David Henry Goodsall: reassessment of the rule.

The life and times of the coloproctologist David Henry Goodsall (1843-1906) is presented outlining his contribution to surgery in general and to the field of colorectal surgery, in particular giving a reassessment of his well-known rule regarding anal fistulae.

[Fistula-in-ano treatment a modo Jonesko using brace].

References to fistula-in-ano date to antiquity. Hippocrates made reference to surgical therapy for fistulous disease. The English surgeon John Arderne described fistulotomy and seton use in 1376. Despite 2500 years of experience, fistula-in-ano remains a perplexing surgical disease. Over the last 30 years, many authors have presented new techniques and case series in an effort to minimize recurrence rates and incontinence complication. We offer a new technique for seton placement using a brace.

New reflections on the instruments represented in the manuscripts of John Arderne's treatise "De Fistula in Ano".

The author believes that there has been insufficient explanation of the use of the instruments described by the medieval English Surgeon John Arderne, to treat fistula in ano. Examining the existing manuscripts which describe the instruments and the operations, brings to light some problems of interpretation, particularly in relation to the tendiculum. The primary text is unknown and we have to use various texts in Latin and Old English from the 14th and 15th Centuries. It is important to understand the way in which John Arderne used illustrations of instruments in his work. The text and drawings were carefully combined and the instruments drawn to scale. In Latin this is described as "sicut depingit" and in 15th century old English "as it is peynted (or paynted)". This is rare in medieval manuscripts, but gives us more insight into both the instruments and the way that they were used. The paper examines the instruments and the techniques that John Arderne described and compares different interpretations that have appeared over the years. In particular Sloane Ms 3844 is felt to be the most accurate and helpful, and extracts from this are looked at in some detail to give a clearer picture of the treatment of fistula in ano described by John Arderne.

Fístulas peri ano-rectales / Perianal fistulas

Introducción: Las fístulas peri ano-rectales continúan siendo un desafío diagnóstico y terapéutico. Material y Método: Se realizó un estudio retrospectivo por revisión de historias clínicas de pacientes intervenidos quirúrgicamente por fístulas peri ano rectales en el Hospital E. Erill y el Hospital Universitario Austral, durante el periodo marzo del año 2000 y marzo de 2005. Se efectuaron 40 procedimientos quirúrgicos en 34 pacientes. Siete fueron del sexo femenino, con una media de edad de 34.7 años y 27 masculinos, con una media de edad de 44.2 años. La relación masculino/femenino fue de 3.8:1. Resultados: En la serie analizada las fístulas interesfinterianas fueron las de mayor incidencia (59 por ciento) y el procedimiento quirúrgico implementado con más frecuencia fue el de la fistulectomía (37.5 por ciento). Nuestro índice de recidivas del 18 por ciento, se reduce al 9 por ciento si se excluyen las producidas en fístulas rectovaginales. La alta tasa de recidivas en FRV hace suponer un comportamiento fisiopatológico diferente a las de origen criptogenético. La incidencia de incontinencia ha sido de 6 por ciento (dos casos) y solo para gases.

Experiencia inicial con el uso de adhesivos de fibrina para el tratamiento de fístulas anorrectales / Initial experience with fibrin glue for the treatment of anorectal fistulae

Antecedentes: Escasas publicaciones sobre esta modalidad de tratamiento para las fistulas anorrectales. Introducción: La reconocida dificultad en el manejo de esta patología con la posibilidad de lesionar el aparato esfinteriano llevó a buscar alternativas menos agresivas. Material y métodos: Fueron intervenidos quince pacientes entre abril y agosto de 2001 dentro de un trabajo prospectivo. Resultados: El índice de recidiva fue de 21 por ciento sin ningún caso de incontinencia. Conclusión: El uso de adhesivos de fibrina para el tratamiento de fístulas anorrectales es un procedimiento único, dado que no lesiona los músculos esfinterianos, pudiendo repetir el procedimiento en caso de fracaso del mismo.

Experiencia inicial con el uso de adhesivos de fibrina para el tratamiento de fístulas anorrectales / Initial experience with fibrin glue for the treatment of anorectal fistulae

Antecedentes: Escasas publicaciones sobre esta modalidad de tratamiento para las fistulas anorrectales. Introducción: La reconocida dificultad en el manejo de esta patología con la posibilidad de lesionar el aparato esfinteriano llevó a buscar alternativas menos agresivas. Material y métodos: Fueron intervenidos quince pacientes entre abril y agosto de 2001 dentro de un trabajo prospectivo. Resultados: El índice de recidiva fue de 21 por ciento sin ningún caso de incontinencia. Conclusión: El uso de adhesivos de fibrina para el tratamiento de fístulas anorrectales es un procedimiento único, dado que no lesiona los músculos esfinterianos, pudiendo repetir el procedimiento en caso de fracaso del mismo. (AU)

All's Well That Ends Well: Shakespeare's treatment of anal fistula.

Textual and contextual evidence suggests that the French king's fistula, a central plot device in Shakespeare's play All's Well That Ends Well, is a fistula-in-ano. Anal fistula was known to the lay public in Shakespeare's time. In addition, Shakespeare may have known of the anal fistula treatise of John Arderne, an ancestor on Shakespeare's mother's side. Shakespeare's use of anal fistula differs from all previous versions of the story, which first appeared in Boccaccio's Decameron and from its possible historical antecedent, the fistula of Charles V of France. This difference makes sense given the conventions of Elizabethan comedy, which included anal humor. It is also understandable when one looks at what wounds in different locations mean in European legend. In this light, it is not surprising that subsequent expurgations treat Boccaccio's and Shakespeare's fistulas differently, censoring only Shakespeare's. This reading has implications for the staging of All's Well That Ends Well, and for our view of the place of anal fistulas in cultural history.

Surgical infection in art.

The earliest images of medicine and surgery in Western art are from the late Middle Ages. Although often attractive, at that time they were illustrative and mirrored the text on how to diagnose or treat a specific condition. These drawings in medieval manuscripts represent management of abscesses, perianal infection and fistulas, amputation, and wound dressings. With the Renaissance, art in all its forms flourished, and surgeons were represented at work draining carbuncles, infected bursae, and mastoiditis; managing ulcers, scrofula, and skin infections; and performing amputations. Specific diagnosis can be made, such as streptococcal infection in the discarded leg of the miraculous transplantation performed by Saints Cosmas and Damian and in the works of Rembrandt van Rijn and Frederic Bazille. Evocations of cytokine activity are evident in works by Albrecht Dürer, Edvard Munch, and James Tissot. The iconography of society's view of a surgeon is apparent and often not complimentary. The surgeon's art is a visual art. Astute observation leads to early diagnosis and better results in surgical infection and the septic state. Learning to see what we look at enhances our appreciation of the world around us but, quite specifically, makes us better clinicians.

Setons in the surgical management of fistula in ano.

Seton techniques have been used in the successful management of fistula in ano for thousands of years. In particular, the cutting seton is useful for complex high anal fistula, and drainage setons may have a significant role in the treatment of sepsis related to Crohn's disease and in immunocompromised patients.