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PubMed2003

Cyclosporin treatment of anal and perianal lesions associated with Crohn's disease.

BACKGROUND/AIMS: To analyse the long-term effect of cyclosporin on anal-perianal lesions associated with Crohn's disease. METHODS: Twenty patients (15 females and 5 males); having Crohn's disease with anal-perianal involvement and resistant to conventional treatment were evaluated. The following criteria of diagnosis and evaluation were applied to all patients: onset of Crohn's disease, description of anal-perianal lesions according to Cardiff classification after proctological examination, onset of symptoms and their aggravation, and previous agents and surgical interventions. Cyclosporin was administered orally following intravenous treatment for 7 days (4 mg/kg/day). Dose adjustments' target was to achieve a cyclosporin level of 100/200 ng/mL. The efficacy of treatment was assessed by proctologists on days; 15 and 30, so-called acute period, and at 3, 6, 7, and 20 months, so-called chronic period. Patients were also seen between these two periods as needed, based on the condition of patients and their symptoms. At each examination, patients were scored according to Cardiff classification and the anatomical localisation of lesions, with the scores recorded subsequently. RESULTS: Symptomatic improvements were seen in 80-85% of patients while proceeding from acute to chronic period. Oral treatment was continued for 3-7 months. In acute period (in the follow-up assessments: on days 15 and 30), 16/20 (80%) patients had symptomatic improvements, 5/20 (25%) had improvements in all anal-perianal lesions, 11/20 (55%) had regression of lesions, and 4/20 (20%) had worsening of lesions. In chronic period (range, 1-20 months; mean, 5 months), no complication occurred and no patient showed reactivation. In chronic period, the observation was that; 45% of fistulae were closed and 70% of ulcers healed. During treatment, 3 (15%) patients underwent a definitive ileostomy and 4 patients underwent surgical drainage of abscess of ano-vaginal and ano-perianal fistula. CONCLUSIONS: In treatment of anal-perianal lesions associated with Crohn's disease, cyclosporin is an important agent in providing regression and healing of lesions in cases refractory to standard treatment. It should be considered an alternative treatment particularly in restorative surgical interventions. Comparisons are needed versus newer agents and cyclosporin for efficacy and superiority.

Adult↗
PubMed2003

[History of patients with pelvic floor dysfunction].

OBJECTIVES: 1) To determine differences between sexes; 2) To determine differences by sex and age groups in symptom onset, time of evolution, clinical forms and probable associated causes. POPULATION AND SAMPLE: 83 consecutive patients with diagnosed PCP (X age = 50.9 SE 2.21). 25 males (30.1% x 51.2 years-old, SE 4.1) and 58 females (69.9%, X 50.8 years-old, SE 2.2). Patients with organic colon-rectum pathology (with the exception of hemorrhoidal pathology, proctologic surgery and active anus fissure) had been excluded. METHODS: Colonic Double-contrasted Rx, rectum-sigma endoscopy, and eventually a Colonofibroscopy Historic facts and syndromic protocol. Diagnosis criteria: 1) Perineal inspection: perineal contraction with pujo; 2) Rectal tact; 3) Ano-Rectum manometry with perfused system; 4) 150 ml Rectal balloon expulsion dynamic; 5) Utoreported signs and symptoms from a cuestionnaire ad hoc. Division into evolutive groups (continuous and intermittent). Division by age (< = 5, 5.1-25, > 25 years old). EXPERIMENT DESIGN: descriptive, comparative, correlation, prospective, simple blind. STATISTICS: Levene, descriptive, chi square, ANOVA, Kruskall-Wallis, Kendal tau b. RESULTS: 1) Difference in sex proportion was significative (p = 0.0001); 2) There were not differences between sexes in age media at the moment of the study (p = 0.92; 3) The continue evolutive form represented 77.1%, (p = 0.0001) but there weren't differences between sexes (p = 0.19) There weren't evolutive differences between age groups. (p = 0-78) 4) Age of onsec: x = 24.04 years-old, SE 2.02 (4-80 years-old), without differences between sexes (p = 0.16). 14.5% started before age of 5, 85% after that age, without differences between sexes (p = 0.07); 5) The time of evolution x = 26.7 years, SE 2.21, without differences between sexes (p = 0.25); 6) Potential causes were divides into tree categories: I "the patient doesn't remember associated facts" (30.1%, II: psychological or physical stress (39.8%), III: facts related to sexual trauma (30.1%). The differences (p = 0.0001); 7) Analyzed in general by sec, the most common cause was psychological-physical stress rather than sexual trauma in men, while among women sexual trauma was most common than psychological-physical stress (p = 0.03); 8) Analyzed by age groups: in the under 5 years-old group: main cause was "I don't remember". In 5.1-25-years-old group: sexual trauma; and psychological-physical stress was the main cause in > 25 years-old group (p 0.0001). CONCLUSIONS: 1) Women suffer from or consult much more frequently than man; 2) Once the disease is present, there would not be differences in age, age of onset, or time or evolution into proportions by sex; 3) The continue forms were the predominant ones; 4) The probable associated causes vary for each age group; 5) The sub-group "I don't remember" could represent in many cases a mismatch learning, but not constantly (there are cases of stress in familiar context); 6) In the subgroup "late childhood-adolescence" the predominant causes were traumatic experiences in erotic zones (rapping intent, sexual abuse, fantasies, elimination of parasites by the anus); 7) in the subgroup "older than 25 years-old" the predominant causes were physical stress, (violence, accidents, surgery) or emotional stress (familiar environment, social environment, affective losses). Some paradigmatic cases are presented. Anismus would be a complex situation involving an striated, voluntary, automatizated muscle (puborectalis) controlling independently genital-sexual, urinary and ano-rectal functions.

Adolescent↗
PubMed2004

A study of hypertrophied anal papillae and fibrous polyps associated with chronic anal fissures.

BACKGROUND: Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice. However, they do cause a few disturbing symptoms. This study describes the advantages of the removal of such pathologies associated with chronic anal fissure. PATIENTS AND METHODS: Following lateral anal sphincterotomy, the polyps or papillae were removed using a radio frequency device. A comparison before and after removal of the papillae or polyps was carried out for the associated complaints such as like pruritus, pricking sensation, wetness, crawling in the anus etc. In a separated randomized and prospective study, 80 patients were divided into two groups. 40 patients underwent only sphincterotomy, while in the remaining 40 patients, the papillae or polyps were removed after sphincterotomy. Symptom comparison was made before and after the procedure at 6- month follow-up. RESULTS: After one month of the procedure, the associated symptoms were significantly reduced, with a near total decline in the primary complaints of pain and bleeding. There was significant reduction in conditions like pruritus (p=0.0001), discharge per anus (p=0.0001), crawling sensation in the anus (p= 0.0006) and sense of incomplete evacuation (p= 0.0001). The prospective study confirmed the above findings. CONCLUSION: The above study establishes that removal of hypertrophied anal papillae and fibrous polyps should be routinely carried out during surgical treatment of anal fissure to add to effectiveness and completeness of the procedure.

Anal Canal↗
PubMed2003

The specialty of colon and rectal surgery: its impact on patient care and role in academic medicine.

The specialty of colon and rectal surgery, a specialty of general surgery, has evolved from the field of proctology. Clinical care has demonstrated decreased number of patients requiring intestinal stomas, improved quality of life in patients with benign anorectal disorders, and more favorable results in patients afflicted with primary and recurrent colorectal cancer. Basic science investigations have spawned from clinical questions such as the molecular biology of colorectal cancer, use of cyclooxygenase inhibitors and polyp regression, and novel cytokine antagonists in inflammatory bowel disease. Medical students are exposed to surgeons with expertise in anorectal anatomy and physiology, mechanisms of carcinogenesis and the importance of screening for detection of colorectal cancer, and novel therapies for inflammatory bowel disease. Surgical residents benefit by having a colorectal surgeon on the faculty by repetitive exposure to anorectal surgery, low pelvic anastomoses, stoma creation and closure, and surgery involving the small intestine. Senior colorectal surgeons will develop critical pathways for the healthcare delivery of patients afflicted with colorectal disease. The specialty of colorectal surgery will continue to translate into improved patient care and positively impact in academic medicine by providing expertise into student and resident training and generate highly sophisticated clinical and basic science investigations.

Colon↗
PubMed2005

Diagnostic work-up of rectal bleeding in general practice.

BACKGROUND: GPs have many patients with gastrointestinal discomfort. Among bowel-related complaints, the sign of rectal bleeding is of particular importance in patients aged 50 years and above, as it can be an early sign for serious bowel diseases such as colon carcinoma. Despite many guidelines offered to GPs for screening and early detection of colorectal carcinomas, there is very little information about the actual diagnostic approach to the sign of rectal bleeding. AIM: The aim of the study was to collect data concerning treatment strategies used by GPs who treat patients presenting with rectal bleeding. DESIGN OF STUDY: Prospective data collection. SETTING: General practices in Germany. METHOD: Over the course of a year, GPs recorded their treatment strategies in patients presenting with rectal bleeding and associated symptoms. Using a digital practice patient file, physicians participating in the study were able to continuously transmit data electronically to the researchers of the study about diagnostics, referrals, hospital admissions, and final diagnoses. RESULTS: During the course of 1 year, 94 participating physicians collected data on 1584 patients. Information about treating rectal bleeding was recorded for 422 patients; 60% of the patients were referred to specialists in internal medicine or gastroenterologists for further diagnostics. A colonoscopy was the most frequently performed diagnostic procedure (46.2%). Twenty-two per cent (n = 93) of the patients--54 of them aged 50 years and above--were exclusively treated by their GP without conducting a colonoscopy or cooperating with specialists. For these patients, GPs diagnosed less severe diseases like haemorrhoids or other proctologic diseases. CONCLUSION: By using a study that allows GPs to transmit electronically their findings and data, it is possible to draw a picture of treatment strategies of GPs in patients presenting with rectal bleeding. The high percentage of patients who received medical treatment in consultation with specialists underscores the significance of the sign of rectal bleeding in general practice. The need for further diagnostic measures in patients who have been treated exclusively by GPs has to be discussed.

Abdominal Pain↗
PubMed1992

[Anal and perianal lesions in symptomatic HIV infections. Prospective study of a series of 190 patients].

The aim of this study was to determine the prevalence and type of symptomatic anal and perianal diseases in patients belonging to group IV of the Centers for Disease Control classification of infections with human immuno-deficiency virus. Among the 190 prospectively included patients, 31 (16.3 percent) (30 men, 29 homosexuals or bisexuals; 1 woman) had anal symptoms and were referred for proctological examination. Thirty-five "specific" diagnoses were reached in 25 (13.2 percent) patients: 21 ulcerations, 7 condyloma acuminata, 6 perianal sepsis and 1 non-Hodgkin malignant lymphoma. The causes of ulcerations were 16 herpes, one syphilitic chancre and one fissure-in-ano. Three ulcerations remained unexplained despite bacteriological, viral, and histological investigations. Eight patients underwent 10 surgical procedures without significantly delayed wound healing.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Surgical management of anal fistula].

UNLABELLED: Anal fistula has been known since the beginning of medical history and is defined as a duct of fibrous infected walls that runs from anal crypt to skin or rectal lumen. Internal orifice is called primary or internal, while cutaneous orifice is referred to as secondary or external. Several techniques have been developed for surgical management of anal fistula, including fistulotomy, fistulectomy with or without sphincter repair, placement of sedal cutting or seton drainage, endorectal advancement flap, and fibrin glue, among others. GENERAL OBJECTIVE: Our aim was to demonstrate the experience in management of anal fistula at the Coloproctology Unit, Gastroenterology Service, of the Mexico City General Hospital. MATERIALS AND METHODS: We conducted a retrospective, longitudinal, and descriptive study in patients with anal fistula. All patients had complete clinical and proctologic studies and pre-operative laboratory analysis. RESULTS: A total of 8,816 files were reviewed from January 1997 to December 2001; 642 (7.28%) patients were carriers of a fistula, but only 595 satisfied inclusion criteria; 500 (84.03%) were male and 95 (15.97%), female, with annual incidence of 119. Average global age was 34 years (37 years in males and 28 years in females). Age range was 17 to 80 years; most frequent decades were 31 to 40 years in 197 patients (33.11%) and 41 to 50 years in 140 patients (23.53%). Anal fistula was intersphincteric in 351 (59%) and transsphincteric in 149 (25.04%). Fistulectomy was carried out in 422 patients (70.92%), fistulotomy in 108 (18.15%), seton division in 22 (3.69%), sedal in 10 (1.68%), seton drainage in two (0.33%), endorectal advancement flap in five (0.84%), fistulectomy with sphincter repair in 14 (2.35%) patients, and in 12 (2.0%) patients it was impossible to know what type of treatment had been carried out. DISCUSSION: The fundamental aims to accomplish in treatment of anal fistula include curing, preserving anal continence, minimizing healing defects, and offering to the patient a quick recovery.

Adult↗
PubMed2001

[Evaluation of surgical treatment of anal fistula].

Second reason for consultations in proctology in our department after hemorroïds-linked illnesses, fistulas in ano constitute a chronic disease which causes therapeutic difficulties linked mainly to the futur functionning of the sphincter, especially in its most complex types. In our group of 43 patients in whom surgical exploration with stylet was the key of the diagnosis, the anorectoscopy and even less chirurgical examination were not often contributive, the fear of post-operative incontinence forced us to prefer ligation-section with rubber every time that the sphincter was involved. With our results, the majority of patients (41/43) healed in normal periods with a sufficient functionning of the anus. This result confirmed our attitude towards the sphincter: that is to save if possible.

Adolescent↗
PubMed2005

A study of the symptomatology of hypertrophied anal papillae and fibrous anal polyps.

BACKGROUND: The presence of Hypertrophied anal papillae and fibrous anal polyps are often ignored in proctology practice. But the experience is that they tend to produce minor but disturbing symptoms. This study is aimed to assay the impact and utility of attending these two conditions concurrently while dealing with cases of fissure in ano. PATIENTS AND METHODS: The study was carried out in 136 patients with chronic anal fissure having concomitant hypertrophied anal papillae or fibrous anal polyps. After relieving sphincter spasm by sphincterotomy, the polyps or papillae were destroyed using the radio frequency device. A comparison was made for the associated complaints like pruritus, pricking sensation, wetness, crawling sensation in the anus etc. before and after the removal of papillae or polyps by an independent observer blinded to the procedure. RESULTS: After one month of the procedure, the associated symptoms were reduced to a significant extent along with a nearly total decline in the primary complaints of pain and bleeding. There was significant reduction in pruritus (p=0.0003), discharge per anus (p=0.0006), crawling sensation in the anus (p=0.0004) and that of incomplete evacuation (p=0.001) At the follow up after 18 months, only 9 % of patients had recurrence of either anal fissure or symptoms like pruritus. CONCLUSION: This study establishes that removal of hypertrophied anal papillae and fibrous polyps should be carried on a routine basis during surgical treatment of anal fissure. This would add to the effectiveness and completeness of the procedure.

Anus Diseases↗
PubMed2005

Incidental discovery of ano-rectal disease during transrectal ultrasound performed for prostatic disease.

Transrectal ultrasound (US) has long been a routine investigation for the study of various diseases of the prostate. The use of 360 degrees transverse scanning probes and recently, of 3D probes, has been proposed as a suitable means of studying the rectal wall. Between January 1997 and February 2004, 3758 subjects suffering from lower urinary tract symptoms associated with micturition disturbances underwent transrectal ultrasound (TRUS) with a multiplane probe having a variable frequency ranging up to 7.5 MHz and, in the later period, with a transrectal 3D volumetric probe. In 489 patients (13%) TRUS yielded suspicious images of the rectal wall. This finding was verified by a proctologic and rectoscopic examination. In 132 cases (27%) it was shown to be a false positive, mainly due to imperfect cleansing of the anal canal; in 284 cases (58%) benign disease was demonstrated (hemorrhoids in 192 patients, abscesses in 21, perianal fistulas in 18, inflamed lymph nodes in 27, polyps in 16). In 34 patients (7%) a malignant tumor was found (infiltration of the anterior rectal wall by a prostatic adenocarcinoma in 13, and a primitive adenocarcinoma of rectal origin in the remaining 21). It can be concluded that transrectal US does not permit a certain diagnosis of the nature of rectal disease, but does raise a diagnostic suspicion that can orient the surgeon to schedule more invasive diagnostic investigations.

Humans↗
PubMedDate not supplied

[Anorectal manometry: standardisation of the execution technique].

Anorectal manometry is the basic investigation for the study of anorectal function. The lack of a standard execution technique and of any common definition of the manometric parameters constitutes a major limitation. The aim of the present study is to propose a standard technique for performing manometry. In addition we also focus on those manometric parameters that are easily identified and interpreted for the systematic study of a proctological patient. The protocol used is organised in three phases: (i) tests with a radial channel probe with continuous extraction, which provide information on the length of the anal canal and on the precise site of maximum pressure; (ii) tests with a radial channel probe with stationary extraction, which does not involve reflex contraction of the sphincter apparatus and therefore permits better evaluation of sphincter pressure when the muscles are relaxed as well as the identification of slow and ultra-slow waves; (iii) tests with a helicoidal probe and a balloon for the evaluation of the anorectal inhibitory reflex and of anorectal sensitivity. Using this protocol it is possible to perform manometry in less than 30 minutes and to define the importance of anorectal function with approximately 10 parameters which are easily identified and interpreted.

Clinical Protocols↗
PubMedDate not supplied

A prospective randomized trial betwen subcutaneous lateral internal sphincterotomy with radiofrequency bistoury and conventional parks' operation in the treatment of anal fissures.

BACKGROUND: Anal fissure is a frequent proctologic disease. There are many and various treatments adopted to cure this disease. In this study we applied radiofrequencies to the subcutaneous lateral internal sphincterotomy and we compared the techniques in a randomised trial. METHODS: Patients have been randomized in two groups: in group A 18 patients underwent subcutaneous lateral internal sphincterotomy using radiofrequency bistoury while in group B 17 patients underwent the conventional lateral internal sphincterotomy described by Parks. RESULTS: The mean values for operative time were 6.6 min for group A and 9.1 min for group B. According to pain score, patients' mean values were 1.8 for group A and 1.9 for group B. Healing of the wound was faster in group A than group B, while healing of the anal fissure was approximately the same. CONCLUSION: Lateral subcutaneous sphincterotomy is the most advantageous operation for the treatment of the idiopathic anal fissure. The radiofrequency bistoury easies the procedure, lessens operating times and healing process of the surgical wounds.

Adult↗
PubMed2005

[Results of application of a new operative procedure in treatment of patients with nonspecific complete extrasphincteric rectal fistula].

In 2003-2005 yrs in the division of proctology there were operated 52 patients for nonspecific complete extrasphincteric rectal fistula using an original method. There were analyzed immediate results of intervention of the method proposed and conventional procedure according to Ryzhikh (the closest analogue). It was established that application of a new operative method is highly effective, essentially influences the general results of treatment, promotes the lowering of the postoperative complications, recurrences and incontinence rate.

Adolescent↗
PubMedDate not supplied

[Synergistic necrotizing fasciitis of the anoperineal and external genitalia: progression to Fournier's gangrene?].

INTRODUCTION: In 1883, Fournier, a French venereal disease physician, described five patients with fulminant surgical infection of the male genitalia. He pointed to three main features: 1) sudden onset, 2) rapid gangrene progression, and 3) no visible cause. Since then, multiple primary causes have been identified such as genitourinary infections, local trauma, different surgical procedures or instruments, as well as acute anorectal disease (ischiorectal abscesses). We describe the experience with patients diagnosed with Fournier's Syndrome or necrotizing anoperineal and genital infection in our hospital service. MATERIAL AND METHODS: Medical files were reviewed from the Proctology Department of the IESS Regional Hospital from January 1, 1980, to May 15, 2004. The method was descriptive, retrospective, and longitudinal. RESULTS: Fifty-one predominantly male patients (48 males and 3 females) with a mean age of 49 years were studied. Symptoms were present for 8.7 days. The most common associated disease was diabetes mellitus (24 patients). Cultures were only used for anaerobes and mainly E. coli was identified. Extensive incisions, continuous debridement and necrotic tissue were included in the surgical procedure as many times as necessary. There was progression in the abdominal wall and the inguinal region. Orchidectomy and diversion colostomy were performed in 10 patients. Average hospital stay was 32 days. Antibiotic treatment was used against aerobes and anaerobes. Eight patients died (15.5%). CONCLUSIONS: In these patients, local resistance is disturbed and cell immunity is impaired. Also, the nutritional and vascular condition of patients is affected because of aerobe/anaerobe bacterial synergy. It is recommended to immediately start pus drainage, incise even hyperemic tissue, and debride and resect necrotized tissue several times to avoid residual infection and sepsis.

Adult↗
PubMed2006

[Comparison of efficacy between procedure for prolapse and hemorrhoids and open hemorrhoidectomy].

OBJECTIVE: To compare the results of procedure for prolapse and hemorrhoids (PPH) and open hemorrhoidectomy. METHODS: A standard questionnaire was given to all patients after PPH or open hemorrhoidectomy from March 2001 to March 2004. In combination with proctological examination, the results including symptoms relief and recurrence were compared between the two groups. RESULTS: There were 184 effective questionnaires, including 96 cases in PPH group and 88 in open hemorrhoidectomy group. PPH and open hemorrhoidectomy both relieved prolapse (92.7% vs 96.8%, P=0.282), bleeding (91% vs 81%, P=0.241) and pain (91.7% vs 91.5%, P=0.977). There were no statistical differences in the overall complication rate (30.2% and 29.5%, P=0.923) and recurrence rate (21.8% vs 20.5%, P=0.814) between the two groups. The overall satisfactory degree was 87.5% in PPH group and 84.8% in open hemorrhoidectomy group (P=0.218). CONCLUSION: PPH is a safe and effective option for prolapsed hemorrhoids compared with open hemorrhoidectomy.

Adult↗
PubMed2006

[Nonspecific ulcerative colitis and Crohn's disease--the main problem of modern coloproctology].

There is adduced modern strategy of treatment of nonspeciphic ulcerative colitis and Crohn's disease, which owe medical and social significance due to their strictly progressive course, severe complications origin threat, invalidisation of patients. Conduction of conservative pathogenetically substantiated therapy of uncomplicated nonspeciphic ulcerative colitis and Crohn's disease in conditions of specialized gastroenterologic or proctologic stationary assists essential limitations of indications for surgical treatment of the patients. Conduction of an adequate operative intervention according to strict indications permits to improve results of the patients' treatment essentially.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1990

[Cancer of the right half of the colon: clinical aspects, diagnosis and immediate results of surgical treatment].

Carcinoma of the right half of the colon (CRHC) is diagnosed in 21-35% of patients with colorectal carcinomas. The Research Institute of Proctology of the RSFSR Ministry of Health has an experience with treatment of 338 patients with CRHC. Most of them (84.9%) were admitted to the clinic with advanced forms of the disease because of poor clinical manifestations at early stages of the disease and resulting in late consultations with the doctor. Surgical treatment was performed in 332 patients. The operation of choice for locally removable tumors of the right half of the colon still remains right-side hemicolectomy. For locally spread CRHC combined operations are thought to be expedient. Immediate results of the surgical treatment of CRHC by the correct curative methods are perfectly favorable, the amount of postoperative complications was 14.5%, lethality--6.6%.

Adult↗
PubMedDate not supplied

Radiofrequency Y-V anoplasty in the treatment of anal stenosis.

BACKGROUND: Anal stenosis is a common proctologic disease often caused from hemorrhoids surgery. Treatments adopted are many and varied. In this study we applied radiofrequencies to the classic Y-V anoplasty operation and reported results obtained. METHODS: Eligibility criteria consisted of patients affected by anal stenosis. Exclusion criteria were those with contraindications to the surgical operation: pregnant patients or American Society of Anaesthesiologists Score III or IV. RESULTS: From January 2002 to December 2004 we operated 7 patients, 4 of them were males. Mean age at the time of diagnosis was 46 years. All patients referred obstructive defecation, painful evacuation or bleeding. Mean values for operative time were 30 min. Postoperative pain was 3.9 at day 1 and 3.0 at 7th day (VAS scale). Patient satisfaction rate was 6.6 at three weeks and 8.3 at 6 and 12 months. No recurrences were observed after 1 year. CONCLUSION: Radiofrequency Y-V anoplasty is a feasible and effective for the treatment of anal stenosis. The radiofrequency bistoury easies the procedure, lessens operating times and the healing process of surgical wounds.

Adult↗