Asunto(s)
Fisura Anal , Humanos , Masculino , Fisura Anal/diagnóstico , Fisura Anal/patología , Úlcera/patologíaRESUMEN
BACKGROUND: Anal fissure is one of the most common benign anal disorders, and medical treatments play an important role in its management. OBJECTIVE: The purpose of this study was to investigate the short-term effects and success of platelet-rich plasma in the treatment of chronic anal fissure. DESIGN: The study is a 2 parallel group, randomized, controlled clinical trial. SETTINGS: The study was performed in 2 tertiary university hospitals. PATIENTS: Forty-four patients with chronic anal fissure were randomly assigned to platelet-rich plasma treatment or control group. Presenting symptoms and pain scores were recorded on enrollment. The control patient self-administered topical glyceryl trinitrate. Platelet-rich plasma was injected locally in the intervention group followed by self-administered glyceryl trinitrate. MAIN OUTCOME MEASURES: The primary outcome measure is a reduction in pain scores. RESULTS: On day 10 and 1 month after treatment, the mean pain score was significantly lower in the patients treated with platelet-rich plasma than in the controls (p = 0.005 and p < 0.005). By 1 month after treatment, the mean pain score declined by 5.7 points in the platelet-rich plasma-treated group compared with a 4.1 mean pain score decline in the control group (mean difference:1.6 points (95% CI, 0.3-2.9)). According to the repeated-measures analyses, pain scores decreased in both groups, but the decrease in the treatment group was statistically higher than in the control group (p < 0.001). Complete epithelialization and recovery rates were significantly higher in the platelet-rich plasma group than in controls at all follow-up times, with p values ranging from 0.034 to <0.001. The observed difference in complete epithelialization after 2 months of treatment between the platelet-rich plasma group and the control group was 56.2% with a 95% CI of 14.03% to 98.4%. LIMITATIONS: This study was limited by its small sample size, and long-term follow-up of the patients was not presented. CONCLUSIONS: Platelet-rich plasma reduced concerns and accelerated epithelialization and healing in patients with chronic anal fissures. See Video Abstract at http://links.lww.com/DCR/B461.RESULTADOS A CORTO PLAZO DEL PLASMA RICO EN PLAQUETAS EN EL TRATAMIENTO DE LA FISURA ANAL CRÓNICA: ESTUDIO CLÍNICO CONTROLADO ALEATORIZADO. ANTECEDENTES: La fisura anal es uno de los trastornos anales benignos más comunes y los tratamientos médicos juegan un papel importante en su manejo. OBJETIVO: El propósito de este estudio fue investigar los efectos a corto plazo y el éxito del plasma rico en plaquetas en el tratamiento de la fisura an33al crónica. DISEO: El estudio es un ensayo clínico controlado, aleatorizado y de dos grupos paralelos. ESCENARIO: El estudio se llevó a cabo en dos hospitales universitarios terciarios. PACIENTES: Cuarenta y cuatro pacientes con fisura anal crónica fueron asignados aleatoriamente al grupo de tratamiento con plasma rico en plaquetas o al grupo control. Los síntomas de presentación y las puntuaciones de dolor se registraron en la inscripción. Los pacientes de control se autoadministraron trinitrato de glicerilo tópico. El plasma rico en plaquetas se inyectó localmente en el grupo de intervención seguido de trinitrato de glicerilo autoadministrado. PRINCIPALES MEDIDAS DE RESULTADO: La principal medida de resultado es una reducción en las puntuaciones de dolor. RESULTADOS: El día 10 y un mes después del tratamiento, la puntuación media de dolor fue significativamente menor en los pacientes con plasma rico en plaquetas que en los controles (p = 0.005 y p <0.005, respectivamente). Un mes después del tratamiento, la puntuación media de dolor disminuyó 5.7 puntos en el grupo tratado con plasma rico en plaquetas en comparación con una disminución de la puntuación media de dolor de 4.1 en el grupo de control (diferencia media: 1.6 puntos [intervalo de confianza del 95%; 0.3-2.9] Según los análisis de medidas repetidas, las puntuaciones de dolor disminuyeron en ambos grupos, pero la disminución en el grupo de tratamiento fue estadísticamente mayor que en el grupo de control (p <0.001). Las tasas de epitelización completa y recuperación fueron significativamente más altas en los pacientes con plasma rico en plaquetas que en los controles en todos los tiempos de seguimiento, con valores de p que van desde 0.034 a <0.001. La diferencia observada en la epitelización completa después de dos meses de tratamiento entre el grupo de plasma rico en plaquetas y el grupo de control fue del 56.2% con un intervalo de confianza del 95% del 14.03% al 98.4%. LIMITACIONES: Este estudio estuvo limitado por el pequeño tamaño de la muestra y porque no se proporcionó un seguimiento a largo plazo de los pacientes. CONCLUSIONES: El plasma rico en plaquetas redujo las molestias y aceleró la epitelización y la curación en pacientes con fisuras anales crónicas. Consulte Video Resumen en http://links.lww.com/DCR/B461. (Traducción-Dr. Jorge Silva Velazco).
Asunto(s)
Fisura Anal/terapia , Dimensión del Dolor/estadística & datos numéricos , Plasma Rico en Plaquetas/química , Repitelización/efectos de los fármacos , Inhibidores de la Liberación de Acetilcolina/administración & dosificación , Inhibidores de la Liberación de Acetilcolina/normas , Inhibidores de la Liberación de Acetilcolina/uso terapéutico , Adulto , Toxinas Botulínicas/administración & dosificación , Toxinas Botulínicas/normas , Toxinas Botulínicas/uso terapéutico , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Fisura Anal/diagnóstico , Fisura Anal/patología , Estudios de Seguimiento , Humanos , Esfinterotomía Lateral Interna/normas , Esfinterotomía Lateral Interna/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Nitroglicerina/administración & dosificación , Nitroglicerina/efectos adversos , Plasma Rico en Plaquetas/fisiología , Repitelización/fisiología , Resultado del Tratamiento , Vasodilatadores/administración & dosificación , Vasodilatadores/efectos adversosRESUMEN
ABSTRACT The internal hemorrhoid, rectal tumor, hypertrophic anal papilla, and secret fecal mass are regarded as the blocks embedded in the rectum. The above blocks hinder defecation, which will inevitably lead to excessive opening of the anal caliber. Once the limit is exceeded, the skin of the anal canal will tear and form anal fissure. Based on the study of historical evolution, hypothesis reasoning, clinical verification and comparison with other theories, a new concept of anal fissure etiology-impaction theory is proposed. The so-called impaction theory refers to the impaction (various primary lesions) in anorectum, which hinders defecation. When defecating, the anal canal expands beyond the limit, and the whole layer of anal canal skin splits, that is to say, anal fissure is formed.
RESUMO A hemorroida interna, o tumor retal, a papila anal hipertrófica e a massa fecal secreta são considerados os blocos incrustados no reto. Os bloqueios acima impedem a defecação, o que inevitavelmente levará a uma abertura excessiva do calibre anal. Uma vez que o limite é excedido, a pele do canal anal rasga e forma uma fissura anal. Com base no estudo da evolução histórica, raciocínio de hipóteses, verificação clínica e comparação com outras teorias, um novo conceito de etiologia da fissura anal - a teoria da impactação - é proposto. A chamada teoria da impactação refere-se à impactação (várias lesões primárias) no anorreto, o que dificulta a defecação. Na defecação, o canal anal se expande além do limite e toda a camada da pele do canal anal rasga, ou seja, forma-se a fissura anal.
Asunto(s)
Humanos , Defecación/fisiología , Fisura Anal/etiología , Fisura Anal/patología , Hemorroides/complicacionesRESUMEN
Perianal abscess (PA) and fistula-in-ano (FIA) are common entities in infancy. Although several hypotheses have been suggested, the pathogenesis of PA/FIA remains elusive. The natural course of these diseases in infancy is self-limiting in the majority of cases whereas older children show similarities to PA/FIA in adults. It is important to rule out rare differential diagnoses of PA/FIA such as inflammatory bowel disease (IBD), surgical complications after colorectal surgery, and immunodeficiencies. Treatment remains empiric, comprises conservative, as well as surgical approaches, and is dependent on the age of the patient. This review summarizes anatomical aspects, current evidence on disease pathogenesis, clinical presentation, and management of pediatric patients with PA and FIA.
Asunto(s)
Absceso/patología , Fisura Anal/patología , Fístula Rectal/patología , Absceso/etiología , Absceso/terapia , Adolescente , Niño , Preescolar , Tratamiento Conservador/métodos , Diagnóstico Diferencial , Femenino , Fisura Anal/etiología , Fisura Anal/terapia , Humanos , Lactante , Masculino , Fístula Rectal/etiología , Fístula Rectal/terapia , Procedimientos Quirúrgicos Operativos/métodosRESUMEN
ABSTRACT Aim of the study To evaluate the role of micronized purified flavanoid fraction and ethanol Graptophyllum pictum extract in the treatment of anal ulcer. Method Twenty-eight Wistar rats were randomly allocated into four groups. Groups 2, 3 and 4 the anus were induced with croton oil, but was not induced on group 1. Groups 1 and 2 were treated with normal saline, while groups 3 and 4 were treated with micronized purified flavanoid fraction, and ethanol G. pictum extract, respectively. On 9th days blood sample were taken from the retro-orbital region, and Wistar was killed by cervical dislocation under ether anesthesia. The anal canal was resected up 2 cm from anal opening, weighted, photographically taken to measure the percentage of residual ulcer, and then prepared for microscopic examination. Elisa methods were done for superoxide dismutase and malondialdedhyde. The total leukocyte in the anal specimen was counted under 400 magnification power. superoxide dismutase, anal coefficient, and total leukocyte for statistical analysis were using ANOVA and LSD, while malondialdedhyde and percentage of ulcers were using Kruskal-Wallis and Mann-Whitney. Result Treatment with ethanol G. pictum extract dose of 100 mg/kg BW significantly reduces the percentage of anal ulcer, the edema, leukocyte infiltration, and malondialdedhyde, and increase the superoxide dismutase in comparison without treatment. Treatment with micronized purified flavanoid fraction did not reduce the leukocyte, anal coefficient, and percentage of anal ulcer, only increase malondialdedhyde and decrease superoxide dismutase significantly.
RESUMO Objetivo do estudo Avaliar o papel da Fração Flavonoica Purificada Micronizada e do Extrato Etanólico de Graptophyllum pictum no tratamento de úlcera anal. Método Vinte e oito ratos Wistar foram randomicamente alocados em quatro grupos. Nos grupos 2, 3 e 4, indução com óleo de cróton foi realizada no ânus, excetuando-se o Grupo 1. Os grupos 1 e 2 foram tratados com solução salina normal, enquanto os grupos 3 e 4 foram tratados com fração flavonoica purificada micronizada e extrato etanólico de Graptophyllum pictum, respectivamente. No nono dia, amostras de sangue foram colhidas da região retroorbital, e o rato Wistar sofreu eutanásia por deslocamento cervical sob anestesia com éter. O canal anal foi ressecado até 2 cm da abertura anal, ponderado e fotografado para medir a porcentagem de úlcera residual e, em seguida, preparado para exame microscópico. Os métodos superoxide dismutase e malondialdedhyde do ensaio Elisa foram realizados. A contagem total de leucócitos foi realizada na amostra anal com ampliação de 400 vezes. ANOVA e LSD foram utilizados para a análise estatística de superoxide dismutase, coeficiente anal e número total de leucócitos, enquanto os testes de Kruskal-Wallis e Mann-Whitney foram utilizados para a análise de malondialdedhyde e porcentagem de úlceras. Resultado O tratamento com o extrato etanólico de Graptophyllum pictum (100 mg/kg de peso corporal) reduz de modo significativo a porcentagem de úlceras anais, o edema, a infiltração de leucócitos e o malondialdedhyde e aumenta a superoxide dismutase, comparado ao não tratamento. O tratamento com a fração flavonoica purificada micronizada não reduziu os leucócitos, o coeficiente anal e a porcentagem de úlceras anais, apenas aumentou o malondialdedhyde e diminuiu significativamente a superoxide dismutase.
Asunto(s)
Ratas , Plantas Medicinales , Flavonoides/uso terapéutico , Fisura Anal/tratamiento farmacológico , Cicatrización de Heridas , Aceite de Crotón , Acanthaceae , Fisura Anal/patologíaRESUMEN
BACKGROUND: Some authors, either with anatomical studies or Doppler laser flowmetric investigations have shown the blood flow to the posterior midline of the anus to be potentially deficient. This relative local ischaemia might explain pathogenesis of anal fissure, which is often located posteriorly. The aim of this study was to record the exact position of the distal branches of the superior rectal artery during Doppler-guided haemorrhoidal artery ligation-rectoanal repair (HAL-RAR) procedures with special reference to posterior distribution of the arteries. METHODS: All consecutive patients with symptomatic haemorrhoids who were treated with the HAL-RAR procedure between February 2008 and February 2014 in a single institution were included in the study. Number and position of Doppler-guided ligations were prospectively collected. Pearson's chi-squared test was used to compare artery locations. RESULTS: A total of 150 patients (75 women) with symptomatic haemorrhoids were included in the study. Median age was 53 years (range 23-83). A median of 10 ligations were placed per patient (range 3-18). A significantly lower number of cumulative arterial ligations was recorded in the posterior position (88 ligations overall, P = 0.025). CONCLUSIONS: The number of distal branches of the superior rectal artery that have been localized by the Doppler-guided HAL-RAR technique is lower at the posterior midline than in the other segments of the lower rectum. This is another evidence of the vascular deficiency at the posterior pole of the anal canal that might explain the pathogenesis of the anal fissure.
Asunto(s)
Canal Anal/diagnóstico por imagen , Arterias/cirugía , Hemorroides/cirugía , Recto/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Canal Anal/irrigación sanguínea , Canal Anal/patología , Arterias/anatomía & histología , Estudios de Casos y Controles , Femenino , Fisura Anal/patología , Hemorroides/clasificación , Humanos , Isquemia/etiología , Ligadura/métodos , Masculino , Persona de Mediana Edad , Recto/irrigación sanguínea , Recto/patología , Estudios Retrospectivos , Ultrasonografía Doppler/métodos , Ultrasonografía Intervencional/métodosRESUMEN
BACKGROUND: Anal abscess is an important complication of anal fissure (AF), whereas interleukin-6R (IL-6R) has been implicated in the development of abscess. In this study, we aimed to explore the possible molecular mechanisms underlying the regulatory effects of miRNAs on IL-6R and other inflammatory factors related to the induction of anal abscess in AF. METHODS: Bioinformatics analysis, luciferase assay, real-time polymerase chain reaction, and Western blot analysis were performed to identify the possible regulatory relationships between IL-6R and miR-124/miR-125a by comparing the differentiated expression of miR-125a, miR-124, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and IL-4 among different groups of AF patients. RESULTS: IL-6R messenger RNA (mRNA) was identified as a target gene of miR-124 because the luciferase activity in cells cotransfected with wild-type IL-6R and miR-124 mimics was significantly reduced. In addition, the expression of IL-6R mRNA and protein was significantly inhibited in the presence of miR-124 or an IL-6R inhibitor, confirming the presence of a negative regulatory relationship between miR-124 and IL-6R. Moreover, miR-124 and inflammatory factors were differentially expressed in AF patients carrying different genotypes of rs531564 polymorphism. CONCLUSIONS: miR-124 and inflammatory factors TNF-α, IFN-γ, and IL-4 may be used as indicators of anal abscess development in AF patients. In addition, miR-124 polymorphism rs531564 is involved with the pathogenesis of anal abscess in AF patients, and the presence of rs531564 may increase the incidence of anal abscess via upregulating the expression of IL-6R, TNF-α, IFN-γ, and IL-4.
Asunto(s)
Absceso/genética , Fisura Anal/genética , MicroARNs/genética , Polimorfismo Genético , Receptores de Interleucina-6/genética , Absceso/sangre , Absceso/complicaciones , Absceso/patología , Emparejamiento Base , Secuencia de Bases , Línea Celular Tumoral , Biología Computacional/métodos , Epidermis/metabolismo , Epidermis/patología , Fisura Anal/sangre , Fisura Anal/complicaciones , Fisura Anal/patología , Regulación de la Expresión Génica , Genes Reporteros , Humanos , Interferón gamma/sangre , Interferón gamma/genética , Interleucina-4/sangre , Interleucina-4/genética , Luciferasas/genética , Luciferasas/metabolismo , MicroARNs/sangre , Receptores de Interleucina-6/sangre , Riesgo , Índice de Severidad de la Enfermedad , Transducción de Señal , Factor de Necrosis Tumoral alfa/sangre , Factor de Necrosis Tumoral alfa/genéticaAsunto(s)
Abdomen/patología , Abuso Sexual Infantil/diagnóstico , Dermatitis Irritante/etiología , Fisura Anal/etiología , Perfumes/efectos adversos , Examen Físico/métodos , Preescolar , Dermatitis Irritante/patología , Diagnóstico Diferencial , Femenino , Fisura Anal/patología , Humanos , Notificación Obligatoria , Profesionales de Enfermería Pediátrica , Enfermedades de Transmisión Sexual , Revelación de la VerdadRESUMEN
Anal and perianal region is a commonly affected area in the course of several inflammatory, infectious, and neoplastic diseases. Several imaging modalities may be used in imaging evaluation of this area and magnetic resonance imaging (MRI) emerges as the imaging modality of choice due to its superb soft tissue resolution. MRI is not only useful for initial detection of anal/perianal pathologies but also in the follow-up of these disorders. In this article, we aimed to illustrate MRI findings of several diseases affecting this area including perianal fistula as well as anal fissure, hypertrophic myopathy of internal anal sphincter, hidradenitis suppurativa, pilonidal sinus, rectovaginal/anovaginal fistula and anal canal carcinoma. We think that this article will serve to familiarize the imaging specialists to the MRI findings of these diseases.
Asunto(s)
Canal Anal/diagnóstico por imagen , Enfermedades del Ano/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Fístula Rectal/diagnóstico por imagen , Canal Anal/patología , Enfermedades del Ano/epidemiología , Enfermedades del Ano/patología , Neoplasias del Ano/diagnóstico por imagen , Neoplasias del Ano/patología , Femenino , Fisura Anal/diagnóstico por imagen , Fisura Anal/patología , Hidradenitis Supurativa/diagnóstico por imagen , Hidradenitis Supurativa/patología , Humanos , Imagen por Resonancia Magnética/normas , Seno Pilonidal/diagnóstico por imagen , Seno Pilonidal/patología , Cuidados Preoperatorios/normas , Fístula Rectal/patología , Fístula Rectovaginal/diagnóstico por imagen , Fístula Rectovaginal/patologíaRESUMEN
RATIONALE: Ulcerative skin tuberculosis (TB) is a rare form of extrapulmonary TB. CASE REPORT: We present a case of a 65-year-old patient with perianal ulcer, which had been present for 1 year. Anamnesis revealed he had been persistently coughing for the same period of time. Histological examination of perianal skin showed necrotizing granulomatous lesions, acid-fast staining in sputum samples was ++++, TB antibody in the blood was positive, TB DNA test was positive, and chest scan that showed secondary pulmonary TB accompanied by possible pulmonary cavity formation in the 2 upper lungs. INTERVENTIONS: Anti-TB therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide for 6 months. The skin ulcer completely healed after 6 months. CONCLUSION: TB should be suspected for nonhealing ulcers. Pertinent studies should be done early during the lesion; finally, TB treatment should be initiated immediately after diagnosis is made.
Asunto(s)
Fisura Anal/patología , Tuberculosis Cutánea/patología , Tuberculosis Pulmonar/diagnóstico por imagen , Anciano , Antituberculosos/uso terapéutico , Etambutol/administración & dosificación , Etambutol/uso terapéutico , Fisura Anal/tratamiento farmacológico , Fisura Anal/microbiología , Humanos , Isoniazida/administración & dosificación , Isoniazida/uso terapéutico , Masculino , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/aislamiento & purificación , Pirazinamida/administración & dosificación , Pirazinamida/uso terapéutico , Rifampin/administración & dosificación , Rifampin/uso terapéutico , Esputo/inmunología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Tuberculosis Cutánea/tratamiento farmacológico , Tuberculosis Cutánea/microbiología , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/patologíaRESUMEN
OBJECTIVE: To evaluate the difference in the clinical therapeutic effects on anal fissure at â and â ¡ stages between the acupoint catgut embedding therapy and western medication. METHODS: Sixty patients of anal fissure at â and â ¡ stages were randomized into an embedding therapy group and a western medication group, 30 cases in each one. In the embedding therapy group, the acupoint catgut embedding therapy was applied at bilateral Tianshu (ST 25), Changqiang (GV 1), bilateral Chengshan (BL 57) and Tigangxue (Extra), once a week. In the western medication group, the external inunctum on the wound was given with 0.2% nitroglycerin ointment, once every morning and evening a day. The treatment lasted for 4 weeks continuously in the two groups. The follow-up visit was done for 3 months after treatment. The visual analogue scale (VAS) and anal pain duration were observed and recorded before treatment and on the 3rd day and the 7th day of treatment separately. The clinical therapeutic effects were compared between the two groups. RESULTS: After treatment, on the 3rd day and the 7th day of treatment, VAS score and anal pain duration were all reduced significantly as compared with those before treatment in the patients of the two groups (all P<0.01). The differences in the embedding therapy gruop were better than those in the western medication group before and after treatment (P<0.01,P<0.05). In the 2nd and 4th weeks after treatment, the clinical therapeutic effects in the embedding therapy group were better than those in the western medication group (both P<0.05). In 3-month follow-up, the recurrent case in the embedding therapy group was one, and the recurrent case in the western medication group was six. CONCLUSIONS: The acupoint catgut embedding therapy is safe and effective in the treatment of anal fissure at â and â ¡ stages and its recurrent case is lower as compared with the treatment of western medication.
Asunto(s)
Puntos de Acupuntura , Catgut , Fisura Anal/terapia , Terapia por Acupuntura/métodos , Fisura Anal/patología , Humanos , Dolor PélvicoRESUMEN
Anorectal disorders are very common among a wide population of patients. Because patients may be embarrassed about the anatomic location of their symptoms, they may present to care late in the course of their illness. Care should be taken to validate patient concerns and normalize fears. This article discusses the diagnoses and management of common anorectal disorders among patients presenting to a primary care physician.
Asunto(s)
Enfermedades del Recto/patología , Enfermedades del Recto/terapia , Fisura Anal/patología , Fisura Anal/terapia , Fármacos Gastrointestinales/uso terapéutico , Hemorroides/patología , Hemorroides/terapia , Humanos , Atención Primaria de Salud , Prurito Anal/patología , Prurito Anal/terapia , Enfermedades del Recto/diagnóstico , Prolapso Rectal/patología , Prolapso Rectal/terapia , Factores de RiesgoRESUMEN
Anal fissure is a common ailment, however, the pathophysiology and optimal treatment strategy is unclear. Anal fissures may be classified as acute or chronic. Acute fissures are effectively treated and prevented with conservative measures, whereas chronic fissures typically require medical or surgical therapy. Invasive interventions have superior healing rates compared with local medical therapies, but may cause persistent incontinence. New interventions are constantly introduced and may be of value in patients with high risk of incontinence, but more evidence is currently needed.
Asunto(s)
Fisura Anal , Enfermedad Aguda , Enfermedad Crónica , Fisura Anal/diagnóstico , Fisura Anal/patología , Fisura Anal/fisiopatología , Fisura Anal/terapia , Humanos , Imagenología Tridimensional , UltrasonografíaAsunto(s)
Fisura Anal/etiología , Enfermedad Injerto contra Huésped/complicaciones , Trasplante de Células Madre Hematopoyéticas , Síndromes Mielodisplásicos/terapia , Enfermedades del Recto/etiología , Úlcera/etiología , Fisura Anal/patología , Enfermedad Injerto contra Huésped/diagnóstico , Enfermedad Injerto contra Huésped/patología , Humanos , Masculino , Persona de Mediana Edad , Proctoscopía , Enfermedades del Recto/patología , Sigmoidoscopía , Úlcera/patologíaRESUMEN
The experience of preoperative application of the intratissue electrophoresis with the dioxysol solution was analyzed for the patients, suffering chronic anal fissure. In the patients, beginning from the first day, there was proved the reduction of the pain syndrome severity, hemodynamic disorders, an acute inflammatory reactions in the anal fissure tissue, the young granulations growth in the edge of the wound and resection. Application of the method proposed have promoted the inflammatory process severity reduction, the reparative processes in anal fissure stimulation, the operation wound epithelization acceleration, the anal sphincter muscle spasmelimination, which constitutes the main pathogenetic mechanism of the disease.
Asunto(s)
Fisura Anal/cirugía , Fisura Anal/terapia , Isotacoforesis/métodos , Lidocaína/uso terapéutico , Dolor/prevención & control , Quinoxalinas/uso terapéutico , Adulto , Anciano , Canal Anal/efectos de los fármacos , Canal Anal/patología , Canal Anal/cirugía , Anestésicos Locales/uso terapéutico , Antiinfecciosos/uso terapéutico , Enfermedad Crónica , Femenino , Fisura Anal/patología , Humanos , Masculino , Persona de Mediana Edad , Dolor/fisiopatología , Dimensión del Dolor , Cuidados Preoperatorios/métodos , Repitelización/fisiología , Resultado del TratamientoRESUMEN
The results of histological investigation of the chronic anal fissure (AF) edges in 95 patients with the disease duration from 6 mo to 4.5 yrs were analyzed. Basing on estimation of severity of an acute inflammation signs and the granulation and cicatricial tissue presence there was established, that duration of an acute inflammation in the AF may constitute up to 6 - 7 mo; subacute--from 8 to 11 mo, chronic cicatricial process was observed in terms from 12 mo and more.
Asunto(s)
Canal Anal/patología , Cicatriz/patología , Fisura Anal/patología , Pólipos/patología , Adulto , Canal Anal/cirugía , Proliferación Celular , Enfermedad Crónica , Cicatriz/complicaciones , Cicatriz/cirugía , Células Epiteliales/patología , Femenino , Fisura Anal/complicaciones , Fisura Anal/cirugía , Humanos , Inflamación , Masculino , Persona de Mediana Edad , Miocitos del Músculo Liso/patología , Pólipos/complicaciones , Pólipos/cirugía , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
Disseminated histoplasmosis has a diverse and non-specific range of clinical signs and symptoms. In a significant minority of patients, cutaneous lesions are apparent at the time of initial presentation, affording an opportunity to establish the diagnosis from a skin biopsy. The most frequently reported clinical scenario in immunocompromised patients with cutaneous involvement is that of multiple papulo-nodular lesions on the face, trunk or extremities. The following report features an immunocompetent patient who presented with a solitary ulcerated plaque on the buttocks close to the anal verge. This case presentation underscores the broad spectrum of clinical presentations as well as the potential for diagnostic confusion with protozoa such as Leishmania or Trypanosoma species during histopathologic examination if special stains for fungal organisms are not performed.