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Ann R Coll Surg Engl 2008; 90: 394-397 394Gallstones are common and are responsible for a significant proportion of acute and sub-acute general surgical consultations in the UK. The prevalence is 9% equating to 5.5 million people in the UK. 1Tw o-thirds of gallstones are asymptomatic and the incidence of developing symptoms from gallstones is 1-4% per year. The most common presentations of symptomatic gallstones are cholelithiasis and acute cholecystitis.The definitive management of gallstones is cholecystectomy, 90% of which can be completed laparoscopically. There has been a trend in recent years to favour early operations.Prolonged out-patient waiting times for elective laparoscopic cholecystectomy for symptomatic gallstones is thought to be associated with higher morbidity particularly for patients with an initial emergency presentation. However, it has been suggested that urgent laparoscopic cholecystectomy elevates the costs and resource consumption in comparison to interval laparoscopic cholecystectomy.6 As yet, early operations for symptomatic gallstones have not become routine in many UK hospitals. Many patients presenting to accident and emergency with cholelithiasis are discharged and followed up in out-patients.The objectives of this study were to evaluate the current management of symptomatic gallstones, to compare the efficacy of the different treatment options in managing Early operations for symptomatic gallstones are gaining favour as the complication rate is thought to be lower and it reduces the overall morbidity. This study was performed to clarify how frequently early operations were being performed and what benefits resulted.

Background and Aim Early hemorrhoidal disease is usually treated conservatively with fiber diet and medical therapy with flavonoids or calcium dobesilate. The purpose of this study was to compare the efficacy of these two agents in the treatment of early hemorrhoidal disease. Materials and Methods Patients having grade I and grade II hemorrhoidal disease were recruited in the study. One group received flavonoid therapy and the other group took calcium dobesilate treatment for three weeks. The symptoms and size of hemorrhoids were then assessed at the fourth week. Results In this study, 70.2% of patients were male and 29.8% of patients were female. Of the total patients, 58.65% of patients were below 45 years of age and 41.34% of patients were above 45 years of age. Moreover, 83.65% of patients had grade II hemorrhoids, whereas 16.34% of patients had grade I hemorrhoids; 80.8% of patients showed a decrease in frequency and amount of bleeding after being treated by flavonoids, whereas 67.3% showed a decrease in frequency and amount of bleeding after administration of calcium dobesilate. A decrease in the size of hemorrhoids was seen in 67.3% of patients after treatment with flavonoids and 38.46% after giving calcium dobesilate. Conclusions Treatment of early hemorrhoidal with flavonoid therapy was more effective in improving the symptoms of disease as compared to calcium dobesilate treatment.