Rubber Band Ligation for Treating Hemorrhoids: Two Case Studies

Study 1

Doctors Who Conducted Study: Lee HH, Spencer RJ, Beart RW Jr.

Title: Multiple hemorrhoidal bandings in a single session

Purpose of Study: To assess the risks of multiple banding in one session

Study Dates: Retrospective examination of patients who had bandings performed between July 1989 and August 1992.

Findings: Patients who underwent multiple bandings in a single session experienced more pain and discomfort than patients who only had one banding (29% vs. 4.5%), but although there was more pain, most patients were able to control the pain with pain relievers. The multiple banding patients also experienced more vasovagal symptoms (these are symptoms related to the vagus nerve which may lead to fainting) (5.2% vs. 0%). Multiple banding patients also had more swelling (2.6% vs. 0%), more urinary hesitancy and frequency (12.3 vs. 0%). However, no multiple banding patients experienced major complications such as massive delayed bleeding or sepsis.

Conclusion: Although multiple bandings in a single session did result in additional risk factors, the risks were found to be "acceptably low" and a "safe and cost-effective alternative".

Study 2

Doctors Who Conducted Study: Di Giorgio A, Arnone P, Canavese A, al Mansour M, Campagna SA, Pallotti M.

Title: Ambulatory treatment of hemorrhoidal pathology with elastic bands according to a modified Barron technique

Purpose of Study: To study the effectiveness of rubber band ligation using a modified Barron method

Study Dates: Results published in 1997

Findings: This study involved the use of a ligator with suction which is a modification of the Barron ligator.

The study involved 84 patients who had multiple treatments over 18 months with follow-up of 6 months, 40 patients were male and 44 were female. On average, the male patients had experienced symptoms of 9 years, while the female patients had experienced the symptoms for 8.9 years. On average, treatments consisted of 3.4 session and 3.6 rubber band ligations.

9 patients had previous received other treatments including: rubber band ligation (3 patients), hemorrhoidectomy (4 patients), sclerotherapy (1 patient) and rubber band ligation and sclerotherapy (1 patient). 10.7 % of patients had Grade I hemorrhoids, 19% Grade II hemorrhoids and 70.2% of patients had Grade III hemorrhoids. A lot of the patients involved in this study had the following pre-existing symptoms: 34 had anal pain, 49 had bleeding, 5 experienced anemia, 21 had thrombosis of the hemorrhoidal plexus, 54 had prolapse, most patients had multiple symptoms.

During the study 285 sessions were performed and 304 hemorrhoids were banded. On average, the male patients had been experiencing symptoms of 9 years, while the female patients had been experiencing the symptoms for 8.9 years. On average, treatments consisted of 3.4 session and 3.6 rubber band ligations.

Multiple sessions were required with advanced grades of hemorrhoids

100% of Grade II hemorrhoids patients required multiple sessions

94% of Grade III hemorrhoids patients required multiple sessions

7 patients only required one session (66.7% had Grade I hemorrhoids)

65 patients had no short-term or long-term complications

9 patients had short-term tenesmus (the feeling of needing to pass stools) for an hour after the procedure

2 patients experienced bleeding 2 weeks after the procedure which cleared up on its own

5 patients required additional rubber band ligations during a follow-up visit

3 patients required trimming surgery during follow-up; this is also done as an outpatient procedure

Conclusion: 90% of patients were able to achieve symptom relief with the modified Barron method and complications were minor. In addition, this treatment option had the benefit of being performed in an outpatient setting and allowed patients to immediately return to normal activity levels. Plus, no anesthesia is required and the procedure allows for a 6 to 12 month follow-up period. The doctors determined that the modified Barron method was a good treatment option for hemorrhoids.

Contagious and Deadly Influenza Strain Built in the Laboratory

The threat of a deadly flu virus wiping out a considerable number of people is always in the back of the collective mind of the medical community. The caution alarm was sounded just recently, when news broke that two scientists reportedly created a variant of the H5N1 flu virus (known colloquially as "bird flu") that is highly contagious. When tested on ferrets, the ferrets transmitted the disease to one another by merely sharing the same air. This strain of flu has the mortality rate close to the wild version of the strain, making it deadlier than the flu that caused the 1918 pandemic.

The strain was not created for entertainment or fun; rather, it was created to see if the H5N1 flu strain could potentially mutate into a form easily spread among humans. From the results of the current mutation, that could very well be the case. While it had been hypothesized that making the strain more accessible to humans would reduce its overall strength, thereby making it less lethal, the results of the mutation fly in the face of that theory. Extra precautions were made during the process, such as requiring scientists to shower and change clothes before leaving the lab.

Those extra precautions are necessary. A virus such as this could have deadly consequences for the public at large, and it could result in a widespread epidemic if it somehow were released. Therefore, any handling of mutated H5N1 virus must take place in a biosafety level 4 (BSL-4) facility. This is done not only to protect the scientists working with the virus, but also the general public. The main concern is keeping the mutated H5N1 virus from being handled in substandard laboratories.

Due to the chances of the highly contagious mutated H5N1 strain doing serious damage if it somehow escaped into the air, the perceived fear associated with the virus is very high. Therefore, there have been calls for a voluntary shutdown of all research on H5N1 virus mutations that may be more transmissible to humans until the proper safety measures can be taken. This mutated virus poses a serious threat to human health, and any research done on it must be handled appropriately and safely. This H5N1 virus mutation has the potential to cause a worldwide epidemic of catastrophic proportions if the virus remains as lethal and contagious as it is right now. Researchers have just agreed not to publish their results in a scientific journal, as they could be used for bioterrorism.

Why Are We Seeing an Explosion in ADHD Among Children?

For as long as it has been around, ADHD has been a controversial diagnosis. Many people, parents and grandparents in particular, wonder why there were no ADHD children in their classrooms when they were children and now suddenly they seem to be everywhere. What has changed so much about children and where did ADHD come from?

One major change that has led to the proliferation of ADD diagnoses is the ubiquity of psychiatry and psychiatric services. Compared to 50 or 100 years, advances in psychiatry have determined that many behavioral problems, from nervousness to hyperactivity, are actually disorders that can be labeled and treated, whether with drugs or even cognitive behavioral therapy, as is the case with many anxiety disorders. Psychiatrists say that ADHD itself has always been around, it's just the label "ADHD" that hasn't.

ADHD is a developmental disorder that is characterized by poor attention skills and hyperactive behavior. Children with ADHD struggle to focus on tasks that they need to complete at home or school and are prone to outbursts of energy that can be disruptive in various social situations. At present, 3-5% of children globally are diagnosed with ADHD and it is one of the most commonly discussed and studied psychiatric disorders.

As with many psychiatric diagnoses, the big debate in ADHD is whether it is a disorder caused by nature or nurture-it is a biological disorder or a maladaptive social disorder? On the one hand, many researchers claim that it has biological roots that can only be treated with drugs like Ritalin. Opponents of the biological approach claim that it does not take into account the social changes that have accompanied ADHD's rise, such as longer, more regulated days in school and homes in which both parents work. The believe that ADHD is a cry for attention due to a society that does not allow them to get their needs met, but simply lines them up for pharmaceutical companies.

So what is the truth behind the nature vs. nurture debate? Probably a little bit of both. Drugs have been shown to help children diagnosed with ADHD, but there is also proof that ADHD can be attenuated by lifestyle and dietary changes. ADHD is a hotly debated topic and will continue to be in the future as people become increasingly suspicious of the health profession's tie to the pharmaceutical industry. However, whether or not you prescribe to nature or nurture, ADHD is a very real disorder for the millions who suffer from it, so it is important that we don't stigmatize them-we must continue to look for ways to help them have a better quality of life.