There were only inflammatory signal alterations with contrast enhancement in perianal or subcutaneous tissues.

In two patients presenting with perianal pain and hemorrhoids, minimal inflammatory changes were detected on MR images.

There were two patients with normal MR imaging findings.

As digital examination of the anorectum and rectoscopy are avoided in neutropenic patients, MR imaging, which clearly demonstrates the perianal pathology should be preferential.