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    Medical Cases1:  Round shape endo-cutaneous hemorrhoids.
    Patient: Ms Cheung,  Age: 42
    Date receiving therapy: November 2005
    Patient's complaint: For 3 years, the patient repeatedly observed blood in her stool, also observed swollen membrane sagging out of her anus.
    History of treatment: October 12, 2005, Ms Cheung registered in our outpatient clinic for medical examination.
    Finding: After detailed examination, a round shape superfluous object at her perianal was observed, which could not be pushed back in. Using sterile gloves to touch the anus at 1 to 5 o'clock positions, we felt the protrusion of soft muscle. No blood or blood stain could be observed. By anoscope examination, it was observed that membrane around the rectum was swollen and surrounded with blood. At the 1, 5, 11, o'clock positions, anal papillae hypertrophy was observed. No surgery restrictions could be found.

    Diagnosis: Round shape endo-cutaneous hemorrhoids.

    Therapy: PPH surgery (Procedure for Prolapse and Hemorrhoids).

    Result: Surgery was successful and no recurrence two years after surgery.
    Specialist's comment: The advantage of "PPH" Surgery is to dissect the loose portion of rectal membrane, remove blood vessels in the membrane, lower blood pressure in the hemorrhoids, and reduce the length of the rectal membrane, resulting in avoidance of hemorrhoid fistula.

    COMMENTARY: (Brief description of PPH surgery)
    PPH surgical technology (Procedure for Prolapse and Hemorrhoids) is designed by Longo in 1998 and is commonly practiced in the United States of America and Japan. It was introduced to China recently. This technique is beneficial to patients because of its minor injury, brief surgery procedure, little bleeding and short inpatient stay (usually about 3 day residing in the hospital). Slight pain feeling after surgery and little complications, quick recovery (due to no or little wound), no anal stenosis or narrowing, and no recurrence are the advantages of PPH. The philosophy of PPH technology is to dissect and remove the rectal membrane above the hemorrhoids with circular stapler and staple the surgical region. This technology renders the loose rectum back to its normal position, improves the self-control ability of anus, decreases the internal pressure of anal channel and eliminates the sagging of hemorrhoids. Without damage to the organization of anal tissue, the ability of anorectal channel to solidify feces and to avoid anal stenosis. Dissecting the end portion of rectum and decreasing the blood supply to hemorrhoids, the cord is reduced and the stimulation of the membrane by the stool, which leads to most of the bleeding, is decreased. Since the region at 1.5 to 2.0 cm above stapling has fewer nerves, pain and discomfort can be reduced. PPH is especially applicable to the serious hemorrhoids bleeding (1st-2nd degree), hemorrhoids prolapse, and rectal membrane prolapse.

    Medical Case2:   Complicated Hemorrhoids Fistula
    Male.  Age: 17, Indonesian Chinese
    Over ten years, the patient suffered from a painful swollen anus and perianal abscess. The patient pursued medical therapy in hospitals both in Indonesia and in South East Asia. Serious anal fistula was diagnosed and seven surgical procedures undertaken, none of which cured the medical condition. This disease brought a lot of pain and inconvenience in his life.  The perianal abscess discharge made him wet at his anus and the patient also suffered from a pruritus ani condition. The scars from the previous surgery contracted and the patient found it difficult to sit down. In May 2003, the patient registered as an outpatient in our clinic for medical examination. After comprehensive examination when he was diagnosed with "High complexity anal fistula", a treatment plan which integrated Traditional Chinese and Western therapies was devised. Surgery was successfully done on seven pieces of fistula channels, after which the patient received Chinese medicine for internal and external treatment. The patient also had moxibustion with Chinese medicine and physical therapy to speed up the time of recovery. Now, the patient is able to sit down and move around normally and there has been no recurrence in three years since treatment.

    Medical Case 3:   Stubborn Hemorrhoids
    Male, Age: 58, Chinese (Hong Kong resident).
    For 40 years, the patient suffered from bloody stool, prolapse of membrane inside the anus resulting in defecation difficulties. The patient had previously received internal and external application medicine and surgery at other hospitals, but instead of healing, the condition got worse. After admission to Clifford Hospital, the patient received Chinese and Western surgeries (to tie his round shape hemorrhoids separately and to create his main hemorrhoids sclerosis by injections). The surgery and injection relieved the patient from pain and also avoided the complication of anal stenosis due to multi-surgery. His medical condition has been stable for three years since his treatment. The patient expressed his appreciation to Clifford Hospital by posting his gratefulness in a newspaper produced by Ta Kung News Press (Hong Kong).


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