WorldWideScience

Sample records for tunnused kriitiline anals

  1. Kordistamine uue majandus- ja juhtimismudeli tunnus. Kordistamise matemaatiline mudel / Tõnis Mets

    Index Scriptorium Estoniae

    Mets, Tõnis, 1952-

    2003-01-01

    Kordistusmehhanismi mudeli kohaselt võib teadmusinvesteeringu rentaablus globaalsesse korporatsioonistruktuuri investeerimisel ületada üksikettevõtte samalaadse investeeringu rentaablust enam kordi kui on globaalses võrgus ettevõtteid. Mudel väärib analüüsi, et leida Eesti ettevõtete võimalusi globaalses konkurentsis ning planeerida vastavat ettevõtluse toetamise ja innovatsioonistrateegiat. Graafikud. Tabel

  2. Anal cancer

    Science.gov (United States)

    ... body through the anus when you have a bowel movement. Anal cancer is fairly rare. It spreads slowly and is ... pain Itching Discharge from the anus Change in bowel habits Swollen lymph nodes in the groin or anal region

  3. 2007 on Eesti majandusele mitmes mõttes kriitiline aasta / Craig Rawlings

    Index Scriptorium Estoniae

    Rawlings, Craig

    2007-01-01

    Ameerika Kaubanduskoja Eesti president Craig Rawling analüüsib Eesti majanduse nõrku ja tugevaid külgi ning kutsub üles valimistel hääletama meeskonna poolt, kel on parim strateegiline, mõistlikele äriprintsiipidele toetuv tegevuskava ja kes ei ohustaks Eesti majandust ning heaolu

  4. Anal Cancer

    Science.gov (United States)

    ... to spread elsewhere in the body (metastasize). Anal cancer is closely related to a sexually transmitted infection called human papillomavirus (HPV). Evidence of HPV is detected in the majority ...

  5. Anal Fissures

    Science.gov (United States)

    ... with anal fissures Your doctor may prescribe stool softeners to make going to the bathroom easier and ... feel better. Fill the tub with enough lukewarm water to cover your hips and buttocks. Don’t ...

  6. Anal Disorders - Multiple Languages

    Science.gov (United States)

    ... Health Information Translations Spanish (español) Expand Section Anal Disorders: MedlinePlus Health Topic - English ... Health Information Translations Characters not displaying correctly on this page? See language display issues . Return to the MedlinePlus Health Information ...

  7. Anal Cancer Treatment

    Science.gov (United States)

    ... the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , ... stage of the cancer being treated. External and internal radiation therapy are used to treat anal cancer. Chemotherapy Chemotherapy ...

  8. Stages of Anal Cancer

    Science.gov (United States)

    ... the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , ... stage of the cancer being treated. External and internal radiation therapy are used to treat anal cancer. Chemotherapy Chemotherapy ...

  9. Anal screening cytology

    Directory of Open Access Journals (Sweden)

    Leiman Gladwyn

    2005-02-01

    Full Text Available Abstract This issue of CytoJournal contains an article on screening for anal intraepithelial neoplasia in high-risk male patients. This accompanying Editorial focuses on current understanding of this relatively new disease entity, with insights as to the potential role of screening cytopathology in the epidemiology, pathophysiology and clinical management of this HIV and HPV related anal lesion, which predominates in male patients living long-term with AIDS. Mention is made of techniques of obtaining samples, methods of preparation, and morphologic classification. Issues of anoscopic confirmation, as well as topical and surgical management are emphasized. The similarity of initial experiences in anal screening to problems encountered early in cervical cancer screening programs several decades ago, are highlighted.

  10. 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.

  11. Long-term anal incontinence after obstetric anal sphincter injury

    DEFF Research Database (Denmark)

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

    2018-01-01

    BACKGROUND: Anal incontinence is a major concern following delivery with obstetric anal sphincter injury and has been related to the degree of sphincter tear. OBJECTIVES: To 1) evaluate whether women with a fourth degree obstetric anal sphincter injury in the first delivery have an increased risk...... of long-term anal- and fecal incontinence after a second delivery and 2) assess the impact of mode of second delivery on anal incontinence and related symptoms in these patients. STUDY DESIGN: We performed secondary analyses of a national questionnaire study in all Danish women with an obstetric anal...... performed uni- and multivariable logistic regression analyses to evaluate the outcomes. RESULTS: In total, 2,008 patients had an obstetric anal sphincter injury of which 12.2% (n=245) had a fourth degree tear in the first delivery. The median follow-up time since the first delivery with OASIS was 11.6 years...

  12. ANAL INCONTINENCE AFTER UNRECOGNISED ANAL SPHINCTER TEAR AT VAGINAL DELIVERY

    Directory of Open Access Journals (Sweden)

    Mija Blaganje

    2018-02-01

    Full Text Available Background: Anal sphincter tears during vaginal delivery may result in serious sequel. Anal sphincter tears occur in approximately 2–19 % of all vaginal deliveries and are the most common precursor for faecal incontinence,1 however »occult« anal sphincter injury has been defined in 33 % of primiparous women following vaginal delivery.2 Methods: 31-year old primiparous woman received transfusion due to atony after delivery. Episiotomy, second degree perineal tear and vaginal tear were surgically corrected immediately after delivery. In the following days inability to control passing of liquid stools and flatulence together with stress urinary incontinence appeared. The complaint persisted. Ultrasound and EMG examination confirmed rupture of the external anal sphincter, which had been missed at delivery. Over a year after delivery the patient had a posterior colporraphy with surgical correction of external anal sphincter, which did not result in any clinical improve- ment. On follow-up ultrasound examination a hypoechoegenic area between the external sphincter and vaginal wall was detected. The patient was referred to The University Hos- pital in Graz, where the tear will be treated with autologous myoblast transplantation in a clinical trial. Conclusions: Treatment of a missed anal sphincter tear is complicated, expensive and unpleasant for the patient. Early detection with immediate appropriate surgical correction after delivery is most efficient, but it takes experience.

  13. Treatment Option Overview (Anal Cancer)

    Science.gov (United States)

    ... the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , ... stage of the cancer being treated. External and internal radiation therapy are used to treat anal cancer. Chemotherapy Chemotherapy ...

  14. 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 ...... sphincter function in patients with faecal incontinence (FI) and to relate these changes to the severity of FI....

  15. 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

    : Women with recurrent ASR between January 2000 and June 2011 were identified at two delivery wards in Copenhagen. The women answered a questionnaire with a validated scoring system for AI (St. Mark`s score), and the results were compared with those obtained in two control groups: women with subsequent......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...

  16. Kriitiline skulptuur "Gaasitoru" / Maria-Kristiina Soomre

    Index Scriptorium Estoniae

    Soomre, Maria-Kristiina, 1978-

    2009-01-01

    Eesti Kunstimuuseumi kaasaegse kunsti kogudesse soetatud Veneetsia arhitektuuribiennaalil rahvusvahelist tähelepanu saanud skulptuurist "Gaasitoru". Mitte ainult füüsilise objekti vaid konteksti, idee, kontseptsiooni säilitamisest

  17. Veneetsias olukord kriitiline / Maria-Kristiina Soomre

    Index Scriptorium Estoniae

    Soomre, Maria-Kristiina, 1978-

    2000-01-01

    Novembri algul tabas Veneetsiat suuruselt kolmas üleujutus 1900. aastast arvates. Üleujutuse otsene kahju ulatub miljonitesse dollaritesse. Kannatada saavad iidsete hoonete alusmüürid, aga ka linna sotsiaalmajanduslik kliima.

  18. Early discharge after external anal sphincter repair

    DEFF Research Database (Denmark)

    Rosenberg, J; Kehlet, H

    1999-01-01

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

  19. 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...

  20. 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...... 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...... in women with obstetric anal sphincter injury in the first delivery and one subsequent vaginal delivery. The questionnaire was sent to all Danish women who fulfilled inclusion criteria and had two vaginal deliveries 1997 -2005. We performed uni- and multivariable analyses to assess how recurrent obstetric...

  1. 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

  2. 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.

  3. Metoodika väljatöötamine konfliktide uurimiseks äriühingute valitsemisel / Kristo Viksi

    Index Scriptorium Estoniae

    Viksi, Kristo

    2005-01-01

    2004. a. Eesti erialases ajakirjanduses ilmunud artiklite analüüsist, millest selgus, millised konfliktid esinevad Eesti äriühingute valitsemises, millised on nende tunnused ja kuidas neid on lahendatud

  4. ANAL SPHINCTER INJURIES (OASIS AT DELIVERY

    Directory of Open Access Journals (Sweden)

    Katja Jakopič

    2018-02-01

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

  5. Large prostate motion produced by anal contraction

    International Nuclear Information System (INIS)

    Onishi, Hiroshi; Kuriyama, Kengo; Komiyama, Takafumi; Marino, Kan; Araya, Masayuki; Saito, Ryo; Aoki, Shinichi; Maehata, Yoshiyasu; Tominaga, Licht; Sano, Naoki; Oguri, Mitsuhiko; Onohara, Kojiro; Watanabe, Iori; Koshiishi, Tsuyota; Ogawa, Kazuhiko; Araki, Tsutomu

    2012-01-01

    Background and purpose: The aim of this study was to define the effects of voluntary anal contraction on prostate motion in an experimental setting. Materials and methods: Thirty-eight patients (median age, 76 years) with prostate cancer underwent thin-slice computed tomography (CT) in the vicinity of the prostate before and after active anal contraction. Three-dimensional displacement of the pelvis and prostate was measured. Results: Mean (±standard deviation, SD) overall displacement of the prostate due to anal contraction was 0.3 ± 1.4 mm to the right, 9.3 ± 7.8 mm to the anterior, and 5 ± 4 mm to the cranial direction. Mean displacement of the pelvis was 0.5 ± 1.8 mm to the right, 4.1 ± 7.1 mm to the anterior, and 1 ± 3 mm to the cranial direction. Mean displacement of the prostate relative to the pelvis was 0.1 ± 1.1 mm to the left, 5.2 ± 3.3 mm to the anterior, and 4 ± 4 mm to the cranial direction. Conclusions: Voluntary anal contraction within an experimental setting induces large prostate and bone motion, mainly in the anterior and cranial directions. The frequency and magnitude of actual anal contractions during radiotherapy for prostate cancer need to be determined.

  6. Anal incontinence after two vaginal deliveries without obstetric anal sphincter rupture

    DEFF Research Database (Denmark)

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

    2017-01-01

    . 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. CONCLUSIONS: Anal incontinence and fecal urgency is reported by one fifth of women with two vaginal...

  7. Primena swot analize na sistem integralnog transporta Vojske Srbije

    OpenAIRE

    Dragan Pamučar

    2008-01-01

    U radu je prikazana primena SWOT analize na sistem integralnog transporta Vojske Srbije. Kao rezultat analize predstavljeni su ciljevi daljeg usavršavanja integralnog transporta, kao i mogući problemi generisani strateškim upravljanjem.

  8. Midwestern Rural Adolescents' Anal Intercourse Experience

    Science.gov (United States)

    Dake, Joseph A.; Price, James H.; McKinney, Molly; Ward, Britney

    2011-01-01

    Purpose: The purpose of this study was to examine the prevalence of anal intercourse and its associated risk behaviors in a sample of Midwestern, predominantly white rural adolescents. Most of the research on this activity has been local or regional studies, with urban East and West Coast racial and ethnic minority adolescents. Methods: A…

  9. 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,…

  10. Chronic anal fissure from suspected adult sexual abuse in a traumatic anal sex practice patient.

    Science.gov (United States)

    Nzimbala, M J; Bruyninx, L

    2007-01-01

    The aetiopathogenesis of chronic anal fissure (CAF) is unclear and is probably multifactorial. CAF represents 10-15% of proctological consultations. This case report identifies adulthood sexual abuse as a significant risk and a potential aetiopathogenic factor of CAF This case history was discovered while carrying out administrated interviews during authors' clinical retrospective study on CAF. The clinical presentation of this 49-year-old woman is predominated by chronic anal lesions (anal tears in the anoderm, anal sphincter hypertrophy), associated medical history as a high consumer of healthcare with very poor mental health, chronic traumatic anal sex practice history, and especially persistent recurrences of gastro-intestinal symptoms after surgery. Surgical history is summarized as: 7x spontaneous abortion; 5x fistulectomy and 3x anal abscess; 4x Bartholin's gland; 4x hypertrophy papilla ablation; 2x anal manometry, 2x fissurectomy and 1x sphincterotomy; 2x haemorrhoid; and 1x hysterectomy. These symptoms initially started and the operations in particular took place after she was married. After 26 years of sexual abuse within her marriage, the clinical diagnosis was made and was consented by this patient. A referral to a psychiatrist was evident and a long course of multidisciplinary therapy (medical, surgical, physiological and psychological approaches) seemed to be of benefit, in terms of improving the clinical symptoms. Authors suggest that physicians should suspect sexual abuse in any patient with a medical history as a high consumer of healthcare and especially when there is persistent recurrence after the lateral subcutaneous internal sphincterotomy. We recognise that the link or causality is difficult to prove and further study is probably needed to shed light on the link between sexual abuse and CAF: although in the United Kingdom, over 20.83% of the population are subject to sexual abuse. 83%.

  11. Risk factors of recurrent anal sphincter ruptures

    DEFF Research Database (Denmark)

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

    2012-01-01

    Please cite this paper as: Jangö H, Langhoff-Roos J, Rosthøj S, Sakse A. Risk factors of recurrent anal sphincter ruptures: a population-based cohort study. BJOG 2012;00:000-000 DOI: 10.1111/j.1471-0528.2012.03486.x. Objective  To determine the incidence and risk factors of recurrent anal sphincter...... rupture (ASR). Design  Population-based retrospective cohort study. Setting  Data were taken from the National Medical Birth Registry, Denmark. Population  Patients with a first and a second vaginal delivery in the time period 1997-2010. Methods  Univariate analysis and multivariate logistic regression...... were used to determine risk factors of recurrent ASR. Main outcome measures  The incidence of recurrent ASR and odds ratios for possible risk factors of recurrent ASR: age, body mass index, grade of ASR, birthweight, head circumference, gestational age, presentation, induction of labour, oxytocin...

  12. 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

  13. 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

    2015-09-01

    The aim of this study was to systematically review the findings of publications addressing the epidemiology of anal human papillomavirus (HPV) infection, anal intraepithelial neoplasia, and anal cancer in women. We conducted a systematic review among publications published from Jan. 1, 1997, to Sept. 30, 2013, to limit to publications from the combined antiretroviral therapy 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. 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. Among HIV-positive women, the prevalence of high-risk (HR)-HPV in the anus was 16-85%. Among HIV-negative women, the prevalence of anal HR-HPV infection ranged from 4% to 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% to 86% and from 5% to 22%, respectively. Histological anal high-grade squamous intraepithelial lesions (anal intraepithelial neoplasia 2 or greater) 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 to 30 per 100,000. Among women with a history of cervical cancer or cervical intraepithelial neoplasia 3, the incidence rates of anal cancer ranged from 0.8 to 63.8 per 100,000 person-years, and in

  14. Development of a pulse height analizer

    International Nuclear Information System (INIS)

    Moreira, E.S.

    1984-01-01

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

  15. 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.

  16. Correlation between anal sphincter incompetence and anal sex practice in male homosexual

    OpenAIRE

    Ferreira, Maíra Costa; Braz, Tatiana Pereira; Machado, Ana Maria Oliveira; Ribeiro, Gabriel; Andrade, Rosana Cristina Pererira de

    2010-01-01

    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 etiolog...

  17. 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.

  18. Nivolumab After Combined Modality Therapy in Treating Patients With High Risk Stage II-IIIB Anal Cancer

    Science.gov (United States)

    2018-03-02

    Anal Basaloid Carcinoma; Anal Canal Cloacogenic Carcinoma; Anal Margin Squamous Cell Carcinoma; Stage II Anal Canal Cancer AJCC v6 and v7; Stage III Anal Canal Cancer AJCC v6 and v7; Stage IIIA Anal Canal Cancer AJCC v6 and v7; Stage IIIB Anal Canal Cancer AJCC v6 and v7

  19. 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...

  20. Anal sphincter responses after perianal electrical stimulation

    DEFF Research Database (Denmark)

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

    1982-01-01

    not fatigued by repeated stimulation, were most dependent on placement of stimulating and recording electrodes, and always had a higher threshold than the third response. The third response was constantly present in normal subjects. It had the longest EMG response and the latency decreased with increasing......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...

  1. Environmental scan of anal cancer screening practices: worldwide survey results

    International Nuclear Information System (INIS)

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

    2014-01-01

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

  2. Mode of delivery after obstetric anal sphincter injury.

    Science.gov (United States)

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

    2015-11-01

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

  3. Giant Anal Condyloma Acuminatum in Childhood: A Case Report ...

    African Journals Online (AJOL)

    Giant Anal Condyloma Acuminatum in Childhood: A Case Report. K. Attipou, K. Yawovi, N. James, G. A. Napo-Koura, A. Tchangaï-Walla, K James. Abstract. The authors report a case of anal giant condyloma acuminatum present for 10 years in a 14 year old. The giant tumor was responsible for difficulty in the sitting and ...

  4. 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...

  5. Tuberculous anal fistulas – prevalence and clinical features in an ...

    African Journals Online (AJOL)

    Tuberculous anal fistulas – prevalence and clinical features in an endemic area. D Stupart, P Goldberg, A Levy, D Govender. Abstract. Introduction. The aim of this study was to determine the prevalence of tuberculosis (TB) in anal fistulas at a referral hospital in Cape Town, and to document the clinical features and course of ...

  6. Sotsiaalvõrgustike analüüs / Innar Liiv

    Index Scriptorium Estoniae

    Liiv, Innar, 1982-

    2005-01-01

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

  7. Anal sphincter complex: endoanal MR imaging of normal anatomy

    NARCIS (Netherlands)

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

    1995-01-01

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

  8. Effect of endorectal pullthrough on external anal sphincter integrity ...

    African Journals Online (AJOL)

    tissue during dissection. Anal sphincter electromyography. (EMG) is an indispensable parameter for the diagnosis of patients with any anorectal dysfunction. The aim of our study was to assess the integrity of the anorectal sphincter after transanal endorectal pullthrough using anal EMG. Methods This prospective study was ...

  9. Kirurgisk behandling af anale fistler ved Crohns sygdom

    DEFF Research Database (Denmark)

    Heyckendorff-Diebold, Tina; Maeda, Yasuko; Buntzen, Steen

    2012-01-01

    The treatment of transsphincteric anal fistulas in Crohn's disease is a balance between the elimination of the sepsis and the functional outcome. Loose setons can be used as a preoperative drainage or chronic treatment. Fibrin glue and the anal fistula plug are methods with excellent functional...

  10. 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.

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

    OpenAIRE

    Corti, Marcelo; Villafañe, María F.; Marona, Esteban; Lewi, Daniel

    2012-01-01

    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,...

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

    Science.gov (United States)

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

    1997-03-01

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

  13. Endoanal ultrasound in benign anal disorders: findings and usefulness

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Tae Haeng; Shin, Hyun Joon; Cho, Young Kwon; Park, Dong Rib; Jeon, Hae Jeong; Park, Jeong Hee; Choi, Yong Chil; Park, Ung Chae; Choi, Jin Yong [Konkuk Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-09-01

    To evaluate the usefulness of endoanal ultrasonography and to determine the imaging features of patients with fecal incontinence, anal abscess or anal fistula. Twenty five patients underwent endoanal ultrasonography between October 1995 and July 1996. Ten of these were fecal incontinence cases, eight had an anal abscess, and seven, an anal fistula. The incontinence grading scale (IGS) was used for clinical grading of fecal incontinence and pudendal nerve terminal motor latency (PNTML) for pudendal nerve injury. Endoanal ultrasonographic features and operative findings were retrospectively reviewed. Endoanal ultrasonography revealed defective sphincteric muscles in all three patients with myogenic fecal incontinence, but in six of seven cases with neurogenic fecal incontinence, these muscles were not difective. Myogenic and neurogenic incontience showed different findings (p=3D0.033). In comparison with surgical findings, endoanal ultrasonography was 88% accurate in anal abscess cases and 86% accurate in those of anal fistula. Endoanal ultrasonography in conjunction with PNTML was very useful for the detection of the site and severity of sphincteric muscle defect and diagnosis of the etiology of fecal incontinence. Through analysis of the site and type of lesion, the procedure can also serve as a guide to the surgical treatment of patients with anal abscess or fistula.=20.

  14. Colgajo anal cutáneo por deslizamiento :

    OpenAIRE

    Rodriguez, Carlos E

    2009-01-01

    Tesis (Doctor)--Universidad Nacional de Córdoba. Facultad de Ciencias Médicas, 2009 Desde Julio del año 2004 a Septiembre del año 2008, se trataron 34 pacientes que presentaban patología ano-orificial beningna, mediante la realización del colgajo anal cutáneo por deslizamiento. La edad promedio fue de 59 años y el sexo predominante el masculino. Las patologías que presentaban fueron, enfermedad hemorroidal el 64%; estenosis anal 18% y fisura anal 18% del total de enfermos operados el 22% t...

  15. Do changes in anal sphincter anatomy correlate with anal function in women with a history of vaginal delivery?

    Science.gov (United States)

    Murad-Regadas, Sthela Maria; Dealcanfreitas, Iris Daiana; Regadas, Francisco Sergio Pinheiro; Rodrigues, Lusmar Veras; Fernandes, Graziela Olivia da Silva; Pereira, Jacyara de Jesus Rosa

    2014-01-01

    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. 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. 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. Fecal incontinence symptoms did not correlate with anal pressures and anal sphincter anatomy changes, but women with sphincter defects have shorter anterior EAS and IAS and a longer gap.

  16.  Surgical excision of extensive anal condylomata is a safe operation without risk of anal stenosis

    Directory of Open Access Journals (Sweden)

    Konrad Wroński

    2012-03-01

    Full Text Available  Introduction:Anal condylomata acuminata was a well-known disease in ancient times but in recent years there has been a rapidly increasing number of people who suffer from this disease. The main cause of this disease is infection of human papilloma virus (HPV which occurs through sexual contact.Currently there are three different ways to treat anal condylomata. Small changes of anal condylomata can be treated with local therapeutic agents, but the best results of treatment of extensive changes are obtained by surgical techniques.Material/Methods:The study group consisted of 30 patients with diagnosed extensive anal condylomata who underwent surgery in Mikolaj Pirogow High Specialized Hospital in Lodz. The survey was conducted from 2007 to 2011. Patients had been directed to the surgical ward by general surgeons and practitioners, proctologists and urologists. The diagnosis was made after proctological assessment in the knee-chest position.Results:All patients underwent surgery and had complete macroscopic electroexcision of anal condylomata. In the research group there was no mortality. Postoperative complications occurred in 4 (13.3�20patients – postoperative bleeding. Strong pain was present in 14 (46.7�20patients but only in the postoperative period. During postoperative follow-up there was no observed infection in the anal region or recurrence of disease. In the operated group there were no observed cosmetic deformations of the anus and/or the anal canal, narrow anal canal or functional fecal incontinence symptoms.Conclusions:Surgical treatment of anal condylomata is an effective and safe method for the patient. In our research there were no serious postoperative complications or recurrence of the disease during the follow-up period.

  17. Også gravide skal rektaleksploreres ved anale symptomer

    DEFF Research Database (Denmark)

    Højgaard, Helle Manfeld; Rahr, Hans

    2012-01-01

    assessment. Following caesarian section, diagnostic workup showed multiple liver metastases. Rectal cancer in pregnancy is rare, while haemorrhoids are common. We recommend keeping the differential diagnoses in mind and performing a digital rectal examination if pregnant women have anal symptoms....

  18. Early pelvic floor muscle training after obstetrical anal sphincter injuries for the reduction of anal incontinence.

    Science.gov (United States)

    Mathé, Mélodie; Valancogne, Guy; Atallah, Anthony; Sciard, Clémentine; Doret, Muriel; Gaucherand, Pascal; Beaufils, Etienne

    2016-04-01

    Between 0.5 and 5% of vaginal deliveries involve obstetrical anal sphincter injuries (OASIS). Thirty to forty percent of patients with OASIS will suffer from anal incontinence in the subacute postpartum period. The aim of the present study was to assess the effectiveness of early pelvic floor muscle training (PFMT) combined with standard rehabilitation on anal incontinence after vaginal deliveries complicated by OASIS. The present work was a retrospective quantitative study performed in a tertiary-level maternity hospital. Women with 3rd or 4th degree obstetric tears were included. Women who gave birth between January 1st, 2011 and December 31st, 2012 underwent standard pelvic-perineal rehabilitation within 6-8 weeks postpartum. Women who gave birth between January 1st, 2013 and July 1st, 2014 had early rehabilitation (within 30 days after delivery) followed by the same standard rehabilitation received by the other group. Rehabilitation was performed by physiotherapists specialized in perineology. No electrostimulation was done in early rehabilitation. An in-house-validated modification of the Jorge and Wexner questionnaire was sent by mail to the patients to assess symptoms. The main judgment criterion was anal incontinence to gas, loose stools and/or solid stool. Two hundred and thirty patients were diagnosed with OASIS. Nineteen women (8.3%) were lost to follow-up. The intention-to-treat analysis included 211 patients, 109 of whom underwent standard rehabilitation and 102 early rehabilitation plus standard rehabilitation. The two groups were comparable in terms of parity, birth weight, assisted delivery, epidural anesthesia and rates of mediolateral episiotomy. Multivariate analyses adjusted for type of perineal lesion were performed. Early rehabilitation significantly reduced gas leakage: OR 0.51 [0.29-0.90] (p=0.02), liquid stool leakage: OR 0.22 [0.08-0.58] (p=0.02) and urinary stress incontinence: OR 0.43 [0.24-0.77] (p=0.004). We recommend early (during the

  19. Economic burden of anal cancer management in France.

    Science.gov (United States)

    Abramowitz, L; Rémy, V; Vainchtock, A

    2010-10-01

    The incidence of anal cancer has increased over the last 25 years. No organized screening exists for the precursors of anal cancer (anal intraepithelial neoplasia and carcinoma in situ) and diagnosis is often delayed. Treatment for precursor lesions is of limited success, while cancer management is traumatic for the patient. Like cancers of the cervix, most cases of anal cancer are associated with infection with human papillomavirus (HPV). With increases in the incidence of anal cancer, and in light of the availability of prevention strategies such as screening and HPV vaccination, it is important, from a public health perspective, to assess the economic burden of anal cancer in France. We performed a retrospective analysis based on data extracted from a French hospital database - the Programme de médicalisation des systèmes d'information (PMSI) - to assess the number and management of patients hospitalized for anal cancer in 2006. Data on radiotherapy sessions performed in private hospitals were obtained from the Statistiques annuelles des établissements de santé (SAE) database. Costs of hospitalization, from the healthcare-payer perspective, were obtained from official diagnosis-related group tariffs for public and private hospitals. Ambulatory and indirect costs were estimated using information obtained from the literature. In 2006, 3,711 patients with anal cancer were treated in hospitals in France. Of these, the majority were women (69%). The annual cost of hospital treatment for anal cancer was estimated at € 20,326,868. The overall estimated cost (including hospitalization, outpatient and daily allowances costs) to the healthcare payer was € 38,249,981. This study, the first to investigate the economic burden of anal cancer in France, shows that the management costs of anal cancer are high and comparable to cervical cancer management costs (€ 44 million). Further research is required to determine the cost of management of precursor lesions, which

  20. Anal sphincter EMG in the diagnosis of parkinsonian syndromes

    DEFF Research Database (Denmark)

    Winge, K; Jennum, Poul Jørgen; Løkkegaard, Annemette

    2010-01-01

    The role of electromyography (EMG) recorded from the external anal sphincter (EAS) in the diagnosis of atypical parkinsonian syndromes is a matter for continuous debate. Most studies addressing this issue are retrospective.......The role of electromyography (EMG) recorded from the external anal sphincter (EAS) in the diagnosis of atypical parkinsonian syndromes is a matter for continuous debate. Most studies addressing this issue are retrospective....

  1. Rare case of gastrointestinal stromal tumor of the anal canal

    Directory of Open Access Journals (Sweden)

    Madhu Kumar

    2013-01-01

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

  2. Defects on endoanal ultrasound and anal incontinence after primary repair of fourth-degree anal sphincter rupture: a study of the anal sphincter complex and puborectal muscle

    DEFF Research Database (Denmark)

    Sakse, A; Secher, N J; Ottesen, M

    2009-01-01

    as the length of the anal canal, and then correlate these measures with AI; and to assess the interobserver measurement agreement between an inexperienced and an experienced sonologist. METHODS: EAUS was offered to 84 consecutive women, who were asked to answer a validated questionnaire after fourth-degree ASR......OBJECTIVES: To perform three-dimensional endoanal ultrasound (EAUS) after primary repair of fourth-degree anal sphincter rupture (ASR) and correlate the sonographic defects with anal incontinence (AI); to measure the axial and sagittal thickness and angle of the puborectal muscle (PRM) as well...... with Starck score. No clear association between the measurements of the PRM and AI was shown. The experienced observer detected more of the small defects than did the inexperienced observer. CONCLUSION: In a 1-9-year follow-up period after primary suture of fourth-degree ASR, the frequency of AI was high...

  3. 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

    2018-03-01

    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 shoulder dystocia, the risk of 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.

  4. 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...... in women. Between 1978-1982 and 2003-2008, the age-standardized incidence rate of anal cancer increased from 0.68 to 1.48 per 100 000 person-years in women and from 0.45 to 0.80 per 100 000 person-years in men. Although there is no systematic screening for AIN in Denmark, we nevertheless identified 608...

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    BACKGROUND: Men with passive fecal leakage represent a distinct clinical entity in which the pathophysiology remains unclear. Standard anorectal investigations fail to demonstrate consistent abnormalities in this group. Anal acoustic reflectometry is a new test of anal sphincter function with gre...... is a sensitive test of anal sphincter function and, unlike anal manometry, can discriminate male leakers from continent subjects. An identifiable abnormality has been detected using anal acoustic reflectometry, which may further our understanding of the pathogenesis in this group....

  6. [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.

  7. Sonographic assessment of the anal sphincter after obstetric anal sphincter injury (OASI) using transperineal ultrasound (TPUS).

    Science.gov (United States)

    Eisenberg, Vered H; Valsky, Dan V; Yagel, Simcha

    2018-03-24

    Obstetric anal sphincter injury (OASI) is the most common cause of anal incontinence and ano-rectal symptoms in women 1 . Reported rates of anal incontinence following primary repair of OASI range between 15-61%, with a mean of 39% 2, 3 . Other possible complications of OASI include perineal pain, dyspareunia, and less commonly, abscess formation, wound breakdown, and rectovaginal fistulae. Symptom onset may occur immediately, several years postpartum, or only late in life when aging of tissues adds to the delivery insult. Having sustained an OASI may impact significantly on women's physical and emotional health. Missed OASI, inadequate repair or lack of follow up are potential sources of litigation 4 . The reported incidence of OASI may be as high as 4-6.6% 4 , averaging 2.9% in the UK 3 . The incidence is higher in primiparae (6.1%) than in multiparae (1.7%) 3 . Recent years are seeing an increased awareness and structured training programs, which appear to have resulted in an increase in the detection rate of OASI 3 . The following risk factors have been identified with varying risk rates reported 3 : Asian ethnicity (OR 2.27, 95% CI 2.14-2.41), nulliparity (relative risk [RR] 6.97, 95% CI 5.40-8.99), birth weight greater than 4 kg (OR 2.27, 95% CI 2.18-2.36), shoulder dystocia (OR 1.90, 95% CI 1.72-2.08), occipito-posterior position (RR 2.44, 95% CI 2.07-2.89), prolonged second stage of labor (up to RR 2.02, 95% CI 1.62-2.51 after four hours duration). Instrumental deliveries and episiotomy use have been extensively studied resulting in the following evidence: Vacuum delivery without episiotomy (OR 1.89, 95% CI 1.74-2.05); vacuum delivery with episiotomy is protective (OR 0.57, 95% CI 0.51-0.63); forceps delivery without episiotomy carries the highest potential risk (OR 6.53, 95% CI 5.57-7.64); and forceps delivery with episiotomy (OR 1.34, 95% CI 1.21-1.49). Other potential risk factors have been suggested with varying evidence such as advanced maternal age at

  8. 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.

  9. The Danish anal sphincter rupture questionnaire: Validity and reliability

    DEFF Research Database (Denmark)

    Due, Ulla; Ottesen, Marianne

    2008-01-01

    Objective. To revise, validate and test for reliability an anal sphincter rupture questionnaire in relation to construct, content and face validity. Setting and background. Since 1996 women with anal sphincter rupture (ASR) at one of the public university hospitals in Copenhagen, Denmark have been...... among health care personnel, followed by an expert panel discussion. Ten women were interviewed about their understanding and attitude toward answering the questionnaire and it was pre-tested on 52 women with ASR. The questionnaire was revised five times during the validation process. The final version...... offered pelvic floor muscle examination and instruction by a specialist physiotherapist. In relation to that, a non-validated questionnaire about anal and urinary incontinence was to be answered six months after childbirth. Method. The original questionnaire was revised and a pilot test was performed...

  10. Pro-inflammatory cytokines in cryptoglandular anal fistulas.

    Science.gov (United States)

    van Onkelen, R S; Gosselink, M P; van Meurs, M; Melief, M J; Schouten, W R; Laman, J D

    2016-09-01

    Sphincter-preserving procedures for the treatment of transsphincteric fistulas fail in at least one out of every three patients. It has been suggested that failure is due to ongoing disease in the remaining fistula tract. Cytokines play an important role in inflammation. At present, biologicals targeting cytokines are available. Therefore, detection and identification of cytokines in anal fistulas might have implications for future treatment modalities. The objective of the present study was to assess local production of a selected panel of cytokines in anal fistulas, including pro-inflammatory interleukin (IL)-1β and tumor necrosis factor α (TNF-α). Fistula tract tissue was obtained from 27 patients with a transsphincteric fistula of cryptoglandular origin who underwent flap repair, ligation of the intersphincteric fistula tract or a combination of both procedures. Patients with a rectovaginal fistula or a fistula due to Crohn's disease were excluded. Frozen tissue samples were sectioned and stained using advanced immuno-enzyme staining methods for detection of selected cytokines, IL-1β, IL-8, IL-10, IL-12p40, IL-17A, IL-18, IL-36 and TNF-α. The presence and frequencies of cytokine-producing cells in samples were quantitated. The key finding was abundant expression of IL-1β in 93 % of the anal fistulas. Frequencies of IL-1β-producing cells were highest (>50 positive stained cells) in 7 % of the anal fistulas. Also, cytokines IL-8, IL-12p40 and TNF-α were present in respectively 70, 33 and 30 % of the anal fistulas. IL-1β is expressed in the large majority of cryptoglandular anal fistulas, as well as several other pro-inflammatory cytokines.

  11. Optimizacija procesa razvoja izdelkov z uporabo metode analize koristnosti

    OpenAIRE

    Majhen, Nejc

    2016-01-01

    Diplomsko delo obravnava razvoj novega izdelka od same ideje pa vse do končnega razvoja novega izdelka. Problemi v podjetjih se kažejo v premalem sodelovanju tehnične, kot tudi ekonomske stroke v podjetju pri razvijanju novih izdelkov. V ta namen sem v diplomi teoretično prikazal možnost sodelovanja področij analize koristnosti in projektnega managementa pri sami ocenitvi in izboru najboljše ideje s pomočjo Combinex metode in primerjavo izvedbe analize koristnosti po domači literaturi in meto...

  12. Steinert's syndrome presenting as anal incontinence: a case report

    Directory of Open Access Journals (Sweden)

    Uzum Ayse

    2011-08-01

    Full Text Available Abstract Introduction Myotonic dystrophy (MD or Steinert's syndrome is a rare cause of chronic diarrhea and anal incontinence. In the presence of chronic diarrhea and fecal incontinence with muscle weakness, neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis. Case Presentation We present the case of a 45-year-old Turkish man with Steinert's syndrome, who was not diagnosed until the age of 45. Conclusions In clinical practice, the persistence of diarrhea and fecal incontinence with muscle weakness should suggest that the physician perform an anal manometric study and electromyography. Neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis.

  13. Gastrointestinal stromal tumor of the anal canal: An unusual presentation

    Directory of Open Access Journals (Sweden)

    Chhanda Das

    2017-01-01

    Full Text Available Gastrointestinal stromal tumors (GISTs are the most common mesenchymal neoplasm of the gastrointestinal tract. The most common site is stomach, followed by small intestine, colon, and esophagus. However, GIST from the anal canal is an extremely rare tumor. Here, we report an extremely rare case of GIST of the anal canal in a 40-year-old female with a history of irregular bowel habits mixed with blood and constipation for 4 months. Diagnosis was made on the basis of histopathological and immunohistochemical examination.

  14. Comparison of anal sac cytological findings and behaviour in clinically normal dogs and those affected with anal sac disease.

    Science.gov (United States)

    James, Danielle J; Griffin, Craig E; Polissar, Nayak L; Neradilek, Moni B

    2011-02-01

    No previous study has explored the relationship between cytology and the frequency of behaviours associated with anal sac disease (ASD). The goals of the study were: (i) to compare the cytological findings between anal sac secretions from normal dogs with no history of ASD to those with non-neoplastic ASD; (ii) to determine whether anal sac cytological findings can be used to differentiate between normal dogs and dogs with ASD; (iii) to explore the correlation of anal sac cytology and behaviour between normal dogs and dogs with ASD; and (iv) to describe behaviours typical of ASD as reported by owners. Thirty dogs were selected for this study, based on their behavioural history as detailed in a questionnaire completed by their owners. Of the thirty dogs, ten were considered normal insofar as they had no history of ASD clinical signs. The remaining 20 dogs were characterized as having ASD, with a chronic history of perianal pruritus, but no other pruritus. All dogs had their anal sacs manually expressed, and the discharge was examined microscopically in a blinded manner. A total of 171 oil immersion fields (OIFs) were examined from normal dogs and 333 OIFs from dogs with ASD. The behavioural results for dogs with ASD revealed that scooting recurred with a median frequency of 3 weeks post-anal sac expression. There were no clinically statistically significant cytological differences between normal dogs and those with ASD, thereby leading to the conclusion that cytology is an ineffective tool for diagnosing ASD. © 2010 The Authors. Journal compilation © 2010 ESVD and ACVD.

  15. 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

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

    Index Scriptorium Estoniae

    Paas, Marge, 1976-

    2015-01-01

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

  17. Modifiable risk factors of obstetric anal sphincter injury in primiparous women

    DEFF Research Database (Denmark)

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

    2014-01-01

    To determine modifiable risk factors and incidence of obstetric anal sphincter injury (OASIS) in primiparous women.......To determine modifiable risk factors and incidence of obstetric anal sphincter injury (OASIS) in primiparous women....

  18. Presence of skin metastasis related to an epidermoid carcinoma of anal canal

    International Nuclear Information System (INIS)

    Danta Fundora, Debora; Collado Otero, Juan Carlos; Vazquez Gonzalez, Jose Manuel; Paredes Lopez, Dagmar

    2009-01-01

    Appearance of spreading skin metastases in colorectal cancer and of anal canal is infrequent. The aim of present paper was to show an interesting case of skin metastasis related to an advanced carcinoma of anal canal infiltrating rectum

  19. Familial Peters Plus syndrome with absent anal canal, sacral ...

    African Journals Online (AJOL)

    Here we report an 8 month old boy with typical features of Peters Plus syndrome including eye anomalies, dysmorphic features, global developmental delay, growth retardation, bilateral talipes equinovarus, complex renal anomalies, absent anal canal, sacral agenesis and sensorineural hearing loss. To our knowledge, the ...

  20. Rectocele and anal sphincter defect – surgical anatomy and ...

    African Journals Online (AJOL)

    carefully directed translabial ultrasound scan of the rectum and anal sphincters. The ultrasound examination was performed by a radi- ologist with specific understanding of the pathology. Conventional two-dimensional ultrasound imaging was performed using a 4 - 8. MHz curved array probe. The patient was in the left ...

  1. Anovestibular fistula with normal anal opening: Is it always congenital?

    Directory of Open Access Journals (Sweden)

    Jain Prashant

    2008-01-01

    Full Text Available Aim: To review 12 cases of anovestibular fistula with normal anal opening. Methods: Retrospective analysis of 12 children with anovestibular fistula and normal anal opening were treated between the years 2000 and 2007. Of these, 11 patients were diagnosed as having acquired anovestibular fistula with normal anal opening and were managed by conservative management. Results: Most of them presented with diarrhea and labial redness. One patient was considered to have fistula of congenital origin and was managed surgically. Eleven patients presented between the ages of 1.5-11 months and were considered as cases of acquired anovestibular fistula and only two of them required surgical management in the form of colostomy and fistula excision. Others were successfully managed by conservative treatment; the fistulous output and labial redness decreased gradually within a period of 5-19 (average 11.5 days. Conclusions: Not all presentations of anovestibular fistula with normal anal opening can be considered as congenital. Presence of inflammation, paramedian fistula, and a favourable response to conservative management/colostomy suggest acquired etiology. Trial of conservative management should be given in the acquired variety.

  2. Gastrointestinal stromal tumor of the anal wall in a Nigerian ...

    African Journals Online (AJOL)

    Documented reports of gastrointestinal stromal tumors (GIST) are relatively few in the sub-Saharan continent. The body of evidence points towards anal wall involvement being a rarity indeed. In this article we document a 61 year old Nigerian man who presented with bleeding per rectum and in whom the histological ...

  3. OEIS Complex (omphalocele-exstrophy of the bladder-anal ...

    African Journals Online (AJOL)

    We describe a Congolese case of OEIS complex: Omphalocele-Exstrophy of the Bladder-anal imperforation-spina bifida, rare congenital malformation complex. Its genetic and environmental factors are not well known. In our case, the fetus has been exposed to alcohol throughout the all pregnancy and the mother ...

  4. Anal incontinence - what the gynaecologist should know | Brouard ...

    African Journals Online (AJOL)

    ... for patients with AI will be performed by other members of the multidisciplinary healthcare team (e.g. colorectal surgeons, dieticians, occupational therapists, physiotherapists) we have an important role to play in identifying these patients and referring them appropriately. Keywords: Anal incontinence; Faecal incontinence; ...

  5. Primary radiation therapy in the treatment of anal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Cantril, S.T. (Children' s Hospital of San Francisco, CA); Green, J.P.; Schall, G.L.; Schaupp, W.C.

    1983-09-01

    From 1966 to 1981, 47 patients with a diagnosis of anal carcinoma were irradiated. This group was composed of 23 males and 24 females, with age ranging from 38 to 84 years (average 64.4 years). Five patients were treated preoperatively and 34 were treated definitively with cancericidal doses of irradiation. Acute radiation reactions requiring a rest-break were noted in 28% of patients, but all were managed as outpatients without untoward chronic sequelae. Chronic complications were noted in 13 patients, including two patients who required colostomy for severe anal stenosis and two who required A-P resection for large painful ulcers. Twenty-eight of 35 patients (80%) treated with irradiation alone have remained locally controlled without further treatment. An additional four have been salvaged by surgery. Only three patients had interstitial implants as part of their treatment course. Actuarial survival at five years for the N/sub 0/ patients and the group as a whole are 95.6 and 79.3%, respectively. It is concluded that external beam irradiation alone, properly fractionated to cancericidal doses, can control anal carcinoma with acceptable morbidity rates and without the use of either chemotherapy or interstitial implants in most cases. There is also a strong correlation suggesting that anal intercourse and male homosexuality play a significant role in the etiology of this disease.

  6. Primary radiation therapy in the treatment of anal carcinoma

    International Nuclear Information System (INIS)

    Cantril, S.T.; Green, J.P.; Schall, G.L.; Schaupp, W.C.

    1983-01-01

    From 1966 to 1981, 47 patients with a diagnosis of anal carcinoma were irradiated. This group was composed of 23 males and 24 females, with age ranging from 38 to 84 years (average 64.4 years). Five patients were treated preoperatively and 34 were treated definitively with cancericidal doses of irradiation. Acute radiation reactions requiring a rest-break were noted in 28% of patients, but all were managed as outpatients without untoward chronic sequelae. Chronic complications were noted in 13 patients, including two patients who required colostomy for severe anal stenosis and two who required A-P resection for large painful ulcers. Twenty-eight of 35 patients (80%) treated with irradiation alone have remained locally controlled without further treatment. An additional four have been salvaged by surgery. Only three patients had interstitial implants as part of their treatment course. Actuarial survival at five years for the N 0 patients and the group as a whole are 95.6 and 79.3%, respectively. It is concluded that external beam irradiation alone, properly fractionated to cancericidal doses, can control anal carcinoma with acceptable morbidity rates and without the use of either chemotherapy or interstitial implants in most cases. There is also a strong correlation suggesting that anal intercourse and male homosexuality play a significant role in the etiology of this disease

  7. The anal verge: localization with multi-slice spiral CT

    International Nuclear Information System (INIS)

    Wang Wei; Tang Guangjian

    2010-01-01

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

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

    NARCIS (Netherlands)

    Broens, PMA; Penninckx, FM

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

  9. adénocarcinome anal sur fistule anale: à propos de 3 cas en Côte d ...

    African Journals Online (AJOL)

    Diagnosis was confirmed by histologic examination of swab and / or biopsy specimens that revealed colloid adenocarcinoma that leads us to evocate that the lesion originates from anal gland. None patient underwent radiation therapy; one of them refused any treatment, the other two underwent abdominoperineal resection ...

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

    International Nuclear Information System (INIS)

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

    1992-01-01

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

  11. Clinicopathological aspects and prevalence of human papillomavirus in anal cancer

    Directory of Open Access Journals (Sweden)

    Marina Tayla Mesquita Aguiar

    2014-04-01

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

  12. Testing for and the role of anal and rectal sensation.

    Science.gov (United States)

    Rogers, J

    1992-03-01

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

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

    Directory of Open Access Journals (Sweden)

    A. M. Vieira

    2010-05-01

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

  14. The Danish anal sphincter rupture questionnaire: Validity and reliability

    DEFF Research Database (Denmark)

    Due, Ulla; Ottesen, Marianne

    2008-01-01

    Objective. To revise, validate and test for reliability an anal sphincter rupture questionnaire in relation to construct, content and face validity. Setting and background. Since 1996 women with anal sphincter rupture (ASR) at one of the public university hospitals in Copenhagen, Denmark have been...... among health care personnel, followed by an expert panel discussion. Ten women were interviewed about their understanding and attitude toward answering the questionnaire and it was pre-tested on 52 women with ASR. The questionnaire was revised five times during the validation process. The final version...... was test-retested among 20 women with ASR. Results. The questionnaire revealed typical problems after ASR. The length, use of language, and the way the questionnaire was constructed, was deemed appropriate. The reliability test showed good to very good correlation (Kappa values from 0.733 to 0.923) in all...

  15. Analýza Stirlingova oběhu

    OpenAIRE

    Hazda, Jakub

    2015-01-01

    Tato práce se zabývá termodynamickým oběhem Strilingova motoru. Je zde uplatněna analýza ideálního cyklu, Schmidtova analýza a metoda druhého řádu se ztrátovou korekcí v rámci softwaru PROSA 2.4. Získané výsledky jsou porovnány s experimentálně získanými daty dvou modelů motorů. This paper deals with the thermodynamic cycle of Striling engine. Analysis of the ideal cycle, Schmidt analysis and second-order method with loss correction by PROSA 2.4 software is applied. The results are compare...

  16. Anal metastasis from recurrent breast lobular carcinoma: A case report

    Science.gov (United States)

    Puglisi, Maria; Varaldo, Emanuela; Assalino, Michela; Ansaldo, Gianluca; Torre, Giancarlo; Borgonovo, Giacomo

    2009-01-01

    We report a case of isolated gastrointestinal metastasis from breast lobular carcinoma, which mimicked primary anal cancer. In July 2000, an 88-year-old woman presented with infiltrating lobular cancer (pT1/G2/N2). The patient received postoperative radiotherapy and hormonal therapy. Four years later, she presented with an anal polypoid lesion. The mass was removed for biopsy. Immunohistochemical staining suggested a breast origin. Radiotherapy was chosen for this patient, which resulted in complete regression of the lesion. The patient died 3 years after the first manifestation of gastrointestinal metastasis. According to the current literature, we consider the immunohistochemistry features that are essential to support the suspicion of gastrointestinal breast metastasis, and since we consider the gastrointestinal involvement as a sign of systemic disease, the therapy should be less aggressive and systemic. PMID:19294770

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

    Science.gov (United States)

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

    2017-01-01

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

  18. 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

  19. MRI in children following surgery for anal and rectal atresia

    International Nuclear Information System (INIS)

    Krahe, T.; Herold, A.; Doelken, W.; Hoecht, B.; Wuerzburg Univ.

    1989-01-01

    MRI of the pelvis was performed in 17 children following surgical correction of anal and rectal atresias and in five children without ano-rectal malformations. A muscle score was used to characterize the muscles of the pelvic floor and their relationship to the rectum. There was close agreement between the MRI muscle score and clinical continence. MRI provided additional information that should improve continence following conservative and surgical treatment. (orig.) [de

  20. The impact of anal sphincter injury on perceived body image.

    Science.gov (United States)

    Iles, David; Khan, Rabia; Naidoo, Kristina; Kearney, Rohna; Myers, Jenny; Reid, Fiona

    2017-05-01

    Obstetric anal sphincter injury is common but the effect on body image is unreported. The aim of this study was to explore patient perceived changes in body image and other psychological aspects in women attending a perineal follow-up clinic. This retrospective study analysed women's responses to a self-reported questionnaire. Consecutive women with anal sphincter injury who attended a United Kingdom Maternity Hospital perineal follow-up clinic between January 1999 and January 2012 were identified and the records obtained and reviewed. Multivariate regression analyses were performed to examine variables influencing self-reported change in body image. Questionnaires and operation notes were analysed from 422 women who attended at a median of four months after delivery. 222 (53%) reported a change in body image with 80 (19%) reporting lower self-esteem and 75 (18%) a change in their personality due to the change in body image. 248 (59%) perceived an anatomical change due to the delivery. Factors associated with increased likelihood of reporting a change in body image were reporting a perceived change in anatomy due to the delivery, adjusted OR 6.11 (3.56-10.49), anal incontinence, OR 1.97 (1.16-3.36), and delivery by forceps, OR 2.59 (1.23-5.43). This is the first study to quantify body image changes in women after anal sphincter injury sustained in childbirth. These were found to be very common, affecting up to 50% of women. The study has several limitations but it does highlight the significant psychosocial problems of negative self-esteem and personality changes associated with a perceived change in body image that has not previously been reported. It also outlines the further research questions that need to be addressed. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Endosonographic appearance of the anal sphincters in patients following colostomy

    International Nuclear Information System (INIS)

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

    2002-01-01

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

  2. Pelvic floor ultrasound and anal incontinence in primiparous women

    DEFF Research Database (Denmark)

    Sakse, Abelone Elisabeth

    2010-01-01

    Afhandlingen havde til formål at undersøge muskulære forandringer på bækkenbundsmuskulaturen i relation til første fødsel, med særligt fokus på anal inkontinens. Forsvaret fandt sted d. 10. september 2010 kl. 14:00 i Auditoriet på Hvidovre Hospital.   ...

  3. The clinical characteristics of patients with chronic idiopathic anal pain

    Directory of Open Access Journals (Sweden)

    Mao Weiming

    2017-05-01

    Full Text Available The aim of this study was to investigate the clinical characteristics, treatment outcomes and psychological distress in patients with chronic idiopathic anal pain. The study was conducted on patients referred to Hangzhou Third Hospital for chronic anal pain from January, 2010 to December, 2014. Patient demographics, clinical history, anorectal physiology, and radiological imaging data were recorded for all patients. The treatment outcome was noted for patients treated and followed up for more than 6 month at the present unit. Ninety-six patients with mean age of 45.1 years (range, 17-82 were studied. Seventy-one patients (74.0% had functional anorectal pain(FARP. The main complaints were dull, sharp, stabbing, or spasm pain. Among all patients, 34.3% reported that their pain radiated into other locations. Fifty-one patients (53.1% had bowel dysfunction, while 28.1% patients had urinary dysfunction. The common factors associated with pain relief were day time, lying down and warm water baths; the factors that contributed to aggravated pain were night time, defecation or sitting. 92.7% (89/96 of patients reported symptoms of psychological disturbance. FARP patients exhibited increased depression than non-FARP patients(P<0.05. In addition, female patients were more likely to have depression than male patients (P<0.05. The overall pain treatment success rate was 55.2% (53/96. The pain treatment outcome was better in non-FARP patients than in FARP patients(χ2=3.85, P<0.05. Conclusively, chronic idiopathic anal pain is a complex clinical symptom, involving pelvic floor muscles, the nervous system, endocrine system, and the patients’ psychological conditions. Further research is needed to improve diagnosis and treatment for patients with chronic idiopathic anal pain.

  4. coloproctectomie avec anastomose colo-sus-anale pour tumeur ...

    African Journals Online (AJOL)

    Une coloproctectomie fut réalisée le 30/06/2014 avec anastomose colo-anale, colostomie de protection sous-couvert d'une transfusion sanguine. L'examen histologique du segment colorectal prélevé objectiva une rectocolite granulomateuse autour de nombreux oeufs de schistosomes. En effet, le patient a vécu à Pahou, ...

  5. Radiotherapy for carcinomas of the anal canal Tenon hospital experience

    International Nuclear Information System (INIS)

    Touboul, E.; Moureau-Zabotto, L.; Lerouge, D.; Pene, F.; Deniaud-Alexandre, E.; Schlienger, M.; Laugier, A.; Tiret, E.; Parc, R.; Sezeur, A.; Houry, S.; Gallot, D.

    2003-01-01

    Since 1980, curative-intent radiation therapy of epidermoid carcinoma of the anal canal is the standard first line treatment. The combined concomitant chemotherapy and radiation therapy is presently established for locally advanced tumors more than 4 cm in length and/or with nodal involvement. We report the Tenon hospital experience since 1972 concerning the long term results after radiation therapy, the modifications of the radiation technique, and the evolution of treatment strategy. (author)

  6. Risk factors for anal high-grade squamous intraepithelial lesions in HIV-positive MSM: is targeted screening possible?

    NARCIS (Netherlands)

    Siegenbeek van Heukelom, Matthijs L.; Marra, Elske; de Vries, Henry J. C.; Schim van der Loeff, Maarten F.; Prins, Jan M.

    2017-01-01

    HIV-positive MSM are at increased risk for developing anal squamous cell carcinoma. Detection of precursor lesions of anal cancer [anal high-grade squamous intraepithelial lesions (HSIL)] is cumbersome and expensive. Our objective was to identify potential risk factors for anal HSIL in HIV-positive

  7. Internal anal sphincter atrophy in patients with systemic sclerosis.

    Science.gov (United States)

    Thoua, Nora M; Schizas, Alexis; Forbes, Alastair; Denton, Christopher P; Emmanuel, Anton V

    2011-09-01

    SSc is a connective tissue, multisystem disorder of unknown aetiology. The gastrointestinal tract (GIT) is affected in up to 90% of patients. The exact pathophysiology of GIT involvement is not known, but it is related to both neurogenic and myogenic abnormalities as well as possible vascular and ischaemic changes. Thinning of the internal anal sphincter (IAS) has been demonstrated in SSc with faecal incontinence. We aimed to investigate anal sphincter structure in patients with SSc. Forty-four SSc patients [24 symptomatic (Sx) and 20 asymptomatic (ASx)] and 20 incontinent controls (ICs) were studied. Patients underwent anorectal manometry and endoanal US. In the ICs, external anal sphincter defects were more common, but the IAS was less atrophic, evident by both atrophy scores and IAS thickness. There was no significant difference in atrophy scores [Sx: 2 (1.5-3) vs ASx: 2 (1-2)] or IAS thickness [Sx: 1.85 (1.5-2.3) vs ASx: 1.8 (1.7-2.25)] between the Sx and ASx SSc patients. Patients with SSc (both Sx and ASx) have thin and atrophic IAS, suggesting that IAS atrophy develops even in ASx patients and this may be amenable to treatment with sacral neuromodulation.

  8. Thermal responses of shape memory alloy artificial anal sphincters

    Science.gov (United States)

    Luo, Yun; Takagi, Toshiyuki; Matsuzawa, Kenichi

    2003-08-01

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

  9. Anal sphincter electromyography in patients with Anorectal Dysfunctions

    International Nuclear Information System (INIS)

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

    2009-01-01

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

  10. Fractal dimension and image statistics of anal intraepithelial neoplasia

    Energy Technology Data Exchange (ETDEWEB)

    Ahammer, H., E-mail: helmut.ahammer@medunigraz.a [Institute of Biophysics, Center of Physiological Medicine, Medical University of Graz, Harrachgasse 21, A-8010 Graz (Austria); Kroepfl, J.M. [Human Performance Research Graz (HPR Graz), Karl-Franzens and Medical University of Graz, Max-Mell Allee 11, A-8010 Graz (Austria); Hackl, Ch. [Research Group of Applied Theoretical Pathology, Department of Pathology, Country Medical Centre St.Poelten, Propst Fuehrer Strasse 4, A-3100 St.Poelten (Austria); Sedivy, R. [Research Group of Applied Theoretical Pathology, Department of Pathology, Country Medical Centre St.Poelten, Propst Fuehrer Strasse 4, A-3100 St.Poelten (Austria); Department of Pathology, Country Medical Centre St.Poelten, Propst Fuehrer Strasse 4, A-3100 St.Poelten (Austria)

    2011-01-15

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

  11. Comparison of an anal fistula plug and mucosa advancement flap for complex anal fistulas: a meta-analysis.

    Science.gov (United States)

    Xu, Yansong; Tang, Weizhong

    2016-12-01

    The aim of this analysis was to compare the advantages of the anal fistula plug (AFP) with the mucosa advancement flap (MAF) for complex anal fistulas. Comparative studies of the efficacy of AFP and MAF were included. Two independent reviewers selected articles for inclusion. After information collection, a meta-analysis was performed using data on overall healing rates, complications, incontinences and recurrences. The quality of postoperative life and cost were also included with the clinical results. Ten studies included 778 patients who were divided into AFP and MAF groups in this meta-analysis. During the follow-up period, no significant difference in healing rates, complications and recurrences were found (P = 0.55, P = 0.78 and P = 0.23, respectively). The incontinence rate of AFP was lower than that of MAF (P = 0.04). The postoperative quality of life of AFP patients was superior to that of MAF patients. The AFP patients had less persistent pain of a shorter duration and shortened healing time and hospital stay. The treatment cost of AFP patient was lower than that of MAF. Compared to the MAF procedure, the AFP procedure has some advantages for complex anal fistulas, but more and large randomized clinical trials comparing the two procedures for fistula management need to be conducted. © 2016 Royal Australasian College of Surgeons.

  12. Anal metastasis of rectal cancer-adenocarcinoma of squamous cells: a case report and literature review.

    Science.gov (United States)

    Sasaki, Shun; Sugiyama, Masahiko; Nakaji, Yu; Nakanishi, Ryota; Nakashima, Yuichiro; Saeki, Hiroshi; Oki, Eiji; Oda, Yoshinao; Maehara, Yoshihiko

    2017-12-01

    Anal metastasis of colorectal cancer is very rare and is usually associated with a history of anal disease, including anal fistula, fissure, hemorrhoidectomy, and anastomotic injury. We report a case of rectal cancer with a synchronous anal metastasis consisting of adenocarcinoma of squamous cells without a history of anal disease. A 60-year-old woman had a chief complaint of melena. She had a 1.5-cm anal tumor on the perianal skin, and a Bollman type 2 rectal tumor on the Ra portion was found on colonoscopy. Biopsy of both tumors revealed a similar histology of well- to moderately differentiated adenocarcinoma. There was no sign of metastases in lymph nodes or other organs. For the purpose of diagnosis and treatment, transperineal local resection of the anal tumor was performed, and it was histologically identified as adenocarcinoma of squamous cells with no invasion to muscles, lymph ducts, or microvessels. The pathological margin was free. Then, to achieve radical cure, laparoscopic low anterior resection (LAR) with D3 lymphadenectomy was performed. The histological diagnosis of the anal tumor was adenocarcinoma of squamous cells without invasion to muscles, lymph ducts, or vessels. The surgical margin was completely free. Immunohistochemical analysis of both tumors revealed similar staining patterns, and the final diagnosis was rectal cancer with metastasis to the anal skin. The patient received no postoperative therapy, and no recurrences have been observed 12 months after surgery. We expect that our sphincter-preserving surgical strategy provided a good prognosis for the synchronous rectal cancer and anal metastasis. This is a rare report of a case with an anal metastasis of colorectal cancer on perianal squamous cells without a history of anal disease that was resected while preserving anal function.

  13. Äriühingu juhtorgani liikme hoolsuskohustus / Tuuve Tiivel

    Index Scriptorium Estoniae

    Tiivel, Tuuve, 1977-

    2005-01-01

    Juhtorgani liikmete hoolsuskohustusest selgitamaks välja selle rikkumise tunnused, mille alusel võib nõuda juhtorgani liikme isikliku tsiviilvastutuse kohaldamist, ning anda hinnang Eesti selle valdkonna kehtivale õiguslikule regulatsioonile võrdleva analüüsi teel teiste riikide õigusega

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

    Directory of Open Access Journals (Sweden)

    Newton Sérgio de Carvalho

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

  15. Evidence for the secondary sexual development of the anal fin in female kokanee salmon Oncorhynchus nerka.

    Science.gov (United States)

    Thorn, M W; Morbey, Y E

    2016-02-01

    This study examines whether the anal fin undergoes secondary sexual development similar to other reproductive traits in salmonids. This hypothesis was tested by comparing the anal-fin size of female kokanee salmon Oncorhynchus nerka that were in the early and late stages of sexual development. Females in an advanced stage of maturation had significantly larger anal fins relative to females in an early state of maturation (+4-7%), indicating that the anal fin undergoes secondary sexual development. The magnitude of this secondary growth was comparable with snout length (+9-10%), which is known to undergo secondary sexual development in female salmonids. When morphological trait dimensions were compared between the sexes, the anal fin was the only morphological trait found to have a female-biased sexual size dimorphism. This is the first study to show that the anal fin of female salmonids undergoes secondary sexual development. © 2015 The Fisheries Society of the British Isles.

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

    Directory of Open Access Journals (Sweden)

    Bikash Medhi

    2008-07-01

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

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

    OpenAIRE

    Barcellos, Lêda Pereira de; Russomano, Fábio; Coutinho, José Ricardo Hildebrandt

    2014-01-01

    OBJECTIVES: To verify the value of conventional cytology for the diagnosis of macroscopic lesions of the anal canal and to describe the limitations of the samples.METHOD: We evaluated 395 conventional cytology samples obtained by brushing the anal canal of patients (predominantly male, HIV-positive) and compared them to the presence of macroscopic lesions of the anal canal observed under anorectal examination.RESULTS: Of the total, 91.6% of samples were classified as adequate. Cellular elemen...

  18. Functional Morphology of Anal Sphincter Complex Unveiled by High Definition Manometery & 3-Dimensional Ultrasound Imaging

    Science.gov (United States)

    Raizada, Varuna; Bhargava, Valmik; Karsten, Anna; Mittal, Ravinder K.

    2011-01-01

    Objective Anal sphincter complex consists of anatomically overlapping internal anal sphincter (IAS), external anal sphincter (EAS) & puborectalis muscle (PRM). We determined the functional morphology of anal sphincter muscles using high definition manometery (HDAM), 3D-ultrasound (US) and Magnetic resonance (MR) imaging. Patients We studied 15 nulliparous women. Interventions HDAM probe equipped with 256 pressure transducers was used to measure the anal canal pressures at rest and squeeze. Lengths of IAS, PRM and EAS were determined from the 3D-US images and superimposed on the HDAM plots. Movements of anorectal angle with squeeze were determined from the dynamic MR images. Results HDAM plots reveal that anal canal pressures are highly asymmetric in the axial and circumferential direction. Anal canal length determined by the 3D-US images is slightly smaller than measured by HDAM. The EAS (1.9 ± 0.5 cm long) and PRM (1.7 ± 0.4 cm long) surround distal and proximal parts of the anal canal respectively. With voluntary contraction, anal canal pressures increase in the proximal (PRM) and distal (EAS zone) parts of anal canal. Posterior peak pressure in the anal canal moves cranially in relationship to the anterior peak pressure, with squeeze. Similar to the movement of peak posterior pressure, MR images show cranial movement of anorectal angle with squeeze. Conclusion Our study proves that the PRM is responsible for the closure of the cranial part of anal canal. HDAM, in addition to measuring constrictor function can also record the elevator function of levator ani/pelvic floor muscles. PMID:21951657

  19. Recurrent anal fistulae: limited surgery supported by stem cells.

    Science.gov (United States)

    Garcia-Olmo, Damian; Guadalajara, Hector; Rubio-Perez, Ines; Herreros, Maria Dolores; de-la-Quintana, Paloma; Garcia-Arranz, Mariano

    2015-03-21

    To study the results of stem-cell therapy under a Compassionate-use Program for patients with recurrent anal fistulae. Under controlled circumstances, and approved by European and Spanish laws, a Compassionate-use Program allows the use of stem-cell therapy for patients with very complex anal fistulae. Candidates had previously undergone multiple surgical interventions that had failed to resolve the fistulae, and presented symptomatic recurrence. The intervention consisted of limited surgery (with closure of the internal opening), followed by local implant of stem cells in the fistula-tract wall. Autologous expanded adipose-derived stem cells were the main cell type selected for implant. The first evaluation was performed on the 8(th) postoperative week; outcome was classified as response or partial response. Evaluation one year after the intervention confirmed if complete healing of the fistula was achieved. Ten patients (8 male) with highly recurrent and complex fistulae were treated (mean age: 49 years, range: 28-76 years). Seven cases were non-Crohn's fistulae, and three were Crohn's-associated fistulae. Previous surgical attempts ranged from 3 to 12. Two patients presented with preoperative incontinence (Wexner scores of 12 and 13 points). After the intervention, six patients showed clinical response on the 8(th) postoperative week, with a complete cessation of suppuration from the fistula. Three patients presented a partial response, with an evident decrease in suppuration. A year later, six patients (60%) remained healed, with complete reepithelization of the external opening. Postoperative Wexner Scores were 0 in six cases. The two patients with previous incontinence improved their scores from 12 to 8 points and from 13 to 5 points. No adverse reactions or complications related to stem-cell therapy were reported during the study period. Stem cells are safe and useful for treating anal fistulae. Healing can be achieved in severe cases, sparing fecal

  20. Histopathologic observations of anorectal abnormalities in anal atresia.

    Science.gov (United States)

    Meier-Ruge, W A; Holschneider, A M

    2000-01-01

    Over the years from 1992 to 1997, 41 anorectal malformations (ARM) with histopathologic alterations were investigated to determine which morphologic abnormalities of the distal rectum accompany ARMs. Three other cases showed normal neuromuscular morphology; 9 further cases could not be evaluated owing to scanty biopsies. All resected specimens were caudocranially coiled and cryostat cut at -20 degrees C into serial sections, which were stained with a lactic dehydrogenase, succinic dehydrogenase, nitroxide synthase, and acetylcholinesterase reaction as well as hemalum and sirius red. Ten low, 15 intermediate, and 10 high forms of anal atresia (AA) were studied. In addition, six cloacal abnormalities were investigated. In 7 cases (17%) (5 intermediate, 2 low AAs), the characteristics of Hirschsprung's disease were observed. Oligoneuronal hypoganglionosis of the myenteric plexus proximal to the anal floor was diagnosed in 7 AAs (12%). In 10 children with high-type AA and resection of 1-5 cm distal rectum and in all cloacal anomalies (n = 6) defects of the muscularis propria were seen in the rectal-atresia sac. These defects were characterized by hypoplasia of the circular-muscle layer and/or the internal anal sphincter (IAS). Intestinal neuronal dysplasia of the submucous plexus was most frequently observed (12%) in high-type AA. A correlation between innervation anomalies or anomalies of the muscularis propria and the type of fistula could not be seen. In conclusion, all cases with high-type AA and cloacal anomalies were characterized by anomalies of the muscularis propria and/or IAS but this was not the case in intermediate and low-type AAs. Anomalies of the enteric nervous system were diagnosed in 60% of AAs.

  1. The Danish anal sphincter rupture questionnaire: Validity and reliability

    DEFF Research Database (Denmark)

    Due, Ulla; Ottesen, Marianne

    2008-01-01

    offered pelvic floor muscle examination and instruction by a specialist physiotherapist. In relation to that, a non-validated questionnaire about anal and urinary incontinence was to be answered six months after childbirth. Method. The original questionnaire was revised and a pilot test was performed...... main questions but one. Two questions needed further explanation. Seven women made minor errors. Conclusion. The validated Danish questionnaire has a good construct, content and face validity. It is a well accepted, reliable, simple and clinically relevant screening tool. It reveals physical problems...

  2. Time-dose considerations in the treatment of anal cancer

    International Nuclear Information System (INIS)

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

    1997-01-01

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

  3. Chronic anal fissure: common aetiopathogenesis, with special attention to sexual abuse.

    Science.gov (United States)

    Nzimbala, M J; Bruyninx, L; Pans, A; Martin, P; Herman, F

    2009-01-01

    Chronic anal fissures represent 15% of proctologic consultations, although their aetiopathogenesis is unclear and multifactorial. This study aims to identify the aetiopathogenesis, risk factor of recurrence after lateral subcutaneous internal anal sphincterotomy and existing correlation with sexual abuse, as sexual abuse accounts for over 21% of anal fissures. We retrospectively studied 80 cases of surgical (n = 54) and medical (n = 26) patients known with chronic anal fissure over eight months. We built an original questionnaire referring to the NorVold Abuse Questionnaire. Sixty cases were interviewed with only twenty filling the questionnaire themselves. Among the aetiological factors observed, as reported by these patients, we underlined chronic constipation 51 (64%), postoperative haemorrhoidectomy 15 (19%), sexual abuse 15 (19%), vaginal delivery and hysterectomy 10 (13%), traumatic anal sex 10 (13%), digital anal examination 4 (5%), anti-inflammatory non-steroid suppository 3 (4%), asthma with chronic cough 3 (4%). The recurrence rate reached 39% (31 cases, 13/26 (50%) in the medical group, against 18/54 (33%) in the surgical group. The 4/15 (27%) of sexual abuse happened in adulthood and 6/15 (40%) never disclosed this information. Sexual abuse is a significant aetiological factor of chronic anal fissures and it is to be suspected in cases of recurrence after anal sphincterotomy. For such cases, a multidisciplinary treatment is crucial to improve the prognosis of the disease. We recognise that the causality is difficult to prove and we cannot confirm that every sexually abused person could inevitably develop chronic anal fissure.

  4. Direct appositional (no flap) closure of deep anal fistula.

    Science.gov (United States)

    Thomson, W H F; Fowler, A L

    2004-01-01

    After sphincter-sparing core fistulectomy for deep anal fistula most surgeons advance a rectal mucosal flap to reinforce closure of the internal opening. Our own method having for many years been simple appositional closure the resulting series presented an opportunity for comparison. From November 1987 to January 2001, 44 patients underwent 46 core fistulectomies with flap-less direct appositional closure in our unit. Records were kept prospectively. Twenty-six fistulae (in 28 patients) appeared healed at two to five months follow-up and the patients had been discharged. A full review was mounted in May 2001, when 16 of the healed patients could be contacted and questionnaires completed. Two patients were excluded from the study. The procedure failed in 16 patients initially and was found to have done so in two more at long-term follow-up (41% overall). Three patients had died and five could not be traced. Simple appositional closure after core fistulectomy for deep anal fistula seems inferior to methods using flap reinforcement.

  5. Intensity-modulated radiation therapy for anal carcinoma

    International Nuclear Information System (INIS)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Alice Capobiango

    2009-12-01

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

  7. A novel four quadrant laser sphincterotomy for idiopathic severe anal stenosis

    Directory of Open Access Journals (Sweden)

    Ashwin Porwal

    2018-01-01

    Full Text Available Anal stricture or stenosis, though uncommon, is disabling condition. It affects the quality of life due to pain, bleeding and difficulty in defecation, incontinence or increased frequency. It occurs when the normally pliable anoderm is replaced with fibrotic connective tissue, leading to an abnormally tight and inelastic anal canal. Mostly it occurs secondary to trauma, iatrogeny, inflammatory diseases, radiation or neoplasia. The treatment of anal stricture is generally considered to be difficult and various methods of treatment have been suggested. It is often unresponsive to conservative medical management. The surgical procedures such as dilatations and anoplasty are associated with significant complications which make it a difficult treatment challenge. Several good treatment options are available currently. Through this case, we report and explore a new medical treatment for anal strictures with four quadrant laser sphincterotomy. Resumo: A estritura ou estenose anal, embora incomum, é problema incapacitante. Essa condição afeta a qualidade de vida por causa da dor, do sangramento e da dificuldade de defecação, de incontinência ou aumento da frequência. A estenose anal ocorre quando o anoderma, normalmente flexível, foi substituído por tecido conjuntivo fibrótico, e o resultado é um canal anal anormalmente estenosado e inelástico. Na maioria dos casos, a estenose anal ocorre secundariamente a trauma, por causa iatrogênica, por doença inflamatória, radiação ou neoplasia. Em geral, se considera que o tratamento dessa condição é tarefa difícil, tendo sido sugeridos diversos métodos de tratamento. Com frequência a estenose anal não responde ao tratamento clínico conservador. Procedimentos cirúrgicos como as dilatações ou a anoplastia estão associados a complicações significativas, implicando difícil desafio terapêutico. Atualmente, o cirurgião conta com várias opções terapêuticas satisfatórias. No

  8. Contribuciones a la automatización de diseños analógicos

    OpenAIRE

    Chávez Orzaez, Jorge Jesús

    1996-01-01

    La automatización del diseño analógico ha experimentado en los últimos años, un notable avance. La popularidad alcanzada por los circuitos ASICs, y la constatación de que la mayor parte de ellos contiene una importante circuitería analógica, son las causa

  9. [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.

  10. Iodamoeba butschlii in an anal pap test confirmed by iodine stain.

    Science.gov (United States)

    Schuetz, Audrey N; Pritt, Bobbi S; Schreiner, Andrew M

    2014-09-01

    We report the finding of Iodamoeba butschlii amebic cysts on a liquid-based anal Pap smear from an HIV-positive male. Iodine staining of the smear confirmed the diagnosis. It is important to distinguish I. butschlii from pathogenic ameobae and other organisms seen on anal Pap smears. Copyright © 2013 Wiley Periodicals, Inc.

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

    Science.gov (United States)

    Adams, Jeffery; Neville, Stephen

    2012-01-01

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

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

    Science.gov (United States)

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

    2018-02-01

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

  13. 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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-09-30

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

  16. Relationship between external anal sphincter atrophy at endoanal magnetic resonance imaging and clinical, functional, and anatomic characteristics in patients with fecal incontinence

    NARCIS (Netherlands)

    Terra, Maaike P.; Deutekom, Marije; Beets-Tan, Regina G. H.; Engel, Alexander F.; Janssen, Lucas W. M.; Boeckxstaens, Guy E. E.; Dobben, Annette C.; Baeten, Cor G. M. I.; de Priester, Jacobus A.; Bossuyt, Patrick M. M.; Stoker, Jaap

    2006-01-01

    PURPOSE: External anal sphincter atrophy at endoanal magnetic resonance imaging has been associated with poor outcome of anal sphincter repair. We studied the relationship between external anal sphincter atrophy on endoanal magnetic resonance imaging and clinical, functional, and anatomic

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-11-15

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

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

    International Nuclear Information System (INIS)

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

    2017-01-01

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

  19. Cianeto em tiquiras: riscos e metodologia analítica

    OpenAIRE

    Furtado,Jomar Livramento Barros; Bezerra,Cícero Wellington Brito; Marques,Edmar Pereira; Marques,Aldalea Lopes Brandes

    2007-01-01

    Tiquira é o destilado alcoólico obtido a partir da sacarificação e fermentação da mandioca, e além de íons cianeto, contém na sua composição as demais espécies potencialmente tóxicas presentes nas aguardentes, tais como: carbamatos, metanol e alguns íons de metais. Neste trabalho, uma metodologia analítica para a determinação de cianeto em amostras de tiquira é proposta, empregando voltametria no modo pulso diferencial, após destilação da amostra em presença de ácido nítrico 0,1 mol.L-1. A me...

  20. Biomarkers in anal cancer: from biological understanding to stratified treatment.

    Science.gov (United States)

    Jones, Christopher M; Goh, Vicky; Sebag-Montefiore, David; Gilbert, Duncan C

    2017-01-17

    Squamous cell carcinomas of the anus and anal canal represent a model of a cancer and perhaps the first where level 1 evidence supported primary chemoradiotherapy (CRT) in treating locoregional disease with curative intent. The majority of tumours are associated with infection with oncogenic subtypes of human papilloma virus and this plays a significant role in their sensitivity to treatment. However, not all tumours are cured with CRT and there remain opportunities to improve outcomes in terms of oncological control and also reducing late toxicities. Understanding the biology of ASCC promises to allow a more personalised approach to treatment, with the development and validation of a range of biomarkers and associated techniques that are the focus of this review.

  1. Anal channel neoplasm: a neoplasm radio chemo curable

    International Nuclear Information System (INIS)

    Torres Lopez, M.; Avondet, I.; Vazquez, J.; Santini Blasco, A.

    1997-01-01

    Presently work is made an exhaustive revision of the anatomy of the region, the history of the treatments and of the current treatments of channel cancer anal. It makes emphasis in the importance of the conservative treatment with radiochemotherapy (RQT). The present is a prospective study,longitudinal and descriptive. Material and method: between January of 1989 and December of 1994 20 patients attended with cancer of anal channel with an illness metastasis. An average age it was of 62.4 years.The sex, 16 men and 4 women. The performance status 0,1 or 2 of the scale of the ECOQ. In the pathological anatomy: 15 patient epidermic neoplasm, 5 patient basal neoplasm. State I: 2 patients, II: 12 patients, III: 6 patients, IV: 0 patients.Treatment: the radiotherapy one carries out with cobalt 60 and it irradiates the primary tumour and the ganglion structures region, pelvic and inguinal. It surrendered to Gy/dia from Monday to Friday up to 50 Gy. The chemotherapy one carries out with mitomicine C 10 mg/ previous day to the radiotherapy and 5-UGH 1 intravenous g/my in infusion the days from 1 to 4 and from 29 to 32 after the radiotherapy.Results: to) control locorregional patient RC-16 (80%) ,RP 2 patients (10%) , without answer or with progression lesional a patient (5%) .b) State vital: living 15 patients, died 5 patients(continuation 12 to 60 months) .e)Tolerance: there were not deaths for the gastrointestinal treatment and haematological with toxicity moderate.To conclude:1) The radiochemotherapy is the treatment of elect.2)A feasible treatment of being carried out in our environment.3)Required of a good relationship predictable interdisciplinary.4)Toxicity and tolerable.5)Results of conservation of the sphincter in 80%(AU) [es

  2. Obstetric anal sphincter injury: incidence, risk factors, and management.

    Science.gov (United States)

    Dudding, Thomas C; Vaizey, Carolynne J; Kamm, Michael A

    2008-02-01

    Obstetric sphincter damage is the most common cause of fecal incontinence in women. This review aimed to survey the literature, and reach a consensus, on its incidence, risk factors, and management. This systematic review identified relevant studies from the following sources: Medline, Cochrane database, cross referencing from identified articles, conference abstracts and proceedings, and guidelines published by the National Institute of Clinical Excellence (United Kingdom), Royal College of Obstetricians and Gynaecologists (United Kingdom), and American College of Obstetricians and Gynecologists. A total of 451 articles and abstracts were reviewed. There was a wide variation in the reported incidence of anal sphincter muscle injury from childbirth, with the true incidence likely to be approximately 11% of postpartum women. Risk factors for injury included instrumental delivery, prolonged second stage of labor, birth weight greater than 4 kg, fetal occipitoposterior presentation, and episiotomy. First vaginal delivery, induction of labor, epidural anesthesia, early pushing, and active restraint of the fetal head during delivery may be associated with an increased risk of sphincter trauma. The majority of sphincter tears can be identified clinically by a suitably trained clinician. In those with recognized tears at the time of delivery repair should be performed using long-term absorbable sutures. Patients presenting later with fecal incontinence may be managed successfully using antidiarrheal drugs and biofeedback. In those who fail conservative treatment, and who have a substantial sphincter disruption, elective repair may be attempted. The results of primary and elective repair may deteriorate with time. Sacral nerve stimulation may be an appropriate alternative treatment modality. Obstetric anal sphincter damage, and related fecal incontinence, are common. Risk factors for such trauma are well recognized, and should allow for reduction of injury by proactive

  3. Per-anal excision of large, rectal, villous adenomas.

    Science.gov (United States)

    Featherstone, J M; Grabham, J A; Fozard, J B

    2004-01-01

    Considering the malignant potential of villous adenoma of the rectum, complete resection at the first intervention is desirable and yet many series suggest that a high recurrence rate must be expected. The experience of one colorectal surgeon in the management of this condition is described. Between 1993 and 2000, 50 patients underwent per-anal resection of villous adenoma. The procedure was conducted in the prone jackknife position unless contraindicated, with dissection performed using a diathermy blade, with particular attention to circumferential and deep margins of excision. The mean distance of the proximal margin of the tumor from the dentate line was 5.6 (range, 0.5-11) cm. The mean length of the tumor was 5.2 (range, 0.5-9) cm. Mean anesthetic time was 27 (range, 10-110) minutes, and median hospital stay was two (range, 1-14) days. There was no significant perioperative morbidity and no mortality. On histology of ten patients, there were foci of adenocarcinoma. Excision was complete histologically in 49 patients. The median follow-up was 30 (range, 6-91) months. The patient with incomplete excision developed a probable recurrence after six months, which was ablated with diathermy (residual tumor rate, 2.1 percent). Two patients have subsequently developed villous adenoma at different sites within the rectum (metachronous tumor rate, 4.3 percent). Many series of this procedure report recurrence in up to 36 percent and significant complication in up to 19 percent of patients. Transanal endoscopic microsurgery has achieved recurrence rates of 2.8 percent and low complication rates but for economic reasons has failed to find a widespread role. This article demonstrates that large, villous tumors of the low and mid rectum can be simply and effectively treated by per-anal resection with recurrence rates equivalent to transanal endoscopic microsurgery.

  4. Dose-time considerations in the treatment of anal cancer

    International Nuclear Information System (INIS)

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

    1996-01-01

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

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

    Science.gov (United States)

    Ros, C; Martínez-Franco, E; Wozniak, M M; Cassado, J; Santoro, G A; Elías, N; López, M; Palacio, M; Wieczorek, A P; Espuña-Pons, M

    2017-04-01

    To compare the sensitivity and specificity of two- (2D) and three- (3D) dimensional transperineal ultrasound (TPUS) and 3D endovaginal ultrasound (EVUS) with the gold standard 3D endoanal ultrasound (EAUS) in detecting residual defects after primary repair of obstetric anal sphincter injuries (OASIS). External (EAS) and internal (IAS) anal sphincters were evaluated by the four ultrasound modalities in women with repaired OASIS. 2D-TPUS was evaluated in real-time, whereas 3D-TPUS, 3D-EVUS and 3D-EAUS volumes were evaluated offline by six blinded readers. The presence/absence of any tear in EAS or IAS was recorded and defects were scored according to the Starck system. Sensitivity, specificity and predictive values were calculated, using 3D-EAUS as reference standard. Inter- and intraobserver analyses were performed for all 3D imaging modalities. Association between patients' symptoms (Wexner score) and ultrasound findings (Starck score) was calculated. Images from 55 patients were analyzed. Compared with findings on 3D-EAUS, the agreement for EAS evaluation was poor for 3D-EVUS (κ = 0.01), fair for 2D-TPUS (κ = 0.30) and good for 3D-TPUS (κ = 0.73). The agreement for IAS evaluation was moderate for both 3D-EVUS (κ = 0.41) and 2D-TPUS (κ = 0.52) and good for 3D-TPUS (κ = 0.66). Good intraobserver (3D-EAUS, κ = 0.73; 3D-TPUS, κ = 0.78) and interobserver (3D-EAUS, κ = 0.68; 3D-TPUS, κ = 0.60) agreement was reported. Significant association between Starck and Wexner scores was found only for 3D-EAUS (Spearman's rho = 0.277, P = 0.04). 2D-TPUS and 3D-EVUS are not accurate modalities for the assessment of anal sphincters after repair of OASIS. 3D-TPUS shows good agreement with the gold standard 3D-EAUS and a high sensitivity in detecting residual defects. It, thus, has potential as a screening tool after primary repair of OASIS. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG

  6. 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...

  7. Anal HPV 16 and 18 viral load: A comparison between HIV-negative and -positive MSM and association with persistence

    NARCIS (Netherlands)

    Marra, Elske; King, Audrey; van Logchem, Elske; van der Weele, Pascal; Mooij, Sofie H.; Heijman, Titia; Meijer, Chris J. L. M.; Verhagen, Dominique W. M.; van der Sande, Marianne A. B.; Schim van der Loeff, Maarten F.

    2018-01-01

    Does anal HPV viral load explain the difference in anal HPV persistence between HIV-negative and -positive men who have sex with men (MSM)? MSM 18 years were recruited in Amsterdam, the Netherlands, in 2010-2011. Anal self-swabs were collected every 6 months and genotyped

  8. Fases pré-analítica, analítica e pós-analítica no monitoramento laboratorial da anticoagulação com antagonistas da vitamina K

    Directory of Open Access Journals (Sweden)

    Jonas Michel Wolf

    2017-07-01

    Full Text Available A trombose é uma doença caracterizada por eventos de hipercoagulabilidade. A terapêutica anticoagulante oral com antagonistas da vitamina K (AVKs é amplamente indicada para prevenção e/ou controle de distúrbios da coagulação. O manuseio de administração dos AVKs é difícil devido à complexidade da definição da dose. Em geral, o monitoramento de indivíduos submetidos à terapêutica com AVK é realizado pela determinação do tempo de protrombina, em que se avalia o grau de anticoagulação através do coeficiente internacional normatizado. Invariavelmente, o fluxo do processamento laboratorial, que compreende as fases pré-analítica, analítica e pós-analítica, é importante para a fidedignidade dos resultados, repercutindo na conduta médica de forma determinante. O objetivo deste estudo foi a realização de uma revisão da literatura científica descritiva utilizando bases de dados eletrônicos para busca de materiais científicos, como Google Scholar, MEDLINE, LILACS, PubMed, SciELO e Science Direct. Abordamos alguns aspectos relacionados ao fluxo analítico da monitoração laboratorial em um laboratório de análises clínicas. Em conclusão, é necessária uma apropriada condução das fases analíticas para que seja possível o sucesso terapêutico com uso dos AVKs. Palavras-chave: Tempo de protrombina; coeficiente internacional normatizado; fases analíticas

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

    Directory of Open Access Journals (Sweden)

    Lei Gao

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

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

    Science.gov (United States)

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

    2017-05-01

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

  11. Modesty and recognition--a qualitative study of the lived experience of recovery from anal cancer

    DEFF Research Database (Denmark)

    Midtgaard, Julie; Hansen, Mette Juel; Grandjean, Birgitte

    2009-01-01

    's phenomenological methodology. FINDINGS: The analysis revealed two concepts, modesty and recognition, which describe the essence of the lived experience of anal cancer, and which each appear to be important resistance resources. While modesty is regarded as an enforced and necessary competence developed......BACKGROUND: Anal cancer is a rare disease within the cancer spectrum. Long-term disabilities are notable and place increased demands on rehabilitation. AIM: The objective of this study was to describe the lived experiences of recovery from anal cancer, including which and how resources may help...

  12. Cortical evoked potentials in response to rapid balloon distension of the rectum and anal canal

    DEFF Research Database (Denmark)

    Haas, S; Brock, C; Krogh, K

    2014-01-01

    healthy women received 30 RBDs in the rectum and the anal canal at intensities corresponding to sensory and unpleasantness thresholds, and response was recorded as cortical evoked potentials (CEPs) in 64-channels. The anal canal stimulations at unpleasantness level were repeated after 4 min to test...... the within-day reproducibility. CEPs were averaged, and to overcome latency variation related to jitter the spectral content of single sweeps was also computed. KEY RESULTS: Repeated stimulation of the anal canal generated CEPs with similar latencies but smaller amplitudes compared to those from the rectum...

  13. La Contabilidad Analítica en los Hospitales Públicos

    Directory of Open Access Journals (Sweden)

    Ma Silvia Fresneda Fuentes

    1998-06-01

    Full Text Available La confección de presupuestos públicos austeros para la consecución de los criterios de convergencia impuestos por el Tratado de Maastricht ha originado una preocupación en todo el Sector Público en general, y en el hospitalario en particular, por la contención de los costes. Esta situación ha puesto de manifiesto la necesidad de introducir sistemas de Contabilidad para la Gestión interna de las organizaciones hospitalarias públicas. Así, la Contabilidad Analítica o de Costes se constituye como un componente más de dichos sistemas y está llamada a alcanzar dos objetivos muy claros, por un lado, la determinación del coste del producto hospitalario para en base a él realizar una presupuestación prospectiva, y por otro, suministrar información interna que permita llevar a cabo un verdadero Control de Gestión. Con este trabajo se pretenden describir los modelos de costes alternativos propuestos por la literatura especializada, señalando su idoneidad en base a la consecución de los objetivos que la Contabilidad Analítica debe satisfacer. Se pondrá de manifiesto la tendencia actual a establecer modelos basados en la nueva definición de producto hospitalario, los cuales tienen como finalidad la determinación de los costes totales de dicho producto, dejando a un lado el objetivo del control de la eficacia y eficiencia de la gestión.The development of strict Public Budgets in order to reach the goals settled by Maastricht agreements have caused a deep concern in the Public Sector and mostly in hospitals in order to brake the growth of costs. Such a situation has stated clearly the necessity of implementing Management Accounting Systems in Public Hospitals organizations. Therefore, costs accounting cames to be a part of such systems, which is to reach two very clear objetives. In one hand, the definition of the hospital product cost using it as the base to develop the hospital budget. On the other hand, to supply internal

  14. Current therapeutic strategies for anal squamous cell carcinoma in Japan

    International Nuclear Information System (INIS)

    Takashima, Atsuo; Shimada, Yasuhiro; Hamaguchi, Tetsuya

    2009-01-01

    In Western countries, chemoradiotherapy (CRT) is well established as the standard therapy for stages II/III anal squamous cell carcinoma (ASCC). In Japan, the therapeutic modalities for and outcomes of this disease have not been clarified because ASCC is quite rare. The Colorectal Cancer Study Group of the Japan Clinical Oncology Group (JCOG-CCSG) conducted a survey to determine the current therapeutic strategies for ASCC in Japan. In July 2006, a questionnaire was sent to 49 institutions affiliated with the JCOG-CCSG to gather information on numbers of cases, therapeutic modalities, and outcomes. The target subjects were patients with stages II/III ASCC, diagnosed from January 2000 to December 2004, who were 20-80 years of age with normal major organ function and no severe complications. Replies were received from 40 institutions. A total of 59 patients satisfied the subject criteria. Detailed information was obtained for 55 subjects; 25 (45%) had stage II ASCC and 30 (55%) had stage III ASCC. CRT was performed in 25 patients (45%); surgery in 17 (31%); surgery combined with radiotherapy (RT), chemotherapy, or CRT in 8 (15%); and RT in 5 (9%). Complete response rate in CRT was 80% (20/25). The 3-year progression-free survival rates for all subjects and for CRT-only subjects were 67% and 77%, respectively. From 2000 to 2004, only 59 patients with ASCC were identified in the JCOG-CCSG survey and about half of them underwent CRT. (author)

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

    Science.gov (United States)

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

    2007-08-01

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

  16. 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.

  17. A New Method to Treat High Anal Fistula - Bidirectional Isobaric Drainage

    DEFF Research Database (Denmark)

    Zheng, Linghua; Wang, Yanmei; Zhao, Jingbo

    2016-01-01

    Background and aim: Traditionally, the principle of the treatment for anal fistula is "open fistula, fistulotomy ". Fistulotomy is the standard treatment for simple and low fistulas. However for the high fistula, the anorectal ring will be disconnected by fistulotomy. A better treatment should...... damage the anorectal ring less and protect the anal function more. The aim of the present study is to explore a new method-bidirectional isobaric drainage radical resection to treat simple high anal fistula. Materials and methods:One hundred and twenty patients with simple high anal fistula were randomly...... cavity, then put the drainage seton to form a two-way isobaric drainage with the low incision. The patients in Control group were treated using a high cutting seton therapy with the low incision. The changes of average wound healing time, the cure rate, the recurrence rate, the postoperative pain (four...

  18. Treating High-grade Lesions to Prevent Anal Cancer in HIV-infected People

    Science.gov (United States)

    This study, called the ANCHOR trial, will investigate whether screening and prevention methods similar to those used to prevent cervical cancer can help prevent anal cancer in HIV-infected men and women.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    INTRODUCTION AND HYPOTHESIS: 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. METHODS: PubMed was searched for preclinical and clinical studies in English published from January 2005 to January 2016. RESULTS: Animal studies have demonstrated that cellular therapy in the form of local injections...... cells stimulate repair of sphincter injuries, and a complex bioengineering strategy for creation and implantation of an intrinsically innervated internal anal sphincter construct has been successfully developed in a series of animal studies. CONCLUSION: Cellular therapies with myogenic cells...

  20. Riskide analüüs aitab kriisi puhuks varusid planeerida / Janis Toomla

    Index Scriptorium Estoniae

    Toomla, Janis

    2005-01-01

    Riskide hindamisele järgnevast organisatsiooni jätkusuutlikkuse planeerimise faasist, kus toimub kriisistsenaariumide analüüs, võimalike kahjude suuruse hindamine ja taasteaja määratlemine (Business Impact Analyse)

  1. Recognizing and treating anal cancer: training medical students and physicians in Puerto Rico.

    Science.gov (United States)

    Ortiz, Ana P; Guiot, Humberto M; Díaz-Miranda, Olga L; Román, Leticia; Palefsky, Joel; Colón-López, Vivian

    2013-12-01

    This training activity aimed at increasing the knowledge of anal cancer screening, diagnostic and treatment options in medical students and physicians, to determine the interest of these individuals in receiving training in the diagnosis and treatment of anal cancer, and to explore any previous training and/or experience with both anal cancer and clinical trials that these individuals might have. An educational activity (1.5 contact hours) was attended by a group of medical students, residents and several faculty members, all from the Medical Sciences Campus of the University of Puerto Rico (n = 50). A demographic survey and a 6-item pre- and post-test on anal cancer were given to assess knowledge change. Thirty-four participants (68%) answered the survey. Mean age was 29.6 +/- 6.6 years; 78.8% had not received training in anal cancer screening, 93.9% reported being interested in receiving anal cancer training, and 75.8% expressed an interest in leading or conducting a clinical trial. A significant increase in the test scores was observed after the educational activity (pre-test: 3.4 +/- 1.2; post-test: 4.7 +/- 0.71). Three of the items showed an increase in knowledge by the time the post-test was taken. The first of these items assessed the participants' knowledge regarding the existence of any guidelines for the screening/treatment of patients with human papillomavirus (HPV)-related anal disease. The second of these items attempted to determine whether the participants recognized that anal intraepithelial neoplasia (AIN) 2 is considered to be a high-grade neoplasia. The last of the 3 items was aimed at ascertaining whether or not the participants were aware that warty growths in the anus are not necessarily a manifestation of high-grade AIN. This educational activity increased the participants' knowledge of anal cancer and revealed, as well, that most of the participants were interested in future training and in collaborating in a clinical trial. Training

  2. The Evaluation of Digital Rectal Examination for Assessment of Anal Tone in Suspected Cauda Equina Syndrome.

    Science.gov (United States)

    Sherlock, Katrina Eve; Turner, William; Elsayed, Sherief; Bagouri, M; Baha, L; Boszczyk, Bronek M; McNally, Donal

    2015-08-01

    Seventy-five doctors completed a questionnaire documenting their grade, specialty, and experience in performing digital rectal examination (DRE). A model anus, using a pressure transducer surrounding an artificial canal, was assembled and calibrated. Participants performed 4 DREs on the model (with a break between attempts) and predicted tone as "reduced" or "normal" (35 and 60 mm Hg, respectively), followed by a "squeeze" test. Thirty health care assistants partook as a control group with no training in DRE. Our main objective was to investigate the validity of digital rectal examination (DRE) for assessment of anal tone. Cauda equina syndrome represents the constellation of symptoms and signs resulting from compression of lumbrosacral nerve routes. Combined with subjective neurological findings, a reduction in anal tone is an important sign, deeming further imaging necessary. DRE is an invasive procedure used to assess anal tone despite debated accuracy. A total of 75 doctors from various specialties were asked to fill in a questionnaire detailing their grade, age, and area of expertise. In addition, information was gathered with regard to prior training in performing DRE to assess anal tone and the importance placed on any findings. Thirty hospital health care assistants (HCAs) were used as a control group. HCAs were selected as a control group because they receive no training on the technique and would never be required to perform it in their clinical practice. A model anus was assembled using a modified pediatric sphygmomanometer cuff to act as a sphincter. The cuff could be inflated to simulate a full range of anal tone. The cuff was incorporated into an artificial anal canal, which was, in turn, placed into a model buttock created from plaster of Paris. The apparatus was calibrated across a range of pressures. In each attempt, 60%, 61%, 63%, and 67% of doctors correctly identified the anal tone, respectively (average accuracy: 64%). HCAs had an identical

  3. Analüütilised voolud psühholoogias ja nende rakendamine pedagoogikas / Aleksander Elango

    Index Scriptorium Estoniae

    Elango, Aleksander, 1902-2004

    2001-01-01

    Analüütise psühholoogia kolm koolkonda - S.Freudì koolkond e. päris-psühhoanalüüs, A.Adlerì koolkond e. individuaalpsühholoogia ja C.G.Jungì psühhoanalüüsi ja individuaalpsühholoogia sünteesi luua püüdev koolkond. Analüütise psühholoogia koolkondade ja pedagoogika suhetest

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

    Science.gov (United States)

    Singh, Siddharth; Verma, Satyajeet; Kala, Sanjay

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Siddharth Singh

    2014-01-01

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

  6. Anal Cancer Risk Among People With HIV Infection in the United States.

    Science.gov (United States)

    Colón-López, Vivian; Shiels, Meredith S; Machin, Mark; Ortiz, Ana P; Strickler, Howard; Castle, Philip E; Pfeiffer, Ruth M; Engels, Eric A

    2018-01-01

    Purpose People with HIV infection have an elevated risk of anal cancer. However, recent calendar trends are incompletely described, and which population subgroups might benefit from cancer screening is unknown. Methods We used linked data from HIV and cancer registries in nine US areas (1996 to 2012). We calculated standardized incidence ratios to compare anal cancer incidence in people with HIV infection with the general population, used Poisson regression to evaluate anal cancer incidence among subgroups of people with HIV and to assess temporal trends, and estimated the cumulative incidence of anal cancer to measure absolute risk. Results Among 447,953 people with HIV infection, anal cancer incidence was much higher than in the general population (standardized incidence ratio, 19.1; 95% CI, 18.1 to 20.0). Anal cancer incidence was highest among men who have sex with men (MSM), increased with age, and was higher in people with AIDS than in those without AIDS (ie, HIV only; adjusted incidence rate ratio, 3.82; 95% CI, 3.27 to 4.46). Incidence among people with HIV increased steeply during 1996 to 2000 (annual percentage change, 32.8%; 95% CI, -1.0% to 78.2%), reached a plateau during 2001 to 2008, and declined during 2008 to 2012 (annual percentage change, -7.2%; 95% CI, -14.4% to 0.6%). Cumulative incidence after a 5-year period was high for MSM with HIV only age 45 to 59 or ≥ 60 years (0.32% to 0.33%) and MSM with AIDS age 30 to 44, 45 to 59, or ≥ 60 years (0.29% to 0.65%). Conclusion Anal cancer incidence is markedly elevated among people with HIV infection, especially in MSM, older individuals, and people with AIDS. Recent declines may reflect delayed benefits of HIV treatment. Groups with high cumulative incidence of anal cancer may benefit from screening.

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

    Science.gov (United States)

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

    2018-04-01

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

  8. Analüütikud soovitavad Eesti Energia börsile viia / Piret Reiljan

    Index Scriptorium Estoniae

    Reiljan, Piret, 1983-

    2008-01-01

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

  9. Variation of the anal resting pressure induced by postexpiratory apnea effort in patients with constipation.

    Science.gov (United States)

    Benetti, Thaís Helena; Santos, Maria Fernanda; Mergulhão, Melissa Eichenberger Alves; Fagundes, João José; Ayrizono, Maria de Lourdes Setsuko; Coy, Cláudio Saddy Rodrigues

    2011-01-01

    Intestinal constipation--a common symptom among the general population--is more frequent in women. It may be secondary to an improper diet or organic or functional disturbances, such as dyskinesia of the pelvic floor. This is basically characterized by the absence of relaxation or paradoxical contraction of the pelvic floor and anal sphincter during evacuation. To analyze, by manometric data, the anal pressure variation at rest, during evacuation effort by using the Valsalva maneuver and forced post-expiratory apnea in subjects with secondary constipation. Twenty-one patients (19 females--90.4%) with a mean age of 47.5 years old (23-72) were studied. The diagnosis was performed using anorectal manometry, with a catheter containing eight channels disposed at the axial axis, measuring the proximal (1) and distal (2) portions of the anal orifice. The elevation of the pressure values in relation to the resting with the evacuation effort was present in all patients. The Agachan score was used for clinical evaluation of constipation. The variables studied were: mean anal pressure of the anal orifice for 20 seconds at rest, the effort of evacuation using Valsalva maneuver and the effort of evacuation during apnea after forced expiration, as well as the area under the curve of the manometric tracing at moments Valsalva and apnea. The analysis of the mean values of the anal pressure variation at rest evidenced difference between proximal and distal channels (P = 0.007), independent of the moment and tendency to differ during moments Valsalva and apnea (P = 0.06). The mean of values of the area under the manometric tracing curve showed differences between moments Valsalva and apnea (P = 0.0008), either at the proximal portion or at the distal portion of the anal orifice. The effort of evacuation associated with postexpiratory apnea, when compared with the effort associated with the Valsalva maneuver, provides lower elevation of anal pressure at rest by the parameter area

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

    Science.gov (United States)

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

    2016-03-01

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

  11. Significance of the thickness of the anal sphincters with age and its relevance in faecal incontinence.

    Science.gov (United States)

    Papachrysostomou, M; Pye, S D; Wild, S R; Smith, A N

    1994-08-01

    Ultrasonographic studies in healthy volunteers showed that the external anal sphincter (EAS) and internal anal sphincter (IAS) thicknesses were inversely related at rest. The functional importance of the two sphincters in continence control was demonstrated in the relationship between the sum of the thicknesses of the two sphincters and the anal canal resting pressure. The aims of the present study were to assess the morphometric appearance of the anal sphincters by endosonography in faecally incontinent patients and to contrast this with that of older healthy subjects. Twenty-eight female patients with neurogenic faecal incontinence (FI) were studied. An older group of 7 healthy women, aged 41-75 years, and a young group of 11 nulliparous healthy women, aged 20-23 years, served as control groups. Anal endosonography was performed with a radial rotating endoprobe, with the subject in the left lateral position. Conventional anal manometry was performed in all subjects. The EAS in the FI group was thicker than the EAS in the old (p IAS thickness in the FI group did not differ from that in the older group. In both these groups the IAS was thicker than in the young women (p IAS in the FI group does not seem to compensate for function and results in a failure of the sphincter mechanism to maintain continence, whereas in healthy elderly subjects the increased IAS thickness appears to be compensatory and important for continence control.

  12. 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, 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......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...

  13. Cough-Anal Reflex May Be the Expression of a Pre-Programmed Postural Action

    Directory of Open Access Journals (Sweden)

    Paolo Cavallari

    2017-09-01

    Full Text Available When coughing, an involuntary contraction of the external anal sphincter occurs, in order to prevent unwanted leakages or sagging of the pelvis muscular wall. Literature originally described such cough-anal response as a reflex elicited by cough, therefore identifying a precise cause-effect relationship. However, recent studies report that the anal contraction actually precedes the rise in abdominal pressure during cough expiratory effort, so that the sphincter activity should be pre-programmed. In recent years, an important family of pre-programmed muscle activities has been well documented to precede voluntary movements: these anticipatory actions play a fundamental role in whole body and segmental postural control, hence they are referred to as anticipatory postural adjustments (APAs. On these basis, we searched in literature for similarities between APAs and the cough-anal response, observing that both follow the same predictive homeostatic principle, namely that anticipatory collateral actions are needed to prevent the unwanted mechanical consequences induced by the primary movement. We thus propose that the cough-anal response also belongs to the family of pre-programmed actions, as it may be interpreted as an APA acting on the abdominal-thoracic compartment; in other words, the cough-anal response may actually be an Anticipatory Sphincter Adjustment, the visceral counterpart of APAs.

  14. Carcinoma epidermoide del margen anal contra calidad de vida

    Directory of Open Access Journals (Sweden)

    Miguel A Reyes Argudín

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

  15. Adenocarcinoma in the anal canal after ileal pouch-anal anastomosis for familial adenomatous polyposis using a double-stapled technique: report of two cases

    NARCIS (Netherlands)

    Vrouenraets, Bart C.; van Duijvendijk, Peter; Bemelman, Willem A.; Offerhaus, G. Johan A.; Slors, J. Frederik M.

    2004-01-01

    Restorative proctocolectomy with an ileal pouch-anal anastomosis is thought to abolish the risk of colorectal adenoma development in patients suffering from familial adenomatous polyposis. Both after mucosectomy with a handsewn anastomosis and after a double-stapled anastomosis, rectal mucosa is

  16. 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?

    OpenAIRE

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

    2010-01-01

    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 o...

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

    International Nuclear Information System (INIS)

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

    2008-01-01

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

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

    Science.gov (United States)

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

    2010-03-01

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

  19. Screening for precancerous anal lesions with P16/Ki67 immunostaining in HIV-infected MSM.

    Directory of Open Access Journals (Sweden)

    Sergio Serrano-Villar

    Full Text Available Screening of anal cancer in HIV-infected MSM with anal cytology results in high rates of false positive results and elevated burden of high-resolution anoscopies. High-risk HPV up-regulates p16 and Ki67 expression in epithelial cells. We assessed the usefulness of P16/Ki-67 immunostaining cytology for the diagnosis of precancerous anal lesions.Cross-sectional multicenter study. Concomitant anal liquid cytology with p16/Ki-67 immunostaining and HRA with biopsy of acetowhite lugol-negative lesions was performed in HIV-infected MSM. We compared the diagnostic performance of an abnormal anal cytology and p16/Ki-67 immunostaining relative to HRA-guided biopsy by logistic regression and comparison of ROC areas.We included 328 HIV-infected MSM. HSIL was histologically diagnosed in 72 subjects (25.1%, and 2 (0.6% were diagnosed with anal cancer. An abnormal cytology showed a sensitivity of 95.6% and a specificity of 58.8% for the diagnosis of biopsy-proven HSIL. P16/Ki67 positivity was associated with the presence of biopsy-proven HSIL (P trend = 0.004 but with low sensitivity (41.2% and specificity (71%. The combination of standard cytology with P16/Ki67 immunostaining did not increment the predictive value of standard cytology alone (AUC 0.685 vs. 0.673, respectively, P = 0.688.In HIV-infected MSM P16/Ki67 immunostaining does not improve the diagnostic accuracy of anal cytology, which shows a high sensitivity yet poor specificity. Other approaches aimed at improving the diagnostic accuracy of current techniques for the diagnostic of precancerous HSIL are warranted.

  20. FREQUENCY OF POST-OPERATIVE FAECAL INCONTINENCE IN PATIENTS WITH CLOSED AND OPEN INTERNAL ANAL SPHINCTEROTOMY.

    Science.gov (United States)

    Ghayas, Nighat; Younus, Syed Muneeb; Mirani, Abdul Jabbar; Ghayasuddin, Mohammed; Qazi, Aamna; Suchdev, Sunil Dutt; Bakshi, Saqib Kamran

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Chang Hun Lee

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

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

    Directory of Open Access Journals (Sweden)

    Dragana N. Petrović

    2013-10-01

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

  3. The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: The PREDICT study

    International Nuclear Information System (INIS)

    Roos, A.-M.; Abdool, Z.; Sultan, A.H.; Thakar, R.

    2011-01-01

    Aim: To determine the accuracy and predictive value of transperineal (TPU) and endovaginal ultrasound (EVU) in the detection of anal sphincter defects in women with obstetric anal sphincter injuries and/or postpartum symptoms of faecal incontinence. Materials and methods: One hundred and sixty-five women were recruited, four women were excluded as they were seen years after their last delivery. TPU and EVU, followed by endonanal ultrasound (EAU), were performed using the B and K Viking 2400 scanner. Sensitivity and specificity, as well as predictive values with 95% confidence intervals, for detecting anal sphincter defects were calculated for EVU and TPU, using EAU as the reference standard. Results: On EAU a defect was found in 42 (26%) women: 39 (93%) had an external (EAS) and 23 (55%) an internal anal sphincter (IAS) defect. Analysable images of one level of the EAS combined with an analysable IAS were available in 140 (87%) women for EVU and in 131 (81%) for TPU. The sensitivity and specificity for the detection of any defect was 48% (30-67%) and 85% (77-91%) for EVU and 64% (44-81%) and 85% (77-91%) for TPU, respectively. Conclusion: Although EAU using a rotating endoprobe is the validated reference standard in the identification of anal sphincter defects, it is not universally available. However while TPU and/or EVU with conventional ultrasound probes can be useful in identifying normality, for clinical purposes they are not sensitive enough to identify an underlying sphincter defect.

  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 sexual partners, and with anal oncogenic HPV infection was age.

  5. 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

    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......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...

  6. Apontamentos sobre a psicologia analítica de Carl Gustav Jung

    Directory of Open Access Journals (Sweden)

    Luís Marcelo Alves Ramos

    2002-01-01

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

  7. O terapêutico e o analítico em Freud

    Directory of Open Access Journals (Sweden)

    Vinicius Anciães Darriba

    2013-06-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  9. Incertidumbre en métodos analíticos de rutina.

    OpenAIRE

    Maroto Sánchez, Maria Alicia

    2002-01-01

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

  10. [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.

  11. Anal Canal Gas Gangrene in Aplastic Anaemia: Rare yet Lethal Entity - A Caveat.

    Science.gov (United States)

    Sudharsanan, Sundaramurthi; Vijayakumar, Chellappa; Manish, Kumar; Elamurugan, T P; Manwar, Ali S

    2017-07-13

    Gas gangrene is one of the most serious infections of traumatic and surgical wounds. The importance lies in the fact that, if not managed at the right time, the condition is fatal. Though perianal cellulitis and gangrene are commonly reported in immunocompromised patients, we report the case of a patient with gas gangrene involving only the anal canal extending to the rectum, a rare presentation to be reported in literature.  An 18-year-old lady, a patient of aplastic anaemia - immunodeficiency, developed gas gangrene of the anal canal possibly due to faecal contamination of anal fissures. The patient was managed with surgical debridement and intravenous antibiotics.  The clinical manifestations of gas gangrene are due to the liberation of toxins by Clostridium perfringens. The infection spreads rapidly and results in necrosis and devitalisation of tissues, unless intervened surgically. The clinical manifestations are more rapid and a high index of suspicion is needed for the diagnosis.

  12. Disorders of the pelvic floor and anal sphincters; a gastroenterologist’s perspective

    Directory of Open Access Journals (Sweden)

    Eamonn M.M. Quigley, MD FRCP FACP FACG FRCPI

    2013-03-01

    Full Text Available The integration and coordination of the musculature of the pelvic floor and the anal sphincters is critical to two important physiological functions: defecation and continence. Consequently, disorders affecting the pelvic floor muscles, the anal sphincters, their innervation or their precise coordination will, depending on their nature, result either in obstructed defecation or fecal incontinence. Both of these disorders are much more common in females and the latter, in particular, is linked with parity. While the symptomatology, presentation and optimal mode of investigation of fecal incontinence are well standardized, considerable debate and controversy continues to surround the contributions of pelvic floor and anal sphincter dysfunction to chronic constipation and the optimal clinical approach to their investigation remains to be defined. In appropriately chosen cases surgical intervention may provide the best outcome for sufferers from incontinence; biofeedback approaches may be of value in both incontinence and obstructed defecation and surgery has little role to play in the latter.

  13. Body Image and Condomless Anal Sex Among Sexual Minority Men Living with HIV.

    Science.gov (United States)

    Gholizadeh, Shadi; Rooney, Benjamin M; Merz, Erin L; Malcarne, Vanessa L; Safren, Steven A; Blashill, Aaron J

    2018-02-01

    The interaction of body dissatisfaction and appearance investment (importance and effort ascribed to appearance) in relation to condomless anal sex has not previously been examined. Body dissatisfaction in the context of varying degrees of appearance investment may yield divergent sexual risk outcomes. Sexual minority men living with HIV (N = 105) completed a battery of self-report measures. A generalized linear model identified a significant interaction [b = 0.08 (95% CI 0.01, 0.16), p = 0.033] such that when appearance investment was low, body dissatisfaction was associated with fewer condomless anal sex acts; when appearance investment was high, body dissatisfaction was associated with increased condomless anal sex.

  14. Postmodernismi apooria või kriitiline postmodernism / Tomi Kaarto ; tõlk. Ülle Põlma

    Index Scriptorium Estoniae

    Kaarto, Tomi

    2000-01-01

    Postmodernistlik film ja vägivald filmis. Käsitluse aluseks mängufilm "Tõeline romanss" ("True Romance") : Stsenarist Quentin Tarantino : režissöör Tony Scott : Ameerika Ühendriigid 1993. Bibliograafia lk. 65

  15. COMPARATIVE STUDY OF LATERAL SPHINCTEROTOMY AND LATERAL SPHINCTEROTOMY WITH V-Y ADVANCEMENT FLAP IN TREATMENT OF CHRONIC ANAL FISSURE

    Directory of Open Access Journals (Sweden)

    S. Meenaa Saravanaperumaal

    2016-12-01

    Full Text Available BACKGROUND Anal fissure is an elongated ulcer in the long axis of lower anal canal. The most frequent site for anal fissure is midline posteriorly and followed by midline anteriorly. It causes severe pain during defecation and rectal bleeding that stain the tissue or streaks the stools. Chronic anal fissure has traditionally been treated by surgery, an effective and standard procedure that results in healing in 90-95% of cases. Lateral sphincterotomy heals chronic anal fissure in 90% of cases that is associated with incontinence to flatus and faeces. Anal advancement flaps was used to cover the chronic anal fissure. Using anal flaps to resurface chronic or recurrent anal fissure to promote wound healing and to assess the added advantage over lateral sphincterotomy in tissues of complete epithelialisation; time of relief of pain; persistent symptoms; patient satisfaction and quality of life. The aim of the study is to- 1. Compare the efficacy of lateral sphincterotomy against lateral sphincterotomy with V-Y advancement flap in treatment of chronic anal fissures. 2. Assess the added advantages of V-Y advancement flap in treatment of chronic anal fissure in terms of wound healing, time of relief of pain, persistent symptoms and patients’ satisfaction. 3. Compare the complications associated with procedures. MATERIALS AND METHODS A study of 50 patients was done. It included 26 females and 24 males. In that, lateral sphincterotomy alone was done in 25 patients and lateral sphincterotomy along with anal advancement flap was done in 25 patients. RESULTS In group A patients only lateral sphincterotomy done. In group B lateral sphincterotomy with anal advancement flap done. Anal advancement flap done by ‘v’ shaped flap formed of skin and subcutaneous tissue was elevated incontinuity with excised tissue to allow to cover the tissue defect. Flap should be broad based with adequate blood supply and avoid tension while suturing with 3-0 vicryl. A study

  16. Locomotion of free-swimming ghost knifefish: anal fin kinematics during four behaviors.

    Science.gov (United States)

    Youngerman, Eric D; Flammang, Brooke E; Lauder, George V

    2014-10-01

    The maneuverability demonstrated by the weakly electric ghost knifefish (Apteronotus albifrons) is a result of its highly flexible ribbon-like anal fin, which extends nearly three-quarters the length of its body and is composed of approximately 150 individual fin rays. To understand how movement of the anal fin controls locomotion we examined kinematics of the whole fin, as well as selected individual fin rays, during four locomotor behaviors executed by free-swimming ghost knifefish: forward swimming, backward swimming, heave (vertical) motion, and hovering. We used high-speed video (1000 fps) to examine the motion of the entire anal fin and we measured the three-dimensional curvature of four adjacent fin rays in the middle of the fin during each behavior to determine how individual fin rays bend along their length during swimming. Canonical discriminant analysis separated all four behaviors on anal fin kinematic variables and showed that forward and backward swimming behaviors contrasted the most: forward behaviors exhibited a large anterior wavelength and posterior amplitude while during backward locomotion the anal fin exhibited both a large posterior wavelength and anterior amplitude. Heave and hover behaviors were defined by similar kinematic variables; however, for each variable, the mean values for heave motions were generally greater than for hovering. Individual fin rays in the middle of the anal fin curved substantially along their length during swimming, and the magnitude of this curvature was nearly twice the previously measured maximum curvature for ray-finned fish fin rays during locomotion. Fin rays were often curved into the direction of motion, indicating active control of fin ray curvature, and not just passive bending in response to fluid loading. Copyright © 2014 Elsevier GmbH. All rights reserved.

  17. DNA methylation profiling across the spectrum of HPV-associated anal squamous neoplasia.

    Science.gov (United States)

    Hernandez, Jonathan M; Siegel, Erin M; Riggs, Bridget; Eschrich, Steven; Elahi, Abul; Qu, Xiaotao; Ajidahun, Abidemi; Berglund, Anders; Coppola, Domenico; Grady, William M; Giuliano, Anna R; Shibata, David

    2012-01-01

    Changes in host tumor genome DNA methylation patterns are among the molecular alterations associated with HPV-related carcinogenesis. However, there is little known about the epigenetic changes associated specifically with the development of anal squamous cell cancer (SCC). We sought to characterize broad methylation profiles across the spectrum of anal squamous neoplasia. Twenty-nine formalin-fixed paraffin embedded samples from 24 patients were evaluated and included adjacent histologically normal anal mucosa (NM; n = 3), SCC-in situ (SCC-IS; n = 11) and invasive SCC (n = 15). Thirteen women and 11 men with a median age of 44 years (range 26-81) were included in the study. Using the SFP(10) LiPA HPV-typing system, HPV was detected in at least one tissue from all patients with 93% (27/29) being positive for high-risk HPV types and 14 (93%) of 15 invasive SCC tissues testing positive for HPV 16. Bisulfite-modified DNA was interrogated for methylation at 1,505 CpG loci representing 807 genes using the Illumina GoldenGate Methylation Array. When comparing the progression from normal anal mucosa and SCC-IS to invasive SCC, 22 CpG loci representing 20 genes demonstrated significant differential methylation (p<0.01). The majority of differentially methylated gene targets occurred at or close to specific chromosomal locations such as previously described HPV methylation "hotspots" and viral integration sites. We have identified a panel of differentially methlylated CpG loci across the spectrum of HPV-associated squamous neoplasia of the anus. To our knowledge, this is the first reported application of large-scale high throughput methylation analysis for the study of anal neoplasia. Our findings support further investigations into the role of host-genome methylation in HPV-associated anal carcinogenesis with implications towards enhanced diagnosis and screening strategies.

  18. DNA methylation profiling across the spectrum of HPV-associated anal squamous neoplasia.

    Directory of Open Access Journals (Sweden)

    Jonathan M Hernandez

    Full Text Available Changes in host tumor genome DNA methylation patterns are among the molecular alterations associated with HPV-related carcinogenesis. However, there is little known about the epigenetic changes associated specifically with the development of anal squamous cell cancer (SCC. We sought to characterize broad methylation profiles across the spectrum of anal squamous neoplasia.Twenty-nine formalin-fixed paraffin embedded samples from 24 patients were evaluated and included adjacent histologically normal anal mucosa (NM; n = 3, SCC-in situ (SCC-IS; n = 11 and invasive SCC (n = 15. Thirteen women and 11 men with a median age of 44 years (range 26-81 were included in the study. Using the SFP(10 LiPA HPV-typing system, HPV was detected in at least one tissue from all patients with 93% (27/29 being positive for high-risk HPV types and 14 (93% of 15 invasive SCC tissues testing positive for HPV 16. Bisulfite-modified DNA was interrogated for methylation at 1,505 CpG loci representing 807 genes using the Illumina GoldenGate Methylation Array. When comparing the progression from normal anal mucosa and SCC-IS to invasive SCC, 22 CpG loci representing 20 genes demonstrated significant differential methylation (p<0.01. The majority of differentially methylated gene targets occurred at or close to specific chromosomal locations such as previously described HPV methylation "hotspots" and viral integration sites.We have identified a panel of differentially methlylated CpG loci across the spectrum of HPV-associated squamous neoplasia of the anus. To our knowledge, this is the first reported application of large-scale high throughput methylation analysis for the study of anal neoplasia. Our findings support further investigations into the role of host-genome methylation in HPV-associated anal carcinogenesis with implications towards enhanced diagnosis and screening strategies.

  19. Correlação entre a incompetência esfincteriana anal e a prática de sexo anal em homossexuais do sexo masculino

    OpenAIRE

    Ferreira, Maíra Costa; Braz, Tatiana Pereira; Machado, Ana Maria Oliveira; Ribeiro, Gabriel; Andrade, Rosana Cristina Pererira de

    2010-01-01

    p. 55-60,jan./mar. 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 ...

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

    Directory of Open Access Journals (Sweden)

    Maria Auxiliadora Prolungatti Cesar

    2008-09-01

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

  1. [Surgical treatment of the perianal and rectovaginal fistulas by means of Surgisis AFP anal fistula plug].

    Science.gov (United States)

    Yaramov, N; Sokolov, M; Angelov, K; Petrov, B; Pavlov, V

    2010-01-01

    Symptoms of painful and uncomfortably occurred in patients with anal and rectovaginal fistulas witch worsened their quality of life. The introduce of Biodesign Fistula Plug is called "dramatic jump in surgery of the fistulas". We can avoid from the traditionally and technicaly difficult treatment of perianal and rectovaginal fistulas through this advice. Therefore like this surgeons can avert frequently complications of the anal sphyncteric apparatus like incontinence or stenosis. We have only two cases like attempt for now but with excellent result followed up about 31 and 33 months.

  2. Preoperative chemoradiotherapy and colonic J-pouch anal anastomosis for lower rectal cancer

    International Nuclear Information System (INIS)

    Inoue, Yasuhiro; Okigami, Masato; Kawamoto, Aya; Hiro, Junichiro; Toiyama, Yuji; Kobayashi, Minako; Tanaka, Koji; Miki, Chikao; Kusunoki, Masato

    2011-01-01

    We performed colonic J-pouch anal anastomosis in 61 patients with rectal cancer located <4 cm from the anal verge. Surgical and oncological results were evaluated in multimodality therapy for advanced rectal cancer. According to Wexner's score, 7% of patients were fully continent, 71% had acceptable function with minor continence problems, and 22% were incontinent. No patients required intermittent self-catheterization during follow-up. After a median follow-up of 49 months, there was only 1 case of local recurrence after surgery. Our surgical approach irrespective of internal sphincter resection produces satisfactory functional and oncological results in multimodality therapy using preoperative chemoradiotherapy for lower rectal cancer. (author)

  3. Assertividade e autocontrole: interpretação analítico-comportamental

    OpenAIRE

    Marchezini-Cunha, Vívian; Tourinho, Emmanuel Zagury

    2010-01-01

    Questões relacionadas à assertividade têm recebido atenção por parte de terapeutas comportamentais há mais de três décadas. É mais recente, porém, o esforço de terapeutas analítico-comportamentais para examinar problemas dessa ordem com os mesmos recursos conceituais e metodológicos empregados por seus pares da pesquisa básica e conceitual. O presente trabalho tem como objetivo oferecer uma interpretação analítico-comportamental para padrões de comportamento assertivos, agressivos e passivos....

  4. Valores do Terapeuta na Clínica Analítico-Comportamental

    OpenAIRE

    Watrin,João Paulo; Canaan,Silvia

    2015-01-01

    RESUMO Desde os anos 1950, tem se constatado que, em alguma medida, os valores do terapeuta se fazem presentes na psicoterapia, podendo, inclusive, influenciar os valores dos clientes. Embora apresente uma concepção de valores diferente das tradicionais, a terapia analítico-comportamental não é uma exceção. Este trabalho busca esclarecer como os valores do terapeuta podem se manifestar na clínica analítico-comportamental, sejam esses valores pessoais ou compartilhados com alguma cultura (e.g....

  5. La revista "Anales de Psicología" desde una perspectiva de redes sociales

    OpenAIRE

    Peñaranda-Ortega, María; Quiñones Vidal, Elena; Osca-Lluch, Julia

    2009-01-01

    Se presentan los resultados obtenidos en el análisis de la revista Anales de Psicología. En este artículo, las autoras analizan la colaboración existente entre autores, instituciones y países en dicha revista. Éste análisis de colaboración se realiza en base al Análisis de Redes Sociales (ARS) con los programas informáticos Pajek y Ucinet. El periodo estudiado abarca desde 1984 hasta 2009, coincidiendo con los 25 años de existencia de Anales de Psicología. Los resultados obtenidos indican un ...

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

    Directory of Open Access Journals (Sweden)

    Katja Jakopič

    2018-02-01

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

  7. Fistules anales à l'Hôpital National Ignace DEEN de Conakry ...

    African Journals Online (AJOL)

    Fistules anales à l'Hôpital National Ignace DEEN de Conakry : Analyse d'une série de 67 cas. ... ont été enregistrés au cours de la première année de suivi post opératoire. La fistule anale est fréquente en Guinée. Le diagnostic est aisé et le traitement chirurgical donne de bons résultats malgré le risque de récidive.

  8. El enfoque meta-analítico de generalización de la fiabilidad

    OpenAIRE

    Sánchez Meca, Julio; López Pina, José Antonio

    2008-01-01

    Frases del tipo «la fiabilidad del test es 0.80» son incorrectas. Es más apropiado decir «la fiabilidad de las puntuaciones del test en una determinada aplicación del mismo es 0.80». El enfoque meta-analítico de generalización de la fiabilidad pretende demostrar que la fiabilidad es una propiedad empírica que varía de una aplicación a otra del test. Este nuevo enfoque meta-analítico está contribuyendo a concienciar a los investigadores sobre la importancia de aportar estimaciones de...

  9. Variation of the anal resting pressure induced by postexpiratory apnea effort in patients with constipation

    Directory of Open Access Journals (Sweden)

    Thaís Helena Benetti

    2011-03-01

    Full Text Available CONTEXT: Intestinal constipation - a common symptom among the general population - is more frequent in women. It may be secondary to an improper diet or organic or functional disturbances, such as dyskinesia of the pelvic floor. This is basically characterized by the absence of relaxation or paradoxical contraction of the pelvic floor and anal sphincter during evacuation. OBJECTIVE: To analyze, by manometric data, the anal pressure variation at rest, during evacuation effort by using the Valsalva maneuver and forced post-expiratory apnea in subjects with secondary constipation. METHODS: Twenty-one patients (19 females - 90.4% with a mean age of 47.5 years old (23-72 were studied. The diagnosis was performed using anorectal manometry, with a catheter containing eight channels disposed at the axial axis, measuring the proximal (1 and distal (2 portions of the anal orifice. The elevation of the pressure values in relation to the resting with the evacuation effort was present in all patients. The Agachan score was used for clinical evaluation of constipation. The variables studied were: mean anal pressure of the anal orifice for 20 seconds at rest, the effort of evacuation using Valsalva maneuver and the effort of evacuation during apnea after forced expiration, as well as the area under the curve of the manometric tracing at moments Valsalva and apnea. RESULTS: The analysis of the mean values of the anal pressure variation at rest evidenced difference between proximal and distal channels (P = 0.007, independent of the moment and tendency to differ during moments Valsalva and apnea (P = 0.06. The mean of values of the area under the manometric tracing curve showed differences between moments Valsalva and apnea (P = 0.0008, either at the proximal portion or at the distal portion of the anal orifice. CONCLUSION: The effort of evacuation associated with postexpiratory apnea, when compared with the effort associated with the Valsalva maneuver, provides

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

    Directory of Open Access Journals (Sweden)

    Antônio Arildo Reginaldo de Holanda

    2007-01-01

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

  11. Handedness is a biomarker of variation in anal sex role behavior and Recalled Childhood Gender Nonconformity among gay men.

    Science.gov (United States)

    Swift-Gallant, Ashlyn; Coome, Lindsay A; Monks, D Ashley; VanderLaan, Doug P

    2017-01-01

    Developmental theories of the biological basis of sexual orientation suggest that sexually differentiated psychological and behavioural traits should be linked with sexual orientation. Subgroups of gay men delineated by anal sex roles differ according to at least one such trait: gender expression. The present study assessed the hypothesis that handedness, a biologically determined sexually differentiated trait, corresponds to differences in subgroups of gay men based on anal sex role. Furthermore, it assessed whether handedness mediates the association between gender nonconformity and male sexual orientation. Straight and gay men (N = 333) completed the Edinburgh Inventory of Handedness and the Recalled Childhood Gender Nonconformity Scale. Gay men also completed measures of anal sex role preference. As in previous studies, gay men showed greater non-right-handedness and gender nonconformity than straight men. Also, among gay men, bottoms/versatiles (i.e., gay men who take a receptive anal sex role, or who take on both a receptive and insertive anal sex role) were more gender-nonconforming than tops (i.e., gay men who take an insertive anal sex role). In support of the hypothesis, bottoms/versatiles were more non-right-handed than tops and handedness mediated the male sexual orientation and anal sex role differences in Recalled Childhood Gender Nonconformity. Together, these findings suggest that developmental processes linked to handedness underpin variation among men in sexual orientation and gender nonconformity as well as variation among subgroups of gay men that are delineated by anal sex roles.

  12. Handedness is a biomarker of variation in anal sex role behavior and Recalled Childhood Gender Nonconformity among gay men

    Science.gov (United States)

    Swift-Gallant, Ashlyn; Coome, Lindsay A.; Monks, D. Ashley; VanderLaan, Doug P.

    2017-01-01

    Developmental theories of the biological basis of sexual orientation suggest that sexually differentiated psychological and behavioural traits should be linked with sexual orientation. Subgroups of gay men delineated by anal sex roles differ according to at least one such trait: gender expression. The present study assessed the hypothesis that handedness, a biologically determined sexually differentiated trait, corresponds to differences in subgroups of gay men based on anal sex role. Furthermore, it assessed whether handedness mediates the association between gender nonconformity and male sexual orientation. Straight and gay men (N = 333) completed the Edinburgh Inventory of Handedness and the Recalled Childhood Gender Nonconformity Scale. Gay men also completed measures of anal sex role preference. As in previous studies, gay men showed greater non-right-handedness and gender nonconformity than straight men. Also, among gay men, bottoms/versatiles (i.e., gay men who take a receptive anal sex role, or who take on both a receptive and insertive anal sex role) were more gender-nonconforming than tops (i.e., gay men who take an insertive anal sex role). In support of the hypothesis, bottoms/versatiles were more non-right-handed than tops and handedness mediated the male sexual orientation and anal sex role differences in Recalled Childhood Gender Nonconformity. Together, these findings suggest that developmental processes linked to handedness underpin variation among men in sexual orientation and gender nonconformity as well as variation among subgroups of gay men that are delineated by anal sex roles. PMID:28234947

  13. Carcinoma espinocelular de canal anal: análise de 11 casos Squamous cell carcinoma of the canal anal: analysis of 11 patients

    Directory of Open Access Journals (Sweden)

    Ana Paula GUIMARÃES

    2001-01-01

    Full Text Available Racional - O câncer de canal anal é um tipo raro de neoplasia, sendo responsável por 4% dos tumores de intestino grosso. São descritos os aspectos clínicos e o tratamento dos pacientes com câncer escamoso desta região. Casuística - Analisaram-se, retrospectivamente, 11 pacientes com carcinoma espinocelular de canal anal. Nove pacientes eram do sexo feminino e dois do masculino. A idade média dos pacientes foi de 57,6 anos (variação 35-82 anos. Resultados - Os sintomas mais freqüentes foram sangramento retal, tumoração e dor local. Seis pacientes tinham lesão benigna prévia local e dois tinham doença metastática na ocasião do diagnóstico. Todos foram submetidos a quimioterapia sistêmica com 5-fluorouracil e mitomicina. Após o tratamento quimio e radioterápico, quatro apresentavam doença residual e foram submetidos a ressecção abdômino-perineal. Três pacientes apresentaram recidiva e quatro morreram pela evolução da própria doença. Conclusão - A maioria dos doentes era do sexo feminino. A químio e a radioterapia podem ser tratamentos curativos nos pacientes com doença localizada; no entanto, aqueles com doença residual devem ser submetidos a ressecção abdômino-perineal. Embora o câncer espinocelular de canal anal seja doença curável, quatro pacientes foram a óbito por terem sido diagnosticados em fase avançada.Background - Anal cancer is an uncommon malignancy accounting for only a small (4% percentage of intestinal cancer. The authors described the clinical aspects and the treatment of the patients with squamous cell carcinoma of the canal anal. Patients - Eleven patients with squamous cell carcinoma treated among 1995 and 1999, were analyzed retrospectively. Nine were women and two were men. The mean age was 57.6 years old (range 35-82 years old. Results - The most common symptoms were rectal bleeding, local tumor and pain. Six of them had previous anal benign disease and two had metastases at the

  14. 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 (P<0.001); and douching with soapy water (P=0.009) among those who douched. Unsats were less common among those with histologic HSIL (P=0.008) and nonsignificantly less common among those with fewer anal 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.

  15. Tehnoloogia aitab varusid juhtida ja analüüsida / Aleksei Dobrõshman

    Index Scriptorium Estoniae

    Dobrõshman, Aleksei

    2005-01-01

    Autor tutvustab logistikavaldkonnas kasutatavaid uusi tarkvaralahendusi: marketingi- ja CRM-süsteemi, elektrooniliste dokumentide vahetamise süsteemi, juhtimise ja analüüsi süsteemi, täiustatud veebitellimuste süsteemi, kliendihaldussüsteemi liikuvatele töötajatele. Lisa: Veebilahendus on mugavam

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

    International Nuclear Information System (INIS)

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

    2008-01-01

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

  17. Parlamentide info- ja analüüsiteenistuste koostöövõrgud / Aare Kasemets

    Index Scriptorium Estoniae

    Kasemets, Aare, 1963-

    2003-01-01

    Euroopa parlamentide teabe- ja analüüsiteenistused ning raamatukogud teevad koostööd mitmes võrgustikus, millest kaks suuremat on Euroopa Parlamendiuuringute ja -dokumentatsiooni Keskus (ECPRD) ning Rahvusvaheline Raamatukoguühingute ja -institutsioonide Liidu (IFLA) parlamendisektsioon. Ülevaade koostöövõrgustikest. Tabel: ECPRD seminarid 2002. ja 2003. aastal

  18. Rectal prolapse and anal incontinence treated with a modified Roscoe Graham operation

    DEFF Research Database (Denmark)

    Klaaborg, K E; Qvist, N; Kronborg, O

    1985-01-01

    The results of abdominal mobilization of the rectum and repair of the pelvic floor behind the anorectal junction are reported in 23 patients with rectal prolapse, being accompanied by some form of anal incontinence in 12. Within 20 months, on the average, three patients had recurrent prolapse. Tw...

  19. Dialoogiaktid ja suhtlusstrateegiad : eesti dialoogikorpuse analüüs / Liina Eskor

    Index Scriptorium Estoniae

    Eskor, Liina

    2005-01-01

    Artikkel põhineb autori magistritööl, mille eesmärgiks oli kohandada soome arvutilingvisti Kristiina Jokineni suhtlusstrateegiate teooriat eestikeelse infodialoogiga ning leida ja analüüsida strateegiate ja dialoogiaktide seoseid. Tutvustatakse ka eesti dialoogikorpust ja dialoogiaktide tüpoloogiat

  20. Laevade erinevate soetamisviiside kommertstingimuste võrdlev analüüs / Ain Eidast, Allan Kivi

    Index Scriptorium Estoniae

    Eidast, Ain, 1939-2013

    2005-01-01

    Laevade erinevate soetamisviiside analüüs näitab, et ühtse, kõikidele osapooltele vastuvõetavate tingimuste väljatöötamine ja rakendamine ei ole tehniliselt võimalik ning majanduslikult õigustatud. Tabelid. Diagrammid

  1. Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis - a randomized trial

    NARCIS (Netherlands)

    Maartense, Stefan; Dunker, Michalda S.; Slors, J. Frederick; Cuesta, Miguel A.; Gouma, Dirk J.; van Deventer, Sander J.; van Bodegraven, Ad A.; Bemelman, Willem A.

    2004-01-01

    Objective: The aim of the study was to evaluate postoperative recovery after hand-assisted laparoscopic or open restorative proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis in a randomized controlled trial. Methods: Sixty patients were

  2. Assertividade e autocontrole: interpretação analítico-comportamental

    Directory of Open Access Journals (Sweden)

    Vívian Marchezini-Cunha

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

  3. PR-spetsid annavad Partsile nõu puhata ja analüüsida

    Index Scriptorium Estoniae

    2005-01-01

    TÜ avalikkussuhete õppejõud Kaja Saksakulm-Tampere soovitab Juhan Partsil toimunut analüüsida, suhtekorraldusspetsialist Ivo Rulli arvates oleks Juhan Partsil mõistlik võtta oma edasises avalikus elus pikem paus, taanduda Res Publica esimehe kohalt ja tegutseda parlamendis opositsioonis

  4. Endoanal MRI of the anal sphincter complex: correlation with cross-sectional anatomy and histology

    NARCIS (Netherlands)

    S.M. Hussain (Shahid); J. Stoker (Jacob); A.W. Zwamborn; J.C. den Hollander (Jan); J.-W. Kuiper (Jan-Willem); C.A. Entius; J.S. Lameris

    1996-01-01

    textabstractThe purpose of this study was to correlate the in vivo endoanal MRI findings of the anal sphincter with the cross-sectional anatomy and histology. Fourteen patients with rectal tumours were examined with a rigid endoanal MR coil before undergoing

  5. Endoanal MRI of the anal sphincter complex: correlation with cross-sectional anatomy and histology

    NARCIS (Netherlands)

    Hussain, S. M.; Stoker, J.; Zwamborn, A. W.; den Hollander, J. C.; Kuiper, J. W.; Entius, C. A.; Laméris, J. S.

    1996-01-01

    The purpose of this study was to correlate the in vivo endoanal MRI findings of the anal sphincter with the cross-sectional anatomy and histology. Fourteen patients with rectal tumours were examined with a rigid endoanal MR coil before undergoing abdominoperineal resection. In addition, 12 cadavers

  6. Schenker laseb kliendil analüüsida teenuse võtmenäitajaid / Toomas Udu

    Index Scriptorium Estoniae

    Udu, Toomas

    2005-01-01

    Logistikaettevõtte Schenker IT- ja arendusdirektor tutvustab klientidele mõeldud veebipõhist analüüsitööriista KPI (Key Performance Indicator - soorituse võtmenäitajad), mille abil on võimalik jälgida saadetise kohaletoimetamise tähtaegadest kinnipidamist. Ekraanipildid

  7. PENGARUH GROUP INVESTIGATION BERBASIS OUTDOOR STUDY TERHADAP KEMAMPUAN BERPIKIR ANALITIS SISWA

    Directory of Open Access Journals (Sweden)

    Valeriana Rasweda

    2016-02-01

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

  8. The use of diverting colostomies in paediatric peri-anal burns ...

    African Journals Online (AJOL)

    2013-08-03

    Aug 3, 2013 ... with stoma formation in children who have suffered severe peri- anal, perineal, buttock and upper-thigh burns. The indications for colostomy and the effect of diversion of the faecal stream on the bacterial profile of the burn wounds, wound healing, graft take and long-term complications were reviewed.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    BACKGROUND: 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. AIMS: To com...

  10. HPV in genital cancers (at the exception of cervical cancer) and anal cancers.

    Science.gov (United States)

    de Sanjosé, Silvia; Bruni, Laia; Alemany, Laia

    2014-12-01

    Human papillomavirus (HPV) infection has been firmly established as a central and necessary cause of invasive cervical cancer and it has been etiologically linked to other anogenital (vulva, vagina, anus and penis) and head and neck cancers, particularly oropharyngeal. Although being rare, the incidence of some of these cancers in some countries has increased in the last decades. HPV-related anogenital tumors share many risk factors with cervical cancer. The HPV aetiological contribution differs in each anatomical location reflecting differences in the natural history and viral tissue tropism. The highest prevalence of HPV DNA in cancers other than cervix has been described for anal, followed by vagina, penile and vulvar cancers. HPV16 has been described as the most common type detected in all cancer sites with different contributions being the highest in anal carcinoma (around 80% of HPV DNA positive anal cancers) and the lowest in vaginal cancers with a contribution similar to that found in cervical cancers (around 60%). Current HPV vaccines have already demonstrated their efficacy in preventing anogenital pre-neoplastic lesions caused by vaccine HPV types. HPV-based prevention tools like HPV vaccination and to a lesser extend screening (e.g. for anal cancer) can be useful measures for reducing the burden of these anogenital cancers. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  11. Kinetics of primary bile acids in patients after proctocolectomy and ileal pouch-anal anastomosis

    NARCIS (Netherlands)

    Gotthardt, Daniel Nils; Sauer, Peter; Schaible, Anja; Stern, Josef; Stiehl, Adolf; Beuers, Ulrich

    2014-01-01

    The high incidence of cholesterol gallstones in patients after proctocolectomy with ileal pouch-anal anastomosis (IPAA) may be due to an increased loss of bile acids. We aimed to evaluate the kinetics of the primary bile acids cholic acid (CA) and chenodeoxycholic acid (CDCA) in these patients. Pool

  12. [Organisation and early outcome of restorative proctocolectomy and ileal pouch-anal anastomosis

    DEFF Research Database (Denmark)

    Ljungmann, K.; Bendixen, A.; Laurberg, S.

    2008-01-01

    INTRODUCTION: Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has become the operation of choice for patients with ulcerative colitis and familial polyposis. However, the procedure is complex with a long learning curve, and carries a risk of both early and late complications...

  13. [DST and low/ultralow/colo-anal anastomoses laparoscopically in the treatment of low rectal cancer].

    Science.gov (United States)

    Zhou, Zongguang; Li, Li; Shu, Ye; Yu, Yongyang; Cheng, Zhong; Lei, Wenzhang; Wang, Tiancai

    2002-01-01

    To assess the feasibility and adequacy of double stapling technique (DST) and anal sphincter preservation with laparoscopic approach for low rectal cancer. DST and low/ultralow/coloanal anastomoses were performed laparoscopically on 30 patients with low rectal cancer. The 30 laparoscopic DST and low/ultralow/colo-anal anastomoses with anal sphincter preservation were successfully completed, and not one of the cases was converted to open procedures. The operation time was 155 min with the ranges from 110 to 320 min. The operative blood loss was 20 ml with a range between 5 and 80 ml. The time of bowel function restoration and post-operative ambulation was 1-2 days after the operation. 14 patients had postoperative analgesic requirement. The hospital stay varied from 5 to 14 days, averaging 8 days, and there were no intraoperative and postoperative complications in the 30 patients. Laparoscopic DST and low/ultralow/colo-anal anastomoses for low rectal cancer is a perspective minimally invasive technique, which is feasible, safe and effective. With the use of this technique, surgeons could accomplish higher rates of sphincter preservation, more accurate autonomic nerve preservation and good micturation with decreased postoperative pain and rapid recovery.

  14. Sources and severity of self-reported food intolerance after ileal pouch-anal anastomosis

    NARCIS (Netherlands)

    Steenhagen, E.; Roos, de N.M.; Bouwman, C.A.; Laarhoven, van C.J.H.M.; Staveren, van W.A.

    2006-01-01

    Data on food intolerance after ileal pouch-anal anastomosis are scarce. The aim of this study was to identify foods causing intolerance and to determine the nature and severity of reported symptoms. Patients from the Dutch Crohn's and Ulcerative Colitis Association were mailed a survey on food

  15. [Gluteus maximus transplantation for fecal incontinence after surgery of high anal atresia].

    Science.gov (United States)

    Kong, Feiteng; Li, Fuyu; Liu, Juxian; Chen, Yongmei; Wu, Yang; Yang, Xiaodong; Xiang, Bo

    2012-05-01

    To investigate the application of gluteus maximus transplantation for fecal incontinence after surgery of high anal atresia. Between December 2002 and November 2010, 25 patients with fecal incontinence were treated with gluteus maximus transplantation, which was caused by surgery of high anal atresia. There were 11 males and 14 females with an average age of 10.2 years (range, 3-22 years). Preoperative radiography, anorectal manometer, and electromyogram showed abnormality or deficiency of anal sphincter function. Wexner score, Fecal Incontinence Quality of Life (FIQL) questionnaire, and Self-rated Health Measurement Scale Version 1.0 (SRHMS) score were used to evaluate life quality of the patients. The anorectal manometer, intra-rectal ultrasound examination, and defecation radiography were performed. Healing of incision by first intention was achieved in 23 cases and rectal-wound fistula occurred in 2 cases. The follow-up time was 1 to 9 years (mean, 6.3 years). Defecation frequency was decreased from more than 10 times to 4-6 times every day. Wexner score and SRHMS were significantly improved at 1 or 2 years after surgery when compared with preoperative socres (P Gluteus maximus transplantation can improve defecation controls in the patients with fecal incontinence after surgery of high anal atresia.

  16. Loovutatava isiku õigused loovutamismenetluses. Kohtupraktika analüüs / Marje Allikmets

    Index Scriptorium Estoniae

    Allikmets, Marje, 1989-

    2013-01-01

    Euroopa vahistamismääruse alusel toimuvast loovutamismenetlusest. Loovutatava isiku õiguste kaitse probleemidest. Artikkel põhineb autori 2013. a. Tartu Ülikooli õigusteaduskonnas kaitstud magistritööl "Loovutatava isiku õigused loovutamismenetluses - kohtupraktika analüüs"

  17. Location Of External Anal Spincter Motoneurons In The Sacral Cord Of The Female Domestic Pig.

    NARCIS (Netherlands)

    Blok, Bertil F.M.; Roukema, Gert; Geerdes, Bas; Holstege, Gert

    1996-01-01

    The location of the striated external anal sphincter motoneurons in the spinal cord was investigated in 12, between 3 and 4 months old, female domestic pigs using the retrograde tracer horseradish peroxidase (HRP). Their motoneuronal cell bodies were found in the spinal segments Sl-S3, and were not

  18. Role of Positron Emission Tomography-Computed Tomography in the Management of Anal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Mistrangelo, Massimiliano, E-mail: mistrangelo@katamail.com [Digestive and Colorectal Surgical Department, Centre of Minimal Invasive Surgery, University of Turin, Molinette Hospital, Turin (Italy); Pelosi, Ettore [PET Center IRMET spa, Turin (Italy); Bello, Marilena [Department of Nuclear Medicine, University of Turin, Molinette Hospital (Italy); Ricardi, Umberto [Department of Radiotherapy, University of Turin, Molinette Hospital (Italy); Milanesi, Enrica [Oncological Centre for Gastrointestinal Neoplasms, University of Turin, Molinette Hospital (Italy); Cassoni, Paola [Department of Biomedical Sciences and Human Oncology, University of Turin, Molinette Hospital (Italy); Baccega, Massimo [Department of Nuclear Medicine, Molinette Hospital (Italy); Filippini, Claudia [Anaesthesia and Intensive Care Unit, University of Turin, Molinette Hospital (Italy); Racca, Patrizia [Oncological Centre for Gastrointestinal Neoplasms, University of Turin, Molinette Hospital (Italy); Lesca, Adriana [Department of Nuclear Medicine, Molinette Hospital (Italy); Munoz, Fernando H. [Department of Radiotherapy, University of Turin, Molinette Hospital (Italy); Fora, Gianluca [Oncological Centre for Gastrointestinal Neoplasms, University of Turin, Molinette Hospital (Italy); Skanjeti, Andrea [Department of Nuclear Medicine, University of Turin, Molinette Hospital (Italy); Cravero, Francesca; Morino, Mario [Digestive and Colorectal Surgical Department, Centre of Minimal Invasive Surgery, University of Turin, Molinette Hospital, Turin (Italy)

    2012-09-01

    Purpose: Pre- and post-treatment staging of anal cancer are often inaccurate. The role of positron emission tomograpy-computed tomography (PET-CT) in anal cancer is yet to be defined. The aim of the study was to compare PET-CT with CT scan, sentinel node biopsy results of inguinal lymph nodes, and anal biopsy results in staging and in follow-up of anal cancer. Methods and Materials: Fifty-three consecutive patients diagnosed with anal cancer underwent PET-CT. Results were compared with computed tomography (CT), performed in 40 patients, and with sentinel node biopsy (SNB) (41 patients) at pretreatment workup. Early follow-up consisted of a digital rectal examination, an anoscopy, a PET-CT scan, and anal biopsies performed at 1 and 3 months after the end of treatment. Data sets were then compared. Results: At pretreatment assessment, anal cancer was identified by PET-CT in 47 patients (88.7%) and by CT in 30 patients (75%). The detection rates rose to 97.9% with PET-CT and to 82.9% with CT (P=.042) when the 5 patients who had undergone surgery prior to this assessment and whose margins were positive at histological examination were censored. Perirectal and/or pelvic nodes were considered metastatic by PET-CT in 14 of 53 patients (26.4%) and by CT in 7 of 40 patients (17.5%). SNB was superior to both PET-CT and CT in detecting inguinal lymph nodes. PET-CT upstaged 37.5% of patients and downstaged 25% of patients. Radiation fields were changed in 12.6% of patients. PET-CT at 3 months was more accurate than PET-CT at 1 month in evaluating outcomes after chemoradiation therapy treatment: sensitivity was 100% vs 66.6%, and specificity was 97.4% vs 92.5%, respectively. Median follow-up was 20.3 months. Conclusions: In this series, PET-CT detected the primary tumor more often than CT. Staging of perirectal/pelvic or inguinal lymph nodes was better with PET-CT. SNB was more accurate in staging inguinal lymph nodes.

  19. Ettevaatust! Läbipõlemisoht! / Mart Raudsaar

    Index Scriptorium Estoniae

    Raudsaar, Mart, 1973-

    2004-01-01

    Raamatu "Burnout - läbipõlemine" autor Mart Jürisoo räägib läbipõlemise olulisematest põhjustest ja tunnustest, võrdleb Eesti ja Rootsi juhtide juhtimisstiile ning analüüsib stressitegureid Eesti organisatsioonides ja ühiskonnas. Lisa: Läbipõlemise olulisemad sümptomid; Difuusse ehk Marshmallow-organisatsiooni tunnused ja probleemid

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

    Science.gov (United States)

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

    2014-05-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2001-04-01

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

  3. Oral and anal vaccination confers full protection against enteric redmouth disease (ERM in rainbow trout.

    Directory of Open Access Journals (Sweden)

    Kasper Rømer Villumsen

    Full Text Available The effect of oral vaccines against bacterial fish diseases has been a topic for debate for decades. Recently both M-like cells and dendritic cells have been discovered in the intestine of rainbow trout. It is therefore likely that antigens reaching the intestine can be taken up and thereby induce immunity in orally vaccinated fish. The objective of this project was to investigate whether oral and anal vaccination of rainbow trout induces protection against an experimental waterborne infection with the pathogenic enterobacteria Yersinia ruckeri O1 biotype 1 the causative agent of enteric redmouth disease (ERM. Rainbow trout were orally vaccinated with AquaVac ERM Oral (MERCK Animal Health or an experimental vaccine bacterin of Y. ruckeri O1. Both vaccines were tested with and without a booster vaccination four months post the primary vaccination. Furthermore, two groups of positive controls were included, one group receiving the experimental oral vaccine in a 50 times higher dose, and the other group receiving a single dose administered anally in order to bypass the stomach. Each group was bath challenged with 6.3 × 10(8 CFU/ml Y. ruckeri, six months post the primary vaccination. The challenge induced significant mortality in all the infected groups except for the groups vaccinated anally with a single dose or orally with the high dose of bacterin. Both of these groups had 100% survival. These results show that a low dose of Y. ruckeri bacterin induces full protection when the bacterin is administered anally. Oral vaccination also induces full protection, however, at a dose 50 times higher than if the fish were to be vaccinated anally. This indicates that much of the orally fed antigen is digested in the stomach before it reaches the second segment of the intestine where it can be taken up as immunogenic antigens and presented to lymphocytes.

  4. Gender Nonconformity and Birth Order in Relation to Anal Sex Role Among Gay Men.

    Science.gov (United States)

    Swift-Gallant, Ashlyn; Coome, Lindsay A; Monks, D Ashley; VanderLaan, Doug P

    2018-05-01

    Androphilia is associated with an elevated number of older brothers among natal males. This association, termed the fraternal birth order effect, has been observed among gay men who exhibit marked gender nonconformity. Gender nonconformity has been linked to gay men's preferred anal sex role. The present study investigated whether these two lines of research intersect by addressing whether the fraternal birth order effect was associated with both gender nonconformity and a receptive anal sex role (243 gay men, 91 heterosexual men). Consistent with previous research, we identified the fraternal birth order effect in our sample of gay men. Also, gay men were significantly more gender-nonconforming on adulthood and recalled childhood measures compared to heterosexual men. When gay men were compared based on anal sex role (i.e., top, versatile, bottom), all groups showed significantly greater recalled childhood and adult male gender nonconformity than heterosexual men, but bottoms were most nonconforming. Only gay men with a bottom anal sex role showed evidence of a fraternal birth order effect. A sororal birth order effect was found in our sample of gay men, driven by versatiles. No significant associations were found between fraternal birth order and gender nonconformity measures. These results suggest that the fraternal birth order effect may apply to a subset of gay men who have a bottom anal sex role preference and that this subgroup is more gender-nonconforming. However, there were no significant associations between fraternal birth order and gender nonconformity at the individual level. As such, based on the present study, whether processes underpinning the fraternal birth order effect influence gender nonconformity is equivocal.

  5. Preoperative Therapy for Lower Rectal Cancer and Modifications in Distance From Anal Sphincter

    International Nuclear Information System (INIS)

    Gavioli, Margherita; Losi, Lorena; Luppi, Gabriele; Iacchetta, Francesco; Zironi, Sandra; Bertolini, Federica; Falchi, Anna Maria; Bertoni, Filippo; Natalini, Gianni

    2007-01-01

    Purpose: To assess the frequency and magnitude of changes in lower rectal cancer resulting from preoperative therapy and its impact on sphincter-saving surgery. Preoperative therapy can increase the rate of preserving surgery by shrinking the tumor and enhancing its distance from the anal sphincter. However, reliable data concerning these modifications are not yet available in published reports. Methods and Materials: A total of 98 cases of locally advanced cancer of the lower rectum (90 Stage uT3-T4N0-N+ and 8 uT2N+M0) that had undergone preoperative therapy were studied by endorectal ultrasonography. The maximal size of the tumor and its distance from the anal sphincter were measured in millimeters before and after preoperative therapy. Surgery was performed 6-8 weeks after therapy, and the histopathologic margins were compared with the endorectal ultrasound data. Results: Of the 90 cases, 82.5% showed tumor downsizing, varying from one-third to two-thirds or more of the original tumor mass. The distance between the tumor and the anal sphincter increased in 60.2% of cases. The median increase was 0.73 cm (range, 0.2-2.5). Downsizing was not always associated with an increase in distance. Preserving surgery was performed in 60.6% of cases. It was possible in nearly 30% of patients in whom the cancer had reached the anal sphincter before the preoperative therapy. The distal margin was tumor free in these cases. Conclusion: The results of our study have shown that in very low rectal cancer, preoperative therapy causes tumor downsizing in >80% of cases and in more than one-half enhances the distance between the tumor and anal sphincter. These modifications affect the primary surgical options, facilitating or making sphincter-saving surgery possible

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

    Science.gov (United States)

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

    2014-03-13

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

  7. Topical glyceryl trinitrate in the treatment of anal fissure Utilidad del gliceril trinitrato en el tratamiento tópico de la fisura anal

    Directory of Open Access Journals (Sweden)

    F. Novell

    2004-04-01

    Full Text Available Aim: the aim of this study was to assess the effectiveness of topical glyceryl trinitrate (GTN in the treatment of anal fissure. Patients: eighty consecutive patients were randomized to receive 0.2% GTN gel twice a day during a minimum of 6 weeks. Of these 80 patients 34 were males and 46 female, with ages be-tween 20 and 78 years. All patients underwent a work-up that included gender, age, symptom duration, site, previous treatment attempts, pain score, associated diseases, and maximum anal resting pressure. These patients were followed at regular intervals of 4, 8, and 12 weeks to assess symptom outcome, rate of healing, adverse effects, and recurrence rate. Results: pain scores were significantly reduced during the treatment period in 65% of cases. After 4 weeks, 55% of patients had healed, and 78% after 9 weeks. In 18 patients (22%, anal fissures did not heal even with 6 additional weeks of treatment, and 12 of them (15% underwent lateral sphincterotomy. Sixty one percent of patients had flushing and 15% severe headaches. Conclusion: the results of this study have demonstrated the significant benefit of topical GTN when administered to patients suffering from anal fissures.Objetivo: el objetivo de este estudio era la valoración de la aplicación tópica de gliceril trinitrato en el tratamiento de las fisuras anales. Pacientes: un total de 80 consecutivos pacientes eran randomizados recibiendo gliceril trinitrato al 0,2% gel dos veces al día, durante un mínimo de 6 semanas. De los 80 pacientes, 34 eran varones y 46 mujeres, con edad comprendida entre 20 y 78 años. En los pacientes se controlaba sexo, edad, duración de síntomas, duración de tratamiento, localización, patología previa asociada, y valoración del dolor. Seguimiento a 4, 8 y 12 semanas, para controlar la sintomatología, el grado de curación, los efectos adversos y la relación de recidiva. Resultados: la disminución del dolor fue significativa en el 65% de los casos y

  8. 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.

  9. Core outcome research measures in anal cancer (CORMAC): protocol for systematic review, qualitative interviews and Delphi survey to develop a core outcome set in anal cancer.

    Science.gov (United States)

    Fish, Rebecca; Sanders, Caroline; Williamson, Paula R; Renehan, Andrew G

    2017-11-22

    The incidence of anal squamous cell carcinoma (ASCC) has increased threefold in the last 30 years. Initial treatment is chemoradiotherapy, associated with short-term and long-term side effects. Future therapy innovations aim to reduce morbidity in treatment of early tumours while maintaining treatment efficacy, and to escalate treatment intensity in locally advanced tumours with acceptable quality of life (QoL). However, all phase III randomised controlled trials to-date have utilised different primary outcomes, which hinders evidence synthesis and presents challenges to the selection of optimal outcomes in future trials. No trial comprehensively assessed long-term side effects and QoL, suggesting outcomes reflecting issues important to patients are under-represented. This project aims to determine the priority outcomes for all stakeholders and reach agreement on a standardised core set of outcomes to be measured and reported on in all future ASCC trials. A systematic review will identify all outcomes reported in trials and observational studies of chemoradiotherapy as primary treatment for ASCC. Outcomes of importance to patients will be identified through patient interviews. The long list of outcomes generated from the systematic review and interviews will be used to create a two-round Delphi process, including key stakeholders (patients and healthcare professionals). The results of the Delphi will be discussed at a face-to-face consensus meeting. Discussion will focus on outcomes that did not achieve consensus through the Delphi process and conclude with anonymous voting to ratify the final core outcome set (COS). The final COS will feed directly into the PersonaLising Anal cancer radioTherapy dOse (PLATO) national anal cancer trials and the Association of coloproctologists of Great Britain and Ireland (ACPGBI) supported national anal cancer database. Utilisation of the COS will increase the relevance of research output to all stakeholders and increase the

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

    Directory of Open Access Journals (Sweden)

    Sidney Roberto Nadal

    2008-12-01

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

  11. Melanoma de canal anal simulando doença hemorroidária: relato de caso Melanoma of the anal canal simulating hemorrhoidal disease: case report

    Directory of Open Access Journals (Sweden)

    Lorena Reuter Motta Gama

    2010-09-01

    Full Text Available O Melanoma Anorretal é um tumor maligno raro com a possibilidade de simular uma doença anorretal, tornando o diagnóstico difícil. Tem baixos índices de cura e elevados índices de mortalidade em curto prazo. Os autores descrevem um caso de melanoma de canal anal cuja interpretação por parte do paciente tratava-se de uma doença hemorroidária que exteriorizava às evacuações. Os autores fazem uma extensa revisão da literatura dando ênfase aos sintomas e a melhor opção terapêutica a ser instituída.Anorectal melanoma is a rare malignant tumor with the small chance of simulating anorectal disease, making the diagnosis hard. There is a low rate of cure and high rate of short term mortality. The authors describe a case of anal melanoma which by the patient's interpretation was hemorrhoid disease that exteriorized evacuations. The authors do an extensive evaluation of the literature, giving emphasis to the symptoms and the best therapeutic option to be used.

  12. Atresia anal com fístula retovaginal em ovino: relato de caso

    Directory of Open Access Journals (Sweden)

    M.L. Antonioli

    Full Text Available RESUMO A atresia anal com fístula retovaginal, é considerada uma afecção congênita rara nos ovinos. Em virtude disso, buscou-se descrever o reparo cirúrgico e cuidados pós-operatórios em uma borrega que apresentava essa afecção. Nesse sentido, uma borrega, sem raça definida, de 25 dias de idade e pesando 7,2kg, apresentou sinais de distensão abdominal e defecação pela vulva. A afecção foi diagnosticada por meio do exame clínico e confirmada radiograficamente, constatando-se atresia anal do tipo III em associação com a fístula.

  13. Anal carcinoma - Survival and recurrence in a large cohort of patients treated according to Nordic guidelines

    DEFF Research Database (Denmark)

    Leon, Otilia; Guren, Marianne; Hagberg, Oskar

    2014-01-01

    OBJECTIVE: To evaluate treatment outcome in a large population-based cohort of patients with anal cancer treated according to Nordic guidelines. MATERIAL: Clinical data were collected on 1266 patients with anal squamous cell carcinoma diagnosed from 2000 to 2007 in Sweden, Norway and Denmark. 886......-inclusion into a protocol were all independent factors associated with worse outcome. Among patients treated according to any of the protocols, the 3-year recurrence-free survival ranged from 63% to 76%, with locoregional recurrences in 17% and distant metastases in 11% of patients. The highest rate of inguinal recurrence...... of the patients received radiotherapy 54-64Gy with or without chemotherapy (5-fluorouracil plus cisplatin or mitomycin) according to different protocols, stratified by tumor stage. RESULTS: High age, male gender, large primary tumor, lymph node metastases, distant metastases, poor performance status, and non...

  14. Dialoogide pragmaatilise analüüsi tarkvara / Software for pragmatic analysis of dialogues

    Directory of Open Access Journals (Sweden)

    Olga Gerassimenko

    2014-04-01

    Full Text Available Meie uurimisobjektiks on eestikeelsed dialoogid (inimestevaheliste suuliste dialoogide transkriptsioonid ja inim-masindialoogide logifailid. Eesmärgiks on määrata, missuguseid dialoogiakte ja missuguseid suhtlusstrateegiaid kasutavad dialoogis osalejad ning missugustest struktuuriosadest dialoogid koosnevad, s.o läbi viia pragmaatilist analüüsi. Selleks, et lihtsustada dialoogide pragmaatilist analüüsi, arendame tarkvara, mis võimaldab tuvastada ja märgendada dialoogi tekstis dialoogiakte, suhtlusstrateegiaid ja dialoogi struktuuriosi (sh alamdialooge. Dialoogiaktide tuvastamiseks rakendame andmepõhist meetodit, samas suhtlusstrateegiate ja dialoogi struktuuri määramine põhineb reeglitel. Tarkvara kasutavad lingvistid dialoogide uurimisel, mille kaugem eesmärk on dialoogsüsteemi arendamine, mis suhtleks kasutajaga loomulikus keeles, järgides inimestevahelise suhtluse norme.

  15. Poor Outcomes of Complicated Pouch-Related Fistulas after Ileal Pouch-Anal Anastomosis Surgery

    DEFF Research Database (Denmark)

    Kjaer, M D; Kjeldsen, J; Qvist, N

    2016-01-01

    . Overall pouch failure, defined as pouch excision or a diverting stoma, was seen in 34 (71%) patients, while pouch excision was seen in 23 (48%) of the patients. Patients who developed Crohn's disease had a significantly higher risk of pouch excision, as did patients with an early onset of the fistula...... after ileal pouch-anal anastomosis (P = 0.006 and P = 0.007, respectively). In conclusion, the present study demonstrated a high risk of pouch failure in patients with complicated pouch-related fistulas. Furthermore, it showed that Crohn's disease and the development of early onset fistulas......BACKGROUND AND AIMS: Development of a pouch-related fistula tract is an uncommon but highly morbid complication to restorative proctocolectomy with ileal pouch-anal anastomosis. Pouch failure with permanent ileostomy is reported in 21%-30% of patients, yet the factors contributing to pouch excision...

  16. Of mice and men: an introduction to mouseology or, anal eroticism and Disney.

    Science.gov (United States)

    Berger, A A

    1991-01-01

    This essay deals with two important comics, Walt Disney's Mickey Mouse and George Herriman's Krazy Kat, and considers the social, cultural, psychological and symbolic significance of the main characters and their creators. In the discussion of Disney and his work (based, in part on writings about him) it is suggested that he exhibited traits associated with anal eroticism, which raises an interesting question about the popularity of his work with the American public. The two dominant themes found in Krazy Kat are described as "the triumph of illusion over reality" and "anti-authoritarianism." In a comparison of the two characters, it is shown they are polar opposites: Mickey Mouse is sadistic, asexual, and anal while Ignatz Mouse, the hero of Krazy Kat, is playful, sexual, and phallic.

  17. 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

  18. Prevalence of genital, oral, and anal HPV infection among STI patients in Italy.

    Science.gov (United States)

    Ciccarese, Giulia; Herzum, Astrid; Rebora, Alfredo; Drago, Francesco

    2017-06-01

    Human papillomavirus (HPV) is a carcinogenic agent responsible for tumor development in many sexually involved tissues. We present a survey on the prevalence of HPV infection in a risk population for sexually transmitted infections (STIs). The studied population was formed by 125 STI clinic attendees, who took part in a screening program on STIs. To be included in the study, the patients had to show no overt clinical signs of HPV infection. Genital (cervical in women, urethral in men), anal, and oral samples were collected with ThinPrep liquid based cytology preparation system. Overall, of the screened population, 56% proved positive for genital HPV, 37% for oral HPV, and 42% for anal HPV infection. Our data indicate that in STI patients, HPV infection is more prevalent, than previously estimated. Further studies are needed to better understand the epidemiological burden of HPV in sexually involved tissues, especially in the oral mucosa. © 2016 Wiley Periodicals, Inc.

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

    DEFF Research Database (Denmark)

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

    fish. The objective for this project is to investigate whether oral and anal vaccination of rainbow trout against Yersinia ruckeri O1 (biotype 1) causing Enteric Red Mouth disease (ERM) can protect rainbow trout against a subsequent experimental bath challenge.The rainbow trout were given oral......The effect of oral vaccines against bacterial fish diseases has been a topic for debate in many years. Recently both M-cells and dendritic cells have been found in fish and it is therefore likely that antigens can be taken up from the intestine and induce immunity in orally and anally vaccinated...... vaccinations with AquaVacTM ERM Oral vet. (MSD animal health) or an experimental vaccine based on formalin killed Yersinia ruckeri O1, (biotype 1) bacteria. Eight groups were studied: 1) Control group (no vaccination, no infection), 2) infected control, 3) experimental vaccine, 4) experimental vaccine w...

  20. Management of persistent anal canal carcinoma after combined-modality therapy: a clinical review.

    Science.gov (United States)

    Musio, Daniela; De Felice, Francesca; Raffetto, Nicola; Tombolini, Vincenzo

    2014-01-28

    Anal canal carcinoma is a rare gastro-intestinal cancer. Radiochemotherapy is the recommended primary treatment for patients with non-metastatic carcinoma; surgery is generally reserved for persistent or recurrent disease. Follow-up and surveillance after primary treatment is paramount to classify patients in those with complete remission, persistent or progressive disease. Locally persistent disease represents a clinically significant problem and its management remains subject of some controversy.The aim of this systematic review is to summarise recommendations for the primary treatment of anal canal carcinoma, to focus on the optimal time to consider residual disease as genuine persistence to proceed with salvage treatment, and to discern how this analysis might inform future clinical trials in management in this class of patients.

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

    DEFF Research Database (Denmark)

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

    The effect of oral vaccines against bacterial fish diseases has been a topic for debate in many years. Recently both M-cells and dendritic cells have been found in fish and it is therefore likely that antigens can be taken up from the intestine and induce immunity in orally and anally vaccinated...... fish. The objective for this project is to investigate whether oral and anal vaccination of rainbow trout against Yersinia ruckeri O1 (biotype 1) causing Enteric Red Mouth disease (ERM) can protect rainbow trout against a subsequent experimental bath challenge.The rainbow trout were given oral...... vaccinations with AquaVacTM ERM Oral vet. (MSD animal health) or an experimental vaccine based on formalin killed Yersinia ruckeri O1, (biotype 1) bacteria. Eight groups were studied: 1) Control group (no vaccination, no infection), 2) infected control, 3) experimental vaccine, 4) experimental vaccine w...

  2. Amines in the marking fluid and anal sac secretion of the tiger, Panthera tigris.

    Science.gov (United States)

    Banks, G R; Buglass, A J; Waterhouse, J S

    1992-01-01

    Analysis of the marking fluid of two tigers (one Bengal and one Sumatran) by GC using an amine-specific column and a nitrogen-specific detector has shown the presence of the following amines: ammonia, methylamine, dimethylamine, trimethylamine, triethylamine, propylamine, and butane-1,4-diamine (putrescine). In contrast to previously published reports, we were unable to detect 2-phenylethylamine. The anal sac secretion was found to have a similar amine content.

  3. External resection of a giant sigmoid lipoma causing colonic intussusception and prolapse through the anal canal.

    Science.gov (United States)

    Tony, Jose; Saji, Sebastian; Sandesh, K; Sunilkumar, K; Ramachandran, T M; Thomas, Varghese

    2007-01-01

    We depict the case of an 80-year-old female patient who presented to us with a history of protruding mass per anum. Sigmoidoscopy revealed a large globular pedunculated polyp at 22 cm from the anal verge resulting in a sigmoidorectal intussusception. Endoscopic polypectomy was not technically possible due to the large size of the polyp. At the time of prolapse the polyp was tied at its pedicle with thread and resected surgically. The patient is asymptomatic on follow-up.

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

    International Nuclear Information System (INIS)

    Wiesmeth, Alfred J.

    2013-01-01

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

  5. An Analysis of Widely Viewed YouTube Videos on Anal Cancer.

    Science.gov (United States)

    Basch, Corey H; Kecojevic, Aleksandar; Berdnik, Alyssa; Cadorett, Valerie; Basch, Charles E

    2017-01-01

    Rates of anal squamous cell carcinoma have increased over recent decades. The aim of this study was to describe characteristics of widely viewed YouTube videos about anal cancer. A total of 57 videos were identified and reviewed. Videos were assessed and coded with respect to date uploaded, upload source, gender of presenter, number of views, length in minutes, number of likes and dislikes, and selected aspects of content. Each video was assessed to determine if the sole purpose of the video was to provide information regarding anal cancer or existed to serve another purpose. Content related to anal cancer was categorized. The mean number of views was 23,548 (range 1014-440,078), and the average length of videos was 8:14 min. The upload source of 57 videos was 19 (33.3%) by consumers, 12 (21.1%) by professional, and 26 (45.6%) by news-based sources. More than half ( n = 30; 52.6%) had the sole purpose of providing information. The most frequently mentioned topics were treatment ( n = 25, 43.9%), symptoms ( n = 15, 26.3%), encouraging screening, human papillomavirus, and pain, respectively ( n = 14, 26.4% for each); only 6 of the 57 videos (10.5%) specifically mentioned prevention. None of 57 most widely viewed videos were uploaded by any agency of the U.S. Public Health Service or by any other U.S. governmental agency. It is important for health practitioners to be aware of the type of information available for their patients on the YouTube platform.

  6. Endoanal MRI of the anal sphincter complex: correlation with cross-sectional anatomy and histology.

    OpenAIRE

    Hussain, S M; Stoker, J; Zwamborn, A W; Den Hollander, J C; Kuiper, J W; Entius, C A; Laméris, J S

    1996-01-01

    textabstractThe purpose of this study was to correlate the in vivo endoanal MRI findings of the anal sphincter with the cross-sectional anatomy and histology. Fourteen patients with rectal tumours were examined with a rigid endoanal MR coil before undergoing abdominoperineal resection. In addition, 12 cadavers were used to obtain cross-sectional anatomical sections. The images were correlated with the histology and anatomy of the resected rectal specimens as well as with the cross-sectional a...

  7. Specific obstetrical risk factors for urinary versus anal incontinence 4years after first delivery.

    OpenAIRE

    Fritel , Xavier; Khoshnood , Babak; Fauconnier , Arnaud

    2013-01-01

    International audience; AIM: Delivery can be complicated by urinary or anal incontinence (UI or AI). We hypothesized that the mechanisms of injury may differ for UI and AI. Hence, obstetrical risk factors may be specific for different types of incontinence. DESIGN: Data on maternal characteristics were collected at first delivery. Data on incontinence were obtained by a questionnaire completed by 627 women 4years after first delivery. UI was defined by "Do you have involuntary loss of urine" ...

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

    International Nuclear Information System (INIS)

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

    2014-01-01

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

  9. Preoperative wireless capsule endoscopy does not predict outcome after ileal pouch-anal anastomosis.

    Science.gov (United States)

    Murrell, Zuri; Vasiliauskas, Eric; Melmed, Gil; Lo, Simon; Targan, Stephan; Fleshner, Phillip

    2010-03-01

    The extent of preoperative small-bowel mucosal inflammation may be an important predictor of pouchitis after ileal pouch-anal anastomosis. This study examined the value of preoperative wireless capsule endoscopy in predicting outcome of ileal pouch-anal anastomosis in patients with ulcerative colitis or indeterminate colitis. Patients undergoing complete wireless capsule endoscopy before ileal pouch-anal anastomosis were identified. Findings on wireless capsule endoscopy were classified as positive (erosions, ulcers or erythema) or negative. Outcome was assessed prospectively and included no pouchitis, acute pouchitis, chronic pouchitis, or de novo Crohn disease. Patients with acute pouchitis, chronic pouchitis, or de novo Crohn disease were considered to have pouch inflammation. The 68 study patients (48 ulcerative colitis; 20 indeterminate colitis) had a median age of 38 years and included 34 males. Median follow-up time after ileostomy closure was 12 months (range, 3-63 months). Wireless capsule endoscopy was positive in 15 patients (22%) and negative in 53 patients (78%). Pouch inflammation was observed in 23 patients (34%), and included 8 patients with acute pouchitis, 3 patients with chronic pouchitis, and 12 patients with de novo Crohn disease. The incidence of acute pouchitis, chronic pouchitis, de novo Crohn disease, and pouch inflammation in the wireless capsule endoscopy-positive patient group was 7%, 7%, 20%, and 33% compared with 13%, 4%, 17%, and 34% in the wireless capsule endoscopy-negative patient group (all P = NS). There was no statistical association between the results of preoperative wireless capsule endoscopy and outcome after ileal pouch-anal anastomosis in patients with ulcerative colitis or indeterminate colitis. There seems to be little value of wireless capsule endoscopy in the preoperative evaluation of these patients.

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

    Science.gov (United States)

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

    2012-08-01

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

  11. ARM tõestab, et ka analüütikud eksivad / Fredy-Edwin

    Index Scriptorium Estoniae

    Esse, Fredy-Edwin

    2011-01-01

    Apple'i iPadidele ja iPhone'idele kiipe tootva Suurbritannia firma ARM Holdings aktsia on kõige suurem tõusja Londoni FTSE 100 indeksi kuue kuu, 12 kuu, 18 kuu, kahe aasta ja kolme aasta lõikes, samas on analüütikud kõigist indeksi aktsiatest kõige negatiivsemalt meelestatud just ARM Holdingsi suhtes. Graafik

  12. Mart Humal, "Uuringuid tonaalsusstruktuuridest. Sissejuhatus ja neliteist analüütilist etüüdi" / Kerri Kotta

    Index Scriptorium Estoniae

    Kotta, Kerri, 1969-

    2007-01-01

    Rets. rmt. : Humal, Mart. Uuringuid tonaalstruktuuridest : sissejuhatus ja neliteist analüütilist etüüdi = Studies on tonal structures : introduction and fourteen analytical studies. Tallinn : Eesti Muusika- ja Teatriakadeemia, 2007. - Töid muusikateooria alalt ; 3

  13. Menetlejate küsitlemistehnikad : alla 14-aastaste laste ülekuulamisprotokollide analüüs / Kristjan Kask

    Index Scriptorium Estoniae

    Kask, Kristjan, 1980-

    2010-01-01

    Alla 14-aastaste laste kohtueelse ülekuulamise videosalvestiste analüüsist. Ülevaade põhineb Justiitsministeeriumi poolt 2009. aastal läbi viidud uurimisprojektil "Alaealiste ülekuulamine kriminaalmenetluses". Tabelid

  14. Võlur Ozi eksperimentide kogumine ja partneri algatatud paranduste analüüs / Siiri Pärkson

    Index Scriptorium Estoniae

    Pärkson, Siiri

    2011-01-01

    Kirjeldatakse teise võlur Ozi kirjalike eksperimentide seeria analüüsi tulemusi. Materjal pärineb dialoogidest, kus katseisikutel paluti testida kirjalikus eesti keeles suhtlevat internetilehel asuvat programmi

  15. A new species of Chaetostoma Tschudi (Siluriformes: Loricariidae from Colombia with a definition of the C. anale species group

    Directory of Open Access Journals (Sweden)

    Gustavo A. Ballen

    2011-01-01

    Full Text Available Chaetostoma formosae sp. nov. is described from piedmont tributaries of the upper río Meta on the Cordillera Oriental in Colombia. The new species is distinguished from its congeners by the presence of an elongate unbranched anal-fin ray with two posterior dermal ridges in mature males, the presence of strongly recurved cheek odontodes, the presence of a parieto-supraoccipital dermal keel, the posterior margin of the pelvic-fin strongly projected and angulate in shape in mature males, and by details of coloration. The new species belongs to an informal monophyletic group herein called the Chaetostoma anale species group, along with two additional species, C. anale and C. jegui, from Colombia and Brazil respectively, based on an apomorphic modification of the anal fin in mature males.

  16. Analýza sportovního areálu vybranými metodami

    OpenAIRE

    Jelínek, Vojtěch

    2014-01-01

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

  17. Genital and Subjective Sexual Response in Women After Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis-A Prospective Clinical Trial

    NARCIS (Netherlands)

    Vlug, Malaika S.; Laan, Ellen T.; van Lunsen, Rik H. W.; van Koperen, Paul J.; Polle, Sebastiaan W.; Bemelman, Willem A.

    2010-01-01

    Introduction. Sexual dysfunction after ileo pouch anal anastomosis (IPAA) is common. The most systematic physical reaction to sexual stimulation is an increase in vaginal vasocongestion. Genital response can be assessed by vaginal pulse amplitude (VPA) using vaginal photoplethysmography. Aim. To

  18. High-resolution magnetic resonance imaging of the anal sphincter using a dedicated endoanal receiver coil

    Energy Technology Data Exchange (ETDEWEB)

    DeSouza, N.M.; Williams, A.D.; Gilderdale, D.J. [Dept. of Radiology, Imperial College School of Medicine, London (United Kingdom)

    1999-04-01

    The use of a surface coil in MR imaging improves signal-to-noise ratio of adjacent tissues of interest. We therefore devised an endoanal receiver coil for imaging the anal sphincter. The probe is solid and re-usable: it comprises a saddle geometry receiver with integral tuning, matching and decoupling. It is placed in the anal canal and immobilised externally. Both in vitro and in vivo normal anatomy is identified. The mucosa is high signal intensity, the submucosa low signal intensity, the internal sphincter uniformly high signal intensity and the external sphincter low signal intensity on T1- and T2-weighted images. In females, the transverse perineal muscle bridges the inferior part of the external sphincter anteriorly. In perianal sepsis, collections and the site of the endoanal opening are identified. In early-onset fecal incontinence following obstetric trauma/surgery, focal sphincter defects are demonstrated; in late-onset fecal incontinence external sphincter atrophy is seen. In fecally incontinent patients with scleroderma, forward deviation of the anterior sphincter musculature with descent of rectal air and feces into the anal canal is noted. The extent of sphincter invasion is assessed in low rectal tumours. In children with congenital anorectal anomalies, abnormalities of the muscle components are defined using smaller-diameter coils. Such information is invaluable in the assessment and surgical planning of patients with a variety of anorectal pathologies. (orig.) With 15 figs., 26 refs.

  19. Restoration of continence following rectopexy for rectal prolapse and recovery of the internal anal sphincter electromyogram.

    Science.gov (United States)

    Farouk, R; Duthie, G S; Bartolo, D C; MacGregor, A B

    1992-05-01

    Twenty-two patients with full-thickness rectal prolapse underwent ambulatory fine wire electromyography of the internal and sphincter (IAS), external and sphincter and puborectalis, together with anorectal manometry, using a computerized system. Examinations were performed both before and 3 to 4 months after rectopexy. The median (interquartile range (i.q.r.)) preoperative IAS electromyogram (EMG) frequency was 0.18 (0.05-0.31) Hz and the median (i.q.r.) preoperative resting anal pressure was 28 (15-64) cmH2O. An improvement in the IAS EMG frequency, median (i.q.r.) 0.29 (0.19-0.38) Hz (P less than 0.03), and resting anal pressure, median (i.q.r.) 41 (20-72) cmH2O (P less than 0.05), was recorded after operation, but these variables remained significantly lower than those found in normal controls: median (i.q.r.) IAS EMG frequency 0.44 (0.36-0.48) Hz and median (i.q.r.) resting anal pressure 92 (74-98) cmH2O. We suggest that repair of the prolapse allows the IAS to recover by removing the cause of persistent rectoanal inhibition.

  20. Uzņēmuma SIA "Spilva" finanšu analīze

    OpenAIRE

    Miloša, Margarita

    2013-01-01

    Bakalaura darba nosaukums ir „Uzņēmuma SIA SPILVA finanšu analīze”. Darba mērķis ir izpētīt finanšu analīzes teorētiskos aspektus, kā arī novērtēt uzņēmuma finansiālo stāvokli, un veikt secinājumus un priekšlikumus uzņēmuma finanšu stāvokļa uzlabošanai.Dаrbа tеоrētiskаjā dаļā арlūkоti finаnšu аnаlīzеs tеоrētiskiе аsреkti, tika noteikts finanšu analīzes jēdziens, aplūkojot Latvijas un ārvalstu zinātnieku pētījumus. Рrаktiskаjā dаļā аutоrе vеiса vispusīgu SIA SPILVA finanšu аnаlīzi laika pos...

  1. [Prevalence of urinary and anal incontinence in women from metropolitan area of Guadalajara].

    Science.gov (United States)

    Martínez Espinoza, Claudia Josefina; Flores Carreras, Oscar; García de Alba García, Javier E; Velázquez Castellanos, Patricia Inés; González Ruiz, María Isabel; Márquez Allegre, René

    2006-06-01

    Female urinary and anal incontinence are common entities in pelvic floor dysfunction. The most frequently age affected range from 45 to 69 years. Previous studies performed in the United States report a prevalence of 24-62% for urinary incontinence and 3-60% for anal incontinence. To determine the prevalence of these disorders in the Guadalajara metropolitan area because we do not know it. A transversal and various stage study was performed recollecting blocks first, then houses, finally interviewing women and applying a structured questionnaire with somatometric and social-demographic data and also clinical-pathological antecedents. The data obtained was registered and processed first manually then using Excel and Epi-Info software. The group of women interviewed (n = 352) were between 15-85 years. The majority were married, housewives, 33% with grammar school, 23% finished high school, 25% professionists and 19% did not finish school; with an average of three pregnancies and with a body mass index (BMI) positive for overweight and obesity. The prevalence for urinary incontinence was 27.8% and anal incontinence of 3.4%. These are results compatible with those reported in the United States. Women living in Guadalajara have the same behavior that European and American women about prevalence of urinary incontinence. We recommend the performance of this type of studies in other states of this country in order to enrich the present information.

  2. Cutting Whole Length or Partial Length of Internal Anal Sphincter in Managementof Fissure in Ano

    Directory of Open Access Journals (Sweden)

    Furat Shani Aoda

    2017-12-01

    Full Text Available A chronic anal fissure is a common painful perianal condition.The main operative procedure to treat this painful condition is a lateral internal sphincteretomy (LIS.The aim of study is to compare the outcome and complications of closed LIS up to the dentate line (whole length of internal sphincter or up to the fissure apex (partial length of internal sphincter in the treatment of anal fissure.It is a prospective comparativestudy including 100 patients with chronic fissure in ano. All patients assigned to undergo closed LIS. Those patients were randomly divided into two groups: 50 patients underwent LIS to the level of dentate line (whole length and other 50 patients underwent LIS to the level of fissure apex (partial length. Patients were followed up weekly in the 1st month, twice monthly in the second month then monthly   for next 2 months and finally after 1 year. There was satisfactory relief of pain in all patients in both groups & complete healing of the fissure occurred. Regarding post operative incontinence no major degree of incontinence occur in both group but minor degree of incontinence persists In 7 patients after whole length LIS after one year. In conclusion, both whole length & partial length LIS associated with improvement of pain, good chance of healing but whole length LIS associated with more chance of long term  flatus incontinence. Hence,we recommend partial length LIS as treatment forchronic anal fissure.

  3. Võlur Ozi eksperimentide kogumine ja partneri algatatud paranduste analüüs

    Directory of Open Access Journals (Sweden)

    Siiri Pärkson

    2011-05-01

    Full Text Available 2009. aastal viidi Eestis läbi teine võlur Ozi kirjalike eksperimentide seeria ning käesolev artikkel annab ülevaate eksperimentide korraldamisest ning kogutud dialoogide partneri algatatud paranduste analüüsimise tulemustest. Katseisikutel paluti testida interneti veebilehel asuvat programmi Aivo, mis on suuteline suhtlema inimesega kirjalikus eesti keeles. Tegelikkuses vastas inimeste küsimustele interneti vahendusel eksperimendi läbiviija (võlur Oz. Kogutud dialooge on analüüsitud toetudes vestlusanalüüsi meetodi mõistestikule. Tartu Ülikoolis välja töötatud dialoogiaktide tüpoloogia järgi jaguneb partneri algatatud parandus üleküsimiseks, ümbersõnastamiseks ja mittemõistmiseks. Artiklis analüüsitakse näidetele toetudes eelnimetatud kolme partneri algatatud paranduse esinemist kogutud dialoogides, pidades silmas tulevikus loodavaid reaalseid dialoogsüsteeme, mis suudaksid arvutikasutajaga suhelda loomulikus eesti keeles. http://dx.doi.org/10.5128/ERYa7.12

  4. Effect of Shengji Yuhong plaster on the wound healing after anal fistula surgery

    Directory of Open Access Journals (Sweden)

    Jin-Zhong Liu

    2016-01-01

    Full Text Available Objective: To observe the effect of Shengji Yuhong plaster on the wound healing after anal fistula surgery. Methods: A total of 120 patients with anal fistula who were admitted in our hospital from January, 2011 to December, 2013 for operation were included in the study and randomized into the observation group and the control group with 50 cases in each group after operation. The patients in the observation group were given external application of Shengji Yuhong plaster, while the patients in the control group were given vaselinum ribbon gauze. The patients in the two groups were given 3-week treatment. The wound area, granulation form, healing rate, healing time, and adverse reactions 1, 2, 3 weeks after operation in the two groups were compared. Results: The wound area 1, 2, 4 weeks after operation in the observation group was significantly less than that in the control group (P<0.05. The granulation form score was significantly lower than that in the control group (P<0.05. The wound repairing rate and the total effective rate were significantly higher than those in the control group (P<0.05, and the average healing time was significantly faster than that in the control group (P<0.05. Conclusions: Shengji Yuhong plaster can significantly shorten the wound healing time in patients after anal fistula surgery and is beneficial for the postoperative rehabilitation.

  5. Chronic idiopathic anal pain. Results of a diagnostic-therapeutic protocol in a colorectal referral unit.

    Science.gov (United States)

    Armañanzas, Laura; Arroyo, Antonio; Ruiz-Tovar, Jaime; López, Alberto; Santos, Jair; Moya, Pedro; Gómez, María Amparo; Candela, Fernando; Calpena, Rafael

    2015-01-01

    Chronic idiopathic anal pain (CIAP) remains a diagnosis of exclusion. Its study and management still lack a standardized protocol. The aim of this study is to evaluate the results obtained with the diagnostic-therapeutic protocol established in our service. We performed a retrospective study of patients diagnosed with CIAP at the Colorectal Unit of the General University Hospital of Elche, between 2005 and 2011. We evaluated 57 patients with a diagnosis of chronic anal pain for functional anorectal disease (FAD). After the application of our diagnostic protocol, final diagnosis of chronic anal pain (CAP) was achieved in 43 cases (75%), including 22 cases of descending perineum syndrome, 12 of proctalgia fugax, 2 of pudendal neuritis and 7 of coccydynia. In 14 patients exclusion diagnosis of CIAP was established. Among the therapies used on patients with CIAP, biofeedback combined with conservative measures improved symptoms in 43% of the cases. Sacral nerve stimulation was assessed in patients who did not respond to other treatments. Through proper anamnesis, physical examination and complementary tests, a specific diagnosis of the cause of CAP by FAD can be achieved, reducing exclusion diagnosis of CIAP to 25% of cases. Conservative measures combined with biofeedback achieved an improvement in pain in more than 40% of the cases of CIAP in our study. Sacral nerve stimulation can be considered as a treatment option in refractory cases. Copyright © 2013 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Seroconversion following anal and genital HPV infection in men: The HIM study

    Directory of Open Access Journals (Sweden)

    Anna R. Giuliano

    2015-12-01

    Full Text Available Background: Protection from naturally acquired human papillomavirus (HPV antibodies may influence HPV infection across the lifespan. This study describes seroconversion rates following genital, anal, and oral HPV 6/11/16/18 infections in men and examines differences by HPV type and anatomic site. Methods: Men with HPV 6/11/16/18 infections who were seronegative for those genotypes at the time of DNA detection were selected from the HPV Infection in Men (HIM Study. Sera specimens collected ≤36 months after detection were analyzed for HPV 6/11/16/18 antibodies using a virus-like particle-based ELISA. Time to seroconversion was separately assessed for each anatomic site, stratified by HPV type. Results: Seroconversion to ≥1 HPV type (6/11/16/18 in this sub-cohort (N=384 varied by anatomic site, with 6.3%, 18.9%, and 0.0% seroconverting following anal, genital, and oral HPV infection, respectively. Regardless of anatomic site, seroconversion was highest for HPV 6 (19.3%. Overall, seroconversion was highest following anal HPV 6 infection (69.2%. HPV persistence was the only factor found to influence seroconversion. Conclusions: Low seroconversion rates following HPV infection leave men susceptible to recurrent infections that can progress to HPV-related cancers. This emphasizes the need for HPV vaccination in men to ensure immune protection against new HPV infections and subsequent disease. Keywords: HPV, Men, Seroconversion, HPV antibodies, Human papillomavirus

  7. Anal fin pigmentation in Brachyrhaphis fishes is not used for sexual mimicry.

    Science.gov (United States)

    Flanary, Kandace M; Johnson, Jerald B

    2018-01-01

    Mimicry can occur in several contexts, including sexual interactions. In some cases, males mimic females to gain access to potential mates. In contrast, there are relatively few examples of species where females mimic males, and we know very little about what drives these patterns. Two hypotheses have been advanced to explain female mimicry of males. The first is that mimicry is used to reduce harassment of females by males. The second is that mimicry is used to display dominance over other females. In this study, we tested these hypotheses in Brachyrhaphis fishes, wherein females of several species have pigmentation on their anal fin of the same coloration and shape, and in the same location, as the genitalia of males. To test if female mimicry of males reduces male harassment, we experimentally manipulated female pigmentation and observed male preference for females with and without male-like pigmentation. To test the effect that female mimicry of males has on female dominance, we observed how females respond to anal fin pigmentation patterns of companion females. We found that neither of these hypotheses was supported by our data. We conclude that similarities in anal fin pigmentation between male and female Brachyrhaphis fishes is not an adaptation to reduce male harassment or to signal dominance between females. Alternative explanations must exist, including the possibility that these similarities are simply non-adaptive.

  8. A novel artificial anal sphincter system in an in vitro and in vivo experiment.

    Science.gov (United States)

    Ke, Lei; Yan, Guo-Zheng; Liu, Hua; Jiang, Ping-Ping; Liu, Zhi-Qiang; Wang, Yong-Bing; Ding, Zai-Xian

    2014-03-01

    This paper presents some of the latest progress in the development of a novel artificial anal sphincter system (AASS) to treat severe fecal incontinence. We have redesigned and integrated an intelligent, remote-controlled artificial anal sphincter based on biological signal feedback mechanisms. The device consists of an external telemetry unit, an internal artificial anal sphincter (IAAS), and a transcutaneous energy transfer system (TETS). The mechanical medical micropump of the IAAS can realize bidirectional flow with a maximum flow rate of 8.5 ml/min and can build backpressure up to 170 kPa. The design of the prosthesis reduces occlusion pressure and allows for low inflation volumes (9 mL-10.5 mL); operating pressures between 4.05 kPa and 7.16 kPa indicate that the risk of ischemic injury to the bowel is minimal. Furthermore, the rechargeable battery based on TETS puts the operation time at an estimated 2 days. The performance characteristics of the AASS and its efficiency in achieving continence and sensing the stool inside the anorectum were evaluated in vitro and in vivo in a pig model. Experimental results confirm that the system can maintain continence and build the sense of defecation successfully. Moreover, this innovation can be integrated into not only severe fecal incontinence, erectile dysfunction, and therapy-resistant reflux disease, but also morbid adiposity therapeutic AASS applications.

  9. Case of anal fistula with Fournier's gangrene in an obese type 2 diabetes mellitus patient.

    Science.gov (United States)

    Yoshino, Hiroshi; Kawakami, Kyoko; Yoshino, Gen; Sawada, Katsuhiro

    2016-03-01

    A 64-year-old man was admitted to Shin-suma General Hospital, Kobe, Japan, complaining of a 3-day history of scrotal swelling and high fever. He had type 2 diabetes mellitus. On examination, his body temperature had risen to 38.5 °C. Examination of the scrotum showed abnormal enlargement. Laboratory data were as follows: white cell count 35,400/μL and glycated hemoglobin 9.6%. Anal fistula was found in an endorectal ultrasound. Computed tomography scan showed a relatively high density of subcutaneous tissue and elevated air density. Thus, he was diagnosed with Fournier's gangrene. On the fourth hospital day, the patient underwent debridement of gangrenous tissue. Seton surgery was carried out for anal fistula on the 34th hospital day. He responded to the treatment very well. He was discharged on the 33rd postoperative day. Once Fournier's gangrene has been diagnosed, considering the association of anal fistula and perianal abscess is important.

  10. Increasing efficacy and reducing side effects in treatment of chronic anal fissures: A study of topical diazepam therapy.

    Science.gov (United States)

    Hang, Minh Tuan H; Smith, Betsy E; Keck, Carson; Keshavarzian, Ali; Sedghi, Shahriar

    2017-05-01

    This is a single institution nonexperimental study intended to analyze the therapeutic efficacy of topical diazepam in treating symptoms of chronic anal fissures.Anal fissures are a common cause of anal pain. Conventional treatments include nonsteroidal anti-inflammatory drugs, topical creams, such as nitroglycerin and nifedipine, and surgery. However, these treatments are usually suboptimally efficacious or have deterring side effects.Patients at an outpatient community center with a diagnosis of a chronic anal fissure were prescribed either topical 2% (n = 19) or 4% (n = 18) diazepam cream between January 2013 and February 2015. We retrospectively analyzed their responses to treatment.All 19 patients using 2% diazepam cream experienced a positive response in pain, whereas 47.4% experienced a complete response, with a numerical rating scale (NRS) score of 0 (0-10). Eighty-eight percent of patients using 4% dose had a positive response in pain, whereas 23.5% experienced a complete response. Ninety-four percent of patients using 2% dose had a positive response in anal bleeding, whereas 68.8% experienced a complete response with an anal bleeding score (ABS) of 2 (2-9). Ninety-four percent of patients using 4% dose had a positive response in anal bleeding, whereas 64.7% experienced a complete response. Only 1 patient reported a side effect from diazepam cream-perianal pruritus.Both 2% and 4% topical diazepam provided significant pain and bleeding relief from chronic anal fissures that were refractory to conventional therapies. There were insignificant differences when assessing independent comparisons for pain and bleeding between the doses.

  11. Sexual restrictions beyond anti-gay prejudice: Anal sex, oral sex, masculinity and sexual prejudice in Jamaica

    OpenAIRE

    West, Keon

    2016-01-01

    This is the first quantitative research to investigate attitudes toward heterosexual anal and oral sex in Jamaica, compare them to anti-gay and anti-lesbian attitudes, and frame them within a broader understanding of sexual prejudice based on gender norms. Fifty Jamaican participants’ attitudes toward heterosexual anal sex were as negative as attitudes toward gay male sex, and more negative than attitudes toward lesbian sex. Negative attitudes toward male sexual behaviours were predicted by m...

  12. Primary Care Provider Practices and Perceptions Regarding HPV Vaccination and Anal Cancer Screening at a Boston Community Health Center.

    Science.gov (United States)

    Apaydin, Kaan Z; Fontenot, Holly B; Shtasel, Derri L; Mayer, Kenneth H; Keuroghlian, Alex S

    2018-02-26

    Human papillomavirus (HPV) vaccination and anal cancer screening are valuable, yet underutilized, tools in prevention of HPV-related cancers among sexual and gender minority (SGM) populations. The aim of this study was to characterize primary care providers' (PCPs) practices and perceptions pertaining to HPV vaccination and anal cancer screening. A survey assessing self-reported practice characteristics related to HPV vaccination and anal cancer screening, as well as perceived barriers to vaccination and anal cancer screening at the patient-, provider-, and system-level was distributed to PCPs at a Federally-Qualified Health Center that specializes in care for SGM populations in the greater Boston area. A total of 33 PCPs completed the survey. All PCPs strongly recommended HPV vaccination to their patients by emphasizing that the vaccine is extremely important or very important. Most PCPs told their patients that the HPV vaccine prevents cervical cancer (96.9%), anal cancer (96.9%), oropharyngeal cancer (72.7%), penile cancer (57.5%), and genital warts (63.6%). There is substantial variability among providers regarding recommendations for anal cancer screening and follow-up. Most PCPs perceived that patient-level factors such as poverty, mental illness, and substance use disorders were barriers to HPV vaccination and anal cancer screening. Systems-level barriers such as lack of clinical time with each patient and lack of staffing were also described as barriers to vaccination and screening. Patient-, provider- and systems-level improvements are important to increase HPV vaccination and anal cancer screening rates.

  13. Prevalence and correlates of heterosexual anal and oral sex in adolescents and adults in the United States.

    Science.gov (United States)

    Leichliter, Jami S; Chandra, Anjani; Liddon, Nicole; Fenton, Kevin A; Aral, Sevgi O

    2007-12-15

    Heterosexual anal and oral sex are related to the acquisition of sexually transmitted infections, including human immunodeficiency virus infection. We examined the correlates of heterosexual anal and oral sex in the general population, using data from the National Survey of Family Growth. The sample included 12,571 men and women aged 15-44 years (79% response rate). One-third of men and women had ever had anal sex, and three-quarters had ever had oral sex. Condom use during last oral or anal sex was relatively uncommon. In separate models for men and women, having ever had anal sex was associated with white race, age of 20-44 years, and having had a non-monogamous sex partner. White race, age of 20-44 years, being married, and having higher numbers of lifetime sex partners were related to having ever given oral sex in men and women. Giving oral sex was associated with having a non-monogamous sex partner in men. Ever receiving oral sex was associated with white race and a non-monogamous sex partner in men and women. It would be beneficial to track the prevalence of heterosexual anal and oral sex and associated condom use on a more frequent basis.

  14. Comparison of anal HPV natural history among men by country of residence: Brazil, Mexico, and the United States.

    Science.gov (United States)

    Sudenga, Staci L; Nyitray, Alan G; Torres, B Nelson; Silva, Roberto; Villa, Luisa; Lazcano-Ponce, Eduardo; Abrahamsen, Martha; Baggio, Maria Luiza; Salmeron, Jorge; Quiterio, Manuel; Giuliano, Anna R

    2017-07-01

    Globally, anal cancer incidence is rare, but is increasing in some world regions. Our objective was to assess differences in anal HPV natural history in three countries. Men aged 18-70 years were recruited from the US (n = 634), Mexico (n = 665), and Brazil (n = 731). Anal specimens were collected every six-months. HPV genotyping was assessed by Linear Array. Anal HPV prevalence was compared using the Fisher's exact test. HPV infection incidence rates (IR) and 95% confidence intervals (CI) were calculated. Any anal HPV prevalence was highest among men from Brazil (24%) compared to Mexico (15%) and the US (15%). When stratified by sexual history, the prevalence of any HPV among MSM/MSMW was 43%, 37%, and 45% and 9%, 12%, and 10% for MSW from Brazil, Mexico, and US, respectively. Any HPV incidence was significantly higher among men from Brazil compared to US men (IRR = 2.4, 95% CI = 1.7-3.4) and comparable between men from Mexico and the US (IRR = 1.2, 95% CI = 0.8-1.8). Men in Brazil and Mexico often have similar, if not higher incidence of anal HPV compared to men from the U.S., and may benefit from gender neutral HPV vaccine policies. Copyright © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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

    International Nuclear Information System (INIS)

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

    1987-01-01

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

  16. ORGAN-SPARING TREATMENT IN PATIENTS WITH SQUAMOUS CELL CARCINOMA OF THE ANAL CANAL

    Directory of Open Access Journals (Sweden)

    Yu. A. Barsukov

    2014-01-01

    Full Text Available Objective: to improve the results of treatment in patients with squamous cell carcinoma of the anal canal, by creating a new combination treatment option, and to increase the rate of organ-sparing treatment.Subjects and methods. A new combination treatment option for squamous cell carcinoma of the anal canal was created, which involved a combination of radiotherapy and a multiple radio modification program (ultrahigh-frequency (UHF hyperthermia and local metronidazole (MZ injection and systemic polychemotherapy (RF patent No. 2427399 “A treatment option for squamous cell carcinoma of the anal canal” registered on 27 August 2011. To evaluate the created treatment option, the latter was analyzed in 157 patients with Т1–4N0–3M0 squamous cell carcinoma of the anal canal, who had been treated in 1990 to 2012. In 22 patients, radiotherapy was performed in combination with 3–5 sessions of local UHF hyperthermia (thermoradiotherapy (TRT; 88 patients received the latter in combination with polychemotherapy (thermoradiochemotherapy (TRCT; in addition to TRCT, 47 patients used MZ (TRCT + MZ.Results. In the TRT, TRCT, and TRCT + MZ groups, organ-sparing treatment was performed in 11 (50 %, 71 (80.7 %, and 44 (93.6 % patients, respectively. In these groups, the median follow-up was 18.6; 51.7, and 15.5 months, respectively. In the 3 groups, the three-year overall survival rates were 71.4; 90.0, and 96.3 % and the three-year relapse free survival rates were 46.7; 60.6, and 75.0 %, respectively.Conclusion. The created combination thermochemoradiotherapy involving a polymer combination with MZ (TRCT + MZ makes it possible to achieve organ-sparing treatment in 93.6 % of the patients and to slightly improve 3-year overall and relapse-free survival rates in patients with squamous cell carcinoma of the anal canal who have received organ-sparing treatment although there is only a tendency for statistical survival difference in this patient group.

  17. Alteração das pressões anais na gravidez Changes in anal pressure at pregnancy

    Directory of Open Access Journals (Sweden)

    Wilmar Artur Klug

    2007-06-01

    Full Text Available A gestação é seguida de alterações digestivas, relacionadas à progesterona e polipeptídios intestinais, como a motilina. É possível que mudanças também ocorram no ânus, alterando as pressões. Para realizar o trabalho selecionamos nos arquivos da Área de Fisiologia Anal da Disciplina de Coloproctologia, 60 laudos de exame manométrico de pacientes enviadas do Ambulatório de Pré-natal de Baixo Risco do Departamento de Obstetrícia e Ginecologia e do Departamento de Cirurgia da Santa Casa de São Paulo, para avaliação clínica, porém sem doença anal ou retal diagnosticada. Estas pacientes formaram quatro grupos de 15: a controle: nuligestas; b primigestas no 1º trimestre; c primigestas no 2º trimestre; d primigestas no 3º trimestre. Em todas realizamos manometria anal e as seguintes medidas: a pressão anal máxima em repouso (basal; b pressão anal ao esforço de contração; c pressão anal ao esforço de evacuação. Os resultados das manometrias, analisados por métodos de estatística, mostraram que na gestação a pressão anal de repouso diminui; a pressão anal ao esforço de contração não se altera; as diferenças registradas mantêm-se no curso da primigestação. Concluímos que as pressões anais são modificadas pela gestação, em primigestas.Pregnancy is followed by physiological digestive system adaptations. Such phenomena are related to the progesterone effect, probably due to motiline inhibition, which stimulates smooth muscles fibers. Presumably the same alterations occur in the anus, varying their pressures. The present investigation intends to evaluate the anal pressures in primigravidae. Methods - Results of examinations on sixty women from the Department of Obstetrics and Gynecology and the Department of Surgery of Santa Casa de São Paulo were selected from archives. Neither was considered ill. They were divided into four groups, each one containing fifteen patients, as follows: A. Control group

  18. Quanto a escova deve ser introduzida no canal anal para avaliação citológica mais eficaz? How deep must the brush be introduced in the anal canal for a more effective cytological evaluation?

    Directory of Open Access Journals (Sweden)

    Sidney Roberto Nadal

    2009-01-01

    Full Text Available OBJETIVO: A sensibilidade da citologia anal varia amplamente na literatura, entre 45% e 98%, o que pode ocorrer devido à falta de padronização quanto à distância que a escova deve ser introduzida no canal anal. Desta forma, nosso objetivo foi investigar se o local de coleta influencia no resultado desse exame. MÉTODOS: Colhemos amostras com escova introduzida 4 cm no canal anal de 114 doentes (Grupo A e 2 cm em outros 94 pacientes (Grupo B, antes do exame proctológico. Realizamos cinco rotações com a escova antes de retirá-la e a esfregar sobre lâmina de vidro, posteriormente submetida ao exame citopatológico padrão. Todos os doentes são HIV-positivo. Submetemos os resultados à avaliação estatística. RESULTADOS: No Grupo A, 39 doentes possuíam condilomas no canal anal e a citologia foi positiva em 29 deles (74,3%. Também observamos alterações citológicas em 30 de 75 doentes (40% sem lesões clínicas no canal anal. No Grupo B, havia 54 doentes com condilomas no canal anal e em 13 (24,1% houve confirmação citológica. Em 40 outros, sem lesões clínicas pelo HPV, notamos que em nove (22,5% havia anormalidades citológicas. Os testes estatísticos revelaram que os exames realizados nos doentes do Grupo A foram mais eficientes. CONCLUSÃO: Os espécimes coletados com escovas inseridas mais profundamente no canal anal melhoraram a eficácia do exame.OBJECTIVE: In literature, sensitivity of Pap smears ranges widely from 45 to 98%. Possibly this is because there is no standard for how far the brush should be introduced into the anal canal. The aim was to evaluate whether the sampling site has an influence on the results of anal Pap smears. Design and setting. This is a non-randomized, non-blinded, retrospective review carried out in the Proctology and Pathology Sectors, Emilio Ribas Infectious Diseases Institute. METHOD: We obtained specimens with brushes introduced 4 cm into the anal canal in 114 patients (Group A and 2 cm in

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

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    M. J. García-Montes

    2010-01-01

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

  20. 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

  1. A study of the effect of renal pelvic and ureteric distention on the anorectal function with identification of the "reno-anal reflex".

    Science.gov (United States)

    Shafik, A

    1998-05-01

    Renal or ureteral diseases are often associated with gastrointestinal symptoms. In this communication, we studied the effect of renal pelvic or ureteric distension on the anorectal function in 12 healthy volunteers. A 3F balloon-tipped catheter was introduced into the renal pelvis. The balloon was filled with saline in increments of 2 ml up to 12 ml and the pressure response of the rectum and anal canal was recorded. Balloon filling was performed twice: rapidly (1 ml/sec) and slowly (1 ml/min). The test was repeated in the ureter with balloon fillings in increments of 0.25 ml up to 1 ml. The electromyographic (EMG) response of the external anal sphincter to distension of the renal pelvis or ureter was evaluated. The pressure response of the rectum, anal canal and external anal sphincter to distension of the anesthetised renal pelvis or ureter was then determined. The test was repeated after external anal sphincter anaesthetisation. Rapid renal pelvic or ureteric distension increased the anal canal pressure (p 0.05). With 10 and 12 ml rapid renal pelvis distension and with 0.75 and 1 ml rapid ureteric distension, the EMG activity of the external anal sphincter increased and was accompanied with loin and anal pain. Slow renal pelvic or ureteric distension caused no significant change in the anal or rectal pressures (p > 0.05) or in the EMG activity of the external anal sphincter and no anal pain was perceived. Distension of the anesthetised renal pelvis or ureter effected no changes in anal or rectal pressures (p > 0.05). The anesthetised external anal sphincter as well as the anal or rectal pressure did not respond to renal pelvis or ureteric distension. In conclusion, rapid renal pelvic or ureteric distension stimulates the mechanoreceptors in the renal pelvis or ureteric wall leading to reflex external anal sphincter contraction. This leads to elevation of the anal canal pressure. The findings suggest the possible involvement of a "reno-anal reflex" which is

  2. Endosonography and magnetic resonance imaging in the diagnosis of high anal fistulae – a comparison

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    Iwona Sudoł-Szopińska

    2014-06-01

    Full Text Available Anal fistula is a benign inflammatory disease with unclear etiology which develops in approximately 10 in 100 000 adult patients. Surgical treatment of fistulae is associated with a risk of damaging anal sphincters. This usually happens in treating high fistulae, branched fistulae, and anterior ones in females. In preoperative diagnosis of anal fistulae, endosonography and magnetic resonance imaging play a significant role in planning the surgical technique. The majority of fistulae are diagnosed in endosonography, but magnetic resonance is performed when the presence of high fistulae, particularly branched ones, and recurrent is suspected. The aim of this paper was to compare the roles of the two examinations in preoperative assessment of high anal fistulae. Material and methods: The results of endosonographic and magnetic resonance examinations performed in 2011–2012 in 14 patients (4 women and 10 men with high anal fistulae diagnosed intraoperatively were subject to a retrospective analysis. The patients were aged from 23 to 66 (mean 47. The endosonographic examinations were performed with the use of a BK Medical Pro Focus system with endorectal 3D transducers with the frequency of 16 MHz. The magnetic resonance scans were performed using a Siemens Avanto 1.5 T scanner with a surface coil in T1, T1FS, FLAIR, T2 sequences and in T1 following contrast medium administration. The sensitivity and specificity of endosonography and magnetic resonance imaging were analyzed. A surgical treatment served as a method for verification. The agreement of each method with the surgery and the agreement of endosonography and magnetic resonance imaging were compared in terms of the assessment of the fistula type, localization of its internal opening and branches. The agreement level was determined based on the percentage of consistent assessments and Cohen’s coefficient of agreement, κ. The integrity of the anal sphincters was assessed in each case

  3. Influence of preoperative (hyperthermic) radiochemotherapy on manometric anal sphincter function in locally advanced rectal cancer

    International Nuclear Information System (INIS)

    Fritzmann, J.; Huenerbein, M.; Slisow, W.; Rau, B.; Gellermann, J.; Wust, P.

    2004-01-01

    Background and purpose: preoperative radiochemotherapy (RCT) followed by curative surgery is a well-accepted therapeutic option in the treatment of advanced rectal cancer. Usually, the anal sphincter is located in the irradiation area of a preoperative RCT regime. The aim of this study is to evaluate the influence of preoperative RCT on anal sphincter function. Patients and methods: between 1994 and 2000, 102 patients with rectal cancer stage uT3/uT4 were analyzed. All patients underwent radiotherapy with 45 Gy (5 x 1.8 Gy) including two cycles of 5-fluorouracil (5-FU)/leucovorin (folinic acid) chemotherapy. 46 patients were treated additionally with up to five sessions of locoregional hyperthermia. The sphincter function was analyzed by perfusion manometry before preoperative therapy and 4 weeks after pretreatment had been finished. For statistics, the Wilcoxon signed rank test and mann-whitney U-test were used (SPSS 9.0 for Windows trademark). Results: the mean value of all 102 patients showed a significant reduction of the mean maximum resting pressure from 97 to 89 mmHg (p = 0.02). For the mean maximal squeeze pressure no significant difference could be shown (178 vs. 176 mmHg). For patients with distal (≤ 7.5 cm from anal verge) tumors the difference was highly significant (92 vs. 79 mmHg). Locoregional hyperthermia had no additional influence on sphincter function. Conclusion: preoperative RCT impairs sphincter function especially in patients with distal tumors. In addition, RCT could have a negative influence on the continence of patients who received sphincter-preserving surgery. (orig.) [de

  4. Effect of Suyuping combined with semiconductor laser irradiation on wound healing after anal fistula surgery

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    Min Zhao

    2016-06-01

    Full Text Available Objective: To explore the effect of Suyuping combined with semiconductor laser irradiation on the wound healing after anal fistula surgery. Methods: A total of 180 patients with anal fistula who were admitted in our hospital from October, 2013 to May, 2015 for surgery were included in the study and randomized into the treatment group and the control group with 90 cases in each group. The patients in the control group were given the conventional surgical debridement dressing, a time a day. On this basis, the patients in the treatment group were given Suyuping smearing on the wound sinus tract combined with semiconductor laser irradiation, a time a day for 10 min, continuous irradiation until wound healing. The postoperative wound swelling fading, wound surface secretion amount, and the clinical efficacy in the two groups were recorded. Results: The wound surface swelling degree and wound pain degree at each timing point after operation in the treatment group were significantly lower than those in the control group (P<0.05. The wound surface area at each timing point after operation in the treatment group was significantly lower than that in the control group (P<0.05. The wound surface secretion amount 6, 9, and 12 days after operation in the treatment group was significantly lower than that in the control group (P<0.05. The total effective rate in the treatment group was significantly higher than that in the control group (P<0.05. The average healing time in the treatment group was significantly faster than that in the control group (P<0.05. Conclusions: Suyuping combined with semiconductor laser irradiation in the treatment of patients after anal fistula can effectively improve the local blood and lymphatic circulation of wound surface, promote the growth of granulation tissues, and contribute the wound healing.

  5. Acute motor axonal neuropathy associated with anal carcinoma: Paraneoplastic neurological syndrome or coincidence?

    International Nuclear Information System (INIS)

    Lopez, J. L.; Amezcua, S.; Pascual, J.; Algara, M.

    2011-01-01

    Aim: Assessment of the association of an acute motor axonal neuropathy with a squamous cell anal carcinoma. Background: Paraneoplastic neurologic syndromes are not a direct consequence of neither primary tumor nor its metastasis. They often parallel the course of the malignancy but may be the presenting sign of an occult cancer. Sometimes it is very difficult to distinguish if it is a paraneoplastic syndrome or just a coincidence. Materials and methods: We report a 60-year-old man that presented with an acute motor deficit of the four limbs. Clinical examination found a pure and severe motor deficit in the four limbs. No sensory abnormality was found and all motor nerves were unexcitable. Electromyography suggested the diagnosis of acute motor axonal neuropathy (AMAN). Four months after developing the AMAN, blood in the stool revealed anal carcinoma. The patient was treated with concurrent chemoradiotherapy. Radiation was given to the tumor and to the pelvis, including inguinal nodes, over a five-week period plus fluorouracil and mitomycin. We investigated the presence of anti ganglioside antibodies as studies suggest that carcinomas can express antigens shared with Schwann cells. Results: Anti-GM1 IgG antibodies were detected by an enzyme-linked immunosorbent assay method. Other antibodies, including antinuclear nucleoprotein antibody (anti-Hu), anti-Tr, anti-Ri, anti-CV2, anti-amphiphysin and anti-Yo, were negative. Clinical improvement of the motor state was observed at the fourth week of oncologic treatment. Conclusion: The presence of anti-GM1 IgG antibodies and the clinical improvement of the motor state after concurrent chemoradiotherapy lead us to believe there is an association between anal carcinoma and this severe impairment. (authors)

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

    Directory of Open Access Journals (Sweden)

    Jennifer O Lam

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

  7. Epigenomic Characterization of Locally Advanced Anal Cancer: An RTOG 98-11 Specimen Study

    Science.gov (United States)

    Siegel, Erin M; Eschrich, Steven; Winter, Kathryn; Riggs, Bridget; Berglund, Anders; Ajidahun, Abidemi; Simko, Jeff; Moughan, Jennifer; Ajani, Jaffer; Magliocco, Anthony; Elahi, Abul; Hoffe, Sarah; Shibata, David

    2014-01-01

    Background The Radiation Therapy Oncology Group 98-11 clinical trial demonstrated the superiority of standard 5FU/mitomycin-C over 5FU/cisplatin in combination with radiation in the treatment of anal squamous cell cancer. Tumor size (>5cm) and lymph node metastases are associated with disease progression. There may be key molecular differences (e.g. DNA methylation changes) in tumors at high-risk for progression. Objectives The objectives of this study were to determine if there are differences in DNA methylation at individual CpG sites and within genes among locally advanced anal cancers, with large tumor size and/or nodal involvement, compared to those that are less advanced. Design Case-case study among 121 patients defined as high-risk (tumor size>5cm and/or nodal involvement; n=59) or low-risk (≤5cm, node negative; n=62) within the mitomycin-C arm of RTOG98-11 trial. DNA methylation was measured using the Illumina HumanMethylation450 Array. Settings Tertiary care cancer center in collaboration with a national clinical trials cooperative group. Patients The patients consisted of 74 women and 47 men with a median age of 54 years (minmax 25-79). Main Outcome Measures DNA methylation differences at individual CpG sites and within genes between low and high-risk patients were compared using Mann-Whitney test (p-valueEpigenetic events likely play a significant role in the progression of anal cancer and may serve as potential biomarkers. PMID:25003289

  8. Subclinical Anal Sphincter Injuries Following Instrumental Delivery–A Physiological Analysis: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Girisha Balaraju

    2017-10-01

    Full Text Available Introduction: Obstetric Anal Sphincter Injuries (OASIS has been reported in up to 25% patients and occult OASIS has been reported in up to 1.2%. Instrumental delivery has been considered a risk factor for OASIS. Aim: To compare the anal sphincter functions as assessed by Anorectal Manometry (ARM in asymptomatic patients following instrument delivery with those of patients who underwent Lower Segment Caesarian Section (LSCS after six months of delivery. Materials and Methods: Seventeen women who had instrumental delivery and thirteen who underwent elective cesarean section were recruited. Evaluation included a detailed history and physical examination, administration of the Cleveland Clinic Questionnaire and ARM to record the basal pressure, squeeze pressure, anorectal sensation and balloon expulsion time. Categorical variables were compared using the Chi-square test. All calculations were done using the software SPSS 21.0. Results: We found statistically significant lower basal (34 ± 3.4 vs 60±2.3 mm hg, p<0.05 and squeeze pressures (56±4.1 vs 76±5.2 mm hg, p<0.05, and higher balloon expulsion time (58±2.9 s vs 19±1.8 seconds, p<0.05 in women with instrument delivery compared to LSCS. The rectal sensation was comparable in both the groups. Conclusion: Persistent subtle anal sphincter dysfunctions are common following instrument delivery compared to LSCS. The role of identifying these and preventing future incontinence in such women needs to be assessed in future studies.

  9. Anatomy and mechanical properties of the anal sphincter muscles in healthy senior volunteers.

    Science.gov (United States)

    Brusa, T; Abler, D; Tutuian, R; Gingert, C; Heverhagen, J T; Adamina, M; Brügger, L E; Büchler, P

    2018-03-15

    A large proportion of age-related fecal incontinence is attributed to weakness or degeneration of the muscles composing the anal continence organ. However, the individual role of these muscles and their functional interplay remain poorly understood. This study employs a novel technique based on the combination of MR imaging and FLIP measurements (MR-FLIP) to obtain anatomical and mechanical information simultaneously. Unlike previous methods used to assess the mechanics of the continence organ, MR-FLIP allows inter-individual comparisons and statistical analysis of the sphincter morpho-mechanical parameters. The anatomy as well as voluntary and involuntary mechanical properties of the anal continence organ were characterized in 20 healthy senior volunteers. Results showed that the external anal sphincter (EAS) forms a funnel-like shape with wall thickness increasing by a factor of 2.5 from distal (6 ± 0 mm) to proximal (15 ± 3 mm). Both voluntary and involuntary mechanical properties in this region correlate strongly with the thickness of the muscle. The positions of least compliance and maximal orifice closing were both located toward the proximal EAS end. In addition, maximal contraction during squeeze maneuvers was reached after 2 s, but high muscle fatigue was measured during a 7 s holding phase, corresponding to about 60% loss of the energy produced by the muscles during the contraction phase. This work reports baseline parameters describing the morpho-mechanical condition of the sphincter muscle of healthy elderly volunteers. New parameters were also proposed to quantify the active properties of the muscles based on the mechanical energy associated with muscle contraction and fatigue. This information could be used to assess patients suffering from AI or for the design of novel implants. © 2018 John Wiley & Sons Ltd.

  10. Anal Cancer

    Science.gov (United States)

    ... to Content ASCO.org Conquer Cancer Foundation ASCO Journals Donate eNews Signup f Cancer.net on Facebook t Cancer.net on Twitter q Cancer.net on YouTube g Cancer.net on Google Menu Home Types of Cancer Navigating Cancer Care Coping With Cancer Research and Advocacy Survivorship Blog About ...

  11. Anal Fissure

    Science.gov (United States)

    ... Library Quality Assessment and Safety Committee Initiatives Healthcare Economics Committee Resources Past Presidents Search form Search Online ... Patients ASCRS Non-Discrimination Statement Privacy Policy Research Foundation of the ASCRS Non-Discrimination Statement About Us ...

  12. Anal Warts

    Science.gov (United States)

    ... Library Quality Assessment and Safety Committee Initiatives Healthcare Economics Committee Resources Past Presidents Search form Search Online ... Patients ASCRS Non-Discrimination Statement Privacy Policy Research Foundation of the ASCRS Non-Discrimination Statement About Us ...

  13. Anal Pain

    Science.gov (United States)

    ... and whole grains, exercising daily, and taking stool softeners, if needed, to facilitate bowel movements, reduce straining and ease pain Sitting in a tub of hot water up to your hips — known as a sitz ...

  14. La lógica proposicional en Analíticos de Aristóteles

    OpenAIRE

    A. Camacho Naranjo, Luis

    2008-01-01

    Contra lo que habitualmente se dice, Aristóteles parece haber conocido el modus ponens, el modus tollens y la afirmación del consecuente en un condicional. Aunque no ponga nombres a las reglas correspondientes, un breve texto en Analíticos utiliza terminología semejante a la de Crisipo. En el artículo defendemos que dicho texto se puede interpretar dentro de la lógica proposicional actual, sin necesidad de postular una supuesta regla adicional que tendría problemas formales de validez.

  15. Abordaje Analítico Versus Abordaje por Medios Tecnológicos

    Directory of Open Access Journals (Sweden)

    María Cecilia Municoy

    2007-12-01

    Full Text Available El presente artículo aborda la problemática de la conveniencia y/o ventajas que presenta el desarrollo analítico de un concepto matemático frente a la resolución por medios tecnológicos a través de un ejemplo concreto, como es el caso de la resolución de un sistema de ecuaciones diferenciales con solución en el campo complejo. Se focalizan las diferencias que presentan ambos abordajes.

  16. Avaliação dos resultados do tratamento de 14 doentes de carcinoma espinocelular anal

    Directory of Open Access Journals (Sweden)

    Luís Augusto Palma Dallan

    2006-03-01

    Full Text Available A radioquimioterapia (RT/QT tornou-se o tratamento de escolha para o carcinoma espinocelular anal (CEC. Na recidiva local ou na persistência da doença, deve-se instituir o tratamento cirúrgico. OBJETIVO: O objetivo deste estudo retrospectivo foi analisar os resultados do tratamento de doentes de CEC anal. MÉTODO: Acompanhamos 17 pacientes com diagnóstico anátomo-patológico de carcinoma espinocelular anal. Eram 14 (82,3% do sexo feminino e três (17,8% do masculino. A idade variou de 36 a 78 anos, com média de idade de 59,1 anos. Utilizando a classificação TNM, tivemos quatro (23,6% no estádio I, seis (35,2% no II, quatro (23,6% no IIIa e três (17,6% no IIIb. Todos foram submetidos a tratamento inicial com RT/QT, exceto um submetido a ressecção local. Definimos que a biópsia negativa, realizada entre 12 e 16 semanas após esse tratamento, determinaria o controle local da doença. RESULTADOS: Perdemos seguimento de três doentes (17,6%. Seguimos os 14 restantes (82,3% entre um e cinco anos. Todos os doentes nos estádios I e II (10 apresentaram regressão total da doença, enquanto que três (75% nos estádios IIIa e IIIb tiveram remissão completa. Realizamos a amputação abdomino-perineal de resgate em dois doentes e ressecção local em outros dois. A recidiva local ocorreu em dois (20% nos estádios I e II e em dois (75% nos estádios mais avançados (IIIa e IIIb. A sobrevivência em 3 anos foi de 100% nos que se encontravam nos estádios I e II, embora o controle da doença fosse atingido em oito (80%. Nos quatro doentes que estavam nos estádios IIIa e IIIb, a sobrevivência em um ano foi de 75% e em três anos foi de 25%. Esse último permanece livre da doença. Complicações do tratamento radioterápico ocorreram em oito doentes (57,1%. Nenhum óbito foi constatado durante o tratamento RT/QT. Os dois doentes, (14,3% com sorologia positiva para HIV, apresentavam infecção anal pelo Papilomavírus humano (HPV. CONCLUSÃO: A

  17. Analítica o evocadora: el debate olvidado de la autoetnografía

    OpenAIRE

    Xavier Montagud Mayor

    2016-01-01

    Existe la necesidad de una estrategia metodológica eficaz para sostener la investigación sobre la práctica profesional de los servicios sociales. La oposición entre el trabajo autoetnográfico de Carolyn Ellis y Arthur Bochner (2000, 2006) y la propuesta analítica de Leon Anderson sirven como una lente a través de la cual explorar los aspectos clave de esta discusión. Mientras Ellis y Bochner rechazan cualquier intento de abstracción o sistematización teórica, Anderson pretende tender puentes ...

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

    International Nuclear Information System (INIS)

    Sauer, Thomas Albert

    2013-01-01

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

  19. Pensamiento meta-analítico: educación estadística

    OpenAIRE

    Frías-Navarro, Dolores; Badenes-Ribera, Laura; Pascual-Soler, Marcos; Monterde-i-Bort, Hector

    2013-01-01

    El procedimiento de significación de la hipótesis nula ha sido la estrategia de análisis dominante en el área de las ciencias sociales y de la salud. Sin embargo, también han sido muchas las críticas que han atacado el pensamiento dicotómico que implica dicho procedimiento. El movimiento de la reforma estadística plantea un cambio de perspectiva desde la significación estadística a la estimación de efectos. Desde esta nueva perspectiva destaca el desarrollo del pensamiento meta-analítico como...

  20. Quality of life outcomes in patients with anal cancer after combined radiochemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Welzel, Grit; Haegele, Verena; Wenz, Frederik; Mai, Sabine Kathrin [Universitaetsklinikum Heidelberg, Mannheim (Germany). Dept. of Radiation Oncology

    2011-03-15

    Purpose: To assess self-reported quality of life (QoL) experienced by anal cancer patients after radiochemotherapy, and to identify patient- and disease-related factors associated with QoL. Patients and Methods: A total of 88 patients treated for anal cancer at our institution between 1990 and 2006 were identified from our database. Of these, 15 patients had died, and 4 were lost to follow-up. QoL was assessed using the EORTC QLQ-C30 questionnaire (cancer-specific QoL) and the colorectal cancer module QLQ-CR38 (site-specific QoL); 52 responses were received. The median follow-up was 36 months (range, 5-137 months). Results: As for cancer-specific QoL, global health QoL score (mean 60.4) was similar to the general German population, whereas most of the function and symptom scale scores were considerably lower/higher in anal cancer patients. The most prominent mean score differences were observed in role functioning (-21.8 points), emotional functioning (-20.7 points), social functioning (-28.9 points), diarrhea (+34.6 points), and financial difficulties (+26.9 points; p < 0.001). As for site-specific QoL, the mean function scale scores ranged from 22.1 (sexual function) to 63.2 (body image), and the mean symptom scale scores from 14.7 (weight loss) to 69.0 (stoma-related problems, 4 patients) and 67.9 (male sexual dysfunction), respectively. Most of the QoL scores were not affected by late toxicity, patient- or disease-related factors. Fatigue (+18.2 points) emerged as the strongest predictor of impaired QoL. Conclusion: The global health QoL of anal cancer patients is comparable with that of the general German population, but there are specific limitations, e.g., sexual dysfunction, urological/gastrointestinal complaints, financial difficulties, fatigue, and a reduction in emotional and social well-being. (orig.)

  1. Management of anal fistula by ligation of the intersphincteric fistula tract

    DEFF Research Database (Denmark)

    Zirak-Schmidt, Samira; Perdawood, Sharaf

    2014-01-01

    INTRODUCTION: Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-preserving procedure for treatment of anal fistulas described in 2007 by Rojanasakul et al. Several studies have since then assessed the procedure with varied results. This review assesses the relevant literature...... ligation methods varied considerably. Primary healing was achieved in 432 out of 612 (70.6%) patients, and no sphincter function impairments were reported. However, ten out of 19 reports did not include an objective assessment of pre- and post-operative continence. No apparent correlation between length...

  2. Quality of life outcomes in patients with anal cancer after combined radiochemotherapy

    International Nuclear Information System (INIS)

    Welzel, Grit; Haegele, Verena; Wenz, Frederik; Mai, Sabine Kathrin

    2011-01-01

    Purpose: To assess self-reported quality of life (QoL) experienced by anal cancer patients after radiochemotherapy, and to identify patient- and disease-related factors associated with QoL. Patients and Methods: A total of 88 patients treated for anal cancer at our institution between 1990 and 2006 were identified from our database. Of these, 15 patients had died, and 4 were lost to follow-up. QoL was assessed using the EORTC QLQ-C30 questionnaire (cancer-specific QoL) and the colorectal cancer module QLQ-CR38 (site-specific QoL); 52 responses were received. The median follow-up was 36 months (range, 5-137 months). Results: As for cancer-specific QoL, global health QoL score (mean 60.4) was similar to the general German population, whereas most of the function and symptom scale scores were considerably lower/higher in anal cancer patients. The most prominent mean score differences were observed in role functioning (-21.8 points), emotional functioning (-20.7 points), social functioning (-28.9 points), diarrhea (+34.6 points), and financial difficulties (+26.9 points; p < 0.001). As for site-specific QoL, the mean function scale scores ranged from 22.1 (sexual function) to 63.2 (body image), and the mean symptom scale scores from 14.7 (weight loss) to 69.0 (stoma-related problems, 4 patients) and 67.9 (male sexual dysfunction), respectively. Most of the QoL scores were not affected by late toxicity, patient- or disease-related factors. Fatigue (+18.2 points) emerged as the strongest predictor of impaired QoL. Conclusion: The global health QoL of anal cancer patients is comparable with that of the general German population, but there are specific limitations, e.g., sexual dysfunction, urological/gastrointestinal complaints, financial difficulties, fatigue, and a reduction in emotional and social well-being. (orig.)

  3. Multisite HPV16/18 Vaccine Efficacy Against Cervical, Anal, and Oral HPV Infection.

    Science.gov (United States)

    Beachler, Daniel C; Kreimer, Aimée R; Schiffman, Mark; Herrero, Rolando; Wacholder, Sholom; Rodriguez, Ana Cecilia; Lowy, Douglas R; Porras, Carolina; Schiller, John T; Quint, Wim; Jimenez, Silvia; Safaeian, Mahboobeh; Struijk, Linda; Schussler, John; Hildesheim, Allan; Gonzalez, Paula

    2016-01-01

    Previous Costa Rica Vaccine Trial (CVT) reports separately demonstrated vaccine efficacy against HPV16 and HPV18 (HPV16/18) infections at the cervical, anal, and oral regions; however, the combined overall multisite efficacy (protection at all three sites) and vaccine efficacy among women infected with HPV16 or HPV18 prior to vaccination are less known. Women age 18 to 25 years from the CVT were randomly assigned to the HPV16/18 vaccine (Cervarix) or a hepatitis A vaccine. Cervical, oral, and anal specimens were collected at the four-year follow-up visit from 4186 women. Multisite and single-site vaccine efficacies (VEs) and 95% confidence intervals (CIs) were computed for one-time detection of point prevalent HPV16/18 in the cervical, anal, and oral regions four years after vaccination. All statistical tests were two-sided. The multisite woman-level vaccine efficacy was highest among "naïve" women (HPV16/18 seronegative and cervical HPV high-risk DNA negative at vaccination) (vaccine efficacy = 83.5%, 95% CI = 72.1% to 90.8%). Multisite woman-level vaccine efficacy was also demonstrated among women with evidence of a pre-enrollment HPV16 or HPV18 infection (seropositive for HPV16 and/or HPV18 but cervical HPV16/18 DNA negative at vaccination) (vaccine efficacy = 57.8%, 95% CI = 34.4% to 73.4%), but not in those with cervical HPV16 and/or HPV18 DNA at vaccination (anal/oral HPV16/18 VE = 25.3%, 95% CI = -40.4% to 61.1%). Concordant HPV16/18 infections at two or three sites were also less common in HPV16/18-infected women in the HPV vaccine vs control arm (7.4% vs 30.4%, P HPV16/18 infections at one or more anatomic sites among some women infected with these types prior to HPV16/18 vaccination. Published by Oxford University Press 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  4. Cervical, anal and oral HPV in an adolescent inner-city health clinic providing free vaccinations.

    Directory of Open Access Journals (Sweden)

    Nicolas F Schlecht

    Full Text Available Published human papillomavirus (HPV vaccine trials indicate efficacy is strongest for those naive to the vaccine-types. However, few high-risk young women have been followed and cervical HPV has been the predominant outcome measure.We collected cervical and anal swabs, as well as oral rinse specimens from 645 sexually active inner-city young females attending a large adolescent health-clinic in New York City that offers free care and HPV vaccination. Specimens were tested for HPV-DNA using a MY09/MY11-PCR system. Type-specific prevalence of HPV at each anatomic site was compared for individuals by vaccination dose using generalized estimating equation logistic regression models.The majority of subjects reported being of non-Caucasian (92% and/or Hispanic ethnicity (61%. Median age was 18 years (range:14-20. All had practiced vaginal sex, a third (33% practiced anal sex, and most (77% had also engaged in oral sex. At enrollment, 21% had not received the vaccine and 51% had received three doses. Prevalent HPV infection at enrollment was detected in 54% of cervical, 42% of anal and 20% of oral specimens, with vaccine types present in 7%, 6% and 1% of specimens, respectively. Comparing prevalence for vaccine types, the detection of HPV in the cervix of vaccinated compared to unvaccinated adolescents was significantly reduced: HPV6/11 (odds ratio [OR] = 0.19, 95%CI:0.06-0.75, HPV16 (OR = 0.31, 95%CI:0.11-0.88 and HPV18 (OR = 0.14, 95%CI:0.03-0.75. For anal HPV, the risk of detecting vaccine types HPV6/11 (OR = 0.27, 95%CI:0.10-0.72 and HPV18(OR = 0.12, 95%CI:0.01-1.16 were significantly reduced for vaccinated adolescents however, the risk for HPV16 was not significantly decreased (OR = 0.63, 95%CI:0.18-2.20.HPV Prevalence is extremely high in inner-city female adolescents. Administration of the HPV vaccine reduced the risk for cervical HPV; however continued follow-up is required to assess the protection for HPV at all sites

  5. Posterior perineal support as treatment for anal fissures--preliminary results with a new toilet seat device.

    Science.gov (United States)

    Tan, Kok-Yang; Seow-Choen, Francis; Hai, Chew Heng; Thye, Gan Kok

    2009-03-01

    Anal fissures can cause morbidity in an otherwise healthy young patient. The process of evacuation results in stretching and descent of the anoderm and perineum especially posteriorly. Posterior perineal support may provide counter pressure at the posterior aspect of the pelvic floor, balancing the pressure exerted by the faeces on the anal wall, thus improving evacuation and reducing the trauma associated with it, and reducing symptoms of anal fissures. Symptoms of constipation may also be reduced secondarily. We report the preliminary results with a novel, simple and noninvasive method of treatment provided by a toilet seat device. A prospective study was performed in 32 patients. The study was designed mainly to investigate the patients' subjective perceptions of their symptoms related to anal fissures and constipation. Questionnaires were provided to patients before, during and after treatment. The study revealed statistically significant improvement in pain, bleeding, symptoms of constipation and abdominal discomfort after 3 months usage of the device. The odds of patients perceiving an improvement in symptoms were also significantly increased after 3 months of treatment compared to 2 weeks of treatment. This preliminary study revealed that a posterior perineal support device can bring about significant improvement in the symptoms of patients with anal fissures. There may also be secondary benefits of a reduction in the symptoms of constipation. Although not conclusive, these results should serve as a springboard for further research into this area.

  6. Defecation into clothing without forewarning and mean radiation dose to bowel and anal-sphincter among gynecological cancer survivors.

    Science.gov (United States)

    Lind, Helena; Alevronta, Eleftheria; Steineck, Gunnar; Waldenström, Ann-Charlotte; Nyberg, Tommy; Olsson, Caroline; Wilderäng, Ulrica; Dunberger, Gail; Al-Abany, Massoud; Åvall-Lundqvist, Elisabeth

    2016-11-01

    To analyze the relationship between mean radiation dose to the bowels and the anal-sphincter and occurrence of 'defecation into clothing without forewarning', a specific and serious fecal incontinence symptom after gynecological radiotherapy. Additional potential risk factors associated with the symptom are explored. Data were collected for 519 eligible gynecological cancer survivors, treated with pelvic radiotherapy, with a median follow-up of 5.8 years, using a study-specific questionnaire and medical records. Correlations between defecation into clothing without forewarning and mean dose to organs at risk; the anal-sphincter region, the rectum, the sigmoid and the small intestines were investigated, also taking other risk factors into account. Twelve percent reported having had the symptom at least once in the preceding six months. Mean doses >50 Gy to the anal-sphincter region, the rectum, the sigmoid and the small intestines were related to the occurrence of the symptom. Significantly associated risk factors were deliveries with high birth weight, heart failure and lactose and/or gluten intolerance. After adjusting for these factors, mean doses >50 Gy to the anal-sphincter region, the sigmoid and the small intestines remained related to the occurrence of the symptom. Mean doses to the bowels and anal-sphincter region are related to the risk of defecation into clothing without forewarning in long-term gynecological cancer survivors treated with pelvic radiotherapy. Further radiobiological modeling may distinguish which organ(s) contribute most to development of the symptom.

  7. Radiochemotherapy in Anal Cancer: cCR, clinical outcomes and quality of life using two different treatment schedules.

    Science.gov (United States)

    Di Santo, Sara; Trignani, Marianna; Neri, Matteo; Milano, Angelo; Innocenti, Paolo; Taraborrelli, Maria; Augurio, Antonietta; Vinciguerra, Annamaria; Di Tommaso, Monica; Ursini, Lucia Anna; Di Pilla, Angelo; Di Nicola, Marta; Genovesi, Domenico

    2015-01-01

    Main endpoint was a response rate to therapy; secondary endpoints were disease-free survival, overall survival, acute and late toxicities, specially in terms of anorectal and urinary continence. Radiochemotherapy for anal cancer achieves a good clinical response, locoregional control, anal function preservation. However, oncologic outcomes can differ using radiotherapy plus fluorouracil and mytomicin vs. cisplatin and fluorouracil. Between 2000 and 2012, 27 anal cancer patients receiving radiotherapy combined with two different radiochemotherapy schedules, fluorouracil and mytomicin (group A) and cisplatin plus fluorouracil (group B). The Kaplan-Meier method was also used to estimate local control, overall survival and disease free survival. Statistical significance between curves was evaluated using the Log-rank test. Complete pathological response was found in 85.2% of patients, with higher rates of response in the group A (100% vs. 63.6%, p = 0.039). No significantly difference was found between the two groups for the other endpoints. Low rates of both acute and late toxicities were recorded. Radiotherapy plus fluorouracil and mytomicin provide a better complete pathological response than radiotherapy plus cisplatin and fluorouracil and a greater rate of anal sphincter function preservation. Globally, radiochemotherapy of the anal cancer provides excellent clinical outcomes with a good profile of acute and late toxicity, without difference between the two groups studied.

  8. Rastreamento e seguimento dos portadores das lesões anais induzidas pelo papilomavírus humano como prevenção do carcinoma anal Screening and follow-up of patients with anal HPV induced lesions for anal carcinoma prevention

    Directory of Open Access Journals (Sweden)

    Sidney Roberto Nadal

    2009-06-01

    Full Text Available O Papilomavírus humano (HPV é o agente sexualmente transmissível mais comum na região perianal. O vírus provoca lesões clínicas e subclínicas que podem evoluir para carcinoma anal. É descrito o aumento da incidência desse tipo de tumor naqueles que praticam sexo anal; nos portadores, de ambos os sexos, de lesões genitais HPV induzidas; nas pessoas com neoplasias intraepiteliais anais de alto grau, o precursor do carcinoma, com maior incidência nos infectados pelo vírus da imunodeficiência humana (HIV, e com outras causas de supressão imunológica. Outra característica das lesões HPV induzidas é a elevada incidência de recidivas. Daí, a importância do seguimento por longo prazo e da pesquisa de meios terapêuticos para reduzir essa ocorrência. A possibilidade da detecção das lesões precursoras indica que programas padronizados de rastreamento para a prevenção do câncer anal deveriam ser instituídos. Os esfregaços anais para citologia vêm sendo realizados, com eficácia semelhante a das coletas cervicais e a colposcopia anal tem sido indicada para biópsias dirigidas quando a citologia mostrou-se alterada, embora muitos recomendam-na, também, como método de rastreamento. Nesse artigo, descrevemos a padronização da coleta de material para citologia anal e o método de realização da colposcopia anal, bem como a periodicidade com que devem ser repetidos.The human papillomavirus is the most frequent sexually transmitted agent in anorectal area. This virus provokes clinical and sub-clinical lesions that can evolve to anal carcinoma. Its incidence is increasing among those who practice anal receptive sex; in both gender patients with genital HPV induced lesions; in those with high grade anal intra-epithelial neoplasia, anal carcinoma precursor, mainly among HIV infected persons or with other causes of immunodeficiency. Another HPV induced lesions characteristic is their elevated incidence of recurrences. Therefore

  9. Instrumentação anal erótica: um problema médico-cirúrgico Anal erotic instrumentation: a medical problem

    Directory of Open Access Journals (Sweden)

    Júlio César Monteiro dos Santos Jr

    2007-03-01

    Full Text Available A inclusão do ânus na esfera sexual e a utilização de objetos fálicos para prática auto-erótica, descrito na literatura médica desde o século 16, é freqüente na sociedade moderna. O problema social traz consigo, além do aspecto curioso, o risco de lesões ano-retais traumáticas de graves repercussões. Nesse artigo destacamos esses aspectos, reunindo 20 pacientes do sexo masculino, dos quais 6 (30% foram atendidos com o objeto retido no reto, e 14 (70% com lesão ano-retal ocorrida durante a prática erótica e provocada pelo corpo fálico. Dentre os pacientes com lesão ano-retal, 10 (71,4% estavam com o reto perfurado. As lesões ano-retais foram tratadas cirurgicamente, e 7 desses pacientes (50% evoluíram com complicações que incluem 2 óbitos (20% entre os que tinham perfuração do reto, o que representa para o grupo todo o índice de 10,5% de mortalidade. A prática do erotismo anal com emprego de objetos fálicos, pelo alto índice de morbi-mortalidade, constitui-se em grave problema médico cirúrgico.Anorectal injuries and colorectal foreign bodies due to anal erotic instrumentation or transanal autoerotism are a common fact of modern homosexual relationship making both a social and surgical problem. Severe anorectal injuries caused by foreign bodies during sexual practice and sexual autostimulation are reported occuring in 20 male patients. These patients are allocated in two different groups. Group 1: patients referred to the hospital with retained like-penis rectal foreign body without anorectal lesions(30 %. Group 2: patients admitted to the hospital with anorectal lesions (70% due to foreign body inserted into the rectum for sexual stimulation. Among them, 10 patients (71,4% had rectal perforation. Fifty per cent exhibited several complications following surgical management of injuries. Among patients of the group 2 there were 20% of mortality. We emphasize the severity of such lesions and claim for judicious

  10. [Orange oily anal leakage: a new entity linked to dietary changes].

    Science.gov (United States)

    Robles, Ignacio; Vásquez, Jose Manuel; Loehnert, Rodrigo; Espino, Alberto; Biel, Francisco; Correa, Ismael; Gobelet, Jaquelina; Sáenz, Marcela; Saenz, Constanza; Sáenz, Roque

    2012-02-01

    Information is accumulating on exceptional cases of oily orange anal leakage, probably caused by certain foods and their form of consumption. The leakage is usually inadvertent and is worrisome for patients. Clinical data was gathered on a case series presenting with massive and inadvertent orange oily anal leakage, without sphincter sensation, causing the patients to feel alarmed. This condition usually occurs after eating fish, especially Japanese cuisine. Eleven patients were included (four women and seven men). The mean age was 47.3 years. Colonoscopy had previously been performed in four patients, with normal results. The symptoms, described as keriorrhea, were probably produced by accumulation of indigestible "wax esters", es Mero present in some oily fish, recently incorporated in raw fish dishes (sashimi) or as Japanese Mero sea bass. These oils, which cannot be absorbed or digested, accumulate in the rectum and may also filter spontaneously and induce toxin-related sphincter dysfunction. The same symptoms are sometimes produced after consumption of cooked versions of these species. The diagnosis is given by clinical data, prior ingestion of these types of fish and the self-limiting nature of the symptoms, without the need for further investigations. We describe a case series of a recently described entity associated with dietary changes. This entity is benign and self-limiting. Clinicians should be familiar with the symptoms to inform patients correctly and avoid unnecessary laboratory studies. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  11. Obesity is a negative predictor of success after surgery for complex anal fistula

    Directory of Open Access Journals (Sweden)

    Schwandner O

    2011-05-01

    Full Text Available Abstract Background It was the aim of this study to compare the outcome of surgery for complex anal fistulas in obese and non-obese patients. Methods All patients with complex anorectal fistulas who underwent fistulectomy and/or rectal advancement flap repair were prospectively recorded. Surgery was performed in a standardized technique. Body mass index (BMI [kg/m2] was used as objective measure to indicate morbid obesity. Patients with a BMI greater than 30 were defined as obese, and patients with a BMI below 30 were defined as non-obese. The parameters analyzed related to BMI included success or failure, and reoperation rate due to recurrent abscess. Success was defined as closure of both internal and external openings, absence of drainage without further intervention, and absence of abscess formation. Results Within two years, 220 patients underwent advancement flap repair and met the inclusion criteria. 55% of patients were females, mean age was 39 (range 18-76 years, and the majority of fistulas were located at the posterior site. 69% of patients (152/220 were non-obese (BMI 30. After a median follow-up of 6 months, primary healing rate ("success" for the whole collective was 82% (180/220. Success was significantly different between non-obese and obese patients: In non-obese patients, recurrence rate was significantly lower than in obese patients (14% vs. 28%; p Conclusion Obese patients are at higher risk for failure after surgery for complex anal fistula.

  12. Correlates of unprotected anal sex among men who have sex with men in Tijuana, Mexico

    Directory of Open Access Journals (Sweden)

    Barrón-Limón Sergio

    2012-06-01

    Full Text Available Abstract Background Although men who have sex with men (MSM are disproportionately affected by HIV/AIDS in Mexico, data on current risk behaviors in this population are lacking. This study investigated the prevalence and correlates of unprotected anal intercourse (UAI in a sample of 260 MSM in Tijuana, Mexico. Methods In June 2010, men attending a gay pride celebration were invited to complete a sexual risk survey. Men who reported UAI with a male partner in the past year were compared with men who reported only protected anal sex during the same period. Results Mean age of participants was 29.7; 54% had a high school diploma or less; and 43% were unemployed. In the past year, 55% had been tested for HIV, 21% reported using illicit drugs before or during sex, and 94% had sex only with men. Overall, 50% reported having UAI with another male in the past year. Factors independently associated with UAI in the past year were unemployment (AOR = 1.87, attending adult movie theaters (AOR = 2.21, using illicit drugs before or during sex (AOR = 2.43, and not having a recent HIV test (AOR = 1.85. Conclusions Interventions to promote HIV testing and condom use among men who have sex with men may want to consider venue-specific approaches, as well as focus on drug-use issues in the context of unsafe sex.

  13. Carcinoma of the apocrine glands of the anal sac in dogs: 113 cases (1985-1995).

    Science.gov (United States)

    Williams, Laurel E; Gliatto, John M; Dodge, Richard K; Johnson, Jeffrey L; Gamblin, Rance M; Thamm, Douglas H; Lana, Susan E; Szymkowski, Mary; Moore, Antony S

    2003-09-15

    To characterize the signalment, clinical signs, biological behavior, and response to treatment of carcinoma of the apocrine glands of the anal sac in dogs. Retrospective study. 113 dogs with histologically confirmed carcinoma of the apocrine glands of the anal sac. Data on signalment, clinical signs, and staging were reviewed and analyzed along with treatment modality for potential association with survival time. Sex distribution was approximately equal (54% female, 46% male). One hundred four dogs underwent treatment consisting of surgery, radiation therapy, chemotherapy, or multimodal treatment. Median survival for treated dogs was 544 days (range, 0 to 1,873 days). Dogs treated with chemotherapy alone had significantly shorter survival (median, 212 days) than those receiving other treatments (median, 584 days). Dogs not treated with surgery had significantly shorter survival (median, 402 days) than those that underwent surgery as part of their treatment (median, 548 days). Dogs with tumors > or = 10 cm2 had significantly shorter survival (median, 292 days) than dogs with tumors dogs, and those dogs had significantly shorter survival (median, 256 days), compared with those that were normocalcemic (median, 584 days). Dogs with pulmonary metastasis had significantly shorter survival (median, 219 days) than dogs without evidence of pulmonary metastasis (median, 548 days). Unlike most previous reports, this study revealed an approximately equal sex distribution, and results suggest a more favorable prognosis.

  14. Alcance y disyuntivas de la ética analógica de M. Beuchot

    Directory of Open Access Journals (Sweden)

    Miquel Seguró

    2016-01-01

    Full Text Available En el presente artículo se discute críticamente el alcance axiológico de la "hermenéutica analógica" de Mauricio Beuchot. Para ello se expone en primer lugar el fundamento ontológico sobre el que se sustenta su propuesta hermenéutica, para luego proceder a una clarificación de su traslación al campo axiológico y de sus problemas. Una vez ponderado y discutido críticamente su planteamiento, en un tercer momento se deducen los principios aporéticos que se vislumbran en los intentos de resolución analógica de los dilemas éticos. El telón de fondo de toda la problemática no es otro que el de la insoslayable finitud primera que constituye la realidad ontológica humana y su capital influencia en el planteamiento fundamental de la cuestión ética.

  15. Transrectal ultrasound color Doppler in the evaluation of recurrence of anal canal cancer

    International Nuclear Information System (INIS)

    Drudi, Francesco M.; Giovagnorio, Francesco; Raffetto, Nicola; Ricci, Paolo; Cascone, Fiammetta; Santarelli, Mario; Trippa, Francesca; Passariello, Roberto

    2003-01-01

    Objective: aim was to obtain elements for a differential diagnosis between post-radiation fibrosis and residual tumor or local relapse in anal canal cancer through detection of presence/absence of intralesional blood flow. Transrectal ultrasound and color Doppler were compared. Methods: 43 patients underwent transrectal ultrasound sonography and color Doppler before and after therapy to assess intralesional blood flow and flow pattern (spotty and linear signals). All diagnostic imaging results were compared to histological analysis. Specificity was submitted to statistical analysis using McNemar test. Results: before therapy 34 lesions (79%) showed color signal; no signal in 9 (21%), which were excluded from our analysis. Eighteen of the 34 patients considered, presented complete response to therapy, 14 partial response and two no response. After therapy, signal disappeared in 17 patients (94%); one false-positive (6%) presented spotty signals; 16 of 34 patients presented changed color signal. Color Doppler showed higher specificity than grey scale transrectal ultrasound in the differentiation of fibrosis from tumor. Response was confirmed by histological examination, considered gold standard. McNemar test demonstrated the significance of color Doppler (P<0.0001). Conclusion: color Doppler considerably increases transrectal ultrasound specificity in differentiating tumor relapse from fibrosis in anal canal cancer

  16. A Comparison of Dacron versus Flocked Nylon Swabs for Anal Cytology Specimen Collection

    Science.gov (United States)

    Gage, Julia C.; Ghosh, Arpita; Borgonovo, Sylvia; Follansbee, Stephen; Wentzensen, Nicolas; Gravitt, Patti E.; Grabe, Niels; Lahrmann, Bernd; Castle, Philip E.

    2011-01-01

    Objectives We compared the performance of commonly used Dacron versus flocked nylon swabs for anal cytology. Study Design From 23 HIV-positive men screened at Kaiser Permanente San Francisco (San Francisco, Calif., USA), 2 anal specimens were collected, 1 with each swab in random order, and placed into liquid cytology medium. Specimens were tested for cellularity by quantifying a genomic DNA (erv-3). The number of cells was assessed from prepared slides by automated image analysis. Performance was compared between swabs using 2-sample t tests and standard crossover trial analysis methods accounting for period effect. Results Flocked swabs collected slightly more erv-3 cells than Dacron for the first sample although not significantly (p = 0.18) and a similar number of erv-3 cells for the second sample (p = 0.85). Flocked swabs collected slightly more cells per slide than the Dacron swabs at both time periods although this was only significant in the second time period (p = 0.42 and 0.03 for first and second periods, respectively). In crossover trial analysis, flocked swabs outperformed Dacron for cell count per slide based on slide imaging (p = 0.03), but Dacron and flocked swabs performed similarly based on erv-3 quantification (p = 0.14). Conclusions Further studies should determine whether flocked swabs increase the representation of diagnostically important cells compared to Dacron. PMID:21791907

  17. Analítica o evocadora: el debate olvidado de la autoetnografía

    Directory of Open Access Journals (Sweden)

    Xavier Montagud Mayor

    2016-07-01

    Full Text Available Existe la necesidad de una estrategia metodológica eficaz para sostener la investigación sobre la práctica profesional de los servicios sociales. La oposición entre el trabajo autoetnográfico de Carolyn ELLIS y Arthur BOCHNER (2000, 2006 y la propuesta analítica de Leon ANDERSON sirven como una lente a través de la cual explorar los aspectos clave de esta discusión. Mientras ELLIS y BOCHNER rechazan cualquier intento de abstracción o sistematización teórica, ANDERSON pretende tender puentes entre la tradición etnográfica y las formas emergentes de narrativa personal. Después de revisar la literatura autoetnográfica, concluyo que si bien la autoetnografía evocadora parece gozar del apoyo mayoritario en este campo, podría ser enriquecida por el enfoque analítico. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1603124

  18. Streptococcus Agalactiae Research on Secretion Vaginal and Anal Pregnant Women of a City of Paulista Northwest

    Directory of Open Access Journals (Sweden)

    Cátia Rezende

    2015-12-01

    Full Text Available Streptococcus agalactiae has great medical importance in infections associated with severe neonatal morbidity and mortality. It is the most frequent bacterium isolated from the tables of septicemia, pneumonia and neonatal meningitis. This study aimed to determine the prevalence of anal and vaginal colonization of S. agalactiae in pregnant women at different gestational ages. We evaluated the incidence of colonization by S. agalactiae in 129 pregnant women of any age. Two samples of secretion were collected for culture: a perianal swab and a vaginal swab. Each of the two swabs were inoculated in test tubes containing Todd-Hewitt broth and subcultured on blood agar. After a period of 24 to 48 hours, the colonies suggestive of S. agalactiae were submitted to morfotintorial analysis and to biochemical tests for identification. Among 129 women studied, 3 (2.33% have tested positive for Streptococcus agalactiae and 126 (97.67% were negative. The results presented in this work are inferior to the data from other studies, however, the methodology used was compatible with most authors. Even so this rate is considered a relevant value taking into account the importance of Streptococcus agalactiae infections in pregnant women and newborns, emphasizing the importance of encouraging the culture of vaginal and anal secretion for the detection of Streptococcus agalactiae in surveys of prenatal care.

  19. Symptoms of anal and urinary incontinence following cesarean section or spontaneous vaginal delivery.

    Science.gov (United States)

    Altman, Daniel; Ekström, Asa; Forsgren, Catharina; Nordenstam, Johan; Zetterström, Jan

    2007-11-01

    The objective of the study was to compare the prevalence of incontinence disorders in relation with spontaneous vaginal delivery or cesarean section. Two hundred women with spontaneous vaginal deliveries only were compared with 195 women with cesarean deliveries only 10 years after first delivery. When compared with cesarean section, vaginal delivery was associated with an increased frequency of stress urinary incontinence (P = .006) and an increased use of protective pads (P = .008) as well as an increased frequency of fecal urgency (P = .048) and gas incontinence (P = .01). At multivariate regression analysis, mode of delivery showed no significant association with incontinence symptoms other than an increased risk for flatus incontinence in women with a history of obstetric anal sphincter injury (odds ratio 3.1; 95% confidence interval, 1.5 to 8.9). Incontinence symptoms are more common following spontaneous vaginal delivery when compared with cesarean section 10 years after first delivery. However, cesarean section is not associated with a major reduction of anal and urinary incontinence.

  20. Tumour-infiltrating lymphocyte scores effectively stratify outcomes over and above p16 post chemo-radiotherapy in anal cancer

    DEFF Research Database (Denmark)

    Gilbert, Duncan C.; Serup-Hansen, Eva; Linnemann, Dorte

    2016-01-01

    Background: The majority (90%) of anal cancers are human papillomavirus (HPV)-driven, identified using immunochemistry for p16. Compared with HPV- patients, those with HPV+ disease generally show improved survival, although relapse rates around 25% indicate a need for further stratification...... of this group. Methods: Using two cohorts of anal cancer, previously characterised for p16, we assessed the prognostic value of tumour-infiltrating lymphocytes (TILs). Results: Tumour-infiltrating lymphocyte scores were used to stratify p16+ cases, where tumours with absent/low levels of TIL had a relapse......-free rate of 63%, as opposed to 92% with high levels of TIL (log rank P=0.006). Conclusions: Assessment of TIL adds to p16 status in the prognosis of anal cancer following chemo-radiotherapy and provides evidence of the clinical importance of the immune response....

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

    International Nuclear Information System (INIS)

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

    2010-01-01

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

  2. Efficacy of topical imiquimod in HIV-positive patients with recurrent anal condylomata acuminata

    Directory of Open Access Journals (Sweden)

    Sidney Roberto Nadal

    2012-03-01

    Full Text Available INTRODUCTION: Imiquimod is a topical chemotherapic and immunostimulant agent with antitumoral and antiviral activities, used for anal condylomata acuminata treatment, mainly in recurrences. OBJECTIVE: Evaluate the imiquimod efficiency in chronic and recurrent anal condylomata acuminata in HIV-infected persons. METHOD: A prospective study that analyzed 61 patients with recurrent anal condylomata treated with topic 5% imiquimod, for at least 8 weeks. These patients had already been submitted to other topical and surgical treatments for anal warts. We evaluated the efficiency of this agent, through wart remission, with clinical examination and high-resolution anoscopy, CD4+ T lymphocyte count and side effects. The patients were 55 males and 6 females, from 22 to 63 years old. RESULTS: Remission was seen in 90%, being 46% complete remission and 44% partial remission. Other 10% did not respond to the treatment with imiquimod within the 16th week. Recurrences were observed in 11% of patients in 24-week follow-up. Statistics showed no differences in CD4+ T cell scores when groups with and without complete remission were compared. Adverse effects were reported by 45% of patients. They were mild to moderate burning (25%, intense burning (7%, ulcerative dermatitis (8% and systemic symptoms (5%. CONCLUSION: Imiquimod was effective in controlling recurrent anal condylomata acuminata in HIV-positive patients, regardless of CD4+ T cell count.INTRODUÇÃO: O imiquimode é agente tópico quimioterápico e imunoestimulante, com atividades antitumoral e antiviral, usado para tratamento dos condilomas acuminados perianais, principalmente os recidivantes. OBJETIVO: Avaliar a eficácia do imiquimode nos condilomas acuminados perianais crônicos e multirrecidivantes dos doentes soropositivos para o vírus da imunodeficiência adquirida (HIV. CASUÍSTICA E MÉTODO: Estudo clínico prospectivo por 12 meses em que observamos o uso tópico de imiquimode creme 5%, por no

  3. Male sex workers who sell sex to men also engage in anal intercourse with women: evidence from Mombasa, Kenya.

    Directory of Open Access Journals (Sweden)

    Priya Mannava

    Full Text Available To investigate self-report of heterosexual anal intercourse among male sex workers who sell sex to men, and to identify the socio-demographic characteristics associated with practice of the behavior.Two cross-sectional surveys of male sex workers who sell sex to men in Mombasa, Kenya.Male sex workers selling sex to men were invited to participate in surveys undertaken in 2006 and 2008. A structured questionnaire administered by trained interviewers was used to collect information on socio-demographic characteristics, sexual behaviors, HIV and STI knowledge, and health service usage. Data were analyzed through descriptive and inferential statistics. Bivariate logistic regression, after controlling for year of survey, was used to identify socio-demographic characteristics associated with heterosexual anal intercourse.From a sample of 867 male sex workers, 297 men had sex with a woman during the previous 30 days - of whom 45% did so with a female client and 86% with a non-paying female partner. Within these groups, 66% and 43% of male sex workers had anal intercourse with a female client and non-paying partner respectively. Factors associated with reporting recent heterosexual anal intercourse in bivariate logistic regression after controlling for year of survey participation were being Muslim, ever or currently married, living with wife only, living with a female partner only, living with more than one sexual partner, self-identifying as basha/king/bisexual, having one's own children, and lower education.We found unexpectedly high levels of self-reported anal sex with women by male sex workers, including selling sex to female clients as well as with their own partners. Further investigation among women in Mombasa is needed to understand heterosexual anal sex practices, and how HIV programming may respond.

  4. Terapia analítico-comportamental da depressão: uma antiga ou uma nova ciência aplicada?

    OpenAIRE

    Abreu,Paulo Roberto

    2006-01-01

    CONTEXTO: A história dos estudos comportamentais no campo da depressão é apresentada. OBJETIVO: Apresentar e analisar os avanços das terapias analítico-comportamentais. MÉTODO: Analisaram-se 37 referências relacionadas a estudos conceituais, de pesquisa de base e aplicada, todos publicados no período de 1961 a 2006. Os preceitos teóricos e metodológicos adotados foram considerados, e o impacto das aplicações propostas, foi discutido. RESULTADOS: Tradicionalmente, os modelos analítico-comporta...

  5. A comparative study of various electrodes in electromyography of the striated urethral and anal sphincter in children

    DEFF Research Database (Denmark)

    Nielsen, K K; Kristensen, E S; Qvist, N

    1985-01-01

    The series comprised 41 children aged 6 to 14 years consecutively referred with recurrent urinary tract infection and/or enuresis. Carbon dioxide cystometry was carried out in the supine and the erect position and combined with simultaneous electromyography (EMG). The external urethral sphincter...... was examined with a ring electrode mounted on a urethral catheter, while recordings from the striated anal sphincter were based on an anal plug electrode and perianal electrocardiographic (ECG) skin electrodes: 211 EMG and cystometric examinations were performed and all three methods gave satisfactory results...

  6. Cálculo analítico de la potencia nominal en transmisión por correa dentada

    OpenAIRE

    Gonzalo González Rey; Maria Eugenia García Domínguez

    2011-01-01

    En el contexto de las actuales normas internacionales, no se dispone de información suficiente para enfrentar el cálculo analítico de la potencia transmisible por una correa dentada. Esta situación restringe el desarrollo de un cálculo computacional o la estimación de la potencia nominal de las correas dentadas para casos no contemplados en los datos declarados por los fabricantes y derivados de ensayos experimentales. Por tal motivo, y con el interés de difundir el cálculo analítico de la po...

  7. HPV16 E6 seropositivity among cancer-free men with oral, anal or genital HPV16 infection

    OpenAIRE

    Beachler, Daniel C.; Waterboer, Tim; Campbell, Christine M. Pierce; Ingles, Donna J.; Kuhs, Krystle A. Lang; Nyitray, Alan G.; Hildesheim, Allan; Pawlita, Michael; Kreimer, Aimée R.; Giuliano, Anna R.

    2016-01-01

    Antibodies against the Human papillomavirus 16 (HPV16) E6 oncoprotein appear years prior to clinical diagnosis of anal and oropharyngeal cancer, but whether they develop around the time of HPV infection is unclear. Serum samples from 173 cancer-free men from the Human Papillomavirus Infection in Men (HIM) Study were tested for HPV antibodies and DNA. HPV16 E6 seropositivity was low among men with oral HPV16-infection (1/28; 3.6%, 95%CI=0.0–18.4%), anal HPV16-infection (1/61; 1.6%, 95%CI=0.0–8...

  8. Teorija Clarisse Pinkole Estes in analize pravljic – študija primera Rdeči čeveljci

    OpenAIRE

    Kužnik, Branka

    2016-01-01

    Diplomsko delo Teorija Clarisse Pinkole Estes in analize pravljic – študija primera Rdeči čeveljci obravnava pravljice, analize vsebin in sporočil, ki jih ima vsaka pravljica. Obravnavane bodo tri pravljice za otroke danskega pravljičarja Hansa Christiana Andersena iz zbirke Pravljice (Ljubljana: Mladinska knjiga, 2005, iz danščine prevedla Silvana Orel Kos, ilustrirala Marija Lucija Stupica). Te pravljice so: Mala morska deklica, Stanovitni kositrni vojak in Rdeči čeveljci. Poleg omenjeni...

  9. 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.

  10. What drives the number of high-risk human papillomavirus types in the anal canal in HIV-positive men who have sex with men?

    NARCIS (Netherlands)

    del Amo, Julia; González, Cristina; Geskus, Ronald B.; Torres, Montse; del Romero, Jorge; Viciana, Pompeyo; Masiá, Mar; Blanco, Jose R.; Hernández-Novoa, Beatriz; Ortiz, Marta; Peña, Alejandro; García, Federico; Torres, Montserrat; Ocampo, Antonio; Da Silva, Alfredo Rodríguez; Miralles, Celia; Mauricio Iribarren, Gustavo; Madrid, Nadia; Dronda, Fernando; Benito, Amparo; Sanz, Itziar; Vera, Mar; Rodríguez, Carmen; Martín Alegre, Carmen; Carlos Carrió, Juan; Raposo, Montse; Trastoy, Mónica; Fontillón, Maria; Robledano, Catalina; Gutierrez, Félix; Padilla, Sergio; Andrada, Encarna; Cervero, Miguel; Ramón Blanco, José; Pérez, Laura; Portilla, Joaquín; Portilla, Irene; Angel Vonwichmann, Miguel; Antonio Iribarren, José; Camino, Xabier; Sendagorta, Elena; Herranz, Pedro; Rodríguez, Patricia; Luis Gómez, Juan; Rosado, Dacil; Alejos, Belén; Angeles Rodríguez, Maria

    2013-01-01

    We estimated the effect of sexual behavior, age, and immunodeficiency on the number of high-risk human papillomavirus (HR-HPV) types in the anal canal among human immunodeficiency virus-positive men who have sex with men (MSM). Anal samples were genotyped with the Linear Array HPV Genotyping Test,

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

    OpenAIRE

    Opazo Valdés, Álvaro Javier

    2012-01-01

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

  12. Low current electrical stimulation upregulates cytokine expression in the anal sphincter.

    Science.gov (United States)

    Salcedo, Levilester; Lian, Lei; Jiang, Hai-Hong; Sopko, Nikolai; Penn, Marc; Damaser, Margot; Zutshi, Massarat

    2012-02-01

    Stem cells are an emerging treatment for regeneration of damaged anal sphincter tissues. Homing to the site of injury can be potentiated by stromal derived factor 1 (SDF-1) and monocyte chemotactic protein 3 (MCP-3) expression. The effects of electrical stimulation (ES) on upregulation of these cytokines were investigated. The anal sphincter complex of Sprague Dawley rats was stimulated with current of 0.25 mA, pulse duration of 40 pulses/s, pulse width of 100 μs, and frequency of 100 Hz for 1 or 4 h. Sham was created using the same needle which was inserted into the anal sphincter without electrical stimulation in different groups of animals. The rats were euthanized immediately or 24 h after stimulation. Cytokine analysis was performed using real-time polymerase chain reaction. Statistical analysis was performed. Results are presented as a fold increase compared to sham that was normalized to 1. SDF-1 and MCP-3 immediately after 1 h were 2.5 ± 0.77 and 3.1± 0.93 vs. sham, respectively, showing significant increase. After 1-h stimulation and euthanasia 24 h after, SDF-1 and MCP-3 were 1.49 ± 0.16 and 1.51± 0.14 vs. sham, respectively, showing significant increase. Immediately and 24 h after 4-h stimulation, SDF-1 was 1.21 ± 0.16 and 0.54 ± 0.16 vs. sham, respectively, and was not significantly different. Immediately and 24 h after 4-h stimulation, MCP-3 was 1.29 ± 0.41 and 0.35 ±1.0 vs. sham, respectively, and was not significantly different. SDF-1 and MCP-3 after 1 h were significantly higher than after 4 h of stimulation at both time points. Electrical stimulation for 1 h significantly upregulates SDF-1 and MCP-3 expression that persists for 24 h. Prolonged stimulation reduced chemokine expression, suggesting electrolysis of cells.

  13. High Prevalence and Genotype Diversity of Anal HPV Infection among MSM in Northern Thailand.

    Directory of Open Access Journals (Sweden)

    Taweewat Supindham

    Full Text Available HPV infection is common and may cause cancer among men who have sex with men (MSM. Anal HPV infection (HPV+ was found in 85% of HIV-positive (HIV+ and 59% of HIV-negative (HIV- MSM in Bangkok, central Thailand. As little is known about HPV in this group in northern Thailand, we studied MSM subgroups comprised of gay men (GM, bisexual men (BM, and transgender women (TGW.From July 2012 through January 2013, 85 (42.5% of 200 GM, 30 (15% BM, and 85 (42.5% TGW who practiced receptive anal intercourse were recruited after informed consent, followed by self-assisted computer interview, HIV testing, and anal swabs for HPV genotyping.Of 197 adequate specimens, the overall prevalence of any HPV was 157 (80%. Prevalence was 89% (76/85 in GM, 48% (14/29 in BM, and 81% (67/83 in TGW. The most common high-risk types were HPV16 (27% of 197, HPV58 (23%, and HPV51 (18%. Prevalence of high-risk types was 74% in 85 GM, 35% in 29 BM, and 71% in 83 TGW. Prevalence of any HPV type, or high-risk type, was 100% and 94%, respectively, among 48 HIV+ MSM, 70% and 54% among 120 HIV- MSM. Of the 197 specimens, 36% (70 had HPV types 16 and/or 18 in the bivalent vaccine, compared to 48% (95 with ≥1 of types 16/18/06/11 in the quadrivalent, 56% (111 for 16/18/31/33/45/52/58 in the 7-valent, and 64% (126 for 16/18/31/33/45/52/58/06/11 in the 9-valent. HIV+, GM, and TGW were independently associated with HPV infection.We found higher rates of both any HPV and high-risk types than previous studies. Among the heretofore unstudied TGW, their equivalent HPV rates were comparable to GM. Current and investigational HPV vaccines could substantially protect GM, BM, and TGW from the serious consequences of HPV infection especially among HIV + MSM.

  14. La hermenéutica analógica en el análisis organizacional

    Directory of Open Access Journals (Sweden)

    Francisco Velázquez

    2014-05-01

    Full Text Available El artículo tiene como objetivo presentar una metodología alterna para el análisis de transcripciones de entrevistas semi-estructuradas considerando el paradigma cualitativo y aplicando la propuesta filosófica de la hermenéutica analógica impulsada por Beuchot (2009. Partiendo de una estrategia metodológica de Estudio de Caso, se describe en un primer momento, la contextualización y justificación del proyecto de investigación sobre la transformación estructural de la Universidad de Guanajuato (UG en México. Posteriormente se detalla el modelo de análisis hermenéutico aplicado a los textos surgidos de ocho entrevistas semiestructuradas realizadas con los principales actores que impulsaron, protagonizaron o se opusieron a este cambio organizacional, como rectores, diputados, profesores y funcionarios universitarios. A diferencia de un análisis cualitativo basado en la construcción de categorías y sub categorías identificadas en el texto de la entrevista, se explican las ventajas de un abordaje hermenéutico basado en una analogía, que nos permite mantener un equilibrio entre la univocidad y la equivocidad. La univocidad se entiende como una minería de la verdad, en donde uno y sólo un significado es válido y aceptable; y en el otro sentido, la equivocidad es entendida como una construcción interpretativa muy abierta que depende del contexto situacional o histórico de quien interpreta. La aplicación de esta metodología ha permitido la construcción de un referente analógico hermenéutico, conformado por un rango de interpretaciones válidas para este estudio de caso. Como resultado de esta metodología se presenta un mapa conceptual que integraesta gama de interpretaciones y se comentan las ventajas de tener este referente analógico no como una interpretación final sino como una herramienta para avanzar en un proceso hermenéutico continuo.

  15. Volumetric modulated arc therapy (VMAT) in the combined modality treatment of anal cancer patients.

    Science.gov (United States)

    Franco, Pierfrancesco; Arcadipane, Francesca; Ragona, Riccardo; Mistrangelo, Massimiliano; Cassoni, Paola; Munoz, Fernando; Rondi, Nadia; Morino, Mario; Racca, Patrizia; Ricardi, Umberto

    2016-01-01

    To report clinical and dosimetric outcomes of a consecutive series of patients with anal cancer treated with volumetric-modulated arc therapy (VMAT) concomitant to chemotherapy (CT). A cohort of 39 patients underwent VMAT employing a schedule consisting of 50.4 Gy/28 fractions to the gross tumour volume (GTV) and 42 Gy/28 fractions to the elective nodal volumes for patients with cT2N0 disease. Patients with cT3-T4/N0-N3 tumours were prescribed 54 Gy/30 fractions to the GTV and 50.4 Gy/30 fractions to the gross nodal volumes if sized ≤3 cm or 54 Gy/30 fractions if > 3 cm. Elective nodal regions were given 45 Gy/30 fractions. CT was administered concurrently following Nigro's regimen. The primary end point was acute toxicity. Secondary end points were colostomy-free survival (CFS), disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS). Dosimetric data are also provided. Median follow-up was 21 months. Maximum acute toxicities were: dermatologic-G3: 18%; gastrointestinal-G3: 5%; genitourinary-G3: 2%; anaemia-G2: 7%; leukopenia-G3: 28%; G4: 8%; neutropenia-G3: 13%; G4: 18%; thrombocytopenia-G3: 11%; and G4: 2%. The actuarial 2-year CFS was 77.9% [95% confidence interval (CI): 54-90.4%]. Actuarial 2-year OS and CSS were 85.2% (95% CI: 60.1-95.1%), while DFS was 75.1% (95% CI: 52.4.7-88.1%). Our clinical results support the use of VMAT as a safe and effective intensity-modulated radiotherapy (IMRT) option in the combined modality treatment of anal cancer, with consistent dosimetry, mild toxicity and promising sphincter preservation and survival rates. IMRT is a standard of care for patients with anal cancer, and VMAT is a robust technical solution in this setting.

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

    Directory of Open Access Journals (Sweden)

    Felipe Purcell de Araújo

    2009-09-01

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

  17. Clinical, manometric, and ultrasonographic results of pneumatic balloon dilatation vs. lateral internal sphincterotomy for chronic anal fissure: a prospective, randomized, controlled trial.

    Science.gov (United States)

    Renzi, Adolfo; Izzo, Domenico; Di Sarno, Giandomenico; Talento, Pasquale; Torelli, Francesco; Izzo, Giuseppe; Di Martino, Natale

    2008-01-01

    This prospective, randomized, controlled trial was designed to compare the clinical, functional, and morphologic results of pneumatic balloon dilatation with lateral internal sphincterotomy for the treatment of chronic anal fissure. All patients with symptomatic chronic anal fissure were randomly assigned to pneumatic balloon dilatation or lateral internal sphincterotomy and invited to complete a standardized questionnaire inquiring about their symptoms. Anal ultrasonography and anal manometry were performed before and six months after surgery. A proctologic examination was performed between the fifth and sixth postoperative weeks. Anal continence, scored by using a validated continence grading scale, was evaluated preoperatively at 1 and 6 weeks and at 12 and 24 months. Fifty-three patients, who satisfied selection criteria, were enrolled in the trial. Four patients (7.5 percent) were lost to follow-up. Twenty-four patients (11 males; mean age, 42 +/- 8.2 years) underwent pneumatic balloon dilatation and 25 patients (10 males; mean age, 44 +/- 7.3 years) underwent lateral internal sphincterotomy. Fissure-healing rates were 83.3 percent in the pneumatic balloon dilatation and 92 percent in the lateral internal sphincterotomy group. Recurrent anal fissure was observed in one patient (4 percent) after lateral internal sphincterotomy. At anal manometry, mean resting pressure decrements obtained after pneumatic balloon dilatation and lateral internal sphincterotomy were 30.5 and 34.3 percent, respectively. After pneumatic balloon dilatation, anal ultrasonography did not show any significant sphincter damage. At 24-month follow-up, the incidence of incontinence, irrespective of severity, was 0 percent in the pneumatic balloon dilatation group and 16 percent in the lateral internal sphincterotomy group (P < 0.0001). As lateral internal sphincterotomy, pneumatic balloon dilatation grants a high anal fissure-healing rate but with a statistically significant reduction in

  18. SQL injekciju uzbrukumu analīze un novēršana

    OpenAIRE

    Kudiņa, Monta

    2015-01-01

    Šī darba mērķis ir iepazīties ar populārākajiem SQL injekciju uzbrukumu veidiem, apzināties kā uzbrukumi tiek realizēti, un noskaidrot preventīvos pasākumus uzbrukumu novēršanai. Bakalaura darbā “SQL injekciju uzbrukumu analīze un novēršana” tiek apskatīti SQL injekciju uzbrukumu veidi un metodes, uzbrukumu realizācijas dažādās datubāzes platformās, SQL injekciju uzbrukumu atklāšana un pasākumi uzbrukumu novēšanai. Darba gaitā tika gan teorētiski, gan praktiski iepazīti SQL uzbrukumi, un apsk...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1986-04-01

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

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

    International Nuclear Information System (INIS)

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

    1986-01-01

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

  1. Pelvic floor and anal sphincter trauma should be key performance indicators of maternity services.

    Science.gov (United States)

    Dietz, H P; Pardey, J; Murray, H

    2015-01-01

    There is an increasing awareness of maternal somatic birth trauma, which affects many more women than previously thought, primarily in the form of anal sphincter and levator ani tears. Given that such trauma occurs in about one-third of all women giving birth vaginally for the first time, and given that it has serious long-term consequences, it should be audited by all maternity services with a view to providing remedial therapy to delay or prevent subsequent morbidity, and to facilitate practice improvement. The increasing availability of modern imaging equipment and the skills of using it for pelvic floor assessment means that it is now becoming possible to provide such services postnatally.

  2. Psicoterapia cognitivo analítica y trastornos de la personalidad: revisión

    Directory of Open Access Journals (Sweden)

    Laura Rodríguez Moya

    2013-06-01

    Full Text Available En los años 80 y 90, A. Ryle desarrolló un modelo de tratamiento denominado Psicoterapia Cognitivo Analítica (PCA. Con un enfoque integrador, breve y focal, la PCA se ha aplicado a diversas patologías, siendo su uso más frecuente con pacientes con trastorno de personalidad, sobre todo con trastorno límite. Estos pacientes poseen un número de disfunciones metacognitivas que dificultan el proceso de darse cuenta de sus diferentes estados mentales y de sus componentes. A través del modelo de Múltiples Estados del self, el objetivo es ayudar al paciente a identificar los procesos disfuncionales o restrictivos del self que está experimentando y dotarle de recursos para que pueda sustituirlos por otros más adaptativos.

  3. Balloon cell melanoma of the anal canal: A wolf in sheep′s clothing?

    Directory of Open Access Journals (Sweden)

    Munita Meenu Bal

    2013-01-01

    Full Text Available Balloon cell melanoma (BCM is a rare histologic variant of cutaneous malignant melanoma with exceptional reports of occurrences at non-cutaneous sites. Herein we present a case of primary amelanotic BCM of anal canal, a heretofore undescribed location. Histologically, the tumor was characterized by sheets of pale cells that bore striking resemblance to foamy macrophages. Presence of rare atypical mitoses confirmed the malignant nature of the cells. Neoplastic cells were immunoreactive for S100, Melan-A, and focally for HMB-45 while were negative for myogenic, gastrointestinal stromal tumor, epithelial and neuroendocrine markers. Resemblance to foamy macrophages, bland cytology and absence of pigment imparts this tumor a deceptively benign histological appearance making it prone to diagnostic pitfalls. Awareness of this rare entity and judicious employment of immunohistochemistry is imperative in segregating it from its diverse mimics.

  4. In vitro and in vivo assessment of an intelligent artificial anal sphincter in rabbits.

    Science.gov (United States)

    Huang, Zong-Hai; Shi, Fu-Jun; Chen, Fei; Liang, Fei-Xue; Li, Qiang; Yu, Jin-Long; Li, Zhou; Han, Xin-Jun

    2011-10-01

    Artificial sphincters have been developed for patients with fecal incontinence, but finding a way to make such sphincters more "intelligent" remains a problem. We assessed the function of a novel intelligent artificial anal sphincter (IAAS) in vitro and in vivo in rabbits. After the prosthesis was activated, rabbits were continent of feces during 81.4% of the activation time. The fecal detection unit provided 100% correct signals on stool in vitro and 65.7% in vivo. The results indicated that the IAAS could efficiently maintain continence and detect stool; however, the IAAS is still in the preliminary experimental stage and more work is needed to improve the system. © 2011, Copyright the Authors. Artificial Organs © 2011, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  5. Cutaneous presentation of disseminated histoplasmosis as a solitary peri-anal ulcer. Case report and discussion.

    Science.gov (United States)

    Hong, Janet H; Stetsenko, Galina Y; Pottinger, Paul S; George, Evan

    2016-05-01

    Disseminated histoplasmosis has a diverse and non-specific range of clinical signs and symptoms. In a significant minority of patients, cutaneous lesions are apparent at the time of initial presentation, affording an opportunity to establish the diagnosis from a skin biopsy. The most frequently reported clinical scenario in immunocompromised patients with cutaneous involvement is that of multiple papulo-nodular lesions on the face, trunk or extremities. The following report features an immunocompetent patient who presented with a solitary ulcerated plaque on the buttocks close to the anal verge. This case presentation underscores the broad spectrum of clinical presentations as well as the potential for diagnostic confusion with protozoa such as Leishmania or Trypanosoma species during histopathologic examination if special stains for fungal organisms are not performed. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. O conceito de resistência na Psicoterapia Grupo-Analítica: repensando um caminho

    Directory of Open Access Journals (Sweden)

    Jorge Ponciano Ribeiro

    Full Text Available O autor faz um estudo da resistência em grupo baseado na obra de Siegmund Heinrich Foulkes, fundador da Psicoterapia Grupo Analítica. Foulkes utilizava os conceitos da Psicologia da Gestalt e da Teoria do Campo para fazer compreender o processo de mudança nos seus grupos, embora essas referências passassem desapercebidas, talvez pela dificuldade epistemológica que ele encontrava em combinar Psicanálise e essas teorias. O autor retoma os rastros de Foulkes e desenvolve, a partir dos conceitos de figura e fundo e aqui e agora, uma visão diferente na perspectiva foulkesiana, acenada por ele, mas não desenvolvida. Foulkes tem também uma linguagem fenomenológica que o autor procura explorar.

  7. Anal canal duplication associated with presacral teratoma in a 5-year old girl

    Directory of Open Access Journals (Sweden)

    Jinyoung Park

    2017-04-01

    Full Text Available This report describes an extremely rare case of anal canal duplication associated with presacral teratoma in a 5-year-old girl who presented with perineal pain and constipation. Abdominopelvic computed tomography (CT revealed a multiloculated heterogeneous mass measuring 5 cm in the presacral area. T2-weighted magnetic resonance imaging (MRI showed a 4.5-cm sized multilocular cystic lesion with high signal intensity. The mass was surgically removed with coccyx. Histologically, the tumor showed components of bronchial and gastrointestinal mucosa, squamous epithelium, cartilage, fibrofatty tissue, and some exocrine glands. The histopathological diagnosis was mature teratoma. Eight months after surgery, the patient is doing well, with no recurrence of tumor.

  8. Concordance Between Anal and Oral Human Papillomavirus Infections Among Young Men Who have Sex With Men.

    Science.gov (United States)

    Steinau, Martin; Gorbach, Pamina; Gratzer, Beau; Braxton, Jim; Kerndt, Peter R; Crosby, Richard A; Unger, Elizabeth R; Markowitz, Lauri E; Meites, Elissa

    2017-06-15

    Prevalence of human papillomavirus (HPV) infections was assessed among 1033 young men who have sex with men (MSM) aged 18-26 years. HPV (any type) was detected in 742 (71.8%) anal specimens and 101 (9.8%) oral specimens. Although HPV was detected in specimens from both anatomical sites in 83 (8.0%) participants, type-specific concordance for at least 1 HPV type was found in only 35 (3.4%) participants. HIV and smoking were associated with higher prevalence at both sites and frequency of concordant types. Coinfections of identical HPV types were rare, suggesting independent infection events and/or different modes of clearance. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  9. Imaging of Anal Fistulas: Comparison of Computed Tomographic Fistulography and Magnetic Resonance Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Liang, Changhu [Shandong Medical Imaging Research Institute, Shandong University, Jinan 250021 (China); Lu, Yongchao [Traditional Chinese Medicine Department, Provincial Hospital Affiliated to Shandong University, Jinan 250021 (China); Zhao, Bin [Shandong Medical Imaging Research Institute, Shandong University, Jinan 250021 (China); Du, Yinglin [Shandong Provincial Center for Disease Control and Prevention, Public Health Institute, Jinan 250014 (China); Wang, Cuiyan [Shandong Medical Imaging Research Institute, Shandong University, Jinan 250021 (China); Jiang, Wanli [Department of Radiology, Taishan Medical University, Taian 271000 (China)

    2014-07-01

    The primary importance of magnetic resonance (MR) imaging in evaluating anal fistulas lies in its ability to demonstrate hidden areas of sepsis and secondary extensions in patients with fistula in ano. MR imaging is relatively expensive, so there are many healthcare systems worldwide where access to MR imaging remains restricted. Until recently, computed tomography (CT) has played a limited role in imaging fistula in ano, largely owing to its poor resolution of soft tissue. In this article, the different imaging features of the CT and MRI are compared to demonstrate the relative accuracy of CT fistulography for the preoperative assessment of fistula in ano. CT fistulography and MR imaging have their own advantages for preoperative evaluation of perianal fistula, and can be applied to complement one another when necessary.

  10. Sobrevoando analIticamente as teorias da administração

    Directory of Open Access Journals (Sweden)

    Luiz Alex Silva Saraiva

    2010-04-01

    Full Text Available A orientação predominantemente descritiva da maior parte das publicações a respeito da Teoria da Administração não resiste, em diversos aspectos, a um exercício analítico mais aprofundado. Via de regra, a descrição é enfatizada em detrimento da análise, o que limita uma perspectiva mais ampla de aprendizado, mas também estimula reflexões teóricas renovadas. O objetivo neste ensaio é fazer um sobrevoo das teorias de Administração sob um prisma crítico, de maneira a contribuir para um debate mais amplo sobre a Ciência da Administração.

  11. Laparoscopic restorative proctocolectomy ileal pouch anal anastomosis: How I do it?

    Science.gov (United States)

    Madnani, Manish A; Mistry, Jitendra H; Soni, Harshad N; Shah, Atul J; Patel, Kantilal S; Haribhakti, Sanjiv P

    2015-01-01

    Surgery for ulcerative colitis is a major and complex colorectal surgery. Laparoscopy benefits these patients with better outcomes in context of cosmesis, pain and early recovery, especially in young patients. For surgeons, it is a better tool for improving vision and magnification in deep cavities. This is not the simple extension of the laparoscopy training. Starting from preoperative preparation to post operative care there are wide variations as compared to open surgery. There are also many variations in steps of laparoscopic surgery. It involves left colon, right colon and rectal mobilisation, low division of rectum, pouch creation and anastomosis of pouch to rectum. Over many years after standardisation of this technique, it takes same operative time as open surgery at our centre. So we present our standardized technique of laparoscopic assisted restorative proctocolectomy and ileal pouch anal anastomosis (IPAA). PMID:26195886

  12. Image analysis in multisample biopsy after ileal pouch-anal anastomosis.

    Science.gov (United States)

    Giarnieri, E; Giovagnoli, M R; Montesani, C; Nagar, C; Pronio, A M; Alderisio, M; Ribotta, G; Vecchione, A

    1996-01-01

    Pouchitis in ileal anal anastomosis represents an important clinical complication after restorative proctocolectomy. Acute and chronic inflammation of the reservoir is a frequent event sometimes associated with villous atrophy and colonic metaplasia. After ileal pouch anastomosis, twenty-one patients affected by ulcerative colitis were studied. An image analyzer CAS 200 (Becton Dickinson) was utilized to evaluate the DNA intranuclear content in every biopsy. In two cases abnormal DNA distribution was observed, and in one case a poliploid pattern was seen. Abnormal DNA distribution was also present in colonic metaplasia. Therefore, image analysis for the detection of DNA aneuploidy may be of additional value together with histologic parameters in follow up, in order to exclude transformation of the ileal mucosa in neoplastic epithelia.

  13. Episiotomy in vacuum-assisted delivery affects the risk of obstetric anal sphincter injury

    DEFF Research Database (Denmark)

    Lund, Ninna S; Persson, Lisa K G; Jangö, Hanna

    2016-01-01

    The risk of obstetric anal sphincter injury (OASIS) is increased in vacuum-assisted delivery. However, it remains unclear whether episiotomy may protect against OASIS in this type of delivery. The objective of this study was to assess whether mediolateral or lateral episiotomy affects the risk...... of OASIS in vacuum-assisted delivery among primiparous women. Data were found searching The PubMed, Cochrane library and Embase databases electronically. Studies investigating the risk of OASIS in vacuum-assisted delivery with and without the use of mediolateral or lateral episiotomy were considered...... for inclusion. Of the 452 studies found, 15 observational studies were included in this meta-analysis. All authors assessed risk of bias of the included studies using the Scottish Intercollegiate Guideline Network (SIGN) quality score. According to this meta-analysis, mediolateral or lateral episiotomy...

  14. Oral and anal vaccination confers full protection against enteric redmouth disease (ERM) in rainbow trout

    DEFF Research Database (Denmark)

    Villumsen, Kasper Rømer; Neumann, Lukas; Otani, Maki

    2014-01-01

    The effect of oral vaccines against bacterial fish diseases has been a topic for debate for decades. Recently both M-like cells and dendritic cells have been discovered in the intestine of rainbow trout. It is therefore likely that antigens reaching the intestine can be taken up and thereby induce...... immunity in orally vaccinated fish. The objective of this project was to investigate whether oral and anal vaccination of rainbow trout induces protection against an experimental waterborne infection with the pathogenic enterobacteria Yersinia ruckeri O1 biotype 1 the causative agent of enteric redmouth...... disease (ERM). Rainbow trout were orally vaccinated with AquaVac ERM Oral (MERCK Animal Health) or an experimental vaccine bacterin of Y. ruckeri O1. Both vaccines were tested with and without a booster vaccination four months post the primary vaccination. Furthermore, two groups of positive controls were...

  15. How long-distance truck drivers and villagers in rural southeastern Tanzania think about heterosexual anal sex: a qualitative study

    NARCIS (Netherlands)

    Mtenga, S.; Shamba, D.; Wamoyi, J.; Kakoko, D.; Haafkens, J.; Mongi, A.; Kapiga, S.; Geubbels, E.

    2015-01-01

    Objective: To explore ideas of truck drivers and villagers from rural Tanzania about heterosexual anal sex (HAS) and the associated health risks. Methods: Qualitative study using 8 in-depth interviews (IDIs) and 2 focus group discussions (FGDs) with truck drivers and 16 IDIs and 4 FGDs with

  16. How long-distance truck drivers and villagers in rural southeastern Tanzania think about heterosexual anal sex: a qualitative study

    NARCIS (Netherlands)

    Mtenga, S.; Shamba, D.; Wamoyi, J.; Kakoko, D.; Haafkens, J.; Mongi, A.; Kapiga, S.; Geubbels, E.

    2015-01-01

    To explore ideas of truck drivers and villagers from rural Tanzania about heterosexual anal sex (HAS) and the associated health risks. Qualitative study using 8 in-depth interviews (IDIs) and 2 focus group discussions (FGDs) with truck drivers and 16 IDIs and 4 FGDs with villagers from the Morogoro

  17. Congenital anorectal atresia: MR imaging of late post-operative appearances in adult patients with anal incontinence

    Energy Technology Data Exchange (ETDEWEB)

    Gartner, Louise; Peiris, Chand; Marshall, Michele [St. Mark' s Hospital, Department of Intestinal Imaging, London (United Kingdom); Taylor, Stuart A.; Halligan, Steve [University College London, Centre for Medical Imaging, London (United Kingdom)

    2013-12-15

    To describe the MR imaging findings in adults presenting with anal incontinence following pull-through perineoplasty for anorectal atresia. 15 adults (12 male, 3 female; age 22-52 years) with anal incontinence following a prior perineal pull-through procedure as an infant for anorectal atresia were identified retrospectively. MR imaging was performed using either an endoanal coil or body coil. MR images were reviewed by three observers who noted whether pelvic floor and sphincter muscles were present and, if so, whether they were thinned or not. Data were tabulated and raw frequencies determined. Images were unavailable for one patient, leaving 14 for analysis. Anal stenosis prevented endoanal coil placement in 5. The pull-through was anatomically correct in 12 (86 %) patients but was misdirected in 2. Thinned muscle was seen in 11 (79 %) patients. External sphincter thinning was commonest (present in 10 patients), with levator plate thinning least common (present in 4 patients). Only one patient had thinning of all muscle groups. MR imaging may be used to determine the extent and quality of residual pelvic floor and anal sphincter muscle in adults who have functional disability following pull-through perineoplasty for anorectal agenesis. (orig.)

  18. Advancement Flap Technique for Anal Fistula in Patients With Crohn's Disease: A Systematic Review of the Literature.

    Science.gov (United States)

    Rozalén, Virginia; Parés, David; Sanchez, Edward; Troya, José; Vela, Sandra; Pacha, Miguel Ángel; Piñol, Marta; Julián, Joan-Francesc

    2017-12-01

    Treatment for anal fistulas in patients with Crohn's disease is still challenging, even for the expert surgeon. The advancement flap technique is characterized by the preservation of the anal sphincter complex. A systematic review of the literature, selecting series of patients affected by Crohn's disease and anal fistulas and treated using advancement flap technique was performed. Patients followed during at least 6 months have been included. From 128 initial studies, 11 studies were selected, including overall 135 patients. Those studies show low- level evidence. Results in a series with follow-up from 8,4 to 82 months, stated a clinical success of 66% and recurrence rate around 30%. However there was an evident heterogeneity of results. The review concludes that the advancement flap technique to treat anal fistulas in patients with Crohn's disease is an adequate alternative. New studies are necessary to provide higher-level evidence. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Sexual function and continence after ileo pouch anal anastomosis : a comparison between a meta-analysis and a questionnaire survey

    NARCIS (Netherlands)

    Hueting, WE; Gooszen, HG; van Laarhoven, CJHM

    Background and aims. Ileo pouch anal anastomosis (IPAA) is the standard restorative procedure for patients with ulcerative colitis and familial adenomatous polyposis, but its pros and cons have not been explored in depth. This study analyzed the long-term complications such as incontinence and

  20. Congenital anorectal atresia: MR imaging of late post-operative appearances in adult patients with anal incontinence

    International Nuclear Information System (INIS)

    Gartner, Louise; Peiris, Chand; Marshall, Michele; Taylor, Stuart A.; Halligan, Steve

    2013-01-01

    To describe the MR imaging findings in adults presenting with anal incontinence following pull-through perineoplasty for anorectal atresia. 15 adults (12 male, 3 female; age 22-52 years) with anal incontinence following a prior perineal pull-through procedure as an infant for anorectal atresia were identified retrospectively. MR imaging was performed using either an endoanal coil or body coil. MR images were reviewed by three observers who noted whether pelvic floor and sphincter muscles were present and, if so, whether they were thinned or not. Data were tabulated and raw frequencies determined. Images were unavailable for one patient, leaving 14 for analysis. Anal stenosis prevented endoanal coil placement in 5. The pull-through was anatomically correct in 12 (86 %) patients but was misdirected in 2. Thinned muscle was seen in 11 (79 %) patients. External sphincter thinning was commonest (present in 10 patients), with levator plate thinning least common (present in 4 patients). Only one patient had thinning of all muscle groups. MR imaging may be used to determine the extent and quality of residual pelvic floor and anal sphincter muscle in adults who have functional disability following pull-through perineoplasty for anorectal agenesis. (orig.)

  1. Clinical role of a modified seton technique for the treatment of trans-sphincteric and supra-sphincteric anal fistulas.

    Science.gov (United States)

    Tokunaga, Yukihiko; Sasaki, Hirokazu; Saito, Tohru

    2013-03-01

    We have devised a modified seton technique that resects the external fistula tract while preserving the anal sphincter muscle. This study assessed the technique when used for the management of complex anal fistulas. Between January 2006 and December 2007, 239 patients (208 males and 31 females, median age: 41 years) underwent surgery for complex anal fistulas using the technique. Of the 239 patients, 198 patients had trans-sphincteric fistula and 41 patients had supra-sphincteric fistula. The durations of the surgeries were 17 min (47, 13) [median (range, interquartile range)] for trans-sphincteric fistulas and 38 (44, 16) for supra-sphincteric fistulas. The durations of the surgeries were significantly (P supra-sphincteric fistula than trans-sphincteric fistula. The hospital stays were 4 (13, 2) days and 5 (14, 3) days, respectively, for trans- and supra-sphincteric fistulas. The durations of seton placement until the spontaneous dropping of the seton were 42 (121, 48) and 141 (171, 55) days respectively. The recurrence rate was 0 % in patients with trans-sphincteric fistulas and 4.9 % (2 of 41) in patients with supra-sphincteric fistulas (P < 0.01). Serious incontinence was not observed. The technique provided favorable results for the treatment of complex anal fistulas and could be safely applied while preserving the sphincter function and conserving fecal continence.

  2. Sacral nerve stimulation increases activation of the primary somatosensory cortex by anal canal stimulation in an experimental model.

    LENUS (Irish Health Repository)

    Griffin, K M

    2011-08-01

    Sacral and posterior tibial nerve stimulation may be used to treat faecal incontinence; however, the mechanism of action is unknown. The aim of this study was to establish whether sensory activation of the cerebral cortex by anal canal stimulation was increased by peripheral neuromodulation.

  3. The role of the defaecating pouchogram in the assessment of evacuation difficulty after restorative proctocolectomy and pouch-anal anastomosis

    NARCIS (Netherlands)

    Stellingwerf, M. E.; Maeda, Y.; Patel, U.; Vaizey, C. J.; Warusavitarne, J.; Bemelman, W. A.; Clark, S. K.

    2016-01-01

    Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the most frequently performed operation for intractable ulcerative colitis (UC) and for many patients with familial adenomatous polyposis (FAP). It can be complicated by a functional evacuation difficulty, which is not

  4. Anal intercourse among female sex workers in East Africa is associated with other high-risk behaviours for HIV

    NARCIS (Netherlands)

    Veldhuijzen, Nienke J.; Ingabire, Chantal; Luchters, Stanley; Bosire, Wilkister; Braunstein, Sarah; Chersich, Matthew; van de Wijgert, Janneke

    2011-01-01

    Introduction: Epidemiological and HIV prevention studies in sub-Saharan Africa have almost exclusively focussed on vaginal transmission of HIV, the primary mode of transmission in the region. Little is known about the prevalence of heterosexual anal intercourse (AI), its correlates and its role in

  5. Stratfori analüütik Sean Noonan: taktikaliselt suri Osama juba ammu / Sean Noonan ; intervjueerinud Holger Roonemaa

    Index Scriptorium Estoniae

    Noonan, Sean

    2011-01-01

    Stratfori analüütiku hinnangul nähakse araabia maades Osama bin Ladeni surmas tõenäoliselt märtrisurma. Lähiajal võib toimuda väga algelisi kättemaksuüritusi, keskplaanis tõenäoliselt toimub suurem radikaliseerumine. Bin Ladeni tapmine annab USA presidendile rohkem motivatsiooni õigustada Afganistanist lahkumist

  6. HPV seroconversion following anal and penile HPV infection in HIV-negative and HIV-infected MSM

    NARCIS (Netherlands)

    Mooij, Sofie H.; Landén, Olivia; van der Klis, Fiona R. M.; van der Sande, Marianne A. B.; de Melker, Hester E.; Xiridou, Maria; van Eeden, Arne; Heijman, Titia; Speksnijder, Arjen G. C. L.; Snijders, Peter J. F.; Schim van der Loeff, Maarten F.

    2014-01-01

    We assessed human papillomavirus (HPV) seroconversion following anal and penile HPV infection in HIV-negative and HIV-infected men who have sex with men (MSM). MSM aged ≥18 years were recruited in Amsterdam, the Netherlands (2010-2011), and followed up semiannually. Antibodies against 7 high-risk

  7. The impact of naloxegol on anal sphincter function - Using a human experimental model of opioid-induced bowel dysfunction

    DEFF Research Database (Denmark)

    Grønlund, Debbie; Poulsen, Jakob L; Krogh, Klaus

    2018-01-01

    of the anal canal. Gastrointestinal symptoms were assessed with the Patient Assessment of Constipation Symptom (PAC-SYM) questionnaire and the Bristol Stool Form Scale. RESULTS: During oxycodone treatment, naloxegol improved RAIR-induced sphincter relaxation by 15% (-45.9 vs -38.8 mm Hg; P 

  8. Management of rare, low anal anterior fistula exception to Goodsall′s rule with Kṣārasūtra

    Directory of Open Access Journals (Sweden)

    Pradeep S Shindhe

    2014-01-01

    Full Text Available Anal fistula (bhagandara is a chronic inflammatory condition, a tubular structure opening in the ano-rectal canal at one end and surface of perineum/peri-anal skin on the other end. Typically, fistula has two openings, one internal and other external associated with chronic on/off pus discharge on/off pain, pruritis and sometimes passing of stool from external opening. This affects predominantly male patients due to various etiologies viz., repeated peri-anal infections, Crohn′s disease, HIV infection, etc., Complex and atypical variety is encountered in very few patients, which require special treatment for cure. The condition poses difficulty for a surgeon in treating due to issues like patient hesitation, trouble in preparing kṣārasūtra, natural and routine infection with urine, stool etc., and dearth of surgical experts and technique. We would like to report a complex and atypical, single case of anterior, low anal fistula with tract reaching to median raphe of scrotum, which was managed successfully by limited application of kṣārasūtra.

  9. Pouchitis-Associated Iritis (Uveitis Following Total Proctocolectomy and Ileal Pouch-to-Anal Anastomosis in Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Hugh James Freeman

    2001-01-01

    Full Text Available A 26-year-old woman with ulcerative colitis treated with a proctocolectomy and ileal pouch-to-anal anastomosis developed an erosive and ulcerative pouchitis. Although no ophthalmological manifestations were present before the staged surgical procedures, iritis developed after appearance of the pouchitis. Both conditions subsequently resolved with oral corticosteroids and metronidazole.

  10. Obstetric anal sphincter injury, risk factors and method of delivery - an 8-year analysis across two tertiary referral centers.

    LENUS (Irish Health Repository)

    Hehir, Mark P

    2013-10-01

    Obstetric anal sphincter injury (OASIS) represents a major cause of maternal morbidity and is a risk factor for the development of fecal incontinence. We set out to analyze the incidence of OASIS and its association with mode of delivery in two large obstetric hospitals across an 8-year study period.

  11. Analysis of Target Volume Definition Using CT, MRI and FDG-PET in Radiotherapy Treatment Planning of Anal Cancer

    DEFF Research Database (Denmark)

    Serup-Hansen, E.; Hendel, H. Westergreen; Johannesen, H. Hjorth

    2012-01-01

    -PETs. Although the GTV-CT were larger, it did not always cover the GTVs of MRI and PET. The GTV-CT increased if overlaying GTV-MRI or one of the GTV-PETs. Based on our study, our recommendations are not to use CT solely for delineating anal tumors; MRI or PET should be considered as a second imaging modality....

  12. Anal and penile high-risk human papillomavirus prevalence in HIV-negative and HIV-infected MSM

    NARCIS (Netherlands)

    van Aar, Fleur; Mooij, Sofie H.; van der Sande, Marianne A. B.; Speksnijder, Arjen G. C. L.; Stolte, Ineke G.; Meijer, Chris J. L. M.; Verhagen, Dominique W. M.; King, Audrey J.; de Vries, Henry J. C.; Schim van der Loeff, Maarten F.

    2013-01-01

    Anal and penile high-risk human papillomavirus (HPV) infection is associated with anogenital cancer, which is especially common in HIV-infected MSM. We assessed HPV prevalence and determinants in MSM. Analysis of baseline data from a prospective cohort study. MSM aged 18 years or older were

  13. Tulemuslikkuse hindamine : efektiivsuse analüüs Käru raamatukogu näitel / Ilme Säde

    Index Scriptorium Estoniae

    Säde, Ilme

    2011-01-01

    Ülevaade Ilme Säde uurimustööst "Raamatukogutöö efektiivsuse analüüs lugejate ja töötajate hinnangute ning kvantitatiivsete tulemusnäitajate abil Käru rahvaraamatukogus aastatel 2005-2010"

  14. SIA „LG Electronics Latvia” mārketinga komunikāciju analīze

    OpenAIRE

    Nikodemus, Uģis

    2011-01-01

    Bakalaura darba tēma ir „SIA „LG Electronics Latvia” mārketinga komunikāciju analīze”. Bakalaura darba mērķis ir, pamatojoties uz mārketinga teorētisko avotu analīzi, izpētīt SIA „LG Electronics Latvia” veidoto mārketinga komunikāciju efektivitāti, kā arī izstrādāt priekšlikumus tās uzlabošanai. Darba gaitā autors izmanto dažādas informācijas apkopošanas un analīzes metodes. Teorētiskās daļas veidošanai darba autors izmantoja literatūras referatīvās analīzes metodi. Informācijas iegūšanai ...

  15. Hand-assisted hybrid laparoscopic-robotic total proctocolectomy with ileal pouch--anal anastomosis.

    Science.gov (United States)

    Morelli, Luca; Guadagni, Simone; Mariniello, Maria Donatella; Furbetta, Niccolò; Pisano, Roberta; D'Isidoro, Cristiano; Caprili, Giovanni; Marciano, Emanuele; Di Candio, Giulio; Boggi, Ugo; Mosca, Franco

    2015-08-01

    Few studies have reported minimally invasive total proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). We herein report a novel hand-assisted hybrid laparoscopic-robotic technique for patients with FAP and UC. Between February 2010 and March 2014, six patients underwent hand-assisted hybrid laparoscopic-robotic total proctocolectomy with IPAA. The abdominal colectomy was performed laparoscopically with hand assistance through a transverse suprapubic incision, also used to fashion the ileal pouch. The proctectomy was carried out with the da Vinci Surgical System. The IPAA was hand-sewn through a trans-anal approach. The procedure was complemented by a temporary diverting loop ileostomy. The mean hand-assisted laparoscopic surgery (HALS) time was 154.6 (±12.8) min whereas the mean robotic time was 93.6 (±8.1) min. In all cases, a nerve-sparing proctectomy was performed, and no conversion to traditional laparotomy was required. The mean postoperative hospital stay was 13.2 (±7.4) days. No anastomotic leakage was observed. To date, no autonomic neurological disorders have been observed with a mean of 5.8 (±1.3) bowel movements per day. The hand-assisted hybrid laparoscopic-robotic approach to total proctocolectomy with IPAA has not been previously described. Our report shows the feasibility of this hybrid approach, which surpasses most of the limitations of pure laparoscopic and robotic techniques. Further experience is necessary to refine the technique and fully assess its potential advantages.

  16. Three-Dimensional Endoanal Ultrasound Features of the Anal Sphincter in Asian Primigravidae.

    Science.gov (United States)

    Wickramasinghe, Dakshitha Praneeth; Senaratne, Supun; Senanayake, Hemantha; Samarasekera, Dharmabandu Nandadeva

    2018-04-17

    The normal parameters of 3-dimensional endoanal ultrasound (3DEAUS) of the anal sphincter have not been reported for primigravidae or pregnant women at present. 3DEAUS parameters in Asian primigravidae were assessed in this study. We analyzed 3DEAUS data of 101 consecutives Asian primigravidae, assessed in the early third trimester. The assessment was performed with a rigid ultrasonic probe (Olympus ® RU 12M-R1 probe and EU-ME1 ultrasound system (Olympus Corp., Shinjuku, Japan). The Wilcoxon signed-rank test was used to detect the differences in pressure in different quadrants. The participants had a mean age of 24.7 (standard deviation [SD], 5.1) years. The Cleveland Clinic Incontinence Score was normal in all participants. The anal sphincter complex had 3 characteristic segments that were identifiable: upper, middle and lower. The puborectalis muscle was identified as a striated "V"-shaped sling, and its mean thickness was 7.44 (SD, 1.41) mm. The mean thickness of internal (IAS) and external (EAS) sphincters at the mid-sphincter level were 1.78 (SD, 0.59) and 5.49 (SD, 1.21) mm, respectively. The EAS measured 6.02 (SD, 1.07) mm at the lower sphincter level. The statistically significant differences seen in the in quadrants were: the IAS was thicker anteriorly (Z = -2.642; P = .008), the EAS at both midsphincter level (Z = -3.70; P IAS was thicker at the 9 o'clock position (Z = -2.081; P = .037). Good symmetry at all 3 levels was seen in the EAS (including the puborectalis muscle). Normal values of 3DEAUS for primigravidae have been identified and may serve as reference values for other laboratories. © 2018 by the American Institute of Ultrasound in Medicine.

  17. [Spanish funded paediatric research: Contribution of Anales de Pediatría to its dissemination].

    Science.gov (United States)

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

    2017-06-01

    To identify Spanish funded paediatric research published in general paediatric journals included in the Web of Science (WoS) from 2010 to 2014) and those published in the Anales de Pediatría. To examine the relationship between funding and the prestige of the journals. To describe the journal conditions to meet the open access criteria. Spanish funded paediatric articles (FA) were identified by using the WoS Funding Agency field, and by reviewing the original documents for the Anales de Pediatria (AP). For the FA published in AP the number and kind of funding agencies were identified. The possible differences in citations between FA and non-funded was assessed for articles published in this journal using the Kruskal-Wallis non-parametric test. For general journals, the patterns of distribution of FA and non-FA were investigated according to the quartile of the journal. The journal's self-archiving conditions were described using Sherpa/romeo database. Funding was received for 27.5%, being 16.6% for those published in AP. In these, 105 funding agencies were identified, with 80% being national. The FA published in AP did not receive significantly more citations. In general journals, the presence of FA is greater in Q1 and Q2 journals. More than half (56%) of articles were published in subscription journals. All journals that publish FA allow self-archiving in repositories, but with embargos of at least 12 months. The role of AP in the dissemination of FA is still limited. Embargos in self-archiving permits compliance of Spanish open access mandate, but may hinder compliance in Europe. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-10-01

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

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

    International Nuclear Information System (INIS)

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

    2014-01-01

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

  20. Management of low anal fistula: fistulectomy alone versus fistulectomy with primary closure

    International Nuclear Information System (INIS)

    Shahid, M.; Malik, S.; Ahmed, Z.

    2017-01-01

    To compare fistulectomy with primary closure of the wound and fistulectomy alone in the treatment of low anal fistula in terms of healing time. Study Design: Randomized control trial. Place and Duration of Study: Department of General Surgery Combined Military Hospital (CMH) Rawalpindi, from Nov 2006 to May 2007. Material and Methods: Total 60 patients of low anal fistula were enrolled in this study after informed consent and ethical approval. Patients were divided in two groups (A and B) each containing 30 patients. Patient of group A underwent fistulectomy alone whereas patients of group B underwent fistulectomy with primary closure of wound. All the patients were followed two weekly for 06 weeks. On each visit, healing was assessed by naked eye examination of epithelialization and noted on a Proforma. SPSS 17 was used to analyze the results. A p-value of <0.005 was considered statistically significant. Results: At 02 weeks after surgery, none of the patient in group A and 6.6% of group B patients showed wound healing, p-value was not significant i.e. 0.492. At 04 weeks after surgery, 23.3% of group A and 86.6% of group B patients showed wound healing p-value <0.001. At 06 weeks after surgery, 93.3% of group A and 100% of group B patients showed wound healing, p-value was not significant i.e. 0.492. Healing of wound was found more rapid in group B patients who underwent fistulectomy with primary closure of wound. Conclusion: Fistulectomy with primary repair was a better treatment as compared to fistulectomy alone in terms of healing time of wound. (author)

  1. Specific obstetrical risk factors for urinary versus anal incontinence 4 years after first delivery.

    Science.gov (United States)

    Fritel, X; Khoshnood, B; Fauconnier, A

    2013-09-01

    Delivery can be complicated by urinary or anal incontinence (UI or AI). We hypothesized that the mechanisms of injury may differ for UI and AI. Hence, obstetrical risk factors may be specific for different types of incontinence. Data on maternal characteristics were collected at first delivery. Data on incontinence were obtained by a questionnaire completed by 627 women 4 years after first delivery. UI was defined by "Do you have involuntary loss of urine" and AI by "Do you have involuntary loss of flatus or stool". A multinomial logistic regression analysis was conducted to assess risk factors for UI only, AI only, and UI+AI. Twenty-two percent of women reported UI only, 6.5% AI only, and 6.5% both. Risk factors associated with UI only were age (at first delivery)≥ 30 (OR 2.27 [95% CI 1.47-3.49]), pre-existing UI (6.44 [2.19-19.0]) and pregnancy UI (3.64 [2.25-5.91]). Risk factors associated with AI only were length of the second active stage> 20minutes (2.86 [1.15-7.13]) and third degree perineal tear (20.9 [1.73-252]). Significant predictors of UI+AI were age ≥ 30 (2.65 [1.29-5.46]), no epidural (4.29 [1.65-11.1]), third degree perineal tear (20.0 [1.28-314]), and UI before pregnancy (32.9 [9.00-120]). Cesarean delivery was not significantly associated with UI, AI, or UI+AI, although for all three outcomes, the adjusted odds ratios were substantially less than one. We found specific associations between obstetrical risk factors and urinary versus anal incontinence 4 years after first delivery. Our results are consistent with the hypothesis that the underlying mechanisms of injury differ for UI and AI. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-06-01

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

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

    International Nuclear Information System (INIS)

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

    2012-01-01

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

  4. [Epidemiology of anal lesions (fissure and thrombosed external hemorroid) during pregnancy and post-partum].

    Science.gov (United States)

    Abramowitz, L; Batallan, A

    2003-06-01

    Thrombosed external hemorrhoids (TEH) and anal fissure (AF) are 2 frequent sources of anal pains during childbirth. We are going to define their incidences as available in publications and in our experience in Bichat hospital. Then we will define their risk factors. According to Martin's and Corby's studies, AF was observed in 10% of the delivered women. In Bichat hospital we performed a proctological assessment to 165 pregnant women during the last third of pregnancy and within the 2 months following delivery. We observed 2 AF (1,2%) during the first period and 25 (15,2%) during the second. Rouillon et al. reported an incidence of TEH in 12,2% (20/164), while Pradel and al. reported 34% (18/52) of it. In Bichat hospital, 13 women (7,9%) were presenting with TEH during the last third of pregnancy and 33 (20%) in post-partum period. Two studies looked for a statistical correlation between AF and obstetrical, foetal or maternal factors. Corby et al. only pointed the role of constipation. In our study, terminal constipation was the most important risk factor for AF with 5.7 (2.7-12), odds ratio (95% confidence intervals). Rouillon et al. observed more TEH among women with a prolonged first stage labor and a big baby. In our study, a big baby and mother little lips tears were observed more often among women with TEH (P <0,05). Also, we observed only one TEH among the 25 women with caesarean section (4%). Finally, observation that TEH arise immediately after delivery is another argument to support the role of traumatic delivery. We also demonstrated the role of terminal constipation as risk factor for TEH after delivery. To conclude, 1/3 of pregnant women develop AF or TEH after delivery. These 2 pathologies are strongly correlated to terminal constipation. TEH seems equally furthered by traumatic delivery.

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

    International Nuclear Information System (INIS)

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

    2014-01-01

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

  6. Use of human papillomavirus genotyping and biomarkers for targeted screening of anal dysplasia in human immunodeficiency virus-infected patients.

    Science.gov (United States)

    Dupin, Clarisse; Siproudhis, Laurent; Henno, Sébastien; Minjolle, Sophie; Arvieux, Cédric; Tattevin, Pierre

    2015-05-01

    Screening for anal dysplasia in human immunodeficiency virus (HIV)-infected patients is not standardized. High-resolution imaging is not adequate for mass screening, and anal cytology requires expertise. New biomarkers, selected because of their use in cervical cancer mass screening, have been originally tested for targeted and easy-to-perform screening. 120 HIV-infected individuals (males 96.4%, mean age 47±11 years) were referred for clinical examination, anoscopy, and cytological studies on anal swab. Dysplasia grading, Human Papilloma Virus genotyping, E6/E7mRNA detection and p16(INK4A)/Ki-67 immunostaining were performed. High-grade lesions were histologically confirmed by anal biopsies after high-resolution anoscopy. Among the 120 anal swabs analyzed, 36 (30%) had low grade and 6 (5%) had high-grade lesions. Virus genotype was identified in 88 patients (73.3%), and 77 (64.2%) were positive for high-risk genotype(s). High-risk genotype was associated to low-grade or high-grade lesions with a sensitivity of 0.93 and a specificity of 0.51. For E6/E7mRNA, sensitivity and specificity for low-grade and high-grade lesions were, respectively, 0.88 and 0.78. Combination of genotyping, E6/E7mRNA and p16(INK4A)/Ki-67 appropriately ruled out dysplasia in 55% of patients. Three routine biomarkers may avoid unnecessary invasive procedures with the perspective of an improvement of patient compliance. A decision making algorithm, based on the combination of these three biomarkers, is proposed. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Jenny C. McCloskey

    2017-12-01

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

  8. Androgen dependent development of a modified anal fin, gonopodium, as a model to understand the mechanism of secondary sexual character expression in vertebrates.

    Science.gov (United States)

    Ogino, Yukiko; Katoh, Hironori; Yamada, Gen

    2004-09-24

    Male external genitalia show structural variations among species. Androgenic hormones are essential for the morphological specification of male type copulatory organs, while little is known about the developmental mechanisms of such secondary sexual characters. Western mosquitofish Gambusia affinis may offer a clue to the sexual differentiation researches, because they show a prominent masculine sexual character for appendage development, anal fin to gonopodium (GP) transition, and its formation could be induced in early juvenile fry by exogenously supplied androgens. We show that GP development is promoted by androgen dependent augmentation of sonic hedgehog (Shh) expression. Two AR cDNAs were cloned and identified as ARalpha and ARbeta from western mosquitofish. Both ARs were predominantly expressed in the distal region of outgrowing anal fin rays. Exposure of fry to androgen caused anal fin outgrowth concomitant with the Shh induction in the distal anal fin ray epithelium. When AR signaling was inhibited by its antagonist flutamide in fry, the initial induction of the Shh was suppressed accompanying retarded anal fin outgrowth. Similar suppression of anal fin outgrowth was induced by treatment with cyclopamine, an inhibitor of Shh signaling. These observations indicate that androgen dependent Shh expression is required for anal fin outgrowth leading to the formation of a genital appendage, the GP in teleost fishes. Androgen-induced GP formation may provide insights into the expression mechanism regulating the specification of sexual features in vertebrates.

  9. Luisa Värk: olen kriitiline ja liiga ambitsioonikas / Luisa Värk ; küsitles Triin Kalter

    Index Scriptorium Estoniae

    Värk, Luisa, 1987-

    2007-01-01

    Intervjuu annab TV 3 saate "Eesti otsib superstaari" finaalis viimase võistlejana välja hääletatud Luisa Värk. Saates osalemisest. Luisa õpib Tallinna Ülikooli Balti Filmi- ja Meediakoolis helirežiid

  10. Comparison of posterior internal anal sphincter myectomy and intrasphincteric botulinum toxin injection for treatment of internal anal sphincter achalasia: a meta-analysis.

    Science.gov (United States)

    Friedmacher, Florian; Puri, Prem

    2012-08-01

    Internal anal sphincter (IAS) achalasia is a clinical condition with presentation similar to Hirschsprung's disease, but with the presence of ganglion cells on rectal suction biopsy (RSB). The diagnosis is made by anorectal manometry (ARM), which demonstrates the absence of the rectosphincteric reflex on rectal balloon inflation. The recommended treatment of choice is posterior IAS myectomy. Recently, intrasphincteric botulinum toxin (Botox) injection has been effectively used for treatment of IAS achalasia. The aim of this meta-analysis was to compare the efficacy of posterior IAS myectomy with intrasphincteric Botox injection for treatment of IAS achalasia. A systematic literature search for relevant articles was conducted using the following databases: MEDLINE( ® ), EMBASE(®), ISI Web of Science(SM) and the Cochrane Library. A meta-analysis was performed with the studies where IAS achalasia was diagnosed based on the results of ARM and RSB. Odds ratio (OR) with 95 % confidence intervals were calculated. Sixteen prospective and retrospective studies, published from 1973 to 2009, were identified. A total of 395 patients with IAS achalasia were included in this meta-analysis. Fifty-eight percent of patients underwent IAS myectomy and 42 % Botox injection. Regular bowel movements were significantly more frequent after IAS myectomy (OR 0.53, [95 % CI 0.29-0.99]; p = 0.04). There was no significant difference in continued use of laxatives or rectal enemas (OR 0.92, [95 % CI 0.34-2.53], p = 0.89) and in overall complication rates between both procedures (OR 0.68, [95 % CI 0.38-1.21]; p = 0.19). Looking at specific complications, the rate of transient faecal incontinence was significantly higher after Botox injection (OR 0.07, [95 % CI 0.01-0.54]; p IAS myectomy (OR 0.56, [95 % CI 0.32-0.97]; p = 0.04 and OR 0.25, [95 % CI 0.15-0.41]; p IAS achalasia, posterior IAS myectomy appears to be a more effective treatment option compared to intrasphincteric

  11. Diseño, fabricación y aplicaciones analíticas de nanocelulosa y sus híbridos

    OpenAIRE

    Ruiz-Palomero, Celia

    2017-01-01

    El gran avance nanotecnológico que ha experimentado la Química Analítica en los últimos años ha sido un indicador del grado de bienestar de la sociedad. La multidisciplinaridad de la Nanociencia y Nanotecnología ha sido esencial para el avance de los métodos y herramientas analíticas, así como para llevar a cabo la automatización, simplificación y miniaturización de los procesos analíticos integrados en los laboratorios [1]. En este campo, son muchos los nanomateriales explorados por sus ...

  12. A CLINICAL STUDY ON PERI ANAL TUBERCULOSIS IN S.V.R.R.G.G. HOSPITAL TIRUPATI

    Directory of Open Access Journals (Sweden)

    Sobha Rani

    2015-09-01

    Full Text Available Tuberculosis around the anus is a rare form of extra pulmonary tuberculosis It is necessary to recognize it due to a specific treatment. (1 Perianal tuberculosis is an uncommon condition; it may not be easily distinguishable from the other inflammatory anal diseases. Undiagnosed cases are associated with high recurrence rates. Perianal tuberculosis can have varied presentation, frequently mimicking other common as well as rare diseases. Ano pe rianal tuberculosis may be associated with abdominal tuberculosis either as an extension of the original lesion or due to its spread via the lymphatics. AIMS & OBJECTIVES OF STUDY : To study the prevalence of ano - perianal tuberculosis in patients attending surgery OPD, SVRR Government General Hospital, Tirupati. To prevent recurrence and morbidity due to peri anal tuberculosis by early detection and intervention with anti tuberculous drugs . MATERIALS AND METHODS : STUDY DESIGN : Prospective study . STUDY SETTING : The present study was conducted at Department of General Surgery, SVRR Government General Hospital, and Tirupati. After getting institutional approval, written and informed consent was taken from each patient. PERIOD OF STUDY : 12 months . SAMPLE SI ZE : 142 patients who attended Surgery OP and were admitted in General Surgery ward, SVRR Government General Hospital, Tirupati with anal and perianal lesions like anal fistulae, perianal suppurations, growths, ulcers during the study period. INCLUSION CRIT ERIA : Age more than 15 years , Both men and women are included , Both sputum positive and negative for AFB , Both HIV positive and negative patients , All Anal and perianal (more than 3cm and within 3cm of anal verge lesions are included , Willingness of the p atient to participate in the study . EXCLUSION CRITERIA : Age less than 15 years , Patients who are not willing to participate in the study . CONCLUSION : Tuberculosis was responsible for 11% cases in recurrent fistula - in - ano

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

    Directory of Open Access Journals (Sweden)

    I. Pascual

    2008-12-01

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

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

    Directory of Open Access Journals (Sweden)

    C. Ciriza de los Ríos

    2010-12-01

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

  15. Hematologic Nadirs During Chemoradiation for Anal Cancer: Temporal Characterization and Dosimetric Predictors

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Andrew Y.; Golden, Daniel W. [Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois (United States); Bazan, Jose G. [Department of Radiation Oncology, The Ohio State University, Columbus, Ohio (United States); Kopec, Malgorzata; Pelizzari, Charles A. [Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois (United States); Aggarwal, Sonya; Chang, Daniel T. [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Liauw, Stanley L., E-mail: sliauw@radonc.uchicago.edu [Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois (United States)

    2017-02-01

    Purpose: Pelvic bone marrow (BM) constraints may offer a means to reduce the toxicity commonly associated with chemoradiation for anal cancer. We conducted a bi-institutional analysis of dose-volume metrics in a time-sensitive fashion to devise practical metrics to minimize hematologic toxicity. Methods and Materials: Fifty-six anal cancer patients from 2 institutions received definitive radiation therapy (median primary dose of 54 Gy) using intensity modulated radiation therapy (IMRT, n=49) or 3-dimensional (3D) conformal therapy (n=7) with concurrent 5-fluorouracil (5-FU) and mitomycin C. Weekly blood counts were retrospectively plotted to characterize the time course of cytopenias. Dose-volume parameters were correlated with blood counts at a standardized time point to identify predictors of initial blood count nadirs. Results: Leukocytes, neutrophils, and platelets reached a nadir at week 3 of treatment. Smaller volumes of the pelvic BM correlated most strongly with lower week 3 blood counts, more so than age, sex, body mass index (BMI), or dose metrics. Patients who had ≥750 cc of pelvic BM spared from doses of ≥30 Gy had 0% grade 3+ leukopenia or neutropenia at week 3. Higher V40 Gy to the lower pelvic BM (LP V40) also correlated with cytopenia. Patients with an LP V40 >23% had higher rates of grade 3+ leukopenia (29% vs 4%, P=.02), grade 3+ neutropenia (33% vs 8%, P=.04), and grade 2+ thrombocytopenia (32% vs 7%, P=.04) at week 3. On multivariate analysis, pelvic BM volume and LP V40 remained associated with leukocyte count, and all marrow subsite volumes remained associated with neutrophil counts at week 3 (P<.1). Conclusions: Larger pelvic BM volumes correlate with less severe leukocyte and neutrophil nadirs, suggesting that larger total “marrow reserve” can mitigate cytopenias. Sparing a critical marrow reserve and limiting the V40 Gy to the lower pelvis may reduce the risk of hematologic toxicity.

  16. Lesão anal por papilomavírus humano em mulher vivendo com HIV/aids = Anal lesion caused by human papillomavirus in a woman living with HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Diefenthäler, Vanessa Laís

    2017-01-01

    Full Text Available OBJETIVOS: Descrever um caso de lesão anal causada por infecção pelo papilomavírus humano em uma mulher vivendo com HIV/aids. DESCRIÇÃO DO CASO: Mulher de 35 anos, diagnosticada há cinco anos com HIV, relatou prurido e sangramento anal, dor ao defecar e visualização de pequenas verrugas na região perianal. Atendida em um serviço de atenção especializada, foi submetida a exame clínico com inspeção visual, o qual revelou condiloma na região perianal. O exame histopatológico confirmou a presença de displasia de grau moderado a acentuado associado a alterações compatíveis com infecção pelo papilomavírus humano. A paciente foi encaminhada para exérese da lesão. No início dos sintomas, a paciente ainda não fazia uso da terapia antirretroviral e apresentava a maior carga viral do HIV de seu histórico laboratorial, com 2. 951 cópias/ml. Também havia passado por estresse emocional e estava com infecções genitais recorrentes pelo vírus Herpes simplex. Esses fatores podem ter contribuído para o desenvolvimento do condiloma anal. CONCLUSÕES: A possibilidade de que a infecção pelo HIV possa alterar a história da infecção pelo HPV alerta para que nessas situações sejam adotadas estratégias rigorosas de rastreamento através do exame citológico, tanto do colo do útero como da região anal

  17. Complete Resolution of a Recurrent Canine Anal Sac Squamous Cell Carcinoma with Palliative Radiotherapy and Carboplatin Chemotherapy.

    Science.gov (United States)

    Giuliano, Antonio; Dobson, Jane; Mason, Sarah

    2017-09-14

    Anal sac squamous cell carcinoma (SCC) is a rare tumor in dogs. Only eight cases have been described in the literature, and previous reports of treatment only describe surgery or palliative treatment with non-steroidal anti-inflammatory drugs. We report a case of a 12-year-old female neutered Labrador with locally advanced anal sac SCC. The dog was treated with four cycles of carboplatin 300 mg/m² and four weekly fractions of 8.5 Gy radiation. The dog achieved a complete response, and one year later the dog is still alive and well with no evidence of tumor recurrence. Radiotherapy in combination with carboplatin chemotherapy was effective in the long-term control of this rare disease.

  18. Estudio de nuevos (nano)materiales para el desarrollo de metodologías analíticas sostenibles

    OpenAIRE

    Jornet Martínez, Neus

    2015-01-01

    Los avances en las nuevas tecnologías y los avances en la investigación de materiales tiene un profundo impacto en la evolución reciente de Química Analítica. Esta tesis tiene como objetivo estudiar cómo la introducción de nuevos materiales ha dado lugar a notables mejoras en las técnicas de detección, de separación y extracción. Nanociencia es un área creciente de investigación en general, y en particular en Química Analítica. Esta tesis se centra en nanopartículas de oro (AuNPs) y nanotu...

  19. Feasibility of preference-driven radiotherapy dose treatment planning to support shared decision making in anal cancer

    DEFF Research Database (Denmark)

    Rønde, Heidi S; Wee, Leonard; Pløen, John

    2017-01-01

    PURPOSE/OBJECTIVE: Chemo-radiotherapy is an established primary curative treatment for anal cancer, but clinically equal rationale for different target doses exists. If joint preferences (physician and patient) are used to determine acceptable tradeoffs in radiotherapy treatment planning, multiple.......7%-points; (0.3; 30.6); p preference [median change in V35Gy: 30.3%-points; (12.4; 43.1); p preferences, although tradeoffs are highly patient-dependent. This study demonstrates...... were generated for 22 anal cancer patients. Multi-criteria optimization handles dynamically changing priorities between clinical objectives while meeting fixed clinical constraints. Four unique dose distributions were designed to represent a wide span of clinically relevant objectives: high...

  20. Trans-anal barotrauma by compressed air leading to sigmoid perforation due to a dangerous practical joke.

    Science.gov (United States)

    Pahwa, Harvinder Singh; Kumar, Awanish; Srivastava, Rohit; Rai, Anurag

    2012-08-01

    To present a case report of trans-anal barotrauma by high-pressure compressed air jet as a dangerous practical joke, that is, playful insufflation of high-pressure air jet through the anal orifice resulting in sigmoid perforation. The patient presented to emergency a day later with complaints of severe pain in the abdomen and abdominal distension following insufflation of high-pressure air jet through the anus. On examination, he had signs suggestive of perforation peritonitis and x-ray of the abdomen showed gas under the diaphragm. An emergency exploratory laparotomy was performed which revealed a 4-cm perforation in the sigmoid colon. Resection of the segment containing perforation along with the surrounding devitalised part was done with double-barrel colostomy. Reversal of colostomy was done after 8 weeks. Follow-up was uneventful.

  1. Feedback control of TET system with variable coupling coefficients for a novel artificial anal sphincter.

    Science.gov (United States)

    Ke, L; Yan, G; Yan, S; Wang, Z; Liu, Z

    2014-03-01

    For treating severe faecal incontinence, the authors developed an intelligent artificial anal sphincter system (AASS) equipped with a feedback sensor that utilized a transcutaneous energy transfer system (TETS). To deliver the correct amount of power (i.e. to match the load demand under variable coupling conditions caused by changes in positioning between the coils due to fitting and changes in posture), a regulating method to stabilize output voltage with a closed loop variable-frequency controller was developed in this paper. The method via which the voltage gain characteristics of a voltage-fed series-tuned TETS were derived is also described. The theoretical analysis was verified by the results of the experiment. A numerical analysis method was used as a control rule with respect to the relationship between operating frequency and output voltage. To validate the feedback control rules, a prototype of the TET charging system was constructed, and its performance was validated with the coupling variation between 0.12-0.42. The results show that the output voltage of the secondary side can be maintained at a constant 7 V across the whole coupling coefficient range, with a switching frequency regulation range of 271.4-320.5 kHz, and the proposed controller has reached a maximal end-to-end power efficiency of 67.5% at 1 W.

  2. Anal cancer with large metastases into the perirectal fat: differential diagnosis and treatment policy

    Directory of Open Access Journals (Sweden)

    A. O. Rasulov

    2015-01-01

    Full Text Available Selected squamous-cell anal carcinoma (SCAC patients are initially presented with large pararectal lymph node metastases.The aim of this study was to investigate safety, efficacy and long-term outcome of chemoradiotherapy in this patient group.Materials and methods. SCAC patients, initially referred with gastrointestinal stromal tumors, rectal cancer diagnosis or patients with regional metastatic lymph nodes more than twice the size of the primary tumour were included in this retrospective analysis. Previous treatment, diagnostic and clinical mistakes of primary care specialists, short- and long-term outcome of chemoradiotherapy were analyzed.Results. 6 patients were included. Primary tumour size varied between 0.5 and 6.5 cm (median – 1.7 cm, metastatic lymph node size varied between 4.2 and 7.4 cm (median – 6.4 cm. All patients received radical doses of chemoradiation. All patients developed grade 3 toxicities, 2 patients developed grade 4 toxicities. Median followup was 15.5 months. 5 out of 6 patients had persistent complete clinical response. 1 patient died of disease progression (incomplete response and metachronous distant metastases.Conclusion. SCAC patients with large regional lymph node metastases have equal prognosis with the rest of the patient group of adequate treatment was carried out.

  3. El significado de las malformaciones anorectales y de las dilataciones anales

    Directory of Open Access Journals (Sweden)

    Aguinaga Benítez Oscar William

    1996-12-01

    Full Text Available

    Es un estudio investigativo de tipo cualitativo, dentro del enfoque hermenéutico, en donde se busca conocer el significado que los padres asignan a las malformaciones anorectales o enfermedad de Hirschprung y el tratamiento en sus hijos, incluyendo las dilataciones anales; con el propósito de encontrar aproximaciones a sus sentidos y construir estrategias de atención que beneficien el estado físico del niño y apunten a un mayor equilibrio psicosocial de los padres. Es por ello, que las categorías de análisis están insertas en la actitud, entendida ésta como la síntesis de lo afectivo, lo cognitivo y lo práxico. Mediante la historia clínica hospitalaria, se seleccionaron a los padres a quienes se les hizo la entrevista y se les observó la actitud frente a las malformaciones y su tratamiento en más de una ocasión, obteniéndose la información que condujo a las conclusiones. Se entrevistaron y observaron 25 padres de familia y sus respectivos hijos, no sin antes señalar que se trató de recoger una experiencia de 4 años atrás, con otros padres con similar problemática.

  4. Analítica de lo moderno: Una introducción

    Directory of Open Access Journals (Sweden)

    Jonathan Xavier Inda

    2011-01-01

    Full Text Available Este texto plantea la relevancia de abordar la modernidad como objeto etnográfico, esto es, examinarla desde discursos y prácticas situadas. Esta etnografía se inspira en un enfoque foucaultiano donde la gubernamentalidad es una categoría clave. Desde esta perspectiva, se propone un abordaje que examine tres dimensiones analíticas de la modernidad. En primera instancia están las razones de gobierno; esta dimensión reúne todas aquellas formas de conocimiento, de experticia y de cálculo que hacen posible que pensemos a los seres humanos como susceptibles de programación política. En segundo lugar están las técnicas de gobierno; al ámbito de lo técnico pertenecen los mecanismos prácticos, los instrumentos y los programas por medio de los cuales autoridades de distintos tipos buscan dar forma e instrumentalizar la conducta humana. Finalmente están los sujetos de gobierno; esta dimensión cubre los diversos tipos de identidad individual y colectiva que emergen a partir de, y al mismo tiempo sustentan, la actividad gubernamental.

  5. COX-1 vs. COX-2 as a determinant of basal tone in the internal anal sphincter.

    Science.gov (United States)

    de Godoy, Márcio A F; Rattan, Neeru; Rattan, Satish

    2009-02-01

    Prostanoids, produced endogenously via cyclooxygenases (COXs), have been implicated in the sustained contraction of different smooth muscles. The two major types of COXs are COX-1 and COX-2. The COX subtype involved in the basal state of the internal anal sphincter (IAS) smooth muscle tone is not known. To identify the COX subtype, we examined the effect of COX-1- and COX-2-selective inhibitors, SC-560 and rofecoxib, respectively, on basal tone in the rat IAS. We also determined the effect of selective deletion of COX-1 and COX-2 genes (COX-1(-/-) and COX-2(-/-) mice) on basal tone in murine IAS. Our data show that SC-560 causes significantly more efficacious and potent concentration-dependent decreases in IAS tone than rofecoxib. In support of these data, significantly higher levels of COX-1 than COX-2 mRNA were found in the IAS. In addition, higher levels of COX-1 mRNA and protein were expressed in rat IAS than rectal smooth muscle. In wild-type mice, IAS tone was decreased 41.4 +/- 3.4% (mean +/- SE) by SC-560 (1 x 10(-5) M) and 5.4 +/- 2.2% by rofecoxib (P IAS from wild-type mice and significantly less (0.080 +/- 0.015 mN/mg) in the IAS from COX-1(-/-) mice (P IAS tone.

  6. Dutch evidence statement for pelvic physical therapy in patients with anal incontinence.

    Science.gov (United States)

    Berghmans, L C M; Groot, J A M; van Heeswijk-Faase, I C; Bols, E M J

    2015-04-01

    To promote agreement among and support the quality of pelvic physiotherapists' skills and clinical reasoning in The Netherlands, an Evidence Statement Anal Incontinence (AI) was developed based on the practice-driven problem definitions outlined. We present a summary of the current state of knowledge and formulate recommendations for a methodical assessment and treatment for patients with AI, and place the evidence in a broader perspective of current developments. Electronic literature searches were conducted in relevant databases with regard to prevalence, incidence, costs, etiological and prognostic factors, predictors of response to therapy, prevention, assessment, and treatment. The recommendations have been formulated on the basis of scientific evidence and where no evidence was available, recommendations were consensus-based. The evidence statement incorporates a practice statement with corresponding notes that clarify the recommendations, and accompanying flowcharts, describing the steps and recommendations with regard to the diagnostic and therapeutic process. The diagnostic process consists of history-taking and physical examination supported by measurement instruments. For each problem category for patients with AI, a certain treatment plan can be distinguished dependent on the presence of pelvic floor dysfunction, awareness of loss of stools, comorbidity, neurological problems, adequate anorectal sensation, and (in)voluntary control. Available evidence and expert opinion support the use of education, pelvic floor muscle training, biofeedback, and electrostimulation in selected patients. The evidence statement reflects the current state of knowledge for a methodical and systematic physical therapeutic assessment and treatment for patients with AI.

  7. Contextual Factors Surrounding Anal Intercourse in Women: Implications for Sexually Transmitted Infection/HIV Prevention.

    Science.gov (United States)

    Stahlman, Shauna; Hirz, Alanna E; Stirland, Ali; Guerry, Sarah; Gorbach, Pamina M; Javanbakht, Marjan

    2015-07-01

    Our objectives were to describe women's reasons for engaging in anal intercourse (AI), contextual factors surrounding AI, and how these vary by current rectal sexually transmitted infection (STI) status, and to assess women's knowledge and concerns about rectal infections. Between January 2011 and June 2013, we conducted semistructured, qualitative interviews among 40 women attending public sexually transmitted disease clinics in Los Angeles County, California. Women were eligible if they were at least 18 years of age, reported AI in the past 90 days, and were tested for rectal Chlamydia trachomatis and Neisseria gonorrhoeae. Interviews, which were guided by the theory of gender and power, were transcribed and coded to explore contextual factors surrounding AI. On average, participants reported having 3 AI partners in their lifetime and most (n = 30) reported being in a serious relationship with a main/regular sex partner at the time of the interview. Motivations for engaging in AI and feelings about AI varied by rectal STI status. Women with a rectal STI more prominently conveyed the idea that AI was intended to please their sexual partner, whereas those who did not have a rectal STI reported AI more as a way to increase intimacy and personal sexual gratification. Almost all women (regardless of rectal STI status) reported limited to no knowledge about the risk of rectal STIs. Among women, risk of acquiring rectal STIs may vary by reason for engaging in unprotected AI as well as other contextual factors. Providers should consider addressing these contextual factors to reduce risk.

  8. A novel puborectalis muscle artificial anal sphincter system with the module of sensory perception.

    Science.gov (United States)

    Wu, Hao; Wang, Zhiwu; Yan, Guozheng; Jin, Wentian; Lu, Shan; Zhou, Zerun

    2017-02-01

    This article presents a novel puborectalis muscle artificial anal sphincter system (PM-AASS) with the module of sensory perception for treating severe faecal incontinence (FI). Due to the implantable feature of PM-AASS, this system applied low-power design and the total energy consumption could drop to 48.8 Ah/d. To reduce the injury of intestine and the pressure exerted on intestine, the actuator, including the structure of tings and the robot mechanism, of PM-AASS was presented and the middle ring was optimised. To realise the sensory perception, the intestinal flexible pressure sensors, comprising the radial sensors and the axial sensors, were designed. The sensors calibration showed the R-square of each fitting line were above 0.998, which presented a high goodness of fit and indicated we could figure out the pressure value with the analogue voltage captured by MCU. Through the in-vitro experiment, the results that the radial sensors were more relevant to the occlusion threshold while the axial sensors had more effect on the alarm threshold could be concluded. The practicability of the PM-AASS was verified by the results of the in-vivo experiment, which showed that the PM-AASS had the effect of improvement to the anorectal internal pressure.

  9. Metodología analítica para la determinación de oxiesteroles

    Directory of Open Access Journals (Sweden)

    Guardiola, F.

    1994-06-01

    Full Text Available This paper deal with the main aspects of the analysis of oxysterols. This analytical problem is quite new and many questions involved are still controversial. Consequently, many methodologies exist that still need improvement and standarization. Therefore, it is interesting to discuss the analytical methodologies proposed by different authors for the extraction, purification and determination (gas chromatography and high performance liquid chromatography of oxysterols.

    El presente trabajo recoge los principales aspectos relacionados con el análisis de los derivados oxidados del colesterol. Este problema analítico es relativamente reciente y muchas cuestiones relacionadas con el mismo son controvertidas. Prueba de ello es la existencia de un número elevado de metodologías, que exigen aún, en muchos casos, una mejora y validación. Por ello, se ha creído interesante una discusión de los principales sistemas propuestos para su determinación (cromatografía de gases y cromatografía de alta eficacia, así como de las etapas previas de extracción y purificación de las muestras.

  10. Anal squamous cell carcinoma - State of the art management and future perspectives.

    Science.gov (United States)

    Martin, Daniel; Balermpas, Panagiotis; Winkelmann, Ria; Rödel, Franz; Rödel, Claus; Fokas, Emmanouil

    2018-02-22

    Anal squamous cell carcinoma (ASCC) is associated with infection with high-risk strains of human papilloma virus (HPV) in 70-90% of cases and a rise in incidence has been observed in the last decades. Definitive chemoradiotherapy (CRT) using 5-fluorouracil and mitomycin C constitutes the standard treatment for localized disease, but about 30% of patients do not respond or relapse locally. Phase I/II trials testing targeted agents, such as epidermal-growth-factor receptor (EGFR) inhibitors, have failed to improve clinical outcome and resulted in increased toxicities. Modern imaging methods and biomarkers, also in the context of HPV status, should be further explored to improve patient stratification. In the present review, we will discuss the current clinical evidence and future perspectives in the management of ASCC. HPV-positive ASCC is more immunogenic with a higher density of tumor infiltrating lymphocytes that correlate with better response to CRT and more favorable prognosis compared to HPV-negative tumors. Immunotherapies including immune checkpoint inhibitors have brought new hope and promising results were recently demonstrated in metastatic ASCC. The addition of immunotherapies to CRT for localized disease is tested in early phase trials, and these results could have a profound impact on the way we treat ASCC in near future. Further research and novel approaches are expected to enhance our understanding of tumor biology and immunology, and improve patient stratification and treatment adaptation in the context of personalized medicine. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Management of giant anal condyloma by wide local excision and anoplasty.

    Science.gov (United States)

    Uribe, N; Rueda, C; López, M; Balciscueta, Z; Martín, M C; Terrádez, J J; Flores, J

    2012-11-01

    Treatment of giant condyloma acuminatum, is controversial, especially in human immunodeficiency virus (HIV)-positive patients, owing to concern over wound healing, complications, risk of progression to carcinoma and a high recurrence rate. The aim of this study was to evaluate the outcome after extensive local excision with V-Y anoplasty. Nine patients were identified from a prospective database, six of whom were HIV positive. All patients had a giant perianal condyloma acuminatum extending into the anal canal and perianal region, which required wide excision with V-Y reconstruction. Postoperative complications, recurrence and continence were all determined. Nine patients were included (eight men, median age 40 years), six seropositive for HIV infection. A bilateral V-Y anoplasty was performed in six patients, and unilateral in two. There were no postoperative infections, graft failures or flap necrosis. The mean follow-up was 92 (2-137) months. One patient developed local recurrence treated with excision under local anaesthesia. Extensive local surgery of giant perianal condyloma with anoplastic reconstruction gives good results even in HIV-positive patients. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

  12. Firmas mārketinga mikrovides faktoru analīze

    OpenAIRE

    Liniņa, Kristīne

    2010-01-01

    Lai uzņēmums spētu efektīvi darboties, katram uzņēmējam ir jāvērtē uzņēmuma darbs un jāveic tā analīze. Uzņēmuma darbību ietekmē daudzi gan iekšējie, gan ārējie faktori. Savas uzņēmējdarbības uzlabošanai, katram vadītājam ir jāanalizē uzņēmuma ietekmējošie faktori, tādējādi novēršot darbības trūkumus un pilnveidojot uzņēmuma darbību. Darbā ir pētīta firmas darbība, mārketinga mikrovide un to veidojošie faktori. Bakalaura darba mērķis ir pētīt, kāda ir uzņēmuma SIA „Amaranta” mikrovide un ...

  13. Impact of liberal use of mediolateral episiotomy on the incidence of obstetric anal sphincter tear.

    Science.gov (United States)

    Zafran, Noah; Salim, Raed

    2012-09-01

    To assess the impact of liberal compared with restrictive use of mediolateral episiotomy on the incidence of obstetric anal sphincter tear (OAST). Data between the years 1999-2001 (era 1) when liberal mediolateral episiotomy was applied were compared with the years 2004-2008 (era 2) when restricted mediolateral episiotomy was implemented. Liberal mediolateral episiotomy was done for fetal or maternal indications, while restrictive mediolateral episiotomy was done when a tear was imminent. Primary outcome was the incidence of OAST. A total of 25,170 women who delivered vaginally were included. After adjusting for potential confounders, the incidence of OAST was found to be significantly higher in era 2 (0.4 %) compared to era 1 (0.1 %), (p = 0.02; adjusted OR 2.23; 95 % CI, 1.16-4.29). Among primiparous women, the incidence of mediolateral episiotomy was 71.8 and 27.1 % in eras 1 and 2, respectively (p liberal policy among primiparous women only, 124 deliveries are needed to prevent one OAST. Liberal compared to restrictive use of mediolateral episiotomy may be a sphincter-saving procedure among primiparous women.

  14. Marginalidade, etnicidade e penalidade na cidade neoliberal: uma cartografia analítica

    Directory of Open Access Journals (Sweden)

    Loïc Wacquant

    2014-12-01

    Full Text Available Este artigo elabora uma cartografia analítica do programa de pesquisa perseguido ao longo dos três livros do autor: Urban outcasts (2008, Punishing the poor (2009 e Deadly symbiosis: race and the rise of the penal State (no prelo. Nessa trilogia, são desfeitos os nexos triangulares entre fragmentação de classe, divisão étnica e remodelagem do Estado na cidade polarizada, na virada do século, para explicar a produção política, a distribuição socioespacial e a gestão punitiva da marginalidade mediante o acoplamento de políticas sociais disciplinares e de justiça criminal neutralizante. Indico como utilizei noções-chave de Pierre Bourdieu (espaço social, campo burocrático, poder simbólico para clarificar categorias que permaneceram fluidas (como a de gueto e forjar novos conceitos (estigmatização territorial e marginalidade avançada, contenção punitiva e paternalismo liberal, hiperencarceramento e sociodiceia negativa como ferramentas para uma sociologia comparada da gênese inconclusa do precariado pós-industrial, da regulação penal da pobreza na era da insegurança social difusa e da construção do Leviatã neoliberal.

  15. A systematic review of sacral nerve stimulation for faecal incontinence following ileal pouch anal anastomosis.

    Science.gov (United States)

    Kong, E; Nikolaou, S; Qiu, S; Pellino, G; Tekkis, P; Kontovounisios, C

    2017-10-30

    Faecal incontinence is a common complication of ileal pouch anal anastomosis (IPAA) and seems to worsen with time. The aim of this paper is to review the evidence of the use of sacral nerve stimulation (SNS) for patients with faecal incontinence after IPAA. A literature search was performed on PubMed and Cochrane databases for all relevant articles. All studies, which reported the outcome of SNS in patients with faecal incontinence after IPAA, were reviewed. Three papers were identified, including a case report, cohort study and retrospective study. The total number of patients was 12. The follow-up duration included 3 months, 6 months and 24 months. After peripheral nerve evaluation, definitive implantation was performed in 10 (83.3%) patients. All three studies reported positive outcomes, with CCF scores and incontinence episodes improving significantly. Preliminary results suggest good outcome after permanent SNS implant. Studies with larger sample sizes, well-defined patient characteristics and standardized outcome measures are required to fully investigate the effect of SNS in IPAA patients.

  16. Gender differences in heterosexual anal sex practices among women and men in substance abuse treatment.

    Science.gov (United States)

    Calsyn, Donald A; Hatch-Maillette, Mary A; Meade, Christina S; Tross, Susan; Campbell, Aimee N C; Beadnell, Blair

    2013-09-01

    Heterosexual anal intercourse (HAI) is an understudied risk behavior among women and men in substance abuse treatment. Rates of HAI for women (n = 441) and men (n = 539) were identified for any, main and casual partners. More men (32.8 %) than women (27.1 %) reported engaging in HAI in the previous 90 days. These rates are higher than those reported for both men (6.0-15.9 %) and women (3.5-13.0 %) ages 25-59 in the National Survey of Sexual Health and Behavior. Men were significantly more likely to report HAI with their casual partners (34.1 %) than women (16.7 %). In a logistic regression model generated to identify associations between HAI and variables previously shown to be related to high risk sexual behavior, being younger, bisexual, and White were significantly associated with HAI. For men, having more sex partners was also a significant correlate. HAI is a logical target for increased focus in HIV prevention interventions.

  17. Anal Canal Cancer: Management of Inguinal Nodes and Benefit of Prophylactic Inguinal Irradiation (CORS-03 Study)

    International Nuclear Information System (INIS)

    Ortholan, Cécile; Resbeut, Michel; Hannoun-Levi, Jean-Michel; Teissier, Eric; Gerard, Jean-Pierre; Ronchin, Philippe; Zaccariotto, Audrey; Minsat, Mathieu; Benezery, Karen; François, Eric; Salem, Naji; Ellis, Steve; Azria, David; Champetier, Cédric; Gross, Emmanuel; Cowen, Didier

    2012-01-01

    Purpose: To evaluate the benefit of prophylactic inguinal irradiation (PII) in anal canal squamous cell carcinoma (ASCC). Methods and Materials: This retrospective study analyzed the outcome of 208 patients presenting with ASCC treated between 2000 and 2004 in four cancer centers of the south of France. Results: The population study included 35 T1, 86 T2, 59 T3, 20 T4, and 8 T stage unknown patients. Twenty-seven patients presented with macroscopic inguinal node involvement. Of the 181 patients with uninvolved nodes at presentation, 75 received a PII to a total dose of 45–50 Gy (PII group) and 106 did not receive PII (no PII group). Compared with the no PII group, patients in the PII group were younger (60% vs. 41% of patients age 2 toxicity of the lower extremity was observed. Conclusion: PII with a dose of 45 Gy is safe and highly efficient to prevent inguinal recurrence and should be recommended for all T3-4 tumors. For early-stage tumors, PII should also be discussed, because the 5-year inguinal recurrence risk remains substantial when omitting PII (about 10%).

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

    International Nuclear Information System (INIS)

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

    2012-01-01

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

  19. Stress and psychopathology and its impact on quality of life in chronic anal fissure (CAF) patients.

    Science.gov (United States)

    Arısoy, Özden; Şengül, Neriman; Çakir, Affan

    2017-06-01

    Chronic anal fissure (CAF) onset, exacerbation, and impact on quality of life are influenced by a host of psychological, physiological, and social factors. We aimed to investigate the difference in psychopathology and stress between normal and CAF groups. Thirty CAF patients and 20 age-sex matched healthy controls were evaluated for Axis I psychopathology, depression, anxiety, and stress with Hamilton and Hospital Depression-Anxiety Scales, Perceived Stress Scale, and SF-36. With a mean age of 39.47, 83.3% of CAF patients were female. Anxiety-depression and stress scores were all significantly higher and functionality was lower in the CAF group compared to controls (p stress factor and 56.6% had an exacerbating stress factor; 56.7% of the patients had an ongoing Axis I psychopathology while 50% had a previous psychopathology. Pain (96.7% had pain (VAS = 6.55)) and bleeding (83.3% had bleeding (VAS = 4.14)) severity showed a negative impact on bodily pain and role limitations emotional subscales of SF36. There is a high comorbidity of psychopathology in the CAF patients and depression and anxiety severities show a negative impact on the quality of life. Stress acts as both a triggering and an exacerbating factor in CAF.

  20. Obstetric anal sphincter injury rates among primiparous women with different modes of vaginal delivery.

    Science.gov (United States)

    Ampt, Amanda J; Patterson, Jillian A; Roberts, Christine L; Ford, Jane B

    2015-12-01

    To determine whether rates of obstetric anal sphincter injuries (OASIS) are continuing to increase and whether risk of OASIS according to mode of delivery is constant over time. In a retrospective population-based study, data were obtained for vaginal singleton vertex deliveries at 37-41 weeks of pregnancy among primiparous women in New South Wales, Australia, between January 2001 and December 2011. Annual OASIS rates were determined among non-instrumental, forceps, and vacuum deliveries with and without episiotomy. Multivariable logistic regression was used to determine adjusted odds ratios for each delivery mode category by year. Trends in adjusted odds ratios over time for each delivery category were compared. OASIS occurred in 955 (4.1%) of 23 081 deliveries in 2001 and 1487 (5.9%) of 25 081 deliveries in 2011. After adjustment for known risk factors, the only delivery categories to show statistically significant increases in OASIS over the study period were non-instrumental deliveries without episiotomy (linear trend Pdeliveries with episiotomy (linear trend P=0.004). Overall, OASIS rates have continued to increase. Known risk factors do not fully explain the increase in OASIS rates in non-instrumental deliveries without an episiotomy and in forceps deliveries with an episiotomy. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.

  1. Australasian Gastrointestinal Trials Group (AGITG) Contouring Atlas and Planning Guidelines for Intensity-Modulated Radiotherapy in Anal Cancer

    International Nuclear Information System (INIS)

    Ng, Michael; Leong, Trevor; Chander, Sarat; Chu, Julie; Kneebone, Andrew; Carroll, Susan; Wiltshire, Kirsty; Ngan, Samuel; Kachnic, Lisa

    2012-01-01

    Purpose: To develop a high-resolution target volume atlas with intensity-modulated radiotherapy (IMRT) planning guidelines for the conformal treatment of anal cancer. Methods and Materials: A draft contouring atlas and planning guidelines for anal cancer IMRT were prepared at the Australasian Gastrointestinal Trials Group (AGITG) annual meeting in September 2010. An expert panel of radiation oncologists contoured an anal cancer case to generate discussion on recommendations regarding target definition for gross disease, elective nodal volumes, and organs at risk (OARs). Clinical target volume (CTV) and planning target volume (PTV) margins, dose fractionation, and other IMRT-specific issues were also addressed. A steering committee produced the final consensus guidelines. Results: Detailed contouring and planning guidelines and a high-resolution atlas are provided. Gross tumor and elective target volumes are described and pictorially depicted. All elective regions should be routinely contoured for all disease stages, with the possible exception of the inguinal and high pelvic nodes for select, early-stage T1N0. A 20-mm CTV margin for the primary, 10- to 20-mm CTV margin for involved nodes and a 7-mm CTV margin for the elective pelvic nodal groups are recommended, while respecting anatomical boundaries. A 5- to 10-mm PTV margin is suggested. When using a simultaneous integrated boost technique, a dose of 54 Gy in 30 fractions to gross disease and 45 Gy to elective nodes with chemotherapy is appropriate. Guidelines are provided for OAR delineation. Conclusion: These consensus planning guidelines and high-resolution atlas complement the existing Radiation Therapy Oncology Group (RTOG) elective nodal ano-rectal atlas and provide additional anatomic, clinical, and technical instructions to guide radiation oncologists in the planning and delivery of IMRT for anal cancer.

  2. Ciclooxygenase inhibitor and metronomic chemotherapy association for the treatment of metastatic anal sac carcinoma in dog: case report

    OpenAIRE

    Teixeira, N.C.T.; Bicalho, A.P.C.V.; Vasconcelos, A.V.; Horta, R.S.; Cunha, R.M.C.; Lavalle, G.E.

    2016-01-01

    ABSTRACT Metronomic chemotherapy consists of an anticancer modality treatment. It is applicable in patients at an advanced stage, with the objective of increasing overall survival. The aim of this study was to report an anal sac apocrine carcinoma case in a dog with lymph node metastasis treated with metronomic chemotherapy sequential to surgery and conventional chemotherapy using gemcitabine and carboplatin. Metronomic chemotherapy was associated with cyclooxygenase-2 (COX-2) inhibitors, due...

  3. Australasian Gastrointestinal Trials Group (AGITG) Contouring Atlas and Planning Guidelines for Intensity-Modulated Radiotherapy in Anal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ng, Michael, E-mail: mng@radoncvic.com.au [Radiation Oncology Victoria, Victoria (Australia); Leong, Trevor [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria (Australia); University of Melbourne (Australia); Chander, Sarat; Chu, Julie [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria (Australia); Kneebone, Andrew [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW (Australia); University of Sydney (Australia); Carroll, Susan [Department of Radiation Oncology, Sydney Cancer Centre, Royal Prince Alfred Hospital, NSW (Australia); University of Sydney (Australia); Wiltshire, Kirsty [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria (Australia); Ngan, Samuel [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria (Australia); University of Melbourne (Australia); Kachnic, Lisa [Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA (United States)

    2012-08-01

    Purpose: To develop a high-resolution target volume atlas with intensity-modulated radiotherapy (IMRT) planning guidelines for the conformal treatment of anal cancer. Methods and Materials: A draft contouring atlas and planning guidelines for anal cancer IMRT were prepared at the Australasian Gastrointestinal Trials Group (AGITG) annual meeting in September 2010. An expert panel of radiation oncologists contoured an anal cancer case to generate discussion on recommendations regarding target definition for gross disease, elective nodal volumes, and organs at risk (OARs). Clinical target volume (CTV) and planning target volume (PTV) margins, dose fractionation, and other IMRT-specific issues were also addressed. A steering committee produced the final consensus guidelines. Results: Detailed contouring and planning guidelines and a high-resolution atlas are provided. Gross tumor and elective target volumes are described and pictorially depicted. All elective regions should be routinely contoured for all disease stages, with the possible exception of the inguinal and high pelvic nodes for select, early-stage T1N0. A 20-mm CTV margin for the primary, 10- to 20-mm CTV margin for involved nodes and a 7-mm CTV margin for the elective pelvic nodal groups are recommended, while respecting anatomical boundaries. A 5- to 10-mm PTV margin is suggested. When using a simultaneous integrated boost technique, a dose of 54 Gy in 30 fractions to gross disease and 45 Gy to elective nodes with chemotherapy is appropriate. Guidelines are provided for OAR delineation. Conclusion: These consensus planning guidelines and high-resolution atlas complement the existing Radiation Therapy Oncology Group (RTOG) elective nodal ano-rectal atlas and provide additional anatomic, clinical, and technical instructions to guide radiation oncologists in the planning and delivery of IMRT for anal cancer.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-09-01

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

  5. Comparison of age-specific patterns of sexual behaviour and anal HPV prevalence in homosexual men with patterns in women.

    Science.gov (United States)

    Poynten, Isobel Mary; Machalek, Dorothy; Templeton, David; Jin, Fengyi; Hillman, Richard; Zablotzska, Iryna; Prestage, Garrett; Holt, Martin; Grulich, Andrew

    2016-05-01

    Anal human papillomavirus (HPV) is highly prevalent in men who have sex with men (MSM) of all ages, whereas cervical HPV declines with age. We explore the hypothesis that different sexual behavioural patterns are the basis of this difference in age distribution. Published data on age-specific HPV prevalence for women (cervical HPV) were extracted from a large meta-analysis and for MSM (anal HPV) from the EXPLORE study of HIV-negative MSM. Age-specific data on recent sexual activity were extracted from two behavioural surveys: the second Australian Study of Health and Relationships survey and the 2013 Gay Community Periodic Survey. At least 50% of MSM at all ages reported more than one sexual partner in the past 6 months. In comparison, 33% of women aged 16-19 years reported more than one partner over the past year. This decreased to 19% and 6% in women aged 20-29 and 30-39 years, respectively, and to fewer than 5% of women in older age groups. Prevalent anal HPV was detected in over 50% of MSM in each age group. Prevalence did not decline with age. In contrast, there was a steady decrease in cervical HPV prevalence with age. Cervical HPV prevalence fell from 23% among North American women aged heterosexual women, the high prevalence and lack of decline in prevalent anal HPV among older MSM are likely to be related to continuing high rates of newly acquired HPV infection from ongoing sexual exposure through new partners. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  6. A comparative analysis of homosexual behaviors, sex role preferences, and anal sex proclivities in Latino and non-Latino men.

    Science.gov (United States)

    Jeffries, William L

    2009-10-01

    Machismo prescribes that homosexual encounters among Latino men are conducted along highly gendered lines: men tend to be anally insertive or receptive over the lifecourse, but not both. Some have argued that Latino men have more lifecourse homosexual behaviors in comparison to other racial/ethnic groups. This is often due to the perception that Latin America has quasi-institutionalized homosexuality, which sharply contrasts it with the United States. Although scholars suggest that sex role preferences and greater likelihoods for homosexual behaviors exist among Latino men in the United States, limited empirical data validate these claims. Latino/non-Latino differences in male homosexual behaviors and sex role preferences were analyzed by using the 2002 cycle of the National Survey of Family Growth, a nationally representative, probability sample of 4,928 men. Findings revealed that non-Mexican Latino, but not Mexican, men had increased likelihoods of ever having anal sex than non-Latino Whites and oral sex than non-Latino Blacks. These relationships remained after controlling for age, education, and foreign birth. Latino men preferred insertive or receptive sex in comparison to non-Latino Blacks and Whites, but this difference disappeared after education was controlled. In full and reduced models, Mexican men tended to be orifice-specific (oral or anal), while non-Mexican Latinos were more oriented to both oral and anal sex. Controlling for other factors, all Latinos were more likely than non-Latino Blacks and Whites to refuse to answer male homosexual behavior questions. The implications of race/ethnicity are discussed for homosexual behavior patterns among U.S. men.

  7. "Ahora" ja "nüüd" ilukirjanduslikus narratiivis : A. Lindgreni "Hulkur Rasmuse" tõlgete analüüs / Triin Lõbus

    Index Scriptorium Estoniae

    Lõbus, Triin

    2005-01-01

    Vaadeldakse deiktikute "ahora" ja "nüüd" rolli vastavalt hispaania- ja eestikeelses kolmandaisikulises narratiivis "Hulkur Rasmuse" tõlgete näitel. Analüüs lähtub nn. deiktilise nihke teooriast

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

    International Nuclear Information System (INIS)

    Aydin, H.

    1987-01-01

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

  9. High prevalence and incidence of HPV-related anal cancer precursor lesions in HIV-positive women in the late HAART era.

    Science.gov (United States)

    Hidalgo-Tenorio, Carmen; de Jesus, Samantha E; Esquivias, Javier; Pasquau, Juan

    2017-12-02

    Anal cancer is one of the most common non-AIDS defining malignancies, especially in men who have sex with men and women living with HIV (WLHIV). To evaluate the prevalence and incidence of precursor lesions (high-grade squamous intraepithelial lesions [HSIL]) and anal cancer in our cohort of women and to compare them to cervical lesions; to calculate the percentage of patients that acquire and clear oncogenic genotypes (HR-HPV) in the anal canal; and to determine predictive factors for anal HPV infection. Prospective-longitudinal study (May 2012-December 2016). At baseline (V1) and follow up visits, anal mucosa samples were taken in liquid medium for cytology and HPV PCR. In cases of abnormal anal cytology and/or positive HR-HPV PCR results, a high resolution anoscopy was performed. Patients were also referred to the gynaecologist. Ninety five women with an average age of 43.7years were included. At baseline, 11.6% had cervical abnormalities (4.1% CIN1, 2.2% CIN2/3, 1.1% cervical cancer), 64.3% anal abnormalities (50% LSIL/AIN1, 9.5% HSIL/AIN2/3 and 2.4% anal cancer) and 49.4% had HR-HPV genotypes. During 36months of follow up, the incidence of anal HSIL was 16×1,000 person-years; 14.8% acquired HR-HPV genotypes and 51.2% cleared them, P=.007. No patients presented CIN1/2/3/ or cervical cancer. In the multivariate analysis we found the following predictive factors for HR-HPV infection: smoking (RR: 1.55, 95%CI: 0.99-2.42), number of sexual partners >3 (RR: 1.69; 95%CI: 1.09-2.62), cervical and anal dysplasia (RR: 1.83; 95%CI: 1.26-2.67) and (RR: 1.55; 95%CI: 1.021-2.35), respectively. Despite clearance rates of anal oncogenic genotypes being higher than acquisition rates, prevalence and incidence of HSIL were still high and greater than cervical HSIL. Therefore, screening for these lesions should perhaps be offered to all WLHIV. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights

  10. [Results of complex treatment of patients with squamous cell carcinoma of the anal canal using advanced radiotherapy technologies].

    Science.gov (United States)

    Glebovskaya, V V; Tkachev, S I; Rasulov, A O; Tsaryuk, V F; Gordeev, S S; Fedyanin, M Yu; Aliev, V A; Mamedly, Z Z; Kuzmichev, D V; Trofimova, O P; Borisova, T N; Yazhgunovich, I P

    2015-01-01

    During recent decades radiotherapy is the basis, on which it is built a medical complex that is the first-line treatment of patients with squamous cell carcinoma of the anal canal. An increase of overall and disease-free survival and quality of life of patients with squamous cell carcinoma of the anal canal at the present stage of development of a comprehensive medical treatment is largely due to the improvement of technical equipment of radiotherapy departments of oncology clinics. The use of modem linear electron accelerators and systems of computer dosimetric planning to create a 3D program of isodose distribution, diagnostic devices (computed tomography and magnetic resonance imaging) as well as a number of other conditions permit accurate summarizing of proposed dose, reducing of absorbed dose to critical structures, diminishing unplanned interruptions in chemoradiotherapy course by means of modern technologies of conformal radiotherapy (3D CRT, IMRT, VMAT). The paper presents the preliminary results of a comprehensive medical treatment of 14 patients with squamous cell carcinoma of the anal canal.

  11. Changes in the absorption of bile acids after total colectomy in patients with an ileostomy or pouch-anal anastomosis

    International Nuclear Information System (INIS)

    Nasmyth, D.G.; Johnston, D.; Williams, N.S.; King, R.F.; Burkinshaw, L.; Brooks, K.

    1989-01-01

    Bile acid absorption was investigated using 75 Se Taurohomocholate (SeHCAT) in controls and patients who had undergone total colectomy with either conventional ileostomy or pouch-anal anastomosis for ulcerative colitis or adenomatous polyposis. Whole-body retention of SeHCAT after 168 hours was greater in the controls than the patients who had undergone colectomy (P less than .05). Retention of SeHCAT did not differ significantly between patients with an ileostomy and patients with pouch-anal anastomosis, but patients with an ileostomy and ileal resection of more than 20 cm retained less SeHCAT than patients with a pouch-anal anastomosis (P less than .01). Analysis of fecal bile acids from ileostomies and pouches showed that bacterial metabolism of primary conjugated bile acids was greater in patients with a pouch. It was concluded that bile acid absorption was not significantly impaired by construction of a pouch compared with conventional ileostomy, but bacterial metabolism of bile acids was greater in the pouches

  12. Changes in the absorption of bile acids after total colectomy in patients with an ileostomy or pouch-anal anastomosis

    Energy Technology Data Exchange (ETDEWEB)

    Nasmyth, D.G.; Johnston, D.; Williams, N.S.; King, R.F.; Burkinshaw, L.; Brooks, K.

    1989-03-01

    Bile acid absorption was investigated using /sup 75/Se Taurohomocholate (SeHCAT) in controls and patients who had undergone total colectomy with either conventional ileostomy or pouch-anal anastomosis for ulcerative colitis or adenomatous polyposis. Whole-body retention of SeHCAT after 168 hours was greater in the controls than the patients who had undergone colectomy (P less than .05). Retention of SeHCAT did not differ significantly between patients with an ileostomy and patients with pouch-anal anastomosis, but patients with an ileostomy and ileal resection of more than 20 cm retained less SeHCAT than patients with a pouch-anal anastomosis (P less than .01). Analysis of fecal bile acids from ileostomies and pouches showed that bacterial metabolism of primary conjugated bile acids was greater in patients with a pouch. It was concluded that bile acid absorption was not significantly impaired by construction of a pouch compared with conventional ileostomy, but bacterial metabolism of bile acids was greater in the pouches.

  13. [Assessment of the quality of scientific evidence in Anales Españoles de Pediatría].

    Science.gov (United States)

    González De Dios, J

    2001-04-01

    Evidence-based medicine is a new scientific paradigm that aims to use medical literature more effectively in guiding medical practice. The aim of this study was to assess the quality of scientific evidence in Spanish pediatric articles. Original articles published in Anales Españoles de Pediatría during a 6.5year period (n733) were compared with those published in Pediatrics during a 1.5year period (n300). The quality of scientific evidence in Anales was high in only 3% of original articles (randomized clinical trials). It was average in 30.4% (non-randomized clinical trials, cohort studies, case-control studies) and poor in 66.6% (descriptive studies, case reports, etc.). Only 10.2% of articles used appropriate methodological concepts according to evidence-based medicine. These concepts were mainly "soft" (odds ratio, relative risk, confidence interval) and no "hard" concepts (number needed to treat, likelihood ratio, odds pretest) were detected. The pediatric specialty showing the highest quality of scientific evidence, greatest use of appropriate methodological concepts and greatest statistical accessibility was pneumology. The first step in improving the quality of scientific evidence would be to establish collaboration between epidemiologists and/or biostatisticians. The evidence-based bibliometric indicators found in Pediatrics serve as a gold standard for Anales.

  14. Partner-Level Factors Associated with Insertive and Receptive Condomless Anal Intercourse Among Transgender Women in Lima, Peru.

    Science.gov (United States)

    Satcher, Milan F; Segura, Eddy R; Silva-Santisteban, Alfonso; Sanchez, Jorge; Lama, Javier R; Clark, Jesse L

    2017-08-01

    Condomless anal intercourse among transgender women (TW) in Peru has been shown to vary by the type of partner involved (e.g. primary vs. casual vs. transactional sex partner), but no previous studies have explored variations in partner-level patterns of condom use according to type of anal intercourse. We evaluated the relationship between partnership characteristics and condom use during insertive (IAI) versus receptive anal intercourse (RAI) among TW with recent, non-female partners. Condomless IAI was more common with transactional and casual sex partners and by TW who self-reported HIV-uninfected serostatus (p < 0.05), alcohol use disorders, or substance use before sex. Condomless RAI was more common with primary partners and by TW who described their HIV serostatus as unknown (p < 0.05). Examining partner-level differences between condomless IAI and RAI reveals distinct patterns of HIV/STI risk among TW, suggesting a need for HIV prevention strategies tailored to the specific contexts of partners, practices, and networks.

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

    Science.gov (United States)

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

    2014-05-01

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

  16. Outcome of peri-anal surgeries without use of prophylactic antibiotics, in terms of post operative wound infection

    International Nuclear Information System (INIS)

    Asif, M.; Mirza, A.A.; Saeed, A.

    2017-01-01

    To determine the outcome of perianal surgeries without use of antibiotics in terms of post operative infection. Study Design: Descriptive study. Place and Duration of study: Department of general surgery, Pakistan Atomic Energy Commission General Hospital, from Jan 2014 to Jun 2015. Material and Methods: All patients, both male and female admitted for hemorrhoidectomy, fistulectomy and lateral internal sphincterotomy for Anal Fissure with minimum 02 months follow-up were included in the study through non probability consecutive sampling technique. The selected patients were not administered any antibiotics pre or postoperatively. All these patients were followed up for any post-operative surgical site infection up to 02 months. Patients were advised only to take pyodine sitz bath regularly. Results: One hundred and eighty two patients were selected for the study. Patients mean age was 48.0 +- 11.4 years. 68.68% were male and 31.3% were female patients. In our study most frequent clinical presentation was hemorrhoids (37.9.0%), followed by anal fissure (33.5%). Least frequent clinical presentation was of anal fistula (28.57%). None of the patients developed surgical site infection post operatively. Conclusions: In our study we found that there was no additional beneficial role of prophylactic antibiotics in perianal surgeries Perianal surgeries can safely be performed without the use pre or post-operative antibiotics there by significantly reducing health care expenses. (author)

  17. Intersphincteric anal lipofilling with micro-fragmented fat tissue for the treatment of faecal incontinence: preliminary results of three patients.

    Science.gov (United States)

    Cestaro, Giovanni; De Rosa, Michele; Massa, Salvatore; Amato, Bruno; Gentile, Maurizio

    2015-07-01

    Faecal incontinence is a very debilitating problem. Many techniques have been proposed to treat this condition, with controversial results. Autologous transplant of fat tissue is an established procedure used for the repair of tissue damage, and recent studies revealed the potentiality of tissue regeneration by human adipose-derived stem cells. We treated this condition with the injection, in the intersphincteric anal groove, of lipoaspirate processed by an innovative technology (Lipogems). The aim of the study was to evaluate the efficacy of Lipogems injection for the treatment of faecal incontinence. In February 2014 we treated 3 patients with faecal incontinence. The surgical procedure required three phases: lipoaspiration, processing of lipoaspirate with the Lipogems system, and injection of the obtained product in the intersphincteric anal groove. An accurate proctological examination followed at 1 week, 1 month and 6 months after treatment. Each patient reported an improved Wexner incontinence score at 1 month after the procedure. We observed an increase of resting pressure (by at least 10 mm Hg) and thickness of the internal anal sphincter respectively at ano-rectal manometry and by ultrasound (US) evaluation at the sixth month of follow-up. Our preliminary results are encouraging, but multicentric studies with longer follow-up are needed to validate this novel technique for treatment of faecal incontinence.

  18. La transferencia epistemológica de un modelo didáctico analógico

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    Javier E. Viau

    2008-01-01

    Full Text Available La línea de investigación sobre los procesos de enseñanza y aprendizaje científico basada en modelos analógicos ha adquirido relevancia en los últimos años, pero notamos que son pocos los trabajos que presentan aplicaciones en el aula para el nivel medio de enseñanza. Basándonos en el concepto de perfil epistemológico que propone Bachelard, hemos ahondado en la idea de modelo al objeto de extraer nuevas conclusiones que nos permitan no sólo redefinirla, sino también evaluar la transposición que resulta de su aplicación. En este trabajo presentamos una propuesta que permita medir la transposición didáctica que es alcanzada por la aplicación de modelos didácticos analógicos en el aula de ciencias, a la cual denominamos: transferencia epistemológica. Así, la transferencia epistemológica de un modelo didáctico analógico nos brinda una medida del perfil epistemológico que es alcanzado con su aplicación en el aula de ciencias.

  19. La transferencia epistemológica de un modelo didáctico analógico

    Directory of Open Access Journals (Sweden)

    Viau, J.E.

    2008-04-01

    Full Text Available La línea de investigación sobre los procesos de enseñanza y aprendizaje científico basada en modelos analógicos ha adquirido relevancia en los últimos años, pero notamos que son pocos los trabajos que presentan aplicaciones en el aula para elnivel medio de enseñanza. Basándonos en el concepto de perfil epistemológico que propone Bachelard, hemos ahondado en la idea de modelo al objeto de extraer nuevas conclusiones que nos permitan no sólo redefinirla, sino también evaluar la transposición que resulta de su aplicación. En este trabajo presentamos una propuestaque permita medir la transposición didáctica que es alcanzada por la aplicación de modelos didácticos analógicos en el aula de ciencias, a la cual denominamos: transferencia epistemológica. Así, la transferencia epistemológica de un modelo didáctico analógico nos brinda una medida del perfil epistemológico que es alcanzadocon su aplicación en el aula de ciencias.

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

    International Nuclear Information System (INIS)

    Sale, Charlotte; Moloney, Phillip; Mathlum, Maitham

    2013-01-01

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

  1. Anal carcinoma – Survival and recurrence in a large cohort of patients treated according to Nordic guidelines

    International Nuclear Information System (INIS)

    Leon, Otilia; Guren, Marianne; Hagberg, Oskar; Glimelius, Bengt; Dahl, Olav; Havsteen, Hanne; Naucler, Gisela; Svensson, Christer; Tveit, Kjell Magne; Jakobsen, Anders; Pfeiffer, Per; Wanderås, Eva; Ekman, Tor; Lindh, Birgitta; Balteskard, Lise; Frykholm, Gunilla; Johnsson, Anders

    2014-01-01

    Objective: To evaluate treatment outcome in a large population-based cohort of patients with anal cancer treated according to Nordic guidelines. Material: Clinical data were collected on 1266 patients with anal squamous cell carcinoma diagnosed from 2000 to 2007 in Sweden, Norway and Denmark. 886 of the patients received radiotherapy 54–64 Gy with or without chemotherapy (5-fluorouracil plus cisplatin or mitomycin) according to different protocols, stratified by tumor stage. Results: High age, male gender, large primary tumor, lymph node metastases, distant metastases, poor performance status, and non-inclusion into a protocol were all independent factors associated with worse outcome. Among patients treated according to any of the protocols, the 3-year recurrence-free survival ranged from 63% to 76%, with locoregional recurrences in 17% and distant metastases in 11% of patients. The highest rate of inguinal recurrence (11%) was seen in patients with small primary tumors, treated without inguinal irradiation. Conclusions: Good treatment efficacy was obtained with Nordic, widely implemented, guidelines for treatment of anal cancer. Inguinal prophylactic irradiation should be recommended also for small primary tumors

  2. Correlates of condomless anal sex among men who have sex with men (MSM in Tijuana, Mexico: The role of public sex venues.

    Directory of Open Access Journals (Sweden)

    Shirley J Semple

    Full Text Available Condomless anal sex between male partners is the primary risk factor for HIV transmission among men who have sex with men (MSM. Correlates of condomless anal sex have been well-studied in developed countries, but they have received less attention in lower-to-middle income countries (LMIC, where MSM are often subject to stigma, discrimination, intolerance, and even the criminalization of same sex behavior. In Mexico, a LMIC where traditional views on homosexuality are common, HIV prevalence among MSM is high (16.9%, yet little research has been conducted on the correlates of condomless anal sex in this high-risk population. The present study examined correlates of condomless anal sex among 201 MSM recruited in Tijuana, Mexico, with a focus on the role of public sex venues in relation to sexual risk behavior. Eligibility requirements were: biologically male, 18 years of age or older, resident of Tijuana, and self-reported anal or oral sex with a male partner in the past year. Participants completed an interviewer-administered, demographic and psychosocial survey, and were tested for HIV and syphilis. A hierarchical multiple linear regression model was tested to identify correlates of condomless anal sex. Thirty-eight percent of participants (N = 76 reported condomless anal sex with a male partner in the past 2 months. Higher levels of condomless anal sex were associated with higher levels of depressive symptoms, greater sexual compulsivity, and more frequent seeking out of sex partners in a public venue in the past 2 months. In view of these findings, we recommend the development of multi-level, "combination" interventions, which in the Mexican context should include enhanced condom promotion and distribution, improved availability and access to mental health treatment and counseling services, and expanded HIV/STI testing in public venues.

  3. Topographic Anatomy of the Anal Sphincter Complex and Levator Ani Muscle as It Relates to Intersphincteric Resection for Very Low Rectal Disease.

    Science.gov (United States)

    Tsukada, Yuichiro; Ito, Masaaki; Watanabe, Kentaro; Yamaguchi, Kumiko; Kojima, Motohiro; Hayashi, Ryuichi; Akita, Keiichi; Saito, Norio

    2016-05-01

    Intersphincteric resection has become a widely used treatment for patients with rectal cancer. However, the detailed anatomy of the anal canal related to this procedure has remained unclear. The purpose of this study was to clarify the detailed anatomy of the anal canal. This is a descriptive study. Histologic evaluations of paraffin-embedded tissue specimens were conducted at a tertiary referral hospital. Tissue specimens were obtained from cadavers of 5 adults and from 13 patients who underwent abdominoperineal resection for rectal cancer. Sagittal sections from 9 circumferential portions of the cadaveric anal canal (histologic staining) and 3 circumferential portions from patients were studied (immunohistochemistry for smooth and skeletal muscle fibers). Longitudinal fibers between the internal and external anal sphincters consisted primarily of smooth muscle fibers that continued from the longitudinal muscle of the rectum. The levator ani muscle attached directly to the lateral surface of the longitudinal smooth muscle of the rectum. The length of the attachment was longer in the anterolateral portion and shorter in the posterior portion of the anal canal. In the lateral and posterior portions, the levator ani muscle partially overlapped the external anal sphincter; however, there was less overlap in the anterolateral portion. In the posterior portion, thick smooth muscle was present on the surface of the levator ani muscle and it continued to the longitudinal muscle of the rectum. We observed only limited portions in some surgical specimens because of obstruction by tumors. The levator ani muscle attaches directly to the longitudinal muscle of the rectum. The spatial relationship between the smooth and skeletal muscles differed in different portions of the anal canal. For intersphincteric resection, dissection must be performed between the longitudinal muscle of the rectum and the levator ani muscle/external anal sphincter, and the appropriate surgical lines

  4. Primena SWOT analize na sistem integralnog transporta Vojske Srbije / SWOT analysis of the intermodal transportation system in the Army of Serbia

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    Dragan S. Pamučar

    2008-04-01

    Full Text Available U radu je prikazana primena SWOT analize na sistem integralnog transporta Vojske Srbije. Kao rezultat analize predstavljeni su ciljevi daljeg usavršavanja integralnog transporta, kao i mogući problemi generisani strateškim upravljanjem. / This work presents the SWOT analysis application to the intermodal transportation system in the Army of Serbia. The analysis resulted in defining goals for the future development of intermodal transportation, as well as possible problems generated by strategic management.

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

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    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

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

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    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

  7. Prognostic Relevance of HPV Infection and p16 Overexpression in Squamous Cell Anal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Mai, Sabine, E-mail: sabine.mai@umm.de [Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim (Germany); Welzel, Grit; Ottstadt, Martine; Lohr, Frank; Severa, Sebastin [Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim (Germany); Prigge, Elena-Sophie [Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, and Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Center, Heidelberg (Germany); Wentzensen, Nicolas [Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland (United States); Trunk, Marcus J. [Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Mannheim (Germany); Wenz, Frederik [Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim (Germany); Knebel-Doeberitz, Magnus von; Reuschenbach, Miriam [Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, and Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Center, Heidelberg (Germany)

    2015-11-15

    Purpose: Human papillomavirus (HPV) DNA and p16 status have both been reported as prognostic factors in anal cancer, but the prognostic relevance of combined detection and particularly HPV−/p16+ and HPV+/p16− signatures is unknown. We evaluated combined HPV DNA and p16 status as a prognostic factor of treatment response in anal cancer. Methods: 106 patients treated with radiochemotherapy (RCT+5-FU/MMC) with available paraffin-embedded tumor tissue specimens were evaluated regarding local control (LC) and overall survival (OS) at 5 years. In addition to HPV DNA/p16 status, the influence of age, gender, previous surgery, initial recurrence, T stage, N status, and tumor localization was analyzed. Results: 63 patients were HPV+/p16+, 9 were HPV+/p16−, 11 were HPV−/p16+, and 23 were HPV−/p16−. In univariate analysis, LC was significantly better in patients with T1/2 stage, female gender, and HPV/p16 status. HPV+/p16+ was associated with significantly better LC (88.1%; 95% confidence interval [CI]: 78.89-97.31) compared with HPV−/p16+ (63.6%; 95% CI: 35.18-92.02; P=.021) and especially HPV−/p16− (55.8%; 95% CI: 33.46-78.14; P=.002) but not with HPV+/p16− (77.8%; 95% CI: 50.56-105.04; P=.270). OS was influenced by T stage and LC. HPV+/p16+ patients showed a trend toward better OS compared with HPV−/p16− patients (HPV+/p16+: 81.1%; 95% CI: 70.12-92.08 vs HPV−/p16−: 68.8%; 95%CI: 47.44-90.16; P=.138). On multivariate analysis, T3/4 stage and HPV/p16 status (HPV−/p16+, HPV−/p16− vs HPV+/p16+) predicted poorer LC (T3/4: 50.3% vs T1/2: 86.6%, hazard ratio [HR] 0.22; 95% CI: 0.09-0.53; P<.001; HPV+/p16+ vs HPV−/p16+: HR 4.73; 95% CI: 1.33-16.82; P=.016, and HPV+/p16+ vs HPV−/p16−: HR 6.40; 95% CI: 2.23-18.35; P<.001), whereas local relapse dramatically influenced OS. Conclusion: Our data suggest that HPV/p16 signature determines prognosis. HPV+/p16+ patients had the best prognosis, and HPV−/p16+ and HPV−/p16− patients

  8. Prognostic Relevance of HPV Infection and p16 Overexpression in Squamous Cell Anal Cancer

    International Nuclear Information System (INIS)

    Mai, Sabine; Welzel, Grit; Ottstadt, Martine; Lohr, Frank; Severa, Sebastin; Prigge, Elena-Sophie; Wentzensen, Nicolas; Trunk, Marcus J.; Wenz, Frederik; Knebel-Doeberitz, Magnus von; Reuschenbach, Miriam

    2015-01-01

    Purpose: Human papillomavirus (HPV) DNA and p16 status have both been reported as prognostic factors in anal cancer, but the prognostic relevance of combined detection and particularly HPV−/p16+ and HPV+/p16− signatures is unknown. We evaluated combined HPV DNA and p16 status as a prognostic factor of treatment response in anal cancer. Methods: 106 patients treated with radiochemotherapy (RCT+5-FU/MMC) with available paraffin-embedded tumor tissue specimens were evaluated regarding local control (LC) and overall survival (OS) at 5 years. In addition to HPV DNA/p16 status, the influence of age, gender, previous surgery, initial recurrence, T stage, N status, and tumor localization was analyzed. Results: 63 patients were HPV+/p16+, 9 were HPV+/p16−, 11 were HPV−/p16+, and 23 were HPV−/p16−. In univariate analysis, LC was significantly better in patients with T1/2 stage, female gender, and HPV/p16 status. HPV+/p16+ was associated with significantly better LC (88.1%; 95% confidence interval [CI]: 78.89-97.31) compared with HPV−/p16+ (63.6%; 95% CI: 35.18-92.02; P=.021) and especially HPV−/p16− (55.8%; 95% CI: 33.46-78.14; P=.002) but not with HPV+/p16− (77.8%; 95% CI: 50.56-105.04; P=.270). OS was influenced by T stage and LC. HPV+/p16+ patients showed a trend toward better OS compared with HPV−/p16− patients (HPV+/p16+: 81.1%; 95% CI: 70.12-92.08 vs HPV−/p16−: 68.8%; 95%CI: 47.44-90.16; P=.138). On multivariate analysis, T3/4 stage and HPV/p16 status (HPV−/p16+, HPV−/p16− vs HPV+/p16+) predicted poorer LC (T3/4: 50.3% vs T1/2: 86.6%, hazard ratio [HR] 0.22; 95% CI: 0.09-0.53; P<.001; HPV+/p16+ vs HPV−/p16+: HR 4.73; 95% CI: 1.33-16.82; P=.016, and HPV+/p16+ vs HPV−/p16−: HR 6.40; 95% CI: 2.23-18.35; P<.001), whereas local relapse dramatically influenced OS. Conclusion: Our data suggest that HPV/p16 signature determines prognosis. HPV+/p16+ patients had the best prognosis, and HPV−/p16+ and HPV−/p16− patients

  9. Modelo analítico del efecto de PRS sobre satélites GPS

    Science.gov (United States)

    Meza, A.; Brunini, C.; Usandivaras, J. C.

    El sistema GPS (Global Position System) es, hoy en día, la herramienta de navegación y posicionamiento más potente y lo será sin duda en la próxima década. Gran parte de su valiosa utilidad se debe a la alta precisión que permite lograr y ésta, a su vez, depende, entre otras causas, de la precisión con que se conocen las órbitas de los satélites. La presión de radiación solar (PRS) fija el límite de la precisión con que pueden calcularse en la actualidad las efemérides satelitarias. El objetivo de este trabajo es proponer una mejor resolución de este fenómeno. El modelo analítico aquí presentado, se basa en el análisis del comportamiento de los residuos de un ajuste por mínimos cuadrados en el que se utiliza el modelo de PRS propuesto por Beutler. El mismo consiste en un modelo determinista del fenómeno con dos parámetros libres. Los resultados obtenidos ponen de manifiesto que, aún después de aplicar dichos parámetros, prevalecen en los residuos efectos semidiurnos en las componentes radial,tangencial y normal. Estos resultados obtenidos se comparan con los de un trabajo desarrollado por el Instituto de Berne (Beutler et al., 1994), en el que se utilizaron como pseudo-observaciones las órbitas precisas del IGS (CODE). El intervalo de integración escogido por este centro fueron las semanas 680 y 681. En resumen se tienen arcos de 14 días para todos los satélites, donde las efemérides precisas de los mismos para los 14 días fueron utilizados como pseudo-observaciones. El modelo de fuerza que empleó dicho centro fue básicamente el tradicional en lo que respecta al modelo de las fuerzas gravitacionales, y para la PRS utilizo el modelo standard de Beutler. Los parámetros de este modelo junto con las 6 condiciones iniciales (posición y velocidad) fueron ajustados por el método general de mínimos cuadrados. Los residuos en la componente radial, tangencial y normal, para los satélites con un buen comportamiento, presentan una

  10. Why do anal wounds heal adequately? A study of the local immunoinflammatory defense mechanisms.

    Science.gov (United States)

    de Paula, Pedro Roberto; Matos, Delcio; Franco, Marcello; Speranzini, Manlio Basílio; Figueiredo, Florêncio; de Santana, Ivonete Cândida Barbosa; Chacon-Silva, Marcos Augusto; Bassi, Deomir Germano

    2004-11-01

    The aim of this study was to identify the tissue defense immunoinflammatory mechanisms present in the healing process of anal region wounds resulting from hemorrhoidectomy by the open technique. Immunohistochemical techniques were applied to biopsies of anal wounds obtained on Day 0 and Day 6 after surgery from 20 patients with hemorrhoid disease to characterize and quantify macrophages, T and B lymphocytes, and natural killer cells in high-power fields (400x). These techniques were also used to identify cells showing immunoexpression of cytokines (transforming growth factor beta 1, transforming growth factor beta 2, transforming growth factor beta 3) and constitutive and induced nitric oxide synthase. Plasma cells were quantified on slides stained with hematoxylin and eosin and the presence of immunoglobulin G, immunoglobulin M, and immunoglobulin A secreting cells was investigated by direct immunofluorescence. An acute nonspecific inflammation with no lymphomononuclear-plasmacytic component was observed on Day 0. On Day 6, an inflammatory cellular infiltration rich in macrophages and lymphoplasmacytic cells was detected, which documented the participation of innate defense mechanisms and the adaptive tissue response. On Day 6, the mean number of immunoinflammatory cells were as follows: macrophages (CD68+) = 190.3; macrophages (HAM56+) = 184.3; T lymphocytes (CD3+) = 59.6; T lymphocytes (CD45RO+) = 47.7; helper T lymphocytes (CD4+) = 89.2; cytotoxic T lymphocytes (CD8+) = 29.4; B lymphocytes (CD20+) = 64.4; plasma cells = 1.7; natural killer cells (NK1+) = 12.9. Macrophages (HAM56+ and CD68+) were present in significantly higher amounts than those of the remaining ones. B lymphocytes (CD20+) predominated over T lymphocytes (CD3+), although the difference between the two cell types was not significant. Participation of the humoral immune system was characterized by the presence of immunoglobulin G-secreting cells. The cellular immune system was characterized by

  11. Results of collagen plug occlusion of anal fistula: a multicentre study of 126 patients.

    Science.gov (United States)

    Blom, J; Husberg-Sellberg, B; Lindelius, A; Gustafsson, U-M; Carlens, S; Oppelstrup, H; Bragmark, M; Yin, L; Nyström, P-O

    2014-08-01

    The Biodesign(®) anal fistula plug was introduced as a means of obliterating the fistula tract and promoting healing through biocompatibility. The results demonstrated unexplained variations from good to bad. This report analysed the results of a retrospective multicentre study. All plug procedures performed in four Stockholm hospitals between June 2006 and June 2010 were identified and studied using a common protocol. The outcome after the first plug-insertion procedure was assessed by chart review performed a minimum of 8 months after plug insertion. Cox proportional-hazards models were used to assess the associations of various factors with fistula healing. One-hundred and twenty-six patients (mean age 47 years) were deemed suitable for the plug procedure. Eighty-five per cent of fistulae were cryptoglandular, 64% of patients were male and a mean of 2.9 previous fistulae procedures had been performed. All patients, except four, had an indwelling seton at the time of the plug procedure, which was performed in accordance with previously established principles of day surgery. After a median of 13 months, 30 (24%) fistulae had closed with no discomfort or secretion reported. The outcome in the four hospitals varied from 13% to 33% with similar numbers of patients in each hospital. A success rate of 12% was observed for patients with anterior fistula compared with 32% for those with posterior tracks [hazard ratio (HR) for successful healing = 2.98; 95% CI: 1.01-8.78) and 41% for those with a lateral internal opening (HR = 3.76; 95% CI: 1.03-13.75). Age, sex and number of previous procedures were not associated with healing. Four independent patient groups showed low success rates after the first plug-insertion procedure. Anterior fistulae were much less likely to heal compared with fistulae in other locations. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

  12. Sexuality and fertility outcomes after hand sewn versus stapled ileal pouch anal anastomosis for ulcerative colitis.

    Science.gov (United States)

    Harnoy, Yann; Desfourneaux, Véronique; Bouguen, Guillaume; Rayar, Michel; Meunier, Bernard; Siproudhis, Laurent; Boudjema, Karim; Sulpice, Laurent

    2016-01-01

    Ileal pouch anal anastomosis (IPAA) may alter sexuality and fertility in women. The laparoscopic approach seems to reduce infertility rates in women after IPAA. However, the impact of hand sewn versus stapled IPAA on sexuality and fertility has never been assessed in patients with ulcerative colitis (UC). The objective of this study was to analyze the impact of the IPAA technique on sexuality and fertility in UC. All UC patients who underwent an IPAA between May 1996 and April 2011 were included. The patients answered mailed questionnaires including sexuality validated questionnaires and fertility questionnaires. The risk factors of sexual dysfunction were explored. A total of 135 patients were included. Eighty-eight patients (65%) answered the questionnaires. Their mean age and follow-up were 37.2 ± 13.4 y and 109.7 ± 57.5 mo. The rates of female and male sexual dysfunction were 50% and 29%, respectively. Intestinal transit disorders were identified as risk factors in both men and women and anastomotic stricture in women sexual dysfunction, in univariate analyses. The IPAA technique did not impact sexual function in women but there was a trend for less erectile dysfunction after hand sewn IPAA (16.7% versus 44.4%). The fertility rate was 47% in women and 75% in men, with a trend for a better fertility in women after hand sewn IPAA (P = 0.07). In this preliminary study, the hand sewn or stapled IPAA technique did not impact the sexuality or fertility outcomes of UC patients, but there was a trend for better female fertility and male erectile function after hand sewn IPAA. Intestinal transit disorders contributed to male and female sexual dysfunction after IPAA. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Anal phyllodes tumor in a male patient: a unique case presentation and literature review.

    Science.gov (United States)

    Ho, Szu-pei; Tseng, Hui-hwa; King, T M; Chow, Philip-C

    2013-03-26

    Lesions of anogenital mammary-like glands are rare, and only 44 female cases have been reported. Herein, we describe a particularly rare case of phyllodes tumor of anogenital mammary-like glands in a 41-year-old male presenting anal bleeding. Papillectomy was performed. The excised tumor was circumscribed in shape, and after it was sliced into sections, it was noted that there were leaf-like slits on the surface of cut side. Under the microscope, the tumor was found to be biphasic, with a bland glandular epithelium and low-to-intermediate cellular stroma, which together created the leaf-like slits. Gynecomastoid hyperplasia was evident at the periphery. The epithelium showed immuno-activity for ER, PR(focal), AR, and GCDFP-15. The stromal cells showed positive staining for CD34 and vimentin. The morphology and immunophenotype were similar to benign phyllodes tumors of breast. To the best of our knowledge, this case report represents the first case of phyllodes tumor of anogenital mammary-like glands with gynecomastoid hyperplasia at the periphery in a male patient. To make a diagnosis, we had to differentiate this lesion from hidradenoma papilliferum of skin appendage, phyllodes tumor of ectopic prostatic tissue, and other tumors of anogenital mammary-like glands analogous to the breast tumor (e.g., fibroadenoma phyllodes, periductal stromal sarcoma, and spindle cell carcinoma). While gynecomastia of male breast is usually a result of hormone imbalance, our patient's tumor did not seem to be related to peripheral hormone status in the anogenital mammary-like glands. Nevertheless, because hormone imbalance has been strongly related to male breast cancer, hormone levels may need to be followed in male patients who have this rare malady. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1509145815899177.

  14. Análisis de la revista Bibliotecas: Anales de Investigación

    Directory of Open Access Journals (Sweden)

    Carlos Luis González-Valiente

    2016-03-01

    Full Text Available El objetivo de este artículo es describir el impacto académico, la calidad del proceso editorial, y las estrategias editoriales y de visibilidad de la revista científica cubana Bibliotecas. Anales de Investigación (BAI, editada por la Biblioteca Nacional de Cuba “José Martí”. Para determinar el impacto académico se efectúa un análisis de las citas recibidas a partir de la base datos Google Académico, mediante los indicadores bibliométricos: citas por año, citación vs. autocitación, revistas citables vs. documentos no citables, Índice Hirsch y factor de impacto. La calidad del proceso editorial y las estrategias de visibilidad se determinan mediante una autoevaluación efectuada con la metodología de los sistemas de indización SciELO, Scopus, CLASE, Redalyc, Latindex, Dialnet, y ERIH PLUS. Los resultados revelan una línea de crecimiento en la citación, destacándose como fuentes citantes las revistas científicas de las áreas Bibliotecología y Ciencia de la Información, Medicina y Ciencias de la Salud, y Educación. Se evidencia que algunos aspectos de formato y contenido inciden negativamente en la calidad del proceso editorial. Se proponen estrategias para mejorar la visibilidad científica a través de la inclusión en bases de datos, directorios, y redes sociales y académicas. En general, este estudio contribuye a la toma de decisiones editoriales para aumentar el impacto y la visibilidad científica de BAI.

  15. Lentes progressivas x lentes multifocais: um estudo baseado na geometria analítica do cone

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    Araújo Marília Cavalcante

    2004-01-01

    Full Text Available OBJETIVO: Compreender, por meio de figuras e funções matemáticas do cone, as lentes progressivas e mostrar que elas não são lentes multifocais porque, nelas, a refração da luz não obedece as leis da geometria euclidiana. MÉTODOS: Foi feito um estudo da geometria analítica do cone, com o programa de computador Auto-CAD 14, dando enfoque óptico às figuras geométricas obtidas com a sua secção. RESULTADOS: Pela análise das figuras obtidas da secção do cone, pudemos observar as superfícies que compõem as lentes progressivas. Estas superfícies são compostas de elipse, círculo, parábola e hipérbole. Diferente do que é dito na literatura, encontramos as elipses com diâmetro maior nas ordenadas e de mesmo sentido seguida por duas superfícies inferiores que são parábola e hipérbole e não o contrário. CONCLUSÕES: As lentes progressivas diferentemente das lentes multifocais apresentam prismas nos centros ópticos como decorrência da sua estrutura. No final, fizemos análise das suas formas mostrando o limite teórico da sua evolução.

  16. Autoestima e inicio de actividad sexual en la adolescencia: un estudio meta-analítico

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    Elvia Vargas-Trujillo

    2006-01-01

    Full Text Available RESUMEN. Se presentan los resultados de un estudio meta-analítico sobre la relación de la autoestima con el inicio de actividad sexual en la adolescencia. Se ubicaron 38 informes de investigación realizados entre 1975 y 2003 con muestras provenientes de Australia, Bolivia, Estados Unidos, Malí, Noruega, Nueva Zelanda y Perú. Se obtuvieron 55 tamaños del efecto independientes que recogían 68.703 datos de adolescentes. Se definió como índice del tamaño del efecto la diferencia media tipificada de autoestima entre el grupo de adolescentes activos o que inician actividad sexual antes de los 16 años (grupo de alto riesgo y el grupo de adolescentes no activos o que inician más tarde (grupo de bajo riesgo. Los resultados mostraron una diferencia media tipificada pequeña pero estadísticamente significativa en el nivel de autoestima que presentan los adolescentes que conforman el grupo de alto riesgo y los que hacen parte del grupo de bajo riesgo (d = -0,0334. El tamaño del efecto sugiere que los adolescentes no activos o que inician más tarde tienden a informar niveles de autoestima más altos que sus pares activos o que inician más temprano. El tamaño del efecto varía en función de algunas características metodológicas de las investigaciones, del grupo étnico y el país de origen de la muestra.

  17. Publicidade visual: uma proposta de percurso analítico da imagem persuasiva

    Directory of Open Access Journals (Sweden)

    Sandra Souza

    2008-11-01

    Full Text Available Desde seu estabelecimento como ciência, a Semiótica tem-se utilizado da publicidade como corpus de análise, elucidando as relações entre imagem e palavra na persuasão dos consumidores. Uma tendência recente é a publicidade visual, na qual os argumentos persuasivos baseiam-se fundamentalmente no discurso e na retórica da imagem. No presente artigo, apresentaremos uma análise da campanha da Fórum Jeans intitulada "Ajude a limpar o Brasil" por meio de um modelo híbrido de leitura do manifesto publicitário. Nosso objetivo é contribuir para o entendimento do processo persuasivo da imagem publicitária, em um percurso analítico que vai da percepção dos elementos expressivos da mensagem até a interpretação da ação pretendida pelo anunciante. Palavras-chave: publicidade; comunicação impressa; semiótica visual; imagem Abstract Visual advertising: proposal of analysis of persuasive image – Since its establishment as a science, Semiotics has used advertising as its analysis corpus, elucidating the relation between images and text in persuading the consumer. A recent trend is visual advertising, in which persuasive arguments are founded basically on the discourse and rhetoric of images. In this article, we analyze a campaign by Forum Jeans dubbed "Help clean Brazil", using a hybrid model of advertising manifesto reading. Our goal is to contribute to the understanding of the persuasive process involved in the advertising image, in an analytical course that ranges from the perception of the expressive elements in the message to the interpretation of the action intended by the advertiser. Keywords: advertising; printed communications; visual semiotics; images

  18. 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.

  19. Anal canal cancer: management of inguinal nodes and benefit of prophylactic inguinal irradiation (CORS-03 Study).

    Science.gov (United States)

    Ortholan, Cécile; Resbeut, Michel; Hannoun-Levi, Jean-Michel; Teissier, Eric; Gerard, Jean-Pierre; Ronchin, Philippe; Zaccariotto, Audrey; Minsat, Mathieu; Benezery, Karen; François, Eric; Salem, Naji; Ellis, Steve; Azria, David; Champetier, Cédric; Gross, Emmanuel; Cowen, Didier

    2012-04-01

    To evaluate the benefit of prophylactic inguinal irradiation (PII) in anal canal squamous cell carcinoma (ASCC). This retrospective study analyzed the outcome of 208 patients presenting with ASCC treated between 2000 and 2004 in four cancer centers of the south of France. The population study included 35 T1, 86 T2, 59 T3, 20 T4, and 8 T stage unknown patients. Twenty-seven patients presented with macroscopic inguinal node involvement. Of the 181 patients with uninvolved nodes at presentation, 75 received a PII to a total dose of 45-50 Gy (PII group) and 106 did not receive PII (no PII group). Compared with the no PII group, patients in the PII group were younger (60% vs. 41% of patients age groups. Median follow-up was 61 months. Fourteen patients in the no PII group vs. 1 patient in the PII group developed inguinal recurrence. The 5-year cumulative rate of inguinal recurrence (CRIR) was 2% and 16% in PII and no PII group respectively (p = 0.006). In the no PII group, the 5-year CRIR was 12% and 30% for T1-T2 and T3-T4 respectively (p = 0.02). Overall survival, disease-specific survival, and disease-free survival were similar between the two groups. In the PII group, no Grade >2 toxicity of the lower extremity was observed. PII with a dose of 45 Gy is safe and highly efficient to prevent inguinal recurrence and should be recommended for all T3-4 tumors. For early-stage tumors, PII should also be discussed, because the 5-year inguinal recurrence risk remains substantial when omitting PII (about 10%). Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Sacral neuromodulation for combined faecal and urinary incontinence following obstetric anal sphincter injury.

    Science.gov (United States)

    Rydningen, M B; Riise, S; Wilsgaard, T; Lindsetmo, R O; Norderval, S

    2018-01-01

    The aim of this study was to investigate the efficacy of sacral neuromodulation (SNM) in the treatment of faecal incontinence and concomitant urinary incontinence in women with a history of obstetric anal sphincter injury (OASIS). In this prospective study, consecutive women with faecal incontinence following OASIS accepted for SNM were screened for concomitant urinary incontinence. The primary outcome was the change in urinary incontinence score on the International Consultation on Incontinence Questionnaire for Urinary Incontinence, Short Form (ICIQ-UI-SF), between baseline and 12 months. Secondary outcomes included the change in St Mark's score, sexual function and quality of life, change in grade of urinary incontinence and disappearance of urgency. From March 2012 to September 2014, 39 women with combined faecal incontinence and urinary incontinence received SNM. Thirty-seven women were available for analysis after 12 months. The mean reduction in the ICIQ-UI-SF score between the baseline and 12 months was 5.8 (95% CI 3.7-8.0, P < 0.001). ICIQ-UI-SF was reduced in 29 (78%) women, urinary incontinence resolved in 13/37 (35%, 95% CI 20%-50%) patients, and urgency disappeared in 14/33 (42%, 95% CI 26%-59%). The mean reduction in the St Mark's score was 10.6 (95% CI 8.6-12.7, P < 0.001). Disease-specific quality of life, Euroqual 5-dimension visual analogue scale (EQ-5D VAS) and several areas of sexual function changed significantly for the better. More than three-quarters of the women with combined faecal and urinary incontinence following OASIS reported a successful outcome with reduction in ICIQ-UI-SF at 12 months after SNM. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

  1. Impact of high-level sport practice on anal incontinence in a healthy young female population.

    Science.gov (United States)

    Vitton, Véronique; Baumstarck-Barrau, Karine; Brardjanian, Sarah; Caballe, Isabelle; Bouvier, Michel; Grimaud, Jean-Charles

    2011-05-01

    Regular physical activity usually confers health benefits, but high-level sport may induce harmful outcomes, such as pelvic floor dysfunction. Urinary incontinence (UI) was previously documented, but few data are available about anal incontinence (AI) in female athletes. Our aim was to determine the role of high-level sport practice on AI in a young, healthy female population. In this cross-sectional study, we included women aged 18-40 years. Self-administered questionnaires were delivered to each female volunteer. Two groups were defined: (1) intensive sport (IS) group: high-level sport (>8 hours weekly), and (2) nonintensive sport (NIS) group: all other subjects. Of the 393 women enrolled, 169 were in the IS group and 224 were in the NIS group. Women of the IS group were significantly younger than the others (21.74±4.28 vs. 24.87±5.61 years, pAI was statistically higher in the IS group than in the NIS group (14.8% vs. 4.9%, p=0.001), as was UI (33.1% vs. 18.3%, p=0.001). Multivariate analysis showed that IS practice (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.29-6.87, p=0.010) and body mass index (BMI) (OR 1.14, 95% CI 1.01-1.28, p=0.033) were significantly linked to AI when taking into account major confounding factors (age and births). In the IS group, AI was mainly represented by loss of flatus in 84%. High-level sport appears to be a significant independent risk factor for AI in healthy young women. These results suggest that preventive measures, such as pelvic floor muscle training, may be proposed for this young population.

  2. Long-standing Crohn's disease and its implication on anal squamous cell cancer management.

    Science.gov (United States)

    Lightner, Amy L; Moncrief, Sara B; Smyrk, Thomas C; Pemberton, John H; Haddock, Michael G; Larson, David W; Dozois, Eric J; Mathis, Kellie L

    2017-05-01

    Anal squamous cell carcinoma (ASCC) is rare, accounting for only 1% of gastrointestinal malignancies. We sought to better understand management strategies for ASCC in the setting of Crohn's disease (CD). A retrospective chart review from 2001 to 2016 was conducted using ICD-9/10 codes for CD (555.9/K50) and ASCC (154.3/C44.520). Adult patients with a diagnosis of CD at the time of ASCC diagnosis were included. Seven patients (five female) were included with a median age of 50 years. The majority presented with perianal pain (three) and bleeding (four). Mean duration of CD was 20 years. Five patients had active perianal fistulizing disease at the time of ASCC diagnosis. Clinical stage at diagnosis of ASCC was stage 0 (n = 1), stage I (n = 1), stage II (n = 1), stage III (n = 2), stage IV (n = 1), and unknown (n = 1). All patients were treated with radiation and chemotherapy. Three patients experienced complications during radiation therapy: fistulizing disease, stenotic disease, and flap necrosis. Two patients had persistent disease at 6 months; one patient underwent abdominoperineal resection (APR) and the other chemotherapy and radiation. Two patients developed locally residual and metastatic disease and died within 1 year of diagnosis. Five-year disease-free survival was 56%. While the standard Nigro protocol remains standard of care in patients with ASCC, in the setting of CD, patients may be best approached as a case-by-case basis and may even require an operation first due to complications from radiation and aggressive nature of disease. Due to poor treatment outcomes, surveillance guidelines for this patient population are necessary.

  3. 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.

  4. 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.

  5. Rastreamento de lesões precursoras do carcinoma espino-celular anal em indivíduos portadores do HIV Tracking precursor lesions of anal squamous cell carcinoma in individuals with HIV

    Directory of Open Access Journals (Sweden)

    Caio Sergio Rizkallah Nahas

    2011-06-01

    Full Text Available INTRODUÇÃO: O carcinoma espino-celular do canal anal é doença que atinge os adultos de meia idade e corresponde a 4% dos cânceres do trato gastrointestinal baixo. Na população geral a incidência é de 1 em 100.000 habitantes, e entre os homens que fazem sexo com homens essa incidência atinge 35 por 100.000 habitantes, sendo que os portadores de HIV têm esse risco duplicado (70 por 100.000 habitantes. MÉTODO: Foi realizada revisão da literatura com consulta nos periódicos das bases Medline/Pubmed, Scielo e Lilacs cruzando os descritores Rastreamento, Lesões pré-cancerosas, Neoplasias do ânus e HIV. Além da revisão bibliográfica, foi adicionada a este trabalho a experiência pessoal dos autores, e a obtida no Departamento de Gastroenterologia - Divisão Cirúrgica, no ICESP - Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira, no Departamento de Moléstias Infeciosas - Casa da AIDS e no Serviço de Coloproctologia do Hospital das Clínicas da Universidade de São Paulo, SP, Brasil. CONCLUSÕES: HIV+ é um grande fator de risco no desenvolvimento de carcinoma espino-celular anal em indivíduos infectados por HPV. A avaliação desses pacientes não deve se restringir à erradicação de condilomas, mas principalmente incluir o rastreamento de lesões displásicas subclínicas potencialmente neoplásicas. Apesar dos métodos de rastreamento ainda não serem ideais, o grande benefício do rastreamento baseia-se no fato de oferecer acompanhamento rigoroso, tornando possível à prevenção ou detecção cada vez mais precoce do carcinoma espino-celular anal.INTRODUCTION: Squamous cell carcinoma of the anal canal is a disease that affects the middle-aged adults and accounts for 4% of cancers of the gastrointestinal tract below. In the general population the incidence is 1 in 100,000, and among men who have sex with men the incidence is 35 per 100,000 inhabitants, those with HIV have doubled this risk (70 per 100

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

    Directory of Open Access Journals (Sweden)

    Sidney Roberto Nadal

    2007-08-01

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

  7. Eri teed tulevikku? : kolmekümneaastaste põlvkonna sissetulekuallikate struktuur ja selle muutused üleminekuperioodil postsotsialistlikes maades / Rein Murakas, Denis Trapido

    Index Scriptorium Estoniae

    Murakas, Rein, 1961-

    2004-01-01

    Järg nr. 8 lk. 1764-1791. Sissetulekuallikate stabiilsuse ja muutlikkuse probleemist Eestis, Sverdlovski ja Harkovi oblastis Ukrainas, Lätis, Moldovas, Valgevenes ja Tadzhikistanis aastatel 1992-1998. Kasutatud on rahvusvahelise longituudse uurimisprojekti "Põlvkonna eluteed" (PE) andmeid. Tabelid: PE riikide sotsiaal-demograafilised ja arengunäitajad siirdeperioodil; valimi maht regiooni ja PE küsitlusetapi lõikes; analüüsis kasutatud tunnused; PE respondentide kuusissetuleku parameetrid regioonide lõikes (sissetulek USA dollarites); sissetulekuallikate esinemissagedus respondentidel (%) ning keskmine sissetulekuallikate arv

  8. 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.

    2016-01-01

    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), 10 ng/L, and 100 ng/L LNG for 8 d using a static replacement exposure design. After 8 d, 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 10 ng/L or 100 ng/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 10 ng/L and 100 ng/L treatments, although these

  9. 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

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    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

  10. A prospective non-randomized two-centre study of patients with passive faecal incontinence after birth trauma and patients with soiling after anal surgery, treated by elastomer implants versus rectal irrigation

    OpenAIRE

    van der Hagen, S. J.; van der Meer, W.; Soeters, P. B.; Baeten, C. G.; van Gemert, W. G.

    2012-01-01

    Aim This study is a prospective evaluation of patients with passive faecal incontinence and patients with soiling treated by elastomer implants and rectal irrigation. Patients and methods Patients with passive faecal incontinence after birth trauma resulting from a defect of the internal sphincter and patients with soiling after previous anal surgery were included. All patients underwent endo-anal ultrasound, magnetic resonance imaging, and anal manometry. The patients with passive faecal inc...

  11. THE USE OF PACLITAXEL IN CHEMORADIOTHERAPY OF PATIENTS WITH SQUAMOUS CELL CARCINOMA OF THE ANAL CANAL: A PILOT STUDY

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    S. S. Gordeev

    2016-01-01

    Full Text Available Objectives: to assess the feasibility of a combination of the intensity-modulated radiation therapy (IMRT with a triplet chemotherapy with paclitaxel, capecitabine, and mitomycin C in the treatment of patients with anal cancer, and to evaluate the toxicity of the proposed treatment regimen.Materials and methods. All patients included in the study had stage I–IIIB anal cancer. All patients underwent IMRT radiotherapy 52–58 Gy (the dosage is calculated according T symbol by 1.8 to 2.2 Gy fractions daily. The proposed chemotherapy scheme includes mitomycin C 10 mg/m2 on day 1, paclitaxel 45 mg/m2 on days 3, 10, 17, 24, 31, capecitabine 625 mg/m2 during radiotherapy. A complete response to treatment after 26 weeks, and the compliance to the study protocol were the primary end points of the study.Results. The study included 38 patients. Among patients stage I anal cancer occurred in 1 (2.6 % case, II – in 5 (13.2 %, IIIA – 15 (39.5 % and IIIB – in 17 (44.7 %. A significant deviation from the protocol reported in 6 (15.8 % patients, in 11 (28.9 % patients a slight alteration from the treatment was documented, and 21 (55.3 % patients completed the treatment of chemoradiotherapy with full compliance to the study protocol. The high profile of toxicity (grade III–IV was recorded in 23 (60.5 % patients. An incomplete clinical response at 26 weeks after treatment was reported in 5 (13.2 % patients, one whom continued watchful waiting and achieved complete response at 9 months posttreatment. Median followup was 27 months. 1 patient developed a local recurrence 1 year posttreatment.Conclusions. The proposed triplet chemotherapy regimen using IMRT is feasible and has acceptable toxicity. For further assess the continuous research is needed. 

  12. [Comparison of bibliometric indicators for neuropaediatrics in Revista de Neurologia and Anales de Pediatria over one decade].

    Science.gov (United States)

    Fernandez-Fernandez, Eva M; Pardo-De la Vega, Rafael; Amigo-Bello, Cristina; Solis-Sanchez, Gonzalo

    2013-07-01

    AIM. Bibliometric analysis of neuropaediatrics articles published in Revista de Neurologia and Anales de Pediatria between 2000 and 2009. MATERIALS AND METHODS. We selected neuropaediatrics articles published in two journal during the last decade (n = 1,085). We investigated authorship, topic and bibliography, to calculate indices of isolation, Price, collaboration, productivity, transience and self-citations. Analyze citations received by Web of Knowledge (WOK): articles cited, sometimes cited and h-index. RESULTS. 1,085 articles were analyzed, 255 published in Anales de Pediatria (9.4% of the total in that period) and 830 in Revista de Neurologia (21.7% total). The collaboration index was 4.3. The 89.7% of the authors were medical care (96% hospital staff, 0,8% of primary care staff and 2.9% of both). The 11.9% ??of the articles were collaborative between regions and the 26% came from foreign centers. The originals were 29.8% (80.8% descriptive observational studies, analytical 18.3% and 0.8% clinical trials). The most frequent topics were paroxysmal disorders (15.9%) and developmental, learning and behavioral disorders (15%). The average number of citations per article was 27.6, with an isolation rate of 13.4% and a Price index of 41.7%. The profile of the articles published in both journals is different, finding significant differences in almost all parameters analyzed. According WOK, the 255 items of Anales de Pediatria have received 40 citations and h-index of 3 and the 830 Revista de Neurologia 2,234 citations with h-index of 13. CONCLUSIONS. There are differences in the pediatric neurology publications between the two magazines with more international projection of Revista de Neurologia.

  13. Enfermedades del piso pelviano y del esfínter anal: perspectiva de un gastroenterólogo

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    Eamonn M.M. Quigley, MD FRCP FACP FACG FRCPI

    2013-03-01

    Full Text Available La integración y coordinación de la musculatura del piso pelviano y del esfínter anal es muy relevante para dos funciones fisiológicas importantes: la defecación y la continencia. En consecuencia, los desórdenes que afecten los músculos del piso pelviano, esfínter anal, su inervación o su precisa coordinación terminarán, dependiendo de su naturaleza, en una obstrucción defecatoria o una incontinencia fecal. Ambas patologías son más frecuentes en las mujeres y la última, en particular, es asociada con la paridad. Aunque la sintomatología, presentación y modo óptimo de investigación de la incontinencia fecal están bastante estandarizados, aún existe considerable debate y controversia en torno a la contribución de la disfunción del piso pelviano y el esfínter anal en la constipación crónica y el óptimo enfoque clínico para su investigación necesita aún ser definido. En casos elegidos adecuadamente, la cirugía puede proporcionar el mejor resultado para los pacientes que presentan incontinencia; los métodos de biofeedback pueden ser de valor tanto en la incontinencia como en la obstrucción defecatoria, la cirugía en este último tiene un escaso rol.

  14. [Spanish paediatric research in ANALES DE PEDIATRÍA: research groups and research areas (2003-2009)].

    Science.gov (United States)

    González Alcaide, G; Valderrama Zurián, J C; Aleixandre Benavent, R; González de Dios, J

    2011-04-01

    Authorships of scientific papers are a significant milestone for researchers. Quantification of authors' contribution in research papers makes it possible to investigate patterns of research collaboration and interactions in scientific community. The objective of this paper is to analyse scientific collaboration and to identify research groups and research areas of ANALES DE PEDIATRÍA. Papers published in ANALES DE PEDIATRÍA between 2003 and 2009 period were selected from Medline. An author name normalization process was carried out. Productivity and scientific collaboration indexes have been determined. Research groups have been identified through co-authorships networks analysis. Thematic areas of research and major domains of research groups have been characterised by means of quantification of Medical Subject Headings terms assigned to documents. An analysis was made of 1,828 documents published by 4,695 authors. The collaboration index (articles) was 5.3 ± 2.3. A total of 97 research groups consisting of between 2 and 80 researchers, which add up 415 researchers have been identified. The main diseases and medical signs studied were asthma (n = 35), multiple abnormalities (n = 28), premature diseases (n = 25), sepsis (n = 24), congenital heart defects (n = 23), respiratory insufficiency (n = 22), HIV infections (n = 21), streptococcal infections (n = 20) and gastroenteritis (n = 20). ANALES DE PEDIATRÍA is one of the most productive Spanish medical journals. Author's collaboration was similar to those observed in other Spanish clinical journals included in Journal Citation Reports. A remarkable number of paediatric research groups publishing on many topics have been identified. Copyright © 2010 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  15. Risk factors for HIV and unprotected anal intercourse among men who have sex with men (MSM in Almaty, Kazakhstan.

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    Mark Berry

    Full Text Available INTRODUCTION: Men who have sex with men (MSM are at high risk for HIV infection. MSM in Central Asia, however, are not adequately studied to assess their risk of HIV transmission. METHODS: This study used respondent driven sampling methods to recruit 400 MSM in Almaty, the largest city in Kazakhstan, into a cross-sectional study. Participation involved a one-time interviewer-administered questionnaire and rapid HIV screening test. Prevalence data were adjusted for respondent network size and recruitment patterns. Multivariate logistic regression was used to investigate the association between HIV and selected risk factors, and unprotected anal intercourse (UAI and selected risk factors. RESULTS: After respondent driven sampling (RDS weighted analysis, 20.2% of MSM were HIV-positive, and 69.0% had unprotected sex with at least one male partner in the last 12 months. Regression analysis showed that HIV infection was associated with unprotected receptive anal sex (AOR: 2.00; 95% CI: 1.04-3.84. Having unprotected anal intercourse with male partners, a measure of HIV risk behaviors, was associated with being single (AOR: 0.38; 95% CI: 0.23-0.64; very difficult access to lubricants (AOR: 11.08; 95% CI: 4.93-24.91; STI symptoms (AOR: 3.45; 95% CI: 1.42-8.40; transactional sex (AOR: 3.21; 95% CI: 1.66-6.22; and non-injection drug use (AOR: 3.10; 95% CI: 1.51-6.36. CONCLUSIONS: This study found a high HIV prevalence among MSM in Almaty, and a population of MSM engaging in multiple high-risk behavior in Almaty. Greater access to HIV education and prevention interventions is needed to limit the HIV epidemic among MSM in Almaty.

  16. Etiologic and clinical analysis of chronic complex anal and rectal inflammation in children less than 3 years old.

    Science.gov (United States)

    Huang, Yanlei; Zheng, Shan; Xiao, Xianmin

    2014-01-01

    To analyze the etiology and clinical diagnostic method for chronic complex anal and rectal inflammation in children less than 3 years old. Seven children (5 males and 2 females; 1 year 8 months to 3 years of age at the time of physician evaluation) with chronic complex anal and rectal inflammation were enrolled between May 2008 and May 2013 at our hospital. Clinical history, results of auxiliary examinations, and empirical treatment of the children were analyzed retrospectively combined with the etiologic diagnosis. Four patients were confirmed to have Crohn's disease and one patient was confirmed to have intestinal tuberculosis; two patients were suspected to have Crohn's disease. Anemia and low pre-albumin level were common (seven patients); serologic testing revealed four patients with elevated IgG levels and seven patients with elevated IgA levels; there were no patients with positive tuberculosis antibody titers and two patients were weakly positive for C-ANCA (one patient with Crohn's disease and one patient intestinal tuberculosis). Colonoscopies revealed that the entire colon was affected in one patient, the left hemicolon was affected in four patients, and the sigmoid colon and rectum were affected in two patients. Two patients with Crohn's disease and one patient with intestinal tuberculosis were diagnosed by colonoscopies in combination with histopathologic examinations. Two patients with Crohn's disease were confirmed after empirical drug treatment, and two other patients were not definitely diagnosed. The possibility of Crohn's disease or intestinal tuberculosis should be considered in the clinical diagnosis of complex chronic anal and rectal inflammation in younger children. Local surgery is sometimes unnecessary. Empirical drug treatment should be used if necessary.

  17. Effects of electroacupuncture combined with stem cell transplantation on anal sphincter injury-induced faecal incontinence in a rat model.

    Science.gov (United States)

    Li, Xiaojia; Guo, Xiutian; Jin, Weiqi; Lu, Jingen

    2018-03-08

    Bone marrow mesenchymal stem cells (BMSCs) and acupuncture are known to mitigate tissue damage. This study aimed to investigate the therapeutic effects of combined electroacupuncture (EA) stimulation and BMSC injection in a rat model of anal sphincter injury-induced faecal incontinence (FI). 60 Sprague-Dawley rats were randomly divided into five groups: sham-operated control, FI, FI+EA, FI+BMSC, and FI+BMSC+EA. The anorectal tissues were collected on days 1, 3, 7 and 14. Repair of the injured anal sphincter was compared using haematoxylin and eosin (HE) and immunocytochemiscal analyses with sarcomeric α actinin. The expression of stromal cell derived factor-1 (SDF-1) and monocyte chemoattractant protein-3 (MCP-3) was detected by quantitative reverse transcription PCR to evaluate the effects of EA on the homing of BMSCs. The therapeutic effect of combined EA+BMSCs on damaged tissue was the strongest among all the groups as indicated by HE and immunohistochemical staining. The expression of SDF-1 and MCP-3 was significantly increased by combined EA and BMSC treatment when compared with the other groups (P=0.01 to P<0.05), suggesting promotive effects of EA on the homing of BMSCs. The combination of EA and BMSC transplantation effectively repaired the impaired anal sphincters. The underlying mechanism might be associated with apparent promotive effects of EA on the homing of BMSCs. Our study provides a theoretical basis for the development of a non-surgical treatment method for FI secondary to muscle impairment. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Can three-dimensional high-resolution anorectal manometry detect anal sphincter defects in patients with faecal incontinence?

    Science.gov (United States)

    Rezaie, A; Iriana, S; Pimentel, M; Murrell, Z; Fleshner, P; Zaghiyan, K

    2017-05-01

    Endoanal ultrasound (EAUS) is the gold standard for detecting anal sphincter defects in patients with faecal incontinence (FI), while anorectal manometry evaluates sphincter function. Three-dimensional high-resolution anorectal manometry (3D HRAM) is a newer modality with the potential to assess both sphincter function and anatomy. The purpose of the present study was to compare 3D HRAM with 3D EAUS for the detection of anal sphincter defects in patients with FI. A linkage analysis was performed between the 3D HRAM and 3D EAUS databases of a tertiary referral centre to identify patients with FI who underwent both 3D EAUS and 3D HRAM. With 3D HRAM, a defect was defined as any pressure measurement below 25 mmHg at rest with at least 18° of continuous expansion. The 3D HRAM findings were compared with those of 3D EAUS. The study cohort included 39 patients with a mean age of 64.7 ± 15.2 years (SD); and 31 (79%) were female. Eight (21%) patients had an anal sphincter defect on EAUS with a median size of 93° (range 40°-136°). Fourteen (36%) had a defect shown by 3D HRAM with a median size of 144° (36°-180°). The sensitivity, specificity and positive and negative predictive values of 3D HRAM in detecting a sphincter defect were 75%, 74%, 43% and 92%, respectively. With a negative predictive value of 92%, 3D HRAM may be a useful screening method for ruling out a sphincter defect in patients with FI, thereby avoiding both EAUS and manometry in selected patients. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  19. Satisfaction and Condomless Anal Sex at Sexual Debut and Sexual Risk Among Young Black Same-Sex Attracted Men.

    Science.gov (United States)

    Oidtman, Jessica; Sherman, Susan G; Morgan, Anthony; German, Danielle; Arrington-Sanders, Renata

    2017-05-01

    First sex may be a sentinel event crucial to understanding sexual health trajectories of young Black same-sex attracted men (YBSSAM). We sought to understand whether satisfaction, condomless anal sex, and contextual factors during first sex were associated with sexual risk and recent condom use in YBSSAM. A total of 201 YBSSAM aged 15-24 years completed an Internet survey exploring first sex, current condom use, and sexual risk. High risk was defined as ≥3 of the following: new/concurrent sex partners, STI history, and no/inconsistent condom use. Multivariate logistic regression assessed the association between predictor (satisfaction and first condomless anal sex) and outcome (sexual risk and condomless sex in the past 3 months) variables. Mean age at first sex was 15.2 (SD = 2.9) years, and emotional satisfaction (51.7 %), physical satisfaction (63.7 %), and condomless first anal sex (55.2 %) were common. YBSSAM describing high levels of satisfaction were no more likely to be at high risk or engage in recent condomless sex. Condomless first sex (AOR = 4.57, p = .001), younger age (AOR = 3.43, p = .02), and having a partner >5 years older (AOR = 2.78, p = .03) at first sex were significantly associated with increased risk. Only condomless first sex (AOR = 4.28, p Satisfaction at first sex may not influence later sexual risk in YBSSAM. However, context of first sex, including condom use at first sex, may play an important role in subsequent risk. Prevention strategies on condom negotiation prior to first sex may help to mitigate HIV burden in YBSSAM.

  20. Epigenomic characterization of locally advanced anal cancer: a radiation therapy oncology group 98-11 specimen study.

    Science.gov (United States)

    Siegel, Erin M; Eschrich, Steven; Winter, Kathryn; Riggs, Bridget; Berglund, Anders; Ajidahun, Abidemi; Simko, Jeff; Moughan, Jennifer; Ajani, Jaffer; Magliocco, Anthony; Elahi, Abul; Hoffe, Sarah; Shibata, David

    2014-08-01

    The Radiation Therapy Oncology Group 98-11 clinical trial demonstrated the superiority of standard 5-fluorouracil/mitomycin-C over 5-fluorouracil/cisplatin in combination with radiation in the treatment of anal squamous cell cancer. Tumor size (>5 cm) and lymph node metastases are associated with disease progression. There may be key molecular differences (eg, DNA methylation changes) in tumors at high risk for progression. The objectives of this study were to determine whether there are differences in DNA methylation at individual CpG sites and within genes among locally advanced anal cancers, with large tumor size and/or nodal involvement, compared with those that are less advanced. This was a case-case study among 121 patients defined as high risk (tumor size >5 cm and/or nodal involvement; n = 59) or low risk (≤5 cm, node negative; n = 62) within the mitomycin-C arm of the Radiation Therapy Oncology Group 98-11 trial. DNA methylation was measured using the Illumina HumanMethylation450 Array. The study was conducted in a tertiary care cancer center in collaboration with a national clinical trials cooperative group. The patients consisted of 74 women and 47 men with a median age of 54 years (range, 25-79 years). DNA methylation differences at individual CpG sites and within genes between low- and high-risk patients were compared using the Mann-Whitney test (p Epigenetic events likely play a significant role in the progression of anal cancer and may serve as potential biomarkers.