Background: "Circumferential prolapsed piles" poses great challenge for colorectal surgeons. "Infrared photocoagulation" (IFC) is a safe procedure for early stages of piles but is not readily available due to high costs. We introduce a simple simulation of (IFC) for management of residual daughter piles after surgical excision of the main piles.Patients and methods: 10 patients with circumferential grade III-IV piles were recruited for "indirect cauterization" of residual daughter piles after open excision of the main piles and were observed for one month for postoperative complications. The results were compared to those of the last 10 correlated patients in the database managed by simple excision of the main piles only.Results: Three cases of SSI (Surgical Site Infection) with minimal, temporary spotting after removal of dressing were found in the study group. No case of incontinence was recorded. Conclusion:The "indirect cauterization" technique is feasible with satisfactory outcome for cases of circumferential piles in low resource areas.

Background “Circumferential prolapsed piles” poses great challenge for colorectal surgeons. “Infrared photocoagulation” (IFC) is a safe procedure for early stages of piles but is not readily available due to high costs. We introduce a simple simulation of (IFC) for management of residual daughter piles after surgical excision of the main piles. Method 10 patients with circumferential grade III-IV piles were recruited for “indirect cauterization” of residual daughter piles after open excision of the main piles and were observed for one month for postoperative complications. The results were compared to those of the last 10 correlated patients in the database managed by simple excision of the main piles only. Results Three cases of SSI (Surgical Site Infection) with minimal, temporary spotting after removal of dressing were found in the study group. No case of incontinence was recorded Conclusion The “indirect cauterization” technique is feasible with satisfactory outcome for cases of circumferential piles in low resource areas.

Background The ability of extrarenal tissues to convert 25-hydroxyvitamin D into 1,25-hydroxyvitamin D and its dependence on substrate levels provide the rationale for supplementing vitamin D in dialysis patients who usually have severe depletion of both calcitriol and vitamin D. The primary aim of the study was to detect serum vitamin D3 levels in a cohort of Egyptian hemodialysis patients and to check the effect of 12-week therapy of cholecalciferol on serum calcium, phosphate, and parathyroid hormone (PTH) in vitamin D-naïve hemodialysis patients with vitamin D deficiency. Patients and methods A total of 40 patients (25 males and 15 females) with chronic kidney disease on regular hemodialysis, attending the Nephrology Unit of internal Medicine Department, Mansoura University Hospital, during the period from January to June 2017, were included. According to laboratory investigations and clinical examination, deficient patients were treated with Devarol-S (cholecalciferol) for 3 months and then revaluated. Deficient patients received intramuscular injection of 50 000 IU monthly for 3 consecutive months. Results The patient group included 40 persons, comprising 27 (73%) male patients and 13 (27%) female patients. Their mean age was 47.16 ± 14.92 years. The mean dialysis duration was 4.68 ± 2.42 years. At 3 months after vitamin D replacement, significant increase in serum calcium (8.33–8.89 mg/dl), phosphorous (4.99–5.85 mg/dl), and vitamin D3 (4.01–28.43 ng/ml) levels were observed compared with pretreatment levels. There was also significant decrease in PTH level (419.30–377.20 pg/ml). After 3 months of follow-up, there were no significant changes in the levels of hemoglobin, Kt/v, albumin, and alkaline phosphatase in the study group. Conclusions In most patients, treatment with cholecalciferol in a 50 000 IU/month dose permits safe correction of vitamin D deficiency and control of PTH level, yet serum phosphorus should be monitored.