[Perianal infection in patients with hemoblastosis: Risk factors and possibilities of prevention]. / Perianal'naya infektsiya u bol'nykh gemoblastozami: faktory riska i vozmozhnosti profilaktiki.

AIM: to identify poor prognostic factors for perianal infection (PI) in patients with hemoblastosis and to define an effective tactic for preventive and therapeutic measures. SUBJECTS AND METHODS: The prospective study enrolled 72 patients (37 men and 35 women; mean age, 47 years) with hemoblastosis that was complicated by the development of one of the following forms of PI: abscess, infiltrate, multiple ulcers. Different clinical and laboratory characteristics of the patients were examined to identify risk factors for PI. The species-specific concordance of microorganisms isolated from the anus and blood in the development of PI was assessed to record the latter as a source of sepsis. Treatment policy was defined according to the clinical form of PI. RESULTS: Acute myeloid leukemias and lymphomas were the most common background diseases in 30 (41.7%) and 22 (30.6%) patients, respectively. During induction chemotherapy cycles, perianal tissue infection occurred twice more frequently (66%) than totally at the onset of hemoblastosis (13%) and after achievement of remission (during consolidation and maintenance therapy) (21%; Fisher's exact test; p=0.01). PI in agranulocytosis was more than twice as common as in its absence: 69.4% vs 30.6% (p=0.01) and was responsible for sepsis in 9 (18%) of 50 patients. The main source of perianal tissue infection in patients with granulocytopenia was anal fissures and fistulas and ulcers of the anal canal: 44 (88%) cases of the 50 cases. In PI as an abscess, the average white blood cell count was 5 times higher (p=0.01) than that in PI as an infiltrate (or multiple ulcers): 6.6·109/l and 1.2·109 g/l. Abscess formation was observed in 16 (22.2%) patients and an indication for surgical drain. The inflammatory infiltrate was found to develop in 48 (66.7%) patients; multiple ulcers were seen in 8 (11.1%); in this group, parenteral antimicrobial therapy proved to be effective in 36 (78%) patients. 29 patients were operated on for anal fissures and fistulas at intercycle intervals. After continuing CT, PI recurrences were observed in 4 (9.1%) patients. In the operated versus medically treated patients, the risk of complications associated with abnormalities in the perianal area during continued CT was 5 times statistically significantly lower (odds ratio=0.2; 95% confidence interval 0.1 to 0.5; p=0.04; Cochran-Mantel test). CONCLUSION: Induction CT cycles, the status of granulocytopenia, and the presence of infection sources in the anal canal as an anal fissure, skin ulcerations, or a fistula should be considered as independent statistically significant prognostic risk factors for PI. The number of granulocytes determines the form of inflammation, the course of infection, and the chance of developing sepsis. The effective prevention encompassing surgical treatment for anal canal diseases reduces the risk of septic complications and the number of paraproctitis recurrences, contributing to the implementation of a planned CT program in patients with hemoblastosis.

[Significance of nontraumatic anal sphincter relaxation for the success of plastic and miniinvasive interventions in coloproctology].

The investigation objective was to estimate the role of nontraumatic anal sphincter (AS) stretching, as a leading factor of success in minimally invasive and/or plastic proctological interventions. One-centre randomized investigation was performed in 83 patients: In 22 of them the AS fissura was revealed (in 16), suprasphincteric fistula (in 3) and coexistent rectocele 2-3 Ap (according to POP-Q classification) with thinning of the AS anterior segment, the degree III hemorrhoids and anterior AS fissure presence. Ninety units of botulotoxin preparation (Disport) were injected between internal and external AS portions 5-15 days preoperatively. The treatment results without botulotoxin injection were compared retrospectively. After botulotoxin injection performance the AS spasm elimination was noted, leading to the pain subsiding promotion before and postoperatively in all the patients observed. The spasm elimination have permitted to escape the anal high fistula recurrence as a result of the mucosal flap shift after intraluminal closure of the fistula or because of the fistula intermuscular electrowelding "suture" rupture, also have guaranteed the plastic sutures on AS, even while the stage II-III rectocele presence, not depending of performance of its simultant surgica correction.

Is topical nifedipine effective for chronic anal fissures?

Patients in this study showed remarkable improvement when 1.5% lidocaine and 0.3% nifedipine were applied twice daily for 6 weeks. This extremely safe, well tolerated, and effective treatment should provide family physicians with a reliable nonsurgical method for treating chronic anal fissures.

Complications of Milligan-Morgan hemorrhoidectomy.

Based on a retrospective review of a personal experience with 500 modified Milligan-Morgan hemorrhoidectomies, technical suggestions for avoiding early and late complications are presented. The problems of early and delayed bleeding, anal verge and mucosal stenosis, pain and prolonged healing due to persistent anal ulcer are discussed

Tratamiento quirurgico de la fisura anal / Surgical treatment of the anal fissure

Se revisaron 33 pacientes por fisura anal entre marzo, 1986 y junio 1988. Fueron tratados con esfinterotomia interna lateral subcutanea 28 pacientes (85%) y con dilatacion forzada o procedimiento de Lord, 5. La fisura se localizo en 27 pacientes (82%) pacientes en la linea media anterior y en los 3 (9%) restantes se localizo lateralmente. En ningun caso se demostro asociacion con enfermedad inflamatoria intestinal. En 10 casos (30%) se encontro el complejo de hemorroide centinela y papila anal hipertrofica; en uno de ellos la histologia de la hemorroide centinela resecada revelo un carcinoma escamocelular in situ. Se presento recidiva en un paciente al que se le practico dilatacion anal forzada. En ninguno de los pacientes sometidos a esfinterotomia interna recidivo la enfermedad. En 4 (12%) pacientes se presentaron complicaciones infecciosas y en 1 (3%) granuloma anal; todos los casos se resolvieron facilmente con drenaje y curetaje del espacio interesfinteriano. El seguimiento de los pacientes se realizo hasta los 6 meses postoperatorio. No se presento ningun caso de incontinencia fecal, filtracion de materia fecal o retardo en la cicatrizacion. Se concluye que la esfinterotomia interna lateral subcutanea es un procedimiento eficaz y sencillo para el tratamiento de la fisura anal cronica. En los casos del presente estudio si hubo complicaciones infecciosas con una frecuencia mucho mayor que la informada en otras series. Esto ha obligado a los autores a depurar la tecnica quirurgica, especialmente si la fisura se acompana de patologia asociada