Quality of life following fistulotomy - short term follow-up.

AIM: Anal fistula causes pain and discharge of pus and blood. Treatment by fistulotomy has the highest success, but can risk continence; treatment needs to balance cure with continence. This study assessed the impact of fistulotomy on quality of life (QOL) and continence. METHOD: Patients selected for fistulotomy prospectively completed the St Mark's Continence Score (full incontinence = 24) and Short Form-36 questionnaires preoperatively at two institutions with an interest in anal fistula. Patients were reassessed 3 months' postoperatively. RESULTS: There were 52 patients with a median age of 44 (range 19-82) years; 10 were women. Preoperative continence scores were median 0 (range 0-23) and there was no significant difference compared with postoperative scores (median 1, range 0-24). Following fistulotomy QOL was significantly improved in four of eight domains - Bodily Pain (P < 0.001), Vitality (P < 0.01), Social Functioning (P < 0.05) and Mental Health (P < 0.001) - and returned to that of the general population. QOL for patients with intersphincteric fistula improved postfistulotomy, and for those with trans-sphincteric fistula it remained the same. Data were further examined in two groups, with and without deterioration in continence score. Where continence improved postoperatively, QOL improved in three domains; where continence deteriorated QOL improved in two domains (P < 0.05). Patients with postoperative continence scores of < 5 had worse QOL than those scoring 4 or less. CONCLUSION: QOL significantly improved at 3 months' follow-up after fistulotomy where continence was maintained or a small reduction occurred.

Quality of life with anal fistula.

INTRODUCTION: Anal fistula affects people of working age. Symptoms include abscess, pain, discharge of pus and blood. Treatment of this benign disease can affect faecal continence, which may, in turn, impair quality of life (QOL). We assessed the QOL of patients with cryptoglandular anal fistula. METHODS: Newly referred patients with anal fistula completed the St Mark's Incontinence Score, which ranges from 0 (perfect continence) to 24 (totally incontinent), and Short form 36 (SF-36) questionnaire at two institutions with an interest in anal fistula. The data were examined to identify factors affecting QOL. RESULTS: Data were available for 146 patients (47 women), with a median age of 44 years (range 18-82 years) and a median continence score of 0 (range 0-23). Versus population norms, patients had an overall reduction in QOL. While those with recurrent disease had no difference on continence scores, QOL was worse on two of eight SF-36 domains (p<0.05). Patients with secondary extensions had reduced QOL in two domains (p<0.05), while urgency was associated with reduced QOL on five domains (p<0.05). Patients with loose seton had the same QOL as those without seton. No difference in urgency was found between patients with and without loose seton. In primary fistula patients, 19.4% of patients experienced urgency versus 36.3% of those with recurrent fistulas. CONCLUSIONS: Patients with anal fistula had a reduced QOL, which was worse in those with recurrent disease, secondary extensions and urgency. Loose seton had no impact on QOL.

The house advancement anoplasty for treatment of anal disorders.

OBJECTIVES: Anal advancement flaps treat a variety of anal disorders. In recent years the "House" advancement flap has been used with good success, the term referring to the shape of the flap used. It is simple with few shortcomings. We reviewed a single centre's experience of this procedure. METHODS: All patients who underwent a house advancement flap between 1996 and 2001 were identified. The case notes were examined and data collected on indication for surgery, complications, follow-up and outcome. RESULTS: Thirteen consecutive patients were identified, mean age of 44 years. Indications for surgery were chronic anal fissure, fistulous disease and post surgical deformity or stenosis of the anal canal. Median follow-up was 37 months (25-84). In 9 patients the flaps healed within 4 weeks. In the remaining 4 patients the flaps healed by secondary intention over a median of 14 weeks (8-20). Postoperative complications occurred in 5 patients (3 donor site separation and 2 flap retraction). Two patients developed recurrence of their original disorder. Eleven patients have relief of pre-operative symptoms with fully healed flaps. CONCLUSION: This procedure is simple, easy to construct and robust. It can be performed for a variety of anal disorders with satisfactory results and few complications and should be in every Coloproctologist's armamentarium.

Long-term outcome following loose-seton technique for external sphincter preservation in complex anal fistula.

BACKGROUND: This study determined the long-term outcome after use of the loose-seton technique (LST) to eradicate complex fistula in ano. METHODS: Twenty patients whose complex fistula in ano was treated by the LST a minimum of 10 years previously were assessed by case-note review, supplemented where necessary by mailed and telephone interview. RESULTS: Eighteen patients had a trans-sphincteric and two a suprasphincteric fistula. There were seven supralevator and 12 ischiorectal secondary extensions. At short-term follow-up, a median of 6 months following seton removal, perianal sepsis had been eradicated in 13 of 20 patients. However, the long-term success rate of the LST was lower than that noted in the short term (four versus 13 of 20). Sixteen patients had persisting or recurrent sepsis, necessitating further surgery in 13. In the long term, external sphincter division was necessary to control sepsis in seven of the 20 patients compared with three of 20 patients at short-term follow-up. The rate of relapse in those with Crohn's disease and cryptoglandular fistula in ano was similar (five of six versus 11 of 14; P = 1.000). The fistula recurred in seven, 11 and 15 patients at 6, 15 and 60 months respectively after seton removal. CONCLUSION: The success rate of the LST for complex fistula in ano falls over time. Counselling before seton removal should emphasize that, although most patients do not require sphincter division and some are cured by this technique, many patients develop further sepsis that usually requires surgery.

DEX1, a novel plant protein, is required for exine pattern formation during pollen development in Arabidopsis.

To identify factors that are required for proper pollen wall formation, we have characterized the T-DNA-tagged, dex1 mutation of Arabidopsis, which results in defective pollen wall pattern formation. This study reports the isolation and molecular characterization of DEX1 and morphological and ultrastructural analyses of dex1 plants. DEX1 encodes a novel plant protein that is predicted to be membrane associated and contains several potential calcium-binding domains. Pollen wall development in dex1 plants parallels that of wild-type plants until the early tetrad stage. In dex1 plants, primexine deposition is delayed and significantly reduced. The normal rippling of the plasma membrane and production of spacers observed in wild-type plants is also absent in the mutant. Sporopollenin is produced and randomly deposited on the plasma membrane in dex1 plants. However, it does not appear to be anchored to the microspore and forms large aggregates on the developing microspore and the locule walls. Based on the structure of DEX1 and the phenotype of dex1 plants, several potential roles for the protein are proposed.

HSP16.6 is involved in the development of thermotolerance and thylakoid stability in the unicellular cyanobacterium, Synechocystis sp. PCC 6803.

The low molecular weight (LMW) heat shock protein (HSP), HSP16.6, in the unicellular cyanobacterium, Synechocystis sp. PCC 6803, protects cells from elevated temperatures. A 95% reduction in the survival of mutant cells with an inactivated hsp16.6 was observed after exposure for 1 h at 47 degrees C. Wild-type cell survival was reduced to only 41%. HSP16.6 is also involved in the development of thermotolerance. After a sublethal heat shock at 43 degrees C for 1 h and subsequent challenge exposure at 49 degrees C for 40 min, mutant cells did not survive, while 64% of wild-type cells survived. Ultrastructural changes in the integrity of thylakoid membranes of heat-shocked mutant cells also are discussed. These results demonstrate an important protective role for HSP16.6 in the protection of cells and, in particular, thylakoid membrane against thermal stress.

Molecular characterization of glyoxalase II from Arabidopsis thaliana.

Glyoxalase II is part of the glutathione-dependent glyoxalase detoxification system. In addition to its role in the detoxification of cytotoxic 2-oxo-aldehydes, specifically methylglyoxal, it has been suggested that the glyoxalase system may also play a role in controlling cell differentiation and proliferation. During the analysis of a T-DNA-tagged mutant of Arabidopsis we identified the gene for a glyoxalase II isozyme (GLY1) that appears to be mitochondrially localized. The cDNA encoding a glyoxalase II cytoplasmic isozyme (GLY2) was also isolated and characterized. Southern blot and sequence analyses indicate that glyoxalase II proteins are encoded by at least two multigene families in Arabidopsis. Escherichia coli cells expressing either GLY1 or GLY2 exhibit increased glyoxalase II activity, confirming that they do, in fact, encode glyoxalase II proteins. Northern analysis shows that the two genes are differentially expressed. Transcripts for the mitochondrial isozyme are most abundant in roots, while those for the cytoplasmic isozyme are highest in flower buds. The identification of glyoxalase II isozymes that are differentially expressed suggests that they may play different roles in the cell.