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1.
Neurol India ; 69(5): 1354-1355, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34747811

RESUMO

The use of intraoperative neurophysiological monitoring is a helpful tool during surgeries of conus medullaris tumors and helps in reducing the risk of post-operative functional compromise like paraparesis, sensory deficits, or urological dysfunctions. External anal sphincter (EAS) motor evoked potential (MEP) monitoring is usually done for monitoring sacral nerve roots and to prevent post-operative neurological deficits. Here we describe a case where unilateral motor cortical stimulation aided us to differentiate the laterality of TcMEP responses in EAS.


Assuntos
Potencial Evocado Motor , Neoplasias da Medula Espinal , Canal Anal/diagnóstico por imagem , Canal Anal/cirurgia , Humanos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Raízes Nervosas Espinhais
2.
Clin Ter ; 172(6): 520-522, 2021 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-34821343

RESUMO

Abstract: Haemorrhoids are considered among the most frequent proctologi-cal condition at a general practitioner (GP) practice. Acute prolapse of internal haemorrhoids is presented with oedema, inflammation and acute pain. The application of granulated sugar on swollen hae-morrhoids leads to an immediate reduction of their edema and to the patient's relief. After the topical application of sugar, haemorrhoids begin to shrink immediately and edema is drastically reduced, while haemorrhoidal tissue can easily retracted back into the anal canal. The method is a cheap, quick and painless way to control the worsening symptoms such as swelling, bleeding and irritation. In addition, this method can easily be applied in the GP practice without the necessity of any form of anaesthesia.


Assuntos
Hemorroidas , Canal Anal , Hemorroidas/complicações , Humanos , Ligadura , Dor , Açúcares
3.
Prague Med Rep ; 122(3): 191-200, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34606431

RESUMO

As a consequence of high-type anorectal malformations (ARMs) pathogenesis, the pelvic floor muscles remain severely underdeveloped or hypoplastic, the rectal pouch is located at the level or above the puborectalis sling, and the bowel terminates outside the sphincter muscle complex support. For children with high-type ARMs the ultimate objective of therapy is mainly to grow up having bowel continence function that is compatible with a good quality of life, and the final prognosis depends significantly on the grade of development of pelvic floor muscles and the successful entering of the anorectum fully within the support of the external anal sphincter due to intraoperative conservation of the puborectalis sling. Pelvic magnetic resonance imaging (MRI) has recently become the preferred imaging study for prediction of functional outcomes, since it can define the anatomy and evaluate the development of the sphincteric muscles before and after surgical correction. Based on recent literature and our clinical experience, we will discuss the relevance of pelvic floor muscles MRI to the clinical outcome of children with high type ARMs.


Assuntos
Malformações Anorretais , Diafragma da Pelve , Canal Anal/diagnóstico por imagem , Canal Anal/cirurgia , Malformações Anorretais/cirurgia , Criança , Humanos , Diafragma da Pelve/diagnóstico por imagem , Diafragma da Pelve/cirurgia , Qualidade de Vida , Resultado do Tratamento
4.
Anticancer Res ; 41(10): 4705-4714, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593418

RESUMO

This review summarises the anatomy and lymphatic systems around the pelvic floor. We investigated the lymphovascular network in the anorectal region, focusing on the hiatal ligament, which comprises smooth muscle fibres derived from the longitudinal muscle and connecting the anal canal and coccyx, and the endopelvic fascia, which seems to comprise collagen and elastic fibres. During rectal surgery, endopelvic fascia is recognized as a sheet of fascia covering the levator ani muscle. Endopelvic fascia is extensively attached to the smooth muscle fibres diverging from the longitudinal muscle of the rectum. Analysis of the lymphovascular network using submucosal India ink injection and indocyanine green fluorescence imaging suggests a functional lymphatic flow between rectal muscle fibres and hiatal ligament and endopelvic fascia. Precise analysis of the lymphatic systems of fascial organization around the pelvic floor may be useful in formulating therapeutic strategies for low rectal cancer.


Assuntos
Fáscia/anatomia & histologia , Sistema Linfático/anatomia & histologia , Diafragma da Pelve/anatomia & histologia , Canal Anal/anatomia & histologia , Humanos , Vasos Linfáticos/anatomia & histologia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto/anatomia & histologia , Reto/cirurgia
7.
Arq Bras Cir Dig ; 34(2): e1594, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34669884

RESUMO

BACKGROUND: Varicose veins appear above and below the dentate line in mixed hemorrhoids, which seriously affects anal function and quality of life. AIM: To propose an improvement in tissue-selecting therapy repair of anal pad combined with complete anal canal epithelial retention comparing with Milligan-Morgan surgery. METHODS: A prospective randomized controlled study was designed enrolling 200 patients with grade III and IV hemorrhoids. They were divided into control and observation groups. The control received Milligan-Morgan surgery, and the observation the modified tissue-selecting therapy stapler combined with complete anal canal preservation surgery. All patients were followed for six months to evaluate the treatment differences. RESULTS: In final, control group included 82 and observation 87. The average operation time of the control group was significantly lower than that of the observation, while the bleeding volume was significantly lower in control group. The control group VAS score was 3 (1, 4), and observation 4 (2, 5). There was no significant difference in the incidence of urinary retention, bleeding and wound margin edema after surgery at one month postoperatively. Digital incidence of anal stenosis in the observation group was significantly lower than in control; the same occurred with residual anal margins. The postoperative anal canal diameter was significantly larger than the control group. Wexner anal incontinence score showed that no anal incontinence occurred in both groups, and the control group scored was significantly higher than observation. In final six months follow-up, the observation group did not experience any relapse and four cases were found among controls. The treatment satisfaction of the observation group was better. CONCLUSIONS: In grades III and IV hemorrhoids, modified tissue-selecting therapy combined with complete anal canal preservation had better prognosis and treatment satisfaction than Milligan-Morgan procedure, and it is a new surgical method for patients with advanced mixed hemorrhoids.


Assuntos
Hemorroidectomia , Hemorroidas , Canal Anal/cirurgia , Hemorroidas/cirurgia , Humanos , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
8.
Ann Palliat Med ; 10(9): 10022-10030, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628926

RESUMO

BACKGROUND: Suprasphincteric anal fistula is a type of high anal fistula. The traditional method of cutting seton (CS) has a high recurrence rate and can cause severe damage to the anal sphincter and anal incontinence. The combination of loose and cutting seton is a novel method developed on the basis of the traditional cutting seton technique, and has already been adopted by some clinicians in China. This study will examine the effectiveness and safety of the loose combined cutting seton (LCCS) technique for the treatment of suprasphincteric anal fistulas. METHODS: This is a single-blinded randomized controlled trial conducted in the Anorectal Department of the China-Japan Friendship Hospital. A total of 76 patients diagnosed with suprasphincteric anal fistula will be randomly divided into two groups. One group will be treated with the LCCS method (the LCCS group; n=38) and the other group will be treated with the traditional CS method (the CS group; n=38). There will be 3 intervention periods, including the screening period, the surgical treatment period, and the postoperative follow-up period. Postoperative follow-up will be carried out on days 3, 5, 7, 14, 21, 28, 90, 180, and 365 after the operation. The main outcome measures are the complete cure rate of postoperative wounds and fistulas, the long-term recurrence rate, and evaluation of postoperative anal function (Wexner anal function assessment and anal function questionnaire). The secondary outcomes are the visual analogue scale (VAS) score for postoperative pain, pressure measurements of the anal canal and rectum before and after treatment, and the incidence of adverse events. All statistical results will be analyzed using the SPSS software 21.0 version. P values <0.05 will be considered statistically significant. DISCUSSION: This research introduces a novel method for the treatment of suprasphincteric anal fistulas. The LCCS method will be compared with the traditional CS method in terms of safety and efficacy. If the LCCS technique is a safe and effective treatment for suprasphincteric anal fistula, its clinical application should be promoted. TRIAL REGISTRATION: ClinicalTrials, Registration number: ChiCTR2100045450; pre-results. PROTOCOL VERSION: 2020-09-10 1.0 version.


Assuntos
Fístula Retal , Técnicas de Sutura , Canal Anal/cirurgia , Humanos , Recidiva Local de Neoplasia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fístula Retal/cirurgia , Resultado do Tratamento
9.
Georgian Med News ; (318): 13-19, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628371

RESUMO

The combined pathology of the anal canal and rectum is a very important problem today, due to its progressive growth, especially in industrialized countries over the past two or three decades. The aim of the study was to conduct a comparative assessment of using high-frequency electrosurgical devices and also radio-frequency device for treatment of combined anal саnal and rectal pathology. The results of treatment of 635 patients with combined anal canal and rectal diseases have been analyzed. Using high-frequency electrosurgical device "ERBE ICC 200" (ERBE Elektromedizin GmbH, Germany) have been operated on 169 (26,6%) patients, high-frequency electrosurgical device "EFA" (Russia) - 114 (17,9%) patients, high-frequency electrosurgical device "KLS Martin" (KLS Martin Group, Germany)- 107 (16,9%) patients and radio-frequency device "Surgitron" (Ellman International, USA) - 245 (38,6%) patients. After operations for assessment the effectiveness of using the above technologies all patients in each group were underwent to morphological investigations of anal canal and rectal tissues to study the depth of coagulation necrosis. In case of using of the high-frequency electrosurgical device "ERBE ICC 200" the incision of tissues occurred with formation of coagulation necrosis layer, which thickness was 0,113-0,457mm, in case of using high-frequency electrosurgical device "EFA" a layer of coagulation necrosis formed with thickness 0,074-0,434mm, in case of using high-frequency electrosurgical device"KLS Martin" forms a thin layer of coagulation necrosis in the thickness along the edge of the cut 0,053-0,333 mm and using of radio-frequency device "Surgitron" was accompanied with the formation on the cut edge of a thin coagulation necrosis layer with depth 0,037-0,297mm. Application of these modern radio-frequency and high-frequency technologies, due to the minimal and slight influence on tissues, contributes to reducing the operations duration, intensity of the postoperative pain, improving the terms of patients rehabilitation.


Assuntos
Eletrocirurgia , Doenças Retais , Canal Anal , Alemanha , Humanos , Federação Russa
10.
Ther Umsch ; 78(9): 528-532, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-34704469

RESUMO

Endosonography in benign and malignant diseases of the anorectum Abstract. Sonographic and endosonographic examinations of the rectum and anal canal have the advantage over other imaging techniques of a very high resolution of detail, so that in benign and malignant diseases decisive information can be obtained for further treatment planning. The ultrasound examinations can be performed quickly, but require correspondingly good knowledge and experience in anatomy, pathology and pathological dysfunctions when performing and interpreting them.


Assuntos
Doenças do Ânus , Endossonografia , Canal Anal/diagnóstico por imagem , Humanos , Reto/diagnóstico por imagem , Ultrassonografia
11.
Ther Umsch ; 78(9): 533-539, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-34704473

RESUMO

Anorectal and perineal pain Abstract. Anorectal pain is a common clinical challenge in the outpatient office. Anal fissures, anal venous thrombosis, proctitis or neoplasms are frequent etiologies for proctalgia. After exclusion of somatic disorders by diagnostic imaging and endoscopy, functional anorectal pain or pathologies like interstitial cystitits, chronic prostatitis, coccycodynia or pudendal neuralgia should be considered. The Rome IV criteria distinguish proctalgia fugax, a sharp paroxysmal pain lasting for maximum 30 minutes, and the levator ani syndrom. Latter is characterized by a tender puborectal muscle on digital rectal examination and pain lasting for more than 30 minutes. Treatment consists in reassurance, sitz bathes, topical vasodilators and anal massage. Biofeedback is a further option for levator ani syndrome. Painful palpation of the ox coccygis leads to the diagnosis of coccycodynia, a non-functional disorder. Therapy consists in anti-inflammatory medications, os coccygis mobilisation and infiltration therapy. Urologic chronic pelvic pain (chronic prostatitis and interstitial cystitis) as well as pudendal neuralgia, both neurogenic pelvic pain syndromes, can cause pain radiating into the after and perineum. The diagnosis and discrimination from functional rectal pain is difficult. Patients with neurogenic anorectal pain are best treated with anti-inflammatory medications, pain modulating antidepressives, anticonvulsives or local infiltration therapy. Interdisciplinary management of complex pain patients is mandatory.


Assuntos
Doenças do Ânus , Dor Crônica , Canal Anal , Doenças do Ânus/diagnóstico , Doenças do Ânus/terapia , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Dor Crônica/terapia , Humanos , Masculino , Diafragma da Pelve , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Dor Pélvica/terapia
12.
Ther Umsch ; 78(9): 513-521, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-34704477

RESUMO

Investigations of Anorectal Function Abstract. Investigations of anorectal function allows measurement of anal sphincter pressure, evaluation of rectal sensitivity and verification of rectoanal reflexes, which are essential elements in the assessment of bowel emptying. It is combined with a balloon expulsion test to ensure that the manometric findings are consistent with anorectal function. These tests are used in the diagnostic work-up of chronic defecation disorders, constipation and faecal incontinence, but can also provide clarification in the pre- and post-operative setting, for functional anorectal pain and other disorders of pelvic floor function. Most patients referred for investigation of these symptoms require a comprehensive assessment of anorectal structure and function. Because of the high variability of normal values and complexity of anorectal function, no single examination provides all the information needed to make a symptom-explaining, conclusive diagnosis and influence treatment decisions. Anorectal manometry is useful to assess the extent of impairment of anorectal function and to differentiate between organic and functional disorders (including pelvic floor dyssynergia). A preceding detailed anamnesis as well as endoscopic (procto / rectoscopy) and imaging procedures (anorectal endosonography, dynamic MR defecography) complete the diagnostic investigation instead.


Assuntos
Canal Anal , Defecação , Constipação Intestinal/diagnóstico , Humanos , Manometria , Reto
13.
Ther Umsch ; 78(9): 509-512, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-34704478

RESUMO

Anal eczema Abstract. In this article, the allergic contact eczema, atopic skin changes, irritative-toxic and vulgar eczema as well as psoriasis inversa are described and illustrated and the associated anamnestic and past medical history information. Furthermore, the pathogen-related perianal streptococcal dermatitis (PSD) and the perianal candidiasis are described.


Assuntos
Eczema , Psoríase , Infecções Estreptocócicas , Canal Anal , Eczema/diagnóstico , Eczema/terapia , Humanos , Pele
14.
Emerg Microbes Infect ; 10(1): 2090-2097, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34689717

RESUMO

Since December 2019, coronavirus disease 2019 (COVID-19) caused by SARS coronavirus 2 (SARS-CoV-2) has spread and threatens public health worldwide. The recurrence of SARS-CoV-2 RNA detection in patients after discharge from hospital signals a risk of transmission from such patients to the community and challenges the current discharge criteria of COVID-19 patients. A wide range of clinical specimens has been used to detect SARS-CoV-2. However, to date, a consensus has not been reached regarding the most appropriate specimens to use for viral RNA detection in assessing COVID-19 patients for discharge. An anal swab sample was proposed as the standard because of prolonged viral detection. In this retrospective longitudinal study of viral RNA detection in 60 confirmed COVID-19 patients, we used saliva, oropharyngeal/nasopharyngeal swab (O/N swab) and anal swab procedures from admission to discharge. The conversion times of saliva and anal swab were longer than that of O/N swab. The conversion time of hyper sensitive-CRP was the shortest and correlated with that of CT scanning and viral detection. Some patients were found to be RNA-positive in saliva while RNA-negative in anal swab while the reverse was true in some other patients, which indicated that false negatives were inevitable if only the anal swab is used for evaluating suitability for discharge. These results indicated that double-checking for viral RNA using multiple and diverse specimens was essential, and saliva could be a candidate to supplement anal swabs to reduce false-negative results and facilitate pandemic control.


Assuntos
Teste de Ácido Nucleico para COVID-19/métodos , COVID-19/diagnóstico , SARS-CoV-2/isolamento & purificação , Saliva/virologia , Adulto , Canal Anal/virologia , Reações Falso-Negativas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Orofaringe/virologia , Alta do Paciente , RNA Viral/análise , Estudos Retrospectivos , Adulto Jovem
16.
J Appl Clin Med Phys ; 22(11): 41-53, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34687138

RESUMO

INTRODUCTION: Limited evidence exists showing the benefit of magnetic resonance (MR)-only radiotherapy treatment planning for anal and rectal cancers. This study aims to assess the impact of MR-only planning on target volumes (TVs) and treatment plan doses to organs at risks (OARs) for anal and rectal cancers versus a computed tomography (CT)-only pathway. MATERIALS AND METHODS: Forty-six patients (29 rectum and 17 anus) undergoing preoperative or radical external beam radiotherapy received CT and T2 MR simulation. TV and OARs were delineated on CT and MR, and volumetric arc therapy treatment plans were optimized independently (53.2 Gy/28 fractions for anus, 45 Gy/25 fractions for rectum). Further treatment plans assessed gross tumor volume (GTV) dose escalation. Differences in TV volumes and OAR doses, in terms of Vx Gy (organ volume (%) receiving x dose (Gy)), were assessed. RESULTS: MR GTV and primary planning TV (PTV) volumes systematically reduced by 13 cc and 98 cc (anus) and 44 cc and 109 cc (rectum) respectively compared to CT volumes. Statistically significant OAR dose reductions versus CT were found for bladder and uterus (rectum) and bladder, penile bulb, and genitalia (anus). With GTV boosting, statistically significant dose reductions were found for sigmoid, small bowel, vagina, and penile bulb (rectum) and vagina (anus). CONCLUSION: Our findings provide evidence that the introduction of MR (whether through MR-only or CT-MR pathways) to radiotherapy treatment planning for anal and rectal cancers has the potential to improve treatments. MR-related OAR dose reductions may translate into less treatment-related toxicity for patients or greater ability to dose escalate.


Assuntos
Radioterapia de Intensidade Modulada , Neoplasias Retais , Canal Anal/diagnóstico por imagem , Feminino , Humanos , Espectroscopia de Ressonância Magnética , Órgãos em Risco , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/radioterapia , Reto/diagnóstico por imagem
17.
Rev Med Suisse ; 17(755): 1792-1797, 2021 Oct 20.
Artigo em Francês | MEDLINE | ID: mdl-34669294

RESUMO

Obstetric anal sphincter injury (OASI) is a complication of vaginal delivery. Its potential consequences are numerous and include anal and/or fecal incontinence, sexual problems and perineal pain, which can be aggravated by future pregnancies and childbirth. One common issue after OASI is the assessment of anorectal function to discuss the delivery modalities during the next pregnancy. This dedicated assessment includes a clinical and paraclinical evaluation, with an ultrasound and/or a manometry. This personalized assessment for each patient with a history of sphincter injury allows for a detailed discussion to decide on the route of delivery in an informed manner.


Assuntos
Canal Anal , Incontinência Fecal , Parto Obstétrico , Incontinência Fecal/etiologia , Incontinência Fecal/terapia , Feminino , Humanos , Parto , Períneo , Gravidez
18.
Am J Case Rep ; 22: e933032, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34699518

RESUMO

BACKGROUND Anorectal mucosal melanoma (AMM) is a rare and aggressive neoplasm, with a 5-year survival rate of 10%. Due to its rarity and nonspecific symptoms, the diagnosis is often made late. Surgical resection remains the criterion standard for treatment of anorectal melanoma. CASE REPORT We present the case of an 81-year-old woman presenting with hematochezia, anal secretion, tenesmus, difficulty in defecation, and perianal pain. On physical examination, there was a prolapse of a 5-cm melanocytic nodule in the anal canal, hard on palpation. Biopsy confirmed anorectal melanoma. Staging revealed anal and metastatic disease, with adrenal, lymphatic, and hepatic involvement. As the patient continued to have bleeding, severe pain, and difficulty in defecation, she was submitted to a wide local excision. At 5-month follow-up, the anal lesion had relapsed, and the patient died 10 months after the procedure. CONCLUSIONS AMM is a rare and extremely aggressive tumor. Symptoms are nonspecific but early diagnosis should be pursued to allow curative treatment. Surgical resection with free margins is the goal of surgical treatment. New therapies are being studied, including immunotherapy, which can improve the dismal prognosis of this rare disease.


Assuntos
Neoplasias do Ânus , Melanoma , Neoplasias Retais , Idoso de 80 Anos ou mais , Canal Anal , Neoplasias do Ânus/diagnóstico , Neoplasias do Ânus/patologia , Feminino , Humanos , Melanoma/diagnóstico , Estadiamento de Neoplasias , Neoplasias Retais/diagnóstico , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto
19.
BMC Surg ; 21(1): 350, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34560857

RESUMO

INTRODUCTION: Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF. METHODS: We studied 110 female patients affected by CAF undergone fissurectomy and anoplasty with V-Y cutaneous flap advancement associating pharmacological sphincterotomy in patients with hypertonic IAS. The follow up was at least for 2 years. The goals were patient's complete healing, the evaluation of FI, recurrence rate and manometry parameters. RESULTS: All wounds healed within 40 days after surgery. We recorded 8 cases of recurrences 6 healed with medical therapy and 2 with dilatation. We recorded 2 "de novo" temporary and low grade post-operative cases of FI. Post-operative value of MRP were unmodified in patient with normotonic IAS but significantly lower at 12 months follow up as compared with the pre-operative ones in patients with hypertonic IAS; after 24 months from surgery MRP values were within the normal range. CONCLUSION: The fissurectomy and anoplasty with V-Y cutaneous flap alone or in association with a pharmacological sphincterotomy in patients with hypertonic IAS may represent an effective approach for the treatment of CAF in female patients.


Assuntos
Incontinência Fecal , Fissura Anal , Canal Anal/cirurgia , Doença Crônica , Feminino , Fissura Anal/cirurgia , Humanos , Estudos Prospectivos , Resultado do Tratamento
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