INTRODUCTION The hemorrhoid is the most common anal disease. Depending on its symptoms, non-invasive treatments such as band ligation, cryotherapy, and sclerotherapy and invasive treatments such as a hemorrhoidectomy have been used to treat hemorrhoids. Among the aforementioned treatments, the hemorrhoidectomy has been most commonly used, but has disadvantages of severe postoperative pain, longer time to return to daily living, and complications such as anal stricture. To overcome these disadvantages, new treatment methods such as the procedure for prolapsed hemorrhoid (PPH) or Doppler-guided hemorrhoidal artery ligation have been introduced. Doppler-guided hemorrhoidal artery ligation has been reported to have a low recurrence rate of less than 10%, 90% or higher patient satisfaction, and minimal pain. It achieves good outcomes in a relatively short time in the treatment of early hemorrhoid where bleeding or anal discomfort are main symptoms.
Press 'Allow' to download. Subheim - Approach(2008) - Perdidas mp3. Download with VKDJ.
However, it has a limitation in the treatment of advanced hemorrhoids where anal prolapse is the main symptom. For this reason, the simultaneous conduct of artery ligation and recto-anal repair has been recently introduced and has been reported to achieve good treatment outcomes. In this research, a one-year follow-up study was conducted on hemorrhoidal patients who had undergone Doppler-guided Hemorrhoidal artery ligation and rectoanal repair (DG-HAL & RAR) to investigate its outcomes and effectiveness. METHODS This was a prospective cohort study conducted on 97 patients who underwent a one-year follow-up study from among patients who had been diagnosed with hemorrhoids and then had undergone a DG-HAL & RAR in the authors' hospital from March 2008 to May 2010.
Examinations of the surgery outcomes through outpatient visits were conducted three times: 7 days, one month, and three months after discharge. One year after discharge, recurrence and complications were followed-up via a telephone interview or outpatient visit. Recurrence was considered to have occurred in cases of re-bleeding or re-prolapse. Pre- and postoperative pain, operation time, and time to return to ordinary living were also examined.
The comparison of preoperative and postoperative pain was assessed using a visual analog scale of 0-10 (0, no pain; 10, the worst pain imaginable). The surgery was conducted on internal hemorrhoidal patients with Goligher grade 2-4 hemorrhoids. Patients who were diagnosed with concomitant anal diseases such as anal fissure or fistula or with an incarcerated hemorrhoid or thrombotic hemorrhoid on preoperative anal examination were excluded from the surgery. All patients underwent the surgery in the lithotomy position.
An anoscope equipped with a Doppler probe was inserted into the anus, together with a specially prepared sleeve. Then, the Doppler probe was placed around 3-5 cm from the upper dentate line to identify the branch of the upper rectal artery. The accurate detection of the branch of the upper rectal artery was confirmed via Doppler sound and the vessel depth displayed on the apparatus screen. Subsequently, a figure of eight suture was conducted using vicryl 2-0 at the rectal mucosa where the artery had been identified using the anoscope.
After accurate ligation had been confirmed via loss of the Doppler vein signal, it was firmly ligated using a pusher. Next, after the hemorrhoidal mass had been exposed between the anoscope and the sleeve by rotating the anoscope, recto-anal repair was conducted in a way that hemorrhoidal mass was sequentially sutured from the artery ligation site to 5 mm of the upper dentate line by using the vicryl used for artery ligation and was firmly ligated in place on the rectal mucosa. The aforementioned procedure was performed on 6 sites (toward 1, 3, 5, 7, 9, and 11 o'clock) starting from the lower middle of the anus and going clockwise. The surgery was completed when no more prolapsed hemorrhoid or artery signal was found. The data of this study are expressed as mean ± SD. A statistical analysis was conducted using SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA).
The difference between pre-operative and post-operative pain was tested via the Wilcoxon signed rank test. RESULTS The patients' mean age was 51.7 ± 13.2 years (range, 22 to 87 years), and the patients consisted of 62 males and 35 females.
The most common main symptom observed in the patients before surgery was prolapsed lesion (83 cases), and anal bleeding (55 cases), defecation pain (22 cases), constipation (12 cases), and fecal incontinence (2 cases) were also observed. Both anal prolapsed lesions and bleeding were observed in 35 patients. The preoperative disease stages included grade 2 hemorrhoids in 13 patients (13.4%), grade 3 hemorrhoids in 68 patients (70.1%), and grade 4 hemorrhoids in 16 patients (16.5%) according to Goligher classification.
Five patients had previous hemorrhoid surgery at least once. Most patients had had hemorrhoidal symptoms for more than one year, and some patients had had them for more than 30 years. Values are presented as number (%). Anesthesia included systemic anesthesia, with intravenous anesthesia in 82 patients (84.5%), spinal anesthesia in 9 patients (9.2%), and local anesthesia in 6 patients (6.3%). In cases of patients being afraid of systemic anesthesia or underlying diseases such as clotting disorder, spinal anesthesia or local anesthesia was conducted instead of systemic anesthesia.
The patients were hospitalized on the day of surgery or one day before surgery, and underwent the surgery. The mean hospitalization period was 1.6 ± 1.1 days. Most patients were discharged on the day of surgery. However, 16 patients were discharged one day after the surgery, and four patients and one patient were discharged two days after the surgery and five days after the surgery, respectively.
The mean operation time was 34.0 ± 7.3 minutes. The number of blood vessels to which ligation was conducted was mean 5.9 ± 0.5. Recto-anal repair was conducted an average of 5.8 ± 0.5 times. In a survey on the return to daily living, patients answered that they were able to return to their daily lives, on average, 2.3 ± 2.0 days after the surgery. The pain score was shown to increase from 1.0 ± 2.2 points before the surgery to 2.4 ± 3.0 points two hours after the surgery to 0.8 ± 1.4 points 7 days after the surgery.
![Subheim approach 2008 rare Subheim approach 2008 rare](/uploads/1/2/5/4/125489863/332516995.jpg)
No significant difference in pain score was found 7 days after the surgery. The result of the follow-up conducted 7 days after the surgery showed tenesmus in 19 patients, bleeding in 8 patients, voiding dysfunction in 7 patients, and prolapse in 2 patients.
However, no serious complications requiring re-hospitalization were observed. In a follow-up study conducted one month after the surgery, tenesmus, bleeding, and prolapse were observed in 6, 4, and 5 patients, respectively. When the four patients with bleeding were examined using an anoscope, two patients showed bleeding caused by acute anal fissure irrelevant to hemorrhoidal bleeding.
In the outpatient visit three months after the surgery, no patient complained of tenesmus, and anal prolapse and bleeding were observed in 5 and 2 patients, respectively. Two patients with acute anal fissure showed no further bleeding after they underwent conservative treatments. In a follow-up study conducted one year after the surgery, the preoperative symptoms recurred in 14 patients (14.4%). Four patients complained of defecation bleeding, of whom two patients had grade 2 internal hemorrhoids and two patients had grade 3 internal hemorrhoids. Ten patients complained of prolapse, of whom four patients had grade 3 internal hemorrhoids and 6 patients had grade 4 internal hemorrhoids. The score of surgery satisfaction one year after the surgery was 7.4 ± 2.9 points, and 76 patients (78.3%) replied in a survey that they would recommend the surgery to other people.
DISCUSSION The hemorrhoid is the most common disease among anal diseases and is known to be caused by anal cushion descent or abnormal congestion of the internal hemorrhoidal venous plexus. Various treatment methods have been developed and used to date. Among the aforementioned methods, the hemorrhoidectomy is the most fundamental treatment method and has been used for a long time. It is a good method to eliminate the pathophysiological factors of hemorrhoids, but has disadvantages of having an approximately 10% postoperative complication rate , requiring time for treatment, and requiring significant time to return to daily living. To overcome these disadvantages, new operation methods have been developed to minimize postoperative pain and to return to daily living as soon as possible. The PPH, which was first introduced by Longo et al. In 1993, is a surgery method that effectively blocks the blood flow of the upper rectal artery into the hemorrhoid by segmentally resecting the rectal mucosa with a regular size in a circular form and suturing them automatically and that fixes the descended rectal mucosa by uplifting it.
It has advantages of less postoperative pain, shorter hospitalization period, and simpler procedure. However, it has a disadvantage in that it may cause serious complications such as bleeding, perforation, peritonitis, and fecal incontinence unless the resection plane is precisely sutured -. In addition, a long-term follow-up study reported that recurrence rate was higher for the PPH than for a hemorrhoidectomy. Doppler-guided hemorrhoidal artery ligation, which was first introduced by Morinaga et al. in 1995, is a surgery method that ligates and contracts hemorrhoid mass after detecting the upper rectal artery branch connected to each hemorrhoid through a Doppler signal, and compared to a conventional hemorrhoidectomy, no difference in the recurrence of preoperative symptoms was reported to have been found in a one-year follow-up study. A 3-year follow-up study including grade 4 hemorrhoids reported good outcomes, such as a 12% recurrence rate and fewer complications ,. However, artery ligation alone has limitations in the removal of the remaining anal mucosa and the treatment of a severely prolapsed hemorrhoid.
Accordingly, the early apparatus was recently modified to simultaneously conduct artery ligation and RAR. Thus, it had an effect of fixing the upper anal canal upward after PPH suturing. The conventional hemorrhoidectomy was conducted in the jackknife position in most cases whereas the technique used in this study was conducted in the lithotomy position. In the jack-knife position, the Doppler probe handle cannot be freely rotated in the leg-assembled position, which limits its use.
However, in the lithotomy position, the Doppler probe can be freely rotated. Therefore, surgeons prefer the lithotomy position to the jack-knife position. In this study, artery ligation and recto-anal repair each were conducted an average of mean six times. The mean operation time was approximately 35 minutes. No significant differences in the operation times and the numbers of artery ligations and recto-anal repairs were found among the patients. Meanwhile, in other studies , -, the number of artery ligations was, on average, 5-10; particularly, the number of recto-anal repairs was a minimum of 1 and a maximum of 5, which was less than the number recto-anal repairs conducted in this study. The reason for this difference is attributed to differences in the surgery methods.
In this study, during artery ligation, the recto-anal repair was simultaneously conducted in such a manner that the prolapsed hemorrhoid mass on the Doppler probe's groove was sequentially sutured. Meanwhile, in other studies, each artery ligation was conducted for the entire anal canal in advance, and several prolapsed hemorrhoids were then separated, followed by recto-anal repair. In a follow-up study conducted 7 days after the surgery, approximately 20% of the patients suffered from tenesmus, which was higher than the frequency reported in another study. This is likely attributable to the fact that the number of recto-anal repairs was higher in this study than in the other study. A further comparative study is required to obtain more evidence. In a follow-up study conducted one year after the surgery, recurrence, including re-bleeding, was observed in 14 patients (14.4%), which was a higher recurrence rate than that shown in other studies , -. The recurrence rates were 15%, 9%, and 38% for grade 2, grade 3, and grade 4 hemorrhoids, respectively.
When only prolapse was considered, recurrence occurred in 10% of the patients. In this case, no significant difference in recurrence rate was found between this study and other studies.
However, the direct comparison is not really reliable as each study had different recurrence criteria. Only prolapse was defined as recurrence in one study whereas prolapse or bleeding was defined as recurrence in this study. In addition, symptoms requiring surgery were defined as recurrence in another study. Thus, an accurate comparison may be difficult. Faucheron et al.
conducted a follow-up study of approximately 34 months after a study conducted on 100 patients with grade 4 hemorrhoids and reported a 9% recurrence rate. This rate is significantly lower than the 38% recurrence rate for grade 4 hemorrhoids of this study. This difference is likely attributable to the different criteria of grade 4 hemorrhoid. In this study, prolapsed hemorrhoids that were prolapsed over the entire anus were mainly included in the criteria of grade 4 hemorrhoid, but in the study conducted by Faucheron et al. , partially prolapsed hemorrhoids were mainly included. A study conducted by Szmulowicz et al. also reported that 65% of recurrent patients had large-sized hemorrhoids prolapsed over the entire anus.
A follow-up study conducted for more than one year showed that DG-HAL & RAR was a safe and effective treatment method for most hemorrhoids except grade 4 hemorrhoids with severe prolapse. This study has a limitation in that it was conducted with a restricted number of surgeons in a single institution. However, as this technique is currently being used in other medical institutions in addition to the authors' hospital, a long-term, large-scale multicenter study could be conducted to compare this technique with other surgery methods in the future. A DG-HAL & RAR for the treatment of most hemorrhoids, except hemorrhoid with severe prolapsed, achieved a satisfactory outcome without significant pain and complications. A further long-term, large-scale multicenter follow-up study is required.
Furthermore, a study on the treatment of hemorrhoids associated with other anal diseases is required.
Skip's free netreleases from 2008 triptunes,skiptunes,electronica,IDM,Drill'n Bass. (I double checked,all links work.) bdownload here- /b b/b Catita -'It is not by mere occasion that this release has the term 'HyperSpace' on the title. On his debut release at Catita, Skip gives us fast lo-fi beats and speedy melodies, mixed up with Aphex Twin and served as what we like to call 'Drum'n'tendo'. A robot from space demanded and Catita delivered.'
1 HyperSpaceAdventure 2 NTD4 3 Planet Cruizer 4 NTD11 bdownload here - /b Pterodactil Squad -'Skip's first release with Pterodactyl Squad is Ecospheric Escape, a selection of 7 scientifically musical tunes, all inspired by a childhood playing video games. Otherworldly and abstract, yet always precise and upbeat, synthy melodies run over speedy drum beats, creating an alien sound which is somehow quite familiar.'
1 Rocketskip 2 Bit Bot 3 Mobeel Idodit 4 Namagem 10 5 Nimtar Yalmix 6 NMGM 16 7 Anti Mighty download here - Them Records -'We have a very special holiday gift from Belgium, and just in time for the holidays. THEM records is happy to release Intimethod from drill'n'chip guru Skip. Skip's latest release reveals his wide variety of styles.
Intimethod moves between melodic drill'n'bass, cheap chiptunes, and instances of daring IDM, all without forgetting the in-betweens. The special blend of styles gives this release a personal and unique taste. Intimethod is colourful, fast, and in constant motion between happiness and nostalgia. 1 Going For Third 2 The Neverending Collpase 3 Ponky Tonky 4 Pix Reversed 5 NTD17 6 Slowawake 7.Wrong Title All music,artwork and crappy mastering by Skip. A forth netrelease on BugWeb,the netlabel of BugKlinik.
Download here- Skip also appears on following free compilations 2007 Digital Vomit Records b/b (features: Skip - Feet Are Deformed Hands) 2008 BugWeb -Limited and exclusive CD-r for the 2008 Happy Days happening. (features: Skip - Plack Blanet) 2008 Caoutchou Records b/b (features: Skip - Elastix Plastix) 2008 Monolog X Records b/b (features: Skip - Snipiteaser) 2009 Caoutchou Records b/b (features: Skip - Eye Earth) 2009 Illphabetic b/b (features: Skip - Triptune 02) 2009 Pterodactyl Squad url=bA Pterodactyl Squad Compilation/url /b(features: Skip - Mr.Glass) 2009 electrobel.FR V.A. Robots like it hot (features Sk'p -Kraeacktor) TO BE CONTINUED. b Mass Murder LP/b With Mumblz and Sighnature - Dance You Fuckers CA2K - Give Me More Cruize Of Fiction - Iatrogenesis Cruize Of Fiction - Al-Nakba Death By Drums - Caught In the Hills Exact - Invasion Viral Infection - Her Master Metaphase Ft. Madgirl - Someday Mind Killa - Mantis Rapture O'nine - Infectable Black Code - End Of Days Qmar - Cold War Envoys Evolution Ft. Prolific - Suicide Available at Itunes, Beatport and any other decent mp3 download store (songs can be bought seperate) b CruizeOfFiction - Weltschmertz/b FREE netrelease 01 - Cruize Of Fiction - Weltschmertz 02 - Cruize Of Fiction - Deviant Direct link: b Fragments Of Mangled Minds EP/b FREE netrelease 01 - Gabba Voodoo & Para Riser - Our Messenger Has Come To Us 02 - Sidereal - Chew Yun Fett 03 - Arganizm - LSD 04 - Igneon System - Leachers 05 - D.T.A. Crusader 06 - Dyre Korr - Terror And Chaos 07 - Cruize Of Fiction - Terroriser 08 - Weirdo - Chasing Chaos 09 - Murder One - Avange You All 10 - Eye - Pa 11 - Infarkt - Blackout 12 - Peter Kurten - Madness 13 - Duzer - Fuck The World Fuck The Love Direct link.and more to come.
Egon Fisk on acroplane records in ireland: the Unstablelist German born, Belgium residing Egon Fisk has been writing music since he was only 12. His varying pieces of recent electronica (available here) show an attention to detail, a musicality and an originality rarely matched these days. Some of it works killer on the dancefloor too, as tested in Belfast by us:) He has recently released some other music on Roulette Records, and i believe he has some music coming out on Umbrelladelika Records soon, so keep an eye out for those. I only wish this was my release, but it's not, i'm just the messenger. Bug Web Presents: BW003.1 Enkidu - Don't look back EP part 1 Enkidu (aka X&trick) presents a collection of previously unreleased tracks which were recorded between 2003 and 2009. After years of travelling the world as dj and live act, Enkidu took all his influences and mixed it into the 'Don't Look Back' Ep's.
This series will take you on a musical journey going trough deep ambient dubscapes, poppy electronica and acid rave-influenced IDM frenzy. ACCESS TO ARASAKA - 'Oppidan' OUT NOW! bCD-Digipack September 2009/b bSpectraliquid & Tympanik Audio SLQ008 + TA031/b, ONLINE ORDERS: The long-awaited and highly-anticipated debut CD from New York’s amazing young new talent Access To Arasaka has finally arrived. With a steady momentum of buzz from fans and critics over the past year, remix collaborations with Zentriert ins Antlitz, Aphorism, and Totakeke, and more-than-well-received compilation appearances for the Hymen Records and Tympanik Audio labels, Access To Arasaka now offers the true scope of his capabilities with his innovative new album ‘Oppidan‘. A futuristic journey of a cerebral nature, demonstrating a virtual equinox of expert beatwork and densely-layered atmospheric explorations, ‘Oppidan‘ transcends complexity and innovation in electronic music and seems to arrive at the very edge of its own inner space.
Dark and cinematic and fascinating to no end, ‘Oppidan‘ is truly full of life and genuine mystic, opening the imagination of the listener into epic new dimensions at the hands of a true master of modern electronic composition. ‘Oppidan‘ is available from Spectraliquid and Tympanik Audio September 8th, 2009. Sound samples: - Tracklist: 01.
Caeropore 06. First Kill (feat.
Beau Jestice) 07. Parisville 09. Delicate Annihilation 12. Sylvan-hesh 14.
Transcednence 15. Waiting War 17.
The new Distant Fires Burning DIY-CDR '7 Sisters' is available through the Music / Store on. For 5 EUR (+2,50 EUR shippingcosts) you get a lightscribe CDR with 7 tracks in a jewelcase with minimal design by me. The first 50 copies will be handnumbered and will contain a small pen drawing. The music is inspired by artists as Biosphere, FSOL, Global Communication, Brian Eno, Loscil, Tim Hecker, Pete Namlook, Deepspace, BpOlar, Tangerine dream, Dead Can Dance, Liquidbass, and all the other ambient artists here at E-bel. For the ones who don't have 'Messierobjekten' yet, there's good news. You can buy '7 Sisters' and 'Messierobjekten' together for 12,50 EUR (+ 3 EUR shippingcosts). Go to to listen. Here on E-bel you can find a free download of the track Celaeno AND an exclusive to electrobel download of the track Electra!
Congratz:) I got one too! SHEPHERD (aka harry poppins) - RIDDLE OF THE UNFLOCKED EP acroplane recordings ACP061 artist: Shepherd catalogue no.: ACP061 release date: 11.10.09 Leading the flocks since 2008, Shepherd brings ewe spiritual guidance in troubled times. The mood is dark, grimy and the landscape desolate.
Let Shepherd's hiphop and dubstep endeavors light your path. Music by Julien Itterbeek. Graphics by graphic non graphic. 7 tracks total. Whereas the 'Endzeit Bunkertracks' contest did not deliver us a record deal at Alfa matrix, we did get some attention from another label, and so Trimetrick is pleased to announce that we have a contract with a small New York based label called MachineKunt Records.
Netrelease Renoised 'Renoised' is a four-track release brought by the label Format Noise format noise Release: form-net-30 - Date: - 4 Tracks + Covers - MnemOnic - Renoised 2009 - 1. Shimmering residues 3. Animo nation 4. Ju jian lai All Tracks are under the license terms of format noise. Format noise is under license of RAUMKLANG MUSIC. This work is licensed under a CREATIVE COMMONS LICENSE Download link.