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Treatment of fistula in ano with fibrin glue: Preliminary results from a prospective study
No full textA case of HPV and acquired genital lymphangioma: over-lapping clinical features
No full textLymphatic malformation or lymphangioma is a benign proliferation of the lymphatics accounting for 4% of all vascular malformations and 26% of all benign vascular tumors. There are several reports about genital lymphangiomas mimicking venereal lesions, such as genital warts. Hereby we described a case of a 24 year old man affected by multiple vesicles and warts in genital area. All hematological and biochemical parameters, Human Immunodeficiency Virus (HIV) and Treponema Pallidum tests, C1-Inhibitor and C1-Q values were within limits. An accurate fulguration and wide excision of bigger lesions were performed. Histological examination showed numerous dilated lymphatic vessels in the superficial dermis with infiltration of inflammatory cells, that is a histopathological picture compatible with genital lymphangioma. Considering our clinical suspicion of condylomatosis, HPV (Human Papilloma Virus) Polimerase Chain Reaction (PCR) Genotyping, named INNOLiPA test, was performed, that revealed a genital infection by HPV - genotype 6. We think that our case can be considered an example of HPV infection and acquired genital lymphangioma overlap clinical syndrome. The patient presented any lesions one year after the procedure at follow-up examination
Harry Potter's Occlusion: Report of a case of pumpkin seeds Bezoar rectal Impact
No full textAbstract
Bezoar is a term from Arabic "bazahr" or ultimately from Middle Persian "p'tzhl" ( padzahr, "bezoar antidote" or less commonaly aegagropile or egagropile (2-4). It was believed to have the power of a universal antidote that works against any poison, and a glass containing a bezoar could neutralize any poison poured into it. In science, it is a mass of hair or undigested vegetable matter found in a human or animal intestines, similar to a hairball. Otherwise, the name could derive from a kind of Turkish goat whose name is just bezoar. Usually, it is found trapped in every part of the gastrointestinal system and must be distinguished by pseudobezoar, which is an nondigestible object voluntarily introduced into the digestive tract. The most common causes are a previous gastric surgery such as a gastric band (for weight loss) or gastric bypass, a reduced stomach acid (hypochlorhydria) or decreased stomach size, and a delayed gastric emptying, typically due to diabetes, autoimmune disorders, or mixed connective tissue disease. Seed bezoars are usually found in the rectum of patients without predisposing factors, causing constipation and pain. Rectal impaction is common after ingestion of seeds, while a true occlusion is rare. Although several cases of phytobezoars composed of various types of seeds are reported in the literature, bezoars of pumpkin seeds have rarely been reported. The authors report a case of fecal impaction by pumpkin seed bezoars with abdominal pain: a difficulty to void with subsequent rectal inflammation and hemorrhoid enlargement was observed. The patient underwent a successful manual disimpaction
HIV screening in patients with anal condylomatosis. An overview about ethical and legal issues
Get PDF: Although there is a strong evidence of prevalence of condylomata in the HIV-positive population, literature on HIV prevalence in HIV-unscreened population diagnosed with condylomata is still unconclusive. Our aim is to review literature about HIV screening and diagnosis of anal condylomata in order to evaluate medical aspects, ethical and legal issues concerning the management of this disease. We undertook an online search on Pubmed for the keywords "HIV", "screening" and "anal condylomata" and 23 papers were analysed, 2 being randomized controlled trial, 11 comparative studies and 10 reviews. A total of 1270 patients were reviewed. All authors strongly recommend HIV testing in patients with clinical evidence of anal condylomata. In undeveloped countries with high prevalence of HIV, a proctological evaluation could be a could represent an unexpected therapeutic option for HIV infected male patients to prevent anal cancer. Clinical trials and prospective studies are necessary to validate this interesting hypothesis. KEY WORDS: Anal condylomatosis, HIV screening, Papilloma virus
Preparazione intestinale meccanica con soluzione orale di glicolpolietilene (PEG): Regime ad alto volume (4 litri) vs. regime a basso volume (2 litri). Trial randomizzato monocentrico
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Lateral internal sphincterotomy (LIS) for chronic anal fissure by LigaSureTM Small Jaws: a comparison with traditional technique
Get PDFBACKGROUND: An anal fissure is a small laceration in the tissue (mucosa) that lines the anus. Anal fissures can cause pain and bleeding with bowel movements. Anal fissures can be attributed to constipation or repeated straining: a hard-fecal bolus cut the mucosa of anal canal that is relatively soft at sphincter level. Management and treatment of the disease are controversial. Many studies recommend conservative and medical treatment modalities as the initial options, since they are noninvasive and do not have risks of sphincter injury. Lateral internal sphincterotomy (LIS) is considered the gold standard for treatment of chronic anal fissure. Nonetheless, anal incontinence is one of the worrisome complications of LIS. LigaSureTM (Medtronic, Dublin, Ireland) is a bipolar electrosurgical device designed to deliver high current and very low voltage to tissue. It monitors tissue impedance between the jaws of the instrument and continuously adjusts the delivery of energy. We have applied the use of this device to a group of patients complaining about chronic anal fissure in order to verify if there is any advantage in performing it, compared to traditional technique (blade, scissors, electrocautery).
METHODS: A group of 436 patients were treated in our institution as proctological day-surgery patients from January 2016 to January 2021. Three hundred fifty-one underwent lateral internal sphincterotomy. As comparative group (CG), we considered the results of the systematic review of Boland et al. whose sphincterotomy group consisted of 349 patients (45% of 775patients) from 9 studies included.
RESULTS: Of 351 patients who underwent to LIS pile excision, 322 healed within 9 weeks from treatment (91.73%) compared to 332 (95.1%) of the CG. Sixty-three out 85 (74.1%) of patients with AF + other treatments. In the LIS group the overall recurrence over a period of 6 months for all patients was 17 patients (4.84%) compared with 6.9% (24/349) over a period of 2-6 months follow-up.
CONCLUSIONS: The use of LigaSureTM Small Jaw (SJ) (Medtronic) was never reported for anal fissures in literature. LigaSureTM SJ (Medtronic) is a bipolar device which allows to perform the procedure in a reduced time and in a safer way even if differences with traditional techniques are not significant. The costs of the operation are higher in LigaSure group. Literature up today does not report any article about the use of LigaSureTM (Medtronic) for treatment of anal fissures. It could be controversial for the cost of the device but is safer and quicker compared to traditional knife or scissors
Conservative versus surgical treatment for chronic anal idiopathic fissure: A prospective randomized trial
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