RESUMO
Background: A fistula-in-ano is an abnormal hollow tract lined with granulation tissue connecting a primary opening inside the anal canal to a secondary opening in the perianal skin. Treatment of fistula-in-ano remains challenging. Surgery is the treatment of choice, with the goals of draining infection, eradicating the fistulous tract, and avoiding persistent or recurrent disease. Aim: This study was intended to investigate the factors determining the course of fistula in ano and its recurrence of patients with fistula in ano came to Govt. Stanley Hospital for 1 year. Materials and methods: 45 patients were selected who were diagnosed as fistula in ano admitted in Govt. Stanley Hospital during June 2015 to May 2016. The anatomy and type of fistula was detected by MRI. Patients underwent definitive treatment. Data regarding the objectives of the study were collected and outcomes of the treatment evaluated by following up the patient for 6 months. Results: Majority of patients (82%) belonged to 31 -60 years of age. Male: Female ratio was 4:1. Most of the fistulas were low anal 41 (91%). About 34 (76%) of external openings were posterior. Fistulectomy was performed in 31 cases, fistulotomy for 10 cases, seton for 4 cases and the operated wound healed in a range of 2 weeks to 8 weeks. Delayed healing was associated with complex fistulas, intersphincteric and transphincteric fistula takes longer time to heal about 4 to 5 weeks (P = 0.007). Fistula of tubercular etiology took minimum 3 weeks to heal (P =0.047). 13 % of cases showed recurrence. Transphincteric fistulas had recurrence rate of 33%. Fistulas with lateral openings had recurrence rate of 67%. Conclusion: Fistulectomy is the commonest and best procedure to get rid of the infective pathology. Fistula in ano has a well recognised incidence of recurrence after surgical treatment
RESUMO
Introduction: The Carotid Canal is an important structure at the base of skull as it conveys the internal carotid artery, along with a sympathetic nerve plexus and a venous plexus. Previous researches done on carotid canal suggest that abnormalities to this canal, such as fractures of carotid canal and carotid sympathetic plexus schwannoma have their effect on the internal carotid artery and the structures passing through it. Cases of absence of carotid canal have also been reported, which causes variations of the internal carotid artery. Attempt has been made in this study to give a detailed view of the ‘external opening of carotid canal’ (EOCC) which is the gateway of the carotid canal at the skull base. This study shall be useful for Surgeons, Radiologists, Anatomists, Forensic Experts, Anthropologists, etc. Aim: This study aims at measuring the various dimensions of the external openings of the carotid canal pair present at the base of skull, and to observe the age changes, sexual dimorphism, and symmetry of the external opening of the carotid canal from the analysis of these measurements. Materials and methods: Total 235 dry skulls that included 181 adolescent to adult skulls of known age and sex (age ranging from 13 years up to old age skulls of 60 years or above) and 54 foetal skulls were studied for this purpose. The longest & shortest diameter of each carotid canal, wasmeasured using a screw adjusted compass and a Vernier Calliper. Their distance from pharyngeal tubercle and from the X axis and Y axis was measured. Observations and Results: In the present study, it was observed that external opening of each carotid canal was unique in its morphology andmorphometry. The dimensions of external opening of carotid canal progressively increased from foetal age to 25 years of age, however after 25 years of age, it did not show any age change within same sex, but it showed age changes when adolescent female skulls of age less than 25 years were compared with adult male skulls of age above 25 years. It was also observed that the external opening of carotid canal showed sexual dimorphism when compared within same age group (that is, between adolescent male and female skulls below 25 years age, and between adult male and female skulls above 25 years age. Further it was also observed that EOCC did not show any asymmetry in foetal age, however it showed asymmetry in female skulls below age 25 years (adolescent).
RESUMO
Infection of the anal glands is the most common cause of anorectal abscess. Ductal obstruction may result in stasis, infection, and abscess formation. Drainage of the abscess through the perianal skin, whether spontaneous or operative, may lead to a fistula. the fistula in the fascial or fatty planes, especially within the intersphincteric space, located between the internal and the external sphincter extending into the ischiorectal fascia. Fistulas are usually divided into four main anatomic categories as described by Parks and colleagues in 1976.(1,2) The most commonly occurring is the intersphincteric fistula, constituting 70% of all anal fistulas. The infectious process starting from its origin passes directly downward to the anal margin, but there are some variants of these type of fistulas that are less common and more complex to treat. Transsphincteric (25%), suprasphincteric (4%), and extrasphincteric (1%) fistulas constitute the remaining 30% of other anal fistulas those are not intersphincteric. Extrasphincteric fistula is rare and difficult to treat. It begins from the perineal skin penetrating directly downward to the rectal wall above the levator ani. The tract it forms is completely outside the sphincteric apparatus. There are numerous causes to anal fistulas, including trauma, carcinoma, and Crohn's disease. We report a rare case of a 46 year old male patient with anal fistula which has a long abnormal course and an external opening in thigh. The patient suffered from pain on the external opening for 3 years, with dirty discharge.