Objective This systematic review aimed to evaluate the short-and long-term safety, efficacy and costs of stapled haemorrhoidopexy (SH) compared with conventional haemorrhoidectomy.Method We searched 26 electronic databases and websites for studies in any language up to July 2006. Inclusion criteria were predefined, and each stage of the review process was conducted in duplicate.Results Twenty-seven randomized controlled trials were included (n = 2279). All had some methodological flaws. Postoperatively, 19 trials (95%) reported less pain, 17 (89%) reported a shorter operating time, 14 (88%) a shorter hospital stay, and 14 (93%) a shorter convalescence time following SH. However, prolapse was significantly more common after SH (OR 3.38; 95% CI: 1.00, 11.47). In the longer term, prolapse was significantly more common after SH (OR 4.34; 95% CI: 1.67, 11.28) as was reintervention for prolapse (OR 6.78; 95% CI: 2.00, 23.00). There were no differences in the rate or type of complications. Conventional haemorrhoidectomy and SH had similar costs during the initial admission.Conclusion Compared with conventional haemorrhoidectomy, SH resulted in less postoperative pain, shorter operating time, a shorter hospital stay, and a shorter convalescence, but a higher rate of prolapse and reintervention for prolapse.

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Autoregulation and chemical vasomotor control of cerebral blood flow (CBF) were quantitatively tested in 19 patients with various types and sites of cerebral ischemia and infarction. The effect of alpha adrenergic blockade of cerebral vessels by phenoxybenzamine (PBZ) also was evaluated in more than half of the patients. No correlation was found between the degree of cerebral dysautoregulation and impairment of chemical vasomotor control of CBF. Patients with brainstem ischemia and infarction showed normal vasomotor reactivity of CBF to changes in Pa CO 2 , despite the impairment of cerebral autoregulation during both induced hypotension and hyper ension. Following intracarotid injection of 10 mg PBZ, the degree of cerebral dysautoregulation lessened during induced hypotension but increased during induced hypertension. Chemical vasomotor control of CBF in response to changes in P CO 2 , was not significantly altered by the PBZ injection. Changes in autoregulation index (a quantitative measure of cerebral autoregulation) after the infusion were compared with changes in chemical regulation index (a quantitative measure of cerebral vasomotor reactivity). Induced hypotension and hypercapnia yielded a proportional correlation between these two indexes, while induced hypotension and hypocapnia revealed a significant inverse correlation. This study demonstrates that cerebral autoregulation is influenced by the autonomic innervation of cerebral vessels. Alpha adrenergic blockade improves impaired autoregulation when cerebral perfusion pressure (CPP) is lowered but worsens it when CPP is raised, indicating that PBZ impairs the ability of cerebral vessels to constrict during induced hypertension and improves their ability to dilate during induced hypotension. This study also supports the view that chemical vasomotor control is regulated not directly by autonomic innervations of cerebral vessels but by a local controlling mechanism.

Cerebral circulation and metabolism during Althesin anaesthesia were studied in seven healthy patients. Althesin was given in a single dose of 0.1 ml/kg and thereafter infused at a constant rate of 0.3 ml/kg/h. During Althesin infusion, the cerebral blood flow (CBF), the cerebral metabolic rate for oxygen (CMRo2) were 29 +/- 10 ml/100 g/min and 1.7 +/- 0.4 ml/133 g/min, respectively. These values were significantly different from those obtained in awake subjects in our laboratory (CBF: 46 +/- 7 ml/100 g/min; CMRo2: 3.1 +/- 0.6 ml/100 g/min). During CBF measurement, the mean cerebral perfusion pressure, cerebral vascular resistance (CVR) and arterial carbon dioxide tension (PaCO2) were 89 +/- 16 mm Hg, 3.4 +/- 1.3 mm Hg/ml/100 g/min, and 36 +/- 9 mm Hg, respectively. The relationship between CBF and PaCO2 were studied and it was found that during Althesin anaesthesia reactivity of cerebral vessels to the alteration of PaCO2 was maintained. It is concluded that Althesin caused cerebral metabolic depression which was accompaned by a decrease in CBF and an increase in CVR.