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The ASCRS guidelines strongly recommend office-based treatments for patients with grade I and II hemorrhoids, and for some with grade III hemorrhoids.3 Ligating the apex of the hemorrhoidal cushion stops the arterial flow and causes the hemorrhoidal tissue to undergo necrosis (Figure 2)

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Nephrol Dial Transplant 21: 3211-3214 Rizos I (2000) Three-year survival of patients with heart failure caused by dilated cardiomyopathy and L-carnitine administration