WorldWideScience

Sample records for human internal anal

  1. 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.

  2. Nature of extracellular signal that triggers RhoA/ROCK activation for the basal internal anal sphincter tone in humans.

    Science.gov (United States)

    Rattan, Satish; Singh, Jagmohan; Kumar, Sumit; Phillips, Benjamin

    2015-06-01

    The extracellular signal that triggers activation of rho-associated kinase (RhoA/ROCK), the major molecular determinant of basal internal anal sphincter (IAS) smooth muscle tone, is not known. Using human IAS tissues, we identified the presence of the biosynthetic machineries for angiotensin II (ANG II), thromboxane A2 (TXA2), and prostaglandin F2α (PGF2α). These end products of the renin-angiotensin system (RAS) (ANG II) and arachidonic acid (TXA2 and PGF2α) pathways and their effects in human IAS vs. rectal smooth muscle (RSM) were studied. A multipronged approach utilizing immunocytochemistry, Western blot analyses, and force measurements was implemented. Additionally, in a systematic analysis of the effects of respective inhibitors along different steps of biosynthesis and those of antagonists, their end products were evaluated either individually or in combination. To further describe the molecular mechanism for the IAS tone via these pathways, we monitored RhoA/ROCK activation and its signal transduction cascade. Data showed characteristically higher expression of biosynthetic machineries of RAS and AA pathways in the IAS compared with the RSM. Additionally, specific inhibition of the arachidonic acid (AA) pathway caused ~80% decrease in the IAS tone, whereas that of RAS lead to ~20% decrease. Signal transduction studies revealed that the end products of both AA and RAS pathways cause increase in the IAS tone via activation of RhoA/ROCK. Both AA and RAS (via the release of their end products TXA2, PGF2α, and ANG II, respectively), provide extracellular signals which activate RhoA/ROCK for the maintenance of the basal tone in human IAS.

  3. RhoA/ROCK pathway is the major molecular determinant of basal tone in intact human internal anal sphincter.

    Science.gov (United States)

    Rattan, Satish; Singh, Jagmohan

    2012-04-01

    The knowledge of molecular control mechanisms underlying the basal tone in the intact human internal anal sphincter (IAS) is critical for the pathophysiology and rational therapy for a number of debilitating rectoanal motility disorders. We determined the role of RhoA/ROCK and PKC pathways by comparing the effects of ROCK- and PKC-selective inhibitors Y 27632 and Gö 6850 (10(-8) to 10(-4) M), respectively, on the basal tone in the IAS vs. the rectal smooth muscle (RSM). Western blot studies were performed to determine the levels of RhoA/ROCK II, PKC-α, MYPT1, CPI-17, and MLC(20) in the unphosphorylated and phosphorylated forms, in the IAS vs. RSM. Confocal microscopic studies validated the membrane distribution of ROCK II. Finally, to confirm a direct relationship, we examined the enzymatic activities and changes in the basal IAS tone and p-MYPT1, p-CPI-17, and p-MLC(20), before and after Y 27632 and Gö 6850. Data show higher levels of RhoA/ROCK II and related downstream signal transduction proteins in the IAS vs. RSM. In addition, data show a significant correlation between the active RhoA/ROCK levels, ROCK enzymatic activity, downstream proteins, and basal IAS tone, before and after ROCK inhibitor. From these data we conclude 1) RhoA/ROCK and downstream signaling are constitutively active in the IAS, and this pathway (in contrast with PKC) is the critical determinant of the basal tone in intact human IAS; and 2) RhoA and ROCK are potential therapeutic targets for a number of rectoanal motility disorders for which currently there is no satisfactory treatment.

  4. Neuromyogenic properties of the internal anal sphincter: therapeutic rationale for anal fissures.

    Science.gov (United States)

    Bhardwaj, R; Vaizey, C J; Boulos, P B; Hoyle, C H

    2000-06-01

    Lateral sphincterotomy diminishes internal anal sphincter hypertonia and thereby reduces anal canal pressure. This improves anal mucosal blood flow and promotes the healing of anal fissures. However, sphincterotomy can be associated with long term disturbances of sphincter function. The optimal treatment for an anal fissure is to induce a temporary reduction of anal canal resting pressure to allow healing of the fissure without permanently disrupting normal sphincter function. Broader understanding of the intrinsic mechanisms controlling smooth muscle contraction has allowed pharmacological manipulation of anal sphincter tone. We performed an initial Medline literature search to identify all articles concerning "internal anal sphincter" and "anal fissures". This review is based on these articles and on additional publications obtained by manual cross referencing. Internal anal smooth muscle relaxation can be inhibited by stimulation of non-adrenergic non-cholinergic enteric neurones, parasympathetic muscarinic receptors, or sympathetic beta adrenoceptors, and by inhibition of calcium entry into the cell. Sphincter contraction depends on an increase in cytoplasmic calcium and is enhanced by sympathetic adrenergic stimulation. Currently, the most commonly used pharmacological agent in the treatment of anal fissures is topical glyceryl trinitrate, a nitric oxide donor. Alternative agents that exhibit a similar effect via membrane Ca2+ channels, muscarinic receptors, and alpha or beta adrenoceptors are also likely to have a therapeutic potential in treating anal fissures.

  5. Anal human papillomavirus DNA in women at a colposcopy clinic.

    NARCIS (Netherlands)

    Hauwers, K.W.M. d'

    2012-01-01

    OBJECTIVES: To describe the type-specific prevalence of anal and cervical human papillomavirus (HPV) infections and the cytology in HIV-negative women without a history of cervical cancer, attending a colposcopy clinic. To examine if an HPV positive anal smear is related to anal pathology and

  6. Anal human papillomavirus DNA in women at a colposcopy clinic.

    NARCIS (Netherlands)

    Hauwers, K.W.M. d'

    2012-01-01

    OBJECTIVES: To describe the type-specific prevalence of anal and cervical human papillomavirus (HPV) infections and the cytology in HIV-negative women without a history of cervical cancer, attending a colposcopy clinic. To examine if an HPV positive anal smear is related to anal pathology and conseq

  7. Internal sphincterotomy versus topical nitroglycerin ointment for chronic anal fissure

    Directory of Open Access Journals (Sweden)

    Muhammad I. Aslam

    2014-01-01

    Conclusion: This quasi-experimental study demonstrates that open partial lateral internal sphincterotomy is superior to topical 0.2% nitroglycerin application in the treatment of chronic anal fissure, with good symptomatic relief, high rate of healing, fewer side effects, and a very low rate of early continence disturbances.

  8. Role of intracellular calcium in contraction of internal anal sphincter

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    @@ INTRODUCTION Internal anal sphincter (IAS) is a continuation of the smooth circular muscle layer thickened at the rectum, innervated by vegetative nerve. IAS is a special smooth muscle, which is different from colonic smooth muscle in physiology and pharmaology[1]. It was found that contraction of gastric smooth muscle depends on the influx of extracellular calcium and release of intracellular calcium[2]. In present study, we observed and compared the effects of extra- and intracellular calcium on the contraction of IAS and colonic smooth muscle.

  9. Benign anal lesions, inflammatory bowel disease and risk for high-risk human papillomavirus-positive and -negative anal carcinoma.

    OpenAIRE

    Frisch, M; Glimelius, B; van den Brule, A. J.; Wohlfahrt, J; Meijer, C. J.; Walboomers, J M; Adami, H. O.; Melbye, M.

    1998-01-01

    A central role in anal carcinogenesis of high-risk types of human papillomaviruses (hrHPV) was recently established, but the possible role of benign anal lesions has not been addressed in hrHPV-positive and -negative anal cancers. As part of a population-based case-control study in Denmark and Sweden, we interviewed 417 case patients (93 men and 324 women) diagnosed during the period 1991-94 with invasive or in situ anal cancer, 534 patients with adenocarcinoma of the rectum and 554 populatio...

  10. The effect of topical anal captopril on resting anal pressure in healthy volunteers: the first human pilot study.

    Science.gov (United States)

    Khaikin, M; Bashankaev, B; Sands, D; Weiss, E G; Zbar, A; Wexner, S D

    2014-01-01

    Previous laboratory studies have shown that angiotensin II is produced locally in the rat internal anal sphincter causing potent contraction. The aim of this first human study was to evaluate the safety and manometric effects of topical application of captopril (an ACE inhibitor) on the resting anal pressure in healthy adult volunteers. Ten volunteers, mean age 32.5 years (range, 19-48 years), underwent anorectal manometric evaluation of the mean anal resting pressure (MRAP) and the length of the high-pressure zone (HPZ) before 20 and 60 min after topical application of captopril (0.28 %) cream. Cardiovascular variables (systolic blood pressure, diastolic blood pressure and pulse) were measured before and for up to 1 h after cream application. Side effects were recorded. Adverse events and patient comfort after the cream application were evaluated within a 24-h period by completing a questionnaire. There was no significant change overall in MRAP following captopril administration, although in half the patients, there were reductions in MRAP after treatment. Half the patients had a reduction in the mean resting HPZ length; however, there was no overall difference between pre- and post-treatment values. There was no effect on basic cardiovascular parameters and no correlation between manometric and cardiovascular variables. Topical application of captopril cream may result in a reduction in MRAP in volunteers without anorectal disease. Its use is associated with minimal side effects. It may be a new potential therapeutic option in the treatment of anal fissure. Further studies are required to determine the optimal concentration, dose and frequency of application.

  11. The effect of lateral internal sphincterotomy on resting anal sphincter pressures

    OpenAIRE

    Peker, Kemal; YILMAZ, İsmayil; DEMİRYILMAZ, İsmail; İNAL, Abdullah; Işik, Arda

    2014-01-01

    Anal fissures are one of the most common proctologic disorders. This study aimed to investigate alterations in anal sphincteric resting pressures after lateral internal sphincterotomy, which was performed for chronic anal fissure treatment. Materials and methods: Fifty-six (68.3%) male and 26 (31.7%) female patients were included in this study. Patients complicated with fistula-in-ano, abscess, cancer, inflammatory bowel disease, dermatitis, poor general condition, allergy to any of the stan...

  12. Chronic anal fissures: Open lateral internal sphincterotomy result; a case series study

    Directory of Open Access Journals (Sweden)

    Abdulwahid M. Salih

    2017-03-01

    Conclusion: lateral sphincterotomy for internal anal sphincter, along, is the procedure of choice for management of CAF because it is effective and it can cure the disease in nearly all patients with good patient satisfaction.

  13. Screening for Anal Cancer in Women

    Science.gov (United States)

    Moscicki, Anna-Barbara; Darragh, Teresa M.; Berry-Lawhorn, J. Michael; Roberts, Jennifer Margaret; Khan, Michelle J.; Boardman, Lori A.; Chiao, Elizabeth; Einstein, Mark H.; Goldstone, Stephen E.; Jay, Naomi; Likes, Wendy M.; Stier, Elizabeth A.; Welton, Mark Lane; Wiley, Dorothy J.; Palefsky, Joel M.

    2015-01-01

    Objective The incidence of anal cancer is higher in women than men in the general population and has been increasing for several decades. Similar to cervical cancer, most anal cancers are associated with human papillomavirus (HPV) and it is believed that anal cancers are preceded by anal high-grade squamous intraepithelial lesions (HSIL). Our goal was to summarize the literature on anal cancer, HSIL and HPV infection in women, and provide screening recommendations in women. Methods A group of experts convened by the ASCCP and the International Anal Neoplasia Society reviewed the literature on anal HPV infection, anal SIL and anal cancer in women. Results Anal HPV infection is common in women but is relatively transient in most. The risk of anal HSIL and cancer varies considerably by risk group, with HIV-infected women and those with a history of lower genital tract neoplasia (LGTN) at highest risk compared with the general population. Conclusions While there are no data yet to demonstrate that identification and treatment of anal HSIL leads to reduced risk of anal cancer, women in groups at the highest risk should be queried for anal cancer symptoms and have digital anorectal examinations to detect anal cancers. HIV-infected women and women with LGTN, may be considered for screening with anal cytology with triage to treatment if HSIL is diagnosed. Healthy women with no known risk factors or anal cancer symptoms do not need to be routinely screened for anal cancer or anal HSIL. PMID:26103446

  14. [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.

  15. 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

  16. [National and international impact factor of Anales de Pediatría].

    Science.gov (United States)

    Aleixandre Benavent, R; Valderrama Zurián, J C; Castellano Gómez, M; Simó Meléndez, R; Navarro Molina, C

    2004-09-01

    The aim of this study was to present bibliometric indicators of the impact of Anales de Pediatría in 2001 and to compare this journal with other Spanish pediatrics journals. A total of 5,388 bibliographic references from 1999, 2000 and 2001 corresponding to citable articles published in 2001 in a sample of 87 selected Spanish medical journals were analyzed. The indicators obtained were the number of citations, the national and international impact factor (IF) and the immediacy index. The national IF of Anales de Pediatría was 0.334 and the international IF was 0.372. The immediacy index was 0.111. This study confirms the leadership of Anales de Pediatría, since this journal is the most frequently cited Spanish pediatrics journal and has the highest IF and immediacy index. The bibliometric indicators obtained are comparable with those observed in other journals included in Journal Citation Reports.

  17. The Physiology, Pharmacology and Therapeutic Manipulation of the Internal Anal Sphincter

    Directory of Open Access Journals (Sweden)

    Oliver M Jones

    2002-01-01

    Full Text Available Recent research into the physiology and pharmacology of the internal anal sphincter has elucidated the importance of this structure in health and disease. Its pharmacological manipulation for therapeutic gain has focused mainly on agents to reduce internal anal sphincter tone, a ‘chemical sphincterotomy’ that might heal chronic anal fissure. However, drugs to increase sphincter tone, and augment intermittent and appropriate relaxation are also being evaluated. The initial results with this medical approach to anorectal disease have often been disappointing, failing to match the results achievable with surgery, and many of these drugs have a high rate of side effects in the short term. However, clinical trials have yet to establish the optimum doses, dose intervals and routes of administration for many of these therapies. Furthermore, it is uncertain whether this medical approach should be applied to all patients or just to an as yet undefined subgroup. Certainly, even in the current environment of uncertainty, there is little reason not to try medical manipulation of the internal sphincter as first-line treatment. Surgery remains an option for treatment failures; patients responding to pharmacological manipulation of the internal anal sphincter are spared the long term risks of continence that are inherent in many surgical procedures on the anorectum.

  18. The epidemiology of anal human papillomavirus infection among women and men having sex with women.

    Science.gov (United States)

    Nyitray, Alan G

    2012-12-01

    The goal of this review is to summarise epidemiological data that support an understanding of the natural history of anal human papillomavirus (HPV) among women and men having sex with women (MSW). HPV is a common infection of the anal canal among women and MSW. Although there have been a limited number of studies to date, both oncogenic and nononcogenic HPV genotypes commonly occur among these populations even when individuals do not report receptive anal sex. Genotype distribution is quite diverse, with recent studies typically detecting more than two dozen genotypes in the anal canal in samples of women and MSW. Factors most consistently associated with HPV in the anal canal among both women and MSW are lifetime number of sexual partners and detection of HPV at the genitals. The common finding of genotypic concordance between the genitals and anal canal in women and MSW, and the infectious nature of HPV, in addition to a limited number of studies offering empirical evidence of anal-to-genital self-inoculation and evidence of HPV hand carriage, may help explain the detection of HPV in the anal canal outside the context of receptive anal sex. HPV vaccination has been shown to reduce anal HPV infection among women and is also a promising prevention strategy among MSW.

  19. RELATIONSHIP BETWEEN INTERNAL ANAL SPHINCTER FUNCTION AND LENGTH OF REMAINING RECTUM AFTER RESECTING RECTAL CARCINOMA

    Institute of Scientific and Technical Information of China (English)

    Xiao Xiaowei

    1998-01-01

    Objective: To study the relationship between internal anal sphincter function and length of remaining rectum after resecting rectal carcinoma. Methods: Preoperatively,21 patients were evaluated via patients' clinical date,including anal resting pressure (resting pressure) assay.Six months postoperatively, repeated manometric studies and clinical evaluations were performed to assess the level of continence. The formula use for calculating postoperative resting pressure is as follows: postoperative resting pressure=0.42×preoperative resting pressure+1.56×length of remaining recturm+12.37 (R2=0.58; P<0.01).Degree of continence was graded based on severity of the dysfunction and grade of the continence score. Results:It was demonstrated the patients with low postoperative resting pressures (<4.0 Kpa) had incontinence, and those with high postoperative resting pressures (>4.7 Kpa) were continent. There were significant correlations between length of the remaining rectum and ratio of the decrease in maximum resting pressure (postoperative/preoperative maximum resting pressure; r=0.62; P<0.01). Conclusion:Continence of rectum is influenced by maximum resting pressure of function of the internal anal sphincter, length of remaining rectum is shorter, the more damage to the internal anal sphincter. It is able to foretell stool incontinence by using the postoperative resting pressure formula, and to determine the length of the remaining rectum.

  20. Botulinum toxin injection versus lateral internal sphincterotomy in the treatment of chronic anal fissure: a non-randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Ulusoy Nefise B

    2004-03-01

    Full Text Available Abstract Background Although lateral internal sphincterotomy is the gold-standard treatment for chronic anal fissure, intrasphincteric injection of botulinum toxin seems to be a reliable new option. The aim of this non-randomized study is to compare the effect of lateral internal sphincterotomy and botulinum toxin injection treatments on the outcome and reduction of anal sphincter pressures in patients with chronic anal fissure. Methods Patients with chronic anal fissure were treated with either botulinum toxin injection or lateral internal sphincterotomy by their own choice. Maximal resting pressure and maximal squeeze pressure measurements were performed before and 2 weeks after treatments by anal manometry. Patients were followed for fissure relapse during 14 months. Results Twenty-one consecutive outpatients with posterior chronic anal fissure were enrolled. Eleven patients underwent surgery and ten patients received botulinum toxin injection treatment. Before the treatment, anal pressures were found to be similar in both groups. After the treatment, the maximal resting pressures were reduced from 104 ± 22 mmHg to 86 ± 15 mmHg in the surgery group (p 0.05 in the surgery group, and from 117 ± 62 mmHg to 76 ± 34 (p 0.05. There were no relapses during the 14 months of follow up. Conclusion Lateral internal sphincterotomy and botulinum toxin injection treatments both seem to be equally effective in the treatment of chronic anal fissure.

  1. Long-term outcome of internal sphincter myectomy in patients with internal anal sphincter achalasia.

    LENUS (Irish Health Repository)

    Doodnath, Reshma

    2012-02-01

    BACKGROUND: Internal anal sphincter achalasia (IASA) is a condition with presentation similar to Hirschsprung\\'s disease (HD), but with the presence of ganglion cells on rectal suction biopsy (RSB). The diagnosis is made on anorectal manometry (ARM) by the absence of the rectosphincteric reflex on rectal balloon inflation. Internal sphincter myectomy (ISM) is the treatment of choice for patients with IASA. Recently, botulinum toxin has been used to treat IASA patients. The purpose of this study was to assess the long-term bowel function in patients with IASA following ISM. METHODS: The medical records of 24 patients with IASA managed by ISM during 1993-2005 were examined. There were 18 boys and 6 girls, aged 2-12 years. All patients presented with intractable constipation with or without soiling. The diagnosis was made by the demonstration of the absence of the rectosphincteric reflex on ARM. HD was excluded by the presence of ganglion cells and normal acetylcholinesterase activity in RSB. Patients were followed 4-14 years later. RESULTS: Fifteen (62.5%) patients at the time of follow-up had regular bowel motions without the use of laxatives. Six (25%) patients had regular bowel motions, but remained on small doses of laxatives. Two (8.3%) patients who suffered from constipation and soiling required twice weekly enemas to remain clean. One (4.2%) patient required resection of dilated rectosigmoid colon 3 years after myectomy, remains on laxatives, but has normal bowel control. No patients had faecal incontinence following ISM. CONCLUSION: This long-term follow-up study shows that the vast majority of IASA patients have normal bowel control following ISM.

  2. Similar mechanisms of traumatic rectal injuries in patients who had anal sex with animals to those who were butt-fisted by human sexual partner.

    Science.gov (United States)

    Sendler, Damian Jacob

    2017-10-01

    Sexual pleasure comes in various forms of physical play, for many it involves stimulation of the vagina, while the anus for others; some enjoy both. A recent report by Cappelletti et al.(1) shows a meta-analysis of cases describing anal trauma due to sexual fisting in human partners. This clinical article reports four cases of males diagnosed with zoophilia, and who received anal sex from animals, resulting in injuries. Surgical and psychiatric evaluations are summarized. Unusual etiology of sexual activity with animals caused peri-anal trauma in men who engaged in anal sex with dogs and farm animals. Injuries to patients who receive anal sex from animals are mechanistically similar to fisting-induced rectal damage. Among zoophiles, the mode of harm occurs through blood-engorged, interlocked penis that causes tissue lacerations upon retraction from an anus. In people experimenting with fisting, repetitive stretching within anal canal and of external sphincter causes the internal injuries. The mode of physical stimulation explains the extent of injuries in fisters vs. zoophiles: in fisting, the pressure applied by hand is controllable proximally around and within anal sphincter, while penetration by the animal penis is unpredictable and occurs within the proximal anal canal. Forensically, the findings presented in this article describe a significant mechanism of injury in fisters versus passive zoophiles. These descriptions may aid in clinically differentiating pleasurable and pathological rectal stimulation. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  3. Anal study in immunocompetent women with human papillomavirus related lower genital tract pathology.

    Science.gov (United States)

    Donaire, Concepción; Reillo, Marcos; Martínez-Escoriza, Juan C; López-Fernández, José A

    2017-04-01

    To estimate the prevalence of anal dysplasia in immunocompetent women with cervical intraepithelial dysplasia. We did a prospective cohort study, in which we enrolled 166 women with gynecological pathology related to human papilloma virus (HPV) infection. All patients underwent an anal cytology and HPV detection. Statistical analysis with a 95% confidence interval was used for prevalence calculations. A Χ2 test and Fisher's exact one were used to determine differences between groups of qualitative variables. Differences between normally distributed and non-normally distributed groups in quantitative variables were accounted for using Student's t-test or Mann-Whitney's U test, respectively. Out of the 166 patients studied, high risk HPV in the anal canal was detected in 107 (64.46%) cases. The most prevalent genotype observed was non 16/18 high risk HPV, present in 54 (50.47%) patients. There was no a significant association with smoking, use of condom, anal intercourse, or anal benign pathology. However, a significant correlation between the presence of high risk HPV in the anal canal and the antecedent of condylomas was observed (p=0.047) (CI95%: 1.00%-12.58%). Women with cervical intraepithelial neoplasia (CIN) grade 1 had a significantly increased presence of high risk HPV in the anal canal (p=0.044). Out of the 166 women, 6 (3.61%) had abnormal anal cytology results, and were referred to high-resolution anoscopy. Anal biopsy was performed in these six cases. In 2 patients the biopsy reported low-grade Anal Intraepithelial Neoplasia: 1.20% (0.15%-4.28%). Women with cervical intraepithelial dysplasia have 1.20% prevalence of anal intraepithelial neoplasia, so that it does not seem necessary to screen this population. Copyright © 2017 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

    Lee, Chang Hun; Lee, Sun Hee; Lee, Shinwon; Cho, Heerim; Kim, Kye-Hyung; Lee, Jung Eun; Jung, Eun Ju; Lee, Su Jin; Kim, Eun Jung; Kim, Ki Hyung; Moon, Eunsoo; Cho, Hong Je

    2016-01-01

    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 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.

  5. [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.

  6. Role of internal anal sphincter damage in the causation of idiopathic faecal incontinence: a prospective study.

    Science.gov (United States)

    Petros, Peter; Anderson, Jim

    2005-02-01

    This prospective study aimed to examine the relationship between internal anal sphincter (IAS) damage and 'idiopathic' faecal incontinence (FI) in 50 consecutive patients, using endoanal ultrasound examination. The external anal sphincter (EAS) was intact on direct and ultrasonic assessment in all patients. IAS damage was defined as complete rupture or attenuation, less than 2 mm thickness in some part of the sphincter. Complete rupture was found in one patient and damage in a further 17 (total 36%). All three nulliparous patients had normal IAS and EAS. IAS damage was only minimally associated with 'idiopathic' FI, suggesting IAS per se is unlikely to be a direct cause of FI in the 'idiopathic' group of FI patients. Its role might be analogous to the periurethral striated horse-shoe shape muscle in the urethra, which is thought to act as a mucosal sealant.

  7. Morphology of the epithelium of the lower rectum and the anal canal in the adult human.

    Science.gov (United States)

    Tanaka, Eiichi; Noguchi, Tsuyoshi; Nagai, Kaoruko; Akashi, Yuichi; Kawahara, Katsunobu; Shimada, Tatsuo

    2012-06-01

    The anal canal is an important body part clinically. However, there is no agreement about the epithelium of the anal canal, the anal transitional zone (ATZ) epithelium in particular. The aim of this study is to clarify the structure of the epithelium of the human lower rectum and anal canal. Intact rectum and anus obtained from patients who underwent surgery for rectal carcinoma were examined by light and scanning electron microscopy (LM and SEM). By LM, three types of epithelium were observed in the anal canal: simple columnar epithelium, stratified squamous epithelium, and stratified columnar epithelium. The lower rectum was composed of simple columnar epithelium. SEM findings showed stratified squamous epithelium that consisted of squamous cells with microridges, changing to simple columnar epithelium consisting of columnar cells with short microvilli at the anorectal line. LM and SEM observations in a one-to-one ratio revealed that the area of stratified columnar epithelium based on LM corresponded to the anal crypt and sinus. In conclusion, the epithelium of the human anal canal was fundamentally composed of simple columnar epithelium and stratified squamous epithelium. We found no evidence of the ATZ.

  8. Natural History of Anal Human Papillomavirus Infection in Heterosexual Women and Risks Associated With Persistence

    Science.gov (United States)

    Moscicki, Anna-Barbara; Ma, Yifei; Farhat, Sepideh; Jay, Julie; Hanson, Evelyn; Benningfield, Susanna; Jonte, Janet; Godwin-Medina, Cheryl; Wilson, Robert; Shiboski, Stephen

    2014-01-01

    Background. Anal cancer is more common in women than in men, yet little is known about the natural history of human papillomavirus (HPV) in women. The objective was to examine the natural history of anal HPV in heterosexual women. Methods. Young women participating in an HPV cohort study were seen at 4-month intervals for cervical and anal HPV testing. Time to clearance was estimated using the Kaplan-Meier approach; risks for persistence were assessed using Cox regression models. Results. Seventy-five women (mean age, 23.5 ± 4.1 years) who tested positive for anal HPV were followed for a mean of 84.5 ± 44.9 months. By 3 years, 82.5% of anal non-16 high-risk (HR) HPV, 82.6% of low-risk (LR) HPV, and 76.2% of HPV-16 infections had cleared. By 3 years, only 36.4% of women had become negative for all HPV types. In the multivariable model, concurrent cervical HPV-16 (P anal touching during sex (P = .045), recent anal sex (P = .04), and no condom use during anal sex (P = .04) were associated with HPV-16 persistence. Greater number of new sex partners (P = .024) and condom use during vaginal sex (P = .003) were associated with clearance. Similar associations were found for clearance in all HR-HPV infections. Only concomitant cervical HPV was associated with non-16 HR-HPV persistence. Conclusions. The majority of anal HPV infections cleared within 3 years. HPV-16 infections were slower to clear than other HR-HPV infections, consistent with its role in anal cancer. Specific sexual behaviors were associated with persistence, suggesting that education and behavioral interventions may decrease persistence. PMID:24368624

  9. Comparison of botox and lateral internal sphincterotomy treatment outcomes in chronic anal fissures

    Directory of Open Access Journals (Sweden)

    Tolga Dinç

    2014-03-01

    Full Text Available Objective: Both botox and lateral internal sfinkterotomi are treatment technics used in chronic anal fissure; provide the relaxation of anal sphincter and as a result of this, healing occurs. Aim of this study is to compare efficacy of botox and LIS treatment in chronic anal fissure and discussing with the literature. Methods: 60 of 66 patients who has chronic anal fissure, that we reached, treated but not healed with medical therapy, appealed to the Dr. Sami Ulus Hospital included the study. Gender, age, fissure localization, complaints (pain, bleeding, itching, constipation, complaint length, recurrences after treatment, continence conditions and complications of patients were registered. Results: Sixty patients were enrolled the study. Of the 60 patients; 38(63.3% were male and 22 (27.7% were female. Mean age of all patients was 35.93 ± 11.45 (21 -60. Pain was the common complaint of the all patients. 10 (32.3% recurrence were detected in botox treatment group (Group-I, only 1 (3.4% recurrence was in LIS group (Group-II. There was no complication as an incontinence in group-I but 3 cases with incontinence (10.39% were obtained in group-II. In the evaluation of these 3 cases by Cleveland Clinic Continence Scoring System, 2 cases classified as gas incontinence and 1 case as moderate fecal incontinence. Conclusion: Although botulinum toxin injection seen as an alternative treatment method with low complication rates such as incontinence, high recurrence is an important shortcoming of this technic. LIS performed by experienced surgeons remained the most popular treatment modality with low complication rates and great deal of healing success.

  10. Prevalence of anal human papillomavirus infection and anal HPV-related disorders in women: a systematic review

    Science.gov (United States)

    Stier, Elizabeth A.; Sebring, Meagan C.; Mendez, Audrey E.; Ba, Fatimata S.; Trimble, Debra D.; Chiao, Elizabeth Y.

    2015-01-01

    Objective The aim of this study was to systematically review the findings of publications addressing the epidemiology of anal HPV infection, anal intraepithelial neoplasia and anal cancer in women. Data Sources We conducted a systematic review among publications published from January 1, 1997 to September 30, 2013 in order to limit to publications from the combined antiretroviral therapy (cART) era. Three searches were performed of the National Library of Medicine PubMed database using the following search terms: “women and anal HPV”, “women anal intraepithelial neoplasia”, and “women and anal cancer.” Study Eligibility Criteria Publications were included in the review if they addressed any of the following outcomes: (1) prevalence, incidence, or clearance of anal HPV infection, (2) prevalence of anal cytological or histological neoplastic abnormalities, or (3) incidence or risk of anal cancer. Thirty-seven publications addressing anal HPV infection and anal cytology remained after applying selection criteria, and 23 anal cancer publications met the selection criteria. Results Among HIV-positive women, prevalence of HR-HPV in the anus was 16-85%. Among HIV-negative women, prevalence of anal HR-HPV infection ranged from 4 - 86%. The prevalence of anal HR- HPV in HIV-negative women with HPV-related pathology of the vulva, vagina and cervix compared with women with no known HPV-related pathology, varied from 23-86%, and 5-22%, respectively. Histologic anal HSIL (AIN 2+) was found in 3-26% of the women living with HIV, 0-9% among women with lower genital tract pathology, and 0-3% for women who are HIV-negative without known lower genital tract pathology. The incidence of anal cancer among HIV-infected women ranged from 3.9-30 per 100,000. Among women with a history of cervical cancer or CIN 3, the IR of anal cancer ranged from 0.8-63.8/100,000 person-years, and in the general population, the IRs ranged from 0.55-2.4/100,000 person-years. Conclusions This

  11. Modeling of human colonic blood flow for a novel artificial anal sphincter system

    Institute of Scientific and Technical Information of China (English)

    Peng ZAN; Guo-zheng YAN; Hua LIU

    2008-01-01

    A novel artificial anal sphincter system has been developed to simulate the normal physiology of the human anorectum. With the goal of engineering a safe and reliable device, the model of human colonic blood flow has been built and the relationship between the colonic blood flow rate and the operating occlusion pressure of the anorectum is achieved. The tissue ischemia is analyzed based on constitutive relations for human anorectum. The results suggest that at the planned operating occlusion pressure of less than 4 kPa the artificial anal sphincter should not risk the vaseularity of the human colon.

  12. Anal human papillomavirus infection: prevalence, diagnosis and treatment of related lesions.

    Science.gov (United States)

    Benevolo, Maria; Donà, Maria Gabriella; Ravenda, Paola Simona; Chiocca, Susanna

    2016-01-01

    Human papillomavirus (HPV) infection is mostly asymptomatic, but may also have many diverse clinical signs encompassing benign ano-genital lesions, and carcinomas. Recently, interest has also particularly focused on anal cancer since, over the last decades, its incidence has been greatly increasing in developed countries, both in women and men and is drastically higher in specific risk groups, such as men who have sex with men (MSM) and HIV-1 infected individuals. Approximately 88% of anal cancer cases worldwide are associated with HPV infection. This review summarizes our current understanding of anal HPV infection, discussing its epidemiology and risk factors in various populations, and the state of the art in the detection of anal HPV infection and its related lesions through both cytology and histology. Finally, we discuss the clinical management and therapy for these lesions.

  13. Anal Human Papillomavirus (HPV) Prevalences and Factors Associated with Abnormal Anal Cytology in HIV-Infected Women in an Urban Cohort from Rio de Janeiro, Brazil

    Science.gov (United States)

    Luz, Paula M.; Lake, Jordan E.; Levi, José Eduardo; Coutinho, José Ricardo; de Andrade, Angela; Heinke, Thais; Derrico, Mônica; Veloso, Valdilea G.; Friedman, Ruth K.; Grinsztejn, Beatriz

    2015-01-01

    Abstract Identifying factors, including human papillomavirus (HPV) genotypes, associated with abnormal anal cytology in HIV-infected women have implications for anal squamous cell cancer (SCC) prevention in HIV-infected women. Anal and cervical samples were collected for cytology, and tested for high-(HR-HPV) and low-risk HPV (LR-HPV) genotypes in a cross-sectional analysis of the IPEC Women's HIV Cohort (Rio de Janeiro, Brazil). Multivariate log-binomial regression models estimated prevalence ratios for factors associated with abnormal anal cytology [≥atypical squamous cells of undetermined significance, (ASC-US)]. Characteristics of the 863 participants included: median age 42 years, 57% non-white, 79% current CD4+ T-cell count >350 cells/mm3, 53% HIV-1 viral load anal specimens contained ≥1 HR-HPV genotype; 31% had abnormal anal cytology [14% ASC-US, 11% low-grade squamous intra-epithelial lesion, (LSIL); 2% atypical squamous cells-cannot exclude high-grade SIL (ASC-H); 4% high-grade SIL/cancer (HSIL+)]. In multivariate analysis, cervical LSIL+, nadir CD4+ T-cell count ≤50 cells/mm3, HIV-1 viral load ≥50 copies/mL, and anal HPV 6, 11, 16, 18, 33, 45, 52, 56, and 58 were associated with ≥anal ASC-US (panal cytology and HR-HPV prevalences were high. HIV-infected women with cervical LSIL+, low nadir CD4+ counts, or detectable HIV-1 viral loads should be a particular focus for enhanced anal SCC screening efforts. PMID:25361401

  14. Prevalence of Human Papillomavirus in Anal and Oral Sites Among Patients with Genital Warts

    DEFF Research Database (Denmark)

    Kofoed, Kristian; Sand, Carsten; Forslund, Ola

    2014-01-01

    Genital warts are caused by human papillomavirus (HPV). HPV is a leading cause of anogenital malignancies and a role of HPV in the aetiology of oro-pharyngeal cancers has been demonstrated. The frequency of oral HPV infection in patients with genital warts and the association between concomitant...... genital, anal and oral infection is unclear. A total of 201 men and women with genital wart-like lesions were recruited. Swab samples were obtained from the genital warts and the anal canal and an oral rinse was collected. Anal HPV was found in 46.2% and oral HPV in 10.4% of the participants. Concordance...... between anal and genital wart HPV types was 78.1%, while concordance between oral and genital wart types was 60.9%. A lower concordance of 21.7% was observed between anal and oral HPV types. Significantly more women than men had multiple HPV types and anal HPV. In conclusion, extra genital HPV is common...

  15. Internal Anal Sphincter and Late Clinical Outcome in Patients with High Type Anorectal Malformation

    Directory of Open Access Journals (Sweden)

    Mirshemirani Ali Reza

    2009-05-01

    Full Text Available The purpose of this study is to investigate the age -related improvement of defecation function in high type anorectal malformation in relation to the assessment of the internal anal sphincter. The function of defecation was studied every 5 years up to 15 years postoperatively according to the Japanese scoring system in our hospital in 50 patients operated for high type (recto-urethral fistula imperforate anus with posterior sagital anorectoplasty (PSARP procedure in 25 patients, and 25patients with endorectal pull-through (ERPT. The internal anal sphincter was assessed by anorectal manometry and histology, and the results were analyzed with the clinical outcomes. The defecation scores of the PSARP cases exceeded those of ERPT cases at all age groups, the averaged total score were 7.0 in the PSARP cases vs. 4.6 for ERPT cases at 5 years old, 7.5 vs. 5.2 at 10 years old, and 8.0 vs. 6.7 at 15 years old. The anorectal reflex was seen in 17 of 25 (68% PSARP cases examined, whereas seen in 5 (20% of ERPT cases examined. Histologically, the well-developed and thickened internal circular muscle at the rectal end was found only in 40% of the cases, whereas discontinuation and hypoplasty of the muscle were seen in most of the cases examined. The present results indicate that the internal sphincter muscle at the rectal end may be histologically maldeveloped in high type anorectal malformations; however, they can potentially develop after transplanted and contribute to the improvement of passive continence in the late post-operative period.

  16. Use of a Balloon Rectal Catheter in Magnetic Resonance Imaging of Complex Anal Fistula to Improve Detection of Internal Openings.

    Science.gov (United States)

    Zhan, Songhua; Yang, Shuohui; Lin, Jiang; Zhu, Qiong; Lu, Fang; Tan, Wenli; Cheng, Ruixin; Gong, Zhigang; Yang, Wei

    2016-01-01

    The aim of this study was to investigate the utility of a balloon rectal channel catheter (BRCC) in complex anal fistula magnetic resonance imaging (MRI). A prospective study was done on 54 patients with clinical diagnosis of complex anal fistula. Eighteen patients had preoperative MRI before and after inserting BRCC. Another 18 underwent MRI with BRCC and the rest without. Fistulas, internal openings, extensions, and abscesses were identified on MRI and compared with surgical findings. Intraindividual and interindividual differences with and without BRCC were analyzed. In intragroup patients, the accuracy of MRI in detecting the number of fistulas, internal openings, extensions, and abscesses before and after using BRCC was 100%/100%, 67%/90%, 95%/95%, and 100%/100%, respectively, with a significant difference on internal openings (P anal fistula.

  17. [Surgical treatment of anal stenosis following hemorrhoid surgery. Results of 150 combined mucosal advancement and internal sphincterotomy].

    Science.gov (United States)

    Carditello, Antonio; Milone, Antonino; Stilo, Francesco; Mollo, Francesco; Basile, Maurizio

    2002-01-01

    The aim of the study was to evaluate the efficacy of anoplasty by mucosal advancement combined with internal sphincterotomy for the treatment of iatrogenic anal stenosis. From January 1990 to December 2000, 149 patients with post-haemorrhoidectomy anal strictures underwent internal sphincterotomy and mucosal advancement flap anoplasty. Seventy-one percent of patients were operated on under local anaesthesia by perineal block according to Marti. In 90 percent of the patients, postoperative pain was mild. No significant complications were seen. The mean hospital stay was two days. Ninety-seven percent of patients were well satisfied with the surgical result one year after operation. Current surgical options for the treatment of post-haemorrhoidectomy anal stricture are reported and the advantages of mucosal advancement flap anoplasty outlined.

  18. Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials.

    Science.gov (United States)

    Chen, H-L; Woo, X-B; Wang, H-S; Lin, Y-J; Luo, H-X; Chen, Y-H; Chen, C-Q; Peng, J-S

    2014-08-01

    Although surgery is the gold standard treatment for anal fissure, the main concern remains its side effects and complications. Botulinum toxin injection and lateral internal sphincterotomy are technical options for patients suffering from chronic anal fissure. However, little is known about the efficacy of these two techniques. The aim of this meta-analysis was to compare the outcomes of botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure. Original studies in English were searched from the MEDLINE database, PubMed, Web of Science, and the Cochrane Library database. Randomized control trials that compared botulinum toxin injection with lateral internal sphincterotomy were identified. Data were independently extracted for each study, and a meta-analysis was performed using fixed and random effects models. Four hundred and eighty-nine patients from seven trials met the inclusion criteria. Patients undergoing lateral internal sphincterotomy had a higher-healing and incontinence rate. No statistically significant differences were noted in total complications between botulinum toxin injection and lateral internal sphincterotomy. Patients treated with lateral internal sphincterotomy had a significantly lower recurrence rate than the patients treated with botulinum toxin injection. Our meta-analysis shows that lateral internal sphincterotomy was superior to botulinum toxin injection in terms of healing rate and lower recurrence rate. Botox, however, is safe associated with a lower rate of incontinence and could be used in certain situations. Further studies with a long-term follow-up are required to confirm our observations.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. 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.

  1. Prevalence of and Risk Factors for Anal Human Papillomavirus Infection Among Young Healthy Women in Costa Rica

    Science.gov (United States)

    Castro, Felipe A.; Quint, Wim; Gonzalez, Paula; Katki, Hormuzd A.; Herrero, Rolando; van Doorn, Leen-Jan; Schiffman, Mark; Struijk, Linda; Rodriguez, Ana Cecilia; DelVecchio, Corey; Lowy, Douglas R.; Porras, Carolina; Jimenez, Silvia; Schiller, John; Solomon, Diane; Wacholder, Sholom; Hildesheim, Allan; Kreimer, Aimée R.

    2012-01-01

    Background. Anal cancer is caused by human papillomavirus (HPV), yet little is known about anal HPV infection among healthy young women. Methods. A total of 2017 sexually active women in the control arm of an HPV-16/18 vaccine trial had a single anal specimen collected by a clinician at the 4-year study visit. Samples were tested for HPV by SPF10 PCR/DEIA/LiPA25, version 1. Results. A total of 4% of women had HPV-16, 22% had oncogenic HPV, and 31% had any HPV detected in an anal specimen. The prevalence of anal HPV was higher among women who reported anal intercourse, compared with those who did not (43.4% vs 28.4%; P anal intercourse, cervical HPV (adjusted odds ratio [aOR], 5.3 [95% confidence interval {CI}, 3.4–8.2]), number of sex partners (aOR, 2.2 [95% CI, 1.1–4.6] for ≥4 partners), and number of anal intercourse partners (aOR, 1.9 [95% CI, 1.1–3.3] for ≥2 partners) were independent risk factors for anal HPV detection. Among women who reported no anal intercourse, cervical HPV (aOR, 4.7 [95% CI, 3.7–5.9]), number of sex partners (aOR, 2.4 [95% CI, 1.7–3.4] for ≥4 partners), and report of anal fissures (aOR, 2.3 [95% CI, 1.1–4.8]) were associated with an increased odds of anal HPV detection. Conclusion. Anal HPV is common among young women, even those who report no anal sex, and was associated with cervical HPV infection. Anal fissures in women who report never having had anal intercourse may facilitate HPV exposure. Clinical Trials Registration. NCT00128661. PMID:22850119

  2. Human Immunodeficiency Virus Status Differentially Associated With Genital and Anal Human Papillomavirus Infection Among Chinese Men Who Have Sex With Men: A Cross-Sectional Survey.

    Science.gov (United States)

    Qian, Han-Zhu; Hu, Yifei; Carlucci, James G; Yin, Lu; Li, Xiangwei; Giuliano, Anna R; Li, Dongliang; Gao, Lei; Shao, Yiming; Vermund, Sten H

    2017-06-28

    Little is known about human papillomavirus (HPV) infection and genotypes when considering both anatomic site and human immunodeficiency virus (HIV) status among men who have sex with men (MSM) in low- and middle-income countries. A cross-sectional study was conducted among MSM in Beijing, China. HIV serostatus was determined, and genital and anal HPV genotyping were performed from respective swabs. Of 1155 MSM, 817 (70.7%) had testing for genital (611; 52.9%) and/or anal (671; 58.1%) HPV. Preference for insertive anal sex (adjusted odds ratio [aOR], 2.60; 95% confidence interval [CI], 1.42-4.75) and syphilis (aOR, 1.50; 95% CI, 1.01-2.23) were associated with genital HPV. Inconsistent condom use during receptive anal sex (aOR, 1.82; 95% CI, 1.17-2.84), and HIV seropositivity (aOR, 2.90; 95% CI, 1.91-4.42) were associated with anal HPV. Among 465 (40.3%) MSM with specimens from both anatomic sites, anal HPV (68%) was more common than genital HPV (37.8%). Prevalence of anal HPV was higher among HIV-infected than uninfected MSM (P anal site of HIV-infected MSM (P Anal HPV was more common than genital HPV, and HIV seropositivity was associated with oncogenic HPV types at the anal site.

  3. Sociodemographic Predictors of Anal Cancer Screening and Follow-up in Human Immunodeficiency Virus-Infected Individuals.

    Science.gov (United States)

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

    2017-07-14

    Anal cancer in the United States is generally rare; however, human immunodeficiency virus (HIV)-infected individuals are 28 times more likely to be given a diagnosis of anal cancer than the general population. The aim of this study was to examine the rates and sociodemographic predictors of anal cancer screening and follow-up anoscopy in a sample of HIV-infected individuals. Data for this study (n = 200) were derived from a retrospective chart review of randomly selected HIV-infected individuals. Data analyses included Pearson's correlation coefficient statistic to examine bivariate associations and logistic regression modeling for prediction of anal Papanicolaou test screening and follow-up anoscopy. Screening rates and follow-up after an abnormal anal Pap test were low. Women were less likely to be screened for anal cancer (odds ratio [OR], 0.244; P = .007). Men who have sex with men were almost 4 times more likely to be screened for anal cancer (OR, 3.7; P = .02). Men who have sex with men were 6 times more likely to have follow-up after an abnormal anal Pap test compared with heterosexual men or women of any sexual orientation (OR, 6.88; P = .002). High-risk groups for anal cancer should be targeted for preventative measures as part of a cancer prevention plan to decrease the personal and clinical burden associated with anal cancer. Cancer prevention is a multistep process that requires screening and follow-up efforts, where healthcare providers play a vital role in these efforts. Findings from this study can inform strategies to improve screening and follow-up rates in HIV-infected individuals.

  4. Heme oxygenase-1 upregulation modulates tone and fibroelastic properties of internal anal sphincter.

    Science.gov (United States)

    Krishna, Chadalavada Vijay; Singh, Jagmohan; Kumar, Sumit; Rattan, Satish

    2014-09-15

    A compromise in the internal anal sphincter (IAS) tone and fibroelastic properties (FEP) plays an important role in rectoanal incontinence. Herein, we examined the effects of heme oxygenase (HO)-1 upregulation on these IAS characteristics in young rats. We determined the effect of HO-1 upregulator hemin on HO-1 mRNA and protein expressions and on basal IAS tone and its FEP before and after HO-1 inhibitor tin protoporphyrin IX. For FEP, we determined the kinetics of the IAS smooth muscle responses, by the velocities of relaxation, and recovery of the IAS tone following 0 Ca(2+) and electrical field stimulation. To characterize the underlying signal transduction for these changes, we determined the effects of hemin on RhoA-associated kinase (RhoA)/Rho kinase (ROCK) II, myosin-binding subunit of myosin light chain phosphatase 1, fibronectin, and elastin expression levels. Hemin increased HO-1 mRNA and protein similar to the increases in the basal tone, and in the FEP of the IAS. Underlying mechanisms in the IAS characteristics are associated with increases in the genetic and translational expressions of RhoA/ROCKII, and elastin. Fibronectin expression levels on the other hand were found to be decreased following HO-1 upregulation. The results of our study show that the hemin/HO-1 system regulates the tone and FEP of IAS. The hemin/HO-1 system thus provides a potential target for the development of new interventions aimed at treatment of gastrointestinal motility disorders, specifically the age-related IAS dysfunction.

  5. Bimodal effect of oxidative stress in internal anal sphincter smooth muscle.

    Science.gov (United States)

    Singh, Jagmohan; Kumar, Sumit; Rattan, Satish

    2015-09-01

    Changes in oxidative stress may affect basal tone and relaxation of the internal anal sphincter (IAS) smooth muscle in aging. We examined this issue by investigating the effects of the oxidative stress inducer 6-anilino-5,8-quinolinedione (LY-83583) in basal as well as U-46619-stimulated tone, and nonadrenergic, noncholinergic (NANC) relaxation in rat IAS. LY-83583, which works via generation of reactive oxygen species in living cells, produced a bimodal effect in IAS tone: lower concentrations (0.1 nM to 10 μM) produced a concentration-dependent increase, while higher concentrations (50-100 μM) produced a decrease in IAS tone. An increase in IAS tone by lower concentrations was associated with an increase in RhoA/Rho kinase (ROCK) activity. This was evident by the increase in RhoA/ROCK in the particulate fractions, in ROCK activity, and in the levels of phosphorylated (p) (Thr696)-myosin phosphatase target subunit 1 and p(Thr18/Ser19)-20-kDa myosin light chain. Conversely, higher concentrations of LY-83583 produced inhibitory effects on RhoA/ROCK. Interestingly, both the excitatory and inhibitory effects of LY-83583 in the IAS were reversed by superoxide dismutase. The excitatory effects of LY-83583 were found to resemble those with neuronal nitric oxide synthase (nNOS) inhibition by l-NNA, since it produced a significant increase in the IAS tone and attenuated NANC relaxation. These effects of LY-83583 and l-NNA were reversible by l-arginine. This suggests the role of nNOS inhibition and RhoA/ROCK activation in the increase in IAS tone by LY-83583. These data have important implications in the pathophysiology and therapeutic targeting of rectoanal disorders, especially associated with IAS dysfunction.

  6. 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

  7. 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; Kaewpoowat, Quanhathai; Supindham, Taweewat; Settakorn, Jongkolnee; Sukpan, Kornkanok; Utaipat, Utaiwan; Miura, Toshiyuki; Kosashunhanan, Natthapol; Saokhieo, Pongpun; Songsupa, Radchanok; Wongthanee, Antika

    2016-01-01

    Background 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. Methods 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. Results 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). Conclusions 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

  8. Anal Itching

    Science.gov (United States)

    Diseases and Conditions Anal itching By Mayo Clinic Staff Anal itching is a common condition. The itch, situated in or around your anus, ... a strong urge to scratch. You may find anal itching to be embarrassing and uncomfortable. Also called ...

  9. The EVVA Cohort Study: Anal and Cervical Type-Specific Human Papillomavirus Prevalence, Persistence, and Cytologic Findings in Women Living With HIV.

    Science.gov (United States)

    de Pokomandy, Alexandra; Kaufman, Elaina; de Castro, Christina; Mayrand, Marie-Hélène; Burchell, Ann N; Klein, Marina; Charest, Louise; Auger, Manon; Rodrigues-Coutlée, Sophie; Coutlée, François

    2017-08-15

    The risk of anal cancer due to high-risk human papillomavirus (HR-HPV) is higher in women living with human immunodeficiency virus (HIV) than in the general population. We present findings of cervical and anal HPV and cytologic tests at baseline in the EVVA cohort study and HPV persistence data 6 months after baseline. Semiannual visits included questionnaires, chart reviews, cervical/anal cytologic and cervical/anal HPV testing for 2 years. Genotyping for 36 HPV genotypes was performed using the Roche Linear Array HPV genotyping test. A total of 151 women living with HIV were recruited. At baseline, 75% had anal HPV, 51% had anal HR-HPV, 50% had cervical HPV, and 29% had cervical HR-HPV. Anal HPV-16 and HPV-51 were more frequent in women born in Canada (31% and 29%, respectively, compared with ≤16% for other women). Most anal HR-HPV types detected at 6 months (57%-93%) were persistent from baseline. Findings of anal cytologic tests were abnormal for 37% of women. Anal HPV is highly prevalent in women living with HIV, and type distribution varies by place of birth. High-resolution anoscopy was indicated in more than one third of results. As anal cancer is potentially preventable, these important findings need to be considered when selecting the best approach for anal cancer screening programs.

  10. HIV-associated anal cancer

    OpenAIRE

    Newsom-Davis, Thomas; Bower, Mark

    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...

  11. Prevalence of human papillomavirus infection of the anal canal in women: A prospective analysis of high-risk populations.

    Science.gov (United States)

    Kost, Bernd P; Hofmann, Jörg; Stoellnberger, Susanne; Bergauer, Florian; Blankenstein, Thomas; Alba-Alejandre, Irene; Stein, Angela; Stuckart, Claudia; Weizsäcker, Katharina; Mylonas, Ioannis; Mahner, Sven; Gingelmaier, Andrea

    2017-04-01

    Infection with certain types of human papillomavirus (HPV) has been associated with the development of cervical and anal cancer. Worldwide, the incidence of anal cancer has increased markedly. The present study aimed to evaluate the prevalence of HPV infection of the uterine cervix and anal canal in human immunodeficiency virus (HIV)- and non-HIV-infected risk populations. Cervical and anal HPV swabs and cytology samples were collected from 287 patients at the University Hospital of Munich, Germany between 2011 and 2013. Patients were divided into HIV-negative controls (G1) and two risk groups, including HIV-negative patients with cytological abnormalities of the cervix (G2) and HIV-infected patients (G3). Data, including clinical parameters, were analysed. The risk groups had significantly more positive results for HPV in the anus (71.03 and 83.15% for G2 and G3, respectively), as compared with G1. The predominant HPV genotypes found in the anus were high-risk HPV genotypes, which were significantly correlated with concomittant cervical HPV findings. In the risk groups, a significant association between the cytological findings and HPV detection in the cervix was found, while the results of the anus revealed no significance. The results of the present study suggested that the prevalence of HPV infection in the anal canal of risk populations is high. Furthermore, patients with abnormal cervical cytology results and HIV-infected women, irrespective of their individual cervical findings, may have a risk of concomittant anal high-risk HPV infection. Based on the predominant HPV genotypes found in the study, HPV vaccination could reduce the incidence of anal cancer. Nevertheless, high-risk patients should be intensively screened for anal squamous intraepithelial abnormalities to avoid invasive cancer stages.

  12. The performance of human papillomavirus biomarkers in predicting anal high-grade squamous intraepithelial lesions in gay and bisexual men.

    Science.gov (United States)

    Jin, Fengyi; Roberts, Jennifer M; Grulich, Andrew E; Poynten, Isobel M; Machalek, Dorothy A; Cornall, Alyssa; Phillips, Samuel; Ekman, Deborah; McDonald, Ross L; Hillman, Richard J; Templeton, David J; Farnsworth, Annabelle; Garland, Suzanne M; Fairley, Christopher K; Tabrizi, Sepehr N

    2017-06-01

    We evaluate the performance of human papillomavirus (HPV) biomarkers in prediction of anal histological high-grade squamous intraepithelial lesions in gay and bisexual men (GBM) in Sydney, Australia. Baseline analysis of a 3-year cohort study. The Study of the Prevention of Anal Cancer is natural history study of anal HPV infection in GBM aged at least 35 years. All participants completed cytological and histological assessments. Stored ThinPrep PreservCyt residua were tested for HPV genotyping (Linear Array and Cobas 4800) and viral load, E6/E7 mRNA expression (NucliSENS easyQ HPV v1) and dual cytology staining of p16/Ki 67 antibodies (CINtecPLUS). Performance of each biomarker was compared with liquid-based anal cytology. The hypothetical referral rates were defined as the proportion of men who had abnormal cytology or tested positive to each of the biomarkers. The median age of the 617 participants was 49 years (range: 35-79), and 35.7% were HIV-positive. All biomarkers were strongly associated with the grade of HPV-associated anal lesions (P anal cytology (78.4 and 75.4 vs. 83.2%, respectively), improved specificity (68.0 and 69.4 vs. 52.4%, respectively) and lower referral rates (47.0 and 45.0 vs. 59.2%, respectively). Specificity was significantly higher in the HIV-negative for HR-HPV viral load (72.3 vs. 58.2%, P = 0.005). HR-HPV viral load and E6/E7 mRNA had similar sensitivity and higher specificity in predicting histological anal high-grade squamous intraepithelial lesion with lower referrals in GBM than anal cytology.

  13. Smoking and anal high-risk human papillomavirus DNA loads in HIV-positive men who have sex with men.

    Science.gov (United States)

    Wieland, Ulrike; Hellmich, Martin; Wetendorf, Janna; Potthoff, Anja; Höfler, Daniela; Swoboda, Jochen; Fuchs, Wolfgang; Brockmeyer, Norbert; Pfister, Herbert; Kreuter, Alexander

    2015-10-01

    HIV-positive men who have sex with men (MSM) have an increased risk for anal human papillomavirus (HPV) infection, anal high-grade intraepithelial lesions (HSIL), and anal cancer. Smoking is associated with abnormal anal cytology and with an increased risk for anal cancer. We collected 3736 intraanal swabs from 803 HIV-positive MSM who participated in an anal cancer screening program between October 2003 and August 2014. HPV prevalence, anal cytology and HPV DNA load of high-risk (HR) HPV-types 16, 18, 31 and 33 of non-smokers and smokers were compared. HPV-typing was performed by alpha-HPV genus-specific PCR and hybridization with 38 type-specific probes using a multiplex genotyping assay. In samples positive for HPV16, 18, 31, or 33, HPV DNA loads were determined by type-specific real-time PCRs and expressed as HPV DNA copies per betaglobin gene copy. At baseline, HR-HPV DNA (80.5 vs. 89.0%, p=0.001), HPV16 DNA (41.6 vs. 52.3%, p=0.003), HPV18 DNA (15.5 vs. 26.0%, panal dysplasia (LSIL+HSIL; 51.5 vs. 58.4%, p=0.045) and HSIL (17.2 vs. 22.7%, p=0.048) were detected more frequently in smokers compared to non-smokers. Throughout the study period 32.7% of non-smokers and 39.9% of smokers developed HSIL (p=0.011), and three smokers developed anal cancer. Considering swabs from the entire study period (median HPV load value per patient per cytology grade), smokers with normal anal cytology had significantly higher HPV16 loads (median 0.29 vs. 0.87, n=201, p=0.007) and cumulative high-risk-HPV loads (median 0.53 vs. 1.08, n=297, p=0.004) than non-smokers. Since elevated HR-HPV DNA loads are associated with an increased risk for HPV-induced anogenital cancers, HPV-infected HIV-positive MSM should be counseled to refrain from smoking. Additionally, for smokers, shorter anal cancer screening intervals than for non-smokers may be appropriate.

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

    Science.gov (United States)

    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

  15. Relationship Among Anal Sphincter Injury, Patulous Anal Canal, and Anal Pressures in Patients with Anorectal Disorders

    Science.gov (United States)

    Prichard, David; Harvey, Doris M.; Fletcher, Joel G.; Zinsmeister, Alan R.; Bharucha, Adil E.

    2015-01-01

    Background & Aims The anal sphincters and puborectalis are routinely imaged with an endoanal magnetic resonance imaging (MRI) coil, which does not assess co-aptation of the anal canal at rest. Using a MRI torso coil, we identified a patulous anal canal in some patients with anorectal disorders. We aimed to evaluate the relationship between anal sphincter and puborectalis injury, a patulous anal canal, and anal pressures. Methods We performed a retrospective analysis of data from 119 patients who underwent MRI and manometry analysis of anal anatomy and pressures, respectively, from February 2011 through March 2013 at the Mayo Clinic. Anal pressures were determined by high-resolution manometry, anal sphincter and puborectalis injury was determined by endoanal MRI, and anal canal integrity was determined by torso MRI. Associations between manometric and anatomical parameters were evaluated with univariate and multivariate analyses. Results Fecal incontinence (55 patients, 46%) and constipation (36 patients. 30%) were the main indications for testing; 49 patients (41%) had a patulous anal canal, which was associated with injury to more than 1 muscle (all P≤.001) and internal sphincter (Panal resting pressure. A patulous anal canal was the only significant predictor (Panal squeeze pressure increment. Conclusions Patients with anorectal disorders commonly have a patulous anal canal, associated with more severe anal injury, anal resting pressure, and squeeze pressure increment. It is therefore important to identify patulous anal canal because it appears to be a marker of not only anal sphincter injury but disturbances beyond sphincter injury, such as damage to the anal cushions or anal denervation. PMID:25869638

  16. High rates of incident and prevalent anal human papillomavirus infection among young men who have sex with men.

    Science.gov (United States)

    Glick, Sara Nelson; Feng, Qinghua; Popov, Viorica; Koutsky, Laura A; Golden, Matthew R

    2014-02-01

    There are few published estimates of anal human papillomavirus (HPV) infection rates among young men who have sex with men (YMSM). We estimated incidence and prevalence of type-specific anal HPV infection using clinician-collected anal swabs for HPV DNA testing obtained during a 1-year prospective study of 94 YMSM (mean age, 21 years) in Seattle. Seventy percent of YMSM had any HPV infection detected during the study, and HPV-16 and/or -18 were detected in 37%. The incidence rate for any new HPV infection was 38.5 per 1000 person-months and 15.3 per 1000 person-months for HPV-16/18; 19% had persistent HPV-16/18 infection. No participant tested positive for all 4 HPV types in the quadrivalent vaccine. The number of lifetime male receptive anal sex partners was significantly associated with HPV infection. The prevalence of HPV-16/18 was 6% among YMSM with a history of 1 receptive anal sex partner and 31% among YMSM with ≥ 2 partners. Although the high prevalence of HPV among YMSM highlights the desirability of vaccinating all boys as a strategy to avert the morbidity of HPV infection, most YMSM appear to remain naive to either HPV-16 or -18 well into their sexual lives and would benefit from HPV immunization.

  17. Laser capture microdissection as a tool to evaluate human papillomavirus genotyping and methylation as biomarkers of persistence and progression of anal lesions

    Science.gov (United States)

    Cornall, Alyssa M; Roberts, Jennifer M; Molano, Monica; Machalek, Dorothy A; Phillips, Samuel; Hillman, Richard J; Grulich, Andrew E; Jin, Fengyi; Poynten, I Mary; Templeton, David J; Garland, Suzanne M; Tabrizi, Sepehr N

    2015-01-01

    Introduction Anal squamous cell carcinoma is preceded by persistent infection with high-risk human papillomavirus (HPV) and the cancer precursor, high-grade squamous intraepithelial lesion (HSIL). Detection of specific HPV genotypes and HPV-related biomarkers may be an option for primary anal screening. However, more data on the natural history of HPV-related anal lesions are required. The outcomes from this study will enhance our understanding of the clinical and biological behaviour of HPV-related anal lesions and inform the development of future HPV genotype and/or biomarker screening tests. Methods and analysis HIV-negative and HIV-positive men who have sex with men, aged 35 years and over, recruited from community-based settings in Sydney, Australia, attend 6 clinic visits over 3 years. At the first 5 visits, participants undergo a digital anorectal examination, an anal swab for HPV genotyping and anal cytology, and high-resolution anoscopy with directed biopsy of any visible abnormalities that are suggestive of any abnormality suspicious of SIL. Tissue sections from participants diagnosed with histologically confirmed HSIL at the baseline clinic visit will undergo laser capture microdissection, HPV detection and genotyping, and quantitation of CpG methylation in baseline and follow-up biopsies. Histological and cytological findings in combination with HPV genotyping data will be used to identify persistent HSIL. HSIL will be stratified as non-persistent and persistent based on their status at 12 months. The performance of HPV genotype and methylation status in predicting disease persistence at 12 months will be assessed, along with associations with HIV status and other covariates such as age. Ethics and dissemination The St Vincent's Hospital Ethics Committee granted ethics approval for the study. Written informed consent is obtained from all individuals before any study-specific procedures are performed. Findings from this study will be disseminated

  18. [Improvement of fecal incontinence with silicone implants in patients with internal anal sphincter injury: First report in North America].

    Science.gov (United States)

    Vergara-Fernández, O; Valdovinos-Díaz, M A; Hagerman-Ruiz Galindo, G; Salinas-Aragón, L E; Ruíz-Campos, M; Castillo-Machado, W

    2011-01-01

    The injection of bulking agents has been described as a useful treatment of urinary and fecal incontinence. Among them, silicone implants have shown benefits in patients with internal anal sphincter (IAS) injury. We describe two patients with a history of hemorrhoidectomy and IAS injuries, which underwent placement of silicone implants. The implants were inserted into the intersphincteric space and the IAS under ultrasound guidance. The Wexner continente score fell from 17 and 19 before treatment, to 6 and 8 at six months follow up, respectively. Patients had no postoperative complications or implants migration. In our patients, injection of silicone implants improved fecal continence score, without postoperative complications or implants migration at six month follow up.

  19. Prevalence of cutaneous beta and gamma human papillomaviruses in the anal canal of men who have sex with women.

    Science.gov (United States)

    Smelov, Vitaly; Hanisch, Rachel; McKay-Chopin, Sandrine; Sokolova, Olga; Eklund, Carina; Komyakov, Boris; Gheit, Tarik; Tommasino, Massimo

    2017-06-01

    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. 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. 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). 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. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  20. Antibody responses following incident anal and penile infection with human papillomavirus in teenage men who have sex with men.

    Science.gov (United States)

    Zou, Huachun; Tabrizi, Sepehr N; Grulich, Andrew E; Hocking, Jane S; Garland, Suzanne M; Bradshaw, Catriona S; Cornall, Alyssa M; Fairley, Christopher K; Chen, Marcus Y

    2016-08-01

    Men who have sex with men (MSM) are at risk for human papillomavirus (HPV)-related anal cancer. Few data exist on antibody responses following incident anogenital infection with HPV in teenage MSM. A cohort of 200 MSM aged 16-20 years from Melbourne, Australia were assessed at baseline, 3, 6 and 12 months. At each visit anal and penile swabs were collected for HPV DNA and serum for HPV antibodies for genotypes 6, 11, 16 and 18 (Merck's Multiplex Assays using Luminex). The main outcome, seroconversion, was defined as the detection of HPV antibodies following a negative antibody result for the same HPV type at baseline. The seroincidence rates for HPV types 6, 11, 16 and 18 were: 19 (95% CI 12-26), 7 (3-12), 4 (1-8) and 6 (3-11) per 100 person-years, respectively. Men who experienced incident anal HPV infections from types 6/11 were significantly more likely to develop serum antibodies to the same HPV type(s) than those who experienced incident anal infections from types 16/18 [73 vs. 18%, odds ratio (OR) = 15, 95% CI: 2-118]. The median time between incident anal HPV infection and seroconversion for HPV 6, 11, 16 and 18 was: 91, 38, 161 and 182 days, respectively. Antibody responses against HPV types 6/11 were significantly more likely to occur following incident anal compared with incident penile infection with HPV types 6/11 (OR = 6, 95% CI: 2-21). The likelihood of antibody responses following anogenital HPV infections depends on the HPV type and site of infection.

  1. Prevalence of Anal Human Papillomavirus Vaccine Types in the Bangkok Men Who Have Sex With Men Cohort Study.

    Science.gov (United States)

    Cranston, Ross D; Althouse, Andrew D; van Griensven, Frits; Janocko, Laura; Curlin, Marcel E; Chaikummao, Supaporn; Chonwattana, Wannee; Siegel, Aaron; Holtz, Timothy H; McGowan, Ian

    2015-12-01

    The quadrivalent human papillomavirus (qHPV) and 9 valent (nHPV) vaccine are licensed for males to prevent anal HPV-associated dysplasia and cancer caused by HPV types 6, 11, 16, and 18 (qHPV) and additional types 33, 35, 45, 52, and 58 (nHPV), respectively. Both conditions are common in HIV-infected and HIV-uninfected men who have sex with men (MSM). It is not well documented which anal HPV vaccine types are most prevalent in Southeast Asia. A convenience sample of 400 anal swabs were obtained from 200 HIV-infected and 200 HIV-uninfected sexually active Bangkok MSM Cohort Study participants. After swab collection in PreservCyt (Cytyc Corp, Marlborough, MA), the media was stored at -80°C until processing. DNA was extracted, amplified by polymerase chain reaction, denatured, and then hybridized to probes for 37 HPV types and β-globin. The mean participant age was 25.6 years (range, 18-55 years); the mean CD4 T-cell count was 410 cells/mm in the HIV-infected participants. Among all swab samples, 386 (192 HIV-positive and 194 HIV-negative) had adequate β-globin for HPV genotype testing. Anal HPV type was detected in 44.3% of participants whose samples underwent genotype testing. Both qHPV and nHPV types were more frequently detected in HIV-infected compared with HIV-uninfected (42.2% vs. 23.2% [P social behaviors (alcohol use, drug use) or sexual behaviors (number of partners, condom usage, sexual positioning) and anal HPV prevalence. The prevalence of anal vaccine HPV types in Thai MSM was similar to that reported in MSM from Western populations and has a similar distribution by HIV status. Targeting young MSM with vaccination could offer protection against HPV vaccine types.

  2. Analýza interní komunikace ve vybrané společnosti

    OpenAIRE

    Koutníková, Lucie

    2011-01-01

    The aim of this thesis is to analyse internal communication in the company DCom spol. s r.o. In the first part there is the descritpion of the DCom company. The second part is theorethical base - there is a characterization of communication, internal communication, its aims, channels and the consequences of internal communication errors. In the last part there is described the analysis of the internal communication in the DCom company and its results.

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

    Science.gov (United States)

    Poynten, I Mary; Tabrizi, Sepehr N; Jin, Fengyi; Templeton, David J; Machalek, Dorothy A; Cornall, Alyssa; Phillips, Samuel; Fairley, Christopher K; Garland, Suzanne M; Law, Carmella; Carr, Andrew; Hillman, Richard J; Grulich, Andrew E

    2017-06-01

    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. 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. 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 (pAnal 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. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  4. Anal cancer in Chinese: human papillomavirus infection and altered expression of p53

    Institute of Scientific and Technical Information of China (English)

    1998-01-01

    AIM To detect the presence of HPV DNA and study the alteration of p53 expression in anal cancers in Chinese.METHODS HPV DNA was amplified by PCR. The amplified HPV DNA was classified by DBH. HPV antigen and p53 expression were respectively detected by immunohistochemistry.RESULTS HPV DNA was amplified only in one case of squamous cell carcinoma of the 72 Chinese anal cancers and further classified as HPV type 16. Others were all HPV negative. HPV antigen and p53 expression were also detected in this case. Positive stainings with anti-p53 antibody were seen in 61.2% anal cancers. There were no statistically significant differences between anal squamous cell carcinomas and adenocarcinomas and between anal adenocarcinomas and rectal adenocarcinomas. p53 protein expression was observed in the basal cells of squamous epithelium of condyloma acuminatum and morphologically normal squamous epithelium in 2 cases invaded by anal adenocarcinoma.CONCLUSION HPV infection was not associated with these cases of anal cancer. p53 alteration was a common event. Positive p53 immunostaining can not be regarded as a marker for differentiating benign from malignant lesions.

  5. Prevalência de papilomavirus humano (HPV anal, genital e oral, em ambulatório geral de coloproctologia Prevalence of anal, genital and oral human papillomavirus (HPV in general ambulatory for diseases of colon and rectum

    Directory of Open Access Journals (Sweden)

    João Carlos Magi

    2006-09-01

    Full Text Available O Papilomavirus Humano (HPV anal tem alta prevalência e incidência na população. O objetivo deste trabalho é verificar a prevalência de HPV anal, bucal e genital em ambulatório público de Coloproctologia, com base no exame de captura hibrida. Foram estudados 64 pacientes atendidos no ambulatório geral de Coloproctologia do Hospital Heliópolis, no período de 22/11/2005 a 20/12/2005, onde foram levantados, de forma prospectiva, dados clínicos, pessoais e comportamentais, identificando o perfil do grupo como não sendo de risco para HPV. Nenhum paciente deste grupo veio à consulta com queixa ou apresentando sinais de HPV ou outra doença sexualmente transmissível. Foram colhidos para cada paciente um esfregaço com escova de boca, outro de vulva/pênis e outro do ânus. O resultado mostrou que 15,62% dos pacientes apresentaram HPV anal, bucal ou genital, sendo que 4,68% do total de pacientes apresentavam HPV anal, um paciente de alto risco associado ao HPV genital, outro misto e outro de baixo risco. Trinta por cento dos pacientes HPV+ apresentavam dor anal como queixa principal. A conclusão é que a prevalência de HPV anal, genital e bucal é elevada, sendo que 4,68% apresentavam HPV anal e daqueles HPV positivos 30% apresentavam dor anal na queixa principal.Anal Human Papilomavirus (HPV has a high prevalence and incidence in the population. The purpose of this project is to verify the prevalence of anal, oral and genital HPV at the Coloproctology Clinic, based on the hybrid capture exam. Sixty four patients were assisted at the clinic from November 22nd to December 20th 2005. Clinical, personal and behavioral data of the patients were set up in a prospective way. The group profile was identified as not being a risky one to HPV. No patient of this group, when was assisted, had complained of or had presented any symptoms of HPV or any other sexually transmitted disease (STD. From each patient it was collected a mouth sample, a vulva

  6. Towards International Humanism

    Science.gov (United States)

    Huxley, Julian

    1971-01-01

    The basic task before the educational profession today is to study and understand the evolutionary-humanist revolution, to follow up its educational implications; and to enable as many as possible of the world's growing minds to be illuminated by its new vision of human destiny. (Author/JB)

  7. Comparative study of internal anal competent seton combined with external anal fistula resection and suture or exclusion for the treatment of high anal fistula%肛管内主管挂线联合肛门外瘘管切除缝合或旷置治疗高位肛瘘疗效的对比研究

    Institute of Scientific and Technical Information of China (English)

    任炜

    2016-01-01

    Objective To compare the effects of internal anal competent seton combined with external anal fistula resection and suture or exclusion on high anal fistula. Methods The curative effect of 65 cases underwent internal anal competent seton combined with external anal fistula resection and su-ture and 62 cases underwent internal anal competent seton combined with external anal fistula exclusion were comparative analyzed. Results The total efficiency of suture group was 90. 77% ,which was signif-icantly higher than that of the exclusion group(70. 97% ),the difference was significant(P ﹤ 0. 05). The suture wound healing time and Wexner score of suture group were significantly lower than those of exclu-sion group(P ﹤ 0. 05). The recurrence rate of suture group(1. 54% )was significantly lower than that of the exclusion group(9. 68% ),the difference was significant(P ﹤ 0. 05). Conclusions Internal anal competent seton combined with external anal fistula resection and suture in the treatment of high anal fis-tula significant can accelerate the healing of incision and improve the recovery of anal function.%目的:比较肛管内主管挂线联合肛门外瘘管切除缝合或旷置治疗高位肛瘘的疗效。方法对65例行肛管内主管挂线联合肛门外瘘管切除缝合术与62例行肛管内主管挂线联合肛门外瘘管旷置术的疗效进行对比分析。结果缝合组的总有效率为90.77%,显著高于旷置组(70.97%),差异有统计学意义(P ﹤0.05);缝合组缝合处愈合时间和 Wexner 评分显著低于旷置组,差异有统计学意义(P ﹤0.05);缝合组复发率(1.54%)显著低于旷置组(9.68%),差异有统计学意义(P ﹤0.05)。结论肛管内主管挂线联合肛门外瘘管切除缝合术治疗高位肛瘘疗效显著,可加快切开愈合,提高肛门功能恢复。

  8. Defensive anality and anal narcissism.

    Science.gov (United States)

    Shengold, L

    1985-01-01

    This paper aims at demonstrating a currently beleaguered assumption: the central importance, the continuing vitality, and the appropriate complexity of Freud's theory of the drives and of his idea of the primacy of the body ego. It is not enough to consider man a thinking machine or a social being; his animal nature must be given a central place in psychology. The paper postulates that 'anal or sphincter defensiveness' is one of the precursors of the repression barrier. Anality has been comparatively neglected in recent psychoanalytic literature, and so has its explorer, Karl Abraham. The paper's thesis is that there is a special defensive importance to anal erogeneity and libido, and to those aspects of ego and superego that are functionally operative (as the 'sadistic-anal organization' (Freud, 1917)) during the so-called 'sadistic-anal' developmental phase. Any of the psychic danger situations can evoke regression to manifestations of 'anal narcissim'--an attempt to master overwhelming feeling by a kind of emotional sphincter action, narrowing down the world to the controllable and the predictable. The basic assumption here is Fliess's idea that the attainment of anal sphincter control functions--with, as-it-were, 'psychic resonance'--as a means to master primal (murderous, cannibalistic) affect. For optimal psychic development, a proper balance must be attained between anal control of, and anal expression of, instinctual derivatives--especially of affect laden with aggression.

  9. Human papillomavirus-related cervical and anal disease in HIV-infected individuals in the era of highly active antiretroviral therapy.

    Science.gov (United States)

    Piketty, Christophe; Kazatchkine, Michel D

    2005-08-01

    HIV-infected men who have sex with men remain at high risk of developing anal cancer despite the widespread use of highly active antiretroviral therapy (HAART). In HIV-infected women, however, there is some evidence that HAART may be associated with regression of human papillomavirus (HPV)-related cervical disease. So far, epidemiologic data provided by cancer registries have shown no reduction in the incidence of cervical and anal cancer in patients with HIV infection since the initiation of HAART in 1996. Recent data suggest that HPV infection occurs in the anal canal of immunocompromised patients, as an opportunistic infection, in the absence of receptive anal intercourse. Taken together, these lines of evidence support the need for developing anal and cervical cancer screening programs for patients with HIV, whether untreated or on HAART.

  10. Topical application of trichloroacetic acid is efficacious for the treatment of internal anal high-grade squamous intraepithelial lesions in HIV-positive men.

    Science.gov (United States)

    Cranston, Ross D; Baker, Jonathan R; Liu, Yimeng; Wang, Lu; Elishaev, Esther; Ho, Ken S

    2014-07-01

    To assess the efficacy of topical 80% trichloroacetic acid (TCA) to treat internal anal high-grade squamous intraepithelial lesions (HSILs) in HIV-positive individuals. All patients who attended the University of Pittsburgh Anal Dysplasia Clinic for treatment of biopsy-proven internal anal HSIL with topical TCA between July 1, 2009, and June 30, 2012, and who had 1 or more follow-up visits to assess treatment efficacy were included in the analysis. Recurrence of HSIL was assessed in July 1, 2013. A total of 98 HSILs from 72 patients were treated, and 77 (78.6%) resolved to normal epithelium or low-grade SIL during follow-up. Forty-eight (49.0%) and 27 (27.6%) of lesions resolved with 1 and 2 TCA treatments, respectively, whereas 1 lesion (1%) each resolved with 3 and 4 TCA treatments. Twenty-one (21.4%) lesions in 20 patients remained without resolution after TCA treatments. These patients were offered an alternative treatment. During follow-up, 8 (15.1%) of 53 patients had a lesion that recurred at the index site (11/53 [20.8%], inclusive of adjacent lesions) and 17 patients had new lesions diagnosed. Topical TCA is an efficacious treatment of internal anal HSIL in an anal dysplasia clinic setting with high-resolution anoscopy capacity. Advantages of TCA for this recurrent disease process include the following: low cost, no requirement for special equipment beyond that for high-resolution anoscopy, and painless application procedure. A larger prospective comparative study would better define efficacy and patient acceptability between treatment methods.

  11. The International Human Epigenome Consortium

    DEFF Research Database (Denmark)

    Stunnenberg, Hendrik G; Hirst, Martin

    2016-01-01

    The International Human Epigenome Consortium (IHEC) coordinates the generation of a catalog of high-resolution reference epigenomes of major primary human cell types. The studies now presented (see the Cell Press IHEC web portal at http://www.cell.com/consortium/IHEC) highlight the coordinated ac...... achievements of IHEC teams to gather and interpret comprehensive epigenomic datasets to gain insights in the epigenetic control of cell states relevant for human health and disease. PAPERCLIP.......The International Human Epigenome Consortium (IHEC) coordinates the generation of a catalog of high-resolution reference epigenomes of major primary human cell types. The studies now presented (see the Cell Press IHEC web portal at http://www.cell.com/consortium/IHEC) highlight the coordinated...

  12. Human papillomavirus infection in anal intraepithelial lesions from HIV infected Cuban men.

    Science.gov (United States)

    Limia, Celia M; Soto, Yudira; García, Yanara; Blanco, Orestes; Kourí, Vivian; López, María V; Toledo, María E; Pérez, Lissette; Baños, Yoanna; Caturla, Yaniris; Aguayo, Francisco

    2017-01-01

    An association between HPV infection and progression to anal squamous intraepithelial lesions (ASIL) has been established, specifically in high-risk populations such as HIV-infected men. In this population, anal cancer is one of the most common non-AIDS-defining malignancies. A cross-sectional study to detect anal lesions and HPV infection was performed. Anal mucosa samples were collected from 56 HIV-infected men from Cuba. The cytological diagnosis was done according to Bethesda 2001 System. HPV DNA detection was determined by qPCR for six high-risk HPV types and end point PCR for low-risk HPV types (6 and 11). The end point PCR with nucleotide sequencing technique was achieved to detect other genotypes of HPV not included in the qPCR in those samples negative for HPV- 6 and 11 or negative for the six genotypes identified in the qPCR. Cytological diagnosis identified 53 of 56 (95%) men with abnormal anal cytology. Among those, 26% (14/53) had atypical squamous cells of undetermined significance (ASC-US), 4% (2/53) had atypical squamous cells of undetermined significance cannot exclude high-grade lesions (ASC-H), 64% (34/53) had low-grade squamous intraepithelial lesions (LSIL), and 6% (3/53) had high-grade squamous intraepithelial lesions (HSIL). HPV DNA was detected in 89% (50/56) of men and 79% had at least one of the high-risk HPV types. HPV- 16 was the most common genotype (52%), while HPV-18 was the most frequently detected genotype in men with HSIL. We found statistically significant differences in the HPV viral loads with respect to the cytology results (p = 0.0006) and that the practice of receptive anal sex was a risk factor for anal HPV infection (p = 0.032). This study shows a high prevalence of ASIL and high-risk HPV infections in the study group and is the first study showing the distribution of HPV genotypes in HIV infected Cuban men with abnormal anal cytology. This information may be of importance for local decision makers to improve

  13. The prevalence of anal human papillomavirus among young HIV negative men who have sex with men

    Directory of Open Access Journals (Sweden)

    Zou Huachun

    2012-12-01

    Full Text Available Abstract Men who have sex with men (MSM especially those who are HIV positive are at risk for HPV-associated anal cancer. We systematically reviewed studies with data on the prevalence of vaccine preventable anal HPV among men who have sex with men aged 25 or younger and identified 6 studies. None of these studies were specifically designed to determine the prevalence of HPV in this population. Available data, albeit limited, suggest many young MSM may not already be HPV infected. Further studies using representative sampling focused on teenage MSM are required to confirm this.

  14. Anal fissure

    Science.gov (United States)

    ... split or tear in the thin moist tissue ( mucosa ) lining the lower rectum (anus). Causes Anal fissures ... Chronic Constipation in infants and children Crohn disease Mucosa Review Date 5/24/2016 Updated by: Mary ...

  15. Anal Cancer

    Science.gov (United States)

    ... has just been diagnosed with anal cancer, this short, simple guide can help. More Resources Read more Cancer Basics Read more Finding Treatment Centers Read more Online Support Communities News & Stories Read More Latest Cancer News Read More Stories ...

  16. Analysis of Internal Opening Expression and Etiological about Anal Fistula%肛瘘内口表达和病因分析

    Institute of Scientific and Technical Information of China (English)

    张波; 沈云天; 王丽群; 毛宽荣

    2014-01-01

    目的:通过临床观察,验证肛瘘病因假说,及其对临床的指导意义。方法根据113例肛瘘患者的内口表达的不同分为三组,观察其所占比例和治疗后的效果。结果内口隐性表达的病例占69.91%,各组的治愈率方面无显著性差异。结论“腺源”学说存在临床质疑,但是“隐窝感染”还是肛瘘发生的重要原因。妥善处理“内口”仍然是治疗肛瘘的重点。%Objective To verified the anal fistula internal opening hypothesis and its clinical significance through clinical observation.Methods One hundred and thirteen cases of anal fistula patients were divided into three groups according to the different internal opening expression.Three groups were observed in the proportion and the effect of treatment.Results Cases of the internal opening recessive expression accounted for 69.91%.There was no significant difference between the groups of cure rate.Conclusion "Gland source" theory existence clinical questions."Crypt infection" theory is important reason of anal fistula. Properly handle the" Internal Opening " is the focus in the treatment of anal fistula.

  17. Relationship between interstitial cells of Cajal, fibroblast-like cells and inhibitory motor nerves in the internal anal sphincter.

    Science.gov (United States)

    Cobine, Caroline A; Hennig, Grant W; Kurahashi, Masaaki; Sanders, Kenton M; Ward, Sean M; Keef, Kathleen D

    2011-04-01

    Interstitial cells of Cajal (ICC) have been shown to participate in nitrergic neurotransmission in various regions of the gastrointestinal (GI) tract. Recently, fibroblast-like cells, which are positive for platelet-derived growth factor receptor α (PDGFRα(+)), have been suggested to participate additionally in inhibitory neurotransmission in the GI tract. The distribution of ICC and PDGFRα(+) cell populations and their relationship to inhibitory nerves within the mouse internal anal sphincter (IAS) are unknown. Immunohistochemical techniques and confocal microscopy were therefore used to examine the density and arrangement of ICC, PDGFRα(+) cells and neuronal nitric-oxide-synthase-positive (nNOS(+)) nerve fibers in the IAS of wild-type (WT) and W/W ( v ) mice. Of the total tissue volume within the IAS circular muscle layer, 18% consisted in highly branched PDGFRα(+) cells (PDGFRα(+)-IM). Other populations of PDGFRα(+) cells were observed within the submucosa and along the serosal and myenteric surfaces. Spindle-shaped intramuscular ICC (ICC-IM) were present in the WT mouse IAS but were largely absent from the W/W ( v ) IAS. The ICC-IM volume (5% of tissue volume) in the WT mouse IAS was significantly smaller than that of PDGFRα(+)-IM. Stellate-shaped submucosal ICC (ICC-SM) were observed in the WT and W/W ( v ) IAS. Minimum surface distance analysis revealed that nNOS(+) nerve fibers were closely aligned with both ICC-IM and PDGFRα(+)-IM. An even closer association was seen between ICC-IM and PDGFRα(+)-IM. Thus, a close morphological arrangement exists between inhibitory motor neurons, ICC-IM and PDGFRα(+)-IM suggesting that some functional interaction occurs between them contributing to inhibitory neurotransmission in the IAS.

  18. 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

    2017-01-06

    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.

  19. Risk factors for anal human papillomavirus infection type 16 among HIV-positive men who have sex with men in San Francisco

    Science.gov (United States)

    Hernandez, Alexandra L.; Efird, Jimmy T.; Holly, Elizabeth A.; Berry, J. Michael; Jay, Naomi; Palefsky, Joel M.

    2015-01-01

    Background and Objective HIV-positive men who have sex with men (MSM) are at high risk of anal cancer compared with the general population. Human papillomavirus (HPV) infection, particularly HPV 16, is causally associated with anal cancer. However, risk factors for anal HPV 16 infection are poorly understood. We determined the prevalence and risk factors for anal HPV 16 infection in a population of HIV-positive MSM, most of whom were being treated with antiretroviral therapy. Design Cross-sectional data from the baseline visit of a 4-year prospective cohort study. Methods 348 HIV-positive MSM were recruited in San Francisco and received a detailed sexual behavior risk-factor questionnaire. An anal swab was used to collect specimens for HPV type-specific DNA testing using L1 HPV DNA PCR. We used log-binomial multivariable models to determine risk factors for anal HPV 16 infection. Results 92% of HIV-positive MSM had at least one anal HPV type, 80% had at least one oncogenic HPV type and 42% had HPV 16. Non-Hispanic white race and higher level of education were associated with a decreased risk of HPV 16 infection. A higher number of total male partners was associated with HPV 16 (RR: 1.6, 95%CI 1.1–2.4, p=0.01) for 201–1000 partners compared with 1–200. Injection drug use (IDU) was independently associated with anal HPV 16 infection (RR: 1.5, 95%CI 1.2–1.9, p=0.003). Conclusions The prevalence of anal HPV infection, including HPV 16, is high in HIV-positive MSM. HIV-positive MSM should be counseled about the risk associated with increased partners and IDU. PMID:23614994

  20. Prevalence of Anal Human Papillomavirus Infection and Risk Factors among HIV-positive Patients in Tokyo, Japan.

    Directory of Open Access Journals (Sweden)

    Naoyoshi Nagata

    Full Text Available Oncogenic human papillomavirus (HPV infection, particularly multiple HPV types, is recognized as a necessary cause of anal cancer. However, a limited number of studies have reported the prevalence of anal HPV infection in Asia. We determined the prevalence, genotypes, and risk factors for anal HPV infection in Japanese HIV-positive men who have sex with men (MSM, heterosexual men, and women.This cross-sectional study included 421 HIV-positive patients. At enrollment, we collected data on smoking, alcohol, co-morbidities, drugs, CD4 cell counts, HIV RNA levels, highly active anti-retroviral therapy (HAART duration, sexually transmitted infections (STIs, and serological screening (syphilis, hepatitis B virus, Chlamydia trachomatis, Entamoeba histolytica. Anal swabs were collected for oncogenic HPV genotyping.Oncogenic HPV rate was 75.9% in MSM, 20.6% in heterosexual men, and 19.2% in women. HPV 16/18 types were detected in 34.9% of MSM, 17.7% of heterosexual men, and 11.5% of women. Multiple oncogenic HPV (≥2 oncogenic types rate was 54.6% in MSM, 8.8% in heterosexual men, and 0% in women. In univariate analysis, younger age, male sex, MSM, CD4 50,000, no administration of HAART, and having ≥2 sexually transmitted infections (STIs were significantly associated with oncogenic HPV infection, whereas higher smoking index and corticosteroid use were marginally associated with oncogenic HPV infection. In multivariate analysis, younger age (OR, 0.98 [0.96-0.99], MSM (OR, 5.85 [2.33-14.71], CD4 <100 (OR, 2.24 [1.00-5.01], and having ≥2 STIs (OR, 2.81 [1.72-4.61] were independently associated with oncogenic HPV infection. These 4 variables were also significant risk factors for multiple oncogenic HPV infection.Among Japanese HIV-infected patients, approximately two-thirds of MSM, one-fifth of heterosexual men, and one-fifth of women have anal oncogenic HPV infection. Younger age, MSM, ≥2 STIs, and immunosuppression confer a higher risk of

  1. Image Spectrum of Anal Ultrasound in Patients with Peri Anal Disease

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Hae Jeong; Kim, Young Jun; ParK, Hee Sun; Jung, Sung Il; Park, Sang Woo; Choi, Young Chil; Shin, Hyun Joon; Park, Uug Chae [Konkuk University School of Medicine, Seoul (Korea, Republic of); Jin, Yong Hyun [Sung Ae General Hospital, Seoul (Korea, Republic of)

    2009-12-15

    Endoanal ultrasonography has recently emerged as a popular diagnostic modality for mapping and imaging the anal sphincter. This procedure can be performed as an outpatient procedure: it is relatively quick and virtually painless. The imaging typically is performed in a proximal to distal manner with defining a variety of levels of the anal canal as it progresses. Anal ultrasound can provide a detailed image of the anal sphincter musculature. The internal anal sphincter appears endosonographically as a hypoechoic circular band that is most prominently seen at the level of the mid-anal canal. The external anal sphincter appears as a thicker circular mixed echogenic band outside of the hypoechoic internal sphincter. Anal ultrasound can be used to evaluate patients with anal fistulas with or without abscess. Imaging is performed and the fistulous tracts or abscesses are identified by hypoechogenicity within the external sphincter muscle or the ischiorectal fossa. Its ability to clearly image the anal sphincters has allowed its use for the evaluation of anal fistulas. Moreover, anal ultrasound has emerged as the technique of choice for imaging the anal sphincters and for evaluating incontinence. Each of the individual physiologic tests offers valuable information that is relevant to the continence mechanism, and the ultrasound yields results that are complementary to other tests. Ultrasound serves as a surveillance tool to monitor the results after sphincterplasty. We illustrate the endo-anal sonographic features of various anal diseases and the ultrasound-anatomic correlation for the anus

  2. The role of oncogenic human papillomavirus determination for diagnosis of high-grade anal intraepithelial neoplasia in HIV-infected MSM.

    Science.gov (United States)

    Burgos, Joaquin; Hernández-Losa, Javier; Landolfi, Stefania; Guelar, Ana; Dinares, MªCarmen; Villar, Judith; Navarro, Jordi; Ribera, Esteve; Falcó, Vicenç; Curran, Adria

    2017-10-23

    To assess the oncogenic human papillomavirus (HPV) determination and the cotesting HPV and anal cytology value to detect high-grade anal intraepithelial neoplasia (HGAIN) in a cohort of HIV-MSM. Prospective study of HIV-infected MSM who underwent screening for anal dysplasia. Screening program includes anal cytology, HPV testing, and high-resolution anoscopy (HRA) at each visit. Histological samples were obtained if suspicious lesions were revealed by HRA. Sensitivity and specificity of the different tests were calculated by using histological results of HRA-guided biopsy as the reference test for HGAIN diagnosis. From May 2009 to August 2016, 692 HIV-infected MSM underwent 1827 anal cytologies, 1841 HRA examinations, and 1607 HPV testing. At first screening visit, anal cytology results were abnormal in 418 (60.4%) of 692 patients, and oncogenic HPV genotypes were found in 482 (79.5%) of 606 patients. Anal cytology showed a sensitivity of 89.2% [95% confidence interval (CI); 80.7-94.2] and a specificity of 44.2% (95% CI; 40.2-48.2) to detect HGAIN. Oncogenic HPV testing had 90.4% sensitivity (95% CI; 82-86.8) and 24.4% specificity (95% CI; 20.8-28.3). Cotesting showed a 97.4% sensitivity (95% CI; 91-99.3) and 14% specificity (95% CI; 11.2-17.3). In patients with atypical squamous cells of uncertain significance on cytology, oncogenic HPV testing had 91.3% sensitivity and 28.3% specificity to detect HGAIN. Abnormal cytology and oncogenic HPV determination showed similar sensitivity for detecting HGAIN. The two tests used together improved the sensitivity but with lowered specificity. In our opinion, HPV testing does not improve HGAIN detection and should not replace anal cytology as a standard screening test for HIV-infected MSM.

  3. Anal herpes

    National Research Council Canada - National Science Library

    Andre Goulart; Jose Pinto; Pedro Leão

    2017-01-01

    ... that irradiated to the buttocks and the physical examination revealed red bumps with ulceration ( figure 1 ). Anal herpes was suspected and the patient was treated with an antiviral (brivudine) and carbamazepine for symptomatic relief. Seven days after treatment the patient had complete resolution of his symptoms and there were no cut...

  4. Prevalence of anal human papillomavirus infection and cytologic abnormalities among HIV-infected and HIV-uninfected men who have sex with men

    Directory of Open Access Journals (Sweden)

    Alessandra Latini

    2014-11-01

    Full Text Available Introduction: Human papillomavirus (HPV is responsible for 85% of anal cancers. Recently, anal cancer incidence has been increasing, particularly in men who have sex with men (MSM. Cytology may be a useful tool for the detection of anal precancerous lesions. We assessed the prevalence and determinants of anal HPV infection and cytologic abnormalities among HIV-infected and -uninfected MSM. Materials and Methods: MSM ≥18-year-old attending an STI clinic in Rome (Italy were enrolled. Anal cytologic samples were collected in PreservCyt (Hologic using a Dacron swab. The Linear Array HPV Genotyping Test (Roche Diagnostics was used for the detection and genotyping of 37 mucosal HPV types. Liquid-based cytological slides were obtained using a ThinPrep2000 processor (Hologic. The morphology of the anal pap-test was classified following the Bethesda 2001 guidelines. Results: We enrolled 180 HIV-infected (median age 41 years, IQR 33–47 and 438 HIV-uninfected MSM (median age 32 years, IQR: 27–39. Most of the individuals were Caucasian (92.2% and 97.0%, respectively. HPV prevalence, both overall (93.3% vs 72.4%, p<.001 and by high-risk (HR HPV types (80.5% vs 56.0%, p<.001, was significantly higher among HIV-infected than HIV-uninfected individuals. HPV-multiple infections were evidenced in 48.2% of the HIV-uninfected and 76.1% of the HIV-infected MSM (p<.001. HPV16 was the most prevalent genotype in both groups (23.3% in HIV-positive and 17.6% in HIV-negative MSM. HPV6 and 84 were the most frequent low-risk types in both cohorts. Anal cytologic abnormalities were found in a significantly higher proportion of HIV-infected MSM (46.1% vs 27.9%, p<.001. H-SILs (high-grade squamous intraepithelial lesions were exclusively observed among the HIV-infected individuals, although at a low prevalence (1.2%. Conclusions: A high prevalence of anal HPV infection and cytologic abnormalities was evidenced in both populations. Nonetheless, HIV-infected MSM showed a

  5. Pharmacotherapy of Anal Cancer.

    Science.gov (United States)

    Rogers, Jane E; Eng, Cathy

    2017-08-02

    Anal squamous cell carcinoma (SCCA), among other malignancies, is associated with the human papillomavirus (HPV) and its incidence continues to rise. Anal SCCA will likely remain an existing healthcare concern given compliance issues with the HPV vaccination seen in the US. Localized disease is predominantly treated with standard of care (SOC) definitive chemoradiation that has remained unchanged for decades. Clinical and molecular prognostic factors have emerged to characterize patients unresponsive to SOC, revealing the need for an alternate approach. Metastatic disease is an extremely small subset and understudied population due to its rarity. Recent prospective trials and mutational analysis have opened treatment options for this subset in need. Our review details the pharmacotherapeutic treatment in localized and metastatic anal SCCA chronologically, while also describing future outlooks.

  6. [Contribution of Anales de Pediatría to the international visibility of Spanish paediatric research in the Web of Science (2010-2014)].

    Science.gov (United States)

    Abad-García, María Francisca; González-Teruel, Aurora; Solís Sánchez, Gonzalo

    2016-12-01

    To describe the role of Anales de Pediatría in highlighting Spanish paediatric research, and to identify the journals with which it competes internationally. Spanish paediatric articles, including those from Anales de Pediatría were identified using the Paediatrics category of the Science Citation Index (2010-2014), and their volume and document type was analysed. For original articles and review articles, the year, the citation and journal of publication was studied. The journals were classified as general and specialised. The productivity of general journals was analysed according to their language, JCR quartile, and article access. A total of 2,701 Spanish paediatric papers were identified, accounting for 2.8% of the paediatrics world output. More than two-thirds (68%) of papers were articles that received an average number of 4.97 citations per article. The 965 papers published in Anales de Pediatría accounted for 38.7% of the Spanish paediatric output, and for 1% of the paediatric world publications. A mean of 1.03 citations per article were received for 439 (45.4%) articles and reviews. Of the 106 journals identified, 82 were classified as specialised (1,196 articles) and 24 as general (741 articles). Anales de Pediatría published 60% of the articles in general journals. The rest of articles (309) were published in general journals published in English (82.8%), with a best position in the JCR ranking (83.4%) and mainly by subscription (73.8%). Anales de Pediatría plays an important role in providing international visibility to a large volume of Spanish scientific production in paediatrics. The results presented are a still only a snapshot of this role that could be used in the near future for assessing its evolution and the changes that could be made in order to improve its quality, positioning and competitiveness. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. [Perianal fistula and anal fissure].

    Science.gov (United States)

    Heitland, W

    2012-12-01

    CRYPTOGLANDULAR ANAL FISTULA: Perianal abscesses are caused by cryptoglandular infections. Not every abscess will end in a fistula. The formation of a fistula is determined by the anatomy of the anal sphincter and perianal fistulas will not heal on their own. The therapy of a fistula is oriented between a more aggressive approach (operation) and a conservative treatment with fibrin glue or a plug. Definitive healing and the development of incontinence are the most important key points. ANAL FISSURES: Acute anal fissures should be treated conservatively by topical ointments, consisting of nitrates, calcium channel blockers and if all else fails by botulinum toxin. Treatment of chronic fissures will start conservatively but operative options are necessary in many cases. Operation of first choice is fissurectomy, including excision of fibrotic margins, curettage of the base and excision of the sentinel pile and anal polyps. Lateral internal sphincterotomy is associated with a certain degree of incontinence and needs critical long-term observation.

  8. Coinfection of Epstein-Barr virus, cytomegalovirus, herpes simplex virus, human papillomavirus and anal intraepithelial neoplasia in HIV patients in Amazon, Brazil

    Directory of Open Access Journals (Sweden)

    Adriana Gonçalves Daumas Pinheiro Guimarães

    2012-03-01

    Full Text Available OBJECTIVE: The prevention of anal cancer is a goal of worldwide Aids support centers. Despite the efforts that have been made and progress in the antiretroviral therapy, effective disease control remains elusive. Difficulty in preventing anal cancer may result from the ineffectiveness of highly active antiretroviral therapy on the human papillomavirus (HPV since the coinfection with HIV and HPV appears to increase the risk of HPV-infected cells, becoming cancerous. METHODS: We evaluated 69 HIV-positive and 30 HIV-negative male patients who underwent cytological evaluation by RT-PCR for the presence of HPV, Epstein-Barr virus, cytomegalovirus and herpes virus types (HSV 1 and 2, and histopathology analysis of the anal canal. RESULTS: The prevalence of anal intraepithelial neoplasia was 35% and it was restricted to HIV-positive patients. Patients infected with high-risk HPV and with fewer than 50 TCD4 cells/µL showed an anal intraepithelial neoplasia rate of 85.7% compared to those with TCD4 cells >200 cells/µL (pOBJETIVO: A prevenção do câncer anal tem sido aplicada pelos centros de apoio a pacientes com Aids em todo o mundo. Apesar dos esforços empregados, o eficaz controle da doença permanece distante. A dificuldade na prevenção do câncer anal pode resultar, em parte, da ineficácia da ação da terapia antirretroviral sobre o papilomavírus humano (HPV, pois a coinfecção com HIV e HPV parece aumentar o risco das células infectadas pelo HPV em tornarem-se cancerosas. MÉTODOS: Foram avaliados 69 HIV-positivos e 30 pacientes HIV-negativos do sexo masculino, que foram submetidos à avaliação citológica anal por real time-PCR para a presença de HPV, vírus Epstein-Barr, citomegalovírus e herpes vírus tipos (HSV 1 e 2 além da análise histopatológica de fragmento de mucosa do canal anal. RESULTADOS: A prevalência de neoplasia intraepitelial anal foi de 35% e foi restrita a pacientes HIV-positivos. Os pacientes infectados com o

  9. Anal and oral human papillomavirus (HPV infection in HIV-infected subjects in northern Italy: a longitudinal cohort study among men who have sex with men

    Directory of Open Access Journals (Sweden)

    Barelli Andrea

    2011-05-01

    Full Text Available Abstract Background A study including 166 subjects was performed to investigate the frequency and persistence over a 6-month interval of concurrent oral and anal Human Papillomavirus (HPV infections in Human Immunodeficiency Virus (HIV-infected men who have sex with men (MSM. Methods Patients with no previously documented HPV-related anogenital lesion/disease were recruited to participate in a longitudinal study. Polymerase chain reaction (PCR was performed to detect HPV from oral and anal swabs and to detect Human Herpes Virus 8 (HHV-8 DNA in saliva on 2 separate specimen series, one collected at baseline and the other collected 6 months later. A multivariate logistic analysis was performed using anal HPV infection as the dependent variable versus a set of covariates: age, HIV plasma viral load, CD4+ count, hepatitis B virus (HBV serology, hepatitis C virus (HCV serology, syphilis serology and HHV-8 viral shedding. A stepwise elimination of covariates with a p-value > 0.1 was performed. Results The overall prevalence of HPV did not vary significantly between the baseline and the follow-up, either in the oral (20.1 and 21.3%, respectively or the anal specimens (88.6 and 86.3%. The prevalence of high-risk (HR genotypes among the HPV-positive specimens was similar in the oral and anal infections (mean values 24.3% and 20.9%. Among 68 patients with either a HR, low-risk (LR or undetermined genotype at baseline, 75% had persistent HPV and the persistence rates were 71.4% in HR infections and 76.7% in LR infections. There was a lack of genotype concordance between oral and anal HPV samples. The prevalence of HR HPV in anus appeared to be higher in the younger patients, peaking (> 25% in the 43-50 years age group. A decrease of the high level of anal prevalence of all genotypes of HPV in the patients > 50 years was evident. HHV-8 oral shedding was positively related to HPV anal infection (p = 0.0046. A significant correlation was found between the

  10. Human Rights: Dialogue and International Cooperation

    Institute of Scientific and Technical Information of China (English)

    王水霞; 孟保林

    2007-01-01

    @@ Dialogue is a major form of international cooperation on human rights issues. It is also instrumental in settling human rights disputes between nations. In this age of globalization, extensive global dialogues on human rights serve to deepen mutual understanding between nations, speed up the formation of international norms governing human rights, and hasten the advent of a harmonious world.

  11. Identification of episomal human papillomavirus and other DNA viruses in cytological anal samples of HIV-uninfected men who have sex with men.

    Science.gov (United States)

    Donà, Maria Gabriella; Paolini, Francesca; Benevolo, Maria; Vocaturo, Amina; Latini, Alessandra; Giglio, Amalia; Venuti, Aldo; Giuliani, Massimo

    2013-01-01

    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.

  12. Identification of episomal human papillomavirus and other DNA viruses in cytological anal samples of HIV-uninfected men who have sex with men.

    Directory of Open Access Journals (Sweden)

    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.

  13. US Human Rights Conduct and International Legitimacy

    DEFF Research Database (Denmark)

    Keating, Vincent Charles

    Did the Bush administration fundamentally harm the international human rights system through its rejection of human rights norms? This is the central question explored within US Human Rights Conduct and International Legitimacy, which analyses the practices of legitimacy between the Bush...... nations have followed in America's footsteps, and that the Bush administration's deviation from international norms has served to reaffirm worldwide commitment to human rights....

  14. Clinical Research on the Treatment of Anal Fistula by the Technique of Closing Internal Opening and Filling Anal Fistula by Biological Patch%生物补片内口封闭瘘道填塞术治疗肛瘘临床观察

    Institute of Scientific and Technical Information of China (English)

    史瑞霞; 王业皇; 吴金萍

    2012-01-01

    Objective:To study the clinical curative effects on the treatment of anal fistula by the technique of closing internal opening and filling anal fistula by biological patch. Methods:The technique of closing internal opening and filling anal fistula by biological patch was used to treat anal fistula. Results: During 13 cases of this group,biological patch and tissue dissolved each other well in the course of disease,part patches were gradually degraded and absorbed and external opening were gradually cured. Al present, 13 cases had been discharged from hospital, among which, 10 cases were cured and in the condition of low - position anal fistula. 1 case achieved excellent effect and was in the condition of low - position and complex anal fistula and 1 case was effective and in the condition of high - position and complex anal fistula. 1 case was ineffective and also in the condition of high - position and complex anal fistula. Conclusion: The technique of closing internal opening and filling anal fistula by biological patch has great superiority in alleviating pain in patients, narrowing areas of wounds,and reducing postoperative defect of anal canal.%目的:探讨生物补片内口封闭瘘道填塞术治疗肛瘘的临床疗效.方法:应用生物补片内口封闭瘘道填塞术治疗肛瘘.结果:本组13例患者均在病程中可见补片与组织相溶良好,部分补片逐渐降解吸收,外口逐渐愈合.经手术出院13例,其中痊愈10例,为低位肛瘘;显效1例,为低位复杂性肛瘘;有效1例,为高位复杂性肛瘘;无效1例,亦为高位复杂性肛瘘.结论:生物补片内口封闭瘘道填塞术在减轻患者疼痛,缩小创面,减少术后肛管缺损等方面具有显著优势.

  15. Cryptoglandular anal fistula.

    Science.gov (United States)

    de Parades, V; Zeitoun, J-D; Atienza, P

    2010-08-01

    Fistula arising from the glands of the anal crypts is the most common form of anoperineal sepsis. It is characterized by a primary internal orifice in the anal canal, a fistulous tract, and an abscess and/or secondary perineal orifice with purulent discharge. Antibiotics are not curative. The treatment of an abscess is urgent and consists, whenever possible, of incision and drainage under local anesthesia. Definitive treatment of the fistulous tract can await a second stage. The primary aim is to control infection without sacrificing anal continence. Fistulotomy is the basis for all treatments but the specific technique depends on the height of the fistula in relation to the sphincteric mechanism. Overall results of fistulotomy are excellent but there is some risk of anal incontinence. This explains the growing interest in sphincter sparing techniques such as the mucosal advancement flap, the injection of fibrin glue, and the plug procedure. However, results of these procedures are not yet good enough and leave much room for improvement.

  16. Open lateral internal anal sphincterotomy under local anesthesia as the gold standard in the treatment of chronic anal fissures: A prospective clinical and manometric study Esfinterotomía lateral interna abierta con anestesia local como gold standard en el tratamiento de la fisura anal crónica: Estudio prospectivo clínico y manométrico a largo plazo

    Directory of Open Access Journals (Sweden)

    A. Sánchez Romero

    2004-12-01

    Full Text Available Background: chronic anal fissure is one of the most frequent proctological disorders in Western populations. Open lateral internal sphincterotomy is one of the therapeutic options accepted as the treatment of choice for chronic anal fissure, since it reduces the hypertonia of the internal anal sphincter (the main etiopathogenic mechanism of fissures, decreases anal pain, and allows the fissure to heal. Material and methods: we carried out a prospective study of 120 patients operated on for chronic anal fissure with open sphincterotomy under local anesthesia at our Proctology Outpatient Unit from 1998 to 2001. No preoperative studies, bowel preparation, or antibiotic prophylaxis were carried out. All patients were followed up after 1 week, 2 months, 6 months, and 1 year, and underwent an anal manometry before and after surgery. Results: early complications: 3 hematoma-ecchymosis of the wound (2.5%, 3 self-limited hemorrhage events (2.5%. No hemorrhoidal thrombosis, fistulas, or perianal abscesses occurred. Fissures recurred in nine patients (7.5% within one year. The initial rate of incontinence of 7.5% at two months dropped down to 5% at six months. The mean resting pressure (MRP in incontinent patients was lower than in continent patients (55±7 mmHg versus 80.7 ± 21 mmHg. The difference in mean squeeze pressure (MSP between incontinent patients and continent patients was not statistically significant. Conclusions: open sphincterotomy under local anesthesia has a long-term rate of healing and a morbidity rate similar to other techniques. It may therefore be considered an effective treatment for chronic anal fissure.Introducción: la fisura anal crónica sigue siendo uno de los problemas proctológicos más frecuentes e incapacitantes en la población occidental actual. La esfinterotomía lateral interna abierta es una de las opciones terapéuticas descritas y aceptadas como tratamiento de elección de la fisura anal crónica, ya que reduce la

  17. 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

    DEFF Research Database (Denmark)

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

    2014-01-01

    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......-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...... 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...

  18. How the anal gland orifice could be found in anal abscess operations

    OpenAIRE

    Shahram Paydar; Ahmad Izadpanah; Leila Ghahramani; Seyed Vahid Hosseini; Alimohammad Bananzadeh; Salar Rahimikazerooni; Faranak Bahrami

    2015-01-01

    Background: On an average 30-50% of patients who undergo incision and drainage (I and D) of anal abscess will develop recurrence or fistula formation. It is claimed that finding the internal orifice of anal abscess to distract the corresponding anal gland duct; will decline the rate of future anal fistula. Surgeons supporting I and D alone claim that finding the internal opening is hazardous. This study is conducted to assess short-term results of optional method to manage patients with anal ...

  19. Sequential Acquisition of Anal Human Papillomavirus (HPV) Infection Following Genital Infection Among Men Who Have Sex With Women: The HPV Infection in Men (HIM) Study.

    Science.gov (United States)

    Pamnani, Shitaldas J; Nyitray, Alan G; Abrahamsen, Martha; Rollison, Dana E; Villa, Luisa L; Lazcano-Ponce, Eduardo; Huang, Yangxin; Borenstein, Amy; Giuliano, Anna R

    2016-10-15

    The purpose of this study was to assess the risk of sequential acquisition of anal human papillomavirus (HPV) infection following a type-specific genital HPV infection for the 9-valent vaccine HPV types and investigate factors associated with sequential infection among men who have sex with women (MSW). Genital and anal specimens were available for 1348 MSW participants, and HPV genotypes were detected using the Roche Linear Array assay. Sequential risk of anal HPV infection was assessed using hazard ratios (HRs) among men with prior genital infection, compared with men with no prior genital infection, in individual HPV type and grouped HPV analyses. In individual analyses, men with prior HPV 16 genital infections had a significantly higher risk of subsequent anal HPV 16 infections (HR, 4.63; 95% confidence interval [CI], 1.41-15.23). In grouped analyses, a significantly higher risk of sequential type-specific anal HPV infections was observed for any of the 9 types (adjusted HR, 2.80; 95% CI, 1.32-5.99), high-risk types (adjusted HR, 2.65; 95% CI, 1.26, 5.55), and low-risk types (adjusted HR, 5.89; 95% CI, 1.29, 27.01). MSW with prior genital HPV infections had a higher risk of a subsequent type-specific anal infection. The higher risk was not explained by sexual intercourse with female partners. Autoinoculation is a possible mechanism for the observed association. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  20. 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....

  1. 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....

  2. Incidence, Duration, Persistence, and Factors Associated With High-risk Anal Human Papillomavirus Persistence Among HIV-negative Men Who Have Sex With Men: A Multinational Study

    Science.gov (United States)

    Nyitray, Alan G.; Carvalho da Silva, Roberto J.; Chang, Mihyun; Baggio, Maria Luiza; Ingles, Donna J.; Abrahamsen, Martha; Papenfuss, Mary; Lin, Hui-Yi; Salmerón, Jorge; Quiterio, Manuel; Lazcano-Ponce, Eduardo; Villa, Luisa L.; Giuliano, Anna R.

    2016-01-01

    Background. Given high rates of anal disease, we investigated the natural history of high-risk anal human papillomavirus (HPV) among a multinational group of men who have sex with men (MSM) aged 18–64 years. Methods. Anal specimens from human immunodeficiency virus–negative men from Brazil, Mexico, and the United States were genotyped. Over 2 years, 406 MSM provided evaluable specimens every 6 months for ≥2 visits. These men were stratified into men who have sex only with men (MSOM, n = 70) and men who have sex with women and men (MSWM, n = 336). Persistence was defined as ≥12 months’ type-specific duration and could begin with either a prevalent or incident infection. Prevalence ratios and 95% confidence intervals were calculated by Poisson regression. Results. Median follow-up time was 2.1 years. Retention was 82%. Annual cumulative incidence of 9-valent vaccine types was 19% and 8% among MSOM and MSWM, respectively (log-rank P = .02). Duration of anal HPV did not differ for MSOM and MSWM and was a median of 6.9 months for HPV-16 after combining men from the 2 groups. Among men with prevalent high-risk infection (n = 106), a total of 36.8%, retained the infection for at least 24 months. For those with prevalent HPV-16 (n = 27), 29.6% were persistent for at least 24 months. Persistence of high-risk HPV was associated with number of male anal sex partners and inversely associated with number of female sex partners. Conclusions. MSM with prevalent high-risk HPV infection should be considered at increased risk for nontransient infection. PMID:26962079

  3. International human resources management challenges and changes

    CERN Document Server

    2015-01-01

    This book covers the issues related to human resource management (HRM) in an international context. It gives perspectives and future direction in International HRM research. The chapters explore the models, tools and processes used by international organizations in order to assist international managers to better face the challenges and changes in HRM. It is suitable to HR managers, engineers, entrepreneurs, practitioners, academics and researchers in the field.

  4. How the anal gland orifice could be found in anal abscess operations

    Directory of Open Access Journals (Sweden)

    Shahram Paydar

    2015-01-01

    Full Text Available Background: On an average 30-50% of patients who undergo incision and drainage (I and D of anal abscess will develop recurrence or fistula formation. It is claimed that finding the internal orifice of anal abscess to distract the corresponding anal gland duct; will decline the rate of future anal fistula. Surgeons supporting I and D alone claim that finding the internal opening is hazardous. This study is conducted to assess short-term results of optional method to manage patients with anal abscess and fitula-in-ano at the same time. Materials and Methods: In this cross-sectional descriptive study 49 from 77 patients with anal abscess whose internal orifice was not identified by pressing on the abscess, diluted hydrogen peroxide (2% and methylene blue was injected into the abscess cavity and the anal canal was inspected to find out the internal opening. Once the opening was distinguished, an incision was given from the anal verge to the internal opening. Results: The internal orifice was identified in 44 out of 49 patients (90% who underwent this new technique. Up to 18 months during follow-up, only 2.5% of patients with primary fistulotomy developed fistula on the site of a previous abscess. Conclusion: Conventional method to seek the internal orifice of anal abscesses is successful in about one-third of cases. By applying this new technique, surgeons would properly find the internal opening in >90% of patients. Needless to say, safe identification of the anal gland orifice in anal abscess disease best helps surgeons to do primary fistulotomy and in turn it would significantly decrease the rate of recurrence in anal abscess and fistula formation.

  5. Postpartum two‐ and three‐dimensional ultrasound evaluation of anal sphincter complex in women with obstetric anal sphincter injury

    National Research Council Canada - National Science Library

    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

    2017-01-01

    ...) in detecting residual defects after primary repair of obstetric anal sphincter injuries (OASIS). Methods External (EAS) and internal (IAS) anal sphincters were evaluated by the four ultrasound modalities in women with repaired OASIS...

  6. Bioethics and international human rights.

    Science.gov (United States)

    Thomasma, D C

    1997-01-01

    Noting how the spread of medical technology is creating clashes with traditional values and within cultures, the author addresses the clash between Western rights-based incentives, as used by the United Nations to guarantee respect for life and dignity, and communitarian traditions. He proposes a mean between wholesale cultural relativism and international absolutism.

  7. Current treatment options for management of anal intraepithelial neoplasia

    Directory of Open Access Journals (Sweden)

    Weis SE

    2013-06-01

    Full Text Available Stephen E Weis1,2 1Division of Dermatology, Department of Internal Medicine, University of North Texas Health Science Center at Fort Worth, 2Preventive Medicine Clinic, Tarrant County Public Health, Fort Worth, TX, USA Abstract: Anal squamous cell cancer is an uncommon malignancy caused by infection with oncogenic strains of Human papilloma virus. Anal cancer is much more common in immunocompromised persons, including those infected with Human immunodeficiency virus. High-grade anal intraepithelial neoplasia (HGAIN, the precursor of anal cancer, is identified by clinicians providing care for patients with anorectal disease, and is increasingly being identified during screening of immunosuppressed patients for anal dysplasia. The traditional treatment for HGAIN has been excision of macroscopic disease with margins. This approach is effective for patients with small unifocal HGAIN lesions. Patients with extensive multifocal HGAIN frequently have recurrence of HGAIN after excision, and may have postoperative complications of anal stenosis or fecal incontinence. This led to the suggestion by some that treatment for HGAIN should be delayed until patients developed anal cancer. Alternative approaches in identification and treatment have been developed to treat patients with multifocal or extensive HGAIN lesions. High-resolution anoscopy combines magnification with anoscopy and is being used to identify HGAIN and determine treatment margins. HGAIN can then be ablated with a number of modalities, including infrared coagulation, CO2 laser, and electrocautery. These methods for HGAIN ablation can be performed with local anesthesia on outpatients and are relatively well tolerated. High-resolution anoscopy-directed HGAIN ablation is evolving into a standard approach for initial treatment and then subsequent monitoring of a disease which should be expected to be recurrent. Another treatment approach for HGAIN is topical treatment, principally with 5

  8. International Perspective on Teaching Human Sexuality

    Science.gov (United States)

    Wylie, Kevan; Weerakoon, Patricia

    2010-01-01

    Objective: The authors outline international training programs in human sexuality. Methods: The authors reviewed the international literature and Internet resources to identify key training opportunities and curricula, with particular emphasis on training opportunities for psychiatrists. Results: The authors outline key resources and training…

  9. Uso de imiquimode tópico no tratamento da infecção anal pelo papilomavírus humano The use of topic imiquimod in the treatment of the anal infection by human papillomavirus

    Directory of Open Access Journals (Sweden)

    Carmen Ruth Manzione

    2010-03-01

    Full Text Available Dos diversos tratamentos da infecção anal pelo papilomavírus humano, uma opção é o imunomodulador imiquimode. Derivado da família imidazoquinolina, o imiquimode é quimioterápico e imuno-estimulante com atividade antitumoral e antiviral. A medicação é aplicada em esquema domiciliar, três vezes por semana em noites alternadas, por oito a 16 semanas. Os efeitos adversos locais são comuns, mas bem tolerados. A droga atinge remissão de 74 a 84%, sendo completa entre 25 e 77% dos doentes, com menor taxa de remissão completa e maior índice de recidiva em imunodeprimidos. Aguardamos estudos com grandes casuísticas para avaliar melhor a eficácia dessa medicação, incluindo a incidência de recidivas e o tempo livre de novas lesões.Considering several kinds of treatments for human papillomavirus anal infection, the topical immune response modifier imiquimod is an option. An imidazoquinoline derivate, imiquimod is a chemotherapic drug and an immune stimulator with antitumoral and antiviral action. The medication is used at home, by patients, three times a week, in alternated nights, for eight to 16 weeks. Side-effects are common, but well tolerated. This drug reaches from 74 to 84% of remission, although from 25 to 77% are complete. There are lower complete remission and higher recurrence in immune compromised patients. Studies with more patients for better evaluation of this medication efficiency are needed, including those about recurrences and time free from new lesions.

  10. Anal squamous intraepithelial neoplasia.

    Science.gov (United States)

    Bejarano, Pablo A; Boutros, Marylise; Berho, Mariana

    2013-12-01

    Diagnosis, follow up, and treatment of anal intraepithelial neoplasia are complex and not standardized. This may be partly caused by poor communication of biopsy and cytology findings between pathologists and clinicians as a result of a disparate and confusing terminology used to classify these lesions. This article focuses on general aspects of epidemiology and on clarifying the current terminology of intraepithelial squamous neoplasia, its relationship with human papilloma virus infection, and the current methods that exist to diagnose and treat this condition. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Risk Factors for Anal HPV Infection and Anal Precancer in HIV-Infected Men Who Have Sex With Men

    OpenAIRE

    Schwartz, Lauren M.; Castle, Philip E.; Follansbee, Stephen; Borgonovo, Sylvia; Fetterman, Barbara; Tokugawa, Diane; Lorey, Thomas S.; Sahasrabuddhe, Vikrant V.; Luhn, Patricia; Gage, Julia C; Darragh, Teresa M.; Wentzensen, Nicolas

    2013-01-01

    Background. Carcinogenic human papillomaviruses (HPVs) cause a large proportion of anal cancers. Human immunodeficiency virus (HIV)–infected men who have sex with men (MSM) are at increased risk of HPV infection and anal cancer compared with HIV-negative men. We evaluated risk factors for HPV infection and anal precancer in a population of HIV-infected MSM.

  12. Human dignity according to international instruments on human rights

    Directory of Open Access Journals (Sweden)

    José Pablo Alzina de Aguilar

    2011-01-01

    Full Text Available According to international instruments on human rights, the dignity of the human person is the foundation of human rights, and both human dignity and human rights are inherent to the human being, universal and inviolable. This understanding of human dignity is not a fruitless truism, but the solid foundation on which to build a world community under the rule of the new ius gentium: the International Law for Humankind. Moreover, it is the clue to answer many questions raised by the new world of globalization and of the exponential growth of international rules.Consequently, there is a need to a common doctrine on a notion of human dignity which will allow the implementation and adjudication of the aforementioned instruments, at the service of the human person and in conformity with the juridical conscience which they reflect. Philosophy of Law concepts which can be traced back to Aristotle provide that notion. According to these concepts, the demanding nature of “human dignity” sustains the notion of “legal personhood”, and both notions pertain to the realm of Law and Right, not of Morale and Values. Thus, human dignity and human rights are and must be, respectively, a basic principle and a necessary part of any Law system, including international law

  13. Anal human papillomavirus infection prevalence in men who have sex with men is age-independent: a role for recent sexual behavior?

    Science.gov (United States)

    Donà, Maria Gabriella; Latini, Alessandra; Benevolo, Maria; Moretto, Domenico; Cristaudo, Antonio; Giuliani, Massimo

    2014-01-01

    Considering that data available on age-specific prevalence of anal human papillomavirus (HPV) infection among men who have sex with men (MSM) are limited and conflicting, we aimed to assess the age-related trend of this infection in HIV-uninfected MSM. Anal samples, collected using a Dacron swab, were analyzed by the Linear Array HPV Genotyping Test (Roche Diagnostics, Milan, Italy). Among the 408 males enrolled, HPV prevalence was 72.8% and did not significantly change across ages both for any (p = 0.506) and high-risk genotypes (p = 0.588). HPV prevalence by age group did not vary also after adjusting for median number and median age of recent partners. Among urban MSM at risk for sexually transmitted infections, this stability in anal HPV prevalence across all ages may be driven by multiple partnerships in association with sexual mixing across all age groups. Interventions to increase awareness of lifetime HPV risk and willingness to adopt preventive measures may reduce HPV-associated health burden in MSM.

  14. Introducing the operation method for curing anal fistula by laser

    Science.gov (United States)

    Ji, Bingzhi

    1993-03-01

    The key to the treatment of anal fistula lies in scavenging the infected anal gland thoroughly, which is the source of anal fistula infection. The fistula tract at the internal orifice of the anal fistula is cut 1 cm using laser with the infectious source completely degenerated and the wound gassified and scanned. The residual distal fistula softens and disappears upon the action of organic fibrinolysin.

  15. Anal Abscess/Fistula

    Science.gov (United States)

    ... to determine if antibiotics are indicated. TREATMENT OF ANAL FISTULA Currently, there is no medical treatment available for ... surgery is almost always necessary to cure an anal fistula. If the fistula is straightforward (involving minimal sphincter ...

  16. Anal fissure - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100154.htm Anal fissure - series—Normal anatomy To use the sharing ... rectum through which passes stool during defecation. The anal sphincter is a critical mechanism for control of ...

  17. Anal and Rectal Disorders

    Science.gov (United States)

    ... switch to the Professional version Home Digestive Disorders Anal and Rectal Disorders Overview of the Anus and ... This Article Medical Dictionary Also of Interest (Quiz) Anal Fissure (Video) Overview of Celiac Disease (News) Another ...

  18. Anal dysplasia screening: an evidence-based analysis.

    Science.gov (United States)

    2007-01-01

    This review considered the role of the anal Pap test as a screening test for anal dysplasia in patients at high risk of anal SCC. The screening process is now thought to be improved with the addition of testing for the human papillomavirus (HPV) in high-risk populations. High-resolution anoscopy (a method to view the rectal area, using an anoscope, a lighted instrument inserted into the rectum) rather than routine anoscopy-guided biopsy, is also now considered to be the diagnostic standard. TARGET POPULATION AND CONDITION Anal cancer, like cervical cancer, is a member of a broader group of anogenital cancers known to be associated with sexually transmitted viral HPV infection. Human papillomavirus is extremely prevalent, particularly in young, sexually active populations. Sexual practices involving receptive anal intercourse lead to significantly elevated risk for anal dysplasia and cancer, particularly in those with immune dysfunctions. Anal cancer is rare. It occurs at a rate of about 1 to 2 per 100,000 in the general population. It is the least common of the lower gastrointestinal cancers, representing about 4% of them, in contrast to colorectal cancers, which remain the third most commonly diagnosed malignancy. Certain segments of the population, however, such as HIV-positive men and women, other chronic immune-suppressed patients (e.g., after a transplant), injection drug users, and women with genital dysplasia /cancer, have a high susceptibility to anal cancer. Those with the highest identified risk for anal cancer are HIV-positive homosexual and bisexual men, at a rate of 70 per 100,000 men. The risk for anal cancer is reported to be increasing dramatically in HIV-positive males and females, particularly since the introduction of highly active antiretroviral therapy in the mid-1990s. The introduction of effective viral therapy has been said to have transformed the AIDS epidemic in developed countries into a chronic disease state of long

  19. Anal Health Care Basics

    Science.gov (United States)

    Chang, Jason; McLemore, Elisabeth; Tejirian, Talar

    2016-01-01

    Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy. The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate. Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area. Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases. In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists. PMID:27723447

  20. Anal Health Care Basics.

    Science.gov (United States)

    Chang, Jason; Mclemore, Elisabeth; Tejirian, Talar

    2016-01-01

    Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate.Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area.Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases.In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists.

  1. Human genetics: international projects and personalized medicine.

    Science.gov (United States)

    Apellaniz-Ruiz, Maria; Gallego, Cristina; Ruiz-Pinto, Sara; Carracedo, Angel; Rodríguez-Antona, Cristina

    2016-03-01

    In this article, we present the progress driven by the recent technological advances and new revolutionary massive sequencing technologies in the field of human genetics. We discuss this knowledge in relation with drug response prediction, from the germline genetic variation compiled in the 1000 Genomes Project or in the Genotype-Tissue Expression project, to the phenome-genome archives, the international cancer projects, such as The Cancer Genome Atlas or the International Cancer Genome Consortium, and the epigenetic variation and its influence in gene expression, including the regulation of drug metabolism. This review is based on the lectures presented by the speakers of the Symposium "Human Genetics: International Projects & New Technologies" from the VII Conference of the Spanish Pharmacogenetics and Pharmacogenomics Society, held on the 20th and 21st of April 2015.

  2. Human Insecurity: Understanding International Migration from A Human Security Perspective

    Directory of Open Access Journals (Sweden)

    Francesca Vietti

    2013-07-01

    Full Text Available This article examines contemporary, mass migration from the perspective of human security. It tracks the development of the human security model of international relations, and compares it to the well-established state security model that has served as the dominant paradigm for international relations since the seventeenth century. The article argues that human security offers a more effective approach to many of the underlying problems and threats associated with mass migration, than does the traditional state-security model.  It challenges national and international authorities to address threats to human security, in order to minimize forced migration and to create the conditions for migration by choice, not necessity.

  3. Prevalence of Anal HPV and Anal Dysplasia in HIV-Infected Women From Johannesburg, South Africa.

    Science.gov (United States)

    Goeieman, Bridgette J; Firnhaber, Cynthia S; Jong, Eefje; Michelow, Pam; Kegorilwe, Patricia; Swarts, Avril; Williamson, Anna-Lise; Allan, Bruce; Smith, Jennifer S; Wilkin, Timothy J

    2017-07-01

    Anal cancer is a relatively common cancer among HIV-infected populations. There are limited data on the prevalence of anal high-risk human papillomavirus (HR-HPV) infection and anal dysplasia in HIV-infected women from resource-constrained settings. A cross-sectional study of HIV-infected women aged 25-65 years recruited from an HIV clinic in Johannesburg, South Africa. Cervical and anal swabs were taken for conventional cytology and HR-HPV testing. Women with abnormal anal cytology and 20% of women with negative cytology were seen for high-resolution anoscopy with biopsy of visible lesions. Two hundred women were enrolled. Anal HR-HPV was found in 43%. The anal cytology results were negative in 51 (26%); 97 (49%) had low-grade squamous intraepithelial lesions (SIL), 32 (16%) had atypical squamous cells of unknown significance, and 19 (9.5%) had high-grade SIL or atypical squamous cells suggestive of high-grade SIL. On high-resolution anoscopy, 71 (36%) had atypia or low-grade SIL on anal histology and 17 (8.5%) had high-grade SIL. Overall, 31 (17.5%) had high-grade SIL present on anal cytology or histology. Abnormal cervical cytology was found in 70% and cervical HR-HPV in 41%. We found a significant burden of anal HR-HPV infection, abnormal anal cytology, and high-grade SIL in our cohort. This is the first study of the prevalence of anal dysplasia in HIV-infected women from sub-Saharan Africa. Additional studies are needed to define the epidemiology of these conditions, as well as the incidence of anal cancer, in this population.

  4. Development of a three-dimensional physiological model of the internal anal sphincter bioengineered in vitro from isolated smooth muscle cells.

    Science.gov (United States)

    Hecker, Louise; Baar, Keith; Dennis, Robert G; Bitar, Khalil N

    2005-08-01

    Fecal incontinence affects people of all ages and social backgrounds and can have devastating psychological and economic consequences. This disorder is largely attributed to decreased mechanical efficiency of the internal anal sphincter (IAS), yet little is known about the pathophysiological mechanisms responsible for the malfunction of sphincteric smooth muscle at the cellular level. The object of this study was to develop a three-dimensional (3-D) physiological model of the IAS bioengineered in vitro from isolated smooth muscle cells. Smooth muscle cells isolated from the IAS of rabbits were seeded in culture on top of a loose fibrin gel, where they migrated and self-assembled in circumferential alignment. As the cells proliferated, the fibrin gel contracted around a 5-mm-diameter SYLGARD mold, resulting in a 3-D cylindrical ring of sphincteric tissue. We found that 1) the bioengineered IAS rings generated a spontaneous basal tone, 2) stimulation with 8-bromo-cAMP (8-Br-cAMP) caused a sustained decrease in the basal tone (relaxation) that was calcium-independent, 3) upon stimulation with ACh, bioengineered IAS rings showed a calcium- and concentration-dependent peak contraction at 30 s that was sustained for 4 min, 4) addition of 8-Br-cAMP induced rapid relaxation of ACh-induced contraction and force generation of IAS rings, and 5) bioengineered sphincter rings show striking functional differences when compared with bioengineered rings made from isolated colonic smooth muscle cells. This is the first report of a 3-D in vitro model of a gastrointestinal smooth muscle IAS. Bioengineered IAS rings demonstrate physiological functionality and may be used in the elucidation of the mechanisms causing sphincter malfunction.

  5. [Pay attention to the imaging diagnosis of complex anal fistula].

    Science.gov (United States)

    Zhou, Zhiyang

    2015-12-01

    The diagnosis and treatment of complex anal fistula has been a significant challenge. Unwise incision and excessive exploration will lead to the secondary branch, sinus and perforation. A simple fistula may become a surgical problem and result in disastrous consequences. Preoperative accurate diagnosis of anal fistula, including in the internal opening, primary track and location of the fistula, extensions and abscess, is important for anal fistula treatment. In the diagnosis of anal fistula, imaging examination, especially MRI plays a crucial role. Localization and demarcation of anal fistula and the relationship with sphincter are important. MRI has been an indispensable confirmatory imaging examination.

  6. Anal verrucous carcinoma is not related to infection with human papillomaviruses and should be distinguished from giant condyloma (Buschke-Löwenstein tumour).

    Science.gov (United States)

    Zidar, Nina; Langner, Cord; Odar, Katarina; Hošnjak, Lea; Kamarádová, Kateřina; Daum, Ondrej; Pollheimer, Marion J; Košorok, Pavle; Poljak, Mario

    2017-05-01

    Verrucous carcinoma (VC) is a variant of well-differentiated squamous cell carcinoma and in the anal region is regarded as synonymous with giant condyloma (Buschke-Löwenstein tumour) (BLT). Aetiology, diagnostic criteria and clinical behaviour of both lesions are controversial. Recent studies suggest that VC at other sites is not associated with human papillomaviruses (HPV). We hypothesized that anal VC is also not related to HPV, while BLT is a HPV-induced lesion. Ten cases of VC and four cases of BLT were included. Several techniques were used for HPV detection: in-situ hybridization for HPV6, 11, 16 and 18, six different polymerase chain reaction (PCR) protocols for detection of at least 89 HPV types from alpha-, beta-, gamma- and mu-PV genera and in-situ hybridization for high-risk HPV E6/E7 mRNA; p16 immunohistochemistry and morphometric analysis were also performed. Alpha-, gamma- and mu-PVs were not found in any case of VC, while HPV6 was detected in all cases of BLT. p16 overexpression was not present in any of the lesions. Among microscopic features, only the absence of koilocytosis and enlarged spinous cells seem to be useful to distinguish VC from BLT. Our results suggest that anal VC, similarly to VC at other sites, is not associated with HPV infection, and must be distinguished from BLT, which is associated with low-risk HPV. Only with well-set diagnostic criteria will it be possible to ascertain clinical behaviour and optimal treatment for both lesions. © 2016 John Wiley & Sons Ltd.

  7. Anal human papillomavirus in HIV-uninfected men who have sex with men: incidence and clearance rates, duration of infection, and risk factors.

    Science.gov (United States)

    Donà, M G; Vescio, M F; Latini, A; Giglio, A; Moretto, D; Frasca, M; Benevolo, M; Rollo, F; Colafigli, M; Cristaudo, A; Giuliani, M

    2016-12-01

    Little is known regarding the natural history of anal human papillomavirus (HPV) infection. We aimed to evaluate incidence and clearance rates, their risk factors, and duration of anal HPV infection in HIV-uninfected men who have sex with men (MSM). A longitudinal study was conducted. Anal samples were analysed using the Linear Array HPV Genotyping test. Incidence and clearance rates, and corresponding risk factors, were estimated using a two-state Markov model. Overall, 155 MSM (median age 33.4 years) attending the largest sexually transmitted infection (STI) centre in Rome, Italy, were followed for a median of 12.2 months (Q1-Q3: 7.0-18.1). Incidence and clearance rates for any HPV were 85.6 (95% CI: 58.4-125.4) and 35.6 (95% CI: 24.7-51.5) × 1000 person-months, respectively; the median duration of infection was 9.4 months (Q1-Q3: 7.5-12.1). Receptive anal sex emerged as the only risk factor for the acquisition of any HPV (Hazard Ratio, HR = 2.65, 95% CI: 1.16-6.06). The incidence rates for carcinogenic and non-carcinogenic types were 42.3 (95% CI: 29.2-61.4) and 29.2 (95% CI: 19.5-43.7) × 1000 person-months, respectively (p = 0.13); their clearance rates were 62.9 (95% CI: 45.1-87.7) and 65.7 (95% CI: 47.4-91.0) × 1000 person-months, respectively (p = 0.83). HPV16 showed the lowest clearance rate among carcinogenic types (59.7 × 1000 person-months), and a duration of infection of 16.8 months. In conclusion, a higher incidence rate was observed for carcinogenic compared to non-carcinogenic HPV types, although the difference was not significant. HPV16 emerged as the type with the longest duration of infection and the lowest clearance rate among carcinogenic types.

  8. New techniques for treating an anal fistula.

    Science.gov (United States)

    Song, Kee Ho

    2012-02-01

    Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing. Another addition to the sphincter-preserving options is the ligation of intersphincteric fistula tract procedure. This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane. Recently, cell therapy for an anal fistula has been described. Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential. These properties are useful for the regeneration or the repair of damaged tissues. This article discusses the rationales for, the estimated efficacies of, and the limitations of new sphincter-preserving techniques for the treatment of anal fistulae.

  9. New Techniques for Treating an Anal Fistula

    Science.gov (United States)

    2012-01-01

    Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing. Another addition to the sphincter-preserving options is the ligation of intersphincteric fistula tract procedure. This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane. Recently, cell therapy for an anal fistula has been described. Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential. These properties are useful for the regeneration or the repair of damaged tissues. This article discusses the rationales for, the estimated efficacies of, and the limitations of new sphincter-preserving techniques for the treatment of anal fistulae. PMID:22413076

  10. Anal abscess and fistula.

    Science.gov (United States)

    Sneider, Erica B; Maykel, Justin A

    2013-12-01

    Benign anorectal diseases, such as anal abscesses and fistula, are commonly seen by primary care physicians, gastroenterologists, emergency physicians, general surgeons, and colorectal surgeons. It is important to have a thorough understanding of the complexity of these 2 disease processes so as to provide appropriate and timely treatment. We review the pathophysiology, presentation, diagnosis, and treatment options for both anal abscesses and fistulas.

  11. International Space Station Research Benefits for Humanity

    Science.gov (United States)

    Thumm, Tracy; Robinson, Julie A.; Johnson-Green, Perry; Buckley, Nicole; Karabadzhak, George; Nakamura, Tai; Kamigaichi, Shigeki; Sorokin, Igor V.; Zell, Martin; Fuglesang, Christer; Sabbagh, Jean; Pignataro, Salvatore

    2012-01-01

    The ISS partnership has seen a substantial increase in research accomplished, crew efforts devoted to research, and results of ongoing research and technology development. The ISS laboratory is providing a unique environment for research and international collaboration that benefits humankind. Benefits come from the engineering development, the international partnership, and from the research results. Benefits can be of three different types: scientific discovery, applications to life on Earth, and applications to future exploration. Working across all ISS partners, we identified key themes where the activities on the ISS improve the lives of people on Earth -- not only within the partner nations, but also in other nations of the world. Three major themes of benefits to life on earth emerged from our review: benefits to human health, education, and Earth observation and disaster response. Other themes are growing as use of the ISS continues. Benefits to human health range from advancements in surgical technology, improved telemedicine, and new treatments for disease. Earth observations from the ISS provide a wide range of observations that include: marine vessel tracking, disaster monitoring and climate change. The ISS participates in a number of educational activities aimed to inspire students of all ages to learn about science, technology, engineering and mathematics. To date over 63 countries have directly participated in some aspect of ISS research or education. In summarizing these benefits and accomplishments, ISS partners are also identifying ways to further extend the benefits to people in developing countries for the benefits of humankind.

  12. International Space Station Benefits for Humanity

    Science.gov (United States)

    Thumm, Tracy L.; Robinson, Julie A.; Buckley, Nicole; Johnson-Green, Perry; Kamigaichi, Shigeki; Karabadzhak, George; Nakamura, Tai; Sabbagh, Jean; Sorokin, Igor; Zell, Martin

    2012-01-01

    The ISS partnership has seen a substantial increase in research accomplished, crew efforts devoted to research, and results of ongoing research and technology development. The ISS laboratory is providing a unique environment for research and international collaboration that benefits humankind. Benefits come from the engineering development, the international partnership, and from the research results. Benefits can be of three different types: scientific discovery, applications to life on Earth, and applications to future exploration. Working across all ISS partners, we identified key themes where the activities on the ISS improve the lives of people on Earth--not only within the partner nations, but also in other nations of the world. Three major themes of benefits to life on earth emerged from our review: benefits to human health, education, and Earth observation and disaster response. Other themes are growing as use of the ISS continues. Benefits to human health range from advancements in surgical technology, improved telemedicine, and new treatments for disease. Earth observations from the ISS provide a wide range of observations that include: marine vessel tracking, disaster monitoring and climate change. The ISS participates in a number of educational activities aimed to inspire students of all ages to learn about science, technology, engineering and mathematics. To date over 63 countries have directly participated in some aspect of ISS research or education. In summarizing these benefits and accomplishments, ISS partners are also identifying ways to further extend the benefits to people in developing countries for the benefits of humankind.

  13. Human papillomavirus mRNA testing for the detection of anal high-grade squamous intraepithelial lesions in men who have sex with men infected with HIV.

    Science.gov (United States)

    Sendagorta, Elena; Romero, Maria P; Bernardino, Jose I; Beato, María J; Alvarez-Gallego, Mario; Herranz, Pedro

    2015-08-01

    Currently, screening for anal high-grade squamous intraepithelial lesions (anal HSIL) relies on anal cytology and high-resolution anoscopy. Since this approach has limited sensitivity and specificity for detecting anal HSIL, there is increasing interest in the role of biomarkers for predicting anal HSIL. The aim of this study is to evaluate the diagnostic accuracy of HPV E6/E7-mRNA expression for the detection of anal HSIL in MSM infected with HIV, in comparison to DNA-HR-HPV and anal cytology. This cross-sectional screening study included 101 MSM followed at the HIV-unit of La Paz University Hospital. Intra-anal swabs from patients participating in a screening program including cytology, high-resolution anoscopy and histology were analyzed. HR-HPV-DNA detection was performed by means of the CLART® HPV2 assay (GENOMICA S.A.U., Madrid, Spain). E6/E7-mRNA detection of HR-HPV-types 16, 18, 31, 33, and 45 was performed using the NucliSENS-EasyQ assay (BioMérieux, Marcy ĺEtoile, France). HR-HPV DNA and HPVE6/E7 mRNA were detected in 82% and 57% of the anal smears respectively. Anal cytology screening was abnormal in 70.3%. For the detection of HSIL sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 71.7%, 55.6%, 57.9%, and 69.8% for E6/E7-mRNA testing, respectively, compared to 100%, 31.5%, 55.4%, and 100% for HR-HPV-DNA testing and to 83%, 40.7%, 54.9%, 73.3% of cytology testing. In comparison with the other tests, HPVE6/E7 mRNA testing yielded a lower clinical sensitivity but a higher clinical specificity and PPV for the detection of anal HSIL in MSM infected with HIV.

  14. Anal cancer; Cancer du canal anal

    Energy Technology Data Exchange (ETDEWEB)

    Fesneau, M.; Champeaux-Orange, E. [Service de radiotherapie, Centre regional universitaire de cancerologie Henry-S.-Kaplan CHU de Tours, Hopital Bretonneau, 37 - Tours (France); Champeaux-Orange, E. [Service d' oncologie-radiotherapie, Centre hospitalier regional d' Orleans, 45 - Orleans (France); Hennequin, C. [Service de cancerologie-radiotherapie, hopital Saint-Louis, 75 - Paris (France)

    2010-07-01

    Anal canal epidermoid carcinomas represent 1.2% of digestive cancers and 6% of ano-rectal cancers. For localized diseases, the treatment is based on radiotherapy with or without chemotherapy (5-FU and cisplatin or mitomycin), according to tumour and nodal extension. The recommended treatment dose is 45 Gy in the anal canal, the mesorectum, para-rectal lymph nodes, and inguinal lymph nodes. An additional dose of 15 to 20 Gy is delivered in the initial tumour for good responders. Salvage surgery is necessary in case of poor response. The organs at risk to be considered are bladder, femur heads, small intestine and vulva. The objective of this work is to summarize the epidemiological and radio-anatomic and prognostic characteristics of this tumour. The conformal radiotherapy technique is illustrated by a case report. (authors)

  15. Survey of anal sphincter dysfunction using anal manometry in patients with fecal incontinence: a possible guide to therapy

    Science.gov (United States)

    Mandaliya, Rohan; DiMarino, Anthony J.; Moleski, Stephanie; Rattan, Satish; Cohen, Sidney

    2015-01-01

    Background Despite the surge of new medical and surgical approaches to treat fecal incontinence, the types of sphincter abnormalities in patients with incontinence have not been well characterized. We aimed to categorize anal sphincter dysfunction using anorectal manometry in patients with fecal incontinence as a potential guide for improved treatment. Methods A retrospective review of 162 consecutive patients with fecal incontinence referred for anorectal manometry was performed. Resting anal pressure and maximal squeeze pressure were considered as measures of internal anal sphincter and external anal sphincter function respectively. Results Mean age of the patients was 63 years (13-89); females (81.5%) and males (18.5%). 74% of the patients had sphincter dysfunction on anorectal manometry. Internal anal sphincter dysfunction was present in 62% patients vs. external anal sphincter dysfunction present in 44% patients. 80% females had abnormal manometry vs. 44% in males (P<0.0001). Internal anal sphincter dysfunction was present in 68% females vs. 37% in males (P=0.0026). Conclusions Overall, abnormal anorectal manometry studies revealed that internal anal sphincter dysfunction is the most common finding, alone or in combination with external anal sphincter dysfunction. We suggest that anorectal manometry may be important to delineate anal sphincter function prior to using newer therapeutic mechanical devices. Future studies using pharmacological agents to increase internal anal sphincter tone may be of clinical importance. Finally, the classification of fecal incontinence based on the type of sphincter dysfunction may be an improved guide in the selection of newer agents in treating fecal incontinence. PMID:26423466

  16. The Role of Polymerase Chain Reaction of High-Risk Human Papilloma Virus in the Screening of High-Grade Squamous Intraepithelial Lesions in the Anal Mucosa of Human Immunodeficiency Virus-Positive Males Having Sex with Males

    OpenAIRE

    Carmen Hidalgo-Tenorio; Mar Rivero-Rodriguez; Concepción Gil-Anguita; Javier Esquivias; Rodrigo López-Castro; Jessica Ramírez-Taboada; Mercedes López de Hierro; Miguel A López-Ruiz; R Javier Martínez; Llaño, Juan P.

    2015-01-01

    Objectives To evaluate the advantages of cytology and PCR of high-risk human papilloma virus (PCR HR-HPV) infection in biopsy-derived diagnosis of high-grade squamous intraepithelial lesions (HSIL = AIN2/AIN3) in HIV-positive men having sex with men (MSM). Methods This is a single-centered study conducted between May 2010 and May 2014 in patients (n = 201, mean age 37 years) recruited from our outpatient clinic. Samples of anal canal mucosa were taken into liquid medium for PCR HPV analysis a...

  17. International criminal tribunals and human rights law: Adherence and contextualization

    NARCIS (Netherlands)

    Zeegers, K.J.

    2015-01-01

    Given their mandate to prosecute persons responsible for the most atrocious of human rights violations, International Criminal Tribunals (ICTs) are generally hailed as welcome enforcers of international human rights law: a new instrument in the toolkit of human rights protectors. However, ICTs inves

  18. Human Rights, Human Needs, Human Development, Human Security - Relationships between four international human discourses.

    NARCIS (Netherlands)

    D.R. Gasper (Des)

    2007-01-01

    markdownabstractAbstract: Human rights, human development and human security form increasingly important, partly interconnected, partly competitive and misunderstood ethical and policy discourses. Each tries to humanize a pre-existing and unavoidable major discourse of everyday life, policy and

  19. KRONİK ANAL FİSSÜR OLGULARINDA CERRAHİ TEDAVİ

    OpenAIRE

    ERSAN, Yılmaz; YAVUZ, Nihat; KUŞASLAN, Ramazan; ÇİÇEK, YUSUF; ERGÜNEY, Sabri

    2014-01-01

    Background.- Chronic anal fissure (Chronic fissure in ano) is a longitudinal or pear-shaped defect of the anal canal mucosa extending usually from the dentate line to the external verge of the anal canal. Circular fibers of the internal anal sphincter are visible on the floor of the fissure and secondary changes; such as a sentinel tag, hypertrophied anal papilla and a degree of anal stenosis frequently accompany chronic fissures. A fissure in ano may occur at any age, but is most common betw...

  20. 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

  1. Toward a Human Rights Method for Measuring International Copyright Law’s Compliance with International Human Rights Law

    Directory of Open Access Journals (Sweden)

    Saleh Al-Sharieh

    2016-04-01

    Full Text Available States parties to international copyright instruments are required to give effect to their obligations under international copyright law and fulfil their international human rights obligations with respect to striking a balance between the human rights of the authors of intellectual works and human rights of the users of those same works. The High Commissioner of Human Rights has concluded that such balance ‘is one familiar to intellectual property law’. This conclusion assumes that international copyright law is already compliant with international human rights law. However, international copyright law instruments are not clear about how to reach an appropriate balance between these rights and, as a result, different stakeholders in the international copyright community seek and defend varied versions of balance which are not necessarily consistent. Concurrently, international human rights law bodies and scholars have examined the human rights of authors and users of intellectual works through a copyright law lens, missing a chance to articulate a clear human rights principle of balance. A proper human rights balance between authors’ and users’ human rights recognises the limited nature of both sets of human rights, rejects any hierarchy between them, and interprets them in conformity with the notion of the interdependence and indivisibility of human rights.

  2. Association of cytologic grade of anal "Pap" smears with viral loads of human papillomavirus types 16, 18, and 52 detected in the same specimens from men who have sex with men.

    Science.gov (United States)

    Utaipat, Utaiwan; Siriaunkgul, Sumalee; Supindham, Taweewat; Saokhieo, Pongpun; Chaidaeng, Butsayarat; Wongthanee, Antika; Settakorn, Jongkolnee; Sukpan, Kornkanok; Ruanpeng, Darin; Kosashunhanan, Natthapol; Chotirosniramit, Nuntisa; Sugandhavesa, Patcharaphan; Miura, Toshiyuki; Chariyalertsak, Suwat

    2016-12-01

    Human papilloma virus (HPV) load has been linked to cellular abnormalities of the uterine cervix, and proposed as predictors of HPV persistence and progression of dysplasia to cervical cancer. However, the association of HPV viral load and anal dysplasia and cancer has not been as thoroughly investigated. To examine the association of the viral loads of high-risk HPV types 16, 18, and 52, with the cytologic severity grading in anal-swab specimens of MSM with and without HIV-1 co-infection. A cross-sectional study recruited 200 MSM in northern Thailand from July 2012 to January 2013. Real-time qPCR amplified portion of the HPV E6E7 gene, as well as the human β-globin gene to validate adequacy of the anal specimens and to normalize interpatient viral-load comparisons. Genotyping by linear-array assay identified and distinguished types 16, 18, and 52. HPV-16, and -18 viral loads increased with respect to the abnormality of the cytologic diagnoses (panal cells, and HPV-18 loads ≥10(3.15), were independently associated with abnormal cytology on logistic regression (p=0.022, p=0.041, respectively). Positive predictive values were 85.2% (23/27) and 80.0% (44/55) for the high viral load of a particular HPV-16 and the combined HPV-16, -18 and -52 types, respectively. High viral loads of HPV types 16 and 18 appear to be associated with anal cytologic abnormalities. The clinical utility of HPV viral loads to predict risk for anal cancer remains to be determined by a larger prospective cohort with sufficient frequency of high-grade dysplasia. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. International human resource management and organizational learning

    Directory of Open Access Journals (Sweden)

    Bogićević-Milikić Biljana

    2005-01-01

    Full Text Available Global companies are pressed by the need to simultaneously manage globally since they consider the whole world as their own market, and locally, because the global market consists of various different and weakly connected market segments. The need to be global and local at the same time presents, perhaps the most important challenge for management of global companies in 21st century. Searching this balance presents also an important challenge for human resource management (HRM, regarding the ways of accomplishing it. HRM is expected to contribute to achievement of global competitive advantage worldwide efficiency, local responsiveness, as well as transfer of learning within global organizations. The transfer of learning gains on its importance as many authors see it as the main motive of establishing global companies. However, regardless of recognized significance of organizational learning for global companies, international HRM literature simply lacks studies related to transfer of learning, recommendations about how to develop this organizational ability, how to improve it and measure, and how to provide permanency of the learning process. Therefore, the aim of this paper is through reviewing the relevant literature, to shed light on different aspects of the responsiveness-integration paradigm and its implications on the transfer of learning in global companies.

  4. Video-assisted anal fistula treatment: a new concept of treating anal fistulas.

    Science.gov (United States)

    Meinero, Piercarlo; Mori, Lorenzo; Gasloli, Giorgio

    2014-03-01

    The surgical treatment of complex anal fistulas is very challenging because of the incidence of incontinence and recurrence after traditional approaches. Video-assisted anal fistula treatment is a novel endoscopic sphincter-saving technique. The aim of this article is to evaluate the results of treating complex anal fistulas from the inside and to focus on the rationale and the advantages of this innovative approach. This is a retrospective observational study. The study was conducted at a tertiary care public hospital in Italy. From February 2006 to February 2012, video-assisted anal fistula treatment was performed on 203 patients (124 men and 79 women; median age, 42 years; range, 21-77 years) who had complex anal fistulas. One hundred forty-nine had undergone previous anal fistula surgery. Video-assisted anal fistula treatment has 2 phases: diagnostic and operative. The fistuloscope is introduced through the external opening to identify the main tract, possible secondary tracts or abscess cavities, and the internal opening. With the use of an electrode, the fistula and its branches are destroyed under direct vision and cleaned. The internal opening is closed by a stapler or a flap. Half a milliliter of synthetic cyanoacrylate is used for suture reinforcement. Successful healing of the fistula was assessed with clinical evaluation. Continence was evaluated by using patient self-reports of the presence/absence of postdefecation soiling. Follow-up was at 2, 4, 6, 12, and 24 months. The 6-month cumulative probability of freedom from fistula estimated according to a Kaplan-Meier analysis is 70% (95%CI, 64%-76%). No major complications occurred. No patients reported a reduction in their postoperative continence score. The limitations of this study included potential single-institution bias, lack of anorectal manometry, and potential selection bias. Video-assisted anal fistula treatment is effective and safe for the treatment of fistula-in-ano.

  5. Obstetric anal sphincter injuries

    Institute of Scientific and Technical Information of China (English)

    Remon Keriakos; Deepa Gopinath

    2015-01-01

    Obstetric anal sphincter injuries can be associated with significant short and long term consequences causing devastating impacts on the quality of lives of young, otherwise healthy women. The major consequence is anal incontinence which may be short or long term and vary in severity. The other consequences include pain, infection, dyspareunia and sexual dysfunction. This may in turn result in considerable economic burden to health care providers and patients. It also has an implication on future deliveries. Although it can never be eliminated, it can be reduced by improving practice, training and provision of high quality multidisciplinary care in order to reduce long-term morbidity. Obstetric anal sphincter injuries are also a source of litigation which can be distressing to both patients and clinicians. The aim of this review article is to explore the available evidence on epidemiology, strategies for preventions, prognosis and also how to deal with governance issues.

  6. Obstetric anal sphincter injuries

    Directory of Open Access Journals (Sweden)

    Remon Keriakos

    2015-10-01

    Full Text Available Obstetric anal sphincter injuries can be associated with significant short and long term consequences causing devastating impacts on the quality of lives of young, otherwise healthy women. The major consequence is anal incontinence which may be short or long term and vary in severity. The other consequences include pain, infection, dyspareunia and sexual dysfunction. This may in turn result in considerable economic burden to health care providers and patients. It also has an implication on future deliveries. Although it can never be eliminated, it can be reduced by improving practice, training and provision of high quality multidisciplinary care in order to reduce long-term morbidity. Obstetric anal sphincter injuries are also a source of litigation which can be distressing to both patients and clinicians. The aim of this review article is to explore the available evidence on epidemiology, strategies for preventions, prognosis and also how to deal with governance issues.

  7. What Are the Risk Factors for Anal Cancer?

    Science.gov (United States)

    ... may have few or no known risk factors. Human papilloma virus (HPV) infection Most squamous cell anal cancers seem to be linked to infection by the human papilloma virus (HPV), the same virus that causes cervical ...

  8. 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.

  9. V-Y Type Flap Internal Opening Duct Drainage In The Treatment Of Complex Anal Fistula Relapse Prevention And Control Points For Operation And Skills%V-Y型皮瓣内口封闭导管引流术治疗复杂肛瘘的临床观察

    Institute of Scientific and Technical Information of China (English)

    高昆; 王进宝

    2013-01-01

    目的 探讨V-Y型皮瓣内口封闭导管引流术治疗复杂肛瘘的可行性.方法 对2010年9月至2012年9月我科收治的复杂肛瘘患者20例,行V-Y型皮瓣内口封闭导管引流术的临床资料作回顾性分析.结果 19例痊愈,1例复发.结论 V-Y型皮瓣内口封闭导管引流术治疗复杂肛瘘是安全有效的,保留了肛门括约肌和肛门的功能,且成功率高.%Objective Through the analysis of the causes of anal fistula,classification,comparison research V-Y type flap internal opening duct drainage in the treatment of complex anal fistula feasibility.Methods clinical collect 20 cases,line V-Y type skin flap internal opening catheter drainage.Results 1 case of recurrence and 19 cases were healed.Conclusion V-Y type flap internal opening duct drainage in the treatment of complex anal fistula is safe and effective,retained the anal sphincter and anal function,high success rate.

  10. Oncogenicidade do papilomavírus humano e o grau de neoplasia intra-epitelial anal em doentes HIV positivo Human papillomavirus oncogenicity and grade of anal intraepithelial neoplasia in HIV positive patients

    Directory of Open Access Journals (Sweden)

    Carmen Ruth Manzione

    2004-09-01

    Full Text Available OBJETIVO: Avaliar se o grau de neoplasia intra-epitelial anal (NIA está associado ao tipo do HPV em doentes HIV positivo, já que esses apresentam imunodepressão durante longos períodos. MÉTODOS: Identificamos os tipos do HPV, pelo método da reação em cadeia da polimerase (PCR, e realizamos exame anatomo-patológico para avaliar o grau de NIA em 39 homens HIV positivo portadores de condilomas acuminados perianais. RESULTADOS: Observamos NIA de alto grau em nove (23,1% e NIA de baixo grau em 30 doentes (76,9%. Os tipos virais mais observados foram os não oncogênicos 6 e 11 em 64% e os oncogênicos 16, 18 e 31 em 20,5%. Não identificamos o tipo viral em quatro doentes (10,2%, embora o teste revelasse a presença do DNA viral. Comparando o padrão histológico e os tipos virais, observamos que os tipos não oncogênicos do HPV também podem estar associados ao desenvolvimento de NIA de alto grau. CONCLUSÃO: Os resultados obtidos nas condições de execução deste estudo permitem concluir que tanto os tipos oncogênicos como os não oncogênicos de HPV podem estar associados ao desenvolvimento de NIA de alto grau em doentes HIV positivo.OBJECTIVE: We decided to evaluate if grade of anal intraepithelial neoplasia (AIN was associated to the HPV type in HIV positive patients, since this group of patients has immunodeficiency over long periods. We identified HPV types by PCR (polimerase chain reaction and histological examination to determine the AIN grade in 39 HIV positive males with anal condylomata acuminata. RESULTS: We observed high grade AIN (HAIN in 9 (23.1 percent and low grade AIN (LAIN in 30 patients (76.9 percent. The most frequent HPV types were 6 and 11 (64 percent and oncogenic types 16, 18 and 31 appeared in 20.5 percent of patients. We could not identify viral type in four patients (10.2 percent despite tests revealing presence of viral deoxiribonucleic acid. Comparing AIN grades with viral types we observed that non

  11. 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...... contractions and to react in stress conditions with fast increase in tension....

  12. Human Rights, Human Needs, Human Development, Human Security : Relationships between four international 'human' discourses

    NARCIS (Netherlands)

    D.R. Gasper (Des)

    2007-01-01

    textabstractHuman rights, human development and human security form increasingly important, partly interconnected, partly competitive and misunderstood ethical and policy discourses. Each tries to humanize a pre-existing and unavoidable major discourse of everyday life, policy and politics; each

  13. Anal itching -- self-care

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000689.htm Anal itching - self-care To use the sharing features on this page, please enable JavaScript. Anal itching occurs when the skin around your anus ...

  14. Clinical effectiveness and cost-effectiveness of quadrivalent human papillomavirus vaccination in HIV-negative men who have sex with men to prevent recurrent high-grade anal intraepithelial neoplasia.

    Science.gov (United States)

    Deshmukh, Ashish A; Chiao, Elizabeth Y; Das, Prajnan; Cantor, Scott B

    2014-12-05

    We examined the long-term clinical and economic benefits of quadrivalent human papillomavirus (qHPV) vaccine as a secondary/adjunct prevention strategy in the prevention of recurrent high-grade intraepithelial neoplasia (HGAIN) in HIV-negative men who have sex with men (MSM) and are 27 years or older. We constructed a Markov model to evaluate the clinical effectiveness and cost-effectiveness of two strategies: (1) no qHPV vaccine after treatment for HGAIN versus (2) qHPV vaccine after treatment for HGAIN. Model parameters, including natural history of anal cancer, vaccine efficacy measured in terms of hazard ratio (HR) (decrease in the risk of recurrent HGAIN), HGAIN treatment efficacy, utilities, and costs, were obtained from the literature. The outcomes were measured in terms of lifetime risk of anal cancer, lifetime cost, quality-adjusted life years, and incremental cost-effectiveness ratios (ICERs). Sensitivity analysis was conducted on all model parameters. We found that vaccinating HIV-negative MSM reduced the lifetime risk of anal cancer by 60.77% at an ICER of US$87,240 per quality-adjusted life-year. The results were highly sensitive to vaccine efficacy, transition of HGAIN to anal cancer, cost of treatment for HGAIN, vaccine degree of protection over time, and the vaccine duration of protection and less sensitive to HPV clearance, cost of qHPV vaccine, and the transitions from normal to low-grade anal intraepithelial neoplasia (LGAIN) and normal to HGAIN. With an HR of 0.3, the ICER was well below a $50,000 willingness-to-pay threshold; with an HR of 0.5, the ICER was still below a threshold of $100,000. The most critical disease-related factor influencing the cost-effectiveness was the progression of HGAIN to anal cancer. At an annual transition probability below 0.001, the ICER was below $50,000. Vaccinating HIV-negative MSM treated for HGAIN decreases the lifetime risk of anal cancer and is likely to be a cost-effective intervention.

  15. Foundations of Collective Cultural Rights in International Human Rights Law

    NARCIS (Netherlands)

    Donders, Y.; Jakubowski, A.

    2016-01-01

    Although collective cultural rights are included in international human rights law, their place and their nature and significance are not well-explored or understood. This chapter aims to classify collective cultural rights in international human rights instruments and to explore how these rights

  16. From Internal Marketing to Human Resource Marketing. A Conceptual Framework of the Human Resources Marketing

    OpenAIRE

    Neagu Olimpia

    2011-01-01

    The paper focuses on shaping a conceptual framework of the human resources marketing, having as starting points the interactions between internal marketing and human management resources at the organisation’s level. The concept of internal customers, belonging to internal marketing and refering to the employees, can be taken in the human resources marketing as focus of the specific processes.

  17. [Preliminary efficacy of video-assisted anal fistula treatment for complex anal fistula].

    Science.gov (United States)

    Liu, Hailong; Xiao, Yihua; Zhang, Yong; Pan, Zhihui; Peng, Jian; Tang, Wenxian; Li, Ajian; Zhou, Lulu; Yin, Lu; Lin, Moubin

    2015-12-01

    To evaluate the preliminary efficacy of video-assisted anal fistula treatment (VAAFT) for complex anal fistula. Clinical data of 11 consecutive patients with complex anal fistula undergoing VAAFT in our department from May to July 2015 were reviewed. VAAFT was performed to manage the fistula under endoscope without cutting or resection. VAAFT was successfully performed in all the 11 patients. The internal ostium was closed using mattress suture in 10 cases, and Endo-GIA stapler in 1 case. The mean operative time was (42.0±12.4) min, mean hospital stay was (4.1±1.5) d. Complication included bleeding and perianal infection in 1 case respectively. After 1 to 3.2 months follow-up, success rate was 72.7%(8/11), and no fecal incontinence was observed. Video-assisted anal fistula treatment is an effective, safe and minimally invasive surgical procedure for complex anal fistula with preservation of anal sphincter function.

  18. Anal intraepithelial neoplasia: A review of diagnosis and management.

    Science.gov (United States)

    Roberts, Joseph R; Siekas, Lacey L; Kaz, Andrew M

    2017-02-15

    Anal intraepithelial neoplasia (AIN) is a premalignant lesion of the anal mucosa that is a precursor to anal cancer. Although anal cancer is relatively uncommon, rates of this malignancy are steadily rising in the United States, and among certain high risk populations the incidence of anal cancer may exceed that of colon cancer. Risk factors for AIN and anal cancer consist of clinical factors and behaviors that are associated with the acquisition and persistence of human papilloma virus (HPV) infection. The strongest HPV-associated risk factors are HIV infection, receptive anal intercourse, and high risk sexual behavior. A history of HPV-mediated genital cancer, which suggests infection with an oncogenic HPV strain, is another risk factor for AIN/anal cancer. Because progression of AIN to anal cancer is known to occur in some individuals over several years, screening for AIN and early anal cancer, as well as treatment of advanced AIN lesions, is reasonable in certain high-risk populations. Although randomized controlled trials evaluating screening and treatment outcomes are lacking, experts support routine screening for AIN in high risk populations. Screening is performed using anal cytological exams, similar to those performed in cervical cancer screening programs, along with direct tissue evaluation and biopsy via high resolution anoscopy. AIN can be treated using topical therapies such as imiquimod, 5-flurouracil, and trichloroacetic acid, as well as ablative therapies such as electrocautery and laser therapy. Reductions in AIN and anal cancer rates have been shown in studies where high-risk populations were vaccinated against the oncogenic strains of HPV. Currently, the CDC recommends both high-risk and average-risk populations be vaccinated against HPV infection using the quadrivalent or nonavalent vaccines. It is important for clinicians to be familiar with AIN and the role of HPV vaccination, particularly in high risk populations.

  19. Anal intraepithelial neoplasia: A review of diagnosis and management

    Science.gov (United States)

    Roberts, Joseph R; Siekas, Lacey L; Kaz, Andrew M

    2017-01-01

    Anal intraepithelial neoplasia (AIN) is a premalignant lesion of the anal mucosa that is a precursor to anal cancer. Although anal cancer is relatively uncommon, rates of this malignancy are steadily rising in the United States, and among certain high risk populations the incidence of anal cancer may exceed that of colon cancer. Risk factors for AIN and anal cancer consist of clinical factors and behaviors that are associated with the acquisition and persistence of human papilloma virus (HPV) infection. The strongest HPV-associated risk factors are HIV infection, receptive anal intercourse, and high risk sexual behavior. A history of HPV-mediated genital cancer, which suggests infection with an oncogenic HPV strain, is another risk factor for AIN/anal cancer. Because progression of AIN to anal cancer is known to occur in some individuals over several years, screening for AIN and early anal cancer, as well as treatment of advanced AIN lesions, is reasonable in certain high-risk populations. Although randomized controlled trials evaluating screening and treatment outcomes are lacking, experts support routine screening for AIN in high risk populations. Screening is performed using anal cytological exams, similar to those performed in cervical cancer screening programs, along with direct tissue evaluation and biopsy via high resolution anoscopy. AIN can be treated using topical therapies such as imiquimod, 5-flurouracil, and trichloroacetic acid, as well as ablative therapies such as electrocautery and laser therapy. Reductions in AIN and anal cancer rates have been shown in studies where high-risk populations were vaccinated against the oncogenic strains of HPV. Currently, the CDC recommends both high-risk and average-risk populations be vaccinated against HPV infection using the quadrivalent or nonavalent vaccines. It is important for clinicians to be familiar with AIN and the role of HPV vaccination, particularly in high risk populations. PMID:28255426

  20. International Human Rights and the Mistreatment of Women During Childbirth.

    Science.gov (United States)

    Khosla, Rajat; Zampas, Christina; Vogel, Joshua P; Bohren, Meghan A; Roseman, Mindy; Erdman, Joanna N

    2016-12-01

    International human rights bodies have played a critical role in codifying, setting standards, and monitoring human rights violations in the context of sexual and reproductive health and rights. In recent years, these institutions have developed and applied human rights standards in the more particular context of maternal mortality and morbidity, and have increasingly recognized a critical human rights issue in the provision and experience of care during and after pregnancy, including during childbirth. However, the international human rights standards on mistreatment during facility-based childbirth remain, in an early stage of development, focused largely on a discrete subset of experiences, such as forced sterilization and lack of access to emergency obstetric care. As a consequence, the range of mistreatment that women may experience has not been adequately addressed or analyzed under international human rights law. Identifying human rights norms and standards related to the full range of documented mistreatment is thus a first step towards addressing violations of human rights during facility-based childbirth, ensuring respectful and humane treatment, and developing a program of work to improve the overall quality of maternal care. This article reviews international human rights standards related to the mistreatment of women during childbirth in facility settings under regional and international human rights law and lays out an agenda for further research and action.

  1. International Human Rights and the Mistreatment of Women During Childbirth

    Science.gov (United States)

    Zampas, Christina; Vogel, Joshua P.; Bohren, Meghan A.; Roseman, Mindy; Erdman, Joanna N.

    2016-01-01

    Abstract International human rights bodies have played a critical role in codifying, setting standards, and monitoring human rights violations in the context of sexual and reproductive health and rights. In recent years, these institutions have developed and applied human rights standards in the more particular context of maternal mortality and morbidity, and have increasingly recognized a critical human rights issue in the provision and experience of care during and after pregnancy, including during childbirth. However, the international human rights standards on mistreatment during facility-based childbirth remain, in an early stage of development, focused largely on a discrete subset of experiences, such as forced sterilization and lack of access to emergency obstetric care. As a consequence, the range of mistreatment that women may experience has not been adequately addressed or analyzed under international human rights law. Identifying human rights norms and standards related to the full range of documented mistreatment is thus a first step towards addressing violations of human rights during facility-based childbirth, ensuring respectful and humane treatment, and developing a program of work to improve the overall quality of maternal care. This article reviews international human rights standards related to the mistreatment of women during childbirth in facility settings under regional and international human rights law and lays out an agenda for further research and action. PMID:28559681

  2. 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.

  3. Chronic anal fissure: new approaches to chemical sphincterotomy

    Directory of Open Access Journals (Sweden)

    Mohammad hassan Emami

    2008-06-01

    Full Text Available

    • An anal fissure is a split in the mucosa extending from the anal verge towards the dentate line. It currently affects 10% of patients attending proctology clinics. Recent studies have highlighted the role of increased internal anal sphincter pressure and decreased anodermal blood flow in the pathogenesis of chronic anal fissures. Acute fissures usually heal with conservative management. Fissures lasting greater than two months with features of chronicity, are unlikely to heal with conservative management. Lateral internal sphincterotomy has been the treatment of choice for chronic anal fissures. Because of the disability associated with surgery for healing anal fissure and the risk of incontinence, medical alternatives for surgery have been sought. Among different chemical agents, Glyceryl trinitrate (GTN has been shown to be the first line treatment for chronic anal fissure but the transient sphincteric relaxation effect of pharmacologic agents such as GTN, makes them less effective than surgery. Although we have different forms of GTN products, they do not show a long acting effect on relaxing and enhancing the perfusion of anal sphincter, because they are soon metabolized. Most difficulties with current usage of drugs are due to poor compliance of patients. It can be taken into consideration that new formulation and novel combination of GTN with other treatments, in slow releasing forms may lead to acceptable strategies in the management of chronic anal fissure. As authors’ experience in this field, other clinical trials on the drug combination and slow releasing formulations are warranted to generate new data on the subject.
    • Key word: chronic anal fissure, review, chemical sphincterotomy 

  4. [Cryptoglandular anal fistulas].

    Science.gov (United States)

    de Parades, Vincent; Zeitoun, Jean-David; Bauer, Pierre; Atienza, Patrick

    2008-10-31

    Cryptoglandular anal fistulae are the most frequently occurring form of perianal sepsis. Characteristically they have an endoanal primary opening, a fistula track and an abscess and/or an external purulent opening. Antibiotic therapy is not of use in initial management except in special cases. Treatment of an abscess, if present, is required urgently and when possible, consists of its incision under local anaesthesia. Treating the fistula track occurs afterwards and aims to dry up the purulent discharge and avoid recurrence of the abscess by means of surgical fistulotomy. These techniques are very effective in terms of eradication of the problem but there is sometimes a risk of anal incontinence. This explains the increasing interest in sphincter preserving techniques using the advancement of a covering flap of rectal mucosa and the injection of fibrin glue.

  5. [Epithelium and anal glands in rectal pouches and fistula. Histologic studies of swine with congenital anal atresia].

    Science.gov (United States)

    Lambrecht, W; Kluth, D; Lierse, W

    1989-02-01

    The epithelial coating of the rectal pouch and fistula was studied morphologically in 33 newborn piglets with high and low forms of anal atresia and was found to be similar to the epithelial coating of the anal canal in normal piglets: the typical epithelium of the rectum changed its character into transitional epithelium at the region of the internal sphincter which surrounded the fistulae in all animals. In the caudal part of the fistula the transitional epithelium was followed by squamous epithelium. Only in male piglets with deformities and recto-urethral fistulae no squamous epithelium was found. In these cases transitional epithelium covered all parts of the fistula and the region of the internal sphincter. Anal glands were found in all animals, with or without anorectal malformations. They always invaded the internal sphincter. According to our morphological studies the fistula in anorectal malformations represents an ectopic anal canal.

  6. Cáncer anal en la era del VIH: papel de la citología anal Anal cancer in the HIV era

    Directory of Open Access Journals (Sweden)

    Juan Carlos Cataño Correa

    2004-09-01

    Full Text Available El cáncer anal solía ser una neoplasia infrecuente que afectaba principalmente a mujeres y personas mayores de 65 años, pero recientemente su incidencia ha venido en aumento debido a la pandemia de VIH, fenómeno que tiende a empeorar porque la terapia antirretroviral altamente activa (HAART, por su sigla en inglés no solo alarga la vida de los pacientes, sino que al mismo tiempo hace posible una prolongada evolución de las lesiones precancerosas que conducen a cáncer anal; además, está plenamente demostrado que la HAART no evita la evolución de las lesiones intraepiteliales escamosas hacia cáncer anal. La citología anal ha demostrado ser una prueba de tamización poblacional útil y costoefectiva para el diagnóstico de las lesiones precancerosas producidas por Papilomavirus humano en el canal anal de hombres homosexuales y bisexuales, principalmente de aquellos positivos para VIH. Esta revisión tiene como objetivo llamar la atención sobre la creciente incidencia de cáncer anal en la población de pacientes VIH positivos, y sobre la utilidad del diagnóstico temprano utilizando la citología anal en este grupo de pacientes de riesgo. Anal cancer used to be an uncommon neoplasia that affected mainly women and people aged over 65 years, but recently its incidence has been growing, mostly due to the HIV pandemic, and it will become worse because highly active antiretroviral therapy (HAART at the same time that lengthens life expectancy in HIV positive subjects, will increase the possibility to develop anal cancer; it has already been demonstrated that HAART does not prevent the evolution of intraepithelial squamous lesions to anal cancer. Anal cytology has demonstrated to be an useful and cost-effective screening tool for detection of precancerous lesions associated with human Papillomavirus (HPV infection in the anal canal of homosexual and bisexual men, specially in those that are HIV positive. This article is an update of the

  7. Progress in the international protection of human rights.

    Science.gov (United States)

    Suter, Keith

    2002-01-01

    Great progress has been made in the international protection of human rights since 10 December 1948 (when the United Nations General Assembly adopted the Universal Declaration of Human Rights). Amidst the doom and gloom of the media's reporting of current affairs, it is easy to overlook this progress. This article provides a definition of 'human rights' and examines early human rights campaigns. It then considers the areas of progress: human rights are now part of the international political vocabulary, there is a recognition that respect for human rights can assist a country's economic and social development, there has been a growth of human rights treaties and techniques and non-governmental organizations (NGOs) see protecting human rights as a major activity. State sovereignty has been eroded as national governments are being held accountable to the international community for their human rights policies. A new challenge is to ensure respect for human rights by non-state entities, such as transnational corporations. The growing culture of international protection of human rights is here to stay. This is not a reason for complacency, but it is a sign of hope.

  8. Infecções anais pelo papilomavírus humano, crioterapia e crioimunologia Anal infections by human papillomavirus, criotherapy, and cryoimunology

    Directory of Open Access Journals (Sweden)

    Raphael Marianelli

    2011-03-01

    Full Text Available As verrugas genitais causadas pelo papilomavírus humano (HPV são problemas comuns na prática clínica do coloproctologista. As opções terapêuticas são numerosas, não havendo padrão-ouro para o tratamento dos condilomas. Dentre elas, é possível destacar a crioterapia, que é eficaz, apesar de pouco utilizada. O efeito destrutivo da crioterapia ocorre por lesão celular direta, causada pelo frio, e por anóxia tecidual, consequente às alterações microcirculatórias. Dentre as vantagens do método, cita-se a segurança; a simplicidade de aplicação; o uso dentro e fora do canal anal, inclusive durante a gestação; e o desconforto local leve, dispensando anestesia. Os agentes criogênicos mais utilizados são o nitrogênio líquido e, mais recentemente, o dimetiléter-propano. Uma vantagem adicional é observada no tratamento das lesões neoplásicas e seus precursores. Postula-se que seu congelamento induziria à resposta imune antitumoral, consequente ao mecanismo de lesão tecidual, que expõe grande quantidade de antígenos intracelulares aos macrófagos e às células dendríticas. Entretanto, a literatura médica ainda carece de estudos abordando especificamente o tema, sobretudo na área da coloproctologia. De qualquer forma, podemos afirmar que a crioterapia é método eficaz, seguro, confortável e prático para o tratamento das verrugas anogenitais induzidas pelo HPV.Genital warts caused by human papillomavirus (HPV are a common problem in clinical practice of colorectal surgeons. There are several therapeutic options, although, there is not a gold standard for the treatment of condilomas. Among them, we could mention cryotherapy, which is an effective method, despite having little use. The destructive effect of cryotherapy is through direct cellular injury, which is provoked by cold, and tissue anoxia, due microcirculatory changes. Among the method advantages, we could relate safety; simplicity of application; use inside

  9. International Human Rights Mechanism and Construction of Harmonious Human Rights Relations

    Institute of Scientific and Technical Information of China (English)

    LIU JIE

    2007-01-01

    @@ The international human rights mechanism is a product of the pursuit for peace and justice of the human society. As the core values of the international human rights mechanism, the universal human rights standards provide the international community with a basic path of human rights development in different countries. In recent years a limited few of countries have utilized the universal human rights standards to promote their own strategic wills, and interfere in the sovereignty and domestic affairs of other countries with the excuse of human rights.However, the establishment and improvement of the human rights mechanism provide an institutional mode and path for the promotion of equality, dialog, and cooperation in the human rights issues of all countries. In addition, the establishment and improvement of the human rights mechanism also benefit the construction of harmonious human rights relations in a faster pace on the precondition of respect for national sovereignty by the international community.

  10. Determinants of human resource investment in internal controls

    National Research Council Canada - National Science Library

    Jong-Hag Choi Joonil Lee Catherine Heyjung Sonu

    2013-01-01

    Using the unique reporting environment in Korea, this study investigates the determinants of human resource investment in internal controls for 1352 listed firms disclosing the number of personnel who...

  11. AFRREV IJAH: An International Journal of Arts and Humanities - Vol ...

    African Journals Online (AJOL)

    PROMOTING ACCESS TO AFRICAN RESEARCH ... AFRREV IJAH: An International Journal of Arts and Humanities - Vol 6, No 2 (2017) ... Taylor and Francis Journals under the critical lens of readability analysis ... Current Issue Atom logo

  12. International Human Resource Management: A Review from Pakistani Perspective

    OpenAIRE

    Shah, Syed Tanveer Hussain; Jamil, Raja Ahmed; Shah, Tazeem Ali; Kazmi, Zain

    2014-01-01

    This article provides information about the International Human Resource Management and discusses HRM according to the international prospective in Pakistan. In this article it is discussed that how environmental and cultural factors affect the recruitment, selection and industry/employee relation in Pakistan. In the end some conclusions are made in reference to the context.

  13. International Human Resource Management: A Review from Pakistani Perspective

    OpenAIRE

    Shah, Syed Tanveer Hussain; Jamil, Raja Ahmed; Shah, Tazeem Ali; Kazmi, Zain

    2014-01-01

    This article provides information about the International Human Resource Management and discusses HRM according to the international prospective in Pakistan. In this article it is discussed that how environmental and cultural factors affect the recruitment, selection and industry/employee relation in Pakistan. In the end some conclusions are made in reference to the context.

  14. Diffuse large B cell lymphoma presenting as a peri-anal abscess.

    Science.gov (United States)

    Jayasekera, Hasanga; Gorissen, Kym; Francis, Leo; Chow, Carina

    2014-06-04

    A non-healing peri-anal abscess can be difficult to manage and is often attributed to chronic disease. This case documents a male in his seventh decade who presented with multiple peri-anal collections. The abscess cavity had caused necrosis of the internal sphincter muscles resulting in faecal incontinence. Biopsies were conclusive for diffuse large B-cell lymphoma. A de-functioning colostomy was performed and the patient was initiated on CHOP-R chemotherapy. Anal lymphoma masquerading as a peri-anal abscess is rare. A high degree of suspicion must be maintained for an anal abscess which does not resolve with conservative management.

  15. Premalignant Lesions of the Anal Canal and Squamous Cell Carcinoma of the Anal Canal

    Science.gov (United States)

    Poggio, Juan Lucas

    2011-01-01

    Squamous cell carcinoma of the anus (SCCA) is a rare tumor. However, its incidence has been increasing in men and women over the past 25 years worldwide. Risk factors associated with this cancer are those behaviors that predispose individuals to human papillomavirus (HPV) infection and immunosuppression. Anal cancer is generally preceded by high-grade anal intraepithelial neoplasia (HGAIN), which is most prevalent in human immunodeficiency virus-positive men who have sex with men. High-risk patients may benefit from screening. The most common presentation is rectal bleeding, which is present in nearly 50% of patients. Twenty percent of patients have no symptoms at the time of presentation. Clinical staging of anal cancer requires a digital rectal exam and a positron emission tomography/computed tomography scan of the chest, abdomen, and pelvis. Endorectal/endoanal ultrasound appears to add more-specific staging information when compared with digital rectal examination alone. Treatment of anal cancer prior to the 1970s involved an abdominoperineal resection. However, the current standard of care for localized anal cancer is concurrent chemoradiation therapy, primarily because of its sphincter-saving and colostomy-sparing potential. Studies have addressed alternative chemoradiation regimens to improve the standard protocol of fluorouracil, misogynic, and radiation, but no alternative regimen has proven superior. Surgery is reserved for those patients with residual disease or recurrence. PMID:22942800

  16. [Diagnostics and conservative treatment of anal incontinence].

    Science.gov (United States)

    Geile, Dorothea; Osterholzer, Georg; Rosenberg, Robert

    2004-01-01

    Anal incontinence is diagnosed primarily by clinical and proctologic examination. Etiological factors of the disease are found in 85% of the patients by additional examinations. Motility dysfunction of colon and rectum has to be excluded (stenosis, dyschezia, internal hernias). Because anal incontinence is a multifactorial disease as a rule, the single compounds have to be diagnosed and have to undergo therapy. Accordingly, useful investigations are: endorectal ultrasound (defect of muscle, inflammatory or tumour infiltration), manometry (alteration of either anal resting pressure and/or anal squeezing pressure) and surface electromyography (ability of contraction, duration of contraction, strength). Neurophysiological examinations are: needle electromyography, pudendal nerve latency time measurement (PNLT). The occurrence of nerve damage determines the outcome of operative intervention! Conservative treatment is indicated in 80 to 90% of all patients, even higher when one includes all patients in the perioperative period. Possible therapy modalities are: nutrition consultation, physiotherapy, pelvic floor training, biofeedback training of pelvic floor and sphincter muscles, electrostimulation and the combination of both (EMG-triggered electrostimulation). Short-term results are satisfying in up to 85% of patients, but later, successful results depend on the patient's willingness or ability to continue training, and on his/her age.

  17. Knowledge and Acceptability of Anal Cytology Screening Among Women.

    Science.gov (United States)

    Blankenship, Stephanie A; Debnath, Priyanka; Szlachta-McGinn, Alec W; Maguire, Karla; Garcia, Jorge J; Aserlind, Alexandra; Lipshultz, Emma; Potter, JoNell E

    2016-01-01

    Medical providers have initiated anal cytology screening among women to detect anal neoplasia early. Lack of knowledge of the human papillomavirus (HPV) and anticipated screening discomfort may limit patient acceptance. This study investigates attitudes toward anal cytology screening among women. Women seen for gynecologic care at an urban university medical center were invited to complete an anonymous survey assessing their understanding of HPV and interest in anal cytology screening. Subjects reported the level of pain, discomfort, and embarrassment they expected from screening on a 100-mm visual analog scale. Four hundred four women with mean (SD) age 36 (13) years met criteria for participation. Three hundred thirty-five women reported their race: 52% were white and 36% were African American. Three hundred forty-eight women reported their ethnicities: 76% were Hispanic and 12% were Haitian. Twenty-two percent had never heard of HPV, 57% were not familiar with anal cytology screening, 67% acknowledged that screening was very helpful in detecting anal neoplasia early, and 28% were very interested in undergoing screening. Mean (SD) level of anticipated pain, discomfort, and embarrassment during screening was 62 (32), 68 (30), and 58 (34) mm, respectively. Level of familiarity with anal cytology screening (p cytology screening among at-risk women to familiarize them with the procedure, describe its role in detecting anal neoplasia, and address expectations surrounding pain to increase its acceptability.

  18. Integrating internal communications, human resource management and marketing concepts into the new internal marketing philosophy

    OpenAIRE

    Dubravka Sinčić; Nina Pološki Vokić

    2007-01-01

    Successful companies attach great importance to human resource management and internal communications, because they are aware of the value of those activities and of strategic advantage they can bring to the organization. They should also realize that it is necessary to live internal marketing philosophy, if they stream to offer quality products and services to both markets: internal and external. The idea of satisfied employees for the benefit of satisfied customers is accepted a...

  19. 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......-associated histological types levelled out or even declined during the 30 years of observation. In women, the increase in HPV-associated cancers was more pronounced among those under 60 years of age. Our findings indicate that vaccines against HPV might play an important role in the prevention of anal cancer and its...... cases of AIN2/3 during the study period. The average annual percentage change of 5% between 1998 and 2008 represents a steep increase in the incidence of AIN in both genders. Furthermore, the incidence rate of HPV-associated anal cancers increased significantly, whereas that of non-HPV...

  20. Human Work Interaction Design Meets International Development

    DEFF Research Database (Denmark)

    Campos, Pedro; Clemmensen, Torkil; Barricelli, Barbara Rita

    2017-01-01

    Over the last decade, empirical relationships between work domain analysis and HCI design have been identified by much research in the field of Human Work Interaction Design (HWID) across five continents. Since this workshop takes place at the Interact Conference in Mumbai, there is a unique oppo...

  1. Video-Assisted Anal Fistula Treatment (VAAFT) for Complex Anal Fistula: A Preliminary Evaluation in China.

    Science.gov (United States)

    Jiang, Hui-Hong; Liu, Hai-Long; Li, Zhen; Xiao, Yi-Hua; Li, A-Jian; Chang, Yi; Zhang, Yong; Lv, Liang; Lin, Mou-Bin

    2017-04-30

    BACKGROUND Although many attempts have been made to advance the treatment of complex anal fistula, it continues to be a difficult surgical problem. This study aimed to describe the novel technique of video-assisted anal fistula treatment (VAAFT) and our preliminary experiences using VAAFT with patients with complex anal fistula. MATERIAL AND METHODS From May 2015 to May 2016, 52 patients with complex anal fistula were treated with VAAFT at Yangpu Hospital of Tongji University School of Medicine, and the clinical data of these patients were reviewed. RESULTS VAAFT was performed successfully in all 52 patients. The median operation time was 55 minutes. Internal openings were identified in all cases. 50 cases were closed with sutures, and 2 were closed with staplers. Complications included perianal sepsis in 3 cases and bleeding in another 3 cases. Complete healing without recurrence was achieved in 44 patients (84.6%) after 9 months of follow-up. No fecal incontinence was observed. Furthermore, a significant improvement in Gastrointestinal Quality of Life Index (GIQLI) score was observed from preoperative baseline (mean, 85.5) to 3-month follow-up (mean, 105.4; panal fistula with preservation of anal sphincter function.

  2. Anal anatomy and normal histology.

    Science.gov (United States)

    Pandey, Priti

    2012-12-01

    The focus of this article is the anatomy and histology of the anal canal, and its clinical relevance to anal cancers. The article also highlights the recent histological and anatomical changes to the traditional terminology of the anal canal. The terminology has been adopted by the American Joint Committee on Cancer, separating the anal region into the anal canal, the perianal region and the skin. This paper describes the gross anatomy of the anal canal, along with its associated blood supply, venous and lymphatic drainage, and nerve supply. The new terminology referred to in this article may assist clinicians and health care providers to identify lesions more precisely through naked eye observation and without the need for instrumentation. Knowledge of the regional anatomy of the anus will also assist in management decisions.

  3. Anal cancer – a review

    Science.gov (United States)

    Salati, Sajad Ahmad; Al Kadi, Azzam

    2012-01-01

    Anal cancer accounts for only 1.5% of gastrointestinal malignancies but this disease has shown a steady increase in incidence particularly in HIV positive males. The understanding of pathophysiology and treatment of anal cancer has changed radically over last thirty years. Risk factors have been identified and organ preservation by chemoradiotherapy has become a standard. This article aims to review the clinical presentation, diagnostic evaluation, and treatment options for anal cancer in the light of current literature. PMID:23580899

  4. 功能性便秘患儿肛门内括约肌检测的临床意义%Clinical significance of detection of internal anal sphincter in children with functional constipation

    Institute of Scientific and Technical Information of China (English)

    侯翔宇; 王凌云; 王维林; 李勇; 白玉作

    2011-01-01

    目的 探讨功能性便秘患儿肛门内括约肌结构及功能的改变以及内括约肌厚度与临床症状严重程度的关系.方法 对中国医科大学附属盛京医院2008年6-12月间收治的35例功能性便秘患儿(便秘组,其中合并失禁者17例)进行肛门直肠测压和肛管内B超检测,并与同期住院治疗的23例经检查排除消化道和内分泌疾病患儿(对照组)进行对照,采用儿童便秘临床症状评分标准(65分法)评估症状的严重程度.结果 便秘组与对照组相比,直肠感知阈值明显增加[(42.4±19.5) ml比(29.1±15.6)ml,P<0.05);引起肛门内括约肌松弛反射的最低充气量明显增高[(55.6±31.6) ml比(30.5±13.8) ml,P<0.05):肛门内括约肌明显增厚[(3.8±1.7)mm比(2.5±1.0) mm,P<0.05);但两组肛管静息压[(170.8±62.3) mm Hg比(161.3±51.1) mmHg]的差异无统计学意义(P>0.05).便秘组患儿临床症状评分为(9.3±4.3)分;肛门内括约肌厚度与临床症状评分呈正相关(r=0.407,P=0.015);与患儿年龄、性别及病程则无相关性(均P>0.05).结论 功能性便秘患儿肛门内括约肌结构与功能均会发生改变.肛门内括约肌厚度在一定程度上可以反映便秘症状严重程度.%Objective 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.Methods A total of 35 children with FC (canstipation 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.Results Anorectal manometry showed

  5. Human Capital Development in the International Organization: Rhetoric and Reality

    Science.gov (United States)

    Kulvisaechana, Somboon

    2006-01-01

    Purpose: The purpose of this study is to present empirical evidence of the nature of corporate rhetoric in developing human capital and how it becomes embedded within a large international organization operating in the Nordic region. The qualitative case study aims to examine the sensemaking of individual managers, and how human capital rhetoric…

  6. Human Rights Education and the International Baccalaureate Diploma Programme

    Science.gov (United States)

    Froman, Nica

    2015-01-01

    In 2003, the International Baccalaureate Diploma Programme (IBDP)--a program implemented in thousands of schools globally--introduced a human rights course (Makivirta, 2003). This curriculum is the first of its kind to hold potential widespread influence on human rights education in the formal education sector. In this study, I analyze the…

  7. The Netherlands and the Development of International Human Rights Instruments

    NARCIS (Netherlands)

    Reiding, H.

    2007-01-01

    When discussing the Netherlands' international human rights policies, the first aspects to come to mind are usually those related to how it addresses and reacts to concrete human rights violations by other countries. In fact, there sometimes appears to be a tendency for public opinion to identify a

  8. International human rights and cultural diversity: a balancing act

    NARCIS (Netherlands)

    Donders, Y.

    2013-01-01

    It is broadly agreed that international human rights law and cultural diversity have a mutually interdependent and beneficial relationship. Many human rights, such as the rights to freedom of expression, freedom of religion, freedom of assembly, as well as the rights to take part in cultural life an

  9. Driving Force to Socialize the International Norms of Human Rights

    Institute of Scientific and Technical Information of China (English)

    LIU BO

    2011-01-01

    Human rights,as a great term and lofty goal,have unquestionably become a topic of mainstream talk in the present-day world.2 Such mainstream talk has been internalized into part of the social structure.The current international society is experiencing a profound reorganization and transition in values.All kinds of new interactions under the context of globalization have resulted in the development of the current norms of international human rights,which are constructed on the basis of law and ethics.Therefore,analyzing the dynamic factors of socialization that support the operation of human rights norms in international society has become increasingly important in today's mutually dependent society.

  10. International Human Trafficking: Measuring Clandestinity by the Structural Equation Approach

    Directory of Open Access Journals (Sweden)

    Alexandra Rudolph

    2017-06-01

    Full Text Available Worldwide human trafficking is the third most often registered international criminal activity, ranked only after drug and weapon trafficking. This article focusses on three questions: 1 How can human trafficking be measured? 2 What are the causes and indicators of this criminal activity which exploits individuals? 3 Which countries observe a high (or low level of human trafficking inflow? We apply the Multiple Indicators Multiple Causes structural equation model to measure human trafficking inflows in a way which includes all potential causes and indicators in one estimation model. The human trafficking measurement focusses on international human trafficking. We use freely available existing data and thus generate an objective measure of the extent of trafficking. Countries are ranked according to their potential to be a destination country based on various characteristics of the trafficking process.

  11. Is routine endoanal ultrasound useful in anal fistulas?

    Directory of Open Access Journals (Sweden)

    I. Pascual Migueláñez

    Full Text Available Objective: to evaluate the effectiveness of endoanal ultrasound with hydrogen peroxide enhancement in the assessment of anal fistula (tract and internal opening, and to value the utility of this examination for anal or perianal suppuration when performed by a colorectal surgeon trained in this technique. Patients: endoanal ultrasound was performed in 103 patients with anal or perianal suppuration. Twenty patients were excluded: 9 had the external opening closed, and 11 had cryptoglandular abscesses. All ultrasound scans were performed by the same explorer using a B&K Diagnostic Ultrasound System with a 7 MHz endoprobe. The examination was based on the identification of the three anal planes, then hydrogen peroxide was infused and the procedure was repeated. Results: out of 83 patients included, 11 had a perianal sinus and 72 an anal fistula. In all fistulas the main tract was found: 24 were inter-sphinteric (33.33%, 33 trans-sphincteric (45.83%, 3 supra-sphincteric (4.17%, and 12 extra-sphincteric (16.67%. An internal opening was identified in 69 (95.83%. Conclusions: endoanal ultrasound with hydrogen peroxide enhancement is an effective examination to visualize fistulous tracts and internal openings. We think it is highly useful for anal or perianal suppuration to identify abscesses, to recognize a perianal sinus, to check the sphincteric condition, and to plan subsequent surgery.

  12. Strategická analýza Citibank a. s.

    OpenAIRE

    Boháčová, Michaela

    2007-01-01

    Bakalářská práce si za svůj cíl vytyčila problematiku strategické analýzy, která je důležitou součástí tvorby strategie. Výstupem strategické analýzy je SWOT analýza. Na závěr práce jsou uvedeny a zhodnoceny používané strategie, které utváří rámec hospodaření Citibank a. s. Stručný obsah: 1. Strategická analýza 1.1. Externí analýza 1.2. Interní analýza 1.3. SWOT analýza 2. Vize a poslání Citibank 3. Zhodnocení zvolené strategie 3.1. Konkurenční strategie 3.2. Investiční strategie 3.3. Strateg...

  13. 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 wi...

  14. Female longitudinal anal muscles or conjoint longitudinal coats extend into the subcutaneous tissue along the vaginal vestibule: a histological study using human fetuses.

    Science.gov (United States)

    Kinugasa, Yusuke; Arakawa, Takashi; Abe, Hiroshi; Rodríguez-Vázquez, Jose Francisco; Murakami, Gen; Sugihara, Kenichi

    2013-05-01

    It is still unclear whether the longitudinal anal muscles or conjoint longitudinal coats (CLCs) are attached to the vagina, although such an attachment, if present, would appear to make an important contribution to the integrated supportive system of the female pelvic floor. Using immunohistochemistry for smooth muscle actin, we examined semiserial frontal sections of 1) eleven female late-stage fetuses at 28-37 weeks of gestation, 2) two female middle-stage fetus (2 specimens at 13 weeks), and, 3) six male fetuses at 12 and 37 weeks as a comparison of the morphology. In late-stage female fetuses, the CLCs consistently (11/11) extended into the subcutaneous tissue along the vaginal vestibule on the anterior side of the external anal sphincter. Lateral to the CLCs, the external anal sphincter also extended anteriorly toward the vaginal side walls. The anterior part of the CLCs originated from the perimysium of the levator ani muscle without any contribution of the rectal longitudinal muscle layer. However, in 2 female middle-stage fetuses, smooth muscles along the vestibulum extended superiorly toward the levetor ani sling. In male fetuses, the CLCs were separated from another subcutaneous smooth muscle along the scrotal raphe (posterior parts of the dartos layer) by fatty tissue. In terms of topographical anatomy, the female anterior CLCs are likely to correspond to the lateral extension of the perineal body (a bulky subcutaneous smooth muscle mass present in adult women), supporting the vaginal vestibule by transmission of force from the levator ani.

  15. Método analítico para a determinação de meloxicam em plasma humano por cromatografia líquida de alta eficiência (CLAE Determination of meloxicam in human plasma by HPLC

    Directory of Open Access Journals (Sweden)

    Valentina Porta

    2005-06-01

    Full Text Available Desenvolveu-se e validou-se método analítico simples, rápido e específico para quantificação de meloxicam (inibidor da COX-2 em plasma humano através da cromatografia líquida de alta eficiência, para aplicação em estudos de bioequivalência. Piroxicam foi utilizado como padrão interno. Empregou-se cromatografia em fase reversa com coluna modelo Synergi RP-MAX (150 x 4,6 mm, à temperatura de 30 ºC e fase móvel constituída por mistura de acetonitrila e tampão fosfato 0,025 mol/L pH 4,5 (40:60, v/v, a um fluxo de 1,0 mL/min. Os analitos foram detectados por UV a 364 nm. As amostras de plasma foram acidificadas com ácido clorídrico 1 mol/L, extraídas utilizando-se éter terc-butil metílico e, após filtração e secagem, o resíduo foi reconstituído em 250 mL de fase móvel para injeção em CLAE. Os tempos de retenção para meloxicam (padrão e piroxicam (padrão interno foram 3,35 e 4,19 minutos, respectivamente. Este método apresentou linearidade na faixa de concentração entre 50-4000 ng/mL (R² = 0,9995, com limite de quantificação inferior de 50 ng/mL e exatidão de 114%. O método analítico desenvolvido neste trabalho demonstrou especificidade, linearidade, precisão e exatidão adequadas, permitindo sua aplicação em ensaios de bioequivalência.A simple, rapid and specific high-performance liquid cromatographic (HPLC method was developed and validated to estimate meloxicam (COX-2 inhibitor levels in human plasma. Piroxicam was used as internal standard. Reversed phase chromatography was conducted using a Synergi RP-MAX (150 x 4.6 mm column at 30 ºC and a mobile phase of acetonitrile and 0.025 mol/L pH 4,5 phosphate buffer (40:60, v/v, at a flow rate of 1mL/min. Analytes were detected at 364 nm. Plasma samples were acidified with 1 mol/L hydrochloric acid and extracted with tert-butyl methyl ether, evaporated to dryness, reconstituted in 250 mL of mobile phase and injected in the column. The retention time of

  16. Hypertrophied anal papillae and fibrous anal polyps, should they be removed during anal fissure surgery?

    Institute of Scientific and Technical Information of China (English)

    Pravin J. Gupta

    2004-01-01

    AIM: Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice.They are mostly ignored being considered as normal structures. The present study was aimed to demonstrate that hypertrophied anal papillae and fibrous anal polyps could cause symptoms to the patients and that they should be removed in treatment of patients with chronic fissure in anus.METHODS: Two groups of patients were studied. A hundred patients were studied in group A in which the associated fibrous polyp or papillae were removed by radio frequency surgical device after a lateral subcutaneous sphincterotomy for relieving the sphincter spasm. Another group of a hundred patients who also had papillae or fibrous polyps, were treated by lateral sphincterotomy alone. They were followed up for one year.RESULTS: Eighty-nine percent patients from group A expressed their satisfaction with the treatment in comparison to only 64% from group B who underwent sphincterotomy alone with the papillae or anal polyps left untreated. Group A patients showed a marked reduction with regard to pain and irritation during defecation (P= 0.0011),pricking or foreign body sensation in the anus (P = 0.0006)and pruritus or wetness around the anal verge (P = 0.0008).CONCLUSION: Hypertrophied anal papillae and fibrous anal polyps should be removed during treatment of chronic anal fissure. This would add to effectiveness and completeness of the procedure.

  17. Clinical Observation of Partial Internal Sphincterotomy Combined with Chinese Herbs in Anal Fissure%内括约肌部分切断术联合中药治疗肛裂疗效观察

    Institute of Scientific and Technical Information of China (English)

    方赤波; 林东华; 邓振辉; 叶惠花; 罗凯凡; 张惠芝

    2013-01-01

    目的:探讨肛门内括约肌部分切断术联合中药对肛裂的治疗效果。方法:肛裂患者80例,观察组(40例)予肛裂切除术与肛门内括约肌部分切断术,术后予中药治疗,对照组(40例)予肛裂切除术,术后常规处理,对比两组疗效。结果:两组患者全部治愈,均未发生肛门失禁等严重并发症,伤口愈合时间无显著差异(P>0.05);观察组术后VAS疼痛指数及止痛药用量均显著优于对照组(P0.05);the VAS pain index and painkillers dose in the observation group was significantly better than the control group (P<0.01). Conclusion:Partial internal sphincterotomy combined with Chinese herbs has curative effect in anal fissure.

  18. Electromagnetic effects on the biological tissue surrounding a transcutaneous transformer for an artificial anal sphincter system*

    Science.gov (United States)

    Zan, Peng; Yang, Bang-hua; Shao, Yong; Yan, Guo-zheng; Liu, Hua

    2010-01-01

    This paper reports on the electromagnetic effects on the biological tissue surrounding a transcutaneous transformer for an artificial anal sphincter. The coupling coils and human tissues, including the skin, fat, muscle, liver, and blood, were considered. Specific absorption rate (SAR) and current density were analyzed by a finite-length solenoid model. First, SAR and current density as a function of frequency (10–107 Hz) for an emission current of 1.5 A were calculated under different tissue thickness. Then relations between SAR, current density, and five types of tissues under each frequency were deduced. As a result, both the SAR and current density were below the basic restrictions of the International Commission on Non-Ionizing Radiation Protection (ICNIRP). The results show that the analysis of these data is very important for developing the artificial anal sphincter system. PMID:21121071

  19. Management of Complex Anal Fistulas

    Science.gov (United States)

    Bubbers, Emily J.; Cologne, Kyle G.

    2016-01-01

    Complex anal fistulas require careful evaluation. Prior to any attempts at definitive repair, the anatomy must be well defined and the sepsis resolved. Several muscle-sparing approaches to anal fistula are appropriate, and are often catered to the patient based on their presentation and previous repairs. Emerging technologies show promise for fistula repair, but lack long-term data. PMID:26929751

  20. DO CHANGES IN ANAL SPHINCTER ANATOMY CORRELATE WITH ANAL FUNCTION IN WOMEN WITH A HISTORY OF VAGINAL DELIVERY?

    Directory of Open Access Journals (Sweden)

    Sthela Maria MURAD-REGADAS

    2014-09-01

    Full Text Available Objectives To evaluate anal sphincter anatomy using three-dimensional ultrasonography (3-DAUS in incontinent women with vaginal delivery, correlate anatomical findings with symptoms of fecal incontinence and determine the effect of vaginal delivery on anal canal anatomy and function. Methods Female with fecal incontinence and vaginal delivery were assessed with Wexner’s score, manometry, and 3DAUS. A control group comprising asymptomatic nulliparous was included. Anal pressure, the angle of the defect and length of the external anal sphincter (EAS, the anterior and posterior internal anal sphincter (IAS, the EAS + puborectal and the gap were measured and correlated with score. Results Of the 62, 49 had fecal incontinence and 13 were asymptomatic. Twenty five had EAS defects, 8 had combined EAS+IAS defects, 16 had intact sphincters and continence scores were similar. Subjects with sphincter defects had a shorter anterior EAS, IAS and longer gap than women without defects. Those with a vaginal delivery and intact sphincters had a shorter anterior EAS and longer gap than nulliparous. We found correlations between resting pressure and anterior EAS and IAS length in patients with defects. Conclusions Avaliar a anatomia do esfíncter anal usando ultra-sonografia tridimensional (3D-US em mulheres incontinentes com parto vaginal, correlacionar os achados anatômicos com sintomas de incontinência fecal e, determinar o efeito do parto vaginal sobre a anatomia e função do canal anal.

  1. Management of Anal Squamous Intraepithelial Lesions

    OpenAIRE

    Pineda, Carlos E.; Welton, Mark L.

    2009-01-01

    Anal squamous intraepithelial lesions include both low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and are caused by chronic infection with the human papillomavirus (HPV). The disease is increasing in both incidence and prevalence, especially among patients with the following risk factors: homosexual men, acquired or iatrogenic immunosuppression, and presence of other HPV-related diseases. Although the natural history of the disease is ...

  2. Direct determination of internal radiation dose in human blood

    OpenAIRE

    Tanır, Ayse Güneş; Güleç, Özge

    2014-01-01

    The purpose of this study is to measure the internal radiation dose using a human blood sample. In the literature, there is no process that allows the direct measurement of the internal radiation dose received by a person. The luminescence counts from a blood sample having a laboratory-injected radiation dose and the waste blood of the patient injected with a radiopharmaceutical for diagnostic purposes were both measured. The decay and dose-response curves were plotted for the different doses...

  3. International law, human rights and HIV/AIDS.

    OpenAIRE

    Patterson, David; London, Leslie

    2002-01-01

    This article explores the relevance of international human rights law in the response to the HIV/AIDS epidemic at national and international levels. Public health advocates can use arguments based on this body of law to promote responses to HIV/AIDS that reflect sound public health principles and documented best practice. Development assistance is increasingly linked to rights-based approaches, such as participatory processes, and strategic alliances between health professionals, organization...

  4. 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.

  5. Human Dignity in International Law: Issues and Challenges

    Directory of Open Access Journals (Sweden)

    Izabela Bratiloveanu

    2012-05-01

    Full Text Available We intend to present in this synthesis study the concept of human dignity, reviewing the main legalinstruments on the protection of human rights that defines it, concisely analysing the jurisprudence of theEuropean Court of Justice and of the European Court of Human Rights, focusing on the key moments of itsjurisprudential definition. Human dignity, through its continuously expending presence in international lawand through the controversies related to it, is an exciting and challenging topic of debate for Romanian andforeign literature, being one of the issues and challenges of the new millennium.

  6. Botulinum toxin A in the treatment of anal fissure

    Directory of Open Access Journals (Sweden)

    Stanković Nebojša

    2004-01-01

    Full Text Available Background. This paper presents our first experience in the treatment of primary anal fissure by injection of botulinum A toxin into the internal sphincter. Methods. The study group of the retrospective study included 12 outpatients (8 females and 4 males, mean age 42 (range 18-60. During the period 2000-2003, after unsuccessful conservative treatment, patients were treated with the injections of botulinum A toxin, 100 units on both sides of the anal fissure laterally into the internal anal sphincter (50 units on either side. The patients were clinically evaluated 3, 7, and 30 days, and 3 and 6 months after the treatment. Results. Three fissures had healed after a month, and seven after 3 months. Two remained unhealed, but asymptomatic. There was no incontinence of flatus or faeces after 3 months of the treatment. After temporary healing, two fissures relapsed after 6 months, and these patients had the adequate tonus of the anal sphincter muscles. Except for the temporary incontinence, there were neither other side-efects, nor serious complications. Conclusion. Injection of botulinum A toxin achieved good results in the treatment of anal fissure. The appropriate use makes this method safe as an alternative to surgical treatment of anal fissure.

  7. Determinants of human resource investment in internal controls

    Directory of Open Access Journals (Sweden)

    Jong-Hag Choi

    2013-09-01

    Full Text Available Using the unique reporting environment in Korea, this study investigates the determinants of human resource investment in internal controls for 1352 listed firms disclosing the number of personnel who are in charge of internal control-related tasks (IC personnel from 2005 to 2008. We find that the number of IC personnel within a firm and several key departments increase with firm size, number of employees, complexity and for Chaebols, and decrease in rapidly growing firms. Additional analysis reveals that the factors influencing internal control systems have an accentuated effect on firms with relatively larger firm size.

  8. Determinants of human resource investment in internal controls

    Institute of Scientific and Technical Information of China (English)

    Jong-Hag; Choi; Joonil; Lee; Catherine; Heyjung; Sonu

    2013-01-01

    Using the unique reporting environment in Korea, this study investigates the determinants of human resource investment in internal controls for 1352 listed firms disclosing the number of personnel who are in charge of internal controlrelated tasks(IC personnel) from 2005 to 2008. We find that the number of IC personnel within a firm and several key departments increase with firm size,number of employees, complexity and for Chaebols, and decrease in rapidly growing firms. Additional analysis reveals that the factors influencing internal control systems have an accentuated effect on firms with relatively larger firm size.

  9. International law, human rights and HIV/AIDS.

    Science.gov (United States)

    Patterson, David; London, Leslie

    2002-01-01

    This article explores the relevance of international human rights law in the response to the HIV/AIDS epidemic at national and international levels. Public health advocates can use arguments based on this body of law to promote responses to HIV/AIDS that reflect sound public health principles and documented best practice. Development assistance is increasingly linked to rights-based approaches, such as participatory processes, and strategic alliances between health professionals, organizations of people living with HIV/AIDS, and affected communities. Legal and human rights advocacy strategies are increasingly productive and necessary. PMID:12571725

  10. [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.

  11. Toward a Hermeneutical Theory of International Human Rights Education

    Science.gov (United States)

    Al-Daraweesh, Fuad; Snauwaert, Dale T.

    2013-01-01

    The purpose of this essay is to articulate and defend the epistemological foundations of international human rights education from the perspective of a hermeneutical interpretive methodology. Fuad Al-Daraweesh and Dale Snauwaert argue here that this methodology potentially alleviates the challenges that face the cross-cultural implementation of…

  12. Toward a Hermeneutical Theory of International Human Rights Education

    Science.gov (United States)

    Al-Daraweesh, Fuad; Snauwaert, Dale T.

    2013-01-01

    The purpose of this essay is to articulate and defend the epistemological foundations of international human rights education from the perspective of a hermeneutical interpretive methodology. Fuad Al-Daraweesh and Dale Snauwaert argue here that this methodology potentially alleviates the challenges that face the cross-cultural implementation of…

  13. The Human Rights Approach to Education in International Organisations

    Science.gov (United States)

    Hufner, Klaus

    2011-01-01

    In this article, the work of three international governmental organisations (IGOs) dealing with human rights will be discussed, namely the United Nations Educational, Scientific and Cultural Organization (UNESCO), the United Nations Children's Fund (UNICEF) and the Council of Europe (CoE). In the first section, the main characteristics of the…

  14. The Human Rights Approach to Education in International Organisations

    Science.gov (United States)

    Hufner, Klaus

    2011-01-01

    In this article, the work of three international governmental organisations (IGOs) dealing with human rights will be discussed, namely the United Nations Educational, Scientific and Cultural Organization (UNESCO), the United Nations Children's Fund (UNICEF) and the Council of Europe (CoE). In the first section, the main characteristics of the…

  15. The role of polymerase chain reaction of high-risk human papilloma virus in the screening of high-grade squamous intraepithelial lesions in the anal mucosa of human immunodeficiency virus-positive males having sex with males.

    Science.gov (United States)

    Hidalgo-Tenorio, Carmen; Rivero-Rodriguez, Mar; Gil-Anguita, Concepción; Esquivias, Javier; López-Castro, Rodrigo; Ramírez-Taboada, Jessica; de Hierro, Mercedes López; López-Ruiz, Miguel A; Martínez, R Javier; Llaño, Juan P

    2015-01-01

    To evaluate the advantages of cytology and PCR of high-risk human papilloma virus (PCR HR-HPV) infection in biopsy-derived diagnosis of high-grade squamous intraepithelial lesions (HSIL = AIN2/AIN3) in HIV-positive men having sex with men (MSM). This is a single-centered study conducted between May 2010 and May 2014 in patients (n = 201, mean age 37 years) recruited from our outpatient clinic. Samples of anal canal mucosa were taken into liquid medium for PCR HPV analysis and for cytology. Anoscopy was performed for histology evaluation. Anoscopy showed 33.8% were normal, 47.8% low-grade squamous intraepithelial lesions (LSIL), and 18.4% HSIL; 80.2% had HR-HPV. PCR of HR-HPV had greater sensitivity than did cytology (88.8% vs. 75.7%) in HSIL screening, with similar positive (PPV) and negative predictive value (NPV) of 20.3 vs. 22.9 and 89.7 vs. 88.1, respectively. Combining both tests increased the sensitivity and NPV of HSIL diagnosis to 100%. Correlation of cytology vs. histology was, generally, very low and PCR of HR-HPV vs. histology was non-existent (treatment protects against the appearance of HSIL [corrected].

  16. International Law and Human Rights: Trends concerning International Migrants and Refugees.

    Science.gov (United States)

    Goodwin-Gill, Guy S.

    1989-01-01

    Places migrants and refugees within the human rights context, contrasting inalienable rights with the demands of sovereignty, and juxtaposing the two in a context of existing and developing international standards. Shows how the law must evolve, responding coherently to contemporary problems, if the structure of rights is to be maintained.…

  17. International Law and Human Rights: Trends concerning International Migrants and Refugees.

    Science.gov (United States)

    Goodwin-Gill, Guy S.

    1989-01-01

    Places migrants and refugees within the human rights context, contrasting inalienable rights with the demands of sovereignty, and juxtaposing the two in a context of existing and developing international standards. Shows how the law must evolve, responding coherently to contemporary problems, if the structure of rights is to be maintained.…

  18. Public Discourse on Human Trafficking in International Issue Arenas

    Directory of Open Access Journals (Sweden)

    Niina Meriläinen

    2015-01-01

    Full Text Available The purpose of this study is to better understand how the complex problem of human trafficking is addressed in international debates. How the discussion about human trafficking develops and how it is debated ultimately influences how the decision-making process unfolds. In order to understand the formation of public policy and laws, therefore, it is important to study the debate that occurs prior to decision making. This analysis focuses on the narratives used by major, well-established human rights and political actors that argue for necessary actions to be undertaken—such as the formation of new policies and laws in the European Union—as an attempt to protect citizens of the EU and other regions in the world from becoming victims of trafficking networks. Our research examines how the topic of human trafficking is framed and how this framework is intertwined in the debate with other social problems. We focus on how human trafficking is discussed by two well-established human rights Non-Governmental Organizations (NGOs, Amnesty International (Amnesty and Human Rights Watch (HRW, in addition to the European Parliament (EP. The research questions for this study include: (1 In what context is human trafficking discussed by the three actors? (2 How do these actors frame the definition of human trafficking in their presentations? To answer these questions, we have conducted a systematic content analysis of documents that include official statements and research reports of the NGOs, as well as resolutions and recommendations of the EP. Altogether, 240 documents were analyzed in detail. These findings indicate that the two human rights organizations, Amnesty and Human Rights Watch, along with the European Parliament, all address human trafficking as an important social problem, albeit to varying degrees. Each actor has a different method of correlating human trafficking with many other social problems, thereby emphasizing different causes and

  19. The Impact of International Human Rights Law on International Criminal Procedure = De invloed van internationale mensenrechten op internationaal strafprocesrecht

    NARCIS (Netherlands)

    Zeegers, K.

    2013-01-01

    This article examines the impact of international human rights law on international criminal procedure. Given the fact that international criminal courts and tribunals (ICTs) are not party to human rights treaties, the question arises whether these norms formally even apply to them. The first part o

  20. The Impact of International Human Rights Law on International Criminal Procedure = De invloed van internationale mensenrechten op internationaal strafprocesrecht

    NARCIS (Netherlands)

    Zeegers, K.

    2013-01-01

    This article examines the impact of international human rights law on international criminal procedure. Given the fact that international criminal courts and tribunals (ICTs) are not party to human rights treaties, the question arises whether these norms formally even apply to them. The first part o

  1. Anal sphincter injury in vaginal deliveries complicated by shoulder dystocia.

    Science.gov (United States)

    Hehir, Mark P; Rubeo, Zachary; Flood, Karen; Mardy, Anne H; O'Herlihy, Colm; Boylan, Peter C; D'Alton, Mary E

    2017-05-18

    Shoulder dystocia is an obstetric emergency that occurs in 0.2-3% of all cephalic vaginal deliveries. We hypothesized that because of the difficult nature of deliveries complicated by shoulder dystocia, the condition may be associated with anal sphincter injury. We sought to identify risk factors for obstetric anal sphincter injury in women with shoulder dystocia. This retrospective analysis included all cases of shoulder dystocia from 2007 to 2011 at two large tertiary referral centers, in the USA and Ireland. Details of maternal demographics, intrapartum characteristics, and delivery outcomes in cases of shoulder dystocia were analyzed. Univariate and multivariate analyses were used to describe the association between shoulder dystocia and anal sphincter injury. There were 685 cases of shoulder dystocia, and the rate of shoulder dystocia was similar at both institutions. The incidence of anal sphincter injury was 8.8% (60 out of 685). The rate was 14% (45 out of 324) in nulliparas and 4.2% (15 out of 361) in multiparas. Women with sphincter injury were more likely to be nulliparous (75% [45 out of 60] vs 45% [279 out of 625]; p anal sphincter injury is 9%. Risk factors include nulliparity, operative vaginal delivery, and use of internal maneuvers, whereas episiotomy was found to have a protective effect against anal sphincter injury during cases of shoulder dystocia.

  2. Electrocautery for Precancerous Anal Lesions

    Science.gov (United States)

    Results from a randomized clinical trial conducted in Amsterdam suggest that electrocautery is better than topical imiquimod or fluorouracil at treating potentially precancerous anal lesions in HIV-positive men who have sex with men.

  3. Anal fistula. Past and present

    National Research Council Canada - National Science Library

    Zubaidi, Ahmad M

    2014-01-01

    Anal fistula is a common benign condition that typically describes a miscommunication between the anorectum and the perianal skin, which may present de novo, or develop after acute anorectal abscess...

  4. Direct and indirect costs for anal fistula in Sweden.

    Science.gov (United States)

    Lundqvist, Adam; Ahlberg, Ida; Hjalte, Frida; Ekelund, Mats

    2016-11-01

    Anal fistula is an abnormal tract with an external and internal opening that cause leakage, discomfort, and occasionally pain. Surgery is standard treatment, but recurrence and anal incontinence is common. The objective of the study was to analyze resource use, costs and sick leave for newly diagnosed patients with anal fistula in Sweden. The study was based on register data from linkages between Swedish population-based registers including patients treated for anal fistula in Västra Götaland County, Sweden. Health care resource use, costs and sick leave were estimated. The sample included 362 patients of which 27% had no surgery, 37% had one surgery and 36% had multiple surgeries. Patients with multiple surgeries underwent over four surgeries on average. Approximately 67% of the contacts occurred during the first year after diagnosis. Estimated mean sick leave was 10.4 full-time equivalent days per patient. Total discounted costs were €5,561 per patient where approximately 80% were direct costs. To our knowledge this is the first study of resource use, costs and sick leave related to anal fistulas. The study indicates that anal fistula is a condition that is costly for society and that the burden of anal fistula in terms of health care resources and sick leave is especially high for patients experiencing multiple surgeries. Anal fistula is a condition that is costly for society and there is an unmet need for the group of patients with multiple surgeries to find appropriate treatment interventions. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  5. Modern management of anal fistula.

    Science.gov (United States)

    Limura, Elsa; Giordano, Pasquale

    2015-01-07

    Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of continence. For the simple and most distal fistulae, conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore, well accepted in clinical practise. However, for the more complex fistulae where a significant proportion of the anal sphincter is involved, great concern remains about damaging the sphincter and subsequent poor functional outcome, which is quite inevitable following conventional surgical treatment. For this reason, over the last two decades, many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function. Among them, the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula. Another technique, the anal fistula plug, derived from porcine small intestinal submucosa, is safe but modestly effective in long-term follow-up, with success rates varying from 24%-88%. The failure rate may be due to its extrusion from the fistula tract. To obviate that, a new designed plug (GORE BioA®) was introduced, but long term data regarding its efficacy are scant. Fibrin glue showed poor and variable healing rate (14%-74%). FiLaC and video-assisted anal fistula treatment procedures, respectively using laser and electrode energy, are expensive and yet to be thoroughly assessed in clinical practise. Recently, a therapy using autologous adipose-derived stem cells has been described. Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae, and studies remain in progress. The aim of this present article is to review the pertinent literature, describing the advantages and limitations of

  6. Comparative study of anal acoustic reflectometry and anal manometry in the assessment of faecal incontinence

    DEFF Research Database (Denmark)

    Hornung, B R; Mitchell, P J; Carlson, G L;

    2012-01-01

    Anal acoustic reflectometry (AAR) is a reproducible technique providing a novel physiological assessment of anal sphincter function. It may have advantages over conventional anal manometry. The aims of this study were to determine the ability of AAR and anal manometry to identify changes in anal...

  7. Anal intraepitelial neoplasia: a narrative review

    Directory of Open Access Journals (Sweden)

    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.

  8. New Techniques for Treating an Anal Fistula

    OpenAIRE

    Song, Kee Ho

    2012-01-01

    Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is exp...

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

    OpenAIRE

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

    2012-01-01

    Objective: 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). Materials and Methods: The study was conducted among FSW attending 11 randomly selected sexually transmitted infection (STI) clinics in Bill and Melinda Gates supported targe...

  10. The third international workshop of human chromosome 5. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-12-31

    The Third International Workshop on Human Chromosome 5 was held in Laguna Beach, California, March 5-8, 1994. The pace at which new mapping information has been published in the last year make almost any report outdated before publication. Much of the information in this report and the most recent data from the Human chromosome 5 Genome Center at U.C. Irvine on the physical map of chromosome 5 are accessible via a WWW server. For most loci referred to in this report that can be detected by Polymerase Chain Reaction, the sequences of the oligonucleotide primers are available and some primer sequences are provided in this report.

  11. International human rights law aspects of forced migrations, evictions and displacement: current issues and challenges

    OpenAIRE

    Scholten, Andrew

    2016-01-01

    The aim of this paper is an analysis of the categories of evictions, forced migrations and internal displacement in the context of international human rights law. Forced migrations and selected categories of internal displacement are important issues of international human rights law and international humanitarian law for more than forty years. The UDHR, adopted in 1948, does not contain any provisions related to forced human mobility and internal displacement. Despite this fact ...

  12. Strategic human resource management: insights from the international hotel industry

    OpenAIRE

    Gannon, Judie; Roper, Angela; Liz, Doherty

    2015-01-01

    In the strategic human resource management (SHRM) field three approaches have dominated, namely, the universal or best-practice, best-fit or contingency and resource-based view (RBV). This study investigates evidence for the simultaneous or mixed adoption of these approaches by eight case study firms in the international hotel industry. Findings suggest there is considerable evidence of the combined use of the first two approaches but that the SHRM RBV approach was difficult to achieve by all...

  13. Euthanasia and international human rights law: prolegomena for an international debate.

    Science.gov (United States)

    Van den Akker, B; Janssens, R M; Ten Have, H A

    1997-10-01

    In this paper we examine in what respects international human rights law can provide a basis for the establishment of an international debate on euthanasia. Such a debate seems imperative, as in many countries euthanasia is considered taboo in the context of medical practice, yet at the same time, supposedly, decisions are taken to intentionally shorten patients' lives. In the Netherlands, the act of euthanasia will not lead to the prosecution of the physician involved if the physician has complied with certain procedures. The Dutch debate centres on procedures marginalizing important moral aspects of euthanasia. An international debate, addressing the fundamental morality of euthanasia and of other medical decisions involving the end of life, will eventually enhance medical practice in the Netherlands as well as in other countries.

  14. FREEDOM OF SPEECH IN INDONESIAN PRESS: INTERNATIONAL HUMAN RIGHTS PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Clara Staples

    2016-06-01

    Full Text Available This paper will firstly examine the international framework of human rights law and its guidelines for safeguarding the right to freedom of speech in the press. Secondly, it will describe the constitutional and other legal rights protecting freedom of speech in Indonesia and assess their compatibility with the right to freedom of speech under the international human rights law framework. Thirdly it will consider the impact of Indonesia’s constitutional law and criminal and civil law, including sedition and defamation laws, and finally media ownership, on the interpretation and scope of the right to freedom of speech in the press. Consideration of these laws will be integrated with a discussion of judicial processes. This discussion will be used to determine how and in what circumstances the constitutional right to freedom of speech in the press may be facilitated or enabled, or on the other hand, limited, overridden or curtailed in Indonesia. Conclusions will then be drawn regarding the strengths and weaknesses of Indonesian laws in safeguarding the right to freedom of speech in the press and the democratic implications from an international human rights perspective. This inquiry will be restricted to Indonesian laws in existence during the post-New Order period of 1998 to the present, and to the information and analysis provided by English-language sources.

  15. Human rights, cultural pluralism, and international health research.

    Science.gov (United States)

    Marshall, Patricia A

    2005-01-01

    In the field of bioethics, scholars have begun to consider carefully the impact of structural issues on global population health, including socioeconomic and political factors influencing the disproportionate burden of disease throughout the world. Human rights and social justice are key considerations for both population health and biomedical research. In this paper, I will briefly explore approaches to human rights in bioethics and review guidelines for ethical conduct in international health research, focusing specifically on health research conducted in resource-poor settings. I will demonstrate the potential for addressing human rights considerations in international health research with special attention to the importance of collaborative partnerships, capacity building, and respect for cultural traditions. Strengthening professional knowledge about international research ethics increases awareness of ethical concerns associated with study design and informed consent among researchers working in resource-poor settings. But this is not enough. Technological and financial resources are also necessary to build capacity for local communities to ensure that research results are integrated into existing health systems. Problematic issues surrounding the application of ethical guidelines in resource-poor settings are embedded in social history, cultural context, and the global political economy. Resolving the moral complexities requires a commitment to engaged dialogue and action among investigators, funding agencies, policy makers, governmental institutions, and private industry.

  16. Conceptualizations of heterosexual anal sex and HIV risk in five East African communities.

    Science.gov (United States)

    Duby, Zoe; Colvin, Christopher

    2014-01-01

    Heterosexual anal sex is underresearched and little understood, particularly in the African context. Existing prevalence data indicate that heterosexual anal sex is a widespread practice, yet little is known about the way in which it is conceptualized and understood. Describing findings from qualitative research conducted in Kenya, Tanzania, and Uganda, we shed light on conceptualizations of heterosexual anal sex and its relation to human immunodeficiency virus (HIV). These findings suggest that penile-anal sex is practiced by men and women in Africa for a range of reasons, including virginity maintenance, contraception, fulfillment of male pleasure, relationship security, menstruation, in the presence of vaginal complications, financial gain, fidelity, and prestige. Despite anal sex being the most efficient way to transmit HIV sexually, there is widespread lack of knowledge about its risks. These findings describe the ways in which anal sex is conceptualized in five East African communities, highlighting how penile-anal intercourse is often not considered "sex" and how the omission of anal sex in safe-sex messaging is interpreted as meaning that anal sex is safe. In light of its frequency and risks, greater attention must be paid to heterosexual anal sex in Africa to ensure a comprehensive approach to HIV prevention.

  17. Anal squamous carcinoma: a new AIDS-defining cancer? Case report and literature review

    Directory of Open Access Journals (Sweden)

    Marcelo Corti

    2012-12-01

    Full Text Available Squamous anal cell carcinoma is a rare malignancy that represents the 1.5% to 2% of all the lower digestive tract cancers. However, an increased incidence of invasive anal carcinoma is observed in HIV-seropositive population since the widespread of highly active antiretroviral therapy. Human papillomavirus is strongly associated with the pathogenesis of anal cancer. Anal intercourse and a high number of sexual partners appear to be risk factors to develop anal cancer in both sexes. Anal pain, bleeding and a palpable lesion in the anal canal are the most common clinical features. Endo-anal ultrasound is the best diagnosis method to evaluate the tumor size, the tumor extension and the infiltration of the sphincter muscle complex. Chemoradiotherapy plus antiretroviral therapy are the recommended treatments for all stages of localized squamous cell carcinoma of the anal canal in HIV-seropositive patients because of its high rate of cure. Here we present an HIV patient who developed a carcinoma of the anal canal after a long time of HIV infection under highly active antiretroviral therapy with a good virological and immunological response.

  18. Documentation: International Legal Human Rights Framework -- Human Rights and the Institutionalisation of ASEAN: An Ambiguous Relationship

    Directory of Open Access Journals (Sweden)

    Theodor Rathgeber

    2014-01-01

    Full Text Available While the ASEAN Charter of 2007 heralded an era of improved democracy, human rights protection and good governance in accordance with the rule of law, the reality on the ground tells a different story. While all of the trappings of a human rights mechanism are in place, the normative and protective capacity of the regime is ambiguous at best. The adoption of core international human rights treaties by ASEAN member states presents an ambiguous picture, one which reveals significant variations between the ten countries. The purported institutionalisation of international human rights standards since 2007 in the region via the creation of an ASEAN human rights mechanism in that year is betrayed by the poor condition of actual protection of human rights at the national and regional level. The article analyses the situation on the ground in light of the normative obligations and aspirations of the states.

  19. The Discourse on Human Rights and the International Regime of Human Rights

    Directory of Open Access Journals (Sweden)

    Eyassu Gayim

    2016-11-01

    Full Text Available The international regime of human rights governs the kinds of freedoms, liberties, benefits, autonomy and protection which human beings are entitled to, what kind of obligations we have in this connection and what the roles of states are in recognizing and protecting these rights. Yet, the sources, foundation and justifications for these rights and who we are by nature to deserve some rights has been contentious over the centuries, not least because we live in social context, which requires balancing rights by meeting the broader community interests: political order, stability, and satisfying the general welfare. This paper re-visits the major contentious positions in the discourse on human rights for purposes of explaining how the international community has navigated when shaping the contours of the international regime of human rights. Has this regime endorsed, rejected or avoided some of these positions? Does it follow a clear political ideology?

  20. Fourth international workshop on human chromosome 5. Final progress report

    Energy Technology Data Exchange (ETDEWEB)

    McPherson, J.D.

    1996-12-31

    The Fourth International Workshop on Human Chromosome 5 was held in Manchester, UK on November 9--10, 1996 and was hosted by the University of Manchester. The major goals of the workshop were: (1) to collate the various genetic, cytogenetic and physical maps of human chromosome 5; (2) to integrate these maps and identify/correct discrepancies between them wherever possible; (3) to catalogue the sequence-ready contigs of the chromosome; (4) to co-ordinate the various sequencing efforts to avoid future duplication; (5) to establish the first (to the author`s knowledge) web site for the human chromosome 5 community which contains the above information in a readily accessible form.

  1. PERFORMANCE OF HUMAN RESOURCE MANAGEMENT IN AN INTERNATIONALLY OPERATING COMPANY

    Directory of Open Access Journals (Sweden)

    Ladislav Mura

    2012-02-01

    Full Text Available In our days, society is greatly influenced and altered by the process of internationalization andglobalization. Globalization refers to a whole set of changes, not to one single dimensional change.The process of internationalization puts a special and high importance on the work of humanresources managers. In order to remain successful and competitive in the international businessenvironment, companies have to pay close attention to cultural factors. These may considerablydiffer among workers in multinational companies. We are taking a careful look at human resourcemanagement in this new age, and especially at the impact of globalization and internationalization.Our case study is built on the company MOL, specifically on some of the activities it develops in thefield of human resource management: training programmes, personnel motivation, careerdevelopment. We highlight some of the critical aspects of human resources management at MOL,and see what lessons are being learned and what conclusions we can draw.

  2. Current treatment options for management of anal intraepithelial neoplasia

    Science.gov (United States)

    Weis, Stephen E

    2013-01-01

    Anal squamous cell cancer is an uncommon malignancy caused by infection with oncogenic strains of Human papilloma virus. Anal cancer is much more common in immunocompromised persons, including those infected with Human immunodeficiency virus. High-grade anal intraepithelial neoplasia (HGAIN), the precursor of anal cancer, is identified by clinicians providing care for patients with anorectal disease, and is increasingly being identified during screening of immunosuppressed patients for anal dysplasia. The traditional treatment for HGAIN has been excision of macroscopic disease with margins. This approach is effective for patients with small unifocal HGAIN lesions. Patients with extensive multifocal HGAIN frequently have recurrence of HGAIN after excision, and may have postoperative complications of anal stenosis or fecal incontinence. This led to the suggestion by some that treatment for HGAIN should be delayed until patients developed anal cancer. Alternative approaches in identification and treatment have been developed to treat patients with multifocal or extensive HGAIN lesions. High-resolution anoscopy combines magnification with anoscopy and is being used to identify HGAIN and determine treatment margins. HGAIN can then be ablated with a number of modalities, including infrared coagulation, CO2 laser, and electrocautery. These methods for HGAIN ablation can be performed with local anesthesia on outpatients and are relatively well tolerated. High-resolution anoscopy-directed HGAIN ablation is evolving into a standard approach for initial treatment and then subsequent monitoring of a disease which should be expected to be recurrent. Another treatment approach for HGAIN is topical treatment, principally with 5-fluorouracil or imiquimod. Topical therapies have the advantage of being nonsurgical and are well suited for treating widespread multifocal disease. Topical treatments have the disadvantage of requiring extended treatment courses and causing a symptomatic

  3. Internalization of cystatin C in human cell lines.

    Science.gov (United States)

    Ekström, Ulf; Wallin, Hanna; Lorenzo, Julia; Holmqvist, Bo; Abrahamson, Magnus; Avilés, Francesc X

    2008-09-01

    Altered protease activity is considered important for tumour invasion and metastasis, processes in which the cysteine proteases cathepsin B and L are involved. Their natural inhibitor cystatin C is a secreted protein, suggesting that it functions to control extracellular protease activity. Because cystatins added to cell cultures can inhibit polio, herpes simplex and coronavirus replication, which are intracellular processes, the internalization and intracellular regulation of cysteine proteases by cystatin C should be considered. The extension, mechanism and biological importance of this hypothetical process are unknown. We investigated whether internalization of cystatin C occurs in a set of human cell lines. Demonstrated by flow cytometry and confocal microscopy, A-431, MCF-7, MDA-MB-453, MDA-MB-468 and Capan-1 cells internalized fluorophore-conjugated cystatin C when exposed to physiological concentrations (1 microm). During cystatin C incubation, intracellular cystatin C increased after 5 min and accumulated for at least 6 h, reaching four to six times the baseline level. Western blotting showed that the internalized inhibitor was not degraded. It was functionally intact and extracts of cells exposed to cystatin C showed a higher capacity to inhibit papain and cathepsin B than control cells (decrease in enzyme activity of 34% and 37%, respectively). The uptake of labelled cystatin C was inhibited by unlabelled inhibitor, suggesting a specific pathway for the internalization. We conclude that the cysteine protease inhibitor cystatin C is internalized in significant quantities in various cancer cell lines. This is a potentially important physiological phenomenon not previously described for this group of inhibitors.

  4. Anal fistula. Past and present.

    Science.gov (United States)

    Zubaidi, Ahmad M

    2014-09-01

    Anal fistula is a common benign condition that typically describes a miscommunication between the anorectum and the perianal skin, which may present de novo, or develop after acute anorectal abscess. Athough anal fistulae are benign, the condition can still negatively influence a patient's quality of life by causing minor pain, social hygienic embarrassment, and in severe cases, frank sepsis. Despite its long history and prevalence, anal fistula management remains one of the most challenging and controversial topics in colorectal surgery today. The end goals of treatment include draining the local infection, eradicating the fistulous tract, and minimizing recurrence and incontinence rates. The goal of this review is to ensure surgeons and physicians are aware of the different imaging and treatment choices available, and to report expected outcomes of the various surgical modalities so they may select the most suitable treatment. 

  5. Expanded benefits for humanity from the International Space Station

    Science.gov (United States)

    Rai, Amelia; Robinson, Julie A.; Tate-Brown, Judy; Buckley, Nicole; Zell, Martin; Tasaki, Kazuyuki; Karabadzhak, Georgy; Sorokin, Igor V.; Pignataro, Salvatore

    2016-09-01

    In 2012, the International Space Station (ISS) (Fig. 1) partnership published the updated International Space Station Benefits for Humanity[1], a compilation of stories about the many benefits being realized in the areas of human health, Earth observations and disaster response, and global education. This compilation has recently been revised to include updated statistics on the impacts of the benefits, and new benefits that have developed since the first publication. Two new sections have also been added to the book, economic development of space and innovative technology. This paper will summarize the updates on behalf of the ISS Program Science Forum, made up of senior science representatives across the international partnership. The new section on "Economic Development of Space" highlights case studies from public-private partnerships that are leading to a new economy in low earth orbit (LEO). Businesses provide both transportation to the ISS as well as some research facilities and services. These relationships promote a paradigm shift of government-funded, contractor-provided goods and services to commercially-provided goods purchased by government agencies. Other examples include commercial firms spending research and development dollars to conduct investigations on ISS and commercial service providers selling services directly to ISS users. This section provides examples of ISS as a test bed for new business relationships, and illustrates successful partnerships. The second new section, "Innovative Technology," merges technology demonstration and physical science findings that promise to return Earth benefits through continued research. Robotic refueling concepts for life extensions of costly satellites in geo-synchronous orbit have applications to robotics in industry on Earth. Flame behavior experiments reveal insight into how fuel burns in microgravity leading to the possibility of improving engine efficiency on Earth. Nanostructures and smart fluids are

  6. Expanded Benefits for Humanity from the International Space Station

    Science.gov (United States)

    Rai, Amelia; Robinson, Julie A.; Tate-Brown, Judy; Buckley, Nicole; Zell, Martin; Tasaki, Kazuyuki; Karabadzhak, Georgy; Sorokin, Igor V.; Pignataro, Salvatore

    2016-01-01

    In 2012, the International Space Station (ISS) partnership published the updated International Space Station Benefits for Humanity, 2nd edition, a compilation of stories about the many benefits being realized in the areas of human health, Earth observations and disaster response, and global education. This compilation has recently been revised to include updated statistics on the impacts of the benefits, and new benefits that have developed since the first publication. Two new sections have also been added to the book, economic development of space and innovative technology. This paper will summarize the updates on behalf of the ISS Program Science Forum, made up of senior science representatives across the international partnership. The new section on "Economic Development of Space" highlights case studies from public-private partnerships that are leading to a new economy in low earth orbit (LEO). Businesses provide both transportation to the ISS as well as some research facilities and services. These relationships promote a paradigm shift of government-funded, contractor-provided goods and services to commercially-provided goods purchased by government agencies. Other examples include commercial firms spending research and development dollars to conduct investigations on ISS and commercial service providers selling services directly to ISS users. This section provides examples of ISS as a test bed for new business relationships, and illustrates successful partnerships. The second new section, Innovative Technology, merges technology demonstration and physical science findings that promise to return Earth benefits through continued research. Robotic refueling concepts for life extensions of costly satellites in geo-synchronous orbit have applications to robotics in industry on Earth. Flame behavior experiments reveal insight into how fuel burns in microgravity leading to the possibility of improving engine efficiency on Earth. Nanostructures and smart fluids are

  7. Ultrastructure of the ganglion on human internal laryngeal nerve.

    Science.gov (United States)

    Ramaswamy, S; Shankar, S K; Manjunath, K Y; Devanathan, P H; Nityaseelan, N

    1994-01-01

    There is now definite evidence for the presence of a macroscopic ganglion on the human internal laryngeal nerve, with the distribution of its post-ganglionic fibres to the glands in the saccule and to the glands at the root of epiglottis in the vicinity of the opening of the saccule. This ganglion could be identified as early as 14 weeks in human foetal larynx, which contains immature neurons. Seven ganglia, dissected from human laryngectomy specimens and resected for carcinoma larynx, were studied by electron microscopy. Ultrastructurally, the neurons and the synaptic terminals had both small, round, luscent vesicles and dense core vesicles. Symmetrical, asymmetrical and electrical synaptic complexes were noted. A few neurons revealed degenerative changes suggestive of axotomy. The location of the ganglion on the internal laryngeal nerve, a branch of nervus vagus, and ultrastructural demonstration of large and small dense core vesicles and small luscent vesicles in the neurons of this ganglion, lead us to believe that the ganglion is parasympathetic in nature.

  8. Acompañamiento in Colombia: international human rights protection of IDPs

    Directory of Open Access Journals (Sweden)

    Luis Enrique Eguren

    1999-04-01

    Full Text Available The deployment of international observerscan effectively deter human rights violationsagainst displaced people and those workingwith them. This article discusses the role oforganisations such as Peace BrigadesInternational in providing international humanrights protection.

  9. Mapping internal connectivity through human migration in malaria endemic countries.

    Science.gov (United States)

    Sorichetta, Alessandro; Bird, Tom J; Ruktanonchai, Nick W; Zu Erbach-Schoenberg, Elisabeth; Pezzulo, Carla; Tejedor, Natalia; Waldock, Ian C; Sadler, Jason D; Garcia, Andres J; Sedda, Luigi; Tatem, Andrew J

    2016-08-16

    Human mobility continues to increase in terms of volumes and reach, producing growing global connectivity. This connectivity hampers efforts to eliminate infectious diseases such as malaria through reintroductions of pathogens, and thus accounting for it becomes important in designing global, continental, regional, and national strategies. Recent works have shown that census-derived migration data provides a good proxy for internal connectivity, in terms of relative strengths of movement between administrative units, across temporal scales. To support global malaria eradication strategy efforts, here we describe the construction of an open access archive of estimated internal migration flows in endemic countries built through pooling of census microdata. These connectivity datasets, described here along with the approaches and methods used to create and validate them, are available both through the WorldPop website and the WorldPop Dataverse Repository.

  10. Direct determination of internal radiation dose in human blood

    CERN Document Server

    Tanır, Ayse Güneş

    2014-01-01

    The purpose of this study is to measure the internal radiation dose using a human blood sample. In the literature, there is no process that allows the direct measurement of the internal radiation dose received by a person. The luminescence counts from a blood sample having a laboratory-injected radiation dose and the waste blood of the patient injected with a radiopharmaceutical for diagnostic purposes were both measured. The decay and dose-response curves were plotted for the different doses. The doses received by the different blood aliquots can be determined by interpolating the luminescence counts to the dose-response curve. This study shows that the dose received by a person can be measured directly, simply and retrospectively by using only a very small amount of blood sample. The results will have important ramifications for the medicine and healthcare fields in particular. This will also be very important in cases of suspicion of radiation poisoning, malpractice and so on.

  11. Invited Commentary: Biological and Clinical Insights From Epidemiologic Research Into HIV, HPV, and Anal Cancer

    Science.gov (United States)

    Engels, Eric A.; Madeleine, Margaret M.

    2013-01-01

    Anal cancer is common among people infected with human immunodeficiency virus (HIV). This cancer is caused by human papillomavirus, and immunosuppression likely contributes to its development. In this issue of the Journal, Bertisch et al. (Am J Epidemiol. 2013;178(6):877–884) present the results of a case-control study of anal cancer among HIV-infected people in Switzerland. They demonstrate that anal cancer risk is increased in association with a low CD4+ cell count (a clinical measurement of immune status). In particular, HIV-induced immunosuppression was most severe among cases approximately 6–7 years prior to the diagnosis of anal cancer. A plausible biological interpretation is that immunosuppression is important at an early stage of the development of anal cancer, but that the neoplastic process becomes irreversible over time with persistent human papillomavirus infection and genetic damage. With current efforts to provide earlier combination antiretroviral therapy to HIV-infected people, anal cancer incidence may start to decline. Bertisch et al. also demonstrate a strong association between serum antibodies against the human papillomavirus type 16 protein E6 and anal cancer risk, highlighting the role of this viral oncoprotein in carcinogenesis. Additional biomarkers could help refine clinical approaches to anal cancer screening and prevention for the HIV-infected population. PMID:23900552

  12. Report on the Second International Workshop on Human Chromosome 9

    Energy Technology Data Exchange (ETDEWEB)

    Kwiatkowski, D.J. [Brigham and Women`s Hospital, Boston, MA (United States); Armour, J. [Univ. of Leicester (England). Dept. of Genetics; Bale, A.E. [Yale Univ., New Haven, CT (United States). Dept. of Genetics] [and others

    1993-12-31

    The Second International Workshop on Human Chromosome 9 was held in Chatham, Massachusetts on April 18--20, 1993. Fifty-three abstracts were received and the data presented on posters. The purpose of the meeting was to bring together all interested investigators working on the map of chromosome 9, many of whom had disease-specific interests. After a brief presentation of interests and highlighted results, the meeting broke up into the following subgroups for production of consensus maps: 9p; 9cen-q32; 9q32 ter. A global mapping group also met. Reports of each of these working groups is presented in the summary.

  13. Human Asset Internalization and Global Sourcing of Services

    DEFF Research Database (Denmark)

    Ørberg Jensen, Peter D.; Petersen, Bent

    In this exploratory study we look at human asset aspects of offshore outsourcing of services that over time become more advanced and strategic potent to the outsourcing firms. As a consequence, the outsourcing firms might want to internalize the operations. We focus on the ways that outsourcing...... firms may transfer key personnel of local service providers to whollyownedsubsidiaries. We argue that a felt need for applying more powerful incentives on key personnel of the service provider ‐ to harness and empower the sourcing operation ‐ may in itself be a motive for, and key driver of...

  14. Human Internal Jugular Valve M-mode Ultrasound Characterization

    OpenAIRE

    Menegatti, Erica; Tessari, Mirko; Gianesini, Sergio; Vannini, Maria Elena; Sisini, Francesco; Zamboni, Paolo

    2013-01-01

    In humans the mechanism governing the internal jugular vein (IJV) valve opening and closure is still unclear. M-mode is used in echo-cardiology for the heart valves assessment. Sometimes it was performed also in deep peripheral veins and in vena cava assessment, but never in the IJV valve. Aim of the present study is to investigate the IJV valves physiology in healthy volunteers, by means of both B and M-mode ultrasound. Eighty-three (83) healthy volunteers (35 Male, 48 Female, 25.7±6.7 y.o.)...

  15. An experience with video-assisted anal fistula treatment (VAAFT) with new insights into the treatment of anal fistulae.

    Science.gov (United States)

    Seow-En, I; Seow-Choen, F; Koh, P K

    2016-06-01

    The aim of this retrospective study was to assess our experience of 41 patients with anal fistulae treated with video-assisted anal fistula treatment (VAAFT). Forty-one consecutive patients with cryptoglandular anal fistulae were included. Patients with low intersphincteric anal fistulae or those with gross perineal abscess were excluded. Eleven (27 %) patients had undergone prior fistula surgery with 5 (12 %) having had three or more previous operations. All patients underwent the diagnostic phase as well as diathermy and curettage of the fistula tracts during VAAFT. Primary healing rate was 70.7 % at a median follow-up of 34 months. Twelve patients recurred or did not heal and underwent a repeat VAAFT procedure utilising various methods of dealing with the internal opening. There was a secondary healing rate of 83 % with two recurrences. Overall, stapling of the internal opening had a 22 % recurrence rate, while anorectal advancement flap had a 75 % failure rate. There was no recurrence seen in six cases after using the over-the-scope-clip (OTSC(®)) system to secure the internal opening. VAAFT is useful in the identification of fistula tracts and enables closure of the internal opening. Adequate closure is essential with the method used to close large or fibrotic internal openings being the determining factor for success or failure. The OTSC system delivered the most consistent result without leaving a substantial perianal wound. Ensuring thorough curettage and drainage of the tract during VAAFT is also important to facilitate healing. We believe that this understanding will bring about a decrease in the high recurrence rates currently seen in many series of anal fistulae.

  16. Can Anal Sphincter Defects Be Identified by Palpation?

    Science.gov (United States)

    Shek, Ka Lai; Atan, Ixora Kamisan; Dietz, Hans Peter

    The aim of this study was to correlate clinical findings of anal sphincter defects and function with a sonographic diagnosis of significant sphincter defects. This is an observational cross-sectional study on women seen 6 to 10 weeks after primary repair of obstetric anal sphincter injuries (OASIs). All patients underwent a standardized interview including the St Mark incontinence score, a digital rectal examination, and 3-/4-dimensional transperineal ultrasound imaging. Two hundred forty-five patients were seen after primary repair of OASIs. Mean age was 29 (17-43) years. They were assessed at a median of 58 (15-278) days postpartum. One hundred fifty-seven (64%) delivered normal vaginally, 72 (29%) delivered by vacuum, and 16 (7%) delivered by forceps. A comparison of external anal sphincter (EAS) and internal anal sphincter ultrasound volume data and palpation was possible in 220 and 212 cases, respectively. Sphincter defects at rest and on contraction were both detected clinically in 17 patients. Significant abnormalities of the EAS were diagnosed on tomographic ultrasound imaging in 99 cases (45%), and significant abnormalities of the internal anal sphincter were diagnosed in 113 cases (53%). Agreement between digital and sonographic findings of sphincter defect was poor (k = 0.03-0.08). Women with significant EAS defects on ultrasound were found to have a lower resistance to digital insertion (P = 0.018) and maximum anal squeeze (P = 0.009) on a 6-point scale. The difference was however small. Digital rectal examination does not seem to be sufficiently sensitive to diagnose residual sphincter defects after primary repair of OASIs. Imaging is required for the evaluation of sphincter anatomy after repair.

  17. Fistulotomy or seton in anal fistula: a decisional algorithm.

    Science.gov (United States)

    Cariati, Andrea

    2013-09-01

    Fistula in ano is a common proctological disease. Several authors stated that internal and external anal sphincters preservation is in the interest of continence maintenance. The aim of the present study is to report our experience using a decisional algorithm on sphincter saving procedures that achieved us to obtain good results with low rate of complications. From 2008 to 2011, 206 patients underwent surgical treatment for anal fistula; 28 patients underwent perianal abscess drainage plus seton placement of trans-sphincteric or supra-sphincteric fistula (13.6 %), 41 patients underwent fistulotomy for submucosal or low inter-sphincteric or low trans-sphincteric anal fistula (19.9 %) and 137 patients underwent partial fistulectomy or partial fistulotomy (from cutaneous plan to external sphincter muscle plan) and cutting seton placement without internal sphincterotomy for trans-sphincteric anal fistula (66.50 %). Healing rates have been of 100 % and healing times ranged from 1 to 6 months in 97 % of patients treated by setons. Transient fecal soiling was reported by 19 patients affected by trans-sphincteric fistula (11.5 %) for 4-6 months and then disappeared or evolved in a milder form of flatus occasional incontinence. No major incontinence has been reported also after fistulotomy. Fistula recurred in five cases of trans-sphincteric fistula treated by seton placement (one with abscess) (1/28) (3.5 %) and four with trans-sphincteric fistula (4/137) (3 %). Our algorithm permitted us to reduce to 20 % sphincter cutting procedures without reporting postoperative major anal incontinence; it seems to open an interesting way in the treatment of anal fistula.

  18. The Roles of Internal Communications, Human Resource Management and Marketing Concepts in Determining Holistic Internal Marketing Philosophy

    OpenAIRE

    Sinčić Ćorić, Dubravka; Pološki Vokić, Nina

    2009-01-01

    The paper analyses the triad of internal marketing (IM), internal communications (IC) and human resource management (HRM) parallely, which was not the prior interest of academics (so far only the dyads of those concepts were analyzed). The scopes, overlaps and differences between the three concepts are analyzed. By combining three before mentioned concepts a holistic internal marketing philosophy is described. The main conclusions are that a holistic internal marketing philosophy is grounded ...

  19. [Clinical characteristics and risk factors for recurrence of anal fistula patients].

    Science.gov (United States)

    Li, Jiaqin; Yang, Wei; Huang, Zhijian; Mei, Zubing; Yang, Dacheng; Wu, Haiyan; Wang, Qingming

    2016-12-25

    To investigate the epidemiology, internal opening location, and risk factors associated with recurrence of anal fistula. Clinical data of 1783 hospitalized patients admitted for anal fistula treatment to Shanghai Shuguang Hospital from January 2013 to September 2015 were retrospectively analyzed. Fistula passing through anorectal ring or locating above was defined as high anal fistula (n=125). Internal opening location was defined as follows: posterior (5 to 7 o'clock), front(11 to 1 o'clock), left (2 to 4 o'clock) and right (8 to 10 o'clock). Among 1783 cases, 1526 were male with a median age of 36 years, 257 were female with a median age of 35 years, and the ratio of male to female was 5.9 vs 1.0. In high anal fistula cases, this ratio of male to female was 7.3 vs 1.0. Posterior internal opening accounted for 51.4%(884/1720), while this percentage was 66.4%(83/125) in high anal fistula cases, which was significantly higher than 50.2%(801/1595) in low anal fistula cases(P=0.002). Postoperative recurrence rate was 2.6%(45/1720) and the rates in high anal fistula and low anal fistula were 13.6%(17/125) and 1.8%(28/1595) respectively, with significant difference(P=0.000). Multivariate logistic regression analysis showed that fistula height(OR=5.475, 95%CI:2.230 to 13.445, P=0.000), treatment history(OR=2.671, 95% CI:1.315 to 5.424, P=0.007), seton placement history (OR=4.707, 95%CI:1.675 to 13.232, P=0.003) and concomitant colitis(OR=10.300, 95%CI:1.187 to 89.412, P=0.034) were independent risk factors for anal fistula recurrence. Seton placement history was an independent risk factor for high anal fistula recurrence (OR=6.476, 95%CI:1.116 to 37.589, P=0.037). Anal fistula occurs in young and middle-aged male patient. Internal opening locates in posterior more commonly, especially in high anal fistula patients. Postoperative recurrence rate of high anal fistula is quite high. Patient with both high anal fistula and seton placement history has significantly high rate

  20. The changes in resting anal pressure after performing full-thickness rectal advancement flaps.

    Science.gov (United States)

    Balciscueta, Zutoia; Uribe, Natalia; Mínguez, Miguel; García-Granero, Eduardo

    2017-09-01

    Advancement flap is an accepted approach for treating complex fistula-in-ano.The purpose was to evaluate the changes in resting pressure along the anal canal after performing a full-thickness flap. Manometric review of patients who have undergone a full-thickness rectal advancement flap procedure for complex anal fistulas of cryptoglandular origin. Recurrence and continence were evaluated. Resting Anal Pressure was assessed along the anal canal by two measures: maximum resting pressure(MRP) and inferior resting pressure(IRP) at 0.5 cm from the anal verge. 119 patients were evaluated. Overall recurrence rate was5.9%. Anal continence was maintained intact in 76.5%. Manometric study showed a significant decrease in postoperative MRP(90.6 ± 31.9 to 45.2 ± 20 mmHg; p anal canal, due to the inclusion of the internal sphincter in flap. It seems crucial to preserve the distal internal sphincter intact as it helps both to maintain the resting pressure in the lower third and avoid deformities of the anal margin. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Experimental model of anal fistula in rats

    OpenAIRE

    Arakaki, Mariana Sousa; Santos,Carlos Henrique Marques dos; Falcão, Gustavo Ribeiro; Cassino,Pedro Carvalho; Nakamura, Ricardo Kenithi; Gomes,Nathália Favero; Santos,Ricardo Gasparin Coutinho dos

    2013-01-01

    INTRODUCTION: the management of anal fistula remains debatable. The lack of a standard treatment free of complications stimulates the development of new options. OBJECTIVE: to develop an experimental model of anal fistula in rats. METHODS: to surgically create an anal fistula in 10 rats with Seton introduced through the anal sphincter musculature. The animals were euthanized for histological fistula tract assessment. RESULTS: all ten specimens histologically assessed had a lumen and surroundi...

  2. The role of polymerase chain reaction of high-risk human papilloma virus in the screening of high-grade squamous intraepithelial lesions in the anal mucosa of human immunodeficiency virus-positive males having sex with males.

    Directory of Open Access Journals (Sweden)

    Carmen Hidalgo-Tenorio

    Full Text Available To evaluate the advantages of cytology and PCR of high-risk human papilloma virus (PCR HR-HPV infection in biopsy-derived diagnosis of high-grade squamous intraepithelial lesions (HSIL = AIN2/AIN3 in HIV-positive men having sex with men (MSM.This is a single-centered study conducted between May 2010 and May 2014 in patients (n = 201, mean age 37 years recruited from our outpatient clinic. Samples of anal canal mucosa were taken into liquid medium for PCR HPV analysis and for cytology. Anoscopy was performed for histology evaluation.Anoscopy showed 33.8% were normal, 47.8% low-grade squamous intraepithelial lesions (LSIL, and 18.4% HSIL; 80.2% had HR-HPV. PCR of HR-HPV had greater sensitivity than did cytology (88.8% vs. 75.7% in HSIL screening, with similar positive (PPV and negative predictive value (NPV of 20.3 vs. 22.9 and 89.7 vs. 88.1, respectively. Combining both tests increased the sensitivity and NPV of HSIL diagnosis to 100%. Correlation of cytology vs. histology was, generally, very low and PCR of HR-HPV vs. histology was non-existent (<0.2 or low (<0.4. Area under the receiver operating characteristics (AUROC curve analysis of cytology and PCR HR-HPV for the diagnosis of HSIL was poor (<0.6. Multivariate regression analysis showed protective factors against HSIL were: viral suppression (OR: 0.312; 95%CI: 0.099-0.984, and/or syphilis infection (OR: 0.193; 95%CI: 0.045-0.827. HSIL risk was associated with HPV-68 genotype (OR: 20.1; 95%CI: 2.04-197.82.When cytology and PCR HR-HPV findings are normal, the diagnosis of pre-malignant HSIL can be reliably ruled-out in HIV suppression with treatment protects against the appearance of HSIL [corrected].

  3. Humane Society International's global campaign to end animal testing.

    Science.gov (United States)

    Seidle, Troy

    2013-12-01

    The Research & Toxicology Department of Humane Society International (HSI) operates a multifaceted and science-driven global programme aimed at ending the use of animals in toxicity testing and research. The key strategic objectives include: a) ending cosmetics animal testing worldwide, via the multinational Be Cruelty-Free campaign; b) achieving near-term reductions in animal testing requirements through revision of product sector regulations; and c) advancing humane science by exposing failing animal models of human disease and shifting science funding toward human biology-based research and testing tools fit for the 21st century. HSI was instrumental in ensuring the implementation of the March 2013 European sales ban for newly animal-tested cosmetics, in achieving the June 2013 cosmetics animal testing ban in India as well as major cosmetics regulatory policy shifts in China and South Korea, and in securing precedent-setting reductions in in vivo data requirements for pesticides in the EU through the revision of biocides and plant protection product regulations, among others. HSI is currently working to export these life-saving measures to more than a dozen industrial and emerging economies. 2013 FRAME.

  4. Enterococcus faecalis internalization in human umbilical vein endothelial cells (HUVEC).

    Science.gov (United States)

    Millán, Diana; Chiriboga, Carlos; Patarroyo, Manuel A; Fontanilla, Marta R

    2013-04-01

    Initial Enterococcus faecalis-endothelial cell molecular interactions which lead to enterococci associating in the host endothelial tissue, colonizing it and proliferating there can be assessed using in vitro models. Cultured human umbilical vein endothelial cells (HUVEC) have been used to study other Gram-positive bacteria-cell interactions; however, few studies have been aimed at establishing the relationship of E. faecalis with endothelial cells. The aggregation substance (AS) family of adhesins represents an E. faecalis virulence factor which has been implicated in endocarditis severity and bacterial persistence. The Asc10 protein (a member of this family) promotes bacterium-bacterium aggregation and bacterium-host cell binding. Evaluating Asc10 role in bacterial internalization by cultured enterocytes has shown that this adhesin facilitates E. faecalis endocytosis by HT-29 cells. A few eukaryotic cell structural components, such as cytoskeletal proteins, have been involved in E. faecalis entry into cell-lines; it is thus relevant to determine whether Asc10, as well as microtubules and actin microfilaments, play a role in E. faecalis internalization by cultured endothelial cells. The role of Asc10 and cytoskeleton proteins in E. faecalis ability to enter HUVEC was assessed in the present study, as well as cell apoptosis induction by enterococcal internalization by HUVEC; the data indicated increased cell apoptosis and that cytoskeleton components were partially involved in E. faecalis entry to endothelial cells, thereby suggesting that E. faecalis Asc10 protein would not be a critical factor for bacterial entry to cultured HUVEC.

  5. Human rights and the requirement for international medical aid.

    Science.gov (United States)

    Tolchin, Benjamin

    2008-08-01

    Every year approximately 18 million people die prematurely from treatable medical conditions including infectious diseases and nutritional deficiencies. The deaths occur primarily amongst the poorest citizens of poor developing nations. Various groups and individuals have advanced plans for major international medical aid to avert many of these unnecessary deaths. For example, the World Health Organization's Commission on Macroeconomics and Health estimated that eight million premature deaths could be prevented annually by interventions costing roughly US$57 bn per year. This essay advances an argument that human rights require high-income nations to provide such aid. The essay briefly examines John Rawls' obligations of justice and the reasons that their applicability to cases of international medical aid remains controversial. Regardless, the essay argues that purely humanitarian obligations bind the governments and citizens of high-income liberal democracies at a minimum to provide major medical aid to avert premature deaths in poor nations. In refusing to undertake such medical relief efforts, developed nations fail to adequately protect a fundamental human right to life.

  6. Conservation and human rights: the need for international standards

    Energy Technology Data Exchange (ETDEWEB)

    Oviedo, Gonzalo [International Union for the Conservation of Nature (International organizations without location); Pabon, Luis [The Nature Conservancy (United States); Painter, Michael; Redford, Kent [The Wildlife Conservation Society (United States); Siegele, Linda [Foundation for International Environmental Law and Development (United Kingdom); Springer, Jenny [WWF-US (United States); Thomas, David [Birdlife International (International organizations without location); Painemilla, Kristen Walker [Conservation International (United States); Roe, Dilys

    2010-05-15

    Conservation doesn't happen in a vacuum. In recent years, awareness has grown of the relationship of international conservation practice to indigenous peoples and local communities, and especially the links between conservation and human rights. The impacts protected areas can have on rural communities – such as evictions and lost access to natural resources – are now under particular scrutiny. Concern is meanwhile rising over the human rights implications of some climate change mitigation and adaptation measures. But awareness is also growing of the positive contributions of nature conservation to the rights of people to secure their livelihoods, enjoy healthy and productive environments, and live with dignity. International NGOs can play a central role in supporting and promoting conservation actions that respect the rights of indigenous peoples and local communities, and help sustain their livelihoods. Many conservation organisations have long worked towards this. It is vital that they hold to consistent principles and implement measures that ensure their application, so their action on conservation remains accountable, transparent and sustainable.

  7. International Guidelines on Human Rights and Drug Control

    Science.gov (United States)

    Pol, Luciana

    2017-01-01

    Abstract Discrimination and inequality shape women’s experiences of drug use and in the drug trade and the impact of drug control efforts on them, with disproportionate burdens faced by poor and otherwise marginalized women. In recent years, UN member states and UN drug control and human rights entities have recognized this issue and made commitments to integrate a ‘gender perspective’ into drug control policies, with ‘gender’ limited to those conventionally deemed women. But the concept of gender in international law is broader, rooted in socially constructed and culturally determined norms and expectations around gender roles, sex, and sexuality. Also, drug control policies often fail to meaningfully address the specific needs and circumstances of women (inclusively defined), leaving them at risk of recurrent violations of their rights in the context of drugs. This article explores what it means to ‘mainstream’ this narrower version of gender into drug control efforts, using as examples various women’s experiences as people who use drugs, in the drug trade, and in the criminal justice system. It points to international guidelines on human rights and drug control as an important tool to ensure attention to women’s rights in drug control policy design and implementation. PMID:28630557

  8. Recurrent obstetric anal sphincter injury and the risk of long term anal incontinence

    DEFF Research Database (Denmark)

    Jangö, Hanna; Langhoff-Roos, Jens; Rosthøj, Susanne

    2017-01-01

    BACKGROUND: Women with an obstetric anal sphincter injury are concerned about the risk of recurrent obstetric anal sphincter injury in their second pregnancy. Existing studies have failed to clarify whether recurrence of obstetric anal sphincter injury affects the risk of anal- and fecal incontin......BACKGROUND: Women with an obstetric anal sphincter injury are concerned about the risk of recurrent obstetric anal sphincter injury in their second pregnancy. Existing studies have failed to clarify whether recurrence of obstetric anal sphincter injury affects the risk of anal- and fecal...... incontinence at long term follow up. OBJECTIVE: To evaluate whether recurrent obstetric anal sphincter injury influenced the risk of anal- and fecal incontinence more than 5 years after the second vaginal delivery. STUDY DESIGN: We performed a secondary analysis of data from a postal questionnaire study...

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

    Science.gov (United States)

    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.

  10. Crimes against humanity: the role of international courts.

    Directory of Open Access Journals (Sweden)

    Eder Milton Schneider

    Full Text Available We study the role of international tribunals, like the International Criminal Court (ICC, as an effective way of reducing the number and/or gravity of crimes against humanity. The action of the ICC is directed against leaders that promote or tolerate these kinds of crimes, that is, political authorities, army commanders, civil leaders, etc. In order to simulate the action of the ICC we build a hierarchical society where the most important leaders have the highest connectivity and can spread their points of view, or their orders, through a chain of less but still highly connected deputy chiefs or opinion chieftains. In this way, if they practice misconduct, corruption, or any kind of discriminatory or criminal actions against individuals or groups, it would very difficult and improbable that they will be prosecuted by the courts of their own country. It is to alleviate this situation that the ICC was created. Its mission is to process and condemn crimes against humanity though a supranational organism that can act on criminal leaders in any country. In this study, the action of the ICC is simulated by removing the corrupt leader and replacing it by a "decent" one. However, as the action of the corrupt leader could have spread among the population by the time the ICC acts, we try to determine if a unique action of the ICC is sufficient or if further actions are required, depending on the degree of deterioration of the human rights in the hypothetical country. The results evidence the positive effect of the ICC action with a relatively low number of interventions. The effect of the ICC is also compared with the action of the local national judiciary system.

  11. Crimes against humanity: the role of international courts.

    Science.gov (United States)

    Schneider, Eder Milton; Iglesias, José Roberto; Hallberg, Karen; Kuperman, Marcelo Néstor

    2014-01-01

    We study the role of international tribunals, like the International Criminal Court (ICC), as an effective way of reducing the number and/or gravity of crimes against humanity. The action of the ICC is directed against leaders that promote or tolerate these kinds of crimes, that is, political authorities, army commanders, civil leaders, etc. In order to simulate the action of the ICC we build a hierarchical society where the most important leaders have the highest connectivity and can spread their points of view, or their orders, through a chain of less but still highly connected deputy chiefs or opinion chieftains. In this way, if they practice misconduct, corruption, or any kind of discriminatory or criminal actions against individuals or groups, it would very difficult and improbable that they will be prosecuted by the courts of their own country. It is to alleviate this situation that the ICC was created. Its mission is to process and condemn crimes against humanity though a supranational organism that can act on criminal leaders in any country. In this study, the action of the ICC is simulated by removing the corrupt leader and replacing it by a "decent" one. However, as the action of the corrupt leader could have spread among the population by the time the ICC acts, we try to determine if a unique action of the ICC is sufficient or if further actions are required, depending on the degree of deterioration of the human rights in the hypothetical country. The results evidence the positive effect of the ICC action with a relatively low number of interventions. The effect of the ICC is also compared with the action of the local national judiciary system.

  12. 76 FR 50221 - International Workshop on Alternative Methods for Human and Veterinary Rabies Vaccine Testing...

    Science.gov (United States)

    2011-08-12

    ... HUMAN SERVICES International Workshop on Alternative Methods for Human and Veterinary Rabies Vaccine... ``International Workshop on Alternative Methods for Human and Veterinary Rabies Vaccine Testing: State of the... approaches that may reduce, refine, or replace animal use in human and veterinary rabies vaccine...

  13. Electrical stimulation of anal sphincter or pudendal nerve improves anal sphincter pressure.

    Science.gov (United States)

    Damaser, Margot S; Salcedo, Levilester; Wang, Guangjian; Zaszczurynski, Paul; Cruz, Michelle A; Butler, Robert S; Jiang, Hai-Hong; Zutshi, Massarat

    2012-12-01

    Stimulation of the pudendal nerve or the anal sphincter could provide therapeutic options for fecal incontinence with little involvement of other organs. The goal of this project was to assess the effects of pudendal nerve and anal sphincter stimulation on bladder and anal pressures. Ten virgin female Sprague Dawley rats were randomly allocated to control (n = 2), perianal stimulation (n = 4), and pudendal nerve stimulation (n = 4) groups. A monopolar electrode was hooked to the pudendal nerve or placed on the anal sphincter. Aballoon catheter was inserted into the anus to measure anal pressure, and a catheter was inserted into the bladder via the urethra to measure bladder pressure. Bladder and anal pressures were measured with different electrical stimulation parameters and different timing of electrical stimulation relative to spontaneous anal sphincter contractions. Increasing stimulation current had the most dramatic effect on both anal and bladder pressures. An immediate increase in anal pressure was observed when stimulating either the anal sphincter or the pudendal nerve at stimulation values of 1 mA or 2 mA. No increase in anal pressure was observed for lower current values. Bladder pressure increased at high current during anal sphincter stimulation, but not as much as during pudendal nerve stimulation. Increased bladder pressure during anal sphincter stimulation was due to contraction of the abdominal muscles. Electrical stimulation caused an increase in anal pressures with bladder involvement only at high current. These initial results suggest that electrical stimulation can increase anal sphincter pressure, enhancing continence control.

  14. [Obstetric damage to the perineum and the anal sphincters. Reconstruction surgery].

    Science.gov (United States)

    Kościński, Tomasz

    2014-08-01

    Damage to the perineum, vulva, anal sphincters, rectal wall and the fascial structures of the pelvic floor may be caused by obstetric trauma. Emergency surgical treatment aims at control of the bleeding, anatomical reconstruction of the disrupted tissues and minimization of the risk of infection. Suturing of the rectal wall and mucosa of the anal canal is followed by reconstruction of the perineal body internal and external anal sphincters, vulva and the perineum. Delayed surgery is undertaken after the complete healing of the obstetric tear. All cicatricial fibers must be saved to reinforce sphincters and perineal body muscles suturing. Anal levators and perineal transvers muscles suturing is used for the rectovaginal septum and pelvic floor reconstruction. Anal sphincters are reconstructed by the 'overlapping' technique. X en Z suturing is used for a perineal skin plasty.

  15. Investigation of anal motor characteristics of the sensorimotor response (SMR) using 3-D anorectal pressure topography

    Science.gov (United States)

    Cheeney, Gregory; Remes-Troche, Jose M.; Attaluri, Ashok

    2011-01-01

    Desire to defecate is associated with a unique anal contractile response, the sensorimotor response (SMR). However, the precise muscle(s) involved is not known. We aimed to examine the role of external and internal anal sphincter and the puborectalis muscle in the genesis of SMR. Anorectal 3-D pressure topography was performed in 10 healthy subjects during graded rectal balloon distention using a novel high-definition manometry system consisting of a probe with 256 pressure sensors arranged circumferentially. The anal pressure changes before, during, and after the onset of SMR were measured at every millimeter along the length of anal canal and in 3-D by dividing the anal canal into 4 × 2.1-mm grids. Pressures were assessed in the longitudinal and anterior-posterior axis. Anal ultrasound was performed to assess puborectalis morphology. 3-D topography demonstrated that rectal distention produced an SMR coinciding with desire to defecate and predominantly induced by contraction of puborectalis. Anal ultrasound showed that the puborectalis was located at mean distance of 3.5 cm from anal verge, which corresponded with peak pressure difference between the anterior and posterior vectors observed at 3.4 cm with 3-D topography (r = 0.77). The highest absolute and percentage increases in pressure during SMR were seen in the superior-posterior portion of anal canal, reaffirming the role of puborectalis. The SMR anal pressure profile showed a peak pressure at 1.6 cm from anal verge in the anterior and posterior vectors and distinct increase in pressure only posteriorly at 3.2 cm corresponding to puborectalis. We concluded that SMR is primarily induced by the activation and contraction of the puborectalis muscle in response to a sensation of a desire to defecate. PMID:21109594

  16. Management of anal squamous intraepithelial lesions.

    Science.gov (United States)

    Pineda, Carlos E; Welton, Mark L

    2009-05-01

    Anal squamous intraepithelial lesions include both low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and are caused by chronic infection with the human papillomavirus (HPV). The disease is increasing in both incidence and prevalence, especially among patients with the following risk factors: homosexual men, acquired or iatrogenic immunosuppression, and presence of other HPV-related diseases. Although the natural history of the disease is unknown, there is significant evidence that untreated HSIL progresses to squamous cell carcinoma in 11% of patients and in up to 50% of patients with extensive disease and immunosuppression. Anal cytology and reflex HPV DNA testing are used to screen for disease, particularly among patients with the aforementioned risk factors. Evaluation of the patient should include physical examination and high-resolution anoscopy (HRA) to evaluate for disease above and below the dentate line. Intervention is warranted and this can be achieved in many ways. The treatment option associated with the best outcomes is ablation directed with HRA, which can be performed in the office or in the operating room with minimal morbidity. This strategy is effective in patients with both low-volume and high-volume disease and is associated with a malignant progression rate of 0.4% in patients with treated HSIL.

  17. Progression of anal high-grade squamous intraepithelial lesions to invasive anal cancer among HIV-infected men who have sex with men.

    Science.gov (United States)

    Berry, J Michael; Jay, Naomi; Cranston, Ross D; Darragh, Teresa M; Holly, Elizabeth A; Welton, Mark L; Palefsky, Joel M

    2014-03-01

    The incidence of anal cancer is elevated in human immunodeficiency virus (HIV)-infected men-who-have-sex-with-men (MSM) compared to the general population. Anal high-grade squamous intraepithelial lesions (HSIL) are common in HIV-infected MSM and the presumed precursors to anal squamous cell cancer; however, direct progression of HSIL to anal cancer has not been previously demonstrated. The medical records were reviewed of 138 HIV-infected MSM followed up at the University of California, San Francisco, who developed anal canal or perianal squamous cancer between 1997 and 2011. Men were followed up regularly with digital anorectal examination (DARE), high-resolution anoscopy (HRA) and HRA-guided biopsy. Although treatment for HSIL and follow-up were recommended, not all were treated and some were lost to follow-up. Prevalent cancer was found in 66 men. Seventy-two HIV-infected MSM developed anal cancer while under observation. In 27 men, anal cancer developed at a previously biopsied site of HSIL. An additional 45 men were not analyzed in this analysis due to inadequate documentation of HSIL in relation to cancer location. Of the 27 men with documented progression to cancer at the site of biopsy-proven HSIL, 20 men progressed from prevalent HSIL identified when first examined and seven men from incident HSIL. Prevalent HSIL progressed to cancer over an average of 57 months compared to 64 months for incident HSIL. Most men were asymptomatic, and cancers were detected by DARE. Anal HSIL has clear potential to progress to anal cancer in HIV-infected MSM. Early diagnosis is facilitated by careful follow-up. Carefully controlled studies evaluating efficacy of screening for and treatment of HSIL to prevent anal cancer are needed. © 2013 UICC.

  18. Video-assisted anal fistula treatment: technical considerations and preliminary results of the first Brazilian experience.

    Science.gov (United States)

    Mendes, Carlos Ramon Silveira; Ferreira, Luciano Santana de Miranda; Sapucaia, Ricardo Aguiar; Lima, Meyline Andrade; Araujo, Sergio Eduardo Alonso

    2014-01-01

    Anorectal fistula represents an epithelized communication path of infectious origin between the rectum or anal canal and the perianal region. The association of endoscopic surgery with the minimally invasive approach led to the development of the video-assisted anal fistula treatment. To describe the technique and initial experience with the technique video-assisted for anal fistula treatment. A Karl Storz video equipment was used. Main steps included the visualization of the fistula tract using the fistuloscope, the correct localization of the internal fistula opening under direct vision, endoscopic treatment of the fistula and closure of the internal opening which can be accomplished through firing a stapler, cutaneous-mucosal flap, or direct closure using suture. The mean distance between the anal verge and the external anal orifice was 5.5 cm. Mean operative time was 31.75 min. In all cases, the internal fistula opening could be identified after complete fistuloscopy. In all cases, internal fistula opening was closed using full-thickness suture. There were no intraoperative or postoperative complications. After a 5-month follow-up, recurrence was observed in one (12.5%) patient. Video-assisted anal fistula treatment is feasible, reproducible, and safe. It enables direct visualization of the fistula tract, internal opening and secondary paths.

  19. [The status of human cloning in the international setting].

    Science.gov (United States)

    Rey del Castillo, Javier

    2006-01-01

    The General Assembly of the United Nations submitted a Declaration on Human Cloning in March 2005. The text of such Declaration was the result of a difficult and long process, taking more than three years. Being a Declaration instead of a Resolution, it has not legal capability in inforcing United Nations members to act according to its recommendations. This article begins with an explanation of several terms referred to cloning. Different countries' legislation on cloning is analyzed. Positions of the same countries at the Convention of the United Nations are as well analyzed. Comparing both countries' views shows that national legislation on cloning is independent and orientated by some countries' particular interests and biological and ethical views on these issues. Future developments on human cloning and its applications will be shared among all countries, both the ones currently allowing and supporting "therapeutic" cloning and the ones now banning it. In such case, it would be important to reach agreements on these issues at an international level. The article discusses possible legislative developments and offers some proposals to reach such agreements.

  20. 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.

  1. Diffuse large B cell lymphoma presenting as a peri-anal abscess

    OpenAIRE

    Jayasekera, Hasanga; Gorissen, Kym; Francis, Leo; Chow, Carina

    2014-01-01

    A non-healing peri-anal abscess can be difficult to manage and is often attributed to chronic disease. This case documents a male in his seventh decade who presented with multiple peri-anal collections. The abscess cavity had caused necrosis of the internal sphincter muscles resulting in faecal incontinence. Biopsies were conclusive for diffuse large B-cell lymphoma. A de-functioning colostomy was performed and the patient was initiated on CHOP-R chemotherapy. Anal lymphoma masquerading as a ...

  2. Anal endosonographic findings in women after vaginal delivery

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Science.gov (United States)

    Clavero, Omar; McCloskey, Jenny; Molina, Vicente Marco; Quirós, Beatriz; Bravo, Ignacio G; de Sanjosé, Silvia; Bosch, F Xavier; Pimenoff, Ville N

    2017-06-01

    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. 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. 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. 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. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  4. Human endothelial progenitor cells internalize high-density lipoprotein.

    Science.gov (United States)

    Srisen, Kaemisa; Röhrl, Clemens; Meisslitzer-Ruppitsch, Claudia; Ranftler, Carmen; Ellinger, Adolf; Pavelka, Margit; Neumüller, Josef

    2013-01-01

    Endothelial progenitor cells (EPCs) originate either directly from hematopoietic stem cells or from a subpopulation of monocytes. Controversial views about intracellular lipid traffic prompted us to analyze the uptake of human high density lipoprotein (HDL), and HDL-cholesterol in human monocytic EPCs. Fluorescence and electron microscopy were used to investigate distribution and intracellular trafficking of HDL and its associated cholesterol using fluorescent surrogates (bodipy-cholesterol and bodipy-cholesteryl oleate), cytochemical labels and fluorochromes including horseradish peroxidase and Alexa Fluor® 568. Uptake and intracellular transport of HDL were demonstrated after internalization periods from 0.5 to 4 hours. In case of HDL-Alexa Fluor® 568, bodipy-cholesterol and bodipy-cholesteryl oleate, a photooxidation method was carried out. HDL-specific reaction products were present in invaginations of the plasma membrane at each time of treatment within endocytic vesicles, in multivesicular bodies and at longer periods of uptake, also in lysosomes. Some HDL-positive endosomes were arranged in form of "strings of pearl"- like structures. HDL-positive multivesicular bodies exhibited intensive staining of limiting and vesicular membranes. Multivesicular bodies of HDL-Alexa Fluor® 568-treated EPCs showed multilamellar intra-vacuolar membranes. At all periods of treatment, labeled endocytic vesicles and organelles were apparent close to the cell surface and in perinuclear areas around the Golgi apparatus. No HDL-related particles could be demonstrated close to its cisterns. Electron tomographic reconstructions showed an accumulation of HDL-containing endosomes close to the trans-Golgi-network. HDL-derived bodipy-cholesterol was localized in endosomal vesicles, multivesicular bodies, lysosomes and in many of the stacked Golgi cisternae and the trans-Golgi-network Internalized HDL-derived bodipy-cholesteryl oleate was channeled into the lysosomal intraellular

  5. Human endothelial progenitor cells internalize high-density lipoprotein.

    Directory of Open Access Journals (Sweden)

    Kaemisa Srisen

    Full Text Available Endothelial progenitor cells (EPCs originate either directly from hematopoietic stem cells or from a subpopulation of monocytes. Controversial views about intracellular lipid traffic prompted us to analyze the uptake of human high density lipoprotein (HDL, and HDL-cholesterol in human monocytic EPCs. Fluorescence and electron microscopy were used to investigate distribution and intracellular trafficking of HDL and its associated cholesterol using fluorescent surrogates (bodipy-cholesterol and bodipy-cholesteryl oleate, cytochemical labels and fluorochromes including horseradish peroxidase and Alexa Fluor® 568. Uptake and intracellular transport of HDL were demonstrated after internalization periods from 0.5 to 4 hours. In case of HDL-Alexa Fluor® 568, bodipy-cholesterol and bodipy-cholesteryl oleate, a photooxidation method was carried out. HDL-specific reaction products were present in invaginations of the plasma membrane at each time of treatment within endocytic vesicles, in multivesicular bodies and at longer periods of uptake, also in lysosomes. Some HDL-positive endosomes were arranged in form of "strings of pearl"- like structures. HDL-positive multivesicular bodies exhibited intensive staining of limiting and vesicular membranes. Multivesicular bodies of HDL-Alexa Fluor® 568-treated EPCs showed multilamellar intra-vacuolar membranes. At all periods of treatment, labeled endocytic vesicles and organelles were apparent close to the cell surface and in perinuclear areas around the Golgi apparatus. No HDL-related particles could be demonstrated close to its cisterns. Electron tomographic reconstructions showed an accumulation of HDL-containing endosomes close to the trans-Golgi-network. HDL-derived bodipy-cholesterol was localized in endosomal vesicles, multivesicular bodies, lysosomes and in many of the stacked Golgi cisternae and the trans-Golgi-network Internalized HDL-derived bodipy-cholesteryl oleate was channeled into the lysosomal

  6. Video-assisted anal fistula treatment.

    Science.gov (United States)

    Kochhar, Gaurav; Saha, Sudipta; Andley, Manoj; Kumar, Ashok; Saurabh, Gyan; Pusuluri, Rahul; Bhise, Vikas; Kumar, Ajay

    2014-01-01

    Fistula in ano is a common disease seen in the surgical outpatient department. Many procedures are advocated for the treatment of fistula in ano. However, none of the procedures is considered the gold standard. The latest addition to the list of treatment options is video-assisted anal fistula treatment (VAAFT). It is a minimally invasive, sphincter-saving procedure with low morbidity. The aim of our study was to compare the results with a premier study done previously. The procedure involves diagnostic fistuloscopy and visualization of the internal opening, followed by fulguration of the fistulous tract and closure of the internal opening with a stapling device or suture ligation. The video equipment (Karl Storz, Tuttlingen, Germany) was connected to an illuminating source. The study was conducted from July 2010 to March 2014. Eighty-two patients with fistula in ano were operated on with VAAFT and were followed up according to the study protocol. The recurrence rate was 15.85%, with recurrences developing in 13 cases. Postoperative pain and discomfort were minimal. VAAFT is a minimally invasive procedure performed under direct visualization. It enables visualization of the internal opening and secondary branches or abscess cavities. It is a sphincter-saving procedure and offers many advantages to patients. Our initial results with the procedure are quite encouraging.

  7. “GAY RIGHTS ARE HUMAN RIGHTS”: : THE FRAMING OF NEW INTERPRETATIONS OF INTERNATIONAL HUMAN RIGHTS NORMS

    NARCIS (Netherlands)

    Holzhacker, Ron

    2014-01-01

    “Gay Rights are Human Rights” may have begun as a slogan chanted in the street, but academics and human rights organizations began to use the international human rights frame systematically in the 1990s to argue for universal human rights to fully apply to LGBT persons. This framing gradually began

  8. “GAY RIGHTS ARE HUMAN RIGHTS”: : THE FRAMING OF NEW INTERPRETATIONS OF INTERNATIONAL HUMAN RIGHTS NORMS

    NARCIS (Netherlands)

    Holzhacker, Ron

    2014-01-01

    “Gay Rights are Human Rights” may have begun as a slogan chanted in the street, but academics and human rights organizations began to use the international human rights frame systematically in the 1990s to argue for universal human rights to fully apply to LGBT persons. This framing gradually began

  9. Botulinum Toxin Type A Internal Intramuscular Combined with Mini-incision Drainage in Treating Stage Ⅱ and Ⅲ Anal Fissure%A型肉毒素内括约肌注联合小切口切扩引流术治疗ⅡⅢ期肛裂的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    杨绍明

    2014-01-01

    目的:观察A型肉毒素内括约肌注联合小切口切扩引流术治疗Ⅱ、Ⅲ期肛裂的疗效及安全性。方法:选取90例Ⅱ、Ⅲ期肛裂患者按照随机数字表法随机分为治疗组60例与对照组30例,治疗组给予A型肉毒素内括约肌注联合小切口切扩引流术,对照组给予传统肛裂切除术联合肛管内括约肌切断术,比较两组患者疗效指标及并发症情况。结果:治疗组治愈率(95.0%)明显高于对照组(83.3%),手术时间及切口愈合时间明显短于对照组(P<0.05),愈合后瘢痕面积明显小于对照组(P<0.05),术后并发症发生率(1.6%)远低于对照组(13.2%),术后24h疼痛评分也明显低于对照组( P<0.05)。结论:A型肉毒素内括约肌注联合小切口切扩引流术治疗Ⅱ、Ⅲ期肛裂较传统手术效果理想,且具有术后恢复快、疼痛轻、并发症少等优点。%Objective:To observe the efficacy and safety of botulinum toxin type A internal intramuscu-lar combined with mini-incision drainage in treating stage Ⅱ and Ⅲ anal fissure .Method:90 cases with stage ⅡandⅢanal fissure were selected and divided into two groups randomLy , the treatment group for 60 cases and the control group for 30 cases.The treatment group was treated with botulinum toxin type A internal intramuscular combined with mini-incision drainage ,and the control group was treated with traditional exci-sion of anal fissure and anal canal sphincter amputation .The efficacy and complications of two groups were compared.Result:The cure rate of the treatment group(95.0%)was evidently higher than that of the control group (83.3%), the operation time and incision healing time of the treatment group was evidently shorter than that of the control group ( P<0.05) , and the scar area after healing was evidently smaller than that of the control group(P<0.05), the incidence rate of complications after

  10. Repatriation of human remains following death in international travellers.

    Science.gov (United States)

    Connolly, Ruairi; Prendiville, Richard; Cusack, Denis; Flaherty, Gerard

    2017-03-01

    Death during international travel and the repatriation of human remains to one's home country is a distressing and expensive process. Much organization is required involving close liaison between various agencies. A review of the literature was conducted using the PubMed database. Search terms included: 'repatriation of remains', 'death', 'abroad', 'tourism', 'travel', 'travellers', 'travelling' and 'repatriation'. Additional articles were obtained from grey literature sources and reference lists. The local national embassy, travel insurance broker and tour operator are important sources of information to facilitate the repatriation of the deceased traveller. Formal identification of the deceased's remains is required and a funeral director must be appointed. Following this, the coroner in the country or jurisdiction receiving the repatriated remains will require a number of documents prior to providing clearance for burial. Costs involved in repatriating remains must be borne by the family of the deceased although travel insurance may help defray some of the costs. If the death is secondary to an infectious disease, cremation at the site of death is preferred. No standardized procedure is in place to deal with the remains of a migrant's body at present and these remains are often not repatriated to their country of origin. Repatriation of human remains is a difficult task which is emotionally challenging for the bereaving family and friends. As a travel medicine practitioner, it is prudent to discuss all eventualities, including the risk of death, during the pre-travel consultation. Awareness of the procedures involved in this process may ease the burden on the grieving family at a difficult time.

  11. INTERNALIZATION OF ANTIMICROBIAL PEPTIDE ACIPENSIN 1 INTO HUMAN TUMOR CELLS

    Directory of Open Access Journals (Sweden)

    E. S. Umnyakova

    2016-01-01

    Full Text Available Search for new compounds providing delivery of drugs into infected or neoplastic cells, is an important direction of biomedical research. Cell-penetrating peptides are among those compounds, due to their ability to translocate through membranes of eukaryotic cells, serving as potential carriers of various therapeutic agents to the target cells. The aim of present work was to investigate the ability of acipensin 1, an antimicrobial peptide of innate immune system, for in vitro penetration into human tumor cells. Acipensin 1 is a cationic peptide that we have previously isolated from leukocytes of the Russian sturgeon, Acipenser gueldenstaedtii. Capability of acipensin 1 to enter the human erytroleukemia K-562 cells has been investigated for the first time. A biotechnological procedure for producing a recombinant acipensin 1 peptide has been developed. The obtained peptide was conjugated with a fluorescent probe BODIPY FL. By means of confocal microscopy, we have shown that the tagged acipensin 1 rapidly enters into K-562 cells and can be detected in the intracellular space within 5 min after its addition to the cell culture. Using flow cytometry technique, penetration kinetics of the labeled peptide into K-562 cells (at nontoxic micromolar concentrations has been studied. We have observed a rapid internalization of the peptide to the target cells, thus confirming the results of microscopic analysis, i.e, the labeled acipensin was detectable in K-562 cells as soon as wihin 2-3 seconds after its addition to the incubation medium. The maximum of fluorescence was reached within a period of approx. 45 seconds, with further “plateau” at the terms of >100 seconds following cell stimulation with the test compound. These data support the concept, that the antimicrobial peptides of innate immunity system possess the features of cell-penetrating peptides, and allow us to consider the studied sturgeon peptide a promising template for development of new

  12. The protection of the accused in international criminal law according to the Human Rights Law Standard

    Directory of Open Access Journals (Sweden)

    Karolina Kremens

    2011-12-01

    Full Text Available The presented paper discusses the influence of international human rights law on international criminal law. It tries to give an answer to the question of whether rules protecting the accused in international criminal proceedings meet the human rights law standard provided by international declarations and covenants. Meaning, if the proceedings before the International Criminal Tribunal for Former Yugoslavia (ICTY, International Criminal Tribunal for Rwanda (ICTR and International Criminal Court (ICC meet the standard provided by international human rights law, in particular the International Covenant on Civil and Political Rights. The paper proves that international human rights law has affected international criminal law tremendously. Moreover, it is argued that the protection of the accused in the law of the international courts and tribunals with regard to his rights has improved when compared to the international human rights law standard. In particular the Rome Statute of the ICC provides the accused with the most comprehensive protection. This is especially visible in the case of such rights as the presumption of innocence, right to an interpreter and right to remain silent. Nevertheless, some shortcomings in the law of the ad hoc tribunals and ICC can be observed, in particular when it comes to identifying the commencement of protection of the accused.

  13. 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...... uncomplicated vaginal delivery or caesarean section. RESULTS: There were 93 437 vaginal deliveries. ASR occurred in 5.5% (n = 2851) of the nulliparous and 1.5% (n = 608) of the multiparous women. Recurrent ASR occurred in 8% (n = 49) of whom 50% reported symptoms of AI. We found no difference in the occurrence...... of AI between women with recurrent ASR, and those who delivered vaginally without repeat ASR (p = 0.37; OR = 2.0) or by caesarean section (p = 0.77; OR = 1.3). CONCLUSION: Women with a past history of ASR have an 8% risk of recurrence. AI affects half of the women with recurrent ASR. Larger studies...

  14. Recurrent obstetric anal sphincter injury and the risk of long-term anal incontinence.

    Science.gov (United States)

    Jangö, Hanna; Langhoff-Roos, Jens; Rosthøj, Susanne; Sakse, Abelone

    2017-06-01

    Women with an obstetric anal sphincter injury are concerned about the risk of recurrent obstetric anal sphincter injury in their second pregnancy. Existing studies have failed to clarify whether the recurrence of obstetric anal sphincter injury affects the risk of anal and fecal incontinence at long-term follow-up. The objective of the study was to evaluate whether recurrent obstetric anal sphincter injury influenced the risk of anal and fecal incontinence more than 5 years after the second vaginal delivery. We performed a secondary analysis of data from a postal questionnaire study in women with obstetric anal sphincter injury in the first delivery and 1 subsequent vaginal delivery. The questionnaire was sent to all Danish women who fulfilled inclusion criteria and had 2 vaginal deliveries 1997-2005. We performed uni- and multivariable analyses to assess how recurrent obstetric anal sphincter injury affects the risk of anal incontinence. In 1490 women with a second vaginal delivery after a first delivery with obstetric anal sphincter injury, 106 had a recurrent obstetric anal sphincter injury. Of these, 50.0% (n = 53) reported anal incontinence compared with 37.9% (n = 525) of women without recurrent obstetric anal sphincter injury. Fecal incontinence was present in 23.6% (n = 25) of women with recurrent obstetric anal sphincter injury and in 13.2% (n = 182) of women without recurrent obstetric anal sphincter injury. After adjustment for third- or fourth-degree obstetric anal sphincter injury in the first delivery, maternal age at answering the questionnaire, birthweight of the first and second child, years since first and second delivery, and whether anal incontinence was present before the second pregnancy, the risk of flatal and fecal incontinence was still increased in patients with recurrent obstetric anal sphincter injury (adjusted odds ratio, 1.68 [95% confidence interval, 1.05-2.70), P = .03, and adjusted odds ratio, 1.98 [95% confidence interval, 1

  15. Anal fistula: Intraoperative difficulties and unexpected findings

    Institute of Scientific and Technical Information of China (English)

    Ahmed A Abou-Zeid

    2011-01-01

    Anal fistula surgery is a commonly performed procedure. The diverse anatomy of anal fistulae and their proximity to anal sphincters make accurate preoperative diagnosis essential to avoid recurrence and fecal incontinence. De-spite the fact that proper preoperative diagnosis can be reached in the majority of patients by simple clinical ex-amination, endoanal ultrasound or magnetic resonance imaging, on many occasions, unexpected findings can be encountered during surgery that can make the oper-ation difficult and correct decision-making crucial. In this article we discuss the difficulties and unexpected find-ings that can be encountered during anal fistula sur-gery and how to overcome them.

  16. Anal fistula: intraoperative difficulties and unexpected findings.

    Science.gov (United States)

    Abou-Zeid, Ahmed A

    2011-07-28

    Anal fistula surgery is a commonly performed procedure. The diverse anatomy of anal fistulae and their proximity to anal sphincters make accurate preoperative diagnosis essential to avoid recurrence and fecal incontinence. Despite the fact that proper preoperative diagnosis can be reached in the majority of patients by simple clinical examination, endoanal ultrasound or magnetic resonance imaging, on many occasions, unexpected findings can be encountered during surgery that can make the operation difficult and correct decision-making crucial. In this article we discuss the difficulties and unexpected findings that can be encountered during anal fistula surgery and how to overcome them.

  17. Human Rights and Education. Comparative & International Education Series, Volume 3.

    Science.gov (United States)

    Tarrow, Norma Bernstein, Ed.

    This book discusses the relationship between human rights and education. Education is discussed both within the context of human rights, and as the ultimate sanction and guarantee of all human rights. Part 1, "Education as a Human Right," is comprised of the following chapters: (1) "Human Rights and Education: An Overview" (D.…

  18. International Human Resource Management Education: A Survey of HR Professionals, Suggestions for Skill Dissemination.

    Science.gov (United States)

    Barclay, Lizabeth A.; Wagner-Marsh, Fraya; Loewe, G. Michael

    2002-01-01

    Surveyed a human resource professional association about training and interest in international human resources management. Based on results, offers recommendations for expanding coverage of this topic in credit and non-credit courses. (EV)

  19. USE OF TRANSPERINEAL ULTRASONOGRAPHY TO STUDY THE EFFECT OF DELIVERY AND EPISIOTOMY ON ANAL SPHINCTER IN WOMEN

    Directory of Open Access Journals (Sweden)

    Rooplekha

    2014-06-01

    Full Text Available Parturition has profound effect on the pelvic floor muscles and is associated with mechanical or neurological injuries. In most women, this effect is transitory, however in a few, permanent damage occurs in the form of urinary or fecal incontinence, fistulae, and sexual problems. often very little attention is paid on to these problems postnataly and few women volunteer to inform about these. Therefore, the true incidence of the problem is unknown. We conducted a study to correlate the various risk factors with the degree of perianal injury caused by the mode of delivery and episiotomy on the anal sphincter. Until recently, defects of external anal sphincter (EAS were detected by electromyography and internal anal sphincter (IAS by measurement of low resting anal pressure. This study uses the transperineal ultrasonography (TPUS. TPUS assesses the anal sphincter under more physiological condition with no intra anal probe like anal endosonography so also demonstrate the internal anal cushion (mucosa & submucosa of the resting canal. TPUS gives accurate images of both sphincter muscles, leading to recognition of unsuspected defects of external & internal sphincter.

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

    Directory of Open Access Journals (Sweden)

    Saroj Tucker

    2012-01-01

    Full Text Available Objective: 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. Materials and Methods: 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. Results: 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. Conclusion: 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.

  1. CLINICAL OBSERVATION ON TREATMENT OF ANAL FISSURE BY APPLYING SPHINCTEROTOMY WITH ACUPOTOM

    Institute of Scientific and Technical Information of China (English)

    段海涛; 沈瑞子; 阳建明; 温伟平; 邱仁斌

    2003-01-01

    Objective: To observe the therapeutic effect end features of acupotomy in the treatment of anal fis-sure. Methods: Seventy-six cases with anal fissure were randomly divided into two groups, namely, acupotomy groupin which 37 patients were treated by anal internal sphincterotomy with acupotomy, and conventional anal sphincteroto-my group (conventional group, n=39) that was treated by conventional amputation of the anal sphincter. Results: Af-ter treatment, twenty-six over 37 cases in acupotomy group recovered completely and the other 9 cases were improvedclinically, with the total effective rate being 94.59%. In conventional group, 27 over 39 cases recovered completelyand the other 11 cases were improved clinically. The total effective rate was 97.44%. There was no significant differ-ence in the curative rate between two groups. However, compared with those of conventional group, patients inacupotomy group had significantly less bleeding, earlier healing of fissure and less pain. Conclusion: The results sug-gest that acupotomy treatment of anal fissure with anal sphincterotomy is a better therapeutic technique with advantagesof easier manipulation, earlier healing and milder wound, less infectious complications end pain.

  2. Anal incontinence and fecal urgency following vaginal delivery with episiotomy among primiparous patients.

    Science.gov (United States)

    Rusavy, Zdenek; Karbanova, Jaroslava; Jansova, Magdalena; Kalis, Vladimir

    2016-12-01

    To investigate anal incontinence following mediolateral or lateral episiotomy during a first vaginal delivery. The present prospective follow-up study enrolled primiparous patients who underwent vaginal delivery including mediolateral or lateral episiotomy between April 1, 2010 and March 31, 2012. Participants completed interviews before delivery, and were given anal-incontinence questionnaires to be returned for analysis at 3 months and 6 months postpartum. Anal incontinence was defined as a St Mark's incontinence score above four and individual anal-incontinence components were analyzed separately; results were compared between the two episiotomy techniques. Questionnaires were returned by 300 and 366 patients who underwent mediolateral and lateral episiotomies, respectively; baseline characteristics were similar. Anal incontinence at 3 months and 6 months was recorded among 21 (7.0%) and 9 (3.0%) patients who underwent mediolateral and 27 (7.4%) and 20 (5.5%) who underwent lateral episiotomy, respectively. The study was underpowered to confirm equivalence between the groups; however, no statistically significant differences were observed in the rates of anal incontinence, flatus, solid or liquid incontinence, and de novo incontinence. Fecal urgency (P=0.017) and de novo fecal urgency (P=0.008) were more prevalent among patients who underwent lateral episiotomies at 6 months. Anal incontinence was comparable between primiparous patients who underwent mediolateral or lateral episiotomy. The association between lateral episiotomy and fecal urgency merits further scientific interest. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  3. Improvement of Anal Function by Adipose-Derived Stem Cell Sheets.

    Science.gov (United States)

    Inoue, Yusuke; Fujita, Fumihiko; Yamaguchi, Izumi; Kinoe, Hiroko; Kawahara, Daisuke; Sakai, Yusuke; Kuroki, Tamotsu; Eguchi, Susumu

    2017-05-12

    One of the most troublesome complications of anal preserving surgery is anal sphincter dysfunction. The aim of this study was to evaluate functional recovery after implantation of adipose-derived stem cell (ADSC) sheets, novel biotechnology, for an anal sphincter resection animal model. Eighteen female Sprague-Dawley rats underwent removal of the nearest half of the internal and external anal sphincter muscle. Nine rats received transplantation with ADSC sheets to the resected area while the remaining rats received no transplantation. The rats were evaluated for the anal function by measuring their resting pressure before surgery and on postoperative days 1, 7, 14, 28, and 56. In addition, the rats were examined for the presence of smooth muscle and also to determine its origin. The improvement of the anal pressure was significantly greater in the ADSC sheet transplantation group compared with the control group. Histologically, at the vicinity of the remaining smooth muscle, reproduction of smooth muscle was detected. Using in fluorescence in situ hybridization, the cells were shown to be from the recipient. Regenerative therapy using ADSC sheet has the potential to recover anal sphincter dysfunction due to anorectal surgery. © 2017 S. Karger AG, Basel.

  4. Systemic glyceryl trinitrate reduces anal sphincter tone: is there a therapeutic indication?

    Science.gov (United States)

    Connolly, C; Tierney, S; Grace, P

    2017-09-13

    Nitric oxide (NO) has diverse roles as a biological messenger. [1] Topically applied nitrate donors cause relaxation of the internal anal sphincter (IAS) and facilitate healing of anal fissures [2,3]. Systemic nitrates are commonly used for the treatment of ischaemic heart disease, yet the effects of systemically administered nitrates on the smooth muscle of the IAS are unknown. Our aim was to test the hypothesis that systemically administered nitrates at a normal dose, cause inhibition of anal sphincter activity. With fully informed consent, anal manometry was performed on nine volunteers. Maximum and mean anal resting pressure (representing the IAS), maximum squeeze pressure (representing the external anal sphincter), heart rate and blood pressure were measured, before and after administration of a normal 400 μg dose of sublingual glyceryl trinitrate spray. Data are expressed as mean (± standard error of the mean (SEM)). In four females and five males ranging from 19 to 50 years of age, administration of GTN resulted in a significant reduction in systolic blood pressure from 138 ± 5 to 127 ± 4 mmHg, P anal sphincter function.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Anal self-massage in the treatment of acute anal fissure: a randomized prospective study.

    Science.gov (United States)

    Gaj, Fabio; Biviano, Ivano; Candeloro, Laura; Andreuccetti, Jacopo

    2017-01-01

    An anal fissure (AF) is a tear in the epithelial lining of the anal canal. This is a very common condition, but the choice of treatment is unclear. The use of anal dilators is effective, economic, and safe. The aim of the study was to compare the efficacy of two conservative treatments, the use of anal dilators or a finger for anal dilatation, in reducing anal pressure and resolving anal fissures. Fifty patients with a clinical diagnosis of AF were randomly assigned to one of the treatments, self-massage of the anal sphincter (group A, 25 patients) or passive dilatation using dilators (group B, 25 patients). All patients were evaluated at baseline, at the end of treatment, and after 12 weeks and 6 months. Pain was measured using a visual analog scale. After the treatment, 60% of patients treated with dilators and 80% of patients treated with anal self-massage using a finger showed disappearance of their anal fissures. A comparison between signs and symptoms reported by the patients in the two groups showed a statistically significant reduction in anal pain (group A, P=0.0001; group B, P=0.0001) and bleeding after defecation (group A, P=0.001, group B, P=0.001). At 6 months after treatment, a significantly greater reduction in anal pain was observed in Group A compared to Group B (P=0.02). The use of anal self-massage with a finger appears to induce a better resolution of acute anal fissure than do anal dilators, and in a shorter time.

  7. Human rights and internal security in Malaysia rhetoric and reality

    OpenAIRE

    Rahim, Noor Hishmuddian

    2006-01-01

    Since 1957, Malaysia has faced external and internal security threats. Over time, Malaysia has succeeded in solving the external threats but internal threats remained. The internal threats have come in many forms, including ethnic conflict, religious extremism and deviationism, and terrorism. Since the safety of the public lies in the hands of the government, measures have been taken to ensure the nation's stability and security, including restriction on civil and political liberties. This th...

  8. Interactions between International Humanitarian Law and International Human Rights Law for the protection of Economic, Social and Cultural Rights

    Directory of Open Access Journals (Sweden)

    Koldo Casla

    2012-01-01

    Full Text Available Economic, Social and Cultural Rights (ESCR are at risk on the battlefield. Thus, human rights lawyers must look for legal means to guarantee the best possible protection of these rights in case of war. It is generally accepted nowadays that both International Humanitarian Law (IHL and International Human Rights Law (IHRL are applicable during armed conflicts. Adding on that and based on a procedural and substantive legal analysis, this paper claims that both IHL and IHRL constantly interact in a relation of synergy or norms.

  9. Cultural pluralism in international human rights law: the role of reservations

    NARCIS (Netherlands)

    Donders, Y.; Vrdoljak, A.F.

    2013-01-01

    This chapter addresses cultural pluralism in international human rights law by analysing one specific aspect of international law, namely reservations to human rights treaties. It has been argued that reservations "…are a legitimate, perhaps even desirable, means of accounting for cultural,

  10. Changes and Challenges in the Flow of International Human Capital: China's Experience

    Science.gov (United States)

    Pan, Su-Yan

    2010-01-01

    This article tracks the changes in the directions of the international flow of Chinese human capital between the 1870s and 2000s. Although many studies on international academic flow adopt the pull-and-push approach, this article argues that the direction of human capital flow is not determined solely by an individual's choice when faced with a…

  11. Book Review: Current Issues in International Human Resource Management and Strategy Research

    DEFF Research Database (Denmark)

    Gretzinger, Susanne

    2009-01-01

    The article reviews the book "Current Issues in International Human Resource Management and Strategy Research," edited by Marion Festing and Susanne Royer.......The article reviews the book "Current Issues in International Human Resource Management and Strategy Research," edited by Marion Festing and Susanne Royer....

  12. Divergent Fates of the Medical Humanities in Psychiatry and Internal Medicine: Should Psychiatry Be Rehumanized?

    Science.gov (United States)

    Rutherford, Bret R.; Hellerstein, David J.

    2008-01-01

    Objective: To determine the degree to which the medical humanities have been integrated into the fields of internal medicine and psychiatry, the authors assessed the presence of medical humanities articles in selected psychiatry and internal medicine journals from 1950 to 2000. Methods: The journals searched were the three highest-ranking…

  13. Book Review: Current Issues in International Human Resource Management and Strategy Research

    DEFF Research Database (Denmark)

    Gretzinger, Susanne

    2009-01-01

    The article reviews the book "Current Issues in International Human Resource Management and Strategy Research," edited by Marion Festing and Susanne Royer.......The article reviews the book "Current Issues in International Human Resource Management and Strategy Research," edited by Marion Festing and Susanne Royer....

  14. The crisis of international human rights law in the global market economy

    NARCIS (Netherlands)

    Augenstein, D.H.

    2014-01-01

    The contribution argues that facticity of the human rights impacts of economic globalisation increasingly undermines the normativity of the state-centred conception of international human rights law. The exposure of the international legal order of states to the operations of global business entitie

  15. The Crisis of International Human Rights Law in the Global Market Economy

    NARCIS (Netherlands)

    Augenstein, Daniel

    2014-01-01

    The article argues that the facticity of the human rights impacts of economic globalisation increasingly undermines the normativity of the state-centred conception of international human rights law. The exposure of the international legal order of states to the operations of global business entities

  16. 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

  17. 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...

  18. 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

  19. Nocturnal faecal soiling and anal masturbation.

    OpenAIRE

    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.

  20. O Proceso analítico

    OpenAIRE

    Yebra Biurrun, María del Carmen

    2013-01-01

    Esta unidade didáctica enfócase de maneira que permita proporcionar unha visión global da Química Analítica e a súa terminoloxía básica, mostrando a importancia da Química Analítica para a resolución de problemas de diversos ámbitos. Este enfoque faise sobre o esquema do proceso analítico como medio de resolución dunha determinada problemática analítica real. Deste xeito, partindo dun esquema sinxelo, explícase o obxectivo e as distintas etapas do proceso analítico: definición do problema...

  1. Synchronous rectal adenocarcinoma and anal canal adenocarcinoma

    Institute of Scientific and Technical Information of China (English)

    GU Jin; LI Jiyou; YAO Yunfeng; LU Aiping; WANG Hongyi

    2007-01-01

    It is difficult to distinguish a tectal carcinoma with anal metastases from coexistent synchronous anorectal carcinomas.The therapeutic strategy for rectal and anal carcinoma is so different that it should be clearly identified.Here,we report on the case of a 63-year-old man who presented with an upper-third rectal adenocarcinoma.Five months after resection,he developed an adenocarcinoma in the anal canal.The histological slides of both tumors were reviewed and immunohistochemical studies for cytokeratins(CKs)7 and 20 were performed.The index tumor demonstrated CK 7-/CK 20+and the second showed CK7+/CK20+.For this reason,we believe the present case had synchronous adenocarcinomas arising from anal canal and the rectum separately.It is very important to difierentiate the anorectal lesions pathologically because of the impact on the therapeutic options available,especially for the lesion arising in the anal canal.

  2. Increased anal basal pressure in chronic anal fissures may be caused by overreaction of the anal-external sphincter continence reflex

    NARCIS (Netherlands)

    van Meegdenburg, Maxime M.; Trzpis, Monika; Heineman, Erik; Broens, Paul M. A.

    2016-01-01

    Chronic anal fissure is a painful disorder caused by linear ulcers in the distal anal mucosa. Even though it counts as one of the most common benign anorectal disorders, its precise etiology and pathophysiology remains unclear. Current thinking is that anal fissures are caused by anal trauma and pai

  3. Increased anal basal pressure in chronic anal fissures may be caused by overreaction of the anal-external sphincter continence reflex

    NARCIS (Netherlands)

    van Meegdenburg, Maxime M.; Trzpis, Monika; Heineman, Erik; Broens, Paul M. A.

    Chronic anal fissure is a painful disorder caused by linear ulcers in the distal anal mucosa. Even though it counts as one of the most common benign anorectal disorders, its precise etiology and pathophysiology remains unclear. Current thinking is that anal fissures are caused by anal trauma and

  4. Viscoelastic assessment of anal canal function using acoustic reflectometry

    DEFF Research Database (Denmark)

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

    2012-01-01

    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.......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....

  5. Treatment of Complete Anal Stricture after Diverting Colostomy for Fournier's Gangrene

    Science.gov (United States)

    Kubota, Tadao; Lefor, Alan Kawarai; Mizokami, Ken

    2017-01-01

    Background. Anal stenosis is a rare but serious complication of anorectal surgery. Severe anal stenosis is a challenging condition. Case Presentation. A 70-year-old Japanese man presented with a ten-hour history of continuous anal pain due to incarcerated hemorrhoids. He had a history of reducible internal hemorrhoids and was followed for 10 years. He had a fever and nonreducible internal hemorrhoids surrounding necrotic soft tissues. He was diagnosed as Fournier's gangrene and treated with debridement and diverting colostomy. He needed temporary continuous renal replacement therapy and was discharged on postoperative day 39. After four months, severe anal stenosis was found on physical examination, and total colonoscopy showed a complete anal stricture. The patient was brought to the operating room and underwent colostomy closure and anoplasty. He recovered without any complications. Conclusion. We present a first patient with a complete anal stricture after diverting colostomy treated with anoplasty and stoma closure. This case reminds us of the assessment of distal bowel conduit and might suggest that anoplasty might be considered in the success of the colostomy closure. PMID:28255493

  6. Prevalence and predictors of unsatisfactory anal cytology tests in a cohort of gay and bisexual men in Sydney, Australia: baseline findings from the Study of the Prevention of Anal Cancer (SPANC).

    Science.gov (United States)

    Templeton, David J; Roberts, Jennifer M; Poynten, I Mary; Law, Carmella; Hillman, Richard J; Farnsworth, Annabelle; Fairley, Christopher K; Tabrizi, Sepehr N; Garland, Suzanne M; Grulich, Andrew E; Jin, Fengyi

    2017-05-01

    Anal cytology has been suggested as a screening test for the anal cancer precursor high-grade squamous intraepithelial lesion (HSIL). We aimed to assess the prevalence and predictors of initial unsatisfactory anal cytology tests ('unsats'). The Study of the Prevention of Anal Cancer is a natural history study of anal human papillomavirus (HPV) and precancerous lesions among gay and bisexual men (GBM) of at least 35 years in Sydney, Australia. At each study visit, an anal swab is collected for cytological testing. Unsats are defined as slides with fewer than 2000 nucleated squamous cells and no abnormal cells. Among 617 GBM enrolled, the median age was 49 (range: 35-79) years and 220 (35.7%) were HIV positive. Initial unsats occurred in 61 (9.9%, 95% confidence interval: 7.6-12.5%), and 29 (4.7%, 95% confidence interval: 3.2-6.7%) remained unsatisfactory on repeat cytology. Initial unsats were associated with fewer lifetime anal-receptive partners with a condom (P=0.007); fewer recent anal-receptive sexual partners without a condom (P=0.005); never having had anal chlamydia (P=0.023) or gonorrhea (P=0.003); HIV-negative status (P=0.002); fewer total (P=0.002), low-risk (P=0.005), and high-risk (P=0.015) HPV types detected; lack of anal HPV18 detection (P=0.001); never having anally douched (Panal canal octants affected by HSIL (P=0.080), but were more common among those who felt more nervous (P=0.020) during the examination. Our findings suggest that unsats are more common among GBM with less receptive anal sexual experience. Avoiding douching with soapy water and strategies to aid patient relaxation during sampling may reduce the unsat rate.

  7. Reproductive cloning and human health: an ethical, international, and nursing perspective.

    Science.gov (United States)

    Sanchez-Sweatman, L R

    2000-03-01

    Human reproductive cloning came to the public's attention when Dolly, a sheep, was cloned in Scotland in 1997. This news quickly spread around the world causing both excitement at the possibilities that cloning techniques could offer, as well as apprehension about the ethical, social and legal implications should human reproductive cloning become possible. Many international organizations, such as the World Health Organization, the International Council of Nurses, and governments were concerned about the impact of human reproductive cloning on human health, dignity and human rights. To this end, many institutions have drafted resolutions, protocols and position statements outlining their concerns. This paper will outline some of the major ethical issues surrounding human reproductive cloning, the position of various international organizations and governments, and specifically the position of the International Council of Nurses.

  8. Human Resource Utilization and Internal Efficiency in State-Owned Universities in Nigeria

    OpenAIRE

    A.Y. Abdulkareem; Fasasi, Y. A.; O.P. Akinnubi

    2011-01-01

    This paper examined the relationship between human resource utilization and internal efficiency in Nigerian state universities. It was a descriptive survey research. Stratified random sampling technique was adopted for selecting 6 out of 12 state-owned universities. Also, 572 lecturers were sampled from Humanities and Science Faculties of the institutions. They responded to “Human Resource Checklist” (HRC) and “Internal Efficiency Checklist” (IEC) designed by the researchers and validated by ...

  9. A qualitative investigation among men who have sex with men on the acceptability of performing a self- or partner anal exam to screen for anal cancer.

    Science.gov (United States)

    Butame, Seyram A; Lawler, Sylvia; Hicks, Joseph T; Wilkerson, J Michael; Hwang, Lu-Yu; Baraniuk, Sarah; Ross, Michael W; Chiao, Elizabeth Yu; Nyitray, Alan G

    2017-08-04

    Persistent infection with oncogenic human papillomavirus (HPV) is the primary cause of anal cancer, a disease that disproportionately affects men who have sex with men (MSM); however, there is no uniform screening protocol to detect anal cancer. This qualitative study explores whether a self-anal exam (SAE) or partner anal exam (PAE), that includes self-palpation or palpation of a partner's anal canal, is an acceptable and self-efficacious screening test, which will cue appropriate follow-up care in MSM. Twenty-four MSM living in Houston took part in four focus group sessions eliciting their responses to a study teaching them to perform an SAE or PAE (SAE/PAE). Participants were asked about the acceptability and feasibility of executing an SAE/PAE routinely. Thematic analysis of session transcripts was used to identify common patterns in participant responses. Overall, participants expressed self-efficacy for performing an SAE/PAE and voiced a preference for being taught the procedure by a clinician. Participants agreed that they would consult with a clinician if they ever discovered an abnormality while performing an SAE/PAE. A lack of knowledge about anal cancer among MSM may present a barrier to adopting SAE/PAE. In discussing their experience of the exams, some participants suggested that it could become a routine practice for them. Our findings suggest that SAE and PAE, as a screen for anal cancer, are acceptable and feasible to MSM. Future research should explore attitudes and beliefs of MSM, with the aim of improving anal cancer education and understanding of pathologic findings.

  10. [Value of three-dimensional endoanal ultrasonography for anal fistula assessment].

    Science.gov (United States)

    Wang, Yonggang; Ding, Jianhua; Zhao, Ke; Ye, Haopeng; Zhao, Yujuan; Zhao, Yong; Lei, Yanan

    2014-12-01

    To explore the value of preoperative evaluation with three-dimensional endoanal ultrasonography (3D-EAUS) for anal fistula in order to provide preoperative assessment for anal fistula. One hundred patients diagnosed with anal fistula undergoing surgery between March 2012 and March 2013 in our department were prospectively enrolled. All the patients were randomly divided into the ultrasound group and the control group with fifty patients in each group. The ultrasound group received 3D-EAUS and the control group received routine examinations (digital examination and probe) to assess the position of the internal opening, the type of fistula and secondary tracks, respectively. The concordance rate of the preoperative assessment and intraoperative exploration was evaluated between the two groups. The accuracy of identifying internal opening was 96.0% for the ultrasound group and 82.0% for the control group with statistically significant difference (P=0.02). The accuracy of identifying internal opening for simple anal fistula was similar (95.0% vs. 91.3%, P=1). For complex anal fistula, the accuracy was also higher in the ultrasound group (96.7% vs. 74.1%, P=0.025). The accuracy of fistula classification was 78.0% for the ultrasound group and 96.0% for the control group with significant difference (P=0.01). The accuracy of identifying a second track was higher in the ultrasound group (96.0% vs. 82.0%, P=0.025). It is significantly superior for 3D-EAUS to detect the internal opening, fistula classification and identification of a second track in complex anal fistulas as compared to conventional examination. 3D-EAUS should be recommended as a preoperative assessment for anal fistula, especially for complex one.

  11. Humans on the International Space Station-How Research, Operations, and International Collaboration are Leading to New Understanding of Human Physiology and Performance in Microgravity

    Science.gov (United States)

    Ronbinson, Julie A.; Harm, Deborah L.

    2009-01-01

    As the International Space Station (ISS) nears completion, and full international utilization is achieved, we are at a scientific crossroads. ISS is the premier location for research aimed at understanding the effects of microgravity on the human body. For applications to future human exploration, it is key for validation, quantification, and mitigation of a wide variety of spaceflight risks to health and human performance. Understanding and mitigating these risks is the focus of NASA s Human Research Program. However, NASA s approach to defining human research objectives is only one of many approaches within the ISS international partnership (including Roscosmos, the European Space Agency, the Canadian Space Agency, and the Japan Aerospace Exploration Agency). Each of these agencies selects and implements their own ISS research, with independent but related objectives for human and life sciences research. Because the science itself is also international and collaborative, investigations that are led by one ISS partner also often include cooperative scientists from around the world. The operation of the ISS generates significant additional data that is not directly linked to specific investigations. Such data comes from medical monitoring of crew members, life support and radiation monitoring, and from the systems that have been implemented to protect the health of the crew (such as exercise hardware). We provide examples of these international synergies in human research on ISS and highlight key early accomplishments that derive from these broad interfaces. Taken as a whole, the combination of diverse research objectives, operational data, international sharing of research resources on ISS, and scientific collaboration provide a robust research approach and capability that no one partner could achieve alone.

  12. Humans on the International Space Station-How Research, Operations, and International Collaboration are Leading to New Understanding of Human Physiology and Performance in Microgravity

    Science.gov (United States)

    Ronbinson, Julie A.; Harm, Deborah L.

    2009-01-01

    As the International Space Station (ISS) nears completion, and full international utilization is achieved, we are at a scientific crossroads. ISS is the premier location for research aimed at understanding the effects of microgravity on the human body. For applications to future human exploration, it is key for validation, quantification, and mitigation of a wide variety of spaceflight risks to health and human performance. Understanding and mitigating these risks is the focus of NASA s Human Research Program. However, NASA s approach to defining human research objectives is only one of many approaches within the ISS international partnership (including Roscosmos, the European Space Agency, the Canadian Space Agency, and the Japan Aerospace Exploration Agency). Each of these agencies selects and implements their own ISS research, with independent but related objectives for human and life sciences research. Because the science itself is also international and collaborative, investigations that are led by one ISS partner also often include cooperative scientists from around the world. The operation of the ISS generates significant additional data that is not directly linked to specific investigations. Such data comes from medical monitoring of crew members, life support and radiation monitoring, and from the systems that have been implemented to protect the health of the crew (such as exercise hardware). We provide examples of these international synergies in human research on ISS and highlight key early accomplishments that derive from these broad interfaces. Taken as a whole, the combination of diverse research objectives, operational data, international sharing of research resources on ISS, and scientific collaboration provide a robust research approach and capability that no one partner could achieve alone.

  13. Advancement of human rights standards for LGBT people through the perspective of international human rights law

    Directory of Open Access Journals (Sweden)

    Lucie Cviklová

    2012-01-01

    Full Text Available The article addresses the issue how various religious and legal systems cope with current developments that undermine binary opposition of man and woman including definition of their sexual and cultural identities. More concretely, it tries to explain, how concrete societies and legislations deal with claims of lesbians, gays, bisexuals, and transsexuals (LGBT that claim broader recognition. It elucidates differences among Western provisions and policies of the relevant legal bodies such as the General Assembly of the United Nations, the European Court of Human Rights and the Supreme Court concerning these issues. It also points to the nature and real impact of international civil society forces such as Yogyakarta principles that formulate extension of rights concerning lesbians, gays, bisexuals, and transsexuals. On the basis of comparison of various legal and religious discourses it explains current practices of direct and indirect discrimination and in some non-European national systems even extra-judicial killings, torture and ill-treatment, sexual assault, rape and other violations of human rights. When emphasizing substantial differences among current European states and non-European ones concerning policies toward lesbian, gay, bisexual and transgender people (LGBT, it shows current tendencies of advancement in the field by common policies of Council of Europe, recent judgments issued by the European Court of Human Rights as well as civil society efforts such as Yogyakarta principles. Swedish standards have been introduced in order to emphasize existing progressive attitudes to LGBT people concerning gay marriages and adoption procedures.

  14. Anal cancer and intraepithelial neoplasia screening: Areview

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    This review focuses on the early diagnosis of anal cancer and its precursor lesions through routine screening. Anumber of risk-stratification strategies as well as screeningtechniques have been suggested, and currently littleconsensus exists among national societies. Much ofthe current clinical rationale for the prevention of analcancer derives from the similar tumor biology of cervicalcancer and the successful use of routine screening toidentify cervical cancer and its precursors early in thedisease process. It is thought that such a strategy ofidentifying early anal intraepithelial neoplasia will reducethe incidence of invasive anal cancer. The low prevalenceof anal cancer in the general population prevents theuse of routine screening. However, routine screeningof selected populations has been shown to be a morepromising strategy. Potential screening modalities includedigital anorectal exam, anal Papanicolaou testing, humanpapilloma virus co-testing, and high-resolution anoscopy.Additional research associating high-grade dysplasiatreatment with anal cancer prevention as well as directcomparisons of screening regimens is necessary todevelop further anal cancer screening recommendations.

  15. 2012 International Conference on Human-centric Computing

    CERN Document Server

    Jin, Qun; Yeo, Martin; Hu, Bin; Human Centric Technology and Service in Smart Space, HumanCom 2012

    2012-01-01

    The theme of HumanCom is focused on the various aspects of human-centric computing for advances in computer science and its applications and provides an opportunity for academic and industry professionals to discuss the latest issues and progress in the area of human-centric computing. In addition, the conference will publish high quality papers which are closely related to the various theories and practical applications in human-centric computing. Furthermore, we expect that the conference and its publications will be a trigger for further related research and technology improvements in this important subject.

  16. Anal erogeneity: the goose and the rat.

    Science.gov (United States)

    Shengold, L

    1982-01-01

    A case is presented in which the patient's traumatically derived intense anal erogeneity (associated with traumatic anxiety as well as with castration anxiety) inhibited his phallic sensations and potency and also his power to sustain productive thought. His passive cravings were disguised and reacted against in his compulsive-exhibitionistically phallic role of a Don Juan. He described at least two levels of anal feelings: a dangerous but exciting, tolerable or even pleasurable tension associated with the imago of the goose; and an unbearable, terrifying overcharged level embodied in the imago of the rat. (He had read of, and had felt himself identified with, Freud's Rat Man.) Contrasts are presented with François Rabelais' account of the instinctual development and anal training of Gargantua, in which the connotations of the goose lead to a happy anal, phallic and intellectual control. Generalizations are ventured about the crucial attainment of command over the anal sphincter for the taming of 'primal affect'(Fliess). With early psychopathology there is a defensive overcathexis of anal control (and of anal mechanisms and character traits) to try to contain over-stimulation. In contrast true anal mastery contributes to the acquisition of optimal genital feelings and functioning and to the capacity for sustaining integrative thinking so necessary for 'owning' one's affects and impulses, and therefore for a feeling of identity. Finally, some remarks of Freud on Rabelais are reviewed in relation to levels of urethral erogeneity, seen as developmental way stations between the anal and the phallic, and partaking of both.

  17. Tratamento dos datos analíticos

    OpenAIRE

    Yebra Biurrun, María del Carmen

    2008-01-01

    Esta unidade didáctica é a primeira toma de contacto do alumnado co estudo do tratamento dos datos analíticos e a comprobación da súa calidade. Este estudo poderase completar máis adiante dentro do programa desta materia cando se presente o resto dos parámetros de calidade dos métodos analíticos. A importancia deste tema radica en que unha vez obtidos os datos analíticos, o primeiro aspecto que se ten que considerar é a verificación da calidade dos mesmos en termos de exactitude e precisió...

  18. Human Rights and Internal Security in Malaysia: Rhetoric and Reality

    Science.gov (United States)

    2006-03-01

    Rights, have become instruments for interpreting human rights as described in the UN Charter. 1 Mahatma ... Gandhi quoted in Aliran Homepage. Database on-line. Available at http://www.aliran.com; accessed 21 May 2005. 2 Lt Col Rosli bin Mohd Yusof, “Human

  19. Methylation of HPV and a tumor suppressor gene reveals anal cancer and precursor lesions

    Science.gov (United States)

    Lorincz, Attila T.; Nathan, Mayura; Reuter, Caroline; Warman, Rhian; Thaha, Mohamed A.; Sheaff, Michael; Vasiljevic, Natasa; Ahmad, Amar; Cuzick, Jack; Sasieni, Peter

    2017-01-01

    We studied DNA methylation patterns of human papillomavirus (HPV) and tumor suppressor gene EPB41L3 in 148 anal and perianal biopsies to determine whether high levels of methylation would be associated with anal intraepithelial neoplasia (AIN). The most prevalent HPV type was HPV16, detected in 54% of the 30 benign biopsies, 33% of the 43 low-grade AIN (lgAIN), 82% of the 59 high grade AIN (hgAIN) and 4 of the 5 anal cancers. A methylation score was developed (0.561*HPV16me+0.439*EPB41L3) which had increasing values with severity of disease: the mean was 8.1% in benign, 13.2% in lgAIN, 22.3% in hgAIN and 49.3% in cancers (p anal disease. PMID:28881579

  20. First Case of the Cervical Lymph Node as the Only Site of Metastasis from Anal Cancer.

    Science.gov (United States)

    Wang, Bo; Jaiswal, Sunny; Saif, Muhammad W

    2017-05-30

    Anal squamous cell carcinoma was a previously uncommon malignancy that has steadily increased in incidence with the increased prevalence of human papillomavirus (HPV) and human immunodeficiency virus (HIV). Anal squamous cell carcinoma is typically characterized by local and regional involvement and distant metastases are far less common. Here, we report a case of a 36-year-old female initially diagnosed with anal squamous cell carcinoma manifesting as an anal mass along with an enlarged inguinal lymph node. After receiving chemoradiation therapy, she remained disease-free until recently, when she presented with an isolated left infraclavicular lymph node found on physical examination followed by a biopsy that was consistent with recurrent anal squamous cell carcinoma. The positron emission tomography-computed tomography (PET-CT) uptake of her original left inguinal lymph node was decreased, suggesting improved regional disease, and no other metastases were found. Our case represents a rare occurrence of metastatic anal squamous cell carcinoma to an isolated distal lymph node and reminds physicians not to forget a unusual site of metastasis and prevent any delay in treatment.

  1. Corporate Human Rights Obligations and International Investment Law

    Directory of Open Access Journals (Sweden)

    Jernej Letnar Cernic

    2010-12-01

    Full Text Available Globalisation has blurred the artificial borders that exist between economies and societies around the world. The activities of corporations in this globalised environment have often served as the catalyst for human rights violations; due to the lack of institutional protection, some corporations are able to exploit regulatory lacunae and the lack of human rights protection. It appears that the paradigmatic change demands an equal emphasis of rights and obligations of corporations. This article discusses and critically analyses corporate human rights obligations and the lack thereof under stabilization clauses in foreign investment contracts. First, stabilization clauses in foreign investment agreements are examined in relation to corporate obligations and responsibility for fundamental human rights. In doing so the substantive and procedural dimension of stabilization clauses is analysed. Second, using the concrete examples of the Mineral Development Agreement between Mittal Steel and the Government of Liberia Mittal Steel Agreement and of the Baku‐Tblisi‐Ceyhan Pipeline Project as case studies, this article considers an application of stabilization clauses in foreign investment contracts in relation to the fundamental human rights obligation of states and of corporations. Third, a proposal for reform in the form of a fundamental human rights clause is introduced. To be clear, the argument here is that the fundamental human rights obligations of investors, particularly of corporations, must be included in foreign investment agreements.

  2. Teaching about Child Labor and International Human Rights. ERIC Digest.

    Science.gov (United States)

    Hamot, Gregory E.; Jensen, Elizabeth S.

    An estimated 246 million children between the ages of 5 and 17 work in the agricultural, industrial, and craft sectors worldwide. Approximately 180 million of these children work under the worst forms of child labor as defined by the International Labor Organization (2002). In spite of conventions and protocols designed to eradicate the worst…

  3. 'Soft' human resource management in small international joint ventures

    DEFF Research Database (Denmark)

    Dao, Li

    2012-01-01

    This paper examines the value creation aspects of HRM in international joint ventures of a relatively small size and their implications for strategic management. We assume that HRM in this context is rather a process than a function, and a ‘soft’ – humanistic rather than a ‘hard’, instrumentalist...

  4. International Journal of Arts and Humanities (IJAH) Bahir Dar- Ethiopia

    African Journals Online (AJOL)

    Nneka Umera-Okeke

    Indexed African Journals Online: www.ajol.info. International .... Rather our intention is to focus on two of the key unnoticed negative consequences ..... price of a product or resource, the lower the quantity demanded (McConnell et al.,. 2009 ... competing buyers to buy at higher prices which in turn drive producers to produce.

  5. VAAFT - Videoassisted anal fistula treatment: a new approach for anal fistula

    OpenAIRE

    Mendes,Carlos Ramon Silveira; FERREIRA, Luciano Santana de Miranda; Sapucaia,Ricardo Aguiar; LIMA, Meyline Andrade; Araujo, Sergio Eduardo Alonso

    2014-01-01

    INTRODUCTION: Anal fistula is an epithelised path between the rectum or anal canal and the perianal region. The use of laparoscopic surgery with a minimally invasive procedure has led to the development of video-assisted surgical treatment of anal fistula.OBJECTIVE: To describe the surgical technique VAAFT as a new approach to fistula.CONCLUSION: This is a safe and reproducible procedure. It enables the study of the entire fistula, obtaining the identification of accessory paths, cavitations ...

  6. The Effect of Topical Nifedipine in Treatment of Chronic Anal Fissure

    Directory of Open Access Journals (Sweden)

    Farzaneh Golfam

    2010-10-01

    Full Text Available Chronic anal fissure is the most common cause of anal pain associated with internal anal sphincter hypertonia. Reduction of hypertonocity is a special treatment for fissure healing. For this purpose chronic anal fissures were conventionally treated by anal dilatation or by lateral sphincterotomy. However, both of these methods may cause a degree of incontinence in some patients. The uptake of medical therapies that create a reversible chemical sphincterotomy has recently become widespread. The aim of this prospective clinical trial study was to assess the effectiveness of nifedipine in healing anal fissure, a calcium channel blocker that reduces sphincter pressure. A single-blind randomized comparative trial was setup to compare traditional treatment with stool softeners and 2% lidocaine cream against 0.5% nifedipine cream for 4 weeks. 110 patients were included in this study, 60 patients in the nifedipine group and 50 patients in the control group and the therapeutic outcome and side effects were recorded. Healing had occurred in 70% of patients in the nifedipine group and in 12% of patients in the control group after 4 weeks treatment (P

  7. Comparison of Endoanal Ultrasound with Clinical Diagnosis in Anal Fistula Assessment.

    Science.gov (United States)

    Sirikurnpiboon, Siripong; Phadhana-anake, Oradee; Awapittaya, Burin

    2016-02-01

    Anal fistula anatomy and its relationship with anal sphincters are important factors influencing the results of surgical management. Pre-operative definitions of fistulous track(s) and the internal opening play a primary role in minimizing damage to the sphincters and recurrence of the fistula. To evaluate the relative accuracy of digital examination and endoanal ultrasound for pre-operative assessment of anal fistula by comparing operative findings. A retrospective review was conducted of all patients with anal fistula admitted to the surgical unit between May 2008 and May 2012. Physical examination and hydrogen peroxide-enhanced endoanal ultrasound (utilising a 10 MHz endoprobe, HITACHI: EUB-7500), were performed in 142 consecutive patients. Results were matched with surgical features to establish their accuracy in preoperative anal fistula assessment. A total of 142 patients (107 men, 35 women), 28 of whom had had previous surgery, were included in the study. Their mean age was 40 (range 18-71) years and their mean BMI was 26.37 (range 17.30-36.11) kg/m². The majority of the fistulas were transphincteric (90.4%) and the rest were intersphincteric (9.6%). The accuracy rates of clinical examination and endoanal ultrasound were 55.63 and 95.07 percent (p anal fistula

  8. Anal Cancer: What Happens After Treatment?

    Science.gov (United States)

    ... see the section Understanding Recurrence . For patients with colostomies Most people treated for anal cancer don’t ... APR, you will need to have a permanent colostomy. If you have a colostomy, follow-up is ...

  9. Treatment of non-IBD anal fistula

    National Research Council Canada - National Science Library

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter; Buntzen, Steen; Thorlacius-Ussing, Ole; Andersen, Jens; Krupa, Marek; Qvist, Niels

    2015-01-01

    The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening...

  10. 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.

  11. The Prominent Role of National Judges in Interpreting the International Definition of Human Trafficking

    Directory of Open Access Journals (Sweden)

    Luuk B Esser

    2016-05-01

    Full Text Available Although there has been much discussion of the scope of the concept of human trafficking in international literature, the part played by national courts in interpreting definitions based on the international definition of human trafficking in the UN Trafficking Protocol has received little attention. When a judge interprets an offence, he or she clarifies or adds new meaning to it. The space for this is even greater when the underlying definition is broadly formulated, as in the case of the international definition of human trafficking. This article demonstrates that, although this international definition establishes the outer parameters within which conduct must be made a criminal offence, domestic courts still have room to flesh out the definition in national contexts. The role of national judges needs more consideration in today’s discourse on the legal definition of human trafficking.

  12. International Journal of Arts and Humanities(IJAH) Bahir Dar- Ethiopia

    African Journals Online (AJOL)

    DrNneka

    International Journal of Arts and Humanities(IJAH). Bahir Dar- Ethiopia ..... Fourthly, relief materials became a business for political elites to amass wealth. Arising from ... Unpublished PhD Thesis, Department of History,. University of Abuja ...

  13. International Conference on New Technologies in the Humanities and Fourth International Conference on Optics Within Life Sciences

    CERN Document Server

    Bally, Gert

    1997-01-01

    New high-tech developments in the field of optics show increasing applicability not only in classical technological fields but also in the humanities. This book contains selected contributions to an international, interdisciplinary joint conference on "New Technologies in the Humanities" and "Optics Within Life Sciences". Its objective is to forward interdisciplinary information and communication between specialists in optics as well as in medicine, biology, environmental sciences, and cultural heritage. It is unique as a presentation of new optical technologies for cultural heritage protection. The contributions cover international research activities in the areas of archaeological research and new technologies, holography and interferometry, material analysis, laser cleaning, pattern recognition, unconventional microscopy, spectroscopial techniques, and profilometry.

  14. Hidden Contradictions and Conditionality: Conceptualisations of Inclusive Education in International Human Rights Law

    Science.gov (United States)

    Byrne, Bronagh

    2013-01-01

    The nature of education that children with disabilities should receive has been subject to much debate. This article critically assesses the ways in which the international human rights framework has conceptualised "inclusive education". It argues that the right to education for children with disabilities in international law is…

  15. Hidden Contradictions and Conditionality: Conceptualisations of Inclusive Education in International Human Rights Law

    Science.gov (United States)

    Byrne, Bronagh

    2013-01-01

    The nature of education that children with disabilities should receive has been subject to much debate. This article critically assesses the ways in which the international human rights framework has conceptualised "inclusive education". It argues that the right to education for children with disabilities in international law is…

  16. 15. APPLICATION OF THE ALKALINE COMET ASSAY IN HUMAN BIOMONITORING: INTERNAL STANDARD AND GLOBAL REPAIR PHENOTYPE

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@An internal standard, composed of untreated an ethy1 methane sulfonate treated K562 cells was validated for its application in comet analysis of human biomonitoring samples. Firstly, the different levels of variability which may influence the damage levels of the internal standards were assessed. Three experimenters performed the comet assay with cells coming from the same set of untreated

  17. Screening, Surveillance, and Treatment of Anal Intraepithelial Neoplasia

    Science.gov (United States)

    Long, Kevin C.; Menon, Raman; Bastawrous, Amir; Billingham, Richard

    2016-01-01

    The prevalence of anal intraepithelial neoplasia has been increasing, especially in high-risk patients, including men who have sex with men, human immunodeficiency virus positive patients, and those who are immunosuppressed. Several studies with long-term follow-up have suggested that rate of progression from high-grade squamous intraepithelial lesions to invasive anal cancer is ∼ 5%. This number is considerably higher for those at high risk. Anal cytology has been used to attempt to screen high-risk patients for disease; however, it has been shown to have very little correlation to actual histology. Patients with lesions should undergo history and physical exam including digital rectal exam and standard anoscopy. High-resolution anoscopy can be considered as well, although it is of questionable time and cost–effectiveness. Nonoperative treatments include expectant surveillance and topical imiquimod or 5-fluorouracil. Operative therapies include wide local excision and targeted ablation with electrocautery, infrared coagulation, or cryotherapy. Recurrence rates remain high regardless of treatment delivered and surveillance is paramount, although optimal surveillance regimens have yet to be established. PMID:26929753

  18. Women, Human Rights, and Counseling: Crossing International Boundaries

    Science.gov (United States)

    Chung, Rita Chi-Ying

    2005-01-01

    The fast-paced movement of globalization has affected all walks of life including professional counselors. As the world becomes more accessible, increased instances of social injustice on a global scale have become more apparent, with women and children being especially identified as victims of social injustice and human rights violations (World…

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

    Science.gov (United States)

    Poulsen, Jakob Lykke; Brock, Christina; Grønlund, Debbie; Liao, Donghua; Gregersen, Hans; Krogh, Klaus; Drewes, Asbjørn Mohr

    2017-10-06

    Opioid analgesics inhibit anal sphincter function and contribute to opioid-induced bowel dysfunction (OIBD). However, it is unknown whether the inhibition can be reduced by opioid antagonism with prolonged-release (PR) naloxone and how this compares to laxative treatment. To compare the effects of combined PR oxycodone/naloxone or PR oxycodone plus macrogol 3350 on anal sphincter function and gastrointestinal symptoms. A randomized, double-blind, crossover trial was conducted in 20 healthy men. Participants were treated for 5 days with combined PR oxycodone/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 consistency were assessed daily. Both PR oxycodone/naloxone and PR oxycodone plus macrogol treatment decreased sphincter relaxation compared to baseline (- 27.5%; P anal pressure and anal canal distensibility did not differ between treatments. PAC-SYM abdominal symptoms score was lower during PR naloxone compared to macrogol (0.2 vs. 3.2; P = 0.002). The number of bowel movements was lower during PR naloxone versus macrogol (4.2 vs. 5.4; P = 0.035). Relaxation of the internal anal sphincter was significantly better after PR oxycodone/naloxone treatment compared to PR oxycodone plus macrogol 3350. These findings highlight that OIBD may require specific therapy against the complex, pan-intestinal effects of opioids.

  20. The Impact of International Cooperation for the Development of Democracy and Human Rights

    Directory of Open Access Journals (Sweden)

    Juan Pablo Prado Lallande

    2009-01-01

    Full Text Available At the end of the Cold War, the developed countries agreed that democracy and human rights would be top priority goals of the international cooperation for development. However, nearly two decades after those official commitments, these goals have not been relevant elements of the international agenda, since political, economic and security issues still prevail over both values. This paper analyzes the existing situation, in reference to the U.S. and European Union experiences. The article includes some considerations for the improvement of the international cooperation ability to promote democracy and human rights in third world countries.

  1. Human rights and development - an international political economy perspective

    Directory of Open Access Journals (Sweden)

    Cristiane Lucena

    2013-12-01

    Full Text Available This research note provides a critical review of the recent literature on the consequences of development and democratization for the protection of human rights. It identifies common lessons and grounds for further research in the field. This literature takes a series of paradoxes that challenge conventional wisdom regarding the relationship between development and democratization as its starting point, on one hand, and the protection of human rights, on the other. To that effect, several unintended adverse consequences of economic development and movements toward democracy for the protection of civil and political rights are identified. The literature focuses on rights to physical integrity, leaving important questions unanswered when it comes to civil liberties and second-generation rights. The article systematizes new knowledge produced by this literature, translates it into recommendations for research and identifies opportunities for new investigations.

  2. Cultural Pluralism in International Human Rights Law: The Role of Reservations

    NARCIS (Netherlands)

    Donders, Y.

    2013-01-01

    This paper addresses cultural pluralism in international human rights law by analysing reservations to human rights treaties. It has been argued that reservations "…are a legitimate, perhaps even desirable, means of accounting for cultural, religious, or political value diversity across nations".

  3. Quality Service in the International Hotel Sector: A Catalyst for Strategic Human Resource Development?

    Science.gov (United States)

    Maxwell, Gill; Watson, Sandra; Quail, Samantha

    2004-01-01

    This paper analyses the nature of, and relationship between, a quality service initiative and the concept of strategic human resource development. Hilton International is the case study used for this analysis. The principal finding is that the quality initiative is acting as a catalyst for a strategic approach to human resource development to…

  4. Quality Service in the International Hotel Sector: A Catalyst for Strategic Human Resource Development?

    Science.gov (United States)

    Maxwell, Gill; Watson, Sandra; Quail, Samantha

    2004-01-01

    This paper analyses the nature of, and relationship between, a quality service initiative and the concept of strategic human resource development. Hilton International is the case study used for this analysis. The principal finding is that the quality initiative is acting as a catalyst for a strategic approach to human resource development to…

  5. International Validation of Two Human Recombinant Estrogen Receptor (ERa) Binding Assays

    Science.gov (United States)

    An international validation study has been successfully completed for 2 competitive binding assays using human recombinant ERa. Assays evaluated included the Freyberger-Wilson (FW) assay using a full length human ER, and the Chemical Evaluation and Research Institute (CERI) assay...

  6. Does human migration affect international trade? A complex-network perspective.

    Directory of Open Access Journals (Sweden)

    Giorgio Fagiolo

    Full Text Available This paper explores the relationships between international human migration and merchandise trade, using a complex-network approach. We firstly compare the topological structure of worldwide networks of human migration and bilateral trade over the period 1960-2000. Next, we ask whether the position of any pair of countries in the migration network affects their bilateral trade flows. We show that: (i both weighted and binary versions of the networks of international migration and trade are strongly correlated; (ii such correlations can be mostly explained by country economic/demographic size and geographical distance; and (iii pairs of countries that are more central in the international-migration network trade more. Our findings suggest that bilateral trade between any two countries is not only affected by the presence of migrants from either countries but also by their relative embeddedness in the complex web of corridors making up the network of international human migration.

  7. Does human migration affect international trade? A complex-network perspective.

    Science.gov (United States)

    Fagiolo, Giorgio; Mastrorillo, Marina

    2014-01-01

    This paper explores the relationships between international human migration and merchandise trade, using a complex-network approach. We firstly compare the topological structure of worldwide networks of human migration and bilateral trade over the period 1960-2000. Next, we ask whether the position of any pair of countries in the migration network affects their bilateral trade flows. We show that: (i) both weighted and binary versions of the networks of international migration and trade are strongly correlated; (ii) such correlations can be mostly explained by country economic/demographic size and geographical distance; and (iii) pairs of countries that are more central in the international-migration network trade more. Our findings suggest that bilateral trade between any two countries is not only affected by the presence of migrants from either countries but also by their relative embeddedness in the complex web of corridors making up the network of international human migration.

  8. Identifying the best therapy for chronic anal fissure

    Institute of Scientific and Technical Information of China (English)

    Mariusz; H; Madalinski

    2011-01-01

    Chronic anal fissure(CAF)is a painful tear or crack which occurs in the anoderm.The optimal algorithm of therapy for CAF is still debated.Lateral internal sphincterotomy(LIS)is a surgical treatment,considered as the’gold standard’therapy for CAF.It relieves CAF symptoms with a high rate of healing.Chemical sphincterotomy(CS)with nitrates,calcium blockers or botulinum toxin(BTX)is safe,with the rapid relief of pain,mild sideeffects and no risk of surgery or anesthesia,but is a statistically less effective therapy for CAF than LIS.This article considers if aggressive treatment should only be offered to patients who fail pharmacological sphincterotomy.Aspects of anal fissure etiology,epidemiology and pathophysiology are considered with their meaning for further management of CAF.A molecular model of chemical interdependence significant for the chemistry of CAF healing is examined.Its application may influence the development of optimal therapy for CAF.BTX is currently considered the most effective type of CS and discussion in this article scrutinizes this method specifically.Although the effectiveness of BTXvs LIS has been discussed,the essential focus of the article concerns identifying the best therapy application for anal fissure.Elements are presented which may help us to predict CAF healing.They provide rationale for the expansion of the CAF therapy algorithm.Ethical and economic factors are also considered in brief.As long as the patient is willing to accept the potential risk of fecal incontinence,we have grounds for the’gold standard’(LIS)as the first-line treatment for CAF.The author concludes that,when the diagnosis of the anal fissure is established,CS should be considered for both ethical and economic reasons.He is convinced that a greater understanding and recognition of benign anal disorders by the GP and a proactive involvement at the point of initial diagnosis would facilitate the consideration of CS at an earlier,more practical stage with

  9. The Influence of Human Resource Practices on Internal Customer Satisfaction and Organizational Effectiveness

    Directory of Open Access Journals (Sweden)

    IRFAN ULLAH

    2013-08-01

    Full Text Available It is generally believed that the impact of Human Resource Practices on internal customer satisfaction can create comparative advantage for the organizational performance. The main objective of this study was to find out the impact of Human Resource Practices on internal customer satisfaction and organizational effectiveness. The impact of human resource practices on the overall performance of organizations has been a leading subject of research and the results havebeen encouraging, indicative of positive relationship between Human Resource practices and organizational effectiveness. Data was collected through personally administered questionnaire-based survey from 290 banking personnel of Pakistan. Structural equation modeling was used to examine the anticipated model. The results showed that some Human Resource Practices appear to be linked to internal customer satisfaction and organizational effectiveness. The implications for practitioners were to modify and emphasize certain human resource practices, and to emphasize the role of internal customers for organizational effectiveness enhancement. These findings revealed the importance of internal customers in enhancing employee morale, organizational commitment, employee productivity, turnover rate and the organization’s ability to attract talent.

  10. The Influence of Human Resource Practices on Internal Customer Satisfaction and Organizational Effectiveness

    Directory of Open Access Journals (Sweden)

    Irfan Ullah

    2013-08-01

    Full Text Available It is generally believed that the impact of Human Resource Practices on internal customer satisfaction can create comparative advantage for the organizational performance. The main objective of this study was to find out the impact of Human Resource Practices on internal customer satisfaction and organizational effectiveness. The impact of human resource practices on the overall performance of organizations has been a leading subject of research and the results have been encouraging, indicative of positive relationship between Human Resource practices and organizational effectiveness. Data was collected through personally administered questionnaire-based survey from 290 banking personnel of Pakistan. Structural equation modeling was used to examine the anticipated model. The results showed that some Human Resource Practices appear to be linked to internal customer satisfaction and organizational effectiveness. The implications for practitioners were to modify and emphasize certain human resource practices, and to emphasize the role of internal customers for organizational effectiveness enhancement. These findings revealed the importance of internal customers in enhancing employee morale, organizational commitment, employee productivity, turnover rate and the organization’s ability to attract talent.

  11. International Security, Development, and Human Rights: Policy Conversion or Conflict?

    Directory of Open Access Journals (Sweden)

    Miao-ling Lin Hasenkamp

    2012-04-01

    Full Text Available This article uses an institutional network governance approach to explore the overlapping dimension of the policy fields between security, development, and human rights, reflected in the US and German provincial reconstruction teams (PRTs in Afghanistan. The past two decades have witnessed a gradually changing paradigm in academic and policy debates regarding the questions of the normative basis of world order and possibilities for tackling imminent threats to security and peace (i.e. intra-state armed conflicts, failed states, terrorism, poverty, and deepening inequality. The introduction of concepts such as “human security” and “the right to humanitarian intervention/responsibility to protect (R2P” as well as critical examinations of peace-, nation-, and state-building missions (PNSB have led to a relativist tendency of state sovereignty and a changing attitude regarding how to address the intersection of security, development, and human rights. Despite this shift, the policy commitments to integrating these policy considerations remain puzzling. How have they been redefined, conceptualized, and put into practice? I argue that an integrated conceptual approach has facilitated the redefinition of common policy goals, principles, and the mobilization of resources. At the same time, civil and military cooperation, as demonstrated in the multifunctional work of PRTs, has been Janus-headed—permanently caught in an ongoing tension between the war on terror and short-term stability operation on the one hand and long-term durable peace and development on the other. The misunderstanding of its interim character, the dynamics of Afghan environment, the blurring of policy lines, and the differences between national PRT models have made it difficult to systematically assess the efficiency and legitimacy of each policy frame and program.

  12. STUDY REGARDING THE HUMAN RESOURCES INTERNAL AUDIT IN ROMANIAN TEXTILES INDUSTRY

    OpenAIRE

    Liviu ILIE?; Hora?iu C?t?lin S?L?GEAN; Dan LUNGESCU; Bogdan BÂLC

    2014-01-01

    This study attempts to identify ways to develop a model of analysis and internal audit of human resources in order to identify best practices and measures to improve human resource management, aiming their implementation in the Romanian textiles industry companies. The study aimed at highlighting the most appropriate ways in which the company management can improve the effectiveness and efficiency of using human resources, taking into account the characteristics and peculiarities of planning,...

  13. THE BASIC OBJECTIVES OF DEMECRACY  AND FUNDAMENTAL INTERNATIONAL AGREEMENTS  FOR THE PROTECTION OF HUMAN RIGHTS

    OpenAIRE

    ILGAZ , Dr.Nesrin DEMİR  Assist.Prof.Dr.Deniz

    2007-01-01

    The basic objectives of democracy, as they take place openly in the definition of the concept and are lead primarily by freedom and equality, are listed as political representation, political participation and rights. The first important document created in the international arena concerning human rights is the Universal Declaration on Human Rights, an instrument of the United Nations. A regional agreement which has great significance is the European Convention on Human Rights and Fundamental...

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

    Directory of Open Access Journals (Sweden)

    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

  15. Quality of life with anal fistula.

    Science.gov (United States)

    Owen, H A; Buchanan, G N; Schizas, A; Cohen, R; Williams, A B

    2016-05-01

    Anal fistula affects people of working age. Symptoms include abscess, pain, discharge of pus and blood. Treatment of this benign disease can affect faecal continence, which may, in turn, impair quality of life (QOL). We assessed the QOL of patients with cryptoglandular anal fistula. Newly referred patients with anal fistula completed the St Mark's Incontinence Score, which ranges from 0 (perfect continence) to 24 (totally incontinent), and Short form 36 (SF-36) questionnaire at two institutions with an interest in anal fistula. The data were examined to identify factors affecting QOL. Data were available for 146 patients (47 women), with a median age of 44 years (range 18-82 years) and a median continence score of 0 (range 0-23). Versus population norms, patients had an overall reduction in QOL. While those with recurrent disease had no difference on continence scores, QOL was worse on two of eight SF-36 domains (pfistula patients, 19.4% of patients experienced urgency versus 36.3% of those with recurrent fistulas. Patients with anal fistula had a reduced QOL, which was worse in those with recurrent disease, secondary extensions and urgency. Loose seton had no impact on QOL.

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

    Directory of Open Access Journals (Sweden)

    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

  17. The International Space Station human life sciences experiment implementation process.

    Science.gov (United States)

    Miller, L J; Haven, C P; McCollum, S G; Lee, A M; Kamman, M R; Baumann, D K; Anderson, M E; Buderer, M C

    2001-01-01

    The selection, definition, and development phases of a Life Sciences flight research experiment has been consistent throughout the past decade. The implementation process, however, has changed significantly within the past two years. This change is driven primarily by the shift from highly integrated, dedicated research missions on platforms with well defined processes to self contained experiments with stand alone operations on platforms which are being concurrently designed. For experiments manifested on the International Space Station (ISS) and/or on short duration missions, the more modular, streamlined, and independent the individual experiment is, the more likely it is to be successfully implemented before the ISS assembly is completed. During the assembly phase of the ISS, science operations are lower in priority than the construction of the station. After the station has been completed, it is expected that more resources will be available to perform research. The complexity of implementing investigations increases with the logistics needed to perform the experiment. Examples of logistics issues include- hardware unique to the experiment; large up and down mass and volume needs; access to crew and hardware during the ascent or descent phases; maintenance of hardware and supplies with a limited shelf life,- baseline data collection schedules with lengthy sessions or sessions close to the launch or landing; onboard stowage availability, particularly cold stowage; and extensive training where highly proficient skills must be maintained. As the ISS processes become better defined, experiment implementation will meet new challenges due to distributed management, on-orbit resource sharing, and adjustments to crew availability pre- and post-increment.

  18. The International Space Station human life sciences experiment implementation process

    Science.gov (United States)

    Miller, L. J.; Haven, C. P.; McCollum, S. G.; Lee, A. M.; Kamman, M. R.; Baumann, D. K.; Anderson, M. E.; Buderer, M. C.

    2001-01-01

    The selection, definition, and development phases of a Life Sciences flight research experiment has been consistent throughout the past decade. The implementation process, however, has changed significantly within the past two years. This change is driven primarily by the shift from highly integrated, dedicated research missions on platforms with well defined processes to self contained experiments with stand alone operations on platforms which are being concurrently designed. For experiments manifested on the International Space Station (ISS) and/or on short duration missions, the more modular, streamlined, and independent the individual experiment is, the more likely it is to be successfully implemented before the ISS assembly is completed. During the assembly phase of the ISS, science operations are lower in priority than the construction of the station. After the station has been completed, it is expected that more resources will be available to perform research. The complexity of implementing investigations increases with the logistics needed to perform the experiment. Examples of logistics issues include- hardware unique to the experiment; large up and down mass and volume needs; access to crew and hardware during the ascent or descent phases; maintenance of hardware and supplies with a limited shelf life,- baseline data collection schedules with lengthy sessions or sessions close to the launch or landing; onboard stowage availability, particularly cold stowage; and extensive training where highly proficient skills must be maintained. As the ISS processes become better defined, experiment implementation will meet new challenges due to distributed management, on-orbit resource sharing, and adjustments to crew availability pre- and post-increment. c 2001. Elsevier Science Ltd. All rights reserved.

  19. The international space station human life sciences experiment implementation process

    Science.gov (United States)

    Miller, LadonnaJ.; Haven, CynthiaP.; McCollum, SuzanneG.; Lee, AngeleneM.; Kamman, MichelleR.; Baumann, DavidK.; Anderson, MarkE.; Buderer, MelvinC.

    2001-08-01

    The selection, definition, and development phases of a Life Sciences flight research experiment has been consistent throughout the past decade. The implementation process, however, has changed significantly within the past two years. This change is driven primarily by the shift from highly integrated, dedicated research missions on platforms with well defined processes to self contained experiments with stand alone operations on platforms which are being concurrently designed. For experiments manifested on the International Space Station (ISS) and / or on short duration missions, the more modular, streamlined, and independent the individual experiment is, the more likely it is to be successfully implemented before the ISS assembly is completed. During the assembly phase of the ISS, science operations are lower in priority than the construction of the station. After the station has been completed, it is expected that more resources will be available to perform research. The complexity of implementing investigations increases with the logistics needed to perform the experiment. Examples of logistics issues include: hardware unique to the experiment; large up and down mass and volume needs; access to crew and hardware during the ascent or descent phases; maintenance of hardware and supplies with a limited shelf life; baseline data collection schedules with lengthy sessions or sessions close to the launch or landing; onboard stowage availability, particularly cold stowage; and extensive training where highly proficient skills must be maintained. As the ISS processes become better defined, experiment implementation will meet new challenges due to distributed management, on-orbit resource sharing, and adjustments to crew availability pre- and post-increment.

  20. Key points for developing an international declaration on nursing, human rights, human genetics and public health policy.

    Science.gov (United States)

    Anderson, G; Rorty, M V

    2001-05-01

    Human rights legislation pertaining to applications of human genetic science is still lacking at an international level. Three international human rights documents now serve as guidelines for countries wishing to develop such legislation. These were drafted and adopted by the United Nations Educational, Scientific and Cultural Organization, the Human Genome Organization, and the Council of Europe. It is critically important that the international nursing community makes known its philosophy and practice-based knowledge relating to ethics and human rights, and contributes to the globalization of genetics. Nurses have particular expertise because they serve in a unique role at grass roots level to mediate between genetic science and its application to public health policies and medical interventions. As a result, nurses worldwide need to focus a constant eye on human rights ideals and interpret these within social, cultural, economic and political contexts at national and local levels. The purpose of this article is to clarify and legitimate the need for an international declaration on nursing, human rights, human genetics and public health policy. Because nurses around the world are the professional workforce by which genetic health care services and genetic research protocols will be delivered in the twenty-first century, members of the discipline of nursing need to think globally while acting locally. Above all other disciplines involved in genetics, nursing is in a good position to articulate an expanded theory of ethics beyond the principled approach of biomedical ethics. Nursing is sensitive to cultural diversity and community values; it is sympathetic to and can introduce an ethic of caring and relational ethics that listen to and accommodate the needs of local people and their requirements for public health.

  1. Quality management for the international transportation of non-human primates

    Directory of Open Access Journals (Sweden)

    David B. Elmore

    2008-03-01

    Full Text Available Safe and humane transportation of live animals requires dedicated, informed personnel who carefully plan and attend to the details of appropriate animal care and handling throughout the shipping process. Specifically, although transportation of non-human primates shares goals common to all live animal transport, it also poses unique challenges stemming from the nature of these animals. Some of these unique challenges of transporting non-human primates, include the impact of public perception of non-human primates as cargo, maintaining biosecurity of non-human primate cargo, safety of both the non-human primate and public contacts, meeting the vital husbandry needs of varying species of non-human primates and compliance with numerous regulatory agencies, which may have overlapping responsibilities. This discussion will focus on these important considerations, as they relate to the legal international transportation of non-human primates for scientific use.

  2. Aqueous exposure to the progestin, levonorgestrel, alters anal fin development and reproductive behavior in the eastern mosquitofish (Gambusia holbrooki).

    Science.gov (United States)

    Frankel, Tyler E; Meyer, Michael T; Orlando, Edward F

    2016-08-01

    Endogenous progestogens are important regulators of vertebrate reproduction. Synthetic progestins are components of human contraceptive and hormone replacement pharmaceuticals. Both progestogens and progestins enter the environment through a number of sources, and have been shown to cause profound effects on reproductive health in various aquatic vertebrates. Progestins are designed to bind human progesterone receptors, but they also have been shown to strongly activate androgen receptors in fish. Levonorgestrel (LNG) activates fish androgen receptors and induces development of male secondary sex characteristics in females of other species. Although behavior has been postulated to be a sensitive early indicator of exposure to certain environmental contaminants, no such research on the reproductive behavior of gestagen-exposed fish has been conducted to date. The goal of our study was to examine the exposure effects of a human contraceptive progestin, LNG, on the reproductive development and behavior of the viviparous eastern mosquitofish (Gambusia holbrooki). Internal fertilization is a requisite characteristic of viviparous species, and is enabled by an androgen driven elongation of the anal fin into the male gonopodium (i.e., phallus). In this study, we exposed adult mosquitofish to ethanol (EtOH control), 10ng/L, and 100ng/L LNG for 8d using a static replacement exposure design. After 8d, a subset of males and females from each treatment were examined for differences in the 4:6 anal fin ratio. In addition, paired social interaction trials were performed using individual control males and control females or females treated 10ng/L or 100ng/L LNG. Female mosquitofish exposed to LNG were masculinized as evidenced by the elongation of the anal fin rays, a feature normal to males and abnormal to females. LNG caused significant increases in the 4:6 anal fin ratios of female mosquitofish in both the 10ng/L and 100ng/L treatments, although these differences were not

  3. [Colo-anal anastomosis. Our experience].

    Science.gov (United States)

    Morlino, A; Tramutola, G; Rossi, M T; Scutari, F

    2009-03-01

    The aim of study is to report the results of our experience about ultra-low rectum carcinomas treated with anterior resection and colo-anal anastomosis. The surgery still represents the treatment of choice for the cancer of the rectum. The problems concern the conservation of the sphincter functions (anal and urethral), and sexual function and the reduction of the locoregional recurrences. From 2005 to 2007, 33 patients underwent surgery for low and ultralow rectal carcinoma (30 treated with neoadjuvant radio-chemotherapy, and 3 only with surgery). In 16 of these we have performed a colo-anal anastomosis, in 11 an ultralow colorectal anastomosis and in 7 a Miles resection. We report our updated results.

  4. Application of YAG laser technique in the treatment of anal fistula

    Science.gov (United States)

    Liu, Jian-xun; Zhang, Xinrong

    1993-03-01

    The method of treating anal fistula with YAG laser technique is described in this essay. One-hundred-twenty patients have been treated successfully with this method and no recurrence was found in our series. Anal fistula is a common disorder in the anus and rectum. The tunnel of fistula zigzags around the external or internal sphincters. If the drainage is poor, and the skin around the external opening grows rapidly, false healing may occur and cause recurrent abscess. In this case, a fistula can not be cured except by operation.

  5. International environmental governance: Lessons learned from Human Rights Institutional Reform

    Energy Technology Data Exchange (ETDEWEB)

    Fauchald, Ole Kristian

    2011-07-01

    This report focuses on the possibility of establishing a High Commissioner for the Environment and transforming the UNEP Governing Council into a Council for the Environment. For this purpose, it considers the parallels between human rights regimes and environmental regimes. It provides a short-list of functions to be covered by a reformed environmental governance regime, and discusses how the reform can be coordinated with UNEP, as well as with the current and future institutional framework for sustainable development. The report also discusses how the reform can be related to fifteen core multilateral environmental agreements. Finally, the report considers how the reform can be carried out through a discussion of five separate options: a decision by the UN General Assembly, by the ECOSOC, or by the UNEP Governing Council, as well as through agreements between conferences of parties of environmental agreements, or directly between states. A main purpose of the report, which has been commissioned by the Norwegian Ministry for the Environment, is to provide input to the preparations for the Rio+20 Conference in 2012.(auth)

  6. Human Rights Education in the Perspective of International Human Rights Law

    Institute of Scientific and Technical Information of China (English)

    卓泽渊

    2007-01-01

    @@ In a statement issued on the 2004 World Human Rights Day, Ms.Louse Arbour, United Nations High Commissioner for Human Rights,described human rights education as a strategy tor attainment of "human rights for all," as a basic means for developing a universal culture of human rights, as an instrument for promoting equality and involvement of the people in decision-making under democratic mechanisms, and as an investment to prevent infringements upon human rights and to ward off conflicts of violence. It should be noted that so much importance attached by UN human rights organ to human rights education epitomizes the empowering characters of human rights education and the functions it performs in the global human rights system.

  7. Interpreting the International Right to Health in a Human Rights-Based Approach to Health.

    Science.gov (United States)

    Hunt, Paul

    2016-12-01

    This article tracks the shifting place of the international right to health, and human rights-based approaches to health, in the scholarly literature and United Nations (UN). From 1993 to 1994, the focus began to move from the right to health toward human rights-based approaches to health, including human rights guidance adopted by UN agencies in relation to specific health issues. There is a compelling case for a human rights-based approach to health, but it runs the risk of playing down the right to health, as evidenced by an examination of some UN human rights guidance. The right to health has important and distinctive qualities that are not provided by other rights-consequently, playing down the right to health can diminish rights-based approaches to health, as well as the right to health itself. Because general comments, the reports of UN Special Rapporteurs, and UN agencies' guidance are exercises in interpretation, I discuss methods of legal interpretation. I suggest that the International Covenant on Economic, Social and Cultural Rights permits distinctive interpretative methods within the boundaries established by the Vienna Convention on the Law of Treaties. I call for the right to health to be placed explicitly at the center of a rights-based approach and interpreted in accordance with public international law and international human rights law.

  8. International Space Station Human Behavior and Performance Competency Model: Volume II

    Science.gov (United States)

    Schmidt, Lacey

    2008-01-01

    This document further defines the behavioral markers identified in the document "Human Behavior and Performance Competency Model" Vol. I. The Human Behavior and Performance (HBP) competencies were recommended as requirements to participate in international long duration missions, and form the basis for determining the HBP training curriculum for long duration crewmembers. This document provides details, examples, knowledge areas, and affective skills to support the use of the HBP competencies in training and evaluation. This document lists examples and details specific to HBP competencies required of astronauts/cosmonauts who participate in ISS expedition and other international long-duration missions. Please note that this model does not encompass all competencies required. While technical competencies are critical for crewmembers, they are beyond the scope of this document. Additionally, the competencies in this model (and subsequent objectives) are not intended to limit the internal activities or training programs of any international partner.

  9. Malignant transformation in an anal condyloma acuminatum.

    Science.gov (United States)

    Ejeckam, G C; Idikio, H A; Nayak, V; Gardiner, J P

    1983-03-01

    A 61-year-old man had malignant transformation of an anal condyloma acuminatum, demonstrated by light and electron microscopic studies. Intranuclear virus-like particles were seen in the benign condylomatous koilocytotic cells but these were absent in the malignant cells. Multinucleation, syncytial giant cells and nuclear atypia in a condyloma acuminatum are considered features of in-situ carcinomatous change. Anal condyloma acuminatum requires wide excision and thorough examination of anorectal canal in order to exclude hidden disease, which will predispose to recurrence. Homosexuality is considered a predisposing factor. The authors stress the importance of histopathologic examination of all anorectal warts to exclude malignant change.

  10. Potential International Approaches to Ownership/Control of Human Genetic Resources.

    Science.gov (United States)

    Rhodes, Catherine

    2016-09-01

    In its governance activities for genetic resources, the international community has adopted various approaches to their ownership, including: free access; common heritage of mankind; intellectual property rights; and state sovereign rights. They have also created systems which combine elements of these approaches. While governance of plant and animal genetic resources is well-established internationally, there has not yet been a clear approach selected for human genetic resources. Based on assessment of the goals which international governance of human genetic resources ought to serve, and the implications for how they will be accessed and utilised, it is argued that common heritage of mankind will be the most appropriate approach to adopt to their ownership/control. It does this with the aim of stimulating discussion in this area and providing a starting point for deeper consideration of how a common heritage of mankind, or similar, regime for human genetic resources would function and be implemented.

  11. Monoclonal antibody to human endothelial cell surface internalization and liposome delivery in cell culture.

    Science.gov (United States)

    Trubetskaya, O V; Trubetskoy, V S; Domogatsky, S P; Rudin, A V; Popov, N V; Danilov, S M; Nikolayeva, M N; Klibanov, A L; Torchilin, V P

    1988-02-01

    A monoclonal antibody (mAb), E25, is described that binds to the surface of cultured human endothelial cells. Upon binding E25 is rapidly internalized and digested intracellularly. Selective liposome targeting to the surface of the cells is performed using a biotinylated E25 antibody and an avidin-biotin system. Up to 30% of the cell-adherent liposomal lipid is internalized.

  12. How does stochastic resonance work within the human brain? - Psychophysics of internal and external noise

    Energy Technology Data Exchange (ETDEWEB)

    Aihara, Takatsugu [ATR Computational Neuroscience Laboratories, 2-2-2 Hikaridai, Seika-cho, Soraku-gun, Kyoto 619-0288 (Japan); Kitajo, Keiichi [Laboratory for Dynamics of Emergent Intelligence, RIKEN Brain Science Institute, Wako, Saitama 351-0198 (Japan); PRESTO, Japan Science and Technology Agency (JST), 4-1-8 Honcho Kawaguchi, Saitama 332-0012 (Japan); Nozaki, Daichi [Educational Physiology Laboratory, Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033 (Japan); Yamamoto, Yoshiharu, E-mail: yamamoto@p.u-tokyo.ac.jp [Educational Physiology Laboratory, Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033 (Japan)

    2010-10-05

    We review how research on stochastic resonance (SR) in neuroscience has evolved and point out that the previous studies have overlooked the interaction between internal and external noise. We propose a new psychometric function incorporating SR effects, and show that a Bayesian adaptive method applied to the function efficiently estimates the parameters of the function. Using this procedure in visual detection experiments, we provide significant insight into the relationship between internal and external noise in SR within the human brain.

  13. Câncer ano-reto-cólico - aspectos atuais: I - câncer anal Anal canal and colorectal cancer - current features: I - anal canal cancer

    Directory of Open Access Journals (Sweden)

    Júlio César M. Santos Jr.

    2007-06-01

    Full Text Available A inclusão do tema - câncer anal - nessa revisão, apesar de sua relativa raridade, responde, em parte, ao propósito de chamar atenção para o significativo aumento dessa lesão e sua estreita relação com doenças sexualmente transmissíveis, principalmente causadas pelo vírus do papiloma humano (HPV; seus aspectos nosológicos, sua epidemiologia, sua etiologia multifatorial, seus fatores de riscos, sua prevenção e, em parte, para revelar a definição atual do tratamento.The inclusion of the theme - anal cancer - in this revision, in spite of its relative rarity, it answers, partly, to the purpose of calling attention for the significant increase of that lesion and its narrow relationship with sexually transmissible diseases mainly caused by the human papilloma virus (HPV; its nosologic aspects, epidemiology, etiology, and the multifactorial nature of risk that is associated to the disease, its prevention, and, partly, to reveal the current definition of the treatment.

  14. 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

  15. Biomedicine and international human rights law: in search of a global consensus.

    Science.gov (United States)

    Andorno, Roberto

    2002-01-01

    Global challenges raised by biomedical advances require global responses. Some international organizations have made significant efforts over the last few years to establish common standards that can be regarded as the beginning of an international biomedical law. One of the main features of this new legal discipline is the integration of its principles into a human rights framework. This strategy seems the most appropriate, given the role of "universal ethics" that human rights play in our world of philosophical pluralism. In addition to the general standards that are gradually being established, a widespread consensus exists on the urgency of preventing two specific procedures: human germ-line interventions and human reproductive cloning. PMID:12571724

  16. Human Trafficking and the Rome Statute of the International Criminal Court

    Directory of Open Access Journals (Sweden)

    CLARE FRANCES MORAN

    2014-12-01

    Full Text Available The case for extending the reach of the Rome Statute to the crime of human trafficking has not yet been made in detail. The brutality which occurs when human beings are trafficked by criminal gangs is of an equally egregious nature as the other crimes covered by the Rome Statute and yet it does not fall within the remit of the International Criminal Court. Such trafficking may also fall outwith the definition of slavery as a crime against humanity, particularly given the State policy threshold set by the Statute. This paper seeks to explore the viability of the inclusion of human trafficking as a discrete international crime within the Rome Statute as a response to this loophole.

  17. 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...

  18. KRAS and BRAF mutations in anal carcinoma

    DEFF Research Database (Denmark)

    Serup-Hansen, Eva; Linnemann, Dorte; Høgdall, Estrid

    2015-01-01

    the frequency and the prognostic value of KRAS and BRAF mutations in a large cohort of patients with anal cancer. One hundred and ninety-three patients with T1-4N0-3M0-1 anal carcinoma were included in the study. Patients were treated with curative (92%) or palliative intent (8%) between January 2000...... and January 2010. KRAS mutations were detected using Therascreen(®)KRAS real-time PCR assay (Qiagen) and V600E or V600D/K BRAF mutations were uncovered using Pyrosequencing. The frequency of KRAS and BRAF mutations was low; KRAS mutations were detected in 1.6% and BRAF mutations in 4.7% of the biopsies....... No impact of KRAS or BRAF status on survival was found. In conclusion, both KRAS and BRAF mutations are rare in anal cancer. The low frequency of KRAS mutations support protocols exploring EGFR-targeted therapy in patients with metastatic anal cancer, while treatment with BRAF inhibitors might be relevant...

  19. Treatment of non-IBD anal fistula

    DEFF Research Database (Denmark)

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter

    2015-01-01

    The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should...

  20. Treatment of non-IBD anal fistula

    DEFF Research Database (Denmark)

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter;

    2015-01-01

    The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should be ...

  1. Do We Know What Causes Anal Cancer?

    Science.gov (United States)

    ... cells are more likely to become cancerous. Lowered immunity When the body is less able to fight off infections, viruses like HPV can become more active, which might trigger the development of anal cancer. HIV, the virus that causes AIDS, weakens the ...

  2. Critical Evaluation of International Treaties and Conventions on Women’s Human Right. A Perspective

    Directory of Open Access Journals (Sweden)

    Sindhu Vijaya KUMAR

    2012-08-01

    Full Text Available Human right is a complete concept within it which never tends to devide the identity of men or women but simply say human. The ways in which women experience human rights and human right violations are unique. While human rights are often understood as the rights that everyone has by virtue of their humanity, the assumption that all humans have the same experiences and needs is particularly problematic for women. The human right revolution which has become a core principle of almost all the laws of the nation around the world discern that its essences is not just in enumerating it into a piece of law but practically applying it and respecting it, as an eternal part of justice. There is an urgent need to adopt balance approach in identifying the rights of women as human right. At the same time identifying this right individually and as part universal phenomenon of human right should be the concern of every woman in every walk of life. The present study undertakes a doctrinal research and attempt to critically analyze the practical application of human right norms from both national and international law perspective, thus drawing the attention of human right activist to this problematic area of concern.

  3. The right to health of prisoners in international human rights law.

    Science.gov (United States)

    Lines, Rick

    2008-01-01

    This paper explores the health rights of prisoners as defined in international law, and the mechanisms that have been used to ensure the rights of persons in detention to realise the highest attainable standard of health. It examines this right as articulated within United Nations and regional human rights treaties, non-binding or so-called soft law instruments from international organisations and the jurisprudence of international human rights bodies. It explores the use of economic, social and cultural rights mechanisms, and those within civil and political rights, as they engage the right to health of prisoners, and identifies the minimum legal obligations of governments in order to remain compliant with human rights norms as defined within the international case law. In addressing these issues, this article adopts a holistic approach to the definition of the highest attainable standard of health. This includes a consideration of adequate standards of general medical care, including preventative health and mental health services. It also examines the question of environmental health, and those poor conditions of detention that may exacerbate health decline, disease transmission, mental illness or death. The paper examines the approach to prison health of the United Nations human rights system and its various monitoring bodies, as well as the regional human rights systems in Europe, Africa and the Americas. Based upon this analysis, the paper draws conclusions on the current fulfilment of the right to health of prisoners on an international scale, and proposes expanded mechanisms under the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment to monitor and promote the health rights of prisoners at the international and domestic levels.

  4. Ethical regulation or regulating ethics? The need for both internal and external governance of human experimentation.

    Science.gov (United States)

    Tomossy, George F

    2002-10-01

    Research regulation is a timely topic for discussions in bioethics and public health policy. This response to articles in the previous special issue of the Monash Bioethics Review emphasises the importance of having both internal and external controls on human experimentation. Unless both elements are incorporated into research ethics governance frameworks, they will ultimately fail to achieve what should be their primary goal: human subject protection.

  5. The Observance of Human Rights and Freedoms in the Extradition Proceedings at National and International Levels

    Directory of Open Access Journals (Sweden)

    Mariana (Mitra Radu

    2013-08-01

    Full Text Available The fundamental rights and freedoms contained in international documents may be the object of the denial of an extradition request as independent exceptions, even if they are not covered by extradition treaties. The right to life is a fundamental human right whose protection must be achieved in the extradition proceedings. By Law no. 30/1994, Romania ratified the Convention for the Protection of Human Rights and Fundamental Freedoms, adopted by the Council of Europe.

  6. Disparity in Human Rights Violations: A Political and International Law Perspective

    Directory of Open Access Journals (Sweden)

    Aidir Amin Daud

    2016-12-01

    Full Text Available Right to life is non-derogable rights. A natural right that should not be revoked arbitrarily by anyone, including the state. A mass murder in events 1 October 1965 and Timor-Timor is a double series of states’ failure in protecting the rights of Indonesian peoples. Moreover, these two events get different treatment in its handling. The disparity in treatment between two cases is a big question related to the consistency of human rights enforcement in Indonesia. This study is a descriptive-qualitative research. While, to prove the truth, this study will use a comparative study. The findings show that the attitude of the United Nations that treat serious human rights violations in Timor-Timor and the events of 1965 in Indonesia, cannot be answered differently in the perspective of international law. Since it has a weakness where the political interests of ruling is very strong in influencing the decisions of the UN. The disparity in law enforcement in the event of serious human rights violations in 1965 and Timor-Timor due to the dynamics of international politics when it does not allow for the demands of human rights violations to the UNs’ International Court due to advantage for a certain state after the event. In order to reduce disparities in human rights violations, reconciliation is the most rational solution at this time compared remains demand the state for the violations. Besides, many human rights violations in certain countries that have successfully resolved through reconciliation approach.

  7. Reconciling international human rights and cultural relativism: the case of female circumcision.

    Science.gov (United States)

    James, Stephen A

    1994-01-01

    How can we reconcile, in a non-ethnocentric fashion, the enforcement of international, universal human rights standards with the protection of cultural diversity? Examining this question, taking the controversy over female circumcision as a case study, this article will try to bridge the gap between the traditional anthropological view that human rights are non-existent -- or completely relativised to particular cultures -- and the view of Western naturalistic philosophers (including Lockeian philosophers in the natural rights tradition, and Aquinas and neo-Thomists in the natural law tradition) that they are universal -- simply derived from a basic human nature we all share. After briefly defending a universalist conception of human rights, the article will provide a critique of female circumcision as a human rights violation by three principal means: by an internal critique of the practice using the condoning cultures' own functionalist criteria; by identifying supra-national norms the cultures subscribe to which conflict with the practice; and by the identification of traditional and novel values in the cultures, conducive to those norms. Through this analysis, it will be seen that cultural survival, diversity and flourishing need not be incompatible with upholding international, universal human rights standards.

  8. Sinanthropus in Britain: human origins and international science, 1920-1939.

    Science.gov (United States)

    Manias, Chris

    2015-06-01

    The Peking Man fossils discovered at Zhoukoudian in north-east China in the 1920s and 1930s were some of the most extensive palaeoanthropological finds of the twentieth century. This article examines their publicization and discussion in Britain, where they were engaged with by some of the world's leading authorities in human evolution, and a media and public highly interested in human-origins research. This international link - simultaneously promoted by scientists in China and in Britain itself - reflected wider debates on international networks; the role of science in the modern world; and changing definitions of race, progress and human nature. This article illustrates how human-origins research was an important means of binding these areas together and presenting scientific work as simultaneously authoritative and credible, but also evoking mystery and adventurousness. Examining this illustrates important features of contemporary views of both science and human development, showing not only the complexities of contemporary regard for the international and public dynamics of scientific research, but wider concerns over human nature, which oscillated between optimistic notions of unity and progress and pessimistic ones of essential differences and misdirected development.

  9. Sonographic appearance of anal cushions of hemorrhoids

    Science.gov (United States)

    Aimaiti, Adilijiang; A Ba Bai Ke Re, Ma Mu Ti Jiang; Ibrahim, Irshat; Chen, Hui; Tuerdi, Maimaitituerxun; Mayinuer

    2017-01-01

    AIM To evaluate the diagnostic value of different sonographic methods in hemorrhoids. METHODS Forty-two healthy volunteers and sixty-two patients with grades I-IV hemorrhoids received two different sonographic examinations from January 2013 to January 2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way. We analyzed the ultrasonographic findings of these participants and evaluated the outcomes. Resected grades III and IV hemorrhoid tissues were pathologically examined. The concordance of ultrasonographic results with pathology results was assessed with the Cohen’s kappa coefficient. RESULTS All healthy volunteers and all patients had no particular complications related to sonography. There were no statistically significant differences between the participants regarding age (P = 0.5919), gender (P = 0.4183), and persistent symptoms (P > 0.8692). All healthy control participants had no special findings. However, 30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography. When grades I and II hemorrhoids were analyzed, there were no significant differences between transrectal ultrasound (TRUS), transperianal ultrasound (TPUS), and transvaginal ultrasound (TVUS) (P > 0.05). Grades III and IV hemorrhoids revealed blood flow with different directions which could be observed as a “mosaic pattern”. In patients with grades III and IV hemorrhoids, the number of patients with “mosaic pattern” as revealed by TRUS, TPUS and TVUS was 22, 12, and 4, respectively. Patients with grades III and IV disease presented with a pathologically abnormal cushion which usually appeared as a “mosaic pattern” in TPUS and an arteriovenous fistula in pathology. Subepithelial vessels of resected grades III and IV hemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina. Some parts of the Trietz’s muscle showed hypertrophy and distortion

  10. Teaching Men's Anal Pleasure: Challenging Gender Norms with "Prostage" Education

    Science.gov (United States)

    Branfman, Jonathan; Ekberg Stiritz, Susan

    2012-01-01

    To help students critique sex/gender norms, sexuality educators should address men's anal pleasure. Men's anal receptivity blurs accepted binaries like male/female, masculine/feminine, and straight/queer. By suppressing men's receptivity, the taboo against men's anal pleasure helps legitimize hegemonic sex/gender beliefs--and the sexism,…

  11. Anal fistulas : New perspectives on treatment and pathogenesis

    NARCIS (Netherlands)

    R.S. van Onkelen (Robbert)

    2015-01-01

    markdownabstractAbstract The objective of modern anal fistula treatment is healing of the fistula without diminished fecal continence. Sphincter saving techniques have been developed for anal fistulas, for which fistulotomy is not suitable. Treatment of these anal fistulas remains challenging

  12. Update on Anal Fistulae: Surgical Perspectives for the Gastroenterologist

    Directory of Open Access Journals (Sweden)

    Helena Tabry

    2011-01-01

    Full Text Available Anal fistulae are common and debilitating; they are characterized by severe pain and discharge. They arise following infection near the anal canal, or as a primary event from an abscess in the abdomen, fistulating into the vagina or perianal skin. The term ‘cryptoglandular’ is given to abscesses arising from the anal glands.

  13. Anal fistulas : New perspectives on treatment and pathogenesis

    NARCIS (Netherlands)

    R.S. van Onkelen (Robbert)

    2015-01-01

    markdownabstractAbstract The objective of modern anal fistula treatment is healing of the fistula without diminished fecal continence. Sphincter saving techniques have been developed for anal fistulas, for which fistulotomy is not suitable. Treatment of these anal fistulas remains challenging and

  14. Is a deuterated internal standard appropriate for the reliable determination of olmesartan in human plasma?

    Science.gov (United States)

    Piórkowska, Edyta; Musijowski, Jacek; Buś-Kwaśnik, Katarzyna; Rudzki, Piotr J

    2017-01-01

    A right choice of the internal standard is one of the most challenging tasks during bioanalytical method development. Surprisingly, among the HPLC-MS methods for the determination of a cardiovascular drug olmesartan in plasma only structural analogues or similar compounds were used as internal standards. We have tried to answer the question whether the stable isotope labelled (deuterated) internal standard, as recommended by regulatory agencies, can be used for the reliable determination of olmesartan in human plasma. An HPLC-MS method using this standard in a simplified liquid-liquid extraction procedure led to accurate and precise results in the linearity range of 5-2500ng/mL. The method is well suited for pharmacokinetic studies following a single 40mg oral dose of olmesartan medoxomil in humans. The method was fully validated according to international guidelines and successfully applied in a bioequivalence study in humans. The use of deuterated olmesartan as the internal standard afforded a reliable tool for regulatory bioanalysis that can indirectly contribute to therapy efficacy and improve the safety of patients treated with generic medicines. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Human Rights Promotion through Transnational Investment Regimes: An International Political Economy Approach

    Directory of Open Access Journals (Sweden)

    Claire Cutler

    2013-05-01

    Full Text Available International investment agreements are foundational instruments in a transnational investment regime that governs how states regulate the foreign-owned assets and the foreign investment activities of private actors. Over 3,000 investment agreements between states govern key governmental powers and form the basis for an emerging transnational investment regime. This transnational regime significantly decentralizes, denationalizes, and privatizes decision-making and policy choices over foreign investment. Investment agreements set limits to state action in a number of areas of vital public concern, including the protection of human and labour rights, the environment, and sustainable development. They determine the distribution of power between foreign investors and host states and their societies. However, the societies in which they operate seldom have any input into the terms or operation of these agreements, raising crucial questions of their democratic legitimacy as mechanisms of governance. This paper draws on political science and law to explore the political economy of international investment agreements and asks whether these agreements are potential vehicles for promoting international human rights. The analysis provides an historical account of the investment regime, while a review of the political economy of international investment agreements identifies what appears to be a paradox at the core of their operation. It then examines contract theory for insight into this apparent paradox and considers whether investment agreements are suitable mechanisms for advancing international human rights.

  16. Human Rights Promotion through Transnational Investment Regimes: An International Political Economy Approach

    Directory of Open Access Journals (Sweden)

    Claire Cutler

    2013-05-01

    Full Text Available International investment agreements are foundational instruments in a transnational investment regime that governs how states regulate the foreign-owned assets and the foreign investment activities of private actors. Over 3,000 investment agreements between states govern key governmental powers and form the basis for an emerging transnational investment regime. This transnational regime significantly decentralizes, denationalizes, and privatizes decision-making and policy choices over foreign investment. Investment agreements set limits to state action in a number of areas of vital public concern, including the protection of human and labour rights, the environment, and sustainable development. They determine the distribution of power between foreign investors and host states and their societies. However, the societies in which they operate seldom have any input into the terms or operation of these agreements, raising crucial questions of their democratic legitimacy as mechanisms of governance. This paper draws on political science and law to explore the political economy of international investment agreements and asks whether these agreements are potential vehicles for promoting international human rights. The analysis provides an historical account of the investment regime, while a review of the political economy of international investment agreements identifies what appears to be a paradox at the core of their operation. It then examines contract theory for insight into this apparent paradox and considers whether investment agreements are suitable mechanisms for advancing international human rights.

  17. The hero, the anima and the claustrum: anality and idealization.

    Science.gov (United States)

    Meredith-Owen, William

    2012-04-01

    Joe Redfearn's (1979) classic paper 'The captive, the treasure, the hero and the anal stage of development' is recognized as seminal to the development of Jungian thought about anality, particularly its integration with mainstream (Freudian, Kleinian) psychoanalytic perspectives. This paper develops such an approach through drawing on contributions from Meltzer, Green, Bion, Chasseguet-Smirgel and Kernberg. More specifically, it is argued that over-investment in hero and anima archetypal configurations may represent an attempt to replace the resource of the internal parental couple that, at the level of unconscious phantasy, has been destroyed by the aggrieved child's attack on the primal scene. Unless this usually dissociated sadism can be integrated, the creative epistemophilic instinct may remain blunted, giving rise, through projective identification, to the adoption of a pseudo-adult identity based on appropriation or assertion. This in turn may lead to manic attempts to reach authentic ('animating') experience through the (often erotized) excitement of heroic endeavour. Consideration of both Redfearn's and the author's own clinical material demonstrates how close attention to process as well as content is fundamental to revealing and addressing such likely-to-be dissociated scenarios.

  18. Papilomavirus humano e o câncer anal

    Directory of Open Access Journals (Sweden)

    Sidney Roberto Nadal

    2006-06-01

    Full Text Available O Papilomavirus humano (HPV é uma das causas mais comuns de doença sexualmente transmissível, podendo provocar os condilomas acuminados que são considerados fatores de risco para displasia e neoplasia. Embora os HPV de alto risco sejam causa necessária para o câncer cervical, eventos genéticos adicionais são indispensáveis para transformação maligna da maioria dos carcinomas anais e de outros sítios. Os trabalhos da literatura especializada ainda não conseguiram demonstrar se esse vírus é o fato determinante ou associado ao carcinoma anal. É preciso que mais pesquisas sejam feitas para resolver esse dilema. De qualquer forma, sugerimos que o controle das lesões clínicas e das sub-clínicas provocadas pelo HPV possa evitar a eventual progressão para carcinoma invasivo.Human Papillomavirus (HPV is one of the commonest sexually transmitted diseases agents. It can provoke condylomata acuminata, considered at risk to dysplasia and neoplasia. Although, high-risk HPVs are necessary to cervical cancer, additional genetic events are essential to malign transormation of most of anal carcinoma. Specialized studies did not explain already if this vírus is the cause or the associated factor to anal carcinoma. More research is needed to solve this doubt. Anyway, we suggest that clinic and sub-clinic lesions control could avoid the eventual evolution to invasive carcinoma.

  19. Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair.

    Science.gov (United States)

    Harvey, Marie-Andrée; Pierce, Marianne; Alter, Jens-Erik W; Chou, Queena; Diamond, Phaedra; Epp, Annette; Geoffrion, Roxana; Harvey, Marie-Andrée; Larochelle, Annick; Maslow, Kenny; Neustaedter, Grace; Pascali, Dante; Pierce, Marianne; Schulz, Jane; Wilkie, David; Sultan, Abdul; Thakar, Ranee

    2015-12-01

    publiée) a été identifiée par l’intermédiaire de recherches menées dans les sites Web d’organismes s’intéressant à l’évaluation des technologies dans le domaine de la santé et d’organismes connexes, dans des collections de directives cliniques, dans des registres d’essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. Valeurs : La qualité des résultats a été évaluée au moyen des critères décrits dans le rapport du Groupe d’étude canadien sur les soins de santé préventifs (Tableau). Avantages, désavantages et coûts : Parmi les avantages de la mise en œuvre de la présente directive clinique, on trouve : l’amélioration du diagnostic des LOSA, l’obtention d’issues fonctionnelles optimales à la suite de la réparation et l’offre de conseils reposant sur des données probantes aux femmes en ce qui concerne leurs futures grossesses. Déclarations sommaires 1. Les lésions obstétricales du sphincter anal mènent à des comorbidités considérables, dont l’incontinence anale, les fistules rectovaginales et la douleur. (II-2) 2. Les lésions obstétricales du sphincter anal sont plus souvent associées aux accouchements par forceps qu’aux accouchements par ventouse obstétricale. (II-2) 3. Réparation des lésions obstétricales du sphincter anal : a. L’utilisation de polyglactin 2-0 ou de polydioxanone 3-0 donne lieu, après six semaines, à des taux semblables de morbidité liée aux sutures. (I) b. La réparation du sphincter anal interne est recommandée puisque les femmes chez lesquelles la présence d’une anomalie affectant ce sphincter est révélée au cours de l’échographie postpartum sont plus susceptibles de connaître une incontinence anale. (III) c. La réparation du sphincter anal externe devrait englober la gaine fasciale. Le recours à la technique de suture « en paletot » (chevauchement) nécessite souvent une mobilisation et une dissection de plus

  20. Long-term outcome of the anal fistula plug for anal fistula of cryptoglandular origin.

    Science.gov (United States)

    Tan, K-K; Kaur, G; Byrne, C M; Young, C J; Wright, C; Solomon, M J

    2013-12-01

    This study aimed to evaluate the long-term outcome of the anal fistula plug in the treatment of anal fistula of cryptoglandular origin. A review of all patients who had at least one anal fistula plug inserted from March 2007 to August 2008 was performed. Only anal fistulae of cryptoglandular origin were included. Success was defined as the closure of the external opening with no further purulent discharge or collection. Thirty anal fistula plugs were inserted in 26 patients [median age 40 (26-70) years]. Twenty-six of the fistulae were transsphincteric and three were suprasphincteric. One patient had a high intersphincteric fistula, which was the only fistula that did not have a seton inserted. The median duration between seton insertion and the plug procedure was 12 (4-28) weeks. The median length of the fistula tract was 3 (1-7.5) cm. After a median follow-up of 59 (13-97) weeks, 26 (86.7%) fistulae recurred. Of the 26 failures, the median time to failure was 8 (2-54) weeks. Subsequent surgical interventions were performed in 20 of the failures. The role of the fistula plug in the management of anal fistula of cryptoglandular origin remains debatable and warrants further evaluation. © 2013 The Authors. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

  1. Curricular Choices of Ultra-Orthodox Jewish Communities: Translating International Human Rights Law into Education Policy

    Science.gov (United States)

    Perry-Hazan, Lotem

    2015-01-01

    This paper employs the provisions of international human rights law in order to analyse whether and how liberal states should regulate Haredi educational practices, which sanctify the exclusive focus on religious studies in schools for boys. It conceptualises the conflict between the right to acceptable education and the right to adaptable…

  2. The Contributions of Digital Communications Technology to Human Rights Education: A Case Study of Amnesty International

    Science.gov (United States)

    Norlander, Rebecca Joy

    2013-01-01

    This dissertation addresses the need for critical assessment and evaluation of human rights education (HRE) programs and activities, especially newer initiatives that incorporate the use of digital information and communications technology (ICT). It provides an in-depth case study of the use of digital ICT in Amnesty International's HRE efforts,…

  3. Rethinking International Migration of Human Capital and Brain Circulation: The Case of Chinese-Canadian Academics

    Science.gov (United States)

    Blachford, Dongyan Ru; Zhang, Bailing

    2014-01-01

    This article examines the dynamics of brain circulation through a historical review of the debates over international migration of human capital and a case study on Chinese-Canadian academics. Interviews with 22 Chinese-Canadian professors who originally came from China provide rich data regarding the possibilities and problems of the contemporary…

  4. Allosteric modulators affect the internalization of human adenosine A1 receptors.

    NARCIS (Netherlands)

    Klaasse, E.C.; Hout, G. van den; Roerink, S.F.; Grip, W.J. de; IJzerman, A.P.; Beukers, M.W.

    2005-01-01

    To study the effect of allosteric modulators on the internalization of human adenosine A(1) receptors, the receptor was equipped with a C-terminal yellow fluorescent protein tag. The introduction of this tag did not affect the radioligand binding properties of the receptor. CHO cells stably expressi

  5. Educational Cooperation between Thailand and Cambodia: Outcomes on Human Development, International Understanding and Future Prospect

    Science.gov (United States)

    Kijtorntham, Wichuda; Ruangdej, Phumjit; Saisuwan, Chatchanog

    2015-01-01

    Thailand and Cambodia set up educational cooperation since 1996, before signed a Memorandum of Understanding on Cooperation in the Promotion of Education in 2003. This research aimed to investigate outcomes of educational cooperation projects on Cambodia human development and international understanding, process of participatory learning and…

  6. Rethinking International Migration of Human Capital and Brain Circulation: The Case of Chinese-Canadian Academics

    Science.gov (United States)

    Blachford, Dongyan Ru; Zhang, Bailing

    2014-01-01

    This article examines the dynamics of brain circulation through a historical review of the debates over international migration of human capital and a case study on Chinese-Canadian academics. Interviews with 22 Chinese-Canadian professors who originally came from China provide rich data regarding the possibilities and problems of the contemporary…

  7. Curricular Choices of Ultra-Orthodox Jewish Communities: Translating International Human Rights Law into Education Policy

    Science.gov (United States)

    Perry-Hazan, Lotem

    2015-01-01

    This paper employs the provisions of international human rights law in order to analyse whether and how liberal states should regulate Haredi educational practices, which sanctify the exclusive focus on religious studies in schools for boys. It conceptualises the conflict between the right to acceptable education and the right to adaptable…

  8. Using "Competing Visions of Human Rights" in an International IB World School

    Science.gov (United States)

    Tolley, William J.

    2013-01-01

    William Tolley, a teaching fellow with the Choices Program, is the Learning and Innovation Coach and head of history at the International School of Curitiba, Brazil (IB). He writes in this article that he has found that the "Competing Visions of Human Rights" teaching unit, developed by Brown University's Choices Program, provides a…

  9. UNESCO and the Associated Schools Project: Symbolic Affirmation of World Community, International Understanding, and Human Rights

    Science.gov (United States)

    Suarez, David F.; Ramirez, Francisco O.; Koo, Jeong-Woo

    2009-01-01

    The UNESCO Associated Schools Project emphasizes world community, human rights, and international understanding. This article investigates the emergence and global diffusion of the project from 1953 to 2001, estimating the influence of national, regional, and world characteristics on the likelihood of a country adopting a UNESCO school. It also…

  10. Using "Competing Visions of Human Rights" in an International IB World School

    Science.gov (United States)

    Tolley, William J.

    2013-01-01

    William Tolley, a teaching fellow with the Choices Program, is the Learning and Innovation Coach and head of history at the International School of Curitiba, Brazil (IB). He writes in this article that he has found that the "Competing Visions of Human Rights" teaching unit, developed by Brown University's Choices Program, provides a…

  11. Regulating the research enterprise: international norms and the right to bodily integrity in human experiment litigation.

    Science.gov (United States)

    Lunstroth, John

    2007-01-01

    This article analyzes international law claims in human subject litigation, arguing that the failure of federal courts or Congress to oversee this kind of litigation by providing or recognizing a federal cause of action for research torts is an injustice. It is about two distinct and somewhat arcane areas of the law, international law and the law of human subjects research. Because they draw on different historical, social and conceptual frameworks, each has its own descriptive section in the article. In the first section, the author briefly describes international law and its place in the U.S. constitutional order. This section explains why international law claims are routinely rejected by the courts. In the second section, the author discusses the moral underpinnings of the research enterprise and explains how the values of science contradict the values of human rights and medicine. The author concludes that Congress or the judiciary should recognize the social magnitude of the research enterprise, the difference between the values of science and the values of medicine, and the meaninglessness of individual informed consent when considered on a population level. Citizens should be provided with a clearly defined cause of action for research harms to human subjects.

  12. NASA Human Research Program (HRP). International Space Station Medical Project (ISSMP)

    Science.gov (United States)

    Sams, Clarence F.

    2009-01-01

    This viewgraph presentation describes the various flight investigations performed on the International Space Station as part of the NASA Human Research Program (HRP). The evaluations include: 1) Stability; 2) Periodic Fitness Evaluation with Oxygen Uptake Measurement; 3) Nutrition; 4) CCISS; 5) Sleep; 6) Braslet; 7) Integrated Immune; 8) Epstein Barr; 9) Biophosphonates; 10) Integrated cardiovascular; and 11) VO2 max.

  13. The Role and Purposes of Public Schools and Religious Fundamentalism: An International Human Rights Law Perspective

    Science.gov (United States)

    Hodgson, Douglas Charles

    2012-01-01

    The question of what are today the legitimate and proper role and purposes of public schools can only be answered by a close examination and analysis of the human right to education which has been developed by such international organizations as the United Nations and the United Nations Educational, Scientific and Cultural Organization, and by…

  14. Report of the Second International Workshop on Human Chromosome 5 Mapping

    Energy Technology Data Exchange (ETDEWEB)

    Westbrook, C.A.; Neuman, W.L. [Chicago Univ., IL (United States); McPherson, J.; Wasmuth, J. [California Univ., Irvine, CA (United States). Dept. of Biological Chemistry; Camper, S. [Michigan Univ., Ann Arbor, MI (United States). Medical School; Plaetke, R. [Eceles Inst. of Human Genetics, Salt Lake City, UT (United States). Dept. of Human Genetics; Williamson, R. [St. Mary`s Hospital Medical School, London (United Kingdom). Dept. of Biochemistry and Molecular Genetics

    1993-12-31

    This report describes the accomplishments of the Second International Workshop on Human Chromosome 5 as was held May 11--13,1992 at the University of Chicago. Included in the report are abstract of individual presentations and a consensus map of the chromosome.

  15. Employing moderate resolution sensors in human rights and international humanitarian law monitoring

    Science.gov (United States)

    Marx, Andrew J.

    Organizations concerned with human rights are increasingly using remote sensing as a tool to improve their detection of human rights and international humanitarian law violations. However, as these organizations have transitioned to human rights monitoring campaigns conducted over large regions and extended periods of time, current methods of using fine- resolution sensors and manpower-intensive analyses have become cost- prohibitive. To support the continued growth of remote sensing in human rights and international humanitarian law monitoring campaigns, this study researches how moderate resolution land observatories can provide complementary data to operational human rights monitoring efforts. This study demonstrates the capacity of moderate resolutions to provide data to monitoring efforts by developing an approach that uses Landsat Enhanced Thematic Mapper Plus (ETM+) as part of a system for the detection of village destruction in Darfur, Sudan. Village destruction is an indicator of a human rights or international humanitarian law violations in Darfur during the 2004 study period. This analysis approach capitalizes on Landsat's historical archive and systematic observations by constructing a historic spectral baseline for each village in the study area that supports automated detection of a potentially destroyed village with each new overpass of the sensor. Using Landsat's near-infrared band, the approach demonstrates high levels of accuracy when compared with a U.S. government database documenting destroyed villages. This approach is then applied to the Darfur conflict from 2002 to 2008, providing new data on when and where villages were destroyed in this widespread and long-lasting conflict. This application to the duration of a real-world conflict illustrates the abilities and shortcomings of moderate resolution sensors in human rights monitoring efforts. This study demonstrates that moderate resolution satellites have the capacity to contribute

  16. Anal Squamous Intraepithelial Lesions and HPV Among Young Black Men Who Have Sex with Men

    Science.gov (United States)

    Keglovitz, Kristin; Lancki, Nicola; Walsh, Tim; Schneider, John A.

    2017-01-01

    Abstract Purpose: Limited data are available on anal squamous intraepithelial lesions (ASILs) and anal human papillomavirus (HPV) infection in young, Black populations. The purpose of this study was to examine the prevalence of and relationships between ASILs and high-risk HPV infection in a young (sex with men (MSM) population. Methods: Results of anal cytology and HPV DNA were gathered for 83 individuals. Results: Forty-two percent of individuals (35) had atypical squamous cells of undetermined significance and 33% (27) had low-grade squamous intraepithelial lesion by cytology. Only 9% tested positive for both high-risk HPV subtypes 16 and 18. Conclusion: Low rates of infection with both HPV types 16 and 18 may provide further evidence that we should continue to vaccinate young, Black MSM against HPV. PMID:27673362

  17. Incidence and cost of anal, penile, vaginal and vulvar cancer in Denmark

    DEFF Research Database (Denmark)

    Olsen, J.; Jorgensen, T. R.; Kofoed, K.

    2012-01-01

    Background: Besides being a causative agent for genital warts and cervical cancer, human papillomavirus (HPV) contributes to 40-85% of cases of anal, penile, vaginal and vulvar cancer and precancerous lesions. HPV types 16 & 18 in particular contribute to 74-93% of these cases. Overall the number...... of new cases of these four cancers may be relatively high implying notable health care cost to society. The aim of this study was to estimate the incidence and the health care sector costs of anal, penile, vaginal and vulvar cancer. Methods: New anogenital cancer patients were identified from the Danish...... anogenital cancers were estimated using regression analysis. Results: The annual incidence of anal cancer in Denmark is 1.9 per 100,000 persons. The corresponding incidence rates for penile, vaginal and vulvar cancer are 1.7, 0.9 and 3.6 per 100,000 males/females, respectively. The total number of new cases...

  18. A Newly Designed Anal Fistula Plug: Clinicopathological Study in an Experimental Iatrogenic Fistula Model

    Science.gov (United States)

    Aikawa, Masayasu; Miyazawa, Mitsuo; Okada, Katsuya; Akimoto, Naoe; Koyama, Isamu; Yamaguchi, Shigeki; Ikada, Yoshito

    2013-01-01

    We report on a clinicopathologic study in an animal model of treatment with a new bioabsorbable polymer plug (BAPP). Over a 2-week period, 6 porcine models, which each had 4 anal fistulae, were created using Blake drains. The pigs were divided into 2 groups: the BAPP-treatment group (n = 12 fistulae) and the control group (n = 12 fistulae). Two weeks later, the pigs were humanely killed, and the perianal sites were excised and examined with gross and pathologic studies. Each fistula in the BAPP group was completely cured. In the pathologic study, the treatment sites had little disarray, few defects in the muscular layer, and small numbers of inflammatory cells. The control group had a significantly greater number of inflammatory cells and microabscesses than the BAPP group. The newly developed BAPP reduced the infection and induced good healing in anal fistulae. The BAPP may be a useful new device for the clinical treatment of anal fistulae. PMID:23701146

  19. International Conference on Harmonisation; Guidance on S8 Immunotoxicity Studies for Human Pharmaceuticals; availability. Notice.

    Science.gov (United States)

    2006-04-13

    The Food and Drug Administration (FDA) is announcing the availability of a guidance entitled "S8 Immunotoxicity Studies for Human Pharmaceuticals." The guidance was prepared under the auspices of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The guidance provides recommendations on nonclinical testing approaches to identify compounds that have the potential to be immunotoxic and guidance on a weight-of-evidence decision making approach for immunotoxicity testing. The guidance is intended to provide recommendations on nonclinical testing for immunotoxicity induced by human pharmaceuticals. The guidance applies to unintended immunosuppression and immunoenhancement, excluding allergenicity or drug-specific autoimmunity.

  20. Anorectal Chlamydia trachomatis Load Is Similar in Men Who Have Sex with Men and Women Reporting Anal Sex.

    Directory of Open Access Journals (Sweden)

    Geneviève A F S van Liere

    Full Text Available Anorectal Chlamydia trachomatis (chlamydia is frequently diagnosed in men who have sex with men (MSM and in women, but it is unknown whether these infections are comparable in clinical impact and transmission potential. Quantifying bacterial load and identifying determinants associated with high bacterial load could provide more insight.We selected a convenience sample of MSM who reported anal sex (n = 90 and women with concurrent urogenital/anorectal chlamydia who reported anal sex (n = 51 or did not report anal sex (n = 61 from the South Limburg Public Health Service's STI unit. Bacterial load (Chlamydia/ml was quantified for all samples and log transformed for analyses. Samples with an unquantifiable human leukocyte antigen (n = 9 were excluded from analyses, as they were deemed inadequately sampled.The mean log anorectal chlamydia load (3.50 was similar for MSM and women who reported having anal sex (3.80, P = 0.21. The anorectal chlamydia load was significantly higher in these groups than in women who did not report having anal sex (2.76, P = 0.001. Detectable load values ranged from 1.81-6.32 chlamydia/ml for MSM, 1.74-7.33 chlamydia/ml for women who reported having anal sex and 1.84-6.31 chlamydia/ml for women who did not report having anal sex. Symptoms and several other determinants were not associated with anorectal chlamydia load.Women who did not report anal sex had lower anorectal loads, but they were within a similar range to the other two groups. Anorectal chlamydia load was comparable between MSM and women who reported anal sex, suggesting similar transmission potential.

  1. Reflections between CSR and international human rights in EU initiatives for a competitive inclusive society

    DEFF Research Database (Denmark)

    Buhmann, Karin

    : The paper aims to contribute to our understanding of whether a shift is taking place in societal attitudes towards a perception that corporations have duties based on international law. This is assessed on the basis of EU initiatives on inclusiveness and responsible competitiveness, particularly...... the EU Multistakeholder Forum and the Lisbon Strategy, with a particular focus on goals or views related to the human rights of non-discrimination and rights to work, education and vocational training, and network governance in (soft) law creation. It is found that despite obvious links, international...... law does not serve as a clear source of inclusiveness or responsible competitiveness. It is also found that the initiatives assessed do not indicate a shift at EU institutional level towards a perception that business holds duties under international law. International law seems at the most to be seen...

  2. Reflections between CSR and international human rights in EU initiatives for a competitive inclusive society

    DEFF Research Database (Denmark)

    Buhmann, Karin

    : The paper aims to contribute to our understanding of whether a shift is taking place in societal attitudes towards a perception that corporations have duties based on international law. This is assessed on the basis of EU initiatives on inclusiveness and responsible competitiveness, particularly...... the EU Multistakeholder Forum and the Lisbon Strategy, with a particular focus on goals or views related to the human rights of non-discrimination and rights to work, education and vocational training, and network governance in (soft) law creation. It is found that despite obvious links, international...... law does not serve as a clear source of inclusiveness or responsible competitiveness. It is also found that the initiatives assessed do not indicate a shift at EU institutional level towards a perception that business holds duties under international law. International law seems at the most to be seen...

  3. Mode of delivery after obstetric anal sphincter injury and the risk of long-term anal incontinence

    DEFF Research Database (Denmark)

    Jangö, Hanna; Langhoff-Roos, Jens; Rosthøj, Susanne

    2016-01-01

    BACKGROUND: Primiparous women have an increased risk of obstetric anal sphincter injury; because most of these patients deliver again, there are major concerns about mode of delivery: the risk of recurrent obstetric anal sphincter injury and the risk of long-term symptoms of anal incontinence...

  4. Human capital on the move: Education as a determinant of internal migration in selected INDEPTH surveillance populations in Africa

    National Research Council Canada - National Science Library

    Ginsburg, Carren; Beguy, Donatien; Augusto, Orvalho; Odhiambo, Frank; Soura, Abdramane; White, Michael J; Bocquier, Philippe; Afolabi, Sulaimon; Derra, Karim; Otiende, Mark; Zabre, Pascal; Collinson, Mark A

    2016-01-01

    BACKGROUND Education, as a key indicator of human capital, is considered one of the major determinants of internal migration, with previous studies suggesting that human capital accumulates in urban...

  5. Human Factors Engineering Requirements for the International Space Station - Successes and Challenges

    Science.gov (United States)

    Whitmore, M.; Blume, J.

    2003-01-01

    Advanced technology coupled with the desire to explore space has resulted in increasingly longer human space missions. Indeed, any exploration mission outside of Earth's neighborhood, in other words, beyond the moon, will necessarily be several months or even years. The International Space Station (ISS) serves as an important advancement toward executing a successful human space mission that is longer than a standard trip around the world or to the moon. The ISS, which is a permanently occupied microgravity research facility orbiting the earth, will support missions four to six months in duration. In planning for the ISS, the NASA developed an agency-wide set of human factors standards for the first time in a space exploration program. The Man-Systems Integration Standard (MSIS), NASA-STD-3000, a multi-volume set of guidelines for human-centered design in microgravity, was developed with the cooperation of human factors experts from various NASA centers, industry, academia, and other government agencies. The ISS program formed a human factors team analogous to any major engineering subsystem. This team develops and maintains the human factors requirements regarding end-to-end architecture design and performance, hardware and software design requirements, and test and verification requirements. It is also responsible for providing program integration across all of the larger scale elements, smaller scale hardware, and international partners.

  6. High Rates of Anal High-Grade Squamous Intraepithelial Lesions in HIV-Infected Women Who Do Not Meet Screening Guidelines.

    Science.gov (United States)

    Gaisa, Michael; Ita-Nagy, Fanny; Sigel, Keith; Arens, Yotam; Hennessy, Mary Ann; Rodriguez-Caprio, Gabriela; Mullen, Michael; Aberg, Judith A; Cespedes, Michelle

    2017-02-01

    Human immunodeficiency virus (HIV)-infected women have a higher burden of anal high-grade squamous intraepithelial lesions (HSIL) and anal cancer (AC) compared with HIV-uninfected women. Guidelines for AC screening in this population are heterogeneous. Here we report outcomes and risk factors for anal HSIL following implementation of universal AC screening offered to all HIV-infected women. Data from women who underwent AC screening with anal cytology from April 2009 to July 2014 were analyzed. Routine clinical data included anal and cervical cytology, demographic/behavioral data, and high-resolution anoscopy (HRA) results. We evaluated the association of cytology with HRA results, and predictors of HSIL pathology, and compared rates of HSIL pathology among women meeting screening guidelines to those who did not. Seven hundred forty-five HIV-infected women were screened with anal cytology. Thirty-nine percent had abnormal anal cytology on initial screen and 15% on secondary screen; 208 women underwent HRA following abnormal anal cytology. HSIL was found in 26% and 18% of anal biopsies following initial and secondary screening, respectively. One woman had AC. Cigarette smoking more than doubled HSIL risk. Among women who underwent AC screening despite not meeting existing guideline criteria, 21% and 10%, respectively, were found to have HSIL on biopsy. Neither meeting criteria for screening nor history of receptive anal sex was significantly associated with HSIL. Anal HSIL is common in HIV-infected women. Substantial numbers of HSIL would have been missed by strictly adhering to existing AC screening guidelines. These results support routine screening of all HIV-infected women regardless of human papillomavirus history or sexual practices. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  7. Human internal and external exposure to PBDEs - A review of levels and sources

    DEFF Research Database (Denmark)

    Frederiksen, Marie; Vorkamp, Katrin; Thomsen, Marianne

    2009-01-01

    ingest more dust than adults. Infants are also exposed to PBDEs via breast milk. Internal human exposure has generally been found to be one order of magnitude larger in North America than in Europe and Asia. These differences cannot solely be explained by the dietary intake as meat products are the only......This paper reviews the existing literature on human exposure to polybrominated diphenyl ethers (PBDEs), with particular focus on external exposure routes (e.g. dust, diet, and air) and the resulting internal exposure to PBDEs (e.g. breast milk and blood). Being lipophilic and persistent organic...... compounds, PBDEs accumulate in lipid-rich tissues. Consequently, food items like fish from high trophic levels or lipid-rich oils have been found to contain relatively high concentrations of PBDEs, thus presenting an important exposure pathway to humans. The presence of PBDEs in various products of everyday...

  8. Squamous cell carcinoma of the anal canal treated with chemoradiotherapy in a patient with HIV.

    Science.gov (United States)

    Sugimoto, Aya; Nakazuru, Shoichi; Sakakibara, Yuko; Nishio, Kumiko; Yamada, Takuya; Ishida, Hisashi; Yajima, Keishiro; Uehira, Tomoko; Mori, Kiyoshi; Mita, Eiji

    2016-01-01

    Since the introduction of combination antiretroviral therapy (ART), the life expectancy has increased for patients infected with human immunodeficiency virus (HIV). This has been associated with reductions in the incidences of some AIDS-defining malignancies, such as Kaposi sarcoma and non-Hodgkin lymphoma, but has coincided with an increased incidence of non-AIDS-defining malignancies, such as anal cancer. However, anal cancers are rare in patients with HIV in Japan. We report the case of an HIV-infected patient with anal cancer treated with chemoradiotherapy. A 37-year-old man receiving ART for HIV infection presented with a 1-month history of left inguinal lymphadenopathy and anal pain. Magnetic resonance imaging and computed tomography revealed a 56-mm mass, left inguinal lymphadenopathy, and left external iliac lymphadenopathy. The mass had infiltrated from the anal canal to the right levator ani and corpus spongiosum. Colonoscopy revealed a tumor with an ulcer in the anal canal. Histological examination of the tumor biopsy specimens confirmed the diagnosis of squamous cell carcinoma. The patient was diagnosed with anal cancer (T4N2M1 stage IV), and he received 5-fluorouracil (1000mg/m(2) on days 1-4 and 29-32) plus mitomycin C (10mg/m(2) on days 1 and 29) and concurrent radiotherapy (total dose, 59.4Gy in 33 fractions) along with ART. The treatment-related adverse events were grade 4 leukopenia and neutropenia, grade 3 thrombocytopenia, and grade 2 radiation dermatitis. Moreover, CD4 suppression was observed:the CD4 count decreased from 190 cells/μl before chemoradiotherapy to 138 cells/μl after 3 months, but increased to 210 cells/μl after 1 year. Because of the grade 4 leukopenia and neutropenia, the dose of 5-fluorouracil was reduced to 800mg/m(2) on days 29-32. A complete response was confirmed on magnetic resonance imaging, and colonoscopy confirmed the disappearance of the anal cancer. The patient is living with no signs of recurrence at 2 years

  9. Anal cushion lifting method is a novel radical management strategy for hemorrhoids that does not involve excision or cause postoperative anal complications

    Institute of Scientific and Technical Information of China (English)

    Gentaro; Ishiyama; Toshihiko; Nishidate; Yuji; Ishiyama; Akihiko; Nishio; Ken; Tarumi; Maiko; Kawamura; Kenji; Okita; Toru; Mizuguchi; Mineko; Fujimiya; Koichi; Hirata

    2015-01-01

    AIM: To describe the anal cushion lifting(ACL) method with preliminary clinical results. METHODS: Between January to September 2007, 127 patients who received ACL method for hemorrhoid was investigated with informed consent. In this study, three surgeons who specialized in anorectal surgery performed the procedures. Patients with grade two or more severe hemorrhoids according to Goligher’s classification were considered to be indicated for surgery. The patients were given the choice to undergo either the ACL method or theligation and excision method. ACL method is an original technique for managing hemorrhoids without excision. After dissecting the anal cushion from the internal sphincter muscle, the anal cushion was lifted to oral side and ligated at the proper position. Clinical characteristics and outcomes of patients were recorded including complications after surgery. RESULTS: A total of 127 patients were enrolled. Their median age was 42(19-84) years, and 74.8% were female. In addition, more than 99% of the patients had grade 3 or worse hemorrhoids. The median followup period was 26(0-88) mo, and the median operative time was 15(4-30) min. After surgery, analgesics were used for a median period of three days(0-21). Pain control was achieved using extra-oral analgesic drugs, although some patients required intravenous injections of analgesic drugs. The median duration of the patients’ postoperative hospital stay was 7(2-13) d. A total of 10 complications(7.9%) occurred. Bleeding was observed in one patient and was successfully controlled with manual compression. Urinary retention occurred in 6 patients, but it disappeared spontaneously in all cases. Recurrent hemorrhoids developed in 3 patients after 36, 47, and 61 mo, respectively. No anal stenosis or persistent anal pain occurred. CONCLUSION: We consider that the ACL method might be better than all other current methods for managing hemorrhoids.

  10. Prevalence of anal symptoms in general practice: a prospective study.

    Science.gov (United States)

    Tournu, Géraldine; Abramowitz, Laurent; Couffignal, Camille; Juguet, Frédéric; Sénéjoux, Agnès; Berger, Stéphane; Wiart, Anne-Laure; Bernard, Marc; Provost, Françoise; Pillant-Le Moult, Hélène; Bouchard, Dominique; Aubert, Jean-Pierre

    2017-08-03

    Anal disorders are largely underestimated in general practice. Studies have shown patients conceal anal symptoms leading to late diagnosis and treatment. Management by general practitioners is poorly described. The aim of this study is to assess the prevalence of anal symptoms and their management in general practice. In this prospective, observational, national study set in France, all adult patients consulting their general practitioner during 2 days of consultation were included. Anal symptoms, whether spontaneously revealed or not, were systematically collected and assessed. For symptomatic patients, the obstacles to anal examination were evaluated. The general practitioner's diagnosis was collected and a proctologist visit was systematically proposed in case of anal symptoms. If the proctologist was consulted, his or her diagnosis was collected. From October 2014 to April 2015, 1061 patients were included by 57 general practitioners. The prevalence of anal symptoms was 15.6% (95% CI: 14-18). However, 85% of these patients did not spontaneously share their symptoms with their doctors, despite a discomfort rating of 3 out of 10 (range 1-5). Although 65% of patients agreed to an anal examination, it was not proposed in 45% of cases with anal symptoms. Performing the examination was associated with a significantly higher diagnosis rate of 76% versus 20% (p anal symptoms are significant in general practice despite the impact on quality of life. Anal examination is seldom done. Improved training of general practitioners is required to break the taboo.

  11. Is anal endosonography useful in the study of recurrent complex fistula-in-ano? ¿Es útil la ecografía endoanal en el estudio de la fístula anal compleja recidivada?

    Directory of Open Access Journals (Sweden)

    A. M. Fernández-Frías

    2006-08-01

    Full Text Available Introduction: performing anal endosonography in complex fistula-in-ano allows us to design a personalized surgical strategy in each case, thereby improving results. However, there are doubts in the literature as to its utility in recurrent complex fistulas. The aim of this study was to compare the utility of anal ultrasonography in the study of primary versus recurrent complex fistula-in-ano. Patients and method: prospective study of patients diagnosed and treated for complex fistula-in-ano. Physical examination and anal ultrasonography provided data on primary track, internal opening, horseshoe extension and the presence of secondary tracks or cavities in a protocol designed specifically for the study. These assessments were subsequently contrasted with operative findings. Results: we included 35 patients, 19 (54.3% with primary complex anal fistulas and 16 (45.7% with recurrent fistulas. According to the operative findings, fistulas were classified as high transsphincteric in 28 patients (80%, suprasphincteric in 6 (17.1% and extrasphincteric in one patient (2.9%, with no differences between groups. Physical examination correctly classified 28 of the 35 fistulous tracks, in contrast to the 32 (91.4% correctly described on ultrasonography (80%. We did not find any statistically significant differences between the primary and the recurrent fistula groups with regard to sensibility, positive predictive value and accuracy of the anal ultrasonography for any of the parameters studied. Conclusion: the accuracy of anal ultrasonography does not decrease in recurrent complex fistula-in-ano.

  12. Oak Ridge National Laboratory Office of International Nuclear Safeguards: Human Capital Development Activity in FY16

    Energy Technology Data Exchange (ETDEWEB)

    Gilligan, Kimberly V. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Nuclear Security and Isotope Technology Division; Gaudet, Rachel N. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Nuclear Security and Isotope Technology Division

    2016-09-30

    In 2007, the U.S. Department of Energy National Nuclear Security Administration (DOE NNSA) Office of Nonproliferation and Arms Control (NPAC) completed a comprehensive review of the current and potential future challenges facing the international safeguards system. One of the report’s key recommendations was for DOE NNSA to launch a major new program to revitalize the international safeguards technology and human resource base. In 2007, at the International Atomic Energy Agency (IAEA) General Conference, then Secretary of Energy Samuel W. Bodman announced the newly created Next Generation Safeguards Initiative (NGSI). NGSI consists of five program elements: policy development and outreach, concepts and approaches, technology and analytical methodologies, human capital development (HCD), and infrastructure development. This report addresses the HCD component of NGSI. The goal of the HCD component as defined in the NNSA Program Plan is “to revitalize and expand the international safeguards human capital base by attracting and training a new generation of talent.” The major objectives listed in the HCD goal include education and training, outreach to universities and professional societies, postdoctoral appointments, and summer internships at national laboratories.

  13. Anal incontinence after two vaginal deliveries without obstetric anal sphincter rupture.

    Science.gov (United States)

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

    2017-06-01

    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. 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 randomly identified, 763 were eligible and received a questionnaire. Maternal and obstetric data were retrieved from the national registry. The response rate was 58.3%. In total, 394 women were included for analysis after reviewing responses according to previously defined exclusion criteria. Median follow-up time was 9.8 years after the first delivery and 6.4 years after the second. The prevalence of flatal incontinence, fecal incontinence and fecal urgency were 11.7, 4.1, and 12.3%, respectively. Overall, 20.1% had any degree of anal incontinence and/or fecal urgency. In 6.3% these symptoms 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. Anal incontinence and fecal urgency is reported by one fifth of women with two vaginal deliveries without OASIS at long-term follow-up. Episiotomy or vacuum extraction did not alter the risk of long-term anal incontinence.

  14. International Space Station Human Behavior and Performance Competency Model: Volume I

    Science.gov (United States)

    Schmidt, Lacey

    2008-01-01

    This document defines Human Behavior and Performance (HBP) competencies that are recommended to be included as requirements to participate in international long duration missions. They were developed in response to the Multilateral Crew Operations Panel (MMOP) request to develop HBP training requirements for the International Space Station (ISS). The competency model presented here was developed by the ITCB HBPT WG and forms the basis for determining the HBP training curriculum for long duration crewmembers. This document lists specific HBP competencies and behaviors required of astronauts/cosmonauts who participate in ISS expedition and other international longduration missions. Please note that this model does not encompass all competencies required. For example, outside the scope of this document are cognitive skills and abilities, including but not limited to concentration, memorization, perception, imagination, and thinking. It is assumed that these skills, which are crucial in terms of human behavior and performance, are considered during selection phase since such professionally significant qualities of the operator should be taken into consideration in order to ensure sufficient baseline levels that can be further improved during general astronaut training. Also, technical competencies, even though critical for crewmembers, are beyond the scope of this document. It should also be noted that the competencies in this model (and subsequent objectives) are not intended to limit the internal activities or training programs of any international partner.

  15. Intra-anal condyloma: surgical or topical treatment?

    Science.gov (United States)

    Dianzani, Caterina; Pierangeli, Alessandra; Avola, Alessandra; Borzomati, Domenico; Persichetti, Paolo; Degener, Anna Marta

    2008-12-15

    Human Papillomavirus infections are the strongest risk factors for genital cancer and are the causative agents of anogenital warts. Although the viral types associated with condylomata usually do not cause carcinoma, in women with a history of these lesions there is an increased risk of intraepithelial neoplasia and cancer. Generally the lesions are not life-threatening, but they provoke significant morbidity, are difficult to treat, and are a source of psychosocial stress. Thus, condylomata represent not only a health problem for the patient but also an economic burden for the society. Considering the individual episodes of care, men experience a longer duration of the lesions and incur greater costs than women. We report a case of a male patient with external and intra-anal condyloma resistant to laser therapy. Initially, surgical intervention appeared required because of florid and intra-anal growth. HPV DNA testing and sequencing revealed the presence of HPV 6. After initial discomfort, the lesions were successfully cleared with topical imiquimod 5 percent cream therapy.

  16. Partial fistulotomy and multiple setons in high anal fistulae.

    Science.gov (United States)

    Chatterjee, Gautam; Ray, Dipankar; Chakravartty, Saurav

    2009-08-01

    Setons are employed in high perianal fistulae. Our study aimed to use multiple setons in addition to a partial fistulotomy in high perianal fistulae involving the sphincter complex to combine the effects of cutting and drainage of the fistulous tract. This prospective study included 16 patients over a period of 4 years who presented with high perianal fistulae. The internal opening was identified and tract laid open till the dentate line. Four prolene threads were passed along the remainder of the tract and taken out through the external opening. One was tied tightly while the others were tightened every 7 days. No patients developed major faecal incontinence. Fistula recurred in one patient within a year and one patient had occasional incontinence to flatus. Multiple setons after partial fistulotomy is an effective treatment for high anal fistulae with low incidence of incontinence and recurrence and adequate patient satisfaction.

  17. Treatment of anal fistula and abscess.

    Science.gov (United States)

    Pigot, F

    2015-04-01

    The glands of Hermann and Desfosses, located in the thickness of the anal canal, drain into the canal at the dentate line. Infection of these anal glands is responsible for the formation of abscesses and/or fistulas. When this presents as an abscess, emergency drainage of the infected cavity is required. At the stage of fistula, treatment has two sometimes conflicting objectives: effective drainage and preservation of continence. These two opposing constraints explain the existence of two therapeutic concepts. On one hand the laying-open of the fistulous tract (fistulotomy) in one or several operative sessions remains the treatment of choice because of its high cure rates. On the other hand surgical closure with tract ligation or obturation with biological components preserves sphincter function but suffers from a higher failure rate. Copyright © 2014. Published by Elsevier Masson SAS.

  18. Squamous cell carcinoma of the anal canal.

    LENUS (Irish Health Repository)

    Martin, F T

    2012-01-31

    Squamous cell carcinoma ofthe anal canal represents 1.5% of all malignancies affectingthe gastrointestinal tract. Over the past 20 years dramatic changes have been seen in both the epidemiological distribution of the disease and in the therapeutic modalities utilised to manage it. CLINICAL MANAGEMENT: Historically abdominoperineal resection had been the treatment of choice with local resection reserved for early stage disease. Work by Nigro et al. has revolutionised how we currently manage carcinoma of the anal canal, demonstrating combined modality chemoradiotherapy as an appropriate alternative to surgical resection with the benefit of preserving sphincter function. Surgery is then reserved for recurrent disease with salvage abdominoperineal resection. This article reviews current literature and highlights the changing therapeutic modalities with selected clinical cases

  19. The application of Shari’ah and international human rights law in Saudi Arabia

    OpenAIRE

    Al-Rodiman, Abdulaziz

    2013-01-01

    This thesis was submitted for the degree of Doctor of Philosophy and was awarded by Brunel University The present dissertation provides an analytical and comparative study of the application of Islamic law (Shari’ah) and international human rights law in the Kingdom of Saudi Arabia. It provides an analysis of the sources of Islamic law as well as the sources of international law to set the background for analysis and defines the nature of both laws. It also tackles the subject of the domes...

  20. International Emergency Psychiatry Challenges: Disaster Medicine, War, Human Trafficking, Displaced Persons.

    Science.gov (United States)

    Jaung, Michael; Jani, Suni; Banu, Sophia; Mackey, Joy M

    2017-09-01

    Mental health disorders are a major cause of morbidity and a growing burden in low-income and middle-income countries; but there is little existing literature on the detailed epidemiology, diagnosis, and treatment in low-resource settings. Special situations with vulnerable populations, such as those created by international humanitarian emergencies, refugees or internally displaced people, and victims of human trafficking, are increasing in prevalence. These victims are often resettled in developed countries and come to the emergency department seeking care. To better care for these populations, knowledge of specialized psychosocial and cultural considerations should inform the comprehensive psychiatric assessment and treatment plan. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Correlação entre a incompetência esfincteriana anal e a prática de sexo anal em homossexuais do sexo masculino Correlation between anal sphincter incompetence and anal sex practice in male homosexual

    Directory of Open Access Journals (Sweden)

    Maíra Costa Ferreira

    2010-03-01

    Full Text Available INTRODUÇÃO: a incontinência anal (IA é uma disfunção de origem multifatorial com impacto significativo na qualidade de vida do indivíduo. Dentre as diversas etiologias para IA encontra-se a traumática, provocada pela penetração de objetos no canal anal. A inclusão do ânus na atividade sexual, já vem sendo descrita, principalmente entre homossexuais do sexo masculino. A partir desta premissa, questionou-se nesta pesquisa a possibilidade da penetração do pênis no ânus se enquadrar como etiologia traumática da incontinência anal. OBJETIVO: verificar a possível correlação entre a incontinência anal e a prática de sexo anal utilizando variáveis como idade, tempo de prática e a freqüência semanal de sexo anal. Métodos: 100 homossexuais masculinos passivos responderam um questionário elaborado pelas pesquisadoras e um Índice de Incontinência Anal. RESULTADOS: a incontinência anal estava presente em 62%, sendo que a perda de gases foi considerada a mais significativa. Contudo, as correlações propostas não se apresentaram estatisticamente significantes. CONCLUSÃO: a maioria dos homossexuais apresentou algum grau de incontinência anal, provavelmente em decorrência da prática do sexo anal.INTRODUCTION: the anal incontinence (AI is a disfunction of multifactorial origin with significant impact in thequality of life of the individual. Amongst the diverse etiologies for AI meets it traumatic, provoked for the object penetration inthe anal canal. The inclusion of the anus in the sexual activity, already comes being described, mainly between homosexuals ofthe masculine sex. From this premise, the possibility of the penetration of the penis in the anus was questioned in this researchif to fit as traumatic etiology of the anal incontinence. OBJECTIVE: to verify the possible correlation between changeable the analincontinence and the practical one of anal sex being used as age, practical time of and the weekly frequency of

  2. Calibration and commutability assessment of the 1st International Standard for Diphtheria Antitoxin Human.

    Science.gov (United States)

    Stickings, Paul; Rigsby, Peter; Coombes, Laura; von Hunolstein, Christina; Ralli, Luisa; Pinto, Antonella; Sesardic, Dorothea

    2013-11-01

    The 1st International Standard for Diphtheria Antitoxin Human (coded 10/262) was established by the World Health Organization Expert Committee on Biological Standardization in 2012. This paper describes the production, characterization and calibration of the new standard which is intended for use in the standardization of assays used to measure diphtheria antibody responses in human serum. The new standard was calibrated in terms of the International Standard for Diphtheria Antitoxin Equine in an international collaborative study. A total of 8 participants from 8 different countries performed in vivo and/or in vitro toxin neutralization tests and returned data that was used to assign units to the proposed new standard. The new standard has a diphtheria antitoxin potency of 2 IU/ampoule and is predicted to be stable. A follow up study was performed to assess commutability of the new standard. The follow up study was an existing external quality assessment, modified to include the new standard. Results obtained suggest that the new standard is commutable, showing comparable behaviour to native human serum samples in the majority of the assays compared, and is therefore suitable for use as a reference preparation in assays used to measure the level of anti-diphtheria antibodies in human serum.

  3. [Combined radio- and chemotherapy of anal cancer].

    Science.gov (United States)

    Dobrowsky, W

    1986-05-30

    The treatment regime in anal carcinoma is changing from being a mainly surgical problem. Combined radio-chemotherapy is of increasing interest as treatment of choice. The new treatment modality, including chemotherapy with Mitomycin C and 5-fluorouracil combined with percutaneous and interstitial radiotherapy is presented. The treatment regimes performed at the University Department for Radiotherapy and Radiobiology Vienna is discussed with regard to tolerance, side effects and local control.

  4. Outplacement Services for Displaced Employees: Attitudes of Human Resource Managers Based on Differences in Internal and External Delivery

    Science.gov (United States)

    Kilcrease, Kelly M.

    2013-01-01

    The results from a survey of 238 human resources executives from organizations that offer outplacement counseling (OPC) internally and 168 that offer it externally suggest that internal OPC delivery is inferior to external OPC delivery. The author found that most internal OPC organizations did not offer the 13 traditional OPC services, even when…

  5. Outplacement Services for Displaced Employees: Attitudes of Human Resource Managers Based on Differences in Internal and External Delivery

    Science.gov (United States)

    Kilcrease, Kelly M.

    2013-01-01

    The results from a survey of 238 human resources executives from organizations that offer outplacement counseling (OPC) internally and 168 that offer it externally suggest that internal OPC delivery is inferior to external OPC delivery. The author found that most internal OPC organizations did not offer the 13 traditional OPC services, even when…

  6. International Human Mission to Mars: Analyzing A Conceptual Launch and Assembly Campaign

    Science.gov (United States)

    Cates, Grant; Stromgren, Chel; Arney, Dale; Cirillo, William; Goodliff, Kandyce

    2014-01-01

    In July of 2013, U.S. Congressman Kennedy (D-Mass.) successfully offered an amendment to H.R. 2687, the National Aeronautics and Space Administration Authorization Act of 2013. "International Participation—The President should invite the United States partners in the International Space Station program and other nations, as appropriate, to participate in an international initiative under the leadership of the United States to achieve the goal of successfully conducting a crewed mission to the surface of Mars." This paper presents a concept for an international campaign to launch and assemble a crewed Mars Transfer Vehicle. NASA’s “Human Exploration of Mars: Design Reference Architecture 5.0” (DRA 5.0) was used as the point of departure for this concept. DRA 5.0 assumed that the launch and assembly campaign would be conducted using NASA launch vehicles. The concept presented utilizes a mixed fleet of NASA Space Launch System (SLS), U.S. commercial and international launch vehicles to accomplish the launch and assembly campaign. This concept has the benefit of potentially reducing the campaign duration. However, the additional complexity of the campaign must also be considered. The reliability of the launch and assembly campaign utilizing SLS launches augmented with commercial and international launch vehicles is analyzed and compared using discrete event simulation.

  7. HIV, disability and discrimination: making the links in international and domestic human rights law.

    Science.gov (United States)

    Elliott, Richard; Utyasheva, Leah; Zack, Elisse

    2009-11-09

    Stigma and discrimination constitute one of the greatest barriers to dealing effectively with the HIV epidemic, underlying a range of human rights violations and hindering access to prevention, care, treatment and support. There is some existing protection against HIV-based discrimination under international law, but the extent of states' obligations to address such discrimination has not been comprehensively addressed in an international instrument.The United Nations Convention on the Rights of Persons with Disabilities entered into force in May 2008. As countries ratify the convention, they are required to amend national laws and policies to give greater protection to the human rights of people with disabilities, including abolishing disability-based discrimination by the state and protecting persons against such discrimination by others. The Disability Convention addresses many of the issues faced by people living with HIV (PLHIV) but does not explicitly include HIV or AIDS within its open-ended definition of "disability".Therefore, the advent of the Disability Convention prompts us to consider the links between HIV and disability and, specifically, to consider the opportunities it and other legal mechanisms, international or domestic, may afford for advancing the human rights of PLHIV facing human rights infringements. We do so in the belief that the movement for human rights is stronger when constituencies with so many common and overlapping interests are united, and that respectful and strategic collaboration ultimately strengthens both the disability rights and the AIDS movements.In this article, we first examine the links between HIV and disability. We then provide a brief overview of how international human rights law has treated both disability and HIV/AIDS. We note some of the different ways in which national anti-discrimination laws have reflected the links between HIV and disability, illustrated with representative examples from a number of countries

  8. HIV, disability and discrimination: making the links in international and domestic human rights law

    Directory of Open Access Journals (Sweden)

    Elliott Richard

    2009-11-01

    Full Text Available Abstract Stigma and discrimination constitute one of the greatest barriers to dealing effectively with the HIV epidemic, underlying a range of human rights violations and hindering access to prevention, care, treatment and support. There is some existing protection against HIV-based discrimination under international law, but the extent of states' obligations to address such discrimination has not been comprehensively addressed in an international instrument. The United Nations Convention on the Rights of Persons with Disabilities entered into force in May 2008. As countries ratify the convention, they are required to amend national laws and policies to give greater protection to the human rights of people with disabilities, including abolishing disability-based discrimination by the state and protecting persons against such discrimination by others. The Disability Convention addresses many of the issues faced by people living with HIV (PLHIV but does not explicitly include HIV or AIDS within its open-ended definition of "disability". Therefore, the advent of the Disability Convention prompts us to consider the links between HIV and disability and, specifically, to consider the opportunities it and other legal mechanisms, international or domestic, may afford for advancing the human rights of PLHIV facing human rights infringements. We do so in the belief that the movement for human rights is stronger when constituencies with so many common and overlapping interests are united, and that respectful and strategic collaboration ultimately strengthens both the disability rights and the AIDS movements. In this article, we first examine the links between HIV and disability. We then provide a brief overview of how international human rights law has treated both disability and HIV/AIDS. We note some of the different ways in which national anti-discrimination laws have reflected the links between HIV and disability, illustrated with representative

  9. Gender equality and human rights approaches to female genital mutilation: a review of international human rights norms and standards.

    Science.gov (United States)

    Khosla, Rajat; Banerjee, Joya; Chou, Doris; Say, Lale; Fried, Susana T

    2017-05-12

    Two hundred million girls and women in the world are estimated to have undergone female genital mutilation (FGM), and another 15 million girls are at risk of experiencing it by 2020 in high prevalence countries (UNICEF, 2016. Female genital mutilation/cutting: a global concern. 2016). Despite decades of concerted efforts to eradicate or abandon the practice, and the increased need for clear guidance on the treatment and care of women who have undergone FGM, present efforts have not yet been able to effectively curb the number of women and girls subjected to this practice (UNICEF. Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change. 2013), nor are they sufficient to respond to health needs of millions of women and girls living with FGM. International efforts to address FGM have thus far focused primarily on preventing the practice, with less attention to treating associated health complications, caring for survivors, and engaging health care providers as key stakeholders. Recognizing this imperative, WHO developed guidelines on management of health complications of FGM. In this paper, based on foundational research for the development of WHO's guidelines, we situate the practice of FGM as a rights violation in the context of international and national policy and efforts, and explore the role of health providers in upholding health-related human rights of women at girls who are survivors, or who are at risk. Findings are based on a literature review of relevant international human rights treaties and UN Treaty Monitoring Bodies.

  10. Método analítico por cromatografía líquida de alta resolución para la determinación de carbamazepina en plasma humano Analytical method by high resolution liquid chromatography for the determination of carbamazepine in human plasma

    Directory of Open Access Journals (Sweden)

    Narda M. Jiménez Alemán

    2007-04-01

    Full Text Available Entre los requisitos para desarrollar los estudios de biodisponibilidad y bioequivalencia se encuentra contar con metodologías analíticas validadas para el trabajo con muestras en fluidos biológicos. Se desarrolló un método por cromatografía líquida de alta resolución para la determinación de carbamazepina en plasma humano, se utilizó como fase móvil una mezcla de hidrógeno fosfato de sodio: acetonitrilo (65:35 ajustada a pH= 3,3 con ácido fosfórico, flujo de 1,2 mL/min y detección ultravioleta a 210 nm. Se empleó propilparabeno como estándar interno. Conforme con las regulaciones establecidas para la validación de métodos en fluidos biológicos se estudiaron los parámetros siguientes: estabilidad de las muestras, linealidad, especificidad, precisión, exactitud y límite de detección y cuantificación. El método resultó específico y sensible con un límite de detección y cuantificación de 0,9 y 1,0 ng, respectivamente. El método fue lineal, preciso y exacto en el rango de concentraciones de 1,07 a 12,67 µg/mL. La recuperación media no fue estadísticamente diferente del 100,0 %. El analito en la matriz biológica propuesta permaneció en el periodo estudiado. La metodología descrita en este trabajo se aplica en nuestro caso al estudio que evalúa la biodisponibilidad y bioequivalencia de una formulación cubana de carbamazepina en voluntarios sanos.One of the requirements to develop the studies of bioavailability and bioequivalence is to have analytic methodologies validated for the work with samples in biological fluids. A method was developed by high resolution liquid chromatography for the determination of carbamazepine in human plasma. A mixture of hydrogen phosphate of sodium: acetonitrile (65:35 adjusted to pH= 3.3 with phosphoric acid, flow of 1.2 mL/min and ultraviolet detection at 210 nm, was used as mobile phase. Propylparabene was used as an internal standard. According to the established regulations for

  11. Human Capital Theory and Internal Migration: Do Average Outcomes Distort Our View of Migrant Motives?

    Science.gov (United States)

    Korpi, Martin; Clark, William A W

    2017-05-01

    By modelling the distribution of percentage income gains for movers in Sweden, using multinomial logistic regression, this paper shows that those receiving large pecuniary returns from migration are primarily those moving to the larger metropolitan areas and those with higher education, and that there is much more variability in income gains than what is often assumed in models of average gains to migration. This suggests that human capital models of internal migration often overemphasize the job and income motive for moving, and fail to explore where and when human capital motivated migration occurs.

  12. International migration, economic policy and human capital accumulation: a simulation study.

    Science.gov (United States)

    Van Dalen, H P

    1993-10-01

    "This paper examines the economic policy implications of international migration and human capital accumulation within a dynamic general equilibrium model. Each country produces by means of physical and human capital of two types (skilled and unskilled labour). Along optimal growth paths in a world of diverging population growth rates immigration can only be beneficial when the free rider effect (i.e., not paying for training costs) exceeds the capital dilution effect of an increase in population growth. Under quite general conditions the optimal immigration rate is zero."

  13. International Human Rights Law and the Right to water: a Brazilian Perspective

    Directory of Open Access Journals (Sweden)

    César Yip

    2016-01-01

    Full Text Available This article discusses the recognition of the right to water in international human rights law and its implications. After demonstrating the disputes with respect to the interpretation of this right, it outlines the Brazilian contribution in regard to its incorporation in domestic law. Jurisprudence on the suspension of water supply due to non-payment is taken as a case study of the question of access to water and sanitation.

  14. Drug Trafficking: A crime against humanity in the Rome Statue of the International Criminal Court?

    Directory of Open Access Journals (Sweden)

    Salvador Cuenca Curbelo

    2014-03-01

    Full Text Available Drug trafficking is a criminal activity that has become an international problem of growing magnitude. In some regions it is an emerging source of instability that threatens to jeopardize international security. Given the danger of this phenome- non, some states have tried to make acts of drug trafficking fall within the jurisdic- tion of an international criminal court. Although no agreement about its inclusion in the Rome Statute of the International Criminal Court was finally reached, the possibility of qualifying such acts as crimes against humanity has been raised from different fronts. This would allow their investigation or prosecution by the Inter- national Criminal Court itself. This paper analyses to what extent criminal orga- nizations involved in drug trafficking can fulfill the contextual elements of crimes against humanity as defined by the Rome Statute and, if so, to what extent acts of drug trafficking, despite not being expressly included in the Rome Statute, can be considered as “other inhumane acts” of a similar character to the acts referred to in Article 7 (1 of the Rome Statute.

  15. The patterns and expression of KDR in normal tissues of human internal organs.

    Science.gov (United States)

    Huang, Jianfei; Zhu, Huijun; Wang, Xudong; Tang, Qi; Huang, Hua; Wu, Kerong; Zhu, Jin; Feng, Zhenqing; Shi, Gongshen

    2011-12-01

    KDR has been implicated for playing an important role in the formation of new blood vessels and in solid tumor growth. It was considered as one of the most important regulators of angiogenesis and a key target in anticancer treatment. In the present study, we characterized KDR mRNA and protein expression in normal tissues of perinatal and adult tissues using One-step Real-Time RT-PCR and immunohistochemistry with a self-made anti-KDR antibody. The expression of KDR mRNA and protein in perinatal internal organs were all higher than in adult organs including brain, kidney, liver, lung and heart, respectively. KDR protein was presented in the cell plasma membrane of human internal tissues. The expression of KDR protein was raised in macrophage of spleen, and decreased in neurons of brain, myocardium, bronchial epithelial cells and alveolar epithelial cell, proximal and distal tubules cells, and hepatic cells with the maturity process of human organs. Notably, the order of KDR protein expression from highest to lowest is as follows: brain, liver, heart, kidney, and lung in adult tissues with statistically significant. It follows that how to balance the potential therapeutic side effect with human internal organs in targeted therapy of over-expressing KDR tumor.

  16. Informed consent in human subject research: a comparison of current international and Nigerian guidelines.

    Science.gov (United States)

    Fadare, Joseph O; Porteri, Corinna

    2010-03-01

    Informed consent is a basic requirement for the conduct of ethical research involving human subjects. Currently, the Helsinki Declaration of the World Medical Association and the International Ethical Guidelines for Biomedical Research of the Council for International Organizations of Medical Sciences (CIOMS) are widely accepted as international codes regulating human subject research and the informed consent sections of these documents are quite important. Debates on the applicability of these guidelines in different socio-cultural settings are ongoing and many workers have advocated the need for national or regional guidelines. Nigeria, a developing country, has recently adopted its national guideline regulating human subject research: the National Health Research Ethics Committee (NHREC) code. A content analysis of the three guidelines was done to see if the Nigerian guidelines confer any additional protection for research subjects. The concept of a Community Advisory Committee in the Nigerian guideline is a novel one that emphasizes research as a community burden and should promote a form of "research friendship" to foster the welfare of research participants. There is also the need for a regular update of the NHREC code so as to address some issues that were not considered in its current version.

  17. Association of HIV Status With Local Immune Response to Anal Squamous Cell Carcinoma: Implications for Immunotherapy.

    Science.gov (United States)

    Yanik, Elizabeth L; Kaunitz, Genevieve J; Cottrell, Tricia R; Succaria, Farah; McMiller, Tracee L; Ascierto, Maria L; Esandrio, Jessica; Xu, Haiying; Ogurtsova, Aleksandra; Cornish, Toby; Lipson, Evan J; Topalian, Suzanne L; Engels, Eric A; Taube, Janis M

    2017-07-01

    The programmed cell death protein 1 (PD-1) and programmed death-ligand 1 (PD-L1) pathway play an important immunosuppressive role in cancer and chronic viral infection, and have been effectively targeted in cancer therapy. Anal squamous cell carcinoma (SCC) is associated with both human papillomavirus and HIV infection. To date, patients with HIV have been excluded from most trials of immune checkpoint blocking agents, such as anti-PD-1 and anti-PD-L1, because it was assumed that their antitumor immunity was compromised compared with immunocompetent patients. To compare the local tumor immune microenvironment (TME) in anal SCCs from HIV-positive and HIV-negative patients. Anal SCC tumor specimens derived from the AIDS and Cancer Specimen Resource (National Cancer Institute) and Johns Hopkins Hospital included specimens. Tumors were subjected to immunohistochemical analysis for immune checkpoints (PD-L1, PD-1, LAG-3) and immune cell (IC) subsets (CD3, CD4, CD8, CD68). Expression profiling for immune-related genes was performed on select HIV-positive and HIV-negative cases in PD-L1+ tumor areas associated with ICs. Programmed death-ligand 1 expression on tumor cells and ICs, PD-L1 patterns (adaptive vs constitutive), degree of IC infiltration, quantified densities of IC subsets, and gene expression profiles in anal SCCs from HIV-positive vs HIV-negative patients. Approximately half of 40 tumor specimens from 23 HIV-positive and 17 HIV-negative patients (29 men and 11 women; mean [SD] age, 51 [9.9] years) demonstrated tumor cell PD-L1 expression, regardless of HIV status. Median IC densities were not significantly decreased in HIV-associated tumors for any cellular subset studied. Both adaptive (IC-associated) and constitutive PD-L1 expression patterns were observed. Immune cell PD-L1 expression correlated with increasing intensity of IC infiltration (r = 0.52; 95% CI, 0.26-0.78; P anal SCCs (fold change, 12.69; P anal SCC. These findings demonstrate an immune

  18. VAAFT: Video Assisted Anal Fistula Treatment; Bringing revolution in Fistula treatment

    OpenAIRE

    2015-01-01

    Objective: To share our findings that the new treatment modality Video Assisted Anal Fistula Treatment (VAAFT) is a better alternate to the conventional treatments of Fistula in Ano in our setup with minor changes in the initial method described by Meinero. Methods: Karl Storz Video equipment including Meinero Fistuloscope was used. Key steps are visualization of the fistula tract, correct localization of the internal fistula opening under direct vision and endoscopic treatment of the fistula...

  19. Acceptable results using plug for the treatment of complex anal fistulas

    DEFF Research Database (Denmark)

    Kleif, Jakob; Hagen, Kikke; Wille-Jørgensen, Peer

    2011-01-01

    The management of complex fistula-in-ano remains a surgical challenge. Previously published studies on the treatment of fistula-in-ano with the anal fistula plug (AFP) have reported a success rate reaching 35-87%. The aim of this study was to assess the results of the AFP procedure in a group...... of Danish patients with complex fistulas, and to analyse if the results were compatible with previous international findings....

  20. Optimal control predicts human performance on objects with internal degrees of freedom.

    Directory of Open Access Journals (Sweden)

    Arne J Nagengast

    2009-06-01

    Full Text Available On a daily basis, humans interact with a vast range of objects and tools. A class of tasks, which can pose a serious challenge to our motor skills, are those that involve manipulating objects with internal degrees of freedom, such as when folding laundry or using a lasso. Here, we use the framework of optimal feedback control to make predictions of how humans should interact with such objects. We confirm the predictions experimentally in a two-dimensional object manipulation task, in which subjects learned to control six different objects with complex dynamics. We show that the non-intuitive behavior observed when controlling objects with internal degrees of freedom can be accounted for by a simple cost function representing a trade-off between effort and accuracy. In addition to using a simple linear, point-mass optimal control model, we also used an optimal control model, which considers the non-linear dynamics of the human arm. We find that the more realistic optimal control model captures aspects of the data that cannot be accounted for by the linear model or other previous theories of motor control. The results suggest that our everyday interactions with objects can be understood by optimality principles and advocate the use of more realistic optimal control models for the study of human motor neuroscience.

  1. Human rights and bioethics: competitors orallies? The role of international law in shaping the contours of a new discipline.

    Science.gov (United States)

    Sándor, Judit

    2008-03-01

    Bioethical norms that had constituted only a rather short chapter in the medical curricula are now integrated into universal human rights. This paper seeks to demonstrate the normative convergence between the fields of bioethics and human rights by discussing the recently adopted relevant international documents and some applicable cases from international law. Human rights case law relevant in this emerging legal domain is analyzed with the aim to tackle changes that have occurred in the fields of human rights and bioethics due to the convergence and interdependence between them. Bioethics and human rights are two different systems of norms but bioethics can enrich human rights by extending the traditional catalogue of rights in certain new fields. The theory of human rights nevertheless dictates some discipline in formulating new and new rights. Therefore it offers to bioethics, as an exchange, a more sufficient enforcement mechanism and international recognition.

  2. THE RIGHT TO A CLEAN ENVIRONMENT. INTERNATIONAL RECOGNITION OF A HUMAN RIGHT TO A CLEAN ENVIRONEMENT BY ECTHR JURISPRUDENCE

    Directory of Open Access Journals (Sweden)

    Oana Maria HANCIU

    2015-07-01

    Full Text Available European Convention on Human Rights (ECHR does not specifically recognize a right to a clean environment, nor speaks specifically about environmental issues. However, there are many cases in the ECtHR jurisprudence which indirectly have a linkage with environmental protection. Often, throughout its decisions, ECtHR considers a positive obligation of States to take all necessary measures to protect human life and thus to provide a suitable environment for human living. The paper analyses the linkage between human rights and the international environment law and the role of ECtHR jurisprudence in enshrining an international human right in the field of environmental protection.

  3. Identification of internalizing human single-chain antibodies targeting brain tumor sphere cells.

    Science.gov (United States)

    Zhu, Xiaodong; Bidlingmaier, Scott; Hashizume, Rintaro; James, C David; Berger, Mitchel S; Liu, Bin

    2010-07-01

    Glioblastoma multiforme (GBM) is the most common and aggressive form of primary brain tumor for which there is no curative treatment to date. Resistance to conventional therapies and tumor recurrence pose major challenges to treatment and management of this disease, and therefore new therapeutic strategies need to be developed. Previous studies by other investigators have shown that a subpopulation of GBM cells can grow as neurosphere-like cells when cultured in restrictive medium and exhibits enhanced tumor-initiating ability and resistance to therapy. We report here the identification of internalizing human single-chain antibodies (scFv) targeting GBM tumor sphere cells. We selected a large naive phage antibody display library on the glycosylation-dependent CD133 epitope-positive subpopulation of GBM cells grown as tumor spheres and identified internalizing scFvs that target tumor sphere cells broadly, as well as scFvs that target the CD133-positive subpopulation. These scFvs were found to be efficiently internalized by GBM tumor sphere cells. One scFv GC4 inhibited self-renewal of GBM tumor sphere cells in vitro. We have further developed a full-length human IgG1 based on this scFv, and found that it potently inhibits proliferation of GBM tumor sphere cells and GBM cells grown in regular nonselective medium. Taken together, these results show that internalizing human scFvs targeting brain tumor sphere cells can be readily identified from a phage antibody display library, which could be useful for further development of novel therapies that target subpopulations of GBM cells to combat recurrence and resistance to treatment. (c)2010 AACR.

  4. Identification of internalizing human single chain antibodies targeting brain tumor sphere cells

    Science.gov (United States)

    Zhu, Xiaodong; Bidlingmaier, Scott; Hashizume, Rintaro; James, C. David; Berger, Mitchel S.; Liu, Bin

    2010-01-01

    Glioblastoma multiforme (GBM) is the most common and aggressive form of primary brain tumor and there is no curative treatment to date. Resistance to conventional therapies and tumor recurrence pose major challenges to treatment and management of this disease, and therefore new therapeutic strategies need to be developed. Previous studies by other investigators have shown that a subpopulation of GBM cells can grow as neurosphere-like cells when cultured in restrictive media, and exhibit enhanced tumor initiating ability and resistance to therapy. We report here the identification of internalizing human single chain antibodies (scFvs) targeting GBM tumor sphere cells. We selected a large naive phage antibody display library on the glycosylation-dependent CD133 epitope-positive subpopulation of GBM cells grown as tumor spheres and identified internalizing scFvs that target tumor sphere cells broadly, as well as scFvs that target the CD133 positive subpopulation. These scFvs were found to be efficiently internalized by GBM tumor sphere cells. One scFv GC4 inhibited self-renewal of GBM tumor sphere cells in vitro. We have further developed a full-length human IgG1 based on this scFv and found that it potently inhibits proliferation of GBM tumor sphere cells and GBM cells grown in regular non-selective media. Taken together, these results show that internalizing human scFvs targeting brain tumor sphere cells can be readily identified from a phage antibody display library, which could be useful for further development of novel therapies that target subpopulations of GBM cells to combat recurrence and resistance to treatment. PMID:20587664

  5. {sup 131}I-CRTX internal dosimetry: animal model and human extrapolation

    Energy Technology Data Exchange (ETDEWEB)

    Andrade, Henrique Martins de; Ferreira, Andrea Vidal; Soares, Marcella Araugio; Silveira, Marina Bicalho; Santos, Raquel Gouvea dos [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN-CNEN-MG), Belo Horizonte, MG (Brazil)], e-mail: hma@cdtn.br

    2009-07-01

    Snake venoms molecules have been shown to play a role not only in the survival and proliferation of tumor cells but also in the processes of tumor cell adhesion, migration and angiogenesis. {sup 125}I-Crtx, a radiolabeled version of a peptide derived from Crotalus durissus terrificus snake venom, specifically binds to tumor and triggers apoptotic signalling. At the present work, {sup 125}I-Crtx biokinetic data (evaluated in mice bearing Erlich tumor) were treated by MIRD formalism to perform Internal Dosimetry studies. Doses in several organs of mice were determinate, as well as in implanted tumor, for {sup 131}I-Crtx. Doses results obtained for animal model were extrapolated to humans assuming a similar concentration ratio among various tissues between mouse and human. In the extrapolation, it was used human organ masses from Cristy/Eckerman phantom. Both penetrating and non-penetrating radiation from {sup 131}I in the tissue were considered in dose calculations. (author)

  6. Proceedings of the Third International Conference on Intelligent Human Computer Interaction

    CERN Document Server

    Pokorný, Jaroslav; Snášel, Václav; Abraham, Ajith

    2013-01-01

    The Third International Conference on Intelligent Human Computer Interaction 2011 (IHCI 2011) was held at Charles University, Prague, Czech Republic from August 29 - August 31, 2011. This conference was third in the series, following IHCI 2009 and IHCI 2010 held in January at IIIT Allahabad, India. Human computer interaction is a fast growing research area and an attractive subject of interest for both academia and industry. There are many interesting and challenging topics that need to be researched and discussed. This book aims to provide excellent opportunities for the dissemination of interesting new research and discussion about presented topics. It can be useful for researchers working on various aspects of human computer interaction. Topics covered in this book include user interface and interaction, theoretical background and applications of HCI and also data mining and knowledge discovery as a support of HCI applications.

  7. The practice of career development in the international human resource management of the European countries

    Directory of Open Access Journals (Sweden)

    Berber Nemanja

    2014-01-01

    Full Text Available The function very close to the training in the management of human resources is certainly the human resource development. Specifically, the employees acquire new knowledge, abilities and skills during the training process, but also gain new experiences through various business tasks during their working life, developing themselves both, in private life and in the professional sense. Human resource development is seen as the development of the expertise of people through organizational development and training of employees in order of improvement of the performances. In this paper authors explored the practice of carrier development in European countries. Research was based on data from international project, CRANET, in the period from 2008 to 2010. The authors presented data about the usage of techniques for evaluation of career development and investigated obtained results.

  8. {sup 131}I-SPGP internal dosimetry: animal model and human extrapolation

    Energy Technology Data Exchange (ETDEWEB)

    Andrade, Henrique Martins de; Ferreira, Andrea Vidal; Soprani, Juliana; Santos, Raquel Gouvea dos [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN-CNEN-MG), Belo Horizonte, MG (Brazil)], e-mail: hma@cdtn.br; Figueiredo, Suely Gomes de [Universidade Federal do Espirito Santo, (UFES), Vitoria, ES (Brazil). Dept. de Ciencias Fisiologicas. Lab. de Quimica de Proteinas

    2009-07-01

    Scorpaena plumieri is commonly called moreia-ati or manganga and is the most venomous and one of the most abundant fish species of the Brazilian coast. Soprani 2006, demonstrated that SPGP - an isolated protein from S. plumieri fish- possess high antitumoral activity against malignant tumours and can be a source of template molecules for the development (design) of antitumoral drugs. In the present work, Soprani's {sup 125}ISPGP biokinetic data were treated by MIRD formalism to perform Internal Dosimetry studies. Absorbed doses due to the {sup 131}I-SPGP uptake were determinate in several organs of mice, as well as in the implanted tumor. Doses obtained for animal model were extrapolated to humans assuming a similar ratio for various mouse and human tissues. For the extrapolation, it was used human organ masses from Cristy/Eckerman phantom. Both penetrating and non-penetrating radiation from {sup 131}I were considered. (author)

  9. Squamous cell carcinoma of the anal sacs in three dogs.

    Science.gov (United States)

    Mellett, S; Verganti, S; Murphy, S; Bowlt, K

    2015-03-01

    Anal sac squamous cell carcinoma is rare in dogs. Five cases have been previously reported, treatment of which involved surgery alone. This report describes three further cases of canine anal sac squamous cell carcinoma which underwent medical (meloxicam) management alone, resulting in survival of up to seven months. No metastases were identified. Squamous cell carcinoma, although extremely uncommon, should be considered as a possible differential diagnosis when a dog is presented for investigation of an anal sac mass.

  10. Update on anal fistulae: Surgical perspectives for the gastroenterologist

    OpenAIRE

    Helena Tabry; Farrands, Paul A

    2011-01-01

    Anal fistulae are common and debilitating; they are characterized by severe pain and discharge. They arise following infection near the anal canal, or as a primary event from an abscess in the abdomen, fistulating into the vagina or perianal skin. The term ‘cryptoglandular’ is given to abscesses arising from the anal glands.For many years, the treatment of choice was to lay open the fistula; however, this risks causing incontinence with potentially devastating consequences. Alternative surgic...

  11. De mundejarismo de los Anales Toledanos Segundos

    Directory of Open Access Journals (Sweden)

    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.

  12. Psychological stress in patients with anal fistula.

    Science.gov (United States)

    Cioli, V M; Gagliardi, G; Pescatori, M

    2015-08-01

    Psychological stress is known to affect the immunologic system and the inflammatory response. The aim of this study was to assess the presence of psychological stress, anxiety, and depression in patients with anal fistula. Consecutive patients with anal fistula, hemorrhoids, and normal volunteers were studied prospectively. Stressful life events were recorded and subjects were asked to complete the state-trait anxiety inventory (STAI), a depression scale, and three different reactive graphic tests (RGT). Seventy-eight fistula patients, 73 patients with grade III-IV hemorrhoids, and 37 normal volunteers were enrolled. Of the fistula patients, 65 (83 %) reported one or more stressful events in the year prior to diagnosis, compared to 16 (22 %) of the hemorrhoid patients (P = 0.001). There were no significant differences in the percentage of subjects with abnormal trait anxiety (i.e., proneness for anxiety) and depression scores between fistula patients, hemorrhoid patients, and controls. Fistula patients had significantly higher (i.e., better) scores compared to hemorrhoid patients in two of three RGT and significantly lower (i.e., worse) scores in all three RGT compared to healthy volunteers. Of 37 patients followed up for a median of 28 months (range 19-41 months) after surgery, 8 (21.6 %) had persistent or recurrent sepsis. There was no significant difference in depression, STAI, and RGT scores between patients with sepsis and patients whose fistula healed. Our results suggest that an altered emotional state plays an important role in the pathogenesis of anal fistula and underline the importance of psychological screening in patients with anorectal disorders.

  13. Efficacy of LIFT for recurrent anal fistula.

    Science.gov (United States)

    Lehmann, J-P; Graf, W

    2013-05-01

    Ligation of the intersphincteric fistula tract (LIFT) is a novel sphincter-preserving technique for anal fistula. This pilot study was designed to evaluate the results in patients with a recurrent fistula. Seventeen patients [nine men; median age 49 (range, 30-76) years] with a recurrent trans-sphincteric fistula were treated with a LIFT procedure between June 2008 and February 2011. All were followed prospectively for a median of 16 (range, 5-27) weeks with clinical examination. Fifteen followed for 13.5 (range, 8-26) months by clinical examination also had three-dimensional (3D) anal ultrasound. The duration of the procedure was 35 (range, 18-70) min. One patient developed a small local haematoma and one had a subcutaneous infection, but otherwise there was no morbidity. At follow up, 11 (65%) patients had a successful closure, two (12%) had a remaining sinus and four (23%) had a persistent fistula. The incidence of persistent or recurrent fistulae at 13.5 months was six (40%) of 15 patients. No de novo faecal incontinence was reported. LIFT is a safe procedure for patients with recurrent anal fistula, with healing at short-term and medium-term follow-up comparable with or superior to that of other sphincter-preserving techniques. Larger studies with a longer follow up are needed to define the ultimate role of LIFT in patients with recurrence. © 2013 The Authors. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

  14. REVIEW OF INTERNATIONAL PROJECTS IN А FIELD OF HUMAN MICROBIAL ECOLOGY AND CONSTRUCTION OF PROBIOTICS

    Directory of Open Access Journals (Sweden)

    S. A. Starovoitova

    2013-06-01

    Full Text Available Modern huge and world-wide known projects concerning studying of human microbial ecology and construction of probiotics, particularly: Society for Microbial Ecology and Disease, Probiotics & Health Targeted Initiative of International Science and Technology Center (TI PROBIO ISTC, Human Microbiome Project of National Institutes of Health, MetaHIT Project (Metagenomics of the Human Intestinal Tract of European Commission, Human Metabolome Project of Canadian University of Alberta and some more else were characterized in the article. Brief historical information and reference to official sites of every discussed project were given. Main goals and tasks of every project were described. Short characteristic of discussed projects and also modern accessible results of researches were given. Importance of every examined project for widening scientific knowledge in the field of human microbial ecology and also for improvement and/or for construction of modern effective probiotics on basis of human normal intestinal microflora were paid attention. Close interaction of scientific data received by realization of every discussed project was shown.

  15. 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?

    Directory of Open Access Journals (Sweden)

    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

  16. Comentarios sobre dibujo analítico

    OpenAIRE

    Mata Botella, Elena

    2004-01-01

    Cuaderno de apoyo a la docencia del DIBUJO DE ARQUITECTURA que pretende hacer reflexionar al alumno (de primero o segundo de carrera) sobre un tipo de dibujo que aquí se ha llamado “dibujo analítico”. Un dibujo que a través de operaciones gráficas y conceptuales como la esquematización y la selección de información, tiende a alejarse de la descripción del objeto arquitectónico para adentrarse en determinados aspectos o dimensiones que subyacen en el proyecto arquitectónico. Unas notas intr...

  17. Comentarios sobre dibujo analítico

    OpenAIRE

    Mata Botella, Elena

    2004-01-01

    Cuaderno de apoyo a la docencia del DIBUJO DE ARQUITECTURA que pretende hacer reflexionar al alumno (de primero o segundo de carrera) sobre un tipo de dibujo que aquí se ha llamado “dibujo analítico”. Un dibujo que a través de operaciones gráficas y conceptuales como la esquematización y la selección de información, tiende a alejarse de la descripción del objeto arquitectónico para adentrarse en determinados aspectos o dimensiones que subyacen en el proyecto arquitectónico. Unas notas intr...

  18. Treatment of non-IBD anal fistula

    DEFF Research Database (Denmark)

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter;

    2015-01-01

    The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should...... be supplemented with an endoluminal ultrasound scan and/or an MRI scan. St. Mark's fistula chart should be used for the description. Simple fistulas are amenable to fistulotomy, whereas treatment of complex fistulas requires special expertise and management of all available treatment modalities to tailor...

  19. Treatment of non-IBD anal fistula

    DEFF Research Database (Denmark)

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter

    2015-01-01

    be supplemented with an endoluminal ultrasound scan and/or an MRI scan. St. Mark's fistula chart should be used for the description. Simple fistulas are amenable to fistulotomy, whereas treatment of complex fistulas requires special expertise and management of all available treatment modalities to tailor......The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should...

  20. [The anal fistula disease and abscess].

    Science.gov (United States)

    Strittmatter, Bernhard

    2004-01-01

    There are two forms of anal fistulas arising from its pathogenesis: the acute stage is the abscess, whereas the chronic stage is the fistula in ano. The classification of the fistula in ano is named after Parks. Pathogenesis and classification are explained. For complete cure, every abscess needs precise examination to be able to show the course and shape of the fistula. The surgical procedure depends on the fistula tract. Most fistulas can be operated by means of a fistulotomy or fistulectomy. Recovery depends on locating the total fistula tract.