History of research of hemorrhoids is a history of one great mistake History of treatment of hemorrhoids is history of needless invasive treatment. vascular nature of hemorrhoids. Aigner F; Bodner G; Gruber H; Conrad F; Fritsch H; Margreiter R; Bonatti H Department of General, Innsbruck Medical University, Innsbruck, Austria. I n The arterial blood supply of the internal hemorrhoid plexus is commonly believed to be associated with the pathogenesis of Anal hemorrhoids. Ultrasound-supported proctoscopic techniques with Doppler-guided ligature of sub mucosal rectal arteries have been introduced for the therapy of hemorrhoids. The present investigation focuses on caliber and flow changes of the terminal branches of the superior rectal artery (SRA) supplying the corpus cavernous recite (CCR) in patients with hemorrhoids. Forty-one outpatients (17 female, 24 male; mean age 48 years) with hemorrhoids of the Goligher grades I-IV were compared with 17 healthy volunteers (nine female, eight male; mean age 29 years) by means of transpersonal color Doppler ultrasound. The mean caliber of the arterial branches in the study group with hemorrhoids was 1.87 +/- 0.68 mm (range, 0.6 to 3.60 mm) and 0.92 +/- 0.15 mm (range, 0.6 to 1.2 mm) in the control group (P < 0.001). The arterial blood flow was significantly higher in patients with hemorrhoids than in the control group (mean 33.9 vs. 11.9 cm/second, P < 0.01). Our findings demonstrate that increased caliber and arterial blood flow of the terminal branches of the SRA are correlated with the appearance of hemorrhoids. We suggest that the hyper vascularizations of the anorectic contributes to the growth of hemorrhoids rather than being a consequence of hemorrhoids. Transperineals color Doppler ultrasound (CDUS) is an appropriate method to assess these findings in patients with hemorrhoids. J Gastrointest Surg. 2006; 10(7):1044-50 Medscape.com Symptomatic hemorrhoids. Adv Surg. 2004; 38:167-82 (ISSN: 0065-3411) Gearhart SL Colorectal Surgery, Johns Hopkins Medical Institutions, Lutherville, Maryland, USA. The most important aspect in the diagnosis of hemorrhoid disease is the exclusion of other, more life-threatening conditions. Hemorrhoid banding remains the most successful method to manage hemorrhoids in the outpatient clinic. Chronic application of local medications to the perineum may result in dermatologiy conditions. It is safe to manage acutely inflamed hemorrhoids surgically. Table 1 is a summary of the various methods for the surgical management of symptomatic prereleasing hemorrhoids. Dietary manipulation, including fiber supplementation, should always accompany surgical
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