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PubMedDate not supplied

Value of MRI performed with phased-array coil in the diagnosis and pre-operative classification of perianal and anal fistulas.

PURPOSE: To assess the value of MRI performed with phased-array coil in the diagnosis and preoperative staging of perianal and anal fistulas. MATERIALS AND METHODS: 20 patients (13 with Crohn's disease) with clinical evidence or suspicion of anal fistulas underwent pelvic MRI (1.5 T) performed with phased-array coil. Images were obtained in the axial and coronal planes using TSE T2-weighted high resolution sequences with and without fat suppression, T2-weighted HASTE and T1-weighted FLASH sequences, with and without fat suppression, before and after gadolinium enhancement. The following parameters were considered: presence of a fistula and relation with the sphincters, and presence of abscesses or complications. All patients underwent surgery. The MRI and surgical findings were assessed using the Park's fistula-in-ano classification and the St. James MR imaging classification of perianal fistulas. Surgery was considered the gold standard. RESULTS: MRI documented no evidence of fistula in 2 patients, intersphinteric fistulas in 5 (grade 1 and 2 St. James), trans-sphincteric fistulas in 9 (grade 3 and 4 St. James), translevator in 2 (grade 5) and complex ano-rectum-vaginal fistulas in 2. Concordance with surgery was 90%. CONCLUSIONS: MRI is an accurate technique for the identification and classification of anal and perianal fistulas and their complications. In our experience the phased-array coil offers both high field of view and spatial resolution, enabling the demonstration of perianal pathology.

Adolescent↗
PubMed2002

[Evaluation of diagnostic methods and characteristics of patients operated on for cervical cancer in Lithuania, 1998-2000].

The total number of new cases of cervical cancer for the three-year period was 1392 patients. The number of cases was fairly evenly distributed among the years of the study period 1998-2000. The total number of new cases of Stages I and II of cervical cancer was 713 (51.2%) cases, and that of Stages III and IV was 623 (44.8%) cases. The number of the new cases with an unknown stage of the disease was found to be 56 (4.0%) cases. The number of patients with Stage IIIB disease was the highest (69 cases) among all the stages of cervical cancer for the study period 1998-2000. The second most common stage was Stage IB disease with 52 patients belonging to this category. One-half (50.0%) of all operated patients because of cervical cancer during the study period 1998-2000 were women of 44 years of age and younger. Therefore, major considerations are to be given for women of reproductive age where effective screening and early detection of cervical pathology could help to avoid a lot of invasive cases of the disease and thus decrease mortality due to it. Generally, the diagnostic work-up and examinations of cervical cancer patients were insufficient, especially in cases of advanced stage disease. Stages III and IV were diagnosed in 44.8% of all cases. Overall, cystoscopy was performed in 39.4% (42 cases) of the total number of cases in Stages IIB through IVA of cervical cancer. Overall, rectosigmoidoscopy was performed in 6.4% (7 cases) of the total number of cases in Stages IIB through IVA of the disease. Finally, the proportion of CT that was performed in cases of Stages IIB through IVB of cervical cancer was 8.4% only. Clinical staging correlates well with pathologic staging in Stage I, particularly Stage IA (88.91%). The data also indicates that parametrial involvement would seem to be the most difficult problem, as 28.59% of Stage IIB and 32.3% of Stage IIIB were down-staged on the basis of pathological findings. This would suggest that in some cases the basic clinical staging rules are not being followed, or clearly understood. Kappa statistics (p = 0.05), diagnostic agreement 86.9% +/- 8%.

Adenocarcinoma↗
PubMed2003

[Streptococcus bovis endocarditis - predictor of colonic carcinoma? ].

The association of Streptococcus bovis endocarditis with colonic neoplasia is classically described and exceeds 50 percent. The prevalence of Streptococcus bovis in fecal cultures from patients with carcinoma of the colon is significantly increased (56%) as compared to that in controls (10%) and also in patients with inflammatory bowel disease (28%). Streptococcus bovis endocarditis is relatively benign, but it stresses the frequency of the associated colonic carcinoma, requiring colonoscopy and making the treatment of the high-risk lesion mandatory. The article covers a literature review and a case report.

Adenocarcinoma↗
PubMed2003

Perianal mucinous adenocarcinoma: unusual case presentations and review of the literature.

Perianal mucinous adenocarcinoma is a rare cancer constituting 3 to 11 per cent of all anal carcinomas. It may arise de novo or from a fistula or abscess cavity. We present two cases of this disease process. Case One is a 52-year-old man with a chronic history of perianal abscesses who presented to the emergency room with a large bowel obstruction. He required diversion and wide local excision with lateral internal sphincterotomy for relief of the obstruction. Pathology from the excised material revealed the unexpected diagnosis of invasive mucinous adenocarcinoma of the anus. Case Two is a 59-year-old man with a chronic history of complex fistulas and abscesses who presented to our office with a horseshoe fistula and deep postanal space abscess. Because of the nonhealing nature of the wound, biopsies from the abscess crater, fistulous tract, and the perianal skin opening were taken. The pathology department identified the specimens as invasive mucinous adenocarcinoma of the anal canal. This is an aggressive cancer often misdiagnosed clinically as benign pathology. A high index of suspicion and biopsy of fistulous tracts and abscesses are the keys to early diagnosis and treatment. With combination chemotherapy and radiation therapy in conjunction with aggressive surgical resection long-term survival might be obtained.

Abscess↗
PubMed2003

[Long term results of treatment of hemorrhagic radiation proctitis by argon plasma coagulation].

AIM: To assess long term results of argon plasma coagulation (APC) treatment in hemorrhagic radiation proctitis. METHODS: Thirty patients treated with APC in 2 departments were enrolled. In 16 patients, APC was the first treatment used. A clinical scale (Chutkan) was used to assess bleeding before and after treatment. An endoscopic scale was used to assess results on mucosa appearance. RESULTS: The mean course number was 2.3 (extremes 1-5). Bleeding score decreased from 2.67 to 0.77 (P<0.001). The success rate was 26/30 patients (87%) in an intention-to-treat analysis with 2 failures (6%), 1 patient lost for follow up and 1 patient not referred after one session. Improvement in endoscopic appearance was observed in the 13 endoscopically controlled patients with a decrease of the endoscopic score from 1.61 to 0.3 (P<0.002). The overall morbidity was 47% with 3 severe complications (10%): 1 severe bleeding, 1 extensive necrosis of lower part of the rectum and 1 perforation. We also noticed 3 microrecties and 2 symptomless rectal stenosis. With regard to tolerance, we observed post treatment pain in 6 patients (20%), easily released by usual antalgics. Complications and side effects occurred, in all patients but one, when power shot was > 45 W. Mean follow up was 20 months (3 to 35 months). Hematochezia recurred in 4 patients, but were easily treated with 1 APC course. CONCLUSION: APC is an effective treatment of hemorrhagic radiation proctitis, with a success rate of 87%. Endoscopic improvement is usual. It seems to be possible to limit the risk of complications by using low power setting.

Aged↗