An anatomical and clinical study aimed at uncovering factors likely to be helpful in understanding the true nature of haemorrhoids is described. The main finding was of specialized 'cushions' of submucosal tissue lining the anal canal; it is argued that piles are merely the result of their displacement.

Biopsy tissues were fixed in buffered formalin and processed routinely through paraffin wax, ensuring optimal orientation at the embedding stage. Sections (5 [t) were cut at six levels and stained with haematoxylin and eosin, periodic acid Schiff, and high iron diamine alcian blue (HIDAB), the latter with strict pH con-

SUMMARY In 52 normal subjects there was an inverse relationship between serum ferritin concentration and iron absorption. In 21 measurements in 15 patients with idiopathic haemochromatosis there was a similar inverse relationship but absorption was higher in relation to iron stores at all levels. Haemochromatotic patients with normal serum ferritin levels had abnormally high values for desferrioxamine chelatable iron and there was no correlation between chelatable iron and iron absorption.Iron balance is maintained by the regulation of iron absorption. The precise mechanism is poorly understood (Jacobs, 1973) and one of the outstanding problems is the relationship of iron stores to absorption. Heinrich (1970) (Bentley and Williams, 1974).More recently, the concentration of ferritin in serum has been shown to relate closely to iron stores in normal subjects and in those with iron deficiency or overload (Jacobs, Miller, Worwood, Beamish, and Wardrop, 1972;Walters, Miller, and Worwood, 1973a;Siimes, Addiego, and Dallman, 1974). The assay of ferritin can be carried out in a reproducible manner on a small serum sample, and a preliminary study indicated an inverse relationship between serum ferritin concentration and iron absorption in normal subjects (Walters, Thompson, Jacobs, and Wood, 1973b). This assay has been used in the present study to confirm the relationship between iron stores and iron absorption in normal subjects and to compare it with data from patients with haemochromatosis.Received for publication 17 October 1974. SubjectsFifty-two healthy adults (22 women and 30 men) were studied. In all cases the serum iron concentration was above 70 jig per dl and the transferrin saturation above 16%. Haemoglobin concentration was above 12-5 g per dl in women and 13-0 g per dl in men.Fifteen patients with primary idiopathic haemochromatosis (one woman and 14 men) were studied; all met the same haematological criteria as the normal subjects. Six of the patients were studied on two occasions giving a total of 21 observations in this group. Three patients were investigated before venesection therapy, nine during and nine after the completion of a course of venesection. Patients studied during treatment were not bled for a minimum of one month before the absorption measurement.All subjects gave their fully informed consent to the investigations. MethodsIron absorption was measured by whole body counting using a flat bed scanning technique. The whole body counter consists of four uncollimated Nal (T1) crystals 10-2 cm thick and 15-2 cm in diameter arranged symmetrically on a vertical metal ring. The subject lies on a fixed bed and the detectors traverse the entire length of the bed. The detectors are connected to a multichannel analyser with 188 on 9 May 2018 by guest. Protected by copyright.

Most patients with piles of any degree can be safely managed by rubber band ligation, but return of symptoms in the long term affects more than half of patients treated.

This technique appears to offer a safe and reliable modification for mesh repair of parastomal herniation, in being designed to obviate the possibility of erosion of the stomal bowel wall by a sharp mesh edge but at the same time providing a sound herniorrhaphy by complete encirclement.