ABSTRACT
OBJECTIVES: In France, seton drainage followed by fistulotomy is currently the standard treatment for high cryptoglandular fistula-in-ano. Biological or synthetic glues, such as Glubran(®) 2, have been recently proposed for sealing the fistula tract. The purpose of this study is to determine the healing rate with glubran 2 and to assess the functional outcome after cure of fistula-in-ano. PATIENTS AND METHODS: From July 2006 to July 2008, 34 patients (20 males; median age 48.5 years, range 22-55 years) with high cryptoglandular anal fistulas were treated with glubran 2. Patients were seen for physical examination at 1, 3 and 6 months, then interviewed by telephone at 1 and 2 years, and in September 2009. The Fecal incontinence severity index (FISI) score was used to assess continence. RESULTS: The healing rate at 1 month was 67.6% (23 patients); the fistula failed to heal in 11 patients. All 23 patients with a healed fistula remained recurrence-free, with no continence disorders noted, during the median 34-month follow-up period (range 21-43 months). One patient was lost to follow-up after 6 months. CONCLUSION: Glubran 2 provides an effective treatment for high fistula-in-ano, with no change in continence. In future, a randomized comparison of this agent with fibrin glues should be useful.
Subject(s)
Cutaneous Fistula/surgery , Cyanoacrylates/therapeutic use , Rectal Fistula/surgery , Tissue Adhesives/therapeutic use , Adult , Aged , Aged, 80 and over , Cyanoacrylates/adverse effects , Fecal Incontinence/prevention & control , Female , Humans , Male , Middle Aged , Pain/etiology , Patient Preference , Postoperative Complications/etiology , Tissue Adhesives/adverse effects , Treatment Outcome , Young AdultABSTRACT
PURPOSE: Few therapeutic tools are available for treating idiopathic anal incontinence. Sacral neuromodulation appears to be effective in selected patients but requires surgical implantation of a permanent electrical stimulator. The aim of this work was to assess the efficiency of posterior tibial nerve (PTN) transcutaneous electrical nerve stimulation (TENS) in the treatment of anal idiopathic incontinence. METHODS: Ten women were treated by PTN TENS, 20 min a day for 4 weeks. Functional results were evaluated by Wexner's incontinence score and anorectal manometry. RESULTS: Eight of the ten patients showed a 60% mean improvement of their incontinence score after 4 weeks. This improvement remained stable over the 12-week follow-up period. Manometric parameters did not differ before and after stimulation. CONCLUSION: PTN neuromodulation without surgically implanted electrode could represent a safe and low-cost alternative to permanent sacral neuromodulation for idiopathic anal incontinence.
Subject(s)
Fecal Incontinence/therapy , Transcutaneous Electric Nerve Stimulation/methods , Adult , Aged , Female , Humans , Male , Manometry , Middle Aged , Tibial NerveABSTRACT
The authors have observed 5 cases of cholestatic jaundice with cytolysis during treatment with amineptine, a new tricyclic compound recently made available. The responsibility of the drug was virtually certain for the following reasons: (a) there was no other cause of jaundice, such as viral infection, gallstones, toxic agents or association with other hepatotoxic drugs; (b) clinical and biochemical findings were similar in all patients; (c) in 2 patients, reintroduction of the drug after temporary withdrawal resulted in rapid recurrence of the condition, with the same symptoms and course. The shorter delay (2 and 8 days instead of 11 and 18 days) between absorption of amineptine and reappearance of the symptoms in these two patients is suggestive of an immunoallergic mechanism.
