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Ram E, Zager Y, Carter D, Saukhat O, Anteby R, Nachmany I, Horesh N. A Prospective, Single-Arm Study to Evaluate the Safety and Efficacy of an Autologous Blood Clot Product in the Treatment of Anal Fistula. Dis Colon Rectum 2024; 67:541-548. [PMID: 38149981 PMCID: PMC10901226 DOI: 10.1097/dcr.0000000000003190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND Surgical treatment of complex perianal fistula is technically challenging, associated with risk of failure, and may require multiple procedures. In recent years, several biologic agents have been developed for permanently eradicating anal fistulous disease with variable success. In this study, the treatment is an autologous whole-blood product created from the patients' blood. It forms a provisional matrix that was found to be safe and effective in healing acute and chronic cutaneous wounds. OBJECTIVE The study aimed to assess the efficacy and safety of an autologous blood clot product as a treatment for transsphincteric perianal fistulas. DESIGN A prospective single-arm study. SETTINGS A single tertiary medical center. PATIENTS Patients with simple or complex transsphincteric fistulas confirmed by MRI were included in the study. Cause was either cryptoglandular or Crohn's disease related (in the absence of active luminal bowel disease). INTERVENTION The outpatient procedure was performed under general anesthesia and consisted of: 1) physical debridement and cleansing of the fistula tract; 2) suture closure of the internal opening; and 3) instillation of the autologous blood clot product into the entire tract. MAIN OUTCOME MEASURES Safety and efficacy at 6- and 12-months after surgery. RESULTS Fifty-three patients (77% men) with a median age of 42 (20-72) years were included in the study. Three patients withdrew consent, and 1 patient was lost to follow-up. At the time of this interim analysis, 49 and 33 patients completed the 6- and 12-month follow-up period. Thirty-four of the 49 patients achieved complete healing (69%) at 6 months, but 20 of the 33 patients (60%) achieved healing after 1 year. All patients who achieved healing at 6 months remained healed at the 1-year mark. In a subgroup analysis of patients with Crohn's disease, 7 of 9 patients completed 1-year follow-up, with 5 patients (71%) achieving clinical remission. No major side effects or postoperative complications were noted, but 2 adverse events occurred (admission for pain control and coronavirus 2019 infection). LIMITATIONS Noncomparative single-arm pilot study. CONCLUSIONS Treatment with an autologous blood clot product in perianal fistular disease was found to be feasible and safe, with an acceptable healing rate in both cryptoglandular and Crohn's disease fistula-in-ano. Further comparative assessment is required to determine its potential role in the treatment paradigm of fistula-in-ano. See Video Abstract . BRAZO PARA EVALUAR LA SEGURIDAD Y EFICACIA DE RDVER, UN COGULO DE SANGRE AUTLOGO, EN EL TRATAMIENTO DE LA FSTULA ANAL ANTECEDENTES:El tratamiento quirúrgico de la fístula perianal compleja es técnicamente desafiante, se asocia con riesgo de fracaso y puede requerir múltiples procedimientos. En los últimos años, se han desarrollado varios agentes biológicos con el fin de erradicar permanentemente la enfermedad fistulosa anal con éxito variable. El tratamiento RD2-Ver.02 es un producto de sangre total autólogo creado a partir de la sangre de los pacientes, que forma una matriz provisional que resultó segura y eficaz para curar heridas cutáneas agudas y crónicas.OBJETIVO:Evaluar la eficacia y seguridad de RD2-Ver.02 como tratamiento para las fístulas perianales transesfinterianas.DISEÑO:Un estudio prospectivo de un solo brazo.LUGARES:Un único centro médico terciario.PACIENTES:Se incluyeron en el estudio pacientes con fístulas transesfinterianas simples o complejas confirmadas mediante resonancia magnética. La etiología fue criptoglandular o relacionada con la enfermedad de Crohn (en ausencia de enfermedad intestinal luminal activa).INTERVENCIÓN:El procedimiento ambulatorio se realizó bajo anestesia general y consistió en: 1) desbridamiento físico y limpieza del trayecto fistuloso; 2) cierre con sutura de la abertura interna; y 3) instilación de RD2-Ver.02 en todo el tracto.PRINCIPALES MEDIDAS DE VALORACIÓN:Seguridad y eficacia a los 6 y 12 meses después de la cirugía.RESULTADOS:Se incluyeron en el estudio 53 pacientes (77% varones) con una mediana de edad de 42 (20-72) años. Tres pacientes retiraron su consentimiento y un paciente se perdió durante el seguimiento. En el momento de este análisis intermedio, 49 y 33 pacientes completaron el período de seguimiento de 6 y 12 meses, respectivamente. Treinta y cuatro (34) pacientes lograron una curación completa (69%) a los 6 meses, mientras que 20 de 33 pacientes (60%) lograron una curación después de un año. Todos los pacientes que lograron la curación a los 6 meses permanecieron curados al año. En un análisis de subgrupos de pacientes con enfermedad de Crohn, 7/9 pacientes completaron un seguimiento de un año y 5 pacientes (71%) alcanzaron la remisión clínica. No se observaron efectos secundarios importantes ni complicaciones postoperatorias, mientras que ocurrieron 2 eventos adversos (ingreso para control del dolor e infección por COVID-19).LIMITACIONES:Estudio piloto no comparativo de un solo brazo.CONCLUSIONES:Se encontró que el tratamiento con RD2-Ver.02 en la enfermedad fístula perianal es factible y seguro, con una tasa de curación aceptable tanto en la fístula criptoglandular como en la de Crohn en el ano. Se requiere una evaluación comparativa adicional para determinar su papel potencial en el paradigma de tratamiento de la fístula anal. (Pre-proofed version ).
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Affiliation(s)
- Edward Ram
- Department of General Surgery B and Transplantation, Sheba Medical Hospital Center, Tel Hashomer, Ramat Gan, Israel
| | - Yaniv Zager
- Department of General Surgery B and Transplantation, Sheba Medical Hospital Center, Tel Hashomer, Ramat Gan, Israel
| | - Dan Carter
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Olga Saukhat
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Roi Anteby
- Department of General Surgery B and Transplantation, Sheba Medical Hospital Center, Tel Hashomer, Ramat Gan, Israel
| | - Ido Nachmany
- Department of General Surgery B and Transplantation, Sheba Medical Hospital Center, Tel Hashomer, Ramat Gan, Israel
| | - Nir Horesh
- Department of General Surgery B and Transplantation, Sheba Medical Hospital Center, Tel Hashomer, Ramat Gan, Israel
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Buk OF, Kucuk GO. A Retrospective Study of the Presentation and Management of Perianal Disease in HIV-Positive Patients Referred to a Surgical Outpatient Unit in Turkey. Med Sci Monit 2024; 30:e943534. [PMID: 38528663 PMCID: PMC10981351 DOI: 10.12659/msm.943534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/09/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND The incidence of human immunodeficiency virus (HIV) infection is on the rise, and perianal region diseases in HIV-infected patients have become increasingly prevalent. This study aimed to analyze the surgical treatment outcomes of HIV-infected patients presenting with perianal concerns. MATERIAL AND METHODS We included 311 HIV-positive patients admitted to the Infectious Diseases Clinic of Samsun Training and Research Hospital between January 2014 and December 2022. From this group, we selected those who sought care at the general surgery outpatient clinic for perianal and anal concerns, retrospectively reviewing their medical records. RESULTS Out of 311 patients, 54 (17.3%) were referred to the general surgery outpatient clinic with anal and/or perianal region complaints. Of these cases, 38 (70.3%) had a single disease, while 16 (29.6%) had combined diseases. There were 20 males (95%) and 1 female (5%). Among these 54 patients, 33 (61.1%) received medical treatment from the outpatient clinic, while 21 (38.9%) underwent surgical intervention. The diagnoses included 22 hemorrhoidal diseases, 24 anal condylomas, 15 anal fissures, 11 anal abscesses, and 4 anal fistulas. We evaluated the postoperative results and recurrence status of these patients. CONCLUSIONS Perianal diseases in HIV-positive patients can be categorized as isolated or combined. The management of patients with postoperative follow-up compliance problems and combined diseases with low CD4 counts may pose treatment challenges.
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Affiliation(s)
- Omer Faruk Buk
- Department of General Surgery, Samsun Training and Research Hospital, Samsun, Turkey
| | - Gultekin Ozan Kucuk
- Department of General Surgery, Samsun Training and Research Hospital, University of Health Sciences, Samsun, Turkey
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Wang C, Zhao S, Tu L, Zeng X. Perianal abscess complicating a high complex-type anal fistula. Asian J Surg 2024; 47:1644-1645. [PMID: 38143172 DOI: 10.1016/j.asjsur.2023.12.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/08/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- ChangXin Wang
- First Clinical Medical College, The Gannan Medical University, Ganzhou, China
| | - ShuFeng Zhao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - LiWen Tu
- First Clinical Medical College, The Gannan Medical University, Ganzhou, China
| | - XiangFu Zeng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.
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Polaino Moreno V, Caballero-Bermejo AF, Artés Caselles M, Serrano González J, Remírez Arriaga X, González Alcolea N, Equisoain Azcona A, Iglesias García E, Lucena de la Poza JL, Sánchez Movilla A, Ruiz-Antorán B. Efficacy of amoxicillin/clavulanic acid after surgical drainage of perianal abscess in the prevention of the development of anal fistula (PERIQxA study): study protocol for a multicenter randomized, double-blind clinical trial. Trials 2024; 25:122. [PMID: 38355562 PMCID: PMC10868096 DOI: 10.1186/s13063-024-07922-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Anorectal fistula, which is a relatively common pathology, is the chronic manifestation of the acute perirectal process that forms an anal abscess. The development of a fistula after incision and drainage of an anal abscess is seen in approximately 26-37%. Its treatment is a relevant topic, and the role of the use of antibiotic therapy in its prevention remains controversial, after the publication of several studies with contradictory results and several methodological limitations. Our hypothesis is that the combination of amoxicillin and clavulanic acid will reduce the incidence of anal fistula. METHOD The aim of this study is to evaluate the efficacy of antibiotherapy after surgical drainage of perianal abscess in the development of perianal fistula. The PERIQxA study is a multicenter, randomized, double-blind controlled trial. The study has been designed to include 286 adult patients who will be randomly (1:1) assigned to either the experimental (amoxicillin/clavulanic acid 875/125 mg TDS for 7 days) or the control arm (placebo). The primary outcome measure is the percentage of patients that develop perianal fistula after surgery and during follow-up (6 months). DISCUSSION This clinical trial is designed to evaluate the efficacy and safety of amoxicillin/clavulanic in the prevention of perianal fistula. The results of this study are expected to contribute to stablish the potential role of antibiotherapy in the therapeutics for anal abscess. TRIAL REGISTRATION EudraCT Number: 2021-003376-14. Registered on November 26, 2021.
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Affiliation(s)
- Verónica Polaino Moreno
- General Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
| | - Antonio F Caballero-Bermejo
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain.
| | - Mariano Artés Caselles
- General Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
| | | | | | | | - Aritz Equisoain Azcona
- General Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
| | - Eva Iglesias García
- General Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
| | - José Luis Lucena de la Poza
- General Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
| | - Arsenio Sánchez Movilla
- General Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
| | - Belén Ruiz-Antorán
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
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Zhu Y, Xu W, Liu Z, Li B, Wu Y, Hua Z, Wang Y, Wang X, Du P, Yang H. Surface-enhanced Raman spectroscopy analysis reveals biochemical difference in urine of patients with perianal fistula. Asian J Surg 2024; 47:140-146. [PMID: 37308382 DOI: 10.1016/j.asjsur.2023.05.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 05/26/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND & AIMS Perianal fistulising Crohn's disease (PFCD) is different from the characteristics and outcomes of traditional non-inflammatory bowel disease (IBD) anal fistulas. The presence of perianal disease was a poor prognostic indicator for Crohn's disease (CD) patients and PFCD patients were more likely to bear an increased risk of recurrence. However, the effective and accurate diagnosis methods to early distinguish PFCD from simple perianal fistula were still scarce. The purpose of this study is to develop a non-invasive detecting approach to predict CD in patients with perianal fistulas. METHODS Data on patients with anal fistulizing disease were collected from July 2020 to September 2020 in two IBD centers. Urine samples from PFCD and simple perianal fistula patients were investigated by surface-enhanced Raman spectroscopy (SERS). Principal component analysis (PCA)-support vector machine (SVM) was utilized to establish classification models to distinguish PFCD from simple perianal fistula. RESULTS After a case-matched 1:1 selection by age and gender, 110 patients were included in the study. By analyzing the average SERS spectra of PFCD and simple perianal fistula patients, it revealed that there were significant differences in intensities at 11 Raman peaks. The established PCA-SVM model distinguished PFCD from simple perianal fistula with a sensitivity of 71.43%, specificity 80.00% and accuracy 75.71% in the leave-one-patient-out cross-validation. The accuracy of the model in validation cohort was 77.5%. CONCLUSIONS Investigation of urine samples by SERS helps clinicians to predict Crohn's disease from perianal fistulas, which make patients achieve benefit from a more individualized treatment strategy.
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Affiliation(s)
- Yilian Zhu
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China
| | - Weimin Xu
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China
| | - Zhiyuan Liu
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, 200093, Shanghai, China
| | - Bingyan Li
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, 200093, Shanghai, China
| | - Yaling Wu
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Zhebin Hua
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China
| | - Yaosheng Wang
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China
| | - Xiaolei Wang
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Peng Du
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China.
| | - Huinan Yang
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, 200093, Shanghai, China.
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Li WW, Li N, Ma K, Huang LQ, Sun CY, Li N, Zhang ZG. [The occurrence, precaution and treatment strategies of postoperative fecal incontinence in rectal and anal diseases]. Zhonghua Wei Chang Wai Ke Za Zhi 2023; 26:1196-1201. [PMID: 38110284 DOI: 10.3760/cma.j.cn441530-20231012-00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
In the surgical treatment of hemorrhoids, rectal prolapse, rectal cancer, anal fissures, or anal fistulas, inadvertent damage to the nerves or muscles responsible for bowel control may potentially lead to varying degrees of fecal incontinence (FI). Surgeons need to conduct preoperative assessments based on the patient's individual condition to select an appropriate surgical plan, aiming to minimize the incidence of postoperative FI and improve the patient's postoperative quality of life as much as possible while effectively treating the disease. Additionally, the proficiency of the surgeon's skills, appropriate preoperative dietary adjustments for the patient, regular bowel habits, and exercises targeting the pelvic floor muscles all contribute to reducing the incidence of postoperative FI in patients. For patients who have already developed FI after surgery, on the basis of suitable diet, regular bowel habits, and medication, clinical practitioners can adopt such methods as biofeedback, pelvic floor muscle exercise, sacral nerve stimulation, percutaneous tibial nerve stimulation, acupuncture, injectable bulking agents, anal or vaginal inserts, transanal irrigation, surgical interventions, psychological support, etc., to individualized treatment for patients' conditions. This article, combining the literature, summarizes the current status of common diseases that may lead to postoperative FI. It elaborates on strategies for the prevention and treatment of postoperative FI, aiming to serve as a reference for peers in the field.
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Affiliation(s)
- W W Li
- Department of General Surgery, Xuzhou Clinical College Affiliated to Xuzhou Medical University, Xuzhou 221004, China
| | - N Li
- Department of Colorectal Surgery, Xuzhou Central Hospital, Xuzhou 221004, China
| | - K Ma
- Department of Colorectal Surgery, Xuzhou Central Hospital, Xuzhou 221004, China
| | - L Q Huang
- Department of Colorectal Surgery, Xuzhou Central Hospital, Xuzhou 221004, China
| | - C Y Sun
- Department of General Surgery, Xuzhou Clinical College Affiliated to Xuzhou Medical University, Xuzhou 221004, China
| | - N Li
- Graduate School, Bengbu Medical University, Bengbu 233030, China
| | - Z G Zhang
- Department of Colorectal Surgery, Xuzhou Central Hospital, Xuzhou 221004, China
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Skovgaards DM, Perregaard H, Dibbern CB, Nordholm-Carstensen A. Fistula development after anal abscess drainage-a multicentre retrospective cohort study. Int J Colorectal Dis 2023; 39:4. [PMID: 38093036 PMCID: PMC10719138 DOI: 10.1007/s00384-023-04576-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Anal abscesses are common and, despite correct treatment with surgical drainage, carry the risk of developing fistulas. Studies identifying risk factors for the development of anal fistulas are sparse. This study aimed to identify the risk factors for anal fistulas after anal abscess surgery. METHODS This was a multicentre, retrospective cohort study of patients undergoing acute surgery for anal abscesses in the Capital Region of Denmark between 2018 and 2019. The patients were identified using ICD-10 codes for anal abscesses. Predefined clinicopathological factors and postoperative courses were extracted from patient records. RESULTS A total of 475 patients were included. At a median follow-up time of 1108 days (IQR 946-1320 days) following surgery, 164 (33.7%) patients were diagnosed with an anal fistula. Risk factors for developing fistulas were low intersphincteric (OR 2.77, 95CI 1.50-5.06) and ischioanal (OR 2.48, 95CI 1.36-4.47) abscesses, Crohn's disease (OR 5.96, 95CI 2.33-17.2), a history of recurrent anal abscesses (OR 4.14, 95CI 2.47-7.01) or repeat surgery (OR 5.96, 95CI 2.33-17.2), E. coli-positive pus cultures (OR 4.06, 1.56-11.4) or preoperative C-reactive protein (CRP) of more than 100 mg/L (OR 3.21, 95CI 1.57-6.71). CONCLUSION Several significant clinical risk factors were associated with fistula development following anal abscess surgery. These findings are clinically relevant and could influence the selection of patients for specialised follow-up, facilitate expedited diagnosis, and potentially prevent unnecessarily long treatment courses.
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Affiliation(s)
- Daniel Mark Skovgaards
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Helene Perregaard
- Surgical Department, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
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Chen X, Wu N, Li W. Obstetric rectal laceration in the absence of an anal sphincter injury: A case report. Asian J Surg 2023; 46:5596-5597. [PMID: 37591751 DOI: 10.1016/j.asjsur.2023.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023] Open
Affiliation(s)
- XiaoYan Chen
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Na Wu
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Wei Li
- Anesthesiology Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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Ortega Ferrete A, López E, Juez Sáez LD, García-Pérez JC, Ocaña J, Ballestero A, Fernández-Cebrián JM, Die Trill J. Fournier's gangrene and fecal diversion. When, in which patients, and what type should I perform? Langenbecks Arch Surg 2023; 408:428. [PMID: 37932463 DOI: 10.1007/s00423-023-03137-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/04/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Fournier's gangrene (FG) is a necrotizing fasciitis affecting the perineum and urogenital tissue. The mortality rate is high although early detection and aggressive debridement can reduce mortality by up to 16%. The prevalence of sequelae is very high and a colostomy is often necessary to control the perineal wound. MATERIAL AND METHODS A retrospective study was carried out to recruit all patients operated on by the General Surgery and Urology Departments with a diagnosis of GF at the University Hospital over 22 years. Mortality, the Fournier gangrene severity index (FGSI), and fecal diversion (either surgical (colostomy) or straight (Flexi-seal)) are collected. RESULTS A total of 149 patients met the inclusion criteria. FG's most frequent cause was a perianal abscess (107 patients-72%). Eighteen patients (12%) died of a specific cause of FG. Age (p = 0.014) and patients with an oncological history (p = 0.038) both were the only mortality risk factors for mortality according to logistic regression. Fifty patients required some form of fecal diversion in the postoperative period (32 colostomies and 18 Flexi-seal). Neither the use of postoperative fecal diversion (surgical or Flexi-seal) nor the timing of its use had any effect on postoperative mortality. CONCLUSIONS One in eight patients died in the immediate postoperative period secondary to FG. Despite improved outcomes, 22% required a colostomy during admission. However, neither the performance of a colostomy nor the timing was associated with decreased FG-associated mortality. Non-invasive methods should be used first and surgical bowel diversion should be postponed as long as possible.
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Affiliation(s)
- Ana Ortega Ferrete
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Km 9.1, 28034, Madrid, Spain
| | - Enrique López
- Urology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Luz Divina Juez Sáez
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Km 9.1, 28034, Madrid, Spain.
- Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain.
| | - Juan Carlos García-Pérez
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Km 9.1, 28034, Madrid, Spain
- Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
- Insituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Juan Ocaña
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Km 9.1, 28034, Madrid, Spain
- Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | - Araceli Ballestero
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Km 9.1, 28034, Madrid, Spain
- Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | - Jose María Fernández-Cebrián
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Km 9.1, 28034, Madrid, Spain
- Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | - Javier Die Trill
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Km 9.1, 28034, Madrid, Spain
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Durgun C, Tüzün A. The use of a loose seton as a definitive surgical treatment for anorectal abscesses and complex anal fistulas. ADV CLIN EXP MED 2023; 32:1149-1157. [PMID: 36920266 DOI: 10.17219/acem/161162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/12/2023] [Accepted: 02/12/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND There is no consensus regarding the standard treatment method for anorectal abscesses accompanied by anal fistulas and complex anal fistulas. Simultaneous surgical treatment of the underlying anal fistula with anorectal abscess drainage is controversial due to incontinence problems. OBJECTIVES We aimed to investigate the effectiveness of the loose seton method for the treatment of chronic anal fistulas and acute anorectal abscesses accompanied by anal fistula. MATERIAL AND METHODS In this retrospective study, 114 patients who were operated on in our clinic due to chronic anal fistulas and anorectal abscesses with an applied loose seton between 2020 and 2022 were included in the study. The patients were divided into 2 groups: those with chronic complex anal fistula and those with anorectal abscess accompanied by anal fistula. The groups were compared in terms of their continence status, rate of recurrence, recurrent abscess formation, postoperative pain scores, duration of operation, and demographic characteristics. RESULTS Of the patients included in the study, 78 had a complex chronic anal fistula, and 36 had an anorectal abscess accompanied by an anal fistula. There were no differences between the demographic characteristics of the 2 groups. The mean seton dissociation time was 6.8 (3-19) months. Gas or stool leakage was not observed in patients during the mean follow-up period of 18 (6-30) months. There was no difference in postoperative continence levels between the 2 groups. No recurrent fistulas were observed in patients during the follow-up period. Recurrent abscesses were observed in 5 (13.9%) patients in the anorectal abscess group. Abscesses due to insufficient drainage were observed in 2 (2.6%) patients in the chronic fistula group. There was no significant difference in operation time between the 2 groups. CONCLUSION A loose seton can be a safe and effective method for the treatment of abscesses. It is a painless surgical method that produces good results in the treatment of all types of abscesses.
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Affiliation(s)
- Cemalettin Durgun
- Clinic of General Surgery, Memorial Dicle Hospital, Diyarbakır, Turkey
| | - Abidin Tüzün
- Department of General Surgery, Gazi Yaşargil Education and Research Hospital, Health Science University, Diyarbakır, Turkey
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Albuquerque A, Cappello C, Stirrup O, Selinger CP. Anal High-risk Human Papillomavirus Infection, Squamous Intraepithelial Lesions, and Anal Cancer in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Crohns Colitis 2023; 17:1228-1234. [PMID: 36929761 DOI: 10.1093/ecco-jcc/jjad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Ulcerative colitis [UC] and Crohn's disease [CD] can be associated with severe comorbidities, namely opportunistic infections and malignancies. We present the first systematic review and meta-analysis evaluating the burden of anal human papillomavirus disease in patients with UC and CD. METHODS PubMed, Web of Science, and Scopus were searched until November 2022. Meta-analyses were performed using random effects models. The protocol was recorded at PROSPERO register with the number CRD42022356728. RESULTS Six studies, including 78 711 patients with UC with a total follow-up of 518 969 person-years, described the anal cancer incidence rate. For anal cancer incidence rate in CD, six studies were selected, including 56 845 patients with a total follow-up of 671 899 person-years. The incidence of anal cancer was 10.2 [95% CI 4.3 - 23.7] per 100 000 person-years in UC and 7.7 [3.5 - 17.1] per 100 000 person-years in CD. A subgroup analysis of anal cancer in perianal CD, including 7105 patients, was calculated with incidence of 19.6 [12.2 - 31.6] per 100 000 person-years [three studies included]. Few studies described prevalence of anal cytological abnormalities [four studies including 349 patients] or high-risk human papillomavirus [three studies including 210 patients], with high heterogeneity. Prevalence of cytological abnormalities or high-risk human papillomavirus was not associated with pharmacological immunosuppression in the studies included. CONCLUSION The incidence of anal cancer is higher in UC than in CD, with the exception of perianal CD. There are limited and heterogeneous data on anal high-risk human papillomavirus infection and squamous intraepithelial lesions prevalence in this population.
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Affiliation(s)
- Andreia Albuquerque
- Gastroenterology Department, Fernando Pessoa Teaching Hospital, Porto, Portugal
- Precancerous Lesions and Early Cancer Management Research Group RISE@CI-IPO [Health Research Network], Portuguese Oncology Institute of Porto [IPO-Porto], Porto, Portugal
| | - Carmelina Cappello
- Homerton Anogenital Neoplasia Service, Homerton University Hospital, London, UK
| | - Oliver Stirrup
- Institute for Global Health, University College London, London, UK
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Yamamoto T, Nakase H, Watanabe K, Shinzaki S, Takatsu N, Fujii T, Okamoto R, Matsuoka K, Yamada A, Kunisaki R, Matsuura M, Shiga H, Bamba S, Mikami Y, Shimoyama T, Motoya S, Torisu T, Kobayashi T, Ohmiya N, Saruta M, Matsuda K, Matsumoto T, Maemoto A, Murata Y, Yoshigoe S, Nagasaka S, Yajima T, Hisamatsu T. Diagnosis and Clinical Features of Perianal Lesions in Newly Diagnosed Crohn's Disease: Subgroup Analysis from Inception Cohort Registry Study of Patients with Crohn's Disease (iCREST-CD). J Crohns Colitis 2023; 17:1193-1206. [PMID: 36869815 PMCID: PMC10441562 DOI: 10.1093/ecco-jcc/jjad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Indexed: 03/05/2023]
Abstract
BACKGROUND AND AIMS Perianal lesion is a refractory phenotype of Crohn's disease [CD] with significantly diminished quality of life. We evaluated the clinical characteristics of perianal lesions in newly diagnosed CD patients and the impact of perianal lesions on the quality of life in Japanese patients with CD. METHODS Patients newly diagnosed with CD after June 2016 were included between December 2018 and June 2020 from the Inception Cohort Registry Study of Patients with CD [iCREST-CD]. RESULTS Perianal lesions were present in 324 [48.2%] of 672 patients with newly diagnosed CD; 71.9% [233/324] were male. The prevalence of perianal lesions was higher in patients aged <40 years vs ≥40 years, and it decreased with age. Perianal fistula [59.9%] and abscess [30.6%] were the most common perianal lesions. In multivariate analyses, male sex, age <40 years and ileocolonic disease location were significantly associated with a high prevalence of perianal lesions, whereas stricturing behaviour and alcohol intake were associated with low prevalence. Fatigue was more frequent [33.3% vs 21.6%] while work productivity and activity impairment-work time missed [36.3% vs 29.5%] and activity impairment [51.9% vs 41.1%] were numerically higher in patients with than those without perianal lesions. CONCLUSIONS At the time of CD diagnosis, approximately half of the patients had perianal lesions; perianal abscesses and perianal fistulas were the most common. Young age, male sex, disease location and behaviour were significantly associated with the presence of perianal lesions. The presence of perianal lesion was associated with fatigue and impairment of daily activities. CLINICAL TRIALS REGISTRY University Hospital Medical Information Network Clinical Trials Registry System [UMIN-CTR, UMIN000032237].
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Affiliation(s)
- Takayuki Yamamoto
- Department of Surgery and Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, 10-8 Hazuyama-cho Yokkaichi, Mie, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, 16-291 South-1 jo-nishi, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Kenji Watanabe
- Centre for Inflammatory Bowel Disease, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Shinichiro Shinzaki
- Centre for Inflammatory Bowel Disease, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noritaka Takatsu
- Department of Inflammatory Bowel Disease Centre, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin Chikushino, Fukuoka, Japan
| | - Toshimitsu Fujii
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Ryuichi Okamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Centre, 564-1 Shimoshizu, Sakura, Chiba, Japan
| | - Akihiro Yamada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Centre, 564-1 Shimoshizu, Sakura, Chiba, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Centre, Yokohama City University Medical Centre, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, Japan
| | - Minoru Matsuura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Tokyo, Japan
| | - Hisashi Shiga
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seyro-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Shigeki Bamba
- Division of Digestive Endoscopy, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, Japan
| | - Yohei Mikami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, 35 Shinanomachi, Shinjiku-ku, Tokyo, Japan
| | - Takahiro Shimoyama
- Department of Surgery and Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, 10-8 Hazuyama-cho Yokkaichi, Mie, Japan
| | - Satoshi Motoya
- IBD Centre, Hokkaido Preventive Welfare Federation of Agricultural Cooperative, Sapporo-Kosei General Hospital, 8-5 Kita-3 johigashi, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, 5-9-1, Shirokane, Minato-ku, Tokyo, Japan
| | - Naoki Ohmiya
- Department of Advanced Endoscopy, Fujita Health University School of Medicine, 1-98 Dengakukubo, Kutsukake-Cho, Toyoake, Aichi, Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
| | - Koichiro Matsuda
- Department of Gastroenterology, Toyama Preventive Central Hospital, 2 -2 -78, Nishinagae, Toyama, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 10-1, Uchimaru, Morioka, Iwate, Japan
| | - Atsuo Maemoto
- IBD Centre, Sapporo Higashi Tokushima Hospital, 3-1, Kita 33 Higashi 14, Higashiku, Sapporo, Hokkaido, Japan
| | - Yoko Murata
- Immunology, Medical Affairs Division, Janssen Pharmaceuticals K.K., 3-5-2 Nishi-Kanda, Chiyoda-ku, Tokyo, Japan
| | - Shinichi Yoshigoe
- Immunology, Medical Affairs Division, Janssen Pharmaceuticals K.K., 3-5-2 Nishi-Kanda, Chiyoda-ku, Tokyo, Japan
| | - Shinya Nagasaka
- Immunology, Medical Affairs Division, Janssen Pharmaceuticals K.K., 3-5-2 Nishi-Kanda, Chiyoda-ku, Tokyo, Japan
| | - Tsutomu Yajima
- Statistics and Decision Sciences (SDS), Janssen Pharmaceuticals K.K., 3-5-2 Nishi-Kanda, Chiyoda-ku, Tokyo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Tokyo, Japan
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Goldenshluger M, Margalit C, Kodesh A, Katz E, Hazzan D, Segev L. Bedside Drainage of Perianal Abscesses: Is It Safe and Effective? Isr Med Assoc J 2023; 25:473-478. [PMID: 37461172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Perianal abscesses require immediate incision and drainage (I&D). However, prompt bedside drainage is controversial as it may compromise exposure and thorough anal examination. OBJECTIVES To examine outcomes of bedside I&D of perianal abscesses in the emergency department (ED) vs. the operating room (OR). METHODS We conducted a retrospective review of all patients presented to the ED with a perianal abscesses between January 2018 and March 2020. Patients with Crohn's disease, horseshoe or recurrent abscesses were excluded. RESULTS The study comprised 248 patients; 151 (60.89%) underwent I&D in the OR and 97 (39.11%) in the ED. Patients elected to bedside I&D had smaller abscess sizes (P = 0.01), presented with no fever, and had lower rates of inflammatory markers. The interval time from diagnosis to intervention was significantly shorter among the bedside I&D group 2.13 ± 2.34 hours vs. 10.41 ± 8.48 hours (P < 0.001). Of patients who underwent I&D in the OR, 7.3% had synchronous fistulas, whereas none at bedside had (P = 0.007). At median follow-up of 24 months, recurrence rate of abscess and fistula formation in patients treated in the ED were 11.3% and 6.2%, respectively, vs. 19.9% and 15.23% (P = 0.023, 0.006). Fever (OR 5.71, P = 0.005) and abscess size (OR 1.7, P = 0.026) at initial presentation were risk factors for late fistula formation. CONCLUSIONS Bedside I&D significantly shortens waiting time and does not increase the rates of long-term complications in patients with small primary perianal abscesses.
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Affiliation(s)
| | | | - Afek Kodesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ephraim Katz
- Department of General Surgery C, Sheba Medical Center, Tel Hashomer, Israel
| | - David Hazzan
- Department of General Surgery C, Sheba Medical Center, Tel Hashomer, Israel
| | - Lior Segev
- Department of General Surgery C, Sheba Medical Center, Tel Hashomer, Israel
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Allisha F, Setiawan G, Rudiman R, Indriasari V. Secondary healing of horseshoe perianal abscess in a patient with morbid obesity: experience at a rural hospital. Wounds 2022; 34:E57-E62. [PMID: 36108243 DOI: 10.25270/wnds/21100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Perianal abscess is defined as a local collection of pus in the perianal tissues. It is among the most common anorectal problems encountered by surgeons. Further extension of this infection into the unilateral or bilateral ischiorectal fossa leads to a horseshoe abscess. Morbid obesity is a risk factor for horseshoe perianal abscess with the potential to disrupt the normal healing process. CASE REPORT A 35-year-old male with morbid obesity presented to the surgery outpatient clinic in a hospital in Subang, West Java, Indonesia, with continuous severe pain and swelling around the anus of approximately 7 days' duration. Local examination of the anogenital area revealed a horseshoe perianal abscess extending to the ischiorectal fossa, approximately 1 cm from the anal verge and measuring 7.5 cm × 4.5 cm × 10 cm. Physical examination findings included tenderness to palpation; the presence of blood, pus, and necrotic tissue; and fluctuance. Incision and drainage were performed in the operating room under general anesthesia. In lieu of colostomy, the patient chose wound healing by secondary intention. Postoperative open wound care consisted of wet-to-moist gauze dressings during the first 2 postoperative days, followed by hydrocolloid dressing after the pus and blood were adequately drained, and finally, alginate dressing after granulation tissue formed. Aluminum silicate (microporous ceramic) was used as the external (secondary) wound dressing. Time to healing was 8 weeks. CONCLUSION Horseshoe abscesses are challenging to manage. Thorough and careful diagnosis, prompt fluid resuscitation to overcome fluid and electrolyte imbalance and to ensure proper antibiotic administration, nutrition intake, and a planned surgical approach as well as individualized postoperative care are necessary to achieve healing.
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Affiliation(s)
- Fidkya Allisha
- Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Central General Hospital, Bandung, Indonesia
| | - Gideon Setiawan
- PT Perkebunan Nusantara VIII Subang General Hospital, Subang, West Java, Indonesia
| | - Reno Rudiman
- Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Central General Hospital, Bandung, Indonesia
| | - Vita Indriasari
- Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Central General Hospital, Bandung, Indonesia
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Zhang Z, Ling X, Liu L, Xi M, Zhang G, Dai J. Natural History of Anal Papillomavirus Infection in HIV-Negative Men Who Have Sex With Men Based on a Markov Model: A 5-Year Prospective Cohort Study. Front Public Health 2022; 10:891991. [PMID: 35646789 PMCID: PMC9130828 DOI: 10.3389/fpubh.2022.891991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/20/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Men who have sex with men (MSM) are at increased risk for Human papillomavirus (HPV) infection compared to women and heterosexual men. We aimed to assess the incidence, clearance and duration of anal human papillomavirus (HPV) infection in HIV-negative MSM and the influencing factors in a 5-year prospective cohort study. Methods From April 2016 to April 2021, HIV-negative MSM were recruited and followed every 6 months in Urumqi, Xinjiang, China. Questionnaires and anal swabs were collected at baseline and every 6 months. We detected 37 anal HPV genotypes using the HPV Geno Array Diagnostic Kit Test. Incidence and clearance rates of anal HPV infection and the influencing factors were estimated using a two-state Markov model. Results A total of 585 MSM were included with a median age of 37 years [interquartile range (IQR): 31–43 years] and were followed for a median 2.8 years (IQR: 1.8–3.6 years). Incidence rates for any HPV and high-risk HPV (Hr-HPV) were 53.4 [95% confidence interval (CI): 49.1–58.0] and 39.0 (95% CI: 35.7–42.5)/1,000 person-months. Median duration of infection was 9.67 (95% CI: 8.67–10.86) and 8.51 (95% CI: 7.57–9.50) months, respectively. Clearance rates for any HPV and Hr-HPV were 50.9 (95% CI: 46.7–55.3) and 62.1 (95% CI: 56.8–66.7)/1,000 person-months, respectively. HPV16 and HPV6 had the highest incidence, lowest clearance rate and longest duration of infection among Hr-HPV and low-risk HPV (Lr-HPV) types, respectively. Receptive anal sex is a risk factor for any HPV [hazard ratio (HR) = 1.66, 95% CI: 1.16–2.38] and Hr-HPV infection (HR = 1.99, 95% CI:1.39–2.85). Recent anal sex without condom use was significantly associated with any HPV (HR = 1.80, 95% CI: 1.10–2.94) and Hr-HPV infection (HR = 2.60, 95% CI: 1.42–4.77). Age ≥35 years was significantly associated with Lr-HPV HPV infection only (HR = 1.40, 95% CI: 1.02–1.93). Both inserted and receptive anal sex (HR = 0.60, 95% CI: 0.40–0.89) and anal sex ≥2 times per week (HR = 0.61, 95% CI: 0.43–0.87) were associated with reduced Hr-HPV clearance. Six of the nine-valent vaccine types (HPV6, 11, 16, 18, 52 and 58) occurred most frequently, which indicates the need for high vaccination coverage in MSM. Conclusions In this cohort study, high incidence and low clearance of any HPV, Hr-HPV and individual HPV infections emphasize the importance of MSM vaccination. Modifiable behavioral factors such as condoms and drug use should be incorporated into HPV prevention strategies.
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Abstract
BACKGROUND Predicting aggressive Crohn's disease is crucial for determining therapeutic strategies. OBJECTIVE We aimed to develop a prognostic model to predict complications leading to surgery within 1 year after diagnosis of Crohn's disease and to create a nomogram to facilitate clinical decision making. DESIGN This is a retrospective study. SETTING This study was conducted from January 2012 to December 2016 in a single tertiary IBD center. PATIENTS Patients diagnosed with Crohn's disease showing B1 behavior according to the Montreal classification were included. MAIN OUTCOME MEASURES We measured the occurrence of complications that would ultimately lead to surgery, including severe GI bleeding (Glasgow-Blatchford score ≥6), stenosis, and perforations, confirmed by endoscopy, CT scan, and/or interventional radiology. RESULTS The mean follow-up period was 54 months (SD 13 months). Of the 614 eligible patients, 13.5% developed complications leading to surgery. Multivariable logistic regression revealed the independent predictors of early-onset complications to be age (adjusted odds ratio per 10-year increase in age = 0.4; 95% CI, 0.2-0.8; p = 0.004), disease duration (adjusted odds ratio = 2.7, 95% CI, 1.9-3.8; p < 0.001), perianal disease (adjusted odds ratio = 16.0; 95% CI, 4.3-59.9; p < 0.001), previous surgery (adjusted odds ratio = 3.7; 95% CI, 1.6-8.6; p = 0.003), and extraintestinal manifestations (adjusted odds ratio = 7.6; 95% CI, 2.3-24.9; p = 0.001). The specificity and sensitivity of the prognostic model were 88.3% (95% CI, 84.8%-91.2%) and 96.6% (95% CI, 88.1%-99.6%), and the area under the curve was 0.97 (95% CI, 0.95-0.98). This model was validated with good discrimination and excellent calibration using the Hosmer-Lemeshow goodness-of-fit test. A nomogram was created to facilitate clinical bedside practice. LIMITATIONS This was a retrospective design and included a small sample size from 1 center. CONCLUSIONS Our validated prognostic model effectively predicted early-onset complications leading to surgery and screened aggressive Crohn's disease, which will enable physicians to customize therapeutic strategies and monitor disease. See Video Abstract at http://links.lww.com/DCR/B442.Registered at Chinese Clinical Trial Registry (ChiCTR1900025751). UN MODELO DE PRONSTICO VALIDADO Y UN NOMOGRAMA PARA PREDECIR COMPLICACIONES PRECOCES QUE REQUIRAN CIRUGA EN PACIENTES CON ENFERMEDAD DE CROHN ANTECEDENTES:Predecir una enfermedad de Crohn muy agresiva es fundamental para determinar la estrategia terapéutica.OBJETIVO:Desarrollar un modelo de pronóstico para predecir las complicaciones que requieran cirugía dentro el primer año al diagnóstico de enfermedad de Crohn y crear un nomograma para facilitar la toma de decisiones clínicas.DISEÑO:El presente etudio es retrospectivo.AJUSTE:Estudio realizado entre Enero 2012 y Diciembre 2016, en un único centro terciario de tratamiento de enfermedad inflamatoria intestinal.PACIENTES:Se incluyeron todos aquellos pacientes diagnosticados de enfermedad de Crohn que mostraban manifestaciones tipo B1 según la clasificación de Montreal.PRINCIPALES MEDIDAS DE RESULTADO:Medimos la aparición de complicaciones que finalmente conducirían a una cirugía, incluida la hemorragia digestiva grave (puntuación de Glasgow-Blatchford ≥ 6), estenosis y perforaciones, confirmadas por endoscopía, tomografía computarizada y / o radiología intervencionista.RESULTADOS:El período medio de seguimiento fue de 54 meses (desviación estándar 13 meses). De los 614 pacientes elegibles, el 13,5% desarrolló complicaciones que llevaron a cirugía. La regresión logística multivariable reveló que los predictores independientes de complicaciones de inicio temprano eran la edad (razón de probabilidades ajustada [ORa] por aumento de 10 años en la edad = 0,4; intervalos de confianza del 95% [IC del 95%]: 0,2-0,8, p = 0,004), duración de la enfermedad (ORa = 2,7, IC del 95%: 1,9-3,8, p <0,001), enfermedad perianal (ORa = 16,0, IC del 95%: 4,3-59,9, p <0,001), cirugía previa (ORa = 3,7, 95% IC: 1,6-8,6, p = 0,003) y manifestaciones extraintestinales (ORa = 7,6, IC del 95%: 2,3-24,9, p = 0,001). La especificidad y sensibilidad del modelo pronóstico fueron 88,3% (IC 95%: 84,8% -91,2%) y 96,6% (IC 95%: 88,1% -99,6%), respectivamente, y el área bajo la curva fue 0,97 (95% % CI: 0,95-0,98). Este modelo fue validado con buena discriminación y excelente calibración utilizando la prueba de bondad de ajuste de Hosmer-Lemeshow. Se creó un nomograma para facilitar la práctica clínica al pié de la cama.LIMITACIONES:Diseño retrospectivo que incluyó un tamaño de muestra pequeña en un solo centro.CONCLUSIONES:Nuestro modelo de pronóstico validado predijo eficazmente las complicaciones precoces que conllevaron a cirugía y la detección de enfermedad de Crohn agresiva, lo que permitió a los médicos personalizar las estrategias terapéuticas y controlar la enfermedad. Consulte Video Resumen en http://links.lww.com/DCR/B442.Registrado en el Registro de Ensayos Clínicos de China (ChiCTR1900025751).
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Affiliation(s)
- Jiayin Yao
- Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yi Jiang
- Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Jia Ke
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yi Lu
- Department of Anesthesiology, Guangzhou Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Jun Hu
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Min Zhi
- Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
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Sun Z, Pappas TN, Migaly J. William Howard Taft and His Complicated Perianal Disease. Dis Colon Rectum 2021; 64:268-273. [PMID: 33395132 DOI: 10.1097/dcr.0000000000001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Zhifei Sun
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Hsieh MH, Lu YA, Kuo G, Chen CY, Sun WC, Lin Y, Tian YC, Hsu HH. Epidemiology and outcomes of anal abscess in patients on chronic dialysis: a 14-year retrospective study. Clinics (Sao Paulo) 2019; 74:e638. [PMID: 30916172 PMCID: PMC6438129 DOI: 10.6061/clinics/2019/e638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 10/02/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES We conducted this retrospective study to elucidate the clinical presentation and outcomes of anal abscess in chronic dialysis patients. METHODS We performed a chart review of patients who were hospitalized for anal abscess from Jan. 2002 to Dec. 2015. A total of 3,074 episodes of anal abscess were identified. Of these, 43 chronic dialysis patients with first-time anal abscess were enrolled. Patients were divided into a surgical group and a nonsurgical group according to the treatment received during hospitalization. The baseline characteristics, clinical findings, treatments and outcomes were obtained and analyzed. The endpoints of this study were in-hospital mortality, one-year mortality and one-year recurrence. RESULTS Of the 43 patients, 27 (62.7%) received surgical treatment, and 16 (37.2%) received antibiotic treatment alone. There was no significant difference in age, sex, body mass index, smoking habits, comorbidities, or dialysis characteristics between the two groups. Perianal abscess was the most common type of anal abscess, and 39.5% of patients experienced fistula formation. Most patients had mixed aerobic and anaerobic flora. Our data demonstrate that there was no significant difference in hospital stay, one-year survival or recurrence rate between the surgical group and nonsurgical group. However, there was a trend toward better in-hospital survival in patients who received surgical treatment (p=0.082). CONCLUSION In chronic dialysis patients with anal abscess, there was no statistically significant difference in clinical presentation and outcomes between the surgical and nonsurgical groups, although the surgical group had a trend of better in-hospital survival.
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Affiliation(s)
- Meng-Hsuan Hsieh
- Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yueh-An Lu
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - George Kuo
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chao-Yu Chen
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chiao Sun
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - YuJr Lin
- Research Services Center For Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsiang-Hao Hsu
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
- Corresponding author. E-mail:
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Volløyhaug I, Taithongchai A, Van Gruting I, Sultan A, Thakar R. Levator ani muscle morphology and function in women with obstetric anal sphincter injury. Ultrasound Obstet Gynecol 2019; 53:410-416. [PMID: 30207014 DOI: 10.1002/uog.20115] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/19/2018] [Accepted: 08/28/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To estimate the prevalence of, and explore the risk factors for, levator ani muscle (LAM) injury in women with clinically diagnosed obstetric anal sphincter injury (OASI). The secondary aim was to assess the association between LAM injury and pelvic floor muscle contraction, anal incontinence (AI) and urinary incontinence (UI) in women with OASI. METHODS This was a cross-sectional study of 250 women with OASI, recruited between 2013 and 2015 from a tertiary referral center at Croydon University Hospital, UK. AI symptoms were assessed using the modified St Mark's incontinence score and UI was assessed using the International Consultation on Incontinence modular Questionnaire for Urinary Incontinence - Short Form. All participants underwent three/four-dimensional transperineal ultrasound at rest and on maximum pelvic floor muscle contraction. Major LAM injury was defined as a unilateral or bilateral defect in all three central slices on tomographic ultrasound imaging. Muscle contraction was assessed using the modified Oxford scale (MOS) and measured on ultrasound as the proportional change in the anteroposterior (AP) levator hiatal diameter between rest and contraction. Multivariable logistic regression analysis was used to study risk factors for LAM injury. Differences in contraction and AI and UI symptoms between women with intact and those with injured LAM were studied using multivariable ANCOVA and the Mann-Whitney U-test. RESULTS Of the 248 women with OASI for whom ultrasound volumes of adequate quality were available, 29.4% were found to have major LAM injury. The prevalence of LAM injury was 23.6% after normal vaginal delivery and 40.2% after operative vaginal delivery (adjusted odds ratio, 4.1 (95% CI, 1.4-11.9); P = 0.01). LAM injury was associated with weaker pelvic floor muscle contraction, with an adjusted mean difference for proportional change in AP diameter of 5.0 (95% CI, 3.0-6.9) and MOS of 0.6 (95% CI, 0.3-0.9) (P < 0.001 for both). AI and UI symptom scores were similar between women with intact and those with injured LAM. CONCLUSIONS Operative vaginal delivery was a risk factor for LAM injury in women with OASI. LAM injury was associated with weaker pelvic floor muscle contraction. Special attention is recommended for women with OASI and LAM injury, as they are at high risk for future pelvic floor disorders. The benefits of implementation of an intensive, focused and structured pelvic floor rehabilitation program need to be evaluated in these women. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- I Volløyhaug
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, Trondheim University Hospital, Trondheim, Norway
| | - A Taithongchai
- Obstetrics and Gynaecology, Croydon University Hospital, Croydon, UK
| | - I Van Gruting
- Obstetrics and Gynaecology, Croydon University Hospital, Croydon, UK
| | - A Sultan
- Obstetrics and Gynaecology, Croydon University Hospital, Croydon, UK
| | - R Thakar
- Obstetrics and Gynaecology, Croydon University Hospital, Croydon, UK
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Vela S, Videla S, Ornelas A, Revollo B, Clotet B, Sirera G, Piñol M, García-Cuyás F. Effectiveness of physically ablative and pharmacological treatments for anal condyloma in HIV-infected men. PLoS One 2018; 13:e0199033. [PMID: 30067738 PMCID: PMC6070186 DOI: 10.1371/journal.pone.0199033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/30/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is limited information on the effectiveness of available treatments for anal condyloma acuminata in HIV-1-infected men. AIM To provide data on the effectiveness of electrosurgical excision, infrared coagulation and pharmacological (imiquimod) treatments for anal condyloma acuminata (peri-anal and/or intra-anal) in HIV-1-infected men based on authors' practice. METHODS Single-center, retrospective descriptive analysis of HIV-1-infected men, 18 years or older treated for anal condyloma acuminata. Standard treatments were offered: electrosurgery excision, infrared coagulation and topical imiquimod. Effectiveness was evaluated by the recurrence rate at 1 year after treatment. Recurrence was defined as any anal condyloma acuminata diagnosed after 3 months of condyloma-free survival post-treatment. Anal cytology and human-papillomavirus-infection (HPV) was assessed. RESULTS Between January 2005 and May 2009, 101 men were treated for anal condyloma acuminata: 65 (64%) with electrosurgery, 27 (27%) with infrared coagulation and 9 (9%) with imiquimod. At 1 year after treatment, the cumulative recurrence rate was 8% (4/65, 95%CI: 2-15%) with electrosurgery excision, 11% (3/27, 95%CI: 4-28%) with infrared coagulation and 11% (1/9, 95%CI: 2-44%) with imiquimod treatment. No predictive factors were associated with recurrence. Anal HPV-6 or HPV-11 was detectable in 98 (97%) patients and all had high-risk HPV genotypes, and 89 (88%) patients had abnormal anal canal cytology. Limitations: this was a retrospective descriptive analysis; limited to a single center; it cannot know if the recurrence is related to new infection. CONCLUSION Recurrence of anal condyloma after any treatment was common. Abnormal anal cytology and high-risk HPV-infection were highly prevalent in this population, therefore at high-risk of anal cancer, and warrants careful follow-up.
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Affiliation(s)
- Sandra Vela
- Department of Surgery, University Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
- Lluita Contra La SIDA Foundation, University Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Sebastian Videla
- Lluita Contra La SIDA Foundation, University Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
- Department of Clinical Pharmacology, University Hospital Bellvitge / IDIBELL / Barcelona University, Hospitalet de Llobregat, Barcelona, Catalonia, Spain
- * E-mail: , ,
| | - Arelly Ornelas
- Lluita Contra La SIDA Foundation, University Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Boris Revollo
- Lluita Contra La SIDA Foundation, University Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
- HIV Clinical Unit, Department of Medicine, University Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Bonaventura Clotet
- Lluita Contra La SIDA Foundation, University Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
- HIV Clinical Unit, Department of Medicine, University Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
- Retrovirology Laboratory IrsiCaixa Foundation, Badalona, Catalonia, Spain
| | - Guillem Sirera
- Lluita Contra La SIDA Foundation, University Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
- HIV Clinical Unit, Department of Medicine, University Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Marta Piñol
- Department of Surgery, University Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
- Lluita Contra La SIDA Foundation, University Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Francesc García-Cuyás
- Department of Surgery, University Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
- Lluita Contra La SIDA Foundation, University Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
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Abstract
A study of 350 women with lichen sclerosus, originally made to elucidate the relationship between lichen sclerosus and autoimmunity, led to the amassing of a considerable amount of clinical material. Our review is confined to those with anogenital lesions (342), supplemented by some new cases (15), giving a total of 357 women with biopsy proven lichen sclerosus. It demonstrates the wide age range of the condition, the association with morphoea and lichen planus and the occurrence of squamous cell carcinoma in some cases. It also shows that inappropriate surgery has continued to be carried out for benign disease.
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Affiliation(s)
- R H Thomas
- Salisbury District Hospital, Wiltshire, England
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Chang H, Kuo MC, Tang TC, Lin TL, Wu JH, Hung YS, Wang PN. Clinical Features and Recurrence Pattern of Perianal Abscess in Patients with Acute Myeloid Leukemia. Acta Haematol 2017; 138:10-13. [PMID: 28586772 DOI: 10.1159/000475589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/10/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Perianal abscess may develop during neutropenia periods in patients with acute myeloid leukemia (AML). The standard of care for perianal abscess in AML is unclear. METHODS We retrospectively collected patient data in our institute from 2009 to 2012. RESULTS Two hundred ninety-two patients with AML were analyzed. In total, 1,051 chemotherapy sessions were administered. Twenty-three patients experienced perianal abscess. Patients with perianal abscess were younger than those without (44 vs. 60 years, p < 0.0001). Perianal abscess developed in various phases of treatment and in the stem cell transplantation period. Twelve recurrences developed in 6 patients. Patients with a prior perianal abscess have a 10-fold risk of developing a subsequent abscess following further chemotherapy. The microbiology profile revealed that most pathogens were derived from the intestinal tracts, which was similar to the findings of previous studies. The 28-day mortality was 14.3% and the direct cause of death was not perianal abscess in any case. Surgical interventions had no impact on recurrence or survival. CONCLUSION In patients with AML, perianal abscess results from gastrointestinal tract pathogens. Many patients do not require surgical interventions. The mortality is low but recurrence is common following subsequent chemotherapies. Therefore, awareness of recurrence is important for the timely management of perianal abscess in AML.
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Affiliation(s)
- Hung Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Kweishan, Taiwan
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Church JT, Gadepalli SK, Talishinsky T, Teitelbaum DH, Jarboe MD. Ultrasound-guided intrasphincteric botulinum toxin injection relieves obstructive defecation due to Hirschsprung's disease and internal anal sphincter achalasia. J Pediatr Surg 2017; 52:74-78. [PMID: 27836361 DOI: 10.1016/j.jpedsurg.2016.10.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 10/20/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE Chronic obstructive defecation can occur in patients with Hirschsprung Disease (HD) and internal anal sphincter (IAS) achalasia. Injection of Botulinum Toxin (BoTox) into the IAS can temporarily relieve obstructive defecation, but can be challenging when performed by tactile sense alone. We compared results of BoTox injections with and without ultrasound (US) guidance. METHODS We retrospectively reviewed BoTox injections into the IAS for obstructive defecation over 5years. Analyzed outcomes included short-term improvement, defined as resolution of enterocolitis, new ability to spontaneously defecate, and/or normalization of bowel movement frequency 2weeks post-operatively, as well as requirement of more definitive surgical therapy (myotomy/myomectomy, colectomy, colostomy, cecostomy/appendicostomy, and/or sacral nerve stimulator implantation). Outcomes were compared using t-test and Fisher's Exact test, with significance defined as p<0.05. RESULTS Twelve patients who underwent BoTox injection were included, including 5 patients who underwent injections both with and without ultrasound. Ten underwent an ultrasound-guided injection (13 injection procedures), 5 of whom had HD. Seven underwent an injection without ultrasound guidance (17 injection procedures), 5 of whom had HD. Procedures performed with US resulted in greater short-term improvement (76% versus 65% without ultrasound) and less requirement of a definitive procedure for obstructive defecation (p<0.05). CONCLUSIONS US-guided BoTox injection is safe and effective for obstructive defecation, and may decrease the need for a definitive operation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Joseph T Church
- Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA.
| | - Samir K Gadepalli
- Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA
| | - Toghrul Talishinsky
- Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA
| | - Daniel H Teitelbaum
- Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA
| | - Marcus D Jarboe
- Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, USA
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Nicol AF, Brunette LL, Nuovo GJ, Grinsztejn B, Friedman RK, Veloso VG, Cunha CB, Coutinho JR, Vianna-Andrade C, Oliveira NS, Woodham AW, DA Silva DM, Kast WM. Secretory Leukocyte Protease Inhibitor Expression and High-Risk HPV Infection in Anal Lesions of HIV-Positive Patients. J Acquir Immune Defic Syndr 2016; 73:27-33. [PMID: 27149102 PMCID: PMC4981526 DOI: 10.1097/qai.0000000000001049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate secretory leukocyte protease inhibitor (SLPI) expression in anal biopsies from HIV-positive (HIV+) individuals, and compare that to anal intraepithelial neoplasia (AIN) diagnoses and human papillomavirus (HPV) status. DESIGN This is a cross-sectional study of a cohort of 54 HIV+ (31 males and 23 females) from an AIDS clinic in Rio de Janeiro, Brazil. METHODS The study material consisted of anorectal tissue biopsies obtained from HIV+ subjects, which were used to construct tissue microarray paraffin blocks for immunohistochemical analysis of SLPI expression. Biopsies were evaluated by an expert pathologist and classified as low-grade AIN1, high-grade AIN2/3, or normal squamous epithelium. In addition, DNA from the biopsies was extracted and analyzed for the presence of low- or high-risk HPV DNA. RESULTS Histologically, normal squamous epithelium from the anorectal region showed strong positive SLPI staining in 17/20 (85%) samples. In comparison, 9/17 (53%) dysplastic squamous epithelial samples from AIN1 patients showed strong SLPI staining, and only 5/17 (29%) samples from AIN2/3 patients exhibited strong SPLI staining, which both were significantly fewer than those from normal tissue (P = 0.005). Furthermore, there was a significantly higher proportion of samples in which oncogenic high-risk HPV genotypes were detected in low SLPI-expressing tissues than that in tissues with high SLPI expression (P = 0.040). CONCLUSIONS Taken together these results suggest that low SLPI expression is associated with high-risk HPV infections in the development of AIN.
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Affiliation(s)
- Alcina F Nicol
- Laboratory of Interdisciplinary Medical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Laurie L Brunette
- Norris Comprehensive Cancer Center, Departments of Obstetrics & Gynecology and Molecular Microbiology & Immunology, University of Southern California, Los Angeles, California, USA
| | - Gerard J Nuovo
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | - Beatriz Grinsztejn
- Laboratory of Interdisciplinary Medical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ruth K Friedman
- Laboratory of Interdisciplinary Medical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Valdiléa G Veloso
- Laboratory of Interdisciplinary Medical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cynthia B Cunha
- LabClin DST/AIDS, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - José R Coutinho
- Laboratory of Interdisciplinary Medical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cecilia Vianna-Andrade
- Laboratory of Interdisciplinary Medical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Nathalia S Oliveira
- Laboratory of Interdisciplinary Medical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Andrew W Woodham
- Norris Comprehensive Cancer Center, Departments of Obstetrics & Gynecology and Molecular Microbiology & Immunology, University of Southern California, Los Angeles, California, USA
| | - Diane M DA Silva
- Norris Comprehensive Cancer Center, Departments of Obstetrics & Gynecology and Molecular Microbiology & Immunology, University of Southern California, Los Angeles, California, USA
| | - W Martin Kast
- Norris Comprehensive Cancer Center, Departments of Obstetrics & Gynecology and Molecular Microbiology & Immunology, University of Southern California, Los Angeles, California, USA
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Nowak RG, Gravitt PE, He X, Ketende S, Dauda W, Omuh H, Blattner WA, Charurat ME. Prevalence of Anal High-Risk Human Papillomavirus Infections Among HIV-Positive and HIV-Negative Men Who Have Sex With Men in Nigeria. Sex Transm Dis 2016; 43:243-8. [PMID: 26967301 PMCID: PMC4789762 DOI: 10.1097/olq.0000000000000431] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Prevalence estimates of anal high-risk human papillomavirus (HR-HPV) are needed in sub-Saharan Africa where HIV is endemic. This study evaluated anal HR-HPV in Nigeria among HIV-positive and HIV-negative men who have sex with men (MSM) for future immunization recommendations. METHODS We conducted a cross-sectional study to compare the prevalence of anal HR-HPV infections between 64 HIV-negative and 90 HIV-positive MSM. Multivariate Poisson regression analyses were used to examine demographic and behavioral risk factors associated with any HR-HPV infections. RESULTS The median age of the 154 participants was 25 years (interquartile range, 22-28 years; range, 16-38 years), and the median age at initiation of anal sex with another man was 16 years (interquartile range, 13-18 years; range, 7-29 years). The prevalence of anal HR-HPV was higher among HIV-positive than HIV-negative MSM (91.1% vs. 40.6%, P < 0.001). In the multivariate analysis, HIV infection (adjusted prevalence ratio [aPR], 2.02; 95% confidence interval [CI], 1.49-2.72), 10 years or more since anal sexual debut (aPR, 1.26; 95% CI, 1.07-1.49), and concurrent relationships with men (aPR, 1.32; 95% CI, 1.04-1.67) were associated with increased anal HR-HPV prevalence. CONCLUSIONS Anal HR-HPV infection is high for young Nigerian MSM, and rates are amplified in those coinfected with HIV. Providing universal coverage as well as catch-up immunization for young MSM may be an effective anal cancer prevention strategy in Nigeria.
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Affiliation(s)
- Rebecca G Nowak
- From the *Institute of Human Virology and †Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; ‡University of New Mexico Health Sciences Center, Albuquerque, NM; §University of Maryland School of Public Health, College Park, MD; ¶Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and ∥Institute of Human Virology Nigeria, Federal Capital Territory, Nigeria
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Komissarov IA, Vasil’ev SV, Nedozimovannyi AI, Dement’eva EA. EXPERIENCE OF APPLICATION OF VOLUME FORMING AGENT «DAM+» IN TREATMENT OF ANAL INCONTINENCE ASSOCIATED WITH INCOMPETENCE AND TRAUMA OF ANAL SPHINCTER. Vestn Khir Im I I Grek 2016; 175:78-81. [PMID: 30427138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The attempts of introduction of volume forming agent in submucous layer started at the beginning of 1990th. The aim of these innovations was to rise of basal pressure. This research has been performing since 2007. It included experimental and clinical phases with participation of 41 patients with anal incompetence aged 3–26 years old. The agent «DAM+» was introduced in submucous layer of anal сanal in four points. The basal pressure was risen in 2–3 times after implantation and it was at the average more 65% of age standards. The application of volume forming agent «DAM+» is effective method of correction of anal incontinence. It’ll require the re-introduction procedure in longterm period.
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Brown B, Davtyan M, Leon SR, Sanchez H, Calvo G, Klausner JD, Galea J. A prospective cohort study characterising the role of anogenital warts in HIV acquisition among men who have sex with men: a study protocol. BMJ Open 2014; 4:e005687. [PMID: 25227629 PMCID: PMC4166134 DOI: 10.1136/bmjopen-2014-005687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION The HIV epidemic in Latin America is concentrated among men who have sex with men (MSM) and transgender women (TGW) with transmission predominately occurring during unprotected anal intercourse. This mode of transmission is also responsible for other sexually transmitted infections (STIs) such as herpes simplex, chlamydia and gonorrhoea, human papillomavirus (HPV)/genital warts and syphilis. Studies assessing the prevalence of HIV and HPV among MSM have not addressed the role of genital warts and HPV-related diseases in the acquisition of HIV infection. Community-based testing programmes are a potentially important way to remove barriers including stigma for individuals to learn about their STI status. METHODS AND ANALYSIS The prospective cohort study will recruit 600 MSM/TGW at a community centre in Lima, Peru, named Epicentro. Half of the participants will have a history of or have current anogenital warts (AGW), and the other half will have no history of AGW. We will measure the prevalence and acquisition of STIs including syphilis, HPV, chlamydia and gonorrhoea and the HIV-incidence in the two groups. To the best of our knowledge, it will be the first study that specifically examines the impact of genital warts on incident HIV infection. This study will help to understand the relationship between AGW and HIV infection among MSM/TGW in Peru. Furthermore, it may facilitate the development of preventive intervention strategies to reduce the prevalence of AGW and prevent incident HIV infection. HPV-related manifestations may be a good proxy for HIV risk. ETHICS AND DISSEMINATION This study was approved by institutional review boards at the University of California, Los Angeles (UCLA) in the USA and Impacta in Peru. Study findings will be shared with the Peruvian Ministry of Health as well as other international and national public health organisations. Study results will be translated into Spanish for participants. TRIAL REGISTRATION NUMBER The Clinicaltrials.gov registration number is NCT01387412.
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Affiliation(s)
- Brandon Brown
- Program in Public Health, Department of Population Health and Disease Prevention, University of California, Irvine, California, USA
| | - Mariam Davtyan
- Program in Public Health, Department of Population Health and Disease Prevention, University of California, Irvine, California, USA
| | - Segundo R Leon
- Unit of Health, Sexuality and Human Development, Cayetano Heredia University School of Public Health, Lima, Peru
| | | | | | - Jeffrey D Klausner
- Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, USA
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Abstract
Perianal diseases are the most common reasons for surgery in HIV-positive patients. This study aimed to evaluate the outcomes of these surgical procedures in Korean patients, focusing on wound healing and postoperative complications. Retrospective analysis was performed on 72 HIV-positive patients who underwent surgery by a single surgeon for benign anal disease between 1998 and 2011. Of these, 68.1% (49/72) of patients received surgery for condyloma acuminata, 19.4% (14/72) for anal fistulas, 6.9% (5/72) for hemorrhoids, and 5.6% (4/72) for perianal abscesses. Patients with condyloma acuminata received surgical excision with electrical coagulation, and all wounds healed completely within 3 months, though 16.3% (8/49) of these patients experienced recurrence. Twelve of the 49 patients (24.5%) who were treated for condyloma acuminata underwent simultaneous operations for concomitant anal fistulas (n = 6), hemorrhoids (n = 4), and perianal abscesses (n = 2). Overall, 3 postoperative complications developed following a total of 94 procedures, and there was no significant increase in complication rate for patients with a low CD4+ T-cell count ( < 200/µL) compared to those with a higher count. The results demonstrate favorable results following perianal surgery in HIV-positive Korean patients.
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Affiliation(s)
- Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hui Moon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seungbum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Kyung Choe
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Del Popolo F, Cioli VM, Plevi T, Pescatori M. Psycho-echo-biofeedback: a novel treatment for anismus--results of a prospective controlled study. Tech Coloproctol 2014; 18:895-900. [PMID: 24858578 DOI: 10.1007/s10151-014-1154-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/12/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND Anismus or non-relaxing puborectalis muscle (PRM), detectable with anal/vaginal ultrasound (US), is a cause of obstructed defecation (OD) and may be treated with biofeedback (BFB). Many patients with anismus are anxious and/or depressed. The aim of this prospective study was to evaluate the outcome of the novel procedure psycho-echo-BFB in patients with anismus and psychological disorders. METHODS Patients presenting at our unit with anismus and psychological disorders between January 2009 and December 2013, and not responding to conventional conservative treatment, were enrolled in the study. All underwent four sessions of psycho-echo-BFB, carried out by two psychologists and a coloproctologist, consisting of guided imagery, relaxation techniques and anal/vaginal US-assisted BFB. A validated score for OD was used, and PRM relaxation on straining measured before and after the treatment. PRM relaxation was also measured in a control group of 7 patients with normal bowel habits. RESULTS Ten patients (8 females, median age 47 years, range 26-72 years) underwent psycho-echo-BFB. The OD score, evaluated prior to and at a median of 25 months (range 1-52 months) after the treatment, improved in 7 out of 10 patients, from 13.5 ± 1.2 to 9.6 ± 2.2 (mean ± standard error of the mean (SEM)), p = 0.06. At the end of the last session, PRM relaxed on straining in all cases, from 0 to 7.1 ± 1.1 mm, i.e., physiological values, not statistically different from those of controls (6.6 ± 1.5 mm). Two patients reported were cured, 3 improved and 5, all of whom had undergone prior anorectal surgery, unchanged. No side effects were reported. CONCLUSIONS Psycho-echo-BFB is safe and inexpensive and allows all patients with anismus to relax PRM on straining. Previous anorectal surgery may be a negative predictor.
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Affiliation(s)
- F Del Popolo
- Coloproctology Unit, Parioli Clinic, Rome, Italy
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Svabik K, Martan A, Masata J, El-Haddad R, Hubka P. Comparison of vaginal mesh repair with sacrospinous vaginal colpopexy in the management of vaginal vault prolapse after hysterectomy in patients with levator ani avulsion: a randomized controlled trial. Ultrasound Obstet Gynecol 2014; 43:365-371. [PMID: 24615948 DOI: 10.1002/uog.13305] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 12/13/2013] [Accepted: 12/18/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare the efficacy of two standard surgical procedures for post-hysterectomy vaginal vault prolapse in patients with levator ani avulsion. METHODS This was a single-center, randomized interventional trial, of two standard surgical procedures for post-hysterectomy vaginal vault prolapse: Prolift Total vs unilateral vaginal sacrospinous colpopexy with native tissue vaginal repair (sacrospinous fixation, SSF), during the period from 2008 to 2011. Entry criteria included at least two-compartment prolapse, as well as complete unilateral or bilateral levator ani avulsion injury. The primary outcome was anatomical failure based on clinical and ultrasound assessment. Failure was defined clinically, according to the Pelvic Organ Prolapse Quantification system, as Ba, C or Bp at the hymen or below, and on translabial ultrasound as bladder descent to 10 mm or more below the lower margin of the symphysis pubis on maximum Valsalva maneuver. Secondary outcomes were evaluation of continence, sexual function and prolapse symptoms based on validated questionnaires. RESULTS During the study period, 142 patients who were post-hysterectomy underwent surgery for prolapse in our unit; 72 of these were diagnosed with an avulsion injury and were offered participation in the study. Seventy patients were randomized into two groups: 36 in the Prolift group and 34 in the SSF group. On clinical examination at 1-year follow-up, we observed one (3%) case of anatomical failure in the Prolift group and 22 (65%) in the SSF group (P < 0.001). Using ultrasound criteria, there was one (2.8%) failure in the Prolift group compared with 21 (61.8%) in the SSF group (P < 0.001). The postoperative POPDI (Pelvic Organ Prolapse Distress Inventory) score for subjective outcome was 15.3 in the Prolift group vs 21.7 in the SSF group (P = 0.16). CONCLUSION In patients with prolapse after hysterectomy and levator ani avulsion injury, SSF has a higher anatomical failure rate than does the Prolift Total procedure at 1-year follow-up.
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Affiliation(s)
- K Svabik
- Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
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Abstract
Although human papillomavirus (HPV) infections are common in HIV-infected adults, little is known about children. Our objective was to examine the prevalence of and risks for HPV of the oral mucosal and external genital areas in nonsexually active (NSA) perinatally (P) HIV+ children and compare with HIV-exposed but uninfected (HEU) children. A convenience sample attending a pediatric clinic were enrolled. Samples for HPV were obtained from the oral and anogenital areas and tested for one of 37 HPV types. The mean age of the 48 PHIV+ children was 14.3±3.9 years vs. 6.2±4.8 for the 52 HEU (p<0.001). Of the 23 PHIV+ girls, 30.4% had anogenital and 17% had oral HPV, and of the 27 HEU girls, 2 (7.4%) anogenital and 0 had oral HPV. Of the boys, 4/23 (17.4%) and 1/25 (4%) PHIV+ had anogenital and oral HPV, respectively, and 3/24 (12.5%) and 1/25 (4%) HEU had anogenital and oral HPV, respectively. Rates of HPV did not differ by age among the PHIV+, whereas older HEU were more likely to have HPV than younger HEU (p=0.07). This large age gap precluded statistical comparison by HIV status. The presence of HPV in NSA PHIV+ children may have implications regarding HPV vaccination efficacy.
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Affiliation(s)
- Anna-Barbara Moscicki
- 1 Division of Adolescent Medicine, Department of Pediatrics, University of California San Francisco , San Francisco, California
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32
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Roche B. [Anorectal pain]. Rev Med Suisse 2014; 10:234-236. [PMID: 24624668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Pellino G, Selvaggi F. Education and imaging. Gastrointestinal: Symmetric lymphangitis of lower limbs originating from a perianal abscess. J Gastroenterol Hepatol 2013; 28:1690. [PMID: 24308045 DOI: 10.1111/jgh.12381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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34
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Mazur A, Karbowski M. [Fournier's gangrene--a case report]. Wiad Lek 2013; 66:260-261. [PMID: 24483035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Fournier's gangren is a rare infectious disease characterized by rapidly necrotising fasciitis of the genital, perineal and perianal regions caused by mixed aerobic and anaerobic bacterial flora. The authors report a case of man with Fournier's gangrene in course of perianal abscess.
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Affiliation(s)
- Andrzej Mazur
- Oddział Chirurgii Ogólnej w Szpitalu Powiatowym w Kedzierzynie-Koźlu
| | - Michał Karbowski
- Oddział Chirurgii Ogólnej w Szpitalu Powiatowym w Kedzierzynie-Koźlu
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35
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Sehnal B, Driák D, Neumannová H, Kolařík D, Menzlová E, Sláma J. [Prevalence of anal human papillomavirus infection among women and its relation to cervical HPV infection]. Ceska Gynekol 2012; 77:210-214. [PMID: 22779720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To summarize current knowledge of prevalence, duration and clearance of anal HPV infection among women and its relation to cervical HPV infection. DESIGN Review article. SETTING Department of Gynecology and Obstetrics, Hospital Na Bulovce and 1st Medical School of Charles University, Prague; Institute for the Care of Mother and Child, Prague; Gynecologic Oncology Center, Department of Gynecology and Obstetrics, General Faculty Hospital and 1st Medical School of Charles University, Prague. RESULTS The infection of human papillomavirus (HPV) is strongly associated with the development of anal cancer. Anal HPV infection is common and most anal HPV infections are transient. Women with cervical HPV infection, cervical dysplasia and cervical cancer are at the increased risk. Concurrent anal and cervical HPV infection is most prevalent among the youngest women. By contrast, the prevalence of anal infection alone remains relatively steady in all age groups. Compared with cervical infections, the overall distribution of HPV genotypes in the anus are more heterogeneous and include a greater proportion of nononcogenic types. A high degree of genotype-specific concordance is observed among concurrent anal and cervical infections, indicating a common source of infection. Tobacco smoking delays clearance of anal HPV. CONCLUSION The high degree of genotype-specific concordance suggests that the cervix may be primary source and may serve as reservoir of HPV infection, too. Any type of sexual contact may be a route of transmission, history of anal intercourse is not a condition. The women with HPV related disease of low genital tract form high-risk group for acquisition of anal HPV infection and development of anal carcinoma.
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Affiliation(s)
- B Sehnal
- Gynekologicko-porodnicka klinika, Univerzity Karlovy.
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Villar M, Petiti G, Guerra A, Vanaclocha F. [Anogenital granulomatosis]. Actas Dermosifiliogr 2011; 103:76-9. [PMID: 22078767 DOI: 10.1016/j.ad.2011.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 05/02/2011] [Accepted: 05/15/2011] [Indexed: 11/17/2022] Open
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Lin CT, Lee YY, Chen CY, Wu CC, Jin JS, Jao SW. Not only condyloma acuminata of the anal canal: a rare case with coexisting adenocarcinoma. Rev Esp Enferm Dig 2011; 103:598-599. [PMID: 22149566 DOI: 10.4321/s1130-01082011001100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Grano C, Aminoff D, Lucidi F, Violani C. Long-term disease-specific quality of life in adult anorectal malformation patients. J Pediatr Surg 2011; 46:691-698. [PMID: 21496539 DOI: 10.1016/j.jpedsurg.2010.10.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 10/11/2010] [Accepted: 10/17/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fecal and urinary incontinence may differently influence various aspects of quality of life (QOL). The main aim of the present study is to determine whether fecal and urinary incontinence measured at time 1 of the study will predict QOL at time 2 (after 4 years), above and beyond the prediction already explained by fecal and urinary incontinence at time 2. METHODS Thirty-six adult patients from the Italian Parents' and Patients' Association for Anorectal Malformations answered items about urinary and fecal incontinence at time 1 of the study and completed the Hirschsprung Disease/Anorectal Malformation Quality of Life questionnaire after 4 years from the first questionnaire. Two sets of hierarchical regression analyses were conducted with fecal and urinary incontinence serving as predictors of QOL and the different areas of QOL from the Hirschsprung Disease/Anorectal Malformation Quality of Life serving as outcome variables. RESULTS The principal findings indicated that fecal continence is a strong predictor of QOL in the areas of social functioning, emotional functioning, and body image and that urinary incontinence predicted sexual functioning. CONCLUSIONS It seems that one's past experience with fecal incontinence is extremely relevant to current QOL, especially for body image. Urinary incontinence contributed less in explaining QOL in our patients, but because it is very relevant for sexual functioning, it should not be disregarded.
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Affiliation(s)
- Caterina Grano
- Department of Psychology, University of Rome "La Sapienza," 00185 Rome, Italy.
| | - Dalia Aminoff
- Italian Parents and Patients Organization for Anorectal Malformation (AIMAR), 00199 Rome, Italy.
| | - Fabio Lucidi
- Department of Social and Development Psychology, University of Rome "La Sapienza," 00185 Rome, Italy.
| | - Cristiano Violani
- Department of Psychology, University of Rome "La Sapienza," 00185 Rome, Italy.
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Monsel G, Martinez V, Izzedine H, Mory B, Bricaire F, Caumes E. Anal tuberculosis complicated by secondary amyloidosis. Med Mal Infect 2011; 41:264-6. [PMID: 21420811 DOI: 10.1016/j.medmal.2010.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 09/21/2010] [Accepted: 12/14/2010] [Indexed: 12/20/2022]
Affiliation(s)
- G Monsel
- Service des maladies infectieuses et tropicales, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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40
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Villa C, Pompili G, Franceschelli G, Munari A, Radaelli G, Maconi G, Cornalba GP. Role of magnetic resonance imaging in evaluation of the activity of perianal Crohn's disease. Eur J Radiol 2011; 81:616-22. [PMID: 21316171 DOI: 10.1016/j.ejrad.2011.01.046] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 01/03/2011] [Indexed: 12/11/2022]
Abstract
AIM To evaluate the diagnostic ability of contrast-enhanced Magnetic Resonance Imaging (MRI) in assessment of the activity of perianal fistulas in Crohn's disease (CD) patients, compared to clinical data. MATERIALS AND METHODS Fifty CD patients (25 men; mean[SD] age: 40.4[12.6] years) with known or suspected perianal fistulas underwent perianal space MRI. Radiological activity of disease was measured as the percentage increase (PI) of ROI values of fistulas in relation to ROI values of healthy local fat, after contrast administration. Clinical activity of disease was defined according to Perianal Disease Activity Index (PDAI) and Fistula Drainage Assessment (FDA). RESULTS Forty-two patients presented perianal disease at MRI (55 fistulas identified). An association between both fistula's PI and PDAI (Pearson's coefficient 0.512, p<0.0001) and between PI and FDA (p=0.003) was demonstrated. Areas under ROC curves of PI values in relation to PDAI and FDA were respectively 0.876 [95%CI=(0.743-1.00), p<0.001] and 0.784 [95%CI=(0.588-0.980), p=0.003]. A cut-off value of PI, calculated on these preliminary data, correctly classified more than 90% of fistulas. CONCLUSIONS Contrast-enhanced MRI with PI calculation offered practical information about activity of perianal fistulas and might be helpful in providing a comprehensive evaluation of CD perianal disease.
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Affiliation(s)
- Chiara Villa
- Department of Diagnostic and Interventional Radiology, San Paolo Hospital, Università degli Studi di Milano, via A. di Rudinì 8, 20142 Milan, Italy.
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41
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Bharucha AE, Wald AM. [Anorectal disorders]. Rev Gastroenterol Mex 2010; 75:497-507. [PMID: 21169120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Adil E Bharucha
- Clinical and Enteric Neuroscience Translational and Epidemiological Research Program, Mayo Clinic, Rochester, Minnesota, USA.
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42
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Urek MC, Korica M, Banić M, Kujundžić M. Therapeutic dilemmas in patient with perianal Crohn's disease and corticosteroid dependent difficult-to-control asthma. J Crohns Colitis 2010; 4:486-7. [PMID: 21122550 DOI: 10.1016/j.crohns.2010.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 07/16/2010] [Indexed: 02/08/2023]
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43
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Garrido-Ríos AA, Sanz-Muñoz C, Miranda-Sivelo A, Miranda-Romero A. Major depressive episode secondary to condylomata acuminata. Gen Hosp Psychiatry 2010; 32:446.e3-5. [PMID: 20633752 DOI: 10.1016/j.genhosppsych.2009.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 07/09/2009] [Accepted: 07/11/2009] [Indexed: 11/18/2022]
Abstract
Psychiatric and psychological morbidity is often associated with skin diseases. Recent research has focused on the epidemiological and clinical aspects of human papillomavirus infection, whereas the psychosocial and emotional factors related to the disease have not been well established. We describe the experience of a 22-year-old male who, after being diagnosed of condyloma acuminata, developed a major depressive disorder.
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44
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Gingelmaier A, Weissenbacher T, Kost B, Kaestner R, Sovric M, Mylonas I, Friese K, Bergauer F. Anal cytology as a screening tool for early detection of anal dysplasia in HIV-infected women. Anticancer Res 2010; 30:1719-1723. [PMID: 20592367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND AND AIM HIV-infected patients show a high rate of anal dysplasia and anal carcinoma but there is no gold standard for early detection. Therefore, the objectives of this prospective study were: a) evaluation of an anal screening using anal/perianal cytology; b) in case of a positive result to investigate its relation to immune status, clinical symptoms of HIV infection and antiretroviral therapy. PATIENTS AND METHODS In every HIV-infected woman visiting our gynaecological outpatient clinic, an anal and perianal swab for anal cytology was taken. One experienced cytologist examined all specimens. Relevant details of the HIV-related history such as CDC classification, CD4 count, viral load, actual antiretroviral therapy etc. were documented. RESULTS Altogether, 104 HIV-infected women were enrolled on this study. The results of 13 (13.5%) anal cytologies were classified as suspicious for low-grade or high-grade anal dysplasia and 6 of these were confirmed in an anal biopsy. A total of 9 out of 13 also had a cervical dysplasia and 12 were positive for high-risk HPV at the cervix. Ten of these women had already experienced clinical symptoms of their HIV infection and 8 showed a nadir of the CD4 count below 200 cells/microl. All but one took a highly active antiretroviral therapy. CONCLUSION In this pilot study, anal screening using anal cytology showed 13.5% suspected anal dysplasia in HIV-infected women. All performed biopsies revealed the presence of a high-grade anal lesion. The majority of these women already had an advanced disease and/or immune defect related to their HIV infection. In summary, we found anal cytology to be a useful tool to early detect anal dysplasia of high-risk patients such as HIV-infected women. How far this screening method contributes to the prevention of anal cancer has to be evaluated in further investigations.
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Affiliation(s)
- Andrea Gingelmaier
- Department of Obstetrics and Gynecology, Downtown Campus, Ludwig Maximilians University, Munich, Germany.
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García-Olmo D, Pascual Migueláñez I. A sonograph in the proctology clinic - an aid to the "learned finger". Rev Esp Enferm Dig 2010; 102:1-6. [PMID: 20187678 DOI: 10.4321/s1130-01082010000100001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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46
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Casado B, Gómez-Fernández C, Feito M, González-Beato MJ. [Perianal verrucous papules in a patient with Bannayan-Riley-Ruvalcaba syndrome]. Actas Dermosifiliogr 2009; 100:920-922. [PMID: 20038379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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Ruiz HD, Musso J, Ortega A, Moreno L, Obredor CM, Zorraquín C. [Primary anal tuberculous fissure]. Acta Gastroenterol Latinoam 2009; 39:190-192. [PMID: 19845258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The anal tuberculous (TBC) fissure is infrequent. For this reason diagnosis is difficult. A case of a female adult patient with anal TBC fissure that consults for bleeding and perianal pain is presented. The perianal tuberculosis is a rare manifestation of the general disease. A routine biopsy must be performed, with the corresponding histopathologic study. A specific origin should be suspected when an anal chronic fissure, painful and bleeding, without response to the habitual treatment, is found. The primary TBC fissure can be cured with the administration of three drugs during 3 to 4 months.
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Affiliation(s)
- Hugo Daniel Ruiz
- Servicio de Cirugía General y Sección Coloproctología, Hospital Nacional Dr Profesor Alejandro Posadas, El Palomar, Buenos Aires, Argentina.
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48
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49
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Hull M, Corton MM. Evaluation of the levator ani and pelvic wall muscles in levator ani syndrome. Urol Nurs 2009; 29:225-231. [PMID: 19718937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Chronic pelvic pain is a difficult problem to evaluate and treat. Knowledge of the pelvic floor and pelvic wall muscles may enable the provider to identify levator ani spasm syndrome, a possible cause of chronic pelvic pain.
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Affiliation(s)
- Margaret Hull
- Center for Pelvic Health, St. Thomas Health Services, Franklin, TN, USA
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50
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Murua AA, González LC, García-Río I, Urra IT, Michelena IA, González-Pérez R, Santarén BC, Arechavala RS. Coexisting perianal squamous cell carcinoma, Bowen's disease, and condylomata acuminata treated with topical imiquimod 5%. Int J Dermatol 2009; 47:1334-6. [PMID: 19126041 DOI: 10.1111/j.1365-4632.2008.03877.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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