Recurrence and incidence of fistula after urgent drainage of an anal abscess. Long-term results.

INTRODUCTION: Anal abscess is the most frequent urgent proctological problem. The recurrence rate and reported incidence of fistula after drainage and debridement of an anal abscess is widely variable. The objective of this study is to analyse the long-term recurrence rate and the incidence of fistula after drainage and urgent debridement of an anal abscess. METHODS: Retrospective observational study of a prospective cohort with anal abscess of cryptoglandular origin. All patients (n = 303) were evaluated two months and one year after the intervention. At the 5th year, all the medical records were reviewed and a telephone call or appointment was made for an assessment if necessary. Specific antecedents of anal pathology, abscess characteristics, time and type of recurrence, presence of symptoms in the first revision and presence of clinical and/or ultrasound fistula were recorded. RESULTS: Mean follow-up 119.7 months. Recurrence rate 48.2% (82.2% in the first year). Two hundred twenty-two ultrasounds performed. Incidence of ultrasound fistula: 70% symptomatic vs. 2.4% asymptomatic (p < 0.001). Global incidence of fistula 40.3%. The history of anal pathology and the presence of symptoms in the postoperative review significantly increase the possibility of recurrence (p < 0.001). The fistula is statistically more frequent if the abscess recurs (p < 0.001). CONCLUSION: After drainage and debridement of an anal abscess, half of the patients relapse and 40% develop fistula especially in the first year, so longer follow-ups are not necessary. Endoanal ultrasound for the evaluation of the presence of fistula is highly questionable in the absence of signs or symptoms.

Fistulectomy and endorectal advancement flap repair for cryptoglandular anal fistula: recurrence and functional outcome over 10 years of follow-up.

PURPOSE: To examine long-term recurrence and anal continence of patients with anal fistula treated by fistulectomy and endorectal advancement flap repair. METHOD: Retrospective analysis of a prospective cohort of 115 patients (77.4% males, mean age 48.9 years) requiring 130 procedures, with a minimum follow-up of 10 years. Recurrence included reappearance of fistula after wound healing or presence of an abscess or chronic suppuration in the operated area at follow-up. Fecal incontinence was evaluated by the Cleveland Clinic Florida (CCF-FI) fecal incontinence scoring system. RESULTS: The mean and SD duration of the follow-up period was 155.5 (21.7) months. Recurrence developed in 31 (23.8%) cases, 28 (90.3%) of which within the first year, with a mean time to recurrence of 4.9 (2.9) months. The success rate was 76.2%. Anal continence was normal in 80% of patients before surgery, 63.8% at 1-year follow-up, and 71.5% at the end of follow-up (p < 0.001). Overall, continence worsened in 16.9% of cases. The mean (95% CI) CCF-FI score was 0.78 (0.35-1.21) preoperatively, 1.04 (0.64-1.43) at 1 year after surgery, 0.90 (0.52-1.29) at 5 years, and 1.16 (0.66-1.67) at the end of the study (p < 0.05). Neither recurrence nor continence was significantly associated with previous anal or fistula surgical procedures or complexity of the fistula. CONCLUSION: In this study, fistulectomy and endorectal advancement flap repair was associated with a long-term high rate of success. Most recurrences occurred within the first year and continence showed a mild deterioration over time. CLINICAL TRIAL REGISTRATION: Not applicable.

Recurrence and incidence of fistula after urgent drainage of an anal abscess. Long-term results. / Recidiva e incidencia de fístula tras el drenaje urgente de un absceso anal. Resultados a largo plazo.

INTRODUCTION: Anal abscess is the most frequent urgent proctological problem. The recurrence rate and reported incidence of fistula after drainage and debridement of an anal abscess is widely variable. The objective of this study is to analyse the long-term recurrence rate and the incidence of fistula after drainage and urgent debridement of an anal abscess. METHODS: Retrospective observational study of a prospective cohort with anal abscess of cryptoglandular origin. All patients (n = 303) were evaluated two months and one year after the intervention. At the 5th year, all the medical records were reviewed and a telephone call or appointment was made for an assessment if necessary. Specific antecedents of anal pathology, abscess characteristics, time and type of recurrence, presence of symptoms in the first revision and presence of clinical and/or ultrasound fistula were recorded. RESULTS: Mean follow-up 119.7 months. Recurrence rate 48.2% (82.2% in the first year). Two hundred twenty-two ultrasounds performed. Incidence of ultrasound fistula: 70% symptomatic vs. 2.4% asymptomatic (p < 0.001). Global incidence of fistula 40.3%. The history of anal pathology and the presence of symptoms in the postoperative review significantly increase the possibility of recurrence (p < 0.001). The fistula is statistically more frequent if the abscess recurs (p < 0.001) CONCLUSION: After drainage and debridement of an anal abscess, half of the patients relapse and 40% develop fistula especially in the first year, so longer follow-ups are not necessary. Endoanal ultrasound for the evaluation of the presence of fistula is highly questionable in the absence of signs or symptoms.

Hepatic portal venous gas. Should it be considered as an ominous radiologic sign?

Portal pneumatosis is considered as an ominous radiologic sign if it is associated to intestinal ischemia. If sepsis is present, mortality reaches 80-90%. However, in inflammatory disease or infections survival rates are close to 70%. With the aim to reconsider the poor prognosis associated with portal pneumatosis, we would like to present the case of a 63-years-old male who went to the emergency room with abdominal pain and peritoneal irritation. Urgent surgery was indicated, findings were: an area of transmural necrosis located in the antimesenteric sigma's face, and patchy necrosis of the colonic mucose. A Hartmann`s procedure was performed. Nowadays, the pacient underwent surgery for restoration of the continuity of the GI.

Particle swarm optimization of nanoantenna-based infrared detectors.

The multi-resonant response of three-steps tapered dipole nano-antennas, coupled to a resistive and fast micro-bolometer, is investigated for the efficient sensing in the infrared band. The proposed devices are designed to operate at 10.6 µm, regime where the complex refractive index of metals becomes important, in contrast to the visible counterpart, and where a full parametric analysis is performed. By using a particle swarm algorithm (PSO) the geometry was adjusted to match the impedance between the nanoantenna and the micro-bolometer, reducing the return losses by a factor of 650%. This technique is compared to standards matching techniques based on transmission lines, showing better accuracy. Tapered dipoles therefore open the route towards an efficient energy transfer between load elements and resonant nanoantennas.

Efecto de enzimas fibrolíticas exógenas en la degradación ruminal in vitro de dietas para vacas lecheras / Effect of exogenous fibrolytyc enzime on in vitro ruminal degradation of rations for dairy cows

Para determinar el efecto in vitro de enzimas fibrolíticas exógenas en la degradación ruminal de la materia seca (DIVMS) y de la fibra detergente neutro (DIVFDN) se incubaron de 3 a 72h en licor ruminal, tres dietas con 40:60, 50:50 y 60:40 relación forraje:concentrado (F:C), con o sin enzimas fibrolíticas. Se usó un diseño de bloques completos al azar con un arreglo factorial 3×2×6 (ración F:C de 40:60, 50:50, 60:40; enzima, 0 o 2g·kg-1 MS; tiempo de incubación de 3, 6, 12, 24, 48 y 72h). La DIVMS de dieta 60:40 F:C fue mayor (P±0,05) que la de 50:50 o 40:60. Por su parte, la DIVFDN de la dieta 50:50 F:C fue mayor que la de 40:60 o 60:40. La interacción entre F:C de la dieta, enzima y el tiempo de incubación indicó que las enzimas fibrolíticas exógenas tuvieron mayor impacto en la DIVMS y en la DIVFDN en las primeras 12h de incubación en la dieta con mayor contenido de fibra.