Resultados do tratamento do carcinoma espinocelular anal e do seu precursor em doentes HIV-positivos Outcome of treatment of anal squamous cell carcinoma and its precursor in HIV-infected patients

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Sidney Roberto Nadal

2007-08-01

Full Text Available OBJETIVO: A incidência de carcinomas espinocelulares anais vem aumentando nos doentes HIV-positivos. O tratamento consiste de radio e/ou quimioterapia, eventualmente seguidos pela ressecção do tumor. O objetivo é avaliar o seguimento desses doentes para verificar as recidivas e a evolução do NIAA para câncer. Apresentação da casuística da Equipe Técnica de Proctologia do Instituto de Infectologia Emílio Ribas, de São Paulo. MÉTODOS: Acompanhamos 45 doentes HIV-positivos portadores de carcinoma espinocelular anal e seu precursor no período de 1996 a 2006. Eram 30 neoplasias intra-epiteliais anais de alto grau (NIAA, tratadas com ressecção local e 15 carcinomas invasores do canal anal. Nove das 15 lesões invasivas foram submetidas ao esquema de Nigro isolado ou associado à ressecção local, amputação abdominoperineal ou colostomia para derivação. RESULTADOS: No seguimento ambulatorial das NIAA tivemos recidiva em 16,7% e não observamos evolução para carcinoma, num período mínimo de três anos. Entre os nove tumores submetidos ao esquema de Nigro, com ou sem operação complementar, cinco estão livres de tumor. Nenhum tratamento foi feito em cinco doentes. Em três, devido às péssimas condições clínicas, e em dois, pois recusaram tratamento. Outro teve diagnóstico na vigência de oclusão intestinal sendo submetido à colostomia de derivação. CONCLUSÃO: Concluímos que a NIAA pode reincidir após excisão local em doentes HIV-positivos, mas não evolui para carcinoma invasor e que os doentes de câncer anal invasor podem ser tratados da mesma maneira que a população soronegativa para o HIV desde que as condições clínicas o permitam.OBJECTIVE: Incidence of anal squamous cell carcinoma is increasing mainly among HIV-positive patients. Treatment consists of radiotherapy and chemotherapy, sometimes followed by tumor resection. The objective was to evaluate the follow-up of such patients to verify recurrences

US Intergroup Anal Carcinoma Trial: Tumor Diameter Predicts for Colostomy

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Ajani, Jaffer A.; Winter, Kathryn A.; Gunderson, Leonard L.; Pedersen, John; Benson, Al B.; Thomas, Charles R.; Mayer, Robert J.; Haddock, Michael G.; Rich, Tyvin A.; Willett, Christopher G.

2009-01-01

Purpose The US Gastrointestinal Intergroup Radiation Therapy Oncology Group 98-11 anal carcinoma trial showed that cisplatin-based concurrent chemoradiotherapy resulted in a significantly higher rate of colostomy compared with mitomycin-based therapy. Established prognostic variables for patients with anal carcinoma include tumor diameter, clinical nodal status, and sex, but pretreatment variables that would predict the likelihood of colostomy are unknown. Methods A secondary analysis was performed by combining patients in the two treatment arms to evaluate whether new predictive and prognostic variables would emerge. Univariate and multivariate analyses were carried out to correlate overall survival (OS), disease-free survival, and time to colostomy (TTC) with pretreatment and treatment variables. Results Of 682 patients enrolled, 644 patients were assessable and analyzed. In the multivariate analysis, tumor-related prognosticators for poorer OS included node-positive cancer (P ≤ .0001), large (> 5 cm) tumor diameter (P = .01), and male sex (P = .016). In the treatment-related categories, cisplatin-based therapy was statistically significantly associated with a higher rate of colostomy (P = .03) than was mitomycin-based therapy. In the pretreatment variables category, only large tumor diameter independently predicted for TTC (P = .008). Similarly, the cumulative 5-year colostomy rate was statistically significantly higher for large tumor diameter than for small tumor diameter (Gray's test; P = .0074). Clinical nodal status and sex were not predictive of TTC. Conclusion The combined analysis of the two arms of RTOG 98-11, representing the largest prospective database, reveals that tumor diameter (irrespective of the nodal status) is the only independent pretreatment variable that predicts TTC and 5-year colostomy rate in patients with anal carcinoma. PMID:19139424

Anal carcinoma and HIV infection: is it time for screening?

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Herranz-Pinto, P; Sendagorta-Cudós, E; Bernardino-de la Serna, J I; Peña-Sánchez de Rivera, J M

2014-03-01

A 38-year-old white man had a 10-year history of human immunodeficiency virus (HIV) infection (A3), with no episodes of opportunistic diseases and in good immunologic recovery (CD4 cell count: 450 and indetectable HIV viral load) while on HAART. He presented with a two-month history of mild anal symptoms, including pruritus and episodic bleeding. He referred past episodes of anal warts, self-treated with several topical compounds, all proven unsuccessful. Perianal examination showed erythema and scratching. A 0.5cm sized tumor, with infiltration at the base was detected on digital exam, located at 15mm from the anal margin. Local biopsy driven by high-resolution anuscopy (AAR) yielded a final diagnosis of infiltrative epidermoid carcinoma. Might that neoplasia have been prevented? Copyright © 2013 Elsevier España, S.L. All rights reserved.

Anal carcinomas: the role of endoanal ultrasound and magnetic resonance imaging in staging, response evaluation and follow-up

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Parikh, Jyoti; Shaw, Aidan; Griffin, Nyree [Guys and St. Thomas' Hospital, Department of Radiology, London (United Kingdom); Grant, Lee A. [Royal Marsden Hospital, Department of Radiology, London (United Kingdom); Schizas, Alexis M.P.; Datta, Vivek; Williams, Andrew B. [Guys and St. Thomas' Hospital, Department of General Surgery, London (United Kingdom)

2011-04-15

Anal carcinoma is an important but rare condition, managed in specialist centres. Both endoanal ultrasound and magnetic resonance imaging (MRI) can be used in the locoregional staging and follow-up of patients with anal cancer, and both may assist in treatment planning and prognosis. Recent guidelines published by the European Society for Medical Oncology have recommended MRI as the technique of choice for assessment of locoregional disease. This paper describes the techniques for both endoanal ultrasound and MRI, and compares the relative merits and disadvantages of each in the local assessment of anal carcinoma. (orig.)

Carcinoma of the anal canal: Intensity modulated radiation therapy (IMRT) versus three-dimensional conformal radiation therapy (3DCRT)

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Sale, Charlotte; Moloney, Phillip; Mathlum, Maitham

2013-01-01

Introduction Patients with anal canal carcinoma treated with standard conformal radiotherapy frequently experience severe acute and late toxicity reactions to the treatment area. Roohipour et al. (Dis Colon Rectum 2008; 51: 147–53) stated a patient's tolerance of chemoradiation to be an important prediction of treatment success. A new intensity modulated radiation therapy (IMRT) technique for anal carcinoma cases has been developed at the Andrew Love Cancer Centre aimed at reducing radiation to surrounding healthy tissue. Methods A same-subject repeated measures design was used for this study, where five anal carcinoma cases at the Andrew Love Cancer Centre were selected. Conformal and IMRT plans were generated and dosimetric evaluations were performed. Each plan was prescribed a total of 54 Gray (Gy) over a course of 30 fractions to the primary site. Results The IMRT plans resulted in improved dosimetry to the planning target volume (PTV) and reduction in radiation to the critical structures (bladder, external genitalia and femoral heads). Statistically there was no difference between the IMRT and conformal plans in the dose to the small and large bowel; however, the bowel IMRT dose–volume histogram (DVH) doses were consistently lower. Conclusion The IMRT plans were superior to the conformal plans with improved dose conformity and reduced radiation to the surrounding healthy tissue. Anecdotally it was found that patients tolerated the IMRT treatment better than the three-dimensional (3D) conformal radiation therapy. This study describes and compares the planning techniques. PMID:26229623

Carcinoma of the anal canal: Intensity modulated radiation therapy (IMRT) versus three-dimensional conformal radiation therapy (3DCRT)

International Nuclear Information System (INIS)

Sale, Charlotte; Moloney, Phillip; Mathlum, Maitham

2013-01-01

Patients with anal canal carcinoma treated with standard conformal radiotherapy frequently experience severe acute and late toxicity reactions to the treatment area. Roohipour et al. (Dis Colon Rectum 2008; 51: 147–53) stated a patient's tolerance of chemoradiation to be an important prediction of treatment success. A new intensity modulated radiation therapy (IMRT) technique for anal carcinoma cases has been developed at the Andrew Love Cancer Centre aimed at reducing radiation to surrounding healthy tissue. A same-subject repeated measures design was used for this study, where five anal carcinoma cases at the Andrew Love Cancer Centre were selected. Conformal and IMRT plans were generated and dosimetric evaluations were performed. Each plan was prescribed a total of 54 Gray (Gy) over a course of 30 fractions to the primary site. The IMRT plans resulted in improved dosimetry to the planning target volume (PTV) and reduction in radiation to the critical structures (bladder, external genitalia and femoral heads). Statistically there was no difference between the IMRT and conformal plans in the dose to the small and large bowel; however, the bowel IMRT dose–volume histogram (DVH) doses were consistently lower. The IMRT plans were superior to the conformal plans with improved dose conformity and reduced radiation to the surrounding healthy tissue. Anecdotally it was found that patients tolerated the IMRT treatment better than the three-dimensional (3D) conformal radiation therapy. This study describes and compares the planning techniques

Carcinoma of the anal canal: Intensity modulated radiation therapy (IMRT) versus three-dimensional conformal radiation therapy (3DCRT).

Science.gov (United States)

Sale, Charlotte; Moloney, Phillip; Mathlum, Maitham

2013-12-01

Patients with anal canal carcinoma treated with standard conformal radiotherapy frequently experience severe acute and late toxicity reactions to the treatment area. Roohipour et al. (Dis Colon Rectum 2008; 51: 147-53) stated a patient's tolerance of chemoradiation to be an important prediction of treatment success. A new intensity modulated radiation therapy (IMRT) technique for anal carcinoma cases has been developed at the Andrew Love Cancer Centre aimed at reducing radiation to surrounding healthy tissue. A same-subject repeated measures design was used for this study, where five anal carcinoma cases at the Andrew Love Cancer Centre were selected. Conformal and IMRT plans were generated and dosimetric evaluations were performed. Each plan was prescribed a total of 54 Gray (Gy) over a course of 30 fractions to the primary site. The IMRT plans resulted in improved dosimetry to the planning target volume (PTV) and reduction in radiation to the critical structures (bladder, external genitalia and femoral heads). Statistically there was no difference between the IMRT and conformal plans in the dose to the small and large bowel; however, the bowel IMRT dose-volume histogram (DVH) doses were consistently lower. The IMRT plans were superior to the conformal plans with improved dose conformity and reduced radiation to the surrounding healthy tissue. Anecdotally it was found that patients tolerated the IMRT treatment better than the three-dimensional (3D) conformal radiation therapy. This study describes and compares the planning techniques.

Carcinoma of the anal canal: Intensity modulated radiation therapy (IMRT) versus three-dimensional conformal radiation therapy (3DCRT)

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Sale, Charlotte; Moloney, Phillip; Mathlum, Maitham [Andrew Love Cancer Centre, Geelong Hospital, Geelong, Victoria (Australia)

2013-12-15

Patients with anal canal carcinoma treated with standard conformal radiotherapy frequently experience severe acute and late toxicity reactions to the treatment area. Roohipour et al. (Dis Colon Rectum 2008; 51: 147–53) stated a patient's tolerance of chemoradiation to be an important prediction of treatment success. A new intensity modulated radiation therapy (IMRT) technique for anal carcinoma cases has been developed at the Andrew Love Cancer Centre aimed at reducing radiation to surrounding healthy tissue. A same-subject repeated measures design was used for this study, where five anal carcinoma cases at the Andrew Love Cancer Centre were selected. Conformal and IMRT plans were generated and dosimetric evaluations were performed. Each plan was prescribed a total of 54 Gray (Gy) over a course of 30 fractions to the primary site. The IMRT plans resulted in improved dosimetry to the planning target volume (PTV) and reduction in radiation to the critical structures (bladder, external genitalia and femoral heads). Statistically there was no difference between the IMRT and conformal plans in the dose to the small and large bowel; however, the bowel IMRT dose–volume histogram (DVH) doses were consistently lower. The IMRT plans were superior to the conformal plans with improved dose conformity and reduced radiation to the surrounding healthy tissue. Anecdotally it was found that patients tolerated the IMRT treatment better than the three-dimensional (3D) conformal radiation therapy. This study describes and compares the planning techniques.

FDG-PET/CT imaging for staging and target volume delineation in conformal radiotherapy of anal carcinoma

International Nuclear Information System (INIS)

Krengli, Marco; Inglese, Eugenio; Milia, Maria E; Turri, Lucia; Mones, Eleonora; Bassi, Maria C; Cannillo, Barbara; Deantonio, Letizia; Sacchetti, Gianmauro; Brambilla, Marco

2010-01-01

FDG-PET/CT imaging has an emerging role in staging and treatment planning of various tumor locations and a number of literature studies show that also the carcinoma of the anal canal may benefit from this diagnostic approach. We analyzed the potential impact of FDG-PET/CT in stage definition and target volume delineation of patients affected by carcinoma of the anal canal and candidates for curative radiotherapy. Twenty seven patients with biopsy proven anal carcinoma were enrolled. Pathology was squamous cell carcinoma in 20 cases, cloacogenic carcinoma in 3, adenocarcinoma in 2, and basal cell carcinoma in 2. Simulation was performed by PET/CT imaging with patient in treatment position. Gross Tumor Volume (GTV) and Clinical Target Volume (CTV) were drawn on CT and on PET/CT fused images. PET-GTV and PET-CTV were respectively compared to CT-GTV and CT-CTV by Wilcoxon rank test for paired data. PET/CT fused images led to change the stage in 5/27 cases (18.5%): 3 cases from N0 to N2 and 2 from M0 to M1 leading to change the treatment intent from curative to palliative in a case. Based on PET/CT imaging, GTV and CTV contours changed in 15/27 (55.6%) and in 10/27 cases (37.0%) respectively. PET-GTV and PET-CTV resulted significantly smaller than CT-GTV (p = 1.2 × 10 -4 ) and CT-CTV (p = 2.9 × 10 -4 ). PET/CT-GTV and PET/CT-CTV, that were used for clinical purposes, were significantly greater than CT-GTV (p = 6 × 10 -5 ) and CT-CTV (p = 6 × 10 -5 ). FDG-PET/CT has a potential relevant impact in staging and target volume delineation of the carcinoma of the anal canal. Clinical stage variation occurred in 18.5% of cases with change of treatment intent in 3.7%. The GTV and the CTV changed in shape and in size based on PET/CT imaging

Has F.D.G. PET/CT an impact on the management of patients with anal carcinoma?

International Nuclear Information System (INIS)

Vercellino, L.; Nataf, V.; Kerrou, K.; Huchet, V.; Pascal, O.; Montravers, F.; Talbot, J.N.; De Parades, V.; Bauer, P.; Touboul, E.

2010-01-01

Purpose: To evaluate the impact of F.D.G. PET/C Ton the management of patients referred for the staging and/or the follow-up of anal carcinoma, and PET/CT on patient management. Patients and methods: We included patients referred to our department for anal carcinoma whose therapeutic management was evaluable thanks to follow-up data during at least 6 months. Results: Data of 44 patients were analysed: 22 had PET/CT for initial staging and 36 during follow-up. PET/CT had impact in nine patients out of 44 (20%) and it was relevant in eight of them. Conclusion: F.D.G. PET/CT is an accurate imaging modality in anal cancer, its impact on patient management is more obvious when persistence or recurrence of disease is suspected. (authors)

Early Squamous Cell Carcinoma of the Anal Canal Resected by Endoscopic Submucosal Dissection

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Yuzuru Tamaru

2015-04-01

Full Text Available The standard treatment approach for squamous cell carcinoma (SCC of the anal canal includes abdominoperineal resection and chemoradiotherapy. However, there are currently very few reports of early SCC of the anal canal resected by endoscopic submucosal dissection (ESD. We report 2 rare cases of SCC of the anal canal resected by ESD. In case 1, a 66-year-old woman underwent a colonoscopy due to blood in her stool, and an elevated lesion, 15 mm in size, was identified from the rectum to the dentate line of the anal canal on internal hemorrhoids. The lesion was diagnosed as an early SCC of the anal canal, and ESD was successfully performed. The histopathological diagnosis was SCC in situ. In case 2, a 71-year-old woman underwent a colonoscopy due to constipation, and an elevated lesion, 25 mm in size, was identified from the dentate line to the anal canal. The lesion was diagnosed as early-stage SCC of the anal canal, and ESD was successfully performed. The histopathological diagnosis was SCC in situ. No complications or recurrence after ESD occurred in either case.

Intensity-modulated radiation therapy for anal carcinoma

International Nuclear Information System (INIS)

Peiffert, D.; Moreau-Claeys, M.V.; Tournier-Rangeard, L.; Huger, S.; Marchesi, V.

2011-01-01

Anal canal carcinoma are highly curable by irradiation, combined with chemotherapy in locally advanced disease, with preservation of sphincter function. The clinical target volume for the nodes is extended, often including the inguinal nodes, which is not usual for other pelvic tumours. Acute and late effects are correlated with the volume and dose delivered to organs at risk, i. e. small bowel, bladder and increased by concomitant chemotherapy. Intensity modulated irradiation (IMRT) makes it possible to optimize the dose distribution in this 'complex U shaped' volume, while maintaining the dose distribution for the target volumes. The conversion from conformal irradiation to IMRT necessitates good knowledge of the definition and skills to delineate target volumes and organs at risk, including new volumes needed to optimize the dose distribution. Dosimetric and clinical benefits of IMRT are described, based on early descriptions and evidence-based publication. The growing development of IMRT in anal canal radiotherapy must be encouraged, and long-term benefits should be soon published. Radiation oncologists should precisely learn IMRT recommendations before starting the technique, and evaluate its early and late results for adverse effects, but also for long-term tumour control. (authors)

Is neoadjuvant chemotherapy prior to radio-chemotherapy beneficial in T4 anal carcinoma?

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Moureau-Zabotto, L; Viret, F; Giovaninni, M; Lelong, B; Bories, E; Delpero, J R; Pesenti, C; Caillol, F; de Chaisemartin, C; Minsat, M; Monges, G; Sarran, A; Resbeut, M

2011-07-01

This study retrospectively describes the outcome of a series of 38 patients (pts) with T4 anal carcinoma exclusively treated by radio and chemotherapy. From 1992 to 2007, 38 pts with UST4-N0-2-M0 anal carcinoma were treated with exclusive radiotherapy and chemotherapy. All patients received external beam radiotherapy (EBRT) (median dose 45 Gy) with a concomitant chemotherapy (5-fluorouracil-cisplatin). Eleven patients received neo-adjuvant chemotherapy (5-fluorouracil-cisplatin). After 2-8 weeks, a 15-20 Gy boost was delivered either with EBRT (20 pts) or interstitial (192)Ir brachytherapy (18 pts). Mean follow-up was 66 months. After chemoradiation therapy (CRT), 13 pts (34%) had a complete response, 23 pts (60%) a response >50% (2 pts were not evaluated). The 5-year-disease-free survival was 79.2 ± 6.5%, and the 5-year overall survival was 83.9 ± 6%. Eight patients developed tumor progression (mean delay 8.8 months), six of them requiring a salvage surgery with definitive colostomy for local relapse. Late severe complication requiring colostomy was observed in 2 pts. The 5-year-colostomy-free survival was 78 ± 6.9%. Patients who received primary chemotherapy had a statistically significant better 5-year colostomy-free survival (100% vs. 38 ± 16.4%, P = 0.0006). T4 anal carcinoma can be treated with a curative intent using a sphincter-sparing approach of CRT, and neo-adjuvant chemotherapy should be considered prior to radiotherapy. Copyright © 2011 Wiley-Liss, Inc.

HIV-associated anal cancer

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Newsom-Davis, T; Bower, M

2010-01-01

HIV-associated anal carcinoma, a non-AIDS-defining cancer, is a human papillomavirus-associated malignancy with a spectrum of preinvasive changes. The standardized incidence ratio for anal cancer in patients with HIV/AIDS is 20-50. Algorithms for anal cancer screening include anal cytology followed by high-resolution anoscopy for those with abnormal findings. Outpatient topical treatments for anal intraepithelial neoplasia include infrared coagulation therapy, trichloroacetic acid, and imiqui...

Anal Cancer—Health Professional Version

Science.gov (United States)

Anal cancer is a rare malignancy and accounts for a small percentage of cancers of the lower alimentary tract. The most common type of anal cancer is squamous cell carcinoma in the anal canal. Find evidence-based information on anal cancer treatment, causes and prevention, research, and statistics.

High survivin expression as a risk factor in patients with anal carcinoma treated with concurrent chemoradiotherapy

International Nuclear Information System (INIS)

Fraunholz, Ingeborg; Rödel, Claus; Distel, Luitpold; Rave-Fränk, Marget; Kohler, Daniela; Falk, Stefan; Rödel, Franz

2012-01-01

To investigate the prognostic value of survivin expression in pretreatment specimens from patients with anal cancer treated with concurrent 5-FU and mitomycin C-based chemoradiation (CRT). Immunohistochemical staining for survivin was performed in pretreatment biopsies of 62 patients with anal carcinoma. Survivin expression was correlated with clinical and histopathological characteristics as well as local failure free- (LFFS), distant metastases free- (DMFS), cancer specific- (CSS), and overall survival (OS). Survivin staining intensity was weak in 10%, intermediate in 48% and intense in 42% of the patients. No association between survivin expression and clinicopathologic factors (tumor stage, age and HIV status) could be shown. In univariate analysis, the level of survivin staining was significantly correlated with DMFS (low survivin vs. high survivin: 94% vs. 74%, p = 0.04). T-stage, N-stage and the tumor grading were significantly associated with OS and CSS and with DMFS and LFFS, respectively. In multivariate analysis, survivin was confirmed as independent prognostic parameter for DMFS (RR, 0.04; p = 0.02) and for OS (RR, 0.27; p = 0.04). Our results demonstrated that the level of pretreatment survivin is correlated with the clinical outcome in patients with anal carcinoma treated with concurrent CRT. Further studies are warranted to elucidate the complex role of survivin for the oncologic treatment and to exploit the protein as a therapeutic target in combined modality treatment of anal cancer

Familial disseminated plaque type porokeratosis with multiple horns and squamous cell carcinoma involving anal skin

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Sarma Nilendu

2009-01-01

Full Text Available Porokeratosis is a disorder of keratinization showing a well-defined lesion with a hyperkeratotic ridge on the border that contains the coronoid lamella. We report familial (autosomal dominant with reduced penetrance disseminated plaque type (Mibelli′s type porokeratosis in a father and son. In the father, there were multiple horns and a large squamous cell carcinoma in a large lesion over the perianal region that reached up to the squamo-columnar junction of the anal mucosa and even invaded the anal sphincteric muscles. Disseminated lesions of the Mibelli′s type, development of horns, and malignancy in this unusual location have not been previously reported.

Retrospective study about 71 patients with anal carcinoma, treated with a uniform radiochemotherapy

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Wiesmeth, Alfred J.

2013-01-01

The aim of this retrospectively prospective study was to examine the outcome (over all survival, tumorspecific survival, local control, colostomy free survival as well as sideeffects of the tumorspecific treatment) on a roughly homogenous and compared to other studies appropriate large group of 71 patients with diagnosed anal carcinoma. All patients underwent primary radiochemotherapy during the period of 1991 to 2010 in a municipal hospital. The median follow-up consisted of 38 month.

Anal squamous intraepithelial lesions in HIV+ MSM

NARCIS (Netherlands)

Siegenbeek van Heukelom, M.L.

2018-01-01

In this thesis we report on several aspects of high-grade anal squamous intraepithelial lesions (HSIL) in HIV+ men who have sex with men (MSM). It is estimated that 10% of HIV+ MSM with anal HSIL will develop anal squamous cell carcinoma (ASCC) over 30 years time. Screening programs similar to

Metastatic anal sac carcinoma with hypercalcaemia and associated hypertrophic osteopathy in a dog

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A. Giuliano

2015-05-01

Full Text Available A seven-year-old male neutered Irish setter was treated for a metastatic anal sac adenocarcinoma (ASAC and hypercalcaemia by complete surgical excision of the primary tumour and partial excision of the sublumbar lymph nodes. Further enlargement of the sublumbar lymph nodes was linked to recurrent hypercalcaemia 3 months after surgical treatment. Medical treatment with Toceranib and Clodronate showed modest results in the treatment of the tumour and the hypercalcaemia. Radiotherapy of the sublumbar lymph nodes and later concurrent carboplatin chemotherapy resulted in partial tumour remission with marked reduction in size of the lymph nodes and normalization of the calcaemia. Unfortunately, concurrently with subsequent relapse of the hypercalaemia, the dog developed hypertrophic osteopathy (HO and lumbar spinal metastasis and the dog was euthanized. To the authors’ knowledge, this is the second case of metastatic apocrine gland carcinoma of the anal sac associated with HO and the first case that describe the development of HO late in the stage of the disease.

Comparação das contagens das células de Langerhans de tecidos contendo carcinoma anal em doentes com e sem infecção pelo HIV Comparison of Langerhans cells counts from tissues containing anal carcinoma of patients with and without HIV infection

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Sidney Roberto Nadal

2006-09-01

Full Text Available INTRODUÇÃO: As células de Langerhans (LC são derivadas da medula óssea e constituem-se nas principais apresentadoras de antígeno da pele.conferindo desta forma, a resposta imune cutânea. Seu número está reduzido nos imunodeprimidos, incluindo na infecção pelo HIV, e a presença do tumor inibe sua migração, impedindo que os linfócitos T promovam regressão das células neoplásicas. OBJETIVO: Conhecer as diferenças entre as contagens de LC no tecido tumoral de doentes de carcinomas anais com e sem AIDS. MÉTODO: Avaliamos 24 doentes, sendo 14 com HIV e 10 outros sem HIV . O tratamento para o carcinoma foi semelhante nos dois grupos. Cortes retirados de blocos parafinados submetidos ao teste imunoistoquímico com anticorpo anti-CD68. Contamos as LC com método da histometria e os comparamos aos números obtidos com amostras previamente conhecidas de doentes sem doença infecciosa anorretal ou infecção pelo HIV. Revisamos também a evolução e as contagens séricas de linfócitos T CD4+ de doentes HIV-positivos. RESULTADOS: Observamos que o carcinoma anal foi mais freqüente em mulheres HIV-negativas e em homens HIV-positivos e que esses ultimos eram mais jovens. As LC foram menos numerosas nos doentes HIV-positivos e as maiores contagens estavam associadas com pior evolução. Os doentes HIV-positivos com os níveis mais baixos de linfócitos T CD4+ também tiveram as piores evoluções. CONCLUSÃO: Concluímos que as LC estavam diminuídas nos doentes HIV-positivos, portadores de carcinoma anal, quando comparados aos soronegativos.Langerhans cells (LC are bone marrow derived dendritic cells that represent the major antigen-presenting cells (APC in the skin, thus representing an integral part of the cutaneous immune response. Immunossupression decreases their number, including HIV infection, and skin tumors products are sufficient to immobilize LC within the tumor, preventing their migration to lymph nodes. This reduces the

Human papillomavirus genotyping and p16 expression as prognostic factors for patients with American Joint Committee on Cancer stages I to III carcinoma of the anal canal

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Serup-Hansen, Eva; Linnemann, Dorte; Skovrider-Ruminski, Wojciech

2014-01-01

-specific survival (DSS) in patients diagnosed with American Joint Committee on Cancer (AJCC) stages I to III carcinoma of the anal canal. PATIENTS AND METHODS: HPV genotyping polymerase chain reaction (high-risk subtypes 16, 18, 31, 33, 45, 52, and 58) and immunohistochemical expression of p16 were analyzed......PURPOSE: Carcinomas of the anal canal are strongly associated with the human papillomavirus (HPV). Expression of p16 is used as a surrogate marker of HPV infection. In a retrospective study, we evaluated HPV genotyping and p16 expression as prognostic markers of overall survival (OS) and disease...... by using paraffin-embedded tumor biopsies from 143 anal carcinomas. The patients were treated with combined chemoradiotherapy or radiotherapy alone. RESULTS: HPV16 was detected in 81.0% of the tumors, followed by HPV33 (5.1%), HPV18 (2.2%), and HPV58 (0.7%). p16 positivity was found in 92.9% of the tumors...

A combined modality therapeutic approach to metastatic anal squamous cell carcinoma with systemic chemotherapy and local therapy to sites of disease: case report and review of literature.

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Gnanajothy, Rosana; Warren, Graham W; Okun, Sherry; Peterson, Lindsay L

2016-06-01

Cases of metastatic anal carcinoma managed with a combination of systemic chemotherapy and local therapies to both solitary sites of metastases and the primary site have been reported in the literature. We present a case of a 55-year-old male with metastatic anal squamous cell carcinoma to the liver treated with induction chemotherapy with cisplatin (CDDP) and 5-fluorouracil (5FU) followed by liver resection and radiation to the anal primary with concurrent 5FU and mitomycin. This approach resulted in control of disease without evidence of recurrence, and no increased toxicities now 19 months from initial diagnosis to time of reporting. This novel approach resulted in a good treatment response as documented by imaging and symptom improvement and a long disease free interval.

Drug eruption (erythema multiforme type) following chemoradiotherapy with mitomycin C and 5-fluorouracil administration for squamous cell carcinoma of the anal canal

International Nuclear Information System (INIS)

Arikawa, Shunji; Uchida, Masafumi; Ogoh, Etsuyo

2010-01-01

We report a case of drug eruption (erythema multiforme type) in a 54-year-old woman, following concurrent chemoradiotherapy for squamous cell carcinoma of the anal canal. Chemotherapy comprised one cycle of mitomycin C 10 mg/m 2 /day (intravenous bolus injection) on day 1 and 5-fluorouracil (5-FU) 1, 000 mg/m 2 /day (continuous intravenous infusion) on days 1-4 of radiotherapy. External irradiation of the pelvic space was performed, using daily fractions of 1.5 Gy (total dose, 33 Gy). From day 4 after chemoradiotherapy, erythema appeared proximal to the forearm site used for drug administration. On day 6, erythema was noted on the trunk, hip and thigh. We suspected erythema multiforme based on the appearance of wheals and target lesions of the skin and a patient history of chemoradiotherapy. Steroids were administered orally, which resolved systemic eruption at week 2. The patient also experienced grade 3 leukocytopenia, neutropenia, thrombopenia, diarrhea, and anorexia. Although we could not provide sufficient chemotherapy and radiation therapy due to severe side effects, squamous cell carcinoma of the anal canal responded extremely well with a marked decrease in complete response. We surmise that the drug eruption was associated with 5-FU. Concurrent chemoradiotherapy is safe and effective for squamous cell carcinoma of the anal canal, but care is required to prevent drug eruption during treatment. (author)

The management of carcinoma of the anal canal by external beam radiotherapy, experience in Vancouver 1971-1988

International Nuclear Information System (INIS)

Newman, G.; Calverley, D.C.; Acker, B.D.; Manji, M.; Hay, J.; Flores, A.D.

1992-01-01

From 1971 to 1988 72 cases of carcinoma of the anal canal were treated by external beam radiotherapy, most commonly by 5000 cGy in 20 fractions given over 4 weeks. The actuarial survival at 5 years was 66% and the disease specific survival 78%. Nine patients had inguinal node metastases at diagnosis; their 5-year disease specific survival was 75%. 63 Patients were inguinal node negative at presentation; their 5-year specific survival was 78%, by UICC 1987 staging: T 1 71%, T 2 88%, T 3 41%, T 4 42%. 17 Patients developed local recurrence; 10 were suitable for abdominoperineal resection which was successful in 7. The probability of local control was related to T stage. 13 patients were left with a colostomy because of recurrence, 2 had a colostomy for radiation damage and 4 had their local recurrence managed palliatively, without a colostomy. As a result, 53 of the 72 patients (74%) were left with a functional anus. Severe late complications occurred in 6 (8%). (author). 13 refs., 3 figs., 7 tabs

The management of carcinoma of the anal canal by external beam radiotherapy, experience in Vancouver 1971-1988

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Newman, G. (Bristol Oncology Centre (United Kingdom)); Calverley, D.C.; Acker, B.D.; Manji, M.; Hay, J.; Flores, A.D. (British Columbia Cancer Inst., Vancouver, BC (Canada))

1992-11-01

From 1971 to 1988 72 cases of carcinoma of the anal canal were treated by external beam radiotherapy, most commonly by 5000 cGy in 20 fractions given over 4 weeks. The actuarial survival at 5 years was 66% and the disease specific survival 78%. Nine patients had inguinal node metastases at diagnosis; their 5-year disease specific survival was 75%. 63 Patients were inguinal node negative at presentation; their 5-year specific survival was 78%, by UICC 1987 staging: T[sub 1] 71%, T[sub 2] 88%, T[sub 3] 41%, T[sub 4] 42%. 17 Patients developed local recurrence; 10 were suitable for abdominoperineal resection which was successful in 7. The probability of local control was related to T stage. 13 patients were left with a colostomy because of recurrence, 2 had a colostomy for radiation damage and 4 had their local recurrence managed palliatively, without a colostomy. As a result, 53 of the 72 patients (74%) were left with a functional anus. Severe late complications occurred in 6 (8%). (author). 13 refs., 3 figs., 7 tabs.

Prognostic impact of RITA expression in patients with anal squamous cell carcinoma treated with chemoradiotherapy.

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Rödel, Franz; Steinhäuser, Kerstin; Kreis, Nina-Naomi; Friemel, Alexandra; Martin, Daniel; Wieland, Ulrike; Rave-Fränk, Margret; Balermpas, Panagiotis; Fokas, Emmanouil; Louwen, Frank; Rödel, Claus; Yuan, Juping

2018-02-01

RBP-J interacting and tubulin-associated protein (RITA) has been identified as a negative regulator of the Notch signalling pathway and its deregulation is involved in the pathogenesis of several tumour entities. RITA's impact on the response of anal squamous cell carcinoma (SCC) to anticancer treatment, however, remains elusive. In our retrospective study immunohistochemical evaluation of RITA was performed on 140 pre-treatment specimens and was correlated with clinical and histopathologic characteristics and clinical endpoints cumulative incidence of local control (LC), distant recurrence (DC), disease-free survival (DFS) and overall survival (OS). We observed significant inverse correlations between RITA expression and tumour grading, the levels of HPV-16 virus DNA load, CD8 (+) tumour infiltrating lymphocytes and programmed death protein (PD-1) immunostaining. In univariate analyses, elevated levels of RITA expression were predictive for decreased local control (p = 0.001), decreased distant control (p = 0.040), decreased disease free survival (p = 0.001) and overall survival (p RITA expression remained significant for decreased local control (p = 0.009), disease free survival (p = 0.032) and overall survival (p = 0.012). These data indicate that elevated levels of pretreatment RITA expression are correlated with unfavourable clinical outcome in anal carcinoma treated with concomitant chemoradiotherapy. Copyright © 2017 Elsevier B.V. All rights reserved.

Chemoradiotherapy in squamous cell carcinoma of the anal canal: a single institution experience

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Kim, Kyung Hwan; Chang, Jee Suk; Keum, Ki Chang; Ahn, Joong Bae; Lee, Chang Geol; Koom, Woong Sub [Yonsei University College of Medicine, Yonsei University Health System, Seoul (Korea, Republic of)

2013-01-15

We reviewed the treatment outcomes and prognostic factors for patients with anal canal carcinoma who were treated with curative intent chemoradiotherapy (CRT) at Severance Hospital from 2005 to 2011. Data for 38 eligible patients treated during this period were reviewed. All patients were treated with curative intent using radiotherapy (RT) with (n = 35) or without concomitant chemotherapy (n = 3). Among 35 patients who received CRT, most of the chemotherapeutic regimens were either 5-fluorouracil (5-FU) plus mitomycin C (23 patients) or 5-FU plus cisplatin (10 patients). Recurrence-free survival (RFS), colostomy-free survival (CFS), overall survival (OS), and locoregional control (LRC) rates were calculated using the Kaplan-Meier method and survival between subgroups were compared using the log-rank test. Cox's proportional hazard model was used for multivariate analysis. Over a median follow-up period of 44 months (range, 11 to 96 months), 3-year RF S, Cfs, OS, and LRC were 80%, 79%, 85%, and 92%, respectively. In multivariate analysis, tumor size >4 cm was an independent predicting factor for poorer RFS (hazard ratio [HR], 6.35; 95% confidence interval [CI], 1.42 to 28.5; p = 0.006) and CFS (HR, 6.25; 95% CI, 1.39-28.0; p = 0.017), while the presence of external iliac lymph node metastasis was an independent prognosticator for poorer OS (HR, 9.32; 95% CI, 1.24 to 70.3; p 0.030). No treatment-related colostomies or deaths occurred during or after treatment. Curative intent CRT resulted in excellent outcomes that were comparable to outcomes in previous randomized trials. No severe treatment-related toxicities were observed.

Carcinoma epidermoide del margen anal contra calidad de vida

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Miguel A Reyes Argudín

Full Text Available La calidad de vida de los pacientes debe tenerse en cuenta. Esta representa el resultado final de la actuación médica desde la perspectiva del paciente. En ocasiones solo nos basamos en este criterio para tomar decisiones terapéuticas ante determinadas enfermedades, como el carcinoma epidermoide de margen anal en estadío terminal. El tratamiento y conducta con fines paliativos tiene como objetivo mejorar la calidad de vida de estas personas. Presentamos el caso de paciente varón de 48 años de edad que acude a consulta por presentar lesión en el ano que no le permitía sentarse y después de realizársele todo el estudio necesario para determinar su diagnóstico definitivo (carcinoma epidermoide de ano evaluarlo y determinar el tratamiento requerido para el grado de la enfermedad, nos percatamos que el tratamiento radical no cambiaba la evolución de su estado y se decide tratamiento paliativo para mejorar la calidad de vida. En ocasiones acuden a consulta pacientes que al culminar su estudio, obtienen el diagnóstico de una enfermedad avanzada y es, a partir de este momento, que nuestro pensamiento médico debe cambiar y encaminar nuestros esfuerzos a mejorar la calidad de vida y no llevarlos a un final tormentoso con el objetivo de revertir la evolución de una enfermedad que no tiene regresión.

Clinicopathological aspects and prevalence of human papillomavirus in anal cancer

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Marina Tayla Mesquita Aguiar

2014-04-01

Full Text Available Anal cancer is relatively rare; however, its incidence has increased in recent years. Several risk factors are associated with the development of anal cancer, including age older than 50 years, low-fiber diet, chronic anal fistulas, smoking, multiple partners, anal intercourse practice, Human Immunodeficiency Virus infection and immunosuppression. However, the presence of human papillomavirus represents the main risk factor for the development of anal cancer. The aim of this study was to evaluate the clinicopathological aspects of a series of patients with anal carcinomas diagnosed in Hospital Araújo Jorge, Goiânia-Goiás, as well as the prevalence of human papillomavirus genome in these tumors. Clinical, pathological and socio-demographic data were collected from the respective medical files and paraffin blocks containing anal carcinomas specimens were used for DNA extraction and detection of human papillomavirus, by means of polymerase chain reaction, using short PCR fragment primers. Forty-three cases were selected and had the data analyzed, while 38 cases were tested for human papillomavirus genome detection. Among the evaluated patients, 62.8% were women; 53.4% of tumors were squamous cell carcinoma and 46.5% of the patients were aged between 60 and 75 years. Risk factors, such as smoking (39.5% and alcoholism (20.9% were recorded in the studied group. Lymph node metastases were detected in 30.2% of cases and 7.0% had distant metastasis. The detection of human papillomavirus DNA was positive in 76% of cases assessed and this was significantly associated with squamous cell carcinomas. Aggressive behavior and advanced stage of anal cancer described in this study highlight the need for preventive measures that contemplate these tumors, including vaccination against human papillomavirus. Resumo: O câncer anal é relativamente raro, entretanto, sua incidência aumentou nos últimos anos. Vários fatores de risco são associados ao

Rectal squamous cell carcinoma in immunosuppressed populations: is this a distinct entity from anal cancer?

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COGHILL, Anna E.; SHIELS, Meredith S.; RYCROFT, Randi K.; COPELAND, Glenn; FINCH, Jack L.; HAKENEWERTH, Anne M.; PAWLISH, Karen S.; ENGELS, Eric A.

2015-01-01

Objective Squamous cell carcinoma (SCC) of the rectum is rare, but as with anal cancer, risk may be increased among immunosuppressed individuals. We assessed risk of rectal SCC in HIV-infected people. Design Population-based registry Methods We utilized the HIV/AIDS Cancer Match, a linkage of US HIV and cancer registries (1991–2010), to ascertain cases of anal SCC, rectal SCC, rectal non-SCC, and colon non-SCC. We compared risk in HIV-infected persons to the general population using standardized incidence ratios (SIRs) and evaluated risk factors using Poisson regression. We reviewed cancer registry case notes to confirm site and histology for a subset of cases. Results HIV-infected persons had an excess risk of rectal SCC compared to the general population (SIR=28.9; 95%CI 23.2–35.6), similar to the increase for anal SCC (SIR=37.3). Excess rectal SCC risk was most pronounced among HIV-infected men who have sex with men (MSM, SIR=61.2). Risk was not elevated for rectal non-SCC (SIR=0.88) or colon non-SCC (SIR=0.63). Individuals diagnosed with AIDS had higher rectal SCC rates than those with HIV-only (incidence rate ratio=1.86; 95%CI 1.04–3.31). Based on available information, one-third of rectal SCCs were determined to be misclassified anal cancer. Conclusions HIV-infected individuals, especially with advanced immunosuppression, appear to have substantially elevated risk for rectal SCC. As for anal SCC, rectal SCC risk was highest in MSM, pointing to involvement of a sexually transmitted infection such as human papillomavirus. Site misclassification was present, and detailed information on tumor location is needed to prove that rectal SCC is a distinct entity. PMID:26372482

Anal sexual experience and HIV risk awareness among female sex workers in Dire Dawa, eastern Ethiopia.

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Mazeingia, Yohannes Teka; Olijjira, Lemessa; Dessie, Yadeta

2017-01-01

Female sex workers have been disproportionately affected with HIV and anal sexual experience elevate their vulnerability. Anal intercourse has more risk of HIV transmission than vaginal intercourse for receptors that coupled with low condom and proper lubricant use behavior during anal sex. Besides majority of them did not understand HIV transmission risk of anal intercourse. In Ethiopia, studies on anal sexual experience is almost none existent, so the purpose of this study is to explored anal sexual experience and HIV transmission risk awareness among female sex worker in Dire Dawa, Eastern Ethiopia. Qualitative study with thematic analysis approach was conducted among 18 female sex workers and recruitment of study participants performed until saturation of information. The principal investigator conducted in-depth interviews using local language (Amharic) and it was recorded on audio recorder. Tape recorded data was transcribed and translated to English and entered into open code version 3.4 for coding and theme identification. Data collection conducted simultaneously with data analysis. Female sex workers practiced anal sex for different themes like financial influence, coercion, intentionally, peer pressure and as a sign of intimacy and love. Coercion, negative attitudes, poor awareness about HIV transmission risks of anal sex and protection capacity of condom and proper lubricants are the identified themes for not using condom and proper lubricants during anal sex by female sex workers. Inaccessibility and unavailability of health services for issues related to anal sex was the core reason for female sex workers' misperception and risk anal sexual experience. Female sex workers practiced anal sex without risk reduction approaches and they did not understand exacerbated risk of anal sex to HIV transmission. Stakeholders including ministry of health need to incorporate potential awareness raising tasks and programs about risk of anal sex and methods of risk

The value of radiotherapy in colorectal and anal carcinomas, judged on the basis of radiation results obtained in Wuerzburg between 1977 and 1985

International Nuclear Information System (INIS)

Aydin, H.

1987-01-01

Investigations were carried out into the effectiveness of radiotherapy in colorectal and anal carcinomas as well as metastases formed by those tumours. The relevance of changes in CT findings and CEA values is discussed in detail. (MBC) [de

Oral Rigosertib for Squamous Cell Carcinoma

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2017-06-22

Head and Neck Squamous Cell Carcinoma; Anal Squamous Cell Carcinoma; Lung Squamous Cell Carcinoma; Cervical Squamous Cell Carcinoma; Esophageal Squamous Cell Carcinoma; Skin Squamous Cell Carcinoma; Penile Squamous Cell Carcinoma

Intracavitary afterloading boost in anal canal carcinoma. Results, function and quality of life

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Vordermark, D.; Flentje, M.; Koelbl, O.; Sailer, M.

2001-01-01

Background: First clinical data on a new intracavitary afterloading boost method for anal canal carcinoma is reported. Patients and Methods: 20 consecutive patients (T1 5%, T2 70%, T3 20%, T4 5%; N0 75%, N1 10%, N2 15%; all M0) treated with external beam pelvic radiotherapy (median dose 56 Gy, range 46-64 Gy), simultaneous 5-FU and mitomycin (in 75%) and an intracavitary afterloading boost (one or two fractions of 5 Gy at 5 mm depth) were analyzed after a mean ±SD follow-up for living patients of 4.4±2.1 years. Quality of life (QoL) and anorectal manometry parameters were assessed in ten colostomy-free survivors. Results: Overall, recurrence-free and colostomy-free survival at 5 years were 84%, 79% and 69%, respectively. No death was tumorrelated. The only local failure was successfully salvaged by local excision. All three colostomies were performed for toxicity. Resting pressure and maximum squeeze pressure of the anal sphincter were reduced by 51% and 71%, as compared with control subjects, but quality of life was similar compared to healthy volunteers. Conclusion: the described regimen is highly effective but associated with increased toxicity. (orig.) [de

Dominant Role of HPV16 E7 in Anal Carcinogenesis

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Thomas, Marie K.; Pitot, Henry C.; Liem, Amy; Lambert, Paul F.

2011-01-01

Ninety percent of anal cancer is associated with human papilloma viruses (HPVs). Using our previously established HPV transgenic mouse model for anal cancer, we tested the role of the individual oncogenes E6 and E7. K14E6 and K14E7 transgenic mice were treated with dimethylbenz[a]anthracene (DMBA) to the anal canal and compared to matched nontransgenic and doubly transgenic K14E6/E7 mice. K14E7 and K14E6/E7 transgenic mice developed anal tumors (papillomas, atypias and carcinomas combined) at significantly higher rates (88% and 100%, respectively) than either K14E6 or NTG mice (18% and 19%, respectively). Likewise, K14E7 and K14E6/E7 transgenic mice developed frank cancer (carcinomas) at significantly higher rates (85% and 85%, respectively) than either K14E6 or NTG mice (18% and 10%, respectively). These findings indicate that E7 is the more potent oncogene in anal cancer caused by HPVs. PMID:21999991

20 years of experience in the treatment of epidermoid carcinoma of anal canal

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Torres, M.

2010-01-01

Objectives: An experimental, longitudinal, prospective and descriptive study was designed (Phase II) with the purpose to evaluate the efficacy of concomitant chemoradiotherapy in local control, toxicity and survival squamous cell carcinoma Anal Canal. Material and Methods: Between 01/01/1989 and 31/12/2008, 120 consecutive patients were treated who had not received any cancer treatment, and did not show neoplasia simultaneously and all were HIV (-). The average age was 59.3 years (Range 34-74) and 80% were females; the performance status was 0-2 ECOG and the TNM (AJCC) classification in the distributed: T1, 36 (30%); T2, 43 (36%); T3 17 (14%); T4, 24 (20%); N0, 86 (72%); N1, 24 (20%); N2, 5 (4%); N3, 5 (4%); M0, 120 (100%). Radiotherapy megavoltage photons used as recommended ICRU-50 (GTV, CTV, PTV); a conventional fractionation was used with fractions 1.8 Gy daily, 5 times per week until 50.40 Gy, using multiple fields ( b ox technique ) ; CDDP chemotherapy was administered, 75 mg / m2 i / v 1 and 24 and 5-FU, 1000 mg / m2 continuous infusion i / v on days 1-5, and 24-28 the course of radiotherapy. The monitoring and the objective of the evaluation was performed according to the RTOG / EORTC and the Kaplan-Meyer recommendations. Results: Local control was : complete remission, 84%; partial remission, 2%; lesional stabilization, 6%; lesion progression, 8%; toxicity was cutaneous, gastrointestinal, and peripheral haematological, grades 2 and 3, and primarily acute neuropathy; There were no deaths due to the combined proceeding or increase colostomies. Survival Overall at 5, 10, 15 and 20 years it was 80%, 75%, 72% and 72% respectively. Conclusions: 1)The results of our study are comparable to those reported in the international literature; 2) Reconsider the current indications of the radiotherapy ( s plit-course, boost, total dose ) and chemotherapy ( i nduction adjuvant, new drugs ) ; 3) The concomitant radiochemotherapy remains the treatment universally accepted

Utilidade da citologia anal no rastreamento dos homens heterossexuais portadores do HPV genital Anal cytology for screening heterosexual men harboring genital HPV infection

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Raphael Marianelli

2010-09-01

Full Text Available Os papilomavírus humanos (HPV de alto risco estão fortemente relacionados à etiologia do carcinoma espinocelular (CEC anogenital e suas lesões precursoras. O HPV-16 é o tipo mais freqüente, estando presente em até 87% dos CEC do canal anal HPV-positivo. Apesar de ser relativamente raro, vem sendo cada vez mais diagnosticado, nas últimas décadas, sobretudo em indivíduos do sexo masculino. A incidência é ainda mais elevada nos grupos considerados de risco, particularmente, os homens e as mulheres HIV-positivo e os homens que fazem sexo com homens (HSH. Grande parte das pesquisas direcionadas à infecção anal pelo HPV e sua relação com neoplasia intraepitelial-anal (NIA e com o carcinoma esteve focada nos grupos de risco. Pouco interesse vem sendo destinado à investigação dos homens heterossexuais. Estudos epidemiológicos da prevalência da infecção pelo HPV em homens, mostraram que os heterossexuais masculinos apresentavam infecção anal pelo HPV em até 12%. As Sociedades médicas e os especialistas recomendam o rastreamento dos portadores de imunodepressão e dos HSH com citologia do raspado do canal anal. Entretanto, até o momento, não há recomendação de rastreamento para homens que fazem sexo com mulheres.The oncogenic human papillomaviruses (HPV are straightly associated with anogenital cancer and dysplasia. The HPV-16 is the most common type, isolated in 87% of the HPV-positive anal squamous cell carcinoma (SCC. Despite being a rare tumor, the incidence of SCC has increased in the last decades, especially in males. Incidence is particularly high amongst men who have sex with men (MSM and among HIV infected men and women. For decades anogenital HPV researches have largely focused risk groups. Poor interest was intended to men who have sex with women (MSW. Prevalence studies of HPV infection in MSW have demonstrated that anal infection was identified in as far as 12%. Medical societies and specialists recommend anal

Radiochemotherapy of locally advanced anal canal carcinoma: Prospective assessment of early impact on the quality of life (randomized trial ACCORD 03)

International Nuclear Information System (INIS)

Tournier-Rangeard, Laetitia; Mercier, Mariette; Peiffert, Didier; Gerard, Jean-Pierre; Romestaing, Pascale; Lemanski, Claire; Mirabel, Xavier; Pommier, Pascal; Denis, Bernard

2008-01-01

Background and purpose: The aim of this study was to prospectively assess the quality of life (QOL) of patients treated by concomitant chemo radiation for locally advanced anal canal carcinoma. Materials and methods: We report on a subgroup of 119 patients enrolled in a 306-patient therapeutic intensification prospective trial (ACCORD 03). This trial evaluated the impact on colostomy-free survival of induction chemotherapy and/or high dose radiotherapy (factorial design 2 * 2 treatment arms). QOL was assessed both before and 2 months after treatment using the EORTC QLQ-C30 questionnaire as well as a questionnaire relating to anal sphincter conservative treatment (AS-CT). Results: Compared to pre-treatment scores, patients reported significant improvement in their emotional function (+8.4 points p = 0.002), global health status (+5.9 points p = 0.0007), as well as a decrease in insomnia (-13.8 points p < 0.0001), constipation (-12.0 points p < 0.0001), appetite loss (-10.3 points p < 0.0001) and pain (-9.6 points p = 0.0002). The AS-CT degree of satisfaction with intestinal functions score was increased (+11.2 points p < 0.0001). Conclusion: This is the first prospective study comparing QOL of patients with advanced anal canal carcinoma, before and 2 months after conservative treatment. Two months after treatment, QOL was improved. Induction chemotherapy and/or high dose radiotherapy did not provide a negative impact on QOL

Chemotherapy and low-dose radiotherapy in the treatment of HIV-infected patients with carcinoma of the anal canal

International Nuclear Information System (INIS)

Peddada, Anuj V.; Smith, Damon E.; Rao, Aroor R.; Frost, Daniel B.; Kagan, A. Robert

1997-01-01

Purpose: To determine the efficacy and tolerance of a standardized protocol of chemotherapy and low-dose radiotherapy in the treatment of anal cancer in human immunodeficiency virus (HIV)-infected patients. Methods and Materials: Between 1987 and 1995, eight HIV-positive patients with squamous cell carcinoma of the anal canal, four of whom had acquired immunodeficiency syndrome (AIDS), received therapy at the Kaiser Permanente Medical Center. All patients were treated using a combined modality approach consisting of lowdose radiotherapy (30 Gy in 15 fractions delivered 5 days/week), and chemotherapy [1000 mg/m 2 of 5-fluorouracil (5-FU) delivered on days 1-4 and 29-32 as a continuous infusion over 96 h, and 10 mg/m 2 of mitomycin C delivered as a bolus injection on day 1]. Patients have been followed from 4 to 81 months (mean 41, median 38). Results: All eight patients completed the therapy with minor variations to the protocol, and all have attained a clinical complete response. Four patients are alive and free of disease, and four died as a result of complications of AIDS, but remained free of anal carcinoma. There were no mortalities from the protocol and the morbidity was acceptable. Only one patient each was noted to have Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Grade 4 hematologic and gastrointestinal acute toxicity, and no Grade 4 skin toxicity was noted. Conclusion: This combined therapy is effective for HIV-infected patients and appears to be tolerable with acceptable toxicities. It is best applied to patients who are HIV positive, or who have AIDS without concurrent major opportunistic infections. This approach is reasonable and affords patients a reasonably good chance at sphincter preservation by avoiding abdominoperineal resection. The optimal therapy for HIV-positive patients with advanced AIDS remains less well defined

The Results of Curative Concurrent Chemoradiotherapy for Anal Carcinoma

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Jeong, Jae Uk; Yoon, Mee Sun; Song, Ju Young; Ahn, Sung Ja; Chung, Woong Ki; Nah, Byung Sik; Nam, Taek Keun [Chonnam National University School of Medicine, Seoul (Korea, Republic of)

2010-11-15

To evaluate the predictive factors for treatment response and prognostic factors affecting survival outcomes after concurrent chemoradiotherapy (CCRT) for patients with anal squamous cell carcinoma. Medical records of forty two patients with histologically confirmed analsquamous cell carcinoma, who had complete CCRT between 1993 and 2008, were reviewed retrospectively. Median age was 61.5 years (39-89 years), and median radiotherapy (RT) dose was 50.4 Gy (30.0-64.0 Gy). A total of 36 patients had equal to or less than T2 stage (85.7%). Fourteen patients (33.3%) showed regional nodal metastasis, 36 patients (85.7%) were treated with 5-fluorouracil (5-FU) plus mitomycin, and the remaining patients were treated by 5-FU plus cisplatinum. The median follow--up time was 62 months (2-202 months).The 5-year overall survival, locoregional relapse-free survival, disease-free survival, and colostomy-free survival rates were 86.0%, 71.7%, 71.7%, 78.2%, respectively. Regarding overall survival, the Eastern Cooperative Oncology Group (ECOG) performance status and complete response were found to be significant prognostic factors on univariate analysis. For multivariate analysis, only the ECOG performance status was significant. No significant factor was found for locoregional relapse-free survival or disease-free survival and similarly for treatment response, no significant factor was determined on logistic regression analysis. There were 7 patients who had local or regional recurrences and one patient with distant metastasis. The only evaluable toxicity in all patients was radiation dermatitis of perianal skin (grade 3), which developed in 4 patients (9.5%) and grade 2 in 22 patients (52.4%). This study revealed that patients with a performance score of ECOG 0-1 survived significantly longer than those with a poorer score. Finally, there was no significant predicting factors tested for treatment response.

Incidence, Trends and Ethnic Differences of Oropharyngeal, Anal and Cervical Cancers: Singapore, 1968-2012

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Lam, Jennifer O.; Lim, Wei-Yen; Chow, Khuan-Yew; D’Souza, Gypsyamber

2015-01-01

In recent decades, several Western countries have reported an increase in oropharyngeal and anal cancers caused by human papillomavirus (HPV). Trends in HPV-associated cancers in Asia have not been as well described. We describe the epidemiology of potentially HPV-related cancers reported to the Singapore Cancer Registry from 1968–2012. Analysis included 998 oropharyngeal squamous cell carcinoma (OPSCC), 183 anal squamous cell carcinoma (ASCC) and 8,019 invasive cervical cancer (ICC) cases. Additionally, 368 anal non-squamous cell carcinoma (ANSCC) and 2,018 non-oropharyngeal head and neck carcinoma (non-OP HNC) cases were included as comparators. Age-standardized incidence rates (ASR) were determined by gender and ethnicity (Chinese, Malay and Indian). Joinpoint regression was used to evaluate annual percentage change (APC) in incidence. OPSCC incidence increased in both genders (men 1993–2012, APC = 1.9%, pSingapore, but Pap screening programs have led to consistently decreasing incidence. PMID:26720001

External validation of leukocytosis and neutrophilia as a prognostic marker in anal carcinoma treated with definitive chemoradiation.

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Schernberg, Antoine; Huguet, Florence; Moureau-Zabotto, Laurence; Chargari, Cyrus; Rivin Del Campo, Eleonor; Schlienger, Michel; Escande, Alexandre; Touboul, Emmanuel; Deutsch, Eric

2017-07-01

To validate the prognostic value of leukocyte disorders in anal squamous cell carcinoma (SCC) patients receiving definitive concurrent chemoradiation. Bi-institutional clinical records from consecutive patients treated between 2001 and 2015 with definitive chemoradiation for anal SCC were retrospectively reviewed. Prognostic value of pretreatment leukocyte disorders was examined, with focus on patterns of relapse and survival. Leukocytosis and neutrophilia were defined as leukocyte or neutrophil count exceeding 10G/L and 7G/L, respectively. We identified 133 patients, treated in two institutions. Eight% and 7% displayed baseline leukocytosis and neutrophilia, respectively. Estimated 3-year overall survival (OS) and progression-free survival (PFS) were 88% and 77%, respectively. In univariate analysis, both leukocytosis and neutrophilia were associated with worse OS, PFS (p<0.01), locoregional control (LRC) and Distant Metastasis Control (DMC) (p<0.05), also after stratification by each institution. In multivariate analysis, leukocytosis and neutrophilia remained as independent risk factors associated with poorer OS, PFS, LRC and DMC (p<0.05). This study validates leukocytosis and neutrophilia as independent prognostic factors in anal SCC patients treated with definitive chemoradiation. Although prospective confirmation is warranted, it is suggested that the leukocyte and neutrophil count parameters are clinically relevant biomarkers to be considered for further clinical investigations. Copyright © 2017 Elsevier B.V. All rights reserved.

Unsatisfactory exfoliative anal cytology samples, 15-year experience with histologic, cytologic, and molecular follow-up.

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Khattab, Ruba; McMeekin, Emily; Taege, Alan J; Hekman, James M; Brainard, Jennifer A; Underwood, Dawn; Procop, Gary W; Sturgis, Charles D

2018-02-01

The incidence of anal carcinoma has risen in recent decades. Exfoliative cytology screening of selected high risk patients is performed in many centers. Unsatisfactory cytology results are frustrating to patients, clinicians, and laboratorians. The aim of this study is to ascertain outcomes of patients with non-diagnostic anal cytology. A retrospective review of anal cytology testing performed at the Cleveland Clinic between 01/01/2001 and 12/31/2015 was performed. All cases were received as liquid-based samples and processed as ThinPreps (Hologic, Marlborough, MA). Co-testing for HR-HPV DNA was performed using Hybrid Capture 2® (Qiagen, Germantown, MD) in the majority of patients. Of 1,276 ThinPrep anal cytology samples, 130 (10%) were deemed unsatisfactory. 77% of patients were HIV positive. 85% were males. Of the unsatisfactory cases, 116 (89%) were co-tested for HR-HPV DNA. Of those, 40 patients (34%) had a simultaneous positive HR-HPV DNA. Adequate follow up cytology within a one year and a two year period revealed that 18/130 (14%) and 26/130 (20%) of patients had ASC or SIL respectively. Histologic follow-up within one and two years showed 3 patients (2%) and 8 patients (6%) with HSIL or worse. High risk patients with unsatisfactory anal cytology are not "negative". At least one-third proved to be concomitantly HR-HPV DNA positive with one-fifth showing subsequent cytologic squamous abnormalities and with more than 5% being diagnosed with a high grade intraepithelial lesion within two years. Prompt repeat cytology and/or HR-HPV DNA is recommended for high risk patients with non-diagnostic cytology. © 2017 Wiley Periodicals, Inc.

Role of 18F-FDG PET/CT in Posttreatment Evaluation of Anal Carcinoma.

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Houard, Clémence; Pinaquy, Jean-Baptiste; Mesguich, Charles; Henriques de Figueiredo, Bénédicte; Cazeau, Anne-Laure; Allard, Jean-Baptiste; Laharie, Hortense; Bordenave, Laurence; Fernandez, Philippe; Vendrely, Véronique

2017-09-01

The aim of this study was to evaluate the relevance of PET/CT and 18 F-FDG as a strategy for response evaluation after chemoradiotherapy for anal cancer. For this, the performance of posttreatment 18 F-FDG PET/CT, the impact on patient care, and the predictive value of metabolic response were assessed. Methods: This was a retrospective and multicenter analysis of 87 patients treated by chemoradiotherapy for anal squamous cell carcinoma between October 2007 and October 2013. All patients underwent systematic posttreatment 18 F-FDG PET/CT and were followed with at least a clinical examination every 4 mo for 2 y and every 6 mo thereafter. Disease progression was confirmed by biopsy for all patients in the case of local recurrence before surgery. Kaplan-Meier and Cox regression models were used to test for associations between metabolic or clinical endpoints and progression-free survival (PFS) or cause-specific survival (CSS). Results: The median follow-up was 25 mo. 18 F-FDG PET/CT was performed 1-8 mo (median, 4 mo) after completion of chemoradiotherapy. Overall, 25 patients relapsed and 13 died. The posttherapy 18 F-FDG PET/CT did not show any abnormal 18 F-FDG uptake (complete metabolic response [CMR]) in 55 patients whereas 32 displayed incomplete response (non-CMR): 15 patients with partial response and 17 with disease progression. The sensitivity of 18 F-FDG PET/CT to detect residual tumor tissue was 92% (95% confidence interval [CI], 75%-97%), specificity was 85% (95% CI, 75%-92%), positive predictive value was 72% (95% CI, 61%-90%), and negative predictive value was 96.4% (95% CI, 90%-98.7%). The 2-y PFS was 96% (95% CI, 90-100) for patients with CMR and 28% (95% CI, 14-47) for non-CMR patients ( P PET/CT changed patient management in 14 cases (16%), with relevant modifications in 12 (14%). A Cox proportional hazards model of survival outcome indicated that a CMR was the only significant predictor of PFS and CSS ( P PET/CT shows good accuracy in posttreatment

Impact of therapeutic factors on local control in T2-T3 anal carcinoma treated by radiation or radiochemotherapy

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Allal, Abdelkarim S.; Mermillod, Bernadette; Kurtz, John M.; Marti, Marc-Claude

1996-01-01

Purpose: To investigate the influence of therapeutic parameters on local control in T2-T3 anal carcinoma treated by chemo-radiotherapy or radiation therapy alone. Materials and Methods: From 1976 to 1993, 137 patients with anal carcinoma staged T2 (85) or T3 (52) completed curative sphincter-conservating treatment, 54 with radiotherapy alone and 83 with concomitant chemo-radiotherapy. Radiation therapy was delivered in two sequences with a median gap of 46 days. The two main techniques used for the first sequence were a direct perineal cobalt field ± a sacral arc field with a median dose of 30 Gy/10 fractions/19 days (27.7%) and two antero-posterior opposed pelvic fields (≥ 6 MV photons) with a median dose of 40 Gy/20 fractions/31 days (62%). Iridium-192 implant boost was used in 116 patients (median dose 20 Gy, Paris system) and external radiation boost in 21 patients (median dose 20 Gy/10 fractions/13 days). Generally the chemoradiotherapy patients received starting on day 1 an IV bolus of Mitomycin-C (0.4 mg/kg, maximum 20 mg) and a 5-day continuous infusion of 5-fluorourcil 600-800 mg/m 2 /day. For surviving patients median follow-up was 65 months. Univariate and multivariate analyses were carried out to determine therapeutic parameters affecting local control after adjustment for clinical factors. Results: The 5-year actuarial local control was 77%. Factors associated with a decrease of local control in univariate analysis included: age less than 66 years (67% vs 85%), male gender (65% vs 81%), tumor extension more than (1(3)) circumference of the anal canal (68% vs 90%), lymph node involvement (64% vs 81%), use of external irradiation for the boost (62% vs 79%), and overall treatment time more than 74 days (69% vs 85%). In a multivariate analysis none of the therapeutic parameters remained significant when adjusted for the four significant clinical factors. The only therapeutic factor which might have had an impact was overall treatment time (p = .09

The impact of MRI sequence on tumour staging and gross tumour volume delineation in squamous cell carcinoma of the anal canal

International Nuclear Information System (INIS)

Prezzi, Davide; Mandegaran, Ramin; Gourtsoyianni, Sofia; Owczarczyk, Katarzyna; Gaya, Andrew; Glynne-Jones, Robert; Goh, Vicky

2018-01-01

To compare maximum tumour diameter (MTD) and gross tumour volume (GTV) measurements between T 2 -weighted (T 2 -w) and diffusion-weighted (DWI) MRI in squamous cell carcinoma of the anal canal (SCCA) and assess sequence impact on tumour (T) staging. Second, to evaluate interobserver agreement and reader delineation confidence. The staging MRI scans of 45 SCCA patients (25 females) were assessed retrospectively by two independent radiologists (0 and 5 years' experience of anal cancer MRI). MTD and GTV were delineated on both T 2 -w and high-b-value DWI images and compared between sequences; T staging was derived from MTD. Interobserver agreement was assessed and delineation confidence scored (1 to 5) by each observer. GTV and MTD were significantly and systematically lower on DWI versus T 2 -w sequences by 14.80%/9.98% (MTD) and 29.70%/12.25% (GTV) for each reader, respectively, causing T staging discordances in approximately a quarter of cases. Bland-Altman limits of agreement were narrower and intraclass correlation coefficients higher for DWI. Delineation confidence was greater on DWI: 40/42 cases were scored confidently (4 or 5) by each reader, respectively, versus 31/36 cases based on T 2 -w images. Sequence selection affects SCCA measurements and T stage. DWI yields higher interobserver agreement and greater tumour delineation confidence. (orig.)

Epidermal Growth Factor Receptor Expression As Prognostic Marker in Patients With Anal Carcinoma Treated With Concurrent Chemoradiation Therapy

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Fraunholz, Ingeborg, E-mail: inge.fraunholz@kgu.de [Department of Radiotherapy and Oncology, Goethe University, Frankfurt/Main (Germany); Rödel, Franz; Kohler, Daniela [Department of Radiotherapy and Oncology, Goethe University, Frankfurt/Main (Germany); Diallo-Georgiopoulou, Margarita [Department of Radiotherapy and Oncology, Goethe University, Frankfurt/Main (Germany); Department of Radiation Oncology, Klinikum Offenbach, Offenbach/Main (Germany); Distel, Luitpold [Department of Radiation Oncology, Friedrich Alexander University, Erlangen (Germany); Falk, Stefan [Pathology Associates, Frankfurt/Main (Germany); Rödel, Claus [Department of Radiotherapy and Oncology, Goethe University, Frankfurt/Main (Germany)

2013-08-01

Purpose: To investigate the prognostic value of epidermal growth factor receptor (EGFR) expression in pretreatment tumor biopsy specimens of patients with anal cancer treated with concurrent 5-fluorouracil and mitomycin C-based chemoradiation therapy (CRT). Methods and Materials: Immunohistochemical staining for EGFR was performed in pretreatment biopsy specimens of 103 patients with anal carcinoma. EGFR expression was correlated with clinical and histopathologic characteristics and with clinical endpoints, including local failure-free survival (LFFS), colostomy-free survival (CFS), distant metastases-free survival (DMFS), cancer-specific survival (CSS), and overall survival (OS). Results: EGFR staining intensity was absent in 3%, weak in 23%, intermediate in 36% and intense in 38% of the patients. In univariate analysis, the level of EGFR staining was significantly correlated with CSS (absent/weak vs intermediate/intense expression: 5-year CSS, 70% vs 86%, P=.03). As a trend, this was also observed for DMFS (70% vs 86%, P=.06) and LFFS (70% vs 87%, P=.16). In multivariate analysis, N stage, tumor differentiation, and patients’ sex were independent prognostic factors for CSS, whereas EGFR expression only reached borderline significance (hazard ratio 2.75; P=.08). Conclusion: Our results suggest that elevated levels of pretreatment EGFR expression could be correlated with favorable clinical outcome in anal cancer patients treated with CRT. Further studies are warranted to elucidate how EGFR is involved in the response to CRT.

Urethral dose sparing in squamous cell carcinoma of anal canal using proton therapy matching electrons with prior brachytherapy for prostate cancer: A case study

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Apinorasethkul, Ontida, E-mail: ontida.a@gmail.com [Medical Dosimetry Graduate Program, University of Wisconsin, La Crosse, WI (United States); Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA (United States); Lenards, Nishele; Hunzeker, Ashley [Medical Dosimetry Graduate Program, University of Wisconsin, La Crosse, WI (United States)

2016-10-01

The purpose of this case study is to communicate a technique on treating the re-irradiation of squamous cell carcinoma (SCC) of anal canal with proton fields matched with electron fields to spare prostatic urethra. A 76-year old male presented with a secondary radiation-induced malignancy as a result of prostate brachytherapy seeds irradiation 10 years prior. A rectal examination revealed a bulky tumor at the top of the anal canal involving the left superior-most aspect of the anal canal extending superiorly into the rectum. The inferior extent was palpable approximately 3 cm from the anal verge and the superior extent of the mass measured greater than 5 cm in the superior-inferior dimension. Chemoradiation was suggested since the patient was opposed to abdominoperineal resection (APR) and colostomy. The use of proton therapy matching with electron fields in the re-irradiation setting could help reduce the complications. A 2 lateral proton beams were designed to treat the bulky tumor volume with 2 electron beams treating the nodal volumes. This complication of treatment fields helped spare the prostatic urethra and reduced the risk of urinary obstruction in the future.

Early effect of external beam radiation therapy on the anal sphincter: A study using anal manometry and transrectal ultrasound

International Nuclear Information System (INIS)

Birnbaum, E.H.; Dreznik, Z.; Myerson, R.J.; Lacey, D.L.; Fry, R.D.; Kodner, I.J.; Fleshman, J.W.

1992-01-01

The early of pelvic irradiation on the anal sphincter has not been previously investigated. This study prospectively evaluated the acute effect of preoperative radiation on anal function. Twenty patients with rectal carcinoma received 4,500 cGy of preoperative external beam radiation. The field of radiation included the sphincter in 10 patients and was delivered above the anorectal ring in 10 patients. Anal manometry and transrectal ultrasound were performed before and four weeks after radiotherapy. No significant difference in mean maximal squeeze or resting pressure was found after radiation therapy. An increase in mean minimal sensory threshold was significant. Histologic examination revealed minimal radiation changes at the distal margin in 8 of 10 patients who underwent low anterior resection and in 1 of 3 patients who underwent abdominoperineal resection. The authors conclude that preoperative radiation therapy has minimal immediate effect on the anal sphincter and is not a major contributing factor to postoperative incontinence in patients after sphincter-saving operations for rectal cancer

Carcinoma basocelular de la región perianal: reporte de un caso y revisión de la literatura

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L.A. Espino-Urbina

2013-01-01

Full Text Available La literatura reporta una incidencia anual de 5,900 casos de carcinoma anal en países desarrollados. Estos involucran a 3 zonas anatómicas distintas: carcinoma del canal anal; carcinoma perianal (antes denominado carcinoma del margen anal, ubicado a una distancia menor a 5 cm de este y carcinoma de la piel perianal (a más de 5 cm de distancia del margen anal. El carcinoma basocelular de la región perianal es una neoplasia poco común (0.27% de todos los carcinomas basocelulares diagnosticados cuyo tratamiento en la inmensa mayoría de las veces es la resección con márgenes libres de enfermedad; debe de diferenciarse de la variante basaloide epidermoide del carcinoma debido a su buen pronóstico y casi nulo potencial de diseminación.

Urethral dose sparing in squamous cell carcinoma of anal canal using proton therapy matching electrons with prior brachytherapy for prostate cancer: A case study.

Science.gov (United States)

Apinorasethkul, Ontida; Lenards, Nishele; Hunzeker, Ashley

2016-01-01

The purpose of this case study is to communicate a technique on treating the re-irradiation of squamous cell carcinoma (SCC) of anal canal with proton fields matched with electron fields to spare prostatic urethra. A 76-year old male presented with a secondary radiation-induced malignancy as a result of prostate brachytherapy seeds irradiation 10 years prior. A rectal examination revealed a bulky tumor at the top of the anal canal involving the left superior-most aspect of the anal canal extending superiorly into the rectum. The inferior extent was palpable approximately 3cm from the anal verge and the superior extent of the mass measured greater than 5cm in the superior-inferior dimension. Chemoradiation was suggested since the patient was opposed to abdominoperineal resection (APR) and colostomy. The use of proton therapy matching with electron fields in the re-irradiation setting could help reduce the complications. A 2 lateral proton beams were designed to treat the bulky tumor volume with 2 electron beams treating the nodal volumes. This complication of treatment fields helped spare the prostatic urethra and reduced the risk of urinary obstruction in the future. Copyright © 2016 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

A Mouse Model for Human Anal Cancer

Science.gov (United States)

Stelzer, Marie K.; Pitot, Henry C.; Liem, Amy; Schweizer, Johannes; Mahoney, Charles; Lambert, Paul F.

2010-01-01

Human anal cancers are associated with high-risk human papillomaviruses (HPVs) that cause other anogenital cancers and head and neck cancers. As with other cancers, HPV16 is the most common high-risk HPV in anal cancers. We describe the generation and characterization of a mouse model for human anal cancer. This model makes use of K14E6 and K14E7 transgenic mice in which the HPV16 E6 and E7 genes are directed in their expression to stratified squamous epithelia. HPV16 E6 and E7 possess oncogenic properties including but not limited to their capacity to inactivate the cellular tumor suppressors p53 and pRb, respectively. Both E6 and E7 were found to be functionally expressed in the anal epithelia of K14E6/K14E7 transgenic mice. To assess the susceptibility of these mice to anal cancer, mice were treated topically with dimethylbenz[a]anthracene (DMBA), a chemical carcinogen that is known to induce squamous cell carcinomas in other sites. Nearly 50% of DMBA-treated HPV16 E6/E7 transgenic mice showed overt signs of tumors; whereas, none of the like treated non-transgenic mice showed tumors. Histopathological analyses confirmed that the HPV16 transgenic mice were increased in their susceptibility to anal cancers and precancerous lesions. Biomarker analyses demonstrated that these mouse anal cancers exhibit properties that are similar to those observed in HPV-positive precursors to human anal cancer. This is the first mouse model for investigating the contributions of viral and cellular factors in anal carcinogenesis, and should provide a platform for assessing new therapeutic modalities for treating and/or preventing this type of cancer. PMID:20947489

Retrospective study about 71 patients with anal carcinoma, treated with a uniform radiochemotherapy; Retrospektive Studie an 71 Patienten mit Analkarzinom, behandelt mit einheitlicher Radiochemotherapie

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Wiesmeth, Alfred J.

2013-07-17

The aim of this retrospectively prospective study was to examine the outcome (over all survival, tumorspecific survival, local control, colostomy free survival as well as sideeffects of the tumorspecific treatment) on a roughly homogenous and compared to other studies appropriate large group of 71 patients with diagnosed anal carcinoma. All patients underwent primary radiochemotherapy during the period of 1991 to 2010 in a municipal hospital. The median follow-up consisted of 38 month.

The prognostic value of HPV status and p16 expression in patients with carcinoma of the anal canal.

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Gloria B Roldán Urgoiti

Full Text Available BACKGROUND: In anal cancer studies, the detection frequency of high-risk HPV (human papillomavirus is variable, depending on the method used. There are limited data reporting results of different HPV detection techniques in the same clinical series, and very few correlating results with clinical outcome. OBJECTIVES: To evaluate tumor expression of p16/HPV16 using three different methods, and to determine their association with clinical outcome in patients with anal canal squamous cell carcinomas (SCC. DESIGN: This retrospective study included patients with anal canal SCC treated with definitive radiotherapy or chemoradiotherapy at a single institution between 1992 and 2005. Formalin-fixed paraffin-embedded tumor samples from 53 of the 89 (60% patient pre-treatment biopsies were adequate for tissue microarray construction. HPV status was determined using: p16 expression by conventional immunohistochemistry (IHC and quantitative IHC (AQUA, HPV genotype analysis by chromogenic in situ hybridization (CISH and HPV linear array sub-typing. Expression status was correlated with clinical outcome. RESULTS: 80% (28/35 of patient tumors had high p16 expression using conventional IHC. HPV16 CISH was positive in 81% (34/42 of tumors, and 78% (28/36 of tumors were HPV subtype 16. HPV16 CISH correlated with p16 evaluated by conventional IHC (correlation coefficient 0.46; p = 0.01 and by p16 AQUA score (correlation coefficient 0.49; p = 0.001. A subset of cases (15% had very high p16 quantitative IHC scores (>244 and were associated with a higher incidence of local or distant recurrence (p = 0.04. CONCLUSIONS: The vast majority (80% of anal canal SCC in our series were positive for HPV16/p16, regardless of the testing method used. The exploratory analysis of automated quantitative IHC scoring was the only technique to define a subset of patients with a worse prognosis by p16 expression status on univariate analysis. Further exploration of the molecular

Anal intraepitelial neoplasia: a narrative review

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Garazi Elorza

2016-01-01

Full Text Available Anal intraepitelial neoplasia (AIN constitutes a major health problem in certain risk groups, such as patients with immunosuppression of varied origin, males who have sexual relations with other males, and females with a previous history of vaginal or cervical abnormalities in cytology. Its relationship with the human papillomavirus (HPV infection has been well documented; however, many of the factors involved in the progression and regression of the viral infection to dysplasia and anal carcinoma are unknown. AIN can be diagnosed through cytology of the anal canal or biopsy guided by high-resolution anoscopy. However, the need for these techniques in high-risk groups remains controversial. Treatment depends on the risk factors and given the high morbidity and high recurrence rates the utility of the different local treatments is still a subject of debate. Surgical biopsy is justified only in the case of progression suggesting lesions. The role of the vaccination in high-risk patients as primary prevention has been debated by different groups. However, there is no general consensus on its use or on the need for screening this population.

Environmental scan of anal cancer screening practices: worldwide survey results

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Patel, Jigisha; Salit, Irving E; Berry, Michael J; Pokomandy, Alexandra de; Nathan, Mayura; Fishman, Fred; Palefsky, Joel; Tinmouth, Jill

2014-01-01

Anal squamous cell carcinoma is rare in the general population but certain populations, such as persons with HIV, are at increased risk. High-risk populations can be screened for anal cancer using strategies similar to those used for cervical cancer. However, little is known about the use of such screening practices across jurisdictions. Data were collected using an online survey. Health care professionals currently providing anal cancer screening services were invited to complete the survey via email and/or fax. Information was collected on populations screened, services and treatments offered, and personnel. Over 300 invitations were sent; 82 providers from 80 clinics around the world completed the survey. Fourteen clinics have each examined more than 1000 patients. Over a third of clinics do not restrict access to screening; in the rest, eligibility is most commonly based on HIV status and abnormal anal cytology results. Fifty-three percent of clinics require abnormal anal cytology prior to performing high-resolution anoscopy (HRA) in asymptomatic patients. Almost all clinics offer both anal cytology and HRA. Internal high-grade anal intraepithelial neoplasia (AIN) is most often treated with infrared coagulation (61%), whereas external high-grade AIN is most commonly treated with imiquimod (49%). Most procedures are performed by physicians, followed by nurse practitioners. Our study is the first description of global anal cancer screening practices. Our findings may be used to inform practice and health policy in jurisdictions considering anal cancer screening

Epidermal Growth Factor Receptor and K-RAS status in two cohorts of squamous cell carcinomas

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Van Laethem Jean-Luc

2010-05-01

Full Text Available Abstract Background With the availability of effective anti-EGFR therapies for various solid malignancies, such as non-cell small lung cancer, colorectal cancer and squamous cell carcinoma of the head and neck, the knowledge of EGFR and K-RAS status becomes clinically important. The aim of this study was to analyse EGFR expression, EGFR gene copy number and EGFR and K-RAS mutations in two cohorts of squamous cell carcinomas, specifically anal canal and tonsil carcinomas. Methods Formalin fixed, paraffin-embedded tissues from anal and tonsil carcinoma were used. EGFR protein expression and EGFR gene copy number were analysed by means of immunohistochemistry and fluorescence in situ hybridisation. The somatic status of the EGFR gene was investigated by PCR using primers specific for exons 18 through 21. For the K-RAS gene, PCR was performed using exon 2 specific primers. Results EGFR immunoreactivity was present in 36/43 (83.7% of anal canal and in 20/24 (83.3% of tonsil squamous cell carcinomas. EGFR amplification was absent in anal canal tumours (0/23, but could be identified in 4 of 24 tonsil tumours. From 38 anal canal specimens, 26 specimens were successfully analysed for exon 18, 30 for exon 19, 34 for exon 20 and 30 for exon 21. No EGFR mutations were found in the investigated samples. Thirty samples were sequenced for K-RAS exon 2 and no mutation was identified. From 24 tonsil specimens, 22 were successfully analysed for exon 18 and all 24 specimens for exon 19, 20 and 21. No EGFR mutations were found. Twenty-two samples were sequenced for K-RAS exon 2 and one mutation c.53C > A was identified. Conclusion EGFR mutations were absent from squamous cell carcinoma of the anus and tonsils, but EGFR protein expression was detected in the majority of the cases. EGFR amplification was seen in tonsil but not in anal canal carcinomas. In our investigated panel, only one mutation in the K-RAS gene of a tonsil squamous cell carcinoma was identified

Epidermal Growth Factor Receptor and K-RAS status in two cohorts of squamous cell carcinomas

International Nuclear Information System (INIS)

Van Damme, Nancy; Pauwels, Patrick; Peeters, Marc; Deron, Philippe; Van Roy, Nadine; Demetter, Pieter; Bols, Alain; Dorpe, Jo Van; Baert, Filip; Van Laethem, Jean-Luc; Speleman, Franki

2010-01-01

With the availability of effective anti-EGFR therapies for various solid malignancies, such as non-cell small lung cancer, colorectal cancer and squamous cell carcinoma of the head and neck, the knowledge of EGFR and K-RAS status becomes clinically important. The aim of this study was to analyse EGFR expression, EGFR gene copy number and EGFR and K-RAS mutations in two cohorts of squamous cell carcinomas, specifically anal canal and tonsil carcinomas. Formalin fixed, paraffin-embedded tissues from anal and tonsil carcinoma were used. EGFR protein expression and EGFR gene copy number were analysed by means of immunohistochemistry and fluorescence in situ hybridisation. The somatic status of the EGFR gene was investigated by PCR using primers specific for exons 18 through 21. For the K-RAS gene, PCR was performed using exon 2 specific primers. EGFR immunoreactivity was present in 36/43 (83.7%) of anal canal and in 20/24 (83.3%) of tonsil squamous cell carcinomas. EGFR amplification was absent in anal canal tumours (0/23), but could be identified in 4 of 24 tonsil tumours. From 38 anal canal specimens, 26 specimens were successfully analysed for exon 18, 30 for exon 19, 34 for exon 20 and 30 for exon 21. No EGFR mutations were found in the investigated samples. Thirty samples were sequenced for K-RAS exon 2 and no mutation was identified. From 24 tonsil specimens, 22 were successfully analysed for exon 18 and all 24 specimens for exon 19, 20 and 21. No EGFR mutations were found. Twenty-two samples were sequenced for K-RAS exon 2 and one mutation c.53C > A was identified. EGFR mutations were absent from squamous cell carcinoma of the anus and tonsils, but EGFR protein expression was detected in the majority of the cases. EGFR amplification was seen in tonsil but not in anal canal carcinomas. In our investigated panel, only one mutation in the K-RAS gene of a tonsil squamous cell carcinoma was identified. This indicates that EGFR and K-RAS mutation analysis is not

Twenty-Five-Year Experience With Radical Chemoradiation for Anal Cancer

International Nuclear Information System (INIS)

Tomaszewski, Jonathan M.; Link, Emma; Leong, Trevor; Heriot, Alexander; Vazquez, Melisa; Chander, Sarat; Chu, Julie; Foo, Marcus; Lee, Mark T.; Lynch, Craig A.; Mackay, John; Michael, Michael; Tran, Phillip; Ngan, Samuel Y.

2012-01-01

Purpose: To evaluate the prognostic factors, patterns of failure, and late toxicity in patients treated with chemoradiation (CRT) for anal cancer. Methods and Materials: Consecutive patients with nonmetastatic squamous cell carcinoma of the anus treated by CRT with curative intent between February 1983 and March 2008 were identified through the institutional database. Chart review and telephone follow-up were undertaken to collect demographic data and outcome. Results: Two hundred eighty-four patients (34% male; median age 62 years) were identified. The stages at diagnosis were 23% Stage I, 48% Stage II, 10% Stage IIIA, and 18% Stage IIIB. The median radiotherapy dose to the primary site was 54 Gy. A complete clinical response to CRT was achieved in 89% of patients. With a median follow-up time of 5.3 years, the 5-year rates of locoregional control, distant control, colostomy-free survival, and overall survival were 83% (95% confidence interval [CI] 78–88), 92% (95% CI, 89–96), 73% (95% CI, 68–79), and 82% (95% CI, 77–87), respectively. Higher T stage and male sex predicted for locoregional failure, and higher N stage predicted for distant metastases. Locoregional failure occurred most commonly at the primary site. Omission of elective inguinal irradiation resulted in inguinal failure rates of 1.9% and 12.5% in T1N0 and T2N0 patients, respectively. Pelvic nodal failures were very uncommon. Late vaginal and bone toxicity was observed in addition to gastrointestinal toxicity. Conclusions: CRT is a highly effective approach in anal cancer. However, subgroups of patients fare relatively poorly, and novel approaches are needed. Elective inguinal irradiation can be safely omitted only in patients with Stage I disease. Vaginal toxicity and insufficiency fractures of the hip and pelvis are important late effects that require prospective evaluation.

Twenty-Five-Year Experience With Radical Chemoradiation for Anal Cancer

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Tomaszewski, Jonathan M., E-mail: jonathan.tomaszewski@petermac.org [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Link, Emma [Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Leong, Trevor [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); University of Melbourne, Parkville, Victoria (Australia); Heriot, Alexander [University of Melbourne, Parkville, Victoria (Australia); Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Vazquez, Melisa [Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Chander, Sarat; Chu, Julie; Foo, Marcus; Lee, Mark T. [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Lynch, Craig A. [Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Mackay, John [University of Melbourne, Parkville, Victoria (Australia); Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Michael, Michael [University of Melbourne, Parkville, Victoria (Australia); Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Tran, Phillip [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Ngan, Samuel Y. [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); University of Melbourne, Parkville, Victoria (Australia)

2012-06-01

Purpose: To evaluate the prognostic factors, patterns of failure, and late toxicity in patients treated with chemoradiation (CRT) for anal cancer. Methods and Materials: Consecutive patients with nonmetastatic squamous cell carcinoma of the anus treated by CRT with curative intent between February 1983 and March 2008 were identified through the institutional database. Chart review and telephone follow-up were undertaken to collect demographic data and outcome. Results: Two hundred eighty-four patients (34% male; median age 62 years) were identified. The stages at diagnosis were 23% Stage I, 48% Stage II, 10% Stage IIIA, and 18% Stage IIIB. The median radiotherapy dose to the primary site was 54 Gy. A complete clinical response to CRT was achieved in 89% of patients. With a median follow-up time of 5.3 years, the 5-year rates of locoregional control, distant control, colostomy-free survival, and overall survival were 83% (95% confidence interval [CI] 78-88), 92% (95% CI, 89-96), 73% (95% CI, 68-79), and 82% (95% CI, 77-87), respectively. Higher T stage and male sex predicted for locoregional failure, and higher N stage predicted for distant metastases. Locoregional failure occurred most commonly at the primary site. Omission of elective inguinal irradiation resulted in inguinal failure rates of 1.9% and 12.5% in T1N0 and T2N0 patients, respectively. Pelvic nodal failures were very uncommon. Late vaginal and bone toxicity was observed in addition to gastrointestinal toxicity. Conclusions: CRT is a highly effective approach in anal cancer. However, subgroups of patients fare relatively poorly, and novel approaches are needed. Elective inguinal irradiation can be safely omitted only in patients with Stage I disease. Vaginal toxicity and insufficiency fractures of the hip and pelvis are important late effects that require prospective evaluation.

Radiation therapy for epidermoid carcinoma of the anal canal, clinical and treatment factors associated with outcome

International Nuclear Information System (INIS)

Myerson, Robert J.; Kong, Fengming; Birnbaum, Elisa H.; Fleshman, James W.; Kodner, Ira J.; Picus, Joel; Ratkin, Gary A.; Read, Thomas E.; Walz, Bruce J.

2001-01-01

Background and purpose: In recent years, treatment with combined chemotherapy and radiation has become the standard of care for epidermoid carcinoma of the anus. However, optimal radiotherapy techniques and doses are not well established. Materials and methods: During the period 1975-1997, 106 patients with epidermoid carcinoma of the anal canal underwent radiation therapy. Treatment policies evolved from radiation therapy alone or with surgery, to combined chemotherapy and radiation followed by surgery, to combined chemotherapy and radiation. Results: Overall 74% of patients were NED (no evidence of disease) at last follow-up. The most important clinical correlate with ultimate freedom from disease (includes the contribution of salvage surgery) was extent of disease. The 5-year ultimate freedom from disease was 87±5% for T1/T2N0, 78±10% for T3N0 (15% salvaged by surgery), and 43±10% for either T4N0 or any N+ lesions (P<0.001, Tarone-Ware). There was no difference between planned vs. expectant surgery (5-year ultimate NED: 67±11% planned surgery vs. 73±5% expectant surgery). The most important correlate with late toxicity was a history of major pelvic surgery (surgical vs. non-surgical group: P=0.013, Fisher's exact test, two-tailed summation). Thirty-three additional malignancies have been seen in 26 patients. The most common additional malignancies were gynecologic (nine cases), head and neck (six cases), and lung cancer (five cases). Conclusions: For T1/T2N0 disease, moderate doses of radiation combined with chemotherapy provided adequate treatment. T4N0 and N+ lesions are the most appropriate candidates for investigational protocols evaluating dose intensification. T3N0 tumors may also be appropriate for investigation; however, dose intensification may ultimately prove counterproductive if the cure rate is not improved and salvage surgery is rendered more difficult. The volume of irradiated small bowel should be minimized for patients who have a past

Postoperative versus definitive chemoradiation in early-stage anal cancer. Results of a matched-pair analysis

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Berger, B.; Menzel, M.; Bamberg, M.; Weinmann, M. [Tuebingen Univ. (Germany). Dept. of Radiation Oncology; Breucha, G. [Kreiskrankenhaus Hechingen, Tuebingen Univ. (Germany). Dept. of Surgery

2012-07-15

Background and purpose: The goal of the present study was to comparatively assess the results of definitive chemoradiation (CRT) with or without previous macroscopically complete resection in patients with early-stage node-negative (T1-2 N0) anal carcinoma. Patients and methods: A total of 20 patients with T1-2 N0 anal carcinoma who received radiotherapy (RT) with or without chemotherapy following incidental R0/1 tumor resection (S/CRT group) were selected. These were matched to 20 comparable patients who underwent definitive chemoradiation without previous surgery (CRT group). Major objectives of this analysis were treatment outcomes in terms of locoregional tumor control (LRC), overall survival (OS), colostomy-free survival, and toxicity. Results: Patients treated postoperatively received significantly lower RT doses (median 54.0 Gy vs. 59.7 Gy; p < 0.001) and less frequently concomitant chemotherapy than those treated definitely. The 5-year LRC and 5-year OS rates were 97.5% and 90.0%, respectively, without significant differences between the S/CRT and the CRT groups. The distribution of acute and late toxicities was comparable, and the 5-year colostomy-free survival was 95% in both groups. Conclusion: This matched-pair comparison of incidental R0/1 resection plus dose-reduced CRT with standard definitive CRT of early-stage anal cancer shows similar treatment results. Thus, dose-reduced RT with or without chemotherapy may be considered in R0/1 resected patients with T1-2 N0 anal carcinoma. (orig.)

Intensity-modulated radiation therapy for anal carcinoma; Radiotherapie conformationnelle avec modulation d'intensite des cancers de l'anus

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Peiffert, D.; Moreau-Claeys, M.V.; Tournier-Rangeard, L.; Huger, S.; Marchesi, V. [Departement de radiotherapie, centre Alexis-Vautrin, 6, avenue de Bourgogne, 54511 Vandoeuvre-les-Nancy cedex (France)

2011-10-15

Anal canal carcinoma are highly curable by irradiation, combined with chemotherapy in locally advanced disease, with preservation of sphincter function. The clinical target volume for the nodes is extended, often including the inguinal nodes, which is not usual for other pelvic tumours. Acute and late effects are correlated with the volume and dose delivered to organs at risk, i. e. small bowel, bladder and increased by concomitant chemotherapy. Intensity modulated irradiation (IMRT) makes it possible to optimize the dose distribution in this 'complex U shaped' volume, while maintaining the dose distribution for the target volumes. The conversion from conformal irradiation to IMRT necessitates good knowledge of the definition and skills to delineate target volumes and organs at risk, including new volumes needed to optimize the dose distribution. Dosimetric and clinical benefits of IMRT are described, based on early descriptions and evidence-based publication. The growing development of IMRT in anal canal radiotherapy must be encouraged, and long-term benefits should be soon published. Radiation oncologists should precisely learn IMRT recommendations before starting the technique, and evaluate its early and late results for adverse effects, but also for long-term tumour control. (authors)

Definitive treatment of anal canal carcinoma with radiotherapy: Adverse impact of a pre-radiation resection. A retrospective study of 57 patients treated with curative intent

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Coquard, R.; Cenni, J.C.; Artru, P.; Lledo, G.; Chalabreysse, P.; Queneau, P.E.; Taieb, S.; Alessio, A.

2009-01-01

Purpose To describe retrospectively the overall survival, the cancer specific survival and the tumor control in an homogeneous series of patients with epidermoid carcinoma of the anal canal treated with definitive radiotherapy; to assess the impact of brachytherapy, chemotherapy and pre-radiotherapy resection on the risk of recurrence. Patients and methods From 1997 to 2007, 57 patients (pts) presenting with an epidermoid carcinoma of the anal canal (T1: 14, T2: 33, T3-4: 10, N0: 31, N1: 19, N2: 3, N3: 4, M0: 57) were treated with definitive radiotherapy by the same radiation oncologist. The treatment included an external beam irradiation (E.B.R.T.) given to the posterior pelvis (45 Gy/25 fractions) and, six weeks later, a boost delivered with interstitial brachytherapy (37/57) or external beam irradiation (20/57). Twelve pts had undergone a surgical resection of the tumour before radiotherapy. A belly board was used for E.B.R.T. in 13 pts. A concurrent platinum based chemotherapy was done in 42 pts. The mean follow-up was 57 months. Results The overall survival rate at 5 years was 89% with a cause specific survival of 96%. Five patients recurred (5-year rate: 12%: four had local relapse (5-year rate: 8%), four had groin recurrence, and distant metastases were seen in two. In univariate analysis, the risk of relapse was higher in patients who had undergone a pre-radiation excision (p = 0.018), in those who did not receive chemotherapy (p = 0.076) and in those who were irradiated on a belly board (p = 0.049). In multivariate analysis, a pre-radiotherapy resection (p = 0.084) had an inverse impact on the tumour control reaching the level of statistical significance and the use of a belly board was of marginal influence (p = 0.13). Conclusion Radiotherapy and chemo radiation with cisplatin-based chemotherapy cure a vast majority of patients with epidermoid carcinoma of the anal canal. Therapeutic factors that may interfere with the definition of the target volume and

Long-term functional outcome of patients treated with chemoradiation therapy for carcinoma of the anal canal

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Ahmad, Neelofur R.; Nagle, Deborah

1996-01-01

PURPOSE: The advent of effective non-operative treatment for anal carcinoma with combined chemotherapy and radiation (CRT) has obviated the need for permanent colostomy in the majority of such patients. However, little is known about the long-term functional outcome of patients treated in this manner. The purpose of this analysis was to assess the outcome, including sphincter function and late toxicity, among anal cancer patients treated with definitive CRT. PATIENTS and METHODS: From 1978 to 1995, 47 anal cancer patients received CRT with curative intent at Thomas Jefferson University Hospital. Radiation (RT) dose to the primary tumor ranged from 30.0 to 72.7 Gy (median 46.8 Gy). RT dose to the pelvis ranged from 30.0 to 45.0 Gy. Chemotherapy consisted of concurrent infusional 5-FU and IV bolus Mitomycin-C. Patient outcome was analyzed with respect to tumor stage and radiation dose. Follow-up time ranged from 7 to 193 months (median 40 months). Actuarial local tumor control (LC), disease-specific survival (DSS) and colostomy + disease-free survival (CDFS) rates were calculated. Sphincter function was assessed among 17 of 20 evaluable patients (alive without colostomy with a minimum follow-up time of 1 year) using the FAIT-F (Version 3) quality of life assessment tool in conjunction with standard continence criteria. RESULTS: Thirty-two patients had Stage I or II disease and 15 had Stage III disease. Twenty-two patients received ≤ 45 Gy of RT and 25 patients received > 45 Gy. Only (3(22)) (14%) of patients receiving ≤ 45 Gy had Stage III disease, compared with(12(25)) (48%) of patients receiving > 45 Gy. The actuarial 5-year patient outcome analysis is summarized below: Overall, (3(47)) (6%) patients required a colostomy following treatment. In 2 patients, salvage abdominal perineal resection (APR) was performed at the time of local failure, and 1 patient who received 65 Gy of RT required a diverting colostomy due to a non-healing anal ulcer following treatment

Dysregulation of Autophagy Contributes to Anal Carcinogenesis.

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Evie H Carchman

Full Text Available Autophagy is an intracellular catabolic process that removes and recycles unnecessary/dysfunctional cellular components, contributing to cellular health and survival. Autophagy is a highly regulated cellular process that responds to several intracellular signals, many of which are deregulated by human papillomavirus (HPV infection through the expression of HPV-encoded oncoproteins. This adaptive inhibitory response helps prevent viral clearance. A strong correlation remains between HPV infection and the development of squamous cell carcinoma (SCC of the anus, particularly in HIV positive and other immunosuppressed patients. We hypothesize that autophagy is inhibited by HPV-encoded oncoproteins thereby promoting anal carcinogenesis (Fig 1.HPV16 transgenic mice (K14E6/E7 and non-transgenic mice (FVB/N, both of which do not spontaneously develop anal tumors, were treated topically with the chemical carcinogen, 7,12-Dimethylbenz[a]anthracene (DMBA, to induce anal cancer. The anuses at different time points of treatment (5, 10, 15 and 20 weeks were analyzed using immunofluorescence (IF for two key autophagy marker proteins (LC3β and p62 in addition to histological grading. The anuses from the K14E6/E7 mice were also analyzed for visual evidence of autophagic activity by electron microscopy (EM. To see if there was a correlation to humans, archival anal specimens were assessed histologically for grade of dysplasia and then analyzed for LC3β and p62 protein content. To more directly examine the effect of autophagic inhibition on anal carcinogenesis, nontransgenic mice that do not develop anal cancer with DMBA treatment were treated with a known pharmacologic inhibitor of autophagy, chloroquine, and examined for tumor development and analyzed by IF for autophagic proteins.Histologically, we observed the progression of normal anoderm to invasive SCC with DMBA treatment in K14E6/E7 mice but not in nontransgenic, syngeneic FVB/N background control mice

Retalhos de avanço no tratamento da fissura anal crônica: experiência inicial Advancement flap in the treatment of chronic anal fissure: inicial experience

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Maria Auxiliadora Prolungatti Cesar

2009-12-01

Full Text Available A fissura anal é uma laceração do canal anal relacionada ao trauma, hipertonia esfincteriana e isquemia. A maioria cicatriza espontaneamente ou com tratamento conservador, e poucas requerem tratamento cirúrgico. O objetivo deste trabalho é verificar os resultados clínicos e alterações manométricas de pacientes submetidos ao tratamento cirúrgico da fissura anal com avançamento de retalhos em v-y. Métodos: Estudo prospectivo, realizado nos anos de 2007, 2008 e 2009, que abrangeu nove pacientes portadores de fissura anal crônica submetidos ao avançamento de retalho anal. Foram avaliadas as pressões do canal anal ao repouso, contração e esforço evacuatório; no pré e pós-operatório. Resultados: Na amostra, todos os pacientes apresentaram hipertonia esfincteriana prévia. seis (66,6% obtiveram resolução total dos sintomas e das lesões. Um (11,11% sofreu deiscência parcial do retalho, sem sintomas clínicos; e outros dois (22,22%, infecção com perda dos mesmos e persistência da fissura. A análise manométrica das pressões de repouso, contração e evacuação nos grupos não mostrou alteração estatisticamente significativa (p>0,05, o que comprova que a cirurgia não incluiu manipulação dos esfíncteres. Conclusão: Os retalhos anais mostraram-se efetivos no tratamento da fissura anal, com cicatrização da lesão, sem que ocorram alterações nas pressões anais desses pacientes.The anal fissure is a laceration of the anal canal related to trauma, hypertonic sphincter and ischemia. The majority heals spontaneously or with conservative treatment and only a few requires surgical treatment. The objective of this study is to verify the clinical results and manometric alterations of patients submitted to the surgical treatment of the anal fissure with advance of v-y skin flaps. Methods: Prospective study, accomplished in 2007,2008 and 2009, in witch nine patients with chronic anal fissure were submitted to v-y advance. The

Role of Brachytherapy in the Boost Management of Anal Carcinoma With Node Involvement (CORS-03 Study)

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Moureau-Zabotto, Laurence, E-mail: moureaul@ipc.unicancer.fr [Department of Radiation Therapy, Institut Paoli Calmettes, Marseille (France); Ortholan, Cecile [Department of Radiation Therapy, Monaco (France); Hannoun-Levi, Jean-Michel [Department of Radiation Therapy, Antoine Lacassagne Cancer Center, Nice (France); Teissier, Eric [Azurean Cancer Center, Mougins (France); Cowen, Didier [Department of Radiation Therapy, Timone Academic Hospital and North Academic Hospital, Marseille (France); Department of Radiation Therapy, Val d' Aurelle Cancer Center, Montpellier (France); Salem, Nagi [Department of Radiation Therapy, Institut Paoli Calmettes, Marseille (France); Lemanski, Claire [Catalan Oncology Center, Perpignan (France); Ellis, Steve [French Red Cross Center, Toulon (France); Resbeut, Michel [Department of Radiation Therapy, Institut Paoli Calmettes, Marseille (France); French Red Cross Center, Toulon (France)

2013-03-01

Purpose: To assess retrospectively the clinical outcome in anal cancer patients, with lymph node involvement, treated with split-course radiation therapy and receiving a boost through external beam radiation therapy (EBRT) or brachytherapy (BCT). Methods and Materials: From 2000 to 2005, among 229 patients with invasive nonmetastatic anal squamous cell carcinoma, a selected group of 99 patients, with lymph node involvement, was studied. Tumor staging reported was T1 in 4 patients, T2 in 16 patients, T3 in 49 patients, T4 in 16 patients, and T unknown in 14 patients and as N1 in 67 patients and N2/N3 in 32 patients. Patients underwent a first course of EBRT (mean dose, 45.1 Gy) followed by a boost (mean dose, 18 Gy) using EBRT (50 patients) or BCT (49 patients). All characteristics of patients and tumors were well balanced between the BCT and EBRT groups. Prognostic factors of cumulative rate of local recurrence (CRLR), cumulative rate of distant (including nodal) recurrence (CRDR), colostomy-free survival (CFS) rate, and overall survival (OS) rate were analyzed for the overall population and according to the nodal status classification. Results: The median follow-up was 71.5 months. The 5-year CRLR, CRDR, CFS rate, and OS rate were 21%, 19%, 63%, and 74.4%, respectively. In the overall population, the type of node involvement (N1 vs N2/N3) was the unique independent prognostic factor for CRLR. In N1 patients, by use of multivariate analysis, BCT boost was the unique prognostic factor for CRLR (4% for BCT vs 31% for EBRT; hazard ratio, 0.08; P=.042). No studied factors were significantly associated with CRDR, CFS, and OS. No difference with regard to boost technique and any other factor studied was observed in N2/N3 patients for any kind of recurrence. Conclusion: In anal cancer, even in the case of initial perirectal node invasion, BCT boost is superior to EBRT boost for CRLR, without an influence on OS, suggesting that N1 status should not be a contraindication to

Intracavitary afterloading boost in anal canal carcinoma. Results, function and quality of life

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Vordermark, D.; Flentje, M.; Koelbl, O. [Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Strahlentherapie; Sailer, M. [Wuerzburg Univ. (Germany). Klinik fuer Chirurgie

2001-05-01

Background: First clinical data on a new intracavitary afterloading boost method for anal canal carcinoma is reported. Patients and Methods: 20 consecutive patients (T1 5%, T2 70%, T3 20%, T4 5%; N0 75%, N1 10%, N2 15%; all M0) treated with external beam pelvic radiotherapy (median dose 56 Gy, range 46-64 Gy), simultaneous 5-FU and mitomycin (in 75%) and an intracavitary afterloading boost (one or two fractions of 5 Gy at 5 mm depth) were analyzed after a mean {+-}SD follow-up for living patients of 4.4{+-}2.1 years. Quality of life (QoL) and anorectal manometry parameters were assessed in ten colostomy-free survivors. Results: Overall, recurrence-free and colostomy-free survival at 5 years were 84%, 79% and 69%, respectively. No death was tumorrelated. The only local failure was successfully salvaged by local excision. All three colostomies were performed for toxicity. Resting pressure and maximum squeeze pressure of the anal sphincter were reduced by 51% and 71%, as compared with control subjects, but quality of life was similar compared to healthy volunteers. Conclusion: the described regimen is highly effective but associated with increased toxicity. (orig.) [German] Hintergrund: Erste klinische Ergebnisse einer neuen Methode zur intrakavitaeren Afterloading-Boost-Bestrahlung des Analkanalkarzinoms werden vorgestellt. Patienten und Methoden: 20 in Folge behandelte Patienten (T1 5%, T2 70%, T3 20%, T4 5%, N0 75%, N1 10%, N2 15 %; alle M0) erhielten eine perkutane Bestrahlung (mediane Dosis 56 Gy, 46-64 Gy), simultan 5-FU und Mitomycin (75%) und einen intrakavitaeren Afterloading-Boost (eine oder zwei Fraktionen mit je 5 Gy in 5 mm Tiefe). Der mittlere Nachbeobachtungszeitraum lebender Patienten betrug 4,4{+-}2,1 Jahre. Zehn kolostomiefrei Ueberlebende wurden bezueglich Lebensqualitaet und anorektaler Manometriewerte untersucht. Ergebnisse: Gesamtueberleben, rezidivfreies und kolostomiefreies Ueberleben nach 5 Jahren betrugen 84%, 79% und 69%. Kein Todesfall war

Chemoradiotherapy of Anal Carcinoma: Survival and Recurrence in an Unselected National Cohort

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Bentzen, Anne Gry, E-mail: anne.gry.bentzen@unn.no [Department of Oncology, University Hospital of Northern Norway, Tromso (Norway); Institute of Clinical Medicine, University of Tromso, Tromso (Norway); Guren, Marianne G.; Wanderas, Eva H. [Department of Oncology, Oslo University Hospital, Oslo (Norway); Frykholm, Gunilla [Department of Oncology, St. Olav' s University Hospital, Trondheim, Norway and The Norwegian Radiation Protection Authority (NRPA), Osteras (Norway); Tveit, Kjell M. [Department of Oncology, Oslo University Hospital, Oslo (Norway); Faculty of Medicine, University of Oslo, Oslo (Norway); Wilsgaard, Tom [Department of Community Medicine, University of Tromso, Tromso (Norway); Dahl, Olav [Section of Oncology, Institute of Medicine, University of Bergen and Department of Oncology, Haukeland University Hospital, Bergen (Norway); Balteskard, Lise [Department of Oncology, University Hospital of Northern Norway, Tromso (Norway); Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromso (Norway)

2012-06-01

Purpose: To evaluate treatment results, elucidate whether national guidelines were followed, and identify areas demanding further treatment optimization. Methods and Material: Between July 2000 and June 2007, 328 patients were treated with curatively intended chemoradiotherapy (CRT) for nonmetastatic squamous cell carcinoma of the anal region, according to national treatment guidelines based on tumor stage. Results: Complete response after CRT was obtained in 87% of patients, rising to 93% after salvage surgery. Chemotherapy, elective irradiation of the groin and salvage surgery were performed to a lesser extent in elderly patients, mainly because of frailty and comorbidity. Recurrence occurred in 24% of the patients, resulting in a 3- and 5-year recurrence-free survival (RFS) of 79% and 74%, respectively. Locoregional recurrences dominated, most commonly in the primary tumor site. Recurrence was treated with curative intent in 45% of the cases. The 3- and 5-year overall survival were 79% and 66%, and cancer-specific survival (CSS) were 84% and 75%, respectively. The risk of adverse outcome increased significantly with more locally advanced tumors and for male gender in multivariable analyses for RFS and CSS. Conclusions: The treatment results are in accordance with similar cohorts. The primary treatment control rate was high, but there was a significant risk of locoregional recurrence in advanced tumors. The loyalty to national guidelines was broad, although individual adjustments occurred. However, caution to avoid toxicity must not lead to inadequate treatment. Male gender seems to have inferior outcome.

Chemoradiotherapy of Anal Carcinoma: Survival and Recurrence in an Unselected National Cohort

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Bentzen, Anne Gry; Guren, Marianne G.; Wanderås, Eva H.; Frykholm, Gunilla; Tveit, Kjell M.; Wilsgaard, Tom; Dahl, Olav; Balteskard, Lise

2012-01-01

Purpose: To evaluate treatment results, elucidate whether national guidelines were followed, and identify areas demanding further treatment optimization. Methods and Material: Between July 2000 and June 2007, 328 patients were treated with curatively intended chemoradiotherapy (CRT) for nonmetastatic squamous cell carcinoma of the anal region, according to national treatment guidelines based on tumor stage. Results: Complete response after CRT was obtained in 87% of patients, rising to 93% after salvage surgery. Chemotherapy, elective irradiation of the groin and salvage surgery were performed to a lesser extent in elderly patients, mainly because of frailty and comorbidity. Recurrence occurred in 24% of the patients, resulting in a 3- and 5-year recurrence-free survival (RFS) of 79% and 74%, respectively. Locoregional recurrences dominated, most commonly in the primary tumor site. Recurrence was treated with curative intent in 45% of the cases. The 3- and 5-year overall survival were 79% and 66%, and cancer-specific survival (CSS) were 84% and 75%, respectively. The risk of adverse outcome increased significantly with more locally advanced tumors and for male gender in multivariable analyses for RFS and CSS. Conclusions: The treatment results are in accordance with similar cohorts. The primary treatment control rate was high, but there was a significant risk of locoregional recurrence in advanced tumors. The loyalty to national guidelines was broad, although individual adjustments occurred. However, caution to avoid toxicity must not lead to inadequate treatment. Male gender seems to have inferior outcome.

The impact of gap duration on local control in anal canal carcinoma treated by split-course radiotherapy and concomitant chemotherapy

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Weber, Damien C.; Kurtz, John M.; Allal, Abdelkarim S.

2001-01-01

Purpose: To investigate the potential benefit of reducing the intersequence gap in patients with anal cancer treated with split-course chemoradiotherapy. Methods: The study group consisted of 90 patients with anal squamous carcinoma treated between 1981 and 1998, using concomitant chemotherapy (CT) and radiation (RT). Median age was 65 years (range 41-87). RT was delivered in a split course, with a median gap of 37.5 days (range 4-97) between sequences. First (pelvic) sequence delivered a median dose of 40 Gy (range 36-50.4), using AP/PA megavoltage photon beams. Boost treatment (median dose 20 Gy, range 13-26) consisted of either Iridium-192 implantation (49 patients) or external beam RT (41 patients). CT consisted of 1-2 cycles of a 5-day continuous infusion of 5-fluorouracil and bolus mitomycin C, usually administered during the first week of each RT course. Median follow-up was 76.2 months. Univariate and multivariate analyses were performed to determine the factors associated with locoregional control (LRC). Results: Five-year actuarial LRC was 72.5%. Factors associated with poorer LRC (univariate) were: age ≤65, male gender, and gap >37.5 days. Number of CT cycles (1 vs. 2 or more), boost technique (brachytherapy vs. external), and T-stage were not significantly associated with LRC. In multivariate analysis, only age (p=0.01), and gap (p=0.02) retained their significance. In patients older than 65 years, LRC was 92.3% and 75% for shorter and longer gaps, respectively. In younger patients, the corresponding values for LRC were 73.7% and 50%. Conclusion: In anal cancers, split-course RT with >50 Gy dose delivery is difficult to avoid because of acute toxicity. The present analysis suggests that shortening the gap contributes to optimizing LRC. Gaps longer than 5 weeks correlated with poorer LRC, with especially unsatisfactory results observed in younger patients

The Impact of Intensity Modulated Radiation Therapy on Hospitalization Outcomes in the SEER-Medicare Population With Anal Squamous Cell Carcinoma

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Pollom, Erqi L., E-mail: erqiliu@stanford.edu [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Wang, Guanying [Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California (United States); Harris, Jeremy P.; Koong, Albert C. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Bendavid, Eran; Bhattacharya, Jay [Center for Health Policy–Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California (United States); Chang, Daniel T. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States)

2017-05-01

Purpose: We examined the impact of intensity modulated radiation therapy (IMRT) on hospitalization rates in the Surveillance, Epidemiology, and End Results (SEER)–Medicare population with anal squamous cell carcinoma (SCC). Methods and Materials: We performed a retrospective cohort study using the SEER-Medicare database. We identified patients with nonmetastatic anal SCC diagnosed between 2001 and 2011 and treated with chemoradiation therapy. We assessed the relation between IMRT and first hospitalization by use of a multivariate competing-risk model, as well as instrumental variable analysis, using provider IMRT affinity as our instrument. Results: Of the 1165 patients included in our study, 458 (39%) received IMRT. IMRT use increased over time and was associated more with regional and provider characteristics than with patient characteristics. The 3- and 6-month cumulative incidences of first hospitalization were 41.9% (95% confidence interval [CI], 37.3%-46.4%) and 47.6% (95% CI, 43.0%-52.2%), respectively, for the IMRT cohort and 46.7% (95% CI, 43.0%-50.4%) and 52.1% (95% CI, 48.4%-55.7%), respectively, for the non-IMRT cohort. IMRT was associated with a decreased hazard of first hospitalization compared with 3-dimensional radiation techniques (hazard ratio, 0.70; 95% CI, 0.58-0.84; P=.0002). Instrumental variable analysis suggested an even greater reduction in hospitalizations with IMRT after controlling for unmeasured confounders. There was a trend toward improved overall survival with IMRT, with an adjusted hazard ratio of 0.77 (95% CI, 0.59-1.00; P=.05). Conclusions: The use of IMRT is associated with reduced hospitalizations in elderly patients with anal SCC. Further work is warranted to understand the long-term health and cost impact of IMRT, particularly for patient subgroups most at risk of toxicity and hospitalization.

Incidence, Trends and Ethnic Differences of Oropharyngeal, Anal and Cervical Cancers: Singapore, 1968-2012.

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Jennifer O Lam

Full Text Available In recent decades, several Western countries have reported an increase in oropharyngeal and anal cancers caused by human papillomavirus (HPV. Trends in HPV-associated cancers in Asia have not been as well described. We describe the epidemiology of potentially HPV-related cancers reported to the Singapore Cancer Registry from 1968-2012. Analysis included 998 oropharyngeal squamous cell carcinoma (OPSCC, 183 anal squamous cell carcinoma (ASCC and 8,019 invasive cervical cancer (ICC cases. Additionally, 368 anal non-squamous cell carcinoma (ANSCC and 2,018 non-oropharyngeal head and neck carcinoma (non-OP HNC cases were included as comparators. Age-standardized incidence rates (ASR were determined by gender and ethnicity (Chinese, Malay and Indian. Joinpoint regression was used to evaluate annual percentage change (APC in incidence. OPSCC incidence increased in both genders (men 1993-2012, APC = 1.9%, p<0.001; women 1968-2012, APC = 2.0%, p = 0.01 and was 5 times higher in men than women. In contrast, non-OP HNC incidence declined between 1968-2012 among men (APC = -1.6%, p<0.001 and women (APC = -0.4%, p = 0.06. ASCC and ANSCC were rare (ASR = 0.2 and 0.7 per 100,000 person-years, respectively and did not change significantly over time except for increasing ANSCCs in men (APC = 2.8%, p<0.001. ICC was the most common HPV-associated cancer (ASR = 19.9 per 100,000 person-years but declined significantly between 1968-2012 (APC = -2.4%. Incidence of each cancer varied across ethnicities. Similar to trends in Western countries, OPSCC incidence increased in recent years, while non-OP HNC decreased. ICC remains the most common HPV-related cancer in Singapore, but Pap screening programs have led to consistently decreasing incidence.

Manejo dos portadores das neoplasias intraepiteliais anais Managment of anal intra-epithelial neoplasia patients

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Sidney Roberto Nadal

2008-12-01

Full Text Available Acredita-se que a neoplasia intraepitelial anal (NIA, provocada pelo HPV, seja a lesão precursora do carcinoma anal. Segundo a literatura, são encontradas entre 11% e 52% dos homens infectados pelo HIV, entre 6% a 20% dos homens e 1% a 2,8% das mulheres sem essa infecção. Entre 8,5% e 13% das NIA de alto grau evoluirão para carcinoma invasivo, indicando a necessidade do rastreamento e do seguimento desses doentes para prevenção. Não há tratamento satisfatório com baixos índices de morbidez e a recidiva é comum. Em geral, as formas de tratamento podem de ser divididas em tópicas, entre elas, ácido tricloroacético, podofilina, podofilotoxina, imiquimod, terapia fotodinâmica, e ablativas, ou seja, excisão cirúrgica, ablação pelo LASER, coagulação pelo infravermelho e eletrofulguração. Há, ainda, os que consideram aceitável a conduta expectante. O tratamento tópico se justifica pelo caráter multifocal da lesão e os ablativos têm taxas de complicação e recidiva muito semelhantes. De qualquer forma, doentes com qualquer anormalidade histológica necessitam de seguimento adequado, principalmente com colposcopia e citologia anal.Anal intra-epithelial neoplasia (AIN, provoked by HPV, is considered as an anal cancer precursor. Some articles noticed that it occurred among 11% and 52% of men who have sex with men (MSM infected with HIV and, among seronegatives, from 6% to 20% of men and from 1% to 2.8% of women. From 8.5% to 13% of high grade AIN will evolve to invasive carcinoma, needing follow-up and screening for prevention. There is no satisfactory treatment with low morbidity and recurrence is frequent. There are two main forms of treatment: topics (trichloroacetic acid, podophylin, podophylotoxin, imiquimod, photodynamic therapy and ablatives (chirurgical excision, LASER, infrared, eletrocautery. Others consider acceptable an expectant management. Topical therapy is justified because of multifocal presentation of HPV

Simultaneous Integrated Boost–Intensity Modulated Radiation Therapy With Concomitant Capecitabine and Mitomycin C for Locally Advanced Anal Carcinoma: A Phase 1 Study

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Deenen, Maarten J. [Division of Clinical Pharmacology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Dewit, Luc [Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam (Netherlands); Boot, Henk [Division of Gastroenterology and Hepatology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Beijnen, Jos H. [Department of Pharmacy and Pharmacology, Slotervaart Hospital, Amsterdam (Netherlands); Faculty of Science, Department of Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, Utrecht (Netherlands); Schellens, Jan H.M. [Division of Clinical Pharmacology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Faculty of Science, Department of Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, Utrecht (Netherlands); Cats, Annemieke, E-mail: a.cats@nki.nl [Division of Gastroenterology and Hepatology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands)

2013-04-01

Purpose: Newer radiation techniques, and the application of continuous 5-FU exposure during radiation therapy using oral capecitabine may improve the treatment of anal cancer. This phase 1, dose-finding study assessed the feasibility and efficacy of simultaneous integrated boost–intensity modulated radiation therapy (SIB-IMRT) with concomitant capecitabine and mitomycin C in locally advanced anal cancer, including pharmacokinetic and pharmacogenetic analyses. Methods and Materials: Patients with locally advanced anal carcinoma were treated with SIB-IMRT in 33 daily fractions of 1.8 Gy to the primary tumor and macroscopically involved lymph nodes and 33 fractions of 1.5 Gy electively to the bilateral iliac and inguinal lymph node areas. Patients received a sequential radiation boost dose of 3 × 1.8 Gy on macroscopic residual tumor if this was still present in week 5 of treatment. Mitomycin C 10 mg/m{sup 2} (maximum 15 mg) was administered intravenously on day 1, and capecitabine was given orally in a dose-escalated fashion (500-825 mg/m{sup 2} b.i.d.) on irradiation days, until dose-limiting toxicity emerged in ≥2 of maximally 6 patients. An additional 8 patients were treated at the maximum tolerated dose (MTD). Results: A total of 18 patients were included. The MTD of capecitabine was determined to be 825 mg/m{sup 2} b.i.d. The predominant acute grade ≥3 toxicities included radiation dermatitis (50%), fatigue (22%), and pain (6%). Fifteen patients (83% [95%-CI: 66%-101%]) achieved a complete response, and 3 (17%) patients a partial response. With a median follow-up of 28 months, none of the complete responders, and 2 partial responders had relapsed. Conclusions: SIB-IMRT with concomitant single dose mitomycin C and capecitabine 825 mg/m{sup 2} b.i.d. on irradiation days resulted in an acceptable safety profile, and proved to be a tolerable and effective treatment regimen for locally advanced anal cancer.

Simultaneous Integrated Boost–Intensity Modulated Radiation Therapy With Concomitant Capecitabine and Mitomycin C for Locally Advanced Anal Carcinoma: A Phase 1 Study

International Nuclear Information System (INIS)

Deenen, Maarten J.; Dewit, Luc; Boot, Henk; Beijnen, Jos H.; Schellens, Jan H.M.; Cats, Annemieke

2013-01-01

Purpose: Newer radiation techniques, and the application of continuous 5-FU exposure during radiation therapy using oral capecitabine may improve the treatment of anal cancer. This phase 1, dose-finding study assessed the feasibility and efficacy of simultaneous integrated boost–intensity modulated radiation therapy (SIB-IMRT) with concomitant capecitabine and mitomycin C in locally advanced anal cancer, including pharmacokinetic and pharmacogenetic analyses. Methods and Materials: Patients with locally advanced anal carcinoma were treated with SIB-IMRT in 33 daily fractions of 1.8 Gy to the primary tumor and macroscopically involved lymph nodes and 33 fractions of 1.5 Gy electively to the bilateral iliac and inguinal lymph node areas. Patients received a sequential radiation boost dose of 3 × 1.8 Gy on macroscopic residual tumor if this was still present in week 5 of treatment. Mitomycin C 10 mg/m 2 (maximum 15 mg) was administered intravenously on day 1, and capecitabine was given orally in a dose-escalated fashion (500-825 mg/m 2 b.i.d.) on irradiation days, until dose-limiting toxicity emerged in ≥2 of maximally 6 patients. An additional 8 patients were treated at the maximum tolerated dose (MTD). Results: A total of 18 patients were included. The MTD of capecitabine was determined to be 825 mg/m 2 b.i.d. The predominant acute grade ≥3 toxicities included radiation dermatitis (50%), fatigue (22%), and pain (6%). Fifteen patients (83% [95%-CI: 66%-101%]) achieved a complete response, and 3 (17%) patients a partial response. With a median follow-up of 28 months, none of the complete responders, and 2 partial responders had relapsed. Conclusions: SIB-IMRT with concomitant single dose mitomycin C and capecitabine 825 mg/m 2 b.i.d. on irradiation days resulted in an acceptable safety profile, and proved to be a tolerable and effective treatment regimen for locally advanced anal cancer

Conservative management of anal and rectal cancer

International Nuclear Information System (INIS)

Gerard, J.P.; Romestaing, P.; Montbarbon, X.

1989-01-01

The role of irradiation in the management of anal and rectal cancer has changed during the past ten years. In small epidermoid carcinomas of the anal canal (T1 T2) irradiation is in most departments considered the primary treatment, giving a 5-year survival rate of between 60 and 80% with good sphincter preservation. Even in larger tumors, irradiation can still offer some chance of cure without colostomy. Surgery remains the basic treatment of rectal cancer but irradiation is used in association with surgery in many cases. Radiotherapy is of value in the conservative management of cancer of the rectum in three situations: In small polypoid cancers contact X-ray therapy can give local control in about 90%. In cancers of the middle rectum, preoperative external irradiation may increase the chances of restorative surgery and reduce the risk of local relapse. In inoperable patients, external radiotherapy and/or intracavitary irradiation may cure some patients with infiltrating tumors (T2 T3) without colostomy. (orig.)

Anal acoustic reflectometry

DEFF Research Database (Denmark)

Mitchell, Peter J; Klarskov, Niels; Telford, Karen J

2011-01-01

Anal acoustic reflectometry is a new technique of assessing anal sphincter function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, the opening and closing elastance, and hysteresis.......Anal acoustic reflectometry is a new technique of assessing anal sphincter function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, the opening and closing elastance, and hysteresis....

Dose-time considerations in the treatment of anal cancer

International Nuclear Information System (INIS)

Constantinou, Eugene C.; Daly, William; Fung, Claire Y.; Willett, Christopher G.; De Laney, Thomas F.

1996-01-01

Purpose: Concurrent chemoradiation has become the standard initial treatment of primary anal carcinomas. The objective of this study was to analyze the impact on treatment outcome of a variety of patient and treatment variables including radiation dose and overall treatment time in patients treated with concurrent chemoradiation for anal carcinomas. Materials and Methods: Retrospective chart review on 50 patients with MO anal cancer treated with concurrent chemoradiation during the years 1984-1993. Patients were identified from the hospital tumor registries. The majority of patients received treatment with 5-FU 1000 mg/m 2 days 1-4, 29-33 and Mitomycin 10-15 mg/m 2 days 1 ± 29. Radiation was given at 180-200 cGy daily starting at day 1 to total doses of 23.6-67.2 Gy (median 54 Gy) usually by shrinking field technique. Local control, disease-free survival, and overall survival of the group was determined and then analyzed with respect to a variety of patient characteristics including T and N stage, histology, radiation dose, overall treatment time, hemoglobin at the start of treatment, age, HIV status, and sex. Local control, disease-free and overall survival were calculated using the Kaplan-Meier method. Tests for significance were done using the log-rank method. Results: Patient characteristics were: (1) histology-squamous 78 %, cloacogenic/basaloid 20%, and adenosquamous 2%; (2) age- range 30-82 years (median 58.5), (3) sex- female 58%, male 42%; (4) T stage- T1 16%, T2 46%, T3 24%, T4 8%, TX 6%; (5) N stage- NO 69%, N+ 23 %, NX 8%; (6) HIV (+) 8%, HIV(-/?) 92%. Follow-up ranged from 2-132 months (median 43 months). Overall survival was 66% and 44% at 5 and 10 years. Disease-free survival was 67% at 5 years and 59% at 10 years. Local control was 70% at 5 and 10 years. Five year local control by T stage: T stage- T1 87.5 %, T2 63%, T3 83%, T4 67%, TX 50%. Doses of ≥ 54 Gy are associated with improved 5-year survival (84 % vs. 47%, p=0.02), disease-free survival

Time-dose considerations in the treatment of anal cancer

International Nuclear Information System (INIS)

Constantinou, Eugene C.; Daly, William; Fung, Claire Y.; Willett, Christopher G.; Kaufman, Donald S.; DeLaney, Thomas F.

1997-01-01

Purpose: To analyze the impact of patient and treatment parameters in concurrent chemoradiation treatment for anal carcinoma. Methods and Materials: Retrospective review of 50 MO anal cancer patients treated from 1984-1994. Most patients received concurrent 5-FU, mitomycin, and radiation. Local control and disease-free/overall survival were determined and analyzed according to patient and treatment parameters. Results: With 43 month median follow-up, projected overall survival is 66% at 5 and 8 years. Disease-free survival is 67% at 5 years and 59% at 8 years. Local control is 70% at 5 and 8 years. Doses of ≥54 Gy are associated with improved 5-year survival (84 vs. 47%, p = 0.02), disease-free survival (74 v. 56%, p = 0.09), and local control (77 vs. 61%, p = 0.04). Although local control, disease-free survival, and overall survival were improved in patients whose overall treatment time was <40 days, this was not statistically significant. Outcome in the four patients with pretreatment hemoglobin (Hgb) <10 appeared worse with 3-year overall survival 50 vs. 68% (p = 0.07), disease-free survival 0 vs. 67% (p = 0.11), and local control 0 vs. 74% (p = 0.05). Projected 5-year overall survival, relapse-free survival, and local control in 4 HIV (+) patients is 0, 75, and 75%. Multivariate analysis reveals that dose (p 0.02) and Hgb (p = 0.05) independently affect local control, dose (p = 0.02) affects disease-free survival, and dose (p = 0.01), Hgb (p = 0.03), T-stage (p = 0.03), and HIV-status (0.07) independently influence overall survival. Conclusion: Radiation doses of ≥54 Gy are associated with significantly improved survival and local control in anal cancer patients treated with chemoradiation. Overall treatment times of less than 40 days are associated with a trend towards improved outcome, but this is not significant. Pretreatment hemoglobin <10 is associated with worse treatment outcome. Survival of HIV (+) patient is poor, but the majority of such patients

Teetering near the edge; women's experiences of anal incontinence following obstetric anal sphincter injury: an interpretive phenomenological research study.

Science.gov (United States)

Tucker, Julie; Clifton, Vicki; Wilson, Anne

2014-08-01

Obstetric anal sphincter injury (OASIS) following vaginal delivery increases the risk of anal incontinence (AI). Subsequent vaginal delivery and ageing increase the risk of worsening symptoms. Very little literature describes any in-depth understanding of what it is like to live with AI following a history of known OASIS. To describe and interpret women's experience of AI following OASIS and its impact on quality of life. An interpretive phenomenological study was conducted in a level 2 tertiary hospital in South Australia. Women with a history of OASIS and AI were purposefully recruited. The St Marks Vaizey score was utilised to identify symptom severity. Semi-structured open-ended interviews were conducted, and data were analysed utilising Van Manen thematic analysis. Participants (n = 10) aged 26-56 years. All women were symptomatic of AI following OASIS, and 80% had received a primary OASIS at their first vaginal delivery. The St Marks Vaizey score mean was 9.1 (range within 4-22). Three essential themes grieving for loss, silence, striving for normality with eight subthemes identified a significant sense of loss and psychological impact of AI for this group of women. Health professionals require a greater understanding of the negative impact of OASIS and AI on women's quality of life. This may improve the management, education and clinical care of this condition which may result as a consequence of OASIS. © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Assessment and in vitro experiment of artificial anal sphincter system based on rebuilding the rectal sensation function.

Science.gov (United States)

Zan, Peng; Liu, Jinding; Jiang, Enyu; Wang, Hua

2014-05-01

In this paper, a novel artificial anal sphincter (AAS) system based on rebuilding the rectal sensation function is proposed to treat human fecal incontinence. The executive mechanism of the traditional AAS system was redesigned and integrated for a simpler structure and better durability. The novel executive mechanism uses a sandwich structure to simulate the basic function of the natural human anal sphincter. To rebuild the lost rectal sensation function caused by fecal incontinence, we propose a novel method for rebuilding the rectal sensation function based on an Optimal Wavelet Packet Basis (OWPB) using the Davies-Bouldin (DB) index and a support vector machine (SVM). OWPB using a DB index is used for feature vector extraction, while a SVM is adopted for pattern recognition.Furthermore, an in vitro experiment with the AAS system based on rectal sensation function rebuilding was carried out. Experimental results indicate that the novel executive mechanism can simulate the basic function of the natural human anal sphincter, and the proposed method is quite effective for rebuilding rectal sensation in patients.

Keratosis reduces sensitivity of anal cytology in detecting anal intraepithelial neoplasia.

Science.gov (United States)

ElNaggar, Adam C; Santoso, Joseph T; Xie, Huiwen Bill

2012-02-01

To identify factors that may contribute to poor sensitivity of anal cytology in contrast to the sensitivity of anoscopy in heterosexual women. We analyzed 324 patients with biopsy confirmed diagnosis of genital intraepithelial neoplasia (either vulva, vaginal, or cervical) from 2006 to 2011 who underwent both anal cytology and anoscopy. Cytology, anoscopy, and biopsy results were recorded. Biopsy specimens underwent independent analysis for quality of specimen. Also, biopsy specimens were analyzed for characteristics that may contribute to correlation, or lack thereof, between anal cytology and anoscopic directed biopsy. 133 (41%) patients had abnormal anoscopy and underwent directed biopsy. 120 patients with normal anal cytology had anoscopy directed biopsies, resulting in 58 cases of AIN (sensitivity 9.4%; 0.039-0.199). This cohort was noted to have extensive keratosis covering the entire dysplastic anal lesion. 18 patients yielded abnormal anal cytology. Of these patients, 13 had anoscopic directed biopsies revealing 6 with AIN and absent keratosis (specificity 88.6%; 0.78-0.95). The κ statistic for anal cytology and anoscopy was -0.0213 (95% CI=-0.128-0.086). Keratosis reduces the sensitivity of anal cytology. Furthermore, anal cytology poorly correlates with anoscopy in the detection of AIN (κ statistic=-0.0213). Copyright © 2011 Elsevier Inc. All rights reserved.

Anal wall sparing effect of an endorectal balloon in 3D conformal and intensity-modulated prostate radiotherapy.

NARCIS (Netherlands)

Smeenk, R.J.; Lin, E.N.J.T. van; Kollenburg, P. van; Kunze-Busch, M.C.; Kaanders, J.H.A.M.

2009-01-01

BACKGROUND AND PURPOSE: To investigate the anal wall (Awall) sparing effect of an endorectal balloon (ERB) in 3D conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for prostate cancer. MATERIALS AND METHODS: In 24 patients with localized prostate carcinoma, two planning

Tumor Response and Survival Predicted by Post-Therapy FDG-PET/CT in Anal Cancer

International Nuclear Information System (INIS)

Schwarz, Julie K.; Siegel, Barry A.; Dehdashti, Farrokh; Myerson, Robert J.; Fleshman, James W.; Grigsby, Perry W.

2008-01-01

Purpose: To evaluate the response to therapy for anal carcinoma using post-therapy imaging with positron emission tomography (PET)/computed tomography and F-18 fluorodeoxyglucose (FDG) and to compare the metabolic response with patient outcome. Patients and Methods: This was a prospective cohort study of 53 consecutive patients with anal cancer. All patients underwent pre- and post-treatment whole-body FDG-PET/computed tomography. Patients had been treated with external beam radiotherapy and concurrent chemotherapy. Whole-body FDG-PET was performed 0.9-5.4 months (mean, 2.1) after therapy completion. Results: The post-therapy PET scan did not show any abnormal FDG uptake (complete metabolic response) in 44 patients. Persistent abnormal FDG uptake (partial metabolic response) was found in the anal tumor in 9 patients. The 2-year cause-specific survival rate was 94% for patients with a complete vs. 39% for patients with a partial metabolic response in the anal tumor (p = 0.0008). The 2-year progression-free survival rate was 95% for patients with a complete vs. 22% for patients with a partial metabolic response in the anal tumor (p < 0.0001). A Cox proportional hazards model of survival outcome indicated that a complete metabolic response was the most significant predictor of progression-free survival in our patient population (p = 0.0003). Conclusions: A partial metabolic response in the anal tumor as determined by post-therapy FDG-PET is predictive of significantly decreased progression-free and cause-specific survival after chemoradiotherapy for anal cancer

Radio(chemo)therapy of the anal carcinoma. A retrospective study

International Nuclear Information System (INIS)

Sauer, Thomas Albert

2013-01-01

In a retrospective study the data of a consecutive cohort of 138 patients with a locally advanced squamous cell anal cancer were analysed, who were treated with a radio(chemo)therapy in the period from 1988 to 2011. The 5-year overall survival rate was 82%±4%. T category, UICC clinical stage, histopathologic grading and the ECOG performance status were significantly associated with overall survival. Acute toxicity grade 3/4 and chronic side effects grade 3 were found in 58% and 37% of the patients, respectively.

Basal Cell Carcinoma: 10 Years of Experience

International Nuclear Information System (INIS)

Cigna, E.; Tarallo, M.; Maruccia, M.; Sorvillo, V.; Pollastrini, A.; Scuderi, N.

2011-01-01

Introduction. Basal cell carcinoma (BCC) is a locally invasive malignant epidermal tumour. Incidence is increasing by 10% per year; incidence of metastases is minimal, but relapses are frequent (40%-50%). The complete excision of the BCC allows reduction of relapse. Materials and Methods. The study cohort consists of 1123 patients underwent surgery for basal cell carcinoma between 1999 and 2009. Patient and tumor characteristics recorded are: age; gender; localization (head and neck, trunk, and upper and lower extremities), tumor size, excisional margins adopted, and relapses. Results. The study considered a group of 1123 patients affected by basal cell carcinoma. Relapses occurred in 30 cases (2,67%), 27 out of 30 relapses occurred in noble areas, where peripheral margin was <3mm. Incompletely excised basal cell carcinoma occurred in 21 patients (1,87%) and were treated with an additional excision. Discussion. Although guidelines indicate 3mm peripheral margin of excision in BCC <2cm, in our experience, a margin of less than 5mm results in a high risk of incomplete excisions

Anal fissure - series (image)

Science.gov (United States)

Anal fissures are tears in the skin overlying the anal sphincter, usually due to increased tone of the anal sphincter muscles, and a failure of these muscle to relax. Anal fissures cause pain during defecation and bleeding from the anus.

IMPORTANCE OF THE ANAL MANOMETRY IN THE JUDICIALMEDICAL EXPERTISE OF THE ANAL PENETRATION

Directory of Open Access Journals (Sweden)

Jelica Miljkovic

2001-11-01

Full Text Available The forceful anal penetration can leave as a consequence a lasting damage ofthe anal sphincter function. The anal manometry is one of the methods that, in anindirect way, by measuring the pressure in the anal channel, may determine theexistence of the anus-closing muscles' function damage. The importance of the analmanometry application as an objective indicator of a possible damage of the analsphincter function is presented in the cases of the judicial-medical expertise of theanal penetration. Three cases of criminal acts of sexual abuse and rape in which thejudicial-medical expertise by the anal manometry method was applied are analyzed.The anal manometry method is reliable in determining the functional stote of theexternal and the internal anal sphincter and it should be accepted as obligatory indiagnostics and verification of the anal penetration.

Incidence and survival patterns of rare anal canal neoplasms using the surveillance epidemiology and end results registry.

Science.gov (United States)

Metildi, Cristina; McLemore, Elisabeth C; Tran, Thuy; Chang, David; Cosman, Bard; Ramamoorthy, Sonia L; Saltzstein, Sidney L; Sadler, Georgia Robins

2013-10-01

Small cell, neuroendocrine tumors, and melanoma of the anus are rare. Limited data exist on the incidence and management for these rare tumors. A large, prospective, population-based database was used to determine incidence and survival patterns of rare anal neoplasms. The Surveillance, Epidemiology and End Results registry was queried to identify patients diagnosed with anal canal neoplasms. Incidence and survival patterns were evaluated with respect to age, sex, race, histology, stage, and therapy. We identified 7078 cases of anal canal neoplasms: melanoma (n = 149), neuroendocrine (n = 61), and small cell neuroendocrine (n = 26). Squamous cell carcinoma (SCC) (n = 6842) served as the comparison group. Anal melanoma (AM) demonstrated the lowest survival rate at 2.5 per cent. Neuroendocrine tumors (NETs) demonstrated similar survival as SCC (10-year survival for regional disease of 25 and 22.3%, respectively). Ten-year survival of small cell NETs resembled AM (5.3 vs 2.5%). Age 60 years or older, sex, black race, stage, and surgery were independent predictors of survival. This study presents the largest patient series of rare anal neoplasms. NETs of the anal canal demonstrate similar survival patterns to SCC, whereas small cell NETs more closely resemble AM. Accurate histologic diagnosis is vital to determine treatment and surgical management because survival patterns can differ among rare anal neoplasms.

Invasive ductal carcinoma vs. invasive lobular carcinoma; mammographic findings

Energy Technology Data Exchange (ETDEWEB)

Lee, Eun Chun; Do, Young Soo; Oh, Hoon Il; Han, Yoon Hee; Kim, Ki Soo; Chin, Soo Yil [Korea Cancer Center Hospital, Seoul (Korea, Republic of)

1996-01-01

The purpose of this study is to evaluate mammographic findings of invasive ductal carcinoma (IDC) and invasive lobular carcinoma(ILC) and to find differential points between the two. 239 patients, who underwent mammography prior to surgery and were proved to have IDC(patients) or ILC(15 patients) pathologically, were analized retrospectively. On mammogram, presence of mass and microcalcification were analized. When there was a mass on mammogram, lesion opacity was classified into high, equal, or low opacity and border of the mass was classified into spiculated, poorly marginated, and well-marginated. When there was no definite mass, mammographic findings were classifie into asymmetric opacity and no mass. Masses were observed in 168 patients(75%) of IDC and 12 patients(80%) of ILC. Border of the masses were spiculated(n=50, 22.3%), poorly marginated(n=112, 50%), or well-marginated(n=6, 2.7%) in patients with IDC. Spiculated and poorly marginated borders were observed in 8 patients(53.3%) and 4 patients(26.7%) respectively, in patients with ILC. Microcalcifications were seen in 88 patients(17.3%) of IDC and patients(33.3%) of ILC. Although equal or low opacities were observed more frequently in ILC and microcalcifications were noted more frequently in IDC, it was difficult to differentiate the two diseases based on mammographic findings.

Invasive ductal carcinoma vs. invasive lobular carcinoma; mammographic findings

International Nuclear Information System (INIS)

Lee, Eun Chun; Do, Young Soo; Oh, Hoon Il; Han, Yoon Hee; Kim, Ki Soo; Chin, Soo Yil

1996-01-01

The purpose of this study is to evaluate mammographic findings of invasive ductal carcinoma (IDC) and invasive lobular carcinoma(ILC) and to find differential points between the two. 239 patients, who underwent mammography prior to surgery and were proved to have IDC(patients) or ILC(15 patients) pathologically, were analized retrospectively. On mammogram, presence of mass and microcalcification were analized. When there was a mass on mammogram, lesion opacity was classified into high, equal, or low opacity and border of the mass was classified into spiculated, poorly marginated, and well-marginated. When there was no definite mass, mammographic findings were classifie into asymmetric opacity and no mass. Masses were observed in 168 patients(75%) of IDC and 12 patients(80%) of ILC. Border of the masses were spiculated(n=50, 22.3%), poorly marginated(n=112, 50%), or well-marginated(n=6, 2.7%) in patients with IDC. Spiculated and poorly marginated borders were observed in 8 patients(53.3%) and 4 patients(26.7%) respectively, in patients with ILC. Microcalcifications were seen in 88 patients(17.3%) of IDC and patients(33.3%) of ILC. Although equal or low opacities were observed more frequently in ILC and microcalcifications were noted more frequently in IDC, it was difficult to differentiate the two diseases based on mammographic findings

[Merkel cell carcinoma experience in a reference medical center.

Science.gov (United States)

Roesch-Dietlen, Federico; Devezé-Bocardi, Raúl; Ruiz-Juárez, Isabel; Grube-Pagola, Peter; Romero-Sierra, Graciela; Remes-Troche, José María; Silva-Cañetas, Carmen Sofía; Lozoya-López Escalera, Hilda

2013-01-01

Background: Merkel cell carcinoma is a rare tumor that occurs on areas exposed to ultraviolet light. It is usually asymptomatic and it is diagnosed late often. The treatment is surgical, associated with adjuvant radiotherapy. The objective was to present the experience in the management of Merkel cell carcinoma in a reference medical center. Methods: all patients with Merkel cell carcinoma treated at the Instituto de Investigaciones Médico-Biológicas of the Universidad Veracruzana during the period 2008 to 2011 were studied. Sex, age, evolution time, tumor localization, size, metastases and treatment were analyzed. Results: of 3217 patients treated, three cases were Merkel cell carcinoma (0.09 %), their age was 52.1 ± 14.17, male predominance of 66.67 %; the evolution time was of 29.66 ± 35.36 months; the tumour localization was on inguinal region, anterior chest and left arm; the noodle size was of 6.0 ± 5.19 cm; two patients had lymph node metastases. In two cases, resection and lymphadenectomy were performed. They all received radiation therapy and chemotherapy in one case. Histologically the medium variant predominated; immunohistochemistry was positive in the three cases. One patient died ten months after the study was done. Conclusions: our experience is similar with others authors, Merkel cell carcinoma is a rare tumor, usually diagnosed late, and it has poor survival.

Conservative treatment of anal canal carcinoma with external radiotherapy and interstitial brachytherapy, with or without chemotherapy: long-term results; Traitement conservateur des cancers du canal anal par irradiation suivie de curietherapie interstitielle, avec ou sans chimiotherapie: resultats a long terme

Energy Technology Data Exchange (ETDEWEB)

Berger, C.; Felix-Faure, C.; Chauvet, B.; Vincent, P.; Alfonsi, M.; Coudurier, P.; Plat, F.; Reboul, F. [Clinique Sainte-Catherine, 84 - Avignon (France)

1999-12-01

Purpose: a retrospective analysis of conservative treatment of anal canal cancers with external radiation therapy and interstitial brachytherapy with or without chemotherapy. Patients and methods: from 1986 to 1996, 69 patients were treated with external radiotherapy (40 Gy/20 fractions) and interstitial brachytherapy (20 Gy) after a mean interval of six weeks for a localized epidermoid carcinoma of the anal canal. Patients who did not complete the whole therapeutic sequence were not included. Forty-five patients received additional 5-fluorouracil- and/or mitomycin C-based chemotherapy regimen. Results: acute toxicity was acceptable. Complete response rate was 81%. Actuarial local control rate was at two and five years, 65% and 59% respectively (median follow-up: eight years). At two, five and ten years, actuarial colostomy rate was 26%, 33% and 33% respectively, and colostomy-free survival rates 61%, 47% and 37%. Overall survival at two, five and ten years was 81%, 65% and 53% respectively. Distant metastases occurred in 11 patients (16%). Prognostic factors for overall survival were performance status (PS) (79% survival at five years for patients with PS 0 versus 50% for patients with PS 1-3, P = 0.04) and tumor stage (80% at five years for T1-T2 versus 53% for T3-T4, P = 0.03). Overall treatment time less than 12 weeks and time interval between external radiotherapy and brachytherapy inferior than six weeks were associated with a better local control (P = 0.05). In multivariate analysis, these prognostic factors were not significant. Conclusion: these results confirm the efficacy of external radiotherapy and brachytherapy in the treatment of small anal canal cancers, and point out the need for improving treatment outcome of larger tumors. (author)

Remedial chemo-radiotherapy for mediastinum and pleuro-pulmonary metastases of an anal canal cancer; Chimio-radiotherapie de rattrapage pour metastases mediastinales et pleuropulmonaires d'un cancer du canal anal

Energy Technology Data Exchange (ETDEWEB)

Moreau, M.V.; Tournier-Rangeard, L.; Peiffert, D. [Centre Alexis-Vautrin, Service de Radiotherapie, 54 - Nancy (France)

2006-11-15

A fifty seven years woman received ten years ago, a radiotherapy with iodine for a Basedow hyperthyroidism. In 2001 she was damaged bu an epidermoid carcinoma of the anal canal. Radiotherapy, then chemotherapy, then brachytherapy. During three years noting special to declare. In 2004, respiratory insufficiency leads her to consult. A PET scanography shows an inter-aortic-pulmonary hyper-metabolism. Cortico-therapy and radiotherapy by X rays are delivered. In front of the positive response a new chemoradiotherapy and three cycles of chemotherapy are made. After twenty five months the patient is in complete remission of her metastases after this remedial treatment. This observation illustrates the radiosensitivity of the anal canal cancers of including metastases situation, the interest of the PET scanography and utility of a remedial treatment with curative goal. (N.C.)

Anal canal carcinoma: Early-stage tumors ≤10 mm (T1 or Tis): Therapeutic options and original pattern of local failure after radiotherapy

International Nuclear Information System (INIS)

Ortholan, Cecile; Ramaioli, Alain; Peiffert, Didier; Lusinchi, Antoine; Romestaing, Pascale; Chauveinc, Laurent; Touboul, Emmanuel; Peignaux, Karine; Bruna, Antoine; La Roche, Guy de; Lagrange, Jean-Leon; Alzieu, Christian; Gerard, Jean Pierre

2005-01-01

Purpose: To investigate the clinical history, management, and pattern of recurrence of very early-stage anal canal cancer in a French retrospective survey. Methods: The study group consisted of 69 patients with Stage Tis and T1 anal canal carcinoma ≤1 cm treated between 1990 and 2000 (12 were in situ, 57 invasive, 66 Stage N0, and 3 Stage N1). The median patient age was 67 years (range, 27-83 years). Of the 69 patients, 66 received radiotherapy (RT) and 3 with in situ disease were treated by local excision alone without RT. Twenty-six patients underwent local excision before RT (12 with negative and 14 with positive surgical margins). Of the 66 patients who underwent RT, 8 underwent brachytherapy alone (median dose, 55 Gy), 38 underwent external beam RT (median dose, 45 Gy) plus a brachytherapy boost (median boost dose, 20 Gy), and 20 underwent external beam RT alone (median dose, 55 Gy). Results: Of the 69 patients, 68 had initial local control. Of the 66 patients treated by RT, 6 developed local recurrence at a median interval of 50 months (range, 13-78 months). Four patients developed local failure outside the initial tumor bed. Of the 3 patients with Tis treated by excision alone, 1 developed local recurrence. No relation was found among prior excision, dose, and local failure. The 5-year overall survival, colostomy-free survival, and disease-free survival rate was 94%, 85%, and 89%, respectively. The rate of late complications (Grade 1-3) was 28% and was 14% for those who received doses <60 Gy and 37% for those who received doses of ≥60 Gy (p = 0.04). Conclusion: Most recurrences occurred after a long disease-free interval after treatment and often outside the initial tumor site. These small anal cancers could be treated by RT using a small volume and moderate dose (40-50 Gy for subclinical lesions and 50-60 Gy for T1)

Anal incontinence after two vaginal deliveries without obstetric anal sphincter rupture

DEFF Research Database (Denmark)

Persson, Lisa K G; Sakse, Abelone; Langhoff-Roos, Jens

2017-01-01

PURPOSE: To evaluate prevalence and risk factors for long-term anal incontinence in women with two prior vaginal deliveries without obstetric anal sphincter injury (OASIS) and to assess the impact of anal incontinence-related symptoms on quality of life. METHODS: This is a nation-wide cross......-sectional survey study. One thousand women who had a first vaginal delivery and a subsequent delivery, both without OASIS, between 1997 and 2008 in Denmark were identified in the Danish Medical Birth Registry. Women with more than two deliveries in total till 2012 were excluded at this stage. Of the 1000 women...... affected their quality of life. No maternal or obstetric factors including episiotomy and vacuum extraction were consistently associated with altered risk of anal incontinence in the multivariable analyses. CONCLUSIONS: Anal incontinence and fecal urgency is reported by one fifth of women with two vaginal...

HPV infection, anal intra-epithelial neoplasia (AIN and anal cancer: current issues

Directory of Open Access Journals (Sweden)

Stanley Margaret A

2012-09-01

Full Text Available Abstract Background Human papillomavirus (HPV is well known as the major etiological agent for ano-genital cancer. In contrast to cervical cancer, anal cancer is uncommon, but is increasing steadily in the community over the last few decades. However, it has undergone an exponential rise in the men who have sex with men (MSM and HIV + groups. HIV + MSM in particular, have anal cancer incidences about three times that of the highest worldwide reported cervical cancer incidences. Discussion There has therefore traditionally been a lack of data from studies focused on heterosexual men and non-HIV + women. There is also less evidence reporting on the putative precursor lesion to anal cancer (AIN – anal intraepithelial neoplasia, when compared to cervical cancer and CIN (cervical intraepithelial neoplasia. This review summarises the available biological and epidemiological evidence for HPV in the anal site and the pathogenesis of AIN and anal cancer amongst traditionally non-high risk groups. Summary There is strong evidence to conclude that high-grade AIN is a precursor to anal cancer, and some data on the progression of AIN to invasive cancer.

Anal Cancer—Patient Version

Science.gov (United States)

Anal cancer cases have been increasing over several decades. Infection with human papillomavirus (HPV) is the major risk factor for anal cancer. Start here to find information on anal cancer treatment, causes and prevention, research, and statistics.

Dose-Painted Intensity-Modulated Radiation Therapy for Anal Cancer: A Multi-Institutional Report of Acute Toxicity and Response to Therapy

International Nuclear Information System (INIS)

Kachnic, Lisa A.; Tsai, Henry K.; Coen, John J.; Blaszkowsky, Lawrence S.; Hartshorn, Kevan; Kwak, Eunice L.; Willins, John D.; Ryan, David P.; Hong, Theodore S.

2012-01-01

Purpose: Chemoradiation for anal cancer yields effective tumor control, but is associated with significant acute toxicity. We report our multi-institutional experience using dose-painted IMRT (DP-IMRT). Patients and Methods: Between August 2005 and May 2009, 43 patients were treated with DP-IMRT and concurrent chemotherapy for biopsy-proven, squamous cell carcinoma of the anal canal at two academic medical centers. DP-IMRT was prescribed as follows: T2N0: 42 Gy, 1.5 Gy/fraction (fx) to elective nodal planning target volume (PTV) and 50.4 Gy, 1.8 Gy/fx to anal tumor PTV; T3-4N0-3: 45 Gy, 1.5 Gy/fx to elective nodal PTV, and 54 Gy, 1.8 Gy/fx to the anal tumor and metastatic nodal PTV >3 cm with 50.4 Gy, 1.68 Gy/fx to nodal PTVs ≤3 cm in size. Acute and late toxicity was reported by the treating physician. Actuarial analysis was performed using the Kaplan-Meier method. Results: Median age was 58 years; 67% female; 16% Stage I, 37% II; 42% III; 5% IV. Fourteen patients were immunocompromised: 21% HIV-positive and 12% on chronic immunosuppression. Median follow-up was 24 months (range, 0.6–43.5 months). Sixty percent completed chemoradiation without treatment interruption; median duration of treatment interruption was 2 days (range, 2–24 days). Acute Grade 3+ toxicity included: hematologic 51%, dermatologic 10%, gastrointestinal 7%, and genitourinary 7%. Two-year local control, overall survival, colostomy-free survival, and metastasis-free survival were 95%, 94%, 90%, and 92%, respectively. Conclusions: Dose-painted IMRT appears effective and well-tolerated as part of a chemoradiation therapy regimen for the treatment of anal canal cancer.

Dose-Painted Intensity-Modulated Radiation Therapy for Anal Cancer: A Multi-Institutional Report of Acute Toxicity and Response to Therapy

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Kachnic, Lisa A., E-mail: lisa.kachnic@bmc.org [Department of Radiation Oncology, Boston Medical Center, Boston, MA (United States); Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Tsai, Henry K. [Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA (United States); Coen, John J. [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Blaszkowsky, Lawrence S. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Hartshorn, Kevan [Department of Medicine, Boston Medical Center, Boston, MA (United States); Kwak, Eunice L. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Willins, John D. [Department of Radiation Oncology, Boston Medical Center, Boston, MA (United States); Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Ryan, David P. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Hong, Theodore S. [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States)

2012-01-01

Purpose: Chemoradiation for anal cancer yields effective tumor control, but is associated with significant acute toxicity. We report our multi-institutional experience using dose-painted IMRT (DP-IMRT). Patients and Methods: Between August 2005 and May 2009, 43 patients were treated with DP-IMRT and concurrent chemotherapy for biopsy-proven, squamous cell carcinoma of the anal canal at two academic medical centers. DP-IMRT was prescribed as follows: T2N0: 42 Gy, 1.5 Gy/fraction (fx) to elective nodal planning target volume (PTV) and 50.4 Gy, 1.8 Gy/fx to anal tumor PTV; T3-4N0-3: 45 Gy, 1.5 Gy/fx to elective nodal PTV, and 54 Gy, 1.8 Gy/fx to the anal tumor and metastatic nodal PTV >3 cm with 50.4 Gy, 1.68 Gy/fx to nodal PTVs {<=}3 cm in size. Acute and late toxicity was reported by the treating physician. Actuarial analysis was performed using the Kaplan-Meier method. Results: Median age was 58 years; 67% female; 16% Stage I, 37% II; 42% III; 5% IV. Fourteen patients were immunocompromised: 21% HIV-positive and 12% on chronic immunosuppression. Median follow-up was 24 months (range, 0.6-43.5 months). Sixty percent completed chemoradiation without treatment interruption; median duration of treatment interruption was 2 days (range, 2-24 days). Acute Grade 3+ toxicity included: hematologic 51%, dermatologic 10%, gastrointestinal 7%, and genitourinary 7%. Two-year local control, overall survival, colostomy-free survival, and metastasis-free survival were 95%, 94%, 90%, and 92%, respectively. Conclusions: Dose-painted IMRT appears effective and well-tolerated as part of a chemoradiation therapy regimen for the treatment of anal canal cancer.

Morphologic changes of the anal sphincter musculature during and after temporary stool deviation.

Science.gov (United States)

Sailer, M; Fein, M; Fuchs, K H; Bussen, D; Grun, C; Thiede, A

2001-04-01

Temporary stool deviation, using a stoma, is a well-known surgical principle to protect low colorectal or coloanal anastomoses. The purpose of this study was to evaluate any morphologic changes with regard to the anal sphincter muscles during and after temporary ileostomy. Forty-four patients with rectal carcinomas were studied prospectively. All patients underwent low anterior resection. Reconstruction was performed using either a coloanal pouch or a straight end-to-end anastomosis. A protective stoma was fashioned in all 44 patients (ileostomy n=41; colostomy n=3). Stoma closure was carried out after a median of 85 days (41-330 days). Using a standard protocol, anal-sphincter thickness [m. puborectalis, external anal sphincter (EAS) and internal anal (IAS) sphincter] was assessed by means of endoanal ultrasonography preoperatively, at the time of stoma closure, and every 3 months thereafter for 1 year. The diameter of the puborectal muscle decreased from a median preoperative value of 6.3 mm to 5.7 mm at the time of stoma closure (P=0.03). After 3 months, 6.2 mm was measured. This value remained stable for the complete follow-up period. Similar results were recorded for the EAS. The IAS thickness remained stable throughout the study period, measuring between 2.1 mm and 2.4 mm. Temporary stool deviation does lead to morphologic changes of the anal sphincter. While the smooth muscle remains unchanged, the striated counterpart undergoes atrophic transformation. However, after passage reconstruction, i.e., stoma closure, a rapid regeneration of the voluntary muscles is observed.

Interstitial high-dose rate brachytherapy as boost for anal canal cancer

International Nuclear Information System (INIS)

Falk, Alexander Tuan; Claren, Audrey; Benezery, Karen; François, Eric; Gautier, Mathieu; Gerard, Jean-Pierre; Hannoun-Levi, Jean-Michel

2014-01-01

To assess clinical outcomes of patients treated with a high-dose rate brachytherapy boost for anal canal cancer (ACC). From August 2005 to February 2013, 28 patients presenting an ACC treated by split-course external beam radiotherapy (EBRT) and HDR brachytherapy with or without chemotherapy in a French regional cancer center in Nice were retrospectively analyzed. Median age was 60.6 years [34 – 83], 25 patients presented a squamous cell carcinoma and 3 an adenocarcinoma; 21 received chemotherapy. Median dose of EBRT was 45 Gy [43.2 – 52]. Median dose of HDR brachytherapy was 12 Gy [10 - 15] with a median duration of 2 days. Median overall treatment time was 63 days and median delay between EBRT and brachytherapy was 20 days. Two-year local relapse free, metastatic free, disease free and overall survivals were 83%, 81.9%, 71.8% and 87.7% respectively. Acute toxicities were frequent but not severe with mostly grade 1 toxicities: 37% of genito-urinary, 40.7% of gastro-intestinal and 3.7% of cutaneous toxicities. Late toxicities were mainly G1 (43.1%) and G2 (22%). Two-year colostomy-free survival was 75.1%, one patient had a definitive sphincter amputation. High-dose rate brachytherapy for anal canal carcinoma as boost represents a feasible technique compared to low or pulsed-dose rate brachytherapy. This technique remains an excellent approach to precisely boost the tumor in reducing the overall treatment time

Analýza experimentů samobuzených oscilací tenkostěnné elastické trubice

Czech Academy of Sciences Publication Activity Database

Chlup, Hynek; Maršík, František; Konvičková, S.

2006-01-01

Roč. 10, č. 1 (2006), s. 189-194 ISSN 1335-2393. [Experimentálna analýza napätosti 2006/44./. Červený Kláštor, 23.05.2006-26.05.2006] R&D Projects: GA ČR(CZ) GA106/04/1181 Institutional research plan: CEZ:AV0Z20760514 Keywords : biomechanics * self -excited oscillation * thin-walled elastic tube Subject RIV: BJ - Thermodynamics

Influence of human papillomavirus and p16INK4a on treatment outcome of patients with anal cancer

International Nuclear Information System (INIS)

Koerber, Stefan Alexander; Schoneweg, Clara; Slynko, Alla; Krug, David; Haefner, Matthias F.; Herfarth, Klaus; Debus, Juergen; Sterzing, Florian; Knebel Doeberitz, Magnus von

2014-01-01

Background: The purpose of this study was to evaluate HPV-DNA and p16 INK4a (p16) expression as prognostic markers for outcome in patients with anal cancer. Methods: From January 2000 to December 2011 a cohort of 105 anal cancer patients was treated with definitive chemoradiation at our institution. Tumor biopsies from 90 patients were analyzed for HPV-DNA by polymerase chain reaction and for p16 expression by immunohistochemistry. Results: Median follow-up was 48.6 months (range 2.8–169.1 months). HPV-DNA or p16-expression was found in 75 anal cancers each (83.3%), concordance was detectable in 70 tumors (77.8%). Significantly improved overall survival (OS) [77.1% vs. 51.4%, p = 0.005], progression-free survival (PFS) [64.0% vs. 35.0%, p < 0.001] and improved local control [81.0% vs. 55.9%, p = 0.023] was found for concomitant HPV- and p16-positive anal carcinomas (cHPPAC) in univariate analysis. Multivariate analysis showed better OS [p = 0.015] and PFS [p = 0.002] for cHPPAC. Conclusion: The combination of HPV-DNA and p16 can be used as an independent prognostic parameter in anal cancer patients

[Paliative managment of oesophageal carcinomas--our experience].

Science.gov (United States)

Polanecký, O; Pazdro, A; Tvrdon, J; Tersíp, T; Smejkal, P; Smejkal, M; Hladík, P; Pafko, P

2006-04-01

The authors of this presentation explain their experience with methods of paliative care of oesophagus carcinoma. The indication criteria are described and compared advantages and disadvantages of those methods. There is an accent in most frequent method--oesophagus stent implementation. The results in the group of patients after the stent implementation are described, also complications and other solutions.

Anal incontinence in women with recurrent obstetric anal sphincter rupture

DEFF Research Database (Denmark)

Bøgeskov, Reneé; Nickelsen, Carsten Nahne Amtoft; Secher, Niels Jørgen

2015-01-01

UNLABELLED: Abstract Objectives: To determine the risk of recurrent anal sphincter rupture (ASR), and compare the risk of anal incontinence (AI) after recurrent ASR, with that seen in women with previous ASR who deliver by caesarean section or vaginally without sustaining a recurrent ASR. METHODS...

[Acute anal pain].

Science.gov (United States)

Pittet, Olivier; Demartines, Nicolas; Hahnloser, Dieter

2013-07-01

Acute anal pain is a common proctological problem. A detailed history together with the clinical examination are crucial for the diagnosis. An acute perianal vein thrombosis can be successfully excised within the first 72 hours. Acute anal fissures are best treated conservatively using stool regulation and topical medications reducing the sphincter spasm. A chronic anal fissure needs surgery. Perianal abscesses can very often be incised and drained in local anesthesia. Proctalgia fugax and the levator ani syndrome are exclusion diagnoses and are treated symptomatically.

Conservative management of anal and rectal cancer. The role of radiation therapy

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Gerard, J.P.; Romestaing, P.; Montbarbon, X. (Centre Hospitalier Lyon Sud, 69 - Pierre-Benite (France). Dept. of Radiotherapy)

1989-01-01

The role of irradiation in the management of anal and rectal cancer has changed during the past ten years. In small epidermoid carcinomas of the anal canal (T1 T2) irradiation is in most departments considered the primary treatment, giving a 5-year survival rate of between 60 and 80% with good sphincter preservation. Even in larger tumors, irradiation can still offer some chance of cure without colostomy. Surgery remains the basic treatment of rectal cancer but irradiation is used in association with surgery in many cases. Radiotherapy is of value in the conservative management of cancer of the rectum in three situations: In small polypoid cancers contact X-ray therapy can give local control in about 90%. In cancers of the middle rectum, preoperative external irradiation may increase the chances of restorative surgery and reduce the risk of local relapse. In inoperable patients, external radiotherapy and/or intracavitary irradiation may cure some patients with infiltrating tumors (T2 T3) without colostomy. (orig.).

Lymphatic mapping inguinal and sentinel lymph node biopsy in anal canal cancers to avoid prophylactic inguinal irradiation; Le marquage lymphatique et la biopsie du ganglion sentinelle inguinal dans les cancers du canal anal pour eviter l'irradiation inguinale prophylactique

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Bobin, J.Y. [Centre Hospitalier Universitaire Lyon-Sud, Service de Chirurgie Oncoloque, 69 - Pierre-Benite (France); Gerard, J.P.; Chapet, O.; Romestaing, P. [Centre Hospitalier Universitaire Lyon-Sud, Dept. de Radiotherapie et Oncologie, 69 - Pierre-Benite (France); Isaac, S. [Centre Hospitalier Universitaire Lyon-Sud, Dept. d' Anatomopathologie, 69 - Pierre-Benite (France)

2003-11-01

Thirty-five patients with clinically N0 cancers of the canal anal, 33 epidermoid carcinomas et 2 melanomas were histologically staged with inguinal sentinel lymphode biopsy (ISN). With the combined technique, blue dye and radiocolloid the ISN was identified in 100 % of the cases. The ISN was invaded in 7 cases/33 for epidermoid tumors and 2/2 for melanomas. After 18 months of follow-up, no inguinal recurrence could be seen in ISN pN0 cases. In conclusion, ISN biopsy is a reliable procedure to stage anal,, canal cancers. It should prevent unnecessary prophylactic inguinal irradiation for pN0 ISN. Inguinal irradiation is only indicated in pN1 ISN. (author)

Endosonographic and manometric assessment of the anal sphincters after ileal pouch-anal anastomosis

International Nuclear Information System (INIS)

Sudol-Szopinska, I.; Jakubowski, W.; Ciesielski, A.; Bielecki, K.; Baczuk, L.; Tarnowski, W.

2003-01-01

Background. The aim of this study was to compare endosonography and manometry of the anal sphincters in patients after ileal pouch-anal anastomosis (IPAA). Patients and methods. Ten patients aged between 23 and 50 years with IPAA performed for ulcerative colitis were examined with anal endosonography (AES) and manometry. Results. AES visualised abnormal image of the internal anal sphincter (IAS) in 9 patients (90%). Defects of the external anal sphincter (EAS) and puborectalis muscle (PR) were shown in 4 patients (40%). In 5 patients (50%) correlation between endosonographic and manometric assessment for the all analysed muscles: IAS, EAS and PR was found. In 4 cases (40%) both methods correlated with the evaluation of the EAS only and in 1 patient (10%) no correlation was found. Correlation between both methods for the IAS was found in half of the patients (50%) while in the evaluation of the EAS and PR dynamic activity, it was found in 9 cases (90%). Conclusions. Anal endosonography and manometry allow us to assess the morphology as well as the function of the anal sphincters in patients with IPAA. The methods mentioned above show high correlation in the assessment of the EAS function (9 cases; 90%) whereas in the case of IAS, manometry frequently (5 patients; 50%) does not confirm endosonografically detected defects. (author)

Chronic anal fissure: morphometric analysis of the anal canal at 3.0 Tesla MR imaging.

Science.gov (United States)

Erden, Ayşe; Peker, Elif; Gençtürk, Zeynep Bıyıklı

2017-02-01

OBJECTıVE: To compare the morphometric data relating to the muscular structures of the anal canal, in patients with chronic anal fissure and in control group, examined at a 3.0 Tesla MR system. Forty-seven consecutive patients with chronic anal fissure and randomly selected 40 patients who had no claims for perianal disease during their life time were included in the study. T2-weighted sagittal, high-resolution (HR) T2-weighted, and contrast-enhanced fat-suppressed T1-weighted oblique axial and oblique coronal images were retrospectively analyzed by two observers in consensus. Thickness of sphincteric muscles, anal canal length, anorectal angle, thickness of anococcygeal ligament, depth of Minor triangle, width between subcutaneous sphincters, vascularity of posterior commissure, visibility of posterosuperior projection of external sphincter, and angle between the distal anal canal and posterosuperior projection of external sphincter (H angle) in patients and in controls were compared and analyzed using t test, Mann-Whitney U test, and Spearman correlation. The patients with chronic anal fissure had longer anal canal (51.50 mm ± 0.91 vs. 44.11 mm ± 0.71; p = 0.000), thicker internal anal sphincter muscle at mid-anal level (4.18 ± 0.15 vs. 3.39 ± 0.07; p = 0.007), and wider space between subcutaneous external sphincters (11.39 ± 0.50 vs. 6.89 ± 0.22; p = 0.000). In patients, there was a positive correlation between H angle and external sphincter thickness at proximal (r = 0.347; p = 0.021), middle (r = 0427; p = 0.000), and distal (r = 0.518; p = 0.000)) levels of the anal canal. CONCLUSıON: 3.0 Tesla MR imaging provides detailed information about the morphometric changes in the anal sphincter muscles in patients with chronic anal fissure.

[Surgical treatment of anal fistula].

Science.gov (United States)

Zeng, Xiandong; Zhang, Yong

2014-12-01

Anal fistula is a common disease. It is also quite difficult to be solved without recurrence or damage to the anal sphincter. Several techniques have been described for the management of anal fistula, but there is no final conclusion of their application in the treatment. This article summarizes the history of anal fistula management, the current techniques available, and describes new technologies. Internet online searches were performed from the CNKI and Wanfang databases to identify articles about anal fistula management including seton, fistulotomy, fistulectomy, LIFT operation, biomaterial treatment and new technology application. Every fistula surgery technique has its own place, so it is reasonable to give comprehensive individualized treatment to different patients, which may lead to reduced recurrence and avoidance of damage to the anal sphincter. New technologies provide promising alternatives to traditional methods of management. Surgeons still need to focus on the invention and improvement of the minimally invasive techniques. Besides, a new therapeutic idea is worth to explore that the focus of surgical treatment should be transferred to prevention of the formation of anal fistula after perianal abscess.

Chemoradiotherapy with or without consolidation chemotherapy using cisplatin and 5-fluorouracil in anal squamous cell carcinoma: long-term results in 31 patients

Directory of Open Access Journals (Sweden)

Roh Jae

2008-01-01

Full Text Available Abstract Background The objectives of this study were to evaluate long-term results of concurrent chemoradiotherapy (CRT with 5-fluorouracil and cisplatin and the potential benefit of consolidation chemotherapy in patients with anal squamous cell carcinoma (ASCC. Methods Between January 1995 and February 2006, 31 patients with ASCC were treated with CRT. Radiotherapy was administered at 45 Gy over 5 weeks, followed by a boost of 9 Gy to complete or partial responders. Chemotherapy consisted of 5-fluorouracil (750 or 1,000 mg/m2 daily on days 1 to 5 and days 29 to 33; and, cisplatin (75 or 100 mg/m2 on day 2 and day 30. Twelve patients had T3–4 disease, whereas 18 patients presented with lymphadenopathy. Twenty-one (67.7% received consolidation chemotherapy with the same doses of 5-fluorouracil and cisplatin, repeated every 4 weeks for maximum 4 cycles. Results Nineteen patients (90.5% completed all four courses of consolidation chemotherapy. After CRT, 28 patients showed complete responses, while 3 showed partial responses. After a median follow-up period of 72 months, the 5-year overall, disease-free, and colostomy-free survival rates were 84.7%, 82.9% and 96.6%, demonstrating that CRT with 5-fluorouracil and cisplatin yields a good outcome in terms of survival and sphincter preservation. No differences in 5-year OS and DFS rates between patients treated with CRT alone and CRT with consolidation chemotherapy was observed. Conclusion our study shows that CRT with 5-FU and cisplatin, with or without consolidation chemotherapy, was well tolerated and proved highly encouraging in terms of long-term survival and the preservation of anal function in ASCC. Further trials with a larger patient population are warranted in order to evaluate the potential role of consolidation chemotherapy.

Results and toxicity of the treatment of anal canal carcinoma by radiation therapy or chemoradiotherapy. Therapieergebniss, Frueh- und Spaettoxizitaet der Behandlung des Analkanalkarzinoms durch Strahlentherapie oder Chemoradiotherapie

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Sommer, K.; Brockmann, W.P.; Wiegel, T.; Kruell, A.; Huebener, K.H.; Birk, S. (Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. fuer Strahlentherapie)

1991-08-01

From 1975 to 1989 114 patients with analcanal carcinoma were treated, 81 of these with radiotherapy (RT) alone and 33 with chemoradiotherapy (CRT). 80% respectively 82% of the patients were colostomy-free at the onset of therapy. RT was given to a total dose of 60 Gy in six weeks, for CRT additional simultaneous 5-fluorouracil (500 mg/m{sup 2} days 1 to 5 and 8 to 12) and mitomycin C (5 mg/m{sup 2} days 5 and 12) was administered. 67% respectively 82% of the patients had UICC stage II to IIIB disease predominantly with G2 and G3 squamous cell carcinomas. Local control after three years was 79% for the RT group vs. 82% for the CRT group. Three-year survival rate was 68% and 71%, respectively. These differences were not signficant. Only for G1-compared to G3-tumors there is a significantly higher survival rate. Acute and late damage was slightly lower for the RT treatment group (77% and 25%) compared to the CRT group (79% and 30%). In both treatment groups there was one patient needing a permanent colostomy due to radiation induced proctitis. In conclusion, RT or CRT should be the primary form of treatment in patients with anal canal carcinoma and abdominoperineal resection should only be performed in case of local recurrence or tumor persitence. The final decision about the indications for RT or CRT can only be made with the results of a prospective randomized trial. (orig.).

Pathophysiology and Natural History of Anorectal Sequelae Following Radiation Therapy for Carcinoma of the Prostate

International Nuclear Information System (INIS)

Yeoh, Eric K.; Holloway, Richard H.; Fraser, Robert J.; Botten, Rochelle J.; Di Matteo, Addolorata C.; Butters, Julie

2012-01-01

Purpose: To characterize the prevalence, pathophysiology, and natural history of chronic radiation proctitis 5 years following radiation therapy (RT) for localized carcinoma of the prostate. Methods and Materials: Studies were performed in 34 patients (median age 68 years; range 54-79) previously randomly assigned to either 64 Gy in 32 fractions over 6.4 weeks or 55 Gy in 20 fractions over 4 weeks RT schedule using 2- and later 3-dimensional treatment technique for localized prostate carcinoma. Each patient underwent evaluations of (1) gastrointestinal (GI) symptoms (Modified Late Effects in Normal Tissues Subjective, Objective, Management and Analytic scales including effect on activities of daily living [ADLs]); (2) anorectal motor and sensory function (manometry and graded balloon distension); and (3) anal sphincteric morphology (endoanal ultrasound) before RT, at 1 month, and annually for 5 years after its completion. Results: Total GI symptom scores increased after RT and remained above baseline levels at 5 years and were associated with reductions in (1) basal anal pressures, (2) responses to squeeze and increased intra-abdominal pressure, (3) rectal compliance and (4) rectal volumes of sensory perception. Anal sphincter morphology was unchanged. At 5 years, 44% and 21% of patients reported urgency of defecation and rectal bleeding, respectively, and 48% impairment of ADLs. GI symptom scores and parameters of anorectal function and anal sphincter morphology did not differ between the 2 RT schedules or treatment techniques. Conclusions: Five years after RT for prostate carcinoma, anorectal symptoms continue to have a significant impact on ADLs of almost 50% of patients. These symptoms are associated with anorectal dysfunction independent of the RT schedules or treatment techniques reported here.

Pathophysiology and Natural History of Anorectal Sequelae Following Radiation Therapy for Carcinoma of the Prostate

Energy Technology Data Exchange (ETDEWEB)

Yeoh, Eric K., E-mail: eric.yeoh@health.sa.gov.au [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide (Australia); Discipline of Medicine, University of Adelaide, Adelaide (Australia); Holloway, Richard H. [Discipline of Medicine, University of Adelaide, Adelaide (Australia); Department of Gastroenterology, Royal Adelaide Hospital, Adelaide (Australia); Fraser, Robert J. [Discipline of Medicine, University of Adelaide, Adelaide (Australia); Gastrointestinal Investigation Unit, Repatriation General Hospital, Adelaide (Australia); Botten, Rochelle J.; Di Matteo, Addolorata C.; Butters, Julie [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide (Australia)

2012-12-01

Purpose: To characterize the prevalence, pathophysiology, and natural history of chronic radiation proctitis 5 years following radiation therapy (RT) for localized carcinoma of the prostate. Methods and Materials: Studies were performed in 34 patients (median age 68 years; range 54-79) previously randomly assigned to either 64 Gy in 32 fractions over 6.4 weeks or 55 Gy in 20 fractions over 4 weeks RT schedule using 2- and later 3-dimensional treatment technique for localized prostate carcinoma. Each patient underwent evaluations of (1) gastrointestinal (GI) symptoms (Modified Late Effects in Normal Tissues Subjective, Objective, Management and Analytic scales including effect on activities of daily living [ADLs]); (2) anorectal motor and sensory function (manometry and graded balloon distension); and (3) anal sphincteric morphology (endoanal ultrasound) before RT, at 1 month, and annually for 5 years after its completion. Results: Total GI symptom scores increased after RT and remained above baseline levels at 5 years and were associated with reductions in (1) basal anal pressures, (2) responses to squeeze and increased intra-abdominal pressure, (3) rectal compliance and (4) rectal volumes of sensory perception. Anal sphincter morphology was unchanged. At 5 years, 44% and 21% of patients reported urgency of defecation and rectal bleeding, respectively, and 48% impairment of ADLs. GI symptom scores and parameters of anorectal function and anal sphincter morphology did not differ between the 2 RT schedules or treatment techniques. Conclusions: Five years after RT for prostate carcinoma, anorectal symptoms continue to have a significant impact on ADLs of almost 50% of patients. These symptoms are associated with anorectal dysfunction independent of the RT schedules or treatment techniques reported here.

[A case of a geriatric patient with stage IV anal canal cancer showing complete response to chemoradiation therapy].

Science.gov (United States)

Kuroda, Masatoshi; Hirai, Ryuji; Ikeda, Eiji; Tsuji, Hisashi; Takagi, Shoji; Yamano, Toshihisa; Yoshitomi, Seiji

2012-11-01

We present a case in which chemoradiation therapy was effective in a geriatric patient with Stage IV anal canal cancer. The patient is an 81-year-old woman who complained of proctorrhagia and anal pain. She was referred to us by her family doctor who suspected rectal cancer. Tumors as large as 6.5 cm in diameter mainly on the right side of the rectum as well as 2 palpable enlarged lymph nodes on the right inguinal area, were found during the initial physical examination. Squamous cell carcinoma was elevated to 16 ng/mL. A CT scan revealed that irregularly shaped masses as large as 7 cm in diameter were externally exposed on the right side of the rectum along with enlarged lymph nodes on the right inguinal area and metastasis at S7 lesion in the liver. Squamous cell carcinoma was diagnosed from biopsy results. Due to her age, the chemotherapy regimen was S-1+CDDP with radiation therapy and 4-port irradiation (50.4 Gy) of the primary tumor, interior of the pelvis, and inguinal lymph nodes. Partial response was observed upon completion of treatment, and complete response was obtained after 6 months. She is currently an outpatient taking S-1: 60 mg/day orally. There is no indication of cancer recurrence after 1 year and 3 months, and she continues to visit an outpatient clinic for regular follow-ups. These results demonstrate the effectiveness of chemoradiation therapy for geriatric patients with Stage IV anal canal cancer.

Anal Sphincter Augmentation Using Biological Material.

Science.gov (United States)

Alam, Nasra N; Narang, Sunil K; Köckerling, Ferdinand; Daniels, Ian R; Smart, Neil J

2015-01-01

The aim of this review is to provide an overview of the use of biological materials in the augmentation of the anal sphincter either as part of an overlapping sphincter repair (OSR) or anal bulking procedure. A systematic search of PubMed was conducted using the search terms "anal bulking agents," "anal sphincter repair," or "overlapping sphincter repair." Five studies using biological material as part of an overlapping sphincter repair (OSR) or as an anal bulking agent were identified. 122 patients underwent anal bulking with a biological material. Anorectal physiology was conducted in 27 patients and demonstrated deterioration in maximum resting pressure, and no significant change in maximum squeeze increment. Quality of life scores (QoLs) demonstrated improvements at 6 weeks and 6 months, but this had deteriorated at 12 months of follow up. Biological material was used in 23 patients to carry out an anal encirclement procedure. Improvements in QoLs were observed in patients undergoing OSR as well as anal encirclement using biological material. Incontinence episodes decreased to an average of one per week from 8 to 10 preoperatively. Sphincter encirclement with biological material has demonstrated improvements in continence and QoLs in the short term compared to traditional repair alone. Long-term studies are necessary to determine if this effect is sustained. As an anal bulking agent the benefits are short-term.

Trends in incidence of anal cancer and high-grade anal intraepithelial neoplasia in Denmark, 1978-2008

DEFF Research Database (Denmark)

Nielsen, Ann; Plum, Christian Edinger Munk; Kjaer, Susanne K

2012-01-01

The aim of the study was to determine the incidences of anal cancer and high-grade anal intraepithelial neoplasia (AIN2/3) over time in Danish women and men. Describing the burden of anal cancer and AIN may be valuable in future evaluations of the human papillomavirus (HPV) vaccine. We included all...... anal cancers in the Danish Cancer Register in the period 1978-2008 and all cases of AIN2/3 in the Danish Registry of Pathology. Overall and age-, period- and histology-specific incidence rates were estimated. During the 30-year period, 2187 anal cancers were identified, two thirds of which were...... in women. Between 1978-1982 and 2003-2008, the age-standardized incidence rate of anal cancer increased from 0.68 to 1.48 per 100 000 person-years in women and from 0.45 to 0.80 per 100 000 person-years in men. Although there is no systematic screening for AIN in Denmark, we nevertheless identified 608...

Prevalence status and association with human papilloma virus of anal squamous proliferative lesions in a patient sample in Taiwan.

Science.gov (United States)

Tsai, Tsen-Fang; Kuo, Guan-Tin; Kuo, Lu-Ting; Hsiao, Cheng-Hsiang

2008-08-01

Anal squamous proliferative lesions, including condyloma, anal high-grade squamous intraepithelial lesion (AHSIL) and squamous cell carcinoma (SCC), are associated with human papilloma virus (HPV) infection. The objectives of the study were to investigate the HPV prevalence of anal squamous proliferative lesion in Taiwan. From 1991 to 2005, 41 cases with condyloma, 12 cases with AHSIL, and 13 cases with SCC were collected. DNA was extracted from the tissue sections of these patients, and the HPV genotype was identified using polymerase chain reaction and gene chip. The integration status of HPV16 DNA was also evaluated by quantitative real-time polymerase chain reaction. Anal condyloma mainly occurred in young males, but AHSIL and anal SCC developed in older patients. In the patients with human immunodeficiency virus (HIV) infection, AHSIL developed much earlier than patients without HIV infection (36 vs. 61 years). HPV DNA was detected in all 56 patients whose specimens contained adequate DNA. High-risk HPVs (type 16, 58, etc.) were mainly detected in the AHSIL and SCC. Multiple HPV infection was found in AHSIL (4 of 12) and condyloma (11 of 34) but was rare in invasive cancer (1 of 12). Seven of 8 patients with HPV16 infection had coexistent episomal and integrated forms. HPV58 is a unique high-risk HPV prevalent in Taiwan. The integration status of HPV seems not correlated with the severity of the dysplasia. In our study, emerging HIV-positive AHSIL in recent years indicates that we should devote more efforts to promote sexual safety among the people who engaged in anal intercourse.

HIV/AIDS, HPV and Anal Cancer

Science.gov (United States)

Wang, Chia-ching J.; Sparano, Joseph; Palefsky, Joel M.

2016-01-01

SYNOPSIS Anal cancer is an increasingly common non-AIDS-defining cancer among HIV-infected individuals. It is associated with human papillomavirus (HPV), the most common sexually transmitted infectious agent. The 14 oncogenic types of HPV are causally associated with 5–10% of all cancers, notably anogenital cancers. HPV16 is the most common genotype detected in about 70% of anal cancers. The HPV types detected in anal cancer are included in the 9-valent vaccine. HPV vaccines have demonstrated efficacy in reducing anal precancerous lesions in HIV-infected individuals. The standard treatment for anal cancer has been fluorouracil (5-FU) and mitomycin (or cisplatin) as chemotherapy agents plus radiation, which can also be effectively used for the HIV-infected patients. Continued studies will be needed to test new treatment strategies in HIV-infected patients with anal cancer to determine which treatment protocols provide the best therapeutic index. PMID:27889034

Rational and progress of the phase 3 trial: intensification of the treatment of locally advanced squamous cell carcinoma of the anal canal; Rationnel et deroulement de l'essai de phase 3: localement therapeutique des cancers epidermoides du canal anal localement evolues (FNCLCC/ACCORD 03, FFCD/9802, SFRO)

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Peiffert, D. [Centre Alexis-Vautrin, 54 - Vandoeuvre-les-Nancy (France)

2003-11-01

Concomitant radiotherapy (5FU -MMC) was proved to be useful in locally advanced anal canal carcinoma. Nevertheless. it remains 30 % of failures after this conservative treatment. The tolerance and efficiency of a neo-adjuvant chemotherapy (5-FU-CDDP) were validated by a phase II trial including 80 patients, which obtained 73 % of colostomy free survival and 70 % of relapse free survival at 3-year follow-up. its usefulness is studied in an ongoing phase III trial, as well as the dose escalation of the boost, from 15 Gy to 25-25 Gy. The results of the 101 first included patients are studied by an intermediate analyze. In July 2003, 222 patients were enrolled by 33 investigating centres out of the 350 planned patients until the end of the trial in December 2004. (author)

ANAL SPHINCTER INJURIES (OASIS AT DELIVERY

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Katja Jakopič

2018-02-01

Full Text Available Background: Anal incontinence severely impairs quality of life. It affects 4 to 19 % of women and is statistically related to number of vaginal deliveries. It is grossly underreported and most patients that do seek help are referred to gastroenterologists or colorectal surgeons. Incidence of recognized sphincter injuries at time of delivery is 1 to 2 %. However studies with anal ultrasound showed incidence of anal sphincter injuries at 28 to 41 %. Depending on the degree of injury symptoms range from partial to complete inability to control passing of winds, liquid or solid stools. About three thirds of patients are asymp- tomatic in puerperium, however half of them are at risk of developing anal incontinence in later life. Hypoestrogenisem, additional perineal trauma during consequent deliveries and sphincter atrophy can unmask anal sphincter damage years later. Timely recognition and treatment are vital for good long term results and quality of life, if possible immediately after delivery. Good knowledge of perineal anatomy, recognition of risk factors, intense search and appropriate treatment and follow-up are essential to management of anal sphincter injuries. All secondary sphincter repair is less effective. Content: Updated overview of current opinion and guidelines on anal sphincter injuries are pre- sented. Anal sphincter is composed of external anal sphincter (EAS and internal anal sphincter (IAS. Striated EAS is divided into three parts – subcutaneous, superficial, deep, and con- nected to puborectalis muscle posteriorly. Smooth-muscled IAS is a continuation of a cir- cular smooth-muscle layer of rectum. In between there is a thin longitudinal muscle layer. IAS constitutes 70 % of resting tone and is under constant contraction. EAS contributes to 30 % of resting tone and almost all pressure during active contraction. EAS injury leads to insufficient contraction after rectal sampling and filling which causes urgency – patient can

PENGARUH GROUP INVESTIGATION BERBASIS OUTDOOR STUDY TERHADAP KEMAMPUAN BERPIKIR ANALITIS SISWA

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Valeriana Rasweda

2016-02-01

Full Text Available The purpose of research is to find out the Group Investigation outdoor study-based having an affect on student’s analytichal thinking ability. The type of research is PretestPosttest Control Group Design. The research was conducted at Lawang 1st Public Senior High School Malang Regency with experiment class X-IIS 1 and control class X-IIS 2. The data is an analytichal thinking ability. Data analysis was done by comparing the gain score student’s analytichal thinking ability using SPSS 17.0 for Windows. The results showed that Group Investigation outdoor study-based having an affect on student’s analytichal thinking ability.  Tujuan penelitian ini adalah untuk mengetahui apakah model Group Investigation berbasis outdoor study berpengaruh terhadap kemampuan berpikir analitis siswa. Penelitian ini merupakan jenis penelitian eksperimen semu (quasi experiment yang termasuk penelitian kuantitatif. Rancangan penelitian yang dikembangkan adalah Pretest-Posttest Control Group Design. Penelitian dilaksanakan di SMA Negeri 1 Lawang Kabupaten Malang. Kelas ekperimen ialah kelas X-IIS 1 dan kelas kontrol ialah kelas X-IIS 2. Data yang digunakan dalam penelitian ini adalah kemampuan berpikir analitis. Analisis data dilakukan dengan membandingkan gain score kemampuan berpikir analitis siswa menggunakan bantuan program SPSS 17.0 for Windows. Hasil dari penelitian ini menunjukkan bahwa model Group Investigation berbasis outdoor study berpengaruh terhadap kemampuan berpikir analitis siswa.

Preliminary results of a screening program for anal cancer and its precursors for HIV-infected men who have sex with men in Vigo-Spain

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Mauricio Iribarren-Díaz

Full Text Available Background and aims: Men who have sex with men (MSM infected with human immunodeficiency virus (HIV have the highest risk of developing anal cancer (AC. The objective of this study was to describe our screening implementation program in this population, and report the prevalence of human papillomavirus (HPV anal infection, and cytological and histological findings in a Spanish medium-size community (Vigo, Spain. Method: Prospective cohort analysis of 240 HIV-infected MSM. Cellular anal sample and high risk HPV (HR-HPV-tests were performed to study cytological changes and HPV genotyping. High resolution anoscopy (HRA was performed in 209 patients. Results were analyzed with respect to epidemiological, clinical and analytical factors. Results: Of 209 patients selected for HRA, the prevalence of HR-HPV anal infection, cytological and histological alterations was 85.6%, 47.5%, and 39.8%, respectively. Sensitivity and specificity for ≥ ASCUS (atypia of squamous cells of undetermined significance cytology in relation to histological alterations were 61% and 85%, (OR: 8.7; IC 95%: 4.4-17.2, respectively. Observed concordance between high-grade squamous intraepithelial lesion (HSIL cytology and HSIL anal intraepithelial neoplasia types 2 and 3 (AIN-2/3 histology was 64% (OR: 11.4; IC 95%: 3.6-36.7. One patient with HSIL cytology presented a prevalent anal squamous carcinoma. Conclusions: HRA was feasible with similar results to relevant groups. There was a high prevalence of anal HR-HPV infection, and cytological and histological alterations.

The prognostic value of HPV combined p16 status in patients with anal squamous cell carcinoma: a meta-analysis.

Science.gov (United States)

Sun, Guorui; Dong, Xiaoyuan; Tang, Xiaolong; Qu, Hui; Zhang, Hao; Zhao, Ensheng

2018-01-30

Human papillomavirus (HPV) DNA and p16 expression have been identified to be related to the progression of anal squamous cell carcinoma (ASCC). However, the prognostic relevance of combined detection, particularly HPV-/p16+ and HPV+/p16- signatures, is unknown. A meta-analysis of epidemiologic studies was therefore conducted to address this issue. Data were collected from studies comparing overall survival (OS) and disease-free survival (DFS) / disease-specific survival (DSS) / relapse-free survival (RFS) / progression-free survival (PFS) in ASCC patients with HPV and p16 status. The electronic databases of MEDLINE and EMBASE were searched from their inception till 31 May 2017. Study-specific risk estimates were pooled using a fixed-effects model for OS and DFS/DSS/RFS/PFS. Four studies involving a total of 398 ASCC cases were included in this meta-analysis. The pooled results showed that HPV+/p16+ cancers were significantly associated with improved OS (HR = 0.30, 95% CI: 0.17-0.51) and DFS/DSS/RFS/PFS (HR = 0.23, 95% CI: 0.14-0.36). However, patients with HPV-/p16+ or HPV+/p16- do not have a comparably good prognosis compared with HPV+/p16+ patients. The meta-analysis indicated that concomitant detection of HPV-DNA and p16 expression may be of prognostic or therapeutic utility in the evaluation of factors contributing to ASCC. Testing tumor specimens for HPV-DNA and p16 expression might indirectly affect treatment decisions.

Concurrent chemoradiotherapy with 5-fluorouracil and mitomycin C for anal carcinoma: Are there differences between HIV-positive and HIV-negative patients in the era of highly active antiretroviral therapy?

International Nuclear Information System (INIS)

Fraunholz, Ingeborg; Rabeneck, Daniela; Gerstein, Johanna; Jaeck, Katharina; Haberl, Annette; Weiss, Christian; Roedel, Claus

2011-01-01

Purpose: To report treatment compliance, toxicity and clinical outcome of chemoradiotherapy (CRT) for anal carcinoma in HIV-negative vs. HIV-positive patients treated with highly active antiretroviral therapy. Material and methods: Between 1997 and 2008, 25 HIV-positive and 45 HIV-negative patients received CRT (50.4 Gy at 1.8 Gy/fraction plus 5.4-10.8 Gy boost; 5-fluorouracil, 1000 mg/m 2 , Days 1-4 and 29-32, mitomycin C, 10 mg/m 2 , Days 1 and 29). Median follow-up was 51 (range, 3-235) months. Results: HIV-positive patients were significantly younger (mean age, 47 vs. 57 years, p < 0.001) and predominantly male (92% vs. 29%, p < 0.001). CRT could be completed in all patients with a reduction of chemotherapy and/or RT-interruption in 28% and 8%, respectively, in HIV-positive patients, and in 9% and 11%, respectively, in HIV-negative patients. Acute Grade 3/4-toxicity occurred in 44% vs. 49% (p = 0.79). Initial complete response (84% vs. 93%, p = 0.41), 5-year rates of local control (65% vs. 78%, p = 0.44), cancer-specific (78% vs. 90%, p = 0.17) and overall survival (71% vs. 77%, p = 0.76) were not significantly different. Conclusion: HIV-positive patients with anal cancer can be treated with standard CRT, with the same tolerability and toxicity as HIV-negative patients. Long-term local control and survival rates are not significantly different between these groups.

Encopresis and anal masturbation.

Science.gov (United States)

Aruffo, R N; Ibarra, S; Strupp, K R

2000-01-01

Current pediatric and psychiatric studies on encopresis and its treatment are heavily influenced by mechanical, physiological, and behavioral considerations. Although psychodynamic treatment has generally been considered to be of little benefit, and its findings suspect, the authors suggest that a psychodynamic approach adds substantially to the understanding of some cases of encopresis; that the anal sensations and anal erotic feelings reported by a number of encopretic children are intense, and that the encopretic symptom, soiling, in these children is the result of a conscious form of anal masturbation in which the fecal mass is used for stimulation; and that any study of encopresis is incomplete that does not include what encopretic children, engaged in a sound therapeutic relationship, know and say about their soiling. The authors further suggest that physical treatments of those children whose encopresis is psychologically driven may be contraindicated. The presence of a large stool does not in itself substantiate a physical illness. Further research is needed to elucidate the prevalence of anal masturbation in encopretic children.

Internal anal sphincter: Clinical perspective.

Science.gov (United States)

Kumar, Lalit; Emmanuel, Anton

2017-08-01

To summarise current knowledge of Internal anal sphincter. The internal anal sphincter (IAS) is the involuntary ring of smooth muscle in the anal canal and is the major contributor to the resting pressure in the anus. Structural injury or functional weakness of the muscle results in passive incontinence of faeces and flatus. With advent of new assessment and treatment modalities IAS has become an important topic for surgeons. This review was undertaken to summarise our current knowledge of internal anal sphincter and highlight the areas that need further research. The PubMed database was used to identify relevant studies relating to internal anal sphincter. The available evidence has been summarised and advantages and limitations highlighted for the different diagnostic and therapeutic techniques. Our understanding of the physiology and pharmacology of IAS has increased greatly in the last three decades. Additionally, there has been a rise in diagnostic and therapeutic techniques specifically targeting the IAS. Although these are promising, future research is required before these can be incorporated into the management algorithm. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Concurrent Chemoradiotherapy With 5-Fluorouracil and Mitomycin C for Invasive Anal Carcinoma in Human Immunodeficiency Virus-Positive Patients Receiving Highly Active Antiretroviral Therapy

International Nuclear Information System (INIS)

Fraunholz, Ingeborg; Weiss, Christian; Eberlein, Klaus; Haberl, Annette; Roedel, Claus

2010-01-01

Purpose: To report the clinical outcomes of chemoradiotherapy (CRT) for anal carcinoma in human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy. Patients and Methods: Between 1997 and 2008, 21 HIV-positive patients who were receiving highly active antiretroviral therapy were treated with CRT (50.4 Gy at 1.8 Gy/fraction plus a 5.4-10.8-Gy external boost; 5-fluorouracil, 1,000 mg/m 2 , Days 1-4 and 29-32; and mitomycin C, 10 mg/m 2 , Days 1 and 29). A retrospective analysis was performed with respect to the tumor response, local control, cancer-specific and overall survival, and toxicity. The immunologic parameters, including pre- and post-treatment CD4 count, viral load, and acquired immunodeficiency syndrome-specific morbidity was recorded during follow-up (median, 53 months; range, 10-99). Results: CRT could be completed in all 21 patients with a reduction in the chemotherapy dose and/or interruption of radiotherapy in 5 and 5 cases, respectively. Acute Grade 3 toxicity occurred in 8 (38%) of the 21 patients. A complete response was achieved in 17 patients (81%), and tumor persistence or early progression was noted in 4 (19%). Six patients (29%) died, 5 of cancer progression and 1 of treatment-related toxicity. The 5-year local control, cancer-specific, and overall survival rate was 59%, 75%, and 67%, respectively. The median CD4 count significantly decreased from 347.5 cells/μL before CRT to 125 cells/μL 3-7 weeks after CRT completion (p <.001). In 6 (32%) of 19 patients, an increase of the HIV viral load was noted. Both parameters returned to the pretreatment values with additional follow-up. Conclusion: Our data have confirmed that in the highly active antiretroviral therapy era, HIV-related anal cancer can be treated with standard CRT without dose reductions. Close surveillance of the immunologic parameters is necessary.

Low dose combined chemotherapy/radiotherapy in the management of locally advanced urethral squamous cell carcinoma

International Nuclear Information System (INIS)

Johnson, D.W.; Kessler, J.F.; Ferrigni, R.G.; Anderson, J.D.

1989-01-01

The successful treatment of a patient with bulky squamous cell carcinoma of the urethra using low dose preoperative radiation therapy and concurrent chemotherapy is described. Dramatic rapid tumor response facilitated surgical resection of the remaining microscopic disease. This clinical behavior is remarkably similar to that seen with squamous cell carcinoma of the anal canal and esophagus when a similar regimen is used. At the latter tumor sites the successful use of combination radiotherapy and chemotherapy has reduced the morbidity of subsequent surgery, and in selected cases has obviated the need for a radical operation. Further investigation of such combination treatment is warranted for urethral carcinoma

Syndemic synergy of HPV and other sexually transmitted pathogens in the development of high-grade anal squamous intraepithelial lesions

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Jenny C. McCloskey

2017-12-01

Full Text Available Background: Anal intraepithelial neoplasia is associated with high-risk human papillomavirus (hrHPV as a precursor to anal cancer. However, factors other than hrHPV are likely to be involved and further study of cofactors is required because of the possibility of syndemic interactions. Methods: Three hundred and fourteen patients underwent 457 operations. Histopathology and hrHPV testing using the Digene Hybrid Capture 2 (HC 2 method were performed. Demographic factors and sexually transmissible infections (STIs were recorded. Results: Results showed that hrHPV alone was associated with HSIL (OR = 4.65, p < 0.001. None of the other STIs were alone associated with HSIL but amplification of risk was found when hrHPV infection occurred with HIV (OR = 11.1; syphilis (OR = 5.58; HSV 2 (OR = 7.85; gonorrhoea (OR = 6.45 and some other infections. Conclusions: These results suggest that hrHPV is a sufficient cause of anal HSIL. Seropositivity for HIV, HSV 2, T. pallidum, HBV and HCV and a history of gonorrhoea or chlamydia exert a powerful amplifying factor increasing the risk of HSIL above the risk with hrHPV alone. Other co-factors which are associated with an increased risk of HSIL are increased age, male gender, MSM behaviour and self-reported history of more than 50 sexual partners. This pattern of disease in patients with warts is characteristic of a syndemic with potential serious increased risk of anal carcinoma. Keywords: HSIL, Anal warts, Sexually transmissible infections, High-risk HPV, HIV, Syndemic

[Effectiveness of human papillomavirus genotyping for detection of high-grade anal intraepithelial neoplasia compared to anal cytology].

Science.gov (United States)

Padilla-España, Laura; Repiso-Jiménez, Juan Bosco; Fernández-Sánchez, Fernando; Pereda, Teresa; Rivas-Ruiz, Francisco; Fernández-Morano, Teresa; de la Torre-Lima, Javier; Palma, Fermín; Redondo, Maximino; de Troya-Martín, Magdalena

2016-01-01

The incidence of high-grade anal intraepithelial neoplasia (HGAIN) -with an aetiological based on high-risk types of human papillomavirus- is increasing in some high-risk groups. Screening for HGAIN includes routine anal cytology and, more recently, HPV genotyping. The main objective of this study was to determine the sensitivity and specificity of anal cytology and HPV genotyping for the detection of HGAIN. This is a study to determine the correlation of cytological and microbiological findings with anal biopsy findings in a cohort of patients at high risk of developing AIN referred to the department of sexually transmitted infections of the Hospital Costa del Sol, Spain, between January 2008 and December 2014. Of the 151 patients subjected to screening, a total of 92 patients, all of them with the result of three screening test (anal cytology, genotyping and biopsy) were included in the study. Just under two-thirds (62%) of them were HIV-positive. The sensitivity and specificity of anal cytology to detect HGAIN were 52.8 and 85.7%, respectively (k: 0.328), and 78 and 62.8% to detect two or more HPV oncogenic genotypes (k: 0.417). The detection of oncogenic HPV genotypes allowed the identification of 23 new cases of HGAIN that had been underdiagnosed with anal cytology, with 14 cases containing at least three high-risk genotypes. Anal cytology did not show enough sensitivity in HGAIN screening. HPV genotyping has shown to be a useful tool to detect HGAIN cases, although it could lead to an over-diagnosis as a solitary screening procedure. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Anal cancer: ESMO–ESSO–ESTRO clinical practice guidelines for diagnosis, treatment and follow-up

International Nuclear Information System (INIS)

Glynne-Jones, Robert; Nilsson, Per J.; Aschele, Carlo; Goh, Vicky; Peiffert, Didier; Cervantes, Andrés; Arnold, Dirk

2014-01-01

Squamous cell carcinoma of the anus (SCCA) is a rare cancer but its incidence is increasing throughout the world, and is particularly high in the human immunodeficiency virus positive (HIV+) population. A multidisciplinary approach is mandatory (involving radiation therapists, medical oncologists, surgeons, radiologists and pathologists). SCCA usually spreads in a loco-regional manner within and outside the anal canal. Lymph node involvement at diagnosis is observed in 30–40% of cases while systemic spread is uncommon with distant extrapelvic metastases recorded in 5–8% at onset, and rates of metastatic progression after primary treatment between 10% and 20%. SCCA is strongly associated with human papilloma virus (HPV, types 16–18) infection. The primary aim of treatment is to achieve cure with loco-regional control and preservation of anal function, with the best possible quality of life. Treatment dramatically differs from adenocarcinomas of the lower rectum. Combinations of 5FU-based chemoradiation and other cytotoxic agents (mitomycin C) have been established as the standard of care, leading to complete tumour regression in 80–90% of patients with locoregional failures in the region of 15%. There is an accepted role for surgical salvage. Assessment and treatment should be carried out in specialised centres treating a high number of patients as early as possible in the clinical diagnosis. To date, the limited evidence from only 6 randomised trials [1,2,3,4,5,6,7], the rarity of the cancer, and the different behaviour/natural history depending on the predominant site of origin, (the anal margin, anal canal or above the dentate line) provide scanty direction for any individual oncologist. Here we aim to provide guidelines which can assist medical, radiation and surgical oncologists in the practical management of this unusual cancer

Epidermoid carcinomas of the anal canal treated with definitive radiation therapy in a series of 305 patients; Carcinomes epidermoides du canal anal traites par irradiation a visee curative: a propos de 305 patients

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Deniaud-Alexandre, E.; Touboul, E.; Huang, R.; Qu, S.H.; Pene, F.; Schlienger, M. [Hopital Tenon, Service d' Oncologie-Radiotherapie, 75 - Paris (France); Tiret, E.; Parc, R. [Hopital Saint-Antoine, Service de Chirurgie Digestive, 75 - Paris (France); Sezeur, A. [Hopital des Diaconesses, Service de Chirurgie Generale, 75 - Paris (France); Houry, S. [Hopital Tenon AP-HP, Service de Chirurgie Digestive, 75 - Paris (France); Gallot, D. [Groupe Hospitalier Bichat-Claude-Bernard, Service de Chirurgie Generale et Digestive B, 75 - Paris (France)

2003-08-01

Purpose. - To identify prognostic factors and treatment toxicity in a series of epidermoid cancers of the anal canal without evident metastasis. Patients and methods. - Between June 1972 and January 1997, 305 patients (pts) were treated with curative-intent radiation therapy (RT). The T-stages according to the 1987 UICC classification were: 26 T1, 141 T2, 104 T3, and 34 T4. There were 49 pts with nodal involvement at presentation. Pretreatment anal function scoring according to our in-house system was: 22 scored 0, 182 scored 1, 74 scored 2, 7 scored 3. 11 scored 4, and 9 not available pts. The treatment started with external beam RT (EBRT) in 303 pts (median dose: 45 Gy). After a rest period of 4 to 6 weeks, a boost of 20 Gy was delivered by EBRT in 279 pts and by interstitial {sup 192}Ir brachytherapy (Bcy) in 17 pts. Seven pts received only one course of EBRT (mean dose: 49.5 Gy) and 2 pts were treated with interstitial {sup 192}Ir Bcy alone (55 and 60 Gy, respectively). concomitant chemotherapy (5-fluoro-uracil and either mitomycin C or cisplatin) was delivered to 19 pts. Mean follow-up was 103 months. Results. - At the end of RT local tumor clinical complete response (cCR) rate was 80%. Out of 61 non responders or local progressive tumors 27 (44%) were salvaged with abdomino-perineal resection (APR). The rate of local tumor relapse (LR) was 12%. Out of 37 LTR, 20 (54%) were salvaged with APR and one with interstitial {sup 192}Ir Bcy. The overall local tumor control (LC) rate with or without salvage local treatment was 84%. LC rate with a good anal function scoring (score 0 and 1) was 56.5%0. Among 181/186 available pts who preserved their anus, 94% had a good anal function scoring. For a subgroup of 15 pts with length tumor <2 cm-N0, the LC rate after the end of RT was 100% the LC rate with or without local salvage treatment was 100%, and among 13 available pts who preserved their anus, the anal function scoring was good in 12 pts (92%). The 10-years disease

The treatment of carcinoma of the cervix and poor-risk endometrial carcinoma using the Cathetron at the Middlesex Hospital: experience since 1979.

Science.gov (United States)

Yeoh, E K; Spittle, M F

1986-03-01

This study reports on 5 years experience of the treatment of carcinoma of the cervix and poor-risk carcinoma of the body of the uterus using a combination of external beam radiotherapy and high-dose-rate intracavitary 60Co-brachytherapy using the Cathetron since 1979 at the Middlesex Hospital, London. Despite a reduction in external beam dose of 20% since 1979, survival rates for both diseases remain unchanged and also compare favourably with those of other centres; they are 70.02% for carcinoma of the cervix of all stages except Ia, and 81.17% for 'poor-risk' carcinoma of body of uterus of all stages. The complication rates were acceptable. Analysis of the results of treatment by stage of disease in those patients with carcinoma of the cervix revealed that, except for Stage I cases, the results were comparable with those reported in the literature. The reason for the poor results in Stage I was found to be due to the high proportion of patients of 35 years of age and under with Stage I disease who fared significantly worse than older patients.

The importance of ultrasound findings in the study of anal pain Importancia de los hallazgos ecográficos en el dolor anal

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A. M. Vieira

2010-05-01

Full Text Available Objective: endoanal ultrasonography can detect organic causes of anal pain without pathology on physical examination. The aim of this study is to evaluate the importance of endoanal ultrasonography in the diagnosis and therapeutic management of idiopathic and functional anal pain. Material and methods: retrospective study, between 15 March 2005 and 15 June 2008, of all patients with proctalgia and normal examination or with alterations not responsible for anal pain at proctologic exam that have undergone an endoanal ultrasonography. Results: a total of 90 patients were analyzed, with a mean age of 50.5 years, 58% were female. Twenty-three patients had functional anal pain clinic criteria. Endoanal ultrasonography revealed alterations in 49% of patients. The primary findings were changes in sphincters in 14 patients, followed by anal sepsis in 12 patients, anal fissure in 10 patients, perirectal lesions in 6 patients and ulcer of the anal canal in 2 patients. Of the patients with sphincter defects, 5 patients had criteria of chronic anal pain. In this group of patients, no differences were found in manometric and defecographic results between the different ultrasound abnormalities. Conclusions: the endoanal ultrasonography detected occult organic lesions to proctologic examination, in half the patients with anal pain. Ultrasound abnormalities were found in 22% of patients with functional anal pain. However, there was no correlation between ultrasound findings and physiological studies, and therefore could not find etiological or pathogenic factors of functional anal pain.Objetivo: la ecografía endoanal puede detectar causas orgánicas en el dolor anal sin patología en la exploración física. El objetivo de este estudio es evaluar la importancia de la ecografía endoanal en el diagnóstico y en el abordaje terapéutico del dolor anal idiopática y funcional. Material y métodos: estudio retrospectivo realizado entre el 15 de marzo de 2005 y el

Volumetric intensity-modulated arc therapy vs. 3-dimensional conformal radiotherapy for primary chemoradiotherapy of anal carcinoma. Effects on treatment-related side effects and survival

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Weber, Hanne Elisabeth; Droege, Leif Hendrik; Hennies, Steffen; Herrmann, Markus Karl; Wolff, Hendrik Andreas [University Medical Center Goettingen, Dept. of Radiotherapy and Radiooncology, Goettingen (Germany); Gaedcke, Jochen [University Medical Center Goettingen, Dept. of General Surgery, Goettingen (Germany)

2015-11-15

Primary chemoradiotherapy (CRT) is the standard treatment for locally advanced anal carcinoma. This study compared volumetric intensity-modulated arc therapy (VMAT) to 3-dimensional conformal radiotherapy (3DCRT) in terms of treatment-related side effects and survival. From 1992-2014, 103 consecutive patients with anal carcinoma UICC stage I-III were treated. Concomitant CRT consisted of whole pelvic irradiation, including the iliac and inguinal lymph nodes, with 50.4 Gy (1.8 Gy per fractions) by VMAT (n = 17) or 3DCRT (n = 86) as well as two cycles of 5-fluorouracil and mitomycin C. Acute organ and hematological toxicity were assessed according to the Common Terminology Criteria (CTC) for Adverse Events version 3.0. Side effects ≥ grade 3 were scored as high-grade toxicity. High-grade acute organ toxicity CTC ≥ 3 (P < 0.05), especially proctitis (P = 0.03), was significantly reduced in VMAT patients. The 2-year locoregional control (LRC) and disease-free survival (DFS) were both 100 % for VMAT patients compared with 80 and 73 % for 3DCRT patients. VMAT was shown to be a feasible technique, achieving significantly lower rates of acute organ toxicity and promising results for LRC and DFS. Future investigations will aim at assessing the advantages of VMAT with respect to late toxicity and survival after a prolonged follow-up time. (orig.) [German] Die primaere Radiochemotherapie (RCT) gilt als Standardtherapie fuer lokal fortgeschrittene Analkarzinome. In dieser Studie wurde die volumetrisch modulierte Rotationstherapie (''volumetric intensity-modulated arc therapy'', VMAT) mit der klassischen dreidimensionalen konformalen Radiotherapie (3DCRT) hinsichtlich therapieassoziierter Nebenwirkungen und Ueberleben verglichen. Von 1992-2014 wurden 103 aufeinanderfolgende Patienten mit einem Analkarzinom im UICC-Stadium I-III behandelt. Die kombinierte RCT bestand aus der Bestrahlung des gesamten Beckens inklusive der iliakalen und der inguinalen

Anal high-risk human papillomavirus infection and high-grade anal intraepithelial neoplasia detected in women and heterosexual men infected with human immunodeficiency virus

Directory of Open Access Journals (Sweden)

Gandra S

2015-01-01

Full Text Available Sumanth Gandra, Aline Azar, Mireya WessolosskyDivision of Infectious Disease and Immunology, University of Massachusetts Medical School, Worcester, MA, USABackground: Although anal high-risk human papillomavirus (HR-HPV infection and anal cytological abnormalities are highly prevalent among human immunodeficiency virus (HIV-infected men who have sex with men (MSM, there are insufficient data on these abnormalities among HIV-infected heterosexual men (HSM and women. In this study, we evaluated the prevalence of anal HR-HPV, cytological abnormalities, and performance of these screening tests in detecting high-grade anal intraepithelial neoplasia (AIN2+ among our cohort of HIV-infected MSM and non-MSM (HSM and women.Methods: A single-center, retrospective cohort study was conducted with HIV-infected individuals who underwent anal cancer screening with anal cytology and HR-HPV testing from January 2011 to January 31, 2013.Results: Screening of 221 HIV-infected individuals for both HR-HPV and anal cytology showed the presence of HR-HPV in 54% (abnormal anal cytology 48% of MSM, 28% (abnormal anal cytology 28% of HSM, and 27% (abnormal anal cytology 34% of women. Among 117 (53% individuals with abnormal results (HR-HPV-positive and/or cytology was atypical squamous cells of undetermined significance or above, 67 underwent high resolution anoscopy. Of these 67 individuals, 22 individuals had AIN2+ (17 MSM, four women, and one HSM. HR-HPV correlated better with AIN2+ than with anal cytology on biopsy in both MSM (r=0.29 versus r=0.10; P=0.05 versus P=0.49 and non-MSM (r=0.36 versus r=-0.34; P=0.08 versus P=0.09.Conclusion: Given the presence of AIN2+ in screened HIV-infected HSM and women, routine anal cancer screening in all HIV-infected individuals should be considered. HR-HPV merits further evaluation for anal cancer screening among non-MSM.Keywords: human immunodeficiency virus, anal human papillomavirus, heterosexual men, women, anal cancer

Anal Itching

Science.gov (United States)

... has many possible causes, such as skin problems, hemorrhoids, and washing too much or not enough. If ... dermatitis. Other medical conditions. These include chronic diarrhea, hemorrhoids, anal tumors and diseases that affect the whole ...

Early discharge after external anal sphincter repair

DEFF Research Database (Denmark)

Rosenberg, J; Kehlet, H

1999-01-01

PURPOSE: The aim of this study was to describe an accelerated-stay program for repair of the external anal sphincter. METHODS: Twenty consecutive patients undergoing overlapping repair of the external anal sphincter were included in the study. Effect parameters were length of hospitalization....... CONCLUSION: We have described a safe accelerated-stay program (24 to 48 hours) for overlapping repair of external anal sphincter....

Mode of delivery after obstetric anal sphincter injury.

Science.gov (United States)

Karmarkar, Roopali; Bhide, Alka; Digesu, Alex; Khullar, Vik; Fernando, Ruwan

2015-11-01

To assess the effect of vaginal delivery and caesarean section on faecal symptoms and structure and function of anal sphincter in women who sustained obstetric anal sphincter injuries (OASIS) in their previous pregnancy and were advised about the mode of delivery based on faecal incontinence symptoms, anal manometry and endoanal ultrasound. It is a descriptive study on a cohort of women who had OASIS from 2006 to 2013. They were assessed after OASIS and during subsequent pregnancy with a questionnaire, endoanal ultrasound and anal manometry. Vaginal delivery was recommended to asymptomatic women with normal investigations. Elective caesarean section was recommended to women with faecal symptoms, anal sphincter defects of more than 30° or low resting or incremental anal pressures. All women were reassessed after subsequent delivery. Fifty women who had pregnancies after OASIS, were seen after OASIS, during subsequent pregnancy and after the second delivery. 15 women had faecal symptoms after OASIS. The external, internal and combined anal sphincter defects were seen in 13, 11 and 9 women respectively. Low resting and incremental pressure were seen in 15 and 11 women respectively. Caesarean section was done in 22 women and 28 women delivered vaginally. Worsening of faecal symptoms and reduction in anal pressures were not observed in planned vaginal delivery or elective caesarean section groups. Faecal symptoms were worse with reduced anal pressures in three women from the planned caesarean section group. One of the women had a vaginal delivery and two women had emergency caesarean section at 7cm and 10cm dilatation. There were no new sphincter defects or recurrent OASIS in any of the women in the study group. Decision about the mode of delivery of pregnancy after OASIS based on symptoms, anal manometry and endoanal ultrasound helps in preserving the anal sphincter function and avoiding unnecessary caesarean sections. Further follow-up of these patients is essential

Diagnóstico de HPV anal em mulheres com NIC: prevenção de câncer do ânus? Anal HPV diagnosis in women with NIC: anal cancer prevention?

Directory of Open Access Journals (Sweden)

Alice Capobiango

2009-12-01

Full Text Available Os objetivos deste estudo foram avaliar a frequência de HPV anal em pacientes com neoplasia intraepitelial cervical (NIC, verificar a concordância entre os subtipos encontrados nos dois locais e investigar os fatores que influenciaram a ocorrência de HPV anal em mulheres com NIC sem evidências clínicas de imunodepressão. Foram avaliadas 52 mulheres com idades entre 16 e 72 anos e diagnóstico de neoplasia intraepitelial cervical graus I, II e III. A identificação do DNA (ácido desoxirribonucleico do HPV e de sete subtipos dos vírus foi realizada por meio da reação em cadeia da polimerase (PCR em material colhido no ânus e colo uterino. Foram pesquisados fatores que poderiam contribuir para a infecção anal, como paridade, número de parceiros, tabagismo, manipulação e coito anal e o tipo de doença ginecológica. Das 52 mulheres, foi diagnosticado HPV na região anal em 25 (48%, das quais 23 (44% também apresentavam HPV no colo uterino - resultado significativo para existência do HPV em portadoras de NIC. Em 16 (31% o HPV foi diagnosticado somente no colo uterino e em 11 (21% não foi identificado em colo ou ânus. Houve associação significativa nas variáveis paridade (p=0,02 e número de parceiros (p=0,04. Concluiu-se que: as mulheres com HPV genital têm mais probabilidade de serem acometidas por HPV anal; não há concordância unânime entre os subtipos do HPV do colo do útero e do ânus e a paridade e o número de parceiros contribuem para aumentar a incidência de HPV anal nas mulheres sem imunodeficiência e com HPV cervical.This study aims were to assess the frequency of HPV anal infection in patients with cervical intra-epithelial neoplasia (CIN, to find out the relation between the found subtypes, when present in both regions, and investigate factors that influenced the occurrence of anal HPV in women with CIN. Fifty two women with age between 16 and 72 years and cervical intra-epithelial neoplasia (CIN diagnosis

Botulinum toxin A injection for chronic anal fissures and anal sphincter spasm improves quality of life in recessive dystrophic epidermolysis bullosa

Directory of Open Access Journals (Sweden)

Cassandra Chaptini, MBBS

2015-12-01

Full Text Available We report a 20-year-old female with generalized, severe, recessive dystrophic epidermolysis bullosa who developed secondary chronic anal fissures. This resulted in anal sphincter spasm and severe, disabling pain. She was treated with five botulinum toxin A injections into the internal anal sphincter over a period of 2 years and gained marked improvement in her symptoms. This case demonstrates the successful use of botulinum toxin A injections to relieve anal sphincter spasm and fissuring, with long-term improvement.

Prostatic pseudohyperplasia carcinoma. Experiences and criteria.

OpenAIRE

Ileana Franco Zunda; Alfredo B. Quiñones Ceballos; Antonio L. Moreno Otero

2005-01-01

Fundament: Prostatic deseases are a havoc in male population older than 45 years old. Pseudohyperplastic carcinoma is a non frecuent variety and hard to diagnose. Objective: to reevaluate prostatic hyperplasia diagnoses to identify pseudohyperplastic carcinomas. Methods: retrospective study in which the prostatic hyperplasia diagnoses of 2004 were reevaluated in the Uiversitary Hospital ¨Dr. Gustavo Aldereguia Lima¨, considering as a basis the criteria given by Julian Arista -Nasr, evaluated ...

Combined radiological and chemical treatment of carcinomas of the anus

International Nuclear Information System (INIS)

Schuck, U.

1988-01-01

A combination of radiotherapy and chemotherapy has proved effective and the toxic reactions to this treatment generally remain within tolerable limits, as there is no need to inflict major wounds and the anal functions can largely be maintained. The tumour remission seen here is more rapid and more radical than that achieved by the simple use of irradiation. This means that the radiation dose may safely be reduced without thereby marring the success of treatment. Cytostatic drugs alone show no great effectiveness against anal carcinomas and are beneficial only in connection with radiation treatment. Acute local reactions were observed in all patients, while the delayed effects seen following surgery or radiotherapy as the sole method of treatment failed to occur here. The main drawback of radiochemical treatment are hematological side-effects in the form of bone marrow depression. (VHE) [de

Anal Carcinoma: Impact of TN Category of Disease on Survival, Disease Relapse, and Colostomy Failure in US Gastrointestinal Intergroup RTOG 98-11 Phase 3 Trial

Science.gov (United States)

Gunderson, Leonard L.; Moughan, Jennifer; Ajani, Jaffer A.; Pedersen, John E.; Winter, Kathryn A.; Benson, Al B.; Thomas, Charles R.; Mayer, Robert J.; Haddock, Michael G.; Rich, Tyvin A.; Willett, Christopher G.

2013-01-01

Purpose The long-term update of US GI Intergroup RTOG 98-11 anal cancer trial found that concurrent chemoradiation (CCRT) with fluorouracil (5-FU) plus mitomycin had a significant impact on disease-free survival (DFS) and overall survival (OS) compared with induction plus concurrent 5-FU plus cisplatin. The intent of the current analysis was to determine the impact of tumor node (TN) category of disease on survival (DFS and OS), colostomy failure (CF), and relapse (local-regional failure [LRF] and distant metastases [DM]) in this patient group. Methods and Materials DFS and OS were estimated univariately by using the Kaplan-Meier method, and 6 TN categories were compared by the log–rank test (T2N0, T3N0, T4N0, T2N1-3, T3N1-3, and T4N1-3). Time to relapse and colostomy were estimated by the cumulative incidence method, and TN categories were compared using Gray’s test. Results Of 682 patients, 620 were analyzable for outcomes by TN category. All endpoints showed statistically significant differences among the TN categories of disease (OS, P<.0001; DFS, P<.0001; LRF, P<.0001; DM, P=.0011; CF, P=.01). Patients with the poorest OS, DFS, and LRF outcomes were those with T3-4N-positive (+) disease. CF was lowest for T2N0 and T2N+ (11%, 11%, respectively) and worst for the T4N0, T3N+, and T4N+ categories (26%, 27%, 24%, respectively). Conclusions TN category of disease has a statistically significant impact on OS, DFS, LRF, DM, and CF in patients treated with CCRT and provides excellent prognostic information for outcomes in patients with anal carcinoma. Significant challenges remain for patients with T4N0 and T3-4N+ categories of disease with regard to survival, relapse, and CF and lesser challenges for T2-3N0/T2N+ categories. PMID:24035327

Anal Carcinoma: Impact of TN Category of Disease on Survival, Disease Relapse, and Colostomy Failure in US Gastrointestinal Intergroup RTOG 98-11 Phase 3 Trial

Energy Technology Data Exchange (ETDEWEB)

Gunderson, Leonard L., E-mail: gunderson.leonard@mayo.edu [Mayo Clinic Cancer Center, Scottsdale, Arizona (United States); Moughan, Jennifer [Radiation Therapy Oncology Group, Philadelphia, Pennsylvania (United States); Ajani, Jaffer A. [The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Pedersen, John E. [Cross Cancer Institute, Edmonton, Alberta (Canada); Winter, Kathryn A. [Radiation Therapy Oncology Group, Philadelphia, Pennsylvania (United States); Benson, Al B. [Northwestern University, Chicago, Illinois (United States); Thomas, Charles R. [Knight Cancer Institute/Oregon Health and Science University, Portland, Oregon (United States); Mayer, Robert J. [Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Haddock, Michael G. [Mayo Clinic Cancer Center, Rochester, Minnesota (United States); Rich, Tyvin A. [University of Virginia, Charlottesville, Virginia (United States); Willett, Christopher G. [Duke University, Durham, North Carolina (United States)

2013-11-15

Purpose: The long-term update of US GI Intergroup RTOG 98-11 anal cancer trial found that concurrent chemoradiation (CCRT) with fluorouracil (5-FU) plus mitomycin had a significant impact on disease-free survival (DFS) and overall survival (OS) compared with induction plus concurrent 5-FU plus cisplatin. The intent of the current analysis was to determine the impact of tumor node (TN) category of disease on survival (DFS and OS), colostomy failure (CF), and relapse (local-regional failure [LRF] and distant metastases [DM]) in this patient group. Methods and Materials: DFS and OS were estimated univariately by using the Kaplan-Meier method, and 6 TN categories were compared by the log–rank test (T2N0, T3N0, T4N0, T2N1-3, T3N1-3, and T4N1-3). Time to relapse and colostomy were estimated by the cumulative incidence method, and TN categories were compared using Gray's test. Results: Of 682 patients, 620 were analyzable for outcomes by TN category. All endpoints showed statistically significant differences among the TN categories of disease (OS, P<.0001; DFS, P<.0001; LRF, P<.0001; DM, P=.0011; CF, P=.01). Patients with the poorest OS, DFS, and LRF outcomes were those with T3-4N-positive (+) disease. CF was lowest for T2N0 and T2N+ (11%, 11%, respectively) and worst for the T4N0, T3N+, and T4N+ categories (26%, 27%, 24%, respectively). Conclusions: TN category of disease has a statistically significant impact on OS, DFS, LRF, DM, and CF in patients treated with CCRT and provides excellent prognostic information for outcomes in patients with anal carcinoma. Significant challenges remain for patients with T4N0 and T3-4N+ categories of disease with regard to survival, relapse, and CF and lesser challenges for T2-3N0/T2N+ categories.

Anal Carcinoma: Impact of TN Category of Disease on Survival, Disease Relapse, and Colostomy Failure in US Gastrointestinal Intergroup RTOG 98-11 Phase 3 Trial

International Nuclear Information System (INIS)

Gunderson, Leonard L.; Moughan, Jennifer; Ajani, Jaffer A.; Pedersen, John E.; Winter, Kathryn A.; Benson, Al B.; Thomas, Charles R.; Mayer, Robert J.; Haddock, Michael G.; Rich, Tyvin A.; Willett, Christopher G.

2013-01-01

Purpose: The long-term update of US GI Intergroup RTOG 98-11 anal cancer trial found that concurrent chemoradiation (CCRT) with fluorouracil (5-FU) plus mitomycin had a significant impact on disease-free survival (DFS) and overall survival (OS) compared with induction plus concurrent 5-FU plus cisplatin. The intent of the current analysis was to determine the impact of tumor node (TN) category of disease on survival (DFS and OS), colostomy failure (CF), and relapse (local-regional failure [LRF] and distant metastases [DM]) in this patient group. Methods and Materials: DFS and OS were estimated univariately by using the Kaplan-Meier method, and 6 TN categories were compared by the log–rank test (T2N0, T3N0, T4N0, T2N1-3, T3N1-3, and T4N1-3). Time to relapse and colostomy were estimated by the cumulative incidence method, and TN categories were compared using Gray's test. Results: Of 682 patients, 620 were analyzable for outcomes by TN category. All endpoints showed statistically significant differences among the TN categories of disease (OS, P<.0001; DFS, P<.0001; LRF, P<.0001; DM, P=.0011; CF, P=.01). Patients with the poorest OS, DFS, and LRF outcomes were those with T3-4N-positive (+) disease. CF was lowest for T2N0 and T2N+ (11%, 11%, respectively) and worst for the T4N0, T3N+, and T4N+ categories (26%, 27%, 24%, respectively). Conclusions: TN category of disease has a statistically significant impact on OS, DFS, LRF, DM, and CF in patients treated with CCRT and provides excellent prognostic information for outcomes in patients with anal carcinoma. Significant challenges remain for patients with T4N0 and T3-4N+ categories of disease with regard to survival, relapse, and CF and lesser challenges for T2-3N0/T2N+ categories

Simplification of total mesorectal excision with colonic J-pouch anal anastomosis for middle and lower rectal cancer. One surgeon's experience

International Nuclear Information System (INIS)

Kusunoki, Masato; Inoue, Yasuhiro; Yanagi, Hidenori

2008-01-01

The introduction of total mesorectal excision (TME) has dramatically improved local control of rectal cancer. Yet, despite its complexity, there is no clear technical explanation of this procedure in the text references. Thus, we attempted to simplify the TME procedure according to its original concept. Our procedure has three principles: posterolateral dissection, which is helpful for performing complete TME with autonomic nerve preservation; detachment of the hiatal ligament, which enables mobilization of the whole mesorectum and transection of the distal rectum just above the anal canal; and colonic J-pouch anal anastomosis to support fecal continence. We evaluated our modified TME, focusing on one surgeon's experience. Between 1993 and 2006, 164 patients underwent modified TME, performed by one surgeon (M.K.). Intraoperative blood loss and operating time were both significantly lower than for conventional resection (P<0.01), and the rate of anastomotic leakage was less than 1%. Modified TME combined with radiotherapy or chemotherapy, or both, also improved prognosis considerably. We have succeeded in simplifying the original TME procedure and improved its outcome even further, based on our familiarity with its anatomyoriented elements. (author)

Local high voltage radiotherapy with curative intent for prostatic carcinoma

International Nuclear Information System (INIS)

Jacobi, G.H.; Kurth, K.H.; Hohenfellner, R.

1979-01-01

In a 10-year interval 179 patients with prostatic carcinoma were treated by cobalt-60 teletherapy (7600 R). A selected group of 47 patients with localized disease and irradiated with curative intent had serial prostatic biopsies and were analized after a minimum follow-up of 1 year. Biopsies of half of the patients rendered definitively negative, on an average 14 months after radiotherapy. 8 patients with initial negative biopsy changed to positive secondarily. In one third of the patients histological conversion was missed, considered as radiation persister. Persistent carcinoma were of predominant low grade. 5 patients developed distant metastases 30 months after irradiation on an average. These patients had persistent positive tissue studies. Over all cumulative 5-years survival was 89%. In patients with prostatic carcinoma and local high voltage radiotherapy with curative intent (stage A through C) serial prostatic biopsies to document therapy effect seen mandatory. (orig.) 891 AJ/orig. 892 BRE [de

Anal intraepithelial neoplasia in HIV+ men

NARCIS (Netherlands)

Richel, O.

2014-01-01

In this thesis we investigated several aspects of anal intraepithelial neoplasia (AIN) in HIV+ men who have sex with men (MSM). This condition has gained clinical interest because of the impressive increase of the anal cancer incidence in HIV+ MSM since the introduction of combination antiretroviral

Electrocautery Superior to Topical Treatments for Precancerous Anal Lesions

Science.gov (United States)

... Professional Anal Cancer Treatment Anal Cancer Prevention Research Electrocautery Superior to Topical Treatments for Precancerous Anal Lesions ... randomized clinical trial conducted in Amsterdam suggest that electrocautery is better than topical imiquimod or fluorouracil at ...

Surveillance of anal carcinoma after radiochemotherapy. A retrospective analysis of 80 patients

Energy Technology Data Exchange (ETDEWEB)

Sauter, Matthias; Vavricka, Stephan R. [Triemli Hospital, Department of Medicine, Division of Gastroenterology, Zurich (Switzerland); University Hospital Zurich, Division of Gastroenterology and Hepatology, Zurich (Switzerland); Keilholz, Georg; Kranzbuehler, Helmut; Lombriser, Norbert [Triemli Hospital, Division of Radiation-Oncology, Zurich (Switzerland); Heinrich, Henriette; Misselwitz, Benjamin [University Hospital Zurich, Division of Gastroenterology and Hepatology, Zurich (Switzerland); Winder, Thomas [University Hospital Zurich, Department of Oncology, Zurich (Switzerland)

2017-08-15

Surveillance after radiochemotherapy of anal carcinoma (ACa) with curative intent is recommended in guidelines, but data regarding the effectiveness of follow-up are lacking. We aimed to assess the performance of an ACa surveillance program in a real-life setting. We retrospectively summarized clinical history, physical findings, and follow-up investigations (endoanal ultrasound, endoscopy, CT scan) obtained during 42 months (±27 months) from 80 patients after radiochemotherapy of ACa. In 7/80 cases (8.8%) an incomplete response to therapy was identified at or before the 6-month time point after the end of treatment; 4 of the 7 cases were identified during scheduled follow-up. In 6 cases (7.5%), recurrent disease was found after the 6-month time point. Recurrence was systemic in 5 cases and local/inguinal in 1 case. In 3 of the 6 cases (50%), recurrence was identified during scheduled follow-up. In one asymptomatic patient, a single liver metastasis was detected during scheduled follow-up and the patient remains free of disease 19 months after surgery. Surveillance resulted in a high rate of false-positive findings (70 findings in 604 investigations), of which only 14 could be confirmed. Scheduled follow-up after treatment of ACa detected recurrent disease at systemic sites, enabling potentially curative treatment in a single case. Effectiveness of abdominal imaging during follow-up after ACa treatment should be tested in a prospective trial. (orig.) [German] Nach kurativ intendierter kombinierter Radiochemotherapie beim Analkarzinom (ACa) wird von den Guidelines eine Nachsorge empfohlen, die Datenlage hierzu ist jedoch mangelhaft. Ziel unserer Studie war es, die Wertigkeit der Nachsorge beim ACa in einem ''Real-life''-Setting zu evaluieren. Es erfolgte die retrospektive Aufarbeitung der Nachsorge inklusive Anamnese, klinischer Untersuchung und Nachsorgeuntersuchungen (untere Endosonographie, Endoskopie, Computertomographie Abdomen

Anorectal function following colo-anal sleeve anastomosis for chronic radiation injury to the rectum

Energy Technology Data Exchange (ETDEWEB)

Varma, J S; Smith, A N

1986-04-01

This paper reports the results of anorectal manometry and electrophysiological studies of the pelvic floor in eight patients who had undergone anterior resection of the rectum with mucosal proctectomy and colo-anal sleeve anastomosis for radiation rectal injury. The group comprised six women and two men (age range 61-84 years, mean 71 years). Six bladder carcinoma patients had received small field (10 x 10 cm) external beam radiotherapy (5500 cGy in 20 treatments over 4 weeks); two cervical cancer patients had been given whole pelvis, external beam radiotherapy supplemented by a single caesium implant (cumulative dosage of 9500 cGy to the vaginal vault, equivalent to 7500 cG to point A).

Anorectal function following colo-anal sleeve anastomosis for chronic radiation injury to the rectum

International Nuclear Information System (INIS)

Varma, J.S.; Smith, A.N.

1986-01-01

This paper reports the results of anorectal manometry and electrophysiological studies of the pelvic floor in eight patients who had undergone anterior resection of the rectum with mucosal proctectomy and colo-anal sleeve anastomosis for radiation rectal injury. The group comprised six women and two men (age range 61-84 years, mean 71 years). Six bladder carcinoma patients had received small field (10 x 10 cm) external beam radiotherapy (5500 cGy in 20 treatments over 4 weeks); two cervical cancer patients had been given whole pelvis, external beam radiotherapy supplemented by a single caesium implant (cumulative dosage of 9500 cGy to the vaginal vault, equivalent to 7500 cG to point A). (UK)

Neuronal hyperplasia in the anal canal

DEFF Research Database (Denmark)

Fenger, C; Schrøder, H D

1990-01-01

In a consecutive series of minor surgical specimens from the anal canal, neuronal hyperplasia was found in nine of 56 haemorrhoidectomy specimens and in four of 23 fibrous polyps. In an additional series of 14 resections of the anal canal, neuronal hyperplasia was present in six cases, of which f...

Thermal responses of shape memory alloy artificial anal sphincters

Science.gov (United States)

Luo, Yun; Takagi, Toshiyuki; Matsuzawa, Kenichi

2003-08-01

This paper presents a numerical investigation of the thermal behavior of an artificial anal sphincter using shape memory alloys (SMAs) proposed by the authors. The SMA artificial anal sphincter has the function of occlusion at body temperature and can be opened with a thermal transformation induced deformation of SMAs to solve the problem of severe fecal incontinence. The investigation of its thermal behavior is of great importance in terms of practical use in living bodies as a prosthesis. In this work, a previously proposed phenomenological model was applied to simulate the thermal responses of SMA plates that had undergone thermally induced transformation. The numerical approach for considering the thermal interaction between the prosthesis and surrounding tissues was discussed based on the classical bio-heat equation. Numerical predictions on both in vitro and in vivo cases were verified by experiments with acceptable agreements. The thermal responses of the SMA artificial anal sphincter were discussed based on the simulation results, with the values of the applied power and the geometric configuration of thermal insulation as parameters. The results obtained in the present work provided a framework for the further design of SMA artificial sphincters to meet demands from the viewpoint of thermal compatibility as prostheses.

Reproducibility and genital sparing with a vaginal dilator used for female anal cancer patients

International Nuclear Information System (INIS)

Briere, Tina Marie; Crane, Christopher H.; Beddar, Sam; Bhosale, Priya; Mok, Henry; Delclos, Marc E.; Krishnan, Sunil; Das, Prajnan

2012-01-01

Purpose: Acute vulvitis, acute urethritis, and permanent sexual dysfunction are common among patients treated with chemoradiation for squamous cell carcinoma of the anal canal. Avoidance of the genitalia may reduce sexual dysfunction. A vaginal dilator may help delineate and displace the vulva and lower vagina away from the primary tumor. The goal of this study was to evaluate the positional reproducibility and vaginal sparing with the use of a vaginal dilator. Materials and methods: Ten female patients treated with IMRT for anal cancer were included in this study. A silicone vaginal dilator measuring 29 mm in diameter and 114 mm in length was inserted into the vagina before simulation and each treatment. The reproducibility of dilator placement was investigated with antero-posterior and lateral images acquired daily. Weekly cone beam CT (CBCT) imaging was used to confirm coverage of the GTV, which was typically posterior and inferior to the dilator apex. Finally, a planning study was performed to compare the vaginal doses for these 10 patients to a comparable group of 10 female patients who were treated for anal cancer with IMRT without vaginal dilators. Results: The absolute values of the location of the dilator apex were 7.0 ± 7.8 mm in the supero-inferior direction, 7.5 ± 5.5 mm in the antero-posterior, and 3.8 ± 3.1 mm in the lateral direction. Coverage of the GTV and CTV was confirmed from CBCT images. The mean dose to the vagina was lower by 5.5 Gy, on average, for the vaginal dilator patients, compared to patients treated without vaginal dilators. Conclusion: The vaginal dilator tended to be inserted more inferiorly during treatment than during simulation. For these ten patients, this did not compromise tumor coverage. Combined with IMRT treatment planning, use of a vaginal dilator could allow for maximum sparing of female genitalia for patients undergoing radiation therapy for anal cancer.

Anal Cancer Treatment (PDQ®)—Patient Version

Science.gov (United States)

Anal cancer is uncommon, but often curable with treatment. Treatments include radiation therapy, chemotherapy, and surgery. Get detailed information about anal cancer including risk factors, symptoms, diagnosis, prognosis, and treatment in this expert-reviewed summary.

Diagnostic methods for prevention of anal cancer and characteristics of anal lesions caused by HPV in men with HIV/AIDS

Directory of Open Access Journals (Sweden)

Araiz Cajueiro Carneiro Pereira

Full Text Available Abnormalities found with anuscopy under colposcopic vision, anal cytology and anal biopsy were evaluated in 21 men with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS at the Federal University of Pernambuco Hospital in Brazil. Mean age was 38.4 ± 6.0 years, and mean time of HIV infection was 8.3 ± 5.1 years; 95.2% of the patients had been on highly active antiretroviral therapy (HAART for an average of 6.6 ± 4.5 years. Mean CD4+ cell count was 482.2 ± 173.75 cells/mm³, and 80.9% presented a HIV viral load of < 5,000 copies/mL. Reported sexual preference was 52.4% homosexuals, 28.6% bisexuals, and 19.0%heterosexuals; 81% reported having had receptive anal intercourse and 61.9% reported more than 10 sexual partners of the same sex. Results of anuscopy under colposcopic vision revealed 17 (81.0% low-grade lesions and/or condylomata or micropapillae and four (19.0% high-grade lesions with or without condylomata. Among the 21 anal cytology examinations, seven (33.3% revealed low-grade squamous intraepithelial lesions (LSIL; three (14.3% presented atypical squamous cells of undetermined significance (ASCUS and 11 (52.4% were normal. Seventeen patients were submitted to anal biopsy with the following findings: three patients (17.6% with normal epithelium, one (5.9% with infection by HPV, three (17.6% with condylomatas, two (11.8% with AIN 1, four (23.6% with AIN 2, three (17.6% with AIN 3, and one (5.9% with PAIN 2. Anuscopy under colposcopic vision was found to be useful for detecting anal lesions and for guiding anal biopsies. Anal cytology was less useful, as it underestimated the frequency of lesions.

Ettevõtte konkurentsieelis inimeste analüüsi abil / Mait Raava

Index Scriptorium Estoniae

Raava, Mait

2015-01-01

Ettevõtte töötajate analüüsimisest, analüütika tulemuste rakendamisest juhtivates ettevõttes. Viiest sambast, millel põhineb inimeste analüüsi edukas rakendamine, analüütika rakendamise etapid

Correlation between CT findings and prognosis of patients with carcinoma of the cervix

International Nuclear Information System (INIS)

Kubota, Susumu; Ohara, Kiyoshi; Okumura, Toshiyuki; Gomi, Hiromichi; Nakano, Takashi; Arai, Tatsuo.

1986-01-01

Ninety-one patients with carcinoma of the cervix received radical radiation therapy from May 1981 through August 1983 at NIRS hospital. The correlation between eight CT findings and the prognosis was analysed in 75 patients, performed CT scan within 15 days form the admision. Among these CT findings, area of uterine cervix correlates well with recurrence, and enlargement of para-aortic lymph nodes showed the strong correlation between metastasis. We also analized these data by a multivariate analytical method (quantification method II). There exists a correlation between the prognosis and the score of quantification method II, and this score will be a good index of the prognosis of patients with carcinoma of the cervix. (author)

Squamous cell carcinoma of the anus-an opportunistic cancer in HIV-positive male homosexuals

Science.gov (United States)

Gervaz, Pascal; Calmy, Alexandra; Durmishi, Ymer; Allal, Abdelkarim S; Morel, Philippe

2011-01-01

Squamous cell carcinoma of the anus (SCCA) is a common cancer in the human immunodeficiency virus (HIV)-infected population, and its incidence continues to increase in male homosexuals. Combined chemoradiation with mitomycin C and 5-fluorouracil was poorly tolerated by severely immunocompromised patients in the early 1990s. In the era of highly active antiretroviral therapy (HAART), however, recent data indicate that: (1) most HIV patients with anal cancer can tolerate standard chemotherapy regimens; and (2) this approach is associated with survival rates similar to those of HIV-negative patients. However, HIV-positive patients with SCCA are much younger, more likely to develop local tumor recurrence, and ultimately die from anal cancer than immune competent patients. Taken together, these findings suggest that anal cancer is an often fatal neoplasia in middle-aged HIV-positive male homosexuals. In this population, SCCA is an opportunistic disease resulting in patients with suboptimal immune function from persistent infection and prolonged exposition to oncogenic human papillomaviruses (HPVs). Large-scale cancer-prevention strategies (routine anuscopy and anal papanicolaou testing) should be implemented in this population. In addition, definitive eradication of oncogenic HPVs within the anogenital mucosa of high-risk individuals might require a proactive approach with repeated vaccination. PMID:21799644

Nocturnal faecal soiling and anal masturbation.

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Clark, A F; Tayler, P J; Bhate, S R

1990-01-01

Two cases of late onset faecal soiling as a result of anal masturbation in children who were neither mentally handicapped nor psychotic were studied. The role of soiling in aiding the young person and his family to avoid separating and maturing is highlighted. We suggest that the association of anal masturbation and resistant nocturnal soiling may be unrecognised. PMID:2270946

Limited Value of Staging Squamous Cell Carcinoma of the Anal Margin and Canal Using the Sentinel Lymph Node Procedure : A Prospective Study with Long-Term Follow-Up

NARCIS (Netherlands)

de Jong, Johannes S.; Beukema, Jannet C.; van Dam, Gooitzen M.; Slart, Riemer; Lemstra, Clara; Wiggers, Theo

2010-01-01

Background. Selection of patients with anal cancer for groin irradiation is based on tumor size, palpation, ultrasound, and fine needle cytology. Current staging of anal cancer may result in undertreatment in small tumors and overtreatment of large tumors. This study reports the feasibility of the

Complex anal fistulas: plug or flap?

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Muhlmann, Mark D; Hayes, Julian L; Merrie, Arend E H; Parry, Bryan R; Bissett, Ian P

2011-10-01

Rectal mucosal advancement flaps (RMAF) and fistula plugs (FP) are techniques used to manage complex anal fistulas. The purpose of this study was to review and compare the results of these methods of repair. A retrospective review of all complex anal fistulas treated by either a RMAF or a FP at Auckland City Hospital from 2004 to 2008. Comparisons were made in terms of successful healing rates, time to failure and the use of magnetic resonance imaging. Overall, 70 operations were performed on 55 patients (55.7% male). The mean age was 44.9 years. Twenty-one patients (30%) had had at least one previous unsuccessful repair. Indications for repair included 57 high cryptoglandular anal (81%), 4 Crohn's anal (6%), 7 rectovaginal (10%), 1 rectourethral (1%) and 1 pouch-vaginal fistula (1%). All patients were followed up with a mean of 4.5 months. Forty-eight RMAFs (69% of total) were performed with 16 successful repairs (33%). Twenty-two FPs (31% of total) were performed with 7 successful repairs (32%, P = 0.9). In failed repairs, there was no difference in terms of mean time to failure (RMAF 4.8 months versus FP 4.1 months, P = 0.62). Magnetic resonance imaging was performed in 21 patients (37%) before the repair. The success rate in these patients was 20%. The results of treatment of complex anal fistulas are disappointing. The choice of operation of either a RMAF or a FP did not alter the poor healing rates of about one third of patients in each group.

Uptake and Predictors of Anal Cancer Screening in Men Who Have Sex With Men

Science.gov (United States)

D'Souza, Gypsyamber; Rajan, Shirani D.; Bhatia, Rohini; Cranston, Ross D.; Plankey, Michael W.; Silvestre, Anthony; Ostrow, David G.; Wiley, Dorothy; Shah, Nisha; Brewer, Noel T.

2013-01-01

Objectives. We investigated attitudes about and acceptance of anal Papanicolaou (Pap) screening among men who have sex with men (MSM). Methods. Free anal Pap screening (cytology) was offered to 1742 MSM in the Multicenter AIDS Cohort Study, who reported history of, attitudes about, and experience with screening. We explored predictors of declining screening with multivariate logistic regression. Results. A history of anal Pap screening was uncommon among non–HIV-infected MSM, but more common among HIV-infected MSM (10% vs 39%; P < .001). Most participants expressed moderate or strong interest in screening (86%), no anxiety about screening (66%), and a strong belief in the utility of screening (65%). Acceptance of screening during this study was high (85%) across all 4 US sites. Among those screened, most reported it was “not a big deal” or “not as bad as expected,” and 3% reported that it was “scary.” Declining to have screening was associated with Black race, anxiety about screening, and low interest, but not age or HIV status. Conclusions. This study demonstrated high acceptance of anal Pap screening among both HIV-infected and non–HIV-infected MSM across 4 US sites. PMID:23865658

Vascularized anal autotransplantation model in rats: preliminary report.

Science.gov (United States)

Araki, J; Mihara, M; Narushima, M; Iida, T; Sato, T; Koshima, I

2011-11-01

Ostomy has served as an effective surgery for various anorectal disfunctions. However, it must also be noted that those patients suffered greatly from stresses caused by their stoma. Many alternative therapies have been developed, but none have solved this critical issue. Meanwhile, due to the improvements in operative methods and immunosuppressive therapy, allotranplantation has gained great popularity in recent years. Therefore, we began development of an anal transplantation model. The operation was performed in six adult Wistar rats that were divided into two groups. Group 1 underwent vascular anastomoses, while group 2 did not Group 1 grafts survived, fully recovering anal function. However, many of the group 2 grafts did not survive; those that did survive showed major defects in their anus, never recovering anal function. We succeeded in establishing the rat anal transplantation model utilizing super-microsurgery. While research in anal transplantation was behind compared to that in other fields, we hope that this model will bring significant possibilities for the future. Copyright © 2011 Elsevier Inc. All rights reserved.

Prevalence of anal cytological abnormalities in women with positive cervical cytology.

Science.gov (United States)

Calore, Edenilson E; Giaccio, Claudia Maria Serafim; Nadal, Sidney R

2011-05-01

The objective of this study was to estimate the prevalence of cytological abnormalities of the anal mucosa in women with positive cervical cytology, but without macroscopic anal lesion. Ultimately we postulated if the anal mucosa may be a reservoir of HPV, which would allow the reinfection of cervix. Forty-nine patients with abnormal cervical cytology were selected for this work. In a period not exceeding one week of collecting cervix cytology, two swab specimens of the anal canal were also collected. Women diagnosed with cervical HSIL by Pap smear were referred for colposcopy with biopsy of the lesions, to confirm the cytologic diagnosis and ablation of the lesion. We demonstrated a high prevalence of anal squamous intraepithelial lesions in patients with cervical squamous intraepithelial lesions (29 of the total of 49 patients = 59.2%). Of the 20 cases of cervical LSIL, 11 (55%) had abnormal anal cytology. Of the 26 cases with cervical HSIL, 16 (61.5%) had abnormal anal cytology. So, there was a discrete higher prevalence of abnormal anal cytology in cases of high-grade cervical squamous lesions (cervical HSIL). These results help to support the hypothesis that the anal mucosa is a reservoir of HPV, which can be a source of re-infection for the cervix. However, there was no significant association between the practice of anal sex and the prevalence of anal cytological abnormalities. These facts are epidemiologically important for future programs for population eradication of cervical lesions related to HPV. Diagn. Cytopathol. 2011;39:323-327. © 2010 Wiley-Liss, Inc. Copyright © 2010 Wiley-Liss, Inc.

Elective Inguinal Node Irradiation in Early-Stage T2N0 Anal Cancer: Prognostic Impact on Locoregional Control

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Zilli, Thomas, E-mail: Thomas.Zilli@hcuge.ch [Department of Radiation Oncology, Geneva University Hospital, Geneva (Switzerland); Betz, Michael [Department of Radiation Oncology, Geneva University Hospital, Geneva (Switzerland); Radiation Oncology Institute, Hirslanden Lausanne, Lausanne (Switzerland); Bieri, Sabine [Department of Radiation Oncology, Geneva University Hospital, Geneva (Switzerland); Ris, Frederic; Roche, Bruno [Department of Surgery, Geneva University Hospital, Geneva (Switzerland); Roth, Arnaud D. [Oncosurgery Unit, Geneva University Hospital, Geneva (Switzerland); Allal, Abdelkarim S. [Department of Radiation Oncology, Geneva University Hospital, Geneva (Switzerland); Department of Radiation Oncology,Hôpital Fribourgeois, Fribourg (Switzerland)

2013-09-01

Purpose: To evaluate the influence of elective inguinal node radiation therapy (INRT) on locoregional control (LRC) in patients with early-stage T2N0 anal cancer treated conservatively with primary RT. Methods and Materials: Between 1976 and 2008, 116 patients with T2 node-negative anal cancer were treated curatively with RT alone (n=48) or by combined chemoradiation therapy (CRT) (n=68) incorporating mitomycin C and 5-fluorouracil. Sixty-four percent of the patients (n=74) received elective INRT. Results: Over a median follow-up of 69 months (range, 4-243 months), 97 (84%) and 95 patients (82%) were locally and locoregionally controlled, respectively. Rates for 5-year actuarial local control, LRC, cancer-specific, and overall survival for the entire population were 81.7% ± 3.8%, 79.2% ± 4.1%, 91.1% ± 3.0%, and 72.1% ± 4.5%, respectively. The overall 5-year inguinal relapse-free survival was 92.3% ± 2.9%. Isolated inguinal recurrence occurred in 2 patients (4.7%) treated without INRT, whereas no groin relapse was observed in those treated with INRT. The 5-year LRC rates for patients treated with and without INRT and with RT alone versus combined CRT were 80.1% ± 5.0% versus 77.8% ± 7.0% (P=.967) and 71.0% ± 7.2% versus 85.4% ± 4.5% (P=.147), respectively. A trend toward a higher rate of grade ≥3 acute toxicity was observed in patients treated with INRT (53% vs 31%, P=.076). Conclusions: In cases of node-negative T2 anal cancer, the inguinal relapse rate remains relatively low with or without INRT. The role of INRT in the treatment of early-stage anal carcinoma needs to be investigated in future prospective trials.

Anal submucosal injection: a new route for drug administration in pelvic malignancies. Part I. Experimental study of misonidazole distribution in serum and tissues, with special reference to urinary bladder. Preliminary report

International Nuclear Information System (INIS)

Shafik, A.; el-Merzabani, M.M.; el-Aaser, A.A.; el-Desouky, G.H.

1986-01-01

The anal and oral administration routes were compared in 30 rats to study the distribution of misonidazole, a radiation sensitizer, in the serum and tissues with special reference to the urinary bladder. 14C-labelled misonidazole was administered in a dose of 0.2 ml water/100 gm body weight containing 1 mu Ci misonidazole. The dose was given orally by stomach tube in 15 rats, and was injected in the submucosa of the anal canal in another 15. Animals were then killed after 15, 30, 60, or 120 minutes or after 24 hours. Organs were dissected, and radioactivity was determined in each by the internal standard method. The study has shown that the highest drug concentration in the bladder tissue relative to the serum was achieved with the anal submucosal route. Its level was eight and five times that of the serum 15 and 30 minutes after administration, respectively, in contrast to the oral route in which the drug concentration was one-quarter and equal to the serum level at the same time intervals. The anal route would thus provide the adequate channel required for misonidazole to promote radiation responsiveness in bladder carcinoma

Diagnostic imaging features of normal anal sacs in dogs and cats.

Science.gov (United States)

Jung, Yechan; Jeong, Eunseok; Park, Sangjun; Jeong, Jimo; Choi, Ul Soo; Kim, Min-Su; Kim, Namsoo; Lee, Kichang

2016-09-30

This study was conducted to provide normal reference features for canine and feline anal sacs using ultrasound, low-field magnetic resonance imaging (MRI) and radiograph contrast as diagnostic imaging tools. A total of ten clinically normal beagle dogs and eight clinically normally cats were included. General radiography with contrast, ultrasonography and low-field MRI scans were performed. The visualization of anal sacs, which are located at distinct sites in dogs and cats, is possible with a contrast study on radiography. Most surfaces of the anal sacs tissue, occasionally appearing as a hyperechoic thin line, were surrounded by the hypoechoic external sphincter muscle on ultrasonography. The normal anal sac contents of dogs and cats had variable echogenicity. Signals of anal sac contents on low-field MRI varied in cats and dogs, and contrast medium using T1-weighted images enhanced the anal sac walls more obviously than that on ultrasonography. In conclusion, this study provides the normal features of anal sacs from dogs and cats on diagnostic imaging. Further studies including anal sac evaluation are expected to investigate disease conditions.

HAART slows progression to anal cancer in HIV-infected MSM.

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Duncan, Katrina C; Chan, Keith J; Chiu, Connie G; Montaner, Julio S G; Coldman, Andy J; Cescon, Angela; Au-Yeung, Christopher G; Wiseman, Sam M; Hogg, Robert S; Press, Natasha M

2015-01-28

Antiretrovirals do not prevent anal intraepithelial neoplasia. However, the influence of antiretrovirals in the natural history of invasive anal cancer is less clear. The objective is to investigate the impact of antiretrovirals in the time to the development of anal cancer in HIV-positive MSM. A retrospective analysis of cases of anal cancer in a cohort of HIV-positive MSM receiving antiretrovirals between 1988 and 2008. Time from first CD4 cell count or HIV RNA viral load test to anal cancer diagnosis was analysed using Cox regression and Kaplan-Meier curves. Anal cancer cases treated in the era prior to HAART (cancer cases (n = 37) were compared with a cohort of 1654 HIV-positive MSM on antiretrovirals. Antiretrovirals were started in the pre-HAART era by 70% of cancer cases, and median CD4 cell count nadir was 70 cells/μl (10-130). Time to development of anal cancer was shorter for cases treated during the pre-HAART era [adjusted hazard ratio (AHR) 3.04, 95% confidence interval (95% CI) 1.48-6.24, P = 0.002], with a CD4 cell count nadir less than 100 cells/μl (AHR 2.21, 95% CI 1.06-4.62, P = 0.035) and longer duration of CD4 cell count less than 100 cells/μl (AHR 1.33, 95% CI 1.11-1.58, P = 0.002). Results show that severe immunosuppression and starting therapy pre-HAART are associated with an increased risk of anal cancer. HIV-positive MSM initiating antiretrovirals during the HAART era (1996-2008) had a longer time to the development of anal cancer than those treated pre-HAART. Our results suggest that early use of HAART may delay progression to anal cancer.

Anal metastasis originating from colorectal cancer: Report of two cases

Energy Technology Data Exchange (ETDEWEB)

Kim, Jae Min; Lim, Joon Seok; Choi, Jin Young; Park, Mi Suk; Kim, Myeong Jin [Dept. of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of); Chung, Taek; Kim, Ho Guen [Dept. of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

2016-12-15

Anal metastasis from colorectal cancer rarely occurs, but it severely impairs the patient's quality of life, often requiring wide resection including the anal sphincter with permanent colostomy. This lesion can be misdiagnosed as a perianal fistula or an abscess, and it can be overlooked at the time of surgery because it is not included in the routine surgical extent of low anterior resection. We report two rare cases of anal metastasis from colorectal cancer. In both cases, perianal nodules with an internal solid portion were detected on preoperative rectal magnetic resonance imaging and additional local excisions of the anal lesions were performed during the process of treatment. Anal metastasis was pathologically confirmed by histology and immunohistochemical staining.

Avaliação manométrica anal de crianças com encoprese Anal manometric evaluation of children with encopresis

Directory of Open Access Journals (Sweden)

Maria Auxiliadora Prolungatti Cesar

2010-12-01

Full Text Available INTRODUÇÃO: A constipação crônica é doença comum na infância, ocorrendo em 5 a 10% dos pacientes pediátricos, considerada a segunda maior causa de procura nos consultórios de pediatria, sendo a encoprese decorrente de constipação grave associada à impactação fecal no reto. Dentre os exames diagnósticos, a manometria anal é utilizada para a avaliação de pacientes com distúrbios funcionais, como a constipação intestinal e a incontinência fecal, em alguns serviços para a avaliação de pacientes com encoprese, pois pode trazer informações sobre o mecanismo evacuatório e possíveis lesões esfincterianas anais. OBJETIVO: Verificar alterações manométricas em pacientes com encoprese. MÉTODOS: Foi realizado estudo de 40 manometrias anais de crianças constipadas com encoprese (G1 e 12 crianças constipados sem encoprese (G2. Foram obtidos os seguintes dados: pressões de repouso, contração e evacuação do canal anal e ampola retal, ponto de maior pressão, reflexo inibitório anal e sensibilidade retal. As manometrias foram realizadas com o aparelho Alacer de perfusão com 8 canais. RESULTADOS: Não foram encontradas diferenças nas pressões de repouso, contração e evacuação do canal anal entre os grupos. Chamou-nos a atenção a ausência de necessidade de maior volume retal para desencadear o reflexo inibitório anal. Não houve diferença da incidência de anismus entre os dois grupos, demonstrando que não se trata de fator importante na manutenção da encoprese, mas sim da constipação. CONCLUSÃO: Não houve necessidade de maior volume para desencadear o reflexo inibitório anal. O anismus não foi diferente entre os dois grupos, não sendo importante na manutenção da encoprese.INTRODUCTION: Chronic constipation is a common childhood disorder that affects 5 to 10% of pediatric patients, being the second most common cause for seeking medical help, with the encopresis arising out of severe constipation

Sotsiaalvõrgustike analüüs / Innar Liiv

Index Scriptorium Estoniae

Liiv, Innar, 1982-

2005-01-01

Sotsiaalvõrgustike analüüs (social network analys - SNA) on tehnikate, meetodite ning vahendite kogum, mis aitab avastada mustreid sotsiaalsetes struktuurides. Analüüsi kasutamisest energeetikaettevõtte Enron ja kohalike ettevõtete võrgustike näitel. Skeemid

Anal Cancer Treatment (PDQ®)—Health Professional Version

Science.gov (United States)

Anal cancer is often curable with treatment. Major prognostic factors are site, size, and nodal status. Treatments include radiation therapy, chemotherapy, and surgery. Get detailed information for anal cancer risk factors, classification, staging, prognosis, and treatment in this summary for clinicians.

Recent Advances in the Pharmacotherapy of Chronic Anal Fissure: An Update

Directory of Open Access Journals (Sweden)

Bikash Medhi

2008-07-01

Full Text Available Surgical sphincterotomy reduces anal tone and sphincter spasm and promotes ulcer healing. Because the surgery is associated with the side effect of faecal incontinence, pharmacological agents to treat chronic anal fissure have been explored recently. Glyceryl trinitrate (GTN ointment (0.2% has an efficacy of up to 68% in healing chronic anal fissure, but it is associated with headache as the major and most common side effect. Though botulinum toxin injected into the anal sphincter healed over 80% of chronic anal fis-sures, it is more invasive and expensive than GTN therapy. Diltiazem ointment achieved healing of chronic anal fissure comparable to 0.2% GTN ointment but was associated with fewer side effects. Other drugs that have been tried are lidocaine, the alpha-adrenergic antagonist indoramin, and the potassium channel opener minoxidil.

Clinical application of continent anal plug in bedridden patients with intractable diarrhea.

Science.gov (United States)

Kim, J; Shim, M C; Choi, B Y; Ahn, S H; Jang, S H; Shin, H J

2001-08-01

Some patients bedridden from various causes such as stroke or spinal cord injury experience poor control of bowel movement. This causes fecal leakage and diarrhea, increases the risk of perianal excoriation and bed sores, and is a burden on caregivers. To evaluate the efficacy of fecal evacuation and the prevention and treatment of skin complications in intractable diarrhea patients using a new device. A continent anal plug (US Patent No. 5 569 216) comprises an inner balloon surrounded by an outer balloon, both of which are mounted on a silicone tube containing a pair of air passages and an enema fluid inlet. The tube is secured in place in the rectum by the inflatable outer balloon and is designed to drain fecal matter through a thin collapsible hose situated in the anal canal. Thirty-two patients (21 male; median age 61 (range, 28-76) years) were evaluated after fully informed consent. Median duration was 12 (range, 3-37) days. The continent anal plug evacuated efficiently in those patients with loose or watery stools who only required irrigation once daily or not at all. Skin excoriations improved in three to seven days. Minimal leakage was seen around the anus. There was no anorectal mucosal injury noted over 37 days. The continent anal plug is an efficient method of treating patients with loss of bowel control and incontinence because it enables controlled fecal evacuation and helps reduce skin complications without causing anorectal mucosal injury.

Abnormal anal cytology risk in women with known genital squamous intraepithelial lesion

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Maria do Socorro Nobre

2016-05-01

Full Text Available The purpose of this study was to assess the risk of abnormal anal cytology in women with known genital squamous intraepithelial lesion. This study evaluated 200 women with and without genital squamous intraepithelial lesion who were recruited for anal Pap smears. Women who had abnormal results on equally or over atypical squamous cells of undetermined significance were classified as having abnormal anal cytology. A multiple logistic regression analysis (stepwise was performed to identify the risk for developing abnormal anal cytology. Data were analyzed using the SPSS 20.0 program. The average age was 41.09 (±12.64. Of the total participants, 75.5% did not practice anal sex, 91% did not have HPV-infected partners, 92% did not have any anal pathology, and 68.5% did not have anal bleeding. More than half (57.5% had genital SIL and a significant number developed abnormal anal cytology: 13% in the total sample and 17.4% in women with genital SIL. A significant association was observed between genital squamous intraepithelial lesion and anal squamous intraepithelial lesion (PR = 2.46; p = 0.03. In the logistic regression model, women having genital intraepithelial lesion were more likely to have abnormal anal Pap smear (aPR = 2.81; p = 0.02. This report shows that women with genital squamous intraepithelial lesion must be more closely screened for anal cancer.

Using of thermoradiotherapy on treatment of cancerous growths of anal canal

International Nuclear Information System (INIS)

Timofeev, Yu.M.; Zikiryakhodjaev, D.Z.

1997-01-01

In this chapter of book authors investigated using of thermoradiotherapy on treatment of cancerous growths of anal canal, methods of using of thermoradiotherapy at morbid with anal cancer, methods of irradiation, the characteristic of clinical observations, using of thermoradiotherapy at treatment of epidermoid cancer of anal zone, using of thermoradiotherapy at treatment of non epithelial cancer of anal zone and using thermoradiotherapy at others types of cancerous growths

Radiological diagnosis in constipation and anal incontinence due to changes in the pelvic floor and sphincter apparatus of the anus

International Nuclear Information System (INIS)

Bistolfi, F.; Grillo Ruggeri, F.; Siragusa, A.

1987-01-01

Rectal constipation, anal incontinence and constipation combined with incontinence, are often caused by organic or simply functional changes in the pelvic floor and sphincterial apparatus. Therefore morphological as well as manometric and electromyographic studies of these anatomical parts are required. This is possible by combining two techniques: Intestinal Transit Time (ITT) and Defecatory Proctogram with Balloon (DPB). Personal experience of 38 patients with constipation with or without incontinence is reported. The results lead to the following conclusion: 1) ITT is a simple and non-invasive radiological technique that provides us with objective evidence of an impairment, i.e. constipation, whose symptoms are often only subjective; especially is allows us to identify rectal constipation, that can be caused by impairment of the anal sphincteral apparatus. 2) Using an uroprophylactic with a collar that adapts to the size of the anal duct, DPB always permits visualization of the duct with good representation of the recto-anal angle, whose changes may be the expression of organic or only functional impairments of the anal sphincterial apparatus. Increasing use of the two radiological techniques is therefore recommended in the diagnosis of alterations of the pelvic floor or anal sphincter

"It Takes a Man to Put Me on the Bottom": Gay Men's Experiences of Masculinity and Anal Intercourse.

Science.gov (United States)

Ravenhill, James P; de Visser, Richard O

2017-12-08

In anal intercourse between gay men, men who are typically insertive ("tops") are often perceived as, and may identify as, more masculine than those who are typically receptive ("bottoms"). "Versatile" men, who may adopt either position, may be perceived as more gender balanced and may transcend the gender-role stereotypes associated with self-labeling as top or bottom. The aim of this study was to explore how gay men's beliefs about masculinity were associated with their beliefs about the gendered nature of sexual self-labels and their behavior in anal intercourse. Individual semistructured interviews were undertaken with 17 UK-based gay men. Interpretative phenomenological analysis (IPA) identified that perceptions of tops and bottoms as gendered social identities varied depending on the extent to which gay men subscribed to the mandates of hegemonic masculinity, the dominant masculinity in Western society. The findings also suggested that some gay men differentiated between top and bottom as social identities and topping and bottoming as gendered behaviors. This had implications for gay men's behaviors in anal intercourse. It is suggested that future efforts to engage with gay men about their sexual behavior should account for their beliefs regarding the gender-role stereotypes associated with gay sexual self-labels.

Seoseid loov kunstiteose analüüs / Anneli Porri

Index Scriptorium Estoniae

Porri, Anneli, 1980-

2013-01-01

Kunstiteose analüüsi seosest riikliku õppekavaga, ülevaade kunstiteose analüüsimeetoditest kunstiteaduses ning metoodilistest tähelepanekutest kunsti ja visuaalkultuuri kujutiste vaatamise kohta gümnaasiumi kunstitunnis

Patients with newly diagnosed cervical cancer should be screened for anal human papilloma virus and anal dysplasia: Results of a pilot study using a STELLA computer simulation and economic model

OpenAIRE

Eli D. Ehrenpreis; Dylan G. Smith

2018-01-01

Background: Women with cervical cancer often have anal human papillomavirus (HPV) infection and anal dysplasia. However, effectiveness of anal HPV screening is unknown. Methods: A dynamic model was constructed using STELLA. Populations are represented as ''stocks'' that change according to model rates. Initial anal cytology in new cervical cancer patients, dysplasia progression and regression, cost of treating high-grade squamous intraepithelial lesions (HSIL), and lifetime costs for anal can...

Association of anorectal dose-volume histograms and impaired fecal continence after 3D conformal radiotherapy for carcinoma of the prostate

International Nuclear Information System (INIS)

Vordermark, Dirk; Schwab, Michael; Ness-Dourdoumas, Rhea; Sailer, Marco; Flentje, Michael; Koelbl, Oliver

2003-01-01

Purpose: The late toxicity of fecal incontinence after pelvic radiotherapy is now frequently recognized but the etiology poorly understood. We therefore investigated associations between dose-volume histogram (DVH) parameters of the rectum and the anal canal with fecal continence as measured by an established 10-item questionnaire. Methods and materials: Forty-four patients treated for carcinoma of the prostate with 58-72 Gy of 3D conformal radiotherapy between 1995 and 1999 who completed the questionnaire formed the study population. Total continence scores of treated patients obtained 1.5 years (median) after radiotherapy were compared to a control group of 30 patients before radiotherapy. Median, mean, minimum and maximum doses as well as the volume (% and ml) treated to 40, 50, 60 and 70 Gy were determined separately for anal canal and rectum. DVH parameters were correlated with total continence score (Spearman rank test) and patients grouped according to observed continence were compared regarding DVH values (Mann-Whitney U-test). Results: Median fecal continence scores were significantly worse in the irradiated than in the control group (31 vs. 35 of a maximum 36 points). In treated patients, 59%/27%/14% were classified as fully continent, slightly incontinent and severely incontinent. Continence was similar in the 58-to-62-Gy, 66-Gy and 68-to-72-Gy dose groups. No DVH parameter was significantly correlated with total continence score, but severely incontinent patients had a significantly higher minimum dose to the anal canal than fully continent/slightly incontinent, accompanied by portals extending significantly further inferiorly with respect to the ischial tuberosities. Conclusions: Excluding the inferior part of the anal canal from the treated volume in 3D conformal therapy for carcinoma of the prostate appears to be a promising strategy to prevent radiation-induced fecal incontinence

Prognostic impact of tumour burden assessed by metabolic tumour volume on FDG PET/CT in anal canal cancer

Energy Technology Data Exchange (ETDEWEB)

Gauthe, Mathieu [Institut Curie, Medecine Nucleaire, Saint-Cloud (France); Hopital Tenon, Medecine Nucleaire, Paris (France); Richard-Molard, Marion [Institut Curie, Radiotherapie, Saint-Cloud (France); Fayard, Juliette; Cacheux, Wulfran [Institut Curie, Oncologie Medicale, Saint-Cloud (France); Alberini, Jean-Louis [Institut Curie, Medecine Nucleaire, Saint-Cloud (France); Lievre, Astrid [Institut Curie, Oncologie Medicale, Saint-Cloud (France); CHU Pontchaillou, Service des Maladies de l' Appareil Digestif, Rennes (France); Universite Rennes 1, Rennes (France)

2017-01-15

The aim of this study was to confirm the prognostic value of metabolic tumour volume (MTV) at the primary site on initial work-up FDG PET/CT in patients with squamous cell carcinoma (SCC) of the anal canal. Patients with a recent diagnosis of SCC of the anal canal without metastases undergoing PET/CT for initial work-up and treated with (chemo)radiotherapy were retrospectively reviewed. Computer-aided MTV and SUVmax were determined. Survival rates were estimated using the Kaplan-Meier method. Cox regression analysis was used to evaluate prognostic variables of progression-free survival and overall survival (OS). The study group comprised 75 patients who had an initial work-up PET/CT. Five patients (6.7 %) had stage I disease, 22 (29.3 %) stage II disease, 20 (26.7 %) stage IIIA disease, and 28 (37.3 %) stage IIIB disease. Median follow-up was 51 months (range 10 - 117 months). Global 4-year OS was 82.7 %, ranging from 100 % in patients with stage I disease to 75 % in patients with stage IIIB disease. MTV at the primary site was significantly and independently correlated with OS (p < 0.05), as patients with MTV less than 7 cm{sup 3} had a better prognosis. SUVmax was not correlated with survival parameters. Metabolic involvement of the inguinal lymph nodes was also correlated with a poor outcome in the univariate analysis (p < 0.05). MTV at the primary site is a prognostic biomarker in anal canal cancer. Hypermetabolic inguinal lymph nodes also appear to be correlated with survival. (orig.)

Anal Human Papillomavirus Infection among HIV-Infected Men in Korea.

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Chang Hun Lee

Full Text Available Little is known about the epidemiology on human papillomavirus (HPV infection among HIV-infected men in Korea. The objective of this study was to determine the prevalence, genotype distribution and risk factors associated with anal HPV infection among HIV-infected men in Korea.A single-center cross-sectional study was conducted with HIV-infected men in Korea. Participants completed a detailed sexual behavior risk factor questionnaire. Anal samples were collected for cytology and HPV genotyping. Factors associated with anal HPV infection were assessed using multivariable logistic regression, stratifying by sexual behaviour.A total of 201 HIV-infected men were included in the study: 133 were from men who have sex with men (MSM and 68 from men who have sex with women (MSW. Any anal HPV infection was detected in 82.7% of HIV-infected MSM and in 51.5% of HIV- infected MSW (P < 0.001. High-risk HPV (HR-HPV prevalence was higher among MSM (47.4% than MSW (25.0%; P = 0.002. The HR-HPV types identified most frequently were HPV 16 (11%, HPV 18 (9.9%, and HPV 58 (5% in MSM, and HPV 58(11% and HPV 16 (8.9% in MSW. Prevalence of any HPV types in 9-valent vaccine types was higher among MSM than MSW (47.4% vs 22.1%. P = 0.001. Abnormal anal cytology was more commonly detected in MSM than MSW (42.9% vs.19.1%, P < 0.001. In HIV-infected MSM, higher number of lifetime male sex partners was significantly associated with any anal HPV infection, but age was a significant risk factor associated with anal HR-HPV infection.Anal HPV infection was highly prevalent in HIV-infected MSM in Korea, and also commonly found in HIV-infected MSW. In HIV-infected MSM, the significant risk factor for being infected with any HPV infection was lifetime number of male sexual partners, and with anal oncogenic HPV infection was age.

Anal endosonography and manometry: comparison in patients with defecation problems.

Science.gov (United States)

Schäfer, R; Heyer, T; Gantke, B; Schäfer, A; Frieling, T; Häussinger, D; Enck, P

1997-03-01

Correlations between anal sphincter function as assessed by anorectal manometry and anal sphincter anatomy measured by endoluminal ultrasound have been reported in the literature both for patients and for healthy individuals but have not been confirmed by other authors. For a larger series of patients (152 consecutive patients, mean age 54.1 +/- 15.5 years; female:male ratio, 111:41) with anorectal dysfunctions such as incontinence (n = 92), constipation (n = 37), and other symptoms (n = 23), diagnostic work-up included conventional multilumen anorectal manometry to evaluate internal sphincter pressure at rest, maximum external sphincter squeeze pressure during contraction, and endoanal sonography to determine anal sphincter integrity and to measure dorsal, left lateral, and right lateral diameter of the internal anal sphincter (IAS) and external anal sphincter (EAS) muscles. Maximum squeeze pressure was significantly correlated to muscle thickness of the EAS (P = 0.001). No association was found between resting pressure and IAS diameter. Women had significantly lower resting and squeeze pressures than men (P = 0.008 and P = 0.003, respectively), but age-related changes of function were only found for resting pressure. Endosonographic values of IAS and EAS did not differ between genders but were significantly correlated with age (P = 0.008 and P = 0.02, respectively). Because all correlations were rather weak, they only can explain a small portion of data variance. Anal manometry and anal ultrasound, therefore, are of complementary value and are both indicated in adequate clinical problems.

Vaccine-preventable anal human papillomavirus in Australian gay and bisexual men

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I. Mary Poynten

2017-06-01

Full Text Available Objective: HPV causes ~90% of anal cancer and HPV16 is the type most commonly associated with anal cancer. Gay and bisexual men (GBM are at greatly increased risk. We investigated patterns of vaccine-preventable anal HPV in older GBM. Methods: The Study of the Prevention of Anal Cancer (SPANC is an ongoing, prospective cohort study of HIV-positive and HIV-negative Australian GBM. Participants completed questionnaires and underwent an anal swab for HPV genotyping using Roche Linear Array. We analysed baseline data from SPANC by HPV type, mean number of types, stratified by age and HIV status. Results: Anal HPV results from 606 (98.2% of 617 participants (median age 49 years, 35.7% HIV-positive showed 525 (86.7% had ≥1 HPV type and 178 (29.4% had HPV16. Over one third of participants (214, 35.3% had no nonavalent vaccine-preventable types detected. Two (0.3% participants had all quadrivalent types and none had all nonavalent vaccine types. HIV-positive participants (p<0.001 and younger participants (p=0.059 were more likely to have more vaccine-preventable HPV types detected. Conclusion: Anal HPV was highly prevalent in this largely community-based GBM cohort. Vaccine-preventable HPV16 was detected in approximately one third of participants. These findings suggest that the potential efficacy of HPV vaccination of older GBM should be explored. Keywords: Human papillomavirus, HPV, Anal, Vaccine, Prevalence, Gay and bisexual men, MSM, HIV

Anal wall sparing effect of an endorectal balloon in 3D conformal and intensity-modulated prostate radiotherapy.

Science.gov (United States)

Smeenk, Robert Jan; van Lin, Emile N J Th; van Kollenburg, Peter; Kunze-Busch, Martina; Kaanders, Johannes H A M

2009-10-01

To investigate the anal wall (Awall) sparing effect of an endorectal balloon (ERB) in 3D conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for prostate cancer. In 24 patients with localized prostate carcinoma, two planning CT-scans were performed: with and without ERB. A prostate planning target volume (PTV) was defined, and the Awall was delineated, using two different methods. Three-field and 4-field 3D-CRT plans, and IMRT plans were generated with a prescription dose of 78Gy. In 144 treatment plans, the minimum dose (D(min)), maximum dose (D(max)), and mean dose (D(mean)) to the Awall were calculated, as well as the Awall volumes exposed to doses ranging from >or=20Gy to >or=70Gy (V(20)-V(70), respectively). In the 3D-CRT plans, an ERB significantly reduced D(mean), D(max), and V(30)-V(70). For IMRT all investigated dose parameters were significantly reduced by the ERB. The absolute reduction of D(mean) was 12Gy in 3D-CRT and was 7.5Gy in IMRT for both methods of Awall delineation. Application of an ERB showed a significant Awall sparing effect in both 3D-CRT and IMRT. This may lead to reduced late anal toxicity in prostate radiotherapy.

[Caesarean section and anal incontinence].

Science.gov (United States)

Kalis, V; Stipán, J; Chaloupka, P; Karbanová, J; Rokyta, Z

2008-04-01

Summary of the impact of Caesarean section on anal incontinence. Review. Department of Gynaecology and Obstetrics, Charles University and University Hospital Plzen. Review of the current international literature. Currently, Caesarean section is not considered to reduce symptoms of anal incontinence. If there is any reduction of symptoms, that remains only for a short term (40% in 3 months after the delivery in the largest trial). In a long term, virtually in no trial has been observed any difference, and others, non-obstetrical factors (particularly aging) prevail. Current knowledge does not allow to assess sufficiently pros and cons of Caesarean compared to vaginal delivery. High risk groups, that would profit from elective Ceasarean, have not been clearly identified yet.

Large Cell Neuroendocrine Carcinoma of the Rectum Presenting with Extensive Metastatic Disease

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Vinay Minocha

2014-01-01

Full Text Available Introduction. Rectal large cell neuroendocrine carcinoma (LCNEC is a poorly differentiated neoplasm that is very rare and belongs within the poorest prognostic subgroup among primary colorectal neoplasms. Here, we describe a case of LCNEC of the rectum, which highlights the aggressive clinical course and poor prognosis associated with this disease. Case Presentation. We report a case of a 63-year-old male who presented to our hospital with a one-month history of lower abdominal pain, constipation, and weight loss. A computed tomography (CT scan of the chest, abdomen, and pelvis revealed a rectal mass as well as metastatic disease of the liver and lung. Flexible sigmoidoscopy revealed a fungating, ulcerated and partially obstructing rectal mass located 6 cm from the anal verge. This mass was biopsied and pathological examination of the resected specimen revealed features consistent with a large cell neuroendocrine carcinoma. Conclusion. Rectal large cell neuroendocrine carcinomas are rare and have a significantly worse prognosis than adenocarcinomas. At diagnosis, a higher stage and metastatic disease are likely to be found. It is important to differentiate large cell, poorly differentiated neuroendocrine carcinomas from adenocarcinomas of the colon and rectum pathologically because patients may benefit from alternative cytotoxic chemotherapeutic regimens.

Radiotherapy in anaplastic thyroid carcinoma: An Australian experience

International Nuclear Information System (INIS)

So, Kevin; Smith, Robin E.; Davis, Sidney R.

2017-01-01

Anaplastic thyroid cancer is a rare and fatal malignancy, associated with significant local tumour and often treatment related morbidity. We report our experience in treating this cancer over a 20-year period. A retrospective review of prospectively collected data from a single Australian Institution (Alfred Health Radiation Oncology) was carried out on patients referred with anaplastic thyroid carcinoma between 1992 and 2013. Thirty patients (17 females and 13 males) were identified with a median age at presentation of 72 years. At presentation, six (20%), 14 (47%) and 10 (33%) patients had stage IVA, IVB and IVC disease respectively. Thirteen patients underwent radical surgical resection with five having microscopic residual (R1) and eight having macroscopic residual (R2) disease. Twenty-eight patients were offered radiotherapy with 27 proceeding with treatment. Of those who received radiotherapy, three, six and 18 were treated with adjuvant, definitive and palliative intent respectively. Six patients had concomitant chemotherapy of which three received trimodality therapy. Only one patient experienced a grade 3 toxicity (oesophagitis). Median survival was 5.3 months and at last follow-up or time of death, 19 of 27 (70.4%) maintained loco-regional control. All patients who had R1 surgical resections and radiotherapy had loco-regional control. Seven of nine (77.8%) and 12 of 18 (66.7%) achieved loco-regional control after receiving definitive or palliative radiotherapy, respectively. Our study suggests that radiotherapy with or without surgery or chemotherapy is well-tolerated and results in durable loco-regional control in a high proportion of patients with anaplastic thyroid carcinoma.

Regenerative medicine provides alternative strategies for the treatment of anal incontinence

DEFF Research Database (Denmark)

Gräs, Søren; Tolstrup, Cæcilie Krogsgaard; Lose, Gunnar

2017-01-01

of culture-expanded skeletal myogenic cells stimulates repair of both acute and 2 - 4-week-old anal sphincter injuries. The results from a small clinical trial with ten patients and a case report support the preclinical findings. Animal studies have also demonstrated that local injections of mesenchymal stem...... cells stimulate repair of sphincter injuries, and a complex bioengineering strategy for creation and implantation of an intrinsically innervated internal anal sphincter construct has been successfully developed in a series of animal studies. CONCLUSION: Cellular therapies with myogenic cells...... and mesenchymal stem cells and the use of bioengineering technology to create an anal sphincter are new potential strategies to treat anal incontinence caused by anal sphincter defects, but the clinical evidence is extremely limited. The use of culture-expanded autologous skeletal myogenic cells has been most...

Exploring dynamics of anal sex among female sex workers in Andhra Pradesh.

Science.gov (United States)

Tucker, Saroj; Krishna, Rama; Prabhakar, Parimi; Panyam, Swarup; Anand, Pankaj

2012-01-01

The anal sex among heterosexual couples is on the rise as reported in many scientific studies. Considering that unprotected anal sex has higher risk of human immunodeficiency virus (HIV) transmission than the vaginal sex, we undertook a study to understand the anal sex practices among Female Sex Workers (FSW). The study was conducted among FSW attending 11 randomly selected sexually transmitted infection (STI) clinics in Bill and Melinda Gates supported targeted interventions in Andhra Pradesh. A structured questionnaire was administered to the 555 FSW attending these clinics by project clinic counselors. Informed consent was obtained from all the study participants. Engaging in anal sex was self reported by 22% of sex workers, though demand from clients was reported to be much higher (40%). The reasons for anal sex practices included more money (61%), clout/influence of the client (45%), risk of losing client (27%), and forced sex (1.2%). Factors associated with anal sex were higher number of clients, higher duration of sex work, higher income, and older age group. Associated risks perceived by FSW were bleeding and injury to anal canal (98%) while only 28% associated it with higher HIV transmission risk. Reported Condom and lubricant use was about 88% and 39% respectively. The study shows that there is frequent anal sex, inconsistent condom and infrequent lubricant usage, economic and physical coercion, and low awareness of STI/HIV transmission risk among FSW, which have serious implications for HIV prevention programmes. There is a need to focus on anal sex education and use of lubricants along with condoms during anal sex in FSW-targeted interventions in AP.

HPV infection and intraepithelial lesions from the anal region: how to diagnose?

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Newton Sérgio de Carvalho

Full Text Available In the last years, the prevalence of HPV infection in the anal region has increased, especially in some groups like homosexual and HIV-positive people. Since this infection can be associated with the development of squamous anal cancer due to its progression from HPV infection to anal intraepithelial neoplasia (AIN and finally to cancer, the screening and evaluation of these conditions are important. Anal cytology and high resolution anoscopy are good methods that are available and can be used. Although useful, these methods should be performed correctly and not indiscriminately in all patients. Patients for whom anal cytology screening is recommended are: HIV-infected patients, homosexuals, women who present with high-grade vulvar squamous intraepithelial neoplasia, vulvar cancer or cervical cancer. An abnormal anal cytology should be further evaluated with high resolution anoscopy.

Magnetic resonance imaging anatomy of the anal canal

International Nuclear Information System (INIS)

Kashyap, P.; Bates, N.

2004-01-01

The anatomy of the anal canal is complex but well demonstrated by MRI. Understanding the anatomy is a prerequisite for determining the true site and the extent of pathology, especially for surgical workup. In this article, the MRI anatomy of the anal canal has been displayed using highlighted MRI images and line diagrams. Copyright (2004) Blackwell Science Pty Ltd

Fiber types in the striated urethral and anal sphincters

DEFF Research Database (Denmark)

Schrøder, H D; Reske-Nielsen, E

1983-01-01

Seven normal human striated urethral and anal sphincters obtained by autopsy were examined using histochemical techniques. In both the urethral sphincter and the subcutaneous (s.c.) and superficial part of the anal sphincter a characteristic pattern with two populations of muscle fibers, abundant...

Merkel Cell Carcinoma of the Head and Neck: A Single Institutional Experience

International Nuclear Information System (INIS)

Morand, G.; Vital, D.; Pezier, T.; Holzmann, D.; Huber, G.F.; Roessle, M.; Cozzio, A.

2013-01-01

Merkel cell carcinoma (MCC) is a rare cutaneous malignancy occurring mostly in older immunocompromised Caucasian males. A growing incidence of MCC has been reported in epidemiological studies. Treatment of MCC usually consists of surgical excision, pathological lymph node evaluation, and adjuvant radiotherapy. This paper reports the experience of a single tertiary center institution with 17 head and neck Merkel cell carcinoma patients. Median followup for the cohort was 37.5 months. After five years, recurrence-free survival, disease specific survival, and overall survival were 85%, 90%, and 83%, respectively. Our limited data support the use of adjuvant radiotherapy. We also report two cases of MCC located at the vestibule of the nose and two cases of spontaneous regression after diagnostic biopsy. About 40% of our patients were referred to our center for surgical revision and pathological lymph node evaluation. Increased awareness of MCC and an interdisciplinary approach are essential in the management of MCC.

Regenerative medicine provides alternative strategies for the treatment of anal incontinence.

Science.gov (United States)

Gräs, Søren; Tolstrup, Cæcilie Krogsgaard; Lose, Gunnar

2017-03-01

Anal incontinence is a common disorder but current treatment modalities are not ideal and the development of new treatments is needed. The aim of this review was to identify the existing knowledge of regenerative medicine strategies in the form of cellular therapies or bioengineering as a treatment for anal incontinence caused by anal sphincter defects. PubMed was searched for preclinical and clinical studies in English published from January 2005 to January 2016. Animal studies have demonstrated that cellular therapy in the form of local injections of culture-expanded skeletal myogenic cells stimulates repair of both acute and 2 - 4-week-old anal sphincter injuries. The results from a small clinical trial with ten patients and a case report support the preclinical findings. Animal studies have also demonstrated that local injections of mesenchymal stem cells stimulate repair of sphincter injuries, and a complex bioengineering strategy for creation and implantation of an intrinsically innervated internal anal sphincter construct has been successfully developed in a series of animal studies. Cellular therapies with myogenic cells and mesenchymal stem cells and the use of bioengineering technology to create an anal sphincter are new potential strategies to treat anal incontinence caused by anal sphincter defects, but the clinical evidence is extremely limited. The use of culture-expanded autologous skeletal myogenic cells has been most intensively investigated and several clinical trials were ongoing at the time of this report. The cost-effectiveness of such a therapy is an issue and muscle fragmentation is suggested as a simple alternative.

Afeto, intensidade e confiança na experiência analítica: algumas considerações sobre a heterodoxia clínica de S. Ferenczi Affection, intensity and confidence in the analytical experience: a few considerations about the S. Ferenczi clinical heterodoxy

Directory of Open Access Journals (Sweden)

Vivian Heringer Pizzinga

2009-12-01

Full Text Available Pretende-se examinar a atualidade das contribuições do pensamento de Sándor Ferenczi para a construção da experiência analítica. Em um primeiro momento, visa-se discutir os conceitos de afeto e intensidade em sua obra, para, em seguida, examinar com mais profundidade algumas questões por ele levantadas acerca do lugar do analista e da importância da confiança e da sinceridade do analista no dispositivo analítico, questões essas intensificadas quando de sua última inventiva metodológica, a saber, a análise mútua.This article aims at studying the currentness of the contributions of Sándor Ferenczi's thought in the building of the psychoanalytical experience. To begin with, the affection and intensity concepts as described in his work will be put into discussion and, subsequently, some issues he raised concerning the analyst's place as well as the analyst's confidence and frankness in the analytical apparatus will be examined in detail. Such issues have been intensified in Ferenczi's late methodology, known as mutual analysis.

The Danish anal sphincter rupture questionnaire: Validity and reliability

DEFF Research Database (Denmark)

Due, Ulla; Ottesen, Marianne

2008-01-01

Objective. To revise, validate and test for reliability an anal sphincter rupture questionnaire in relation to construct, content and face validity. Setting and background. Since 1996 women with anal sphincter rupture (ASR) at one of the public university hospitals in Copenhagen, Denmark have bee...

Cancer of the anal canal: Diagnosis, staging and follow-up with MRI

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Durot, Carole; Hoeffel, Christine [Dept. of Radiology, Centre Hospitalo-Universitaire de Reims, Reims (France); Dohan, Anthony; Boudiaf, Mourad; Soyer, Philippe [Dept. of Abdominal Imaging, Hopital Lariboisiere-APHP, Paris(France); Servois, Vincent [Dept. of Radiology and Nuclear Medicine, Institut Curie, Paris (France)

2017-11-15

Although a rare disease, anal cancer is increasingly being diagnosed in patients with risk factors, mainly anal infection with the human papilloma virus. Magnetic resonance imaging (MRI) with external phased-array coils is recommended as the imaging modality of choice to grade anal cancers and to evaluate the response assessment after chemoradiotherapy, with a high contrast and good anatomic resolution of the anal canal. MRI provides a performance evaluation of size, extent and signal characteristics of the anal tumor before and after treatment, as well as lymph node involvement and extension to the adjacent organs. MRI is also particularly helpful in the assessment of complications after treatment, and in the diagnosis for relapse of the diseases.

Cancer of the anal canal: Diagnosis, staging and follow-up with MRI

International Nuclear Information System (INIS)

Durot, Carole; Hoeffel, Christine; Dohan, Anthony; Boudiaf, Mourad; Soyer, Philippe; Servois, Vincent

2017-01-01

Although a rare disease, anal cancer is increasingly being diagnosed in patients with risk factors, mainly anal infection with the human papilloma virus. Magnetic resonance imaging (MRI) with external phased-array coils is recommended as the imaging modality of choice to grade anal cancers and to evaluate the response assessment after chemoradiotherapy, with a high contrast and good anatomic resolution of the anal canal. MRI provides a performance evaluation of size, extent and signal characteristics of the anal tumor before and after treatment, as well as lymph node involvement and extension to the adjacent organs. MRI is also particularly helpful in the assessment of complications after treatment, and in the diagnosis for relapse of the diseases

Use of Anal Acoustic Reflectometry in the Evaluation of Men With Passive Fecal Leakage

DEFF Research Database (Denmark)

Hornung, Benjamin R; Telford, Karen J; Carlson, Gordon L

2017-01-01

with greater sensitivity and discriminatory ability than conventional anal manometry. OBJECTIVE: The aim of this study was to determine whether men with fecal leakage have an abnormality in anal sphincter function that is detectable by anal acoustic reflectometry. DESIGN: This was an age-matched study......BACKGROUND: Men with passive fecal leakage represent a distinct clinical entity in which the pathophysiology remains unclear. Standard anorectal investigations fail to demonstrate consistent abnormalities in this group. Anal acoustic reflectometry is a new test of anal sphincter function...... of continent and incontinent men. SETTINGS: The study was conducted at a university teaching hospital. PATIENTS: Male patients with isolated symptoms of fecal leakage were recruited. Anal acoustic reflectometry, followed by conventional anal manometry, was performed. Results were then compared with those from...

The anal verge: localization with multi-slice spiral CT

International Nuclear Information System (INIS)

Wang Wei; Tang Guangjian

2010-01-01

Objective: To determine and evaluate the method of localization of anal verge by multislice spiral CT. To provide an imaging reference for operative guidance of low-rectal cancer. Methods Forty eight consecutive adult patients suspected of abnormalities other than rectal disease were evaluated with abdominal and pelvic CT scans since August, 2009. They were divided into two groups based on sex and age. There were 23 men and 25 women. The ages of young group were 28 to 50 years and the average age was 41 years. The ages of elderly group were 52 to 81 years and the average age was 64 years. A small cotton ball dipped with contrast media was put at the anal verge as a marker and CT scans were performed with 64-slice spiral CT scanner. The distances between the cotton balls and the lower margin of the pubis combination (La), the lower margin of the Sth sacral vertebra (Lb), the inferior aperture of minor pelvis (Lc) and the lower margin of the basement of external anal sphincter (Ld) were measured on the mid- sagittal images obtained by MPR. The averages, the standard deviations (s), the 95% and 80% confidence intervals of La, Lb, Lc and Ld were calculated. We took the intervals of ±1.96 s or ±1.28 s 0.05) between two different sex groups [male group, (10.0±1.2) mm], female group, (9.6±1.2) mm and between two age groups [young group, (9.6±1.2) mm, elderly group, (9.9±1.3) mm]. Conclusions: The lower margin of the basement of external anal sphincter was a useful anatomic landmark for localizing the anal verge, and could be definitely identified on the middle sagittal pelvic CT image. The distance between the structure and anal verge is constant enough and can be used in measuring distance from low rectal lesion to the anal verge. (authors)

Value of conventional cytology in the presence of macroscopic lesions of the anal canal

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Lêda Pereira de Barcellos

2014-01-01

Full Text Available Objectives: To verify the value of conventional cytology for the diagnosis of macroscopic le- sions of the anal canal and to describe the limitations of the samples. Method: We evaluated 395 conventional cytology samples obtained by brushing the anal canal of patients (predominantly male, HIV-positive and compared them to the presence of macroscopic lesions of the anal canal observed under anorectal examination. Results: Of the total, 91.6% of samples were classified as adequate. Cellular elements repre- sentative of the anal transformation zone were observed in 63.5% of samples. Sensitivity in the presence or absence of cellularity was 80% and 31%, respectively. Conclusion: The study demonstrates the feasibility of using conventional anal cytology in outpatients. Resumo: Objetivo: verificar o valor da citologia convencional no diagnóstico de lesões macroscópicas do canal anal e descrever as limitações das amostras obtidas. Método: avaliamos 395 exames citológicos convencionais obtidos por escovado do canal anal de pacientes predominantemente do sexo masculino, soropositivos para HIV, e com- paramos com a presença de lesões macroscópicas do canal anal constatadas ao exame proctológico. Resultado: o percentual de amostras adequadas foi de 91,6%, e os elementos celulares re- presentativos da zona de transformação anal foram observados em 63,5% das amostras. Encontramos sensibilidade de 80% e 31% na presença ou ausência desta celularidade, res- pectivamente. Conclusão: O estudo demonstra a possibilidade de utilização da citologia anal convencional no rastreio de lesões macroscópicas do canal anal em pacientes ambulatoriais. Keywords: HPV Prevention of anal neoplasia Conventional cytology, Palavras-chave: HPV Prevenção de neoplasia anal Citologia convencional

Anal sphincter complex: endoanal MR imaging of normal anatomy

NARCIS (Netherlands)

Hussain, S. M.; Stoker, J.; Laméris, J. S.

1995-01-01

To determine the normal anatomy of the anal sphincter complex on magnetic resonance (MR) images. Ten healthy volunteers (four men, six women; age range, 21-26 years) underwent MR imaging with an endoanal coil. The lower part of the anal canal contained the internal sphincter, the longitudinal muscle

Development of a pulse height analizer

International Nuclear Information System (INIS)

Moreira, E.S.

1984-01-01

The development of a Pulse Height Analizer is described. This equipment is essential to analize data coming from detectors producing information codified in pulse amplitudes. The system developed consist of a Signal Input Module connected to a Controller Module based on a 8085A microprocessor capable to memorize pulses up to 1 uS in 256 channels with a resolution better than 20 mV. A Communication Module with a serial interface is used for data transfer to a host computer using RS232c protocol. The Monitoring and Operation Module consist of a hexadecimal Keybord, a 6 digit 7-segment display and a XY analog output enabling real time visualization of data on a XY monitor. The hardware and the software designed for this low cost system were optimized to obtain a typical dead time of approximately 100 uS. As application, this device was used to adquire curves at the Small Angle X-ray Scattering Laboratory in this Department. The apparatus performance was tested by comparing its data with a Northern Pulse Height Analizer model NS633 output, with favorable results. (Author) [pt

Leiomyoma of the anal canal: report of two cases.

Science.gov (United States)

Witz, M; Bernheim, J; Griffel, B; Dinbar, A

1986-10-01

Leiomyoma of the rectum and anal canal is an unusual clinical entity. Generally, it does not produce any clinical signs and in most cases it is discovered incidentally in the course of routine rectal examination. The clinical presentation, diagnosis, and surgical treatment are described in two presented cases of anal canal leiomyoma.

Squamous intraepithelial lesions of the anal squamocolumnar junction: Histopathological classification and HPV genotyping

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Omar Clavero

2017-06-01

Full Text Available Background: Human papillomavirus (HPV-related anal cancer lesions are often found adjacent to the squamocolumnar junction (SCJ. We have assessed the histopathology and associated HPV genotypes in anal SCJ lesions in surgically excised anal warts in HIV-negative and –positive patients. Methods: Histopathology identified 47 squamous intraepithelial lesions (SILs adjacent to the SCJ amongst a total of 145 cases of clinically diagnosed anal condylomata. The anal SCJ lesions were further analyzed with p16, CK7 and p63 immunohistochemistry and HPV genotyping. Results: Sixteen (16/47 of the excised anal wart lesions contained HSIL; Three were HSIL and exclusively associated with oncogenic HPVs. A further thirteen (13/47 were mixed lesions. Of these eight were HSILs with LSIL and six were HSILs with papillary immature metaplasia (PIM; Ten of the mixed lesions were associated with one or more oncogenic HPVs, while three cases were exclusively associated with HPV6. Conclusions: Clinically diagnosed anal warts cannot be assumed to be limited to low-grade lesions as anal warts of the SCJ often show heterogeneous lesions, with coexistence of LSIL, PIM, and HSIL. Lesions showing PIM, however, may mimic HSIL, because they are hypercellular, but lack the nuclear atypia and conspicuous mitotic activity of HSIL; and are p16 negative. Keywords: Anal squamocolumnar junction, Low-grade squamous intraepithelial lesion (LSIL, High-grade squamous intraepithelial lesion (HSIL, Papillary immature metaplasia (PIM, HPV, HIV

An integrative review of guidelines for anal cancer screening in HIV-infected persons.

Science.gov (United States)

Wells, Jessica S; Holstad, Marcia M; Thomas, Tami; Bruner, Deborah Watkins

2014-07-01

HIV-infected individuals are 28 times more likely than the general population to be diagnosed with anal cancer. An integrative review of recommendations and guidelines for anal cancer screening was performed to provide a succinct guide to inform healthcare clinicians. The review excluded studies that were of non-HIV populations, redundant articles or publications, non-English manuscripts, or nonclinical trials. The review found no formal national or international guidelines exist for routine screening of anal cancer for HIV-infected individuals. To date, no randomized control trial provides strong evidence supporting efficaciousness and effectiveness of an anal cancer screening program. The screening recommendations from seven international-, national-, and state-based reports were reviewed and synthesized in this review. These guidelines suggest anal cancer screening, albeit unproven, may be beneficial at decreasing the incidence of anal cancer. This review highlights the paucity of screening-related research and is an area of need to provide clear direction and to define standard of care for anal cancer screening in HIV-infected persons.

Surgical Treatment of Anal Stenosis with Diamond Flap Anoplasty Performed in a Calibrated Fashion.

Science.gov (United States)

Gülen, Merter; Leventoğlu, Sezai; Ege, Bahadir; Menteş, B Bülent

2016-03-01

Regarding anoplasty for anal stenosis, it is not clear to what extent the final anal caliber should be targeted. The aim of this study was to investigate the results of diamond-flap anoplasty performed in a calibrated manner for the treatment of severe anal stenosis due to a previous hemorrhoidectomy. Prospectively prepared standard forms were evaluated retrospectively. Anoplasty with unilateral or bilateral diamond flaps was performed for moderate or severe anal stenosis, targeting a final anal caliber of 25 to 26 mm. The demographic characteristics, causes of anal stenosis, number of previous surgeries, anal stenosis staging (Milsom and Mazier), anal calibers (millimeter), the Cleveland Clinic Incontinence Score, and the modified obstructed defecation syndrome Longo score were recorded on pre-prepared standard forms, as well as postoperative complications and the time of return to work. From January 2011 to July 2013, 18 patients (12 males, 67%) with a median age of 39 years (range, 27-70) were treated. All of the patients had a history of previous hemorrhoidectomy. The number of previous corrective interventions was 2.1 ± 1.8 (range, 0-4), and 2 patients had a history of failed anoplasty. Five patients (28%) had moderate anal stenosis and 13 (72%) had severe anal stenosis. Preoperative, intraoperative, and 12-month postoperative anal calibration values were 9 ± 3 mm (range, 5-15), 25 ± 0.75 mm (range, 24-26), and 25 ± 1 mm (range, 23-27) (p < 0.0001, for immediate postoperative and 12-month postoperative anal calibers compared with the intraoperative). Preoperative and 12-month postoperative Cleveland Clinic Incontinence Scores were 0.83 ± 1.15 (range, 0-4) and 0.39 ± 0.70 (range, 0-2) (p = 1.0). The clinical success rate was 88.9%. No severe postoperative complications were observed. This study was limited because it was a single-armed, retrospective analysis of prospectively designed data. Diamond-flap anoplasty performed in a standardized and calibrated

A trial of radiofrequency ablation for anal intraepithelial neoplasia.

Science.gov (United States)

Goldstone, Robert N; Hasan, Shirin R; Drury, Steven; Darragh, Teresa M; van Zante, Annemieke; Goldstone, Stephen E

2017-03-01

Radiofrequency ablation (RFA) effectively treats esophageal high-grade dysplasia, but its efficacy in treating anal canal high-grade squamous intraepithelial lesions (HSILs) is unsubstantiated. This prospective study assessed the safety and efficacy of applying hemi-circumferential RFA to anal canal HSIL. Twenty-one HIV-negative participants with HSIL occupying ≤ half the anal canal circumference were treated with hemi-circumferential anal canal RFA. Participants were assessed every 3 months for 12 months with high-resolution anoscopy; recurrence in the treatment zone was re-treated with focal RFA. Twenty-one participants with a mean of 1.7 lesions (range 1-4) enrolled and completed the trial. Six (29 %) participants had recurrent HSIL within the treated hemi-circumference within 1 year. Four participants (19 %) had persistence of an index lesion at 3 months. One (2.9 %) index HSIL persisted again at 12 months. No participants had more than two RFA treatments. KM curve-predicted HSIL-free survival within the treatment zone at 1 year was 76 % (95 % CI 52-89 %). Comparing the first 7 and last 14 participants, the predicted 1-year HSIL-free survivals are 43 % (95 % CI 10-73 %) and 93 % (95 % CI 59-99 %), respectively (p = 0.008), suggesting a learning curve with the treating physician. Multivariable analysis showed decreased recurrence in the last 14 participants (HR 0.02; 95 % CI 0.001-0.63) while increasing BMI increased recurrence (HR 1.43, 95 % CI 1.01-2.01). No participants had device or procedure-related serious adverse events, anal stricture, or heavy bleeding. Hemi-circumferential RFA yielded a high rate of anal HSIL eradication in HIV-negative patients at 1 year with minimal adverse events. Lesion persistence was probably related to incomplete initial ablation.

Overdiagnosis and rising rate of obstetric anal sphincter injuries (OASIS): time for reappraisal.

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Sioutis, D; Thakar, R; Sultan, A H

2017-11-01

To determine the accuracy of clinical diagnosis of obstetric anal sphincter injuries (OASIS) using three-dimensional (3D) endoanal ultrasound (EA-US) and to compare symptoms and anal manometry measurements between women with anal sphincters adequately repaired and those with persistent anal sphincter defects. The EA-US images of women with clinically diagnosed and repaired OASIS, defined as third- or fourth-degree perineal tear, who attended the perineal clinic at Croydon University Hospital over a 10-year period (2003-2013) were reanalyzed by a single expert blind to symptoms and the results of clinical examination. St Mark's Incontinence Scores (SMIS) and anal manometry measurements were obtained and compared between women with an intact anal sphincter and those with an anal sphincter scar and between those with an intact anal sphincter and those with a defect. Anal manometry measurements were compared between women with an external anal sphincter (EAS) defect and those with an internal anal sphincter (IAS) defect. The images of 908 women were reanalyzed. No evidence of OASIS was found in 64 (7.0%) women, an EAS scar alone was detected in 520 (57.3%) and an anal sphincter defect in 324 (35.7%). Of the 324 women with a defect, 112 had an EAS defect, 90 had an IAS defect and 122 had a combined IAS and EAS defect. SMIS results were significantly higher in women with an anal sphincter defect compared with those with no evidence of OASIS (P = 0.018), but there was no significant difference in scores between women with an intact sphincter and those with an EAS scar only. Women with a defect had a significantly lower maximum resting pressure (median (range), 44 (8-106) vs 55 (29-86) mmHg; P 40) vs 25 (10-40) mm; P = 0.003). Seven percent of women with a clinical diagnosis of OASIS were wrongly diagnosed. We believe that this rate may differ from that of other units but training methods and competency assessment tools for the diagnosis and repair of OASIS need

Anal wall sparing effect of an endorectal balloon in 3D conformal and intensity-modulated prostate radiotherapy

International Nuclear Information System (INIS)

Smeenk, Robert Jan; Lin, Emile N.J.Th. van; Kollenburg, Peter van; Kunze-Busch, Martina; Kaanders, Johannes H.A.M.

2009-01-01

Background and purpose: To investigate the anal wall (Awall) sparing effect of an endorectal balloon (ERB) in 3D conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for prostate cancer. Materials and methods: In 24 patients with localized prostate carcinoma, two planning CT-scans were performed: with and without ERB. A prostate planning target volume (PTV) was defined, and the Awall was delineated, using two different methods. Three-field and 4-field 3D-CRT plans, and IMRT plans were generated with a prescription dose of 78 Gy. In 144 treatment plans, the minimum dose (D min ), maximum dose (D max ), and mean dose (D mean ) to the Awall were calculated, as well as the Awall volumes exposed to doses ranging from ≥20 Gy to ≥70 Gy (V 20 - V 70 , respectively). Results: In the 3D-CRT plans, an ERB significantly reduced D mean , D max , and V 30 - V 70 . For IMRT all investigated dose parameters were significantly reduced by the ERB. The absolute reduction of D mean was 12 Gy in 3D-CRT and was 7.5 Gy in IMRT for both methods of Awall delineation. Conclusions: Application of an ERB showed a significant Awall sparing effect in both 3D-CRT and IMRT. This may lead to reduced late anal toxicity in prostate radiotherapy.

The prognostic role of hemoglobin levels in patients undergoing concurrent chemo-radiation for anal cancer.

Science.gov (United States)

Franco, Pierfrancesco; Montagnani, Francesco; Arcadipane, Francesca; Casadei, Chiara; Andrikou, Kalliopi; Martini, Stefania; Iorio, Giuseppe Carlo; Scartozzi, Mario; Mistrangelo, Massimiliano; Fornaro, Lorenzo; Cassoni, Paola; Cascinu, Stefano; Ricardi, Umberto; Casadei Gardini, Andrea

2018-05-02

Concurrent chemo-radiation (CT-RT) is a standard therapy for squamous cell carcinoma of anal canal. Different clinical and biological factors may potentially affect outcome. We investigated the prognostic role of baseline hemoglobin (Hb) in a cohort of anal cancer patients submitted to CT-RT with 5-fluorouracil and mitomycin C. Up to 161 patients with clinical stage T1-T4/N0-N3/M0 were treated. Response was assessed at 6 weeks and thereafter at 3, 6 and 12 months. Two different approaches were used:a)simultaneous integrated boost following RTOG 05-29 indications;b)first sequence of 45Gy/25 fractions to the pelvis followed by 9-14.4 Gy/5-8 fractions to the macroscopic disease. Primary endpoints were progression-free survival (PFS) and overall survival (OS). On multivariate analysis, pre-treatment Hb level had a significant correlation to OS (HR:0.53;95% CI:0.33-0.87; p = 0.001), but not to PFS (HR:0.78;95% CI:0.53-1.15; p = 0.12) Patients with pre-treatment Hb ≥ 12 g/dl had 5-year PFS and OS of 82.2%, compared to 29.3% and 32.8% for those below the threshold. The likelihood to achieve a complete remission increased by 5.6% for every single-unit (g/dl) increase in baseline Hb level over 11 g/dl. On multivariate analysis, response to treatment had a significant correlation to PFS (incomplete vs complete response - HR:5.43;95% CI:2.75-10.7; p < 0.0001) and OS (HR: 6.96;95% CI:2.96-16.5; p < 0.0001). We showed that baseline Hb level is a strong indicator for poor response to RT-CT in anal cancer patients. A close clinical monitoring for incomplete response to treatment should be advised in patients with low pre-treatment Hb. The hypothesis that the preservation of adequate Hb level during treatment may lead to a better outcome needs prospective evaluation.

Viscoelastic assessment of anal canal function using acoustic reflectometry: a clinically useful technique.

Science.gov (United States)

Mitchell, Peter J; Klarskov, Niels; Telford, Karen J; Hosker, Gordon L; Lose, Gunnar; Kiff, Edward S

2012-02-01

Anal acoustic reflectometry is a new reproducible technique that allows a viscoelastic assessment of anal canal function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, opening and closing elastance, and hysteresis. The aim of this study was to assess whether the parameters measured in anal acoustic reflectometry are clinically valid between continent and fecally incontinent subjects. This was an age- and sex-matched study of continent and incontinent women. The study was conducted at a university teaching hospital. One hundred women (50 with fecal incontinence and 50 with normal bowel control) were included in the study. Subjects were age matched to within 5 years. Parameters measured with anal acoustic reflectometry and manometry were compared between incontinent and continent groups using a paired t test. Diagnostic accuracy was assessed by the use of receiver operator characteristic curves. Four of the 5 anal acoustic reflectometry parameters at rest were significantly different between continent and incontinent women (eg, opening pressure in fecally incontinent subjects was 31.6 vs 51.5 cm H2O in continent subjects, p = 0.0001). Both anal acoustic reflectometry parameters of squeeze opening pressure and squeeze opening elastance were significantly reduced in the incontinent women compared with continent women (50 vs 99.1 cm H2O, p = 0.0001 and 1.48 vs 1.83 cm H2O/mm, p = 0.012). In terms of diagnostic accuracy, opening pressure at rest measured by reflectometry was significantly superior in discriminating between continent and incontinent women in comparison with resting pressure measured with manometry (p = 0.009). Anal acoustic reflectometry is a new, clinically valid technique in the assessment of continent and incontinent subjects. This technique, which assesses the response of the anal canal to distension and relaxation, provides a detailed viscoelastic assessment of anal canal function. This technique

Cytological Anal Squamous Intraepithelial Lesions Associated with Anal High-Risk Human Papillomavirus Infections among Men Who Have Sex with Men in Northern Thailand.

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Darin Ruanpeng

Full Text Available Anal cancer, one of human papillomavirus (HPV related malignancies, has increased in recent decades, particularly among men who have sex with men (MSM and HIV-infected (HIV+ persons. We aimed to explore the prevalence of anal squamous intraepithelial lesions (ASIL using Papanicolau (Pap screening among MSM in northern Thailand and its associated factors.Two hundreds MSM aged ≥18 years reporting receptive anal intercourse in the prior 6 months were recruited from July 2012 through January 2013. Medical history and behavioral data were collected by staff interview and computer-assisted self interview. Anal Pap smear, HPV genotyping, and HIV testing were performed. Two pathologists blinded to HPV and HIV status reported cytologic results by Bethesda classification.Mean age was 27.2 years (range 18-54. Overall, 86 (43.0% had ASIL: 28 (14.2% with atypical cells of undetermined significance (ASCUS, 1 (0.5% with atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H, 56 (28.4% with low-grade squamous intraepithelial lesion (LSIL, and 1 (0.5% with high-grade squamous intraepithelial lesion (HSIL. ASIL was associated by univariate analysis (p ≤0.05 with older age, gender identity other than bisexual (i.e., gay men and transgender women, rectal douching, anal symptoms, genital warts, HIV positivity, and high-risk-HPV infection. However, on multiple logistic regression ASIL was associated only with high-risk HPV type (p = 0.002 and HIV infection (p = 0.01.ASIL is quite common in high-risk MSM in northern Thailand and is associated with high-risk HPV types and HIV infection. Routine anal Pap screening should be considered, given the high frequency of ASIL, particularly in the HIV+. High resolution anoscopy (HRA, not done here, should be to confirm PAP smears whose sensitivity and specificity are quite variable. Timely HPV vaccination should be considered for this population.

Cytological Anal Squamous Intraepithelial Lesions Associated with Anal High-Risk Human Papillomavirus Infections among Men Who Have Sex with Men in Northern Thailand.

Science.gov (United States)

Ruanpeng, Darin; Chariyalertsak, Suwat; Kaewpoowat, Quanhathai; Supindham, Taweewat; Settakorn, Jongkolnee; Sukpan, Kornkanok; Utaipat, Utaiwan; Miura, Toshiyuki; Kosashunhanan, Natthapol; Saokhieo, Pongpun; Songsupa, Radchanok; Wongthanee, Antika

2016-01-01

Anal cancer, one of human papillomavirus (HPV) related malignancies, has increased in recent decades, particularly among men who have sex with men (MSM) and HIV-infected (HIV+) persons. We aimed to explore the prevalence of anal squamous intraepithelial lesions (ASIL) using Papanicolau (Pap) screening among MSM in northern Thailand and its associated factors. Two hundreds MSM aged ≥18 years reporting receptive anal intercourse in the prior 6 months were recruited from July 2012 through January 2013. Medical history and behavioral data were collected by staff interview and computer-assisted self interview. Anal Pap smear, HPV genotyping, and HIV testing were performed. Two pathologists blinded to HPV and HIV status reported cytologic results by Bethesda classification. Mean age was 27.2 years (range 18-54). Overall, 86 (43.0%) had ASIL: 28 (14.2%) with atypical cells of undetermined significance (ASCUS), 1 (0.5%) with atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H), 56 (28.4%) with low-grade squamous intraepithelial lesion (LSIL), and 1 (0.5%) with high-grade squamous intraepithelial lesion (HSIL). ASIL was associated by univariate analysis (p ≤0.05) with older age, gender identity other than bisexual (i.e., gay men and transgender women), rectal douching, anal symptoms, genital warts, HIV positivity, and high-risk-HPV infection. However, on multiple logistic regression ASIL was associated only with high-risk HPV type (p = 0.002) and HIV infection (p = 0.01). ASIL is quite common in high-risk MSM in northern Thailand and is associated with high-risk HPV types and HIV infection. Routine anal Pap screening should be considered, given the high frequency of ASIL, particularly in the HIV+. High resolution anoscopy (HRA), not done here, should be to confirm PAP smears whose sensitivity and specificity are quite variable. Timely HPV vaccination should be considered for this population.

Carcinoma of the pancreas

International Nuclear Information System (INIS)

Humphrey, L.J.; Hartman, G.V.

1974-01-01

Experience with 17 patients with incurable carcinoma of the pancreas treated by radiation therapy and immunotherapy is described. Results observed have prompted a program of aggressive surgery, radiation therapy, immunotherapy, and long-term chemotherapy. Optimism for significant palliation and survival for these patients with curable and incurable pancreatic carcinoma is warranted. (U.S.)

Relation between anal electrosensitivity and rectal filling sensation and the influence of age

NARCIS (Netherlands)

Broens, PMA; Penninckx, FM

PURPOSE: The aim of this study was to assess the effect of age and sex on the rectal filling sensation and anal electrosensitivity and to explore the relation between anal electrosensitivity and the parameters of the rectal filling sensation. METHODS: Anal mucosal electrosensitivity and anorectal

The identification of specialized pacemaking cells in the anal sphincters.

Science.gov (United States)

Shafik, Ahmed; El Sibai, Olfat; Ahmed, Ismail

2006-07-01

Interstitial cells of Cajal (ICC) are claimed to generate the electrical activity in the colon and stomach. As the external (EAS) and internal (IAS) anal sphincters exhibit resting electrical activity, we hypothesized the presence of ICC in these sphincters. This hypothesis was investigated in the current study. Specimens from the EAS and IAS were taken from normal areas of the anorectum which had been surgically excised by abdominoperineal operation for rectal cancer of 28 patients (16 men, 12 women, mean age 42.2+/-4.8 years). The specimens were subjected to c-kit immunohistochemistry. Controls for the specificity of the antisera consisted of tissue incubation with normal rabbit serum substituted for the primary antiserum. Fusiform, c-kit positive, ICC-like cells were detected in the anal sphincters; they had dendritic processes. They were clearly distinguishable from the non-branching, c-kit negative smooth and striated muscle cells of the anal sphincters. The specimens contained also c-kit positive mast cells, but they had a rounded body with no dendritic processes. Immunoreactivity was absent in negative controls in which the primary antibody was omitted. We have identified, for the first time, cells in EAS and IAS with morphological and immunological phenotypes similar to ICCs of the gut. These cells appear to be responsible for initiating the slow waves recorded from the anal sphincters and for controlling their activity. A deficiency or absence of these cells may affect the anal motile activity. Studies are needed to explore the role of these cells in anal motility disorders.

Incertidumbre en métodos analíticos de rutina.

OpenAIRE

Maroto Sánchez, Maria Alicia

2002-01-01

Para que los laboratorios de análisis puedan acreditarse según la norma ISO 17025, es necesario que los resultados analíticos vayan acompañados de dos parámetros de calidadbásicos: su trazabilidad y su incertidumbre. Esto ha hecho que, hoy en día, la verificaciónde la trazabilidad y el cálculo de la incertidumbre de los resultados analíticos sea cada vezmás importante. En esta tesis doctoral hemos propuesto diversas metodologías para calcularla incertidumbre en métodos analíticos que se utili...

Endosonographic and manometric evaluation of internal anal sphincter in patients with chronic anal fissure and its correlation with clinical outcome after topical glyceryl trinitrate therapy.

Science.gov (United States)

Pascual, Marta; Pera, Miguel; Courtier, Ricard; Gil, Mariá José; Parés, David; Puig, Sonia; Andreu, Montserrat; Grande, Luis

2007-08-01

Anorectal pressure studies have demonstrated internal anal sphincter (IAS) hypertonia in patients with chronic anal fissure. It is unknown however, if these changes in IAS function are associated with any abnormality in sphincter morphology. The first aim was to investigate the clinical characteristics and the manometric and endosonographic findings of the IAS in a cohort of patients with chronic anal fissure. The second aim was to investigate the association between these findings and the outcome with topical Glyceryl trinitrate (GTN) therapy. All patients who presented with chronic anal fissure from November 1999 to May 2004 were included after failure of conservative therapy. Anorectal manometry and anal endosonography were performed before treatment with 0.2% GTN ointment twice daily was initiated. Patients were evaluated after 8 weeks. One hundred and twenty-four patients (66 women, mean age, 45.2 +/- 14.8 years) were included. Hypertonia of the IAS was found in 84 (68%) patients. The mean maximum IAS thickness was 3.6 +/- 0.76 mm (1.6-5.5). An abnormally thick IAS, adjusted by age, was observed in 113 (91.1%) patients. We found no correlation between resting pressure and IAS thickness (r = 0.074; p = 0.41). At 8 weeks, 52 patients (42%) had healed with complete symptoms resolution. No statistically significant differences were observed when clinical features and manometric and endosonographic findings were compared between healing and no-healing fissures. The majority of patients with chronic anal fissure present an abnormally thick IAS. Clinical, manometric and endosonographic features had no association with outcome after GTN treatment.

PENGARUH MODEL PROBLEM BASED LEARNING TERHADAP KEMAMPUAN BERPIKIR ANALITIS DAN KETERAMPILAN PROSES SAINS KIMIA PESERTA DIDIK

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Eli Rohaeti

2017-10-01

Full Text Available This research aimed to investigate the effect of PBL model on students’ analytical thinking abilities and science process skills at rate reaction. This research was quasi experimental research using posttest-only control design. The sample was consisted 2 classess, experiment class used Problem Based Learning model and control class used Direct Instruction model with a total sample of 61 students. Instruments of this research were the observation sheet for measuring science process skills and the integrated assessment instrument which involved two indicators, analytical thinking abilities and science process skills. The result of this study shows that PBL model can increase students’ analytical thinking abilities and science process skills. The mean of posttest analytical thinking abilities and science process skills in experiment class is better than control class. The result of the statistic tests using ancova analysis shows that significance 0.000 < 0.05 at 5% significance level, so there’s effect of the using of PBL model on students’ analytical thinking abilities and science process skills. Abstrak Penelitian ini bertujuan untuk menguji pengaruh model PBL terhadap kemampuan berpikir analitis dan keterampilan proses sains kimia peserta didik pada materi laju reaksi menggunakan instrumen penilaian terintegrasi. Jenis penelitian ini adalah penelitian eksperimen semu. Desain penelitian yang digunakan, yaitu posttest control group design. Sampel dalam penelitian ini sebanyak 61 peserta didik yang dibagi dalam dua kelas, yaitu kelas eksperimen dan kelas kontrol. Kelas eksperimen menggunakan model Problem Based Learning, sedangkan kelas kontrol menggunakan model Direct Instruction. Instrumen yang digunakan dalam penelitian, yaitu lembar observasi untuk mengukur keterampilan proses sains kimia dan instrumen penilaian terintegrasi yang mencakup indikator kemampuan berpikir analitis dan keterampilan proses sains kimia peserta didik. Hasil

A presença de retocele interfere nos resultados de exames de fisiologia anal? Rectocele influences results of anal physiological examinations?

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Maria Auxiliadora Prolungatti Cesar

2008-09-01

Full Text Available INTRODUÇÃO: A retocele é causa comum de constipação por defecação obstruída. Freqüentemente está relacionada com outras causas de defecação obstruída, e os exames de fisiologia anal são importantes para o diagnóstico preciso da causa de constipação intestinal. OBJETIVO: observar a influência da retocele nos exames de fisiologia anal, e a necessidade da realização desses após o diagnóstico da retocele. MÉTODO: Para este trabalho foram estudados 40 pacientes com diagnóstico de defecação obstruída. Todos os pacientes foram submetidos aos exames de manometria, sensibilidade retal, eletromiografia, latência do nervo pudendo e proctografia, e foram separados em 2 grupos: portadores e não portadores de retocele . Foram encontrados 18 pacientes com retocele, e o diagnóstico mais freqüentemente associado foi o anismus . Em relação aos exames foi encontrada diferença significante apenas na proctografia no ângulo ano retal, demonstrando que a presença de retocele não interferiu nos resultados de exames de fisiologia anal quando comparados com outros constipados, mas esteve associada a outras causas de constipação, como anismus que necessita de outro tipo de tratamento. CONCLUSÃO: A retocele não interferiu nos valores dos exames de fisiologia anal, mas esteve associada a outros diagnósticos, sendo importante a realização dos mesmos.INTRODUCTION: Rectocele is a common cause of constipation for obstructed defecation. It often is related with other causes of outlet obstruction and the examinations of anal physiology tests are important for necessary diagnosis of the constipation cause. OBJECTIVE: To observe the influence of rectocele in the anal physiology tests and the necessity of its accomplishment to the diagnosis of rectocele. METHOD: In this study, 40 patients with diagnosis of outlet obstruction had been analyzed. All the patients had been submitted to manometry, rectal sensitivity, electromyography, pudendal

Anal canal plasmacytoma - An uncommon presentation site

International Nuclear Information System (INIS)

Antunes, M. I.; Bujor, L.; Grillo, I. M.

2011-01-01

Background: Extramedullary plasmacytomas (EMP) are rare plasma cell tumors that arise outside the bone marrow. They are most often located in the head and neck region, but may also occur in the other locations. The lower gastrointestinal EMP represents less than 5% of all cases, and location in the anal canal is exceedingly rare. Aim: We present an exceedingly rare case of anal canal plasmacytoma, aiming to achieve a better understanding of this rare entity. Methods: We report a case of a 61-year-old man with a bulky mass in the anal canal. The lesion measured about 6 cm and invaded in all layers of the anal canal wall. The biopsy was performed and revealed a round and plasmocitoid cell population with a solid growth pattern and necrosis. The tumoral cells have express CD79a and CD138 with lambda chains. There was no evidence of disease in other locations and these features were consistent with the diagnosis of an extra-osseous plasmacytoma. The patient was submitted to conformal radiotherapy 50.4 Gy total dose, 1.8 Gy per fraction. After 24 months, the patient is asymptomatic and the lesion has completely disappeared. Conclusions: EMP accounts for approximately 3% of plasma cell malignancies. The median age is about 60 years, and the majority of patients are male. The treatment of choice for extramedullary plasmacytoma is radiation therapy in a dosage of about 50 Gy. Patients should be followed-up for life with repeated bone marrow aspiration and protein studies to detect the development of multiple myeloma. (authors)

Initial prevalence of anal human papilloma virus infection in liver transplant recipients.

Science.gov (United States)

Grąt, Michał; Grąt, Karolina; Hołówko, Wacław; Malejczyk, Magdalena; Walter de Walthoffen, Szymon; Lewandowski, Zbigniew; Kobryń, Konrad; Patkowski, Waldemar; Majewski, Sławomir; Młynarczyk, Grażyna; Krawczyk, Marek

2014-08-01

Although liver transplant recipients are at increased risk of human papilloma virus (HPV)-related anal cancer, limited data are available regarding the initial prevalence of anal HPV infection in this population. Anal swabs collected from 50 liver transplant recipients within the first three postoperative weeks were subjected to real-time polymerase chain reaction for detection of the four HPV genotypes: 6, 11, 16, and 18. Predictors of any, low-risk, and high-risk anal HPV infection were evaluated. Overall, the prevalence of any anal HPV infection was 18.0%, with the corresponding rates for high- and low-risk HPV genotypes being 8.0% and 10.0%, respectively. Infection with any type of anal HPV was higher in patients with hepatitis B virus (HBV) infection (P = 0.027), ≥3 sexual partners (P = 0.031), and alcoholic liver disease (P = 0.063). HBV infection was the only factor significantly associated with high-risk HPV infection (P = 0.038). Male sex (P = 0.050), age ≥52 years (P = 0.016), ≥30 sexual partners (P = 0.003), age at first intercourse ≤18 years (P = 0.045), and time since first intercourse ≥38 years (P = 0.012) were identified as predictors of low-risk HPV infection. These results indicate that HPV vaccination of liver transplant candidates and screening for anal HPV infection in high-risk groups should be considered. © 2014 Steunstichting ESOT.

Anal endosonographic findings in women after vaginal delivery

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Kolodziejczak, Malgorzata [Department of Proctology, Hospital at Solec, Warsaw (Poland); Sudol-Szopinska, Iwona, E-mail: iwsud@ciop.pl [Department of Proctology, Hospital at Solec, Warsaw (Poland); Department of Diagnostic Imaging, Second Faculty of Warsaw Medical University, Warsaw (Poland); Stefanski, Robert [Department of Proctology, Hospital at Solec, Warsaw (Poland); Department of Diagnostic Imaging, Second Faculty of Warsaw Medical University, Warsaw (Poland); Panorska, Anna K. [Department of Mathematics and Statistics, University of Nevada, Reno (United States); Gardyszewska, Agnieszka [Second Clinic of Obstetrics and Gynecology, Warsaw (Poland); Krasnodebski, Ireneusz [Department of General and Gastroenterological Surgery and Nutrition, Medical University, Warsaw (Poland)

2011-04-15

Objective: To estimate a frequency of obstetric anal sphincters defects in women after vaginal delivery. Methods: The study included 102 women, aged from 16 to 40 years (mean age 28.6 years). 28 women had perineal lacerations of 3rd and 4th degree. 22 women had instrumental delivery. Anal endosonography was performed on all participants using BK Medical scanner Pro focus with a 3D endoprobe during the first week after delivery. Starck's classification was used to score sphincters defects. Results: The endosonographic images were abnormal in 8 out of 102 women (7.8%). Follow-up examinations after 6 weeks confirmed defects in 6 out of 102 women (5.8%). Five women had external anal sphincter torn, and 1 woman had both sphincters, internal and external, defected. Discordance between endosonographic diagnosis of defect and clinical assessment of sphincters continuity was demonstrated in 6 (5.9%) out of 8 initially found, including 2 (1.9%) false endosonographic results and 4 (3.9%) false clinical diagnosis (occult sphincter defects). The endosonography sensitivity and accuracy in sphincter defect diagnostic amounted to 100% and 98%, respectively. Conclusions: (1) Anal sphincters' tears in symptomatic women are not as frequent as it was believed. (2) The defect diagnosis in the first week after delivery should be verified by a follow-up endosonography in 6 weeks, after regression of the edema and hematoma.

Oral and anal sex practices among high school youth in Addis Ababa, Ethiopia

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Cherie Amsale

2012-01-01

Full Text Available Abstract Background Understanding the full range of sexual behaviors of young people is crucial in developing appropriate interventions to prevent and control sexually transmitted infections including HIV. However, such information is meager in developing countries. The objective of this study was to describe oral and anal sex practices and identify associated factors among high school youth. Methods A cross-sectional study was conducted among high school youth in Addis Ababa, Ethiopia. A multi-stage sampling procedure was followed to select a representative sample of school youth. The total sample size for this study was 3840. Data were collected using a self-administered questionnaire. Data analysis was guided by the ecological framework. Results The overall proportion of people who reported ever having oral sex was 5.4% (190 and that of anal sex was 4.3% (154. Of these 51.6% (98 had oral sex and 57.1% (87 had anal sex in the past 12 months. Multiple partnerships were reported by 61.2% of the respondents who had oral sex and 51.1% of students practicing anal sex. Consistent condom use was reported by 12.2% of those practicing oral sex and 26.1% of anal sex. Reasons for oral and anal sex included prevention of pregnancy, preserving virginity, and reduction of HIV and STIs transmission. Oral sex practice was strongly and significantly associated with perception of best friends engagement in oral sex (AOR = 5.7; 95% CI 3.6-11.2 and having illiterate mothers (AOR = 11.5; 95%CI 6.4-18.5. Similarly, anal sex practice was strongly and significantly associated with favorable attitude towards anal sex (AOR = 6.2; 95%CI 3.8-12.4, and perceived best friends engagement in anal sex (AOR = 9.7; 95%CI 5.4-17.7. Conclusion Considerable proportion of adolescents had engaged in oral and anal sex practices. Multiple sexual partnerships were common while consistent condom use was low. Sexual health education and behavior change communication strategies need to

Correlates of unprotected anal intercourse: the influence of anal sex position among men who have sex with men in Beijing, china.

Science.gov (United States)

Zhang, Heng; Lu, Hongyan; Pan, Stephen W; Xia, Dongyan; Zhao, Yuejuan; Xiao, Yan; He, Xiong; Yue, Hai; Sun, Zheya; Xu, Yunan; Ruan, Yuhua; Shao, Yiming

2015-02-01

Understanding barriers to consistent condom use among men who have sex with men (MSM) requires consideration of the context in which risk behaviors occur. Anal sex position is one such context. This pooled cross-sectional study used survey data from 1,230 MSM and their 2,618 reported male sexual partnerships. Overall, nearly half of the participants engaged in unprotected anal intercourse (UAI) with at least one of upto three partners in the past 6 months. "Insertive" men engaged in less UAI (39 %) than "receptive" (53 %) or "versatile" (51 %) men. Regardless of sexual position, UAI was associated with cohabiting with a male or female partner and perceiving great or moderate risk of HIV from male contact at the individual level, and steady (vs. casual) partnership at the dyad level. However, early MSM anal sex debut, high number of male partners, alcohol use, receiving and buying condoms, HIV testing, and MSM sex-seeking venues were found to be only statistically significantly correlated with UAI among some but not all sexual positions, implying that interventions to increase condom use should take into account how anal sex position may influence willingness and ability to engage in safer sex. Dyad level data appear to provide additional insight into the influence of sexual positions, and should be used to complement individual data for future intervention designs.

Samatähenduslike sünteetiliste ja analüütiliste verbide kasutamine

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Pille Eslon

2015-10-01

Full Text Available Huvi samatähenduslike sünteetiliste ja analüütiliste verbide vastu tekkis artikli esimesel autoril vene-eesti-vene tõlkesõnastikke toimetades, kui silma hakkasid regulaarsed valikud vene verbi grammatilise aspekti ning eesti keele sünteetiliste ja analüütiliste verbide vahel. Kuigi tegu on raskesti märgatava ja sugugi mitte sagedase nähtusega, tekitab see küsimusi: millal eelistab emakeelekõneleja kasutada sünteetilist, millal analüütilist verbi; kas lisaks samatähenduslikkusele ja vormilisele lihtsusele (sünteetiline verb koosneb ühest komponendist või keerukusele (analüütiline verb vähemalt kahest komponendist on veel tunnuseid, mis sünteetilise ja analüütilise verbi valikuid piiravad. Käesoleva uurimuse eesmärk on leida nendele küsimustele vastuseid. Analüüsitakse viit samatähendusliku sünteetilise ja analüütilise verbi paari (igatsema – igatsust tundma, lahkuma – ära minema, nõustuma – nõus olema, muretsema – muret tundma, töötama – tööd tegema, otsitakse mõlema verbi kasutusele omaseid keelestruktuure, analüüsitakse nende leksikaalsemantilise ja morfosüntaktilise varieerumise piire, võrreldakse verbide tähendusi. Nende tunnuste põhjal saab teha mõningaid järeldusi selle kohta, kas tegu võiks olla ühe verbi kahe vormiga või kahe erineva verbiga. Uurimuse empiiriline aspekt on seotud hüpoteesiga semantiliselt lähedaste sünteetiliste ja analüütiliste verbide tõmbumisest, millega kaasnevad ühelt poolt struktuursed, morfoloogilised, morfosüntaktilised ja leksikaalsemantilised kasutuspiirangud ning teisalt vaba varieerumine. Sisuliselt vastandlikud tendentsid – kinnistumine ja varieerumine – toimivad keele leksikaalgrammatilises perifeerias sama eesmärgi nimel, tagades keele pideva uuenemise ja säilimise.

Cause-Specific Colostomy Rates After Radiotherapy for Anal Cancer: A Danish Multicentre Cohort Study

DEFF Research Database (Denmark)

Sunesen, Kåre G; Nørgaard, Mette; Lundby, Lilli

2011-01-01

In anal cancer, colostomy-free survival is a measure of anal sphincter preservation after treatment with radiotherapy or chemoradiotherapy. Failure to control anal cancer and complications of treatment are alternative indications for colostomy. However, no data exist on cause-specific colostomy...

The Danish anal sphincter rupture questionnaire: Validity and reliability

DEFF Research Database (Denmark)

Due, Ulla; Ottesen, Marianne

2008-01-01

Objective. To revise, validate and test for reliability an anal sphincter rupture questionnaire in relation to construct, content and face validity. Setting and background. Since 1996 women with anal sphincter rupture (ASR) at one of the public university hospitals in Copenhagen, Denmark have been...... main questions but one. Two questions needed further explanation. Seven women made minor errors. Conclusion. The validated Danish questionnaire has a good construct, content and face validity. It is a well accepted, reliable, simple and clinically relevant screening tool. It reveals physical problems...... offered pelvic floor muscle examination and instruction by a specialist physiotherapist. In relation to that, a non-validated questionnaire about anal and urinary incontinence was to be answered six months after childbirth. Method. The original questionnaire was revised and a pilot test was performed...

Thyroid carcinoma: The experience at the Oncology Centre in Nicosia, Cyprus

International Nuclear Information System (INIS)

Frangos, S.; Petrou, M.; Katodritis, N.

2004-01-01

Full text: Carcinoma of the thyroid is usually of follicular cell origin. Four distinct histologic types of follicular cell-derived cancers (FCDC) are recognized. The majority of cases are papillary, with its major sub-type being the follicular variant (FVPTC). The other histological types are follicular, oxyphilic or Hurthle cell, and anaplastic. Each tumour type differs substantially in its initial mode of spread and subsequent pattern of recurrence and metastatic involvement. Although thyroid nodules are extremely common but clinically recognized thyroid carcinomas constitute less than 1% of all human malignant tumours. The annual incidence of thyroid cancer varies worldwide from 0.5 to 10 per 100000 population. In Cyprus, in the year 2000, there were 41 registered cases of newly diagnosed thyroid carcinoma (medullary excluded) in the Cancer Archive. This is an incidence of 5.6 per 100000. A Bank of Cyprus Oncology Center (BOCOC) was established in 1998 and very soon became the referral hospital for oncological patients in Cyprus. The thyroid clinic of the center was also established in that year which in collaboration with the NM department of the Nicosia General Hospital provided follow-up services to thyroid cancer patients. The Nuclear Medicine Department of the BOCOC was established on 1 July 2001 and since then the radioiodine therapy and follow-up thyroid carcinoma patients is done in this center. The patients are referred to the clinic after surgery and confirmed diagnosis of Thyroid Cancer. A total of 34 patients (5 males 29 females, age range 20-79 years) of thyroid carcinoma (medullary excluded) visited the clinic between July 2001 and July 2003. The histopathological form was 32 papillary and 2 follicular thyroid carcinoma. Of the 32 papillary 2 were metastatic, 4 papillary with follicular elements, 1 with papillary at the isthmus and follicular in right lobe and 1 papillary in the thyroglossal cyst. Preoperative diagnosis in most of the patients was

[Detection and analysis of the characteristic expression of microRNAs of anal fistula patients].

Science.gov (United States)

Qiu, Jianming; Yu, Jiping; Yang, Guangen; Xu, Kan; Tao, Yong; Lin, Ali; Wang, Dong

2016-07-01

To detect and analyze the characteristic miRNAs profile of anal fistula and explore their possible target genes and potential clinical significance. The anal mucosa close to the hemorrhoids were collected from three patients undergoing fistulectomy and hemorrhoidectomy (fistula group) as well as three patients receiving only hemorroidectomy(hemorrhoids group), matching with fistula group in age, gender and body weight. miRNA microarray was used to compare the expression of 1 285 human miRNAs of the anal mucosa between two groups. Cluster analysis was adopted to analyze the accumulation of the differentially expressed miRNAs(Pcharacteristic miRNAs profile in anal fistula patients, which may play a role in the occurrence and development of anal fistula.

Tunni analüüs - mis see on? / Peep Leppik

Index Scriptorium Estoniae

Leppik, Peep

2001-01-01

Tunni analüüs, õppe-kasvatustöö eesmärgid. Tunni analüüs on hinnangu andmine protsessidele, mille kutsub esile õpetaja tegevus (või tegevusetus) tunnis. Tunni läbiviimise protsessi mõjutavad õpilaste koosseis klassis, erinevate õppevormide ja õppemeetodite kasutamine, kasutatud õppevõtete otstarbekus, erinevad metoodikad ja õppesüsteemid

HPV and anal cancer in HIV-infected individuals: a review

NARCIS (Netherlands)

Schim van der Loeff, Maarten F.; Mooij, Sofie H.; Richel, Oliver; de Vries, Henry J. C.; Prins, Jan M.

2014-01-01

HIV infection is one of the strongest risk factors for anal squamous cell cancer (ASCC). Most ASCC are caused by HPV, and most HPV-associated ASCC are caused by HPV-16. Anal HPV infections are very common in men who have sex with men (MSM), and nearly universal among HIV-infected MSM. High-grade

Candidíase vulvovaginal: sintomatologia, fatores de risco e colonização anal concomitante Vulvovaginal candidiasis: symptomatology, risk factors and concomitant anal colonization

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Antônio Arildo Reginaldo de Holanda

2007-01-01

Full Text Available OBJETIVO: analisar pacientes com candidíase vulvovaginal quanto a sintomatologia, fatores de risco e resultados da cultura anal, identificar a freqüência de Candida albicans e não C. albicans e correlacionar as colonizações anal e vaginal. MÉTODOS: foram incluídas 99 pacientes com suspeita clínica de candidiase vulvovaginal, procedentes de Natal, RN, atendidas entre maio de 2003 e maio de 2005, perfazendo-se o total de 294 coletas. O material clínico, colhido por zaragatoas, foi semeado em CHROMagar Candida®. As leveduras foram identificadas pelo método clássico, além da prova de crescimento a 42 e 45ºC e da prova do caldo Sabouraud hipertônico. A sintomatologia, fatores de risco e colonização anal foram analisados de acordo com a positividade ou negatividade para Candida spp. As culturas positivas para C. albicans nos dois sítios foram comparadas com outros resultados encontrados. Para análise estatística utilizou-se o teste do chi2, com correção de Yates e o teste exato de Fisher. RESULTADOS: a espécie mais frequente foi C. albicans em 69% dos casos. Uso de roupas íntimas justas e/ou sintéticas, presença de doenças alérgicas, ocorrência de prurido, leucorréia e hiperemia apresentaram associação com a positividade vaginal para Candida spp. A chance de uma paciente com colonização anal positiva de apresentar positividade vaginal concomitante foi 2,8 e 4,9 vezes maior, respectivamente, para Candida spp e C. albicans. A chance de uma paciente com cultura anal positiva para C. albicans de apresentar resultado vaginal positivo foi 3,7 vezes maior quando comparada a espécies não C. albicans. CONCLUSÕES: C. albicans foi a espécie mais comum, tendo sido observada associação da positividade vaginal para Candida spp com uso de roupas justas e/ou sintéticas, doenças alérgicas, prurido, leucorréia e eritema (pPURPOSE: to analyze patients with vulvovaginal candidiasis with respect to risk factors, symptomatology

The anal canal as a risk organ in cervical cancer patients with hemorrhoids undergoing whole pelvic radiotherapy.

Science.gov (United States)

Jang, Hyunsoo; Baek, Jong Geun; Jo, Sunmi

2015-01-01

Tolerance of the anal canal tends to be ignored in patients with cervical cancer undergoing whole pelvic radiotherapy. However, patients with hemorrhoids may be troubled with low radiation dose. We tried to analyze the dose-volume statistics of the anal canal in patients undergoing whole pelvic radiotherapy. The records of 31 patients with cervical cancer who received definite or postoperative radiotherapy at one institution were reviewed. Acute anal symptoms, such as anal pain and bleeding, were evaluated from radiotherapy start to 1 month after radiotherapy completion. Various clinical and dosimetric factors were analyzed to characterize relations with acute anal complications. The anal verge was located an average of 1.2 cm (range -0.6~3.9) below the lower border of the ischial tuberosity and an average of 2.7 cm (range -0.6~5.7) behind the sacral promontory level. The presence of hemorrhoids before radiotherapy was found to be significantly associated with acute radiation-induced anal symptoms (p = 0.001), and the mean induction dose for anal symptoms was 36.9 Gy. No patient without hemorrhoids developed an anal symptom during radiotherapy. Dosimetric analyses of V30 and V40 showed marginal correlations with anal symptoms (p = 0.07). The present study suggests a relation between acute anal symptoms following radiotherapy and acute hemorrhoid aggravation. Furthermore, the location of the anal verge was found to be variable, and consequently doses administered to the anal canal also varied substantially. Our results caution careful radiation treatment planning for whole pelvic radiotherapy, and that proper clinical management be afforded patients with hemorrhoids during radiotherapy.

Anal HPV infection in HIV-positive men who have sex with men from China.

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Lei Gao

Full Text Available BACKGROUND: Anal HPV infection, which contributes to the development of anal warts and anal cancer, is well known to be common among men who have sex with men (MSM, especially among those HIV positives. However, HIV and anal HPV co-infection among MSM has not been addressed in China. METHODS: A cross-sectional study was conducted in Beijing and Tianjin, China. Study participants were recruited using multiple methods with the collaboration of local volunteer organizations. Blood and anal swabs were collected for HIV-1 serological test and HPV genotyping. RESULTS: A total of 602 MSM were recruited and laboratory data were available for 578 of them (96.0%. HIV and anal HPV prevalence were 8.5% and 62.1%, respectively. And 48 MSM (8.3% were found to be co-infected. The HPV genotypes identified most frequently were HPV06 (19.6%, HPV16 (13.0%, HPV52 (8.5% and HPV11 (7.6%. Different modes of HPV genotypes distribution were observed with respect to HIV status. A strong dose-response relationship was found between HIV seropositivity and multiplicity of HPV genotypes (p<0.001, which is consistent with the observation that anal HPV infection was an independent predictor for HIV infection. CONCLUSIONS: A high prevalence of HIV and anal HPV co-infection was observed in the MSM community in Beijing and Tianjin, China. Anal HPV infection was found to be independently associated with increased HIV seropositivity, which suggests the application of HPV vaccine might be a potential strategy to reduce the acquisition of HIV infection though controlling the prevalence of HPV.

HIV-positive MSM's knowledge of HPV and anal cancer self-sampling: A scoping review.

Science.gov (United States)

Poon, M K L; Wong, J P H; Li, A T W; Manuba, M; Bisignano, A; Owino, M; Vahabi, M

2018-02-01

Human papillomavirus (hpv) infection is the cause of anal squamous cell cancer (ascc) in 80% of cases. Available research has also shown high prevalence of anal hpv infection among men who have sex with men (msm). However, hpv vaccination is low among msm in Canada. In light of this information, we conducted a scoping review with the aim of exploring (1) the knowledge of hpv and anal cancer among hiv-positive msm and (2) the acceptability of hpv and anal cancer self-sampling in this population. In conducting the review, we searched five electronic databases for peer-reviewed articles and abstracts published in English, between 2007 and 2017. A total of 803 articles were retrieved; after accounting for duplicates ( n= 40) and unmet criteria ( n= 754), a total of 794 articles were excluded. A final total of nine articles were used in this review. Results of this review show that hiv-positive msm have limited knowledge regarding the risks of anal cancer associated with hiv and hpv coinfection. Furthermore, there is limited research on hpv and anal cancer self-sampling in this population. However, the review of available studies suggested that hiv-positive msm were open to anal cancer self-sampling. It also identified potential barriers to self-sampling. In conclusion, we provide suggestions and future directions for policy-makers and educators to develop inclusive and accessible strategies to reach hiv-positive msm regarding anal cancer education and self-screening.

Hereditary internal anal sphincter myopathy causing proctalgia fugax and constipation. A newly identified condition.

Science.gov (United States)

Kamm, M A; Hoyle, C H; Burleigh, D E; Law, P J; Swash, M; Martin, J E; Nicholls, R J; Northover, J M

1991-03-01

A newly identified myopathy of the internal anal sphincter is described. In the affected family, at least one member from each of five generations had severe proctalgia fugax; onset was usually in the third to fifth decades of life. Three members of the family have been studied in detail. Each had severe pain intermittently during the day and hourly during the night. Constipation was an associated symptom, in particular difficulty with rectal evacuation. Clinically the internal anal sphincter was thickened and of decreased compliance. The maximum anal canal pressure was usually increased with marked ultraslow wave activity. Anal endosonography confirmed a grossly thickened internal anal sphincter. Two patients were treated by internal anal sphincter strip myectomy; one showed marked improvement and one was relieved of the constipation but had only slight improvement of the pain. The hypertrophied muscle in two of the patients showed unique myopathic changes, consisting of vacuolar changes with periodic acid-Schiff-positive polyglycosan bodies in the smooth muscle fibers and increased endomysial fibrosis. In vitro organ-bath studies showed insensitivity of the muscle to noradrenaline, isoprenaline, carbachol, dimethylpiperazinium, and electrical-field stimulation. Immunohistochemical studies for substance P, calcitonin gene-related peptide, galanin, neuropeptide Y, and vasoactive intestinal peptide showed staining in a similar distribution to that in control tissue. A specific autosomal-dominant inherited myopathy of the internal anal sphincter that causes anal pain and constipation has been identified and characterized.

Should anorectal ultrasonography be included as a diagnostic tool for chronic anal pain?

Science.gov (United States)

García-Montes, M J; Argüelles-Arias, Federico; Jiménez-Contreras, S; Sánchez-Gey, S; Pellicer-Bautista, F; Herrerías-Gutiérrez, J M

2010-01-01

To assess the efficiency of endorectal ultrasound (ERUS) in the study of chronic idiopathic anal pain (CIAP). This is a prospective and descriptive study in which 40 patients, 18 men and 22 women with an average of 47 years, were included. They had chronic anal pain of at least 3 months duration. A complete colonoscopy was performed in all patients, which found no abnormalities to explain clinical symptoms. Patients with anal fissure and internal hemorrhoids of any degree, perianal suppurative processes, and pelvic surgery were excluded from the study. An ALOKA ProSound SSD-4000 ultrasound console attached to a multifrequency radial transductor ASU-67 (7.5 and 10 MHz) was used. One patient could not tolerate the examination. In 8 patients (20% of cases) alterations were detected during ultrasonography: in 4 patients (10% of the cases; 1 man and 3 women) internal anal sphincter (IAS) hypertrophy, and in 5 patients (4 women and 1 man) a torn sphincter complex. A tear in the upper IAS canal and hypertrophy of the middle anal canal were observed in one patient (1 woman). ERUS is a simple, economic and useful test to study anorectal pathologies. Although in most studied cases no damage to the anal canal or rectal wall was detected, in a considerable number of patients we observed a thickening of the IAS, a probable cause of anal pain. Therefore, we understand that ERUS should be included in the study of CIAP.

Chronic effects of therapeutic irradiation for localized prostatic carcinoma on anorectal function

International Nuclear Information System (INIS)

Yeoh, Eric E.K.; Botten, Rochelle; Russo, Antonietta; McGowan, Roz; Fraser, Robert; Roos, Daniel; Penniment, Michael; Borg, Martin; Sun Weiming

2000-01-01

Purpose: To evaluate prospectively the prevalence and pathophysiology of anorectal dysfunction following radiation therapy (RTH) for localized carcinoma of the prostate. Methods and Materials: The following parameters of anorectal function were evaluated in each of 35 patients (aged 55-82 years) with localized prostatic carcinoma treated with RTH either to a dose of 55 Gy/20 fractions/4 weeks (18 patients) or 64 Gy/32 fractions/6.5 weeks (17 patients), before RTH and 4-6 weeks and at a mean (± SD) of 1.4 (± 0.2) years after its completion: (1) anorectal symptoms (questionnaire), (2) anorectal pressures at rest and in response to voluntary squeeze and increases in intra-abdominal pressure (multiport anorectal manometry), (3) rectal sensation (balloon distension) and (4) anal sphincteric morphology (endoanal ultrasound). Results: All but 1 patient completed three series of measurements. RTH had no effect on anal sphincteric morphology. The increase in frequency of defecation and fecal urgency and incontinence scores previously reported in the patients 4-6 weeks after RTH were sustained 1 year later (p < 0.001, p < 0.001, and p < 0.05, cf. baseline, respectively). At this time, 56% (19 of 34), 50% (17 of 34) and 26% (9 of 34) of the patients had increased frequency of defecation, fecal urgency, and incontinence, respectively. Decreases in anal sphincteric pressures at rest and in response to voluntary squeeze recorded in the patients 4-6 weeks after RTH were not sustained 1 year later but the volumes of rectal distension associated with perception of the stimulus and desire to defecate were lower compared with baseline volumes (p < 0.01 and p < 0.05, respectively), reflecting heightened rectal sensitivity in the patients. There was no difference in measurements between the two radiation dose regimens. Univariate logistical regression analysis was performed on patients who had experienced increased symptom scores or decreases in recorded motor and sensory manometric

Treatment Outcome of Carcinoma Vulva Ten-Year Experience from a Tertiary Cancer Centre in South India.

Science.gov (United States)

Jeevarajan, Sakthiushadevi; Duraipandian, Amudhan; Kottayasamy Seenivasagam, Rajkumar; Shanmugam, Subbiah; Ramamurthy, Rajaraman

2017-01-01

Carcinoma vulva is a rare disease accounting for 1.3% of all gynaecological malignancies. The present study is a 10-year retrospective review of our experience of the surgical options, morbidity, failure pattern, and survival for invasive carcinoma vulva. Retrospective analysis of case records of 39 patients who underwent surgery for invasive vulval cancer between 2004 and 2013 in the Department of Surgical Oncology at the Government Royapettah Hospital, Chennai. The median age was 55 years. Radical vulvectomy was the preferred surgery. 31 patients underwent lymphadenectomy. Seroma formation and groin skin necrosis were the most common postoperative complications. With a median follow-up of 32 months, 8 patients (20.5%) developed recurrence (systemic = 1, regional = 4, and local = 3). The estimated 5-year disease-free survival (DFS) was 65.4% and the overall survival (OS) was 85.1%. On univariate analysis, stage and lymph node involvement significantly affected OS. Nodal involvement with extracapsular spread (ECS) significantly affected both DFS and OS. The treatment of carcinoma vulva should be individualized with multidisciplinary cooperation. The paucity of data, especially from India, necessitates the need for more studies, preferably multicentric, keeping in mind the low prevalence.

Restorative proctocolectomy with ileal pouch-anal anastomosis in 203 patients: the Auckland experience.

Science.gov (United States)

Neilly, P; Neill, M E; Hill, G L

1999-01-01

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become an established operation for patients with ulcerative colitis and familial adenomatous polyposis (FAP). The results of a 15-year experience with IPAA are reported. Between September 1982 and June 1997, 203 patients had IPAA surgery. From a review of the charts, data were collected on the surgical procedure, the diagnosis and early and late complications. Pouch function was assessed by means of a postal questionnaire. Of the 201 patients (median age of 32 years; 89 women) with complete records, 122 had J pouches, 65 had W pouches and 14 S pouches were constructed. The pre-operative diagnosis in 88% was ulcerative colitis and in 10% it was FAP. During a median follow-up time of 6.1 years the diagnoses were changed for 8% of the patients; in 4% the diagnosis was changed to Crohn's disease. The overall mortality was 1.5% (early = 2, late = 1). The overall morbidity was 62% (early = 17%, late = 52%). The pouch was removed or was non-functional in 9%. All patients with a final diagnosis of Crohn's disease have had their pouch excised. The median stool frequency was 4.0 (range 1.3-8.7) during the day, and 0.7 (range 0-2.1) during the night. The fewer night-time stools (J = 1.0+/-0.6; W = 0.4+/-0.5 P requirement of the W-pouch patients for anti-diarrhoeals (P = 0.004) were offset by the need for two W-pouch patients to pass a catheter to empty their pouches. The type of patients who present for IPAA surgery and the outcomes observed in this series of Auckland patients are similar to those reported from major centres elsewhere.

Carcinoma of female urethra. Manitoba experience: 1958-1987

International Nuclear Information System (INIS)

Hahn, P.; Krepart, G.; Malaker, K.

1991-01-01

Fourteen female patients with primary urethral carcinoma were treated at the Manitoba Cancer Foundation in the last twenty-nine years. The relationship of natural history to the stage, location, and therapeutic modality has been reviewed. A higher stage and length of urethral involvement affected prognosis negatively, whereas lower stage had a positive prognostic effect and location of tumor had no prognostic influence. Two patients with Stage C, who failed to received inguinal node radiotherapy, died of disease recurring in the inguinal area. Patients who received inguinal radiation (3 patients Stages B, C, and D1) had no regional recurrence. It is suggested that, for all female urethral carcinoma, bilateral ilioinguinal nodes be included in the radiation field. For radical treatment, iridium 192 insertion in combination with external beam treatment is recommended

ESTUDIOS MACRO Y MICROSCOPICO DEL SACO ANAL DEL COIPO (Myocastor coypus)

OpenAIRE

Rafasquino, Marta E.; Ramos, Pablo A.; Alonso, Cristina R.; Idiart, Julio R.

1998-01-01

RESUMEN:Fue realizada la disección del saco anal de 44 coipos, de ambos sexos, de distintas edades y procedencias, observándose algunas características similares a los sacos anales del perro y gato, aunque es impar y está ubicado en ventral del ano. Es ovoídeo o piriforme, siendo más grande en los adultos y, entre éstos, más aún en los machos que en las hembras; posee un conducto que desemboca en el canal anal a un centímetro del ano y que se exterioriza en el momento de secretar el producto ...

Testing for and the role of anal and rectal sensation.

Science.gov (United States)

Rogers, J

1992-03-01

The rectum is insensitive to stimuli capable of causing pain and other sensations when applied to a somatic cutaneous surface. It is, however, sensitive to distension by an experimental balloon introduced through the anus, though it is not known whether it is the stretching or reflex contraction of the gut wall, or the distortion of the mesentery and adjacent structures which induces the sensation. No specific sensory receptors are seen on careful histological examination of the rectum in humans. However, myelinated and non-myelinated nerve fibres are seen adjacent to the rectal mucosa, but no intraepithelial fibres arise from these. The sensation of rectal distension travels with the parasympathetic system to S2, S3 and S4. The two main methods for quantifying rectal sensation are rectal balloon distension and mucosal electrosensitivity. The balloon is progressively distended until particular sensations are perceived by the patient. The volumes at which these sensations are perceived are recorded. Three sensory thresholds are usually defined: constant sensation of fullness, urge to defecate, and maximum tolerated volume. The modalities of anal sensation can be precisely defined. Touch, pain and temperature sensation exist in normal subjects. There is profuse innervation of the anal canal with a variety of specialized sensory nerve endings: Meissner's corpuscles which record touch sensation, Krause end-bulbs which respond to thermal stimuli, Golgi-Mazzoni bodies and pacinian corpuscles which respond to changes in tension and pressure, and genital corpuscles which respond to friction. In addition, there are large diameter free nerve endings within the epithelium. The nerve pathway for anal canal sensation is via the inferior haemorrhoidal branches of the pudendal nerve to the sacral roots of S2, S3 and S4. Anal sensation may be quantitatively measured in response to electrical stimulation. The technique involves the use of a specialized constant current generator

Should anorectal ultrasonography be included as a diagnostic tool for chronic anal pain?

Directory of Open Access Journals (Sweden)

M. J. García-Montes

Full Text Available Objective: to assess the efficiency of endorectal ultrasound (ERUS in the study of chronic idiopathic anal pain (CIAP. Material and method: this is a prospective and descriptive study in which 40 patients, 18 men and 22 women with an average of 47 years, were included. They had chronic anal pain of at least 3 months' duration. A complete colonoscopy was performed in all patients, which found no abnormalities to explain clinical symptoms. Patients with anal fissure and internal hemorrhoids of any degree, perianal suppurative processes, and pelvic surgery were excluded from the study. An ALOKA ProSound SSD-4000 ultrasound console attached to a multifrequency radial transductor ASU-67 (7.5 and 10 MHz was used. Results: one patient could not tolerate the examination. In 8 patients (20% of cases alterations were detected during ultrasonography: in 4 patients (10% of the cases; 1 man and 3 women internal anal sphincter (IAS hypertrophy, and in 5 patients (4 women and 1 man a torn sphincter complex. A tear in the upper IAS canal and hypertrophy of the middle anal canal were observed in one patient (1 woman. Conclusions: ERUS is a simple, economic and useful test to study anorectal pathologies. Although in most studied cases no damage to the anal canal or rectal wall was detected, in a considerable number of patients we observed a thickening of the IAS, a probable cause of anal pain. Therefore, we understand that ERUS should be included in the study of CIAP.

Phase II-trial of radiation therapy with 45 Gy, 5-fluorouracil (5-FU) and mitomycin C (MMC) in patients with anal cancer - a rationale to add regional hyperthermia?

International Nuclear Information System (INIS)

Graf, R.; Wust, P.; Gellermann, J.; Mohr, B.; Goegler, H.; Riess, H.; Felix, R.

1996-01-01

Purpose: To evaluate the effect of standard regimen of chemoradiation for anal cancer with a radiation dose of 45 Gy on survival, local control and toxicity with respect to the discussion about intensification of therapy. Assessment of prognostic factors and designing improved treatment strategies for certain risk groups. Materials and Methods: From 1987 to 1995 46 patients with localized anal cancer were eligible. Thirty-five women and 11 men with a median age of 54 years were treated according to the protocoll. Thirty-two (70%) patients had histologically a squamous cell carcinoma, 12 (26%) a cloacogenic carcinoma. Thirty-one patients (68%) had T1, T2 tumors, 15 patients (33%) had locally advanced primary tumors (T3, T4), 9 patients (20%) had N1-3 disease. Radiotherapy consisted of 30 Gy to the primary tumor and pelvic lymph nodes, followed by one week treatment break and boost to the primary tumor to a total dose of 45 Gy with a single dose of 2 Gy, mean duration of radiotherapy 44 days. 5-FU was given on days 1-5 and 29-33 as continuous infusion (800 mg/m 2 /day), MMC (10 mg/m 2 ) was given intravenously as bolus on day 1 and 29. Patients were followed for survival and local control. Toxicity was assessed using Common Toxicity Criteria and the LENT score (late effects normal tissues). The mean follow-up time was 34,4 months. Results: The cancer specific actuarial 5-year survival rate was 69%: 79% in T1, T2 and 41% in T3, T4 tumors (p = 0,03). The 5-year actuarial local control rate was 74%: 89% in T1, T2 tumors, 42% ind T3, T4 tumors (p 5 cm): p 4 cm): p = 0,04, depth of infiltration: p < 0,00, response: p < 0,00. No local control was achievable for tumors greater than 6 cm, whereas all local failures occurred when there was extrasphincteric infiltration. Conclusions: Colostomy-free survival was unsatisfactory. Depth of infiltration (extrasphincteric involvement) as well as tumor size (≥ 5 cm) has been shown as negative prognostic factor for local control

[Proctalgia fugax. Differential diagnosis and therapy of fleeting anal cramp].

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Staude, G

1992-05-30

Proctalgia fugax--short-lived anal spasm--is a common, extremely unpleasant, painful condition that occurs completely unexpectedly, often waking the victim at night. Scientific assessment is difficult on account of the functional nature of the condition and its multifactorial genesis. Before the patient is labeled "anal neurotic", however, he/she should be investigated by a specialist. The results of treating the rarely absent pathological organic findings give rise to optimism.

Assertividade e autocontrole: interpretação analítico-comportamental

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Vívian Marchezini-Cunha

Full Text Available Questões relacionadas à assertividade têm recebido atenção por parte de terapeutas comportamentais há mais de três décadas. É mais recente, porém, o esforço de terapeutas analítico-comportamentais para examinar problemas dessa ordem com os mesmos recursos conceituais e metodológicos empregados por seus pares da pesquisa básica e conceitual. O presente trabalho tem como objetivo oferecer uma interpretação analítico-comportamental para padrões de comportamento assertivos, agressivos e passivos. Recuperamos algumas definições de assertividade/agressividade/passividade e examinamos os fenômenos correspondentes enquanto relações comportamentais; discutimos alguns aspectos da abordagem analítico-comportamental para o autocontrole; e sugerimos que as relações comportamentais definidas como assertividade/agressividade/passividade podem ser interpretadas enquanto instâncias de autocontrole ou impulsividade. A abordagem pode abrir novas perspectivas de investigação clínica de habilidades sociais sob um enfoque analítico-comportamental.

Rectal necrosis following external radiation therapy for carcinoma of the prostate: report of a case

International Nuclear Information System (INIS)

Quan, S.H.Q.; O'Kelly, P.J.

1975-01-01

Increasing attention is being paid to the use of radiation therapy in the management of primary carcinoma of the prostate. Since 1965, radical radiation therapy has been used at Memorial Hospital to treat primary carcinoma of the prostate. Small primary tumors are treated by implantation with radioactive iodine ( 125 I) seeds and larger tumors considered unsuitable for implantation are treated by external supervoltage beam therapy. Fifty patients had been treated by implantation and 30 by external beam therapy at the time of this report. None of the patients treated by implantation developed rectal symptoms. Proctitis developed in all patients treated by external radiation therapy and in half the patients chronic proctitis ensued, accompanied by the passage of mucus. The constant leaking of mucus through the anal sphincter produces irritation of the skin and intermittent attacks of pruritus ani, a discomfiting sequel. Apart from the proctitis, most patients tolerated treatment well, with one notable exception, in whom rectal necrosis developed. This case is described

Correlates of anal sex roles among Malay and Chinese MSM in Kuala Lumpur, Malaysia.

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Dangerfield, Derek T; Gravitt, Patti; Rompalo, Anne M; Tai, Raymond; Lim, Sin How

2016-03-01

Identifying roles for anal sex is an important issue for populations of MSM. We describe the prevalence of identifying as being 'top', 'bottom', 'versatile', or 'don't know/not applicable' among Malay and Chinese MSM in Kuala Lumpur, Malaysia, and behavioural outcomes according to these labels for sexual role identity. Data analysis was conducted on a survey administered during weekly outreach throughout Kuala Lumpur in 2012. Pearson's Chi square tests were used to compare demographic and behavioural characteristics of MSM who reported roles for anal sex. Binary logistic regression was used to explore the odds of behavioural outcomes among MSM who identified as 'bottom', 'versatile,' and 'don't know' compared to MSM who reported that 'top' was their sexual role. Labels for anal sex roles were significantly associated with condom use for last anal sex. Among MSM who used labels for anal sex roles, MSM who identified as 'bottom' had highest level of not using condoms for last anal sex (24.1%, p = .045). In binary logistic regression model, identifying as 'top' was significantly associated with reporting using a condom during last anal sex and reported consistent condom use for anal sex in the past six months (p = .039 and .017, respectively). With regard to sexual role identity, some MSM may be a part of a special subgroup of at-risk men to be targeted. Future research should evaluate the origins, meanings, and perceptions of these labels, and the developmental process of how these MSM identify with any of these categories. Research should also uncover condom use decision making with regard to these labels for sexual positioning. © The Author(s) 2016.

Anal canal duplication and triplication: a rare entity with different presentations.

Science.gov (United States)

Palazon, P; Julia, V; Saura, L; de Haro, I; Bejarano, M; Rovira, C; Tarrado, X

2017-05-01

Anal canal duplication (ACD) is the rarest of gastrointestinal duplications. Few cases have been reported. Most cases present as an opening in the midline, posterior to the normal anus. The aim of our revision is to contribute with eight new cases, some of them with unusual presentations: five presented as the typical form, one with a perianal nodule, and two presented as two separate orifices (anal canal triplication). Complete excision was performed in all patients with no complications. ACD is the most distal and the least frequent digestive duplication. Its treatment should be surgical excision, to avoid complications such as abscess, fistulization, or malignization. Anal canal triplication has never been described before.

[Usefulness of human papillomavirus testing in anal intraepithelial neoplasia screening in a risk behaviour population].

Science.gov (United States)

Padilla-España, Laura; Repiso-Jiménez, Bosco; Fernández-Sánchez, Fernando; Frieyro-Elicegui, Marta; Fernández-Morano, Teresa; Pereda, Teresa; Rivas-Ruiz, Francisco; Redondo, Maximino; de-Troya Martín, Magdalena

2014-11-01

The incidence of intraepithelial anal neoplasia is increasing in certain risk behaviour groups, and human papillomavirus (HPV) infection is involved in its pathogenesis. The systematic use of anal cytology, and more recently HPV detection by hybrid capture and genotyping, have been introduced into screening programs in recent decades. A retrospective cohort study was carried out on individuals with risk behaviours of developing intraepithelial anal neoplasia and who attended Sexually Transmitted Infections clinics in the Dermatology area of the Hospital Costa del Sol from January 2010 to December 2012. The intraepithelial anal neoplasia screening was performed using anal cytology and HPV genotyping. Half (50%) of the study population were HIV positive. A high frequency of anal dysplasia and presence of HPV in cytology (82.1%) and genotype (79%) was found. A statistically significant association (P<.005) was obtained between the presence of high-risk HPV genotypes and the presence of high-grade dysplasia in the second directed cytology. HPV genotyping enabled 17 cases (22%) of severe dysplasia to be identified that were under-diagnosed in the first cytology. Cases of high-grade dysplasia can be under-diagnosed by a first anal cytology. Detection of HPV can supplement this procedure, leading to the identification of those patients most at risk of developing high-grade anal dysplasia. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Addressing Risk and Reluctance at the Nexus of HIV and Anal Cancer Screening

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Ka‘opua, Lana Sue I.; Cassel, Kevin; Shiramizu, Bruce; Stotzer, Rebecca L.; Robles, Andrew; Kapua, Cathy; Orton, Malulani; Milne, Cris; Sesepasara, Maddalynn

2015-01-01

Anal cancer disproportionately burdens persons living with human immunodeficiency virus (PLHIV) regardless of natal sex, sexual orientation, gender expression, and ethnic identity. Culturally competent communications are recommended to address health disparities, with sociocultural relevance ensured through constituent dialogic processes. Results are presented from six provider focus groups conducted to inform the promotion/education component of a Hawai‘i-based project on anal cancer screening tools. Krueger’s focus group methodology guided discussion queries. Verbatim transcripts of digitally recorded discussions were analyzed using grounded theory and PEN-3 procedures. Adherence to an audit trail ensured analytic rigor. Grounded theory analysis detected the overall theme of risk and reluctance to anal cancer screening, characterized by anal cancer not being “on the radar” of PLHIV, conflicting attributions of the anus and anal sex, fear of sex-shaming/-blaming, and other interrelated conceptual categories. PEN-3 analysis revealed strategies for destigmatizing anal cancer, through “real talk” (proactive, candid, nonjudgmental discussion) nested in a framework of sexual health and overall well-being, with additional tailoring for relevance to Native Hawaiians/Pacific Islanders, transgender persons, and other marginalized groups. Application of strategies for health practice are specific to the Hawai‘i context, yet may offer considerations for developing strengths-based, culturally relevant screening promotion/education with diverse PLHIV in other locales. PMID:26630979

Addressing Risk and Reluctance at the Nexus of HIV and Anal Cancer Screening.

Science.gov (United States)

Ka'opua, Lana Sue I; Cassel, Kevin; Shiramizu, Bruce; Stotzer, Rebecca L; Robles, Andrew; Kapua, Cathy; Orton, Malulani; Milne, Cris; Sesepasara, Maddalynn

2016-01-01

Anal cancer disproportionately burdens persons living with human immunodeficiency virus (PLHIV) regardless of natal sex, sexual orientation, gender expression, and ethnic identity. Culturally competent communications are recommended to address health disparities, with sociocultural relevance ensured through constituent dialogic processes. Results are presented from six provider focus groups conducted to inform the promotion/education component of a Hawai'i-based project on anal cancer screening tools. Krueger's focus group methodology guided discussion queries. Verbatim transcripts of digitally recorded discussions were analyzed using grounded theory and PEN-3 procedures. Adherence to an audit trail ensured analytic rigor. Grounded theory analysis detected the overall theme of risk and reluctance to anal cancer screening, characterized by anal cancer not being "on the radar" of PLHIV, conflicting attributions of the anus and anal sex, fear of sex-shaming/-blaming, and other interrelated conceptual categories. PEN-3 analysis revealed strategies for destigmatizing anal cancer, through "real talk" (proactive, candid, nonjudgmental discussion) nested in a framework of sexual health and overall well-being, with additional tailoring for relevance to Native Hawaiians/Pacific Islanders, transgender persons, and other marginalized groups. Application of strategies for health practice are specific to the Hawai'i context, yet may offer considerations for developing strengths-based, culturally relevant screening promotion/education with diverse PLHIV in other locales. © 2015 Society for Public Health Education.

Prevalence of Anal HPV Infection Among HIV-Positive Men Who Have Sex With Men in India.

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Hernandez, Alexandra L; Karthik, Rajiv; Sivasubramanian, Murugesan; Raghavendran, Anantharam; Gnanamony, Manu; Lensing, Shelly; Lee, Jeannette Y; Kannangai, Rajesh; Abraham, Priya; Mathai, Dilip; Palefsky, Joel M

2016-04-01

India has a large population of HIV-positive individuals, including men who have sex with men (MSM), and the incidence of human papillomavirus (HPV)-related cancers is high. In developed countries, HIV-positive MSM exhibit the highest prevalence of anal HPV infection and incidence of anal cancer. Little is known about anal HPV infection in HIV-positive Indian MSM. We evaluated 300 HIV-positive MSM from 2 cities in India. Men were tested for anal HPV infection using L1-HPV DNA polymerase chain reaction with probes specific for 29 types and a mixture of 10 additional types. CD4 level and plasma HIV viral load were measured. Participants completed an interviewer-administered questionnaire including a sexual history. The prevalence of anal HPV was 95% (95% confidence interval: 91% to 97%). The 3 most common types were HPV 35 (20%), HPV 16 (13%), and HPV 6/11 (13%). History of taking antiretroviral medications decreased risk of anal HPV 16 infection [relative risk (RR): 0.6 (0.4-1.0)]. Having an increased number of vaginal sex partners lowered risk of any anal HPV infection. Ever having receptive sex increased risk of any anal HPV [RR: 1.2 (1.1-1.4)] and anal HPV 16 [RR: 6.5 (1.8-107)]. Almost all Indian HIV-positive MSM had anal HPV infection. The prevalence of HPV 16 was lower and the prevalence of other oncogenic HPV types was higher than in similar populations in North America and Europe. Vaccine-based prevention strategies for HPV infection in India should consider potential differences in HPV type distribution among HIV-infected MSM when designing interventions.

Resisting the "Condom Every Time for Anal Sex" Health Education Message

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Adams, Jeffery; Neville, Stephen

2012-01-01

Objective: Ensuring men who have sex with men (MSM) adopt and maintain condom use for anal sex is a challenging health education goal. In order to inform the development of social marketing practices to encourage safe-sex practices, the views of MSM about a key HIV health education message ("using a condom every time for anal sex") were…

Anal sphincter electromyography in patients with Anorectal Dysfunctions

International Nuclear Information System (INIS)

Trinchet Soler, Rafael; Hidalgo Marrero, Yanet; Espichicoque Megret, Arianne; Manzano Suarez, Jianeya; Perez Gonzales, Ruth Maite

2009-01-01

The purpose of this work is to evaluate the electromyography value of anal sphincter in patients with anorectal dysfunctions. Anorectal dysfunctions are frequent reason of pediatric consultation in children, especially with anal incontinence. A study of series of cases in patient with anorectal dysfunctions was carried out from January 2002 to January of 2006. 65 patients were studied. Anorectal malformations (ARM) represented the predominant affection with 38 patients (58.5%), prevailing the male sex in 25 patients (65.8%). Encopresis and intestinal agagliosis dicrease was observed. Sphincter was found before surgical treatment through electromyography in patients with anorectal malformations and colostomy; in those with definitive operation and open colostomy, it avoided the operation in a patient that did not have muscular activity of the external sphincter. In children already operated and with closed colostomy several electromyography changes were observed in correspondence with different incontinence grades. In encopresis cases the study was useful to rule out sphincter functional alterations. Electromyography was pathological in all the operated patients of intestinal aganglionosis. This procedure was very useful for anal incontinence study that helped to determine and establish the prognosis. (author)

Associação de agenesia sacrococcígea e atresia anal em gato sem raça definida Sacrococcygeal agenesis association and anal atresia in mixed breed cats

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Felipe Purcell de Araújo

2009-09-01

Full Text Available O presente trabalho teve como objetivo descrever o caso de um felino, que desde o nascimento apresentou atresia anal, ausência de cauda e malformação dos membros pélvicos. Ao exame radiográfico, pôde-se observar presença de agenesia da sétima vértebra lombar, sacro e vértebras coccígeas, espinha bífida, meningocele, hiperflexão dos joelhos e desvio valgo dos tarsos, diagnosticando-se agenesia sacrococcígea associada à atresia anal.This paper has the objective to report a case of a cat that since birth had anal atresia, absence of tail and malformation of the pelvic member. The radiographic examination revealed agenesis of the seventh lumbar vertebra, sacral and coccygeal vertebrae, spina bifida, meningocele, hyperflexion of the knees and tarsal valgus deviation, diagnosing sacrococcygeal agenesis associated with anal atresia.

Empaatia kogemus kunstiteoses kujutatud subjekti suhtes: fenomenoloogiline analüüs / Marge Paas

Index Scriptorium Estoniae

Paas, Marge, 1976-

2015-01-01

Analüüsitakse vaataja esteetilist kogemust kunstiteose suhtes. Autor tugineb Edith Steini empaatia kogemuse uurimusele ja fenomenoloogilisele uurimismeetodile. Vaataja empaatia kogemuse analüüs Maarit Murka maalisarjas "Hairpower" kujutatud subjekti suhtes

Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors.

Science.gov (United States)

Solans-Domènech, Maite; Sánchez, Emília; Espuña-Pons, Montserrat

2010-03-01

To estimate frequency and severity and to identify risk factors of urinary incontinence (UI) and anal incontinence during pregnancy and after delivery in previously continent nulliparous women. We designed a cohort study of healthy, continent, nulliparous pregnant women attending public health care services. The field work was conducted during the control visits of the three trimesters of pregnancy, at the time of delivery, and postpartum. A self-administered questionnaire was used to assess UI (validated and adapted) and anal incontinence. Frequency of UI and anal incontinence and their confidence intervals (95% CIs) were calculated. The correlations between the severity of UI and the degree of effect on daily life were also estimated. Multivariable Cox models were applied to estimate hazard ratios for both incontinences (urinary/anal) during pregnancy and postpartum. The cumulative incidence rate during pregnancy was 39.1% (95% CI 36.3-41.9) for UI and 10.3% (95% CI 8.3-12.3) for anal incontinence. The correlation between severity of UI and effect on daily life was moderate. Age, baseline body mass index, and family history of UI were significantly associated with the occurrence of UI during pregnancy, while age and excess weight gain during pregnancy were associated with the occurrence of anal incontinence during pregnancy. Postpartum, the identified risk factors for both incontinences were incontinence during pregnancy and vaginal delivery. The occurrence of UI and anal incontinence during the postpartum period is related to the presence of incontinence in pregnancy, and vaginal delivery increases the risk of persistent incontinence. Some risk factors for both incontinences during pregnancy and postpartum are related to lifestyles and obstetric practices.

Does Sacral Nerve Stimulation Improve Continence Through Enhanced Sensitivity of the Anal Canal?

DEFF Research Database (Denmark)

Haas, S; Brock, C; Krogh, K

2016-01-01

. DESIGN: This is an explorative study. PATIENTS: Fifteen women with idiopathic fecal incontinence (mean age, 58 ± 12.2 years) were selected. INTERVENTIONS: Cortical evoked potentials were recorded during repeated rapid balloon distension of the rectum and the anal canal both before and during temporary...... the threshold for urge to defecate elicited from the anal canal, whereas supraspinal responses remained unaltered. This may suggest that sacral nerve stimulation, at least in part, acts via somatic afferent fibers enhancing anal sensation....

O terapêutico e o analítico em Freud

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Vinicius Anciães Darriba

2013-06-01

Full Text Available Este artigo tem como objetivo investigar, na obra de Freud, a demarcação que se institui entre o terapêutico e o analítico. Tal investigação enfoca, primeiramente, a passagem da hipnose à associação livre e o direcionamento do autor à questão da causa, o que estabelece uma visada para a cura analítica em confluência com o que se desdobra da exploração do campo do inconsciente e da consideração de um domínio pulsional. Delimitados por esta via os objetivos terapêuticos e analíticos, interroga-se, em seguida, como a dimensão do terapêutico se veria reintroduzida nos termos da nova direção de cura proposta por Freud.

Pouch failures following ileal pouch-anal anastomosis for ulcerative colitis

DEFF Research Database (Denmark)

Mark-Christensen, A; Erichsen, R; Brandsborg, S

2018-01-01

BACKGROUND: The ileal pouch-anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain risk factors associated with failure. METHOD: 1,991 patients with ulc......BACKGROUND: The ileal pouch-anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain risk factors associated with failure. METHOD: 1,991 patients......-anal anastomosis from Denmark, where pouch surgery is centralized, females had a higher risk of pouch failure. Of modifiable factors, low hospital volume and non-diversion were associated with a higher risk of pouch failure. This article is protected by copyright. All rights reserved....

Analýza sportovního areálu vybranými metodami

OpenAIRE

Jelínek, Vojtěch

2014-01-01

Bakalářská práce se zabývá analýzou sportovního areálu U Hrocha, který má být dokončen v roce 2014. Obsahuje teoretická východiska, která jsou následně implementována do skutečné reality podniku, a to prostřednictvím PESTLE analýzy, Porterovy analýzy a SWOT analýzy. Závěrem je vyhodnocena situace a jsou navržena řešení pro optimalizaci chodu sportovního areálu. This bachelor´s thesis deals with analysis of the sports complex U Hrocha, which will be completed in 2014. It contains theoretica...

Differences in the pressures of canal anal and rectal sensitivity in patients with fecal incontinence, chronic constipation and healthy subjects Diferencias en las presiones del canal anal y la sensibilidad rectal en pacientes con incontinencia anal, estreñimiento crónico y sujetos sanos

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C. Ciriza de los Ríos

2010-12-01

Full Text Available Introduction: There exist a great variability in the manometric findings between patients with anal incontinence (AI and healthy subjects. The correlation between the pressures of the anal canal and the AI is not exact by the wide rank of normal values. Objectives: Prospective study to evaluate differences in the pressures of the anal canal and in rectal sensitivity in patients with AI, chronic constipation (CC and healthy subjects. Material and methods: Ninety four patients with AI, 36 patients with CC and 15 healthy subjects were included. The following data were obtained: age, sex, resting pressure, anal canal length (ACL, squeeze maximum pressure (SMP, squeeze pressure duration (SPD, first sensation, urge and maximum tolerated volume (MTV. Statistical study: test of Kruskal-Wallis, test of Mann-Whitney, and multinomial logistic regression test. Results: There were significant differences in the resting pressure (p Introducción: Existe gran variabilidad en los hallazgos manométricos entre pacientes con incontinencia anal (IA y sujetos sanos. La correlación entre las presiones del canal anal y la IA no es exacta por el amplio rango de valores normales. Objetivos: Estudio prospectivo para evaluar diferencias en las presiones del canal anal y en la sensibilidad rectal en pacientes con IA, estreñimiento crónico (EC y sujetos sanos. Material y métodos: Noventa y cuatro pacientes con IA, 36 pacientes con EC y 15 sujetos sanos. Se obtuvieron: edad, sexo, presión de reposo, longitud del canal anal (LCA, presión de máxima contracción voluntaria (PMCV, duración de la contracción voluntaria, primera sensación, sensación de urgencia y máximo volumen tolerado (MVT. Estudio estadístico: test de Kruskal-Wallis, test de Mann-Whitney, regresión logística multinomial. Resultados: Se encontraron diferencias significativas en la edad (p < 0,001, la presión de reposo (p < 0,001, la LCA (p < 0,001 y la PMCV (p < 0,01 en el grupo de IA con

Treatment Outcome of Carcinoma Vulva Ten-Year Experience from a Tertiary Cancer Centre in South India

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Sakthiushadevi Jeevarajan

2017-01-01

Full Text Available Background. Carcinoma vulva is a rare disease accounting for 1.3% of all gynaecological malignancies. The present study is a 10-year retrospective review of our experience of the surgical options, morbidity, failure pattern, and survival for invasive carcinoma vulva. Materials and Methods. Retrospective analysis of case records of 39 patients who underwent surgery for invasive vulval cancer between 2004 and 2013 in the Department of Surgical Oncology at the Government Royapettah Hospital, Chennai. Results. The median age was 55 years. Radical vulvectomy was the preferred surgery. 31 patients underwent lymphadenectomy. Seroma formation and groin skin necrosis were the most common postoperative complications. With a median follow-up of 32 months, 8 patients (20.5% developed recurrence (systemic = 1, regional = 4, and local = 3. The estimated 5-year disease-free survival (DFS was 65.4% and the overall survival (OS was 85.1%. On univariate analysis, stage and lymph node involvement significantly affected OS. Nodal involvement with extracapsular spread (ECS significantly affected both DFS and OS. Conclusion. The treatment of carcinoma vulva should be individualized with multidisciplinary cooperation. The paucity of data, especially from India, necessitates the need for more studies, preferably multicentric, keeping in mind the low prevalence.

The value of high-resolution anoscopy in the diagnosis of anal cancer precursor lesions in hiv-positive patients

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Felicidad Gimenez

2011-06-01

Full Text Available CONTEXT: Anal cancer, although a still rare disease, is being observed in ascending rates among some population segments known to be at risk for the development of the disease. Human papillomavirus (HPV infection, immunodepression and anal intercourse are some factors associated with the development of the malignancy. Its similarities to cervical cancer have led to many studies aiming to establish guidelines for detecting and treating precursor lesions of anal cancer, with the goal of prevention. High-resolution anoscopy is routinely used for the diagnosis of anal cancer precursor lesions in many centers but the medical literature is still deficient concerning the role of this diagnostic modality. OBJECTIVES: To evaluate diagnostic validation and precision measures of high-resolution anoscopy in comparison to histopathological results of anal biopsies performed in HIV-positive patients treated at the Tropical Medicine Foundation of Amazonas, AM, Brazil. To observe any possible association between some risk factors for the development of anal cancer and the presence of anal squamous intraepithelial lesions. METHODS: A hundred and twenty-eight HIV-positive patients were submitted to anal canal cytological sampling for the detection of HPV infection by a PCR based method. High-resolution anoscopy was then performed after topical application of acetic acid 3% in the anal canal for 2 minutes. Eventual acetowhite lesions that were detected were recorded in respect to location, and classified by their tinctorial pattern, distribution aspect, relief, surface and vascular pattern. Biopsies of acetowhite lesions were performed under local anesthesia and the specimens sent to histopathological analysis. The patients were interviewed for the presence of anal cancer risk factors. RESULTS: The prevalences of anal HPV infection and of anal squamous intraepithelial lesions in the studied population were, respectively, 79% and 39.1%. High-resolution anoscopy

Should anorectal ultrasonography be included as a diagnostic tool for chronic anal pain? ¿Se debe incluir la ecografía rectoanal como prueba diagnóstica del dolor anal crónico?

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M. J. García-Montes

2010-01-01

Full Text Available Objective: to assess the efficiency of endorectal ultrasound (ERUS in the study of chronic idiopathic anal pain (CIAP. Material and method: this is a prospective and descriptive study in which 40 patients, 18 men and 22 women with an average of 47 years, were included. They had chronic anal pain of at least 3 months' duration. A complete colonoscopy was performed in all patients, which found no abnormalities to explain clinical symptoms. Patients with anal fissure and internal hemorrhoids of any degree, perianal suppurative processes, and pelvic surgery were excluded from the study. An ALOKA ProSound SSD-4000 ultrasound console attached to a multifrequency radial transductor ASU-67 (7.5 and 10 MHz was used. Results: one patient could not tolerate the examination. In 8 patients (20% of cases alterations were detected during ultrasonography: in 4 patients (10% of the cases; 1 man and 3 women internal anal sphincter (IAS hypertrophy, and in 5 patients (4 women and 1 man a torn sphincter complex. A tear in the upper IAS canal and hypertrophy of the middle anal canal were observed in one patient (1 woman. Conclusions: ERUS is a simple, economic and useful test to study anorectal pathologies. Although in most studied cases no damage to the anal canal or rectal wall was detected, in a considerable number of patients we observed a thickening of the IAS, a probable cause of anal pain. Therefore, we understand that ERUS should be included in the study of CIAP.Objetivo: evaluar el rendimiento de la ecografía rectoanal (ERA en el estudio del dolor anal crónico idiopático (DACI. Material y método: se trata de un estudio prospectivo y descriptivo en el que se han incluido 40 pacientes, 18 hombres y 22 mujeres, con edad media de 47 años, con clínica de dolor anal crónico de al menos 3 meses de evolución. A todos los pacientes se les había realizado una colonoscopia completa, en la que no se encontró anomalía que justificara la clínica. Se

Primena cost-benefit-benefit analize u vrednovanju i izboru javnih projekata (ekonomski aspekt

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Dragana N. Petrović

2013-10-01

Full Text Available Cost-benefit analiza je celovita analiza koristi i troškova koje jedan projekat donosi samom vlasniku projekta i društvu u celini (uključujući i investitora. Izbor najbolje investicione alternative ostvaruje na osnovu finansijske i ekonomske analize, kao dva integralna dela cost-benefit analize. Prvu od ovih analiza obradila je ista grupa autora u članku „Primena cost-benefit analize u vrednovanju i izboru javnih projekata (finansijski aspekt“, objavljenom u prethodnom broju časopisa Vojnotehnički glasnik. Predmet obrade ovog rada je ekonomska analiza, kao logički nastavak prethodnog rada. Zbog toga se na brojne oznake tabela, uključenih u sadržaj finansijske analize (1-–5, nadovezuju (prema hronološkom redu oznake tabela koje pripadaju ekonomskoj analizi (6–8 Sprovođenje ekonomske analize ostvaruje se prema određenoj, dosta složenoj proceduri, a završava se utvrđivanjem kriterijuma ekonomske (društvene isplativosti projekta. U radu su obrađeni osnovni pokazatelji ekonomskog (društvenog prinosa projekta,  kao što su: neto sadašnja vrednost novčanih tokova i cost-benefit koeficijent.

Rare case of gastrointestinal stromal tumor of the anal canal

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Madhu Kumar

2013-01-01

Full Text Available Gastrointestinal stromal tumor (GIST is a rare mesenchymal neoplasm of the gastrointestinal tract. GIST of anal canal is very rare representing only 3% of all anorectal mesenchymal tumors. We report an extremely rare case of GIST of the anal canal in 60-years-old man with history of irregular bowel habits with dark colored stool mixed with blood and constipation from 6 month. Diagnosis was made on the basis of histomorphological and immunohistochemical examination.

Anal Papilloma: An Exceptional Presentation of Fibrocystic Disease in Anogenital Mammary-Like Glands

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Priya Subashchandrabose

2015-01-01

Full Text Available Previously ectopic breast tissue was thought to be derived from the caudal remnants of the primitive embryonic milk ridges; anogenital mammary-like glands are presently considered as normal constituents of the anogenital region. We report a case of young female, who presented with an anal papilloma. Histopathological examination revealed extensive fibrocystic changes in anogenital mammary-like glands. To date, a lot of benign changes and a wide range of benign and malignant neoplasms have been reported in these glands. However, extensive fibrocystic change of these glands in anal region is very rare. In addition, fibrocystic disease of anal mammary glands, masquerading clinically as an anal papilloma, has not been reported in literature. Hence, it is essential for clinicians and the pathologists to be aware of such a rare presentation. The features of fibrocystic disease in perianal region are also discussed.

Anal Papilloma: An Exceptional Presentation of Fibrocystic Disease in Anogenital Mammary-Like Glands.

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Subashchandrabose, Priya; Esakkai, Muthuvel; Venugopal, Palani; Kannaiyan, Ilavarasan; Srinivasan, Chitra; Reddy, Punuru Tejashwini; Ebenezer, Evelyn Elizabeth

2015-01-01

Previously ectopic breast tissue was thought to be derived from the caudal remnants of the primitive embryonic milk ridges; anogenital mammary-like glands are presently considered as normal constituents of the anogenital region. We report a case of young female, who presented with an anal papilloma. Histopathological examination revealed extensive fibrocystic changes in anogenital mammary-like glands. To date, a lot of benign changes and a wide range of benign and malignant neoplasms have been reported in these glands. However, extensive fibrocystic change of these glands in anal region is very rare. In addition, fibrocystic disease of anal mammary glands, masquerading clinically as an anal papilloma, has not been reported in literature. Hence, it is essential for clinicians and the pathologists to be aware of such a rare presentation. The features of fibrocystic disease in perianal region are also discussed.

Anal microbiota profiles in HIV-positive and HIV-negative MSM.

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Yu, Guoqin; Fadrosh, Doug; Ma, Bing; Ravel, Jacques; Goedert, James J

2014-03-13

Because differences in anal microbial populations (microbiota) could affect acquisition of HIV or other conditions, especially among MSM, we profiled the microbiota of the anal canal, assessed its stability, and investigated associations with diversity and composition. Microbiota profiles in anal swabs collected from 76 MSM (52 in 1989, swab-1; 66 1-5 years later, swab-2) were compared by HIV status (25 HIV-positive), T-cell subsets, and questionnaire data. Bacterial 16S rRNA genes were amplified, sequenced (Illumina MiSeq), and clustered into species-level operational taxonomic units (QIIME and Greengenes). Regression models and Wilcoxon tests were used for associations with alpha diversity (unique operational taxonomic units, Shannon's index). Composition was compared by Adonis (QIIME). Most anal bacteria were Firmicutes (mean 60.6%, range 21.1-91.1%) or Bacteroidetes (29.4%, 4.1-70.8%). Alpha diversity did not change between the two swabs (N = 42 pairs). In swab-2, HIV-positives had lower alpha diversity (P ≤ 0.04) and altered composition, with fewer Firmicutes and more Fusobacteria taxa (P ≤ 0.03), not completely attributable to very low CD4(+) cell count (median 232 cells/μl), prior AIDS clinical diagnosis (N = 17), or trimethoprim-sulfamethoxazole use (N = 6). Similar but weaker differences were observed in swab-1 (HIV-positive median 580 CD4(+) cells/μl; no trimethoprim-sulfamethoxazole). Associations with T-cell subsets, smoking, and sexual practices were null or inconsistent. The anal microbiota of MSM was relatively stable over 1-5 years. However, with uncontrolled, advanced HIV infection, the microbiota had altered composition and reduced diversity partially attributable to antibiotics. Investigations of microbial community associations with other immune perturbations and clinical abnormalities are needed.

Heterosexual anal intercourse and HIV infection risks in the context of alcohol serving venues, Cape Town, South Africa

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Carey Kate B

2011-10-01

Full Text Available Abstract Background The most efficient sexual behavior for HIV transmission is unprotected receptive anal intercourse. However, it is unclear what role heterosexual unprotected anal sex is playing in the world's worst HIV epidemics of southern Africa. The objective is to examine the prevalence of heterosexual unprotected anal intercourse among men and women who drink at informal alcohol serving establishments (shebeens in South Africa. Methods Cross-sectional surveys were collected from a convenience sample of 5037 patrons of 10 shebeens in a peri-urban township of Cape Town, South Africa. Analyses concentrated on establishing the rates of unprotected anal intercourse practiced by men and women as well as the factors associated with practicing anal intercourse. Results We found that 15% of men and 11% of women reported anal intercourse in the previous month, with 8% of men and 7% of women practicing any unprotected anal intercourse. Multiple logistic regression showed that younger age, having primary and casual sex partners, and meeting sex partners at shebeens were independently associated with engaging in anal intercourse. Mathematical modeling showed that individual risks are significantly impacted by anal intercourse but probably not to the degree needed to drive a generalized HIV epidemic. Conclusions Anal intercourse likely plays a significant role in HIV infections among a small minority of South Africans who patronize alcohol serving establishments. Heterosexual anal intercourse, the most risky sexual behavior for HIV transmission, should not be ignored in HIV prevention for South African heterosexuals. However, this relatively infrequent behavior should not become the focus of prevention efforts.

Symptom outcomes important to women with anal incontinence: a conceptual framework.

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Sung, Vivian W; Rogers, Rebecca G; Bann, Carla M; Arya, Lily; Barber, Matthew D; Lowder, Jerry; Lukacz, Emily S; Markland, Alayne; Siddiqui, Nazema; Wilmot, Amanda; Meikle, Susan F

2014-05-01

To develop a framework that describes the most important symptom outcomes for anal incontinence treatment from the patient perspective. A conceptual framework was developed by the Pelvic Floor Disorders Network based on four semistructured focus groups and confirmed in two sets of 10 cognitive interviews including women with anal incontinence. We explored: 1) patient-preferred terminology for describing anal incontinence symptoms; 2) patient definitions of treatment "success"; 3) importance of symptoms and outcomes in the framework; and 4) conceptual gaps (defined as outcomes not previously identified as important). Sessions were conducted according to grounded theory transcribed, coded, and qualitatively and quantitatively analyzed to identify relevant themes. Content and face validity of the framework were further assessed using cognitive interviews. Thirty-four women participated in focus groups and 20 in cognitive interviews. Overall, 29 (54%) were aged 60 years or older, 42 (78%) were white, and 10 (19%) had a high school degree or less. Two overarching outcome themes were identified: "primary bowel leakage symptoms" and "ancillary bowel symptoms." Subdomains important in primary bowel leakage symptoms included leakage characteristics (symptom frequency, amount of leakage, symptom bother) and conditions when bowel leakage occurs (predictability, awareness, urgency). Subdomains important under ancillary bowel symptoms included emptying disorders (constipation, obstructed defecation, and wiping issues) and discomfort (pain, burning). New outcomes identified included predictability, awareness, wiping issues, and discomfort. Women with anal incontinence desire a wide range of symptom outcomes after treatment. These are captured in our conceptual framework, which can aid clinicians and researchers in assessing anal incontinence. LEVEL OF EVIEDENCE: II.

Dosimetric comparison of IMRT rectal and anal canal plans generated using an anterior dose avoidance structure

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Leicher, Brian, E-mail: bleicher@wpahs.org [Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA (United States); Day, Ellen [Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA (United States); Colonias, Athanasios; Gayou, Olivier [Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA (United States); Drexel University College of Medicine, Allegheny Campus, Philadelphia, PA (United States)

2014-10-01

To describe a dosimetric method using an anterior dose avoidance structure (ADAS) during the treatment planning process for intensity-modulated radiation therapy (IMRT) for patients with anal canal and rectal carcinomas. A total of 20 patients were planned on the Elekta/CMS XiO treatment planning system, version 4.5.1 (Maryland Heights MO) with a superposition algorithm. For each patient, 2 plans were created: one employing an ADAS (ADAS plan) and the other replanned without an ADAS (non-ADAS plan). The ADAS was defined to occupy the volume between the inguinal nodes and primary target providing a single organ at risk that is completely outside of the target volume. Each plan used the same beam parameters and was analyzed by comparing target coverage, overall plan dose conformity using a conformity number (CN) equation, bowel dose-volume histograms, and the number of segments, daily treatment duration, and global maximum dose. The ADAS and non-ADAS plans were equivalent in target coverage, mean global maximum dose, and sparing of small bowel in low-dose regions (5, 10, 15, and 20 Gy). The mean difference between the CN value for the non-ADAS plans and ADAS plans was 0.04 ± 0.03 (p < 0.001). The mean difference in the number of segments was 15.7 ± 12.7 (p < 0.001) in favor of ADAS plans. The ADAS plan delivery time was shorter by 2.0 ± 1.5 minutes (p < 0.001) than the non-ADAS one. The ADAS has proven to be a powerful tool when planning rectal and anal canal IMRT cases with critical structures partially contained inside the target volume.

Dosimetric comparison of IMRT rectal and anal canal plans generated using an anterior dose avoidance structure

International Nuclear Information System (INIS)

Leicher, Brian; Day, Ellen; Colonias, Athanasios; Gayou, Olivier

2014-01-01

To describe a dosimetric method using an anterior dose avoidance structure (ADAS) during the treatment planning process for intensity-modulated radiation therapy (IMRT) for patients with anal canal and rectal carcinomas. A total of 20 patients were planned on the Elekta/CMS XiO treatment planning system, version 4.5.1 (Maryland Heights MO) with a superposition algorithm. For each patient, 2 plans were created: one employing an ADAS (ADAS plan) and the other replanned without an ADAS (non-ADAS plan). The ADAS was defined to occupy the volume between the inguinal nodes and primary target providing a single organ at risk that is completely outside of the target volume. Each plan used the same beam parameters and was analyzed by comparing target coverage, overall plan dose conformity using a conformity number (CN) equation, bowel dose-volume histograms, and the number of segments, daily treatment duration, and global maximum dose. The ADAS and non-ADAS plans were equivalent in target coverage, mean global maximum dose, and sparing of small bowel in low-dose regions (5, 10, 15, and 20 Gy). The mean difference between the CN value for the non-ADAS plans and ADAS plans was 0.04 ± 0.03 (p < 0.001). The mean difference in the number of segments was 15.7 ± 12.7 (p < 0.001) in favor of ADAS plans. The ADAS plan delivery time was shorter by 2.0 ± 1.5 minutes (p < 0.001) than the non-ADAS one. The ADAS has proven to be a powerful tool when planning rectal and anal canal IMRT cases with critical structures partially contained inside the target volume

Anal sphincter responses after perianal electrical stimulation

DEFF Research Database (Denmark)

Pedersen, Ejnar; Klemar, B; Schrøder, H D

1982-01-01

By perianal electrical stimulation and EMG recording from the external anal sphincter three responses were found with latencies of 2-8, 13-18 and 30-60 ms, respectively. The two first responses were recorded in most cases. They were characterised by constant latency and uniform pattern, were...... not fatigued by repeated stimulation, were most dependent on placement of stimulating and recording electrodes, and always had a higher threshold than the third response. The third response was constantly present in normal subjects. It had the longest EMG response and the latency decreased with increasing...... stimulation to a minimum of 30-60 ms. This response represented the clinical observable spinal reflex, "the classical anal reflex". The latencies of the two first responses were so short that they probably do not represent spinal reflexes. This was further supported by the effect of epidural anaesthesia which...

High-Resolution Anoscopy: Clinical Features of Anal Intraepithelial Neoplasia in HIV-positive Men

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Richel, Olivier; Hallensleben, Nora D. L.; Kreuter, Alexander; van Noesel, Carel J. M.; Prins, Jan M.; de Vries, Henry J. C.

2013-01-01

BACKGROUND: High-resolution anoscopy is increasingly advocated to screen HIV+ men who have sex with men for anal cancer and its precursor lesions, anal intraepithelial neoplasia. A systematic comparison between clinical features and the histopathology of suspect lesions is lacking. OBJECTIVE: This

Does endoscopic ultrasound improve detection of locally recurrent anal squamous-cell cancer?

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Peterson, Carrie Y; Weiser, Martin R; Paty, Philip B; Guillem, Jose G; Nash, Garrett M; Garcia-Aguilar, Julio; Patil, Sujata; Temple, Larissa K

2015-02-01

Evaluating patients for recurrent anal cancer after primary treatment can be difficult owing to distorted anatomy and scarring. Many institutions incorporate endoscopic ultrasound to improve detection, but the effectiveness is unknown. The aim of this study is to compare the effectiveness of digital rectal examination and endoscopic ultrasound in detecting locally recurrent disease during routine follow-up of patients with anal cancer. This study is a retrospective, single-institution review. This study was conducted at an oncologic tertiary referral center. Included were 175 patients with nonmetastatic anal squamous-cell cancer, without persistent disease after primary chemoradiotherapy, who had at least 1 posttreatment ultrasound and examination by a colorectal surgeon. The primary outcomes measured were the first modality to detect local recurrence, concordance, crude cancer detection rate, sensitivity, specificity, and predictive value. Eight hundred fifty-five endoscopic ultrasounds and 873 digital rectal examinations were performed during 35 months median follow-up. Overall, ultrasound detected 7 (0.8%) mesorectal and 32 (3.7%) anal canal abnormalities; digital examination detected 69 (7.9%) anal canal abnormalities. Locally recurrent disease was found on biopsy in 8 patients, all detected first or only with digital examination. Four patients did not have an ultrasound at the time of diagnosis of recurrence. The concordance of ultrasound and digital examination in detecting recurrent disease was fair at 0.37 (SE, 0.08; 95% CI, 0.21-0.54), and there was no difference in crude cancer detection rate, sensitivity, specificity, and negative or positive predictive values. The heterogeneity of follow-up timing and examinations is not standardized in this study but is reflective of general practice. Endoscopic ultrasound did not provide any advantage over digital rectal examination in identifying locally recurrent anal cancer, and should not be recommended for

Association of Human Papillomavirus Infection and Abnormal Anal Cytology among HIV-Infected MSM in Beijing, China

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Zhang, Zhihui; Qian, Han-Zhu; Ruan, Yuhua; Zhou, Feng; Gao, Cong; Li, Mufei; Jin, Qi; Gao, Lei

2012-01-01

Background In the recent years, dramatic increases in HIV transmission among men who have sex with men (MSM) have been observed in China. Human papillomavirus (HPV) infection related anal cancer is more common among HIV-infected MSM as compared to the general population. However, HPV infection and anal cytology has been rarely studied in HIV-infected MSM in China. Methods HIV-infected MSM in Beijing, China were invited to participate in this study between January and April 2011. Anal swabs were collected for examining cytology and HPV genotypes. Results Ninety-five eligible participants with complete questionnaire and laboratory data were included in the analyses. Thirty six of them (37.9%) showed abnormal anal cytology as follows: atypical squamous cells of undetermined significance (ASC-US) in 19 (20.0%), atypical squamous cells but cannot exclude HSIL (ASC-H) in 1 (1.1%), low-grade squamous intraepithelial lesion (LSIL) in 15 (15.8%), and high-grade squamous intraepithelial lesion (HSIL) in 1 (1.1%). HPV6 (20.0%), HPV16 (10.9%), HPV56 (10.9%), HPV52 (9.1%) and HPV39 (9.1%) were observed most frequently among those with normal anal cytology, while different distribution was found in the ones with abnormal anal cytology as HPV6 (19.4%), HPV16 (19.4%), HPV45 (16.7%), HPV52 (16.7%) and HPV18 (11.1%). In addition, HPV16, HPV45, HPV52 and HPV18 were the most frequent high-risk types in patients with abnormal anal cytology. HPV multiplicity was found to be significantly related to the prevalence of abnormal anal cytology (p for trend = 0.04). Conclusions High prevalence of HPV infection and abnormal anal cytology was observed among HIV-infected MSM in China. Infection of multiple HPV types or high-risk types was found to be associated with an increased risk of abnormal anal cytology. PMID:22558293

Association of human papillomavirus infection and abnormal anal cytology among HIV-infected MSM in Beijing, China.

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Yu Yang

Full Text Available BACKGROUND: In the recent years, dramatic increases in HIV transmission among men who have sex with men (MSM have been observed in China. Human papillomavirus (HPV infection related anal cancer is more common among HIV-infected MSM as compared to the general population. However, HPV infection and anal cytology has been rarely studied in HIV-infected MSM in China. METHODS: HIV-infected MSM in Beijing, China were invited to participate in this study between January and April 2011. Anal swabs were collected for examining cytology and HPV genotypes. RESULTS: Ninety-five eligible participants with complete questionnaire and laboratory data were included in the analyses. Thirty six of them (37.9% showed abnormal anal cytology as follows: atypical squamous cells of undetermined significance (ASC-US in 19 (20.0%, atypical squamous cells but cannot exclude HSIL (ASC-H in 1 (1.1%, low-grade squamous intraepithelial lesion (LSIL in 15 (15.8%, and high-grade squamous intraepithelial lesion (HSIL in 1 (1.1%. HPV6 (20.0%, HPV16 (10.9%, HPV56 (10.9%, HPV52 (9.1% and HPV39 (9.1% were observed most frequently among those with normal anal cytology, while different distribution was found in the ones with abnormal anal cytology as HPV6 (19.4%, HPV16 (19.4%, HPV45 (16.7%, HPV52 (16.7% and HPV18 (11.1%. In addition, HPV16, HPV45, HPV52 and HPV18 were the most frequent high-risk types in patients with abnormal anal cytology. HPV multiplicity was found to be significantly related to the prevalence of abnormal anal cytology (p for trend = 0.04. CONCLUSIONS: High prevalence of HPV infection and abnormal anal cytology was observed among HIV-infected MSM in China. Infection of multiple HPV types or high-risk types was found to be associated with an increased risk of abnormal anal cytology.

Impact of hypothyroidism on primary anal malignant melanoma: A rare entity

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Siddharth Singh

2014-01-01

Full Text Available Primary melanoma of the anal canal is rare and highly malignant condition, which is 1% of all invasive tumors in this site. This condition is often mistaken for benign conditions as either hemorrhoids or rectal polyp. Thyroid-stimulating hormone stimulation causes high proliferation of malignant melanoma. The association of hypothyroidism with primary malignant melanoma of anal canal is very rare. We are reporting such a very rare case.

Impact of hypothyroidism on primary anal malignant melanoma: a rare entity.

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Singh, Siddharth; Verma, Satyajeet; Kala, Sanjay

2014-01-01

Primary melanoma of the anal canal is rare and highly malignant condition, which is 1% of all invasive tumors in this site. This condition is often mistaken for benign conditions as either hemorrhoids or rectal polyp. Thyroid-stimulating hormone stimulation causes high proliferation of malignant melanoma. The association of hypothyroidism with primary malignant melanoma of anal canal is very rare. We are reporting such a very rare case.

Estudio de la fisiología del esfínter anal interno porcino y de la rata, y de la fisiopatología de las alteraciones de la motilidad del esfínter anal interno en pacientes con fisura anal

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Opazo Valdés, Álvaro Javier

2011-01-01

Descripció del recurs: el 01 setembre 2012 Las patologías anorectales benignas (fisura anal, incontinencia fecal, hemorroides) presentan una elevada prevalencia. De forma general, se desconoce la fisiopatología de estas enfermedades en las que se producen diversas alteraciones del esfínter anal interno (EAI). Los objetivos para esta tesis fueron: 1º Caracterizar los mecanismos y neurotransmisores implicados en el control del tono, la relajación y la contracción del EAI en dos modelos anima...

Analysis and description of disease-specific quality of life in patients with anal fistula.

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Ferrer-Márquez, Manuel; Espínola-Cortés, Natalia; Reina-Duarte, Ángel; Granero-Molina, José; Fernández-Sola, Cayetano; Hernández-Padilla, José Manuel

2018-04-01

In patients diagnosed with anal fistula, knowing the quality of life specifically related to the disease can help coloproctology specialists to choose the most appropriate therapeutic strategy for each case. The aim of our study is to analyzse and describe the factors related to the specific quality of life in a consecutive series of patients diagnosed with anal fistula. Observational, cross-sectional study carried out from March 2015 to February 2017. All patients were assessed in the colorectal surgery unit of a hospital in southeast of Spain. After performing an initial anamnesis and a physical examination, patients diagnosed with anal fistula completed the Quality of Life in Ppatients with Anal Fistula Questionnaire (QoLAF-Q). This questionnaire specifically measures quality of life in people with anal fistula and its score range is the following: zero impact = 14 points, limited impact = 15 to 28 points, moderate impact = 29 to 42 points, high impact = 43 to 56 points, and very high impact = 57 to 70 points. A total of 80 patients were included. The median score obtained in the questionnaire for the sample studied was 34.00 (range=14-68). Statistically significant differences between patients with "primary anal fistula" (n=65) and "recurrent anal fistula" (n=15) were observed (mean rank=42.96 vs. mean rank=29.83, p=0.048). Furthermore, an inverse proportion (P=.016) between "time with clinical symptoms" and "impact on quality of life" was found (5 years: mean rank = 19.00). There were no statistically significant differences (P=.149) between quality of life amongst patients diagnosed with complex (mean rank = 36.13) and simple fistulae (mean rank = 43.59). Anal fistulae exert moderate-high impact on patients' quality of life. "Shorter time experiencing clinical symptoms" and the "presence of primary fistula" are factors that can be associated with worse quality of life. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Differential gene expression in patients with anal fistula reveals high levels of prolactin recepetor

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Song Yi-Huan

2017-01-01

Full Text Available Background/Aim. There are limited data examining variations in the local expression of inflammatory mediators in anal fistulas where it is anticipated that an improved understanding of the inflammatory milieu might lead to the potential therapeutic option of instillation therapy in complicated cases. The aim of the present study was to examine prolactin receptors (PRLR as inflammatory markers and to correlate their expression with both the complexity of anal fistulas and the likelihood of fistula recurrence. Methods. Microarray was used to screen the differentially expressed gene profile of anal fistula using anal mucosa samples with hemorrhoids with ageand sex-matched patients as controls and then a prospective analysis of 65 patients was conducted with anal fistulas. PRLR immunohistochemistry was performed to define expression in simple, complex and recurrent anal fistula cases. The quantitative image comparison was performed combining staining intensity with cellular distribution in order to create high and low score PRLR immunohistochemical groupings. Results. A differential expression profile of 190 genes was found. PRLR expression was 2.91 times lower in anal fistula compared with control. Sixty-five patients were assessed (35 simple, 30 complex cases. Simple fistulas showed significantly higher PRLR expression than complex cases with recurrent fistulae showing overall lower PRLR expression than de novo cases (p = 0.001. These findings were reflected in measurable integrated optical density for complex and recurrent cases (complex cases, 8.31 ± 4.91 x 104 vs simple cases, 12.30 ± 6.91 x 104; p < 0.01; recurrent cases, 7.21 ± 3.51 x 104 vs primarily healing cases, 8.31 ± 4.91 x 104; p < 0.05. In univariate regression analysis, low PRLR expression correlated with fistula complexity; a significant independent effect maintained in multivariate analysis odds ratio [(OR low to high PRLR expression = 9.52; p = 0.001]. Conclusion. PRLR

Conversor analógico digital basado en oscilador controlado por tensión

OpenAIRE

Cardes García, Fernando

2012-01-01

Convencionalmente, los micrófonos dan una salida analógica debida a la variación de presión que produce el sonido, y esta señal se digitaliza por medio de conversores analógico digitales tradicionales. En este proyecto se aborda el diseño de un sistema que obtenga como salida un código digitalizado a partir del sonido recibido por la cápsula microfónica. La principal ventaja de utilizar este sistema es que el circuito analógico que acondiciona la señal se simpli ca considerable...

Frequency of operative trauma to anal sphincters: evaluation with endoanal ultrasound.

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Stamatiadis, Apostolos; Konstantinou, Evangelos; Theodosopoulou, Eleni; Mamoura, Konstantinia

2002-01-01

Sphincter trauma after anorectal surgery is usually asymptomatic. Frequency of trauma cannot be established with the clinical examination only. The frequency of operative sphincter defects and their correlation with disorders of continence was evaluated with the endoanal ultrasound. This study includes 123 subjects who had undergone anorectal surgery in the past and were examined with endoanal ultrasound for various indications such as continence disorders, recurrent fistula, idiopathic perineal pain, or simple postoperative follow-up. No subjects had isolated external anal sphincter defects. Nineteen of 123 patients (15%) had minor or major continence disorders, 55 patients (45%) had no sphincter defects, 42 (34%) had only internal anal sphincter (IAS) defects, and 26 (21%) had simultaneously external and internal anal sphincter (EAS) defects. The incidence of IAS and EAS trauma after Milligan-Morgan hemorrhoidectomy was 1/18 (5.5%) and 0/18 respectively; after fistula repair, 24/42 (57%) and 12/42 (29%); and after anal dilatation, 13/17 (76%) and 4/17 (24%). Sixteen of 26 patients (62%) with EAS trauma and 51/68 patients (75%) with IAS trauma did not report any disorders of continence. In patients with two or more operations, the frequency of IAS trauma was 74%, 30% for EAS trauma, and 26% for continence disorders.

Earlier anal sexarche and co-occurring sexual risk are associated with current HIV-related risk behaviors among an online sample of men who have sex with men in Asia

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Cheung, Doug H.; Suharlim, Christian; Guadamuz, Thomas E.; Lim, Sin How; Koe, Stuart; Wei, Chongyi

2014-01-01

Studies of heterosexual populations across the globe and men who have sex with men (MSM) in a few developed countries showed that earlier sexual debut (sexarche) was associated with higher levels of co-occurring and subsequent HIV risk behaviors. We examined the relationships between earlier anal sexarche, unprotected earlier anal sexarche and current HIV risks among MSM from Asia. A cross-sectional online survey was conducted among MSM (N = 10,826) in Asia in 2010. Bivariate and multivariable logistic regressions were used to identify co-occurring (i.e., sexual experiences during sexarche) and current HIV-related risk factors (i.e., past six months) associated with earlier anal sexarche (before the age of 18) and unprotected earlier anal sexarche, respectively. Earlier anal sexarche was significantly associated with lack of condom use, being anal receptive or both receptive and insertive, and having a partner who were older during sexarche. It was also associated with current HIV-related risk behaviors including having multiple male sexual partners, having been paid for sex, and increased frequencies of recreational drug use. Unprotected earlier anal sexarche was significantly associated with inconsistent condom use in the past the six months. Improved and culturally sensitive sex education at schools should be included in national and regional HIV/AIDS prevention programming and policies in Asia. Such sex education programs should incorporate curriculum that address sexuality, sexual orientation, and sexual behaviors beyond those related to reproductive health. PMID:24920344

Evaluation of radiotherapy and chemoradiotherapy for anal canal epidermoid cancer in our center

International Nuclear Information System (INIS)

Obara, Kunihiko; Sahara, Rikisaburo; Yamana, Tetsuro; Okamoto, Kinya; Takahashi, Tomoko; Furukawa, Satomi; Okada, Daisuke; Kaneko, Yasushi; Matsumoto, Atsuo

2008-01-01

The efficacy and safety of radiotherapy (RT) and chemoradiotherapy (CRT) for anal canal epidermoid cancer were evaluated. Twenty-four patients with anal canal epidermoid cancer were treated in our center between 1988 and 2006, consisting of 13 patients treated by RT and 11 by CRT. In these patients, the efficacy and safety of RT and CRT were evaluated in terms of adverse events, 5-year local control rates, 5-year disease-free survival rates, and 5-year survival rates. No grade 3 or higher adverse events were noted in patients receiving RT. In contrast, anorexia, diarrhea, neutropenia, and anemia were observed in 33.3%, 10%, 33.3%, and 10%, respectively, of the patients receiving CRT. The anal preserving rate, 5-year local control rate, 5-year disease-free survival rate, and 5-year survival rate were 66.7%, 73%, 77.5%, and 88.4%, respectively. RT and CRT for anal canal epidermoid cancer should be first-line treatments because of their safety and efficacy. (author)

Hypopharyngeal carcinoma: King Faisal Specialist Hospital and Research Center experience

International Nuclear Information System (INIS)

Mahasin, Z.; Khan, B.

1996-01-01

From 1975 to 1985, 202 patients with hypopharyngeal cancer were seen at King Faisal Specialist Hospital and Research Center (KFSHRC). The endoscopic investigation showed that 28.3% of these patients had postcricoid carcinoma; 19.85% had pyriform fossa carcinoma and 52.9% had involvement of both sites. The pathological diagnosis of all cases was squamous cell carcinoma type. The majority of the patients (62.98%) had T4 lesions, which showed a late presentation to KFSHRC. Information related to survival was available for a smaller number of patients to many lost-to-follow-up cases. The overall median survival time was 8.5 months (1-110 months). The survival rate for each site was calculated, as well as the staging of the disease and treatment modality used. It appeared that pyriform fossa (median 21 months) had the best survival rate. In addition the earlier the lesion was detected and the more aggressive the treatment applied, the better the survival rate. Fifty percent of the patients receiving radiation therapy and surgery had a five year survival arte. Factors other than smoking and/on drinking should be looked for in our community as predisposing to this disease in our population. (author)

Surgical Management of Renal Cell Carcinoma Extending Into Venous System: A 20-Year Experience.

Science.gov (United States)

Xiao, X; Zhang, L; Chen, X; Cui, L; Zhu, H; Pang, D; Yang, Y; Wang, Q; Wang, M; Gao, C

2017-11-01

The purpose of this study is to report our 20-year experience with the surgical management of renal cell carcinoma extending into the inferior vena cava using a novel classification system. We retrospectively reviewed the data of 103 patients (69 males, 34 females, mean age: 52.9 ± 12.6 years) with renal cell carcinoma involving the venous system treated between 1993 and 2014. The inferior vena cava tumor thrombus was classified into five levels: 0 (renal vein, n = 12), 1 (infrahepatic, n = 33), 2a (low retrohepatic, n = 26), 2b (high retrohepatic, n = 19), and 3 (supradiaphragmatic, n = 13). Clinical data were summarized, and overall survival, cancer-specific survival, and disease-free survival were examined by Cox regression analysis. All patients underwent radical surgery. Complete resections of the renal tumor and thrombus were achieved in 101 patients (98.1%). Two intraoperative and one postoperative in-hospital deaths (2.9%) occurred. In total, 19 patients (18.8%) had a total of 29 postoperative complications. Mean follow-up time was 46 months (range, 1-239 months). The 5- and 10-year overall survival rates were 62.9% and 56.0%, respectively. Metastasis, rather than thrombus level, was a significant risk factor associated with overall survival (hazard ratio = 4.89, 95% confidence interval: 2.24-10.67, p system can be used to select the optimal surgical approach and method for patients with renal cell carcinoma and venous thrombus. Its use is associated with prolonged survival and relatively few complications. Metastasis is an independent risk factor of overall survival.

Risk factors of recurrent anal sphincter ruptures

DEFF Research Database (Denmark)

Jangö, Hanna; Langhoff-Roos, J; Rosthøj, Steen

2012-01-01

Please cite this paper as: Jangö H, Langhoff-Roos J, Rosthøj S, Sakse A. Risk factors of recurrent anal sphincter ruptures: a population-based cohort study. BJOG 2012;00:000-000 DOI: 10.1111/j.1471-0528.2012.03486.x. Objective  To determine the incidence and risk factors of recurrent anal sphincter...... were used to determine risk factors of recurrent ASR. Main outcome measures  The incidence of recurrent ASR and odds ratios for possible risk factors of recurrent ASR: age, body mass index, grade of ASR, birthweight, head circumference, gestational age, presentation, induction of labour, oxytocin...... augmentation, epidural, episiotomy, vacuum extraction, forceps, shoulder dystocia, delivery interval and year of second delivery. Results  Out of 159 446 women, 7336 (4.6%) experienced an ASR at first delivery, and 521 (7.1%) had a recurrent ASR (OR 5.91). The risk factors of recurrent ASR in the multivariate...

Adjuvant Therapy for Thymic Carcinoma--A Decade of Experience in a Taiwan National Teaching Hospital.

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Yen-Han Tseng

Full Text Available Thymic carcinomas are rare tumors for which surgical resection is the first treatment of choice. The role of adjuvant treatment after surgery is unknown because of limited available data. The present study evaluated the efficacy of post-surgery adjuvant chemotherapy or radiotherapy in patients with thymic carcinoma.To evaluate the role of adjuvant therapy in patients with thymic carcinoma, we retrospectively reviewed the records of patients with thymic carcinoma who were diagnosed and treated between 2004 and 2014.Among 78 patients with thymic carcinoma, 30 patients received surgical resection. Progression-free survival (PFS and overall survival (OS were significantly longer among these patients than among patients who received other treatments (PFS: 88.4 months vs 9.1 months, p<0.001; OS: 134.9 months vs 60.9 months; p = 0.003. Patients with stage III thymic carcinoma who received surgery had a longer OS than patients who did not receive surgery (70.1 months vs 23.9 months; p = 0.017, n = 11. Among 47 patients with stage IV carcinoma, 12 patients who received an extended thymothymectomy had a longer PFS than 35 patients who did not receive surgery (18.9 months vs 8.7 months; p = 0.029. Among 30 patients (with stage I- IV carcinoma who received primary lesion surgery, 19 patients received an R0 resection and 9 patients of the 19 patients received adjuvant radiotherapy. These patients had longer PFS (50.3 months than 2 patients who received adjuvant chemotherapy (5.9 months or 4 patients who received concurrent chemoradiotherapy (7.5 months after surgery (p = 0.003.Surgical resection should be considered for patients with thymic carcinoma, even for patients with locally advanced or stage IV carcinoma. Adjuvant radiotherapy resulted in a better PFS after R0 resection.

Radiotherapy with or without chemotherapy in the treatment of anal cancer. 20-year experience from a single institute

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Fakhrian, K.; Sauer, T.; Klemm, S.; Bayer, C.; Haller, B.; Molls, M.; Geinitz, H. [Technische Univ. Muenchen (Germany). Klinikum rechts der Isar

2013-01-15

Purpose: To report the efficacy and toxicity of radio(chemo)therapy (RCT) in the management of squamous cell anal carcinoma (SQ-AC) and to evaluate the prognostic factors influencing the outcomes. Patients and methods: A consecutive cohort of 138 patients with cT1-4, cN0-3, cM0 SQ-AC were treated with RCT between 1988 and 2011 at our department. Median follow-up time for surviving patients from the start of RCT was 98 months (range, 1-236 months). Patients were treated with a median radiation dose of 56 Gy (range, 4-61 Gy). Concurrent chemotherapy was administered to 119 patients (86%). Results: The survival rates at 2, 5, and 10 years were 88 {+-} 3, 82 {+-} 4, and 59 {+-} 6%, respectively, with a median overall survival (OS) of 167 months. The cumulative incidence for local recurrence at 2 and 5 years was 8 {+-} 2 and 11 {+-} 3%, respectively. The median disease-free survival (DFS) and colostomy-free survival (CFS) times were 132 and 135 months, respectively. In 19 patients (14%), a distant metastasis was diagnosed after a median time of 19 months. In the multivariate analysis, UICC (International Union Against Cancer) stage I-II, female gender, Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, and good/moderate histologic differentiation (G1-2) were significantly associated with a better OS, DFS, and CFS. Conformal radiotherapy planning techniques were significantly associated with a lower cumulative incidence of local recurrence (11 {+-} 3% vs. 38 {+-} 19% at 5 years, p = 0.006). A higher radiation dose beyond 54 Gy was not associated with an improvement in outcome, neither for smaller - (T1/T2) nor for larger tumors (T3/T4). Conclusion: RCT leads to excellent outcomes - especially in patients with stage I/II and G1/G2 tumors - with acceptable toxicity. The probable advantages of high-dose radiotherapy should be considered carefully against the risk of a higher rate of toxicity. Future studies are needed to investigate the role of a more

De mundejarismo de los Anales Toledanos Segundos

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Felipe MAÍLLO SALGADO

2009-12-01

Full Text Available Como es sabido los Anales Toledanos (Primeros, Segundos y Terceros, compuestos en su mayor parte durante el siglo XIII en distintos momentos y por diferentes manos, son piezas importantes de la historiografía medieval hispánica, tanto por recoger gran cantidad de noticias —por más que éstas sean escuetas— cuanto por estar todas ellas rigurosamente fechadas; de ahí que sean de gran utilidad para el historiador.De estos tres anales, los Segundos (A.T.II tienen unas peculiaridades que los distinguen fuertemente de los otros; sin embargo, en una primera hojeada el lector poco avisado vería que, por su aspecto formal, nada difieren de otros escritos del mismo género, un género éste cuya condición esencial radica en la consignación del evento fechado, esto es, se presenta en párrafos que comienzan o terminan —como es aquí el caso— con una fecha determinada. Nuestro imaginario lector, por otra parte, se encontraría con las peladas noticias típicas del género analístico, a saber: una serie de referencias que dan cuenta de fenómenos naturales (como son las sequías prolongadas o las excesivas lluvias, las heladas intempestivas, los terremotos, los eclipses..., que informan de las épocas de hambre o carestía, de los precios de los artículos, de prodigios, de acontecimientos locales, etc.; el todo amalgamado con noticias de carácter político-militar.

Preliminary experience with external hemipelvectomy for locally advanced and recurrent pelvic carcinoma

DEFF Research Database (Denmark)

Nielsen, Mette Bak; Rasmussen, Peter Chr.; Keller, Johnny Østergaard

2012-01-01

was found. With agreement by the multidisciplinary team, surgery was performed by a colorectal surgeon and an orthopaedic sarcoma surgeon and, if needed, by an urologist and vascular surgeon. Patients were reconstructed with either a femoral or a gluteal musculocutaneous flap. Results Of the eight women...... [median age 54.5 (40– 68) years], two had primary carcinoma and six local recurrence of a previously treated carcinoma. R0 was possible in six patients and R1 resection in two. The median duration of hospital stay was 29.5 (17– 102) days. The median follow up was 8.3 (4.7– 52.8) months. Three patients...... for a highly selected group of patients with locally advanced carcinoma or recurrence involving the lumbosacral neural plexus....

HIV infection connected to rising anal cancer rates in men in the U.S.

Science.gov (United States)

Human immunodeficiency virus (HIV) infection contributes substantially to the epidemic of anal cancer in men, but not women in the United States, according to new research from NCI. Chart shows overall incidence rates of anal cancers in general population

OCCULT ANAL SPHINCTER INJURIES (OASIS IN DEPARTMENT OF PERINATOLOGY IN LJUBLJANA – INCIDENCE AND RISK FACTORS

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Katja Jakopič

2018-02-01

Full Text Available Background: Vaginal delivery is the most important risk factors for development of faecal incontinence, which significantly affects quality of life. Foreign studies show OASIS occur at 20 to 40 % of vaginal deliveries. In Slovenia we recognize sphincter injuries at 1.7 % of deliveries, while true incidence of OASIS in our population remains unknown. Caesarean section prevents anal sphincter injuries. Known risk factors in foreign studies include prolonged second stage of labour, fetal weight > 3500 g, malpresentation, forceps delivery, maternal age more than 35 years at the time of first delivery, first delivery. Few women complain about defecatory problems in puerperium unless they are directly asked about them, so true incidence of such injuries is grossly underestimated. Previously compensated anal sphincter dysfunction can clinically manifest as late as in menopause. The most probable cause is atrophy of muscle and fibrous tissue of pelvic floor and anal sphincter due to lack of estrogen support in this period. With anal ultrasound we tried to determine the incidence of occult damage to anal sphincter in primiparas after vaginal delivery and the relation of injury to symptoms 6 weeks after delivery and identify possible risk factors in our population. We also tried to find out how many patients with anal sphincter injury become symptomatic immediately after deliv- ery. Methods: From January to June 2009 we examined 26 primiparas after vaginal delivery in the Ljubljana Maternity Hospital with anal ultrasound and compared various data about the delivery from our national delivery form. We excluded all patients with caesarean section, recognized anal sphincter injury at the time of the delivery or previous anorectal surgery, history of irritable bowel syndrome or pre-existing inflammatory bowel disease. All patients completed a bowel-function questionnaire, which included questions about faecal urgency and involuntary passing of gas, liquid or

A case of anal canal cancer which developed fournier's syndrome after chemoradiotherapy

International Nuclear Information System (INIS)

Momma, Tomoyuki; Kikuchi, Daiki; Watanabe, Yohei; Onozawa, Hisashi; Suzuki, Satoshi; Nakamura, Izumi; Ohki, Shinji; Takenoshita, Seiichi; Yoshida, Noriyuki

2013-01-01

Fournier's syndrome is an acute necrotizing fasciitis of the perineum which progresses rapidly, resulting in poor prognosis if not treated appropriately at an early stage. Here we report a case of anal canal cancer which developed Fournier's syndrome after chemoradiotherapy (CRT). A 79-year-old man with anal canal cancer received a double-barrel sigmoid colostomy followed by concurrent CRT (50.4 Gy) with S-1 (100 mg/body). Although the patient was discharged after CRT, he developed a fever at 10 days after discharge and visited our hospital complaining of pain in the anal region. He was hospitalized with a diagnosis of Fournier's syndrome. Extensive drainage, administration of antibiotics, additional drainage and continuous irrigation of the affected region improved the symptoms of Fournier's syndrome. Multiple liver metastases were found on a CT scan at 3 months after onset of Fournier's syndrome, and the patient was transferred to another hospital for systemic chemotherapy. There have been no reports on the onset of Fournier's syndrome after CRT for rectal cancer with anal canal involvement; we report this case with a review of the literature. (author)

Role of age, bowel function and parity on anorectocele pathogenesis according to cinedefecography and anal manometry evaluation.

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Soares, F A; Regadas, F S P; Murad-Regadas, S M; Rodrigues, L V; Silva, F R S; Escalante, R D; Bezerra, R F

2009-11-01

The study aimed to verify the role of parity, age and bowel function in the pathogenesis of anorectocele. A cross-sectional study was conducted regarding age, obstetrical history, Cleveland Clinic Constipation Score (CCCS), cinedefecography and anal manometry findings. Forty-five adult women complaining of obstructed defecation were evaluated; the median age was 46 years and median CCCS, 13. Fifteen patients were nulliparous and 23 multiparous (median parity 2). Eighteen had a history of episiotomy, fourteen delivered large babies and two had forceps-assisted delivery. Statistical analysis was performed using Spearman's correlation test and Fisher's exact test. Anal hypertonia was found in 14 (31.1%) patients, anal hypotonia in eight (17.8%), anismus in 13 (28.9%) and anorectoceles in 34 (75.6%) [median size 2.8 cm (0-6.4)]. There were no correlations between anorectocele and anal hypertonia (P = 0.7171), anismus (P = 0.4666), parity comparing nulliparous and multiparous patients (P = 1.000), episiotomy (P = 1.0000), forceps assistance (P = 1.0000), delivery of a large baby (P = 1.0000) anal resting pressure (P = 0.0883), anal voluntary pressure (P = 0.7327), parity (P = 0.4987) and age (P = 0.8603). There were correlations between anorectocele and the CCCS (P = 0.0082) and anal hypotonia (P = 0.0141). Anorectocele is not correlated with parity, age, episiotomy, delivery of a large baby and anismus. It was more frequent in patients with severe constipation and less common in patients with anal hypotonia.

Coexistence of parathyroid adenoma and papillary thyroid carcinoma: Experience of a single center

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Ebubekir Gündeş

2013-01-01

Full Text Available Objective: The aim of this study was to describe experienceswith concurrent parathyroid adenoma and papillarythyroid carcinoma.Methods: Eight patients with concurrent parathyroid adenomaand papillary thyroid carcinoma were identifiedbetween 2005 and 2012, and their medical records werereviewed retrospectively.Results: Of the eight patients identified, two were maleand six were female; their mean age was 53.6 years.The mean serum calcium concentration was 11.7 mg/dL.Intact parathyroid hormone (iPTH concentrations werehigh in all patients, with a mean concentration of 338 pg/mL. The most frequently used surgical technique was totalthyroidectomy plus parathyroid adenoma excision (n=6.The mean size of the thyroid carcinoma was 1.2 cm, andone case showed metastatic lymph nodes in the centralcompartment. The mean parathyroid adenoma size wasfound to be 2.1(0.6- 3.5 cm, according to the longest sizeof the adenom. Six patients (75% developed postoperativecomplications, including temporary symptomatic hypocalcemiain 4 patients (50%, hematoma developmentin 1 patient (12.5% and temporary vocal cord paralysis inone patient (12.5%.Conclusion: Thyroid carcinoma and parathyroid adenomaare rarely concomitant. Rarely hyperparathyroidismmay be accompanied with thyroid carcinomas so preoperativelythyroid gland should be properly examined. Thyroidwith parathyroid surgery are risk factors of recurrentlaryngeal nerve injury and hypoparathyroidism.Key words: Papillary thyroid cancer; parathyroid adenoma;thyroidectomy

Paradoxical Impact of Ileal Pouch-Anal Anastomosis on Male and Female Fertility in Patients With Ulcerative Colitis.

Science.gov (United States)

Pachler, Frederik R; Brandsborg, Søren B; Laurberg, Søren

2017-06-01

Birth rates in males with ulcerative colitis and ileal pouch-anal anastomosis have not been studied. This study aimed to estimate birth rates in males and females with ulcerative colitis and study the impact of ileal pouch-anal anastomosis. This was a retrospective registry-based cohort study that was performed over a 30-year period. Records for parenting a child from the same period were cross-linked with patient records, and birth rates were calculated using 15 through 49 years as age limits. All data were prospectively registered. All patients with ulcerative colitis and ulcerative colitis with ileal pouch-anal anastomosis between 1980 and 2010 were identified in Danish national databases. The primary outcomes measured were birth rates in females and males with ulcerative colitis and ulcerative colitis with ileal pouch-anal anastomosis. We included 27,379 patients with ulcerative colitis (12,812 males and 14,567 females); 1544 had ileal pouch-anal anastomosis (792 males and 752 females). Patients with ulcerative colitis have slightly reduced birth rates (males at 40.8 children/1000 years, background population 43.2, females at 46.2 children/1000 years, background population 49.1). After ileal pouch-anal anastomosis, males had increased birth rates at 47.8 children/1000 years in comparison with males with ulcerative colitis without ileal pouch-anal anastomosis (40.5 children/1000 years), whereas females had reduced birth rates at 27.6 children/1000 years in comparison with females with ulcerative colitis without ileal pouch-anal anastomosis (46.8 children/1000 years). Only birth rates were investigated and not fecundability. Furthermore, there is a question about misattributed paternity, but this has previously been shown to be less than 5%. Ulcerative colitis per se has little impact on birth rates in both sexes, but ileal pouch-anal anastomosis surgery leads to a reduction in birth rates in females and an increase in birth rates in males. This has clinical

Fecal incontinence, sexual complaints, and anorectal function after third-degree obstetric anal sphincter injury (OASI): 5-year follow-up.

Science.gov (United States)

Visscher, A P; Lam, T J; Hart, N; Felt-Bersma, R J F

2014-05-01

Our aim was to evaluate alterations in anorectal function after anal sphincteroplasty for third-degree obstetric anal sphincter injury (OASI) in relation to clinical outcome. In this retrospective, descriptive, cross-sectional study conducted between 1998 and 2008, women with persisting fecal incontinence (FI) after 3a OASI and all women with grade 3b or 3c OASI were sent for anorectal function evaluation (AFE) consisting of anal manometry and endosonography 3 months after sphincteroplasty. In 2011, questionnaires regarding FI (Vaizey/Wexner), urinary incontinence (UI) [International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF)], sexual function [Female Sexual Function Index (FSFI)], and quality of life (QOL) (Rand-36) were sent and women were asked to undergo additional AFE. Sixty-six women underwent AFE. Mean follow-up was 5.0 years. Forty (61%) patients returned questionnaires regarding FI and UI. Prevalence of FI was 63% flatus, 50% liquid stool, and 20% solid stool. Thirty-two of 40 also reported on QOL and SF. Sexual dysfunction was present in the majority of women (cutoff value 26.55) and more pronounced in larger OASI. Sixteen of 40 women underwent additional AFE. Women with combined internal (IAS) and external (EAS) anal sphincter injury (n = 6) had worse FI (P 40) than women with isolated EAS injury (n = 10). Follow-up after third-degree OASI suggests poor anorectal and sexual function. Women with combined external and internal OASI show more deterioration in anorectal function and experience worse FI. Therefore, special attention should be paid to these women in order to mitigate these symptoms later in life.

Oral and Anal vaccination against enteric red mouth disease protection against yersiniosis

DEFF Research Database (Denmark)

Neumann, Lukas; Villumsen, Kasper Rømer; Kragelund Strøm, Helene

dose of ERM bacterin fully protected rainbow trout when they are vaccinated anally. Oral vaccination can also induce full protection but the dose of the bacterin has to be 100 times higher than if the fish was to be vaccinated anally. This indicates that much of the oral feed bacteria is digested...... in the stomach of rainbow trout. This work has shown that it is possible to vaccinated orally against ERM, but the bacteria has to be coated in order to avoid digestion. Protection mechanisms will be discussed....... fish. The objective for this project is to investigate whether oral and anal vaccination of rainbow trout against Yersinia ruckeri O1 (biotype 1) causing Enteric Red Mouth disease (ERM) can protect rainbow trout against a subsequent experimental bath challenge.The rainbow trout were given oral...

Metástase cutânea rara de provável carcinoma basaloide de cólon simulando granuloma piogênico Rare cutaneous metastasis from a probable basaloid carcinoma of the colon mimicking pyogenic granuloma

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Gustavo Costa Verardino

2011-06-01

Full Text Available As acrometástases, principalmente para as mãos, são incomuns e representam cerca de 0,0070,2% de todas as lesões metastáticas. O pulmão é o sítio de origem mais comum, colaborando com 4050% dos casos relatados na literatura. Os rins e mamas são outras localizações também relacionadas a neoplasias que metastatizam para as mãos, além de, mais raramente, trato gastrointestinal, outros tumores sistêmicos e sarcomas. Seu diagnóstico precoce é difícil, pois pode ser assintomático, se assemelhar a tenossinovite, artrite, paroníquia, granuloma piogênico ou infecção local. No presente relato, os autores apresentam paciente com diagnóstico de acrometástase, em ambos os quartos quirodáctilos, oriunda de carcinoma basaloide de canal anal, com pobre resposta à radioterapiaAcrometastasis is a rare occurrence, especially when affecting the hands. It represents around 0.007-0.2% of all metastatic lesions. The most common site of origin is the lung, accounting for 40-50% of all cases reported in the literature. Kidneys and breasts are other sites also associated with neoplastic lesions that disseminate to the hands. More rarely, the site of origin may be the gastrointestinal tract or other systemic tumors or sarcomas. Early diagnosis is difficult, since the condition may be asymptomatic or may mimic tenosynovitis, arthritis, paronychia, pyogenic granuloma or a local infection. In the present paper, the authors report on a patient with the diagnosis of acrometastasis on both hands originating from a basaloid carcinoma of the anal canal. Response to radiotherapy was poor

Diversity of human papillomavirus in the anal canal of men: the HIM Study.

Science.gov (United States)

Sichero, L; Nyitray, A G; Nunes, E M; Nepal, B; Ferreira, S; Sobrinho, J S; Baggio, M L; Galan, L; Silva, R C; Lazcano-Ponce, E; Giuliano, A R; Villa, L L

2015-05-01

Human papillomavirus (HPV) infections are associated with the development of anogenital lesions in men. There are no reports describing the distribution of non-α HPV types in the anal canal of a sexually diverse group of men. The HPV Infection in Men (HIM) Study is a multicentre study on the natural history of HPV infection in Brazil, Mexico, and the USA. At baseline, 12% of anal canal PCR HPV-positive specimens were not typed by the Roche Linear Array, and were considered to be unclassified. Our goals were to characterize HPVs among these unclassified specimens at baseline, and to assess associations with participant socio-demographic and behavioural characteristics. Unclassified HPVs were typed by sequencing of amplified PGMY09/11 products or cloning of PGMY/GP + nested amplicons followed by sequencing. Further analysis was conducted with FAP primers. Of men with unclassified HPV in the anal canal, most (89.1%) were men who have sex with women. Readable sequences were produced for 62.8% of unclassified specimens, of which 75.2% were characterized HPV types. Eighteen, 26 and three different α-HPV, β-HPV and γ-HPV types were detected, respectively. α-HPVs were more commonly detected among young men (18-30 years) than among older men (45-70 years), whereas β-HPVs were more frequent among mid-adult men (31-44 years). β-HPVs were more common among heterosexual men (85.0%) than among non-heterosexual men. All β-HPVs detected among non-heterosexual men were β2-HPV types. The high prevalence of β-HPV in the anal canal of men who do not report receptive anal sex is suggestive of other forms of transmission that do not involve penile-anal intercourse. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Endosonographic appearance of the anal sphincters in patients following colostomy

International Nuclear Information System (INIS)

Sudol-Szopinska, I.; Jakubowski, W.; Szczepkowski, M.; Panorska, A.

2002-01-01

Background. The aim of the study was to visualize, by anal ultrasound (AUS), the suspected defects of the anal sphincters in the patients after colostomy and to analyze possible factors that could have led to such defects. Patients and methods. AUS, using a 7.0 MHz endorectal probe, was performed in a group of 25 patients with colostomy. The internal anal sphincter (IAS), external anal sphincter (EAS) and puborectalis muscle (PR) were visualized and the defects within them were qualified and quantified. For statistical analysis, the analysis of variance (ANOVA) was used. Results. The IAS was thin in all but three patients (22 patients; 88 %) with the mean thickness of 1.62 mm. A circular reduction of the thickness along the entire length of the IAS was seen in 20 patients (90.9 %). The echogenicity of the IAS was increased in 15 patients (60 %), and in 10 of them (66.6%), this defect embraced the whole length and circumference of the IAS. The margins of the IAS were not well-defined in 10 patients (40%). A significant correlation was found between the length of the patient's life with the stoma and the IAS echogenicity defect (p-value = 0.0001). No significant correlation was found between the dynamic examination, the IAS thickness and the IAS borders definition. Conclusion. The reduced thickness, increased echogenicity and borders definition defect of the IAS are seen in the patients after colostomy. The only significant correlation was confirmed between the length of the patient's life with the stoma and the IAS echogenicity defect. (author)

Incontinence after primary repair of obstetric anal sphincter tears is related to relative length of reconstructed external sphincter

DEFF Research Database (Denmark)

Norderval, S; Røssaak, K.; Markskog, A

2012-01-01

To determine if anatomic primary repair with end-to-end reconstruction of the external anal sphincter (EAS) in its full length combined with separate repair of coexisting internal anal sphincter (IAS) tear, when present, results in less incontinence and better anal sphincter integrity compared...

Topical 5-fluorouracil treatment of anal intraepithelial neoplasia in human immunodeficiency virus-positive men

NARCIS (Netherlands)

Richel, O.; Wieland, U.; de Vries, H. J. C.; Brockmeyer, N. H.; van Noesel, C.; Potthoff, A.; Prins, J. M.; Kreuter, A.

2010-01-01

Background Anal intraepithelial neoplasia (AIN), a human papillomavirus (HPV) induced potential precursor lesion of anal cancer, is frequent among human immunodeficiency virus (HIV)-positive men who have sex with men (MSM). So far, only a few prospective studies have been performed on the topical

Prolonged-Release Oxycodone/Naloxone Improves Anal Sphincter Relaxation Compared to Oxycodone Plus Macrogol 3350

DEFF Research Database (Denmark)

Poulsen, Jakob Lykke; Brock, Christina; Grønlund, Debbie

2017-01-01

/naloxone or PR oxycodone plus macrogol 3350. Resting anal pressure, anal canal distensibility, and relaxation of the internal sphincter to rectal distension were evaluated before treatment (baseline) and on day 5. The Patient Assessment of Constipation Symptom (PAC-SYM) questionnaire, stool frequency, and stool...

Fractal dimension and image statistics of anal intraepithelial neoplasia

International Nuclear Information System (INIS)

Ahammer, H.; Kroepfl, J.M.; Hackl, Ch.; Sedivy, R.

2011-01-01

Research Highlights: → Human papillomaviruses cause anal intraepithelial neoplasia (AIN). → Digital image processing was carried out to classify the grades of AIN quantitatively. → The fractal dimension as well as grey value statistics was calculated. → Higher grades of AIN yielded higher values of the fractal dimension. → An automatic detection system is feasible. - Abstract: It is well known that human papillomaviruses (HPV) induce a variety of tumorous lesions of the skin. HPV-subtypes also cause premalignant lesions which are termed anal intraepithelial neoplasia (AIN). The clinical classification of AIN is of growing interest in clinical practice, due to increasing HPV infection rates throughout human population. The common classification approach is based on subjective inspections of histological slices of anal tissues with all the drawbacks of depending on the status and individual variances of the trained pathologists. Therefore, a nonlinear quantitative classification method including the calculation of the fractal dimension and first order as well as second order image statistical parameters was developed. The absolute values of these quantitative parameters reflected the distinct grades of AIN very well. The quantitative approach has the potential to decrease classification errors significantly and it could be used as a widely applied screening technique.

Apontamentos sobre a psicologia analítica de Carl Gustav Jung

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Luís Marcelo Alves Ramos

2002-01-01

Full Text Available O texto faz uma introdução à Psicologia Analítica do psicólogo e psiquiatra suíço Carl Gustav Jung: define o conceito de Psicologia Analítica, traz uma biografia resumida de Carl Gustav Jung, indica as principais diferenças entre a Psicologia Analítica e a Psicanálise, descreve a estrutura e o funcionamento da psique e, por fim, apresenta sinteticamente as características dos tipos de personalidades traçadas por Jung. The text makes an introduction to the Analytical Psychology of the psychologist and swiss psychiatrist Carl Gustav Jung: it defines the concept of Analytical Psychology, brings a summarized biography of Carl Gustav Jung, indicates the main differences between Analytical Psychology and the Psychoanalysis, describes the structure and the functioning of psyche and, finally, presents synthetically the characteristics of the types of personalities traced by Jung.

Nasopharyngeal carcinoma treated by radical radiotherapy alone: Ten-year experience of a single institution

International Nuclear Information System (INIS)

Yi Junlin; Gao Li; Huang Xiaodong; Li Suyan; Luo Jinwei; Cai Weiming; Xiao Jianping; Xu Guozhen

2006-01-01

Purpose: To report on our experience in the treatment of nasopharyngeal carcinoma (NPC) by radical radiotherapy alone in our institution during the last decade. Methods and Materials: From January 1990 to May 1999, 905 NPC patients were treated and were studied retrospectively. Radical radiotherapy was given to this cohort by conventional technique in a routine dose of 70-72 Gy to the primary tumor and metastatic lymph nodes. In case of residual primary lesion, a boost dose of 8-24 Gy was delivered by either 192 Ir afterloading brachytherapy, fractionated stereotactic radiotherapy, conformal radiotherapy, or small external-beam fields. Results: The 5-year and 10-year local-regional control, overall survival, and disease-free survival rates were 81.7% and 76.7%, 76.1% and 66.5%, 58.4% and 52.1%, respectively. In case of residual primary lesions after a dose of 70-72 Gy of conventional external-beam radiotherapy (EBRT), an additional boost was able to achieve a local control of 80.8%, similar to that obtained with primary lesions that completely disappeared at 70-72 Gy (82.6%, p = 0.892). Conclusions: The treatment results of radical EBRT followed by a boost dose to the residual primary tumor for nasopharyngeal carcinoma in our institution are promising

Hemorrhoids and anal fissures in inflammatory bowel disease.

Science.gov (United States)

D'Ugo, S; Stasi, E; Gaspari, A L; Sileri, P

2015-12-01

Perianal disease is a common complication of inflammatory bowel disease (IBD). It includes different conditions from more severe and potentially disabling ones, such as abscesses and fistulas, to more benign conditions such as hemorrhoids, skin tags and fissures. Most literature has been focused on anal sepsis and fistulae, as they carry the majority of disease burden and often alter the natural course of the disease. Hemorrhoids and anal fissures in patients with IBD have been overlooked, although they can represent a challenging problem. The management of hemorrhoids and fissures in IBD patients may be difficult and may significantly differ compared to the non-affected population. Historically surgery was firmly obstructed, and hemorrhoidectomy or sphincterotomy in patients with associated diagnosis of IBD was considered harmful, although literature data is scant and based on small series. Various authors reported an incidence of postoperative complications higher in IBD than in the general populations, with potential severe events. Considering that a spontaneous healing is possible, the first line management should be a medical therapy. In patients non-responding to conservative measures it is possible a judicious choice of surgical options on a highly selective basis; this can lead to acceptable results, but the risk of possible complications needs to be considered. In this review it is analyzed the current literature on the incidence, symptoms and treatment options of hemorrhoids and anal fissures in patients with Crohn's disease and ulcerative colitis.

El juego simbólico una alternativa en las dilataciones anales

OpenAIRE

Aguinaga B. Oscar William

1993-01-01

"Las malformaciones ano-rectales están entre las más comunes de las malformaciones de tipo congénito causadas por anormalidades del desarrollo, aproximadamente uno de cada cinco mil partos con producto vivo, en Estados Unidos". Clasificaciones existen muchas, pero la de uso más generalizado y tenida en cuenta en el Hospital de la Misericordia, servicio de quirúrgicas, es: Estenosis anal congénita, agenecia anal, atresia rectal, fístula rectoperineal, fístula rectovaginal.

Giant basal cell carcinoma Carcinoma basocelular gigante

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Nilton Nasser

2012-06-01

Full Text Available The basal cell carcinoma is the most common skin cancer but the giant vegetating basal cell carcinoma reaches less than 0.5 % of all basal cell carcinoma types. The Giant BCC, defined as a lesion with more than 5 cm at its largest diameter, is a rare form of BCC and commonly occurs on the trunk. This patient, male, 42 years old presents a Giant Basal Cell Carcinoma which reaches 180 cm2 on the right shoulder and was negligent in looking for treatment. Surgical treatment was performed and no signs of dissemination or local recurrence have been detected after follow up of five years.O carcinoma basocelular é o tipo mais comum de câncer de pele, mas o carcinoma basocelular gigante vegetante não atinge 0,5% de todos os tipos de carcinomas basocelulares. O Carcinoma Basocelular Gigante, definido como lesão maior que 5 cm no maior diâmetro, é uma forma rara de carcinoma basocelular e comumente ocorre no tronco. Este paciente apresenta um Carcinoma Basocelular Gigante com 180cm² no ombro direito e foi negligente em procurar tratamento. Foi realizado tratamento cirúrgico e nenhum sinal de disseminação ou recorrência local foi detectada após 5 anos.

Epidemiology of anal HPV infection in high-risk men attending a sexually transmitted infection clinic in Puerto Rico.

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Vivian Colón-López

Full Text Available Recent studies in Puerto Rico have reported an increasing incidence of anal cancer in Puerto Rican men. The objective of this study was to determine the prevalence, genotype distribution and risk factors associated with anal HPV infection among men attending an STI clinic in Puerto Rico.We conducted a cross-sectional study among 205 men 18 years and older. A comprehensive survey was administered that included a demographic and a behavioral assessment. Separate logistic regression models were performed to determine factors associated with any, high-risk (HR, and multiple anal HPV infection.The mean age of the study sample was 38.0±13.5 years. The most common HR types were 58, 51 and 31. Overall, HR anal HPV infection was found in 53.5% of the participants. Multiple HPV types in the anal canal were found in 47.6% of the sample. A third (29.8% of participants reported being men who had sex with men (MSM. MSM had a significantly higher prevalence of any, HR and multiple HPV infection (p-value<0.05. Separate multivariate logistic regression analyses showed that being MSM was associated with any (OR = 4.5; [95%CI: 1.9-10.7], HR (OR = 3.4; [95%CI: 1.1-10.3 and multiple anal HPV infection (OR = 3.6; [95%CI: 1.5-9.1. HIV was marginally associated with multiple anal HPV infection in multivariate analysis (OR = 3.3; 95%CI = 1.0-11.0.Anal HPV is common among sexually active men attending this STI clinic, with higher likelihood of anal HPV infection among MSM.

Frequency of post-operative faecal incontinence in patients with closed and open internal anal sphincterotomy

International Nuclear Information System (INIS)

Ghayas, N.G.; Younus, S.M.; Mirani, A.J.; Ghayasuddin, M.

2015-01-01

Fissure in ano is one of the commonest benign and painful proctologic diseases causing considerable morbidity and reduction in quality of life. There are medical as well as surgical treatment options for anal fissure. The study was conducted to compare the frequency of postoperative faecal incontinence in patients with closed lateral internal anal sphincterotomy with von-greaves knife versus standard Parks operation (open method) for chronic anal fissure. Methods: This was a randomized controlled trial (RCT) was conducted at the Department of Surgery, KVSS, S.I.T.E. Hospital, Karachi, for a period of six months from 13th February to 12th August 2011. Ninety four consecutive patients having chronic anal fissure were assigned through blocked randomization to groups A and B, with 47 patients in each group. Closed lateral internal anal sphincterotomy (CLIAS) via von-greaves knife was carried out in patients of group-A whereas patients of group-B were subjected to open internal anal sphincterotomy (OIAS) also known as Parks procedure. Faecal incontinence was noted on the 5th post-operative day. Data was analysed using SPSS 16. Results: There were 81 (86.2%) males and 13 (13.8%) females with male to female ratio being 6:1. Mean age was 38.38 mp±14.56 years. Post-operative faecal incontinence in patients undergoing CLIAS was 4.3% while it was 21.3% in those undergoing OIAS with a p-value of 0.027. CLIAS with von-greaves knife is effective in reducing faecal incontinence on 5th postoperative day as compared to standard OIAS. Conclusion: CLIAS with von-greaves knife is effective in reducing faecal incontinence on 5th postoperative day as compared to OIAS (Park's procedure). Therefore, this technique may be used in future regularly to treat chronic anal fissure for prevention of this morbidity. (author)

Analüütikud soovitavad Eesti Energia börsile viia / Piret Reiljan

Index Scriptorium Estoniae

Reiljan, Piret, 1983-

2008-01-01

Kohalikud analüütikud soovitavad viia Eesti Energia börsile, kuna see elavdaks aktsiaturgu ja tõmbaks ligi välisinvestoreid. Vt. samas: Raivo Vare: raske aeg töötab Eesti Energia börsiletoomise kasuks; Analüüs ootab pääsu valitsuskabinetti; Juhid ei püsi enam Eesti Energias. Diagrammid: Majandusnäitajad; Varade maht

Concurrent cisplatin, continuous infusion fluorouracil and radiotherapy followed by tailored consolidation treatment in non metastatic anal squamous cell carcinoma

International Nuclear Information System (INIS)

Zampino, Maria G; Orecchia, Roberto; Magni, Elena; Leonardi, Maria C; Santoro, Luigi; Petazzi, Elena; Fodor, Cristiana; Petralia, Giuseppe; Trovato, Cristina; Nolè, Franco

2011-01-01

To evaluate efficacy and feasibility of chemo-radiotherapy in patients with non-metastatic anal squamous-cell-cancer. TNM staged anal squamous-cell cancer patients were treated with pelvic radiotherapy concomitant to continuous infusion fluorouracil plus cisplatin for at least 2 cycles. In T3-T4 or any T - N+ tumours or in 'slow-responder' cases, 1-2 chemotherapy courses were subsequently administered. Tumour assessment was performed at baseline and 6-8 weeks after radiotherapy to evaluate response. 29 patients were enrolled: 4 males, 25 females; median age 57 years; baseline T1/T2/T3/T4 2/12/7/8; N involvement 17. Median dose pelvic radiotherapy was 59.4 Gy (range: 54-74). In 5 patients 2 chemotherapy courses, in 12 patients three and in 12 patients four courses were performed. At first evaluation, 27 CR (93.1%; 95% CI: 78% - 98%) and 2 SD were observed. Main grade (G) 3 toxic events were neutropenia (8%), diarrhoea (8%) and dermatitis (62%). Most frequent late events G3-G4 occurred in 14 patients: proctitis (5), dermatitis (4), bladder dysfunctions (2), sexual dysfunctions (9), lower extremity venous thromboses (2), dysuria (1), stenosis (1) and tenesmus (1). Five patients reported G1 leucopoenia. The rate of colostomy was 14%. After a median follow up of 42 months (range: 4-81), 20 patients are still alive without relapse and 3 died due to PD. The estimated 7-year DFS was 83.4% (C.I.: 68.3%-98.5%) and the estimated 7-year OS was 85.7% (C.I.: 70% - 100%). The 1-year and the estimated 7-year colostomy-free survivals were 85.9% (C.I.: 73.1% - 98.7%). Concurrent cisplatin plus fluorouracil and radiotherapy is associated with favourable local control rates and acute toxicity. Future investigations will be directed towards research into molecular biomarkers related to disease progression and resistance to chemo-radiotherapy and to the evaluation of new cytotoxic agents or targeted drugs, such as anti-epidermal growth factor receptor, concomitant to RT and to

Concurrent cisplatin, continuous infusion fluorouracil and radiotherapy followed by tailored consolidation treatment in non metastatic anal squamous cell carcinoma

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Petralia Giuseppe

2011-02-01

Full Text Available Abstract Background To evaluate efficacy and feasibility of chemo-radiotherapy in patients with non-metastatic anal squamous-cell-cancer. Methods TNM staged anal squamous-cell cancer patients were treated with pelvic radiotherapy concomitant to continuous infusion fluorouracil plus cisplatin for at least 2 cycles. In T3-T4 or any T - N+ tumours or in "slow-responder" cases, 1-2 chemotherapy courses were subsequently administered. Tumour assessment was performed at baseline and 6-8 weeks after radiotherapy to evaluate response. Results 29 patients were enrolled: 4 males, 25 females; median age 57 years; baseline T1/T2/T3/T4 2/12/7/8; N involvement 17. Median dose pelvic radiotherapy was 59.4 Gy (range: 54-74. In 5 patients 2 chemotherapy courses, in 12 patients three and in 12 patients four courses were performed. At first evaluation, 27 CR (93.1%; 95% CI: 78% - 98% and 2 SD were observed. Main grade (G 3 toxic events were neutropenia (8%, diarrhoea (8% and dermatitis (62%. Most frequent late events G3-G4 occurred in 14 patients: proctitis (5, dermatitis (4, bladder dysfunctions (2, sexual dysfunctions (9, lower extremity venous thromboses (2, dysuria (1, stenosis (1 and tenesmus (1. Five patients reported G1 leucopoenia. The rate of colostomy was 14%. After a median follow up of 42 months (range: 4-81, 20 patients are still alive without relapse and 3 died due to PD. The estimated 7-year DFS was 83.4% (C.I.: 68.3%-98.5% and the estimated 7-year OS was 85.7% (C.I.: 70% - 100%. The 1-year and the estimated 7-year colostomy-free survivals were 85.9% (C.I.: 73.1% - 98.7%. Conclusions Concurrent cisplatin plus fluorouracil and radiotherapy is associated with favourable local control rates and acute toxicity. Future investigations will be directed towards research into molecular biomarkers related to disease progression and resistance to chemo-radiotherapy and to the evaluation of new cytotoxic agents or targeted drugs, such as anti-epidermal growth

Merkel Cell Carcinoma Analysis of Outcomes: A 30-Year Experience.

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Evan Liang

Full Text Available Merkel cell carcinoma (MCC is an aggressive cutaneous malignancy with poor prognosis. Limited data exists to guide treatment decisions. Here we report on our institutional experience and outcomes treating patients with MCC.A database search (1984-2014 of patients treated at the University of Wisconsin Hospital and Clinics was used to identify patients with histologically confirmed MCC. Patient, tumor, and treatment characteristics were examined via review of medical records. Statistical analyses were performed to assess outcomes and associated prognostic factors.A total of 87 patients with MCC were identified with a median follow-up of 17 months (mean: 38, range: 0-210 months. Two and five-year overall survival rates were 53.9% and 32.8%, respectively. Recurrence was documented in 31.0% of patients (85.2% locoregional, 48.1% distant and 33.3% both. Patients with a history of immunosuppression exhibited significantly worse survival (hazard ratio, 2.01; 95% CI, 1.1-3.7 when compared to immune-competent individuals. The head and neck region was the most common location of primary lesion (N=49 followed by the extremities (N=31. Upper extremity primaries predicted significantly better overall survival (hazard ratio, 0.48; 95% CI, 0.23-0.99 while lower extremity primaries did not have significantly better results (hazard ratio, 0.5; 95% CI, 0.21-1.2 in comparison to head and neck site of primary. Nodal involvement (hazard ratio, 2.95; 95% CI, 1.5-5.79 was also a negative prognostic factor associated with poor overall survival when compared with clinically node negative patients. Primary tumor size > 2 cm (hazard ratio, 1.76; 95% CI, 0.91-3.4 was not associated with survival.This study highlights the role of various factors in determining prognosis of Merkel cell carcinoma; history of immunosuppression, nodal involvement, and head/neck primary predicted worse overall survival. These findings suggest that improvements in both distant and locoregionally

Renal cell carcinoma in children and adolescence: Our experience ...

African Journals Online (AJOL)

Background: Literature on renal cell carcinoma (RCC) in children is lacking. Occasional case report has been mentioned. Aims and objective of our study are to evaluate the clinical presentation and outcome in children with RCC. Patients and Methods: Records of 11 children and adolescence, from January 2007 to June ...

Genetic Architecture of the Variation in Male-Specific Ossified Processes on the Anal Fins of Japanese Medaka.

Science.gov (United States)

Kawajiri, Maiko; Fujimoto, Shingo; Yoshida, Kohta; Yamahira, Kazunori; Kitano, Jun

2015-10-28

Traits involved in reproduction evolve rapidly and show great diversity among closely related species. However, the genetic mechanisms that underlie the diversification of courtship traits are mostly unknown. Japanese medaka fishes (Oryzias latipes) use anal fins to attract females and to grasp females during courtship; the males have longer anal fins with male-specific ossified papillary processes on the fin rays. However, anal fin morphology varies between populations: the southern populations tend to have longer anal fins and more processes than the northern populations. In the present study, we conducted quantitative trait locus (QTL) mapping to investigate the genetic architecture underlying the variation in the number of papillary processes of Japanese medaka fish and compared the QTL with previously identified QTL controlling anal fin length. First, we found that only a few QTL were shared between anal fin length and papillary process number. Second, we found that the numbers of papillary processes on different fin rays often were controlled by different QTL. Finally, we produced another independent cross and found that some QTL were repeatable between the two crosses, whereas others were specific to only one cross. These results suggest that variation in the number of papillary processes is polygenic and controlled by QTL that are distinct from those controlling anal fin length. Thus, different courtship traits in Japanese medaka share a small number of QTL and have the potential for independent evolution. Copyright © 2015 Kawajiri et al.

Basal cell carcinoma of the skin with areas of squamous cell carcinoma: a basosquamous cell carcinoma?

OpenAIRE

de Faria, J

1985-01-01

The diagnosis of basosquamous cell carcinoma is controversial. A review of cases of basal cell carcinoma showed 23 cases that had conspicuous areas of squamous cell carcinoma. This was distinguished from squamous differentiation and keratotic basal cell carcinoma by a comparative study of 40 cases of compact lobular and 40 cases of keratotic basal cell carcinoma. Areas of intermediate tumour differentiation between basal cell and squamous cell carcinoma were found. Basal cell carcinomas with ...

Hallazgos ecográficos en la proctalgia espontánea y postoperatoria Ultrasound findings in spontaneous and postoperative anal pain

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I. Pascual

2008-12-01

Full Text Available Objetivo: valorar la utilidad de la ecografía endoanal como prueba de imagen para identificar la causa del dolor anal en los pacientes que presentan proctalgia idiopática o dolor postoperatorio y analizar cuáles son sus causas más frecuentes. Métodos: se realiza un estudio descriptivo de los hallazgos encontrados en las ecografías endoanales de pacientes con dolor anal en los últimos seis años. Todas las ecografías se llevaron a cabo con un ecógrafo B&K (Cheetah 2003, B&K Medical, Gentofte, Denmark con sonda endoanal de 7 MHz. Resultados: se estudiaron noventa y cinco casos de proctalgia mediante ecografía endoanal. Sesenta y siete correspondieron a pacientes con una cirugía previa perineal o pélvica tras la cual comenzó el dolor anal: 48 habían sido intervenidos de fisura anal, 12 de hemorroidectomía, 4 de episiotomía, 2 de fístula y 1 de prostatectomía. El hallazgo más frecuente tras la cirugía de fisura anal fue la presencia de una esfinterotomía incompleta. Entre los veintiocho pacientes sin cirugía previa, el 57,14% presentaba hipertrofia del esfínter anal interno como única alteración ecográfica. Conclusiones: los pacientes con proctalgia espontánea y postoperatoria pueden ser estudiados mediante ecografía endoanal ya que el uso de la sonda no impide completar la exploración. Con esta prueba se encontró una causa del dolor en el 81,93% de los casos. La hipertrofia del esfínter anal interno aislada es el hallazgo ecográfico más frecuente asociado a proctalgia espontánea.Objective: to assess the use of endoanal ultrasounds to identify anal pain etiology in patients with either spontaneous or postoperative pain, and to review the most frequent causes. Methods: a descriptive study of ultrasound findings in patients with anal pain during the last six years was performed. All ultrasound scans were performed using a B&K Diagnostic Ultrasound System (Cheetah 2003, B&K Medical, Gentofte, Denmark with a 7-MHz

High Prevalence of Anal Human Papillomavirus-Associated Cancer Precursors in a Contemporary Cohort of Asymptomatic HIV-Infected Women.

Science.gov (United States)

Heard, Isabelle; Etienney, Isabelle; Potard, Valérie; Poizot-Martin, Isabelle; Moore, Catherine; Lesage, Anne-Carole; Ressiot, Emmanuelle; Crenn-Hebert, Catherine; Fléjou, Jean-François; Cubie, Heather; Costagliola, Dominique; Darragh, Teresa M

2015-05-15

Although human immunodeficiency virus (HIV)-infected women are at high risk for anal cancer, few data have been published on prevalence of and risk factors for anal precancer and potential screening strategies in this risk group. A cross-sectional anal screening study was nested in a gynecological cohort of HIV-infected women. Anal swab specimens were collected for cytology and human papillomavirus (HPV) testing. High-resolution anoscopy, with biopsy when indicated, was systematically performed. Among the 171 enrolled women, median age was 47.3 years and 98% were receiving combination antiretroviral therapy. Median CD4(+) count was 655 cells/µL and HIV load was associated with increased risk of HG-AIN+. Abnormal anal cytology and HPV-16 infection performed best as a screening strategy for HG-AIN+ histology, with positive likelihood ratios of 3.4 (95% CI, 2.3-5.1) and 4.7 (95% CI, 2.5-8.7) and negative likelihood ratios of 0.2 (95% CI, .07-.8) and 0.4 (95% CI, .2-.9), respectively. HIV-infected women with a history of HPV-associated cervical disease are at increased risk for HG-AIN+ and should be offered anal cancer screening. Anal cytology and HPV-16 genotyping had the best screening performance. Anal cytology is easy to perform routinely; it may be the best candidate for screening for HG-AIN among HIV-infected women. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Multimodality approach to surgical management of locally advanced epidermoid carcinoma of the anorectum

International Nuclear Information System (INIS)

Wanebo, H.J.; Futrell, W.; Constable, W.

1981-01-01

Seven patients (five female, two male) had locally advanced epidermoid carcinoma of the anal canal. Three patients had recurrent or persistent disease previously treated and four had advanced primary cancer. Five patients had groin node metastasis. The treatment protocol consisted of chemotherapy with continuous 5-day infusion of 5-fluorouracil, 750 mg/m2, and mitomycin C, 15 mg/m2, by bolus injection and radiation 3000 rads. All patients received one or two cycles of chemotherapy pre-operatively and four (not previously irradiated) received radiation. Tumor regression greater than 50% occurred in five patients, minor regression (25-50%) occurred in one patient and one patient showed no regression (on chemotherapy alone). All patients had total resection of all gross tumor with microscopic clear margins and five had groin dissection. One patient had no residual cancer in specimen and one patient had a microscopic focus only. Four of five patients had residual nodal metastases at groin dissection. Currently three patients are free of disease at 24, 24, and 26 months. Two patients died with disease at 6 months and 34 months, and two patients died of other causes while still free of disease, at 4 and 5 months after resection. Multimodality therapy of locally advanced epidermoid cancer of anal canal can provide effective control and palliation of many of these tumors and, in some, possibly effect cure

Assessing the impact of FDG-PET in the management of anal cancer

International Nuclear Information System (INIS)

Nguyen, Brandon T.; Joon, Daryl Lim; Khoo, Vincent; Quong, George; Chao, Michael; Wada, Morikatsu; Joon, Michael Lim; See, Andrew; Feigen, Malcolm; Rykers, Kym; Kai, Cynleen; Zupan, Eddy; Scott, Andrew

2008-01-01

Purpose: To assess the utility of FDG-PET in anal cancer for staging and impact on radiotherapy planning (RTP), response and detection of recurrent disease. Methods and materials: Fifty histopathological anal cancer patients were reviewed between 1996 and 2006. The median age was 58 years (range 36-85) with 19 males:31females. Clinical assessment with CT was compared to PET. Impact on management, disease response, recurrence and metastases was evaluated. Results: The non-PET staging was Stage I(8), Stage II(18), Stage III(22), and Stage IV(2)s. The primary was strongly FDG avid in 98% with non-excised tumors compared to CT (58%). PET upstaged 17% with unsuspected pelvic/inguinal nodal disease. Pre-treatment PET identified 11 additional by involved nodal groups in 48 patients causing RTP amendments in 19%. Post-treatment PETs at median 17 weeks (range 9-28) showed complete responses in 20 (80%) and 5 (20%) partial responses (PR). PRs were biopsy positive in 2 and negative in 3. Fifteen had follow-up scans of which all nine PETs detected recurrences were pathologically confirmed. Conclusions: Anal cancer is FDG-PET avid. PET upstages 17% and changes the RTP in 19%. PET can aid in anal cancer staging and identification of residual disease, recurrent/metastatic disease but warrants further prospective studies

Prevalence and correlates of heterosexual anal and oral sex in adolescents and adults in the United States.

Science.gov (United States)

Leichliter, Jami S; Chandra, Anjani; Liddon, Nicole; Fenton, Kevin A; Aral, Sevgi O

2007-12-15

Heterosexual anal and oral sex are related to the acquisition of sexually transmitted infections, including human immunodeficiency virus infection. We examined the correlates of heterosexual anal and oral sex in the general population, using data from the National Survey of Family Growth. The sample included 12,571 men and women aged 15-44 years (79% response rate). One-third of men and women had ever had anal sex, and three-quarters had ever had oral sex. Condom use during last oral or anal sex was relatively uncommon. In separate models for men and women, having ever had anal sex was associated with white race, age of 20-44 years, and having had a non-monogamous sex partner. White race, age of 20-44 years, being married, and having higher numbers of lifetime sex partners were related to having ever given oral sex in men and women. Giving oral sex was associated with having a non-monogamous sex partner in men. Ever receiving oral sex was associated with white race and a non-monogamous sex partner in men and women. It would be beneficial to track the prevalence of heterosexual anal and oral sex and associated condom use on a more frequent basis.

The impact of anal sphincter injury on perceived body image.

Science.gov (United States)

Iles, David; Khan, Rabia; Naidoo, Kristina; Kearney, Rohna; Myers, Jenny; Reid, Fiona

2017-05-01

Obstetric anal sphincter injury is common but the effect on body image is unreported. The aim of this study was to explore patient perceived changes in body image and other psychological aspects in women attending a perineal follow-up clinic. This retrospective study analysed women's responses to a self-reported questionnaire. Consecutive women with anal sphincter injury who attended a United Kingdom Maternity Hospital perineal follow-up clinic between January 1999 and January 2012 were identified and the records obtained and reviewed. Multivariate regression analyses were performed to examine variables influencing self-reported change in body image. Questionnaires and operation notes were analysed from 422 women who attended at a median of four months after delivery. 222 (53%) reported a change in body image with 80 (19%) reporting lower self-esteem and 75 (18%) a change in their personality due to the change in body image. 248 (59%) perceived an anatomical change due to the delivery. Factors associated with increased likelihood of reporting a change in body image were reporting a perceived change in anatomy due to the delivery, adjusted OR 6.11 (3.56-10.49), anal incontinence, OR 1.97 (1.16-3.36), and delivery by forceps, OR 2.59 (1.23-5.43). This is the first study to quantify body image changes in women after anal sphincter injury sustained in childbirth. These were found to be very common, affecting up to 50% of women. The study has several limitations but it does highlight the significant psychosocial problems of negative self-esteem and personality changes associated with a perceived change in body image that has not previously been reported. It also outlines the further research questions that need to be addressed. Copyright © 2017 Elsevier B.V. All rights reserved.

Handedness is a biomarker of variation in anal sex role behavior and Recalled Childhood Gender Nonconformity among gay men.

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Swift-Gallant, Ashlyn; Coome, Lindsay A; Monks, D Ashley; VanderLaan, Doug P

2017-01-01

Developmental theories of the biological basis of sexual orientation suggest that sexually differentiated psychological and behavioural traits should be linked with sexual orientation. Subgroups of gay men delineated by anal sex roles differ according to at least one such trait: gender expression. The present study assessed the hypothesis that handedness, a biologically determined sexually differentiated trait, corresponds to differences in subgroups of gay men based on anal sex role. Furthermore, it assessed whether handedness mediates the association between gender nonconformity and male sexual orientation. Straight and gay men (N = 333) completed the Edinburgh Inventory of Handedness and the Recalled Childhood Gender Nonconformity Scale. Gay men also completed measures of anal sex role preference. As in previous studies, gay men showed greater non-right-handedness and gender nonconformity than straight men. Also, among gay men, bottoms/versatiles (i.e., gay men who take a receptive anal sex role, or who take on both a receptive and insertive anal sex role) were more gender-nonconforming than tops (i.e., gay men who take an insertive anal sex role). In support of the hypothesis, bottoms/versatiles were more non-right-handed than tops and handedness mediated the male sexual orientation and anal sex role differences in Recalled Childhood Gender Nonconformity. Together, these findings suggest that developmental processes linked to handedness underpin variation among men in sexual orientation and gender nonconformity as well as variation among subgroups of gay men that are delineated by anal sex roles.

Handedness is a biomarker of variation in anal sex role behavior and Recalled Childhood Gender Nonconformity among gay men.

Directory of Open Access Journals (Sweden)

Ashlyn Swift-Gallant

Full Text Available Developmental theories of the biological basis of sexual orientation suggest that sexually differentiated psychological and behavioural traits should be linked with sexual orientation. Subgroups of gay men delineated by anal sex roles differ according to at least one such trait: gender expression. The present study assessed the hypothesis that handedness, a biologically determined sexually differentiated trait, corresponds to differences in subgroups of gay men based on anal sex role. Furthermore, it assessed whether handedness mediates the association between gender nonconformity and male sexual orientation. Straight and gay men (N = 333 completed the Edinburgh Inventory of Handedness and the Recalled Childhood Gender Nonconformity Scale. Gay men also completed measures of anal sex role preference. As in previous studies, gay men showed greater non-right-handedness and gender nonconformity than straight men. Also, among gay men, bottoms/versatiles (i.e., gay men who take a receptive anal sex role, or who take on both a receptive and insertive anal sex role were more gender-nonconforming than tops (i.e., gay men who take an insertive anal sex role. In support of the hypothesis, bottoms/versatiles were more non-right-handed than tops and handedness mediated the male sexual orientation and anal sex role differences in Recalled Childhood Gender Nonconformity. Together, these findings suggest that developmental processes linked to handedness underpin variation among men in sexual orientation and gender nonconformity as well as variation among subgroups of gay men that are delineated by anal sex roles.

Handedness is a biomarker of variation in anal sex role behavior and Recalled Childhood Gender Nonconformity among gay men

Science.gov (United States)

Swift-Gallant, Ashlyn; Coome, Lindsay A.; Monks, D. Ashley; VanderLaan, Doug P.

2017-01-01

Developmental theories of the biological basis of sexual orientation suggest that sexually differentiated psychological and behavioural traits should be linked with sexual orientation. Subgroups of gay men delineated by anal sex roles differ according to at least one such trait: gender expression. The present study assessed the hypothesis that handedness, a biologically determined sexually differentiated trait, corresponds to differences in subgroups of gay men based on anal sex role. Furthermore, it assessed whether handedness mediates the association between gender nonconformity and male sexual orientation. Straight and gay men (N = 333) completed the Edinburgh Inventory of Handedness and the Recalled Childhood Gender Nonconformity Scale. Gay men also completed measures of anal sex role preference. As in previous studies, gay men showed greater non-right-handedness and gender nonconformity than straight men. Also, among gay men, bottoms/versatiles (i.e., gay men who take a receptive anal sex role, or who take on both a receptive and insertive anal sex role) were more gender-nonconforming than tops (i.e., gay men who take an insertive anal sex role). In support of the hypothesis, bottoms/versatiles were more non-right-handed than tops and handedness mediated the male sexual orientation and anal sex role differences in Recalled Childhood Gender Nonconformity. Together, these findings suggest that developmental processes linked to handedness underpin variation among men in sexual orientation and gender nonconformity as well as variation among subgroups of gay men that are delineated by anal sex roles. PMID:28234947

NMR imaging of the anal levator and sphincter muscles in anorectal malformations

International Nuclear Information System (INIS)

Aoyagi, Hiroshi; Takahashi, Hideyo; Maie, Masahiko; Ohnuma, Naomi; Etoh, Takao; Iwai, Jun

1986-01-01

Magnetic resonance imaging (MRI) of the anal levater and sphincter muscles was obtained on 4 normal volunteers and 11 patients with postoperative anorectal malformations (including 8 supra-levator type and 3 low type). Balloon catheter were inserted into the rectum and marked it as the center of a anal canal. Four normal subjects revealed the levater and sphincter muscles were thick and well developed in all sections (Sagittal, Transevse, Coronal). In most of the supra-levator type of anorectal malformations, thin levator and sphincter muscles were observed by Sagittal and Coronal scans. Transeverse scan revealed that the neorectum was not effectively pull-throughed into the puborectal muscle in one patient. Coronal scan showed the dameged external sphincter muscle. In three low types of anorectal malformations, the levator and the sphincter muscles were all well developed, but in one patient the external sphincter muscle existed at the posterior part of the anal canal. These observations were usefull in managing the postoperative care of anorectal malformations. (author)

SIA „Origami” saimnieciskās darbības analīze

OpenAIRE

Skalbiņš, Verners

2014-01-01

Bakalaura darba tēma ir „SIA „Origami” saimnieciskās darbības analīze”. Darbā apskatītais uzņēmums ir poligrāfijas nozares uzņēmums, kas specializējas lielformāta drukas jomā. Darba mērķis ir identificēt uzņēmuma stiprās un vājās puses, un izstrādāt priekšlikumus tā attīstībai un uzlabošanai. Mērķa sasniegšanai izvirzīti sekojoši uzdevumi: izpētīt uzņēmuma analīzes veikšanai nepieciešamo teorētisko bāzi, uz tās balstoties veikt uzņēmuma analīzi, kā arī izstrādāt secinājumus par līdzšinējo ...

Disorders of the pelvic floor and anal sphincters; a gastroenterologist’s perspective

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Eamonn M.M. Quigley, MD FRCP FACP FACG FRCPI

2013-03-01

Full Text Available The integration and coordination of the musculature of the pelvic floor and the anal sphincters is critical to two important physiological functions: defecation and continence. Consequently, disorders affecting the pelvic floor muscles, the anal sphincters, their innervation or their precise coordination will, depending on their nature, result either in obstructed defecation or fecal incontinence. Both of these disorders are much more common in females and the latter, in particular, is linked with parity. While the symptomatology, presentation and optimal mode of investigation of fecal incontinence are well standardized, considerable debate and controversy continues to surround the contributions of pelvic floor and anal sphincter dysfunction to chronic constipation and the optimal clinical approach to their investigation remains to be defined. In appropriately chosen cases surgical intervention may provide the best outcome for sufferers from incontinence; biofeedback approaches may be of value in both incontinence and obstructed defecation and surgery has little role to play in the latter.

Detekce útoku DNS Amplification z pasivní analýzy DNS provozu

OpenAIRE

Míšaný, Daniel

2014-01-01

Táto práce je zaměřená na analýzu a detekci útoku DNS amplification, který patří mezi útoky typu DoS. Úvod práce je zaměřený na základní teorii zahrnující počítačové sítě, službu DNS a útoky typu DoS. Větší část práce se zabývá analýzou útoku DNS amplification, návrhem a implementací nástroje pro detekci v jazyce C++. Závěr je věnovaný analýze výsledků detekčního nástroje. This thesis is focused on the analysis and detection of DNS Amplification attack which is type of the DoS attack. Intr...

Võlur Ozi eksperimentide kogumine ja partneri algatatud paranduste analüüs

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Siiri Pärkson

2011-05-01

Full Text Available 2009. aastal viidi Eestis läbi teine võlur Ozi kirjalike eksperimentide seeria ning käesolev artikkel annab ülevaate eksperimentide korraldamisest ning kogutud dialoogide partneri algatatud paranduste analüüsimise tulemustest. Katseisikutel paluti testida interneti veebilehel asuvat programmi Aivo, mis on suuteline suhtlema inimesega kirjalikus eesti keeles. Tegelikkuses vastas inimeste küsimustele interneti vahendusel eksperimendi läbiviija (võlur Oz. Kogutud dialooge on analüüsitud toetudes vestlusanalüüsi meetodi mõistestikule. Tartu Ülikoolis välja töötatud dialoogiaktide tüpoloogia järgi jaguneb partneri algatatud parandus üleküsimiseks, ümbersõnastamiseks ja mittemõistmiseks. Artiklis analüüsitakse näidetele toetudes eelnimetatud kolme partneri algatatud paranduse esinemist kogutud dialoogides, pidades silmas tulevikus loodavaid reaalseid dialoogsüsteeme, mis suudaksid arvutikasutajaga suhelda loomulikus eesti keeles. http://dx.doi.org/10.5128/ERYa7.12

Significance of the thickness of the anal sphincters with age and its relevance in faecal incontinence.

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Papachrysostomou, M; Pye, S D; Wild, S R; Smith, A N

1994-08-01

Ultrasonographic studies in healthy volunteers showed that the external anal sphincter (EAS) and internal anal sphincter (IAS) thicknesses were inversely related at rest. The functional importance of the two sphincters in continence control was demonstrated in the relationship between the sum of the thicknesses of the two sphincters and the anal canal resting pressure. The aims of the present study were to assess the morphometric appearance of the anal sphincters by endosonography in faecally incontinent patients and to contrast this with that of older healthy subjects. Twenty-eight female patients with neurogenic faecal incontinence (FI) were studied. An older group of 7 healthy women, aged 41-75 years, and a young group of 11 nulliparous healthy women, aged 20-23 years, served as control groups. Anal endosonography was performed with a radial rotating endoprobe, with the subject in the left lateral position. Conventional anal manometry was performed in all subjects. The EAS in the FI group was thicker than the EAS in the old (p IAS thickness in the FI group did not differ from that in the older group. In both these groups the IAS was thicker than in the young women (p IAS in the FI group does not seem to compensate for function and results in a failure of the sphincter mechanism to maintain continence, whereas in healthy elderly subjects the increased IAS thickness appears to be compensatory and important for continence control.

Papillary carcinoma

International Nuclear Information System (INIS)

Shah, D.H.; Samuel, A.M.

1999-01-01

Papillary carcinoma of the thyroid (PTC) constitutes a major proportion of all thyroid cancers and is generally believed to be a slow growing tumor with an indolent course. The diagnosis of PTC often makes the physician overly optimistic and complacent and yet this tumor can be aggressive in a subset of patients leading to death in a few months. The fundamental but subtle differences underlying the extremes in biologic behaviour of this complex and fascinating tumor remain poorly understood. Although there is a general agreement among the investigators regarding prognostic factors, controversy exists about the management of the disease. There is divided opinion with respect to the type and extent of surgery and the need for radioiodine (1 31 I) treatment in case of PTC. The experiences at Radiation Medicine Centre (RMC) of 1904 cases of differentiated thyroid carcinoma (DTC) registered during the period 1963-1990 are reviewed

Patterns of repeated anal cytology results among HIV-positive and HIV-negative men who have sex with men

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Hilary A. Robbins

2018-06-01

Full Text Available Background: Men who have sex with men (MSM are at increased risk for anal cancer. In cervical cancer screening, patterns of repeated cytology results are used to identify low- and high-risk women, but little is known about these patterns for anal cytology among MSM. Methods: We analyzed Multicenter AIDS Cohort Study (MACS data for MSM who were offered anal cytology testing annually (HIV-positive or every 2 years (HIV-negative for 4 years. Results: Following an initial negative (normal cytology, the frequency of a second negative cytology was lower among HIV-positive MSM with CD4 ≥ 500 (74% or CD4 < 500 (68% than HIV-negative MSM (83% (p < 0.001. After an initial abnormal cytology, the frequency of a second abnormal cytology was highest among HIV-positive MSM with CD4 < 500 (70% compared to CD4 ≥ 500 (53% or HIV-negative MSM (46% (p = 0.003. Among HIV-positive MSM with at least three results, 37% had 3 consecutive negative results; 3 consecutive abnormal results were more frequent among CD4 < 500 (22% than CD4 ≥ 500 (10% (p = 0.008. Conclusions: More than one-third of HIV-positive MSM have consistently negative anal cytology over three years. Following abnormal anal cytology, a repeated cytology is commonly negative in HIV-negative or immunocompetent HIV-positive men, while persistent cytological abnormality is more likely among HIV-positive men with CD4 < 500. Keywords: Anal cancer, Anal cytology, HIV, MSM, Anal cancer screening

Multidisciplinary training in perineal care during labor and delivery for the reduction of anal sphincter injuries.

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Frost, Jonathan; Gundry, Rowan; Young, Helen; Naguib, Adel

2016-08-01

To determine whether the introduction of a multidisciplinary intrapartum perineal-care training program reduced the rate of obstetric anal sphincter injuries in patients undergoing vaginal deliveries. A prospective observational cohort study enrolled women undergoing vaginal deliveries at a district general hospital maternity unit in the United Kingdom between April 1, 2012 and March 31, 2014. All women experiencing obstetric anal sphincter injuries during the study period were identified and the rate of obstetric anal sphincter injuries before (2012-2013) a multidisciplinary training program was implemented was compared with the rate after (2013-2014) implementation using logistic regression analysis. The study enrolled 4920 patients. Following the implementation of the training program, the rate of obstetric anal sphincter injuries decreased from 4.8% to 3.1% of vaginal deliveries (odds ratio 0.66; 95% confidence interval 0.493-0.899; P = 0.008). The integration of intrapartum perineal-care training into mandatory annual staff training was associated with a statistically and clinically significant reduction in the rate of obstetric anal sphincter injuries. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Clinical experiences with Curietron after-loading apparatus in patients with gynecological carcinomas

International Nuclear Information System (INIS)

Vigvary, Zoltan; Csoemoer, Sandor; Feher, Laszlo; Hintalan, Albert; Semmelweis Orvostudomanyi Egyetem, Budapest

1985-01-01

On the basis of experiences the afterloading method using sup(137)Cs source with activities between 15 and 19.2 mCi seems to be effective in a large number of cervix-corpus carcinomas, when the parameters are identified exactly, and correspond with the admissible dose. By the individual dose planning a tumour dose under the threshold limit on the wall of the bladder and rectum can be achieved. According to calculations it is between 5-30 Gy on the posterior wall of the bladder, and 15-35 Gy on the anterior wall of rectum. The patients tolerate well the relatively long duration of treatment (48-60 hs) with the help of mild sedatives. The small intestines are considerably safe by this low R/min protracted method. These explain the lack of complications in the intestines. The application, the localization and the nursing can be performed in radiation-free environment. (author)

The increasing incidence of anal cancer: can it be explained by trends in risk groups?

NARCIS (Netherlands)

van der Zee, R. P.; Richel, O.; de Vries, H. J. C.; Prins, J. M.

2013-01-01

Anal cancer incidence is gradually increasing. The cause of this increase is not exactly known. This systematic literature review aimed to investigate the trend in time of anal cancer incidence and to find an explanation for the supposed increase. The TRIP database and PubMed were searched for

Event-Level Analysis of Anal Sex Roles and Sex Drug Use Among Gay and Bisexual Men in Vancouver, British Columbia, Canada.

Science.gov (United States)

Rich, Ashleigh J; Lachowsky, Nathan J; Cui, Zishan; Sereda, Paul; Lal, Allan; Moore, David M; Hogg, Robert S; Roth, Eric A

2016-08-01

This study analyzed event-level partnership data from a computer-assisted survey of 719 gay and bisexual men (GBM) enrolled in the Momentum Health Study to delineate potential linkages between anal sex roles and the so-called "sex drugs," i.e., erectile dysfunction drugs (EDD), poppers, and crystal methamphetamine. Univariable and multivariable analyses using generalized linear mixed models with logit link function with sexual encounters (n = 2514) as the unit of analysis tested four hypotheses: (1) EDD are significantly associated with insertive anal sex roles, (2) poppers are significantly associated with receptive anal sex, (3) both poppers and EDD are significantly associated with anal sexual versatility, and (4) crystal methamphetamine is significantly associated with all anal sex roles. Data for survey respondents and their sexual partners allowed testing these hypotheses for both anal sex partners in the same encounter. Multivariable results supported the first three hypotheses. Crystal methamphetamine was significantly associated with all anal sex roles in the univariable models, but not significant in any multivariable ones. Other multivariable significant variables included attending group sex events, venue where first met, and self-described sexual orientation. Results indicate that GBM sex-drug use behavior features rational decision-making strategies linked to anal sex roles. They also suggest that more research on anal sex roles, particularly versatility, is needed, and that sexual behavior research can benefit from partnership analysis.

Anal Canal Cancer: Management of Inguinal Nodes and Benefit of Prophylactic Inguinal Irradiation (CORS-03 Study)

International Nuclear Information System (INIS)

Ortholan, Cécile; Resbeut, Michel; Hannoun-Levi, Jean-Michel; Teissier, Eric; Gerard, Jean-Pierre; Ronchin, Philippe; Zaccariotto, Audrey; Minsat, Mathieu; Benezery, Karen; François, Eric; Salem, Naji; Ellis, Steve; Azria, David; Champetier, Cédric; Gross, Emmanuel; Cowen, Didier

2012-01-01

Purpose: To evaluate the benefit of prophylactic inguinal irradiation (PII) in anal canal squamous cell carcinoma (ASCC). Methods and Materials: This retrospective study analyzed the outcome of 208 patients presenting with ASCC treated between 2000 and 2004 in four cancer centers of the south of France. Results: The population study included 35 T1, 86 T2, 59 T3, 20 T4, and 8 T stage unknown patients. Twenty-seven patients presented with macroscopic inguinal node involvement. Of the 181 patients with uninvolved nodes at presentation, 75 received a PII to a total dose of 45–50 Gy (PII group) and 106 did not receive PII (no PII group). Compared with the no PII group, patients in the PII group were younger (60% vs. 41% of patients age 2 toxicity of the lower extremity was observed. Conclusion: PII with a dose of 45 Gy is safe and highly efficient to prevent inguinal recurrence and should be recommended for all T3-4 tumors. For early-stage tumors, PII should also be discussed, because the 5-year inguinal recurrence risk remains substantial when omitting PII (about 10%).

Programmed death-ligand 1 expression correlates with diminished CD8+ T cell infiltration and predicts poor prognosis in anal squamous cell carcinoma patients

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Zhao Y

2017-12-01

Full Text Available Yu-Jie Zhao,1 Wei-Peng Sun,2 Jian-Hong Peng,1 Yu-Xiang Deng,1 Yu-Jing Fang,1 Jun Huang,2 Hui-Zhong Zhang,3 De-Sen Wan,1 Jun-Zhong Lin,1,* Zhi-Zhong Pan,1,* 1Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 2Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, 3Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China *These authors contributed equally to this work Objective: Increased expression of programmed death-ligand 1 (PD-L1 on tumor cells can be found in various malignancies; however, very limited information is known about its role in anal squamous cell carcinoma (ASCC. This study explored PD-L1 expression in ASCC patients and its association with patients’ clinicopathological features, CD8+ T cell infiltration, and prognosis.Methods: Formalin-fixed paraffin-embedded tumor samples from 26 patients with ASCC were retrieved. The levels of PD-L1 expression on the membrane of both tumor cells and tumor-infiltrating mononuclear cells (TIMCs were evaluated by immunohistochemistry. CD8+ T cell densities, both within tumors and at the tumor–stromal interface, were also analyzed. Baseline clinicopathological characteristics, human papilloma virus (HPV status, and outcome data correlated with PD-L1-positive staining.Results: PD-L1 expression on tumor cells and TIMCs was observed in 46% and 50% of patients, respectively. Nineteen patients (73% were HPV positive, with 7 showing PD-L1-positive staining on tumor cells and 9 showing PD-L1-positive staining on TIMCs. Increasing CD8+ density within tumors, but not immune stroma, was significantly associated with decreased PD-L1 expression by both tumor cells and TIMCs (P=0.0043 and P=0.0007. Patients with negative PD-L1 expression had significantly better progression-free survival (P=0.038 and P

Histopathologic observations of anorectal abnormalities in anal atresia.

Science.gov (United States)

Meier-Ruge, W A; Holschneider, A M

2000-01-01

Over the years from 1992 to 1997, 41 anorectal malformations (ARM) with histopathologic alterations were investigated to determine which morphologic abnormalities of the distal rectum accompany ARMs. Three other cases showed normal neuromuscular morphology; 9 further cases could not be evaluated owing to scanty biopsies. All resected specimens were caudocranially coiled and cryostat cut at -20 degrees C into serial sections, which were stained with a lactic dehydrogenase, succinic dehydrogenase, nitroxide synthase, and acetylcholinesterase reaction as well as hemalum and sirius red. Ten low, 15 intermediate, and 10 high forms of anal atresia (AA) were studied. In addition, six cloacal abnormalities were investigated. In 7 cases (17%) (5 intermediate, 2 low AAs), the characteristics of Hirschsprung's disease were observed. Oligoneuronal hypoganglionosis of the myenteric plexus proximal to the anal floor was diagnosed in 7 AAs (12%). In 10 children with high-type AA and resection of 1-5 cm distal rectum and in all cloacal anomalies (n = 6) defects of the muscularis propria were seen in the rectal-atresia sac. These defects were characterized by hypoplasia of the circular-muscle layer and/or the internal anal sphincter (IAS). Intestinal neuronal dysplasia of the submucous plexus was most frequently observed (12%) in high-type AA. A correlation between innervation anomalies or anomalies of the muscularis propria and the type of fistula could not be seen. In conclusion, all cases with high-type AA and cloacal anomalies were characterized by anomalies of the muscularis propria and/or IAS but this was not the case in intermediate and low-type AAs. Anomalies of the enteric nervous system were diagnosed in 60% of AAs.

RTOG 0529: A Phase 2 Evaluation of Dose-Painted Intensity Modulated Radiation Therapy in Combination With 5-Fluorouracil and Mitomycin-C for the Reduction of Acute Morbidity in Carcinoma of the Anal Canal

Energy Technology Data Exchange (ETDEWEB)

Kachnic, Lisa A., E-mail: lisa.kachnic@bmc.org [Department of Radiation Oncology, Boston University Medical Center, Boston, Massachusetts (United States); Winter, Kathryn [Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States); Myerson, Robert J. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Goodyear, Michael D. [Department of Medicine, Dalhousie University, Halifax (Canada); Willins, John [Department of Radiation Oncology, Boston University Medical Center, Boston, Massachusetts (United States); Esthappan, Jacqueline [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Haddock, Michael G. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Rotman, Marvin [Department of Radiation Oncology, State University of New York—Downstate Medical Center, Brooklyn, New York (United States); Parikh, Parag J. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Safran, Howard [Department of Medicine, Brown University, Providence, Rhode Island (United States); Willett, Christopher G. [Department of Radiation Oncology, Duke University, Durham, North Carolina (United States)

2013-05-01

Purpose: A multi-institutional phase 2 trial assessed the utility of dose-painted intensity modulated radiation therapy (DP-IMRT) in reducing grade 2+ combined acute gastrointestinal and genitourinary adverse events (AEs) of 5-fluorouracil (5FU) and mitomycin-C (MMC) chemoradiation for anal cancer by at least 15% compared with the conventional radiation/5FU/MMC arm from RTOG 9811. Methods and Materials: T2-4N0-3M0 anal cancer patients received 5FU and MMC on days 1 and 29 of DP-IMRT, prescribed per stage: T2N0, 42 Gy elective nodal and 50.4 Gy anal tumor planning target volumes (PTVs) in 28 fractions; T3-4N0-3, 45 Gy elective nodal, 50.4 Gy ≤3 cm or 54 Gy >3 cm metastatic nodal and 54 Gy anal tumor PTVs in 30 fractions. The primary endpoint is described above. Planned secondary endpoints assessed all AEs and the investigator’s ability to perform DP-IMRT. Results: Of 63 accrued patients, 52 were evaluable. Tumor stage included 54% II, 25% IIIA, and 21% IIIB. In primary endpoint analysis, 77% experienced grade 2+ gastrointestinal/genitourinary acute AEs (9811 77%). There was, however, a significant reduction in acute grade 2+ hematologic, 73% (9811 85%, P=.032), grade 3+ gastrointestinal, 21% (9811 36%, P=.0082), and grade 3+ dermatologic AEs 23% (9811 49%, P<.0001) with DP-IMRT. On initial pretreatment review, 81% required DP-IMRT replanning, and final review revealed only 3 cases with normal tissue major deviations. Conclusions: Although the primary endpoint was not met, DP-IMRT was associated with significant sparing of acute grade 2+ hematologic and grade 3+ dermatologic and gastrointestinal toxicity. Although DP-IMRT proved feasible, the high pretreatment planning revision rate emphasizes the importance of real-time radiation quality assurance for IMRT trials.

Prevalence of cutaneous beta and gamma human papillomaviruses in the anal canal of men who have sex with women

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Vitaly Smelov

2017-06-01

Full Text Available Background: Data regarding anal cutaneous HPV detection among HIV-positive and HIV-negative persons largely relies on studies among men who have sex with men in limited geographical settings. Understanding the distribution, determinants, and potential human health effects of anal cutaneous HPV types among men who have sex with women (MSW is important. Methods: Anal canal swab samples from 415 Russian MSW (384 HIV-negative and 31 HIV-positive were tested for 43 β-HPVs and 29 γ-HPVs, using a multiplex PCR combined with Luminex technology. Results: β-HPV was detected in 24.4% and γ-HPV in 15.9% of anal samples of all Russian MSW. In total, 34 β-HPV and 19 γ-HPV types were detected, with the most commonly detected β-HPV types being 110, 22 and 124 and the most common γ-HPV types being 95, 132 and 50. For both genera, being HIV-positive at the time of testing was a significant determinant of detection (74.2% for β-HPVs and 48.4% for γ-HPVs compared to 20.1% and 12.5% in HIV-negative MSW, respectively. Conclusions: A wide spectrum and moderate prevalence of anal β-HPV and γ-HPV types was found in our MSW study sample, suggesting that routes other than penile-anal intercourse may be important in cutaneous HPV transmission. Keywords: Anal cutaneous HPV, Beta-HPV, Gamma-HPV, HIV-negative MSW, Penile-anal, HPV transmission

Behavioral and psychosocial correlates of anal sex among male clients of female sex workers in Tijuana, Mexico.

Science.gov (United States)

Semple, Shirley J; Strathdee, Steffanie A; Pitpitan, Eileen V; Chavarin, Claudia; Patterson, Thomas L

2015-05-01

Most studies of heterosexual sex risk practices have focused on condomless vaginal sex despite evidence that condomless anal sex has a significantly higher risk of HIV transmission. The present study focused on male clients' anal sex practices with female sex workers (FSWs) in Tijuana, Mexico, where an HIV epidemic is growing among high-risk groups. Logistic regression analyses were used to identify psychosocial and behavioral correlates of anal sex among male clients. Our sample of HIV-negative men (N = 400) was predominantly Latino (87.5 %), born in Mexico (78.8 %), never married (36.8 %) or in a regular or common-law marriage (31.5 %), and employed (62.8 %), with an average age and education of 37.8 and 9.2 years, respectively. Eighty-nine percent identified as heterosexual and 11 % as bisexual. By design, 50 % of the sample resided in Tijuana and the other 50 % in San Diego County. Nearly half (49 %) reported at least one incident of anal sex with a FSW in Tijuana in the past 4 months; of those participants, 85 % reported that one or more of their anal sex acts with FSWs had been without a condom. In a multivariate model, anal sex with a FSW in the past 4 months was associated with bisexual identification, methamphetamine use with FSWs, repeat visits to the same FSW, higher scores on perceived stigma about being a client of FSWs, and sexual compulsivity. Prevention programs are needed that address the behavioral and psychosocial correlates of heterosexual anal sex in order to reduce HIV/STI transmission risk among male clients, FSWs, and their sexual network members.

Anal Cytology and Human Papillomavirus Genotyping in Women With a History of Lower Genital Tract Neoplasia Compared With Low-Risk Women.

Science.gov (United States)

Robison, Katina; Cronin, Beth; Bregar, Amy; Luis, Christine; DiSilvestro, Paul; Schechter, Steven; Pisharodi, Latha; Raker, Christina; Clark, Melissa

2015-12-01

To compare the prevalence of abnormal anal cytology and high-risk human papillomavirus (HPV) among women with a history of HPV-related genital neoplasia with women without a history of HPV-related genital neoplasia. A cross-sectional cohort study was performed from December 2012 to February 2014. Women were recruited from outpatient clinics at an academic medical center. Women with a history of high-grade cervical, vulvar, or vaginal cytology, dysplasia, or cancer were considered the high-risk group. Women with no history of high-grade anogenital dysplasia or cancer were considered the low-risk group. Human immunodeficiency virus-positive women were excluded. Anal cytology and HPV genotyping were performed. Women with abnormal anal cytology were referred for high-resolution anoscopy. There were 190 women in the high-risk group and 83 in the low-risk group. The high-risk group was slightly older: 57 years compared with 47 years (P=.045); 21.7% of low-risk women had abnormal anal cytology compared with 41.2% of high-risk women (P=.006). High-risk HPV was detected in the anal canal of 1.2% of the low-risk group compared with 20.8% of the high-risk group (PHuman immunodeficiency virus-negative women with a history of lower genital tract neoplasia are more likely to have positive anal cytology, anal high-risk HPV, and anal intraepithelial neoplasia. Anal cancer screening should be considered for these high-risk women. II.

Gastric Metastasis of Triple Negative Invasive Lobular Carcinoma.

Science.gov (United States)

Geredeli, Caglayan; Dogru, Osman; Omeroglu, Ethem; Yilmaz, Farise; Cicekci, Faruk

2015-05-05

Invasive lobular carcinomas are the second most common type (5% to 15%) of invasive breast carcinomas. The most frequent sites of breast cancer metastasis are the local and distant lymph nodes, brain, lung, liver, and bones; metastasis to the gastrointestinal system, especially to the stomach, is rare. When a mass is detected in an unusual place in a patient with invasive lobular carcinoma, it should be kept in mind that such a mass may be either a second primary carcinoma or the metastasis of an invasive lobular carcinoma. In this report, we present a case of gastric metastasis from triple-negative invasive lobular breast cancer. It is important to make an accurate diagnosis by distinguishing gastric metastasis from breast cancer in order to select the best initial treatment for systemic diseases of breast cancer. Considering our case, healthcare professionals should take into account that cases with invasive lobular breast cancer may experience unusual metastases.

Hand-assisted hybrid laparoscopic-robotic total proctocolectomy with ileal pouch--anal anastomosis.

Science.gov (United States)

Morelli, Luca; Guadagni, Simone; Mariniello, Maria Donatella; Furbetta, Niccolò; Pisano, Roberta; D'Isidoro, Cristiano; Caprili, Giovanni; Marciano, Emanuele; Di Candio, Giulio; Boggi, Ugo; Mosca, Franco

2015-08-01

Few studies have reported minimally invasive total proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). We herein report a novel hand-assisted hybrid laparoscopic-robotic technique for patients with FAP and UC. Between February 2010 and March 2014, six patients underwent hand-assisted hybrid laparoscopic-robotic total proctocolectomy with IPAA. The abdominal colectomy was performed laparoscopically with hand assistance through a transverse suprapubic incision, also used to fashion the ileal pouch. The proctectomy was carried out with the da Vinci Surgical System. The IPAA was hand-sewn through a trans-anal approach. The procedure was complemented by a temporary diverting loop ileostomy. The mean hand-assisted laparoscopic surgery (HALS) time was 154.6 (±12.8) min whereas the mean robotic time was 93.6 (±8.1) min. In all cases, a nerve-sparing proctectomy was performed, and no conversion to traditional laparotomy was required. The mean postoperative hospital stay was 13.2 (±7.4) days. No anastomotic leakage was observed. To date, no autonomic neurological disorders have been observed with a mean of 5.8 (±1.3) bowel movements per day. The hand-assisted hybrid laparoscopic-robotic approach to total proctocolectomy with IPAA has not been previously described. Our report shows the feasibility of this hybrid approach, which surpasses most of the limitations of pure laparoscopic and robotic techniques. Further experience is necessary to refine the technique and fully assess its potential advantages.

Analüütilised voolud psühholoogias ja nende rakendamine pedagoogikas / Aleksander Elango

Index Scriptorium Estoniae

Elango, Aleksander, 1902-2004

2001-01-01

Analüütise psühholoogia kolm koolkonda - S.Freudì koolkond e. päris-psühhoanalüüs, A.Adlerì koolkond e. individuaalpsühholoogia ja C.G.Jungì psühhoanalüüsi ja individuaalpsühholoogia sünteesi luua püüdev koolkond. Analüütise psühholoogia koolkondade ja pedagoogika suhetest

Carcinoma of the so-called empty breast and its relation to the Wolfe's parenchymal classification

International Nuclear Information System (INIS)

Schwarz, E.; Eiter, H.; Taxer, F.

1983-01-01

Carcinoma in the ''empty breast'' in our experience is so common that we doubt Wolfe's conclusions in his classification of parenchymal patterns. Amongst patients over 60 years, almost 70% of carcinomas were situated in an ''empty'' parenchyma and they did not develop in a parechymal group above P1. Mammographically, the ''empty breast'' is the structureless fatty breast of older women after the menopause. Some authors believe that there is a lower incidence of carcinomas in this type of breast than in other types of parenchyma, such as those showing mastopathies. Our experience concerning carcinomas in involuted breasts is described. (orig.) [de

De chirurgische betekenis van de inwendige kringspier van het anale kanaal : een klinisch en manometrisch onderzoek

NARCIS (Netherlands)

W.R. Schouten (Ruud)

1990-01-01

textabstractThe high pressure zone within the anal canal is largely due to the activity of the internal anal sphincter and provides an effective barrier against rectal pressure. The continuous contraction of the internal sphincter also has a congesting effect on the vascular cushions, thereby

Design of sEMG assembly to detect external anal sphincter activity: a proof of concept.

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Shiraz, Arsam; Leaker, Brian; Mosse, Charles Alexander; Solomon, Eskinder; Craggs, Michael; Demosthenous, Andreas

2017-10-31

Conditional trans-rectal stimulation of the pudendal nerve could provide a viable solution to treat hyperreflexive bladder in spinal cord injury. A set threshold of the amplitude estimate of the external anal sphincter surface electromyography (sEMG) may be used as the trigger signal. The efficacy of such a device should be tested in a large scale clinical trial. As such, a probe should remain in situ for several hours while patients attend to their daily routine; the recording electrodes should be designed to be large enough to maintain good contact while observing design constraints. The objective of this study was to arrive at a design for intra-anal sEMG recording electrodes for the subsequent clinical trials while deriving the possible recording and processing parameters. Having in mind existing solutions and based on theoretical and anatomical considerations, a set of four multi-electrode probes were designed and developed. These were tested in a healthy subject and the measured sEMG traces were recorded and appropriately processed. It was shown that while comparatively large electrodes record sEMG traces that are not sufficiently correlated with the external anal sphincter contractions, smaller electrodes may not maintain a stable electrode tissue contact. It was shown that 3 mm wide and 1 cm long electrodes with 5 mm inter-electrode spacing, in agreement with Nyquist sampling, placed 1 cm from the orifice may intra-anally record a sEMG trace sufficiently correlated with external anal sphincter activity. The outcome of this study can be used in any biofeedback, treatment or diagnostic application where the activity of the external anal sphincter sEMG should be detected for an extended period of time.

Preoperative Therapy for Lower Rectal Cancer and Modifications in Distance From Anal Sphincter

International Nuclear Information System (INIS)

Gavioli, Margherita; Losi, Lorena; Luppi, Gabriele; Iacchetta, Francesco; Zironi, Sandra; Bertolini, Federica; Falchi, Anna Maria; Bertoni, Filippo; Natalini, Gianni

2007-01-01

Purpose: To assess the frequency and magnitude of changes in lower rectal cancer resulting from preoperative therapy and its impact on sphincter-saving surgery. Preoperative therapy can increase the rate of preserving surgery by shrinking the tumor and enhancing its distance from the anal sphincter. However, reliable data concerning these modifications are not yet available in published reports. Methods and Materials: A total of 98 cases of locally advanced cancer of the lower rectum (90 Stage uT3-T4N0-N+ and 8 uT2N+M0) that had undergone preoperative therapy were studied by endorectal ultrasonography. The maximal size of the tumor and its distance from the anal sphincter were measured in millimeters before and after preoperative therapy. Surgery was performed 6-8 weeks after therapy, and the histopathologic margins were compared with the endorectal ultrasound data. Results: Of the 90 cases, 82.5% showed tumor downsizing, varying from one-third to two-thirds or more of the original tumor mass. The distance between the tumor and the anal sphincter increased in 60.2% of cases. The median increase was 0.73 cm (range, 0.2-2.5). Downsizing was not always associated with an increase in distance. Preserving surgery was performed in 60.6% of cases. It was possible in nearly 30% of patients in whom the cancer had reached the anal sphincter before the preoperative therapy. The distal margin was tumor free in these cases. Conclusion: The results of our study have shown that in very low rectal cancer, preoperative therapy causes tumor downsizing in >80% of cases and in more than one-half enhances the distance between the tumor and anal sphincter. These modifications affect the primary surgical options, facilitating or making sphincter-saving surgery possible

The use of P63 immunohistochemistry for the identification of squamous cell carcinoma of the lung.

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Esther Conde

Full Text Available INTRODUCTION: While some targeted agents should not be used in squamous cell carcinomas (SCCs, other agents might preferably target SCCs. In a previous microarray study, one of the top differentially expressed genes between adenocarcinomas (ACs and SCCs is P63. It is a well-known marker of squamous differentiation, but surprisingly, its expression is not widely used for this purpose. Our goals in this study were (1 to further confirm our microarray data, (2 to analize the value of P63 immunohistochemistry (IHC in reducing the number of large cell carcinoma (LCC diagnoses in surgical specimens, and (3 to investigate the potential of P63 IHC to minimize the proportion of "carcinoma NOS (not otherwise specified" in a prospective series of small tumor samples. METHODS: With these goals in mind, we studied (1 a tissue-microarray comprising 33 ACs and 99 SCCs on which we performed P63 IHC, (2 a series of 20 surgically resected LCCs studied for P63 and TTF-1 IHC, and (3 a prospective cohort of 66 small thoracic samples, including 32 carcinoma NOS, that were further classified by the result of P63 and TTF-1 IHC. RESULTS: The results in the three independent cohorts were as follows: (1 P63 IHC was differentially expressed in SCCs when compared to ACs (p<0.0001; (2 half of the 20 (50% LCCs were positive for P63 and were reclassified as SCCs; and (3 all P63 positive cases (34% were diagnosed as SCCs. CONCLUSIONS: P63 IHC is useful for the identification of lung SCCs.

The Use of P63 Immunohistochemistry for the Identification of Squamous Cell Carcinoma of the Lung

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Conde, Esther; Angulo, Bárbara; Redondo, Pilar; Toldos, Oscar; García-García, Elena; Suárez-Gauthier, Ana; Rubio-Viqueira, Belén; Marrón, Carmen; García-Luján, Ricardo; Sánchez-Céspedes, Montse; López-Encuentra, Angel; Paz-Ares, Luis; López-Ríos, Fernando

2010-01-01

Introduction While some targeted agents should not be used in squamous cell carcinomas (SCCs), other agents might preferably target SCCs. In a previous microarray study, one of the top differentially expressed genes between adenocarcinomas (ACs) and SCCs is P63. It is a well-known marker of squamous differentiation, but surprisingly, its expression is not widely used for this purpose. Our goals in this study were (1) to further confirm our microarray data, (2) to analize the value of P63 immunohistochemistry (IHC) in reducing the number of large cell carcinoma (LCC) diagnoses in surgical specimens, and (3) to investigate the potential of P63 IHC to minimize the proportion of “carcinoma NOS (not otherwise specified)” in a prospective series of small tumor samples. Methods With these goals in mind, we studied (1) a tissue-microarray comprising 33 ACs and 99 SCCs on which we performed P63 IHC, (2) a series of 20 surgically resected LCCs studied for P63 and TTF-1 IHC, and (3) a prospective cohort of 66 small thoracic samples, including 32 carcinoma NOS, that were further classified by the result of P63 and TTF-1 IHC. Results The results in the three independent cohorts were as follows: (1) P63 IHC was differentially expressed in SCCs when compared to ACs (p<0.0001); (2) half of the 20 (50%) LCCs were positive for P63 and were reclassified as SCCs; and (3) all P63 positive cases (34%) were diagnosed as SCCs. Conclusions P63 IHC is useful for the identification of lung SCCs. PMID:20808915

High prevalence and incidence of HPV-related anal cancer precursor lesions in HIV-positive women in the late HAART era.

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Hidalgo-Tenorio, Carmen; de Jesus, Samantha E; Esquivias, Javier; Pasquau, Juan

2017-12-02

Anal cancer is one of the most common non-AIDS defining malignancies, especially in men who have sex with men and women living with HIV (WLHIV). To evaluate the prevalence and incidence of precursor lesions (high-grade squamous intraepithelial lesions [HSIL]) and anal cancer in our cohort of women and to compare them to cervical lesions; to calculate the percentage of patients that acquire and clear oncogenic genotypes (HR-HPV) in the anal canal; and to determine predictive factors for anal HPV infection. Prospective-longitudinal study (May 2012-December 2016). At baseline (V1) and follow up visits, anal mucosa samples were taken in liquid medium for cytology and HPV PCR. In cases of abnormal anal cytology and/or positive HR-HPV PCR results, a high resolution anoscopy was performed. Patients were also referred to the gynaecologist. Ninety five women with an average age of 43.7years were included. At baseline, 11.6% had cervical abnormalities (4.1% CIN1, 2.2% CIN2/3, 1.1% cervical cancer), 64.3% anal abnormalities (50% LSIL/AIN1, 9.5% HSIL/AIN2/3 and 2.4% anal cancer) and 49.4% had HR-HPV genotypes. During 36months of follow up, the incidence of anal HSIL was 16×1,000 person-years; 14.8% acquired HR-HPV genotypes and 51.2% cleared them, P=.007. No patients presented CIN1/2/3/ or cervical cancer. In the multivariate analysis we found the following predictive factors for HR-HPV infection: smoking (RR: 1.55, 95%CI: 0.99-2.42), number of sexual partners >3 (RR: 1.69; 95%CI: 1.09-2.62), cervical and anal dysplasia (RR: 1.83; 95%CI: 1.26-2.67) and (RR: 1.55; 95%CI: 1.021-2.35), respectively. Despite clearance rates of anal oncogenic genotypes being higher than acquisition rates, prevalence and incidence of HSIL were still high and greater than cervical HSIL. Therefore, screening for these lesions should perhaps be offered to all WLHIV. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights

Anal cytological abnormalities and epidemiological correlates among men who have sex with men at risk for HIV-1 infection

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Donà Maria

2012-10-01

Full Text Available Abstract Background The incidence of anal cancer, a Human Papillomavirus (HPV-related neoplasia, has been increasing in recent decades, mainly in men who have sex with men (MSM. Cytological changes of the anal epithelium induced by HPV can be detected through an anal pap smear. This study aimed to evaluate the prevalence and epidemiological correlates of anal cytological abnormalities among relatively young MSM at risk for HIV-1 infection, to help clarify whether or not this population deserves further investigation to assess the presence of anal cancer precursor lesions. Methods MSM were recruited among attendees of a large STI clinic for a HIV-1 screening program. Anal samples, collected with a Dracon swab in PreservCyt, were used both for liquid-based cytology and HPV testing by the Linear Array HPV Genotyping Test. Data regarding socio-demographic characteristics and sexual behavior were collected in face-to-face interviews. Results A total of 346 MSM were recruited (median age 32 years. Overall, 72.5% of the individuals had an anal HPV infection, with 56.1% of them being infected by oncogenic HPV genotypes. Anal cytological abnormalities were found in 29.8% of the cases (16.7% ASC-US and 13.1% L-SIL. Presence of ASC-US+ was strongly associated with infection by any HPV type (OR=4.21, 95% CI: 1.97-9.23, and particularly by HPV 16 and/or 18 (OR=5.62, 95% CI: 2.33-13.81. A higher proportion of ASC-US+ was found in older MSM, in those with a higher number of lifetime partners and in those with a history of ano-genital warts. However, none of these variables or the others analyzed showed any significant association with abnormal cytological findings. Conclusions The presence of anal cytological abnormalities in about one third of the recruited MSM and their strong association with HPV infection, in particular that caused by HPV 16 and/or 18, might provide a further complement to the data that now support the introduction of HPV vaccination among

Anal cytological abnormalities and epidemiological correlates among men who have sex with men at risk for HIV-1 infection.

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Donà, Maria Gabriella; Benevolo, Maria; Vocaturo, Amina; Palamara, Guido; Latini, Alessandra; Giglio, Amalia; Moretto, Domenico; Rollo, Francesca; Impara, Giampaolo; Ensoli, Fabrizio; Pimpinelli, Fulvia; Di Carlo, Aldo; Giuliani, Massimo

2012-10-16

The incidence of anal cancer, a Human Papillomavirus (HPV)-related neoplasia, has been increasing in recent decades, mainly in men who have sex with men (MSM). Cytological changes of the anal epithelium induced by HPV can be detected through an anal pap smear. This study aimed to evaluate the prevalence and epidemiological correlates of anal cytological abnormalities among relatively young MSM at risk for HIV-1 infection, to help clarify whether or not this population deserves further investigation to assess the presence of anal cancer precursor lesions. MSM were recruited among attendees of a large STI clinic for a HIV-1 screening program. Anal samples, collected with a Dracon swab in PreservCyt, were used both for liquid-based cytology and HPV testing by the Linear Array HPV Genotyping Test. Data regarding socio-demographic characteristics and sexual behavior were collected in face-to-face interviews. A total of 346 MSM were recruited (median age 32 years). Overall, 72.5% of the individuals had an anal HPV infection, with 56.1% of them being infected by oncogenic HPV genotypes. Anal cytological abnormalities were found in 29.8% of the cases (16.7% ASC-US and 13.1% L-SIL). Presence of ASC-US+ was strongly associated with infection by any HPV type (OR = 4.21, 95% CI: 1.97-9.23), and particularly by HPV 16 and/or 18 (OR = 5.62, 95% CI: 2.33-13.81). A higher proportion of ASC-US+ was found in older MSM, in those with a higher number of lifetime partners and in those with a history of ano-genital warts. However, none of these variables or the others analyzed showed any significant association with abnormal cytological findings. The presence of anal cytological abnormalities in about one third of the recruited MSM and their strong association with HPV infection, in particular that caused by HPV 16 and/or 18, might provide a further complement to the data that now support the introduction of HPV vaccination among MSM to protect them from the development of HPV

Adenocarcinoma in the anal canal after ileal pouch-anal anastomosis for familial adenomatous polyposis using a double-stapled technique: report of two cases

NARCIS (Netherlands)

Vrouenraets, Bart C.; van Duijvendijk, Peter; Bemelman, Willem A.; Offerhaus, G. Johan A.; Slors, J. Frederik M.

2004-01-01

Restorative proctocolectomy with an ileal pouch-anal anastomosis is thought to abolish the risk of colorectal adenoma development in patients suffering from familial adenomatous polyposis. Both after mucosectomy with a handsewn anastomosis and after a double-stapled anastomosis, rectal mucosa is

Squamous Cell Carcinoma

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... Kids’ zone Video library Find a dermatologist Squamous cell carcinoma Overview Squamous cell carcinoma: This man's skin ... a squamous cell carcinoma on his face. Squamous cell carcinoma: Overview Squamous cell carcinoma (SCC) is a ...

Treatment results of nasopharyngeal carcinoma: a 15-year single institutional experience.

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Khademi, Bijan; Mahmoodi, Jalal; Omidvari, Shapour; Mohammadianpanah, Mohammad

2006-06-01

Nasopharyngeal Carcinoma (NPC) is a common malignant neoplasm of the head and neck that occurs most commonly in people in the South Eastern Asia but its condition in Iran is not much clear. In this retrospective study, we evaluated the treatment characteristics determining the outcome in patients with NPC. In this retrospective study, we reviewed the records of one hundred and seven patients with biopsy proven diagnosis of NPC who were referred to the radiation oncology department, Nemazee Hospital, Shiraz University of Medical Sciences, Iran, during the time period from January 1985 to December 2000. Eightyfive patients (79.4%) received 60-70Gy radiation (1.8- 2Gy/fraction, one fraction per day, and 5 fractions per week). Sixty-two patients (57.5%) received radiotherapy combined with adjuvant chemotherapy which consisted of cisplatin and 5-fluorouracil. Eighty-six patients (80.4%) had WHO II-III histopathologic diagnosis. According to the AJCC 1997 staging system, 4 (3.6%), 3 (2.7%), 33 (30.8%) and 67 (62%) patients were in stages I, II, III and IV, respectively. With a median follow-up of 12 months, the 2-year overall and disease-free survival rates were 35% and 21%, respectively. According to the multivariate analysis for overall survival, patients under 40 years had a better prognosis (p=0.041). Node stage and stage of disease were significant prognostic factors (p=0.0001). On multivariate analysis for disease-free survival, age and node stage were significant prognostic factors. The patients who received more than 60Gy radiation had a better prognosis (p=0.02), however; sequential adjuvant chemotherapy had no impact on survival and response (p=0.6). Our experience confirmed earlier reports showing poor outcomes for locoregionally advanced nasopharyngeal carcinomas. This study failed to demonstrate improvement in the outcome regarding overall and disease-free survival by adding sequential adjuvant chemotherapy after radiotherapy for patients with advanced NPC.

Treatment Results of Nasopharyngeal Carcinoma: A 15- Year Single Institutional Experience

International Nuclear Information System (INIS)

Khademi, B.; Mahmoodi, J.; Omidvari, S.; Anpanah, M.M.

2006-01-01

Background: Nasopharyngeal Carcinoma (NPC) is a common malignant neoplasm of the head and neck that occurs most commonly in people in the South Eastern Asia but its condition in Iran is not much clear. Objective: In this retrospective study, we evaluated the treatment characteristics determining the outcome in patients with NPC. Patients and Methods: In this retrospective study, we reviewed the records of one hundred and seven patients with biopsy proven diagnosis of NPC who were referred to the radiation oncology department, Nemazee Hospital, Shiraz University of Medical Sciences, Iran, during the time period from January 1985 to December 2000. Eighty five patients (79.4%) received 60-70 Gy radiation (1.82 Gy/fraction, one fraction per day, and 5 fractions per week). Sixty-two patients (57.5%) received radiotherapy combined with adjuvant chemotherapy which consisted of cisplatin and 5-fluorouracil. Eighty-six patients (80.4%) had WHO II-III histopathologic diagnosis. According to the AlCC 1997 staging system, 4 (3.6%), 3 (2.7%), 33 (30.8%) and 67 (62%) patients were in stages I, II, III and IV, respectively. Results: With a median follow-up of 12 months, the 2-year overall and disease-free survival rates were 35% and 21%, respectively. According to the multivariate analysis for overall survival, patients under 40 years had a better prognosis (p=0.041). Node stage and stage of disease were significant prognostic factors (p=0.0001. On multivariate analysis for disease-free survival, age and node stage were significant prognostic factors. The patients who received more than 60 Gy radiation had a better prognosis (p=0.02), however; sequential adjuvant chemotherapy had no impact on survival and response (p=0.6). Conclusion: Our experience confirmed earlier reports showing poor outcomes for locoregionally advanced nasopharyngeal carcinomas. This study failed to demonstrate improvement in the outcome regarding overall and disease-free survival by adding sequential

Prevalence of and risk factors for anal human papillomavirus infection in men who have sex with women: a cross-national study.

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Nyitray, Alan G; Smith, Dan'elle; Villa, Luisa; Lazcano-Ponce, Eduardo; Abrahamsen, Martha; Papenfuss, Mary; Giuliano, Anna R

2010-05-15

Although the primary cause of anal cancer is human papillomavirus (HPV) infection in the anal canal, little attention has been paid to the epidemiology of anal HPV infection in men who have sex with women (MSW). Exfoliated cells from the anal canal of 902 MSW in Brazil (São Paulo), Mexico (Cuernavaca), and the United States (Tampa) were tested for HPV DNA. The prevalence of HPV infection in the anal canal (12.0%) was similar among MSW in each city (P=.77), whereas 7.0% had infection with oncogenic types. Men in Tampa had a 4-fold higher prevalence of infection with HPV type 16 (HPV-16) than that among men in São Paulo or Cuernavaca (PMen who have a larger lifetime number of female sex partners, who are in a sexual relationship of men were most likely to have an anal HPV infection.

Evaluation of MSCTA for parasitic blood supply in hepatic carcinoma

International Nuclear Information System (INIS)

Yang Weihong; Liu Pengcheng; Liang Shanhu; Yuan Zhidong; Yu Hongjian; Deng Qianhua

2008-01-01

Objective: To evaluate the multi-slice spiral computer tomography for hepatocarcinoma parasitic blood supply, and analyze the mechanism of the parasitic angiogenesis. Methods: Forty cases confirmed by DSA and confirmed with the existence of parasitic blood supply through manifestations of MSCTA were retrospectively analized. Comparing the coincidence of different reconstruction modalities of MSCTA and DSA in displaying the parasitic blood supply and then to assess the characteristics of MSCTA of the cases with existing parasitic blood supply. Results: DSA displayed parasitic blood supply in 50 arterial rami and MSCTA displayed only 40 rami, with positive rate of 80%. The best display could be reached by the reconstruction of combining MIP and VRT. This kind of reconstruction revealed not only the parasitic blood supply but also the peripheral sites of the primary focci with average length of diameter of 6.9 cm. Conclusions: MSCTA possesses nearly the same capability with DSA in demonstrating the parasitic blood supply to primary hepatic carcinoma, therefore it could be utilized in evaluation of intervention therapy and surgical, operation and transplantation. The primary hepatic carcinoma with this kind of parasitic blood supply is always located at the bare were of liver and ligmentarn suspensoram together with direct invasion of nearby organs with adhesions may contribute the main factor of parasitic blood supply, furthermore the repetition of TACE inducing the decrease of collateral circulation may also be the another major factor. (authors)

Evaluation of MSCTA for parasitic blood supply in hepatic carcinoma

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Weihong, Yang; Pengcheng, Liu; Shanhu, Liang; Zhidong, Yuan; Hongjian, Yu; Qianhua, Deng [Department of Radiology, Shenzhen Hospital of Beijing College, Guangdong, Shenzhen (China)

2008-09-15

Objective: To evaluate the multi-slice spiral computer tomography for hepatocarcinoma parasitic blood supply, and analyze the mechanism of the parasitic angiogenesis. Methods: Forty cases confirmed by DSA and confirmed with the existence of parasitic blood supply through manifestations of MSCTA were retrospectively analized. Comparing the coincidence of different reconstruction modalities of MSCTA and DSA in displaying the parasitic blood supply and then to assess the characteristics of MSCTA of the cases with existing parasitic blood supply. Results: DSA displayed parasitic blood supply in 50 arterial rami and MSCTA displayed only 40 rami, with positive rate of 80%. The best display could be reached by the reconstruction of combining MIP and VRT. This kind of reconstruction revealed not only the parasitic blood supply but also the peripheral sites of the primary focci with average length of diameter of 6.9 cm. Conclusions: MSCTA possesses nearly the same capability with DSA in demonstrating the parasitic blood supply to primary hepatic carcinoma, therefore it could be utilized in evaluation of intervention therapy and surgical, operation and transplantation. The primary hepatic carcinoma with this kind of parasitic blood supply is always located at the bare were of liver and ligmentarn suspensoram together with direct invasion of nearby organs with adhesions may contribute the main factor of parasitic blood supply, furthermore the repetition of TACE inducing the decrease of collateral circulation may also be the another major factor. (authors)

Analytic and clinical performance of cobas HPV testing in anal specimens from HIV-positive men who have sex with men.

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Wentzensen, Nicolas; Follansbee, Stephen; Borgonovo, Sylvia; Tokugawa, Diane; Sahasrabuddhe, Vikrant V; Chen, Jie; Lorey, Thomas S; Gage, Julia C; Fetterman, Barbara; Boyle, Sean; Sadorra, Mark; Tang, Scott Dahai; Darragh, Teresa M; Castle, Philip E

2014-08-01

Anal human papillomavirus (HPV) infections are common, and the incidence of anal cancer is high in HIV-infected men who have sex with men (MSM). To evaluate the performance of HPV assays in anal samples, we compared the cobas HPV test (cobas) to the Roche Linear Array HPV genotyping assay (LA) and cytology in HIV-infected MSM. Cytology and cobas and LA HPV testing were conducted for 342 subjects. We calculated agreement between the HPV assays and the clinical performance of HPV testing and HPV genotyping alone and in combination with anal cytology. We observed high agreement between cobas and LA, with cobas more likely than LA to show positive results for HPV16, HPV18, and other carcinogenic types. Specimens testing positive in cobas but not in LA were more likely to be positive for other markers of HPV-related disease compared to those testing negative in both assays, suggesting that at least some of these were true positives for HPV. cobas and LA showed high sensitivities but low specificities for the detection of anal intraepithelial neoplasia grade 2/3 (AIN2/3) in this population (100% sensitivity and 26% specificity for cobas versus 98.4% sensitivity and 28.9% specificity for LA). A combination of anal cytology and HPV genotyping provided the highest accuracy for detecting anal precancer. A higher HPV load was associated with a higher risk of AIN2/3 with HPV16 (P(trend) < 0.001), HPV18 (P(trend) = 0.07), and other carcinogenic types (P(trend) < 0.001). We demonstrate that cobas can be used for HPV detection in anal cytology specimens. Additional tests are necessary to identify men at the highest risk of anal cancer among those infected with high-risk HPV. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Tracking vaginal, anal and oral infection in a mouse papillomavirus infection model.

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Hu, Jiafen; Budgeon, Lynn R; Cladel, Nancy M; Balogh, Karla; Myers, Roland; Cooper, Timothy K; Christensen, Neil D

2015-12-01

Noninvasive and practical techniques to longitudinally track viral infection are sought after in clinical practice. We report a proof-of-principle study to monitor the viral DNA copy number using a newly established mouse papillomavirus (MmuPV1) mucosal infection model. We hypothesized that viral presence could be identified and quantified by collecting lavage samples from cervicovaginal, anal and oral sites. Nude mice infected at these sites with infectious MmuPV1 were tracked for up to 23 weeks starting at 6 weeks post-infection. Viral DNA copy number was determined by SYBR Green Q-PCR analysis. In addition, we tracked viral DNA load through three complete oestrous cycles to pinpoint whether there was a correlation between the DNA load and the four stages of the oestrous cycle. Our results showed that high viral DNA copy number was reproducibly detected from both anal and cervicovaginal lavage samples. The infection and disease progression were further confirmed by histology, cytology, in situ hybridization, immunohistochemistry and transmission electron microscopy. Interestingly, the viral copy number fluctuated over the oestrous cycle, with the highest level at the oestrus stage, implying that multiple sampling might be necessary to provide a reliable diagnosis. Virus DNA was detected in oral lavage samples at a later time after infection. Lower viral DNA load was found in oral samples when compared with those in anal and vaginal tracts. To our knowledge, our study is the first in vivo study to sequentially monitor papillomavirus infection from mucosal anal, oral and vaginal tracts in a preclinical model.

The male bulbospongiosus muscle and its relation to the external anal sphincter.

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Peikert, Kevin; Platzek, Ivan; Bessède, Thomas; May, Christian Albrecht

2015-04-01

The bulbospongiosus muscle is part of the superficial muscular layer of the perineum and pelvic floor. Its morphology remains controversial in the literature. Therefore, we reinvestigated the fascial arrangement and fiber courses of the bulbospongiosus muscle and its topographical relation to the external anal sphincter. The perineum was dissected in 9 male cadavers (mean ± SD age 78.3 ± 10.7 years). Select samples were obtained for histology and immunohistochemistry. In 43 patients (mean age 60.7 ± 12 years) the topographical relation between the bulbospongiosus muscle and the external anal sphincter was determined by magnetic resonance imaging. The perineum contains several fascial layers consisting of elastic and collagen fibers as well as bundles of smooth muscle cells. The bulbospongiosus muscle was subdivided into a ventral and dorsal portion, which developed in 4 variants. The ventral insertion formed a morphological unity with the ischiocavernous muscle while the dorsal origin had a variable relation to the external anal sphincter (5 variants). A muscle-like or connective tissue-like connection was frequently present between the muscles. However, in some cases the muscles were completely separated. We suggest a concept of variations of bulbospongiosus muscle morphology that unifies the conflicting literature. Its ventral fiber group and the ischiocavernosus muscle form a functional and morphological unity. While the bulbospongiosus muscle and the external anal sphincter remain independent muscles, their frequent connection might have clinical implications for perineal surgery and anogenital disorders. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Recurrence of hepatocellular carcinoma after liver transplantation presenting as anastomotic biliary stricture Presentación del carcinoma hepatocelular recurrente tras el trasplante de hígado en forma de estenosis biliar anastomótica

Directory of Open Access Journals (Sweden)

S. Y. Chen

2008-07-01

Full Text Available A 52-year-old man visited our hospital complaining of anorexia and fatigue two months after receiving orthotopic liver transplantation for hepatocellular carcinoma. A laboratory investigation demonstrated a clinical picture of obstructive jaundice. T-tube cholangiography showed biliary stricture over the anastomotic site. Percutaneous transluminal balloon dilatation and stenting was attempted but failed. Magnetic resonance cholangiography showed possible tumor recurrence over the site of the anastomotic biliary stricture. A biopsy sample was obtained via ultrasound-guided aspiration and histopathological study revealed inflammatory and fibrotic changes. With high suspicion of recurrence of the hepatocellular carcinoma, surgical exploration was performed and an intraoperative frozen section proved the recurrence. We thus diagnosed this case as a recurrence of hepatocellular carcinoma after liver transplantation. To our knowledge, there have been no previous reports of early tumor recurrence after liver transplantation being the cause of an anastomotic biliary stricture.Un varón de 52 años visitó nuestro hospital quejándose de anorexia y fatiga a los dos meses de haber recibido un trasplante hepático ortotópico a causa de un carcinoma hepatocelular. La analítica mostró un cuadro clínico de ictericia obstructiva. La colangiografía con tubo en T mostró una estenosis biliar sobre la anastomosis. Se intentó una dilatación transluminal percutánea con globo y colocación de endoprótesis, que fracasó. La colangiografía por resonancia magnética mostró una posible recurrencia tumoral sobre el lugar de la estenosis biliar anastomótica. Se extrajo una muestra de biopsia mediante aspiración bajo guía ecográfica y el estudio histopatológico mostró alteraciones inflamatorias y fibróticas. Al sospecharse la recurrencia del carcinoma hepatocelular, se realizó una exploración quirúrgica; un corte intraoperatorio congelado demostr

Cause-specific colostomy rates after radiotherapy for anal cancer: a Danish multicentre cohort study.

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Sunesen, Kåre G; Nørgaard, Mette; Lundby, Lilli; Havsteen, Hanne; Buntzen, Steen; Thorlacius-Ussing, Ole; Laurberg, Søren

2011-09-10

In anal cancer, colostomy-free survival is a measure of anal sphincter preservation after treatment with radiotherapy or chemoradiotherapy. Failure to control anal cancer and complications of treatment are alternative indications for colostomy. However, no data exist on cause-specific colostomy rates. We examined this in a cohort study. Through national registries and review of medical records, we identified patients with anal cancer diagnosed from 1995 to 2003 who had curative-intent radiotherapy or chemoradiotherapy in four Danish centers. We computed cumulative incidence of tumor-related colostomy and therapy-related colostomy, treating colostomy and death as competing events. Follow-up started at completion of radiotherapy and continued throughout 2008. We used competing risk regression to compute hazard ratios (HRs) to compare the cumulative incidence of cause-specific colostomies between age, sex, tumor size, chemotherapy, and local excision before radiotherapy. We included 235 patients with anal cancer. The 5-year cumulative incidences of tumor-related and therapy-related colostomy were 26% (95% CI, 21% to 32%) and 8% (95% CI, 5% to 12%), respectively. Tumor size greater than 6 cm versus less than 4 cm was a risk factor for tumor-related colostomy (adjusted HR, 3.8; 95% CI, 1.7 to 8.1), and local excision before radiotherapy was a risk factor for therapy-related colostomy (adjusted HR, 4.5; 95% CI, 1.5 to 13.5). After curative-intent radiotherapy or chemoradiotherapy, one third of patients had a colostomy, of which one third were related to therapy. Large tumor size was associated with a higher risk of tumor-related colostomy, whereas history of prior excision was associated with an increased incidence of therapy-related colostomy.

Gender Nonconformity and Birth Order in Relation to Anal Sex Role Among Gay Men.

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Swift-Gallant, Ashlyn; Coome, Lindsay A; Monks, D Ashley; VanderLaan, Doug P

2018-05-01

Androphilia is associated with an elevated number of older brothers among natal males. This association, termed the fraternal birth order effect, has been observed among gay men who exhibit marked gender nonconformity. Gender nonconformity has been linked to gay men's preferred anal sex role. The present study investigated whether these two lines of research intersect by addressing whether the fraternal birth order effect was associated with both gender nonconformity and a receptive anal sex role (243 gay men, 91 heterosexual men). Consistent with previous research, we identified the fraternal birth order effect in our sample of gay men. Also, gay men were significantly more gender-nonconforming on adulthood and recalled childhood measures compared to heterosexual men. When gay men were compared based on anal sex role (i.e., top, versatile, bottom), all groups showed significantly greater recalled childhood and adult male gender nonconformity than heterosexual men, but bottoms were most nonconforming. Only gay men with a bottom anal sex role showed evidence of a fraternal birth order effect. A sororal birth order effect was found in our sample of gay men, driven by versatiles. No significant associations were found between fraternal birth order and gender nonconformity measures. These results suggest that the fraternal birth order effect may apply to a subset of gay men who have a bottom anal sex role preference and that this subgroup is more gender-nonconforming. However, there were no significant associations between fraternal birth order and gender nonconformity at the individual level. As such, based on the present study, whether processes underpinning the fraternal birth order effect influence gender nonconformity is equivocal.

Imaging of cervical carcinomas

International Nuclear Information System (INIS)

Soyer, P.; Michel, G.; Masselot, J.

1990-01-01

Recently, magnetic resonance imaging (MRI) and transrectal or transvaginal ultrasound (TRUS, TVUS) had an important place in imaging techniques of cervical carcinomas and raise the question of modifying the imaging strategies. For the diagnosis of primitive tumor, those techniques cannot take the place of clinical examination and gross examination. In the assessment of parametrial involvement, TRUS which has better accuracy than clinical examination, and MRI which is considered as the most accurate technique, have an important role to play. In the follow-up and the detection of recurrences, MRI is actually considered as the best imaging technique. The authors, according to recent data in literature and their own experience, present basic concepts of imaging strategies for staging and follow-up of cervical carcinomas [fr

Comparison of anal HPV natural history among men by country of residence: Brazil, Mexico, and the United States.

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Sudenga, Staci L; Nyitray, Alan G; Torres, B Nelson; Silva, Roberto; Villa, Luisa; Lazcano-Ponce, Eduardo; Abrahamsen, Martha; Baggio, Maria Luiza; Salmeron, Jorge; Quiterio, Manuel; Giuliano, Anna R

2017-07-01

Globally, anal cancer incidence is rare, but is increasing in some world regions. Our objective was to assess differences in anal HPV natural history in three countries. Men aged 18-70 years were recruited from the US (n = 634), Mexico (n = 665), and Brazil (n = 731). Anal specimens were collected every six-months. HPV genotyping was assessed by Linear Array. Anal HPV prevalence was compared using the Fisher's exact test. HPV infection incidence rates (IR) and 95% confidence intervals (CI) were calculated. Any anal HPV prevalence was highest among men from Brazil (24%) compared to Mexico (15%) and the US (15%). When stratified by sexual history, the prevalence of any HPV among MSM/MSMW was 43%, 37%, and 45% and 9%, 12%, and 10% for MSW from Brazil, Mexico, and US, respectively. Any HPV incidence was significantly higher among men from Brazil compared to US men (IRR = 2.4, 95% CI = 1.7-3.4) and comparable between men from Mexico and the US (IRR = 1.2, 95% CI = 0.8-1.8). Men in Brazil and Mexico often have similar, if not higher incidence of anal HPV compared to men from the U.S., and may benefit from gender neutral HPV vaccine policies. Copyright © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Relationship between external anal sphincter atrophy at endoanal magnetic resonance imaging and clinical, functional, and anatomic characteristics in patients with fecal incontinence

NARCIS (Netherlands)

Terra, Maaike P.; Deutekom, Marije; Beets-Tan, Regina G. H.; Engel, Alexander F.; Janssen, Lucas W. M.; Boeckxstaens, Guy E. E.; Dobben, Annette C.; Baeten, Cor G. M. I.; de Priester, Jacobus A.; Bossuyt, Patrick M. M.; Stoker, Jaap

2006-01-01

PURPOSE: External anal sphincter atrophy at endoanal magnetic resonance imaging has been associated with poor outcome of anal sphincter repair. We studied the relationship between external anal sphincter atrophy on endoanal magnetic resonance imaging and clinical, functional, and anatomic

Verrucoid Variant of Invasive Squamous Cell Carcinoma in Oral Submucous Fibrosis: A Clinicopathological Challenge.

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Ramani, Priya; Krithika, C; Ananthalakshmi, R; Singaram, Mamta; Jagdish, Praveena; Janardhanan, Sunitha; Jeevakarunyam, Sathiyajeeva

2016-11-04

Verrucous carcinoma (VC) is an exophytic, low-grade, well-differentiated variant of squamous cell carcinoma. It is described as a lesion appearing in the sixth or seventh decade of life that has minimal aggressive potential and, in long-standing cases, has been shown to transform into squamous cell carcinoma. Oral submucous fibrosis (OSMF) is a potentially malignant disorder, and about one-third of the affected population develop oral squamous cell carcinoma. The histopathological diagnosis of verrucous carcinoma is challenging, and the interpretation of early squamous cell carcinoma requires immense experience. Here we present a rare case of a 24-year-old male with OSMF transforming to verrucous carcinoma with invasive squamous cell carcinoma. Even though the case had a straightforward clinical diagnosis, the serial sectioning done for pathological diagnosis disclosed the squamous cell carcinoma.

coloproctectomie avec anastomose colo-sus-anale pour tumeur ...

African Journals Online (AJOL)

Une coloproctectomie fut réalisée le 30/06/2014 avec anastomose colo-anale, colostomie de protection sous-couvert d'une transfusion sanguine. L'examen histologique du segment colorectal prélevé objectiva une rectocolite granulomateuse autour de nombreux oeufs de schistosomes. En effet, le patient a vécu à Pahou, ...

Ligation of the intersphincteric fistula tract (LIFT): a minimally invasive procedure for complex anal fistula: two-year results of a prospective multicentric study.

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Sileri, Pierpaolo; Giarratano, Gabriella; Franceschilli, Luana; Limura, Elsa; Perrone, Federico; Stazi, Alessandro; Toscana, Claudio; Gaspari, Achille Lucio

2014-10-01

The surgical management of anal fistulas is still a matter of discussion and no clear recommendations exist. The present study analyses the results of the ligation of the intersphincteric fistula tract (LIFT) technique in treating complex anal fistulas, in particular healing, fecal continence, and recurrence. Between October 2010 and February 2012, a total of 26 consecutive patients underwent LIFT. All patients had a primary complex anal fistula and preoperatively all underwent clinical examination, proctoscopy, transanal ultrasonography/magnetic resonance imaging, and were treated with the LIFT procedure. For the purpose of this study, fistulas were classified as complex if any of the following conditions were present: tract crossing more than 30% of the external sphincter, anterior fistula in a woman, recurrent fistula, or preexisting incontinence. Patient's postoperative complications, healing time, recurrence rate, and postoperative continence were recorded during follow-up. The minimum follow-up was 16 months. Five patients required delayed LIFT after previous seton. There were no surgical complications. Primary healing was achieved in 19 patients (73%). Seven patients (27%) had recurrence presenting between 4 and 8 weeks postoperatively and required further surgical treatment. Two of them (29%) had previous insertion of a seton. No patients reported any incontinence postoperatively and we did not observe postoperative continence worsening. In our experience, LIFT appears easy to perform, is safe with no surgical complication, has no risk of incontinence, and has a low recurrence rate. These results suggest that LIFT as a minimally invasive technique should be routinely considered for patients affected by complex anal fistula. © The Author(s) 2013.

Acute anal stretch inhibits NMDA-dependent pelvic-urethra reflex potentiation via spinal GABAergic inhibition in anesthetized rats.

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Chen, Sung-Lang; Huang, Yu-Hui; Kao, Yu-Lin; Chen, Gin-Den; Cheng, Chen-Li; Peng, Hsien-Yu; Liao, Jiuan-Miaw; Huang, Pei-Chen; Tsai, Shih-Jei; Lin, Tzer-Bin

2008-10-01

The impact of acute anal stretch on the pelvic-urethra reflex potentiation was examined in urethane-anesthetized rats by recording the external urethra sphincter electromyogram activity evoked by the pelvic afferent stimulation. Test stimulation (1 stimulation/30 s) evoked a baseline reflex activity with a single action potential that was abolished by gallamine (5 mg/kg iv). On the other hand, the repetitive stimulation (1 stimulation/1 s) induced spinal reflex potentiation (SRP) that was attenuated by intrathecal 6-cyano-7-nitroquinoxaline-2,4-dione (a glutamatergic alpha-amino-3-hydroxy-5-methyl-4-isoxazoleproprionat receptor antagonist, 100 microM, 10 microl) and d-2-amino-5-phosphonovalerate [a glutamatergic N-methyl-D-aspartate (NMDA) antagonist, 100 microM, 10 microl]. Acute anal stretch using a mosquito clamp with a distance of 4 mm exhibited no effect, whereas distances of 8 mm attenuated and 12 mm abolished the repetitive stimulation-induced SRP. Intrathecal NMDA (100 microM, 10 microl) reversed the abolition on SRP caused by anal stretch. On the other hand, pretreated bicuculline [gamma-aminobutyric acid (GABA) A receptor antagonist, 100 microM, 10 microl] but not hydroxysaclofen (GABAB receptor antagonist) counteracted the abolition on the repetitive stimulation-induced SRP caused by the anal stretch. All of the results suggested that anal stretch may be used as an adjunct to assist voiding dysfunction in patients with overactive urethra sphincter and that GABAergic neurotransmission is important in the neural mechanisms underlying external urethra sphincter activity inhibited by anal stretch.

Postpartum two- and three-dimensional ultrasound evaluation of anal sphincter complex in women with obstetric anal sphincter injury.

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Ros, C; Martínez-Franco, E; Wozniak, M M; Cassado, J; Santoro, G A; Elías, N; López, M; Palacio, M; Wieczorek, A P; Espuña-Pons, M

2017-04-01

To compare the sensitivity and specificity of two- (2D) and three- (3D) dimensional transperineal ultrasound (TPUS) and 3D endovaginal ultrasound (EVUS) with the gold standard 3D endoanal ultrasound (EAUS) in detecting residual defects after primary repair of obstetric anal sphincter injuries (OASIS). External (EAS) and internal (IAS) anal sphincters were evaluated by the four ultrasound modalities in women with repaired OASIS. 2D-TPUS was evaluated in real-time, whereas 3D-TPUS, 3D-EVUS and 3D-EAUS volumes were evaluated offline by six blinded readers. The presence/absence of any tear in EAS or IAS was recorded and defects were scored according to the Starck system. Sensitivity, specificity and predictive values were calculated, using 3D-EAUS as reference standard. Inter- and intraobserver analyses were performed for all 3D imaging modalities. Association between patients' symptoms (Wexner score) and ultrasound findings (Starck score) was calculated. Images from 55 patients were analyzed. Compared with findings on 3D-EAUS, the agreement for EAS evaluation was poor for 3D-EVUS (κ = 0.01), fair for 2D-TPUS (κ = 0.30) and good for 3D-TPUS (κ = 0.73). The agreement for IAS evaluation was moderate for both 3D-EVUS (κ = 0.41) and 2D-TPUS (κ = 0.52) and good for 3D-TPUS (κ = 0.66). Good intraobserver (3D-EAUS, κ = 0.73; 3D-TPUS, κ = 0.78) and interobserver (3D-EAUS, κ = 0.68; 3D-TPUS, κ = 0.60) agreement was reported. Significant association between Starck and Wexner scores was found only for 3D-EAUS (Spearman's rho = 0.277, P = 0.04). 2D-TPUS and 3D-EVUS are not accurate modalities for the assessment of anal sphincters after repair of OASIS. 3D-TPUS shows good agreement with the gold standard 3D-EAUS and a high sensitivity in detecting residual defects. It, thus, has potential as a screening tool after primary repair of OASIS. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG

Intensity-Modulated Radiotherapy (IMRT) vs Helical Tomotherapy (HT) in Concurrent Chemoradiotherapy (CRT) for Patients with Anal Canal Carcinoma (ACC): an analysis of dose distribution and toxicities

International Nuclear Information System (INIS)

Yeung, Rosanna; McConnell, Yarrow; Warkentin, Heather; Graham, Darren; Warkentin, Brad; Joseph, Kurian; Doll, Corinne M

2015-01-01

Intensity-modulated radiotherapy (IMRT) and helical tomotherapy (HT) have been adopted for radiotherapy treatment of anal canal carcinoma (ACC) due to better conformality, dose homogeneity and normal-tissue sparing compared to 3D-CRT. To date, only one published study compares dosimetric parameters of IMRT vs HT in ACC, but there are no published data comparing toxicities. Our objectives were to compare dosimetry and toxicities between these modalities. This is a retrospective study of 35 ACC patients treated with radical chemoradiotherapy at two tertiary cancer institutions from 2008–2010. The use of IMRT vs HT was primarily based on center availability. The majority of patients received fluorouracil (5-FU) and 1–2 cycles of mitomycin C (MMC); 2 received 5-FU and cisplatin. Primary tumor and elective nodes were prescribed to ≥54Gy and ≥45Gy, respectively. Patients were grouped into two cohorts: IMRT vs HT. The primary endpoint was a dosimetric comparison between the cohorts; the secondary endpoint was comparison of toxicities. 18 patients were treated with IMRT and 17 with HT. Most IMRT patients received 5-FU and 1 MMC cycle, while most HT patients received 2 MMC cycles (p < 0.01), based on center policy. HT achieved more homogenous coverage of the primary tumor (HT homogeneity and uniformity index 0.14 and 1.02 vs 0.29 and 1.06 for IMRT, p = 0.01 and p < 0.01). Elective nodal coverage did not differ. IMRT achieved better bladder, femoral head and peritoneal space sparing (V30 and V40, p ≤ 0.01), and lower mean skin dose (p < 0.01). HT delivered lower bone marrow (V10, p < 0.01) and external genitalia dose (V20 and V30, p < 0.01). Grade 2+ hematological and non-hematological toxicities were similar. Febrile neutropenia and unscheduled treatment breaks did not differ (both p = 0.13), nor did 3-year overall and disease-free survival (p = 0.13, p = 0.68). Chemoradiotherapy treatment of ACC using IMRT vs HT results in differences in dose homogenity and

Urinary bladder carcinoma with divergent differentiation featuring small cell carcinoma, sarcomatoid carcinoma, and liposarcomatous component.

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Yasui, Mariko; Morikawa, Teppei; Nakagawa, Tohru; Miyakawa, Jimpei; Maeda, Daichi; Homma, Yukio; Fukayama, Masashi

2016-09-01

Both small cell carcinoma and sarcomatoid carcinoma of the urinary bladder are highly aggressive tumors, and a concurrence of these tumors is extremely rare. We report a case of urinary bladder cancer with small cell carcinoma as a predominant component, accompanied by sarcomatoid carcinoma and conventional urothelial carcinoma (UC). Although the small cell carcinoma component had resolved on receiving chemoradiotherapy, rapid growth of the residual tumor led to a fatal outcome. A 47-year-old man presented with occasional bladder irritation and had a 2-year history of asymptomatic hematuria. Cystoscopy revealed a huge mass in the urinary bladder, and transurethral resection was performed. Microscopically, small cell carcinoma was detected as the major tumor component. Spindle-shaped sarcomatoid cells were also observed that were intermingled with small cell carcinoma and conventional UC. In addition, a sheet-like growth of the lipoblast-like neoplastic cells was observed focally. Initially, by providing chemoradiotherapy, we achieved a marked tumor regression; however, the tumor rapidly regrew after the completion of chemoradiotherapy, and the patient underwent radical cystectomy. Only conventional UC and sarcomatoid carcinoma were identified in the cystectomy specimen. The patient died of the disease 4 months after cystectomy. Urinary bladder cancer may include a combination of multiple aggressive histologies as in the present case. Because the variation in the tumor components may affect the efficacy of therapy, a correct diagnosis of every tumor component is necessary. Copyright © 2016 Elsevier GmbH. All rights reserved.

Clinical, manometric, and ultrasonographic results of pneumatic balloon dilatation vs. lateral internal sphincterotomy for chronic anal fissure: a prospective, randomized, controlled trial.

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Renzi, Adolfo; Izzo, Domenico; Di Sarno, Giandomenico; Talento, Pasquale; Torelli, Francesco; Izzo, Giuseppe; Di Martino, Natale

2008-01-01

This prospective, randomized, controlled trial was designed to compare the clinical, functional, and morphologic results of pneumatic balloon dilatation with lateral internal sphincterotomy for the treatment of chronic anal fissure. All patients with symptomatic chronic anal fissure were randomly assigned to pneumatic balloon dilatation or lateral internal sphincterotomy and invited to complete a standardized questionnaire inquiring about their symptoms. Anal ultrasonography and anal manometry were performed before and six months after surgery. A proctologic examination was performed between the fifth and sixth postoperative weeks. Anal continence, scored by using a validated continence grading scale, was evaluated preoperatively at 1 and 6 weeks and at 12 and 24 months. Fifty-three patients, who satisfied selection criteria, were enrolled in the trial. Four patients (7.5 percent) were lost to follow-up. Twenty-four patients (11 males; mean age, 42 +/- 8.2 years) underwent pneumatic balloon dilatation and 25 patients (10 males; mean age, 44 +/- 7.3 years) underwent lateral internal sphincterotomy. Fissure-healing rates were 83.3 percent in the pneumatic balloon dilatation and 92 percent in the lateral internal sphincterotomy group. Recurrent anal fissure was observed in one patient (4 percent) after lateral internal sphincterotomy. At anal manometry, mean resting pressure decrements obtained after pneumatic balloon dilatation and lateral internal sphincterotomy were 30.5 and 34.3 percent, respectively. After pneumatic balloon dilatation, anal ultrasonography did not show any significant sphincter damage. At 24-month follow-up, the incidence of incontinence, irrespective of severity, was 0 percent in the pneumatic balloon dilatation group and 16 percent in the lateral internal sphincterotomy group (P < 0.0001). As lateral internal sphincterotomy, pneumatic balloon dilatation grants a high anal fissure-healing rate but with a statistically significant reduction in

Radiochemotherapy in Anal Cancer: cCR, clinical outcomes and quality of life using two different treatment schedules.

Science.gov (United States)

Di Santo, Sara; Trignani, Marianna; Neri, Matteo; Milano, Angelo; Innocenti, Paolo; Taraborrelli, Maria; Augurio, Antonietta; Vinciguerra, Annamaria; Di Tommaso, Monica; Ursini, Lucia Anna; Di Pilla, Angelo; Di Nicola, Marta; Genovesi, Domenico

2015-01-01

Main endpoint was a response rate to therapy; secondary endpoints were disease-free survival, overall survival, acute and late toxicities, specially in terms of anorectal and urinary continence. Radiochemotherapy for anal cancer achieves a good clinical response, locoregional control, anal function preservation. However, oncologic outcomes can differ using radiotherapy plus fluorouracil and mytomicin vs. cisplatin and fluorouracil. Between 2000 and 2012, 27 anal cancer patients receiving radiotherapy combined with two different radiochemotherapy schedules, fluorouracil and mytomicin (group A) and cisplatin plus fluorouracil (group B). The Kaplan-Meier method was also used to estimate local control, overall survival and disease free survival. Statistical significance between curves was evaluated using the Log-rank test. Complete pathological response was found in 85.2% of patients, with higher rates of response in the group A (100% vs. 63.6%, p = 0.039). No significantly difference was found between the two groups for the other endpoints. Low rates of both acute and late toxicities were recorded. Radiotherapy plus fluorouracil and mytomicin provide a better complete pathological response than radiotherapy plus cisplatin and fluorouracil and a greater rate of anal sphincter function preservation. Globally, radiochemotherapy of the anal cancer provides excellent clinical outcomes with a good profile of acute and late toxicity, without difference between the two groups studied.

Design and Psychometric Evaluation of the Quality of Life in Patients With Anal Fistula Questionnaire.

Science.gov (United States)

Ferrer-Márquez, Manuel; Espínola-Cortés, Natalia; Reina-Duarte, Angel; Granero-Molina, José; Fernández-Sola, Cayetano; Hernández-Padilla, José Manuel

2017-10-01

Quality of life is often considered when deciding and evaluating the treatment strategy for patients diagnosed with anal fistula. The purpose of this study was to develop and psychometrically test the Quality of Life in Patients with Anal Fistula Questionnaire. This was an observational cross-sectional study for the development and validation of a psychometric tool. The study was conducted at a general hospital in the southeast of Spain. A convenience sample included 54 patients diagnosed with anal fistula. The reliability of the tool was assessed through its internal consistency (Cronbach α) and temporal stability (Spearman correlation coefficient (r) between test-retest). The content validity index of the items and the scale was calculated. Correlation analysis and an ordinal regression analysis between the developed tool and the Short Form 12 Health Survey examined its concurrent validity. Principal component analysis and known-group analysis using the Kruskal-Wallis test examined its construct validity. The reliability of the developed questionnaire was very high (α = 0.908; r = 0.861; p questionnaire to detect expected differences in patients presenting with different symptomatology. The major limitations of this study were the use of a small sample of Spanish-speaking patients, not including patients in the initial development of the questionnaire, and developing the scoring system using a summation method. The Quality of Life in Patients with Anal Fistula Questionnaire has proven to be a valid, reliable, and concise tool that could contribute to the evaluation of quality of life among patients with an anal fistula. See Video Abstract at http://links.lww.com/DCR/A368.

Predisposing factors and histopathological variants of cutaneous squamous cell carcinoma: Experience from a North Indian teaching hospital

Directory of Open Access Journals (Sweden)

Geeti Khullar

2016-01-01

Full Text Available Background: Squamous and basal cell carcinomas together constitute the majority of non-melanoma skin cancers. These malignancies are infrequent in Indians as compared to the white skinned population. Literature on squamous cell carcinoma in dark skin is limited. Aim: To analyze the risk factors and to characterize the histopathological subtypes of cutaneous squamous cell carcinoma in Indian patients in an area, non-endemic for arsenicosis. Methods: A retrospective analysis of data from January 2003 to August 2013 was performed to evaluate the predisposing factors and histopathological types of cutaneous squamous cell carcinoma at the Postgraduate Institute of Medical Education and Research (PGIMER, Chandigarh. Demographic and disease characteristics such as age, gender and predisposing factors, particularly premalignant dermatoses were recorded and histopathology slides were reviewed. Results: Of the 13,426 skin biopsy specimens received during the 10-year period, there were 82 (0.6% cases of squamous cell carcinoma and 170 (1.7% of basal cell carcinoma. The mean age at diagnosis of cutaneous squamous cell carcinoma was 53.7 years and the male to female ratio was 2:1. The most common site of involvement was the lower limbs in 34 (41.5% patients. Marjolin's ulcer was present in 36 (43.9% cases. No predisposing factor was identified in 35 (42.7% patients. Histopathologically, the tumors were classified most commonly as squamous cell carcinoma not otherwise specified in 33 (40.2% cases. Limitations: This was a retrospective study and details of occupation and interval between the precursor lesions and development of tumor were not recorded. Immunohistochemistry for human papilloma virus and p53 tumor suppressor protein were not performed as these tests were not available. Conclusion: Cutaneous squamous cell carcinoma is uncommon in Indian patients and a high index of suspicion is necessary when a rapidly enlarging nodule, verrucous fungating plaque

Liver transplantation for hepatocellular carcinoma: the Hong Kong experience.

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Ng, Kelvin K; Lo, Chung Mau; Chan, See Ching; Chok, Kenneth S; Cheung, Tan-To; Fan, Sheung Tat

2010-09-01

Orthotopic liver transplantation (OLT) is the best treatment option for selected patients with hepatocellular carcinoma (HCC) with the background of cirrhosis since this treatment modality can cure both diseases at once. Over the years, the applicability of OLT for HCC has evolved. In Asia, including Hong Kong, a shortage of deceased donor liver grafts is a universal problem having to be faced in all transplant centers. Living-donor liver transplant (LDLT) has therefore been developed to counteract organ shortage and the high prevalence of HCC. The application of LDLT for HCC is a complex process involving donor voluntarism, selection criteria for the recipient and justification with respect to long-term survival in comparison to the result of deceased donor liver transplant. This article reviews the authors' experience with OLT for HCC patients in Hong Kong, with emphasis on the applicability and outcome of LDLT for HCC. Donor voluntarism has a significant impact on the application of LDLT. "Fast-track" LDLT in the setting of recurrence following curative treatment carries a high risk of recurrence even though the tumor stage fulfills the standard criteria. Although the survival outcome may be worse following LDLT than DDLT for HCC, LDLT is still the main treatment option for patients with transplantable HCC in Hong Kong, and a reasonable survival outcome can be achieved in selected patients with extended indications. It is particularly true that LDLT provides the only hope for patients with advanced HCC under the constricting problem of organ shortage.

The nested variant of bladder transitional cell carcinoma: Review of 12 cases and review of the literature.

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Carrion-Ballardo, C J; Gala-Solana, L; Portillo-Martin, J A; Azueta-Etxebarria, A; Truan-Cacho, D; Campos-Juanatey, F

2015-01-01

The nested variant of bladder transitional cell carcinoma is extremely rare and has a different biological behavior to other bladder tumors. The aim of this study is to analize if their behavior is as aggressive as has been described in the literature. Review of 12 diagnosed cases with nested variant of bladder transitional cell carcinoma and analysis of demographic characteristics, clinical presentation, tumor characteristics, treatment options, analysis of recurrence and cancer-specific survival between January 1997 and December 2010 in our hospital. 50% of the cases had a pathologic stage ≥T2, with grade of differentiation G2 (50%) or G3 (50%). After the pathological result of the TUR (transurethral resection) Bladder, 5 cases underwent radical cystoprostatectomy, 3 a second TUR bladder and 4 cases with treatment chemotherapy and/or radiotherapy (RT). Five out of 12 cases (41.7%) died due to bladder cancer and 3 died (25%) of other causes (urinary sepsis, respiratory failure, renal failure). With a median follow up of 40 months, the overall survival was 50% and cancer-specific survival of 65.6%. The nested variant of bladder transitional cell carcinoma is a disease with an advanced-stage presentation, with high recurrence and mortality rates despite the use of different treatments. So far there is not a clinical practice guideline for this variety of urothelial tumor. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Laparoscopic restorative total proctocolectomy with ileal pouch anal anastomosis for familial adenomatous polyposis.

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Palanivelu, C; Jani, Kalpesh; Sendhilkumar, K; Parthasarathi, R; Senthilnathan, P; Maheshkumar, G

2008-01-01

Familial adenomatous polyposis is a hereditary disease characterized by the presence of thousands of colonic adenomas, which, if untreated, invariably undergo malignant transformation. Because this disease manifests at a young age, the laparoscopic approach to perform surgery would be desirable due to its cosmetic benefits. We describe our experience with this procedure and review the literature on the topic. This is a case series of 15 patients who underwent restorative proctocolectomy with ileo-anal pouch anastomosis for familial adenomatous polyposis between 2000 and 2007. The salient operative steps are described. There were 9 males and 6 females, 32 to 52 years of age, with an average age of 44.8 years. The median body mass index was 21.5 (range, 17 to 28). Rectal cancer was already present in 4 patients at the time of diagnosis. The median operating time was 225 minutes. Mean blood loss was 60 mL, with none of the patients requiring perioperative blood transfusion. None of the surgeries required conversion to the open approach. Bowel function resumed on the second postoperative day in 12 patients and on the third postoperative day in 3 patients. The median hospital stay was 8 days. Postoperatively, there was no mortality and no serious morbidity. Laparoscopic restorative proctocolectomy with ileal pouch anal anastomosis is a feasible surgery for familial adenomatous polyposis, and considering its cosmetic benefit, is a desirable option for this group of predominantly young patients.

Ultrasound-guided percutaneous treatment of hepatocellular carcinoma by radiofrequency hyperthermia with a 'cooled-tip needle'. A preliminary clinical experience.

Science.gov (United States)

Francica, G; Marone, G

1999-05-01

Radiofrequency hyperthermia using the newly-developed 'cooled-tip' needle has recently been proposed as a therapeutic modality for hepatocellular carcinoma (HCC). Herein we report our preliminary results on feasibility and effectiveness of the thermal ablation of mono- or pauci-focal hepatocellular carcinoma with the cooled-tip needle. We treated 15 cirrhotic patients (mean age 68.8 years; 12 males; 14 HCV-positive; 13 in Child's Class A and 2 in Class B) with 20 hepatocellular carcinoma nodules (mean diameter 28.1 mm; range 10-43 mm; nine lesions with diameter greater than 3 cm). None of the patients had portal thrombosis and/or extrahepatic spread. We used a radiofrequency generator (100 W of power) connected to a 18 g perfusion electrode needle with an exposed tip of 2-3 cm. The circuit was closed through a dispersive electrode positioned under the patient's thighs. A peristaltic pump infused a chilled (2-5 degrees C) saline solution to guarantee the continuous cooling of the needle tip. The needle was placed into target lesions under US guidance. The interventional procedure was carried out in general anesthesia without intubation. Dynamic helical CT was carried out 15-20 days after thermal ablation to assess therapeutic efficacy. In all, 38 areas of coagulation necrosis (at 1000-1200 mA for 10-15 min) were generated in 24 sessions in the 20 hepatocellular carcinoma nodules (mean 1.9 lesions per nodule and 1.2 sessions per nodule). Complete necrosis as assessed at dynamic CT (lack of enhancement during the arteriographic phase) was achieved in 75% of cases in a single session; after a second RF session success rate was 90% (18 out of 20 nodules). A self-limited pleurisy along with a 5-fold increase in transaminases occurred in one patient; a 3-fold elevation of transaminases was encountered in three other patients. During the follow-up (median 15 months) five patients had recurrent hepatocellular carcinoma with a 1-year disease free interval of 64%. Of the

Rectocele and anal sphincter defect – surgical anatomy and ...

African Journals Online (AJOL)

carefully directed translabial ultrasound scan of the rectum and anal sphincters. The ultrasound examination was performed by a radi- ologist with specific understanding of the pathology. Conventional two-dimensional ultrasound imaging was performed using a 4 - 8. MHz curved array probe. The patient was in the left ...

Clinical Application of F-18 FDG PET (PET/CT) in Colo-rectal and Anal Cancer

International Nuclear Information System (INIS)

Kim, Byung Il

2008-01-01

In the management of colo-retal and anal cancer, accurate staging, treatment evaluation, early detection of recurrence are main clinical problems. F-18 FDG PET (PET/CT) has been reported as useful in the management of colo-rectal and anal cancer because that PET has high diagnostic performance comparing to conventional studies. In case of liver metastases, for confirmation of no extrahepatic metastases, in case of high risk of metastasis, for avoiding unnecessary operation, PET (PET/CT) is expected more useful. In anal cancer, PET is expected useful in lymph node staging. For the early prediction of chemotherapy or radiation therapy effect PET has been reported as useful, also. In early detection of recurrence by PET, cost-benefit advantages has been suggested, also. PET/CT is expected to have higher diagnostic performance than PET alone

Basal Cell Carcinoma

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... Kids’ zone Video library Find a dermatologist Basal cell carcinoma Overview Basal cell carcinoma: This skin cancer ... that has received years of sun exposure. Basal cell carcinoma: Overview Basal cell carcinoma (BCC) is the ...

Merkel Cell Carcinoma

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... Kids’ zone Video library Find a dermatologist Merkel cell carcinoma Overview Merkel cell carcinoma: This rare skin ... hard patch (1) or firm bump (2). Merkel cell carcinoma: Overview What is Merkel cell carcinoma? Merkel ...

Preoperative chemoradiotherapy and colonic J-pouch anal anastomosis for lower rectal cancer

International Nuclear Information System (INIS)

Inoue, Yasuhiro; Okigami, Masato; Kawamoto, Aya; Hiro, Junichiro; Toiyama, Yuji; Kobayashi, Minako; Tanaka, Koji; Miki, Chikao; Kusunoki, Masato

2011-01-01

We performed colonic J-pouch anal anastomosis in 61 patients with rectal cancer located <4 cm from the anal verge. Surgical and oncological results were evaluated in multimodality therapy for advanced rectal cancer. According to Wexner's score, 7% of patients were fully continent, 71% had acceptable function with minor continence problems, and 22% were incontinent. No patients required intermittent self-catheterization during follow-up. After a median follow-up of 49 months, there was only 1 case of local recurrence after surgery. Our surgical approach irrespective of internal sphincter resection produces satisfactory functional and oncological results in multimodality therapy using preoperative chemoradiotherapy for lower rectal cancer. (author)

Aberrant E-cadherin staining patterns in invasive mammary carcinoma

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Brogi Edi

2005-11-01

Full Text Available Abstract Background E-cadherin, a cell surface protein involved in cell adhesion, is present in normal breast epithelium, benign breast lesions, and in breast carcinoma. Alterations in the gene CDH1 on chromosome 16q22 are associated with changes in E-cadherin protein expression and function. Inactivation of E-cadherin in lobular carcinomas and certain diffuse gastric carcinomas may play a role in the dispersed, discohesive "single cell" growth patterns seen in these tumors. The molecular "signature" of mammary lobular carcinomas is the loss of E-cadherin protein expression as evidenced by immunohistochemistry, whereas ductal carcinomas are typically E-cadherin positive. Patients and methods We report on E-cadherin immunostaining patterns in five cases of invasive mammary carcinoma Results These were five exceptional instances in which the E-cadherin immunophenotype did not correspond to the apparent histologic classification of the lesion. These cases which are exceedingly rare in our experience are the subject of this report. Conclusion Findings such as those illustrated in this study occur in virtually all biologic phenomena and they do not invalidate the very high degree of correlation between the expression of E-cadherin and the classification of breast carcinomas as ductal or lobular type on the basis of conventional histologic criteria.

Posterior perineal support as treatment for anal fissures--preliminary results with a new toilet seat device.

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Tan, Kok-Yang; Seow-Choen, Francis; Hai, Chew Heng; Thye, Gan Kok

2009-03-01

Anal fissures can cause morbidity in an otherwise healthy young patient. The process of evacuation results in stretching and descent of the anoderm and perineum especially posteriorly. Posterior perineal support may provide counter pressure at the posterior aspect of the pelvic floor, balancing the pressure exerted by the faeces on the anal wall, thus improving evacuation and reducing the trauma associated with it, and reducing symptoms of anal fissures. Symptoms of constipation may also be reduced secondarily. We report the preliminary results with a novel, simple and noninvasive method of treatment provided by a toilet seat device. A prospective study was performed in 32 patients. The study was designed mainly to investigate the patients' subjective perceptions of their symptoms related to anal fissures and constipation. Questionnaires were provided to patients before, during and after treatment. The study revealed statistically significant improvement in pain, bleeding, symptoms of constipation and abdominal discomfort after 3 months usage of the device. The odds of patients perceiving an improvement in symptoms were also significantly increased after 3 months of treatment compared to 2 weeks of treatment. This preliminary study revealed that a posterior perineal support device can bring about significant improvement in the symptoms of patients with anal fissures. There may also be secondary benefits of a reduction in the symptoms of constipation. Although not conclusive, these results should serve as a springboard for further research into this area.

The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: The PREDICT study

Energy Technology Data Exchange (ETDEWEB)

Roos, A.-M., E-mail: annemarie.roos@gmail.com [Department of Obstetrics and Gynaecology, Mayday University Hospital, Croydon (United Kingdom); Abdool, Z. [Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria (South Africa); Sultan, A.H.; Thakar, R. [Department of Obstetrics and Gynaecology, Mayday University Hospital, Croydon (United Kingdom)

2011-07-15

Aim: To determine the accuracy and predictive value of transperineal (TPU) and endovaginal ultrasound (EVU) in the detection of anal sphincter defects in women with obstetric anal sphincter injuries and/or postpartum symptoms of faecal incontinence. Materials and methods: One hundred and sixty-five women were recruited, four women were excluded as they were seen years after their last delivery. TPU and EVU, followed by endonanal ultrasound (EAU), were performed using the B and K Viking 2400 scanner. Sensitivity and specificity, as well as predictive values with 95% confidence intervals, for detecting anal sphincter defects were calculated for EVU and TPU, using EAU as the reference standard. Results: On EAU a defect was found in 42 (26%) women: 39 (93%) had an external (EAS) and 23 (55%) an internal anal sphincter (IAS) defect. Analysable images of one level of the EAS combined with an analysable IAS were available in 140 (87%) women for EVU and in 131 (81%) for TPU. The sensitivity and specificity for the detection of any defect was 48% (30-67%) and 85% (77-91%) for EVU and 64% (44-81%) and 85% (77-91%) for TPU, respectively. Conclusion: Although EAU using a rotating endoprobe is the validated reference standard in the identification of anal sphincter defects, it is not universally available. However while TPU and/or EVU with conventional ultrasound probes can be useful in identifying normality, for clinical purposes they are not sensitive enough to identify an underlying sphincter defect.

The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: The PREDICT study

International Nuclear Information System (INIS)

Roos, A.-M.; Abdool, Z.; Sultan, A.H.; Thakar, R.

2011-01-01

Aim: To determine the accuracy and predictive value of transperineal (TPU) and endovaginal ultrasound (EVU) in the detection of anal sphincter defects in women with obstetric anal sphincter injuries and/or postpartum symptoms of faecal incontinence. Materials and methods: One hundred and sixty-five women were recruited, four women were excluded as they were seen years after their last delivery. TPU and EVU, followed by endonanal ultrasound (EAU), were performed using the B and K Viking 2400 scanner. Sensitivity and specificity, as well as predictive values with 95% confidence intervals, for detecting anal sphincter defects were calculated for EVU and TPU, using EAU as the reference standard. Results: On EAU a defect was found in 42 (26%) women: 39 (93%) had an external (EAS) and 23 (55%) an internal anal sphincter (IAS) defect. Analysable images of one level of the EAS combined with an analysable IAS were available in 140 (87%) women for EVU and in 131 (81%) for TPU. The sensitivity and specificity for the detection of any defect was 48% (30-67%) and 85% (77-91%) for EVU and 64% (44-81%) and 85% (77-91%) for TPU, respectively. Conclusion: Although EAU using a rotating endoprobe is the validated reference standard in the identification of anal sphincter defects, it is not universally available. However while TPU and/or EVU with conventional ultrasound probes can be useful in identifying normality, for clinical purposes they are not sensitive enough to identify an underlying sphincter defect.

Hereditary vacuolar internal anal sphincter myopathy causing proctalgia fugax and constipation: a new case contribution.

Science.gov (United States)

de la Portilla, Fernando; Borrero, Juan José; Rafel, Enrique

2005-03-01

Hereditary anal sphincter myopathy is rare. We present a family with one affected member with proctalgia fugax, constipation and internal anal sphincter hypertrophy. Ultrastructural findings show vacuolization of smooth muscle cells without the characteristic polyglucosan inclusion. Further relief of symptoms was obtained using an oral calcium antagonist. Based on clinical presentation, endosonography and morphological findings, we consider our case is a histological variant of the vacuolar myopathy originally described.

Dose planning objectives in anal canal cancer IMRT: the TROG ANROTAT experience

Energy Technology Data Exchange (ETDEWEB)

Brown, Elizabeth, E-mail: elizabeth@mebrown.net [Princess Alexandra Hospital, Brisbane, Queensland (Australia); Cray, Alison [Peter MacCallum Cancer Cancer Centre, Box Hill, Victoria (Australia); Haworth, Annette [Peter MacCallum Cancer Cancer Centre, Box Hill, Victoria (Australia); University of Melbourne, Melbourne, Victoria (Australia); Chander, Sarat [Peter MacCallum Cancer Cancer Centre, Box Hill, Victoria (Australia); Lin, Robert [Medica Oncology, Hurstville, New South Wales (Australia); Subramanian, Brindha; Ng, Michael [Radiation Oncology Victoria, Melbourne, Victoria (Australia); Princess Alexandra Hospital, Brisbane, Queensland (Australia)

2015-06-15

Intensity modulated radiotherapy (IMRT) is ideal for anal canal cancer (ACC), delivering high doses to irregular tumour volumes whilst minimising dose to surrounding normal tissues. Establishing achievable dose objectives is a challenge. The purpose of this paper was to utilise data collected in the Assessment of New Radiation Oncology Treatments and Technologies (ANROTAT) project to evaluate the feasibility of ACC IMRT dose planning objectives employed in the Australian situation. Ten Australian centres were randomly allocated three data sets from 15 non-identifiable computed tomography data sets representing a range of disease stages and gender. Each data set was planned by two different centres, producing 30 plans. All tumour and organ at risk (OAR) contours, prescription and dose constraint details were provided. Dose–volume histograms (DVHs) for each plan were analysed to evaluate the feasibility of dose planning objectives provided. All dose planning objectives for the bone marrow (BM) and femoral heads were achieved. Median planned doses exceeded one or more objectives for bowel, external genitalia and bladder. This reached statistical significance for bowel V30 (P = 0.04), V45 (P < 0.001), V50 (P < 0.001), external genitalia V20 (P < 0.001) and bladder V35 (P < 0.001), V40 (P = 0.01). Gender was found to be the only significant factor in the likelihood of achieving the bowel V50 (P = 0.03) and BM V30 constraints (P = 0.04). The dose planning objectives used in the ANROTAT project provide a good starting point for ACC IMRT planning. To facilitate clinical implementation, it is important to prioritise OAR objectives and recognise factors that affect the achievability of these objectives.

Prevalence of anal infection due to high-risk human papillomavirus and analysis of E2 gene integrity among women with cervical abnormalities.

Science.gov (United States)

Gonzalez-Losa, María Del Refugio; Puerto-Solís, Marylin; Ayora-Talavera, Guadalupe; Gómez-Carvallo, Jesús; Euán-López, Alejandra; Cisneros-Cutz, José I; Rosado-López, Ariel; Echeverría Salazar, Jesúa; Conde-Ferráez, Laura

2018-04-01

High-risk human papillomaviruses (HR-HPV) infection has been associated with 90% of anal cancer cases. Women with abnormal cytology are a high-risk group to develop anal neoplasia. The aim of this study is to describe the prevalence and epidemiology of HR-HPV 16, 18, 45, and 58 anal infections in women with cervical abnormalities, as well as to assess E2 gene integrity. A cross-sectional study was performed on 311 cervical and 311 anal samples from patients with abnormal cytology in two colposcopy clinics in Yucatan, Mexico. A specific PCR for oncogenes was performed in order to identify HVP 16, 18, 45 and 58. Real time PCR was used to amplify the whole HPV 16, 18, and 58 E2 gene to verify its integrity in anal samples. High risk HPV 16, 18, 58, and/or 45 were found in 41.47% (129/311) of cervical samples, and in 30.8% (96/331) of anal samples, with 18% (57/311) of the patients being positive in both samples. The same genotypes in both anatomical sites were observed in 11.25% (35/311). The E2 gene was disrupted in 82% of all tested samples. The frequency of genome disruption viral integration in anal samples by genotype was: HPV 58 (97.2%); HPV 16 (72.4%), and HPV 18 (0%). Women with cervical disease have HR-HPV anal infections, and most of them have the E2 gene disrupted, which represents a risk to develop anal cancer. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Compliance to consensus recommendations, surgeon's experience, and introduction of a quality assurance and management program: influence on therapy of early-stage ovarian carcinoma.

Science.gov (United States)

Kommoss, Stefan; Harter, Philipp; Traut, Alexander; Strutas, Deivis; Riegler, Nina; Buhrmann, Christine; Gomez, Ruth; du Bois, Andreas

2009-05-01

State-of-the-art surgical staging and adjuvant chemotherapy in early-stage ovarian carcinoma have an impact on patient's outcome, but compliance to guidelines and consensus recommendations is still poor. This article reports on our results before and after introduction of a quality assurance and management program in our clinic in 2001. Patients with ovarian carcinoma limited to the pelvis who underwent primary surgery in our hospital from 1997 to October 2007 were eligible for this study. Univariate and multivariate logistic regression analyses were performed to evaluate the impact of compliance with our management program and physician's experience in ovarian carcinoma surgery on achieving both standards of surgery and chemotherapy. In a total of 117 women, a significant impact on adherence to guideline-defined comprehensive surgical staging was found for poor Eastern Cooperative Oncology Group performance status (odds ratio [OR], 22.16; confidence interval [CI] 3.2-152.0; P = 0.002) and year of surgery before 2001 (OR, 47.60; CI, 9.20-245.22; P grading less than G3 (OR, 4.14; CI, 1.20-14.22; P = 0.02) was a statistically significant predictor for receiving standard adjuvant chemotherapy. Survival analyses showed a trend toward improved survival for patients having received guideline-adopted therapy, but event numbers were too low for adequate analyses. The introduction of a quality assurance program for treatment of ovarian carcinoma represents a major improvement of patient care. It led to a higher compliance with consensus recommendations and showed already a trend toward improved outcome. Further outcome research should focus on methods for implementation of guidelines in daily practice in institutions caring for patients with ovarian carcinoma.

Adjuvant therapy for ampullary carcinomas: The Mayo Clinic experience

International Nuclear Information System (INIS)

Bhatia, Sumita; Miller, Robert C.; Haddock, Michael G.; Donohue, John H.; Krishnan, Sunil

2006-01-01

Purpose: To determine the effects of adjuvant radiotherapy and chemotherapy for carcinoma of the ampulla of Vater. Methods and Materials: We retrospectively reviewed the records of 125 patients who underwent definitive surgery for carcinomas involving the ampulla of Vater between April 1977 and February 2005 and who survived more than 50 days after surgery. Twenty-nine of the patients also received adjuvant radiotherapy (median dose, 50.4 Gy in 28 fractions) with concurrent 5-fluorouracil chemotherapy. Adverse prognostic factors were investigated, and overall survival (OS) and local and distant failure were estimated. Results: Adverse prognostic factors for decreased OS by univariate analysis included lymph node (LN) involvement, locally advanced tumors (T3/T4), and poor histologic grade. By multivariate analysis, positive LN status (p = 0.02) alone was associated with decreased OS. The addition of adjuvant radiotherapy and chemotherapy improved OS for patients with positive LN (p = 0.01). Median survival for positive LN patients receiving adjuvant therapy was 3.4 years, vs. 1.6 years for those with surgery alone. Conclusions: The addition of adjuvant radiotherapy and 5-fluorouracil chemotherapy may improve OS in patients with LN involvement. The effect of adjuvant therapy on outcomes for patients with poor histologic grade or T3/T4 tumors without LN involvement could not be assessed

Avelumab With Valproic Acid in Virus-associated Cancer

Science.gov (United States)

2018-06-11

Cancer That is Associated With a Chronic Viral Infection; p16 Positive SCCHN; Squamous Cell Carcinoma of the Cervix; p16 Positive Squamous Cell Carcinoma of the Vagina or Vulva; p16 Positive Squamous Cell Carcinoma of the Penis; p16 Positive Squamous Cell Carcinoma of the Anus or Anal Canal; EBER Positive NPC; EBER Positive Hodgkins and Non-hodgkins Lymphona

Gut-associated Lymphoid Tissue (GALT) Carcinoma or Dome Carcinoma?

Science.gov (United States)

Rubio, Carlos A; Schmidt, Peter T

2016-10-01

The vast majority of colorectal carcinomas (CRCs) evolve from mucosa not associated to lymphoid tissues aggregates via the adenoma-carcinoma sequence or via the serrated pathway. Rarely CRCs evolve from gut mucosa associated to lymphoid tissue (GALT). Based on the presence of a circumscribed elevation in the colorectal mucosa, GALT carcinomas are also referred to as dome carcinomas (DC). Descriptions of the surface mucosa covering 21 GALT-CRCs appearing in pathological reports were reviewed. Three of the 21 GALT-CRCs fulfilled the criteria of dome carcinoma. Of the remaining 18 GALT-CRCs, nine were described as polypoid lesions, five as plaque-like lesions, two as sessile elevated lesions or mass, one as ulcerated and one as histological finding. Hence, only 14.3% (n=3) of the 21 GALT-CRCs displayed a dome configuration, whereas the majority, 85.7% (n=18), exhibited structures other than dome shapes at gross or at histologic examination. It becomes apparent that by using "dome" in addressing carcinomas in the colorectal mucosa, many cases of GALT carcinomas might be overlooked. Another drawback of using the "dome" nomenclature is that dome-like outlines may be detected in small metastatic tumors in the submucosa or in small colorectal carcinomas not arising from GALT mucosa. Instead, by using "GALT carcinoma", that is the histologic diagnosis in addressing these neoplasias, all cases of GALT-CRCs will be included. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Nivolumab and Ipilimumab in Treating Patients With Rare Tumors

Science.gov (United States)

2018-05-14

Acinar Cell Carcinoma; Adenoid Cystic Carcinoma; Adrenal Cortex Carcinoma; Adrenal Gland Pheochromocytoma; Anal Canal Neuroendocrine Carcinoma; Anal Canal Undifferentiated Carcinoma; Appendix Mucinous Adenocarcinoma; Bartholin Gland Transitional Cell Carcinoma; Bladder Adenocarcinoma; Cervical Adenocarcinoma; Cholangiocarcinoma; Chordoma; Colorectal Squamous Cell Carcinoma; Desmoid-Type Fibromatosis; Endometrial Transitional Cell Carcinoma; Endometrioid Adenocarcinoma; Esophageal Neuroendocrine Carcinoma; Esophageal Undifferentiated Carcinoma; Extrahepatic Bile Duct Carcinoma; Fallopian Tube Adenocarcinoma; Fallopian Tube Transitional Cell Carcinoma; Fibromyxoid Tumor; Gastric Neuroendocrine Carcinoma; Gastric Squamous Cell Carcinoma; Gastrointestinal Stromal Tumor; Giant Cell Carcinoma; Intestinal Neuroendocrine Carcinoma; Intrahepatic Cholangiocarcinoma; Lung Carcinoid Tumor; Lung Sarcomatoid Carcinoma; Major Salivary Gland Carcinoma; Malignant Odontogenic Neoplasm; Malignant Peripheral Nerve Sheath Tumor; Malignant Testicular Sex Cord-Stromal Tumor; Metaplastic Breast Carcinoma; Metastatic Malignant Neoplasm of Unknown Primary Origin; Minimally Invasive Lung Adenocarcinoma; Mixed Mesodermal (Mullerian) Tumor; Mucinous Adenocarcinoma; Mucinous Cystadenocarcinoma; Nasal Cavity Adenocarcinoma; Nasal Cavity Carcinoma; Nasopharyngeal Carcinoma; Nasopharyngeal Papillary Adenocarcinoma; Nasopharyngeal Undifferentiated Carcinoma; Oral Cavity Carcinoma; Oropharyngeal Undifferentiated Carcinoma; Ovarian Adenocarcinoma; Ovarian Germ Cell Tumor; Ovarian Mucinous Adenocarcinoma; Ovarian Squamous Cell Carcinoma; Ovarian Transitional Cell Carcinoma; Pancreatic Acinar Cell Carcinoma; Pancreatic Neuroendocrine Carcinoma; Paraganglioma; Paranasal Sinus Adenocarcinoma; Paranasal Sinus Carcinoma; Parathyroid Gland Carcinoma; Pituitary Gland Carcinoma; Placental Choriocarcinoma; Placental-Site Gestational Trophoblastic Tumor; Primary Peritoneal High Grade Serous Adenocarcinoma

[Clinical significance of detection of internal anal sphincter in children with functional constipation].

Science.gov (United States)

Hou, Xiang-yu; Wang, Ling-yun; Wang, Wei-lin; Li, Yong; Bai, Yu-zuo

2011-10-01

To investigate the structural and functional changes of internal anal sphincter (IAS) in children with functional constipation (FC), and to evaluate the association between the thickness of IAS and the severity of clinical symptoms. A total of 35 children with FC(constipation group,17 with incontinence) between June 2008 and December 2008 at the Shengjing Hospital of China Medical University were evaluated using anal manometry and endosonography. These patients were compared to 23 hospitalized children who were excluded for digestive and endocrinal diseases(control group). A validated symptom score(SS) was used to assess the severity of symptoms. The sum of SS ranged between 0 and 65. Anorectal manometry showed reflex relaxation of IAS in response to distension of rectal balloon in all patients. Rectal perceptional threshold in FC group was significantly higher than that in the controls[(42.4 ± 19.5) ml vs.(29.1 ± 15.6) ml, PIAS was significantly higher than that in the controls [(55.6 ± 31.6) ml vs.(30.5 ±13.8) ml, PIAS was noted in all the patients[(3.8 ± 1.7) mm vs.(2.5 ± 1.0) mm, P0.05]. The median symptom score was 9.3 ± 4.3 in the FC group. The thickness of IAS correlated significantly with total symptom severity score(r=0.407, PIAS and age, sex, or duration of disease(P>0.05). Structural and functional changes of internal anal sphincter exist in children with functional constipation. The thickness of internal anal sphincter correlates significantly with symptom severity.

Feasibility of preference-driven radiotherapy dose treatment planning to support shared decision making in anal cancer

DEFF Research Database (Denmark)

Rønde, Heidi S; Wee, Leonard; Pløen, John

2017-01-01

PURPOSE/OBJECTIVE: Chemo-radiotherapy is an established primary curative treatment for anal cancer, but clinically equal rationale for different target doses exists. If joint preferences (physician and patient) are used to determine acceptable tradeoffs in radiotherapy treatment planning, multipl...... that preference-informed dose planning is feasible for clinical studies utilizing shared decision making....... dose plans must be simultaneously explored. We quantified the degree to which different toxicity priorities might be incorporated into treatment plan selection, to elucidate the feasible decision space for shared decision making in anal cancer radiotherapy. MATERIAL AND METHODS: Retrospective plans.......7%-points; (0.3; 30.6); p decision space available in anal cancer radiotherapy to incorporate preferences, although tradeoffs are highly patient-dependent. This study demonstrates...

Superselective intra-arterial infusion of high-dose cisplatin combined with radiation therapy for head and neck carcinoma. Experience of Yamagata University Hospital

International Nuclear Information System (INIS)

Hamamoto, Yasushi; Niino, Keiji; Ishiyama, Hiromichi; Koike, Shuji; Hosoya, Takaaki; Aoyagi, Masaru

2003-01-01

Local effectiveness and complication of superselective intra-arterial infusion of high-dose cisdiamminedichloroplatinum (CDDP) (SIC) combined with radiation therapy (RT) were investigated. Between 1998 and 2000, 18 head and neck carcinomas including 10 maxillary carcinomas (T3; 1, T4; 9), 3 oral cavity carcinomas (T2; 1, T4; 2), and 5 oropharyngeal carcinomas (T2; 2, T4; 3) were treated with SIC and RT with or without surgery. CDDP of 100-150 mg/body was administered weekly in principle for 2-9 weeks (mean: 4.9) with the simultaneous administration of sodium thiosulfate. Radiation doses ranged from 40 Gy to 70 Gy (mean: 56.8 Gy). Complete response was obtained in 7 of 10 maxillary carcinomas, 2 of 3 oral-cavity carcinomas, and 2 of 5 oropharyngeal carcinomas, respectively. When surgical intervention was performed if necessary, 2-year local control rates for maxillary carcinoma, and other carcinoma including oral-cavity carcinoma and oropharyngeal carcinoma were 80% and 63% respectively. Two-year local control rates for T4 maxillary carcinoma, and other T4 carcinoma including oral-cavity carcinoma and oropharyngeal carcinoma were 78% and 40% respectively. Two-year overall survival rates for all cases, maxillary carcinoma, and oral-cavity/oropharyngeal carcinoma were 88%, 90% and 86% respectively. All local recurrences occurred within 6 months from the initiation of treatment. The systemic toxicity of weekly SIC was comparatively mild; however, a total CDDP dose of 1,000 mg or more and/or RT of 70 Gy induced complications of local soft tissue such as mucosal ulcer and fistula. SIC combined with RT is useful to improve the local control/survival rates and to avoid the aggressive surgery for locally advanced head and neck carcinoma. A high total dose of CDDP and/or RT of a comparatively high dose may be risk factors for local soft tissue complications. (author)

Clinical and manometric evaluation of women with chronic anal fissure before and after internal subcutaneous lateral sphincterotomy

Directory of Open Access Journals (Sweden)

Silvana Marques e Silva

2012-06-01

Full Text Available OBJECTIVE: To evaluate clinical and manometric parameters of chronic anal fissure females undergoing lateral internal sphincterotomy (LIS. METHODS: A total of eight women with chronic anal fissure who underwent LIS were included in this study. The preoperative assessment was performed one week before surgery and included general and anorectal examination, anorectal manometry, and Jorge Wexner questionnaire. The post operative follow up was made every 15 days until complete healing. Jorge Wexner questionnaires and anorectal manometry were repeated at 1 month and 3 months after the surgery. Time to healing, manometric changes and complications were assessed. RESULTS: All patients had preoperative increased anal resting pressure. The resting pressures and anal canal length were significantly decreased 3 months after surgery. Patients' complaints of itching and bleeding were also reduced. Fissures healed in 7 patients and median healing time was 45 days. No complications were observed due to the procedure. One patient had transient incontinence to flatus. CONCLUSION: Lateral internal sphincterotomy provided clinical improvement and reduced resting pressure of the internal anal sphincter in women with chronic anal fissure.OBJETIVO: Avaliar a evolução clínica e manométrica de mulheres com fissura anal crônica submetidas à esfincterotomia lateral interna subcutânea. MÉTODOS: Estudo prospectivo com oito pacientes. A avaliação inicial foi realizada por meio de questionários, exame físico e manometria anorretal na semana anterior ao procedimento cirúrgico. Durante o período pós-operatório, as pacientes foram avaliadas clinicamente a cada 15 dias, até a cicatrização completa. Os questionários e a manometria anorretal foram repetidos 1 mês e 3 meses após a operação. Foi avaliado o tempo para cicatrização da fissura, as alterações manométricas e as complicações decorrentes do procedimento. RESULTADOS: Todas as pacientes

Identification of episomal human papillomavirus and other DNA viruses in cytological anal samples of HIV-uninfected men who have sex with men.

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Maria Gabriella Donà

Full Text Available To date, there have been only few studies that investigated integration of anal Human Papillomavirus (HPV. Most of them were conducted on HIV-infected individuals and mainly analyzed samples from high-grade lesions and invasive cancer. We aimed to investigate HPV physical status in HIV-negative men who have sex with men (MSM with a detectable anal HPV infection, irrespective of the presence of lesions. We also sought to explore the presence of other circular DNA viruses in the anal region. Study participants were attendees of an STI screening program, which were also screened for anal HPV infection and cytological abnormalities. HPV physical status was assessed using multiply-primed RCA. HPV16-positive samples were also analyzed using E2/E6 multiplex PCR, qRT-PCR and APOT assay. RCA and virus-specific PCR were employed to investigate the presence of other DNA viruses. Anal HPV infection was detected in 76.9% of the 230 MSM enrolled. The anal cytological reports were: 129 NILM, 37 ASC-US and 28 L-SIL (36 samples were inadequate for interpretation. HPV physical status was evaluated in the 109 anal specimens that harbored one or two different HPV genotypes. Integration was observed only in one HPV16-positive sample (0.9%, in which integrate-derived viral transcripts of type B were detected. Integration occurred in chromosome 14 q. In 22 of the 53 (41.5% mucosal HPV-negative samples, RCA restriction results would seem to indicate the presence of circular DNA viruses. Indeed, cutaneous HPV (4 samples, MCPyV (5 samples and TTV (4 samples were detected. In conclusion, anal HPV integration was rarely evidenced in HIV-uninfected MSM with no or mild anal cytological abnormalities, although the integration rate may have been underestimated because of the limitations of the employed assays. Other DNA viruses were detected in the anal samples of these individuals, although the significance of this occurrence needs to be assessed.