Patterns of impaired internal anal sphincter activity in patients with anal fissure.

AIM: The patterns of impaired internal anal sphincter activity were studied in patients with anal fissure (AF). METHOD: Twenty healthy controls and 61 patients with acute AF were studied, using anorectal manometry with electromyography (EMG), and 53 patients with chronic AF using high-resolution manometry and ultrasonography. Mean and maximal resting anal pressure (MRAP), spontaneous rhythmic slow and ultraslow waves (USW) and relaxation induced by rectal distension were measured. RESULTS: Patients with acute AF had higher mean (106.4 ± 28.1 mmHg) and maximal resting anal pressure (161.5 ± 43.7 mmHg) than those with chronic AF (P < 0.05); 95% of patients had slow waves (SW) and 67% ultraslow waves. Patients with chronic AF had higher mean (92.4 ± 22.6 mmHg) and maximal resting anal pressure (117.5 ± 32.0 mmHg) than controls and 94% of patients had slow waves and 69% ultraslow waves. Patients with ultraslow waves (with either acute or chronic AF) had increased internal sphincter hypertonicity (mean and maximal resting pressure), decreased internal sphincter relaxation and increased after-contraction following rectal distension. CONCLUSIONS: Patients with acute AF had higher hypertonicity than those with chronic AF and both had increased spontaneous rhythmic activity (waves). Patients with AF and ultraslow waves had higher internal anal sphincter hypertonicity and reduced internal sphincter relaxation and enhanced after-contraction following rectal distension.

Lymphocytic autoimmune hidradenitis, cutaneous leucocytoclastic vasculitis and primary Sjögren's syndrome.

We describe a 60-year-old woman with primary Sjögren's syndrome, mixed cryoglobulinaemia and cutaneous leucocytoclastic vasculitis who developed generalized hypohidrosis with a markedly decreased sweating response to pilocarpine chloride. Skin biopsies demonstrated dense peri-eccrine lymphocytic infiltrates in the lower reticular dermis, with glandular atrophy. From previous studies it is evident that although patients with Sjögren's syndrome commonly have skin dryness, a lymphocytic hidradenitis has been documented only in a few cases. The histological findings in this case support the role of autoimmune hidradenitis in the development of hypohidrosis in Sjögren's syndrome.

Fine needle aspiration cytology of undifferentiated (embryonal) sarcoma of the liver. A case report.

BACKGROUND: Undifferentiated (embryonal) sarcoma of the liver (UESL) is a rare malignant mesenchymal hepatic tumor with an incidence among liver tumors of 27.7%. It occurs predominantly in children under the age of 15. CASE: The cytologic findings in a case of UESL in fine needle aspiration biopsy material in a 12-year-old girl are described. The patient presented clinically with upper abdominal pain and a palpable mass in the right hepatic lobe. Cytologic features included a combination of polygonal and spindle cells. The polygonal cells were large, with round or lobulated nuclei, and occasionally multinucleated, with one or several nucleoli and variable cytoplasm with poorly defined borders. A few intracytoplasmic and extracytoplasmic eosinophil globules were observed. Histologic and immunohistochemical studies were performed, and staining for vimentin and alpha-1 antichemotrypsin was positive. CONCLUSION: It is important to recognize the cytologic features of this type of liver tumor since rapid diagnosis and initiation of early treatment may improve the poor prognosis of these neoplasms.