Histiocitosis de células de Langerhans en un paciente con lesión perianal. Caso clínico / Langerhans cell histiocytosis in a patient with perianal lesion. A case report

La histiocitosis de células de Langerhans es una expresión de células dendríticas mieloides, asociada a un componente inflamatorio significativo y compromiso sistémico variado. La edad más frecuente de presentación es entre 1 y 4 años, y predomina en el sexo masculino. Se comunica el caso de un niño de 5 años de edad cuya forma de presentación fue una lesión granulomatosa con fístula perianal, afectación pulmonar y de oído externo. El abordaje interdisciplinario permitió llegar al diagnóstico, realizar las intervenciones necesarias e iniciar el tratamiento adecuado.

Langerhans cell histiocytosis is an expression of myeloid dendritic cells, associated with a significant inflammatory component and varied systemic involvement. The most common age at presentation is between 1 and 4 years, and it prevails among male subjects. Here we describe the case of a 5-year-old boy who presented with a granulomatous lesion with perianal fistula and lung and external ear involvement. An interdisciplinary approach helped to make a diagnosis, provide the necessary interventions, and start an adequate treatment.

Resistencia antibiótica y aspectos clínicos de Neisseria gonorrhoeae anorrectal en un hospital de CABA, Argentina / Antimicrobial resistance and clinical aspects in anorectal Neisseria gonorrhoeae in a hospital in CABA, Argentina

La infección por Neisseria gonorrhoeae (NG) es considerada de alta prioridad en salud pública, por su capacidad para desarrollar resistencia a la mayoría de los antibióticos empleados para tratarla. La presentación anorrectal suele ser asintomática y frecuente en hombres que tienen sexo con hombres (HSH). En Argentina, se recomienda terapia antibiótica dual (ceftriaxona+azitromicina/doxiciclina) como primera línea empírica. Este estudio observacional y retrospectivo se realizó para evaluar el porcentaje de positividad de NG anorrectal, el perfil de sensibilidad a penicilina, tetraciclina, ciprofloxacina, ceftriaxona, cefixima y azitromicina, así como los aspectos clínicos-epidemiológicos de los pacientes atendidos entre 20/10/2015 y 20/03/2020 en consultorios coloproctológicos de un hospital público. Se detectaron 55/436 hisopados rectales positivos para NG (13%). El 95% era HSH y 71%, VIH+. En 18/55 NG fue la única infección. Las co-infecciones más frecuentes: HPV (38%) y C. trachomatis (35%). La sensibilidad a cefalosporinas de espectro extendido (CEE) y a azitromicina fueron 100% y 98%, respectivamente. Se observó la emergencia local de los primeros cinco aislamientos de NG anorrectal con sensibilidad reducida (SR) a CEE, el primer aislamiento con categoría no-sensible a azitromicina y otro con SR a azitromicina concomitantemente con SR a CEE. Aunque el uso de terapia empírica dual sigue siendo adecuado para nuestra institución, se observó la emergencia de aislamientos con SR y NS a las drogas de primera línea, evidenciando la importancia de la vigilancia epidemiológica a nivel local para definir los tratamientos empíricos.

Neisseria gonorrhoeae (NG) infection is considered a high public health priority because of its ability to develop resistance to most of the antibiotics used to treat it.The anorectal presentation is generally asymptomatic and frequent in men who have sex with men (MSM). In Argentina, dual therapy (ceftriaxone+azithromycin/doxycycline) is recommended as first line empiric therapy.This observational and retrospective study was conducted to evaluate the percentage of anorectal NG positivity, the susceptibility profile to penicillin, tetracycline, ciprofloxacin, ceftriaxone, cefixime and azithromycin, as well as the clinical-epidemiological aspects of patients attended between 20/10/2015 and 20/03/2020 in coloproctology of a public hospital.We detected 55/436 positive rectal swabs for NG (13%). 95% were MSM and 71% were PLHIV. In 18/55 NG was the only infection. The most frequent co-infections: HPV (38%) and C. trachomatis (35%).Susceptibility to extended-spectrum cephalosporins (ESCs) and azithromycin was 100% and 98%, respectively. Local emergence of the first five anorectal NG isolates with decreased susceptibility (DS) to ESCs, the first isolate with nonsusceptible category to azithromycin and another with DS to azithromycin concomitantly with DS to ESCs were observed.Although the use of dual empirical therapy continues to be adequate for our institution, the emergence of isolates with DS and NS to first-line drugs was observed, evidencing the importance of epidemiological surveillance at the local level to define empirical treatments

Traumatismo anorrectal contuso. Reporte de un caso y revisión bibliográfica / Blunt anorectal trauma. Case reportand literature review

Introducción: El traumatismo anorrectal es una causa poco frecuente de consulta al servicio de emergencias, con una incidencia del 1 al 3%. A menudo está asociado a lesiones potencialmente mortales, por esta razón, es fundamental conocer los principios de diagnóstico y tratamiento, así como los protocolos de atención inicial de los pacientes politraumatizados. Método: Reportamos el caso de un paciente masculino de 47 años con trauma anorrectal contuso con compromiso del esfínter anal interno y externo, tratado con reparación primaria del complejo esfinteriano con técnica de overlapping, rafia de la mucosa, submucosa y muscular del recto. A los 12 meses presenta buena evolución sin incontinencia anal. Conclusión: El tratamiento del trauma rectal, basado en el dogma de las 4 D (desbridamiento, derivación fecal, drenaje presacro, lavado distal) fue exitoso. La técnica de overlapping para la lesión esfinteriana fue simple y efectiva para la reconstrucción anatómica y funcional. (AU)

Introduction: Anorectal trauma is a rare cause of consultation to the Emergency Department, with an incidence of 1 to 3%. It is often associated with life-threatening injuries, so it is essential to know the principles of diagnosis and treatment, as well as the initial care protocols for the polytrau-matized patient. Methods: We present the case of a 47-year-old man with a blunt anorectal trauma involving the internal and external anal sphincter, treated with primary overlapping repair of the sphincter complex and suturing of the rectal wall. At 12 months the patient presents good outcome, without anal incontinence. Conclusion: The treatment of rectal trauma, based on the 4 D ́s dogma (debridement, fecal diversion, presacral drainage, distal rectal washout lavage) was successful. Repair of the overlapping sphincter injury was simple and effective for anatomical and functional reconstruction. (AU)

Presentaciones de la sífilis anorrectal: la gran simuladora / Anorectal syphilis presentations: the great pretender

Antecedentes: La sífilis es una infección sexualmente transmisible sistémica crónica que afecta a docenas de millones de personas al año. A nivel anorrectal, su manifestación polimórfica obliga al diagnóstico diferencial con enfermedades anorrectales benignas y malignas. Objetivo: Describir las diferentes presentaciones de la sífilis anorrectal a propósito de 5 casos clínicos. Método: Estudio observacional, retrospectivo, descriptivo. Resultados: La mayoría de los pacientes fueron VIH positivos en edad sexual activa. Las manifestaciones registradas, al igual que las reportadas en la bibliografía fueron las fisuras, úlceras perianales y pseudotumores. Conclusiones: La sífilis es considerada "la gran simuladora". En la localización anorrectal se requiere una alta sospecha diagnóstica para diferenciarla de presentaciones similares de otras enfermedades anales benignas, la enfermedad inflamatoria intestinal y el cáncer anorrectal, con el fin de evitar el consiguiente riesgo de sobretratamiento. (AU)

Background: Syphilis is a chronic systemic sexually transmitted infection that affects tens of millions of people annually. At the anorectal level, its polymorphic manifestation requires differential diagnosis with benign and malignant anorectal diseases. Objective: To review the presentation of anorectal syphilis from 5 clinical cases. Methods: Observational, retrospective, descriptive study. Results: Most of the patients were HIV positive in sexually active age. The manifestations recorded and reported in the literature were fissures, perianal ulcers, and pseudotumors. Conclusions: Syphilis is considered "the great pretender". In anorectal syphilis, a high diagnostic suspicion is needed to differentiate it from similar presentations due to other anal conditions, inflammatory bowel disease, and anorectal cancer, to avoid the consequent risk of overtreatment. (AU)

Conhecimento para apoio aos profissionais responsáveis pelo diagnóstico de citologia anal: revisão narrativa e interpretação de critérios citomorfológicos

Resumo:Introdução:O câncer anal é uma patologia considerada rara, apesar de crescente na população. A citologia anal tem sido uma aposta para diagnosticar as alterações pré-neoplásicas, evitando a evolução ao câncer. Objetivos:I) Abordar aspectos de satisfatoriedade da amostra celular e revisar os critérios citomorfológicos dos achados benignos e malignos nos esfregaços de citologia anal. II) Tornar este artigo um instrumento de suporte aos profissionais de saúde que atuam no setor de Citopatologia vinculados ao Sistema Único de Saúde (SUS) ou à iniciativa privada. Métodos:Revisão narrativa, com busca nas bases PubMed, Science Direct e SciELO, de fevereiro a abril/2023. Desenvolvimento:A análise da literatura aponta para a aplicação da citologia anal para diagnóstico das alterações induzidas pelo Papilomavírus Humano (HPV) no canal anal. O rastreamento se baseia na semelhança ao controle do câncer de colo uterino e à história natural da doença, reconhecendo que as lesões precursoras evoluem ao câncer invasivo. Essa janela entre a lesão e o câncer abre espaço para detecção precoce. Oportunamente, a técnica pode diagnosticar agentes responsáveis por outras Infecções Sexualmente Transmissíveis (IST). Conclusão: Qualificar os laudos de diagnóstico citopatológico pode apoiar o cuidado desde a atenção primária. O intuito deste trabalho foi contribuir com o processo de aprendizagem dos profissionais da saúde e apoiar a saúde pública nas estratégias de garantia de cuidado às pessoas.

¿Es la técnica de la ligadura del trayecto fistuloso interesfintérico (LIFT) la mejor alternativa para el tratamiento de la fístula anorrectal compleja?

La fistulotomía es aceptada como la técnica ideal en el tratamiento de la fístula anorrectal (FA) simple con porcentajes de curación superiores al 95% y mínimo daño al aparato esfinteriano, a pesar de que la técnica, por definición, incluye la sección inmediata de la porción distal del esfínter interno. En la FA compleja, el daño potencial a la continencia es una secuela temida, lo que ha motivado la búsqueda de múltiples alternativas terapéuticas, algunas dificultosas y/o que requieren instrumentos sofisticados. La ligadura del trayecto fistuloso interesfintérico (LIFT) es una técnica conservadora que ha sido investigada en forma exhaustiva en los últimos 13 años con resultados variables. Se analiza las posibles causas de las fallas del LIFT (40% como promedio) y las variantes propuestas, incluyendo la técnica preferida del autor en los últimos 15 años, que se caracteriza por un abordaje interesfinteriano del trayecto fistuloso que permite tratar tanto el foco interesfintérico como el orificio fistuloso interno y las glándulas afectadas mediante una setón interesfintérico ajustado, más un pequeño drenaje cutáneo externo. Es un procedimiento simple, reproducible y con óptimos resultados en cuanto a curación, sin sección inmediata del esfínter interno y sin alteración de la continencia. A pesar de ser una técnica promisoria, con la información disponible, el LIFT no cumple con los requisitos para ser considerada como la técnica de elección en el tratamiento de la FA compleja.

Fistulotomy is the best surgical technique to treat a simple anal fistula with success in more than 95% of the cases and minor damage of anal continence. Complex anal fistula is a challenging problem due to higher recurrence rates and incontinence associated to surgical procedures. New methods have been developed for the management of complex anal fistula and some of them include complex procedure and/or the use of sophisticated instruments. Relapses are caused by reactivation of the infection at the internal fistula orifice. This is left untreated by some technique including LIFT, a promising conservative technique that has shown success rates between 20% to 86%. We analyze the probably causes of the failure of LIFT and some variations proposed, including the alternative techniques of intersphincteric approach plus treatment of the pathological anal glands with immediate section of the internal sphincter. In the experience of the author over 15 years, the intersphincteric approach to the fistulous tract, the treatment of the internal fistula orifice with a loose seton and a small cutaneous drainage is the safest technique to cure the complex fistula anal with no damage to anal continence. The benefits of conservative techniques like LIFT must be counterbalanced with the relative high recurrence rates. The quality of current evidence is not good enough to consider LIFT as the gold standard in the treatment of complex anal fistula.

Prevalencia y características genotípicas de la infección anal por papilomavirus en una cohorte de hombres que tienen sexo con hombres VIH-positivos / Prevalence and genotypic characteristics of anal papillomavirus infection in a cohort of HIV-positive men who have sex with men

RESUMEN Objetivo: Determinar la prevalencia y las características genotípicas de la infección anal por papilomavirus en hombres que tienen sexo con hombres (HSH) VIH-positivos. Materiales y métodos: Es un estudio observacional prospectivo de corte transversal en HSH VIH-positivos del Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, realizado entre setiembre del 2017 y diciembre del 2018. El estudio del papilomavirus se realizó con una técnica de reacción en cadena de polimerasa evaluando 21 genotipos estratificados según el riesgo oncogénico: seis de bajo riesgo y quince de alto riesgo. Resultados: Se evaluaron 214 HSH VIH-positivos. La prevalencia general de la infección anal por papilomavirus fue de 70% (150/214). 86% (129/150) tuvieron genotipos de alto riesgo oncogénico, de ellos 79% (102/129) tuvieron dos o más genotipos de papilomavirus. Los genotipos de alto riesgo oncogénico más frecuentes fueron: VPH-16, 31% (46/150); VPH-52, 22% (33/150); VPH-33, 21% (31/150); VPH-58, 21% (31/150) y VPH-31, 20% (30/150). El VPH-18 alcanzó el 7% (10/150). Los genotipos de bajo riesgo oncogénico más frecuentes fueron: VPH-6, 30% (45/150) y VPH-11, 29% (44/150). Conclusiones: La prevalencia de la infección anal por papilomavirus en HSH VIH-positivos es muy alta en el hospital investigado. La gran mayoría de estas infecciones se producen con genotipos de alto riesgo oncogénico. El papilomavirus 16 fue el genotipo de alto riesgo más frecuente.

ABSTRACT Objective: To determine the prevalence and genotypic characteristics of anal papillomaviruses in HIV-positive men who have sex with men (MSM). Materials and methods: This is a prospective cross-sectional observational study of HIV-positive MSM at Almenara General Hospital between September 2017 and December 2018. HPV detection and typing was performed using a polymerase chain reaction technique that evaluated 21 genotypes stratified according to oncogenic risk into six low-risk and fifteen high-risk. Results: we evaluated 214 HIV-positive MSM. The overall prevalence of anal infection by papillomavirus infection was 70% (150/214). 86% (129/150) were caused by high-risk genotypes, 79% (102/129) of them were affected by a two or more-papillomavirus genotype. The most frequent high-risk genotypes were HPV-16, 31% (46/150); HPV-52, 22% (33/150); HPV-33, 21% (31/150); HPV-58, 21% (31/150) and HPV-31, 20% (30/150). In addition, HPV-18 reached 7% (10/150). The most frequent low-risk genotypes were HPV-6, 30% (45/150) and HPV 11, 29% (44/150). Conclusions: Prevalence of anal papillomavirus infection in HIV-positive MSM is very high in the hospital investigated. Most of these infections occurs with high-risk oncogenic genotypes. Papillomavirus 16 was the most frequent high-risk genotype.

Strategic planning for paying attention to anal preservation in low rectal cancer / 解放军医学杂志

Based on the background of a multidisciplinary treatment team and the increasing high-quality life aspirations of patients,the preservation of anal function for patients with low rectal cancer has undergone changes in recent years.With the optimization of neoadjuvant therapy,refinement of surgical techniques,and the deepening of the concept of anal preservation after surgery,the concept of anal preservation for low rectal cancer has gradually shifted from traditional simple surgery to comprehensive treatment,and anal preservation surgery tends to be more accurate preservation.The goal of comprehensive treatment is to preserve good anal function and reduce surgical damage.However,comprehensive treatment for anal preservation in low rectal cancer is still in its infancy,and there is no consensus on the strategy planning for anal preservation.Therefore,summarizing various preoperative,intraoperative,and postoperative treatment strategies for low rectal cancer is of great significance for the selection of anal preservation schemes for patients with low rectal cancer.This article focus on exploring the optimization of neoadjuvant therapy models,"watch and wait"plans,the development of anal preservation techniques,and postoperative and preservation strategies,aiming to review the current status of anal preservation strategy planning for low rectal cancer.

Effect of transanal mucosal flap displacement and transanal intersphincterotomy on the treatment of complex anal fistulas and their influence on the pressure of anorectal canal / 临床外科杂志

Objective To explore the effect of Endoanal advancement flap(ERAF)and transanal opening of interphincteric space(TROPIS)in the treatment of complex anal fistula and their impact on anorectal pressure,so as to provide a reference for clinical selection of surgical methods.Methods Eighty-four patients with complex anal fistula admitted from October 2018 to October 2022 were divided into group E received ERAF treatment(n=48)and group T received TROPIS treatment(n=36).The clinical efficacy,operation,wound surface and anorectal pressure of the two groups were compared.Results The effective rate of treatment in Group T was 97.22％,which was higher than that in Group E(87.50％),with no statistically significant difference(P＞0.05).The surgical time[(31.53 ±7.29)minutes],intraoperative bleeding volume[(29.56±7.37)ml],and wound area[(10.03± 0.96)cm2,(8.76±0.87)cm2,(6.20±0.77)cm2]on the day of surgery,7 and 14 days after surgery in Group T were all smaller than those in Group E[(35.36±8.54)min,(36.86±8.04)ml,(12.09± 1.23)cm2,(10.52±1.09)cm2 and(7.36±0.85)cm2](P＜0.05).After surgery,the VAS score and Wexner incontinence score of Group T were(1.38±0.27)and(0.21±0.08),respectively.Group E was(1.56±0.29)and(0.33±0.09),respectively.In group T,the anorectal systolic pressure at 20 mm and 30 mm and the anorectal resting pressure at 20 mm and 30 mm were(138.18±29.58)mmHg,(136.22±35.41)mmHg,(35.47±6.58)mmHg,and(32.97±8.01)mmHg,respectively.In Group E,the data was(152.78±31.53)mmHg,(156.29±32.74)mmHg,(38.29±7.62)mmHg and(36.41±7.63)mmHg,respectively.Both groups showed a decrease in score and anorectal pressure,and group T was lower than group E(P＜0.05).The incidence of adverse reactions in Group E was 20.83％,which was higher than that in Group T(11.11％),but the difference was not statistically significant(P＞0.05).Conclusion TROPIS has a better effect in the treatment of complex anal fistula,which can shorten the operation time,reduce intraoperative bleeding,reduce postoperative pain,and protect anal function.

Interstitial implantation of 125I radioactive seeds for low rectal cancer with anal sphincter preservation / 中华内分泌外科杂志

Objective:To assess the effectiveness and characteristics of intratumoral radioactive seed implantation in low rectal cancer with anal sphincter preservation.Methods:Clinical data of 8 patients (not willing or can not to undergo radical resection of rectal carcinoma) with low rectal cancer receiving radioactive seed implantation with anal sphincter preservation were retrospectively analyzed.Results:All the 8 patients successfully completed intratumoral radioactive seed implantation. Preoperative clinical symptoms of discomfort were significantly improved, and CEA levels decreased significantly. Colonoscopy and CT examination showed that tumor disappeared in 4 cases, anal function was successfully preserved in all patients. The mean survival time was 32.4 months.Conclusions:Intratumoral radioactive seed implantation in low rectal cancer with anal sphincter preservation can effectively improve the quality of life of patients.

Application of multimodal MRI in complex anal fistula / 实用放射学杂志

Objective To investigate the application value of multimodal MRI in complex anal fistula.Methods The clinical and MRI data of 50 cases with complex anal fistula confirmed by surgery were collected.All patients were examined with 1.5T MR before surgery,including three major modules of conventional MRI,diffusion weighted imaging(DWI)and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI).Finally,the diagnostic efficacy of different MRI modules in complex anal fistula was evaluated based on the surgical results.Results The surgery detected 73 internal orifices,81 external orifices,58 main fistulas,47 branch fistulas and 37 abscesses.Before the surgery,there were 63 internal orifices(86.3%),75 external orifices(92.6%),53 main fistulas(91.4%),40 branch fistulas(85.1%),and 37 abscesses(100%)correctly diagnosed by conventional MRI.Sixty internal orifices(82.2%),75 external orifices(92.6%),51 main fistulas(87.9%),37 branch fistulas(78.7%),and 37 abscesses(100%)were correctly diagnosed by conventional MRI+DWI,while 68 internal orifices(93.2%),78 external orifices(96.3%),56 main fistulas(96.6%),44 branch fistulas(93.6%),and 37 abscesses(100%)were correctly diagnosed by conventional MRI+DCE-MRI.There were 68 internal orifices(93.2%),78 external orifices(96.3%),56 main fistulas(96.6%),44 branch fistulas(93.6%),and 37 abscesses(100%)correctly diagnosed by conventional MRI+DWI+DCE-MRI.Compared with conventional MRI,conventional MRI+DWI or conventional MRI+ DCE-MRI,conventional MRI+DWI+DCE-MRI could find more internal orifices,main fistulas and branch fistulas,and the difference was statistically significant.The multimodal MRI had the highest consistency with the surgical results(Kappa=0.734,P<0.001).Conclusion MRI can accurately estimate the information of internal orifices,external orifices,main fistula,branch fistula and abscess of cases with complex anal fistula.The diagnostic accuracy of multimodal joint application is superior than that of single-modal and dual-modal application.

Precision diagnosis and standardized treatment of mid-low rectal cancer / 中华消化外科杂志

Colorectal cancer is a major digestive disease in China, with mid-low rectal cancer as the predominant cause. Over the years, Chinese colorectal surgery has made considerable strides, attaining certain successes in clinical diagnosis and treatment, scientific research, and data platform construction. Nevertheless, there is still room for improvement in terms of the accuracy of diagnosis and standardization of treatment. Furthermore, immune checkpoint therapy represented by programmed death-1 have demonstrated initial efficacy in the treatment of mid-low rectal cancer. Further research is required to better understand the relationship and role between immune checkpoint inhibitors and traditional radiotherapy and chemotherapy, and to apply them to precise clinical practice. The authors elaborate on current status of diagnosis and treatment for mid-low rectal cancer in China, in order to provide references for its precission diagnosis and standardized treatment.

Explore the Mechanism of Jiawei Shengji Yuhong Ointment in Promoting Wound Healing after Anal Fistula of Damp-heat Type Based on NF-κB/VEGF Signaling Pathway / 浙江中医药大学学报

[Objective]To discuss the effect of Jiawei Shengji Yuhong Ointment on wound healing of rat model after anal fistula operation and its internal mechanism.[Methods]Seventy SD rats were randomly divided into blank group,Vaseline group(model group),Kangfuxin liquor group(control group),Jiawei Shengji Yuhong Ointment group(experimental group),ammonium pyrrolidine dithiocarbamate(PDTC)+vaseline group(PDTC+model group),PDTC+Kangfuxin liquid group(PDTC+control group),PDTC+Jiawei Shengji Yuhong Ointment group(PDTC+experimental group).The damp-heat wound model of rats after anal fistula operation was established and treated with different drugs.At the same time,PDTC intervention group was given intraperitoneal injection of nuclear factor-κB(NF-κB)signaling pathway inhibitor PDTC for 5 consecutive days on the basis of drug intervention.The wound healing of rats in each group was recorded,and the wound healing rate of rats in each group was calculated.On the 3rd,7th and 14th days,the granulation tissues of rats in each group were taken for Western blot and immunohistochemistry to detect the protein expression of NF-κB p65.The expression of interleukin-1β(IL-1β)and vascular endothelial growth factor(VEGF)was detected by enzyme-linked immunosorbent assay(ELISA).Hematoxylin-eosin(HE)staining was used for histomorphological observation.[Results]Compared with other groups,the experimental group and PDTC+experimental group could significantly shorten the wound healing time,and the wound healing rates of PDTC+experimental group and experimental group were higher(P＜0.05).HE staining results also confirmed that PDTC+experimental group can effectively promote the rapid growth of granulation tissue.The results of immunohistochemistry and Western blot showed that was inhibited significantly in experimental group and PDTC+experimental group the protein expression of NF-κB p65 in rat wound tissue,and the difference was statistically significant compared with the other groups(P＜0.05).The results of ELISA showed that the content of IL-1 β in each group decreased gradually at 3,7 and 14 d after treatment,and the content of IL-1[3 in PDTC+experimental group was the lowest(P＜0.05).The content of VEGF in each group increased gradually,and the content of VEGF in PDTC+experimental group and experimental group was the highest(P＜0.05).[Conclusion]Jiawei Shengji Yuhong Ointment can inhibit the expression of NF-κB p65 and IL-1 β protein and up-regulate the expression of VEGF protein through NF-κB signaling pathway,thereby promoting the angiogenesis of vascular endothelial cells,reducing inflammation,and promoting the wound healing after anal fistula surgery.

Effect and mechanism of Panax notoginseng saponins on wound healing after anal fistula surgery in rats / 中国药房

OBJECTIVE To investigate the effect and mechanism of Panax notoginseng saponins （PNS） on wound healing after anal fistula surgery in rats by regulating the hypoxia-inducible factor-1α （HIF-1α）/vascular endothelial growth factor （VEGF）/ vascular endothelial growth factor receptor-2 （VEGFR2） signaling pathway. METHODS SD rats were selected to establish a postoperative rat model of anal fistula by infecting wound with Escherichia coli. The model rats were randomly grouped into model group， PNS low-dose and high-dose groups （15， 30 mg/cm2）， high-dose of PNS+2-methoxyestradiol （2ME2） group （PNS 30 mg/cm2+HIF-1α inhibitor 2ME2 4 mg/kg）， with 10 rats in each group. Another 10 normal rats were selected for back hair removal treatment as the control group. Each drug group was injected with the corresponding drug solution intramuscularly or （and） intraperitoneally， once a day， for 3 weeks. After the last administration， the wound healing rate （excluding the control group）， microvascular density （MVD）， the expression of collagen Ⅰ and fibronectin （FN） in the wound tissue were detected in each group； the levels of angiogenic factors [VEGF， E-mail：842710813@qq.com angiopoietin-Ⅰ （Ang-Ⅰ）， Ang-Ⅱ] in serum， the levels of inflammatory factors [interleukin-6 （IL-6） and IL-2] in serum binggui7183@163.com and wound tissue as well as the expressions of the related proteins of HIF-1α/VEGF/VEGFR2 signaling pathway in the wound tissue of rats were also detected in each group. RESULTS The MVD， the expression of collagen Ⅰ and FN in the wound tissue， and the levels of IL-6 and IL-2 in serum and wound tissue of rats increased significantly in the model group， compared to the control group （P＜0.05）， while the serum levels of VEGF， Ang- Ⅰ and Ang-Ⅱ decreased significantly （P＜0.05）. The wound healing rate， the MVD in wound tissue， the serum levels of VEGF， Ang-Ⅰ and Ang-Ⅱ， the expressions of collagen Ⅰ and FN in the wound tissue， and protein expressions of HIF-1α， VEGF and VEGFR2 in the PNS low-dose and high-dose groups increased significantly， compared to the model group （P＜0.05）， while the levels of IL-6 and IL-2 in serum and wound tissue decreased significantly （P＜0.05）； the high-dose PNS had a stronger effect （P＜ 0.05）. 2ME2 could weaken the effect of PNS on above indicators of rats after anal fistula surgery （P＜0.05）. CONCLUSIONS PNS can promote the production of angiogenic factors and inhibit the production of pro-inflammatory factors， thereby promoting wound healing in rats after anal fistula surgery. The above effects are related to the activation of HIF-1α/VEGF/VEGFR2 signaling pathway.

Clinical characteristics of 118 cases of complex anal fistulas in infants and types of traditional chinese medicine syndromes / 中国现代医生

@#Objective To retrospectively analyse the clinical characteristics of complex anal fistula and the distribution of TCM syndrome in infants and young children.Methods The clinical data of 118 children with complex anal fistula who were hospitalised in the Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine from 1 January 2019 to 1 January 2023 were retrospectively analysed for gender,age,fistula,internal and external orifices,and distribution of TCM syndrome.Results Totally 115 cases(97.5%)were male and 3 cases(2.5%)were female among the 118 cases,with statistically significant differences(P<0.05);they occurred within 1 year of age;among them,there were 93 cases(78.8%)of low complex anal fistula,and 25 cases(21.2%)of high complex anal fistula;there were 2 fistulas(76.3%),followed by 3 fistulas(21.2%)and 4 fistulas(2.5%);the relationship between the number of internal and external orifices was dominated by external orifices = internal orifices(71.2%),and the internal and external orifices were mostly located at the 3 and 9 points(truncation);dampness-heat pouring downward was the most common syndrome(58.5%),followed by foetal toxin(23.7%),and spleen deficiency and dampness(17.8%).Conclusion Complex anal fistula in infants and young children occurred in male children less than 1 year old,and most of them were low complex anal fistula with two fistulas,and the internal and external orifices were mostly distributed in the 3 and 9 points(truncation),and dampness-heat pouring downward was the main TCM syndrome.

Prevalencia y factores de riesgo de la neoplasia intraepitelial anal en pacientes con lesión intraepitelial cervical de alto grado / Prevalence and risk factors for anal intraepithelial neoplasia in patients with high- grade cervical intraepithelial lesion

Resumen OBJETIVO: Determinar la prevalencia de alteraciones en la citología anal, infección anal por virus del papiloma humano y en la neoplasia intraepitelial anal; además, explorar los factores de riesgo y los serotipos asociados en pacientes con lesión intraepitelial cervical de alto grado, a partir de la hipótesis de que esta población tiene mayor riesgo de lesiones precursoras o cáncer anal. MATERIALES Y MÉTODOS: Estudio observacional, descriptivo y transversal, con componente analítico, efectuado en pacientes con diagnóstico de lesión intraepitelial cervical de alto grado (LIEAG) en dos instituciones de salud: una privada y otra pública de Bogotá, atendidas entre enero de 2017 y febrero de 2018. Se efectuó un muestreo no probabilístico, por conveniencia. RESULTADOS: Se incluyeron 119 participantes, en 4 de ellas se evidenció, en la citología anal, el hallazgo de células anormales en el tejido que reviste la parte exterior del cuello uterino. Se encontraron 14 anoscopias anormales que dieron una prevalencia de neoplasia intraepitelial anal del 6.7%. Siete eran neoplasia intraepitelial anal de bajo grado y una de alto grado. Se encontró infección por VPH anal en 45 participantes (37.8%) y se detectaron genotipos de VPH-AR en 29 participantes (24.4%). Más de 3 compañeros sexuales, más de 3 hijos y tener menos de 21 años antes del primer embarazo tuvieron un valor de p < 0.05 que confiere mayor riesgo de infección por VPH anal. CONCLUSIÓN: Es importante establecer en Colombia protocolos para la detección de la neoplasia intraepitelial anal en grupos de alto riesgo, como las pacientes con neoplasia intraepitelial cervical o cáncer de cuello uterino, e incentivar el adiestramiento en la anoscopia de alta resolución en especialistas relacionados con el diagnóstico de patología anogenital.

Abstract OBJECTIVE: To determine the prevalence of alterations in anal cytology, anal human papillomavirus infection, and anal intraepithelial neoplasia, and to explore the risk factors and associated serotypes in patients with high-grade cervical intraepithelial lesion, based on the hypothesis that this population is at higher risk for precancerous lesions or anal cancer. MATERIALS AND METHODS: Observational, descriptive, cross-sectional study, with analytical component, performed in patients diagnosed with high-grade cervical intraepithelial lesion (HG-CIL) in two health institutions: one private and one public in Bogota, visited between January 2017 and February 2018. A non-probabilistic sampling was performed, by convenience, with a sample calculated in 124 patients. RESULTS: 119 participants were included, in 4 of them it was evidenced in the anal cytology, the finding of abnormal cells in the tissue lining the outside of the cervix. Fourteen abnormal anoscopies were found, giving a prevalence of anal intraepithelial neoplasia of 6.7%. Seven were low-grade anal intraepithelial neoplasia and one was high-grade. Anal HPV infection was detected in 45 participants (37.8%) and HR-HPV genotypes were detected in 29 participants (24.4%). More than 3 sexual partners, more than 3 children and being younger than 21 years before first pregnancy had a p-value < 0.05 conferring an increased risk of anal HPV infection. CONCLUSION: It is important to establish protocols in Colombia for the detection of anal intraepithelial neoplasia in high-risk groups, such as patients with cervical intraepithelial neoplasia or cervical cancer, and to promote training in high-resolution anoscopy in specialties related to the diagnosis of anogenital pathology.

Prevalence of colorectal symptoms and anal incontinence in patients with pelvic organ prolapse attended at an outpatient urogynecology service

Abstract Objective: To analyze data of patients with symptomatic pelvic organ prolapse evaluated with PFDI20 and its subscales to report the prevalence of lower gastrointestinal symptoms and anal incontinence in the population of a public hospital and analyze its impact on quality of life. Methods: Cross-sectional study of patients with symptomatic POP. Patients were evaluated with demographic data, POP-Q, pelvic floor ultrasonography, urological parameters, and pelvic floor symptoms (PFDI-20), and quality of life (P-QoL) surveys. Patients were classified as CRADI-8 "positive" for colorectal symptoms, with responses "moderate" in at least 3 and/or "severe" in at least 2 of the items in the CRADI-8 questionnaires. Results: One hundred thirteen patients were included. 42.5% (48) were considered positive for colorectal symptoms on CRADI-8. 53.4% presented anal incontinence. No significant differences were found in sociodemographic variables, POP-Q stage, ultrasound parameters, or urological parameters. Positive patients had a significantly worse result in PFDI-20, POPDI (48 vs 28; p<0.001), UDI6 (51 vs 24; p<0.001), and in the areas of social limitation (44.4 vs 22.2; p = 0.045), sleep- energy (61.5 vs 44.4; p = 0.08), and severity (56.8 vs 43.7, p=0.015) according to P-QoL. Conclusion: Moderate or severe colorectal symptoms are seen in 40% of patients with symptomatic POP in our unit. Full evaluation of pelvic floor dysfunction symptoms should be performed routinely in urogynecology units. (FONIS SA12I2I53 - NCT02113969).

Medical illustration: a pictorial essay visual illustration of obstetric anal sphincter injuries (OASIS) degrees of severity, a picture is worth a thousand words

Obstetric anal sphincter injury affects about 5.7% of primiparous women who deliver vaginally. Perineal injury during childbirth is a common event with important morbidity associated with third-and-fourth degree perineal tears (also referred to as obstetric anal sphincter injuries -OASIS). As there was a lack of consistency in the classification of a partial anal sphincter injury, with up to 33% of consultant obstetricians classifying a complete or partial tear of the EAS as a second-degree tear. We have proposed simple, digital diagrammatic drawings to visually represent all degrees (grades) of OASIS based on the WHO OASIS classification. (AU)

Perianal Paget's disease metachronically associated with adenocarcinoma

Introduction: This article describes an unusual case of perianal Paget's Disease in a 42-year-old man, highlighting distinct characteristics about more typical cases. Case report: 42-year-old male patient with persistent perianal lesion, recurrent abscesses, and discomfort. Magnetic resonance imaging indicated a possible fistulous path. Biopsy revealed secondary anal Paget's disease and adenocarcinoma. Chemotherapy and radiotherapy treatment demonstrated a positive response. Discussion: Perianal Paget's Disease is a rare condition of the anal canal that is part of the Extramammary Paget's Disease (EMPD) group. Symptoms include itching, pain, perianal bleeding, and skin lesions. Diagnosis can be challenging and usually involves performing a histopathological biopsy associated with an immunohistochemical study. Treatment varies and may involve surgery, radiotherapy, and chemotherapy. Due to the rarity of the disease, the best therapeutic approach is not yet well defined, and follow-up is essential due to the risk of recurrence. Conclusion: Perianal Paget's Disease is rare and requires differentiation from other conditions. Early detection is essential to prevent malignancy. (AU)

Effectiveness and safety of ultra-low-dose spinal anesthesia versus perineal blocks in hemorroidectomy and anal fistula surgery: a randomized controlled trial

Abstract Background: Ultra-low-dose Spinal Anesthesia (SA) is the practice of employing minimal doses of intrathecal agents so that only the roots that supply a specific area are anesthetized. The aim of this study was to compare the effectiveness and safety of ultra-low-dose spinal anesthesia with that of Perineal Blocks (PB). Methods: A two-arm, parallel, double-blind randomized controlled trial comparing two anesthetic techniques (SA and PB) for hemorrhoidectomy and anal fistula surgery was performed. The primary outcomes were postoperative pain, complementation and/or conversion of anesthesia, and hemodynamic changes. Results: Fifty-nine patients were included in the final analysis. The mean pain values were similar in the first 48 h in both groups (p > 0.05). The individuals allocated to the SA group did not need anesthetic complementation; however, those in the PB group required it considerably (SA group, 0% vs. PB group, 25%; p = 0.005). Hemodynamic changes were more pronounced after PB: during all surgical times, the PB group showed lower MAP values and higher HR values (p < 0.05). Postoperative urinary retention rates were similar between both groups (SA group 0% vs. PB group 3.1%, p = 0.354). Conclusion: SA and PB are similarly effective in pain control during the first 48 h after hemorrhoidec-tomy and anal fistula surgery. Although surgical time was shorter among patients in the PB group, the SA technique may be preferable as it avoids the need for additional anesthesia. Furthermore, the group that received perineal blocks was under sedation with a considerable dose of propofol.