Internal Haemorrhoids-Clark et al. DiscussionDifficulties arise in the interpretation of the results of conservative treatment for internal haemorrhoids because of the frequent spontaneous remissions in symptoms that may occur in such cases, and also perhaps because of the fact that treatment by any method is often accompanied by simple advice on the avoidance of constipation, which might produce a slight amelioration in the condition. The number of patients so far treated in our trial does not allow of a full evaluation of all the factors, but all those in this series had had episodes of symptoms twice a year or more. A review at six months therefore seems reasonable to evaluate therapy ; and the random selection of patients into treatment groups minimizes errors of interpretation association with multifactorial analysis.Treatment by injection is generally painless and well tolerated by the patients. None of the complications which can arise from this treatment (Goligher, 1967) were encountered in these patients. On the other hand, treatment by ring ligation may be very uncomfortable, and was the reason for four patients refusing further treatment. Six other patients complained of some discomfort, often lasting for several days, and two patients lost time from work One of these patients developed painful groin glands two days after treatment. This disadvantage of treatment, however, was rewarded by a better objective endresult. The results from the present study indicate the need for further evaluation of the conservative treatment of this common condition. One hundred patients have now been admitted to the trial, and those treated are to be observed after six months and one year. These preliminary results, however, indicate that the conventional treatment by injections may not be as satisfactory as is generally supposed. The long-term results of treatment by the ring applicator are generally encouraging, though our experience shows that this treatment is usually a good deal more uncomfortable for the patients and is not well tolerated by all of them. If it is to be used it is important to keep well above the pectinate line with the ligation, and to prescribe analgesics such as pethidine 100 mg. for the first two or three nights after application of the ring. The rubber ring treatment is better confined to prolapsing piles alone; for firstdegree piles where bleeding is the main symptom injections with 5 % phenol in almond oil remain the treatment of choice. There seems to be no advantage in the use of almond oil alone. SummaryThe treatment of haemorrhoids by conservative methods has been examined. Injection therapy with the use of phenol in almond oil was effective in controlling bleeding, but with almond oil alone it was not. A comparison between the results of injection therapy and the technique of rubber ring ligation showed objectively better results after six months with ligations. However, ligation was sometimes followed by pain, and a few patients refused to continue with this form of treatment.These pre...

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Bdellovibrio bacteriovorus is a small deltaproteobacterial predator that has evolved to invade, reseal, kill, and digest other gram-negative bacteria in soils and water environments. It has a broad host range and kills many antibiotic-resistant, clinical pathogens in vitro, a potentially useful capability if it could be translated to a clinical setting. We review relevant mechanisms of B. bacteriovorus predation and the physiological properties that would influence its survival in a mammalian host. Bacterial pathogens increasingly display conventional antibiotic resistance by expressing and varying surface and soluble biomolecules. Predators coevolved alongside prey bacteria and so encode diverse predatory enzymes that are hard for pathogens to resist by simple mutation. Predators do not replicate outside pathogens and thus express few transport proteins and thus few surface epitopes for host immune recognition. We explain these features, relating them to the potential of predatory bacteria as cellular medicines.

The importance of the direct perforating veins of the lower leg in the aetiology of venous ulceration is supported by the results of a 6-year study of 77 patients with 109 ulcerated legs. Incompetent perforating veins were demonstrated by examination and Doppler ultrasound, and confirmed at operation, in 108 legs. Subfascial ligation of these veins, with stripping of incompetent saphenous veins when necessary, was followed by elastic compression stockings in 44 legs (40 per cent) in which deep vein incompetence was demonstrated by non-invasive methods and phlebography. Some 91 ulcers (84.3 per cent) remain healed (76 per cent greater than 3-year follow up). Eight patients with rheumatoid arthritis in addition to venous incompetence had a 75 per cent failure rate. If these patients are excluded, 88 (92 per cent) of 96 ulcerated legs remain healed. It is submitted that these results support the argument for the importance of perforating vein incompetence in the aetiology of venous ulceration. They also suggest that a more optimistic attitude towards treatment is justified.

In worldwide conditions of increasingly antibiotic-resistant hospital infections, it is important to research alternative therapies. Bdellovibrio bacteriovorus bacteria naturally prey on Gram-negative pathogens, including antibiotic-resistant strains and so B. bacteriovorus have been proposed as “living antibiotics” to combat antimicrobially-resistant pathogens. Predator-prey interactions are complex and can be altered by environmental components. To be effective B. bacteriovorus predation needs to work in human body fluids such as serum where predation dynamics may differ to that studied in laboratory media. Here we combine mathematical modelling and lab experimentation to investigate the predation of an important carbapenem-resistant human pathogen, Klebsiella pneumoniae, by B. bacteriovorus in human serum versus buffer. We show experimentally that B. bacteriovorus is able to reduce prey numbers in each environment, on different timescales. Our mathematical model captures the underlying dynamics of the experimentation, including an initial predation-delay at the predator-prey-serum interface. Our research shows differences between predation in buffer and serum and highlights both the potential and limitations of B. bacteriovorus acting therapeutically against K. pneumoniae in serum, informing future research into the medicinal behaviours and dosing of this living antibacterial.

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