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A Pattern of mycobacterial infections and their associations with HIV among laboratory confirmed cases of pulmonary tuberculosis in Nigeria. A Improving laboratory capacity in Africa through step-wise accreditation program.
A Virologic versus immunologic monitoring and the rate of accumulated genotypic resistance to first-line antiretroviral drugs in Uganda. To retrospectively study the outcome of patients with anorectal malformations ARM presenting late for definitive procedure. Of the 36 cases, 5 patients 3 boys and 2 girls had presented with colostomy done elsewhere. Four patients had high anomalies.
Of the 33 girls, 14 had rectovestibular fistula and 9 had anovestibular fistula. Bowel preparation with peglec was used in patients without colostomy. On table irrigation was required in four. Two patients had mild post-op wound infection, and were managed with local care. Delayed presentation of ARM especially in girls is quite common in developing countries.
With proper perioperative care, these cases may be managed successfully with a single stage procedure in most cases. The mature tissue growth with age allows proper tissue dissection and good repair of the perineal body in girls. The double auditory meatus--a rare first branchial cleft anomaly : clinical presentation and treatment. To discuss the embryology, classification, clinical experience with, and management of first branchial cleft anomalies.
Retrospective case review. Tertiary referral center. Patients with a first branchial cleft anomaly. Surgery or revision surgery. Classifications according to Work, Olsen, Chilla; previous diagnostic and therapeutic pitfalls; outcome of intervention including facial nerve function.
Between and , first branchial cleft anomalies were diagnosed in 18 patients. Surgical treatment was the treatment of choice. The authors' approach in Work type I and type 2 lesions is described, and surgical aspects of revision surgery are discussed. The importance of early establishment of the relationship of the anomaly to the facial nerve is stressed. In 8 patients, previous surgical attempts had been undertaken without establishment of the diagnosis first.
After intervention, the outcome was favorable. First branchial cleft anomalies occur sporadically in ordinary clinical practice. They may go unrecognized or may be mistaken for tumors or other inflammatory lesions of in the periauricular region. However, the distinct clinical features, which can be derived from embryologic development, usually lead to the correct diagnosis.
This avoids both treatment delay and eventual failure. Objective: To analysize the clinical characteristics as well as the effect and methods of the surgical treatment in patiets with the third and fourth branchial anomalies. Method: The clinical data of 25 patients diagnosed as third and fourth branchial cleft fistula by pathological method were analyzed retrospectively. Two of 25 patients had undergone fistulectomy simply. Based on the embryologicc and anatomic features of branchial anomalies ,23 of 25 patients had received different types of selective neck dissection.
All of lesions were confirmed as branchial cleft fistula by pathology. Result: The features of the third and the fourth bianchial fistula were as following:most patients suffered from recurrent neck abscess and had undergone incision and drainage. Esophagus myelography and CT were important auxiliary examination for branchial anomalies.
Conclusion: Branchial anomalies is characterized by recurrent acute abscess,acute thyroiditis or fistula secretion inferior to neck. Complete removal of branchial lesions and inflammatory granuloma using selective neck dissection is a safty and effective treatment for recurrent branchial anomalies.
VACTERL association refers to a combination of congenital anomalies that can include: vertebral anomalies , anal atresia, cardiac malformations, tracheo-esophageal fistula with esophageal atresia, renal anomalies typically structural renal anomalies , and limb anomalies.
Out of the overall cohort, 48 patients with at least three component features of VACTERL and who had abdominal ultrasound performed met criteria for analysis. Four other patients were additionally analyzed separately, with the hypothesis that subtle renal system anomalies may occur in patients who would not otherwise meet criteria for VACTERL association. Given the high prevalence of isolated VUR in our cohort, we recommend a screening VCUG or other imaging modality be obtained to evaluate for VUR if initial renal ultrasound shows evidence of obstruction or renal scarring, as well as ongoing evaluation of renal health.
Portal vascular anomalies in Down syndrome: spectrum of clinical presentation and management approach. The occurrence of portal vascular anomalies in Down syndrome has been sporadically reported in the literature. These rare disorders have a wide spectrum of anatomical and clinical presentations.
The aim of this communication was to describe the clinical course, imaging features, and management approaches in patients with this association. We conducted a comprehensive search of the databases of the Vascular Anomalies Center and the Department of Radiology at Children's Hospital Boston for patients with Down syndrome and portal vascular anomalies.
Medical records and imaging studies of varying modalities were reviewed. Three children with Down syndrome and portal anomalies portosystemic shunt, simple arterioportal shunt, complex arterioportal shunt were managed at our institution. The portosystemic shunt was clinically insignificant and resolved without any intervention. The simple arterioportal shunt was successfully treated with embolization. The complex arterioportal shunt was associated with major congenital cardiac defects and the child ultimately expired despite a decrease in the arterioportal shunting after embolization.
Three is a wide spectrum of clinical and anatomical features of portal vascular shunts in Down syndrome. The management approach should be tailored based on the severity of symptoms. Percutaneous embolization can offer a safe, effective, and minimally invasive alternative to the surgical approach in selective cases. Copyright Elsevier Inc. Expanding the clinical spectrum of ocular anomalies in Noonan syndrome: Axenfeld- anomaly in a child with PTPN11 mutation.
Ocular anomalies have been frequently reported in Noonan syndrome. We report on a neonate with a confirmed PTPN11 mutation and ocular findings consistent with Axenfeld anomaly. The patient initially presented with non-immune hydrops and subsequently developed hypertrophic cardiomyopathy and dysmorphic features typical of Noonan syndrome.
This finding expands the spectrum of anterior chamber anomalies seen in Noonan syndrome and perhaps suggests a common neural crest related mechanism that plays a critical role in the development of the eye and other organs. The antegrade continence enema procedure and total anorectal reconstruction. Patients may present with anal incontinence AI following repair of a congenital anorectal anomaly years previously, or require total anorectal reconstruction TAR following radical rectal extirpation, most commonly for rectal cancer.
Others may require removal of their colostomy following sphincter excision for Fournier's gangrene, or in cases of severe perineal trauma. Most of the data pertaining to antegrade continence enema the ACE or Malone procedure comes from the pediatric literature in the management of children with AI, but also with supervening chronic constipation, where the quality of life and compliance with this technique appears superior to retrograde colonic washouts.
The advantages and disadvantages of these techniques and their outcome are presented here. Anorectal melanoma: not a haemorrhoid. Melanoma of the anorectum is a rare malignancy which is particularly aggressive compared to cutaneous melanoma. Due to its presenting symptoms, location and rarity there is often a delay in diagnosis.
The purpose of this paper is to raise awareness of anorectal melanoma in New Zealand by presenting our institution's experience of four cases. The presentation, management and outcomes of four cases are described. A review of the literature surrounding anorectal melanoma was also carried out. Three patients had metastatic disease at presentation, and the remaining patient was found to have a concurrent lymphoma which was treated with chemotherapy before he underwent excision of the melanoma.
Surgical excision is the mainstay of treatment and recent literature suggests transanal excision of the primary tumour to have equivalent overall survival to abdominoperineal resection. Anorectal melanoma is rare tumour with a poor prognosis. Patients are commonly misdiagnosed as having haemorrhoids; therefore a high index of suspicion is needed to enable early diagnosis.
Metastatic disease is common at presentation, and the key prognostic indicator. Local control can be obtained with transanal excision, avoiding the morbidity of abdominoperineal resection. Adjuvant therapies available at present provide little survival advantage. Anesthesia for ambulatory anorectal surgery.
Operations are performed on ambulatory or hour stay basis. Requirements for ambulatory anesthesia are: rapid onset and recovery, ability to provide quick adjustments during maintenance, lack of intraoperative and postoperative side effects, and cost-effectiveness.
Anorectal surgery requires deep levels of anesthesia. The aim is achieved with 1 regional blocks alone or in combination with monitored anesthesia care or 2 deep general anesthesia, usually with muscle relaxants and tracheal intubation. Modern general anesthetics provide smooth, quickly adjustable anesthesia and are a good choice for ambulatory surgery. Popular regional methods are: spinal anesthesia, caudal blockade, posterior perineal blockade and local anesthesia.
The trend in regional anesthesia is lowering the dose of local anesthetic, providing selective segmental block. Adjuvants potentiating analgesia are recommended. Postoperative period may be complicated by: 1 severe pain, 2 urinary retention due to common nerve supply, and 3 surgical bleeding.
Complications may lead to hospital admission. In conclusion, novel general anesthetics are recommended for ambulatory anorectal surgery. Further studies to determine an optimal dose and method are needed in the group of regional anesthesia. Do anorectic men share personality traits with opiate dependent men? A case-control study.
The co-diagnosis of a substance use disorder in male ED patients is frequent. Nevertheless, knowledge about the mutual predisposing factors or personality analogies is currently scarce and hypotheses are controversial. The Temperament and Character Inventory TCI was used to assess 21 anorectic men, 79 heroin-dependent men, and 75 control men matched for age and education. Anorectic and opiate-addicted patients displayed higher Harm Avoidance and lower Self-directedness and Cooperativeness.
Anorectic men displayed lower Reward Dependence and higher Persistence. Opiate addicts had higher Novelty Seeking and Self-transcendence. Anorectic and heroine-dependent subjects share personality traits related to anxiety, fearfulness and antisocial features. Nevertheless, the personality profile does not completely overlap and this could influence the choice of the "substance" of abuse and the related clinical differences between anorexia and heroin dependence.
High incidence of post-dural puncture headache in patients with spinal saddle block induced with Quincke needles for anorectal surgery: a randomised clinical trial. Spinal saddle block represents nearly the ideal anaesthesia technique for anorectal surgery. Though, cutting Quincke type needles are still widely used for economic reasons, leading to a higher rate of PDPH.
We performed this study to demonstrate a reduction of PDPH by the use of very small G compared with commonly used G Quincke type spinal needles. The incidence of PDPH was assessed during 1 week after surgery. Ambulatory patients had a later onset of PDPH than in-patients 24 h [0. The use of G compared with G Quincke needles led to no reduction of PDPH and is considerably higher compared with data from pencil-point needles. The use of non-cutting or pencil-point spinal needles should become the standard for performing spinal saddle block.
Anorectal injury in pelvic blast. The signature injury of the Afghanistan campaign has, amongst other things, included an increased incidence of destructive anorectal injury. There is no significant body of evidence about this type of injury on which to base management strategies. This review examines the historical military data, later civilian reports, many of which have challenged the military dogmas of Vietnam, and the spartan contemporaneous military data which does not particularly address pelviperineal blast injury.
There is no evidence to support a move away from the doctrine of the four D's diversion, distal washout, drainage and direct repair , but sound surgical judgement remains the mainstay of managing these challenging and highly morbid injuries. Branchial cleft anomalies : accuracy of pre-operative diagnosis, clinical presentation and management.
To examine the accuracy of the pre-operative diagnosis of branchial cleft anomalies , and also to describe their occurrence, clinical presentation and management. Retrospective review of the records of patients diagnosed with a branchial cleft anomaly between and One hundred and twenty-six patients were included. Pre-operative diagnosis had a positive predictive value of 0.
These patients' demographic data, investigations, findings and management are presented, along with a possible strategy for dealing with solitary cystic masses in the neck. As pre-operative diagnosis has a positive predictive value of 86 per cent, cystic lesions in the neck should be presumed to be carcinomatous until proven otherwise. Branchial fistulae and sinuses seem to be a disease of childhood, while branchial cysts occur mainly in adults. Branchial cleft anomalies are equally frequent in men and women, and equally distributed on the left and right side of the neck.
Although target-controlled infusion has been in use for more than two decades, its benefits are being obscured by anomalies in clinical practice caused by a number of important problems. These include: a variety of pharmacokinetic models available in open target-controlled infusion systems, which often confuse the user; the extrapolation of anthropomorphic data which provokes anomalous adjustments of dosing by such systems; and the uncertainty of regulatory requirements for the application of target-controlled infusion which causes uncontrolled exploitation of drugs and pharmacokinetic models in target-controlled infusion devices.
Comparison of performance of pharmacokinetic models is complex and mostly inconclusive. However, a specific behaviour of a model in a target-controlled infusion system that is neither intended nor supported by scientific data can be considered an artefact or anomaly. Several of these anomalies can be identified in the current commercially available target-controlled infusion systems and are discussed in this review. Esophageal and anorectal involvement in systemic sclerosis: a systematic assessment with high resolution manometry.
In systemic sclerosis SSc , esophageal and anorectal involvements are frequent and often associated with each other. In clinical practice, esophageal explorations are often prescribed, while anorectal explorations are rarely proposed and therefore, under-recognised.
The main objective was the systematic evaluation and detection of esophageal and anorectal involvements in SSc patients. In this monocentric retrospective study, all patients with SSc addressed in the Department of Functional Digestive Explorations, North Hospital, Marseille for esophageal and anorectal explorations were included.
Self-Questionnaires, evaluating the symptoms and quality of life, were filled by patients during their visit. With regard to the symptoms, The incidence of esophageal dismotility was Duration of SSc and altered quality of life was correlated with the severity of digestive involvement.
Anorectal dysfunction appears to be closely linked to esophageal involvement in SSc. Their routine screening is undoubtedly essential to limit the occurrence of severe symptoms such as FI. While gastrointestinal disease is common among HIV infected individuals, the prevalence and distribution of ano-rectal pathology has not been well studied in our setting.
The objective of this study therefore was to determine the prevalence and determinants of ano-rectal pathology in HIV infected patients attending the Douala General Hospital HIV treatment centre. A hospital-based cross-sectional study was undertaken. We collected socio-demographic, clinical and laboratory data using a structured questionnaire and patients' files. Each study participant had a full physical and ano-rectal examination.
We included HIV infected patients. Prevalence of ano-rectal pathology was Ano-rectal pathology is common amongst HIV infected patients. First branchial cleft anomaly : clinical insight into its relevance in otolaryngology with pediatric considerations. First branchial cleft anomalies FBCA represent a small subset of congenital malformations in neck. Prime objective of this study is to share our experience with FBCA, emphasize its relevance in otolaryngology and deal with its pediatric perspective.
Embryology, pathologic anatomy and varied spectra of clinical presentations of FBCA are discussed. Along with this we have illustrated three different cases; all of them were of pediatric age group and were misdiagnosed by their treating specialists elsewhere. In this article we have also laid special emphasis on its pediatric considerations. FBCA are mostly misdiagnosed due to their unfamiliar clinical signs and symptoms.
Swellings may masquerade as other neck masses. Majority of patients give a history of previous incision and drainage. While dealing with pediatric patients the important factors to be kept in mind are the age of child, superficial course of facial nerve, any associated agenesis of parotid gland. Alteration in surgical technique may be required in children. A thorough medical examination with high index of clinical suspicion should be kept in mind while dealing with such anomalies.
Owing to their complex presentation and close relation with facial nerve they are challenging lesions for surgeons. Clinical significance of circumportal pancreas, a rare congenital anomaly , in pancreatectomy. Circumportal pancreas is a rare congenital pancreatic anomaly. The aim of this study was to clarify the clinical characteristics of patients with circumportal pancreases undergoing pancreatectomy.
The medical records of patients who underwent pancreatectomy were retrospectively reviewed. The prevalence of circumportal pancreas and related anatomical variations were assessed. Surgical procedures and postoperative outcomes were compared in patients with and without circumportal pancreas.
Circumportal pancreas was observed in 9 of the patients 1. In all nine patients, the portal vein was completely encircled by the pancreatic parenchyma above the level of the splenoportal junction, and the main pancreatic duct ran dorsal to the portal vein. The rate of variant hepatic artery did not differ significantly in patients with and without circumportal pancreas. Despite being rare, circumportal pancreas may increase the risk of postoperative pancreatic fistula in patients undergoing pancreatectomy.
However, a prospective, large-cohort study is necessary to determine the real incidence of relevant anatomical variations and the definitive clinical significance of this rare anomaly. High-resolution anorectal manometry: An expensive hobby or worth every penny? This review, which accompanies two articles in this issue of Neurogastroenterology and Motility, reviews the methods, clinical indications, utility, and pitfalls of anorectal manometry and revisits the American Gastroenterological Association AGA Medical Position Statement on Anorectal Testing Techniques, which was last published in High-resolution manometry provides a refined assessment of the anorectal pressure profile, obviates the need for station pull-through maneuvers, and minimizes movement artifacts.
In selected cases, this refined assessment may be useful for identifying structural abnormalities or anal weakness. However, many manometry patterns that were previously regarded as abnormal are also observed in a majority of healthy patients, which substantially limits the utility of manometry for identifying defecatory disorders. It is our impression that most conclusions of the AGA medical position statement from remain valid today.
High-resolution techniques have not substantially affected the number of publications on or management of anorectal disorders. The ongoing efforts of an international working group to standardize techniques for anorectal manometry are welcome. Although high-resolution manometry is more than an expensive hobby, improvements in catheter design and further research to rigorously define and evaluate these techniques are necessary to determine if they are worth every penny.
Dental anomalies in 14 patients with IP: clinical and radiological analysis and review. Current knowledge on dental anomalies in patients with incontinentia pigmenti IP has been obtained by examining case reports; however, an overall characterization of such alterations remains lacking.
The objective of this study was to determine the frequency, type and location of dental alterations in IP using a case series. Fourteen patients 9 children and 5 adults with a clinical diagnosis of IP who presented dental anomalies were included in this study. All patients were administered a clinical questionnaire, dental examination and radiological investigation.
Most cases were missing at least 6 teeth. Second molar agenesis was present in 13 patients Anomalies in dental crowns occurred in Two adult patients still had primary teeth. Malocclusion was found in 10 patients Patients with IP present alterations in both primary and permanent dentition. Because the agenesis of permanent teeth is more common, primary teeth are not always replaced.
In addition, the durability of primary dentition appears to be greater in IP. This study shows that patients with IP experience significant loss of teeth, especially in permanent dentition, and have an increased risk of high-arched palate compared to the general population. Prophylactic care of primary teeth in IP is relevant for improving functional and aesthetic outcomes until dental prostheses are implanted. We review our experience with Magnetic Resonance Imaging MRI in the evaluation of 6 patients showing anorectal malformation, and 4 more with persistent postoperative fecal incontinence.
Preoperative sagittal, axial and coronal planes were studied with special consideration to the pelvic and vertebral structures. The excellent resolution of MRI allowed accurate identification of the pelvic musculature in all patients, including those with bizarre sacral abnormalities. MRI revealed structural anomalies not detected previously, such as teathering cord, intraspinal lipoma, presacral mass and renal malformation. In our institution, MRI has replaced the CT scan in the study of patients suffering of persistent fecal incontinence.
In non operated on cases of anorectal malformations, MRI determines with extraordinary accuracy the location of the rectal atretic pouch, the actual pelvic muscular quality, and the detection of previously unsuspected associated anomalies. Functional anorectal disorders such as faecal incontinence FI , functional anorectal pain, and functional defecation disorders FDD are highly prevalent and represent a high socioeconomic burden.
Several tests of anorectal function exist in this setting; however, high-resolution anorectal manometry HR-ARM is a new tool that depicts pressure all along the anal canal and can assess rectoanal coordination. HR-ARM is used in the diagnosis of FI and especially FDD although data in health is still sparse, and pressure phenomena seen during simulated defecation, such as dyssynergia, are highly prevalent in health.
Update on the management of anorectal malformations. Thirty-three years ago, on 10 August , in Mexico City, the first patient with an anorectal malformation was operated on using the posterior sagittal approach. At that time it was not obvious that we were actually opening a "Pandora's box" that continues to give many positive surprises, a few disappointments, and the constant hope that each day we can learn more about how to improve the quality of life of children born with all different types of anorectal malformations.
In November , patient number in our database was operated in the city of Cochabamba, Bolivia; during one of our International Courses of Anorectal Malformations and Colorectal Problems in Children. The goal of this article is to give a brief update on the current management of patients with anorectal malformation, based on the multiple lessons learned during this period.
Histopathologic observations of anorectal abnormalities in anal atresia. Over the years from to , 41 anorectal malformations ARM with histopathologic alterations were investigated to determine which morphologic abnormalities of the distal rectum accompany ARMs. Three other cases showed normal neuromuscular morphology; 9 further cases could not be evaluated owing to scanty biopsies.
All resected specimens were caudocranially coiled and cryostat cut at degrees C into serial sections, which were stained with a lactic dehydrogenase, succinic dehydrogenase, nitroxide synthase, and acetylcholinesterase reaction as well as hemalum and sirius red. Ten low, 15 intermediate, and 10 high forms of anal atresia AA were studied. In addition, six cloacal abnormalities were investigated. A correlation between innervation anomalies or anomalies of the muscularis propria and the type of fistula could not be seen.
Anorectal pain is a common symptom, often as part of functional gastrointestinal disorders. Children seldom present with this complaint. Proctalgia fugax and chronic proctalgia are both anorectal pain syndromes but differ in duration and frequency of episodes and in pain characteristics.
No research has been conducted on anorectal pain syndromes in children. We present two patients. Firstly, an 8-year-old girl who suffered from anorectal cramps. We found no underlying cause apart from constipation. The symptoms disappeared spontaneously. The second concerned an 8-year-old boy who presented with recurrent anorectal cramps. He was diagnosed with celiac disease. Anorectal dysfunction and visceral hypersensitivity have been described in adult celiac patients. Symptoms of anorectal pain in children are rare probably because it often remains unrecognised.
Noninvasive diagnostic methods and interventions are preferred in paediatric medicine. Screening for celiac disease in children with anorectal pain episodes should be considered. Results of a randomised clinical trial]. The popular belief advocates the use of sitz sitting baths with cold water for the treatment of acute anal pain, but clinical practice guides recommend the use of hot water for its known effect on the at-rest anal pressure.
The objective of the study was to examine the analgesic effect on the quality of life, manometer data and clinical progress, of the two temperatures in sitz baths in patients with anal pain. A randomised clinical trial on patients with acute anal pain due to haemorrhoids or anal fissures, divided into Group 1: Sitz baths with water at a temperature of less than 15 degrees C, and Group 2: Baths with a water temperature above 30 degrees C.
The analgesia was the same in both groups. An analysis was made of the pain at 7 days visual analogue scale , quality of life SF , anal at-rest pressure and disease progress. The rest of the variables were similar. There were no statistically significant differences in pain control from day 1 to day 7 in the Group with sitz baths with hot water.
Constipation: evaluation and treatment of colonic and anorectal motility disorders. This article focuses on the colonic and anorectal motility disturbances that are associated with chronic constipation and their management. Functional chronic constipation consists of three overlapping subtypes: slow transit constipation, dyssynergic defecation, and irritable bowel syndrome with constipation.
The Rome criteria may serve as a useful guide for making a clinical diagnosis of functional constipation. Today, an evidence-based approach can be used to treat patients with chronic constipation. The availability of specific drugs for the treatment of chronic constipation, such as tegaserod and lubiprostone, has enhanced the therapeutic armamentarium for managing these patients.
Randomized controlled trials have also established the efficacy of biofeedback therapy in the treatment of dyssynergic defecation. Wassink, Thomas H. Karyotyping, however, may fail to detect abnormalities of chromosome subtelomeres, which are gene rich regions prone to anomalies.
We assessed whether panels of FISH probes targeted for subtelomeres could detect abnormalities beyond those identified by…. Anorectal malformations ARM are common congenital anomalies seen throughout the world. Comparison of outcome data has been hindered because of confusion related to classification and assessment systems. The goals of the Krinkenbeck Conference on ARM was to develop standards for an International Classification of ARM based on a modification of fistula type and adding rare and regional variants, and design a system for comparable follow up studies.
Lesions were classified into major clinical groups based on the fistula location perineal, recto-urethral, recto-vesical, vestibular , cloacal lesions, those with no fistula and anal stenosis. Rare and regional variants included pouch colon, rectal atresia or stenosis, rectovaginal fistula, H-fistula and others. Groups would be analyzed according to the type of procedure performed stratified for confounding associated conditions such as sacral anomalies and tethered cord.
A standard method for postoperative assessment of continence was determined. A new International diagnostic classification system, operative groupings and a method of postoperative assessment of continence was developed by consensus of a large contingent of participants experienced in the management of patients with ARM. These methods should allow for a common standardization of diagnosis and comparing postoperative results. Hyperammonemia in anorectic tumor-bearing rats. Assessment of ammonia levels in blood draining these sarcomas indicated nearly a fold increase as compared with venous blood in control rats, suggesting the tumor mass as the source of this increase in ammonia.
Infusing increasing concentrations of ammonium salts produced anorexia and alterations in brain amino acids in normal rats that were similar to those observed in anorectic tumor-bearing rats. Therefore, these results suggest that ammonia released by tumor tissue may be an important factor in the etiology of cancer anorexia. Pulmonary vascular anomalies : a review of clinical and radiological findings of cases presenting with different complaints in childhood.
Congenital pulmonary vascular abnormalities arise from several etiologies. These anomalies are difficult to categorize and sorted into distinct classifications. Major pulmonary vascular abnormalities can be ranked as interruption of the main pulmonary artery or its absence, emergence of the left pulmonary artery in the right pulmonary artery, pulmonary venous drainage abnormalities, and pulmonary arteriovenous malformations PAVMs.
Some of the cases are asymptomatic and diagnosed by coincidence, whereas a few of them are diagnosed by typical findings in the newborn and infancy period, symptoms, and radiological appearances. Early diagnosis is important, since death may occur as a result of pulmonary and cardiac pathologies developed in patients with pulmonary vascular anomalies. In this case presentation, the clinical and radiological findings of patients that presented with different complaints and were diagnosed with pulmonary vascular anomalies were introduced.
The prevalence, pattern and clinical presentation of developmental dental hard-tissue anomalies in children with primary and mix dentition from Ile-Ife, Nigeria. The study of dental anomalies is important because it generates information that is important for both the anthropological and clinical management of patients.
The objective of this study is to determine the prevalence and pattern of presentation of dental hard-tissue developmental anomalies in the mix dentition of children residing in Ile-Ife, a suburban region of Nigeria. Information on age, sex and socioeconomic status was collected from 1, children aged four months to 12 years through a household survey. Clinical examination was conducted to assess the presence of dental anomalies. Associations between age, sex, socioeconomic status, prevalence, and pattern of presentation of the developmental hard-tissue dental anomalies were determined.
Two hundred and seventy six Of these, Of the children with anomalies , More anomalies were seen in permanent than primary dentition. Anomalies of tooth structure were most prevalent Dens evaginatus, peg-shaped lateral, macrodontia, and talon cusp were more prevalent in the permanent dentition, and dens evaginatus peg-shaped lateral and macrodontia were more prevalent in the maxilla.
There were significantly more macrodontia anomalies in males and in children of high socioeconomic status. This large survey of dental hard-tissue anomalies found in the primary dentition and mixed dentition of children in Nigeria provides anthropological and clinical data that may aid the detection and management of dental problems of children in Nigeria.
The aim of this study was to elucidate whether fecoflowmetry FFM could evaluate more detailed evacuative function than anorectal manometry by comparing between FFM or anorectal manometric findings and the clinical questionnaires and the types of surgical procedure in the patients who received anal-preserving surgery.
Fifty-three patients who underwent anal-preserving surgery for low rectal cancer were enrolled. The relationships between FFM or the manometric findings and the clinical questionnaires and the types of procedure of anal-preserving surgery were evaluated. There were significant differences between FFM markers and the clinical questionnaire and the types of the surgical procedure, whereas no significant relationship was observed between the manometric findings and the clinical questionnaire and the types of the surgical procedure.
FFM might be feasible and useful for the objective assessment of evacuative function and may be superior to manometry for patients undergoing anal-preserving surgery. Perianal infections are the most feared complication, considering the lack of natural defense against infectious microorganisms.
Although anorectal diseases are a frequent complication with potentially fatal outcomes among patients with hematologic diseases, sufficient data are not available in the literature. In this study, we aimed to investigate the anorectal complications developing during the neutropenic period in patients with hematologic diseases.
Methods A total of 79 patients whose neutropenic period absolute neutrophil count anorectal complications, of them 6 7. The patients were characterized according to the hematological disease and its status active or not , the type of treatment and the presence of a history of an anorectal pathology before the onset of the hematologic disease.
Nineteen In addition, the overall mortality rate was higher among the patients who developed anorectal complications compared to another group Conclusion Anorectal pathology is a common complication with high recurrence rate in neutropenic patients. Perianal infections are important as they can cause life-threatening outcomes although they are relatively rare among all anorectal complications. Therefore perianal signs and symptoms should be meticulously evaluated concerning early.
Effects of herbal medicine Dai-Kenchu-to on anorectal function in children with severe constipation. We administered the herbal medicine Dai-Kenchu-To DKT to children with severe chronic constipation or with severe constipation after surgery for anorectal malformations.
We then objectively assessed the effect of DKT on anorectal function by manometric study in addition to using a clinical scoring system. Ten children with severe chronic constipation and 5 children with severe constipation after surgery for anorectal malformations were assessed. These 15 children received 0. We objectively assessed their bowel function, sphincter function and rectal reservoir function by anorectal manometry and clinical scoring.
In 10 children with severe chronic constipation, the clinical score after administration of DKT 7. It appears that the results were secondary to DKT-stimulated peristalsis of the intestine, which promoted regular bowel habits. The terminology for anorectal dysfunction in women has long been in need of a specific clinically -based Consensus Report. Appropriate core clinical categories and sub classifications were developed to give an alphanumeric coding to each definition.
An extensive process of twenty rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion consensus. A Terminology Report for anorectal dysfunction, encompassing over separate definitions, has been developed.
It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific anorectal investigations and imaging ultrasound, radiology and MRI has been included whilst appropriate figures have been included to supplement and help clarify the text.
A consensus-based Terminology Report for female anorectal dysfunction terminology has been produced aimed at being a significant aid to clinical practice and a stimulus for research. Micturating cystography and "double urethral catheter technique" to define the anatomy of anorectal malformations. Ano-rectal malformations ARM in the male patient may be associated with a fistulous communication between the rectum and urethra.
Pre-operative radiological assessment is important to delineate a the presence and level of the fistula, b the anatomy of the posterior urethra and c any anomalies in adjacent structures. Bladder catheterisation can be technically difficult when performing an MCUG and distal loopogram in such patients.
This can be due to urethral stricture, tortuous or kinked urethra or preferential passage of catheter into a large fistula and leads to an inadequate study. We describe a "double urethral catheter technique" to enable urethral catheterisation when the fistula is large. European consensus meeting of ARM-Net members concerning diagnosis and early management of newborns with anorectal malformations.
The ARM-Net anorectal malformation network consortium held a consensus meeting in which the classification of ARM and preoperative workup were evaluated with the aim of improving monitoring of treatment and outcome. The Krickenbeck classification is appropriate in describing ARM for clinical use. The preoperative workup was slightly modified. In males with a visible fistula, no cross-table lateral X-ray is needed and an anoplasty or mini- posterior sagittal anorectoplasty can directly be performed.
In females with a small vestibular fistula Hegar size 5 mm, and in the meantime, gentle painless dilatations can be performed. In both male and female perineal fistula and either a low birth weight anomalies , prolonged preoperative painless dilatations might be indicated to decrease perioperative morbidity caused by general anesthesia.
Is anorectal endosonography valuable in dyschesia? Aims: Dyschesia can be provoked by inappropriate defecation movements. Methods: Twenty consecutive patients with a medical history of dyschesia and a control group of 20 healthy subjects underwent linear anorectal endosonography Toshiba models IUV and PVL RT. In both groups, the dimensions of the anal sphincter and the m.
Statistical analysis was performed within and between the two groups. Changes in sphincter length were statistically significantly different p anorectal endosonography demonstrated incomplete or even absent relaxation of the anal sphincter and the m. Biofeedback based on anomanometric techniques has been shown to be effective in the treatment of children with encopresis. The long-term efficacy of biofeedback and which variables of anorectal manometry anorectal manometry could help to establish biofeedback indications are currently the subject of debate.
To identify which variables of anorectal manometry, in addition to symptoms, could be useful in deciding which patients could benefit from biofeedback therapy and to assess the outcome of this treatment. Anorectal manometry was performed in 88 patients, who were referred to our service complaining of soiling at least once a month for a minimum of 6 months after a period of normal continence of 1 year or more.
The chronological and mental age of the patients was 4 years. All patients were otherwise in good health and had shown no response to medical treatment. The following variables were studied: anal canal profile, rectoanal inhibitory reflex RAIR , continence reflex, rectal sensitivity, external anal sphincter EAS activity and defecatory maneuver. The indications and outcome of biofeedback were assessed through clinical course and anorectal manometry. In the statistical analysis, the mean and standard deviation were calculated.
The chi-squared test with Yates' correction was used to compare clinical and manometric qualitative parameters; Student's t-test was used to compare quantitative parameters; nonparametric tests consisted of the Mann-Whitney test and the Wilcoxon test was used for paired data.
Patients treated with biofeedback therapy presented shorter anal canal, greater pressure in the rectal ampulla P Standard symptom- and sexual history-based testing misses anorectal Chlamydia trachomatis and neisseria gonorrhoeae infections in swingers and men who have sex with men. Currently, individuals at risk for sexually transmitted diseases STDs are tested extragenitally only if indicated, most often when there is a history of self-reported symptoms or self-reported anal sex.
The sensitivity of such selective symptom- and sexual history-based testing for detection of anorectal STD has not been determined. We compared STD prevalence at anorectal site based on universal versus selective testing. Universal testing may be a more effective strategy for interrupting the ongoing transmission in high-risk sexual networks.
Anorectal and inguinal lymphogranuloma venereum among men who have sex with men in Amsterdam, The Netherlands: trends over time, symptomatology and concurrent infections. We included MSM consultations from whom a swab from anorectum, bubo or an genital ulcer was taken for Chlamydia trachomatis Ct screening. Anorectal swabs were taken from all MSM who reported receptive anorectal intercourse in the preceding 6 months.
Patient symptoms, clinical and anoscopic inflammatory signs, and STI co-infections were noted; Gram-stained anorectal mucosal smears were examined. Anal LGV is asymptomatic in a quarter of cases. Profile of patients with genitourinary anomalies treated in a clinical genetics service in the Brazilian unified health system. Abstract Objective: To describe the profile of patients with genitourinary abnormalities treated at a tertiary hospital genetics service.
A total of cases suggestive of genitourinary anomalies were selected, regardless of age. A standardized clinical protocol was used, as well as karyotype, hormone levels and genitourinary ultrasound for basic evaluation.
Laparoscopy, gonadal biopsy and molecular studies were performed in specific cases. Chi-square, Fisher and Kruskal—Wallis tests were used for statistical analysis and comparison between groups. The age was younger in the GUA group p anomalies.
Vascular Anomalies. Vascular anomalies encompass a wide variety of clinical conditions involving the vasculature. Over the past several decades, the terminology has changed as our understanding of these conditions has improved. A well-accepted classification scheme has evolved with constant additions, updates, and revisions. Imaging techniques have also advanced with greater resolution and a better understanding of the correlation between imaging, clinical behavior, and natural history.
Meanwhile, the treatment of these conditions has also changed, with greater focus on minimally invasive techniques as opposed to radical surgery. Despite these changes, surgical intervention remains a high-value option for select patients. With greater understanding of the molecular basis of these diseases, medical treatment has improved especially in severe cases where options remain limited.
A multidisciplinary approach to comprehensive patient care usually yields the best outcome and is strongly encouraged. Congenital anomalies. Over the past decade, amniotic fluid-derived stem cells have emerged as a novel, experimental approach for the treatment of a wide variety of congenital anomalies diagnosed either in utero or postnatally. There are a number of unique properties of amniotic fluid stem cells that have allowed it to become a major research focus.
These include the relative ease of accessing amniotic fluid cells in a minimally invasive fashion by amniocentesis as well as the relatively rich population of progenitor cells obtained from a small aliquot of fluid. Mesenchymal stem cells, c-kit positive stem cells, as well as induced pluripotent stem cells have all been derived from human amniotic fluid in recent years.
The current status in the use of amniotic fluid-derived stem cells, particularly as they relate as substrates in tissue engineering-based applications, is described in various animal models. A roadmap for further study and eventual clinical application is also proposed. Brain neuroimaging disclosed a complex cerebral vascular anomaly CVA with stenosis of the right anterior cerebral artery and telangiectatic collateral vessels supplying the cerebral cortex, consistent with moyamoya disease.
Fecal incontinence after minor anorectal surgery. Fecal leakage after open lateral internal anal sphincterotomy for chronic anal fissure is common, but underreported. The aim of this study was to prospectively assess the physiologic and morphologic effects of sphincterotomy, comparing continent and incontinent patients after surgery. This group was further compared with an unselected group of patients presenting with incontinence after hemorrhoidectomy.
Between January and June , 23 patients were prospectively followed up through internal sphincterotomy with conventional and vector volume anorectal manometry, parametric assessment of the rectoanal inhibitory reflex, and endoanal magnetic resonance imaging. Fourteen continent patients were compared with 9 incontinent postoperative cases, 9 patients referred with incontinence after hemorrhoidectomy, and 33 healthy volunteers without anorectal disease.
Significant differences were noted between continent and incontinent postsphincterotomy cases for all resting conventional and vector volume parameters and for some squeeze parameters. Although there was a significant reduction in postoperative high pressure zone length at rest, there were no differences between the postoperative groups.
There was an increase in sphincter asymmetry of 6. Significant differences were noted for resting parameters between incontinent postsphincterotomy and posthemorrhoidectomy patients, with a higher resting sphincter asymmetry in the latter group. The area under the rectoanal inhibitory curve was smaller in postsphincterotomy incontinent patients when compared with continent cohorts over the distal and intermediate sphincter zones at rest with a reduced latency of inhibition.
There was no difference in the magnetic resonance images of the sphincterotomy site between incontinent and continent postsphincterotomy cases and no posthemorrhoidectomy. Fifteen years of experience in the treatment of anorectal malformations. To analyze our experience in the treatment of anorectal malformations ARM with the posterior sagittal anorectoplasty PSARP , and our modifications through the last few years and the outcomes. We reviewed cases divided into two groups: Former F: and Recent R: Type of ARM, associated anomalies , management and complications were noted.
A telephone questionnaire regarding continence outcome was addressed to the 74 cases older than 3 years. According to the type of ARM, there were 53 perineal fistulas, 2 anal stenoses, 11 no fistulas, 12 rectourethral fistulas 5 rectobulbar and 7 rectoprostatic fistulas , 22 vestibular fistulas, 1 rectovesical fistulas and 6 cloacas.
A total of 47 patients presented with 73 associated malformations. The most frequent one was rectal mucosa prolapse in 14 12F and 2R and 2 wound infections F. Continence was good in 62, poor in 3 and fair in 5. Seven out of eight children with poor or fair continence had associated malformations. Cumulative experience helps avoid colostomies and reduce complication and reoperation rates. Interval review years is anticipated to keep the document updated and as widely acceptable as possible.
Chromosomal microarray in clinical diagnosis: a study of patients with congenital anomalies and developmental delays or intellectual disability. To determine the diagnostic yield and criteria that could help to classify and interpret the copy number variations CNVs detected by chromosomal microarray CMA technique in patients with congenital and developmental abnormalities including dysmorphia, developmental delay DD or intellectual disability ID , autism spectrum disorders ASD and congenital anomalies CA.
In 30 of patients, chromosomal imbalances had previously been detected by classical cytogenetic and molecular cytogenetic methods. In 73 of patients, clinically relevant variants were detected and better characterized. Variants of unknown clinical significance VOUS were discovered in 35 patients. Penile, vulvar and anal squamous cell carcinomas SCCs share histomorphological overlap and are prone to lymphatic dissemination into inguinal nodes.
These anatomically distinct zones differ in terms of their embryological development. CDX2 might be valuable in terms of narrowing the possible sites of origin to be considered in the setting of SCC with unknown primary presenting with inguinal lymph node metastasis. However, despite its favourable specificity, the diagnostic benefit achieved by this observation is limited by the low sensitivity.
Safety and clinical efficacy of Onyx for embolization of extracranial head and neck vascular anomalies. Onyx was developed for embolization of central nervous system AVMs but is increasingly used extracranially because of its unique physical properties. We review our experience and results with the use of Onyx for the treatment of fast-flow extracranial vascular lesions. We retrospectively analyzed clinical and imaging records of 22 patients who underwent 71 extracranial embolizations from March through January Clinical goals included amelioration of pain and control of bleeding.
The clinical efficacy of embolization was judged by symptom control, and adverse events were assessed by clinical examination and history, both postembolization and 4 weeks postprocedure. Control of subacute bleeding episodes and pain was achieved for all patients.
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Wacker Chemie AG Internal combustion engine, method for auto-ignition operation and computer readable storage device. Mazda Motor Corporation Chronographic watch with adjustable countdown display. Richemont International S. Kokuyo Co. Faurecia Bloc Avant Method for controlling at least one passenger retention system of a motor vehicle and motor vehicle.
Rohr, Inc. Canon Kabushiki Kaisha Refrigeration circuit system with a multistage rotary compressor. Wilhelm Sihn Jr. KG Operating table. Berchtold Holding GmbH Honeycomb structure and bonded type honeycomb structure. KUKA Roboter GmbH Device for transferring ceramic moulded articles, press for ceramic intermediate products and assembly with a press and a transport device. Potter, Mr Roy Rear view unit with airbag. SMR Patents S. Affectis Pharmaceuticals AG Method for producing reduced metal using upgraded coal.
Sumitomo Electric Device Innovations, Inc. Feluwa Pumpen GmbH A drive mechanism. Rolls-Royce plc Method and device for detecting shape of sheet roll. Yujin Instec Co. Sony Computer Entertainment Inc. KG Amplifying circuit and amplifying method. Rectal digital examination was abnormal in 75 cases Severe disease was encountered in 22 patients neoplasm, angiodysplasia, and inflammatory bowel disease; 10 patients had polyps, 6 had colorectal cancer, and 6 had inflammatory bowel disease.
Out of 63 patients younger than 50 years, 5 had severe disease, all of them in the form of inflammatory bowel disease. Conclusions: a neoplasm of the rectum and colon in patients younger than 50 years is a rare event. A colonoscopy must be performed in this group of patients to rule out inflammatory bowel disease.
Treatment and prognosis of patients with late rectal bleeding after intensity-modulated radiation therapy for prostate cancer. Radiation proctitis after intensity-modulated radiation therapy IMRT differs from that seen after pelvic irradiation in that this adverse event is a result of high-dose radiation to a very small area in the rectum.
We evaluated the results of treatment for hemorrhagic proctitis after IMRT for prostate cancer. Among these patients, 64 patients who developed late rectal bleeding were evaluated. Forty patients had received IMRT using a linear accelerator and 24 by tomotherapy.
Their median age was 72 years. Depending on the severity, steroid suppositories or enemas were administered up to twice daily and Argon plasma coagulation APC was performed up to 3 times. Response to treatment was evaluated using the Rectal Bleeding Score RBS , which is the sum of Frequency Score graded from 1 to 3 by frequency of bleeding and Amount Score graded from 1 to 3 by amount of bleeding.
Stoppage of bleeding over 3 months was scored as RBS 1. The median follow-up period for treatment of rectal bleeding was 35 months range, 12—69 months. Grade of bleeding was 1 in 31 patients, 2 in 26, and 3 in 7. One patient treated with steroid enema 0. However, short. Conformal irradiation of the prostate: estimating long-term rectal bleeding risk using dose-volume histograms. Conclusions: There is a dose-volume relationship for rectal mucosal bleeding in the region between 60 and 75 CGE; therefore, efforts to spare rectal wall volume using improved treatment planning and delivery techniques are important.
Stratifying dose-volume histograms DVHs into risk groups, as done in this study, represents a useful means of analyzing empirical data as a function of heterogeneous dose distributions. Modeling efforts may extend these results to more heterogeneous treatment techniques. Such analysis of DVH data may allow practicing clinicians to better assess the risk of various treatments, fields, or doses, when caring for an individual patient.
Chronic rectal bleeding after high-dose conformal treatment of prostate cancer warrants modification of existing morbidity scales. Hanlon, Alexandra L. Purpose: Serious late morbidity Grade 3 4 from the conformal treatment of prostate cancer has been reported in rectal bleeding requiring multiple fulgerations. This communication documents the frequency of rectal bleeding requiring multiple fulgerations and illustrates the variation in reported late serious GI complication rates by the selection of morbidity scale.
Methods and Materials: Between May and December , patients with T1-T3 nonmetastatic prostate cancers were treated with our four-field conformal technique without special rectal blocking. This technique includes a 1-cm margin from the clinical target volume CTV to the planning target volume PTV in all directions.
The median follow-up for these patients was 36 months range , and the median center of prostate dose was 74 Gy range Latency is measured from the end of radiotherapy to surgery, first blood transfusion, or third coagulation procedure. Two patients required surgery colostomy or sigmoid resection , three required multiple blood transfusions, two required one or two blood transfusions, and nine required at least three.
Full Text Available Abstract Background Radiation proctitis after intensity-modulated radiation therapy IMRT differs from that seen after pelvic irradiation in that this adverse event is a result of high-dose radiation to a very small area in the rectum. Response to treatment was evaluated using the Rectal Bleeding Score RBS, which is the sum of Frequency Score graded from 1 to 3 by frequency of bleeding and Amount Score graded from 1 to 3 by amount of bleeding.
Full Text Available Background: Solitary rectal ulcer syndrome SRUS is a chronic disorder of the gastrointestinal tract and its etiology is not well understood. There is no specific treatment for this syndrome and patients with SRUS may, for years, experience many complications. The aim of the present research was the biopsychosocial study of patients with SRUS. Their medical records were reviewed retrospectively to evaluate the clinical spectrum of the patients along with the endoscopic and histological findings.
Moreover, psychiatric and personality disorders [based on Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Text Revision DSM IV-TR], psychosocial stressors, early life traumas, and coping mechanisms were assessed through structured interviews. Results: At presentation, mean age of the patients was 39 years 16 to Common symptoms reported included rectal bleeding The most common histological findings were superficial ulceration Conclusion: Given the evidence in this study, we cannot ignore the psychosocial problems of patients with SRUS and biopsychosocial assessment of SRUS is more appropriate than biomedical evaluation alone.
Presacral venous haemorrhage during rectal movement is low, but is often massive, and even fatal. Our objective is the "in vitro" determination of the results of electrocoagulation applied to a fragment of muscle on the sacral bone surface during rectal resection due to a malignant neoplasm of the rectum. The method was used on 6 patients with bleeding of the presacral venous plexus.
In the "in vitro" study, boiling point was reached in 90 seconds from applying the single-pole current on the muscle fragment. The use of indirect electrocoagulation on a fragment of the rectus abdominis muscle is a straightforward and highly effective technique for controlling presacral venous haemorrhage.
Published by Elsevier Espana. All rights reserved. Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding. Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding : a prospective international multicenter study Colonic duplication in adults: Report of two cases presenting with rectal bleeding. Gastrointestinal duplication is an uncommon congenital abnormality in two-thirds of cases manifesting before the age of 2 years.
Ileal duplication is common while colonic duplication, either cystic or tubular, is a rather unusual clinical entity that remains asymptomatic and undiagnosed in most cases. Mostly occurring in pediatric patients,colonic duplication is encountered in adults only in a few cases.
This study reports two cases of colonic duplication in adults. Both cases presented with rectal bleeding on admission. The study was focused on clinical, imaging,histological, and therapeutical aspects of the presenting cases. Gastrografin enema established the diagnosis in both cases. The cystic structure and the adjacent part of the colon were excised en-block. The study implies that colonic duplication, though uncommon, should be included in the differential diagnosis of rectal bleeding.
Colonic duplication in adults: report of two cases presenting with rectal bleeding. Mostly occurring in pediatric patients, colonic duplication is encountered in adults only in a few cases. The study was focused on clinical, imaging, histological, and therapeutical aspects of the presenting cases. Yeoh, Eric, E-mail: eric. Purpose: To evaluate and compare the effect of argon plasma coagulation APC and topical formalin for intractable rectal bleeding and anorectal dysfunction associated with chronic radiation proctitis.
After a follow-up duration of months, only 1 patient in each group needed further treatment. Reductions in rectal compliance and volumes of sensory perception occurred after APC, but no effect on anorectal symptoms other than rectal bleeding was observed. There were no differences between APC and topical formalin for anorectal symptoms and function, nor for anal sphincteric morphology.
Conclusions: Argon plasma coagulation and topical formalin had comparable efficacy in the durable control of rectal bleeding associated with chronic radiation proctitis but had no beneficial effect on anorectal dysfunction. Limitations of combined flexible sigmoidoscopy and double contrast barium enema in patients with rectal bleeding. Hixson, L. Eighty-seven outpatients with non-massive rectal bleeding or asymptomatic positive fecal occult blood were evaluated with 35 cm flexible sigmoidoscopy, double contrast barium enema DBCE and colonoscopy.
The combination of flexible sigmoidoscopy and DCBE missed none of 7 malignant lesions. Massive gastrointestinal bleeding is an emergency that can sometimes require immediate surgery. We report the first case, to the best of our knowledge, of massive rectal bleeding due to Yersinia enterocolitica, requiring ileocecal resection. A year-old North African woman was admitted to our emergency department for massive rectal bleeding.
She had a history of an iron deficiency anemia of unknown cause, and diarrhea 2 months before the admission. On admission to our emergency unit, she was in a state of hemodynamic collapse. An examination showed discolored conjunctivas, massive rectal bleeding with clots and no abdominal pain. The first medical treatment included the use of noradrenaline. An upper gastrointestinal endoscopy was performed and did not show any lesions.
Computed tomography of her abdomen showed significant and hypervascular wall thickening of her terminal ileum suggestive of a tumor. Because her massive rectal bleeding worsened and her collapse persisted, an exploratory laparotomy and ileocecal resection were immediately performed on the patient. Histopathological analysis showed enteritis caused by Yersinia enterocolitica. Her outcome was favorable. Enteritis due to Yersinia enterocolitica can take a pseudotumoral form and mislead the diagnosis of gastrointestinal bleeding.
Rectal Bleeding. Full Text Available The incidence of presacral bleeding during rectal mobilization is low, but such bleeding may be massive and even fatal. Haemostasis can be difficult to achieve using conventional methods because of the complex interlacing of the venous network at the sacral periosteum.
Historically, pelvic packing and metallic thumbtacks have been the more commonly used methods in our institution. However, the need for repeat surgery to remove the packs and the difficulties encountered in tack application have forced us to explore other methods. In , the procedure termed muscle fragment welding, which uses electrocautery through a rectus muscle fragment, was introduced to control presacral bleeding.
From January to February , six of patients undergoing pelvic surgery in our institution developed massive presacral haemorrhage and, therefore, this technique was used. Haemostasis was immediate and permanent. No major untoward postoperative events such as re- bleeding or infection were noted. One case developed a second-degree burn in the right elbow due to a misplaced ground conduction plate.
Rectus muscle fragment welding is, in our experience, an effective and practical method of controlling presacral haemorrhage. Rectal bleeding after conformal 3D treatment of prostate cancer: Time to occurrence, response to treatment and duration of morbidity. Purpose: Rectal bleeding is the most common late sequelae of high-dose 3D conformal treatment 3DCRT for prostate cancer and may limit attempts to improve local control by dose escalation. The clinical course of this complication is reported including time to onset, response to treatment, duration of morbidity, and multivariate analysis for predictors.
Eighty-nine patients developed Grade 2 or Grade 3 complications due to rectal bleeding and are analyzed. Multivariate analysis results for predictors of Grade 2 and 3 rectal bleeding are reported as well as time to development, response to initial and retreatment, and duration of morbidity. For Grade 2 bleeding , medication or coagulation was highly effective as initial or retreatment resolving 66 of 73 patients.
Of seven nonresponders to treatment for Grade 2 bleeding , three have died of intercurrent disease at 10, 19, and 26 months, while four are alive with continuing Grade 2 bleeding at 12, 14, 15, and 30 months after onset. The four nonresponders to treatment for Grade 3 bleeding continue to bleed 1, 9, 32, and 35 months after the third coagulation despite continuing. Transitioning from conventional radiotherapy to intensity-modulated radiotherapy for localized prostate cancer.
Changing focus from rectal bleeding to detailed quality of life analysis. With the advent of modern radiation techniques, we have been able to deliver a higher prescribed radiotherapy dose for localized prostate cancer without severe adverse reactions. We reviewed and analyzed the change of toxicity profiles of external beam radiation therapy EBRT from the literature. Furthermore, intensity-modulated radiation therapy IMRT reduced it further to a few percentage points. However, simultaneously, urological toxicities were enhanced by dose escalation using highly precise external radiotherapy.
Those factors shift the main focus of treatment purpose from survival and avoidance of PSA failure to maintaining good QOL, particularly in older patients. In conclusion, the focus of toxicity analysis after radiotherapy for prostate cancer patients is changing from rectal bleeding to total elaborate quality of life assessment. Detection of colorectal cancer in symptomatic outpatients without visible rectal bleeding : Validity of the fecal occult blood test. In , a new diagnostic strategy in symptomatic outpatients without known established colorectal cancer risk factors aged 40 years or older was implemented in Denmark.
Typical presentations are palpable purpura, abdominal pain, arthritis, and hematuria. This vasculitic syndrome can present as an uncommon cause of rectal bleeding in older patients. He presented with rectal bleeding and acute kidney injury secondary to IgA mesangioproliferative glomerulonephritis.
Case presentation A year-old Pol Late rectal bleeding after 3D-CRT for prostate cancer: development of a neural-network-based predictive model. Tomatis, S. The aim of this study was to develop a model exploiting artificial neural networks ANNs to correlate dosimetric and clinical variables with late rectal bleeding in prostate cancer patients undergoing radical radiotherapy and to compare the ANN results with those of a standard logistic regression LR analysis.
This multicenter protocol was characterized by the prospective evaluation of rectal toxicity, with a minimum follow-up of 36 months. Radiotherapy doses were between 70 and 80 Gy. Information was recorded for comorbidity, previous abdominal surgery, use of drugs and hormonal therapy. For each patient, a rectal dose-volume histogram DVH of the whole treatment was recorded and the equivalent uniform dose EUD evaluated as an effective descriptor of the whole DVH.
The overall population was split into training and verification sets, both of which were involved in model instruction, and a test set, used to evaluate the predictive power of the model with independent data.
Fourfold cross-validation was also used to provide realistic results for the full dataset. The LR was performed on the same data. Five variables were selected to predict late rectal bleeding : EUD, abdominal surgery, presence of hemorrhoids, use of anticoagulants and androgen deprivation. Following a receiver operating characteristic analysis of the independent test set, the areas under the curves AUCs were 0.
When evaluated with cross-validation, the AUC was 0. When a practical discrimination threshold was selected, ANN could classify data with sensitivity and specificity both equal to These data provide reasonable evidence that results obtained with. Significant correlation between rectal DVH and late bleeding in patients treated after radical prostatectomy with conformal or conventional radiotherapy Methods and Materials: Data of consecutive patients, including three-dimensional treatment planning and dose-volume histograms DVHs of the rectum including filling , were retrospectively analyzed.
Clinical parameters such as diabetes mellitus, acute rectal bleeding , hypertension, age, and hormonal therapy were considered. Median follow-up was 36 months range Median and quartile values of all parameters were taken as cutoff for statistical analysis. Univariate log-rank and multivariate Cox hazard model analyses were performed. A significant correlation between a number of cutoff values and late rectal bleeding was found.
Concerning clinical variables, acute bleeding p bleeding , and a trend was found for. Rectal bleeding after conformal 3D treatment of prostate cancer: time to occurrence, response to treatment and duration of morbidity. Teshina, Teruki; Hanks, Gerald E. Purpose: Late rectal bleeding is the most common sequelae of high dose 3D conformal treatment 3DCRT for prostate cancer and limits attempts to improve local control by dose escalation.
The clinical course of this complication is reported including time to onset, response to treatment, duration of morbidity and risk factor analysis by multivariate analysis. They are compared to patients without Grade 2,3 morbidity in multivariate analysis. Time to development, response to initial and retreatment and duration of morbidity are tabulated. Of 4 non-responders to treatment of.
In patients undergoing radiotherapy for localized prostate cancer, dose-volume histograms and clinical variables were examined to search for correlations between radiation treatment planning parameters and late rectal bleeding. We analyzed patients with localized prostate cancer who were managed from to at our institution.
All radiation treatment plans were retrospectively reconstructed, dose-volume histograms of the rectum were generated, and the doses delivered to the rectum were calculated. Time to rectal bleeding ranged from 9 - 53 months, with a median of Of the patients, 33 patients had Grade 1 bleeding and were treated with steroid suppositories, while 25 patients with Grade 2 bleeding received argon plasma laser coagulation therapy APC.
Three patients with Grade 3 bleeding required both APC and blood transfusion. The 5-year incidence rate of Grade 2 or 3 rectal bleeding was Univariate analysis showed significant differences in the average values from V65 to V10 between Grades 0 - 1 and Grades 2 - 3. Of the 28 patients of Grade 2 or 3 rectal bleeding , 17 patients Thus, none of the patients had any further rectal bleeding after the second APC session.
Incidence of late rectal bleeding in high-dose conformal radiotherapy of prostate cancer using equivalent uniform dose-based and dose-volume-based normal tissue complication probability models. Purpose: Accurate modeling of rectal complications based on dose-volume histogram DVH data are necessary to allow safe dose escalation in radiotherapy of prostate cancer. Methods and Materials: Data for patients treated at the William Beaumont Hospital with three-dimensional conformal radiotherapy 3D-CRT under an adaptive radiotherapy protocol were used for this study.
The parameters and their confidence intervals were determined using maximum likelihood estimation. Results: Of the patients, 51 Rectal wall mean dose did not correlate to Grade 2 or higher bleeding. However, this model fitted the data more poorly than the EUD-based models. Conclusions: Our study clearly confirms a volume effect for late rectal bleeding. Dose-volume-based cutoff-dose models performed worse. Gastrointestinal duplication is an infrequent congenital abnormality. Colonic and tubular duplications are the least common.
In neonates there are few described cases. It's difficult to identify the duplication preoperatively and a standard surgical approach has not been developped. We report a neonate with bleeding of the digestive tube who presented a colonic duplication who required multiple diagnostic test before the diagnosis was made for colonoscopy. Laparotomy showed a total tubular duplication of the right, transverse and left colon with proximal and distal communication.
Exclusion of the duplicated segment was performed, but three months after the operation, subocclusion due to stenosis of the colonic distal loop was developed. This finding was confirmed by a second colonoscopy and septum was partially removed. The study implies that CD, though uncommon, should be included in the differential diagnosis of rectal bleeding and the importance of the colonoscopy in the diagnosis and treatment of this malformation.
Methods and Materials. We retrospectively reviewed 61 prostate adenocarcinoma patients from to The majority Ten patients By univariate analysis, age, stage, Gleason sum, PSA, hormonal therapy, pelvic radiation, postoperative prostate volume, D9, V, individual source activity, total implanted activity per cm 3 , and duration of interval before implant did not impact rectal bleeding.
Implant R was higher in patients with rectal bleeding : on average, 0. A trend for significance was seen for prostate V and total implanted activity. Minimizing implant R may reduce the rate of rectal bleeding in similar patients. Full Text Available Haemangioma of the rectum and colon is very rare malformation with only around cases have been reported so far.
Most commonly young adult is affected. Common site is recto sigmoid junction. Here we present three cases of rectal haemangioma affecting two males and one female patient. All were having cavernous type of haemangioma at rectum and recto sigmoid junction with one involving additional caecum and ascending colon.
All the cases were misdiagnosed previously. Colonoscopy is the cornerstone for evaluation of these patients showing bluish discoloration with engorged mucosa. Rectum and sigmoid colon are commonly affected. Abdominoperineal resection was the favored procedure in the past.
At present, definitive treatment of diffuse cavernous haemangioma DCH of rectum and sigmoid colon is excision of the involved bowel with sphincter saving procedure with either stapling or hand sewn anastomosis of colon and anal canal. Key words: Rectal haemangioma; sphincter saving surgery. DOI: Key words : Rectal haemangioma; sphincter saving surgery. Methods and Materials: From June to January , a Web-based survey was sent to American and Canadian academic radiation oncologists who treat prostate cancer.
Participants were provided 4 case vignettes in which patients received radiation therapy and developed rectal bleeding and were asked for management plans and to rate the bleeding according to NCI CTC v. In 2 cases, participants were also asked whether they would send the patient for colonoscopy.
A multilevel, random intercept modeling approach was used to assess sources of variation case, respondent in toxicity grading to calculate the intraclass correlation coefficient ICC. Agreement between respondents was moderate ICC 0. Respondents who chose an invasive management were more likely to select a higher toxicity grade P rectal bleeding using 2 common scales. Clearer definitions of late rectal bleeding toxicity should be constructed to reduce this variability and avoid ambiguity in both.
Full Text Available Diarrhea and fecal incontinence are common in critically ill patients and present a challenging problem in patient management. There have been only few case reports describing the complications with the use of this device. Here, we present a case of a year-old woman who was admitted due to massive hematochezia while on anticoagulation.
She was found to have a large rectal ulcer caused by the Flexi-Seal device, used during the last hospital stay for fecal incontinence. Flexi-Seal device can be effective for the management of incontinence; however, caution should be exercised during handling and pressure from the retention balloon should be relieved periodically.
Anticoagulant medications are commonly used for the prevention and treatment of thromboembolism. Although highly effective, they are also associated with significant bleeding risks. Numerous individual clinical factors have been linked to an increased risk of hemorrhage, including older age, anemia, and renal disease.
To help quantify hemorrhage risk for individual patients, a number of clinical risk prediction tools have been developed. These risk prediction tools differ in how they were derived and how they identify and weight individual risk factors. At present, their ability to effective predict anticoagulant-associated hemorrhage remains modest.
Use of risk prediction tools to estimate bleeding in clinical practice is most influential when applied to patients at the lower spectrum of thromboembolic risk, when the risk of hemorrhage will more strongly affect clinical decisions about anticoagulation. Using risk tools may also help counsel and inform patients about their potential risk for hemorrhage while on anticoagulants, and can identify patients who might benefit from more careful management of anticoagulation. Case presentation A year-old Polish man with a history of diverticulosis presented with a five-day history of rectal bleeding.
He had first noticed colicky left lower abdominal pain two months previously. At that time he was treated with a day course of ciprofloxacin and metronidazole for possible diverticulitis. He subsequently presented with rectal bleeding to our emergency department. Physical examination revealed generalized palpable purpuric rash and tenderness on his left lower abdomen.
Laboratory testing showed a mildly elevated serum creatinine of 1. Computed tomography of his abdomen revealed a diffusely edematous and thickened sigmoid colon. Flexible sigmoidoscopy showed severe petechiae throughout the colon. Colonic biopsy showed small vessel acute inflammation. Skin biopsy resulted in a diagnosis of leukocytoclastic vasculitis. Due to worsening kidney function, microscopic hematuria and new onset proteinuria, he underwent a kidney biopsy which demonstrated IgA mesangioproliferative glomerulonephritis.
Intravenous methylprednisolone was initially started and transitioned to prednisone tapering orally to complete six months of therapy. There was marked improvement of abdominal pain. Skin lesions gradually faded and gastrointestinal bleeding stopped. Acute kidney injury also improved. A year-old Polish man with a history of diverticulosis presented with a five-day history of rectal bleeding.
Purpose: To determine the predictive risk factors for Grade 2 or worse rectal bleeding after high-dose-rate brachytherapy HDR-BT combined with hypofractionated external-beam radiotherapy EBRT for prostate cancer using dose—volume histogram analysis. Late rectal bleeding and genitourinary morbidity after high dose rate brachytherapy combined with hypofractionated external beam radiotherapy for localized prostate cancer.
The purpose of this study was to evaluate late rectal bleeding and genitourinary GU morbidity in patients consecutively treated with combined high-dose-rate HDR brachytherapy and external beam radiation therapy EBRT. Data from 80 patients treated consecutively from October to May were analyzed.
The median age was 69 years old, median follow-up 31 months, ranging from months. All patients received endocrine therapy before radiation therapy. The distribution of fractionation was scheduled as follows; 5 Gy x 5 times in 14 patients, 7 Gy x 3 times in 19 patients, and 9 Gy x 2 times in 47 patients. The rectal bleeding was graded using the toxicity criteria of the Radiation Therapy Oncology Group and European Organization for Research and Treatment of Cancer while the genitourinary morbidities were graded using the toxicity criteria of the Common Terminology Criteria for Adverse Events v.
Grade 2 or worse rectal bleeding developed in 9 patients Grade 2 and 3 rectal bleeding was recognized in 8 and 1 patients, respectively. Grade 3 morbidity developed in the biopsied sites that were performed in the other hospital. No significant difference was observed in any HDR brachytherapy fractionation schedule. Grade 2 or worse GU morbidities were recognized in 30 patients Twenty-one patients in Grade 2 morbidity had an increase in the frequency of urination or nocturia, and urethral strictures developed in 3 patients.
The 3-year actuarial probability of urethral stricture was 6. One patient experienced Grade 3. Comparison of rectal volume definition techniques and their influence on rectal toxicity in patients with prostate cancer treated with 3D conformal radiotherapy: a dose-volume analysis.
To evaluate the impact of four different rectum contouring techniques and rectal toxicities in patients with treated with 3D conformal radiotherapy 3DCRT. Clinical and dosimetric data were evaluated for 94 patients who received a total dose 3DCRT of 70 Gy, and rectal doses were compared in four different rectal contouring techniques: the prostate-containing CT sections method 1 ; 1 cm above and below the planning target volume PTV method 2 ; mm starting from the anal verge method 3 ; and from the anal verge to the sigmoid flexure method 4.
The percentage of rectal volume receiving RT doses 30—70 Gy and minimum, mean rectal doses were assessed. Median age was 69 years. Mean rectal dose was significant predictor of rectal bleeding only in method 3 Different techniques of rectal contouring significantly influence the calculation of radiation doses to the rectum and the prediction of rectal toxicity.
Assessing correlations between the spatial distribution of the dose to the rectal wall and late rectal toxicity after prostate radiotherapy: an analysis of data from the MRC RT01 trial ISRCTN Many studies have been performed to assess correlations between measures derived from dose-volume histograms and late rectal toxicities for radiotherapy of prostate cancer.
The purpose of this study was to quantify correlations between measures describing the shape and location of the dose distribution and different outcomes. The dose to the rectal wall was projected on a two-dimensional map. In order to characterize the dose distribution, its centre of mass, longitudinal and lateral extent, and eccentricity were calculated at different dose levels.
Furthermore, the dose-surface histogram DSH was determined. Correlations between these measures and seven clinically relevant rectal -toxicity endpoints were quantified by maximally selected standardized Wilcoxon rank statistics. The analysis was performed using data from the RT01 prostate radiotherapy trial.
For some endpoints, the shape of the dose distribution is more strongly correlated with the outcome than simple DSHs. Rectal bleeding was most strongly correlated with the lateral extent of the dose distribution. For loose stools, the strongest correlations were found for longitudinal extent; proctitis was most strongly correlated with DSH.
For the other endpoints no statistically significant correlations could be found. The strengths of the correlations between the shape of the dose distribution and outcome differed considerably between the different endpoints. Due to these significant correlations, it is desirable to use shape-based tools in order to assess the quality of a dose distribution. Purpose: We investigated whether integration of machine learning and bioinformatics techniques on genome-wide association study GWAS data can improve the performance of predictive models in predicting the risk of developing radiation-induced late rectal bleeding and erectile dysfunction in prostate cancer patients.
Methods: We analyzed a GWAS dataset generated from prostate cancer patients treated with radiotherapy. Using genotype information from these patients, we designed a machine learning-based predictive model of late radiation-induced toxicities: rectal bleeding and erectile dysfunction. To identify important single nucleotide polymorphisms SNPs , we computed the SNP importance score, resulting from our random forest regression model. Conclusion: Our approach that combines machine learning and bioinformatics techniques.
Full Text Available A digital rectal examination is a highly important procedure carried out on infants and children during visits to the gastroenterology clinic, but is often accompanied with physiologic and psychologic trauma in patients, along with being diagnostically inaccurate in the results obtained from it. In order to avoid causing discomfort to the patients, and to improve the accuracy of the results obtained from a DRE, we have articulated a much safer and more precise method of conducting the examination.
The use of a 16 French Foley Catheter in the collection of stool samples during a DRE has proved to be an innovative technique, which eliminates discomfort in patients, provides a less stressful environment for both the physician and the family of the patient, along with providing unambiguous results for the FOBT.
The use of this technique will not only produce accurate results, but will also eliminate reasons to avoid such an important examination due to the uncomfortable situation a normal DRE would cause. Rectal fistulas after prostate brachytherapy.
Purpose: To compare the rectal and prostatic radiation doses for a prospective series of patients, 44 of whom developed persistent rectal bleeding , and 2 of whom developed rectal -prostatic fistulas. Methods and Materials: The patients were randomized and treated by implantation with I vs.
Patients were treated between September and October and had a minimum of 24 months of follow-up. The patient groups were treated concurrently. Treatment-related morbidity was monitored by mailed questionnaires, using standard American Urological Association and Radiation Therapy Oncology Group criteria, at 1, 3, 6, 12, 18, and 24 months. Patients who reported Grade 1 or greater Radiation Therapy Oncology Group rectal morbidity were interviewed by telephone to clarify details regarding their rectal bleeding.
Three of the patients with rectal bleeding required a colostomy, two of whom developed a fistula. No patient was lost to follow-up. The rectum was considered as a solid structure defined by the outer wall, without attempting to differentiate the inner wall or contents. In univariate analysis, multiple parameters were associated with late rectal bleeding , including all rectal brachytherapy indexes.
Rectal fistulas occurred. Application of objective clinical human reliability analysis OCHRA in assessment of technical performance in laparoscopic rectal cancer surgery. Laparoscopic rectal resection is technically challenging, with outcomes dependent upon technical performance. No robust objective assessment tool exists for laparoscopic rectal resection surgery. This study aimed to investigate the application of the objective clinical human reliability analysis OCHRA technique for assessing technical performance of laparoscopic rectal surgery and explore the validity and reliability of this technique.
Laparoscopic rectal cancer resection operations were described in the format of a hierarchical task analysis. Potential technical errors were defined. The OCHRA technique was used to identify technical errors enacted in videos of twenty consecutive laparoscopic rectal cancer resection operations from a single site.
The procedural task, spatial location, and circumstances of all identified errors were logged. Clinical validity was assessed through correlation with clinical outcomes; reliability was assessed by test-retest. A total of execution errors identified, with a median 15 per operation. TV sonographic assessment in postmenopausal women with bleeding. The aim of this study was to evaluate retrospectively the usefulness of transvaginal sonography for the detection of endometrial disease in postmenopausal women with bleeding.
This study involved postmenopausal women aged years median None of them were on hormone replacement therapy and all had had amenorrhea for more than one year. Concerning the age of the study patients, we confirm that endometrial cancer occurs at any age, but more commonly in ages above 58 years. Transvaginal sonography was performed in all women. About In postmenopausal symptomatic women premalignant or malignant causes of bleeding can not be excluded with just transvaginal ultrasound.
Bleeding We evaluated the rate of significant colonic and extra-colonic abnormalities at computed tomography colonography CTC , according to symptoms and age. We retrospectively evaluated consecutive average-risk subjects males, average age: In addition, clinically significant extra-colonic findings were noted.
Objective: The present study was aimed at developing a thermoluminescent dosimetric system capable of assessing the doses delivered to the rectum of patients submitted to high-dose-rate brachytherapy for uterine cervix cancer. Materials and methods: LiF:Mg,Ti,Na powder was the thermoluminescent material utilized for evaluating the rectal dose.
The powder was divided into small portions 34 mg which were accommodated in a capillary tube. This tube was placed into a rectal probe that was introduced into the patient's rectum. Results: The doses delivered to the rectum of six patients submitted to high-dose-rate brachytherapy for uterine cervix cancer evaluated by means of thermoluminescent dosimeters presented a good agreement with the planned values based on two orthogonal anteroposterior and lateral radiographic images of the patients.
Conclusion: The thermoluminescent dosimetric system developed in the present study is simple and easy to be utilized as compared to other rectal dosimetry methods. The system has shown to be effective in the evaluation of rectal doses in patients submitted to high-dose-rate brachytherapy for uterine cervix cancer. Women with abnormal uterine bleeding AUB report significant reductions in quality of life QOL , which can be attributed in many cases to the fear of embarrassing episodes of bleeding.
We performed this study to determine whether or not during clinical encounters physicians addressed the impact of AUB on patient-reported QOL. Between October and May , we conducted a cross-sectional study of members of the American College of Obstetricians and Gynecologists. Surveys were distributed using a mixed method web- and mail-based and included questions about physician characteristics and types of questions used when obtaining a clinical history from a patient with AUB.
No physician characteristics such as years since completing residency, geography, or gender were associated with how commonly providers reported asking questions regarding impact of bleeding on QOL. Physicians may not be optimizing patient-provider interactions during menstrual history taking with patients with AUB by failing to assess impact of AUB on QOL in a way that is meaningful to patients.
Assessment of reliability of endometrial brush cytology to determine the etiology of abnormal uterine bleeding and postmenopausal bleeding. Full Text Available Objective: To demonstrate diagnostic efficacy of endometrial cytologic sampling for detection of endometrial pathologies endometrial hyperplasias and cancers,by comparing endometrial full curettage and endometrial cytologic smear pathologic results performed in patients with abnormal uterine bleeding.
Materials and Methods: Totally reproductive and postmenopausal women with abnormal uterine bleeding who applied our clinic between January June were included in the study. After measurement of endometrial thickness by transvaginal ultrasound, patients were treated initialy with endometrial cytologic sampling using endometrial brush then endometrial full curettage using sharp curette. Pathology and cytology reports were evaluated retrospectively.
Results: The most frequent diagnoses in endometrial cytologic specimens obtained by endometrial brush was nondiagnostic with a rate of When all patients were analysed together, diagnosis was nondiagnostic in Cytologic assessment was resulted as sufficient in only Endometrial full curettage pathologic diagnoses were resulted as insufficient in The second most frequent diagnosis was endometrial polyp in 13 Full Text Available Objective.
Assessment of the histological and endoscopic features of the colo- rectal polyps is requered for the application of the new diagnostic and therapeutical strategies in the managment of the diminutive polyps. Rectal lymphoscintigraphy. Regional lymph nodes of the rectum are not demonstrable by pedal lymphoscintigraphy. The authors have evaluated the technique of rectal lymphoscintigraphy, using a technique similar to that which has been used in the assessment of lymph nodes in breast and prostatic cancer.
Thirty-five patients were studied: ten normal subjects and 25 patients with rectal cancer. In normal subjects, the lymph nodes accompanying the superior hemorrhoidal artery and the inferior mesenteric artery are demonstrable in succession; after three hours the aortic lymph nodes are demonstrable. The 25 patients with rectal cancer underwent resection of their primary tumor and the stage was defined according to Dukes In five patients stage A no alteration was demonstrable.
In 11 patients stage B the demonstration of regional lymph nodes was delayed vs. In nine cases stage C the demonstration of regional lymph nodes was delayed and defective versus the control group. Assessment of the bleeding risk of antithrombotic agents is usually performed in healthy animals with some form of vascular injury to peripheral organs to induce bleeding.
However, bleeding observed in patients with currently marketed antithrombotic drugs is typically spontaneous in nature such as intracranial haemorrhage ICH and gastrointestinal GI bleeding , which happens most frequently on top of preexisting pathologies such as GI ulcerations and polyps. We evaluated the effect of warfarin, dabigatran etexilate, apixaban and clopidogrel in this model by administering them in diet or in the drinking water to mice for weeks.
Effect of a prostaglandin - given rectally for prevention of radiation-induced acute proctitis - on late rectal toxicity. Results of phase III randomized, placebo-controlled, double-blind study. Kertesz, Tereza; Herrmann, Markus K. Background and purpose: to assess the late effect of a prostaglandin, given rectally during irradiation, on late rectal toxicity.
In the acute treatment setting no significant differences in reducing the incidence of acute proctitis symptoms in patients receiving misoprostol, however, significantly more rectal bleeding had been reported. Patients and methods: a total of patients who had undergone radiotherapy for prostate cancer had been entered into this phase III randomized, placebo-controlled, double-blind study with misoprostol or placebo suppositories.
Results: the median follow-up was 50 months. Frequency, bleeding and urgency were the most commonly reported symptoms. In keeping with other studies and clinical experience, the symptoms peaked within the first 2 years with a median for grade 1 of 13 months and for grade 2 of 15 months. Conclusion: misoprostol given as once-daily suppository for prevention of acute radiation-induced proctitis does neither influence the incidence and severity of radiation-induced acute nor late rectal toxicity.
Misoprostol has no negative impact on the incidence and severity of late rectal bleeding , in contrast to acute rectal bleeding. The routine clinical use of misoprostol suppositories cannot be recommended. Rectal cancer staging: Multidetector-row computed tomography diagnostic accuracy in assessment of mesorectal fascia invasion.
Imaging data were reviewed as axial and as multiplanar reconstructions MPRs images along the rectal tumor axis. MRI study, performed on 1. Diagnostic accuracy of both modalities was compared and statistically analyzed. DWI allowed to recognize the tumor as a focal mass with high signal intensity on high b-value images, compared with the signal of the normal adjacent rectal wall or with the lower tissue signal intensity background.
Circumferential resection margin CRM positivity after MRI assessment and adjuvant treatment in patients undergoing rectal cancer resection. The management of rectal cancer relies on accurate MRI staging. Multi-modal treatments can downstage rectal cancer prior to surgery and may have an effect on MRI accuracy.
We aim to correlate the findings of MRI staging of rectal cancer with histological analysis, the effect of neoadjuvant therapy on this and the implications of circumferential resection margin CRM positivity following neoadjuvant therapy. An analysis of histological data and radiological staging of all cases of rectal cancer in a single centre between and were conducted. Two hundred forty-one patients had histologically proved rectal cancer during the study period.
One hundred eighty-two patients underwent resection. Median age was R1 resection rate was MRI assessments of the circumferential resection margin in patients without neoadjuvant radiotherapy were Eighteen patients had predicted positive margins following chemoradiotherapy, of which MRI assessment of the circumferential resection margin in rectal cancer is associated with high accuracy. Neoadjuvant chemoradiotherapy has a detrimental effect on this accuracy, although accuracy remains high.
In the presence of persistently predicted positive margins, complete resection remains achievable but may necessitate a more radical approach to resection. Late rectal toxicity after conformal radiotherapy of prostate cancer I : multivariate analysis and dose-response. Skwarchuk, Mark W. Purpose: The purpose of this paper is to use the outcome of a dose escalation protocol for three-dimensional conformal radiation therapy 3D-CRT of prostate cancer to study the dose-response for late rectal toxicity and to identify anatomic, dosimetric, and clinical factors that correlate with late rectal bleeding in multivariate analysis.
The 5-year actuarial rate of late rectal toxicity was assessed using Kaplan-Meier statistics. A retrospective dosimetric analysis was performed for patients treated to Univariate and multivariate logistic regression was performed to correlate late rectal bleeding with several anatomic, dosimetric, and clinical variables.
Gastrointestinal bleeding. Gastrointestinal hemorrhage. Methods of comprehensive geriatric assessment of older patients with rectal cancer. Full Text Available The article presents a literature review on application of modern risk predictors of complications and morbidity necessary for selection of oncologically justified treatment methods for older patients with rectal cancer taking into account advancement of the disease and concomitant pathology.
Use of modern scales, calculators, and questionnaires for evaluation of functional and physical status of this complex patient category by a multidisciplinary team allows to personalize therapy approach, minimize complications and morbidity after specific treatment. Application of the developed algorithms of assessment of older patients creates satisfactory conditions for their treatment based on oncological adequacy, functionality, and safety.
To discuss the application of the degree of portal systemic shunting in assessing the upper gastrointestinal bleeding in patients with hepatic schistosomiasis. Thirty-three patients with upper gastrointestinal bleeding caused by hepatic schistosomiasis a bleeding group and 29 schistosomiasis cirrhosis patients without bleeding a non- bleeding group were enrolled as investigation subjects in Jinshan Hospital.
The subjects were scanned by the abdominal slice spiral CT. The degrees of the shunting vessels of the subjects were evaluated and compared, and the relationship between upper gastrointestinal bleeding and the degree of the shunting was analyzed.
In the bleeding group, the occurrence rates of the shunting vessels were found as follows: In the bleeding group, the occurrence rates and the degree of shunt were significantly higher than those in the non- bleeding group in esophageal varices, esophageal vein, left gastric vein and gastric varices all P upper gastrointestinal bleeding in patients with hepatic schistosomiasis.
The patents with higher degree of the shunting vessels have a higher risk of gastrointestinal bleeding. Comparative analysis of assessment methods for operational and anesthetic risks in ulcerative gastroduodenal bleeding. Full Text Available Aim of the investigation: to conduct a comparative analysis of methods of evaluation of surgical and anesthetic risks in ulcerative gastroduodenal bleeding.
Materials and methods. A retrospective analysis ofthe extent of the surgical and anesthetic risks and results of treatment of 71 patients with peptic ulcer bleeding has been conducted in the study. Lebedev et al. To compare the efficacy ofthe methods the following indicators are used: sensitivity, specificity and prediction of positive result.
The study compared the results ofthe risk assessment emergency operation by using these methods with the outcome ofthe operation. Rockall and SPRK are worse than the developed method of classification trees in recognizing patients with poor outcome of surgery.
The method of classification trees can be considered as the most accurate method of evaluation of surgical and anesthetic risks in ulcerative gastroduodenal bleeding. Benign solitary ulcer of the rectum - another cause for rectal stricture. Benign rectal ulcer syndrome is an uncommon cause of lower gastrointestinal bleeding.
Patients may present with mild, often recurrent, rectal bleeding frequently ascribed to hemorrhoids. Barium enema may be normal during the early, nonulcerative phase of proctitis. Single or multiple ulcers with or without rectal stricture are the hallmarks of the radiographic diagnosis. Radiologic demonstration of the ulcer s is not required, however, for the diagnosis. Benign rectal ulcer should be included in the differential diagnosis of benign-appearing rectal strictures.
The use of PET in assessing tumor response after neoadjuvant chemoradiation for rectal cancer. Methods and materials: Twenty patients with locally advanced rectal cancer were identified between and The median age was 57 years range with 14 males and 6 females. The response on PET and pathology was assessed and correlated.
Patient outcome according to PET response was also assessed. At surgery, complete pathological response was recorded in 7 patients, incomplete response in 10 and no response in 3. After a median follow-up of 62 months range , twelve patients were alive with no evidence of disease.
All patients achieving complete metabolic response were alive with no evidence of disease, while as those who had no metabolic response, all died as a result of metastatic disease. Conclusions: PET is a promising complementary assessment tool for assessing tumor response after CRT if there is a complete or no response. PET response may also predict for outcome.
Hrycushko, Brian A. Hrycushko utsouthwestern. Methods and Materials: A 1. Radiation was delivered to a 1-cm-diameter cylindrical volume about the cooling device and rectal wall. Histologic scoring was performed on all study rats. A confirmatory study in a large animal model with anatomic and physiologic similarities to humans is suggested.
Transcatheter emboilization therapy of massive colonic bleeding.
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Most plastic anoscopes are disposable. Not only do disposable plastic anoscopes require less preparation and post-procedure cleaning, but they are also advantageous because of their clear construction. You can see through the transparent material to detect fissures or other concerns with the tissue under the scope. Typically, an anoscope is about 2 inches wide, which is comparable to the width of a normal bowel movement.
In other words, the body is used to accommodating an object of that size. Even still, inserting a probe from the opposite end can require some coaxing. Therefore, it is important to generously coat the instrument with lubricant before attempting insertion. This will ease the effort required of the medical practitioner and will increase comfort for the patient. A water-based, medical-grade lubricant is recommended.
To perform a careful and thorough exam, the rectal area must be fully illuminated. Practitioners have several options for this requirement. Some anoscopes have built-in lights. Others do not come with attached lights, which gives the doctor the freedom to use the preferred light of his or her choice. A penlight or other handheld device can work well because it allows the practitioner to direct the beam precisely where it is needed. If you do not have a free hand, an assistant can hold the light.
A rectal exam opens up the anus and the rectum so you have access to the tissue inside. Once access has been granted, you may need swabs with which to clean the passage or to examine the health of the region. For example, long cotton swabs are useful for wiping away fecal matter or excess lubricant in the examination area. Culture swabs may be necessary if an infection is suspected.
The doctor and nurses involved with the procedure should dress in the appropriate protective gear to reduce the transmission of infection and to protect their clothing during the exam. Only the patient's buttocks must be exposed during the procedure.
For comfort and a sense of privacy, you can provide a gown with which the patient can cover his or her top half. Alternatively, you may choose to have the patient keep wearing his or her shirt. To cover the legs, a drape can be placed over them. If other procedures will be done in conjunction with the exam, the medical team should also gather the necessary supplies for those steps before beginning the procedure. For example, if a tissue biopsy may be required, the doctor should come prepared with the necessary surgical tools to collect a tissue sample.
Additional supplies will vary based on the procedures that are performed in conjunction with the exam. Doctors have multiple options for how to position a patient for a rectal exam. One common position is the left lateral decubitus position.
For this style, the patient lies on his or left side with buttocks near the edge of the examination table and knees and hips bent. In the jackknife position, the patient is folded at the waist over an exam table, and the buttocks are elevated for easy access. See a patient receive an exam in this position in the video "Jackknife Position. If you are not already wearing your protective gear, put it on now before continuing with the procedure.
Then, use the water-based lubricant to generously coat the outside of the anoscope. Hold the obturator in place so that its exposed parts are coated as well. Moving the anoscope into position is a two-handed procedure. With one hand, separate and hold the buttocks. The other hand is used for inserting the anoscope. Ask the patient to take a deep breath and push down with the muscles used for a bowel movement.
Slowly and steadily push the anoscope into the anus until it is fully inserted. Hold the obturator in place while doing this. Although the patient may feel some discomfort, this is not generally a painful procedure. If the patient does mention pain, take note of the point at which it began. This may be an indication of a problem in the tissue at that site. Once the anoscope is fully inserted, you can remove the obturator.
However, you should reinsert the obturator before each turn of the anoscope to prevent the scope from catching on any skin lesions or other imperfections in the tissue. Remove the obturator again to perform any further examination. In the below picture of a SapiMed anoscope, notice the two pieces of the anoscope. But she said the current plan still makes little sense. Like, how does that even make sense?
So how can we be both things? How can we be so high risk, and then not important enough to vaccinate? So for them not to be considered front line is sort of insulting. Contact Heidi Knapp Rinella at hrinella reviewjournal. Follow HKRinella on Twitter. Contact Al Mancini at amancini reviewjournal. As as the area struggles to bounce back from another economic crisis, the chef believes people will be looking for value.
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